The intersection of immigration policy impacts and COVID-19 for Latinx young adults.

For many Latinx young adults, COVID-19 has exposed exclusionary policies that heighten risk for contracting the virus and that leave them and their parents unprotected. This study has a dual purpose; first, to quantitatively examine immigration policy impacts of discrimination, isolation, threats to family, and vulnerability, and their association to economic consequences experienced by Latinx young adults in Central Texas during the initial months of the COVID-19 pandemic. Second, to qualitatively explore how policy impacts affected Latinx young adults during the pandemic, and the coping mechanisms they utilized to minimize these impacts. Quantitative results show that on average, Latinx young adults (N = 83) reported low discrimination and isolation but moderate threats to family and vulnerability, with rates of isolation and vulnerability higher for foreign-born than U.S.-born Latinx young adults. Perceived discrimination due to one's own or family immigration status was associated with economic hardship. Qualitative findings show that Latinx young adults (n = 21) experienced (a) precarious conditions that pose a threat of COVID-19 infection for Latinxs, (b) parental job loss due to vulnerable employment leads to deprivation, and (c) policies that disproportionally discriminate against the Latinx community and exclude them from vital services. Despite these challenges, participants also drew on resilience and expressed hope for the future. The article concludes with implications for policymakers and practitioners to provide protections and services to Latinx young adults and their family members.

Loss of job-related right to healthcare is associated with reduced quality and clinical outcomes of diabetic patients in Mexico.

OBJECTIVES: The Mexican Institute of Social Security (IMSS) provides a package of health, economic and social benefits to workers employed in private firms within the formal labour market and to their economic dependants. Affiliates have a right to these benefits only while they remain contracted, thus posing a risk for the continuity of healthcare. This study evaluates the association between the time (in days) without the right to healthcare due to job loss in the formal labour market and the quality of healthcare and clinical outcomes among IMSS affiliates with Type 2 diabetes mellitus (T2DM). DESIGN: Retrospective cohort study 2013-2015. SETTING: Six IMSS family medicine clinics (FMC) in Mexico City. PARTICIPANTS: T2DM patients (n = 27 217) affiliated with job-related health insurance and at least one consultation with a family doctor during 2013. SOURCE OF INFORMATION: IMSS affiliation department database and electronic health records and clinical laboratory databases. MAIN OUTCOME MEASURE(S): Quality of the processes (eight indicators) and outcomes (three indicators) of healthcare. RESULTS: The results indicated that losing IMSS right to healthcare is frequent, occurring to one-third of T2DM patients during the follow-up period. The time without the right to healthcare in the observed period was of 120 days on average and was associated with a 43.2% loss of quality of care and a 19.2% reduction in clinical outcomes of T2DM. CONCLUSION: Policies aimed at ensuring access and continuity of care, regardless of job status, are critical for improving the quality of processes and outcomes of healthcare for diabetic patients.

Measuring health inequities in low and middle income countries for the development of observatories on inequities and social determinants of health.

BACKGROUND: Almost seven years after the publication of the final report of the World Health Organization's Commission on Social Determinants of Health (CSDH), its third recommendation has not been attended to properly. Measuring health inequities (HI) within countries and globally, in order to develop and evaluate evidence-based policies and actions aimed at the social determinants of health (SDH), is still a pending task in most low and middle income countries (LMIC) in the Latin American region. In this paper we discuss methodological and conceptual issues to measure HI in LMIC and suggest a three-stage methodology for the creation of observatories on health inequities (OHI) and social determinants of health, based on the experience of the Brazilian Observatory on Health Inequities (BOHI) that has been successfully operating since 2010 at the Fundação Oswaldo Cruz (FIOCRUZ). METHODS: A three-stage methodology for the creation of an OHI was developed based on a literature review on the following topics: SDH, HI measurement, and the process of setting-up of health observatories; followed by semi-structured interviews with key informants from the BOHI. We describe the three stages and discuss the replicability of this methodology in other Latin American countries. We also carried out a search of suitable national information systems to feed an OHI in Mexico, along with an outline of the institutional infrastructure to sustain it. RESULTS: When implementing the methodology for an OHI in LMIC such as Mexico, we found that having strong infrastructure of information systems for measuring HI is required, but not sufficient to build an OHI. Adequate funding and intersectoral network collaborations lead by a group of experts is a requirement for the consolidation and sustainability of an OHI in LMIC. CONCLUSION: According to the described methodology, and the available information systems on health, the creation of an OHI in LMIC, particularly in Mexico, is plausible in the near future. However, institutional support (in academic, financial, and policymaking terms) is essential to materialize such needed instance, thus locally contributing to attain health equity.

SDH-NET: a South-North-South collaboration to build sustainable research capacities on social determinants of health in low- and middle-income countries.

BACKGROUND: It is desirable that health researchers have the ability to conduct research on health equity and contribute to the development of their national health system and policymaking processes. However, in low- and middle-income countries (LMICs), there is a limited capacity to conduct this type of research due to reasons mostly associated with the status of national (health) research systems. Building sustainable research capacity in LMICs through the triangulation of South-North-South (S-N-S) collaborative networks seems to be an effective way to maximize limited national resources to strengthen these capacities. This article describes how a collaborative project (SDH-Net), funded by the European Commission, has successfully designed a study protocol and a S-N-S collaborative network to effectively support research capacity building in LMICs, specifically in the area of social determinants of health (SDH); this project seeks to elaborate on the vital role of global collaborative networks in strengthening this practice. METHODS: The implementation of SDH-Net comprised diverse activities developed in three phases. Phase 1: national level mapping exercises were conducted to assess the needs for SDH capacity building or strengthening in local research systems. Four strategic areas were defined, namely research implementation and system performance, social appropriation of knowledge, institutional and national research infrastructure, and research skills and training/networks. Phase 2: development of tools to address the identified capacity building needs, as well as knowledge management and network strengthening activities. Phase 3: identifying lessons learned in terms of research ethics, and how policies can support the capacity building process in SDH research. RESULTS: The implementation of the protocol has led the network to design innovative tools for strengthening SDH research capacities, under a successful S-N-S collaboration that included national mapping reports, a global open-access learning platform with tools and resources, ethical guidelines for research, policy recommendations, and academic contributions to the global SDH discourse. CONCLUSIONS: The effective triangulation of S-N-S partnerships can be of high value in building sustainable research capacity in LMICs. If designed appropriately, these multicultural, multi-institutional, and multidisciplinary collaborations can enable southern and northern academics to contextualize global research according to their national realities.

[A first analysis of research on social determinants of health in Mexico: 2005-2012]. / Un primer análisis de la investigación en México sobre los determinantes sociales de la salud: 2005-2012.

OBJECTIVE: To examine the research on social determinants of health (SDH) produced in Mexico during the period 2005-2012, based on the characterization of the national health research system and the scientific production on this topic. MATERIALS AND METHODS: Two-stage analyses: Review of Mexican documents and official sources on health research and systematic bibliographic review of the literature on SDH. RESULTS: Although SDH were mentioned in the Specific Action Plan for Health Research 2007-2012, they are not implemented in strategies and goals, as the emphasis is put mostly in infrastructure and administrative aspects of research. In the period studied, 145 articles were published on SDH topics such as health conditions, health systems and nutrition and obesity. CONCLUSIONS: In spite of the availability of research on SDH in Mexico, the operationalization of such findings into health policies has not been possible. The current Sectorial Program on Health 2013-2018 represents a window of opportunity to position research findings that promote health equity policies.

Global Health Diplomacy (GHD) and the integration of health into foreign policy: Towards a conceptual approach.

Since the end of the Cold War, health has gone from a peripheral concern in foreign policy negotiations to a prominent place on the global political agenda. While the rise of health onto the foreign policy agenda is by now old news, the driving forces behind its expansion into new political spheres remain understudied and undertheorized. This article builds on empirical findings from a four-country study of the integration of health into foreign policy, and proposes a conceptual approach to GHD to improve understanding of the conditions under which health is successfully positioned on the foreign policy agenda. Our approach consists of three dimensions: features of institutions and the interest various actors represent in GHD; the ideational environment in which GHD operates; and issue characteristics of the specific health concern entering foreign policy. Within each dimension, we identify specific variables that, in combination, make up the explanatory power of the proposed approach. The proposed approach does not relate to, or build upon, a single social sciences, public health, or international relations (IR) theory, but can be seen as a heuristic device to identify dimensions and variables that may shape why certain health issues rise onto the foreign policy agenda.

Occupational Stress and Mental Health Among Healthcare Workers Serving Socially Vulnerable Populations During the COVID-19 Pandemic.

The purpose of this study was to analyze occupational and personal stressors, mental health indicators, perceived discrimination and help-seeking behaviors among healthcare workers and providers (HCWPs) serving socially vulnerable groups such as immigrants, refugees, farmworkers, homeless individuals, people living in poverty, and other disadvantaged populations in the United States (U.S.) during the COVID-19 pandemic. Using a cross-sectional descriptive approach, we gathered information between July and September 2020, from a sample of 407 affiliates of two national organizations of clinic-based HCWPs who worked at federally funded and community safety-net clinics. Informed consent was obtained from all participants who completed a self-administered online survey available in English and Spanish. Our results indicated that the HCWPs serving vulnerable groups in the midst of the pandemic experienced high levels of occupational and personal stressors as well as anxiety and depressive symptomology. Major occupational stressors were excessive workload, long working-hours, and institutional barriers to refer and follow-up on their clients' access to needed social services. High-rated personal stressors included sleep disorders, lack of and child-care, partner's loosing job, and other family related situations. Our findings suggest that HCWPs working with vulnerable populations need specialized interventions that bolster their mental health and well-being as the pandemic continues to unfold. We recommend implementing initiatives that encourage HCWPs' to be actively involved in clinic decisions regarding employee safety and protection as well as in management decisions to improve work place infrastructure and capacity to respond to the social needs of their clients. Lessons learned from the pandemic are useful tools in designing protocols for addressing the mental-health needs of HCWPs in health-care organizations that attend to socially underprivileged populations.

The Transformative Potential of Strategic Partnerships to Form a Health Equity Network of the Americas.

Health inequities across the Americas are avoidable and unjust yet continue to persist. Systemic social determinants of health, which could be addressed at the policy level, are root causes of many inequities and prevent marginalized individuals and at-risk populations from reaching optimal health and well-being. In this article, we describe our approach to promote health equity through the intersectoral partnerships that were forged, and strategies that were shared, during the convening entitled "Summit 2017: Health Equity in the Americas" and the resulting emergence of the Health Equity Network of the Americas (HENA). We illustrate how this international network will raise awareness of policies and programs to inform decision makers about actions they can take to put an end to the unjust, persistent and mostly avoidable health inequities facing the Americas today.

[Accidental injuries in older adults: a challenge for the health systems]. / Lesiones accidentales en adultos mayores: un reto para los sistemas de salud.

OBJECTIVE: To identify factors (sociodemographic, health, and social support) associated with the presence of accidental injuries in older adults living in deprived urban neighborhoods in four Mexican municipalities. MATERIAL AND METHODS: Cross-sectional survey carried out in 2004-2005, with a non-probabilistic, intentional sample of 799 male and female elderly living in deprived urban areas in four Mexican municipalities. For the statistical analysis, non-parametric tests and multivariate logistic regression models were used. RESULTS: More than a third (37%) of the sample reported injuries; with falls being the main cause. Home was the venue where most accidents took place (52%). Risk factors for accidental injuries were: advanced age, working, greater number of illnesses, consumption of more medicines and remedies, self-perception of "poor" health , consumption of alcoholic beverages, inadequate family support and being a caretaker of others. CONCLUSIONS: The multi-causality of accidental injuries in older adults demands the participation of all sectors of society, and particularly public health interventions.

Well-being and family support among elderly rural Mexicans in the context of migration to the United States.

OBJECTIVE: To explore perceptions of well-being, family support, and economic resources in relation to level of contact with migration to the U.S. among a sample of elderly males from rural Mexico. METHOD: The snowballing technique was used to obtain a sample of 372 participants. Four groups were created according to the level of contact with migration among older adults and their children. RESULTS: Greater level of contact with migration was associated with a higher likelihood that an older adult was literate, married or living with someone, self-employed, and retired or pensioned. In addition, greater level of contact with migration to the U.S. was associated with a higher level of perceived well-being, family support, and economic security. DISCUSSION: Elderly, rural Mexican men with a greater degree of contact with migration to the U.S. seem to have more security and well-being in their old age.

Association between migration and physical activity of school-age children left behind in rural Mexico.

OBJECTIVES: The purpose of this study was to explore in rural communities of Mexico, the association between physical activity (PA) in school-age children and exposure to migration. METHODS: We measured PA through a questionnaire validated in school-age children and used in Mexican National Surveys. Migration status was measured as the number of years a family member had been in the US, and the amount of remittances that family member had sent to their household in Mexico. We used multivariable linear regression to measure the association between physical activity and migration. RESULTS: School-age children who had a migrant family member spent less time on PA per day, especially recreation activities, compared to school-age children without the migrating influence. Also, children who belonged to a family that received remittances and their migrant relative lived ≥ 5 years in US were less likely to engage in PA. CONCLUSIONS: Exposure to migration may predict reduction in PA in school-age children left behind in Mexican rural communities from the State of Morelos. These findings call for PA-tailored interventions that consider household migration characteristics.

Un primer análisis de la investigación en México sobre los determinantes sociales de la salud: 2005-2012 / A first analysis of research on social determinants of health in Mexico: 2005-2012

Objetivo. Examinar la investigación hecha en México sobre los determinantes sociales de la salud (DSS) durante el periodo 2005-2012 con base en la caracterización del sistema nacional de investigación en salud y la producción científica sobre este tema. Material y métodos. Análisis en dos etapas: revisión documental de fuentes oficiales sobre investigación en salud en México y búsqueda sistemática de literatura sobre DSS. Resultados. Los DSS fueron mencionados en el Programa de Acción Específico de Investigación en Salud 2007-2012, pero no figuran en las estrategias y objetivos; en su lugar, se enfatizan primordialmente aspectos de infraestructura y administrativos. En el periodo se publicaron 145 artículos sobre DSS, cuyas temáticas más abordadas fueron "condiciones de salud", "sistemas de salud" y "nutrición y obesidad". Conclusiones. A pesar de que existe investigación en México sobre DSS, la instrumentación de esos hallazgos en políticas de salud no se ha implementado. El Programa Sectorial de Salud 2013-2018 representa una ventana de oportunidad para posicionar resultados de investigación que promuevan políticas de equidad en salud.

Objective. To examine the research on social determinants of health (SDH) produced in Mexico during the period 2005-2012, based on the characterization of the national health research system and the scientific production on this topic. Materials and methods. Two-stage analyses: Review of Mexican documents and official sources on health research and systematic bibliographic review of the literature on SDH. Results. Although SDH were mentioned in the Specific Action Plan for Health Research 2007-2012, they are not implemented in strategies and goals, as the emphasis is put mostly in infrastructure and administrative aspects of research. In the period studied, 145 articles were published on SDH topics such as health conditions, health systems and nutrition and obesity. Conclusions. In spite of the availability of research on SDH in Mexico, the operationalization of such findings into health policies has not been possible. The current Sectorial Program on Health 2013-2018 represents a window of opportunity to position research findings that promote health equity policies.

Aplicación del análisis estadístico de datos censurados para el manejo de respuestas incompletas en la escala CES-D / Application of censored-data analysis for managing CES-D incomplete responses

Purpose To provide an example of censored data analysis in the management of CED-S missing data, using a data set of a study conducted with Mexican rural women. Material and Methods Data used for this exercise were collected in a cross-sectional study with 416 women in the Mexican region known as the Mixteca Baja. Using a Survival Analysis (SA) focus we present a general description of the scores, along with the estimation of association patterns between those scores and the independent variables departing from Cox's proportional risk model. A comparison is made of these results and those obtained through a regression analysis. Results Using only the information from observations with complete data, the average CES-D score was 11.0 and the prevalence of symptoms above the cut-off point (16) was 23.2%. Twenty-six percent of the women did not respond to at least one item. When conducting the SA, the estimated mean score of the scale was 14.0. Survival above the cut-off point corresponded to an estimated prevalence of 21%. Conclusions SA is useful in the management of data sets with missing data in scales such as the CES-D. In this example, the increased percentage of observations with missing data produced a loss of precision in the estimators. The differences in mean item scores between observation with complete and incomplete data suggested a non-random, no-response pattern, if this is not taken into consideration it could bias the estimation in the scale mean and its association with other variables. Conducting SA we were able to use the information of most women participating in the study, including those who did not respond to all items in the scale.

Objetivo Ejemplificar el uso del análisis de datos censurados en el manejo de datos incompletos de la CES-D utilizando una base de datos de un estudio con mujeres rurales de México. Material y Método Los datos analizados se recogieron en un estudio transversal con 416 mujeres de la Mixteca Baja, al sur de México. Con un enfoque de Análisis de Supervivencia (AS), se presenta una descripción general del comportamiento de las puntuaciones de la CES-D junto con la estimación de patrones de asociación entre esos puntajes y variables independientes a partir del modelo de riesgos proporcionales de Cox, y se hace una comparación entre estos resultados y los obtenidos de un modelo de regresión lineal. Resultados Utilizando sólo la información de las observaciones con datos completos, la puntuación promedio de la CES-D fue de 11.0 y la preva-lencia de síntomas por arriba del punto de corte (16) fue de 23.2%. El 25.2% de las mujeres no contestó al menos un reactivo. Al hacer el AS, el promedio estimado de la puntuación fue de 14.8. La supervivencia por encima del punto de corte corresponde a una prevalencia estimada del 21%. Conclusiones El AS es útil en el manejo de bases que presentan datos faltantes por ejemplo en escalas como CES-D. En nuestro ejemplo, el elevado porcentaje de observaciones con respuestas faltantes ocasionó una pérdida de precisión en los estimadores. Las diferencias de puntuaciones promedio por reactivo entre observaciones con datos perdidos y completos sugieren un patrón de no-respuesta que no es aleatorio, y que de no tomarse en cuenta podría sesgar la estimación, tanto del promedio de la escala como de su asociación con otras variables. El AS utilizó la información de casi la totalidad de las participantes en el estudio incluyendo aquellas que no respondieron todos los reactivos de la escala.

[Violence scale and severity index: a methodological proposal for measuring violence by the partner in Mexican women]. / Escala de violencia e indice de severidad: una propuesta metodológica para medir la violencia de pareja en mujeres mexicanas.

OBJECTIVE: To construct and validate a scale to assess violence by the male partner against women. An index of severity of the emotional and physical damage was also designed to assess the intensity of the violent actions against women. MATERIAL AND METHODS: The sample consisted of a total of 26 042 women who participated as respondents in the National Survey on Violence against Women (ENVIM per its abbreviation in Spanish) conducted in Mexico during 2003. Respondents were all users of health services provided by the Mexican government. The questionnaire was organized into 17 sections, one of which was a 27-item scale to assess partner violence. The purpose of this scale was to measure the type (physical, emotional, sexual and financial) and degree of violence based on severity. A severity index was constructed based on two procedures: 1) the validity, reliability, and factor analyses of the scale and 2) the assessment of severity by expert judges who assigned a value to each item of the scale. RESULTS: The validity and reliability results indicated this scale has adequate internal validity (Cronbach's Alpha = 0.99). The factor analysis with Varimax rotation yielded a four-factor solution. The factors were: 1) Psychological violence; 2) Physical violence; 3) Severe physical violence; and 4) Sexual violence. The combination of the four factors accounted for 62.2% of the variance in the scale. Using the ratings from the judges a table of values for each of the violent actions described was obtained. The scores assigned by the judges ranged from 0 to 354. Results revealed a prevalence of 21% partner violence in the last twelve months. The prevalence of psychological violence was 18.5%; of physical violence 10.1%; severe physical violence 6.7% and sexual violence 7.0%. CONCLUSION: The scale of violence described in this article is a very useful and reliable instrument to assess marital violence against women. It is suggested that this instrument be used in other settings to compare results with different samples.

[Gender violence and other factors associated with emotional distress in female users of public health services in Mexico]. / Violencia de género y otros factores asociados a la salud emocional de las usuarias del sector salud en México.

OBJECTIVE: To identify and describe the factors associated with emotional distress in a national sample of women users of public health services in Mexico, such a Secretaria de Salud (SSA), Instituto Mexicano del Seguro Social (IMSS), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE). MATERIAL AND METHODS: This research study was conducted using the database of the National Survey of Violence against Women that consisted of the responses of a total of 26 042 female users of health care services provided by the Mexican government health agencies. The Personal Health Scale (ESP per its initials in Spanish) was used to assess emotional distress. To measure violence a 19-item scale which explores different types of violence as well as severity was used. The relationship between emotional distress and gender violence was determined through a binary logistic regression model, as were economic status and demographic variables. RESULTS: One of the most important findings of this study is the high prevalence of emotional distress (15.3%) among women seeking health care services from the public sector and the relationship of such emotional distress with the experience of marital physical, psychological, and sexual violence. Factors associated with emotional distress among female users of health care services were age (26 and older); activity (laborer); working hours (71 hours a week or more); alcohol intake (greater intake); abuse during childhood (frequency and types of abuse); severity of marital violence (severe violence); socioeconomic status (very low SES); and type of dwelling (urban). CONCLUSIONS: The principal predictor of emotional distress was intimate partner abuse, especially in severe expression. The next predictor was violence in childhood. Taking into consideration these predictors it is recommended to use screening instruments to identify emotional distress and gender violence in health setting. It is important to design and implement attention and reference programs in public health services for women suffering from emotional distress and gender violence.

["Damage, not age, is what makes a person old": ageing and health in rural males]. / "No hacen viejos los años, sino los daños": envejecimiento y salud en varones rurales.

OBJECTIVE: To analyze the social factors associated with the health status of elderly men, 60 years and older, who live in poverty in the rural areas of Mexico. MATERIAL AND METHODS: A cross-sectional, descriptive study was conducted between February and October 2002, in a convenience sample of 392 elderly men residing in rural areas of the states of Guerrero, Morelos and Jalisco states. A validated questionnaire was applied to collect data on sociodemographic characteristics, general wellbeing, health problems, food consumption, and some indicators of mental health, personal strength and social support. Data analysis was performed with the SPSS v. 11. software, to obtain chi-squared tests; food intake measures were analized with one-way ANOVA. RESULTS: Study subjects were married or were widowers and had six children on average. A higher proportion of the elderly men of Morelos state reported to have suffered more illnesses and a higher consumption of alcohol when compared to the other two state groups. Sixty percent of the men in the study used both home remedies and medication for their health problems. More than one half of them did not receive adequate social support from their families. CONCLUSIONS: The results of this study suggest that the process of ageing among rural elderly men is perceived as a burden, mainly because of the context of poverty in which they live. The lack of appropriate income and access to health services through adequate pension and retirement plans for the elderly poor is a problem that requires immediate attention.

[A model for integrating mental health care resources in the rural population of Mexico]. / Modelo de integración de recursos para la atención de la salud mental en la población rural de México.

OBJECTIVE: The purpose of this project was to identify behaviors of health service utilization to solve mental health-related problems among rural inhabitants of Mexico. A model of pathways to mental health services was built. Based on this model, an integration-intervention model is proposed to help improve access to mental health services and their quality. MATERIAL AND METHODS: In 1997, in-depth interviews were conducted among 21 adults (9 men and 12 women) and seven healthcare providers, in a rural community in Jalisco, Mexico. Women's age ranged from 23 to 44 years; ten were married and two single. Men were between 30 and 74 years old; eight were married and one was a widower. Healthcare providers in the same community were: a priest, a general physician, a pharmacy clerk, two nurses, and two traditional healers. RESULTS: The pathways models suggest that the first attempt a person does to solve a symptom is self-care. When such strategies are not sufficient to relief the symptom, the person turns to the members of his/her social network for help, who in addition to providing information about remedies, offer their emotional and instrumental support. If after consulting the social network, the symptom is not relieved, the individual seeks help from other external resources, such as the members of the ethnomedical local system. Inhabitants of rural communities tend to seek help from physicians, only when the symptom persists and the suffering associated with it seems to be out of the individual's control, or if members of the social network or the ethno-medical local system refer the patient to the physician. Seeking help from a specialist in mental health (psychiatrist or psychologist) is quite improbable among the rural inhabitants of Mexico, mostly due to difficulties in accessing these services, such as geographical location, distance, transportation, cost, and cultural distance between the health providers and the patient. CONCLUSIONS: In order to conduct successful intervention programs that are culturally sensitive for rural inhabitants, it is necessary first, to have detailed information derived from research and second, the active participation of all human and institutional resources, from professionals and truly multi-disciplinary researchers, to educators, social, religious, political leaders, and members of the communities and local institutions. The proposed model of integration of personal and community resources for healthcare requires establishing programs that sensitize, inform, and train community members, as well as members the ethno-medical system and the formal heath system.

Low birth weight in Mexico: new evidence from a multi-site postpartum hospital survey.

OBJECTIVE: To identify factors related to cases of low birth weight among a sample of Mexican women. MATERIAL AND METHODS: The present analysis utilizes data from a post partum survey of 565 women implemented in eight different social security hospitals in western Mexico during 2001. Women giving birth to low weight infants (2.5 kgs) were oversampled and make up half of the sample. RESULTS: A series of logistic regression equations are presented that estimate the risk of low birth weight. Study findings indicate that, although behavioral factors appear to be highly significant in predicting the odds of low birth weight, socioeconomic and sociodemographic factors were found to be important in determining utilization of prenatal care. CONCLUSIONS: The key role of behavioral characteristics in determining low birth weight risk and the role of socioeconomic and sociodemographic factors in determining prenatal care usage highlights the need to improve prenatal care utilization by disadvantaged populations.

Lesiones accidentales en adultos mayores: un reto para los sistemas de salud / Accidental injuries in older adults: a challenge for the health systems

OBJETIVO: Identificar los factores sociodemográficos, de salud y apoyo social relacionados con las lesiones accidentales en adultos mayores residentes de colonias urbanas marginales de las ciudades de Cuernavaca, Chilpancingo, Guadalajara y Culiacán. MATERIAL Y MÉTODOS: En 2004-2005 se llevó a cabo un estudio transversal; mediante muestra no probabilística, se entrevistó a 799 adultos mayores; se emplearon pruebas no paramétricas y un modelo multivariado de regresión logística. RESULTADOS: Del total de entrevistas, 37 por ciento notificaron lesiones y la causa principal fueron las caídas (54 por ciento). El hogar fue el sitio con mayor número de accidentes (52 por ciento). Los factores de riesgo asociados fueron edad avanzada, trabajar, mayor número de enfermedades, mayor consumo de medicamentos, remedios y bebidas alcohólicas, percepción de "mala salud", apoyo familiar inadecuado y ser cuidador de otros. CONCLUSIONES: La multicausalidad obliga, por una parte, a que toda la sociedad participe y, por la otra, a la intervención del área de la salud para prevenir y atender el problema.

OBJECTIVE: To identify factors (sociodemographic, health, and social support) associated with the presence of accidental injuries in older adults living in deprived urban neighborhoods in four Mexican municipalities. MATERIAL AND METHODS: Cross-sectional survey carried out in 2004-2005, with a non-probabilistic, intentional sample of 799 male and female elderly living in deprived urban areas in four Mexican municipalities. For the statistical analysis, non-parametric tests and multivariate logistic regression models were used. RESULTS: More than a third (37 percent) of the sample reported injuries; with falls being the main cause. Home was the venue where most accidents took place (52 percent). Risk factors for accidental injuries were: advanced age, working, greater number of illnesses, consumption of more medicines and remedies, self-perception of "poor" health , consumption of alcoholic beverages, inadequate family support and being a caretaker of others. CONCLUSIONS: The multi-causality of accidental injuries in older adults demands the participation of all sectors of society, and particularly public health interventions.