Patricia Constantino-Casas

Socioeconomic factors and low birth weight in Mexico.

BackgroundLow birth weight (LBW) is a public health problem linked to lack of equity in populations. Despite efforts to decrease the proportion of newborns with LBW, success has been quite limited. In recent years, studies focused on explaining how social factors influence this problem have shown that populations with greater inequities have a greater proportion of newborns with LBW.MethodsThe objective was to describe socioeconomic factors related to LBW adjusted by demographic, reproductive and health services variables in Mexico City. A case-control study was carried out in three hospitals with gynaecological and obstetrics services in Mexico City during the first half of 1996. During the recruiting period all children with LBW (cases), defined as newborns weighing <2500 grams, were matched with children born on the same day to control for time of birth. Upon arrival at the hospital for delivery, women were interviewed to determine if they met our inclusion criteria. Women with a history of chronic conditions and those with twin or multiple pregnancies were excluded. Variables with clinical and statistical significance were included in a multivariate model (logistic regression).ResultsWe found that low socioeconomic level was the most important risk factor for LBW and was independent of other factors, including those related to reproduction and nutrition, smoking, morbidity during pregnancy, accessibility to health services and prenatal care (OR 2.68; 95% CI 1.19, 6.03).ConclusionWe found that socioeconomic factors are relevant to LBW. However further research should be done in different population groups as well as developing precise ways of measuring socioeconomic factors and their role in reproductive health.

Socioeconomic factors associated with drug consumption in prison population in Mexico

BackgroundConsumption of illegal drugs is a public health problem in Mexico, and the prison population is a vulnerable group with higher rates of prevalence than in the general population. The objective of this study was to determine the main socioeconomic variables associated with drug consumption in the prison population.MethodsUtilizing data from the Second Incarcerated Population Survey carried out by the Centre of Research and Teaching of Economics (CIDE) in Mexico, a logistic model in two stages was developed. The first stage analyzed the determinants of habitual drug consumption by prisoners (prior to admittance into prisons), while the second stage of the model addressed drug consumption within prisons.ResultsPrevalence of drug consumption previous to incarceration was 28.5%, although once people were imprisoned this figure dropped to 7.4%. The characteristics that most heavily influenced against the possibility of habitual drug consumption prior to admittance to prison were: preparatory school or higher, being employed and having children; while the variables associated negatively were: male gender, childhood home shared with adults who consumed illegal drugs; abandoning childhood home; and having previous prison sentences. Once in prison, the negative conditions in there are associated with drug consumption.ConclusionsWork and study during incarceration, in addition to being instruments for rehabilitation, seem to exert an important positive association against drug consumption. However, this correlation seems to be minimized in the face of negative conditions of the penal institution; thus, public policies are necessary to improve the prisoners environment.

Survey on physicians' knowledge and attitudes towards clinical practice guidelines at the Mexican Institute of Social Security

OBJECTIVE A survey was organized to determine the general level of knowledge and attitudes of medical personnel towards clinical practice guidelines (CPG). METHODS A questionnaire modified from two validated instruments was used. Multi-stratified sampling was applied, and 1782 questionnaires were completed. RESULTS A total of 80.4% of physicians had regular employment contract, 8.6% managerial post and 9.3% temporary work contract. Average age and working time were 43.7 and 15 years respectively; 64.3% were male. It was reported that 47.9% participated in academic activities, 70.8% belonged to a medical association, 40.3% identified CPG as steps towards arriving at a diagnosis and/or treatment and 14.9% thought that CPG were norms. A total of 10.7% of the physicians believed that guidelines are based on scientific evidence, 10% perceived them as supporting tools, 10.8% had no knowledge of them, 65% said that they used them, 76.7% thought that personal experience was as important as CPG recommendations and 57.4% thought that CPG were necessary for good medical practice. Physicians preferred that CPG be produced by personnel from outside the Mexican Institute of Social Security, or who had followed validity criteria. CONCLUSIONS The majority of physicians considered CPG to be useful tools. It was evident that few knew where to acquire CPG, and this would lead to their limited use. Findings from this study enabled procuring a broader idea of the level of knowledge and attitudes of Mexican Institute of Social Security physicians towards CPG. This information is relevant when planning strategies for the purpose of sharing and implementing CPG.

Health and working conditions of pregnant women working inside and outside the home in Mexico City

BackgroundTo explore differences related to health and working conditions by comparing socio-demographic parameters, reproductive and prenatal care characteristics and working conditions among pregnant women who are employed outside the home (extra-domestic) while still performing a domestic workload versus those who perform exclusively domestic work in the home (intra-domestic).MethodsA cross-sectional study was carried out at Family Medicine Unit N 31 of the Mexican Institute of Social Security (IMSS) in Mexico City between April and July 2003. Interviews were conducted with 537 pregnant women engaged in either extra-domestic work plus intra-domestic tasks, or those performing strictly intra-domestic work. Information was obtained regarding their demographic status, prenatal care, reproductive, work characteristics, and health during pregnancy.ResultsOne hundred ninety-six (36.5%) of the interviewed women had paid jobs outside the home in addition to domestic tasks, while three hundred forty-one (63.5 %) engaged in exclusively intra-domestic occupations. Of the women with paid jobs, 78.6% worked as clerks. Among domestic tasks, we found that the greatest workload was associated with washing of clothes, and our micro-ergonomic analysis revealed that women who worked strictly inside the home had a higher domestic workload versus employed women (69.2 vs. 44.9%). When we analyzed the effect of work on health during pregnancy, we observed that women who worked strictly inside the home were at a higher risk for musculoskeletal and genitourinary symptoms than those employed outside the home.ConclusionThese findings suggest that the effect of intra-domestic work should not be ignored when considering womens health during pregnancy, and that greater attention should be paid to womens working conditions during intra and extra-domestic work.

Estudio de las necesidades de salud en atención primaria mediante el diagnóstico de salud de la familia

Objetivo Analizar las necesidades de salud en la poblacion adscrita al Instituto Mexicano del Seguro Social (IMSS). Diseno Estudio observacional, descriptivo y transversal. Emplazamiento La Unidad de Medicina Familiar numero 8 del IMSS en la ciudad de Tlaxcala, Mexico. Participantes Muestra de 1.200 familias por muestreo polietapico. El estudio se realizo entre octubre de 1999 y marzo de 2000. Mediciones principales Se ha aplicado el cuestionario «Diagnostico de salud de la familia», previamente elaborado y validado. Resultados El 19,2% de las familias tenia un nivel socioeconomico muy bajo y un 14,9% de los sujetos no tuvo derecho a la Seguridad Social. El 12,6% de las familias tenia al menos un miembro analfabeto. De acuerdo con el resultado del test de Apgar familiar, el 93% de las familias era functional y los dos tercios de las familias se clasificaron como nucleares. La cobertura de los programas de deteccion de cancer cervicouterino y de mama en las mujeres fue del 51,1 y el 36,9%, respectivamente. Solo en el 25% de la poblacion adulta se realizaron pruebas de deteccion de diabetes mellitus e hipertension arterial. El 10,9% de la poblacion refirio tener alguna enfermedad cronica. El 56,4% de las familias considero que la calidad de la atencion fue buena y solo el 18,13% estuvo satisfecho con la atencion recibida. Conclusiones El diagnostico de salud familiar es importante en el proceso de evaluacion de las necesidades de salud en la poblacion para la jerarquizacion de problemas, asi como para el desarrollo de los programas de salud que permitiran una mayor equidad en la atencion.