Medical research at the Mexican Institute of Social Security: Seven decades of work, achievements, and challenges.

Since its foundation, more than 75 years ago, the Mexican Institute of Social Security (IMSS) has carried out multidisciplinary research -biomedical, clinical and epidemiological- focused on understanding and solving the medical problems that afflict its beneficiaries (more than 50% of the Mexican population). Initially, research was the result of individual and isolated efforts. In the 1960s, a small number of researchers formed the first research groups. Currently, 240 full-time scientists work at five centers and 40 research units located in different states of Mexico. In addition, approximately 270 doctors carry out clinical research at different primary, secondary and tertiary care units. During these seven decades, IMSS scientists have made relevant contributions to medicine, which have not only helped increase knowledge on the etiopathogenesis of numerous diseases, but also their diagnosis, prognosis and treatment. This article presents an overview of medical research carried out at IMSS, based on a historical approach and a review of some of the most relevant contributions in different fields of research.

Desde su fundación, hace más de 75 años, el Instituto Mexicano del Seguro Social (IMSS) realiza investigación multidisciplinaria ­biomédica, clínica y epidemiológica­ enfocada a entender y resolver los problemas médicos que aquejan a sus derechohabientes (más de 50 % de la población mexicana). En un inicio, la investigación fue resultado de esfuerzos individuales y aislados. En la década de 1960, un número reducido de investigadores conformó los primeros grupos de investigación. Actualmente, 240 científicos de tiempo completo trabajan en cinco centros y 40 unidades de investigación ubicados en distintos estados de México. Además, aproximadamente 270 médicos efectúan investigación clínica en las distintas unidades de primer, segundo y tercer nivel de atención. Durante estas siete décadas, los científicos del IMSS han realizado aportaciones relevante para la medicina, las cuales no solo han ayudado a incrementar el conocimiento acerca de la etiopatogenia de numerosas enfermedades, sino también al diagnóstico, pronóstico y tratamiento de ellas. En este artículo se presenta un panorama general sobre la investigación médica que se desarrolla en el IMSS, a partir de un enfoque histórico y de la revisión de algunas de las contribuciones más relevantes en los distintos campos de la investigación.

Trends (2007-2019) of major atopic diseases throughout the life span in a large Mexican population.

Background: Major atopic diseases such as atopic dermatitis (AD), allergic rhinitis (AR), and asthma share the same atopic background, but they often show differences in their epidemiological behavior. Objective: We aimed to report the profile of these atopic diseases in a large Mexican population, including their age-related incidences, male:female (M:F) ratios, recent time trends, and association with altitude. Methods: Registries from the largest, nationwide health institution in Mexico (more than 34 million insured subjects), were reviewed. New cases of AD, AR, and asthma diagnosed each year by family physicians from 2007 to 2019 were adjusted by the corresponding insured population to estimate incidence rates. Results: Incidences of the 3 atopic diseases were highest in the 0-4 years age-group and progressively decreased thereafter until adolescence. Asthma and AR, but not AD, were more frequent in males during childhood (M:F ratios of 1.5, 1.3, and 0.95, respectively), but predominated in females during adulthood (M:F ratios of 0.52, 0.68, and 0.73, respectively). Time trends showed an initial increasing trend of annual incidences, with a peak around 2009-2011, and a downward trend afterward. This decreasing trend was seen in all age-groups and was more evident for AD (∼50% drop) and asthma (∼40% drop) than for AR (∼20% drop). Geographical distribution suggested that incidences of asthma and AR, but not of AD, had an inverse association with altitude. Conclusion: Annual incidences of the 3 major atopic diseases have declined in recent years in almost all age groups, and their epidemiological profile during the life span showed contrasting differences according to age, sex, and ecological association with altitude, mainly regarding AD.

Childhood Cancer Survival, 2006-2012 Cohorts of Mexican Institute of Social Security Beneficiaries at the Central-South Region of Mexico.

Introduction: In Mexico, the main institution of social security is the "Instituto Mexicano del Seguro Social" (IMSS), with more than 60 million enrolled individuals. This study of childhood cancer survival is the first based on complete cohorts of incident cases for the population IMSS- affiliated in the central-south region, which represents 27% of all children IMSS affiliated. Methods: It is an observational cohort study from 2006 to 2012 to estimate the 5-year observed survival of the minors under 18 years old, identified in the Central-South Region Registry of Children with Cancer. The survival of cases was carried out through the active and passive search. Survival rates were estimated by the Kaplan-Meier (KM) method, the analysis of equality of survival functions was evaluated for some clinical variables. Results: The study included 2,357 minors; the 5-year observed survival was 56.1% with a time of survival median of 3.4 years, and the overall loss of follow-up was 18.4%. The 5-year survival in cases with a diagnosis of leukemia was 53.5%, while for solid tumors, it was 57.9%. The median time of death was 1 year. The types of cancer with a survival greater than 70% were group V-retinoblastoma (87.2%), IIa-Hodgkin's lymphoma (86.8%), Xc- gonadal tumors (83.3%), Iid-miscellaneous lymphomas (80%), IVa-nephroblastoma (79.5%), and IIc-Burkitt's lymphoma (75.4%). Meanwhile, the lowest survival rates were in group VIII-bone tumors (32.3%), III-CNS (central nervous system; 44.1%), and IX-soft tissues (46.8%). Conclusions: Survival results in the 2006-2012 cohorts show a significant gap in relation to the goal of 60% proposed by the World Health Organization for 2030.

Resistance Sources to Brown Blotch Disease (Pseudomonas tolaasii) in a Diverse Collection of Pleurotus Mushroom Strains.

Brown blotch disease (BBD) caused by Pseudomonas tolaasii is one of the most devastating diseases of Pleurotus spp. worldwide. Breeding for resistant strains is the most effective method for controlling BBD. To identify resistant germplasm for BBD management, 97 strains comprising 21 P. cf. floridanus, 20 P. ostreatus, and 56 P. pulmonarius were screened by two different methods; namely, inoculation of the pathogen on the mushroom pileus (IMP) and on the spawned substrate (IMSS) under controlled conditions. Out of the 97 strains screened, 22 P. pulmonarius, and four P. cf. floridanus were moderately resistant to BBD using the IMP method. Eleven P. pulmonarius, six P. cf. florida, and one P. ostreatus strains were highly resistant to BBD using the IMSS method. All of the 97 strains showed varying degrees of susceptibility using the IMP method, but eight strains were completely resistant using the IMSS method. Combining these two methods, five strains were highly resistant (four P. pulmonarius and one P. cf. floridanus) and 11 were moderately resistant (eight P. pulmonarius and three P. cf. floridanus). The resistance sources to P. tolaasii identified in P. pulmonarius and P. cf. floridanus could be used for further breeding of Pleurotus spp.

Implementation of a Nationwide Strategy for the Prevention, Treatment, and Rehabilitation of Cardiovascular Disease "A Todo Corazón".

The cardiovascular diseases (CVDs) have a growing impact over the world mortality, affecting mostly low and middle-income countries. This is due to changes in the population pyramid and the increase in unhealthy lifestyles that predispose the global population to cardiovascular risk factors such as overweight, obesity, smoking, hypertension, diabetes, dyslipidemias and metabolic syndrome. Ischemic heart disease and the cerebral vascular event remain the first causes of death reported by the World Health Organization (WHO) for more than a decade. Mexico has high prevalence in obesity, overweight, hypertension and diabetes in the population over 20 years old; Within the OECD countries (Organization for Economic Cooperation and Development) are the country with the highest mortality due to acute myocardial infarction over 45 years in the first 30 days. In order to face the growing pandemic of CVDs, the IMSS, it has developed and implemented a comprehensive care program called "A Todo Corazon", it is the first program of integral care which seeks to strengthen the actions to improving the impact of CVDs from health. This review is focused on describing the 7 axes that make up the program; each axe is described in detail. Axes one to three are dedicated to promotion and primary prevention of CVDs. Axes 4 and 5 are dedicated to infarction code, as a national strategy to confront the principal cause of death in Mexico. Finally axes 6 and 7 are dedicated to intensive care, secondary prevention and rehabilitation of CVDs.

The Transformation of the Mexican Social Security Institute (IMSS): Progress and Challenges.

Abstract-In 2013, the Mexican Social Security Institute (IMSS), the largest social security institution in Latin America, began a major transformation with two clear objectives: first, to improve the quality of its services in order to achieve better health outcomes and increase satisfaction among its 70 million beneficiaries and, second, to stabilize the Institute's finances. As in many other emerging economies, Mexico's demographic and epidemiological transitions, in conjunction with bureaucratic inefficiencies, left the Institute in a precarious financial situation. In 2012, the previous administration reported to the Mexican Congress that the Institute could remain financially self-sufficient until 2014. In the first year of this administration (2013), the deficit was reduced by half. By the second year (2014), the deficit was stabilized at the same level and the trend in the use of reserves consolidated. These results consolidated financial stability of the IMSS and, even better, were carried out while maintaining service quality and improving productivity. This article discusses how the IMSS transformation prioritized micro reforms over a macro approach to solve short-term problems by administering IMSS's limited resources in a more efficient and productive manner. The article also discusses the deep transformation that IMSS health care and resource management models will need to undergo in order to face pending medium and long-term challenges to ensure that IMSS can be sustainable in the long-term.

[Financial expenses incurred by herniated disk in health professionals]. / Costo del subsidio por diagnóstico de hernia de disco en trabajadores del Instituto Mexicano del Seguro Social.

BACKGROUND: Long-term sick leave by illeness is cause of financial expences and worker's loss of productivity. OBJECTIVE: To evaluate the financial expense incurred by spinal disk herniation in health professionals. METHODS: 3000 health professionals of the Instituto Mexicano del Seguro Social work in Tecate, Tijuana and Rosarito, cities of Baja California, Mexico. During 2009-2011, 1070 health professionals had long sick leave certificates and 48 had a cervical or lumbar disk herniation. We evaluated the total days of absenteeism in comparison with the absenteeism days suggested by the Medical Disability Advisor. RESULTS: Of the 48 spinal herniated disks, 54% were cervical and 65% had surgical management. The mean (± SD) days of absence was 125 ± 84 and 24 (50%) of the spinal herniated disks exceeded the Medical Disability Advisor disability duration parameters, in 6 (26%), 12 (52%), and 5 (22%) patients due to no diagnostic concordance, diagnosis delay and residual pain, respectively. The total cost of the spinal herniated disks that extended outside of the Medical Disability Advisor disability duration parameters was 683,026 pesos versus 367,081 pesos of the spinal herniated disks that did not exceed the Medical Disability Advisor disability duration parameters. After 12 months of follow-up, 9 (18.8%) continue with sick leave and 2 (4%) had permanent disability. CONCLUSIONS: In patients with a spinal herniated disk, the costs of subsidies were two-fold more due principally to a not diagnostic agreement.

Antecedentes: las incapacidades prolongadas no sólo tienen un alto costo económico sino también repercusiones en la productividad debido a la ausencia del trabajador. Objetivo: evaluar el costo del subsidio pagado por el Instituto Mexicano Seguro Social (IMSS) a los trabajadores que incapacita por hernia de disco. Material y métodos: estudio observacional, descriptivo, transversal y retrospectivo efectuado con trabajadores del IMSS a quienes se incapacita para no laborar por más de 14 días. El estudio se efectuó mediante la revisión de los registros asentados entre 2009-2011 de 1,070 trabajadores con incapacidad prolongada de los que 48 tuvieron diagnóstico de hernia de disco. Se cuantificaron los días totales de incapacidad, días subsidiados por incapacidad versus los días sugeridos por el consejero médico de incapacidades. Resultados: de los 48 pacientes con hernias de disco, 54% fueron cervicales y 65% recibieron tratamiento uirúrgico. Los días totales promedio de incapacidad por hernias de disco fueron 125 ± 84 y 24 (50%), respectivamente. De las que rebasaron las recomendadas por el consejero médico, 6 (26%) fueron por concordancia diagnóstica, 12 (52%) por diferimiento en el diagnóstico y 5 (22%) por dolor residual. El costo de las incapacidades laborales originadas por hernias de disco que rebasaron las sugeridas por el consejero médico fue de 683,026 pesos en comparación con 367,081 pesos que no rebasaron la recomendación de éste. Después de 12 meses de seguimiento, 9 casos (18.8%) seguían con incapacidad y 2 (4%) tuvieron pensión por invalidez. Conclusiones: el costo en subsidio por incapacidades a pacientes con hernia de disco se duplicó principalmente por diferimiento en el diagnóstico.

Consumo de tabaco en la población derechohabiente del Instituto Mexicano del Seguro Social / Tobacco consumption among the active insured population of the Mexican Social Security Institute

Objetivo. Conocer la prevalencia derechohabiente usuaria del Instituto Mexicano del Seguro Social. Material y métodos. En un estudio transversal se entrevistó a la población usuaria de las 36 delegaciones, mediante un cuestionario estructurado y autoaplicable sobre el consumo de tabaco, edad de inicio, cantidad de cigarros y suspensión del consumo. Resultados. Se estudiaron 45 117 sujetos, en proporción similar por género. La prevalencia de fumadores fue del 40 por ciento en hombres, del 17.6 por ciento en mujeres y mayor en los estados del norte que en el resto del país. Existe un efecto de edad en el consumo de tabaco y más de la mitad de los fumadores iniciaron el hábito en la adolescencia. Conclusiones. La prevalencia de tabaquismo que se encontró es elevada, aunque el promedio de cigarros consumidos no es alto. No obstante, el índice de abandono es bajo. Se requieren medidas de intervención en salud pública para disminuir esta adicción

Panorama epidemiológico de la mortalidad por cáncer en el Instituto Mexicano del Seguro Social: 1991-1995 / Epidemiologic panorama of cancer mortality in the Mexican Institute of Social Security: 1991-1995

Objetivo. Describir el comportamiento de la mortalidad global por cáncer, así como la mortalidad específica para las principales neoplasias malignas en población adulta derechohabiente (DH) del Instituto Mexicano del Seguro Social (IMSS). Material y métodos. A partir de los registros oficiales de defunción y de la información sobre la población para los años 1991-1995, se estimaron las tasas anuales de mortalidad global y específica para las 10 principales neoplasias malignas por sexo, en mayores de 20 años. Asimismo, se estimaron las tendencias nacionales y estatales para las principales neoplasias malignas para cada sexo por medio de regresión de Poisson. Se calcularon las diferencias de tasas de mortalidad específica para las dos pricipales neoplasias por sexo restando las tasas estatales a su respectiva tasa nacional en 1995. Resultados. La mortalidad global por cáncer en los hombres se incrementó de 76.2 en 1991, a 94.8 por 100000 DH en 1995; entre las mujeres, ésta se incrementó de 85.6 a 105.8 por 100000 DH, representando un incrmento de 24.4 y de 24 por ciento en hombres y mujeres, respectivamente, durante el periodo de estudio. Entre los hombres las neoplasias de riñón, leucemia, páncreas, próstata y pulmón; y entre mujeres las de colon, mama, páncreas, leucemias e hígado, mostraron los incrementos más significativos. Conclusiones. En el IMSS es impostergable la conformación de un registro poblacional de cáncer que permita una mejor vigilancia epidemiológica de las neoplasias y una evaluación permanente del impacto de programas específicos para la prevención y control de este padecimiento en las instituciones

Utilización adecuada de la atención prenatal en el Instituto Mexicano del Seguro Social / Adequate use of antenatal care in the Mexican Institute of Social Security

Objetivo. Establecer la proporción de mujeres que utilizan adecuadamente los servicios de salud para la atención prenatal y medir la asociación entre utilización adecuada y los factores obstétricos, socioeconómicos, demográficos y culturales de una población de derechohabientes embarazadas, atendidas en un hospital general de zona del Instituto Mexicano del Seguro Social. Material y métodos. Se entrevistaron 394 mujeres de 12 a 49 años de edad que cursaban con embarazo de 28 a 42 semanas. Se aplicó un cuestionario que incluyó variables demográficas sociales, económicas y culturales; conocimientos sobre el embarazo y sus complicaciones, antecedentes ginecobstétricos, y barreras para la utiización de los servicios de salud para la atención prenatal. Se hizo análisis descriptivo y se estableció la fuerza de asociación utilizando razón de momios y un modelo de regresión logística. Resultados. El 75 por ciento de las embarazadas inició su atención prenatal en el primer trimestre, de ellas el 23.8 por ciento acudió a nueve consultas o más (utilización adecuada). Los factores asociados a utilización adecuada fueron: unidad de medicina familiar (UMF) con sistema computarizado; conocimiento y conducta ante complicaciones del embarazo; paridad; atención prenatal en UMF por el mismo médico; y ocupación de las mujeres. Conclusiones. La utilización adecuada de los servicios de salud para la atención prenatal se observó en una proporción baja de mujeres. Algunos de los factores que favorecen la utilización adecuada pueden considerarse para mejorar los programas institucionales

Objective. To establish what proportion of women utilize antenatal care adequately and analyze obstetric, economic, social and cultural factors related to the adequacy of antenatal care use at the Mexican Institute of Social Security (IMSS). Material and methods. This cross-sectional study included 394 women from 12 to 49 years of age at twenty eight to forty two weeks of gestation. A questionnaire was applied that collected information on the following: demographic, social, economic and cultural variables; knowledge about pregnancy and complications; gyneco-obstetric history, and barriers to use of antenatal health care services. Data were analyzed by using descriptive statistics, odds ratios and logistic regression modelling. Results. Antenatal care was started during the first trimester by 75% of women; 23.8% of these made at least nine antenatal care visits (adequate utilization). Adequate utilization was associated to prenatal care in family medicine units with a computer system, knowledge and behavior regarding complications,parity, care by the same physician at IMSS, and the woman's occupation. Conclusions. The proportion of women who utilize prenatal care adequately is low at IMSS. Information about related factors could be used in order to improve institutional programs.