Hacia el diseño de Vida Saludable, un nuevo programa de estudios para la educación básica en México.

OBJETIVO: Describir el proceso de diseño de Vida Saludable, un nuevo programa de estudios para la educación básica en México. Material y métodos. Se conformó un equipo de trabajo entre especialistas en salud y la Secretaría de Educación Pública. Se establecieron las bases científicas de Vida Saludable, se seleccionaron y evaluaron materiales para Vida Saludable, y se revisaron contenidos vigentes de salud incluidos en otras asignaturas. RESULTADOS: Alimentación, actividad física e higiene y limpieza fueron definidos como los tres ejes temáticos para Vida Saludable. Se aprobaron 3 de 228 insumos para usarse en Vida Saludable y 71.7% de los con-tenidos vigentes en educación básica sobre salud requieren ediciones. CONCLUSIONES: Vida Saludable es un parteaguas hacia la alfabetización en materia de salud en educación básica en México, que se alinea con la agenda global para preservar la salud humana y planetaria.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud.

La creciente epidemia de obesidad ha sido uno de los retos más importantes de salud pública en México durante los últimos años. Con apoyo de la Federación Mundial de Obesidad, en 2021 formamos un grupo de profesionales para identificar y resumir las acciones prioritarias en las que puede enfocarse nuestro país para hacer frente a esta epidemia. Al proceso de desarrollo y discusión de este grupo se sumaron más de 1 000 profesionales de la salud para retomar recomendaciones de documentos y guías de alto nivel previamente publicados. En conmemoración del Día Mundial de la Obesidad, en este 2022 se presenta esta postura como insumo para el desarrollo de acciones en el ámbito profesional y de los diferentes sectores, en la que se incluyen 10 recomendaciones de acción, desde la perspectiva poblacional hasta la atención individualizada, y se enfatiza en la importancia de la participación social, de las intervenciones integrales con visión centrada en la persona y de la sostenibilidad planetaria, además de mejorar la educación y las campañas de difusión, propiciar un ambiente promotor de entornos activos y blindar de conflictos de interés los esfuerzos de prevención y control. La postura hace un llamado para abordar la obesidad de manera seria, con base en la evidencia científica, oportuna e integral, con enfoque de curso de vida, de forma ética y sensible, y sin perpetuar las barreras del estigma de peso en la sociedad.

HPV Self-Sampling in the Workplace: A Qualitative Study of Benefits, Barriers, and Opportunities for Improvement Perceived by Health Professionals and Managers.

AIM: To inform the implementation of Human Papillomavirus Self-Sampling (HPV-SS) in the workplace, we assessed the perspectives of healthcare professionals and managers on the benefits, barriers, and opportunities for improvement of a pilot program. METHODS: A qualitative descriptive study based on in-depth telephone interviews was conducted between June and August 2023. Data were analyzed through inductive thematic analysis. Fifteen health professionals from different companies and fifteen managers from the Mexican Institute of Social Security (IMSS) were interviewed. RESULTS: Participants identified several benefits of the HPV-SS, including ease of use, privacy, convenience, affordability, reduced workplace absences, and promotion of a prevention culture. However, there were also individual and organizational barriers to program implementation. The former consisted of women's concerns about collecting a reliable sample or injuring themselves, lack of confidence in the HPV test, fear of positive results, and discomfort caused by the brush used to collect the sample. Organizational barriers included failure to follow up on positive test results, lack of knowledge of program indicators, perceived negative impact on the established Pap smear cervical cancer screening indicator, and the lack of government regulations supporting HPV testing. To improve the program, participants suggested disseminating information through mass media campaigns and social networks, providing companies with additional support from IMSS preventive staff, extending the work hours of IMSS Family Medicine clinics, and training IMSS health staff on the follow-up of women with HPV test results. CONCLUSIONS: The study findings suggest potential areas for improvement in HPV-SS programs.

[The estimated economic impact of cardiovascular and diabetes mellitus complications 2019-2028]. / Estimación del impacto económico por complicaciones cardiovasculares y de diabetes mellitus 2019-2028.

Background: In Mexico, diabetes mellitus (DM) and diseases cardiovascular, register an upward trend. Objective: To estimate the number of complications due to cardiovascular events (CVD) and complications derived from DM (CDM) accumulated in beneficiaries of the Mexican Institute of Social Security (IMSS) from 2019 to 2028, as well as the expense for medical and economic benefits in a scenario baseline and one of change in metabolic profile due to lack of medical follow-up during the COVID-19 pandemic. Material and methods: The number of CVD and CDM was estimated from 2019, with a 10-year risk projection using the ESC CVD Risk Calculator and United Kingdom Prospective Diabetes Study, considering risk factors registered in the institutional databases. Results: From 2019 to 2028, cumulative CVD cases were estimated at 2 million and those of CDM in 960 thousand, with an impact on medical spending of 439,523 million pesos and on the economic benefits of 174,085 millions. When considering the COVID-19 pandemic, CVD events and CDM increased by 589 thousand, with an increase in spending of 93,787 million pesos for medical care and 41,159 million for economic benefits. Conclusions: Without a comprehensive intervention in the management of CVD and CDM, the cost by both diseases will continue to increase, with financial pressures getting older.

Introducción: en México la diabetes mellitus (DM) y las enfermedades cardiovasculares, registran una tendencia ascendente. Objetivo: estimar el número de complicaciones por eventos cardiovasculares (ECV) y complicaciones derivadas de la DM (CDM) acumuladas en derechohabientes del Instituto Mexicano del Seguro Social (IMSS) de 2019 a 2028, así como el gasto por prestaciones médicas y económicas en un escenario de referencia y uno de cambio en el perfil metabólico debido a la falta de seguimiento médico durante la pandemia por COVID-19. Material y métodos: se estimó el número de ECV y CDM a partir de 2019, con una proyección de riesgo a 10 años con los modelos ESC CVD Risk Calculator y United Kingdom Prospective Diabetes Study, considerando los factores de riesgo registrados en las bases de datos institucionales. Resultados: de 2019 a 2028, los casos acumulados de ECV se estimaron en 2 millones y los de CDM en 960 mil, con un impacto sobre el gasto médico de 439,523 millones de pesos y sobre las prestaciones económicas de 174,085 millones. Al considerar la pandemia por COVID-19, los eventos de ECV y de las CDM aumentaron en 589 mil, con un incremento del gasto en 93,787 millones de pesos por atención médica y en 41,159 millones por prestaciones económicas. Conclusiones: sin una intervención integral al manejo de ECV y de CDM, el gasto por ambas enfermedades seguirá incrementándose, con presiones financieras cada vez mayores.

[Validity and reliability of mammographic interpretation by Mexican radiologists, using the BI-RADS system]. / Validez y reproducibilidad de la interpretación de la mamografía por radiólogos mexicanos, mediante el sistema BI-RADS.

OBJECTIVE: Mammographic interpretation using the BI-RADS system determines if a patient will continue in the regular screening program or needs additional studies for breast cancer diagnosis, hence the importance of its evaluation. Sensitivity, specificity, diagnostic accuracy of mammographic interpretation and inter- and intra-observer variation, were assessed in a random sample of 29 radiologists from the Mexican Ministry of Health. MATERIAL AND METHODS: Eighty diagnostic and screening mammographic studies were selected from the National Cancer Institute in Mexico City. Under the same conditions, two interpretations using the BI-RADS system were performed by each of the participating radiologists. RESULTS: Sensitivity in the first and second measurement was 72 and 74% respectively, while the specificity was 80% for the first and 82% for second. Multivariate analysis showed a positive association between the last year number of interpreted mammograms, the number of courses taken and diagnostic accuracy (beta=0.00002, 95% CI 0.000004, 0.00003, p=0.02, beta=0.005, CI 95% -0.0004, 0.01, p=0.07, respectively). Inter-observer agreement was low in both measurements (kappa=0.24, kappa=0.25, respectively). However, after combining BI-RADS categories in 2, agreement increased to 0.46 for both measurements. The intra-observer agreement was good (kappa=0.67). CONCLUSIONS: The number of mammographic studies interpreted the previous year is a good measure of the experience of the radiologist and is reflected in the diagnostic accuracy of mammographic interpretation. Courses on mammographic interpretation also have a positive impact on performance.

[Public policies for the detection of breast cancer in Mexico]. / Políticas públicas para la detección del cáncer de mama en México.

Breast Cancer is a significant public health problem associated with epidemiological and demographic transitions that are currently taking place in Mexico. Aging and increased exposure to risk factors are thought to increase breast cancer incidence, having great relevance for the society and health services. Under this scenario, the health system must respond to the growing needs for better breast cancer screening services. In this paper we present an update of breast cancer mortality, general international recommendations for breast cancer screening programs and key aspects of the Mexico Action Program for Breast Cancer Screening and Control 2007-2012. Breast cancer policies are aimed at organizing and increasing the infrastructure to develop a National Program for Detection, Diagnosis and Treatment of Breast Cancer with optimal quality, friendliness and respect for patient's rights.

Implementation of a Nationwide Strategy for the Prevention, Treatment, and Rehabilitation of Cardiovascular Disease "A Todo Corazón".

The cardiovascular diseases (CVDs) have a growing impact over the world mortality, affecting mostly low and middle-income countries. This is due to changes in the population pyramid and the increase in unhealthy lifestyles that predispose the global population to cardiovascular risk factors such as overweight, obesity, smoking, hypertension, diabetes, dyslipidemias and metabolic syndrome. Ischemic heart disease and the cerebral vascular event remain the first causes of death reported by the World Health Organization (WHO) for more than a decade. Mexico has high prevalence in obesity, overweight, hypertension and diabetes in the population over 20 years old; Within the OECD countries (Organization for Economic Cooperation and Development) are the country with the highest mortality due to acute myocardial infarction over 45 years in the first 30 days. In order to face the growing pandemic of CVDs, the IMSS, it has developed and implemented a comprehensive care program called "A Todo Corazon", it is the first program of integral care which seeks to strengthen the actions to improving the impact of CVDs from health. This review is focused on describing the 7 axes that make up the program; each axe is described in detail. Axes one to three are dedicated to promotion and primary prevention of CVDs. Axes 4 and 5 are dedicated to infarction code, as a national strategy to confront the principal cause of death in Mexico. Finally axes 6 and 7 are dedicated to intensive care, secondary prevention and rehabilitation of CVDs.

[Protocol for the care of acute myocardial infarction in emergency: Código infarto (The Infarction Code)]. / Protocolo para atención de infarto agudo de miocardio en urgencias: Código infarto.

Cardiovascular diseases are a major public health problem because of their they impact on more than 30% of all deaths worldwide. In our country and in the Instituto Mexicano del Seguro Social (IMSS) are also the leading cause of death and the main cause of lost of healthy life years due to disability or premature death. 50% of deaths are premature; most of them are due to acute myocardial infarct. However, the investment for cardiovascular health is poor and there are no comprehensive cares programs focused on the treatment of this diseases or the control of their risk factors. To address this problem, the first institutional care program was developed, called "A todo corazón", which aims to strengthen actions to promote healthy habits, prevention and care of cardiovascular diseases. The initial approach is to implement a protocol of care emergency services called "Código infarto", which is intended to ensure the diagnosis and treatment of patients demanding emergency care for acute myocardial infarction and receive reperfusion treatment with primary angioplasty in the first 90 minutes, or fibrinolytic therapy in the first 30 minutes after the admission to the IMSS emergency services.

Las enfermedades cardiovasculares son un problema de salud pública por su impacto en más del 30% de las muertes del mundo. En nuestro país y en el IMSS son también la primera causa de muerte y en años de vida saludable perdidos por muerte prematura o discapacidad. El 50% de las muertes son prematuras, y la mayor parte se deben a infarto agudo de miocardio. Sin embargo, sigue siendo pobre la inversión para la salud cardiovascular y no existen programas de atención integral enfocados al tratamiento de estas enfermedades ni para el control de los factores de riesgo. Ante esta problemática se desarrolló el primer programa de atención integral a nivel institucional llamado "A todo corazón", que pretende fortalecer las acciones para promoción de hábitos saludables, la prevención y atención de las enfermedades cardiovasculares. El enfoque inicial es implementar un protocolo de atención para los servicios de urgencias llamado "Código infarto", el cual pretende garantizar el diagnóstico y tratamiento del paciente que demanda atención de urgencias por infarto agudo de miocardio, de manera que pueda recibir tratamiento de reperfusión con angioplastía primaria en los primeros 90 minutos, o terapia fibrinolítica en los primeros 30 minutos posteriores a su ingreso a los servicios de urgencias del IMSS.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

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Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

[Strategy of provision and assessment of preventive health services]. / Estrategia de prestación y evaluación de servicios preventivos.

This paper describes the strategy of provision and assessment of preventive health services that the Mexican Institute of Social Security (IMSS) established in 2002 and that for social communication purposes, was called PREVENIMSS. The strategy is composed by five programs: Children's Health, Adolescents' Health, Women's Health, Men's Health and Seniors' Health. The objectives of these programs are the following: to provide a group of actions to promote and protect health, according to their age, sex and risk factors; to incorporate new preventive actions in order to face demographic and epidemiologic transition; to promote the participation of population in health care; to integrate provision of preventive services in family medicine clinics, and to broaden their coverage and impact. The modernization process of the statistical information system is also described in this paper. It included several aspects, such as the establishment of an automated record of preventive actions, which allowed the generation of relevant and timely information to measure the coverage and both national and local impacts.

Políticas públicas para la detección del cáncer de mama en México / Public policies for the detection of breast cancer in Mexico

El cáncer de mama es un problema de salud pública, prioritario por su magnitud y trascendencia, que se relaciona con las transiciones demográfica y epidemiológica del país. Con el envejecimiento de la población, y una mayor exposición a los factores de riesgo, cobrará mayor relevancia en la sociedad y los servicios de salud, que deberán responder a las necesidades crecientes de detección y atención de esta tumoración mediante programas costo-efectivos. El propósito de este artículo es exponer un análisis de la mortalidad por el cáncer de mama, así como las recomendaciones internacionales con mayor consenso sobre la organización de los programas de tamizaje; por último, se presentan los aspectos medulares del programa de acción para la detección y control del cáncer de mama durante la presente administración (2007-2012). Las políticas para el control de esta neoplasia en México están dirigidas a la organización y el crecimiento de la infraestructura para el desarrollo de un programa nacional de detección temprana, diagnóstico oportuno y tratamiento con calidad óptima, trato cordial y respeto a los derechos de las pacientes.

Breast Cancer is a significant public health problem associated with epidemiological and demographic transitions that are currently taking place in Mexico. Aging and increased exposure to risk factors are thought to increase breast cancer incidence, having great relevance for the society and health services. Under this scenario, the health system must respond to the growing needs for better breast cancer screening services. In this paper we present an update of breast cancer mortality, general international recommendations for breast cancer screening programs and key aspects of the Mexico Action Program for Breast Cancer Screening and Control 2007-2012. Breast cancer policies are aimed at organizing and increasing the infrastructure to develop a National Program for Detection, Diagnosis and Treatment of Breast Cancer with optimal quality, friendliness and respect for patient's rights.