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1.
Gac Sanit ; 2021 Mar 26.
Artigo em Espanhol | MEDLINE | ID: mdl-33781616

RESUMO

The Mendelian randomization is an epidemiologic method proposed to control for spurious associations in observational studies. These associations are commonly caused by confusion derived from social, environmental, and behavioral factors, which can be difficult to measure. Mendelian randomization is based on the selection of genetic variants that are used as instrumental variables that influence exposure patterns or are associated with an intermediate phenotype of the disease. The present work aims to discuss how to select the appropriate genetic variants as instrumental variables and to present methodological tools to deal with the limitations of this epidemiological method. The use of instrumental variables for modifiable exposures has the potential to mitigate the effects of common limitations, such as confusion, when robust genetic variants are chosen as instrumental variables.

2.
Rev Panam Salud Publica ; 44: e136, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33165413

RESUMO

Objective: To investigate the magnitude and distribution of the main causes of death, disability, and risk factors in Haiti. Methods: We conducted an ecological analysis, using data estimated from the Global Burden of Disease Study 2017 for the period 1990-2017, to present life expectancy (LE), healthy life expectancy (HALE) at under 1-year-old, cause-specific deaths, years of life lost (YLLs), years lived with disability (YLDs), disability adjusted life-years (DALYs), and risk factors associated with DALYs. Results: LE and HALE increased substantially in Haiti. People may hope to live longer in 2017, but in poor health. The Caribbean countries had significantly lower YLLs rates than Haiti for ischemic heart disease, stroke, lower respiratory infections, and diarrheal diseases. Road injuries were the leading cause of DALYs for people aged 5-14 years. Road injuries and HIV/AIDS were the leading causes of DALYs for men and women aged 15-49 years, respectively. Ischemic heart disease was the main cause of DALYs for people older than 50 years. Maternal and child malnutrition were the leading risk factors for DALYs in both sexes. Conclusion: Haiti faces a double burden of disease. Infectious diseases continue to be an issue, while non-communicable diseases have become a significant burden of disease. More attention must also be focused on the increase in worrying public health issues such as road injuries, exposure to forces of nature and HIV/AIDS in specific age groups. To address the burden of disease, sustained actions are needed to promote better health in Haiti and countries with similar challenges.

3.
Artigo em Inglês | PAHO-IRIS | ID: phr-52938

RESUMO

[ABSTRACT]. Objective. To investigate the magnitude and distribution of the main causes of death, disability, and risk factors in Haiti. Methods. We conducted an ecological analysis, using data estimated from the Global Burden of Disease Study 2017 for the period 1990-2017, to present life expectancy (LE), healthy life expectancy (HALE) at under 1-year-old, cause-specific deaths, years of life lost (YLLs), years lived with disability (YLDs), disability adjusted life-years (DALYs), and risk factors associated with DALYs. Results. LE and HALE increased substantially in Haiti. People may hope to live longer in 2017, but in poor health. The Caribbean countries had significantly lower YLLs rates than Haiti for ischemic heart disease, stroke, lower respiratory infections, and diarrheal diseases. Road injuries were the leading cause of DALYs for people aged 5-14 years. Road injuries and HIV/AIDS were the leading causes of DALYs for men and women aged 15-49 years, respectively. Ischemic heart disease was the main cause of DALYs for people older than 50 years. Maternal and child malnutrition were the leading risk factors for DALYs in both sexes. Conclusion. Haiti faces a double burden of disease. Infectious diseases continue to be an issue, while non-communicable diseases have become a significant burden of disease. More attention must also be focused on the increase in worrying public health issues such as road injuries, exposure to forces of nature and HIV/AIDS in specific age groups. To address the burden of disease, sustained actions are needed to promote better health in Haiti and countries with similar challenges.


[RESUMEN]. Objetivo. Investigar la magnitud y la distribución de las principales causas de muerte, discapacidad y factores de riesgo en Haití. Métodos. Se llevó a cabo un análisis ecológico con datos estimados a partir del estudio Carga Global de Morbilidad 2017 para el período 1990-2017 para presentar la esperanza de vida (LE), la esperanza de vida saludable (HALE), la mortalidad por causas específicas, los años de vida perdidos (YLL), los años vividos con discapacidad (YLD), los años de vida ajustados por discapacidad (DALY), y los factores de riesgo asociados a los DALY. Resultados. La LE y la HALE aumentaron sustancialmente en Haití. En 2017, la población puede esperar vivir más, pero con mala salud. Los países del Caribe tuvieron tasas de YLL significativamente más bajas que Haití en cuanto a cardiopatías isquémicas, accidentes cerebrovasculares, infecciones respiratorias bajas y enfermedades diarreicas. Las lesiones debidas a accidentes de tránsito fueron la principal causa de DALY para las personas de 5 a 14 años. Las lesiones debidas a accidentes de tránsito y el VIH/sida fueron las principales causas de DALY en hombres y mujeres de 15 a 49 años de edad, respectivamente. Las cardiopatías isquémicas fueron la principal causa de DALY para las personas mayores de 50 años. Las desnutriciones materna e infantil fueron los principales factores de riesgo de DALY en ambos sexos. Conclusión. Haití se enfrenta a una doble carga de enfermedad. Las enfermedades infecciosas siguen siendo un problema, mientras que las enfermedades no transmisibles se han convertido en una carga significativa de enfermedad. También debe prestarse más atención al aumento de problemas de salud pública preocupantes, como las lesiones por accidentes de tránsito, la exposición a fenómenos naturales y el VIH/sida en grupos etarios específicos. Para hacer frente a la carga de morbilidad es necesario adoptar medidas sostenidas para promover una mejor salud en Haití y en los países con desafíos similares.


Assuntos
Expectativa de Vida , Morte , Mortalidade , Anos Potenciais de Vida Perdidos , Pessoas com Deficiência , Haiti , Expectativa de Vida , Morte , Mortalidade , Anos Potenciais de Vida Perdidos , Pessoas com Deficiência , Haiti
4.
Nutr Res ; 81: 81-89, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32942060

RESUMO

Low-grade inflammation is a suggested mechanism in the development of metabolic syndrome (MetS), and diet could act as a regulator. Therefore, we hypothesized that the cumulative Dietary Inflammatory Index (DII®) exposure from diet during infancy through adulthood would be positively associated with the MetS and its components in young Mexican adults. One hundred participants from the Early Life Exposures in Mexico to Environmental Toxicants cohort were included in this analysis. The dietary inflammatory potential of the diet (without supplements) was assessed using 27 nutrients obtained from repeated food frequency questionnaires (1-22 years) using the DII, a validated score. The cumulative exposure of DII was constructed using the area under the curve (AUC of DII). The MetS was defined using the International Diabetes Federation criteria, and the Metabolic Syndrome Risk Z-score (MetRisk Z-score) was estimated. Linear regressions were conducted to assess the association between the AUC of DII with MetRisk Z-score and MetS components, adjusting for sex, socioeconomic status, smoking status, physical activity, birth weight, and body mass index. In adulthood, the mean age was 21.5 years, 54% were male, and 17% had MetS. Positive associations were found between AUC of DII with MetRisk Z-score (ß = .12; 95% confidence interval [CI]: 0.03-0.22; P = .009) and systolic (ß = .33; 95% CI: 0.05-0.61; P = .023) and diastolic blood pressure (ß = .24; 95% CI: 0.01-0.47; P = .040). A cumulative proinflammatory diet from infancy through young adulthood is associated with higher MetRisk Z-scores as well as blood pressure. These findings may provide evidence for the implementation of anti-inflammatory diet interventions throughout early life for the prevention of cardiometabolic risk.

5.
BMC Health Serv Res ; 20(1): 451, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448289

RESUMO

BACKGROUND: According to UNAIDS, the HIV epidemic has stabilized. This as a result of increased condom use and greater access to coverage for antiretroviral therapy (ART). In Central America, civil society organizations work with self-help groups (SHGs) organized in conjunction with public health services to implement interventions seeking to increase condom use and ART adherence for people living with HIV (PLH). METHOD: To analyze the effectiveness of SHGs in Central America aimed on increasing condom use and ART adherence in PLH, We conducted a cross-sectional study using a questionnaire and a random sample of 3024 intervention group and 1166 control group. Based on propensity scoring and one-to-one matching (with replacement), we formed a comparison group to help estimate the effectiveness of the above-mentioned intervention on two outcome variables (condom use and ART adherence). The internal consistency of the results was tested through weighted least squares (WLS) and instrumental variable (IV) regression. RESULTS: Although bivariate comparisons yielded differences between intervention and control group, we found no evidence that the intervention was effective; nor did we find evidence of a heterogeneous impact among countries after adjusting for propensity scoring and the IV model. The impact observed after performing raw comparisons of the indicators may be attributable to self-selection on the part of PLH rather than to the SHGs strategy. Our results demonstrate that it is imperative to use rigorous intervention evaluation methodology to validate the consistency of results. CONCLUSIONS: The intervention had no impact on the outcome indicators measured. We recommend prioritizing the allocation of economic resources for the implementation of interventions with previously proven effectiveness. We also recommend that future studies explore why the intervention failed to produce the expected impact on condom use and ART adherence.

6.
Am J Hum Biol ; 32(6): e23426, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32329554

RESUMO

OBJECTIVE: Hispanic populations typically show a high prevalence of dyslipidemias, especially of low high-density lipoproteins (HDLs) or HDL cholesterol. Highly admixed populations are ideal groups to clarify the role of genetic ancestry on HDL concentrations, isolating it from that of other factors. The objective of this study was to estimate the association between Native American genetic ancestry and HDL-cholesterol levels independent of socioeconomic factors in a representative sample of the Mexican population. METHODS: We used data from the Mexican National Health Survey 2000, analyzing 1647 subjects from whom stored DNA samples and HDL measurements were available. To estimate proportional genetic ancestry (Native American, African, and European), we used a 107 genetic ancestry informative marker panel with the software STRUCTURE. To estimate the association between genetic ancestry and low HDL levels, we fitted logistic regression models with the percentage of Native American genetic ancestry, in quartiles, as the main predictor. RESULTS: Mean HDL levels were 38.9 mg/dL, with 62% of subjects having levels below 40 mg/dL. Participants had on average 53.6% Native American, 39% European, and 7.3% African genetic ancestry. Those in the fourth quartile of Native American genetic ancestry had 35% higher odds of having low HDL-cholesterol relative to those in the first quartile (odds ratio, 1.35; 95% confidence interval, 0.99-1.81) after adjustment for socioeconomic level and other covariates, although the association is clearly nonlinear. CONCLUSION: Native American genetic ancestry seems to play a small but distinct role in the development of low HDL cholesterol levels.

7.
Health Policy Plan ; 35(5): 609-615, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32236544

RESUMO

The 'Seguro Médico Siglo XXI' (SMSXXI), a universal coverage medical insurance programme for children under 5 years of age, started in 2006 to help avoid catastrophic health expenditures in poor families without social security in Mexico. The study used information from the National Health Information System for the 2006-14 period. An ecological approach was followed with a panel of the 2457 municipalities of Mexico as the units of analysis. The outcome variables were the municipality-level neonatal mortality and infant mortality rates in population without access to social security. The programme variable was the coverage of the SMSXXI programme at the municipality level, expressed as a proportion. Demographic and economic variables defined at the municipality level were included as covariates. Impact was estimated by fitting a fixed-effects negative binomial regression model. Results reveal that the SMSXXI significantly reduced both infant and neonatSal mortality in the target population, although in a non-linear fashion, with minimum mortality levels found around the 70% coverage range. The effect is mostly given by the transition from the first quintile to the fourth quintile of coverage (<13% vs 70.5-93.7% coverage), and it is attenuated significantly at coverage levels very close to or at 100%. The observed risk reduction amounted to an estimated total of 11 358 infant deaths being avoided due to the SMSXXI during the 2006-14 period, of which 48% were neonatal. In conclusion, we found a significant impact of the SMSXXI programme on both infant mortality and neonatal mortality. An attenuation of the effect of the insurance on mortality rates at levels close to 100% coverage may reflect the saturation of health units in detriment of the quality of care.

8.
BMC Med Educ ; 20(1): 97, 2020 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-32234024

RESUMO

BACKGROUND: Continuing education is essential for healthcare workers. Education interventions can help to maintain and improve competency and confidence in the technical skills necessary to address adverse events. However, characteristics of the health provider such as age (related to more critical and reflexive attitude); sex (relationship with gender socialization), profession and work conditions might have an influence on the effect of continuing education efforts. METHODS: A training in the management of obstetric and neonatal emergencies (PRONTO, Spanish acronym for Neonatal and Obstetric Rescue Program: Optimal and Timely treatment) was implemented in 14 hospitals in six Mexican states between 2013 and 2014, with a before-after evaluation design. A total of 351 health providers including physicians, interns, nurses and midwives completed the training and were included in the analytic sample. Mixed-effects regression models were fitted to model changes in knowledge and self-efficacy scores after the training for each training topic. Interaction terms of training with age, gender, profession, and shift were included to evaluate possible heterogeneities of effect. All models considered the within-hospital clustering of participants. RESULTS: After training, all participants showed a significant knowledge gain by an average of 19 percentage points for hemorrhage, 23 for neonatal resuscitation, 19 for shoulder dystocia, and 15 for preeclampsia/eclampsia (p < 0.001). Participants who worked night shifts showed lower scores for overall knowledge, compared with morning shift workers. Interns perceived the lowest self-efficacy while they scored very high in knowledge. Self-efficacy in managing obstetric and neonatal emergencies increased significantly by 16 percentage points in average. CONCLUSIONS: Our results show that PRONTO is generally successful in increasing knowledge and self-efficacy on all topics but knowledge and self efficacy levels vary greatly by factors such as work shift. Training should be particularly aimed at personnel working during weekends and night shifts, as well as interns and nurses.

9.
Women Birth ; 33(6): 574-582, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32111555

RESUMO

PROBLEM: In Mexico, women are often disrespected and abused during birth, evidence-based practices are seldom used, while outdated and dangerous procedures linger. BACKGROUND: Disrespectful and abusive practices in Mexico have been reported but are not necessarily well-documented; none of the reports so far have relied on direct observation of births. AIM: To describe birth practices and factors associated with respectful and evidence-based care at 15 referral hospitals in Mexico. METHODS: We observed 401 births from 2010-2016. We analysed woman, provider, and hospital characteristics and their association with the performance of 14 evidence-based and 15 respectful birth practices via descriptive statistics and multiple logistic regression models. FINDINGS: Only in four births were all the analysed evidence-based and respectful-birth practices performed. Essential interventions like uterine massage was only given to 46.1% of women and the administration of a uterotonic soon after birth only occurred in 58.3% of births. Professionals who were trained in respectful birth care were more likely to address women by their name (Odds Ratio=3.34, p<0.05), allow consumption of liquids during labour (Odds Ratio=31.6, p<0.05), encourage skin-to-skin contact (Odds Ratio=31.82, p<0.05), and examine the placenta after birth (Odds Ratio=16.55, p<0.01); they were less likely to perform episiotomies (Odds Ratio=0.27, p<0.05). DISCUSSION: This study reveals low rates of evidence-based practices and respectful maternity care but shows training in the topic can have a considerable positive impact. Our results call for further efforts to improve the quality of maternal healthcare, a universal right.

10.
Ann Glob Health ; 86(1): 20, 2020 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-32140430

RESUMO

Background: Lead is a neurotoxic metal potentially affecting the developing brain. Children are particularly susceptible since they can absorb between 50% and 100% of ingested lead. There is no safe level for lead, therefore preventing exposure is crucial. We previously reported a positive association between lead concentrations found in candy and concurrent blood lead levels in Mexican children. This first report garnered media and the general public's attention. Objective: To conduct a follow-up study to assess lead concentrations in candy brands that we previously reported with concentrations ≥0.1ppm the U.S. Food and Drug Administration's recommended maximum lead level in candy likely to be consumed frequently by small children. Methods: In 2018 we analyzed 50 additional candy samples. Lead concentrations were analyzed by an inductively coupled plasma mass spectrometer and lead content per candy unit was calculated. Findings: We found concentrations were typically low, with a marked decrease from prior levels (2008). Nevertheless two candy units had concentrations of 0.1 ppm of lead. Conclusions: Candy may have lead concentrations up to 0.1 ppm and 1.2 µg per unit. This is a concern because candies are exported and consumed in many countries worldwide potentially resulting in human exposure. Continued public health surveillance is needed to protect populations especially vulnerable to lead exposure, especially children.

11.
Women Birth ; 33(3): 240-250, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31196831

RESUMO

PROBLEM AND BACKGROUND: During the past two decades, Mexico has launched innovative maternal health initiatives to improve maternal and neonatal outcomes, placing emphasis on the incorporation of professional midwifery practices into the healthcare system. This study explored the perceptions of healthcare providers and women using public birth care services regarding professional midwifery practices and how can the inclusion of evidence-based midwifery techniques improve the quality of service. METHODOLOGY: We conducted a qualitative, cross-sectional study of three healthcare networks in Mexico. A content analysis was performed of data collected through 109 semi-structured interviews: 72 with healthcare providers and 37 with women. RESULTS: Healthcare providers and women had minimal knowledge of the competencies and skills of professional midwives. Medical personnel accepted the incorporation of some evidence-based midwifery practices. Women had experienced fear and anguish during childbirth so they considered that incorporating professional midwifery practices into maternal health services would be favourable in that it would render birth care more respectful. DISCUSSION AND CONCLUSIONS: Healthcare providers are willing to consider the inclusion of some evidence-based midwifery practices in health services and regard assistance from professional midwives. They believe that structural conditions will complicate their incorporation. Although the women interviewed had experienced fear, anxiety and loneliness during childbirth, most of them admitted to feeling "safer" in a hospital (secondary-care health centre) setting where possible complications could be resolved. This perception of safety served to justify the delivery of healthcare in a manner that is inattentive to women's needs, which go beyond biomedical issues and include emotions and the positive experience of childbirth.


Assuntos
Parto Obstétrico/psicologia , Pessoal de Saúde/psicologia , Serviços de Saúde Materna/estatística & dados numéricos , Tocologia/métodos , Adolescente , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , México , Parto/psicologia , Gravidez , Pesquisa Qualitativa , Adulto Jovem
12.
Disaster Med Public Health Prep ; : 1-9, 2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33731243

RESUMO

OBJECTIVE: Local characteristics of populations have been associated with coronavirus disease 2019 (COVID-19) outcomes. We analyze the municipality-level factors associated with a high COVID-19 mortality rate (MR) of in Mexico. METHODS: We retrieved information from cumulative confirmed symptomatic cases and deaths from COVID-19 as of June 20, 2020, and data from most recent census and surveys of Mexico. A negative binomial regression model was adjusted, the dependent variable was the number of COVID-19 deaths, and the independent variables were the quintiles of the distribution of sociodemographic and health characteristics among the 2457 municipalities of Mexico. RESULTS: Factors associated with high MRs from COVID-19, relative to quintile 1, were diabetes and obesity prevalence, diabetes mortality rate, indigenous population, economically active population, density of economic units that operate essential activities, and population density. Among factors inversely associated with lower MRs from COVID-19 were high hypertension prevalence and houses without sewage drainage. We identified 1351 municipalities without confirmed COVID-19 deaths, of which, 202 had high and 82 very high expected COVID-19 mortality (mean = 8 and 13.8 deaths per 100,000, respectively). CONCLUSION: This study identified municipalities of Mexico that could lead to a high mortality scenario later in the epidemic and warns against premature easing of mobility restrictions and to reinforce strategies of prevention and control of outbreaks in communities vulnerable to COVID-19.

13.
BMJ Open ; 9(8): e030427, 2019 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-31455712

RESUMO

PURPOSE: The Early Life Exposure in Mexico to ENvironmental Toxicants (ELEMENT) Project is a mother-child pregnancy and birth cohort originally initiated in the mid-1990s to explore: (1) whether enhanced mobilisation of lead from maternal bone stores during pregnancy poses a risk to fetal and subsequent offspring neurodevelopment; and (2) whether maternal calcium supplementation during pregnancy and lactation can suppress bone lead mobilisation and mitigate the adverse effects of lead exposure on offspring health and development. Through utilisation of carefully archived biospecimens to measure other prenatal exposures, banking of DNA and rigorous measurement of a diverse array of outcomes, ELEMENT has since evolved into a major resource for research on early life exposures and developmental outcomes. PARTICIPANTS: n=1643 mother-child pairs sequentially recruited (between 1994 and 2003) during pregnancy or at delivery from maternity hospitals in Mexico City, Mexico. FINDINGS TO DATE: Maternal bone (eg, patella, tibia) is an endogenous source for fetal lead exposure due to mobilisation of stored lead into circulation during pregnancy and lactation, leading to increased risk of miscarriage, low birth weight and smaller head circumference, and transfer of lead into breastmilk. Daily supplementation with 1200 mg of elemental calcium during pregnancy and lactation reduces lead resorption from maternal bone and thereby, levels of circulating lead. Beyond perinatal outcomes, early life exposure to lead is associated with neurocognitive deficits, behavioural disorders, higher blood pressure and lower weight in offspring during childhood. Some of these relationships were modified by dietary factors; genetic polymorphisms specific for iron, folate and lipid metabolism; and timing of exposure. Research has also expanded to include findings published on other toxicants such as those associated with personal care products and plastics (eg, phthalates, bisphenol A), other metals (eg, mercury, manganese, cadmium), pesticides (organophosphates) and fluoride; other biomarkers (eg, toxicant levels in plasma, hair and teeth); other outcomes (eg, sexual maturation, metabolic syndrome, dental caries); and identification of novel mechanisms via epigenetic and metabolomics profiling. FUTURE PLANS: As the ELEMENT mothers and children age, we plan to (1) continue studying the long-term consequences of toxicant exposure during the perinatal period on adolescent and young adult outcomes as well as outcomes related to the original ELEMENT mothers, such as their metabolic and bone health during perimenopause; and (2) follow the third generation of participants (children of the children) to study intergenerational effects of in utero exposures. TRIAL REGISTRATION NUMBER: NCT00558623.


Assuntos
Osso e Ossos/metabolismo , Exposição Ambiental/efeitos adversos , Poluentes Ambientais/efeitos adversos , Chumbo/efeitos adversos , Chumbo/metabolismo , Efeitos Tardios da Exposição Pré-Natal/etiologia , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Adulto , Fatores Etários , Feminino , Humanos , Recém-Nascido , Masculino , México , Gravidez , Adulto Jovem
14.
J Clin Endocrinol Metab ; 103(9): 3386-3393, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30020462

RESUMO

Context: Early life cortisol plays an important role in bone, muscle, and fat mobilization processes, which could influence body composition, affecting anthropometric indicators such as weight and height. Objective: To explore the association between diurnal cortisol levels and growth indexes in children from 12 to 48 months of age. Design: This study includes data from 404 children from the Programming Research in Obesity, Growth, Environment and Social Stressors Mexican birth cohort. Cortisol was measured in eight saliva samples collected at four time points during the day (from wakeup to bedtime), over 2 days, when the child was either 12, 18, or 24 months old. Total daytime cortisol levels were calculated by averaging the area under the curve (AUC) for the 2 days. Height and weight were measured from 12 to 48 months of age. Growth indexes were constructed according to z scores following World Health Organization standards: weight-for-age z score (Z-WFA), height/length-for-age z score, weight-for-height/length z score (Z-WFH), and body mass index-for-age z score (Z-BMIFA). Mixed models were used to analyze the association between cortisol AUC quartiles and growth indexes. Results: Cortisol showed an inverted U-shaped association with the four growth indexes. Compared with the first quartile, all quartiles had a positive association with indexes that include weight, with the second quartile having the strongest association, resulting in an average change of ß (95% CI) 0.38 (0.13-0.64) for Z-WFA, 0.36 (0.10-0.62) for Z-WFH, and 0.43 (0.17-0.69) for Z-BMIFA. Conclusions: Results suggest that early life daytime cortisol levels, as a reflection of hypothalamic-pituitary-adrenal axis development, might influence growth in early infancy.


Assuntos
Estatura/fisiologia , Índice de Massa Corporal , Peso Corporal/fisiologia , Hidrocortisona/análise , Antropometria , Área Sob a Curva , Pré-Escolar , Ritmo Circadiano , Cidades , Estudos de Coortes , Feminino , Humanos , Sistema Hipotálamo-Hipofisário/crescimento & desenvolvimento , Lactente , Masculino , México , Sistema Hipófise-Suprarrenal/crescimento & desenvolvimento , Saliva/metabolismo
15.
PLoS One ; 13(5): e0198275, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29851984

RESUMO

BACKGROUND: Quality of obstetric care may not be constant within clinics and hospitals. Night shifts and weekends experience understaffing and other organizational hurdles in comparison with the weekday morning shifts, and this may influence the risk of maternal deaths. OBJECTIVE: To analyze the hourly variation of maternal mortality within Mexican health institutions. METHODS: We performed a cross-sectional multivariate analysis of 3,908 maternal deaths and 10,589,444 births that occurred within health facilities in Mexico during the 2010-2014 period, using data from the Health Information Systems of the Mexican Ministry of Health. We fitted negative binomial regression models with covariate adjustment to all data, as well as similar models by basic cause of death and by weekdays/weekends. The outcome was the Maternal Mortality Ratio (MMR), defined as the number of deaths occurred per 100,000 live births. Hour of day was the main predictor; covariates were day of the week, c-section, marginalization, age, education, and number of pregnancies. RESULTS: Risk rises during early morning, reaching 52.5 deaths per 100,000 live births at 6:00 (95% UI: 46.3, 62.2). This is almost twice the lowest risk, which occurred at noon (27.1 deaths per 100,000 live births [95% U.I.: 23.0, 32.0]). Risk shows peaks coinciding with shift changes, at 07:00, and 14:00 and was significantly higher on weekends and holidays. CONCLUSIONS: Evidence suggests strong hourly fluctuations in the risk of maternal death with during early morning hours and around the afternoon shift change. These results may reflect institutional management problems that cause an uneven quality of obstetric care.


Assuntos
Hospitais/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Mortalidade Materna , Qualidade da Assistência à Saúde , Adolescente , Adulto , Criança , Feminino , Humanos , México , Gravidez , Complicações na Gravidez/mortalidade , Fatores de Tempo , Adulto Jovem
16.
BMC Pregnancy Childbirth ; 18(1): 232, 2018 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-29902983

RESUMO

BACKGROUND: A significant proportion of newborn and maternal deaths can be prevented through simple and cost-effective strategies. The main aim of this study was to evaluate the impact of the PRONTO obstetric-emergency management training for improving evidence-based birth attendance practices among providers attending the training at 12 hospitals in three states of Mexico from 2010 to 2012, and to estimate dissemination of the training within the hospitals. METHODS: The average treatment on the treated effect of the PRONTO intervention for the probability of performing certain practices during birth attendance was estimated in a sample of 310 health providers. Impact estimates were obtained by performing provider-level matching using a mixed Mahalanobis distance one-to-one nearest-neighbor and exact matching approach. A secondary analysis estimated the positive externalities caused by the intervention in the treated hospitals using the same analytical approach. Provider-level fixed effects regression models were used to estimate the rate of decay of the probability of performing the examined practices. RESULTS: Providers attending the PRONTO training showed significant increases in the probability of performing the complete active management of the third stage of labor, especially the first and third steps, and skin-to-skin-contact. There was a negative and significant effect on the probability of performing uterine sweeping. Providers who did not attend the training in treated hospitals also showed marked significant changes in the same practices, except for uterine sweeping. There was no evidence of a significant decay of the probability of performing the routine practices over time among the treated providers. CONCLUSIONS: PRONTO is efficacious in changing trained providers' behavior, but not on all practices, suggesting that some practices are deeply ingrained. The results also suggest that information on practices is effectively transmitted to peers within treated hospitals. Previous findings of the dilution of the effect of PRONTO on some practices seem to be more related to the rotation of personnel (mainly interns) rather than providers returning to their former habits. TRIAL REGISTRATION: NCT01477554 . Registered on November 18, 2011; retrospectively registered.


Assuntos
Parto Obstétrico/educação , Parto Obstétrico/estatística & dados numéricos , Obstetrícia/educação , Obstetrícia/estatística & dados numéricos , Competência Clínica , Parto Obstétrico/métodos , Emergências , Feminino , Pessoal de Saúde/educação , Humanos , Terceira Fase do Trabalho de Parto , México , Obstetrícia/métodos , Equipe de Assistência ao Paciente , Gravidez , Probabilidade
17.
Salud Publica Mex ; 60(1): 86-96, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29689661

RESUMO

OBJECTIVE: To design and analyze the efficacy of an Ecohealth competency-based course on the prevention and control of vector-borne-diseases for specific stakeholders. MATERIALS AND METHODS: Multiple stakeholders and sectors of the region were consulted to identify Ecohealth group-specific competencies using an adjusted analysis matrix. Eight courses based on the competencies were implemented to train EA tutors. The effectiveness of the course was evaluated through the use of paired- t-tests by intervention group. RESULTS: Strategic, tactical, academia and community stakeholder groups and their competencies were identified. An overall gain of 43 percentage points (p<0.001) was observed in terms of competencies score in trained tutors, which further trained 1 033 people. CONCLUSIONS: The identification of the stakeholders and their competencies proved to be useful to guide training courses to significantly improve the initial competencies and create a critical mass to further advance the EA in the region.


Assuntos
Doença de Chagas/prevenção & controle , Dengue/prevenção & controle , Ecologia/educação , Controle de Infecções/métodos , Infectologia/educação , Malária/prevenção & controle , Animais , Doença de Chagas/epidemiologia , Doença de Chagas/transmissão , Currículo , Dengue/epidemiologia , Dengue/transmissão , Estudos de Avaliação como Assunto , Humanos , Insetos Vetores , Comunicação Interdisciplinar , Cooperação Internacional , América Latina/epidemiologia , Malária/epidemiologia , Malária/transmissão , Avaliação de Programas e Projetos de Saúde , Participação dos Interessados , Capacitação de Professores
18.
Salud pública Méx ; 60(1): 86-96, Jan.-Feb. 2018. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-903847

RESUMO

Abstract: Objective: To design and analyze the efficacy of an Ecohealth competency-based course on the prevention and control of vector-borne-diseases for specific stakeholders. Materials and methods: Multiple stakeholders and sectors of the region were consulted to identify Ecohealth group-specific competencies using an adjusted analysis matrix. Eight courses based on the competencies were implemented to train EA tutors. The effectiveness of the course was evaluated through the use of paired- t-tests by intervention group. Results: Strategic, tactical, academia and community stakeholder groups and their competencies were identified. An overall gain of 43 percentage points (p<0.001) was observed in terms of competencies score in trained tutors, which further trained 1 033 people. Conclusion: The identification of the stakeholders and their competencies proved to be useful to guide training courses to significantly improve the initial competencies and create a critical mass to further advance the EA in the region.


Resumen: Objetivo: Diseñar y analizar la eficacia de un curso basado en competencias de Eco-Salud para la prevención y control de enfermedades transmitidas por vectores, para actores específicos. Material y métodos: Se consultaron múltiples actores y sectores de la región para identificar las competencias específicas del enfoque de Ecosalud, que deberían de tener los grupos clave utilizando un análisis de matriz ajustado. Se implementaron cursos de capacitación utilizando las competencias para capacitar a tutores en el enfoque. La efectividad del curso se evaluó mediante el uso de pruebas t pareadas por grupo de intervención. Resultados: Se identificaron los grupos clave para la prevención y control de las ETVs: estratégico, táctico, académico y comunitario, así como sus competencias. Se capacitaron tutores y se obtuvo un incremento en relación con las competencias iniciales de 43 puntos porcentuales (p <0.001). Conclusión: La identificación de los grupos clave y sus competencias demostró ser útil en el diseño de un curso para incrementar el nivel inicial de competencias y crear una masa crítica para Ecosalud en la región.

19.
J Am Heart Assoc ; 7(2)2018 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-29331960

RESUMO

BACKGROUND: Cardiovascular disease in women often develops without conventional risk factors. Prenatal loss is a common pregnancy outcome that may result in physiological changes can increase the potential future risk of cardiovascular disease. Insufficient information exists regarding the impact of pregnancy loss on early markers of cardiovascular disease risk. METHODS AND RESULTS: Cross-sectional analysis of 1767 disease-free women from the MTC (Mexican Teachers' Cohort) who had been pregnant was used to evaluate the relationship between pregnancy loss and carotid intima-media thickness (IMT). Participants responded to a questionnaire regarding their reproductive history, risk factors, and medical conditions. We defined pregnancy loss as history of miscarriage and/or stillbirth. Trained neurologists measured IMT using ultrasound. We log-transformed IMT and defined subclinical carotid atherosclerosis (SCA) as IMT ≥0.8 mm and/or plaque. We used multivariable linear and logistic regression models to assess the relation of pregnancy loss, IMT, and SCA. The mean age of participants was 49.8±5.1 years. The prevalence of pregnancy loss was 22%, and we observed SCA in 23% of participants. Comparing participants who reported a pregnancy loss and those who did not, the multivariable-adjusted odds ratio for SCA was 1.52 (95% confidence interval, 1.12-2.06). Women who experienced a stillbirth had 2.32 higher odds (95% confidence interval, 1.03-5.21) of SCA than those who did not. Mean IMT appeared to be higher in women who reported a pregnancy loss relative to those who did not; nevertheless, this was not statistically significant. CONCLUSIONS: Pregnancy loss could be linked to cardiovascular disease later in life. The key findings of our study await confirmation and further investigation of the potential underlying mechanisms for this association is required.


Assuntos
Aborto Espontâneo/epidemiologia , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/epidemiologia , Espessura Intima-Media Carotídea , Natimorto/epidemiologia , Aborto Espontâneo/diagnóstico , Adulto , Fatores Etários , Doenças Assintomáticas , Estudos Transversais , Feminino , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Gravidez , Prevalência , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Professores Escolares
20.
Salud Publica Mex ; 59(2): 154-164, 2017 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-28562716

RESUMO

Objective:: To estimate the effective coverage (EC) of treatment of hypertension (HT) in Mexican adults in 2012 and compared with those reported in 2006. Materials and methods:: The National Health and Nutrition Survey 2012 was analyzed. The EC has three dimensions: health need as prevalence of HT, utilization of health services when the need is real and quality as recovering health after the treatment. The EC of treatment of HT was estimated using instrumental variables. Results:: In 2012, the EC national of treatment of HT was 28.3% (95%CI 26.5-30.1), ranging from Michoacan with 19.3% (15.3-23.4) to State of Mexico with 39.7% in (25.3-54.0). From 2006 to 2012 the national EC increased 22.5%. Conclusion:: The EC treatment of hypertension is low and heterogeneous. The use of synthetic indicators should be a daily exercise of measurement, because report summarizes the performance of state health systems.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Cobertura do Seguro , Adulto , Uso de Medicamentos , Feminino , Geografia Médica , Inquéritos Epidemiológicos , Humanos , Hipertensão/epidemiologia , Masculino , México/epidemiologia , Prevalência , Previdência Social
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