Luis Durán-Arenas

Hacia una base normativa mexicana en la medición de calidad de vida relacionada con la salud, mediante el Formato Corto 36

Objective. To present the results of the application of the short format 36 instrument (SF-36) in the Mexican states of Sonora and Oaxaca. The levels of quality of life were compared with those from Canada and the United States. Material and Methods. The data were obtained using a survey on health service access, usage, and quality. The SF-36 is composed of 36 questions, which represent eight different domains on the health-related quality of life. These domains are used to estimate the physical and mental components of health. Data analysis was performed to calculate the average scores for each domain for the total sample, by gender and age groups in each state. The regional differences were assessed by the difference of means. Results. The total response was 98.5% of the 4200 selected households. The percent response values were similar between the two states. A total of 5961 subjects older than 25 years of age completed the questionnaire. Males scored higher than females in all domains and in both components. Regardless of sex, the highest variation was observed in adults up to 64 years of age mainly in three domains: overall health, social function, and mental health; in the 65-74 year age group occurred mostly in social function and mental health; and in adults older than 75 years only in mental health. The young adult age group (25 to 44 years) showed variation in a greater number of domains, while women exhibited more variation in the “extreme” age groups, 25 to 34 years and 75 years and older. The mean scores in our sample were higher than Duran-Arenas L, Gallegos-Carrillo K, Salinas-Escudero G, Martinez-Salgado H. Hacia una base normativa mexicana en la medicion de calidad de vida relacionada con la salud, mediante el Formato Corto 36. Salud Publica Mex 2004;46:306-315. El texto completo en ingles de este articulo esta disponible en: http://www.insp.mx/salud/index.html

Role of depressive symptoms and comorbid chronic disease on health-related quality of life among community-dwelling older adults.

OBJECTIVE This study examined the influence of depressive symptoms on health-related quality of life (HRQOL) among community-dwelling older adults suffering from various categories of chronic comorbidity. METHODS A population-based survey in adults aged 60 years or more was conducted within a random sample of 1085 beneficiaries of the Mexican Institute of Social Security in Mexico City. Depressive symptoms were evaluated with the 15-item Geriatric Depression Scale, and chronic comorbidity was determined with self-reports concerning prior medical diagnoses and the HRQOL Short Form-36 health survey. We carried out a stratified analysis by comorbidity category, evaluating the impact of depressive symptoms on HRQOL through an analysis of variance and modeling the independent association of depression symptoms with HRQOL using multiple linear regression analyses adjusted for comorbidity and other covariables. RESULTS HRQOL scores were low in the presence of depressive symptoms, while their impact increased when chronic diseases were also present. The group with the poorest HRQOL was older adults suffering from both depressive symptoms and two or more chronic diseases (P<.05). The stratified analysis by comorbidity and multivariate analysis, adjusted for covariables, indicated that depressive symptoms and comorbidity had cumulative negative effects on HRQOL. CONCLUSION The HRQOL of older adults deteriorated when depressive symptoms were present and decreased even further with the simultaneous occurrence of chronic illnesses. Identifying depression symptoms-either alone or along with chronic conditions-is crucial for implementation of measures aimed at improving elderly peoples HRQOL.

Self-perceived health status: an approach of the elderly in Mexico

OBJECTIVE To evaluate health status of the elderly in Mexico through their self-perception and to describe social, organizational and health-related factors. METHODS A study was carried out on secondary data from the 2000 National Health Survey in Mexico. Multiple logistic regression models were used. The dependent variable health status was measured through self-perception. The independent variables included were: sociodemographic characteristics, risk behaviors, accidents, disease diagnosis and clinical measures. RESULTS A total of 7,322 adults aged 60 years and older were studied, which represents 7% of the total population in that age group in Mexico. Of them, 19.8% reported poor or very poor health status. Factors found to be associated to poor health were age, female sex, having no social security, being divorced, homemaker, disabled, unemployed, tobacco consumption, having a health condition, accidents and diagnosed with chronic diseases. CONCLUSIONS The study allowed to identifying factors that may contribute to poor health status in the elderly. These findings could be taken into account in the development of actions and health care programs for this population in Mexico.

Alternative models for the epidemiological analysis of obesity as a public health problem

Public health problems have been analyzed over time using different approaches involving a variety of methodological and theoretical models. The classical epidemiological model and the social epidemiological model are two examples of models used in public health research. Although each of these models covers a whole range of public research approaches, it is possible to identify the different theoretical and methodological criteria and the different ideological assumptions on which they are based. The objective of this article is to make a comparison of the criteria used by the classical and social epidemiological models in the study of public health problems, with special emphasis on the study of obesity. This comparison shows that the knowledge generated by studies carried out under each of these models is rather different, as an effect of the different theoretical, methodological and ideological criteria used by each model. However, far from being contradictory, the knowledge generated by each model can complement that generated by the other. Finally, the inclusion of social sciences as a tool for the analysis of public health problems, specifically the problem of obesity, is discussed.Los problemas de salud publica han sido estudiados desde muy diversas perspectivas y utilizando diferentes modelos teoricos y metodologicos. Dos modelos que han sido frecuentemente utilizados son el modelo epidemiologico clasico y el modelo epidemiologico social. Estos modelos emplean distintos criterios conceptuales, metodologicos e ideologicos. Se objetivo hacer una contrastacion entre estos modelos de acuerdo a los criterios mencionados, utilizando el estudio de la obesidad como ejemplo de la utilizacion de estos modelos. Esta contrastacion muestra que el conocimiento generado por cada modelo es muy distinto. Se discuten posibles areas de complementariedad entre ambos modelos y la utilizacion de las ciencias sociales como estrategia para ampliar nuestro conocimiento sobre problemas de salud publica, en especial el problema de la obesidad.

Health care utilization and health-related quality of life perception in older adults: a study of the Mexican Social Security Institute

OBJECTIVE To establish how health care service utilization patterns are associated with health-related quality of life (HRQL) perception in older adults. MATERIAL AND METHODS A cross-sectional study in adults aged 60 years or more was conducted in a random sample of 1150 beneficiaries of the Mexican Social Security Institute (IMSS) in Mexico City during 2003. Health care services utilization was categorized as preventive or curative, which generated six usage profiles. HRQL was measured by means of the SF-36 questionnaire. Analyses of variance and multiple linear regressions were conducted to evaluate the relationship between health care services utilization and HRQL. RESULTS The use of preventive and curative services has a positive association with HRQL levels. Usage profiles with a prevalence of preventive services have a stronger positive association with HRQL scales. CONCLUSIONS This study suggests a positive association between use patterns for primarily preventive health care services and a better HRQL perception among older adults.

Evaluación de un programa de monitoría de la calidad de los servicios otorgados por una Organización no Gubernamental

Objective. To evaluate the effect of a quality-monitoring program on the occurrence of sentinel events and on attitudes and behaviors of personnel’s responses in a Non-Governmental-Organization (NGO). Material and methods. Between 1998 and 1999, a quasi-experimental design of the before-after type was conducted in 13 NGO clinics. Analysis of changes in attitudes and behaviors consisted in differences of means and analysis of variance between groups. Results. The number of sentinel events decreased from 32 events detected before the quality-monitoring program to only 2 after it. Attitudes and behaviors improved, with differences of means of +1.1 and +1.2 (p<0.05). Conclusions. The quality-monitoring program achieved the expected effects. It is noteworthy that attitudes and behaviors to prevent the occurrence of sentinel events were more prevalent after the intervention.

Design of the 2009 evaluation of the Medical Insurance for a New Generation program

OBJECTIVE To describe the mixed-method approach to evaluate the Medical Insurance for a New Generation (Seguro Médico para una Nueva Generación, SMNG). MATERIALS AND METHODS The program has been comprehensively evaluated. It has four key domains: 1) SMNG design; 2) childrens health status and socio-demographic characteristics; 3) performance by measuring coverage, efficiency and productivity; 4) family health expenditure. Quantitative and qualitative research approaches have been used. This included reviews of existing databases and clinical charts, collection of empirical data through in-depth interviews with healthcare providers, and a nation-wide household survey. CONCLUSION The results should serve as baseline data of the health status of SMNG children and the current staus of the program.

Strategies to improve the medical device life cycle in Mexico

OBJECTIVE To analyze the role of stakeholders to three alternative strategies to improve processes and practices regarding the regulation, assessment, and management of orthopaedic medical devices in Mexico. MATERIALS AND METHODS The study was based on document analysis and 17 structured interviews with multiple key actors within the Mexican health system to inform a stakeholder analysis aiming at assessing the political feasibility of these strategies. RESULTS Central level government agencies, those with a relation to quality of care, were identified as most relevant stakeholders to influence the adaption and application of the strategies. Major barriers identified are financial and human resources, and organisational culture towards reform. CONCLUSIONS Discussed strategies are political feasible. However, solving identified barriers is crucial to achieve changes directed to improve outputs and outcomes of medical device life cycle and positively influence the quality of health care and the health systems performance.

El acceso a métodos anticonceptivos en adolescentes de la Ciudad de México

Resumen: Objetivo: Estudiar y comprender el fenomeno del acceso a los metodos anticonceptivos en adolescentes mexicanos a partir del modelo de Levesque y colaboradores, el cual permite observar la participacion del sistema y la del usuario en el proceso de acceso. Material y metodos: Se realizo un estudio cualitativo con la tecnica de grupos focales en una secundaria y preparatoria de la Ciudad de Mexico, en 2014. Resultados: La capacidad de la poblacion adolescente para acceder al sistema de salud es limitada; esta no conoce los mecanismos de atencion ni la oferta de los metodos anticonceptivos. Los prejuicios de los prestadores de servicios provocan una reaccion negativa en los adolescentes. La familia es una fuente de informacion para estos ultimos en la toma de decisiones. Conclusiones: El modelo permitio valorar el acceso a los metodos anticonceptivos entre adolescentes. Se identificaron aspectos que actuan como barreras de acceso y que proveen de informacion a los prestadores de servicios de salud sobre la salud sexual y reproductiva de esta poblacion.

Correction: Calculation of the Average Cost per Case of Dengue Fever in Mexico Using a Micro-Costing Approach

[This corrects the article DOI: 10.1371/journal.pntd.0004897.].