Assessing need for palliative care services for children in Mexico.

BACKGROUND: Pediatric palliative care increasingly became integrated into health care institutions worldwide over the last decade. However, in Mexico and other developing countries with large populations of children, little is known regarding the need for palliative care services. We aimed to assess the need for palliative and end-of-life care for children dying in public hospitals affiliated with Secretaria de Salud in Mexico. MEASUREMENT: We conducted a retrospective review of deaths of children (1-17 years old) occurring during 2011 and determined deaths associated with underlying complex chronic conditions by reviewing the four causes of death listed in the death certificate. We collected sociodemographic and clinical data and utilized univariate and multivariate analyses to determine factors associated with complex chronic conditions. RESULTS: A total of 2715 pediatric deaths were studied. We found 41% were associated with a complex chronic condition. The most frequent types of conditions were malignancies (47%), neuromuscular (18%), cardiovascular (12%), and renal (10%). Children with renal and malignant conditions died at an older age than children with other types of complex chronic conditions. Multivariate analysis indicated the independent predictors of death with complex chronic condition were no indigenous ethnicity, lack of admission to the intensive care unit during the final hospital stay, and having affiliation with an institution for health care. CONCLUSIONS: A large proportion of pediatric deaths are associated with complex chronic conditions indicating the provision of adequate funding for professional education and palliative care initiatives for children in Mexico, should be a topic of the national health care agenda.

Hospital versus home death: results from the Mexican Health and Aging Study.

CONTEXT: Characterizing where people die is needed to inform palliative care programs in Mexico. OBJECTIVES: To determine whether access to health care influences the place of death of older Mexicans and examine the modifying effects of demographic and clinical characteristics. METHODS: We analyzed 2001 baseline and 2003 follow-up data from the Mexican Health and Aging Study. Cases included adults who completed the baseline interview and died before the follow-up interview and for whom a proxy interview was obtained in 2003. The main outcome variable was the place of death (hospital vs. home). The predictors of the place of death were identified using logistic regression analysis. RESULTS: The study group included 473 deceased patients; 52.9% died at home. Factors associated with hospital death were having spent at least one night in a hospital during the last year of life (odds ratio [OR]: 6.73; 95% confidence interval [CI]: 3.29, 13.78) and dying in a city other than the city of usual residence (OR: 4.68, 95% CI: 2.56, 8.57). Factors associated with home death were not having health care coverage (OR: 2.78, 95% CI: 1.34, 5.88), living in a city of less than 100,000 residents (OR: 2.44, 95% CI: 1.43, 4.17), and older age (OR: 1.03, 95% CI: 1.01, 1.05). CONCLUSION: Older Mexicans with access to health care services were more likely to die in the hospital even after controlling for important clinical and demographic characteristics. Findings from the study may be used to plan the provision of accessible end-of-life hospital and home-based services.

Percepción del riesgo sobre protección y pérdida auditiva en trabajadores expuestos a ruido en el trabajo / Risk perception about hearing protection and hearing loss in workers exposed to noise in the workplace

La percepción del riesgo de pérdida de la audición y de la protección auditiva es un factor psicosocial aún no estudiado en México. Para este estudio, el cuestionario “Creencias acerca de la protección auditiva y la pérdida de la audición” fue aplicado a 24 trabajadores de una fábrica metalmecánica, para explorar la percepción de este riesgo entre los trabajadores. Los principales descubrimientos fueron que un 90 por ciento de los trabajadores sabía que el ruido podía dañar su audición, pero sólo el 80 por ciento sabía que los protectores auditivos pueden proteger su audición cuando trabajan en áreas muy ruidosas. Muchos de ellos pensaban que los protectores auditivos eran incómodos de utilizar y que limitaban su capacidad de identificar problemas o señales en su lugar de trabajo. Muchos trabajadores no sabían cómo utilizar protectores auditivos, cuándo usarlos y cómo reemplazarlos. Estos resultados muestran una limitada supervisión, entrenamiento y evaluación de la seguridad y los programas de salud en este lugar de trabajo, y hacen necesario implementar un programa preventivo de la pérdida de audición que incluya información acerca de efectos auditivos relacionados con el ruido y actividades para cambiar la percepción del riesgo en los trabajadores.

The workers' risk perception about hearing loss and hearing protection isan unstudied psychosocial factor in Mexico. For this study a “Beliefs about hearing protection and hearing loss” questionnaire was applied to 24 workers from a metal mechanic factory, to explore the workers' risk perception. The principal findings were that a 90 percent of workers knew that noise could damage their hearing but only 80 percent knew that hearing protectors can protect their hearing when they work in loud noise areas. Many of them thought that the hearing protectors were uncomfortable to use and limit their ability to identify problems or signals at their job place. Many workers don't know how to use hearing protectors, when to use them and how to replace them. These results express a limited supervision, training and evaluation of safety and health programs at this work place, and makes necessary to implement a preventive hearing loss program, including information about noise-related hearing effects and activities to change the workers' risk perception.

The place of death of children with cancer in the metropolitan areas of Mexico.

We sought to understand the factors associated with the place of death of children with cancer in metropolitan Mexico by carrying a retrospective review of death certificates. We selected deaths occurring in the metropolitan areas and included a total of 1948 cases with cancer as underlying cause of death. Cases were registered from 2002 to 2004, age < 18 years, and with complete data on socio-demographics. The study outcome was death occurring in a medical unit or home. Eighty-five percent of the cases died in hospitals. Multivariate analysis indicated patients diagnosed with leukemia or lymphomas were 2.5 times more likely to die in hospitals than patients diagnosed with other cancers (p < 0.001). Patients < 1-year old were 2.9 times more likely to die in hospitals than those older than 15 (p = 0.03). Higher average annual family income per county of residency was significantly associated with in-hospital death (p=0.02). Compared with patients who died at home, in-hospital deaths were more likely to occur if cases were transient residents of the study areas (OR 79.7 95% CI 24.9, 255.0, (p < 0.001) and if death occurred in the areas of Monterrey or Guadalajara compared to the Valley of Mexico (OR 1.60 95% CI 1.12, 2.29, (p = 0.01] and (OR 4.01 95% CI 2.24, 7.21, (p < 0.001), respectively. By highlighting the characteristics of children with cancer dying at home or in hospitals is crucial to allocating palliative care services. Children of older age, lower socioeconomic status, and those diagnosed with non-hematological cancers should be the target of home-based interventions.

Personal exposures to volatile organic compounds among outdoor and indoor workers in two Mexican cities.

There are limited data on exposures to ambient air toxics experienced by inhabitants of urban areas in developing countries that have high levels of outdoor air pollution. In particular, little is known about exposures experienced by individuals working outdoors - typically as part of the informal sector of the economy - as compared to workers in office-type environments that approach the indoor air quality conditions of the more developed countries. The objective of this study is to explore these differences in personal exposures using a convenience sample of 68 outdoor and indoor workers living in Mexico City (higher outdoor air pollution) and Puebla (lower outdoor air pollution), Mexico. Occupational and non-occupational exposures to airborne volatile organic compounds (VOCs) were monitored during a 2 day period, monitoring 2 consecutives occupational and non-occupational periods, using organic vapor monitors (OVMs). Socio-demographic and personal time-location-activity information were collected by means of questionnaires and activity logs. Outdoor workers experienced significantly higher exposures to most VOCs compared to indoor workers in each of these cities. The outdoor workers in Mexico City had the highest exposures both during- and off-work, with maximum occupational exposures for toluene, MTBE, n-pentane, and d-limonene exceeding 1 mg/m(3). The inter-city pattern of exposures between the outdoor workers is consistent with the higher outdoor air pollution levels in Mexico City, and is above exposures reported for urban areas of the more developed countries. Results from this study suggest that elevated outdoor air pollution concentrations have a larger impact on outdoor workers' personal exposures compared to the contribution from indoor pollution sources. This contrasts with the more dominant role of indoor air VOC contributions to personal exposures typically reported for urban populations of the more developed countries.

Factors associated with place of death of cancer patients in the Mexico City Metropolitan area.

OBJECTIVE: To improve the care of cancer patients by understanding the factors associated with the place of death. PATIENTS AND METHODS: We conducted a retrospective study of death certificates registered in Mexico during 2003. Adult cases were included if the underlying cause of death was cancer, death location was in the Mexico City Metropolitan Area (MCMA), and information was available on sociodemographic characteristics and place of death (home or medical unit). MAIN RESULTS: Of the 10,561 cases meeting the inclusion criteria, 54% died at home. More women (55%) than men died of cancer and at a younger age (63 vs 64 years, respectively; p<0.001). Multivariate analysis indicated that patients diagnosed with leukemia and lymphoma were 3.6 times more likely to die in hospitals than patients diagnosed with other cancers (p<0.001). Compared with patients who died at home, patients who died in hospitals were significantly more educated, younger, and residents of counties with more hospital beds density (p<0.001, p<0.001, and p=0.003, respectively). Certificates for in-hospital deaths were more likely to be signed by other physician or health professional than were those for at-home deaths (p<0.001). Cases with usual residency located outside the study area were 27 times more likely to die in hospitals than were metropolitan-area residents (p<0.001). CONCLUSIONS: Patients dying at home tended to be of older age, less educated, diagnosed with prostate, urinary tract or gastrointestinal cancers, and residents of the MCMA. Health planners should consider determinants of place of death when allocating hospital or home-based palliative care units.

Health conditions in a population living near an industrial waste recycling plant in Mexico

The present study was conducted in a population living near a recycling plant for zinc and other metallic dusts to determine whether exposures to these substances were occurring and producing adverse health effects. The plant is situated in a suburb of Monterrey, which is the third most populous city in Mexico and the second most industrialized. A cross-sectional study design was used for the investigation, which was carried out from September 1994 to November 1994. Using cluster sampling procedures, homes in two areas were selected - one exposed through proximity to the plant, and the other unexposed to serve as a control - until the desired sample size was achivied (621 individuals, with an average of five per dwelling). A specially trained psychology student administered a questionnaire to an adult member of each family, soliciting data on the presence of acute and chronic infections, complications of pregnancy, and congenital diseases among the family members. One hundred twenty-seven questionnaires were administered in the exposed population, yieldind information on 596 individuals. In the unexposed population, 147 questionnaires were administered furnishing data on 743 individuals. The sex and age distributions of the two populations were similar. The unexposed population had a slightly longer average duration of residence. The most common health problems in the exposed population were irritation of the eyes and upper respiratory tract, allergies, sleep disturbances, bronchitis, excessive fatigue, skin problems, otitis, and anemia. The exposed population had significantly higher risks for skin eruptions and diseases, excessive fatigue, sleep disturbances, upper respiratory infections, otitis, bronchitis, and allergies. Exposed and unexposed women had comparable prevalences of obstetrical problems, spontaneous abortions, congenitally malformed offspring, and low birthweigth. The questionnaire used to detect health problems has low sensitivity and may have generated underestimates of some conditions. Nevertheless, the analysis controlled for several different biases, and thus it can be concluded that a positive association exists between environmental exposure to these wastes and increased risk of disease

Health conditions in a population living near an industrial waste recycling plant in Mexico

The present study was conducted in a population living near a recycling plant for zinc and other metallic dusts to determine whether exposures to these substances were occurring and producing adverse health effects. The plant is situated in a suburb of Monterrey, which is the third most populous city in Mexico and the second most industrialized. A cross-sectional study design was used for the investigation, which was carried out from September 1994 to November 1994. Using cluster sampling procedures, homes in two areas were selected - one exposed through proximity to the plant, and the other unexposed to serve as a control - until the desired sample size was achivied (621 individuals, with an average of five per dwelling). A specially trained psychology student administered a questionnaire to an adult member of each family, soliciting data on the presence of acute and chronic infections, complications of pregnancy, and congenital diseases among the family members. One hundred twenty-seven questionnaires were administered in the exposed population, yieldind information on 596 individuals. In the unexposed population, 147 questionnaires were administered furnishing data on 743 individuals. The sex and age distributions of the two populations were similar. The unexposed population had a slightly longer average duration of residence. The most common health problems in the exposed population were irritation of the eyes and upper respiratory tract, allergies, sleep disturbances, bronchitis, excessive fatigue, skin problems, otitis, and anemia. The exposed population had significantly higher risks for skin eruptions and diseases, excessive fatigue, sleep disturbances, upper respiratory infections, otitis, bronchitis, and allergies. Exposed and unexposed women had comparable prevalences of obstetrical problems, spontaneous abortions, congenitally malformed offspring, and low birthweigth. The questionnaire used to detect health problems has low sensitivity and may have generated underestimates of some conditions. Nevertheless, the analysis controlled for several different biases, and thus it can be concluded that a positive association exists between environmental exposure to these wastes and increased risk of disease

Condiciones de salud de la población vecina a una planta recicladora de residuos en México / Health conditions in a population living near a waste recycling plant in Mexico

El presente estudio se realizó en México en una población vecina a una planta recicladora de cinc y de otros polvos metálicos ante la posibilidad de que estas sustancias entraran en contacto con la población y produjeran diferentes efectos nocivos sobre la salud. La planta se sitúa en un municipio cercano a Monterrey, que s la tercera ciudad más poblada de México y la segunda más industrializada. Se aplicó un diseño transversal comparativo para llevar a cabo la investigación, que duró de septiembre a noviembre de 1994. Mediante un muestreo por cuotas se seleccionaron viviendas en dos zonas - una zona expuesta por vecindad a la planta y otra no expuesta que sirvió de control - hasta lograr el tamaño muestral deseado (621 individuos, a un promedio de cinco por vivienda). En cada domicilio un estudiante de psicología adiestrado aplicó un cuestionario a un familiar mayor de edad para recoger datos sobre la presencia de afecciones agudas y crónicas, trastornos del embarazo y enfermedades congénitas en los integrantes del hogar. En la población expuesta se aplicaron 127 cuestionarios, que arrojaron información sobre 596 personas, y en la población no expuesta se administraron 147, que proporcionaron datos sobre 743 personas. Las distribuciones por sexo y edad fueron semejantes en las dos poblaciones y el tiempo de residencia en la zona fue ligeramente mayor en los individuos no expuestos. Los problemas de salud más frecuentes en la población expuesta fueron irritación ocular y de vias respiratorias superiores, alergias, trastornos del sueño, bronquitis, cansancio excesivo, problemas cutáneos, otitis y anemias. Las razones de prevalencias fueron significativas en el caso de erupciones y otras enfermedades cutáneas, cansancio excesivo, trastornos del sueño, infecciones respiratorias superiores, otitis, bronquitis y alergias. Cuando se compararon los dos grupos de mujeres no se encontraron diferencias significativas en las prevalencias de problemas obstétricos, abortos espontáneos o hijos con malformaciones congénitas o bajo peso al nacer. La sensibilidad del cuestionario utilizado para detectar problemas de salud es pobre y podría haber causado una subestimación de algunas afecciones. No obstante, diferentes sesgos de información fueron controlados y ello permite concluir que la población expuesta tiene un mayor riesgo de padecer ciertas enfermedades y trastornos que la población no expuesta

Condiciones de salud de la población vecina a una planta recicladora de residuos en México / Health conditions in a population living near a waste recycling plant in Mexico

El presente estudio se realizó en México en una población vecina a una planta recicladora de cinc y de otros polvos metálicos ante la posibilidad de que estas sustancias entraran en contacto con la población y produjeran diferentes efectos nocivos sobre la salud. La planta se sitúa en un municipio cercano a Monterrey, que s la tercera ciudad más poblada de México y la segunda más industrializada. Se aplicó un diseño transversal comparativo para llevar a cabo la investigación, que duró de septiembre a noviembre de 1994. Mediante un muestreo por cuotas se seleccionaron viviendas en dos zonas - una zona expuesta por vecindad a la planta y otra no expuesta que sirvió de control - hasta lograr el tamaño muestral deseado (621 individuos, a un promedio de cinco por vivienda). En cada domicilio un estudiante de psicología adiestrado aplicó un cuestionario a un familiar mayor de edad para recoger datos sobre la presencia de afecciones agudas y crónicas, trastornos del embarazo y enfermedades congénitas en los integrantes del hogar. En la población expuesta se aplicaron 127 cuestionarios, que arrojaron información sobre 596 personas, y en la población no expuesta se administraron 147, que proporcionaron datos sobre 743 personas. Las distribuciones por sexo y edad fueron semejantes en las dos poblaciones y el tiempo de residencia en la zona fue ligeramente mayor en los individuos no expuestos. Los problemas de salud más frecuentes en la población expuesta fueron irritación ocular y de vias respiratorias superiores, alergias, trastornos del sueño, bronquitis, cansancio excesivo, problemas cutáneos, otitis y anemias. Las razones de prevalencias fueron significativas en el caso de erupciones y otras enfermedades cutáneas, cansancio excesivo, trastornos del sueño, infecciones respiratorias superiores, otitis, bronquitis y alergias. Cuando se compararon los dos grupos de mujeres no se encontraron diferencias significativas en las prevalencias de problemas obstétricos, abortos espontáneos o hijos con malformaciones congénitas o bajo peso al nacer. La sensibilidad del cuestionario utilizado para detectar problemas de salud es pobre y podría haber causado una subestimación de algunas afecciones. No obstante, diferentes sesgos de información fueron controlados y ello permite concluir que la población expuesta tiene un mayor riesgo de padecer ciertas enfermedades y trastornos que la población no expuesta

Las condiciones de salud de los conductores de autotransportes urbanos de pasajeros de la ciudad de México / Health conditions among drivers of urban passenger transport vehicles in México City

Con el objeto de conocer los efectos nocivos de las condiciones de trabajo de los conductores de autotransportes urbanos de pasajeros, entre 1985 y 1988 se realizó en la empresa Ruta 100 de la ciudad de México una investigación epidemiológica en dos fases. En la primera fueron entrevistados nueve de cinco conductores cada uno que dieron sus opiniones sobre sus condiciones laborales y los posibles trastornos relacionados con ellas. A partir de esta información se diseño una encuesta epidemiológica que se aplicó mediante un diseño muestral polietápico a 170 conductores y a otros dos grupos de otros tantos trabajadores de mantenimiento y administrativos que sirvieron como grupos de control. En el grupo de conductores se halló una prevalencia elevada de trastornos respiratorios y neuropsiquiátricos, diarrea, miopía, hipertensión arterial, molestias urinarias, hemorroides, sordera, dolor de espalda, varices, úlcera péptica, diabetes, cardiopatías, hernias abdominales y apendicitis. La razón de prevalencias conductores/personal de mantenimiento y conductores/administrativos fue estadísticamente significativa en lo referente a hipertensión arterial, hemorroides, "padecimiento de nervios" y trastornos psiquiátricos

Las condiciones de salud de los conductores de autotransportes urbanos de pasajeros de la ciudad de México / Health conditions among drivers of urban passenger transport vehicles in México City

Con el objeto de conocer los efectos nocivos de las condiciones de trabajo de los conductores de autotransportes urbanos de pasajeros, entre 1985 y 1988 se realizó en la empresa Ruta 100 de la ciudad de México una investigación epidemiológica en dos fases. En la primera fueron entrevistados nueve de cinco conductores cada uno que dieron sus opiniones sobre sus condiciones laborales y los posibles trastornos relacionados con ellas. A partir de esta información se diseño una encuesta epidemiológica que se aplicó mediante un diseño muestral polietápico a 170 conductores y a otros dos grupos de otros tantos trabajadores de mantenimiento y administrativos que sirvieron como grupos de control. En el grupo de conductores se halló una prevalencia elevada de trastornos respiratorios y neuropsiquiátricos, diarrea, miopía, hipertensión arterial, molestias urinarias, hemorroides, sordera, dolor de espalda, varices, úlcera péptica, diabetes, cardiopatías, hernias abdominales y apendicitis. La razón de prevalencias conductores/personal de mantenimiento y conductores/administrativos fue estadísticamente significativa en lo referente a hipertensión arterial, hemorroides, "padecimiento de nervios" y trastornos psiquiátricos