The state of international collaboration for health systems research: what do publications tell?

AIM: International collaboration for health system development has been identified as a critical input to meet pressing global health needs. North-South collaboration has the potential to benefit both parties, while South-South collaboration offers promise to strengthen capacity rapidly and efficiently across developing countries. There is an emerging trend to analyze the fruits of such collaboration. This paper builds on this trend by applying an innovative concept-based bibliometric method to identify the international scope of collaboration within the field of health policy and systems research. Two key questions are addressed: to what extent are papers comparing developing countries as against reporting on single country studies? To what extent are papers in either case being produced by researchers within their respective countries or through North-South or South-South collaboration? METHODS: A total of 8,751 papers published in Medline between 1999 and 2003 with data on health systems and policies in developing countries were identified and content-analyzed using an innovative concept-based search technology. A sample of 13% of papers was used to identify the corresponding institution and countries covered. The sampled data was then analyzed by income group. RESULTS: Papers with an international, cross-country focus account for only 10% of the total. Just over a third of all papers are led by upper middle income country authors, closely followed by authors from high income countries. Just under half of all papers target low income countries. Cross-country papers are led mostly by institutions in high income countries, with 74% of the total. Only seven countries concentrate 60% of the papers led by developing country institutions. Institutions in the United States and the United Kingdom concentrate between them as many as 68% of the papers led by high income countries. Only 11% of all single-country papers and 21% of multi-country studies are the product of South-South collaboration. Health Financing is the topic with the greatest international scope, with 26% of all papers in the topic. Topics such as Costing and Cost Effectiveness, Finance, Sector Analysis and Insurance, regardless of their national or international scope, are led in 38% to 54% of cases by high income authors. CONCLUSION: While there is modest health systems research capacity in many developing countries for single country studies, capacity is severely limited for multi-country studies. While North-South collaboration is important, the number of international studies is still very limited to produce the kind of knowledge required to learn from experiences across countries. The fact that lead institutions as well as study countries are concentrated in a handful of mostly middle income countries attests to great disparities in research capacity. However, disparities in research capacity and interest are also evident in the North. It is urgent to build cross-country research capacity including appropriate forms of South-South and North-South collaboration

Plan de exportación de jarabe de maguey Saniz a España

La presente investigación se realizó en el municipio de Calpulalpan, en la comunidad de Felipe Sultepec, en la empresa familiar Saniz. El trabajo tuvo como objetivo principal desarrollar un plan de exportación que le permita comercializar su producto en el mercado español. El método utilizado fue hipotético deductivo, mediante investigación descriptiva tomando como referencia la guía básica del exportador BANCOMEXT 2005 y PROMÉXICO 2015. Los resultados obtenidos indicaron que el jarabe de maguey es un producto 100% natural con un proceso de elaboración artesanal, el mercado meta al que va dirigido, son personas diabéticas y población viggie (veganos, vegetarianos y flexitarianos), que pertenencen al nivel socioeconómico IC según la Asociación para la Investigación de medios de Comunicación y la Asociación de Empresas de Investigación de Mercados y Opinión (AIMC y aneimo, 2015)

Leadership, institution building and pay-back of health systems research in Mexico

<p>Abstract</p> <p>Background</p> <p>Health systems research is being increasingly called upon to support scaling up of disease control interventions and to support rapid health sector change. Yet research capacity building and pay-back take years or even decades to be demonstrated, while leadership and institution building are critical for their success. The case of Mexico can be illustrative for middle income countries and emerging economies striving to build health research systems.</p> <p>Methods</p> <p>Historical reflection suggests the relationship between health sector reforms and economic crisis, on the one hand, and research capacity building and payback, on the other. Mexico's post-revolutionary background and its three health sector reforms are analyzed to identify the emphases given to health systems research.</p> <p>Results</p> <p>The first wave of health reform in the 1940s emphasized clinical and epidemiological research. Health systems research was not encouraged in a context of rapid economic development and an authoritarian regime. In contrast, health systems research was given a privileged place with the second wave of health reforms in the 1980s, which addressed health system coordination, decentralization and the universal right to health in a context of a deep economic crisis. The third wave of health reforms between 2003 and 2006 was based on the health system models proposed through research in the 90s. The credibility gained by research institutions was critical to ensure government uptake. Research influence can be traced through the role it played in defining a problem, in designing innovative insurance mechanisms and in establishing evaluation frameworks. It is argued that the Ministry of Health's budget increase of 56% between 2003 and 2006 and the reductions in inequity are pay-back to research investments since the 1980s.</p

La división de una fracción entre un número natural: análisis de una experiencia didáctica

En la escuela primaria las fracciones se introducen a partir de la división de unidades entre un número entero (se divide un pastel, una pizza, una naranja, una barra de chocolate, etc.). Conservando este contexto, en el presente estudio se explora el potencial didáctico para el aprendizaje de la noción de fracción a partir de un tipo de problema prácticamente ausente en la enseñanza escolar en este nivel: la división de una fracción de unidad entre un entero. El estudio constituye una experiencia de microingeniería didáctica: con base en un análisis preliminar, se diseñó una secuencia de ocho situaciones didácticas que se aplicó en un grupo de quinto grado de primaria. Una parte del grupo de alumnos logró desarrollar procedimientos diversos para resolver la división de una fracción unitaria entre un entero, incluyendo un algoritmo. La división de fracciones no unitarias, en cambio, resultó considerablemente más difícil; se documentan todos estos procesos. Las dificultades que surgieron, principalmente debidas a los cambios de unidad de referencia de las fracciones, sugieren que, efectivamente, el estudio del tipo de problema planteado podría favorecer una comprensión más profunda de la noción de fracción como partes de unidad en este nivel escolar

"Hospital utilization by Mexican migrants returning to Mexico due to health needs"

<p>Abstract</p> <p>Background</p> <p>A total of 12.7 million Mexicans reside as migrants in the United States, of whom only 45% have health insurance in this country while access to health insurance by migrants in Mexico is fraught with difficulties. Health insurance has been shown to impact the use of health care in both countries. This paper quantifies hospitalizations by migrants who return from the US seeking medical care in public and private hospitals in the US-Mexico border area and in communities of origin. The proportion of bed utilization and the proportion of hospitalizations in Mexico out of the total expected by migrants in the US were estimated.</p> <p>Methods</p> <p>The universe included 48 Ministry of Health and 47 private hospitals serving municipalities of high or very high migration in Mexico, where 17% of remittance-receiving households are located, as well as 15 public and 159 private hospitals in 10 Mexican cities along the border with the US. Hospitals were sampled through various methods to include 27% of beds. Patients and staff were interviewed and data triangulated to quantify migrants that returned to Mexico seeking medical care. Official hospital discharge statistics and secondary data from migration databases and published statistics were analyzed to identify bed occupancy, general migrant hospitalization rates and the size of the migrant population that maintains close relationships with households in communities of origin.</p> <p>Results</p> <p>Up to 1609 migrants were admitted to public hospitals (76.6%) and 492 to private hospitals (23.4%) serving municipalities of high and very high migration intensity in 2008. Up to 0.90% of public hospital capacity was used. In the border area up to 908 and 2416 migrants were admitted to public (27.3%) and private (72.7%) hospitals, respectively. Up to 1.18% of public hospital capacity was used. Between 2.4% and 20.4% of the expected hospitalization needs of migrants with dependent households are satisfied through these services. The most common diagnostic categories mentioned across hospitals were traumatisms, complications of diabetes and elective surgery, in that order. Private hospitals mention elective surgeries as the main diagnostic category followed by complications of diabetes.</p> <p>Conclusions</p> <p>Hospitals in communities of origin in Mexico are devoting few resources to respond to hospitalization needs of migrants in the US. Currently no hospital programs exist to stimulate migrant demand or to cater to their specific needs. Registering migratory history in clinical and administrative records can be readily implemented. Developing bi-national referral networks and insuring migrants in the US within current Mexican federal programs could greatly increase migrant access to hospitals.</p

The Opacity of Spiral Galaxy Disks VI: Extinction, stellar light and color

In this paper we explore the relation between dust extinction and stellar light distribution in disks of spiral galaxies. Extinction influences our dynamical and photometric perception of disks, since it can distort our measurement of the contribution of the stellar component. To characterize the total extinction by a foreground disk, Gonzalez et al. (1998) proposed the ``Synthetic Field Method'' (SFM), which uses the calibrated number of distant galaxies seen through the foreground disk as a direct indication of extinction. The method is described in Gonzalez et al. (1998) and Holwerda et al. (2005a). To obtain good statistics, the method was applied to a set of HST/WFPC2 fields Holwerda et al. (2005b) and radial extinction profiles were derived, based on these counts. In the present paper, we explore the relation of opacity with surface brightness or color from 2MASS images, as well as the relation between the scalelengths for extinction and light in the I band. We find that there is indeed a relation between the opacity (A_I) and the surface brightness, particularly at the higher surface brightnesses. No strong relation between near infrared (H-J, H-K) color and opacity is found. The scalelengths of the extinction are uncertain for individual galaxies but seem to indicate that the dust distribution is much more extended than the stellar light. The results from the distant galaxy counts are also compared to the reddening derived from the Cepheids light-curves Freedman et al. (2001). The extinction values are consistent, provided the selection effect against Cepheids with higher values of A_I is taken into account. The implications from these relations for disk photometry, M/L conversion and galaxy dynamical modeling are briefly discussed.Comment: 9 pages, 2 tables, 10 figures, accepted by A&

Evidence-informed health policy: are we beginning to get there at last

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Mapping of health system functions to strengthen priority programs. The case of maternal health in Mexico

<p>Abstract</p> <p>Background</p> <p>Health system strengthening is critical to ensure the integration and scaling-up of priority health promotion, disease prevention and control programs. Normative guidelines are available to address health system function imbalances while strategic and analytical frameworks address critical functions in complex systems. Tacit knowledge-based health system constructs can help identify actors' perspectives, contributing to improve strengthening strategies. Using maternal health as an example, this paper maps and analyses the health system functions that critical actors charged with formulating and delivering priority health programs consider important for their success.</p> <p>Methods</p> <p>Using concept mapping qualitative and statistical methods, health system functions were mapped for different categories of actors in high maternal mortality states of Mexico and at the federal level. Functions within and across maps were analyzed for degree of classification, importance, feasibility and coding.</p> <p>Results</p> <p>Hospital infrastructure and human resource training are the most prominent functions in the maternal health system, associated to federal efforts to support emergency obstetric care. Health policy is a highly diffuse function while program development, intercultural and community participation and social networks are clearly stated although less focused and with lower perceived importance. The importance of functions is less correlated between federal and state decision makers, between federal decision makers and reproductive health/local health area program officers and between state decision makers and system-wide support officers. Two sets of oppositions can be observed in coding across functions: health sector vs. social context; and given structures vs. manageable processes.</p> <p>Conclusions</p> <p>Concept mapping enabled the identification of critical functions constituting adaptive maternal health systems, including aspects of actor perspectives that are seldom included in normative and analytical frameworks. Important areas of divergence across actors' perceptions were identified to target capacity strengthening efforts towards better integrated, performing health systems.</p