[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.

Infection and death by COVID-19 in a cohort of healthcare workers in Mexico.

OBJECTIVE: This study aimed to estimate the risk of SARS-Cov2 infection and severe COVID-19 among healthcare workers from a major social security system. METHODS: This study actively followed a cohort of social security workers from March to December 2020 to determine the number of laboratory-confirmed symptomatic cases, asymptomatic associated contacts and COVID-19-associated hospitalizations and deaths. Workers were classified into those providing direct care to infected patients (COVID teams), other active healthcare workers (OAHCW), and workers under home protection (HPW). The number of cases and rates were also estimated by job category. RESULTS: Among a total of 542 381 workers, 41 461 were granted stay-at-home protection due to advanced age or comorbidities. Among the 500 920 total active workers, 85 477 and 283 884 were classified into COVID teams and OAHCW, respectively. Infection rates for COVID teams, OAHCW, and HPW were 20.1% [95% confidence interval (CI) 19.8-20.4], 13.7% (95% CI 15.0-15.3), and 12.2% (95% CI 11.8-12.5), respectively. The risk of hospitalization was higher among HPW. COVID teams had lower mortality rate per 10 000 workers compared to HPW (5.0, 95% CI 4.0-7.0 versus 18.1, 95% CI 14.0-23.0). Compared to administrative workers, ambulance personnel (RR 1.20; 95% CI 1.09-1.32), social workers (RR 1.16; 95% CI 1.08-1.24), patient transporters (RR 1.15; 95% CI 1.09-1.22) and nurses (RR 1.13; 95% CI 1.10-1.15) had a higher risk of infection after adjusting for age and gender. Crude differences in mortality rates were observed according to job category, which could be explained by differences in age, sex, and comorbidity distribution. Diabetes, obesity, hypertension, hemolytic anemia, and HIV were associated with increased fatality rates. CONCLUSIONS: COVID team workers had higher infection rates compared to the total population of active workers and HPW. Doctors had lower risk of infection than respiratory therapists, nurses, and patient transporters, among whom interventions should be reconsidered to reduce risks. The presence of comorbidities, such as diabetes, obesity, arterial hypertension, hemolytic anemia, and HIV, increased the likelihood of complications caused by COVID-19, culminating in a poor prognosis.