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Alcalde-Rabanal JE, Flores-Loera Y, Chivardi C, Ruelas-González MG, Macías N, González-Robledo MC. Evaluation of Health Promotion Program at the Community Level in Mexico: Is the Program Efficient and Effective? J Public Health Manag Pract 2023; 29:654-662. [PMID: 37097184 DOI: 10.1097/phh.0000000000001741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
CONTEXT Health promotion programs have been encouraged in the Americas since 1990. In Mexico, health program promotion at the community level was implemented by the Ministry of Health in 2001 to encourage community health status improvement. Despite the longtime of its implementation, evaluations of its efficiency and effectiveness are scarce. OBJECTIVE To evaluate the efficiency of the Healthy Environments and Communities Program (HECP) through 2 means: (1) efficiency of the implementation and (2) technical efficiency, as well as to evaluate its effectiveness. SETTING Target communities of the HECP of 32 Mexican states during 2013-2017. The HECP developed community interventions to improve community organization, health behaviors, and family and communitarian sanitation. METHODOLOGY We conducted a cross-sectional study to evaluate the efficiency of HECP implementation and estimated the inclusion of target communities (focalization index), the retention of communities (continuity index), and the desertion of communities in the program (desertion index). To evaluate the adequate use of the program resources (technical efficiency), we used data-enveloped analysis and the Tobit regression model to identify external factors that can influence results. Finally, to evaluate the program's effectiveness, we estimated the index of the communities that improved their health indicators and were certified as healthy (community certification). RESULTS The median rate of focalization was 3.44 (1.31-85.13); the continuity of communities' rate was 0.50 (0.16-2.67). Regarding technical efficiency to reach healthy communities, only 2 states reached the optimal efficiency (score 1); where the efficiency was adjusted for external factors, 6 states reached a score of 1. The median of global effectiveness was 0.19 (0.01-0.78). We found differences in efficiency and effectiveness scores among states. CONCLUSION We found lower efficiency of the implementation and technical efficiency, as well as poor effectiveness of the program to reach healthy communities. To achieve HECP purpose, it is necessary to revise its guidelines, improve its strategies to work in communities, and establish the right mechanisms to monitor its implementation. It is essential to focus on the resources used to enhance technical efficiency and effectiveness at the community level.
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Affiliation(s)
- Jacqueline E Alcalde-Rabanal
- Center for Health System Research (Drs Alcalde-Rabanal and González-Robledo), Center for Evaluation and Survey (Dr Ruelas-González), and Center for Nutrition and Health Research (Ms Macías), Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico; Centre for Health Economics, University of York, England (Mr Chivardi); and Instituto de Seguridad Social y Salud de Trabajadores del Estado, Cancún, Q.R., Mexico (Ms Flores-Loera)
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González-Robledo MC, Gonzalez-Robledo LM, Nudel-Ontiveros A, Agudelo-Botero M, Rodríguez-Cuevas FG, Reyes-Morales H. Trabajadoras comunitarias de salud: experiencias en el abordaje de la salud mental en zonas rurales de Chiapas. Salud Publica Mex 2023; 65:275-284. [PMID: 38060883 DOI: 10.21149/14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/07/2022] [Indexed: 12/18/2023] Open
Abstract
OBJETIVO Analizar, desde la perspectiva de las trabajadoras comunitarias de salud (TCS), los conocimientos y experiencias en la atención de la salud mental (SM) en comunidades rurales de Chiapas. Material y métodos. Se utilizó el enfoque fenomenológico descriptivo. Se realizaron 18 entrevistas semiestructuradas a TCS, las cuales fueron audiograbadas, transcritas, codificadas y analizadas utilizando como técnica, el análisis cualitativo de contenido con ayuda del software Atlas ti. RESULTADOS Las TCS mental tienen una amplia comprensión de la cultura, el lenguaje y los problemas de sus comunidades, permitiéndoles fungir como enlace entre los servicios de salud y la población. Identifican que hay buena SM cuando "una persona tiene ánimo de realizar su trabajo diario" y enfermedad cuando "las personas sufren o tienen pensamientos chuecos". Sus experiencias de trabajo están ligadas con el acompañamiento individual (psico-educación) y el apoyo de actividades realizadas por profesionales de Compañeros En Salud (CES). Conclusión. Las TCS mental que trabajan con CES desarrollan un papel importante en la promoción de la SM, de riesgos y acompañamiento de pacientes con trastornos mentales. Estos hallazgos consolidan la evidencia e importancia del desarrollo de las intervenciones comunitarias en SM a través de este personal, en contextos de escasa disponibilidad de servicios de salud.
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Affiliation(s)
| | | | | | - Marcela Agudelo-Botero
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México. Ciudad de México, México..
| | | | - Hortensia Reyes-Morales
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México..
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Serván-Mori E, Gonzalez-Robledo LM, Nigenda G, Quezada AD, González-Robledo MC, Rodríguez-Cuevas FG. Prevalence of Depression and Generalized Anxiety Disorder Among Mexican Indigenous Adolescents and Young Adults: Challenges for Healthcare. Child Psychiatry Hum Dev 2021; 52:179-189. [PMID: 32388771 DOI: 10.1007/s10578-020-01001-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Providing evidence on mental disorders in indigenous adolescents is critical to achieving universal health coverage (UHC). The prevalence of symptoms of depression and generalized anxiety disorder symptoms were estimated for 2082 adolescents aged 14-20 years in Chiapas, Mexico. Mental disorders were assessed using the 9-item Patient-Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale. Among the adolescents evaluated, 35.8% suffered from depression or generalized anxiety disorder. Of those, 6.1% reported a previous diagnosis. 32.1% of adolescents with both mental disorders reported having attempted suicide. Gender, substance use, adverse living experiences and living conditions were correlated to the presence of depression and/or generalized anxiety disorder. It is mandatory for Mexican health authorities to develop effective instruments aiming to screen and diagnose mental health conditions in adolescents, as well as to provide timely treatment in primary health-care units.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Amado D Quezada
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Mexico
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dos Santos ATC, da Silva RP, de Almeida LM, Bosi MLM, de Menezes MDFB, Skaba MMVF, Nigenda G, Arruda CAM, Pinheiro CPO, González-Robledo MC, Knaul FM. Cancer survivorship needs in Brazil: Patient and family perspective. PLoS One 2020; 15:e0239811. [PMID: 33031426 PMCID: PMC7544129 DOI: 10.1371/journal.pone.0239811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/14/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Cancer Survivorship is a growing public health challenge. Effective responses from health care and social services depend on appropriate identification of survivors and their families´ specific needs. There are few studies on survivorship in low and middle-income countries, therefore, more evidence-based studies are necessary to develop a comprehensive approach to cancer survivorship. Objectives Identify the needs of cancer survivors and their relatives, specifically those of individuals with breast, cervical or prostate cancer, and with acute lymphocytic leukemia (ALL). Methods A qualitative, exploratory study conducted in two referral institutions in Brazil, located in Rio de Janeiro (Southeast region) and Fortaleza (Northeast region). The study included 47 patients of public and private health services and 12 family members. We used script-based semi-structured interviews. The discursive material obtained was categorized and analyzed using the Thematic Analysis approach. Results The analysis identified three central themes: 1) consequences of cancer treatment; 2) Changes in daily life associated with cancer survivorship; and 3) Unmet structural needs in cancer survivorship. Conclusion Social and cancer control policies in Brazil should provide resources, specific care standards and clinical, psychological and social support. Cancer survivors should also receive rehabilitation and work reintegration guidelines. This matter requires broader access to qualified cancer information, development of an integrated patient-centered care and care model, and more research resources for the country's post-treatment cancer period.
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Affiliation(s)
- Antonio Tadeu Cheriff dos Santos
- Population Research Division, Nucleus of Research and Qualitative Studies, National Cancer Institute, Rio de Janeiro, Brazil
- * E-mail:
| | - Rildo Pereira da Silva
- Population Research Division, Nucleus of Research and Qualitative Studies, National Cancer Institute, Rio de Janeiro, Brazil
| | - Liz Maria de Almeida
- Division of Population Research, National Cancer Institute, Rio de Janeiro, Brazil
| | - Maria Lúcia Magalhães Bosi
- Laboratory of Qualitative Research and Evaluation in Health, Federal University of Ceara, Fortaleza, Ceará, Brazil
| | | | | | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of México, México City, México
| | - Carlos André Moura Arruda
- Laboratory of Qualitative Research and Evaluation in Health, Federal University of Ceara, Fortaleza, Ceará, Brazil
| | | | | | - Felícia Marie Knaul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Coral Gables, Florida, United States of America
- Institute for Advanced Study of the Americas, University of Miami, Coral Gables, Florida, United States of America
- Programa Universalidad y Competitividad en Salud, Fundación Mexicana para la Salud, Mexico City, Mexico
- Tómatelo a Pecho, Mexico City, Mexico
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Agudelo-Botero M, González-Robledo MC, Reyes-Morales H, Giraldo-Rodríguez L, Rojas-Russell M, Mino-León D, Ocampo-Morales DI, Valdez-Ortiz R. Health care trajectories and barriers to treatment for patients with end-stage renal disease without health insurance in Mexico: a mixed methods approach. Int J Equity Health 2020; 19:90. [PMID: 32513177 PMCID: PMC7282114 DOI: 10.1186/s12939-020-01205-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 05/28/2020] [Indexed: 12/24/2022] Open
Abstract
Background Mexico has the sixth-highest premature death rate from chronic kidney disease (CKD) in the world. From 1990 to 2017, the age-standardized CKD mortality rate jumped from 28.7 to 58.1 per 100,000 inhabitants, making it the second-leading cause of death that year. Medical care for the disease is inequitable, as those without health insurance have limited access to renal replacement therapy (RRT). The objective of this study is to describe the healthcare trajectories of patients with end-stage renal disease (ESRD) in a public hospital in Mexico City and the barriers they face in receiving peritoneal dialysis and haemodialysis. Methods This study uses a convergent mixed methods approach and is predominantly qualitative. Patients completed 199 surveys, and 42 semi-structured interviews with patients having ESRD and their families were conducted. The quantitative data were analysed using descriptive statistics, and the qualitative data were processed using a phenomenological approach. Results It was found that 76.9% of the patients received peritoneal dialysis or haemodialysis as their first RRT. Over 30% began their treatment at least a month after a health professional prescribed it. Almost 50% had been hospitalized for complications related to the disease in the previous year, and 36% had uncertainties about their treatment. Close to 64% of the haemodialysis patients received treatment intermittently. Barriers to accessing treatment, information, contact with health services, and treatment availability were identified. Patients and their families encountered economic and emotional difficulties at every phase of their search for medical care and treatment. Conclusion Mexico urgently needs to implement public policies related to CKD that are primarily directed at its prevention but should also implement policies directed at slowing its progression, reducing its complications, and providing funding for uninsured patients who require RRT. These policies must be based on the perspectives of human rights and equality, and the perspectives of patients, their families and the general population should be included in the policy creation process.
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Affiliation(s)
- Marcela Agudelo-Botero
- Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Hortensia Reyes-Morales
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Liliana Giraldo-Rodríguez
- Department of Demographic Epidemiology and Social Determinants, National Institute of Geriatrics, Mexico City, Mexico
| | - Mario Rojas-Russell
- Faculty of Higher Studies Zaragoza, National Autonomous University of Mexico, Mexico City, Mexico
| | - Dolores Mino-León
- Research Unit in Clinical Epidemiology. Specialty Hospital of the 21st Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico
| | - Dayan Irene Ocampo-Morales
- Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rafael Valdez-Ortiz
- Nephrology Services, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico.
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Agudelo-Botero M, Valdez-Ortiz R, Giraldo-Rodríguez L, González-Robledo MC, Mino-León D, Rosales-Herrera MF, Cahuana-Hurtado L, Rojas-Russell ME, Dávila-Cervantes CA. Overview of the burden of chronic kidney disease in Mexico: secondary data analysis based on the Global Burden of Disease Study 2017. BMJ Open 2020; 10:e035285. [PMID: 32213523 PMCID: PMC7170614 DOI: 10.1136/bmjopen-2019-035285] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To describe the evolution of the burden of chronic kidney disease (CKD) in Mexico by states, sex and subtypes from 1990 to 2017. DESIGN Secondary data analysis based on the Global Burden of Disease Study (GBD) 2017. PARTICIPANTS Mexico and its 32 states. Data were publicly available and de-identified and individuals were not involved. METHODS We analysed age-standardised mortality rates, years of life lost (YLL) due to premature death, years lived with disability (YLD) and disability-adjusted life years (DALY), as well as the percentage of change of these indicators between 1990 and 2017. RESULTS From 1990 to 2017, the number of deaths, YLL, YLD and DALY due to CKD increased from 12 395 to 65 033, from 330 717 to 1 544 212, from 86 416 to 210 924 and from 417 133 to 1 755 136, respectively. Age-standardised rates went from 28.7 to 58.1 for deaths (% of change 102.3), from 601.2 to 1296.7 for YLL (% of change 115.7), from 158.3 to 175.4 for YLD (% of change 10.9) and from 759.4 to 1472.2 for DALY (% of change 93.8). The highest burden of CKD was for Puebla and the lowest for Sinaloa. It was also greater for men than women. By subtypes of CKD, diabetes and hypertension were the causes that contributed most to the loss of years of healthy life in the Mexican population. CONCLUSIONS Mexico has experienced exponential and unprecedented growth in the burden of CKD with significant differences by states, sex and subtypes. Data from the GBD are key inputs to guide decision-making and focus efforts towards the reduction of inequities in CKD. These results should be considered a valuable resource that can help guide the epidemiological monitoring of this disease and prioritise the most appropriate health interventions.
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Affiliation(s)
- Marcela Agudelo-Botero
- Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rafael Valdez-Ortiz
- Service of Nephrology, General Hospital of Mexico, Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Liliana Giraldo-Rodríguez
- Demographic Epidemiology and Social Determinants Department, Subdirection of Research on Geriatrics, National Institute of Geriatrics, Mexico City, Mexico
| | | | - Dolores Mino-León
- Research Unit in Clinic Epidemiology, Specialties Hospital of the National Medical Centre SXXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - María Fernanda Rosales-Herrera
- Politics, Population and Health Research Center, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Magaña-Valladares L, González-Robledo MC, Rosas-Magallanes C, Mejía-Arias MÁ, Arreola-Ornelas H, Knaul FM. Training Primary Health Professionals in Breast Cancer Prevention: Evidence and Experience from Mexico. J Cancer Educ 2018; 33:160-166. [PMID: 27357140 PMCID: PMC5762772 DOI: 10.1007/s13187-016-1065-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
To analyze the key successful factors of a national educational strategy for early breast cancer detection developed in Mexico for primary health care personnel from 2008 to 2014, an educational strategy to train physicians, nurses, health promoters, and medical students from local ministries of health with a competency-based approach was developed and implemented using diverse educational modalities, face-to-face, blended, and a massive open online course (MOOC). Formative and summative evaluations were used during the implementation of the course. A total of 19,563 health professionals were trained from 2008 to 2014. The graduation rate, an average of all educational modalities, was 91 %, much higher than those previously reported in the literature. The factors that might have influenced this success were (1) the training strategy, which was designed according to the characteristics and specific needs of the target groups; (2) the political will and commitment of the country's health authorities; (3) the technological and educational models used; and (4) the punctual follow-up of participants. This study shows that carefully designed educational interventions can improve service professionals' competencies and that regardless of the modality, face-to-face, blended learning, or MOOC, high graduation rates can be achieved. Further evaluation is required to demonstrate that the competencies remained in all target groups after 6 months of the intervention and that the women served by the trained personnel were provided accurate information and timely diagnoses of breast cancer.
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Affiliation(s)
- Laura Magaña-Valladares
- Secretaría Académica, Instituto Nacional de Salud Pública, México, Universidad 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - María Cecilia González-Robledo
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, México, Avenida Universidad 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico.
| | - Cynthia Rosas-Magallanes
- Secretaría Académica, Instituto Nacional de Salud Pública, México, Universidad 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Miguel Ángel Mejía-Arias
- Secretaría Académica, Instituto Nacional de Salud Pública, México, Universidad 655, Col. Santa María Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Héctor Arreola-Ornelas
- Competitividad y Universalidad en Salud, Fundación Mexicana para la Salud, A.C., Periférico Sur 4809, El Arenal Tepepan, Tlalpan, 14610, México, DF, Mexico
- Tómatelo a Pecho, A.C. Periférico Sur 4809, El Arenal Tepepan, Tlalpan, 14610, México, DF, Mexico
| | - Felicia M Knaul
- Competitividad y Universalidad en Salud, Fundación Mexicana para la Salud, A.C., Periférico Sur 4809, El Arenal Tepepan, Tlalpan, 14610, México, DF, Mexico
- Tómatelo a Pecho, A.C. Periférico Sur 4809, El Arenal Tepepan, Tlalpan, 14610, México, DF, Mexico
- Miller School of Medicine, University of Miami, 1601 NW 12th Ave, Miami, FL, 33136, USA
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Gómez-Dantés H, Lamadrid-Figueroa H, Cahuana-Hurtado L, Silverman-Retana O, Montero P, González-Robledo MC, Fitzmaurice C, Pain A, Allen C, Dicker DJ, Hamavid H, López A, Murray C, Naghavi M, Lozano R. The burden of cancer in Mexico, 1990-2013. Salud Publica Mex 2017; 58:118-31. [PMID: 27557370 DOI: 10.21149/spm.v58i2.7780] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/04/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To analyze mortality and incidence for 28 cancers by deprivation status, age and sex from 1990 to 2013. MATERIALS AND METHODS The data and methodological approaches provided by the Global Burden of Disease (GBD 2013) were used. RESULTS Trends from 1990 to 2013 show important changes in cancer epidemiology in Mexico. While some cancers show a decreasing trend in incidence and mortality (lung, cervical) others emerge as relevant health priorities (prostate, breast, stomach, colorectal and liver cancer). Age standardized incidence and mortality rates for all cancers are higher in the northern states while the central states show a decreasing trend in the mortality rate. The analysis show that infection related cancers like cervical or liver cancer play a bigger role in more deprived states and that cancers with risk factors related to lifestyle like colorectal cancer are more common in less marginalized states. CONCLUSIONS The burden of cancer in Mexico shows complex regional patterns by age, sex, types of cancer and deprivation status. Creation of a national cancer registry is crucial.
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Gálvez-Hernández CL, González-Robledo MC, Barragán-Carrillo R, Villarreal-Garza C. Special Needs of Young Women with Breast Cancer in Limited Resource Settings. Rev Invest Clin 2017; 69:210-222. [PMID: 28776606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Young women with breast cancer (YWBC) comprise a group of patients with unique biopsychosocial characteristics with a special perception of needs throughout their disease and survivorship. Contexts marked by restricted allocations and economic constraints might further aggravate the struggle of these patients living within limited resource settings and can demand added requirements for them and their families. OBJECTIVE To analytically explore the existing knowledge regarding the needs of YWBC in low- and middle- income countries (LMICs). METHODS We conducted a thorough literature review of scientific journal databases available in Spanish and English containing information on YWBC in LMICs. RESULTS We did not find any publications exclusively assessing this topic in resource-limited settings. We looked for data on the different types of YW need from studies in the region that assessed the needs of breast cancer (BC) patients in general and described in their findings the particularities of young patients. Young BC patients described within the literature present a variety of needs. Those reported most frequently as unmet were related to information needs and psychological counseling, practical and physical assistance, and social and spiritual support. CONCLUSIONS Published literature on the subject - particularly in Latin America - is extremely scarce. This offers an area of opportunity for conducting further research in this topic that would help improve health professional training and establish health policies in favor of YWBC.
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Affiliation(s)
- Carmen Lizette Gálvez-Hernández
- Catedrática-CONACYT, Instituto Nacional de Cancerología, Mexico City, Mexico
- Joven y Fuerte: Programa para la Atención e Investigación de Mujeres Jóvenes con Cáncer de Mama, Mexico City, Mexico, Mexico
| | | | - Regina Barragán-Carrillo
- Joven y Fuerte: Programa para la Atención e Investigación de Mujeres Jóvenes con Cáncer de Mama, Mexico City, Mexico, Mexico
- Centro de Cáncer de Mama, Hospital Zambrano Hellion, Tecnológico de Monterrey, Monterrey, NL, Mexico
| | - Cynthia Villarreal-Garza
- Joven y Fuerte: Programa para la Atención e Investigación de Mujeres Jóvenes con Cáncer de Mama, Mexico City, Mexico, Mexico
- Centro de Cáncer de Mama, Hospital Zambrano Hellion, Tecnológico de Monterrey, Monterrey, NL, Mexico
- Department of Investigation and Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
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González-Robledo MC, Wong R, Ornelas HA, Knaul FM. Costs of breast cancer care in Mexico: analysis of two insurance coverage scenarios. Ecancermedicalscience 2015; 9:587. [PMID: 26557885 PMCID: PMC4631579 DOI: 10.3332/ecancer.2015.587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Breast cancer (BC) is a major cause of disease and death worldwide. In addition to its contribution to mortality and disability, it is a major economic burden both public and private. OBJECTIVE To estimate the average direct medical cost/year of care for the diagnosis and treatment of BC in two coverage scenarios in Mexico: What is 'ideal' based on service usage patterns according to international guidelines and what is 'current' using the service usage patterns of suppliers in Mexico. MATERIAL AND METHODS The pattern and intensity of use of procedures for the care of BC in the Mexican Social Security Institute (IMSS) for 2009 were identified and prices were associated using the guidelines from the System of Social Protection in Health (SPSS) and the IMSS for the current scenario and the ideal scenario, international patterns (Breast Health Global Initiative BHGI after its acronym in English) were used and prices were associated from the SPSS guidelines. RESULTS The annual average direct medical cost per patient in the 'current' scenario was 8557 US$, while the cost in the 'ideal' scenario was 4554 US$. There are differences in costs between 'what we do' and 'what should be done', due to differences in the implementation of the interventions for the treatment of the different stages of the disease. A proportional increase in the average cost was also identified as the diagnosis stage advanced (from I to III). CONCLUSIONS Given that in Mexico there is universal insurance coverage for the treatment of BC, it is necessary to use economic resources more efficiently. It is necessary to continue to examine this topic in more depth and the next step will be to assess the effectiveness of both scenarios in order to provide enough evidence for the decision-making process.
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Affiliation(s)
- María Cecilia González-Robledo
- Center for Research in Health Systems, National Institute of Public Health, Av. Universidad 655 cerr. Los Pinos y Caminera, Col. Santa María Ahuacatitlán C.P. 62100, Cuernavaca, Morelos, Mexico
| | - Rebeca Wong
- WHO Collaborating Centre/PAHO Aging and Health, University of Texas Medical Branch, Texas, USA
| | - Héctor Arreola Ornelas
- Economic Research and Research Promotion Council of Competitiveness and Health, Mexican Health Foundation, Mexico
| | - Felicia Marie Knaul
- Miami Institute of Americas & Miller School of Medicine, Miami University, Miami, USA; Mexican Health Foundation & Founding President of Tómatelo a Pecho A.C., México
- At the time of writing the paper, Director of the Harvard Global Equity Initiative at Harvard University
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González-Robledo LM, González-Robledo MC, Nigenda G. Dentist education and labour market in Mexico: elements for policy definition. Hum Resour Health 2012; 10:31. [PMID: 22974344 PMCID: PMC3515346 DOI: 10.1186/1478-4491-10-31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 07/09/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Here, the educational and labour market characteristics of Mexican dentists are revised. Dentistry is a health profession that has been scarcely studied in developing countries. This analysis attempts to understand the relationships and gaps between the supply and demand of dentists in the country. Around 5000 new dentists graduate every year looking for a place in the labour market. METHODS A cross-sectional study with exploratory, descriptive and correlational scope was carried out between 2006 and 2008. Analyses of quantitative data on dentists from national surveys and occupational statistics were complemented with qualitative information provided by 43 key informants in five Mexican states. RESULTS The 2008 dentist labour market can be characterized as follows: 75% worked in the private sector, most of them independently; more than two-thirds were women; the proportion of specialists was low (slightly more than 10%); unemployment was more than 20% and labour wastage was nearly 40%, with most wastage corresponding with female dentists. The increase in the number of dentists entering the labour market during the last two decades is more related to the educational market than to the population's health needs and the number of dentists actually required to meet them. CONCLUSIONS The problems identified in the Mexican dentist labour market necessitate urgent intervention on behalf of regulatory bodies in order to balance the tendencies of supply and demand in the number of trained professionals as well as in their incorporation into different market areas. Adequate policies are required to increase the likelihood of achieving this objective.
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Affiliation(s)
- Luz María González-Robledo
- Universidad Autónoma del Estado de Morelos, Calle Leñeros esquina Iztaccíhuatl s/n Col. Volcanes, CP 62350, Cuernavaca, Morelos, México
| | - María Cecilia González-Robledo
- Universidad Autónoma del Estado de Morelos, Calle Leñeros esquina Iztaccíhuatl s/n Col. Volcanes, CP 62350, Cuernavaca, Morelos, México
| | - Gustavo Nigenda
- Universidad Autónoma del Estado de Morelos, Calle Leñeros esquina Iztaccíhuatl s/n Col. Volcanes, CP 62350, Cuernavaca, Morelos, México
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Aracena-Genao B, González-Robledo MC, González-Robledo LM, Palacio-Mejía LS, Nigenda-López G. [Fund for Protection against Catastrophic Expenses]. Salud Publica Mex 2012; 53 Suppl 4:407-15. [PMID: 22282203 DOI: 10.1590/s0036-36342011001000004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 10/07/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To document the status of operational and managerial processes of the Fund for Protection against Catastrophic Expenses (FPGC), as well as to describe its evolution, and to explore the relationship between covered diseases and the Mexican health profile. MATERIAL AND METHODS This is a joint management study, which included a qualitative and a quantitative phase. We conducted semi-structured interviews with key informants. We also analyzed the records of CNPSS, the hospital discharge and mortality data bases. RESULTS Fifty two percent of the states take twice as long to report and validate the cases. From 2004-2009 the FPGC increased its coverage from 6 to 49 interventions, that means a spending increase of 2 306.4% in nominal terms and 1 659.3% in real terms. The HIV/AIDS was the intervention prioritized with 39.3% and Mexico City had the highest proportion of expenditure (25.1%). A few diseases included in the health profile are covered by the FPGC. CONCLUSIONS The review of the inclusion criteria of diseases is urgent, so as to cover diseases of epidemiological importance.
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Affiliation(s)
- Belkis Aracena-Genao
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública. México.
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González-Robledo LM, González-Robledo MC, Nigenda G, López-Carrillo L. [Government actions for the early detection of breast cancer in Latin America. Future challenges]. Salud Publica Mex 2011; 52:533-43. [PMID: 21271013 DOI: 10.1590/s0036-36342010000600009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Documentary research carried out in 2009 aims to document the regulatory framework and existing programs for the early detection of breast cancer in Latin America and the Caribbean in order to establish the most important challenges for the containment of the epidemic in the region. The governments of the region have developed diverse efforts and initiatives to confront the rise in mortality due to said cause, including early detection, treatment and research strategies. Despite advances in the early detection of breast cancer, the challenge remains to link efforts to ensure continuity of care (diagnostic confirmation, treatment and monitoring) in order to achieve higher efficiency, effectiveness and benefits for women with this disease.
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González-Robledo LM, Nigenda G, González-Robledo MC, Reich M. Separación de funciones en el Sistema de Protección Social en Salud, México 2009: avances y retos. Salud pública Méx 2011; 53 Suppl 4:416-24. [DOI: 10.1590/s0036-36342011001000005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 05/18/2011] [Indexed: 11/21/2022] Open
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