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To compare sociodemographic and clinical characteristics among obese and non-obese women in Mexico and analyze the association between obesity and pregnancy complications.We conducted a secondary data analysis of the 2018-2019 Mexican National Survey of Health and Nutrition. We included women aged 20-49 years who had at least one live birth in the five years preceding the survey (n = 1573). We performed a double-weighted (by IP-weights and survey-weights) multilevel multiple logistic regression analysis.Obesity was prevalent in 32% of pregnant women. Obese and non-obese women received similar antenatal care. 42.6% of obese women, compared to 33.6% of non-obese had one or more pregnancy or labor complications. Compared with non-obese women, obese women were older and had more chronic diseases. Obesity was associated with a 48% increase in the probability of complications.Due to the high prevalence of obesity among Mexican women of reproductive age and given the independent association between obesity and complications during pregnancy and labor, the development and implementation of specific clinical guidelines on weight management before conception, during pregnancy, and post-partum for women who are obese is an unmet need in Mexico.

To analyze acute myocardial infarction (AMI) admissions and in-hospital mortality rates and evaluate the competence of the Ministry of Health (MOH) hospitals to provide AMI treatment.We used a mixed-methods approach: 1) Joinpoint analysis of hos-pitalizations and in-hospital mortality trends between 2005 and 2017; 2) a nation-wide cross-sectional MOH hospital survey.AMI hospitalizations are increasing among men and patients aged60 years; women have higher mortal-ity rates. The survey included 527 hospitals (2nd level =471; 3rdlevel =56). We identified insufficient competence to diagnose AMI (2nd level 37%, 3rd level 51%), perform pharmacological perfusion (2nd level 8.7%, 3rd level 26.8%), and mechanical reperfusion (2nd level 2.8%, 3rd level 17.9%).There are wide disparities in demand, supply, and health outcomes of AMI in Mexico. It is advisable to build up the competence with gender and age perspectives in order to di-agnose and manage AMI and reduce AMI mortality effectively.Analizar las tendencias de admisiones y mortali-dad hospitalaria por infarto agudo al miocardio (IAM) y eva-luar la competencia hospitalaria de la Secretaría de Salud (SS) para tratarlo.Enfoque de métodos mixtos: Jointpoint análisis de tendencias de hospitalizaciones y mortalidad hospitalaria entre 2005 y 2017, y encuesta en hospitales de la SS.Las hospitalizaciones por IAM están aumentando entre hombres y pacientes60 años. Las mujeres tienen mayor mortalidad. La encuesta incluyó 527 hospitales (2º nivel =471, 3er nivel =56). Los hospitales tienen competencias insuficientes para diagnosticar IAM (2º nivel 37%, 3er nivel 51%), realizar perfusión farmacológica (2º nivel 8.7%, 3er nivel 26.8%) y reperfusión mecánica (2º nivel 2.8%, 3er nivel 17.9%).Existen disparidades en demanda, oferta y resultados en salud del IAM. Es aconsejable fortalecer las competencias, con perspectivas de género y edad, para diagnosticar y tratar IAM, y reducir su mortalidad efectivamente.

Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total outpatient visits declined by 9–40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.

In Mexico, paediatric cancer is the leading cause of death for children aged 0–18 years. This study analyses the main challenges for paediatric cancer care from the perspective of three key health systems functions: stewardship, financing and service delivery. The study used a mixed methods approach comprised of: (1) a scoping literature review, (2) an analysis of 2008–18 expenditures on paediatric cancer by the Fund for Protection against Catastrophic Expenditures (FPGC) of Seguro Popular and (3) a nation-wide survey of the supply capacity of 59 Ministry of Health (MoH) and 39 Mexican Institute of Social Security (IMSS) hospitals engaged in paediatric cancer care. The study found that while Mexico has made substantial progress towards universal health coverage (UHC) for paediatric cancer treatment, serious gaps persist. FPGC funds for paediatric cancer increased from 2008 to 2011 to reach US$36 million and then declined to US$13.6 million in 2018, along with the number of covered cases. The distribution of health professionals and paediatric oncology infrastructure is uneven between MoH and IMSS hospitals and across Mexican regions. Both institutions share common barriers for continuous and co-ordinated health care and lack monitoring activities that cripple their capacity to apply uniform standards for high-quality cancer care. In conclusion, achieving universal and effective coverage of paediatric cancer treatment is a critical component of UHC for Mexico. This requires periodic and ongoing assessment of health system performance specific to paediatric cancer to identify gaps and propose strategies for continued investment and improvement of access to care and health outcomes for this important cause of premature mortality.

Universal health coverage is a national priority in Mexico, with active efforts to expand public healthcare system access, increase financial protection and improve quality of care. We estimated effective coverage of multiple conditions within the Mexican Institute of Social Security (IMSS), which covers 62 million individuals. We identified routinely collected performance indicators at IMSS from 2016 related to use and quality of care for conditions avertable with high-quality healthcare; where candidate indicators were available, we quantified need for service from a population-representative survey and calculated effective coverage as proportion of individuals in need who experience potential health gains. We assessed subnational inequality across 32 states, and we weighted conditions by relative contribution to national disease burden to estimate composite effective coverage. Conditions accounting for 51% of healthcare-avertable disability-adjusted life years lost in Mexico could be assessed: antenatal care, delivery care, newborn care, childhood diarrhoea, cardiovascular disease and diabetes. Estimated effective coverage ranged from a low of 27% for childhood diarrhoea to a high of 74% for newborn care. Substantial inequality in effective coverage existed between states, particularly for maternal and child conditions. Overall effective coverage of these six conditions in IMSS was 49% in 2016. Gaps in use and quality of care must be addressed to ensure good health for all in Mexico. Despite extensive monitoring of health status and services in Mexico, currently available data are inadequate to the task of fully and routinely assessing health system effective coverage. Leaders at IMSS and similar healthcare institutions must be more purposeful in planning the assessment of population need, utilization of care and quality impacts of care to enable linkage of these data and disaggregation by location or population sub-group. Only then can complex health systems be fairly and fully evaluated.

The aim of the study was to measure survival of children with acute lymphoblastic leukemia (ALL) under Mexico’s public health insurance for the population treated under Seguro Popular. A retrospective cohort study using claims data from Mexico’s Seguro Popular program, covering cancer treatment from 2005 to 2015 was conducted. Overall 5-year national and state-specific survival for children with ALL across Mexico who initiated cancer treatment under this program was estimated. From 2005 to 2015, 8,977 children with ALL initiated treatment under Seguro Popular. Under this financing scheme, the annual number of treated children doubled from 535 in 2005 to 1,070 in 2015. The estimates for 5-year overall survival of 61.8% (95%CI 60.8, 62.9) remained constant over time. We observed wide gaps in risk-standardized 5-year overall survival among states ranging from 74.7% to 43.7%. We found a higher risk of mortality for children who received treatment in a non-pediatric specialty hospital (Hazards Ratio, HR = 1.18; 95%CI 1.09, 1.26), facilities without a pediatric oncology/hematology specialist (HR = 2.17; 95%CI 1.62, 2.90), and hospitals with low patient volume (HR = 1.22; 95%CI 1.13, 1.32). In a decade Mexico’s Seguro Popular doubled access to ALL treatment for covered children and by 2015 financed the vast majority of estimated ALL cases for that population. While some progress in ALL survival may have been achieved, nationwide 5-year overall survival did not improve over time and did not achieve levels found in comparable countries. Our results provide lessons for Mexico’s evolving health system and for countries moving toward universal health coverage.

Postnatal care is essential to identify and treat at the appropriate time adverse health events in the puerperium. In Mexico, the factors that affect postnatal care have not been documented.To identify the factors associated with the lack of postnatal care.Cross-sectional study of 202 women of reproductive age affiliated with six primary care clinics of the Mexican Institute for Social Security. We analyzed these factors: (1) sociodemographic: age, education, schooling, distance between home and clinic; (2) psychosocial: social support; (3) obstetric and gynecologic: number of pregnancies, type of delivery, presence of comorbidity and suspected depression, and (4) health services: deficient prenatal control and incomplete postpartum hospital care. We performed multiple Poisson regression with a robust variance.49.5% of women had postnatal control. Factors associated with a higher probability of lack of postnatal control were: distance ≥ 5 km between home and clinic (adjusted prevalence ratio [aPR] 1.48, 95% confidence interval [95% CI] 1.16-1.88, p = 0.001), poor prenatal care (aPR 1.21, 95% CI 1.001-1.46, p = 0.049), and incomplete postpartum care (aPR 1.42, 95% CI 1.23-1.63, p0.001).The low attendance of postnatal care in primary care clinics highlights the need to seek and implement feasible healthcare alternatives, such as home care or telemedicine, to women who cannot attend to postnatal consultations.el control posnatal es esencial para identificar y tratar oportunamente las afecciones de salud de la mujer en el puerperio. En México no se han documentado los factores que limitan la atención posnatal.identificar los factores asociados a la falta de control posnatal.estudio transversal con 202 mujeres en edad reproductiva adscritas a seis clínicas de atención primaria del Instituto Mexicano del Seguro Social. Analizamos los siguientes factores: (1) sociodemográficos: edad, escolaridad, distancia entre domicilio y clínica de atención; (2) psicosociales: apoyo social; (3) ginecoobstétricos: número de embarazos, tipo de parto, presencia de comorbilidad y sospecha de depresión; (4) servicios de salud: control prenatal deficiente y atención hospitalaria posparto incompleta. El análisis incluyó regresión múltiple de Poisson con varianza robusta.49.5% de las mujeres acudieron a control posnatal. Los factores asociados con mayor probabilidad de falta de control prenatal fueron: distancia ≥ 5 km entre domicilio y clínica de atención (razones de prevalencia ajustadas [RPa] 1.48, intervalo de confianza del 95% [IC 95%] 1.16-1.88, p = 0.001), control prenatal deficiente (RPa 1.21, IC 95% 1.001-1.46, p = 0.049) y atención posparto incompleta (RPa 1.42, IC 95% 1.23-1.63, p0.001).la baja asistencia a control posnatal en las clínicas de atención primaria destaca la necesidad de buscar e implementar alternativas factibles, como teleasistencia y consultas a domicilio, para facilitar que las mujeres que viven lejos de su clínica de atención primaria reciban atención posnatal.

Objective To evaluate factors associated with COVID-19 preventive health behaviors among adults in Mexico City and the State of Mexico. Methods and findings We conducted a cross-sectional survey from June to October 2020 through a structured, internet-based questionnaire in a non-probabilistic sample of adults >18 years living in Mexico City and the State of Mexico. The independent variables included sociodemographic and clinical factors; health literacy; access to COVID-19 information; and perception of COVID-19 risk and of preventive measures’ effectiveness. The dependent variable was COVID-19 preventive health behaviors, defined as the number of preventive actions adopted by participants. The data were analyzed through multivariate negative binomial regression analysis. The survey was completed by 1,030 participants. Most participants were women (70.7%), had a high school or above level of education (98.8%), and had adequate health literacy and access to COVID-19 information. Only 18% perceived having a high susceptibility to COVID-19, though 83.8% recognized the disease’s severity and 87.1% the effectiveness of preventive measures. The median number of COVID-19 preventive actions was 13.5 (range 0–19). The factors associated with preventive health behavior were being female, of older age, a professional worker, a homemaker, or a retiree; engaging in regular physical exercise; having high health literacy and access to COVID-19 information sources; and perceiving COVID-19 as severe and preventive measures as effective. Conclusion People with high education and internet access in Mexico City and the State of Mexico reported significant engagement in COVID-19 preventive actions during the first wave of the COVID-19 pandemic.

Objective To compare the prevalence of depression, supportive care needs (SC-needs), and quality of patient-centered cancer care (PCC-quality) between women with breast cancer and women with cervical cancer and to assess the association of SC-needs and PCC-quality with depression. Methods We conducted a cross-sectional survey in a public oncology hospital in Mexico City with 247 breast cancer and 165 cervical cancer ambulatory patients aged ≥18 years with at least one hospitalization and ≤five years since diagnosis. Participants completed the short-form Supportive Care Needs Survey, the Patient-Centered Quality of Cancer Care Questionnaire, and the Hospital Anxiety and Depression Scale. We performed multiple logistic regression analyses to evaluate the association between SC-needs, PCC-quality, and probable presence of depression. Results Nearly all women reported SC-needs-mainly health system and information needs, followed by physical and psychological needs. PCC-quality was substandard in both groups. PCC-quality was lowest when addressing biopsychosocial needs, followed by information for treatment decision-making needs. Cervical cancer patients had probable presence of depression more often (41.2%) than those with breast cancer (29.5%). Having unmet psychological and care needs was associated with increased odds of probable depression, while high-quality timely care was associated with reduced odds of probable depression. Conclusion In Mexico, women with cervical and breast cancer face unmet SC-needs, probable depression, and substandard PCC-quality, pointing to priority areas for improvements in cancer care. This article is protected by copyright. All rights reserved.

Background The objective was to investigate factors associated with patient-related timing (PRT) to seek healthcare and health service-related timing (HSRT) to diagnose cancer and provide treatment to children without social security in Mexico. Procedure A cross-sectional survey was conducted in 13 Ministry of Health hospitals in the states of Chihuahua, Jalisco, Mexico City, Morelos, Oaxaca, Puebla, Queretaro, State of Mexico, and Tlaxcala. Study participants were parents of recently diagnosed pediatric cancer patients (≤ 17 years of age). Three groups of factors were investigated: (1) patients (child and parent characteristics); (2) healthcare providers (HCPs) (first-contact HCP, institution, perceptions of barriers to healthcare, etc.); and (3) disease factors (cancer type/site, stage/risk at diagnosis). PRT and HSRT-associated factors were identified using multiple negative binomial regressions. Results The study included 265 children; 49% sought care when symptoms first appeared. The median PRT was seven days, and the median HSRT was 40 days. Parents' perceptions of long wait times for appointments were associated with longer PRT and HSRT. Residing in the lowest or highest socioeconomic regions and persistent or worsening symptoms increased the probability of longer PRT. Older patient age, HCP requests for imaging tests or prescription for steroids, a higher number of doctors consulted, having a urinary tract cancer, and having an advanced stage or high-risk cancer increased the probability of longer HSRT. Conclusion Strategies to shorten lag time from symptom onset to diagnosis and treatment are urgently needed for childhood cancers in Mexico.

We aimed to measure survival of children with acute lymphoblastic leukaemia (ALL) under Mexico’s public health insurance for the population without social security, and explore patient groups that may be at risk for increased mortality.We conducted a retrospective cohort study using claims data from Mexico’s Seguro Popular program, covering cancer treatment in people without social security, 2005-15. We estimated 5-year national and state-specific survival for children with ALL across Mexico who initiated cancer treatment under this public healthcare insurance scheme.8,977 children with ALL were treated under Seguro Popular in 2005-15. Under this financing scheme, treated children doubled from 535 in 2005 to 1,070 in 2015, and their 5-year survival was 61.8% (95%CI 60.8, 62.9). Estimates for 5-year survival remained constant over time. We observed wide gaps in risk-standardized 5-year survival among states ranging from 74.7% to 43.7%. We found a higher risk of mortality for children who received treatment in a non-paediatric specialty hospital (Hazards Ratio, HR=1.18; 95%CI 1.09, 1.26), facilities without a paediatric oncology/haematology specialist (HR=2.17; 95%CI 1.62, 2.90), and hospitals with low patient volume (HR=1.22; 95%CI 1.13, 1.32).In a decade Mexico’s Seguro Popular doubled access to ALL treatment for children without social security and by 2015 financed the vast majority of estimated ALL cases for that population. While some progress in ALL survival may have been achieved, nationwide 5-year survival was unsatisfactory and did not improve over time.Our results provide lessons for Mexico’s evolving health system and for countries moving towards universal health coverage.Novelty and impactThere has been no comprehensive assessment of the health outcomes of Mexico’s policy for financing high-cost cancer treatments that was part of Seguro Popular, health reform aimed at providing care to the population without social security. The study identified several factors amenable to intervention that could improve survival for childhood ALL in Mexico and reduce the observed disparities.Decision could consider administrative databases as a source of clinical outcomes to ensure the quality their systems.

Purpose To assess the supportive care needs (SC-needs), quality of patient-centered care (PCC), and factors associated with increased SC-needs of patients with lung cancer (LC) in Mexico. Methods We conducted a cross-sectional survey in the main oncology hospital of the Mexican Institute of Social Security in Mexico City. The study included LC ambulatory patients aged ≥18 years with at least one hospitalization before the survey, ≤five years since diagnosis, and without memory loss. Participants answered SC-needs and quality of PCC questionnaires. We performed a multiple negative binomial regression analysis to evaluate the factors associated with an increased number of SC-needs. Results One hundred twenty-eight LC patients participated. Most participants had adenocarcinoma (61.7%) and were at an advanced disease stage (92.1%). In the month preceding the survey, 3.9% had undergone surgery and 78.9% had been receiving chemotherapy and/or radiotherapy; 28.9% had symptoms of depression and 21.9% had anxiety. All patients reported one or more SC-needs—predominantly physical, daily living, information, and psychological needs. The significant gaps in PCC-quality were in the domains of care that addressed biopsychosocial needs and information for treatment decision-making. Factors that decreased the probability of SC-needs were respectful and coordinated care, high-school education, and older age. The factors increasing the likelihood of SCneeds were the type of LC (adenocarcinoma, mesenchymal tumors), chemotherapy and/or radiotherapy, and anxiety. Conclusion PCC improvement initiatives to address SC-needs of LC patients should be prioritized and focus on: (1) information on physical suffering relief and treatment; (2) psychological support; and (3) SC-needs monitoring.

ObjectivesTo develop and validate a Patient-Centred Quality of Cancer Care Questionnaire in Spanish (PCQCCQ-S) appropriate to the Mexican context.DesignPsychometric validation of a questionnaire.SettingTwo public oncology hospitals in Mexico City.Participants1809 patients with cancer aged ≥18 years.Source of informationCross-sectional survey.MethodsThe validation procedures comprised (1) content validity through a group of experts and patients; (2) item reduction and evaluation of the factor structure, through an exploratory factor analysis based on the polychoric correlation matrix; (3) internal consistency using Cronbach’s alpha; (4) convergent validity between the PCQCCQ-S and supportive care needs scale; (5) correlation analysis between the PCQCCQ-S and quality of life scale by calculating Spearman’s rank-correlation coefficient; and (6) differentiation by ‘known groups’ through the Wilcoxon rank-sum test.ResultsThe PCQCCQ-S has 30 items with the following five factors accounting for 96.5% of the total variance: (1) timely care; (2) clarity of the information; (3) information for treatment decision-making; (4) activities to address biopsychosocial needs; and (5) respectful and coordinated care. Cronbach’s alpha values ranged from 0.73 to 0.90 among the factors. PCQCCQ-S has moderate convergent validity with supportive care needs scale, revealing that higher quality is correlated with lower patient needs. PCQCCQ-S has acceptable ability to differentiate by ‘known groups’, showing that older patients and those with low levels of education perceived lower total quality of care as compared with their counterparts.ConclusionPCQCCQ-S has acceptable psychometric properties and can be used to measure quality of patient-centred cancer care in Mexico and serve as a reference to develop PCQCCQ-S in other Spanish-speaking countries.

To evaluate educational and health insurance–related inequalities in supportive care (SC) needs and quality of patient-centered care (PCC) for cancer patients in Mexico. We conducted a cross-sectional survey in one Mexican Institute of Social Security (IMSS) and one Ministry of Health (MoH) oncology hospital in Mexico City. Formal labor market workers and their families have access to social health insurance that IMSS provides, while unemployed and informal workers receive care at the MoH. The study population comprised breast, colorectal, prostate, and hematologic cancer patients, aged ≥ 18 years, who attended outpatient consultations. Patients responded a short-form SC-needs questionnaire and a quality of PCC questionnaire. We used multiple logistic regression models to determine the independent association between educational attainment and high SC-needs and quality of PCC after controlling for sociodemographic and clinical covariates. We included 1058 IMSS and 606 MoH cancer patients. MoH patients perceived higher SC-needs and lower quality of PCC than IMSS patients. MoH patients with low education had a greater probability of high psychological and health system SC needs and lower likelihood of being informed for treatment decision-making and care for their biopsychosocial needs. IMSS patients with low educational levels had lower probability of receiving timely care and clarity of information than those with high education. Receiving high-quality PCC was associated with decreased SC needs. Uninsured cancer patients with low educational attainment have higher SC-needs and receive lower quality of PCC than their counterparts. Health services should face these challenges to reduce inequalities in Mexico.

IntroductionThe COVID-19 pandemic has disrupted health systems around the world. The objectives of this study are to estimate the overall effect of the pandemic on essential health service use and outcomes in Mexico, describe observed and predicted trends in services over 24 months, and to estimate the number of visits lost through December 2020.MethodsWe used health information system data for January 2019 to December 2020 from the Mexican Institute of Social Security (IMSS), which provides health services for more than half of Mexico’s population—65 million people. Our analysis includes nine indicators of service use and three outcome indicators for reproductive, maternal and child health and non-communicable disease services. We used an interrupted time series design and linear generalised estimating equation models to estimate the change in service use and outcomes from April to December 2020. Estimates were expressed using average marginal effects on the risk ratio scale.ResultsThe study found that across nine health services, an estimated 8.74 million patient visits were lost in Mexico. This included a decline of over two thirds for breast and cervical cancer screenings (79% and 68%, respectively), over half for sick child visits and female contraceptive services, approximately one-third for childhood vaccinations, diabetes, hypertension and antenatal care consultations, and a decline of 10% for deliveries performed at IMSS. In terms of patient outcomes, the proportion of patients with diabetes and hypertension with controlled conditions declined by 22% and 17%, respectively. Caesarean section rate did not change.ConclusionSignificant disruptions in health services show that the pandemic has strained the resilience of the Mexican health system and calls for urgent efforts to resume essential services and plan for catching up on missed preventive care even as the COVID-19 crisis continues in Mexico.

To evaluate the effect of an internet-based educational intervention to increase knowledge of sexually transmitted infections (STIs), attitudes and self-efficacy toward consistent condom use in Mexican adolescents. A field trial with an intervention and control group was conducted in 14- to 15-year-old students in two secondary schools. The intervention was delivered via a website that included four educational sessions during a 4-week period and six 30-min class discussions during a 3-month period. In the control group, the investigators observed the general sex education provided by the school. Outcome variables were 1) knowledge about STIs, 2) attitudes regarding condom use, and 3) self-efficacy toward consistent condom use. Differences-in-differences (Diff-in-Diff) treatment effect was estimated for each outcome variable. There were 246 adolescents in the intervention group and 210 in the control group. The intervention had a positive effect on improving knowledge of STIs, attitudes and self-efficacy toward consistent condom use. The major effect was observed on adolescents' knowledge on STIs (Diff-in-Diff 30.34 points, P < 0.0001). A youth-friendly, culturally-contextualized, internet-based educational intervention complemented by class discussions may be a significant addition to the regular secondary school sex education program to improve knowledge of STIs, attitudes and self-efficacy toward consistent condom use among adolescents. TRIAL REGISTRATION The study was registered at the ClinicalTrials.gov ID: NCT02686736.

Introduction. Low adherence to diabetes self-care affects glycemic control and increases the risk of diabetes complications and premature deaths. Studies from the United States have found a relationship between distress and adherence to self-care in patients with diabetes; however, there is a lack of research on distress and its association with self-care in Mexican patients with diabetes. Objective. To evaluate the prevalence and association of distress with low self-care in patients with type 2 diabetes. Method. A cross-sectional study was carried out in two family medicine clinics of the Mexican Institute of Social Security in Mexico City. Four hundred eighty-nine type 2 diabetic patients ≥ 19 years of age participated. The statistical analysis incorporated a multiple Poisson regression. Results. Of the patients 18.8% had distress, 44.8% had low adherence to medication, 43.8% had low adherence to regular physical exercise, 82.4% did not consume the recommended amount of vegetables and 51.1% consumed foods with high sugar content. The distress was associated with poor adherence to medication and lack of regular physical exercise. Discussion and conclusion. The high prevalence of distress in type 2 diabetic patients in comparison with the general population reveals the importance of distress screening and health care at family practice clinics

The opinions and experiences of the public regarding health services are valuable insights into identifying opportunities to improve healthcare systems. We analyzed the 2012-2013 Public Opinion Health Policy Survey carried out in Brazil (n = 1486), Colombia (n = 1485), El Salvador (n = 1460), Jamaica (n = 1480), México (n = 1492) and Panama (n = 1475). In these countries between 82 and 96% of participants perceived that their health systems needed fundamental changes. The most frequent barrier to access to healthcare was lack of the primary medical home, difficulties in obtaining medical care during the weekends and financial barriers. Type of health insurance and challenges in obtaining medical care during the weekends were associated with an increased opinion for the need for fundamental changes in healthcare systems, whereas having a primary medical home showed a protective effect. Focusing on tackling organizational and financial barriers and ensuring access to a primary medical home should be placed on the agenda of Latin American countries.

Background and Aims There is a growing need for evidence based answers to multimorbidity, especially in primary care settings. The aim was estimate the prevalence and patterns of multimorbidity in a Mexican population of public health institution users ≥60 years old. Methods Observational and multicenter study was carried out in four family medicine units in Mexico City; included older men and women who attended at least one consultation with their family doctor during 2013. The most common diseases were grouped into 11 domains. The observed and expected rates, as well as the prevalence ratios, were calculated for the pairs of the more common domains. Logistic regression models were developed to estimate the magnitude of the association. Cluster and principal components analyses were performed to identify multimorbidity patterns. Results Half of all of the patients who were ≥60 years old and treated by a family doctor had multimorbidity. The most common disease domains were hypertensive and endocrine diseases. The highest prevalence of multimorbidity concerned the renal domain. The domain pairs with the strongest associations were endocrine + renal and hypertension + cardiac. The cluster and principal components analyses revealed five consistent patterns of multimorbidity. Conclusions The domains grouped into five patterns could establish the framework for developing treatment guides, deepen the knowledge of multimorbidity, develop strategies to prevent it, decrease its burden, and align health services to the care needs that doctors face in daily practice.

Background The study aimed to assess the performance of a multidisciplinary-team diabetes care program called DIABETIMSS on glycemic control of type 2 diabetes (T2D) patients, by using available observational patient data and machine-learning-based targeted learning methods. Methods We analyzed electronic health records and laboratory databases from the year 2012 to 2016 of T2D patients from six family medicine clinics (FMCs) delivering the DIABETIMSS program, and five FMCs providing routine care. All FMCs belong to the Mexican Institute of Social Security and are in Mexico City and the State of Mexico. The primary outcome was glycemic control. The study covariates included: patient sex, age, anthropometric data, history of glycemic control, diabetic complications and comorbidity. We measured the effects of DIABETIMSS program through 1) simple unadjusted mean differences; 2) adjusted via standard logistic regression and 3) adjusted via targeted machine learning. We treated the data as a serial cross-sectional study, conducted a standard principal components analysis to explore the distribution of covariates among clinics, and performed regression tree on data transformed to use the prediction model to identify patient sub-groups in whom the program was most successful. To explore the robustness of the machine learning approaches, we conducted a set of simulations and the sensitivity analysis with process-of-care indicators as possible confounders. Results The study included 78,894 T2D patients, from which 37,767patients received care through DIABETIMSS. The impact of DIABETIMSS ranged, among clinics, from 2 to 8% improvement in glycemic control, with an overall (pooled) estimate of 5% improvement. T2D patients with fewer complications have more significant benefit from DIABETIMSS than those with more complications. At the FMC’s delivering the conventional model the predicted impacts were like what was observed empirically in the DIABETIMSS clinics. The sensitivity analysis did not change the overall estimate average across clinics. Conclusions DIABETIMSS program had a small, but significant increase in glycemic control. The use of machine learning methods yields both population-level effects and pinpoints the sub-groups of patients the program benefits the most. These methods exploit the potential of routine observational patient data within complex healthcare systems to inform decision-makers.

espanolAntecedentes: en Mexico, se desconoce la calidad de la atencion medica para los pacientes con el virus de la inmunodeficiencia humana (VIH). Los objetivos del estudio fueron desarrollar indicadores de calidad de la atencion (QoC) para la atencion ambulatoria de pacientes con VIH, evaluar la calidad de los procesos de atencion (QPC) y los resultados, y analizar la asociacion entre la QPC y la supresion viral entre los pacientes con VIH. Metodos: El estudio utilizo un enfoque de metodos mixtos: (1) Desarrollo de indicadores de QoC a traves del metodo RAND / UCLA; (2) estudio transversal de evaluacion de QoC; y (3) regresiones multiples de Poisson para medir la asociacion entre el QPC y la supresion viral. El estudio incluyo a 439 pacientes con VIH, ≥ 19 anos de edad, con al menos una consulta ambulatoria durante 2017 en un hospital publico en el Estado de Mexico. Resultados: desarrollamos 21 indicadores de QoC para evaluar la atencion del VIH. Segun estos indicadores, las brechas de QoC que surgieron estaban relacionadas con la historia clinica (el 24% de los registros de pacientes incluian informacion de historia sexual), la evaluacion de cumplimiento de rutina (ningun registro demostro el registro regular de la adherencia al tratamiento antirretroviral) y la deteccion y derivacion (50% fueron examinado para detectar depresion y 42% para tuberculosis; 1.2% de los pacientes con indice de masa corporal anormal fueron remitidos a un dietista). En promedio, los pacientes con VIH recibieron el 63% de los QPC recomendados; El 77.7% logro la supresion viral. Recibir mas del 75% de los QPC recomendados se asocio con una mayor probabilidad de supresion viral (razon de prevalencia ajustada 1.13, intervalo de confianza del 95% 1.03-1.24). Conclusiones: La evaluacion de la QoC para pacientes con VIH es esencial para identificar y abordar las brechas en la calidad de la atencion medica para aumentar la probabilidad de supresion viral. EnglishBackground: In Mexico, the quality of health care for human immunodeficiency virus (HIV) patients is unknown. The study objectives were to develop quality of care (QoC) indicators for outpatient care of HIV patients, evaluate the quality of the processes of care (QPC) and outcomes, and analyze the association between the QPC and viral suppression among HIV patients. Methods: The study used a mixed-methods approach: (1) Development of QoC indicators through RAND/UCLA method; (2) cross-sectional study of QoC evaluation; and (3) multiple Poisson regressions to measure the association between the QPC and viral suppression. The study included 439 HIV patients, ≥ 19 years of age, with at least one outpatient consultation during 2017 at a public hospital in the State of Mexico. Results: We developed 21 QoC indicators to evaluate HIV care. Based on these in- dicators, the QoC gaps that emerged were related to clinical history (24% of patient records included sexual history information), routine adherence assessment (no records demonstrated regular recording of antiretroviral treatment adherence), and screen- ing and referral (50% were screened for depression, and 42% for tuberculosis; 1.2% of patients with abnormal body mass index were referred to a dietitian). On average, HIV patients received 63% of recommended QPC; 77.7% achieved viral suppression. Receiving over 75% of recommended QPC was associated with a higher probability of viral suppression (adjusted prevalence ratio 1.13, 95% confidence interval 1.03-1.24). Conclusions: Evaluation of the QoC for HIV patients is essential to identify and address gaps in health-care quality to increase the probability of viral suppression. (REV INVEST CLIN. 2019;71:330-8)

Background To estimate the incremental cost-effectiveness ratio (ICER) of the use of continuous subcutaneous insulin infusion (CSII) therapy versus multiple daily injections (MDI) therapy in adult patients with type 1 diabetes (T1D) at the Mexican Institute of Social Security (IMSS). Methods An analysis was developed using the internationally validated Core Diabetes Model (CDM) with which the incidence and progression of acute and chronic complications and the mortality of T1D was simulated throughout life. The baseline characteristics of the simulated cohorts were obtained from Mexican T1D adult patients aged ≥ 18 years that received care at two national IMSS medical centres in 2016. In the base case, the costs of the complications and treatment of the disease with both therapies were estimated in Mexican currency from the perspective of the institution, using Diagnosis Related Groups for outpatient and inpatient care. Utilities were taken from the international bibliography. In a secondary analysis, indirect costs were included using a human capital approach. The model used a lifetime time horizon, and a discount rate of 5% was applied for health outcomes and costs. A one-way sensitivity analysis was conducted on key variables and patient sub-groups; uncertainty was evaluated using a Cost-Effectiveness Acceptability Curve. Results The average age of the cohort was 32 years, with diabetes duration of 19 years, an average HbA1c of 9.2%; 29% were men. A gain of 0.614 Quality Adjusted Life Years (QALYs) was estimated with the use of CSII therapy. The estimated ICER was MXN$478,020 per QALY in the base case, and MXN$369,593 when indirect costs were considered. The sensitivity analysis showed that, in adult patients with HbA1c > 9.0%, the ICER was MXN$262,237. Conclusions This is the first economic evaluation study that compares CSII therapy versus MDI therapy for T1D adult patients in Mexico. The insulin pump therapy can be considered cost-effective in the context of the IMSS when considering a threshold of three GDPs per capita with 43.9% probability. Results improve substantially when patients have an HbA1c above 9%.

This study evaluates the health literacy of people with type 2 diabetes and its association with health outcomes. We conducted a cross-sectional survey in two family medicine clinics of the Mexican Institute of Social Security that included 778 diabetic patients19 years of age. The Spanish version of the European Health Literacy questionnaire served to measure health literacy. Multiple logistic regressions were performed to determine the association between the independent variable (health literacy) and dependent variables (good self-rated health, glycemic control, and diabetes-related hospitalizations) after controlling for conceptually relevant patient's characteristics. Only 17.6% of patients had adequate health literacy; while, the remaining percentage showed inadequate (23%), or problematic (59.4%) health literacy. After adjusting for the patients' characteristics, those with adequate health literacy had 4.66 (95%CI: 2.26-9.61) times the odds of good self-rated health compared to those with inadequate literacy. Patients with adequate health literacy had 0.65 (95%CI: 0.49-0.86) times the odds of hospitalization due to diabetes compared to those with inadequate literacy. Compared to inadequate health literacy, problematic literacy was associated with increased odds of glycemic control. In conclusion, healthcare providers should actively address the health literacy needs of patients to increase good self-rated health, glucose control and reduce hospitalizations.

Beginning in 2001 Mexico established Seguro Popular, a health insurance scheme aimed at providing coverage to its large population of uninsured people. While recent studies have evaluated the health benefits of Seguro Popular, evidence on perinatal health outcomes is lacking. We conducted a population-based study using Mexican birth certificate data for 2010 to assess the relationship between enrollment in Seguro Popular and preterm delivery among first-time mothers with singleton births in Mexico. Seguro Popular enrollees with no formal education had a far greater reduction in risk of preterm delivery, while enrollees with any formal education experienced only slight reduction in risk, after maternal age, marital status, education level, mode of delivery, and trimester in which prenatal care was initiated were controlled for. Seguro Popular appears to facilitate access to health services among mothers with low levels of education, reducing their risk for preterm delivery. Providing broad-scale health insurance coverage may help improve perinatal health outcomes in this vulnerable population.

This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated. We used thematic content and descriptive analyses to analyse the data. We found that QoC foundations, evaluation and improvement activities pose essential challenges for the Mexican health sector. Governance for QoC is weakly aligned across MoH, IMSS and ISSSTE. Each institution follows its own agenda of evaluation and improvement programmes and has distinct QoC indicators and information systems. The institutions share similar barriers to strengthening QoC: poor organizational structure at a facility level, scarcity of financial resources, lack of training in QoC for executive/managerial staff and health professionals and limited public participation. In conclusion, a stronger legal framework and policy dialogue is needed to foster governance by the MoH, to define and align health sector-wide QoC policies, and to set common goals and articulate QoC improvement actions among institutions. Robust QoC organizational structure with designated staff and clarity on their responsibilities should be established at all levels of healthcare. Investment is necessary to fund formal and in-service QoC training programmes for health professionals and to reinforce quality evaluation and improvement activities and quality information systems. QoC evaluation results should be available to healthcare providers and the population. Active public participation in the design and implementation of improvement initiatives should be strengthened.

To analyze the coverage of lung cancer in Mexico and offer recommendations in this regard.By means of the conformation of a multidisciplinary group, we analyze the burden of the disease relative to the lung cancer and the access to the medical treatment offered by the different public health subsystems in Mexico.Important inequalities in lung cancer care are documented among the different public health subsystems. Our data suggest differential access and coverage to both traditional treatments and existing therapeutic innovations and differences in the capacity of health service providers to guarantee the right to health protection without distinction.Recommendations are made on the need to improve actions for tobacco control, early diagnosis for lung cancer and inclusion of innovative therapies and homologation among different public health service providers through financing via tobacco taxes.Analizar la cobertura en salud de cáncer pulmonar en México y ofrecer recomendaciones al respecto.Mediante la conformación de un grupo multidisciplinario se analizó la carga de la enfermedad relativa al cáncer de pulmón y el acceso al tratamiento médico que ofrecen los diferentes subsistemas de salud en México.Se documentan desigualdades importantes en la atención del cáncer de pulmón entre los distintos subsistemas de salud que sugieren acceso y cobertura en salud variable, tanto a los tratamientos tradicionales como a las innovaciones terapéuticas existentes, y diferencias en la capacidad de los prestadores de servicios de salud para garantizar el derecho a la protección de la salud sin distinciones.Se hacen recomendaciones sobre la necesidad de mejorar las acciones para el control del tabaco, el diagnóstico temprano y la inclusión de terapias innovadoras y la homologación entre los diferentes prestadores públicos de servicios de salud a través del financiamiento con la recaudación de impuestos al tabaco.

En la region de America Latina y Caribe (ALC), la mayoria de los paises buscan reformar sus sistemas de salud para lograr la cobertura universal y mejorar la eficiencia de sus gastos sanitarios, al tiempo que cumplen con las expectativas cada vez mayores de los ciudadanos acerca de la calidad de la atencion. El papel de la atencion primaria de salud (APS) destaca como clave para lograr esos objetivos de forma integrada. Por ello, el Banco Interamericano de Desarrollo llevo a cabo, entre 2012 y 2014, la Encuesta sobre Acceso, Experiencia y Coordinacion de la Atencion Primaria de Salud en America Latina y el Caribe, en poblaciones adultas de Colombia, Mexico, Brasil, El Salvador, Panama y Jamaica, buscando contribuir al diseno de politicas publicas de salud, y considerando especialmente el punto de vista de los pacientes. Los dos primeros capitulos del presente libro presentan el contexto y desafios de los sistemas de salud de la region y describen el marco conceptual y la metodologia del estudio. Los capitulos tres al ocho tratan, por separado, de cada uno de los seis paises estudiados, con resultados sobre las experiencias de los pacientes con la atencion primaria de salud y su integracion con los demas niveles de atencion. El capitulo nueve cierra el libro con un analisis comparativo entre los seis paises de ALC y extiende la comparacion a 11 paises de altos ingresos de la OCDE, donde se evidencian las brechas persistentes en los indicadores de acceso, experiencia y coordinacion en la APS entre los paises de ALC y los de la OCDE. Un analisis multivariado con los 17 paises demuestra que los principales atributos observados de la APS estan directamente vinculados a las percepciones de los pacientes acerca de la necesidad de cambios fundamentales en los sistemas de salud y de la calidad de los servicios utilizados.

Background: In December 2006, Seguro Popular (SP) implemented the Medical Insurance Century XXI program (SMSXXI) to provide public healthcare insurance to children under five years old who lack social security. SMSXXI aims to increase access to health services, reduce out-of-pocket health-related expenditures (OOPHE), and lower health inequities. Methods: We assessed the effects of SMSXXI on health outcomes and financial protection for Mexico's children using multiple nationally representative surveys and administrative data sources spanning the period between 2001 and 2016. The identification of effects relied on detailed hospital level affiliation data mapping the geographical expansion of the program's coverage across the country over time. The final outcomes were neonatal and infant mortality, self-reported morbidity (health status, flu, and diarrhea) and child's height. Intermediate outcomes were OOPHE, hospital discharges and quality of service provision. Effects controlled for fixed and time-variant confounders using double- and triple-difference estimation strategies. Where feasible, we also estimated effects using exogenous variation in program eligibility rules that limited enrollment in SMSXXI to children born after December 1, 2006. Findings: SMSXXI reduced the infant mortality rates of conditions covered by the program by 5.3%. The effects were largest in high baseline mortality areas. Long-run health effects, eight years after the onset of SMSXXI, were reflected in a 0.44 cm average increase in height for birth cohorts exposed to the program, and an average effect on height of almost 1cm for low-income populations. Approximately three to six years after the program started, children reported having better health status and lower incidence of the flu and diarrhea. The program led to a 10% reduction in OOPHE, primarily from hospital-related expenses. No effects were detected on hospital discharges, suggesting that the program may not have increased utilization. Rather, improvements in the quality of healthcare and specialized personnel are likely channels driving improvements in health outcomes. Interpretation: SMSXXI covers uninsured, primarily low-income populations who may be most at risk from the financial and health consequences of costly medical interventions. The program transfers resources from the federal level to states and providers for the enrollment and treatment of children under five years old. Transfers are conditioned on the compliance of medical facilities with accreditation standards (criteria of capacity, quality and safety for the patient). Funds are used to strengthen local health services through the purchase of equipment and staffing of medical specialists. We use previously unexploited sources of exogenous variation in program assignment to identify causal effects on health and financial risk. Results suggest that SMSXXI reduced infant mortality, improved long-run health as proxied by self-reported morbidity and child height, and protected low-income families from the adverse economic consequences of health shocks. Funding: Funding for this study was provided through Inter-American Development Bank (IDB) Technical Cooperation ME-T1307. Declaration of Interest: Dr. Celhay has nothing to disclose. Dr. Martinez has nothing to disclose. Mr. Munoz has nothing to disclose. Mrs. Perez has nothing to disclose. Dr. Perez Cuevas has nothing to disclose. Ethical Approval: The study consists in a secondary data analysis of several databases; all these databases have the de-identified data; thus, it is not possible to trace any of the data to the actual individual. In accordance to the Internal Regulation of the Interamerican Development Bank, this secondary data analysis can be considered exempt of institutional review board approval.

As a relatively new area in health sciences, health systems research (HSR) is an interdisciplinary field that seeks to understand and improve how societies organize themselves for achieving health goals, and how health systems respond and adapt to health policies. HSR focusses on generating and transferring new knowledge that enables health programs, interventions and services, to respond effectively to health population needs. For aging population, health needs should consider a broader spectrum that comprises social determinants of health, and coordination among public sectors such a social networks, pensions, housing, and social services, among others, for improving their wellbeing. From this perspective, contribution of HSR to achieve suitable health systems and health services for the aging is particularly relevant. This chapter provides a general description of study designs and methods in HSR; it is intended to be descriptive and able to give an appropriate springboard for those who plan to conduct a type of research that has multiple and different layers, for contributing with scientific evidence in improving health in old people.

Background: Upper respiratory infections are the principal cause of morbidity in children

The purpose of this study is to validate the Mexican version of the Short-Form Supportive Care Needs survey (SCNS-SFM). A cross-sectional survey was conducted from June to December 2013 at the Oncology Hospital of the Mexican Institute of Social Security in Mexico City. The study included 825 subsequent cancer patients >20 years of age with all forms of solid cancer. Patients had prior surgical removal of histologically confirmed cancer and attended outpatient consultations. Validation of SCNS-SFM included the following: (1) content validity through a group of experts; (2) construct validity through an exploratory factor analysis based on the polychoric correlation matrix; (3) internal consistency using Cronbach’s alpha; (4) convergent validity between SCNS-SFM and quality of life, anxiety, and depression scales by calculating Pearson’s correlation coefficient; (5) discriminative validity through analysis of MANOVAs; and (6) test–retest reliability using intraclass correlation coefficient calculations. SCNS-SFM has 33 items with five factors accounting for 59 % of total variance. Cronbach’s alpha values ranged from 0.78 to 0.90 among factors. SCNS-SFM has good convergent validity compared with quality of life and depression and anxiety scales and good discriminative validity, revealing great information, psychological support, and physical daily living needs for women, patients

Objectives To develop quality of care (QoC) indicators, evaluate the quality of the processes of care (QPC) and clinical outcomes, and analyze the association between the QPC and severe clinical outcomes of preterm newborns admitted to neonatal intensive care units (NICUs). Design Mixed methods approach: (1) development of QoC indicators via modified RAND/UCLA method; (2) cross-sectional study of QoC evaluation and (3) multiple logistic regression analysis to ascertain the association between the QPC and severe clinical outcomes. Setting Two NICUs belonged to the Mexican Institute of Social Security in Mexico City. Participants About 489 preterm neonates (

Background Patients with cancer have supportive care needs. Studies that analyze the relationship between supportive care needs and health-related quality of life (HRQoL) are scarce. Cultural differences in supportive care needs and perceived QoL are also worth analyzing. Objective The aim of this study was to assess the association between supportive care needs and HRQoL of Mexican adults given a diagnosis of solid cancers. Methods We performed a secondary data analysis of a cross-sectional survey of 825 adult patients with cancer treated at the Oncology Hospital of the Mexican Institute of Social Security. The QLQ-30 from the European Organization for Research and Treatment of Cancer served to measure HRQoL, and the Supportive Care Needs Questionnaire was used to ascertain the needs. The analysis included multiple linear regression models for each HRQoL domain controlled for demographic, clinical, and social support covariates. Results There was an association between psychological needs with low scores in the HRQoL domains of global health, emotional functioning, and increased fatigue. Physical and daily living needs were associated with most HRQoL domains except the emotional domain. Patient care needs were related to low scores in the emotional and social functioning domains. Health systems and information needs were associated with low scores on cognitive functioning. Conclusions Physical, psychological, patient care, and informational needs were associated with decreased HRQoL of Mexican patients with cancer. Implications for practice Healthcare providers, including nurses, are encouraged to perform routine, comprehensive evaluations of the supportive care needs and HRQoL of patients with solid cancers to respond in a timely manner to their needs.

Mexico has the second-highest prevalence of cesarean deliveries in the Americas, behind Brazil. Having had a previous cesarean delivery is highly predictive of having subsequent cesarean deliveries, yet evidence on the drivers of primary (that is, first-time) cesarean deliveries is sparse. Using 2014 Mexican birth certificate data and performing population-level analyses of data on 600,124 first-time mothers giving birth after at least thirty-seven weeks of gestation, we examined the prevalence and determinants of primary cesarean deliveries. We found a very high prevalence of cesarean deliveries among these women-48.7 percent-and wide variations across insurance coverage types. Enrollees in Seguro Popular, the public health insurance program introduced in 2003 for the previously uninsured and gradually rolled out nationally, had a cesarean rate of 40 percent, while women insured through the Social Security Institute for Civil Servants had a rate of 78 percent. The lower risk of primary cesarean deliveries among Seguro Popular enrollees persisted after adjustment for covariates. Rates of primary cesarean deliveries were particularly high in private birthing facilities for all first-time mothers. Reducing the rate of cesarean deliveries in Mexico will require interventions across types of insurance and birthing facilities and will also require targeted public health messaging.

ResumenIntroducciónLa evaluación de la calidad de la atención del recién nacido con complicaciones es un elemento indispensable para las estrategias de mejora orientadas a reducir las tasas de mortalidad neonatal. El objetivo de este trabajo fue evaluar la calidad de atención técnica e interpersonal en el manejo de la taquipnea transitoria del recién nacido (TTRN) de pacientes afiliados al Seguro Médico Siglo XXI.MétodosSe realizó un estudio transversal en 61 hospitales de la Secretaría de Salud, que durante el primer semestre de 2011 reportaron al menos dos casos de TTRN. Se analizaron diferentes variables con respecto a la madre, el embarazo, el nacimiento y las complicaciones neonatales, así como intervenciones realizadas al recién nacido y condiciones de salud al egreso. Para medir la calidad de atención, se definieron y validaron indicadores de calidad en los ámbitos de la prevención, diagnóstico y tratamiento.ResultadosSe analizaron 256 expedientes de casos con diagnóstico de TTRN. El 8.9% de las madres tenía alguno de los factores de riesgo (asma, diabetes) y el 53.5% presentó complicaciones en el embarazo. El 60% de los casos de TTRN nacieron por cesárea; un tercio tuvieron bajo peso al nacimiento y el 14% fueron trasladados a otro hospital. En cuanto a los indicadores de calidad, en el rubro de prevención se identificó que en más del 90% se registraron los factores de riesgo (tabaquismo, asma, parto por cesárea); los de diagnóstico reflejaron que en el 86-98% se buscaron manifestaciones de insuficiencia respiratoria. Los de tratamiento lograron cifras satisfactorias para las medidas de monitorización y soporte.ConclusionesLos resultados permiten considerar que la mayoría de los casos con TTRN recibieron un tratamiento apropiado. Es recomendable desarrollar estrategias efectivas, como reducir la creciente tasa de partos por cesárea, para prevenir la TTRN.AbstractBackgroundEvaluation of the quality of care of the newborn with complications is an indispensable element for the improvement of strategies directed to reduce newborn mortality rates. The aim of this work was to evaluate the quality of technical and interpersonal care in the management of transient tachypnea of the newborn (TTN) of patients affiliated with the program “Medical Insurance Siglo XXI”.MethodsA cross-sectional study was conducted in 61 hospitals affiliated with the Health Ministry with at least two cases of TTN during the first semester of 2011. Variables such as mother's health, pregnancy, birth and birth complication characteristics were analyzed. Also, newborn interventions and health conditions upon discharge were included. To measure the quality of care according to prevention, diagnosis and treatment, quality indicators were defined and validated.ResultsWe analyzed 256 case files with a diagnosis of TTN; 8.9% of the mothers presented risk factors (asthma, diabetes) and 53.5% had complications during pregnancy. There were 60% of cases with TTN born by cesarean delivery; one third of these children had low birth weight and 14% were transferred to another hospital. As for the quality indicators in the area of prevention, more than 90% of risk factors (smoking, asthma, cesarean delivery) were identified. Diagnostic indicators showed that 86-98% of respiratory distress symptoms were sought. Indicators of treatment achieved satisfactory figures for monitoring and support measures.ConclusionsPrevention, diagnosis and treatment indicators made it possible to consider that most TTN cases received appropriate treatment. It is advisable to develop effective strategies to prevent TTN, such as increasing efforts to reduce the increasing rates of cesarean deliveries.

The objective of the study was to design and evaluate a pilot programme aimed at promoting the active ageing of older adults at the Mexican Institute of Social Security. The study was conducted in three stages: (a) design; (b) implementation; and (c) before–after evaluation through analysis of changes in functional status, occupational functioning and health-related quality of life. To overcome the limitations of the study design, we evaluated the effect of 80 per cent adherence to the programme on the outcome variables using the generalised linear regression models (GLM). Two hundred and thirty-nine older adults agreed to participate, of whom 65 per cent completed the programme. Most were women; the average age was 77 years. Adherence to the programme was higher than 75 per cent for the group who completed active ageing services and less than 60 per cent for the drop-out group. Overall, 46 per cent of older adults reached an adherence level of 80 per cent or higher. Adherence was significantly associated with improved quality of life total score (coefficient 2.7,pp

Objetivo. Analizar la cobertura en salud de cáncer pul­monar en México y ofrecer recomendaciones al respecto. Material y métodos. Mediante la conformación de un grupo multidisciplinario se analizó la carga de la enfermedad relativa al cáncer de pulmón y el acceso al tratamiento médico que ofrecen los diferentes subsistemas de salud en México. Resultados. Se documentan desigualdades importantes en la atención del cáncer de pulmón entre los distintos subsistemas de salud que sugieren acceso y cobertura en salud variable, tanto a los tratamientos tradicionales como a las innovaciones terapéuticas existentes, y diferencias en la capacidad de los prestadores de servicios de salud para garantizar el derecho a la protección de la salud sin distin­ciones. Conclusión. Se hacen recomendaciones sobre la necesidad de mejorar las acciones para el control del tabaco, el diagnóstico temprano y la inclusión de terapias innovadoras y la homologación entre los diferentes prestadores públicos de servicios de salud a través del financiamiento con la re­caudación de impuestos al tabaco

Objective. To assess the association between quality of care and health-related quality of life among type 2 diabetes patients. Design. A cross-sectional study assessing the association between quality of care and quality of life using multiple linear regression analysis. Setting. Family medicine clinics (FMC) (n= 39) of the Mexican Institute of Social Security (IMSS) in Mexico City. Participants. Type 2 diabetes patients (n= 312), older than 19 years. Main Outcome Measure(s). Health-related quality of life was measured using the MOS Short-Form-12 (SF-12); quality of healthcare was measured as the percentage of recommended care received under each of four domains: early detection of diabetes complications, non-pharmacological treatment, pharmacological treatment and health outcomes. Results. The average quality of life score was 41.4 points on the physical component and 47.9 points on the mental component. Assessment of the quality of care revealed deficiencies. The average percentages of recommended care received were 21.9 for health outcomes and 56.6 for early detection of diabetes complications and pharmacological treatment; for every 10 percent additional points on the pharmacological treatment component, quality of life improved by 0.4 points on the physical component (coefficient 0.04, 95% confidence intervals 0.01–0.07). Conclusions. There was a positive association between the quality of pharmacological care and the physical component of quality of life. The quality of healthcare for type 2 diabetes patients in FMC of the IMSS in Mexico City is not optimal.

OBJETIVO Analizar el efecto de un programa piloto de tele-asistencia y tele-alarma en la autopercepción del estado de salud de los adultos mayores y conocer la satisfacción y aceptación del programa. METODOS Estudio transversal que incluyó entrevistas a 378 adultos mayores, 294 cuidadores/familiares y 53 profesionales de la salud, realizado en la Ciudad de México en 2010. Variables sociodemográficas, de autopercepción del estado de salud, satisfacción y aceptación del programa se obtuvieron por medio de cuestionario estandarizado. Se realizó análisis descriptivo y se utilizaron pruebas no paramétricas. RESULTADOS Se observaron efectos significativos en la autopercepción del estado de salud, 6,17 (DE 17,9 p < 0,05) puntos por encima de la media. El programa tuvo una buena aceptación por parte de los adultos mayores, de sus cuidadores familiares y de los profesionales de la salud. CONCLUSIONES El programa contribuye a mantener o mejorar la calidad de vida, permite la atención preventiva y es un medio ideal para dar apoyo psicosocial a los adultos mayores.

Research on factors associated with poor adherence to self-care focuses primarily on psychiatric emotional disorders such as depression and anxiety, whereas non-psychiatric chronic-disease-related emotional distress has received little attention in hypertensive patients. The objective of this study was to evaluate the association of hypertension-related distress with the lack of self-care including low adherence to pharmacological treatment, lack of regular physical activity, low intake of fruits and vegetables and frequent intake of high-salt foods. A cross-sectional survey was conducted in 2014 in two family medical units affiliated with the Mexican Institute of Social Security. The study included 487 hypertensive patients >19 years of age. The conceptual framework for the study was based on the Health Promotion Model. The analysis included multiple Poisson regression models. We found that 21.1% of participants had hypertension-related distress. Low adherence to pharmacological treatment was identified in 45.8% of patients, whereas 46.8% lacked regular physical activity, 30.8% reported a low consumption of fruits and vegetables, and 54.6% frequently consumed foods high in salt content. Hypertension-related distress was associated with lack of regular physical activity and low intake of fruits and vegetables. These findings highlight the importance of addressing distress in order to improve self-care of hypertensive patients.

Background To analyze the factors associated with regular physical exercise and routine consumption of fruits and vegetables, and both healthy behaviors among Mexican older adults. Methods We conducted a secondary data analysis of the baseline data (2014) of the Study on Obesity, Sarcopenia and Fragility in older adults affiliated with the Mexican Institute of Social Security. The study included 948 adults who were ≥60 years of age. Multiple Poisson regression was performed. Results Routine consumption of fruits and vegetables was reported by 53.8 % of older adults, 42.7 % reported engaging in regular physical exercise and 23.1 % reported participating in both types of healthy behaviors. Women, adults with a stable income, those with a self-perception of good health and those with a history of physical exercise at the age of 50 years had an increased likelihood of engaging in healthy eating and regular physical activity. Conclusions Many older adults do not routinely consume fruits and vegetables or engage in regular physical exercise despite the fact that most have a fixed income and a social network. It is relevant to conduct research-based interventions that take into account the contextual factors to promote healthy behaviors.

To evaluate an integrative health-care model (IHCM) with an empowerment approach for self-care in terms of improving health-related quality of life (HR-QoL) and lifestyle.We conducted a field trial with one intervention (IHCM) and one comparison group receiving usual care (UC), with ex ante and ex post measurements. The IHCM was provided for 3 months to each woman in the first group, with follow-up of both groups at 3 and 6 months. The differences in differences estimator was used to assess the effect of intervention, adjusting for clinically important covariates in the framework of a generalized linear regression model.A total of 380 women (IHCM 190 and UC 190) participated in the study. The differences in differences estimator between IHCM and UC for aerobic physical activity was 81 and 87 min/week at 3 and 6 months, respectively; for consumption of dairy products, fruit and vegetables the estimator was 4.8, 6.6 and 9.4 servings per week respectively at 3 months, and 3.9, 6.3 and 9.7 servings at 6 months. The effect of IHCM on HR-QoL at 3 months was greater for the domains of vasomotor, somatic symptoms and sleep problems (11.7, 10.0 and 13.2 points, respectively); at 6 months the differences of major positive change were observed in the domains of memory/concentration, vasomotor symptoms and sleep problems (12.2, 10.4 and 10.8 points, respectively).The results support the importance of patient-centered health care during the climacteric stage, within integrative care programs with an empowerment approach.

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. Pediatr Blood Cancer 2013;60:196– 203. 2012 Wiley Periodicals, Inc.

Background and objectives In Mexico, hypertension is among the top five causes for visits to primary care clinics; its complications are among the main causes of emergency and hospital care. The present study reports the effectiveness of a continuing medical education (CME) intervention to improve appropriate care for hypertension, on blood pressure control of hypertensive patients in primary care clinics. Methods A secondary data analysis was carried out using data of hypertensive patients treated by family doctors who participated in the CME intervention. The evaluation was designed as a pre-/post-intervention study with control group in six primary care clinics. The effect of the CME intervention was analysed using multiple logistic regression modelling in which the dependent variable was uncontrolled blood pressure in the post-intervention patient measurement. Results After the CME intervention, the net reduction of uncontrolled blood pressure between stages in the intervention group was 10.3%. The model results were that being treated by a family doctor who participated in the CME intervention reduced by 53% the probability of lack of control of blood pressure; receiving dietary recommendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood pressure at the baseline stage increased the probability of lack of control in 166%, and per each unit of increase in body mass index the lack of control increased 7%. Conclusions CME intervention improved the medical decision-making process to manage hypertension, thus increasing the probability of hypertensive patients to have blood pressure under control.

Objectives To develop and test two educational programmes (interactive and passive) aimed at improving family doctors' (FD) prescribing practices and patient's knowledge and use of non-opioid analgesics (NOA). Methods The educational programmes were conducted in two family medicine clinics by using a three-stage approach: baseline evaluation, design, and implementation of educational activities, and post-programme evaluation. An interactive educational programme (IEP) was compared with a passive educational programme (PEP); both were participated by FDs and patients. The IEP for FDs comprised of workshops, discussion groups, in-service training and guidelines, while for patients the IEP consisted of an interactive session with a video, leaflets and a discussion. The PEP consisted in delivering the guidelines to the FDs and the leaflets to patients. The effect of the programmes on the FDs was measured through the appropriateness of prescriptions and analysed using the differences-in-differences estimator (D-in-D), and on patients through changes in self-medication and in their knowledge about the proper use and adverse events by analysing the inter- and intra-group differences before and after the programmes. Results The IEP obtained better results to improve appropriate FDs prescription of NOA than PEP (D-in-D = 15%). Regarding the patients, the PEP group reached higher reduction of self-medication than the IEP group (13.4% vs. 9.1%); the knowledge of proper NOA use increased by 8.5% in both groups, whereas knowledge of NOA-related adverse events was better in the IEP (39.6%) than in the PEP group (9.2%). Conclusions The IEP was better to improve the doctors' abilities to prescribe NOAs, and both programmes improved patients' knowledge.

Background The ongoing influenza A (H1N1) pandemic stroked Mexico and posed a huge challenge to the medical care and public health systems. This report analyzes the clinical course and process of care of patients who died due to atypical pneumonia and fulfilled the clinical criteria of suspected case of novel influenza A (H1N1) virus infection. Methods We conducted a retrospective analysis of a series of 38 patients who died between April 7 and April 28, 2009 at Instituto Mexicano del Seguro Social (IMSS) hospitals due to severe pneumonia and respiratory distress. These cases coincided with the beginning of the outbreak, so patients did not undergo laboratory testing to diagnose influenza. According to IMSS and CDC criteria, post-hoc analysis allowed considering the presumptive diagnosis of S-OIV infection. A multidisciplinary group analyzed the information from the clinical charts, laboratory tests, radiographic studies and death certificates, using descriptive statistics. Results Most cases were middle-aged (mean 33 years, range: 4–62 years) and previously healthy; 18.4% had an underlying chronic disease, 23.7% were obese and 7.9% were current smokers. None had received the seasonal influenza vaccine; they had cough (92%), fever (86.8%), and malaise (73.7%). The median time from disease onset to hospital admission was 6 days (range 0–8 days). All were admitted to the intensive care unit with pneumonia and/or respiratory distress. Average time from disease onset to death was 8 days (range 4–18 days). Conclusions An increased number of severe cases of atypical pneumonia in previously healthy adults highlight the importance of the availability of a timely surveillance system able to identify sudden increases in the number of cases or presentation of apparently known diseases.