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1.
Diabetes Care ; 2020 Nov 18.
Artículo en Inglés | MEDLINE | ID: mdl-33208487

RESUMEN

OBJECTIVE: Diabetes is an important risk factor for severe coronavirus disease 2019 (COVID-19), but little is known about the marginal effect of additional risk factors for severe COVID-19 among individuals with diabetes. We tested the hypothesis that sociodemographic, access to health care, and presentation to care characteristics among individuals with diabetes in Mexico confer an additional risk of hospitalization with COVID-19. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional study using public data from the General Directorate of Epidemiology of the Mexican Ministry of Health. We included individuals with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 between 1 March and 31 July 2020. The primary outcome was the predicted probability of hospitalization, inclusive of 8.5% of patients who required intensive care unit admission. RESULTS: Among 373,963 adults with COVID-19, 16.1% (95% CI 16.0-16.3) self-reported diabetes. The predicted probability of hospitalization was 38.4% (37.6-39.2) for patients with diabetes only and 42.9% (42.2-43.7) for patients with diabetes and one or more comorbidities (obesity, hypertension, cardiovascular disease, and chronic kidney disease). High municipality-level of social deprivation and low state-level health care resources were associated with a 9.5% (6.3-12.7) and 17.5% (14.5-20.4) increased probability of hospitalization among patients with diabetes, respectively. In age-, sex-, and comorbidity-adjusted models, living in a context of high social vulnerability and low health care resources was associated with the highest predicted probability of hospitalization. CONCLUSIONS: Social vulnerability contributes considerably to the probability of hospitalization among individuals with COVID-19 and diabetes with associated comorbidities. These findings can inform mitigation strategies for populations at the highest risk of severe COVID-19.

2.
Acta bioeth ; 26(2): 189-194, oct. 2020.
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1141924

RESUMEN

Abstract The purpose of this paper is to discuss one of the most common ethical predicaments faced by public health practitioners: the distribution of limited resources for health. The question we address is the following: If there are limited resources to provide necessary health care, how can we reasonably establish priorities? We discuss this question using as reference a real-life situation, which was the establishment of priorities in the design of a package of high-cost interventions for Seguro Popular in Mexico, a public insurance scheme that extended social protection in health to over 50 million people between 2003 and 2018. The main conclusion of this paper is that the use of explicit ethical assumptions in the design of public policies contribute to their acceptability and eventual success.


Resumen El propósito de este artículo es discutir uno de los dilemas éticos que con mayor frecuencia enfrentan quienes se dedican a la salud pública: la distribución de recursos limitados para la salud. La pregunta a la que se pretende responder es la siguiente: si existen recursos limitados para prestar los servicios de salud necesarios, ¿cómo podemos fijar prioridades? Intentamos responder a esta pregunta haciendo referencia a una situación de la vida real que fue el establecimiento de prioridades en el diseño de un paquete de intervenciones de alto costo para el Seguro Popular de México, un seguro público que extendió la protección social en salud a más de 50 millones de personas entre 2003 y 2018. La principal conclusión de este artículo es que el uso de un marco ético explícito en el diseño de las políticas públicas incrementa su aceptabilidad y favorece su eventual éxito.


Resumo O propósito deste artigo é discutir um dos dilemas éticos que com maior frequência aqueles que se dedicam à saúde pública enfrentam: a distribuição de recursos limitados para a saúde. A pergunta que se pretende responder é a seguinte: se existem recursos limitados para prestar os serviços de saúde necessários, como podemos fixar prioridades? Tentamos responder a esta pregunta fazendo referência a uma situação de vida real que foi o estabelecimento de prioridades na concepção de um pacote de intervenções de alto custo para o Seguro Popular do México, um seguro público que estendeu a proteção social em saúde a mais de 50 milhões de pessoas entre 2003 e 2018. A principal conclusão deste artigo é que o uso de um enquadramento ético explícito na concepção das políticas públicas aumenta sua aceitação e favorece seu eventual sucesso.

3.
Salud Publica Mex ; 62(3): 298-305, 2020.
Artículo en Español | MEDLINE | ID: mdl-32520487

RESUMEN

The Haitian health system includes a public and a private sector. The public sector comprises the Ministry of Health and Population (MSPP) and a social security institution (Ofatma). The private sector includes private insurance agencies and providers. MSPP provides health services to the non-salaried population, while Ofatma provides services to the salaried population. Health expenditure in Haiti in 2016 was 5.4% of gross domestic product. Expenditure per capita in health was 38 American dollars. There is a great dependency on foreign resources. The MSPP is in charge of most stewardship functions. The main challenge faced by the Haitian health system is the provision of comprehensive health services with financial protection to all the population. This goal will not be met without additional financial resources, mostly public, and an effort to strengthen health institutions.

4.
Salud Publica Mex ; 62(5): 593-597, 2020.
Artículo en Español | MEDLINE | ID: mdl-32516869

RESUMEN

After eight years of a civil war which devastated the country, Spanish flu, one of the worst pandemics in the history of humankind, arrived in Mexico in October of 1918. This article discusses its arrival to the port of Veracruz in ships coming from Habana and New York City; its dissemination from the Gulf of Mexico area to the rest of the country, including Mexico City; and the responses of both federal and local health authorities. Two events associated to this pandemic are particularly relevant, in addition to the high number of deaths: the testing of the sanitary dispositions added to the 1917 Mexican Constitution and the extraordinary role played by civil society organizations.

5.
Int J Health Plann Manage ; 35(4): 867-877, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32037604

RESUMEN

OBJECTIVE: To generate evidence on the influence of good management of resources in the delivery of maternal health services in Mexico. MATERIAL AND METHODS: We studied the managerial processes involved in the provision of maternal health services in four states of Mexico exhibiting differences in maternal mortality, maternal health service coverage, and maternal health expenditure. Analysis was based on five analytical dimensions of the cyclic process model designed by the National Council for the Evaluation of Social Development Policy in Mexico. We describe the processes, identify areas of opportunity, and discuss opinions concerning the relevance, timeliness, and sufficiency of human and material resources employed in the delivery of maternal health services. RESULTS: Managerial performance in the four entities was very heterogeneous. In most of the analyzed entities, implementation of the processes was rated from "average" to "very good." CONCLUSION: In order to contribute to universal coverage of maternal health services, managerial processes at the state level need to ensure an adequate, timely, and sufficient supply of resources.

6.
Salud Publica Mex ; 62(1): 114-117, 2020.
Artículo en Español | MEDLINE | ID: mdl-31869568

RESUMEN

This paper discusses the situation of healthcare in Mesoamerica before and immediately after 1519. In the first 50 years after the Conquest, the Spaniards made extensive use of Nahuatl medicine. However, the influence of this medical tradition was limited due to the rapid imposition of a very different medical system which took little advantage of, among other things, the therapeutic wealth of pre-Hispanic healing traditions.


Asunto(s)
Prestación de Atención de Salud/historia , Medicina Tradicional/historia , Prestación de Atención de Salud/etnología , Prestación de Atención de Salud/organización & administración , Epidemias/historia , Historia del Siglo XV , Historia del Siglo XVI , Historia del Siglo XVII , Historia del Siglo XVIII , Hospitales/historia , México
9.
Salud Publica Mex ; 61(2): 202-211, 2019.
Artículo en Español | MEDLINE | ID: mdl-30958963

RESUMEN

This paper describes the creation of the legal framework and the origin, growth and consolidation of the institutions and interventions (initiatives, programs and policies) that nourished public health in Mexico in the past century. It also discusses the recent efforts to guarantee universal social protection in health. This quest, which lasted a century, developed through three generations of reform that gave birth to a health system that offers protection against sanitary risks, protection of health care quality and financial protection to all the population in the country.


Asunto(s)
Reforma de la Atención de Salud/historia , Salud Pública/historia , Política Pública/historia , Reforma de la Atención de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/historia , Accesibilidad a los Servicios de Salud/organización & administración , Historia del Siglo XX , Historia del Siglo XXI , Humanos , México , Atención Individual de Salud/historia , Atención Individual de Salud/organización & administración , Salud Pública/legislación & jurisprudencia , Política Pública/legislación & jurisprudencia , Derecho a la Salud/historia
10.
Salud pública Méx ; 61(2): 202-211, Mar.-Apr. 2019. tab
Artículo en Español | LILACS-Express | LILACS | ID: biblio-1058973

RESUMEN

Resumen: En este artículo se describen la creación de los marcos legales y el origen, crecimiento y consolidación de las instituciones e intervenciones (iniciativas, programas, políticas) que han conformado la salud pública moderna en México. También se discuten los esfuerzos recientes por hacer universal la protección social en salud. Esta gesta, que duró un siglo, se fue abriendo paso a través de tres generaciones de reformas que dieron lugar a un sistema de salud que hoy ofrece protección contra riesgos sanitarios, protección de la calidad de la atención y protección financiera a los habitantes de todo el país.


Abstract: This paper describes the creation of the legal framework and the origin, growth and consolidation of the institutions and interventions (initiatives, programs and policies) that nourished public health in Mexico in the past century. It also discusses the recent efforts to guarantee universal social protection in health. This quest, which lasted a century, developed through three generations of reform that gave birth to a health system that offers protection against sanitary risks, protection of health care quality and financial protection to all the population in the country.

12.
Health Syst Reform ; 4(3): 175-182, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30207905

RESUMEN

This essay questions the achievements and assessments of the Cuban health system. It argues that health policies in Cuba in the past half century have been implemented with limited concern for civil liberties and certain human rights which are considered a core component of a responsive, transparent, and accountable health system. Three cases are discussed in support of this assessment: 1) the persecution of Cuban analysts who questioned the official version of the socio-economic situation of pre-revolutionary Cuba, including the health state of affairs; 2) the harassment and segregation of gays and people living with HIV; and 3) the violation of labor rights of Cuban physicians working in international missions.


Asunto(s)
Prestación de Atención de Salud , Países en Desarrollo , Política de Salud , Derechos Humanos , Programas Nacionales de Salud , Médicos , Indicadores de Calidad de la Atención de Salud , Logro , Derechos Civiles , Cuba , Libertad , Programas de Gobierno , Infecciones por VIH , Homosexualidad , Humanos , Misiones Médicas , Derechos del Paciente , Salud Pública , Condiciones Sociales , Discriminación Social , Habla , Trabajo
13.
Arch Med Res ; 49(2): 79-83, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29960828

RESUMEN

This paper discusses the health challenges faced by countries in Latin America. These challenges have two dimensions: those related to the health needs of populations and those related to the way in which health systems are responding to these needs. The main conclusion is that in order to improve health conditions and move towards universal health coverage, Latin American countries need to design a new generation of policy innovations based on the separation of the three main functions of health systems: financing, delivery and stewardship.


Asunto(s)
Prestación de Atención de Salud/economía , Prestación de Atención de Salud/métodos , Cobertura Universal del Seguro de Salud , Humanos , América Latina , Desarrollo Sostenible
14.
PLoS One ; 13(7): e0199543, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29966002

RESUMEN

The purpose of this study is to analyze the alignment of supply and demand for antenatal care (ANC) in Mexico based on the definition of access provided by Donabedian: the "degree of adjustment" between resources and needs. Alignment was studied in the teenage and adult population of Mexico that lacked conventional social security between 2008 and 2015, a period of expanding financial resources for health and public health insurance coverage. Spatial econometric methods were used to analyze data from the Ministry of Health on the supply and demand for ANC in 2,314 municipalities (94% of all municipalities in Mexico). During this period, the relative weight of ANC demand among adolescents increased 37% while the production of antenatal consultations for adolescent and adult women remained unchanged. Bivariate spatial analyses of correlation between supply and demand for ANC services yielded a minimal spatial correlation, or lack of territorial correspondence, between supply and demand among women in both age groups. Spatial econometric analysis confirmed a non-significant association between supply and demand for ANC services. Our findings suggest the existence of misalignment between supply and demand for these services. This requires a reassessment of the management and delivery of ANC services at the local level in order to increase effective coverage and improve the overall performance of the health system.


Asunto(s)
Servicios de Salud Materna/estadística & datos numéricos , Salud Mental/estadística & datos numéricos , Adolescente , Adulto , Algoritmos , Niño , Femenino , Geografía , Humanos , Masculino , México , Persona de Mediana Edad , Modelos Teóricos , Embarazo , Atención Prenatal , Adulto Joven
16.
Salud Publica Mex ; 60(2): 212-217, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29738661

RESUMEN

Mental and substance use disorders account for 18.9% of years lived with disability worldwide. A rising prevalence of mental disorders was identified in the past decade and a call for global attention to this challenge was made. The purpose of this paper is to discuss new strategies to address mental health problems in developing nations aimed at dealing with them within the frame of the overall health system. Mainstreaming mental disorders implies five dimensions of integration: i) incorporating mental health interventions to the global strategy to address non-communicable diseases; ii)moving away both from the biological and sociological reductionisms around mental health prevalent in the past century; iii) addressing the whole range of conditions related to mental health; iv) migrating from the idea that mental disorders have to be treated in secluded clinical spaces, and v) the use of a comprehensive approach in the treatment of these disorders.


Asunto(s)
Trastornos Mentales , Países en Desarrollo , Humanos , Servicios de Salud Mental , Estigma Social
17.
Salud pública Méx ; 60(2): 212-217, mar.-abr. 2018. graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-962461

RESUMEN

Abstract: Mental and substance use disorders account for 18.9% of years lived with disability worldwide. A rising prevalence of mental disorders was identified in the past decade and a call for global attention to this challenge was made. The purpose of this paper is to discuss new strategies to address mental health problems in developing nations aimed at dealing with them within the frame of the overall health system. Mainstreaming mental disorders implies five dimensions of integration: i) incorporating mental health interventions to the global strategy to address non-communicable diseases; ii) moving away both from the biological and sociological reductionisms around mental health prevalent in the past century; iii) addressing the whole range of conditions related to mental health; iv) migrating from the idea that mental disorders have to be treated in secluded clinical spaces, and v) the use of a comprehensive approach in the treatment of these disorders.


Resumen: Los problemas de salud mental y el abuso de sustancias concentran 18.9% de los años vividos con discapacidad. En la década pasada se identificó una creciente prevalencia de padecimientos mentales que obligó a hacer un llamado global para atender este reto. El propósito de este artículo es discutir nuevas estrategias para enfrentar los problemas de salud mental en los paises en desarrollo, en el marco de los servicios de salud convencionales. La incorporación de la salud mental al sistema de salud comprende cinco niveles de integración: i) sumar la salud mental a las estrategias globales vinculadas con las enfermedades no transmisibles; ii) alejarse de los reduccionismos biológico y sociológico asociados a la salud mental prevalentes en el siglo pasado; iii) atender todo el rango de condiciones relacionadas con la salud mental; iv) alejarse de la idea de que los trastornos mentales deben tratarse en espacios clínicos aislados, y v) tratar de manera integral los padecimientos mentales.

20.
Lancet ; 390(10095): 648, 2017 08 12.
Artículo en Inglés | MEDLINE | ID: mdl-28816134
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