Efecto del contexto, rutinas y funcionamiento en la salud de familias mexicanas con diabetes tipo 2

RESUMEN Objetivo: Explicar el efecto del contexto, rutinas y funcionamiento familiar en la salud de familias mexicanas donde un integrante padece Diabetes mellitus tipo 2 (DM2). Material y Métodos: Diseño transversal-correlacional; previo consentimiento informado el reclutamiento y recogida de datos fue entre enero a abril de 2015; participaron 60 díadas familiares (n=120), conformadas por persona con DM2 y cuidador familiar, entre 18 a 66 años, sin distinción de género, que hubieran convivido bajo el mismo techo al menos por un año y asistían a consulta en una institución de salud en México durante el 2015. El contexto familiar se midió con una cédula, dos escalas midieron rutinas, funcionamiento y salud familiar. Resultados: Predominaron las mujeres (64,2%), de 47,5 (±11,5) años de edad, con escolaridad de 7,2 años (± 4,4), los enfermos diagnosticados hace 11,5 años (± 8,4), con tratamiento desde hace 9,2 años (± 8,6). Se encontraron interrelaciones significativas entre las variables del contexto (edad, años de estudio, tiempo de diagnóstico y tratamiento), rutinas y funcionamiento con la salud familiar (todas entre p≤ ,0001 y p ≤ ,005). El funcionamiento explicó el 39,1% y las rutinas el 18,8% de la varianza de la salud familiar (R2 ajustada= , 391; F(1,118)= 77,4; p≤ ,0001; R2ajustada= ,188; F(1,118)= 28,6; p≤ ,0001). El funcionamiento explicó la varianza de rutinas en 19,3% (R2= ,193; F(1,118)= 28,1 p≤ ,0001). Conclusiones: La salud familiar se relaciona significativamente con el contexto, rutinas y funcionamiento de las díadas familiares que viven con diabetes tipo 2; además la salud familiar está influida significativamente por rutinas y funcionamiento familiar.

ABSTRACT Objective: To explain the effect of the context, routines and family functioning on the health of Mexican families where a member suffers from Type 2 Diabetes mellitus. Materials and Methods: Cross-correlational design; after prior informed consent, recruitment and data collection were carried out between January and April 2015. The sample included 60 family dyads (n = 120), consisting of a person with 2DM and a family caregiver, between 18 and 66 years old, without gender distinction, who had lived in the same home for at least one year and attended a consultation in a health institution in Mexico during 2015. The family context was measured with a card, two scales measured routines, family functioning and health. Results: There were more women (64.2%), aged 47.5 (± 11.5), with 7.2 years (± 4.4) of schooling; patients diagnosed 11.5 years ago (± 8.4), under treatment for 9.2 years (± 8.6). Significant interrelations were found between the context variables (age, years of study, diagnosis and treatment time), routines, and functioning regarding family health (all between p≤ .0001 and p ≤ .005). Functioning explained 39.1% and routines 18.8% of the family health variance (adjusted R2= .391; F (1.118) = 77.4 p≤ .0001; adjusted R2= .188; F (1.118) = 28.6 p≤ .0001). Functioning also explained the variance of routines in 19.3% (R2 = .193; F (1.118) = 28.1 p≤ .0001). Conclusions: Family health is significantly related to the context, routines and functioning of family dyads living with type 2 diabetes. In addition, family health is significantly influenced by routines and family functioning.

RESUMO Objetivo: Explicar o efeito do contexto, rotinas e funcionamento na saúde de famílias mexicanas onde um membro sofre de Diabetes mellitus Tipo 2 (DM2). Material e Métodos: Desenho transversal-correlacional; com consentimento informado prévio o recrutamento e coleta dos dados foram entre janeiro e abril de 2015; participaram 60 díades familiares (n = 120), formadas por pessoa com DM2 e cuidador familiar, entre 18 e 66 anos, sem distinção de gênero, que moraram na mesma casa por pelo menos um ano e que assistiam a uma consulta em uma instituição de saúde no México durante 2015. O contexto familiar foi medido com um cartão, duas escalas avaliaram as rotinas, o funcionamento e a saúde familiar. Resultados: Predominaram as mulheres (64,2%), de 47,5 (±11,5) anos, com escolaridade de 7,2 anos (± 4,4), as pessoas diagnosticadas há 11,5 anos (± 8,4), com tratamento há 9,2 anos (± 8,6). Foram encontradas inter-relações significativas entre as variáveis do contexto (idade, anos de estudo, tempo de diagnóstico e de tratamento), rotinas e funcionamento com a saúde familiar (todas entre p≤ ,0001 e p≤ ,005). O funcionamento explicou o 39,1% e as rotinas o 18,8% da variância da saúde familiar (R2ajustada= ,391; F(1,118)= 77,4 p≤ ,0001; R2 ajustada= ,188; F(1,118)= 28,6 p≤ ,0001). O funcionamento explicou a variância das rotinas em 19,3% (R2= ,193; F(1,118)= 28,1 p≤ ,0001). Conclusões: A saúde familiar está significativamente relacionada ao contexto, rotinas e funcionamento das díades familiares que vivem com diabetes tipo 2; além disso, a saúde familiar está significativamente influenciada por rotinas e funcionamento familiar.

Obesity, physical activity and prediabetes in adult children of people with diabetes.

OBJECTIVES: Determine prevalence of obesity / overweight, physical activity (PA) and prediabetes in adult children of parents with type 2 diabetes; identify differences according to sociodemographic variables, and describe the relationship of obesity/overweight with fasting glucose (FG) and glycosylated hemoglobin (A1C). METHODS: Cross-sectional study in 30 Mexican families with 53 participating adult children. Obesity / overweight was determined with Body Mass Index (BMI), Waist Circumference (WC) and body fat percentage (BFP); PA with the short International Physical Activity Questionnaire (IPAQ), and prediabetes with FG. RESULTS: 64% of participants presented obesity / overweight, 32% low PA, and 19% prediabetes. Men had higher WC than women (U= 219, p= 0.03). Women showed more BFP than men (U= 142, p <0.01). Blood glucose was related to BFP (rs= 0.336, p < 0.05), the A1C with the BMI (rs= 0.417, p <0.01), WC (rs= 0.394, p<0.01), BFP (rs= 0.494, p<0.01) and intense PA (rs= - 0.285, p<0.05). CONCLUSIONS: High prevalence of obesity / overweight and low PA were found. The FG was related only to BFP and A1C, in addition to BMI, WC and inversely with intense BP. It is recommended to modify the educational strategies of nursing at a family level.

Obesity, physical activity and prediabetes in adult children of people with diabetes / Obesidade, atividade física e pré-diabetes em filhos de pessoas com diabetes / Obesidad, actividad física y prediabetes en hijos de personas con diabetes

ABSTRACT Objectives: Determine prevalence of obesity / overweight, physical activity (PA) and prediabetes in adult children of parents with type 2 diabetes; identify differences according to sociodemographic variables, and describe the relationship of obesity/overweight with fasting glucose (FG) and glycosylated hemoglobin (A1C). Methods: Cross-sectional study in 30 Mexican families with 53 participating adult children. Obesity / overweight was determined with Body Mass Index (BMI), Waist Circumference (WC) and body fat percentage (BFP); PA with the short International Physical Activity Questionnaire (IPAQ), and prediabetes with FG. Results: 64% of participants presented obesity / overweight, 32% low PA, and 19% prediabetes. Men had higher WC than women (U= 219, p= 0.03). Women showed more BFP than men (U= 142, p <0.01). Blood glucose was related to BFP (rs= 0.336, p < 0.05), the A1C with the BMI (rs= 0.417, p <0.01), WC (rs= 0.394, p<0.01), BFP (rs= 0.494, p<0.01) and intense PA (rs= - 0.285, p<0.05). Conclusions: High prevalence of obesity / overweight and low PA were found. The FG was related only to BFP and A1C, in addition to BMI, WC and inversely with intense BP. It is recommended to modify the educational strategies of nursing at a family level.

RESUMO Objetivos: Determinar a prevalência de obesidade/sobrepeso, atividade física (AF) e pré-diabetes em filhos de pessoas com diabetes mellitus tipo 2; identificar diferenças de acordo com variáveis sociodemográficas e descrever a relação de obesidade/sobrepeso com a glicose em jejum (GJ) e a hemoglobina glicosilada (HbA1c). Métodos: Estudo transversal em 30 famílias mexicanas com 53 filhos participantes. A obesidade/sobrepeso foi determinada por meio do Índice de Massa Corporal (IMC), Circunferência da Cintura (CC) e percentual de gordura corporal (GC); a AF com o Questionário Internacional de Atividade Física curto (IPAQ) e pré-diabetes com a GJ. Resultados: 64% dos participantes apresentaram obesidade/sobrepeso, 32% baixa AF e 19% pré-diabetes. Os homens tiveram maior CC do que as mulheres (U= 219, p= 0.03). As mulheres mostraram mais GC do que os homens (U= 142, p <0.01). A glicose sanguínea esteve relacionada com a GC (rs= 0.336, p < 0.05), a HbA1c com o IMC (rs= 0.417, p <0.01), CC (rs= 0.394, p<0.01), GC (rs= 0.494, p<0.01) e AF intensa (rs= - 0.285, p<0.05). Conclusões: Foram encontradas altas prevalências de obesidade/sobrepeso e baixa AF. A GJ esteve relacionada somente com a GC e a HbA1c, além da GC, teve relação com o IMC, CC e de maneira inversa com a AF intensa. Recomenda-se modificar as estratégias educativas de enfermagem a nível familiar.

RESUMEN Objetivos: Determinar prevalencia de obesidad/sobrepeso, actividad física (AF) y prediabetes en hijos de personas con diabetes tipo 2; identificar diferencias de acuerdo a variables sociodemográficas y describir la relación de obesidad/sobrepeso con glucosa en ayuno (GA) y hemoglobina glucosilada (A1c). Métodos: Estudio transversal en 30 familias mexicanas con 53 hijos participantes. La obesidad/sobrepeso se determinó con Índice de Masa Corporal (IMC), Circunferencia de Cintura (CC) y porcentaje de grasa corporal (GC); la AF con el cuestionario IPAQ corto y prediabetes con GA. Resultados: 64% de los participantes presentó obesidad/sobrepeso, 32% baja AF y 19% prediabetes. Los hombres tuvieron mayor CC que las mujeres (U= 219, p= 0.03). Las mujeres mostraron más GC que los hombres (U= 142, p <0.01). La glucosa sanguínea estuvo relacionada con la GC (rs= 0.336, p < 0.05), la A1c con el IMC (rs= 0.417, p <0.01), CC (rs= 0.394, p<0.01), GC (rs= 0.494, p<0.01) y AF intensa (rs= - 0.285, p<0.05). Conclusiones: Se encontraron altas prevalencias de obesidad/sobrepeso y baja AF. La GA estuvo relacionada sólo con GC y la A1c además con el IMC, CC y de manera inversa con la AF intensa. Se recomienda modificar las estrategias educativas de enfermería a nivel familiar.

Pacientes pediátricos con VIH/sida en Baja California, México: alteraciones bucales relacionadas / Pediatric patients with HIV/AIDS in Baja California, Mexico: oral disorders related

Antecedentes: Baja California, México, ocupa el cuarto lugar nacional en casos reportados de VIH/sida. Por ser los pacientes pediátricos la población más vulnerable, el odontólogo debe diagnosticarlos y canalizarlos oportunamente para una adecuada atención. Objetivo: describir las alteraciones dentales y de mucosa oral asociadas más frecuentes en pacientespediátricos con diagnóstico de VIH/sida en Baja California. Metodología: se realizó un estudioclínico de corte transversal a pacientes pediátricos diagnosticados antes de los 12 años de edad, registrados en los Departamentos de Epidemiología del estado hasta agosto del 2006. Se aplicó un cuestionario para registrar variables sociodemográficas, antecedentes heredofamiliares, patológicos, concentraciones de CD4 y cargas virales. Posteriormente, demanera calibrada y siguiendo los índices establecidos por la OMS, se realizó exploración intraoral y de estructuras extraorales. Cuando se identificó la presencia de manifestaciones orales asociadas al VIH/sida, se realizaron frotis. Resultados: se revisaron 46 pacientes VIH positivos, con edad media de 6,4 ± 4,4 años, 57% de sexo masculino, 50% en categoríaclínica sintomática ligera y 67% sin supresión, 50% tenía antecedentes de hospitalizaciones por enfermedades como tuberculosis y neumonía, 63% presentaba caries y 44% lesionesen la mucosa oral, siendo la candidosis oral la de mayor frecuencia. El índice CPO-d fue de 5,2 ± 4,9. Conclusiones: este estudio describe lesiones orales en una población infantil condiagnóstico de VIH/sida en Baja California. Ya que no existen estudios previos, el valor del trabajo radica en que aporta información para el desarrollo de programas odontológicos y provee una base de comparación para futuros trabajos...

Background: Baja California, Mexico, ranks fourth nationally in reported cases of HIV/AIDS. Since paediatric patients are the most vulnerable population, the dentist must do awell-timed diagnosis and channel them for adequate care. Objective: To describe the most frequent dental and oral mucosa alterations associated with HIV/AIDS in diagnosed pediatricpatients from Baja California. Methods: A cross-sectional clinical study was carried out with pediatric patients diagnosed with HIV/AID before age 12, who were registered atEpidemiology Departments of the state until August 2006. A questionnaire including sociodemographic variables, family history, pathology, CD4 and viral load levels was applied. Later, calibrated observers registering the indicators determined by the WHO performed intraoral and extraoral examination. When an oral alteration associated with HIV/AIDS was identified, tissues smears were obtained. Results: 46 HIV positive patients with a mean of 6.4 ± 4.4 years of age were examined. 57% were male, 50% were in light symptomatic clinical category and 67% did not have suppression, 50% reported a history of hospitalizations for diseases such as Tuberculosis and Pneumonia, 63% had caries and 44% oral mucosal lesions, of which oral candidiasis was the most frequent. The DMF-T index was 5.2 ± 4.9. Conclusion: The population studied presented lesions associated with HIV/AIDS; they may be markers of immune status in which they are, so that immediate oral care, supervision and monitoring must accompany immunosuppression therapy...

[Teen pregnancy in migrants: socioeconomic, gynecobstetric, and neonatal variables]. / Embarazo en adolescentes migrantes: características sociodemográficas, ginecoobstétricas y neonatales.

OBJECTIVE: Identify and correlate characteristics of adolescent mothers in a border city of Mexico with their migratory status. METHODS: We surveyed post partum adolescent mothers in the discharge rooms of two public hospitals in Tijuana, Mexico. We assessed obstetric, gynecologic, socioeconomic and neonatal variables. Mothers living fewer than 5 years in the area were designated as 'migrant.' RESULTS: 324 adolescent mothers were identified; 86% had healthy babies; 27% had previous pregnancies; age of onset of sexual activity was 15.5 +/- 1.4 years. 115 (36%) were identified as 'migrant,' among whom we found they had interrupted their studies (24% vs. 33%; OR 2.62: CI 95% 1.39-4.94), had a higher incidence of failure to use contraception (74% vs. 62%; OR 1.79: C.I. 95% 1.07-3.01) and a lower incidence of prenatal care (28% vs. 38%; OR 1.8: C.I. 95% 1.04-3.15). A larger percentage of migrant adolescents already lived with their partner (39% vs. 24%; OR 2.00: C.I. 95% 1.21-3.30) and expressed a desire to become pregnant (55% vs. 37%; OR 2.10: C.I. 95% 1.31-3.37). The observed association persisted in multivariate analysis. We did not observe differences between other ob-gyn and neonatal variables. CONCLUSIONS: Being a female migrant should be considered a risk factor in the reproductive health of adolescent mothers.

Oral lesions in HIV+/AIDS adolescents perinatally infected undergoing HAART.

OBJECTIVE: To assess the prevalence of the oral lesions related to HIV-infection (HIV-OL) in HIV+/AIDS adolescents (=13 years old), and the differences with HIV+/AIDS children (=3 - <13 years old) perinatally infected. MATERIAL AND METHODS: 25 HIV+/AIDS adolescents and 62 HIV+/AIDS children, undergoing Highly Active Antiretroviral Therapy, were orally examined. HIV-OL was diagnosed in accordance with EC-Clearinghouse-World Health Organization. The patients were classifies with respect to their immune status in relation with the CD4+ cell counts as moderately immunodeficient; mildly immunodeficient and severely immunodeficient in accordance to the revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years (CDC-USA). The virological status was established in relation to the copies of RNA-HIV-1/mL as follows: with undetectable viral load (UDVL); with low viral load and with high viral load. A chi-square test was performed (p<0.05 IC95%). RESULTS: The prevalence of HIV-OL in HIV+/AIDS adolescents was 20% while in HIV/AIDS children was 30.6% (p>0.05). Oral candidiasis was the most prevalent oral lesion in both groups. Association (p<0.05) of a high prevalence of HIV-OL and oral candidiasis with a high viral load was observed in both study groups. CONCLUSIONS: Adolescents perinatally HIV-infected have a high prevalence of HIV-OL. Oral Candidiasis still is the most frequent oral opportunistic infection. Oral lesions could have association to viral failure in HIV+/AIDS adolescents undergoing HAART.

Venta indiscriminada de cigarrillos a menores de edad en Tijuana, Baja California: ¿Qué estamos haciendo mal? / Indiscriminate sale of tobacco products to minors in Tijuana, Mexico: What are we doing wrong?

Introducción. En México, desde 1984, la Ley General de Salud prohíbe la venta de cigarrillos a menores de edad. A pesar de ello, encuestas recientes realizadas en México muestran una prevalencia de tabaquismo en adolescentes que oscila entre 13 y 28%. Métodos. Se seleccionaron aleatoriamente 10 regiones en la ciudad de Tijuana, Baja California. En cada zona fueron elegidos 15 negocios que vendían cigarrillos; se formaron 4 equipos para los intentos de compra, cada uno incluyendo un menor de edad (14-17 años de edad). Resultados. De 150 intentos de compra, 99 (66%) tuvieron éxito; estos intentos fueron significativamente más exitosos cuando el menor era mujer, si el expendedor no preguntaba edad o pedía identificación, y no había letreros que prohibían la venta de cigarrillos a menores. En regresión logística, sólo la presencia de carteles prohibiendo la venta a menores y la petición del documento de identificación al menor se asociaron significativamente con un intento fallido de compra. Conclusiones. Poner señalamientos prohibiendo la venta de cigarrillos a menores y que el expendedor pida un documento de identificación, constituyen medidas sencillas y de muy bajo costo que pudieran reducir de manera significativa la venta de cigarrillos a menores en nuestra ciudad.

Introduction. In Mexico, since 1984, the General Health Law prohibits the sale of tobacco products to minors. Nonetheless, recent surveys conducted in several Mexican cities report a prevalence of between 13 and 28% among high school students. Methods. Ten zones from the city of Tijuana, Mexico in the state of Baja California were randomly selected from the city map. In each zone, 15 tobacco-selling businesses were then chosen. Four teams were created for the cigarette purchase attempts, each including one minor (14-17 years of age). Results. A total of 150 purchase attempts were made. Ninety nine were successful (66%). Attempts were significantly more frequently successful when the minor was a female, when the clerk did not ask for the minor's age or ID and when there were no signs prohibiting cigarette sales to minors in the store. In a logistic regression analysis, only the request for ID by the clerk and the clerk asking for the minor's age were significantly associated with an unsuccessful purchase attempt. Conclusions. Two simple policies -the posting of signs prohibiting cigarette sale to minors and the store clerk asking for valid ID- could significantly reduce the sale of cigarettes to minors in the city of Tijuana, Mexico.

[Oral autopsy in dead women from breast cancer]. / Autopsia verbal de mujeres fallecidas por cáncer de mama en Baja California.

OBJECTIVE: To discover, through the use of verbal autopsies, the primary characteristics of patients who have died of breast cancer (BCa). METHODS: We reviewed 105 death certificates where BCa was registered as the cause of death in a one-year period. A verbal autopsies instrument was designed for BCa, it was validated through expert consultation. A test-retest and Spearman coefficient were applied. The instrument explored sociodemographic, biological, life-style and health services variables. Data was obtained from patients' relatives. Any patient whose family could not be located or declined to participate was excluded from the study. RESULTS: Eighty-one verbal autopsies were applied (77%). The mean age at the time of death was 53 +/- 15. There was a direct family history of BCa in 25%; and in 31 % there was overweight or obesity. Only 17% of the tumors were discovered by health care workers, and the mean survival after diagnosis was 2.3 +/- 2 years. CONCLUSION: The verbal autopsy for BCa is a useful tool. It showed that 83 % of the deceased women identified the tumor by themselves. The health services must reinforce programs for BCa early detection.

[The use of the Health Popular Insurance Program in pregnant women]. / Utilización del Seguro Popular de Salud en mujeres embarazadas.

OBJECTIVE: To evaluate the use of the Popular Insurance of health (PIH) during the pregnancy and the factors associated with its adquisicition. METHODS: From November of 2006 to January of the 2007, women in puerperal immediate hospitalized in the General Hospital of Tijuana, BC were invited to participate in the study. A direct interrogation through a structured questionnaire was applied, exploring sociodemographic variables, variables related to the pregnancy, trimester in which SPS was acquired, consumption of tobacco and alcohol, drug use, prenatal control, complications during the pregnancy, childbirth and time of hospital stay. Descriptive and bivaried analysis was performed to identify association between variables and the use of PIH. RESULTS: 730 women where studied. The average age was of 23-6 +/- 6.3, schooling 7.4 +/- 2.8 years and 72 % cohabitated. Five hundred and forty women (74 %) acquired PIH during pregnancy, 36 women never assist to antennal visits despite to have PIH and only 15 % already had it from the first trimester of pregnancy. Women with SPS had statically significant higher levels of schooling (7.8 versus. 6.8 p = 0.003), minor smoker frequency during pregnancy (1.5 % versus 4.2 %, p = 0.002) and minor rate of premature childbirth (3.7 versus 8.9, p=. 005). The mean catasthropic expenditure in women with not PIH was 2546 +/- 131 Mexican pesos. CONCLUSIONS: Fifty per cent of women acquired the PIH in the third trimester of pregnancy this could be related more to protecting households during periods of financial crisis than for utilization of prenatal care services.

[Stress levels in health care workers from primary care units]. / Niveles de estrés en trabajadores de la salud adscritos a unidades de medicina familiar.

OBJECTIVE: To determine stress levels in health care workers (HCW) from Primary Care Units (PCU). METHODS: A descriptive study in HCW from two PCU was done to investigate stress in relation with environment, activity/occupation, relationship and lifestyle. The "Individual Evaluation Stress Inventory" was applied to 167 HCW from different job areas and categories. RESULTS: The mean age was 41 +/- 8 years; 31 % were males, and the worker seniority mean age was 16.2 +/- 5.9 years. The population was constituted by 32 % physicians; 38 % nurser/medical assistants and 30 % from the support areas. A low stress was presented in 11 %; minimum in 25 %; normal level in 37 %; high in 25 %, and 2 % had critical stress level. There was no significant association between stress and other variables. HCW with higher stress were married (56 % versus 78 %, p = 0.06), had less seniority (13.6 +/- 6.0 versus 16.6 +/- 6.0, p = 0.09). Females had higher stress than males. CONCLUSIONS: Stress in HCW was inferior to international and national score. The principal associated factors were: being married, having less seniority and being female.