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Doubova SV, Quinzaños Fresnedo C, Paredes Cruz M, Perez-Moran D, Pérez-Cuevas R, Meneses Gallardo V, Garcia Cortes LR, Cerda Mancillas MC, Martínez Gaytan V, Romero Garcia MA, Espinoza Anrubio G, Perez Ruiz CE, Prado-Aguilar CA, Sarralde Delgado A, Kruk ME, Arsenault C. A comprehensive assessment of care competence and maternal experience of first antenatal care visits in Mexico: Insights from the baseline survey of an observational cohort study. PLoS Med 2024; 21:e1004456. [PMID: 39226243 PMCID: PMC11371229 DOI: 10.1371/journal.pmed.1004456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 07/31/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Comprehensive antenatal care (ANC) must prioritize competent, evidence-based medical attention to ensure a positive experience and value for its users. Unfortunately, there is scarce evidence of implementing this holistic approach to ANC in low- and middle-income countries, leading to gaps in quality and accountability. This study assessed care competence, women's experiences during the first ANC visit, and the factors associated with these care attributes. METHODS AND FINDINGS The study analyzed cross-sectional baseline data from the maternal eCohort study conducted in Mexico from August to December 2023. The study adapted the Quality Evidence for Health System Transformation (QuEST) network questionnaires to the Mexican context and validated them through expert group and cognitive interviews with women. Pregnant women aged 18 to 49 who had their first ANC visit with a family physician were enrolled in 48 primary clinics of the Instituto Mexicano del Seguro Social across 8 states. Care competence and women's experiences with care were the primary outcomes. The statistical analysis comprised descriptive statistics, multivariable linear and Poisson regressions. A total of 1,390 pregnant women were included in the study. During their first ANC visit, women received only 67.7% of necessary clinical actions on average, and 52% rated their ANC experience as fair or poor. Women with previous pregnancies (adjusted regression coefficient [aCoef.] -3.55; (95% confidence intervals [95% CIs]): -4.88, -2.22, p < 0.001), at risk of depression (aCoef. -3.02; 95% CIs: -5.61, -0.43, p = 0.023), those with warning signs (aCoef. -2.84; 95% CIs: -4.65, -1.03, p = 0.003), common pregnancy discomforts (aCoef. -1.91; 95% CIs: -3.81, -0.02, p = 0.048), or those who had a visit duration of less than 20 minutes (<15 minutes: aCoef. -7.58; 95% CIs: -10.21, -4.95, p < 0.001 and 15 to 19 minutes: aCoef. -2.73; 95% CIs: -4.79, -0.67, p = 0.010) and received ANC in the West and Southeast regions (aCoef. -5.15; 95% CIs: -7.64, -2.66, p < 0.001 and aCoef. -5.33; 95% CIs: -7.85, -2.82, p < 0.001, respectively) had a higher probability of experiencing poorer care competence. Higher care competence (adjusted prevalence ratio [aPR] 1.004; 95% CIs:1.002, 1.005, p < 0.001) and receiving care in a small clinic (aPR 1.19; 95% CIs: 1.06, 1.34, p = 0.003) compared to a medium-sized clinic were associated with a better first ANC visit experience, while common pregnancy discomforts (aPR 0.94; 95% CIs: 0.89, 0.98, p = 0.005) and shorter visit length (aPR 0.94; 95% CIs: 0.88, 0.99, p = 0.039) were associated with lower women's experience. The primary limitation of the study is that participants' responses may be influenced by social desirability bias, leading them to provide socially acceptable responses. CONCLUSIONS We found important gaps in adherence to ANC standards and that care competence during the first ANC visit is an important predictor of positive user experience. To inform quality improvement efforts, IMSS should institutionalize the routine monitoring of ANC competencies and ANC user experience. This will help identify poorly performing facilities and providers and address gaps in the provision of evidence-based and women-centered care.
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Affiliation(s)
- Svetlana V. Doubova
- Unidad de Investigación Epidemiológica y Servicios de Salud del CMN SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | | | - Martín Paredes Cruz
- Unidad de Investigación Epidemiológica y Servicios de Salud del CMN SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Diana Perez-Moran
- Unidad de Investigación Epidemiológica y Servicios de Salud del CMN SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Interamerican Development Bank, Washington, DC, United States of America
| | | | - Luis Rey Garcia Cortes
- OOAD Estado de México Oriente, Instituto Mexicano del Seguro Social, Tlalnepantla de Baz, Estado de México, México
| | | | - Victoria Martínez Gaytan
- Unidad Médica de Alta Especialidad, Hospital de Gineco obstetricia N°23 Dr. Ignacio Morones Prieto, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México
| | | | | | | | | | | | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
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Benítez-Chao DF, García-Hernández M, Cuellar JM, García G, Islas JF, Garza-Treviño EN, Padilla-Rivas GR. Impact of comorbidities on COVID-19 mortality in hospitalized women: Insights from the metropolitan area of the Valley of Mexico from 2020 to 2022. IJID REGIONS 2024; 12:100420. [PMID: 39257852 PMCID: PMC11385434 DOI: 10.1016/j.ijregi.2024.100420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 09/12/2024]
Abstract
Objectives This research summarizes the impact of the major comorbidities impacting hospitalized women with COVID-19 and their relation to death. Methods Public data from national databases (2020-2022) for hospitalized women, including identification data, hospitalization time, comorbidities, and intensive care unit (ICU) admissions, were analyzed. Women were stratified by age (split at 50 years). Binary regression models determined the correlation between comorbidities and COVID-19 with mortality, expressed as odds ratios. Results A total of 46,492 women were hospitalized, with 70.1% aged above 50 years. A total of 17,728 fatalities occurred, with 86.5% in the older age group. A total of 5.82% women required intensive care. The common comorbidities were pneumonia, hypertension, diabetes, obesity, and intubation. A total of 56.6% died within the 1st week; in the ICU, 65.7% died by week 2. In the logistic regression, diabetes and chronic kidney disease (CKD) were initially significant, followed by pneumonia and CKD (days 8-14), intubation and, ICU stay (beyond the 15th day). In the ICU, intubation impact worsened over time. Conclusions Our study highlights the significant impact of comorbidities on COVID-19 mortality in women in the Valley of Mexico. Pneumonia, diabetes, CKD, and intubation were notably prevalent and correlated strongly with death in older women. Timely intubation improves survival, whereas delayed intubation increases mortality risk, particularly, in the ICU. Urgent targeted interventions are required, especially for older hospitalized women.
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Affiliation(s)
- Diego Francisco Benítez-Chao
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Departamento de Bioquímica y Medicina Molecular, Dr. Eduardo Aguirre Pequeño, Monterrey CP.64460, México
| | - Marisela García-Hernández
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Departamento de Bioquímica y Medicina Molecular, Dr. Eduardo Aguirre Pequeño, Monterrey CP.64460, México
| | - José M Cuellar
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Departamento de Bioquímica y Medicina Molecular, Dr. Eduardo Aguirre Pequeño, Monterrey CP.64460, México
| | - Gabriel García
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Departamento de Bioquímica y Medicina Molecular, Dr. Eduardo Aguirre Pequeño, Monterrey CP.64460, México
| | - Jose Francisco Islas
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Departamento de Bioquímica y Medicina Molecular, Dr. Eduardo Aguirre Pequeño, Monterrey CP.64460, México
| | - Elsa N Garza-Treviño
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Departamento de Bioquímica y Medicina Molecular, Dr. Eduardo Aguirre Pequeño, Monterrey CP.64460, México
| | - Gerardo R Padilla-Rivas
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Departamento de Bioquímica y Medicina Molecular, Dr. Eduardo Aguirre Pequeño, Monterrey CP.64460, México
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Are C, Murthy SS, Sullivan R, Schissel M, Chowdhury S, Alatise O, Anaya D, Are M, Balch C, Bartlett D, Brennan M, Cairncross L, Clark M, Deo SVS, Dudeja V, D'Ugo D, Fadhil I, Giuliano A, Gopal S, Gutnik L, Ilbawi A, Jani P, Kingham TP, Lorenzon L, Leiphrakpam P, Leon A, Martinez-Said H, McMasters K, Meltzer DO, Mutebi M, Zafar SN, Naik V, Newman L, Oliveira AF, Park DJ, Pramesh CS, Rao S, Subramanyeshwar Rao T, Bargallo-Rocha E, Romanoff A, Rositch AF, Rubio IT, Salvador de Castro Ribeiro H, Sbaity E, Senthil M, Smith L, Toi M, Turaga K, Yanala U, Yip CH, Zaghloul A, Anderson BO. Global Cancer Surgery: pragmatic solutions to improve cancer surgery outcomes worldwide. Lancet Oncol 2023; 24:e472-e518. [PMID: 37924819 DOI: 10.1016/s1470-2045(23)00412-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 11/06/2023]
Abstract
The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.
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Affiliation(s)
- Chandrakanth Are
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Shilpa S Murthy
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Makayla Schissel
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjib Chowdhury
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Olesegun Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Daniel Anaya
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Madhuri Are
- Division of Pain Medicine, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Charles Balch
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, Global Cancer Surgery: pragmatic solutions to improve USA
| | - David Bartlett
- Department of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Murray Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Matthew Clark
- University of Auckland School of Medicine, Auckland, New Zealand
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Dudeja
- Division of Surgical Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Domenico D'Ugo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Armando Giuliano
- Cedars-Sinai Medical Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Washington DC, USA
| | - Lily Gutnik
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Pankaj Jani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | | | - Laura Lorenzon
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Premila Leiphrakpam
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Augusto Leon
- Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Kelly McMasters
- Division of Surgical Oncology, Hiram C Polk, Jr MD Department of Surgery, University of Louisville, Louisville, KY, USA
| | - David O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Vibhavari Naik
- Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Lisa Newman
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | | | - Do Joong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Saieesh Rao
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | | | - Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Eman Sbaity
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, University of California, Irvine, Irvine, CA, USA
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Masakazi Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Kiran Turaga
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ujwal Yanala
- Surgical Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Contreras Sánchez SE, Doubova SV, Grajales Álvarez R, Dip Borunda AK, Martínez Pineda WJ, Nuñez Cerrillo JG, Silva Bravo F, Zalapa Velázquez R, Gutiérrez De la Barrera M, Leslie HH. Design and evaluation of a digital health intervention with proactive follow-up by nurses to improve healthcare and outcomes for patients with breast cancer in Mexico: protocol for a randomised clinical trial. BMJ Open 2023; 13:e077322. [PMID: 37931967 PMCID: PMC10632859 DOI: 10.1136/bmjopen-2023-077322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
INTRODUCTION Nearly 30 000 Mexican women develop breast cancer annually, frequently presenting unmet supportive care needs. In high-income countries, incorporating electronic patient-reported outcomes (ePROs) into cancer care has demonstrated potential for increasing patient-centred care and reducing unmet needs. No such ePRO interventions have been implemented in Mexico. This paper presents the study protocol for designing and evaluating an ePRO digital health application combined with proactive follow-up by nurses. METHODS AND ANALYSIS We designed a two-component intervention for women receiving breast cancer treatment: a responsive web application for monitoring ePROs and clinical algorithms guiding proactive follow-up by nurses. We will conduct a pilot test of the intervention with 50 patients with breast cancer for 6 weeks to assess feasibility and adjust the application. We will conduct a parallel arm randomised controlled trial assigning 205 patients each to intervention and control in one of Mexico's largest public oncology hospitals. The intervention will be provided for 6 months, with additional 3 months of post-intervention observation. The control group will receive usual healthcare and a list of breast cancer information sources. Women diagnosed with stages I, II or III breast cancer who initiate chemotherapy and/or radiotherapy will be invited to participate. The primary study outcome will be supportive care needs; secondary outcomes include global quality of life and breast symptoms. Information on the outcomes will be obtained through web-based self-administered questionnaires collected at baseline, 1, 3, 6 and 9 months. ETHICS AND DISSEMINATION The National Research and Ethics Committees of the Mexican Institute of Social Security approved the study (R-2021-785-059). Participants will sign an informed consent form prior to their inclusion. Findings will be disseminated through a policy brief to the local authorities, a webinar for patients, publications in peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER NCT05925257.
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Affiliation(s)
- Saúl Eduardo Contreras Sánchez
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico
| | | | | | | | | | - Fernando Silva Bravo
- Oncology Department, Speciality Hospital CMN Manuel Ávila Camacho, IMSS, Puebla, Puebla, Mexico
| | - Rita Zalapa Velázquez
- Oncology Department, Speciality Hospital CMN Manuel Ávila Camacho, IMSS, Puebla, Puebla, Mexico
| | | | - Hannah H Leslie
- Division of Prevention Science, University of California San Francisco, San Francisco, California, USA
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Delgado-Gallegos JL, Padilla-Rivas GR, Gastelum-Arias LJ, Zuñiga-Violante E, Avilés-Rodríguez G, Arellanos-Soto D, Franco-Villareal H, Garza-Treviño EN, Cosío-León MDLÁ, Romo-Cardenas GS, Ramos-Jiménez J, Rivas-Estrilla AM, Moreno-Cuevas JE, Islas JF. Parent's Perspective towards Child COVID-19 Vaccination: An Online Cross-Sectional Study in Mexico. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:290. [PMID: 35010556 PMCID: PMC8751075 DOI: 10.3390/ijerph19010290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/25/2022]
Abstract
COVID-19 vaccination programs continue in child populations. Thus, parents' attitude towards COVID-19 vaccination of their children is crucial for these strategies to succeed. The present study derives from the application of an online COVID-19 Vaccine Acceptance & Hesitancy Questionnaire (COV-AHQ) in which we measure parent's hesitancy towards children's vaccination (section 4 of the COV-AHQ) and other significant factors. A logistic regression analysis with backward stepwise method was used to quantify the associations between factors and parent's hesitancy. According to the correlation analysis, the most representative factors predicting vaccine hesitancy/acceptance were positive attitude towards vaccination, parents believing that the COVID-19 vaccine will enhance the economic situation of the country, parents actively researching information, having the willingness to obtain the COVID-19 vaccine themselves, and the possibility of their children developing adverse effects. Our findings also showed that parents are highly interested in having their children vaccinated. Nonetheless, parents expressed high levels of concern involving their children in developing adverse effects from the vaccine. In addition, obtaining influenza immunization prompted interest in obtaining the COVID-19 vaccine, and younger-aged parents are much more concerned with having their children vaccinated. Therefore, in order to ensure successful vaccination programs, policymakers and health authorities should design strategies to gain confidence and provide security amongst the population, including giving continuous information about the benefits of vaccination and presenting the frequency of side effects to bring parents on board with vaccinating their children.
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Affiliation(s)
- Juan Luis Delgado-Gallegos
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (J.L.D.-G.); (G.R.P.-R.); (L.J.G.-A.); (D.A.-S.); (E.N.G.-T.); (J.R.-J.); (A.M.R.-E.)
| | - Gerardo R. Padilla-Rivas
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (J.L.D.-G.); (G.R.P.-R.); (L.J.G.-A.); (D.A.-S.); (E.N.G.-T.); (J.R.-J.); (A.M.R.-E.)
| | - Lilia Julieta Gastelum-Arias
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (J.L.D.-G.); (G.R.P.-R.); (L.J.G.-A.); (D.A.-S.); (E.N.G.-T.); (J.R.-J.); (A.M.R.-E.)
| | - Erika Zuñiga-Violante
- Facultad de Ingeniería y Tecnología, Universidad de Montemorelos, Montemorelos 67515, Mexico;
| | - Gener Avilés-Rodríguez
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (G.A.-R.); (G.S.R.-C.)
| | - Daniel Arellanos-Soto
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (J.L.D.-G.); (G.R.P.-R.); (L.J.G.-A.); (D.A.-S.); (E.N.G.-T.); (J.R.-J.); (A.M.R.-E.)
| | | | - Elsa N. Garza-Treviño
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (J.L.D.-G.); (G.R.P.-R.); (L.J.G.-A.); (D.A.-S.); (E.N.G.-T.); (J.R.-J.); (A.M.R.-E.)
| | | | - Gerardo Salvador Romo-Cardenas
- Facultad de Ingeniería, Arquitectura y Diseño, Universidad Autónoma de Baja California, Ensenada 22860, Mexico; (G.A.-R.); (G.S.R.-C.)
| | - Javier Ramos-Jiménez
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (J.L.D.-G.); (G.R.P.-R.); (L.J.G.-A.); (D.A.-S.); (E.N.G.-T.); (J.R.-J.); (A.M.R.-E.)
| | - Ana Ma. Rivas-Estrilla
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (J.L.D.-G.); (G.R.P.-R.); (L.J.G.-A.); (D.A.-S.); (E.N.G.-T.); (J.R.-J.); (A.M.R.-E.)
| | - Jorge E. Moreno-Cuevas
- Departamento de Ciencias Básicas, Universidad de Monterrey, San Pedro Garza García 66238, Mexico
| | - Jose Francisco Islas
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico; (J.L.D.-G.); (G.R.P.-R.); (L.J.G.-A.); (D.A.-S.); (E.N.G.-T.); (J.R.-J.); (A.M.R.-E.)
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Alhassan RK, Ketor CE, Ashinyo A, Ashinyo ME, Nutor JJ, Adjadeh C, Sarkodie E. Quality of antiretroviral therapy services in Ghana: Implications for the HIV response in resource-constrained settings. SAGE Open Med 2021; 9:20503121211036142. [PMID: 34377475 PMCID: PMC8326618 DOI: 10.1177/20503121211036142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Number of People Living with Human Immune-deficiency Virus in Ghana is over 300,000 and unmet need for antiretroviral therapy is approximately 60%. This study sought to determine the quality of antiretroviral therapy services in selected ART sites in Ghana using the input-process-outcome approach. Methods This is a descriptive cross-sectional case study that employed modified normative evaluation to assess quality of antiretroviral therapy services in the Oti and Volta regions of Ghana among People Living with HIV (n = 384) and healthcare providers (n = 16). The study was conducted from 11 March to 9 May 2019. Results Resources for managing HIV clients were largely available with the exception of viral load machines, reagents for CD4 counts, and antifungals such as Fluconazole and Cotrimoxazole. Patients enrolled on antiretroviral therapy within 2 weeks was 71% and clients retained in care within 2 weeks of enrolment was 90%. Approximately 26% of enrolled clients recorded viral load suppression; 33% of People Living with HIV who were not insured with the National Health Insurance Scheme paid for some antiretrovirals and cotrimoxazole. Adherence to ART and Cotrimoxazole were 95% and 88%, respectively, using pill count on their last three visits. Time spent with clinical team was among the worst rated (mean = 2.98, standard deviation = 0.54) quality indicators by patients contrary to interpersonal relationship with health provider which was among the best rated (mean = 3.25, standard deviation = 0.41) indicators. Conclusion Observed quality care gaps could potentially reverse gains made in HIV prevention and control in Ghana if not addressed timely; an important value addition of this study is the novel application of input-process-outcome approach in the context of antiretroviral therapy services in Ghana. There is also the need for policy dialogue on inclusion of medications for prophylaxis in antiretroviral therapy on the National Health Insurance Scheme to promote adherence and retention.
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Affiliation(s)
- Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Courage Edem Ketor
- Pharmacy Department, Jasikan District Hospital, Ghana Health Service, Jasikan, Ghana
| | - Anthony Ashinyo
- National AIDS/STI Control Programme, Ghana Health Service, Accra, Ghana
| | - Mary Eyram Ashinyo
- Department of Quality Assurance and Safety, Ghana Health Service, Accra, Ghana
| | - Jerry John Nutor
- Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Conrad Adjadeh
- Pharmacy Department, Margaret Marquart Catholic Hospital Kpando, Kpando, Ghana
| | - Emmanuel Sarkodie
- Pharmacy Department, Kwame Nkrumah University of Science and Technology (KNUST) Hospital, Kumasi, Ghana
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Sosa-Rubí SG, Seiglie JA, Chivardi C, Manne-Goehler J, Meigs JB, Wexler DJ, Wirtz VJ, Gómez-Dantés O, Serván-Mori E. Incremental Risk of Developing Severe COVID-19 Among Mexican Patients With Diabetes Attributed to Social and Health Care Access Disadvantages. Diabetes Care 2021; 44:373-380. [PMID: 33208487 PMCID: PMC7818336 DOI: 10.2337/dc20-2192] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/26/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is an important risk factor for severe coronavirus disease 2019 (COVID-19), but little is known about the marginal effect of additional risk factors for severe COVID-19 among individuals with diabetes. We tested the hypothesis that sociodemographic, access to health care, and presentation to care characteristics among individuals with diabetes in Mexico confer an additional risk of hospitalization with COVID-19. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study using public data from the General Directorate of Epidemiology of the Mexican Ministry of Health. We included individuals with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 between 1 March and 31 July 2020. The primary outcome was the predicted probability of hospitalization, inclusive of 8.5% of patients who required intensive care unit admission. RESULTS Among 373,963 adults with COVID-19, 16.1% (95% CI 16.0-16.3) self-reported diabetes. The predicted probability of hospitalization was 38.4% (37.6-39.2) for patients with diabetes only and 42.9% (42.2-43.7) for patients with diabetes and one or more comorbidities (obesity, hypertension, cardiovascular disease, and chronic kidney disease). High municipality-level of social deprivation and low state-level health care resources were associated with a 9.5% (6.3-12.7) and 17.5% (14.5-20.4) increased probability of hospitalization among patients with diabetes, respectively. In age-, sex-, and comorbidity-adjusted models, living in a context of high social vulnerability and low health care resources was associated with the highest predicted probability of hospitalization. CONCLUSIONS Social vulnerability contributes considerably to the probability of hospitalization among individuals with COVID-19 and diabetes with associated comorbidities. These findings can inform mitigation strategies for populations at the highest risk of severe COVID-19.
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Affiliation(s)
- Sandra G Sosa-Rubí
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Carlos Chivardi
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - James B Meigs
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of General Medicine, Massachusetts General Hospital, Boston, MA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA
| | - Octavio Gómez-Dantés
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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8
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Mehta R, Martagon AJ, Galan Ramirez GA, Antonio-Villa NE, Vargas-Vázquez A, Elias-Lopez D, Gonzalez-Retana G, Rodríguez-Encinas B, Ceballos-Macías JJ, Romero-Zazueta A, Martinez-Alvarado R, Morales-Portano JD, Alvarez-Lopez H, Sauque-Reyna L, Gomez-Herrera LG, Simental-Mendia LE, Garcia-Aguilar H, Ramirez-Cooremans E, Peña-Aparicio B, Mendoza-Zubieta V, Carrillo-Gonzalez PA, Ferreira-Hermosillo A, Caracas-Portilla N, Jimenez-Dominguez G, Ruiz-Garcia AY, Arriaga-Cazares HE, Gonzalez-Gonzalez JR, Mendez-Valencia CV, Padilla FG, Madriz-Prado R, De Los Rios-Ibarra MO, Vazquez-Cardenas A, Arjona-Villicaña RD, Acevedo-Rivera KJ, Allende-Carrera R, Alvarez JA, Amezcua-Martinez JC, de Los Reyes Barrera-Bustillo M, Carazo-Vargas G, Contreras-Chacon R, Figueroa-Andrade MH, Flores-Ortega A, Garcia-Alcala H, Garcia de Leon LE, Garcia-Guzman B, Garduño-Garcia JJ, Garnica-Cuellar JC, Gomez-Cruz JR, Hernandez-Garcia A, Holguin-Almada JR, Juarez-Herrera U, Lugo-Sobrevilla F, Marquez-Rodriguez E, Martinez-Sibaja C, Medrano-Rodriguez AB, Morales-Oyervides JC, Perez-Vazquez DI, Reyes-Rodriguez EA, Robles-Osorio ML, Rosas-Saucedo J, Torres-Tamayo M, Valdez-Talavera LA, Vera-Arroyo LE, Zepeda-Carrillo EA, Aguilar-Salinas CA. Familial hypercholesterolemia in Mexico: Initial insights from the national registry. J Clin Lipidol 2021; 15:124-133. [PMID: 33422452 DOI: 10.1016/j.jacl.2020.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/18/2020] [Accepted: 12/04/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) remains underdiagnosed and undertreated. OBJECTIVE Report the results of the first years (2017-2019) of the Mexican FH registry. METHODS There are 60 investigators, representing 28 federal states, participating in the registry. The variables included are in accordance with the European Atherosclerosis Society (EAS) FH recommendations. RESULTS To date, 709 patients have been registered, only 336 patients with complete data fields are presented. The mean age is 50 (36-62) years and the average time since diagnosis is 4 (IQR: 2-16) years. Genetic testing is recorded in 26.9%. Tendon xanthomas are present in 43.2%. The prevalence of type 2 diabetes is 11.3% and that of premature CAD is 9.8%. Index cases, male gender, hypertension and smoking were associated with premature CAD. The median lipoprotein (a) level is 30.5 (IQR 10.8-80.7) mg/dl. Statins and co-administration with ezetimibe were recorded in 88.1% and 35.7% respectively. A combined treatment target (50% reduction in LDL-C and an LDL-C <100 mg/dl) was achieved by 13.7%. Associated factors were index case (OR 3.6, 95%CI 1.69-8.73, P = .002), combination therapy (OR 2.4, 95%CI 1.23-4.90, P = .011), type 2 diabetes (OR 2.8, 95%CI 1.03-7.59, P = .036) and age (OR 1.023, 95%CI 1.01-1.05, P = .033). CONCLUSION The results confirm late diagnosis, a lower than expected prevalence and risk of ASCVD, a higher than expected prevalence of type 2 diabetes and undertreatment, with relatively few patients reaching goals. Recommendations include, the use of combination lipid lowering therapy, control of comorbid conditions and more frequent genetic testing in the future.
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Affiliation(s)
- Roopa Mehta
- Unidad de Investigación de Enfermedades Metabolicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México City, Mexico; Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Alexandro J Martagon
- Unidad de Investigación de Enfermedades Metabolicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México City, Mexico; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Gabriela A Galan Ramirez
- Unidad de Investigación de Enfermedades Metabolicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México City, Mexico
| | - Neftali Eduardo Antonio-Villa
- Unidad de Investigación de Enfermedades Metabolicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México City, Mexico
| | - Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades Metabolicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México City, Mexico
| | - Daniel Elias-Lopez
- Unidad de Investigación de Enfermedades Metabolicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México City, Mexico; Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Gustavo Gonzalez-Retana
- Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Bethsabel Rodríguez-Encinas
- Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Guadalupe Jimenez-Dominguez
- Hospital General Zona #46 IMSS, Villahermosa, Tabasco, Mexico; Hospital Angeles de Villahermosa, Tabasco, Mexico
| | | | - Hector E Arriaga-Cazares
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico; Centro Medico Nacional del Noreste IMSS, Monterrey, Nuevo Leon, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabolicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México City, Mexico; Departamento de Endocrinologia y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Direccion de Nutricion, Instituto Nacional de Ciencias Médicas y Nutricion Salvador Zubiran, Mexico City, Mexico; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico.
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Delgado-Gallegos JL, Montemayor-Garza RDJ, Padilla-Rivas GR, Franco-Villareal H, Islas JF. Prevalence of Stress in Healthcare Professionals during the COVID-19 Pandemic in Northeast Mexico: A Remote, Fast Survey Evaluation, Using an Adapted COVID-19 Stress Scales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7624. [PMID: 33086744 PMCID: PMC7593933 DOI: 10.3390/ijerph17207624] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
The world is currently subjected to the worst health crisis documented in modern history: an epidemic led by the novel coronavirus disease 2019 (COVID-19). At the epicenter of this crisis, healthcare professionals continue working to safeguard our well-being. To the regular high levels of stress, COVID-19 adds even more so to healthcare professionals in particular, depending on their area, specialty, and type of work. Here we investigated what are the tendencies or areas most affected. Through an adaptation of the original COVID-stress scales, we developed a remote, fast test designed for healthcare professionals in the northeastern part of Mexico, an important part of the country with economic and cultural ties to the United States. Our results showed four key correlations as highly dependent: work area-xenophobia (p < 0.045), work with COVID patients-traumatic stress (p < 0.001), total number of COVID patients per day-traumatic stress (p < 0.027), and total number of COVID patients-compulsive checking and reassurance. Overall, we concluded that normal levels of stress have increased (mild-moderate). Additionally, we determine that the fear of being an asymptomatic patient (potential to spread without knowing) continues being a concern.
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Affiliation(s)
- Juan Luis Delgado-Gallegos
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Avenida Dr. Eduardo Aguirre Pequeño, Col. Mitras Centro, Monterrey, NL 64460, Mexico; (J.L.D.-G.); (G.R.P.-R.)
| | - Rene de Jesús Montemayor-Garza
- Instituto de Salud para el Bienestar, Clínica Psiquiátrica Dr. Everardo Neumann Peña, Carr Matehuala 8, Fracción los Olivos, Soledad de Graciano Sánchez, SLP 78430, Mexico;
| | - Gerardo R. Padilla-Rivas
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Avenida Dr. Eduardo Aguirre Pequeño, Col. Mitras Centro, Monterrey, NL 64460, Mexico; (J.L.D.-G.); (G.R.P.-R.)
| | - Héctor Franco-Villareal
- Althian Clinical Research, Calle Capitán Aguilar Sur 669, Col. Obispado Monterrey, NL 64000, Mexico;
| | - Jose Francisco Islas
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Avenida Dr. Eduardo Aguirre Pequeño, Col. Mitras Centro, Monterrey, NL 64460, Mexico; (J.L.D.-G.); (G.R.P.-R.)
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10
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Leslie HH, Doubova SV, Pérez-Cuevas R. Assessing health system performance: effective coverage at the Mexican Institute of Social Security. Health Policy Plan 2019; 34:ii67-ii76. [DOI: 10.1093/heapol/czz105] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/21/2022] Open
Abstract
Abstract
Universal health coverage is a national priority in Mexico, with active efforts to expand public healthcare system access, increase financial protection and improve quality of care. We estimated effective coverage of multiple conditions within the Mexican Institute of Social Security (IMSS), which covers 62 million individuals. We identified routinely collected performance indicators at IMSS from 2016 related to use and quality of care for conditions avertable with high-quality healthcare; where candidate indicators were available, we quantified need for service from a population-representative survey and calculated effective coverage as proportion of individuals in need who experience potential health gains. We assessed subnational inequality across 32 states, and we weighted conditions by relative contribution to national disease burden to estimate composite effective coverage. Conditions accounting for 51% of healthcare-avertable disability-adjusted life years lost in Mexico could be assessed: antenatal care, delivery care, newborn care, childhood diarrhoea, cardiovascular disease and diabetes. Estimated effective coverage ranged from a low of 27% for childhood diarrhoea to a high of 74% for newborn care. Substantial inequality in effective coverage existed between states, particularly for maternal and child conditions. Overall effective coverage of these six conditions in IMSS was 49% in 2016. Gaps in use and quality of care must be addressed to ensure good health for all in Mexico. Despite extensive monitoring of health status and services in Mexico, currently available data are inadequate to the task of fully and routinely assessing health system effective coverage. Leaders at IMSS and similar healthcare institutions must be more purposeful in planning the assessment of population need, utilization of care and quality impacts of care to enable linkage of these data and disaggregation by location or population sub-group. Only then can complex health systems be fairly and fully evaluated.
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Affiliation(s)
- Hannah H Leslie
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 90 Smith Street, 3rd floor, Boston, MA, USA
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Cuidad de México, Av. Cuauhtémoc 330, Doctores, PC, Mexico
| | - Ricardo Pérez-Cuevas
- Health System Research Center, National Institute of Public Health, Avenida Universidad 655, Santa María Ahuacatitlán, Cuernavaca, Mexico
- Division of Social Protection and Health, Jamaica Country Office, Inter-American Development Bank, 6 Montrose Road, Kingston, Jamaica
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