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This article describes 8 guiding principles for the digital transformation of the health sector and identifies their relationship with the COVID-19 pandemic, as well as highlights their importance to countries undergoing digital transformation processes. In the Region of the Americas, among other gaps, 30% of people do not have access to the Internet, which is why it is mandatory to develop policies and actions to deliver public health interventions equitably and sustainably to ensure that no one is left behind. The 8 principles focus on the 4 areas of a sustainable health system—human, social, economic, and environmental—and highlight the broader possibilities for using digital technology to have an impact on the sustainability of health systems. (Am J Public Health. 2022;112(S6):S621–S624. https://doi.org/10.2105/AJPH.2022.306749 )

espanolObjetivo. Identificar caracteristicas de las escuelas de me-dicina asociadas con desempeno en un examen de admision a residencias. Material ymetodos. Utilizando una base de datos con 153 654 registros de aspirantes entre 2014-2018 se analizaron el desempeno y seleccion en el Examen Nacional de Aspirantes a Residencias Medicas (ENARM) y su relacion con tipo de escuela y estatus de acreditacion, asi como region geografica. Resultados. El desempeno fue 62.5% para programas acreditados y 61.4% para no acredi-tados (p EnglishObjective. To identify medical school characteristics as-sociated with performance in a medical residency admission test. Materials and methods.Performance and selection rates according to type of medical school (Student s t-test, Chi-squared test), accreditation status (Student s t-test) and geographic regions (Anova) were analyzed from a database comprising 153 654 physicians who took the residency admission test Examen Nacional de Aspirantes a Residencias Medicas (ENARM) in the period 2014-2018. Results. Per-formance was 62.5% for accredited programs and 61.4% for non-accredited programs (p

In Mexico, paediatric cancer is the leading cause of death for children aged 0–18 years. This study analyses the main challenges for paediatric cancer care from the perspective of three key health systems functions: stewardship, financing and service delivery. The study used a mixed methods approach comprised of: (1) a scoping literature review, (2) an analysis of 2008–18 expenditures on paediatric cancer by the Fund for Protection against Catastrophic Expenditures (FPGC) of Seguro Popular and (3) a nation-wide survey of the supply capacity of 59 Ministry of Health (MoH) and 39 Mexican Institute of Social Security (IMSS) hospitals engaged in paediatric cancer care. The study found that while Mexico has made substantial progress towards universal health coverage (UHC) for paediatric cancer treatment, serious gaps persist. FPGC funds for paediatric cancer increased from 2008 to 2011 to reach US$36 million and then declined to US$13.6 million in 2018, along with the number of covered cases. The distribution of health professionals and paediatric oncology infrastructure is uneven between MoH and IMSS hospitals and across Mexican regions. Both institutions share common barriers for continuous and co-ordinated health care and lack monitoring activities that cripple their capacity to apply uniform standards for high-quality cancer care. In conclusion, achieving universal and effective coverage of paediatric cancer treatment is a critical component of UHC for Mexico. This requires periodic and ongoing assessment of health system performance specific to paediatric cancer to identify gaps and propose strategies for continued investment and improvement of access to care and health outcomes for this important cause of premature mortality.

En este artículo se describen ocho principios rectores para la transformación digital del sector de la salud, se establece su relación con la pandemia de COVID-19 y se destaca su importancia para los países que se encuentran en un proceso de transformación digital. En la Región de las Américas, 30% de las personas no tiene acceso a Internet, entre otras brechas, por lo que es imperativo adoptar políticas y medidas para que la implementación de las intervenciones de salud pública sea equitativa y sostenible, de manera de garantizar que nadie se quede atrás. Los ocho principios se centran en las cuatro esferas de un sistema de salud sostenible (humana, social, económica y ambiental) y ponen de relieve las posibilidades más amplias de utilizar las tecnologías digitales para incidir en la sostenibilidad de los sistemas de salud.

This article describes eight guiding principles for the digital transformation of the health sector and identifies their relationship with the COVID-19 pandemic, as well as highlighting their importance to countries undergoing digital transformation processes. In the Region of the Americas, among other gaps, 30% of people do not have access to the Internet, which is why it is mandatory to develop policies and actions to deliver public health interventions equitably and sustainably to ensure that no one is left behind. The eight principles focus on the four areas of a sustainable health system - human, social, economic and environmental - and highlight the broader possibilities using digital technology to impact the sustainability of health systems.Este artigo descreve oito princípios norteadores para a transformação digital do setor da saúde e identifica sua relação com a pandemia de COVID-19, além de destacar sua importância para os países que estão em processo de transformação digital. Na Região das Américas, entre outras lacunas, 30% das pessoas não têm acesso à Internet; portanto, é imprescindível desenvolver políticas e ações para realizar intervenções de saúde pública de maneira equitativa e sustentável, para assegurar que ninguém seja deixado para trás. Os oito princípios enfocam as quatro áreas de um sistema de saúde sustentável – humana, social, econômica e ambiental – e destacam possibilidades mais amplas do uso da tecnologia digital para impactar a sustentabilidade dos sistemas de saúde.

On 15 February 2020, during the Munich Security Conference(1), the Director of the World Health Organization (WHO), Dr.Tedros Adhanom Ghebreyesus, stated that the fight against the COVID-19 pandemic was accompanied by a fight against an “infodemic”, leading to a series of initiatives by the WHO and other organizations to face this challenge. This situation is not new: others have occurred during other health emergen-cies, but never one of the current magnitude, resulting from the increased use of digital applications (2). In the age of digital interdependence, this phenomenon is amplified by the conver-gence of increased access to mobile devices, internet access, and the use of social networks, which are spreading it like a virus, further and faster than ever before (3).

BackgroundThe sustainable development goals (SDGs) have generated momentum for global health, aligning efforts from governments and international organisations toward a set of goals that are expected to reflect improvements in life conditions across the globe. Mexico has huge social inequalities that can affect access to quality care and health outcomes. The objective of this study is to analyse inequalities among Mexico’s 32 states on the health-related SDG indicators (HRSDGIs) from 1990 to 2017.MethodsThese analyses rely on the estimation of HRSDGIs as part of the Global Burden of Disease study 2017. We estimated the concentration index for 40+3 HRSDGI stratified by Socio-demographic Index and marginalisation index, and then for indicators where inequalities were identified, we ran decomposition analyses using structural variables such as gross domestic product per capita, poverty and health expenditure.FindingsMexico has made progress on most HRSDGIs, but current trends in improvement do not appear to fast enough to meet 2030 targets. Out of 43 HRSDGIs, we identified evidence of inequality between Mexico’s states for 30 indicators; of those, 23 HRSDGIs were unequal distributed affecting states with lower development and seven affecting states with higher development. The decomposition analysis indicates that social determinants of health are major drivers of HRSDGI inequalities in Mexico.InterpretationModifying current trends for HRSDGIs will require subnational-level and national-level policy action, of which should be informed by the latest available data and monitoring on the health-related SDGs. The SDGs’ overarching objective of leaving no-one behind should be prioritised not only for individuals but also for communities and other subnational levels.

The introduction of Seguro Popular de Salud (SPS) expanded the practice of contracting in the Mexican health system. Specifically, SPS established that formal relationships among institutional agencies should be mediated by written agreements and contracts. These contracts were supposed to ensure a technically sound interaction between financing and service provision agencies. This study aims to assess the degree to which the contracts adhere to five characteristics of cost-effective contracting proposed by Figueras et al. Information was extracted from a purposive sample of 30 institutional agreements and contracts formalizing the relationship among federal, state, and local public agencies and between public and private agencies. Contracts and management agreements were obtained from of a series of SPS evaluations carried out between 2007 and 2012 (including some agreements signed in 2006); additional contracts signed after 2012 were obtained through an Internet search. Most of the five framework characteristics were identified in the sample of contracts, but certain elements such as pay-for-performance and the explicit definition of the volume of services to be provided were clearly deficient. This analysis found that over time SPS contracts have been modified to better establish inter-institutional relationships in compliance with guidelines regarding the allocation of funds and the purchasing of services, but they still need further improvements to accomplish their role of increasing efficiency in the flow of funds through the Mexican health system.

[Extracto]. El 15 de febrero de 2020, durante la Conferencia sobre Seguridad en Munich, el director de la Organizacion Mundial de la Salud (OMS), el Dr. Tedros Adhanom Ghebreyesus, indico que a la lucha contra la epidemia por la COVID-19 se le sumaba la lucha contra la “infodemia”, dando asi inicio a una serie de acciones desde la OMS y otras organizaciones para enfrentar este desafio. Esta situacion no es nueva, ya que casos similares han sucedido durante otras emergencias sanitarias, pero nunca antes con la magnitud actual, producto del aumento del uso de las aplicaciones digitales. En la era de la interdependencia digital, este fenomeno se amplifica debido a la convergencia del aumento en el acceso a los dispositivos moviles, el acceso a Internet y el uso de las redes sociales, que se propagan cada vez mas lejos y mas rapido, como un virus. [...]

Objetivo. Analizar las desigualdades en indicadores de atención a niños de 0 a 9 años en México, documentando los cambios en las brechas y gradientes. Material y mé­todos. Análisis de encuestas nacionales de salud estimando las brechas absoluta y relativa así como el gradiente de des­igualdad para cuatro indicadores seleccionados (cobertura de vacunación, atención a infecciones respiratorias agudas (IRA), prácticas saludables en enfermedad diarreica aguda (EDA) y atención por accidentes). Resultados. El análisis documenta el logro de la equidad inmunológica en México y la eliminación de la brecha por condiciones socioeconómicas relacionadas con la atención a accidentes, en tanto que per­siste la relacionada con la atención a IRA, misma que también persistente por ámbito de residencia y para la población indígena. Conclusión. En México han disminuido las brechas en los indicadores de salud en niños. Si bien persisten en particular para intervenciones que requieren la participación de los establecimientos de salud, es necesario dirigir acciones específicas para asegurar el acceso homogéneo en todo el país a los servicios e intervenciones.

Resumen: Objetivo: Analizar indicadores de eficiencia de los recursos humanos (RH) de la Secretaria de Salud de Mexico. Material y metodos: Utilizando informacion secundaria se exploraron tres dimensiones de eficiencia: a) desperdicio de fuerza laboral, b) distribucion de RH entre niveles de atencion, y c) productividad. Resultados: El grupo de trabajadores de salud analizado se caracteriza por presentar niveles importantes de desempleo y subempleo de RH, una distribucion distante de las recomendaciones internacionales y niveles de produccion heterogeneos entre los estados. Conclusiones: Es imperativo disenar e implementar un plan de RH en salud alineado a las necesidades y demandas de las poblaciones cubiertas que contemple medidas regulatorias del mercado de formacion de estos recursos, su distribucion entre y al interior de los sistemas estatales de salud y la generacion de incentivos para el desempeno.

Background: An infodemic is an overabundance of information—some accurate and some not—that occurs during an epidemic. In a similar manner to an epidemic, it spreads between humans via digital and physical information systems. It makes it hard for people to find trustworthy sources and reliable guidance when they need it. Objective: A World Health Organization (WHO) technical consultation on responding to the infodemic related to the coronavirus disease (COVID-19) pandemic was held, entirely online, to crowdsource suggested actions for a framework for infodemic management. Methods: A group of policy makers, public health professionals, researchers, students, and other concerned stakeholders was joined by representatives of the media, social media platforms, various private sector organizations, and civil society to suggest and discuss actions for all parts of society, and multiple related professional and scientific disciplines, methods, and technologies. A total of 594 ideas for actions were crowdsourced online during the discussions and consolidated into suggestions for an infodemic management framework. Results: The analysis team distilled the suggestions into a set of 50 proposed actions for a framework for managing infodemics in health emergencies. The consultation revealed six policy implications to consider. First, interventions and messages must be based on science and evidence, and must reach citizens and enable them to make informed decisions on how to protect themselves and their communities in a health emergency. Second, knowledge should be translated into actionable behavior-change messages, presented in ways that are understood by and accessible to all individuals in all parts of all societies. Third, governments should reach out to key communities to ensure their concerns and information needs are understood, tailoring advice and messages to address the audiences they represent. Fourth, to strengthen the analysis and amplification of information impact, strategic partnerships should be formed across all sectors, including but not limited to the social media and technology sectors, academia, and civil society. Fifth, health authorities should ensure that these actions are informed by reliable information that helps them understand the circulating narratives and changes in the flow of information, questions, and misinformation in communities. Sixth, following experiences to date in responding to the COVID-19 infodemic and the lessons from other disease outbreaks, infodemic management approaches should be further developed to support preparedness and response, and to inform risk mitigation, and be enhanced through data science and sociobehavioral and other research. Conclusions: The first version of this framework proposes five action areas in which WHO Member States and actors within society can apply, according to their mandate, an infodemic management approach adapted to national contexts and practices. Responses to the COVID-19 pandemic and the related infodemic require swift, regular, systematic, and coordinated action from multiple sectors of society and government. It remains crucial that we promote trusted information and fight misinformation, thereby helping save lives., peer-reviewed

This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated. We used thematic content and descriptive analyses to analyse the data. We found that QoC foundations, evaluation and improvement activities pose essential challenges for the Mexican health sector. Governance for QoC is weakly aligned across MoH, IMSS and ISSSTE. Each institution follows its own agenda of evaluation and improvement programmes and has distinct QoC indicators and information systems. The institutions share similar barriers to strengthening QoC: poor organizational structure at a facility level, scarcity of financial resources, lack of training in QoC for executive/managerial staff and health professionals and limited public participation. In conclusion, a stronger legal framework and policy dialogue is needed to foster governance by the MoH, to define and align health sector-wide QoC policies, and to set common goals and articulate QoC improvement actions among institutions. Robust QoC organizational structure with designated staff and clarity on their responsibilities should be established at all levels of healthcare. Investment is necessary to fund formal and in-service QoC training programmes for health professionals and to reinforce quality evaluation and improvement activities and quality information systems. QoC evaluation results should be available to healthcare providers and the population. Active public participation in the design and implementation of improvement initiatives should be strengthened.

Background In September 2013, two cases of cholera were reported in Mexico; 1 week later, a new outbreak was reported in the Huasteca region of Hidalgo. Upon the determination that the diagnostic and therapeutic interventions implemented by health personnel overlooked predefined procedures, the National Institute of Public Health, in coordination with the Ministry of Health, immediately designed the massive open online course “Proper cholera containment and management measures” to strengthen and standardize basic prevention and control practices. Methods During the first 5 months, 35,968 participants from across the country finished the course: medical and nursing personnel, health promoters, and hospital staff. To understand the magnitude of the data, an analysis was performed to calculate the MOOC coverage, and multiple linear regression models were generated to relate the score earned in the course to the characteristics of the participants. In addition, a qualitative analysis was performed to identify the dissemination of information, technological barriers, and feedback on course design. A total of 17% of participants were from the state where the outbreak originated, and 33.5% were from its neighboring states. Results This study shows that the need for information is greater when an emergency occurs, and the involvement of the authorities increased the extent of the training response. Conclusion A MOOC can be a useful training strategy to prepare personnel for emergency situations.

La provisión efectiva de servicios de salud tiene como factor crítico la formación de capital humano con las competencias para atender los requerimientos de la población. Estos requerimientos, sin embargo, no son unidimensionales, la población requiere servicios de salud de cierto tipo, en cierto lugar y en una cierta cantidad. De este modo, la planeación para la formación de capital humano tiene que desdoblarse también en varias dimensiones que permitan responder a las preguntas ¿qué tipo de profesionales se requieren?, ¿en qué lugares?, y ¿en qué cantidad?, explore las condiciones existentes y defina las que son necesarias, para que una vez que se respondan estas preguntas se puedan realizar las acciones para contar con ese personal en la cantidad y lugar que se requiere La provisión efectiva de servicios de salud tiene como factor crítico la formación de capital humano con las competencias para atender los requerimientos de la población. Estos requerimientos, sin embargo, no son unidimensionales, la población requiere servicios de salud de cierto tipo, en cierto lugar y en una cierta cantidad. De este modo, la planeación para la formación de capital humano tiene que desdoblarse también en varias dimensiones que permitan responder a las preguntas ¿qué tipo de profesionales se requieren?, ¿en qué lugares?, y ¿en qué cantidad?, explore las condiciones existentes y defina las que son necesarias, para que una vez que se respondan estas preguntas se puedan realizar las acciones para contar con ese personal en la cantidad y lugar que se requiere

El sistema de salud mexicano ha tenido logros importantes que se reflejan en la mejora creciente del nivel de salud. Empero, la heterogeneidad en la calidad de los servicios y su repercusión en la salud de diferentes grupos poblacionales continúan siendo un reto. Los costos de fallos en la calidad representan de 20 a 40% del gasto de los sistemas de salud. Es necesario desarrollar la capacidad organizacional para implementar sistemas de gestión de calidad que permitan identificar, evaluar, superar y prevenir los retos del sistema de salud. Para ello, se propone una estrategia integral de formación de recursos humanos basada en competencias y responsabilidades, que incluye programas de pregrado, posgrado y educación continua para favorecer el ejercicio efectivo de la función de calidad en los diversos niveles de responsabilidad del sistema de salud. La estrategia responde a las necesidades del sistema mexicano, pero puede ser adaptada a diferentes sistemas y contextos.

Universal health coverage has been proposed as a strategy to improve health in low-income and middle-income countries (LMICs). However, this is contingent on the provision of good-quality health care. We estimate the excess mortality for conditions targeted in the Sustainable Development Goals (SDG) that are amenable to health care and the portion of this excess mortality due to poor-quality care in 137 LMICs, in which excess mortality refers to deaths that could have been averted in settings with strong health systems.Using data from the 2016 Global Burden of Disease study, we calculated mortality amenable to personal health care for 61 SDG conditions by comparing case fatality between each LMIC with corresponding numbers from 23 high-income reference countries with strong health systems. We used data on health-care utilisation from population surveys to separately estimate the portion of amenable mortality attributable to non-utilisation of health care versus that attributable to receipt of poor-quality care.15·6 million excess deaths from 61 conditions occurred in LMICs in 2016. After excluding deaths that could be prevented through public health measures, 8·6 million excess deaths were amenable to health care of which 5·0 million were estimated to be due to receipt of poor-quality care and 3·6 million were due to non-utilisation of health care. Poor quality of health care was a major driver of excess mortality across conditions, from cardiovascular disease and injuries to neonatal and communicable disorders.Universal health coverage for SDG conditions could avert 8·6 million deaths per year but only if expansion of service coverage is accompanied by investments into high-quality health systems.BillMelinda Gates Foundation.

To analyze trends from 2000 to 2012 in socioeconomic inequalities in health related to diabetes and hypertension indicators in Mexico.Cross-sectional analysis of three national health surveys (2000, 2006 and 2012), measuring inequality using absolute and relative gaps as well as the Slope Index of Inequality for diabetes and hypertension indicators.From 2000 to 2012, there is a reduction in the gap related to the prevalence of diagnosed diabetes and hypertension, with a parallel reduction in the inequality related to care for those conditions, while an inequality gradient on diabetes care remains.While there is an evident progress in the reduction of inequalities for diabetes and hypertension diagnostic and care in Mexico, some inequalities remain. Given the contribution of these conditions to the burden of disease in the country, there is a need to strength the quality of health services that will promote effective access.

To analyze trends in inequality in financial protection and healthcare in Mexico between 2000 and 2012, using simple and complex measures.Analysis of national health surveys 2000, 2006 and 2012, generating estimates of absolute and relative gaps and the slope index of inequality using imputated income as socioeconomic measure, and differences by sex, rural/urban residence, and ethnic background.Between 2000 and 2012, socioeconomic inequality in financial protection vanished, while it remains in healthcare access, with larger barriers to access healthcare among those in the lowest socioeconomic condition. These results are consistent with the differences by urban/rural residence and ethnic background.The health reform in 2003, aiming to increase health insurance, resulted in the virtual elimination of socioeconomic inequality in financial protection, but there is still inequality in access to healthcare. Actions to eliminate access barriers related to quality of health services are urgent to promote effective access to healthcare.

To document socioeconomic health inequalities on adolescents' risk behaviors in Mexico using gap and gradient measures.Analysis of the national health surveys 2000 and 2012 measuring absolute and relative gaps as well as the slope index of inequality for risk behavior indicators on adolescents using socioeconomic indicators and also measuring gaps for sex, urban/rural residency, and indigenous/non-indigenous population.For sexual risk behaviors, inequalities are reflected in a lower probability of using protection at the first sexual intercourse among those living in households with lower income for women and men as well as higher probability of ever being pregnant for adolescents of lower income. For tobacco and alcohol consumption and for violence related health problems, inequalities imply higher probability of consumption among those in household with larger incomes.Socioeconomic health inequalities are a relevant challenge for adolescents' wellbeing in Mexico, with a complex scenario where resource scarcity is related to increasing risk behaviors that may compromise their future. A better understanding of health inequalities is needed to design effective interventions.

To analyze inequalities in health care indicators of children 0 to 9 years old in Mexico reporting gap and gradient measures.Cross-sectional analysis of national health surveys in 2000, 2006 and 2012, measuring absolute and relative gap measures as well as the Slope Index of Inequality for four health care indicators (vaccination, care for acute respiratory infections, care for acute diarrheal diseases, and care for accidents) with socioeconomic stratification, as well as absolute gaps by sex, urbanicity and ethnic background.Between 2000 and 2012, immunological equity was reached in Mexico, as well as elimination in the socioeconomic gap related to care for accidents; nevertheless, there is a persistent socioeconomic gap of care for acute respiratory infections that is also there regarding rural residence and indigenous population.In Mexico, there is a trend to the elimination of socioeconomic differences in the probability of receiving adequate health care among children, although some socioeconomic gaps remain in particular related to provision of services that require more participation of health personnel. There is a need to ensure homogenous access to effective services for all.

Objective This study aimed to estimate the magnitude of the association between overall household health expenditures & the presence of members with a chronic disease in the household. Research design & methods This was a cross-sectional analysis of a probabilistic household survey, which gathered data on previously diagnosed type 2 diabetes mellitus and hypertension as well as health expenditure in Mexico. From an analytic sample of 44,000 households, we identified those having at least one member with diabetes or hypertension and determined their health expenditure. Using matching procedures, we compared these data with those of households lacking such individuals. Results We found that 24% of the households had at least one member who had been diagnosed with diabetes, hypertension, or both. Households with such members reported health expenditures that were 25%–34% (P

Clinically metamizol (MZ) has been related to alteration on haemodynamic parameters and modifications on blood pressure in humans when administered intravenously. These effects have been observed at MZ therapeutic doses. Experimentally, MZ is able to induce relaxation on several types of vascular smooth muscles and modulates the contraction induced by phenylephrine. However, the mechanism underlying the MZ effects on vascular reactivity is not clear. Potassium channels (K) present on vascular smooth muscle cells closely regulate the vascular reactivity and membrane potential. There are four described types of K in vascular tissue: K voltage sensitive (K(V)), K calcium sensitive (K(Ca)2+), K ATP sensitive (K(ATP) and K inward rectification (K(IR), voltage sensitive). The aim of this work was to investigate MZ effects on angiotensin II (AT II) and noradrenaline (NA) induced contraction and to evaluate the K participation on MZ modulating effect on vascular smooth muscle contraction, using isometric and patch clamp techniques. MZ induces relaxation in a concentration dependent manner. Furthermore, MZ strongly inhibits in a concentration dependent fashion the contraction induced by AT II. However, MZ inhibition on NA induced contraction was moderated compared with that observed on AT II. MZ effects on AT II induced contraction was blocked by glybenclamide (a specific K(ATP) blocker, 3 microM, *p < 0.01). In patch clamp experiments, MZ (3 mM) induces an increase on potassium current (K+) mediated by K(ATP) in similar way as diazoxide (a specific K(ATP) opener, 3 microM). Our results suggest that MZ induces relaxation and inhibits contraction induced by AT II acting as a K(ATP) opener.

Background Effective access measures are intended to reflect progress toward universal health coverage. This study proposes an operative approach to measuring effective access: in addition to the lack of financial protection, the willingness to make out-of-pocket payments for health care signifies a lack of effective access to pre-paid services. Methods Using data from a nationally representative health survey in Mexico, effective access at the individual level was determined by combining financial protection and effective utilization of pre-paid health services as required. The measure of effective access was estimated overall, by sex, by socioeconomic level, and by federal state for 2006 and 2012. Results In 2012, 48.49% of the Mexican population had no effective access to health services. Though this represents an improvement since 2006, when 65.9% lacked effective access, it still constitutes a major challenge for the health system. Effective access in Mexico presents significant heterogeneity in terms of federal state and socioeconomic level. Conclusions Measuring effective access will contribute to better target strategies toward universal health coverage. The analysis presented here highlights a need to improve quality, availability, and opportuneness (location and time) of health services provision in Mexico.

Background. During the 2009 spring epidemic outbreak in Mexico, an important research and policy question faced was related to the differences in clinical profile and population characteristics of those affected by the new H1N1 virus compared with the seasonal virus. Methods and Findings. Data from clinical files from all influenza A deaths in Mexico between April 10 and July 13, 2009 were analyzed to describe differences in clinical and socioeconomic profile between H1N1 and non-H1N1 cases. A total of 324 influenza A mortality cases were studied of which 239 presented rt-PCR confirmation for H1N1 virus and 85 for seasonal influenza A. From the differences of means and multivariate logistic regression, it was found that H1N1 deaths occurred in younger and less educated people, and among those who engage in activities where there is increased contact with other unknown persons (OR 4.52, 95% CI 1.56–13.14). Clinical symptoms were similar except for dyspnea, headache, and chest pain that were less frequently found among H1N1 cases. Conclusions. Findings suggest that age, education, and occupation are factors that may be useful to identify risk for H1N1 among influenza cases, and also that patients with early dyspnea, headache, and chest pain are more likely to be non-H1N1 cases.