[Adolescense pregnancy in a marginalized rural community in Mexico]. / Embarazo en adolescentes de una comunidad rural de alta marginalidad. Un estudio mixto de caso.

OBJECTIVE:: To identify objective and subjective conditions in the lives of pregnant teens within a highly-marginalized community in the state of Puebla, Mexico. MATERIALS AND METHODS:: Objective and subjective conditions of pregnant teens were evaluated through a mixed methodology (surveys, observation guides and a structured interview guide). RESULTS:: The main family characteristic is the absence of a father due to migration, no desire to study or work and the new meaning of pregnancy: the initial social stigma for engaging in a sexual activity and then, the stigma for being a young mother. CONCLUSIONS:: Objective conditions show family disintegration, lack of access to education at the community, high school and college level as well as unemployment as processes linked to teen pregnancy; thus, making it practically impossible to develop life goals. Subjective conditions center around the reproduction of gender stereotypes related to maternity.

["Give me a pill": the meanings of AIDS in bareback practice in Mexico City and its implications for HIV prevention]. / "Dame una pastilla": los significados del VIH/sida en la práctica del bareback en la ciudad de México e implicaciones para la prevención.

OBJECTIVE: To analyze and understand the meanings that gay men in Mexico City associate to unprotected sex such as bareback practices. MATERIALS AND METHODS: Exploratory qualitative study that uses grounded theory analysis of semistructured interviews with gay men that practice bareback sex recruited through the internet. Also a documentary analysis was performed. RESULTS: Gay men engage in bareback sexual practices because they have access to antiretroviral therapy. Access to treatment changes the meanings around AIDS and the perceived risk of infection. The confidence on treatment and the dropback of the Mexican government on preventive strategies explain these perceptions. CONCLUSIONS: Urban and middle class gay men in Mexico City have changed their perception with respect to HIV infection. It is necessary to understand the meanings related to bareback sexual practices and the use of condoms as a preventive strategy. We have to retake the discussion on preventive strategies, damage mitigation, stigma, discrimination, early diagnosis and the impact of antiretroviral therapy.

[The operation of the health program SICALIDAD: the role of managers in primary care and hospitals]. / Operación del programa Sistema Integral de Calidad en Salud (SICALIDAD): la función de los gestores en atención primaria y hospitales.

OBJECTIVE: To characterize the role of quality managers in health care units and health districts, identifying the constraints they experience in their performance. MATERIAL AND METHODS: An interview guide and a questionnaire were carried out and were applied to quality managers in nine states as well as in Mexico City´s Health Services, in a Reference Federal Hospital and in a National Institute of Health. These instruments were analyzed using SPSS and Atlas.ti software. RESULTS: The activities done by the managers depend on the organizational level of services, which can be a care unit or the health jurisdiction. For each of these, we identified different order constraints that affect the performance of the role of management in the strategies to improve the quality of the services for population without social insurance, which together make up the government program called Integrated Quality Health System. Jurisdictional managers are the link between care units and state authorities in the management of information, while the medical units' managers drive operational strategies to improve the quality. CONCLUSION: Although the health program is implemented with the personal and infrastructure of the health system, it requires a greater institutionalization and strengthening of its structure and integration, as well as greater human and material resources.

[A qualitative approach to drug supply in Mexico: evaluation in the services for population with no medical insurance]. / Análisis cualitativo del abasto de medicamentos en México: evaluación en los servicios a población no asegurada.

OBJECTIVE: To identify the main problems that the drug supply chain (DSCh) faces in the state health systems (SHS); establishing how they relate to the degree of outsourcing. MATERIAL AND METHODS: Officials of the SHS hospitals and health centers were interviewed in a sample of 12 entities during the first half of 2008. Transcripts of the interviews were processed through the qualitative analysis program Atlas.ti 5.0; the analysis was aimed at reconstructing the phases of DSCh for identifying problems narrated by informants using the phenomenological approach to discourse analysis. RESULTS: There is a marked tendency to replace the conventional model by one that is characterized by greater involvement of private providers; all the models show specific problems that might be derived from the degree of outsourcing. CONCLUSION: The supply of drugs in the studied SHS differ from the pattern implemented according to the modality adopted; outsourcing is not exempt of problems and does not seem to fully resolve the difficulties encountered in conventional ways.

[Radio-diagnostic congruence improvement in a first-level unit]. / Mejoramiento de congruencia radiodiagnóstica en una unidad de primer nivel de atención.

Background: Radiology is a fundamental tool on outpatient Family Medicine practice. Its adverse effects include its abuse, given that the patient is exposed to unnecessary radiation, and health care costs increase. Objective: To evaluate the implementation of a radio-diagnostic congruence strategy (RDCS) in a first-level unit in Mexico City. Material and methods: It was carried out an experimental, longitudinal study that covered both a previous period of time and another one after implementing the RDCS. It was evaluated the congruence between the diagnosis and the appropriateness of the imaging studies on the basis of the correspondent clinical practice guidelines. It was applied as well a bivariate statistical analysis that associated the diagnosis, the anatomical region and the patients' sex. Results: The number of imaging studies diminished substantially, while the congruence increased; this was associated to the anatomical region and the diagnosis; sex was not a decisive variable. Conclusions: Implementing the RDCS shows positive effects, since the number of requests for imaging diminished (in 43.7%), and the radio-diagnostic congruence increased (8.5%) after implementing the RDCS. The reduction of requests for imaging could have been influenced by the fact that the medical staff could have been inhibited after been monitored, which could have led them to dispatch only the necessary requests for imaging. Our findings concur with the literature in the number of imaging studies requested in the first level of care, and the necessity to check out its appropriateness in order to increase its effectivity.

Introducción: la radiología es un recurso fundamental en la consulta externa de Medicina Familiar. Sus efectos adversos incluyen su abuso, pues se expone al paciente a radiación innecesaria y se eleva el gasto en los servicios públicos. Objetivo: evaluar la implementación de una estrategia de congruencia radiodiagnóstica (ECR) en una unidad del primer nivel de atención en Ciudad de México. Material y métodos: se hizo un estudio experimental, longitudinal, que abarcó un periodo previo y uno posterior a la ECR. Se evaluó la congruencia entre el diagnóstico y la pertinencia del estudio con base en las guías de práctica clínica correspondientes. Se aplicó un análisis bivariado con cálculo de medidas de asociación y significación estadística entre el diagnóstico, la región anatómica y el sexo de los pacientes. Resultados: disminuyó sustancialmente el número de estudios y aumentó la congruencia. Esta estuvo asociada a la región anatómica y al diagnóstico. El sexo no fue una variable que influyera. Conclusiones: implementar la ECR muestra efectos positivos, pues disminuyó el número de estudios radiológicos solicitados (en un 43.7%) y se elevó la congruencia radiodiagnóstica en el periodo expost (en un 8.5%). En la disminución de estudios realizados pudo influir una inhibición del personal médico, que quizás se percibió auditado y restringió la solicitud de radiografías solo a los casos necesarios. Nuestros hallazgos coinciden con la literatura en el número de estudios radiológicos que se solicitan en el primer nivel de atención y la necesidad de revisar su correcta indicación para elevar su efectividad.

Response to Comments on article "Improvement of radiodiagnostic congruence in the first level of care".

Se agradecen los comentarios y el interés por los resultados reportados en el artículo Mejoramiento de congruencia radiodiagnóstica en una unidad de primer nivel de atención, se amplían algunos detalles sobre la lista de cotejo y se presentan algunas sugerencias sobre las condiciones de trabajo en equipo al interior de una unidad de atención primaria para facilitar la reproducibilidad del estudio.While thanking the comments and interest in the results reported on the article Improvement of radiodiagnostic congruence in a first-level care unit, some details related on the checklist are expanded, and some suggestions on working conditions are presented; in particular on the conformation of medical teams within a primary care unit, to facilitate the reproducibility of the study.

Prevalence of overweight, obesity and history of chronic disease in Mexican students / Prevalencia de sobrepeso, obesidad y antecedentes de enfermedad crónica en universitarios mexicanos

Background: Chronic-degenerative diseases are the main causes of morbidity and mortality in Mexico and are associated with overweight and obesity, which are considered a global epidemic. There is an increased risk of these conditions in patients with family history of chronic-degenerative diseases. Objective: To determine the prevalence of overweight and obesity and its association with family history of type 2 diabetes mellitus (T2DM) and high blood pressure (HBP) in university students from Mexico City. Methods: An observational and prevalence study was designed. It was administered a survey to 1168 university students and their clinical history was used; multivariate analysis was performed to determine association measures (odds ratio) and statistical significance (chi squared). Results: Combined prevalence of overweight and obesity was 36.38%, 26.02% for overweight and 10.36% for obesity. The prevalence of parental antecedents of T2DM and HBP was 42.38%; there were no significant differences by sex. The history of chronic disease increased the probability of being overweight and obese. This probability is higher if both parents have T2DM or HBP. The prevalence of T2DM/HBP comorbidity in both parents was low. Conclusions: Family history of T2DM and HBP is associated with the combined presence of overweight and obesity, but not differentially. Students whose parents have T2DM and HBP should be monitored to prevent these diseases, especially those who already are overweight and obese.

Introducción: las enfermedades crónico-degenerativas son de las principales causas de morbimortalidad en México y están asociadas a sobrepeso y obesidad, que son consideradas una epidemia mundial. Hay un mayor riesgo de estos padecimientos en quienes tienen antecedentes familiares de enfermedades crónico-degenerativas. Objetivo: determinar la prevalencia de sobrepeso y obesidad y su asociación con antecedentes parentales de diabetes mellitus tipo 2 (DM2) e hipertensión arterial sistémica (HAS) en universitarios de la Ciudad de México. Métodos: estudio observacional y de prevalencia; se aplicó una encuesta a 1168 universitarios y se consultó su historia clínica; se realizó un análisis multivariado para determinar medidas de asociación (razón de momios) y significación estadística con prueba de chi cuadrada. Resultados: se encontró una prevalencia combinada de sobrepeso y obesidad de 36.38%; por separado, 26.02% de sobrepeso y 10.36% de obesidad. La prevalencia de antecedentes paternos de DM2 y HAS fue 42.38%; no hubo diferencias importantes por sexo. Los antecedentes de enfermedad crónica elevaron la probabilidad de mostrar sobrepeso y obesidad. Esta es mayor si ambos padres padecen DM2 o HAS. La prevalencia de comorbilidad DM2/HAS en ambos padres fue baja. Conclusiones: los antecedentes familiares de DM2 y HAS están asociados a la presencia combinada de sobrepeso y obesidad, pero no diferencialmente. Se debe monitorear a los universitarios con padres con DM2 y HAS para prevenir su desarrollo, especialmente en quienes ya muestran sobrepeso y obesidad.

[Identity and mental health risks for young gays in Mexico: recreating the homosexual experience]. / Identidad y riesgos para la salud mental de jóvenes gays en México: recreando la experiencia homosexual.

In Mexico, mental disorders have displayed a sharp upward trend. Suicidal conduct is one of the most important mental health problems in the young population, with sexual orientation as a risk factor, since homosexuals show higher probability of suicide as compared to heterosexuals. Suicidal conduct is associated with prior health problems such as depression, anxiety, and low self-esteem, related to predisposing factors like formative experiences with personality. The current study takes a qualitative approach to explore the risk of mental health disorders in homosexuals, associated with suicidal conduct, based on their experience with homophobia in primary and secondary socialization settings. Discourse analysis revealed the relationship interviewees assigned to social rejection of their sexuality and key symptoms of depression (sadness), anxiety (fear), and suicidal conduct (intent and ideation).

Life, health and work conditions of taxi drivers in Mexico City / Condiciones de vida, salud y trabajo en conductores de taxi en la Ciudad de México

Background: In informal work, unfavorable working conditions derived from labor flexibility, employment insecurity and reduction of purchasing power have more impact in marginal population. For taxi drivers, informal work may be detrimental to their working conditions, and to their life and health as well. Objective: To analyze the relationship between the living and working conditions of taxi drivers from the Milpa Alta precinct and their health conditions from March to July, 2016. Methods: A complete medical record was performed on 44 male taxi drivers, aged 21 to 73 years, from a Milpa Alta taxi stand in Mexico City. Two questionnaires were administered, one on material life conditions and another on labor conditions. Anthropometric measures were taken as well as the lipid levels and glucose through capillary samples. The diagnosis of metabolic syndrome (MS) was made with ATPIII criteria. Based on the results, the pathological profile was defined and the relationship between working and health conditions, the frequencies of the symptomatology by devices and systems, as well as the prevalence of the diagnoses of degenerative disease were analyzed. Results: It was found that 93% of the participants presented some component of MS; 34% presented three or more components. The nosological entities with highest frequencies were dyslipidemia (86%), obesity (52%), type 2 diabetes mellitus (18%) and hypertension (25%). Conclusions: The symptoms with higher frequencies were those related to the work process instead of the material conditions of life.

Introducción: Las inadecuadas condiciones de trabajo generadas por la flexibilidad laboral, la inseguridad del empleo y la disminución del poder adquisitivo en el trabajo informal tienen más impacto en la población marginal. Para los operadores de taxi, la informalidad puede afectar sus condiciones de trabajo, de vida y de salud. Objetivo: Analizar la relación entre las condiciones de vida y trabajo de varones operarios de taxi de la delegación Milpa Alta y sus condiciones de salud en el periodo de marzo a julio de 2016. Métodos: Se realizó una historia clínica completa a 44 operadores de taxi del sexo masculino de 21 a 73 años, de un sitio de taxis de Milpa Alta, Ciudad de México. Se aplicaron dos cuestionarios, uno sobre condiciones materiales de vida y otro sobre condiciones laborales. Se hicieron mediciones de lípidos y glucosa en muestras capilares y medidas antropométricas. El diagnóstico de síndrome metabólico (SM) se estableció con los criterios del ATPIII. A partir de los resultados se definió el perfil patológico y se analizaron las relaciones entre las condiciones de trabajo y de salud, las frecuencias de la sintomatología por aparatos y sistemas, así como la prevalencia diagnósticos de enfermedad crónico-degenerativa. Resultados: El 93% de los participantes presentó algún componente del SM; 34% cumplió con tres o más criterios. Las entidades nosológicas con mayor prevalencia fueron las dislipidemias (86%), la obesidad (52%), la diabetes mellitus tipo 2 (18%) y la hipertensión arterial (25%). Conclusiones: Los síntomas más frecuentes fueron aquellos que se relacionan con el proceso de trabajo más que con las condiciones materiales de vida.

[Social actors in HIV/AIDS prevention: opposition and interests in educational policy in Mexico, 1994-2000]. / Actores sociales en la prevención del VIH/SIDA: oposiciones e intereses en la política educativa en México, 1994-2000.

Studies and recommendations by health agencies have emphasized the importance of education in HIV-AIDS prevention. Mexico has included topics on sexuality and HIV-AIDS in school programs, triggering resistance by some social actors. The current study seeks to clarify the various positions and interests and their influence on the textbook content. A literature search was conducted on the period during which the last educational reform was implemented in Mexico. The discourse analysis focused on the ethnography of communication, which identified: the various actors' positions, arguments, actions, economic and political power, and relations to others. The results show that those who oppose the inclusion of these themes in the school curriculum base their position on tradition, contrary to modernization and secularization of social life, and that their positions range from refusal to raising conditions. Networks have been formed that provide such groups with significant economic and political power. Government has given in to some demands by partially modifying the textbook contents. The current analysis proposes to reflect on the potential repercussions of such actions on the control of the epidemic.

Violence against bisexuals, gays and lesbians in Mexico City.

An essential premise of this work is that three dominant ideologies explain oppression against BGL, as a result of a gender system: adhesion to gender stereotypes, androcentrism and heterosexism. Three hundred eighteen bisexual and gay males (BG) and 188 bisexual and lesbian females (BL) were surveyed. By means of a self-applied questionnaire, variables of interest were researched. The following trends were observed: an important number of men and women interviewed suffered violence in their childhood and adolescence because they defied gender stereotypes, and not because of their sexual orientation; BG males were more often victims of violence than BL females. Within the BG group, those who challenged gender stereotypes were more frequently attacked than those who did not; men were identified as aggressors more frequently than women; and in the BG group, gender stereotype transgression was associated with the perception of suffering violence in the future.

[Work segregation and gender. Characterization of psychiatric morbidity registered in a hospital of Mexico City (1993-1995)]. / Segregación laboral y género. Caracterización de la morbilidad psiquiátrica registrada en un Hospital de la ciudad de México (1993-1995).

BACKGROUND: Different studies have documented that the differential distribution of the health-illness process depends upon economic, political and cultural factors. For the purpose of identifying and explaining the relationship between gender as related to occupation and psychiatric morbility, an analysis is made of the distribution of the statistics for these disorders for one population of mental patients. METHODS: Documentary research was conducted throughout the 1993-1995 period, during which the clinical records of those patients who had been admitted for the first time to a psychiatric hospital in Mexico City over a three-year period were reviewed, obtaining the main socioeconomic and diagnosis-related data. A second stage consisted of the statistical analysis in which the relationship among the gender, occupation and diagnosis variables was measured. RESULTS: A total of 1,084 individuals with some mental disorder were recorded, statistically significant differences having been found between men and women with regard to their occupation and to the specific mental disorder with which they were diagnosed, especially as far as depression and drug use-related disorders were concerned. CONCLUSIONS: The gender and occupation-related segregation due to said gender are social processes involved in the differential distribution of mental disorders, this being a relationship which is revealed in specific patterns of detriment to the mental health of the males and females who were cared for at this hospital.

Sintomatología asociada al estrés y condiciones laborales de operarios de taxi de un sitio de la Ciudad de México / Stress-related symptoms and working conditions among Mexico City taxi drivers

Introducción: Los estilos de vida no saludables se relacionan con hábitos y conductas que deterioran los órganos y sus funciones generando envejecimiento prematuro y enfermedades crónicodegenerativas, estas condiciones se ven agravadas por las desigualdades sociales en ciertos grupos laborales, tal es el caso de los conductores de taxis, los cuales presentan riesgos ambientales, físicos, químicos, bioquímicos, así como exigencias laborales como son extensión de jornada, bajos salarios, las formas de organización y la falta de apoyo sindical. Estudiar el proceso salud/enfermedad de estos trabajadores, permite identificar el desgaste laboral y la integridad mental determinada por la cantidad e intensidad de trabajo y proponer medidas de prevención. Método: Se diseñó un estudio transversal, observacional y descriptivo, se aplicó una encuesta, valoración antropométrica, análisis bioquímicos, cuyos resultados tuvieron un procesamiento para identificar asociaciones y significancia estadística. Resultados: el 32.5% de la muestra conduce más de 9 horas. al día sin descansos, el 21.8% presentó supervisión estricta y 48.7% son obligados a cubrir cuotas diarias. Más de la mitad de la muestra se encuentra con exposición constante a condiciones adversas tanto en la unidad como en el lugar de trabajo. Se encontró asociación de estas condiciones con la prevalencia de enfermedades crónico degenerativas como diabetes mellitus, hipertrigliceridemia e hipercolesterolemia, más altas con las reportadas a nivel nacional. Conclusiones: las condiciones de los conductores de taxis tanto laborales como de salud mental y física se encuentran deterioradas de manera extrema por lo cual se necesitan estrategias multidisciplinarias para su disminución(AU)

Introduction: Unhealthy lifestyles are related to habits and behaviors that can contribute to the deterioration and function of organ systems, leading to premature aging and degenerative chronic diseases. These conditions are aggravated due to the social inequality in certain occupations. Such is the case of taxi drivers, who experience environmental, physical, chemical, and biochemical risks, as well as high work demands such as long work days, low pay and little union support. By studying the health / disease process of these workers we can identify occupational burnout and mental integrity determined by the amount and intensity of the work, and propose preventive measures. Methods: A cross-sectional, observational and descriptive study was designed. We obtained data via a survey, anthropometric measurements, and laboratory testing. We examined associations and tested them for statistical significance. Results: Of the overall respondents, 32.5% reported driving more than 9 hours a day without breaks; 21.8% mentioned strict supervision and 48.7% reported being required to meet daily fee quotas. More than half the sample was continuously exposed to adverse conditions in the cab and the workplace. We found associations between these working conditions and the prevalence of chronic degenerative diseases, including diabetes, hypertriglyceridemia and hypercholesterolemia, higher than national average prevalence figures. Conclusion: occupational, physical and psychological working conditions among taxi drivers are very poor, and multidisciplinary strategies are needed to diminish them(AU)

Embarazo en adolescentes de una comunidad rural de alta marginalidad. Un estudio mixto de caso / Adolescense pregnancy in a marginalized rural community in Mexico

Resumen: Objetivo: Identificar condiciones de vida y asociaciones subjetivas en el embarazo en adolescentes de una comunidad rural marginal en Puebla, México. Material y métodos: Con metodología cualicuantitativa, que incluyó una encuesta, guías de observación y una entrevista semiestructurada, caracterizando el contexto, identificando condiciones materiales de vida y obteniendo narrativas del plan de vida en adolescentes embarazadas entre 2013 y 2014. Resultados: Se observó migración y desintegración familiar, limitados servicios educativos, de salud y escasas opciones de trabajo. Destacan condiciones como ausencia parental, baja escolaridad e ingreso, malas condiciones de vivienda y saneamiento básico deficiente, que buscan superarse mediante estudio y empleo. Se narran estereotipos tradicionales de género y modelos familiares que se repiten generacionalmente. Conclusión: Tanto las condiciones objetivas como el aprendizaje subjetivo limitan las oportunidades para realizar el plan de vida y determinan la incidencia del embarazo entre adolescentes.

Abstract: Objective: To identify objective and subjective conditions in the lives of pregnant teens within a highly-marginalized community in the state of Puebla, Mexico. Materials and methods: Objective and subjective conditions of pregnant teens were evaluated through a mixed methodology (surveys, observation guides and a structured interview guide). Results: The main family characteristic is the absence of a father due to migration, no desire to study or work and the new meaning of pregnancy: the initial social stigma for engaging in a sexual activity and then, the stigma for being a young mother. Conclusions: Objective conditions show family disintegration, lack of access to education at the community, high school and college level as well as unemployment as processes linked to teen pregnancy; thus, making it practically impossible to develop life goals. Subjective conditions center around the reproduction of gender stereotypes related to maternity.

"Dame una pastilla": los significados del VIH/sida en la práctica del bareback en la ciudad de México e implicaciones para la prevención / "Give me a pill": the meanings of AIDS in bareback practice in Mexico City and its implications for HIV prevention

Objetivo. Analizar los significados que, sobre el sexo bareback, tienen hombres gay en la ciudad de México. Material y métodos. Investigación cualitativa basada en la teoría fundamentada que utilizó entrevistas semiestructuradas a barebackeros reclutados a través de páginas web. También se realizó un análisis documental sobre el tema. Resultados. Los entrevistados reportaron tener sexo desprotegido. La argumentación al respecto indicó que el acceso al tratamiento antirretroviral modifica la percepción del riesgo de infección. La confianza en torno a los beneficios de este tratamiento y la disminución de las campañas de prevención se identificaron como nociones que guían esta práctica. Conclusiones. Los hombres gay de la ciudad de México con ingresos económicos medios y altos y acceso a antirretrovirales han variado su percepción respecto al VIH. Esto hace necesaria una revisión de los programas de prevención, reducción de riesgos, diagnósticos tempranos y un análisis de nuevas formas de estigmatización y discriminación que podrían causar las campañas que desconozcan estos nuevos significados.

Objective. To analyze and understand the meanings that gay men in Mexico City associate to unprotected sex such as bareback practices. Materials and methods. Exploratory qualitative study that uses grounded theory analysis of semistructured interviews with gay men that practice bareback sex recruited through the internet. Also a documentary analysis was performed. Results. Gay men engage in bareback sexual practices because they have access to antiretroviral therapy. Access to treatment changes the meanings around AIDS and the perceived risk of infection. The confidence on treatment and the dropback of the Mexican government on preventive strategies explain these perceptions. Conclusions. Urban and middle class gay men in Mexico City have changed their perception with respect to HIV infection. It is necessary to understand the meanings related to bareback sexual practices and the use of condoms as a preventive strategy. We have to retake the discussion on preventive strategies, damage mitigation, stigma, discrimination, early diagnosis and the impact of antiretroviral therapy.

Operación del programa Sistema Integral de Calidad en Salud (SICALIDAD): la función de los gestores en atención primaria y hospitales / The operation of the health program SICALIDAD: the role of managers in primary care and hospitals.

OBJETIVO. Caracterizar el papel que desempeñan los gestores de calidad en unidades de atención médica y jurisdicciones sanitarias, identificando las limitaciones que experimentan en su desempeño. MATERIAL Y MÉTODOS. Se aplicó una guía de entrevista y un cuestionario a gestores de calidad de nueve entidades federativas, además de los Servicios de Salud del Distrito Federal, un hospital federal de referencia y un instituto nacional de salud. Dichos instrumentos fueron analizados mediante los programas Atlas.ti y SPSS. RESULTADOS. Las actividades que desempeñan los gestores dependen del nivel organizacional de los servicios, ya sea unidad de atención o jurisdicción sanitaria. Para cada uno se identifican limitaciones de distinto orden que afectan el desempeño de la función de gestoría de las estrategias para elevar la calidad de los servicios dirigidos a población sin seguridad social que conjuntamente integran el programa gubernamental denominado Sistema Integral de Calidad en Salud. Los gestores jurisdiccionales son enlace entre las unidades de atención y autoridades estatales en la gestión de información, mientras que los de las unidades de atención médica impulsan las estrategias operativas para elevar la calidad. CONCLUSIÓN. Aunque el programa se implementa con personal e infraestructura del sistema de salud, se requiere de una mayor institucionalización y fortalecimiento en su estructura e integración, así como mayores recursos humanos y materiales.

OBJECTIVE. To characterize the role of quality managers in health care units and health districts, identifying the constraints they experience in their performance. MATERIAL AND METHODS. An interview guide and a questionnaire were carried out and were applied to quality managers in nine states as well as in Mexico City´s Health Services, in a Reference Federal Hospital and in a National Institute of Health. These instruments were analyzed using SPSS and Atlas.ti software. RESULTS. The activities done by the managers depend on the organizational level of services, which can be a care unit or the health jurisdiction. For each of these, we identified different order constraints that affect the performance of the role of management in the strategies to improve the quality of the services for population without social insurance, which together make up the government program called Integrated Quality Health System. Jurisdictional managers are the link between care units and state authorities in the management of information, while the medical units' managers drive operational strategies to improve the quality. CONCLUSION. Although the health program is implemented with the personal and infrastructure of the health system, it requires a greater institutionalization and strengthening of its structure and integration, as well as greater human and material resources.

Análisis cualitativo del abasto de medicamentos en México: evaluación en los servicios a población no asegurada / A qualitative approach to drug supply in Mexico: evaluation in the services for population with no medical insurance

OBJETIVO. Identificar las principales problemáticas que muestra la cadena de abasto de medicamentos (CAM) en los Sistemas Estatales de Salud (SESA), estableciendo la relación que guardan con la tercerización. MATERIAL Y MÉTODOS. Se entrevistó a funcionarios de los SESA y de hospitales y centros de salud de una muestra de 12 entidades durante la primera mitad de 2008. Las transcripciones de las entrevistas se procesaron en el programa de análisis cualitativo Atlas.ti 5.0; el análisis se orientó a reconstruir las fases de la CAM e identificar las problemáticas narradas por los informantes mediante el enfoque fenomenológicodeanálisisdel discurso. RESULTADOS. Existe una marcada tendencia a sustituir el modelo convencional por otro caracterizado por una mayor participación de proveedores privados; los modelos muestran problemáticas particulares que no parecen derivarse del grado de tercerización. CONCLUSIÓN. El abasto de medicamentos en los SESA estudiados difiere según la modalidad adoptada; la tercerización no está exenta de problemáticas y no parece resolver totalmente las dificultades identificadas en las formas convencionales.

OBJECTIVE. To identify the main problems that the drug supply chain (DSCh) faces in the state health systems (SHS); establishing how they relate to the degree of outsourcing. MATERIAL AND METHODS. Officials of the SHS hospitals and health centers were interviewed in a sample of 12 entities during the first half of 2008. Transcripts of the interviews were processed through the qualitative analysis program Atlas.ti 5.0; the analysis was aimed at reconstructing the phases of DSCh for identifying problems narrated by informants using the phenomenological approach to discourse analysis. RESULTS. There is a marked tendency to replace the conventional model by one that is characterized by greater involvement of private providers; all the models show specific problems that might be derived from the degree of outsourcing. CONCLUSION. The supply of drugs in the studied SHS differ from the pattern implemented according to the modality adopted; outsourcing is not exempt of problems and does not seem to fully resolve the difficulties encountered in conventional ways.

[Social Differences in Proper Detection of Cervical Uterine Cancer among Employees at a University in Mexico City]. / Diferencias sociales de la detección oportuna de cáncer cérvico uterino en las mujeres trabajadoras de una Universidad de la Ciudad de México.

OBJECTIVE: In Mexico, cervical uterine cancer (CUC) is one of the leading causes of death among women, however a low degree of participation in the early detection programs has been found. This study is aimed at describing the social determinants of knowledge related to cervical uterine cancer and proper testing being conducted by establishing the social differences with regard thereto among a population of female employees at a public university in Mexico. METHODS: An analytical cross-sectional study was made. During the March-April 2003 period, a survey was conducted of a representative sample of the female employees who were working at a public university (n=228), 110 of whom were professors (PF) and 118 administrative staff (AS). This population was chosen due to the major socioeconomic differentiation thereof in terms of their job positions (PF versus AS), thus affording the possibility of evaluating the bearing social inequality has on health-related behavior. The survey explored three aspects: living conditions, knowledge of CUC and of proper cervical uterine cancer detection testing. RESULTS: The female professors showed higher levels of income,schooling and knowledge of CUC and of cervical uterine cancer detection testing than the administrative staff. Income and schooling were positively related to the knowledge regarding cervical uterine cancer, cervical uterine cancer detection testing being related to the latter. CONCLUSIONS: Socioeconomic inequality among the women studied was reflected in differences in the degree of knowledge and in cervical uterine cancer detection testing being undergone. These differences are associated, above all, to the differences in the level of schooling.

OBJETIVO: En México el cáncer cérvicouterino (CACU) es una de las principales causas de muerte en mujeres; sin embargo, se ha encontrado una baja participación en los programas de su detección oportuna (DOCACU). El objetivo de este estudio fue describir los determinantes sociales del conocimiento sobre el cáncer cérvicouterino y la realización de la detección oportuna estableciendo las diferencias sociales que al respecto muestra una población de mujeres trabajadoras de una universidad pública de México. METODOS: Se realizó un estudio transversal analítico. Entre marzo y abril de 2003 se aplicó una encuesta a una muestra representativa de las trabajadoras que laboraban en una universidad pública (n=228), 110 eran académicas (AC) y 118 administrativas (AD). Se eligió esta población por su elevada diferenciación socioeconómica en función del puesto laboral (AC vs. AD), esto permitió evaluar la influencia de la desigualdad social sobre las conductas en salud. La encuesta exploró tres aspectos: condiciones de vida, conocimiento del CACU y DOCACU. RESULTADOS: Las mujeres académicas mostraron mayores niveles de ingreso, escolaridad, conocimiento del CACU y DOCACU que las administrativas. El ingreso y la escolaridad se relacionaron positivamente con el conocimiento sobre el cáncer cervicouterino, la realización de detección oportuna se relacionó con este último. CONCLUSIONES: La desigualdad socioeconómica entre las mujeres estudiadas se reflejó en diferencias en el grado de conocimiento y en la práctica de la detección oportuna. Estas diferencias se asocian,sobre todo, a las diferencias en el grado de escolaridad.

La vivencia del rechazo en homosexuales universitarios de la Ciudad de México y situaciones de riesgo para VIH/sida / The experience of rejection in homosexual university students from Mexico City and risk situations for HIV/AIDS.

OBJETIVO: Describir la relación que establece un grupo de varones homosexuales entre la percepción del rechazo social a su homosexualidad, sus prácticas sexuales y el riesgo de VIH/sida. MATERIAL Y MÉTODOS: Se aplicaron entrevistas a profundidad a homosexuales de una universidad de la Ciudad de México reclutados mediante la técnica de "bola de nieve". Las entrevistas se grabaron y procesaron en el programa Atlas.ti y el análisis del discurso se realizó con el método denominado "teoría fundamentada". RESULTADOS: La experiencia de la homofobia que manifestaron los entrevistados generó sufrimiento psíquico, incluidos tristeza, miedo y conducta suicida, asociado con situaciones de riesgo para VIH/sida: escasa comunicación, baja negociación para usar el condón y prácticas de riesgo como la penetración anal. CONCLUSIONES: La homofobia, traducida en discriminación, incrementa la vulnerabilidad a la transmisión sexual del VIH.

OBJETIVES: To describe the relationship established by a male homosexual group between the perception of social rejection towards their homosexuality, sexual practices and risk of HIV/AIDS. MATERIAL AND METHODS: In-depth interviews were administered to homosexual men at a Mexico City university by means of a snowball technique. The interviews were recorded and processed with Atlas.ti software and the analysis of the discourse was made using the Grounded Theory method. RESULTS: The experience of homophobia as expressed by the interviewees resulted in psychological suffering, including sadness, fear, loneliness and suicidal behavior associated with risk situations for HIV/AIDS. CONCLUSIONS: Homophobia, translated into discrimination, contributes to an increased vulnerability to the sexual transmission of HIV.

Identidad y riesgos para la salud mental de jóvenes gays en México: recreando la experiencia homosexual / Identity and mental health risks for young gays in Mexico: recreating the homosexual experience

En México, los trastornos mentales están mostrando una tendencia importante al incremento, la conducta suicida es uno de los problemas de salud mental más importantes en la población joven, entre sus causas se refiere a la orientación sexual como factor de riesgo, ya que los homosexuales muestran mayores probabilidades de suicidio que los heterosexuales. La presencia de conducta suicida se asocia a daños a la salud previos como la depresión, la ansiedad y bajos niveles de autoestima que se relacionan con factores predisponentes como las experiencias formativas de la personalidad. Este trabajo explora, con un enfoque cualitativo, el riesgo que muestran los homosexuales a daños a la salud mental que se asocian a conducta suicida en base a la experiencia de la homofobia en los ámbitos primarios y secundarios de socialización. Con el análisis discursivo se logra identificar la relación que los entrevistados le asignan al rechazo social a su sexualidad y síntomas clave de depresión (tristeza), ansiedad (temor) y conducta suicida (intento e ideación).

In Mexico, mental disorders have displayed a sharp upward trend. Suicidal conduct is one of the most important mental health problems in the young population, with sexual orientation as a risk factor, since homosexuals show higher probability of suicide as compared to heterosexuals. Suicidal conduct is associated with prior health problems such as depression, anxiety, and low self-esteem, related to predisposing factors like formative experiences with personality. The current study takes a qualitative approach to explore the risk of mental health disorders in homosexuals, associated with suicidal conduct, based on their experience with homophobia in primary and secondary socialization settings. Discourse analysis revealed the relationship interviewees assigned to social rejection of their sexuality and key symptoms of depression (sadness), anxiety (fear), and suicidal conduct (intent and ideation).