RESUMO
This report describes the implementation process and functional structure of the Observatory of Security and Citizen Conviviality of the Juarez Municipality (Observatorio de Seguridad y Convivencia Ciudadanas del Municipio de Juárez) in Chihuahua, Mexico, and discusses the most relevant lessons learned and main challenges in the near future. The Observatory, created in 2008, is a joint effort of the Juarez Municipal Government, Autonomous University of Ciudad Juarez (Universidad Autónoma de Ciudad Juárez), and the Pan American Health Organization. The Observatory's main objective is to propose strategies and public policy recommendations to prevent and control violence and injuries in the Juarez Municipality. Most key federal, state, and local agencies have joined this independent autonomous citizen-based initiative, feed the databases, and benefit from the information produced by a multisectoral, multidisciplinary approach. The Observatory contributes far more than the technical data provided and its facilitating functions. The clear results obtained in such a short time-as seen in the preliminary results of the case study on road injuries from January 2009 to July 2011-demonstrate the appropriateness of this course of action and should stimulate the creation of new observatories whenever and wherever needed. Lessons learned, as discussed here, can open the way to new endeavors, and current challenges show how much work remains to be done.
Assuntos
Tomada de Decisões , Política de Saúde , Cooperação Internacional , Saúde Pública/métodos , Violência/prevenção & controle , Ferimentos e Lesões/prevenção & controle , Sistemas de Informação Geográfica , Humanos , México , Vigilância da População , Estados Unidos , Violência/estatística & dados numéricosRESUMO
This report describes the implementation process and functional structure of the Observatory of Security and Citizen Conviviality of the Juarez Municipality (Observatorio de Seguridad y Convivencia Ciudadanas del Municipio de Juárez) in Chihuahua, Mexico, and discusses the most relevant lessons learned and main challenges in the near future. The Observatory, created in 2008, is a joint effort of the Juarez Municipal Government, Autonomous University of Ciudad Juarez (Universidad Autónoma de Ciudad Juárez), and the Pan American Health Organization. The Observatorys main objective is to propose strategies and public policy recommendations to prevent and control violence and injuries in the Juarez Municipality. Most key federal, state, and local agencies have joined this independent autonomous citizen-based initiative, feed the databases, and benefit from the information produced by a multisectoral, multidisciplinary approach. The Observatory contributes far more than the technical data provided and its facilitating functions. The clear results obtained in such a short timeas seen in the preliminary results of the case study on road injuries from January 2009 to July 2011 demonstrate the appropriateness of this course of action and should stimulate the creation of new observatories whenever and wherever needed. Lessons learned, as discussed here, can open the way to new endeavors, and current challenges show how much work remains to be done.
Assuntos
Humanos , Tomada de Decisões , Política de Saúde , Cooperação Internacional , Saúde Pública/métodos , Violência/prevenção & controle , Ferimentos e Lesões/prevenção & controle , Sistemas de Informação Geográfica , México , Vigilância da População , Estados Unidos , Violência/estatística & dados numéricosAssuntos
Internacionalidade , Guerra , Pobreza , Saúde Pública , Segurança , Medidas de Segurança , Violência , Disparidades nos Níveis de Saúde , Saúde GlobalAssuntos
Monitoramento Epidemiológico , Violência , Acidentes de Trânsito , Sistemas de Informação Geográfica , Saúde na Fronteira , México , Estados Unidos , Estados Unidos , Tomada de Decisões , Política de Saúde , Cooperação Internacional , Saúde Pública , Violência , Ferimentos e Lesões , Sistemas de Informação Geográfica , Vigilância da PopulaçãoAssuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Programas Governamentais/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Adulto , Idade de Início , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/etiologia , Criança , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Masculino , México/epidemiologia , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/etnologia , Fatores Socioeconômicos , Sudoeste dos Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To describe and analyze, utilizing a case study approach, the U.S.- Mexico Border Diabetes Prevention and Control Project, a health research cooperation initiative incorporating the participation of federal, state, and local institutions of both countries. METHODS: A model of equal representation, participation, consensus, and shared leadership was used, with the participation of more than 130 institutions. A sample of 4 020 people over 18 years of age was obtained by a random, multistage, stratified, clustered design. A questionnaire about diabetes mellitus type 2 (DM2) and health was applied. The statistical analysis took into account the design effect. RESULTS: The prevalence of diagnosed DM2 was 14.9% (95% confidence interval [95% CI]: 12.5-17.6) and the prevalence of diagnosed DM2 adjusted by age was 19.5% (95% CI: 16.8-22.6) on the Mexican side of the border and 16.1% (IC95%: 13.5-19.2) on the U.S. border side. There were differences between the DM2 prevalence and risk factors along the border. CONCLUSIONS: The U.S.-Mexico Border Diabetes Prevention and Control Project allowed the border zone between the two countries to be considered, for the first time ever, as a unit for epidemiological research. A shared understanding among all participating institutions and entities of sociopolitical structures and procedures is required for effective border health cooperation initiatives.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Programas Governamentais/métodos , Inquéritos Epidemiológicos/métodos , Cooperação Internacional , Pesquisa/organização & administração , Adulto , Financiamento de Capital , Comunicação , Estudos Transversais/economia , Estudos Transversais/ética , Estudos Transversais/métodos , Cultura , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Órgãos Governamentais , Programas Governamentais/economia , Programas Governamentais/ética , Programas Governamentais/organização & administração , Programas Governamentais/estatística & dados numéricos , Inquéritos Epidemiológicos/economia , Inquéritos Epidemiológicos/ética , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Relações Interinstitucionais , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Avaliação de Programas e Projetos de Saúde , Pesquisa/economia , Sudoeste dos Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To examine the relationship between access to health care and undiagnosed diabetes among the high-risk, vulnerable population in the border region between the United States of America and Mexico. METHODS: Using survey and fasting plasma glucose data from Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project (February 2001 to October 2002), this epidemiological study identified 178 adults 18-64 years old with undiagnosed diabetes, 326 with diagnosed diabetes, and 2 966 without diabetes. Access to health care among that sample (n = 3,470), was assessed by type of health insurance coverage (including "none"), number of health care visits over the past year, routine pattern of health care utilization, and country of residence. RESULTS: People with diabetes who had no insurance and no place to go for routine health care were more likely to be undiagnosed than those with insurance and a place for routine health care (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.0-6.6, and OR 4.5, 95% CI 1.4-14.1, respectively). When stratified by country, the survey data showed that on the U.S. side of the border there were more people with undiagnosed diabetes if they were 1) uninsured versus the insured (28.9%, 95% CI 11.5%-46.3%, versus 9.1%, 95% CI 1.5%-16.7%, respectively) and if they 2) had made no visits or 1-3 visits to a health care facility in the past year versus had made ≥ 4 visits (40.8%, 95% CI 19.6%-62.0%, and 23.4%, 95% CI 9.9%-36.9%, respectively, versus 2.4%, 95% CI -0.9%-5.7%) (all, P < 0.05). No similar pattern was found in Mexico. CONCLUSIONS: Limited access to health care--especially not having health insurance and/or not having a place to receive routine health services--was significantly associated with undiagnosed diabetes in the U.S.-Mexico border region.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Adulto , Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Instalações de Saúde/estatística & dados numéricos , Instalações de Saúde/provisão & distribuição , Inquéritos Epidemiológicos , Humanos , Cobertura do Seguro , Masculino , Pessoas sem Cobertura de Seguro de Saúde , México/epidemiologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos , Sudoeste dos Estados Unidos/epidemiologia , Inquéritos e Questionários , Populações Vulneráveis , Adulto JovemRESUMO
OBJECTIVE: To assess and monitor the quality of care provided to Hispanics diagnosed with diabetes living in the border region between the United States of America and Mexico. METHODS: From April 2001 to November 2002, Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project, a prevalence study of type 2 diabetes and its risk factors, was conducted along the U.S.-Mexico border using two-stage cluster sampling of towns and households within towns. A questionnaire was administered on diabetes (self-reported) and lifestyle and a physical examination and blood sample were obtained. Of the 4 027 study participants, 521 (13.0%) reported receiving a pre-study diagnosis of diabetes. Of those, 466 were of Hispanic origin (226 on the Mexican side of the border and 240 on the U.S. side). RESULTS: Results indicated 42.1% of Hispanics on the U.S. side of the border (95% confidence interval [CI] 35.8%-48.6%) and 37.6% of Hispanics on the Mexican side (95% CI 31.3%-44.3%) had controlled diabetes (defined as glycosylated hemoglobin A1c < 7.0 %), and only one (on the Mexican side of the border) received optimal diabetes care, defined according to international criteria for systolic blood pressure and body mass index as well as health provider provision of yearly examinations of foot and eyes as preventive care measures for early detection of diabetes complications. CONCLUSIONS: Adult Hispanics diagnosed with diabetes and living on the U.S.-Mexico border region are not receiving adequate diabetes-related care, and health care professionals are not following international recommendations for providing that care. To improve diabetes control in the region, health care providers must become more aware of the effect of education and culture on diabetes self-care as well as the provision of preventative measures by health care professionals.