Javier E. de Alba García

Variation in Asthma Beliefs and Practices Among Mainland Puerto Ricans, Mexican-Americans, Mexicans, and Guatemalans

This study reports on community surveys of 160 representative Latino adults in Hartford, CT; Edinburg, TX; Guadalajara, Mexico; and in rural Guatemala. A 142-item questionnaire covered asthma beliefs and practices (e.g., causes, symptoms, and treatments). The cultural consensus model was used to analyze the agreement among respondents within each sample and to describe beliefs. Beliefs were then compared across the four samples. Analysis of the questionnaire data shows that there was overall consistency or consensus regarding beliefs and practices among individuals at each site (intraculturally) and to a lesser extent across respondents of all four different Latino cultural groups (i.e., interculturally). This pattern of response is indicative of a shared belief system among the four groups with regard to asthma. Within this shared belief system though, there is systematic variation between groups in causes, symptoms, and treatments for asthma. The most widely recognized and shared beliefs concerned causes of asthma. Notable differences were present between samples in terms of differences in beliefs about symptoms and treatments. The biomedical model is shown to be a part of the explanatory model at all sites; in addition to the biomedical model, ethnocultural beliefs such as the humoral (“hot/cold”) aspects and the importance of balance are also evident. The Connecticut Puerto Ricans had a greater degree of shared beliefs about asthma than did the other three samples (p<0.00005). It was concluded that the four Latino groups studied share an overall belief system regarding asthma, including many aspects of the biomedical model of asthma. In addition, traditional Latino ethnomedical beliefs are present, especially concerning the importance of balance in health and illness. Many beliefs and practices are site-specific, and caution should be used when using inclusive terms such as “Hispanic” or “Latino,” since there is variation as well as commonality among different ethnic groups with regard to health beliefs and practices.

A Cross-Cultural Approach to the Study of the Folk Illness Nervios

To systematically study and document regional variations in descriptions of nervios, we undertook a multisite comparative study of the illness among Puerto Ricans, Mexicans, Mexican Americans, and Guatemalans. We also conducted a parallel study on susto (Weller et al. 2002, Culture, Medicine and Psychiatry 26(4): 449– 472), which allows for a systematic comparison of these illnesses across sites. The focus of this paper is inter- and intracultural variations in descriptions in four Latino populations of the causes, symptoms, and treatments of nervios, as well as similarities and differences between nervios and susto in these same communities. We found agreement among all four samples on a core description of nervios, as well as some overlap in aspects of nervios and susto. However, nervios is a much broader illness, related more to continual stresses. In contrast, susto seems to be related to a single stressful event.

Regional variation in Latino descriptions of susto.

Susto, a folk illness notrecognized by biomedical practitioners as adisease, is now formally part of the diagnosticclassification system in psychiatry as a“culture-bound syndrome.” Susto has beenreported among diverse groups of LatinAmericans, but most of those reports areseveral decades old and many were conducted inIndian communities. This study focuses oncontemporary descriptions of susto anduses a cross-cultural, comparative design todescribe susto in three diverse Latinopopulations. Mestizo/ladino populations wereinterviewed in Guatemala, Mexico, and southTexas. An initial set of open-ended interviewswas conducted with a sample of “key” informantsat each site to obtain descriptive informationabout susto. A structured interviewprotocol was developed for use at all threesites, incorporating information from thoseinitial interviews. A second set of structuredinterviews was then conducted with arepresentative sample at each site. Resultsindicate a good deal of consistency in reportsof what susto is: what causes it, itssymptoms, and how to treat it. There appear tobe, however, some notable regional variationsin treatments and a difference between pastdescriptions and contemporary reports ofetiology.

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.

Beliefs about AIDS in five Latin and Anglo‐American populations: The role of the biomedical model

Abstract This paper focuses on variability in beliefs about AIDS among Latin Americans, as compared with middle class Americans. Four geographically dispersed groups of Latin Americans were chosen for study as well as a middle class, largely Anglo‐American population. Coherent sets of beliefs were found at each site, and despite tremendous variability among the five populations, beliefs were remarkably similar across sites. The biomedical model is widely shared, and the critical variable in the extent to which it is understood is community prevalence of AIDS.

Prevalencia del síndrome de agotamiento profesional (burnout) en médicos familiares mexicanos: análisis de factores de riesgo

Introduction Burn-out syndrome refers to a psycho-social problem that is common among physicians.

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.

Conocimiento y uso de las plantas medicinales en la zona metropolitana de Guadalajara

Se destaca el conocimiento popular de �herbolarios, hierberos, yerberos o yerbateros� sobre las plantas medicinales utilizadas en mercados de la Zona Metropolitana de Guadalajara (zmg), en comparacion con estudios fitoquimicos. Se rescatan datos sobre la practica medica herbolaria con tecnicas de antropologia cognitiva. Las especies mas utilizadas son: arnica, cuachalalate, tila, gordolobo, salvia, cola de caballo y boldo. Los resultados demuestran que existe consenso sobre las plantas medicinales que se usan, su efectividad y la conveniencia economica en contraste con las medicinas de patente. Se enfatiza la importancia de la comprension del uso y significado de la enfermedad, y de la adquisicion del conocimiento a traves de generaciones por parte de los hierberos como un patron de conocimiento cultural

A scientific approach to the definition of quality in medical care: a model for Mexican reality

This paper analyzes the problem of quality of medical care and its evolution in various health service institutions. It concludes that quality strategies for countries like Mexico should be of the decentralized/participant type, and that all quality programs in medical care should include five fundamental elements: evaluation, monitoring, design, development, and organizational change.

Análisis de los posibles factores de riesgos sociodemográficos y laborales y prevalencia del síndrome de agotamiento profesional (burnout) en odontólogos mexicanos

Resumen Objetivo Determinar la prevalencia del sindrome de agotamiento profesional (burnout) en odontologos y analizar los posibles factores de riesgos sociodemograficos y laborales. Metodos Estudio observacional, descriptivo y transversal, mediante el censo del personal odontologico de la Zona Metropolitana de Guadalajara, Mexico, del Instituto Mexicano del Seguro Social, de la Universidad de Guadalajara y de los que ejercen la practica privada, en el que participaron 203. Se les aplico una ficha de identificacion y el Maslach Burnout Inventory-Human Services Survey en formulario autoaplicable. Las estadisticas descriptivas y el analisis inferencial se realizaron mediante SPSS 15.0 y EpiInfo V6.1. Resultados Se logro el 88,3% de respuesta. La frecuencia del sindrome de agotamiento profesional (burnout) detectada es del 52,2%. Se obtuvieron diferencias significativas en funcion de la contratacion definitiva. Se observo correlacion negativa entre las subescalas agotamiento emocional y despersonalizacion y correlacion positiva con la falta de realizacion personal en el trabajo. Conclusiones El sindrome de agotamiento profesional (burnout) es frecuente (52,2%) entre los odontologos. Sus posibles factores de riesgo: laborar en una institucion publica, ser varon mayor de 40 anos sin pareja estable o con mas de 15 anos en pareja, no tener hijos, ser especialista con 10 anos o mas de antiguedad laboral y en el puesto actual de trabajo, turno matutino, contratacion definitiva y tener otro trabajo. La afectacion del agotamiento emocional se comporta como el sindrome. Los niveles medios de las subescalas se encuentran en general cerca de la normalidad. Se encontro una correlacion negativa entre las subescalas agotamiento emocional y despersonalizacion y positiva entre la falta de realizacion personal en el trabajo con la presencia del sindrome. Lo anterior nos lleva a considerar la necesidad de establecer medidas preventivas en el ambito laboral y personal o realizar programas de intervencion individuales, sociales u organizacionales para reducir la prevalencia encontrada.OBJECTIVES To determine the prevalence of professional exhaustion syndrome (burnout) in dentists and to analyze possible sociodemographic and occupational risk factors . METHODS An observational, descriptive and cross-sectional survey of 203 dental staff of the Metropolitan Zone of Guadalajara, Mexico, from the Mexican Social Security Institute, University of Guadalajara, and those in private practice. A self-reported identification form and the Maslach Burnout Inventory-Human Services Survey were used to gather data. Descriptive statistics and inferential analyzes were performed using SPSS 15.0 support and EpiInfo V6.1. RESULTS There was an 88.3% response. Professional exhaustion syndrome (burnout) was detected in 52.2% of them. Significant differences were obtained depending on the employment contract. A negative correlation was observed between the subscales emotional exhaustion and depersonalization, and a positive one between the lack of personal accomplishment at work. CONCLUSIONS Professional exhaustion syndrome (burnout) is common (52.2%) for dentists, their possible risk factors: working in a public institution, being male, over 40 years, without a regular partner, and with more than 15 years with a partner, not having children, being a specialist with 10 years or more in an institution and the current job, morning shift, permanent recruitment, and having another job. The involvement of emotional exhaustion behaves like the syndrome. Average levels of the subscales are generally near normal. A negative correlation was found between the subscales emotional exhaustion and depersonalization, and positive between the lack of personal fulfillment at work with the presence of the syndrome. This leads us to consider the need for preventive measures in the workplace and personnel, as well as intervention programs at an individual, social or organizational level to reduce the prevalence found.