[Quality of life among primary caregivers of patients in dialysis in the city of Chihuahua, Mexico]. / Calidad de vida en cuidadores primarios de pacientes en diálisis en la ciudad de Chihuahua, México.

BACKGROUND: Caregivers of patients with end-stage renal disease (ESRD) in dialysis endure a process of physical/emotional erosion derived from the implications of treatment and permanent care for prolonged periods of time. OBJECTIVE: To assess the quality of life (QoL) of primary caregivers of patients with ESRD in dialysis, and to identify predictors of low QoL. MATERIAL AND METHODS: Cross-sectional multicenter study. From May to September 2019, 137 caregivers and 174 patients, residents of Chihuahua city, were interviewed from four hospitals. Instruments used included: 1) questionnaire for sociodemographic/clinical data, 2) SF-36 and KD-SF to assess QoL of caregivers and patients with ESRD, respectively, 3) Zarit burden interview for caregivers, and 4) Goldberg anxiety/depression scale symptom inventory. RESULTS: Except for mental health, where mean QoL scores were similar between patients, caregivers, and non-caregivers, means were higher in caregivers and non-caregivers for all other domains. Caregivers showed lower summary scores compared with healthy non-caregivers in both physical and mental components. Caregiver's age, anxiety, time in dialysis, and patient's QoL were predictors of low QoL. CONCLUSIONS: Caregivers of patients in dialysis have better QoL compared with patients, but relatively similar to healthy individuals who do not take care of patients.

INTRODUCCIÓN: los cuidadores de pacientes con enfermedad renal crónica terminal (ERCT) en diálisis sufren un proceso de erosión física-emocional derivado de las implicaciones del tratamiento y del cuidado permanente por largos periodos de tiempo. OBJETIVO: evaluar la calidad de vida (CV) de cuidadores primarios de pacientes con ERCT en diálisis, e identificar predictores de baja CV. MATERIAL Y MÉTODOS: estudio multicéntrico transversal. De mayo a septiembre de 2019 se entrevistó a 137 cuidadores y 174 pacientes residentes de la ciudad de Chihuahua de cuatro hospitales. Los instrumentos empleados incluyeron: 1) un cuestionario para datos sociodemográficos/clínicos; 2) cuestionarios SF-36 y KD-SF para evaluar CV en cuidadores y pacientes con ERCT, respectivamente; 3) la escala de sobrecarga de Zarit para cuidadores, y 4) el inventario de síntomas para ansiedad y depresión de Goldberg. RESULTADOS: excepto para salud mental, donde las puntuaciones medias de CV fueron similares entre pacientes, cuidadores y no cuidadores sanos de referencia externa, las medias fueron mayores en cuidadores y no cuidadores para los demás dominios. Los cuidadores tuvieron menores medias para los componentes físico y mental, en comparación con los no cuidadores sanos. La edad del cuidador, la ansiedad, el tiempo en diálisis y la CV del paciente fueron predictores de baja CV. CONCLUSIONES: los cuidadores de pacientes en diálisis tienen mejor calidad de vida que los pacientes, y relativamente similar a la de individuos sanos que no cuidan pacientes.

Nursing care for renal patients on hemodialysis: challenges, dilemmas and satisfactions. / El cuidado de enfermería a los enfermos renales en hemodiálisis: desafíos, dilemas y satisfacciones.

OBJECTIVE: To identify the challenges, dilemmas and satisfactions presented by nursing professionals in hemodialysis services during the care of renal patients. METHOD: Institutional ethnography was used, and 18 semi-structured interviews were conducted with nine members of the nursing staff. Conventional content analysis was performed. RESULTS: For the nursing staff, care presents challenges such as the complex physical and emotional condition of patients, the management of technology for care, and coping with the suffering and death of patients with whom they have established a close relationship. The dilemmas are related to providing care for patients who refuse to receive it, and the personal and family costs involved in treatment in contrast to the limited quality of life of some patients. The main satisfactions are collaborative work, the sufficiency of resources and the confidence and recognition for performing independent work. CONCLUSION: The findings of the study are associated with the presence of professional burnout and interference in the ability to build satisfactory interpersonal relationships, lower job satisfaction and quality of care.

Experiencias del cuidado familiar durante el cáncer de mama: la perspectiva de los cuidadores / Experiências do cuidado familiar durante o câncer de mama: a perspectiva dos cuidadores / Experiences of family care during breast cancer: the perspective of caregivers

RESUMEN Objetivo Describir la experiencia del cuidado familiar a la mujer con cáncer de mama durante el tratamiento, desde la perspectiva de los cuidadores en el contexto mexicano. Método Estudio cualitativo fenomenológico. Fueron realizadas entrevistas en profundidad con cuidadores de mujeres sobrevivientes de cáncer de mama seleccionados mediante muestreo intencional, acumulativo y secuencial. Se llevó a cabo un análisis de contenido convencional. Resultados Participaron siete cuidadores. Los cuidadores refieren sus experiencias positivas y negativas al asumir su rol de cuidadores informales en el contexto familiar. Sobre la fortaleza de la reciprocidad del cuidado y su recompensa, prevalecen los momentos críticos, los sentimientos negativos y la falta de recursos de apoyo durante la experiencia. Ello permite entender el vínculo del cuidado informal para potenciarlo con estrategias de afrontamiento y orientación especifica por parte del personal de enfermería. Conclusión Los participantes experimentaron una transformación en su identidad como cuidadores y al ser conscientes de su experiencia, fueron capaces de describir sus cualidades lo que incrementa sus estrategias de afrontamiento tanto de la enfermedad como de los desafíos del cuidado.

RESUMO Objetivo Descrever a experiência do cuidado familiar com a mulher com câncer de mama durante o tratamento, do ponto de vista dos cuidadores no contexto mexicano. Método Estudo qualitativo fenomenológico. Foram realizadas entrevistas em profundidade com cuidadores de mulheres sobreviventes ao câncer de mama selecionados por meio de amostragem intencional, acumulativa e sequencial. Foi realizada uma análise de conteúdo convencional. Resultados Participaram sete cuidadores. Os cuidadores relatam suas experiências positivas e negativas ao assumir seu papel de cuidadores informais no contexto familiar. Sobre a força da reciprocidade do cuidado e sua recompensa, prevalecem os momentos críticos, os sentimentos negativos e a falta de recursos de apoio durante a experiência. Isso permite entender o vínculo do cuidado informal para potencializá-lo com estratégias de enfrentamento e orientação específica por parte do pessoal de enfermagem. Conclusão Os participantes experimentaram uma transformação na sua identidade como cuidadores e, ao ser conscientes da sua experiência, foram capazes de descrever suas qualidades, o que aumenta suas estratégias de enfrentamento tanto da doença quanto dos desafios do cuidado.

ABSTRACT Objective To describe the experience of family care to women with breast cancer during treatment from the perspective of caregivers in the Mexican context. Method Qualitative phenomenological study. In-depth interviews were conducted with caregivers of women who survived breast cancer. Participants were selected by intentional, cumulative and sequential sampling. A conventional content analysis was performed. Results Participation of seven caregivers, who reported their positive and negative experiences when assuming their role as informal caregivers in the family context. On the strength of the reciprocity of care and its reward, prevailed critical moments, negative feelings, and lack of support resources during the experience. This enables the understanding of the informal care bond in order to enhance it with coping strategies and specific guidance from the nursing staff. Conclusion Participants experienced a transformation in their identity as caregivers and by being aware of their experience, they could describe their qualities, which increased their coping strategies with the disease and the care challenges.

Experiences of family care during breast cancer: the perspective of caregivers. / Experiencias del cuidado familiar durante el cáncer de mama: la perspectiva de los cuidadores.

OBJECTIVE: To describe the experience of family care to women with breast cancer during treatment from the perspective of caregivers in the Mexican context. METHOD: Qualitative phenomenological study. In-depth interviews were conducted with caregivers of women who survived breast cancer. Participants were selected by intentional, cumulative and sequential sampling. A conventional content analysis was performed. RESULTS: Participation of seven caregivers, who reported their positive and negative experiences when assuming their role as informal caregivers in the family context. On the strength of the reciprocity of care and its reward, prevailed critical moments, negative feelings, and lack of support resources during the experience. This enables the understanding of the informal care bond in order to enhance it with coping strategies and specific guidance from the nursing staff. CONCLUSION: Participants experienced a transformation in their identity as caregivers and by being aware of their experience, they could describe their qualities, which increased their coping strategies with the disease and the care challenges.

Experiencia de cuidadores familiares de mujeres con cáncer de mama: una revisión integradora / Experience of Family Caregivers of Women with Breast Cancer: An Integrative Review / Experiência de cuidadores familiares de mulheres com câncer de mama: uma revisão integradora

RESUMEN Objetivo: identificar la evidencia científica de enfermería relacionada con la experiencia de los cuidadores familiares de mujeres con cáncer de mama. Metodología: revisión integradora siguiendo los lineamientos de Ganong; búsqueda en bases de datos: EMBASE, OVID, PUBMED, SAGE journals, SCIELO, Google Academic, ISI Web of Science y SCOPUS, artículos publicados entre los años 2000 y 2016. Resultados: se incluyeron 18 artículos producto de investigaciones primarias de tipo cualitativo, cuyos referentes teórico-metodológicos fueron fenomenología y teoría fundamentada, las técnicas de recolección de datos fueron la entrevista semiestructurada y en profundidad. Se presentan y discuten como hallazgos las siguientes categorías: impacto del diagnóstico; lo que implica ser cuidador; efectos en el cuidador; estrategias de afrontamiento; cambios en los roles y las relaciones; apoyo social. Conclusiones: las características de los cuidadores son variables, es necesario conocer sobre la cultura y recursos propios de cada contexto. Los cuidadores requieren información clara y oportuna en relación su función y las habilidades a desarrollar, especialmente para otorgar apoyo emocional. Es necesaria la indagación de dichas experiencias en el contexto mexicano. Las relaciones padres e hijos en las familias de mujeres con cáncer de mama es un asunto poco estudiado, se requieren futuros estudios en este tema.

ABSTRACT Objective: identify scientific nursing evidence related to the experience of family caregivers of women who have breast cancer. Methodology: An integrative review was conducted following Ganong's guidelines. It included a database search of EMBASE, OVID, PUBMED, SAGE journals, SCIELO, Google Academic, ISI Web of Science and SCOPUS. The focus was on articles published between 2000 and 2016. Results: The review included 18 articles that are the result of qualitative primary studies; their theoretical-methodological references were phenomenology and the grounded theory. Semi-structured and in-depth interview were the data collection techniques used. The following categories are presented and discussed as findings: impact of the diagnosis; what it means to be a caregiver; effects on the caregiver; coping strategies; changes in roles and relationships; and social support. Conclusions: The characteristics of the caregivers vary and it is necessary to know about the culture and resources in each context. Caregivers require clear and timely information about their role and the skills they must develop, especially if they are to provide emotional support. It is necessary to research these experiences in the Mexican context. The relationship between parents and children in the families of women with breast cancer is a topic that has received little study, and future research on this subject is required.

RESUMO Objetivo: identificar a evidência científica de enfermagem relacionada com a experiência dos cuidadores familiares de mulheres com câncer de mama. Metodologia: revisão integradora que segue os lineamentos de Ganong; busca em bases de dados: Embase, OVID, PubMed, Sage journals, SciELO, Google Academic, ISI Web of Science e Scopus, artigos publicados entre 2000 e 2016. Resultados: foram incluídos 18 artigos produto de pesquisas primárias de tipo qualitativo, cujos referenciais teórico-metodológicos foram fenomenologia e teoria fundamentada, técnicas de coleta de dados foram a entrevista semiestruturada e em profundidade. São apresentados e discutidos como achados as seguintes categorias: impacto do diagnóstico; o que implica ser cuidador; efeitos no cuidador; estratégias de enfretamento; mudanças nos papéis e nas relações; apoio social. Conclusões: as características dos cuidadores são variáveis; é necessário conhecer sobre a cultura e recursos próprios de cada contexto. Os cuidadores requerem informação clara e oportuna sobre sua função e habilidades a desenvolver, em especial para oferecer apoio emocional. Requer-se o questionamento dessas experiências no contexto mexicano. As relações pais-filhos nas famílias de mulheres com câncer de mama é assunto pouco estudado e, portanto, exige estudos.

Breakfast Skipping, Anxiety, Exercise, and Soda Consumption are Associated with Diet Quality in Mexican College Students.

ABSTEACT Despite the reported poor dietary habits and risk of weight gain in college students, they remain understudied in Mexico. Mexican college students are in a rapidly changing economic environment; a shift from a traditional, homemade cuisine to a diet more heavily influenced by an industrialized culture seems to be occurring, potentially affecting the quality of their dietary intake. A health and nutrition survey was conducted among 450 Mexican college students to study the relationship between sociodemographic factors and diet quality. Dietary data were used to build macro- and micronutrient scores, dichotomized as low and normal quality. Adjusted odds (OR [95% CI]) were computed to determine the probability of low dietary quality. Breakfast skipping (5.3 [1.2, 22.7]) and risk of anxiety (2.3 [1.3, 4.4]) were associated with a greater risk of low macronutrient quality, and caloric intake < 1,800 kcal (5.8 [3.5, 9.7]), breakfast skipping (3.7 [1.4, 10.3]), vigorous exercise ≤ 1 h/wk (2.6 [1.3, 5.2]), and soda consumption > 250 mL/d (2.0 [1.2, 3.3]) with low micronutrient quality.

Ansiedad, depresión y actividad física asociados a sobrepeso/obesidad en estudiantes de dos universidades mexicanas / Anxiety, depression and physical activity associated with overweight/obesity in students from two mexican universities / Ansiedade, depressão e atividade física associada ao excesso peso/obesidade em estudantes de duas universidades mexicanas

OBJETIVO: Determinar la asociación entre los trastornos afectivos (ansiedad, depresión), la actividad física y la prevalencia combinada de sobrepeso/obesidad en un grupo de estudiantes universitarios. MATERIALES Y MÉTODOS: Estudio descriptivo transversal realizado de mayo de 2013 a noviembre de 2014 en una muestra aleatoria de 450 estudiantes de enfermería y nutrición de dos universidades mexicanas. Se aplicó un cuestionario estructurado sobre actividad física y síntomas presuntivos de ansiedad y depresión, se midieron peso, talla y se calculó el índice de masa corporal (IMC). Los datos obtenidos se procesaron y analizaron en el software estadístico SPSS. RESULTADOS: La prevalencia combinada de sobrepeso/obesidad estimada según el IMC fue 32,4% en el total de la población de estudio; mayor en la Universidad Autónoma de Yucatán (UADY, 41%) que en la Universidad Autónoma de San Luis Potosí (UASLP, 27,5%), la diferencia entre universidades es estadísticamente significativa (p<0,05) la prevalencia es mayor en hombres (38,5%) que en mujeres (30,5%). Las variables que indagan sobre alteraciones en el apetito según el estado emocional advierten asociación estadísticamente significativa (p<0,05) entre sobrepeso/obesidad y aumento del apetito ante el estrés, ansiedad y tristeza. No existe suficiente evidencia estadística en los datos para establecer asociación entre sobrepeso-obesidad y la realización de actividad física, ni se encontraron diferencias en características de la actividad física entre universidades. CONCLUSIÓN: Se evidencian síntomas de ansiedad y depresión en estudiantes universitarios del área de salud, los cuales, asociados a una ingesta alimentaria excesiva y una actividad física leve predisponen al sobrepeso y la obesidad

OBJECTIVE: To decide the association between affective disorders (anxiety, depression), physical activity and combined prevalence of overweight/obesity in a group of university students. MATERIAL AND METHODS: Cross-sectional descriptive study conducted from May 2013 to November 2014 in a random sample of 450 nursing and nutrition students from two Mexican universities. A structured questionnaire on physical activity and presumptive symptoms of anxiety and depression was applied, weight and height were measured, and body mass index (BMI) was calculated. The data obtained was processed using the SPSS statistical software. RESULTS: The combined prevalence of overweight-obesity estimated by BMI was 32.4% in the total study population; it was higher in the Universidad Autónoma de Yucatán (UADY) (41%) than in the Universidad Autónoma San Luis Potosí (UASLP) (27.5%). The difference between universities is statistically significant (p<0.05), prevalence is higher in men (38.5%) than in women (30.5%). Variables that investigate alterations in appetite according to the emotional state show statistically significant association (p<0.05) between overweight-obesity and increased appetite for stress, anxiety and sadness. There is insufficient statistical evidence in the data to establish an association between overweight-obesity and physical activity and differences in physical activity characteristics between universities were not found. CONCLUSION: Symptoms of anxiety and depression in university students in the health area are evident, which, associated with excessive food intake and mild physical activity, lead to overweight and obesity

OBJECTIVO: Determinar a associação entre transtornos afetivos (ansiedade, depressão), atividade física e prevalência combinada de sobrepeso/obesidade em um grupo de estudantes universitários em duas universidades no México. MATERIAIS E MÉTODOS: De maio de 2013 a novembro de 2014, um estudo descritivo transversal foi realizado em uma amostra aleatória de 450 estudantes de enfermagem e nutrição em dois universidades mexicanas. Foi aplicado um questionário estruturado de atividade física e sintomas presuntivos de ansiedade e depressão, foram medidos peso, altura e índice de massa corporal (IMC) foi calculado. Os dados obtidos foram processados no software estatístico SPSS. RESULTADOS: A prevalência combinada de excesso de peso a obesidade é estimada pelo IMC de 32,4% na população total do estudo; maior na Universidade Autônoma de Yucatán (UADY) (41%) do que na Universidade Autônoma de San Luis Potosí (UASLP) (27,5%), a diferença entre universidades é estatisticamente significativa (p<0.05). A prevalência é maior em homens (38,5%) do que mulheres (30,5%). As variáveis que investigam alterações no apetite como o estado emocional alertar associação estatisticamente significativa (p<0,05) entre o excesso de peso à obesidade e aumento do apetite ao estresse, ansiedade e tristeza. Não há evidências estatísticas suficientes nos dados para estabelecer associação entre o excesso de peso à obesidade e atividade física, não há diferenças nas características da atividade física entre universidades. CONCLUSÃO: Se mostram sintomas de ansiedade e depressão em estudantes universitários da área de saúde, que, associada à ingestão excessiva de alimentos e atividade física uma ligeira vantagem ao sobrepeso e à obesidade

Coordinated hospital-home care for kidney patients on hemodialysis from the perspective of nursing personnel.

OBJECTIVE: To examine, from the nursing perspective, the needs and challenges of coordinated hospital-home care for renal patients on hemodialysis. METHODS: A qualitative analysis was conducted with an ethnographic approach in a hemodialysis unit in San Luis Potosi, Mexico. Semistructured interviews were conducted with nine nurses, selected by purposeful sampling. Structured content analysis was used. RESULTS: Nurses recounted the needs and challenges involved in caring for renal patients. They also identified barriers that limit coordinated patient care in the hospital and the home, mainly the work overload at the hemodialysis unit and the lack of a systematic strategy for education and lifelong guidance to patients, their families and caregivers. CONCLUSIONS: This study shows the importance and necessity of establishing a strategy that goes beyond conventional guidance provided to caregivers of renal patients, integrating them into the multidisciplinary group of health professionals that provide care for these patients in the hospital to establish coordinated hospital-home care that increases therapeutic adherence, treatment substitution effectiveness and patient quality of life.

Coordinated hospital-home care for kidney patients on hemodialysis from the perspective of nursing personnel / Cuidado coordenado hospital-domicílio para pacientes renais em hemodiálise sob a perspectiva do profissional de enfermagem / Cuidado coordinado hospital-hogar para enfermos renales en hemodiálisis desde la perspectiva del personal de enfermería

OBJECTIVE: To examine, from the nursing perspective, the needs and challenges of coordinated hospital-home care for renal patients on hemodialysis. METHODS: A qualitative analysis was conducted with an ethnographic approach in a hemodialysis unit in San Luis Potosi, Mexico. Semistructured interviews were conducted with nine nurses, selected by purposeful sampling. Structured content analysis was used. RESULTS: Nurses recounted the needs and challenges involved in caring for renal patients. They also identified barriers that limit coordinated patient care in the hospital and the home, mainly the work overload at the hemodialysis unit and the lack of a systematic strategy for education and lifelong guidance to patients, their families and caregivers. CONCLUSIONS: This study shows the importance and necessity of establishing a strategy that goes beyond conventional guidance provided to caregivers of renal patients, integrating them into the multidisciplinary group of health professionals that provide care for these patients in the hospital to establish coordinated hospital-home care that increases therapeutic adherence, treatment substitution effectiveness and patient quality of life. .

OBJETIVO: estudar, sob a perspectiva do enfermeiro, as necessidades e desafios do cuidado coordenado hospital-domicílio no atendimento a pacientes renais em hemodiálise. MÉTODOS: foi realizada uma análise qualitativa, com abordagem etnográfica, em uma unidade de hemodiálise em San Luis Potosí, México. Foram realizadas entrevistas semiestruturadas com nove enfermeiros, selecionados através de amostragem proposital. Foi utilizada uma análise de conteúdo estruturado. RESULTADOS: os enfermeiros relatam necessidades e desafios envolvidos nos cuidados de pacientes renais. Também apontam barreiras que limitam os cuidados do paciente no hospital e em casa, de maneira coordenada, principalmente a sobrecarga de trabalho na unidade de hemodiálise e a falta de uma estratégia sistemática para educação e orientação vitalícia dos pacientes, familiares e cuidadores. CONCLUSÕES: este estudo mostra a importância e a necessidade de se estabelecer uma estratégia além da orientação convencional fornecida a cuidadores de pacientes renais, integrando-os ao grupo multidisciplinar de profissionais de saúde que prestam atendimento a esses pacientes no hospital, para um cuidado coordenado hospital-domicílio, aumentando a adesão à terapêutica, eficácia do tratamento de substituição e qualidade de vida do paciente. .

OBJETIVO: examinar, desde la perspectiva del personal de enfermería, las necesidades y desafíos del cuidado coordinado hospital-hogar en la atención a enfermos renales en hemodiálisis. MÉTODOS: se realizó una evaluación cualitativa con enfoque etnográfico en una unidad de hemodiálisis en San Luis Potosí, México. Se llevaron a cabo entrevistas semiestructuradas con nueve enfermeras, seleccionadas mediante muestreo intencional. Se empleó análisis de contenido estructurado. RESULTADOS: el personal de enfermería refiere las necesidades y desafíos que implica el cuidado al enfermo renal. Señalan también las barreras que limitan el cuidado del enfermo en el hospital y en el hogar de manera coordinada, principalmente, la sobrecarga de trabajo en la unidad de hemodiálisis y la falta de una estrategia sistemática para la educación y orientación permanente a los enfermos, sus familiares y cuidadores. CONCLUSIONES: este estudio muestra la importancia y necesidad de establecer una estrategia que supere la orientación convencional que se brinda a los cuidadores de enfermos renales, integrándolos al grupo multidisciplinar de profesionales de la salud que brindan atención a estos enfermos en el hospital, para establecer un cuidado coordinado hospital-hogar que permita incrementar la adhesión a la terapéutica, la efectividad del tratamiento sustitutivo y la calidad de vida del enfermo. .

Medical therapeutic itineraries of women with breast cancer diagnosis affiliated to the People's Health Insurance in San Luis Potosí, central Mexico.

This study aims to describe the medical itineraries followed by breast cancer women affiliated to the People's Health Insurance in San Luis Potosí, central Mexico. We used an ethnographic approach based on oral histories of 12 women diagnosed with breast cancer in the year prior to the first meeting. Two face-to-face sessions per participant lasting 60 minutes each were conducted followed by a telephone interview. Content and diachronic analyses were used. Three main itineraries were identified: (1) diagnostic process, (2) final diagnosis to treatment, and (3) cancer control and relapse. Findings suggested that infrastructure and human resources to adequately screen and timely diagnose breast cancer were scant and insufficiently trained, respectively. Deferral of medical assessment was related with lack of information about breast cancer consequences, with women being afraid of a positive result, and with economic constraints. The current screening program needs to be redesigned to prevent diagnostic delays, as these seem to explain the high frequency of advanced stages reported at the time of diagnosis.

Medical therapeutic itineraries of women with breast cancer diagnosis affiliated to the People's Health Insurance in San Luis Potosí, central Mexico / Itinerarios terapéuticos de mujeres con diagnóstico de cáncer de mama afiliadas al Seguro Popular de Salud en San Luis Potosí, región centro de México / Itinerários terapêuticos de mulheres com diagnóstico de câncer de mama filiadas ao Seguro de Saúde Popular em San Luís Potosí, região central do México

This study aims to describe the medical itineraries followed by breast cancer women affiliated to the People's Health Insurance in San Luis Potosí, central Mexico. We used an ethnographic approach based on oral histories of 12 women diagnosed with breast cancer in the year prior to the first meeting. Two face-to-face sessions per participant lasting 60 minutes each were conducted followed by a telephone interview. Content and diachronic analyses were used. Three main itineraries were identified: (1) diagnostic process, (2) final diagnosis to treatment, and (3) cancer control and relapse. Findings suggested that infrastructure and human resources to adequately screen and timely diagnose breast cancer were scant and insufficiently trained, respectively. Deferral of medical assessment was related with lack of information about breast cancer consequences, with women being afraid of a positive result, and with economic constraints. The current screening program needs to be redesigned to prevent diagnostic delays, as these seem to explain the high frequency of advanced stages reported at the time of diagnosis.

Describir los itinerarios de atención medicalizada seguidos por mujeres con cáncer de mama, afiliadas al Seguro Popular de Salud en San Luis Potosí, México. Se realizó un estudio cualitativo con enfoque etnográfico en el que participaron 12 mujeres. Se recolectaron historias orales, dos entrevistas cara a cara y una telefónica por participante. Se efectuó análisis de contenido y diacrónico. Tres itinerarios fueron identificados en la búsqueda de atención: (1) el proceso de diagnóstico, (2) del diagnóstico al tratamiento, y (3) el control del cáncer y la recaída. Los hallazgos sugieren que la infraestructura y los recursos humanos son escasos para obtener una detección adecuada y un diagnóstico oportuno. El aplazamiento de la valoración médica también se relaciona con la falta de información sobre las consecuencias del cáncer y el temor de las mujeres al resultado. El programa de cribado actual necesita ser rediseñado para evitar retrasos de diagnóstico, los cuales parecen explicar la alta frecuencia de estadios avanzados reportados.

Descrever as rotas seguidas para os cuidados de mulheres com câncer de mama filiadas ao Seguro Popular de Saúde em San Luís Potosí, no México. Pesquisa qualitativa realizada com abordagem etnográfica, envolvendo 12 mulheres que foram diagnosticadas. Foram conduzidas histórias narradas por duas participantes, seguidas de uma entrevista por telefone. As análises do conteúdo e diacrônica foram realizadas. Três opções foram identificadas em busca de atenção: (1) o processo de diagnóstico, (2) a partir do diagnóstico até o tratamento, e (3) controle e reincidência do câncer. Os resultados sugerem que os recursos de infraestrutura e humanos são escassos para a detecção adequada e diagnóstico oportuno. O adiamento da avaliação médica também está relacionado com a falta de informação sobre as consequências do câncer e o medo das mulheres em saber o resultado. O programa de rastreio atual precisa ser redesenhado para evitar atrasos no diagnóstico, que parecem explicar a alta frequência de estágios avançados relatados.

Fortalezas y debilidades del programa para la detección y el control del cáncer cervicouterino. Evaluación cualitativa en San Luis Potosí, México / Strengths and weaknesses of a cervical cancer detection and control program: a qualitative evaluation in San Luis Potosi, Mexico

Objetivo Identificar, desde la perspectiva del personal de salud, las fortalezas y debilidades del programa para la detección y el control del cáncer cervicouterino mediante una evaluación cualitativa, en tres centros de salud de San Luis Potosí, México, entre agosto de 2008 y noviembre de 2009.MétodosSe realizó una evaluación cualitativa. En el estudio participaron nueve prestadores de servicios, seleccionados mediante muestreo por conveniencia, bajo el criterio de participación voluntaria. Inicialmente se obtuvo información de los centros de salud para conocer las características y el contexto en que opera el programa; posteriormente, a los nueve informantes se les realizaron 18 entrevistas semiestructuradas para indagar su perspectiva. Se empleó un análisis de contenido dirigido. Resultados Las fortalezas referidas por el personal son el carácter gratuito del programa, la disponibilidad de recursos materiales, así como algunas estrategias que facilitan la captación de mujeres y su acceso al cribado. Las principales debilidades son las limitaciones de recursos humanos y en la estructura física, la ineficiente organización de actividades, la deficiente capacidad técnica del personal y las limitadas acciones de promoción, así como las dificultades en el seguimiento de las mujeres con resultados positivos. Conclusiones Este estudio muestra la necesidad de incrementar los recursos humanos, realizar cambios en la normatividad y reorganizar las acciones del programa en algunos centros de salud, para garantizar la calidad del servicio y satisfacer los requerimientos de las mujeres, y así favorecer la cobertura en todas sus acciones (AU)

Objective To identify, from the perspective of the health staff, the strengths and weaknesses of the program for the detection and control of cervical cancer through a qualitative assessment implemented in three health centers in the city of San Luis Potosi, Mexico, from August 2008 to November 2009.MethodsA qualitative evaluation was performed. Nine providers participated in the study. The providers were selected by purposeful sampling using a voluntary participation criterion. Initially, information on the characteristics and the context in which the program operates was obtained from the health centers. Later, 18 semi-structured interviews were conducted with nine informants to probe their perspective. A directed content analysis was used. Results The strengths reported by staff were the fact that the program is free of charge, the availability of material resources, and the strategies that helped encourage the recruitment of women and their access to screening. The main weaknesses consisted of limitations in human resources and physical infrastructure, inefficient organization of activities, the staff's poor technical training, limited promotion of activities, and limitations in monitoring women with positive results. Conclusions This study reveals the need for increased human resources, changes in regulations and reorganization of the program's actions in some health centers to ensure the quality of the service, meet women's needs, and promote coverage in all the program's actions (AU)

[Strengths and weaknesses of a cervical cancer detection and control program: a qualitative evaluation in San Luis Potosi, Mexico]. / Fortalezas y debilidades del programa para la detección y el control del cáncer cervicouterino. Evaluación cualitativa en San Luis Potosí, México.

OBJECTIVE: To identify, from the perspective of the health staff, the strengths and weaknesses of the program for the detection and control of cervical cancer through a qualitative assessment implemented in three health centers in the city of San Luis Potosi, Mexico, from August 2008 to November 2009. METHODS: A qualitative evaluation was performed. Nine providers participated in the study. The providers were selected by purposeful sampling using a voluntary participation criterion. Initially, information on the characteristics and the context in which the program operates was obtained from the health centers. Later, 18 semi-structured interviews were conducted with nine informants to probe their perspective. A directed content analysis was used. RESULTS: The strengths reported by staff were the fact that the program is free of charge, the availability of material resources, and the strategies that helped encourage the recruitment of women and their access to screening. The main weaknesses consisted of limitations in human resources and physical infrastructure, inefficient organization of activities, the staff's poor technical training, limited promotion of activities, and limitations in monitoring women with positive results. CONCLUSIONS: This study reveals the need for increased human resources, changes in regulations and reorganization of the program's actions in some health centers to ensure the quality of the service, meet women's needs, and promote coverage in all the program's actions.

Entre la disponibilidad y el acceso a la atención médica: la mirada de los enfermos crónicos en condiciones de pobreza / Between the availability and accessibility to health care: the perspective of patients with chronic diseases living in poverty

La atención a los enfermos crónicos es un problema cada vez más complejo; de allí que la evaluación de los programas dirigidos a este grupo cobre interés creciente. Este trabajo examina la disponibilidad y el acceso a la atención médica desde la perspectiva de quienes viven con padecimientos crónicos y en la pobreza. Se realizó una evaluación cualitativa en una ciudad mexicana. Participaron diez personas con enfermedades crónicas, mayores de 60 años. Se realizaron 45 entrevistas, llevándose a cabo análisis de contenido. Según los hallazgos, tres modelos coexisten en materia de acceso y uso de la atención médica: uno vinculado a la seguridad social; otro a los servicios públicos de salud, y un tercero a los servicios médicos privados. Pero el hallazgo primordial común pone en evidencia la brecha existente entre los recursos sanitarios disponibles y el acceso y uso limitado de la atención médica debido a obstáculos de diversa índole.

Health care of people with chronic diseases is a complex issue; hence there is a growing concern to evaluate health programs oriented to such group. This paper examines availability and accessibility to health care from the perspective of those with chronic diseases living in poverty. A qualitative evaluation was carried out in a Mexican city. Ten persons with chronic diseases, and above 60 years, participated in the study. Forty five interviews were carried out; data were content analyzed. According to the findings, there are three models for accessing and using health care: one is linked to the social security; another to public health services, and a third one related to private health services. Nevertheless, the main common finding shows that there is a gap between existing health care resources and the access and a minor utilization of them due to multiple obstacles.

Enseñando investigación cualitativa en salud: evaluación de un curso de formación en la perspectiva de los alumnos / Ensinando pesquisa qualitativa em saúde: avaliação de um curso de formação na perspectiva dos alunos / Teaching qualitative health research: evaluation of an educational program based on the students' point of view

Se implementaron numerosas intervenciones educativas visando la capacitación en pesquisa cualitativa. No obstante son escasos los trabajos que valoran sus procesos o resultados, sobre todo considerando la perspectiva de los participantes. Este estudio valora un curso de especialización en pesquisa cualitativa en salud a partir de la perspectiva de los alumnos. El curso se realizó en cuatro ocasiones, siendo su valuación de tipo cualitativo. Aproximadamente ochenta profesionales de salud y ciencias sociales participaron del curso. Para la obtención de los datos se utilizó triangulación de métodos: cuestionarios con preguntas abiertas, entrevistas individuales y la retro-alimentación de los participantes. Una variante del método SWOT fue utilizada. Se empleó el análisis de contenido para el tratamiento de las informaciones. Según los alumnos, el curso les permitió adquirir conocimientos y aprender teorías sobre pesquisa cualitativa y, en menor escala, elaborar proyectos de pesquisa. También se refirieron a dificultades y obstáculos, como falta de tiempo, de recursos y de apoyo. Se sugieren varias estrategias para perfeccionar el proceso de formación valuado.

Several educational strategies have been used to teach qualitative research. However, few studies have evaluated its processes and results, particularly from the participants' point of view. This paper reports on an evaluation of a specialization in qualitative health research from the student's perspective. The course was carried-out on four different occasions and its evaluation was a qualitative one. Approximately eighty health and social science professionals attended and evaluated the course. Triangulation methods were used for data gathering: an open-ended questionnaire, individual interviews, and participants' feed-back; a modified SWOT method was also used. Data was analyzed using content analysis. From the participants' point of view, the course allowed them to acquire knowledge on qualitative research approaches and methods and, to lesser extent, on how to write a research project. Participants encountered difficulties: lack of time, limited resources as well as lack of support. Several strategies are suggested for improving the course.

Numerosas intervenções educativas foram implementadas visando à capacitação em pesquisa qualitativa. Contudo, são escassos os trabalhos que avaliam seus processos ou resultados, sobretudo considerando a perspectiva dos participantes. Este estudo avalia um curso de especialização em pesquisa qualitativa em saúde com base na perspectiva dos alunos. O curso foi realizado em quatro ocasiões, sendo sua avaliação de tipo qualitativo. Aproximadamente oitenta profissionais de saúde e ciências sociais participaram do curso. Para a obtenção dos dados utilizou-se triangulação de métodos: questionários com perguntas abertas, entrevistas individuais e a retroalimentação dos participantes. Uma variante do método SWOT foi utilizada. Empregou-se a análise de conteúdo para o tratamento das informações. Segundo os alunos, o curso lhes permitiu adquirir conhecimentos e aprender teorias sobre pesquisa qualitativa e, em menor escala, a elaborar projetos de pesquisa. Também se referiram a dificuldades e obstáculos: como falta de tempo, recursos e apoio. Sugerem-se várias estratégias para aperfeiçoar o processo de formação avaliado.

Evaluación cualitativa de un programa de formación de enfermeras. La perspectiva de los profesores y los estudiantes / Qualitative evaluation of a nursing education program. Professors and students´ perspective

Objetivo: analizar desde la perspectiva de los profesores y estudiantes el proceso de implementación de un plan de estudios de Licenciatura en Enfermería en la Facultad de Enfermería de la Universidad Autónoma de San Luis Potosí, México, que fue reestructurado en forma radical. Metodología: se realizó una evaluación, cualitativa con enfoque etnográfico, de enero de 2004 a agosto de 2005. Participaron como informantes 36 profesores y 42 alumnos seleccionados en un muestreo por conveniencia. Para la recolección de información se establecieron 11 grupos focales. Los datos fueron analizados mediante el análisis de contenido de tipo temático. Resultados: los profesores y estudiantes se refirieron a las fortalezas y debilidades que ellos perciben de acuerdo con sus experiencias y valoracionessobre los contenidos y la ejecución de los programasteóricos y prácticos, el proceso enseñanza aprendizaje y los elementos que lo conforman, como las estrategias didácticas y la evaluación, la perspectiva sobre los actores implicados y la relación que se establece entre ambos. Conclusión: se evidencian las fortalezas y debilidades de la estructura y de los procesos de un programa formativo que planteó objetivos ambiciosos, principalmente porque los enfoques pedagógicos que lo sustentan exigen una transformación de prácticas en losinvolucrados. La reestructuración constructivista y crítica del plan de estudios detonó cambios en el espacio educativo para profesores y estudiantes enfrentar la necesidad de cambiar. El proceso les ha permitido a algunos enfrentarse a sí mismos y tomar decisiones para transformar sus prácticas; en otros, ha provocado mayores resistencias.

Methodological issues in emergent evaluations of health programs: lessons from Iberoamerica.

There has been growing interest in nonmainstream approaches to assessing health programs, but methodological strategies have not been a concern. In this article, we review methodological strategies used in emergent evaluations of health policies and programs in Iberoamerica, focusing on participatory, qualitative, critical, hermeneutical, bottom-up, collaborative, and transdisciplinary approaches. A literature search was performed combining strategies: database review, consultation of bibliography, expert interviews, and search engines. The review took place from 2003 to 2006. Research published in the past two decades was included. Nearly 70 articles were found on emergent research and evaluation of health programs in the region. Participatory and qualitative approaches were the most used. Theoretical issues are more emphasized than are methodological ones. Data gathering also was more explored than were design, participant selection, or analysis. The frequently used methodological strategies contradict some basic assumptions of the emergent evaluative research, such as its participatory and collaborative nature.

Efectividad de un programa educativo en el control del enfermo con diabetes / Effectiveness of an educational program in the control of diabetic patients

Objetivo: evaluar la efectividad de un programa de intervención educativa dirigido a personas con diabetes mellitus tipo 2 en una Unidad de Medicina Familiar de San Luis Potosí, México. Metodología: es un estudio de intervención, longitudinal, comparativo; se utilizó muestreo probabilístico de tipo sistemático con asignación aleatoria. Las variables de estudio fueron: el nivel de conocimientos respecto a la enfermedad y el autocuidado y el control metabólico del enfermo. Al grupo de estudio se le aplicó un programa de intervención educativa durante nueve meses y el grupo control recibió la asistencia convencional establecida en la unidad de atención; a ambos grupos se les realizaron mediciones de hemoglobina glucosilada y del nivel de conocimientos antes y después de la intervención. Los datos se procesaron y analizaron mediante el paquete SPSS 8.0. Se aplicaron medidas de estadística descriptiva e inferencial. Resultados y Discusión: los resultados mostraron evidencia estadística de la efectividad del programa educativo ya que mejoró el nivel de conocimientos y porque a través de la prueba de Friedman se mostró que el promedio de hemoglobina glucosilada era menor en el grupo de estudio. Conclusiones: el programa evaluado es efectivos al favorecer tanto el incremento del nivel de los conocimientos sobre la enfermedad, las medidas para el control y la terapéutica, como el control metabólico del paciente.

[Medical care for chronic disease: reflexions on methodologic procedures of a qualitative study]. / La atención médica a la enfermedad crónica: reflexiones sobre los procedimientos metodológicos de un estudio cualitativo.

Chronic diseases have been the focus of qualitative researchers. However, few studies have explained in depth the methodological options choOsed in the studies and their reasons. This paper presents some reflections on the methodological strategies and procedures used in a multisite, qualitative study whose focus are the individual's perspectives on chronic conditions and medical care. Such reflections are on the study's orientation, the selection of the area, the focus groups and the social relations among participants. We conclude stating that the methodological options and the strategies used, rather than being solely a technical issue, are deeply linked to the study's object, the social relations among participants and the context of research.

La atención médica a la enfermedad crónica: reflexiones sobre los procedimientos metodológicos de un estudio cualitativo / Chronic illness health care. Reflections on the methodological procedures of a qualitative study

Las enfermedades crónicas han pasado a ser objeto de creciente atención por parte de investigadores con una orientación cualitativa. Pocos trabajos, sin embargo, han profundizado en las decisiones metodológicas empleadas en los estudios. El objetivo de este artículo es presentar algunas reflexiones sobre la metodología empleada en un estudio cualitativo multicéntrico centrado en las perspectivas sobre las enfermedades crónicas y su atención. Los temas objeto de reflexión son la orientación del estudio, la selección del área y la muestra, el empleo de los grupos focales y las relaciones entre los participantes. Concluimos sustentando que las opciones y estrategias metodológicas empleadas, más que ser un asunto de índole técnico, están íntimamente vinculadas al objeto de estudio, a las relaciones sociales establecidas entre los participantes y al contexto del estudio (AU)

Chronic diseases have been the focus of qualitative researchers. However, few studies have explained in depth the methodological options chosed in the studies and their reasons. This paper presents some reflections on the methodological strategies and procedures used in a multisite, qualitative study whose focus are the individual's perspectives on chronic conditions and medical care. Such reflections are on the study's orientation, the selection of the area, the focus groups and the social relations among participants. We conclude stating that the methodological options and the strategies used, rather than being solely a technical issue, are deeply linked to the study's object, the social relations among participants and the context of research (AU)