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1.

The United States–Mexico border environmental public health: the challenges of working with two systems/ La salud pública ambiental en la frontera entre México y los Estados Unidos: los retos que plantea trabajar con dos sistemas/ A saúde pública ambiental na fronteira entre o México e os Estados Unidos: os desafios de trabalhar com dois sistemas

Carrillo, Genny; Uribe, Felipe; Lucio, Rose; Ramirez Lopez, Alberto; Korc, Marcelo
| Idioma(s): Inglés
This report shares the challenges and opportunities encountered by a binational project that examined the availability of environmental and public health information for the United States–Mexico border area. The researchers interviewed numerous national and binational agencies on both sides of the border, endeavoring to develop a framework to advance the knowledge of academic and public health professionals in the area of environmental border health. However, the lack of standardized indicators and metrics in both countries validates the emergent need to establish a viable framework for the collection, analysis, and dissemination of environmental information. Recommendations for next steps are included. En este informe se describen los retos y las oportunidades que ha detectado un proyecto binacional que examinó la disponibilidad de información sobre salud ambiental y salud pública en la zona fronteriza entre México y los Estados Unidos. Los investigadores entrevistaron a numerosos organismos nacionales y binacionales a ambos lados de la frontera, a fin de elaborar un marco para la difusión del conocimiento de los profesionales académicos y de la salud pública en el ámbito de la salud ambiental fronteriza. La falta de indicadores y métodos de medición normalizados en ambos países confirma la necesidad emergente de establecer un marco viable para la recopilación, el análisis y la difusión de información ambiental. Se incluyen recomendaciones para los próximos pasos. Este relatório apresenta os desafios e oportunidades encontrados por um projeto binacional que examinou a disponibilidade de informações ambientais e de saúde pública na região da fronteira entre o México e os Estados Unidos. Os pesquisadores entrevistaram diversas agências nacionais e binacionais em ambos os lados da fronteira, procurando desenvolver um sistema destinado a promover os conhecimentos de profissionais acadêmicos e de saúde pública na área da saúde ambiental em regiões de fronteira. No entanto, a falta de indicadores e métodos de medição padronizados entre os dois países destaca a necessidade emergente de estabelecer um sistema viável para a coleta, análise e difusão de informações ambientais. São feitas recomendações sobre as próximas medidas a serem tomadas.
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2.

Costes directos de atención médica del pie diabético en el segundo nivel de atención médica/ Direct costs in the management of diabetic foot

Montiel-Jarquín, Álvaro José; García Villaseñor, Arturo; Castillo Rodríguez, Carlos; Romero-Figueroa, María Socorro; Etchegaray-Morales, Ivet; García-Cano, Eugenio; Arévalo-Ramírez, Minou
| Idioma(s): Español
Introducción: Una de las complicaciones frecuentes de la diabetes mellitus es el pie diabético; su manejo oportuno define el futuro funcional del paciente y disminuye el gasto en la atención de estos pacientes. Objetivo: Analizar los costos directos en la atención de pacientes con pie diabético con base en la escala de Wagner. Material y métodos: Estudio transversal en pacientes con pie diabético en el que se analizaron los costes directos de la atención médica; se evaluaron días de hospitalización, estudios de laboratorio e imagen, debridaciones quirúrgicas, amputaciones menores y amputaciones mayores. En todo momento se conservó el anonimato de los participantes. Resultados: Se incluyeron 68 pacientes con pie diabético. De estos, 22 se eliminaron por tener expedientes clínicos incompletos, quedando finalmente 46 pacientes. Treinta y tres (72%) eran hombres, con una edad promedio de 59 años. Se observó incremento de los costos promedio/totales en forma ascendente desde el Wagner 1 al Wagner 5. Los costos directos más altos de hospitalización se atribuyeron a los costes día/cama y a las debridaciones quirúrgicas. Conclusiones: El incremento del coste de atención es directamente proporcional a la escala de Wagner. Este estudio constituye un punto de partida hacia la cuantificación de la carga económica del pie diabético en instituciones de seguridad social. La atención médica en estos pacientes es menor en el I nivel comparada con el II nivel de atención. El diagnóstico precoz disminuiría los costes de la atención de estos pacientes. Introduction: Diabetic foot is one of the common complications of diabetes mellitus, early management defines the functional future of the patient and reduces the cost in attention. Objective: To analyze the direct costs of patients diagnosed with diabetic foot based on Wagner Scale. Material and methods: Cross-sectional study, in patients with diabetic foot; direct costs of medical care were evaluated: days of hospitalization, laboratory and imaging tests, surgical debridations, minor and major amputations were evaluated. At all times the anonymity of the participants was preserved. Results: There were 68 patients with diabetic foot, of these 22 were removed for having incomplete medical records, being included 46 patients: 33(72%) men, mean age 59 years-old. Ascending increase in average and total costs was observed, from 1 to 5 Wagner Classification. Direct costs were higher in day hospitalization and debridations compared to others. Conclusions: This study is a starting point for the quantification of the economic burden of diabetic foot in Social Security Institutions. A guide based treatment for diabetic foot whould lower direct costs for these patients. Medical attention costs in these patients are less in I Level Medical Facility compared with II Level.
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3.

Educar para mejorar en la prevención de infecciones de vías urinarias en pacientes con sonda vesical instalada/ Educate to heal in the prevention of urinary tract infections in patients with bladder catheter installed

Ortiz-Luis Silvia Rubí
| Idioma(s): Español
Resumen Introducción: educar para mejorar en la prevención de infecciones relacionadas con la atención de la salud, asegura un progreso social por su trascendencia económica y un desafío para las instituciones de salud y para el personal responsable del cuidado. Objetivo: evaluar el efecto de una estrategia de capacitación para la mejora en el cumplimiento del indicador Prevención de infecciones de vías urinarias en pacientes con sonda vesical instalada. Metodología: estudio de intervención con 39 enfermeras, para la evaluación inicial y final del cumplimiento de criterios básicos se utilizó el formato No. 1 de recolección de datos (Fl-PIVUPSVI/05). Los datos se procesaron con SPSS V-17, se realizó análisis descriptivo e inferencial con t de Student, análisis de varianza y coeficiente de correlación de Pearson. Resultados: se logró un incremento de 21 puntos porcentuales (42 a 63%) en el cumplimiento posterior a la capacitación; el mayor incremento (de 31 a 77%) fue en criterio de registro de las medidas higiénicas del paciente. Conclusión: la estrategia de capacitación produjo cambios a favor del cumplimiento del indicador Prevención de infecciones urinarias en pacientes con sonda vesical instalada.(AU) Abstract Introduction: Educate to heal in the prevention of infections related to health care, ensures social progress for its economic importance and a challenge for health institutions and care personnel. Objective: To evaluate the effect of a training strategy to improve compliance with the indicator Prevention of urinary tract infections in patients with installed bladder catheter. Methods: Intervention study, with 39 nurses, for the initial and final evaluation of compliance with basic criteria, the data collection format No. 1 (Fl-PIVUPSVI /05) was used. Data were processed with SPSS V-17, descriptive and inferential analyzes were performed with Student's t-test, analysis of variance and Pearson's correlation coefficient. Results: An increase of 21 percentage points (42% to 63%) was achieved in post-training compliance; the largest increase of 46% (31%-77%) was in the criteria for recording the patient's hygienic measures. Conclusion: The training strategy produced changes in favor of compliance with the indicator Prevention of urinary tract infections in patients with installed bladder catheter.(AU)
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4.

Los determinantes sociales de la salud, el caso de enfermería/ The social determinants of health, the case of nursing

Salcedo-Álvarez, Rey Arturo; Zárate-Grajales, Rosa Amarilis; González-Caamaño, Blanca Consuelo; Rivas-Herrera, José Cruz
| Idioma(s): Español
Resumen En enfermería, sus teóricas disciplinares describen diferentes abordajes para el cuidado de las personas, recurriendo siempre al metaparadigma, obteniendo así una perspectiva teorizada del cuidado. En este sentido, los discursos que institucionalizan y sustentan su práctica tratan generalmente sobre apoyo, ayuda, autodeterminación, autonomía, confort, enseñanza del cuidado, humanismo, integralidad, limitación del daño, prevención de la enfermedad y/o promoción de la salud. No obstante, en la práctica diaria se demuestra que más que procurar acciones preventivas que tomen como punto de partida de intervención los determinantes sociales de salud para aportar un cuidado incluyente, transcultural y humanizado, la mayoría del quehacer cotidiano que se realiza se fundamenta en acciones que en el mejor de los casos son para la curación, o bien, para la contención de la enfermedad, es por ello que en la práctica diaria las acciones de prevención son minúsculas. Finalmente, la suficiencia de recursos humanos, materiales y financieros son el factor más importante para poder proveer cuidados seguros; la idoneidad o escasez de estos es el resultado conjunto de las políticas públicas prevalecientes, mismas que favorecen, o no, un sistema de salud justo e incluyente y son también las que mayormente impactan la realidad nacional en salud.(AU) Abstract In nursing, their disciplinary theorists describe different approaches to caring for people always using the metaparadigm, thus obtaining a theorized care perspective. In this sense the speeches that institutionalize and sustain their practice usually deal on support, help, self-determination, autonomy, comfort, care education, humanism, integrity, damage limitation, disease prevention and/or health promotion. However, in daily practice it is shown that rather than taking preventive actions that have as an intervention starting point social determinants of health to provide an inclusive, transcultural and humanized care, most of the daily work done is based on actions that in best-case scenario are for healing or for containing the disease, which is why in daily practice prevention actions are tiny. Finally, the adequacy of human, material and financial resources are the most important factor to provide safe care; the suitability or lack of these is the combined result of the prevailing public policies that favor or not a fair and inclusive health system and are also those that mostly impact the national health reality.(AU)
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5.

Asignación financiera en el Sistema de Protección Social en Salud de México: retos para la compra estratégica./ [Financial allocations in the System for Social Protection in Health in Mexico: challenges for strategic purchasing].

González-Block, Miguel Ángel; Figueroa, Alejandro; García-Téllez, Ignacio; Alarcón, José
| Idioma(s): Español
Objective:: The financial coordination of the System of Social Protection in Health (SPSS) was analyzed to assess its support to strategic purchasing. Materials and methods:: Official reports and surveys were analyzed. Results:: SPSS covers a capita of 2 765 Mexican pesos, equivalent to 0.9% of GDP. The Ministry of Health contributed 35% of the total, state governments 16.7% and beneficiaries 0.06%. The National Commission for Social Protection in Health received 48.3% of resources, allocating 38% to State Social Protection Schemes in Health and paying 7.4% of the total directly to providers.The state contribution is in deficit while family contributions tend not to be charged. Conclusion:: SPSS has not built funds specialized in strategic purchasing, capable of transforming historical budgets.The autonomy of providers is key to reduce out-of-pocket spending through the supply of quality services.
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6.

¿El aseguramiento público en salud mejora la atención en los servicios? El caso de la atención prenatal en adolescentes en México./ [Does public health insurance improve health care? The case of prenatal care for adolescents in Mexico].

Saavedra-Avendaño, Biani; Darney, Blair G; Reyes-Morales, Hortensia; Serván-Mori, Edson
| Idioma(s): Español
Objective:: To test the association between public health insurance and adequate prenatal care among female adolescents in Mexico. Materials and methods:: Cross-sectional study, using the National Health and Nutrition Survey 2000, 2006, and 2012.We included 3 978 (N=4 522 296) adolescent (12-19) women who reported a live birth.We used logistic regression models to test the association of insurance and adequate (timeliness, frequency and content) prenatal care. Results:: The multivariable predicted probability of timely and frequent prenatal care improved over time, from 0.60 (IC95%:0.56;0.64) in 2000 to 0.71 (IC95%:0.66;0.76) in 2012. In 2012, the probability of adequate prenatal care was 0.54 (IC95%:0.49;0.58); women with Social Security had higher probability than women with Seguro Popular and without health insurance. Conclusion:: Having Social Security is associated with receipt of adequate prenatal care among adolescents in Mexico.
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7.

Costo-efectividad de una alternativa para la prestación de servicios de atención primaria en salud para los beneficiarios del Seguro Popular de México./ [Cost-effectiveness analysis of an alternative for the provision of primary health care for beneficiaries of Seguro Popular in Mexico].

Figueroa-Lara, Alejandro; González-Block, Miguel A
| Idioma(s): Español
Objective:: To estimate the cost-effectiveness ratio of public and private health care providers funded by Seguro Popular. Materials and methods:: A pilot contracting primary care health care scheme in the state of Hidalgo, Mexico, was evaluated through a population survey to assess quality of care and detection decreased of vision. Costs were assessed from the payer perspective using institutional sources.The alternatives analyzed were a private provider with capitated and performance-based payment modalities, and a public provider funded through budget subsidies. Sensitivity analysis was performed using Monte Carlo simulations. Results:: The private provider is dominant in the quality and cost-effective detection of decreased vision. Conclusions:: Strategic purchasing of private providers of primary care has shown promising results as an alternative to improving quality of health services and reducing costs.
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8.

Exploring the Chronic Illness Experience of Rural-Dwelling Latinos of Mexican Origin.

Guzman, Anissa
| Idioma(s): Inglés
INTRODUCTION: Chronic illness is a complex and ever-growing phenomenon that is affecting millions of Americans every day, and it is disproportionately experienced by Latinos of Mexican origin. METHOD: In this quantitative study, the specific aims were to evaluate perceptions of chronic illness(es), locus of control (health and God), health status, and cultural orientation of rural-dwelling Latinos of Mexican origin in Colorado who have one or more chronic illnesses and to explore the relationships existing between these concepts. RESULTS: A sample of 102 varied from overall national statistics for this population in the United States by gender, mean annual income, and education completed. CONCLUSION: As Latinos of Mexican origin move toward becoming the largest minority population in the United States, it is important to improve the body of nursing science that targets this population.
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9.

Projected Impact of Mexico's Sugar-Sweetened Beverage Tax Policy on Diabetes and Cardiovascular Disease: A Modeling Study.

Sánchez-Romero, Luz Maria; Penko, Joanne; Coxson, Pamela G; Fernández, Alicia; Mason, Antoinette; Moran, Andrew E; Ávila-Burgos, Leticia; Odden, Michelle; Barquera, Simón; Bibbins-Domingo, Kirsten
| Idioma(s): Inglés
BACKGROUND: Rates of diabetes in Mexico are among the highest worldwide. In 2014, Mexico instituted a nationwide tax on sugar-sweetened beverages (SSBs) in order to reduce the high level of SSB consumption, a preventable cause of diabetes and cardiovascular disease (CVD). We used an established computer simulation model of CVD and country-specific data on demographics, epidemiology, SSB consumption, and short-term changes in consumption following the SSB tax in order to project potential long-range health and economic impacts of SSB taxation in Mexico. METHODS AND FINDINGS: We used the Cardiovascular Disease Policy Model-Mexico, a state transition model of Mexican adults aged 35-94 y, to project the potential future effects of reduced SSB intake on diabetes incidence, CVD events, direct diabetes healthcare costs, and mortality over 10 y. Model inputs included short-term changes in SSB consumption in response to taxation (price elasticity) and data from government and market research surveys and public healthcare institutions. Two main scenarios were modeled: a 10% reduction in SSB consumption (corresponding to the reduction observed after tax implementation) and a 20% reduction in SSB consumption (possible with increases in taxation levels and/or additional measures to curb consumption). Given uncertainty about the degree to which Mexicans will replace calories from SSBs with calories from other sources, we evaluated a range of values for calorie compensation. We projected that a 10% reduction in SSB consumption with 39% calorie compensation among Mexican adults would result in about 189,300 (95% uncertainty interval [UI] 155,400-218,100) fewer incident type 2 diabetes cases, 20,400 fewer incident strokes and myocardial infarctions, and 18,900 fewer deaths occurring from 2013 to 2022. This scenario predicts that the SSB tax could save Mexico 983 million international dollars (95% UI $769 million-$1,173 million). The largest relative and absolute reductions in diabetes and CVD events occurred in the youngest age group modeled (35-44 y). This study's strengths include the use of an established mathematical model of CVD and use of contemporary Mexican vital statistics, data from health surveys, healthcare costs, and SSB price elasticity estimates as well as probabilistic and deterministic sensitivity analyses to account for uncertainty. The limitations of the study include reliance on US-based studies for certain inputs where Mexico-specific data were lacking (specifically the associations between risk factors and CVD outcomes [from the Framingham Heart Study] and SSB calorie compensation assumptions), limited data on healthcare costs other than those related to diabetes, and lack of information on long-term SSB price elasticity that is specific to geographic and economic subgroups. CONCLUSIONS: Mexico's high diabetes prevalence represents a public health crisis. While the long-term impact of Mexico's SSB tax is not yet known, these projections, based on observed consumption reductions, suggest that Mexico's SSB tax may substantially decrease morbidity and mortality from diabetes and CVD while reducing healthcare costs.
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10.

Moving Beyond Salmon Bias: Mexican Return Migration and Health Selection.

Diaz, Christina J; Koning, Stephanie M; Martinez-Donate, Ana P
| Idioma(s): Inglés
Despite having lower levels of education and limited access to health care services, Mexican immigrants report better health outcomes than U.S.-born individuals. Research suggests that the Mexican health advantage may be partially attributable to selective return migration among less healthy migrants-often referred to as "salmon bias." Our study takes advantage of a rare opportunity to observe the health status of Mexican-origin males as they cross the Mexican border. To assess whether unhealthy migrants are disproportionately represented among those who return, we use data from two California-based studies: the California Health Interview Survey; and the Migrante Study, a survey that samples Mexican migrants entering and leaving the United States through Tijuana. We pool these data sources to look for evidence of health-related return migration. Results provide mixed support for salmon bias. Although migrants who report health limitations and frequent stress are more likely to return, we find little evidence that chronic conditions and self-reported health are associated with higher probabilities of return. Results also provide some indication that limited health care access increases the likelihood of return among the least healthy. This study provides new theoretical considerations of return migration and further elucidates the relationship between health and migration decisions.
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