Impact of urban farming on health: a systematic review.

BACKGROUND: Urban farms are spaces designated for the cultivation of plants for food security, medicinal and curative purposes. Since the turn of the century, they have become more widespread and health benefits have been claimed; however, no consensus exists regarding this information. Hence, this study aims to provide information about the health effects of urban farming. METHODS: Protocol register number CRD42023448001. We followed the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies addressing urban farming interventions in any population group were included without age limitation of publication from PubMed, DOAJ, CAB Abstracts and NIH. Risk of bias was assessed using the Risk of Bias In Non-randomized Studies - of Interventions tool, and data were narratively synthesized. RESULTS: The search retrieved 2578 manuscripts, reduced to seven after screening. Urban farming's impact on health has been reflected in the physical domain by increasing self-reported health levels, physical activity, perceived general health, healthy eating and decreasing drug use. Parasites' presence has also been reported. In the mental aspect, urban farming is associated with relaxation and stress reduction. From a social perspective, urban farms provide a sense of belonging, personal growth and happiness. CONCLUSIONS: The benefits of urban farming outweigh the disadvantages. Further research should be conducted to clarify the potential benefits of this practice.

Association between self-reported sleep duration and dietary quality in Mexican school-aged children.

Short sleep duration has been associated with poor diet quality in school-aged children in multiple populations. However, investigations of sleep and dietary quality in Mexican school-aged children are scarce. The main objective of this work was to assess the association between sleep duration and dietary quality in Mexican school-aged children stratified by sex. The data were collected from 373 (138 girls and 235 boys) elementary school children aged 6-12 years in Monterrey, Nuevo Leon, Mexico. Surveys collected information on general demographic characteristics and self-reported sleep duration. Diet was assessed with 24-h recalls, and dietary quality was calculated by the Healthy Eating Index (HEI-2015). Results indicated that overall mean sleep duration was 8.23 ± 1.06 h. From the total sample, 6.7% slept ≤6 h (not recommended), 55.8% 7-8 h (may be appropriate), and 37.5% ≥ 9 h (recommended). Average total HEI-2015 score was 64.6 (out of possible 100), with boys having lower HEI-2015 scores than girls (57.7 vs 69.4). Moreover, girls and boys with shorter sleep duration (≤6 h compared to ≥ 9 h) had lower HEI-2015 scores (-1.03 [95% CI -2.74, -0.47; p < .01] and -1.78 [95% CI -3.15, -0.86; p < .001], respectively). Regarding the individual components of dietary quality, those with ≤6 h of sleep had lower scores particularly in vegetables, protein sources, added sugars and saturated fats for girls and boys compared to those with ≥9 h. These findings suggest sleep may be an important determinant of dietary practices within the Mexican children.

Estimating and differentiating maternal feeding practices in a country ranked first in childhood obesity.

OBJECTIVE: Mexico ranks first in childhood obesity worldwide. However, little is known about the factors influencing maternal feeding practices. The present study aimed to estimate the prevalence of feeding practices and explore associations between weight concern, weight perception, sociodemographic characteristics and those feeding practices. DESIGN: Cross-sectional. SETTING: North-eastern Mexico. PARTICIPANTS: Mothers aged ≥18 years who were in charge of feeding a singleton child aged 2-6 years with no endocrine disease or visible genetic malformations (n 507). Information on six maternal feeding practices, concern and perception of the child's weight and demographics were collected by interview. The mother's and child's height and weight were measured. The feeding practices questionnaire was subject to content, construct and convergent validity analysis. Then, mean feeding scores were obtained and prevalence and 95 % CI were determined for scores ≥3; multivariate logistic regression was performed. RESULTS: Not modelling (63·5 %; 95 % CI 59·2, 67·8 %) and pressuring to eat (55·6 %; 95 % CI 51·2, 60·0 %) were the most frequent feeding practices, followed by easy access to unhealthy foods (45·4 %; 95 % CI 40·9, 49·8 %) and child control (43·2 %; 95 % CI 38·8, 47·6 %). They prevailed despite concern about the child's excess weight or a perception of the child as overweight/obese. Education was associated with the highest number of practices (educated mothers used more pressuring to eat, less regulation and less easy access; or monitoring was less absent). CONCLUSIONS: The frequency of certain feeding practices needs to be improved. Emphasis on the child's weight concern, obesity perception and maternal education is essential for optimizing intervention planning.

Stages of Change for Mammography Among Mexican Women and a Decisional Balance Comparison Across Countries.

An analysis of the adoption of secondary preventive behaviors is significant in regions with disparities in mammography use and breast cancer survival. Therefore, we determined the cognitive factors and the degree to which they differentiate stages of change in mammography among Mexican women. We also compared the decisional balance performance at Mexico, Switzerland, South Korea, and the USA. A cross-sectional study was designed for women in the stages of precontemplation (n = 240), contemplation (n = 243), action (n = 205), maintenance (n = 311), and relapse (n = 348). We only considered those ≥40 years with no cancer history. We measured the pros, cons, and self-efficacy, among other components. The decisional balance was estimated, and the result was transformed into T-scores. Odds ratios (OR) and 95% confidence intervals (CI) were estimated with multinomial logistic regression using precontemplation as the reference group. The decisional balance distinguished stages partially: in contemplation, the OR was 1.26 (95%CI 1.08, 1.47) and in maintenance, 1.34 (95%CI 1.13, 1.59); in action and relapse, the statistical significance was marginal (p < 0.10). The decisional balance T-score performance registered variations among countries. Additionally, the effect of self-efficacy progressively ascended from contemplation to action and maintenance (OR = 1.29 [95%CI 1.05, 1.58], 1.53 [95%CI 1.20, 1.96], and 2.48 [95%CI 1.82, 3.39], respectively). Furthermore, risk perception and severity did not have an effect on stages of change among Mexican women. Recognition of what provokes action in a population is a key factor in the efficacy of screening programs. Variations among countries highlight the necessity for importance of investigating cognitive determinants for mammography in specific areas.

Prevalence and Determinants of Repeat Mammography Among Women from a Developing Country.

Failures in repeat mammography decrease the potential benefits of screening; however, it is notable that the recent use of mammography is more frequently studied than repeat use. We estimated the prevalence and analyzed determinants for repeat mammography among women from Mexico, a developing country of Latin America. It was a two-stage study with an initial cross-sectional design (n = 1045) and a final case-control design that involved women of at least 45 years of age with no history of breast, ovarian, or uterine cancer. Case subjects were those with three or more mammograms in the last 5 years, with the last one carried out within the last two years (n = 444); control subjects included those who underwent ≥3 mammograms throughout their life with the most recent carried out >2 years ago (n = 444). Through interviews, we evaluated context-dependency, fulfillment of expected outcomes, self-efficacy, and risk perception, among other factors. We estimated the prevalence with 95 % confidence intervals (CI), and odds ratios (OR) using multivariate binary logistic regression. The prevalence of repeat mammography was 40.4 % (95 % CI 37.4-43.4). Self-efficacy demonstrated the highest effect on repeat use (OR 7.7, 95 % CI 4.7-12.6), followed by awareness context-dependency (OR 4.9, 95 % CI 3.3-7.2), the use of Papanicolaou testing (OR 3.5, 95 % CI 2.3-5.2), the fulfillment of expected waiting time outcome (OR 2.4, 95 % CI 1.2-4.7), and context-dependency related to self-referral/health provider referral (OR 2.4, 95 % CI 1.7-3.4), independent of risk perception, age, education, and positive emotional state of mind. The study showed a need for increasing the prevalence of promoting awareness of the determining factors of repeat mammography, which is a necessary component in the early detection of breast cancer.

Nutritional care, time period since diagnosis, demographics and body mass index in HIV/AIDS patients.

BACKGROUND: Nutritional status and nutritional care have long been ignored among HIV/AIDS patients. Furthermore, in Mexico there is no information on potential factors favoring weight increase in such population. OBJECTIVE: To assess the association between the time period since diagnosis, demographics and BMI in different categories of patients with HIV/AIDS in Monterrey, Mexico. In addition, to provide information on overweight/obesity prevalence and nutritional care referral. MATERIAL AND METHODS: This was a cross-sectional study of HIV/AIDS positive patients receiving outpatient secondary care (n = 231). Nutritional care referral, time period since diagnosis and demographic data were obtained by interview. A standardized and registered dietitian collected anthropometrics measures. Binary multiple logistic regression was used to evaluate the association between increasing BMI categories and variables of interest. RESULTS: Mean patient age was 40.6 ± 11.2 years, 87% were male, 79.2% were economically active, 65% were single and 60% had less than a college education. The average time since diagnosis was 6.5 ± 5.4 years. Overweight and obesity prevalence were 35.8% and 12.5%, respectively. Only 18% of patients had ever been referred for nutritional care. The time period since diagnosis, the sum of skinfold measurements and the waist-to-hip ratio, were significantly predictive of the BMI category (normal/underweight vs. overweight/obese), when controlling for nutritional care referral and daily carbohydrate intake; age and marital status were not associated with BMI category. CONCLUSIONS: Identification of predisposing factors to overweight/obesity among HIV/AIDS patients constitutes a significant step for providing nutritional care, of the same importance as the load or CD4+ count, especially nowadays, with more common increased survival rates and consequently, longer lives with the disease.

Idealistic, realistic, and unrealistic expectations of pharmacological treatment in persons with type 2 diabetes in primary care.

Introduction: Information on treatment expectations in diabetes is scarce for Mexican and Latino populations. We determined idealistic, realistic, and unrealistic expectations for metformin, insulin, and glyburide in primary care. We also explored the association between sociodemographic attributes, time since diagnosis, and expectations. Methods: This was a cross-sectional study conducted during 2020-2022 in governmental primary care centers. We consecutively included persons with type 2 diabetes aged 30-70 years under pharmacological medication (n = 907). Questions were developed using information relevant to expectation constructs. Data were collected by interview. We used descriptive statistics, a test of the difference between two proportions, and multivariate ordinal logistic regression. Results: A high percentage of participants would like to have fewer daily pills/injections or the option of temporarily stopping their medication. Realistic expectations ranged from 47% to 70%, and unrealistic expectations from 31 to 65%. More insulin users wished they could take a temporary break (p < 0.05) or would like to be able to change the route of administration (p < 0.001) than metformin users. More persons with diabetes on insulin expected realistic expectations compared to those on metformin or glyburide (p ≤ 0.01). Being able to interrupt medication upon reaching the glucose goal was higher in combined therapy users (p < 0.001). Conclusion: Time since diagnosis, place of residence, sex, and diabetes education were factors associated to expectations. Management of expectations must be reinforced in primary care persons with type 2 diabetes undergoing pharmacological medication.

Self-Perception of Body Weight in Schoolchildren in Northeastern Mexico.

Mexican schoolchildren are among the individuals most affected by obesity in the world. It has been observed that body-image dissatisfaction has increased in children. We evaluated their body weight perception and its relationship with actual weight; we compared this variable on three different scales according to age and sex and determined the sensitivity and specificity of these scales. This cross-sectional study was conducted with students from public and private schools in Northeastern Mexico. Boys and girls aged 6-12 years (n = 533) were included in this study. To assess the body weight perception, the following scales were used: (A) Collins (figure rating scale), (B) Eckstein (parents' perceptions of their child's weight and health scale), and (C) Truby and Paxton (children's body image scale). Agreement was evaluated using the Cohen's kappa test, determining the sensitivity and specificity. Girls and children aged 10-12 years were more likely to perceive themselves adequately (their self-perception corresponds to the figure that indicates their weight status). The children showed increased body-image distortion in the three scales. In terms of sensitivity and specificity, children with overweight or obesity were more precisely identified in scale A, whereas a healthy weight was more clearly identified in scale C.

Differences in Social Determinants of Health between Urban Indigenous Migrants and Non-Indigenous People in North-Eastern Mexico: An Analysis to Prioritize.

The degree to which social determinants of health differ between indigenous migrants and non-indigenous people born and raised locally is currently unknown. We compared social determinants of health between indigenous migrants and non-indigenous people from urban north-eastern Mexico. Additionally, we ranked priorities for addressing the negative social determinants of health. This was a population-based comparative cross-sectional study (n = 235 indigenous migrants and 168 non-indigenous people). A two-stage non-random sampling was carried out from June to August of 2019. Heads of households ≥18 years and those with the ability to communicate in Spanish were recruited house by house. Structural and intermediary determinants of health were identified according to the World Health Organization Conceptual Framework and priorities were ranked using Z-scores. Being a migrant indigenous increased 1.6 times the odds of low education (95% CI = 1.1, 2.4). In addition, the migrant indigenous status increased the odds of poor housing, unhealthy behaviour and low social cohesion (p < 0.05). Housing, behaviours and health service accessibility were top priorities for indigenous migrants and structural determinants for non-indigenous people. The findings show that the right to access the social determinants of health has not yet been guaranteed for indigenous communities.

Multiple Unhealthy Behaviors Share Equivalent Profiles of Readiness for Change in Patients with Type 2 Diabetes.

Few studies have considered more than one behavior, despite the tendency towards multiple behaviors, and there are none that have focused on a Latino population. We determined the concurrence of four unhealthy behaviors related to glycemic control and identified common cognitive factors at advanced stages of readiness for change in patients with type 2 diabetes treated in primary care. A cross-sectional study was carried out during August-December 2018 in northeastern Mexico. We consecutively included patients between 20 and 70 years who were without medical contraindication, physical impediment against exercise, pregnancy and edentulism, among other selection criteria (n = 407). Stages of behavior were measured according to the Transtheoretical Model. Pros, cons, self-efficacy, susceptibility, and severity data were collected by interview. Statistical analysis consisted of descriptive statistics and multiple logistic regression. A total of 36.7% exhibited more than one unhealthy behavior in precontemplation or contemplation (no interest or some interest in changing consumption of refined sugars and saturated fats, exercise, or oral hygiene behavior). Cons (p < 0.05) and self-efficacy (p < 0.001) were common to all four unhealthy behaviors, independent of potential confounders. Studies like ours facilitate the recognition of individuals with multiple unhealthy behaviors who share equivalent profiles of readiness for change before implementing public health programs.

[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.

Factors associated with abandoning exclusive breastfeeding in Mexican mothers at two private hospitals.

BACKGROUND: Exclusive breastfeeding (EBF) has multiple benefits for both the child and the mother; however, there is little data regarding the reason why Mexican mothers with a high socio-economic level abandon EBF before 6 months, and there is limited information about the practice of breastfeeding in private hospitals. The objective was to identify the factors associated with the cessation of exclusive breastfeeding in Mexican mothers at two private hospitals. METHODS: A cross-sectional study was conducted with 218 upper-class mothers selected according to their place of residence by geographic location, socio-economic level, and pediatric consultations cost. They were over 18 years old and with children aged 6 to 24 months. Data were collected between July and November 2016 by face to face interview using a structured questionnaire while the mothers waited for the pediatric postnatal care consultation in two private hospitals in northeastern Mexico. Exclusive breastfeeding was measured according to World Health Organization (WHO) recommendations, which consist of providing only breast milk for the first 6 months of life. Chi-squared tests and multivariate logistic regression were performed. RESULTS: Mean maternal age was 31.4 years (SD of 4.4) and most of the participants had an undergraduate education, were married, and worked outside the home. The prevalence of exclusive breastfeeding at 6 months was 28%. Upper-class working mothers are less likely to continue breastfeeding. There was a negative association with employment (AOR 13.69; 95% CI 1.59, 111.11), bottle use in the first 6 months (AOR 7.93; 95% CI 3.07, 20.48), and a low level of knowledge (AOR 2.18; 95% CI 1.04, 4.56). After 6 months, only 61 mothers (28%) maintained exclusive breastfeeding. CONCLUSIONS: Knowledge level, bottle use, and employment are associated with premature cessation of EBF in Mexican upper-class mothers, attending two private hospitals. There was a high percentage of breastfeeding cessation in the sample. It is necessary to reinforce a strategy that coordinates the action of the different laws, regulations and programs affecting the exclusive breastfeeding practice, in order to adequately promote breastfeeding and support mothers in both public and private sectors.

Assessment of multiple intelligences in elementary school students in Mexico: An exploratory study.

Multiple Intelligence (MI) helps to evaluate the brain processes of individuals. Identifying the types of multiple intelligence can help teachers to understand their students better. Several studies have identified MI in school children; nevertheless, in Mexico, these studies have been scarce. Therefore, the objective of this study was to analyze the differences of MI between genders and the grades-in-school of Mexican elementary schoolchildren. In an effort to investigate the differences of MI in elementary school children in Mexico, we provided a self-administered questionnaire to 161 Mexican students. Overall, our findings showed that the students' mean averages in the eight categories of MI were similar in both genders; in fact, the only significant differences in gender were found in intrapersonal intelligence (males reporting higher intrapersonal differences than females). No other significant differences in MI were found, nor were there interaction effects between gender and the grade in school. In summary, these results give us an understanding that the different types of MI may not be that well implemented in elementary school children.

Lifestyle, Quality of Life, and Health Promotion Needs in Mexican University Students: Important Differences by Sex and Academic Discipline.

Few studies have evaluated and contrasted the lifestyles and quality of life of university students by academic discipline. We compared university students' lifestyle and quality of life, and schools' compliance with health promotion guidelines. Then, needs were ranked and prioritized. This was a cross-sectional study carried out in a public university in Northeastern Mexico. Higher education students with no visual or hearing impairment from six different academic disciplines were included (N = 5443). A self-administered and anonymous questionnaire was applied that included the HPLP (Health-Promoting Lifestyle Profile) and SF-12 scales. A check list was employed for measuring 26 on-site schools' compliance with health promotion guidelines, and needs were ranked using Z-scores. The mean lifestyle was 53.9 ± 14.8 and the mean quality of life was 69.7 ± 5. Men had healthier lifestyles with more exercise and better stress management. The mean compliance with health promotion guidelines was 58.7%. Agricultural Sciences students had the highest need for improving both lifestyle and quality of life. Arts, Education, and Humanities, Engineering and Technology, and Social and Administrative Sciences schools ranked first in need for health promotion actions. The methodology used allowed hierarchization of areas requiring planning and implementation of specific actions, and the results indicated that healthy lifestyles and quality of life should be a priority.

[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.

Determinants of the use of breast cancer screening among women workers in urban Mexico.

INTRODUCTION: This case-control study aimed to determine critical factors influencing the use of clinical breast examination and mammography among women workers in Monterrey, Mexico. METHODS: We determined case and control status from survey results. Cases were defined in accordance with the guidelines of the Official Mexican Standard as lack of at least one clinical breast examination during the past year by surveyed women. For women older than 40 years, cases were further defined as lack of at least one mammogram in the previous 2 years and, for women older than 50, lack of a mammogram in the previous year. Controls were defined as adherence by surveyed women to these guidelines. Participants (N = 306 clerks aged 18-60) provided information about their practices, knowledge, and perceptions regarding breast cancer screening. Factors identified by odds ratio analysis as significantly different between cases and controls were analyzed by multivariate logistic regression. RESULTS: Survey participants' knowledge about the utility of breast self-examination (odds ratio, 6.0; 95% confidence interval, 1.0-33.9), perception that the health care system has enough equipment and personnel for clinical breast examination (odds ratio, 4.7; 95% confidence interval, 1.7-13.2), and perception that they have enough time to wait for and receive clinical breast examinations (odds ratio, 2.5; 95% confidence interval, 1.1-5.8) significantly predisposed women to use screening services independent of years of formal education, number of pregnancies, number of living children, hours worked per week, and monthly family income. CONCLUSION: Perception of organizational and structural factors played a significant role in screening use. Our findings have implications for the general population, provider practices, community interventions, and future development of strategies to increase use of screening services in similar locales.

Percepción e intención de practicar la lactancia materna en adolescentes del noreste de México / Perception and intention to practice breastfeeding in adolescents in northeastern Mexico

Resumen: Objetivo: Analizar la percepción e intención de práctica de la lactancia materna (LM) en adolescentes de ambos sexos que aún no han sido padres. Material y métodos: Se efectuó un estudio cualitativo basado en la teoría fundamentada y siguiendo el criterio de la saturación empírica. Se realizaron 21 entrevistas semiestructuradas a estudiantes entre 15 y 18 años de edad en preparatorias de la ciudad de Monterrey, Nuevo León, México. Resultados: Se identificaron cuatro patrones sobre la percepción e intención de practicar la LM: tradicional; indecisa; rechazo; e igualitarista. Conclusiones: La intención de apoyar o practicar la LM se relaciona a identidades de género y al proyecto de tener hijos y/o un proyecto de desarrollo personal-laboral. Existe convergencia entre distintas percepciones e intenciones de practicar la LM en el futuro, lo cual apunta a revisar las políticas en la materia.

Abstract: Objective: To analyze the perception and intention to practice breastfeeding (BF) in adolescents of both genders who have not yet been parents. Material and Methods: This was a qualitative study based on grounded theory with empirical saturation. Twenty-one semi-structured interviews were conducted with students between 15 and 18 years of age in preparatory schools in Monterrey, Nuevo León, Mexico. Results: Four patterns on the perception and intention of practicing breastfeeding were identified: traditional; undecided; rejection; and egalitarian. Conclusions: The intention to support or practice BF is related to gender identities and the project of having children and / or a personal- labor development project. There is convergence between different perceptions and intentions to practice BF in the future, which aims to review policies in this area.

[Differences in the use of family planning methods by adolescent females according to the education model utilized during pregnancy. Monterrey, Mexico]. / Diferencias en la utilización de métodos de planificación familiar por mujeres adolescentes en Monterrey, Mexico, segújn el modelo de educación sanitaria utilizado.

BACKGROUND: The objective was to compare the use of family planning methods during the immediate postpartum period and two years following childbirth among the adolescent females who had followed two different intervention programs during their pregnancies. METHODS: A quasi-experimental study was designed. A total of 62 pregnant adolescents were selected to comprised two intervention groups, the PRECEDE model and the Health Belief model (MCS) groups. Non-parametric statistical tests were employed and 95% confidence intervals estimated. RESULTS: The average starting knowledge in the MCS groups was 69.12 points (95% CI 63.27-74.97) and ending 89.71 points (95% CI 86.24-93.17), while the starting knowledge for the PRECEDE group was 49.39 points (95% Cl 42.24-56.54) and ending 75.25 points (95% CI 71.12-79.38). IN the immediate postpartum, 93% (95% CI 83.5-100) of the adolescents in the PRECED group accepted the use of a family planning method similar to that employed by the MCS group, of 94.2 (95% CI 86.3-100). As regards the continued use of the method, that is, two years later, the PRECEDE strategy had a greater effect that the MCS strategy, respectively 92% (95% Cl 82-100) and 72% (95% CI 56.9-87.1). CONCLUSIONS: A difference was found to exist between models as regards the use of family planning methods 2 years following childbirth. The PRECEDE program is proposed as the education strategy for preventing a second pregnancy among adolescent females.

[Discrepancy in attitudes toward diabetes between physicians and diabetic patients attending the private, social security or state medical services]. / Comparación de actitudes hacia la diabetes entre médicos y pacientes diabéticos usuarios del sector privado, seguridad social o servicios de salud del Estado.

OBJECTIVE: One of the biggest challenges of the Mexican Health System is to get results of the treatment goals in diabetic patients, which can be frustrated by physician and patient's attitudes. The present study evaluates divergence of attitude of health providers and diabetic patients according to health sectors: private, social security or State medical services. MATERIAL AND METHODS: They contributed 255 physicians and 255 diabetic patients in ambulatory care from three health sectors: private, social security and welfare (employees and patients were exclusive providers and patients of corresponding institutions). The Diabetes Attitude Scale 3 (DAS-3) was applied, a self-administered instrument used to compare attitudes between health care professionals and patients. Discrepancies were analyzed with t-tests, chi2, one-way ANOVA and post hoc multiple comparisons for observed means based on the Tukey test. RESULTS: Physician and patient's attitudes differed in all scales except for psychosocial impact of diabetes, which was independent of the health sector. Attitudes were not alike with respect to severity of the disease, value of tight control of glucose levels and patient autonomy, with no distinction of health sector. Discrepancy of need for special training was the only attitude that varied by health sector (F = 4.1; p = 0.02); it was similar for the private and social security sector but different for the welfare sector. CONCLUSIONS: All health sectors should recognize attitude discrepancies between doctors and patients to favor collaborative strategies that benefit a better control of the disease.

[Waiting time? Triage. An alternative in emergency department]. / Tiempos de espera? El triage. Una alternativa en el Departamento de Emergencias.

OBJECTIVE: To evaluate the impact of a triage system on waiting times and patient satisfaction of one secondary care hospital emergency department (ED). MATERIAL AND METHODS: This was a quasiexperimental study. All patients > 15 years demanding emergency care of the selected hospital were included (n = 1,010); a sample was drawn for applying a satisfaction questionnaire (n = 198). The intervention, in charge of trained nurses, consisted of a classification system based on the national scale of the United Kingdom of five categories. The real waiting time was measured from registration to initiation of care. The analysis included descriptive statistics, the sign test and multiple logistic regression analysis. RESULTS: Seventy-one percent of the patients attended the ED spontaneously. The first three categories, considered real emergencies, engaged more than half of the patients. Immediate care was received in category 1 similar to the standard (p > 0.05); the real waiting time in the rest of categories was less than the expected standard (p < 0.01). Sixty-three percent was very satisfied with the waiting time from triage to initiation of care and 74%, with overall care of the ED. Satisfaction with nursing care and waiting time from arrival to initiation of medical care were determinants for satisfaction with overall care, independent of sex and age. CONCLUSIONS: The triage system largely challenged the not easy ED demand and its waiting times in addition to patient satisfaction. This simple classification scale allows improvement in managing emergency services and cases, the benefits can be potentially extended to other health care services.