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To test the association between public health insurance and adequate prenatal care among female adolescents in Mexico.Cross-sectional study, using the National Health and Nutrition Survey 2000, 2006, and 2012.We included 3 978 (N=4 522 296) adolescent (12-19) women who reported a live birth.We used logistic regression models to test the association of insurance and adequate (timeliness, frequency and content) prenatal care.The multivariable predicted probability of timely and frequent prenatal care improved over time, from 0.60 (IC95%:0.56;0.64) in 2000 to 0.71 (IC95%:0.66;0.76) in 2012. In 2012, the probability of adequate prenatal care was 0.54 (IC95%:0.49;0.58); women with Social Security had higher probability than women with Seguro Popular and without health insurance.Having Social Security is associated with receipt of adequate prenatal care among adolescents in Mexico.

Design of clinical research whose purpose is to answer questions about causality can be classified in relation to four axes: the number of study groups, the implementation of an experimental maneuver, cause-effect directionality and source from which the data are collected. The basic designs used in epidemiology are the clinical trial, the cohort study, the case-control study and the cross-sectional survey. This text aims to facilitate the identification and understanding of each of these designs through examples related to the association between rotavirus vaccination and intussusception.

To identify, prioritize and relate barriers and facilitators in the implementation of Clinical Practice Guidelines (GPC, in Spanish).We used qualitative methods to study and compare the introduction of GPC across the domains of the consolidated research implementation framework in hospitals of the three main public institutions in a state of Mexico. Authorities and hospital staff were interviewed using a semi-structured questionnaire.The main barriers to implementation are the absence of standards, training, resources and incentives. The most important implementation facilitators are the characteristics of the GPC, which are perceived as properly designed and with simple language as well as with capacity to improve the work environment.The barriers to implementation must be solved to achieve the goal of standardizing the healthcare process across the sector; the positive perception of the GPC should promote the continuous actualization of the evidence and a sectoral view from their development stage to ensure adoption in the heterogeneous environments that characterize health institutions.

Ancestral medicinal use of guava (Psidium guajava L. Fam. Myrtaceae) is today supported by numerous biomedical studies concerning the properties of leaf extracts. However, insufficient clinical studies are reported on the use of this plant resource in the treatment of gastrointestinal ailments. The present work reports a randomized, double-blinded, clinical study performed to evaluate the safety and efficacy of a phytodrug (QG-5®) developed from guava leaves, standardized in its content of quercetin and orally administered to a group of adult patients with acute diarrheic disease. Capsules containing 500 mg of the product were administered to 50 patients every 8 h during 3 days. Results obtained showed that the used guava product decreased the duration of abdominal pain in these patients.

Vitamin A deficiency (VAD) has been closely related to acute respiratory infections (ARI), although information is still incomplete; for example, the frequency of VAD in children5 years of age with pneumonia is not known, and the conditions associated with VAD have not been identified. This study was conducted to gain insight into the status of vitamin A in children with pneumonia. A secondary objective was to identify the sociodemographic, individual, and nutritional factors associated with VAD in these children.A cross-sectional study was conducted in the Mexican state of Hidalgo, one of the poorest in the country. Children with community-acquired pneumonia treated at nine public hospitals were included. Information was obtained by interviewing mothers, and ascertainment of vitamin A status was performed with relative-dose-response (RDR) test.A total of 422 cases were included. VAD was identified in 17.8% of children; 50.3% showed normal results, 24.6% had liver reserve depletion, and 7.3% showed results attributable to the infectious process. Variables associated with VAD were as follows: age2 months (OR 3.44, 95% CI: 1.84-9.24); children6 months of age fed with formula (OR 0.37, 95% CI: 0.15-0.91), and affiliation with the Mexican Social Security Institute (IMSS) health system (OR 0.40, 95% CI: 0.22-0.72).The frequency of VAD in children with community-acquired pneumonia confirms that the problem of deficiency persists in Mexico. The associated factors for VAD found in this study can be taken into account when planning and evaluating vitamin A supplementation activities in populations with high risk for deficiency.

In diverse contexts comparison of groups is giving frequently. Particularly, comparison of groups based on non-inferiority statistical tests is becoming more frequent and have had a very special boom in clinical trials, especially in trials related to testing new anti-infective products. Non-inferiority tests are statistical procedures that allow verify whether a sample provides sufficient evidence that the efficacy of a new treatment is not substantially inferior to the known efficacy of a standard treatment. For the selection of the non-inferiority margin for anti-infective trials, the Food and Drug Administration (FDA) and the Committee for Proprietary of Medical Products (CPMP) have provided some general guidance. In this investigation we propose a new parametric family of margin functions for testing non-inferiority in the context of anti-infective trials. One important feature of this parametric family is that fit together recommendations of FDA and CPMP jointly with some other important mathematical properties underlined in this research.

Childhood is a basic period for the development of habits and their continuation during the course of life. The objective of this study was to identify food preferences and their variations according to the nutritional status in school-age children living in Mexico City.A cross-sectional study was carried out including 1465 school-age children attending eight public elementary schools in Mexico City. Children were asked to complete a questionnaire regarding their preferences to 70 selected different foods. Anthropometric measurements were also carried out. Parents of the children provided sociodemographic information. For each food, the preference was evaluated using a Likert scale. Frequencies were calculated for the total sample and for different nutritional status levels.Median age of children was 9 years old. Forty-eight percent of the children were overweight or obese. The most preferred foods were fruits, pizzas, flavored milk, and French fries. The least preferred foods were vegetables, whole-grain cereals, fish, meat, and panela cheese. Plain water (72%) and sugar-sweetened beverages (71%) had a high level of preference. There was no preference variation according to nutritional status.Food preference patterns of school-age children are a risk for unhealthy food consumption as well as for the increase in obesity prevalence in this population. Interventions focused on the promotion of a healthy food environment are necessary, aimed at improving food preferences from early childhood.

To evaluate the effectiveness of incorporating the pharmacist into the ambulatory health care team to increase the proportion of patients with type 2 diabetes mellitus (T2DM) and/or hypertension who adhere to their drug regimen and to improve disease control.A non-randomized clinical trial was carried out in patients with T2DM and/or hypertension from two primary care clinics. Patients from one of the clinics comprised the intervention group (IG) who received 'counselling' from the pharmacist. The control group (CG) was comprised of patients who attended another clinic and received the usual care. Adherence was measured by counting pills; hypertension control was evaluated by blood pressure and diabetes control by blood glucose. Statistical analysis was carried out by intention to treat using generalized linear models.There were 440 patients included. There was no difference in the proportion of IG and CG patients who adhered to treatment according to baseline measurements. An increase in the proportion of adherence at baseline and final determination was observed in both groups (IG 71-80%, P=0.006 and CG 72-87%, P=0.000). Generalized linear models showed a 55% or higher probability of IG patients achieving control of hypertension in comparison with the CG. Patients from the IG with T2DM have 13% more possibility of achieving glycaemic control than those of the CG.Counselling offered by the pharmacist proved to be effective for improving drug adherence of diabetic and hypertensive patients in ambulatory health care.

To develop a composite index for coverage of antenatal and delivery continuum of care, and use it to measure the gaps among different populations of pregnant women in Mexico.Based in the information of 5 766 women from the National Health and Nutrition Survey 2012, a composite index of coverage of continuum of care (Cobac in spanish) was developed, integrating five interventions for antenatal, delivery, and puerperium periods.Women living in metropolitan areas who were affiliated to social security had the best Cobac (0.879; IC95%:0.867-0.891); the worst were found in women living in rural areas, with the lower socio-economic level (NSE-I), (0.722; IC95%: 0.700-0.745), women without health insurance (0.735; IC95%: 0.700-0.770), and indigenous women (0.759; IC95%: 0.740-0.779).The Cobac during pregnancy and childbirth has important differences within the country, which allows for the identification of areas where we must focus efforts to move towards universal health coverage.

OBJECTIVE—To evaluate whether sensitivity and specificity of tachypnoea for the diagnosis of pneumonia change with age, nutritional status, or duration of disease. METHODS—Diagnostic testing of 110 children with acute respiratory infection, 51 of whom presented with tachypnoea. The gold standard was a chest roentgenogram. Thirty five children had a radiological image of pneumonia; 75 were diagnosed as not having pneumonia. Sensitivity, specificity, and percentage of correct classification of tachypnoea, by itself or in combination with other clinical signs for all children, by age groups, nutritional status, and disease duration were calculated. RESULTS—Tachypnoea as the sole clinical sign showed the highest sensitivity (74%) and a specificity of 67%; 69% of cases were classified correctly. Sensitivity was reduced when other clinical signs were combined with tachypnoea, and there was no significant increase in correct classification, although specificity increased to 84%. In children with a disease duration of less than three days, tachypnoea had a lower sensitivity and specificity (55% and 64%, respectively), and a lower percentage of correct classification (62%). In children with low weight for age (< 1 Z-score), tachypnoea had a sensitivity of 83%, a specificity of 48%, and 60% correct classification. Sensitivity and specificity did not vary with age groups. CONCLUSIONS—Tachypnoea used as the only clinical sign is useful for identifying pneumonia in children, with no significant variations for age. In children with low weight for age, tachypnoea had higher sensitivity, but lower specificity. However, during the first three days of disease, the sensitivity, specificity, and percentage of correct classification were significantly lower.

Mass media communication is an important strategy for increasing parental uptake and to promote community participation when large-scale immunization activities are carried out. In Mexico, the National Vaccination Council (CONAVA) launches three immunization campaigns every year accompanied by three vaccination promotion campaigns. This study was conducted to assess whether communication activities to promote CONAVA's Second National Health Week (SNHW) were effective in providing information to mothers about the importance of immunizing their children under five years of age and in prompting them to seek immunization services. A probability sample of mothers living in the metropolitan area of Mexico City and having at least one child under five years old was selected for the study. Four outcome variables were defined as measuring the impact of the campaign: (1) mothers' knowledge about the SNHW; (2) mothers' comprehension indicating how well they understood the campaign messages (aware, partly aware and unaware); (3) mothers' motivation, i.e. whether or not they sought out immunizations for their children under the age of five and (4) mothers' opinion of how well they liked the messages. A total of 935 mothers were interviewed; 88.2% knew about the SNHW, 64.3% were aware that the campaign aimed to provide immunizations, and most held a favorable opinion about the messages. Among aware mothers, 87.5% of their children received immunizations. In this group 72.1% were prompted by the information in the campaign to seek immunizations for their children while 27.9% had to be personally invited to participate in the campaign. The latter occurred either when health workers or volunteers visited mothers in their homes or by soliciting mothers' participation as they visited or passed by immunization health posts. In the unaware mothers group, 72.7% of their children received immunizations; 62.5% of the mothers took their children because of information they received through the campaign while 37.5% had to be personally invited to immunize their children. Mothers with better socioeconomic status were more aware of the campaign, but a high percentage of them did not seek immunizations, while mothers with middle and lower socioeconomic status were motivated to immunize their children through the campaign. Promotion activities and messages communicated through the mass media were appropriate to inform and motivate mothers to seek immunization services for their children.

Background This study was conducted to assess the magnitude of the risk of high morbidity (⩾7 episodes/year) for acute respiratory infections (ARI) in infants attending day care centers (DCC), and to compare the incidence, duration, and severity of ARI in children staying at home (Home). Methods Using a cohort design, 282 infants (DCC, 138 and Home, 144) were followed for a year. Age at entry into the study ranged from 43 days to 4 months. During follow-up, social workers interviewed the mothers weekly to register whether the infants had an ARI. Also, infant health conditions and physical growth were updated monthly. Results ARI incidence was 14 episodes per child/year among DCC infants with a median of 74 sick days, while among children at home, the ARI incidence was 6 episodes, and the median was 40 days. The incidence density ratio for DCC children was 2.33 (95% CI, 2.13–2.54); after adjusting for other covariates, the relative risk increased to 5.27 (95% CI, 3.54–7.83). Conclusions Infants attending DCCs will suffer ARI more frequently than children cared for at home. We did not find seasonal variations in the incidence rates among DCC infants. The quality of care provided at these facilities should be analyzed in more depth for proposing measures to decrease ARI incidence.

Malnutrition and morbidity have a synergistic association that often leads to death. However, malnutrition in children who die is largely underreported, because anthropometry of the deceased child is rarely known. This study had two purposes: i) to develop a scale that would help determine if a child had low weight-for-age (w/a), in the absence of anthropometric measures; and ii) to select an appropriate cut-off that would give the best sensitivity (Se) and specificity (Sp) of the proposed scale when contrasted with actual w/a measurement. The study was designed as a diagnostic test, and carried out in a rural area in central Mexico. We included 132 children under 5 y old with w/a under -2 Z score and 284 children with marginal or no w/a deficit as a control group. The proposed scale included potential predictive variables from clinical, socioeconomic and family factors. The best logistic regression model to predict low w/a included: birth weight less than 2,800 g, introduction of weaning foods after the sixth month of life, introduction of animal protein after the sixth month of life, low socioeconomic status, low w/a in siblings and more than three morbidity episodes in the previous 6 mon. Selecting a cut-off of 4 for this model to identify children with low w/a showed a Se and Sp of 85 and 95%, respectively. We tested the external validity of the scale in a different locale, and included 877 children under 5 y old from 10 rural communities. In this population, the scale showed Se of 84% and Sp of 81% to identify low w/a. Based on these results, we propose that the scale be included as a means of identifying low w/a in children who have died. We believe that this should be done in verbal autopsies, which, based on our previous research, the Ministry of Health adopted as part of the regular activities to monitor problems in the disease to health-seeking to death process.

Objetivo. Evaluar el proceso de atencion y el acceso a servicios de salud en menores de cinco anos fallecidos por enfermedad diarreica (ED), en cuatro estados de la Republica mexicana. Material y metodos. Se realizo un estudio transversal que incluyo defunciones ocurridas durante un ano; mediante autopsia verbal se obtuvo informacion de caracteristicas clinicas, atencion durante la enfermedad y acceso a los servicios de salud; se realizo un analisis descriptivo y comparativo de acuerdo con el tamano de la localidad. Resultados. De 553 defunciones, la mayoria ocurrio en ninos sin derecho a seguridad social o residentes en localidades rurales; la muerte en el hogar, la edad menor a un ano y la corta evolucion de la enfermedad caracterizaron a mas de la mitad de los casos. Se proporciono terapia de hidratacion oral por decision de la madre a casi 75% de los ninos; 20% recibio atencion no medica, principalmente de curanderos. La atencion medica fue otorgada en 60% de los casos; a una elevada proporcion le fue indicado algun medicamento y no se le envio a hospital ni se recomendo regresar ante la presencia de signos de alarma; la indicacion de hidratacion oral fue mayor por medicos de servicios publicos y en localidades rurales; en estas, el acceso geografico y economico fue menor. Conclusiones. Si bien se confirmo el problema de acceso a los servicios de salud, se identificaron fallas importantes en la atencion medica primaria. Se propone la creacion de unidades docente-asistenciales como una estrategia para la reduccion de la mortalidad por ED.

A population-based case control study was conducted to ascertain whether the process of primary care can be a determinant of infant mortality due to Acute Respiratory Infection (ARI). Cases were 118 infants who died from ARI, individually matched with 118 infants who suffered an ARI episode and recovered. Information was gathered through interviewing mothers. Study variables were assembled into five subsets: children's characteristics; mothers' characteristics; access to medical services; process of primary care, and; sociodemographic variables. An index per subset was built to analyze the independent influence of each on ARI death risk. The index was constructed upon the weighted sum of the adjusted odds ratios (OR) within each subset. Then, the values of each index were collapsed into high/low values with the 50 percentile as a cut-off value. Next, by means of a conditional logistic regression procedure, an explanatory model of ARI mortality was obtained. The final multivariate model included the indexes that showed an independent effect: I) Process of care (OR 9.68, CI 95% 3.59-26.1): inadequate referral, attention provided by more than one physician and being attended by a private physician; II) children's characteristics (OR 7.22, CI 95% 2.35-22.2): perinatal history, lack of breast-feeding and incomplete immunization scheme; III) access to medical services (OR 5.27, CI 95% 2.02-13.7): geographic and economic barriers, lack of confidence in public health services, and; IV) mothers' characteristics (OR 4.03, CI 95% 1.18-13.8), mainly represented by untimely care seeking. We conclude that the management of the disease is a key determinant in which factors relating to the mother and the health services are strongly related. Our study reveals untimely care seeking, difficult access and inadequate disease treatment as important factors which deserve careful attention in the future. We also confirm the importance of biological determinants previously described. A main strategy to reduce infant mortality due to ARI should be to encourage training of primary care physicians, including private practitioners, focused on providing effective case management and emphasizing the education to mothers.Findings are reported from a case-control study conducted to determine whether the process of primary care can be a determinant of infant mortality due to acute respiratory infection (ARI). 118 infants who died from ARI were individually matched with 118 infants who experienced an ARI episode and recovered. Information was collected through interviews with the children's mothers. Multivariate analysis identified the independent effects of the process of care, children's characteristics, access to medical services, and mothers' characteristics upon ARI-related infant mortality. Managing disease is a key determinant to survival in which factors relating to the mother and health services are strongly related. Untimely care seeking, difficult access, and inadequate disease treatment deserve close attention in the future. A strategy to reduce the level of infant mortality due to ARI would be to encourage the training of primary care physicians, including private practitioners, focusing upon providing effective case management and emphasizing the education of mothers.

Health vulnerability refers to a lack of protection for specific population groups with specific health problems, as well as the disadvantages they face in solving them in comparison with other population groups. This major public health problem has multiple and diverse causes, including a shortage of trained health care personnel and the lack of family, social, economic, and institutional support in obtaining care and minimizing health risks. Health vulnerability is a dynamic condition arising from the confluence of multiple social determinants. This article attempts to describe the health situation of three vulnerable groups in Mexico-older adults, indigenous people, and migrants-and, after defining the needs of each, explore measures that could contribute to the design and implementation of public health policies better tailored to their respective needs.

Evaluate the effect of the relationship among public health expenditures, income inequality, and the marginalization index on maternal and child mortality in Mexico, to determine the effect of these factors on health system performance from a technical efficiency perspective.An ecological study of 32 Mexican states. Correlations were estimated between maternal and infant mortality and public health expenditures in total per capita, federal per capita, and state per capita for the years 2000, 2005, and 2010 (Gini coefficient and marginalization index). Linear regressions were used to explore the association of these variables with health indicators in the state systems.Negative correlations were observed for the marginalization index and Gini coefficient with regard to life expectancy at birth (-0.62 and -0.28 respectively). Furthermore, there was a positive correlation of 0.59 between the marginalization index and infant mortality (P0.05). Multiple linear regression models revealed a negative effect of the marginalization index and Gini coefficient on health out-comes. Federal funding had a positive effect on system performance in terms of health indicators.Health system reform in Mexico has had a positive impact on the country's health indicators; federal financial investment seems to be effective in this regard. Social determinants have an important effect on health system performance, and analysis using multisectoral and multidisciplinary approaches are needed in addressing them.

To identify users' perception about ambulatory healthcare services quality and associated factors in Mexico.Analysis of the 2006 and 2012 National Surveys of Health and Nutrition that included users' perception of healthcare services and improvement in health status. A multivariate regression analysis allowed identifying the associated factors with the perception of improved health status.Between 2006 and 2012, users' positive perception of healthcare services increased from 82 to 85%, and user report of improvement in health status increased from 79 to 81%. Health status improvement, explanations about the disease and treatment, being attended without appointment, freedom to choose the provider and short waiting time were associated with a perception of better quality of care.Users' perception about the quality of care in ambulatory healthcare settings has improved, yet it is still neccessary to strengthen organizational strategies to provide healthcare when needed and to improve fulfillment of users' expectations.

Objective Commercialization of rosiglitazone, an oral blood glucose-lowering drug of the thiazolidinedione class, was recently suspended in Europe and significantly restricted in the United States due to a possibly increased risk of ischemic heart disease; the drug is still being marketed in Mexico. This study was aimed to analyze the post-marketing occurrence of adverse drug reactions (ADRs) with rosiglitazone when used in combination therapy in Mexican Type 2 Diabetes patients. Methods A prospective observational study was conducted at a primary health-care clinic in Mexico City. Eligible subjects were adult patients with Type 2 diabetes inadequately controlled with maximal doses of oral monotherapy, in which one of two combined therapeutic schemes was prescribed: rosiglitazone/glibenclamide (R/G), or rosiglitazone/metformin (R/M). Patients' blood pressure, weight, treatment adherence and occurrence of ADRs were monitored during a 6-month follow-up period. Results 174 patients received treatment with R/M or R/G (112 and 62 patients, respectively). At least one ADR was observed in about 75%, of patients. Prior to the end of the follow-up period, moderate ADRs leading to discontinuation of the treatment occurred in 29.5% and 14.5% of patients treated with R/M and R/G, respectively. The ADRs most frequently observed were peripheral edema and moderate weight gain. Conclusions The use of rosiglitazone in combination with other oral anti-diabetic drugs was associated with a high frequency of ADRs in Mexican patients with Type 2 diabetes. Post-marketing studies are relevant to identify drug-associated risks to patients in clinical practice.

Prescription with more than one drug increases the risk of drug-drug interaction (D-DI), therapeutic failure, high pharmacological effect, or adverse events. The objectives of this study were to estimate the frequency of potential drug-drug interactions in prescriptions for hospitalized patients, and to identify the associated factors for these prescriptions.A secondary data analysis ofa cohort was carried out, including 284 patients at the internal medicine ward in a third level hospital in Mexico City. Age, gender, diagnosis at admission, days of hospitalization, prescription and administration of the drugs were analyzed. The potential D-DI were identified and registered according to the severity. Descriptive and crude association analyses including the outcome variable and co variables, and Poisson regression analysis for adjusting the variables were performed.The median of age was 53+/-18 years old; 53% of the patients were women, and 34% were older than 65 years of age. Sixty-three percent of the patients received one prescription identified as potential D-DI, and 33.5% of these prescriptions were "major D-DIs". The most frequently pairs of drugs prescribed were: fluoroquinolones-hypoglycemics (20.5%), enoxaparin- nonsteroidal antiinflammatory drugs or anticoagulants (18.1%), furosemide- angiotensin converting enzyme inhibitors (ACE inhibitor) (12.2%), alopurinol-ACE inhibitor (9%), and spironolactone-ACE inhibitor (9%). Thirty-three percent of patients older than 65 years of age received a prescription including one potential D-DI. Gender and the number of drugs received were associated factors to the potential D-DI.High percentage of prescriptions with potential D-DI makes necessary to implement educational programs or alert strategies including the identified associated factors, aimed to improve the quality of prescriptions and to reduce the risks for hospitalized patients.

To identify factors associated with the seeking of the legal-interruption-pregnancy (LIP) services in Mexico City.We used a case-control design. Users who utilized the LIP were defined as cases, while users of the antenatal care service with gestational age 13 or more weeks and who reported having an unwanted pregnancy were defined as controls. Logistic regressions were fitted to estimate odds ratios.Higher level of education (OR=1.47, 95% CI:1.04-2.07), women's occupation (being student OR=7.31, 95% CI:1.58-33.95; worker OR=13.43, 95% CI:2.04-88.54), and number of previous abortions (OR=11.41, 95% CI:1.65-79.07) were identified as factors associated with the lookup of LIP.In Mexico City context, empowered women with a higher level of education, or having a work activity are the users of LIP services. Strategies for improving access of women with low empowerment conditions are needed.

To identify factors associated with root caries development in a 12- month period, in an elderly Mexican population, so as to develop a prediction model for the occurrence of root caries.A case-cohort study was carried out with 698 randomly selected beneficiaries of the Mexican Institute of Social Security (IMSS), residing in the southeast of Mexico City. Initially, base line (t₀) data regarding sociodemographic variables, general health, general and oral healthy habits, salivary conditions, cariogenic microorganisms and oral health clinical indicators were collected. Twelve months from the date of the first clinical evaluation (t₁), a new examination was carried out to determine the root caries increment. Variables that showed a significant association (P ≤ 0.05) with the root caries increment were included in the prediction model.Six hundred and ninety-eight elderly subjects were included in the cohort (t₀), with 76.1% (n = 531) of the elderly patients followed up at 12 months (t₁). Incidence of root caries was 21.7% (n = 115), a mean root caries increase of 0.4 (1.0) surfaces. The variables, DLBA limitations (Yes), smoking (Yes), mouthwash (No), Mutans streptococci (≥10⁵ CFU/ml), healthy root surfaces (≥6) and Root Caries Index (≥8%), showed a statistically significant association (P0.05). This model showed a correct classification in 80.0% (n = 425) and an area under the Receiver Operating Characteristic curve of 0.75.This is a good prediction model for the 12 months root caries increment in this population of elderly Mexicans.

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).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. The IEP for FDs comprised of workshops, discussion groups, in-service training and guidelines, while for patients the IEP consisted of an interactive session with a video, leaflets and a discussion. The PEP consisted in delivering the guidelines to the FDs and the leaflets to patients. The effect of the programmes on the FDs was measured through the appropriateness of prescriptions and analysed using the differences-in-differences estimator (D-in-D), and on patients through changes in self-medication and in their knowledge about the proper use and adverse events by analysing the inter- and intra-group differences before and after the programmes.The IEP obtained better results to improve appropriate FDs prescription of NOA than PEP (D-in-D = 15%). Regarding the patients, the PEP group reached higher reduction of self-medication than the IEP group (13.4% vs. 9.1%); the knowledge of proper NOA use increased by 8.5% in both groups, whereas knowledge of NOA-related adverse events was better in the IEP (39.6%) than in the PEP group (9.2%).The IEP was better to improve the doctors' abilities to prescribe NOAs, and both programmes improved patients' knowledge.

A clinical practice guideline was developed as a response to the increasing of elderly in Mexican population due to the epidemiological transition; this instrument allows the assessment of health conditions for people from 60 years of age and older, and it can be a tool for helping family physicians and nurses in providing care for the main health problems of this group of age. The guideline for gerontologic assessment includes six principal health priorities in older people (loss of vision, difficulty to hear, falls or problems walking, nutritional disorders, memory difficulties, and sleep disorders); additionally, another four components for assessment are revised (medication use, physical functionality, quality of life, and social support). Simple recommendations for detection, diagnosis and management of these problems in primary care settings are presented.

OBJETIVOS: Evaluar la efectividad de la participacion de enfermeras de atencion primaria en la atencion integral a pacientes con hipertension arterial (HTA) y diabetes mellitus tipo 2 (DM2). METODOS: Se realizo un estudio cuasi-experimental antes-despues, sin grupo control, en ocho clinicas de medicina familiar. Enfermeras capacitadas otorgaron atencion integral en coordinacion con un equipo formado por medico familiar, nutricionista, trabajadora social y estomatologo. La intervencion duro siete meses y utilizo como variables de resultado cambios en el indice de masa corporal, glucemia en ayunas, presion arterial, autopercepcion del estado de salud, adherencia terapeutica y solicitud de servicios de urgencias. El cambio se determino comparando la medicion basal y final mediante entrevistas y registro de las variables de interes. RESULTADOS: 1 131 pacientes completaron el seguimiento, de los cuales 44,9% fue diagnosticado con HTA, 27% con DM2 y 28,1% con ambos padecimientos. La proporcion de pacientes atendidos coordinadamente por el equipo de salud aumento; se observo incremento de casos con peso normal y sobrepeso, reduccion en la proporcion de obesos (P < 0,05) y aumento de hipertensos con presion arterial < 130/80mmHg (P < 0,05). No se modifico la proporcion de diabeticos con glucemia < 140 mg/dl; 18,2% notifico mejoria en la autopercepcion del estado de salud (P < 0,05); hubo mejoria en la adherencia terapeutica (P < 0,05) y reduccion de solicitud de atencion a urgencias en las clinicas (-4,5%) y en los hospitales (-6,8%) (P < 0,05). CONCLUSIONES: La atencion integral a pacientes con enfermedades cronicas mediante la participacion de enfermeras contribuye a mejorar los resultados de salud en servicios de atencion primaria.

Objective We sought to investigate whether prenatal vitamin C and E supplementation reduces the incidence of gestational hypertension (GH) and its adverse conditions among high- and low-risk women. Study Design In a multicenter randomized controlled trial, women were stratified by the risk status and assigned to daily treatment (1 g vitamin C and 400 IU vitamin E) or placebo. The primary outcome was GH and its adverse conditions. Results Of the 2647 women randomized, 2363 were included in the analysis. There was no difference in the risk of GH and its adverse conditions between groups (relative risk, 0.99; 95% confidence interval, 0.78–1.26). However, vitamins C and E increased the risk of fetal loss or perinatal death (nonprespecified) as well as preterm prelabor rupture of membranes. Conclusion Vitamin C and E supplementation did not reduce the rate of preeclampsia or GH, but increased the risk of fetal loss or perinatal death and preterm prelabor rupture of membranes.

To understand the health needs of the population living in Mexico's marginalized urban areas.A population-based survey of families residing in poor, urban neighborhoods, in five geographic areas in Mexico (northern, central, southern, south-east, and Mexico City), selected through multistage sampling. Interviews were conducted and anthropometric measurements were taken in the home, and included all members of the participating family. Analysis was carried out on positive health factors, nutrition, reproductive health, health problems, and mental health, and results were disaggregated by age and sex.In all, 24,707 individuals participated. The interviewees were found to have minimal schooling (6 years or less). Only 46.8% had health care coverage, be it public or private. Among the children, 19.8% were malnourished; overweight was prevalent from adolescence onwards. Of adolescents 12-19 years of age, 15.7% were sexually active, but only 57.7% of the males and 41.9% of the females in this age group were using some method of contraception. Of the adults, 5.9% suffered from diabetes and 11.5%, from high blood pressure. In the sample of adolescents, adults, and elderly adults, tobacco use was 21.2%; alcohol consumption, 36.0%; illicit drug use, 9.5%; and depression, 20.2%.The health needs of people living in Mexico's marginalized urban areas proliferate in the context of a young population with weak ties and little support from family and health services. They face crisis and disease--infant malnutrition, high-risk pregnancy, and addictions--the byproducts of disparities in social progress. The rate of chronic conditions was similar to that of the general population of Mexico.

The Mexican Institute of Social Security (IMSS) is the largest public health care system in Mexico. IMSS family physicians' management of clinical problems is frequently not consistent with published evidence. This study aimed to evaluate the effects of a multifaceted educational intervention to improve management of acute respiratory infections (ARI) by IMSS family physicians.A non-randomized pre-post intervention with comparison group design was conducted in eight IMSS family medicine clinics in which 106 family physicians practiced. An evidence-based clinical guideline for ARI management was developed, and clinical tutors were trained. The three-stage intervention comprised interactive workshops, individual tutorials, and round-table peer-review sessions. The main outcome was appropriate ARI case management. The intervention effect was calculated by using the differences-in-differences model, adjusting for cluster of physicians.In the intervention group, the difference in mean proportion of improvement compared with baseline evaluation was 22.6% (95% confidence interval [CI]=10.3 to 34.9) for appropriate prescription of antibiotics, 29.8% (95% CI=17.2 to 42.4) for indication of worsening signs, and 19.6% (95% CI=11.2 to 28.0) for overall appropriate case management. The comparison group showed no significant changes.The educational intervention improved ARI management. Further studies are needed to analyze organizational implications, cost, sustainability, and effects on health outcomes.

OBJETIVO: Evaluar las necesidades de salud de la poblacion residente en areas urbanas marginadas de Mexico. METODOS: Encuesta poblacional a familias residentes en colonias urbanas pobres de cinco regiones geograficas de Mexico (Norte, Centro, Sur, Sureste y Ciudad de Mexico), seleccionadas mediante un muestreo polietapico. Se realizaron entrevistas y mediciones antropometricas en sus domicilios a todos los integrantes de las familias seleccionadas y se analizaron las caracteristicas de salud positiva, nutricion, salud reproductiva, danos a la salud y salud mental por grupos de analisis formados por edad y sexo. RESULTADOS: Participaron 24 707 personas. En los entrevistados se observo una baja escolaridad (6 anos o menos) y solo 46,8% tuvo cobertura de servicios de salud, ya fuera en instituciones publicas o privadas. De los ninos, 19,8% presentaba desmedro y el sobrepeso predomino a partir de la adolescencia. En los adolescentes de 12 a 19 anos, 15,7% tenia vida sexual activa, pero solo 57,7% de los hombres y 41,9% de las mujeres de ese grupo de edad usaban algun metodo anticonceptivo. De los adultos, 5,9% padecia diabetes y 11,5% hipertension arterial. En la muestra de adolescentes, adultos y adultos mayores, el tabaquismo fue de 21,2%, el consumo de alcohol de 36,0%, el uso de drogas de 9,5% y la depresion de 20,2%. CONCLUSIONES: La vulnerabilidad sanitaria de las personas que viven en las areas urbanas marginadas de Mexico se manifiesta en la existencia de una poblacion joven, con pocas redes de apoyo familiar y de servicios de salud, que sufre trastornos y enfermedades, como la desnutricion infantil, el alto riesgo reproductivo y las adicciones en adolescentes y adultos, producto del rezago en el desarrollo social. La prevalencia de enfermedades cronicas fue similar a la de la poblacion mexicana no marginada.

The purpose of this guide is to provide for general practitioners or physicians of primary care a comprehensive, evidence based tool that permits them to take an adequate decision about the appropriate use of the non-opioid analgesics in the management of pain.

Urinary incontinence is a frequent geriatric syndrome, characterized by involuntary urine losses that have a negatively influence on the health, their functionality and social relationships in whom suffered it. Nevertheless, most of these patients are not diagnosed and they do not receive treatment. The objective of this clinical guideline is to provide recommendations based on the best scientific evidence available for diagnosis and treatment of the urinary incontinence in the elderly, at primary care attention. Articles of clinical relevance were selected based on clinical evidence and analyzed by two family physicians, one geriatrician, one gerontologist and two experts in methods for elaboration of clinical guidelines. To verify comprehension and clinical applicability, 4 workshops including 35 family physicians were carried out, and the corresponding adjustments were made. The clinical guideline can be a tool for physicians at primary care attention to classify urinary incontinence and to provide pharmacologic and nonpharmacologic treatment. Additionally, the guideline presents recommendations for identification of patients who need specialized care.

"Debido al envejecimiento de la población mexicana derivado de la transición epidemiológica y consecuente aumento en la demanda de atención por los adultos mayores, se consideró importante diseñar un instrumento que permita el abordaje integral de las condiciones de salud de las personas a partir de los 60 años, con el fin de apoyar al personal médico y de enfermería en la atención de los principales problemas de salud en esta población. La guía de evaluación gerontológica integral incluye seis de las principales prioridades de salud en los adultos mayores (problemas de visión, audición, caídas o dificultad al caminar, trastornos de la nutrición, trastornos de memoria y alteraciones del sueño), así como cuatro aspectos fundamentales en la evaluación (consumo de medicamentos, funcionalidad física, calidad de vida y apoyo social). Se ofrecen recomendaciones sencillas para la detección, diagnóstico y alternativas de manejo en atención primaria."

In this paper we propose a statistical methodology to analyze the trends of very high values of tropospheric ozone. The methodology is based on the estimation of percentiles of the distribution of extreme values. The asymptotic distribution of the estimated percentiles is obtained with a normal result. This allows us to use a linear regression to investigate linear and non-linear trends. To illustrate the proposed methodology we use the information on ozone levels from some monitoring stations in Mexico City during the period from 1986 to 2005. The analysis of the information indicates a decrease in the very high ozone levels in the later years. Copyright © 2009 John Wiley & Sons, Ltd.

To evaluate the effectiveness of involving primary care nurses in comprehensive care of patients with hypertension and diabetes mellitus type II (DM2).A quasi-experimental, before-and-after study was conducted, without a control group, in eight family-practice clinics. Trained nurses offered comprehensive care in conjunction with a team made up of a family doctor, a nutritionist, a social worker, and a dentist. The intervention lasted seven months and its outcome variables were changes in body mass index, fasting blood glucose, blood pressure, self-perceived health status, treatment compliance, and emergency services requests. Any change was determined by comparing the baseline to the final measurement through interviews and recording the variables of interest in a spreadsheet.In all, 1 131 patients completed the follow-up, of which 44.9% were diagnosed with hypertension, 27% with DM2, and 28.1% with both conditions. The proportion of patients seen by the coordinated health teams increased; there was a rise in cases of normal weight and overweight; a decrease in the proportion of obese (P0.05); and an increase in hypertensives with high blood pressure (130/ 80mmHg) (P0.05). There was no change in the proportion of diabetics with high blood glucose (140 mg/dl); 18.2% reported improved self-perceived health status (P0.05); there was improved treatment compliance (P0.05); and a decrease in requests for emergency services at the clinics (-4.5%) and at the hospitals (-6.8%) (P0.05).Comprehensive care for chronically ill patients through the involvement of nurses contributes to improved health outcomes in primary care.

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% de las mujeres refirió APES+ y 58% APES-. Los factores vinculados con APES- fueron primaria completa o menos (RM=1.78;IC95% 1.62-1.95), no tener trabajo remunerado (RM=1.20; IC95% 1.09-1.33), menopausia (RM=1.22; IC95% 1.11-1.33), diabetes (RM=1.88; IC95% 1.65-2.13), hipertensión (RM=2.01; IC95% 1.82-2.22), actividad física irregular (RM=1.30; IC95% 1.12-1.50), sedentarismo (RM=1.395; IC95% 1.23-1.57), falta de integridad de detección (RM=0.82; IC95% 0.75-0.89) y de información sobre el climaterio por parte de los servicios de salud (RM=1.17; IC95% 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.

To evaluate the efficacy of a clinical practice guideline for treating type-2 diabetes patients in family medicine clinics.Nonrandomized control trial that took place in two family medicine clinics. Patients with more than 10 years of being diabetic were included. The study comprised one intervention group and one control group. The intervention group was treated by family doctors previously trained to use the guideline, while the control group was treated by family doctors unaware of the clinical practice guideline. The clinical practice guideline identifies disease risk factors, classifies the disease, and indicates criteria for diagnosis, pharmacological treatment, monitoring and timely identification of acute complications. It also addresses patients' education regarding dietary and exercise recommendations. The study had three stages: baseline, intervention and post-intervention.the primary outcome was control of glycemia, determined by HbA1c levels. The criterion for control was an HbA1c value of 7% or below. Secondary outcomes were changes in lifestyle, body mass index, cholesterol and triglyceride levels.Of the 419 patients with type-2 diabetes included in the study, 340 (81%, 175 intervention group and 165 control group) completed the six-month follow-up. In the final evaluation, the mean HbA1c in the intervention group had decreased from 9 to 8.3%, while it increased from 8.9 to 9.5% in the control group (p0.001). The proportion of obese patients decreased in the intervention group but remained the same in the control group.The clinical practice guideline was effective in improving the HbA1c level and decreasing the proportion of obese patients.

To evaluate self-rated health (SRH) in climacteric women and to identify the factors associated with negative SRH.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.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).Factors associated with negative SRH such as lack of information and physical activity should be strengthened.

Background In Mexico, inappropriate prescription of drugs with potential interactions causing serious risks to patient health has been little studied. Work in this area has focused mainly on hospitalized patients, with only specific drug combinations analyzed; moreover, the studies have not produced conclusive results. In the present study, we determined the frequency of potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age, who used Mexican Institute of Social Security (IMSS) family medicine clinics. In addition, we aimed to identify the associated factors for these interactions. Methods We collected information on general patient characteristics, medical histories, and medication (complete data). The study included 624 ambulatory patients over 50 years of age, with non-malignant pain syndrome, who made ambulatory visits to two IMSS family medicine clinics in Mexico City. The patients received 7-day prescriptions for non-opioid analgesics. The potential interactions were identified by using the Thompson Micromedex program. Data were analyzed using descriptive, bivariate and multiple logistic regression analyses. Results The average number of prescribed drugs was 5.9 ± 2.5. About 80.0% of patients had prescriptions implying one or more potential drug-drug interactions and 3.8% of patients were prescribed drug combinations with interactions that should be avoided. Also, 64.0% of patients had prescriptions implying one or more potential drug disease interactions. The factors significantly associated with having one or more potential interactions included: taking 5 or more medicines (adjusted Odds Ratio (OR): 4.34, 95%CI: 2.76–6.83), patient age 60 years or older (adjusted OR: 1.66, 95% CI: 1.01–2.74) and suffering from cardiovascular diseases (adjusted OR: 7.26, 95% CI: 4.61–11.44). Conclusion The high frequency of prescription of drugs with potential drug interactions showed in this study suggests that it is common practice in primary care level. To lower the frequency of potential interactions it could be necessary to make a careful selection of therapeutic alternatives, and in cases without other options, patients should be continuously monitored to identify adverse events.

To evaluate the impact of a continuing medical education program on family doctors to improve prescription of hypoglycemic drugs.An observational study was conducted with two groups of comparison (with-without program) and before-after periods. The unit of analysis was the visit. The period of evaluation comprised six months before and six after implementing the program. The outcome variable was the appropriateness of prescription that was based upon two criteria: appropriate selection and proper indication of the drug. Logistic regression models and the double differences technique were used to analyze the information. Models were adjusted by independent variables related with the patient, the visit and the PCC, the more relevant ones were: sex, obesity, conditions other than diabetes, number of visits in the analyzed period, number of drugs prescribed, size of the PCC and period.the program increases 0.6% the probability of appropriate prescription and 11% the probability of appropriate choice of the hypoglycemic drug in obese patients.

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.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. Cigarette smoking, alcohol and drug consumption, as well as frequency of accidents and violence, age at sexual initiation and use of contraception methods were analyzed.the highest frequencies of consumption were: 27.8 % for cigarette smoking and 35.2 % for alcohol, both in adolescents from 16 to 19 years; accidents (5 %) and violence (1.7 %); age (median) at sexual initiation was 16 years, about 50 % of adolescents with regular sexual activity reported use of a contraception method.comparing our data with National Health Surveys; in poor urban areas, most adolescents health risks are higher than those found for same group age in the general population, however, presentation of accidents and violence are similar.: los adolescentes son un grupo con vulnerabilidad y necesidades de salud poco conocidas en México, principalmente en áreas de pobreza urbana. El objetivo de esta investigación fue identificar los riesgos para la salud de los adolescentes en las áreas urbanas marginadas en cinco regiones del país.análisis secundario de una encuesta de salud para adolescentes realizada en áreas urbanas marginadas del Distrito Federal y regiones norte, centro, sur y sureste del país; se analizó consumo de tabaco, alcohol y drogas; historia de accidentes y violencias, edad de inicio de vida sexual y uso de métodos anticonceptivos; se calcularon frecuencias absolutas y relativas.los consumos más altos fueron para tabaco (27.8 %) y alcohol (35.2 %), ambos en el grupo de 16 a 19 años de edad; 5 % sufrió algún accidente y 1.7 %, violencia; el inicio de la vida sexual tuvo una mediana de 16 años y 50 % utilizaba algún método anticonceptivo.al comparar nuestros datos con los de otras encuestas nacionales, se encontró que los riesgos para la salud son mayores en los adolescentes de áreas urbanas marginadas que en adolescentes de la población general, sin embargo, la frecuencia de accidentes y violencias fue similar.

The primary was to assess the frequency of therapeutic non-compliance due to ADRs in a cohort of patients with recently diagnosed systemic hypertension. The secondary objectives were to evaluate the blood pressure control during the follow-up in the whole cohort and in patients who received non-steroidal anti-inflammatory drugs (NSAIDs).A cohort of 73 recently diagnosed ambulatory hypertensive patients was followed-up for 6 months. Validated questionnaires for identification of therapeutic scheme changes and ADRs were applied monthly, during each medical visit.Family physicians selected monotherapy in 79% of patients. The frequency of therapeutic non-compliance was 44%; non-compliance secondary to ADR was 7%. Systolic and diastolic blood pressure at the beginning of the study were 140 +/- 15/90 +/- 15 mm Hg for the whole cohort. At the end of the study the figures were 130 +/- 11/85 +/- 6 (p0.001). Patients receiving non-steroidal anti-inflammatory drugs (NSAIDs) had higher blood pressure levels than the groups of patients not receiving such kind of drugs (134 +/- 10 vs. 128 +/- 8 mm Hg, p = 0.025 and 88 +/- 7 vs. 83 +/- 5 mm Hg, p = 0.05).The drugs used in the present study as monotherapy are considered acceptable choices for hypertension treatment. The frequency of therapeutic non-compliance was within the limits reported in the literature and the frequency of therapeutic non-compliance secondary to ADRs in this cohort was lower than that reported in the literature. Higher blood pressure was found in the group of patients receiving NSAIDs.

to analyze the mortality behavior due to infectious diseases (acute diarrheal diseases, acute respiratory infections and lung tuberculosis) and chronic non-transmissible diseases (cervical cancer, breast cancer, diabetes mellitus and ischemic heart disease) in insured population of the Mexican Institute of Social Security (IMSS), in insured population user of the health services of IMSS and in uncovered population, from 1991 to 2004.a descriptive study was carried out, in which the annual rates of national mortality for the selected causes were calculated by specific age groups in both insured and uninsured population. Death records were taken from the official registers of the National Institute of Statistics, Geography and Informatics and from the IMSS Mortality System. Population data were obtained from projections of the National Council of Population and IMSS records.mortality due to acute diarrheal diseases, acute respiratory infections, lung tuberculosis and cervical cancer had a descending behavior, while breast cancer, diabetes mellitus and ischemic heart disease increased. Mortality for all causes analyzed was higher in uninsured population, except for diabetes mellitus, which was higher in insured population. This can be explained by the socioeconomic characteristics of the studied populations, as well as those of health services.

to analyze the decrease in mortality due to cervical cancer in insured population of the Mexican Institute of Social Security (IMSS) and its relation to changes in the organization of the Program for Prevention and Control of Cervical Cancer (PCCaCu).a descriptive study in which the annual rates of national mortality due to cervical cancer was analyzed from 1991 to 2005 was carried out. Information of deaths due to cervical cancer was obtained from the IMSS Mortality System (SISMOR), a database that identifies deaths occurred in insured population user of IMSS. The tendency was compared in three periods: I. 1991-1995, reorganization of the original program, II. 1996-2000, transition, and III. 2001-2005, incorporation to PREVENIMSS strategy.between 1991 and 2005, the mortality rate due to cervical cancer by 100 thousand women older than 24 years, decreased from 16.2 to 8.9 (45.1%). Between 1991 and 1995, the mortality rate increased 4.9%; between 1996 and 2000, it decreased 27% and in the last period, 2001-2005, it decreased 29.4%. The only differences that were statistically significant were the ones between the transition and the consolidation periods. The greatest decrease was registered when the PCCaCu was incorporated to PREVENIMSS strategy.the acceleration in the decrease of mortality rate due to cervical cancer can be explained by the reorganization and expansion of PCCaCu to target population and its incorporation to PREVENIMSS.

the National Survey of Coverage of Integrated Health Programs (ENCOPREVENIMSS) are probabilistic population-based surveys with delegation representativeness of insured population of the Mexican Institute of Social Security, belonging to different age groups.to evaluate the coverage of the Integrated Health Programs for Children and Adolescents during 2003-2005.a descriptive analysis of ENCOPREVENIMSS 2003, 2004 and 2005 was carried out, with regard to the components of Children and Adolescents' Health Programs, in the 37 delegations (states) of IMSS. Through a home sample, information of sociodemographic characteristics, use of health services and coverage of the main components of PREVENIMSS, were collected. The concentration of information and the data analysis took place at the Coordination of Integrated Health Programs.from 2003 to 2005, the coverage of both groups increased, mainly in children. The advances of coverage were different for each activity. The ones with best results were the incorporation to protocols of preventive attention, and vaccination, as well as weight and height measurement. The actions with lowest achievement were the detection of visual problems and the nutritional evaluation.coverage analysis is useful to ascertain the degree of application of the different preventive activities and it is also a good basis for planning.

In order to assess the progress of preventive health programs by measuring the coverage and other health indicators, ENCOPREVENIMSS (Health National Surveys) 2003, 2004 and 2005 were carried out. These surveys were applied nationwide to population affiliated to the Mexican Institute of Social Security, and were representative at a state level. The sampling frame was stratified, with several stages, by clusters, and had a minimum sample of 328 people per program group in each delegation. The applied questionnaires were previously designed and evaluated through a pilot test. They included specific questions for each program component per age group. In 2004, two sections were added, based on validated instruments to evaluate frequency of food intake and physical activity. A total of 79,797 people were surveyed: 117,884 in 2004, and 122,380 in 2005. A third of the population was insured, while the rest was beneficiary; about half the population was between 20 and 59 years old, and the proportion of people older than 60 increased almost 2% from 2003 to 2005. More than 90% of those who claimed to have a paid job were factory workers or employees. More than 90% of the population were assigned to a family physician in all the assessed years. The information obtained from ENCOPREVENIMSS is a valuable tool to conduct institutional policies for public health.

to determine the prevalence of physical activity in population from 20 to 59 years old covered by the Mexican Institute of Social Security.the prevalence of physical activity was estimated, classifying it according to its intensity, frequency and duration. Recommended physical activity was considered when moderate activity was done at least five days a week, for 30 minutes, or when vigorous activity was done three days a week, for 20 minutes. Insufficient activity was that with lower frequency or duration than recommended, and inactivity, when no activity was done.the sample included 30,270 women and 25,237 men. The global prevalence of recommended physical activity was 17.7%; the one of insufficient physical activity, 65.5%, and the one of physical inactivity, 16.8%. The prevalence of physical inactivity in men and women was 13.8 and 19.4%, respectively. The most frequently reported activities in men and women with recommended or insufficient activity levels were walking (44.3%), running or jogging (34.2%) and soccer (10%). Women and men who watched television very often had a prevalence of physical inactivity of 30.9 and 20.5%, respectively.the prevalence of recommended physical activity is low and that of inactivity is high. Some measures of intervention are needed in order to promote physical activity in adults.

The prevalence of depression in patients with type 2 diabetes mellitus (DM2) is of up to 49.3% in primary care clinics. Nevertheless, medical doctors only recognize only 30% of these cases. Depression is associated with poor glycemic control, increase of diabetes complications, deterioration in patient's quality of life, and increase in demand and resources to provide care. The objective was to design and validate a clinimetric scale for the diagnosis of depression (CSDD in patients with DM2, in primary care units.The study was conducted on 528 DM2 patients in Family Medicine Unit No. 10 of the Instituto Mexicano del Seguro Social (Mexican Social Security Institute), during 2003. A diagnostic test design was employed, with the golden standard consisting of the composite international diagnostic interview. Samples were constructed around consecutive cases. Depression and its degrees were the dependent variables. Absolute and relative frequencies were calculated, along with the Kappa index, sensibility, specificity, positive predictive values (PPV) and negative predictive values (NPV) and ROC curves.The CSDD presented a concordance between observers of 0.7739. The best cut-off point in the ROC curves for diagnosis of depression was 6, which obtained a sensibility of 95.3%, a specificity of 96.8%, a PPV of 92.2%, and a NPV of 98.1%.The CSDD is a consistent and valid instrument and easy to use for the diagnosis of depression in patients with DM2 in primary care clinic.