The Omicron wave in Mexico: vaccine protection against progression to severe Covid-19 in SARS-CoV-2-infected workers.

OBJECTIVE: To assess the effectiveness of seven Covid-19 vaccines in preventing disease progression (DP) using data from national private sector workers during the Omicron wave in Mexico from January 2 to March 5, 2022. MATERIALS AND METHODS: This study employed an administrative retrospective cohort design, analyzing DP (hospitalization or death due to respiratory disease) among workers who filed a respiratory short-term disability claim and tested positive for SARS-CoV-2. Risk ratios (RRadj) were estimated using Poisson regression models adjusted for various factors. RESULTS: Vaccinated individuals had a lower risk of hospitalization and death compared with unvaccinated individuals. The overall RRadj for hospitalization and death were 0.36 (95%CI 0.32, 0.41) and 0.24 (0.17, 0.33), respectively. When evaluating vaccines individually, the RRadj for hospitalization were as follows Pfizer BioNTech 0.27 (95%CI 0.22, 0.33), Moderna 0.29 (95%CI 0.15, 0.57), Sinovac 0.32 (95%CI 0.25, 0.41), AstraZeneca 0.39 (95%CI 0.34, 0.46), Sputnik 0.39 (95%CI 0.28, 0.53), CanSino 0.41 (95%CI 0.24, 0.7), and Janssen 0.53 (95%CI 0.39, 0.72). The RRadj for death were as follows: Pfizer BioNTech 0.12 (95%CI 0.07, 0.19), Sputnik 0.15 (95%CI 0.06, 0.38), Sinovac 0.29 (95%CI 0.16, 0.53), AstraZeneca 0.30 (95%CI 0.20, 0.44), CanSino 0.38 (95%CI 0.1, 1.4), and Janssen 0.50 (95%CI 0.26, 0.97). CONCLUSION: Covid-19 vaccines significantly reduced the risk of severe disease during the Omicron wave in Mexico.

Strengthening Essential Health Services Recovery Policy after the COVID-19 Pandemic. Evidence from the Mexican Institute of Social Security.

AIM: To evaluate the progress of the Mexican Institute of Social Security Recovery Policy (IMSS-RP) in addressing the decline in essential health services caused by the COVID-19 pandemic. METHODS: We analyzed eleven indicators of essential health services from 35 IMSS state delegations. The assessment included ambulatory and hospital care indicators such as breast and cervical cancer screening, family medicine, dental and specialty visits, diabetes and hypertension visits and health outcomes, deliveries, and elective surgeries. We analyzed the period before (January 2018-March 2021) and during (April 2021-June 2023) the implementation of the IMSS-RP. Statistical analysis to determine the association of the policy with service indicators and the change in their trends included an interrupted time series analysis and Poisson Generalized Estimating Equation models. RESULTS: The volume of services showed substantial declines during the first year of the COVID-19 pandemic, reaching between 11 and 81% of pre-pandemic levels. All services increased significantly during the first 27 months of the IMSS-RP implementation; specialty visits, cervical and breast cancer screening, and diabetes control exceeded pre-pandemic levels (103%,112%,103%, and 138%, respectively). However, only deliveries and the percentage of patients with controlled diabetes and hypertension showed a stable increase following the IMSS-RP implementation, whereas the remaining services showed an initial increase but began to decrease over time. CONCLUSIONS: After 27 months of implementation, IMSS-RP achieved progress in increasing the volume of essential health services and improving chronic disease control. However, declining trends in several services signal the need to focalize the policy.

Outbreak of Fusarium solani Meningitis in Immunocompetent Persons Associated With Neuraxial Blockade in Durango, Mexico, 2022-2023.

Background: Fungal meningitis can be associated with epidural anesthesia procedures. Fusariosis is a rare infection typically affecting immunocompromised patients and rarely causes meningitis. During 2022-2023, public health officials responded to a large outbreak of Fusarium solani meningitis associated with epidural anesthesia in Durango, Mexico. Methods: The public health response and epidemiological and clinical features of patients affected by this outbreak were described. Coordinated actions were addressed to identify the etiological agent, determine its drug susceptibility, develop diagnostic tests, and implement clinical and epidemiological protocols. Retrospective analyses of clinical variables and outcomes were performed to determine association with better patient survival. Results: A total of 1801 persons exposed to epidural anesthesia were identified, of whom 80 developed meningitis. Fusarium solani was found in 3 brain biopsies and showed susceptibility to voriconazole and amphotericin B. After F solani polymerase chain reaction (PCR) implementation, 57 patients with meningitis were PCR-screened, and 31 (38.8%) had a positive result. Most patients were female (95%), and cesarean section was the most common surgical procedure (76.3%). The case fatality rate was 51.3% (41 patients) and the median hospitalization duration was 39.5 days (interquartile range, 18-86 days). Seventy-one patients (88.8%) received voriconazole/amphotericin B and 64 subjects (80%) additionally received steroids. Cox regression analysis showed an increased lethality risk in patients who received antifungal treatment after 5 days (hazard ratio, 2.1 [95% confidence interval, 1.01-4.48], P < .05). Conclusions: The F solani meningitis outbreak in Durango was an unprecedented medical challenge. Timely treatment and effective healthcare management were associated with better survival outcomes.

Epidemiology of childhood acute leukemias in marginalized populations of the central-south region of Mexico: results from a population-based registry.

Introduction: Acute leukemias (AL) are the main types of cancer in children worldwide. In Mexico, they represent one of the main causes of death in children under 20 years of age. Most of the studies on the incidence of AL in Mexico have been developed in the urban context of Greater Mexico City and no previous studies have been conducted in the central-south of the country through a population-based study. The aim of the present work was to identify the general and specific incidence rates of pediatric AL in three states of the south-central region of Mexico considered as some of the marginalized populations of Mexico (Puebla, Tlaxcala, and Oaxaca). Methods: A population-based study was conducted. Children aged less than 20 years, resident in these states, and newly diagnosed with AL in public/private hospitals during the period 2021-2022 were identified. Crude incidence rates (cIR), standardized incidence rates (ASIRw), and incidence rates by state subregions (ASIRsr) were calculated. Rates were calculated using the direct and indirect method and reported per million children under 20 years of age. In addition, specific rates were calculated by age group, sex, leukemia subtype, and immunophenotype. Results: A total of 388 cases with AL were registered. In the three states, the ASIRw for AL was 51.5 cases per million (0-14 years); in Puebla, it was 53.2, Tlaxcala 54.7, and Oaxaca de 47.7. In the age group between 0-19 years, the ASIRw were 44.3, 46.4, 48.2, and 49.6, in Puebla, Tlaxcala, and Oaxaca, respectively. B-cell acute lymphoblastic leukemia was the most common subtype across the three states. Conclusion: The incidence of childhood AL in the central-south region of Mexico is within the range of rates reported in other populations of Latin American origin. Two incidence peaks were identified for lymphoblastic and myeloid leukemias. In addition, differences in the incidence of the disease were observed among state subregions which could be attributed to social factors linked to the ethnic origin of the inhabitants. Nonetheless, this hypothesis requires further investigation.

[Renoprotection. About World Kidney Day]. / Renoprotección. A propósito del Día Mundial del Riñón.

The World Kidney Day was founded in 2003 by doctor Joel D. Kopple, American nephrologist, who in the session in the Congress of the International Federation of Kidney Foundations explained the need to implement the celebration on a day that alludes to this organ, in order to direct preventive actions for kidney disease and raise awareness in the medical community and the general population on the importance of caring for the kidneys. 3 years later, the proposal was accepted and as of 2006 World Kidney Day is celebrated. The diffusion is found throughout the world and in each place there are talks, courses, workshops, cultural activities and even marathons related to the prevention, diagnosis and treatment of kidney disease. Chronic kidney disease (CKD) is a disorder with a chronic, degenerative, and lethal evolution. Managing CKD requires a large amount of human, financial, and infrastructure resources. It impairs the quality of life and negatively affects survival. On the other hand, it leads to dialysis and kidney transplant treatments, which are expensive enough to put any health institution at financial risk, especially those most vulnerable. The main idea of these non-profit international organizations is to promote the well-being and improve the quality of life of people with CKD with and without dialysis, and to promote kidney transplantation as the first treatment option.

El Día Mundial del Riñón se fundó en el año 2003 por el doctor Joel D. Kopple, nefrólogo norteamericano, quien en el pleno del Congreso de la Federación Internacional de Fundaciones Renales expuso la necesidad de implementar la celebración en un día que aludiera a este órgano, con el fin de dirigir acciones de prevención para la enfermedad renal y concientizar a la comunidad médica y a la población en general de la importancia de cuidar los riñones. Tres años después, la propuesta fue aceptada y a partir del 2006 se celebra el Día Mundial del Riñón. La difusión se encuentra en todo el mundo y en cada lugar se desarrollan pláticas, cursos, talleres, actividades culturales y hasta maratones relacionados con la prevención, el diagnóstico y el tratamiento de la enfermedad renal. La enfermedad renal crónica (ERC) es un trastorno de evolución crónica, degenerativa y letal. Su atención demanda gran cantidad de recursos humanos, financieros y de infraestructura. Es una enfermedad que deteriora la calidad de vida y afecta negativamente la supervivencia. Por otra parte, conduce a realizar tratamientos costosos de diálisis y trasplante renal que ponen en riesgo financiero a cualquier institución de salud, sobre todo a aquellas más vulnerables. La idea principal de estos organismos internacionales sin fines de lucro es promover el bienestar y mejorar la calidad de vida de las personas con ERC con y sin diálisis, y promover el trasplante renal como primer opción de tratamiento.

[What has been done at IMSS regarding the users's mental health in the COVID-19 pandemic?] / ¿Qué se ha hecho en el IMSS en cuanto a la salud mental de los derechohabientes en la pandemia por COVID-19.

Nowadays, mental health has acquired greater relevance and attention as a consequence mainly of the COVID-19 pandemic, to which is attributed a negative impact on the development of life, work and social coexistence of people, along with the magnitude derived from non-communicable diseases. This is why the Instituto Mexicano del Seguro Social (IMSS, Mexican Institute for Social Security) developed the Mental Health Comprehensive Program 2021-2024, whose main purpose was to establish strategies and lines of action for the prevention, early detection and timely management regarding mental health and addictions. Based on this, different actions have been carried out, for example, the identification of the material and human resources available at IMSS to meet the mental health issue; the training of healthcare professionals at the three levels of care; the integration of a census that has reported a prevalence of anxiety and depressive episodes in the users of 39.9 and 3%, respectively, as well as the evaluation of instruments for screening mental disorders. Therefore, this document describes what has been done in the IMSS in relation to the user's mental health in the context of the COVID-19 pandemic.

Hoy en día la salud mental ha adquirido mayor relevancia y atención como consecuencia principalmente de la pandemia por COVID-19, a la cual se le atribuye un impacto negativo en el desarrollo de la vida, el trabajo y la convivencia social de las personas, todo esto aunado a la magnitud derivada de los padecimientos no transmisibles. Es por eso que en el Instituto Mexicano del Seguro Social (IMSS) se elaboró el Programa Integral de Salud Mental 2021-2024, cuyo principal propósito fue establecer estrategias y líneas de acción para la prevención, detección temprana y manejo oportuno respecto a la salud mental y adicciones. A partir de ello se han materializado diferentes acciones, entre las que destaca la identificación de los recursos materiales y humanos con los que cuenta el IMSS para atender esta necesidad; la capacitación del personal de salud de los tres niveles de atención; la integración de un censo que ha reportado una prevalencia de ansiedad y episodio depresivo en la población derechohabiente de 39.9 y 3%, respectivamente, y la evaluación de instrumentos para realizar tamizajes de trastornos mentales. Por lo anterior, en este documento se describe lo que se ha hecho en el IMSS en relación con la salud mental de la población derechohabiente en el contexto de la pandemia por COVID-19.

A Geospatial Model to Identify Areas Associated with Late- Stage Breast Cancer: A Spatial Epidemiology Approach.

OBJECTIVE: The aim of this study was to show how a geospatial model can be used to identify areas with a higher probability for late-stage breast cancer (BC) diagnoses. METHODS: Our study considered an ecological design. Clinical records at a tertiary care hospital were reviewed in order to obtain the place of residence and stage of the disease, which was classified as early (0-IIA) and late (IIB-IV) and whose diagnoses were made during the 2013-2017 period. Then, they were geolocated to identify the distribution and spatial trend. Subsequently, the pattern of location, i.e. scattered, random and concentrated, was statistically assessed and a geospatial model was elaborated to determine the probability of late diagnoses in the state of Jalisco, Mexico. RESULT: There were 1 954 (N) geolocated BC diagnoses: 58.3% were late. During the five-year period, a southwest-northeast trend was identified, nearly 9.5% of the surface of Jalisco, where 6 out of 10 (n= 751) late- stage diagnoses were concentrated. A concentrated and statistically significant pattern was identified in the southern, central and northern Pacific area of Jalisco, where the geospatial model delimited the places with the highest probability of late clinical stages (p <0.05). CONCLUSION: The geographical differences associated with the late diagnoses of BC suggest it is necessary to adapt and focus the strategies for early detection as an alternative to create a major impact on the population. Reproducible analysis tools were used in other contexts where geolocation data are available to complement public policies and strategies aimed to control BC.

Telephonic Follow-up and the Risk of Death in Ambulatory Patients with COVID-19.

BACKGROUND: Primary care level close monitoring of mild COVID-19 patients has shown to provide a risk reduction in hospitalization and death. We aimed to compare the risk of all-cause death among COVID-19 ambulatory patients who received and did not receive telephonic follow-up in primary health care settings. METHODS: A secondary database analysis, 2-group comparative study, was conducted with data from the medical information systems of the Mexican Institute of Social Security. A total of 1,498,808 ambulatory patients aged 20 years old and over and with laboratory confirmed SARS-CoV-2 by PCR or rapid antigen test were analyzed. Of them, 535,898 (35.8%) where followed by telephonic calls. The cases were attended from October 14, 2020, to April 10, 2022. Death incidence was evaluated. To assess the association between death and telephonic follow-up we calculated risk ratio using a multivariate logistic model. RESULTS: Case fatality rate was 1.29% in the patients who received telephonic follow-up and 2.95% in the cases who did not receive phone calls. Medical history of chronic kidney disease, COPD, cardiovascular disease, tobacco consumption and diabetes were associated with increased risk of death. In the multivariate model, telephonic follow-up was associated with lower risk of all-cause death, with an adjusted risk ratio of 0.61 (95% confidence interval from 0.59, 0.64). CONCLUSION: Our data suggest that telephonic follow-up is associated with a risk of death reduction in adult outpatients with mild COVID-19, in the context of a multimodal strategy in the primary health care settings.

SARS-CoV-2 Omicron variants BA.4 and BA.5 dominated the fifth COVID-19 epidemiological wave in Mexico.

In Mexico, the BA.4 and BA.5 Omicron variants dominated the fifth epidemic wave (summer 2022), superseding BA.2, which had circulated during the inter-wave period. The present study uses genome sequencing and statistical and phylogenetic analyses to examine these variants' abundance, distribution, and genetic diversity in Mexico from April to August 2022. Over 35 % of the sequenced genomes in this period corresponded to the BA.2 variant, 8 % to the BA.4 and 56 % to the BA.5 variant. Multiple subvariants were identified, but the most abundant, BA.2.9, BA.2.12.1, BA.5.1, BA.5.2, BA.5.2.1 and BA.4.1, circulated across the entire country, not forming geographical clusters. Contrastingly, other subvariants exhibited a geographically restricted distribution, most notably in the Southeast region, which showed a distinct subvariant dynamic. This study supports previous results showing that this region may be a significant entry point and contributed to introducing and evolving novel variants in Mexico. Furthermore, a differential distribution was observed for certain subvariants among specific States through time, which may have contributed to the overall increased diversity observed during this wave compared to the previous ones. This study highlights the importance of sustaining genomic surveillance to identify novel variants that may impact public health.

Subclassification of B-acute lymphoblastic leukemia according to age, immunophenotype and microenvironment, predicts MRD risk in Mexican children from vulnerable regions.

Introduction: The decisive key to disease-free survival in B-cell precursor acute lymphoblastic leukemia in children, is the combination of diagnostic timeliness and treatment efficacy, guided by accurate patient risk stratification. Implementation of standardized and high-precision diagnostic/prognostic systems is particularly important in the most marginalized geographic areas in Mexico, where high numbers of the pediatric population resides and the highest relapse and early death rates due to acute leukemias are recorded even in those cases diagnosed as standard risk. Methods: By using a multidimensional and integrated analysis of the immunophenotype of leukemic cells, the immunological context and the tumor microenvironment, this study aim to capture the snapshot of acute leukemia at disease debut of a cohort of Mexican children from vulnerable regions in Puebla, Oaxaca and Tlaxcala and its potential use in risk stratification. Results and discussion: Our findings highlight the existence of a distinct profile of ProB-ALL in children older than 10 years, which is associated with a six-fold increase in the risk of developing measurable residual disease (MRD). Along with the absence of CD34+ seminal cells for normal hematopoiesis, this ProB-ALL subtype exhibited several characteristics related to poor prognosis, including the high expression level of myeloid lineage markers such as MPO and CD33, as well as upregulation of CD19, CD34, CD24, CD20 and nuTdT. In contrast, it showed a trend towards decreased expression of CD9, CD81, CD123, CD13, CD15 and CD21. Of note, the mesenchymal stromal cell compartment constituting their leukemic niche in the bone marrow, displayed characteristics of potential suppressive microenvironment, such as the expression of Gal9 and IDO1, and the absence of the chemokine CXCL11. Accordingly, adaptive immunity components were poorly represented. Taken together, our results suggest, for the first time, that a biologically distinct subtype of ProB-ALL emerges in vulnerable adolescents, with a high risk of developing MRD. Rigorous research on potential enhancing factors, environmental or lifestyle, is crucial for its detection and prevention. The use of the reported profile for early risk stratification is suggested.

[Integrated Care Protocols, a strategy for chronic diseases]. / Protocolos de Atención Integral, una estrategia para las enfermedades crónicas.

Noncommunicable diseases (NCD) cause more than 41 million deaths each year, equivalent to 71% of all deaths globally. The main types of NCD are: cardiovascular diseases (heart attack or cerebrovascular infarction), diabetes, cancer and chronic respiratory diseases (chronic obstructive pulmonary disease and asthma). In Mexico, NCD are responsible of more than three-quarters of deaths. This supplement describes a novel strategy by the Instituto Mexicano del Seguro Social (IMSS) to confront chronic diseases, known as Integrated Care Protocols, which aim to be a simple and easy-to-interpret reference document, but at the forefront of national and international knowledge, based on scientific evidence and normative documents. In addition, they specify the indispensable, optional actions and those that have to be avoided by the expanded health team. Therefore, this tool will guide our actions according to scientific advances and social needs.

Las enfermedades no transmisibles (ENT) son causa de más de 41 millones de fallecimientos cada año, lo que equivale al 71% de todas las muertes a nivel mundial. Los principales tipos de ENT son: las enfermedades cardiovasculares (infarto cardíaco o cerebrovascular), la diabetes, el cáncer y las enfermedades respiratorias crónicas (enfermedad pulmonar obstructiva crónica y asma). Las ENT constituyen las tres cuartas partes de las muertes ocurridas en México. En este suplemento se describe una novedosa estrategia del Instituto Mexicano del Seguro Social (IMSS) para afrontar a las enfermedades crónicas, conocida como Protocolos de Atención Integral, los cuales tienen como objetivo ser un documento de consulta sencillo y de fácil interpretación, pero a la vanguardia de los conocimientos nacionales e internacionales, con base en la evidencia científica y documentos normativos. Además, especifican las acciones indispensables, opcionales y las que se tienen que evitar por parte del equipo ampliado de salud. Por lo tanto, esta herramienta orientará nuestras acciones conforme a los avances científicos y a las necesidades sociales.

[The transformation of the IMSS in the face of the health crisis caused by COVID-19 and the challenges of the 21st century]. / La transformación del IMSS ante la crisis sanitaria por COVID-19 y frente a los retos del siglo XXI.

The Mexican Social Security Institute, the most prominent social security institution in Mexico, plays a significant role in Mexican health care. Throughout almost eight decades of existence, it has faced significant challenges, whose experiences have contributed to the generation of health policies in the country. Recently, the health emergency caused by COVID-19 evidenced a strong impact of the epidemiological transition associated with the high prevalence of chronic-degenerative diseases, which meant an increased risk of complications and death when facing emerging diseases. The institute is transformed through changes in its policies and forms of health care for the population to provide innovative responses and fulfill the commitment to provide social security to our country.

El Instituto Mexicano del Seguro Social, como la institución más grande de seguridad social de México, juega un papel muy importante para la atención a la salud de los mexicanos. A lo largo de casi ocho décadas de existencia, ha enfrentado retos significativos, cuyas experiencias han aportado para la generación de políticas de salud en el país. Recientemente, la emergencia sanitaria por COVID-19 evidenció una población con un fuerte impacto de la transición epidemiológica, asociado a la alta prevalencia de enfermedades crónico-degenerativas, lo que significó un alto riesgo de complicaciones y muerte al enfrentar enfermedades emergentes. El instituto se transforma a través de cambios en sus políticas y formas de atención a la salud de la población para dar respuestas innovadoras y cumplir el compromiso de dar seguridad social a nuestro país.

[Behavior and demand patterns for medical consultations for Kidney Disease at the IMSS, 2011-2020]. / Comportamiento y patrones de demanda de consultas por afección renal en el IMSS, 2011-2020.

Background: Mortality from Chronic Kidney Disease (CKD) has increased particularly in the Americas, the trend of wich could also be observed in Mexico, mainly due to the magnitude that Diabetes Mellitus and Arterial Hypertension have reached as the main causal factors. Objective: To examine the behavior and patterns associated with the demand for medical consultations for Kidney Disease (KD) in the IMSS during the period 2011-2020. Material and methods: According to the medical consultations for KD, general and adjusted rates were estimated by year and population assigned to first-level medical unit (UMF). Through geographic information systems and spatial statistics, the magnitude, behavior and patterns associated with the estimated indicators were analyzed. Results: From 2011 to 2020, the demand for KD medical consultations increased 45.8%; the behavior was unusually higher only in 1 out of 5 UMF (p < 0.05), up to 550.2 medical consultations per 1000 persons, wich were located mainly in Jalisco, Veracruz and Chiapas. The unusually higher pattern for medical consultations (p < 0.05) was observed in the same areas during each year of study. Conclusions: The demand for medical consultations by KD has increased in IMSS and has been significantly higher in UMF located in the west, east and southeast border of Mexico, which could indicate endemic areas of KD and require the development of epidemiological research to elucidate the causality of the disease.

Introducción: la mortalidad por enfermedad renal crónica (ERC) ha aumentado particularmente en las Américas, tendencia que también podría observarse en México, principalmente por la magnitud que han alcanzado la diabetes mellitus y la hipertensión arterial como principales factores causales. Objetivo: examinar el comportamiento y los patrones asociados a la demanda de consultas otorgadas por afección renal (AR) en el IMSS durante el periodo 2011-2020. Material y métodos: según las consultas otorgadas por AR se estimaron tasas generales y ajustadas por año y población adscrita a las unidades de medicina familiar (UMF). Mediante sistemas de información geográfica y estadística espacial se analizó la magnitud, comportamiento y patrones asociados a los indicadores estimados. Resultados: de 2011 a 2020 la demanda de consultas por AR en las UMF del IMSS aumentó 45.8%; el comportamiento fue atípicamente alto solo en 1 de cada 5 UMF (p < 0.05), hasta 550.2 consultas por mil derechohabientes, localizadas principalmente en Jalisco, Veracruz y Chiapas. El patrón de demanda de consultas atípicamente alto (p < 0.05) se observó en las mismas zonas durante cada año de estudio. Conclusiones: la demanda de consultas otorgadas por AR en el IMSS ha aumentado y ha sido significativamente mayor en UMF localizadas en el occidente, oriente y frontera sureste de México, lo cual podría indicar zonas endémicas de AR y, además, requerir el desarrollo de investigación epidemiológica para dilucidar la causalidad del padecimiento.

[PRIISMA Project: Transformation into a more preventive, resilient, comprehensive, innovative, sustainable, modern and accessible IMSS]. / Proyecto PRIISMA: transformación hacia un IMSS más preventivo, resiliente, integral, innovador, sostenible, moderno y accesible.

Two years after the onset of the COVID-19 pandemic, the Mexican Institute for Social Security (IMSS, according to its initials in Spanish) rethought new projects focused on the new needs of the population and social security organizations and institutions. The Institute, as a cornerstone in the search for the wellbeing of Mexicans, aligned with the National Development Plan and the Strategic Health for Wellbeing Program, sought to direct its transformation towards a preventive, resilient, comprehensive, innovative, sustainable, modern and accessible IMSS. For this reason, the Medical Services Director designed the PRIISMA Project, as the one that over the next three years could make possible to innovate and improve its medical care processes, starting with the recovery of medical services and identifying those groups of beneficiaries who experience the most vulnerable circumstances. The PRIISMA project consisted of five sub-projects: 1. Vulnerable groups; 2. Efficient and effective care; 3. Prevent IMSS plus; 4 IMSS University and 5. Recovery of medical services. The strategies of each project seek to improve medical care for all IMSS beneficiaries and users with a human rights perspective and by priority groups; the goal is reducing the gaps in access to health care, leaving no one behind and leaving no one out; and to surpass the goals for medical services provided before the pandemic. This document provides an overview of strategies and progress of the PRIISMA sub-projects achieved during 2022.

Después de dos años del inicio de la pandemia por COVID-19, el Instituto Mexicano del Seguro Social (IMSS) se replanteó nuevos proyectos enfocados a las nuevas necesidades de la población y de las organizaciones e instituciones de salud y seguridad social. El Instituto, como piedra angular de la búsqueda del bienestar de las mexicanas y mexicanos, alineado al Plan Nacional de Desarrollo y al Programa Estratégico de Salud para el Bienestar, buscó dirigir su transformación hacia un IMSS más preventivo, resiliente, integral, innovador, sostenible, moderno y accesible. Por ello la Dirección de Prestaciones Médicas diseñó el Proyecto PRIISMA, el cual durante los próximos tres años permitirá innovar y mejorar sus procesos de atención médica, comenzando con la recuperación de los servicios médicos y la identificación de aquellos grupos de derechohabientes que experimentan mayores circunstancias en situación de vulnerabilidad. El Proyecto PRIISMA está constituido por cinco subproyectos: 1) grupos en situación de vulnerabilidad; 2) atención eficiente y eficaz; 3) PrevenIMSS más; 4) Universidad IMSS, y 5) recuperación de servicios médicos. Las estrategias de cada proyecto buscan mejorar la atención médica de todos los derechohabientes y usuarios del IMSS con perspectiva de derechos humanos y por grupos prioritarios; se trata de reducir las brechas para el acceso a la salud sin dejar a nadie atrás y a nadie fuera; además, con ellas se busca superar las metas de atención de servicios médicos otorgados antes de la pandemia. El presente documento da a conocer los porqués, las estrategias y los avances de los subproyectos PRIISMA logrados durante el 2022.

[The need for paradigm change in maternal care: AMIIMSS model, scopes and challenges]. / La necesidad de un cambio de paradigma en atención materna: Modelo AMIIMSS, alcances y retos.

Undoubtedly, great advances have been made in terms of maternal and infant morbidity and mortality. However, in Mexican Social Security System, the quality of maternal care is questionable, as reflected in proportions of cesarean births three times higher than those recommended by WHO, abandonment of exclusive breastfeeding and the fact that up to one in three women is a victim of abuse during delivery. Given this, the IMSS decides to implement the model called Integral Maternal Care AMIIMSS, focused on users experience and based on friendly obstetric care, along different stages of the reproductive process. Four pillars underpin the model, women's empowerment, infrastructure adaptation, training and adaptation of processes and standards. Although there are advances, with 73 pre-labor rooms enabled and 14,103 friendly attentions granted, there are pending tasks and challenges. In terms of empowerment, the birth plan needs to be included as an institutional practice. In terms of infrastructure adequacy, a budget is required to build and adapt friendly spaces. In addition, it is necessary to update the staffing tables and include new categories, for an adequate operation of the program. On training, the adaptation of academic plans for doctors and nurses is pending. In terms of processes and regulations, there is a lack of qualitative evaluation of the impact of the program on people's experience and satisfaction and elimination of obstetric violence.

Sin duda, se han logrado grandes avances en materia de morbimortalidad materno-infantil. Sin embargo, la calidad de la atención en las instituciones de seguridad social es cuestionable, tal como lo reflejan las proporciones de nacimientos mediante cesárea al triple de lo recomendado por la OMS, el abandono en la lactancia materna y el hecho que hasta una de cada tres mujeres es víctima de maltrato durante la atención. Ante esto, el IMSS ha decidido implementar el modelo denominado Atención Materna Integral AMIIMSS, centrado en las personas usuarias y con sustento en la atención obstétrica amigable, que abarca distintas etapas. Cuatro pilares sustentan al modelo: empoderamiento de la mujer, adaptación de la infraestructura, capacitación y adecuación de procesos y normas. Si bien hay avances, con 73 salas de prelabor habilitadas y 14,103 atenciones amigables otorgadas, hay retos y desafíos por vencer. En materia de empoderamiento, falta incluir el plan de parto como una práctica institucional. En cuanto a adecuación de infraestructura, se requiere presupuesto para construir y adecuar espacios amigables. Además, es necesaria la actualización de las plantillas de personal e inclusión de nuevas categorías para una adecuada operación del programa. Sobre capacitación, está pendiente la adecuación de planes formativos de médicos y enfermeras. En materia de procesos y normatividad, falta evaluación cualitativa del impacto sobre la experiencia y la satisfacción de las personas y la eliminación de la violencia obstétrica.

[Geographic analysis of diabetic nephropathy and renal insufficiency in the primary care, IMSS 2019]. / Análisis geográfico de nefropatía diabética e insuficiencia renal en el primer nivel de atención, IMSS 2019.

Background: In a context where the prevalence of Diabetes Mellitus and Hypertension has increased significantly in recent years, kidney diseases become important for the potential demand for specialized health care and resources required. Objective: To analyze the geographical distribution of Diabetic Nephropathy (DN) and Renal Insufficiency (RI) based on the medical consultations given in first-level units of IMSS during 2019, to identify the medical units with the highest burden of care. Material and methods: Ecological-exploratory study in which indicators were estimated for every thousand persons in relation to medical consultations given by ND and RI according to service time, first-level medical unit (UMF) and representation to analyze the magnitude and geographic distribution at the national level. Results: 45% of medical consultations were by ND and 52.4% by RI. The highest burden per DN was registered in UMF No. 50 Cd. Juarez (Chihuahua) and No. 49 Gabino Barreda (Veracruz Sur), with 1.7 first-time medical consultations and 148.3 subsequent medical consultations per 1,000 persons, respectively. While in UMF No. 40 Manlio Fabio Altamirano and No. 25 Cotaxtla, in Veracruz Norte, the highest burden was for RI, with 4.9 first-time medical consultations and 134.2 subsequent medical consultations per 1000 persons, respectively. Conclusions: The results could contribute to strengthening of medical units where it is necessary and the efficient allocation of resources available to meet the demand for health services of ND and RI in IMSS.

Introducción: en un contexto donde la prevalencia de diabetes mellitus e hipertensión arterial ha aumentado significativamente en años recientes, las enfermedades renales adquieren importancia por la potencial demanda de atención especializada y de recursos en salud que requieren. Objetivo: analizar la distribución geográfica de la nefropatía diabética (ND) y la insuficiencia renal (IR) con base en las consultas otorgadas en unidades de primer nivel del Instituto Mexicano del Seguro Social (IMSS) durante 2019, para identificar las unidades médicas con mayor carga de atención. Material y métodos: estudio ecológico-exploratorio en el que se estimaron indicadores por cada mil derechohabientes en relación a las consultas otorgadas por ND e IR según la ocasión de servicio, la unidad médica familiar (UMF) de primer nivel y la representación. Se utilizó estadística espacial para analizar dichos indicadores. Resultados: el 45% de las consultas otorgadas fue por ND y el 52.4% por IR. La mayor carga por ND se registró en la UMF No. 50 de Cd. Juárez (Chihuahua) y en la No. 49 Gabino Barreda (Veracruz Sur), con 1.7 consultas de primera vez y 148.3 subsecuentes por mil derechohabientes, respectivamente. Mientras que en la UMF No. 40 Manlio Fabio Altamirano y No. 25 Cotaxtla, en Veracruz Norte, la mayor carga fue por IR, con 4.9 consultas de primera vez y 134.2 subsecuentes por mil derechohabientes, respectivamente. Conclusiones: los resultados podrían contribuir al fortalecimiento de las unidades médicas que así lo requieran y en la distribución eficiente de los recursos disponibles para atender la demanda de servicios de salud de ND e IR en el IMSS.

[Infarction Code care protocol, towards the federalization of IMSS Bienestar]. / Protocolo de atención Código Infarto, hacia la federalización de IMSS Bienestar.

Since 2015, the Instituto Mexicano del Seguro Social (IMSS) has developed and implemented the Infarct Code emergency care protocol, with the aim of improving the diagnosis and treatment of acute myocardial infarction and thus eventually reducing mortality. In the context of the federalization and implementation of the new IMSS Bienestar care model in several states, the possibility of increasing the coverage and extension of the protocol service networks is presented, not only to eligible population but also to those who do not have social security and resides in contexts of social marginalization, to comply with article 4o. constitutional. This document describes how the proposal was made to extend and increase the service network of the Infarct Code care protocol, based on material, human and infrastructure resources of the IMSS Ordinario and Bienestar.

En el Instituto Mexicano del Seguro Social (IMSS) desde el 2015 desarrolló e implementó, el protocolo de atención de urgencias Código Infarto, con el objetivo de mejorar el diagnóstico y tratamiento del infarto agudo de miocardio y así reducir, eventualmente, la mortalidad. En el contexto de la federalización e implementación del nuevo modelo de atención IMSS-Bienestar en varias entidades federativas, se presenta la posibilidad de incrementar la cobertura y extensión de las redes de servicios del protocolo, no solo a población derechohabiente sino también a aquella que no cuenta con seguridad social, capacidad contributiva y reside en contextos de marginación social, para con ello dar cumplimiento al artículo 4º Constitucional. En este documento se describe cómo se realizó la propuesta para extender e incrementar la red de servicios del protocolo de atención Código Infarto, haciendo uso de recursos materiales, humanos y de infraestructura del IMSS Ordinario y Bienestar.

[PREVENIMSS: a brief overview of its 20 years, challenges and opportunities]. / PREVENIMSS: un breve recorrido de sus 20 años, retos y oportunidades.

Twenty years after its launch, the most ambitious preventive program implemented at the institutional level in Mexico called PREVENIMSS focuses on new challenges and moves towards relaunching. This paper reviews the foundations and design of PREVENIMSS and its evolution throughout these two decades. The PREVENIMS coverage assessment through national surveys set a relevant precedent in evaluating programs at the Mexican Institute of Social Security. PREVENIMSS has shown progress in preventing vaccine-preventable diseases. However, given the current epidemiological profile, there is still a need to provide more effective primary and secondary prevention of chronic noncommunicable diseases. New digital resources and orientation of PREVENIMSS towards a more comprehensive approach that contemplates secondary prevention and rehabilitation can help to face the growing challenges that the program still faces.

A 20 años de su lanzamiento, el programa preventivo más ambicioso implementado a nivel institucional en México llamado PREVENIMSS se enfoca en nuevos desafíos y avanza hacia el relanzamiento. Este artículo hace un breve recorrido de sus fundamentos, diseño y evolución a lo largo de estas dos décadas. La estimación de las coberturas de PREVENIMSS a través de encuestas nacionales también marcó un precedente en la evaluación de programas en el Instituto Mexicano del Seguro Social. PREVENIMSS ha mostrado avances en prevención de enfermedades prevenibles por vacunación, pero aún existe la necesidad de brindar prevención primaria y secundaria más efectivos de las enfermedades crónicas no transmisibles ante el perfil epidemiológico actual. Nuevos recursos digitales y la orientación hacia un enfoque más integral que contemple la prevención secundaria y la rehabilitación pueden ayudar a enfrentar los crecientes desafíos que aún enfrenta el programa.

[Systematization of a comprehensive intervention for strengthening the COVID-19 medical care]. / Sistematización de una intervención gerencial integral para fortalecer la atención médica por COVID-19.

The COVID-19 pandemic established a new challenge for health services in Mexico, which is why these services faced the challenge of responding to the affected people, by providing them services with opportunity, efficiency, effectiveness and safety. The Instituto Mexicano del Seguro Social (IMSS, Mexican Institute for Social Security) gave medical attention to the larger number of affected people: towards the end of September, 2022, 3,335,552 patients were registered, who represented 47% of the total (7,089,209) of confirmed COVID-19 cases since the beginning of the pandemic in 2020. Of all the cases treated, 295,065 (8.8%) required hospitalization. In addition of new scientific evidence and the implementation of best practices in medical care and directive management (with the general objective of improvement of the processes in hospital attention, even without an effective treatment at the time), we presented an evaluation, supervision method with a comprehensive (involving the three levels of health services) and analytic (structure, process, result and directive management components) approach. The achievement of specific goals and lines of action was established in a technical guideline with health policies for the COVID-19 medical care. These guidelines were instrumented with a standardized evaluation tool, a result dashboard and a risk assessment calculator, improving the quality of medical care and directive management by the multidisciplinary health team.

La pandemia por COVID-19 puso a prueba la prestación de servicios de los sistemas de salud en México, por lo que estos enfrentaron el reto de responder a la necesidad de las personas afectadas al otorgar servicios oportunos, eficientes, eficaces y seguros. El Instituto Mexicano del Seguro Social (IMSS) atendió el mayor número de personas afectadas: al cierre de septiembre del 2022, se registraron 3,335,552 pacientes atendidos, quienes representaron 47% del total (7,089,209) de casos confirmados desde el inicio de la pandemia en 2020. De los casos notificados por el IMSS, 295,065 (8.8%) requirieron hospitalización. Mediante un atento seguimiento de la evolución de la evidencia científica (que permitió identificar y adoptar las mejores prácticas de atención médica y gestión directiva para fortalecer los procesos sustantivos en la atención hospitalaria, aun sin un tratamiento eficaz), se integró un método de evaluación, supervisión y asesoría, con enfoque integral (que involucró los tres niveles de atención médica) y analítico (componentes de estructura, proceso, resultado y gestión directiva). Los objetivos de la atención y las líneas de acción se describieron en una guía técnica que estableció las políticas de atención médica al COVID-19. Asimismo, fue instrumentado con una cédula de evaluación estandarizada, un tablero de control de resultados y una herramienta de estratificación del riesgo. Con ello se mejoró la calidad de atención por medio de la participación del personal directivo y de equipos multidisciplinarios de salud, los cuales permitieron la toma de decisiones clínicas y gerenciales.

[Mental health: relevance of the problem, strategies and challenges to face in IMSS]. / Salud mental: relevancia del problema, estrategias y retos que afrontar en el IMSS.

In the context of the 80th anniversary of the Instituto Mexicano del Seguro Social (IMSS), there are several health problems and challenges to be faced in relation to user population, which currently represents 42% of Mexico´s population. Among these issues, once five waves of COVID-19 infections have passed and mortality rates have decreased, mental and behavioral disorders stand out as a re-emerging and priority problem. In response to this, in 2022 the Mental Health Comprehensive Program (MHCP, 2021-2024) materialized, which represents, for the first time, the opportunity to provide health services that address mental disorders and addictions of user´s population IMSS, under the Primary Health Care model. That is, prioritizing health promotion, risk factors prevention, screening, timely diagnosis, and not just hospitalization and drug supply. Among the MHCP strategies, which motivated the writing of this document, we highlight the availability of reliable data, through the census of mental and behavioral disorders, related to important characteristics in terms of population, state, hospital, prevalence of disorders, in order to act accordingly through the infrastructure and human resources available at the IMSS, with emphasis on the first level of care.

En el contexto del 80 aniversario del Instituto Mexicano del Seguro Social (IMSS), son varios los problemas de salud y retos que afrontar en relación con la población derechohabiente, que en la actualidad representa aproximadamente el 42% de los habitantes en México. Entre éstos, una vez que han transitado cinco olas de contagios por COVID-19 y disminuido los índices de mortalidad, destacan los trastornos mentales y del comportamiento como problema re-emergente y prioritario. En atención a ello, en el 2022 se materializó el Programa Integral de Salud Mental del IMSS 2021-2024 (PISM-IMSS), lo que representa, por primera vez, la oportunidad de proporcionar servicios de salud que atiendan los problemas de salud mental y adicciones de la población derechohabiente, bajo el modelo de Atención Primaria de la Salud. Esto es, priorizando la promoción de la salud, prevención de factores de riesgo, tamizaje, diagnóstico oportuno, y no sólo la hospitalización y suministro de fármacos. Entre las estrategias del PISM-IMSS, que motivaron la redacción de este documento, destacamos la disponibilidad de datos confiables, a través del censo de trastornos mentales y del comportamiento, relacionados con importantes características en cuanto a la población, representación, unidad médica, prevalencias de trastornos, para así actuar en consecuencia mediante la infraestructura y recursos humanos disponibles en el IMSS, con énfasis en el primer nivel de atención.