[Hemophilia camps.] / Campamentos para pacientes con hemofilia.

We reported the experience of hemophilia camps which was accomplished with patients from hospitals of the Instituto Mexicano del Seguro Social. The aim was to prepare the families and patients regarding the disease treatment, in order to promote the self sufficiency and to know the impact of the program on the course of the disease. Surveys were applied about treatment items and personal opinions were collected. The results of the national hemophilia camp were: group of 56 patients, average 14 years, 2 % women, 51 % severe hemophilia and 43 % had hemophilic brothers. Benefits: patients increased their knowledge about earlier bleeding identification and the self-infusion method; they became aware on their responsibility in self care, timely treatment and duties at home. Hemophilia camps with patients are an option for attitude change before disease complications. Social network creation and the increase in self-sufficiency are other benefits.

Se informa la experiencia con los campamentos de hemofilia que incluyen a pacientes de un hospital del Instituto Mexicano del Seguro Social en la Ciudad de México y de otros hospitales en el país, realizados con el objetivo de capacitar a los enfermos y a sus familiares en los cuidados de la enfermedad y de promover la autosuficiencia. Se aplicaron cuestionarios sobre los temas tratados y se recabaron las opiniones personales. De la experiencia con el primer campamento nacional de hemofilia se observó que en el grupo de 56 pacientes (promedio de edad de 14 años, 2 % mujeres, 51 % con hemofilia severa, 43 % con hermanos con hemofilia) se incrementaron los conocimientos en la identificación de los sangrados y la técnica de autoinfusión. De igual forma, los pacientes se concientizaron acerca de su responsabilidad en el autocuidado, el tratamiento oportuno y los deberes en el hogar. De tal forma, se señala que los campamentos son una opción para el cambio de actitud ante la enfermedad, para crear redes sociales y favorecer la autosuficiencia.

[Clinical practice guideline. Diagnosis and treatment of dyslipidemia.] / Guía de práctica clínica. Diagnóstico y tratamiento de las dislipidemias.

Non-communicable diseases are a public health problem in México. Coronary heart disease and diabetes mellitus are the first and second cause of death in the country, followed by thrombotic cerebrovascular events. Cardiovascular diseases are the leading cause of death; one primary risk factor is hypercholesterolemia. The detection and treatment of lipid abnormalities is the key to the prevention and management of chronic non-communicable diseases. Two nationally representative surveys have shown that lipid abnormalities are the most common risk factors in Mexican adults. The purpose of this guide is to provide a basis for identifying dyslipidemia in a timely manner, and to systematize the criteria for diagnosis and treatment in the first and second level of care.

Las enfermedades crónicas no transmisibles son un problema de salud pública en México; entre ellas, la enfermedad coronaria y la diabetes son la primera y la segunda causa de muerte en el país, seguidas de los eventos vasculares cerebrales embólicos. Entre los principales factores de riesgo se encuentra la hipercolesterolemia. La detección y el tratamiento de las alteraciones de los lípidos son clave para la prevención y manejo de las enfermedades crónicas no transmisibles. Dos encuestas nacionales representativas han mostrado que las anormalidades de los lípidos son los factores de riesgo más comunes en los adultos mexicanos. El propósito de esta guía es servir de base para identificar de manera oportuna las dislipidemias, además de sistematizar los criterios para el diagnóstico y tratamiento en el primer y segundo nivel de atención.

[Social support in the rehabilitation of patients with disabilities due to stroke]. / La discapacidad por enfermedad vascular cerebral. Apoyo social para la rehabilitación.

OBJECTIVE: to describe a strategy of social support in the recovery of functional capacity on basic activities of daily living (ADL), quality of life and ways to face stress in patients after a stroke. METHODS: patients (56) with stroke, were integrated in support groups during the three months of rehabilitation. Outcomes were assessed through the Barthel Index, SF-36 questionnaire, and the Lazarus-Folkman measure. RESULTS: there was an improvement in functional capacity, with an increase in the emotional support (p = 0.0191) and affectivity (p = 0.0085). There was no change in caregiver. In quality of life 13.3 % of patients met the floor values in the dimension of physical function, 40 % in physical role and emotional role 36.7%. The most frequently used facing strategy in patients and caregivers were magical thinking that led a positive facing in the area of passive facing or directed to emotion; while in active facing or directed to the problem more flexibility in the addressed problem was used. CONCLUSIONS: the social support strategies in the rehabilitation of patients with stroke reflected an improvement on functional recovery, and quality of life.

[Clinical guideline for the prevention, diagnosis and treatment of ischemic cerebral disease]. / Guía de práctica clínica. Enfermedad vascular cerebral isquémica.

Stroke is considered a big public health problem in adults and older adults. Increased life expectancy is one of the greatest achievements of development; however it is also a great challenge because of the implications with regard to increasing chronic disease that it will lead complications such as stroke. Stroke is the leading cause of disability worldwide in adulthood and the second leading cause of dementia. In developing countries, it is estimated that the costs of care for stroke are from 6000 to 8000 euros, as well as the social costs of informal care and changes in family dynamics around patients. So the purpose of this clinical practice guideline is to define recommendations based on the best available evidence for the standardization of health care of patients with stroke.

[Diagnosis and treatment guideline for primary hypothyroidism in adulthood]. / Guía de práctica clínica. Diagnóstico y tratamiento del hipotiroidismo primario en adultos.

Our objective was to develop clinical guidelines based on the best clinical evidence to help the staff of medical setting of all levels (first, second and third medical attention levels) to provide evidence based care and diagnosis of hypothyroidism in adults nationwide. The guidelines were built using structured and relevant clinical questions. A strategy was developed to identify the main clinical guidelines for hypothyroidism in adult patient. The working group selected six documents. For aspects not considered in those documents, structured searches using Pubmed, Medical Disability Advisor, and Cochrane Library Plus were done. The results were qualified according its level of evidence and grade of recommendation. The diagnosis of hypothyroidism should be done precisely and without delay. Specialized care should be used rationally, using primary care units as the main resource for the treatment of hypothyroidism. This is the reason why the first primary care physicians should understand and apply a guideline for the diagnosis and treatment of hypothyroidism in adulthood.

[Obstetrical hemorrhage as a maternal death cause in the Instituto Mexicano del Seguro Social during 2011]. / Hemorragia obstétrica, causa de muerte materna. IMSS, 2011.

OBJECTIVE: to describe the clinical data associated to maternal deaths due to fetomaternal bleeding. METHODS: we analyzed 32 of 135 cases of maternal deaths that occurred in the Instituto Mexicano del Seguro Social (IMSS) during 2011. The main inclusion feature was the presence of severe hemorrhage during pregnancy, childbirth or puerperium. RESULTS: obstetric hemorrhage as the underlying cause of maternal death was presented in 65.6 % and in 34.4 % severe obstetric hemorrhage occurred due to different underlying cause of maternal death. The age group with the highest maternal deaths by massive bleeding was the group of 30 to 39 years. The resolution of the pregnancy was by cesarean in most cases. The cases of placenta accrete and uterine atony were others maternal death causes. CONCLUSIONS: the massive bleeding during pregnancy, birth and/or postpartum continues as the second leading cause of maternal mortality in the IMSS. It is necessary to continue training for improving (the performance) in the management of the pregnancy woman with hemorrhage.

[Clinical guideline. Obstetrical hemorrhage in the second half of pregnancy]. / Guía de práctica clínica. Hemorragia obstétrica en la segunda mitad del embarazo.

Pregnancy at older ages and the increased frequency of caesarean births may increase the incidence of diseases associated with obstetric haemorrhage. Obstetric haemorrhage is the second leading cause of maternal mortality, preceded only by preeclampsia-eclampsia in Mexico and the Instituto Mexicano del Seguro Social. In recent years several studies have been conducted to improve the detection, diagnosis and treatment of women at risk of obstetric haemorrhage to reduce maternal and perinatal mortality. The objective of this clinical practice guideline is defining recommendations based in the best available evidence to standardize actions regarding the diagnosis and management of obstetric haemorrhage in hospital units.

[A clinical practice guideline for diagnosis and treatment of chronic obstructive pulmonary disease]. / Guía de práctica clínica. Diagnóstico y tratamiento de la enfermedad pulmonar obstructiva crónica.

The World Health Organization (WHO) in 2000 considered that 274 million people died in the world because of chronic obstructive pulmonary disease (COPD). Global mortality by COPD depends on the stage of the disease and 30 to 48 % die during the next four to seven years after the diagnosis. The global burden of disease for the 2020 measurement through the years of potential life lost (YPLL) estimates that COPD is in the 10th place at world-wide level. The great variability in the care of the patients with COPD, as well as the increase in the number of patients with acute exacerbations makes necessary the development of a clinical practice guideline to standardize the treatment and the interventions of rehabilitation, nutrition in the three levels of health care with the objective to improve the quality of care and to promote the efficient use of the resources.

[The clinical guidelines of practice project at the Instituto Mexicano del Seguro Social]. / Proyecto para el desarrollo de guías de práctica clínica en el Instituto Mexicano del Seguro Social.

The advance in the knowledge and technology is growing quickly and greater quantity, so it is difficult for the health professional to access to whole information that is generated every day on diagnostic and therapeutic strategies more effective, so the clinic practice guidelines (CPG) is a resource to support the updating of the health professional and support them in making clinical decisions. The CPG is also a better support to the manager of health services in making decisions regarding the strategies that have performed for the patient and less risk to the individual and collective health. They also support the response capacity of the medical units and hospitals and guide the planning of services to the optimization of the resources. This paper summarizes the methodology of a national project for the development of GPC coordinated by the Mexican Social Security Institute with the collaboration of more than 1200 health professionals of the institution in a great effort institutional update and make information accessible to the entire health sector, which also defines the steps to upgrade and maintain the updating of knowledge and technology expressed in them.

[Epidemiological pattern of breast cancer mortality in Mexico State]. / Patrón epidemiológico de la mortalidad por cáncer de mama en el Estado de México.

BACKGROUND: breast cancer (BC) is the leading cause of death secondary to malignancy in women. It ranks third in mortality in women in reproductive age, produced by non-modifiable (genetic and hormonal) and modifiable factors. Our objective was to describe and analyze the epidemiological characteristics of deaths from BC in the State of Mexico. RESULTS: of 273 verbal autopsies, the most common age (23.07 %) was between 40 and 49 years. The educational level of schooling were complete elementary school (20.51 %), incomplete elementary school (19.04 %) and complete high school (13.91 %). the institution with the highest number of patients was the Instituto Mexicano del Seguro Social with 139 (50.91 %). The towns with a higher frequency were Malinalco, Ayapango, Atizapán, Zacualpan and Apaxco. The Mortality was higher in Valle de Bravo, Coatepec Harinas and Toluca. CONCLUSIONS: the increase in BC has permitted the emergence of a new hypothesis known as endocrine disruption, according to this premise, this results from exposure to chemicals introduced into the environment by human activity capable of altering the hormonal balance.

[The clinical guidelines as a potential tool to improving health care quality]. / El potencial de las guías de práctica clínica para mejorar la calidad de la atención.

There is an increasing demand to ensure quality in the providing and receiving health care. Health care services face different challenges, such as: a growing aging population, increasing care costs, variations in clinical practice, and a fasting increase in the generation of information on diagnostic methods and therapies. In this context, a wave of development and use of clinical guidelines (CGL) based on scientific evidence has emerged worldwide, with the aim to creating tools to promote clinical excellence in practice. Our country and the Instituto Mexicano del Seguro Social (IMSS), with its experience in developing CGL has joined this trend as a main project. It is beneficial for IMSS health professionals and their patients. The aim of this paper is to present general information on definitions, structure, quality standards, development proceedings, updating, and potential advantages and disadvantages by using CGL. To achieve the expectations of a positive impact on quality and the health care budget distribution, health care personnel must be open to and receptive to the CGL recommendations and be flexible in changing their clinical practice.

[Prescription of temporal disability certificates in workers attending to IMSS from the perspective of health economy]. / Prescripción de certificados de incapacidad temporal en el IMSS. Perspectiva desde la economía de la salud.

The repercussion of health-disease state on social life or individual includes his/her work performance. In many countries, social security is one of the options for diffusing and buffering the impact of the disease. This paper is focused on the analysis of the unjustified prescription of temporary sick leave certificates (CITT), which combines the social security medical components and economic benefits (subsidies). The objective is to analyze the mechanism of prescription of CITT from the perspective of health economics and health care services. The detailed flow of CITT at the Mexican Institute of Social Security is described, as are some concepts of the health economics perspective that contribute to explain the prescription of CITT. Statistical data of sick leaves due to work-related and non-work-related diseases are presented from the institutional perspective. Finally, it is emphasized that although CITT are a medical prescription, it is advisable to take into account the economic perspective and its concepts in order to achieve an efficient use of resources.