Local research ethics committees of the Mexican Institute of Social Security: results of a national survey.

OBJECTIVE: To identify the structure, composition and work of the local research ethics committees (LRECs) of the Mexican Institute of Social Security (IMSS) in Mexico. DESIGN: A descriptive cross-sectional study was performed that included all LRECs of the IMSS. METHODS: A total of 335 questionnaires coded in advance were posted to each LREC secretary. The requested information was from January to December 2001. RESULTS: The response rate was 100%. Two hundred and thirty-eight (71%) LRECs were reported as 'active' during the evaluation period. Although almost all LRECs were composed of diverse professionals, physicians dominated the LRECs' membership. The rejection rate for research projects was lower than 1 per 1000, and less than half of the LRECs held meetings to issue a report of projects' evaluation. CONCLUSIONS: LRECs need to foster good ethical research; implementation of an audit system to examine their work might help improve LRECs' performance and accountability.

[Barrier family planning methods as risk factor which predisposes to preeclampsia]. / Los métodos de planificación familiar de barrera como factor de riesgo que predispone a la presencia de preeclampsia.

Preeclampsia is a pregnancy-specific syndrome, it occurs in approximately 5-10% of all pregnancies and the etiology remains unknown, but the primigravida adolescent as such as multigravid older women whom have conceived with a new sexual partner have a greater risk, this has been associated also with the use of barrier contraceptive methods that prevent exposure to sperm with the endometrial cavity. An immunological factor has been suspected because fetal antigen's could cause antigenic reaction with the maternal immunological apparatus, for first exposure at these antigens, since the fetus is considered like an allotransplantation. This is supported in some studies that report that the use of condoms, spermicides and withdrawal are associated with developing of preeclampsia in subsequent pregnancy, and another hand indicate at cohabitation preceded for long period, practiced oral sex and use of contraceptive methods that permit exposure to sperm viable with uterus decreased the prevalence of preeclampsia. To test this hypothesis, we initially used data from two groups of pregnant women, comparing the contraceptive and reproductive history of 73 pregnant women with preeclampsia and 70 pregnant women without preeclampsia. The odds ratio for preeclampsia indicated a 2.52-fold (with 95% confidence interval, 1.17 to 5.44, p < 0.05), increased risk of preeclampsia for users of barrier contraceptives compared with women using nonbarrier contraceptives methods. Other variables like socio-demographic and obstetrics analysis were not different between both groups. This study suggest that nonbarrier contraceptive methods or the exposure of paternal spermatic antigens is protective against development of preeclampsia. Further immunological studies are necessary to determine the role of contraception methods and preeclampsia.

[Bibliometric analysis of publications by the Mexican Social Security Institute staff]. / Análisis bibliométrico de las publicaciones realizadas por el personal del IMSS.

OBJECTIVE: To describe and analyze the general characteristics and methodology of indexed publications by the health staff of the Mexican Social Security Institute in 1997. MATERIAL AND METHODS: Original articles were evaluated. The primary sources included Index Medicus, Current Contents and the Mexican National Council of Science and Technology (CONACYT) index. The following information was gathered for each article: affiliation and chief activity of the first author; impact factor of the journal; research type; field of study; topic of study, and methodological conduction. This latter point included congruence between design and objective, reproducibility of methods, applicability of the analysis, and pertinence of the conclusions. RESULTS: A total of 300 original articles was published of which 212 (71%) were available for the present study: full-time investigators (FTI) generated 109 articles and investigators with clinical activities (CAI) wrote 103 articles. The median impact factor of the journals in which FTI published was 1.337 (0.341 to 37.297) and for CAI publications, 0.707 (0.400 to 4.237). Biomedical research predominated in the first group (41%) and clinical investigation in the second (66%). Statistically significant differences were identified for the methodological conduction between groups of investigators. CONCLUSIONS: Descriptive studies and publications in journals without impact factor predominated. The FTI group had the highest bibliographic production of original articles in indexed journals with an impact factor.

Satisfaction related factors of attendants to a medical research meeting.

OBJECTIVE: To assess satisfaction of attendants to a National Meeting on Medical Research in relation with the scientific quality and level of discussion of the research work. MATERIAL AND METHODS: An anonymous self-applied questionnaire was handed out to gather opinions about the scientific quality, level of discussion of the research work, and overall satisfaction with the meeting. The studied population included 400 physicians, all of them authors or collaborators of the research work presented. RESULTS: The rate of response was 62% (n = 249). Two hundred and twenty-four approved the scientific quality (90%), and 203 were satisfied with the level of discussion of research (88%); 239 were satisfied with the meeting as a whole (96%). The factors associated with dissatisfaction regarding the quality of the scientific meeting were the masculine gender (OR = 2.7, CI 95% = 0.8-9.l, p = 0.06), having an M.Sc. or Ph.D. degree (OR = 2.3, CI 95% = 0.9-5.5, p = 0.03), and having attending prior meetings more than twice (OR = 5.0, CI 95% = 1.5-18.4, p = 0.001). CONCLUSIONS: Most of the attendants were satisfied with the scientific quality and discussions of the research work. The masculine gender, having an M.Sc. or Ph.D. degree, and prior assistance were the factors associated with dissatisfaction of the scientific quality of the Meeting.

[Concordance of the clinical and autoptic pathological diagnosis]. / Concordancia entre el diagnóstico clínico y el patológico por necropsias.

OBJECTIVE: To determine the degree of concordance between clinical and autopsy diagnosis. MATERIAL AND METHODS: The records of 67 autopsies and clinical files of children and adults, comprising the years 1995 to 1996, from a third level hospital in the State of Veracruz, Mexico, were revised. The concordance score was calculated with the statistical kappa. RESULTS: In general, the rate of autopsy was 10.5%, with higher frequency for children (17.5%). In children, 59% of clinical diagnoses revealed mistakes and in adults, 57%. The degree of agreement in the underlying cause ante and postmortem was 26% in children and 41% in adults. CONCLUSIONS: The high rate of diagnostic error and low concordance score between clinical and autopsy diagnosis strongly suggests that, in spite of increased availability of modern diagnostic techniques, the necessity of postmortem studies to control the level of medical practice is evident.

[Clinical-histopathological diagnostic agreement of lymph node biopsies in a tertiary care hospital]. / Concordancia clínico-histopatológica en biopsias de ganglio linfático en un hospital de tercer nivel.

OBJECTIVE: To determine the clinical-histopathologic concordancy in lymph node biopsies as well as the sensitivity and specificity of the clinical diagnoses in our institution. METHODS: We reviewed the files of patients with lymph node biopsy performed from January 1991 to July 1997. We estimated the clinical-histopathologic concordancy with a kappa test. Our institution lacked the immunochemistry and ultrastructural techniques complementing the diagnoses. RESULTS: There were 72 biopsies. Most were from the cervical (N = 27), mesenteric (N = 13) or supraclavicular (N = 12) regions. The supraclavicular lymph nodes had the highest sensitivity for clinical diagnosis (S = 67%) and was mostly associated with neoplasias (lymphoma or metastatic cancer) in 75% of the cases. The global concordancy was fair (kappa 0.37) and the sensitivity and specificity of the clinical diagnoses were 50%. CONCLUSIONS: The concordancy as well as the clinical diagnostic sensitivity and specificity were low in our hospital. This justifies the efforts of continuing medical education in our institution to reduce errors in the diagnostic process.