Relación del machismo con la aceptación de la diabetes mellitus tipo 2 en hombres adultos / Machismo relationship with type 2 diabetes mellitus acceptance among adult men / Relação do machismo com a aceitação do diabetes mellitus tipo 2 em homens adultos

RESUMEN Introducción La aceptación de la diabetes mellitus tipo 2 contribuye al apego del tratamiento y al control de la enfermedad. Pero se ha reportado que los hombres tienen menor aceptación al diagnóstico de este padecimiento. En los hombres mexicanos la no aceptación puede estar relacionada con el machismo. Objetivo Identificar la relación del machismo con la aceptación de la diabetes mellitus tipo 2. Metodología Se realizó un estudio transversal y correlacional. La población de interés fue de hombres con diabetes mellitus tipo 2 entre 20 y 59 años de edad registrados en centros de atención primaria del área metropolitana de Monterrey, Nuevo León, México. Se obtuvo una muestra de 121 participantes a través de un muestreo por conveniencia. Los instrumentos utilizados fueron el Inventario de Conformidad de las Normas Masculinas y la Escala Aceptación en DMT2. Para el análisis estadístico se empleó el programa SPSS versión 25; se realizó un modelo de regresión lineal múltiple. Resultados Los resultados señalan que los hombres con percepción de mayor machismo, jornadas laborales extensas y consumo elevado de cigarrillos aceptan menos el diagnóstico y la enfermedad de la diabetes mellitus tipo 2. Para las subdimensiones del machismo, la homofobia fue el mejor predictor de la aceptación o no de la diabetes mellitus tipo 2. Conclusiones El profesional de salud debe desarrollar programas para la aceptación de la diabetes mellitus tipo 2 en hombres de reciente diagnóstico que contribuyan a aceptar su enfermedad, y así, permitan mejorar el autocuidado, control glucémico y prevención de complicaciones.

ABSTRACT Introduction Accepting a diagnosis of type 2 diabetes mellitus contributes to the adher- ence to the treatment and control of the illness; however, it has been reported that men tend to have a lower acceptance of this diagnosis. Among Mexican men, in particular, this low acceptance could be related to their machismo. Objective To identify the relationship of machismo with the acceptance of a type 2 diabetes mellitus diagnosis. Methodology This is a transversal and correlational study. The population of interest were Mexican men diagnosed with type 2 diabetes mellitus between 20 and 59 years registered in centers of primary attention in the city of Monterrey, Mexico. The sample was constituted of 121 participants chosen by convenience. The instruments used were the Conformity to Masculine Norms Inventory and the Acceptance Scale for DM2. The statistical analysis and the multiple linear regression model were carried out using SPSS v25. Results Findings suggest that men who show machismo, who have long labor shifts, and who consume large quantities of cigarettes tend not to accept a diagnosis of type 2 diabetes mellitus. Regarding the subdimensions of the machismo construct, homophobia was the best predictor of accepting or not a diagnosis of type 2 diabetes mellitus. Conclusions Healthcare professionals should develop programs aimed at improving the acceptance attitude of a type 2 diabetes mellitus diagnosis among men, including those with machismo, in order to better manage self-care, glucose control, and also prevent complications.

RESUMO Introdução A aceitação do diabetes mellitus tipo 2 contribui para a adesão ao tratamento e controle da doença. Mas, tem sido relatado que os homens têm menos aceitação do diagnóstico desta doença. Nos homens mexicanos, a não aceitação pode estar relacionada ao machismo. Objetivo Identificar a relação do machismo com a aceitação do diabetes mellitus tipo 2. Metodologia Foi realizado um estudo transversal e correlacional. A população de interesse foram homens com diabetes mellitus tipo 2 entre 20 e 59 anos registrados em centros de atenção primária na área metropolitana de Monterrey, Nuevo León, México. Foi obtida uma amostra de 121 participantes por amostragem de conveniência. Os instrumentos utilizados foram o Inventário de Conformidade com Normas Masculinas e a Escala de Aceitação DMT2. Para a análise estatística utilizou-se o programa SPSS versão 25; um modelo de regressão linear múltipla foi realizado. Resultados Os resultados indicam que homens com percepção de maior machismo, longas jornadas de trabalho e alto consumo de cigarro aceitam menos o diagnóstico e a doença de diabetes mellitus tipo 2. Para as subdimensões do machismo, a homofobia foi o melhor preditor de aceitação ou não de diabetes melito tipo 2. Conclusões O profissional de saúde deve desenvolver programas de aceitação da diabetes mellitus tipo 2 em homens recém-diagnosticados que contribuam para a aceitação da sua doença e, assim, permitam melhorar o autocuidado, o controlo glicémico e a prevenção de complicações.

[Notes on some reproductive self-determination possibilities in Latin America]. / Apuntes sobre algunas posibilidades de autodeterminacion reproductiva en America Latina.

PIP: Some current directions of action and research concerning women's reproductive rights in Latin America are examined, with particular emphasis on the institutional context created by the Catholic Church, which has exhibited little flexibility in regard to the processes of reproductive self-determination. In the past 15 years, the concepts of health and reproductive rights have transformed representations and social practices related to reproduction. The work begins by analyzing several terms that preceded health and reproductive rights, attempting to demonstrate how they have helped perpetuate the subordination of women. The terms birth control, family planning, responsible parenthood, and maternal and child health have reflected contemporary social practices, playing a role in establishing reproductive norms and standards of care. The questioning by women's groups of the activities of family planning organizations is examined in this light. The doctrines of the Catholic Church pertaining to reproductive self-determination, and some progressive alternatives to official doctrine from within or outside the Church, are next analyzed. The work of groups of Catholics in Brazil and elsewhere who are struggling to reconcile Church teachings with alternative visions of autonomy and human rights in the reproductive sphere are described. Current research is described on attitudes of Catholic women in different contexts who question the relevance of Church teachings on reproduction, contraception, and abortion to their problems of daily life.^ieng

[Approaching the area of reproductive rights through a focus on conflicts]. / Una aproximacion al entorno de los derechos reproductivos por medio de un enfoque de conflictos.

PIP: This work identifies human rights conflicts that may result from the confrontation of the reproductive patterns of a population with family planning policies. It seeks to identify the parties involved in specific conflicts in order to document them and propose resources for their management. The fertility decline that began in Mexico in the 1970s and the significance of family planning policy as a means of facilitating the preexisting desire of couples to control fertility are examined. Possible sources of conflict are then explored in the relations between the population and health care providers. Class differences between service providers and clients, possible failure of providers to provide full information on reproductive and contraceptive options to their clients, imposition of one-sided decision making and power relations, and gender discrimination should all be examined from this perspective. Failure to allow a sufficient delay between birth of the last child and sterilization is a concrete example in which questions may be asked concerning safeguarding of the reproductive rights of individuals. The relationship of service providers to population and health policy is a potential source of conflict if, as has occurred in Mexico, the goals for fertility reduction are not met and the decision is made to redouble institutional efforts rather than modify the goal. A first step in confronting possible conflicts is to demonstrate systematically that inequalities exist in access to rights. Conflicts should be documented and interpreted in terms of underlying power relations. The concepts of reproduction, human rights, and family planning should be analyzed for their exact semiotic significance to indicate possible sources of conflict at the level of conceptualization. An awareness of reproductive rights and a willingness to defend them should be promoted in the population.^ieng

[The reproductive characteristics of adolescents and young adults in Mexico City]. / Características reproductivas de adolescentes y jóvenes en la Ciudad de México.

This article presents the preliminary findings of the Survey on Teenagers and Youth Reproductive Behavior in the Metropolitan Area of Mexico City, which contains information on 1,010 teenagers and young adults from 10 to 25 years of age interviewed in 1987. The average age was 17 years; 51.7 per cent of those interviewed were male and 48.3 per cent were female. A total of 14.6 per cent were married, being the average age at marriage 19.2 years for males and 17.8 years for females. Menarche occurred at an average age of 12.4 years, and spermarche at 14. Of those interviewed, 32.7 per cent have had sexual intercourse at least once in their lives. The average age at which sexual activity had begun, in the case of males, was 16 years and for females, 17 years. Of this group, 33.8 per cent stated that they had used some form of contraception during the first sexual intercourse; the contraceptive methods used most often were rhythm and withdrawal. The main source of supply of other methods is the pharmacy, in 67 per cent. 18.4 per cent of women had been pregnant, and 20.4 per cent of men's partners had presented this same condition. The first pregnancy occurred at 17.8 years for women and 18.7 for men. Of those men and women with a pregnancy experience 66.1 per cent and 57.3 per cent, respectively, stated that their first pregnancy was an unplanned one. Also, first pregnancy was related to their first marriage in 48.1 per cent of women and 82.4 per cent of male. The data presented here will reinforce current knowledge and will enable us to obtain a profile of the reproductive behavior of teenagers and young adults in the metropolitan area of Mexico City.

[Contraceptive practices among adolescents and youths of the metropolitan area of Mexico City]. / Práctica anticonceptiva en adolescentes y jóvenes del área metropolitana de la Ciudad de México.

The purpose of this article is to provide a brief description of the information that the adolescent and youth population of Mexico City has concerning the knowledge and use of contraceptive methods, as well as the reasons why they do not adopt some contraceptive method during their sexual relations. The data obtained from the Survey on Adolescent and Youth Reproductive Behavior in the Metropolitan Area of Mexico City serves as a basis for pointing out several behavior patterns of the male and female population from 10 to 25 years of age. Of those interviewed, 32.7 per cent had had at least one sexual contact; the average age at which sexual relations had begun was 16 years for males and 17 for females. A total of 33.8 per cent of those who had had sexual contact stated that they had used some form of contraception, the principal methods used during first sexual intercourse being rhythm (36.9%); withdrawal (23.6%), and condoms (12.3%). The reasons for not using any contraceptive method were as follows: lack of knowledge regarding the methods, how to use them or where to obtain them (39.4%), and unplanned sexual intercourse (28.9%). During the last sexual contact they had, 70.5 per cent had used a contraceptive. The methods most frequently used were hormonal contraceptives and IUD (40.9%); rhythm (23.8%), and withdrawal and condoms. The reasons why no contraceptive was used in the last sexual contact were: neither partner thought that pregnancy would occur (27.1%) and the sexual contact was unplanned.

[Reproductive behavior and health: reflections on the supply of services]. / Comportamiento reproductivo y salud: reflexiones a partir de la prestación de servicios.

The aim of this article is to put forward a series of reflections on the role that service providers have played in defining the interactions between reproductive behavior and health. In the first section some approximations are presented of what could constitute a framework for analyzing the topic under study, including demographic aspects and the ones involving the provision of services as well as the aspects related to the epistemology of health and a commentary on the importance of norms in the provision of services. In the second section a couple of recent experiences related to the provision of services in a context of "having an impact on reproduction for the purpose of improving health" discussed. The source of information used were two national surveys (Encuesta Nacional sobre Factores de Riesgo en la Anticoncepción Hormonal, or National Survey on Risk Factors in Hormonal Contraception, and Encuesta Nacional sobre Fecundidad y Salud, or National Fertility and Health Survey) made in 1984 and 1987 with women of childbearing age and health service providers (the first of the two surveys mentioned). Based on the experience stated by the female users of the contraceptive methods most frequently used by Mexicans, and on the responses of service providers, an evaluation is made of the medical norms of the institutions belonging to the Mexican health sector, and some hypotheses are suggested on the possible reasons why there are deficiencies in the observance of these norms. Lastly, some lines to prompt a discussion along this subject are proposed.

[Discontinuation of contraception]. / El abandono de la anticoncepcion.

PIP: Institutional studies and demographic surveys have demonstrated that side effects or fear of side effects are by far the most important factor in discontinuation of usage of modern contraceptives. The most recent information in Mexico, from the 1987 National Survey of Fertility and Health, indicates that 15-24% of women who accepted IUDs, oral contraceptives (OCs), and injectable contraceptives reported discontinuing usage during the 1st year because of real or feared side effects. Discontinuance because of side effects is much less frequent with traditional methods, but such methods have much higher failure rates than do the modern methods. The reasons given for discontinuing use given by women in surveys correspond to their perceptions. Side effects thus include fears of possible future effects and effects attributed by users to the methods but which are not actually related, as well as real effects of varying severity and importance. In a recent survey, 2/3 of women who experienced contraceptive side effects were not aware of the possibility that they would arise at the time they began use of the method. This finding indicates that information services are lacking for the temporary methods promoted by institutional family planning programs. In case of female sterilization the couple is not able to terminate method use. It would be expected that a careful and fully informed decision process would precede acceptance of sterilization. But 1 out of 10 sterilized women interviewed for the survey stated they would not undergo sterilization again if they were able to choose. The women most likely to state they would not repeat sterilization were the ones who received the least information prior to operation, experienced a deficient acceptance process, received the least medical follow-up, and waited the shortest time between the sterilization decision and the actual operation. Such problems are more common among less educated and rural women. A basic condition for assuring that childbearing decisions are free and responsible is access to complete and accurate information. The reports of these women indicate that this condition is not being met.^ieng

[Sociodemographic research on family planning: the case of the Health Department]. / Investigación sociodemográfica sobre planificación familiar: el caso de la Secretaría de Salud.

The Head Office for Family Planning of the Mexican Ministry of Health implemented a program of sociodemographic research for the purpose of studying family planning. On the basis of the sociodemographic profile drawn up in 1983--the year in which said research program was initiated--research needs were gradually identified and then met by means of surveys and monographs for individual states in Mexico. This paper comments on the main features of the research projects that have been carried out. We order to show the data bank which the Head Office for Family Planning has at the present time for studying the phenomenon all of its activities are centered around.

[The dynamics of contraceptive use in Mexico]. / Dinamica del uso de metodos anticonceptivos en Mexico.

PIP: The authors identify some variables associated with the adoption and continuation of contraception in Mexico. The focus is on determinants of choice of different methods, as well as the impact of selected socioeconomic and demographic factors and the influence of institutions providing family planning services on choice of method.^ieng