Health Institutions In Mexico Research Articles

EE446 Economic Burden of Mild or Moderate Asthma in Pediatric Patients from the Perspective of Public Health Institutions in Mexico

EE446 Economic Burden of Mild or Moderate Asthma in Pediatric Patients from the Perspective of Public Health Institutions in Mexico

Health-care policies during the COVID-19 pandemic in Mexico: A continuous case of heterogeneous, reactive, and unequal response

BackgroundThe pandemic in Mexico underlined pre-existing health-care system inequalities. Within the first six months of the COVID-19 pandemic, 154 health policies across health institutions were found to be uncoordinated and heterogeneous, leading to health inequalities in access and potential health outcomes. Data & methodsUsing a rapid qualitative research methodology, data was collected using purposive sampling of institutional policies published for public access on the official websites of the four public health institutions in Mexico from June 16th, 2020 to October 30th, 2021. This policy review used archival analysis to understand the differences in health-care policies during the COVID-19 pandemic in Mexico. These policies were classified under the RREAL framework and as a continuation of our first publication. ResultsDuring this study, categories of public health response and vaccination dominated the policies enacted. The SSA was the main author of publications. There seems to be a more unified policy response. However, health inequalities persist. ConclusionsThe Mexican government continued to be reactive to the increase in cases or the arrival of new variants, rather than preventative. Research and development of policies need to work together in soaring cases like COVID-19 to work more effectively against the economic and epidemiological burden of a pandemic. It is suggested that this “vaccination” should be included in the RREAL classification. Other sectors (i.e. the ministry of foreign affairs) should be considered relevant players in the future management of a pandemic.

EE91 Economic Evaluation of Durvalumab for the Treatment of Patients With Stage III Unresectable Locally Advanced Non-Small Cell Lung Cancer Whose Disease Has Not Progressed After Platinum-Based Chemoradiation Therapy

To perform an economic evaluation of durvalumab for the treatment of patients with stage III unresectable locally advanced non-small cell lung cancer whose disease has not progressed after platinum-based chemoradiation therapy from the perspective of public health institutions in Mexico.

Analysis of Medical Specialists Graduated in Mexico from 2012 to 2018. National Study

Objective: to analyze the educational quality of graduates through the following academic indicators: a. Occupational mobility, b. Number and type of scientific publications, c. Publication of chapters or medical literature, d. Postgraduate studies, and e. Certification by the corresponding specialty board. Method: descriptive cross-sectional study. Different databases were reviewed, the following stand out: 1. List of graduates. 2. Registry of the different specialties; National Regulatory Committee of Medical Specialties Councils to know both the certification status, and in the General Management of Professions, belonging to the Ministry of Public Education, the professional certificate status. 3. Index of journal authors (PubMed, Embase, Medline), 4. Databases of medical insurance and health institutions in Mexico and 5. Databases of Postgraduate Degrees in Medicine Results: The academic indicators of 14,770 medical specialists who graduated from the Sub-direction of Medical Specialties of the unam in the last six years were analyzed. The trajectory of the graduates shows a gradual increase in the percentage of board certifications, number of published articles, and postgraduate courses. Nearly 60% of the specialists work in Mexico’s three largest cities. Conclusion: the number of graduated specialists is insufficient in quantity and distribution to cover the health needs of the country. Despite the increase in scientific production, there is still a need to increase the number of research projects, and scientific publications by graduates. It is necessary to rethink medical specialty programs in accordance with health care needs, and the international context.

EE378 Economic Burden of Spinal Muscular Atrophy from the Perspective of Public Health Institutions in Mexico

EE378 Economic Burden of Spinal Muscular Atrophy from the Perspective of Public Health Institutions in Mexico

POSB110 Economic Evaluation of Acalabrutinib for Previously-Treated Patients with Mantle Cell Lymphoma in Mexico

To perform an economic evaluation of acalabrutinib use in adult patients with Mantle Cell Lymphoma (MCL) who have received at least one previous therapy from the perspective of public health institutions in Mexico.

Technology Transfer Model between National Health Institutions in Mexico: Case of Pacs-Inr System for Medical Images Management

Technology Transfer Model between National Health Institutions in Mexico: Case of Pacs-Inr System for Medical Images Management

915. Hepatitis A Burden of Disease and Associated Complications in Children and Adults in Mexico: A Retrospective Database Study from 2000-2019

BackgroundIn Mexico, Hepatitis A virus (HAV) infection is the leading cause of viral hepatitis in children, yet the pediatric HAV vaccine is not included in the national immunization program (NIP). Since 2013, 1-dose HAV vaccine is only given to infants of agricultural workers and in day-care centers. Mexico has intermediate HAV endemicity, yet the real burden of symptomatic HAV is unknown. The objective of this study is to describe the burden of HAV infection and severe complications in children and adults in Mexico.MethodsA retrospective database study was performed using the national surveillance system from all public health institutions in Mexico. Data on laboratory/clinically confirmed HAV cases, hospitalizations, and deaths, including for severe complications (Fulminant Hepatic Failure, Acute Liver Failure, Liver transplant), from 2000 to 2019 were analyzed (Table 1). Descriptive analyses were performed to estimate the disease burden and direct medical costs due to HAV per year for all ages, sex, and region. Table 1. Definition HAV-associated disease based on ICD-10 codes HAV, Hepatitis A Virus; ICD-10, International Classification of Diseases 10 Classification SystemResultsDuring the analysis period, the average annual incidence was 29.4 per 100,000 population (range: 43.0–10.9); the average hospitalization rate/year was 5.8% (range: 2.9%– 9.6%); and the average fatality rate/year was 0.44% (range: 0.23%–0.83%) (Figures 1a-b). Overall, there was a decreasing trend in HAV incidence over 2000–2017, with a recent increase in 2017–2019. As the incidence risk of HAV infection decreased, the mean age of infection increased. The biggest burden of HAV continued to be in children (1–9 years-old), yet there was an increase in incidence and hospitalizations (with complications) in older age groups (≥ 10–64 years-old) (Figures 2-3). The total direct medical costs (2019) due to HAV and related complications was estimated at &3.8 million Mexican pesos, which represented about 0.063% of total 2019 expenditure of the federal public budget for the health function. Figure 1. (a) Hospitalization rate (%) due to HAV infection by year in Mexico. (b) Fatality rate (%) due to HAV infection by year in Mexico. HAV, Hepatitis A Virus Figure 2. Incidence of HAV cases by age group and year in Mexico. HAV, Hepatitis A Virus; YoA, Years of Age Figure 3. Hospitalizations due to HAV infection and complications by age group and year in Mexico. HAV, Hepatitis A Virus; YoA, Years of Age ConclusionIn addition to Mexico’s intermediate HAV endemicity and improved sanitary conditions, these results describe an increase of HAV infection from children to adolescents/adults, which increases the risk for more severe and complicated disease and greater demand on healthcare resources. Our findings support the evidence for HAV vaccine inclusion in the NIP in Mexico.Disclosures Gerardo Luna-Casas, MD, The GSK Group of Companies (Scientific Research Study Investigator, Other Financial or Material Support, Company Owner (Estimatio SC)) Gilberto Sanchez-Gonzalez, PhD, The GSK Group of Companies (Scientific Research Study Investigator, Other Financial or Material Support, Company Owner (Estimatio SC)) Maria Yolanda Cervantes Apolinar, MD, The GSK Group of Companies (Employee, Shareholder) Gloria Huerta, MD, The GSK Group of Companies (Employee, Shareholder) Adriana Guzman Holst, MPH, The GSK Group of Companies (Employee)

Prognostic Factors for Survival in Patients with Gastric Cancer Treated at Two Public Health Institutions in Mexico

Objective: To analyze the clinical records of patients with gastric adenocarcinoma, treated at two different public health institutions in Mexico to determine survival rates. Methods: Cox proportional-hazards model was fitted to identify the factors involved in survival of patients. Result: The results show that subjects aged 41 to 50 years of age had a 56% lower risk of death from gastric cancer compared to those <40 years of age. Asthenia and/or adynamia, weight loss and leukocytosis increased the risk of dying. The incidence of melena was found to be a protective factor for mortality. Conclusion: At age <40 years, symptoms such as asthenia, adynamia and weight loss and leukocytosis are poor prognosis predictors in patients with gastric cancer. Melena seems to be a protective sign of gastric cancer mortality in Mexico. Given the low 5-year survival rate in patients with gastric cancer, further studies are necessary to explore the factors associated with survival to contribute to effective intervention.

Tratamiento y protección de datos personales en el sector público de la salud. El tránsito hacia el expediente clínico electrónico

Hasta hace algunos años el expediente clínico se integraba en forma exclusiva como un registro que constaba en formato físico; no obstante, con la intervención de los avances tecnológicos se ha ido evolucionando hacia la integración del expediente clínico electrónico por parte de diversas instituciones de salud en México, que han optado por la aplicación de las tecnologías de la información y comunicación (TIC), en aras de facilitar el ordenamiento de la información clínica y una atención sanitaria de mayor calidad y más enfocada en el paciente. Al respecto, si bien el expediente clínico electrónico se presenta como un instrumento de incalculable valor para los avances en el sector de la salud, al mismo tiempo plantea nuevas interrogantes no sólo desde el punto de vista médico, sino también jurídico, relacionadas con su propiedad, titularidad y acceso a la información personal en él contenida, así como la protección de los datos sensibles relativos al paciente, situación que en ocasiones resulta compleja ante la enorme cantidad de información que dicho sector genera y las distintas hipótesis en cuanto a su acceso y protección.

Hepatitis C in the three main health institutions in Mexico: a 13-year mortality and hospitalization analysis.

ABSTRACTThere are no studies in Mexico comparing Hepatitis C virus (HCV) epidemiology among Health Institutions. In this report, we described the deaths and hospitalizations due to HCV in the three main Health Institutions in Mexico: the Mexican Institute of Social Security, the Institute of Social Security for State Workers and the Ministry of Health, during the period 2004-2017. A secondary analysis was carried out across the country using hospital administrative death databases. Adult deaths and hospitalizations rates were calculated in reference to the total affiliated population and all-cause in-hospital mortality risk were also evaluated. There were 7,914 deaths and 9,002 hospitalizations due to HCV. Mortality and hospitalization rates of these three institutions together showed a continuous decrease over the analyzed time: the mortality rate dropped from 1.25 to 0.41 per 100,000 affiliates during 2004 and 2017, respectively (66.9% of change), and the hospitalization rate dropped from 2.19 to 0.39 per 100,000 affiliates (81.9% of change). All-cause in-hospital survival accounted for 89.6%. Older age groups and Ministry of Health hospitalizations were associated with higher all-cause in-hospital death rates. In conclusion, the mortality and hospitalizations rates found in this study reflect a decrease in the burden of HCV in Mexico.

PATTERNS OF DISABILITY ACCORDING TO ENROLLMENT TO HEALTH INSTITUTIONS AMONG ADULTS AGE 50 AND OLDER IN MEXICO

The aim is to describe and analyze the progression of the limitation in the Basic Activities of Daily Living (ADL) in the period 2012 - 2015, in adults over 50, grouped by their enrollment to public health services and private health institutions in Mexico (6 groups). The sociodemographic and health characteristics of each set of adults are included in this study. Disability is measured using the ADL scale. Data come from the longitudinal Mexican Health and Aging Study in the years 2012 and 2015. Multinomial logistic regressions and multi-state life tables were carried out for the analysis. Between 35% and 50% of the participants with disabilities at the beginning of the study, recovered their functionality regardless of which health institution they were enrolled to. Those individuals enrolled in two or more institutions are .33 times more likely to have no disability, compared to those who are not enrolled in any institution. Transition probabilities from active life to ADL disability rise sharply with age until 86 years old (21%), from which it begins to descend. Conditional life expectancy estimates for those initially healthy at the age 60 is 30.07 years. Of the above, 4.74 years are lived with disabilities. The disability process follows different trajectories in each group of enrollees. These trajectories were associated with socioeconomic and health factors (age, sex, diabetes and cognition). Being enrolled in 2 or more institutions is related to the prevention of disability. This is probably due to the increased access to health services.

2139 Modification of Vecchietti's Laparoscopic Technique for Neovagina in a Mexico

Study Objective To show the success obtained in the development of a low cost modified technique for neovagina by traction and use of balloon with laparoscopic assistance, based on anatomical and functional results. Design Retrospective study in female adult patients with Mayer-Rokitansky-Küster-Hauser syndrome treated by using our low cost modified technique, during the period of January 2010-January 2018. Setting N/A Patients or Participants Female patients, over 18 years of age diagnosed with Mayer-Rokitansky-Küster-Hauser syndrome, treated by our group with a neovagina using traction and balloon with laparoscopic assistance technique in the period from January 2010 to January 2018. Interventions After informed consent, in a total of 15 patients were operated with a modified surgery of Vecchietti's laparoscopic technique using an inexpensive traction device. Our group evaluated both functional outcomes and anatomical/aesthetic results. By te functional, one the female sexual function index of Rosen R. et al. was evaluated, and the anatomical/aesthetic results was evaluated with vaginoscopy exam. Measurements and Main Results A total of 15 patients were evaluated who met the inclusion criteria in a period of ten years, with a mean age of 19 years, who reported with sexual functionality and satisfaction of it after 3 years since surgery follow-up. According to the functional evaluation, the total score obtained in our study was on average of 26 pts, ruling out sexual dysfunction. The anatomical result was evaluated by vaginoscopy with a vaginal length of 11 +/-2 cm; in 3 months after surgery follow-up. Conclusion Our group concluded that the modification of Vecchietti´s laparoscopic technique, decreases widelly material costs (material cost of this technique is estimated of $10.000 dls, making it a more accessible treatment option for patients in public health institutions in Mexico. To show the success obtained in the development of a low cost modified technique for neovagina by traction and use of balloon with laparoscopic assistance, based on anatomical and functional results. Retrospective study in female adult patients with Mayer-Rokitansky-Küster-Hauser syndrome treated by using our low cost modified technique, during the period of January 2010-January 2018. N/A Female patients, over 18 years of age diagnosed with Mayer-Rokitansky-Küster-Hauser syndrome, treated by our group with a neovagina using traction and balloon with laparoscopic assistance technique in the period from January 2010 to January 2018. After informed consent, in a total of 15 patients were operated with a modified surgery of Vecchietti's laparoscopic technique using an inexpensive traction device. Our group evaluated both functional outcomes and anatomical/aesthetic results. By te functional, one the female sexual function index of Rosen R. et al. was evaluated, and the anatomical/aesthetic results was evaluated with vaginoscopy exam. A total of 15 patients were evaluated who met the inclusion criteria in a period of ten years, with a mean age of 19 years, who reported with sexual functionality and satisfaction of it after 3 years since surgery follow-up. According to the functional evaluation, the total score obtained in our study was on average of 26 pts, ruling out sexual dysfunction. The anatomical result was evaluated by vaginoscopy with a vaginal length of 11 +/-2 cm; in 3 months after surgery follow-up. Our group concluded that the modification of Vecchietti´s laparoscopic technique, decreases widelly material costs (material cost of this technique is estimated of $10.000 dls, making it a more accessible treatment option for patients in public health institutions in Mexico.

PMD90 - ECONOMIC EVALUATION OF THE IMMUNOCYTOCHEMISTRY TEST FOR THE SIMULTANEOUS QUALITATIVE DETECTION OF PROTEINS P16INKA AND KI-67 (CINTEC PLUS CYTOLOGY KIT®) IN CERVICAL TISSUE

The presence of both P16INKa and KI-67 in cervical tissue indicates HPV infections, as well as precursor and cancerous lesions, given which they can be used as a complementary test to Papanicolau. Additionally, while in Papanicolau the patient needs negative results for three years, with these biomarkers the patient only needs one negative result. A complete economic evaluation of the immunocytochemistry test for the simultaneous qualitative detection of proteins P16INKa and KI-67 (CINtec PLUS Cytology Kit®) in cervical tissue was carried out from the payer perspective, to evaluate the cost-effectiveness of this test in comparison to the available alternatives in the National Formulary. A decision tree approach was used to determine the flow of women through the screening algorithm; then, a markov model was used to evaluate disease progression of those with a diagnosis of CIN3 or cervical cancer, selected from the first model. The efficacy of the alternatives was obtained from a meta-analysis developed from a systematic review. Cost are expressed in Mexican pesos. The time horizon was 3 years with a discount rate of 5%. Deterministic and probabilistic sensitivity analysis were performed on the variables that could generate uncertainty. CINtec PLUS Cytology Kit® showed higher effectiveness than its comparator (standard monitoring) in detecting lesions CIN2 with a cost-saving of $1,852.00 and an extra effectiveness of 0.03. In cases where cervical cancer was detected, CINtec™ PLUS Cytology Kit also showed a higher effectiveness in the prompt detection (incremental effectiveness of 0.14) and a cost-saving per patient of $1,678.70. Tornado diagram showed that the costs of routine visits are the ones that affect most the results. The immunocytochemistry test CINtec PLUS Cytology Kit® for the simultaneous detection of proteins P16INKa and KI-67 in cervical tissue is a cost-effective option in comparison to available alternatives in public health institutions in Mexico.

10 years Analysis of Diabetes-related Major Lower Extremity Amputations in Mexico

Little is known about diabetes-related major lower extremity amputations (DMLEA) burden in México. To describe DMLEA hospitalization rates, in-hospital survival rates, characteristics associated with all-cause in-hospital mortality and direct costs of hospitalization during the 2005-2015 period, in the two principal Health Institutions in Mexico: the Mexican Institute of Social Security (IMSS) and the Ministry of Health (MoH). A secondary data analysis was conducted using hospital discharge information obtained from administrative databases. Non-traumatic DMLEA hospitalizations in adults aged 20years and over were analyzed. Hospitalization characteristics and in-hospital all-cause mortality risk were also assessed. Direct costs of hospitalization including length of hospital stay, surgical procedure, wound care and medical emergency consultation were accounted in U.S. dollars (USD, 2015). There were 34,051 DMLEA hospitalizations and 1,268 in-hospital deaths. DMLEA hospitalizations rates increase from 4.71-6.12 × 100,000 affiliates during 2005 and 2015 respectively for both institutions together. Females and age ≥60years were associated with all-cause in-hospital death. The all-period direct costs of hospitalization amounted to $132.51 million USD ($86.30 in the IMSS and $46.21 in the MoH), and showed a sustained increment: from $4.14 million USD in 2005 to $24.84 million USD in 2015 (percentage increase 499.3%). In-hospital mortality was 3.7%. Female sex and age ≥60years were characteristics associated with all-cause in-hospital death. The increase in the number of DMLEA hospitalizations and their direct costs, reflects a negative progression of diabetes in the two largest Health Institutions in Mexico.

Validación de la escala UWES-9 en profesionales de la salud en México

Objective. To examine the psychometric properties of the short scale of engagement at work (UWES-9) compared to the original scale (UWES-15) in a sample of health professionals in Mexico. Method. The UWES- 15 and UWES-9 scales were applied in a sample of 475 professionals who belonged to two health institutions in Mexico: Mexican Institute of Social Security ( n = 249) and Secretary of Health ( n = 226). Results. The results from the MultiGroup Confirmatory Factor Analyses confirmed the three-factorial structure (vigor, dedication and absorption) in both scales. In addition, the UWES-9 showed rates of adjustment significantly better to those obtained in the long version, being the structure invariant in both institutions. Conclusion . The validity of the short measure of the UWES in Mexican health professionals is confirmed.

Epidemiological and financial indicators of hypertension in older adults in Mexico: challenges for health planning and management in Latin America.

This study estimated the epidemiological and financial indicators of hypertension in order to identify challenges in strategic planning and management for health systems in Latin America. This is a longitudinal study with a population base of 187 326 reported cases of older adults with hypertension, diagnosed at public health institutions in Mexico. The cost-evaluation method that was used was based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2015-2017, time series analyses and probabilistic models were constructed according to the Box-Jenkins technique. Regarding epidemiological changes for 2015 versus 2017, an increase of 8-12% is expected (p < 0.001). Comparing the economic impact in 2015 versus 2017 (p < 0.001), there is a 22% increase in financial requirements. The total amount estimated for hypertension in 2015 (in US dollars) was $1 575 671 330. It included $747 527 259 as direct costs and $829 144 071 as indirect costs. If the risk factors and the different healthcare services for older adults remain as they are currently, the financial consequences of epidemiological changes in older adults will have a major impact on the users' pockets, following in order of importance, on social security providers and on public assistance providers. The challenges and implications of our findings in the context of universal coverage reforms in Latin America reinforce the urgent need to develop more and better strategic planning for the prevention of chronic diseases. Copyright © 2016 John Wiley & Sons, Ltd.

The Role of Health Inequality in the Maternal Health Services Provided by Public Institutions in Mexico

This work aims to determine the role of inequality in the provision of maternal health services among five regions in Mexico (northwest, northeast, central, the Mexico City-State of Mexico region and the south). We consider the most important service providers corresponding to the main health institutions in Mexico (IMSS, ISSSTE, SESAS, IMSS-Oportunidades). Therefore, a cross-sectional prospective study was conducted to analyze eight intervention packages (Prenatal Care, Syphilis, Influenza, Obstetric Urgent Care, HIV in pregnancy, delivery care, neonatal care and accessibility) offered by the Maternal and Perinatal Health (MPH) program. A quantitative analysis demonstrates low to marginal performance of the MPH program in three regions (South, Mexico City-State of Mexico and the Northwest) and marginal in two other regions (Central and Northeast). Furthermore, four of the intervention packages presented the lowest performance in the South (Prenatal Care, Syphilis, Influenza and Obstetric Urgent Care), as did the average of the total of the MPH packages. The performance of HIV in Pregnancy package was marginal in the Southern and Mexico City-State of Mexico regions and Neonatal Care was low in the Northwest. The assessment of the MPH intervention packages allows us to identify their strengths and weaknesses. This information allows us to identify similarities and differences among the geographical regions in order to describe and analyze the strengths, weaknesses, opportunities and threats in the current system and hence to improve the decision making regarding the Maternal and Perinatal Health Programs in Mexico. The results suggest that a homogenization has taken place in terms of the low quality of the services.

Revisión de modelos para el análisis de dilemas éticos

In pediatric medical practice it is common to encounter situations that represent a dilemma for health professionals. A dilemma occurs when ethical problems found in professional practice cause serious internal conflicts because they imply actions that contradict their colleagues, employees, or their own personal values and are classified as personal value conflicts, conflicts with other professionals, conflicts with clients and with organizations.A literature review allowed identifying different models to debate these types of dilemmas. The present work is a review of the search of scientific articles using databases such as Ebsco Host, ProQuest, Ovid, and InMex as well as metasearch tools such as metacrawler. The models found are as follows: Model of Anne Davis, Nijmegen method, Method of Diego Gracia, Integral method, Bochum Center Ethics model, Model of Brody and Payton, Model of Curtin and Flaherty, Model of Thompson and Thompson, SAD method, Model of Javier Morata, Model of Elaine Congress, IFSW model, Model of Loewenberg and Dolgoff, Ley Social Model, DOER method, Model of Brommer, Model of Corey and Callanan, Model of Pope and Vasquez, Model of Bush, Connell and Denney, Model of Ferrell, Gresham and Fraedrich, and Model of Hunt and Vitell.The key criteria shared in the different models are a) specifying the ethical dilemma, b) description of the facts, c) value definition, moral code and facts, decision making and d) identifying alternative solutions. In order to review the literature, some models are explained with the purpose of identifying and representing critical elements that clinical ethics committees could use in a practical manner in pediatric health institutions in Mexico.

Determination of the size and weight through the heel‐knee length compared to direct measurement in patients who use wheelchairs (1026.3)

Introduction: Due to the lack of appropriate anthropometric equipment in many health institutions in Mexico , it was decided to compare direct and indirect methods in making measurements , we attempt to evaluate alternative strategies to assist in the realization of the nutritional assessment . Aim. Determine the height and weight through the knee‐height compared to direct measurement in patients who use wheelchairs. Methodology: The study population consisted of seventeen adult male patients who are hospitalized at the Psychiatric Hospital “ Dr. Samuel Ramirez Moreno”; determinations for this study were height, weight, knee‐height, calf circumference, Mid‐arm circumference, subscapular skinfold thickness, arm span and weight through chair scale for weighing while seated. Results: The weight obtained by direct and indirect method (knee‐height Chumlea) is equals (Mann‐Whitney, P = 0.121 ) , so it is reliable to use any method in this population. In the case of height obtained with the method of Chumlea and arm span, was mostly unchanged this to find the mean value of 156.74 and 153 ( “t” Student, p = 0.181). Conclusions: Indirect methods of knee‐height weight determination and method of Chumlea and arm span to height, can be used in patients in a wheelchair at the hospital attended.