Qualidade da relação da equipe de saúde com pacientes hospitalizados, Cidade do México

OBJECTIVE: To assess quality of the relationship between inpatients and health providers. METHODS: A qualitative study was carried out in a tertiary care hospital in the Mexico City, Mexico, between February and July 2005. In-depth interviews were conducted with 40 inpatients. The following categories of analysis were used to explore the respondent's perception of care: attitudes and actions of medical and nursing providers, effective communication, level of knowledge of patients and their family on the diagnosis, clinical treatment, and evolution. RESULTS: Overall the level of satisfaction with health care was high. Inpatients perceived everyday (non-clinical) interactions with medical and nursing providers as inadequate due to lack of confidence to request information on their condition. In addition, this perception was reinforced by excessive use by providers of technical terminology. CONCLUSIONS: The routine relationship between health providers and their patients is perceived as inadequate showing that clinical effectiveness does not mean high quality of care. There is a need to bring together technical-scientific efficiency and patients' needs and expectations of non-clinical interactions.OBJETIVO: Analizar la calidad de la relación del personal de salud con los pacientes hospitalizados. MÉTODOS: Estudio cualitativo realizado de febrero a julio del 2005, en la Ciudad de México. Se aplicaron 40 entrevistas a profundidad a pacientes internados en un hospital de tercer nivel. Las categorías de análisis para explorar la percepción del trato entre los informantes fueron las siguientes: actitudes y acciones del personal médico y de enfermería, comunicación efectiva, grado de conocimiento del paciente y/o familiares sobre el diagnóstico, tratamiento clínico, evolución del agravo. RESULTADOS: En general, se encontró un alto grado de satisfacción con la atención médica. No obstante, los pacientes hospitalizados percibieron como inadecuado el trato cotidiano (no clínico) del personal médico y de enfermería del hospital, relacionado con la falta de confianza para solicitar información acerca de su padecimiento. El uso excesivo de tecnicismos por parte del prestador de servicios reforzó esta percepción de trato inadecuado. CONCLUSIONES: La percepción del trato inadecuado por el personal de salud fuera del ámbito técnico, mostró que la efectividad clínica no significa una plena calidad de la atención y que es necesario incorporar las necesidades y expectativas de trato no clínico de los pacientes a la eficiencia técnica y científica.OBJETIVO: Analisar a qualidade da relação da equipe de saúde com os pacientes hospitalizados. MÉTODOS: Estudo qualitativo realizado de fevereiro a julho de 2005, na Cidade do México. Foram realizadas entrevistas em profundidade com 40 pacientes em internação prolongada. As categorias de análise para explorar a percepção de trato entre os informantes foram as seguintes: atitudes e ações do pessoal médico e de enfermaria, comunicação efetiva, grau de conhecimento do paciente e/ou familiares sobre o diagnóstico, tratamento clínico, evolução do agravo. RESULTADOS: Em geral, observou-se um alto grau de satisfação com a atenção médica. Entretanto, os pacientes hospitalizados perceberam como inadequado o trato cotidiano (não-clínico) realizado pelo pessoal médico e de enfermagem do hospital, relacionado à falta de confiança para solicitar informação sobre sua enfermidade. O uso excessivo de termos técnicos por parte do prestador de serviços reforçou esta percepção de trato inadequado. CONCLUSÕES: A percepção do trato inadequado pelo pessoal de saúde foi de âmbito técnico, mostrando que a efetividade clínica não significa uma plena qualidade de atenção e que é necessário incorporar as necessidades e expectativas de trato não-clínico dos pacientes à eficiência técnica e científica

Inverse Association between Dietary Iron Intake and Gastric Cancer: A Pooled Analysis of Case-Control Studies of the Stop Consortium

Background: Inconsistent findings have been reported regarding the relationship between dietary iron intake and the risk of gastric cancer (GC). Methods: We pooled data from 11 case-control studies from the Stomach Cancer Pooling (StoP) Project. Total dietary iron intake was derived from food frequency questionnaires combined with national nutritional tables. We derived the odds ratios (ORs) and 95% confidence intervals (CIs) for quartiles of dietary iron through multivariable unconditional logistic regression models. Secondary analyses stratified by sex, smoking status, caloric intake, anatomical subsite and histological type were performed. Results: Among 4658 cases and 12247 controls, dietary iron intake was inversely associated with GC (per quartile OR 0.88; 95% CI: 0.83-0.93). Results were similar between cardia (OR = 0.85, 95% CI = 0.77-0.94) and non-cardia GC (OR = 0.87, 95% CI = 0.81-0.94), and for diffuse (OR = 0.79, 95% CI = 0.69-0.89) and intestinal type (OR = 0.88, 95% CI = 0.79-0.98). Iron intake exerted an independent effect from that of smoking and salt intake. Additional adjustment by meat and fruit/vegetable intake did not alter the results. Conclusions: Dietary iron is inversely related to GC, with no difference by subsite or histological type. While the results should be interpreted with caution, they provide evidence against a direct effect of iron in gastric carcinogenesis

Relación del personal de salud con los pacientes en la Ciudad de México Qualidade da relação da equipe de saúde com pacientes hospitalizados, Cidade do México Relationship between health providers and patients in Mexico City

OBJETIVO: Analizar la calidad de la relación del personal de salud con los pacientes hospitalizados. MÉTODOS: Estudio cualitativo realizado de febrero a julio del 2005, en la Ciudad de México. Se aplicaron 40 entrevistas a profundidad a pacientes internados en un hospital de tercer nivel. Las categorías de análisis para explorar la percepción del trato entre los informantes fueron las siguientes: actitudes y acciones del personal médico y de enfermería, comunicación efectiva, grado de conocimiento del paciente y/o familiares sobre el diagnóstico, tratamiento clínico, evolución del agravo. RESULTADOS: En general, se encontró un alto grado de satisfacción con la atención médica. No obstante, los pacientes hospitalizados percibieron como inadecuado el trato cotidiano (no clínico) del personal médico y de enfermería del hospital, relacionado con la falta de confianza para solicitar información acerca de su padecimiento. El uso excesivo de tecnicismos por parte del prestador de servicios reforzó esta percepción de trato inadecuado. CONCLUSIONES: La percepción del trato inadecuado por el personal de salud fuera del ámbito técnico, mostró que la efectividad clínica no significa una plena calidad de la atención y que es necesario incorporar las necesidades y expectativas de trato no clínico de los pacientes a la eficiencia técnica y científica.OBJETIVO: Analisar a qualidade da relação da equipe de saúde com os pacientes hospitalizados. MÉTODOS: Estudo qualitativo realizado de fevereiro a julho de 2005, na Cidade do México. Foram realizadas entrevistas em profundidade com 40 pacientes em internação prolongada. As categorias de análise para explorar a percepção de trato entre os informantes foram as seguintes: atitudes e ações do pessoal médico e de enfermaria, comunicação efetiva, grau de conhecimento do paciente e/ou familiares sobre o diagnóstico, tratamento clínico, evolução do agravo. RESULTADOS: Em geral, observou-se um alto grau de satisfação com a atenção médica. Entretanto, os pacientes hospitalizados perceberam como inadequado o trato cotidiano (não-clínico) realizado pelo pessoal médico e de enfermagem do hospital, relacionado à falta de confiança para solicitar informação sobre sua enfermidade. O uso excessivo de termos técnicos por parte do prestador de serviços reforçou esta percepção de trato inadequado. CONCLUSÕES: A percepção do trato inadequado pelo pessoal de saúde foi de âmbito técnico, mostrando que a efetividade clínica não significa uma plena qualidade de atenção e que é necessário incorporar as necessidades e expectativas de trato não-clínico dos pacientes à eficiência técnica e científica.OBJECTIVE: To assess quality of the relationship between inpatients and health providers. METHODS: A qualitative study was carried out in a tertiary care hospital in the Mexico City, Mexico, between February and July 2005. In-depth interviews were conducted with 40 inpatients. The following categories of analysis were used to explore the respondent's perception of care: attitudes and actions of medical and nursing providers, effective communication, level of knowledge of patients and their family on the diagnosis, clinical treatment, and evolution. RESULTS: Overall the level of satisfaction with health care was high. Inpatients perceived everyday (non-clinical) interactions with medical and nursing providers as inadequate due to lack of confidence to request information on their condition. In addition, this perception was reinforced by excessive use by providers of technical terminology. CONCLUSIONS: The routine relationship between health providers and their patients is perceived as inadequate showing that clinical effectiveness does not mean high quality of care. There is a need to bring together technical-scientific efficiency and patients' needs and expectations of non-clinical interactions

Economic impact of dengue in Mexico considering reported cases for 2012 to 2016.

BACKGROUND:Given that dengue disease is growing and may progress to dengue hemorrhagic fever (DHF), data on economic cost and disease burden are important. However, data for Mexico are limited. METHODOLOGY/PRINCIPAL FINDINGS:Burden of dengue fever (DF) and DHF in Mexico was assessed using official databases for epidemiological information, disabilities weights from Shepard et al, the reported number of cases and deaths, and costs. Overall costs of dengue were summed from direct medical costs to the health system, cost of dengue to the patient (out-of-pocket expenses [medical and non-medical], indirect costs [loss of earnings, patient and/or caregiver]), and other government expenditures on prevention/surveillance. The first three components, calculated as costs per case by a micro-costing approach (PAATI; program, actions, activities, tasks, inputs), were scaled up to overall cost using epidemiology data from official databases. PAATI was used to calculate cost of vector control and prevention, education, and epidemiological surveillance, based on an expert consensus and normative construction of an ideal scenario. Disability-adjusted life years (DALYs) for Mexico in 2016 were calculated to be 2283.46 (1.87 per 100,000 inhabitants). Overall economic impact of dengue in Mexico for 2012 was US$144 million, of which US$44 million corresponded to direct medical costs and US$5 million to the costs from the patient's perspective. The estimated cost of prevention/surveillance was calculated with information provided by federal government to be US$95 million. The overall economic impact of DF and DHF showed an increase in 2013 to US$161 million and a decrease to US$133, US$131 and US$130 million in 2014, 2015 and 2016, respectively. CONCLUSIONS/SIGNIFICANCE:The medical and economic impact of dengue were in agreement with other international studies, and highlight the need to include governmental expenditure for prevention/surveillance in overall cost analyses given the high economic impact of these, increasing the necessity to evaluate its effectiveness

Information sources for costings.

<p>Information sources for costings.</p

Ideal and real average costs per case of dengue fever in the Secretariat of Health and Mexican Social Security Institute settings.

<p>Ideal and real average costs per case of dengue fever in the Secretariat of Health and Mexican Social Security Institute settings.</p

Indirect costs of dengue fever according to Secretariat of Health and Mexican Social Security Institute settings.

<p>Indirect costs of dengue fever according to Secretariat of Health and Mexican Social Security Institute settings.</p

Mushroom consumption and risk of gastric cancer: a pooled analysis within the stomach cancer pooling project and a combined meta-analysis with other observational studies.

Edible mushrooms have high concentrations of vitamins and minerals. They are considered functional foods for their disease-prevention properties. Mushroom consumption may reduce the risk of gastric cancer, the fifth most common cancer worldwide. We investigated the association between mushroom consumption and gastric cancer risk in a pooled analysis within the Stomach Cancer Pooling (StoP) Project and in a meta-analysis that also included previously published studies. A total of 3900 gastric cancer cases and 7792 controls from 11 studies were included in the StoP analysis. Mushroom consumption was measured using food frequency questionnaires. Higher mushroom consumption was associated with a lower risk of gastric cancer [relative risk (RR) for the highest vs. lowest consumption categories, 0.82; 95% confidence interval (CI), 0.71-0.95]. The corresponding RRs were 0.59 (95% CI, 0.26-1.33) in a meta-analysis of four previously published studies and 0.77 for all studies combined (95% CI, 0.63-0.95; n = 15 studies). In geographic subgroup analysis, the pooled risk in Western Pacific countries was (RR, 0.59; 95% CI, 0.40-0.87; n = 6). The stronger effect in Asian countries may reflect high level of antioxidants in mushroom species consumed in Asia