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.

Critical analysis of deaths due to atypical pneumonia during the onset of the influenza A (H1N1) virus epidemic.

BACKGROUND: The ongoing influenza A (H1N1) pandemic stroked Mexico and posed a huge challenge to the medical care and public health systems. This report analyzes the clinical course and process of care of patients who died due to atypical pneumonia and fulfilled the clinical criteria of suspected case of novel influenza A (H1N1) virus infection. METHODS: We conducted a retrospective analysis of a series of 38 patients who died between April 7 and April 28, 2009 at Instituto Mexicano del Seguro Social (IMSS) hospitals due to severe pneumonia and respiratory distress. These cases coincided with the beginning of the outbreak, so patients did not undergo laboratory testing to diagnose influenza. According to IMSS and CDC criteria, post-hoc analysis allowed considering the presumptive diagnosis of S-OIV infection. A multidisciplinary group analyzed the information from the clinical charts, laboratory tests, radiographic studies and death certificates, using descriptive statistics. RESULTS: Most cases were middle-aged (mean 33 years, range: 4-62 years) and previously healthy; 18.4% had an underlying chronic disease, 23.7% were obese and 7.9% were current smokers. None had received the seasonal influenza vaccine; they had cough (92%), fever (86.8%), and malaise (73.7%). The median time from disease onset to hospital admission was 6 days (range 0-8 days). All were admitted to the intensive care unit with pneumonia and/or respiratory distress. Average time from disease onset to death was 8 days (range 4-18 days). CONCLUSIONS: An increased number of severe cases of atypical pneumonia in previously healthy adults highlight the importance of the availability of a timely surveillance system able to identify sudden increases in the number of cases or presentation of apparently known diseases.

[Self-rated health among climacteric women affiliated with the Instituto Mexicano del Seguro Social]. / Autopercepción del estado de salud en climatéricas derechohabientes del Instituto Mexicano del Seguro Social.

OBJECTIVE: To evaluate self-rated health (SRH) in climacteric women and to identify the factors associated with negative SRH. MATERIAL AND METHODS: Information from 9 248 women aged 40 to 59 years was analyzed. SRH was the dependent variable. Independent variables were demographic characteristics, history of reproductive and chronic diseases, physical activity, and participation in screening and health education programs. Data were analyzed using descriptive statistics, bivariate analysis, and logistic regression modeling. RESULTS: Forty-two percent of women reported positive SRH and 58% reported negative SRH. Factors associated with negative SRH were: low literacy level (OR 1.78, CI95% 1.62-1.95), unemployment (OR 1.20, CI95% 1.09-1.33), menopause (OR 1.22, CI95% 1.11-1.33), type 2 diabetes (OR 1.88, CI95% 1.65-2.13) hypertension (OR 2.01, CI95% 1.82-2.22), irregular physical exercise (OR 1.30, CI95% 1.12-1.50), sedentarism (OR 1.395, CI95% 1.23-1.57), lack of information about climacteric (OR 1.17, CI95% 1.07-1.28) and lack of screening for chronic diseases (OR 0.82, CI95% 0.75-0.89). CONCLUSIONS: Factors associated with negative SRH such as lack of information and physical activity should be strengthened.

Autopercepción del estado de salud en climatéricas derechohabientes del Instituto Mexicano del Seguro Social / Self-rated health among climacteric women affiliated to Instituto Mexicano del Seguro Social

OBJETIVO: Evaluar la autopercepción del estado de salud positivo (APES +) o negativo (APES -) de mujeres climatéricas e identificar los factores relacionados con la APES-. MATERIAL Y MÉTODOS: Se analizó la información de 9 248 mujeres de 40 a 59 años. Las variables dependientes fueron la APES y las independientes las características generales, antecedentes ginecoobstétricos, enfermedades crónicas, actividad física, participación en programas de detección y educación. Se realizó un análisis descriptivo, bivariado y multivariado. RESULTADOS: Una proporción de 42 por ciento de las mujeres refirió APES+ y 58 por ciento APES-. Los factores vinculados con APES- fueron primaria completa o menos (RM=1.78; IC95 por ciento 1.62-1.95), no tener trabajo remunerado (RM=1.20; IC95 por ciento 1.09-1.33), menopausia (RM=1.22; IC95 por ciento 1.11-1.33), diabetes (RM=1.88; IC95 por ciento 1.65-2.13), hipertensión (RM=2.01; IC95 por ciento 1.82-2.22), actividad física irregular (RM=1.30; IC95 por ciento 1.12-1.50), sedentarismo (RM=1.395; IC95 por ciento 1.23-1.57), falta de integridad de detección (RM=0.82; IC95 por ciento 0.75-0.89) y de información sobre el climaterio por parte de los servicios de salud (RM=1.17; IC95 por ciento 1.07-1.28). CONCLUSIÓN: Los factores relacionados con APES- son múltiples y algunos, como la información acerca del climaterio y la actividad física, deben fortalecerse.

OBJECTIVE: To evaluate self-rated health (SRH) in climacteric women and to identify the factors associated with negative SRH. MATERIAL AND METHODS: Information from 9 248 women aged 40 to 59 years was analyzed. SRH was the dependent variable. Independent variables were demographic characteristics, history of reproductive and chronic diseases, physical activity, and participation in screening and health education programs. Data were analyzed using descriptive statistics, bivariate analysis, and logistic regression modeling. RESULTS: Forty-two percent of women reported positive SRH and 58 percent reported negative SRH. Factors associated with negative SRH were: low literacy level (OR 1.78, CI95 percent 1.62-1.95), unemployment (OR 1.20, CI95 percent 1.09-1.33), menopause (OR 1.22, CI95 percent 1.11-1.33), type 2 diabetes (OR 1.88, CI95 percent 1.65-2.13) hypertension (OR 2.01, CI95 percent 1.82-2.22), irregular physical exercise (OR 1.30, CI95 percent 1.12-1.50), sedentarism (OR 1.395, CI95 percent 1.23-1.57), lack of information about climacteric (OR 1.17, CI95 percent 1.07-1.28) and lack of screening for chronic diseases (OR 0.82, CI95 percent 0.75-0.89). CONCLUSIONS: Factors associated with negative SRH such as lack of information and physical activity should be strengthened.

[Study of primary care health needs through family health diagnosis]. / Estudio de las necesidades de salud en atención primaria mediante el diagnóstico de salud de la familia.

OBJECTIVE: To assess the health needs of the eligible public population of the Mexican Institute of Social Security (IMSS). DESIGN: Observational, descriptive, transversal study. SETTING: Family Medicine Unit number 8 of the IMSS, in the city of Tlaxcala, Mexico. PARTICIPANTS: A sample of 1200 families using multi-stage sampling, between October 1999 and March 2000. MAIN MEASUREMENTS: The designed and validated questionnaire on "Family health diagnosis" was used. RESULTS: A 19.2% of the families had a very low socio-economic level, and 14.9% of subjects were not entitled to Social Security. Functional illiteracy in at least one member was found in 12.6% of the families. According to the family Apgar, 93% of families were functional and two-thirds of the families were classified as nuclear. About 51.1% and 36.9% of women used programs for detection of cervical/uterine and breast cancer, respectively. Only 25% of the adult population underwent the detection tests for diabetes mellitus and hypertension and 10.9% had a chronic disease. 56.4% of families considered the quality of health care good, and only 18.13% were satisfied with the care received. CONCLUSIONS: Identification of health needs through diagnosis of family health is useful as a basis for establishing a hierarchy of problems as well as for developing health programs that may facilitate greater equity in attention.