Services In Mexico Research Articles

243.6: Addressing disparities liver organ allocation: Towards equitable access to transplantation services in Mexico.

243.6: Addressing disparities liver organ allocation: Towards equitable access to transplantation services in Mexico.

COVID-19 pandemic exacerbation of disparities in access to public abortion services in Mexico

BackgroundWe describe clients in Mexico City’s public abortion programme, Interrupción Legal de Embarazo (ILE), during the COVID-19 pandemic and test whether the pandemic exacerbated inequities in access.MethodsWe conducted a cohort...

Value Added Taxbenefits for hotel services in Mexico and other countries.

Tourism is one of the most important economic activities for the development of any country, which is why different benefits are granted to this sector. The objective of this research is to know the VAT benefits for hotel services that exist in Mexico and other countries. It is a qualitative investigation, with a non-experimental, cross-sectional and exploratory design. There are a series of benefits in the different countries that seek to promote and stimulate international tourism; these are granted through tax incentives, such as exemption from paying taxes for the tourist for the services received, to the refund of the same at the time of leaving the visited country. Taking into account how important this activity is due to the economic development it generates, the jobs it creates and the inflow of foreign currency, it is vital to grant it benefits.

Evaluating the Screening and Enrollment of People at Risk of HIV in Mexico's Preexposure Prophylaxis Demonstration Project, 2018-2020.

Screening tools in which participants self-report sexual behaviors can identify people at risk of HIV acquisition for enrollment in preexposure prophylaxis (PrEP). We compared enrollment outcomes (ie, receiving PrEP vs being excluded by a counselor or declining PrEP) in Mexico's PrEP demonstration project and evaluated the validity of a 4-criteria PrEP eligibility tool in which participants self-reported risk behavior-having condomless anal sex, transactional sex, a partner living with HIV, or a sexually transmitted infection-as compared with PrEP eligibility assessed by a counselor. We recruited men who have sex with men and transwomen who were offered PrEP services in Mexico. We characterized participants according to enrollment outcome and identified underlying factors through logistic regression analyses. We calculated the sensitivity and specificity of the self-reported risk criteria, using the counselor's risk assessment as the point of reference. Of 2460 participants, 2323 (94%) had risk criteria of HIV acquisition according to the 4-criteria tool; 1701 (73%) received PrEP, 247 (11%) were excluded by a counselor, and 351 (15%) declined PrEP despite being considered eligible by the counselor. Participants who were excluded or who declined PrEP were less likely to report HIV risk behaviors than those who received PrEP, and participants who declined PrEP were more likely to be transwomen (vs men who have sex with men) and aged ≤25 years (vs >25 y). The 4-criteria risk tool had high sensitivity (98.6%) and low specificity (29.8%). The screening tool identified most participants at risk of HIV acquisition, but counselors' assessment helped refine the decision for enrollment in PrEP by excluding those with low risk. Public health strategies are needed to enhance enrollment in PrEP among some groups.

Seeking care across the US-Mexico border: The experiences of Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress

BackgroundMany Latinx and Indigenous Mexican populations in the United States Southwest live in unincorporated communities in the US-Mexico borderlands called colonias. These environmental justice communities often lack basic infrastructure, including healthcare services, prompting many to seek services across the border. However, due to geopolitical factors more vulnerable caregivers are limited to utilize healthcare services in the US. This paper reports the experiences and healthcare decision-making of caregivers living in colonias in the US-Mexico border region who care for children with respiratory health conditions. MethodsThis study was carried out from September to December 2020. Focus groups and interviews were conducted with Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress. Qualitative interviews elicited caregivers' perspectives on the environmental factors affecting children's chronic health conditions and use of healthcare services. The analysis employed the concept of structure vulnerability to theorize geography as a structural determinant of health for caregivers faced with making healthcare decisions for their suffering from respiratory health conditions. A survey was administered to collect basic sociodemographic information. ResultsA total of 36 caregivers participated in the study. Structural factors including unincorporated community status and government inaction intersected with social determinants of health to prompt caregivers to cross the US-Mexico border to access healthcare services in Mexico for their children. Yet, more vulnerable caregivers (i.e., those without documentation status in the US) and their children, accessing healthcare services in the US was not an option limiting caregivers' ability to meet their children's healthcare needs. In such cases, geography acts as a structural determinant of health. ConclusionThis study shows the importance of geography in health. Rural unincorporated colonias located in the borderlands are precariously located and lack basic critical infrastructure including healthcare access. Within such places, historically and socially marginalized populations become invisible, are subject to the health effects of environmental hazards, and are limited depending on their positionality and thus vulnerability to healthcare services.

Assessment and Integrated Model of Language Components: Implications for Basic and Special Education Services in Mexico

VALUTAZIONE E MODELLO INTEGRATO DI COMPONENTI DEL LINGUAGGIO: IMPLICAZIONI PER I SERVIZI DI EDUCAZIONE BASICA E SPECIALE IN MESSICO Abstract Language development is important in a person’s life because it is the basis for some learning processes; failure to achieve optimal levels of language development can result in problems related to reading. The present study had two main objectives: first, to assess the communication skills corresponding to the different language components, as well as their relationship with the literacy learning process in children; and second, to explain the relationship between oral communication skills, letter knowledge and reading ability. To achieve this goal, we examined reading ability, letter knowledge, and oral communication skills through three different instruments. We evaluated total of 121 children enrolled in three different elementary in Hermosillo, Mexico schools were evaluated. Among the findings, 54.5% of the participants scored less than one standard deviation below the mean in language development, indicating a possible delay in the reading skills. The results of our model also confirmed that reading ability is predicted by letter knowledge and oral communication skills. The model suggests that letter knowledge has an indirect effect on the relationship between oral communication skills and reading ability.

Adolescent use of outpatient health services in Mexico: their health needs and associated factors

Objective. To estimate adolescent use of outpatient services, identifying their health needs and associated socioeconomic factors. Materials and methods. Using data from Ensanut 2018-2019, adolescents (ages 10-19) with health needs and those receiving care from health personnel (users) were identified. Needs were analyzed by sex and socioeconomic status (SES). Logistic models were used to assess the factors associated with the use of health care and choice of provider. Results. 6% of adolescents reported health needs, of whom 64% used outpatient services. Respiratory and gastrointestinal infections were the principal health needs prompting use of services overall. However, by SES, motivations centered on pregnancy for the poor and accidental injuries for the wealthy. One in three adolescents with health needs, particularly the poorest, received no care. Living with a partner and having health insurance were the main predictors of use. Greater schooling among household heads and higher SES correlated with the use of private services. Conclusions. Despite being aware of their health needs, adolescents are the group that uses health services the least in Mexico. Promoting preventative and timely treatment for this population would encourage youths to seek care more often.

From Risk Perception to the Use of Technical Restrictions of SVoD Services in Mexico, the Mediating Role of Parent Involvement and Knowledge

ABSTRACT Using parental mediation and protection motivation theory, a serial moderated mediation model was developed to study what drives parents to employ technical restriction tools offered by Subscription Video on Demand (SVoD) services. Based on a survey of 1,022 parents of elementary school children (generally between the ages of 5–12) in Mexico, it was found that for Netflix and Amazon Prime Video, the use of technical restrictions appears to be triggered by parents’ perception of risk and that parental involvement in children’s media use and perceived knowledge of the available technical restrictions mediates the usage of the parental control tools.

Mental health help-seeking in Mexico.

Most people in need of mental health services in Mexico do not seek formal support or professional services to address their mental health needs. Understanding help-seeking behaviors is crucial to addressing underutilized mental health services and to leverage health promotion efforts. Data were collected as part of a larger research project on stigma and help-seeking for mental-health-related concerns in Mexico. A convenience sample of 469 adults residing in Mexico City participated in the study using an experimental vignette methodology assessing stigma toward individuals with mental health conditions, along with characteristics and demographic correlates of help-seeking. All survey measures were administered in Spanish. A structural regression was conducted for the outcome 'openness to professional help seeking for mental health problems' as a latent variable. Compared with males, females were more open to professional help seeking (b = 0.09, p = 0.038), as were people who endorsed higher spirituality (b = 0.01, p = 0.006); while people who experienced self-stigma were less open to professional help-seeking for mental health concerns (b = -0.15, p = 0.005). Self-stigma was a major driver of low service utilization. Contrary to previous studies, spirituality was a significant positive predictor of professional help-seeking. A more nuanced understanding of mental health help-seeking in Mexico can be useful for outreach efforts to increase service utilization both in Mexico and among Latinos in the United States (US). Given historical, geographic, and cultural ties with the US, it is important to understand mental health help-seeking in Mexico, which may relate directly to help-seeking behaviors in many US Latinos who have immigrated to the US. Directions for future research and practice implications are discussed, including a roadmap for health promotion activities.

P31-019-23 Weight and Height Discrimination and Access to Health Services in Mexico

P31-019-23 Weight and Height Discrimination and Access to Health Services in Mexico

Efficiency, quality, and management practices in multidisciplinary and traditional diabetes healthcare services in Mexico

AbstractDiabetes is a major health issue in middle-income countries like Mexico. Multidisciplinary healthcare (MHC) models aim to improve diabetes care and reduce costs. However, the relationship between management practices, efficiency, and quality of care in MHC and traditional healthcare (THC) models is unclear. This study evaluates the efficiency and quality of diabetes healthcare models in Mexico, identifying associated management practices. Methodology. Data from a retrospective longitudinal analysis were used to compare 20 THC and 20 MHC. Technical efficiency (TE) scores were estimated using data envelopment analysis (DEA), quality scores were calculated based on provider competence and patient performance. The relationship between efficiency, quality, and management practices was analyzed using positive deviance regression. Results. DEA analysis indicate higher TE in MHC units (mean score: 65, SD = 19) compared to THC units (mean score: 24, SD = 23). MHC units scored 78.55 (SD = 18.71) in performance score, while THC units scored 37.7 (SD = 18.97). MHC units also outperformed THC units in competence scores (mean: 68.71, SD = 18.31 vs. 49.97, SD = 23.31). Several management practices were associated with best performance in terms of both efficiency and quality strategic thinking, human resource management, financial management, operations management, performance management, and governance. Conclusion. This study highlights the higher efficiency of MHC models in diabetes care compared to THC models in Mexico. However, both models require improvement in quality. Understanding the relationship between management practices, efficiency, and quality can guide policymakers in enhancing diabetes care in low- and middle-income countries.

Contraceptive access experiences and perspectives of Mexican-origin youth: a binational qualitative study

Access to comprehensive contraceptive services for youth is essential to improving sexual and reproductive health. However, youth in many countries still face substantial obstacles to contraceptive access and use. The purpose of this study is to compare the contraceptive access experiences and perspectives of pregnant and parenting Mexican-origin youth in Guanajuato, Mexico, and Fresno County, California. Focus groups and in-depth interviews were conducted in Spanish and English among female youth in Mexico (n = 49) and California (n = 25). Participants also completed a brief sociodemographic survey. Using a modified grounded theory approach, qualitative data were coded and thematically analysed based on Penchansky and Thomas's Theory of Access, and results were compared by location. Although knowledge of a service provider was high among youth in both locations, access was affected by social, cultural, and institutional dynamics and contraceptive use was mixed. Across locations, participants described obstacles to accessing their preferred method. Participants worried about parental and peer opinions about their use of contraception (acceptability), and about perceived side effects including infertility and pain (adequacy). Contextual differences included lack of contraceptive choice in Guanajuato (availability) and incomplete knowledge about options in Fresno County (awareness). The power to request and receive their method of choice (agency) emerged as an important dimension that was not part of the original theory. Latina youth living in Mexico and the United States face multiple challenges accessing needed contraceptive options and services. Recognising and reducing these barriers can strengthen the contraceptive care landscape and promote the reproductive health and agency of young people. DOI: 10.1080/26410397.2023.2216527 Plain language summary: Although sexually active youth need access to comprehensive sexual and reproductive health services, youth in many countries face substantial barriers to care. This study compares the experiences of pregnant and parenting youth in accessing contraceptive services in Mexico and the United States. We conducted interviews and focus groups with 74 Mexican-origin young women and found that contraceptive use and access was affected by their concerns about parental and peer opinions as well as by provider attitudes. In Mexico, several participants reported being denied their preferred method by their provider. Identifying and addressing barriers to services can improve the quality of care and the reproductive health of young people.

Abstract P5-07-06: Prospective cohort of breast cancer patients exposed to a navigation program for timely access to referral services in Mexico

Abstract Background: Patient navigation (PN) is an essential component of cancer care that reduces barriers and enhances the provision of comprehensive, patient-centered care. PN programs and evidence regarding their effectiveness in low- and middle-income countries are limited. This study aimed to assess whether a PN program for the systematic identification of breast cancer (BC) patients’ medical and support needs facilitated referral and timely access to the specialty and supportive care services they required. Methods: This prospective cohort included women ≥18 years with a recent BC diagnosis (≤3 months [m]), treated at Hospital Zambrano Hellion TecSalud in Mexico, and who provided signed informed consent to participate in the PN program from Apr-21 to Jul-22. Participants completed a series of target questions and validated questionnaires to systematically identify their health needs at baseline, 3 m and 6 m since diagnosis. Subsequently, the navigator had a face-to-face or remote meeting with each patient to inform them about the needs detected at each timepoint. According to these needs, the navigator provided referral to the required services. However, it was each patient’s decision whether she attended to the recommended services. Patients’ attendance to referrals provided at baseline and 3 m were assessed at 3 m and 6 m, respectively. Descriptive statistics were employed. Results: During the analyzed period, 263 patients were invited to participate in the study. Of these, 161 (61%) agreed to participate, 57 (22%) agreed but did not complete any survey, and 45 (17%) denied participation. At the time of the analysis, 148, 119 and 86 patients had completed baseline, 3 m and 6 m navigation, respectively. Median time from BC diagnosis to the baseline navigation meeting post survey-completion was 46 days (12-90). Patients’ median age at baseline was 48 years (24-88). Most had ≥high school education (93%), were unemployed (51%) and were married/in domestic partnership (73%). As for medical insurance, most had public (32%) or both public and private coverage (32%), while the rest had private (26%) or no insurance (9%). Patients’ referrals according to their needs and the rate of attendance to those services are detailed in the Table. The main barriers that were qualitatively identified for non-attendance to referral services were time restrictions, patient-provider miscommunication, medical coverage limitations, and financial constraints. Feedback regarding the PN program was provided in 72 cases. All respondents were very satisfied (97%) or satisfied (3%) with the program; affirmed the navigator had facilitated their referral to all (97%) or some (3%) of the services they believed they needed; and stated that the program aided to better cope with their illness (100%). Conclusion: Patients experienced diverse health needs during their trajectory through BC, mainly in terms of psychological support, genetic counseling, maintenance of an adequate weight and access to support groups. However, a suboptimal proportion of patients received attention by the required services. This PN program effectively detected patients’ needs and provided referrals to specific services. Moreover, patients were highly satisfied with the program and believed it aided their coping process. Yet, several barriers that hinder attendance to the referral services might exist and should be identified to enhance the provision of timely, comprehensive care. Table. Patients’ referral and attendance to specialty and supportive care services. Citation Format: Fernanda Mesa-Chavez, Emmeline Rochelle-Palacios, Mauricio Canavati-Marcos, Cynthia Villarreal-Garza. Prospective cohort of breast cancer patients exposed to a navigation program for timely access to referral services in Mexico [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-06.

Post-COVID19 strategies to support the health care interactions of U.S. Mexican immigrants and return migrants with the Mexican health system

BackgroundMexican migrants in the United States (U.S.) are twice more likely to underutilize health care and to experience low quality of care compared to the U.S.-born population. Current and former Mexican migrants in the U.S have used health services in Mexico due to lower cost, perceived quality, cultural familiarity, and the geographic proximity of the two countries. ObjectiveThis study aims to characterize the different health care interactions of current and former U.S. Mexican migrants with public and private health care organizations of the Mexican health system and to identify strategies to improve health care interactions post-COVID19. MethodsWe use a typology of cross-border patient mobility to analyze the facilitators and barriers to improve the health care interactions of current and former U.S. Mexican migrants with the Mexican health system. Our policy analysis framework examines how an outcome can be achieved by various configurations or combinations of independent variables. The main outcome variable is the improvement of health care interactions of U.S. Mexican migrants and return migrants with different government agencies and public and private health care providers in the Mexican health system. The main explanatory variables are availability, affordability, familiarity, perceived quality of health care and type of health coverage. FindingsAs the Mexican health system emerges from the COVID19 pandemic, new strategies to integrate current and former U.S. Mexican migrants to the Mexican health system could be considered such as the expansion of telehealth services, a regulatory framework for health services used by transnational patients, making enrollment procedures more flexible for return migrants and guiding return migrants as they reintegrate to the Mexican health system. ConclusionsThe health care interactions of U.S. Mexican migrants with the Mexican health system are likely to increase in the upcoming decades due to population ageing. Regulatory improvements and programs that address the unique needs of U.S. Mexican migrants and return migrants could substantially improve their health care interactions with the Mexican health system.

Enhancing School Health Services in Mexico: A Pathway to Student Well-being

Enhancing School Health Services in Mexico: A Pathway to Student Well-being

An exploration of card payment services in Mexico: A managerial and customer perspective

An exploration of card payment services in Mexico: A managerial and customer perspective

Epidemiología y mortalidad hospitalaria por evento vascular cerebral en un hospital de la Ciudad de México: estudio prospectivo de 2 años.

To describe patient characteristics, case fatality rate, and assess predictors of in-hospital acute ischemic (IS) or hemorrhagic stroke (HS) mortality. Adult patients with confirmed stroke were recruited from January 1st, 2018 to December 31st, 2019.Data collect included demographic and laboratory characteristics, risk factors, and clinical outcome. A binary logistic regression model with relative risk and 95% confidence interval was performed. A total of 172 patients were recruited; IS was present in 78.5% of patients. The mean of age was 75.27 ± 11.44 years in IS group and 71.62 ± 11.72 years in HS group. Hypertension was present in > 70% of patients in both groups; the in-hospital case fatality rate was 15.5% for IS and 21.5% for HS. Severe NIHSS score (> 13) was significantly associated with in-hospital mortality in both stroke types. Hypertension was the most common risk factor in patients with stroke. The in-hospital case fatality rate was lower to previously reported in Mexico. Nevertheless, it remains high compared to reported in developed countries. NIHSS scale was the strongest predictor of mortality. There is a need to develop more effective stroke management services in Mexico.

The road to recovery: an interrupted time series analysis of policy intervention to restore essential health services in Mexico during the COVID-19 pandemic.

BackgroundRecovery of health services disrupted by the COVID-19 pandemic represents a significant challenge in low- and middle-income countries. In April 2021, the Mexican Institute of Social Security (IMSS), which provides health care to 68.5 million people, launched the National Strategy for Health Services Recovery (Recovery policy). The study objective was to evaluate whether the Recovery policy addressed COVID-related declines in maternal, child health, and non-communicable diseases (NCDs) services.MethodsWe analysed the data of 35 IMSS delegations from January 2019 to November 2021 on contraceptive visits, antenatal care consultations, deliveries, caesarean sections, sick children’s consultations, child vaccination, breast and cervical cancer screening, diabetes and hypertension consultations, and control. We focused on the period before (April 2020 – March 2021) and during (April 2021 – November 2021) the Recovery policy and used an interrupted time series design and Poisson Generalized Estimating Equation models to estimate the association of this policy with service use and outcomes and change in their trends.ResultsDespite the third wave of the pandemic in 2021, service utilization increased in the Recovery period, reaching (at minimum) 49% of pre-pandemic levels for sick children’s consultations and (at maximum) 106% of pre-pandemic levels for breast cancer screenings. Evidence for the Recovery policy role was mixed: the policy was associated with increased facility deliveries (IRR = 1.15, 95%CI = 1.11-1.19) with a growing trend over time (IRR = 1.04, 95%CI = 1.03-1.05); antenatal care and child health services saw strong level effects but decrease over time. Additionally, the Recovery policy was associated with diabetes and hypertension control. Services recovery varied across delegations.ConclusionsHealth service utilization and NCDs control demonstrated important gains in 2021, but evidence suggests the policy had inconsistent effects across services and decreasing impact over time. Further efforts to strengthen essential health services and ensure consistent recovery across delegations are warranted.

Loss of coastal ecosystem services in Mexico: An approach to economic valuation in the face of sea level rise

The economic valuation of coastal ecosystem services is a critical step for the design of sound public policies that support the preservation of the services that nature provides to society in the context of climate change. Using the value transfer method, we obtained the economic valuation that represents the loss of coastal ecosystem services caused by sea level rise in Mexico. Using the Bathtub method, digital elevation models and sea level data, we identified the areas in the country prone to flooding and the associated ecosystem impacts. In Mexico, the annual economic loss caused by the disappearance of coastal ecosystem services is estimated at $6,476,402,405 USD, where wetlands represent the greatest economic losses, since they represent the largest affected ecosystem by area. However, beaches and dunes are the most valued ecosystem due to the economic activities that occur in these areas. In the mangroves, the service as habitat, refuge and nursery is the most valued for its positive relationship with fisheries. The states with the most economic losses are Baja California Sur, Sinaloa and Campeche. The protection of the coastal zone in Mexico should be a priority in the development strategies in the country because its loss and/or rehabilitation imply high economic costs and compromises the wellbeing of society.

Care friendliness in adolescent sexual and reproductive health services in Mexico and a characterisation of their clients.

Sexual and reproductive health (SRH) is a very important issue in public health programs in low -and middle-income countries (LMICs). Health services that meet specific and differentiated needs of adolescents are increasingly relevant in LMICs. To provide quality services, it is necessary to know the profile of its users and the perspective that adolescents have about SRH services aimed at them. We conducted a cross-sectional analysis of primary data from a survey of 489 adolescents recruited in 11 primary-care facilities in the state of Morelos, Mexico. We followed the guidelines outlined in the World Health Organization Quality Assessment Guidebook: A guide to assessing health services for adolescent clients. Data on friendliness of services were obtained through 70 questions divided into 18 characteristics which, in turn, were grouped into five domains: equity, accessibility, acceptability, appropriateness, and effectiveness. The "friendliness" (a proxy for quality of care) of services was measured according to an additive index of friendliness (FI) ranging from 0 (no friendliness) to 1 (maximum friendliness). We also described the socio-demographic, SRH, and service utilization profiles of clients. The health services analysed were characterised as having low levels of accessibility (FI=0.62) and effectiveness (FI=0.77), moderate acceptability (FI=0.84), and high levels of appropriateness (FI=0.93) and equity (FI=0.92). Of the total number of adolescents surveyed, 51% stated that they had initiated a sexual life, 37% did not use any method of protection during their first sexual intercourse and 64% of the adolescents had already experienced a pregnancy. It is essential to improve the accessibility and effectiveness dimensions of adolescent-friendly services in Mexico. This requires the implementation of strategies specifically designed to promote well-informed, planned and healthy sexual behaviours that avert risk and vulnerability. Strategies need to consider the profile of the adolescent client population.