Uso de material sexual en línea y sexo seguro en hombres que tienen sexo con hombres / Use of online sexual material and safe sex in men who have sex with men

Introducción: El material sexual en línea ha representado, desde sus orígenes, un papel relevante en la vida de hombres que tienen sexo con hombres. Internet, convertido en un vehículo sin restricción para su acceso, ha favorecido un incremento en el uso de este material, y ha repercutido en la conducta sexual de estos hombres. Objetivo: Determinar si el uso de material sexual en línea influye en la conducta sexual segura en hombres que tienen sexo con hombres. Material y método: Se realizó un estudio observacional analítico, con una muestra de 251 hombres que tienen sexo con hombres de una ciudad en el noreste de México. Se usó el muestreo dirigido por entrevistados, se aplicó un cuestionario ad hoc de datos sociodemográficos y de sexualidad, un cuestionario para medir el uso de material sexual en línea y un cuestionario de conducta sexual segura. Resultados: El modelo de regresión lineal simple muestra que el uso de material sexual en línea influye negativamente en la conducta sexual segura (R2 = 0,062; F[1,249] = 16,937; p < 0,01). Conclusiones: Los hallazgos proporcionan la pauta para continuar con estudios en la indagación de dicha variable sociocultural, y se propone su consideración en los programas enfocados a la prevención del VIH en esta población

Introduction: Sexual material online has represented, from its origins, an important role in the life of men who have sex with men. Internet, which has become a vehicle without restriction for its access, has favored an increase in the use of this material, and has had an impact on the sexual behavior of these men. Objective: To determine if the use of online sexual material influences safe sexual behavior in men who have sex with men. Material and method: An analytical observational study was conducted, with a sample of 251 men who have sex with men from a city in northeastern Mexico. The respondent driven sampling was used, an ad hoc sociodemographic and sexuality data questionnaire was applied, and a questionnaire to measure the use of online sexual material and questionnaire on safe sexual behavior. Results. The simple linear regression model shows that the use of online sexual material negatively influences safe sexual behavior (R2 = 0.062; F[1,249] = 16.937; p < 0.01). Conclusions: The findings provide the guideline to continue with studies in the investigation of said sociocultural variable and its consideration is proposed in the programs focused on the prevention of HIV in this population

Factores interpersonales como predictores de la autoestima sexual en mujeres del noreste de México / Interpersonal factors as predictors of sexual self-esteem in women in Northeast Mexico

Objetivo: La autoestima sexual ha generado resultados que dejan en claro su impacto en la salud sexual, la cual se forja de las interacciones con otras personas. Por tal motivo, el objetivo de este estudio es evaluar si las variables tiempo con la pareja, número de parejas sexuales, apoyo de la pareja, asertividad sexual y violencia de pareja predicen la autoestima sexual en mujeres del noreste de México. Material y método: Estudio correlacional, predictivo y transversal. La muestra estuvo formada por 605 mujeres usuarias de centros de salud de atención primaria. Como criterios de inclusión se tuvo en cuenta que las participantes tuviesen una edad entre 18 y 40 años (M = 27,68; DT = 6,52), que mantuviesen una relación de pareja de al menos 3 meses y con actividad sexual dentro de esa relación. Resultados: El apoyo de pareja, la violencia de pareja y la asertividad sexual se comportaron como factores predictivos, explicando un 32% de la autoestima sexual en mujeres (F = 52,410, p < 0,001). Conclusiones: Los factores interpersonales son elementos clave en la comprensión y evaluación de la autoestima sexual en las mujeres. Estos hallazgos apoyarán al mejoramiento de la salud sexual de esta población, quien es un grupo vulnerable ante problemas de índole sexual en México

Objective: Sexual self-esteem has generated results that make clear their impact on sexual health, which is forged by interactions with other people. For this reason, the goal of this study is to evaluate if the variables time spent with the partner, number of sexual partners, support of the couple, sexual assertiveness and partner violence predict sexual self-esteem in women in Northeast Mexico. Material and method: Predictive and correlational study. The sample consisted of 605 women users of primary health care centers. As inclusion criteria, it was considered that participants were between 18 and 40 years of age (M = 27.68; TD = 6.52), who maintained a relationship of at least three months and with sexual activity within that relationship. Results: Couple support, partner violence and sexual assertiveness behaved as predictive factors, accounting for 32% of sexual self-esteem in women (F = 52.410, p < 0.001). Conclusions: Interpersonal factors are key elements in the understanding and evaluation of sexual self-esteem in women. These findings will support the improvement of the sexual health of this population, who are a vulnerable group to sexual problems in Mexico

[Interpersonal factors as predictors of sexual self-esteem in women in Northeast Mexico]. / Factores interpersonales como predictores de la autoestima sexual en mujeres del noreste de México.

OBJECTIVE: Sexual self-esteem has generated results that make clear their impact on sexual health, which is forged by interactions with other people. For this reason, the goal of this study is to evaluate if the variables time spent with the partner, number of sexual partners, support of the couple, sexual assertiveness and partner violence predict sexual self-esteem in women in Northeast Mexico. MATERIAL AND METHOD: Predictive and correlational study. The sample consisted of 605 women users of primary health care centers. As inclusion criteria, it was considered that participants were between 18 and 40 years of age (M=27.68; TD=6.52), who maintained a relationship of at least three months and with sexual activity within that relationship. RESULTS: Couple support, partner violence and sexual assertiveness behaved as predictive factors, accounting for 32% of sexual self-esteem in women (F=52.410, p<0.001). CONCLUSIONS: Interpersonal factors are key elements in the understanding and evaluation of sexual self-esteem in women. These findings will support the improvement of the sexual health of this population, who are a vulnerable group to sexual problems in Mexico.

[Use of online sexual material and safe sex in men who have sex with men]. / Uso de material sexual en línea y sexo seguro en hombres que tienen sexo con hombres.

INTRODUCTION: Sexual material online has represented, from its origins, an important role in the life of men who have sex with men. Internet, which has become a vehicle without restriction for its access, has favored an increase in the use of this material, and has had an impact on the sexual behavior of these men. OBJECTIVE: To determine if the use of online sexual material influences safe sexual behavior in men who have sex with men. MATERIAL AND METHOD: An analytical observational study was conducted, with a sample of 251 men who have sex with men from a city in northeastern Mexico. The respondent driven sampling was used, an ad hoc sociodemographic and sexuality data questionnaire was applied, and a questionnaire to measure the use of online sexual material and questionnaire on safe sexual behavior. RESULTS: The simple linear regression model shows that the use of online sexual material negatively influences safe sexual behavior (R2=0.062; F[1,249]=16.937; p<0.01). CONCLUSIONS: The findings provide the guideline to continue with studies in the investigation of said sociocultural variable and its consideration is proposed in the programs focused on the prevention of HIV in this population.

Riesgo percibido y balance decisional hacia la prueba del VIH en hombres que tienen sexo con hombres de Monterrey, México / Perceived risk and decisional balance to HIV testing in men who have sex with men from Monterrey, Mexico

El riesgo percibido hacia el VIH y el balance decisional (pros y contras) hacia la prueba del VIH son aspectos fundamentales para la comprensión de la motivación de los hombres que tienen sexo con hombres para involucrarse en conductas que reduzcan o aumenten el riesgo de infección ante el virus. Objetivos: Describir el riesgo percibido hacia el VIH y el balance decisional hacia la prueba del VIH y determinar la asociación entre el riesgo percibido y el balance decisional hacia la prueba del VIH en hombres que tienen sexo con hombres. Método: Diseño descriptivo correlacional, se utilizó un muestreo dirigido por entrevistados con el cual se reclutaron 202 hombres que tienen sexo con hombres. Resultados: Edad media de 27,79 (DE=8,13), el 66,3% reportó baja percepción de riesgo hacia el VIH. Los pros más significativos fueron: «si tuviera el VIH no quisiera infectar a nadie más» (95%) y «quisiera estar seguro de no tener el VIH para decírselo a mi pareja sexual» (90,6%). Lo contras más significativos fueron: «tengo miedo a la aguja utilizada para la prueba de detección del VIH» (53%), «la gente me podría rechazar si tuviera el VIH» (78,7%). Finalmente, se identificó correlación entre el riesgo percibido y el balance decisional hacia la prueba del VIH (rs=0,759, p<0,001). Conclusiones: Ante tales datos, es importante considerar en futuras intervenciones, información sobre la importancia de la prueba del VIH de forma periódica, así como acciones para aumentar la percepción de vulnerabilidad hacia el VIH en esta población

The perceived risk to HIV and the decisional balance (pros and cons) towards HIV testing are fundamental aspects for understanding the motivation of men who have sex with men to engage in behaviours that reduce or increase the risk of infection with the virus. Objectives: To describe the perceived risk of HIV and the decisional balance towards HIV testing and determine the association between perceived risk and the decisional balance towards HIV testing of men who have sex with men. Method: Descriptive correlational design, we used respondent-driven sampling, with which we recruited 202 men who have sex with men. Results: Mean age of 27.79 (SD=8.13), 66.3% reported low perceived risk to HIV. The most significant pros were: "If I had HIV I would not want to infect anyone else" (95%) and "I would like to be sure I did not have HIV to tell my sexual partner" (90.6%). The most significant cons were: "I am afraid of the needle used for the HIV test" (53%), "people could reject me if they had HIV" (78.7%). Finally, there was a correlation between the perceived risk and the decisional balance towards HIV testing (rs=.759, p<.001). Conclusions: Given such data, in future interventions it is important to consider information about the importance of HIV testing on a regular basis, as well as actions to increase the perception of vulnerability to HIV in this population

Perceived risk and decisional balance to HIV testing in men who have sex with men from Monterrey, Mexico. / Riesgo percibido y balance decisional hacia la prueba del VIH en hombres que tienen sexo con hombres de Monterrey, México.

The perceived risk to HIV and the decisional balance (pros and cons) towards HIV testing are fundamental aspects for understanding the motivation of men who have sex with men to engage in behaviours that reduce or increase the risk of infection with the virus. OBJECTIVES: To describe the perceived risk of HIV and the decisional balance towards HIV testing and determine the association between perceived risk and the decisional balance towards HIV testing of men who have sex with men. METHOD: Descriptive correlational design, we used respondent-driven sampling, with which we recruited 202 men who have sex with men. RESULTS: Mean age of 27.79 (SD=8.13), 66.3% reported low perceived risk to HIV. The most significant pros were: "If I had HIV I would not want to infect anyone else" (95%) and "I would like to be sure I did not have HIV to tell my sexual partner" (90.6%). The most significant cons were: "I am afraid of the needle used for the HIV test" (53%), "people could reject me if they had HIV" (78.7%). Finally, there was a correlation between the perceived risk and the decisional balance towards HIV testing (rs=.759, p<.001). CONCLUSIONS: Given such data, in future interventions it is important to consider information about the importance of HIV testing on a regular basis, as well as actions to increase the perception of vulnerability to HIV in this population.

Validación de la Sexual Assertiveness Scale en mujeres mexicanas / Validation of the Sexual Assertiveness Scale in Mexican Women

RESUMEN La asertividad sexual constituye una dimensión fundamental de la sexualidad humana por su relación con distintos indicadores de la salud sexual. Es la capacidad de las personas para iniciar la actividad sexual, rechazar la actividad sexual no deseada y emplear métodos anticonceptivos y así desarrollar comportamientos saludables. Esta se mide a través de la Sexual Assertiveness Scale (SAS). Hasta la fecha, la SAS no se ha validado en población mexicana, por lo que se considera importante examinar sus propiedades psicométricas en esta población. Por lo tanto, este estudio tuvo como objetivo validar la SAS en una muestra de 202 mujeres mexicanas. Mediante un análisis factorial confirmatorio, se confirmó la estructura trifactorial del SAS: inicio, rechazo y embarazo-enfermedades de transmisión sexual (CFI = .953; TLI = .927). Asimismo, se obtuvo una confiabilidad adecuada en las tres subescalas y, de forma global (<±> = .85), sus puntuaciones correlacionaron significativamente en la dirección esperada con autoestima sexual y depresión rasgo. Se concluye que la SAS presenta buenas propiedades psicométricas en población femenina mexicana.

ABSTRACT Given its relationship to various indicators of sexual health, sexual assertiveness is a fundamental dimension of human sexuality. This is defined as the ability that people have to initiate sexual activity, refuse unwanted sexual activity, and use contraceptive methods, thereby developing healthy behaviours - which can be measured using the Sexual Assertiveness Scale (SAS). To date, the SAS has not been validated in the Mexican population, albeit it is considered important to examine the psychometric properties of the latter. Therefore, to the aim of this study was to validate the SAS in a sample of 202 Mexican women. Confirmatory factor analysis confirmed the three-factor structure of the SAS: initiation, rejection, and pregnancy-sexually transmitted diseases (CFI = .953; TLI = .927). Similarly, adequate reliability was obtained in the three subscales and overall (<±> = .85). Their scores significantly correlated in the expected direction with sexual self-esteem and the trait depression. It is concluded that the SAS has psychometric properties which are acceptable in Mexican women.

Autocuidado en el adulto mayor con diabetes tipo 2. Monterrey, México / Self-care in older adults with type 2 diabetes. Monterrey, México

Determinar diferencias de autocuidado por edad y sexo en adultos mayores con diabetes tipo 2, que acuden a la consulta de medicina familiar. Material y métodos: estudio descriptivo de corte trasversal. La muestra estuvo constituida por 109 adultos mayores (63 Mujeres y 46 Hombres). Se aplicó el Resumen de Actividades de Autocuidado en Diabetes, se utilizó estadística descriptiva (frecuencias simples y relativas, medidas de dispersión e IC95%), U de Mann-Whitney y diferencia de proporciones. Resultados: el promedio de tiempo de diagnóstico con la DT2 fue de 12,24 (+/-9.9) años, el 31,2% (34) comentaron tener alguna complicación propia de la DT2, la másn común fue la retinopatía con un 22,9% (25). El 33,0% (36) de los adultos mayores tuvieron prácticas de autocuidado, las prácticas de cuidado que realizan con mayor frecuencia fueron cuidado de pies y consumo de medicamentos. El 28,6% (18) de las mujeres presentaron prácticas de autocuidado, esta cifra se reportó un poco mayor en los hombres 39,1% (18) (p > 0,05). Los adultos mayores de 60 a 69 años presentaron mayor prácticas de autocuidado que los mayores de 70 años (34,9% vs 30,4%; p > 0,05). Conclusiones: las prácticas de autocuidado en esta población fueron pobres a pesar de que tienen una patología, según las actividades se concluyó, que le dan mayor importancia al consumo de medicamentos y cuidado de los pies. Los hombres y los adultos mayores de menor edad son los que reportaron realizar mayor actividades de autocuidado...

To determine self-care differences by age and gender in older adults with type 2 diabetes, attending in a family health clinic. Material and Methods: The sample was 109 older adults (63 women and 46 men). The self-care was evaluated with the Summary of Diabetes Self-Care Activities. The data analysis was used descriptive statistics (frequencies, measures of dispersion and 95%CI), Mann-Whitney and difference of proportions. Results: The mean of diagnosis time was 12.24 (+/- 9.9) years, 31.2% (34) said to have some complication by the pathology, the most common of this was retinopathy on 22.9% (25), 33.0% (36) of older did self-care practices, the care that were performed more frequently were care of foot and drugs; The women had self-care practices, this data was reported slightly higher in men (28.6% vs 39.1%; p> 0.05). Adults of 60-69 years had higher self-care practices to those over 70 years (4.9 % vs 30.4 %; p> 0.05). Conclusions: Self-care practices in this population are poor despite they have a disease, according to activities with higher frequencies we concludes that older give most importance to the consumption of drugs, and foot care. Men and younger older adults are reporting higher performing self-care activities...

A physical-cognitive intervention to enhance gait speed in older Mexican adults.

PURPOSE: To test the effects of a physical-cognitive exercise intervention on gait parameters under dual-task conditions in community-dwelling older adults. DESIGN: A repeated-measures quasi-experimental design, with control and exercise groups, was used. SETTING: Study participants consist of a convenience sample recruited from senior citizens' centers in Monterrey, Mexico. SUBJECTS: A total of 143 sedentary participants ages 65 to 92 years per group participated. INTERVENTION: A combined 45- to 60-minute program of physical and cognitive exercises was conducted in three weekly sessions during 12 weeks for the exercise group. Measures . The spatial gait parameters of speed (cm/s), step width, and stride length (cm); and the temporal parameters of single and double support time, cadence (steps per minute), and swing time(s) were measured using the GaitRite. Counting backwards or naming animals represented cognitive performance. ANALYSIS: Two (groups: exercise group vs. control group) by three (time: baseline, week 6, and week 12) repeated-measures multivariate analysis of variance (MANOVA) was applied. RESULTS: Repeated-measures multivariate analysis of variance revealed a significant group effect (Wilks lambda F4,279 = 6.78, p < .001); univariate analysis showed significant differences for gait speed (m/s), stride length, cadence, step width, and double support time. Time-by-group interaction showed significance in gait speed and stride length. CONCLUSION: The exercise group participants showed increased gait speed, cadence, and stride length, and reduced their step width and time spent with both feet on the ground. Walking while simultaneously performing a cognitive task might prepare older adults for competing/interfering demands from their environments. The protective health benefits of this intervention remain to be investigated.

Intensidad y manejo del dolor posoperatorio en pacientes hospitalizados / Intensity and management of postoperative pain in hospitalized patients

Introducción: Identificar la intensidad y manejo del dolor posoperatorio; además de explorar diferencias en la intensidad del dolor de acuerdo al sexo y su asociación con edad y escolaridad del paciente, así como según el entrenamiento para el manejo del dolor por personal de enfermería y pacientes asignados por turno en una muestra de 151 adultos hospitalizados en una institución de seguridad social de Nuevo León, México. Materiales y Métodos: Diseño descriptivo, incluyó encuesta por muestreo sistemático. Resultados: Se encontró que el 90.1% de los participantes presentó dolor posoperatorio, 57.6% manifestó intensidad de dolor severo en las primeras 24 horas y 28.5% recibió un manejo de dolor inadecuado. Únicamente se encontró diferencia significativa en la intensidad del dolor de acuerdo al sexo (U = 1799, p = .006) con predominio en las mujeres. Discusión y Conclusiones: Es urgente implementar protocolos para el manejo del dolor posoperatorio, que incluyan la participación del equipo multidisciplinario y consideren el tratamiento farmacológico con potencia adecuada de acuerdo a la demanda del paciente y la valoración del dolor de manera regular, principales áreas de oportunidad identificadas en el presente estudio.

Introduction: To determine the intensity and management of postoperative pain. We explored the differences according to age, sex and education of patients and in relation to the nursing staff’s training in pain management and the patients assigned per shift. Materials and Methods: The descriptive design included a survey by systematic sampling, using a sample of 151 adults hospitalized in a Nuevo Leon, México, social security institution. Results: We found that 90.1% of the participants presented postoperative pain, 57.6% expressed severe pain intensity in the first 24 hours and 28.5% received inappropriate pain management. Only one significant difference in the pain intensity was found according to sex (U = 1799, p = .006), predominantly in women. Discussion and Conclusions: We concluded it is urgent to implement postoperative pain management protocols that involve the participation of a multidisciplinary team, and consider pharmacological treatment with appropriate power according to patient demand and pain assessment regularly, identified key areas of opportunity in the present study.

[Infant day care centers, a space for nutritional surveillance]. / Guarderías infantiles, un espacio para la vigilancia alimentaria y nutricional.

BACKGROUND: The goal of a nutrition and food surveillance system is to examine the nutritional effect of food policies and nutritional programs and predict future trends. PURPOSE: To assess nutritional status of infants after implementing a nutritional and food surveillance system (SISVAN) in day care centers. MATERIAL AND METHODS: Study population consisted of 988 children between 45 days and 60 months of age registered in the SISVAN from april 2006 to May 2007; users of 18 day care centers located in 11 counties of the state of Nuevo Leon. Analysis consisted of descriptive statistics and paired t tests for comparison of Z Score (ZS) means of nutritional indicators such as weight for height (W/H), height for age (H/A) and weight for age (W/A), between 2006 and 2007. Malnutrition prevalence rates were also estimated for both years. RESULTS: Fifty-two percent of infants were male. In 2006, W/I H ZS mean was -0.32 +/- 0.99 and in 2007, 0.01 +/- 0.83 (p < 0.05); H/A was -0.05 +/- 0.98 and 0.46 +/- 0.89 in 2006 and 2007, respectively (p < 0.05); and W/A was -0.37 +/- 0.94 and 0.17 +/- 0.91, respectively (p < 0.05). In 2006, undernourishment prevalence varied from 14.5 to 17.8% depending of the anthropometric indicator; and in 2007, from 10.0 to 11.6%. In 2006, overweight and obesity prevalence was between 8.8 and 14.3%, also depending of the anthropometric indicator, while in 2007 between 9.7 and 10.7%. CONCLUSIONS: The present study showed a positive result in malnutrition rates after one year of SISVAN implementation in children in day care centers.

[Effects of incorporating group visits on the metabolic control of type 2 diabetic patients]. / Diabetes y consulta médica grupal en atención primaria. ¿Vale la pena el cambio?

BACKGROUND: A better metabolic control is an important objective of health care in diabetes mellitus. This objective has been achieved elsewhere, incorporating group visits to the usual care of diabetic patients. AIM: To evaluate the effects of a primary care group visit model after 9 and 15 months of implementation, on the metabolic control of diabetic patients. MATERIAL AND METHODS: Two cohorts of type 2 diabetic patients, matched by sex, age and fasting plasma glucose (FPG) were studied. Group visits (monthly medical consultation and one hour sessions with group interaction on the same day) were implemented in 600 patients and routine visits (monthly one-to-one medical consultation) were implemented in 601 patients. The evolution on FPG, cholesterol, systolic (SBP) and diastolic blood pressure (DBF) and body mass index (BMI) were compared. RESULTS: At 15 months of follow up, mean FPG was lower in patients with group visits compared to those in usual individual care (155.3 +/- 59.5 and 175.7 +/- 67.7 mg/dL respectively, p <0.01). SBP and DBF were also lower in patients on group visits (123.6 +/- 13.4 and 127.5 +/-12.8 mmHg, respectively for systolic pressure, p <0.01 and 73.5 +/-8.5 and 79.4 +/-6.3 mmHg, respectively for diastolic pressure, p <0.01). No differences between groups were observed for blood cholesterol or BMI. CONCLUSIONS: Incorporation of group visits in type 2 diabetic patients improved metabolic control and blood pressure, compared to the usual individual care model.

Diabetes y consulta médica grupal en atención primaria: ¿Vale la pena el cambio? / Effects of incorporating group visits on the metabolic control of type 2 diabetic patients

Background: A better metabolic control is an important objective of health care in diabetes mellitus. This objective has been achieved elsewhere, incorporating group visits to the usual care of diabetic patients. Aim: To evaluate the effects of a primary care group visit model after 9 and 15 months of implementation, on the metabolic control of diabetic patients. Material and methods: Two cohorts of type 2 diabetic patients, matched by sex, age and fasting plasma glucose (FPG) were studied. Group visits (monthly medical consultation and one hour sessions with group interaction on the same day) were implemented in 600 patients and routine visits (monthly one-to-one medical consultation) were implemented in 601 patients. The evolution on FPG, cholesterol, systolic (SBP) and diastolic blood pressure (DBF) and body mass index (BMI) were compared. Results: At 15 months of follow up, mean FPG was lower in patients with group visits compared to those in usual individual care (155.3 ± 59.5 and 175.7 ± 67.7 mg/dL respectively, p <0.01). SBP and DBF were also lower in patients on group visits (123.6 ± 13.4 and 127.5 ±12.8 mmHg, respectively for systolic pressure, p <0.01 and 73.5 ±8.5 and 79.4 ±6.3 mmHg, respectively for diastolic pressure, p <0.01). No differences between groups were observed for blood cholesterol or BMI. Conclusions: Incorporation of group visits in type 2 diabetic patients improved metabolic control and blood pressure, compared to the usual individual care model.

Eficiencia técnica de la atención al paciente con diabetes en el primer nivel / Technical efficiency in primary care for patients with diabetes

OBJETIVO: Cuantificar en un primer nivel la eficiencia técnica de la atención al paciente con diabetes y distinguir la provisión de servicios y los resultados en salud, además de reconocer las fuentes potenciales de variación. MATERIAL Y MÉTODOS: Se incluyeron insumos, actividades clínicas y resultados en salud de 47 clínicas familiares del IMSS Nuevo León. La medida de la eficiencia se realizó mediante el análisis envolvente de datos y se aplicaron modelos de regresión de Tobit. RESULTADOS: Siete clínicas fueron eficientes en cuanto a la provisión de servicios y nueve en salud; dos coincidieron en ambos aspectos. La localización metropolitana y el total de consultas favorecieron la eficiencia en relación con la provisión de servicios, cualesquiera que fueran los atributos del paciente; y la edad del médico, la eficiencia de los resultados en salud. CONCLUSIONES: El desempeño varió en una misma unidad y entre una y otra; algunas fueron eficientes para suministrar servicios y otras para mejorar la salud. Las fuentes de variación también difirieron. Se recomienda incluir ambos productos en el estudio de la eficiencia en diabetes en el primer nivel.

OBJECTIVE: To quantify the technical efficiency of diabetes care in family practice settings, characterize the provision of services and health results, and recognize potential sources of variation. MATERIAL AND METHODS: We used data envelopment analysis with inputs and outputs for diabetes care from 47 family units within a social security agency in Nuevo Leon. Tobit regression models were also used. RESULTS: Seven units were technically efficient in providing services and nine in achieving health goals. Only two achieved both outcomes. The metropolitan location and the total number of consultations favored efficiency in the provision of services regardless of patient attributes; and the age of the doctor, the efficiency of health results. CONCLUSIONS: Performance varied within and among family units; some were efficient at providing services while others at accomplishing health goals. Sources of variation also differed. It is necessary to include both outputs in the study of efficiency of diabetes care in family practice settings.

[Technical efficiency in primary care for patients with diabetes]. / Eficiencia técnica de la atención al paciente con diabetes en el primer nivel.

OBJECTIVE: To quantify the technical efficiency of diabetes care in family practice settings, characterize the provision of services and health results, and recognize potential sources of variation. MATERIAL AND METHODS: We used data envelopment analysis with inputs and outputs for diabetes care from 47 family units within a social security agency in Nuevo Leon. Tobit regression models were also used. RESULTS: Seven units were technically efficient in providing services and nine in achieving health goals. Only two achieved both outcomes. The metropolitan location and the total number of consultations favored efficiency in the provision of services regardless of patient attributes; and the age of the doctor, the efficiency of health results. CONCLUSIONS: Performance varied within and among family units; some were efficient at providing services while others at accomplishing health goals. Sources of variation also differed. It is necessary to include both outputs in the study of efficiency of diabetes care in family practice settings.

Accesibilidad geográfica para detección temprana de enfermedades crónico-degenerativas / Estimation of a geographic accessibility index of different health centers in México

Background: The accessibility to health centers is a limitation to the use of preventive and curative health centers. Aim: To assess geographic accessibility using a parameter that integrates information about the use ofpreventive services and travelling time froin home to the health center. Material and methods: We analyzed target geographical áreas of10 community centers located at the Northeast of México. A survey was conducted to collect information about the utilization of preventive services for detection of diabetes and hypertension within last year and in women, detection of cervical and breast cáncer. The time required to travel between the health center and the farthest location point at every neighborhood of each geographic área, using public or private transportation, was calculated. Health service use and transportation time were condensed in a single parameter, called geographic accessibility index. Data was normalized using z scores. Resulte: Three geographical areas denominated 7, 8 and 10 had the lowest detection rates of chronic diseases, with valúes rangingfrom 45 percent to 48 percent. By car, área number 3 had the longest travelling time, corresponding to 14 minutes. The longest travelling times by public transportation were detected in áreas 1 and 3, corresponding to 27 and 29 minutes, respectively The geographic accessibility index showed that the least favorable z scores travelling by car corresponded to areas 6 and 10 and, when travelling on public transportation, to áreas 8 and 10. Conclusions: The geographic accessibility index identified areas that required improvements in accessibility.

[Accessibility unmet needs for preventive actions seen from the population's perspective in Monterrey, México, during 2005]. / Necesidades de accesibilidad para acciones preventivas: Una perspectiva de la población en Monterrey, México en 2005.

BACKGROUND: Integrated programs make the task of concentrating preventive actions for specific groups easier. However, health services must firstly be accessible, an essential condition for the population to use them. Hence, the objective of this study was to identify municipalities with the highest needs of accessibility of preventive actions through information synthesized in an accessibility index. METHODS: This cross-sectional study considered eight metropolitan municipalities of Monterrey, Mexico and 323 individuals sampled at random. We measured attendance for at least one preventive action the year before the survey, including vaccination, diabetes or hypertension diagnosis, and cervical or breast cancer among women. The accessibility index consisted of use and access barriers, quality and resource indicators standardized using Z-scores. RESULTS: Ninety-nine percent had attended health services for some preventive action. The municipality with the highest unmet need was Santa Catarina (Z -6.9) followed by Apodaca (Z -1.5) and Benito Juárez (Z -1.2). San Pedro registered the highest unmet need concerning economical access barriers (Z -3.5), whereas Apodaca was not good enough with quality perception (Z -4.7) and Santa Catarina with perception of sufficient physical, human and material resources (Z -4.9). CONCLUSIONS: Three of the eight studied metropolitan municipalities registered the highest unmet need.

Necesidades de accesibilidad para acciones preventivas: Una perspectiva de la población en Monterrey, México en 2005 / Accesibility unmet needs for preventive actions seen from the population´s perspective in Monterrey México, during 2005

Fundamento: Los programas integrados facilitan la tarea de concentrar acciones preventivas para grupos específicos. Sin embargo, los servicios de salud deben contar con la accesibilidad que es una condición básica para que la población acuda a ellos. El objetivo del trabajo fue identificar los municipios con mayor necesidad de accesibilidad de acciones preventivas utilizando información sintetizada en un índice de accesibilidad. Métodos: Estudio transversal en ocho municipios de la zona metropolitana de Monterrey, México, a partir de una muestra aleatoria formada por 323 personas. Se consideró el uso de una acción preventiva por lo menos en el año previo a la fecha de la entrevista (vacunación, detección de diabetes o hipertensión). Se sintetizó la información en un índice de necesidades de accesibilidad considerando indicadores trazadores de uso y barreras por acceso, calidad del servicio y disponibilidad de recursos. Cada indicador fue estandarizado con base a puntajes normalizados Z. Resultados: El 98,9% de la población estudiada recibió alguna acción preventiva. Los municipios con mayor necesidad de accesibilidad fueron Santa Catarina (Z -6,9), Apodaca (Z -1,5) y Benito Juárez (Z -1,2). San Pedro Garza García se vio más afectado por barreras de acceso geográfico o económico (Z -3.5); Apodaca, por percepción de calidad (Z -4,7); y Santa Catarina, por disponibilidad de recursos físicos, humanos o materiales (Z -4,9). Conclusiones: La mayor necesidad de accesibilidad se presentó en tres de los ocho municipios de la zona estudiada (AU)

Background: Integrated programs make the task of concentrating preventive actions for specific groups easier. However, health services must firstly be accessible, an essential condition for the population to use them. Hence, the objective of this study was to identify municipalities with the highest needs of accessibility of preventive actions through information synthesized in an accessibility index. Methods: This cross-sectional study considered eight metropolitan municipalities of Monterrey, Mexico and 323 individuals sampled at random. We measured attendance for at least one preventive action the year before the survey, including vaccination, diabetes or hypertension diagnosis, and cervical or breast cancer among women. The accessibility index consisted of use and access barriers, quality and resource indicators standardized using Z-scores. Results: Ninety-nine percent had attended health services for some preventive action. The municipality with the highest unmet need was Santa Catarina (Z -6.9) followed by Apodaca (Z -1.5) and Benito Juárez (Z -1.2). San Pedro registered the highest unmet need concerning economical access barriers (Z -3.5), whereas Apodaca was not good enough with quality perception (Z -4.7) and Santa Catarina with perception of sufficient physical, human and material resources (Z -4.9). Conclusions: Three of the eight studied metropolitan municipalities registered the highest unmet need (AU)

[Estimation of a geographic accessibility index of different health centers in Mexico]. / Accesibilidad geográfica para detección temprana de enfermedades crónico-degenerativas.

BACKGROUND: The accessibility to health centers is a limitation to the use of preventive and curative health centers. AIM: To assess geographic accessibility using a parameter that integrates information about the use of preventive services and travelling time from home to the health center. MATERIAL AND METHODS: We analyzed target geographical areas of 10 community centers located at the Northeast of Mexico. A survey was conducted to collect information about the utilization of preventive services for detection of diabetes and hypertension within last year and in women, detection of cervical and breast cancer. The time required to travel between the health center and the farthest location point at every neighborhood of each geographic area, using public or private transportation, was calculated. Health service use and transportation time were condensed in a single parameter, called geographic accessibility index. Data was normalized using z scores. RESULT: Three geographical areas denominated 7, 8 and 10 had the lowest detection rates of chronic diseases, with values ranging from 45% to 48%. By car, area number 3 had the longest travelling time, corresponding to 14 minutes. The longest travelling times by public transportation were detected in areas 1 and 3, corresponding to 27 and 29 minutes, respectively The geographic accessibility index showed that the least favorable z scores travelling by car corresponded to areas 6 and 10 and, when travelling on public transportation, to areas 8 and 10. CONCLUSIONS: The geographic accessibility index identified areas that required improvements in accessibility.

Aplicación de medidas preventivas en adultos mayores de acuerdo al programa integrado de salud (PREVENIMSS) / Performance of preventive measures in elderly population according to health integrated program (PREVENIMSS)

Objetivo: Evaluar la aplicación de acciones preventivas del Programa Integrado de Salud (PREVENIMSS) en adultos de 60 años y más de la Zona Metropolitana de Monterrey, Nuevo León. Metodología: Se revisaron 384 expedientes de adultos mayores (60 años y más) de cuatro unidades médicas. La aplicación de esquemas se midió a través de la frecuencia y periodicidad de las acciones de inmunización y detección, con los siguientes indicadores: aplicación recomendada, menos de lo recomendado, más de lo recomendado y no hay registro, se incluyeron las vacunas antineumocóccica (VAN), antiinfluenza (VAI) y toxoide tetánico diftérico (TTD); detección de diabetes mellitus (DDM), hipertensión arterial (DHTA), cáncer mamario (DCAMA) y cáncer cérvico uterino (DCACU). La información se recabó en una ficha de colección de datos diseñada para este fin. El análisis se realizó con estadística descriptiva. Resultados: La VAI se aplicó de acuerdo a lo recomendado en 2.6%, VAN 16.1% y TTD 30.2%. En DDM 30.6%, DHTA 42.1%, DCAMA 20.8% y DCACU 34.2%. Conclusiones: Las acciones de detección PREVENIMSS se aplicaron en menos de la mitad de la población, mientras que las de vacunación fueron de 3 a 30% de los adultos mayores. Trabajos como éste son fuente importante de datos que ayudan a la evaluación de programas.

Objective: To evaluate the performance of preventive actions in the Health Integrated Program (PREVENIMSS) in elder of 60 years and older in the metropolitan zone of Monterrey, Nuevo Leon. Methodology: 384 older people's charts (60 years old and older) from four medical units were reviewed. Performance of schemes was measured through frequency and length of measures of immunization and detection with the following indicators: recommended action, less than recommended action, more than recommended action, and no-record; vaccines that were included are Pneumovaccine (VAN), Flu vaccine (VAI), and titanicdiphtheria toxoid (TTD), besides the detection of Diabetes Mellitus (DDM), high blood pressure (DHTA), breast cancer (DCAMA), and cervical-uterus cancer (DCACU). Information was gathered in a collecting data card designed for this goal. Analysis was done with descriptive statistics. Results: VAI was performed according to recommended in 26%; VAN 16.1%; and TTD 30.2%.For DDM 30.6; DHTA 42.1%; DCAMA 20.8%; and DCACU 34.2%. Conclusions: The actions for detection from PREVENIMSS were performed in less than a half of population; meanwhile, vaccinations went from 3 to 30% in elderly people. Performances like this are important source of data to help in evaluation of programs.