[Developments in medical units. 1915]. / Sucesos en las Unidades Médicas: 1915.

In 1915 the political, economic, and social instability initiated the destruction of medical units; they had no administrative bases and they lacked the resources. However, needs encouraged that structures arose to meet the wounded, fractured, and traumatized, called "blood" hospitals and so-called crosses and sanitary trains.

[Revista Médica del IMSS: Institutional heritage and Important reference]. / Revista Médica del IMSS: patrimonio institucional e importante referente formativo.

In a context that has tended towards globalization, in which obtaining economic resources is usually the driving force of societies, information resources have frequently been treated as private goods for which one must pay. A strategy for the above has been open and free access to information, a factor of great importance for the construction of more open media.

En un contexto que ha tendido a lo globalizado, en el que la obtención de recursos económicos suele ser el motor de las sociedades, los recursos de información han sido tratados con frecuencia como bienes privados por los que hay que pagar. Una estrategia a lo anterior ha sido el acceso abierto y gratuito a la información, un factor de gran importancia para la construcción de medios más abiertos.

Application of artificial neural networks in assigned leadership and academic success in medical graduates.

OBJECTIVE: To apply an artificial neural networks analysis (ANN) model to identify variables that predict assigned leadership and academic success in graduates of six generations of medical school. METHOD: Analytical, retrospective, comparative study. A total of 1434 graduates participated. A questionnaire was sent to them by e-mail including a voluntary participation consent. A multivariate statistical analysis using multi-layer perceptron ANN, decision trees and driver analysis was performed. RESULTS: The ANN identified seven independent variables that predicted professional success and eight for leadership in medical graduates. The decision trees identified significant differences in the variables professional performance (p = 0.000), age (p = 0.005) and continuing education activities (p = 0.034) related to professional success, and for leadership the variables gender (p = 0.000), high school grades (p = 0.042), performing clinical practice during the social service year (p = 0.002) and continuing education activities (p = 0.011). CONCLUSIONS: The ANN identified the main independent predictor variables of professional success and leadership of the graduates. This study opens up two new lines of research little studied with the techniques of in the area of medicine.

OBJETIVO: Aplicar un modelo de análisis de redes neuronales artificiales (RNA) para identificar las variables que predicen el liderazgo asignado y el éxito académico en egresados de seis generaciones de la carrera de Medicina. MÉTODO: Estudio analítico, retrospectivo y comparativo. Participaron 1434 egresados. Se envió un cuestionario por correo electrónico que incluyó el consentimiento de participación voluntaria. Se realizó análisis estadístico multivariado mediante RNA del tipo perceptrón multicapa, árboles de decisión y análisis de impulsores. RESULTADOS: Las RNA identificaron siete variables independientes que predijeron el éxito profesional y ocho para el liderazgo en los médicos egresados. Los árboles de decisión identificaron diferencias significativas en las variables desempeño profesional (p = 0.000), edad (p = 0.005) y actividades de educación continua (p = 0.034) relacionadas con el éxito profesional, y para el liderazgo las variables sexo (p = 0.000), promedio en el bachillerato (p = 0.042), realizar práctica clínica en el servicio social (p = 0.002) y actividades de educación continua (p = 0.011). ­. CONCLUSIONES: Las RNA identificaron las principales variables independientes predictoras del éxito profesional y el liderazgo de los egresados. El estudio abre dos líneas de investigación poco estudiadas con las técnicas de RNA en el área de la medicina.

[First steps of medical administration at the IMSS]. / Primeros pasos de la administración médica en el IMSS.

The creation of an institution as large as the Instituto Mexicano del Seguro Social (IMSS) required a lot of planning to manage all the benefits provided to the population. Thus, it is necessary to have health personnel with knowledge and experience in health services administration. This manuscript is an acknowledgment to doctors Manuel Barquín Calderón, Antonio Ríos Vargas and Carlos Zamarripa Torres, pioneers and recognized protagonists in the planning and organization (administration) of the IMSS medical services between 1945 and 1955, who also had rational initiatives and constructive, doing their duty. On the other hand, the Institute exposed and projected that medical-administrative activities were a complex task, and that its practice required specialized knowledge that could not be left to chance, empiricism, good will, beliefs or nonobjective imagination.

La creación de una organización tan grande como el Instituto Mexicano del Seguro Social (IMSS) requirió de mucha planeación para lograr administrar todas las prestaciones que se brindan a la población. Siendo así una necesidad contar con personal de salud con conocimientos y experiencia en administración en servicios de salud. El presente manuscrito es un reconocimiento a los doctores Manuel Barquín Calderón, Antonio Ríos Vargas y Carlos Zamarripa Torres, pioneros y protagonistas reconocidos en la planeación y organización (administración) de los servicios médicos del IMSS entre 1945 y 1955, quienes además tuvieron iniciativas racionales y constructivas, cumpliendo con su deber. Por otro lado, el Instituto expuso y proyectó que las actividades médico-administrativas eran una tarea compleja, y que su práctica necesitaba conocimientos especializados que no podían dejarse al azahar, al empirismo, a la buena voluntad, a las creencias o a la imaginación no objetiva.

[Farewell to a great doctor and extraordinary believer, creator of Quality of Care: Dr. Héctor Aguirre Gas]. / Despedida a un gran médico y extraordinario creyente, creador de la Calidad de la Atención: Dr. Héctor Aguirre Gas.

From these lines a farewell is expressed to Dr. Héctor Gerardo Aguirre Gas, excellent doctor and great exponent of the Quality of Medical Care and Patient Safety, trained and servant in the medical services of the Instituto Mexicano del Seguro Social (IMSS), noble companion and friend. A man with universal ethical values and a straight and humble figure, active and bold behavior, committed to serving others.

Desde estas líneas se expresa una despedida al Dr. Héctor Gerardo Aguirre Gas, excelente médico y gran exponente de la Calidad de la Atención Médica y Seguridad del Paciente, formado y servidor en los servicios médicos del Instituto Mexicano del Seguro Social (IMSS), noble compañero y amigo. Un hombre con valores éticos universales y una figura recta y sencilla, proceder activo y audaz, empeñado en servir al prójimo.

[In memory of the first editor of the Revista Médica del IMSS]. / En recuerdo del primer editor de la Revista Médica del IMSS.

This article is dedicated to the memory of doctor Francisco Olvera Esnaurrizar (1929-2019), first editor of the Revista Médica del Instituto Mexicano del Seguro Social -Medical Journal of the Mexican Institute for Social Security- (1962-1973).

El presente artículo está dedicado a la memoria del doctor Francisco Olvera Esnaurrizar (1929-2019), primer editor de la Revista Médica del Instituto Mexicano del Seguro Social (1962-1973).

[Historical analysis of the hospital bed]. / Historia de la cama de hospital. Investigación en diversos lugares y tiempos.

Until now the bed has been the basic physical resource in hospitals. This type of furniture has served to study and treat patients, through out the centuries it has undergone changes in the materials they are made of dimensions, functionality, accessories, aesthetic, and design. The hospital bed history is not well known, there are thousands of documents about the evolution of hospitals, but not enough is known about hospital beds, a link between the past and the present. The medical, anthropological, technological, social, and economic dynamics and knowledge have produced a variety of beds in general and hospital beds in particular. From instinctive, rustic, poor and irregular "sites" that have differed in shape and size they had evolved into ergonomic equipment. The history of the hospital bed reflects the culture, techniques and human thinking. Current hospital beds include several types: for adults, for children, for labor, for intensive therapy, emergency purposes, census and non census beds etc.

Characteristics among six generations of medicine graduates.

BACKGROUND: Medical graduates follow-up programs allow the improvement of the curriculum of the Medicine career. Through identifying opportunity areas and strengthening points, institutions become increasingly competitive. OBJECTIVE: Identify the socio-demographic, formative, labor insertion and satisfaction characteristics among six generations of graduates of the Medical School of the Faculty of Medicine of the National Autonomous University of Mexico (2004-2009). METHOD: It is a descriptive, cross-sectional, retrospective, comparative study integrating the answers of mailed electronic questionnaires to 5295 graduates who concluded studies between 2004 and 2009. Descriptive and inferential techniques were used for analysis. RESULTS: An upward trend in the number of years to conclude the career was identified and an increase in failed assignments in the last three generations. Noticeable was also that, as time went by, the incorporation of physicians into the labor market was slower. Although the percentage of general unemployment was very low (2.9%). CONCLUSIONS: There are no major changes in the characteristics of the Medicine graduates. Although it is necessary to identify the reason for the increased in failed assignments which affects the length of completion. Further improvement in Research and Social Medicine programs are to be considered.

ANTECEDENTES: Los programas de seguimiento de egresados permiten mejorar los programas y el currículo de la carrera de Medicina, identificando las áreas de oportunidad y haciendo más competitivas a las instituciones educativas. OBJETIVO: Identificar las características sociodemográficas, formativas, de inserción laboral y de satisfacción, en seis generaciones de egresados de la carrera de Medicina de la Universidad Nacional Autónoma de México (2004-2009). MÉTODO: Estudio descriptivo, transversal, retrospectivo y comparativo, con 5295 egresados de la carrera de Medicina que concluyeron entre 2004 y 2009. Se envió un cuestionario por correo electrónico a cada uno de los egresados y se analizaron los resultados mediante técnicas descriptivas e inferenciales. RESULTADOS: Se observó un incremento en el número de años para concluir la carrera y un aumento en el número de materias reprobadas en las últimas tres generaciones. Además, hubo mayor lentitud en la inserción laboral en el mismo periodo, aunque el porcentaje de desempleo general fue muy bajo (2.9%). CONCLUSIONES: No hay cambios en la caracterización de los egresados respecto a generaciones anteriores; no obstante, será fundamental identificar las causas del incremento en el número de materias reprobadas que está afectando la eficiencia terminal, además de mejorar los programas de investigación epidemiológica y socio-médica.

Management of medical care, a fundamental tool for resident doctors.

In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young medical doctors begin a residence at hospitals, they hardly possess knowledge about the way medical services work as well as the processes they involve, which directly affects the fulfillment of their tasks, their process of learning and more importantly, it interferes in the services provided by the hospital. Therefore, it is imperative to immerse residents in the management of medical care and let them know that its main function is to harmoniously articulate every medical-administrative process related to patients as well as human, material and financial resources. One of the main goals is to achieve the fulfillment of the hospital's mission and vision with operational efficiency and humanism. This path will help physicians to make the best decisions, as well as achieving an adequate management of resources always remembering that quality in medical services and patient's safety are important.

En el área de la enseñanza médica, y particularmente dentro de nuestro país, las residencias médicas en hospitales son el mejor modelo para realizar un posgrado; sin embargo, cuando un médico joven inicia su residencia y arriba a un hospital, difícilmente posee los conocimientos de los servicios, tipo de pacientes y procesos que se realizan en dicho lugar, lo que repercute directamente en el cumplimiento de sus tareas, aprendizaje y, más importante, los servicios que ofrece el hospital. Por lo tanto, es imperante hacer partícipes a los médicos residentes en la gestión de la atención médica, darles a conocer que esta es la encargada de articular de forma armónica todos los procesos médico-administrativos en los que participan pacientes, recursos humanos, materiales y financieros, para alcanzar el cumplimiento de la misión y la visión hospitalaria con eficiencia operativa y sentido humano. De esta manera será posible orientarlos a realizar una correcta toma de decisiones y una gestión adecuada de los recursos, y a que su contribución en los procesos médico-administrativos brinde un servicio de calidad y seguridad para el paciente.

[A brief historical account of IMSS hospital in Orizaba, Veracruz]. / Breve historia de los hospitales del IMSS en Orizaba, Veracruz.

In 1947, Orizaba City was chosen, due its political, economic and labor importance, for the Instituto Mexicano del Seguro Social (IMSS) to establish its health service in Veracruz State. At the beginning, hospital care was rented out at the Hospital Civil "Ignacio de la Llave." In 1959 a hospital was specifically constructed and had 280 beds. In 1973 a earthquake partially destroyed the hospital building and the medical services were almost discontinued. In 1975 it was rebuilt, and was renamed "Ignacio García Téllez," who had been a founder member of IMSS. At the beginning the main causes of hospital admissions were infectious diseases and gynecologic and obstetric problems; at present the challenges are the chronic diseases and accidents.

Management of medical care, a fundamental tool for resident doctors. / Gestión de la atención médica, herramienta fundamental para los médicos residentes

In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young medical doctors begin a residence at hospitals, they hardly poses knowledge about the way medical services work as well as the processes they involve, which directly affects the fulfillment of their tasks, their process of learning and more importantly, it interferes in the services provided by the hospital. Therefore, it is imperative to immerse residents in the management of medical care and let them know that its main function is to harmoniously articulate every medical-administrative process related to patients as well as human, material and financial resources. One of the main goals is to achieve the fulfillment of the hospital's mission and vision with operational efficiency and humanism. This path will help physicians to make the best decisions, as well as achieving an adequate management of resources always remembering that quality in medical services and patient's safety are important.

En el área de la enseñanza médica, y particularmente dentro de nuestro país, las residencias médicas en hospitales son el mejor modelo para realizar un posgrado; sin embargo, cuando un médico joven inicia su residencia y arriba a un hospital, difícilmente posee los conocimientos de los servicios, tipo de pacientes y procesos que se realizan en dicho lugar, lo que repercute directamente en el cumplimiento de sus tareas, aprendizaje y, más importante, los servicios que ofrece el hospital. Por lo tanto, es imperante hacer partícipes a los médicos residentes en la gestión de la atención médica, darles a conocer que esta es la encargada de articular de forma armónica todos los procesos médico-administrativos en los que participan pacientes, recursos humanos, materiales y financieros, para alcanzar el cumplimiento de la misión y la visión hospitalaria con eficiencia operativa y sentido humano. De esta manera será posible orientarlos a realizar una correcta toma de decisiones y una gestión adecuada de los recursos, y a que su contribución en los procesos médico-administrativos brinde un servicio de calidad y seguridad para el paciente.

Primeros pasos de la administración médica en el IMSS / First steps of medical administration at the IMSS

La creación de una organización tan grande como el Instituto Mexicano del Seguro Social (IMSS) requirió de mucha planeación para lograr administrar todas las prestaciones que se brindan a la población. Siendo así una necesidad contar con personal de salud con conocimientos y experiencia en administración en servicios de salud. El presente manuscrito es un reconocimiento a los doctores Manuel Barquín Calderón, Antonio Ríos Vargas y Carlos Zamarripa Torres, pioneros y protagonistas reconocidos en la planeación y organización (administración) de los servicios médicos del IMSS entre 1945 y 1955, quienes además tuvieron iniciativas racionales y constructivas, cumpliendo con su deber. Por otro lado, el Instituto expuso y proyectó que las actividades médico-administrativas eran una tarea compleja, y que su práctica necesitaba conocimientos especializados que no podían dejarse al azahar, al empirismo, a la buena voluntad, a las creencias o a la imaginación no objetiva.

The creation of an institution as large as the Instituto Mexicano del Seguro Social (IMSS) required a lot of planning to manage all the benefits provided to the population. Thus, it is necessary to have health personnel with knowledge and experience in health services administration. This manuscript is an acknowledgment to doctors Manuel Barquín Calderón, Antonio Ríos Vargas and Carlos Zamarripa Torres, pioneers and recognized protagonists in the planning and organization (administration) of the IMSS medical services between 1945 and 1955, who also had rational initiatives and constructive, doing their duty. On the other hand, the Institute exposed and projected that medical-administrative activities were a complex task, and that its practice required specialized knowledge that could not be left to chance, empiricism, good will, beliefs or nonobjective imagination.

[Profiles and remains of the first hospital in America: the Hospital San Nicolás de Bari, in Santo Domingo, Dominican Republic]. / Perfiles y ruinas del primer hospital de América: Hospital San Nicolás de Bari, en Santo Domingo, República Dominicana.

The first hospital services in America were created in the Dominican Republic--formerly known as the Espariola--by a black woman at the beginning of the Conquest. In 1503 fray Nicolá de Ovando, second governor of the Española built what nowadays would be considered a hospital and named it Hospital San Nicolás de Bari (Saint Nicholas Hospital). During the Colony, the poor and sick were cared for following the precepts of the Catholic religion in the San Nicolas de Bari Hospital. In 1586 the hospital was badly damaged due to a pirate's attack. During the XVIII century the hospital cared for ill soldiers and so its name was changed to Hospital Militar (Military Hospital). Between 1795 and 1865 the social and political conditions under which the hospital had to operate made running the hospital a tremendously hard task. Today, the physical ruins of the Hospital San Nicolás de Bari--built in typical Spanish colonial style--with thick fortress like walls and stone floors echoes a place where rustic beds were used to care for patients. The San Nicolás de Bari Hospital operated for over 350 years. It finally disappeared during the second part of the XIX century after undergoing severe financial restrictions and lack of supplies and personnel that in the end hampered its work.

[Historical exploration of Acapulco hospitals, Guerrero, Mexico]. / Explorando la historia de los hospitales de Acapulco, Guerrero.

This study attempts to recount the history of the main hospitals of the port of Acapulco from colonial times until the end of the 20th century. The Augustine friars began hospital care at the end of the first part of the 16th century. Later, Bernardino Alvarez (1514?-1584), with the support of the Spanish crown, founded the first formal hospital in Acapulco called Hospital de Nuestra Señora de la Consolación (Our Lady of Consolation Hospital). During the 16th and 17th centuries, the sick were attended by friars, and by the end of the 19th century there were physicians and surgeons. From the end of the Independence War until the end of the 19th century, the port did not have any true hospital. The first degreed physicians and surgeons arrived and resided in Acapulco in 1920. In 1938, the Hospital Civil Morelos (Morelos Civil Hospital) began providing services. It was replaced by the Hospital General de Acapulco (General Hospital of Acapulco). At the fourth decade of the past century the Cruz Roja (Red Cross) was created. In 1957 the hospital services of the Instituto Mexicano del Seguro Social (IMSS, Mexican Institute of Social Security), which was founded in 1963, was inaugurated with the Unidad Medico/Social (Medical and Social Unit) of the IMSS in Acapulco. This began the journey of modernity in Acapulco. In 1992, Hospital Regional Vicente Guerrero (Regional Hospital Vicente Guerrero) of the IMSS, initiated its services. In 1960, medical services for civil workers and their families were housed in the Hospital Civil Morelos (Morelos Civil Hospital). Shortly afterwards, the Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE, Security and Social Services Institute for State Employees) had their own hospital. During the 20th century, Acapulco has added other hospital services to care for members of the navy and armed forces, as well as for those persons with financial resources for private care.

[The first three hospitals in Oaxaca City, Mexico]. / Los tres primeros hospitales de la ciudad de Oaxaca.

The first hospitals of Oaxaca City were San Cosme and San Damián Hospital, Santa Caterina Hospital, and Nuestra Señora de Guadalupe Hospital; the foundation and operation of the hospitals were linked to the Catholic Church. The hospitals were created during colonial times. The hospitals disappeared at the end of the XVIII century and the beginning of the XIX century due to financial problems, political situations and disgrace of the religious orders. The hospitals took care of the sick, the poor and the homeless. Patients were treated with prayers, penitences, and vegetal, animal and mineral products.

[Brief history of hospital care in Tapachula, Chiapas, Mexico]. / Escudriñando la historia de la atención hospitalaria en Tapachula, Chiapas.

This paper presents the history of hospital care in Tapachula, Chiapas. Hospital services began 100 years ago. At present there is one government hospital, hospitals of the Social Security systems, private hospitals and one hospital of the Mexican Red Cross. Hospital services have been oriented to attend labor and delivery, infectious diseases, malnutrition and accidents.

[Four stages in the history of the Centro Médico Nacional Siglo XXI of the IMSS]. / Cuatro etapas en la historia del Centro Médico Nacional Siglo XXI del IMSS.

This document presents four stages in the history of the Centro Médico Nacional Siglo XXI (Centro Médico Nacional XXI Century) of the Instituto Mexicano del Seguro Social. The first stage started at the end of the third decade of the twentieth century and ended in 1961, it corresponded to the conception, planning and construction of what was to be the Centro Médico del Distrito Federal (Centro Médico of the Distrito Federal) belonging to the Secretaría de Salubridad y Asistencia (Ministry of Health and Assistance). The second stage began when the Center was acquired by the Institute, then was known like Centro Médico Nacional (Centro Médico Nacional ), being put into full operation in 1963, more than twenty-two years later, in 1985, an earthquake virtually ended it, immediately began its reconstruction, finishing the second stage. In 1989 began the third stage, different and new buildings complemented or replaced the structures damaged or destroyed by the earthquake which formed the now Centro Médico Nacional Siglo XXI (Centro Médico Nacional XXI Century). In 2004 the fourth stage opened when the four hospitals of the Center were categorized like Unidades Médicas de Alta Especialidad (High Specialized Medical Units).

En este documento se presenta en cuatro etapas la historia del hoy Centro Médico Nacional Siglo XXI del IMSS. La primera etapa se inició a fines de los años treinta del siglo XX y terminó en 1961, correspondió a la concepción, planeación y construcción de lo que iba a ser el Centro Médico del Distrito Federal que pertenecía a la Secretaría de Salubridad y Asistencia. La segunda etapa inició cuando el Centro fue adquirido por el Instituto Mexicano del Seguro Social, conociéndose como Centro Médico Nacional, el cual fue puesto en funcionamiento completamente en 1963; más de veintidós años después, en 1985, un sismo prácticamente lo acabó, aunque de inmediato se inició su reconstrucción, la cual terminó en 1989, año en que comenzó la tercera etapa. Fue entonces cuando diferentes y nuevas construcciones complementaron o sustituyeron a las edificaciones dañadas o destruidas por el temblor, que son las que hasta el día de hoy conforman el Centro Médico Nacional Siglo XXI. En el año 2004 se abrió la cuarta etapa, al categorizarse a los cuatro hospitales que configuran el Centro Médico Nacional Siglo XXI como Unidades Médicas de Alta Especialidad (UMAE).

[The dimension of the paradigm of complexity in health systems]. / La dimensión del paradigma de la complejidad en los sistemas de salud.

This article presents elements to better understand health systems from the complety paradigm, innovative perspective that offers other ways in the conception of the scientific knowledge prevalent away from linear, characterized by the arise of emerging dissociative and behaviors, based on the intra and trans-disciplinarity concepts such knowledges explain and understand in a different way what happens in the health systems with a view to efficiency and effectiveness. The complexity paradigm means another way of conceptualizing the knowledge, is different from the prevalent epistemology, is still under construction does not separate, not isolated, is not reductionist, or fixed, does not solve the problems, but gives other bases to know them and study them, is a different strategy, a perspective that has basis in the systems theory, informatics and cybernetics beyond traditional knowledge, the positive logics, the newtonian physics and symmetric mathematics, in which everything is centered and balanced, joint the "soft sciences and hard sciences", it has present the Social Determinants of Health and organizational culture. Under the complexity paradigm the health systems are identified with the following concepts: entropy, neguentropy, the thermodynamic second law, attractors, chaos theory, fractals, selfmanagement and self-organization, emerging behaviors, percolation, uncertainty, networks and robusteness; such expressions open new possibilities to improve the management and better understanding of the health systems, giving rise to consider health systems as complex adaptive systems.

[Mexico's healthcare in the 20th century]. / La Atención Médica en Mexico a lo Largo del Siglo XX.

The purpose of this article is to present Mexico's healthcare in the 20th century. This was a process that was based on illustrated rationalism, positivism and neopositivism. Knowledge and science used to veer away from all aspects of charity and beneficence. Liberal legacy were favourable to government stocks and the state managed to raise a considerable amount of financial and human resources.