Evaluation of effective coverage for type 2 diabetes in Mexican primary care health information systems: a retrospective registry analysis.

BACKGROUND: As the leading cause of disability and the fourth leading cause of premature death in Mexico, type 2 diabetes (T2D) represents a serious public health concern. The incidence of diabetes has increased dramatically in recent years, and data from the Mexican National Health and Nutrition Survey (ENSANUT) indicate that many people remain undiagnosed. Persistent socioeconomic health care barriers exacerbate this situation, as T2D morbidity and mortality are worsened in vulnerable populations, such as those without social security. We evaluated the performance of public primary health centers (PHCs) in T2D medical attention through the measure of effective coverage (EC, a combined measure of health care need, use, and quality) at national, state, health jurisdiction, and municipality levels. METHODS: This retrospective analysis used blinded data recorded during 2017 in the Non-communicable Diseases National Information System (SIC) and T2D prevalence reported in 2018 ENSANUT to evaluate the EC achieved. We included individuals ≥ 20 years old without social security who did not declare the use of private health care services. Each EC component (need, use, and quality) was estimated based on the Shengelia adapted framework. The Kruskal-Wallis test was applied to evaluate the associations among EC quintiles and demographics. RESULTS: In 2017, 26.5 million individuals, aged ≥ 20 years, without social security, and without the use of private health care services, were under the care of 12,086 PHCs. The national prevalence of T2D was 10.3%, equivalent to 2.6 million people living with T2D in need of primary health care. Large contrasts were seen among EC components between and within Mexican states. We found that only 37.1% of the above individuals received health services at PHCs and of them, 25.8% improved their metabolic condition. The national EC was 9.3%, and the range (by health jurisdiction) was 0.2%-38.6%, representing a large geographic disparity in EC. We found an evident disconnect among need, utilization, and quality rates across the country. CONCLUSIONS: Expansion and improvement of EC are urgently needed to address the growing number of people living with T2D in Mexico, particularly in states with vulnerable populations.

Periannular extension of infective endocarditis.

OBJECTIVES: This prospective study was designed to assess the current clinical course, risk factors, microbiologic profile and echocardiographic findings of patients with left-sided endocarditis and perivalvular complications. BACKGROUND: Periannular complications worsen the prognosis of patients with endocarditis. The relation between these complications and the clinical and microbiologic data has not been clearly defined. METHODS: In this clinical cohort study, 211 patients with left-sided endocarditis, according to the Duke criteria, were prospectively recruited. All patients underwent conventional and transesophageal echocardiography. The mean follow-up interval was 151 days. RESULTS: Perivalvular complications were detected in 78 patients (37%). The incidence of periannular extension of infection in native and prosthetic valves was 29% and 55%, respectively. The presence of prosthesis (relative risk [RR] 1.88, 95% confidence interval [CI] 1.35 to 2.64) and previous endocarditis (RR 1.78, 95% CI 1.16 to 2.7) were the only pre-existing heart conditions associated with perivalvular complications. Aortic infection (RR 1.8, 95% CI 1.23 to 2.66) and the development of atrioventricular (AV) block (RR 2.55, 95% CI 1.91 to 3.41) were related with the existence of these complications. Coagulase-negative staphylococci were very common in patients with perivalvular complications (RR 1.77, 95% CI 1.21 to 2.59), and small vegetations were more frequent in these patients (RR l.45, 95% CI 0.95 to 2.22). An operation was more frequently performed in patients with perivalvular complications, but mortality was similar in patients with and without these complications. CONCLUSIONS: Aortic infection, prosthetic endocarditis, new AV block and coagulase-negative staphylococci were independent risk factors of periannular complications. The period between symptom onset and diagnosis, the incidence of pericardial effusion and persistent signs of infection were similar between patients with and without perivalvular complications. Patients with perivalvular complications did not demonstrate a difference in the presence or size of vegetations or the frequency of embolism. An operation was more frequently performed in these patients, but mortality was similar in both groups.

Improving perinatal care in the rural regions worldwide by wireless enabled antepartum fetal monitoring: a demonstration project.

Background. Fetal and neonatal morbidity and mortality are significant problems in developing countries; remote maternal-fetal monitoring offers promise in addressing this challenge. The Gary and Mary West Health Institute and the Instituto Carlos Slim de la Salud conducted a demonstration project of wirelessly enabled antepartum maternal-fetal monitoring in the state of Yucatán, Mexico, to assess whether there were any fundamental barriers preventing deployment and use. Methods. Following informed consent, high-risk pregnant women at 27-29 weeks of gestation at the Chemax primary clinic participated in remote maternal-fetal monitoring. Study participants were randomized to receive either prototype wireless monitoring or standard-of-care. Feasibility was evaluated by assessing technical aspects of performance, adherence to monitoring appointments, and response to recommendations. Results. Data were collected from 153 high-risk pregnant indigenous Mayan women receiving either remote monitoring (n = 74) or usual standard-of-care (n = 79). Remote monitoring resulted in markedly increased adherence (94.3% versus 45.1%). Health outcomes were not statistically different in the two groups. Conclusions. Remote maternal-fetal monitoring is feasible in resource-constrained environments and can improve maternal compliance for monitoring sessions. Improvement in maternal-fetal health outcomes requires integration of such technology into sociocultural context and addressing logistical challenges of access to appropriate emergency services.

Radiation therapy of early vocal cord carcinoma stage T1N0 twenty-one years' experience at Isaac González Martínez Oncologic Hospital

Se llevó a cabo un análisis detallado retrospectivo de 72 pacientes con cáncer de cuerda vocal estádio T1N0M0 tratados en el Departamento de Radioterapia del Hospital Oncológico Isaac González Martínez en San Juan, Puerto Rico desde enero de 1960 hasta diciembre de 1980. La edad de la mayoría de los pacientes fluctuaba de 50 a 79 años y el 88% eran varones. Todos los pacientes tuvieron un periodo de seguimiento mínimo de cinco años. La sobrevida global a cinco años fue de un 86% . Trece pacientes tuvieron recidiva local del tumor de los cuales diez fueron rescatados mediante cirugía. El control local final fue de un 96% . El tiempo medio para recidiva fue de 25 meses. Se diagnosticaron segundos tumores primarios en 12 pacientes durante el seguimiento. Los resultados de este estudio confirman el valor de la radioterapia como modalidad de tratamiento primário para el cáncer temprano de las cuerdas vocales ofreciendo una excelente curabilidad y preservación de la voz

Estudio descriptivo longitudinal-retrospectivo de las gestantes inscritas al programa de salud familiar del Barrio Horizontes: enero 1 a diciembre 31 de 1988 / Descriptive study of pregnants of the family health program: Jan-Dec 1988

Se realizó un estudio descriptivo longitudinal retrospectivo de las gestantes del programa de Salud Familiar en el barrio Horizontes de Bogotá, a las 416 familias inscritas en 1988, se les realizó una primera encuesta con lo que se obtuvo un universo de 81 embarazos, con esto se llevó a cabo una segunda encuesta para determinar y analizar las características de las gestantes: esta información se obtuvo mediante la revisión de la historia clínica y una visita familiar. Entre las variables analizadas en las encuestas estan: la edad en el momento del embarazo, paridad, estado civil, escolaridad, planificación familiar, deseo del embarazo, antecedenes tóxicos, terminación del embarazo anterior, causa subjetiva de muerte, atención del parto y patologías durante el embarazo. Entre los datos mas relevantes del estudio se encontró una tasa de embarazo elevada (190 por ciento) con respecto a datos en estudios nacionales, pero un estudio similar con el obtenido en el año 1987 en otro estudio realizado en la misma población