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IntroductionType 2 diabetes (T2D) is a global epidemic, and nations are struggling to implement effective healthcare strategies to reduce the burden. While efficacy studies demonstrate that metformin can reduce incident T2D by half among younger, obese adults with prediabetes, its real-world effectiveness are understudied, and its use for T2D prevention in primary care is low. We describe the design of a pragmatic trial to evaluate the incremental effectiveness of metformin, as an adjunct to a simple lifestyle counseling.MethodsThe "Prevención de la Diabetes con Ejercicio, Nutrición y Tratamiento" [Diabetes Prevention with Exercise, Nutrition and Treatment; PRuDENTE, (Spanish acronym)] is a cluster-randomized trial in Mexico City's public primary healthcare system. The study randomly assigns 51 clinics to deliver one of two interventions for 36 months: 1) lifestyle only; 2) lifestyle plus metformin, to 3060 patients ages 30-65 with impaired fasting glucose and obesity. The primary endpoint is incident T2D (fasting glucose ≥126 mg/dL, or HbA1c ≥6.5%). We will also measure a range of implementation-related process outcomes at the clinic-, clinician- and patient-levels to inform interpretations of effectiveness and enable efforts to refine, adapt, adopt and disseminate the model. We will also estimate the cost-effectiveness of metformin as an adjunct to lifestyle counseling in Mexico.DiscussionFindings from this pragmatic trial will generate new translational knowledge in Mexico and beyond, both with respect to metformin's real-world effectiveness among an 'at-risk' population, and uncovering facilitators and barriers to the reach, adoption and implementation of metformin preventive therapy in public primary care settings.Trial registrationThis trial is registered at Clinicaltrials.gov (NCT03194009).

Objective. Estimate the risk of death from SARS-CoV-2 as a function of socio-territorial inequalities in Mexico City during February 2020-June 2022. Materials and methods. A retrospective analysis of death from SARS-CoV-2 by residential neighborhoods, in Mexico City. The Social Development Index (SDI [Consejo de Evaluación de la Ciudad de México, in Spanish]) classifies residential neighborhoods as very low, low, medium, high, and very high social development level, respectively. Results. Deaths in neighborhoods with Very Low and Low SDI represented almost half of the deaths due to SARS-CoV-2. The population residing in the territories with the worst socio-territorial conditions died, on average, 10 years younger than that of the stratum with the best SDI. Conclusions. Differences in the risk of dying from SARS-CoV-2 were associated with the socio-territorial conditions. The risk of death was higher for people residing in neighborhoods with very low and low SDI. These differences were reduced starting with the third wave, possibly because of mass vaccination in Mexico City. [ABSTRACT FROM AUTHOR]

The public health policy implemented by the current government synthesizes a radical transformation of Mexico's public health system. It was designed as a project of national magnitude with local nuances. For Mexico City in particular, it represents a continuous and permanent commitment to guaranteeing rights, freedoms and democracy, and at the same time, it represents challenges in various of its components such as financial and budgetary; organizational culture, as well as in specialized health fields such as medical care and collective care to mention a few. This article aims to point out the main aspects involved in the implementation of the new Health Model in the capital, taking into consideration four temporary moments, but of great impact: first, the incorporation of the Salud en tu Vida model in local law and its implementation, second, to confront the Covid-19 pandemic and with it, the reorganization of health services, third, to conclude the transfer of medical care services to a newly created organization called IMSS-BIENESTAR Health Services, and, fourth, strengthen the capacity and stewardship functions of the Ministry of Health of Mexico City. [ABSTRACT FROM AUTHOR]

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En los últimos 17 años, la política de salud en México ha transitado de una concepción de atención integral y de extensión gradual de coberturas como responsabilidad del Estado, a través de las instituciones públicas de salud, a una activa promoción gubernamental de la mercantilización de servicios, complementada con una política de beneficencia hacia la población pobre. En esta transformación se identifican tres periodos que se corresponden con los sexenios presidenciales y que expresan tres momentos distintos de la reforma del sector salud: el primero (1982-1988) caracterizado como transicional, el segundo (1988-1994), en donde emerge con claridad la estrategia bipolar de mercantilización y beneficencia y el tercero (1994-2000), en donde las estrategias gubernamentales se orientan a fortalecer los mercados de la salud. Esta reestructuración del sector salud ha sido instrumentada en forma explícita desde 1982 y forma parte del conjunto de reformas secundarias derivadas de la adecuación subordinada del campo social a las políticas de ajuste estructural y a los megaproyectos económicos y sociales impuestos por los organismos financieros internacionales.

Los problemas de salud pública han sido estudiados desde muy diversas perspectivas y utilizando diferentes modelos teóricos y metodológicos. Dos modelos que han sido frecuentemente utilizados son el modelo epidemiológico clásico y el modelo epidemiológico social. Estos modelos emplean distintos criterios conceptuales, metodológicos e ideológicos. Se objetivó hacer una contrastación entre estos modelos de acuerdo a los criterios mencionados, utilizando el estudio de la obesidad como ejemplo de la utilización de estos modelos. Esta contrastación muestra que el conocimiento generado por cada modelo es muy distinto. Se discuten posibles áreas de complementariedad entre ambos modelos y la utilización de las ciencias sociales como estrategia para ampliar nuestro conocimiento sobre problemas de salud pública, en especial el problema de la obesidad.

The article addresses maternal health as an integral right, linked to such an approach, a review of the concept of maternal health is made. The conditions of care during pregnancy, childbirth and puerperium in Mexico and its relation to the transgression of women's rights are also briefly reviewed. Finally, the document is based on and raises the need to integrate the perspective of human rights in the provision of maternal health services, in order to provide timely and appropriate care. [ABSTRACT FROM AUTHOR]

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In light of the labor conditions defined within the framework of neoliberalism implemented in Mexico, labor dynamics are problematized, the main problems of access to the health and social security system are identified and the systematic violation of rights - especially the right to work, to social security and to health - are discussed. The objective of this article is to contribute with proposals for the construction of a comprehensive, inclusive, healthcare and social security system that contributes to the improvement of the lives of workers.

This study addressed the shaping of Mexico's health system in recent years, with an analysis of the social determination conditioning the system's current formulation, the consequences for the population's living and working conditions, and the technical and legal reform measures that shaped the system's transformation. The article then analyzes the survival of social security institutions and the introduction of an individual insurance model and its current implications and consequences. From the perspective of the right to health, the article compares the measures, resources, and interventions in both health care models and highlights the relevance of the social security system for Popular Insurance. The article concludes that the measures implemented to reform the Mexican health system have failed to achieve the intended results; on the contrary, they have led to a reduction in interventions, rising costs, and a decrease in the installed capacity and professional personnel for the system's operation, thus falling far short of solving the problem, rather aggravating the inequities without solving the system's structural contradictions. Health systems face new challenges, inevitably requiring that the analyses be situated in a broader framework rather than merely focusing on the functional, administrative, and financial operation of the systems in the respective countries.

This study presents a critical approach on health sector reform in Mexico and its impact on access and equity in state health systems. We discuss the main strategies adopted and made an assessment of its contribution to achieving equity in health, using socioeconomic indicators of health services and interventions for two moments, 1990 y 2002. We conclude that the dynamics of deepening inequalities in the period and the transformation of state health systems do not contribute to the achievement of equity in access.

The aim of this study was to assess the association between different types of economic and social deprivation and infant mortality rates reported in 2008 in Mexico. We conducted an ecological study analyzing the correlation and relative risk between the human development index and levels of social and economic differences in State and national infant mortality rates. There was a strong correlation between higher human development and lower infant mortality. Low schooling and poor housing and crowding were associated with higher infant mortality. Although infant mortality has declined dramatically in Mexico over the last 28 years, the decrease has not been homogeneous, and there are persistent inequalities that determine mortality rates in relation to different poverty levels. Programs with a multidisciplinary approach are needed to decrease infant mortality rates through comprehensive individual and family development.

Objective: To assess the consequences of private outsourcing on the overall supply and filling of prescriptions in state health services., Material and Methods: The research was conducted using quantitative and qualitative techniques in 13 states. The information was collected through interviews and direct observation. The interviews were carried on staff of state health services related to the drug supply chain and users of health services. The quantitative approach examined the percentage of stocked full recipes in a sample of users., Results: States that have opted for the fully outsourced model, and properly monitored this choice, have increased the supply of drugs to their users and guaranteed the supply in the care units in charge. Other states with the outsourced model have multiple problems: direct purchase of drugs not included in the basic drugs catalogue, failure of suppliers and shortage of supplies in the laboratories that provide the company. The main disadvantages identified in all models were: the subordination of the medical criteria to administrative criteria, insufficient planning based on local care needs, heterogeneous procedures, insufficient knowledge of regulations and lack of normativity., Conclusion: The results indicate that the incorporation of private providers in the drug supply chain may not be the solution to bring down the shortage faced by health services, especially at the hospital level. The shift to outsourcing models has developed without incorporating evaluation mechanisms and the consequences that this transition can have on state health systems must be investigated more deeply.

This paper presents a discussion regarding Public Health's main challenges: knowledge of it, professional practice and training human resources. It begins by recognising Latin-America's unequal and polar socio-sanitary context and the sanitary field's myriad single referents, paying special attention to essential public health functions, the Millennium development goals and the Latin-American Association of Public Health Education. Emphasis is placed on three components: knowledge of public health (levels, domains, disciplines, temporality, dimensions and complexity), social practice (state-public, collective general practice and group professional practice) and human resources' training (professional, technical, training and up-dating). An essential challenge is then identified for each of these components and a set of proposals to be launched from the Latin-American Association of Public Health Education is outlined (interchange, partnerships and advocacy).