Hospital care direct costs due to ambulatory care sensitive conditions related to diabetes mellitus in the Mexican public healthcare system.

Background: Hospitalizations for ambulatory care sensitive conditions (ACSC) incur substantial costs on the health system that could be partially avoided with adequate outpatient care. Complications of chronic diseases, such as diabetes mellitus (DM), are considered ACSC. Previous studies have shown that hospitalizations due to diabetes have a significant financial burden.

Avoidable Hospitalization Trends From Ambulatory Care-Sensitive Conditions in the Public Health System in México.

Objectives: To estimate and identify the variations in rates of Avoidable Hospitalization for Ambulatory Care Sensitive Conditions (AH-ACSC) in public institutions of the Mexican health system during the period 2010-2017.

Methods: Secondary analysis of the hospital discharge database of the Ministry of Health (MoH) from 2010 to 2017. AH for ACSC was calculated by age group and sex per 100,000.

Barriers and opportunities to improve the foundations for high-quality healthcare in the Mexican Health System.

This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated. We used thematic content and descriptive analyses to analyse the data.

[Characterization of stroke patients attended at IMSS hospitals in Mexico City].

Background: Cerebrovascular disease (CD) is considered a problem of huge social, economic and public health implications worldwide in adults and elderly. In Mexico, the information concerning the provision of services to people and their characteristics is limited. The objective is to describe the characteristics of patients with CV who attended the hospitals of the Instituto Mexicano del Seguro Social (IMSS) in Mexico City.

[Experience of the Mexican National Health System in the development of clinical practice guidelines].

Background: Clinical practice guidelines are tools that have been able to streamline decisions made in health issues and to decrease the gap between clinical action and scientific evidence.

Objective: The objective of the study is to share the experience in the development and to update the guidelines by the National Health System of Mexico.

Material And Methods: The methodology in the development of the guidelines consists of 5 phases: prioritisation, establishment of work groups, development by adoption of international guidelines of de novo, validation and integration in the Master catalogue of clinical practice guidelines for its dissemination.

[Clinical practice guideline. Diagnosis and treatment of dyslipidemia.].

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.

[Hemophilia camps.].

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.

[Clinical practice guideline. Traumatic urethral stenosis in males].

The incidence of urethral stenosis in Mexico had not been documented. At the Centro Médico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial.

Caregiver burden of Mexican dementia patients: the role of dysexecutive syndrome, sleep disorders, schooling and caregiver depression.

Aims: As a result of the accelerated growth of the elderly population, reconfiguration of families and member roles, and the increase of mental disorders, it is necessary to investigate the effects of this set of factors on the caregivers of patients with dementia in Mexico. Mental disorders of individuals have a negative impact on their physical and emotional quality of life, leading to greater dependence and making the caring experience a heavy burden. Several studies (none in Mexico) have used either the characteristics of the patient or caregiver to determine the burden, but few studies have included both profiles within a single study.

[Practice guideline. Diagnosis and treatment of type 2 diabetes mellitus].

Our objective was to develop a guide based on the best available evidence that allow family physicians to establish criteria for screening, diagnosis, prevention, treatment of disease, early detection and management of complications; to standardize the organizing processes of the diabetic patient's care in the primary care level; and to achieve lifestyle modification for patients and promote self-care. Clinical questions were stated according to the diagram and structured patient-intervention-comparison-outcome. We used a mixed methodology-adoption adjustment, and include 32 guides.

[Perspective on type 2 diabetes mellitus in the Instituto Mexicano del Seguro Social].

The Instituto Mexicano del Seguro Social--always sensitive to the needs of health of the beneficiary population and to the demographic and epidemiological changes of the society--has developed and implemented DiabetlMSS, a program of attention to the diabetic patient. DiabetlMSS organizes care processes based on the needs and values of the patients, through simultaneous activities of individual consultation and group meetings granted by the multidisciplinary health team. These actions and activities are focused to affect patients' lifestyles positively.

[Clinical guideline. Obstetrical hemorrhage in the second half of pregnancy].

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.

[Obstetrical hemorrhage as a maternal death cause in the Instituto Mexicano del Seguro Social during 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.

[Clinical guideline for the prevention, diagnosis and treatment of ischemic cerebral disease].

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.

[Social support in the rehabilitation of patients with disabilities due to stroke].

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.

[Diagnosis and treatment guideline for primary hypothyroidism in adulthood].

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.

[Clinical practice guideline: a complete geriatric evaluation].

The care of elderly patients requires an evaluation that deserves a host of special considerations, such as biological aspects of aging, those related to activities of daily living and functionality, neuro-psychological conceptions, family dynamics and economic conditions. The growth of the aging population in our country is accompanied by an increase in chronic diseases and more individuals have greater vulnerability, requiring a more consumption of resources because of the high demand for services. This requires the incorporation of specialized care in the institutional system, which has caused serious consequences in the current health system, benefiting specialization and technology, but with a loss of an integrated and horizontal view of the patient.

[A clinical practice guideline for diagnosis and treatment of chronic obstructive pulmonary disease].

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.

[Epidemiological pattern of breast cancer mortality in Mexico State].

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.

[The clinical guidelines of practice project at the 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.

[Validation of the Quality of Life in Alzheimer's Disease (QOL-AD) scale in Mexican patients with Alzheimer, vascular and mixed-type dementia].

Aim: To adapt the Quality of Life in Alzheimer's Disease (QOL-AD) scale to Spanish, as well as to evaluate its reliability and validity in Mexico.

Subjects And Methods: The study involved a sample of 114 patients diagnosed with Alzheimer, vascular and mixed-type dementia, according to the criteria of the National Institute for Neurological and Communicative Disorders/Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA), the National Institute of Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) and the Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC), respectively. Their primary caregivers (n = 114) and a control group (n = 30) of persons aged 60 or over without dementia and their closest relatives were also evaluated.

Effects of two educational programmes aimed at improving the utilization of non-opioid analgesics in family medicine clinics in Mexico.

Objectives: To develop and test two educational programmes (interactive and passive) aimed at improving family doctors' (FD) prescribing practices and patient's knowledge and use of non-opioid analgesics (NOA).

Methods: The educational programmes were conducted in two family medicine clinics by using a three-stage approach: baseline evaluation, design, and implementation of educational activities, and post-programme evaluation. An interactive educational programme (IEP) was compared with a passive educational programme (PEP); both were participated by FDs and patients.

[Health risks for adolescents in underserved areas].

Background: adolescent population is an important age group, with vulnerability and health needs not well known, especially for those living in urban slums. Our objective was to identify health risks for adolescents living in poor urban areas in five geographical regions of Mexico.

Methods: a secondary data analysis from a nationwide adolescents ́ survey was carried out from population living in poor urban areas of the north, center, DF, south and southeast of Mexico.

Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico.

Objective: Rehabilitation strategies have been developed to improve functional state in stroke patients. The main objective of this study was to evaluate the effectiveness of the early rehabilitation at hospital and its continuity at home provided by nurses, on the functional recovery of basic and social activities in stroke patients compared with conventional care.

Design: A randomised clinical trial was carried out in three general hospitals of the Mexican Institute of Social Security (IMSS) in Mexico City between April 2003-May 2004.