Public Policy for the Poor? A Randomised Assessment of the Mexican Universal Health Insurance Programme

Background: We assessed aspects of Seguro Popular, a programme aimed to deliver health insurance, regular and preventive medical care, medicines, and health facilities to 50 million uninsured Mexicans. Methods: We randomly assigned treatment within 74 matched pairs of health clusters—ie, health facility catchment areas—representing 118 569 households in seven Mexican states, and measured outcomes in a 2005 baseline survey (August, 2005, to September, 2005) and follow-up survey 10 months later (July, 2006, to August, 2006) in 50 pairs (n=32 515). The treatment consisted of encouragement to enrol in a health-insurance programme and upgraded medical facilities. Participant states also received funds to improve health facilities and to provide medications for services in treated clusters. We estimated intention to treat and complier average causal effects non-parametrically. Findings: Intention-to-treat estimates indicated a 23% reduction from baseline in catastrophic expenditures (1·9% points; 95% CI 0·14–3·66). The effect in poor households was 3·0% points (0·46–5·54) and in experimental compliers was 6·5% points (1·65–11·28), 30% and 59% reductions, respectively. The intention-to-treat effect on health spending in poor households was 426 pesos (39–812), and the complier average causal effect was 915 pesos (147–1684). Contrary to expectations and previous observational research, we found no effects on medication spending, health outcomes, or utilisation. Interpretation: Programme resources reached the poor. However, the programme did not show some other effects, possibly due to the short duration of treatment (10 months). Although Seguro Popular seems to be successful at this early stage, further experiments and follow-up studies, with longer assessment periods, are needed to ascertain the long-term effects of the programme. Funding: Mexican Ministry of Health, the National Institute of Public Health of Mexico, and Harvard University Institute for Quantitative Social ScienceGovernmen

Diseño de un modelo organizacional para la empresa Estrategia & Gestión

En este proyecto se desarrolla el diseño de un modelo organizacional para la empresa Estrategia & Gestión, compañía de desarrollo de proyectos IT en Colombia. Dicho modelo busca orientar el manejo de la empresa hacia el crecimiento empresarial y se desarrolla bajo el marco referente de las metodologías y conceptos del diseño organizacional. El proyecto inicia con un análisis del ecosistema de la empresa, que permite tener los insumos necesarios para el planteamiento del direccionamiento estratégico de la entidad, siendo la base principal del modelo organizacional. La estructura organizacional, procesos y personas y el monitoreo y control son componentes del modelo, sobre los cuales se presenta una hoja de ruta que busca guiar la implementación del modelo desarrollado.MaestríaMagister en Ingeniería Administrativ

Estudios y diseños para ampliación de la red de acueducto de las veredas La Tetilla, La Carrera, Manuel Sur y Manuel Norte del municipio de Ricaurte Cundinamarca

El presenten proyecto “Estudios y Diseños Para Ampliación De La Red De Acueducto De Las Veredas La Tetilla, La Carrera, Manuel Sur Y Manuel Norte Del Municipio De Ricaurte Cundinamarca”, se plantea con el fin de proponer una alternativa para así poder darle una solución a la problemática actual presentada en las veredas anteriormente mencionadas, que sufren de un sistema de abastecimiento mínimo de agua potable de buena calidad, eficiencia y continuidad en el servicio para los habitantes de estos sectores y por ende aportar con la posibilidad de facilitar a la comunidad de dichas veredas el acceso al agua potable, cumpliendo con el objetivo de desarrollo sostenible “ODS 6. Garantizar la disponibilidad y la gestión sostenible del agua y el saneamiento” y por consiguiente satisfacer las necesidades de esta comunidad. La gestión de este proyecto se desarrolla tomando como base la guía del Project Management Institute PMI, aplicando los lineamientos establecidos en la guía PMBOK

Bias correction by use of errors-in-variables regression models in studies with K-X-ray fluorescence bone lead measurements

In-vivo measurement of bone lead by means of K-X ray fluorescence (KXRF) is the preferred biological marker of chronic exposure to lead. Unfortunately, considerable measurement error associated with KXRF estimations can introduce bias in estimates of the effect of bone lead when this variable is included as the exposure in a regression model. Estimates of uncertainty reported by the KXRF instrument reflect the variance of the measurement error and, although they can be used to correct the measurement error bias, they are seldom used in epidemiological statistical analyses. Errors-in-variables regression (EIV) allows for correction of bias caused by measurement error in predictor variables, based on the knowledge of the reliability of such variables. The authors propose a way to obtain reliability coefficients for bone lead measurements from uncertainty data reported by the KXRF instrument and compare, by use of Monte Carlo simulations, results obtained using EIV regression models versus those obtained by the standard procedures. Results of the simulations show that Ordinary Least Square (OLS) regression models provide severely biased estimates of effect, and that EIV provides nearly unbiased estimates. Although EIV effect estimates are more imprecise, their mean squared error is much smaller than that of OLS estimates. In conclusion, EIV is a better alternative than OLS to estimate the effect of bone lead when measured by KXRF

Evaluating the Validity of Self-Reported Smoking in Mexican Adolescents

Objectives We aimed to evaluate the validity of the self-reported smoking indicator used in the Global Youth Tobacco Survey (GYTS). Setting 43 middle and high-school classrooms from 26 schools were selected from Mexico City and Cuernavaca, Morelos. Participants A total of 1257 students provided both a questionnaire and a urine sample. Primary and secondary outcome Sensitivity and specificity of self-reported smoking compared to urinary cotinine. Validity indices were evaluated by subgroups of gender, social acceptability of smoking (ie, smoking parents or friends) and smoking frequency. Results Sensitivity and specificity for current smoking were 93.2% and 81.7%, respectively. Validity indices remained stable across gender. Parental smoking status moderated the validity of self-report, which had lower sensitivity in adolescents with non-smoking parents (86.7%) than in adolescents with smoking parents (96.6%). Sensitivity and specificity increased with smoking frequency. Conclusions This first validation study of self-reported current smoking used in the GYTS among Mexican adolescents suggests that self-reported smoking in the past 30 days is a valid and stable indicator of current smoking behaviour. This measure appears suitable for public health research and surveillance

Concentrations of Nicotine, Nitrosamines, and Humectants in Legal and Illegal Cigarettes in Mexico

Background: Article 10 of the World Health Organization Framework Convention on Tobacco Control states the need for industry disclosure of tobacco contents and emissions. Currently, the profiles of key tobacco compounds in legal and illegal cigarettes are largely unknown. We aimed to analyze and compare concentrations of nicotine, nitrosamines, and humectants in legal and illegal cigarettes collected from a representative sample of smokers. Methods: Participants of the International Tobacco Control cohort provided a cigarette pack of the brand they smoked during the 2014 wave. Brands were classified as legal or illegal according to the Mexican legislation. Nicotine, nitrosamines, glycerol, propylene glycol, and pH were quantified in seven randomly selected packs of each brand. All analyses were done blinded to legality status. Average concentrations per brand and global averages for legal and illegal brands were calculated. Comparisons between legal and illegal brands were conducted using t tests. Results: Participants provided 76 different brands, from which 6.8% were illegal. Legal brands had higher nicotine (15.05 ± 1.89 mg/g vs 12.09 ± 2.69 mg/g; p \u3c 0001), glycerol (12.98 ± 8.03 vs 2.93 ± 1.96 mg/g; p \u3c 0.001), and Nnitrosanatabine (NAT) (1087.5 ± 127.0 vs 738.5 ± 338 ng/g; p = 0.006) concentrations compared to illegal brands. For all other compounds, legal and illegal brands had similar concentrations. Conclusion: Compared to illegal cigarettes, legal brands seem to have higher concentrations of nicotine, NAT, and glycerol. Efforts must be made to implement and enforce Article 10 of the Framework Convention on Tobacco Control to provide transparent information to consumers, regulators, and policy-makers; and to limit cigarette engineering from the tobacco industry

Relación entre la resistencia a antibióticos y la producción de biofilm de aislados de Staphylococcus aureus provenientes de mastitis bovina

The objective was to analyze the relationship between the antibiotic-resistance profile and the biofilm formation of S. aureus isolates from bovine mastitis. Thirty (30) isolates of S. aureus from cases of subclinical mastitis in dairy farms in semi-intensive production and backyard production systems, located in the states of Guanajuato and Michoacán, Mexico, were analyzed. An antibiogram was performed by the Kirbi-Bauer disc-diffusion method. Biofilm formation was determined by the violet crystal staining method. For the evaluation of antibiotic resistance genes and biofilm formation, genomic DNA was obtained from a colony for the identification of the genes: blaZ, mecA, tetK, tetM, gyrA and gyrB, and icaA and icaD. The results showed that 100 % of the isolates were resistant to penicillin and dicloxacillin, followed by cefotaxime (86.6 %), ampicillin and cephalotin (83.3 %) and ceftazidime (80.0 %), while a 36.6 % resistance to oxacillin was observed. It was identified that all isolates of S. aureus had the ability to form biofilm with a range between 20 to 98 %. It was also observed that isolates with a high multi-resistance presented a greater formation of biofilm, establishing a significant positive correlation. In conclusion, S. aureus isolates from bovine mastitis presented high levels of antibiotic resistance; as well as an important biofilm-forming capacity, demonstrating the existence of a positive correlation between these two factors.El objetivo fue analizar la relación entre el perfil de resistencia a antibióticos y la formación de biofilm de aislados de S. aureus provenientes de mastitis bovina. Se analizaron 30 aislados de S. aureus procedentes de casos de mastitis subclínica en granjas lecheras en sistemas de producción semi-intensivo y de traspatio ubicadas en los estados de Guanajuato y Michoacán, México. Se realizó un antibiograma por el método de difusión en disco Kirbi Bauer. La formación de biofilm se determinó por el método de tinción con cristal violeta. Para la evaluación de genes de resistencia a antibióticos y de formación de biofilm se obtuvo ADN genómico de una colonia para la identificación de los genes: blaZ, mecA, tetK, tetM, gyrA y gyrB, y icaA e icaD. Los resultados mostraron que el 100 % de los aislados fueron resistentes a penicilina  y dicloxacilina, seguidos  por cefotaxima  (86.6 %),  ampicilina y cefalotina (83.3 %) y ceftazidima (80.0 %), mientras que se observó un 36.6 % de resistencia a oxacilina. Se identificó que todos los aislados de S. aureus presentaron la capacidad de formar biofilm con un rango del 20 a 98 %. Se observó además que los aislados con una multirresistencia elevada presentaron una mayor formación de biofilm; estableciéndose una correlación positiva significativa. En conclusión, los aislados de S. aureus provenientes de mastitis bovina presentaron elevados niveles de resistencia a antibióticos; así como una importante capacidad formadora de biofilm, demostrando la existencia de una correlación positiva entre estos dos factores