Guidelines on epidemics in Mexico. Historical perspective.

A perspective of epidemics and pandemics in Mexico is offered, focusing on three time periods, namely, end of the 18th century, the 20th century, and the 21st century, in order to analyze how they were approached by health and government authorities, as well as the challenges they have represented. Historical documentary sources were consulted and, in current cases, participation in them was analyzed. Epidemiological and social historical methodologies were combined. The presence of epidemics in Mexico is a constant on its evolution, which highlights the need for the epidemiological surveillance system to be updated, the importance of being prepared to face an epidemic and to develop a contingency plan.

Se ofrece una perspectiva de las epidemias y pandemias en México en tres periodos: fines del siglo XVIII y siglos XX y XXI, con el fin de analizar cómo las autoridades sanitarias y gubernamentales abordaron estos problemas, así como los desafíos que han representado. Se consultaron fuentes históricas documentales y, en los casos actuales, la participación en ellos. Se combinó metodología epidemiológica e histórica social. La presencia de las epidemias en México es una constante, lo cual evidencia la necesidad de actualizar el sistema de vigilancia epidemiológica, de estar preparados para enfrentar una epidemia y de elaborar un plan de contingencia.

Directrices en torno a las epidemias en México. Perspectiva histórica / Guidelines on epidemics in Mexico. Historical perspective

Resumen Se ofrece una perspectiva de las epidemias y pandemias en México en tres periodos: fines del siglo XVIII y siglos XX y XXI, con el fin de analizar cómo las autoridades sanitarias y gubernamentales abordaron estos problemas, así como los desafíos que han representado. Se consultaron fuentes históricas documentales y, en los casos actuales, la participación en ellos. Se combinó metodología epidemiológica e histórica social. La presencia de las epidemias en México es una constante, lo cual evidencia la necesidad de actualizar el sistema de vigilancia epidemiológica, de estar preparados para enfrentar una epidemia y de elaborar un plan de contingencia.

Abstract A perspective of epidemics and pandemics in Mexico is offered, focusing on three time periods, namely, end of the 18th century, the 20th century, and the 21st century, in order to analyze how they were approached by health and government authorities, as well as the challenges they have represented. Historical documentary sources were consulted and, in current cases, participation in them was analyzed. Epidemiological and social historical methodologies were combined. The presence of epidemics in Mexico is a constant on its evolution, which highlights the need for the epidemiological surveillance system to be updated, the importance of being prepared to face an epidemic and to develop a contingency plan.

Pharmaceuticals as emerging contaminants in the aquatic environment of Latin America: a review.

Pharmaceutical active compounds (PhACs) are environmentally ubiquitous around the world, and the countries of Latin America (LATAM) are not the exception; however there is still little knowledge of the magnitude and conditions of their occurrence in LATAM and of the environmental consequences of their presence. The present work reviews 79 documents published from 2007 to 2019 on the occurrence, concentrations, and sources of PhACs and hormones in surface water (SW), wastewater (WW), and treated wastewater (TWW) in LATAM and on the circumstances of their release to the environment. Research efforts are reported in only ten countries and confirm the presence of 159 PhACs, mainly analgesics and anti-inflammatories, although extraordinarily high concentrations of carbamazepine (830 µg/L) and ethinylestradiol (6.8 µg/L) were found in Ecuador and Brazil, respectively. The analysis of maximum concentrations and the ecotoxicological risk assessment corroborate that (1) these values exceed the environmental concentrations found in other parts of the world, (2) the environmental risk posed by these concentrations is remarkably high, and (3) there is no statistically significant difference between the maximum concentrations found in WW and those found in TWW. The main source of PhACs in LATAM's aquatic environment is WW; hence, these countries should direct substantial efforts to develop efficient and cost-effective treatment technologies and plan and apply WW management strategies and regulations. This analysis presents the current states of occurrence, concentrations, and sources of PhACs in the aquatic environment of LATAM and outlines the magnitude of the environmental problem in that part of the world.

Body Fat Percentage Rather than Body Mass Index Related to the High Occurrence of Type 2 Diabetes.

BACKGROUND: Diabetes prevalence estimation and reduction of its risk factors remain the major goals of health services. While obesity is the major risk factor for diabetes, body fat distribution may be a better predictor. AIMS: To estimate the prevalence of diabetes in an adult working population in Mexico City, and to evaluate the strength of association with different risk factors. METHODS: A cross-sectional survey was conducted in two city halls of Mexico City. Anthropometrics, blood pressure, physical activity, diet, and biochemical parameters were assessed. Diabetes was defined as a fasting plasma glucose level ≥7.0 mmol/l or referred diabetes. The bioelectrical impedance analysis of body components was performed and weight, soft lean mass, body fat percentage and abdominal fat were obtained. Prevalence with 95% confidence intervals was estimated, as well as odds ratios derived from a logistic regression model. RESULTS: The prevalence of type 2 diabetes was 11.0% (95% CI 9.6-12.4%). The proportion of individuals with diabetes who were unaware of having the disease was higher in women (42.5 vs. 36.9%), and the degree of metabolic control was better in women (39.1 vs. 25.0%). Age, blood pressure, triglycerides and the percentage of body fat, were major risk factors related to the occurrence of type 2 diabetes. No relation was observed with physical activity and diet. CONCLUSIONS: The prevalence of type 2 diabetes in Mexico continues to be high and obesity measured by body fat percentage seems to be a better predictor of its occurrence than body mass index.

From ISET to InDRE. V. Institute of Epidemiological Diagnosis and Reference. Global strategic position, 2012-2019.

This document describes the changes at the Institute of Epidemiological Diagnosis and Reference (InDRE) from 2012 to 2019, the administrative and equipment modifications, the new headquarters and the National System of Epidemiological Surveillance legal modifications. The process of relocation is mentioned, especially the careful transfer of the biological material protected by the Institute, and the new way of studying epidemic outbreaks, endemic diseases and the negative network is analyzed. At the international level, the promotion of links with global networks of the Pan American Health Organization, the World Health Organization (WHO) and other international organizations is described. The assignation to InDRE of four WHO collaborating centres is also mentioned. The Global Health Security Initiative Laboratory Network acknowledged InDRE's leadership, which co-chaired the working group during the study period.

En este documento se describen los cambios en el Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE) de 2012 a 2019, las modificaciones administrativas y de equipamiento, la nueva sede y las modificaciones jurídicas al Sistema Nacional de Vigilancia Epidemiológica. Se menciona el proceso de mudanza, en especial el cuidadoso traslado del material biológico que resguarda el Instituto y se analiza la nueva forma de estudiar los brotes epidémicos, los padecimientos endémicos y la red negativa. Respecto al ámbito internacional, se describe el fomento de la vinculación con redes globales de la Organización Panamericana de la Salud, la Organización Mundial de la Salud (OMS) y otros organismos internacionales. También se menciona la designación en el InDRE de cuatro centros colaboradores de la OMS. La Red de Laboratorios de la Iniciativa Global para la Seguridad en Salud reconoció el liderazgo del InDRE, cuyo director ocupó la copresidencia del grupo de trabajo en el periodo de estudio.

Del ISET al InDRE. V. Instituto de Diagnóstico y Referencia Epidemiológicos. Posición estratégica global, 2012-2019 / From ISET to InDRE. V. Institute of Epidemiological Diagnosis and Reference. Global strategic position, 2012-2019

Resumen En este documento se describen los cambios en el Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE) de 2012 a 2019, las modificaciones administrativas y de equipamiento, la nueva sede y las modificaciones jurídicas al Sistema Nacional de Vigilancia Epidemiológica. Se menciona el proceso de mudanza, en especial el cuidadoso traslado del material biológico que resguarda el Instituto y se analiza la nueva forma de estudiar los brotes epidémicos, los padecimientos endémicos y la red negativa. Respecto al ámbito internacional, se describe el fomento de la vinculación con redes globales de la Organización Panamericana de la Salud, la Organización Mundial de la Salud (OMS) y otros organismos internacionales. También se menciona la designación en el InDRE de cuatro centros colaboradores de la OMS. La Red de Laboratorios de la Iniciativa Global para la Seguridad en Salud reconoció el liderazgo del InDRE, cuyo director ocupó la copresidencia del grupo de trabajo en el periodo de estudio.

Abstract This document describes the changes at the Institute of Epidemiological Diagnosis and Reference (InDRE) from 2012 to 2019, the administrative and equipment modifications, the new headquarters and the National System of Epidemiological Surveillance legal modifications. The process of relocation is mentioned, especially the careful transfer of the biological material protected by the Institute, and the new way of studying epidemic outbreaks, endemic diseases and the negative network is analyzed. At the international level, the promotion of links with global networks of the Pan American Health Organization, the World Health Organization (WHO) and other international organizations is described. The designation of four WHO collaborating centres granted to InDRE is also mentioned. The Global Health Security Initiative Laboratory Network acknowledged InDRE's leadership, which co-chaired the working group during the study period.

From ISET to InDRE. IV. Institute of Epidemiological Diagnosis and Reference: new orientation, 1990-2012.

From 1990 to 2012, the Sanitary and Tropical Diseases Institute experienced the most important changes. In 1989, its name and orientation were modified to become the National Institute of Epidemiological Diagnosis and Reference. Shortly before, it had been formalized as the apex of the National Network of Public Health Laboratories and had incorporated laboratories for preventive programs such as exfoliative cytology and rabies, malaria and tuberculosis diagnosis; subsequently, it would incorporate other networks that emerged as part of the response to major epidemic outbreaks and to the new epidemiological outlook. In this period, 27 priority diagnostic algorithms were defined, organized in 18 networks, some of which began to collaborate with global networks. In 2001, the Institute started working with pathogens related to bioterrorism. By then, space restrictions of the headquarter's building were evident; in 2008, starting the construction of new facilities was decided. The Institute and its diagnostic networks constitute a milestone in Latin American public health of the 21st century.

De 1990 a 2012, el Instituto de Salubridad y Enfermedades Tropicales experimentó los cambios más importantes desde su origen. En 1989 modificó su nombre y orientación a Instituto Nacional de Diagnóstico y Referencia Epidemiológicos. Poco antes se había formalizado como cúspide de la organización piramidal denominada Red Nacional de Laboratorios en Salud Pública y había incorporado los laboratorios de programas preventivos como el de citología exfoliativa y los de diagnóstico de rabia, paludismo, tuberculosis; posteriormente incorporaría otras redes que surgieron como parte de la respuesta a brotes epidémicos importantes (cólera, VIH-sida, sarampión, influenza) y al nuevo panorama epidemiológico (dengue, Chagas, rotavirus). En este periodo se definieron 27 algoritmos diagnósticos prioritarios organizados en 18 redes, algunas de las cuales comenzaron a colaborar con redes globales. En 2001, en el Instituto se empezó a trabajar con patógenos relacionados con el bioterrorismo. Para entonces, las severas restricciones de espacio del edificio construido en 1935 fueron evidentes; en 2008, las autoridades decidieron iniciar el diseño y construcción de las nuevas instalaciones. En conjunto, el InDRE y sus redes diagnósticas constituyen un hito en la salud pública latinoamericana del siglo XXI.

Desde el ISET al InDRE. IV. Instituto de Diagnóstico y Referencia Epidemiológicos: nueva orientación, 1990-2012 / From ISET to InDRE. IV. Institute of Epidemiological Diagnosis and Reference: new orientation, 1990-2012

Resumen De 1990 a 2012, el Instituto de Salubridad y Enfermedades Tropicales experimentó los cambios más importantes. En 1989 modificó su nombre y orientación a Instituto Nacional de Diagnóstico y Referencia Epidemiológicos. Poco antes se había formalizado como cúspide de la Red Nacional de Laboratorios en Salud Pública y había incorporado los laboratorios de programas preventivos como el de citología exfoliativa y los de diagnóstico de rabia, paludismo, tuberculosis; posteriormente incorporaría otras redes que surgieron como parte de la respuesta a brotes epidémicos y al nuevo panorama epidemiológico. En este periodo, 27 algoritmos diagnósticos se definieron y organizaron en 18 redes, algunas de las cuales comenzaron a colaborar con redes globales. En 2001, en el Instituto se empezó a trabajar con patógenos relacionados con el bioterrorismo. Para entonces, las restricciones del edificio sede fueron evidentes; en 2008, se decidió construir nuevas instalaciones. El Instituto y sus redes diagnósticas constituyen un hito en la salud pública latinoamericana del siglo XXI.

Abstract From 1990 to 2012, the Sanitary and Tropical Diseases Institute experienced the most important changes. In 1989, its name and orientation were modified to become the National Institute of Epidemiological Diagnosis and Reference (InDRE). Shortly before, it had been formalized as the apex of the National Network of Public Health Laboratories and had incorporated laboratories for preventive programs such as exfoliative cytology and rabies, malaria and tuberculosis diagnosis; subsequently, it would incorporate other networks that emerged as part of the response to major epidemic outbreaks and to the new epidemiological outlook. In this period, 27 priority diagnostic algorithms were defined and organized in 18 networks, some of which began to collaborate with global networks. In 2001, the Institute started working with pathogens related to bioterrorism. By then, space restrictions of the headquarters’ building were evident; in 2008, starting the construction of new facilities was decided. The institute and its diagnostic networks constitute a milestone in Latin American public health of the 21st century.

Desde el ISET al InDRE. III. Instituto de Salubridad y Enfermedades Tropicales: crisis y renovación, 1965-1989.

This paper analyzes the situation and the changes made in the Institute of Sanitary and Tropical Diseases between 1965 and 1989 to become the National Institute of Epidemiological Diagnosis and Reference. Three major stages are identified during this period: crisis, transition and renewal. The factors that led to the crisis, the decisions made to overcome it and to harmonize the work of laboratories with epidemiological and public health criteria are discussed. The recognition obtained by researchers of the Institute despite the crisis is described, as well as the way the institution managed to continue with projects despite the changing global situation. The transition included the arrival of a new generation of professionals with modern computer-based and conceptual tools and the remarkably well met challenge of participating in national surveys with rigorous criteria. All this moved the institution to define its profile towards diagnosis and reference.

El artículo analiza la situación y los cambios efectuados en el Instituto de Salubridad y Enfermedades Tropicales entre 1965 y 1989 para transformarse en el Instituto Nacional de Diagnóstico y Referencia Epidemiológicos. Se identifican tres grandes etapas en el periodo: crisis, transición y renovación. Se señalan los elementos que llevaron a la crisis, las decisiones que se tomaron para salir de ella y armonizar el trabajo de los laboratorios con criterios epidemiológicos y de salud pública. Se citan las distinciones obtenidas por investigadores del Instituto a pesar de la crisis y se describe cómo la institución logró seguir con proyectos a pesar de la cambiante situación mundial. La transición incluyó la llegada de una nueva generación de profesionales con modernas herramientas informáticas y conceptuales y el desafío de participar en encuestas nacionales con criterios rigurosos. Todo ello movió a la institución a definir su perfil hacia el diagnóstico y la referencia.

Desde el ISET al InDRE. II. Instituto de Salubridad y Enfermedades Tropicales: madurez y consolidación, 1940-1964.

The period that starts in 1940 is crucial for the creation of Mexico's modern health system. The Institute of Sanitary and Tropical Diseases is the pioneer institution in health research and on its first two decades it achieved maturity and consolidated lines of research expressed in almost 1700 publications. It also obtained notorious international visibility and was selected as a regional reference for epidemiological surveillance of influenza, streptococcus and salmonella. Its evolution took place with an innovation rhythm that would be decreasing by the end of this period. It faced limitations to renew lines of research, researchers and laboratory equipment. However, its role in public health decisions of the country remained central.

El periodo que comienza en 1940 es crucial para la creación del moderno sistema de salud de México. El Instituto de Salubridad y Enfermedades Tropicales es la institución pionera en investigación en salud y en sus primeras dos décadas logra madurez y consolida líneas de investigación expresadas en casi 1700 publicaciones. También obtiene notoria visibilidad internacional y fue seleccionado como referencia regional para la vigilancia epidemiológica de influenza, estreptococo y salmonela. Su evolución se produjo con ritmo de innovación que iría disminuyendo para el final de ese periodo. Enfrentó limitaciones para renovar líneas de trabajo, investigadores y equipo de laboratorio, sin embargo, su papel en las decisiones de la salud pública del país siguió siendo central.

Desde el ISET al InDRE. II. Instituto de Salubridad y Enfermedades Tropicales: madurez y consolidación, 1940-1964 / From ISET to InDRE. II. Institute of Public Health and Tropical Diseases: maturity and consolidation, 1940-1964

Resumen El periodo que comienza en 1940 es crucial para la creación del moderno sistema de salud de México. El Instituto de Salubridad y Enfermedades Tropicales es la institución pionera en investigación en salud y en sus primeras dos décadas logra madurez y consolida líneas de investigación expresadas en casi 1700 publicaciones. También obtiene notoria visibilidad internacional y fue seleccionado como referencia regional para la vigilancia epidemiológica de influenza, estreptococo y salmonela. Su evolución se produjo con ritmo de innovación que iría disminuyendo para el final de ese periodo. Enfrentó limitaciones para renovar líneas de trabajo, investigadores y equipo de laboratorio, sin embargo, su papel en las decisiones de la salud pública del país siguió siendo central.

Abstract The period that starts in 1940 is crucial for the creation of Mexico’s modern health system. The Institute of Sanitary and Tropical Diseases is the pioneer institution in health research and on its first two decades it achieved maturity and consolidated lines of research expressed in almost 1700 publications. It also obtained notorious international visibility and was selected as a regional reference for epidemiological surveillance of influenza, streptococcus and salmonella. Its evolution took place with an innovation rhythm that would be decreasing by the end of this period. It faced limitations to renew lines of research, researchers and laboratory equipment. However, its role in public health decisions of the country remained central.

Desde el ISET al InDRE. I. Instituto de Salubridad y Enfermedades Tropicales: génesis y primeros años, 1934-1940.

Lázaro Cárdenas government vision, and the process to create the Sanitary and Tropical Diseases Institute, which is considered strategic for public health, were consistent with the actions that were carried out: the Department of Public Sanitary asked the most relevant scientist of those days, Eliseo Ramírez, to design and follow-up the Institute's project. A commission of the Higher Education and Scientific Research Council reviewed and approved the project and conferred this institution its nature of research center with social and humanistic vocation since its foundation. Sanitary and Tropical Diseases Institute became the first post-revolutionary health institution that was born with well-remunerated job positions to conduct full-time research in Mexico, offering clinical services, teaching and supporting disease prevention and control campaigns. It was with no doubt a milestone in Mexican public health and crystalized the expectations of several generations of physicians and health researchers about having a high-level institution. It is the most significant public health institution of the country, with a new phase as Institute of Epidemiological Diagnosis and Reference. Without it, Mexican modern public health cannot be understood.

La visión del gobierno cardenista y el proceso para crear el Instituto de Salubridad y Enfermedades Tropicales, considerado estratégico para la salud pública, fueron congruentes con las acciones llevadas a cabo: el Departamento de Salubridad Pública encargó al científico más relevante de la época, Eliseo Ramírez, el diseño y seguimiento del Instituto, que una comisión del Consejo Nacional de Educación Superior y la Investigación Científica revisó, aprobó y desde su inicio le confirió el carácter de investigación con vocación social y humanística. El Instituto de Salubridad y Enfermedades Tropicales se convirtió en el primer organismo posrevolucionario que nació con plazas bien remuneradas para realizar investigación de tiempo completo en México, ofreciendo servicio clínico y enseñanza y apoyando las campañas sanitarias en la prevención y control de las enfermedades. Sin duda fue un parteaguas en la salud pública mexicana y cristalizó las expectativas de varias generaciones de médicos e investigadores en salud para tener una institución de alto nivel. Es la más significativa institución de salud pública del país, con una nueva etapa como Instituto de Diagnóstico y Referencia Epidemiológicos; sin ella no se entiende la moderna salud pública de México.

Desde el ISET al InDRE. I. Instituto de Salubridad y Enfermedades Tropicales: génesis y primeros años, 1934-1940 / From ISET to InDRE. I. Institute of Public Health and Tropical Diseases: genesis and early years, 1934-1940

Resumen La visión del gobierno cardenista y el proceso para crear el Instituto de Salubridad y Enfermedades Tropicales, considerado estratégico para la salud pública, fueron congruentes con las acciones llevadas a cabo: el Departamento de Salubridad Pública encargó al científico más relevante de la época, Eliseo Ramírez, el diseño y seguimiento del Instituto, que una comisión del Consejo Nacional de Educación Superior y la Investigación Científica revisó, aprobó y desde su inicio le confirió el carácter de investigación con vocación social y humanística. El Instituto de Salubridad y Enfermedades Tropicales se convirtió en el primer organismo posrevolucionario que nació con plazas bien remuneradas para realizar investigación de tiempo completo en México, ofreciendo servicio clínico y enseñanza y apoyando las campañas sanitarias en la prevención y control de las enfermedades. Sin duda fue un parteaguas en la salud pública mexicana y cristalizó las expectativas de varias generaciones de médicos e investigadores en salud para tener una institución de alto nivel. Es la más significativa institución de salud pública del país, con una nueva etapa como Instituto de Diagnóstico y Referencia Epidemiológicos; sin ella no se entiende la moderna salud pública de México.

Abstract Lázaro Cárdenas government vision, and the process to create the Sanitary and Tropical Diseases Institute, which is considered strategic for public health, were consistent with the actions that were carried out: the Department of Public Sanitary asked the most relevant scientist of those days, Eliseo Ramírez, to design and follow-up the Institute's project. A commission of the Higher Education and Scientific Research Council reviewed and approved the project and conferred this institution its nature of research center with social and humanistic vocation since its foundation. Sanitary and Tropical Diseases Institute became the first post-revolutionary health institution that was born with well-remunerated job positions to conduct full-time research in Mexico, offering clinical services, teaching and supporting disease prevention and control campaigns. It was with no doubt a milestone in Mexican public health and crystalized the expectations of several generations of physicians and health researchers about having a high-level institution. It is the most significant public health institution of the country, with a new phase as Institute of Epidemiological Diagnosis and Reference. Without it, Mexican modern public health cannot be understood.

Successful up-scaled population interventions to reduce risk factors for non-communicable disease in adults: results from the International Community Interventions for Health (CIH) Project in China, India and Mexico.

BACKGROUND: Non-communicable disease (NCD) is increasing rapidly in low and middle-income countries (LMIC), and is associated with tobacco use, unhealthy diet and physical inactivity. There is little evidence for up-scaled interventions at the population level to reduce risk in LMIC. METHODS: The Community Interventions for Health (CIH) program was a population-scale community intervention study with comparator population group undertaken in communities in China, India, and Mexico, each with populations between 150,000-250,000. Culturally appropriate interventions were delivered over 18-24 months. Two independent cross-sectional surveys of a stratified sample of adults aged 18-64 years were conducted at baseline and follow-up. RESULTS: A total of 6,194 adults completed surveys at baseline, and 6,022 at follow-up. The proportion meeting physical activity recommendations decreased significantly in the control group (C) (44.1 to 30.2%), but not in the intervention group (I) (38.0 to 36.1%), p<0.001. Those eating ≥ 5 portions of fruit and vegetables daily decreased significantly in C (19.2 to 17.2%), but did not change in I (20.0 to 19.6%,), p=0.013. The proportion adding salt to food was unchanged in C (24.9 to 25.3%) and decreased in I (25.9 to 19.6%), p<0.001. Prevalence of obesity increased in C (8.3 to 11.2%), with no change in I (8.6 to 9.7%,) p=0.092. Concerning tobacco, for men the difference-in-difference analysis showed that the reduction in use was significantly greater in I compared to C (p=0.014). CONCLUSIONS: Up-scaling known health promoting interventions designed to reduce the incidence of NCD in whole communities in LMIC is feasible, and has measurable beneficial outcomes on risk factors for NCD, namely tobacco use, diet, and physical inactivity.

Eficiente administración sanitaria? Caso clínica estomatológica / Efficient sanitary administration? The Stomatologic Clinic Case

La administración en las instituciones de salud es un tema importante para el logro de la satisfacción de los pacientes y familiares, a la par de la correcta utilización de los recursos disponibles. El sistema de salud en Cuba es presupuestado, y por ello, una gestión eficiente es vital para distribuir los recursos en función de los mejores resultados. Un importante indicador a considerar en este tema lo constituyen los costos de calidad. Dentro del sistema nacional de salud, las clínicas estomatológicas son organizaciones donde resulta muy novedoso el tema de mejoramiento continuo de su gestión a partir de los costos de calidad. En el presente trabajo se realizó una evaluación de los costos de calidad en la Clínica Estomatológica Docente III Congreso del PCC, lo cual constituyó la base del programa de mejoras. El costo total de calidad fue de 22 394.15 pesos en el año 2011, siendo el 62,69 por ciento por fallos relacionados esencialmente a reelaboraciones, desperdicios, paralización parcial por poco instrumental, entre otras causas que fueron la base del programa de mejora.

The administration of health care institutions is an important theme for achieving the patients and relatives satisfaction, and the right usage of the available resources at the same time. Health Care System in Cuba is budgeted and for that, an efficient management is vital in distributing the resources for better results. Quality costs are an important indicator to consider in this theme. Inside the national Health Care System, stomatologic clinics are organizations where it is fashionable the theme of the continuous management improvement on the basis of the quality costs. In the current work we carried out an evaluation of the quality costs at the Teaching Stomatologic Clinic III Congreso del Partido, took as the basis of the improvement program. The total quality cost was 22 394.15 pesos in 2011. 62,69 percent was caused by mistakes essentially related with re-elaboration, wastes, partial paralyzing because of few instrumental, among other causes that were the base of the improvement program.

Inside the outbreak of the 2009 influenza A (H1N1)v virus in Mexico.

BACKGROUND: Influenza viruses pose a threat to human health because of their potential to cause global disease. Between mid March and mid April a pandemic influenza A virus emerged in Mexico. This report details 202 cases of infection of humans with the 2009 influenza A virus (H1N1)v which occurred in Mexico City as well as the spread of the virus throughout the entire country. METHODOLOGY AND FINDINGS: From May 1st to May 5th nasopharyngeal swabs, derived from 751 patients, were collected at 220 outpatient clinics and 28 hospitals distributed throughout Mexico City. Analysis of samples using real time RT-PCR revealed that 202 patients out of the 751 subjects (26.9%) were confirmed to be infected with the new virus. All confirmed cases of human infection with the strain influenza (H1N1)v suffered respiratory symptoms. The greatest number of confirmed cases during the outbreak of the 2009 influenza A (H1N1)v were seen in neighbourhoods on the northeast side of Mexico City including Iztapalapa, Gustavo A. Madero, Iztacalco, and Tlahuac which are the most populated areas in Mexico City. Using these data, together with data reported by the Mexican Secretariat of Health (MSH) to date, we plot the course of influenza (H1N1)v activity throughout Mexico. CONCLUSIONS: Our data, which is backed up by MSH data, show that the greatest numbers of the 2009 influenza A (H1N1) cases were seen in the most populated areas. We speculate on conditions in Mexico which may have sparked this flu pandemic, the first in 41 years. We accept the hypothesis that high population density and a mass gathering which took in Iztapalapa contributed to the rapid spread of the disease which developed in three peaks of activity throughout the Country.

Assessment of groundwater contamination by landfill leachate: a case in México.

In México, uncontrolled landfills or open-dumps are regularly used as "sanitary landfills". Interactions between landfills/open-dumps and shallow unconfined aquifers have been widely documented. Therefore, evidence showing the occurrence of aquifer contamination may encourage Mexican decision makers to enforce environmental regulations. Traditional methods such as chemical analysis of groundwater, hydrological descriptions, and geophysical studies including vertical electrical sounding (VES) and ground penetrating radar (GPR) were used for the identification and delineation of a contaminant plume in a shallow aquifer. The Guadalupe Victoria landfill located in Mexicali is used as a model study site. This landfill has a shallow aquifer of approximately 1m deep and constituted by silty sandy soil that may favor the transport of landfill leachate. Geophysical studies show a landfill leachate contaminant plume that extends for 20 and 40 m from the SE and NW edges of the landfill, respectively. However, the zone of the leachate's influence stretches for approximately 80 m on both sides of the landfill. Geochemical data corroborates the effects of landfill leachate on groundwater.

[Coronary heart disease in Mexico and the clinical epidemiological and preventive relevance]. / La cardiopatía coronaria en México y su importancia clínica, epidemiológica y preventiva.

Coronary heart disease is dominant among heart diseases in the population, a problem to control. Heart diseases have been first place in the general mortality for the last 20 years. The trend show an annual increase without control. Atherosclerosis is responsible for at least for one fourth of all deaths in the country. The combined data of mortality and morbidity, from hospital discharges or the whole country, disclose that one out of three die of acute myocardial infarction (AMI). While only 8% of all deaths registered were admitted to a hospital. Most, 92% were never admitted to any hospital for some reason. The estimated annual incidence of AMI cases is 140,000, on the basis of 3 cases surviving for each case death, accounted by the Death Certification System, which rounds 35,000. Standardized mortality rates of AMI in Mexico are greater than in USA o Canada creating a more concerned worry. The most probable explanation to that situation is lack of preventive care, which should also include the acute care and before reaching the hospital facilities. Running the same chances are hypertension crisis and strokes and diabetic complications. The appropriate care for critical situations might reduce significantly the cardiovascular mortality in the country, in a short and middle term. Prevention is not only for chronic conditions but for acute and critical situations. The programs of preventive care should also include cultural promotion and community awareness. The timely care is life and myocardium saving. The reinforcement of prior to hospital care reduces the delay for AMI adequate intervention. These activities agree quite well with the ongoing programs of CPR, organizing the surviving chain and the training programs for paramedical emergency technicians.

La cardiopatía coronaria en México y su importancia clínica, epidemiológica y preventiva / Coronary heart disease in Mexico and the clinical, epidemiological and preventive relevance

La cardiopatía coronaria en el país es la patología cardiovascular dominante, un problema de prevención y control. Las estadísticas generales informan que las Enfermedades del Corazón figuran en 1er. Lugar, como causa de muerte, desde hace más de 20 años. El problema, ahora se agrava gradualmente, al ritmo de entonces y sin indicio de control. La aterosclerosis en todas sus formas es responsable de por lo menos la cuarta parte de todos los fallecimientos del país. Los datos combinados de mortalidad y morbilidad, general y hospitalaria, indican que la letalidad hospitalaria llega a ser de 25% por infarto agudo de miocardio (IAM). La atención, antes de morir, la recibe sólo 8 de cada 100, testimonio del certificado de defunción. El restante 92% no acude a ningún hospital, por algún motivo. La incidencia anual de IAM se estima en 140,000 casos; considerando que por cada fallecido (35,000) sobreviven 3. Las tasas de mortalidad por IAM, estandarizadas por edad, son más altas que EEUU y Canadá, lo cual crea una expectativa de mayor preocupación. La explicación más plausible sobre la situación es la deficiencia de la atención preventiva, misma que se debe incluir en las situaciones de urgencia y antes de llegar al hospital. Las formas agudizadas de hipertensión arterial, accidentes cerebrovasculares y diabetes mellitus comparten la misma suerte. La atención temprana y adecuada para estas condiciones críticas, puede contribuir importantemente a disminuir la mortalidad cardiovascular del país, a corto y mediano plazo. El enfoque preventivo debe considerarse tanto en lo crónico como en lo urgente y lo crítico. Conviene incluir en el fomento a la salud la cultura por un corazón saludable y paralelamente promover una conciencia colectiva acerca de los problemas sobreagudos. La prestación de cuidados oportunos salva vidas y miocardios. El refuerzo a la atención pre-hospitalaria reducirá el tiempo de retraso en la llegada de casos con IAM. Llevar a cabo estas actividades es compatible con los programas existentes de reanimación cardiopulmonar, cadena de supervivencia y capacitación a técnicos en urgencias médicas.

Coronary heart disease is dominant among heart diseases in the population, a problem to control. Heart diseases have been first place in the general mortality for the last 20 years. The trend show an annual increase without control. Atherosclerosis is responsible for at least for one fourth of all deaths in the country. The combined data of mortality and morbidity, from hospital discharges or the whole country, disclose that one out of three die of acute myocardial infarction (AMI). While only 8% of all deaths registered were admitted to a hospital. Most, 92% were never admitted to any hospital for some reason. The estimated annual incidence of AMI cases is 140,000, on the basis of 3 cases surviving for each case death, accounted by the Death Certification System, which rounds 35,000. Standardized mortality rates of AMI in Mexico are greater than in USA o Canada creating a more concerned worry. The most probable explanation to that situation is lack of preventive care, which should also include the acute care and before reaching the hospital facilities. Running the same chances are hypertension crisis and strokes and diabetic complications. The appropriate care for critical situations might reduce significantly the cardiovascular mortality in the country, in a short and middle term. Prevention is not only for chronic conditions but for acute and critical situations. The programs of preventive care should also include cultural promotion and community awareness. The timely care is life and myocardium saving. The reinforcement of prior to hospital care reduces the delay for AMI adequate intervention. These activities agree quite well with the ongoing programs of CPR, organizing the surviving chain and the training programs for paramedical emergency technicians. (Arch Cardiol Mex 2003; 73:105-114).