The (temporary) Covid-19 baby bust in Mexico.

In this paper, we investigate whether fertility and newborn health changed during the Covid-19 pandemic in Mexico. We use national administrative data and an event-study design to examine the impact of the Covid-19 pandemic on fertility and newborn health characteristics. Our findings suggest that Mexico's fertility declined temporarily as measured by conceptions that likely occurred during the stay-at-home order. Initially, the general fertility rate fell by 11-12 per cent but quickly rebounded and returned close to its original levels by the end of 2021. Newborn health also deteriorated during the pandemic. Instances of low birthweight and prematurity substantially increased, with both remaining elevated over the entire pandemic period.

Catastrophic health expenditure during the COVID-19 pandemic in five countries: a time-series analysis.

BACKGROUND: The COVID-19 pandemic disrupted health systems in 2020, but it is unclear how financial hardship due to out-of-pocket (OOP) health-care costs was affected. We analysed catastrophic health expenditure (CHE) in 2020 in five countries with available household expenditure data: Belarus, Mexico, Peru, Russia, and Viet Nam. In Mexico and Peru, we also conducted an analysis of drivers of change in CHE in 2020 using publicly available data. METHODS: In this time-series analysis, we defined CHE as when OOP health-care spending exceeds 10% of consumption expenditure. Data for 2004-20 were obtained from individual and household level survey microdata (available for Mexico and Peru only), and tabulated data from the National Statistical Committee of Belarus and the World Bank Health Equity and Financial Protection Indicator database (for Viet Nam and Russia). We compared 2020 CHE with the CHE predicted from historical trends using an ensemble model. This method was also used to assess drivers of CHE: insurance coverage, OOP expenditure, and consumption expenditure. Interrupted time-series analysis was used to investigate the role of stay-at-home orders in March, 2020 in changes in health-care use and sector (ie, private vs public). FINDINGS: In Mexico, CHE increased to 5·6% (95% uncertainty interval [UI] 5·1-6·2) in 2020, higher than predicted (3·2%, 2·5-4·0). In Belarus, CHE was 13·5% (11·8-15·2) in 2020, also higher than predicted (9·7%, 7·7-11·3). CHE was not different than predicted by past trends in Russia, Peru, and Viet Nam. Between March and April, 2020, health-care visits dropped by 4·6 (2·6-6·5) percentage points in Mexico and by 48·3 (40·6-56·0) percentage points in Peru, and the private share of health-care visits increased by 7·3 (4·3-10·3) percentage points in Mexico and by 20·7 (17·3-24·0) percentage points in Peru. INTERPRETATION: In three of the five countries studied, health systems either did not protect people from the financial risks of health care or did not maintain health-care access in 2020, an indication of health systems failing to maintain basic functions. If the 2020 response to the COVID-19 pandemic accelerated shifts to private health-care use, policies to cover costs in that sector or motivate patients to return to the public sector are needed to maintain financial risk protection. FUNDING: The Bill & Melinda Gates Foundation.

Hand-held cardiac ultrasound screening performed by family doctors with remote expert support interpretation.

OBJECTIVE: To assess the usefulness of hand-held cardiac ultrasound (HCU) performed by family doctors (FDs) in primary care, with web-based remote expert support interpretation, in a cohort of patient with symptoms or physical examination signs suggestive of cardiovascular disease. METHODS: This prospective observational study included 1312 consecutive patients, in three remote primary care areas, with symptoms or physical examination signs suggestive of cardiovascular disease. In 859 patients (group A), FDs had indicated conventional echocardiography (CE), and in 453 (Group B) the study was performed to complement the physical examination. HCU was carried out by 14 FDs after a short training period. The scans and preliminary FD reports were uploaded on a web-based program for remote expert support interpretation in <24 h. RESULTS: Experts considered HCU to be inconclusive in 116 (8.8%) patients. FD and expert agreement on diagnosis was moderate (K=0.40-0.70) except in mitral stenosis (K=0.29) and in left atrial dilation (K=0.38). Diagnostic agreement between expert interpretation and CE was good (K=0.66-0.85) except in mitral stenosis (K=0.43). After remote expert interpretation, conventional echocardiograms were finally requested by FDs in only 276 (32.1%) patients, and discharges increased by 10.2%. Furthermore, significant heart diseases were diagnosed in 32 (7%) patients of group B. CONCLUSIONS: HCU performed at the point of care by FDs with remote expert support interpretation using a web-based system is feasible, rapid and useful for detecting significant echocardiographic abnormalities and reducing the number of unnecessary echocardiographic studies.

Nutrición y rendimiento en atletas con discapacidad intelectualy conocimientos de sus cuidadores / Nutrition and physical performance in athletes with intellectual disability and knowledge level of their caregivers

Introduction: It has been proven that the population with intellectual disability presents health and nutrition risk factors; however, there are only a few studies that characterize this problematic situation. Objective: The purpose of this study was to determine the food consumption, nutritional diagnosis, physical performance and hydration status of 179 athletes with intellectual disability affiliated to the Guanajuato Special Olympics, from nine cities, as well as the knowledge level and hydration habits of parents or caregivers. Methodology: A descriptive, prospective and transversal study has been con ducted. Food consumption was obtained through a validated semi-quantitative questionnaire; the nutrition diagnosis was determined by anthropometric parameters; physical performance was evaluated by the tests DIDEFI®; the hydration status was calculated by urinary density using a refractometer; and the knowledge level, hydration and nutrition habits of the caregivers were assessed by two validated questionnaires. Results: The age group 11 to 20 years has the highest calorie and macronutrient ingestion. In relation to the nutritional status: 43.6% is overweight in some degree and 4.5% underweight. A tendency was found in the physical tests to monotonic growth in hand strength and abdominals per minute, a parabolic tendency in horizontal jump and a random representation in trunk flexion. 56.42% of the athletes presented dehydration. Regarding the parents/caregivers, their average knowledge was higher than their grade in the hydration habits questionnaire, with a significant statistics difference. Conclusions: The athletes with intellectual disabilities must be considered as a risk group because of factors such as alterations in weight and dehydration, as well as their parents’/caregivers’ lack of knowledge in nutrition and hydration, which could risk their health and physical performance.

Herramientas para el diagnóstico del ambiente individual de gestión de la información en una organización / Tools for diagnose of the individual environment for the information management at organization

La gestión de la empresa estatal cubana requiere estudiar el ambiente individual de la gestión de la información en las organizaciones como un elemento clave de sus recursos de información. La aplicación informática construida con estos fines permite mostrar los resultados e interpretaciones del instrumento de captación de información previamente diseñado y empleado. Se presenta el algoritmo para el servicio de consultoría y el uso de las tablas dinámicas para el análisis de información introspectivo. El producto final es una herramienta útil a las empresas, en especial para aquellas que apuestan por cambios organizacionales donde la información desempeña un papel determinante.

Managing Cuban enterprises requires studying the individual environment of the information management becoming a key element of its resources of information. The computer built application allows showing those results and interpretations from the instrument of reception of information previously designed. It is showed up the algorithm for the consultancy service and the use of the dynamic charts for the introspective analysis of information. The final product is a useful tool for companies, especially for those that are betting for organizational changes, where the information plays a decisive part.

Complicaciones de la nutrición parenteral en el recién nacido / Complications in the use of total parenteral nutrition in newborns

Introducción. La nutrición parenteral total (NPT) es un instrumento que se emplea con mucha frecuencia en el recién nacido (RN) críticamente enfermo, pero no es inocua. El objetivo de este estudio es determinar la frecuencia de las complicaciones de la NPT y a qué factores se asociaron. Material y métodos. Durante un lapso de 2 años 5 meses (enero de 1993 a mayor de 1995) se estudiaron en forma retrospectiva 146 expedientes de pacientes que habían recibido NPT por un tiempo mínimo de 2 días, 74 fueron masculinos y 72 femeninos, 79 de pretérmino y los restantes de término. Los resultados se evaluaron con estadística descriptiva e inferencial a través de t de Student, Chi cuadrada o probabilidad exacta de Fisher. Resultados. Las complicaciones más frecuentes fueron: acidosis metabólica con 38 casos (26 por ciento), hiperglucemia con 37 casos (25.3 por ciento), hiperkalemia 28 casos (19.1 por ciento), colestasis 19 casos (13 por ciento), septicemia 14 casos 89.5 por ciento) y otras tales como: hipocalcemia, obstrucción del catéter y flebitis menos frecuentes. Hubo correlación significativa entre el tiempo de duración de la NPT y septicemia (P=0.002); la colestasis se asoció a la administración de proteínas de 2.5 g o más por kg de peso por día (P=0.003) y a una duración de NPT mayor a 21 días (P=0.006). La duración de la NPT en relación a las complicaciones también fue significativa (P=0.0002). Conclusiones. Se concluye que la NPT es una buena alternativa para el manejo del RN que la requiera, en donde deben de monitorizarse estrechamente los cuidados del catéter y aspectos metabólicos. Cuando no se cuente con aminoácidosis especiales para RN se recomienda no utilizar proteínas por arriba de 2.4 g/kg/día