RESUMO
Diabetes is a serious public health problem in the border region between the United States of America and Mexico, reflecting and by some measures surpassing the extent of national diabetes burden of each country. The U.S.-Mexico Border Diabetes Prevention and Control Project, a two-phase prevalence study on type 2 diabetes and its risk factors, was conceived and developed by culturally diverse groups of people representing more than 100 government agencies and nongovernmental organizations; health care providers; and residents of 10 U.S. and Mexican border states, using a participatory approach, to address this disproportionate incidence of diabetes. This report describes the project's history, conceptualization, participatory approach, implementation, accomplishments, and challenges, and recommends a series of steps for carrying out other binational participatory projects based on lessons learned.
Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Programas Governamentais/história , Inquéritos Epidemiológicos/história , Adulto , Centers for Disease Control and Prevention, U.S. , Estudos Transversais/economia , Estudos Transversais/história , Estudos Transversais/métodos , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Feminino , Órgãos Governamentais , Programas Governamentais/economia , Programas Governamentais/métodos , Programas Governamentais/organização & administração , Inquéritos Epidemiológicos/economia , Inquéritos Epidemiológicos/métodos , História do Século XX , História do Século XXI , Humanos , Relações Interinstitucionais , Cooperação Internacional , Masculino , México/epidemiologia , Organização Pan-Americana da Saúde , Avaliação de Programas e Projetos de Saúde , Sudoeste dos Estados Unidos/epidemiologia , Estados Unidos , Organização Mundial da SaúdeRESUMO
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 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.
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
Diabetes is a serious public health problem in the border region between the United States of America and Mexico, reflecting and by some measures surpassing the extent of national diabetes burden of each country. The U.S.-Mexico Border Diabetes Prevention and Control Project, a two-phase prevalence study on type 2 diabetes and its risk factors, was conceived and developed by culturally diverse groups of people representing more than 100 government agencies and nongovernmental organizations; health care providers; and residents of 10 U.S. and Mexican border states, using a participatory approach, to address this disproportionate incidence of diabetes. This report describes the project's history, conceptualization, participatory approach, implementation, accomplishments, and challenges, and recommends a series of steps for carrying out other binational participatory projects based on lessons learned.
La diabetes es un problema grave de salud pública en la zona fronteriza entre México y los Estados Unidos, que refleja y, en cierta medida, sobrepasa la magnitud de la carga nacional de la diabetes de cada país. El Proyecto de Prevención y Control de la Diabetes en la Frontera México-Estados Unidos, un estudio de prevalencia de dos fases sobre la diabetes tipo 2 y sus factores de riesgo, se ideó y elaboró por grupos de personas culturalmente diversos que representaban a más de 100 organismos estatales y organizaciones no gubernamentales, profesionales de salud y residentes de 10 estados de la zona fronteriza entre México y los Estados Unidos, con la aplicación de un enfoque participativo, a fin de estudiar esta desproporcionada incidencia de diabetes. En este informe se describen la historia, la conceptualización, el enfoque participativo, la ejecución, los logros y los retos del proyecto, y se recomienda una serie de pasos para la realización de otros proyectos participativos binacionales, a partir de las lecciones aprendidas.
Assuntos
Humanos , Masculino , Feminino , Adulto , História do Século XX , História do Século XXI , /prevenção & controle , Programas Governamentais/história , Inquéritos Epidemiológicos/história , Centers for Disease Control and Prevention, U.S. , Estudos Transversais/economia , Estudos Transversais/história , Estudos Transversais/métodos , /epidemiologia , /etnologia , Órgãos Governamentais , Programas Governamentais/economia , Programas Governamentais/métodos , Programas Governamentais/organização & administração , Inquéritos Epidemiológicos/economia , Inquéritos Epidemiológicos/métodos , Relações Interinstitucionais , Cooperação Internacional , México/epidemiologia , Organização Pan-Americana da Saúde , Avaliação de Programas e Projetos de Saúde , Sudoeste dos Estados Unidos/epidemiologia , Estados Unidos , Organização Mundial da SaúdeRESUMO
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.