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1.
PLoS One ; 15(12): e0243833, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33306744

RESUMEN

INTRODUCTION: Influenza morbidity and mortality are significant in the countries of South America, yet influenza vaccination is as low as 56.7% among pregnant women, reaching 76.7% of adults with chronic diseases. This article measures the relative values for the vaccination hesitancy indicators of confidence, complacency and convenience by risk-groups in urban areas of five countries of South America with contrasting vaccination rates, analyzing their association with sociodemographic variables and self-reported immunization status. METHODS: An exit survey was applied to 640 individuals per country in Brazil, Chile, Paraguay, Peru and Uruguay, distributed equally across risk groups of older adults, adults with risk factors, children ≤6 and pregnant women. Indicators were constructed for vaccine confidence, complacency and convenience. Analysis of variance and multiple logistic analysis was undertaken. RESULTS: Adults with risk factors are somewhat more confident of the influenza vaccine yet also more complacent. Convenience is higher for mothers of minors. Children and older adults report higher levels of vaccination. The 3Cs are more different across countries than across risk groups, with values for Chile higher for confidence and those for Uruguay the lowest. Complacency is lower in Brazil and higher in Uruguay. Results suggest that confidence and complacency affect vaccination rates across risk groups and countries. CONCLUSIONS: Influenza vaccine confidence, complacency and convenience have to be bolstered to improve effective coverage across all risk groups in the urban areas of the countries studied. The role played by country contextual and national vaccination programs has to be further researched in relation to effective coverage of influenza vaccine.

2.
Hum Vaccin Immunother ; : 1-10, 2020 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-32750258

RESUMEN

Influenza vaccination has been available under Peru's national immunization program since 2008, but vaccination coverage has decreased lately. Surveys and focus groups were conducted among four risk groups (pregnant women, mothers of children aged <6 years, adults with risk factors, and adults aged ≥65 years) to identify factors affecting influenza vaccine hesitancy in Peru. The 3Cs model (Confidence, Complacency, and Convenience) was used as a conceptual framework for the study. Most pregnant women and mothers of young children (70.0%), but less than half (46.3%) of older adults and adults with risk factors were vaccinated against influenza. Vaccine confidence and complacency were positively associated with educational level. Complacency was the most deficient of the 3Cs. Pregnant women and mothers were the most informed and least complacent among risk groups. Focus groups revealed the misconceptions behind the high level of complacency observed, including the perception of influenza risk and the role assigned to vaccination in preventing the disease. Interviews with officials identified that most strategies are directed to vaccination availability and hence to convenience, with opportunities for strategies to improve vaccination uptake and community engagement. The results highlight the importance of implementing in Peru communication strategies to increase perceptions of vaccine safety and effectiveness thus improving confidence and reducing complacency. The establishment of explicit incentives should also be considered to increase vaccination uptake, particularly to health personnel.

3.
Rev Invest Clin ; 71(3): 168-177, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31184332

RESUMEN

Background: The incidence of dengue in Mexico has increased in recent decades. It has been suggested that dengue outbreaks may compromise treatment quality in hospitals. Objective: The objective of the study was to quantify the burden imposed by dengue on hospital services in Mexico. Methods: We analyzed 19.2 million records contained in the database of hospital services of the Mexican Ministry of Health between 2008 and 2014. The number of admissions due to dengue was compared to other potentially preventable hospitalizations. Hospital departments were categorized to reflect dengue-related activity as high dengue activity (HDA), low dengue activity (LDA), or zero dengue activity departments, and the impact of dengue activity on general in-hospital mortality in HDA departments was assessed. Results: Dengue was the cause of more hospital admissions than most of the potentially preventable prevalent acute and chronic conditions and other infectious diseases. In HDA departments, dengue patient load was found to be a significant risk factor for overall in-hospital mortality. There was an approximately two-fold higher dengue case-fatality rate in LDA versus HDA departments, irrespective of dengue severity. Conclusions: This study confirms that dengue is an important cause of hospitalization in Mexico and highlights the impact of dengue activity not only on dengue case-fatality rate but also on the overall in-hospital mortality.


Asunto(s)
Costo de Enfermedad , Dengue/epidemiología , Hospitalización/estadística & datos numéricos , Bases de Datos Factuales , Dengue/mortalidad , Mortalidad Hospitalaria , Hospitales/estadística & datos numéricos , Humanos , Incidencia , México/epidemiología , Alta del Paciente
4.
Vaccine ; 37(13): 1868-1875, 2019 03 22.
Artículo en Inglés | MEDLINE | ID: mdl-30826144

RESUMEN

BACKGROUND: The background incidence of viscerotropic- (VLD) and neurotropic-like disease (NLD) unrelated to immunization in dengue-endemic countries is currently unknown. METHODS: This retrospective population-based analysis estimated crude and standardized incidences of VLD and NLD in twelve hospitals in Brazil (n = 3), Mexico (n = 3), and Malaysia (n = 6) over a 1-year period before the introduction of the tetravalent dengue vaccine. Catchment areas were estimated using publicly available population census information and administrative data. The denominator population for incidence rates was calculated, and sensitivity analyses assessed the impact of important assumptions. RESULTS: Total cases adjudicated as definite VLD were 5, 57, and 56 in Brazil, Mexico, and Malaysia, respectively. Total cases adjudicated as definite NLD were 103, 29, and 26 in Brazil, Mexico, and Malaysia, respectively. Crude incidence rates of cases adjudicated as definite VLD in Brazil, Mexico, and Malaysia were 1.17, 2.60, and 1.48 per 100,000 person-years, respectively. Crude incidence rates of cases adjudicated as definite NLD in Brazil, Mexico, and Malaysia were 4.45, 1.32, and 0.69 per 100,000 person-years, respectively. CONCLUSIONS: Background incidence estimates of VLD and NLD obtained in Mexico, Brazil, and Malaysia could provide context for cases occurring after the introduction of the tetravalent dengue vaccine.


Asunto(s)
Vacunas contra el Dengue/efectos adversos , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/etiología , Adolescente , Adulto , Anciano , Brasil/epidemiología , Niño , Preescolar , Vacunas contra el Dengue/administración & dosificación , Vacunas contra el Dengue/inmunología , Femenino , Humanos , Incidencia , Lactante , Malasia/epidemiología , Masculino , Tamizaje Masivo , México/epidemiología , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/diagnóstico , Vigilancia de la Población , Estudios Retrospectivos , Adulto Joven
5.
J Glob Oncol ; 4: 1-12, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-30096010

RESUMEN

Purpose The incidence of infection-associated cancers and lethality of cancers amenable to treatment are closely correlated with the income of countries. We analyzed a core part of this global cancer divide-the distribution of premature mortality across country income groups and cancers-applying novel approaches to measure avoidable mortality and identify priorities for public policy. Methods We analyzed avoidable cancer mortality using set lower- and upper-bound age limits of 65 and 75 years (empirical approach), applying cancer-specific and country income group-specific ages of death (feasibility approach), and applying cancer-specific ages of death of high-income countries to all low- and middle-income countries (LMICs; social justice approach). We applied these methods to 2015 mortality data on 16 cancers for which prevention is possible and/or treatment is likely to result in cure or significant increase in life expectancy. Results At least 30% and as much as 50% of cancer deaths are premature, corresponding to between 2.6 and 4.3 million deaths each year, and 70% to 80% are concentrated in LMICs. Using the feasibility approach, 36% of cancer deaths are avoidable; with the social justice approach, 45% of cancer deaths are avoidable. Five cancer types-breast, colorectal, lung, liver, and stomach-account for almost 75% of avoidable cancer deaths in LMICs and worldwide. Conclusion Each year, millions of premature cancer deaths could be avoided with interventions focused on four priority areas: infection-associated cancers, lifestyle and risk factors, women's cancers, and children's cancers. Our analysis of the global burden and the specific cancer types associated with avoidable cancer mortality suggests significant opportunities for health systems to redress the inequity of the global cancer divide.


Asunto(s)
Neoplasias/mortalidad , Anciano , Femenino , Humanos , Mortalidad Prematura , Factores de Riesgo , Análisis de Supervivencia
6.
Mem Inst Oswaldo Cruz ; 113(8): e180082, 2018 Jul 23.
Artículo en Inglés | MEDLINE | ID: mdl-30043823

RESUMEN

Dengue remains an unmet public health burden. We determined risk factors for dengue in-hospital mortality in Brazil. Of 326,380 hospitalised dengue cases in 9-45-year-old individuals, there were 971 deaths. Risk of dying was 11-times higher in the presence of underlying common comorbidities (renal, infectious, pulmonary disease and diabetes), similar to the risk of dying from severe dengue and much higher with the combination. Ensuring access to integrated dengue preventative measures in individuals aged ≥ 9 years including those with comorbidities may help achieve the WHO objective of 50% reduction in mortality and 25% reduction in morbidity due to dengue by 2020.


Asunto(s)
Dengue/epidemiología , Mortalidad Hospitalaria , Adolescente , Adulto , Brasil/epidemiología , Niño , Comorbilidad , Dengue/mortalidad , Femenino , Humanos , Enfermedades Renales/mortalidad , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Dengue Grave/diagnóstico , Dengue Grave/mortalidad , Análisis de Supervivencia , Adulto Joven
7.
Trans R Soc Trop Med Hyg ; 112(5): 223-229, 2018 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-29917129

RESUMEN

Background: Dengue is the most important arboviral disease in the world. Seroprevalence has been proposed as a marker of endemicity, however, studies are scarce. Methods: We conducted a cross-sectional, stratified cluster, random sample study to measure the seroprevalence of antibodies to dengue virus (DENV) in Mexico. The target population was school children ages 6-17 y from 22 endemic states in Mexico, clustered in four regions: Pacific, South-Central, Southeast and Low. Results: A total of 2134 subjects provided blood samples for immunoglobulin G antibody detection in serum by enzyme-linked immunosorbent assay. Overall, the seroprevalence of antibodies against DENV was 33.5% (95% confidence interval [CI] 27.5 to 40.1). The Southeast had the highest regional seroprevalence, reaching 70.9% (95% CI 60.3 to 79.7). Seroprevalence was higher in older children in the Southeast region: 62.1% (95% CI 46.9 to 75.2) in children 6-8 y and 82.6% (95% CI 73.8 to 88.9) in 13-17 years old (y). However, this was not consistent in all regions. Seroprevalence was associated with dengue incidence. Conclusions: DENV seroprevalence in Mexico was found to be heterogeneous at the country, regional and state levels. Seroprevalence was linked to long-term exposure and did not adequately reflect recent patterns of transmission, suggesting that utilization of a single epidemiological indicator to define endemic regions should be avoided.


Asunto(s)
Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Virus del Dengue/inmunología , Dengue/epidemiología , Dengue/inmunología , Adolescente , Anticuerpos Neutralizantes/sangre , Niño , Estudios Transversales , Dengue/tratamiento farmacológico , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunoglobulina G/sangre , Masculino , México/epidemiología , Distribución Aleatoria , Estudios Seroepidemiológicos
8.
Mem. Inst. Oswaldo Cruz ; 113(8): e180082, 2018. tab
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1040600

RESUMEN

Dengue remains an unmet public health burden. We determined risk factors for dengue in-hospital mortality in Brazil. Of 326,380 hospitalised dengue cases in 9-45-year-old individuals, there were 971 deaths. Risk of dying was 11-times higher in the presence of underlying common comorbidities (renal, infectious, pulmonary disease and diabetes), similar to the risk of dying from severe dengue and much higher with the combination. Ensuring access to integrated dengue preventative measures in individuals aged ≥ 9 years including those with comorbidities may help achieve the WHO objective of 50% reduction in mortality and 25% reduction in morbidity due to dengue by 2020.

9.
Cir Cir ; 84(2): 173-9, 2016.
Artículo en Español | MEDLINE | ID: mdl-26775056

RESUMEN

BACKGROUND: Clinical practice guidelines are tools that have been able to streamline decisions made in health issues and to decrease the gap between clinical action and scientific evidence. OBJECTIVE: The objective of the study is to share the experience in the development and to update the guidelines by the National Health System of Mexico. MATERIAL AND METHODS: The methodology in the development of the guidelines consists of 5 phases: prioritisation, establishment of work groups, development by adoption of international guidelines of de novo, validation and integration in the Master catalogue of clinical practice guidelines for its dissemination. RESULTS: The Master catalogue of clinical practice guidelines contains 664 guidelines, distributed in 42% Internal Medicine, 22% Surgery, 24% Pediatrics and 12% Gynecology. From the total of guidelines coverage is granted at an 85% of the Universal catalogue of health services, an 84% of the Catastrophic expenses protection fund and a 61% of the XXI Century Medical Insurance of the National Commission of Social Protection in Health. DISCUSSION: The result is the sum of a great effort of coordination and cooperation between the institutions of the National Health System, political wills and a commitment of 3,477 health professionals that participate in guidelines' development and update. CONCLUSION: Master catalogue guidelines' integration, diffusion and implantation improve quality of attention and security of the users of the National Health System.


Asunto(s)
Prestación de Atención de Salud , Guías de Práctica Clínica como Asunto , Humanos , México , Guías de Práctica Clínica como Asunto/normas
10.
Salud pública Méx ; 55(6): 618-626, nov.-dic. 2013. ilus, tab
Artículo en Español | LILACS | ID: lil-705987

RESUMEN

Objetivo. Cuantificar el abasto en farmacia y el nivel de surtimiento de medicamentos en las unidades de especialidades médicas de enfermedades crónicas (UNEMES-EC) de México. Material y métodos. Los indicadores de abasto y surtimiento se midieron en 30 de 86 UNEMES-EC existentes en el país. El abasto de medicamentos se registró mediante una lista de cotejo que incluía 17 medicamentos básicos relacionados con la atención de diabetes mellitus, hipertensión y sobrepeso/obesidad. La información sobre surtimiento de recetas procede de un cuestionario aplicado directamente a 1 200 usuarios. Resultados. Sólo 13.3% de las unidades reportó abasto completo de medicamentos esenciales y dicho abasto fue más frecuente en aquellas unidades con servicio tercerizado de farmacia. Del total de pacientes entrevistados, 35% alguna vez tuvo que comprar medicamentos con recursos propios. Conclusión. Las UNEMES-EC deben mejorar su abasto de medicamentos y el surtimiento completo de recetas para evitar que sus usuarios incurran en gastos de bolsillo.


Objective. To quantify the supply of essential drugs and the fully filled-in prescription level in the Units Specialized in the Treatment of Chronic Diseases (UNEMES-EC) in Mexico. Materials and methods. The supply and prescription indicators were measured in 30 of the 86 existing UNEMES-EC. The supply of drugs was recorded using a list of 17 essential drugs related to the treatment of diabetes, hypertension, overweight and obesity. The information on fully filled-in prescriptions was obtained through a questionnaire applied to 1 200 health care users. Results. Only 13.3% of these units showed a complete supply of the 17 essential drugs: Supply levels were higher in units with external drugstore service. 35% of the interviewed patients reported out-of-pocket expenditures in medicines. Conclusion. UNEMES-EC should improve their levels of drug supply and fully filled-in prescriptions to reduce out-of-pocket expenditures.


Asunto(s)
Humanos , Enfermedad Crónica/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricos , Medicamentos Esenciales/provisión & distribución , México
11.
Salud Publica Mex ; 55(4): 394-8, 2013 Aug.
Artículo en Español | MEDLINE | ID: mdl-24165715

RESUMEN

OBJECTIVE: To describe the effect of the Fund against Catastrophic Expenditures in Health on the provision of services for patients with cataract. MATERIALS AND METHODS: We used administrative dataset on hospital discharges and official figures on population to estimate the rate of care and the coverage for cataract. To estimate the variation on resources, we used data from the National System of Health Information. RESULTS: Coverage for this disease had a significant increase between 2000 and 2010, passing from 24 per thousand cataract patients receiving attention to 58.8 per thousand. This growth is mainly due to the incorporation of cataract to the catalog of diseases covered by the Fund against Catastrophic Expenditures in Health, although this variation is not based on additional resources but in a higher productivity. The growth of services is noticeable in Aguascalientes, Coahuila, Distrito Federal and Nayarit. CONCLUSIONS: Our results suggest that policy-making based on evidence have actually brought benefits for Mexican population.


Asunto(s)
Catarata/economía , Catarata/terapia , Administración Financiera , Cobertura del Seguro/economía , Enfermedad Catastrófica/economía , Femenino , Humanos , Masculino , México , Persona de Mediana Edad
12.
Rev. Fac. Med. UNAM ; 56(5): 6-13, ago.-sep. 2013. ilus, tab
Artículo en Español | LILACS-Express | LILACS | ID: biblio-956956

RESUMEN

Objetivo: Analizar la relación entre la existencia de políticas para el manejo de antisépticos, la presencia de antisépticos obsoletos y la prevalencia de infecciones nosocomiales (IN) en unidades de cuidados intensivos de hospitales públicos. Material y métodos: Análisis ecológico en 41 hospitales de 3 instituciones públicas de salud en México. Mediante regresión lineal se estimó la asociación entre la prevalencia de IN con la existencia de políticas y la presencia de antisépticos obsoletos. Resultados: Se observó una alta prevalencia de antisépticos inadecuados, particularmente peróxido de hidrógeno (46.7%). Los hospitales con antisépticos obsoletos tuvieron una prevalencia de IN 7 puntos porcentuales más elevada (p=0.001) en comparación con aquellos que carecían de éstos. Aquellos que contaban con evidencia de políticas para el manejo de antisépticos tuvieron una prevalencia 2 puntos porcentuales menor. Conclusiones: Nuestros hallazgos sugieren que la selección adecuada de antisépticos puede redundar en mejorar la seguridad del paciente.


Objective: To analyze the relationship between explicit policies for antiseptics handling, the presence of obsolete antiseptics and nosocomial infections prevalence in intensive care units public hospitals. Methods: An ecological analysis was conducted involving 41 general hospitals of three public health institutions. We use linear regression to estimate the association between hospital-level nosocomial infection prevalence and existence of antiseptics policy and obsolete antiseptics presence. Results: Adjusting by potential confounders, hospitals where had obsolete antiseptics had seven points higher prevalence of nosocomial infection (p=0.001). Those who had evidence of handling policies antiseptics had two points prevalence lower. There was high prevalence of inadequate antiseptics, particularly hydrogen peroxide (46.7%). Conclusions: Our findings confirm that proper selection of antiseptics can lead to improved patient safety. Antiseptics obsolete, even in suitable compounds presence, correlated with higher nosocomial infection prevalence.

13.
Salud Publica Mex ; 55(3): 294-300, 2013.
Artículo en Español | MEDLINE | ID: mdl-23912542

RESUMEN

OBJECTIVE: To describe and quantify hospital services given by units of the Ministry of Health (MoH) to patients with social security or living in states different to those where the hospitals are located. MATERIALS AND METHODS: With data from the automatized system for hospital discharges patients were classified, according to the place of living, into locals or outsiders; and, according to their insurance status, into social security beneficiaries or not beneficiaries. Frequencies of services for these groups were estimated, and characteristics of patients and services were described. RESULTS: 5.6% of patients of MoH hospitals were outsiders. This percentage reaches 50% in the National Institutes of Health. Only 1.7% of the patients had social security insurance. Sociodemographic and services characteristics are quite different between outsiders or social security patients and those without those attributes. CONCLUSION: Despite its segmentation, in the National Health System there is a continuous process of exchange of services between different providers.


Asunto(s)
Hospitales/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , México
14.
Salud pública Méx ; 55(4): 394-398, Jul.-Aug. 2013. ilus, tab
Artículo en Español | LILACS | ID: lil-690357

RESUMEN

Objetivo. Documentar el efecto que el Fondo de Protección contra Gastos Catastróficos (FPGC) ha tenido sobre la cobertura de servicios y la disponibilidad de recursos para la atención de cataratas. Material y métodos. Con datos 2000-2010 del Sistema Automatizado de Egresos Hospitalarios y las estimaciones de población del Consejo Nacional de Población, se calcularon la tasa anual y la cobertura de atención de cataratas. Los datos de recursos proceden del Sistema Nacional de Información en Salud. Resultados. La cobertura de atención creció de 24 pacientes atendidos por 1 000 pacientes con cataratas en 2000 a 58.8 en 2012. El mayor aumento ocurrió entre 2006 y 2007 como consecuencia de la incorporación de la atención de cataratas al FPGC. Este aumento se sustenta más en la productividad por oftalmólogo que en un incremento de los recursos. Sobresalen los incrementos en la tasa de egresos observados en Aguascalientes, Coahuila, Distrito Federal y Nayarit. Conclusiones. Los resultados aquí presentados muestran beneficios sobre la salud poblacional derivados de decisiones político-organizacionales basadas en evidencias.


Objective. To describe the effect of the Fund against Catastrophic Expenditures in Health on the provision of services for patients with cataract. Materials and methods. We used administrative dataset on hospital discharges and official figures on population to estimate the rate of care and the coverage for cataract. To estimate the variation on resources, we used data from the National System of Health Information. Results. Coverage for this disease had a significant increase between 2000 and 2010, passing from 24 per thousand cataract patients receiving attention to 58.8 per thousand. This growth is mainly due to the incorporation of cataract to the catalog of diseases covered by the Fund against Catastrophic Expenditures in Health, although this variation is not based on additional resources but in a higher productivity. The growth of services is noticeable in Aguascalientes, Coahuila, Distrito Federal and Nayarit. Conclusions. Our results suggest that policy-making based on evidence have actually brought benefits for Mexican population.


Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Catarata/economía , Catarata/terapia , Administración Financiera , Cobertura del Seguro/economía , Enfermedad Catastrófica/economía , México
15.
Salud pública Méx ; 55(3): 294-300, may.-jun. 2013. ilus, tab
Artículo en Español | LILACS | ID: lil-681054

RESUMEN

OBJETIVO: Describir y cuantificar los servicios prestados en hospitales de la Secretaría de Salud a pacientes con seguridad social o que habitan en entidades distintas a la del hospital del que egresaron. MATERIAL Y MÉTODOS: Utilizando el Sistema Automatizado de Egresos Hospitalarios, los pacientes se clasificaron, según su residencia, en locales o foráneos; y por tipo de aseguramiento, en derechohabientes o no derecho-habientes. Se calculó la frecuencia de servicios otorgados y se analizaron las características diferenciales de los pacientes y los servicios. RESULTADOS: De los pacientes 5.6% fueron foráneos. En los Institutos Nacionales de Salud este porcentaje alcanzó 50%. Sólo 1.7% de los pacientes registraron ser derechohabientes. Las características sociodemográficas y del perfil de servicios son claramente distinguibles entre pacientes foráneos y derechohabientes y aquellos sin estos atributos. DISCUSIÓN: Independientemente del carácter segmentado y fragmentado del Sistema Nacional de Salud, existe un proceso de intercambio de servicios entre proveedores.


OBJECTIVE: To describe and quantify hospital services given by units of the Ministry of Health (MoH) to patients with social security or living in states different to those where the hospitals are located. MATERIALS AND METHODS: With data from the automatized system for hospital discharges patients were classified, according to the place of living, into locals or outsiders; and, according to their insurance status, into social security beneficiaries or not beneficiaries. Frequencies of services for these groups were estimated, and characteristics of patients and services were described. RESULTS: 5.6% of patients of MoH hospitals were outsiders. This percentage reaches 50% in the National Institutes of Health. Only 1.7% of the patients had social security insurance. Sociodemographic and services characteristics are quite different between outsiders or social security patients and those without those attributes. CONCLUSION: Despite its segmentation, in the National Health System there is a continuous process of exchange of services between different providers.


Asunto(s)
Adulto , Femenino , Humanos , Masculino , Hospitales , Admisión del Paciente/estadística & datos numéricos , Estudios Transversales , México
16.
Salud Publica Mex ; 55(6): 618-26, 2013 Dec.
Artículo en Español | MEDLINE | ID: mdl-24715014

RESUMEN

OBJECTIVE: To quantify the supply of essential drugs and the fully filled-in prescription level in the Units Specialized in the Treatment of Chronic Diseases (UNEMES-EC) in Mexico. MATERIALS AND METHODS: The supply and prescription indicators were measured in 30 of the 86 existing UNEMES-EC. The supply of drugs was recorded using a list of 17 essential drugs related to the treatment of diabetes, hypertension, overweight and obesity. The information on fully filled-in prescriptions was obtained through a questionnaire applied to 1 200 health care users. RESULTS: Only 13.3% of these units showed a complete supply of the 17 essential drugs: Supply levels were higher in units with external drugstore service. 35% of the interviewed patients reported out-of-pocket expenditures in medicines. CONCLUSION: UNEMES-EC should improve their levels of drug supply and fully filled-in prescriptions to reduce out-of-pocket expenditures.


Asunto(s)
Enfermedad Crónica/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricos , Medicamentos Esenciales/provisión & distribución , Humanos , México
17.
Salud Publica Mex ; 53 Suppl 4: 480-3, 2011.
Artículo en Español | MEDLINE | ID: mdl-22282210

RESUMEN

OBJECTIVE: To introduce the Hospital Standardized Mortality Ratio (HSMR) as an alternative to assess the quality of hospital care in Mexico. MATERIAL AND METHODS: Data-sets of public hospital discharges were used as source of information. The analyses were based in a logistic model to estimate the risk of hospital death adjusting by sex, age, length of stay and main diagnosis. The HSMR is estimated dividing the observed deaths by the addition of the risk for each discharge by hospital. RESULTS: The ISSSTE had the lowest HSMR. At state level, the best figure was obtained by the hospitals of the ISSSTE in Veracruz, while the worst performance corresponds to hospitals of the SS in Nayarit. CONCLUSION: Our results suggest that this indicator can be used as a suitable alternative to evaluate the performance of hospitals in terms of mortality.


Asunto(s)
Mortalidad Hospitalaria , Garantía de la Calidad de Atención de Salud/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , México , Persona de Mediana Edad , Adulto Joven
18.
Salud Publica Mex ; 53 Suppl 4: 484-90, 2011.
Artículo en Español | MEDLINE | ID: mdl-22282211

RESUMEN

OBJECTIVE: To measure the prevalence of adverse events (AE) in surgical adult patients from the main public health institutions in Mexico. MATERIAL AND METHODS: A two stage retrospective medical record review was carried out. A total of 6 119 medical records were randomly selected. The medical records were evaluated by a doctor. Logistic regression was used to identify likely associated variables. RESULTS: The AE prevalence was 4.1%. There were no significant differences by sex or institution. The patients 65 years or older who are served in big hospitals have more risk of suffering an AE. Patients with an AE remained in the hospital an average of nine more days than those without one. CONCLUSION: According to our results, in 2008 there were at least 128 400 AE in Mexico. It is necessary to develop further studies to investigate the main factors associated to surgical adverse events and to improve patient safety.


Asunto(s)
Complicaciones Posoperatorias/epidemiología , Adulto , Femenino , Hospitales Públicos , Humanos , Masculino , México , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos
19.
Salud pública Méx ; 53(supl.4): 480-483, 2011. ilus, tab
Artículo en Español | LILACS | ID: lil-611837

RESUMEN

OBJETIVO. Presentar la Razón Estandarizada de Mortalidad Intrahospitalaria (REMI) como alternativa para medir la calidad de atención hospitalaria en México. MATERIAL Y MÉTODOS. Las fuentes de información fueron los registros de egresos hospitalarios del Instituto Mexicano del Seguro Social (IMSS), del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) y de la Secretaría de Salud en 2008. Mediante regresión logística se estimó la probabilidad de muerte intrahospitalaria controlando por sexo, edad, días de estancia y diagnóstico. La REMI es el resultado de dividir las muertes observadas entre la suma de las probabilidades estimadas para cada hospital. RESULTADOS. La REMI más baja correspondió a los hospitales del ISSSTE. Por entidad, los servicios con mejores resultados fueron los del ISSSTE en Veracruz, y los que tuvieron peor desempeño fueron los de la SS en Nayarit. CONCLUSIÓN. Los resultados obtenidos sugieren que la REMI puede constituirse como una alternativa adecuada para monitorear el desempeño de los hospitales en términos de la mortalidad observada.


OBJECTIVE. To introduce the Hospital Standardized Mortality Ratio (HSMR) as an alternative to assess the quality of hospital care in Mexico. MATERIAL AND METHODS. Data-sets of public hospital discharges were used as source of information. The analyses were based in a logistic model to estimate the risk of hospital death adjusting by sex, age, length of stay and main diagnosis. The HSMR is estimated dividing the observed deaths by the addition of the risk for each discharge by hospital. RESULTS. The ISSSTE had the lowest HSMR. At state level, the best figure was obtained by the hospitals of the ISSSTE in Veracruz, while the worst performance corresponds to hospitals of the SS in Nayarit. CONCLUSION. Our results suggest that this indicator can be used as a suitable alternative to evaluate the performance of hospitals in terms of mortality.


Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Adulto Joven , Mortalidad Hospitalaria , Garantía de la Calidad de Atención de Salud/métodos , México
20.
Salud pública Méx ; 53(supl.4): 484-490, 2011. ilus, tab
Artículo en Español | LILACS | ID: lil-611838

RESUMEN

OBJETIVO. Cuantificar la prevalencia de eventos adversos (EA) en pacientes quirúrgicos adultos atendidos en instituciones públicas de México. MATERIAL Y MÉTODOS. Se evaluaron 6 119 expedientes clínicos de pacientes quirúrgicos seleccionados aleatoriamente. La prevalencia de EA se estimó mediante la aplicación de dos instrumentos secuenciales por parte de médicos capacitados. Se efectuó análisis multivariado por regresión logística para identificar variables asociadas. RESULTADOS. La prevalencia de EA fue de 4.1 por ciento. No existieron diferencias significativas por institución ni sexo. Los pacientes mayores de 64 años y los atendidos en hospitales grandes presentaron mayor riesgo de tener un EA. Los pacientes con EA permanecieron hospitalizados en promedio nueve días más que aquellos sin EA. 62 por ciento de los EA fueron considerados prevenibles. CONCLUSIÓN. La prevalencia encontrada significa que, durante el 2008, se presentaron por lo menos 128 400 EA quirúrgicos en México. Es necesario seguir investigando la naturaleza de estos últimos para mejorar la seguridad de los pacientes.


OBJECTIVE. To measure the prevalence of adverse events (AE) in surgical adult patients from the main public health institutions in Mexico. MATERIAL AND METHODS. A two stage retrospective medical record review was carried out. A total of 6 119 medical records were randomly selected. The medical records were evaluated by a doctor. Logistic regression was used to identify likely associated variables. RESULTS. The AE prevalence was 4.1 percent. There were no significant differences by sex or institution. The patients 65 years or older who are served in big hospitals have more risk of suffering an AE. Patients with an AE remained in the hospital an average of nine more days than those without one. CONCLUSION. According to our results, in 2008 there were at least 128 400 AE in Mexico. It is necessary to develop further studies to investigate the main factors associated to surgical adverse events and to improve patient safety.


Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Hospitales Públicos , México , Prevalencia , Estudios Retrospectivos
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