COVID-19 Vaccination Hesitancy in Mexico City among Healthy Adults and Adults with Chronic Diseases: A Survey of Complacency, Confidence, and Convenience Challenges in the Transition to Endemic Control.

Background. Monitoring of SARS-COV-2 vaccine hesitancy is important for epidemic control. We measured vaccine hesitancy among healthy adults and adults with chronic diseases after they had been offered the first dose of the vaccine in Mexico City. Methods. An observational cross-sectional study was undertaken among 185 healthy adults and 175 adults living with chronic diseases. Differences in means of variables for confidence, complacency, and convenience were analyzed. Aggregate indicators were constructed and their association with socioeconomic and demographic conditions and vaccination acceptance analyzed using multivariate analysis of variance and multivariate logistic analysis. Results. Up to 16.8% of healthy adults and 10.3% of sick adults reported not having received the SARS-COV-2 vaccine. Healthy adults were more complacent about COVID-19 risks than adults with chronic diseases, while no differences were found between the two groups regarding other hesitancy aggregate indicators. Among adults with chronic diseases, those with more education and enrolled with a social insurance institution were less complacent of COVID-19, while education was positively associated with convenience across both groups. Less complacency with COVID-19 and more confidence in the vaccine were associated with higher vaccine acceptance across both groups. Among adults living with chronic diseases, the odds ratios of vaccine acceptance were higher for less complacency (OR = 2.4, p = 0.007) than for confidence (OR = 2.0, p = 0.001). Odds ratios of vaccine acceptance in these two hesitancy indicators were similar among healthy adults (OR = 3.3, p = <0.005) and higher than for adults with comorbidities. Conclusions. Confidence in the vaccine and complacency regarding COVID-19 risks play an important role for vaccine acceptance in Mexico City, particularly among healthy adults. The perception of risk regarding COVID-19 is more important than confidence in vaccine safety and effectiveness. Promotion of COVID-19 vaccines needs to focus on decreasing complacency with COVID-19 and increasing vaccine confidence, particularly among healthy adults.

Diabetes care innovation in the Mexican Institute for Social Insurance: Scaling up the preventive chronic disease care model to address critical coverage constraints.

BACKGROUND: With diabetes prevalence in Mexico at 11.3% of adults, the Mexican Institute of Social Insurance (IMSS) is piloting the Chronic Disease Preventive Model (CDPM). CDPM includes intensive patient education, care by multidisciplinary teams and risk management in primary care. The objective of this article is to determine CDPM coverage bottlenecks and to explore facilitators and barriers to implementation. METHODS: The National Health and Nutrition Survey 2018 was processed to identify key diabetes prevalence, coverage, quality and outcome indicators. Key IMSS informant interviews and document content analyses were undertaken following the Tanahashi coverage decay model and the Consolidated Framework for Implementation Research (CFIR). RESULTS: IMSS screens 49% of adult beneficiaries for diabetes but only 26% with presumptive diagnosis proceed to confirmation. Out of 4.1 million adults with diabetes, IMSS diagnoses 94% and treats 85%. Medications are received by 90% of patients but only 63% of those requiring insulin receive it. The overall quality of care indicator attains 37% of potential. Coverage of diabetes education, monitoring with HbA1c and interdisciplinary care are 20%, 15% and 3%, respectively. Among IMSS beneficiaries treated by the institute 38.1% have HbA1c levels below 7% and 26.1% have levels above 9%. CDPM facilitators are the perceived threat of uncontrolled diabetes, compatibility of innovation values and willingness for institutional learning. Barriers are centralized decision making, functional differentiation across managers and practitioners and lack of incentives, resource shortages and the lack of measures to ensure fidelity. CONCLUSIONS: CDPM scale-up has to address organizational and process barriers while ensuring the necessary resources for sustainability.

The importance of confidence, complacency, and convenience for influenza vaccination among key risk groups in large urban areas of Peru.

Influenza vaccination has been available under Peru's national immunization program since 2008, but vaccination coverage has decreased lately. Surveys and focus groups were conducted among four risk groups (pregnant women, mothers of children aged <6 years, adults with risk factors, and adults aged ≥65 years) to identify factors affecting influenza vaccine hesitancy in Peru. The 3Cs model (Confidence, Complacency, and Convenience) was used as a conceptual framework for the study. Most pregnant women and mothers of young children (70.0%), but less than half (46.3%) of older adults and adults with risk factors were vaccinated against influenza. Vaccine confidence and complacency were positively associated with educational level. Complacency was the most deficient of the 3Cs. Pregnant women and mothers were the most informed and least complacent among risk groups. Focus groups revealed the misconceptions behind the high level of complacency observed, including the perception of influenza risk and the role assigned to vaccination in preventing the disease. Interviews with officials identified that most strategies are directed to vaccination availability and hence to convenience, with opportunities for strategies to improve vaccination uptake and community engagement. The results highlight the importance of implementing in Peru communication strategies to increase perceptions of vaccine safety and effectiveness thus improving confidence and reducing complacency. The establishment of explicit incentives should also be considered to increase vaccination uptake, particularly to health personnel.

Influenza vaccination hesitancy in five countries of South America. Confidence, complacency and convenience as determinants of immunization rates.

INTRODUCTION: Influenza morbidity and mortality are significant in the countries of South America, yet influenza vaccination is as low as 56.7% among pregnant women, reaching 76.7% of adults with chronic diseases. This article measures the relative values for the vaccination hesitancy indicators of confidence, complacency and convenience by risk-groups in urban areas of five countries of South America with contrasting vaccination rates, analyzing their association with sociodemographic variables and self-reported immunization status. METHODS: An exit survey was applied to 640 individuals per country in Brazil, Chile, Paraguay, Peru and Uruguay, distributed equally across risk groups of older adults, adults with risk factors, children ≤6 and pregnant women. Indicators were constructed for vaccine confidence, complacency and convenience. Analysis of variance and multiple logistic analysis was undertaken. RESULTS: Adults with risk factors are somewhat more confident of the influenza vaccine yet also more complacent. Convenience is higher for mothers of minors. Children and older adults report higher levels of vaccination. The 3Cs are more different across countries than across risk groups, with values for Chile higher for confidence and those for Uruguay the lowest. Complacency is lower in Brazil and higher in Uruguay. Results suggest that confidence and complacency affect vaccination rates across risk groups and countries. CONCLUSIONS: Influenza vaccine confidence, complacency and convenience have to be bolstered to improve effective coverage across all risk groups in the urban areas of the countries studied. The role played by country contextual and national vaccination programs has to be further researched in relation to effective coverage of influenza vaccine.

Health policy and systems research publications in Latin America warrant the launching of a new specialised regional journal.

BACKGROUND: Scientific journals play a critical role in research validation and dissemination and are increasingly vocal about the identification of research priorities and the targeting of research results to key audiences. No new journals specialising in health policy and systems research (HPSR) and focusing in the developing world or in a specific developing world region have been established since the early 1980s. This paper compares the growth of publications on HPSR across Latin America and the world and explores the potential, feasibility and challenges of innovative publication strategies. METHODS: A bibliometric analysis was undertaken using HPSR MeSH terms with journals indexed in Medline. A survey was undertaken among 2500 authors publishing on HPSR in Latin America (LA) through an online survey, with a 13.1% response rate. Aggregate indicators were constructed and validated, and two-way ANOVA tests were performed on key variables. RESULTS: HPSR publications on LA observed an average annual growth of 27.5% from the years 2000 to 2018, as against 11.4% worldwide and yet a lag on papers published per capita. A total of 48 journals with an Impact Factor publish HPSR on LA, of which 5 non-specialised journals are published in the region and are ranked in the bottom quintile of Impact Factor. While the majority of HPSR papers worldwide is published in specialised HPSR journals, in LA this is the minority. Very few researchers from LA sit in the Editorial Board of international journals. Researchers highly support strengthening quality HPSR publications through publishing in open access, on-line journals with a focus on the LA region and with peer reviewers specialized on the region. Researchers would support a new open access journal specializing in the LA region and in HPSR, publishing in English. Open access up-front costs and disincentives while waiting for an Impact Factor can be overcome. CONCLUSION: Researchers publishing on HPSR in LA widely support the launching of a new specialised journal for the region with a vigorous editorial policy focusing on regional and country priorities. Strategies should be in place to support English-language publishing and to develop a community of practice around the publication process. In the first years, special issues should be promoted through a priority-setting process to attract prominent authors, develop the audience and attain an Impact Factor.

Loss of job-related right to healthcare associated with employment turnover: challenges for the Mexican health system.

BACKGROUND: The Mexican health system segments access and right to healthcare according to worker position in the labour market. In this contribution we analyse how access and continuity of healthcare gets interrupted by employment turnover in the labour market, including its formal and informal sectors, as experienced by affiliates to the Mexican Institute of Social Security (IMSS) at national level, and of workers with type 2 diabetes (T2DM) in Mexico City. METHODS: Using data from the National Employment and Occupation Survey, 2014, and from IMSS electronic medical records for workers in Mexico City, we estimated annual employment turnover rates to measure the loss of healthcare access due to labour market dynamics. We fitted a binary logistic regression model to analyse the association between sociodemographic variables and employment turnover. Lastly we analysed job-related access to health care in relation to employment turnover events. RESULTS: At national level, 38.3% of IMSS affiliates experienced employment turnover at least once, thus losing the right to access to healthcare. The turnover rate for T2DM patients was 22.5%. Employment turnover was more frequent at ages 20-39 (38.6% national level; 28% T2DM) and among the elderly (62.4% national level; 26% T2DM). At the national level, higher educational levels (upper-middle, OR = 0.761; upper, OR = 0.835) and income (5 minimum wages or more, OR = 0.726) were associated with lower turnover. Being single and younger were associated with higher turnover (OR = 1.413). T2DM patients aged 40-59 (OR = 0.655) and with 5 minimum wages or more (OR = 0.401) experienced less turnover. Being a T2DM male patient increased the risk of experiencing turnover (OR = 1.166). Up to 89% of workers losing IMSS affiliation and moving on to other jobs failed to gain job-related access to health services. Only 9% gained access to the federal workers social security institute (ISSSTE). CONCLUSIONS: Turnover across labour market sectors is frequently experienced by the workforce in Mexico, worsening among the elderly and the young, and affecting patients with chronic diseases. This situation needs to be prospectively addressed by health system policies that aim to expand the financial health protection during an employment turnover event.

Detección oportuna de pacientes Gineco-Obstetricia con disfunción psicosocial / Opportune detection of Gyneco-obstetrical patients with psychosocial dysfunction

Actualmente se reconoce que la conducta humana y sus determinantes sociales son variables críticas par entender la etiología, tratamiento y prevención de muchos trastornos que previamente eran sólo atribuídos al sustratobiológico. Entre las muchas categorías que han recibido especial atención por parte de los investigadores de la salud: los eventos de la vida, las respuestas de enfrentamiento a estrés y el estado emocional, constituyen una línea de investigación de particular interés. La relación de estas categorías no sólo se centra en la enfermedad, malestar, inhabilidad, etc. sino que su conprensión permite conocer también la salud, habilidades, recursos y otros aspectos positivos del funcionamiento humano. Por otro lado, la reestructuración de los servicios de salud plantea el trabajo interdisciplinario para atender de forma integral a los pacientes. Además de que se reconoce que los pacientes en la práctica médica general que conllevan alguna disfunción psicosocial hacen uso de un mayor número de servicios innecesariamente, por lo que se requiere balancear el costo-beneficio de los servicios para aprovechar adecuadamente los recursos humanos y materiales con los que se cuente. Bajo esta perspectiva, en el presente trabajo se informan los resultados obtenidos en las tres categorías de análisis antes mencionadas: Eventos de la vida, respuestas de enfrentamiento ante el estrés y su relación con el estado emocional en una muestra representativa de 399 pacientes que acudieron en 1986, al Instituto nacional de Perinatología -INPer-: 297 pacientes obstétricas-OBS- y 102 pacientes con trastornos ginecológicos-GINE-, a quienes se les aplicó el Cuestionario General de Salud, La escala de respuestas para Enfrentar Sucesos Importantes y La Escala de Eventos de la Vida. Los Resultados obtenidos permitieron delimitar aquellos evntos de la vida, respuestas de enfrentamiento y síntomas psicológicos significativamente asociados al estado emocional en las pacientes OBS y GINE. Además, según el punto establecido en el instrumento de tamizaje (CGS-30), los índices obtenidos permitieron distringuir a las pacientes "probable caso"(con necesidad de apoyo psicoterapéutico), de las "no caso". De este modo, esta información proporciona algunos lineamientos para propuestas de intervención así como de detección, implementado en ellas versiones breves de los instrumentos utilizados conteniendo los elementos significativos asociados al estado emocional de las pacientes en cada con

Indicadores del establecimiento de la lactancia en mújeres primíparas / Indicators of the unitialization of lactancy in primiparous women

El objetivo del presente trabajo fue conocer el perfil de la mujer primípara en riesgo de no iniciar o abandonar tempranamente la lactancia, bajo la influencia de las prácticas hospitalarias, el control prenatal y la educación en salud. A partir de un banco de datos creado por tres estudios longitudinales-prospectivos en mujeres captadas desde el embarazo hasta los 6 meses postparto. El proceso utilizado fue análisis categórico multivariado. Los modelos categóricos para 907 primíparas mostraron que cuando las mujeres y sus compañeros presentan escolaridades < = a 9 años, la mujer trabaje fuera del hogar, desea alimentar con fórmula a su nuevo hijo, es soltera, además de atenderse en instituciones que no promueben la lactancia, así como no asistir a cursos de educación en salud durante el embarazo; lleva que la lactancia se establezca por abajo del 20%, porque las mujeres con este perfil, reuniendo dos o más de las características anteriores, inicia la introducción de sucedáneos antes de los 15 días de vida del niño.