Análisis de aspectos relacionados con la equidad en salud y la insuficiencia renal crónica para el caso de la mujer en México / Healthcare equity and chronic renal failure in Mexico: an analysis for the case of women

INTRODUCCIÓN La insuficiencia renal crónica es una enfermedad que se encuentra en un estado de constante crecimiento. La discapacidad que genera esta enfermedad debe considerar efectos físicos y sociales, dada la falta de atención y a las condiciones socioeconómicas que la generan. Por lo tanto, el acceso a los servicios para tratar la insuficiencia renal crónica está condicionado a factores de tipo social y de tipo biológico. OBJETIVO Analizar el efecto de los componentes sociales en la insuficiencia renal crónica en un sector de la población de México que padece la enfermedad, en particular para el caso de la mujer. MÉTODOS Se aplicó el modelo lineal generalizado de Poisson, seleccionando las variables relacionadas con la equidad en la aplicación de los servicios de salud. Se tomaron datos estadísticos reportados en mujeres por el Instituto Nacional de Estadística y Geografía de México en el periodo 2009-2015. Las variables consideradas fueron grado de escolaridad, ocupación, acceso a la salud, región geográfica y zona habitable, así como le etapa de vida. RESULTADOS La mayor tasa de incidencia para la insuficiencia renal crónica corresponde a la mujer adulta intermedia, que trabaja en servicios informales excluidos legalmente de la cobertura institucional de salud, tiene baja escolaridad y vive en un área rural de la zona centro; mientras que la mujer adulta joven que vive en una metrópoli urbana de la zona norte presenta el perfil de menor incidencia. CONCLUSIONES Los determinantes económicos derivados de la actividad de las personas, así como la edad, el nivel educativo y el entorno en el que habitan, influyen tanto en el padecimiento de la enfermedad como en las posibilidades de enfrentarla con éxito.

INTRODUCTION Kidney chronic disease patients are being increasingly identified. The disability generated by this disease must consider physical and social effects given the lack of attention and the socioeconomic conditions that generate it. Therefore, access to services to treat kidney chronic disease is determined by social and biological factors. OBJECTIVE To analyze the effect of the social components on kidney chronic disease in a sector of the Mexican population that suffers from the disease, particularly in the case of women. METHODS The Poisson generalized linear model was applied, selecting the variables related to equity in the administration of health services. Statistical data reported by the National Institute of Statistics and Geography of Mexico in the period 2009-2015 in women was taken. The variables considered were the level of schooling, occupation, access to health, geographical region and habitable zone, as well as stage of life. RESULTS The highest incidence rate for kidney chronic disease is attributed to the intermediate adult woman, who works in informal services legally excluded from institutional health coverage, has low schooling and lives in a rural area of the Center zone, while the young adult woman that lives in an urban metropolis in the North zone presents lowest incidence profile. CONCLUSION The economic determinants derived from people's activities, as well as their age, the educational level and the environment in which they live influence both the acquisition of the disease and the possibilities of managing it successfully.

Análisis de los procesos centrados al paciente en el área de radiología: Un enfoque orientado al modelado de procesos de negocio / Analysis of processes centered to the patient in the radiology area: An approach oriented to modeling business processes

En los últimos años se han desarrollado herramientas para el modelado de procesos que fueron diseñadas en un principio para el ámbito industrial y que hoy en día aún no han sido ampliamente aplicadas en el medio hospitalario. En este trabajo se presenta el análisis de los procesos de atención a pacientes ambulatorios y hospitalizados atendidos en el servicio de radiología del Instituto Nacional de Rehabilitación de la Ciudad de México, mediante la aplicación del modelado de procesos de negocio BPMN el cual mostró a través de índices de flujo de trabajo que la duración de los procesos a los pacientes de urgencias (7.87±4.50 min/estudio) fue menor en comparación a la atención a los pacientes de estudios especiales (53.69±13.12 min/estudio); así mismo se calcularon los tiempos de utilización de la tecnología médica radiológica y se mostró la secuencia de actividades del personal involucrado en los procesos. Además, fue posible identificar las variables que influyen en la realización de estudios radiológicos (edad y condición física) siendo la edad la más estadísticamente significativa en la realización de estudios de urgencias (p = 0.004). La aplicación de BPMN en los procesos de salud brinda una herramienta de apoyo a la mejora continua, a la optimización de los recursos e identificación de los elementos limitadores en los procesos de atención a los servicios médicos.

In recent years, a set of tools for processes modeling have been developed, that was originally designed for the industrial environment, and that up to date has not been widely applied in healthcare environment. This paper presents the implementation of the processes analysis of outpatients and inpatients care attended in the radiology department of the National Institute of Rehabilitation in Mexico City, applying the business processes modeling notation (BPMN), which showed through the use of workflow indexes, that the attention processes duration for emergency patients (7.87±4.50 min/study) was lower when compared to the special studies patients (53.96±13.12 min/study), as well as the using time of medical radiological technology and the sequence of activities of the personnel involved in the processes. In addition, it was possible to identify the variables that influence the realization time of radiological studies (age and physical condition), being age the one with the greatest statistical significance for the realization time of emergency studies (p = 0.004). The application of BPMN in health processes provides a supporting tool for continuous improvement, resources optimization and identification limiting factors in the processes of care medical services.

[Overpricing and affordability of drugs: the case of essential drugs in Mexico]. / Sobrepecio y acceso a los medicamentos: el caso de los medicamentos: el caso de los medicamentos esenciales en México.

Accessibility and availability of drugs has been a matter of great concern for health services all over the world, especially for less developed countries. The World Health Organization has devoted considerable time to this matter, as evidenced in several documents and policies, such as model lists of essential drugs and the strategy "Health for All by the Year 2000". The WHO policy for essential drugs has been widely accepted, and the WHO List of Essential Drugs is now in the ninth revised edition. Although the essential drug policy has been well-accepted by health agencies and NGOs, the pharmaceutical industry has not proven willing to produce essential drugs at affordable prices. The purpose of this study is to examine price levels of essential drugs in Mexico. The evaluation was performed through a comparison of international and national prices for leading drugs in the respective therapeutic categories and included in the WHO model list of essential drugs. The study shows clearly that prices of essential brand-name drugs in Mexico are very high. Per capita consumption has remained stable despite a sharp decrease in the Mexican GDP since 1995. The article discusses the reasons for this and proposes measures to deal with the problem.

[Economic development and health]. / Desarrollo económico y salud.

The purpose of this work is to examine the relationship between economic development and the population's level of health. Consequently, we will establish a comparison between Mexico and other countries in various stages of development. The interrelationship between economic development and health is a complex problem which is little understood, even though it is acknowledged that at increased levels of economic development the levels of health of a population will also increase. These considerations can be taken into account when we accept the fact that the health conditions in industrialized countries are generally better than the health conditions in non-industrialized countries. In the case of Mexico, the problems relating to social disparities due to the type of economic development are reflected in the country's level of health. Poor health conditions and the deterioration of health services in Mexico, based on international references, are matters that must be resolved by means of a clear political decision accompanied by the appropriate corresponding resources so that the strategies put forth by the National Health Program (1989-1994) can be carried out.