[El consentimiento informado: recomendaciones para su documentación].

Informed consent is an indispensable element to obtain adequate patient participation either in research protocols or in therapeutic design. The Committee of Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine developed several recommendations for informed consent to be documented.

El consentimiento informado es un elemento indispensable para obtener la adecuada participación del paciente, ya sea en protocolos de investigación o en diseños terapéuticos. El Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI) de la Academia Nacional de Medicina elaboró varias recomendaciones para documentar el consentimiento informado.

[Transition from Millennium Development Goals to Sustainable Development Goals from the perspective of the social determinants of health and health equity]. / La transición de los Objetivos de Desarrollo del Milenio a los Objetivos de Desarrollo Sostenible desde la perspectiva de los determinantes sociales de la salud y la equidad en salud.

The United Nations Declaration of 2000 agreed on eight millennium development goals (MDGs) to be met in 2015. The results show that poverty continues through population growth and advances in both rich and poor countries are threatened by economic crises and inequities in geographic areas and population groups within countries. In a globalized world with great social and economic inequalities, from the perspective of the social determinants of health (SDH), the relevance of the new 17 sustainable development goals (SDGs) is greater. Faced with the health challenges in our country to achieve SDGs, the symposium "The transition from MDGs to SDGs from the perspective of SDH and health equity" was presented at the XLIV Congress of the National Academy of Medicine. The presentations dealt with five important aspects of the transition in Mexico: background and context; the current state of the MDGs in childhood; the impact on gender equity and adolescent fertility; the health system and the theme of environmental health and were presented by Dr. Raffaela Schiavon, Jacobo Finkelman, Luis Jasso and Rafael Lozano.

Recommendations to improve healthcare of neonates with respiratory insufficiency beneficiaries of Seguro Popular.

OBJECTIVE: To evaluate the structure and processes of care of neonatal intensive care units (NICU) providing health care to neonates with respiratory insufficiency, and financed by Seguro Popular. MATERIALS AND METHODS: A cross-sectional design was used; 21 NICU were included. Information was collected from four sources: Seguro Popular database, self-applicable interviews to medical staff, structure and processes format, and reviews of clinical charts. VARIABLES: structure, processes of care, drug supplies, training, and neonates' clinical conditions. RESULTS: The analysis of the database included 9 679 newborns. The respiratory disorders were transitory tachypnea, non-specific respiratory insufficiency, respiratory distress syndrome, (RDS) perinatal asphyxia, and meconium aspiration syndrome. 90% of NICU'S directors considered that drug supply was good, whereas only 16% of neonatologist had this opinion. 58.5% of neonates with RDS had <37 gestation weeks. 34.2% with RDS were prescribed alveolar surfactant; 51% received dosages above recommended standards. CONCLUSIONS: Recommendations to improve infrastructure and care processes are issued.

Quality of health care of the medical units that provide services for Medical Insurance for a New Generation enrollees.

OBJECTIVE: In this evaluation we assess the quality of the general and clinical structure in medical units that deliver health services for the Medical Insurance for a New Generation (SMNG) enrollees. MATERIALS AND METHODS: The study population included 82 medical units that deliver health services to enrollees of the SMNG in 15 states of Mexico, during 2009. Two indexes: the general structure index and the clinical structure index were created. RESULTS: It was found an unequal quality of the general and clinical structure in the different levels of care. The results suggest that the first level of care lacks both important general and clinical structural items. They also show on average a regular quality in the second level of care and a good quality in the third level of care medical units. CONCLUSIONS: Our results support the main conclusion of the work of Bulatao, "Improving services requires moving beyond policy reform to strengthening implementation of services".

The use of the tracer methodology to assess the quality of care for patients enrolled in Medical Insurance for a New Generation.

OBJECTIVE: To assess the quality of care provided at medical units that provide services to Medical Insurance for a New Generation (SMNG) enrollees. MATERIALS AND METHODS: The tracer methodology was used in a sample of 82 medical units selected in fifteen states of Mexico and data collected in November 2009. RESULTS: Problems were found to locate the minimal number of the 18 medical charts requested in three of the tracers. The first level of care on the average reports that the quality of the process of care is 6, in a 10 point scale. In the second level improves and the third level of care is better qualified. CONCLUSIONS: The tracer methodology has enabled us to assess the quality of care. There is room for improvement in the medical units of the state health services, to that end should be directed the efforts in the health system in Mexico.

Design of the 2009 evaluation of the Medical Insurance for a New Generation program.

OBJECTIVE: To describe the mixed-method approach to evaluate the Medical Insurance for a New Generation (Seguro Médico para una Nueva Generación, SMNG). MATERIALS AND METHODS: The program has been comprehensively evaluated. It has four key domains: 1) SMNG design; 2) children's health status and socio-demographic characteristics; 3) performance by measuring coverage, efficiency and productivity; 4) family health expenditure. Quantitative and qualitative research approaches have been used. This included reviews of existing databases and clinical charts, collection of empirical data through in-depth interviews with healthcare providers, and a nation-wide household survey. CONCLUSION: The results should serve as baseline data of the health status of SMNG children and the current staus of the program.

[Comparative profile of medications at the "Hospital Infantil de México" and the "Instituto Mexicano del Seguro Social"]. / Perfil comparativo de medicamentos en el Hospital Infantil de México y el Instituto Mexicano del Seguro Social.

BACKGROUND: Compare the distribution of medications according to therapeutic groups (TGs) as a function of codes, cost, price weighted index (PWI) and volume between the Instituto Mexicano del Seguro Social, a conglomerate of hospitals and family medicine clinics and the Hospital Infantil de México "Federico Gómez" a tertiary care referral pediatric hospital. METHODS: Medications were classified by TGs according to drug code, purchase cost, PWI, and volumes purchased. RESULTS: TGs showed similar profiles according to cost of purchase, volume and code numbers, not according to PWI. There were only minor differences in cost among the 15 most expensive medications among both institutions. CONCLUSIONS: Despite the marked asymmetry between both institutions, drug profiles were not significantly different, to a large extent due to the fact that the Hospital Infantil de Mexico acquires all TGs.

Descriptive study of adverse drug reactions in a tertiary care pediatric hospital in México from 2014 to 2017.

INTRODUCTION: In Pediatrics, adverse drug reactions (ADRs) affect morbidity and mortality. In Mexico, the characteristics of ADRs and suspect drugs have not been described in hospitalized children. OBJECTIVE: To estimate the frequency of ADRs and describe them, as well as suspect drugs, in a tertiary care pediatric hospital in Mexico. METHODS: A total of 1,649 Hospital Infantil de Mexico Federico Gómez ADR reports were analyzed. Completeness of the information was assessed, and ADRs severity and seriousness were assigned based on NOM-220-SSA1-2012, with causality being established according to the Naranjo algorithm. ADRs were classified with WHO Adverse Drug Reaction Terminology (WHO-ART). The drugs involved in ADRs were categorized according to the Anatomical Therapeutic Chemical (ATC) classification. Descriptive analysis was performed using the SPSS 20 statistical package. RESULTS: Of all the reports, 5.8% lacked sufficient information for the analysis (grade 0). ADRs frequency ranged from 2.12% to 8.07%. ADRs occurred most commonly in children (56.9%), in the female gender (52%), in subjects with normal BMI Z-score (46.6%) and malnutrition (35.3%), diagnosed with neoplasms (72.2%) and in the Emergency Department (70.0%). ADRs were severe in 14.4% of cases, in 81.0% they were serious and 2.1% were classified as definite. Most common serious ADR was febrile neutropenia (44.5%). The 0.7% of patients recovering with sequelae; 1.1% died (with the medication being associated) and 70.3% were admitted to the hospital as a result of an ADR. Antineoplastic and immunomodulating agents were more commonly associated with serious ADRs. CONCLUSION: ADRs affected morbidity and mortality, which is why strengthening pharmacovigilance programs in Mexican pediatric hospitals is necessary.

Potential drug-drug interactions and their risk factors in pediatric patients admitted to the emergency department of a tertiary care hospital in Mexico.

BACKGROUND: Drug-drug interactions (DDIs) detected in a patient may not be clinically apparent (potential DDIs), and when they occur, they produce adverse drug reactions (ADRs), toxicity or loss of treatment efficacy. In pediatrics, there are only few publications assessing potential DDIs and their risk factors. There are no studies in children admitted to emergency departments (ED). The present study estimates the prevalence and describes the characteristics of potential DDIs in patients admitted to an ED from a tertiary care hospital in Mexico; in addition, potential DDI-associated risk factors are investigated. METHODS: A secondary analysis of data from 915 patients admitted to the ED of the Hospital Infantil de México "Federico Gómez" was conducted. The Medscape Drug Interaction Checker software was used to identify potential DDIs. The results are expressed as number of cases (%), means (95% CI) and medians (25-75th percentiles). Count data regressions for number of total and severity-stratified potential DDIs were performed adjusting for patient characteristics, number of administered drugs, days of stay, presence of ADRs and diagnoses. RESULTS: The prevalence of potential DDIs was 61%, with a median of 4 (2-8). A proportion of 0.2% of potential DDIs was "Contraindicated", 7.5% were classified as "Serious", 62.8% as "Significant" and 29.5% as "Minor". Female gender, age, days of stay, number of administered drugs and diagnoses of Neoplasms (C00-D48), Congenital malformations (Q00-Q99), Diseases of the Blood, Blood-forming Organs and Immunity (D50-D89) and Diseases of the nervous system (G00-G99) were significantly associated with potential DDIs. CONCLUSION: The prevalence of potential DDIs in the ED is high, and strategies should therefore be established to monitor patients' safety during their stay, in addition to conducting investigations to estimate the real harm potential DDIs inflict on patients.

[Congenital macroglossia: clinical features and therapeutic strategies in paediatric patients]. / Macroglosia congénita: características clínicas y estrategias de tratamiento en la edad pediátrica.

Congenital macroglossia is a condition that consists in an enlarged tongue that in resting position protrudes beyond the alveolar ridge. It has been classified in two categories: true macroglossia, which occurs in congenital or acquired forms, and relative macroglossia. As this alteration may be due to different causes, its incidence is not known. It is more frequently associated to Beckwith-Wiedemann syndrome, to mucopolysaccharidosis diseases and to Pompe's disease, and it has been less frequently associated to lymphangioma, hemangioma or isolated muscular hypertrophy. Macroglossia is characterized by an enlarged and thick tongue that may have fissures and ulcers, may cause language alterations, difficulties for feeding and swallowing, sialorrhea and recurrent infections of the upper airway or even its obstruction. Its clinical evaluation must include a complete clinical chart with careful physical exploration and a pedigree of that may identify the presence or absence of a hereditary associated syndrome. Macroglossia management is complex. More than twenty different surgical options to reduce the tongue size have been proposed, however, so far there is not a general agreement in this respect. The objective of this work is to review clinical and surgical aspects related to macroglossia from the point of view of non-surgical pediatricians and genetists, addressed to the different medical specialists, including the maxillofacial surgeons involved in the management of these patients.

A comprehensive intervention for adverse drug reactions identification and reporting in a Pediatric Emergency Department.

BACKGROUND: Physicians identify from 45.7 to 96.2 % of Adverse Drug Reactions (ADRs) in their patients, with under-reporting ranging from 6 to 100 %. In order to improve ADR reporting, several interventions have been evaluated in different studies, but not with regard to ADR identification. In addition, it is not known whether some patient characteristics might influence on ADR identification and reporting by physicians. OBJECTIVES: (a) To assess the effectiveness of a comprehensive intervention directed to Emergency Department physicians and coordinated by a pharmacist in a tertiary care pediatric hospital on ADR identification and reporting. (b) To assess if some of the children's characteristics might influence on ADR identification and reporting. Setting The Emergency Department of the Hospital Infantil de México "Federico Gómez", which is a national pediatric institute of health in México. METHODS: A Quasi-experimental, pre-post test trial was designed. During the intervention, the pharmacist gave talks on Pharmacovigilance and on the program for electronic capture of data, took part in patient visits, left reminders, improved accessibility to ADR report format and performed feedback activities. To classify and quantify correctly identified ADRs and ADRs reported to the Institutional Pharmacovigilance Center (IPC), 1136 clinical records were reviewed. The models were adjusted for patient variables. MAIN OUTCOME MEASURES: Total ADRs, ADRs correctly identified by physicians, ADRs reported to the IPC by physicians. Results Before the intervention, 97 % of ADRs were correctly identified and 6.1 % reported by physicians. During the intervention, 99.6 % were correctly identified and 41.2 % were reported, and after the intervention, 99.6 and 41.7 %, respectively. Identification during the intervention showed a sevenfold increase with regard to preintervention and was maintained post-intervention. ADR reporting during the intervention showed a 14-fold increase with regard to pre-intervention and was maintained during post-intervention. CONCLUSION: Physicians do identify ADRs, but fail to report them. The intervention increased ADR correct identification and reporting. The effect was maintained after the intervention.

[Pharmacovigilance IV. The institutional experience]. / Farmacovigilancia IV. La experiencia institucional.

The main purpose of this fourth paper of the pharmacovigilance series proposes to communicate the institutional experience during the year 2003 represented by 890 adverse drug reaction reports (ADRs) and to compare these with the international experience. The therapeutic drug classes more frequently included in these reports were antibiotic and antiparasitic drugs (38.2%) followed by oncologic (17.7%), analgesic (16.6%), and cardiologic drugs (7.1%), among others; the drug most frequently implicated in the reports was sulfamethoxazole-trimethoprim (12%). In addition, we processed data ascertain the 10 drugs most frequently implicated in each therapeutic class, including vaccines and toxoid-group ADRs; using the body system-organ classification, the 20 clinical manifestations most frequently reported are presented herein, skin the most frequently affected organ (874 reports). In relation to severity of suspected adverse drug reactions reported, 68.7% were mild, 26.4% moderate, 3.9% severe, and 0.8%, lethal. This article also includes causality assessment results, quality of information contained in the reports, and patient consequences. After reviewing the results of both the International Drug Monitoring Programme and the Institutional Program during the year 2003, it is possible to conclude that comparisons are similar.

[Pharmacosurveillance III: international experience]. / Farmacovigilancia III. La experiencia internacional.

This article, the third of the series called pharmacovigilance, deals with international experience with adverse drug reactions. It highlights the countries with the greatest cumulative number of reports and how their position changes with the use of the country-adjusted number of reports by million of inhabitants/year. It includes, in decreasing order, the number of reports of twenty therapeutic drug classes. Included in each one are the most plausible explanations for their frequency and, finally, the cumulative number of reports for clinical manifestations of adverse drug reactions.

[Do pediatricians identify adverse drug reactions even when they do not report them?] / ¿Los pediatras detectan las reacciones adversas a medicamentos aunque no las reporten?

INTRODUCTION: Spontaneous notification depends on the ability of pediatricians to identify adverse drug reactions (ADRs) along with their habit of reporting these incidents. During the years 2008 and 2009, the frequency of reports of ADRs to the Electronic Program of Pharmacovigilance (SISFAR) in the Hospital Infantil of Mexico Federico Gomez (HIMFG) was low (0.44% and 0.20%, respectively). Because of the above, the ability of pediatricians from the Emergency Department (ED) to identify ADRs using the clinical chart review was evaluated in 2010 in this study. METHODS: A descriptive, observational, cross-sectional retrospective study was conducted in the ED from March 1 to August 31. ADRs were classified and quantified as "ADRs identified by pediatricians" when there was evidence in the clinical chart that pediatricians associated a clinical sign, symptom and laboratory value with an ADR. The numbers of notifications reported in SISFAR were quantified. Descriptive analysis was done using SPSS v.18. RESULTS: Considering patients who were admitted to the ED, the frequency of ADRs was 21.8%. The frequency of ADRs identified by physicians in clinical charts was 86%. The pharmacist detected 14% of ADRs. The frequency of ADRs reported by physicians was 6.1%. CONCLUSIONS: Although identification of ADRs in the clinical charts by pediatricians was high, it is possible that some ADRs were undetected. Because underreporting was very high, it is necessary to take actions to improve the reporting process.

[Evaluation of the quality of care of transient tachypnea in newborns affiliated with the Medical Insurance Siglo XXI program]. / Evaluación de la calidad de la atención de la taquipnea transitoria en recién nacidos afiliados al Seguro Médico Siglo XXI.

BACKGROUND: Evaluation of the quality of care of the newborn with complications is an indispensable element for the improvement of strategies directed to reduce newborn mortality rates. The aim of this work was to evaluate the quality of technical and interpersonal care in the management of transient tachypnea of the newborn (TTN) of patients affiliated with the program "Medical Insurance Siglo XXI". METHODS: A cross-sectional study was conducted in 61 hospitals affiliated with the Health Ministry with at least two cases of TTN during the first semester of 2011. Variables such as mother's health, pregnancy, birth and birth complication characteristics were analyzed. Also, newborn interventions and health conditions upon discharge were included. To measure the quality of care according to prevention, diagnosis and treatment, quality indicators were defined and validated. RESULTS: We analyzed 256 case files with a diagnosis of TTN; 8.9% of the mothers presented risk factors (asthma, diabetes) and 53.5% had complications during pregnancy. There were 60% of cases with TTN born by cesarean delivery; one third of these children had low birth weight and 14% were transferred to another hospital. As for the quality indicators in the area of prevention, more than 90% of risk factors (smoking, asthma, cesarean delivery) were identified. Diagnostic indicators showed that 86-98% of respiratory distress symptoms were sought. Indicators of treatment achieved satisfactory figures for monitoring and support measures. CONCLUSIONS: Prevention, diagnosis and treatment indicators made it possible to consider that most TTN cases received appropriate treatment. It is advisable to develop effective strategies to prevent TTN, such as increasing efforts to reduce the increasing rates of cesarean deliveries.

Macroglosia congénita: características clínicas y estrategias de tratamiento en la edad pediátrica / Congenital macroglossia: clinical features and therapeutic strategies in paediatric patients

Resumen: La macroglosia congénita es una condición que se caracteriza por una lengua que en posición de reposo protruye más allá del borde alveolar; se ha clasificado en dos categorías: verdadera, que puede ser congénita o adquirida, y relativa. Debido a la asociación de esta alteración con múltiples causas, su incidencia es variable. Es más frecuente que la macroglosia se asocie con el síndrome de Beckwith-Wiedemann, con las mucopolisacaridosis y con la enfermedad de Pompe, y con menor frecuencia a linfangioma, hemangioma o hipertrofia muscular aislada. La macroglosia se caracteriza por una lengua alargada, engrosada o ancha, protruida crónicamente en reposo, con presencia o no de fisuras y úlceras, alteraciones del lenguaje, dificultad para la alimentación y deglución, sialorrea e infecciones recurrentes de la vía respiratoria superior u obstrucción de la misma. Su valoración en niños debe iniciarse con una historia clínica y exploración física completas y con la elaboración de un árbol genealógico de al menos tres generaciones, además de investigar la presencia o no de una entidad sindrómica. Se han propuesto más de 20 técnicas quirúrgicas para resolver la macroglosia congénita; sin embargo, a la fecha no existe consenso para la aplicación de una técnica en particular para reducir su tamaño. En esta revisión se pretende destacar los aspectos clínicos y quirúrgicos de la macroglosia, desde la perspectiva de pediatras no cirujanos y genetistas, dirigido a la comunidad de especialistas médicos que atiende a estos pacientes incluyendo a los cirujanos maxilofaciales que atienden a estos pacientes.

Abstract: Congenital macroglossia is a condition that consists in an enlarged tongue that in resting position protrudes beyond the alveolar ridge. It has been classified in two categories: true macroglossia, which occurs in congenital or acquired forms, and relative macroglossia. As this alteration may be due to different causes, its incidence is not known. It is more frequently associated to Beckwith-Wiedemann syndrome, to mucopolysaccharidosis diseases and to Pompe's disease, and it has been less frequently associated to lymphangioma, hemangioma or isolated muscular hypertrophy. Macroglossia is characterized by an enlarged and thick tongue that may have fissures and ulcers, may cause language alterations, difficulties for feeding and swallowing, sialorrhea and recurrent infections of the upper airway or even its obstruction. Its clinical evaluation must include a complete clinical chart with careful physical exploration and a pedigree of that may identify the presence or absence of a hereditary associated syndrome. Macroglossia management is complex. More than twenty different surgical options to reduce the tongue size have been proposed, however, so far there is not a general agreement in this respect. The objective of this work is to review clinical and surgical aspects related to macroglossia from the point of view of non-surgical pediatricians and genetists, addressed to the different medical specialists, including the maxillofacial surgeons involved in the management of these patients.

¿Los pediatras detectan las reacciones adversas a medicamentos aunque no las reporten? / Do pediatricians identify adverse drug reactions even when they do not report them?

Resumen:Introducción: La notificación espontánea depende de la capacidad de los médicos de detectar las reacciones adversas a medicamentos (RAM) y del hábito de reportarlas. En 2008 y 2009, la frecuencia de reportes de RAM al Programa Electrónico de Farmacovigilancia (SISFAR) del total de egresos del Hospital Infantil de México Federico Gómez fueron bajas (0.44 y 0.20%, respectivamente). Por esta razón, en el 2010 se decidió evaluar la capacidad de los médicos de identificar las RAM utilizando como estrategia la revisión de los expedientes clínicos.Métodos: Se llevó a cabo un estudio observacional, descriptivo, transversal y retrospectivo en el Departamento de Urgencias (DU), del 1 de marzo al 31 de agosto del 2010. Se clasificaron y cuantificaron como RAM identificadas por los médicos cuando existió evidencia por escrito en el expediente clínico de que ellos habían asociado una manifestación clínica con una RAM, incluyendo además la evaluación del número de reportes al SISFAR. Se realizó el análisis descriptivo con SPSS versión 18.Resultados: La frecuencia de RAM de los pacientes que ingresaron al DU fue del 21.8%. El 86% de ellas fueron identificadas por los médicos en el expediente clínico y el 14% por el farmacéutico. Se reportó solamente el 6.1% al SISFAR.Conclusiones: Aunque fue elevada la identificación de las RAM en el expediente clínico, es posible que existan algunas que no se hayan detectado. Por otra parte, se confirmó el elevado grado de subreporte al SISFAR, por lo que se requieren acciones para fomentar el hábito del reporte.

Abstract:Introduction: Spontaneous notification depends on the ability of pediatricians to identify adverse drug reactions (ADRs) along with their habit of reporting these incidents. During the years 2008 and 2009, the frequency of reports of ADRs to the Electronic Program of Pharmacovigilance (SISFAR) in the Hospital Infantil of Mexico Federico Gomez (HIMFG) was low (0.44% and 0.20%, respectively). Because of the above, the ability of pediatricians from the Emergency Department (ED) to identify ADRs using the clinical chart review was evaluated in 2010 in this study.Methods: A descriptive, observational, cross-sectional retrospective study was conducted in the ED from March 1 to August 31. ADRs were classified and quantified as "ADRs identified by pediatricians" when there was evidence in the clinical chart that pediatricians associated a clinical sign, symptom and laboratory value with an ADR. The numbers of notifications reported in SISFAR were quantified. Descriptive analysis was done using SPSS v.18.Results: Considering patients who were admitted to the ED, the frequency of ADRs was 21.8%. The frequency of ADRs identified by physicians in clinical charts was 86%. The pharmacist detected 14% of ADRs. The frequency of ADRs reported by physicians was 6.1%.Conclusions: Although identification of ADRs in the clinical charts by pediatricians was high, it is possible that some ADRs were undetected. Because underreporting was very high, it is necessary to take actions to improve the reporting process.

El impacto de los Determinantes Sociales de la Salud en los niños / Impact of the Social Determinants of Health in children

El impacto de los Determinantes Sociales de la Salud (DSS) en los niños requiere ser analizado. Al evaluar los DSS en países desarrollados se observan amplias diferencias que deben ser analizadas. México, comparado con los países de la Organización por la Co-operación y el Desarrollo Económico (OCDE), muestra bajas calificaciones en la mayoría de los indicadores de bienestar infantil. Si bien nuestra posición internacional ha mejorado, aún revela importantes deficiencias. Destaca el impacto que los DSS tienen tanto en los ámbitos rurales como en los urbanos, en los que existen áreas de oportunidad para mejorar las condiciones de los niños. En el contexto Latinoamericano y del Caribe también existen algunos países con mejor desempeño que el nuestro. En México existen importantes diferencias en varios indicadores de bienestar infantil entre las entidades federativas, como la proporción de comunidades rurales y urbanas, la situación de la población infantil con discapacidad, la composición de las familias, el ejercicio del derecho a la identidad, las condiciones propias de la salud, la educación, la pobreza, la vivienda, el trabajo infantil y la regulación y protección del Estado sobre estos derechos. Por lo anterior, México requiere reforzar todas aquellas acciones que permitan, en el menor tiempo posible, lograr resultados más cercanos a los estándares del resto de los países de la OCDE. Para ello es indispensable una firme, estrecha y simultánea colaboración entre los sectores públicos, que incidan en las deficiencias en educación, vivienda, seguridad y condiciones sanitarias de las localidades, entre otras.

The impact of the Social Determinants of Health (SDH) needs to be analyzed. Upon evaluating SDH in developed countries, we observed broad differences. Mexico, compared with countries belonging to the Organization for Cooperation and Economic Development (OCED), shows low ratings in many of the indicators for childhood well-being. On the positive side, our international position has improved as well as revealing significant deficiencies. Emphasis is placed on the impact of SDH on both rural and urban localities where there are areas of opportunity to improve the conditions of children. In the context of Latin American and the Caribbean, some countries demonstrate better performance than Mexico. In Mexico, important differences exist according to various indicators of childhood well-being in both rural and urban areas where there are still major shortcomings: the childhood population with disabilities, the family composition, the right to autonomy, the actual health conditions, education, poverty, housing, child labor and the regulation and protection of rights provided by the government. Therefore, Mexico requires strengthening of all actions within the shortest time possible in order to achieve standards equal to other OECD countries. Essential to this is a strong, close and simultaneous collaboration among the public sectors to impact on deficiencies in education, housing, safety and health conditions of the various localities, among others.

Evaluation of the quality of care of neonates with necrotizing enterocolitis affiliated with Seguro Popular in Mexico

Background: In Mexico there is an important gap of information regarding the quality of care for neonates with necrotizing enterocolitis (NEC). This study aimed at evaluating the quality of care for neonates with NEC affiliated with the program Medical Insurance Century XXI (MIC-XXI), which is a branch of Seguro Popular. Methods: From December 2011 to March 2012, a cross-sectional study took place in 61 hospitals of the Ministry of Health located in 22 Mexican states. A set of 16 quality indicators based on a literature review served for the evaluation. Results: We reviewed 262 medical records of neonates with NEC. More than half were male and born by caesarean section; 55.8% were premature, 55.3% had low birth weight and 12.2% died. Regarding the quality of care, 72.5% were breastfed before being diagnosed with NEC. Most cases had abdominal radiography (90%), 75.0% had diagnosis of NEC according to Bell's criteria, but only 30% had reported symptoms that met the criteria for the recorded stage. Suspension of enteral feeding and administration of antibiotics reached 95.8% and 93.9%, respectively. Twenty six neonates underwent surgery, of which 34% had reported radiographic findings. Conclusion: A wide margin exists to improve the quality of care of neonates with NEC in Mexican Hospitals.