[Effectiveness of interventions for improving drug prescribing in Primary Health Care]. / Efectividad de las intervenciones para mejorar la prescripción de medicamentos en atención primaria.

OBJECTIVE: To determine the effectiveness of interventions for improving drug prescribing in Primary Health Care units. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Searches were made in MedLine©, ScienceDirect©, Springer©, SciELO©, Dialnet©, RedALyC© and Imbiomed©, in Spanish, English and Portuguese, using keywords "drug prescribing", "intervention studies" and "primary health care", indexed in each data base up to August 2014. SELECTION OF STUDIES: Experimental and quasi-experimental studies were included that had a CASP-score>5 and that evaluated effect of any type intervention on the quality of drug prescription in Primary Health Care. RESULTS: A total of 522 articles were found, and an analysis was performed on 12 that reported 17 interventions: 64.7% educational, 23.5% incorporating pharmacists into the health team, and 11.8% on the use of computer applications. The strong "intervention/improvement" associations were educational interventions OR=2.47 (95% CI; 2.28 - 2.69), incorporation of pharmacists OR=3.28 (95% CI; 2.58 4.18), and use of computer applications OR=10.16 (95% CI; 8.81 -11.71). CONCLUSIONS: The use of interventions with computer applications showed to be more effective than educational interventions and incorporation pharmacists into the health team. Future studies are required that include economic variables such as, implementation costs, drug costs and other expenses associated with health care and treatment of diseases.

A Geospatial Model to Identify Areas Associated with Late- Stage Breast Cancer: A Spatial Epidemiology Approach.

OBJECTIVE: The aim of this study was to show how a geospatial model can be used to identify areas with a higher probability for late-stage breast cancer (BC) diagnoses. METHODS: Our study considered an ecological design. Clinical records at a tertiary care hospital were reviewed in order to obtain the place of residence and stage of the disease, which was classified as early (0-IIA) and late (IIB-IV) and whose diagnoses were made during the 2013-2017 period. Then, they were geolocated to identify the distribution and spatial trend. Subsequently, the pattern of location, i.e. scattered, random and concentrated, was statistically assessed and a geospatial model was elaborated to determine the probability of late diagnoses in the state of Jalisco, Mexico. RESULT: There were 1 954 (N) geolocated BC diagnoses: 58.3% were late. During the five-year period, a southwest-northeast trend was identified, nearly 9.5% of the surface of Jalisco, where 6 out of 10 (n= 751) late- stage diagnoses were concentrated. A concentrated and statistically significant pattern was identified in the southern, central and northern Pacific area of Jalisco, where the geospatial model delimited the places with the highest probability of late clinical stages (p <0.05). CONCLUSION: The geographical differences associated with the late diagnoses of BC suggest it is necessary to adapt and focus the strategies for early detection as an alternative to create a major impact on the population. Reproducible analysis tools were used in other contexts where geolocation data are available to complement public policies and strategies aimed to control BC.

Public Policies and Programs for the Prevention and Control of Breast Cancer in Latin American Women: Scoping Review.

BACKGROUND: Breast cancer has positioned itself worldwide as one of the main public health problems, especially in Latin America. In some countries, several programs for the prevention and control of breast cancer in women have been developed and implemented on a permanent basis, but there are no public reports on the policies that originated such programs. OBJECTIVE: A scoping review of scientific publications that identify the type, extent, and scope of policies and programs for the prevention and control of breast cancer in Latin American women was performed, and the main results were presented in this paper. METHODS: This scoping review was carried out according to the method by Arksey and O'Malley based on 3 fundamental questions about breast cancer prevention and control policies in Latin America: their type, extent and scope, and reference framework. The search period was from 2000 to 2019, and the search was carried out in the following databases: MEDLINE (PubMed), MEDLINE (EbscoHost), CINAHL (EbscoHost), Academic Search Complete (EbscoHost), ISI Web of Science (Science Citation Index), and Scopus in English, Spanish, and Portuguese, and Scielo, Cochrane, and MEDES-MEDicina in Spanish and Portuguese. Of the 743 studies found, 20 (2.7%) were selected, which were analyzed using descriptive statistics and qualitative content analysis. RESULTS: The selected studies identified several Latin American countries that have generated policies and programs to prevent and control breast cancer in women, focusing mainly on risk communication, prevention and timely detection, effective access to health services, improvement of the screening process, and evaluation of screening programs. Evaluation criteria and greater participation of civil society in policy design and program execution are still lacking. This could undoubtedly help eliminate existing barriers to effective action. CONCLUSIONS: Although several Latin American countries have generated public policies and action programs for the prevention and control of breast cancer, a pending issue is the evaluation of the results to analyze the effectiveness and impact of their implementation given the magnitude of the public health problem it represents and because women and civil society play an important role in its prevention and control. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/12624.

[Spatio-temporal trend in detections of diabetes mellitus and systematic arterial hypertension in IMSS users, 2004-2019]. / Tendencia espacio-temporal de detecciones de diabetes mellitus e hipertensión arterial sistémica en usuarios del IMSS, 2004-2019.

Background: Diabetes Mellitus (DM) and heart diseases, which include Systemic Arterial Hypertension (SAH), have been positioned as the two main causes of mortality in Mexico, which represents important challenges for the different health institutions. Objective: To analyze the spatio-temporal trend of DM and SAH based on the detections made in first and and second level units of the Instituto Mexicano del Seguro Social, during the period 2004-2019. Material and methods: Ecological study in which detection rates of both diseases were calculated per 1,000 persons according to year, triennium and representation. The spatiotemporal trend was analyzed by spatial statistics using Geographic Information Systems. Results: During 2004-2019 therere were 9 399 889 and 11 862 069 detections on average of DM and SAH, respectively. Regarding DM, the detection rate ranged from 203.4 (2004) to 384.4 (2019) per 1000 persons, this trend increased in Tamaulipas. While SAH decreased from 1140.2 (2004) to 352 (2019) per 1000 persons in Veracruz Sur and Tamaulipas, respectively. Conclusions: The observed spatio-temporal trend can contribute to organizing and guiding, according to representation and level of care, institutional programs, integrated care protocols, clinical practice guidelines and other public policy instruments available at the Instituto Mexicano del Seguro Social to improve early detection, care, control and access to medications for DM and SAH.

Introducción: la diabetes mellitus (DM) y las enfermedades del corazón, entre las que se incluye la hipertensión arterial sistémica (HTA), se han posicionado entre las primeras causas de mortalidad en México, lo que plantea retos importantes para las diferentes instituciones de salud. Objetivo: analizar la tendencia espacio-temporal de DM e HTA con base en las detecciones realizadas en unidades de primero y segundo nivel del Instituto Mexicano del Seguro Social (IMSS), durante el periodo 2004-2019. Materiales y métodos: estudio ecológico en el que se calcularon las tasas de detección de ambos padecimientos por mil derechohabientes según año, trienio y representación. La tendencia espacio-temporal se analizó mediante estadística espacial utilizando Sistemas de Información Geográfica. Resultados: de 2004 a 2019 hubo 9 399 889 y 11 862 069 detecciones en promedio de DM e HTA, respectivamente. Referente al primer padecimiento, la tasa de deteccion osciló de 203.4 (2004) a 384.4 (2019) por mil derechohabientes, cuya tendencia aumentó en Tamaulipas. Mientras que la HTA disminuyó de 1140.2 (2004) a 352 (2019) detecciones por mil derechohabientes en Veracruz Sur y Tamaulipas, respectivamente. Conclusiones: la tendencia espacio-temporal observada puede contribuir a organizar y orientar, según su representación y nivel de atención, los programas institucionales, protocolos de atención, guías de práctica clínica y demás instrumentos de políticia pública disponibles en el IMSS para mejorar la detección oportuna, atención, control y acceso a medicamentos para DM e HTA.

A Local Health Situation Room for COVID-19: Recommendations for Decision-Making From a Higher Education Institution in Mexico.

Introduction: The Situation Room is a physical or virtual space where experts systematically analyze information to characterize a health situation, especially during emergencies. Decision-making processes are made toward solving health needs and promoting collaboration among institutions and social sectors. This paper presents the context and circumstances that led the University of Guadalajara (UdeG) to install a local health situation room (HSR) to address the COVID-19 pandemic at this institution based in the state of Jalisco, Mexico, a narrative is also made of its working processes and some of its results. Methods: The design of this situation room for COVID-19 was based on the methodology established by the Pan American Health Organization (PAHO)/WHO. This local-type situation room was installed on February 12, 2020. The health problem was characterized, and strategic lines, objectives, and goals were established; the first analysis was derived from an action plan deployed at the UdeG. The strategic lines were situational diagnosis, preventive actions, and containment strategies. Results: The situation room influenced the activities of the UdeG before the epidemic cases started in the state. One of the actions with the greatest impact was developing a mathematical model for predicting COVID-19 cases. Subsequently, new models have been developed according to the epidemiological evolution of the disease, helping manage the epidemic in the state. Another important result was the early closing of face-to-face university activities, reducing contagion risks and the mobility of more than 310,000 students, faculty, and administrative personnel throughout Jalisco. Conclusions: A consequence of the closure was that the confinement generated by the pandemic was the change to virtual meetings from April 2020 to date; but at the same time, this working format was a strength, since it influenced the decision of the university board to change all the academic activities to virtual format before other educational, economic, and social activities in the state did. By April 2020, the situation room transcended its institutional boundaries and was invited to participate at the Jalisco State's Health Committee. Its recommendations have helped to maintain the state with one of Mexico's lowest COVID-19 incidence and mortality rates.

Policies and Programs for the Prevention and Control of Breast Cancer in Mexican and Latin American Women: Protocol for a Scoping Review.

BACKGROUND: Breast cancer has become a major public health problem around the world, especially in Mexico and Latin America. Screening for breast cancer, which involves self-examination, mammography, and clinical breast examination, is crucial for early diagnosis, which in turn is associated with improved outcomes and survival rates. Although breast cancer prevention and control activities are being implemented in Mexico and Latin America, as in many other countries, there are no comprehensive public reports that provide information on the number, type, and scope of these activities; the impact of the programs and actions implemented; and the policies that form the basis of these programs. OBJECTIVE: This study aims to present the design of a protocol for a scoping review on the policies and action programs for breast cancer care in Mexico and Latin America, as well as their objectives and implementation plans. METHODS: This scoping review is guided by the methodological reference framework proposed by Arksey and O'Malley. A systematic search of the following electronic databases will be performed: MEDLINE (PubMed), MEDLINE (EBSCOHost), CINAHL (EBSCOHost), Academic Search Complete (EBSCOHost), ERIC, ISI Web of Science (Science Citation Index) in English and Cochrane and MEDES-MEDicina in Spanish. A search will be conducted to identify relevant studies published between 2000 and 2018. Data will be analyzed and presented in descriptive statistics and qualitative content analyses with analysis matrices and semantic networks. The selected studies will be arranged according to the Specific Action Program, Prevention and Control of Female Cancer 2013-2018. RESULTS: The intention is to perform this review during the first and second quarters of 2019 and present the results to health authorities by the first quarter of 2020. Results will also be sent for publication to an indexed journal by the second quarter of 2020. CONCLUSIONS: We present a protocol for a scoping review-type literature revision based on the Arksey and O'Malley methodology to be performed during the first quarter of 2019. According to this 6-stage methodology, we will identify the scientific publications that present or analyze first-level action policies and programs for breast cancer care in Mexican women, as well as the results of these policies and programs, if any. The outcome of this review will be used to define the basis of a research project intended to design an educational intervention strategy for the general public in Mexico to enable them to deal with this public health problem. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/12624.

Development of the Health Atlas of Jalisco: A New Web-Based Service for the Ministry of Health and the Community in Mexico.

BACKGROUND: Maps have been widely used to provide a visual representation of information of a geographic area. Health atlases are collections of maps related to conditions, infrastructure or services provided. Various countries have put resources towards producing health atlases that support health decision makers to enhance their services to the communities. Latin America, as well as Spain, have produced several atlases of importance such as the interactive mortality atlas of Andalucía, which is very similar to the one that is presented in this paper. In Mexico, the National Institute of Public Health produced the only health atlas found that is of relevance. It was published online in 2003 and is currently still active. OBJECTIVE: The objective of this work is to describe the methods used to develop the Health Atlas of Jalisco (HAJ), and show its characteristics and how it interactively works with the user as a Web-based service. METHODS: This work has an ecological design in which the analysis units are the 125 municipalities (counties) of the state of Jalisco, Mexico. We created and published online a geographic health atlas displaying a system based on input from official health database of the Health Ministry of Jalisco (HMJ), and some databases from the National Institute of Statistics and Geography (NISGI). The atlas displays 256 different variables as health-direct or health-related indicators. Instant Atlas software was used to generate the online application. The atlas was developed using these procedures: (1) datasheet processing and base maps generation, (2) software arrangements, and (3) website creation. RESULTS: The HAJ is a Web-based service that allows users to interact with health and general data, regions, and categories according to their information needs and generates thematic maps (eg, the total population of the state or of a single municipality grouped by age or sex). The atlas is capable of displaying more than 32,000 different maps by combining categories, indicators, municipalities, and regions. Users can select the entire province, one or several municipalities, and the indicator they require. The atlas then generates and displays the requested map. CONCLUSIONS: This atlas is a Web-based service that interactively allows users to review health indicators such as structure, supplies, processes, and the impact on public health and related sectors in Jalisco, Mexico. One of the main interests is to reduce the number of information requests that the Ministry of Health receives every week from the general public, media reporters, and other government sectors. The atlas will support transparency, information diffusion, health decision-making, and the formulation of new public policies. Furthermore, the research team intends to promote research and education in public health.

Tendencia espacio-temporal de detecciones de diabetes mellitus e hipertensión arterial sistémica en usuarios del IMSS, 2004-2019 / Spatio-temporal trend in detections of diabetes mellitus and systematic arterial hypertension in IMSS users, 2004-2019

Introducción: la diabetes mellitus (DM) y las enfermedades del corazón, entre las que se incluye la hipertensión arterial sistémica (HTA), se han posicionado entre las primeras causas de mortalidad en México, lo que plantea retos importantes para las diferentes instituciones de salud. Objetivo: analizar la tendencia espacio-temporal de DM e HTA con base en las detecciones realizadas en unidades de primero y segundo nivel del Instituto Mexicano del Seguro Social (IMSS), durante el periodo 2004-2019. Material y métodos: estudio ecológico en el que se calcularon las tasas de detección de ambos padecimientos por mil derechohabientes según año, trienio y representación. La tendencia espacio-temporal se analizó mediante estadística espacial utilizando Sistemas de Información Geográfica. Resultados: de 2004 a 2019 hubo 9 399 889 y 11 862 069 detecciones en promedio de DM e HTA, respectivamente. Referente al primer padecimiento, la tasa de deteccion osciló de 203.4 (2004) a 384.4 (2019) por mil derechohabientes, cuya tendencia aumentó en Tamaulipas. Mientras que la HTA disminuyó de 1140.2 (2004) a 352 (2019) detecciones por mil derechohabientes en Veracruz Sur y Tamaulipas, respectivamente. Conclusiones: la tendencia espacio-temporal observada puede contribuir a organizar y orientar, según su representación y nivel de atención, los programas institucionales, protocolos de atención, guías de práctica clínica y demás instrumentos de políticia pública disponibles en el IMSS para mejorar la detección oportuna, atención, control y acceso a medicamentos para DM e HTA.

Background: Diabetes Mellitus (DM) and heart diseases, which include Systemic Arterial Hypertension (SAH), have been positioned as the two main causes of mortality in Mexico, which represents important challenges for the different health institutions. Objective: To analyze the spatio-temporal trend of DM and SAH based on the detections made in first and and second level units of the Instituto Mexicano del Seguro Social, during the period 2004-2019. Material and methods: Ecological study in which detection rates of both diseases were calculated per 1,000 persons according to year, triennium and representation. The spatio-temporal trend was analyzed by spatial statistics using Geographic Information Systems. Results: During 2004-2019 therere were 9 399 889 and 11 862 069 detections on average of DM and SAH, respectively. Regarding DM, the detection rate ranged from 203.4 (2004) to 384.4 (2019) per 1000 persons, this trend increased in Tamaulipas. While SAH decreased from 1140.2 (2004) to 352 (2019) per 1000 persons in Veracruz Sur and Tamaulipas, respectively. Conclusions: The observed spatio-temporal trend can contribute to organizing and guiding, according to representation and level of care, institutional programs, integrated care protocols, clinical practice guidelines and other public policy instruments available at the Instituto Mexicano del Seguro Social to improve early detection, care, control and access to medications for DM and SAH.

Diabetes: the layperson's theories of causality.

The authors examine laypersons' perspectives of illness: the content of causal explanations of diabetes and differences in explanations according to gender. Qualitative research was carried out in Guadalajara, Mexico. A nonprobabilistic sample of 20 diabetic individuals participated in interviews, and the content of the interviews was analyzed. On the origin of their condition, participants offered explanations that match neither the biomedical model nor any other formal causal theory. Participants attributed the onset of diabetes to socioemotional circumstances linked to their life experiences and practices. Men attributed causality to work and social circumstances outside the home; women attributed it to family life and domestic circumstances. The authors discuss how lay theories can be useful for the reorganization of health services.

Prescripción inadecuada de medicamentos: aportaciones de los paradigmas científicos a su conocimiento / Inadequate drugs prescription: contributions of scientific paradigms to your knowledge

Resumen Se realizó una revisión narrativa con análisis temático sobre las aportaciones de los paradigmas científicos al conocimiento de la prescripción inadecuada de medicamentos. Se buscaron artículos de acceso abierto indexados en PubMed© entre 2010-2014, y se sistematizó información sobre el paradigma, tipo de publicación, perspectiva teórica, objetivo, método y resultados. De los 992 artículos encontrados, se seleccionaron 118, y se tomó una muestra propositiva de 15, según su diseño, representando los cuatro paradigmas. Los artículos positivistas reportaron prevalencia, factores asociados, efectividad de intervenciones y criterios de evaluación; los interpretativos explicaron las causas del problema según los involucrados; los críticos denunciaron la influencia de la industria farmacéutica; y el participativo abordó el problema secundariamente y lo solucionó en un escenario para una enfermedad y grupo farmacológico específicos. Se concluyó que la prescripción inadecuada de medicamentos como problema de investigación en salud pública recibe aportes de los cuatro paradigmas, con dominio del positivismo, lo que se atribuye al carácter paradigmático de la ciencia desde la que se le aborda habitualmente, y que una perspectiva multi-paradigmática es el mejor abordaje.

Abstract This study conducted a narrative review with thematic analysis about contributions of scientific paradigms to knowledge of inadequate drugs prescription. We searched open access articles indexed in PubMed© between 2010 and 2014, and we systematized information about scientific paradigm, publication type, theoretical perspective, objective, method and results. From the 992 articles found, 118 were selected. From those, we chose a purposive sample of 15, according to the design of the studies, representing the four paradigms. The positivists articles reported prevalence, associated factors, effectiveness of interventions and evaluation criteria; the interpretive explained the causes of the problem according to those involved; the critics denounced the influence of pharmaceutical industry; and the participative addressed the problem secondarily and solved it in a scenario for a specific disease and pharmacological. We concluded that the inadequate drugs prescription as research problem in public health had contributions from the four paradigms, with dominance of positivism, which is attributed to the paradigmatic perspective of the science, from which it is usually studied, and that a multi-paradigmatic perspective is the best approach to the public health issue.

Evaluación de la calidad de la información en Internet: estado del arte y consideraciones para su aplicación en la BVS Adolec México / Assessment of the quality of the information available in Internet: state of the art and considerations for its application in the Adolescent Health Virtual Libary, Mexico

Objetivo: Presentar el estado del arte en cuanto a las propuestas y criterios para evaluar la calidad de la información que se difunde en Internet, en particular, aquella relacionada con el campo de la salud. Métodos: Se empleó un diseño cualitativo con un acercamiento de investigación documental. A partir de la consulta de diversos motores de búsqueda y bases de datos en línea, se obtuvieron más de 200 documentos. Se aplicó un análisis de contenido temático a los documentos seleccionados y se identificaron las propuestas existentes. Resultados: Las propuestas para la evaluación de la calidad de los recursos en la red se clasifican de la siguiente forma: a) propuestas de criterios para evaluar los recursos de la red, b) referencias o guías de autores y sitios que evalúan los recursos, c) evaluación de recursos y creación de índices para su consulta, y d) propuestas de evaluación de materiales no tradicionales. Conclusiones: Existe una gran cantidad de propuestas para la evaluación de la calidad de los recursos disponibles en Internet sin clasificar y sistematizar. Se identificaron los diferentes tipos de propuestas y sus características. Esto permitirá establecer las bases para asegurar la calidad de los recursos en la biblioteca virtual en salud sobre adolescentes en México

Las fuentes de apoyo de los individuos con diabetes en una zona marginal de Guadalajara, México / Sources of support among diabetic people in a deprived area of Guadalajara, Mexico

El presente estudio tuvo como objetivo conocer los factores sociodemográficos asociados a las fuentes de apoyo de los individuos con diabetes mellitus tipo II en una zona marginal de Guadalajara, México. Participaron 121 sujetos con diabetes e igual número de cónyuges e hijos considerados como cuidadores. Los resultados mostraron que las características del enfermo son diferentes en relación con la edad, el sexo y el parentesco de las fuentes de apoyo. En cambio, las variables de la unidad doméstica que mostraron diferencias fueron la composición de los hijos por sexo y de los integrantes de la familia. No se encontraron diferencias entre las características de la diabetes y las de los cuidadores. Se concluye que estos hallazgos pueden ser de utilidad para el establecimiento de nuevas estrategias en los servicios de salud, en tanto se ha mostrado que la participación de las fuentes de apoyo de los enfermos mejora la calidad y la eficacia de los mismos servicios

This article examines the relationship between sociodemographic factors and sources of support in non-insulin dependent diabetes mellitus patients living in a socially deprived area of Guadalajara, Mexico. A total of 121 diabetic subjects and the same number of caretakers, spouses and children, participated in the study. Findings show that some variables of diabetic individuals are associated with caretakers' age, sex and kinship. Moreover, sex distribution of children and family composition were also associated with sources of support. No association was found between disease characteristics and those of caretakers. The impact of these results on health services programs is discussed.