Quality of care and health-related quality of life of climacteric stage women cared for in family medicine clinics in Mexico

<p>Abstract</p> <p>Objectives</p> <p>1) To design and validate indicators to measure the quality of the process of care that climacteric stage women receive in family medicine clinics (FMC). 2) To assess the quality of care that climacteric stage women receive in FMC. 3) To determine the association between quality of care and health-related quality of life (HR-QoL) among climacteric stage women.</p> <p>Methods</p> <p>The study had two phases: I. Design and validation of indicators to measure the quality of care process by using the RAND/UCLA Appropriateness Method. II. Evaluation of the quality of care and its association with HR-QoL through a cross-sectional study conducted in two FMC located in Mexico City that included 410 climacteric stage women. The quality of care was measured by estimating the percentage of recommended care received (PRCR) by climacteric stage women in three process components: health promotion, screening, and treatment. The HR-QoL was measured using the Cervantes scale (0-155). The association between quality of care and HR-QoL was estimated through multiple linear regression analysis.</p> <p>Results</p> <p>The lowest mean of PRCR was for the health promotion component (24.1%) and the highest for the treatment component (86.6%). The mean of HR-QoL was 50.1 points. The regression analysis showed that in the treatment component, for every 10 additional points of the PRCR, the global HR-QoL improved 2.8 points on the Cervantes scale (coefficient -0.28, P < 0.0001).</p> <p>Conclusion</p> <p>The indicators to measure quality of care for climacteric stage women are applicable and feasible in family medicine settings. There is a positive association between the quality of the treatment component and HR-QoL; this would encourage interventions to improve quality of care for climacteric stage women.</p

Integrative health care model for climacteric stage women: design of the intervention

<p>Abstract</p> <p>Background</p> <p>Climacteric stage women experience significant biological, psychological and social changes. With demographic changes being observed in the growing number of climacteric stage women in Mexico, it is important to improve their knowledge about the climacteric stage and its potential associated problems, encourage their participation in screening programs, and promote the acquisition of healthy lifestyles.</p> <p>At Mexican health care institutions the predominant health care model for climacteric stage women has a biomedical perspective. Medical doctors provide mostly curative services and have limited support from other health professionals. This study aims to design an integrative health care model (IHCM: bio-psycho-social, multidisciplinary and women-centered) applicable in primary care services aimed at climacteric stage women.</p> <p>Methods/Design</p> <p>We present the design, inclusion criteria and detailed description of an IHCM. The IHCM consists of collaborative and coordinated provision of services by a health team, which is involves a family doctor, nurse, psychologist, and the woman herself. The health team promotes the empowerment of women through individual and group counseling on the climacteric stage and health related self-care. The intervention lasts three months followed by a three-month follow-up period to evaluate the effectiveness of the model. The effectiveness of the model will be evaluated through the following aspects: health-related quality of life (HR-QoL), empowerment, self-efficacy and knowledge regarding the climacteric stage and health-related self-care activities, use of screening services, and improvement in lifestyles (regular leisure time physical activity and healthy diet).</p> <p>Discussion</p> <p>Participation in preventive activities should be encouraged among women in Mexico. Designing and evaluating the effectiveness of an integrative health care model for women at the climacteric stage, based on the empowerment approach and focus on health-related self-care to improve their HR-QoL is pertinent for current health conditions of this age group.</p> <p>Trial registration</p> <p>The study is registered at the ClinicalTrials.gov (<a href="http://www.controlled-trials.com/NCT01272115">NCT01272115</a>).</p

Scaling up cancer care for children without medical insurance in developing countries: The case of Mexico

Background: In 2006, the Mexican government launched the Fund for Protection Against Catastrophic Expenditures (FPGC) to support financially healthcare of high cost illnesses. This study aimed at answering the question whether FPGC improved coverage for cancer care and to measure survival of FPGC affiliated children with cancer. Procedure A retrospective cohort study (2006–2009) was conducted in 47 public hospitals. Information of children and adolescents with cancer was analyzed. The coverage was estimated in accordance with expected number of incident cases and those registered at FPGC. The survival was analyzed by using Kaplan–Meier survival curves and Cox proportional hazards regression modeling. Results: The study included 3,821 patients. From 2006 to 2009, coverage of new cancer cases increased from 3.3% to 55.3%. Principal diagnoses were acute lymphoblastic leukemia (ALL, 46.4%), central nervous system (CNS) tumors (8.2%), and acute myeloid leukemia (AML, 7.4%). The survival rates at 36 months were ALL (50%), AML (30.5%), Hodgkin lymphoma (74.5%), Non-Hodgkin lymphoma (40.1%), CNS tumors (32.8%), renal tumors (58.4%), bone tumors (33.4%), retinoblastoma (59.2%), and other solid tumors (52.6%). The 3-year overall survival rates varied among the regions; children between the east and south-southeast had the higher risks (hazard ratio 3.0; 95% CI: 2.3–3.9) and 2.4; 95% CI: 2.0–2.8) of death from disease when compared with those from the central region. Conclusion: FPGC has increased coverage of cancer cases. Survival rates were different throughout the country. It is necessary to evaluate the effectiveness of this policy to increase access and identify opportunities to reduce the differences in survival

Plan de Responsabilidad Social Empresarial para Inmobiliaria e Inversiones SanSteShi S.A.S.

Texto y enlaceEl propósito del trabajo presentado a continuación es exponer la elaboración del Plan de Responsabilidad Social Empresarial para Inmobiliaria e Inversiones SanSteShi S.A.S., a partir del análisis de su situación actual a fin de maximizar los resultados mediante la implementación de estrategias de RSE que atiendan los intereses de stakeholders e integren una mejora continua de sus procesos, para llegar a ser una empresa de excelencia al retribuir y beneficiar a todos los entes de la sociedad que son impactados de una forma u otra por las actividades que la organización realiza. La importancia del Plan de RSE propuesto radica en la necesidad de que la compañía logre el total cumplimiento de la norma ISO 26000, pues actualmente la organización no cuenta con campañas ni programas enfocados en la preservación y promoción de la salud de los clientes y la comunidad. El Plan de RSE puede considerarse por lo tanto en un lineamiento de carácter ético que le permitirá a la organización actuar de la mejor manera posible frente a los diferentes aspectos de su entorno, mejorando su imagen corporativa, el nivel de compromiso con sus colaboradores y su capacidad para posicionarse en el mercado y garantizar un crecimiento económico.The purpose of the following work is to present the elaboration of the Corporate Social Responsibility Plan for Inmobiliaria e Inversiones SanSteShi S.A.S., based on the analysis of its current situation in order to maximize results by implementing CSR strategies that meet the interests of stakeholders and integrate a continuous improvement of its processes, to become a company of excellence by rewarding and benefiting all the entities of society that are impacted in one way or another by the activities that the organization carries out. The importance of the proposed CSR Plan lies in the need for the company to achieve full compliance with the ISO 26000 standard, as currently the organization does not have campaigns or programs focused on preserving and promoting the health of clients and the community. The CSR Plan can therefore be considered as an ethical guideline that will allow the organization to act in the best possible way against the different aspects of its environment, improving its corporate image, the level of commitment to its collaborators and its Ability to position itself in the market and guarantee economic growth

Hallux Limitus Influence on Plantar Pressure Variations during the Gait Cycle: A Case-Control Study

´[Abstract] Background: Hallux limitus is a common foot disorder whose incidence has increased in the school-age population. Hallux limitus is characterized by musculoskeletal alteration that involves the metatarsophalangeal joint causing structural disorders in different anatomical areas of the locomotor system, affecting gait patterns. The aim of this study was to analyze dynamic plantar pressures in a school-aged population both with functional hallux and without. Methods: A full sample of 100 subjects (50 male and 50 female) 7 to 12 years old was included. The subjects were identified in two groups: the case group (50 subjects characterized as having hallux limitus, 22 male and 28 female) and control group (50 subjects characterized as not having hallux limitus, 28 male and 22 female). Measurements were obtained while subjects walked barefoot in a relaxed manner along a baropodometric platform. The hallux limitus test was realized in a seated position to sort subjects out into an established study group. The variables checked in the research were the surface area supported by each lower limb, the maximum peak pressure of each lower limb, the maximum mean pressure of each lower limb, the body weight on the hallux of each foot, the body weight on the first metatarsal head of each foot, the body weight at the second metatarsal head of each foot, the body weight at the third and fourth metatarsal head of each foot, the body weight at the head of the fifth metatarsal of each foot, the body weight at the midfoot of each foot, and the body weight at the heel of each foot. Results: Non-significant results were obtained in the variable of pressure peaks between both study groups; the highest pressures were found in the hallux with a p-value of 0.127 and in the first metatarsal head with a p-value 0.354 in subjects with hallux limitus. A non-significant result with a p-value of 0.156 was obtained at the second metatarsal head in healthy subjects. However, significant results were observed for third and fourth metatarsal head pressure in healthy subjects with a p-value of 0.031 and regarding rearfoot pressure in subjects with functional hallux limitus with a p-value of 0.023. Conclusions: School-age subjects with hallux limitus during gait exhibit more average peak plantar pressure in the heel and less peak average plantar pressure in the third and fourth metatarsal head as compared to healthy children aged between 7 and 12 years old

Analysis of static plantar pressures in school-age children with and without functional Hallux Limitus: a case-control study

Background: The presence of hallux limitus in adulthood is frequently encountered in clini cal practice, generating other biomechanical, structural, and functional compensations in dynamics secondary to blockage of the main pivot in the sagittal plane, the first metatarsophalangeal joint. In addition, the presence of functional hallux limitus (FHL) in school-age children is also increasing. Currently, there is a lack of scientific literature about this condition in the pediatric population, and early diagnosis is necessary to reduce future biomechanical disorders and avoid the development of foot arthritis. The purpose of this research was to identify static plantar pressures in school-age children with and without hallux limitus. Methods: A total sample of 106 children aged between six and twelve years old was divided into two groups: the case group (53 subjects with functional hallux limitus) and the control group (53 subjects without functional hallux limitus). Data were acquired with the participants in a standing barefoot position on the pressure platform, and the hallux limitus functional test was performed in a sitting position to classify the individuals into the determined study group. The variables analyzed in the research were: plantar pressure, bilateral forefoot and rearfoot surface area, bilateral forefoot and rearfoot ground reaction forces, bilateral forefoot and rearfoot distribution of body weight, total left and right surface area, maximum pressure of the left foot and right foot, medium pressure of the left foot and right foot, ground reaction forces of the left foot and right foot, and the weight of each foot. Results: Age was the only descriptive quantitative variable that showed a significant difference between the two study groups, with a p-value of 0.031. No statistically significant differences were found between groups in the bilateral forefoot and rearfoot surface area, ground reaction forces, distribution of body weight, or maximum and medium plantar pressure in the left and right foot. Conclusions: Changes in the location of the maximum pressure were observed, particularly in older participants with FHL, but these results were not significant. The findings of this study did not show significant differences between the static plantar pressures of school-age individuals with and without functional hallux limitus

Nível de conhecimento sobre COVID-19 em pacientes com emergências odontológicas

Introduction: knowledge concerning COVID-19 among patients with dental emergencies, it is of high importance since they can become infected and infect health care personnel. Objective: to describe the level of knowledge concerning COVID-19 in patients who were attended at the Clínica Estomatológica Provincial “Mártires del Moncada” in Santiago de Cuba. Method: a descriptive cross-sectional study was conducted between March and June 2020. A total of 180 patients, in both sex and older than 18 and who gave their consent to be part of this research, were selected by a probability simple random sampling. Those with obvious acute respiratory syndrome were excluded. Age, sex, dental emergencies and knowledge level were assessed. The Chi-square test was used (alpha level of 0.05) to determine the association between knowledge Level, age, and sex.  Results: odontalgia and acute dentoalveolar abscesses were the predominant dental conditions, and the level of knowledge concerning COVID-19 in patients with dental emergencies attended at the clinic was good. Conclusions: despite the good knowledge concerning COVID-19 showed by the patients affected with dental conditions, the lack of knowledge or non-compliance of measurements for the prevention and control of this infection may be the start point to spread the COVID-19 to the health personnel in service.Introducción: los conocimientos sobre COVID-19 que posean los pacientes aquejados por urgencias estomatológicas son de vital importancia, ya que pueden infectarse y contagiar al personal de salud. Objetivo: describir el nivel de conocimientos sobre COVID-19 en pacientes atendidos en la consulta de Urgencias de la Clínica Estomatológica Provincial “Mártires del Moncada” de Santiago de Cuba. Método: se realizó un estudio descriptivo transversal entre marzo y junio de 2020, con un universo de 180 pacientes seleccionados mediante un muestreo probabilístico aleatorio simple, de ambos sexos y mayores de 18 años, que dieron su consentimiento para participar en la investigación. Se excluyeron aquellos con síndrome respiratorio agudo evidente. Se evaluaron la edad, sexo, urgencias estomatológicas y nivel de conocimientos. Se empleó la prueba Chi-cuadrado, con un grado de significación α=0,05, para determinar la asociación entre nivel de conocimientos, la edad y el sexo. Resultados: las odontalgias y los abscesos dentoalveolares agudos fueron las afecciones estomatológicas predominantes, el nivel de conocimientos sobre COVID-19 predominante en los pacientes atendidos por urgencias estomatológicas fue bueno. Conclusiones: a pesar de que los pacientes afectados por urgencias estomatológicas poseen conocimientos buenos sobre la COVID-19, el desconocimiento o incumplimiento de algunas de las medidas de prevención y control de esta infección, puede contribuir a la transmisión de esta enfermedad hacia el personal de salud que los asiste, al ignoran su potencial de contagio.Introdução: o conhecimento sobre a COVID-19 que os pacientes em situação de emergência odontológica possuem é de vital importância, pois podem infectar e infectar o pessoal de saúde. Objetivo: descrever o nível de conhecimento sobre o COVID-19 em pacientes atendidos no Pronto-Socorro da Clínica Estomatológica Provincial “Mártires del Moncada” de Santiago de Cuba. Método: estudo transversal descritivo realizado entre março e junho de 2020, com um universo de 180 pacientes selecionados por amostragem probabilística aleatória simples, de ambos os sexos e maiores de 18 anos. Foram avaliados idade, sexo, emergências odontológica e nível de conhecimento. Foi utilizado o teste Qui-quadrado, com grau de significância α=0,05, para verificar a associação entre nível de conhecimento, idade e sexo. Resultados: odontalgias e abscessos dentoalveolares agudos foram as condições estomatológicas predominantes, o nível de conhecimento predominante sobre a COVID-19 nos pacientes atendidos nas emergências odontológicas foi bom. Conclusões: apesar de os pacientes acometidos por emergências odontológicas possuírem bons conhecimentos sobre a COVID-19, o desconhecimento ou não cumprimento de algumas das medidas de prevenção e controle desta infecção, pode contribuir para a transmissão desta doença aos profissionais de saúde que auxilia-os, ignorando seu potencial de contágio

Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City

Background: Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics. Methods: We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children’s height and weight and parents reported children’s diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values. Results: 93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program. Conclusions: Although satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI. Trial registration ClinicalTrials.gov NCT01539070. Comisión Nacional de Investigación Científica del IMSS: 2009-785-120

Caracterização da autoestima e higiene bucal em idosos, Santiago de Cuba 2017

Introduction: in the Periodontics department of the "Mártires del Moncada" Teaching Provincial Stomatology Clinic in Santiago de Cuba, the level of self-esteem and oral hygiene of the elderly has not been characterized.Objective: to characterize the levels of self-esteem and oral hygiene in the elderly, during the period July to December 2017.Method: a descriptive-cross-sectional study was carried out in the 32 older adults who attended the Periodontics Department of the Teaching Provincial Stomatological Clinic from Santiago de Cuba, which met the inclusion criteria: over 60 and older, of both genders, who gave their consent to participate in the research. The variables were studied: age, sex, education, level of self-esteem and oral hygiene.Results: the 65-69 year old group (37.5%), the female sex (62.5%), the pre-university school level (37.5%), the average self-esteem level (56.2%) and poor oral hygiene (53.1%).Conclusions: the level of average self-esteem is one of the psychological elements closely linked to poor oral hygiene in the older adults studied, so special attention is required in the comprehensive assessment of these patients, given its possible influence with the state of health oral.Introducción: en el departamento de Periodoncia de la Clínica Estomatológica Provincial Docente "Mártires del Moncada" de Santiago de Cuba, no se ha caracterizado el nivel de autoestima e higiene bucal de los adultos mayores.Objetivo: caracterizar los niveles de autoestima e higiene bucal en los adultos mayores, durante el periodo julio a diciembre del 2017.Método: se realizó un estudio descriptivo-transversal en los 32 adultos mayores que acudieron al departamento de Periodoncia de la Clínica Estomatológica Provincial Docente de Santiago de Cuba, que cumplieron con los criterios de inclusión: mayores de 60 y más años, de ambos géneros, que dieron su consentimiento para participar en la investigación. Se estudiaron las variables: edad, sexo, escolaridad, nivel de autoestima e higiene bucal. Resultados: predominó el grupo de 65-69 años (37,5 %), el sexo femenino (62,5 %), el nivel escolar pre-universitario (37,5 %), el nivel de autoestima medio (56,2 %) y la higiene bucal deficiente (53,1 %).Conclusiones: el nivel de autoestima medio es uno de los elementos psicológicos estrechamente vinculado con la higiene bucal deficiente en los adultos mayores estudiados, por lo que se requiere especial atención en la valoración integral de estos pacientes, dada su posible influencia con el estado de salud bucal.Introdução: no departamento de Periodontia da Clínica Provincial de Estomatologia Mártires del Moncada, em Santiago de Cuba, o nível de auto-estima e higiene bucal dos idosos não foi caracterizado.Objetivo: caracterizar os níveis de autoestima e higiene bucal em idosos, no período de julho a dezembro de 2017.Método: foi realizado um estudo descritivo-transversal dos 32 idosos atendidos no Departamento de Periodontia da Clínica de Estomatologia Provincial de Ensino de Santiago de Cuba, que atendiam aos critérios de inclusão: maiores de 60 anos, de ambos os sexos, que consentiram em participar da pesquisa. As variáveis estudadas foram: idade, sexo, escolaridade, nível de autoestima e higiene bucal.Resultados: grupo de 65 a 69 anos (37,5%), sexo feminino (62,5%), nível de ensino pré-universitário (37,5%), nível médio de auto-estima (56,2%) e falta de higiene bucal (53,1%).Conclusões: o nível médio de autoestima é um dos elementos psicológicos intimamente ligados à falta de higiene bucal nos idosos estudados, sendo necessária atenção especial na avaliação abrangente desses pacientes, dada a sua possível influência no estado de saúde bucal