RESUMO
BACKGROUND: Northwestern Nicaragua has a high prevalence of chronic kidney disease (CKD) of unknown cause among young adult men. In addition, frequent occurrence of urinary tract infections (UTI) among men and a dysuria syndrome described by sugarcane workers as "chistata" are both reported. This study examines health professionals´ perceptions regarding etiology of these conditions and their treatment approaches, including use of potentially nephrotoxic medications. METHODS: Nineteen in-person semi-structured interviews were conducted in November 2010 among ten physicians and nine pharmacists practicing in the region. RESULTS: Health professionals perceived CKD as a serious and increasing problem in the region, primarily affecting young men working as manual laborers. All interviewees regarded occupational and environmental exposure to sun and heat, and dehydration as critical factors associated with the occurrence of CKD. These factors were also considered to play a role in the occurrence of chistata in the region. Health professionals indicated that reluctance among workers to hydrate might be influenced by perceptions of water contamination. Symptoms often were treated with non-steroidal anti-inflammatory drugs (NSAIDs), diuretics and antibiotics. Physicians acknowledged that the diagnosis of UTI usually was not based on microbial culture and opined that the use of potentially nephrotoxic medications may be contributing to CKD. CONCLUSIONS: Interviews provided evidence suggesting that medications such as diuretics, antibiotics and NSAIDs are widely used and sold over the counter for symptoms that may be related to dehydration and volume depletion. These factors, alone or in combination, may be possible contributors to kidney damage. Acute kidney damage coupled with volume depletion and exposures including medications and infectious agents should be further evaluated as causal factors for CKD in this region.
Assuntos
Atitude do Pessoal de Saúde , Farmacêuticos/psicologia , Médicos/psicologia , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/terapia , Disuria/etiologia , Disuria/terapia , Epidemias , Feminino , Humanos , Masculino , Nicarágua/epidemiologia , Pesquisa Qualitativa , Insuficiência Renal Crônica/epidemiologia , Infecções Urinárias/etiologia , Infecções Urinárias/terapia , Adulto JovemRESUMO
Qualitative research uses nonnumeric data to understand people's opinions, motives, understanding, and beliefs about events or phenomena. In this analysis, I report the use of qualitative methods and data in the study of the relationship between environmental exposures and human health. A primary search for peer-reviewed journal articles dated from 1991 through 2008 included the following three terms: qualitative, environ*, and health. Searches resulted in 3,155 records. Data were extracted and findings of articles analyzed to determine where and by whom qualitative environmental health research is conducted and published, the types of methods and analyses used in qualitative studies of environmental health, and the types of information qualitative data contribute to environmental health. The results highlight a diversity of disciplines and techniques among researchers who used qualitative methods to study environmental health. Nearly all of the studies identified increased scientific understanding of lay perceptions of environmental health exposures. This analysis demonstrates the potential of qualitative data to improve understanding of complex exposure pathways, including the influence of social factors on environmental health, and health outcomes.
Assuntos
Saúde Ambiental , Humanos , Pesquisa Qualitativa , Fatores de TempoRESUMO
Qualitative research uses nonnumeric data to understand people's opinions, motives, understanding, and beliefs about events or phenomena. In this analysis, I report the use of qualitative methods and data in the study of the relationship between environmental exposures and human health. A primary search for peer-reviewed journal articles dated from 1991 through 2008 included the following three terms: qualitative, environ*, and health. Searches resulted in 3,155 records. Data were extracted and findings of articles analyzed to determine where and by whom qualitative environmental health research is conducted and published, the types of methods and analyses used in qualitative studies of environmental health, and the types of information qualitative data contribute to environmental health. The results highlight a diversity of disciplines and techniques among researchers who used qualitative methods to study environmental health. Nearly all of the studies identified increased scientific understanding of lay perceptions of environmental health exposures. This analysis demonstrates the potential of qualitative data to improve understanding of complex exposure pathways, including the influence of social factors on environmental health, and health outcomes.
Pesquisa qualitativa usa dados não numéricos para entender opiniões, motivos e crenças sobre eventos e fenômenos. Nesta análise, o uso de métodos e de dados qualitativos é reportado no estudo da relação entre exposição ambiental e saúde humana. Uma pesquisa preliminar por artigos de 1991 a 2008 incluiu os três seguintes termos: qualitativo, ambiente e saúde. A pesquisa resultou em 3.155 registros. Dados foram extraídos e artigos analisados para determinar onde e por quem a pesquisa de saúde ambiental foi conduzida e publicada, os tipos de métodos e análises usados em estudos qualitativos de saúde ambiental e os tipos de dados de informação qualitativa que contribuem para a saúde ambiental. Os resultados ressaltam uma diversidade de disciplinas e técnicas entre pesquisadores que usaram métodos qualitativos para estudar saúde ambiental. Quase todos os estudos identificaram um aumento da compreensão científica de percepções de exposições de saúde ambiental. A análise demonstra o potencial de dados qualitativos para melhorar a compreensão de caminhos de exposição complexos, incluindo a influência de fatores sociais em saúde ambiental e resultados.