Social inequalities in supportive care needs and quality of patient-centered care of cancer patients in Mexico.

PURPOSE: To evaluate educational and health insurance-related inequalities in supportive care (SC) needs and quality of patient-centered care (PCC) for cancer patients in Mexico. METHODS: We conducted a cross-sectional survey in one Mexican Institute of Social Security (IMSS) and one Ministry of Health (MoH) oncology hospital in Mexico City. Formal labor market workers and their families have access to social health insurance that IMSS provides, while unemployed and informal workers receive care at the MoH. The study population comprised breast, colorectal, prostate, and hematologic cancer patients, aged ≥ 18 years, who attended outpatient consultations. Patients responded a short-form SC-needs questionnaire and a quality of PCC questionnaire. We used multiple logistic regression models to determine the independent association between educational attainment and high SC-needs and quality of PCC after controlling for sociodemographic and clinical covariates. RESULTS: We included 1058 IMSS and 606 MoH cancer patients. MoH patients perceived higher SC-needs and lower quality of PCC than IMSS patients. MoH patients with low education had a greater probability of high psychological and health system SC needs and lower likelihood of being informed for treatment decision-making and care for their biopsychosocial needs. IMSS patients with low educational levels had lower probability of receiving timely care and clarity of information than those with high education. Receiving high-quality PCC was associated with decreased SC needs. CONCLUSION: Uninsured cancer patients with low educational attainment have higher SC-needs and receive lower quality of PCC than their counterparts. Health services should face these challenges to reduce inequalities in Mexico.

Comparison between Covid-19 and influenza A(H1N1) pandemic experiences and risk perception in Mexican university.

OBJECTIVE: To compare the perceptions and experiences between the A(H1N1) and Covid-19 pandemics in a univer-sity population. MATERIALS AND METHODS: Online surveys were administered during the influenza A(H1N1) -originated in Mexico in 2009- and Covid-19 epidemics. MEASURES: so-ciodemographic characteristics, knowledge, information and communication, perception of risk, physical and mental health, effects on daily life, and preventive behaviors. RESULTS: This study included 24 998 respondents, 51.36% from the A(H1N1) group and 48.63% from the Covid-19 group. Differences were observed in the perception of severity. During the influenza A(H1N1) pandemic worry was the feeling reported most frequently, while for Covid-19 it was anxiety. Covid-19 had greater impact on students' family economy and caused a higher uncertainty. CONCLUSIONS: The perceptions and ex-periences of the two pandemics were similar but the impact has been much greater for Covid-19, especially in terms of the severity, family economy, preventive behaviors, and uncertainty.

Experiences with health care and health-related quality of life of patients with hematologic malignancies in Mexico.

BACKGROUND: In Mexico, patients with hematologic malignancies (HMs) are characterized by being at high risk and advanced stages at diagnosis and by having a low cure rate; yet information on their experiences with health care and health-related quality of life (HRQL) is scarce. We aimed to evaluate experiences with health care and HRQL of patients with HMs and the association between these patient-reported measures. METHODS: We conducted a cross-sectional survey in two public oncology hospitals in Mexico City. The study included outpatient cancer patients aged ≥18 years with a diagnosis of leukemia, lymphoma, or multiple myeloma. We used a patient-centered quality of cancer care questionnaire to assess patient experiences with receiving 1) timely care; 2) clear information; 3) information for treatment decision-making; 4) care to address biopsychosocial needs; and 5) respectful and coordinated care. We applied the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) to measure HRQL. We performed a multiple linear regression to evaluate the association between patient-reported experiences (independent variables) and the QLQ-C30 summary score (dependent variable). RESULTS: Of the 515 participating HM patients, 46.6% had lymphoma, 34% leukemia, and 19.4% multiple myeloma; 70.9% were at advanced stages or at high risk. Additionally, 15.1% had anxiety and 12.8% had depression. Over one third (35.9%) reported receiving clear information, 28.5% timely care, 20.6% information for treatment decision-making, 23.7% care that addressed their biopsychosocial needs, and 31% respectful and coordinated care. The mean QLQ-C30 summary score was 71.9 points. Timely care, clear information, and care that addresses biopsychosocial needs were associated with higher HRQL. CONCLUSIONS: Health care services for HM patients at public oncology hospitals in Mexico need improvement. Notably, providing timely care, clear information, and care that addresses patients' biopsychosocial needs can increase the likelihood of better HRQL. Health care providers should measure and improve the experiences of HM patients with health care.

User experience and satisfaction with specialty consultations and surgical care in secondary and tertiary level hospitals in Mexico.

BACKGROUND: To evaluate the association between user experience and satisfaction with specialty consultations and surgical care at the Mexican Institute of Social Security (IMSS) secondary and tertiary level hospitals. METHODS: We conducted secondary data analysis of the cross-sectional 2017 IMSS National Satisfaction Survey. The dependent variables were user satisfaction with outpatient consultation and with surgery. The study's independent variables were user experience with these services. The Lancet Global Health Commission on High Quality Health Systems in the Sustainable Development Era framework was used to guide the analysis. For each dependent variable a double-weighted Poisson regression model with robust variance was performed and considered clustering of the observations within 111 secondary level and 25 tertiary level hospitals. RESULTS: The study included 6713 outpatient consultation users and 528 surgery users. 83% of users attending outpatient consultations and 86.6% of users who underwent inpatient surgery at IMSS hospitals were satisfied with the service received. The common patient negative experiences with specialty consultations and surgical care were long waiting time (40%) and lack of hospital cleanliness (20%). An additional concern was the lack of clinical examination during the consultation (25%). Shorter waiting times, health provider courtesy, good communication, clinical examination, and hospital cleanliness were associated with patient satisfaction with specialty consultations. Having the surgery without prior postponement(s) and without complications increased the probability of patient satisfaction. CONCLUSION: Patient satisfaction with hospital outpatient consultations and surgical care may be raised by focusing on improvement strategies to enhance positive patient experiences with care.

Effects of an internet-based educational intervention to prevent high-risk sexual behavior in Mexican adolescents.

To evaluate the effect of an internet-based educational intervention to increase knowledge of sexually transmitted infections (STIs), attitudes and self-efficacy toward consistent condom use in Mexican adolescents. A field trial with an intervention and control group was conducted in 14- to 15-year-old students in two secondary schools. The intervention was delivered via a website that included four educational sessions during a 4-week period and six 30-min class discussions during a 3-month period. In the control group, the investigators observed the general sex education provided by the school. Outcome variables were 1) knowledge about STIs, 2) attitudes regarding condom use, and 3) self-efficacy toward consistent condom use. Differences-in-differences (Diff-in-Diff) treatment effect was estimated for each outcome variable. There were 246 adolescents in the intervention group and 210 in the control group. The intervention had a positive effect on improving knowledge of STIs, attitudes and self-efficacy toward consistent condom use. The major effect was observed on adolescents' knowledge on STIs (Diff-in-Diff 30.34 points, P < 0.0001). A youth-friendly, culturally-contextualized, internet-based educational intervention complemented by class discussions may be a significant addition to the regular secondary school sex education program to improve knowledge of STIs, attitudes and self-efficacy toward consistent condom use among adolescents. TRIAL REGISTRATION: The study was registered at the ClinicalTrials.gov ID: NCT02686736.

Factors associated with quality of life of caregivers of Mexican cancer patients.

PURPOSE: To evaluate factors associated with a poor quality of life (QoL) of caregivers of Mexican cancer patients. METHODS: This is a secondary analysis of a cross-sectional survey of 826 primary caregivers of adult cancer patients at the Oncology Hospital of the Mexican Institute of Social Security. Dependent variables were physical composite score (PCS) and mental composite score (MCS) of QoL of caregivers measured by the Short Form (SF-12) of Medical Outcomes Survey questionnaire. Independent variables included general characteristics of the caregivers, their unmet needs, caregiving and characteristics of cancer patients. Multiple linear regression analysis for each QoL composite score was carried out. RESULTS: The average PCS was 48.7 and MCS was 47.1. Lower PCS was associated with older age, symptoms of chronic illness, depression and unmet personal needs, while concerns about the future were associated with higher physical QoL. Lower MCS was associated with anxiety, depression, unmet personal and emotional needs, and surgery in the last month. Caring for patients with a high global health status was associated with a higher MCS. CONCLUSION: Information about caregivers' QoL and its associated factors is important in order to identify and address modifiable factors. Also, studies from different cultures like México are essential in order to identify possible generalities and particularities in QoL and its associated factors. Given the limitations of the cross-sectional design of our study, future longitudinal studies on the changes of Mexican caregivers' quality of life and their determinants will be an important step to further understanding these phenomena.

Internet-based educational intervention to prevent risky sexual behaviors in Mexican adolescents: study protocol.

BACKGROUND: Risky sexual behaviors of adolescents in Mexico are a public health problem; 33.4 % of adolescent girls and 14.7 % of boys report not having used any protection at their first intercourse. The fertility rate is 77 births/1000 girls aged 15-19 years. The infrequent contact of adolescents with health services and the limited extent of school sex and reproductive health education require the support of innovative strategies. The objective of this paper is to present the design of an internet-based educational strategy to prevent risky sexual behaviors in Mexican adolescents. METHODS: A field trial with intervention and comparison group and with ex-ante and ex-post measurements will be conducted in two public secondary schools. Adolescents between 14 and 15 years of age will participate. The intervention will be conducted in one school and the second school will serve as a comparison group where the investigators will observe the usual sex education provided by the school. The intervention will be delivered using an internet web page that includes four educational sessions provided during a 4 week period. Follow-up will last 3 months. Information on the study variables will be obtained through an Internet-based self-applied questionnaire and collected on three occasions: 1) when the adolescents enter the study (baseline), 2) once the intervention is completed (at 1 month) and 3) after 3 months of follow-up (at the fourth month). There will be three outcome variables: 1) knowledge in regard to sexually transmitted infections, 2) attitudes regarding condom use, and 3) self-efficacy toward consistent condom use. The generalized linear model will be used to assess changes in each outcome variable controlling for baseline measures and for study covariates. DISCUSSION: The design and evaluation of an Internet-based educational strategy to prevent risky sexual behaviors in Mexican adolescents is important in order to provide a new, large-scale, easily implemented preventive tool. TRIAL REGISTRATION: The study was registered at the ClinicalTrials.gov ID: NCT02686736 .

Factors associated with regular physical exercise and consumption of fruits and vegetables among Mexican older adults.

BACKGROUND: To analyze the factors associated with regular physical exercise and routine consumption of fruits and vegetables, and both healthy behaviors among Mexican older adults. METHODS: We conducted a secondary data analysis of the baseline data (2014) of the Study on Obesity, Sarcopenia and Fragility in older adults affiliated with the Mexican Institute of Social Security. The study included 948 adults who were ≥60 years of age. Multiple Poisson regression was performed. RESULTS: Routine consumption of fruits and vegetables was reported by 53.8 % of older adults, 42.7 % reported engaging in regular physical exercise and 23.1 % reported participating in both types of healthy behaviors. Women, adults with a stable income, those with a self-perception of good health and those with a history of physical exercise at the age of 50 years had an increased likelihood of engaging in healthy eating and regular physical activity. CONCLUSIONS: Many older adults do not routinely consume fruits and vegetables or engage in regular physical exercise despite the fact that most have a fixed income and a social network. It is relevant to conduct research-based interventions that take into account the contextual factors to promote healthy behaviors.

Doctor-Patient Relationship Between Individuals With Fibromyalgia and Rheumatologists in Public and Private Health Care in Mexico.

The aim of this article was to describe and analyze the doctor-patient relationship between fibromyalgia patients and rheumatologists in public and private health care contexts within the Mexican health care system. This medical anthropological study drew on hospital ethnography and patients' illness narratives, as well as the experiences of rheumatologists from both types of health care services. The findings show how each type of medical care subsystem shape different relationships between patients and doctors. Patient stigmatization, overt rejection, and denial of the disease's existence were identified. In this doctor-patient-with-fibromyalgia relationship, there are difficult encounters, rather than difficult patients. These encounters are more fluid in private consultations compared with public hospitals. The doctor-centered health care model is prevalent in public institutions. In the private sector, we find the characteristics of the patient-centered model coexisting with the traditional physician-centered approach.

Supportive care needs of Mexican adult cancer patients: validation of the Mexican version of the Short-Form Supportive Care Needs Questionnaire (SCNS-SFM).

PURPOSE: The purpose of this study is to validate the Mexican version of the Short-Form Supportive Care Needs survey (SCNS-SFM). METHODS: A cross-sectional survey was conducted from June to December 2013 at the Oncology Hospital of the Mexican Institute of Social Security in Mexico City. The study included 825 subsequent cancer patients >20 years of age with all forms of solid cancer. Patients had prior surgical removal of histologically confirmed cancer and attended outpatient consultations. Validation of SCNS-SFM included the following: (1) content validity through a group of experts; (2) construct validity through an exploratory factor analysis based on the polychoric correlation matrix; (3) internal consistency using Cronbach's alpha; (4) convergent validity between SCNS-SFM and quality of life, anxiety, and depression scales by calculating Pearson's correlation coefficient; (5) discriminative validity through analysis of MANOVAs; and (6) test-retest reliability using intraclass correlation coefficient calculations. RESULTS: SCNS-SFM has 33 items with five factors accounting for 59 % of total variance. Cronbach's alpha values ranged from 0.78 to 0.90 among factors. SCNS-SFM has good convergent validity compared with quality of life and depression and anxiety scales and good discriminative validity, revealing great information, psychological support, and physical daily living needs for women, patients <60 years, and high physical daily living needs for those with <1 year since cancer diagnosis, with advanced disease stages and current chemo- or radiotherapy. Intraclass correlation coefficient between SCNS-SFM measurements was 0.9. CONCLUSION: SCNS-SFM has acceptable psychometric properties and is suitable to evaluate supportive care needs of cancer patients.

Needs of caregivers of cancer patients: validation of the Mexican version of the Support Person Unmet Needs Survey (SPUNS-SFM).

PURPOSE: The purpose of this study was to validate the Mexican version of the Support Person Unmet Needs Survey (SPUNS-SFM). METHODS: A cross-sectional survey that included 826 primary caregivers of cancer patients was conducted from June to December 2013 at the Oncology Hospital of the Mexican Institute of Social Security in Mexico City. The validation procedure comprised (1) content validity through a group of experts; (2) construct validity through an exploratory factor analysis based on the polychoric correlation matrix; (3) internal consistency using Cronbach's alpha; (4) convergent validity between SPUNS-SFM and quality of life, anxiety-and-depression scales by calculating Spearman's rank correlation coefficient;( 5) discriminative validity through the Wilcoxon rank-sum test; and (6) test-retest reliability using intraclass correlation coefficient. RESULTS: SPUNS-SFM has 23 items with six factors accounting for 65 % of the total variance. The domains were concerns about the future, access and continuity of healthcare, information, work and finance, and personal and emotional needs. Cronbach's alpha values ranged from 0.70 to 0.88 among factors. SPUNS-SFM had moderate convergent validity compared with quality of life and depression-and-anxiety scales and good discriminative validity, revealing high needs for younger caregivers and more emotional needs for caregivers of patients with advanced cancer stages. Intraclass correlation coefficient between SPUNS-SFM measurements was 0.78. CONCLUSION: SPUNS-SFM is a valid and reliable tool to identify needs of caregivers of cancer patients.

Development and validation of a questionnaire to assess delay in treatment for breast cancer.

BACKGROUND: This study reports the reliability and validity of a questionnaire designed to measure the time from detection of a breast cancer to arrival at a cancer hospital, as well as the factors that are associated with delay. METHODS: The proposed questionnaire measures dates for estimation of the patient, provider and total intervals from detection to treatment, as well as factors that could be related to delays: means of problem identification (self-discovery or screening), the patients' initial interpretations of symptoms, patients' perceptions of delay, reasons for delay in initial seeking of medical care, barriers perceived to have caused provider delay, prior utilisation of health services, use of alternative medicine, cancer-screening knowledge and practices, and aspects of the social network of support for medical attention. The questionnaire was assembled with consideration for previous research results from a review of the literature and qualitative interviews of patients with breast cancer symptoms. It was tested for face validity, content validity, reliability, internal consistency, convergent and divergent validity, sensitivity and specificity in a series of 4 tests with 602 patients. RESULTS: The instrument showed good face and content validity. It allowed discrimination of patients with different types and degrees of delay, had quite good reliability for the time intervals (with no significant mean differences between the two measurements), and fairly good internal consistency of the item dimensions (with Cronbach's alpha values for each dimension between 0.42 and 0.85). Finally, sensitivity and specificity were 74.68% and 48.81%, respectively. CONCLUSIONS: To the best of our knowledge, this is the first published report of the development and validation of a questionnaire for estimation of breast cancer delay and its correlated factors. It is a valid, reliable and sensitive instrument.

[Factors associated with a lack of postnatal care]. / Factores asociados a la falta de control posnatal materno.

Background: Postnatal care is essential to identify and treat at the appropriate time adverse health events in the puerperium. In Mexico, the factors that affect postnatal care have not been documented. Objective: To identify the factors associated with the lack of postnatal care. Material and methods: Cross-sectional study of 202 women of reproductive age affiliated with six primary care clinics of the Mexican Institute for Social Security. We analyzed these factors: (1) sociodemographic: age, education, schooling, distance between home and clinic; (2) psychosocial: social support; (3) obstetric and gynecologic: number of pregnancies, type of delivery, presence of comorbidity and suspected depression, and (4) health services: deficient prenatal control and incomplete postpartum hospital care. We performed multiple Poisson regression with a robust variance. Results: 49.5% of women had postnatal control. Factors associated with a higher probability of lack of postnatal control were: distance ≥ 5 km between home and clinic (adjusted prevalence ratio [aPR] 1.48, 95% confidence interval [95% CI] 1.16-1.88, p = 0.001), poor prenatal care (aPR 1.21, 95% CI 1.001-1.46, p = 0.049), and incomplete postpartum care (aPR 1.42, 95% CI 1.23-1.63, p < 0.001). Conclusions: The low attendance of postnatal care in primary care clinics highlights the need to seek and implement feasible healthcare alternatives, such as home care or telemedicine, to women who cannot attend to postnatal consultations.

Introducción: el control posnatal es esencial para identificar y tratar oportunamente las afecciones de salud de la mujer en el puerperio. En México no se han documentado los factores que limitan la atención posnatal. Objetivo: identificar los factores asociados a la falta de control posnatal. Material y métodos: estudio transversal con 202 mujeres en edad reproductiva adscritas a seis clínicas de atención primaria del Instituto Mexicano del Seguro Social. Analizamos los siguientes factores: (1) sociodemográficos: edad, escolaridad, distancia entre domicilio y clínica de atención; (2) psicosociales: apoyo social; (3) ginecoobstétricos: número de embarazos, tipo de parto, presencia de comorbilidad y sospecha de depresión; (4) servicios de salud: control prenatal deficiente y atención hospitalaria posparto incompleta. El análisis incluyó regresión múltiple de Poisson con varianza robusta. Resultados: 49.5% de las mujeres acudieron a control posnatal. Los factores asociados con mayor probabilidad de falta de control prenatal fueron: distancia ≥ 5 km entre domicilio y clínica de atención (razones de prevalencia ajustadas [RPa] 1.48, intervalo de confianza del 95% [IC 95%] 1.16-1.88, p = 0.001), control prenatal deficiente (RPa 1.21, IC 95% 1.001-1.46, p = 0.049) y atención posparto incompleta (RPa 1.42, IC 95% 1.23-1.63, p < 0.001). Conclusiones: la baja asistencia a control posnatal en las clínicas de atención primaria destaca la necesidad de buscar e implementar alternativas factibles, como teleasistencia y consultas a domicilio, para facilitar que las mujeres que viven lejos de su clínica de atención primaria reciban atención posnatal.

Perception of risk and impact of the COVID-19 pandemic on patients with rheumatic diseases: a case-control study.

OBJECTIVES: Risk perception of the COVID-19 pandemic may affect chronic disease outcomes among patients with rheumatic diseases (RD). To describe and compare the perception of risk and effects of the COVID-19 pandemic on patients with RD from two health care centers compared with a control group. METHODS: A retrospective case-control study was conducted. Patient respondents completed an online survey to measure risk perception and effects of the COVID-19 pandemic. The case group consisted of patients with a confirmed diagnosis of RD, coming from two third-level health care centers. The control group was a population group without RD from a public university. RESULTS: A total of 3944 participants were included: 986 patients with an RD (cases) from the two hospital centers and 2958 controls without RD. A greater perception of risk severity and perception of contagion was observed in the group of patients with RD, OR: 1.70, 95% CI 1.44‒2.01 and OR: 2.0, 95% CI 1.79‒2.23, respectively; more significant deterioration in family life OR: 1.14, 95% CI 1.01‒1.29; greater economic impact, OR 3.94, 95% CI 3.48‒4.46; as well as negative emotions and feelings (alarmed, anxiety, depression, confusion, fear, isolation, and discrimination). This impact was maintained when the model was adjusted for comorbidities. CONCLUSION: In the face of an unexpected and catastrophic event such as the COVID-19 pandemic, patients with RD report apparently greater impact on their mental state and economic situation than the control population, as well as increased perception of discrimination. Key Points • The multidisciplinary analyses of risk perception are required to promote actions that can enhance the preparedness and responses of public efforts for possible future pandemics in a way that considers the specific needs of vulnerable people like patients with rheumatic diseases. • Identifying risk perceptions of possible effects of the pandemic, sources of communication, and opinions is essential to ensure self-care in rheumatic disease. • The impact of COVID-19 has been much greater for people with rheumatic disease, especially in terms of the perceived severity of the pandemic, impacts on family and economy, preventive behaviors, and uncertainty.

Heterogeneity of COVID-19 Risk Perception: A Socio-Mathematical Model.

The perception of risk has been a key element in the experiences, containment and differential impact of the COVID-19 pandemic worldwide. The complexity of this phenomenon requires the interdisciplinary integration of theoretical and methodological aspects, as this integration informs the objective of developing a mathematical proposal based on a conceptual model located within the social theory of risk at the micro-social level. The mathematical risk model used here was developed from a secondary analysis of a study of 12,649 individuals on the experiences of the COVID-19 pandemic in a population in which the quantity and quality of the information made it possible to define a risk factor and its relationship to emotions and the sources of information used. Four sequential strategies were used to construct the model: choosing the variables for the questionnaire that theoretically corresponded to the conceptual model, constructing the risk vector and initial grouping of individuals by perception of risk, modeling by using principal component analysis and applying network methods. The theoretical model of risk, proposed and constructed through the analysis of groupings by quartiles and by networks in the studied population from a social and mathematical perspective, demonstrates the heterogeneity of risk perception as manifested by differences in perception by age, gender, expression of feelings and media consulted in a university community. The knowledge and methodology generated in these analyses contribute to the body of knowledge informing the response to future epidemiological contingencies.

Psychometric validation of a Patient-Centred Quality of Cancer Care Questionnaire in Mexico.

OBJECTIVES: To develop and validate a Patient-Centred Quality of Cancer Care Questionnaire in Spanish (PCQCCQ-S) appropriate to the Mexican context. DESIGN: Psychometric validation of a questionnaire. SETTING: Two public oncology hospitals in Mexico City. PARTICIPANTS: 1809 patients with cancer aged ≥18 years. SOURCE OF INFORMATION: Cross-sectional survey. METHODS: The validation procedures comprised (1) content validity through a group of experts and patients; (2) item reduction and evaluation of the factor structure, through an exploratory factor analysis based on the polychoric correlation matrix; (3) internal consistency using Cronbach's alpha; (4) convergent validity between the PCQCCQ-S and supportive care needs scale; (5) correlation analysis between the PCQCCQ-S and quality of life scale by calculating Spearman's rank-correlation coefficient; and (6) differentiation by 'known groups' through the Wilcoxon rank-sum test. RESULTS: The PCQCCQ-S has 30 items with the following five factors accounting for 96.5% of the total variance: (1) timely care; (2) clarity of the information; (3) information for treatment decision-making; (4) activities to address biopsychosocial needs; and (5) respectful and coordinated care. Cronbach's alpha values ranged from 0.73 to 0.90 among the factors. PCQCCQ-S has moderate convergent validity with supportive care needs scale, revealing that higher quality is correlated with lower patient needs. PCQCCQ-S has acceptable ability to differentiate by 'known groups', showing that older patients and those with low levels of education perceived lower total quality of care as compared with their counterparts. CONCLUSION: PCQCCQ-S has acceptable psychometric properties and can be used to measure quality of patient-centred cancer care in Mexico and serve as a reference to develop PCQCCQ-S in other Spanish-speaking countries.

Delay of medical care for symptomatic breast cancer: a literature review.

The purpose of this paper is to organize and summarize existing information on delayed medical attention for women with breast cancer and identify research needs in this area. This review is organized in six parts: origins and permanence of the message 'do not delay' medical attention for potential cancer symptoms; definition and classification of breast cancer delay; impact of delay on breast cancer prognosis; factors related to breast cancer delay and the ways these have been studied; the study of breast cancer delay in Mexico; and directions for future research in developing countries, with a special focus on Mexico. We point out the need of a more integral study of delay that takes into account socio-structural and health services factors, in order to find modifiable factors towards which political actions should be directed to improve breast cancer medical attention in underdeveloped countries.

Barriers and opportunities to improve the foundations for high-quality healthcare in the Mexican Health System.

This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated. We used thematic content and descriptive analyses to analyse the data. We found that QoC foundations, evaluation and improvement activities pose essential challenges for the Mexican health sector. Governance for QoC is weakly aligned across MoH, IMSS and ISSSTE. Each institution follows its own agenda of evaluation and improvement programmes and has distinct QoC indicators and information systems. The institutions share similar barriers to strengthening QoC: poor organizational structure at a facility level, scarcity of financial resources, lack of training in QoC for executive/managerial staff and health professionals and limited public participation. In conclusion, a stronger legal framework and policy dialogue is needed to foster governance by the MoH, to define and align health sector-wide QoC policies, and to set common goals and articulate QoC improvement actions among institutions. Robust QoC organizational structure with designated staff and clarity on their responsibilities should be established at all levels of healthcare. Investment is necessary to fund formal and in-service QoC training programmes for health professionals and to reinforce quality evaluation and improvement activities and quality information systems. QoC evaluation results should be available to healthcare providers and the population. Active public participation in the design and implementation of improvement initiatives should be strengthened.

Factores asociados a la falta de control posnatal materno / Factors associated with a lack of postnatal care

Introducción: el control posnatal es esencial para identificar y tratar oportunamente las afecciones de salud de la mujer en el puerperio. En México no se han documentado los factores que limitan la atención posnatal. Objetivo: identificar los factores asociados a la falta de control posnatal. Material y métodos: estudio transversal con 202 mujeres en edad reproductiva adscritas a seis clínicas de atención primaria del Instituto Mexicano del Seguro Social. Analizamos los siguientes factores: (1) sociodemográficos: edad, escolaridad, distancia entre domicilio y clínica de atención; (2) psicosociales: apoyo social; (3) ginecoobstétricos: número de embarazos, tipo de parto, presencia de comorbilidad y sospecha de depresión; (4) servicios de salud: control prenatal deficiente y atención hospitalaria posparto incompleta. El análisis incluyó regresión múltiple de Poisson con varianza robusta. Resultados: 49.5% de las mujeres acudieron a control posnatal. Los factores asociados con mayor probabilidad de falta de control prenatal fueron: distancia ≥ 5 km entre domicilio y clínica de atención (razones de prevalencia ajustadas [RPa] 1.48, intervalo de confianza del 95% [IC 95%] 1.16-1.88, p = 0.001), control prenatal deficiente (RPa 1.21, IC 95% 1.001-1.46, p = 0.049) y atención posparto incompleta (RPa 1.42, IC 95% 1.23-1.63, p < 0.001). Conclusiones: la baja asistencia a control posnatal en las clínicas de atención primaria destaca la necesidad de buscar e implementar alternativas factibles, como teleasistencia y consultas a domicilio, para facilitar que las mujeres que viven lejos de su clínica de atención primaria reciban atención posnatal

Background: Postnatal care is essential to identify and treat at the appropriate time adverse health events in the puerperium. In Mexico, the factors that affect postnatal care have not been documented. Objective: To identify the factors associated with the lack of postnatal care. Material and methods: Cross-sectional study of 202 women of reproductive age affiliated with six primary care clinics of the Mexican Institute for Social Security. We analyzed these factors: (1) sociodemographic: age, education, schooling, distance between home and clinic; (2) psychosocial: social support; (3) obstetric and gynecologic: number of pregnancies, type of delivery, presence of comorbidity and suspected depression, and (4) health services: deficient prenatal control and incomplete postpartum hospital care. We performed multiple Poisson regression with a robust variance. Results: 49.5% of women had postnatal control. Factors associated with a higher probability of lack of postnatal control were: distance ≥ 5 km between home and clinic (adjusted prevalence ratio [aPR] 1.48, 95% confidence interval [95% CI] 1.16-1.88, p = 0.001), poor prenatal care (aPR 1.21, 95% CI 1.001-1.46, p = 0.049), and incomplete postpartum care (aPR 1.42, 95% CI 1.23-1.63, p < 0.001). Conclusions: The low attendance of postnatal care in primary care clinics highlights the need to seek and implement feasible healthcare alternatives, such as home care or telemedicine, to women who cannot attend to postnatal consultations

Comparison between Covid-19 and influenza A(H1N1) pandemic experiences and risk perception in a Mexican university / Experiencias y percepción de riesgo ante la influenza A(H1N1) y Covid-19 en universitarios mexicanos

Abstract: Objective: To compare the perceptions and experiences between the A(H1N1) and Covid-19 pandemics in a university population. Materials and methods: Online surveys were administered during the influenza A(H1N1) -originated in Mexico in 2009- and Covid-19 epidemics. Measures: sociodemographic characteristics, knowledge, information and communication, perception of risk, physical and mental health, effects on daily life, and preventive behaviors. Results: This study included 24 998 respondents, 51.36% from the A(H1N1) group and 48.63% from the Covid-19 group. Differences were observed in the perception of severity. During the influenza A(H1N1) pandemic worry was the feeling reported most frequently, while for Covid-19 it was anxiety. Covid-19 had greater impact on students' family economy and caused a higher uncertainty. Conclusions: The perceptions and experiences of the two pandemics were similar but the impact has been much greater for Covid-19, especially in terms of the severity, family economy, preventive behaviors, and uncertainty.

Resumen: Objetivo: Comparar las experiencias y percepciones de riesgo entre las pandemias de A(H1N1) y Covid-19 en universitarios. Material y métodos: Encuestas en línea comparables de las epidemias de influenza A(H1N1) -originada en México en 2009- y Covid-19. Evaluaciones: características sociodemográficas, conocimientos, información y comunicación, percepción de riesgo, salud física y mental, efectos en la vida cotidiana, conductas preventivas. Resultados: Participaron 24 998 sujetos; 51.36% de grupo de A(H1N1) y 48.63% del grupo de Covid-19. Se observaron diferencias en la percepción de las epidemias. En influenza A(H1N1) la preocupación fue el sentimiento más frecuente y para Covid-19, la ansiedad. En Covid-19 hubo mayor impacto en la economía familiar y mayor incertidumbre para el regreso a clases. Conclusión: Las percepciones y experiencias de las dos pandemias fueron similares, pero el impacto ha sido mucho mayor para Covid-19 especialmente en la gravedad, economía familiar, conductas preventivas y en la incertidumbre.