[The National Medical Arbitration Commission: 20 years]. / La Comisión Nacional de Arbitraje Médico: 20 años.

Cuando la Secretaría de Salud todavía tenía el logotipo azul que decía SSA, corrían tiempos difíciles porque no había dinero y la idea de crear nuevas instituciones era recibida con reservas, no sólo por el Presidente Zedillo, siempre generoso y atento a las necesidades de salud de la población, sino también, como ya es costumbre, por el secretario de Hacienda, responsable de cuidar el erario público. Y es que la idea de hacer crecer el gasto corriente del gobierno se percibía, no sin razón, como un acto que podía infligir el riesgo de fomentar estructuras administrativas ineficaces y obesas. No ha sido el caso de la Comisión Nacional de Arbitraje Médico (CONAMED), pues sus aproximadamente 200 trabajadores siguen realizando una labor inmensa con una estructura ligera.

[The impact of globalization on mental health]. / Impactos de la globalización en la salud mental.

Psychosis, dementias, anxiety, depression, suicide and suicide attempts, as well as psychiatric disorders associated to violence and poverty have increased the global burden of disease. Other related problems associated to special diets, body image, compulsive use of computers and mobile phones, and those frequently observed in migrants subjected to intense distress are reviewed as well. Information and communication technologies may have undesirable side effects affecting some individuals in their conduct and social interactions.

[Local impact of health global problems. Introduction]. / Problemas globales de salud de impacto local. Introducción.

During the last 3 years the National Academy of Medicine, the School of Medicine and the Ministry of Health have analyzed several global health issues with local impact. The group of articles presented in this symposium is focused on the health systems. The Mexican health system has evolved through the years facing different challenges and showing its strengths as well as several inconsistencies, flaws and limitations. The subjects analyzed deal with several alternatives to face the health challenges. All health systems are under constant change and financial resources as well as conceptual clarity, human resources, coordination, and leadership are needed.

[The future of medical investigation in Mexico]. / El futuro de la investigación médica en México.

The current situation of clinical research in Mexico is analyzed. The main findings are as follows: 10% of total number of researchers in Mexico are engaged in medical research; there is a highly centralized distribution in the Mexico City metropolitan area; there exists unequal academic development among disciplines, and there is an overwhelming number of researchers in public educational and health institutions. A substantial increase in medical publications during the last 15 years with reasonable citation impact was also found. Several urgent matters to attend were identified, such as financing problems, effect of health services descentralization completed in 1997, and the need to selectively support certain research areas such as accidents, mental health, addictions, geriatrics and chronic diseases.

El futuro de la investigación médica en México / The Future of Medical Investigation in Mexico

Se hace un análisis del estado que guarda la investigación médica en México. Destacamos el desigual desarrollo científico de las disciplinas médicas, el centralismo que prevalece en el área metropolitana y la abrumadora mayoría de los investigadores en instituciones publicas del sector salud y del educativo. Se analiza el incremento en la producción científica, en los últimos 15 años y su impacto en la literatura internacional. Concluimos que contamos con una comunidad de investigación médica productiva, aunque todavía pequeña para el país. Se señalan cuestiones urgentes de atender como: el agudo problema del financiamiento, los efectos de la descentralización de los servicios de salud y la necesidad de apoyar, por su importancia epidemiológica, áreas como las de accidentes, salud mental, adicciones, geriatría y enfermedades crónico degenerativas.

The current situation of clinical research in México is analyzed. The main findings are as follows: 10% of total number of researchers in Mexico are engaged in medical research; there is a highly centralized distribution in the Mexico City metropolitan area; there exists unequal academic development among disciplines, and there is an over whelming number of researchers in public educational and health institutions. A substantial increase in medical publications during the last 15 years with reasonable citation impact was also found. Several urgent matters to attend were identified, such as financing problems, effect of health services descentralization completed in 1997, and the need to selectively support certain research areas such as accidents, mental health, addictions, geriatrics and chronic diseases.

Responsabilidad social del médico / Physician social responsability

Las obligaciones que el médico tiene con sus pacientes no se derivan de la ideología, la historia o la sociología de la profesión ni deben estar influidas por el hecho de que la retribución por su servicio sea directa o indirecta; se derivan del impacto de la enfermedad sobre la condición humana, de la vulnerabilidad de la persona enferma, de su necesidad de ser amparada y de la naturaleza intrinseca de su relación con el médico.

Implementation and evaluation of a national external quality control program for cervical cytology in Mexico.

OBJECTIVE: To evaluate cytology laboratories and the performance of cytotechnologists for establishing efficient external quality control for Mexico's National Program for the Prevention and Control of Cervical Cancer. MATERIAL AND METHODS: During January and February 1998, an onsite evaluation of all cytology laboratories of the Ministry of Health found that only 70% of the microscopes were in adequate working conditions, reagents were out of date, and working conditions were sub-optimal. A program for external quality control based on proficiency testing was established for cytotechnologists. Fifty slide sets with 20 Papanicolaou slides and 10 photographic slides were prepared. The sets were given to the cytotechnologists for evaluation and again one year later by courier. RESULTS: Twenty-one percent of microscopes were repaired and 9% replaced; reagents were distributed and laboratory facilities improved. Only 16% of cytotechnologists passed the initial proficiency test. Cytotechnologists received a refresher training course: one year later 67% of them passed the proficiency test. To ascertain that each slide was correctly diagnosed, 41 sets were rescreened by expert cytopathologists or cytologists and their diagnoses compared to the original ones. Thirty-seven sets had 86% to 96% concordance. CONCLUSIONS: This new system for external quality control of cervical cytology allowed the opportune and reliable evaluation of the performance of cytotechnologists.