CRIS

Permanent URI for this communityhttps://scripta.up.edu.mx/handle/20.500.12552/1

Browse

Search Results

Now showing 1 - 10 of 23

Some of the metrics are blocked by your
consent settings
Episiotomy Decision‐Making and Perceived Consequences: A Qualitative Study From Two Public Hospitals in Mexico
(Wiley, 2026)
Jaimes‐Jiménez, Ithandehui
;
Valtierra‐Gutiérrez, Erika Sofia
;
González‐De Ita, Rodrigo A.
;
Caballero‐Torres, Luis Ernesto
;
González‐Ledesma, Arturo
Introduction: Episiotomy remains a widely performed procedure in many countries, despite international recommendations favoring a restrictive approach. In Mexico, high rates persist in several settings, including public hospitals. Understanding the factors that sustain this practice is key to designing evidence-based respectful birth care strategies. This study aimed to explore healthcare professionals' perspectives on the decision-making process, performance, and perceived consequences of episiotomy, and to engage them in the co-design of behavioral science–informed interventions to promote its restrictive use. Methods: A two-phase qualitative study was conducted in two public hospitals in Mexico, as part of a broader project aimed at promoting the restrictive use of episiotomy. In Phase 1, we conducted 22 semi-structured interviews with maternal health care workers, selected through purposive sampling. Interviews were analyzed inductively using iterative coding and thematic grouping. In Phase 2, group interviews were conducted to discuss findings and collaboratively design interventions for a future pilot quasi-experimental study. Results: Episiotomy decisions are often guided by clinical and preventive considerations. Non-clinical factors, including productivity burdens and training, also contributed to the high rates of episiotomy. Despite the absence of formal institutional monitoring of episiotomy rates, professionals expressed a strong interest in receiving feedback and training. Conclusion: Episiotomy practices in this setting are influenced by clinical, systemic, and educational factors. Addressing potential overuse of episiotomy requires institutional feedback systems, evidence-based training, and strategies to improve dignity in care. Engaging stakeholders through a participatory approach helps ensure that potential interventions are contextually relevant and feasible to implement. ©the authors © Wiley.
Some of the metrics are blocked by your
consent settings
Development and validation of a questionnaire to assess the health related Social Capital for Chronic Kidney Disease among Mexican adolescents
(Public Library of Science (PLoS), 2025)
Quiñones-Villalobos, Carolina
;
Prado-Aguilar, Carlos Alberto
;
Obrador, Gregorio
;
Arreola-Guerra, José Manuel
;
Padilla-López, Jannett
Background: Social Capital on health has been studied widely, to date there is no valid and reliable questionnaire that measure it in Chronic Kidney Disease (CKD). Objective: To develop, validate and assess the reliability of Social Capital related to CKD questionnaire for Mexican adolescents. Methods: An instrumental study was employed to validate a questionnaire that assesses the cognitive and structural domains of Social Capital related to CKD. The questionnaire was generated by operationalization of the constructs and validated by assessing the content, face validity, criteria and construct validity. Reliability was assessed through the Cronbach´s alpha. Results: The content validity of the questionnaire was confirmed through Kendall’s W of 0.925 (p = 0.01) and its face validity was evaluated by four focus groups. A principal component analysis on a sample of 281 adolescents indicated that 72.78% of the variance was explained by the cognitive domain and 83.20% by the structural domain. A confirmatory analysis returned a chi-squared value of 142.99 (p = 0.05), a CFI of 0.97, a TLI of 0.96, a RMSEA of 0.040 and a SRMR of 0.07 for the cognitive domain. Similarly, a chi-squared of 408.296 (p < 0.001), a CFI of 0.98, a TLI of 0.97, a RMSEA 0.03 and a SRMR of 0.06 were returned for the structural domain. The validity of the criteria was assessed through a Pearson’s correlation for both the cognitive and structural domains. There was a mild-to-strongly significant correlation (p ≤ 0.001) among items and dimensions within each domain, with correlation coefficients ranging from 0.23 to 0.83. As a determinant of the reliability of the questionnaire, the Cronbach’s alpha was 0.84 and 0.94 for the cognitive and structural domain, respectively. Conclusions: A valid and reliable questionnaire has been developed to measure the influence of Social Capital on health in relation to CKD among Mexican adolescents. ©The authors ©Public Library of Science (PLoS) ©PLOS One.
Some of the metrics are blocked by your
consent settings
Epidemiology of Kidney Disease in the Elderly
(Springer Nature Switzerland, 2024)
Obrador, Gregorio
Concomitant with population aging, kidney disease incidence and prevalence among the elderly is growing globally. The prevalence of chronic kidney disease (CKD) increases with age and is higher in women than in men. Impaired kidney function in older people is associated with adverse outcomes. Older people are more likely to die than to reach kidney replacement therapy. Discontinuation of maintenance dialysis is frequent and a leading cause of death. Kidney transplant recipients in recent years are older than in the past on average. Conservative kidney management is an alternative therapy for end-stage kidney disease, and is especially suited for older patients with multiple comorbid conditions. Elderly patients have many risk factors for developing acute kidney injury, increasing the risk of chronic kidney disease, kidney failure, and mortality. The prevalence of glomerular diseases in the elderly is growing and faces significant diagnostic and therapeutic challenges. © The author © Springer.
Some of the metrics are blocked by your
consent settings
Conservative kidney management and kidney supportive care: core components of integrated care for people with kidney failure
(Elsevier, 2024)
Davison, Sara N.
;
Pommer, Wolfgang
;
Brown, Mark A.
;
Douglas, Claire A.
;
Gelfand, Samantha L.
Integrated kidney care requires synergistic linkage between preventative care for people at risk for chronic kidney disease and health services providing care for people with kidney disease, ensuring holistic and coordinated care as people transition between acute and chronic kidney disease and the 3 modalities of kidney failure management: conservative kidney management, transplantation, and dialysis. People with kidney failure have many supportive care needs throughout their illness, regardless of treatment modality. Kidney supportive care is therefore a vital part of this integrated framework, but is nonexistent, poorly developed, and/or poorly integrated with kidney care in many settings, especially in low- and middle-income countries. To address this, the International Society of Nephrology has (i) coordinated the development of consensus definitions of conservative kidney management and kidney supportive care to promote international understanding and awareness of these active treatments; and (ii) identified key considerations for the development and expansion of conservative kidney management and kidney supportive care programs, especially in low resource settings, where access to kidney replacement therapy is restricted or not available. This article presents the definitions for conservative kidney management and kidney supportive care; describes their core components with some illustrative examples to highlight key points; and describes some of the additional considerations for delivering conservative kidney management and kidney supportive care in low resource settings. ©Elsevier
Scopus© Citations 12 38 2
Some of the metrics are blocked by your
consent settings
Associations of Haemoglobin Values and Rate of Changes With MACE in the ASCEND-ND Randomised Clinical Trial
(2022)
Singh, Ajay K.
;
Macdougall, Iain C.
;
Johansen, Kirsten
;
Jha, Vivekanand
;
Correa-Rotter, Ricardo
Background and aims: Rapid changes in haemoglobin (Hb) following treatment with erythropoiesis-stimulating agents (ESAs) in patients with anaemia of chronic kidney disease (CKD) have been suggested to be associated with adverse outcomes [1–3]. This exploratory post-hoc analysis was performed to investigate the association between absolute Hb values or Hb changes over a 4-week period and the occurrence of first adjudicated major adverse cardiovascular event (MACE) in CKD patients not on dialysis who were treated with either daprodustat or darbepoetin. Method: ASCEND-ND was an event driven, cardiovascular outcomes trial conducted in over 30 countries that randomized 3872 CKD patients not on dialysis with baseline Hb of 8–10 g/dL if not on a prior ESA, or 8–11 g/dL if receiving an ESA, to receive either oral, once-daily daprodustat (1937 patients) or subcutaneous darbepoetin (1935 patients). Available doses were daprodustat 1–24 mg once-daily and darbepoetin 20–400 µg total 4-weekly dose. The study was recently reported to have met the co-primary endpoints of non-inferiority for first occurrence of adjudicated MACE and mean Hb change from baseline to weeks 28 through 52 [4]. MACE was a composite of death from any cause, non-fatal myocardial infarction or non-fatal stroke, and events were adjudicated by an independent clinical events committee blinded to treatment assignment. In this exploratory post-hoc analysis, we examined the associations of post-randomization absolute Hb values and Hb changes categorized into quintiles (see Table 1) with first adjudicated MACE. Each patient's time in the study, prior to a first MACE or end of follow-up, was divided into distinct 4-week intervals, with each interval associated with a particular post-randomization Hb value and rate of change. Separately for each treatment group, these 4-week periods were grouped according to quintiles of Hb values, and MACE rates were calculated for each quintile. This analysis was repeated using quintiles derived from Hb rate of decrease and increase. MACEs that occurred prior to Week 4, the first scheduled post-randomization Hb collection, were not included in the analysis. Copyright © Oxford University Press
24 1
Some of the metrics are blocked by your
consent settings
Nephrology in Mexico
(2021)
García-García, Guillermo
;
Chávez-Iñiguez, Jonathan Samuel
;
Vázquez-Rangel, Armando
;
Cervantes-Sánchez, Cynthia Gabriela
;
Paniagua, Ramón
Nephrology in Mexico started in 1955 with the opening of the nephrology department at Mexico’s National Heart Institute, where the first nephrology training program began in 1958. Pediatric nephrology care was first offered at Mexico’s Federico Gomez Children’s Hospital in 1953, among the first pediatric nephrology programs in the world. Kidney transplantation began in 1963 at the IMSS General Hospital. The Sociedad Mexicana de Nefrologia, the first Mexican nephrology society, was established in 1967, followed by the publication of Nefrologia Mexicana, its official journal, in 1980. Chronic kidney disease has emerged as a public health problem in Mexico. However, the fragmentation of the health system has resulted in unequal access to renal replacement therapy. Seguro Popular, a public health-care insurance for the poor, does not cover renal replacement therapy. As a consequence, many uninsured patients refuse dialysis, eventually abandon their treatment, or lose their kidney grafts because sustaining dialysis or immunosuppression becomes unaffordable. The lack of a national dialysis registry results in a vacuum of information on the burden of treated end-stage renal disease and its outcomes. In addition to the high burden of traditional risk factors (i.e., diabetes mellitus), a number of “hotspots” of chronic kidney disease of unknown origin have been recently described in the country. Despite the increased burden of chronic kidney disease, strategies to prevent chronic kidney disease have not been part of the nation’s noncommunicable disease health policies. Chronic kidney disease screening is not part of the National Health Surveys. Peritoneal dialysis continues to be the dialysis modality of choice, although a significant shift to hemodialysis has been observed over the last two decades. The number of nephrologists (9.1 per million population) is insufficient to match the demand imposed by the burden of chronic kidney disease. In conclusion, after 65 years of the beginning of nephrology in Mexico, kidney disease care remains unjust, unequal, and below the quality of international standards. The current infrastructure and resources are insufficient to satisfy the demand of renal care in our society. Therefore, it is important to consider it as a public health priority and to implement a comprehensive program for the prevention and control of this illness. The establishment of a national public policy for the prevention and treatment of chronic kidney disease is urgently needed. © Springer Nature
Scopus© Citations 2 15 2
Some of the metrics are blocked by your
consent settings
Management of Anemia in Nondialysis Chronic Kidney Disease: Current Recommendations, Real-World Practice, and Patient Perspectives
(2020)
Guedes, Murilo
;
Robinson, Bruce M.
;
Obrador, Gregorio
;
Tong, Allison
;
Pisoni, Ronald L.
In nondialysis CKD (ND-CKD), anemia is a multifactorial and complex condition in which several dysfunctions dynamically contribute to a reduction in circulating hemoglobin (Hb) levels in red blood cells. Anemia is common in CKD and represents an important and modifiable risk factor for poor clinical outcomes. Importantly, symptoms related to anemia, including reduced physical functioning and fatigue, have been identified as high priorities by patients with CKD. The current management of anemia in ND-CKD (i.e., parameters to initiate treatment, Hb and iron indexes targets, choice of therapies, and effect of treatment on clinical and patient-reported outcomes) remains controversial. In this review article, we explore the epidemiology of anemia in ND-CKD and revise current recommendations and controversies in its management. Exploring data from real-world clinical practices, particularly from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps), we highlight the current challenges to translating current recommendations to clinical practice, providing patients' perspectives of anemia and how it affects their quality of life. Finally, we summarize recent advances in the field of anemia that may change the way this condition will be managed in the future. Copyright © 2020 by the American Society of Nephrology.
Scopus© Citations 14 6 2
Some of the metrics are blocked by your
consent settings
Regional Variation of Erythropoiesis-Stimulating Agent Hyporesponsiveness in the Global Daprodustat Dialysis Study (ASCEND-D)
(Karger Publishers, 2023)
Macdougall, Iain C.
;
Meadowcroft, Amy M.
;
Blackorby, Allison
;
Cizman, Borut
;
Cobitz, Alexander R.
Introduction: Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) affects 10-15% of the chronic dialysis population. We explored baseline characteristics and predictors of ESA hyporesponsiveness in a global randomized cardiovascular outcomes study comparing an investigational hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), daprodustat, with conventional ESA treatment. Methods: ASCEND-D (NCT02879305) recruited 2,964 chronic dialysis patients receiving ESA treatment (standardized to weekly intravenous [IV] epoetin) who were iron replete at baseline. The primary ESA hyporesponsiveness definition was an ESA Resistance Index (ERI, ESA units/kg/week/hemoglobin g/L) ≥2 or IV standardized ESA dose ≥450 units/kg/week. Predictors of ESA hyporesponsiveness were determined using a multivariable regression model. Alternative hyporesponder definitions were explored. The Author(s). Published by S. Karger AG, Basel.
Scopus© Citations 6 33
Some of the metrics are blocked by your
consent settings
The ASCEND-NHQ randomized trial found positive effects of daprodustat on hemoglobin and quality of life in patients with non-dialysis chronic kidney disease
(2023)
Johansen, Kirsten L.
;
Cobitz, Alexander R.
;
Singh, Ajay K.
;
Macdougall, Iain C.
;
Lopes, Renato D.
The ASCEND-NHQ trial evaluated the effects of daprodustat on hemoglobin and the Medical Outcomes Study 36-item Short Form Survey (SF-36) Vitality score (fatigue) in a multicenter, randomized, double-blind, placebo-controlled trial. Adults with chronic kidney disease (CKD) stages 3-5, hemoglobin 8.5-10.0 g/dl, transferrin saturation 15% or more, and ferritin 50 ng/ml or more without recent erythropoiesis-stimulating agent use were randomized (1:1) to oral daprodustat or placebo to achieve and maintain target hemoglobin of 11-12 g/dl over 28 weeks. The primary endpoint was the mean change in hemoglobin between baseline and the evaluation period (Weeks 24-28). Principal secondary endpoints were proportion of participants with a 1 g/dl or more increase in hemoglobin and mean change in the Vitality score between baseline and Week 28. Outcome superiority was tested (1-sided alpha level of 0.025). Overall, 614 participants with non-dialysis-dependent CKD were randomized. The adjusted mean change in hemoglobin from baseline to the evaluation period was greater with daprodustat (1.58 vs 0.19 g/dl). The adjusted mean treatment difference (AMD) was significant at 1.40 g/dl (95% confidence interval 1.23, 1.56). A significantly greater proportion of participants receiving daprodustat showed a 1 g/dl or greater increase in hemoglobin from baseline (77% vs 18%). The mean SF-36 Vitality score increased by 7.3 and 1.9 points with daprodustat and placebo, respectively; a clinically and statistically significant 5.4 point Week 28 AMD increase. Adverse event rates were similar (69% vs 71%); relative risk 0.98, (95% confidence interval 0.88, 1.09). Thus, in participants with CKD stages 3-5, daprodustat resulted in a significant increase in hemoglobin and improvement in fatigue without an increase in the overall frequency of adverse events. Copyright © 2023 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.
Scopus© Citations 16 11 1
Some of the metrics are blocked by your
consent settings
The environment and kidney health: challenges and opportunities
(2022)
Bharati, Joyita
;
Zavaleta-Cortijo, Carol
;
Bressan, Tiana
;
Shingada, Aakash
;
Obrador, Gregorio
The accelerating environmental degradation as a result of modernisation and climate change is an urgent threat to human health. Environment change can impact kidney health in a variety of ways such as water scarcity, global heating and changing biodiversity. Ever increasing industrialization of health care has a large carbon footprint, with dialysis being a major contributor. There have been calls for all stakeholders to adopt a ‘one health approach’ and develop mitigation and adaptation strategies to combat this challenge. Because of its exquisite sensitivity to various elements of environment change, kidney health can be a risk marker and a therapeutic target for such interventions. In this narrative review, we discuss the various mechanisms through which environmental change is linked to kidney health and the ways that the global kidney health communities can respond to environmental change. ©D.R. © por el sitio: Instituto Nacional de Salud Pública.
Scopus© Citations 4 41 1

CRIS

Browse

Filters

Settings

Sort By

Results per page

Search Results