63rd Annual Meeting / LXIII Reunión Anual
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1 Actividad Fisica en el Adulto Mayor María de los Angeles Alatorre Esquivel; Juana Edith Cruz Quevedo, MCE Propósito del estudio El propósito del estudio fue describir el nivel de actividad física que realiza el adulto mayor de una colonia urbana de la ciudad de Nuevo Laredo, Tamaulipas. El diseño fue descriptivo (Polit & Hungler, 1999). El muestreo fue no probabilístico por conveniencia; el tamaño de muestra de 183 adultos mayores estimado para intervalo de confianza para media con un nivel de significancia de.05, para una prueba bidireccional. Métodos utilizados Se utilizó el Cuestionario de Actividad Física para Adultos Mayores (Vorrips et al., 1990). Para el análisis de los resultados se utilizó estadística descriptiva, la prueba de Kolmogorov- Smirnov. A través de la correlación simple de Spearman y U de Mann-Whitney se describió el comportamiento de la actividad física. Resultados La muestra estudiada presentó una mediana de edad de 68 años y una mediana de escolaridad de 6 años, el 54.1% fueron del sexo femenino y el 61.2% tenían pareja. La media de actividad física fue de 8.71 mets (DE = 2.93). Las actividades del hogar mostraron una media de 1.40 mets (DE = 0.69), ejercicio con una media de 1.83 mets (DE = 1.49) y actividades de tiempo libre con una media de 6.16 (DE = 2.69). La principal actividad de ejercicio fue la caminata (44.2%). La actividad física no mostró relación con edad, ni con escolaridad (p >.05). Los hombres realizan mayor ejercicio que las mujeres (U = , p =.00) pero las mujeres realizan mayor actividad del hogar (U = , p =.00). Las actividades del hogar y ejercicio mostraron diferencia por estado marital y presencia de enfermedad crónica (p =.00). Conclusiones y Recomendaciones: La actividad física en el adulto mayor de la ciudad de Nuevo Laredo, Tamaulipas es mas alta en comparación con los estudios revisados.este estudio confirmó empíricamente lo reportado por diversos autores respecto a asociación del género con el tipo de actividad física realizada. Los hombres realizan mayor ejercicio que las mujeres, pero las mujeres realizan mayor actividad del hogar. Se encontró que existen además otras diferencias que pueden estar modificando la actividad física de los sujetos. Al analizar la actividad física de acuerdo al estado marital y presencia de enfermedad crónica muestra diferencias estadísticamente significativas en actividades del hogar y ejercicio. Se recomienda explorar más ampliamente las diferencias por estado marital y presencia de enfermedad crónica. Se recomienda también comparar la actividad física del adulto mayor en diferentes poblaciones, ciudades fronterizas y no fronterizas. Es necesario empezar a promover la actividad física en el adulto mayor utilizando el conocimiento sobre ejercicio hasta ahora existente y continuar explorando el fenómeno en la población mexicana.
2 Addressing Client Understanding of HIV Disease Management in Southern New Mexico Veronica L Salcido-Harding; Michelle Valverde, PhD. Along the New Mexico/Mexico border, the service area of Camino de Vida Center for HIV Services (CdV), the provision of HIV/AIDS medical care is impacted by the instability typical of most underserved rural medical communities. Once in care, it becomes critical for persons living with HIV/AIDS to learn to effectively manage their HIV disease, which in turn promotes improved health outcomes. In light of the reality that the client is the constant in an unstable medical and social service arena, the need for a client-focused training series became evident. An assessment of client understanding of HIV disease management also supported this notion by illustrating that the traditional education clients were receiving as part of case management services, while beneficial, could be enhanced. Thus, the NM Border Health Initiative established the client educational series (CES). The objective of the CES is to increase client understanding of HIV disease management through a minimum of six client-targeted trainings per year. The evaluation of the CES consists of post-training assessments. Feedback from the assessments indicates that clients are very satisfied. They find the trainings to be informative and have provided numerous examples about how they plan to apply the information. Examples include being better prepared to communicate with family, friends, and community members about managing HIV, understanding how the virus works, and understanding treatment issues and the importance of adherence. Approximately 1/3, or 52, of CdV s 150 clients have attended at least 1 training since June 2003, resulting in an average of 8 clients per training. To date, 13 trainings have been completed, and 5 are pending, meeting the goal of 6 per year. One important lesson learned is that the CES is meeting the needs of a core group of clients; however, other avenues, such as newsletters and peer education are also being offered for clients who do not prefer group trainings. Providing the trainings in different communities when in a large rural area and making sure the trainings and materials are in both Spanish and English are also essential. Finally, evaluations completed at the end of the trainings are valuable in informing future topics. In conclusion, effective programs must be client-centered, and being clientcentered means continually evolving. An ongoing evaluation helps to ensure that the program continues to meet the needs of clients in the ever-changing arena of HIV. One policy recommendation for the state and/or federal level is to allow funds to be used for client trainings. Policy makers at the local level need to be responsive to the needs of clients, and one of the best ways to ensure this is to get their continuous feedback.
3 Alliance of Border Coalitions Naomi Fahrenkrug; Marge Bartoletti The Vision of the Alliance of Border Coalitions is a Safe and Healthy Border Communities, free of Drugs and Alcohol Abuse. The Mission is to Create safe and healthy border communities through collective action. The strategies to accomplish this are: 1) to form a bi-national alliance of border coalitions and networks, 2) to strengthen the capacity of local coalitions and networks along the border, 3) to promote multiple strategies over multiple sectors with the focus on environmental policy approaches to reduce alcohol and illegal drug problems. Community coalitions, more than any other entity, are poised to connect multiple sectors of the community, including businesses, parents, media, law enforcement, schools, faith organizations, health providers, social service agencies, and the government. By acting through a coalition, all of the partners gain a more complete understanding of the community's problems. Together, the partners organize and develop plans and programs to coordinate their anti-drug efforts. The result is a comprehensive, community-wide approach to substance abuse and its related problems in the border region. In July 2004 approximately 40 Drug Free Community Coalitions from the four border states of Texas, New Mexico, Arizona and California, met in Las Cruces, NM. The community leaders were challenged to form an umbrella organization, which was named the ALLIANCE of Border Coalitions, to unify as a voice concerning substance abuse issues unique to the border. The Alliance of Border Coalition s aim is to develop and sustain a strong, equitable effective binational alliance of border coalitions and networks to reduce substance abuse rates, alcohol abuse, and drug related problems. The US-Mexico Border Health Association (USMBHA) is the lead agency in the Alliance of Border Coalitions to assist in the development and implementation of an integrated system to improve and expand substance abuse prevention and treatment services to marginalized Latino youth ages Through the delivery of border-wide environmental prevention strategies, substance abuse will be addressed as a regional issue, will strengthening collaboration among communities, private and nonprofit agencies, Federal, State and Local governments as well as US-Mexico Border Organizations. The program will produce the following outcomes: Increase citizen participation and greater collaboration among all sectors of and organizations within a community Enhance community efforts to promote and deliver effective and culturally competent substance abuse prevention strategies Increase the capacity of partner coalitions to provide environmental prevention and education on substance abuse, particularly to marginalized Latino youth and to disseminate information about the program Assess the effectiveness of community substance abuse prevention initiatives directed toward youth, and assist Coalitions to adapt and evaluate effective environmental interventions Provide information about effective substance abuse prevention initiatives that can be replicated in other communities
4 An Environmental Health Resource Guide for Doña Ana County, New Mexico Thomas R. Ruiz The Environmental Health Committee (EHC) of the New Mexico Border Health Council identified the need for an environmental health resource guide for Doña Ana County, New Mexico. The committee saw many gaps in information for answers to various questions posed by the general public regarding environmental health issues. Members of the EHC, along with undergraduate and graduate student interns, then collected the necessary information to fill these gaps and created a frequently asked questions section. The bilingual guide, in its first printing, has been made available to the public at various state offices, health clinics, mutual domestic water associations and has been distributed at many health fairs throughout the county. The effort of developing such a guide demonstrates the worth of the EHC in identifying and addressing needs of the community and the resourcefulness of its members in creating such a valuable product.
5 Analysis of the Funding and Provision of Health Care to Immigrants after Welfare Reform: Local Consequences and Variation in New Mexico Lisa Cacari-Stone; Dan Reyna; Alice Salcido, Using a qualitative research design, this study addressed one overarching question: What are the local consequences of the 1996 PRWORA (Welfare Reform) on the funding and provision of health services to immigrants? This local level investigation will provide policy makers with an understanding of how the 1996 PRWORA has resulted in variation in local policies and in the responses (decision-making and practices) of safety net providers to these changes. The presentation will provide an understanding of the responses of state, counties and safety-net providers to the elgibility and benefit changes in the 1996 PRWORA pertinent to the funding and provision of health services to immigrants; the impact of welfare reform on the willingness and ability of the safety-net providers in New Mexico to serve immigrants; and, a summary of New Mexico's policies regarding the funding and provision of health services to immigrants in comparison to those of other border states (Arizona, Texas and California). The unique contribution this study makes to the literature is the focus on the role of counties and local safety-net providers and the factors shaping local policies and behaviors regarding the funding and provision of health care to immigrants. Consistent with other research, the rationing of Federal Medicaid funds to immigrants has shifted the costs and responsibilities of financing health care to the state, local governments and safety-net providers. This and other key findings will be addressed and expanded upon.
6 Años de Vida Potencial Perdidos por Deficiencias en la Nutrición según Analisis de Causa Multiple Chihuahua. Luz Helena Sanin Aguirre; Ofelia Urita Sánchez; Juan Alfredo Gutierrez Argüelles; Mireya Isabel Torres Jacobo; Flor Alejandra García Otríz Se recomienda que países incorporen indicadores derivados de los Años de Vida Potencial Perdidos a sus publicaciones, por ser de utilidad para llamar la atención sobre problemas que causen la muerte a edades tempranas, e instrumentar medidas correctivas. El objetivo de este trabajo es comparar los cambios en la mortalidad asociada a deficiencias en la nutrición ocurridos entre 1990 y 2000, mediante el cálculo de Índice de Años de Vida Potencial Perdidos, según edad, sexo y lugar de procedencia, para establecer la magnitud del problema y los grupos vulnerables. El presente estudio es descriptivo-comparativo, retrospectivo y corresponde a la segunda parte del proyecto Mortalidad asociada a deficiencias en la nutrición por causa múltiple en el Estado de Chihuahua 2000, de donde se tomó la información de defunciones por deficiencias en la nutrición por causa básica y múltiple y se calculo el Índice de Años de Vida Potencial Perdidos; obteniendo que existe una importante disminución promedio del 64%, El Indice más alto lo presenta Guachochi con en los menores de un año y en el grupo de 1 a 4 años, para el grupo de edad de 45 a 64 años el Indice mas alto se encontró en Creel con 31.7 y el Fuerte con 25, En Conclusión el Indice es un apoyo para tomar decisiones en busca de la mejoría de la alimentación, nutrición y salu d así como para que la asignación de recursos se realice acorde con las necesidades de la población.
7 Autoeficacia percibida y consumo de alcohol en trabajadores de la salud María Sosa Briones; María Magdalena Alonso Castillo MSP Propósito: El propósito del estudio fue conocer la relación de algunos factores sociodemográficos y la autoeficacia percibida con el consumo de alcohol en trabajadores de la salud utilizando el concepto de autoeficacia percibida de la teoría cognitiva social de Bandura aplicado a conductas adictivas (1999) ya que existen registros que indican que el consumo de alcoholes ha convertido en un problema de salud en la frontera norte del país. Metodos utilizados: El diseño del estudio fue descriptivo correlacional. El muestreo fue probabilístico estratificado con asignación proporcional al tamaño del estrato. Los cuatro estratos corresponden a las combinaciones de categorías laborales (profesionales de la salud y personal de apoyo) y sexo (masculino y femenino). El tamaño de la muestra (n=168) se estimó con un 95% de nivel de confianza (α=0.05) para una prueba bilateral, con una correlación alternativa de.30 y una potencia de 80% para el modelo de regresión lineal simple. Los instrumentos utilizados fueron: a) Cuestionario de Identificación de Trastornos por Uso de Alcohol (AUDIT), b) Cuestionario de Confianza Situacional (SCQ).y una Cédula de Datos Personales Los instrumentos presentaron consistencia interna aceptable. Se aplicó estadística descriptiva e inferencial; se obtuvieron índices de las escalas y subescalas de los cuestionarios AUDIT y SCQ, se usó la prueba de Kolmogorov- Smirnov, la prueba de U de Mann-Whitney, el Coeficiente de Spearman, el Modelo de Regresión Lineal Múltiple y el procedimiento de selección. Resultados: El estudio permitió verificar empíricamente la relación de las variables sociodemográficas y autoeficacia percibida con el consumo de alcohol en trabajadores de la salud, obteniendo una relación negativa y significativa de la autoeficacia percibida con el consumo de alcohol rs = -.50, p<.001 lo que significa que a mayor autoeficacia percibida menor es el consumo de alcohol. Destaca un efecto significativo (p<.01) de la categoría laboral con el consumo dependiente y dañino de alcohol. Conclusiones: Los trabajadores del sexo masculino consumen más alcohol que los del sexo femenino (U = , p<.001). El personal de apoyo consume más alcohol que el personal profesional (U = , p<.001). Recomendaciones:Se recomienda realizar un estudio de intervención en trabajadores de la salud considerando la autoeficacia percibida como variable independiente cuyo efecto permita disminuir el consumo de alcohol e incorporar variables de estudio como estrés laboral y jornadas de trabajo en trabajadores de la salud.
8 Barriers to Childhood Immunization Rates Ashley Kelm; Trish Langley; Leslie Barron; Zach May; Stephanie Curs; Jennifer Myers; Tammy Henry; Shanette Lewis; Arianna Nesbitt This study is the second part of a Bush School capstone research project. A previous capstone group conducted Part One and presented its findings to the San Antonio City Metropolitan Health District in May The previous group created a literature review to determine common factors affecting child immunization rates, conducted a secondary data analysis to determine the relevance of these factors as they apply to the nine zip codes targeted by the San Antonio Metropolitan Health District, and developed initial survey instruments. Part Two builds on the foundation established in Part One. This study sought to determine the factors that affect child immunization rates for at-risk children in San Antonio. The study had three specific aims: Specific Aim 1: Research immunization programs in other cities around the nation and state to guide the development of survey instruments and determine additional factors that may affect child immunization rates. Specific Aim 2: Revise initial survey instruments and administer them to parents and immunization providers to determine specific barriers within the nine zip code area of San Antonio. Specific Aim 3: Formulate policy recommendations for the city of San Antonio to aid in the development of programs that will improve child immunization rates in the nine zip code area. The existing literature suggested six possible barriers to child immunization rates: economic/monetary factors, location/transportation factors, trust factors, cultural factors, clinic accessibility, and clinic structure, policy, and standard operating procedures. These six factors were used to create a framework for determining the factors that affect child immunization rates in the nine zip code area. The parent/guardian survey and immunization provider survey data indicate that four factors may not act as barriers in the nine zip code area. The data reveal no relationship between economic/monetary factors, trust factors, cultural factors, or clinic accessibility and child immunizations in the survey sample. However, location and clinic structure, policy, and standard operating procedures may inhibit some parents from immunizing their children. The survey data also reveal findings unrelated to the six factors. Survey respondents indicate that giving parents more information about immunizations and diseases would improve immunization rates. Additionally, survey data, as well as information found in case studies of immunization programs in other cities, indicate that networking and community collaboration could also increase child immunization rates. Based on the literature review, the data analyses, and case studies of city programs, we recommend the following three policies to raise the immunization rate within the nine zip code area of interest in San Antonio: - Review the location of clinics and consider increasing the variety of immunization location sites. Specifically, consider schools, mobile clinics and other community-networked locations as prime sites. - Provide parents with additional information about immunizations and what diseases they prevent. - Increase networking and collaboration between providers and community organizations.
9 Border Vision Fronteriza/Access Plus: Helping Families Navigate Through Systems Sandra M Gonzales; Alice M. Salcido, MPH CHES, Consultant; Renee T Despres, PhD, Consultant The Border Vision Fronteriza-NM Model (BVF), a part of a federally funded border wide project, is an example of the successful integration of Community Health Workers (CHWs)/promotoras into health and social service systems. BVF is a community-based outreach program that uses CHWSs/promotoras to facilitate enrollment of pregnant women and children into Medicaid and/or the State Children s Insurance Program (SCHIP) and to ensure that enrollees are actually using health services. Data from this project s 5-year history reflects that the project exceeded the federally set enrollment goals by an average of 400%. Through the BFV/Access Plus (AP) program, the focus of BVF changed to providing the Dona Ana County Children s Court, the Juvenile Probation Department and the Dona Ana County Juvenile Detention Center with health care access screening services for families with children that are being placed within the Juvenile Justice System (JJS). Special attention is given in assisting juveniles in the Dona Ana Detention Center awaiting transfer to an appropriate treatment program in order to reduce the time of incarceration. BVF/AP Promotoras provide families with education and information about the specific needs of the family and help families navigate the judicial, medical and behavioral health systems. The families gain an understanding of their responsibility and the impact the family s involvement has on the successful completion of their child/children s probation treatment agreement. NM Medicaid recently changed the certification period from one year to a 6-month period. Informing families and keeping them enrolled in NM Medicaid programs and community safety-net programs in order to have continued access to services for their specific needs is one of the many challenges BVF/AP Promotoras experience. To help alleviate theses issues, BVF/AP Program has designed and implemented a database that will be used to interview in determining health care needs, eligibility and enrollment of families into a health care access program, follow up with enrollment due dates, health and social services referrals and will track health care access outcomes. The BVF contact form used throughout the program will continue to be used to track enrollments. In 2003, the BVF-NM Model was the recipient of one of the Border Models of Excellence Awards from the U.S./Mexico Border Health Commission. Funds from that award were used design a replication guide of the BVF-NM Model. There is great interest in replicating the BVF-NM Model throughout NM using the CHWs/promotoras to work with families involved with the Juvenile Justice System for enrollment in NM Medicaid programs for access to health services.
10 CAUSAS DE HOSPITALIZACIÓN DEL ADULTO CON DIABETES MELLITUS TIPO 2 EN NUEVO LAREDO, TAMAULIPAS. Yari Rodriguez Santamaría; MCE MARIA TERESA; SALAS CANTU Propósito y Método del Estudio: El propósito de este estudio fue determinar la prevalencia por causas de hospitalización del adulto con diabetes mellitus tipo 2, sus características sociodemográficas y asociación con las conductas de riesgo (consumo de tabaco y alcohol) por cada causa de hospitalización, en un hospital de segundo nivel de atención. El diseño fue de tipo epidemiológico, en la modalidad de encuesta transversal. La muestra de estudio se conformó 100% de pacientes adultos hospitalizados por diabetes mellitus tipo 2 en una unidad de segundo nivel de seguridad social de una ciudad fronteriza. Contribuciones y Conclusiones: Los resultados corresponden a 40 adultos hospitalizados (50% hombres y 50% mujeres), con edad promedio años( DE= +9.09; 34-80); la educación formal 5.13 años (DE= 4.26; 0-16) y años de diagnóstico de la diabetes de años (DE= 8.44; 1-45). La estimación de prevalencia por causa de hospitalización del adulto con diabetes mellitus tipo 2, posicionó como primera causa de ingreso hospitalario el pie diabético (45%) seguido de la insuficiencia renal crónica (40%). En el primer caso, la mayor frecuencia se presentó en el sexo masculino y en el segundo, en el femenino. Estos pacientes eran menores de 65 años de edad, con menos de seis años de escolaridad y más de diez años de diagnóstico. El patrón de consumo de alcohol y tabaco no se relacionó con la causa de hospitalización. Sin embargo, se identificó asociación significativa entre la insuficiencia renal crónica y el sexo femenino, hospitalizándose tres mujeres por cada hombre (Odds Ratio.167; ).
11 Community Organizing for Community Health Improvement - A New Mexico Model Dan Reyna; Dawn Sanchez; Silvia Sierra Participants will learn how New Mexico Department of Health staff assisted in the development of a model community advisory board as an instrument for establishing a general community health improvement mechanism in a county directed but non state-mandated local health department. The presentation will focus on the steps taken to plan, develop, approve and implement a formal community health improvement advisory board. The unique nature of this activity is that the state of New Mexico does not mandate nor legislate the establishment of local health departments, but that through the initiative of the local county government a health and human services department was established. With the technical assistance and guidance from key Office of Border Health and Community Health Improvement staff, the local health department was able to establish a model mechanism for community input and action. The presentation will further focus on the advantages and pitfalls in the numerous steps of actions and implementation which could be useful in the development of similiar models throughout the border. Specific and practical recommendations will be enumerated for discussion and debate.
12 CONSUMO DE DROGAS LICITAS E ILICITAS EN ESTUDIANTES DE NIVEL MEDIO SUPERIOR Brenda Guadalupe Yañes Castillo; MCE TERESITA DE JESUS CAMPA Propósito y Método de Estudio: Los objetivos del estudio fueron conocer el consumo de drogas lícitas (alcohol y tabaco) e ilícitas (marihuana, cocaína e inhalables) en estudiantes de nivel medio superior, además de identificar la edad y tipo de droga de inicio de consumo, así como identificar la diferencia del consumo de drogas lícitas (alcohol y tabaco) e ilícitas (marihuana, cocaína e inhalables) con respecto al sexo, semestre y turno en los estudiantes de nivel medio superior. El diseño del estudio fue descriptivo, la población de estudio se conformó por estudiantes de nivel medio superior de una Institución Pública de la Cuidad de Nuevo Laredo, Tamps. La selección de los participantes fue de tipo aleatorio con doble asignación proporcional por semestre y turno, considerando una muestra total de 282 estudiantes. Se utilizo el Cuestionario de Consumo de Drogas en estudiantes (CDE). Se utilizo estadística descriptiva como frecuencias, porcentajes, media, mediana y medidas de variabilidad. Contribución y Conclusiones: El consumo de drogas se presentó con mayor frecuencia en los estudiantes de nivel medio superior (62.4%);la edad de inicio de consumo fue a partir de los 6 años, con mayor proporción en el grupo de edad de 11 a 14 (48.2%). La droga de inicio de consumo en los estudiantes fue el alcohol (63.0%). La droga lícita de mayor consumo para las mujeres fué el alcohol (61.0%), entre tanto la marihuana y cocaína para los hombres(4.3%). El semestre en que los estudiantes reportaron mayor consumo de drogas lícitas fue en quinto semestre (64.8%), mientras que el consumo de drogas ilícitas se presentó en el tercer semestre (4.0%) En el turno matutino fue mayor el porcentaje de consumo para drogas lícitas (alcohol 63.3%,), sin embargo el consumo de drogas ilícitas se observó con mayor proporción en el turno vespertino (marihuana 4.2%).
13 Cultura y Cuidado de la Salud del Adulto Mayor Rosa M. Aguilar; Aurora Félix Alemán; Ma. del Carmen Vega Alanís; Aurora Félix Alemán; Gilberto Méndez Valdez El aumento de la esperanza de vida exige de los profesionales de salud acciones eficaces para los adultos mayores. La cultura es relevante para las condiciones de vida y de salud, la cual tiene que ver con educación, conocimientos, creencias, hábitos y costumbres de las personas como miembros de una sociedad. Propósitos: Identificar aspectos culturales del adulto mayor relacionados con el cuidado de la salud y proponer su consideración en la prestación de servicios de salud. Métodos: Descriptivo, transversal. Población: Residentes, de 60 años y más de ambos sexos, de la colonia Lauro Vi llar. Muestreo por conveniencia, tamaño 40 personas. Técnica de recolección: Entrevista estructurada. Instrumento una guía para la entrevista con 62 reactivos de elección múltiple, diseñada por la OPS y validada en un estudio previo en la Facultad de Enfermería Tampico de la Universidad Autónoma de Tamaulipas. Datos procesados con el Paquete Estadístico SPSS versión Se analizó la información a partir de los porcentajes. Se aplicó la prueba Chi cuadrado de variables relevantes. Resultados. Los entrevistados fueron 37.5 % hombres y 62.5 % mujeres, casados 40 % y en igual porcentaje son viudos. El nivel de estudios es nulo para el 47.5 %. El 90% considera que la religión es importante en su vida; El 57.7% no realiza trabajo remunerado y desea trabajar el 50%. El 22.5 % tiene ingresos por pensión o jubilación. 57.5% hacen ejercicio; el 55 % toma café diariamente, una taza en promedio. El 52.5 % cuenta con seguridad social; el 60% solicita atención sólo cuando tiene problemas. El 50% considera su estado de salud como regular; el 80% refiere enfermedades o molestias; el 70 % se le ha diagnosticado una enfermedad; el 55% realiza cuidados para su enfermedad; el 55 % es dependiente en actividades instrumentales; el 75.5% tiene alto riesgo nutricional; el 77 % tiene función intelectual integra y el 62.5% no tiene relaciones sexuales. La prueba de chi cuadrada fue significativa entre.000 y.001 en variables: aspectos culturales y cuidado de salud, lo cual significa que la cultura tiene relación con el cuidado de la salud. Conclusiones: La población estudiada tiene un bajo nivel educativo, no tienen ingresos que les permita satisfacer sus necesidades y no cuentan con apoyo suficiente para el cuidado de la salud. Más de la mitad del grupo estudiado evidencian condiciones de desventaja para desarrollar su potencial de desarrollo. Recomendaciones: Las acciones para el cuidado de salud, para ser efectivas, deben instrumentarse considerando el contexto cultural y sus posibilidades de transformación en beneficio de los grupos desprotegidos como son los adultos mayores.
14 De la reflexión a la acción: Fortalecimiento de organizaciones nogubernamentales en lafrontera Mexico-US, utilizando la metodologia I-STAR; Sistema Integrado para la Transformacion, Apreciacion y Resultados (por sus siglas en ingles) Rosalinda Cano-Hays; Carmen Cutre; Blanca Lomeli Propósito del programa/servicio Los retos que las organizaciones de la sociedad civil (OCS) enfrentan en la frontera México- Estados Unidos son múltiples, y exigen una preparación constante y una capacidad de respuesta rápida. El propósito de los programas de fortalecimiento en la Iniciativa de Salud Fronteriza (ISF) es ofrecer una alternativa práctica para el fortalecimiento de las organizaciones en la región San Diego -Tijuana, Valle Imperial- Mexicali. I-STAR permite a las agencias participantes obtener un diagnóstico de fortalezas y debilidades, y elaborar un plan de cambio organizacional en un tiempo corto. A la fecha, la ISF ha facilitado varios procesos de Fortalecimiento organizacional (FO) con gran impacto y excelentes resultados. La medición se realiza por medio de un proceso de auto-reflexión facilitado y se lleva a cabo con la participación de personal clave. Generalmente se desarrolla en cuatro tiempos; mesa redonda (diálogo facilitado), medición de estándares (auto-evaluación) y finalmente un detallado análisis de resultados y planeación de estrategias de cambio. Este instrumento de medición fue diseñado entre Project Concern International y Educational Development Center, a través de varios años de trabajo en diversos países del mundo. I-STAR es un proceso basado en estándares y cuenta con cuatro objetivos principales: 1. Ofrecer un modelo de comportamiento organizacional 2. Realizar un cambio planeado 3. Desarrollar un ejercicio que combina ciencia y reflexión 4. Identificar necesidades y oportunidades de FO Objetivos del programa / servicio El principal objetivo de este programa es mejorar la capacidad organizacional de OCS que trabajan en salud y desarrollo en la frontera México-Estados Unidos. Las organizaciones con capacidad mejorada serán capaces de responder y adaptarse a cambios en su entorno, que les permita mejorar su entrega de servicios y sostenibilidad. Evaluación y lecciones aprendidas Las organizaciones que han participado en esta primera fase han encontrado que la metodología utilizada es práctica y les ofrece resultados inmediatos, en forma de un plan de cambio organizacional. El éxito de este programa se debe en parte a que este proceso busca que las organizaciones participantes identifiquen un mejor balance entre la razón de ser de la organización (su misión), sus recursos y su estructura. Conclusiones y recomendaciones La ISF considera necesario seguir fomentando una cultura de desarrollo y crecimiento organizacional, brindando herramientas a las organizaciones fronterizas para mejorar y establecer programas modelos encaminados a brindar calidad de servicios que puedan beneficiar a los sistemas de salud en ambos lados de la frontera.
15 Diabetes la Comunidad en Accion Rosalba F. Ruiz Reyes; Rita Diaz Kenney; Martha Londoño; Andrew Winters Diabetes la Comunidad en Acción is a training program that looks at diabetes from a public health perspective. The goal of the training is to create community-based diabetes initiatives to help people prevent and control with diabetes. The philosophy of this curriculum is that people can take charge of diabetes at the community level. Rather than relying on expensive medical treatment after the complications of diabetes have already developed, community members people with diabetes or at risk of developing diabetes and their families, health professionals, and other concerned individuals can work together to prevent and control diabetes. By emphasizing public health and community organizing and group facilitation skills, this curriculum focuses on the strengths of communities and their ability to work creatively to deal with the problems caused by diabetes. The training program is designed to empower communities throughout the country to develop and implement strong diabetes program plans and, over time, significantly reduce the personal and financial costs of diabetes to individuals, families, communities, States, and the Nation. Training Design La Comunidad en Acción training has two levels. The first level is a 3-day training session for future facilitators primarily State diabetes control program staff, representatives of national organizations, and key community leaders. During the 3-day training, participants learn about principles of adult learning and enhance their facilitation skills by becoming familiar with the materials. Facilitators trained then conduct the second level of the curriculum with leaders at the community level. Community leaders, working together and drawing on other community resources, then apply the program planning and evaluation process they have learned from La Comunidad en Acción to plan and implement actual interventions to reduce the heavy burden of diabetes in their communities. The community-level course teaches participants an interactive program planning and evaluation process, which is central to success at the community level. A basic assumption of the course is that community leaders who contribute their knowledge, experience, and ideas to program planning and evaluation will develop a sense of ownership and commitment to the program s plan. In turn, a solid plan leads to successful program implementation and evaluation. Similarly, the involvement of leaders from different socioeconomic levels and racial/ethnic groups in the community ensures that all aspects of the program are sensitive and responsive to cultural differences affecting attitudes about various diabetes control practices. Facilitators are encouraged to keep in contact with community leaders after training and to assist them in using the skills they have learned. Along the US- Mexico Border 11 trainings have been conducted and more are underway. This curriculum has been validated as a useful tool to prevent and control diabetes.
16 Educational Tools on menopause Carmen Ferlan; Jo Jo Elenes The purpose of this project was to collaboratively develop educational tools on menopause that are culturally and linguistically relevant to Hispanic women of Mexican descent. this joint projects was conducted by academic Center's of Excellence in Women's Health, University of Washington, UCLA, and UCSF and Mariposa Community Center of Excellence in Women's Health to address the health care needs of underserved and minority women, including ethnic minorities. The development process included: developing a list of " Talking Points", evaluating the effectiveness of educational interventions, 13 focus groups of woman, male partners and medical providers, english/spanish translation, and community feedback. The educational curriculum includes: lay health worker manual, visual aids for each session and the participant manual. The sessions are: What is menopause? hormone replacement therapy, nutrition and menopause, physical activity, family support and stress. Also as part of the total project are: spanish, tutorial for the use of the video discussion and focus group feedback.
17 EHUI Rehabilitacion Integral Programa Comunitaria Rural Carmen R. Hernandez; Francisca Marquez- Psicologa Proposito Brindar a la comunidad DISCAPACITADA neuromotora y psicosocial, del medio rural y co urbano del municipio de Hermosillo (San Pedro el Saucito, El Tazajal, El Tronconal, La Victoria, Molino de Camou...), acciones PREVENTIVAS Y CURATIVAS mediante un servicio medico especializado en rehabilitacion, ortopedia, neurologia, acupuntura t posicologia, asi como terapio fisica y equino terapia. Objetivo Dado que la DISCAPACIDAD es considerado un PROBLEMA DE SALUD PUBLICA a nivel mundial, nuestro objetivo es contribuir al abatimiento de los indices de discapacidad rural y co urbana, con especial apoyo a pacientes de escasos recursos economicos. Evaluacion A cuatro años de actividad permanente en las comunidades de San Pedro el Saucito, El Tronconal, El Tazajal, La Victoria, Molino de Camou, Pesqueira y el municipio de Hermosillo, nos damos cuenta que hay una gran necesidad de servicios de rehabilitacion en la poblacion rural que en las mayorias de los casos no tienen la oportunidad de acceder a clinicas particulares y del gobierno por desconocimiento, por falta de recursos economicos, faltas de transporte especializado, por idiosincracia, o por encontrarse distantes a ellos. Nuestra promocion en las comunidades aledañas a nuestro centro EHUI ha sido un exito asi como la programacion DE UNA RUTA DE TRANSPORTE PARA DISCAPACITADOS la cual viene a coadyuvar aun mas el acceso a sus tratamiento de rehabilitacion en nuestro centro abatiendo las indicencias y el rezago de servicios de rehabilitacion en dichas comunidades. Es importante mencionar que los logros obtenidos estan basados en la aplicacion de terapias tradicionales de medicina fisica y rehabilitacion conjugados CON LA EQUINOTERAPIA. tecnioca de vanguardia reconocida internacionalmente mediante sus aportaciones ludicas, deportivas, eductivas y psicologicas que complementan exitosamente estos tratamientos amen a que son supervisados por un equipo medico multidisciplinario de grandes dotes humanisticos y profesionales. Conclusiones Este tipo de centros altruistas de caracteristicas holisticas de vanguardia actualmente requiere de una mayor promocion asi como contar con mas apoyos para garantizar la sustentabilidad y poder incorporar mas servicios para una rehabilitacion mas integral que beneficie a este sector vulnerable de los discapacitados del medio rural del municipio de Hermosillo, Sonora.
18 EQUIPO MULTIDISCIPLINARIO PARA EL TRATAMIENTO DE NIÑOS CON PARALISIS CEREBRAL Olga Lilia Bastidas; Dr. José Fusillo; Dr. Bernardo Ramírez Mante PROPÓSITO DEL PROGRAMA/SERVICIO Crear un equipo interdisciplinario que realice el diagnóstico y tratamiento de pacientes con trastornos de la marcha y de los movimientos. El mismo será seleccionado en la población infantil y adolescente y en aquellos trastornos originados por un daño cerebral y que dejaron como secuela alteraciones para caminar y/o realizar cualquier tipo de movimientos y que dificultan el normal crecimiento y desarrollo. OBJETIVOS DEL PROGRAMA/SERVICIO A)Reunir a un equipo multidisciplinario para evaluar, diagnosticar y presentar un plan de trabajo. B)El equipo estará integrado por especialistas relacionados que hayan sido entrenados para asistir pacientes con dificultades motoras. C)Se realizarán reuniones periódicas con la finalidad de admitir nuevos pacientes y controlar el tratamiento de los ya ingresados. D) Aplicar técnicas de tratamiento actualizadas desde los bloqueos con toxina botulínica y fenol hasta mínimas cirugías tempranas ortopédicas que conlleven a una reducción en el tiempo de tratamiento y una reintegración más rápida a la sociedad. E)Registrar los resultados con escalas valorativas, registros fílmicos y aplicar rigurosos esquemas de tratamiento para validar los procedimientos y realizar las correcciones necesarias y demostrar en trabajos de comunicación las ventajas de nuestro procedimiento. EVALUACIÓN Y LECCIONES APRENDIDAS La evolución de la medicina ha demostrado que es sumamente difícil para un solo profesional resolver muchas enfermedades y traen como consecuencia problemáticas sociales. La capacitación de un profesional debería ser continua para adquirir nuevas técnicas que mejoren lo inabordable, pero ni en ese caso ideal es impensable pretender conocer todas las vertientes del conocimiento y estar entrenado para aplicarlas en lo cotidiano de la práctica médica. Con la creación de esta actividad interdisciplinaria, demostrada por la experiencia en este campo de los profesionales que la integran, abrirán nuevas posibilidades de tratamiento más efectivos, en un menor tiempo y mucho menos costosas, de pacientes. Habitualmente en nuestro medio, deambulan de un profesional a otro, de un centro a otro y el sistema no sólo no soluciona el problema médico y social sino que los costos son tan altos que se generan acciones frustrantes e infructuosas entre los profesionales de la salud. CONCLUSIONES Y RECOMENDACIONES Creemos que la acción profesional de alto nivel, integrada y con ideas de realizar nuevos aportes a la comunidad médica será un valuarte para ser emulada y apoyada por todas aquellas personas y organismos que deseen un mayor bienestar para esta población de pacientes que no son adecuadamente atendidos en la actualidad.
19 Etapas de Adquisicion y Consumo de Alcohol en Trabajadores de una Industria Maquiladora Yolanda Botello Moreno; Teresa Campa Magallon Propósito y Método del Estudio: Los propósitos del presente estudio fueron determinar el tipo de consumo de alcohol en los trabajadores de una industria maquiladora de la ciudad de Nuevo Laredo, Tamaulipas de acuerdo al sexo, categoría laboral y antigüedad en el trabajo; además de identificar la etapa de adquisición de los trabajadores no consumidores de alcohol de acuerdo al sexo y categoría laboral y antigüedad, así como conocer la relación que existe entre la edad, escolaridad y antigüedad con el consumo de alcohol. El diseño del estudio fue de tipo descriptivo correlacional. Se utilizó un muestreo de tipo probabilístico estratificado de acuerdo al sexo y la categoría laboral. El tamaño de la muestra fue de 159 trabajadores, la muestra fue estimada con un 95% de confianza y con un alfa de.05, obtenida a través de un enfoque conservador. Los instrumentos utilizados fueron: El Cuestionario de Alcohol y Salud de los Jóvenes de Werch y el Cuestionario de Identificación de Trastornos por Uso de Alcohol (AUDIT) de De la Fuente y Kershenobich. Para el análisis de los datos se aplicó estadística descriptiva como media, mediana, y medidas de dispersión, posteriormente se utilizó la prueba de Kolmogorov Smirnov para verificar la normalidad de las variables de acuerdo a ello se utilizó del Coeficiente de Correlación de Spearman. Contribución y Conclusiones: El estudio mostró que la mayor proporción de los trabajadores consumen alcohol (74.2%), la etapa de adquisición que predominó en la población no consumidora fue la etapa de precontemplación (78.1%) en la categoría de obreros y con una antigüedad en el trabajo menor a un año (92.9%). El tipo de consumo que predominó fue el sensato en población femenina, mientras que el consumo dañino fue en mayor proporción para el sexo masculino, de acuerdo a la categoría laboral el consumo sensato y dependiente fue mayor para los trabajadores administrativos (40% para cada consumo). La antigüedad del trabajador mostró relación positiva significativa con el AUDIT (rs =.29, p.007), frecuencia y cantidad del consumo (rs =.27, p.002). Un hallazgo adicional fue la diferencia significativa del consumo de alcohol por sexo, dónde el consumo dañino se presentó en mayor proporción en el sexo masculino (X2=21.018, p=.000).
20 Health Disparities and OCD at the United States - Mexico Border Tom Olson; Beatriz Vera, M.A. Epidemiologic data suggest that obsessive-compulsive disorder (OCD) affects between 2% and 3% of the world s population, making it one of the most common major psychiatric disorders. OCD is two to three times more common than schizophrenia and is associated with a similarly negative impact on quality of life. Yet very little is known about the relationship between OCD, culture, ethnicity and place. This is particularly true in relation to Mexicans and Mexican-Americans. Thus, the purpose of this ongoing, qualitative pilot study is to explicate the lived experiences of persons with obsessive-compulsive disorder (OCD) in a population at high risk for health disparities, those living in the U.S-Mexico border area of El Paso, Texas and Ciudad Juarez, Mexico. Consistent with other qualitative research in health care, the aim of this study is clarified by two closely related research questions: 1) Are there distinguishable, characterisitic similarities and differences in the experiences of adults diagnosed with OCD living in the U.S.-Mexico border area? 2) If so, what are these similarities and differences and how can they be accounted for or understood? This research represents the first phase of a two-part research project that will ultimately focus on accessible, culturally-sensitive health interventions for persons with OCD. The study methodology includes a purposive sample of 10 to 12 adults selected for maximum variation based on gender, age, and ethnicity/race. Semi-structured, taped interviews are being used to collect data. Transcriptions of the interviews are currently being analyzed for significant statements and themes. The two investigators will independently review each transcript and then share their findings with a research consultant to help ensure credibility. The major themes that have emerged thus far include: 1) lack of understanding among professionals and the general public in recognizing OCD; 2) helpfulness of positive activity in interrupting interrupt obsessive thoughts and rituals; and 3)importance of social relationships. An earlier, isolated study highlighted the unique significance of this last theme among Hispanic individuals. The findings thus far suggest a range of practical interventions, including the use of culturally-sensitive educational material aimed at health care providers and the general community, as well as the facilitation of support groups and support networks. Overall, this research promises to deepen understanding of health disparities and OCD at the United States-Mexico border and to provide the basis for accessible and effective health interventions.
21 Healthcare access among Mexico-California migrants: Evidence from the California-Mexico Epidemiological Surveillance Pilot Alvaro Garza; Matthew A. Stanich, MPH; Maria T. Hernandez, MPH; George Lemp, DrPH Objectives: To describe the utilization of selected preventive healthcare services, and identify demographic, social, and behavioral characteristics associated with receiving services among Mexican migrants in California. Methods: We analyzed data collected between January and December 2004 in Fresno County for the California-Mexico Epidemiological Surveillance Pilot, a survey composed of a venue and housing-based, targeted random sample of Mexico-California migrants using a 35-minute face-to-face questionnaire. Results: Of 340 respondents, 101 (30%) received health services for HIV/AIDS, STI, or TB within the past 12 months. Approximately two-thirds received services in California. Health services were accessed more by females (35%) than males (25%). Half of MSM (N=11) and all transgender respondents (N=6) received services. Respondents who received health services showed a significant association with some schooling in the U.S. (18% vs. 5%; p<0.001), more years of education (8.9 years vs. 7.1 years; p<0.001), high language acculturation score (40% vs. 14%; p<0.001), attending a health fair in the last year (14% vs. 7%; p=0.041), having access to condoms when needed (41% vs. 26%; p=0.009), and higher HIV transmission-risk knowledge score (85% vs. 74%; p<0.001). Conclusions: The Mexico-California migrant population in Fresno lives most of the year in California, where they primarily receive HIV/AIDS, STI, and TB services. Results suggest that accessing health services is related to education, acculturation, and attending health fairs as well as to disease prevention outcomes, such as increased availability of condoms and better HIV risk knowledge. These results support continuing and expanding health educational and outreach efforts with Mexico- California migrants.
22 Healthy Gente 2010-New Mexico Perspectiva Jacob Nevarez; Dr. Hugo Vilchis; Dan Reyna Description Healthy Gente (HG) 2010 is the health promotion and disease prevention agenda for the United States Border region. Healthy Gente draws on the national health objectives defined in Healthy People 2010, identifying 25 important indicators for the distinct needs and concerns of the border. Healthy Gente aims to develop preventive goals, objectives and strategies, resulting in a strategic management tool that will be used by the four Border States, communities and many other public and private sector partners. Background/Methodology In 1998, the 25 indicators were developed by a group of experts from federal organizations, Border Healt h Offices, and Universities using the following principles to guide the selection process: a) They should address key health issues on the border. b) They should be limited in number. c) Should be compatible with federal and state objectives. The goal was to develop a set of indicators that will resonate with the border population, will be easily understood, and will help to coordinate future public and private health programs. The purpose of these health indicators is to assist border health systems to focus on key health problems and to improve the allocation of resources. The indicators are also intended to provide direction to organizations and communities supporting good health through health promotion policies. The New Mexico Outreach Office (NM ORO) of the US-Mexico Border Health Commission has been working on developing a database to track the 25 HG indicators for the counties of NM. The intent is to link the completed database to the web for others to access and assist health authorities to focus on key health problems and to improve the allocation of health resources based on the 25 HG indicators. The indicators are also intended to provide direction to organizations and communities supporting good health through health promotion policies. The NM ORO is using Healthy Gente to establish an effective framework focused on building capacity within communities to address health disparities and complement the work of existing county-based organizations to address the health disparities in Southern New Mexico.
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