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Ensuring regular and timely access to efficient and quality health services reduces the risk of maternal mortality. Specifically, improving technical efficiency (TE) can result in improved health outcomes. To date, no studies in Mexico have explored the connection of TE with either the production of maternal health services at the primary-care level or the maternal-mortality ratio (MMR) in populations without social security coverage. The present study combined data envelopment analysis (DEA), longitudinal data and selection bias correction methods with the purpose of obtaining original evidence on the impact of TE on the MMR during the period 2008-2015. The results revealed that MMR fell 0.36% (P < 0.01) for every percentage point increase in TE at the jurisdictional level or elasticity TE-MMR. This effect proved lower in highly marginalized jurisdictions and disappeared entirely in those with low- or medium-marginalization levels. Our findings also highlighted the relevance of certain social and economic aspects in the attainment of TE by jurisdictions. This clearly demonstrates the need for comprehensive, cross-cutting policies capable of modifying the structural conditions that generate vulnerability in specific population groups. In other words, achieving an effective and sustainable reduction in the MMR requires, inter alia, that the Mexican government review and update two essential elements: the criteria behind resource allocation and distribution, and the control mechanisms currently in place for executing and ensuring accountability in these two functions.
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Eficiência Organizacional/estatística & dados numéricos , Serviços de Saúde Materna/organização & administração , Mortalidade Materna/tendências , Atenção Primária à Saúde/organização & administração , Feminino , Recursos em Saúde , Humanos , Estudos Longitudinais , Serviços de Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/provisão & distribuição , Serviços de Saúde Materna/tendências , México , Gravidez , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Fatores SocioeconômicosRESUMO
OBJECTIVE: To analyze the formation of spatial clusters of technical efficiency (TE) in the production of outpatient maternal health services in México for the period 2008 to 2015. METHODS: We performed a longitudinal analysis of administrative and structural data related to the 243 Mexican health jurisdictions. We use window data envelopment analysis and spatial and econometric techniques. Structural correlates of each TE cluster obtained were identified estimating a pooled multinomial logit model. RESULTS: We observed an increase in the overall TE, accompanied by a reduction in its standard deviation. Furthermore, we identified positive TE spatial dependence both globally and locally. Multiple regression analysis showed that the maximum-performance TE cluster was composed of health jurisdictions located in the North of México and characterized by social marginalization, a reduced indigenous population, and a low demand for maternal health services. CONCLUSIONS: The identification of TE clusters can provide elements to induce decision makers to innovative in ways of allocating resources and manage their utilization. In México as other low- and middle-income countries, it is key to develop targeting strategies to implement specific health services innovations putting to the population to be served at the front of the strategy. This implies testing new modalities to strengthen primary health services, the empowerment of community participation, the training and allocation of health personnel that could respond adequately to population's demand, and the active involvement of competent state and local authorities in the assessment of the results of these innovations.
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Assistência Ambulatorial/organização & administração , Eficiência Organizacional , Serviços de Saúde Materna/organização & administração , Eficiência Organizacional/estatística & dados numéricos , Humanos , Estudos Longitudinais , México , Modelos Organizacionais , Modelos Estatísticos , Programas Médicos Regionais/organização & administração , Programas Médicos Regionais/estatística & dados numéricos , Análise Espaço-TemporalRESUMO
A simple and green method for the synthesis of six ethyl cinnamates was performed via Horner-Wadsworth-Emmons reaction under microwave irradiation. The photoluminescent properties of all compounds in ethyl acetate solutions were evaluated demonstrating that all compounds exhibit fluorescence. Five compounds exhibited blue emissions in the 369-442 nm range, and another compound exhibited blue-green emission at 504 nm. This last compound showed the largest Stokes shift (134 nm), and the highest quantum yield (17.8%). Two compounds showed extinction coefficient values (ε) higher than 30 000 M-1 cm-1, which are appropriate for cell bioimaging applications. In this sense, cytotoxicity assays were performed using Vero cells at different concentrations; the results showed that these compounds were not cytotoxic at the highest concentration tested (20 µg mL-1). Finally, the analysis by fluorescence microscopy for localization and cellular staining using Vero cells demonstrated that the compounds stained the cytoplasm and the nuclei in a selective way.
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AIMS: We aimed to characterize and illustrate the regional and state-level change in type 2 diabetes (T2D) prevalence in Mexico between 1990 and 2017. METHODS: We conducted an ecological and secondary analysis using data from the Global Burden of Disease study on T2D prevalence of the adult Mexican population. We estimated the absolute increase and annual growth rate of T2D prevalence between 1990 and 2017, stratified by age group and region. RESULTS: Nationally, between 1990 and 2017, the prevalence of T2D in Mexico increased from 9.5% to 14.3%. The highest increase in T2D prevalence was observed in the East and Southcentral regions, with the lowest absolute change in T2D prevalence observed in Northern states. The highest average annual growth rate in T2D prevalence was observed in Southern Mexico, in the three Southern states with the lowest human development index, and among individuals ages 15-49 years across all regions, compared to those 50 years and older. CONCLUSIONS: The prevalence of T2D in Mexico has increased substantially over the past three decades, with a clear shift in T2D prevalence from Northern to Southern states and a faster increase occurring in Southern Mexico among younger adults and in areas with lower economic resources.
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Diabetes Mellitus Tipo 2 , Adolescente , Adulto , Diabetes Mellitus Tipo 2/epidemiologia , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
We assess technical efficiency (TE) level for Mexican Ministry of Health (MoH) primary care units. Assessment was focused on the production of adequate maternal health services defined as the coverage level of women who received timely and frequent antenatal care, and institutional and medical care during childbirth. We conducted a longitudinal analysis of administrative and socio-demographic information concerning 233 health jurisdictions for the period 2008-15. Crude TE was calculated using window data envelopment analysis (Windows-DEA). Empirical analysis included the description of several factors affecting the production of maternal health services, including the heterogeneity and trends assessment of TE among health jurisdictions. We estimated a pooled regression model with robust standard errors to identify correlates of TE and estimated adjusted performance scores. Results indicate that while the production of adequate maternal-health services and TE in health jurisdictions proved insufficient, they rose by 22% (from 40.9% to 49.8%) and 14% (from 54.3% to 62%), respectively, over time. Furthermore, variance in efficiency among production units diminished and persistent regularities were observed. Performance was highest in the Northern as opposed to the Southern and Southeastern health jurisdictions, but lowest in the most marginalized zones of the country marked by economic inequality and the presence of indigenous populations. The Mexican Health System has reached a paradoxical situation: the steady escalation of financial resources in the public health subsystem over the past 15 years has yielded sub-optimal results as regards coverage for essential maternal health interventions among the poorest. Mexican government must put in place a set of measures to guarantee efficiency in the system's performance without affecting equity gains. This necessarily involves reconsidering, and where necessary replacing, the criteria behind the allocation and distribution of resources, as well as the mechanisms for controlling how resources are used and accountability is fulfilled.
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Eficiência Organizacional/estatística & dados numéricos , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Eficiência Organizacional/tendências , Feminino , Recursos em Saúde , Humanos , Estudos Longitudinais , Serviços de Saúde Materna/provisão & distribuição , Serviços de Saúde Materna/tendências , México , Grupos Populacionais , Áreas de Pobreza , Atenção Primária à Saúde/organização & administração , Fatores SocioeconômicosRESUMO
Use of multi-wall carbon nanotubes (MWCNTs) in external layers (A-layers) of ABA-trilayer polypropylene films was investigated, with the purpose of determining intrinsic and extrinsic factors that could lead to antistatic behavior of transparent films. The incorporation of 0.01, 0.1, and 1 wt % of MWCTNs in the A-layers was done by dilution through the masterbatch method. Masterbatches were fabricated using isotactic polypropylene (iPP) with different melt flow indexes 2.5, 34, and 1200 g/10 min, and using different ultrasound assist methods. It was found that films containing MWCNTs show surface electrical resistivity of 1012 and 1016 Ω/sq, regardless of the iPP melt flow index (MFI) and masterbatch fabrication method. However, electrostatic charge was found to depend upon the iPP MFI, the ultrasound assist method and MWCNT concentration. A percolation electron transport mechanism was determined most likely responsible for this behavior. Optical properties for films containing MWCNTs do not show significant differences compared to the reference film at MWCNT concentrations below 0.1 wt %. However, an enhancement in brightness was observed, and it was attributed to ordered iPP molecules wrapping the MWCNTs. Bright transparent films with low electrostatic charge were obtained even for MWCNTs concentrations as low as 0.01 wt %.
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El consumo de bebidas carbonatadas es común a nivel mundial. En El Salvador es frecuente en la dieta de la población; sin embargo, algunos de sus componentes pueden ser responsables de afectar la salud. Objetivo. Evaluar los efectos a la salud de dos bebidas carbonatadas administradas continuamente durante 10 semanas a ratones experimentales. Metodología. Se utilizaron 12 ratones distribuidos en 3 grupos de 4 ratones cada uno; un control y dos experimentales, para administrar dos bebidas carbonatadas azucaradas de alto consumo dentro de la población salvadoreña por vía intragástrica. Resultados. Los chequeos clínicos presentaron alteraciones en algunos aspectos evaluados, como deshidratación, piloerección y diarrea. En peso corporal, hubo diferencias entre el grupo control y los experimentales. En la evaluación macroscópica de los órganos, los grupos tratados sufrieron irregularidades, tanto en la apariencia como en el color, aunque en su peso no existieron diferencias, a excepción del riñón derecho del grupo tratado con bebida carbonatada 1. La química sanguínea mostró únicamente diferencia en el colesterol total del grupo tratado con bebida carbonatada 2. Conclusión. La apariencia de los ratones tratados con bebidas carbonatadas mostró daños a la salud, principalmente el daño provocado en la apariencia de los órganos internos
Currently, the consumption of carbonated beverages is very common worldwide. In El Salvador it is frequent in the diet of the population; while some constituent components may be responsible for affecting health. Objective. To assess the health effects of two carbonated beverages administered continuously for 10 weeks to experimental mice. Methodology. Two carbonated beverages with high consumption sugar were chosen within the Salvadoran population. In this study 12 mice distributed in 3 groups of 4 mice each were used; one control and two experimental. The substances were administered intragastrically. Results. The clinical check-ups showed alterations in some aspects evaluated, such as dehydration, piloerection and diarrhea. In body weight, there were significant differences between the control and the experimental group. In the macroscopic evaluation of the organs, the treated groups suffered from certain irregularities, both in appearance and color, although there were no differences in weight, except for the right kidney of the group treated with carbonated beverage 1. Blood chemistry showed only
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Animais , Camundongos , Bebidas Gaseificadas , Impactos da Poluição na Saúde , El SalvadorRESUMO
Background and Purpose Sphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is any relationship between various isolated or combined fractures of facial skeleton and sphenoid bone and sphenoid sinus fractures. Methods We retrospectively studied hospital charts of all patients who reported to the trauma center at Hospital de San José with facial fractures from December 2009 to August 2011. All patients were evaluated by computed tomography scan and classified into low-, medium-, and high-energy trauma fractures, according to the classification described by Manson. Design This is a retrospective descriptive study. Results The study data were collected as part of retrospective analysis. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Thirty-eight patients were excluded. A total of 212 patients had facial fractures; 33 had a combination of sphenoid sinus and sphenoid bone fractures, and facial fractures were identified within this group (15.5%). Gender predilection was seen to favor males (77.3%) more than females (22.7%). The mean age of the patients was 37 years. Orbital fractures (78.8%) and maxillary fractures (57.5%) were found more commonly associated with sphenoid sinus and sphenoid bone fractures. Conclusions High-energy trauma is more frequently associated with sphenoid fractures when compared with medium- and low-energy trauma. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures.
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Exponemos el resultado analítico de una consulta de un corpus documental representativo en la investigación social sobre el estado actual de los estudios sobre la infancia. Los criterios para elaborar el análisis y exposición de los resultados son: la variedad de concepciones sociales; el origen histórico y la perspectiva sociológica; la experiencia social de la infancia; las imágenes o representaciones que la sociedad tiene de ella; los desarrollos conflictivos de los derechos de la infancia en términos de educación y castigo jurídico; y el porvenir de la infancia moderna como sujeto de medios de comunicación. Historiadores e historiadoras, antropólogos y antropólogas, pedagogos y pedagogas, juristas y sociólogos y sociólogas, analizan los diversos sistemas de representación de la infancia constituidos en el tiempo y en el espacio.
We present the analytical results of the consultation of a representative documentary "corpus" from the social research about the current status of the studies on childhood. The criteria to undertake the analysis and presentation of the results are: variety of social conceptions; historical origin and sociological perspective; the social experience of childhood; images or representations that society has thereof; the conflicting developments of children's rights in terms of education and legal punishment; and the future of modern childhood as subject of the media. Historians, anthropologists, teachers, jurists and sociologists analyze the different systems of childhood representations constituted in time and space.
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Criança , Meios de Comunicação , PopulaçãoRESUMO
Introducción: las plantas medicinales constituyen una valiosa alternativa terapéutica y su validación científica es una necesidad. Objetivo: identificar los posibles efectos tóxicos producidos por la infusión de Chenopodium ambrosioides L. (Chenopodiaceae) sobre el modelo biológico utilizado. Métodos: para determinar la toxicidad subcrónica de la infusión se emplearon ratones albinos suizos NIH de los 2 sexos, a los que se les administró por vía oral infusiones de la especie estudiada a concentraciones de 32, 64 y 134 mg/mL por 90 días. Al mismo tiempo se realizaron observaciones clínicas diarias con el fin de identificar algún efecto tóxico posadministración de la sustancia. Después fueron sacrificados para realizar los exámenes hematológicos (hematocrito, hemoglobina, glóbulos rojos, glóbulos blancos, neutrófilos y linfocitos) y bioquímicos (alanino aminotransferasa y creatinina), así como estudios macroscópicos e histológicos de los órganos internos (riñón, hígado, pulmón e intestino). Resultados: se encontró que la infusión de Chenopodium ambrosioides a las dosis administradas no causó efectos determinantemente significativos en los parámetros toxicológicos, en el peso corporal, en hematología y química sanguínea, al igual que tampoco provocó alteraciones anatomopatológicas sobre los órganos y tejidos evaluados. Conclusiones: la infusión de Chenopodium ambrosioides bajo estas condiciones experimentales no presentó actividad tóxica.
Introduction: medicinal plants represent a valuable therapeutic alternative and their scientific validation is a must. Objectives: to determine the possible toxic effects produced by the infusion of Chenopodium ambrosioides L. (Chenopodiaceae) on the used biological model. Methods: to determine the subchronic toxicity of the infusion, NIH Swiss albino mice of both sexes were used, to which infusions from the tested species, at concentrations of 32, 64, and 134 mg/mL , were orally administered for 90 days. At the same time, daily clinical observations were performed in order to identify any toxic post-dose administration. Afterwards, they were sacrificed for conduction of hematological tests (hematocrit, hemoglobin, red blood cells, white cells, neutrophils and lymphocytes) and biochemical (alanine aminotransferase and creatinine) and macroscopic and histological studies of the internal organs (kidney, liver, lung and intestine.). Results: the infusion of Chenopodium ambrosioides at the tested doses caused neither decisively significant effects on the toxicological parameters, body weight, hematology and blood chemistry nor pathological changes on organs and tissues. Conclusions: the infusion of Chenopodium ambrosioides under our experimental conditions showed no toxic activity.
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Antecedentes. El embarazo es un evento que se acompaña de repercusiones psicológicas que pueden acentuarse cuando coexiste un alto riesgo perinatal, y entre ellas está la ansiedad. Las escalas disponibles actualmente para medir este fenómeno fueron construidas para población abierta y normalizadas para mujeres embarazadas con bajo riesgo, por lo que no se despone de una escala válidad y estandarizada para medir ansiedad en mujeres embarazadas con alto riesgo. Objetivo. Construir una escala válida, confiable y estandarizada para medir ansiedad en pacientes embarazadas con alto riesgo perinatal. Material y método. Se elaboró un cuestionario de 74 items con respuesta tipo Liker que se transformó en escala y se aplicó a una muestra de 1477 mujeres mexicanas, embarazadas con alto riesgo, usuarias del Instituto Nacional de Perinatología. Para determinar la confiabilidad y validez de la escala se aplicaron los procedimientos recomendados por Nunnally. Resultados. Se obtuvieron cuatro factores con valores propios superiores a 1.00 que en conjunto explican 46 por ciento de la varianza total de la esclaa. La consistencia interna determinada por el alpha de Cronbach fue de 0.87. Se presentan también los puntajes crudos, "Z" y "T" de la escala y sus repectivos baremos. Conclusiones. Con base en los resultados puede afirmarse que la escala construida es válida, confiable y está estandarizada para medir ansiedad en mujeres embarazadas de alto riesgo que puede ser muy útil para estudios posteriores en población latinoamericana
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Humanos , Feminino , Gravidez , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Gravidez de Alto Risco/psicologia , Testes PsicológicosRESUMO
CONCLUSIONES Y RECOMENDACIONES: 1) Los niños y jóvenes son vistos como "proyectos de ciudadanos", por lo tanto no tienen voz y voto en las decisiones que la institución toma respecto a los procesos educativos que realiza con ellos, en el mejor de los casos se escucha a los adolescentes. 2) Al interior de las instituciones deben generarse procesos de conocimiento y reconocimiento de los actores institucionales como ciudadanos. 3) La autoridad es ejercida de manera vertical, para mantener la disciplina que la institución necesita, negándose a compartir puntos de vista, a establecer relaciones que propicien el desarrollo de la autonomía. 4) Cuando el adulto establece una relación afectiva con los niños y jóvenes, logra su reconocimiento como sujeto social. 5) Cuando los adultos tienen una actitud de respeto y afecto hacia el niño es más fácil lograr su desarrollo. 6) En las instituciones se presentan situaciones de maltrato que van desde formas sutiles hasta formas activas de maltrato. 7) La representación del maltrato en niños, jóvenes y adultos, sigue estando relacionada con el castigo físico y con la familia como maltratante. 8) La única situación de maltrato que es reconocida por los adultos es aquella que se da entre pares. 9) La representación que los niños y jóvenes hacen del adulto esta ligada a las figuras simbólicas del padre o la madre, lo cual implica que se sigue añorando la familia. 10) Los educadores deben constituírse en modelos...(TRUNCADO A LOS 1500 CARACTERES)
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Maus-Tratos Infantis , Criança Institucionalizada , Violência , ColômbiaRESUMO
El maltrato se considera como una acción relacional entre los individuos que hacen parte de la institución donde se vulneran los derechos y deberes adquiridos socialmente. En esta acción la comunicación es suplantada por la agresión que modifica las intenciones de armonía que deben animar las relaciones sociales al interior de las instituciones. La ruptura de la acción relacional genera espacios psicológicos, culturales, físicos, sociales y ambientales disfuncionales o inarmónicos, cuya presencia puede manifestarse de dos formas: oculta (sutil) y evidente, caracterizada bajo dos expresiones: activa y pasiva. Entre las formas de expresión pasiva se tienen: la indiferencia, el silencio, el contexto ambiental, las condiciones socioeconómicas del pais, la religión, el entorno inmediato de los jóvenes y la familia, las condiciones institucionales que corresponden al impacto de agresión donde la entidad es víctima silenciosa de la realidad inmediata. Entre las formas de expresión activa está el maltrato físico, la agresión física que enmarca el abuso sexual, los golpes y lesiones corporales, otras expresiones maltratadoras hacen referencia a que las necesidades fundamentales no satisfechas como albergue, alimentación, vestuario y servicios públicos entre otros, se conviertan en el origen del maltrato institucional. Existe también el maltrato social, cuyas causas son: la desintregración familiar, la falta de cuidado y asistencia en salud, educación, oportunidades laborales, etc