Comprensión lectora: asunto de todos

Universidad Interamericana de Puerto Rico, Recinto Metropolitan

La alfabetización académica en el paradigma educativo puertorriqueño: políticas y proyectos

A partir del concepto de alfabetización académica de Carlino (2013), Gasalla (2012) y Fang (2012) entre otros, se examinan las prácticas de alfabetización académica en dos universidades en Puerto Rico: una pública y una privada. Esto permitió explorar cuáles son las políticas oficiales que permiten la incorporación de la alfabetización académica en el currículo e identificar los proyectos vigentes y los futuros. La metodología utilizada consistió en el análisis de documentos oficiales y normativos de dichas instituciones y la información obtenida se integró en dos grandes categorías: políticas y proyectos. De esta forma se describió la situación prevaleciente en ambos centros docentes y se analizó en qué medida han realizado cambios en su política luego de la investigación realizada por Quintana et al (2010). Los resultados revelan que han ocurrido muy pocos cambios en las políticas institucionales. A pesar de que en teoría se reconoce la importancia de enseñar a leer y a escribir en las disciplinas académicas, en ninguno de los dos recintos se ha incorporado un plan de alfabetización académica. Si bien se documentan algunas iniciativas aisladas, prevalecen enfoques tradicionales en los que se incluye el desarrollo de las destrezas lingüísticas principalmente en los cursos de lengua, no en otras disciplinas. Se reconfirma la necesidad de que las instituciones puertorriqueñas repiensen su paradigma educativo para darles prioridad a la lectura y la escritura en el marco del currículo universitario. Para lograrlo, hace falta capacitación y mayor compromiso, tanto de parte de la administración como de los docentes

Aplicación de la investigación de operaciones a la distribución de recursos relacionados con la COVID-19

Aim: To apply the vehicle routing model based on optimized decision-making for the distribution of medical resources to hospitalized patients, and patients with a possible COVID-19 diagnosis, in Camagüey, Cuba. Methods: Heterogeneous vehicle routing problems with time windows were used in combination with optimization algorithms to cope with the distribution of supplies. Main results: A total of 15 models were used in the experiment to study the behavior of the algorithms applied to the problem. The CVRP library was run in Matlab. Three metaheuristic models were utilized: EDA, SA, VNS. FSMVRPTW was solved according to the information modeled, through the EDA and VNS algorithms. The latter was included in the study for its open source code, in Excel. Conclusions: Studies of vehicle routing problems have shown their usefulness in different complex scenarios, such as pandemics, to optimize the distribution of resources. The existence of optimum organization of transportation to distribute medical resources in COVID-19 times is a vital tool for decision-making in the province of Camagüey, which can be extended to the whole country.Objetivo: Aplicar el modelo de enrutamiento de vehículos combinado con algoritmos de optimización para la toma de decisiones en la distribución de insumos relacionados con el servicio asistencial a pacientes hospitalizados y sospechosos de la COVID-19 en Camagüey, Cuba. Métodos: Se utilizaron los problemas de enrutamiento de vehículos heterogéneos con ventanas de tiempo, en combinación con algoritmos de optimización para solucionar la distribución de estos recursos. Principales resultados: Se experimentó con un total de 15 modelos para el estudio del comportamiento de los algoritmos aplicados al problema, donde se utilizó la biblioteca CVRP, implementada en Matlab. Se implementaron tres de metaheurísticas: EDA, SA, VNS. A partir de la información modelada se procedió a la solución del problema FSMVRPTW a través de algoritmos EDA y VNS, utilizado este último por contar con una implementación de código abierto en Excel. Conclusiones: Los estudios acerca del problema de enrutamiento de vehículos han demostrado su utilidad en diferentes situaciones complejas, como las pandemias, para optimizar la distribución de recursos. En tiempos de COVID-19, contar con una organización del transporte óptima para distribuir los recursos médicos, es una herramienta vital para la toma de decisiones en la provincia Camagüey, extensible a toda Cuba

EVALUACION DEL COMPORTAMIENTO BIOLOGICO, CLINICO Y MICROBIOLOGICO DE RESINAS DE ULTIMA GENERACION

An study of three clases of resins of last generation was done evaluating the clinical conduct histological, microbiological and microfiltración through electronical microscopic concluting that the clinical answer in the three tippies of resins in casties of 3 mm of intensity were not present, in histologic grade you cannot see qualitive changes, in the microbiological aspect it was verified y kal the efect antimi crobianie is only produced with direct contact with the resens through the shape of an halo, with reference to the microscopic observation one of resens presented a total of a hyborderm cave.Se realizó un estudio sobre tres clases de resinas de última generación evaluándose el comportamiento clínico, histológico, microbiológico y microfiltración a través del microscopio electrónico de barrido, concluyéndose que la respuesta clínica en los tres tipos de resinas en cavidades de 3 mm de profundidad estuvo ausente, a nivel histológico no se aprecian cambios cualitativos, en el aspecto microbiológico se verificó que el efecto antimicrobiano solo se produce en contacto directo con la resina a través de la formación de un halo de inhibición, con respecto a la observación microscópica una de las resinas presentó formación total de capa híbrida

Strategies, learning styles and academic performance in undergraduate students of dentistry

La Facultad de Odontología está comprometida en la búsqueda de la calidad educativa, lo que implica que el docente en su ejercicio académico debe propiciar el aprendizaje de los estudiantes; interactuando con el conocimiento a través de actividades variadas, que atiendan las diferencias individuales en relación a sus formas, estilos y estrategias de aprender para un mejor rendimiento académico. El presente estudio tiene como objetivo identificar las estrategias, los estilos de aprendizaje en los estudiantes ingresantes en la Facultad de Odontología y su relación con el rendimiento académico. Las unidades de observación lo constituyen 26 estudiantes que participaron en forma voluntaria en la convocatoria al Programa de Tutoría, el que tuvo dificultades de implementación. Se evaluó los estilos y estrategias de aprendizaje utilizando los cuestionarios de Honey‐Alonso, (CHAEA) y el de las estrategias de aprendizaje de los estudiantes universitarios por Gargallo; mientras que el rendimiento académico se evaluó con el historial académico. Se halló diferencias significativas entre la motivación extrínseca inicial y final; asimismo entre la motivación con el rendimiento académico; se determinó que las estrategias se modifican y se plasman en su rendimiento; lo que describe que el estudiante ingresante aún está en proceso de construcción de su autonomía y requiere orientación.The Faculty of Dentistry is committed to the pursuit of quality education, which implies that the learning of the students should be promote by the teachers; they should interact with knowledge through varied activities that meet the individual differences in their relationship with their modes, styles and learning strategies in order to improve their academic performance. This study aims to identify the strategies and learning styles of the incoming students at the Faculty of Dentistry and its relationship to academic performance. Twenty-six students participated voluntarily in the Tutoring Program, this issue had implementation difficulties. Styles and learning strategies were evaluated using questionnaires: Honey-Alonso Learning Styles (CHAEA) and the learning strategies of university students by Gargallo; while academic performance was assessed with the academic record. It was found significant differences between the initial and final extrinsic motivation; also between motivation and academic performance; it was determined that strategies are modified and reflected in their academic performance. It was concluded the incoming student is still in the process of establishing their independence and requires guidance

Experience implementing a mentoring program for incoming students at Faculty of Dentistry

El Objetivo del estudio fue evaluar el desarrollo del proceso de tutoría y el desempeño del docente tutor en un Programa Piloto de tutoría desde la perspectiva del estudiante y docente participante. El diseño de la investigación es pre experimental, aplicativo, cualicuantitativo; la población de estudio es constituida por 61 estudiantes y 12 docentes. El estudio tuvo tres fases, en la primera se realizó capacitación a los docentes tutores y se aperturó una aula virtual. En la segunda se identificó el perfil del estudiante ingresante y se conformó grupos, en la tercera se ejecutó el programa de tutorías y se realizó la evaluación de esta. Resultados: El 44 % de estudiantes asiste con cierta frecuencia y en forma regular a las tutorias, mientras que de los docentes 6 fueron constantes. Los ingresantes y docentes valoraron tres acciones positivas de desempeño del tutor, el establecer objetivos de la tutoria en forma conjunta, el apoyo en el diseño del plan de trabajo según necesidades, generar clima propicio para comunicarse. Mientras que el aspecto negativo señalado es el seguimiento sistemático de las actividades y acuerdos establecidos con el estudiante, lo cual se atribuye a la falta de tiempo en un 90 %, pues no se cuenta con un horario prestablecido en el plan de estudios. La tutoría requiere una decisión política institucional para su implementación, asimismo el trabajo coordinado con las áreas académicas y administrativas, para obtener mayores logros, sin embargo tuvo limitaciones por ser un proyecto piloto. La tutoría permitió evidenciar el esfuerzo del tutor por ayudar al estudiante y potencializar sus habilidades y del tutorado el logro de un empoderamiento con mayor autonomía y capacidad crítica creadora.The purpose of this study was to evaluate the development of mentoring process and performance of the tutor in a mentoring pilot program from the perspective of student and teacher, the research design is pre experimental, application, qualitative and quantitative, the group consisted of 61 students and 12 tutors. This research had three stages; in the first teachers were trained as tutors with e-learning and was opened a virtual classroom. In the second stage was made some groups, the incoming student's profile was identified, in the third stage was performed the mentoring program and was evaluated.Results: 44% of students attend quite frequently and regularly to the tutoring program, while 6 teachers were constant. Students and teachers assessed three positive actions of tutor performance, the goals for the tutoring program were setting together, the support in the design of the plan was according to the needs, it was created a favorable climate for communication. While the negative topic was the systematic monitoring of the activities and agreements with the student, which they attribute to lack of time by 90%, since they have not assigned a schedule in the curriculum. Mentoring requires institutional policy decision for implementation also the work coordinated with the academic and administrative areas,to record greater achievements, but it had limitations because it was a pilot project. Tutoring allows evidence student’s empowerment with more autonomy and a creative criticism and showed tutor’s effort to improve student’s skills

Learning styles and their relationship to academic achievement in freshmen students of dentistry

El presente estudio tuvo como propósito identificar los estilos de aprendizaje y su relación con el rendimiento académico en los estudiantes ingresantes. Metodología: Se utilizó el cuestionario Honey-Alonso de Estilos de aprendizaje (CHAEA), así como el historial académico como evidencia del su rendimiento académico de 48 estudiantes voluntarios, quienes participaron en el programa de Tutoría; se capacitó a docentes, tutores y estudiantes. Resultados: El 32% de los estudiantes proviene de instituciones educativas públicas y el 78% de privadas; la edad promedio es de 19 años DE +-2,73. Se encontró que prevalece el estilo teórico (35, 4%), seguido del activo (25 %), con una preferencia moderada. Se compararon los estilos de aprendizaje a su ingreso y al término del año académico y se encontraron diferencias en el activo, teórico y pragmático; asimismo se halló relación entre el estilo de aprendizaje reflexivo, teórico y pragmático con el rendimiento académico de los estudiantes. El estilo de aprendizaje reflexivo ha estado muy por debajo del promedio, es necesario impulsarlo pues permite fortalecer la autonomía en el aprendizaje del estudiante, equilibrando el estilo teórico como el activo. Además, al estar inmerso en una institución que brinda servicios de salud, en contacto directo con otro ser humano, se requiere ser cauto, discreto y concienzudo, así como saber observar y escuchar para poder brindar una mejor atención a los pacientes.This study aimed to identify learning styles preference and their relationship to academic achievement in freshman students. Methodology: Honey-Alonso Learning Styles (CHAEA) questionnaire was used; and evaluation report academic of the freshman students as evidence of their performance 48 student volunteers who participated in the mentoring program; mentor teachers and students were trained. Results: The 32% of freshman students come from public educational institutions and from 78% private; the average age is 19 years old and SD + -2.73. It was found that the theoretical learning style prevails (35, 4%), followed by active learning style (25%) with a moderate preference. Learning styles preference were compared at the beginning and at the end of the academic year, it was founded differences in active, theoretical and pragmatic learning styles; also it was founded relation between reflexive, theoretical and pragmatic learning styles with academic performance of the freshman students. The reflexive learning style has been very below average, it is necessary to motivate them in order to strengthen autonomy in student learning, balancing theoretical style as the active, in addition to being immersed in an institution that provides health services , contact live with another human being , one must be cautious , discreet and thorough , as well as know how to observe and listen to deliver better care to patients, as have the ability of self-education is the most appropriate health professional

First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR)

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.Fil: Pons Estel, Bernardo A.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; ArgentinaFil: Bonfa, Eloisa. Universidade de Sao Paulo; BrasilFil: Soriano, Enrique R.. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cardiel, Mario H.. Centro de Investigación Clínica de Morelia; MéxicoFil: Izcovich, Ariel. Hospital Alemán; ArgentinaFil: Popoff, Federico. Hospital Aleman; ArgentinaFil: Criniti, Juan M.. Hospital Alemán; ArgentinaFil: Vásquez, Gloria. Universidad de Antioquia; ColombiaFil: Massardo, Loreto. Universidad San Sebastián; ChileFil: Duarte, Margarita. Hospital de Clínicas; ParaguayFil: Barile Fabris, Leonor A.. Hospital Angeles del Pedregal; MéxicoFil: García, Mercedes A.. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Amigo, Mary Carmen. Centro Médico Abc; MéxicoFil: Espada, Graciela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Catoggio, Luis J.. Hospital Italiano. Instituto Universitario. Escuela de Medicina; ArgentinaFil: Sato, Emilia Inoue. Universidade Federal de Sao Paulo; BrasilFil: Levy, Roger A.. Universidade do Estado de Rio do Janeiro; BrasilFil: Acevedo Vásquez, Eduardo M.. Universidad Nacional Mayor de San Marcos; PerúFil: Chacón Díaz, Rosa. Policlínica Méndez Gimón; VenezuelaFil: Galarza Maldonado, Claudio M.. Corporación Médica Monte Sinaí; EcuadorFil: Iglesias Gamarra, Antonio J.. Universidad Nacional de Colombia; ColombiaFil: Molina, José Fernando. Centro Integral de Reumatología; ColombiaFil: Neira, Oscar. Universidad de Chile; ChileFil: Silva, Clóvis A.. Universidade de Sao Paulo; BrasilFil: Vargas Peña, Andrea. Hospital Pasteur Montevideo; UruguayFil: Gómez Puerta, José A.. Hospital Clinic Barcelona; EspañaFil: Scolnik, Marina. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Pons Estel, Guillermo J.. Centro Regional de Enfermedades Autoinmunes y Reumáticas; Argentina. Hospital Provincial de Rosario; ArgentinaFil: Ugolini Lopes, Michelle R.. Universidade de Sao Paulo; BrasilFil: Savio, Verónica. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Drenkard, Cristina. University of Emory; Estados UnidosFil: Alvarellos, Alejandro J.. Hospital Privado Universitario de Córdoba; ArgentinaFil: Ugarte Gil, Manuel F.. Universidad Cientifica del Sur; Perú. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Babini, Alejandra. Instituto Universitario Hospital Italiano de Buenos Aires. Rectorado.; ArgentinaFil: Cavalcanti, André. Universidade Federal de Pernambuco; BrasilFil: Cardoso Linhares, Fernanda Athayde. Hospital Pasteur Montevideo; UruguayFil: Haye Salinas, Maria Jezabel. Hospital Privado Universitario de Córdoba; ArgentinaFil: Fuentes Silva, Yurilis J.. Universidad de Oriente - Núcleo Bolívar; VenezuelaFil: Montandon De Oliveira E Silva, Ana Carolina. Universidade Federal de Goiás; BrasilFil: Eraso Garnica, Ruth M.. Universidad de Antioquia; ColombiaFil: Herrera Uribe, Sebastián. Hospital General de Medellin Luz Castro de Gutiérrez; ColombiaFil: Gómez Martín, DIana. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Robaina Sevrini, Ricardo. Universidad de la República; UruguayFil: Quintana, Rosana M.. Hospital Provincial de Rosario; Argentina. Centro Regional de Enfermedades Autoinmunes y Reumáticas; ArgentinaFil: Gordon, Sergio. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Fragoso Loyo, Hilda. Instituto Nacional de la Nutrición Salvador Zubiran; MéxicoFil: Rosario, Violeta. Hospital Docente Padre Billini; República DominicanaFil: Saurit, Verónica. Hospital Privado Universitario de Córdoba; ArgentinaFil: Appenzeller, Simone. Universidade Estadual de Campinas; BrasilFil: Dos Reis Neto, Edgard Torres. Universidade Federal de Sao Paulo; BrasilFil: Cieza, Jorge. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: González Naranjo, Luis A.. Universidad de Antioquia; ColombiaFil: González Bello, Yelitza C.. Ceibac; MéxicoFil: Collado, María Victoria. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Sarano, Judith. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Retamozo, Maria Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Ciencias de la Salud. Universidad Nacional de Córdoba. Instituto de Investigaciones en Ciencias de la Salud; ArgentinaFil: Sattler, María E.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Gamboa Cárdenas, Rocio V.. Hospital Nacional Guillermo Almenara Irigoyen; PerúFil: Cairoli, Ernesto. Universidad de la República; UruguayFil: Conti, Silvana M.. Hospital Provincial de Rosario; ArgentinaFil: Amezcua Guerra, Luis M.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Silveira, Luis H.. Instituto Nacional de Cardiologia Ignacio Chavez; MéxicoFil: Borba, Eduardo F.. Universidade de Sao Paulo; BrasilFil: Pera, Mariana A.. Hospital Interzonal General de Agudos General San Martín; ArgentinaFil: Alba Moreyra, Paula B.. Universidad Nacional de Córdoba. Facultad de Medicina; ArgentinaFil: Arturi, Valeria. Hospital Interzonal General de Agudos General San Martín; ArgentinaFil: Berbotto, Guillermo A.. Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal de Agudos "Eva Perón"; ArgentinaFil: Gerling, Cristian. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Gobbi, Carla Andrea. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gervasoni, Viviana L.. Hospital Provincial de Rosario; ArgentinaFil: Scherbarth, Hugo R.. Hospital Interzonal General de Agudos Dr Oscar Alende. Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas; ArgentinaFil: Brenol, João C. Tavares. Hospital de Clinicas de Porto Alegre; BrasilFil: Cavalcanti, Fernando. Universidade Federal de Pernambuco; BrasilFil: Costallat, Lilian T. Lavras. Universidade Estadual de Campinas; BrasilFil: Da Silva, Nilzio A.. Universidade Federal de Goiás; BrasilFil: Monticielo, Odirlei A.. Hospital de Clinicas de Porto Alegre; BrasilFil: Seguro, Luciana Parente Costa. Universidade de Sao Paulo; BrasilFil: Xavier, Ricardo M.. Hospital de Clinicas de Porto Alegre; BrasilFil: Llanos, Carolina. Universidad Católica de Chile; ChileFil: Montúfar Guardado, Rubén A.. Instituto Salvadoreño de la Seguridad Social; El SalvadorFil: Garcia De La Torre, Ignacio. Hospital General de Occidente; MéxicoFil: Pineda, Carlos. Instituto Nacional de Rehabilitación; MéxicoFil: Portela Hernández, Margarita. Umae Hospital de Especialidades Centro Medico Nacional Siglo Xxi; MéxicoFil: Danza, Alvaro. Hospital Pasteur Montevideo; UruguayFil: Guibert Toledano, Marlene. Medical-surgical Research Center; CubaFil: Reyes, Gil Llerena. Medical-surgical Research Center; CubaFil: Acosta Colman, Maria Isabel. Hospital de Clínicas; ParaguayFil: Aquino, Alicia M.. Hospital de Clínicas; ParaguayFil: Mora Trujillo, Claudia S.. Hospital Nacional Edgardo Rebagliati Martins; PerúFil: Muñoz Louis, Roberto. Hospital Docente Padre Billini; República DominicanaFil: García Valladares, Ignacio. Centro de Estudios de Investigación Básica y Clínica; MéxicoFil: Orozco, María Celeste. Instituto de Rehabilitación Psicofísica; ArgentinaFil: Burgos, Paula I.. Pontificia Universidad Católica de Chile; ChileFil: Betancur, Graciela V.. Instituto de Rehabilitación Psicofísica; ArgentinaFil: Alarcón, Graciela S.. Universidad Peruana Cayetano Heredia; Perú. University of Alabama at Birmingahm; Estados Unido

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations