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Villaquiran-Hurtado AF, Jácome Velasco SJ, Chantre-Ortega LA, Mueses- Tapue LJ, Ramos-Valencia OA, Salazar-Villamarin CI. Entrenamiento intermitente de alta intensidad versus continuo en mujeres con hipertensión. AVANCES EN ENFERMERÍA 2020. [DOI: 10.15446/av.enferm.v38n2.84618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: comparar los efectos de la implementación de un programa de ejercicio continuo de mediana intensidad vs. un programa de ejercicio interválico de alta intensidad sobre los parámetros antropométricos y de condición física en mujeres hipertensas.Materiales y método: estudio experimental con pre y post prueba, realizado en 62 mujeres hipertensas divididas en 3 grupos: el primer grupo realizó ejercicio interválico de alta intensidad, el segundo hizo ejercicio continuo de mediana intensidad y el tercero es el grupo control. La intervención se realizó durante 12 semanas con una frecuencia semanal de 3 repeticiones. En todas las mujeres hipertensas se evaluó su condición física y características antropométricas.Resultados: posterior a la intervención, se encontraron diferencias estadísticamente significativas entre el grupo HiiT (high intensity interval training) y el grupo control en cuanto a las variables porcentaje de grasa (p = 0,014), densidad corporal (p = 0,014) e índice de conicidad [IC] (p = 0,003). Adicionalmente, se identificaron diferencias entre los dos grupos de ejercicio y el grupo control en las variables distancia recorrida (p = 0,04), flexibilidad en miembro superior derecho (p = 0,00) y fuerza en miembros inferiores (p = 0,01).Conclusiones: el estudio demostró que el ejercicio es una herramienta efectiva para mejorar la aptitud física de mujeres hipertensas. Sin embargo, no se encontraron diferencias en la efectividad entre el entrenamiento interválico de alta intensidad y el entrenamiento continuo.
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Correia JC, Lachat S, Lagger G, Chappuis F, Golay A, Beran D. Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review. BMC Public Health 2019; 19:1542. [PMID: 31752801 PMCID: PMC6873661 DOI: 10.1186/s12889-019-7842-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.
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Affiliation(s)
- Jorge César Correia
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Sarah Lachat
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Grégoire Lagger
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Alain Golay
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
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Alcalde-Rabanal JE, Orozco-Núñez E, Espinosa-Henao OE, Arredondo-López A, Alcayde-Barranco L. The complex scenario of obesity, diabetes and hypertension in the area of influence of primary healthcare facilities in Mexico. PLoS One 2018; 13:e0187028. [PMID: 29370171 PMCID: PMC5784882 DOI: 10.1371/journal.pone.0187028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/12/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Among non-communicable chronic diseases (NCCD), diabetes and hypertension are the main cause of adult mortality worldwide. Among the members of the Organization for Economic Cooperation and Development, Mexico is first in prevalence of diabetes and second in obesity. To face this problematic situation of NCCDs the Ministry of Health declared a national epidemiological alert against the overweight, obesity and diabetes. The target of this study is to characterize the status of obesity, diabetes and hypertension in the adult population in the area of influence of primary health facilities located in high social marginality areas. METHODS We conducted a cross-sectional observational study and used a convenience sample. A survey was conducted on a population of 18 years old and above in four primary health facilities in four Mexican States. The survey explored sociodemographic characteristics, the presence of chronic diseases, the access to healthcare services, risk factors and life styles. We also applied a complementary questionnaire to 20% of the participants, in order to explore food consumption during the last week and physical activity (International Physical Activity Questionnaire). We based our analysis on descriptive statistics and logistic multivariate regression to analyze factors associated with diabetes and hypertension. RESULTS 73% (n = 7531, CI 0.72-0.74) percent of the population reported being diabetic, hypertensive and/or overweight. The majority of them receive healthcare in public health services. People over 40 years old, are 11 times more probable of living with diabetes and 8.7 times more probable of living with hypertension. Both conditions affect mostly women, whose main activity is to be a housewife. People who have lunch and dinner out of home are more likely to develop diabetes. People who perform intense physical activity are less likely to live with hypertension. CONCLUSION According to the self-report, more than 70% of adult population living in areas with high social marginality suffer diabetes, hypertension and obesity. However, the percentage of people who live with these chronic conditions and are not aware of them, is unknown. The Mexican health system needs a primary healthcare that emphasizes on health promotion, timely detection of risk factors of Non Communicable Diseases and prevention of their complications.
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Affiliation(s)
- J. E. Alcalde-Rabanal
- Center for Health System Research / National Institute of Public Health. Cuernavaca, México
| | - E. Orozco-Núñez
- Center for Health System Research / National Institute of Public Health. Cuernavaca, México
| | - O. E. Espinosa-Henao
- Center for Health System Research / National Institute of Public Health. Cuernavaca, México
| | - A. Arredondo-López
- Center for Health System Research / National Institute of Public Health. Cuernavaca, México
| | - L. Alcayde-Barranco
- Center for Health System Research / National Institute of Public Health. Cuernavaca, México
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Parro-Moreno A, Serrano-Gallardo P, Díaz-Holgado A, Aréjula-Torres JL, Abraira V, Santiago-Pérez IM, Morales-Asencio JM. Impact of primary care nursing workforce characteristics on the control of high-blood pressure: a multilevel analysis. BMJ Open 2015; 5:e009126. [PMID: 26644122 PMCID: PMC4679997 DOI: 10.1136/bmjopen-2015-009126] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To determine the impact of Primary Health Care (PHC) nursing workforce characteristics and of the clinical practice environment (CPE) perceived by nurses on the control of high-blood pressure (HBP). DESIGN Cross-sectional analytical study. SETTING Administrative and clinical registries of hypertensive patients from PHC information systems and questionnaire from PHC nurses. PARTICIPANTS 76,797 hypertensive patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with a higher socioeconomic situation and South-West Zone (SWZ) with a lower socioeconomic situation, and 442 reference nurses. Segmented analyses by area were made due to their different socioeconomic characteristics. PRIMARY OUTCOME MEASURE Poor HBP control (adequate figures below the value 140/90 mm Hg) associated with the characteristics of the nursing workforce and self-perceived CPE. RESULTS The prevalence of poor HBP control, estimated by an empty multilevel model, was 33.5% (95% CI 31.5% to 35.6%). In the multilevel multivariate regression models, the perception of a more favourable CPE was associated with a reduction in poor control in NWZ men and SWZ women (OR=0.99 (95% CI 0.98 to 0.99)); the economic immigration conditions increased poor control in NWZ women (OR=1.53 (95% CI 1.24 to 1.89)) and in SWZ, both men (OR=1.89 (95% CI 1.43 to 2.51)) and women (OR=1.39 (95% CI 1.09 to 1.76)). In all four models, increasing the annual number of patient consultations was associated with a reduction in poor control (NWZ women: OR=0.98 (95% CI0.98 to 0.99); NWZ men: OR=0.98 (95% CI 0.97 to 0.99); SWZ women: OR=0.98 (95% CI 0.97 to 0.99); SWZ men: OR=0.99 (95% CI 0.97 to 0.99). CONCLUSIONS A CPE, perceived by PHC nurses as more favourable, and more patient-nurse consultations, contribute to better HBP control. Economic immigration condition is a risk factor for poor HBP control. Health policies oriented towards promoting positive environments for nursing practice are needed.
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Affiliation(s)
- Ana Parro-Moreno
- Department of Nursing, Department of Preventive Medicine and Public Health, Department of Surgery, School of Medicine, Universidad Autónoma de Madrid/IISPHM, Madrid, Spain
| | - Pilar Serrano-Gallardo
- Department of Nursing, School of Medicine, Universidad Autónoma de Madrid/IDIPHIM/INAECU, Madrid, Spain
| | - Antonio Díaz-Holgado
- Information System Unit, Directorate for Public Health, Health Service of Madrid, Spain
| | - Jose L Aréjula-Torres
- Information System Unit, Directorate for Public Health, Health Service of Madrid, Spain
| | - Victor Abraira
- Clinical Biostatistics of Ramón y Cajal University Hospital/IRYCIS/Centre for Biomedical Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Isolina M Santiago-Pérez
- Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Santiago de Compostela, Spain/IBIMA, A Coruña, Santiago de Compostela, Spain
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Nigenda G, Muños JA. Projections of specialist physicians in Mexico: a key element in planning human resources for health. HUMAN RESOURCES FOR HEALTH 2015; 13:79. [PMID: 26391878 PMCID: PMC4578266 DOI: 10.1186/s12960-015-0061-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/09/2015] [Indexed: 06/01/2023]
Abstract
Projections are considered a useful tool in the planning of human resources for health. In Mexico, the supply and demand of specialist doctors are clearly disconnected, and decisions must be made to reduce labour market imbalances. Thus, it is critical to produce reliable projections to assess future interactions between supply and demand. Using a service demand approach, projections of the number of specialist physicians required by the three main public institutions were calculated using the following variables: a) recent recruitment of specialists, b) physician productivity and c) retirement rates. Two types of scenarios were produced: an inertial one with no changes made to current production levels and an alternative scenario adjusted by recommended productivity levels. Results show that institutions must address productivity as a major policy element to act upon in future contracting of specialist physicians. The projections that adjusted for productivity suggest that the hiring trends for surgeons and internists should be maintained or increased to compensate for the increase in demand for services. In contrast, due to the decline in demand for obstetric and paediatric services, the hiring of new obstetrician-gynaecologists and paediatricians should be reduced to align with future demand.
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Affiliation(s)
- Gustavo Nigenda
- School of Medicine, Morelos State Autonomous University, Cuernavaca, Morelos, Mexico.
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Pérez-Cuevas R, Doubova SV, Suarez-Ortega M, Law M, Pande AH, Escobedo J, Espinosa-Larrañaga F, Ross-Degnan D, Wagner AK. Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico. BMC Med Inform Decis Mak 2012; 12:50. [PMID: 22672471 PMCID: PMC3437217 DOI: 10.1186/1472-6947-12-50] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 06/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several low and middle-income countries are implementing electronic health records (EHR). In the near future, EHRs could become an efficient tool to evaluate healthcare performance if appropriate indicators are developed. The aims of this study are: a) to develop quality of care indicators (QCIs) for type 2 diabetes (T2DM) in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCIs using the IMSS EHR data; and c) to evaluate the quality of care (QC) provided to IMSS patients with T2DM. METHODS We used a three-stage mixed methods approach: a) development of QCIs following the RAND-UCLA method; b) EHR data extraction and construction of indicators; c) QC evaluation using EHR data from 25,130 T2DM patients who received care in 2009. RESULTS We developed 18 QCIs, of which 14 were possible to construct using available EHR data. QCIs comprised both process of care and health outcomes. Several flaws in the EHR design and quality of data were identified. The indicators of process and outcomes of care suggested areas for improvement. For example, only 13.0% of patients were referred to an ophthalmologist; 3.9% received nutritional counseling; 63.2% of overweight/obese patients were prescribed metformin, and only 23% had HbA1c <7% (or plasma glucose≤130 mg/dl). CONCLUSIONS EHR data can be used to evaluate QC. The results identified both strengths and weaknesses in the electronic information system as well as in the process and outcomes of T2DM care at IMSS. This information can be used to guide targeted interventions to improve QC.
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Affiliation(s)
- Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Inter-American Development Bank, Washignton, USA
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, México, DF, Mexico
| | - Magdalena Suarez-Ortega
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, México, DF, Mexico
| | - Michael Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Aakanksha H Pande
- Department of Population Medicine and WHO Collaborating Center in Pharmaceutical Policy, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jorge Escobedo
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional 1 Carlos MacGregor Sánchez Navarro, IMSS, México, DF, México
| | | | - Dennis Ross-Degnan
- Department of Population Medicine and WHO Collaborating Center in Pharmaceutical Policy, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Anita K Wagner
- Department of Population Medicine and WHO Collaborating Center in Pharmaceutical Policy, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Doubova SV, Espinosa-Alarcón P, Flores-Hernández S, Infante C, Pérez-Cuevas R. Integrative health care model for climacteric stage women: design of the intervention. BMC WOMENS HEALTH 2011; 11:6. [PMID: 21333027 PMCID: PMC3050836 DOI: 10.1186/1472-6874-11-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 02/20/2011] [Indexed: 11/29/2022]
Abstract
Background 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. 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. Methods/Design 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). Discussion 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. Trial registration The study is registered at the ClinicalTrials.gov (NCT01272115).
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Affiliation(s)
- Svetlana V Doubova
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México.
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