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Doubova SV, García-Saiso S, Pérez-Cuevas R, Sarabia-González O, Pacheco-Estrello P, Infante-Castañeda C, Santamaría C, Del Pilar Torres-Arreola L, Leslie HH. Quality governance in a pluralistic health system: Mexican experience and challenges. LANCET GLOBAL HEALTH 2018; 6:e1149-e1152. [PMID: 30196095 DOI: 10.1016/s2214-109x(18)30321-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/27/2018] [Indexed: 12/17/2022]
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Doubova SV, Ferreira-Hermosillo A, Pérez-Cuevas R, Barsoe C, Gryzbowski-Gainza E, Valencia JE. Socio-demographic and clinical characteristics of type 1 diabetes patients associated with emergency room visits and hospitalizations in Mexico. BMC Health Serv Res 2018; 18:602. [PMID: 30075779 PMCID: PMC6091092 DOI: 10.1186/s12913-018-3412-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To describe the demographic and clinical characteristics of Type 1 diabetes (T1D) patients affiliated with the Mexican Institute of Social Security (IMSS) and ascertain the socio-demographic and clinical risk factors associated with emergency room (ER) visits and diabetes-related hospitalizations. METHODS We conducted secondary data analysis of a cross-sectional study. The study included T1D patients 18 years of age and older who in 2016 attended follow-up visits at the endocrinology department of two IMSS tertiary care hospitals in Mexico City. The study variables included demographics, acute and chronic complications, and healthcare services utilization. Multiple Poisson and negative binomial regressions served to determine the association between the study covariates and the dependent variables: ER visits and diabetes-related hospitalizations. RESULTS The study included 192 patients, of which 29.2% were men; average age was 32.3 years, with only 13.6% controlled (glycosylated hemoglobin (HbA1C) < 7%); the mean HbA1C was 9.2, and 64.6% presented chronic complications. During 2016, 39.0% visited ER services, and 33.9% were hospitalized. The common risk factors for ER visits and hospitalization were older age at the beginning of diabetes, severe acute complications, chronic microvascular and macrovascular complications, and other comorbidities. Female sex, high school education, depression, and repeated visits to the endocrinologist were associated with ER visits, whereas active smoking and the interaction between diabetes duration > 10 years and HbA1c > 9.0% were additional risk factors for hospitalization. CONCLUSION The poor clinical conditions of T1D patients contribute to explain the escalating demand for health services for diabetes patients at the IMSS. The identification of risk factors enables focalizing interventions to improve the health outcomes of T1D patients and reduce the proportion of ER visits and hospital admissions.
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Doubova SV, Pérez-Cuevas R. Going further to measure improvements in health-care access and quality. Lancet 2018; 391:2190-2192. [PMID: 29803588 DOI: 10.1016/s0140-6736(18)30987-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/23/2018] [Indexed: 10/16/2022]
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Pérez-Cuevas R, Guanais FC, Doubova SV, Pinzón L, Tejerina L, Pinto Masis D, Rocha M, Harris DO, Macinko J. Understanding public perception of the need for major change in Latin American healthcare systems. Health Policy Plan 2017; 32:816-824. [PMID: 28335011 DOI: 10.1093/heapol/czx020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2017] [Indexed: 11/13/2022] Open
Abstract
The opinions and experiences of the public regarding health services are valuable insights into identifying opportunities to improve healthcare systems. We analyzed the 2012-2013 Public Opinion Health Policy Survey carried out in Brazil (n = 1486), Colombia (n = 1485), El Salvador (n = 1460), Jamaica (n = 1480), México (n = 1492) and Panama (n = 1475). In these countries between 82 and 96% of participants perceived that their health systems needed fundamental changes. The most frequent barrier to access to healthcare was lack of the primary medical home, difficulties in obtaining medical care during the weekends and financial barriers. Type of health insurance and challenges in obtaining medical care during the weekends were associated with an increased opinion for the need for fundamental changes in healthcare systems, whereas having a primary medical home showed a protective effect. Focusing on tackling organizational and financial barriers and ensuring access to a primary medical home should be placed on the agenda of Latin American countries.
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Doubova SV, Martinez-Vega IP, Infante-Castañeda C, Pérez-Cuevas R. Effects of an internet-based educational intervention to prevent high-risk sexual behavior in Mexican adolescents. HEALTH EDUCATION RESEARCH 2017; 32:487-498. [PMID: 29177452 DOI: 10.1093/her/cyx074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/04/2017] [Indexed: 06/07/2023]
Abstract
UNLABELLED To evaluate the effect of an internet-based educational intervention to increase knowledge of sexually transmitted infections (STIs), attitudes and self-efficacy toward consistent condom use in Mexican adolescents. A field trial with an intervention and control group was conducted in 14- to 15-year-old students in two secondary schools. The intervention was delivered via a website that included four educational sessions during a 4-week period and six 30-min class discussions during a 3-month period. In the control group, the investigators observed the general sex education provided by the school. Outcome variables were 1) knowledge about STIs, 2) attitudes regarding condom use, and 3) self-efficacy toward consistent condom use. Differences-in-differences (Diff-in-Diff) treatment effect was estimated for each outcome variable. There were 246 adolescents in the intervention group and 210 in the control group. The intervention had a positive effect on improving knowledge of STIs, attitudes and self-efficacy toward consistent condom use. The major effect was observed on adolescents' knowledge on STIs (Diff-in-Diff 30.34 points, P < 0.0001). A youth-friendly, culturally-contextualized, internet-based educational intervention complemented by class discussions may be a significant addition to the regular secondary school sex education program to improve knowledge of STIs, attitudes and self-efficacy toward consistent condom use among adolescents. TRIAL REGISTRATION The study was registered at the ClinicalTrials.gov ID: NCT02686736.
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Martinez-Vega IP, Doubova SV, Pérez-Cuevas R. Distress and its association with self-care in people with type 2 diabetes. SALUD MENTAL 2017. [DOI: 10.17711/sm.0185-3325.2017.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. Low adherence to diabetes self-care affects glycemic control and increases the risk of diabetes complications and premature deaths. Studies from the United States have found a relationship between distress and adherence to self-care in patients with diabetes; however, there is a lack of research on distress and its association with self-care in Mexican patients with diabetes. Objective. To evaluate the prevalence and association of distress with low self-care in patients with type 2 diabetes. Method. A cross-sectional study was carried out in two family medicine clinics of the Mexican Institute of Social Security in Mexico City. Four hundred eighty-nine type 2 diabetic patients ≥ 19 years of age participated. The statistical analysis incorporated a multiple Poisson regression. Results. Of the patients 18.8% had distress, 44.8% had low adherence to medication, 43.8% had low adherence to regular physical exercise, 82.4% did not consume the recommended amount of vegetables and 51.1% consumed foods with high sugar content. The distress was associated with poor adherence to medication and lack of regular physical exercise. Discussion and conclusion. The high prevalence of distress in type 2 diabetic patients in comparison with the general population reveals the importance of distress screening and health care at family practice clinics
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Cortés-Bonilla M, Alonso-Campero R, Bernardo-Escudero R, Francisco-Doce MT, Chavarín-González J, Pérez-Cuevas R, Chedraui P. Improvement of quality of life and menopausal symptoms in climacteric women treated with low-dose monthly parenteral formulations of non-polymeric microspheres of 17β-estradiol/progesterone. Gynecol Endocrinol 2016; 32:831-834. [PMID: 27187320 DOI: 10.1080/09513590.2016.1183628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the short term effect over menopausal symptoms and quality of life (QoL) of monthly parenteral formulations of 17β-estradiol (E)/progesterone (P) non-polymeric microspheres. METHODS This is a secondary analysis of a multicenter, randomized, single-blinded study that included peri- and post-menopausal symptomatic women assigned to receive a monthly intramuscular injection of 0.5 mg E + 15 mg P (Group A, n = 34), 1 mg E + 20 mg P (Group B, n = 24), or 1 mg E + 30 mg P (Group C, n = 26) for 6 months. Intensity of menopausal symptoms was assessed before and after treatment with the Greene Climacteric Scale (GCS) and QoL with the Utian Quality of Life Scale (UQoLS). RESULTS Menopausal symptoms improved for all groups at six months evidenced by lower cluster/sub-cluster GCS scores. Equally, there was an overall trend for QoL improvement for all groups evidenced by higher domain UQoLS scores at six months; but only significant for the emotional (Groups A and B) and occupational domains (Groups A and C). CONCLUSION The three low-dose continuous sequential intramuscular monthly formulations of E/P microspheres exerted a positive effect over menopausal symptoms and QoL. Long-term research is warranted with these formulations. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov Identifiers NCT 00775242.
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Doubova SV, Martinez-Vega IP, Aguirre-Hernandez R, Pérez-Cuevas R. Association of hypertension-related distress with lack of self-care among hypertensive patients. PSYCHOL HEALTH MED 2016; 22:51-64. [PMID: 27677320 DOI: 10.1080/13548506.2016.1239830] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Research on factors associated with poor adherence to self-care focuses primarily on psychiatric emotional disorders such as depression and anxiety, whereas non-psychiatric chronic-disease-related emotional distress has received little attention in hypertensive patients. The objective of this study was to evaluate the association of hypertension-related distress with the lack of self-care including low adherence to pharmacological treatment, lack of regular physical activity, low intake of fruits and vegetables and frequent intake of high-salt foods. A cross-sectional survey was conducted in 2014 in two family medical units affiliated with the Mexican Institute of Social Security. The study included 487 hypertensive patients >19 years of age. The conceptual framework for the study was based on the Health Promotion Model. The analysis included multiple Poisson regression models. We found that 21.1% of participants had hypertension-related distress. Low adherence to pharmacological treatment was identified in 45.8% of patients, whereas 46.8% lacked regular physical activity, 30.8% reported a low consumption of fruits and vegetables, and 54.6% frequently consumed foods high in salt content. Hypertension-related distress was associated with lack of regular physical activity and low intake of fruits and vegetables. These findings highlight the importance of addressing distress in order to improve self-care of hypertensive patients.
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Doubova SV, Sánchez-García S, Infante-Castañeda C, Pérez-Cuevas R. Factors associated with regular physical exercise and consumption of fruits and vegetables among Mexican older adults. BMC Public Health 2016; 16:952. [PMID: 27612444 PMCID: PMC5016856 DOI: 10.1186/s12889-016-3628-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/02/2016] [Indexed: 12/21/2022] Open
Abstract
Background To analyze the factors associated with regular physical exercise and routine consumption of fruits and vegetables, and both healthy behaviors among Mexican older adults. Methods We conducted a secondary data analysis of the baseline data (2014) of the Study on Obesity, Sarcopenia and Fragility in older adults affiliated with the Mexican Institute of Social Security. The study included 948 adults who were ≥60 years of age. Multiple Poisson regression was performed. Results Routine consumption of fruits and vegetables was reported by 53.8 % of older adults, 42.7 % reported engaging in regular physical exercise and 23.1 % reported participating in both types of healthy behaviors. Women, adults with a stable income, those with a self-perception of good health and those with a history of physical exercise at the age of 50 years had an increased likelihood of engaging in healthy eating and regular physical activity. Conclusions Many older adults do not routinely consume fruits and vegetables or engage in regular physical exercise despite the fact that most have a fixed income and a social network. It is relevant to conduct research-based interventions that take into account the contextual factors to promote healthy behaviors.
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Doubova SV, Infante-Castañeda C, Pérez-Cuevas R. Internet-based educational intervention to prevent risky sexual behaviors in Mexican adolescents: study protocol. BMC Public Health 2016; 16:343. [PMID: 27089870 PMCID: PMC4835873 DOI: 10.1186/s12889-016-2990-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risky sexual behaviors of adolescents in Mexico are a public health problem; 33.4 % of adolescent girls and 14.7 % of boys report not having used any protection at their first intercourse. The fertility rate is 77 births/1000 girls aged 15-19 years. The infrequent contact of adolescents with health services and the limited extent of school sex and reproductive health education require the support of innovative strategies. The objective of this paper is to present the design of an internet-based educational strategy to prevent risky sexual behaviors in Mexican adolescents. METHODS A field trial with intervention and comparison group and with ex-ante and ex-post measurements will be conducted in two public secondary schools. Adolescents between 14 and 15 years of age will participate. The intervention will be conducted in one school and the second school will serve as a comparison group where the investigators will observe the usual sex education provided by the school. The intervention will be delivered using an internet web page that includes four educational sessions provided during a 4 week period. Follow-up will last 3 months. Information on the study variables will be obtained through an Internet-based self-applied questionnaire and collected on three occasions: 1) when the adolescents enter the study (baseline), 2) once the intervention is completed (at 1 month) and 3) after 3 months of follow-up (at the fourth month). There will be three outcome variables: 1) knowledge in regard to sexually transmitted infections, 2) attitudes regarding condom use, and 3) self-efficacy toward consistent condom use. The generalized linear model will be used to assess changes in each outcome variable controlling for baseline measures and for study covariates. DISCUSSION The design and evaluation of an Internet-based educational strategy to prevent risky sexual behaviors in Mexican adolescents is important in order to provide a new, large-scale, easily implemented preventive tool. TRIAL REGISTRATION The study was registered at the ClinicalTrials.gov ID: NCT02686736 .
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Doubova SV, Guanais FC, Pérez-Cuevas R, Canning D, Macinko J, Reich MR. Attributes of patient-centered primary care associated with the public perception of good healthcare quality in Brazil, Colombia, Mexico and El Salvador. Health Policy Plan 2016; 31:834-43. [DOI: 10.1093/heapol/czv139] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2015] [Indexed: 11/13/2022] Open
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Doubova SV, Pérez-Cuevas R. Magnitud de las brechas en el diagnóstico y consejería nutricional para niños de uno a 5 años de edad en medicina familiar en México: análisis de los datos del expediente electrónico. Aten Primaria 2016; 48:64-6. [PMID: 25959291 PMCID: PMC6877811 DOI: 10.1016/j.aprim.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 02/28/2015] [Accepted: 03/04/2015] [Indexed: 11/18/2022] Open
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Beyeler N, González-Pier E, Alleyne G, Barraza-Lloréns M, Frenk J, Pablos-Mendez A, Pérez-Cuevas R, Regalia F, Sepúlveda J, Jamison D, Yamey G. Salud global 2035: implicaciones para México. SALUD PUBLICA DE MEXICO 2015. [DOI: 10.21149/spm.v57i5.7624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
En noviembre de 2014, la Secretaría de Salud de México fue sede de una mesa redonda con miembros de la Comisión de The Lancet para la Inversión en Salud (CIS) para analizar el informe de esta misma comisión titulado Salud global 2035 y sus posibles implicaciones para el mejoramiento de la salud pública...
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Beyeler N, González-Pier E, Alleyne G, Barraza-Lloréns M, Frenk J, Pablos-Mendez A, Pérez-Cuevas R, Regalia F, Sepúlveda J, Jamison D, Yamey G. [Global health 2035: implications for Mexico (commentary)]. SALUD PUBLICA DE MEXICO 2015; 57:441-443. [PMID: 26545006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
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Souza JP, Betran AP, Dumont A, de Mucio B, Gibbs Pickens CM, Deneux-Tharaux C, Ortiz-Panozo E, Sullivan E, Ota E, Togoobaatar G, Carroli G, Knight H, Zhang J, Cecatti JG, Vogel JP, Jayaratne K, Leal MC, Gissler M, Morisaki N, Lack N, Oladapo OT, Tunçalp Ö, Lumbiganon P, Mori R, Quintana S, Costa Passos AD, Marcolin AC, Zongo A, Blondel B, Hernández B, Hogue CJ, Prunet C, Landman C, Ochir C, Cuesta C, Pileggi-Castro C, Walker D, Alves D, Abalos E, Moises E, Vieira EM, Duarte G, Perdona G, Gurol-Urganci I, Takahiko K, Moscovici L, Campodonico L, Oliveira-Ciabati L, Laopaiboon M, Danansuriya M, Nakamura-Pereira M, Costa ML, Torloni MR, Kramer MR, Borges P, Olkhanud PB, Pérez-Cuevas R, Agampodi SB, Mittal S, Serruya S, Bataglia V, Li Z, Temmerman M, Gülmezoglu AM. A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study. BJOG 2015; 123:427-36. [PMID: 26259689 PMCID: PMC4873961 DOI: 10.1111/1471-0528.13509] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 12/01/2022]
Abstract
Objective To generate a global reference for caesarean section (CS) rates at health facilities. Design Cross‐sectional study. Setting Health facilities from 43 countries. Population/Sample Thirty eight thousand three hundred and twenty‐four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing. Methods We hypothesised that mathematical models could determine the relationship between clinical‐obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three‐step approach to generate the global benchmark of CS rates at health facilities: creation of a multi‐country reference population, building mathematical models, and testing these models. Main outcome measures Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate. Results According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C‐Model, with summary estimates ranging from 0.832 to 0.844. The C‐Model was able to generate expected CS rates adjusted for the case‐mix of the obstetric population. We have also prepared an e‐calculator to facilitate use of C‐Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/). Conclusions This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C‐Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS. Tweetable abstract The C‐Model provides a customized benchmark for caesarean section rates in health facilities and systems. The C‐Model provides a customized benchmark for caesarean section rates in health facilities and systems.
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Doubova SV, Pérez-Cuevas R, Canning D, Reich MR. Access to healthcare and financial risk protection for older adults in Mexico: secondary data analysis of a national survey. BMJ Open 2015; 5:e007877. [PMID: 26198427 PMCID: PMC4513520 DOI: 10.1136/bmjopen-2015-007877] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES While the benefits of Seguro Popular health insurance in Mexico relative to no insurance have been widely documented, little has been reported on its effects relative to the pre-existing Social Security health insurance. We analyse the effects of Social Security and Seguro Popular health insurances in Mexico on access to healthcare of older adults, and on financial risk protection to their households, compared with older adults without health insurance. SETTING Secondary data analysis was performed using the 2012 Mexican Survey of Health and Nutrition (ENSANUT). PARTICIPANTS The study population comprised 18,847 older adults and 13,180 households that have an elderly member. OUTCOME MEASURES The dependent variables were access to healthcare given the reported need, the financial burden imposed by health expenditures measured through catastrophic health-related expenditures, and using savings for health-related expenditures. Separate propensity score matching analyses were conducted for each comparison. The analysis for access was performed at the individual level, and the analysis for financial burden at the household level. In each case, matching on a wide set of relevant characteristics was achieved. RESULTS Seguro Popular showed a protective effect against lack of access to healthcare for older adults compared with those with no insurance. The average treatment effect on the treated (ATET) was ascertained through using the nearest-neighbour matching (-8.1%, t-stat -2.305) analysis. However, Seguro Popular did not show a protective effect against catastrophic expenditures in a household where an older adult lived. Social Security showed increased access to healthcare (ATET -11.3%, t-stat -3.138), and protective effect against catastrophic expenditures for households with an elderly member (ATET -1.9%, t-stat -2.178). CONCLUSIONS Seguro Popular increased access to healthcare for Mexican older adults. Social Security showed a significant protective effect against lack of access and catastrophic expenditures compared with those without health insurance.
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Pérez-Cuevas R, Jasso Gutiérrez L, Doubova S, Flores Hernández S, Mantilla Trollé C, González Guerra E, Muñoz Hernández O. [Evaluation of the quality of care of transient tachypnea in newborns affiliated with the Medical Insurance Siglo XXI program]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 71:346-351. [PMID: 29421630 DOI: 10.1016/j.bmhimx.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/16/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Evaluation of the quality of care of the newborn with complications is an indispensable element for the improvement of strategies directed to reduce newborn mortality rates. The aim of this work was to evaluate the quality of technical and interpersonal care in the management of transient tachypnea of the newborn (TTN) of patients affiliated with the program "Medical Insurance Siglo XXI". METHODS A cross-sectional study was conducted in 61 hospitals affiliated with the Health Ministry with at least two cases of TTN during the first semester of 2011. Variables such as mother's health, pregnancy, birth and birth complication characteristics were analyzed. Also, newborn interventions and health conditions upon discharge were included. To measure the quality of care according to prevention, diagnosis and treatment, quality indicators were defined and validated. RESULTS We analyzed 256 case files with a diagnosis of TTN; 8.9% of the mothers presented risk factors (asthma, diabetes) and 53.5% had complications during pregnancy. There were 60% of cases with TTN born by cesarean delivery; one third of these children had low birth weight and 14% were transferred to another hospital. As for the quality indicators in the area of prevention, more than 90% of risk factors (smoking, asthma, cesarean delivery) were identified. Diagnostic indicators showed that 86-98% of respiratory distress symptoms were sought. Indicators of treatment achieved satisfactory figures for monitoring and support measures. CONCLUSIONS Prevention, diagnosis and treatment indicators made it possible to consider that most TTN cases received appropriate treatment. It is advisable to develop effective strategies to prevent TTN, such as increasing efforts to reduce the increasing rates of cesarean deliveries.
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Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, Tunçalp Ö, Mori R, Morisaki N, Ortiz-Panozo E, Hernandez B, Pérez-Cuevas R, Qureshi Z, Gülmezoglu AM, Temmerman M. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. LANCET GLOBAL HEALTH 2015; 3:e260-70. [DOI: 10.1016/s2214-109x(15)70094-x] [Citation(s) in RCA: 718] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Giraldo-Rodríguez L, Torres-Castro S, Martínez-Ramírez D, Gutiérrez-Robledo LM, Pérez-Cuevas R. Tele-care and tele-alarms for the elderly: preliminary experiences in Mexico. Rev Saude Publica 2014; 47:711-7. [PMID: 24346662 DOI: 10.1590/s0034-8910.2013047004574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 04/21/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the effect of a pilot program of tele-assistance and tele-alarms on the elderly's self-perception of health status and to identify the satisfaction with and acceptance of the program. METHODS Cross-sectional study that included interviews with 378 elderly individuals, 294 caretakers/relatives and 53 health care professionals. The program was run in Mexico City in 2010. The variables were socio-demographic characteristics, self-rated health, satisfaction and acceptance of the program. The information was gathered through a standardized questionnaire. The statistical analysis included descriptive analysis and nonparametric tests. RESULTS Significant effects on self-perception of health were observed, 6.17 (SD 17.9 p < 0.05) points above the average. The program was well received and accepted by the elderly, family caregivers and health professionals. CONCLUSIONS The program helps to maintain or improve quality of life, allows preventive care and is an ideal means of providing psychosocial support to the elderly.
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Pérez-Cuevas R, Doubova SV, Wirtz VJ, Servan-Mori E, Dreser A, Hernández-Ávila M. Effects of the expansion of doctors' offices adjacent to private pharmacies in Mexico: secondary data analysis of a national survey. BMJ Open 2014; 4:e004669. [PMID: 24852298 PMCID: PMC4039785 DOI: 10.1136/bmjopen-2013-004669] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare the sociodemographic characteristics, reasons for attending, perception of quality and associated out-of-pocket (OOP) expenditures of doctors' offices adjacent to private pharmacies (DAPPs) users with users of Social Security (SS), Ministry of Health (MoH), private doctor's offices independent from pharmacies and non-users. SETTING Secondary data analysis of the 2012 National Survey of Health and Nutrition of Mexico. PARTICIPANTS The study population comprised 25 852 individuals identified as having had a health problem 15 days before the survey, and a random sample of 12 799 ambulatory health service users. OUTCOME MEASURES Sociodemographic characteristics, reasons for attending healthcare services, perception of quality and associated OOP expenditures. RESULTS The distribution of users was as follows: DAPPs (9.2%), SS (16.1%), MoH (20.9%), private providers (15.4%) and non-users (38.5%); 65% of DAPP users were affiliated with a public institution (MoH 35%, SS 30%) and 35% reported not having health coverage. DAPP users considered the services inexpensive, convenient and with a short waiting time, yet they received ≥3 medications more often (67.2%, 95% CI 64.2% to 70.1%) than users of private doctors (55.7%, 95% CI 52.5% to 58.6%) and public institutions (SS 53.8%, 95% CI 51.6% to 55.9%; MoH 44.7%, 95% CI 42.5% to 47.0%). The probability of spending on consultations (88%, 95% CI 86% to 89%) and on medicines (97%, 95% CI 96% to 98%) was much higher for DAPP users when compared with SS (2%, 95% CI 2% to 3% and 12%, 95% CI 11% to 14%, respectively) and MoH users (11%, 95% CI 9% to 12% and 32%, 95% CI 30% to 34%, respectively). CONCLUSIONS DAPPs counteract current financial protection policies since a significant percentage of their users were affiliated with a public institution, reported higher OOP spending and higher number of medicines prescribed than users of other providers. The overprescription should prompt studies to learn about DAPPs' quality of care, which may arise from the conflict of interest implicit in the linkage of prescribing and dispensing processes.
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Doubova SV, Pérez-Cuevas R, Ortiz-Panozo E, Hernández-Prado B. Evaluation of the quality of antenatal care using electronic health record information in family medicine clinics of Mexico City. BMC Pregnancy Childbirth 2014; 14:168. [PMID: 24885103 PMCID: PMC4029895 DOI: 10.1186/1471-2393-14-168] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 05/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluation of the quality of antenatal care (ANC) using indicators should be part of the efforts to improve primary care services in developing countries. The growing use of the electronic health record (EHR) has the potential of making the evaluation more efficient. The objectives of this study were: (a) to develop quality indicators for ANC and (b) to evaluate the quality of ANC using EHR information in family medicine clinics (FMCs) of Mexico City. METHODS We used a mixed methods approach including: (a) in-depth interviews with health professionals; (b) development of indicators following the RAND-UCLA method; (c) a retrospective cohort study of quality of care provided to 5342 women aged 12-49 years who had completed their pregnancy in 2009 and attended to at least one ANC visit with their family doctor. The study took place in four FMCs located in Mexico City. The source of information was the EHR. SAS statistical package served for programing and performing the descriptive statistical analysis. RESULTS 14 ANC quality indicators were developed. The evaluation showed that 40.6% of women began ANC in the first trimester; 63.5% with low-risk pregnancy attended four or more ANC visits; 4.4% were referred for routine obstetric ultrasound, and 41.1% with vaginal infection were prescribed metronidazole. On average, the percentage of recommended care that women received was 32.7%. CONCLUSIONS It is feasible to develop quality indicators suitable for evaluating the quality of ANC using routine EHR data. The study identified the ANC areas that require improvement; which can guide future strategies aimed at improving ANC quality.
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Martínez-Andrade GO, Cespedes EM, Rifas-Shiman SL, Romero-Quechol G, González-Unzaga MA, Benítez-Trejo MA, Flores-Huerta S, Horan C, Haines J, Taveras EM, Pérez-Cuevas R, Gillman MW. Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City. BMC Pediatr 2014; 14:77. [PMID: 24649831 PMCID: PMC3999907 DOI: 10.1186/1471-2431-14-77] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 03/17/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics. METHODS We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children's height and weight and parents reported children's diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values. RESULTS 93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program. CONCLUSIONS Although satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI. TRIAL REGISTRATION ClinicalTrials.gov NCT01539070.Comisión Nacional de Investigación Científica del IMSS: 2009-785-120.
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Vogel JP, Souza JP, Mori R, Morisaki N, Lumbiganon P, Laopaiboon M, Ortiz-Panozo E, Hernandez B, Pérez-Cuevas R, Roy M, Mittal S, Cecatti JG, Tunçalp Ö, Gülmezoglu AM. Maternal complications and perinatal mortality: findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 Suppl 1:76-88. [DOI: 10.1111/1471-0528.12633] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 12/01/2022]
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Doubova SV, Ramírez-Sánchez C, Figueroa-Lara A, Pérez-Cuevas R. [Human resources requirements for diabetic patients healthcare in primary care clinics of the Mexican Institute of Social Security]. SALUD PUBLICA DE MEXICO 2013; 55:607-617. [PMID: 24715013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 09/23/2013] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To estimate the requirements of human resources (HR) of two models of care for diabetes patients: conventional and specific, also called DiabetIMSS, which are provided in primary care clinics of the Mexican Institute of Social Security (IMSS). MATERIALS AND METHODS An evaluative research was conducted. An expert group identified the HR activities and time required to provide healthcare consistent with the best clinical practices for diabetic patients. HR were estimated by using the evidence-based adjusted service target approach for health workforce planning; then, comparisons between existing and estimated HRs were made. RESULTS To provide healthcare in accordance with the patients' metabolic control, the conventional model required increasing the number of family doctors (1.2 times) nutritionists (4.2 times) and social workers (4.1 times). The DiabetIMSS model requires greater increase than the conventional model. CONCLUSIONS Increasing HR is required to provide evidence-based healthcare to diabetes patients.
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V Doubova S, Ramírez-Sánchez C, Figueroa-Lara A, Pérez-Cuevas R. Recursos humanos para la atención de pacientes con diabetes en unidades de medicina familiar del Instituto Mexicano del Seguro Social. ACTA ACUST UNITED AC 2013. [DOI: 10.21149/spm.v55i6.7306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objetivo. Evaluar las necesidades de recursos humanos (RH) para atender pacientes con diabetes en dos modelos de atención: convencional y específico para diabetes (DiabetIMSS) en clínicas de atención primaria del Instituto Mexicano del Seguro Social (IMSS). Material y métodos. Investigación evaluativa; un grupo de expertos, en congruencia con las mejores prácticas clínicas, definió las actividades y tiempos que los RH requieren para atender a pacientes diabéticos. Seguidamente, se utilizó el método de planificación basado en evidencia ajustado por objetivos. Los RH estimados se contrastaron con los existentes para determinar la necesidad. Resultados. Para otorgar atención a los pacientes diabéticos en congruencia con su control metabólico, el modelo convencional requiere aumentar la plantilla de médicos (1.2 veces), nutriólogos (4.2 veces) y trabajadores sociales (4.1 veces); el modelo DiabetIMSS requiere mayores incrementos. Conclusiones. Es indispensable aumentar los RH en el primer nivel para otorgar atención basada en evidencia a pacientes diabéticos.
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