Hospital care direct costs due to ambulatory care sensitive conditions related to diabetes mellitus in the Mexican public healthcare system.

BACKGROUND: Hospitalizations for ambulatory care sensitive conditions (ACSC) incur substantial costs on the health system that could be partially avoided with adequate outpatient care. Complications of chronic diseases, such as diabetes mellitus (DM), are considered ACSC. Previous studies have shown that hospitalizations due to diabetes have a significant financial burden. In Mexico, DM is a major health concern and a leading cause of death, but there is limited evidence available. This study aimed to estimate the direct costs of hospitalizations by DM-related ACSC in the Mexican public health system. METHODS: We selected three hospitals from each of Mexico's main public institutions: the Mexican Social Security Institute (IMSS), the Ministry of Health (MoH), and the Institute of Social Security and Services for State Workers (ISSSTE). We employed a bottom-up microcosting approach from the healthcare provider perspective to estimate the total direct costs of hospitalizations for DM-related ACSC. Input data regarding length of stay (LoS), consultations, medications, colloid/crystalloid solutions, procedures, and laboratory/medical imaging studies were obtained from clinical records of a random sample of 532 hospitalizations out of a total of 1,803 DM-related ACSC (ICD-10 codes) discharges during 2016. RESULTS: The average cost per DM-related ACSC hospitalization varies among institutions, ranging from $1,427 in the MoH to $1,677 in the IMSS and $1,754 in the ISSSTE. The three institutions' largest expenses are LoS and procedures. Peripheral circulatory and renal complications were the major drivers of hospitalization costs for patients with DM-related ACSC. Direct costs due to hospitalizations for DM-related ACSC in these three institutions represent 1% of the gross domestic product (GDP) dedicated to health and social services and 2% of total hospital care expenses. CONCLUSIONS: The direct costs of hospitalizations for DM-related ACSC vary considerably across institutions. Disparities in such costs for the same ACSC among different institutions suggest potential disparities in care quality across primary and hospital settings (processes and resource utilization), which should be further investigated to ensure optimal supply utilization. Prioritizing preventive measures for peripheral circulatory and renal complications in DM patients could be highly beneficial.

Design and validation of indicators for the comprehensive measurement of quality of care for type 2 diabetes and acute respiratory infections in ambulatory health services.

Developing ambulatory health services (AHS) of optimal quality is a pending issue for many health systems at a global level, especially in middle- and low-income countries. An effective health response requires indicators to measure the quality of care that are context-specific and feasible for routine monitoring. This paper aimed to design and validate indicators for assessing the technical and interpersonal quality dimensions for type 2 diabetes (T2D) and acute respiratory infections (ARI) care in AHS. The study was conducted in two stages. First, technical and user-centered-based indicators of quality of care for T2D and ARI care were designed following international recommendations, mainly from the American Diabetes Association standards and the National Institute for Health and Care Excellence guidelines. We then assessed the validity, reliability, relevance, and feasibility of the proposed indicators implementing the modified Delphi technique. A panel of 17 medical experts from five countries scored the indicators using two electronic questionnaires, one for each reason for consultation selected, sent by email in two sequential rounds of rating. We defined the levels of consensus according to the overall median for each performance category, which was established as the threshold. Selected indicators included those with scores equal to or higher than the threshold. We designed 36 T2D indicators, of which 16 were validated for measuring the detection of risks and complications, glycemic control, pharmacological treatment, and patient-centered care. Out of the 22 indicators designed for ARI, we validated 10 for diagnosis, appropriate prescription of antimicrobials, and patient-centered care. The validated indicators showed consistency for the dimensions analyzed. Hence, they proved to be a potentially reliable and valuable tool for monitoring the performance of the various T2D and ARI care processes in AHS. Further research will be needed to verify the applicability of the validated indicators in routine clinical practice.

Acreditación de servicios y calidad de la atención a neonatos en hospitales mexicanos.

OBJETIVO: Comparar la calidad de atención a neonatos con sepsis neonatal, hipoxia intrauterina, prematuridad y asfixia perinatal en hospitales acreditados (HA) y no acreditados (HNA). Material y métodos. Se evaluaron 28 hospi-tales de la Secretaría de Salud en 11 estados de México; la evaluación incluyó infraestructura, equipamiento e insumos, procesos de gestión de calidad e indicadores de calidad clínica. Se utilizó LQAS y se estimó el cumplimiento promedio de criterios e indicadores en HA y HNA. RESULTADOS: Hubo diferencias significativas en favor de HA en equipamiento e insumos y no significativas en existencia y funcionamiento de los comités hospitalarios. No hubo diferencias consistentes ni significativas en cumplimiento de indicadores clínicos entre los HA y HNA. CONCLUSIONES: La acreditación para la atención de neonatos con los diagnósticos seleccionados no se asocia a diferencias en la calidad de la atención.

Sedentarismo laboral en distintos contextos ocupacionales en México: prevalencia y factores asociados.

Objetivo. Analizar la prevalencia de sedentarismo laboral en diferentes contextos ocupacionales y estimar los factores asociados de acuerdo con el sector de actividad económica. Material y métodos. Análisis secundario de datos de la Encuesta Nacional de Ocupación y Empleo (ENOE); se identificó la ocupación y se clasificó en cuatro categorías. La variable dependiente fue el sedentarismo laboral; las variables independientes fueron sexo, edad, escolaridad, ingreso, zona de residencia urbana del trabajador, formalidad laboral y región socioeconómica. Los factores asociados se estimaron mediante regresión logística múltiple por sector de actividad económica. Resultados. La mayor prevalencia del seden-tarismo laboral se encontró en el sector de servicios (43%, IC95%: 42.3-43.6). Los factores asociados fueron nivel de estudios superior, mayores ingresos, ser mujer y trabajar en el sector formal. Conclusiones. La prevalencia de seden-tarismo laboral es alta en sectores productivos estratégicos, por lo que es necesario considerar los factores de riesgo identificados en este trabajo para establecer estrategias de mitigación.

Carencias y variabilidad en la calidad de la atención a neonatos hospitalizados en México. Estudio transversal en 28 hospitales públicos.

Objetivo. Evaluar la calidad de la atención a neonatos con indicadores de proceso, en patologías seleccionadas. Ma-terial y métodos. Evaluación multicéntrica, transversal de nueve indicadores en 28 hospitales de 11 entidades de México. Se utilizó Lot Quality Assurance Sampling (LQAS) para estándares de calidad y muestra por hospital. Casos seleccio-nados al azar del Subsistema Automatizado de Egresos Hos-pitalarios. Se clasifican hospitales como "cumplimiento con estándar"/"no cumplimiento" por indicador y, cumplimiento con IC95% exacto binomial, regional y nacional, según mues-treo estratificado no proporcional. Resultados. Ningún indicador cumple el estándar de 75% en hospitales, con 0 a 19 hospitales que cumplen, según indicador. Excepto la iden-tificación oportuna de asfixia perinatal e inicio de antibiótico correcto en sospecha de sepsis temprana, el cumplimiento es <50% en todos los demás indicadores. Conclusiones. La calidad de la atención a neonatos en hospitales es heterogé-nea y deficiente. Se proponen indicadores para monitorizar iniciativas de mejora.

Barreras y facilitadores en la implementación de guías de práctica clínica en México: perspectiva del personal de salud.

Objetivo. Identificar barreras, facilitadores y propuestas de mejora en la implementación de Guías de Práctica Clínica (GPC) desde la perspectiva de los profesionales de la salud. Material y métodos. Estudio cualitativo a través de 85 entrevistas semiestructuradas a responsables de implementa-ción, difusión y aplicación, y del personal operativo en centros de atención primaria y hospitales en siete estados de México. El contenido fue codificado y analizado con ATLAS.ti 7.0. Resultados. Las principales barreras encontradas fueron la no actualización de las GPC y baja alineación con otras normas, e imposibilidad de implementarlas debido a la sobre-carga de trabajo y los recursos limitados. Conclusiones. El esfuerzo por implementar GPC parece haber sido errático e insuficiente, y la evaluación de su utilización inexistente. Se propone crear estrategias integradas y contextualizadas que resulten ser más efectivas y eficientes para la implementación exitosa de GPC.

Cut-off points for serum ferritin to identify low iron stores during the first year of life in a cohort of Mexican infants.

The aim of this study was to identify serum ferritin (SF) cut-off points (COPs) in a cohort of healthy full-term normal birth weight infants who had repeated measurements of SF and haemoglobin every 3 months during the first year of life. The study included 746 full-term infants with birth weight ≥2,500 g, having uncomplicated gestations and births. Participants received prophylactic iron supplementation (1 mg/day of iron element) from the first to the 12th month of life and did not develop anaemia during the first year of life. Two statistical methods were considered to identify COPs for low iron stores at 3, 6, 9 and 12 months of age: deviation from mean and cluster analysis. According to the K-means cluster analysis results by age and sex, COPs at 3 and 6 months for girls were 39 and 21 µg/L and for boys 23 and 11 µg/L, respectively. A single COP of 10 µg/L was identified, for girls and boys, at both 9 and 12 months. Given the physiological changes in SF concentration during the first year of life, our study identified dynamic COPs, which differed by sex in the first semester. Adequate SF COPs are necessary to identify low iron stores at an early stage of iron deficiency, which represents one of the most widespread public health problems around the world, particularly in low- and middle-income countries.

[Quality of care in type 2 diabetes, progressand challenges from 2012 to 2018-19 forthe Mexican health system]. / Calidad de la atención en diabetes tipo 2, avances y retos de 2012 a 2018-19 para el sistema de salud de México.

OBJECTIVE: To estimate changes in the quality of process of care and its association with glycaemic control in adults with type 2 diabetes. MATERIALS AND METHODS: Changes in compliance of 14 process of care indicators for 9 038 adults with type 2 diabetes and glycaemic control in a subsample were estimated. Averages, weighted changes and associations without or controlling for other factors were estimated us-ing statistical weights for the combined data (Ensanut 2012 and Ensanut 2018-19). RESULTS: From 2012 to 2018-19, glycaemic control doubled. Early detection of complications and increased insuline use improved, but identification and treatment of cardiovascular risk factors decreased. The overall quality of care was associated with optimal glycaemic control. CONCLUSIONS: There are areas of opportunity for improvement of quality of care, that deserve comprehensive strategies and continuous monitoring.

OBJETIVO: Estimar cambios en la calidad del proceso de atención y su asociación con control glucémico en adultos con diabetes tipo 2. MATERIAL Y MÉTODOS: cambio en el cumplimiento de 14 indicadores del proceso de atención en 9 038 adultos con diabetes tipo 2 y del control glucémico en una submuestra. Se estimaron promedios, cam-bios ponderados y asociaciones crudas y ajustadas utilizando ponderaciones estadísticas para datos combinados (Ensanut 2012 y Ensanut 2018-19). RESULTADOS: De 2012 a 2018-19, el control glucémico se duplicó. Mejoró la detección tem-prana de complicaciones y aumentó el uso de insulina, pero disminuyó la identificación y tratamiento de factores de riesgo cardiovascular. La calidad global de la atención se asoció con el control glucémico óptimo. CONCLUSIONES: Existen áreas de oportunidad para la mejora de la calidad en la atención que ameritan estrategias integrales y monitorización continua.

[Quality of the health information system: A comparative analysis of reported indicators, OECD Mexico 2010-2016.] / Calidad del sistema de información en salud: análisis comparativo de indicadores reportados, México OCDE 2010-2016.

OBJECTIVE: To analyze quantity and quality of the information reported by Mexico to OECD in relation to health indicators. MATERIALS AND METHODS: Analysis of frequency of indicators reporting, data quality, and comparison of reported values in the OECD environment. RESULTS: We analyzed 191 indicators. Mexico reported annually (2010-2016) 52.9% of them. Never reported 45.5%. The highest frequency of not reported (84%) is in the "Quality of care" group. Among the reported, information is of poor quality in 28.7% of them. Comparatively, Mexico holds the worst results in OECD indicators on screening of cancer, child and in-hospital mortality from myocardial infarction, and hospitalization for diabetes, among others. CONCLUSIONS: Mexico has problems of lack and quality of reported information, and frequently unfavorable values among OECD countries. The information system needs improvement, in both quantity and quality of data, and its effective utilization.

OBJETIVO: Analizar cantidad y calidad de la información sobre indicadores de salud reportada por México a la Organización para la Cooperación y el Desarrollo Económicos (OCDE). MATERIAL Y MÉTODOS: Análisis de frecuencia de indicadores reportados, calidad de los datos y comparación de valores reportados en el entorno OCDE. RESULTADOS: Se analizan 191 indicadores. México reportó anualmente (2010-2016) 52.9% de ellos. Nunca reportó 45.5%. La mayor frecuencia de no reportados (84%) es en el grupo "Calidad de la atención". En los reportados, la información es de calidad deficiente en 28.7%. Comparativamente, México ostenta los peores resultados de OCDE en indicadores sobre tamizaje de cáncer, mortalidad infantil e intrahospitalaria por infarto de miocardio y hospitalización por diabetes, entre otros. CONCLUSIONES: México tiene problemas de carencia y calidad de la información reportada y valores frecuentemente desfavorables en el entorno OCDE. Se requiere mejorar el sistema de información incidiendo tanto en cantidad como en calidad de los datos, y su utilización efectiva.

[Indigenous condition in health services: comparison of quality of care 2012-2018 for poor population.] / La condición indígena en los servicios de salud: comparación de la calidad en la atención 2012-2018 para la población en pobreza.

OBJECTIVE: To compare the perception of the quality of ambulatory care in users of health services in 2012 and 2018, by indigenous and non-indigenous condition. MATERIALS AND METHODS: With information from two population surveys (Encuesta Nacional de Salud y Nutrición [Ensanut] 2012 and Ensanut 100k) the quality of care was analyzed based on indicators of structure, process, health outcome and care satisfaction. RESULTS: Between 2012 and 2018, the use of private health services increased; favorable opinion about the conditions of the site, and perception of short waiting times decreased among non-indigenous people. In public health services, the supply of medicines remained high, the laboratory and Rx tests in the same care unit and pharma- cology treatment explanation decreased, particularly among non-indigenous patients. Perception of health improvement and satisfaction of care was adequate. CONCLUSIONS: An ambulatory care model aimed to response needs and expectations of the most vulnerable population, mainly the indigenous population, is a priority.

OBJETIVO: Comparar la percepción de la calidad de atención ambulatoria de servicios de salud en 2012 y 2018, por condición indígena y no indígena. MATERIAL Y MÉTODOS: Con información de dos encuestas poblacionales (Encuesta Nacional de Salud y Nutrición [Ensanut] 2012 y Ensanut 100k) se analizó la calidad de atención con indicadores de estructura, proceso, resultado en salud y satisfacción. RESULTADOS: Entre 2012 y 2018 aumentó la utilización de servicios privados, disminuyó la buena opinión sobre las condiciones del lugar y la percepción de tiempo de espera corto para utilizadores no indígenas. Para servicios públicos se mantuvo alto el surtimiento de medicamentos, disminuyó la realización de estudios de laboratorio y gabinete en la unidad de atención y la explicación del tratamiento farmacológico principalmente en no indígenas. La percepción de mejoría y la satisfacción fue buena. CONCLUSIONES: Es prioritario un modelo de atención ambulatoria acorde con las necesidades y expectativas de la población más vulnerable y, principalmente, indígena.

[Quality care indicators for neonates with selected pathologies: pilot study.] / Indicadores de calidad de la atención a neonatos con patologías seleccionadas: estudio piloto.

OBJECTIVE: Develop and pilot indicators of quality of care to neonates with relevant conditions in Mexico (prematurity, neonatal sepsis, perinatal asphyxia, and intrauterine hypoxia). MATERIALS AND METHODS: Own indicators were built based on key recommendations of national clinical practice guidelines and indicators found in international repositories. With previous search, selection and prioritization, the indicators were piloted within two hospitals. The feasibility of measuring, (kappa index) reliability and usefulness was analyzed to detect quality problems. RESULTS: 23 indicators were selected and piloted, 12 are compounds, of the total, nine were feasible and reliable. The quality of the hospital's information was diverse and often poor, limiting both the feasibility and the reliability of the indicators. Improvement opportunities were identified thorough the compliance levels. CONCLUSIONS: A set of nine indicators valid, reliable, feasible and useful indicators is proposed in order to monitor the quality of care of pathological neonates.

OBJETIVO: Desarrollar y pilotar indicadores de calidad de la atención a neonatos con padecimientos relevantes en México (prematuridad, sepsis neonatal, asfixia perinatal e hipoxia intrauterina). MATERIAL Y MÉTODOS: Se construyeron indicadores propios a partir de recomendaciones clave de las guías de práctica clínica nacionales e indicadores encontrados en repositorios internacionales. Previa búsqueda, selección y priorización, los indicadores fueron pilotados en dos hospitales. Se analizó la factibilidad de medición, fiabilidad (índice kappa) y utilidad para detectar problemas de calidad. RESULTADOS: Se seleccionaron y pilotaron 23 indicadores; 12 eran compuestos. Del total, nueve fueron factibles y fiables. La calidad de la información en los hospitales fue diversa y frecuentemente deficiente, limitando tanto la factibilidad como la fiabilidad de los indicadores. Los niveles de cumplimiento identificaron oportunidades de mejora. CONCLUSIONES: Se propone un set de nueve indicadores válidos, factibles, fiables y útiles para la monitorización de la calidad en la atención a neonatos patológicos.

Use of DNA sequencing for noncommunicable diseases in low-income and middle-income countries' primary care settings: A narrative synthesis.

OBJECTIVE: To present a systematic narrative review, informed by international experience, on the use of genomic analysis technologies in the primary care of noncommunicable chronic diseases (NCDs) during the last 20 years. METHODS: We used the methodology for conducting systematic reviews proposed by the Center for Coordination and Information on Evidence for Policies and Practices. The selected articles were organized by time, place, study design, and type of DNA sequencing. Finally, we analyzed the implications of our findings for health systems in middle-income and low-income countries focusing on a NCD high prevalence country such as México. RESULTS: Evidence concerning the use of DNA sequencing in primary care for NCDs was scarce and geographically concentrated in high-income countries. Use was limited by costs, insufficient knowledge among health care personnel, and a lack of confidence on the part of users. CONCLUSIONS: The use of DNA sequencing for primary care of NCDs is a challenge for low- and middle-income countries. More evidence is needed on cost effectiveness, public funding mechanisms, and the training of health care personnel for its implementation.

Prevalence and factors associated with violence and abuse of older adults in Mexico's 2012 National Health and Nutrition Survey.

BACKGROUND: Factors associated with violence and the abuse of older adults are understudied and its prevalence in Mexico has not been reported. The aim of this study was to identify the prevalence and factors associated with violence and abuse of older adults in Mexico. METHODS: We used Mexico's 2012 National Health and Nutrition Survey, which included a sample of 8,894 individuals who are 60 years or older and who self-reported a negative health event related to robbery, aggression or violence in the previous 12 months. We used chi-squared test and Fisher's exact test to analyze the variables related to violence. Adjusted estimates were completed with multiple logistic regression models for complex surveys. RESULTS: The prevalence of violence was 1.7 % for both men and women. In 95 % of the cases, the aggression was from an unknown party. Verbal aggressions were the most prevalent (60 %). Among men, physical aggression was more common. Violence frequently occurred in the home (37.6 %); however, men were primarily assaulted in public places (42.4 %), in comparison to women (30.7 %). There were also differences in the risk factors for violence. Among men, risk was associated with younger age (60-64 years), higher education (secondary school or above) and higher socioeconomic status. Among women, risk was associated with depression, not being the head of the family, and region of the country. CONCLUSIONS: Violence against older adults presents differently for men and women, which means it is necessary to increase knowledge about the dynamics of the social determinants of violence, particularly in regards to the role of education among men. The relatively low prevalence found in this study may reflect the difficulty and fear of discussing the topic of violence. This may occur because of cultural factors, as well as by the perception of helplessness perpetuated by the scarce access to social programs that ensure protection and problem solving with regards to the complex social determinants of individual and family violence that this population group endures.

Effect of supplementation with ferrous sulfate or iron bis-glycinate chelate on ferritin concentration in Mexican schoolchildren: a randomized controlled trial.

BACKGROUND: Iron deficiency is one of the most common nutritional deficiencies worldwide. It is more prevalent when iron requirements are increased during pregnancy and during growth spurts of infancy and adolescence. The last stage in the process of iron depletion is characterized by a decrease in hemoglobin concentration, resulting in iron deficiency anemia. Iron deficiency, even before it is clinically identified as anemia, compromises the immune response, physical capacity for work, and intellectual functions such as attention level. Therefore, interventions addressing iron deficiency should be based on prevention rather than on treatment of anemia. The aim of this study was to compare short- and medium-term effects on ferritin concentration of daily supplementation with ferrous sulfate or iron bis-glycinate chelate in schoolchildren with iron deficiency but without anemia. METHODS: Two hundred schoolchildren from public boarding schools in Mexico City who had low iron stores as assessed by serum ferritin concentration but without anemia were randomly assigned to a daily supplement of 30 mg/day of elemental iron as ferrous sulfate or iron bis-glycinate chelate for 12 weeks. Iron status was evaluated at baseline, one week post-supplementation (short term), and 6 months (medium term) after supplementation. RESULTS: Ferritin concentration increased significantly between baseline and post-supplementation as well as between baseline and 6 months after supplementation. One week post-supplementation no difference was found in ferritin concentration between iron compounds, but 6 months after supplementation ferritin concentration was higher in the group that received bis-glycinate chelate iron. However, there is no difference in the odds for low iron storage between 6 months after supplementation versus the odds after supplementation; nor were these odds different by type of supplement. Hemoglobin concentration did not change significantly in either group after supplementation. CONCLUSIONS: Supplementing with 30 mg/d of elementary iron, either as ferrous sulfate or iron bis-glycinate chelate for 90 days, showed positive effects on increasing ferritin concentration in schoolchildren with low iron stores, and this effect persisted 6 months after supplementation.

[Impact of self-reported periodontal status on oral health-related quality of life in adult population with Type 2 Diabetes from Mexico City]. / Impacto del estado periodontal autorreportado en la calidad de vida relacionada con la salud oral en población adulta con diabetes tipo 2 de la Ciudad de México.

OBJECTIVE: Periodontitis ranks sixth as a type 2 diabetes (T2D) complication. According to its severity, it may cause pain, discomfort and tooth loss. The aim of this study was to evaluate the impact of self-reported periodontal status on the Oral Health Related Quality of Life (OHRQoL) of people with T2D. METHODS: A cross-sectional study was conducted involving seventy-nine adults with T2D who visited the Metabolic Syndrome clinic at the Cosío Villegas National Institute of Respiratory Diseases in Mexico City between August and November 2010. The OHRQoL was evaluated with the shortened Oral Health Impact Profile (OHIP-EE14). Periodontitis was measured by self-report, probing depth (PD), and clinical attachment loss (CAL). The association between self-reported periodontal status and OHRQoL was evaluated with binomial regression models. RESULTS: Mean age of the participants was 60,4 years (SD=9,6); diabetes duration was 10,1 years (SD=6,6). The OHRQoL was associated with self-perception of bad breath (RR=1,58; p=0,025), self-perception of poor gum health (RR=1,66; p=0,016), dissatisfaction with chewing ability (RR=2,22; p≤0,001), tooth loss due to mobility (RR=1,74; p=0,019), and presence of 20 teeth or less (RR=1,57; p=0,045). CONCLUSIONS: OHRQoL is associated with self-report of bad breath, poor gum health and dissatisfaction with chewing ability in people with T2D, which suggests that self-perceived oral conditions represent signs and symptoms of functional and psychological impairment related to severe periodontitis.

OBJECTIVE: La periodontitis es la sexta complicación de la diabetes tipo 2 (DT2); dependiendo de su severidad puede causar dolor, incomodidad o hasta pérdida dental. El objetivo del estudio fue evaluar el impacto del estado periodontal autorreportado en la Calidad de Vida Relacionada con la Salud Oral (CVRSO) en personas con DT2. METHODS: Se realizó un estudio transversal que incluyó a setenta y nueve adultos con DT2 atendidos en la Clínica de Síndrome Metabólico del Instituto Nacional de Enfermedades Respiratorias Cosío Villegas en la Ciudad de México, entre agosto y noviembre de 2010. La CVRSO se evaluó con el cuestionario Perfil de Impacto en la Salud Bucal acortado (OHIP-EE14). La periodontitis se evaluó por autorreporte, profundidad al sondeo (PS) y pérdida de inserción clínica (PIC). La asociación entre estado periodontal autorreportado y CVRSO se evaluó con modelos de regresión binomial negativa. RESULTS: La edad promedio fue de 60,4 años (DE=9,6); la duración de diabetes de 10,1 años (DE=6,6). La CVRSO se asoció con la autopercepción de mal aliento (RR=1,58, p=0,025), autopercepción de mala salud de las encías (RR=1,66, p=0,016), insatisfacción de la habilidad para masticar (RR=2,22, p≤0,001), pérdida de algún diente con movilidad previa (RR=1,74, p=0,019) y 20 dientes presentes o menos (RR=1,57, p=0,045). CONCLUSIONS: La CVRSO se asocia con el autorreporte de mal aliento, mala salud de las encías e insatisfacción de la habilidad para masticar en personas con DT2; esto sugiere que las condiciones bucales autopercibidas representan signos y síntomas de deterioro funcional y psicológico relacionados con la periodontitis severa.

Scaling up cancer care for children without medical insurance in developing countries: The case of Mexico.

BACKGROUND: In 2006, the Mexican government launched the Fund for Protection Against Catastrophic Expenditures (FPGC) to support financially healthcare of high cost illnesses. This study aimed at answering the question whether FPGC improved coverage for cancer care and to measure survival of FPGC affiliated children with cancer. PROCEDURE: A retrospective cohort study (2006-2009) was conducted in 47 public hospitals. Information of children and adolescents with cancer was analyzed. The coverage was estimated in accordance with expected number of incident cases and those registered at FPGC. The survival was analyzed by using Kaplan-Meier survival curves and Cox proportional hazards regression modeling. RESULTS: The study included 3,821 patients. From 2006 to 2009, coverage of new cancer cases increased from 3.3% to 55.3%. Principal diagnoses were acute lymphoblastic leukemia (ALL, 46.4%), central nervous system (CNS) tumors (8.2%), and acute myeloid leukemia (AML, 7.4%). The survival rates at 36 months were ALL (50%), AML (30.5%), Hodgkin lymphoma (74.5%), Non-Hodgkin lymphoma (40.1%), CNS tumors (32.8%), renal tumors (58.4%), bone tumors (33.4%), retinoblastoma (59.2%), and other solid tumors (52.6%). The 3-year overall survival rates varied among the regions; children between the east and south-southeast had the higher risks (hazard ratio 3.0; 95% CI: 2.3-3.9) and 2.4; 95% CI: 2.0-2.8) of death from disease when compared with those from the central region. CONCLUSION: FPGC has increased coverage of cancer cases. Survival rates were different throughout the country. It is necessary to evaluate the effectiveness of this policy to increase access and identify opportunities to reduce the differences in survival.

[Users' perception about of quality ambulatory healthcare services in Mexico]. / Percepción de los usuarios sobre la calidad de la atención ambulatoria en servicios de salud en México.

OBJECTIVE: To identify users' perception about ambulatory healthcare services quality and associated factors in Mexico. MATERIALS AND METHODS: Analysis of the 2006 and 2012 National Surveys of Health and Nutrition that included users' perception of healthcare services and improvement in health status. A multivariate regression analysis allowed identifying the associated factors with the perception of improved health status. RESULTS: Between 2006 and 2012, users' positive perception of healthcare services increased from 82 to 85%, and user report of improvement in health status increased from 79 to 81%. Health status improvement, explanations about the disease and treatment, being attended without appointment, freedom to choose the provider and short waiting time were associated with a perception of better quality of care. CONCLUSIONS: Users' perception about the quality of care in ambulatory healthcare settings has improved, yet it is still neccessary to strengthen organizational strategies to provide healthcare when needed and to improve fulfillment of users' expectations.

Psychometric Properties of the Access of Older Adults to Outpatient Primary-Care Health Services Scale.

This study evaluates the psychometric properties of the Access of Older Adults to Outpatient Primary-Care Health Services Scale (AOAOPHSS), in research conducted among 707 Mexican older adults selected by convenience from 14 rural and one urban locations. The AOAOPHSS explores 10 dimensions of two integrated subscales: Accessibility and Personal Abilities. Data analysis was performed in five phases. First, potentially biased responses were identified. Second, the response efficiency of the items and their association with external variables were evaluated. Third, the basic properties of the scores for the subscales' dimensions of the AOAOPHSS were identified using non-parametric Mokken Scaling Analysis (MSA). Fourth, the Structural Equation Modeling methodology was used to identify the properties of the internal structure of the latent construct. Finally, reliability and internal consistency were evaluated at both score and item levels. The following findings emerged. 13 items with inefficient response options were removed, and 24 were retained using the MSA. The latent structure of the latter was defined based on 21 items of five Accessibility Subscale dimensions. Its internal consistency reliability ranged between 0.67 and 0.81 (omega coefficients) and between 0.61 and 0.78 (alpha coefficients). Accordingly, this paper discusses the overall implications of using the Accessibility Subscale.

Readiness for Integrated Care of Older People: A Cross-Sectional Study in Mexico.

AIM: To evaluate the readiness of the Mexican healthcare system to implement the integrated care for older people (ICOPE) approach into an existing healthcare model. METHODS: We conducted a cross-sectional study with data from 2473 healthcare workers analyzed using the model for understanding success in quality (MUSIQ) framework to gather data from healthcare professionals. Their perceptions regarding the readiness for ICOPE were assessed across five dimensions: team, microsystem, infrastructure, organization, and external environment. RESULTS: Only 717 (29%) of the participants believed ICOPE could be successfully implemented in Mexico without any modifications. A total of 1261 (51%) participants rated the readiness of ICOPE with some barriers. The main barriers were reallocating resources and the external environment. OBSERVATION: Mexico's healthcare system faces barriers to innovation that could hinder the successful integration of the ICOPE approach. A systematic identification of these barriers provides an opportunity to suggest adaptations and refinements to increase the probability of success. Using the contextual factors identified as facilitators and the proposal of interventions such as the ICOPE app could improve the chances of success. CONCLUSION: The participants of this study evaluated ICOPE as ready to implement, with some contextual barriers. The readiness evaluation supports the stakeholders' and policymakers' decisions in implementing and monitoring the program in a natural setting. Evaluating the readiness of the intervention increases the possibility of aligning the innovation with contextual factors, increasing the chances of its successful adoption and implementation.

Postmarketing pharmacovigilance of adverse drug reactions: the case of rosiglitazone in Mexico.

OBJECTIVE: Commercialization of rosiglitazone, an oral blood glucose-lowering drug of the thiazolidinedione class, was recently suspended in Europe and significantly restricted in the United States due to a possibly increased risk of ischemic heart disease; the drug is still being marketed in Mexico. This study was aimed to analyze the post-marketing occurrence of adverse drug reactions (ADRs) with rosiglitazone when used in combination therapy in Mexican Type 2 Diabetes patients. METHODS: A prospective observational study was conducted at a primary health-care clinic in Mexico City. Eligible subjects were adult patients with Type 2 diabetes inadequately controlled with maximal doses of oral monotherapy, in which one of two combined therapeutic schemes was prescribed: rosiglitazone/glibenclamide (R/G), or rosiglitazone/metformin (R/M). Patients' blood pressure, weight, treatment adherence and occurrence of ADRs were monitored during a 6-month follow-up period. RESULTS: 174 patients received treatment with R/M or R/G (112 and 62 patients, respectively). At least one ADR was observed in about 75%, of patients. Prior to the end of the follow-up period, moderate ADRs leading to discontinuation of the treatment occurred in 29.5% and 14.5% of patients treated with R/M and R/G, respectively. The ADRs most frequently observed were peripheral edema and moderate weight gain. CONCLUSIONS: The use of rosiglitazone in combination with other oral anti-diabetic drugs was associated with a high frequency of ADRs in Mexican patients with Type 2 diabetes. Post-marketing studies are relevant to identify drug-associated risks to patients in clinical practice.