Aprendizaje o calificaciones: un dilema ético en los alumnos de medicina / Learning or grading: an ethical dilemma in medical students / Aprender ou classificar: um dilema ético em estudantes de medicina

Resumen: Los estudiantes de medicina deben moldear su futuro laboral, antes, durante y después de su vida estudiantil. Es necesidad del médico en general, desde su etapa de estudiante, tener un aprendizaje basado en lo que debe desempeñar para su posterior actividad laboral profesional. Este desarrollo escolar de aprendizaje usualmente se ve influenciado por la forma de los planes de estudio que cada una de las instituciones educativas permiten. En la mayoría de ellas, los privilegios de los alumnos durante su trayectoria están otorgados a través de los promedios de calificaciones que obtienen en cada ciclo escolar. Muy frecuentemente, al alcanzar los privilegios que ofrecen las escuelas, se crean problemas éticos en los alumnos que tienen como alternativa el aprendizaje profesional. El confrontamiento de este dilema puede ocasionar en el estudiante alteraciones en su desarrollo escolar y hasta en su salud física o mental.

Abstract: Medical students must shape their future work, before, during and after their student life. It is a necessity for physicians in general from their student stage to have an apprenticeship based on what they must perform for their later professional work activity. This school development of learning is usually influenced by the form of the curricula that each of the educational institutions allow. In most of them, the privileges that students have during their trajectory are granted through the grade point averages they have in each school cycle. Very often, achieving the privileges offered by schools creates bioethical problems for students who have professional learning as an alternative. The confrontation of this dilemma can cause alterations in the student's school development and even in his physical or mental health.

Resumo: Os estudantes de medicina devem moldar a sua carreira futura, antes, durante e depois da sua vida de estudante. É necessário que os médicos em geral, desde a fase de estudante, tenham uma aprendizagem baseada no que se espera que desempenhem no seu trabalho profissional subsequente. Este desenvolvimento da aprendizagem escolar é geralmente influenciado pela forma dos currículos que as instituições de ensino individuais permitem. Na maioria deles, os privilégios que os estudantes têm durante a sua carreira são concedidos através das médias de notas que têm em cada ciclo escolar. Muito frequentemente, a obtenção dos privilégios oferecidos pelas escolas cria problemas bioéticos para os estudantes que têm a alternativa da aprendizagem profissional. O confronto deste dilema pode causar alterações no desenvolvimento escolar do aluno e mesmo na sua saúde física ou mental.

Life history of two abundant populations of Dipetalogaster maximus (Uhler, 1894) (Hemiptera: Reduviidae: Triatominae) in northwestern Mexico.

We focused on the analysis of biological parameters of two different abundant populations of Dipetalogaster maximus (Uhler) (Hemiptera: Reduviidae: Triatominae) from northwestern Mexico. The biological parameters were related to hatching of eggs, life cycle, and meal needed for molting by each instar of two populations from environmentally similar areas (El Fandango and San Dionisio) with a similar number of available hosts as blood meal sources. The D. maximus populations from the two locations were evaluated and compared. No significant differences (P>0.05) were recorded for the average hatching time of the two cohorts. The median egg-to-adult development time and the number of blood meals at each nymphal group were significantly shorter (P<0.05) for the El Fandango cohort. The number of obtained females at the end of the cycles, number of eggs laid, and rate of egg hatching were significantly higher (P<0.05) for the El Fandango cohort. These results contribute to the estimation of abundances of the studied populations of D. maximus in areas where many tourists go for camping and have an increased risk of being bitten and infected by this species.

Polimorfismo rs4285184 del gen MGAT1 como factor de riesgo de obesidad en la población mexicana / The rs4285184 polymorphism of the MGAT1 gene as a risk factor for obesity in the Mexican population

Antecedentes y objetivo: La obesidad es un factor que contribuye a la morbilidad de ciertas enfermedades, y a la mortalidad mundial. MGAT1 es una glucosiltransferasa implicada en la síntesis de los oligosacáridos ligados a proteínas y lípidos, y es posible que sus polimorfismos estén implicados en la etiología de la obesidad. Investigamos la asociación entre el polimorfismo rs4285184 del gen MGAT1 y la obesidad en adultos del estado de Colima, México. Métodos: Se realizó un estudio caso-control que incluyó a 244 sujetos. Todos ellos fueron agrupados con arreglo a su porcentaje de grasa corporal, determinado mediante impedancia bioeléctrica, y fueron genotipados para el polimorfismo rs4285184 del gen MGAT1 mediante PCR-RFLP. Se analizaron los resultados para buscar su asociación con el porcentaje de grasa corporal. Resultados: El alelo G reflejó una frecuencia del 49,19% y el 38,75% para los casos y controles, respectivamente (p= 0,020) (OR 1,53; IC 95% 1,068-2,193). La frecuencia del genotipo A/G + G/G fue del 75% en los pacientes obesos, cifra significativamente superior en comparación al 57,5% del grupo control (p = 0,004) (OR 2.217; IC 95% 1,287-3,821). Conclusiones: La presencia del polimorfismo rs4285184 del gen MGAT1 incrementó el riesgo de desarrollar grasa corporal asociada a la obesidad en la población mexicana (AU)

Background and objective: Obesity is a factor that contributes to the morbidity of certain diseases and to worldwide mortality. MGAT1 is a glycosyltransferase involved in the synthesis of protein-bound and lipid-bound oligosaccharides and its polymorphisms are possibly involved in the etiology of obesity. We investigated the association of the rs4285184 polymorphism of the MGAT1 gene with obesity in adults in the State of Colima, Mexico. Methods: A case-control study was conducted that included 244 subjects. All of them were grouped according to their percentage of body fat, determined through bioelectrical impedance, and they were genotyped for the rs4285184 polymorphism of the MGAT1 gene through PCR-RFLP. The results were analyzed for their association with the percentage of body fat. Results: The G allele had a frequency of 49.19 and 38.75% for the cases and controls, respectively (P = .020) (OR 1.53; 95% CI 1.068-2.193). The frequency of the A/G + G/G genotype was 75% in the obese patients, which was significantly higher compared with the 57.5% of the control group (P = .004) (OR 2.217; 95% CI 1.287-3.821). Conclusions: The presence of the rs4285184 polymorphism of the MGAT1 gene increased the risk for developing body fat associated with obesity in the Mexican population (AU)

The rs4285184 polymorphism of the MGAT1 gene as a risk factor for obesity in the Mexican population. / Polimorfismo rs4285184 del gen MGAT1 como factor de riesgo de obesidad en la población mexicana.

BACKGROUND AND OBJECTIVE: Obesity is a factor that contributes to the morbidity of certain diseases and to worldwide mortality. MGAT1 is a glycosyltransferase involved in the synthesis of protein-bound and lipid-bound oligosaccharides and its polymorphisms are possibly involved in the etiology of obesity. We investigated the association of the rs4285184 polymorphism of the MGAT1 gene with obesity in adults in the State of Colima, Mexico. METHODS: A case-control study was conducted that included 244 subjects. All of them were grouped according to their percentage of body fat, determined through bioelectrical impedance, and they were genotyped for the rs4285184 polymorphism of the MGAT1 gene through PCR-RFLP. The results were analyzed for their association with the percentage of body fat. RESULTS: The G allele had a frequency of 49.19 and 38.75% for the cases and controls, respectively (P=.020) (OR 1.53; 95% CI 1.068-2.193). The frequency of the A/G+G/G genotype was 75% in the obese patients, which was significantly higher compared with the 57.5% of the control group (P=.004) (OR 2.217; 95% CI 1.287-3.821). CONCLUSIONS: The presence of the rs4285184 polymorphism of the MGAT1 gene increased the risk for developing body fat associated with obesity in the Mexican population.

Glycophosphopeptical as adjuvant treatment of diabetic foot injury: a pilot study.

BACKGROUND: Due to the complexity of the diabetic foot, its high frequency of amputations and accompanying immunosuppression, treatment is difficult. We tested the usefulness of glycophosphopetical immunoregulator as adjuvant therapy for diabetic foot injury. METHODS: We carried out a prospective double-blind randomized controlled study with 19 patients per group with diabetic foot injury III and IV (Wagner injury classification). The study group was treated orally with glycophosphopeptical (1 g/every 8 h for 4 weeks). Control group was treated with placebo. Both groups received conventional treatment: wound debridement, antibiotic therapy and metabolic control. Area and depth of injury was measured at the beginning of the study and after 2 months. Patients who were healed or showed improvement were quantified as well with serum levels of TNF-α, interferon-γ and IL-1ß, 15 days after treatment initiation. RESULTS: The study group was comprised of 13 males and six females (mean age 61.6 ± 14.9 years) and the control group was comprised of five females and 14 males (mean age 56.7 ± 14.6 years). At the end of the study, the area and depth of the lesions were significantly lower in the study group (p <0.05). There were 13 amputations in the study group vs. 17 in the control group. In the group treated with glycophosphopeptical, there were 15 patient who were healed or improved and four failures vs. seven patients in the control group who were healed or improved and 12 failures. There were only four failures in the study group vs. seven in the control group with 12 failures (p = 0.03). TNF-α was lower in the study group than in the control group (p <0.02). CONCLUSION: Glycophosphopeptical is useful as adjuvant therapy in diabetic foot injuries.

Distribution and infection of triatomines (Hemiptera: Reduviidae) by Trypanosoma cruzi in the state of Michoacán, Mexico.

An entomological study of triatomine species was carried out to assess their prevalence in 10 localities of the state of Michoacán, Mexico. Entomological indices were calculated to estimate the risk for vector-borne transmission of Trypanosoma cruzi to the human population in this area. Four triatomine species (Triatoma barberi, Triatoma dimidiata, Meccus pallidipennis and Meccus longipennis) were collected from the study area. This is the first report of M. longipennis and T. dimidiata in Michoacán. M. pallidipennis was significantly (p < 0.05) more abundant than any of the other species collected in the study area. Infection indices were greater than 50% for each of the four collected triatomine species. Significantly more triatomines were collected from intradomiciliary areas than from peridomiciliary or sylvatic areas. Infestation, crowding and density indices were low, whereas colonisation indices were high in five localities. The current vectorial conditions in the study area require continuous entomological and serological surveillance to diminish the risk of T. cruzi transmission to human populations.

Distribution and infection of triatomines (Hemiptera: Reduviidae) by Trypanosoma cruzi in the state of Michoacán, Mexico

An entomological study of triatomine species was carried out to assess their prevalence in 10 localities of the state of Michoacán, Mexico. Entomological indices were calculated to estimate the risk for vector-borne transmission of Trypanosoma cruzi to the human population in this area. Four triatomine species (Triatoma barberi, Triatoma dimidiata, Meccus pallidipennis and Meccus longipennis) were collected from the study area. This is the first report of M. longipennis and T. dimidiata in Michoacán. M. pallidipennis was significantly (p < 0.05) more abundant than any of the other species collected in the study area. Infection indices were greater than 50 percent for each of the four collected triatomine species. Significantly more triatomines were collected from intradomiciliary areas than from peridomiciliary or sylvatic areas. Infestation, crowding and density indices were low, whereas colonisation indices were high in five localities. The current vectorial conditions in the study area require continuous entomological and serological surveillance to diminish the risk of T. cruzi transmission to human populations.

[Monitoring triatomid bug (Hemiptera: Reduviidae) presence by sentinel chicken coops in Southern Jalisco State, México]. / Vigilancia de la presencia de triatominos mediante gallineros en el sur de Jalisco, México.

INTRODUCTION: Chagas disease is an important public health problem in Mexico. At least 30 Triatominae species, vectors of that disease have been recorded, most with domiciliary habits and tendency to invade human dwellings. OBJECTIVE: The usefulness of using chicken coops was evaluated for monitoring peridomestic triatomine presence, identity and infection with Trypanosoma cruzi. Materials and methods. A year-long, longitudinal field study was designed. Fifty chicken coops were placed in 50 human dwellings on three localities in Teocuitatlán de Corona County, Jalisco State, Mexico. The coops and human dwellings were routinely inspected to determine if the coops alone can monitor for the presence of triatomines. RESULTS: Significantly (p<0.05) more Meccus longipennis specimens (93.0%) than of Triatoma barberi (7.0%) were collected. Almost a third (31.3%) of M. longipennis and none of T. barberi specimens were collected in the coops. Meccus longipennis was found with infections of Trypanosoma cruzi of 25.7%, and T. barberi of 53.2%. Most triatomines were collected in spring and summer months. CONCLUSIONS: Chicken coops proved useful tools to detect presence of M. longipennis; however, they were not effective for T. barberi. The importance of M. longipennis as a potential vector was confirmed, and the possible primary vector role of T. barberi was established as well.

Vigilancia de la presencia de triatominos mediante gallineros en el sur de Jalisco, México / Monitoring triatomid bug (Hemiptera: Reduviidae) presence by sentinel chicken coops in Southern Jalisco State, México

Introducción. En México, la enfermedad de Chagas es un problema de salud pública. Se han registrado, al menos, 30 especies de triatominos vectores, la mayoría con hábitos domésticos y tendencia a invadir las viviendas humanas. Objetivo. Evaluar la utilidad de gallineros en la vigilancia de la presencia de triatominos peridomésticos y conocer su situación en el área de estudio. Materiales y métodos. Se realizó un estudio de campo, experimental, longitudinal, por un año. Se instalaron 50 gallineros en 50 viviendas de tres localidades del municipio de Teocuitatlán de Corona, en el estado de Jalisco, México. Se inspeccionaron los gallineros y las viviendas para saber si aquéllos podían detectar la presencia de triatominos, para estimar la situación vectorial en el área. Resultados. Se recolectaron significativamente (p<0,05) más especímenes de Meccus longipennis (93%) que de Triatoma barberi (7%). Aproximadamente, un tercio (31,3%) de los especímenes de M. longipennis y ninguno de T. barberi se recolectó en los gallineros. M. longipennis tuvo un porcentaje de infección por Trypanosoma cruzi de 25,7%, y T. barberi, de 53,2%. Los meses de primavera y verano fueron en los que se recolectaron más ejemplares de triatominos. Conclusiones. Los gallineros se consideran una herramienta útil para detectar la presencia de ejemplares de M. longipennis, aunque no funcionaron para T. barberi. Se confirma la importancia de M. longipennis y se establece el posible rol primario de T. barberi como vector en el área de estudio.

Introduction. Chagas disease is an important public health problem in Mexico. At least 30 Triatominae species, vectors of that disease have been recorded, most with domiciliary habits and tendency to invade human dwellings. Objective. The usefulness of using chicken coops was evaluated for monitoring peridomestic triatomine presence, identity and infection with Trypanosoma cruzi. Materials and methods. A year-long, longitudinal field study was designed. Fifty chicken coops were placed in 50 human dwellings on three localities in Teocuitatlán de Corona County, Jalisco State, Mexico. The coops and human dwellings were routinely inspected to determine if the coops alone can monitor for the presence of triatomines. Results. Significantly (p<0.05) more Meccus longipennis specimens (93.0%) than of Triatoma barberi (7.0%) were collected. Almost a third (31.3%) of M. longipennis and none of T. barberi specimens were collected in the coops. Meccus longipennis was found with infections of Trypanosoma cruzi of 25.7%, and T. barberi of 53.2%. Most triatomines were collected in spring and summer months. Conclusions. Chicken coops proved useful tools to detect presence of M. longipennis; however, they were not effective for T. barberi. The importance of M. longipennis as a potential vector was confirmed, and the possible primary vector role of T. barberi was established as well.

[Foot ulceration risk factors in type 2 diabetes mellitus]. / Factores de riesgo de ulceración de los pies en diabéticos tipo 2.

OBJECTIVE: To identify risk factor prevalence for development of foot ulcers in patients with type 2 diabetes (DM2). METHODS: A cross sectional study, of 2067 patients with DM2 from seven primary care units was conducted. A questionnaire exploring age, sex, occupation, time from diabetes mellitus diagnosis (DMD), and data concerning neuropathy, vascular changes, and presence of infections, anthropometry, and gait was applied. RESULTS: We found mean age, 59.96 +/- 11.47 years and time from DMD, 10.2 +/- 8.09 years. From 1360 women, 65.8 % presented the following risk factors: age, 34.7 %; schooling, 49.5 %; time from DMD, 38.8 %; occupation, 20 %; smoking, 24.3 %; alcoholism, 4.6 %; fasting glucose disturbance, 78 %; ulcer history, 10 %. In relation to associated diseases, 67.5 % of patients had one or more antecedent. The presence of risk factors in the sample was 9.716 +/- 2.52, of which 6.259 +/- 1.59 were modifiable. CONCLUSIONS: Patients studied presented high risk factor prevalence for development of foot ulcer. The majority of RF is potentially modifiable by adjusting patients' customs and habits.

[Taste sensitivity diminution in hyperglycemic type 2 diabetics patients]. / Disminución de la sensibilidad gustativa en diabéticos tipo 2 con hiperglucemia.

OBJECTIVE: To determine the relationship between fasting blood glucose (FBG) values and gustatory sensitivity alterations in type 2 diabetic patients (DM2) without peripheral neuropathy (PNP). METHODS: Assessment of the strength of association between FBG and detection and recognition taste thresholds for the four primary tastes measured by chemical gustometry were performed in 140 DM2 without PNP with evolution < 10 years. RESULTS: FBG values above 7.77 mmol/L (140 mg/dL) induce in a dependent manner, the increase in the detection and recognition taste thresholds only to sweetness; whereas, values above 16.65 mmol/L (300 mg/dL) did not cause further decreasing in taste acuity to sweet flavor. Statistically significant differences where found for detection and recognition, taste thresholds for sucrose between well controlled (HbA1c < or = 7 %) normoglycemic and hyperglycemic diabetics, as well as between alarming uncontrolled (HbA1c > 10 %) normoglycemic and hyperglycemic patients. CONCLUSIONS: Hyperglycemia induces a concentration-dependent impairment of sweet taste perception in DM2 patients as the result of an adaptation of the sensory cell to elevated circulating concentrations of glucose.

Conocimientos usuales de los pacientes diabéticos en los estudiantes de medicina del occidente de México” / Usual knowledge of medical students form Western Mexico on diabetic patients

Objetivo: Identificar el conocimiento que presentan los estudiantes de Medicina acerca de los conceptos usuales de los pacientes diabéticos sobre su enfermedad. Material y métodos: Estudio descriptivo en 275estudiantes de Medicina del Centro Universitario del Sur de la Universidad de Guadalajara. Se seleccionó la muestra en forma aleatoria a los alumnos inscritos en el calendario 2006 A, para aplicarles el instrumento Diabetes Knowledge Questionnaire (24). Se utilizó el programa de estadística EPI INFO 2000, se tomó una significancia estadística <0.05.Resultados: Edad en los estudiantes: 20.03±1.9 años. El promedio total de contestaciones acertadas fue: estudiantes 17.56± 3.24, los alumnos de 7º y 8º. ciclo presentaron 19.53 ±2.15 y 19.75±1.92 aciertos. En cuanto a conocimientos básicos de la enfermedad solo el 75.82% contesto adecuadamente los reactivos, en el control glucémico 70.7% y en medidas de prevención y complicaciones 71.9% de los estudiantes. Conclusiones: El conocimiento de los estudiantes de Medicina en cuanto a los conceptos que deben detener los pacientes diabéticos sobre su enfermedad se incrementa en forma significativa en cuanto aumenta los semestres de estudio, los primeros ciclos escolares tienen la tendencia a ser semejantes a la población de pacientes diabéticos de la región (AU)

Objective: To identify the knowledge that presents Medicine students about the usual concepts of the diabetic patients on their disease. Material and Methods: Cross sectional study in 275Medicine alumni of the University Center of the South of the University of Guadalajara. Sample was selected in randomized form in the students enrolled in calendar 2006 A, in order to apply them instrument Diabetes Knowledge Questionnaire (24). The statistic program was used EPI INFO 2000, a statistical significance was taken <0.05.Results: Students age: 20.03±1.9 years. The total average of guessed right answers was: 17.56± 3.24,students of 7º and 8º. cycle presented 19.53 ±2.15 and 19.75±1.92 right answers. As far as basic knowledge of the disease 75,82% answered the reagents suitably, in glycemic control 70.7% and prevention measures and complications 71.9%.Conclusions: knowledge in Medicine students as far as the concepts that must have the diabetic patients on their disease increases in significant form as soon as it increases the semesters of study, the first scholastic cycles have the tendency to be similar to the population in regional diabetic patients (AU)

[Utility of adequate values of an occasional fasting and postprandial glycemia in the chronic control of the type-2 diabetic patient]. / Control de la glucemia en diabeticos tipo 2. Utilidad de mediciones en ayuno y posprandiales.

OBJECTIVE: To identify the sensitivity and specificity of occasional fast and postprandial glycemias as for a chronic control of the type-2-diabetic patient. MATERIAL AND METHODS. DESIGN: Descriptive, cross-sectional in 850 type-2-diabetic adults patients from the outpatient clinic of the Zone General Hospital and Family Medicine 9 in Ciudad Guzmán, Jalisco, Mexico, without insulin therapy, with creatinine values lower than 132.6 micromol/L (1.5 mg/ dL), and glycemia over 4.4 mmol/L (80 mg/dL). PROCEDURE: Blood extraction was carried out to determine fasting glycemia, cholesterol, triglycerides and glycosilated haemoglobin (HbA1c). After that, they were given a breakfast of 320 Kcal, and new blood samples were taken for postprandial glycemia. The statistical programs used were Epi-Info 2000, Epi-Dat. RESULTS: Age, 59. +/- 11.2 years old; antiquity in diabetic diagnosis, 4.8 +/- 6.7 years; fasting glycemia average, 9.9 +/- 4.4 mmol/L (178.6 +/- 79.4 mg/ dL); postprandial glycemia, 14 +/- 6.1 mmol/L (251.6 +/- 109.6 mg/dL); HbA1c, 9.3 +/- 3.4 %. An acceptable fasting glycemia presents an adequate chronic control sensitivity of 44.8 %, with a specificity of 82.1 %. On the other hand, a postprandial glycemia presented a sensitivity of 46.5 % and specificity of 77.3 %; both acceptable parameters have a sentivity of 31.4 % and specificity of 83.3 % to identify a good control of HbA1c. CONCLUSIONS: Random parameters present very little sensitivity to the diagnosis of a good chronic control of the patient; however, as screening tests, they show an acceptable specificity for the HbA1c poor values.

Lipid profile, insulin secretion, and insulin sensitivity in psoriasis.

BACKGROUND: Psoriasis has been associated with an abnormal plasma lipid metabolism and diabetes mellitus possibly related to alterations in insulin secretion and sensitivity. OBJECTIVE: We sought to identify lipid profile, insulin secretion, and insulin sensitivity in patients with psoriasis and healthy control patients. METHODS: A cross-sectional study was performed in 44 nonobese adults, 22 with psoriasis and 22 without. The psoriasis activity was evaluated by the psoriasis area and severity index. Insulin secretion was estimated using the homeostasis model analysis beta-cell function index. Insulin sensitivity was assessed with the insulin tolerance test. RESULTS: High-density lipoprotein cholesterol was significantly decreased in patients with psoriasis (P =.02). There were no significant differences in insulin secretion or sensitivity in patients with psoriasis compared with control patients. CONCLUSION: Patients with psoriasis had significantly decreased high-density lipoprotein cholesterol concentrations. There were no differences in insulin secretion or sensitivity compared with control patients.

Prevalencia de lactancia materna exclusiva en niños de seis meses y menores / The prevalence of exclusive maternal beast-feeding in children six months of age and under

Objetivo: conocer la prevalencia de lactancia materna exclusiva en menores de seis meses, cuyas madres estaban adscritas al Hospital General de Zona con Unidad de Medicina Familiar 9, de Ciudad Guzmán, Jalisco.Material y métodos: estudio descriptivo, transversal y prospectivo, mediante encuesta dirigida a 390 madres de niños de seis meses y menores. Variables: edad infantil y materna, estado civil, número de hijos, lactancia materna, solicitud y ayuda láctea, adquisición de leche adicional e ingesta de otros alimentos. Procedimiento: entrevista por medio de interrogatorio directo.Resultados: edad materna 26 ñ 6 años e infantil 3 ñ 1.7 meses; promedio de hijos 2 ñ 1. La lactancia exclusiva fue otorgada en 71 por ciento durante el primer mes y en 4 por ciento durante el sexto mes; la artificial fue de 3 a 19 por ciento; y la mixta varió de 26 a 77 por ciento en el mismo periodo; 34 por ciento de las madres compraba leche y 35 por ciento proporcionaba otro alimento.Conclusiones: la gran mayoría de las madres otorgó lactancia materna. La forma exclusiva fue de casi 75 por ciento en el primer mes a menos de 5 por ciento en el sexto mes

Costumbres en el otorgamiento de la lactancia materna por parte del personal de enfermería / Customs in the granting of breastfeeding by nurses

El objetivo fue demostrar la prevalencia de la lactancia materna entre las enfermeras. El diseño del estudio fue una encuesta descriptiva transversal en enfermeras madres del Hospital General de Zona N° 9 en Ciudad Guzmán. Jalisco, del Instituto Mexicano del Seguro Social. Fueron analizados los siguientes factores: categoría, edad, estado civil, número de hijos, otorgamiento de lactancia y dificultades, hora de lactancia, anticoncepción con lactancia y familia. La muestra estuvo integrada por 71 enfermeras con edad promedio de 35.38 años. Solamente tres refirieron no haber lactado. El otorgamiento de la lactancia fue en promedio de 6.98 meses. 23.9% de ellas la llevaron a cabo por un periodo de menos de tres meses. 67.5% de tres a 12 meses y 4% por más de un año. La lactancia materna fue abandonada principalmente por insuficiencia en la producción láctea y problemas laborales. La prevalencia de la lactancia en las enfermeras fue mayor que en la población en general al inicio de la misma, pero disminuyó a los seis meses. La actividad laboral intervino de manera importante en la falta de otorgamiento de la lactancia.

Objective: characterization of nurse's habits on breast-feeding. Methods: design descriptive, transversal. Universe: nurses mothers from the General Hospital Zone 9 at the Social Security Mexican Institute. Studied parameters: category, civil state, children's number, breast feeding time, breastfeeding-anticonception and family, breast feeding troubles. Results: sample 71 nurses. Age: 35.38 years old. Nurse's category: 18 auxiliary, 41 general, 3 specialist, 7 floor chief, 2 nurse's subchief. Exceptfor 3 nurses, who never breast-feed their babies, personnel inquired supplied breastfeeding by mean 6.98 months, 23.9% of them practiced this in less than 3 months, 67.5% from 3 to less than 12 months and 4% did it for about 1 year or more. Quitting arguments: insufficient milk production and employment difficulties. Conclusion: at the beginning, nurse's breast-feeding was better than the general population, butthisdecreasedat6 months. Labor condition is an important obstacle in nurse's breast-feeding.

Costumbres sexuales en una población semirrural: estudio comparativo / Sexual practices of a semirural population: comparative study

Se realizó un estudio por medio de interrogatorio directo a 100 adultos que acudieron al azar a la Unidad de Medicina Familiar No. 18 del Instituto mexicano del Seguro Social, localizada en Zapotiltic, Jal. La muestra se dividió para ambos sexos en dos grupos: menores y mayores de 40 años, con el fin de determinar cambios en el comportamiento entre ambas generaciones. Se encontraron cambios moderados en los roles de conducta sexual de los varones, probablemente debido al abandono de ciertos hábitos de comportamiento rural por parte de los menores de 40 años y a su emigración a centros más urbanizados, notándose apenas pequeños esbozos de cambios conductuales. Se encontró una marcada diferencia en los roles de comportamiento entre los dos sexos, constatándose la sumisión femenina y el machismo en el hombre