This study assessed and quantified the effect of quality of care on death preventability, independent of social and biological variables. One hundred and eighty-one avoidable perinatal deaths (cases) were compared to 341 non-avoidable ones (controls). Judgement criteria on death preventability were based predominantly on compliance with explicit hospital medical care standards, determined by peer review. The overall perinatal mortality rate was 24.8 per 1000 births and could be reduced by 35% if all avoidable perinatal deaths were prevented. Sixteen per cent of the deaths presented structural and 31.2% process deficiencies; both predominated among avoidable perinatal deaths (35.4% vs 5.3%, p < 0.000; and 79.3% vs 5.9%, p < 0.000, respectively). Structural deficiencies increased the risk of an avoidable perinatal death eleven-fold (95% confidence interval (CI) 4.1, 26.9; p < 0.001) and process deficiencies eighty-eightfold (95% CI 37.2, 204.5, p < 0.001), after controlling for confounders. The strength of the association between quality of care and preventable perinatal mortality was estimated.
Abstract:In Mexico, as in many other Latin American countries, the use of dental health services (UDHS) has been scarcely studied, especially the one related with groups that are considered at risk in certain areas. The aim of this study was to evaluate the factors associated with UDHS in an at risk population in primary care. Material and Methods: Cross-sectional study, involving students (T), pregnant women (PW), workers (W) and older adults (OA) (n=368). Variables such as the use of dental health services and factors such as geographical, economic, and organizational barriers were measured. Descriptive statistics, Chi Square test and multivariate binary logistic regression analysis were used. Results: 40.2% (95% CI 30.2-50.2) of the W group had a history of UDHS in primary care, 20% (95% CI 11.8-28.2) of the PW group had spent more than a year without visiting the dentist and 33% (95% CI 23.7-43.9) had been treated at a private dental care service. Level of schooling, occupation, federal support from "Programa Oportunidades" and access to dental care services (p<0.01) were factors associated with UDHS, independent of potential confounders. Conclusion: The health system should guarantee health care by offering comprehensive dental health services and removing organizational barriers to promote a more equitable access to dental care.
This study ranked the cost-effectiveness of health interventions in the metal working industry in a developing country. Data were based on 82 034 workers of the Northern region of Mexico. Effectiveness was measured through 'healthy life years' (HeaLYs) gained. Costs were estimated per worker according to type and appropriate inputs from selected health interventions. 'Hand' was the anatomical region that yielded the most gain of HeaLYs and amputation was the injury that yielded the most gain of HeaLYs. The most effective health intervention corresponded to training, followed by medical care, education, helmets, safety shoes, lumbar supports, safety goggles, gloves and safety aprons. In dollar terms, education presented the best cost-effectiveness ratio (US$637) and safety aprons presented the worst cost-effectiveness ratio (US$1 147 770). Training proved to be a very expensive intervention, but presented the best effectiveness outcome and the second best cost-effectiveness ratio (US$2084). Cost-effectiveness analyses in developing countries are critical. Corporations might not have the same funds and technology as those in developed countries or multinational companies.
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