HPV Self-Sampling in the Workplace: A Qualitative Study of Benefits, Barriers, and Opportunities for Improvement Perceived by Health Professionals and Managers.

AIM: To inform the implementation of Human Papillomavirus Self-Sampling (HPV-SS) in the workplace, we assessed the perspectives of healthcare professionals and managers on the benefits, barriers, and opportunities for improvement of a pilot program. METHODS: A qualitative descriptive study based on in-depth telephone interviews was conducted between June and August 2023. Data were analyzed through inductive thematic analysis. Fifteen health professionals from different companies and fifteen managers from the Mexican Institute of Social Security (IMSS) were interviewed. RESULTS: Participants identified several benefits of the HPV-SS, including ease of use, privacy, convenience, affordability, reduced workplace absences, and promotion of a prevention culture. However, there were also individual and organizational barriers to program implementation. The former consisted of women's concerns about collecting a reliable sample or injuring themselves, lack of confidence in the HPV test, fear of positive results, and discomfort caused by the brush used to collect the sample. Organizational barriers included failure to follow up on positive test results, lack of knowledge of program indicators, perceived negative impact on the established Pap smear cervical cancer screening indicator, and the lack of government regulations supporting HPV testing. To improve the program, participants suggested disseminating information through mass media campaigns and social networks, providing companies with additional support from IMSS preventive staff, extending the work hours of IMSS Family Medicine clinics, and training IMSS health staff on the follow-up of women with HPV test results. CONCLUSIONS: The study findings suggest potential areas for improvement in HPV-SS programs.

Users' perception of quality as a driver of private healthcare use in Mexico: Insights from the People's Voice Survey.

OBJECTIVE: The Mexican government has pursued multiple initiatives to improve healthcare coverage and financial protection. Yet, out-of-pocket health spending and use of private sector providers in Mexico remains high. In this paper, we sought to describe the characteristics of public and private healthcare users, describe recent visit quality across provider types, and to assess whether perceiving the public healthcare sector as poor quality is associated with private health sector use. METHODS AND FINDINGS: We analyzed the cross-sectional People's Voice Survey conducted from December 2022 to January 2023. We used Chi-square tests to compare contextual, individual, and need-for-care factors and ratings of most recent visits between users of public (social security and other public providers) and private sector providers (stand-alone private providers and providers adjacent to pharmacies). We used a multivariable Poisson regression model to assess associations between low ratings of public healthcare sources and the use of private care. Among the 811 respondents with a healthcare visit in the past year, 31.2% used private sources. Private healthcare users were more educated and had higher incomes than public healthcare users. Quality of most recent visit was rated more highly in private providers (70.2% rating the visit as excellent or very good for stand-alone private providers and 54.3% for pharmacy-adjacent doctors) compared to social security (41.6%) and other public providers (46.6%). Those who perceived public health institutions as low quality had a higher probability of seeking private healthcare. CONCLUSION: Users rated public care visits poorly relative to private care; at the population level, perceptions of poor quality care may drive private care use and hence out-of-pocket costs. Improving public healthcare quality is necessary to ensure universal health coverage.

Strengthening Essential Health Services Recovery Policy after the COVID-19 Pandemic. Evidence from the Mexican Institute of Social Security.

AIM: To evaluate the progress of the Mexican Institute of Social Security Recovery Policy (IMSS-RP) in addressing the decline in essential health services caused by the COVID-19 pandemic. METHODS: We analyzed eleven indicators of essential health services from 35 IMSS state delegations. The assessment included ambulatory and hospital care indicators such as breast and cervical cancer screening, family medicine, dental and specialty visits, diabetes and hypertension visits and health outcomes, deliveries, and elective surgeries. We analyzed the period before (January 2018-March 2021) and during (April 2021-June 2023) the implementation of the IMSS-RP. Statistical analysis to determine the association of the policy with service indicators and the change in their trends included an interrupted time series analysis and Poisson Generalized Estimating Equation models. RESULTS: The volume of services showed substantial declines during the first year of the COVID-19 pandemic, reaching between 11 and 81% of pre-pandemic levels. All services increased significantly during the first 27 months of the IMSS-RP implementation; specialty visits, cervical and breast cancer screening, and diabetes control exceeded pre-pandemic levels (103%,112%,103%, and 138%, respectively). However, only deliveries and the percentage of patients with controlled diabetes and hypertension showed a stable increase following the IMSS-RP implementation, whereas the remaining services showed an initial increase but began to decrease over time. CONCLUSIONS: After 27 months of implementation, IMSS-RP achieved progress in increasing the volume of essential health services and improving chronic disease control. However, declining trends in several services signal the need to focalize the policy.

Addressing the unmet needs of women with breast cancer in Mexico: a non-randomised pilot study of the digital ePRO intervention.

OBJECTIVES: This study aimed to explore the acceptability, feasibility, usability, and preliminary effect of an electronic patient-reported outcome (ePRO) intervention for patients with breast cancer in Mexico. DESIGN: We conducted a multimethod non-randomised pilot study. We used a pre-test/post-test design for quantitative assessment of the intervention's effect on patients' supportive care needs and quality of life. We conducted in-depth interviews (IDIs) with participants and healthcare workers to explore the intervention's benefits and barriers and understand its feasibility. PARTICIPANTS: 50 women aged 20-75 diagnosed with stage I-III breast cancer were enrolled within 2 weeks of starting neoadjuvant or adjuvant treatment with chemotherapy or radiotherapy. We excluded illiterate women and those with visual impairment, cognitive disability or severe depression. IDIs were conducted with 18 participants and 10 healthcare providers. SETTING: Oncology services in three public hospitals of the Mexican Social Security Institute. INTERVENTION: The ePRO intervention consisted of a responsive web application for weekly symptom reporting combined with proactive follow-up by nurses guided by predefined clinical algorithms for 6 weeks. RESULTS: 50 women were enrolled out of 66 eligible patients approached (75.8%). All 50 completed the 4-week follow-up assessment (100% retention). Completion of the symptom registry declined from 100% in week 1 to 66% in week 6. Participants experienced decreases in supportive care needs and increased quality of life. The ePRO application was rated highly usable. Participants and health professionals both perceived intervention benefits. Drawbacks included poor fit for women receiving radiotherapy and challenges using the application for women with low digital literacy or experiencing severe symptoms. CONCLUSIONS: This pilot study provided evidence of the high usability and potential efficacy of a web-based ePRO intervention. We revised recruitment during the pilot to include multiple facilities, and we will further revise for the randomised trial to address barriers to successful ePRO implementation. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID: NCT05925257.

Social determinants of hypertensive disorders of pregnancy trends in Mexican municipalities.

OBJECTIVES: To analyze the hypertensive disorders of pregnancy (HDP) trends in the 2000-2020 period and its association with social determinants of health (SDH) in Mexican municipalities. STUDY DESIGN: This was a retrospective longitudinal study analyzing data from routine information systems on 21,493,076 hospital discharges due to maternal causes and SDH data of 2,439-2,450 municipalities between 2000 and 2020. MAIN OUTCOMES MEASURES: We used joinpoint regression models to analyze HDP trends and hybrid negative binomial regression models to examine the association between SDH and HDP rates at intra- and inter-municipality levels. RESULTS: HDP rate increased from 0.54 in 2000 to 2.42 cases per 100 live births in 2020 (annual average percent change of 7.7 %, 95 % CI 6.6-8.9). Municipalities with higher marginalization index had higher HDP rates (IRR 1.12, 95 % CI 1.01-1.24; 1.36, 95 % CI 1.25-1.47; 1.30, 95 % CI 1.23-1.37, and 1.06, 95 % CI 1.00-1.12, in 2000-2004, 2005-2009, 2010-2014, 2015-2020, respectively). Municipal increases in the percentage of population with high schooling were associated with decreases in HDP rates in 2000-2009. Meanwhile, the role of socioeconomic status at the state level was less consistent, yet the HDP rates were lower in most socially advantaged regions. CONCLUSION: During 21 years, HDP rates increased overall in Mexican municipalities, suggesting an increased maternal morbidity burden due to HDP. The association of municipal marginalization and socioeconomic level with HDP trends indicates a need to ensure equitable interventions to improve maternal health in Mexican municipalities.

Primary health care in practice: usual source of care and health system performance across 14 countries.

Primary health care (PHC) is central to attainment of the Sustainable Development Goals, yet comparable cross-country data on key aspects of primary care have not been widely available. This study analysed data from the People's Voice Survey, which was conducted in 2022 and 2023 in 14 countries. We documented usual source of care across countries and examined associations of usual source of care with core PHC services, quality ratings, and health system confidence. We found that 75% of respondents had a usual source of care, and that 40% of respondents accessed usual care in the public sector at primary level. 44% rated their usual source of care as very good or excellent. Access to PHC-linked screenings and treatments varied widely within and across countries. Having any usual source of care was associated with higher take-up of preventive services, greater access to treatment including mental health services, and greater health system endorsement. Strengthening links between health system users and primary care providers could improve take-up of preventive care and increase user satisfaction with health system performance.

Inequalities in health system coverage and quality: a cross-sectional survey of four Latin American countries.

The premise of health as a human right in Latin America has been challenged by health system fragmentation, quality gaps, a growing burden of chronic disease, sociopolitical upheaval, and the COVID-19 pandemic. We characterised inequities in health system quality in Colombia, Mexico, Peru, and Uruguay. We did a cross-sectional telephone survey with up to 1250 adults in each country. We created binary outcomes in coverage, user experience, system competence, and confidence in the system and calculated the slope index of inequality by income and education. Although access to care was high, only a third of respondents reported having a high-quality source of care and 25% of those with mental health needs had those needs met. Two-thirds of adults were able to access relevant preventive care and 42% of older adults were screened for cardiovascular disease. Telehealth access, communication and autonomy in most recent visit, reasonable waiting times, and receiving preventive health checks showed inequalities favouring people with a high income. In Uruguay, inequality between government and social security services explained a substantial proportion of disparities in preventive health access. In other study countries, inequalities were also substantial within government and social security subsectors. Essential health system functions are unequal in these four Latin American countries.

Health system quality and COVID-19 vaccination: a cross-sectional analysis in 14 countries.

The social and behavioural determinants of COVID-19 vaccination have been described previously. However, little is known about how vaccinated people use and rate their health system. We used surveys conducted in 14 countries to study the health system correlates of COVID-19 vaccination. Country-specific logistic regression models were adjusted for respondent age, education, income, chronic illness, history of COVID-19, urban residence, and minority ethnic, racial, or linguistic group. Estimates were summarised across countries using random effects meta-analysis. Vaccination coverage with at least two or three doses ranged from 29% in India to 85% in Peru. Greater health-care use, having a regular and high-quality provider, and receiving other preventive health services were positively associated with vaccination. Confidence in the health system and government also increased the odds of vaccination. By contrast, having unmet health-care needs or experiencing discrimination or a medical mistake decreased the odds of vaccination. Associations between health system predictors and vaccination tended to be stronger in high-income countries and in countries with the most COVID-19-related deaths. Access to quality health systems might affect vaccine decisions. Building strong primary care systems and ensuring a baseline level of quality that is affordable for all should be central to pandemic preparedness strategies.

Dimensions of suffering and the need for palliative care: experiences and expectations of patients living with cancer and diabetes and their caregivers in Mexico - a qualitative study.

OBJECTIVES: Over 40 million people in low-income and middle-income countries (LMICs) experience serious health-related suffering (SHS) annually and require palliative care. Patient and caregiver experiences of SHS in LMICs are understudied despite their importance in guiding palliative care provision. Diabetes and cancer are the second-leading and third-leading causes of death in Mexico, causing a significant SHS burden on patients, families and health systems. This study examines SHS and palliative care from the point of view of patients with cancer and diabetes and their caregivers. DESIGN: A qualitative descriptive study based on in-depth telephone interviews was conducted between August 2021 and February 2022. Data were analysed through inductive thematic analysis. PARTICIPANTS: Overall, 20 patients with end-stage cancer, 13 patients with diabetes and 35 family caregivers were interviewed individually. SETTING: Participants were recruited from two family medicine clinics and a pain clinic in Mexico City. RESULTS: Seven themes emerged: (1) suffering as a multifaceted phenomenon, (2) diversity in perceptions of suffering, (3) different coping strategies, (4) need and perceived importance of relief from suffering, (5) barriers to accessing services to relieve suffering, (6) demand for the health sector's active and humane role in addressing suffering and (7) preferences and need for comprehensive care for relief from suffering. The primary coping strategies included family companionship, protective buffering and faith-based support. Participants lacked knowledge of palliative care. They expressed the importance of relief from suffering, viewing it as the health sector's responsibility and requesting more humane, personalised care and access to medicines and pain clinics. CONCLUSIONS: The multifaceted nature of SHS highlights the health system's responsibility to provide high-quality palliative care. Policies to enhance access to palliative care should integrate it into primary care, redesigning services towards patient and caregiver biopsychosocial and spiritual needs and ensuring access to medicines and competent health personnel.

Design and evaluation of a digital health intervention with proactive follow-up by nurses to improve healthcare and outcomes for patients with breast cancer in Mexico: protocol for a randomised clinical trial.

INTRODUCTION: Nearly 30 000 Mexican women develop breast cancer annually, frequently presenting unmet supportive care needs. In high-income countries, incorporating electronic patient-reported outcomes (ePROs) into cancer care has demonstrated potential for increasing patient-centred care and reducing unmet needs. No such ePRO interventions have been implemented in Mexico. This paper presents the study protocol for designing and evaluating an ePRO digital health application combined with proactive follow-up by nurses. METHODS AND ANALYSIS: We designed a two-component intervention for women receiving breast cancer treatment: a responsive web application for monitoring ePROs and clinical algorithms guiding proactive follow-up by nurses. We will conduct a pilot test of the intervention with 50 patients with breast cancer for 6 weeks to assess feasibility and adjust the application. We will conduct a parallel arm randomised controlled trial assigning 205 patients each to intervention and control in one of Mexico's largest public oncology hospitals. The intervention will be provided for 6 months, with additional 3 months of post-intervention observation. The control group will receive usual healthcare and a list of breast cancer information sources. Women diagnosed with stages I, II or III breast cancer who initiate chemotherapy and/or radiotherapy will be invited to participate. The primary study outcome will be supportive care needs; secondary outcomes include global quality of life and breast symptoms. Information on the outcomes will be obtained through web-based self-administered questionnaires collected at baseline, 1, 3, 6 and 9 months. ETHICS AND DISSEMINATION: The National Research and Ethics Committees of the Mexican Institute of Social Security approved the study (R-2021-785-059). Participants will sign an informed consent form prior to their inclusion. Findings will be disseminated through a policy brief to the local authorities, a webinar for patients, publications in peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER: NCT05925257.

Biosimilars approvals by thirteen regulatory authorities: A cross-national comparison.

Biosimilars are biological medicines highly similar to a previously licensed reference product and their licensing is expected to improve access to biological therapies. This study aims to present an overview of biosimilars approval by thirteen regulatory authorities (RA). The study is a cross-national comparison of regulatory decisions involving biosimilars in Argentina, Australia, Brazil, Chile, Canada, Colombia, Europe, Hungary, Guatemala, Italy, Mexico, Peru and United States. We examined publicly available documents containing information regarding the approval of biosimilars and investigated the publication of public assessment reports for registration applications, guidelines for biosimilars licensing, and products approved. Data extraction was conducted by a network of researchers and regulatory experts. All the RA had issued guidance documents establishing the requirements for the licensing of biosimilars. However, only three RA had published public assessment reports for registration applications. In total, the investigated jurisdictions had from 19 to 78 biosimilars approved, most of them licensed from 2018 to 2020. In spite of the advance in the number of products in recent years, some challenges still persist. Limited access to information regarding the assessment of biosimilars by RA can affect confidence, which may ultimately impact adoption of these products in practice.

Validation of the health literacy scale in patients with hypertension in Mexico.

INTRODUCTION: Health literacy integrates skills around health care. The measurement of health literacy is relevant for proposing improvement interventions. The European HLS-EU-Q16 scale allows to comprehensively evaluate health literacy, but its psychometric properties have not been assessed in Mexico. OBJECTIVE: To validate the HLS-EU-Q16 scale in patients with hypertension in Mexico. METHODS: A validation study of a measuring instrument was carried out. The construct was evaluated by means of factor analysis; internal consistency, using Cronbach's alpha; and test-retest reliability, using intraclass correlation coefficient (ICC). The information was collected by interviewing 349 patients with hypertension in a family medicine unit of the Mexican Institute of Social Security, from April to June 2022. RESULTS: In 23.8% of the patients, health literacy was inadequate; in 44.4%, problematic; and in 31.8%, sufficient. The scale was found to retain 12 items and two factors (HLS-EU-Q12M). Cronbach's alpha was 0.83, and ICC was 0.94. CONCLUSION: The HLS-EU-Q12M scale in Mexican Spanish is a valid instrument for assessing health literacy in adults with hypertension.

ANTECEDENTES: La alfabetización en salud integra las habilidades en torno al cuidado de la salud. La medición de la alfabetización en salud es relevante para proponer intervenciones de mejora. La escala europea HLS-EU-Q16 permite evaluar la alfabetización en salud de forma integral, pero sus propiedades psicométricas no se han evaluado en México. OBJETIVO: Validar la escala HLS-EU-Q16 en pacientes con hipertensión en México. MATERIAL Y MÉTODOS: Se realizó estudio de validación de un instrumento de medición. El constructo se evaluó mediante análisis factorial, la consistencia interna mediante alfa de Cronbach y la confiabilidad prueba-reprueba mediante coeficiente de correlación intraclase (CCI). La información fue recolectada mediante entrevistas a 349 pacientes con hipertensión en una unidad de medicina familiar del Instituto Mexicano del Seguro Social, de abril a junio de 2022. RESULTADOS: El 23.8 % de los pacientes tuvo una alfabetización en salud inadecuada; 44.4 %, problemática; y 31.8 %, suficiente. Se encontró que la escala está conformada por 12 reactivos y dos factores (HLS-EU-Q12M). El alfa de Cronbach fue de 0.83 y el CCI, de 0.94. CONCLUSIÓN: La escala HLS-EU-Q12M es un instrumento válido en español de México para evaluar la alfabetización en salud en adultos con hipertensión arterial.

Validación de la escala de alfabetización en salud en pacientes con hipertensión arterial en México / Validation of the health literacy scale in patients with hypertension in Mexico

Resumen Antecedentes: La alfabetización en salud integra las habilidades en torno al cuidado de salud. La medición de la alfabetización en salud es relevante para proponer intervenciones de mejora. La escala europea HLS-EU-Q16 permite evaluar la alfabetización en salud de forma integral, pero sus propiedades psicométricas no se han evaluado en México. Objetivo: Validar la escala HLS-EU-Q16 en pacientes con hipertensión en México. Material y métodos: Se realizó estudio de validación de un instrumento de medición. El constructo se evaluó mediante análisis factorial, la consistencia interna mediante alfa de Cronbach y la confiabilidad prueba-reprueba mediante coeficiente de correlación intraclase (CCI). La información fue recolectada mediante las entrevistas a 349 pacientes con hipertensión en una unidad de medicina familiar del Instituto Mexicano del Seguro Social, de abril a junio de 2022. Resultados: El 23.8 % de los pacientes tuvo una alfabetización en salud inadecuada; 44.4 %, problemática; y 31.8 %, suficiente. Se encontró que la escala está conformada por 12 reactivos y dos factores (HLS-EU-Q12M). El alfa de Cronbach fue de 0.83 y el CCI, de 0.94. Conclusión: La escala HLS-EU-Q12M es un instrumento válido en español de México para evaluar la alfabetización en salud en adultos con hipertensión arterial.

Abstract Background: Health literacy integrates skills around health care. The measurement of health literacy is relevant for proposing improvement interventions. The European HLS-EU-Q16 scale allows to comprehensively evaluate health literacy, but its psychometric properties have not been assessed in Mexico. Objective: To validate the HLS-EU-Q16 scale in patients with hypertension in Mexico. Material and methods: A validation study of a measuring instrument was carried out. The construct was evaluated by means of factor analysis; internal consistency, using Cronbach's alpha; and test-retest reliability, using intraclass correlation coefficient (ICC). The information was collected by interviewing 349 patients with hypertension in a family medicine unit of the Mexican Institute of Social Security, from April to June 2022. Results: In 23.8% of the patients, health literacy was inadequate; in 44.4%, problematic; and in 31.8%, sufficient. The scale was found to retain 12 items and two factors (HLS-EU-Q12M). Cronbach's alpha was 0.83, and ICC was 0.94. Conclusion: The HLS-EU-Q12M scale in Mexican Spanish is a valid instrument for assessing health literacy in adults with hypertension.

Associations between the stringency of COVID-19 containment policies and health service disruptions in 10 countries.

BACKGROUND: Disruptions in essential health services during the COVID-19 pandemic have been reported in several countries. Yet, patterns in health service disruption according to country responses remain unclear. In this paper, we investigate associations between the stringency of COVID-19 containment policies and disruptions in 31 health services in 10 low- middle- and high-income countries in 2020. METHODS: Using routine health information systems and administrative data from 10 countries (Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, South Korea, and Thailand) we estimated health service disruptions for the period of April to December 2020 by dividing monthly service provision at national levels by the average service provision in the 15 months pre-COVID (January 2019-March 2020). We used the Oxford COVID-19 Government Response Tracker (OxCGRT) index and multi-level linear regression analyses to assess associations between the stringency of restrictions and health service disruptions over nine months. We extended the analysis by examining associations between 11 individual containment or closure policies and health service disruptions. Models were adjusted for COVID caseload, health service category and country GDP and included robust standard errors. FINDINGS: Chronic disease care was among the most affected services. Regression analyses revealed that a 10% increase in the mean stringency index was associated with a 3.3 percentage-point (95% CI -3.9, -2.7) reduction in relative service volumes. Among individual policies, curfews, and the presence of a state of emergency, had the largest coefficients and were associated with 14.1 (95% CI -19.6, 8.7) and 10.7 (95% CI -12.7, -8.7) percentage-point lower relative service volumes, respectively. In contrast, number of COVID-19 cases in 2020 was not associated with health service disruptions in any model. CONCLUSIONS: Although containment policies were crucial in reducing COVID-19 mortality in many contexts, it is important to consider the indirect effects of these restrictions. Strategies to improve the resilience of health systems should be designed to ensure that populations can continue accessing essential health care despite the presence of containment policies during future infectious disease outbreaks.

Patients and nursing-related factors associated with switching from peritoneal dialysis to hemodialysis: A cross-sectional survey.

The study aimed at analyzing patients and nursing-related factors associated with switching from peritoneal dialysis to hemodialysis. A telephone survey with 574 patients receiving care at six peritoneal dialysis centers of the Mexican Institute of Social Security was conducted: 64.3% were on peritoneal dialysis, and 35.7% had transitioned from peritoneal dialysis to hemodialysis. Data were collected on participants' sociodemographic and clinical characteristics, peritoneal dialysis center size, and nursing workload. Descriptive, bivariate, and multiple Poisson regression analyses were performed. Factors associated with an increased probability of switching from peritoneal dialysis to hemodialysis were a history of catheter dysfunction, peritonitis, and being treated in a large peritoneal dialysis center with a low (<50 patients per nurse per month) or high nursing workload (>70 patients per nurse per month) located in the State of Mexico, compared to a medium-size peritoneal dialysis center with a moderate workload (50-70 patients per nurse per month). To decrease the odds of switching from peritoneal dialysis to hemodialysis, improvement programs should aim to limit nurses' workload to 50-70 patients per nurse per month and implement evidence-based nursing interventions to prevent, detect, and manage peritonitis and peritoneal catheter dysfunction.

Tracking health system performance in times of crisis using routine health data: lessons learned from a multicountry consortium.

COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand. We compiled a large set of indicators related to common health conditions for the purpose of multicountry comparisons. The study compiled 73 indicators. A total of 43% of the indicators compiled pertained to reproductive, maternal, newborn and child health (RMNCH). Only 12% of the indicators were related to hypertension, diabetes or cancer care. We also found few indicators related to mental health services and outcomes within these data systems. Moreover, 72% of the indicators compiled were related to volume of services delivered, 18% to health outcomes and only 10% to the quality of processes of care. While several datasets were complete or near-complete censuses of all health facilities in the country, others excluded some facility types or population groups. In some countries, RHIS did not capture services delivered through non-visit or nonconventional care during COVID-19, such as telemedicine. We propose the following recommendations to improve the analysis of administrative and RHIS data to track health system performance in times of crisis: ensure the scope of health conditions covered is aligned with the burden of disease, increase the number of indicators related to quality of care and health outcomes; incorporate data on nonconventional care such as telehealth; continue improving data quality and expand reporting from private sector facilities; move towards collecting patient-level data through electronic health records to facilitate quality-of-care assessment and equity analyses; implement more resilient and standardized health information technologies; reduce delays and loosen restrictions for researchers to access the data; complement routine data with patient-reported data; and employ mixed methods to better understand the underlying causes of service disruptions.

The Neglected Problem of Obesity during Pregnancy in Mexico: Secondary Data Analysis of the 2018 National Survey of Health and Nutrition.

OBJECTIVES: To compare sociodemographic and clinical characteristics among obese and non-obese women in Mexico and analyze the association between obesity and pregnancy complications. METHODS: We conducted a secondary data analysis of the 2018-2019 Mexican National Survey of Health and Nutrition. We included women aged 20-49 years who had at least one live birth in the five years preceding the survey (n = 1573). We performed a double-weighted (by IP-weights and survey-weights) multilevel multiple logistic regression analysis. RESULTS: Obesity was prevalent in 32% of pregnant women. Obese and non-obese women received similar antenatal care. 42.6% of obese women, compared to 33.6% of non-obese had one or more pregnancy or labor complications. Compared with non-obese women, obese women were older and had more chronic diseases. Obesity was associated with a 48% increase in the probability of complications. CONCLUSION: Due to the high prevalence of obesity among Mexican women of reproductive age and given the independent association between obesity and complications during pregnancy and labor, the development and implementation of specific clinical guidelines on weight management before conception, during pregnancy, and post-partum for women who are obese is an unmet need in Mexico.

The road to recovery: an interrupted time series analysis of policy intervention to restore essential health services in Mexico during the COVID-19 pandemic.

Background: Recovery of health services disrupted by the COVID-19 pandemic represents a significant challenge in low- and middle-income countries. In April 2021, the Mexican Institute of Social Security (IMSS), which provides health care to 68.5 million people, launched the National Strategy for Health Services Recovery (Recovery policy). The study objective was to evaluate whether the Recovery policy addressed COVID-related declines in maternal, child health, and non-communicable diseases (NCDs) services. Methods: We analysed the data of 35 IMSS delegations from January 2019 to November 2021 on contraceptive visits, antenatal care consultations, deliveries, caesarean sections, sick children's consultations, child vaccination, breast and cervical cancer screening, diabetes and hypertension consultations, and control. We focused on the period before (April 2020 - March 2021) and during (April 2021 - November 2021) the Recovery policy and used an interrupted time series design and Poisson Generalized Estimating Equation models to estimate the association of this policy with service use and outcomes and change in their trends. Results: Despite the third wave of the pandemic in 2021, service utilization increased in the Recovery period, reaching (at minimum) 49% of pre-pandemic levels for sick children's consultations and (at maximum) 106% of pre-pandemic levels for breast cancer screenings. Evidence for the Recovery policy role was mixed: the policy was associated with increased facility deliveries (IRR = 1.15, 95%CI = 1.11-1.19) with a growing trend over time (IRR = 1.04, 95%CI = 1.03-1.05); antenatal care and child health services saw strong level effects but decrease over time. Additionally, the Recovery policy was associated with diabetes and hypertension control. Services recovery varied across delegations. Conclusions: Health service utilization and NCDs control demonstrated important gains in 2021, but evidence suggests the policy had inconsistent effects across services and decreasing impact over time. Further efforts to strengthen essential health services and ensure consistent recovery across delegations are warranted.

[Quality of care in patients with prostate cancer treated in Mexico]. / Calidad de atención en pacientes con cáncer de próstata atendidos en México.

Background: Patient-centered care model improves quality of care, decreases unnecessary use of services, optimizes costs and quality of life and survival for cancer patients. Objective: To compare the patient-centered quality of care of prostate cancer patients with and without social security in two oncology hospitals in Mexico City. Material and methods: The information of the 2019 survey of prostate cancer patients in two oncology hospitals, one from the Mexican Institute of Social Security (IMSS) and the other from the Ministry of Health (SSA), was analyzed (n = 307). The survey included sociodemographic and patient-centered quality of care variables. A descriptive and bivariate analysis was performed to compare the quality of care between both hospitals using chi-square test, Fisher's exact test and Student's t test. Results: 234 patients treated at the IMSS and 73 at the SSA were included, with a mean age of 66.6 years. In both hospitals, more than 90% of the patients perceived respectful and coordinated care, as well as clear information. Only 58.9% of patients treated at SSA received information for decision-making, in contrast to 80.8% at IMSS (p = 0.001). Supportive care for biopsychosocial needs was low in both places (IMSS: 23.9%, SSA: 13.7%, p = 0.063). Conclusions: The quality of care focused on patients with prostate cancer was perceived as good, except in the care of biopsychosocial needs; given the importance of this last aspect, it is recommended a multidisciplinary approach in their care.

Introducción: la asistencia centrada en el paciente permite mejorar la calidad de atención, disminuye el uso innecesario de los servicios y optimiza costos y calidad de vida y sobrevida en pacientes con cáncer. Objetivo: : comparar la calidad de la atención en pacientes con cáncer de próstata con y sin seguridad social en dos hospitales de oncología de la Ciudad de México. Material y métodos: se usó información de una encuesta a pacientes con cáncer de próstata del 2019 de dos hospitales de oncología, uno del Instituto Mexicano del Seguro Social (IMSS) y otro de la Secretaría de Salud (SSA), n = 307. La encuesta incluyó variables sociodemográficas y de calidad de atención desde la perspectiva centrada en el paciente. Se hizo análisis descriptivo y bivariado para comparar la calidad de atención de ambos hospitales mediante chi cuadrada, prueba exacta de Fisher y t de Student. Resultados: se incluyeron 234 pacientes atendidos en el IMSS y 73 en la SSA; su edad promedio fue 66.6 años. Más del 90% percibieron una atención respetuosa y coordinada e información clara en ambos lugares. Solo 58.9% de pacientes atendidos en SSA recibieron información para la toma de decisiones en contraste con 80.8% de pacientes del IMSS (p = 0.001). Sin embargo, la atención de las necesidades biopsicosociales fue baja en ambos lugares (IMSS: 23.9%, SSA: 13.7%, p = 0.063). Conclusiones: la calidad de atención centrada en pacientes con cáncer de próstata fue percibida como buena, salvo la atención de necesidades biopsicosociales; dado esto último, se recomienda incorporar un abordaje multidisciplinario en su atención.