[Usefulness of the Delphi method for reaching consensus in the allocation of deceased donor kidneys in six Mexican hospitals]. / Utilidad del método Delphi para la construcción de acuerdos en la asignación de riñones de donante fallecido en seis hospitales de México.

OBJECTIVE: To ascertain medical criteria and their priority in the allocation of deceased patient kidneys in pediatrics among members of Internal Transplant Committees of six hospitals. To assess if, by using the Delphi method, it is possible to reach consensus to reduce heterogeneity of criteria in the allocation of renal transplant organs among physicians ascribed to Nephrology and Surgery services in six hospital centers in Mexico. METHODOLOGY: A study was carried out by the Delphi method of independent experts panel, with three stages and two rounds. The method makes possible iteration and controlled feedback from experts to identify behaviors and trends with the synergy of the debate in a group. Kappa index was applied to assess results agreement. RESULTS: Results of first round show the criteria heterogeneity for the allocation of cadaveric origin organs within each hospital, and among hospitals compared to each other. With the results of the second round, consensus increased in four hospitals for the selection of both first and second recipient. Kappa coefficient shows the reliability of results. CONCLUSION: Our Country needs a point-score system to allocate deceased donor organs, ideally including HLA matching. Expecting that the Internal Transplant Committees throughout the Mexican territory may have available a useful tool as this, the Delphi method makes it possible to reach consensus in this task, in order to minimize subjectivity in the staff involved in the decision-making process.

En hospitales d México: criterios de asignación de riñón de pacientes fallecidos / Mexico: criteria for the assignment of kidneys of deceased patients

En México, los riñones de donador fallecido se asignan a los receptores de conformidad con la Ley General de Salud que no proporciona criterios claros de distribución, y por desgracia no se hacen pruebas de histocompatibilidad. Para evaluar los criterios de asignación utilizamos un cuestionario con información de cinco historias clínicas de pacientes en lista de espera para un trasplante, y se les preguntó por el orden para recibir el órgano. Los resultados mostraron que no hubo criterios comunes dentro de cada hospital ni entre los hospitales comparados entre sí. En condiciones ideales debería existir un sistema de puntaje para la asignación de órganos de paciente fallecido que incluya las pruebas de histocompatibilidad.

In Mexico, kidneys from deceased donors are assigned to recipients in accordance with the General Health Act, which provides no clear criteria on distribution and, unfortunately, no histocompatibility tests are done. A questionnaire with information concerning five case histories of patients on a waiting list for a transplant was used to evaluate the criteria on allocation. The questionnaire was applied by asking in what order the patients would be assigned a kidney. The results showed there were no common criteria within each hospital or among the hospitals in the sample. Under ideal conditions, there should be a point system for assigning organs from deceased donors that includes histocompatibility tests.

Em México, os rins de doador falecido atribuem-se aos receptores seguindo a Lei General de Saúde. No entanto, esta não dá critérios claros de atribuição nem se fazem provas de histocompatibilidade. Para avaliar os critérios de atribuição, usamos um questionário com informação de cinco histórias clínicas de pacientes estarem em uma lista de espera para transplante. Foram perguntados pela ordem para receber o órgão. Os resultados revelaram que no existem critérios comuns em cada hospital nem entre os hospitais comparados entre si. Em condições ideais, deveria existir um sistema de puntagem para a atribuição de órgãos de paciente falecido, que inclua provas de histocompatibilidade.

Efectos de una intervención de manejo de estrés en mujeres con hipertensión arterial sistémica / Effects of a stress management intervention in women with systemic arterial hypertension / Efeitos de uma intervenção de manejo do estresse em mulheres com hipertensão arterial sistêmica

Actualmente, los padecimientos cardiovasculares tienen una gran prevalencia a nivel mundial, por lo cual es importante desarrollar tratamientos no farmacológicos para mejorar el pronóstico de las personas que los padecen. El objetivo fue evaluar el efecto de una intervención de manejo de estrés sobre el control de la hipertensión arterial en mujeres. Se utilizó un diseño cuasi-experimental, transversal, (pre-post intervención). Las participantes fueron 14 mujeres con edades entre 35 y 55 años, diagnosticadas con hipertensión arterial tipo 1, adscritas a un hospital de tercer nivel. Los instrumentos empleados fueron: la Lista de Eventos Recientes Potencialmente Estresantes, la Escala de distrés y una prueba computarizada (Stroop-cardiovascular). La intervención consistió en cuatro sesiones de diferentes tipos de relajación y terapia racional emotiva (reestructuración cognitiva). Los resultados, no arrojaron diferencias significativas al comparar la presión arterial del grupo, del pre al postest; no obstante, tres pacientes lograron reducirla al final del entrenamiento. Además, se registraron cambios favorables en eventos positivos, eventos negativos y distrés. El estudio concluyó que el manejo de estrés es una alternativa no farmacológica coadyuvante en el control de la hipertensión arterial, recomendable en poblaciones más grandes.

Currently, cardiovascular diseases have a high prevalence worldwise, so it is necessary to develop non pharmacological treatments to improve the prognosis of people who suffer from this disorder. The aim of this research was to identify the effect of an intervention program on stress management to control arterial hypertension in women. The design used was quasi-experimental cross-sectional (pre-post intervention). Participants were 14 women between 35 and 55 years old, diagnosed with hypertension type 1 and attached to a third level hospital. A special list of recent potentially stressful events, a distress scale, and a computerized discrimination test (Stroop-cardiovascular) were the instruments utilized. The intervention consisted of 4 sessions of different types of relaxation and rational emotive therapy (cognitive restructuring). Results did not indicate significant differences in the group between pre and post-test blood pressure measurements. Nevertheless, three patients reduced their blood pressure by the end of treatment. Additionally, favorable changes in positive events, negative events and distress were registered. The study concluded that stress management is a non- pharmacological alternative contributory to the control of arterial hypertension and recommended for larger populations.

Na atualidade as doenças cardiovasculares têm muita prevalencia no mondo. Portanto é importante desenvolver tratamentos não farmacológicos para melhorar o prognóstico dos pacientes. O objetivo foi avaliar o efeito de uma intervenção de manejo do estresse no controle da hipertensão arterial em mulheres. Foi aplicado um desenho transversal quase experimental (pré-pós intervenção). Participaram 14 mulheres com idades entre 35 e 55 anos, diagnosticadas com hipertensão arterial tipo 1, inscritas a um hospital do terceiro nível. Empregaram-se os seguintes instrumentos: Lista de Eventos Recentes Potencialmente Estressantes, Escala de distrés e uma prova computadorizada (Stroop-cardiovascular). A intervenção consistiu em quatro sessões de diversas classes de relaxação e terapia racional emotiva (re-estruturação cognitiva). Os resultados não mostraram diferencias significativas ao comparar a pressão arterial do grupo, do pré ao pós-test. No entanto, três pacientes a reduziram ao final do treinamento. Além disso, foram registradas mudanças favoráveis em eventos positivos, eventos negativos e distrés. O estudo conclui que o manejo do estresse é uma alternativa não farmacológica coadjuvante no controle da hipertensão arterial, recomendável em populações maiores.

Prevalence and correlates of adolescent dating violence: baseline study of a cohort of 7,960 male and female Mexican public school students.

INTRODUCTION: Factors correlated with adolescent dating violence have yet to be documented in most developing countries; this study assesses the prevalence and correlates of victimization with and perpetration of dating violence among Mexican youth. METHODS: This was the baseline measurement (1998-1999) of a cohort of 7960 public school students (11-24 years) developed to explore various health behaviors in Mexican youth. Multinomial logistic regression models were constructed with adolescent dating violence as the dependent variable. RESULTS: Prevalence of dating violence victimization was 9.37% (female) and 8.57% (male) for psychological violence; 9.88% (female) and 22.71% (male) for physical violence, and 8.63% (female) and 15.15% (male) for both psychological and physical violence. Prevalence of perpetration was 4.21% (female) and 4.33% (male) for psychological violence; 20.99% (female) and 19.54% (male) for physical violence; and 7.48% (female) and 5.51% (male) for both types of violence. Factors associated with dating violence victimization for both genders included: two or more lifetime sexual partners and intra-familial violence. Higher age, alcohol use and illegal drug use were significantly associated with victimization only among girls. The following were significantly associated with perpetration of dating violence in both genders: gang membership, illegal drug use, two or more lifetime sexual partners and intra-familial violence. Higher age and alcohol use were significantly associated with perpetration only among girls. High or middle socio-economic status was associated with perpetration only in boys. CONCLUSIONS: Future research on adolescent dating violence in Mexico should further explore severity and frequency of violent behaviors, include a focus on severe dating violence and take into account the context and meaning of dating violence. A longitudinal design that allows determination of causality will also be needed in order to develop prevention strategies.

[Dating violence and associations with depression and risk behaviors: female students in Morelos, Mexico]. / Violencia durante el noviazgo, depresión y conductas de riesgo en estudiantes femeninas (12-24 años).

OBJECTIVE: Determine the prevalence of dating violence and its association with depression and various risk behaviors in a sample of female students from the state of Morelos. MATERIAL AND METHODS: This is a baseline cohort study of a sample of 13 293 students from 12 to 24 years of age who attended public schools in the state of Morelos during the 1998-1999 school year. The participants were selected from a random sample of 260 junior high schools, 92 high schools and one university. For the purpose of this analysis, a total of 4 587 female students who had a previous dating relationship were selected. To control for possible confounding variables, multiple logistic regression analysis was used. RESULTS: The total prevalence of dating violence in females who attended public schools in Morelos was 28%. The following variables were associated with dating violence: depression (OR = 1.92; 95% CI 1.61-2.28); tobacco smoking (OR = 1.31; 95% CI 1.06-1.60); alcohol abuse (OR = 1.30, 95% CI 1.12-1.51); poor academic performance (low grades) (OR = 1.25; 95% CI 1.03-1.52); a history of sexual relations (OR = 1.52; 95% CI 1.26-1.82). CONCLUSIONS: The results of this study clearly indicate that women experience partner violence beginning with dating during adolescence. Health and education professionals need to establish intervention strategies to prevent or treat dating violence among female students. Such strategies should take into account the association between depression and violence, as well as other related risk behaviors.

Violencia durante el noviazgo, depresión y conductas de riesgo en estudiantes femeninas (12-24 años) / Dating violence and associations with depression and risk behaviors: female students in Morelos, Mexico

OBJETIVO: Conocer la prevalencia de la violencia durante el noviazgo y su nexo con la depresión y las conductas de riesgo en una muestra de estudiantes femeninas del estado de Morelos. MATERIAL Y MÉTODOS: El estudio se efectuó en una cohorte de 13 293 estudiantes de 12 a 24 años de edad de escuelas públicas del estado de Morelos durante el ciclo escolar 1998-1999. Los participantes provienen de una selección aleatoria de 260 escuelas secundarias, 92 escuelas preparatorias y una universidad. Para fines de la investigación se seleccionó a un total de 4 587 alumnas, todas con el antecedente de relaciones de noviazgo. Para controlar las posibles variables de confusión, se recurrió a un análisis de regresión logística múltiple. RESULTADOS: La prevalencia total de violencia durante el noviazgo en mujeres de escuelas públicas de Morelos fue de 28 por ciento. Las siguientes variables se vincularon con violencia durante el noviazgo: depresión (RM=1.92; IC95 por ciento 1.61-2.28); consumo de tabaco (RM=1.31; IC95 por ciento 1.06-1.60); abuso de alcohol (RM=1.30; IC95 por ciento 1.12-1.51); bajo rendimiento escolar (promedio de calificaciones de 7 o menor) (RM=1.25; IC95 por ciento 1.03-1.52); antecedente de relaciones sexuales (RM=1.52; IC95 por ciento 1.26-1.82). CONCLUSIONES: Los resultados indican con claridad que las mujeres sufren violencia de pareja desde las relaciones de noviazgo. Los profesionales de la salud y la educación requieren establecer medidas de intervención para prevenir y atender el problema de la violencia en el noviazgo entre las estudiantes; tales medidas deben tomar en cuenta la relación entre la depresión y la violencia, además del conjunto de comportamientos riesgosos relacionados.

OBJECTIVE: Determine the prevalence of dating violence and its association with depression and various risk behaviors in a sample of female students from the state of Morelos. MATERIAL AND METHODS: This is a baseline cohort study of a sample of 13 293 students from 12 to 24 years of age who attended public schools in the state of Morelos during the 1998-1999 school year. The participants were selected from a random sample of 260 junior high schools, 92 high schools and one university. For the purpose of this analysis, a total of 4 587 female students who had a previous dating relationship were selected. To control for possible confounding variables, multiple logistic regression analysis was used. RESULTS: The total prevalence of dating violence in females who attended public schools in Morelos was 28 percent. The following variables were associated with dating violence: depression (OR= 1.92; 95 percentCI 1.61-2.28); tobacco smoking (OR= 1.31; 95 percentCI 1.06-1.60); alcohol abuse (OR= 1.30, 95 percentCI 1.12-1.51); poor academic performance (low grades) (OR= 1.25; 95 percentCI 1.03-1.52); a history of sexual relations (OR= 1.52; 95 percentCI 1.26-1.82). CONCLUSIONS: The results of this study clearly indicate that women experience partner violence beginning with dating during adolescence. Health and education professionals need to establish intervention strategies to prevent or treat dating violence among female students. Such strategies should take into account the association between depression and violence, as well as other related risk behaviors.