Search

Objective: The objective of the present study was to provide statewide estimates of real-world effectiveness in reducing the odds of one primary (symptomatic COVID-19 infection) and two secondary outcomes (hospitalization and severe COVID-19 infection) by four vaccines BNT162b2 (Pfizer-BioNTech), ChAdOx1 (AstraZeneca), Ad5-nCoV (CanSinoBIO), and CoronaVac (Sinovac Life Sciences), used in Northeast Mexico., Design: We conducted a test-negative case-control study and analyzed statewide surveillance data from December 2020 to August 2021. SITE: Primary attention and hospitalization., Participants: Two inclusion criteria were applied, age≥18 years and having a real-time reverse-transcriptase-polymerase-chain-reaction assay or a rapid test for antigen detection in postnasal samples (N=164,052). The vaccination was considered complete if at least 14 days had passed since the application of the single or second dose and the beginning of symptomatology., Interventions: Does not apply., Main Measurements: Point and 95% confidence intervals (CI) of vaccine effectiveness were calculated per type of vaccine using the formula 1 - odds ratio, adjusted by sex and age., Results: Complete vaccination offered from none (CoronaVac - Sinovac) to 75% (95%CI 71, 77) (BNT162b2 - Pfizer) effectiveness in reducing symptomatic COVID-19 infection, regardless of sex and age. The fully ChAdOx1 (AstraZeneca) scheme reached the maximum effectiveness in hospitalization (80%, 95%CI 69, 87) and the fully BNT162b2 (Pfizer) scheme the maximum effectiveness in severity (81%, 95%CI 64, 90)., Conclusions: More studies are needed to compare benefits of different vaccines and guide policy makers select the best option for their population., (Copyright © 2023 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To determine the impact of primary care on hospitalization of type 2 diabetics with equal conditions of health insurance., Design: A case-control study. Case = diabetic hospitalized by a disease related condition. Control = diabetic without hospitalization during the last 12 months., Setting: Urban primary care centers., Participants: Cases were consecutively selected from four out of five urban hospitals (n=123). Controls were chosen at random from primary care units matched by primary care source (n=135). Women with gestational diabetes were excluded as well as individuals with missing medical charts (approximately 15%)., Measurements: A primary care index was constructed with process and outcome indicators recommended by the American Medical Association, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, the American Diabetes Association and the Official Mexican Standards. Compliance to less than 60% of recommendations was considered unsatisfactory primary care., Results: The following were hospitalization risk factors: less than 2 visits to family physician during the last year (OR adjusted, 16,2; 95% CI, 1,5-174,2), glucose level (OR adjusted, 1,006; 95% CI, 1,002-1,010) and cognitive level (OR adjusted, 0,98; 95% CI, 0,96-0,99), in addition to exercising and year of diagnosis. Sixty-five percent of cases observed unsatisfactory primary care compared with 49,1% of controls (P=0,03). Unsatisfactory primary care increased 2,5 times the risk of hospitalization (95% CI, 1,2-5,0) (pseudo R2=0,279; P<0,001)., Conclusions: Primary care is a potential factor for reducing hospitalization of type 2 diabetics. Effective primary care programs would contribute to a better disease control and less unnecessary hospitalizations.

Objective: To assess health care access integrating the availability of resources, medical institution and the patient point of view., Setting: Nuevo León, México., Measurements and Main Results: A random sample of patients were interviewed about their perceptions on different barriers, which also were assessed for the institution utilizing the corresponding indicator. Availability of resources were also measured for every primary and secondary medical care unit of the greatest Mexican health care system in Nuevo León. It was observed a 70% access; 70% for primary care and 73% for secondary care. Availability of human resources was an important factor but barriers as observed by the institution were the most important (waiting time and traveling cost). Barriers were rated different by the institution and the patient., Conclusions: The combination of institutional barriers, patient barriers and resources for assessing health care access is discussed.

Objective: To assess if work-related activities represented a threatening situation for nursing personnel through the correlation between the level of usual anxiety (trait-anxiety) and the level of anxiety present during working hours (state-anxiety). As well as, to determine state-anxiety risk factors., Material and Methods: The state-trait-anxiety inventory was administered to 285 nurses of a health care institution chosen at random., Results: The correlation coefficient was 0.53 (CI 95% = 0.43, 0.60, p = 0.001), after controlling for age, marital status, number of children, workload, service, category, level of care, years of service and personal relationships. Negative personal relationships and = 1 year of service influenced the level of anxiety present during working hours (beta = -0.21, beta = -0.24, p = 0.001, respectively)., Conclusions: Work-related activities represented a threatening situation and contributed to anxiety. It is necessary to recognize anxiety work-related risk factors for developing coping strategies and preventing well-being damage.