Summary
Objective To assess the capacity for research collaboration and implementation research in strengthening networks and institutions in developing countries.
Methods Bibliometric analysis of ...implementation research on diseases of poverty in developing countries from 2005 to 2010 through systematically searching bibliographic databases. Methods identified publication trends, participating institutions and countries and the cohesion and centrality of networks across diverse thematic clusters.
Results Implementation research in this field showed a steadily growing trend of networking, although networks are loose and a few institutions show a high degree of centrality. The thematic clusters with greatest cohesion were for tuberculosis and malaria.
Conclusions The capacity to produce implementation research on diseases of poverty is still low, with the prominence of institutions from developed countries. Wide ranges of collaboration and capacity strengthening strategies have been identified which should be put into effect through increased investments.
Objectif: Evaluer la capacité de collaboration de recherche et de la recherche sur l’implémentation dans le renforcement des réseaux et des institutions des pays en développement.
Méthodes: Analyse bibliométrique de la recherche sur l’implémentation dans les maladies de la pauvreté dans les pays en développement de 2005 à 2010 à travers la recherche systématique des bases de données bibliographiques. Les méthodes ont identifiées les tendances en matière de publications, les institutions et les pays participants et la cohésion et centralité des réseaux à travers divers groupes thématiques.
Résultats: La recherche sur l’implémentation dans ce domaine a montré une tendance en croissance continue des réseaux de collaboration bien que ceux‐ci soient lâches et que certaines institutions présentent un degréélevé de centralité. Les groupes thématiques avec la plus grande cohésion sont pour la tuberculose et le paludisme.
Conclusions: La capacité de produire une recherche sur l’implémentation pour les maladies de la pauvreté est encore faible, avec une proéminence des institutions des pays développés. De larges gammes de collaboration et de stratégies de renforcement de la capacité ont été identifiées, qui devraient être effectives à travers l’augmentation des investissements.
Objetivo: Evaluar la capacidad de colaboración y de investigación en la implementación en el fortalecimiento de las redes e instituciones de países en vías de desarrollo.
Métodos: Análisis bibliométrico de la investigación en la implementación en enfermedades relacionadas con la pobreza, en países en vías de desarrollo, entre el 2005 y el 2010 mediante una búsqueda sistemática de bases de datos bibliográficas. Los métodos identificaron tendencias, instituciones y países participantes y la cohesión y centralización de las redes a lo largo de diversos grupos temáticos.
Resultados: La implementación de la investigación en este campo mostró una tendencia creciente de interacción aunque las redes son débiles y pocas instituciones muestran un alto nivel de centralización. Los grupos temáticos con mayor cohesión eran los de tuberculosis y malaria.
Conclusiones: La capacidad de producir investigación sobre implementación para enfermedades relacionadas con la pobreza es aún baja, con el protagonismo de instituciones de países desarrollados. Se han identificado amplios rangos de colaboración y estrategias para el fortalecimiento de capacidades que deberían ponerse en marcha con mayores inversiones.
Abstract
Mexico's system is dominated by corporatist, social insurance organizations governed by employer and employee trade unions in close relationship to the federal government, supplemented with ...government services for the uninsured, and a thriving private sector. Social insurance covers about half the population, although coverage for most is sporadic. Furthermore, these organizations have divergent service, financing, and governance structures, posing inequities and barriers in responding to beneficiary needs. Profiting from a growing capacity gap, the private sector now provides almost half of total outpatient consultations. Major public health challenges include obesity and diabetes, and social and health inequalities. Fiscal policy and improved preventive programs across institutions have had some effect on reducing health risks. Health policy has aimed towards universal coverage through coordinating government providers and strengthened public health programs. Since 2004 Seguro Popular had made progress toward universal health coverage, protecting about 85% of the population, reducing catastrophic expenses, and increasing coverage of high-cost interventions. However, to address health care package limits, attain universal financial protection and respond to corruption, President Lopez Obrador's administration canceled Seguro Popular from 2020 and established the National Health Institute for Wellbeing (INSABI). INSABI aims to equalize benefits across the insured and uninsured and re-centralize health authority by establishing the federal government as sole funder and provider of coverage for the uninsured. The separation of funding and provision, a hallmark of Seguro Popular, was replaced with supply-side funding, following the social insurance model. While these policies have challenges, they could facilitate integrating social insurance and tax funding into a single-payer capable of increasing efficiency and continuity of care as well as achieving greater equity.
Although COVID-19 (coronavirus disease 2019) in children is usually mild, they need hospitalization and intensive care in exceptional cases. Adverse outcomes have been observed mainly among children ...with comorbidities, justifying their vaccination. This study aimed to assess the risk of hospitalization and death in Mexican children and adolescents with COVID-19 and comorbidities.
A cross-sectional study was performed on 366,542 confirmed COVID-19 cases under 18 years, reported by the Mexican Ministry of Health up to July 9, 2022. Logistic regression models were performed.
The mean age was 10.98 years, 50.6% were male, and 7.3% reported at least one comorbidity. The percentage of hospitalization and death in COVID-19 patients with and without comorbidities was 3.52%, and 0.20%, respectively; children with comorbidities presented a higher percentage of hospitalization (14.0%) and death (1.9%). The probability of hospitalization was 5.6 times greater in pediatric patients with COVID-19 and comorbidities, and the comorbidities that showed the greatest risk were immunosuppression (odds ratio (OR) 22.06), chronic kidney disease (CKD) (11.36), and cardiovascular diseases (5.66). The probability of death in patients with comorbidities was 11.01 times higher than in those without diseases, and the highest risk was observed in those with CKD (OR 12.57), cardiovascular diseases (6.87), and diabetes (5.83).
Pediatric patients with comorbidities presented a higher risk of severe COVID-19. It is suggested that vaccination should be promoted with greater emphasis on pediatric patients with comorbidities.
Retos a la Encuesta Nacional de Salud y Nutrición 2017 González-Block, Miguel A.; Figueroa-Lara, Alejandro; Ávila-Burgos, Leticia ...
Salud pública de México,
04/2017, Letnik:
59, Številka:
2, mar-abr
Journal Article
Recenzirano
Odprti dostop
Señor editor: La Encuesta Nacional de Salud 2017 deberá levantarse a cinco años de la Ensanut 2012, siguiendo la periodicidad esperada. La Ensanut 2017 será una herramienta fundamental para dar ...cuenta de tres importantes tendencias en el panorama de la salud de México: la predominancia de las enfermedades crónicas no transmisibles, el acercamiento a la protección financiera universal y la integración de redes de atención personalizadas. La Ensanut 2012 aportó información clave para las políticas en materia de: prevalencia del sobrepeso, obesidad, diabetes e hipertensión; así como en relación con las oportunidades para mejorar la calidad de la atención y el desencuentro entre actividad física y sedentarismo…
Research is an essential tool in facing the challenges of scaling up interventions and improving access to services. As in many other countries, the translation of research evidence into drug policy ...action in Tanzania is often constrained by poor communication between researchers and policy decision-makers, individual perceptions or attitudes towards the drug and hesitation by some policy decision-makers to approve change when they anticipate possible undesirable repercussions should the policy change as proposed. Internationally, literature on the role of researchers on national antimalarial drug policy change is limited.
To describe the (a) role of researchers in producing evidence that influenced the Tanzanian government replace chloroquine (CQ) with sulfadoxine-pyrimethamine (SP) as the first-line drug and the challenges faced in convincing policy-makers, general practitioners, pharmaceutical industry and the general public on the need for change (b) challenges ahead before a new drug combination treatment policy is introduced in Tanzania.
In-depth interviews were held with national-level policy-makers, malaria control programme managers, pharmaceutical officers, general medical practitioners, medical research library and publications officers, university academicians, heads of medical research institutions and district and regional medical officers. Additional data were obtained through a review of malaria drug policy documents and participant observations were also done.
In year 2001, the Tanzanian Government officially changed its malaria treatment policy guidelines whereby CQ--the first-line drug for a long time was replaced with SP. This policy decision was supported by research evidence indicating parasite resistance to CQ and clinical CQ treatment failure rates to have reached intolerable levels as compared to SP and amodiaquine (AQ). Research also indicated that since SP was also facing rising resistance trend, the need for a more effective drug was indispensable but for an interim 5-10 year period it was justifiable to recommend SP that was relatively more cost-effective than CQ and AQ. The government launched the policy change considering that studies (ethically approved by the Ministry of Health) on therapeutic efficacy and cost-effectiveness of artemisinin drug combination therapies were underway. Nevertheless, the process of communicating research results and recommendations to policy-making authorities involved critical debates between policy makers and researchers, among the researchers themselves and between the researchers and general practitioners, the speculative media reports on SP side-effects and reservations by the general public concerning the rationale for policy change, when to change, and to which drug of choice.
Changing national drug policy will remain a sensitive issue that cannot be done overnight. However, to ensure that research findings are recognised and the recommendations emanating from such findings are effectively utilized, a systematic involvement of all the key stakeholders (including policy-makers, drug manufacturers, media, practitioners and the general public) at all stages of research is crucial. It also matters how and when research information is communicated to the stakeholders. Professional organizations such as the East African Network on Malaria Treatment have potential to bring together malaria researchers, policy-makers and other stakeholders in the research-to-drug policy change interface.
The pace and breadth of health reforms point to the need for a comparative methodology to support shared learning from country experiences. A common understanding of health reforms is a first ...prerequisite for comparative research. Dimensions characterising content, sequence, process, purpose and scope of policy change are identified on the basis of a literature review. Reforms can have a gradual build up, starting with piecemeal policy changes that can be eventually integrated to enhance their benefits. Comprehensive reforms can be defined as policy formulation and implementation that comprises the systemic, programmatic, organisational and instrumental policy levels through explicit strategies sustained in well-documented experiences and theories and implemented with the support of a specialised agency with consensus-building capacity. A minimum-data set is proposed on the basis of an extensive literature review to support the comparability of health reform case studies and descriptions. Its components are: the current health system, its background and context, the reform rationale, the specific proposals, political actors and processes, achievements and limitations, and lastly the reform's wider impact. Case studies can be compared historically, through particularistic comparisons, using ideal types and by means of exemplars. The advantages and limitation of each method are analysed as well as how they can be combined to frame the research questions and minimise resources. Finally, the International Clearinghouse for Health System Reform Initiatives is described as an instrument to disseminate comparative research and analysis in support of shared learning.
Having good evidence to inform difficult decisions can be politically attractive, as shown, for example, by the US Government's decision to include US$1.1 billion for comparative research (including ...systematic reviews and clinical trials) as part of its $787 billion economic stimulus bill.3 To paraphrase Billy Beane, Newt Gingrich, and John Kerry, who have argued for a health-care system that is driven by robust comparative clinical evidence by substituting policy makers for doctors: Evidence-based health care would not strip policymakers of their decision-making authority nor replace their expertise. Because professionals sometimes do more harm than good when they intervene in the lives of other people, their policies and practices should be informed by rigorous, transparent, up-to-date evaluations.
In Mexico, people utilize public, private and traditional health providers interchangeably and in contrast to official access policies. Access policies for prenatal and child delivery services are ...evaluated using data from the National Health Survey of 1988. The study documents significant coverage gaps on the part of public providers with respect to their potential coverage, and especially, large cross-utilization of social security, Ministry of Health and private providers by beneficiaries. Child deliveries in Mexico are attended by a physician in only 66% of cases. The percentages are 85% for social security affiliates, 53% for women within reach of IMSS-Solidarity services (a relief programme for the rural poor) and only 31% for women with official access to private or Ministry of Health care, or beyond the reach of services. Seventy-eight per cent of medical deliveries by women affiliated to social security occur at their pre-paid facilities, while 14% deliver at extra cost with private physicians, contributing to 32% of deliveries so offered. Even though only 7% of insured women deliver at Ministry of Health facilities, this amounts to 20% of the Ministry's relief offer. In all, only 66% of affiliates use social security delivery services. On the other hand, 36% of deliveries by non-insured women are cared for by Ministry of Health providers, and 39% by the private sector; 22% of such deliveries occur in social security institutions, amounting to 18% of these institutions' care offer. These results indicate a wide departure between policy and fact, and the working of distributive and redistributive forces that impinge on the quality and efficiency of health care. Open access to the reproductive health services of all public institutions, with coordination among them and private providers, is suggested as a possible solution.
PDF
