Ana L. Salcedo Rocha

Explanatory models of diabetes in the U.S. and Mexico: The patient–provider gap and cultural competence

Successful management of type 2 diabetes requires support and collaboration between diabetic patients, their health care providers, family and community. Using data collected in 1994-2001, we describe illness beliefs of physicians, patients, and representative samples of community members in the US and Mexico. We test whether differences in conceptualizations of diabetes are greater across national and linguistic boundaries or between physicians and lay groups. Interviews were conducted in southern Texas on the Mexican border and in Guadalajara, Mexico. Culturally appropriate interview materials were developed with a mixed-methods approach. Qualitative interviews elicited beliefs about causes, risks, symptoms, and treatments for diabetes and salient themes were incorporated into structured interviews. A cultural consensus analysis was used to verify salient themes within each of the six samples. The consistency in responses in each of the six samples indicated a shared core of beliefs that transcended individual variations. The greatest differences occurred between physician and lay samples; patient and community models were more similar to one another than to the physician models. Differences between physicians and patients may affect optimal management of diabetes, but these differences do not appear to be simply a function of differences in national culture and language, as the largest differences occurred in Mexico. This suggests that rather than cultural competence per se, formal educational levels and class differences may also play an important role in patient understanding and the gap in patient-provider understanding.

The relative effect of self-management practices on glycaemic control in type 2 diabetic patients in Mexico

Objective: In this study, we examined the relative impact of self-management activities on glycaemic control in a population at high risk for developing complications. Methods: Patients diagnosed with diabetes mellitus of at least 1 year in duration at 30 years of age or older were sampled from the Instituto de Mexico Seguro Social (IMSS) Family Medicine Clinics in Guadalajara, Mexico (n=800). Demographic, clinical and health behaviour variables were used to predict good/poor glycaemic control, as measured by haemoglobin A1c (A1C). Results: Most (72.24%) patients had poor control (A1C≥7.0). Hyperglycaemia was significantly associated with factors not under patient control, such as having diabetes for a longer time [odds ratio (OR)=2.40, 95% confidence interval (CI) 1.39, 4.14], having a first-degree relative with diabetes (OR=1.52; 95% CI 1.06, 2.19), and being prescribed anti-diabetic medications, e.g. insulin (OR=7.88, 95% CI 2.42, 25.63). After controlling for these variables, the only self-management variable that reduced the likelihood of hyperglycaemia was following a special diet (OR=0.49; 95% CI 0.32, 0.76). Furthermore, depression had an important effect on self-management, as those with lower levels of depressive symptoms were more likely to follow a diet and exercise. Discussion: While patients in this population have little control over many factors associated with glycaemic control, an important exception is diet. However, because of the adverse effect of depression on dieting, both depression management and dietary education are important for this population.

Variation and Persistence in Latin American Beliefs About Evil Eye

In a comparative study of evil eye (mal de ojo), we demonstrate a methodology appropriate for the study of cultural transmission of beliefs. We studied four diverse populations with historical links to Spain: Puerto Ricans in Connecticut, Mexican Americans in south Texas, Mexicans in Guadalajara, and rural Guatemalans. Using agreement on ideas or themes about evil eye within and across sites, we identify specific ideas that may have persisted through time. The relevance of specific themes was estimated with a cultural consensus analysis. Mal de ojo was widely recognized in each community and higher community prevalence was associated with higher agreement on reported causes, symptoms, and treatments. Each community exhibited a distinct model for ojo, although models were highly similar between sites. Agreement among individuals and across communities suggests a pan-regional description for mal de ojo and possible content of older versions of these beliefs in Latin America.

Reanimación cardiopulmonar presenciada en el contexto hospitalario mexicano: un estudio de caso en pacientes y familiares

En este articulo se plantea el estudio de la reanimacion cardiopulmonar presenciada (RCPp) como objeto de analisis en el marco de las reconfiguraciones culturales actuales. De la opinion de 90 pacientes que ingresaron a Urgencias y 90 familiares que aceptaron participar en una encuesta, se encontro consenso cultural entre los familiares y pacientes a favor de la RCPp. Se rescata esta experiencia a partir de una mirada que va mas alla de la racionalidad tecnica, para establecer algunas bases que puedan dar origen a una politica humanistica que reconozca el derecho a la presencia de los otros (familiares) y del paciente en los lugares de acogida

Experiences of motherhood: Unmet expectations of immigrant and native mothers, about the Portuguese health system.

INTRODUCTION AND OBJECTIVES This study aims to identify the unmet expectations of Portuguese and immigrant women, for the National Health System, during pregnancy, childbirth and postpartum. PARTICIPANTS AND METHODS This is a qualitative, exploratory, descriptive study, using semi structured interviews and content analysis proposed by Bardin, with the categorization of verbatim interviews of 82 Portuguese and immigrant women, supported by NVivo 10. RESULTS Major emerging categories of unmet expectations referred to the accessibility, human resources, incentives to maternity, physical and environmental conditions, and organization of the health system. There was a greater representation of dashed expectations among immigrant users when compared to Portuguese women. CONCLUSION The areas of greatest shortage in meeting the needs of users are: surveillance by experts in the health centre and maternity hospital; reduced waiting time for pregnant women in consultations; home visits; more incentives to maternity; longer duration of hospitalization; higher number of professionals and presence of a companion with the parturient.