María Cecilia González-Robledo

Acciones gubernamentales para la detección temprana del cáncer de mama en América Latina: Retos a futuro

Se presenta investigacion documental realizada en 2009 que pretende documentar el marco normativo y los programas vigentes para la deteccion temprana del cancer mamario en America Latina y establecer los retos mas importantes para contener la epidemia en la region. Se identificaron diversas iniciativas emprendidas por las autoridades gubernamentales de salud para contrarrestar el crecimiento de la morbi-mortalidad por esta causa mediante estrategias de deteccion temprana, atencion e investigacion. A pesar de los avances en el diseno de politicas, programas, protocolos y guias de manejo clinico, persisten importantes retos para lograr los objetivos propuestos y la contencion de este problema.

Validation of public health competencies and impact variables for low- and middle-income countries

BackgroundThe number of Master of Public Health (MPH) programmes in low- and middle-income countries (LMICs) is increasing, but questions have been raised regarding the relevance of their outcomes and impacts on context. Although processes for validating public health competencies have taken place in recent years in many high-income countries, validation in LMICs is needed. Furthermore, impact variables of MPH programmes in the workplace and in society have not been developed.MethodA set of public health competencies and impact variables in the workplace and in society was designed using the competencies and learning objectives of six participating institutions offering MPH programmes in or for LMICs, and the set of competencies of the Council on Linkages Between Academia and Public Health Practice as a reference. The resulting competencies and impact variables differ from those of the Council on Linkages in scope and emphasis on social determinants of health, context specificity and intersectoral competencies. A modified Delphi method was used in this study to validate the public health competencies and impact variables; experts and MPH alumni from China, Vietnam, South Africa, Sudan, Mexico and the Netherlands reviewed them and made recommendations.ResultsThe competencies and variables were validated across two Delphi rounds, first with public health experts (N = 31) from the six countries, then with MPH alumni (N = 30). After the first expert round, competencies and impact variables were refined based on the quantitative results and qualitative comments. Both rounds showed high consensus, more so for the competencies than the impact variables. The response rate was 100%.ConclusionThis is the first time that public health competencies have been validated in LMICs across continents. It is also the first time that impact variables of MPH programmes have been proposed and validated in LMICs across continents. The high degree of consensus between experts and alumni suggests that these public health competencies and impact variables can be used to design and evaluate MPH programmes, as well as for individual and team assessment and continuous professional development in LMICs.

Dentist education and labour market in Mexico: elements for policy definition

BackgroundHere, 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.MethodsA 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.ResultsThe 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.ConclusionsThe 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.

Outcome and impact of Master of Public Health programs across six countries: education for change

BackgroundThe human resources for health crisis has highlighted the need for high-level public health education to add specific capacities to the workforce. Recently, it was questioned whether Master of Public Health (MPH) training prepared graduates with competencies relevant to low- and middle-income countries (LMICs). This study aims to examine the influence of the MPH programs geared towards LMICs offered in Vietnam, China, South Africa, Mexico, Sudan, and the Netherlands on graduates’ careers, application of acquired competencies, performance at the workplace, and their professional contribution to society.MethodsA self-administered questionnaire was sent to graduates from six MPH programs. Frequency distributions of the answers were calculated, and a bivariate analysis and logistic regression of certain variables was performed.ResultsThe response rate was 37.5%. Graduates reported change in leadership (69%), in technical position (69%), acquiring new responsibilities (80%), and increased remuneration (63%); they asserted that MPH programs contributed significantly to this. Graduates’ attribution of their application of 7 key competencies ‘substantially to the MPH program’ ranged from 33% to 48%. Of the 26 impact variables, graduates attributed the effect they had on their workplace substantially to the MPH program; the highest rated variable ranged from 31% to 73% and the lowest ranged from 9% to 43%. Of the 10 impact variables on society, graduates attributed the effect they had on society substantially to the MPH program; for the highest rated variable (13% to 71%); for the lowest rated variable (4% to 42%). Candidates’ attribution of their application of acquired competencies as well as their impact at the workplace varied significantly according to institution of study and educational background.ConclusionsThis study concludes that these MPH programs contribute to improving graduates’ careers and to building leadership in public health. The MPH programs contribute to graduates’ application of competencies. MPH programs contribute substantially towards impact variables on the workplace, such as development of research proposals and reporting on population health needs, and less substantially to their impact on society, such as contributing equitable access to quality services. Differences reported between MPH programs merit further study. The results can be used for curriculum reform.

Breast cancer policy in Latin America: account of achievements and challenges in five countries

BackgroundThe recent increase of breast cancer mortality has put on alert to most countries in the region. However it has taken some time before breast cancer could be considered as a relevant problem. Only in recent years breast cancer has been considered a priority in some Latin American countries and resources have been mobilized to confront the problem at the institutional level. The article analyzes the efforts made in five Latin American countries (Argentina, Brazil, Colombia, Mexico and Venezuela) in the last 15 years to design and implement policies to address the growing incidence of breast cancer.MethodsData was collected between July and December 2010 from both primary and secondary sources. Semi-structured interviews were conducted with key informants from governmental and non-governmental organizations. Secondary data was obtained from publications in journals, government reports and official statistics in each country. Analysis combines information from both types of sources.ResultsCountries have followed different paths and are in different stages of policy implementation. In all cases early detection is a key strategy. Through the design of programs and guidelines, the allocation of financial resources to treat patients, as well as a formally structured information system, Brazil and Mexico have been able to set up comprehensive national policies. Argentina, Colombia and Venezuela have made important advancements but not yet capable of coordinating comprehensive national policies.ConclusionBreast cancer is being considered a priority in all five countries but there are different stages in the rolling out of comprehensive national policies due to differences in their capacity to allocate resources, implement operational strategies and encourage the participation of relevant stakeholders.

El Fondo de Protección contra Gastos Catastróficos: tendencia, evolución y operación

OBJETIVO. Documentar los procesos operativos y de gestion del Fondo de Proteccion contra Gastos Catastroficos (FPGC), evolucion y distribucion del gasto y explorar semejanza entre padecimientos cubiertos y perfil epidemiologico. MATERIAL Y METODOS. Estudio mixto, de naturaleza gerencial, que incluyo entrevistas semiestructuradas, revision de bases de datos de la Comision Nacional de Proteccion Social en Salud (CNPSS), egresos hospitalarios y mortalidad. RESULTADOS. El 52% de los estados tardan el doble del tiempo establecido para notificar y validar los casos. De 2004 a 2009 el FPGC paso de 6 a 49 intervenciones, equivalente a un incremento nominal y real del gasto de 2 306.4 y 1 659.3%, respectivamente. La intervencion priorizada fue VIH/SIDA con 39.3%; el Distrito Federal obtuvo la mayor proporcion del gasto (25.1%). Algunas de las principales causas de mortalidad son cubiertas por el FPGC. CONCLUSIONES. La revision de los criterios de inclusion de enfermedades y la adecuacion del fondo para atender la demanda creciente es impostergable.

Formación de médicos y enfermeras para la detección temprana del cáncer de mama en México

Objetivo Analizar la formacion academica que reciben los estudiantes de medicina y enfermeria sobre el cancer de mama (CaMa) durante el trascurso de su carrera universitaria. Materiales y Metodos Estudio exploratorio realizado en 2009. Basado en entrevistas semi-estructuradas a actores clave y revision documental. Poblacion de estudio: 199 Facultades/Escuelas de medicina y 108 Escuelas/Institutos de enfermeria. Unidad de analisis: plan de estudios. Resultados En 16,8 % de los planes de estudio de medicina y 6,3 % de enfermeria se encontro informacion especifica de contenidos sobre CaMa. La capacitacion que reciben los medicos es predominantemente desarrollada por las areas biomedica y clinica y en menor proporcion en el area socio-medica. En enfermeria los temas que mas se desarrollan son en areas comunitarias, abordando contenidos de promocion de la salud y prevencion de la enfermedad (estilos de vida saludable e identificacion de mujeres con alto riesgo de padecer CaMa). Discusion Se encontro escasa evidencia sobre entrenamiento especifico para la deteccion y atencion del cancer de mama en los planes de estudio. Por los resultados encontrados es necesario fortalecer los curriculos para formar a los futuros profesionales con capacidades para trabajar en la solucion de los problemas y necesidades especificos de salud de la poblacion particularmente en acciones de prevencion primaria y secundariaOBJECTIVE Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. MATERIALS AND METHODS This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. RESULTS 16.8% of the medical courses and 6.3% of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). DISCUSSION Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected populations problems and health needs, particularly regarding primary and secondary prevention.Objective Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. Materials and Methods This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. Results 16.8 % of the medical courses and 6.3 % of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). Discussion Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected populations problems and health needs, particularly regarding primary and secondary prevention.

Separación de funciones en el Sistema de Protección Social en Salud, México 2009: avances y retos

Objective. To evaluate advancements and challenges in the separation of functions within Mexico’s System of Social Protection in Health. Material and Methods. A 2009 evaluation study involving nine states and the National Commission for Social Protection in Health was carried out via semi-structured interviews with key actors and literature analysis. Results. The main advancement has been the creation of the State Regimens for Social Protection in Health (REPSS in Spanish) which act as intermediaries between users and health service providers, making these state-level entities responsible for both managing financial resources and shaping and coordinating the health care delivery network. However, most of the REPSS studied were found to be in a state of inertia, leading to inadequate compliance with legally mandated functions. Conclusion. Normative, technical, political and managerial obstacles persist, impeding the successful separation of functions.

Doctors and nurses' training for the early detection of the breast cancer in Mexico

Objetivo Analizar la formacion academica que reciben los estudiantes de medicina y enfermeria sobre el cancer de mama (CaMa) durante el trascurso de su carrera universitaria. Materiales y Metodos Estudio exploratorio realizado en 2009. Basado en entrevistas semi-estructuradas a actores clave y revision documental. Poblacion de estudio: 199 Facultades/Escuelas de medicina y 108 Escuelas/Institutos de enfermeria. Unidad de analisis: plan de estudios. Resultados En 16,8 % de los planes de estudio de medicina y 6,3 % de enfermeria se encontro informacion especifica de contenidos sobre CaMa. La capacitacion que reciben los medicos es predominantemente desarrollada por las areas biomedica y clinica y en menor proporcion en el area socio-medica. En enfermeria los temas que mas se desarrollan son en areas comunitarias, abordando contenidos de promocion de la salud y prevencion de la enfermedad (estilos de vida saludable e identificacion de mujeres con alto riesgo de padecer CaMa). Discusion Se encontro escasa evidencia sobre entrenamiento especifico para la deteccion y atencion del cancer de mama en los planes de estudio. Por los resultados encontrados es necesario fortalecer los curriculos para formar a los futuros profesionales con capacidades para trabajar en la solucion de los problemas y necesidades especificos de salud de la poblacion particularmente en acciones de prevencion primaria y secundariaOBJECTIVE Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. MATERIALS AND METHODS This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. RESULTS 16.8% of the medical courses and 6.3% of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). DISCUSSION Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected populations problems and health needs, particularly regarding primary and secondary prevention.Objective Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. Materials and Methods This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. Results 16.8 % of the medical courses and 6.3 % of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). Discussion Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected populations problems and health needs, particularly regarding primary and secondary prevention.