[Reproducibility of a questionnaire for studying climacteric]. / Reproducibilidad de un cuestionario para el estudio del climaterio.

OBJECTIVE: This study evaluated the reproducibility of a questionnaire concerned with the clinical and epidemiological aspects of menopause. MATERIAL AND METHODS: The study population consisted of a hundred perimenopausal Mexican women seeking care at gynecology and obstetric health care services. Their participation was voluntary and they answered the same questionnaire two times with a 15-30 day lag between each application. RESULTS: The Kappa coefficient was high (0.81-1.0) for categorical variables such as: type of menstrual cycles, type of menopause, breast-feeding, use of estrogen during menopause and use of hormonal contraceptives. The Kappa coefficient was moderate (0.7-0.8) for symptoms related to menopause such as hot flashes, sweating, painful coitus, vaginal dryness and a decrease in libido. Mean differences were calculated for continuous variables such as age at menarche, age at menopause, time using estrogen and the duration of breast-feeding, the majority had a value of zero and 95% confidence intervals for these mean differences included the null value. The questionnaire also included other characteristics such as tobacco consumption and a short food frequency questionnaire, which showed high concordance (Kappa 0.7-1.0). CONCLUSIONS: The results of this study show that this questionnaire has a high level of reproducibility and can be useful as a research tool to explore menopause in Mexican women.

[Maternal-infant care as a basic instrument of medical services for the population in developing countries]. / La asistencia materno infantil, como instrumento básico de la atención médica a las ploblaciones en desarrollo.

PIP: Among the 18 million persons covered by the Mexican Institute of Social Security (IMSS) are 7 million under age 15 and 4.5 million fertile aged women. The strategy of medical attention based on the concept of risk permits the organization of health services to favor the groups most exposed to risk, who are identified and become the target of positive interventions designed to reduce risks. IMSS statistics were analyzed to identify the most frequent risks of the population under 15 and fertile aged women. The main reasons for consultations among children under 1 year were acute respiratory infections, intestinal infections, helminthiasis, bronchitis, and amoebiasis. The reasons were almost the same for older children but the order of importance was slightly altered. The 2 main causes of death of infants under 1 year and children 1-4 were intestinal infections and acute respiratory infections. Division of pregnant women into high risk and low risk categories based on well known risk factors has allowed medical care to be rationalized. High risk cases are seen more frequently. Rates of perinatal illness and death are higher in premature and low birth weight babies, those born following pathological pregnancies, and those experiencing fetal distress at any point. Medical care can modify all of these factors. Follow-up of women not attending appointments and provision of care by paramedical personnel in low risk cases can permit greater attention of the physician to high risk cases and new cases. The head of the clinical department is responsible for the quality of care and the director of the unit is responsible for quantitative aspects of service delivery. The fewest possible instructions should be given for making the risk-based strategy operational. A form with closed questions should be administered to identify risk factors in pregnant women and young children. Efforts should be made to contact a client if an appointment is missed, especially in high risk cases. Indicators should be developed for planning and evaluation. A-5 stage program of diffusion, implantation, consolidation, evaluation, and redirection was designed for IMSS maternal and child health services. The 1st phase was to be completed in 2 months, the next 3 phases would require 12 months each, and redirection would take place in the 4th year. A pilot study was organized in the Maya Peninsular Region to determine whether medical activities organized according to risk factors would improve the initial health profile. 11% of births occurring from January-September 1984 were analyzed. Rates of perinatal mortality and prematurity declined with increasing number of prenatal visits for both high risk and low risk populations. Through January 1985, only the subprogram for women had been implanted. It was expected to be consolidated in 1985 and evaluated in 1986. The child health program is expected to be implanted in 1985.^ieng

[Program for instruction in comprehensive general medicine: conceptualization and strategies for its evaluation]. / Programa de enseñanza de medicina general integral: conceptualización y estrategias para su evaluación.

This article describes the concepts and strategies underlying the evaluation of the Comprehensive General Medicine Program of the School of Medicine of the Autonomous National University of Mexico. The exact purpose of that evaluation, done in 1982, was to strengthen and redirect the lines of this program's current development, which had been conceived since its inception in 1974 as an experimental study plan based on a system of modular and tutorial instruction. The article describes the identified conceptual, methodological, logistic, operational and attitudinal obstacles to this evaluation process. The methodology involves a sequence consisting in the evaluational experiences of basically innovative programs of undergraduate medical instruction, the selection of an evaluation model, identification of the aspects to be evaluated, the determination of priorities, and the definition of specific evaluation projects. From the aspects identified and given priority the following 12 evaluation projects emerged: curriculum review, follow-up of alumni, instruction materials, tutors, integration of knowledge, student performance, instructional activities, students in social service, student enrollments, dropping out, professional examination, and education administration.

Hipertiroxinemia en la enfermedad trofoblastica. / Hyperthyroxinemia in trophoblastic disease

Con el fin de analizar las variaciones de las hormonas tiroideas cen el embarazo molar se estudiaron 13 casos. Las hormonas tiroideas en la sangre se cuantificaron periodicamente hasta 12 semanas despues del vaciamiento molar. La captacion de T3 se mantuvo baja durante todo el estudio, debido a la elevacion en la globulina transportadora de hormonas tiroideas por el efecto del embarazo y despues por los anticonceptivos hormonales. Se demostro hipertiroxinemia con T4 total de 18.25% + ou - 1.47 ng/dl e indice de tiroxina libre de 6.0 + ou - 0.61, cifras que alcanzaron valores normales hasta la segunda y primera semanas postevacuacion respectivamente.No obstante lo anterior, ninguna de las pacientes tuvo datos clinicos de hipertiroidismo

[Aspects of reproduction related to human rights. IV. Sterilization by surgical means]. / Aspectos de la reproducción relacionados con los derechos humanos. IV. Esterilización por métodos quirúrgicos.

PIP: Sexual sterilization can be done for eugenic reasons, as in cases of serious mental retardation, or in cases of genetic transmission of congenital malformations, or for therapeutic reasons, as in the case of a diabetic or cardiopathic mother, or in cases of repeated cesarean section. When sterilization was introduced into Mexico about 20 years ago, it was very much opposed; it is today one of the most popular family planning methods. All countries which allow sterilization for socioeconomic reasons ask some prerequisities of the couple which include: 1) age, which should be above 30, 2) a minimum number of living children, 3) the consent of both members, 4) a waiting period before the actual operation, 5) selection of the member to be sterilized should be based on attitude and emotional maturity, 6) the couple must be very well informed about the irreversible nature of the operation, and 7) the operation must be done by qualified physicians and not by paramedical personnel.^ieng

[Concept of regionalization of obstetric and neonatal management]. / Concepto de regionalización del manejo obstétrico y neonatal.

PIP: Modern technology in the field of obstetrics has helped enormously to lower the incidence of maternal-infant mortality and morbidity. What is important at the present time is to expose an ever increasing number of expecting mothers to the advantages of modern medicine. About 10-20% of pregnancies are high risk and need specialized personnel, care, and equipment. To better distribute the cost of maternal health services in Mexico, and to better care for patients, the authors of this article propose division of services into 3 levels, from the least to the most specilized. This system presupposes an accurate selection of patients, and a careful detection of any eventual problem. The first level of medical attention can be given at a general hospital by a general practitioner, with no special equipment. The second level requires a specialized hospital, a specialist in gyneco-obstetrics, specially trained nurses, and a well equipped delivery room. The third level requires a higher degree of specialization from doctors and nurses, and a complete equipment for intensive prenatal, intrapartum, and postpartum care of mothers and newborns.^ieng

Studies on maternal mortality in Mexico.

The sociocultural, psychological, and medical effects of maternal death are described and analyzed for the purpose of appraising the value of the given death as a measure of the quality of medical care. The work of the Maternal Mortality Committee of the Hospital de Gineco-Obstetetricia No. 1 of the Mexican Social Security Institute over its three years of operation and some results on responsiblity for death and its possible predictabilty are presented. The results show that it is necessary to broaden the Committee's functions in a social, professional, and institutional context so that the indicated factors may be objectively assessed and also that the Committee be transformed into a dynamic organism that will contribute to solving the problem. Recommendations for the operation of the Maternal Mortality Committees are given.