Diabetes self-management, an essential component of diabetes care, includes weight control practices and requires guidance from providers. Minorities are likely to have less access to quality health care than White non-Hispanics (WNH) (American College of Physicians-American Society of Internal Medicine, 2000). Medical advice received and understood may differ by race/ethnicity as a consequence of the patient-provider communication process; and, may affect diabetes self-management. This study examined the relationships among participants’ report of: 1) medical advice given; 2) diabetes self-management, and; 3) health outcomes for Mexican-Americans (MA) and Black non-Hispanics (BNH) as compared to WNH (reference group) using data available through the National Health and Nutrition Examination Survey (NHANES) for the years 2007-2008. This study was a secondary, single point analysis. Approximately 30 datasets were merged; and, the quality and integrity was assured by analysis of frequency, range and quartiles. The subjects were extracted based on the following inclusion criteria: belonging to either the MA, BNH or WNH categories; 21 years or older; responded yes to being diagnosed with diabetes. A final sample size of 654 adults [MA (131); BNH (223); WNH (300)] was used for the analyses.The findings revealed significant statistical differences in medical advice reported given. BNH [OR = 1.83 (1.16, 2.88), p = 0.013] were more likely than WNH to report being told to reduce fat or calories. Similarly, BNH [OR = 2.84 (1.45, 5.59), p = 0.005] were more likely than WNH to report that they were told to increase their physical activity. Mexican-Americans were less likely to self-monitor their blood glucose than WNH [OR = 2.70 (1.66, 4.38), pThese findings indicate a need for patient-provider communication and care to be assessed for effectiveness and, the importance of ongoing diabetes education for persons with diabetes.

Am 1. September 2009 wurde das 3. Gesetz zur Änderung des Betreuungsrechts erlassen. Seitdem ist die Einhaltung von Patientenverfügungen rechtlich bindend. Ärztliche Beratung zur Patientenverfügung wird empfohlen, ist aber keine Gültigkeitsvoraussetzung. Es wurde eine Studie durchgeführt, in der Ärztinnen und Ärzte dazu befragt wurden, in welchem Ausmaß zur Patientenverfügung beraten wird, wie die Qualität der Beratung beurteilt wird, welchen Stellenwert ärztliche Beratung zur Patientenverfügung hat und wie die Finanzierung ärztlicher Beratung beurteilt wird. Es wurde deutlich, dass die Patientenverfügung als Instrument durchaus anerkannt ist. Die befragten Ärztinnen und Ärzte schätzen ihre Beratungskompetenz hoch ein. Trotzdem wird Fortbildung gewünscht. Offizielle Empfehlungen und Standards zur ärztlichen Beratung wären sehr sinnvoll. Die Frage der Finanzierung sollte dringend abschließend geklärt werden. Eine zumindest anteilige Übernahme der Beratungskosten durch die Solidargemeinschaft wird vom Großteil der Befragten gefordert. In diesem Rahmen wäre auch eine eigene Abrechnungsziffer für Beratungsgespräche sinnvoll.

<p>The 19th century is often described as a period when sexual differences were strongly accentuated in medical interpretations. While this is not an inaccurate description, it is in need of greater nuance. For one thing, notions of the male are usually forgotten in the process. As the female body by the shift to the 18th hundreds, to a greater extent than before, became associated with reproduction and biological constraints of various kinds, representations of the male body also changed. According to medical texts published in Sweden in the 19th century, men’s blood, bones, breath and digestion bore witness to their "freedom" from a forced sexual body. Physically, the male constituted an abstract, cultivated and highly differentiated individual, focused on his own development and wellbeing. The male body was described as clearly fit for public and political life, which legitimized male claims to a monopoly on power as well as the doctrine of "the separate spheres" in 19th century bourgeois society. </p><p>But there is more to this story. A closer examination of more limited discussions in medical texts and advice literature reveal that representations of the male and female body were remarkably unstable and marked by tensions and contradictions. During the Romantic era of medicine in Sweden during the 1830’s and 40’s, the way sex and individuality in the body were valued were totally different from the description above. Reproduction and physical desires were characteristic, according to a number of medical men, of highly developed creatures, connected to God, society, and culture, whereas sexless species, immature children and "lower" peoples were seen as materialistic and focused only on their own individual development. Discussions regarding female puberty and single men further reveal the unstable polarization between sex and individuality as well as culturally constructed differences, not only between men and women, but also between classes, age groups, single and married persons, cultivated and non-cultivated peoples. Notions about nature/culture, tradition/progress, female/male, sex/individuality were not organized into stable dichotomies—rather they constituted an unstable body of representations. </p>

The 19th century is often described as a period when sexual differences were strongly accentuated in medical interpretations. While this is not an inaccurate description, it is in need of greater nuance. For one thing, notions of the male are usually forgotten in the process. As the female body by the shift to the 18th hundreds, to a greater extent than before, became associated with reproduction and biological constraints of various kinds, representations of the male body also changed. According to medical texts published in Sweden in the 19th century, men’s blood, bones, breath and digestion bore witness to their "freedom" from a forced sexual body. Physically, the male constituted an abstract, cultivated and highly differentiated individual, focused on his own development and wellbeing. The male body was described as clearly fit for public and political life, which legitimized male claims to a monopoly on power as well as the doctrine of "the separate spheres" in 19th century bourgeois society. But there is more to this story. A closer examination of more limited discussions in medical texts and advice literature reveal that representations of the male and female body were remarkably unstable and marked by tensions and contradictions. During the Romantic era of medicine in Sweden during the 1830’s and 40’s, the way sex and individuality in the body were valued were totally different from the description above. Reproduction and physical desires were characteristic, according to a number of medical men, of highly developed creatures, connected to God, society, and culture, whereas sexless species, immature children and "lower" peoples were seen as materialistic and focused only on their own individual development. Discussions regarding female puberty and single men further reveal the unstable polarization between sex and individuality as well as culturally constructed differences, not only between men and women, but also between classes, age groups, single and married persons, cultivated and non-cultivated peoples. Notions about nature/culture, tradition/progress, female/male, sex/individuality were not organized into stable dichotomies—rather they constituted an unstable body of representations.

El presente trabajo de investigación se centra en Qura, el cual consiste en brindar un aplicativo, que contenga el servicio de delivery especializado en boticas y farmacias, teleconsultas con médicos especializados, comparador de precios de diversas boticas y farmacias dentro del radio de la ubicación, recordatorio para la ingesta de medicinas, entre otros. El servicio está dirigido a hombres y mujeres del NSE A, B y C entre las edades de 18 a 50 años que residan en Lima Metropolitana, Lima Centro y Callao y que se encuentren interesadas en hacer uso del servicio. Los experimentos desarrollados a lo largo del trabajo nos permitieron validar el interés de compra de nuestros posibles consumidores, ya que ellos manifiestan que es un servicio nuevo que les va a ayudar a reducir el tiempo de compra y espera de boticas y farmacias. Ante ello, se pudieron realizar ventas por medio de las redes sociales de Qura, Facebook e instagram, donde se pudo comprobar que el servicio tiene la aceptación del público. El contenido del trabajo se divide en la descripción del modelo de negocio, la validación de los diversos cuadrantes el Business Model Canvas, la validación de la intención de compra y el plan financiero. Gracias a todo ello, se pudo verificar la viabilidad del proyecto. / This research work focuses on Qura, which consists of providing an application that contains a delivery service specialized in drugstores and pharmacies, teleconsultations with specialized doctors, price comparator of various drugstores and pharmacies within the radius of the location, reminder for the intake of medicines, among others. The service is aimed at men and women of NSE A, B and C between the ages of 18 and 50 who reside in Metropolitan Lima, Central Lima and Callao and who are interested in using the service. The experiments carried out throughout the study allowed us to validate the interest of our potential consumers in buying the service, since they stated that it is a new service that will help them reduce the time spent shopping and waiting in drugstores and pharmacies. In view of this, sales could be made through Qura's social networks, Facebook and Instagram, where it was possible to verify that the service is accepted by the public. The content of the work is divided into the description of the business model, the validation of the various quadrants of the Business Model Canvas, the validation of the purchase intention and the financial plan. Thanks to all this, it was possible to verify the feasibility of the project. / Trabajo de investigación

El presente proyecto trata sobre un aplicativo móvil llamado “Dr. App” para promocionar los servicios médicos de distintos doctores con distintas especializaciones, ya que actualmente atravesamos una pandemia donde a los usuarios o pacientes nos es difícil poder acceder, en un primer descarte, a un centro médico. Así mismo, este aplicativo contará con una asistente virtual quien organizará sus citas programadas con sus centros de atención; es decir, el paciente podrá acceder a la información sobre las distintas instituciones donde esté doctor atiende. El paciente tendrá distintas opciones de médicos y lugares donde se pueda atender, gracias a la geolocalización, podrá ver una lista de distintos centros médicos y también podrá elegir al doctor mediante un sistema de calificaciones. Todos los doctores que harán el triaje para destinarlo con una especialidad son médicos recién colegiados; por otro lado, en la plataforma podrán verificar sus documentos y códigos de estos ante cualquier consulta. El aplicativo móvil tendrá una sección donde los pacientes podrán ver la trayectoria de los doctores especializados, es decir, donde han trabajado, especializaciones y otros. / This project deals with a mobile application called “Dr. App” to promote the medical services of doctors with different specializations, since we are currently going through a pandemic where users or patients find it difficult to access a medical center in the first instance. Likewise, this application will have a virtual assistant who will organize your scheduled appointments with your care centers; that is, the patient will be able to access information about the different institutions where the doctor attends. The patient will have different options of doctors and places where he can attend, thanks to geolocation, he will be able to see a list of different medical centers and he will also be able to choose the doctor through a rating system. All the doctors who will do the triage to assign it to a specialty are recently registered doctors; on the other hand, on the platform they will be able to verify their documents and their codes before any query. The mobile application will have a section where patients can see the trajectory of specialized doctors, that is, where they have worked, specializations and others. / Trabajo de investigación