RESUMO
BACKGROUND: The work climate (WC) affects the performance of service providers and has an impact on the care provided to users. This is important in the case of conditions that affect the quality of life, as is the case of chronic kidney disease (CKD) treated with haemodialysis. In Mexico, the demand for the care of CKD cases is increasing and the haemodialysis offer is limited. The purpose of this study was to describe and compare the WC in public, private and social security haemodialysis units in Mexico and to validate a tool to measure WC in haemodialysis units (HU). METHOD: 372 professionals from 84 HU in 27 states were interviewed using a questionnaire. This included questions about the WC, quality of care and structure and organisation of the HU. Variables were compared by type of institution and profession. RESULTS: Significant correlations were observed between the WC and indicators of the quality of care. Nine out of fourteen variables presented important differences by type of unit, with a better perception of WC in private units and a poorer perception in social security ones. CONCLUSIONS: The perception of WC relies on the organisation and planning of the institutions, as well as on their infrastructure. In the case of Social Security HU in Mexico, these appear to be the areas that require improvement in order to encourage a better work climate.
Assuntos
Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Cultura Organizacional , Recursos Humanos em Hospital/estatística & dados numéricos , Previdência Social/organização & administração , Local de Trabalho , Adulto , Estudos Transversais , Feminino , Administradores Hospitalares/psicologia , Administradores Hospitalares/estatística & dados numéricos , Humanos , Satisfação no Emprego , Masculino , Corpo Clínico Hospitalar/psicologia , Corpo Clínico Hospitalar/estatística & dados numéricos , México , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar/psicologia , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Recursos Humanos em Hospital/psicologia , Percepção Social , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
We use a time dependent modification of the Kermack and McKendrick model to study the evolution of the influenza A(H1N1)v epidemic reported in the Mexico City area under the control measures used during April and May 2009. The model illustrates how the sanitary measures postponed the peak of the epidemic and decreased its intensity. It provides quantitative predictions on the effect of relaxing the sanitary measures after a period of control. We show how the sanitary measures reduced the maximal prevalence of the infected population from 10% to less than 6% of the total population. We also show how the model predicts the time of maximal prevalence and explains the effect of the control measures.
Assuntos
Surtos de Doenças/estatística & dados numéricos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Modelos de Riscos Proporcionais , Medição de Risco/métodos , População Urbana/estatística & dados numéricos , Humanos , Incidência , México , Vigilância da População , Portugal/epidemiologia , Fatores de RiscoRESUMO
OBJECTIVE: To evaluate the independent and joint effects of dietary folate, vitamin B(12) consumption and methylenetetrahydrofolate reductase (MTHFR) polymorphisms (677C>T and 1298A>C) on the circulating folate and homocysteine (Hcy) levels among Mexican women of reproductive age. DESIGN: A cross-sectional, population-based study. SUBJECTS: The first 130 healthy non-pregnant women (aged 16-34 years) who agreed to participate in a reproductive cohort in Morelos, Mexico. MAIN OUTCOME MEASUREMENTS: Dietary intakes of vitamin B(12) and folate were estimated using a semiquantitative food frequency questionnaire. MTHFR 677C>T and 1298A>C polymorphisms were ascertained using the PCR-based method. Serum levels of Hcy and folate were determined using high-performance liquid chromatography and radioimmunoassay, respectively. RESULTS: Genotype frequencies for the MTHFR 677C>T polymorphism were 21.5% (CC), 52.3% (CT) and 26.2% (TT) among Mexican women. Of the population, 22% had the MTHFR 1298AC genotype, while no individual carried the 1298CC genotype. We observed an increased level of Hcy among carriers of the 677TT genotype, compared to carriers of the 677CC genotype. The highest level of Hcy was observed among MTHFR 677TT carriers with low B(12) intake (<2.0 microg/day), which resulted with a significant interaction (P=0.01). CONCLUSION: Vitamin B(12) is an important determinant of Hcy levels in Mexico. Supplementation of folic acid with vitamin B(12) may be preferable when the MTHFR 677T variant allele is prevalent.
Assuntos
Ácido Fólico/administração & dosagem , Homocisteína/sangue , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Polimorfismo Genético , Vitamina B 12/administração & dosagem , Adolescente , Adulto , Alelos , Cromatografia Líquida de Alta Pressão , Estudos de Coortes , Estudos Transversais , Feminino , Frequência do Gene , Genótipo , Humanos , México , Reação em Cadeia da Polimerase , Radioimunoensaio , Inquéritos e QuestionáriosRESUMO
Information on the association between exposure to beta-hexachlorocyclohexane (beta-HCH), hexachlorobenzene (HCB) or polychlorinated biphenyls (PCBs) and the incidence of breast cancer is inconclusive. However, exposure to such compounds is a public health concern in Mexico and is subject to recent regulation. Serum levels of beta-HCH, HCB and PCBs were analysed in 95 histologically confirmed breast cancer cases and 95 hospital controls, 20-79 years of age, from Mexico City, enrolled between March 1994 and April 1996. After adjusting for established risk factors, there was no evidence of a relationship between beta-HCH, HCB and PCBs and breast cancer risk (OR for beta-HCH tertile 3 versus tertile 1: 1.05 95% CI 0.46-2.40; OR for HCB tertile 3 versus tertile 1: 0.46 95% CI 0.20-1.07; OR for PCBs 1.31 95% CI 0.33-5.21 for the high category of exposure). This study lends no support to the case for a role for beta-HCH, HCB or PCBs in breast cancer aetiology.
Assuntos
Neoplasias da Mama/sangue , Exposição Ambiental , Hexaclorobenzeno/sangue , Hexaclorocicloexano/sangue , Bifenilos Policlorados/sangue , Adulto , Idoso , Neoplasias da Mama/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Razão de Chances , RiscoRESUMO
OBJECTIVE: To evaluate the modes of detection of breast malignancies in Mexico City and to estimate the number of patients diagnosed in advanced stages. MATERIAL AND METHODS: This cross-sectional study was conducted between 1994 and 1996, among 256 women with a histological diagnosis of breast cancer, at three tertiary level public hospitals in Mexico City. Personal interviews were conducted to collect data on reproductive characteristics, clinical history, and breast cancer modes of detection. Data analysis consisted of percentages, odds ratios, and 95% confidence intervals. RESULTS: Ninety percent of women sought medical care after identifying a breast lump by themselves. Only 10% of patients had a stage-I tumor; all 27 cases first identified by a physician were in stage II-B and higher. CONCLUSIONS: An increasing trend of breast cancer mortality in Mexico City will persist, unless a greater proportion of tumors in situ is detected; this would require enhancing breast cancer screening programs and conducting an intense educational intervention among women at risk.
Assuntos
Neoplasias da Mama/epidemiologia , Programas de Rastreamento , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Estudos Transversais , Feminino , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
OBJECTIVE: To assess the impact of occupational exposure to noise, as well as its relationship with other factors that can induce hearing loss. MATERIAL AND METHODS: In January and February 1997, we conducted sonometry and dosimetry tests in a cement factory, as well as audiometric test in 85 cement workers, to identify sources of noise and evaluate the effect to noise exposure and other factors, of the prevalence of occupational hearing loss. Statistical analysis was conducted using measures of central tendency, bivariate analysis and polynominal regression models. RESULTS: High noise levels were found in the crushing, crude milling, and cement milling sites. The highest individual dose corresponded to the packer job post. Fifty-five per cent of the study population presented some degree of hearing loss due to noise exposure. The cement processing area with the highest percentage of damaged workers was calcination. CONCLUSIONS: Our results show that noise is a serious risk factor in particular sites of cement factories, and also that an elevated number of hearing loss cases are due to occupational noise exposure in this industry; Our findings underscore the need for designing and implementing hearing protection programs, to assure the health and safety of cement workers.
Assuntos
Materiais de Construção , Surdez/epidemiologia , Ruído/efeitos adversos , Doenças Profissionais/epidemiologia , Adolescente , Adulto , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
The present work pretend to describe the development achieved in the field of health technology assessment and to propose a set of criteria to evaluate them, with the intention that it will lead to the development of health programs and policy with a tendency to maximize effectiveness, efficiency and quality, within a frame of increasing needs and scarce technical and economic resources for health care. For this work, a comprehensive review was carried out about the background of health technology adoption in our country, and the context by which to evaluate the accessibility and utilization of the health technology. In the section for technology assessment, it is propose a method to evaluate based upon the natural history of disease, that is, the traditional form of health assessment is restricted to a cross section in time (vertical evaluation), and in this study the authors propose a model with a horizontal approach, that should offer as its main virtues the development of guidelines with regards to prevention, diagnosis and treatment, in addition to cost containment, in support to a more effective and higher quality medical practice.
Assuntos
Nível de Saúde , Ciência de Laboratório Médico , Países em Desenvolvimento/economia , Métodos Epidemiológicos , Estudos de Avaliação como Assunto , Previsões , Acessibilidade aos Serviços de Saúde , Humanos , Serviços de Informação , Ciência de Laboratório Médico/economia , México , Modelos Teóricos , Pesquisa , Transferência de TecnologiaRESUMO
OBJECTIVE: To develop an effective strategy to inform Mexican women between 12 and 47 years of age about breast cancer (BC) and train them to perform breast self-examination (BSE). MATERIAL AND METHODS: Between April, 1996 and July, 1998, two different strategies to teach BSE were designed and evaluated in Cuernavaca, State of Morelos, Mexico. These strategies included teaching materials and were based on opinions of women participating in the first stage of this study. Both strategies consisted of the presentation of a leaflet and a video. The first strategy was delivered by a public health nurse in charge of leading the session. The second one was presented by a BC survivor. This second strategy included slides and silicon breast models. These two strategies were then compared to a third one, consisting of a primary care nurse handling out a leaflet and showing a video, based on Health Secretariat's guidelines. In total, 149 women were trained. They were randomly assigned to any one of these three strategies. The effectiveness of the teaching strategies was determined by assessing the changes in the women's knowledge of BC and BSE, as well as in their ability to identify the largest number of lumps on a natural size silicon breast, before and after training. Statistical analysis included Student's t test, variance analysis, McNemar's chi 2, Pearson's chi 2, and multiple linear regression. RESULTS: With all three strategies, there was an increase of approximately 30% in women's knowledge of BC and BSE as well as in their ability to detect lumps. Although at the beginning of the training only one out of every 20 women were able to identify more than three lumps in the silicon model, by the end between 3 and 4 of every 10 women were able to do this, with values of p < 0.05. Some factors determine women's learning of both BSE and information about BC as well as their ability to identify lumps. CONCLUSIONS: Teaching BSE with any of the strategies evaluated could be included in an integral program to educate Mexican women on breast cancer prevention and early detection. The appropriate and monthly practice of BSE is linked both to a decrease in the amount of time elapsing between the identification of suspect signs and the demand for medical care, such as requesting a clinical breast examination, which entails identifying small tumors when BC is present.
Assuntos
Neoplasias da Mama/diagnóstico , Autoexame de Mama/métodos , Educação em Saúde/métodos , Adolescente , Adulto , Neoplasias da Mama/prevenção & controle , Criança , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , México , Pessoa de Meia-Idade , Materiais de EnsinoRESUMO
We analyzed the intake of selected foods that contain phytoestrogens in relation to breast cancer (BC) risk using data from a hospital-based case-control study performed in Mexico City from 1994 to 1995. A total of 198 women with BC, aged 21-79 years, were individually age matched to an identical number of women with no breast disease. By a direct interview, information on socioeconomic characteristics and diet was obtained. A semiquantitative questionnaire was used to estimate the frequency of consumption of 95 foods. The effect of selected foods that contain phytoestrogens on BC risk was estimated using logistic regression models. The adjusted odds ratio for the consumption of more than one slice of onion per day and BC was 0.27 (95% confidence interval = 0.16-0.47), with a statistically significant trend (p < 0.001). This protective effect remained after adjustment for known risk factors of BC. Among premenopausal women, there was also a protective and significant effect due to the intake of lettuce and spinach and nonsignificant protective effects for the consumption of apples and herbal tea. Additional studies aimed at evaluating the potential protective effect of particular phytoestrogens on BC risk are needed.
Assuntos
Neoplasias da Mama/epidemiologia , Dieta , Estrogênios não Esteroides/administração & dosagem , Isoflavonas , Plantas Comestíveis , Adulto , Idoso , Anticarcinógenos/administração & dosagem , Anticarcinógenos/análise , Neoplasias da Mama/prevenção & controle , Estudos de Casos e Controles , Registros de Dieta , Estrogênios não Esteroides/análise , Feminino , Análise de Alimentos , Humanos , Entrevistas como Assunto , Modelos Logísticos , México/epidemiologia , Pessoa de Meia-Idade , Fitoestrógenos , Preparações de Plantas , Plantas Comestíveis/química , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
The objective of this study was to determine the risk of preterm birth in relation to umbilical cord blood lead levels (UCL) among primiparous and multiparous women. A case-cohort study was performed in Mexico City during 1995. A total of 459 full-term births was compared with 161 preterm births (before 37 gestational weeks). Mothers were interviewed before the delivery about their reproductive histories and other related factors of preterm birth. Lead was determined by atomic absorption spectrophotometry. Lead levels were higher in primiparous women who had a preterm birth than in primiparous women with a full-term birth (9.77+/-2.0 microgram/dl vs 8.24+/-2.15 microgram/dl); this difference was marginally significant. After adjusting for other known preterm birth risk factors, the frequency of preterm birth was almost three times higher among women who had UCL levels greater or equal to 5.1 microgram/dl compared to those who had UCL levels lower than 5.1 microgram/dl. This difference was not observed among multiparous women. Our results suggest that intrauterine lead exposure may be associated with preterm birth in first deliveries but not in subsequent ones.