Work climate in Mexican hemodialysis units: a cross-sectional study.

BACKGROUND: The work climate (WC) affects the performance of service providers and has an impact on the care provided to users. This is important in the case of conditions that affect the quality of life, as is the case of chronic kidney disease (CKD) treated with haemodialysis. In Mexico, the demand for the care of CKD cases is increasing and the haemodialysis offer is limited. The purpose of this study was to describe and compare the WC in public, private and social security haemodialysis units in Mexico and to validate a tool to measure WC in haemodialysis units (HU). METHOD: 372 professionals from 84 HU in 27 states were interviewed using a questionnaire. This included questions about the WC, quality of care and structure and organisation of the HU. Variables were compared by type of institution and profession. RESULTS: Significant correlations were observed between the WC and indicators of the quality of care. Nine out of fourteen variables presented important differences by type of unit, with a better perception of WC in private units and a poorer perception in social security ones. CONCLUSIONS: The perception of WC relies on the organisation and planning of the institutions, as well as on their infrastructure. In the case of Social Security HU in Mexico, these appear to be the areas that require improvement in order to encourage a better work climate.

[Drug supplies in primary care units at the Ministry of Health in Mexico]. / Abastecimiento de medicamentos en unidades de primer nivel de atención de la Secretaría de Salud de México.

OBJECTIVE: To identify the availability of some essential drugs (ED) at primary health care units of the Mexican Ministry of Health (SSA), using data from a research work conducted in 1996 and 1997. MATERIALS AND METHODS: A random sample of the 18 sanitary jurisdictions of states participating in the Extension of Coverage Program (ECP) was drawn. All primary care units from selected jurisdictions were evaluated through an inspection visit, using a checklist that included 36 ED. In phase I of the analysis, the absolute number and proportion of units without a single item of any of the 36 drugs were calculated. In the units with available drugs, the median of the distribution was also calculated. In phase II, the medians according to the type of health unit and state was obtained. The statistic utilized for the comparison of the medians was the Scheffé test with one way variance analysis. In addition, the drugs were classified according to their therapeutic indication and the medians and proportion of available drugs were calculated. The differences in proportion were evaluated with the statistic chi 2. RESULTS: During the visits, on average, 18 of the 36 drugs included in the list of the study were found in the health units. The availability of antibiotics, antituberculosis drugs, and antimalarial drugs was particularly poor. In contrast, oral rehydration salts, family planning methods and vaccines were usually available. In general, the PAC3 states presented the best availability figures. CONCLUSIONS: The Ministry of Health of México will have to develop an enormous effort to overcome the obstacles related to the supply of essential drugs in primary health care units. Otherwise, all other efforts directed to meet the needs of the non-insured population will end up being useless, and enormous amounts of the already scarce resources of the health sector will be wasted since drugs are a vital component of the long chain of health care.

[Medical technology and health. A lot of crunching but few nuts?]. / Las tecnologías médicas y la salud. Mucho ruido y pocas nueces?

The present work pretend to describe the development achieved in the field of health technology assessment and to propose a set of criteria to evaluate them, with the intention that it will lead to the development of health programs and policy with a tendency to maximize effectiveness, efficiency and quality, within a frame of increasing needs and scarce technical and economic resources for health care. For this work, a comprehensive review was carried out about the background of health technology adoption in our country, and the context by which to evaluate the accessibility and utilization of the health technology. In the section for technology assessment, it is propose a method to evaluate based upon the natural history of disease, that is, the traditional form of health assessment is restricted to a cross section in time (vertical evaluation), and in this study the authors propose a model with a horizontal approach, that should offer as its main virtues the development of guidelines with regards to prevention, diagnosis and treatment, in addition to cost containment, in support to a more effective and higher quality medical practice.

[Breast feeding and weaning: a survey in rural communities of Mexico]. / Lactancia materna, destete y ablactación: una encuesta en comunidades rurales de México.

OBJECTIVE: To determine the prevalence of lactation, the use of industrialized milk and weaning, and the factors related to lack of breast-feeding and early weaning in young infants of rural communities. MATERIAL AND METHODS: Transversal study performed by last year medical students doing Social Service in 222 rural communities in Mexico who applied structured interviews to 5,409 families with children younger than 1 year of age. RESULTS: The percentages of children who were never breast-fed were: in the north (N) 21.4%, in the center (C) 7.6% and in the south (S) 5.3%. Children who were still being breast-fed, either exclusively or with mixed feeding by the third trimester were 35.6% (N), 67.6% (C) and 77.5% (S); in the second trimester, 67.2% (N), 40.9% (C) and 51.6% (S) had been weaned. In the N region it was observed that lack of breast-feeding was associated to the health personnel who attended delivery, mothers with six or more years of education and less than four children, dwellings with permanent material floors, two or more household commodities and a head of the family different from the father. Early weaning was essentially associated to the same factors; additionally, to the child being taken care of by someone different from the mother, artificial lactation by parental decision or due to medical recommendation and the use of health services provided by social security or private physicians. CONCLUSIONS: Artificial lactation and early weaning are typical of small families, with high educational level of the mother, better living conditions and contact with medical personnel, especially in the N of the country. Children are weaned before the second semester of life and it is therefore deemed necessary to implement health programs which promote breast-feeding and gradual weaning after the sixth month of life among the infant population of Mexican rural communities.

[Mortality from tetanus in children less than 1 year of age, Mexico, 1970-1982]. / La mortalidad por tétanos en menores de un año, México 1970-1982.

The results of a study about mortality by tetanus in Mexican children under one year of age, during the 1970-1982 period, are reported. This age-group was subdivided in three, as follows: perinatal (less than 7 days), neonatal (less than 29 days) and postneonatal (29 to 364 days). Mortality by tetanus in children under one year of age showed a decreasing trend during the mentioned period, and this was most pronounced from 1979, because of changes in the codification of mortality by tetanus in this group of age. On the other hand, it was found that the greatest proportion of deaths by tetanus happened in the under one year of age group, and particularly in the neonatal group (less than 29 days). The geographic distribution of tetanus in Mexico was studied later, and showed a predominant incidence of the disease in coastal states of the country; an additional finding in this investigation was the displacement of the disease from the Pacific strip to the Gulf of Mexico. Finally, the mortality differentials by sex were studied, and showed that males were the most affected in the three age groups. We cannot explain this finding at the time.