Objective. Breast cancer is a leading cause of morbidity and mortality in Mexico. We assessed the effectiveness of a trainthe-trainer program in two Mexican states in improving knowledge among professional and nonprofessional community health workers. Materials and Methods. We worked with local organizations to develop and implement a train-the-trainer program to improve breast cancer knowledge among community health workers, including professional health promoters (PHPs) who were trained and then trained nonprofessional community health promoters (CHPs). We surveyed participants before and after training that included in-person and online classes and again approximately 3 months later. We used paired t tests and chi-square tests to compare survey responses at the different times. We also used logistic regression to assess whether promoter characteristics were associated with greater improvements in breast cancer knowledge after training. Results. Overall, 169 PHPs (mean age, 36 years) completed training and provided a 10-hour training course to 2,651 CHPs, who also completed the pre-and post-training survey. For both PHPs and CHPs, post-training surveys demonstrated increases in an understanding of breast cancer as a problem; an understanding of screening, treatment, and insurance coverage issues; and knowledge of breast cancer risk factors, symptoms, and what constitutes a family history of breast cancer (all p , .05). These improvements were maintained 3 to 6 months after training. Conclusion. Train-the-trainer programs hold promise for leveraging community health workers, who far outnumber other health professionals in many low-and middle-income countries, to engage in health promotion activities for cancer and other noncommunicable diseases.
BackgroundBreast cancer (BC) is a major cause of disease and death worldwide. In addition to its contribution to mortality and disability, it is a major economic burden both public and private.ObjectiveTo estimate the average direct medical cost/year of care for the diagnosis and treatment of BC in two coverage scenarios in Mexico: What is ‘ideal’ based on service usage patterns according to international guidelines and what is ‘current’ using the service usage patterns of suppliers in Mexico.Material and MethodsThe pattern and intensity of use of procedures for the care of BC in the Mexican Social Security Institute (IMSS) for 2009 were identified and prices were associated using the guidelines from the System of Social Protection in Health (SPSS) and the IMSS for the current scenario and the ideal scenario, international patterns (Breast Health Global Initiative BHGI after its acronym in English) were used and prices were associated from the SPSS guidelines.ResultsThe annual average direct medical cost per patient in the ‘current’ scenario was 8557 US$, while the cost in the ‘ideal’ scenario was 4554 US$. There are differences in costs between ‘what we do’ and ‘what should be done’, due to differences in the implementation of the interventions for the treatment of the different stages of the disease. A proportional increase in the average cost was also identified as the diagnosis stage advanced (from I to III).ConclusionsGiven that in Mexico there is universal insurance coverage for the treatment of BC, it is necessary to use economic resources more efficiently. It is necessary to continue to examine this topic in more depth and the next step will be to assess the effectiveness of both scenarios in order to provide enough evidence for the decision-making process.
Background More than 5·5 billion people, most in low-income and middle-income income countries (LMICs), live with limited or no access to pain control and palliative care. This inequality-the pain divide-is a grave injustice. As a result, many patients around the world, especially those with chronic diseases, needlessly suff er pain. The Harvard Global Equity Initiative-Lancet Commission on Global Access to Pain Control and Palliative Care (GAPCPC) aims to address the pain divide through the promotion of eff ective universal health coverage (UHC) and by harnessing existing platforms for health systems strengthening.Methods The Commission has convened experts from the health systems, global health, and palliative care communities. It merges eff orts between research, policy, and implementation partners at the global and national levels for policy-oriented research and evidence-based policy-making. The Commission is reviewing country cases of innovative reform and policy-making on palliative care in Mexico, Colombia, and Costa Rica, to identify the greatest opportunities and challenges for UHC. Findings The Commission noted examples of reforms in legislature, education, and health systems to improve access to pain relief in Mexico, Colombia, and Costa Rica. Such reforms include the development of palliative care curricula for undergraduate and post-graduate courses to expand protocols for prescription of opioids for pain control. The Commission focuses on the impact of contextual and enabling factors to producing equitable, eff ective, and aff ordable pain control and palliative care services in various LMICs, including these three Latin American countries. Further, it examines the policy, regulatory, and training barriers to achieving eff ective UHC and strategies for future reform. It aims to enhance knowledge exchange between experts and policy-makers in LMICs on pain policy, as well as on the training of diff erent cadres of the health workforce and models of service delivery to meet palliative care needs across diseases, and throughout the life course.Interpretation Policy-makers require guidelines for action and eff ective planning at the country level. A systematic guide and tool for drafting national pain and palliative care plans in LMICs is missing. Documenting the process and the development of guiding tools based on country cases of eff ective strategies can help other LMICs along their trajectories in making pain control and palliative care for all a reality.
bined with current cervical cancer screening and HPV disease treatment practices in Turkey. For the vaccination strategy 85% coverage rate was assumed in the frame of a mandatory school-based program. Reference strategy was current cervical cancer screening and HPV disease treatment practices in Turkey. Costs were estimated from the perspective of the Turkish healthcare system, using direct medical costs associated with the diagnosis and treatment of cervical diseases. RESULTS: Over 100 years, cumulative % (absolute) reduction in the incidence of 6/11/16/18-related cases of CIN1, CIN2/3, cervical cancer, cervical cancer deaths, genital warts-female, and genital-warts-male was 78% (4,894), 72% (32,537), 57% (73,277), 54% (40,513), 86% (404,674), and 86% (409,029), respectively, in the vaccination group compared to the reference group. Number of 6/11/16/18-related CIN1, CIN2/3, cervical cancer, cervical cancer deaths, and genital warts (both in female and male population) was halved in the vaccination strategy group compared to the reference strategy group by year 19, 24, 41, 44, and 14, respectively. The incremental cost-effectiveness ratio for routine vaccination of 12-year-old girls was 18,251 TRY/QALY over 100 years. CONCLUSIONS: A quadrivalent HPV vaccination program can reduce the incidence of cervical cancer, CINs and genital warts in Turkey at a cost-per-QALY ratio within the range defined as cost effective.
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