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De Rezende H. How relational leadership can enhance nurses' well-being and productivity. Nurs Stand 2024; 39:77-81. [PMID: 38563115 DOI: 10.7748/ns.2024.e12271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 04/04/2024]
Abstract
Leadership is an essential skill in nursing and has a fundamental role in ensuring high-quality patient care and the effective functioning of healthcare systems. Effective nursing leadership is vital to support nursing teams as they negotiate the challenges confronting the profession, such as ageing populations and the increased use of healthcare technology. This article discusses various relational leadership styles that can be used to promote nurses' health and well-being and enhance productivity. The author also explores the benefits and challenges of implementing relational leadership in nursing.
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Affiliation(s)
- Helena De Rezende
- Faculty of Health & Social Sciences, Department of Nursing Science, Bournemouth University, Bournemouth, England
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Saturno-Hernández P, Moreno-Zegbe E, Poblano-Verastegui O, Torres-Arreola LDP, Bautista-Morales AC, Maya-Hernández C, Uscanga-Castillo JD, Flores-Hernández S, Gómez-Cortez PM, Vieyra-Romero WI. Hospital care direct costs due to ambulatory care sensitive conditions related to diabetes mellitus in the Mexican public healthcare system. BMC Health Serv Res 2024; 24:507. [PMID: 38659025 PMCID: PMC11041024 DOI: 10.1186/s12913-024-10937-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Hospitalizations for ambulatory care sensitive conditions (ACSC) incur substantial costs on the health system that could be partially avoided with adequate outpatient care. Complications of chronic diseases, such as diabetes mellitus (DM), are considered ACSC. Previous studies have shown that hospitalizations due to diabetes have a significant financial burden. In Mexico, DM is a major health concern and a leading cause of death, but there is limited evidence available. This study aimed to estimate the direct costs of hospitalizations by DM-related ACSC in the Mexican public health system. METHODS We selected three hospitals from each of Mexico's main public institutions: the Mexican Social Security Institute (IMSS), the Ministry of Health (MoH), and the Institute of Social Security and Services for State Workers (ISSSTE). We employed a bottom-up microcosting approach from the healthcare provider perspective to estimate the total direct costs of hospitalizations for DM-related ACSC. Input data regarding length of stay (LoS), consultations, medications, colloid/crystalloid solutions, procedures, and laboratory/medical imaging studies were obtained from clinical records of a random sample of 532 hospitalizations out of a total of 1,803 DM-related ACSC (ICD-10 codes) discharges during 2016. RESULTS The average cost per DM-related ACSC hospitalization varies among institutions, ranging from $1,427 in the MoH to $1,677 in the IMSS and $1,754 in the ISSSTE. The three institutions' largest expenses are LoS and procedures. Peripheral circulatory and renal complications were the major drivers of hospitalization costs for patients with DM-related ACSC. Direct costs due to hospitalizations for DM-related ACSC in these three institutions represent 1% of the gross domestic product (GDP) dedicated to health and social services and 2% of total hospital care expenses. CONCLUSIONS The direct costs of hospitalizations for DM-related ACSC vary considerably across institutions. Disparities in such costs for the same ACSC among different institutions suggest potential disparities in care quality across primary and hospital settings (processes and resource utilization), which should be further investigated to ensure optimal supply utilization. Prioritizing preventive measures for peripheral circulatory and renal complications in DM patients could be highly beneficial.
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Feagin FC, Hearld LR, Carroll NW, O'Connor S, Sen B. Does Interdisciplinary Care Team Care Management Improve Health Quality and Demonstrate Cost-Effectiveness? Med Care Res Rev 2024; 81:19-30. [PMID: 37679955 DOI: 10.1177/10775587231197846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
This study evaluated the impact of an interdisciplinary care teams (IDCT) care management program on cost and quality outcomes using a novel algorithm to identify 400 high-risk patients out of 48,235 Medicare Advantage (MA) beneficiaries. Of the 400, 252 were enrolled in the IDCT care management intervention program, while the remaining 148 were not enrolled. A second comparison group consisted of 660 who were referred to the IDCT program but not selected by the algorithm. The program's effectiveness was evaluated 1-year postintervention. Analyses found that health care costs for members enrolled in the IDCT program were reduced by US$1,121.76 and US$1,625.61 per member per month, respectively, relative to those not enrolled and those enrolled by referral. The cost reduction from the program generated a net savings of US$1.9MM, covering the program's cost. Findings suggest IDCTs can cost-effectively manage populations of high-risk patients with better selection and fostering greater interdependence.
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Affiliation(s)
| | | | | | | | - Bisakha Sen
- The University of Alabama at Birmingham, USA
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Zheng Z, Bird SR, Layton J, Hyde A, Moreland A, Wong Lit Wan D, Stupans I. Patient engagement as a core element of translating clinical evidence into practice- application of the COM-B model behaviour change model. Disabil Rehabil 2023; 45:4517-4526. [PMID: 36476254 DOI: 10.1080/09638288.2022.2153935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The results of rehabilitation trials are often not fully attained when the intervention is implemented beyond the initial trial. One of the key reasons is that a patients' ability and/or capacity to take part in their own healthcare is not considered in the trial design yet has significant impact on the outcomes during the implementation phase. BODY OF TEXT We propose a shift from a therapist-focus to patient-focus in trial design, through addressing patient engagement as a core consideration in trials. We argue that engaging patients in any rehabilitation program is a process of behavioural change. Exercise prescription is used as an example to illustrate how the Behaviour Change Wheel can be applied to analyse barriers and facilitators associated with patients' capabilities, opportunities and motivations in integrating trial interventions into their daily life. We propose a framework to assist in this shift. CONCLUSION A core part of implementing rehabilitation interventions at the primary care level requires patient engagement. Related aspects of interventions should be identified and assessed using the COM-B model at the outset of trial design to ensure that the results are realistic, meaningful and transferable, so as to enable real impact.
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Affiliation(s)
- Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Stephen R Bird
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Jennifer Layton
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Anna Hyde
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Ash Moreland
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Dawn Wong Lit Wan
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Ieva Stupans
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
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Desse TA, Mc Namara K, Yifter H, Manias E. Current practices and future preferences of type 2 diabetes care in Ethiopia: A qualitative study on the perspectives of patients, health professionals, and policymakers. Diabetes Metab Syndr 2022; 16:102585. [PMID: 35939942 DOI: 10.1016/j.dsx.2022.102585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS This study aimed to examine perspectives of patients, health professionals, and policymakers on current practices and their future preferences for type 2 diabetes care in a tertiary hospital in Ethiopia. METHODS An exploratory qualitative study was undertaken through interviews and focus groups with patients, health professionals, and policymakers. The participants were purposively sampled. Thematic analysis was undertaken. RESULTS Fifty-nine participants were involved in the study. Participants' perspectives on current practices and future preferences comprised three themes: organisation of type 2 diabetes care delivery and infrastructure; continuity of care; and structured diabetes education. The current organisation comprised physicians, such as endocrinologists and endocrinology fellows, and nurses. Some nurses received training on diabetes foot and diabetic eye, which enabled patients to receive diabetes foot and diabetic eye care, respectively. The hospital lacked essential resources, such as medications, laboratory and diagnostic services, and diabetes educators, which hindered patient-centred care. Patients complained that the physical set-up at the hospital was not conducive to their privacy during consultations. Participants reported infrequent patient follow-up and monitoring, which contributed to uncontrolled diabetes. Future preferences involved access to essential resources and comprehensive diabetes care, such as structured diabetes education for improved patient outcomes. Participants sought out the development of tailored and context-specific diabetes management approaches that could meet specific patient needs and preferences. CONCLUSIONS The findings have implications for designing patient-centred diabetes care tailored to the hospital's context and key stakeholders' preferences. This tailoring requires strong leadership to ensure availability of essential resources.
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Affiliation(s)
- Tigestu Alemu Desse
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia; College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Kevin Mc Namara
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia; Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Helen Yifter
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
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Ndahimana D, Kim YJ, Wang CS, Kim EK. Energy cost of walking in older adults: accuracy of the ActiGraph accelerometer predictive equations. Nutr Res Pract 2022; 16:565-576. [PMID: 36238379 PMCID: PMC9523204 DOI: 10.4162/nrp.2022.16.5.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 07/12/2021] [Accepted: 11/05/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES Various accelerometer equations are used to predict energy expenditure (EE). On the other hand, the development of these equations and their validation studies have been conducted primarily without including older adults. This study assessed the accuracy of 8 ActiGraph accelerometer equations to predict the energy cost of walking in older adults. SUBJECTS/METHODS Thirty-one participants with a mean age of 74.3 ± 3.3 yrs were enrolled in this study (20 men and 11 women). The participants completed 8 walking activities, including 5 treadmill and 3 self-paced walking activities. The EE was measured using a portable indirect calorimeter, with each participant simultaneously wearing the ActiGraph accelerometer. Eight ActiGraph equations were assessed for accuracy by comparing the predicted EE with indirect calorimetry results. RESULTS All equations resulted in an overall underestimation of the EE across the activities (bias −1 to −1.8 kcal·min−1 and −0.7 to −1.8 metabolic equivalents [METs]), as well as during treadmill-based (bias −1.5 to −2.9 kcal·min−1 and −0.9 to −2.1 METs) and self-paced (bias −1.2 to −1.7 kcal·min−1 and −0.2 to −1.3 METs) walking. In addition, there were higher rates of activity intensity misclassifications, particularly among vigorous physical activities. CONCLUSIONS The ActiGraph equations underestimated the EE for walking activities in older adults. In addition, these equations inaccurately classified the activities based on their intensities. The present study suggests a need to develop ActiGraph equations specific to older adults.
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Affiliation(s)
- Didace Ndahimana
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung 25457, Korea
| | - Ye-Jin Kim
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung 25457, Korea
| | - Cui-Sang Wang
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung 25457, Korea
| | - Eun-Kyung Kim
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung 25457, Korea
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Meskarpour Amiri M, Kazemian M, Motaghed Z, Abdi Z. Systematic review of factors determining health care expenditures. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Foo CD, Surendran S, Jimenez G, Ansah JP, Matchar DB, Koh GCH. Primary Care Networks and Starfield's 4Cs: A Case for Enhanced Chronic Disease Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2926. [PMID: 33809295 PMCID: PMC8001119 DOI: 10.3390/ijerph18062926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis was conducted with data from an earlier study exploring facilitators and barriers GPs enrolled in PCN's face in chronic disease management. The objective of this study is to map features of PCN to Starfield's "4Cs" framework. The "4Cs" of primary care-comprehensiveness, first contact access, coordination and continuity-offer high-quality design options for chronic disease management. Interview transcripts of GPs (n = 30) from the original study were purposefully selected. Provision of ancillary services, manpower, a chronic disease registry and extended operating hours of GP practices demonstrated PCN's empowering features that fulfil the "4Cs". On the contrary, operational challenges such as the lack of an integrated electronic medical record and disproportionate GP payment structures limit PCNs from maximising the "4Cs". However, the enabling features mentioned above outweighs the shortfalls in all important aspects of delivering optimal chronic disease care. Therefore, even though PCN is in its early stage of development, it has shown to be well poised to steer GPs towards enhanced chronic disease management.
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Affiliation(s)
- Chuan De Foo
- Department of Health Systems and Behavioural Sciences, Saw Swee Hock School of Public Health, National University Singapore, Singapore 117549, Singapore; (S.S.); (G.C.H.K.)
| | - Shilpa Surendran
- Department of Health Systems and Behavioural Sciences, Saw Swee Hock School of Public Health, National University Singapore, Singapore 117549, Singapore; (S.S.); (G.C.H.K.)
| | - Geronimo Jimenez
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - John Pastor Ansah
- Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, Singapore 169857, Singapore; (J.P.A.); (D.B.M.)
| | - David Bruce Matchar
- Health Services and Systems Research, Duke-National University of Singapore Graduate Medical School, Singapore 169857, Singapore; (J.P.A.); (D.B.M.)
- Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Gerald Choon Huat Koh
- Department of Health Systems and Behavioural Sciences, Saw Swee Hock School of Public Health, National University Singapore, Singapore 117549, Singapore; (S.S.); (G.C.H.K.)
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Martínez-García M, Gutiérrez-Esparza GO, Roblero-Godinez JC, Marín-Pérez DV, Montes-Ruiz CL, Vallejo M, Hernández-Lemus E. Cardiovascular Risk Factors and Social Development Index. Front Cardiovasc Med 2021; 8:631747. [PMID: 33708806 PMCID: PMC7940205 DOI: 10.3389/fcvm.2021.631747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/20/2021] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular diseases (CVD) are the leading causes of morbidity and mortality worldwide. The complex etiology of CVD is known to be significantly affected by environmental and social factors. There is, however, a lag in our understanding of how population level components may be related to the onset and severity of CVD, and how some indicators of unsatisfied basic needs might be related to known risk factors. Here, we present a cross-sectional study aimed to analyze the association between cardiovascular risk factors (CVRF) and Social Development Index (SDI) in adult individuals within a metropolitan urban environment. The six components of SDI as well as socioeconomic, anthropometric, clinical, biochemical, and risk behavior parameters were explored within the study population. As a result, several CVRF (waist circumference, waist-to-height ratio, body mass index, systolic blood pressure, glucose, lower high-density lipoprotein cholesterol, triglycerides, and sodium) were found in a higher proportion in the low or very low levels of the SDI, and this pattern occurs more in women than in men. Canonical analysis indicates a correlation between other socioeconomic features and anthropometric, clinical, and biochemical factors (canonical coefficient = 0.8030). Further studies along these lines are needed to fully establish how to insert such associations into the design of health policy and interventions with a view to lessen the burden of cardiovascular diseases, particularly in metropolitan urban environments.
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Affiliation(s)
| | | | | | | | | | - Maite Vallejo
- Sociomedical Research, National Institute of Cardiology, Mexico City, Mexico
| | - Enrique Hernández-Lemus
- Computational Genomics Division, National Institute of Genomic Medicine, Mexico City, Mexico
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Arredondo A, Recamán AL, Suarez-Herrera JC, Cuadra SM. Recent trends for the management of hypertension in older adults in Latin America in the context of universal coverage: Evidence from Mexico. Int J Health Plann Manage 2020; 36:579-586. [PMID: 33368667 DOI: 10.1002/hpm.3103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 11/23/2020] [Accepted: 12/09/2020] [Indexed: 11/08/2022] Open
Abstract
Taking the Mexican case as a tracer of what is happening in Latin America on public health, we estimate the recent changes and challenges for the management of hypertension in older adults in the context of universal health coverage. The population base was 200, and 308 reported cases of older adults with hypertension. The cost-evaluation method used was based on the instrumentation and consensus technique. Regarding epidemiological changes for 2016 versus 2018, there is an increase of 21% (CI: 95%, p < 0.001). Comparing the economic impact in 2016 versus 2018 (CI: 95%, p < 0.001), the increase is 33%. The total amount estimated for hypertension in 2018 (in US dollars) was $ 1,896,520,273. It includes $ 898,064,979 as direct costs and $ 998,455,294 as indirect costs. The recent trends show that the financial requirements for the coming years do not guarantee the effectiveness of the coverage rates required for the elderly. In terms of catastrophic expenditure, the challenge is not minor, the greatest economic burden is for the pocket of patients and their families.
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Affiliation(s)
- Armando Arredondo
- Center for Health System Research, National Institute of Public Health, Cuernavaca, México
| | | | - José Carlos Suarez-Herrera
- Department of Strategy, Entrepreneurship and Sustainable Development, KEDGE Business School, Marseille, France
| | - Silvia Magali Cuadra
- Center for Health System Research-National Institute of Public Health, Cuernavaca, México
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Foo CD, Tan YL, Shrestha P, Eh KX, Ang IYH, Nurjono M, Toh SA, Shiraz F. Exploring the dimensions of patient experience for community-based care programmes in a multi-ethnic Asian context. PLoS One 2020; 15:e0242610. [PMID: 33237953 PMCID: PMC7688169 DOI: 10.1371/journal.pone.0242610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of this study is to explore patients’ experiences with community-based care programmes (CCPs) and develop dimensions of patient experience salient to community-based care in Singapore. Most countries like Singapore are transforming its healthcare system from a hospital-centric model to a person-centered community-based care model to better manage the increasing chronic disease burden resulting from an ageing population. It is thus critical to understand the impact of hospital to community transitions from the patients’ perspective. The exploration of patient experience will guide the development of an instrument for the evaluation of CCPs for quality improvement purposes. Methods A qualitative exploratory study was conducted where face-to-face in-depth interviews were conducted using a purposive sampling method with patients enrolled in CCPs. In total, 64 participants aged between 41 to 94 years were recruited. A deductive framework was developed using the Picker Patient Experience instrument to guide our analysis. Inductive coding was also conducted which resulted in emergence of new themes. Results Our findings highlighted eight key themes of patient experience: i) ensuring care continuity, ii) involvement of family, iii) access to emotional support, vi) ensuring physical comfort, v) coordination of services between providers, vi) providing patient education, vii) importance of respect for patients, and viii) healthcare financing. Conclusion Our results demonstrated that patient experience is multi-faceted, and dimensions of patient experience vary according to healthcare settings. As most patient experience frameworks were developed based on a single care setting in western populations, our findings can inform the development of a culturally relevant instrument to measure patient experience of community-based care for a multi-ethnic Asian context.
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Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- * E-mail:
| | - Yan Lin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
| | - Ke Xin Eh
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Ian Yi Han Ang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Milawaty Nurjono
- Centre for Health Services and Policy Research (CHSPR), Saw Swee Hock School of Public Health National University of Singapore, Singapore, Singapore
- Health Services Research, Changi General Hospital, Singapore Health Services, Singapore, Singapore
| | - Sue-Anne Toh
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
- Regional Health System Office, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Farah Shiraz
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
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Correr CJ, Coura-Vital W, Frade JCQP, Nascimento RCRM, Nascimento LG, Pinheiro EB, Ferreira WM, Reis JS, Melo KFS, Pontarolo R, Lenzi MSA, Almeida JV, Pedrosa HC, João WSJ. Prevalence of people at risk of developing type 2 diabetes mellitus and the involvement of community pharmacies in a national screening campaign: a pioneer action in Brazil. Diabetol Metab Syndr 2020; 12:89. [PMID: 33062060 PMCID: PMC7545923 DOI: 10.1186/s13098-020-00593-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Brazil is one of top 10 countries with the highest number of people with diabetes mellitus (DM), affecting 16.8 million peoples. It is estimated that 7.7 million people (20-79 years) in the country have not yet been diagnosed, representing an under-diagnosis rate of 46.0%. Herein we aimed to screen people for high blood glucose or risk for developing type 2 DM (T2DM) through community pharmacies in Brazil. METHODS A cross-sectional study was carried out in November 2018, involving 977 pharmacists from 345 municipalities in Brazil. The study evaluated people between 20 and 79 years old without a previous diagnosis of DM. Glycemia was considered high when its value was ≥ 100 mg/dL fasting and ≥ 140 mg/dL in a casual feeding state. The FINDRISC (Finnish Diabetes Risk Score) was used to estimate the risk for developing T2DM. The prevalence of high blood glucose was estimated and the associated factors were obtained using Poisson's multivariate analysis with robust variance. RESULTS During the national screening campaign, 17,580 people were tested with the majority of the consultations (78.2%) being carried out in private pharmacies. The population was composed mainly of women (59.5%) and people aged between 20 and 45 years (47.9%). The frequency of participants with high blood glucose was 18.4% (95% CI 17.9-19.0). Considering the FINDRISC, 22.7% of people had a high or very high risk for T2DM. The risk factors associated with high blood glucose were: Body Mass Index > 25 kg/m2, abdominal circumference > 94 cm for men and > 80 cm for women; education level below 15 years of study, no daily intake of vegetables and fruits; previous diagnosis of arterial hypertension; history of high blood glucose and family history of DM. CONCLUSIONS This is the largest screening study that evaluated the frequency of high blood glucose and its associated factors in a population without a previous diagnosis ever performed in community pharmacies in Brazil. These results may help to improve public health policies and reinforce the role of pharmacists in screening and education actions aimed at this undiagnosed population in a continent-size country such as Brazil.
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Affiliation(s)
- Cassyano J. Correr
- Departamento de Farmácia, Universidade Federal do Paraná, Curitiba, Paraná Brazil
| | - Wendel Coura-Vital
- Programa de Pós Graduação em Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais Brazil
| | | | - Renata C. R. M. Nascimento
- Programa de Pós Graduação em Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais Brazil
| | - Lúbia G. Nascimento
- Programa de Pós Graduação em Ciências Farmacêuticas, Escola de Farmácia, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais Brazil
| | | | | | - Janice S. Reis
- Sociedade Brasileira de Diabetes, Ensino e Pesquisa da Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais Brazil
| | - Karla F. S. Melo
- Sociedade Brasileira de Diabetes, Equipe de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Pontarolo
- Departamento de Farmácia, Universidade Federal do Paraná, Curitiba, Paraná Brazil
| | | | - José V. Almeida
- Conselho Federal de Farmácia, Brasília, Distrito Federal Brazil
| | - Hermelinda C. Pedrosa
- Sociedade Brasileira de Diabetes, São Paulo, Brazil
- Secretaria de Estado da Saúde, Polo de Pesquisa da Unidade de Endocrinologia FEPECS-HRT, Brasília, Distrito Federal Brazil
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Jacob VYP, Felber J, Müller N, Kloos C, Müller UA, Stallmach A. The High-Resolution Three-Dimensional Magnetic Detector System 3D-Magma Accurately Measures Gastric and Small Bowel Motility in People with Type 2 Diabetes with Neuropathy. Exp Clin Endocrinol Diabetes 2020; 130:94-100. [PMID: 32557505 DOI: 10.1055/a-1163-7230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Gastroparesis is an important complication of diabetes. Motility disorders are underdiagnosed and can lead to unexplained hypoglycemia. Currently diagnostic options are limited. All established methods harbor certain disadvantages. The 3D-MAGMA system is capable of reliably measuring gastric and small intestinal motility. The aim of the current study was to determine if 3D-MAGMA is able to detect changes in intestinal motility in people with type 2 diabetes. 18 healthy volunteers and 19 people with type 2 diabetes underwent motility testing by 3D-MAGMA. In the control group the retention time in the stomach was 33.0 [min] compared to 75.3 [min] in the diabetes group. The median time in the duodenum was 12.7 [min] compared to 8.1 [min]. The time for the first 50 cm of the jejunum was 29.9 [min] compared to 28.2 [min]. Discussion and conclusion: 3D-MAGMA is able to detect changes in intestinal motility. Its clinical value might be useful in patients with fluctuating blood glucose levels and unexplained hypoglycemic episodes.
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Affiliation(s)
- Veit Yves Pascal Jacob
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Jörg Felber
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Nicolle Müller
- Department of Internal Medicine III Endocrinology and Metabolic Diseases, Jena University Hospital, Jena, Germany
| | - Christof Kloos
- Department of Internal Medicine III Endocrinology and Metabolic Diseases, Jena University Hospital, Jena, Germany
| | - Ulrich Alfons Müller
- Department of Internal Medicine III Endocrinology and Metabolic Diseases, Jena University Hospital, Jena, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Jena, Germany
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MIRZAEI H, ABDI Z, AHMADNEZHAD E, GOHRIMEHR M, ABDALMALEKI E, ALVANDI R, HARIRCHI I. Health Status in the Islamic Republic of Iran, Middle East and North Africa Countries: Implications for Global Health. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:86-95. [PMID: 32309227 PMCID: PMC7152645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the health status of the Iranians following the sustainable development goals' (SDGs) introduction and the recent health reform implementation in Iran and to compare with those of the Middle East and North Africa region (MENA) and global average. METHODS This comparative study used secondary data to investigate socio-demographic and health status indicators. The sources included census, population-based surveys and death registries. Global and regional health status indicators were obtained from international databases including WHO, the World Bank and the Institute for Health Metric and Evaluation (IHME). RESULTS Life expectancy and human development index improved following the reform implementation. Among causes of death, 74.6% were attributed to non-communicable diseases (NCDs). There was an increasing trend in risk factors for NCDs in Iran, while at the same time neonatal, infant and under-5 mortality rates reduced. Compared to the MENA, Iran has a lower maternal mortality ratio, neonatal, infant, and under-5 mortality rates, and a higher life expectancy. NCDs and road traffic injuries accounted for a larger portion of disability-adjusted life years in Iran compared to the MENA and worldwide. CONCLUSION Actions against communicable diseases and road traffic injuries are required together with continued efforts to address NCDs. Although based on the results, Iran has relatively high rankings, there is a need to develop a roadmap to accelerate achieving global health goals and SDGs targets.
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Affiliation(s)
- Hossein MIRZAEI
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Zhaleh ABDI
- National Institute for Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Elham AHMADNEZHAD
- National Institute for Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
| | - Mahshad GOHRIMEHR
- National Institute for Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Elham ABDALMALEKI
- National Institute for Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Rezvaneh ALVANDI
- National Institute for Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj HARIRCHI
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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15
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Ndahimana D, Go NY, Ishikawa-Takata K, Park J, Kim EK. Validity of the dietary reference intakes for determining energy requirements in older adults. Nutr Res Pract 2019; 13:256-262. [PMID: 31214294 PMCID: PMC6548704 DOI: 10.4162/nrp.2019.13.3.256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/10/2019] [Accepted: 05/23/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/OBJECTIVES The objectives of this study were to evaluate the accuracy of the Dietary Reference Intakes (DRI) for estimating the energy requirements of older adults, and to develop and validate new equations for predicting the energy requirements of this population group. MATERIALS/METHODS The study subjects were 25 men and 23 women with a mean age of 72.2 ± 3.9 years and 70.0 ± 3.3 years, and mean BMI of 24.0 ± 2.1 and 23.9 ± 2.7, respectively. The total energy expenditure (TEE) was measured by using the doubly labeled water (DLW) method, and used to validate the DRI predictive equations for estimated energy requirements (EER) and to develop new EER predictive equations. These developed equations were cross-validated by using the leave-one-out technique. RESULTS In men, the DRI equation had a -7.2% bias and accurately predicted the EER (meaning EER values within ±10% of the measured TEE) for 64% of the subjects, whereas our developed equation had a bias of -0.1% and an accuracy rate of 84%. In women, the bias was -6.6% for the DRI equation and 0.2% for our developed equation, and the accuracy rate was 74% and 83%, respectively. The predicted EER was strongly correlated with the measured TEE, for both the DRI equations and our developed equations (Pearson's r = 0.915 and 0.908, respectively). CONCLUSIONS The DRI equations provided an acceptable prediction of EER in older adults and these study results therefore support the use of these equations in this population group. Our developed equations had a better predictive accuracy than the DRI equations, but more studies need to be performed to assess the performance of these new equations when applied to an independent sample of older adults.
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Affiliation(s)
- Didace Ndahimana
- Department of Food and Nutrition, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung 25457, Korea
| | - Na-Young Go
- Department of Food and Nutrition, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung 25457, Korea
| | - Kazuko Ishikawa-Takata
- Department of Nutrition and Metabolism, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan
| | - Jonghoon Park
- Department of Physical Education, Korea University, 145 Anam-Ro, Seongbuk-Gu, Seoul 02841, Korea
| | - Eun-Kyung Kim
- Department of Food and Nutrition, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung 25457, Korea
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Alhuwail D. Understanding health information management practices in public hospitals in Kuwait. Health Inf Manag 2019; 49:127-136. [PMID: 30894029 DOI: 10.1177/1833358319837247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Health information technology (IT) solutions can aid healthcare reform efforts, but without proper information management, these efforts are futile. In this study, we used Kuwait as an example of a high per-capita gross domestic product country that faces information management challenges to draw insights that can be generalised to other developed countries. OBJECTIVE (i) to uncover the status quo of information management practices in public hospitals and (ii) to offer recommendations to improve them. METHOD This study analysed qualitative and quantitative accreditation-related data pertaining to the compliance with the information management standard at all secondary care public hospitals over two accreditation cycles. RESULTS Overall, public hospitals had made positive progress in their compliance with the information management standard. However, issues still existed with (i) developing and implementing an information management plan, (ii) involving the appropriate stakeholders in selecting health IT solutions and (iii) access to the Internet by staff and patients. CONCLUSION Evidence underscored the importance of proper information management driven by clear centralised strategic plans. IMPLICATIONS With the rapid adoption of digital health systems, the role of health information management leaders should not be undervalued. Embracing health IT solutions with strong information management practices can aid healthcare reform efforts.
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Affiliation(s)
- Dari Alhuwail
- Kuwait University, Kuwait; Dasman Diabetes Institute, Kuwait
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17
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Unar‐Munguía M, Stern D, Colchero MA, González de Cosío T. The burden of suboptimal breastfeeding in Mexico: Maternal health outcomes and costs. MATERNAL & CHILD NUTRITION 2019; 15:e12661. [PMID: 30136370 PMCID: PMC7199088 DOI: 10.1111/mcn.12661] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/21/2022]
Abstract
Longer duration of breastfeeding is associated with a lower risk of type 2 diabetes, breast and ovarian cancer, myocardial infarction, and hypertension diseases in women. Mexico has one of the lowest breastfeeding rates worldwide; therefore, estimating the disease and economic burden of such rates is needed to influence public policy. We considered suboptimal breastfeeding when fewer than 95% of parous women breastfeed for less than 24 months per child, according to the World Health Organization recommendations. We quantified the lifetime excess cases of maternal health outcomes, premature death, disability-adjusted life years, direct costs, and indirect costs attributable to suboptimal breastfeeding practices from Mexico in 2012. We used a static microsimulation model for a hypothetical cohort of 100,000 Mexican women to estimate the lifetime economic cost and disease burden of type 2 diabetes, breast and ovarian cancer, myocardial infarction, and hypertension in mothers, due to suboptimal breastfeeding, compared with an optimal scenario of 95% of parous women breastfeeding for 24 months. We expressed cost in 2016 USD. We used a 3% discount rate and tested in sensitivity analysis 0% and 5% discount rates. We found that the 2012 suboptimal scenario was associated with 5,344 more cases of all analysed diseases, 1,681 additional premature deaths, 66,873 disability-adjusted life years, and 561.94 million USD for direct and indirect costs over the lifetime of a cohort of 1,116 million Mexican women. Findings suggest that investments in strategies to enable more women to optimally breastfeed could result in important health and cost savings.
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Affiliation(s)
- Mishel Unar‐Munguía
- Center for Research on Health and NutritionNational Institute of Public HealthCuernavacaMorelosMexico
| | - Dalia Stern
- CONACYT—Center for Research on Population HealthNational Institute of Public HealthCuernavacaMorelosMexico
| | - Monica Arantxa Colchero
- Center for Health Systems ResearchNational Institute of Public HealthCuernavacaMorelosMexico
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18
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Casariego E, Cebrián-Cuenca AM, Llisterri JL, Micó-Pérez RM, Orozco-Beltran D, Otero-Cacabelos M, Román-Sánchez P, Sáez FJ. OPENCRONIC Study. Knowledge and Experiences of Spanish Patients and Carers about Chronic Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010039. [PMID: 30586925 PMCID: PMC6339193 DOI: 10.3390/ijerph16010039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 11/16/2022]
Abstract
Background: Chronic diseases are currently the main cause of morbidity and mortality and represent a major challenge to healthcare systems. The objective of this study is to know Spanish public opinion about chronic disease and how it affects their daily lives. Methods: Through a telephone or online survey of 24 questions, data was gathered on the characteristics of the respondents and their knowledge and experiences of chronic diseases. Results: Of the 2522 survey respondents, 325 had a chronic disease and were carers, 1088 had a chronic disease and were not carers, 140 did not have a chronic disease but were carers, and 969 did not have chronic disease and were not carers. The degree of knowledge on these diseases was good or very good for 69.4%, 56.0%, 62.2%, and 46.7%, respectively, for each group. All the groups agreed that chronic diseases mainly affect mood, quality of life and having to make sacrifices. Conclusions: Knowledge about chronic diseases is relatively good, although it can be improved among the Spanish population, especially among patients who report having a chronic disease and play the role of carers. However, it is important to continue maintaining the level of information and training concerning these diseases.
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Affiliation(s)
- Emilio Casariego
- Internal Medicine Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain.
| | | | | | | | - Domingo Orozco-Beltran
- Research Unit, Alicante-Sant Joan D'Alacant Department, Cabo Huertas Health Centre, 03540 Alicante, Spain.
| | | | - Pilar Román-Sánchez
- Internal Medicine Department, Hospital General de Requena, Requena, 46340 Valencia, Spain.
| | - Francisco José Sáez
- Primary Care Management Department of the Madrid Health Service, 28035 Madrid, Spain.
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19
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Arredondo A, Azar A, Recaman AL. Challenges and dilemmas on universal coverage for non-communicable diseases in middle-income countries: evidence and lessons from Mexico. Global Health 2018; 14:89. [PMID: 30143010 PMCID: PMC6109335 DOI: 10.1186/s12992-018-0404-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite more than 20 years of reform projects in health systems, the universal coverage strategy has not reached the expected results in most middle-income countries (MICs). Using evidence from the Mexican case on diabetes and hypertension as tracers of non-communicable diseases, the effective coverage rate barely surpasses half of the expected goals necessary to meet the challenges that these two diseases represent at the population level. Prevalence and incidence rates do not diminish either; they even grow. In terms of the economic burden, this means that lack of financial protection and catastrophic expense rates have increased, contrary to what could have been expected. DISCUSSION As any complex system, health systems present challenges and dilemmas that are difficult to solve. In terms of universal coverage, when contrasting normative coverage versus effective coverage, the epidemiological, cultural, organizational and economic challenges and barriers become evident. Such challenges have not allowed a greater effectiveness of the contributions of state of the art medicine in the resolution of health problems, particularly in relation to diabetes and hypertension. CONCLUSIONS Despite of the existence of many universal coverage projects, strategies and programs implemented in MICs, challenges remain and, far from disappearing, unresolved problems are still present, even with increasing trends. The model of care based on a curative biomedical approach was enough to respond to the health needs of the last century, but is no longer adapted to the needs of the present century. The dilemmas of continuity vs. rupture require to review and discuss the background and structure of health systems and their underlying models of care. These two elements have not allowed the different coverage schemes to guarantee greater effectiveness in the application of state of the art medicine, nor a greater health care financial protection for patients and their families. We thus can either accept the fragmented health systems and bio-medical-curative models of care approach or, instead, we can move towards integrated health systems that would be based on a socio-medical-preventive approach to health care.
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Affiliation(s)
- Armando Arredondo
- National Institute of Public Health-Mexico, Av Universidad 655, Col., Sta Maria Ahuacatitlan, CP 62508 Cuernavaca, Mexico
| | - Alejandra Azar
- National Institute of Public Health-Mexico, Av Universidad 655, Col., Sta Maria Ahuacatitlan, CP 62508 Cuernavaca, Mexico
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20
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Barradas-Bautista D, Alvarado-Mentado M, Agostino M, Cocho G. Cancer growth and metastasis as a metaphor of Go gaming: An Ising model approach. PLoS One 2018; 13:e0195654. [PMID: 29718932 PMCID: PMC5931478 DOI: 10.1371/journal.pone.0195654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/27/2018] [Indexed: 01/03/2023] Open
Abstract
This work aims for modeling and simulating the metastasis of cancer, via the analogy between the cancer process and the board game Go. In the game of Go, black stones that play first could correspond to a metaphor of the birth, growth, and metastasis of cancer. Moreover, playing white stones on the second turn could correspond the inhibition of cancer invasion. Mathematical modeling and algorithmic simulation of Go may therefore benefit the efforts to deploy therapies to surpass cancer illness by providing insight into the cellular growth and expansion over a tissue area. We use the Ising Hamiltonian, that models the energy exchange in interacting particles, for modeling the cancer dynamics. Parameters in the energy function refer the biochemical elements that induce cancer birth, growth, and metastasis; as well as the biochemical immune system process of defense.
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Affiliation(s)
| | | | - Mark Agostino
- Curtin Health Innovation Research Institute and Curtin Institute Computation, Curtin University, Perth, Australia
| | - Germinal Cocho
- Complex Sciences Center, UNAM, Mexico City, Mexico.,Physics Institute, UNAM, Mexico City, Mexico
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21
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Salas-Zapata L, Palacio-Mejía LS, Aracena-Genao B, Hernández-Ávila JE, Nieto-López ES. Costos directos de las hospitalizaciones por diabetes mellitus en el Instituto Mexicano del Seguro Social. GACETA SANITARIA 2018; 32:209-215. [PMID: 27495830 DOI: 10.1016/j.gaceta.2016.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/04/2016] [Accepted: 06/14/2016] [Indexed: 11/25/2022]
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Arredondo A, Recaman AL, Pinzon C, Azar A. Financial consequences from smoking‐related diseases in middle‐income countries: Evidence and lessons from Mexico. Int J Health Plann Manage 2018; 33:e454-e463. [DOI: 10.1002/hpm.2487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- Armando Arredondo
- Health System DepartmentNational Institute of Public Health Cuernavaca Mexico
| | | | - Carlos Pinzon
- Public Health DepartmentUniversity of La Sabana Chía Colombia
| | - Alejandra Azar
- Health System DepartmentNational Institute of Public Health Cuernavaca Mexico
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23
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Arredondo A, Díaz-Castro L, Cabello-Rangel H, Arredondo P, Recaman AL. [Cost analyses of medical care for schizophrenia and depression in México, 2005-2013]. CAD SAUDE PUBLICA 2018; 34:e00165816. [PMID: 29412321 DOI: 10.1590/0102-311x00165816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 06/13/2017] [Indexed: 11/21/2022] Open
Abstract
The study aimed to analyze the costs of medical care for mental disorders in the Mexican health system. This was a retrospective cross-sectional evaluation study. As markers for the problem, the study selected two of the principal psychological processes in mental disorders in recent years: depression and schizophrenia. Annual accumulated incidence was identified based on epidemiological reporting by type of institution in 2005-2013. The mean annual case management cost was determined with the instrumentation and consensus technique, identifying the production functions, types of inputs, costs, and amounts of inputs ordered, concentrated in the mean case matrix. Finally, an econometric adjustment factor was applied to control the inflationary effect for each year in the study period. Mean annual case management cost was USD 2,216.00 for schizophrenia and USD 2,456.00 for depression. All the institutions in the Mexican health system showed upward and constant epidemiological and economic trends. The total cost for the two disorders in the last year of the period (2013) was USD 39,081,234.00 (USD 18,119,877.00 for schizophrenia and USD 20,961,357.00 for depression). The largest impact for the two disorders combined was in institutions serving the population without health insurance (USD 24,852,321.00) versus the population with private insurance (USD 12,891,977.00). The cost of meeting the demand for services for the two disorders differs considerably between institutions that treat the population with private health service versus the population without, and is higher in the latter. The study's epidemiological and economic indicators provide evidence for decision-making in the use and allocation of healthcare resources for these two disorders in the coming years.
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Alcalde-Rabanal JE, Orozco-Núñez E, Espinosa-Henao OE, Arredondo-López A, Alcayde-Barranco L. The complex scenario of obesity, diabetes and hypertension in the area of influence of primary healthcare facilities in Mexico. PLoS One 2018; 13:e0187028. [PMID: 29370171 PMCID: PMC5784882 DOI: 10.1371/journal.pone.0187028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 10/12/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Among non-communicable chronic diseases (NCCD), diabetes and hypertension are the main cause of adult mortality worldwide. Among the members of the Organization for Economic Cooperation and Development, Mexico is first in prevalence of diabetes and second in obesity. To face this problematic situation of NCCDs the Ministry of Health declared a national epidemiological alert against the overweight, obesity and diabetes. The target of this study is to characterize the status of obesity, diabetes and hypertension in the adult population in the area of influence of primary health facilities located in high social marginality areas. METHODS We conducted a cross-sectional observational study and used a convenience sample. A survey was conducted on a population of 18 years old and above in four primary health facilities in four Mexican States. The survey explored sociodemographic characteristics, the presence of chronic diseases, the access to healthcare services, risk factors and life styles. We also applied a complementary questionnaire to 20% of the participants, in order to explore food consumption during the last week and physical activity (International Physical Activity Questionnaire). We based our analysis on descriptive statistics and logistic multivariate regression to analyze factors associated with diabetes and hypertension. RESULTS 73% (n = 7531, CI 0.72-0.74) percent of the population reported being diabetic, hypertensive and/or overweight. The majority of them receive healthcare in public health services. People over 40 years old, are 11 times more probable of living with diabetes and 8.7 times more probable of living with hypertension. Both conditions affect mostly women, whose main activity is to be a housewife. People who have lunch and dinner out of home are more likely to develop diabetes. People who perform intense physical activity are less likely to live with hypertension. CONCLUSION According to the self-report, more than 70% of adult population living in areas with high social marginality suffer diabetes, hypertension and obesity. However, the percentage of people who live with these chronic conditions and are not aware of them, is unknown. The Mexican health system needs a primary healthcare that emphasizes on health promotion, timely detection of risk factors of Non Communicable Diseases and prevention of their complications.
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Affiliation(s)
- J. E. Alcalde-Rabanal
- Center for Health System Research / National Institute of Public Health. Cuernavaca, México
| | - E. Orozco-Núñez
- Center for Health System Research / National Institute of Public Health. Cuernavaca, México
| | - O. E. Espinosa-Henao
- Center for Health System Research / National Institute of Public Health. Cuernavaca, México
| | - A. Arredondo-López
- Center for Health System Research / National Institute of Public Health. Cuernavaca, México
| | - L. Alcayde-Barranco
- Center for Health System Research / National Institute of Public Health. Cuernavaca, México
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Palumbo R. Examining the impacts of health literacy on healthcare costs. An evidence synthesis. Health Serv Manage Res 2017; 30:197-212. [PMID: 29034727 DOI: 10.1177/0951484817733366] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Scholars and practitioners share a significant concern about rising healthcare costs. Health literacy is widely presented as a solution to this momentous issue, paving the way for a more appropriate access to care and therefore, for cost savings. However, to date little is still known about the ultimate effects of better health literacy on healthcare costs. Drawing from the findings of a systematic literature review which ultimately involved 29 papers retrieved from Scopus-Elsevier and PubMed. This manuscript is aimed at shedding light on the relationship between health literacy and healthcare costs. The inadequate ability of patients to understand health information and to navigate the healthcare system was found to be an important predictor of inappropriateness in the access to health care. In addition, people living with problematic health literacy are discouraged to be engaged in the provision of health services and are expected to show poor self-efficacy in dealing with their health-related conditions. From this point of view, poor health literate patients are assumed to be at high risk of exacerbation of their health problems, which in turn contributes in rising healthcare costs. In spite of these findings, both policy makers and practitioners seem to overlook the importance of health literacy. Eventually, the joint intervention on laws, policies, organizational strategies, and practices is crucial to handle the challenges related to limited health literacy.
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Arredondo A. Changing paradigms and challenges: evidence on the epidemiological and economic burden of diabetes in Latin America. Diabet Med 2017; 34:1009-1010. [PMID: 28004431 DOI: 10.1111/dme.13311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/02/2016] [Accepted: 12/19/2016] [Indexed: 12/12/2022]
Affiliation(s)
- A Arredondo
- National Institute of Public Health, Cuernavaca, Mexico
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27
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Arredondo A, Azar A, Recamán AL. Diabetes, a global public health challenge with a high epidemiological and economic burden on health systems in Latin America. Glob Public Health 2017; 13:780-787. [PMID: 28447537 DOI: 10.1080/17441692.2017.1316414] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This manuscript presents the results of an analysis that highlights the challenges of diabetes as a global public health problem. The analysis was conducted in two phases: the first phase deals with primary data and results of a longitudinal study to provide evidence on the Mexican case. Regarding epidemiological changes between 2014 and 2016, there is an increase of 9-13% (p < .001). Comparing the economic burden from epidemiological changes in 2014 versus 2016 (p < .05), there is a 26% increase. The total amount spent on diabetes in 2015 (US dollars) was $ 8,974,662,570. This includes $ 3,981,426,810 in direct costs and $ 4993,235,752 in indirect costs. The second phase emphasises the analysis of diabetes as a major global public health challenge in the Americas. For this purpose a comparative analysis of epidemiological trends was carried out in seven selected Latin American countries (LACs). The results of both phases showed evidence leading to the conclusion that if the risk factors and models of health care remain as they currently are in LACs, there will be a high economic impact to patients' pockets and to health systems, which could lead to financial collapse.
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Affiliation(s)
| | - Alejandra Azar
- a National Institute of Public Health , Cuernavaca , Mexico
| | - Ana Lucía Recamán
- b Department of Management and Marketing , La Salle University , Cuernavaca , Mexico
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Mendoza W, Miranda JJ. Global Shifts in Cardiovascular Disease, the Epidemiologic Transition, and Other Contributing Factors: Toward a New Practice of Global Health Cardiology. Cardiol Clin 2017; 35:1-12. [PMID: 27886780 DOI: 10.1016/j.ccl.2016.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One of the major drivers of change in the practice of cardiology is population change. This article discusses the current debate about epidemiologic transition paired with other ongoing transitions with direct relevance to cardiovascular conditions. Challenges specific to patterns of risk factors over time; readiness for disease surveillance and meeting global targets; health system, prevention, and treatment efforts; and physiologic traits and human-environment interactions are identified. This article concludes that a focus on the most populated regions of the world will contribute substantially to protecting the large gains in global survival and life expectancy accrued over the last decades.
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Affiliation(s)
- Walter Mendoza
- United Nations Population Fund, Peru Country Office, Av. Guardia Civil 1231, San Isidro, Lima 27, Peru
| | - J Jaime Miranda
- School of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres, Lima 31, Peru; CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru.
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Low-grade albuminuria and incidence of cardiovascular disease and all-cause mortality in nondiabetic and normotensive individuals. J Hypertens 2016; 34:506-12; discussion 512. [PMID: 26820477 DOI: 10.1097/hjh.0000000000000809] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies indicate that, in people with diabetes or hypertension and in the general population, low-grade albuminuria (LGA) below the microalbuminuria threshold is a predictor for incidence of cardiovascular disease (CVD) and mortality. However, it remains unclear whether LGA predicts the risk of CVD incidence and death in nondiabetic and normotensive individuals. METHODS A total of 3599 individuals aged not less than 40 years from the general population who are free of CVD in nondiabetic and normotensive individuals with preserved glomerular filtration rate were followed for CVD incidence and all-cause death. LGA was defined as urinary albumin to creatinine ratio (UACR) less than 30 mg/g. It was examined whether there is an association between LGA and CVD incidence or all-cause death. RESULTS During the average 5.9 years of follow-up, 61 individuals had first CVD events, and 85 individuals died. The hazard ratios (HRs) for CVD incidence and all-cause death after full adjustment by potential confounders increased significantly in the top tertile of LGA (UACR ≥ 9.6 mg/g for men, ≥ 12.0 mg/g for women) compared with the first tertile [HR = 2.79, 95% confidence interval (CI), 1.41-5.52, HR = 1.69, 95% CI, 1.00-2.84, respectively]. Population-attributable fractions of the top tertile of LGA for CVD incidence and all-cause death were 37.9 and 20.1%, respectively. CONCLUSION In apparently healthy individuals with optimal blood pressure and no diabetes, LGA independently predicts CVD incidence and all-cause death, particularly with the large contribution to the excessive incidence of CVD.
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Ski CF, Thompson DR, Castle DJ. Trialling of an optimal health programme (OHP) across chronic disease. Trials 2016; 17:445. [PMID: 27612634 PMCID: PMC5018188 DOI: 10.1186/s13063-016-1560-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 08/20/2016] [Indexed: 11/11/2022] Open
Abstract
Population ageing is a worldwide phenomenon, most advanced in developed countries and expected to continue over the next few decades. As people are surviving longer with age-associated disease and disability, there is an imperative to identify innovative solutions for an already overburdened health care system. Such innovations need to be focused on disease management, taking into consideration the strong associations that have been established between psychosocial factors and pathophysiological mechanisms associated with chronic disease. Aside from personal and community costs, chronic diseases produce a significant economic burden due to the culmination of health care costs and lost productivity. This commentary reports on a programme of research, Translating Research, Integrated Public Health Outcomes and Delivery, which will evaluate an optimal health programme that adopts a person-centred approach and engages collaborative therapy to educate, support and improve the psychosocial health of those with chronic disease. The effectiveness of the optimal health programme will be evaluated across three of the most significant contributors to disease burden: diabetes mellitus, chronic kidney disease and stroke. Cost-effectiveness will also be evaluated. The findings derived from this series of randomised controlled trials will also provide evidence attesting to the potential applicability of the optimal health programme in other chronic conditions.
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Affiliation(s)
- Chantal F Ski
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, VIC, 3000, Australia. .,Department of Psychiatry, University of Melbourne, Melbourne, VIC, 3010, Australia. .,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia.
| | - David R Thompson
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, VIC, 3000, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - David J Castle
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, VIC, 3000, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, 3010, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
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31
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Murillo-Zamora E, García-Ceballos R, Delgado-Enciso I, Garza-Guajardo R, Barboza-Quintana O, Rodríguez-Sánchez IP, Mendoza-Cano O. Regional-level estimation of expected years of life lost attributable to overweight and obesity among Mexican adults. Glob Health Action 2016; 9:31642. [PMID: 27606969 PMCID: PMC5015640 DOI: 10.3402/gha.v9.31642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/07/2016] [Accepted: 07/15/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excess body weight has become a major public health problem worldwide, and the burden of overweight and obesity was calculated in this work from a health economics perspective. OBJECTIVE To estimate the burden of disease attributable to overweight and obesity among males and females aged 20 years and older using years of life lost (YLL) and age-standardized YLL rates (ASYLL), and to rank the leading causes of premature death. DESIGN A cross-sectional study took place (2010-2014) and 6,054 deaths were analyzed. Thirteen basic causes of death associated with overweight or obesity were included. The population attributable fraction (PAF), YLL, and ASYLL were calculated. RESULTS The overall burden attributable to overweight and obesity was 36,087 YLL, and the estimated ASYLL per 10,000 persons was 1,098 and 1,029 in males and females, respectively. Type 2 diabetes mellitus was the main cause of premature death (males, 968 ASYLL; females, 772 ASYLL). CONCLUSIONS Overweight and obesity are major risk factors of chronic diseases that are main causes of premature death in the study population. Strategies for preventing overweight and obesity may decrease the incidence and mortality associated with these non-communicable diseases. ASYLL seems to be an indicator that is particularly well adapted to decision-making in public health.
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Affiliation(s)
- Efrén Murillo-Zamora
- Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima, México
| | - Raúl García-Ceballos
- Coordinación de Vigilancia Epidemiológica, Servicios de Salud del Estado de Colima, Colima, México
| | - Iván Delgado-Enciso
- Facultad de Medicina, Universidad de Colima, Colima, México
- Instituto Estatal de Cancerología, Servicios de Salud del Estado de Colima, Colima, México
| | - Raquel Garza-Guajardo
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "José Eleuterio González", Servicio de Anatomía Patológica y Citopatología, Monterrey, Nuevo León, México
| | - Oralia Barboza-Quintana
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "José Eleuterio González", Servicio de Anatomía Patológica y Citopatología, Monterrey, Nuevo León, México
| | - Irám P Rodríguez-Sánchez
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "José Eleuterio González", Departamento de Genética, Monterrey, Nuevo León, México
| | - Oliver Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, Colima, México
- Center for Health and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, MA, USA; ,
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Wall-Medrano A, Ramos-Jiménez A, Hernandez-Torres RP, Villalobos-Molina R, Tapia-Pancardo DC, Jiménez-Flores JR, Méndez-Cruz AR, Murguía-Romero M, Gallardo-Ortíz IA, Urquídez-Romero R. Cardiometabolic risk in young adults from northern Mexico: Revisiting body mass index and waist-circumference as predictors. BMC Public Health 2016; 16:236. [PMID: 26956639 PMCID: PMC4782332 DOI: 10.1186/s12889-016-2896-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/19/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A body mass index (BMI) ≥30 kg/m(2) and a waist circumference (WC) ≥80 cm in women (WCF) or ≥90 cm in men (WCM) are reference cardiometabolic risk markers (CMM) for Mexicans adults. However, their reliability to predict other CMM (index tests) in young Mexicans has not been studied in depth. METHODS A cross-sectional descriptive study evaluating several anthropometric, physiological and biochemical CMM from 295 young Mexicans was performed. Sensitivity (Se), specificity (Sp) and Youden's index (J) of reference BMI/WC cutoffs toward other CMM (n = 14) were obtained and their most reliable cutoffs were further calculated at Jmax. RESULTS Prevalence, incidence and magnitude of most CMM increased along the BMI range (p < 0.01). BMI explained 81 % of WC's variance [Se (97 %), Sp (71 %), J (68 %), Jmax (86 %), BMI = 30 kg/m(2)] and 4-50 % of other CMM. The five most prevalent (≥71 %) CMM in obese subjects were high WC, low HDL-C, and three insulin-related CMM [Fasting insulin, HOMA-IR, and QUICKI]. For a BMI = 30 kg/m(2), J ranged from 16 % (HDL-C/LDL-C) to 68 % (WC), being moderately reliable (Jmax = 61-67) to predict high uric acid (UA), metabolic syndrome (MetS) and the hypertriglyceridemic-waist phenotype (HTGW). Corrected WCM/WCF were moderate-highly reliable (Jmax = 66-90) to predict HTGW, MetS, fasting glucose and UA. Most CMM were moderate-highly predicted at 27 ± 3 kg/m(2) (CI 95 %, 25-28), 85 ± 5 cm (CI 95 %, 82-88) and 81 ± 6cm (CI 95 %, 75-87), for BMI, WCM and WCF, respectively. CONCLUSION BMI and WC are good predictors of several CMM in the studied population, although at different cutoffs than current reference values.
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Affiliation(s)
- Abraham Wall-Medrano
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Anillo Envolvente del Pronaf y Estocolmo, Ciudad Juárez, 32300, Chihuahua, México.
| | - Arnulfo Ramos-Jiménez
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Anillo Envolvente del Pronaf y Estocolmo, Ciudad Juárez, 32300, Chihuahua, México.
| | - Rosa P Hernandez-Torres
- Facultad de Ciencias de la Cultura Física, Universidad Autónoma de Chihuahua, Chihuahua, México.
| | - Rafael Villalobos-Molina
- Unidad de Biomedicina, Universidad Nacional Autónoma de México, Tlalnepantla, México.
- Laboratorio Nacional en Salud: Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-Degenerativas, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México.
| | | | - J Rafael Jiménez-Flores
- Unidad de Biomedicina, Universidad Nacional Autónoma de México, Tlalnepantla, México.
- Laboratorio Nacional en Salud: Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-Degenerativas, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México.
| | - A René Méndez-Cruz
- Unidad de Biomedicina, Universidad Nacional Autónoma de México, Tlalnepantla, México.
- Laboratorio Nacional en Salud: Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-Degenerativas, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México.
| | - Miguel Murguía-Romero
- Unidad de Biomedicina, Universidad Nacional Autónoma de México, Tlalnepantla, México.
- Laboratorio Nacional en Salud: Diagnóstico Molecular y Efecto Ambiental en Enfermedades Crónico-Degenerativas, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México.
| | | | - René Urquídez-Romero
- Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Anillo Envolvente del Pronaf y Estocolmo, Ciudad Juárez, 32300, Chihuahua, México.
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