COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Delay of medical care for symptomatic breast cancer: a literature review El retraso en la atención médica del cáncer de mama: una revisión de la literatura

The purpose of this paper is to organize and summarize existing information on delayed medical attention for women with breast cancer and identify research needs in this area. This review is organized in six parts: origins and permanence of the message "do not delay" medical attention for potential cancer symptoms; definition and classification of breast cancer delay; impact of delay on breast cancer prognosis; factors related to breast cancer delay and the ways these have been studied; the study of breast cancer delay in Mexico; and directions for future research in developing countries, with a special focus on Mexico. We point out the need of a more integral study of delay that takes into account socio-structural and health services factors, in order to find modifiable factors towards which political actions should be directed to improve breast cancer medical attention in underdeveloped countries.<br>El objetivo de esta revisión es integrar información disponible con respecto al retraso en la atención médica del cáncer de mama e identificar necesidades de investigación en este tema. La revisión consta de seis apartados: origen del mensaje "no retrasar" ante la aparición de síntomas de cáncer; definición y clasificación del retraso en la atención del cáncer de mama; impacto del retraso sobre el pronóstico de la enfermedad; factores asociados con el retraso; la investigación del retraso en la atención del cáncer de mama en México; y necesidades de investigación en este tema. Se señala la necesidad de estudiar el retraso en la atención del cáncer de mama de forma más integral, tomando en cuenta características socio-estructurales y de servicios de salud, para identificar factores modificables hacia los cuales dirigir esfuerzos para mejorar la atención de esta enfermedad en países en vías de desarrollo

Breast cancer delay: A grounded model of help-seeking behaviour

The conventional definition and classifications of breast cancer delay are based on arbitrary empirical time cut-offs. In general, studies of cancer delay are based on these traditional definitions of patient and provider delay and are essentially atheoretical. If we aim to better understand delay, a reconsideration of its traditional conceptualisation and study methods is warranted. We propose a multidimensional model of breast cancer delay grounded in data from in-depth interviews with symptomatic patients and nested in the theory of illness behaviour. Our results show that delay prior to the first encounter with health services has to do with more than simply the patient as an individual, and delay posterior to this encounter is not due only to the health care providers. In fact, delay is a result of the interplay between the patient's socio-cultural context, individual characteristics that influence symptom interpretation and decision-making, interaction with the social network and types of support obtained, and aspects of the local health services. Future research on cancer delay should approach the problem integrally, taking into account the diverse dimensions involved.Breast cancer Delay Lagtime Conceptual model Mexico Qualitative methods Illness behaviour Help-seeking career

Internet-based educational intervention to prevent risky sexual behaviors in Mexican adolescents: study protocol

Abstract Background Risky sexual behaviors of adolescents in Mexico are a public health problem; 33.4 % of adolescent girls and 14.7 % of boys report not having used any protection at their first intercourse. The fertility rate is 77 births/1000 girls aged 15–19 years. The infrequent contact of adolescents with health services and the limited extent of school sex and reproductive health education require the support of innovative strategies. The objective of this paper is to present the design of an internet-based educational strategy to prevent risky sexual behaviors in Mexican adolescents. Methods A field trial with intervention and comparison group and with ex-ante and ex-post measurements will be conducted in two public secondary schools. Adolescents between 14 and 15 years of age will participate. The intervention will be conducted in one school and the second school will serve as a comparison group where the investigators will observe the usual sex education provided by the school. The intervention will be delivered using an internet web page that includes four educational sessions provided during a 4 week period. Follow-up will last 3 months. Information on the study variables will be obtained through an Internet-based self-applied questionnaire and collected on three occasions: 1) when the adolescents enter the study (baseline), 2) once the intervention is completed (at 1 month) and 3) after 3 months of follow-up (at the fourth month). There will be three outcome variables: 1) knowledge in regard to sexually transmitted infections, 2) attitudes regarding condom use, and 3) self-efficacy toward consistent condom use. The generalized linear model will be used to assess changes in each outcome variable controlling for baseline measures and for study covariates. Discussion The design and evaluation of an Internet-based educational strategy to prevent risky sexual behaviors in Mexican adolescents is important in order to provide a new, large-scale, easily implemented preventive tool. Trial registration The study was registered at the ClinicalTrials.gov ID: NCT02686736

Factors associated with regular physical exercise and consumption of fruits and vegetables among Mexican older adults

Abstract Background To analyze the factors associated with regular physical exercise and routine consumption of fruits and vegetables, and both healthy behaviors among Mexican older adults. Methods We conducted a secondary data analysis of the baseline data (2014) of the Study on Obesity, Sarcopenia and Fragility in older adults affiliated with the Mexican Institute of Social Security. The study included 948 adults who were ≥60 years of age. Multiple Poisson regression was performed. Results Routine consumption of fruits and vegetables was reported by 53.8 % of older adults, 42.7 % reported engaging in regular physical exercise and 23.1 % reported participating in both types of healthy behaviors. Women, adults with a stable income, those with a self-perception of good health and those with a history of physical exercise at the age of 50 years had an increased likelihood of engaging in healthy eating and regular physical activity. Conclusions Many older adults do not routinely consume fruits and vegetables or engage in regular physical exercise despite the fact that most have a fixed income and a social network. It is relevant to conduct research-based interventions that take into account the contextual factors to promote healthy behaviors

Social inequalities in supportive care needs and quality of patient-centered care of cancer patients in Mexico

To evaluate educational and health insurance-related inequalities in supportive care (SC) needs and quality of patient-centered care (PCC) for cancer patients in Mexico. We conducted a cross-sectional survey in one Mexican Institute of Social Security (IMSS) and one Ministry of Health (MoH) oncology hospital in Mexico City. Formal labor market workers and their families have access to social health insurance that IMSS provides, while unemployed and informal workers receive care at the MoH. The study population comprised breast, colorectal, prostate, and hematologic cancer patients, aged ≥ 18 years, who attended outpatient consultations. Patients responded a short-form SC-needs questionnaire and a quality of PCC questionnaire. We used multiple logistic regression models to determine the independent association between educational attainment and high SC-needs and quality of PCC after controlling for sociodemographic and clinical covariates. We included 1058 IMSS and 606 MoH cancer patients. MoH patients perceived higher SC-needs and lower quality of PCC than IMSS patients. MoH patients with low education had a greater probability of high psychological and health system SC needs and lower likelihood of being informed for treatment decision-making and care for their biopsychosocial needs. IMSS patients with low educational levels had lower probability of receiving timely care and clarity of information than those with high education. Receiving high-quality PCC was associated with decreased SC needs. Uninsured cancer patients with low educational attainment have higher SC-needs and receive lower quality of PCC than their counterparts. Health services should face these challenges to reduce inequalities in Mexico

Psychometric validation of a Patient-Centred Quality of Cancer Care Questionnaire in Mexico

ObjectivesTo develop and validate a Patient-Centred Quality of Cancer Care Questionnaire in Spanish (PCQCCQ-S) appropriate to the Mexican context.DesignPsychometric validation of a questionnaire.SettingTwo public oncology hospitals in Mexico City.Participants1809 patients with cancer aged ≥18 years.Source of informationCross-sectional survey.MethodsThe validation procedures comprised (1) content validity through a group of experts and patients; (2) item reduction and evaluation of the factor structure, through an exploratory factor analysis based on the polychoric correlation matrix; (3) internal consistency using Cronbach’s alpha; (4) convergent validity between the PCQCCQ-S and supportive care needs scale; (5) correlation analysis between the PCQCCQ-S and quality of life scale by calculating Spearman’s rank-correlation coefficient; and (6) differentiation by ‘known groups’ through the Wilcoxon rank-sum test.ResultsThe PCQCCQ-S has 30 items with the following five factors accounting for 96.5% of the total variance: (1) timely care; (2) clarity of the information; (3) information for treatment decision-making; (4) activities to address biopsychosocial needs; and (5) respectful and coordinated care. Cronbach’s alpha values ranged from 0.73 to 0.90 among the factors. PCQCCQ-S has moderate convergent validity with supportive care needs scale, revealing that higher quality is correlated with lower patient needs. PCQCCQ-S has acceptable ability to differentiate by ‘known groups’, showing that older patients and those with low levels of education perceived lower total quality of care as compared with their counterparts.ConclusionPCQCCQ-S has acceptable psychometric properties and can be used to measure quality of patient-centred cancer care in Mexico and serve as a reference to develop PCQCCQ-S in other Spanish-speaking countries