RESUMO
BACKGROUND: Cardiovascular disease (CVD) is a major cause of mortality, with economic implications for the health system. OBJECTIVE: To characterize the burden of CVD in Mexico from 1990 to 2021 based on the Global Burden of Disease (GBD) study, to address the burden of health and disease, its implications for public health and for the development of the health care system. MATERIAL AND METHODS: CVD mortality in Mexico is described, and the extent to which population growth and aging explain the observed trends, sex differences, and geographic patterns is examined. RESULTS: CVD is the leading cause of mortality, mainly due to hypertensive heart disease, intracerebral hemorrhage, subarachnoid hemorrhage, ischemic heart disease and ischemic stroke. A change of trend was observed in men and women, with higher mortality in people older than 80 years and in the northern states of the country. CONCLUSIONS: Mexico must invest in public health programs to address modifiable risks, promote healthy aging, and reduce premature death due to CVD.
ANTECEDENTES: La enfermedad cardiovascular (ECV) es una causa importante de mortalidad, con implicaciones económicas para el sistema de salud. OBJETIVO: Caracterizar la carga de ECV en México de 1990 a 2021 con base en el estudio Global Burden of Disease (GBD), para abordar la carga de salud y enfermedad, sus implicaciones en la salud pública y el desarrollo del sistema de atención médica. MATERIAL Y MÉTODOS: Se describe la mortalidad de las ECV en México y se examina en qué medida el crecimiento y el envejecimiento de la población explican las tendencias, las diferencias por sexo y los patrones geográficos. RESULTADOS: Las ECV representan la primera causa de mortalidad, principalmente por cardiopatía hipertensiva, hemorragia intracerebral, hemorragia subaracnoidea, cardiopatía isquémica y accidente cerebrovascular isquémico. Se observó un cambio de tendencia en hombres y mujeres, mayor mortalidad en mayores de 80 años y en estados del norte del país. CONCLUSIONES: México debe invertir en programas de salud pública para abordar los riesgos modificables, promover el envejecimiento saludable y reducir la muerte prematura por ECV.
Assuntos
Doenças Cardiovasculares , Cardiopatias , Hipertensão , Feminino , Humanos , Masculino , Doenças Cardiovasculares/epidemiologia , Carga Global da Doença , México/epidemiologia , Saúde Global , Fatores de RiscoRESUMO
INTRODUCTION: The National Autonomous University of Mexico Faculty of Medicine created the Adolescent Pregnancy Prevention Program, which is aimed at students. OBJECTIVE: To determine the sexual-reproductive health profile of medical students through a diagnostic questionnaire and of those who participated in an educational intervention on sexuality (three modules). METHOD: First-year undergraduate students, schoolyear 2017-2018, participated. Students were considered to be trained when they took at least one module. RESULTS: The questionnaire was answered by 1157 students, 21.9 % participated in at least one module, 43.1% had initiated sexual activity and 25 % received the educational intervention. Not having used a condom in their last intercourse was identified in 20 %, and a high prevalence of intercourse under the influence of alcohol was observed. CONCLUSIONS: It is important for specific sexuality competences to be promoted among those who will be doctors in the future.
INTRODUCCIÓN: La Facultad de Medicina de la Universidad Nacional Autónoma de México creó el Programa de Prevención de Embarazo en Adolescentes, dirigido a estudiantes. OBJETIVO: Determinar el perfil de la salud sexual-reproductiva de estudiantes de medicina mediante un cuestionario diagnóstico y de quienes participaron en una intervención educativa de sexualidad (tres módulos). MÉTODO: Participaron estudiantes del primer año de la carrera, ciclo 2017-2018. Se consideró que el estudiante fue capacitado cuando cursó al menos un módulo. RESULTADOS: Contestaron el cuestionario 1157 estudiantes, 21.9 % participó en al menos un módulo, 43.1 % había iniciado vida sexual y 25 % recibió la intervención educativa. El 20 % no usó condón en su última relación y se observó alta prevalencia de relaciones sexuales bajo el influjo de alcohol. CONCLUSIONES: Es importante promover competencias específicas en sexualidad entre quienes serán los futuros médicos.
Assuntos
Saúde Sexual , Estudantes de Medicina , Humanos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To know the characteristics of medical education and identify its strengths and weaknesses. MATERIALS AND METHODS: A transversal and quantitative study of the characteristics of medical education in 29 medical schools in Mexico was carried out, between April and September 2017. Questionnaire with Likert scale was applied to explore context, regulation, structure, process, results and impact of medical education. Bivariate analysis was performed with a Chi square test and the significance level was equal to or less than 0.05. RESULTS: The political context obtained 64%, economical context 10% and mechanisms of regulation 31%. The educational structure was 61% and the social impact was 93%. CONCLUSIONS: Public policies, regulatory mechanisms and public investment must be strengthened to improve the quality of medical education.
OBJETIVO: Conocer las características de la educación médica e identificar sus fortalezas y debilidades. MATERIAL Y MÉTODOS: Se realizó un estudio transversal y cuantitativo para conocer las características de la educación médica en 29 escuelas de medicina en México, entre abril y septiembre de 2017. Se utilizó un cuestionario con escala tipo Likert para explorar el contexto, la regulación, la estructura, el proceso, los resultados y el impacto de la educación médica. Se realizó un análisis bivariado con ji cuadrada y una significancia estadística de p igual o menor a 0.05. RESULTADOS: El contexto político obtuvo 64%, el contexto económico 10%, los mecanismos de regulación 31%, la estructura educativa 61% y el impacto social 93%. CONCLUSIONES: Se requiere fortalecer las políticas públicas, la regulación y la inversión pública, para mejorar la calidad de la educación médica.
Assuntos
Educação Médica/normas , Setor Privado/normas , Setor Público/normas , Faculdades de Medicina/normas , Distribuição de Qui-Quadrado , Estudos Transversais , Currículo , Educação Médica/economia , Educação Médica/legislação & jurisprudência , Educação Médica/organização & administração , México , Programas Nacionais de Saúde , Médicos/provisão & distribuição , Setor Privado/economia , Setor Privado/organização & administração , Probabilidade , Política Pública , Setor Público/economia , Setor Público/organização & administração , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Evaluate the capacity of the federal legal framework to govern financing of health institutions in the public sector through innovative schemes--otherwise known as functional integration--, enabling them to purchase and sell health services to and from other public providers as a strategy to improve their performance. MATERIALS AND METHODS: Based on indicators of normative alignment with respect to functional integration across public health provider and governance institutions, content analysis was undertaken of national health programs and relevant laws and guidelines for financial coordination. RESULTS: Significant progress was identified in the implementation of agreements for the coordination of public institutions. While the legal framework provides for a National Health System and a health sector, gaps and contradictions limit their scope. The General Register of Health is also moving forward, yet it lacks the necessary legal foundation to become a comprehensive tool for integration. The medical service exchange agreements are also moving forward based on tariffs and shared guidelines. However, there is a lack of incentives to promote the expansion of these agreements. CONCLUSIONS: It is recommended to update the legal framework for the coordination of the National Health System, ensuring a more harmonious and general focus to provide functional integration with the needed impulse.
Assuntos
Organizações/economia , Organizações/legislação & jurisprudência , Saúde Pública/economia , Saúde Pública/legislação & jurisprudência , Financiamento Governamental , México , Organizações/organização & administraçãoRESUMO
Gender-based violence (GBV) and cyber-aggression are growing problems in Mexico, but there is a dearth of information on their associated risks. We aimed to determine the prevalence of dating violence (DV) and cyber-aggression in a public campus and compared students' acceptability of abusive DV based on their sex and sexual orientation. We employed a cross-sectional design to survey 964 first-year medical students attending a public university. We analyzed who found "acceptable" abusive behaviors from a dating partner and carried out descriptive analyses of sample characteristics by sex. We included 633 women and 331 men. Homosexual and bisexual orientation was lower among women (1.5%, 4.8%) vs. men (16.9%, 7.2%). Of women and men, respectively, 64.2% and 35.8% reported having been in a dating relationship. Experiencing abusive behaviors in the year prior to the study was associated with students' level of "acceptability". A total of 43.5% of the students who experienced cyber-aggression did not report any mental health consequences, 32.6% did not seek professional help, and 17.4% reported feeling depressed. Students that accepted emotionally abusive DV behaviors displayed a fourfold risk of experiencing physical abuse. Women and sexual minorities are more at risk of experiencing GBV and DV. More male students reported being victims of cyber-aggression.
Assuntos
Vítimas de Crime , Violência por Parceiro Íntimo , Estudantes de Medicina , Humanos , Masculino , Feminino , Universidades , México , Estudos Transversais , Vítimas de Crime/psicologia , Violência por Parceiro Íntimo/psicologiaRESUMO
INTRODUCTION: SARS-CoV-2 continues to have a high rate of contagion worldwide. The new variant of concern, Omicron, has mutations that decrease the effectiveness of vaccines and evade antibodies from previous infections resulting in a fourth wave of the pandemic. It was identified in Mexico in December 2021. METHODS: The Traveler's Preventive Care Clinic from the Faculty of Medicine UNAM at Mexico City International Airport has performed rapid antigen and PCR SARS CoV2 tests since January 2021 to comply with the new travel requirements. Demographic and clinical characteristics were collected from each passenger and the fourth wave of the pandemic in Mexico mainly caused by Omicron was analyzed in the travelers. RESULTS: A total of 5176 travelers attended the clinic between the second half of December 2021 and January 2022. Ten percent of all the tests performed were positive (13% of PCR and 9.3% of antigens, p = 0.001). Most of the SARS CoV2 positive cases were asymptomatic (78%), with a ratio of 3.5:1 over the symptomatic. By age groups, this ratio was higher for those under 20 years old (8.7:1). DISCUSSION: This study shows the rapid escalation of positivity that occurred in Mexico, detected in travelers, from the second half of December 2020 and throughout the month of January 2021. The incidence of COVID-19 was extremely high in travelers who were mostly asymptomatic for the period under study.
Assuntos
COVID-19 , Adulto , Aeroportos , COVID-19/epidemiologia , Humanos , México/epidemiologia , Prevalência , SARS-CoV-2 , Adulto JovemRESUMO
An elderly person who lives alone must often be autonomous and self-sufficient in daily living activities. We explored if living alone and marital status were associated with mild cognitive impairment and low cognitive reserve in a sample of Mexican women aged 60+ attending continuing education courses using a cross-sectional design. Objective cognitive functions were assessed using the MMSE and Blessed Dementia Scale. We administered the Cognitive Reserve Questionnaire. Independence skills were assessed with the Katz index and Lawton index. Multivariate logistic regression analysis was used. We recruited 269 participants (x¯ = 69.0 ± 5.8 years). Single, widowed, separated, and divorced women comprised 73% of the participants. A third lived alone and 84% had completed high school. Mild cognitive deficit was observed among 24.5-29.0%; the upper range for cognitive reserve was 61.7%. Living alone versus living with someone was associated with cognitive impairment (OR = 0.51, p = 0.04) and with low to medium cognitive reserve (OR = 0.51, p = 0.02) after adjusting for confounding variables. Living alone was an independent factor associated with a lower probability of displaying mild cognitive impairment and a higher probability of displaying high cognitive reserve. Women living alone in this study had a more robust cognitive framework and had built their own support networks.
Assuntos
Disfunção Cognitiva , Reserva Cognitiva , Atividades Cotidianas , Idoso , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Feminino , Humanos , México/epidemiologiaRESUMO
Latin America hosts the most restrictive abortion legislation globally. In 2007, Mexico, the second largest Catholic country in the world, decriminalized elective abortion within the first twelve weeks of pregnancy in the capital: Mexico City (also known as Federal District of Mexico). Following the reform, the Mexico City Ministry of Health (MX-MOH) implemented safe and legal services. Free services are provided to Mexico City residents and a sliding fee of up to $100 is applied to women from other Mexican states. Conscientious objection (CO) was addressed and included in service provision guidelines. Since 2007, 18 of 32 states amended their penal codes to restrict abortion. The road toward increasing access to abortion services at the MX-MOH included a shift from dilation and curettage (D&C) to medical abortion (MA), first with the misoprostol-alone regimen, followed by the combined mifepristone-misoprostol regimen. Manual vacuum aspiration is offered to out-of-state-women or to those beyond the gestational age where MA is less effective. Contraceptive uptake among abortion seekers is high (up to 95% of them prefer a free method of their choice). The Legal Interruption of Pregnancy program at the MX-MOH continues to provide effective, safe, reliable, and free services. However, women from indigenous groups residing in rural areas, those with low schooling, and adolescents with an unintended pregnancy who live in rural, urban, peri-urban districts, and at the state level are underserved despite being legally eligible to receive abortion services. Therefore, information and services for the disadvantaged groups need to be strengthened.
Assuntos
Aborto Induzido/legislação & jurisprudência , Aborto Legal/legislação & jurisprudência , Anticoncepção Pós-Coito , Política de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde , Direitos Sexuais e Reprodutivos/legislação & jurisprudência , Direitos da Mulher/legislação & jurisprudência , Adolescente , Feminino , Humanos , México , Mifepristona , Misoprostol , Gravidez , Curetagem a VácuoRESUMO
OBJECTIVE: To analyze medical complaints over a period of 11 years, for making recommendations for prevention and improving planning for responding. MATERIAL AND METHODS: We studied the medical complaints at the National Medical Arbitration Commission (Conamed, per its acronym in Spanish) between 1996 and 2007 using descriptive statistics to identify their general profile in relation to the variables of time, place and person. We also studied the frequency of evident medical malpractice as well as the severity of the damage it produces. RESULTS: The request for responses to medical complaints increased between 1996 and 2007 and there was less demand between July and December. Two states in the country account for 69.7% of the complaints and 74.0% are from public institutions. Fifty-eight percent come from women and the 25-34 and 65+ age groups have the highest percentage. We found in 27.0% of the complaints there is evidence of medical malpractice and obstetrics and gynecology have the highest percentage of complaints, physical harm and severity of injury. Complaints about treatment are nearly four times more than diagnosis. CONCLUSIONS: It is necessary to improve the quality of diagnosis and treatment and identify cost-effective measures to reduce medical malpractice and the severity of physical damage in patients.
Assuntos
Imperícia/estatística & dados numéricos , Negociação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Ginecologia , Instalações de Saúde , Humanos , Lactente , Masculino , Medicina , México/epidemiologia , Pessoa de Meia-Idade , Obstetrícia , Gravidez , Estações do Ano , Especialização , Adulto JovemRESUMO
OBJECTIVE: To carry out the epidemiological analysis of 122 influenza A (H1N1) deaths confirmed by laboratory and help to improve the diagnosis and timely managing of cases. MATERIAL AND METHODS: A total of 122 clinical records were analyzed of patients with confirmed influenza A (H1N1) virus infection who died. RESULTS: Fifty-one percent of patients were female and 49% were male. A total of 45.l% who died were between 20 and 39 years old. Overall fatality was 2.2% and ranged between 0.3% for the l0 to l9 year-old group to 6.3% for the 50 to 59 year-old group. Forty-three percent of deaths were concentrated in only two of the thirty-two states and 5l% received medical attention in social security institutions. Only l7% received hospital attention within 72 hours and 42% died within 72 hours of hospital attention. DISCUSSION: Novel Influenza A (H1N1) virus produces higher mortality in young people whereas seasonal influenza has a greater impact on young children and older people. Delay in medical care and the associated morbidity were relevant factors for death.
Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana/mortalidade , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Influenza Humana/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Several pathologies can involve muscles that control vocal folds. The abnormality can affect peripheral nerves or central nervous system centers. Clinically, muscle function can be assessed by observing the movement of structures themselves or by recording electrical activity of these muscles using (electromyography-EMG). Since EMG is an invasive technique, its use is not very widespread in the diagnosis and management of voice disorders, Laryngeal EMG can be helpful in those patients with voice problems of suspected neurological or neuromuscular etiology. OBJECTIVE: Assess the role of laryngeal EMG in the clinical evaluation of unilateral vocal cord immobility. METHODS: Twenty-five patients with unilateral vocal cord paralysis were studied. Twenty-five patients with unilateral arytenoid dislocation were studied as controls. The sensitivity and specificity of the EMG as a diagnostic marker for vocal fold paralysis were obtained. RESULTS: Laryngeal EMG showed a 100% sensitivity and 92% specificity. Only two patients displaying arytenoid dislocation displayed abnormal EMG recordings. CONCLUSIONS: EMG constitutes a safe and reliable tool to aid the evaluation of patients with vocal fold immobility. EMG recordings were helpful in differentiating vocal cord paralysis from arytenoid dislocation. Moreover, EMG can provide useful data regarding denervation and reinnervation of laryngeal muscles. Aside from its diagnostic usefulness, serial EMG can help to monitor recovery and establish a reliable prognosis. Hence, an adequate treatment plan can be determined.
Assuntos
Paralisia das Pregas Vocais/fisiopatologia , Adolescente , Adulto , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Resumen Antecedentes: La enfermedad cardiovascular (ECV) es una causa importante de mortalidad, con implicaciones económicas para el sistema de salud. Objetivo: Caracterizar la carga de ECV en México de 1990 a 2021 con base en el estudio Global Burden of Disease (GBD), para abordar la carga de salud y enfermedad, sus implicaciones en la salud pública y el desarrollo del sistema de atención médica. Material y métodos: Se describe la mortalidad de las ECV en México y se examina en qué medida el crecimiento y el envejecimiento de la población explican las tendencias, las diferencias por sexo y los patrones geográficos. Resultados: Las ECV representan la primera causa de mortalidad, principalmente por cardiopatía hipertensiva, hemorragia intracerebral, hemorragia subaracnoidea, cardiopatía isquémica y accidente cerebrovascular isquémico. Se observó un cambio de tendencia en hombres y mujeres, mayor mortalidad en mayores de 80 años y en estados del norte del país. Conclusiones: México debe invertir en programas de salud pública para abordar los riesgos modificables, promover el envejecimiento saludable y reducir la muerte prematura por ECV.
Abstract Background: Cardiovascular disease (CVD) is a major cause of mortality, with economic implications for the health system. Objective: To characterize the burden of CVD in Mexico from 1990 to 2021 based on the Global Burden of Disease (GBD) study, to address the burden of health and disease, its implications for public health and for the development of the health care system. Material and methods: CVD mortality in Mexico is described, and the extent to which population growth and aging explain the observed trends, sex differences, and geographic patterns is examined. Results: CVD is the leading cause of mortality, mainly due to hypertensive heart disease, intracerebral hemorrhage, subarachnoid hemorrhage, ischemic heart disease and ischemic stroke. A change of trend was observed in men and women, with higher mortality in people older than 80 years and in the northern states of the country. Conclusions: Mexico must invest in public health programs to address modifiable risks, promote healthy aging, and reduce premature death due to CVD.
RESUMO
Resumen Introducción: La Facultad de Medicina de la Universidad Nacional Autónoma de México creó el Programa de Prevención de Embarazo en Adolescentes, dirigido a estudiantes. Objetivo: Determinar el perfil de la salud sexual-reproductiva de estudiantes de medicina mediante un cuestionario diagnóstico y de quienes participaron en una intervención educativa de sexualidad (tres módulos). Método: Participaron estudiantes del primer año de la carrera, ciclo 2017-2018. Se consideró que el estudiante fue capacitado cuando cursó al menos un módulo. Resultados: Contestaron el cuestionario 1157 estudiantes, 21.9 % participó en al menos un módulo, 43.1 % había iniciado vida sexual y 25 % recibió la intervención educativa. El 20 % no usó condón en su última relación y se observó alta prevalencia de relaciones sexuales bajo el influjo de alcohol. Conclusiones: Es importante promover competencias específicas en sexualidad entre quienes serán los futuros médicos.
Abstract Introduction: The National Autonomous University of Mexico Faculty of Medicine created the Adolescent Pregnancy Prevention Program, which is aimed at students. Objective: To determine the sexual-reproductive health profile of medical students through a diagnostic questionnaire and of those who participated in an educational intervention on sexuality (three modules). Method: First-year undergraduate students, schoolyear 2017-2018, participated. Students were considered to be trained when they took at least one module. Results: The questionnaire was answered by 1157 students, 21.9 % participated in at least one module, 43.1% had initiated sexual activity and 25 % received the educational intervention. Not having used a condom in their last intercourse was identified in 20 %, and a high prevalence of intercourse under the influence of alcohol was observed. Conclusions: It is important for specific sexuality competences to be promoted among those who will be doctors in the future.
Assuntos
Humanos , Estudantes de Medicina , Saúde Sexual , Inquéritos e QuestionáriosRESUMO
Resumen: Objetivo: Conocer las características de la educación médica e identificar sus fortalezas y debilidades. Material y métodos: Se realizó un estudio transversal y cuantitativo para conocer las características de la educación médica en 29 escuelas de medicina en México, entre abril y septiembre de 2017. Se utilizó un cuestionario con escala tipo Likert para explorar el contexto, la regulación, la estructura, el proceso, los resultados y el impacto de la educación médica. Se realizó un análisis bivariado con ji cuadrada y una significancia estadística depigual o menor a 0.05. Resultados: El contexto político obtuvo 64%, el contexto económico 10%, los mecanismos de regulación 31%, la estructura educativa 61% y el impacto social 93%. Conclusiones: Se requiere fortalecer las políticas públicas, la regulación y la inversión pública, para mejorar la calidad de la educación médica.
Abstract: Objective: To know the characteristics of medical education and identify its strengths and weaknesses. Materials and methods: A transversal and quantitative study of the characteristics of medical education in 29 medical schools in Mexico was carried out, between April and September 2017. Questionnaire with Likert scale was applied to explore context, regulation, structure, process, results and impact of medical education. Bivariate analysis was performed with a Chi square test and the significance level was equal to or less than 0.05. Results: The political context obtained 64%, economical context 10% and mechanisms of regulation 31%. The educational structure was 61% and the social impact was 93%. Conclusions: Public policies, regulatory mechanisms and public investment must be strengthened to improve the quality of medical education.
Assuntos
Faculdades de Medicina/normas , Setor Público/normas , Setor Privado/normas , Educação Médica/normas , Distribuição de Qui-Quadrado , Estudos Transversais , Currículo , Educação Médica/economia , Educação Médica/legislação & jurisprudência , Educação Médica/organização & administração , México , Programas Nacionais de SaúdeRESUMO
OBJETIVO: Evaluar la capacidad del marco legal federal para gobernar el financiamiento de las instituciones públicas de salud mediante esquemas innovadores que les permiten comprar y vender servicios de salud de y a otros proveedores públicos, como una estrategia para mejorar su desempeño. MATERIAL Y MÉTODOS: Con base en indicadores de alineamiento normativo respecto de la integración funcional entre instituciones proveedoras públicas y de gobernanza, se analizó el contenido de los programas nacionales de salud y de leyes y lineamientos oficiales pertinentes para la coordinación financiera. RESULTADOS: Se identificó un avance considerable en la implementación de convenios para la coordinación de las instituciones públicas. No obstante, el marco legal en apoyo al Sistema Nacional de Salud y al sector salud muestra deficiencias y contradicciones que limitan su alcance, mientras que el Padrón General de Salud carece del sustento legal necesario para convertirse en una herramienta de amplio beneficio para la integración. Si bien los convenios de intercambio de servicios están avanzando con base en tarifas y lineamientos compartidos, se carece de incentivos que promuevan su expansión. CONCLUSIONES: Es recomendable actualizar el marco legal para la coordinación del Sistema Nacional de Salud, procurando un enfoque más armónico y general que impulse la integración funcional.
OBJECTIVE: Evaluate the capacity of the federal legal framework to govern financing of health institutions in the public sector through innovative schemes -otherwise known as functional integration-, enabling them to purchase and sell health services to and from other public providers as a strategy to improve their performance. MATERIALS AND METHODS: Based on indicators of normative alignment with respect to functional integration across public health provider and governance institutions, content analysis was undertaken of national health programs and relevant laws and guidelines for financial coordination. RESULTS: Significant progress was identified in the implementation of agreements for the coordination of public institutions. While the legal framework provides for a National Health System and a health sector, gaps and contradictions limit their scope. The General Register of Health is also moving forward, yet it lacks the necessary legal foundation to become a comprehensive tool for integration. The medical service exchange agreements are also moving forward based on tariffs and shared guidelines. However, there is a lack of incentives to promote the expansion of these agreements. CONCLUSIONS: It is recommended to update the legal framework for the coordination of the National Health System, ensuring a more harmonious and general focus to provide functional integration with the needed impulse.
Assuntos
Organizações/economia , Organizações/legislação & jurisprudência , Saúde Pública/economia , Saúde Pública/legislação & jurisprudência , Financiamento Governamental , México , Organizações/organização & administraçãoRESUMO
OBJECTIVE: To analyze medical complaints over a period of 11 years, for making recommendations for prevention and improving planning for responding. MATERIAL AND METHODS: We studied the medical complaints at the National Medical Arbitration Commission (Conamed, per its acronym in Spanish) between 1996 and 2007 using descriptive statistics to identify their general profile in relation to the variables of time, place and person. We also studied the frequency of evident medical malpractice as well as the severity of the damage it produces. RESULTS: The request for responses to medical complaints increased between 1996 and 2007 and there was less demand between July and December. Two states in the country account for 69.7 percent of the complaints and 74.0 percent are from public institutions. Fifty-eight percent come from women and the 25-34 and 65+ age groups have the highest percentage. We found in 27.0 percent of the complaints there is evidence of medical malpractice and obstetrics and gynecology have the highest percentage of complaints, physical harm and severity of injury. Complaints about treatment are nearly four times more than diagnosis. CONCLUSIONS: It is necessary to improve the quality of diagnosis and treatment and identify cost-effective measures to reduce medical malpractice and the severity of physical damage in patients.
OBJETIVO: Analizar las quejas médicas atendidas en un periodo de 11 años con el fin de formular recomendaciones para prevenirlas y mejorar la planeación para su atención. MATERIAL Y MÉTODOS: Se estudiaron las quejas de la Comisión Nacional de Arbitraje Médico (Conamed) recibidas entre 1996 y 2007 y se utilizaron medidas de estadística descriptiva para conocer su perfil general en relación con las variables de tiempo, lugar y persona. También se determinó la frecuencia de mala práctica médica evidente, así como la gravedad del daño que producen. RESULTADOS: La solicitud de atención de quejas se incrementó entre 1996 y 2007, y existió menor demanda de atención en julio y diciembre. Dos estados del país concentran 69.7 por ciento de las quejas y 74 por ciento proviene de instituciones públicas. El 58 por ciento son de mujeres y los grupos de 25 a 34, y de 65 y más años tienen el mayor porcentaje. En 27 por ciento de las quejas atendidas hay evidencia de mala práctica médica y ginecología y obstetricia presenta el mayor porcentaje de quejas, daño físico y gravedad del daño. Las quejas por tratamiento son casi cuatro veces más que las de diagnóstico. CONCLUSIONES: Es necesario mejorar la calidad del diagnóstico y el tratamiento e identificar medidas efectivas para el costo que reduzcan la mala práctica médica y la gravedad del daño físico en los pacientes.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Gravidez , Adulto Jovem , Imperícia/estatística & dados numéricos , Negociação , Ginecologia , Instalações de Saúde , México/epidemiologia , Obstetrícia , Estações do Ano , Medicina , Adulto JovemRESUMO
OBJETIVO: Efectuar el análisis epidemiológico de 122 defunciones por influenza A (H1N1) confirmadas por laboratorio y contribuir a mejorar el diagnóstico y atención oportuna de casos. MATERIAL Y MÉTODOS: Se Analizaron 122 expedientes de pacientes fallecidos por influenza A (H1N1). RESULTADOS: Una proporción de 51 por ciento correspondió a mujeres y 49 por ciento a varones. Hasta 45.1 por ciento ocurrió entre los 20 y 39 años. La letalidad general fue de 2.2 por ciento y varió entre 0.3 por ciento en el grupo de 10 a 19 años y 6.3 por ciento en el de 50 a 59. Una cifra de 43 por ciento de las defunciones se concentró en dos de las 32 entidades federativas y 5l por ciento se atendió en instituciones de seguridad social. Sólo 17 por ciento recibió atención hospitalaria en las primeras 72 horas y 42 por ciento falleció en las primeras 72 horas de hospitalización. En 58.2 por ciento de los fallecidos había algún padecimiento asociado. DISCUSIÓN: El Nuevo virus A (H1N1) produce mayor mortalidad en personas jóvenes, al contrario de lo que sucede con la influenza estacional que muestra un mayor impacto en niños pequeños y personas de edad avanzada. El retraso de la atención médica y la morbilidad asociada fueron factores relevantes del fallecimiento.
OBJECTIVE: To carry out the epidemiological analysis of 122 influenza A (H1N1) deaths confirmed by laboratory and help to improve the diagnosis and timely managing of cases. MATERIAL AND METHODS: A total of 122 clinical records were analyzed of patients with confirmed influenza A (H1N1) virus infection who died. RESULTS: Fifty-one percent of patients were female and 49 percent were male. A total of 45.l percent who died were between 20 and 39 years old. Overall fatality was 2.2 percent and ranged between 0.3 percent for the l0 to l9 year-old group to 6.3 percent for the 50 to 59 year-old group. Forty-three percent of deaths were concentrated in only two of the thirty-two states and 5l percent received medical attention in social security institutions. Only l7 percent received hospital attention within 72 hours and 42 percent died within 72 hours of hospital attention. DISCUSSION: Novel Influenza A (H1N1) virus produces higher mortality in young people whereas seasonal influenza has a greater impact on young children and older people. Delay in medical care and the associated morbidity were relevant factors for death.
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/mortalidade , Influenza Humana/epidemiologia , México/epidemiologia , Adulto JovemRESUMO
Antecedentes: Existen patologías que pueden involucrar a los músculos que controlan la movilidad de las cuerdas vocales, por afección de la función periférica o del sistema nervioso central. La función muscular puede evaluarse mediante observación directa de la laringe o por electromiografía (EMG), la cual por ser invasiva ha tenido un uso limitado en el diagnóstico y manejo de los trastornos de la voz. Objetivo: El propósito de este estudio fue evaluar la utilidad de la EMG laríngea en la evaluación de la parálisis cordal unilateral. Métodos: Se estudiaron 25 sujetos con parálisis cordal y 25 controles con dislocación unilateral del aritenoides. Se obtuvieron los valores de sensibilidad y especificidad de la EMG como prueba diagnóstica. Resultados: La EMG mostró sensibilidad de 100% y especificidad de 92%. Solo dos pacientes con dislocación de aritenoides mostraron anormalidades en la EMG. Conclusiones: La EMG parece una prueba confiable y segura para complementar la evaluación de alteraciones de la movilidad de una cuerda vocal y diferenciar parálisis cordal de dislocación de aritenoides. Puede proveer evidencia de la denervación muscular y la reinervación, y los datos en serie pueden contribuir a establecer un pronóstico más confiable para delinear un plan de tratamiento adecuado a cada caso.
BACKGROUND: Several pathologies can involve muscles that control vocal folds. The abnormality can affect peripheral nerves or central nervous system centers. Clinically, muscle function can be assessed by observing the movement of structures themselves or by recording electrical activity of these muscles using (electromyography-EMG). Since EMG is an invasive technique, its use is not very widespread in the diagnosis and management of voice disorders, Laryngeal EMG can be helpful in those patients with voice problems of suspected neurological or neuromuscular etiology. OBJECTIVE: Assess the role of laryngeal EMG in the clinical evaluation of unilateral vocal cord immobility. METHODS: Twenty-five patients with unilateral vocal cord paralysis were studied. Twenty-five patients with unilateral arytenoid dislocation were studied as controls. The sensitivity and specificity of the EMG as a diagnostic marker for vocal fold paralysis were obtained. RESULTS: Laryngeal EMG showed a 100% sensitivity and 92% specificity. Only two patients displaying arytenoid dislocation displayed abnormal EMG recordings. CONCLUSIONS: EMG constitutes a safe and reliable tool to aid the evaluation of patients with vocal fold immobility. EMG recordings were helpful in differentiating vocal cord paralysis from arytenoid dislocation. Moreover, EMG can provide useful data regarding denervation and reinnervation of laryngeal muscles. Aside from its diagnostic usefulness, serial EMG can help to monitor recovery and establish a reliable prognosis. Hence, an adequate treatment plan can be determined.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Paralisia das Pregas Vocais/fisiopatologia , EletromiografiaRESUMO
Entre las causas de pérdida de audición, la hipoacusia neurosensorial inducida por ruido es uno de los problemas más comunes a los que se enfrenta el otorrinolaringologo y el médico general y con no muy buenas expectativas para el paciente.Se estima que un tercio de la población mundial padece algún grado de sordera o pérdida auditiva causada por la exposición a sonidos de alta intensidad.La exposición a ruidos tiene efectos más importantes de los que podamos pensar, ya que la incapacidad para la comunicación personal reduce la calidad de vida del ser humano y su socialización, representa además un alto costo económico y afecta a la sociedad entera.Aunque tradicionalmente se sabe que la fuente más común de ruido se encuentra en los lugares de trabajo, cada vez más podemos encontrarlos en la casa, en los espacios de recreación, oficinas, escuelas, etc. y esto provoca que ahora todos los miembros de la sociedad estén siendo afectados sin importar, edad o sexo.