[Cost of family planning care in 10-19 years old teenagers]. / Costo de atención por servicios de planificación familiar a adolescentes de 10-19 años.

Objetives: To identify the costs of family planning care in adolescents. Material and methods: Longitudinal study of the cost of care for family planning carried out in 2015 in a group of individuals with age limits of 10 and 19 years in a unit first level of health care in the state of Queretaro, Mexico. The profile of use of family planning (FP) was created for the teen was performed services through counseling, provision of contraception and review of intrauterine device (IUD) in a year; cost projections for the population of adolescents and different coverage scenarios between 5 and 100% were made. Results: The average annual cost was 228.84 Mexican pesos. Ideally the identified cost was 2,708.94 pesos. The projection with 20 % coverage was 207,251,330 pesos. The average annual family planning consultations was 0.9. The most commonly used method was with medroxyprogesterone-estradiol at doses of 25 and 5 mg. Conclusion: The cost of planning in adolescents is low, taking into account the costs that the care of high-risk pregnancies and associated comorbidities.

Seguridad del paciente: percepción de estudiantes de una universidad pública / Patient safety: Perceptions of students in a public university / Segurança do paciente: percepção de estudantes de uma universidade pública

RESUMEN Introducción: La seguridad del paciente es una prioridad mundial para los sistemas de salud. Las instituciones educativas formadoras de recursos humanos deben incluir la temática en su currículo. Objetivo: Identificar la percepción sobre la seguridad del paciente en los estudiantes de licenciatura en enfermería. Metodología: Estudio descriptivo y transversal. Población total de 516 alumnos de licenciatura en enfermería de la Universidad Autónoma de Tamaulipas, México. Se utilizó el cuestionario APQS-III y se diseñó una cédula con variables sociodemográficas. Resultados: La mayoría de los participantes son mujeres, edad promedio: 20 años. La mitad de los alumnos no tiene cursos que avalen sus conocimientos sobre seguridad del paciente. En la dimensión entrenamiento recibido, 63.5 % concuerda que la formación de pregrado los capacita para entender las causas de un evento adverso por enfermería, los habilita para prevenir errores y desarrollar una adecuada comprensión en materia de seguridad. 50.3 % está totalmente de acuerdo en la dimensión confianza en el reporte del error y es semejante la proporción en la dimensión horas de trabajo como causas de error. Discusión: La identificación positiva de la percepción que se tiene acerca de la seguridad del paciente por parte de los estudiantes, favorece desde el pregrado la creación de una cultura de seguridad que fomenta la confianza y el interés de estos para desarrollar un enfoque integrado en el tema estudiado. Conclusiones: Los estudiantes en su mayoría refieren actitudes positivas confiados en que su entrenamiento sobre seguridad los prepara para entender y prevenir las causas de errores en seguridad del paciente.

ABSTRACT Introduction: Patient safety is a priority of health systems worldwide and therefore, the education institutions responsible for the formation of human resources for health must address this goal in detail. Objective: To identify the perceptions of baccalaureate nursing students regarding patient safety. Methodology: This is a descriptive and transversal study on 516 baccalaureates in nursing students from the Universidad Autónoma de Tamaulipas, Mexico. The APQS-III and a specific social-demographic data questionnaire were used. Results: The majority of the participants were female. The average age was 20 years old. Nearly half of the students do not have enough courses to strengthen their knowledge on patient safety. Regarding the training received, 63.5 % of the participants agree that the baccalaureate level formation prepares them to understand the causes of adverse events in nursing, to prevent errors, and to have an adequate understanding of security. 50.3 % of the participants approved the dimension's confidence approach regarding error reporting. Many participants considered that the excessive long hours working dimension is a cause of errors. Discussion: The perception of patient safety as being very important favors and further promotes a culture of security. Conclusions: The majority of the students trust their training regarding patient safety and know how to prevent possible causes of errors.

RESUMO Introdução: A segurança do paciente é uma prioridade mundial para os sistemas de saúde. As instituições educacionais formadoras de recursos humanos devem incluir a temática em seu currículo. Objetivo: Identificar a percepção sobre a segurança do paciente nos estudantes de graduação em enfermagem. Metodologia: Estudo descritivo e transversal. População total de 516 alunos de graduação em enfermagem da Universidad Autónoma de Tamaulipas, México. Foi utilizado o questionário APQS-III e realizou-se um questionário com variáveis sociodemográficas. Resultados: A maioria dos participantes são mulheres, idade média: 20 anos. Metade dos estudantes não tem cursos que avaliem seus conhecimentos sobre segurança do paciente. Na dimensão do treinamento recebido, 63,5 % concordam que a formação de graduação os treina para entender as causas de um evento de enfermagem adverso, lhes permite prevenir erros e desenvolver uma compreensão adequada da segurança. 50,3 % concordam fortemente sobre a dimensão de confiança no relatório dos erros e a proporção e da mesma forma sobre a dimensão das horas de trabalho como causa dos erros. Discussão: A identificação positiva da percepção que se tem sobre a segurança do paciente por parte dos alunos, favorece desde a graduação a criação de uma cultura de segurança que fomente a confiança e o interesse destes em desenvolver uma abordagem integrada na o assunto estudado. Conclusões: A maioria dos alunos relata atitudes positivas, confiantes de que seu treinamento em segurança os prepara para compreender e prevenir as causas dos erros na segurança do paciente.

The cost of diabetes mellitus and its impact on health spending in Mexico.

BACKGROUND: The objective of this study was to determine the cost of diabetes mellitus, its impact on health spending in Mexico, and its percentage of the gross domestic product (GDP). METHODS: There was a four-stage approach: identification of the epidemiology of the use of health services; estimate of treatment cost; determination of the diabetic population, and calculation of the percentage of health spending. RESULTS: The average annual cost per diabetic patient was $708 U.S. dollars (USD), the total annual cost of diabetics was $2,618,000 USD, the percentage of health spending was 15.48%, and the percentage of the GDP was 0.79%. CONCLUSIONS: It is necessary to seek strategies that allow for a more efficient use of resources designated for type 2 diabetes treatment.

[Preventive practices of the residents over 25 years of age in Monterrey and its metropolitan area (Mexico)]. / Prácticas preventivas de los habitantes mayores de 25 años en Monterrey y su zona metropolitana (México).

BACKGROUND: Chronic and degenerative disorders are the leading causes of morbidity-mortality in Mexico, as a result of which the Health Sector has implemented preventive and suitable detection measures. The use of the health services is a dynamic behavior on the part of the population. In order for people to use these preventive measures, the barriers to accessing these services must be lessened. Hence, the objective of this study was that of ascertaining the use of the services for the detection of diabetes mellitus, high blood pressure, cervical-uterine and breast cancer and tetanus and diphtheria toxoide vaccinations. METHODS: The sample size was that of 254 individuals age 25 and over living in Monterrey or in the greater Monterrey metropolitan area. Those having employed preventive measures during the year immediately prior to the study were taken into account with regard to the use of preventive measures. The analysis consisted of descriptive statistics and bivariate analysis. RESULTS: Over 60% of the population was female, the average age being 42.3 + 14 years of age, three fourths of the population being on the social security rolls. A total 37% mentioned having undergone the diabetes test, and 44.5 the test for high blood pressure, while 31.1% had been vaccinated with the tetanus and diphtheria toxoide. Regarding specifically female checkups, 34.3% of all females had undergone the corresponding cervical-uterine cancer test, 29.5% having been screened for breast cancer. No relationship was found to exist between the use of measures and family histories and the perception of the importance of the checks. CONCLUSIONS: The use of preventive measures fall below some international standards. Individuals exposed to the risk must be sought in order to fittingly detect any chronic disorder.

[Costs of maternal-infant care in an institutionalized health care system]. / Costo de la atención materno infantil en un sistema de salud institucionalizado.

Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities.

[Accessibility of health services for users]. / Accesibilidad de los servicios de salud en población usuaria.

OBJECTIVE: To measure the accessibility to health services and determine a model to explain this accessibility. MATERIALS AND METHODS: All states of the Mexican Republic were included. The measurement of accessibility considers the availability of resources and the perception of barriers. Place of residence, education, participation in the work forces and household conditions were included in the model. RESULTS: The average of availability resources was 64.59% sd 15.68 (range 42 to 100) and the average corresponding to perception of barriers, 87.61% SD 4.04 (range 79.23 to 95.65). Accessibility was 71.50% SD 10.74 (range 56 to 96). The states with highest accessibility were the Federal District and Baja California Sur and the lowest, Chiapas and Oaxaca. The model included education and labor participation (R2 = 0.67, p < 0.05). CONCLUSIONS: Accessibility was determined by socioeconomic factors.

[Impact of primary care on hospitalization of type 2 diabetics with equal conditions of health insurance]. / Impacto de la atención ambulatoria del primer nivel de atención en la hospitalización de población asegurada con diabetes mellitus tipo 2.

OBJECTIVE: To determine the impact of primary care on hospitalization of type 2 diabetics with equal conditions of health insurance. DESIGN: A case-control study. Case = diabetic hospitalized by a disease related condition. Control = diabetic without hospitalization during the last 12 months. SETTING: Urban primary care centers. PARTICIPANTS: Cases were consecutively selected from four out of five urban hospitals (n=123). Controls were chosen at random from primary care units matched by primary care source (n=135). Women with gestational diabetes were excluded as well as individuals with missing medical charts (approximately 15%). MEASUREMENTS: A primary care index was constructed with process and outcome indicators recommended by the American Medical Association, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, the American Diabetes Association and the Official Mexican Standards. Compliance to less than 60% of recommendations was considered unsatisfactory primary care. RESULTS: The following were hospitalization risk factors: less than 2 visits to family physician during the last year (OR adjusted, 16,2; 95% CI, 1,5-174,2), glucose level (OR adjusted, 1,006; 95% CI, 1,002-1,010) and cognitive level (OR adjusted, 0,98; 95% CI, 0,96-0,99), in addition to exercising and year of diagnosis. Sixty-five percent of cases observed unsatisfactory primary care compared with 49,1% of controls (P=0,03). Unsatisfactory primary care increased 2,5 times the risk of hospitalization (95% CI, 1,2-5,0) (pseudo R2=0,279; P<0,001). CONCLUSIONS: Primary care is a potential factor for reducing hospitalization of type 2 diabetics. Effective primary care programs would contribute to a better disease control and less unnecessary hospitalizations.

[Nutritional risk in patients with pulmonary tuberculosis: the patient's or the health services' problem?]. / Riesgo nutricional en pacientes con tuberculosis pulmonar: cuestión del paciente o de los servicios de salud?

OBJECTIVE: To determine nutritional risk factors in a population of patients with pulmonary tuberculosis (PT). MATERIAL AND METHODS: During 1997, one-hundred and eighty-five patients with PT were chosen at random from two health institutions in Monterrey, Nuevo León, México. Variables analyzed were: anthropometric measures, socioeconomic status, utilization of the nutrition clinic, access to foodstuffs, adverse reactions to drugs, and disease attributable to malnutrition. Statistical analysis consisted of descriptive, bivariate, and multivariate logistic regression, in addition to prevalence ratios and 95% confidence intervals. RESULTS: The mean age was 42.4 +/- 19.9 years. The mean body mass index was 19.8 +/- 3.2; 57% of patients presented malnutrition; 26% of them were referred to the nutrition clinic, 24.3% of whom actually attended it. Multivariate analysis showed that adverse reactions of tuberculosis drugs were risk factors for malnutrition, independent of age, gender, education, occupation, year of diagnosis and access to foodstuffs, disease attributable, and utilization of the nutrition clinic. (chi 2 = 10.58; p = 0.051, R2 = 0.42). CONCLUSIONS: Nutritional risk in patients with pulmonary tuberculosis is both a patient and a health services issue. The high prevalence of malnutrition, the low utilization rate of nutritional services, and the effect of adverse reactions to therapeutic drugs, justify the need to focus attention on this particular group of patients.

[Cost at the first level of care]. / Costo en el primer nivel de atención.

OBJECTIVE: To estimate the unit cost of 15 causes of demand for primary care per health clinic in an institutional (social security) health care system, and to determine the average cost at the state level. MATERIAL AND METHODS: The cost of 80% of clinic visits was estimated in 35 of 40 clinics in the social security health care system in the state of Nuevo Leon, Mexico. The methodology for fixed costs consisted of: departmentalization, inputs, cost, weights and construction of matrices. Variable costs were estimated for standard patients by type of health care sought and with the consensus of experts; the sum of fixed and variable costs gave the unit cost. A computerized model was employed for data processing. RESULTS: A large variation in unit cost was observed between health clinics studied for all causes of demand, in both metropolitan and non-metropolitan areas. Prenatal care ($92.26) and diarrhea ($93.76) were the least expensive while diabetes ($240.42) and hypertension ($312.54) were the most expensive. Non-metropolitan costs were higher than metropolitan costs (p < 0.05); controlling for number of physician's offices showed that this was determined by medical units with only one physician's office. CONCLUSIONS: Knowledge of unit costs is a tool that, when used by medical administrators, allows adequate health care planning and efficient allocation of health resources.

[Quality of the Early Cervical Cancer Detection Program in the State of Nuevo León]. / Calidad del Programa de Detección Oportuna de Cáncer Cervicouterino en el estado de Nuevo León.

OBJECTIVE: To determine the quality of the Early Cervical Cancer Detection Program in the state of Nuevo León. MATERIAL AND METHODS: A random selection of 4791 cytologic reports were analyzed, emitted by the State Ministry of Health, the University Hospital and the Mexican Institute for Social Security early cervical cancer detection modules. Pap tests of women with hysterectomy, current pregnancy, menopause or positive result were excluded. Quality was measured with previously defined standards. Analysis included, besides univariate statistics, tests of significance for proportions and means. RESULTS: The quality of the program was fairly satisfactory at the level of the State. The quality of the sampling procedure was low; 39.9% of the tests contained endocervical cells. Quality of coverage was low; 15.6% were women 25+years with first time Pap test. Quality of opportunity was high; 8.5 +/- 7 weekdays between the date of the pap smear and the interpretation date. CONCLUSIONS: Strategies are needed to increase the impact of the state program, such as improving the sampling procedure and the coverage quality levels.

Risk factors of breast cancer in Mexican women.

OBJECTIVE: To investigate the association between family history (FH) of neoplasia, gyneco-obstetric factors and breast cancer (BC) in a case-control study. In cases, to analyze those variables in relation with early onset of BC, the manner of detection (self-examination, prompted by pain, or casual), the size of tumor, and the elapsed time to seek medical attention. MATERIAL AND METHODS: Data from 151 prevalent BC cases and 235 age-matched controls were analyzed by multiple logistic regression, to assess the influence of BC risk factors. RESULTS: Ten per cent of patients and 1% of controls had first-degree relatives (FDR) with BC. Family history of FDR with BC (OR, 11.2; 95% CI 2.42-51.92) or with gastric or pancreatic cancer (OR, 17.7; 95% CI 2.2-142.6) was associated with BC risk. Breastfeeding at or under 25 years of age was protective against BC (OR, 0.40; 95% CI 0.24-0.66). The manner of tumor detection did not influence its size at the time of diagnosis. CONCLUSIONS: Our study confirms that FH of BC and/or of gastric or pancreatic carcinoma are risk factors for BC, while lactation at 25 years of age or earlier is protective.

[Health needs of the diabetic user of primary care]. / Necesidades en salud del diabético usuario del primer nivel de atención.

OBJECTIVE: To determine the extent and importance of unmet health needs of type 2 diabetic patients seen at primary care services. MATERIAL AND METHODS: A cross-sectional study was conducted in 1999, among rural and urban patients of the Mexican Institute of Social Security, in Nuevo Leon, Mexico. The study population consisted of 256 subjects selected at random, diagnosed with type-II diabetes for at least two years. Data were obtained by interview and complemented with medical charts and provider interviews. Five health areas and four health determinants were evaluated, through Mexican Official Standards and American Diabetes Association standards of medical care for diabetic patients. Analysis consisted of descriptive statistics and estimation of z scores. RESULTS: Health needs were met in 49% of cases. A lower mean of health need satisfaction was found in rural regions as compared to urban regions (36.8% vs. 53.3%, p < .01). Nutrition was the most affected health area (z score = -6), followed by the physical exercise (z score = -1), the metabolic health area (z score = +1), the non-smoking health area (z score = +2), the prevention and early detection of complications health area (z score = +2), and the cognitive health area (z score = +3). The health determinant with the highest requirement corresponded to utilization (z score = -5), followed by resource availability (z score = -4), perceived health need (z score = +4), and access barriers (z score = +6). CONCLUSIONS: Health need measurement allows evaluating the effectiveness of existing interventions, in addition to identifying areas with higher unmet health needs. These findings facilitate analysis and decision-making to devise specific health policies and actions directed at improving the quality of care for diabetic patients. The English version of this paper is available at: http://www.insp.mx/salud/index.html

[Assessment of accessibility to health services facilities]. / Evaluación de la accesibilidad en los servicios de salud.

OBJECTIVE: To assess health care access integrating the availability of resources, medical institution and the patient point of view. SETTING: Nuevo León, México. MEASUREMENTS AND MAIN RESULTS: A random sample of patients were interviewed about their perceptions on different barriers, which also were assessed for the institution utilizing the corresponding indicator. Availability of resources were also measured for every primary and secondary medical care unit of the greatest Mexican health care system in Nuevo León. It was observed a 70% access; 70% for primary care and 73% for secondary care. Availability of human resources was an important factor but barriers as observed by the institution were the most important (waiting time and traveling cost). Barriers were rated different by the institution and the patient. CONCLUSIONS: The combination of institutional barriers, patient barriers and resources for assessing health care access is discussed.

[Work-related anxiety among nursing personnel]. / Ansiedad laboral en personal de enfermería.

OBJECTIVE: To assess if work-related activities represented a threatening situation for nursing personnel through the correlation between the level of usual anxiety (trait-anxiety) and the level of anxiety present during working hours (state-anxiety). As well as, to determine state-anxiety risk factors. MATERIAL AND METHODS: The state-trait-anxiety inventory was administered to 285 nurses of a health care institution chosen at random. RESULTS: The correlation coefficient was 0.53 (CI 95% = 0.43, 0.60, p = 0.001), after controlling for age, marital status, number of children, workload, service, category, level of care, years of service and personal relationships. Negative personal relationships and = 1 year of service influenced the level of anxiety present during working hours (beta = -0.21, beta = -0.24, p = 0.001, respectively). CONCLUSIONS: Work-related activities represented a threatening situation and contributed to anxiety. It is necessary to recognize anxiety work-related risk factors for developing coping strategies and preventing well-being damage.