Guidelines on epidemics in Mexico. Historical perspective.

A perspective of epidemics and pandemics in Mexico is offered, focusing on three time periods, namely, end of the 18th century, the 20th century, and the 21st century, in order to analyze how they were approached by health and government authorities, as well as the challenges they have represented. Historical documentary sources were consulted and, in current cases, participation in them was analyzed. Epidemiological and social historical methodologies were combined. The presence of epidemics in Mexico is a constant on its evolution, which highlights the need for the epidemiological surveillance system to be updated, the importance of being prepared to face an epidemic and to develop a contingency plan.

Se ofrece una perspectiva de las epidemias y pandemias en México en tres periodos: fines del siglo XVIII y siglos XX y XXI, con el fin de analizar cómo las autoridades sanitarias y gubernamentales abordaron estos problemas, así como los desafíos que han representado. Se consultaron fuentes históricas documentales y, en los casos actuales, la participación en ellos. Se combinó metodología epidemiológica e histórica social. La presencia de las epidemias en México es una constante, lo cual evidencia la necesidad de actualizar el sistema de vigilancia epidemiológica, de estar preparados para enfrentar una epidemia y de elaborar un plan de contingencia.

Directrices en torno a las epidemias en México. Perspectiva histórica / Guidelines on epidemics in Mexico. Historical perspective

Resumen Se ofrece una perspectiva de las epidemias y pandemias en México en tres periodos: fines del siglo XVIII y siglos XX y XXI, con el fin de analizar cómo las autoridades sanitarias y gubernamentales abordaron estos problemas, así como los desafíos que han representado. Se consultaron fuentes históricas documentales y, en los casos actuales, la participación en ellos. Se combinó metodología epidemiológica e histórica social. La presencia de las epidemias en México es una constante, lo cual evidencia la necesidad de actualizar el sistema de vigilancia epidemiológica, de estar preparados para enfrentar una epidemia y de elaborar un plan de contingencia.

Abstract A perspective of epidemics and pandemics in Mexico is offered, focusing on three time periods, namely, end of the 18th century, the 20th century, and the 21st century, in order to analyze how they were approached by health and government authorities, as well as the challenges they have represented. Historical documentary sources were consulted and, in current cases, participation in them was analyzed. Epidemiological and social historical methodologies were combined. The presence of epidemics in Mexico is a constant on its evolution, which highlights the need for the epidemiological surveillance system to be updated, the importance of being prepared to face an epidemic and to develop a contingency plan.

[The estimated economic impact of cardiovascular and diabetes mellitus complications 2019-2028]. / Estimación del impacto económico por complicaciones cardiovasculares y de diabetes mellitus 2019-2028.

Background: In Mexico, diabetes mellitus (DM) and diseases cardiovascular, register an upward trend. Objective: To estimate the number of complications due to cardiovascular events (CVD) and complications derived from DM (CDM) accumulated in beneficiaries of the Mexican Institute of Social Security (IMSS) from 2019 to 2028, as well as the expense for medical and economic benefits in a scenario baseline and one of change in metabolic profile due to lack of medical follow-up during the COVID-19 pandemic. Material and methods: The number of CVD and CDM was estimated from 2019, with a 10-year risk projection using the ESC CVD Risk Calculator and United Kingdom Prospective Diabetes Study, considering risk factors registered in the institutional databases. Results: From 2019 to 2028, cumulative CVD cases were estimated at 2 million and those of CDM in 960 thousand, with an impact on medical spending of 439,523 million pesos and on the economic benefits of 174,085 millions. When considering the COVID-19 pandemic, CVD events and CDM increased by 589 thousand, with an increase in spending of 93,787 million pesos for medical care and 41,159 million for economic benefits. Conclusions: Without a comprehensive intervention in the management of CVD and CDM, the cost by both diseases will continue to increase, with financial pressures getting older.

Introducción: en México la diabetes mellitus (DM) y las enfermedades cardiovasculares, registran una tendencia ascendente. Objetivo: estimar el número de complicaciones por eventos cardiovasculares (ECV) y complicaciones derivadas de la DM (CDM) acumuladas en derechohabientes del Instituto Mexicano del Seguro Social (IMSS) de 2019 a 2028, así como el gasto por prestaciones médicas y económicas en un escenario de referencia y uno de cambio en el perfil metabólico debido a la falta de seguimiento médico durante la pandemia por COVID-19. Material y métodos: se estimó el número de ECV y CDM a partir de 2019, con una proyección de riesgo a 10 años con los modelos ESC CVD Risk Calculator y United Kingdom Prospective Diabetes Study, considerando los factores de riesgo registrados en las bases de datos institucionales. Resultados: de 2019 a 2028, los casos acumulados de ECV se estimaron en 2 millones y los de CDM en 960 mil, con un impacto sobre el gasto médico de 439,523 millones de pesos y sobre las prestaciones económicas de 174,085 millones. Al considerar la pandemia por COVID-19, los eventos de ECV y de las CDM aumentaron en 589 mil, con un incremento del gasto en 93,787 millones de pesos por atención médica y en 41,159 millones por prestaciones económicas. Conclusiones: sin una intervención integral al manejo de ECV y de CDM, el gasto por ambas enfermedades seguirá incrementándose, con presiones financieras cada vez mayores.

New routes to the future.

Not available.

The COVID-19 pandemic: A call to action for health systems in Latin America to strengthen quality of care.

The Covid-19 and other recent pandemics has highlighted existing weakness in health systems across the Latin-America and the Caribbean (LAC) region to effectively prepare for and respond to Public Health Emergencies. It has been stated that quality of care will be among the most influential factors on Covid 19 mortality rates and low systems performance is the common case in these countries. More comprehensive and system level strategies are required to address the challenges. These must focus on redesigning and strengthening health systems to make them more resilient to the changing needs of populations and based on quality improvement methods that have shown rigorously evaluated positive effects in previous local and regional experiences. A call to action is being made by the Latin American Consortium for Quality, Patient Safety and Innovation (CLICSS) and they provide specific recommendations for decision makers.

Great personalities of medicine, great lessons.

The analysis of three characters corresponding to different spaces and times shows the close link between literature and the history of medicine. On one hand, Don Quixote of La Mancha, who reflects the thought of the last years of the Renaissance and that has been assimilated in contemporary Mexico. On the other hand, Doctors Miguel Francisco Jiménez and Rita Levi Montalcini, who lived in the 19th and 20th centuries, respectively. Despite the years that separate these three personalities, many elements in common are observed that do not lose their validity: the value that is given to health, ethics, tenacity and experience to attain successful results. All three characters refer to the medicine of their time, their achievements and the promotion of humanism, always inherent to medicine.

El análisis de tres personajes correspondientes a espacios y tiempos diferentes muestra el estrecho vínculo entre la literatura y la historia de la medicina. Por un lado, don Quijote de la Mancha, quien refleja el pensamiento de los últimos años del Renacimiento y ha sido asimilado en el México contemporáneo. Por otro lado, los doctores Miguel Francisco Jiménez y Rita Levi Montalcini, quienes vivieron en los siglos XIX y XX, respectivamente. A pesar de los años que separan a los tres personaje, se advierten numerosos elementos en común que no pierden vigencia: el valor que se otorga a la salud, la ética, la tenacidad y la experiencia para obtener resultados exitosos, entre otros. Los tres personajes aluden a la medicina de su tiempo, los logros alcanzados y la promoción del humanismo, siempre inherente a la medicina.

Grandes personajes de la medicina, grandes lecciones / Great personalities of medicine. Great lessons

Resumen El análisis de tres personajes correspondientes a espacios y tiempos diferentes muestra el estrecho vínculo entre la literatura y la historia de la medicina. Por un lado, don Quijote de la Mancha, quien refleja el pensamiento de los últimos años del Renacimiento y ha sido asimilado en el México contemporáneo. Por otro lado, los doctores Miguel Francisco Jiménez y Rita Levi Montalcini, quienes vivieron en los siglos XIX y XX, respectivamente. A pesar de los años que separan a los tres personaje, se advierten numerosos elementos en común que no pierden vigencia: el valor que se otorga a la salud, la ética, la tenacidad y la experiencia para obtener resultados exitosos, entre otros. Los tres personajes aluden a la medicina de su tiempo, los logros alcanzados y la promoción del humanismo, siempre inherente a la medicina.

Abstract The analysis of three characters corresponding to different spaces and times shows the close link between literature and the history of medicine. On one hand, Don Quixote of La Mancha, who reflects the thought of the last years of the Renaissance and that has been assimilated in contemporary Mexico. On the other hand, Doctors Miguel Francisco Jiménez and Rita Levi Montalcini who lived in the 19th and 20th centuries, respectively. Despite the years that separate these three personalities, many elements in common are observed that do not lose their validity: the value that is given to health, ethics, tenacity and experience to attain successful results. All three characters refer to the medicine of their time, their achievements and the promotion of humanism, always inherent to medicine.

[Results of certification audit in Mexican hospitals, a review from 2009 to 2012]. / Revisión de los resultados de la auditoría de certificación en hospitales mexicanos de 2009 a 2012.

OBJECTIVE: To analyze the participation of Mexican hospitals in the certification process (equivalent to accreditation in other countries). MATERIAL AND METHODS: Crosssectional study that analyzes results of 136 establishments audited between 2009 and 2012. Standards with an excellent rating (9.0-10.0), approving (6-8.9) and non-approving (0-5.9) were identified. With a multinomial model, the probability of obtaining non-approving, approving and excellent qualification was calculated. RESULTS: The general average score was 7.72, higher in ambulatory surgery centers (9.10), than in general hospitals (7.30) and specialty hospitals (7.99). All public establishments obtained an approval score. Hospitals audited in 2011 had a higher risk of obtaining an approval (RRR= 4.6, p<0.05) and excellent (RRR= 6.6, p<0.05) rating. CONCLUSIONS: The scope of the certification process in Mexico has been limited, with greater participation of the private sector. The evaluation certificate applied in 2011 favored the achievement of approval and excellence results. We recommend homologating the entire process with that of the Joint Commission International JCI.

OBJETIVO: Analizar la participación de hospitales mexicano en el proceso de certificación (equivalente a la acreditación en otros países). MATERIAL Y MÉTODOS: Estudio transversal, analiza resultados de 136 establecimientos auditados entre 2009 y 2012. Se identificaron estándares con calificación excelente (9.0-10.0), aprobatoria (6-8.9) y no aprobatoria (0-5.9). Con un modelo logístico multinomial se calculó la probabilidad de obtener calificación no aprobatoria, aprobatoria y excelente. RESULTADOS: La calificación promedio general fue 7.72, más alta en hospitales de cirugía ambulatoria (9.10), que en hospitales generales (7.30) y de especialidad (7.99). Todos los establecimientos públicos obtuvieron calificación aprobatoria. Los hospitales auditados en 2011 tuvieron mayor riesgo de obtener calificación aprobatoria (RRR= 4.6, p<0.05) y excelente (RRR= 6.6, p<0.05). CONCLUSIONES: El alcance del proceso de certificación en México ha sido limitado, con mayor participación del sector privado. La cé- dula de evaluación aplicada en 2011 favoreció la obtención de resultados aprobatorios y de excelencia. Se recomienda homologar el proceso en su totalidad con el empleado por la Joint Commission International (JCI).

Revisión de los resultados de la auditoría de certificación en hospitales mexicanos de 2009 a 2012 / Results of certification audit in Mexican hospitals, a review from 2009 to 2012

Resumen: Objetivo: Analizar la participación de hospitales mexicanos en el proceso de certificación (equivalente a la acreditación en otros países). Material y métodos: Estudio transversal, analiza resultados de 136 establecimientos auditados entre 2009 y 2012. Se identificaron estándares con calificación excelente (9.0-10.0), aprobatoria (6-8.9) y no aprobatoria (0-5.9). Con un modelo logístico multinomial se calculó la probabilidad de obtener calificación no aprobatoria, aprobatoria y excelente. Resultados: La calificación promedio general fue 7.72, más alta en hospitales de cirugía ambulatoria (9.10), que en hospitales generales (7.30) y de especialidad (7.99). Todos los establecimientos públicos obtuvieron calificación aprobatoria. Los hospitales auditados en 2011 tuvieron mayor riesgo de obtener calificación aprobatoria (RRR= 4.6, p<0.05) y excelente (RRR= 6.6, p<0.05). Conclusiones: El alcance del proceso de certificación en México ha sido limitado, con mayor participación del sector privado. La cédula de evaluación aplicada en 2011 favoreció la obtención de resultados aprobatorios y de excelencia. Se recomienda homologar el proceso en su totalidad con el empleado por la Joint Commission International (JCI).

Abstract: Objective: To analyze the participation of Mexican hospitals in the certification process (equivalent to accreditation in other countries). Materials and methods: Cross-sectional study that analyzes results of 136 establishments audited between 2009 and 2012. Standards with an excellent rating (9.0-10.0), approving (6-8.9) and non-approving (0-5.9) were identified. With a multinomial model, the probability of obtaining non-approving, approving and excellent qualification was calculated. Results: The general average score was 7.72, higher in ambulatory surgery centers (9.10), than in general hospitals (7.30) and specialty hospitals (7.99). All public establishments obtained an approval score. Hospitals audited in 2011 had a higher risk of obtaining an approval (RRR= 4.6, p<0.05) and excellent (RRR= 6.6, p<0.05) rating. Conclusions: The scope of the certification process in Mexico has been limited, with greater participation of the private sector. The evaluation certificate applied in 2011 favored the achievement of approval and excellence results. We recommend homologating the entire process with that of the Joint Commission International JCI.

[Benefits for the nation: population health care]. / Beneficios que ha traído a la nación: población atendida.

The best way to assess the Social Service is by measuring its impact on the population, on the health care institutions and on the very students in Social Service. Yet, we have to face the difficulty to obtain reliable data to measure those benefits beyond any doubt. How much the health system is really benefited from these students in relation to the benefits for the population and to the students themselves is also a matter of speculation. Thus, the Social Service could be evaluated as a public policy, a medical act, and a teaching process, if it is really so. The number of consultations provided is not enough, since also preventive actions and health promotion activities are also performed which are even harder to be measured.

[Quality and accessibility]. / Calidad y accesibilidad.

The accessibility and quality makes sense of the historical moment in which they discuss, so, before starting the actual analysis of these concepts, we present a historical overview of development and their application within the Mexican health system. Remarkable efforts have been made in Mexico to increase the accessibility and quality of health services. However, the challenges are growing: to break the paradigm of "curing the disease" where the disease process is countered by the medical staff has required increasing specialization in more areas, and which has resulted in fragmentation of care, and therefore services for the "prevention" which not only interfere the medical field, but everyone involved. The shift to this paradigm could lead to a better quality medical care.

[Quality and health systems]. / Calidad y los sistemas de salud.

The purpose of this paper is to demonstrate, through an example, the impact of health systems in populations in terms of access and quality. One of the most telling examples is the issue of maternal deaths in which both variables, accessibility and quality, are expressed starkly, for better or for worse. Before that, it is necessary to consider three principles as a framework of reference. Hence, from the premises will look at the example and from there reach some conclusions on the topic.

[Public policy, structures of the State and the advocacy of the right to health protection]. / Políticas públicas, estructuras del Estado y defensa del derecho a la protección de la salud.

Not always public policies for the advocacy of citizen rights meet their goal, among other things, because between their formulation and their implementation there is a lack of appropriate structures to generate, articulate and execute these policies. This has been the case of Mexico regarding the advocacy of the rights of non smokers. Very few has been achieved in this matter in the past. This article lists some of the potential causes of the lack of implementation of public policies. At the same time, explores the highly dynamic nature of the health care system at the present and towards the future. The magnitude of the challenges faced by the health care system requires concerted actions of many actors, not only from the very health care system but also from outside. Thus, public policies have to be considered not just at the governmental level but at the state level. Therefore, the main argument of this paper is that given the need to respond to complex challenges to protect the health of the population and their rights in a very complex context, there is a need to formulate and implement state policies that require the intervention of the appropriate state structures to make sure that the design and execution leads to the expected achievements. One such structure at the state level, among others, is the General Health Council, an organization established in 1841, that was incorporated within the Mexican Constitution in 1917, depending directly from the President of Mexico as Head of State. This Council has been reinforced to improve its assigned role to better participate, along other state structures, in the formulation and implementation of public policies such as those for the advocacy of citizen rights.

[Adverse events identified in medical complaints]. / Eventos adversos identificables en las quejas médicas.

BACKGROUND: "To err is human" (Institute of Medicine, 1999) begun the Patients' Safety movement worldwide. We undertook this study to determine the frequency of patient complaints related to adverse events in the National Health Services. METHODS: The National Commission of Medical Arbitration and the Vice-Ministry for Innovation and Quality has the aim of determining the frequency of real adverse events as a reason for complaints by patients and relatives against healthcare professionals and health services. RESULTS: The Emergency Department registered the highest number of events. Negligence and absence of protocols account for more than half of the adverse events. CONCLUSIONS: Management protocols in emergency departments are areas of opportunity for improvement that must be considered.

Eventos adversos identificables en las quejas médicas / Adverse events identified in medical complaints

BACKGROUND: "To err is human" (Institute of Medicine, 1999) begun the Patients' Safety movement worldwide. We undertook this study to determine the frequency of patient complaints related to adverse events in the National Health Services. METHODS: The National Commission of Medical Arbitration and the Vice-Ministry for Innovation and Quality has the aim of determining the frequency of real adverse events as a reason for complaints by patients and relatives against healthcare professionals and health services. RESULTS: The Emergency Department registered the highest number of events. Negligence and absence of protocols account for more than half of the adverse events. CONCLUSIONS: Management protocols in emergency departments are areas of opportunity for improvement that must be considered.

Políticas públicas, estructuras del Estado y defensa del derecho a la protección de la salud / Public policy, structures of the State and the advocacy of the right to health protection

Si bien existen estructuras del Estado, que no sólo de gobierno, cuya misión es impulsar y proteger los derechos ciudadanos, es claro que ésta no siempre se cumple cabalmente. Desde la formulación de leyes, políticas públicas, y regulaciones que deben hacer efectivas ambas, y entre todas éstas y su ejecución para asegurar el impacto deseado, existen con frecuencia brechas que terminan por hacerlas inoperantes. El caso de las medidas que a lo largo de muchos años se han establecido para el control del tabaco en México es un claro ejemplo de ello. En efecto, en múltiples ocasiones en el pasado se tomaron medidas de diversa índole que por una u otra razón han sido inefectivas. El postulado central de este ensayo es que desde el diseño de una ley, una política pública, y el logro de su propósito, intervienen necesariamente los fundamentos sobre los cuales se construyó esa política, su pertinencia a las necesidades que le dieron origen y las estructuras que la crean y/o las que deben hacerse responsables no sólo de acatar la ley y de convertirla en una política operativa sino de asegurar que esa operatividad se concrete en logros demostrables en los plazos esperados y con los recursos necesarios. El Consejo de Salubridad General se fortalece y rescata su vocación primigenia para responder como una de las estructuras del Estado que debe contribuir, con otras más, a la articulación de la génesis, formulación y ejecución de políticas públicas para que éstas transiten de un desideratum hacia una realidad de efectos positivos demostrables.

Not always public policies for the advocacy of citizen rights meet their goal, among other things, because between their formulation and their implementation there is a lack of appropriate structures to generate, articulate and execute these policies. This has been the case of Mexico regarding the advocacy of the rights of non smokers. Very few has been achieved in this matter in the past. This article lists some of the potential causes of the lack of implementation of public policies. At the same time, explores the highly dynamic nature of the health care system at the present and towards the future. The magnitude of the challenges faced by the health care system requires concerted actions of many actors, not only from the very health care system but also from outside. Thus, public policies have to be considered not just at the governmental level but at the state level. Therefore, the main argument of this paper is that given the need to respond to complex challenges to protect the health of the population and their rights in a very complex context, there is a need to formulate and implement state policies that require the intervention of the appropriate state structures to make sure that the design and execution leads to the expected achievements. One such structure at the state level, among others, is the General Health Council, an organization established in 1841, that was incorporated within the Mexican Constitution in 1917, depending directly from the President of Mexico as Head of State. This Council has been reinforced to improve its assigned role to better participate, along other state structures, in the formulation and implementation of public policies such as those for the advocacy of citizen rights.