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1.
Salud Publica Mex ; 2020 09 23.
Artigo em Espanhol | MEDLINE | ID: mdl-33021361

RESUMO

OBJECTIVE: To analyze the prevalence of modern contraceptive methods (CM) use in adolescents aged 12 to 19 years in 2012 and 2018-19, and the factors associated with consistent use of modern CM. MATERIALS AND METHODS: Using the Health and Nutrition National Surveys 2012 and 2018-2019 we calculated the outcome variables: long-acting reversible contraceptives (LARC) use, dual protection and consistent use of CM. We estimated prevalence by sex and adjusted logistic models with consistent use (which is understood as CM use in the first and last sexual relationship) as a dependent variable. RESULTS: LARC use in last intercourse increased between surveys (4.1 to 6.3%). For women, being older, not having been pregnant, and school attendance increased the likelihood of consistent use. For men, school attendance increases the likelihood while cohabiting, early sexual initiation and having smoked more than 100 cigarettes reduces it. CONCLUSIONS: It is necessary to promote access and consistent use of MC, based on respect for sexual and reproductive rights.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32365602

RESUMO

The purpose of this study was to assess whether government policies to expand the coverage of maternal health and family planning (MHFP) services were benefiting the adolescents in need. To this end, we estimated government MHFP expenditure for 10- to 19-year-old adolescents without social security (SS) coverage between 2003 and 2015. We evaluated its evolution and distribution nationally and sub-nationally by level of marginalization, as well as its relationship with demand indicators. Using Jointpoint regressions, we estimated the average annual percent change (AAPC) nationally and among states. Expenditure for adolescents without SS coverage registered 15% for AAPC for the period 2003-2011 and was stable for the remaining years, with 88% of spending allocated to maternal health. Growth in MHFP expenditure reduced the ratio of spending by 13% among groups of states with greater/lesser marginalization; nonetheless, the poorest states continued to show the lowest levels of expenditure. Although adolescents without SS coverage benefited from greater MHFP expenditure as a consequence of health policies directed at achieving universal health coverage, gaps persisted in its distribution among states, since those with similar demand indicators exhibited different levels of expenditure. Further actions are required to improve resource allocation to disadvantaged states and to reinforce the use of FP services by adolescents.


Assuntos
Serviços de Planejamento Familiar/economia , Financiamento Governamental , Gastos em Saúde , Serviços de Saúde Materna/economia , Adolescente , Criança , Feminino , Humanos , Saúde Materna , México , Gravidez , Adulto Jovem
3.
Medicine (Baltimore) ; 99(7): e19092, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049814

RESUMO

To determine the treatment needs and the care index for dental caries in the primary dentition and permanent dentition of schoolchildren and to quantify the cost of care that would represent the treatment of dental caries in Mexico.A secondary analysis of data from the First National Caries Survey was conducted, which was a cross-sectional study conducted in the 32 states of Mexico. Based on dmft (average number of decayed, extracted, and filled teeth in the primary dentition) and DMFT (average number of decayed, extracted, and filled teeth in permanent dentition) information, a treatment needs index (TNI) and a caries care index (CI) were calculated.At age 6, the TNI for the primary dentition ranged from 81.7% to 99.5% and the CI ranged from 0.5% to 17.6%. In the permanent dentition, the TNI ranged from 58.8% to 100%, and the CI ranged from 0.0% to 41.2%. At age 12, the TNI ranged from 55.4% to 93.4%, and the CI ranged from 6.5% to 43.4%. At age 15, the TNI ranged from 50.4% to 98.4%, and the CI ranged from 1.4% to 48.3%. The total cost of treatment at 6 years of age was estimated to range from a purchasing power parity (PPP) of USD $49.1 to 287.7 million in the primary dentition, and from a PPP of USD $3.7 to 24 million in the permanent dentition. For the treatment of the permanent dentition of 12-year-olds, the PPP ranged from USD $13.3 to 85.4 million. The estimated cost of treatment of the permanent dentition of the 15-year-olds ranged from a PPP of USD $10.9 to 70.3 million. The total estimated cost of caries treatment ranged from a PPP of USD $77.1 to 499.6 million, depending on the type of treatment and provider (public or private).High percentages of TNI for dental caries and low CI values were observed. The estimated costs associated with the treatment for caries have an impact because they represent a considerable percentage of the total health expenditure in Mexico.


Assuntos
Cárie Dentária/epidemiologia , Cárie Dentária/terapia , Adolescente , Criança , Custos e Análise de Custo , Estudos Transversais , Índice CPO , Cárie Dentária/economia , Feminino , Humanos , Masculino , México/epidemiologia , Prevalência
4.
Salud Publica Mex ; 62(6): 637-647, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33620962

RESUMO

OBJECTIVE: To identify sociodemographic and health services factors associated with receipt of immediate post-partum (IPP) contraception and the type of contraceptive method received. MATERIALS AND METHODS: We used the National Health and Nutrition Survey (Ensanut), 2018-19, which contains information on 4 548 women aged 12-49 years who gave birth. We described receipt of IPP contraception and method type and used multivariable logistic (n=4 544) and multinomial regression (n=2 903) to examine receipt of any modern method and type of method. RESULTS: 65% of women received IPP contraception. 56.8% of adolescents received long-acting reversible contraception (43.7% IUD & 13.1% implant). Being indigenous, having only one child, or receiving care in State Health Services/IMSS-Prospera or private sector facilities were associated with lower odds of receiving IPP contraception. CONCLUSIONS: We identify progress in the IPP contraception coverage among adoles-cents. Disparities persist in receipt of IPP contraception by type of health insurance.

5.
Salud Publica Mex ; 61(6): 742-752, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31869539

RESUMO

OBJECTIVE: To analyze the adolescent motherhood trend and associated factors in under-100 000-inhabitants communities. MATERIALS AND METHODS: Cross-sectional analysis of 16 686 women in under-100 000-inhabitants communities in Encuesta Nacional de Salud y Nutrición (Ensanut) 2006, 2012 and 100k 2018. We adjusted robust Poisson models with adolescent motherhood as dependent variable for women aged 12-19 and 20-24. RESULTS: Attending school and using modern contraceptives decrease adolescent motherhood prevalence in both age groups. Among adolescent girls, having a health financing scheme, and early sexual debut in the case of adults, is positively associated with adolescent motherhood. CONCLUSIONS: It is necessary to strengthen public policies seeking to modify structural factors that provide life choices, and to maintain and strengthen the actions and coverage proposed by Estrategia Nacional para la Prevención del Embarazo en Adolescentes (ENAPEA) targeting this population.


Assuntos
Gravidez na Adolescência/estatística & dados numéricos , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , México , Densidade Demográfica , Gravidez , Gravidez na Adolescência/prevenção & controle , Fatores de Tempo , Adulto Jovem
6.
Salud Publica Mex ; 61(6): 753-763, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31869540

RESUMO

OBJECTIVE: To compare the coverage of continuous ma- ternal healthcare and early childhood care in women with and without adolescent motherhood (AM) who live in under-100 000-inhabitants communities. MATERIALS AND METHODS: Cross-sectional analysis of Ensanut 100k 2018 of 767 women aged 12 to 49 years living in under-100 000-in- habitants communities who had their last birth two years before the survey. RESULTS: Women with AM have lower continuous coverage of maternal care than those without AM (8.1 and 19.6%, respectively). Infant care coverage with adequate content was lower than 30%, and there were no differences between the groups. CONCLUSIONS: It is necessary to strengthen actions focused on this group of women in order to reduce the gaps in coverage and improve maternal and child health.


Assuntos
Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Humanos , México , Pessoa de Meia-Idade , Densidade Demográfica , Adulto Jovem
7.
Salud Publica Mex ; 61(6): 876-887, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31869551

RESUMO

OBJECTIVE: To characterize medical care and self-care actions in a population with diabetes in locations smaller than 100 000 inhabitants. MATERIALS AND METHODS: With information from the Encuesta Nacional de Salud y Nutrición 100k (Ensanut 100k), two logistic regression models were obtained: not performing five basic actions in the last consultation and not taking priority self-care actions. RESULTS: Having low schooling, belonging to the low economic stratum, and speaking indigenous language, increase the probability of not taking self-care actions. On the contrary, as age increases, the chances of self-care are reduced by 3%. Belonging to an indigenous household and the low tercile, increases the chances that health personnel will not perform the five basic actions during the consultation. CONCLUSIONS: It is essential that a diabetes control program be established that includes patient education and update courses for medical staff.


Assuntos
Diabetes Mellitus/terapia , Autocuidado , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Densidade Demográfica , Fatores Socioeconômicos , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-31652519

RESUMO

BACKGROUND: This paper describes the health and economic burden of cardiovascular diseases (CVD) in Mexico and other mega-countries through a review of literature and datasets. METHODS: Mega-countries with a low (Nigeria), middle (India), high (China/Brazil/Mexico), and very high (the U.S.A./Japan) human development index were included. The review was focused on prevalence of dyslipidemias and CVD economic impact and conducted according to the PRISMA statement. Public datasets of CVD indicators were explored. RESULTS: Heterogeneity in economic data and limited information on dyslipidemias were found. Hypertriglyceridemia and hypercholesterolemia were higher in Mexico compared with other countries. Higher contribution of dietary risk factors for cardiovascular mortality and greater probability of dying prematurely from CVD were observed in developing countries. From 1990-2016, a greater decrease in cardiovascular mortality in developed countries was registered. In 2015, a CVD expense equivalent to 4% of total health expenditure was reported in Mexico. CVD ranked first in health expenditures in almost all these nations and the economic burden will remain significant for decades to come. CONCLUSIONS: Resources should be assured to optimize CVD risk monitoring. Educational and medical models must be improved to enhance CVD diagnosis and the prescription and adherence to treatments. Long-term benefits could be attained by modifying the food system.


Assuntos
Doenças Cardiovasculares/epidemiologia , Efeitos Psicossociais da Doença , Brasil , Doenças Cardiovasculares/economia , China/epidemiologia , Países Desenvolvidos , Países em Desenvolvimento , Humanos , Índia , Japão , México/epidemiologia , Nigéria , Prevalência , Fatores de Risco
9.
Salud Publica Mex ; 61(5): 685-691, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31661746

RESUMO

The initiative including an Act Project for reforming the Ley General de Salud of Mexico, submitted in 2019 to the Congress of the Union, proposes the creation of a system of universal and free access to health services and associated medicines for the population lacking of social security benefits, and the creation of the Instituto de Salud para el Bienestar. This article analyzes the substantive aspects of the project, with the aim of motivating the reflection of the proposed reform and its most important components, to contribute to achieving its aim. The conclusion is that the main themes of the Project require precision in relevant areas, such as the transformation of the financing scheme for care, the strengthening of stewardship and governance, the responsibility in the provision of services, and the regulation and access to medicines. The contributions of academics, decision makers and social organizations will be essential to create a public health policy based on evidence and social equity.


Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Legislação de Medicamentos , Programas Nacionais de Saúde/legislação & jurisprudência , Assistência à Saúde/legislação & jurisprudência , Financiamento Governamental/legislação & jurisprudência , Regulamentação Governamental , Administração de Serviços de Saúde/legislação & jurisprudência , Humanos , México , Preparações Farmacêuticas/provisão & distribução
10.
Salud pública Méx ; 61(5): 685-691, sep.-oct. 2019.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1127332

RESUMO

Resumen: La iniciativa con Proyecto de Decreto por el que se reforma la Ley General de Salud de México presentada en 2019 ante el Congreso de la Unión propone la creación de un sistema de acceso universal y gratuito a los servicios de salud y a medicamentos asociados para la población sin seguridad social y la creación del Instituto de Salud para el Bienestar. Este artículo analiza algunos aspectos sustantivos del Proyecto de Decreto con el objetivo de motivar la reflexión sobre la reforma propuesta y sus componentes más importantes para contribuir a su propósito. Se concluye que los principales temas del proyecto requieren precisión en rubros relevantes, como la transformación del esquema de financiamiento para la atención, el fortalecimiento de la rectoría y gobernanza, la responsabilidad en la provisión de servicios y la regulación y acceso a medicamentos. Las aportaciones de académicos, tomadores de decisiones y organizaciones sociales serán indispensables para una política pública de salud basada en evidencia y con equidad social.


Abstract: The initiative including an Act Project for reforming the Ley General de Salud of Mexico, submitted in 2019 to the Congress of the Union, proposes the creation of a system of universal and free access to health services and associated medicines for the population lacking of social security benefits, and the creation of the Instituto de Salud para el Bienestar. This article analyzes the substantive aspects of the project, with the aim of motivating the reflection of the proposed reform and its most important components, to contribute to achieving its aim. The conclusion is that the main themes of the Project require precision in relevant areas, such as the transformation of the financing scheme for care, the strengthening of stewardship and governance, the responsibility in the provision of services, and the regulation and access to medicines. The contributions of academics, decision makers and social organizations will be essential to create a public health policy based on evidence and social equity.

11.
Salud pública Méx ; 61(5): 685-691, sep.-oct. 2019.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1127336

RESUMO

Resumen: La iniciativa con Proyecto de Decreto por el que se reforma la Ley General de Salud de México presentada en 2019 ante el Congreso de la Unión propone la creación de un sistema de acceso universal y gratuito a los servicios de salud y a medicamentos asociados para la población sin seguridad social y la creación del Instituto de Salud para el Bienestar. Este artículo analiza algunos aspectos sustantivos del Proyecto de Decreto con el objetivo de motivar la reflexión sobre la reforma propuesta y sus componentes más importantes para contribuir a su propósito. Se concluye que los principales temas del proyecto requieren precisión en rubros relevantes, como la transformación del esquema de financiamiento para la atención, el fortalecimiento de la rectoría y gobernanza, la responsabilidad en la provisión de servicios y la regulación y acceso a medicamentos. Las aportaciones de académicos, tomadores de decisiones y organizaciones sociales serán indispensables para una política pública de salud basada en evidencia y con equidad social.


Abstract: The initiative including an Act Project for reforming the Ley General de Salud of Mexico, submitted in 2019 to the Congress of the Union, proposes the creation of a system of universal and free access to health services and associated medicines for the population lacking of social security benefits, and the creation of the Instituto de Salud para el Bienestar. This article analyzes the substantive aspects of the project, with the aim of motivating the reflection of the proposed reform and its most important components, to contribute to achieving its aim. The conclusion is that the main themes of the Project require precision in relevant areas, such as the transformation of the financing scheme for care, the strengthening of stewardship and governance, the responsibility in the provision of services, and the regulation and access to medicines. The contributions of academics, decision makers and social organizations will be essential to create a public health policy based on evidence and social equity.

12.
BMJ Open ; 9(9): e027101, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31537556

RESUMO

OBJECTIVE: The present study aimed to identify preventive and curative dental health service utilisation (DHSU) in the context of associated clinical and non-clinical factors among adolescents and young adults in Mexico. DESIGN: Cross-sectional study. SETTING: Applicants to a public university in Mexico. PARTICIPANTS: Participants were 638 adolescents and young adults aged 16-25 randomly selected from university applicants. INTERVENTIONS: Data were collected using a self-administered questionnaire filled out by the students. For assessment of dental caries experience, we used the index of decayed, missing and filled teeth. PRIMARY OUTCOME: The dependent variable was DHSU in the previous 12 months, coded as 0=non-use, 1=use of curative services and 2=use of preventive services. RESULTS: The mean age was 18.76±1.76 years, and 49.2% were women. The prevalence of DHSU was 40.9% (95% CI 37.1 to 44.8) for curative services and 22.9% (95% CI 19.7 to 26.3) for preventive services. The variables associated with curative services were age, sex, mother's education, dental pain in the previous 12 months, caries experience, use of self-care devices and oral health knowledge. For preventive services, the variables associated were mother's education, dental pain in the previous 12 months, caries experience, use of self-care devices and self-perception of oral health. CONCLUSIONS: While differences emerged by type of service, a number of variables (sociodemographic and socioeconomic characteristics as well as dental factors) remained in the final model. Greater oral health needs and socioeconomic inequalities remained as predictors of both types of DHSU. Given the differences revealed by our study, oral health policies should refer those seeking dental care for oral diseases to preventive services, and promote the use of such services among the poorer and less educated population groups.


Assuntos
Assistência Odontológica , Serviços de Saúde Bucal/estatística & dados numéricos , Saúde Bucal , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde , Doenças Estomatognáticas , Adolescente , Estudos Transversais , Assistência Odontológica/métodos , Assistência Odontológica/estatística & dados numéricos , Inquéritos de Saúde Bucal , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , México/epidemiologia , Prevalência , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Doenças Estomatognáticas/epidemiologia , Doenças Estomatognáticas/terapia , Adulto Jovem
13.
Medicine (Baltimore) ; 98(30): e16634, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348316

RESUMO

INTRODUCTION: Dental caries is the most frequent oral disease worldwide and the main cause of tooth loss in children and young adults. One of the most frequently affected areas is the occlusal surfaces of the first permanent molars (FPM) due to their morphological complexity. At present, several preventive treatments can reduce the incidence of this disease in school populations. In Mexico, the most commonly used technologies are those derived from some presentation of fluoride; on the other hand, research on this topic has been limited. OBJECTIVE: To determine the cost-effectiveness of two different methods for preventing the incidence of caries on the FPM of schoolchildren (6-8 years of age) from public primary schools. MATERIAL AND METHODS: This is a randomized experimental design. Participants will be assigned to two treatment groups of 114 each. In the first group, pit and fissure sealants will be applied, whereas the second group will receive a fluoride varnish. The work will be carried out in schoolchildren that attend public elementary schools in the state of Hidalgo, Mexico. The result variable will be the incidence of caries and the total cost of each of the interventions will be calculated in order to calculate the intervention's cost-effectiveness. CONCLUSION: This work will allow us to compare the cost-effectiveness of the pit and fissure sealants and the fluoride varnish in order to determine which offers the best results.


Assuntos
Cárie Dentária/prevenção & controle , Fluoretos Tópicos/uso terapêutico , Selantes de Fossas e Fissuras/uso terapêutico , Criança , Análise Custo-Benefício , Método Duplo-Cego , Feminino , Fluoretos Tópicos/administração & dosagem , Fluoretos Tópicos/economia , Humanos , Masculino , México , Selantes de Fossas e Fissuras/economia , Projetos de Pesquisa
14.
Artigo em Inglês | MEDLINE | ID: mdl-31195612

RESUMO

Aim: The objective of this study was to estimate the Out-Of-Pocket Expenditures (OOPEs) incurred by households on dental care, as well as to analyze the sociodemographic, economic, and oral health factors associated with such expenditures. Method: A cross-sectional study was conducted among 763 schoolchildren in Mexico. A questionnaire was distributed to parents to determine the variables related to OOPEs on dental care. The amounts were updated in 2017 in Mexican pesos and later converted to 2017 international dollars (purchasing power parities-PPP US $). Multivariate models were created: a linear regression model (which modeled the amount of OOPEs), and a logistic regression model (which modeled the likelihood of incurring OOPEs). Results: The OOPEs on dental care for the 763 schoolchildren were PPP US $53,578, averaging a PPP of US $70.2 ± 123.7 per child. Disbursements for treatment were the principal item within the OOPEs. The factors associated with OOPEs were the child's age, number of dental visits, previous dental pain, main reason for dental visit, educational level of mother, type of health insurance, household car ownership, and socioeconomic position. Conclusions: The average cost of dental care was PPP US $70.2 ± 123.7. Our study shows that households with higher school-aged children exhibiting the highest report of dental morbidity-as well as those without insurance-face the highest OOPEs. An array of variables were associated with higher expenditures. In general, higher-income households spent more on dental care. However, the present study did not estimate unmet needs across the socioeconomic gradient, and thus, future research is needed to fully ascertain disease burden.


Assuntos
Assistência Odontológica/economia , Países em Desenvolvimento/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Seguro Saúde , Masculino , México , Fatores Socioeconômicos , Inquéritos e Questionários
15.
JAMA Pediatr ; 173(6): e190337, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31034019

RESUMO

Importance: Understanding causes and correlates of health loss among children and adolescents can identify areas of success, stagnation, and emerging threats and thereby facilitate effective improvement strategies. Objective: To estimate mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories. Design, Setting, and Participants: This study examined levels, trends, and spatiotemporal patterns of cause-specific mortality and nonfatal health outcomes using standardized approaches to data processing and statistical analysis. It also describes epidemiologic transitions by evaluating historical associations between disease indicators and the Socio-Demographic Index (SDI), a composite indicator of income, educational attainment, and fertility. Data collected from 1990 to 2017 on children and adolescents from birth through 19 years of age in 195 countries and territories were assessed. Data analysis occurred from January 2018 to August 2018. Exposures: Being under the age of 20 years between 1990 and 2017. Main Outcomes and Measures: Death and disability. All-cause and cause-specific deaths, disability-adjusted life years, years of life lost, and years of life lived with disability. Results: Child and adolescent deaths decreased 51.7% from 13.77 million (95% uncertainty interval [UI], 13.60-13.93 million) in 1990 to 6.64 million (95% UI, 6.44-6.87 million) in 2017, but in 2017, aggregate disability increased 4.7% to a total of 145 million (95% UI, 107-190 million) years lived with disability globally. Progress was uneven, and inequity increased, with low-SDI and low-middle-SDI locations experiencing 82.2% (95% UI, 81.6%-82.9%) of deaths, up from 70.9% (95% UI, 70.4%-71.4%) in 1990. The leading disaggregated causes of disability-adjusted life years in 2017 in the low-SDI quintile were neonatal disorders, lower respiratory infections, diarrhea, malaria, and congenital birth defects, whereas neonatal disorders, congenital birth defects, headache, dermatitis, and anxiety were highest-ranked in the high-SDI quintile. Conclusions and Relevance: Mortality reductions over this 27-year period mean that children are more likely than ever to reach their 20th birthdays. The concomitant expansion of nonfatal health loss and epidemiological transition in children and adolescents, especially in low-SDI and middle-SDI countries, has the potential to increase already overburdened health systems, will affect the human capital potential of societies, and may influence the trajectory of socioeconomic development. Continued monitoring of child and adolescent health loss is crucial to sustain the progress of the past 27 years.


Assuntos
Saúde do Adolescente/tendências , Saúde da Criança/tendências , Carga Global da Doença/tendências , Saúde Global/tendências , Morbidade/tendências , Ferimentos e Lesões/epidemiologia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Análise Espaço-Temporal , Ferimentos e Lesões/etiologia , Adulto Jovem
16.
PLoS One ; 14(3): e0212841, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30893312

RESUMO

AIM: To assess the adherence of physicians to the Medical-Care Guidelines for Malignant Breast Tumors in Mexico, before and after the allocation of federal subsidies from the Catastrophic Health Expenditure Fund (FPGC by its Spanish initials) to accredited hospitals, a strategy implemented with the view of offering free treatment to women with breast cancer (BC). MATERIAL AND METHODS: Based on a cross-sectional design, we gathered information on 479 BC patients who had been attended to at in four FPGC-accredited hospitals. Analysis centered on those treated within either three years before or three years after the accreditation of their attending hospitals. The four hospitals analyzed were located in the North, South, West and Center of the country. Information on all medical procedures performed during treatment was drawn from hospital medical records. Information on the socio-demographic characteristics of the patients was obtained by means of face-to-face interviews conducted in their homes. RESULTS: Adherence of physicians to the Guidelines grew by 12.8 percent (from 43.4 to 56.2 percent) after FPGC accreditation (p<0.001) and varied according to the clinical stage of the disease, with much lower levels of adherence observed in the advanced stages (p<0.05). CONCLUSIONS: The FPGC strategy increased the adherence of physicians to the Medical-Care Guidelines for Malignant Breast Tumors in Mexico.


Assuntos
Neoplasias da Mama/terapia , Fidelidade a Diretrizes/estatística & dados numéricos , Oncologia/normas , Programas Nacionais de Saúde/economia , Médicos/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/economia , Neoplasias da Mama/patologia , Estudos Transversais , Feminino , Hospitais Públicos/economia , Hospitais Públicos/normas , Humanos , Oncologia/economia , Oncologia/estatística & dados numéricos , México , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Médicos/economia , Médicos/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde
17.
PLoS One ; 14(1): e0210319, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30699156

RESUMO

INTRODUCTION: Family planning (FP) is one of the key services provided by health care systems. Extending beyond matters of sexual and reproductive health, its area of influence impacts directly on the development of individuals and nations. After 60 years of intense FP activities in Mexico, and in light of recent restructuring of health service supply and financing, services need to be assessed from a user perspective. OBJECTIVE: Based on a comprehensive conceptual framework, this article assesses the quality of the FP services provided by the Mexican Ministry of Health (MoH). Analysis considers not only accessibility and availability but also the users' perceptions of the care process, particularly as regards the interpersonal relations they experience with staff and the type of information they are provided. MATERIAL AND METHODS: This study used a descriptive, qualitative design based on maximum variation sampling in six Mexican states. It included visits to 12 clinics in urban and rural areas. Thematic analysis was performed on 86 semi-structured interviews administered to FP service users. RESULTS: While access was described by users as "easy," their experiences revealed normalized barriers. One of our key findings referred to inverse availability, meaning that the contraceptive methods available were generally not the ones preferred by users, with their selection therefore being shaped by shortage of supplies. Challenges included disrespect for the free choice of FP users and coercion during consultations for contraception post obstetric event. Finally, information provided to users left considerable room for improvement. CONCLUSIONS: After six decades of FP service supply, results indicate a series of quality issues that may lie at the heart of the unmet demand reported in the literature. Based on a comprehensive conceptual scheme, the present study analyzes the quality of services, highlighting areas for improvement that should be considered by the MoH in future efforts.


Assuntos
Serviços de Planejamento Familiar/normas , Adolescente , Adulto , Anticoncepção/métodos , Aconselhamento , Serviços de Planejamento Familiar/economia , Serviços de Planejamento Familiar/provisão & distribução , Feminino , Planejamento em Saúde , Acesso aos Serviços de Saúde , Humanos , Masculino , México , Pessoa de Meia-Idade , Gravidez , Relações Profissional-Paciente , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Educação Sexual , Adulto Jovem
18.
Int J Health Plann Manage ; 34(2): 619-635, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30615218

RESUMO

OBJECTIVE: To assess the relationship between government expenditure on maternal health (GE) and maternal mortality (MM) in Mexican poor population between 2000 and 2015 in the 2457 Mexican municipalities. METHODS: Using administrative data, we performed the analysis in three stages: First, we tested the presence of selection bias in MM. Next, we assessed the presence of spatial dependence in the incidence and severity of MM. Finally, we estimated a spatial error model considering the correction of estimates for the spatial dependence and selection bias assessed before. RESULTS: MM and GE were not randomly distributed throughout the Mexican territory; the most socially vulnerable municipalities exhibited the highest levels of MM severity but the lowest levels of GE and available human and physical resources for maternal health; the incidence of MM was independent of GE; elasticity of GE-severity in MM was -4% (P < 0.01). CONCLUSIONS: Resource allocation for maternal health must move towards a more comprehensive vision, and efforts to achieve an effective delivery of universal health services must improve, particularly regarding the most vulnerable municipalities.


Assuntos
Financiamento Governamental/estatística & dados numéricos , Gastos em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mortalidade Materna , Adulto , Financiamento Governamental/economia , Acesso aos Serviços de Saúde/economia , Humanos , Incidência , Saúde Materna/economia , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/economia , Serviços de Saúde Materna/estatística & dados numéricos , México/epidemiologia , Modelos Econométricos , Modelos Estatísticos , Alocação de Recursos , Fatores Socioeconômicos , Análise Espacial , Adulto Jovem
19.
JAMA ; 320(8): 792-814, 2018 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-30167700

RESUMO

Importance: Understanding global variation in firearm mortality rates could guide prevention policies and interventions. Objective: To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. Design, Setting, and Participants: This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths. Exposures: Firearm ownership and access. Main Outcomes and Measures: Cause-specific deaths by age, sex, location, and year. Results: Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (-0.2% [95% UI, -0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P < .001; R2 = 0.21) and homicide (P < .001; R2 = 0.35). Conclusions and Relevance: This study estimated between 195 000 and 276 000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups.


Assuntos
Armas de Fogo/estatística & dados numéricos , Homicídio/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Saúde Global/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Distribuição por Sexo , Adulto Jovem
20.
JAMA Oncol ; 4(11): 1553-1568, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29860482

RESUMO

Importance: The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required. Objective: To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus. Evidence Review: Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition. Findings: In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories. Conclusions and Relevance: Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.


Assuntos
Carga Global da Doença/tendências , Saúde Global/normas , Neoplasias/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Feminino , História do Século XX , História do Século XXI , Humanos , Incidência , Masculino , Neoplasias/mortalidade , Análise de Sobrevida
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