An explanatory analysis of economic and health inequality changes among Mexican indigenous people, 2000-2010

INTRODUCTION: Mexico faces important problems concerning income and health inequity. Mexico’s national public agenda prioritizes remedying current inequities between its indigenous and non-indigenous population groups. This study explores the changes in social inequalities among Mexico’s indigenous and non-indigenous populations for the time period 2000 to 2010 using routinely collected poverty, welfare and health indicator data. METHODS: We described changes in socioeconomic indicators (housing condition), poverty (Foster-Greer-Thorbecke and Sen-Shorrocks-Sen indexes), health indicators (childhood stunting and infant mortality) using diverse sources of nationally representative data. RESULTS: This analysis provides consistent evidence of disparities in the Mexican indigenous population regarding both basic and crucial developmental indicators. Although developmental indicators have improved among the indigenous population, when we compare indigenous and non-indigenous people, the gap in socio-economic and developmental indicators persists. CONCLUSIONS: Despite a decade of efforts to promote public programs, poverty persists and is a particular burden for indigenous populations within Mexican society. In light of the results, it would be advisable to review public policy and to specifically target future policy to the needs of the indigenous population

Embedded implementation research determinants in Latin American health systems

OBJECTIVE: To assess the determinants of embedded implementation research (EIR) conduct in seven Latin American and Caribbean countries. METHODS: This qualitative interpretative study conducted and analyzed 14 semi-structured interviews based on a grounded theory approach using Atlas-ti© 7.5.7. We grouped the conditions appointed by interviewees as determinants of EIR conduct into six domains. RESULTS: The participation of high-level engaged decision makers as research co-producers is an important EIR determinant that fosters research use. Nevertheless, EIR faces challenges such as dealing with key personnel changes and fluctuating political contexts. CONCLUSIONS: Despite its limitations, EIR is effective in creating a sense of ownership of research results among implementers, which helps bridge the gap between research and decision-making in health syste

Migration Decision-Making Among Mexican Youth: Individual, Family, and Community Influences

We explored migration decisions using in-depth, semi-structured interviews with male and female youth ages 14 to 24 (n=47) from two Mexican communities, one with high and one with low U.S. migration density. Half were return migrants and half were non-migrants with relatives in the U.S. Migrant and non-migrant youth expressed different preferences, especially in terms of education and their ability to wait for financial gain. Reasons for migration were mostly similar across the two communities; however, the perceived risk of the migration journey was higher in the low density migration community while perceived opportunities in Mexico were higher in the high density migration community. Reasons for return were related to youths’ initial social and economic motivations for migration. A greater understanding of factors influencing migration decisions may provide insight into the vulnerability of immigrant youth along the journey, their adaptation process in the U.S., and their reintegration in Mexico

Servicios Amigables para Adolescentes: evaluación de la calidad con usuarios simulados

OBJETIVO: Evaluar la calidad de los servicios de salud amigables para adolescentes. MÉTODOS: Evaluación cualitativa utilizando la técnica de usuario simulado en clínicas de primer nivel de los Servicios de Salud de Morelos, México durante 2018. Se seleccionaron aleatoriamente 10 de 17 establecimientos con servicios amigables no exclusivos para adolescentes. Se incluyó adicionalmente un centro con servicios amigables exclusivo para adolescentes como submuestra de tipo intensivo. Cuatro adolescentes fungieron como usuarios simulados interpretando diferentes casos de consulta en las clínicas. Se realizaron 43 entrevistas semiestructuradas de salida y se hicieron dos grupos nominales para evaluar la calidad percibida a partir de la percepción de amigabilidad y la experiencia de los adolescentes. Se realizó análisis temático de los datos obtenidos. RESULTADOS: La actitud del personal destacó como un elemento clave para la experiencia de los adolescentes. Se encontraron fallas como la existencia de barreras burocráticas para el acceso, falta de señalamientos en las clínicas, falta de privacidad y confidencialidad, fallas en la exploración física durante la consulta y falta de seguimiento de los motivos de consulta. La clínica exclusiva para adolescentes ofreció servicios amigables más adecuados en comparación con las clínicas no exclusivas. CONCLUSIÓN: Aunque en la mayoría de los establecimientos visitados el servicio es accesible, aun distan de cumplir con las características de amigabilidad de acuerdo con las recomendaciones internacionales. La clínica exclusiva para adolescentes destacó al contar con mecanismos mejor estructurados que pueden ser implementados en clínicas no exclusivas para mejorar el proceso de atención.OBJECTIVE: To assess the quality of adolescent friendly health services. METHODS: Qualitative assessment using the simulated user technique in first level clinics of Health Services of Morelos, Mexico, during 2018. Ten out of 17 facilities with non-exclusive adolescent friendly services were randomly selected. An additional facility with exclusive adolescent friendly services was included as an intensive subsample. Four adolescents served as simulated users interpreting different cases in the clinics. The total of 43 semi-structured exit interviews were conducted, and two nominal groups were made to assess the perceived quality from the adolescents’ perception of friendliness and experience. Thematic analysis of the data obtained was performed. RESULTS: Staff attitude was highlighted as a key element in the adolescents’ experience. Failures were found, such as the existence of bureaucratic barriers to access, lack of signage in clinics, lack of privacy and confidentiality, failure of physical examination during the appointment and lack of monitoring of the reasons for appointment. The exclusive clinic for adolescents offered more appropriate friendly services compared with nonexclusive clinics. CONCLUSION: Although the service is accessible in most of the clinics visited, it is still far from being friendly according to international recommendations. The exclusive clinic for adolescents stood out for having better structured mechanisms that can be implemented in nonexclusive clinics to improve the care process

The Deep-Water Red Shrimp Fishery in the Spanish Mediterranean Sea

Publicado

Reflexiones y aportaciones metodológicas

los aportes reunidos en esta obra, provienen de experiencias previas de trabajo profesional y de investigación, lo cual es resultado de distintos enfoques y vivencias de los grupos de investigación aquí involucrados, los que han interactuado en distintos eventos académicos y específicamente, en seminarios que propiciaron la producción que se reúne en esta publicación colectiva. Finalmente, esta experiencia acumulada es una de las mejores recomendaciones para la lectura por demás interesante y propositivo.El presente libro, identifica los aportes metodológicos del trabajo cotidiano en diferentes capítulos para integrarlos a los propios de las disciplinas del diseño. Asimismo, uno de los capítulos aborda la necesidad de estudiar un contexto de referencia que el destinatario pueda interpretar, entre un canal físico y una conexión psicológica a modo de estrategia interpretativa individual y colectiva. Este discurso, sostienen los coautores, se enmarca en la hermenéutica y dentro de lo colectivo, ya que este proceso se estudia desde las aportaciones del interaccionismo simbólico. Se abandona la construcción de las utopías, a la vez que busca soluciones diseñísticas, actuales y novedosas. Es así que el sentido del mensaje del objeto de diseño como texto conlleva un discurso que no “es realizado por el emisor, sino por el receptor y es la enunciación, narración y reconfiguración de los textos, en donde el discurso conforma una determinada idea de la realidad”

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Acceptability and reliability of an adolescent risk behavior questionnaire administered with audio and computer support Aceptabilidad y fiabilidad de un cuestionario sobre el comportamiento de riesgo de los adolescentes aplicado con el apoyo de audio y computadora

OBJECTIVE: To test acceptability and reliability of audio computer-assisted self-interviewing (ACASI) system administered at the household level to gather data on risk behaviors among adolescents in Mexico. METHODS: Answers to sensitive behavior-related questions obtained using ACASI systems were compared with answers to the same questions obtained through face-to-face interviews (FFIs). Focus groups were conducted to explore ACASI acceptability among adolescents and its feasibility in obtaining better self-reported data on sensitive behaviors. RESULTS: ACASI was adolescents' preferred method for reporting risk behaviors, particularly sexual behavior, and did not pose greater challenges to respondents versus FFIs. Also, more risk behaviors were reported through ACASI versus FFIs. CONCLUSION: The use of ACASI systems in disadvantaged households to obtain data on adolescent risk behavior is not only feasible but may also improve data quality in the case of complex questionnaires, compared with FFIs, and should therefore be considered as an alternative survey method.<br>OBJETIVO: Evaluar la aceptabilidad y fiabilidad de un sistema de autoentrevista asistido por audio y computadora (ACASI) aplicado en los hogares para recopilar información sobre el comportamiento de riesgo de los adolescentes en México. MÉTODOS: Se compararon las respuestas obtenidas mediante el sistema ACASI y entrevistas cara a cara (FFI) sobre aspectos sensibles del comportamiento. Se analizó en grupos focales la aceptabilidad de ACASI para los adolescentes y la factibilidad de obtener mejor información en los autoinformes sobre aspectos sensibles de su conducta. RESULTADOS: Los adolescentes prefirieron el sistema ACASI para informar sobre conductas de riesgo, en particular las relacionadas con el sexo, y no constituyó un mayor reto para los entrevistados en comparación con las FFI. Se informaron más comportamientos de riesgo mediante ACASI que en las FFI. CONCLUSIONES: El empleo del sistema ACASI para obtener información sobre las conductas de riesgo de adolescentes en hogares con dificultades económicas no solo es factible, sino que en el caso de cuestionarios complejos puede mejorar la calidad de la información en comparación con las FFI y debe considerarse como un método alternativo de encuesta

Percepciones sobre uso de condón e ITS/VIH: migrantes y no-migrantes de México a EE. UU.

Estudio cualitativo que explora percepciones del uso de condón en relación con las ITS/VIH de jóvenes mexicanos migrantes y no migrantes a los Estados Unidos. Realizamos 40 entrevistas a profundidad a hombres y mujeres de 15 a 24 años de edad en dos municipios de México. Indagamos respecto a la construcción social de la sexualidad, la percepción del riesgo y la vulnerabilidad, en relación con el uso del condón e ITS. Los hallazgos indican que la percepción de riesgo se expresa mediante el concepto “quién es quién”, que refleja procesos sociales de confianza y control, generando tipologías de parejas que podrían contribuir al riesgo y vulnerabilidad de los jóvenes y las jóvenes frente a ITS/VIH

Percepciones sobre uso de condón e ITS/VIH: migrantes y no-migrantes de México a EE.UU.

Estudio cualitativo que explora percepciones del uso de condón en relación con las ITS/VIH de jóvenes mexicanos migrantes y no migrantes a los Estados Unidos. Realizamos 40 entrevistas a profundidad a hombres y mujeres de 15 a 24 años de edad en dos municipios de México. Indagamos respecto a la construcción social de la sexualidad, la percepción del riesgo y la vulnerabilidad, en relación con el uso del condón e ITS. Los hallazgos indican que la percepción de riesgo se expresa mediante el concepto quién es quién, que refleja procesos sociales de confianza y control, generando tipologías de parejas que podrían contribuir al riesgo y vulnerabilidad de los jóvenes y las jóvenes frente a ITS/VIH.-1.Introducción. -2.Marco Teórico. -3.Métodos. -4.Resultados. -5.Discusión. -6. Agradecimientos. -Lista de referencias