Effectiveness of an integrative health-care model for climacteric-stage women.

OBJECTIVES: To evaluate an integrative health-care model (IHCM) with an empowerment approach for self-care in terms of improving health-related quality of life (HR-QoL) and lifestyle. METHODS: We conducted a field trial with one intervention (IHCM) and one comparison group receiving usual care (UC), with ex ante and ex post measurements. The IHCM was provided for 3 months to each woman in the first group, with follow-up of both groups at 3 and 6 months. The differences in differences estimator was used to assess the effect of intervention, adjusting for clinically important covariates in the framework of a generalized linear regression model. RESULTS: A total of 380 women (IHCM 190 and UC 190) participated in the study. The differences in differences estimator between IHCM and UC for aerobic physical activity was 81 and 87 min/week at 3 and 6 months, respectively; for consumption of dairy products, fruit and vegetables the estimator was 4.8, 6.6 and 9.4 servings per week respectively at 3 months, and 3.9, 6.3 and 9.7 servings at 6 months. The effect of IHCM on HR-QoL at 3 months was greater for the domains of vasomotor, somatic symptoms and sleep problems (11.7, 10.0 and 13.2 points, respectively); at 6 months the differences of major positive change were observed in the domains of memory/concentration, vasomotor symptoms and sleep problems (12.2, 10.4 and 10.8 points, respectively). CONCLUSION: The results support the importance of patient-centered health care during the climacteric stage, within integrative care programs with an empowerment approach.

Toward healthy aging through empowering self-care during the climacteric stage.

BACKGROUND: While they progress through the climacteric stage, women often develop physical and psychological health needs, calling for innovative health-care services that can be translated into preventive programs and empowerment towards self-care. OBJECTIVE: To identify the changes in women's discourse regarding their concerns and needs about the climacteric stage and self-care after they had participated in an integrative women-centered health-care model with empowerment for self-care. METHODS: Women's narratives during counseling group sessions were analyzed using qualitative inductive thematic analysis. RESULTS: A total of 121 women between 45 and 59 years of age participated. At the beginning of the counseling group sessions, we identified the following themes: (1) Lack of information about changes during the climacteric stage and self-care; (2) Tradition: the climacteric stage as a taboo subject; (3) Life's changes and transitions: the complexity of the climacteric experience; (4) Stigma of menopause; (5) Relationship between the traditional gender role and the lack of self-care. At the end of the counseling group sessions, the themes were: (1) The climacteric as a natural stage; (2) Expectations for old age; (3) Empowerment and the change of awareness for self-care; (3) De-medicalization of the climacteric; (4) The richness of group work; (5) Empowerment as motivation to convey acquired knowledge. CONCLUSION: Women in the climacteric stage require more information about their physical, psychological and social needs, as well as the potential impact on their health during old age. Empowerment during the climacteric can contribute to improving the perception about this stage as well as the importance of self-care.

[Social implications of physician professional and certification quality]. / Implicaciones sociales de la calidad profesional de los médicos y de la certificación.

The paper analyzes the social implications of the professional quality of physicians and of their process of certification. The adequate competencies of physicians are especially relevant in countries that have broad social asymmetries and cultural plurality. This diversity of social and epidemiologic conditions demands a profile of physicians able to work in a wide range of environments and able to achieve the best professional practice, making the best use of the available resources for medical care. Medical competencies and quality of care are interrelated. The process of coupling universal knowledge and local conditions creates a synchronic diversity of professional practices. Medical certification must be viewed as part of the process of diffusion of innovations. The development of a variety of abilities to cope with innovations contributes to the production of a diachronic diversity of medical practices. In the light of continuing quality improvement, it is necessary that certification systems be articulated with both continuing medical education and the accreditation and progress of healthcare institutions. Otherwise, there is the risk of increasing inequality in medical practice that, in the last analysis, blames the victim.

[Utilization of prenatal care services: influence of perceived morbidity and of social networks of support]. / Utilización de servicios de atención prenatal: influencia de la morbilidad percibida y de las redes sociales de ayuda.

Differences in prenatal help seeking patterns were found in a sample of women of a household survey (9,139) that showed a high prenatal care coverage. The personal factors associated with the help seeking behavior were: the nature and individual perception of the symptoms and the existence of social support networks. Symptoms that make woman suspect of risk, produced a high demand of medical consultation (between 75 and 100%). Bothersome symptoms produced a medium utilization associated with its prevalence. Emotional symptoms produced a low demand of medical consultation (between 18 and 27%). Pregnant women who obtained support from their social networks consulted the doctor 3.3 times as much as those who didn't have a social network. The reinforcement of women's interaction with their natural social network is recommended as one of the basic components of prenatal care.

[Potential coverage and real coverage of ambulatory health care services in the state of Mexico. The case of 3 marginal communities in Atenco and Chalco]. / Cobertura potencial y cobertura real de servicios ambulatorios de salud en el estado de México. El caso de tres comunidades marginadas en Atenco y Chalco.

Less than a third of the non-insured population studied through a sample in the State of Mexico was covered by the Institute of Health of the State of México. This low coverage was observed in spite the fact that health services were available within 2 kilometer radius. 33 per cent of the non-insured preferred to utilize other services within their own community, and 24 per cent of them traveled to bigger localities to receive care. These results suggest that to attain adequate coverage, utilization patterns should be investigated so that health services can meet the needs of the target population.

[A database for research in public health]. / Base de datos para la investigación en salud pública "BISP".

Epidemiological and health system research projects are often delayed due to the difficulties to build validated data basis in personal computers. This papers presents a new computer interactive program for handling numeric data from a given questionnaire to a structured archive. The questionnaire includes the basic variables of the dwelling and of the members of the household. A list of sociodemographic and health variables are selected, although other variables can be easily added, according to special needs. All the intermediate steps regularly needed to construct a data base are included in the package: capture, verification, validation and record linkage. The package is equipped with the basic procedures needed to produce tabulations and basic statistical analysis.

[Health measurement: theoretical and methodologic perspectives]. / La medición de salud: perspectivas teóricas y metodológicas.

The present article consists of a revision of the different ways health has been measured and was ordered according to the historic evolution of the health concept and conditions. The development of health measures has paralleled the changes occurred in the epidemiologic profiles and the many refinements in the conceptualization and interpretation of health. Along the years, the meaning of health has become increasingly wider. Initially, only infectious diseases were considered; later, degenerative processes were included. Nowadays, health is viewed as multifactorial and as a reflection of the life style and conditions. This essay contains a description of the theoretical postulates upon which the different health measures are based, their strategies and some of their limitations. It is divided into five main sections: morbidity, disability, and mortality indicators; measures of the health of the populations; sociomedical indicators, including measures of physical and mental health, as well as of the social component of health, positive health indicators and, finally a revision of measures of health need. It is of the utmost importance to be aware of the perspective used in the different public health research efforts since it has direct repercussions for the planning and evaluation of the health services and, in particular, for the quality of health care.

[Induced abortion in figures: analysis of the dissemination of statistics in the press]. / El aborto inducido en cifras: análisis de la difusión de las estadísticas en la prensa.

The use of secondary sources of information such as the newspaper is necessary in order to do research on the degree of diffusion of public health issues. The problem of abortion in México has been scarcely studied due to several factors mentioned in this paper. Content analysis of articles published in the newspapers is a strategy that allows the study of the role of public opinion on this socio-political and health problem. A research based on content analysis was carried out in 771 newspaper articles on abortion found in seven national newspapers from 1974 to 1982. The results show a great inconsistency in the statistics on the numbers of abortions and the number of maternal deaths due to this cause. On the other hand, the information published on the characteristics of the women that have had an abortion in Mexico was found to be congruent. These elements point to the fact that the health sector has to produce and publish reliable statistics on abortion.