[Health and turism]. / Salud y turismo.

Tourism and health are two closely linked concepts. Both are directly related and very important to national economy and social policies. In this paper we present some reflections regarding those salient aspects of health and tourism that require to be strengthened. A series of recommendations are offered to contribute to the improvement of sanitation in the tourism sector, with special emphasis on preventive measures, joint action between the sectors involved, and emphasizing the role of the emporiatry concerning the protection and promotion of the health of the tourist. Finally, it is recognized that the actions required are the responsibility of all of those individuals involved in tourism: the visitor and the residents on the one hand; and services providers and the authorities, on the other hand.

[Health services research and its application]. / La investigación en servicios de salud y su aplicación.

This paper discusses the history of research in health services in Mexico, its limitations and the challenges which lie ahead.

[Strategies for municipal decentralization in health]. / Estrategias para la descentralización municipal en salud.

The decentralization of health services has been planned as a process that must reach the municipal level. The present work analyses the global framework of the decentralization strategy, the components for structural health changes, the characteristics of the transferences to the states, and ends with the basic elements of strengthening and decentralization of health services to the municipalities.

[Basis for the evaluation of health care quality at the medical units of the health sector]. / Bases para la evaluación de la calidad de la atención en las unidades médicas del sector salud.

A methodology for evaluating the quality of services rendered by the health institutions is presented. This methodology, proposed by the Basic Evaluation Group of the Health Sector, includes an operational diagnosis of the health care units, allowing the identification of service-rendering problems, this facilitating the elaboration of alternative solutions in the patient's best interests. It can be applied at all levels of the institutional hierarchy, from service and department levels to the macro dimension of health care. In order to obtain its best results, the methodology must be utilized systematically and continuously.

[Doctrinal bases of health activities]. / Fundamentos doctrinales del quehacer de la salud.

During his administration as Minister of Health, doctor Guillermo Soberón led one of the most important structural changes in health of this century in Mexico. All along the process, an ideological and doctrinal corpus was created. In this paper the main streams of this corpus are presented.

[New hospitals of the program for reconstruction and reorganization of health services in the metropolitan area]. / Los nuevos hospitales del programa de reconstrucción y reordenamiento de los servicios de salud en el area metropolitana.

This article describes the stages in the building of the general hospitals of 144 beds included in the Health Services Reconstruction and Reordering Program. The Program is being carried out by the Health Ministry in the metropolitan area of Mexico City, emphasizing the reordering sense of the activities developed to cope with the observed unbalances in the distribution of health services among the various zones in the area. The article examines also the coordination among the internal units of the Health Ministry and other agencies in the Health Sector. Finally, the lessons of the experience derived from those processes are discussed.

Coverage and patterns of ambulatory medical care use in Tlalpan, Mexico City.

Health officials planned a stepped care system (regionalized) for Tlalpan, in the Federal District of Mexico (D.F.), to address problems of duplicated services, inappropriate use of available resources, increasing costs of medical care, and unmet health needs in the population. Cross-sectional surveys were carried out in the community, in health centers and in hospital based ambulatory services (outpatient department and emergency department) to obtain current, specific and valid information about need and utilization patterns. Users of the various services differed from each other and from the community by age, educational level, occupation, rights to prepaid care and utilization patterns. Emergency department users came back for care repeatedly and sought preventive services from the emergency department. Major reasons for attending the emergency department included respiratory and gastrointestinal problems, plus poisonings, accidents, and complications of pregnancy. Outpatient department users arrived without referral from medical sources and continued to return frequently for care. Users were mostly adults, particularly older adults, with problems of a more chronic nature, e.g. nervous system problems, genitourinary problems, etc. The health centers attended clients from the designated area of influence who had referred themselves to the center for care. Children were the most frequent clients with acute, common problems, e.g. diarrhea and respiratory problems. Health maintenance activities were assessed for which children received the most complete coverage, but some women lacked the necessary care for perinatal health and family planning. In general, health centers seemed to be functioning appropriately, although the magnitude of unattended need in their areas of influence must be investigated further.(ABSTRACT TRUNCATED AT 250 WORDS)

[Program for instruction in comprehensive general medicine: conceptualization and strategies for its evaluation]. / Programa de enseñanza de medicina general integral: conceptualización y estrategias para su evaluación.

This article describes the concepts and strategies underlying the evaluation of the Comprehensive General Medicine Program of the School of Medicine of the Autonomous National University of Mexico. The exact purpose of that evaluation, done in 1982, was to strengthen and redirect the lines of this program's current development, which had been conceived since its inception in 1974 as an experimental study plan based on a system of modular and tutorial instruction. The article describes the identified conceptual, methodological, logistic, operational and attitudinal obstacles to this evaluation process. The methodology involves a sequence consisting in the evaluational experiences of basically innovative programs of undergraduate medical instruction, the selection of an evaluation model, identification of the aspects to be evaluated, the determination of priorities, and the definition of specific evaluation projects. From the aspects identified and given priority the following 12 evaluation projects emerged: curriculum review, follow-up of alumni, instruction materials, tutors, integration of knowledge, student performance, instructional activities, students in social service, student enrollments, dropping out, professional examination, and education administration.

Analisis de la mortalidad general y las principales causas de defuncion en Mexico, 1950-1975: informe preliminar. / Analysis of of the general mortality and the principal causes of death in Mexico, 1950-1975

RESUMEN Este trabajo informa sobre los hallazgos preliminares de un estudio sobre las tendencias seculares de la mortalidad en México durante el período de 1950a 1975. El propósito fue identificar el perfil de las causas de muerte más importantes en el país y determinar sus variaciones en relación con la mortalidad general, mediante comparación de las tasas de mortalidad correspondientes al período mencionado. Para el análisis se usaron los totales de las defunciones registradas en el país durante los años 1950. 1955. 1960. 1965. 1970 y 1975. Las causas de muerte se estudiaron tomando los datos codificados según la lista "A" de la Clasificación Internacional de Enfermedades, de acuerdo a las revisiones 6a, 7a y 8a. Después, por cada año estudiado se identificaron las veinte principales causas de defunción según su frecuencia; y además, se calcula ron las tasas de mortalidad general y las tasas de mortalidad específicas por causas. El perfil de las causas de muerte más importantes durante el período 1950-1975, se formó en total por 30 rubros diagnósticos distintos que aparecieron por lo menos una vez en los listados de las 20 causas más frecuentes. Para los análisis posteriores se eliminaron dos rubros diagnósticos del perfil de 30 causas de muerte, puesto que no formaron parte de la lista "A" de la Cf E en todas las revisiones utilizadas. También se identificaron once causas de muerte que permanecieron todo el periodo dentro de las 20 causas más frecuentes. Las tendencias de la mortalidad, general y por causa, se estudiaron mediante dos métodos. Primero, se calculó el cambio porcentual entre las tasas correspondientes a los años 1950y 1975.En segundo lugar, se hicieron regresiones lineales utilizando la transformación a logaritmos comunes de las tasas de mortalidad, y como variable independiente el tiempo transcurrido (0 a 25 años). La linea de regresión de la mortalidad general tuvo una pendiente b = -0.013, que representa la tendencia al descenso ya conocida. En relación con este resultado, el perfil de las causas más importantes de muerte fue dividido en tres grupos: 1) las causas que tuvieron tendencia similar a la que mostró la mortalidad general; 2) las causas que tuvieron decremento más acelerado que el de la mortalidad general; y 3) las causas que se mantuvieron estables o tendieron al incremento. Los resultados del estudio permiten citar tres aspectos relevantes. Primero, el perfil de las principales causas de defunción en el país ha sido modificado en forma parcial durante 25 años; asimismo, se identificaron once causas de muerte que permanecieron en los listados de veinte causas principales desde 1950 hasta 1975. Segundo, muchas de las causas principales de muerte presentes en todos los años analizados corresponden a estados morbosos mal precisados y otros rubros residuales; esto sugiere que persisten los grandes problemas de accesibilidad a los servicios de atención médica y se mantiene una alta frecuencia de certificación no médica de las defunciones. Tercero, se identificó un grupo de cinco causas de defunción cuya tendencia al incremento o estabilización sugiere que estas enfermedades van a tener importancia mayor en los próximos años

Programa de enseñanza de medicina general integral: conceptualización y estrategias para su evaluación / Program for instruction in comprehensive general medicine: conceptualization and strategies for its evaluation

This article describes the concepts and strategies underlying the evaluation of the Comprehensive General Medicine Program of the School of Medicine of the Autonomous National University of Mexico. The exact purpose of that evaluation, done in 1982, was to strengthen and redirect the lines of this program's current development, which had been conceived since its inception in 1974 as an experimental study plan based on a system of modular and tutorial instruction. The article describes the identified conceptual, methodological, logistic, operational and attitudinal obstacles to this evaluation process. The methodology involves a sequence consisting in the evaluational experiences of basically innovative programs of undergraduate medical instruction, the selection of an evaluation model, identification of the aspects to be evaluated, the determination of priorities, and the definition of specific evaluation projects. From the aspects identified and given priority the following 12 evaluation projects emerged: curriculum review, follow-up of alumni, instruction materials, tutors, integration of knowledge, student performance, instructional activities, students in social service, student enrollments, dropping out, professional examination, and education administration (Au)