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Biomedical subjects

J L Bobadilla

Publications and source records attributed to J L Bobadilla.

At least 19 recordsLinked to original sources
PubMed1996

The effectiveness of antenatal care in preventing intrauterine growth retardation and low birth weight due to preterm delivery.

A case-control study was conducted to assess the effectiveness of antenatal care in preventing intrauterine growth retardation (IUGR) and low birth weight due to preterm delivery (PD), using data from 1837 births which took place in 25 hospitals in Mexico City during 1984. Women with an inadequate number of visits for gestational age had 63% greater odds of IUGR (95% CI: 1.01, 2.65) and 51% greater odds of PD (95% CI: 1.02, 2.23) than women with an adequate number. The content of antenatal visits showed no independent effect on the prevention of IUGR. Women having had poor content showed a PD OR of 1.76 (95% IC: 1.33, 2.34). An important reduction in the incidence of births with IUGR and PD could be expected if women could attend an adequate number of antenatal visits (11 and 9% reductions, respectively). Eighteen per cent of the PD births would probably be prevented if antenatal care could include at least six procedures: blood pressure, height and weight, urine and blood samples, and pelvic examination.

Adolescent↗
PubMed1994

[The epidemiological transition in Latin America].

The changes in health conditions that have occurred in most of the countries of Latin America in the second half of the twentieth century are analyzed. "This paper analyzes the main mechanisms involved in the epidemiologic transition, which are: changes in risk factors, fertility decline and improvements in health care technology." The authors use a mortality profile ratio, obtained by dividing the mortality rate due to infectious and parasitic diseases over the mortality rate due to cardiovascular diseases and neoplasms, to analyze trends in 15 countries. "Three distinct groups can be recognized. Each of them represents a different transitional experience. Such experiences are discussed in detail, including a new 'protracted polarized model' of the epidemiologic transition, which characterizes several Latin American countries. Finally, evidence is provided to illustrate the relationship among economic development, fertility change, and mortality profiles." (SUMMARY IN ENG)

Birth Rate↗
PubMed1994

Design, content and financing of an essential national package of health services.

A minimum package of public health and clinical interventions, which are highly cost-effective and deal with major sources of disease burden, could be provided in low-income countries for about US$ 12 per person per year, and in middle-income countries for about $22. Properly delivered, this package could eliminate 21% to 38% of the burden of premature mortality and disability in children under 15 years and 10-18% of the burden in adults. The cost would exceed what governments now spend on health in the poorest countries but would be easily affordable in middle-income countries. Governments should ensure that, at the least, poor populations have access to these services. Additional public expenditure should then go either to extending coverage to the non-poor or to expansion beyond the minimum collection of services to an essential national package of health care, including somewhat less cost-effective interventions against a larger number of diseases and conditions.

Adult↗
PubMed1992

Evaluation of maternal health programs: approaches, methods and indicators.

Evaluation of maternal health services is an essential function of any health system. Single or multiple aspects of a program can be evaluated but they must be clearly defined. To assess success of a program the dimensions of coverage, equity, quality, women's satisfaction, efficiency and cost-effectiveness must be considered. These can be measured according to some standard criteria, and various methods are described, including randomized clinical trials, randomized community trials, before and after studies, and observational studies, including the case-control approach and confidential inquiries into maternal deaths. Indicators to assess effectiveness of a maternal health program may relate to structure, i.e., available resources or organizational arrangement; process, including changes in quantity of services provided; or outcome indicators that measure maternal mortality or morbidity.

Female↗
PubMed1992

Birthweight distributions in Mexico City and among US Southwest Mexican Americans: the effect of altitude.

In this study birthweight distributions for Mexican Americans and Mexico City were compared. Sharp differences in the two distributions were nearly eliminated by controlling for altitude. The small remaining excess in low birthweight in Mexico City appears to be due to a slight overrepresentation of tertiary hospital deliveries, and possibly to a greater prevalence of pathological conditions. The results are consistent with the favorable low birthweight rate reported for Mexican Americans and illustrate the need to adjust for altitude in studies of low birthweight.

Altitude↗
PubMed1992

[Advances and challenges in setting priorities in health].

The advances and problems in the definition of explicit criteria to measure health needs are discussed. In part one the advantages and limitations of the retrospective and prospective approaches in the identification of health needs for a rational distribution of resources are described. In part two progress in the application of explicit criteria for the prioritization of diseases and interventions to control them are analyzed. Finally, the methodological, conceptual, and operative challenges confronted by this field are discussed.

Health Priorities↗
PubMed1991

Early neonatal mortality and cesarean delivery in Mexico City.

The relationship between cesarean delivery and neonatal mortality is presented with information from 292 early neonatal deaths (cases) and 3098 survivors (controls) born in 25 hospitals in Mexico City during the summer of 1984. The overall rate of cesarean delivery was 27%. Variations between health agencies and different social groups were not related to obstetric risk, suggesting that a sizable proportion of the operations were probably unjustified. Babies of normal birth weight (greater than or equal to 2500 gm) delivered by cesarean section were 2.5 times more likely to die in the early neonatal period compared with vaginally delivered babies of the same weight. The excess of mortality could not be explained by the effect of maternal characteristics or complications or by differences in birth weight or gestational age. It is suggested that the conditions under which the operation was performed probably explain the increased risk of early neonatal death. It is likely that poor quality of resuscitation and respiratory care are implicated in the link between "unnecessary" cesarean section and early neonatal mortality.

Birth Weight↗
PubMed1991

Elements for a theory of the health transition.

This article presents the basic elements for developing a theory of the health transition. Such elements include the definition of concepts, the specification of a framework on the determinants of health status, the analysis of the mechanisms through which health change occurs in populations, the characterization of the attributes that allow us to identify different transition models, and the enumeration of the possible consequences of the transition. The propositions are presented with a sufficient level of generality as to make them applicable to different contexts; at the same time, an attempt is made to provide them with the necessary specificity to account for different national experiences, thus opening a space for future comparative research efforts. Through the systematization exercise presented in this article, we hope to contribute to the progress of a topic that has grown in importance during recent years. Such importance is due to the enormous potential that health transition theory has for understanding and transforming the growing complexity of our times.

Demography↗
PubMed1991

[The epidemiologic transition in Latin America].

The concept of health transition is considered to include two interrelated processes: transition of health care and epidemiological transition. The latter encompasses three basic processes: (a) replacement of the common infectious diseases by noncommunicable diseases and injuries as the leading causes of death; (b) a shift in peak morbidity and mortality from the young to the elderly; and (c) change from a situation in which mortality predominates in the epidemiological panorama to one in which morbidity is dominant. Latin America is characterized by a heterogeneous health profile in which different countries are in various stages of epidemiological transition. However, in most of them, the transition experience is unlike that of the developed countries and is distinguished by: (a) a simultaneous high incidence of diseases from both the pre- and post-transitional stages; (b) a resurgence of some infectious diseases that had previously been under control; (c) a lack of resolution of the transition process, so that the countries appear to be caught in a state of mixed morbidity; (d) a peculiar epidemiological polarization, not only between countries but also in the different geographical areas and between the various social classes of a single country. This experience is called a "prolonged polarized model."

Adolescent↗
PubMed1990

[Evaluation of literature published about research on perinatal health carried out in Mexico, 1980-1988].

In this paper, the authors present an analysis of the quantity and quality of Mexican literature on perinatal health, corresponding to the period 1980-January 1989. The articles here analyzed were published in journals of the Index Medicus. First, the authors established the Mexican contribution to the international bibliographic production. After that, the articles were classified according to the subject under discussion. The relevance of these themes, in relation to the Mexican epidemiologic situation, is discussed. In second place, a preliminary evaluation of the quality of some of the national articles was done. With this purpose, a scoring system (including conceptual and methodological criteria) was elaborated. The authors concluded that Mexican scientific production on perinatal health is still very scanty and they observed that it diminished during the present decade. One possible reason for that is the reduction of the budget devoted to research and the scarcity of researchers salaries. The analysis by themes showed that the scientific production is spread out and that the subjects most frequently treated do not always correspond to the most important epidemiologic problems in Mexico. The evaluation of quality is considered by the authors as preliminary. Anyway, this first approach shows that most of the papers are based on research projects with a transversal design, without an explicit theoretical framework and focused on hospital settings. The authors conclude that the evaluation of the quantity of the scientific production contributes to research development. Perinatal health; analysis of research.

Evaluation Studies as Topic↗
PubMed1986

An innovative approach to public health research: the case of a new center in Mexico.

This paper presents the conceptual and organizational elements that have guided the development of the Center for Public Health Research (CPHR) in Mexico. The CPHR was established in August 1984, in the midst of the most profound health care reform in Mexico in the last 40 years. The reform has included, among other measures, a Constitutional amendment recognizing the social right to health care, an energetic effort to decentralize the system so that each state will run its own services, an ambitious drive to extend primary health care coverage to all the population, and a strong promotion of research as the basis for strategic planning and for the development of standards of care. The creation of the CPHR is a response to the need for a firm base of epidemiologic and health systems research in Mexico. This need arises from the increasing complexity of the country's organizational arrangements for health care. In addition, the patterns of morbidity and mortality are also becoming more intricate, as Mexico is experiencing an epidemiologic transition whereby chronic diseases, mental ailments, and accidents are on the rise even as the incidence of infectious diseases and malnutrition continues to be high. As a unit of the Ministry of Health, the CPHR must strike a balance between relevance to decision making and excellence in the strict adherence to the norms of scientific research. To do so, it has developed a conceptual framework based on a tridimensional matrix. The dimensions of the matrix include substantive areas (i.e., the phenomena to be researched), knowledge areas (i.e., the disciplines pertinent to public health), and methodological areas (i.e., the methods to be applied in each project). The intersection of these dimensions produces different configurations of "research modules" that can be adapted to changing priorities. Current priorities of the CPHR include epidemiologic studies of the emerging conditions in the transition, migration and health, child survival, social organization and primary health care, health systems management, quality of care, and the development of information systems and quantitative models for public health research. Research projects are undertaken in a matrix type of organization in which academic departments are structured according to problems rather than disciplines. The analysis of Mexico's Center for Public Health Research may contribute to similar endeavors in other countries and also to the wider development of comparative studies on research organizations.

Mexico↗
PubMedDate not supplied

[Coverage and quality of the registration of perinatal deaths occurring in health institutions in the Federal District].

"This paper presents the results of the first direct attempt at evaluating the coverage of the perinatal death registration in the Distrito Federal [of Mexico]; this study is based on the information gathered from 574 deaths which took place in 23 hospitals in the Distrito Federal during a three month period in 1984. Both the causes of the failure to register many of these deaths and the quality of the information presented in perinatal death certificates are pointed out and discussed here. According to the evidence analyzed, it is clear that underregistration in the Distrito Federal is extremely marked.... The paper suggests the possibility of establishing a hospital registration system which would keep a record of both deaths and births. It also stresses the need for establishing rules to detect fetal deaths plus the need for unifying criteria regarding the definition of 'live birth'." (SUMMARY IN ENG)

Americas↗
PubMedDate not supplied

[Elements for a theory of transition in health].

This article presents the basic elements for developing a theory of the health transition. Such elements include the definition of concepts, the specification of a framework on the determinants of health status, the analysis of the mechanisms through which changes in health occur in populations, the characterization of the attributes that allow us to identify different transition models, and the enumeration of the possible consequences of the transition. The propositions are presented with a sufficient level of generality as to make them applicable to different contexts; at the same time, an attempt is made to provide them with the necessary specificity to account for different national experiences, thus opening a space for future comparative research efforts. Through the systematization exercise presented in this paper, we hope to contribute to the progress of a topic that has gained growing importance during recent years. Such importance is due to the enormous potential that health transition theory has for understanding and transforming the growing complexity of our times.

Birth Rate↗