Knowledge, Attitudes, and Practices of Parents in the Use of Antibiotics: A Case Study in a Mexican Indigenous Community.

The rise and spread of antibiotic-resistant bacteria have become a global health problem. At the community level, bacterial resistance has been linked to antibiotic misuse practices. These practices are related to social factors such as education level, poverty, ethnicity, and use of traditional medicine. Through a survey, this study aims to analyse the knowledge, attitudes, and practices (KAP) of antimicrobial use, in an indigenous community in the south of Oaxaca, Mexico. It was observed that the population had a low socioeconomic profile, poor access to healthcare services, low academic level, little knowledge of antibiotics, the use of traditional medicine, and proper attitudes and practices regarding antibiotics use. Therefore, social factors are related to bacterial resistance only if they make the population prone to the use of antimicrobials. Lack of medical access and cultural factors drives this population to use ancestral alternatives such traditional medicine to treat conditions that in other contexts could be treated with antibiotics. This is an example of how the population can reduce the consumption of antimicrobials in infections if they have a reliable alternative that improves their symptoms.

Unpacking participation in healthcare governance: Lessons from two local health councils in Brazil and Spain.

This paper describes and compares the integration of cross-sector actors' participation into the governance of two local health councils, one located in Salvador de Bahia (Brazil) and the other in the Canary Islands (Spain). Based on the cross-national comparative research conducted as part of a doctoral thesis, a qualitative design based on secondary data analysis was proposed on the three stages of the organisational integration process of participation. We used information from individual semi-structured interviews (n = 70), situational observation, focus groups, literature review, and field notes to understand participatory processes of networking between multiple cross-sector actors and to show how such processes might be associated with innovative practices. For these innovations to be successfully implemented, stakeholders need to acquire adequate competencies in cross-sector collaboration, enabling them to learn about new organisational practices and to adapt the network of actors to the often unpredictable influences of contextual factors.

Governance in mental healthcare policies during the COVID-19 pandemic in Mexico.

The COVID-19 pandemic has become the greatest burden of disease worldwide and in Mexico, affecting more vulnerable groups in society, such as people with mental disorders (MD). This research aims to analyze the governance processes in the formulation of healthcare policies for people with MD in the face of the COVID-19 pandemic. An analytical qualitative study, based on semi-structured interviews with key informants in the healthcare system was conducted in 2020. The study followed the theoretical-methodological principles of the Governance Analytical Framework (GAF). The software ATLAS.ti-V.9 was used for inductive thematic analysis, classifying themes and their categories. To ensure the proper interpretation of the data, a process of triangulation among the researchers was carried out. The findings revealed that in Mexico, the federal Secretary of Health issued guidelines for mental healthcare, but there is no defined national policy. Decision-making involved multiple actors, with different strategies and scopes, depending on the type of key-actor and their level of influence. Majority of informants described a problem of implementation in which infection control policies in the psychiatric population were the same as in the general populations which decreased the percentage of access to healthcare during the pandemic, without specific measures to address this vulnerable population. The results suggest that there is a lack of specific policies and measures to address the needs of people with mental disorders during the COVID-19 pandemic in Mexico. It also highlights the importance of considering the role of different actors and their level of influence in the decision-making process.

Ethical, Legal, Organisational and Social Issues of Teleneurology: A Scoping Review.

BACKGROUND: Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. METHODS: A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. RESULTS: 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. CONCLUSIONS: This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data.

Ethical, legal, organizational and social issues related to the use of scalp cooling for the prevention of chemotherapy-induced alopecia: A systematic review.

INTRODUCTION: Scalp cooling (SC) aims to prevent chemotherapy-induced alopecia. The goal of this systematic review is to tackle ethical, legal, organizational and social issues related to SC. METHODS: A critical appraisal of the literature was carried out using a systematic review design. MEDLINE, Embase and Web of Science databases were searched up until 2 June 2021. Studies addressing these aspects in English or Spanish were considered. Representatives of both patient associations and professional scientific societies related to the topic participated in the design of the protocol and the review of the findings. RESULTS: A total of 17 studies were included. Articles were critically appraised using the MMAT and SANRA. Findings were organized into four categories: (1) ethical aspects focused on equal access, gender equity and doctor-patient communication supported by Patient Decision Aids (PtDAs); (2) patient perspective and acceptability; (3) professional perspective and acceptability; (4) organizational aspects focused on accessibility and feasibility. CONCLUSION: Cancer patients' expectations when using SC need to be adjusted to reduce the potential distress associated with hair loss. PtDAs could help patients clarify their values and preferences regarding SC. Equal access to technology should be guaranteed. PATIENT OR PUBLIC CONTRIBUTION: In this systematic review, the representatives of the patient associations (Ms. María Luz Amador Muñoz of the Spanish Association Against Cancer [AECC] and Ms. Catiana Martinez Cánovas of the Spanish Breast Cancer Federation [FECMA]) participated in the review of the study protocol, as well as in the results, discussion and conclusions, making their contributions. In the type of design of these studies (systematic reviews), it is not usual to have the direct participation of patients, but in this one, we have done so, as it is a systematic review that is part of a report of the Spanish Network of Health Technology Assessment Agencies (ETS).

Recent trends for the management of hypertension in older adults in Latin America in the context of universal coverage: Evidence from Mexico.

Taking the Mexican case as a tracer of what is happening in Latin America on public health, we estimate the recent changes and challenges for the management of hypertension in older adults in the context of universal health coverage. The population base was 200, and 308 reported cases of older adults with hypertension. The cost-evaluation method used was based on the instrumentation and consensus technique. Regarding epidemiological changes for 2016 versus 2018, there is an increase of 21% (CI: 95%, p < 0.001). Comparing the economic impact in 2016 versus 2018 (CI: 95%, p < 0.001), the increase is 33%. The total amount estimated for hypertension in 2018 (in US dollars) was $ 1,896,520,273. It includes $ 898,064,979 as direct costs and $ 998,455,294 as indirect costs. The recent trends show that the financial requirements for the coming years do not guarantee the effectiveness of the coverage rates required for the elderly. In terms of catastrophic expenditure, the challenge is not minor, the greatest economic burden is for the pocket of patients and their families.

La participación social como estrategia central de la nutrición comunitaria para afrontar los retos asociados a la transición nutricional / Social participation as a central strategy of community nutrition to face the challenges associated with the nutritional transition

Las sociedades modernas vienen experimentando en las últimasdécadas un proceso de transición nutricional acelerada quefavorece la aparición, a escala planetaria, de problemas nutricionalesde naturaleza contradictoria, tales como la obesidad y ladesnutrición. Estos problemas suponen un auténtico desafío paralos responsables de la Salud Pública, que adoptan gradualmenteuna serie de estrategias bajo una perspectiva poblacional. Sinembargo, la naturaleza colectiva de estas estrategias puede ir endetrimento de las necesidades nutricionales particulares de losindividuos y las familias.Consideramos que la participación social favorece la contemplaciónsimultánea de ambas perspectivas, individual y poblacional,durante las diferentes fases de desarrollo de los programas de NutriciónComunitaria necesarios para tratar la naturaleza paradójica deeste tipo de problemas. Sin embargo, debido a factores de tipo contextual,se observa una tendencia creciente a desarrollar una dimensiónmás tecnocrática de las prácticas participativas, lo que desvirtúael potencial emancipador y trasformativo de la participación social.Para evitar dicha tendencia, proponemos el uso de los cincoejes de intervención de la Carta de Ottawa para la Promoción de laSalud como guía para una integración sistémica de la participaciónsocial en los procesos de planificación, implementación y evaluaciónde los programas de nutrición comunitaria. De este modo, contemplamosla integración de la participación social en los esfuerzosdestinados al desarrollo de competencias individuales, al refuerzode la acción colectiva, a la creación de entornos favorables, a lareorganización de servicios y sistemas de salud y, finalmente, a laelaboración de políticas en materia de nutrición y salud pública(AU)

In last decades modern societies are undergoing a rapidnutrition transition process that reinforces, at international level,the emergence of nutritional problems of contradictory nature,such as malnutrition and obesity. This represents a considerablechallenge for contemporary Public Health leaders, who have beengradually developing a set of strategies which overwhelminglyadopt a population perspective. Nevertheless, the collective natureof these strategies could neglect the particular individual andfamily needs.We consider social participation as an approach tosimultaneously reinforce both individual and populationperspectives during the divers phases of development ofCommunity Nutrition programs which tackle the paradoxicalnature of this problematic. However in relation to some contextualfactors, we find a growing trend to develop a more technocraticdimension of participatory practices, which distorts theemancipator and transformative potential of social participation.In order to avoid this tendency, we propose the use of the fiveintervention axes of the Ottawa Chart for Health Promotion as aguide for a systemic integration of social participation in planning,implementation and evaluation processes of Community Nutritionprograms. We therefore take into account the integration of socialparticipation in the efforts made in developing individual capacitybuilding,reinforcing collective action, creating enablingenvironments, health care reorganization, and finally, implementingnutritional and public health policies(AU)

[Social participation as a central strategy of community nutrition to face the challenges associated with the nutritional transition]. / La participación social como estrategia central de la nutrición comunitaria para afrontar los retos asociados a la transición nutricional.

In last decades modern societies are undergoing a rapid nutrition transition process that reinforces, at international level, the emergence of nutritional problems of contradictory nature, such as malnutrition and obesity. This represents a considerable challenge for contemporary Public Health leaders, who have been gradually developing a set of strategies which overwhelmingly adopt a population perspective. Nevertheless, the collective nature of these strategies could neglect the particular individual and family needs. We consider social participation as an approach to simultaneously reinforce both individual and population perspectives during the divers phases of development of Community Nutrition programs which tackle the paradoxical nature of this problematic. However in relation to some contextual factors, we find a growing trend to develop a more technocratic dimension of participatory practices, which distorts the emancipator and transformative potential of social participation. In order to avoid this tendency, we propose the use of the five intervention axes of the Ottawa Chart for Health Promotion as a guide for a systemic integration of social participation in planning, implementation and evaluation processes of Community Nutrition programs. We therefore take into account the integration of social participation in the efforts made in developing individual capacity-building, reinforcing collective action, creating enabling environments, health care reorganization, and finally, implementing nutritional and public health policies.

Community nutrition programmes, globalization and sustainable development.

On an international scale, the last seventy-five years have been a period of deep social, economic and political transformation for the developing countries. They have been especially influenced by the international phenomenon of globalization, the benefits of which have been unequally distributed among countries. In this context, the strategies used to improve the general nutritional health of the population of developing countries include broad approaches integrating nutritional interventions in a context of sustainable community development, while valuing the existing relations between fields as diverse as agriculture, education, sociology, economy, health, environment, hygiene and nutrition. The community nutrition programmes are emblematic of these initiatives. Nevertheless, in spite of the increasing evidence of the potential possibilities offered by these programmes to improve the nutritional status and contribute to the development and the self-sufficiency of the community, their success is relatively limited, due to the inappropriate planning, implementation and evaluation of the programmes. In the present article, I attempt to emphasie the importance of community participation of the population of developing countries in the community nutrition programmes within the context of globalization. This process is not only an ethical imperative, but a pragmatic one. It is a crucial step in the process of liberation, democratization and equality that will lead to true sustainable development.