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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.

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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3.

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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4.

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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5.

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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6.

Análisis de la mortalidad por VIH/SIDA en México en el periodo 1990-2013: ¿se cumplirá la meta establecida en los Objetivos de Desarrollo del Milenio (ODM) para el año 2015?/ [Analysis of HIV/AIDS mortality in Mexico from 1990 to 2013: An assessment of the feasibility of millennium development goals by 2015].

Bravo-García, Enrique; Ortiz-Pérez, Hilda
| Idioma(s): Español
OBJECTIVE: We aimed to assess the feasibility of achieving the goal of Mexican AIDS mortality in the Millennium Development Goals, nationally and by state. METHODS: For the period 1990-2013, we estimated annual rates of decline/increase in AIDS mortality according to five-year interval, using published data from the Mexican Instituto Nacional de Estadística y Geografía and Consejo Nacional de Población. Subsequently, we analyzed the feasibility of achieving the Millennium Development Goals target by 2015 by estimating the year in which the country and each state could achieve them. RESULTS: We estimated that only 13/32 states (40%) would achieve the goal established for AIDS mortality by Millennium Development Goals. Mexico, as a country, and the remaining 19 states (60%) did not will attain it. It is important to emphasize that seven states, rather than decrease, had an upward trend in mortality in the last five years analyzed. CONCLUSIONS: The free and universal access to antiretroviral treatment against HIV/AIDS has failed to reduce mortality as expected in Mexico. It is urgent to improve access to HIV testing by using more aggressive strategies. Also, it is necessary to apply interventions to link and retain persons in care until they are virologically suppressed.
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7.

Cost of glaucoma treatment in a developing country over a 5-year period.

Lazcano-Gomez, Gabriel; Ramos-Cadena, María de Los Angeles; Torres-Tamayo, Margarita; Hernandez de Oteyza, Alejandra; Turati-Acosta, Mauricio; Jimenez-Román, Jesús
| Idioma(s): Inglés
The aim of the study was to disclose a realistic estimate of primary open-angle glaucoma treatment, follow-up costs, and patients' monthly glaucoma-economic burden in an ophthalmology hospital in Mexico City.Prospective survey of 462 primary open-angle glaucoma patients from 2007 to 2012 was carried out. Costs from visits, glaucoma follow-up studies, laser, and glaucoma surgical procedures were obtained from hospital pricings. Education, employment, and monthly income were interrogated. Total cost was divided into hypotensive treatment cost, nonpharmacologic treatment cost (laser and surgeries), and follow-up studies and consults. Average wholesale price for drugs analyzed was obtained from IMS Health data; monthly cost was calculated using: Monthly cost  = ([average wholesale price/number of drops per eye dropper] × number of daily applications) × 30 days.Patients were classified according to their glaucoma severity, and data were analyzed based on monthly income (average annual exchange rate: 12.85 Mexican pesos = 1 USD).The mean age was 70 ±â€Š10 years, women = 81%, elementary school = 39%, and unemployed = 53%. Low-income group = 266 patients (57%), 146 with mild glaucoma; moderate-income group = 176 patients (38%), 81 with mild glaucoma; high-income group = 20 patients (4.3%), 10 with mild glaucoma. Patients' monthly average economic burden in glaucoma treatment: low-income patients = 61.5%, moderate-income patients = 19.5%, and high-income patients = 7.9%.Glaucoma-economic burden is substantial not only for health systems, but for the family and the patient. Therefore, screening plans for earlier diagnosis, and health policies that lessen the cost of disease management and increase adherence to treatment, and reduce the prevalence of blindness attributed to glaucoma are essential. These would improve quality of life, reduce personal and national expenditure, and help increase national economy.
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8.

Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Gómez-Dantés, Héctor; Fullman, Nancy; Lamadrid-Figueroa, Héctor; Cahuana-Hurtado, Lucero; Darney, Blair; Avila-Burgos, Leticia; Correa-Rotter, Ricardo; Rivera, Juan A; Barquera, Simon; González-Pier, Eduardo; Aburto-Soto, Tania; de Castro, Elga Filipa Amorin; Barrientos-Gutiérrez, Tonatiuh; Basto-Abreu, Ana C; Batis, Carolina; Borges, Guilherme; Campos-Nonato, Ismael; Campuzano-Rincón, Julio C; de Jesús Cantoral-Preciado, Alejandra; Contreras-Manzano, Alejandra G; Cuevas-Nasu, Lucia; de la Cruz-Gongora, Vanessa V; Diaz-Ortega, Jose L; de Lourdes García-García, María; Garcia-Guerra, Armando; de Cossío, Teresita González; González-Castell, Luz D; Heredia-Pi, Ileana; Hijar-Medina, Marta C; Jauregui, Alejandra; Jimenez-Corona, Aida; Lopez-Olmedo, Nancy; Magis-Rodríguez, Carlos; Medina-Garcia, Catalina; Medina-Mora, Maria E; Mejia-Rodriguez, Fabiola; Montañez, Julio C; Montero, Pablo; Montoya, Alejandra; Moreno-Banda, Grea L; Pedroza-Tobías, Andrea; Pérez-Padilla, Rogelio; Quezada, Amado D; Richardson-López-Collada, Vesta L; Riojas-Rodríguez, Horacio; Ríos Blancas, Maria J; Razo-Garcia, Christian; Mendoza, Martha P Romero; Sánchez-Pimienta, Tania G; Sánchez-Romero, Luz M
| Idioma(s): Inglés
BACKGROUND: Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS: We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS: From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION: Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING: Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.
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9.

Health inequalities: Mexico's greatest challenge.

Gutiérrez, Juan Pablo; García-Saisó, Sebastián
| Idioma(s): Inglés
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10.

Mercury and selenium concentrations in marine shrimps of NW Mexico: health risk assessment.

Frías-Espericueta, M G; Ramos-Magaña, B Y; Ruelas-Inzunza, J; Soto-Jiménez, M F; Escobar-Sánchez, O; Aguilar-Juárez, M; Izaguirre-Fierro, G; Osuna-Martínez, C C; Voltolina, D
| Idioma(s): Inglés
We determined total Hg and Se contents of hepatopancreas, exoskeleton, and muscle, and the Se:Hg molar ratios in the muscle of shrimps Farfantepenaeus californiensis and Litopenaeus stylirostris caught in NE Pacific Mexican waters. Total Hg mean values in muscle, hepatopancreas, and exoskeleton were 0.31 ± 0.26, 0.28 ± 0.29, and 0.24 ± 0.06 µg g , and 0.46 ± 0.46, 0.41 ± .034, and 0.24 ± 0.06 µg g for F. californiensis and L. stylirostris, respectively. In all tissues, the mean concentrations of Se tended to be close to one order of magnitude higher than the respective Hg values. In F. californiensis, the hepatopancreas of the larger commercial size had significantly (p < 0.05) higher Hg content than smaller sizes, but correlations size-Hg concentration calculated for each tissue of either species were not significant. The Hg content of the muscle of all commercial sizes of both species was lower than the permissible limit and their Se:Hg ratios in all sizes were higher than 1, indicating low risk for human consumption.
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