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BACKGROUND: Little is known about awareness and willingness to use or purchase HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Mexico. METHODS: MSM in Mexico were recruited via advertisements on online social venues to participate in Encuesta de Sexo Entre Hombres, an online behavioral survey. Awareness of PrEP, willingness to take PrEP if available for free, willingness to purchase PrEP, awareness of post-exposure prophylaxis (PEP), and ever PEP use were assessed in descriptive and multivariate analyses. RESULTS: Overall, 54.8% (4588/8376) of participants were aware of PrEP. Of those aware, 77.6% were willing to use PrEP if free and 52.6% were willing to purchase PrEP, generally at a maximum monthly cost of $500MXP. Both awareness of and willingness to use PrEP if free or for purchase were significantly greater among MSM who were younger, and varied by demographic, recent healthcare use, and behavioral risk factors. Only 8.2% had ever used PEP, which was highly associated with healthcare utilization. CONCLUSIONS: About half of Mexican MSM were aware of PrEP. The majority of those aware were willing to use PrEP if available for free and many were willing to purchase PrEP at low cost. Leveraging demographic, recent healthcare use, and behavioral risk characteristics associated with awareness and willingness to use PrEP could be useful in designing future PrEP programs for MSM in Mexico. Expanding healthcare settings in which PEP is available may also support identifying candidates for PrEP and scaling up PrEP implementation.
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Fármacos Anti-HIV , Infecções por HIV , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina , Aceitação pelo Paciente de Cuidados de Saúde , Profilaxia Pós-Exposição , Profilaxia Pré-Exposição , Humanos , Masculino , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , México , Adulto , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/administração & dosagem , Adulto Jovem , Pessoa de Meia-Idade , Inquéritos e Questionários , Adolescente , Assunção de RiscosRESUMO
OBJECTIVE: We sought to test whether a 2-week Total Worker Health (TWH) training mapped to TWH education competencies could be administered to a Mexican audience of occupational safety and health professionals and could lead to positive changes to knowledge and behaviors. METHODS: This study used robust program evaluation methods collected before and after each of the nine training days and at the end of the course. RESULTS: Overall course quality received a mean score of 4.6 (SD = 0.6) and 98.8% of participants agreed that their TWH knowledge increased. All participants intended to make at least one change to their professional practice, most frequently helping companies assess their organizational culture to support health, safety, and well-being. CONCLUSIONS: This TWH training was well received and led to positive self-reported increase in knowledge and abilities to influence workers' health, safety, and well-being.
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Saúde Ocupacional , Humanos , México , Saúde Ocupacional/educação , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Promoção da Saúde/métodos , Avaliação de Programas e Projetos de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Cultura OrganizacionalRESUMO
Background: Studies have suggested that children are less likely than adults to develop COVID-19; however, with the emergence of SARS-CoV-2 variants, hospitalization and death due to this cause have increased among the youngest ones. Methods: Retrospective, descriptive analytical study of the COVID-19 cases, hospitalizations and deaths occurred in children under five years who attended in Child Day-Care Centers (Centros de Atención Infantil-CAIs) of the Mexican Social Security Institute (IMSS) from 20th July 2020 to 31st March 2023. Results were compared with Mexico's and the US's national-level data. Incidence, attack (children and workers) and mortality rates were estimated. The risks of getting sick, being hospitalized and dying due to COVID-19 were calculated by year. Results: There were 4,369 COVID-19 cases among children from IMSS CAIs; 67 (1.5%) required hospitalization and only two deaths were reported (0.04%). Both at IMSS CAIs and at a national level in Mexico and the US, the highest incidences of COVID-19 among children under five years occurred during Omicron prevalence. The attack rate among workers (32.93%) was higher than children (4.99%). Hospitalization and mortality rates in the US decreased since the anti-COVID 19 vaccine was introduced in children older than six months, unlike the rates in Mexico, where the vaccine for this age group was not available. By the year 2020, the children that attended the IMSS CAIs were 77.3% less likely to be hospitalized; 80.9% in 2021, 93.2% in 2022, and 77.7% by March 2023, compared to same age children in Mexico. In 2021, the children that attended IMSS CAIs were 90.6% less likely to die due to COVID-19, and by March 2023, this likelihood was 34.3% lower than the rest of children in this age group in Mexico. Conclusions: Children that attended IMSS CAIs had a smaller risk of hospitalization and death due to COVID-19. However, the high rates of hospitalization and death due to SARS-CoV-2 in children under five years in our country point to the need and urgency of vaccination against this virus in this age group, as well as of the adherence to strict detection and medical referral protocols.
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Resumen: Objetivo: Describir el diseño, implementación y el perfil de los participantes de la Encuesta de Sexo Entre Hombres (ES Entre Hombres). Material y métodos: ES Entre Hombres es una encuesta en línea no probabilística aplicada a nivel nacional a hombres de 18 años o más, que tienen sexo con hombres (HSH) y que usan internet. La población de estudio se reclutó a través de publicidad en diversos sitios de encuentro en línea y los cuestionarios se autoaplicaron con SurveyGizmo. Resultados: Durante 11 semanas se registró un total de 15 875 autoaplicaciones elegibles y completas de las 32 entidades del país. La mayoría de los participantes fueron jóvenes (<29 años; 65.7%) y personas que acceden a internet diariamente (94.3%). Conclusión: Las encuestas realizadas por internet para poblaciones como los HSH representan un método costoefectivo de estudio poblacional, ya que tienen el potencial de ahorrar recursos y alcanzar muestras grandes, lo que a la vez facilita la cobertura geográfica a un bajo costo.
Abstract: Objective: To describe the design, implementation and profile of participants in the Sex Between Men Survey (ES entre Hombres). Materials and methods: ES entre Hombres is an online non-probabilistic survey applied at a national level to men 18 years of age or older, who have sex with men (MSM) and who use the internet. The target population was recruited through advertising on various online meeting sites and the questionnaires were self-administered using SurveyGizmo. Results: During 11 weeks a total of 15 875 eligible participants completed a self-applied questionnaire in 32 Mexican states. Most of the participants were young people (<29 years old; 65.7%) and people who access the internet daily (94.3%). Conclusion: Internet surveys for populations such as MSM represent a cost-effective method for population-based studies, since they have the potential to save resources and reach large samples sizes, providing geographic coverage at a low cost.
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Resumen: Objetivo: Describir a la plataforma Cursos en Línea Masivos del IMSS (CLIMSS) como herramienta de alfabetización en salud, a través de la evaluación de la eficiencia terminal, la ganancia de competencias y satisfacción de los usuarios de cursos en línea masivos en el tema de Covid-19. Material y métodos: Se analizaron datos de 20 cursos ofertados entre marzo y octubre de 2020. Se evaluaron las calificaciones pre y pos, el número total de registros, el total de cursos terminados y la satisfacción del usuario. Resultados: Se registraron un total de 4.9 millones de usuarios y 10 millones de inscripciones, en todos los estados de la República mexicana, con una eficiencia terminal de 85%, una ganancia de competencias de 30% y una satisfacción de 9.34 (10). Conclusiones: La plataforma CLIMSS ha mostrado ser una herramienta para la alfabetización en salud con un alcance de millones de mexicanos en temas relacionados con la crisis sanitaria Covid-19.
Abstract: Objective: To describe the Massive Online Open Courses (MOOC) or Cursos en Línea Masivos del IMSS (CLIMSS) platform as a health literacy tool by evaluating the terminal efficiency, the competence gains, and the users' satisfaction of the massive online courses offered by the Mexican Institute of Social Security, on Covid- 19. Materials and methods: Data from 20 courses offered between March and October 2020 were analyzed. We evaluated scores from the pre and post-tests, the total number of registries, total courses completed, and users' satisfaction. Results: We registered a total of 4.9 million users and 10 million registrations, in all Mexican states, with a terminal efficiency of 85%, a competence gain of 30%, and a users' satisfaction of 9.34 (10). Conclusions: The CLIMSS platform has proven to be a tool for health literacy reaching millions of Mexicans on Covid-19 related topics.
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Resumen: Objetivo: Establecer criterios médicos de retorno al trabajo en personal con riesgo de complicaciones por Covid-19. Material y métodos. Se realizó una revisión sistemática para identificar las condiciones y las características clínicas que influyen en el riesgo de desarrollar Covid-19 grave. Resultados: Se ha demostrado incremento del riesgo en obesidad, edad >60 años, diabetes mellitus, hipertensión arterial, enfermedad pulmonar obstructiva crónica, enfermedad cardiovascular, enfermedad renal crónica y cáncer. Solamente en diabetes se ha estudiado si el control previo influye. Se proponen condiciones específicas y el nivel de riesgo epidemiológico para el retorno al trabajo. Conclusiones: El retorno laboral de estos grupos debe priorizarse buscando favorecer el control de la enfermedad, identificando el estado de salud que incrementa el riesgo y protegiendo el derecho al trabajo. Se presentan recomendaciones para guiar la reincorporación al trabajo.
Abstract: Objective: To establish medical criteria for return to work to people with increased risk of severe illness from Covid-19. Materials and methods. We performed a systematic review to identify the conditions and clinical characteristics that influence the risk of developing severe Covid-19. Results: Increased risk has been shown in obesity, age >60 years old, diabetes mellitus, arterial hypertension, chronic obstructive pulmonary disease, cardiovascular disease, chronic kidney disease and cancer. Only in diabetes it has been studied whether prior control influences. Specific medical conditions and epidemiological risk level for return to work are proposed. Conclusions: Return to work of vulnerable groups should be prioritized, seeking to promote disease control, identifying health conditions that increase risk, and protecting the right to work. We present recommendations to guide the return to work.
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Resumen: Objetivo: Estimar el exceso de defunciones por todas las causas en México durante 2020. Material y métodos: Se construyó un canal endémico con las defunciones (2015-2019), estableciendo el umbral epidémico en el percentil 90, y se comparó con las actas de defunción para estimar el exceso de mortalidad. Resultados: A la semana 53, ocurrieron 326 612 defunciones en exceso (45.1%), con un máximo en la semana 28 (98.0%) y un mínimo en la semana 41 (35.2%); después de la semana 42, la tendencia vuelve a ser ascendente por el resto del año. Esto fue proporcionalmente mayor en los hombres (51.3%), principalmente de 45-64 años de edad, sin embargo, en los de 60 años o más ocurrió el mayor número de defunciones. Conclusión: En México, el exceso de mortalidad ha sido prolongado en comparación con otros países, con alta variabilidad interestatal. Esto podría deberse a las condiciones socioeconómicas y a la alta prevalencia de comorbilidades que aumentan el riesgo de morir en la población mexicana.
Abstract: Objective: To estimate excess mortality from all causes in Mexico in 2020. Materials and methods: We constructed an endemic channel with deaths (2015-2018) establishing the epidemic threshold at the 90th percentile, comparing with death certificates counts to estimate excess mortality. Results: At week 53, there were 326 612 excess deaths (45.1%), with a maximum in week 28 (98.0%) and a minimum at week 41 (35.2%); after week 42, the increasing trend remained for the rest of the year. It was proportionally higher in men, mainly aged 45-64 years, however, in those aged 60 and over, the highest number of deaths occurred. Conclusion: In Mexico, excess mortality has been prolonged compared to other countries, with high interstate variability. This could be explained by socioeconomic conditions and the high prevalence of comorbidities in the Mexican population.
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Resumen: Objetivo: Describir el comportamiento de la epidemia de SARS-CoV-2 entre los trabajadores afiliados al Instituto Mexicano del Seguro Social (IMSS). Material y métodos: Se analizaron las incapacidades temporales para el trabajo por enfermedades respiratorias (ITT-ER), las hospitalizaciones y defunciones asociadas durante el periodo del 1 marzo al 31 diciembre 2020. Se estimó la tasa de ataque (TA) por SARS-CoV-2, así como los riesgos relativos (RR) de ITT-ER, hospitalización y defunción. Resultados: De los trabajadores afiliados al IMSS, 8.8% (n=1 730 334) recibió al menos una ITT-ER. La TA fue mayor en mujeres y en ambos sexos fue menor en el grupo de >60 años. Los RR de hospitalización y defunción fueron mayores en hombres y aumentaron con la edad. Comparado con las ITT-ER de 2015-2019, Durango, Tamaulipas y Nuevo León tuvieron un RR mayor de ITT-ER que el resto del país. Conclusiones: La epidemia de SARS-CoV-2 tuvo repercusiones importantes en los trabajadores afiliados al IMSS; se observó un exceso de ITT-ER de 4.6 veces respecto a la frecuencia esperada y cerca de un millón de casos de SARS-CoV-2. Los datos sugieren que el sistema de ITT-ER puede ser utilizado como elemento adicional para la vigilancia epidemiológica de enfermedades emergentes.
Abstract: Objective: To describe the behavior of SARS-CoV-2 epidemic among workers affiliated to the Mexican Social Security Institute. Materials and methods: We analyzed Short Term Disability Claims due to Respiratory Diseases (RD-STDC), associated hospitalizations and deaths (March 1 - December 31, 2020). We estimated the attack rate (AR) for SARS-CoV-2, and relative risks (RR) of TWD-RD, hospitalization and deaths. Results: 1 730 334 workers received at least one RD-STDC. AR was higher in women and in both sexes it was lower in >60 years old. RR of hospitalization and death were higher in men and increased with age. Compared with RD-STDC of 2015-2019, the states of Durango, Tamaulipas and Nuevo Leon had a higher RR of RD-STDC than the rest of the country. Conclusions: The SARS-CoV-2 epidemic impacted IMSS-affiliated workers significantly. We observed a 4.6 fold excess in RD-STDC compared to the expected frequency and nearly 1 million SARS-CoV-2 cases in this population. Our data suggest that the RD-STDC system can be used as an additional resource for epidemiological surveillance of emerging diseases.
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Resume: Objetivo: Analizar la rectoría y los mecanismos de procuración de insumos en el contexto del Programa de Acción Específico de Prevención y Control de la Rabia Humana y la Semana Nacional de Vacunación Antirrábica canina y felina en México (SNVA-C). Material y métodos: La información se obtuvo mediante solicitudes al Instituto Nacional de Transparencia, Acceso a la Información y Protección de Datos Personales. Resultados: De 2009 a 2017 se aplicaron 158.9 millones de dosis de vacuna antirrábica canina y felina (VAR-CF) por un monto de compra aproximado de 1 915 MDP. Se documentó una débil rectoría que permite prácticas monopólicas y compras fragmentadas y directas. Las adquisiciones se han fincado con precios que varían entre entidades federativas y son significativamente más altos que los precios internacionales. Conclusión: Después de 30 años de operación de la SNVA-C en México, persisten pagos excesivos para la VAR-CF, los cuales son indicativos de una falla importante del mercado, caracterizada por nula competencia, información asimétrica y estructuras de incentivos desalineadas que impiden obtener un precio competitivo.
Abstract: Objective: To analyze decision-making concerning stewardship and procurement mechanisms in the context of the Program for Prevention and Control of Human Rabies and the National Canine and Feline Vaccination Week in Mexico. Materials and methods: The information was obtained through requests to the National Institute of Transparency, Access to Information and Protection of Personal Data. Results: From 2009 to 2017, 158.9 million doses of canine rabies vaccine (VAR-CF) were applied with an estimated budget of 1 915 million pesos. Our findings suggest weak stewardship and ineffective governance that allows monopolistic practices and fragmented and direct purchases. Prices for the same product vary discretionally between states and are significantly higher than those offered at international level. Conclusions: After 30 years of operation of the SNVA-C in Mexico, high prices of the VAR-CF persist, which are indicative of a significant market failure, characterized by zero competition, asymmetric information and misaligned incentive structures that precluded favorable price negotiation.
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Animais , Gatos , Cães , Raiva/veterinária , Vacina Antirrábica/administração & dosagem , Doenças do Gato/prevenção & controle , Vacinação/veterinária , Doenças do Cão/prevenção & controle , Raiva/prevenção & controle , Vacina Antirrábica/economia , Vacinação/economia , Vacinação/estatística & dados numéricos , Competição Econômica , MéxicoRESUMO
Resumen: Objetivo: Analizar la veracidad de las cifras oficiales de acuerdo con la información disponible e identificar oportunidades de mejora. Material y métodos: Estimamos las coberturas de vacunación y tasas de deserción (para las vacunas administradas en multidosis) del esquema básico para niños menores de un año de edad, con base en la información de cubos dinámicos de la Secretaría de Salud de 2015 a 2017. Resultados: Observamos variaciones en los reportes mensuales de vacunación que indican bajas tasas de vacunación, así como índices altos de deserción al comparar primeras y terceras dosis aplicadas. La cobertura nacional de esquema completo se estimó en 48.9 por ciento. Conclusión: No se cuenta con información confiable que permita estimar las coberturas reales de vacunación. En los reportes oficiales hay una constante sobrestimación de las coberturas que ha creado a una "falsa sensación de seguridad". Esto se ha constituido en una barrera que impide el análisis crítico del Programa Universal de Vacunación.
Abstract: Objective: To analyze the validity of the official vaccination figures according to the available information and to identify opportunities for improvement. Materials and methods: We estimated vaccination coverage and dropout rates (for multi-dose vaccines) for one-year-old children, based on public information from the dynamic cubes of the Ministry of Health, for the years 2015 to 2017. Results: We observed variations in the vaccination monthly reports, which indicate low rates of vaccination, as well as high dropout rates when comparing first and third doses applied. For children 1 year of age, the national complete coverage was estimated at 48.9%. Conclusion: There is no reliable information to estimate the actual vaccination coverage. Government documents report a constant overestimation of vaccination coverage that creates a "false sense of security". This has become a barrier for the critical analysis of the Universal Vaccination Program.
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Criança , Humanos , Lactente , Vacinas contra Influenza/provisão & distribuição , Vacinação , Cobertura Vacinal , Seguimentos , MéxicoRESUMO
Abstract: Objective: To describe in a national sample 1) the prevalence, awareness, treatment and control of dyslipidemias 2) the prevalence of dyslipidemias through previous national surveys. Materials and methods: We analyzed data of the National Health and Nutrition Survey 2012, a representative cross-sectional study. Serum samples of 9 566 adults ≥20 years old with fasting ≥8 hours were analyzed for lipid fractions. Age-adjusted prevalences were calculated, by sociodemographic variables. Prevalence of awareness, treatment and control was estimated. A description of the dyslipidemia prevalence reported in previous surveys is reported. Results: Hypoalphalipoproteinemia and elevated LDL-C are the most prevalent dyslipidemias in Mexican adults. One in four adults had hypercholesterolemia at the moment of the interview without previous diagnosis. Awareness, treatment and control of dyslipidemia were 12.6, 3.7 and 3.1%, respectively. Conclusions: Dyslipidemias are the most prevalent risk factor for cardiovascular diseases in Mexico. Public policies to increase awareness, access to therapy and sustained control are urgently needed.
Resumen: Objetivo: Describir en una muestra nacional 1) la prevalencia de dislipidemias, su diagnóstico previo, tratamiento y control, y 2) la prevalencia de dislipidemias en las encuestas previas. Material y métodos: Se analizaron datos de la Encuesta Nacional de Salud y Nutrición 2012 con representatividad nacional. Se analizaron fracciones de lípidos séricos de 9 566 adultos ≥20 años con ayuno ≥8 horas. Se estimaron las prevalencias de dislipidemias, diagnóstico previo (DP), tratamiento y control, ajustadas por edad. Se presenta un análisis comparativo de las prevalencias de dislipidemias reportadas previamente. Resultados: Las dislipidemias más prevalentes en adultos mexicanos fueron hipoalfalipoproteinemia y LDL-C elevado. Uno de cada cuatro adultos tenía hipercolesterolemia al momento de la entrevista, sin DP. El DP, tratamiento y control de dislipidemias fue de 12.6, 3.7 y 3.1%, respectivamente. Conclusiones: Las dislipidemias son el factor de riesgo para enfermedades cardiovasculares más prevalente en adultos mexicanos. Se necesitan políticas públicas para incrementar el diagnóstico, acceso a terapia y control.
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Adulto , Humanos , Adulto Jovem , Dislipidemias/epidemiologia , Conscientização , Prevalência , Dislipidemias/terapia , Lipídeos/sangue , México/epidemiologiaRESUMO
Resumen Objetivo: Describir la submuestra de adultos para el análisis de biomarcadores de enfermedades crónicas, así como los tamaños de muestra (n) y la representatividad de las mismas en la Encuesta Nacional de Salud y Nutrición 2016. Material y métodos: Se calculó una submuestra con representatividad nacional para la obtención de sangre, suero y orina en adultos. Se comparó la prevalencia de variables de interés para las submuestras. Resultados: Las n obtenidas de suero y orina fueron de 4 000 y 3 782 adultos con al menos un valor en algún marcador bioquímico sérico y marcadores de orina, respectivamente. Esta n varió con el agrupamiento de marcadores y selección por horas de ayuno. No se observaron diferencias en la distribución de las variables de interés entre las muestras de hogar, sangre y orina. Conclusión: Los datos ponderados de las submuestras de marcadores en orina, suero y sangre son comparables con la muestra total de adultos de la encuesta. Los datos de las submuestras permitirán monitorear la distribución de enfermedades crónicas en México, incluidas las alteraciones en función hepática, renal, y consumo de sodio.
Abstract Objective: To describe the adult subsample for the analysis of biomarkers of chronic diseases, as well as the sample sizes (n) and representativity of the Encuesta Nacional de Salud y Nutrición (Ensanut) 2016. Materials and methods: An adult subsample with national representativity was calculated to obtain blood, serum and urine samples. The prevalence of variables of interest was compared for each subsample. Results: The n for at least one serum biomarker and urine samples were 4 000 and 3 782, respectively. The n varied depending on the grouping of biomarkers and fasting time selection. No differences were observed in the distribution of variables between the whole sample, urine and blood biomarkers samples. Conclusion: The weighted subsamples of urine, serum and blood biomarkers are comparable to the weighted sample of adults in the survey. The data of the subsample will allow to monitor the distribution of chronic diseases in Mexico, including altered function of liver and kidney, and sodium intake.
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Adulto , Humanos , Biomarcadores , Doença Crônica/epidemiologia , Inquéritos Nutricionais , México/epidemiologiaRESUMO
Abstract: Objective: To provide an overview of morbidity and mortality due to acute diarrheal disease in Mexico in order to understand its magnitude, distribution, and evolution from 2000 to 2016. Materials and methods: We carried out a longitudinal ecological study with secondary sources of information. We used data from epidemiological surveillance, health services, and vital statistics. We calculated and mapped measures of utilization of health services rates and mortality due to diarrheal diseases. Results: Diarrhea morbidity decreased by 42.1% across the period. However, emergency department attendances increased by 50.7% in the Ministry of Health. The hospitalization rate and mortality among the general population decreased by 37.6 and 39.7%, respectively, and the infant mortality rate decreased by 72.3% among children under five years of age. Chiapas and Oaxaca had the highest mortality among the states of Mexico. Conclusions: Cases of diarrhea, including rotavirus, have decreased in Mexico. However, in 2016, 3.4 per 100 000 people died due to diarrhea, which could have been avoided with health promotion.
Resumen: Objetivo: Ofrecer un panorama de la morbimortalidad por enfermedad diarreica aguda (EDA) entre 2000 y 2016 en México, para entender su magnitud, distribución y evolución. Material y métodos: Estudio ecológico longitudinal, con fuentes de información secundarias. Se analizaron datos de vigilancia epidemiológica, prestación de servicios y estadísticas vitales. Se calcularon tasas de utilización de servicios y mortalidad. Resultados: La morbilidad por EDA disminuyó 42.1% en el periodo, sin embargo, la atención por urgencias aumentó 50.7% en SS. La tasa de hospitalización descendió 37.6% y la mortalidad 39.7% en población general y 72.3% en menores de cinco años. Chiapas y Oaxaca fueron los estados con mayor tasa de mortalidad. Conclusiones: Los casos de diarrea, incluyendo los de rotavirus, han disminuido en el país. Sin embargo, en 2016 se encontró una tasa de 3.4 por 100 000 personas que mueren por EDA, lo cual podría evitarse con promoción de la salud.
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Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Diarreia/epidemiologia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Vigilância da População , Doença Aguda , Estudos Longitudinais , Morbidade , Conglomerados Espaço-Temporais , Diarreia/mortalidade , Serviços Médicos de Emergência/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Hospitalização/tendências , Hospitalização/estatística & dados numéricos , México/epidemiologiaRESUMO
Resumen: Objetivo: Estimar la prevalencia de diabetes (total, diagnosticada y no diagnosticada), de descontrol glucémico en México y sus factores asociados. Material y métodos: Se analizaron 3 700 adultos participantes en la Encuesta Nacional de Salud y Nutrición de 2016. Se estimaron las prevalencias con ponderadores poblacionales y los factores asociados con diabetes total y descontrol glucémico con modelos de regresión de Poisson. Resultados: La prevalencia total de diabetes fue de 13.7% (9.5% diagnosticada, 4.1% no diagnosticada); 68.2% de los diagnosticados presentó descontrol glucémico. Mayor tiempo de diagnóstico, vivir en el centro/sur del país y ser atendido en farmacias se asoció con descontrol glucémico, mientras que ser atendido en los servicios de seguridad social se asoció con mejor control glucémico. Conclusión: Se requieren esfuerzos multisectoriales para fortalecer el tamizaje, diagnóstico oportuno y control de la enfermedad, considerando las diferencias por región y tipo de servicio de salud.
Abstract: Objective: To estimate the prevalence of total, diagnosed and undiagnosed diabetes, and the prevalence of poor glycemic control in Mexico, and its associated factors. Materials and methods: Data from 3 700 adult participants were analysed in the 2016 National Health and Nutrition Survey. Diabetes prevalences were estimated with population weights, and the factors associated with total diabetes and poor glycemic control with Poisson regression models. Results: The total prevalence of diabetes was 13.7% (9.5% diagnosed, 4.1% undiagnosed); 68.2% of people with diagnosed diabetes presented poor glycemic control. Longer disease duration, living in the centre or south of the country and being treated in pharmacies were associated with poor glycemic control. Being treated in a social security system was associated with better glycemic control. Conclusion: Multisectoral efforts are needed to strengthen screening, timely diagnosis and disease control, considering differences by region and type of health service.
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Diabetes Mellitus Tipo 2/epidemiologia , Fatores Socioeconômicos , Glicemia/análise , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/análogos & derivados , Distribuição de Poisson , Prevalência , Distribuição por Sexo , Distribuição por Idade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diagnóstico Tardio/estatística & dados numéricos , México/epidemiologiaRESUMO
Resumen: Objetivo: Evaluar el desempeño de las facultades y escuelas de medicina (FEM) utilizando como subrogado los resultados del Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Material y métodos: Se analizaron las bases de datos oficiales del ENARM 2016 y 2017, empleando cinco criterios de desempeño (CD) por cada FEM: dos oficiales y tres creados exprofeso. Resultados. En 2016 y 2017 se registraron sustentantes de 112 y 115 FEM, respectivamente. Dependiendo del CD, la FEM que quedó clasificada en el primer lugar obtuvo entre 5 y 20 puntos más que la del segundo lugar, y entre 23 y 98 puntos más que la FEM ubicada en el último lugar. Aproximadamente 25% de los sustentantes fueron calificados como "deficientes en conocimientos" y aproximadamente 80% de éstos provenían de menos de un tercio de las FEM. Conclusiones: El ENARM arroja información sobre el desempeño de las FEM. Aproximadamente uno de cada cuatro sustentantes obtuvo puntajes menores al aprobatorio en cualquier especialidad.
Abstract: Objective: To assess the performance of medical schools (FEM) by analyzing the results of their applicants in the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Materials and methods: Five performance criteria, two official and three created on purpose, were calculated from the ENARM-2016 and -2017 official databases to assess FEM performance. Results: In 2016 and 2017, applicants registered from 112 and 115 FEM, respectively. Depending on the performance criteria, the FEM in the first place obtained 5 to 20 points more than the one placed second, and 23 to 98 points more than the FEM in the last place. Approximately 25% applicants were classified as "knowledge-deficient," and about 80% of these originated from less than one third of the FEM. Conclusion: The ENARM results provide information on the performance of the FEM. Approximately one of every four applicants obtained scores lower than the approval threshold of any specialty.
Assuntos
Humanos , Masculino , Feminino , Adulto , Faculdades de Medicina/normas , Desempenho Acadêmico/normas , Internato e Residência , Qualidade da Assistência à Saúde , Faculdades de Medicina/estatística & dados numéricos , Modelos Lineares , Fatores Sexuais , Bases de Dados Factuais , Medicina de Família e Comunidade/educação , Medicina Geral/educação , Desempenho Acadêmico/estatística & dados numéricos , MéxicoRESUMO
Abstract: Mexico was the first country in the Americas to sign and ratify the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC) in 2004. More than a decade later, it is appropriate to evaluate legislative and regulatory progress and the associated challenges; and also, to propose a roadmap to prioritize the problems to be addressed to achieve long-term sustainable solutions. Mexico has made substantial progress in tobacco control. However, regulations have been only weakly enforced. The tobacco industry continues to interfere with full implementation of the WHO-FCTC. As a result, tobacco consumption remains stable at about 17.6%, with a trend upwards among vulnerable groups: adolescents, women and low-income groups. The growing popularity of new tobacco products (electronic cigarettes or e-cigs) among young Mexicans is an increasing challenge. Our review reveals the need to implement all provisions of the WHO-FCTC in its full extent, and that laws and regulations will not be effective in decreasing the tobacco epidemic unless they are strictly enforced.
Resumen: México fue el primer país de América en firmar y ratificar el Convenio Marco de la OMS para el Control del Tabaco (CMCT-OMS) en 2004. Un poco más de una década después, es relevante evaluar aspectos legislativos, regulatorios, avances y desafíos, además de proponer una ruta crítica con soluciones sustentables a largo plazo. México ha avanzado en el control del tabaco; sin embargo, las medidas se han implementado parcialmente y la industria del tabaco continúa interfiriendo con la implementación completa del CMCT-OMS. Como resultado, el consumo de tabaco se mantiene estable alrededor de 17.6%, con una tendencia ascendente entre los más vulnerables: adolescentes, mujeres y grupos de bajos ingresos. La creciente popularidad de uso de los e-cig entre los jóvenes mexicanos trae nuevos y complejos desafíos. Es perentorio implementar al más alto nivel todas las disposiciones del CMCT-OMS: las leyes y los reglamentos no serán eficaces para abatir la epidemia de tabaquismo si no se aplican adecuadamente.
Assuntos
Humanos , Prevenção do Hábito de Fumar/tendências , Fatores de Tempo , Prevenção do Hábito de Fumar/legislação & jurisprudência , Prevenção do Hábito de Fumar/organização & administração , MéxicoRESUMO
Resumen: Objetivo: Monitorear el consumo de drogas a través de la medición de sus metabolitos en aguas residuales. Material y métodos: Se obtuvieron muestras de 31 plantas de tratamiento de agua residual y de 95 sitios con poblaciones específicas (38 escuelas, 42 unidades de tratamiento de adicciones y 15 centros de readaptación social). Usando cromatografía líquida de ultra-alta resolución, se midieron nueve metabolitos de seis drogas. Resultados: Ocho de nueve metabolitos de drogas fueron identificados en aguas residuales. Los metabolitos de marihuana (THC-COOH), cocaína (benzoilecgonina) y metanfetamina fueron identificados en escuelas, centros de readaptación social y de tratamiento de adicciones. En Nuevo Laredo, Culiacán y Torreón se encontraron los consumos per cápita más elevados de cocaína, marihuana, anfetamina y metanfetamina. Conclusiones: El monitoreo del uso de drogas a través de aguas residuales es factible en México y podría constituir un sistema de vigilancia para identificar cambios de su consumo en el tiempo.
Abstract: Objective: Monitor drug use through wastewater metabolite measurement. Materials and methods: Wastewater samples were obtained from 31 wastewater treatment plants and 95 sites with specific populations (38 schools, 42 units of addiction treatment and 15 penitentiaries). Using ultra high liquid chromatography, we measured nine metabolites from six drugs. Results: Eight out of nine drug metabolites were identified in the samples. Marijuana (THC-COOH), cocaine (benzoylecgonine) and methamphetamine were identified in schools, centers of addiction treatment and penitentiaries. Nuevo Laredo, Culiacan and Torreon had the highest consumption of cocaine, marijuana, amphetamine and methamphetamine. Conclusions: Monitoring drug use through wastewater is feasible in Mexico and could constitute a surveillance system to identify changes in the time.
Assuntos
Humanos , Drogas Ilícitas/análise , Consumo de Água (Saúde Ambiental) , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Dronabinol/análise , Dronabinol/análogos & derivados , Cannabis/química , Estudos de Viabilidade , Cromatografia Líquida de Alta Pressão , Cidades/epidemiologia , Cocaína/análise , Cocaína/análogos & derivados , Serviços de Saúde Comunitária/estatística & dados numéricos , Purificação da Água , Heroína/análise , Metanfetamina/análise , México/epidemiologiaRESUMO
Abstract: Objective: To assess the assumption of 'equity' of Mexico's resident-selection assessment tool, the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Materials and methods: Official ENARM-2016 and -2017 databases were analyzed. Differences in the absolute number of correct answers (multivariable linear regression) and the number of applicants reaching their specialty minimum score (SMS) per test day (odds ratio [OR]) were calculated. Applicants affected by test-day inequity were estimated. Results: There were 36 114 applicants in 2016, and 38 380 in 2017. In 2016, day-2 applicants had significantly higher scores and more reached the SMS than on days 1-3-4 (OR 1.55), and 5 (OR 3.8); 3 565 non-passing applicants were affected by inequity (equivalent to 44.64% of those selected). In 2017, day-1 and -2 applicants had significantly higher scores and more reached the SMS than on days 3-4 (OR 1.85), and 5 (OR 4.04); 3,155 non-passing applicants were affected by inequity (37.2% of those selected). Conclusion: Analysis of official ENARM databases does not support the official attribution of equity, suggesting the test should be redesigned.
Resumen_ Objetivo: Evaluar el atributo de "equidad" asignado al Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Material y métodos: Se analizaron las bases de datos oficiales del ENARM 2016 y 2017. Se compararon las diferencias inter-día de respuestas correctas (regresión linear multivariable) y de sustentantes que alcanzaron el puntaje mínimo de su especialidad (PME) (razón de momios [RM]). Se estimó a los afectados por la inequidad. Resultados: Hubo 36 114 sustentantes en 2016 y 38 380 en 2017. Los días 2 (ENARM-2016) y 1-2 (ENARM-2017) registraron puntajes significativamente más altos, y más sustentantes alcanzaron el PME que en los días 1-3-4 (RM 1.55) y 5 (RM 3.8) en 2016, y los días 3-4 (RM 1.85) y 5 (RM 4.04) en 2017. Se estimó que cuatro de cada diez sustentantes que aprobaron el ENARM no lo hubieran hecho si el examen fuera equitativo. Conclusión: Los resultados sugieren que el atributo de equidad del ENARM está en duda.
Assuntos
Humanos , Masculino , Feminino , Adulto , Seleção de Pessoal/normas , Avaliação Educacional/normas , Internato e Residência/estatística & dados numéricos , Modelos Lineares , Razão de Chances , Bases de Dados Factuais , Desempenho Acadêmico/normas , MéxicoRESUMO
Resumen: Objetivo: Analizar la cobertura en salud de cáncer pulmonar en México y ofrecer recomendaciones al respecto. Material y métodos: Mediante la conformación de un grupo multidisciplinario se analizó la carga de la enfermedad relativa al cáncer de pulmón y el acceso al tratamiento médico que ofrecen los diferentes subsistemas de salud en México. Resultados: Se documentan desigualdades importantes en la atención del cáncer de pulmón entre los distintos subsistemas de salud que sugieren acceso y cobertura en salud variable, tanto a los tratamientos tradicionales como a las innovaciones terapéuticas existentes, y diferencias en la capacidad de los prestadores de servicios de salud para garantizar el derecho a la protección de la salud sin distinciones. Conclusión: Se hacen recomendaciones sobre la necesidad de mejorar las acciones para el control del tabaco, el diagnóstico temprano y la inclusión de terapias innovadoras y la homologación entre los diferentes prestadores públicos de servicios de salud a través del financiamiento con la recaudación de impuestos al tabaco.
Abstract: Objective: To analyze the coverage of lung cancer in Mexico and offer recommendations in this regard. Materials and methods: By means of the conformation of a multidisciplinary group, we analyze the burden of the disease relative to the lung cancer and the access to the medical treatment offered by the different public health subsystems in Mexico. Results: Important inequalities in lung cancer care are documented among the different public health subsystems. Our data suggest differential access and coverage to both traditional treatments and existing therapeutic innovations and differences in the capacity of health service providers to guarantee the right to health protection without distinction. Conclusions: Recommendations are made on the need to improve actions for tobacco control, early diagnosis for lung cancer and inclusion of innovative therapies and homologation among different public health service providers through financing via tobacco taxes.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Neoplasias Pulmonares/terapia , Saúde Pública , MéxicoRESUMO
Abstract: Objective: To estimate the seroprevalence of CHKV antibodies and assess correlates of seropositivity at a small geographical scale. Materials and methods: A community-based serosurvey of 387 households in Puente de Ixtla, Morelos (central Mexico). Serum IgG antibodies to CHKV were detected by immunoassay. Results: From 27 April to 29 May 2016, we interviewed and collected blood samples from 387 individuals at the same number of households. A total of 114 (29.5%) participants were seropositive to CHK, 36 (31.6%) of them reported no symptoms of CHKV infection within 12 months before the survey. Conclusion: The estimated seroprevalence to CHKV antibodies was higher than expected by the small number of confirmed cases of CHKV infection reported in Mexico by the National Surveillance System.
Resumen: Objetivo: Estimar la seroprevalencia de anticuerpos CHKV y evaluar correlatos de seropositividad a pequeña escala geográfica. Material y métodos: Encuesta serológica comunitaria en 387 hogares en Puente de Ixtla, Morelos (región central de México). Se detectaron anticuerpos IgG contra CHKV mediante inmunoensayo. Resultados: Del 27 de abril al 29 de mayo de 2016 se entrevistó a 387 individuos en el mismo número de hogares y se recolectaron muestras de sangre de los mismos. En total, 114 (29.5%) participantes fueron seropositivos a CHK, 36 (31.6%) de ellos negaron síntomas de infección por CHKV durante los 12 meses previos a la encuesta. Conclusión: La seroprevalencia estimada de anticuerpos contra CHKV; fue mayor a la esperada con base en el pequeño número de casos confirmados de infección por CHKV informados en México por el Sistema Nacional de Vigilancia.