RESUMO
We explored how low-risk, nulliparous pregnant women and their doctors in two contiguous U.S.-Mexico border communities communicate about methods of delivery and how they perceive that the delivery method decision is made. We recruited 18 women through obstetricians in El Paso, Texas (n = 10), and prenatal care providers in Ciudad Juárez, Mexico (n = 8). We observed prenatal care visits, interviewed women prenatally and postpartum, and interviewed the El Paso obstetricians. Qualitative analysis demonstrated that birthing decisions are complex and involve multiple influences, including women's level of knowledge about birth, doctor-patient communication, and women's participation in decision making.
Assuntos
Tomada de Decisões , Parto Obstétrico/métodos , Participação do Paciente , Relações Médico-Paciente , Gestantes/psicologia , Adolescente , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , México , Paridade , Gravidez , Gestantes/etnologia , Pesquisa Qualitativa , Gravação em Fita , TexasRESUMO
In Ciudad Juarez, Chihuahua, Mexico, morbidity and mortality from injuries have increased alarmingly since 2008. This paper aims to examine the changes in the number of hospital discharges for external injuries recorded during the 2008-2010 period in a hospital in Ciudad Juarez. A descriptive retrospective study conducted at the Ciudad Juarez General Hospital looked at the incidence of external injuries as the reason for hospital discharges during the period under analysis. The average proportion of hospital discharges attributed to external injuries was 27%, with the 25-44-year-old age group being the most affected. More than half of the discharges were for fractures. The incidence rate of hospital discharges attributed to injuries in Ciudad Juarez was almost four times greater than that reported at the national level.
Assuntos
Hospitais/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Violência/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Adulto , Feminino , Humanos , Incidência , Masculino , México/epidemiologia , Estudos Retrospectivos , Risco , Ferimentos e Lesões/epidemiologiaRESUMO
In Ciudad Juarez, Chihuahua, Mexico, morbidity and mortality from injuries have increasedalarmingly since 2008. This paper aims to examine the changes in the numberof hospital discharges for external injuries recorded during the 20082010 period in ahospital in Ciudad Juarez. A descriptive retrospective study conducted at the CiudadJuarez General Hospital looked at the incidence of external injuries as the reason forhospital discharges during the period under analysis. The average proportion of hospitaldischarges attributed to external injuries was 27%, with the 2544-year-old agegroup being the most affected. More than half of the discharges were for fractures.The incidence rate of hospital discharges attributed to injuries in Ciudad Juarez wasalmost four times greater than that reported at the national level.
En Ciudad Juárez (Chihuahua), México, la morbilidad y la mortalidad por lesiones aumentaronen forma alarmante a partir de 2008. El presente trabajo se propone determinar los cambiosen el número de egresos hospitalarios por causas externas registrados durante el período 20082010 en un hospital de dicha ciudad. Se realizó un estudio retrospectivo descriptivo sobre laincidencia de causas externas como causa de egreso hospitalario en los años antes mencionadosen el Hospital General Ciudad Juárez. La media de egresos hospitalarios por causas externasfue de 27%, con el grupo etario de 25 a 44 años como el más afectado. Las fracturas fueron lacausa de más de la mitad de los egresos. Los egresos hospitalarios por lesiones en Ciudad Juárezpresentan una incidencia casi cuatro veces mayor que la reportada a nivel nacional.
Assuntos
Humanos , Masculino , Feminino , Adulto , Hospitais/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Violência/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Incidência , México/epidemiologia , Estudos Retrospectivos , Risco , Ferimentos e Lesões/epidemiologiaAssuntos
Violência , Ferimentos e Lesões , Ferimentos por Arma de Fogo , México , Violência , Ferimentos e Lesões , Ferimentos e Lesões , Ferimentos por Arma de Fogo , Hospitais , Ferimentos por Arma de Fogo , Risco , Ferimentos e Lesões , Alta do Paciente , Violência , Incidência , Estudos Retrospectivos , Ferimentos e LesõesRESUMO
This paper reviews and discusses the main procedures and policies that need to be followed when designing and implementing a binational survey such as the United States of America (U.S.)-Mexico Border Diabetes Prevalence Study that took place between 2001 and 2002. The main objective of the survey was to determine the prevalence of diabetes in the population 18 years of age or older along U.S.-Mexico border counties and municipalities. Several political, administrative, financial, legal, and cultural issues were identified as critical factors that need to be considered when developing and implementing similar binational projects. The lack of understanding of public health practices, implementation of existing policies, legislation, and management procedures in Mexico and the United States may delay or cancel binational research, affecting the working relation of both countries. Many challenges were identified: multiagency/multifunding, ethical/budget clearances, project management, administrative procedures, laboratory procedures, cultural issues, and project communications. Binational projects are complex; they require coordination between agencies and institutions at federal, state, and local levels and between countries and need a political, administrative, bureaucratic, cultural, and language balance. Binational agencies and staff should coordinate these projects for successful implementation.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Programas Governamentais/métodos , Inquéritos Epidemiológicos/métodos , Adulto , Financiamento de Capital , Centers for Disease Control and Prevention, U.S. , Criança , 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 , Cooperação Internacional , Masculino , México/epidemiologia , Organização Pan-Americana da Saúde , Prevalência , Avaliação de Programas e Projetos de Saúde , Sudoeste dos Estados Unidos/epidemiologia , Estados Unidos , Organização Mundial da SaúdeRESUMO
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 estimate prevalence of type 2 diabetes (diabetes) and impaired fasting glucose (IFG) in the border region between the United States of America and Mexico, by ethnic origin and country of residence; identify risk factors associated with both conditions; and explore the extent to which these factors account for cross-border or ethnic disparities in prevalence. METHODS: From April 2001 to November 2002, Phase I of the U.S.-Mexico Border Diabetes Prevention and Control Project, a prevalence study of diabetes and its risk factors, was conducted at the U.S.-Mexico border using multistage cluster sampling. A questionnaire was administered on diabetes (self-reported) and lifestyle and a physical examination and blood sample were obtained. A total of 4,027 adults participated in the study: 2,120 Hispanics from the Mexican side of the border and 1,437 Hispanics and 470 non-Hispanics (of whom 385 were classified as "white") from the U.S. side of the border. RESULTS: The age-adjusted prevalence of self-reported and unrecognized diabetes in Hispanics was 15.4% (16.6% on the Mexican side of the border and 14.7% on the U.S. side). The age-adjusted prevalence of IFG was similar on both sides of the border (14.1% on the Mexican side and 13.6% on the U.S. side). CONCLUSIONS: Established risk factors for diabetes (e.g., age, obesity, and family history) were relevant and there was an inverse relationship between diabetes and education and socioeconomic level. While diabetes prevalence is high on both sides of the U.S.-Mexico border, one-third of the cases remain undiagnosed, suggesting a need for development and implementation of a public health program for prevention, diagnosis, and control of diabetes in the region.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Etnicidade/estatística & dados numéricos , Adulto , Idoso , Antropometria , Glicemia/análise , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnologia , Feminino , Hábitos , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Americanos Mexicanos/estatística & dados numéricos , México/epidemiologia , México/etnologia , Pessoa de Meia-Idade , Prevalência , História Reprodutiva , Fatores de Risco , Fatores Socioeconômicos , Sudoeste dos Estados Unidos/epidemiologia , Inquéritos e Questionários , População Branca/estatística & dados numéricosRESUMO
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.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Americanos Mexicanos/estatística & dados numéricos , Qualidade da Assistência à Saúde , População Branca/estatística & dados numéricos , Adulto , Idoso , Pressão Sanguínea , Índice de Massa Corporal , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Hemoglobinas Glicadas/análise , Hábitos , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , México/epidemiologia , México/etnologia , Pessoa de Meia-Idade , História Reprodutiva , Fatores Socioeconômicos , Sudoeste dos Estados Unidos/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
This paper reviews and discusses the main procedures and policies that need to be followed when designing and implementing a binational survey such as the United States of America (U.S.)-Mexico Border Diabetes Prevalence Study that took place between 2001 and 2002. The main objective of the survey was to determine the prevalence of diabetes in the population 18 years of age or older along U.S.-Mexico border counties and municipalities. Several political, administrative, financial, legal, and cultural issues were identified as critical factors that need to be considered when developing and implementing similar binational projects. The lack of understanding of public health practices, implementation of existing policies, legislation, and management procedures in Mexico and the United States may delay or cancel binational research, affecting the working relation of both countries. Many challenges were identified: multiagency/multifunding, ethical/budget clearances, project management, administrative procedures, laboratory procedures, cultural issues, and project communications. Binational projects are complex; they require coordination between agencies and institutions at federal, state, and local levels and between countries and need a political, administrative, bureaucratic, cultural, and language balance. Binational agencies and staff should coordinate these projects for successful implementation.
En este artículo se analizan los principales procedimientos y normas que se deberían seguir al diseñar y ejecutar una encuesta binacional, como el estudio de prevalencia de la diabetes en la zona fronteriza entre México y los Estados Unidos que se llevó a cabo entre el 2001 y el 2002. El objetivo principal de la encuesta fue determinar la prevalencia de diabetes en las personas de 18 años o mayores en los condados y municipios fronterizos entre México y los Estados Unidos. Se definieron diversos aspectos políticos, administrativos, financieros, legales y culturales como factores fundamentales que se deben tener en cuenta al elaborar y ejecutar proyectos binacionales similares. La falta de comprensión de las prácticas de salud pública, la ejecución de las normas existentes, la legislación y los procedimientos de gestión en México y los Estados Unidos pueden retardar o cancelar las actividades de investigación binacional, y afectar las relaciones de trabajo entre ambos países. Se señalaron muchas dificultades con respecto a la multiplicidad de organismos y fuentes de financiación, las autorizaciones de carácter ético y presupuestario, la gestión del proyecto, los procedimientos administrativos, los procedimientos de laboratorio, los aspectos culturales y la comunicación del proyecto. Los proyectos binacionales son complejos; requieren coordinación entre los organismos y las instituciones a escalas federal, estatal, local y entre países, y precisan un equilibrio político, administrativo, burocrático, cultural e idiomático. El personal y los organismos binacionales deben coordinar estos proyectos con objeto de lograr su eficaz ejecución.
Assuntos
Humanos , Masculino , Feminino , Criança , Adulto , /epidemiologia , Programas Governamentais/métodos , Inquéritos Epidemiológicos/métodos , Financiamento de Capital , Centers for Disease Control and Prevention, U.S. , Comunicação , Estudos Transversais/economia , Estudos Transversais , Estudos Transversais/métodos , Cultura , /sangue , /etnologia , /prevenção & controle , Órgãos Governamentais , Programas Governamentais/economia , Programas Governamentais , Programas Governamentais/organização & administração , Programas Governamentais/estatística & dados numéricos , Inquéritos Epidemiológicos/economia , Inquéritos Epidemiológicos , Inquéritos Epidemiológicos/estatística & dados numéricos , Relações Interinstitucionais , Cooperação Internacional , México/epidemiologia , Organização Pan-Americana da Saúde , Prevalência , Avaliação de Programas e Projetos de Saúde , Sudoeste dos Estados Unidos/epidemiologia , Estados Unidos , Organização Mundial da SaúdeRESUMO
OBJETIVO: Describir y analizar con un enfoque de estudio de caso el Proyecto de Prevención y Control de la Diabetes en la Frontera México-Estados Unidos (PDF-México/Estados Unidos), un esfuerzo de cooperación en investigación en salud en el que participaron instituciones federales, estatales y locales de ambos países. MÉTODOS: El proyecto utilizó un modelo de igual representación, participación, consenso y liderazgo compartido, con la participación de más de 130 instituciones coordinadas por organismos de ambos países. Se estudió una muestra aleatoria, multietápica, estratificada y por conglomerados de 4 020 personas mayores de 18 años que respondieron un cuestionario de preguntas relacionadas con la diabetes mellitus tipo 2 (DM2) y la salud. El análisis estadístico de la información muestral obtenida tuvo en cuenta el efecto del diseño. RESULTADOS: La prevalencia de DM2 diagnosticada fue de 14,9 por ciento (intervalo de confianza de 95 por ciento [IC95 por ciento]: 12,5-17,6) y la prevalencia de DM2 diagnosticada ajustada por edad fue de 19,5 por ciento (IC95 por ciento: 16,8-22,6) en la parte mexicana y de 16,1 por ciento (IC95 por ciento: 13,5-19,2) en la estadounidense. La prevalencia de la DM2 y los factores de riesgo no fueron exactamente iguales a lo largo de la frontera. CONCLUSIONES: La ejecución del PDF-México/Estados Unidos ha permitido por primera vez considerar la franja fronteriza entre ambos países como una unidad para la investigación epidemiológica. En iniciativas fronterizas futuras, se sugiere fortalecer el entendimiento mutuo de la estructura sociopolítica y de las formas de actuación por parte de las instituciones y otras entidades participantes en ambos lados de la frontera.
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 percent (95 percent confidence interval [95 percent CI]: 12.5-17.6) and the prevalence of diagnosed DM2 adjusted by age was 19.5 percent (95 percent CI: 16.8-22.6) on the Mexican side of the border and 16.1 percent (IC95 percent: 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.