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Association between life-course socio-economic status and prevalence of cardio-metabolic risk ractors in five middle-income countries.

Ogunsina, Kemi; Dibaba, Daniel T; Akinyemiju, Tomi
| Idioma(s): Inglés
Background: The burden of non-communicable diseases has increased rapidly in low- and middle-income countries. Past studies have reported an association between socioeconomic status (SES) and cardio-metabolic risk factors, but most have focused on upper income countries. The purpose of this study is to examine the association between SES over the life-course and the burden of cardio-metabolic risk factors in middle-income countries. Methods: A total of 38 297 adults from China, Mexico, India, South Africa and Russia were included in this cross-sectional study. Life-course SES was defined based on maternal and participant education, and data on blood pressure, body mass index (BMI), self-reported diabetes and hypertension were obtained by trained interviewers. Descriptive, age standardized and multivariable adjusted analyses were conducted using survey weighted statistical procedures in SAS 9.4 (SAS Institute, Cary, NC, USA). Results: Although 14% of men and 12% of women had current hypertension based on blood pressure measurements, only 2% of men and 4% of women were aware of their hypertensive status. Men with stable high life-course SES had higher odds of being overweight/obese (odds ratio OR = 2.01, 95% confidence interval (CI) = 1.30-3.10), diabetic (OR = 4.82, 95% CI = 2.07-11.2) and hypertensive based on self-report (OR = 3.42, 95% CI = 1.85-6.32) compared to men of low life-course SES. Among women, the odds of being overweight/obese were significantly higher among women with high life-course SES (OR = 1.50, 95% CI = 1.08-2.08). Conclusions: Higher life-course SES for both men and women was associated with increased odds of overweight/ obesity, and additionally diabetes and hypertension for men in middle income countries.
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Pre-hospitalization, hospitalization, and post-hospitalization costs of patients with neurocysticercosis treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City, Mexico.

Bhattarai, Rachana; Carabin, Hélène; Flores-Rivera, Jose; Corona, Teresa; Proaño, Jefferson V; Flisser, Ana; Budke, Christine M
| Idioma(s): Inglés
The objective of this study was to estimate the direct costs associated with the diagnosis and treatment of neurocysticercosis (NCC) during pre-hospitalization, hospitalization, and post-hospitalization periods for 108 NCC patients treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City, Mexico. Information on clinical manifestations, diagnostic tests, hospitalizations, surgical procedures, prescription medication, and other treatments was collected via medical chart reviews. Uncertain values for costs and frequency of treatments were imputed using bootstrap techniques. The average per-patient pre-hospitalization and hospitalization costs were US$ 257 (95% CI: 185 - 329) and US$ 2,576 (95% CI: 2,244 - 2,908), respectively. Post-hospitalization costs tended to decrease over time, with estimates for the first five years post-hospitalization of US$ 475 (95% CI: 423 - 527), US$ 228 (95% CI: 167 - 288), US$ 157 (95% CI: 111 - 202), US$ 150 (95% CI: 106 - 204), and US$ 91 (95% CI: 27 - 154), respectively. NCC results in a significant economic burden for patients requiring hospitalization, with this burden continuing years post-hospitalization.
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Street dust from a heavily-populated and industrialized city: Evaluation of spatial distribution, origins, pollution, ecological risks and human health repercussions.

Urrutia-Goyes, R; Hernandez, N; Carrillo-Gamboa, O; Nigam, K D P; Ornelas-Soto, N
| Idioma(s): Inglés
Emissions from vehicles include particles from tire and brake wearing that can settle down and join industrial discharges into street dust. Metals present in street dust may create ecological and health threats and their analysis is of great environmental relevance. The city of Monterrey, Mexico is an industrial pillar of the country and shows an increasing fleet during the last years, which has yielded higher traffic and emissions. This study analyzes 44 street dust samples taken across the city for total element concentrations by using X-ray fluorescence. Associations and indicators are calculated to define possible origins, levels of pollution, natural or anthropogenic sources, and ecological and human health risks. High concentrations of As, Ba, Cu, Fe, Mo, Ni, Pb, Ti, and Zn were found. Main sources of metals were defined as: tire wearing for Zn and Fe; brake wearing for Ba, Cu, Fe, Pb and Zr; additional industrial sources for Mo, Ni, Pb, and Ti; and other natural sources for As. Ecological risk was found to be moderate across the city and risk due to Pb concentrations was established for children.
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Supply-side interventions to improve health: Findings from the Salud Mesoamérica Initiative.

Mokdad, Ali H; Palmisano, Erin B; Zúñiga-Brenes, Paola; Ríos-Zertuche, Diego; Johanns, Casey K; Schaefer, Alexandra; Desai, Sima S; Haakenstad, Annie; Gagnier, Marielle C; McNellan, Claire R; Colombara, Danny V; López Romero, Sonia; Castillo, Leolin; Salvatierra, Benito; Hernandez, Bernardo; Betancourt-Cravioto, Miguel; Mujica-Rosales, Ricardo; Regalia, Ferdinando; Tapia-Conyer, Roberto; Iriarte, Emma
| Idioma(s): Inglés
BACKGROUND: Results-based aid (RBA) is increasingly used to incentivize action in health. In Mesoamerica, the region consisting of southern Mexico and Central America, the RBA project known as the Salud Mesoamérica Initiative (SMI) was designed to target disparities in maternal and child health, focusing on the poorest 20% of the population across the region. METHODS AND FINDINGS: Data were first collected in 365 intervention health facilities to establish a baseline of indicators. For the first follow-up measure, 18 to 24 months later, 368 facilities were evaluated in these same areas. At both stages, we measured a near-identical set of supply-side performance indicators in line with country-specific priorities in maternal and child health. All countries showed progress in performance indicators, although with different levels. El Salvador, Honduras, Nicaragua, and Panama reached their 18-month targets, while the State of Chiapas in Mexico, Guatemala, and Belize did not. A second follow-up measurement in Chiapas and Guatemala showed continued progress, as they achieved previously missed targets nine to 12 months later, after implementing a performance improvement plan. CONCLUSIONS: Our findings show an initial success in the supply-side indicators of SMI. Our data suggest that the RBA approach can be a motivator to improve availability of drugs and services in poor areas. Moreover, our innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need.
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A cohort study of the effects of older adult care dependence upon household economic functioning, in Peru, Mexico and China.

Guerchet, Maëlenn M; Guerra, Mariella; Huang, Yueqin; Lloyd-Sherlock, Peter; Sosa, Ana Luisa; Uwakwe, Richard; Acosta, Isaac; Ezeah, Peter; Gallardo, Sara; Liu, Zhaorui; Mayston, Rosie; Montes de Oca, Veronica; Wang, Hong; Prince, Martin J
| Idioma(s): Inglés
BACKGROUND: While links between disability and poverty are well established, there have been few longitudinal studies to clarify direction of causality, particularly among older adults in low and middle income countries. We aimed to study the effect of care dependence among older adult residents on the economic functioning of their households, in catchment area survey sites in Peru, Mexico and China. METHODS: Households were classified from the evolution of the needs for care of older residents, over two previous community surveys, as 'incident care', 'chronic care' or 'no care', and followed up three years later to ascertain economic outcomes (household income, consumption, economic strain, satisfaction with economic circumstances, healthcare expenditure and residents giving up work or education to care). RESULTS: Household income did not differ between household groups. However, income from paid work (Pooled Count Ratio pCR 0.88, 95% CI 0.78-1.00) and government transfers (pCR 0.80, 95% CI 0.69-0.93) were lower in care households. Consumption was 12% lower in chronic care households (pCR 0.88, 95% CI 0.77-0.99). Household healthcare expenditure was higher (pCR 1.55, 95% CI 1.26-1.90), and catastrophic healthcare spending more common (pRR 1.64, 95% CI 1.64-2.22) in care households. CONCLUSIONS: While endogeneity cannot be confidently excluded as an explanation for the findings, this study indicates that older people's needs for care have a discernable impact on household economics, controlling for baseline indicators of long-term economic status. Although living, typically, in multigenerational family units, older people have not featured prominently in global health and development agendas. Population ageing will rapidly increase the number of households where older people live, and their societal significance. Building sustainable long-term care systems for the future will require some combination of improved income security in old age; incentivisation of informal care through compensation for direct and opportunity costs; and development of community care services to support, and, where necessary, supplement or substitute the central role of informal caregivers.
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Childhood obesity in Mexico: social determinants of health and other risk factors.

Avelar Rodriguez, David; Toro Monjaraz, Erick Manuel; Ignorosa Arellano, Karen Rubi; Ramirez Mayans, Jaime
| Idioma(s): Inglés
Approximately 50 million children and adolescents in Latin America are affected by the childhood obesity pandemic. We present the case of a 5-year-old Mexican girl with obesity and gastro-oesophageal reflux disease (GORD), in whom prenatal, lifestyle and environmental risk factors were identified. Here, we demonstrate how childhood obesity is rooted since pregnancy and the perinatal stage, and how the social determinants of health like unsafe outdoor conditions, lack of infrastructure to exercise and a suboptimal physical activity curriculum in government schools strongly influence the development and maintenance of childhood obesity and complicate management.
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Challenges on the epidemiological and economic burden of diabetes and hypertension in Mexico.

Arredondo, Armando; Orozco, Emanuel; Alcalde-Rabanal, Jaqueline; Navarro, Juan; Azar, Alejandra
| Idioma(s): Español; Inglés
OBJECTIVE To analyze the epidemiological and economic burden of the health services demand due to diabetes and hypertension in Mexico. METHODS Evaluation study based on a time series study that had as a universe of study the assured and uninsured population that demands health services from the three main institutions of the Health System in Mexico: The Health Department, the Mexican Institute of Social Security, and Institute of Services and Social Security for State Workers. The financing method was based on instrumentation and consensus techniques for medium case management. In order to estimate the epidemiological changes and financial requirements, a time series of observed cases for diabetes and hypertension 1994-2013 was integrated. Probabilistic models were developed based on the Box-Jenkins technique for the period of 2013-2018 with 95% confidence intervals and p < 0.05. RESULTS Comparing results from 2013 versus 2018, in the five regions, different incremental trends of 14%-17% in epidemiological changes and 58%-66% in the economic burden for both diseases were observed. CONCLUSIONS If the risk factors and the different models of care remained as they currently are in the three institutions analyzed, the financial consequences would be of greater impact for the Mexican Institute of Social Security, following in order of importance the Institute of Services and Social Security for State Workers and lastly the Health Department. The financial needs for both diseases will represent approximately 13%-15% of the total budget allocated to the uninsured population and 15%-17% for the population insured depending on the region.
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Risk perception and level of knowledge of diseases transmitted by Aedes aegypti.

Menchaca-Armenta, Imelda; Ocampo-Torres, Moisés; Hernández-Gómez, Arnulfo; Zamora-Cerritos, Karen
| Idioma(s): Inglés
Diseases caused by viruses such as dengue, chikungunya and zika are mosquito-borne diseases transmitted by Aedes aegypti. We performed a cross-sectional study of healthcare personnel and the general population using questionnaires to identify the level of knowledge, attitudes and practices, and risk perception for dengue, chikungunya and zika. A total of 248 questionnaires were applied, 63.3% to healthcare personnel and 36.7% to the general population. Of the healthcare personnel, 53% were men, and in the general population 74% were women. Nahuatl and Spanish were spoken by both, healthcare personnel (28%) and the general population (23%). The level of knowledge, attitudes and practices and risk perception of the population and personnel showed significant differences (p<0.05). Among healthcare personnel, nurses and vector operating staff had the lowest level of knowledge. On the other hand, the questions with the lowest scores were 1) symptoms of Zika in both groups, 2) circulating dengue serotypes in healthcare personnel and 3) symptoms of chikungunya in the general population. The results of this work allow us to identify information gaps in which knowledge, attitudes and practices, and risk perception need to be increased.
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Public insurance program impact on catastrophic health expenditure on acute myocardial infarction.

Martínez-García, M; Vargas-Barrón, J; Bañuelos-Téllez, F; González-Pacheco, H; Fresno, C; Hernández-Lemus, E; Martínez-Ríos, M A; Vallejo, M
| Idioma(s): Inglés
OBJECTIVE: ST-segment elevation myocardial infarction (STEMI) has an important economic burden that poised the urgent need to evaluate its catastrophic medical expense. This study evaluates the first 5 years of the national health initiative called Popular Insurance (PI) at the National Institute of Cardiology in Mexico. STUDY DESIGN: Retrospective data analysis. METHODS: STEMI patients with (n=317) and without (n=260) PI were selected. Analysed variables included socio-economical context, management care, cost evaluation and three outcomes (mortality, hospital readmission and therapeutic adherence). Descriptive statistical analyses, Kaplan-Meier survival and Support Vector Machine models were used accordingly. RESULTS: Treatment costs were higher for PI-covered individuals (P=0.022) and only 1.89% of them remained in debt, in contrast to 16.15% of those without PI. Statistically significant differences were found in relation to days in hospital wards (P<0.001), imaging studies (P<0.001) and surgical materials (P=0.04). Survival analysis (P=0.44) and therapeutic adherence (P=0.38) showed no differences. Hospital readmission was predicted with an 81.97% accuracy. The most important predictive variables included were stent type, number of days at the coronary care unit and hospital wards. CONCLUSIONS: The PI has proven to be a successful program where no differences were found in terms of health care and survival, whereas it provides timely financial support for families facing catastrophic health challenging events.
Resultados  1-10 de 2.988