Antibiotics in Mexico: An analysis of problems, policies, and politics

The inappropriate use of antibiotics poses a risk to individual health, is a waste of health resources, and triggers antibiotic resistance, a global health problem. Despite strategies promoted internationally to address antibiotic misuse and resistance (AMR), few low and middle-income countries have fully incorporated them into their national health policies. There is scarce research on the factors that affect the development of AMR policies at the national level. The present study addresses this gap by applying a policy-analysis approach to understand agenda setting, policy inaction and policy change with regard to AMR, focusing on the case of Mexico. This study is designed as a longitudinal case-study, looking at events between 2001 and 2012 in Mexico, which cover two periods of government. The study used Kingdon’s multiple streams (MS) theory of agenda-setting to guide the analysis, explaining both when the issue of AMR was denied a position on the agenda (first period studied) and when the issue gained agenda status and a policy change occurred (second period studied). The methods used were semi-structured interviews with key social actors, document analysis and media analysis. The following factors hindered AMR inclusion in the health policy agenda during the 2000-2006 administration: a) low problem visibility and a narrow definition that pulled AMR away from the scope of public policies; b) lack of clarity on the policy alternatives and their feasibility; c) absence of policy entrepreneurs promoting these policies; d) within the health-reform context, improving medicine stocks was the priority. During the 2006-2012 administration, the problem of self-medication with antibiotics gained visibility when it was related to the 2009 influenza pandemic; a group of specialists acted as policy entrepreneurs supporting AMR policies. The national health crisis and a previous designation of an institutional body to control medicine sales favoured agenda placement and the development of a narrow-focused regulation, but hindered the formation of a comprehensive national policy on AMR. The usefulness of Kingdon’s theory in examining AMR agenda-setting, in the context of Mexico, is explained. The research findings are discussed in light of other studies to draw lessons for Mexico and other countries aiming to develop AMR policies

Access to cancer medicines in public hospitals in Mexico:The view of stakeholders

BACKGROUND: Access to cancer medicines is a core component of comprehensive cancer care; as such, it is included in Mexico's public health insurance: Seguro Popular de Salud (SPS). Learning about stakeholders' experiences on processes and barriers influencing access to essential cancer medicines within healthcare facilities allows identifying needed policies to improve access to cancer care. OBJECTIVE: The aim of this study was to obtain the insights of health professionals in public hospitals in Mexico on how SPS influences access to cancer medicines regarding medicine selection, financing, and procurement and supply systems. The purpose is to identify policy areas that need strengthening to improve access to cancer medicines. METHODS: Semi-structured interviews were conducted with 67 health professionals from 21 public hospitals accredited by SPS across Mexico. A framework analysis was used with categories of analysis derived from the World Health Organization's Access framework. RESULTS: Most stakeholders reported that the availability of listed cancer medicines was sufficient. However, cancer specialists reported that medicines coverage by SPS was restrictive covering only basic cancer care. Public hospitals followed SPS treatment protocols in selecting and prescribing cancer medicines but used different procurement procedures. When essential cancer medicines were unavailable (not listed or stocked-out), hospitals reported several strategies such as prescribing alternative therapies, resorting to direct purchases, and assisting patients in obtaining medicines elsewhere. Other reported barriers to access to treatment were: distance to health facilities, poor insurance coverage, and financial restrictions. CONCLUSIONS: Health professionals have encountered benefits and challenges from the implementation of SPS influencing access to cancer medicines and care in Mexico, pointing to areas in which action is necessary. Finding the right balance between expanding the range and cost of cancer treatments covered by insurance and making basic cancer care available to all is a challenge faced by Mexico and other middle-income countries

Geometrical Defects in Josephson Junction Arrays

Dislocations and disclinations in a lattice of Josephson junctions will affect the dynamics of vortex excitations within the array. These defects effectively distort the space in which the excitations move and interact. The interaction energy between such defects and excitations are determined and vortex trajectories in twisted lattices are calculated. Finally, possible experiments observing these effects are presented.Comment: 26 pages including 5 figure

Availability, prices, and affordability of selected essential cancer medicines in a middle-income country - the case of Mexico

BACKGROUND: More alternatives have become available for the diagnosis and treatment of cancer in low- and middle-income countries. Because of increasing demands, governments are now facing a problem of limited affordability and availability of essential cancer medicines. Yet, precise information about the access to these medicines is limited, and the methodology is not very well developed. We assessed the availability and affordability of essential cancer medicines in Mexico, and compared their prices against those in other countries of the region. METHODS: We surveyed 21 public hospitals and 19 private pharmacies in 8 states of Mexico. Data were collected on the availability and prices of 49 essential cancer medicines. Prices were compared against those in Chile, Peru, Brazil, Colombia and PAHO's Strategic Fund. RESULTS: Of the various medicines, mean availability in public and private sector outlets was 61.2 and 67.5%, respectively. In the public sector, medicines covered by the public health insurance "People's Health Insurance" were more available. Only seven (public sector) and five (private sector) out of the 49 medicines were considered affordable. Public sector procurement prices were 41% lower than in other countries of the region. CONCLUSIONS: The availability of essential cancer medicines, in the public and private sector, falls below World Health Organization's 80% target. The affordability remains suboptimal as well. A national health insurance scheme could serve as a mechanism to improve access to cancer medicines in the public sector. Comprehensive pricing policies are warranted to improve the affordability of cancer medicines in the private sector

“Ten Commandments” for the Appropriate use of Antibiotics by the Practicing Physician in an Outpatient Setting

A multi-national working group on antibiotic stewardship, from the International Society of Chemotherapy, put together ten recommendations to physicians prescribing antibiotics to outpatients. These recommendations are: (1) use antibiotics only when needed; teach the patient how to manage symptoms of non-bacterial infections; (2) select the adequate ATB; precise targeting is better than shotgun therapy; (3) consider pharmacokinetics and pharmacodynamics when selecting an ATB; use the shortest ATB course that has proven clinical efficacy; (4) encourage patients’ compliance; (5) use antibiotic combinations only in specific situations; (6) avoid low quality and sub-standard drugs; prevent prescription changes at the drugstore; (7) discourage self-prescription; (8) follow only evidence-based guidelines; beware those sponsored by drug companies; (9) rely (rationally) upon the clinical microbiology lab; and (10) prescribe ATB empirically – but intelligently; know local susceptibility trends, and also surveillance limitations

Acceptance criteria for new approach methods in toxicology and human health-relevant life science research - part I

Every test procedure, scientific and non-scientific, has inherent uncertainties, even when performed according to a standard operating procedure (SOP). In addition, it is prone to errors, defects, and mistakes introduced by operators, laboratory equipment, or materials used. Adherence to an SOP and comprehensive validation of the test method cannot guarantee that each test run produces data within the acceptable range of variability and with the precision and accuracy determined during the method validation. We illustrate here (part I) why controlling the validity of each test run is an important element of experimental design. The definition and application of acceptance criteria (AC) for the validity of test runs is important for the setup and use of test methods, particularly for the use of new approach methods (NAM) in toxicity testing. AC can be used for decision rules on how to handle data, e.g., to accept the data for further use (AC fulfilled) or to reject the data (AC not fulfilled). The adherence to AC has important requirements and consequences that may seem surprising at first sight: (i) AC depend on a test method's objectives, e.g., on the types/concentrations of chemicals tested, the regulatory context, the desired throughput; (ii) AC are applied and documented at each test run, while validation of a method (including the definition of AC) is only performed once; (iii) if AC are altered, then the set of data produced by a method can change. AC, if missing, are the blind spot of quality assurance: Test results may not be reliable and comparable. The establishment and uses of AC will be further detailed in part II of this series.Toxicolog

Pharmacy customers' knowledge of side effects of purchased medicines in Mexico

To analyse pharmacy customers' knowledge and information sources about side effects of medicines they purchased and factors associated with this knowledge. Cross-sectional survey and semi-structured interviews with customers of 52 randomly selected community pharmacies in Morelos state, Mexico. Customers were included if they were older than 18 years, bought at least one drug either with or without medical prescription, and agreed to take part in the survey. Data were analysed using a multinomial logistic regression model. A total of 1445 customers buying 1946 drugs were surveyed (age 42.9 +/- 15.7 years, 56.9% female); 627 (59%) of 1055 customers who purchased prescription-only medicines (POM) did so without a prescription. Of all customers interviewed, 172 (11.9%) affirmed that the bought medicine(s) could cause harm. Only half of those (87 or 6%) were able to identify correctly at least one side effect of the purchased medicines. The majority received the information about side effects from a physician. Customers in semirural areas knew less about side effects (odds ratio: 0.26; 95% CI: 0.11-0.61; P = 0.00); whereas customers buying medicines for chronic pain, hypertension or diabetes knew more (odds ratio 2.63; 95% CI: 1.44-4.80; P = 0.00). The overall majority of customers did not know that medicines they bought could be harmful. This is particularly alarming because they frequently used POM without consulting a physician.Analyser la connaissance des clients de la pharmacie et les sources d'information sur les effets secondaires des mEdicaments qu'ils achetent ainsi que les facteurs associEs a ces connaissances. Etude transversale et interviews semi-structurEes avec les clients de 52 pharmacies d'officine sElectionnEes alEatoirement dans l'Etat de Morelos au Mexique. Les clients ont EtE inclus s'ils Etaient agEs de plus de 18 ans, ont achetE au moins un mEdicament avec ou sans prescription mEdicale et ont dEcidE de prendre part a l'enquete. Les donnEes ont EtE analysEes en utilisant un modele multinominal de rEgression logistique. 1445 clients qui ont achetE 1870 mEdicaments ont EtE interrogEs (age: 42,9 +/- 15,7 ans, 56,9% des femmes), 627 (59%) des 1055 clients qui ont achetE seulement des mEdicaments sur prescription uniquement l'ont fait sans ordonnance. De tous les clients interrogEs, 172 (11,9%) ont affirmE que les mEdicaments achetEs pourraient causer des dommages. Seule la moitiE de ceux-ci (87 ou 6%) Etaient en mesure d'identifier correctement au moins un effet secondaire des mEdicaments achetEs. La majoritE a recu des informations sur les effets secondaires du mEdecin. Les clients dans les zones semi-rurales savaient moins sur les effets secondaires (odds ratio: 0,26; IC95%: 0,11-0,61, p = 0,00), alors que les clients achetant des mEdicaments pour la douleur chronique, l'hypertension ou le diabete en savaient plus (odds ratio 2,63; IC95%: 1,44-4,80, p = 0.00). Dans l'Etat de Morelos au Mexique, la grande majoritE des clients ne savent pas que les mEdicaments qu'ils achetent pourraient causer des dommages. Cela est particulierement alarmant car ils utilisent frEquemment des mEdicaments sous prescription uniquement sans consulter un mEdecin.Analizar los conocimientos de clientes de farmacias y sus fuentes de informacion sobre efectos secundarios de los medicamentos que compran, asi como factores asociados a dicho conocimiento. Estudio croseccional y entrevistas semiestructuradas con clientes de 52 farmacias comunitarias seleccionadas al azar en el estado de Morelos, MEjico. Los clientes fueron incluidos si eran mayores de 18 anos, compraban al menos un medicamento con o sin receta mEdica, y estaban de acuerdo en participar en el estudio. Los datos fueron analizados utilizando un modelo de regresion logistica multinomial. 1,445 clientes compraron; 1,870 medicamentos fueron inspeccionados (edad 42.9 + /-15.7 anos, 56.9% mujers); 627 (59%) de 1055 clientes que compraron medicamentos que solo se venden con receta mEdica, lo hicieron sin tener la prescripcion. De todos los clientes entrevistados, 172 (11.9%) afirmaron que los medicamentos que compraban podian causar dano. Solo la mitad de ellos (87 o 6%) eran capaces de identificar correctamente al menos un efecto secundario de los medicamentos adquiridos. La mayoria recibia informacion sobre los efectos secundarios de boca de un mEdico. Los clientes de areas semi-rurales tenian menos conocimientos sobre los efectos secundarios (odds ratio: 0.26; 95%IC 0.11, 0.61; p = 0.00); mientras que los clientes que compraban medicinas para dolor cronico, hipertension o diabetes tenian mas conocimientos (odds ratio 2.63; 95% IC 1.44, 4.80; p = 0.00). En el estado de Morelos, MEjico, la mayoria de los clientes no eran conscientes de que los medicamentos que compraban podian ser nocivos. Esto es particularmente alarmante puesto que frecuentemente utilizan medicinas que requieren receta mEdica sin haber consultado previamente un mEdico