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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.
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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.
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¿Qué pasaría si tuviéramos la capacidad de enviar en un solo evento a todo un país para una revisión con el médico? ¿Qué información obtendríamos? ¿Para qué nos serviría? Lo obtenido de este maratónico esfuerzo sería crucial para saber por qué los mexicanos enfermamos y de qué enfermamos, conoceríamos más sobre cómo hacer frente a los factores [...].
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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.