[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.

Analysis of the Internal Marketing Dimensions in Social Economy Organizations: Study Applied to Co-operativism in Ecuador.

Internal marketing involves the development of organizational strategies that promote the welfare of the employees who, in turn, play a transcendental role in achieving institutional goals. Ecuadoran co-operativism lacks relevant studies of this construct and, because of this, this research intends to analyze the dimensions of internal marketing, through the validation of a measuring instrument that has been adapted to this sector of the social economy, in a developing country. The methodology is based on the completion of field work, where a structured questionnaire for a representative sample of 2,499 employees and officers of the operatives of Ecuador was applied. The suitability of the scale was determined through the means of a model of Ecuadoran structural equations. The results show that internal marketing is a multi-dimensional construct and it can be measured in six dimensions: Identify Value Exchange (IVE), Internal Market Segmentation (IMS), Internal Communication (IC), Management Concern (MC), Training (TR), and Work/Family Balance (WFB).

EAU Guidelines on Assessment and Nonsurgical Management of Urinary Incontinence.

CONTEXT: The European Association of Urology guidelines on urinary incontinence (UI) have been updated in cyclical fashion with successive major chapters being revised each year. The sections on assessment, diagnosis, and nonsurgical treatment have been updated as of mid-2016. OBJECTIVE: We present a condensed version of the full guideline on assessment and nonsurgical management of UI, with the aim of improving accessibility and increasing their dissemination. EVIDENCE ACQUISITION: Our literature search was updated from the previous cut-off of July 2010 up to April 2016. Evidence synthesis was carried out by a pragmatic review of current systematic reviews and any newer subsequent high-quality studies, based on Population, Interevention, Comparator, and Outcome questions. Appraisal was conducted by an international panel of experts, working on a strictly nonprofit and voluntary basis, to develop concise evidence statements and action-based recommendations using modified Oxford and GRADE criteria. EVIDENCE SYNTHESIS: The guidelines include algorithms that summarise the suggested pathway for standard, uncomplicated patients with UI and are more useable in daily practice. The full version of the guideline is available at http://uroweb.org/guideline/urinary-incontinence/. CONCLUSIONS: These updated guidelines provide an evidence-based summary of the assessment and nonsurgical management of UI, together with a clear clinical algorithm and action-based recommendations. Although these guidelines are applicable to a standard patient, it must be remembered that therapy should always be tailored to individual patients' needs and circumstances. PATIENT SUMMARY: Urinary incontinence is a very common condition which negatively impacts patient's quality of life. Several types of incontinence exist and since the treatments will vary, it is important that the diagnostic evaluation establishes which type is present. The diagnosis should also identify patients who need rapid referral to an appropriate specialist. These guidelines aim to provide sensible and practical evidence-based guidance on the clinical problem of urinary incontinence.

EAU guidelines on assessment and nonsurgical management of urinary incontinence.

CONTEXT: The previous European Association of Urology (EAU) guidelines on urinary incontinence comprised a summary of sections of the 2009 International Consultation on Incontinence. A decision was made in 2010 to rewrite these guidelines based on an independent systematic review carried out by the EAU guidelines panel, using a sustainable methodology. OBJECTIVE: We present a short version of the full guidelines on assessment, diagnosis, and nonsurgical treatment of urinary incontinence, with the aim of increasing their dissemination. EVIDENCE ACQUISITION: Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches, based on Population, Intervention, Comparator, Outcome questions. Appraisal of papers was carried out by an international panel of experts, who also collaborated on a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system. EVIDENCE SUMMARY: The full version of the guidelines is available online (http://www.uroweb.org/guidelines/online-guidelines/). The guidelines include algorithms that refer the reader back to the supporting evidence, and they are more immediately useable in daily clinical practice. CONCLUSIONS: These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where such evidence does not exist, they present a consensus of expert opinion.

Are all metabolic syndrome components responsible for penile hemodynamics impairment in patients with erectile dysfunction? The role of body fat mass assessment.

INTRODUCTION: Erectile dysfunction (ED) is a common disease that is mostly vasculogenic in nature. ED correlates with cardiovascular risk factors, with endothelial dysfunction being the common link. Hypertension (HTA) and insulin resistance are the most important determinants of arteriogenic ED, and are also components of the metabolic syndrome (MetS), which supports a strong association between MetS and ED. However, MetS and, specifically, obesity interference on penile hemodynamics is still controversial. AIM: To evaluate the impact of independent MetS criteria and obesity on penile duplex Doppler ultrasound (PDDU) parameters in men with ED. METHODS: Consecutive patients (n = 212) referred to a unit of PDDU were evaluated for cardiovascular risk factors and MetS (ATP III criteria). Body mass index and body fat percentage (BF%) were calculated. Each patient underwent a PDDU by the same investigator. Data are expressed as mean ± standard deviation, and statistical significance was considered at P level < 0.05. Statistical analysis of clinical, laboratory, and PDDU parameters was performed with SPSS® software. MAIN OUTCOME MEASURES: To evaluate the individual power of MetS clusters and obesity as predictive factors for penile hemodynamic changes namely mean peak systolic velocity (mPSV). RESULTS: MetS was present in 24.8% of men, and 80.8% of them presented penile hemodynamics alterations, with mPSV significantly lower comparatively to no MetS patients (29.0 vs. 35.4 cm/s, P = 0.004). Multivariate analysis demonstrated that, considering all MetS parameters, only HTA was significantly associated with diminished mPSV. However, after further adjustment for all cardiovascular risk factors, BF% remained the sole independent clinical factor for penile hemodynamics impairment. CONCLUSIONS: There is a strong association between MetS and ED, but within MetS criteria, only HTA was independently associated with the deterioration of penile hemodynamics parameters. Although the classical methods of evaluating obesity in MetS were not individually associated with PDDU impairment, BF% represented by itself an excellent predictor of vascular ED.

Short-term assessment of a tension-free vaginal tape for treating female stress urinary incontinence.

OBJECTIVE: To evaluate the short-term surgical complications and results of a tension-free vaginal tape (TVT) system (TVT-Secur, Gynecare, Ethicon, Somerville, NJ, USA) in the treatment of female stress urinary incontinence (SUI). PATIENTS AND METHODS: TVT-Secur was applied to 107 women with SUI through a vaginal incision and left abutting the urethra. Postoperative pain, complications, de novo lower urinary tract symptoms, incontinence cure rate and the King's Health Questionnaire (KHQ) score were evaluated. RESULTS: The operative duration was 12 min; the mean pain score was 2.3 and only one patient had transient voiding difficulties. After a mean follow-up of 15 months, 71% of the patients were dry and 14% improved. The KHQ scores decreased significantly for most subscores. Urgency appeared de novo in six patients (5.6%), and vaginal erosion required one TVT-Secur explantation. CONCLUSION: This study shows that TVT-Secur is a simple and safe treatment for female SUI, but before recommending this sling as a first choice for treating SUI, TVT-Secur must pass the test of time and comparative studies with conventional slings.

Cirugía craneofacial: resultados, costo-beneficio y calidad de vida / Craniofacial surgery. Results: cost-efficiency and quality of life

Antecedentes: La cirugía craneofacial tiene por objeto la exéresis completa de todos los tumores que en forma presunta o confirmada invaden la base del cráneo, ya sea por una lesión facial que progrese en sentido craneal o de un tumor encefálico que lo haga caudalmente. Objetivo: Comunicar resultados, costo-beneficio y calidad de vida alcanzada. Lugar de aplicación: Hospital público terciario especializado en el tratamiento de tumores. Diseño: Prospectivo. Población: 42 operaciones en 39 enfermos, 61 por ciento masculinos. La localización fue mayor en seno maxilar y etmoides. La patología fue maligna en el 94,8 por ciento. El 35,9 por ciento era virgen de tratamiento. Método: Cirugía sólo del primario en 90,4 por ciento, extendida a órbita en el 30,9 por ciento y al cuello en el 9,5 por ciento. En el 69 por ciento fueron anteriores y en el resto laterales. En 17 operaciones fue necesario algún procedimiento reconstructivo de partes blandas. Resultados: Se produjeron complicaciones en el 59,5 por ciento. La más frecuente fue la supuración local, seguida de la pérdida de LCR. El 50 por ciento de la muestra tuvo la posibilidad de estar vivo a los 27,5 meses. Los costos alcanzaron una media de $4698. La calidad de vida mejoró en el 55 por ciento. Conclusiones: La cirugía craneofacial es un procedimiento sencillo, económico, seguro y efectivo para tratar estos enfermos

Factores que inciden en el rendimiento del alumno de medicina / Factors that can improve the performance of students from medical schools

El objetivo de este trabajo es determinar el perfil del alumnado de Medicina de la Universidad de buenos Aires y los factores personales que estadísticamente modifican su rendimiento...El resultado fue que el perfil de la población que estudia medicina en la UBA es joven, soltero, no trabaja, domina otros idiomas e informática.A medida que pasan los años por encima de los 25, se observó un marcado alargamiento de los años de la carrera y No. de aplazos. Esta situación se vió agravada en el sexo masculino, los alumnos casados, con hijos y trabajando para sostener sus estudios.Como conclusión, el cumplimiento exitoso de la carrera de Medicina depende de la edad <25 años, el estado civil y el sostén económico.Sin embargo, la crisis de la enseñanza no es un problema sencillo. compromete a docentes, alumnos y medios en que se dicta