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      El significado de la diabetes mellitus entre indígenas chontales de Tabasco, México Translated title: Meaning of diabetes mellitus among Chontal Indigenous people of Tabasco, Mexico

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          Abstract

          Resumen: Introducción: La diabetes mellitus (DM) es un problema de salud pública en aumento y las poblaciones indígenas no son la excepción. Aunque se ha estudiado desde diversas perspectivas, poco se ha indagado el significado que tiene para esta población. Objetivo: Comprender el significado de la diabetes y algunas diferencias de género en indígenas chontales. Metodología: Se realizó un estudio de corte cualitativo con 29 personas de 20 años y más, seleccionados del registro del centro de salud. Se utilizó la entrevista a profundidad, previo consentimiento se grabó en audio. El análisis se realizó a través de transcripción, codificación, segmentación, reducción e interpretación de los discursos producidos. Resultados: Participaron 29 informantes, de quienes 21 fueron mujeres. El promedio de edad fue 48.5 años; Todas las personas participantes estaban casadas. El 100 % las mujeres se dedicaban al trabajo doméstico no remunerado; la escolaridad predominante fue la primaria (seis años o menos). La DM se percibía como destino fatal, se encontró desconfianza en los tratamientos de diálisis e insulina, que se conciben como precursores del fallecimiento. La herbolaria es utilizada y significada como tratamiento eficaz para la diabetes; al decir de los informantes, son las mujeres quienes realizan más el autocuidado de la enfermedad. Por último, se encontró una importante confianza en Dios para los resultados de salud. Conclusiones: La diabetes tiene un significado de sentencia de muerte. La diálisis e insulina se perciben como procedimientos que aceleran la muerte. Esto sugiere a los proveedores de cuidado de la salud, considerar los significados de la enfermedad e incorporar la interculturalidad en la atención de personas indígenas.

          Translated abstract

          Abstract: Background: Diabetes Mellitus (DM) is a growing public health problem and indigenous populations are no exception. Although the problem has been studied from different perspectives, little has been investigated about the meaning it has for this population; Objective: To understand the meaning of Diabetes and some gender differences in indigenous Chontales. Methodology: A qualitative study was carried out with 29 people aged 20 years and over, selected from the registry of the health center; the in-depth interview was used, prior consent was audio-recorded; the analysis was carried out through transcription, coding, segmentation, reduction and interpretation of the discourses produced. Results: 29 informants participated, 21 women; average age was 48.5 years; All married; 100% women were engaged in unpaid domestic work; the predominant schooling was primary (six years or less). DM was signified as a fatal fate; distrust was found in the dialysis and insulin treatments, meant as precursors of death. Herbalism is used and signified as an effective treatment for Diabetes; According to the informants, it is women who carry out the self-care of the disease the most; Lastly, significant trust in God was found for health outcomes. Conclusions: Diabetes is meant as a death sentence; Dialysis and insulin are meanings as procedures that accelerate death, this suggests to health care providers to consider the meanings of the disease and incorporate interculturality in the care of indigenous people.

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          A glossary for social epidemiology

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            Obesity trends in Latin America: transiting from under- to overweight.

            Latin America is undergoing a rapid demographic and nutritional transition. A recent WHO/PAHO survey on obesity in the region revealed an increasing trend in obesity as countries emerge from poverty, especially in urban areas. In contrast, in middle income countries, obesity tends to decline as income increases; this is especially so in women. Dietary changes and increasing inactivity are considered the crucial contributory factors that explain this rise. The end result is a progressive rise in overweight and obesity, especially in low income groups who improve their income and buy high fat/high carbohydrate energy-dense foods. Intake of these foods increases to the detriment of grains, fruits and vegetables. Most aboriginal populations of the Americas have changed their diet and physical activity patterns to fit an industrialized country model. They now derive most of their diet from Western foods and live sedentary and physically inactive lives. Under these circumstances they develop high rates of obesity, insulin resistance and type 2 diabetes. Supplementary feeding programs are common in the region; the number of beneficiaries significantly exceeds the malnourished. Weight-for-age definition of undernutrition without assessment of length will overestimate the dimension of malnutrition and neglect the identification of stunted overweight children. Providing food to low income stunted populations may be beneficial for some, although it may be detrimental for others, inducing obesity especially in urban areas. Defining the right combination of foods/nutrients, education and lifestyle interventions that are required to optimize nutrition and health is a present imperative.
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              Evidence of a Strong Association Between Frequency of Self-Monitoring of Blood Glucose and Hemoglobin A1c Levels in T1D Exchange Clinic Registry Participants

              OBJECTIVE Despite substantial evidence of the benefit of frequent self-monitoring of blood glucose (SMBG) in type 1 diabetes, certain insurers limit the number of test strips that they will provide. The large database of the T1D Exchange clinic registry provided an opportunity to evaluate the relationship between the number of SMBG measurements per day and HbA1c levels across a wide age range of children and adults. RESEARCH DESIGN AND METHODS The analysis included 20,555 participants in the T1D Exchange clinic registry with type 1 diabetes ≥1 year and not using a continuous glucose monitor (11,641 younger than age 18 years and 8,914 18 years old or older). General linear models were used to assess the association between the number of SMBG measurements and HbA1c levels after adjusting for potential confounding variables. RESULTS A higher number of SMBG measurements per day were associated with non-Hispanic white race, insurance coverage, higher household income, and use of an insulin pump for insulin delivery (P < 0.001 for each factor). After adjusting for these factors, a higher number of SMBG measurements per day was strongly associated with a lower HbA1c level (adjusted P < 0.001), with the association being present in all age-groups and in both insulin pump and injection users. CONCLUSIONS There is a strong association between higher SMBG frequency and lower HbA1c levels. It is important for insurers to consider that reducing restrictions on the number of test strips provided per month may lead to improved glycemic control for some patients with type 1 diabetes.
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                Author and article information

                Journal
                psm
                Población y Salud en Mesoamérica
                PSM
                Universidad de Costa Rica. Centro Centroamericano de Población (San Pedro, San José, San Pedro de Montes de Oca, Costa Rica )
                1659-0201
                December 2020
                : 18
                : 1
                : 149-175
                Affiliations
                [1] orgnameUniversidad Juárez Autónoma de Tabasco Mexico Marcelina.cruz@ 123456ujat.mx
                [2] orgnameUniversidad Juárez Autónoma de Tabasco Mexico Maria.cruz@ 123456ujat.mx
                Article
                S1659-02012020000200149 S1659-0201(20)01800100149
                10.15517/psm.v18i1.40092
                fd816ee9-b98b-45f8-b221-7f0c6f21cf96

                This work is licensed under a Creative Commons Attribution 3.0 International License.

                History
                : 11 December 2019
                : 01 June 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 45, Pages: 27
                Product

                SciELO Costa Rica

                Categories
                Artículo

                indigenous people,México,qualitative study,Tabasco,significado diabetes,población indígena,estudio cualitativo,meaning diabetes

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