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Comparar la adquisición de habilidades básicas de sutura en estudiantes de medicina según la enseñanza práctica por cirujanos o por pares.Estudio preexperimental antes y después. Se realizó un taller práctico de suturas para 46 estudiantes de medicina de octavo semestre de la Universidad de Concepción, entre noviembre y diciembre de 2017. Se distribuyó aleatoriamente a los participantes. La mitad de ellos fueron entrenados por cirujanos subespecialistas y la otra mitad por estudiantes de medicina (monitores de sutura). Se evaluaron la sutura continua y discontinua sobre un modelo biológico mediante la escala "The Objective Structured Assessment Of Technical Skills" (OSATS). Se aplicó una encuesta de satisfacción al finalizar el taller. Se comparan los resultados de la escala OSATS antes y después del taller. Se utilizó SPSS24Ambos grupos progresaron significativamente en la escala OSATS al comparar los resultados antes y después del taller: 13.0 vs. 26.0 (p0.001) para cirujanos y 16.8 vs. 28.0 (p0.001) para monitores de sutura. Los resultados después del taller no presentan diferencias significativas.Los participantes adquieren habilidades básicas de sutura evidenciando una progresión significativa y similar grado de satisfacción independientemente de si son entrenados por cirujanos subespecialistas o por pares entrenados.To compare the acquisition of basic procedural suture skills in medical students according to practical teaching by surgeons versus peers.Pre-experimental study before and after, a practical suture workshop was held for 46 eighth-semester medical students of the University of Concepción between November and December 2017. Participants were randomly distributed in such a way that half of them were trained by sub-specialists surgeons and the other by medical students (suture instructor). The continuous and discontinuous suture was evaluated on the biological model using the “the objective structured assessment of technical skills” (OSATS) scale. A satisfaction survey was applied at the end of the workshop. Results of the OSATS scale are compared before and after the workshop, SPSS24Both groups progressed significantly on the OSATS scale (13.0 vs. 26.0, p0.001 for surgeons and 16.8 vs. 27.9, p0.001 for suture instructors) when comparing pre- versus post-workshop results, respectively. The post-workshop results do not show significant differences.Participants acquire basic surgical suture skills evidencing significant progression and similar degree of satisfaction regardless of whether they are trained by subspecialist surgeons or trained peers.

ResumenAntecedentesLos Equipos de Respuesta Inmediata hospitalarios tienen factores obstaculizadores y facilitadores. Se determinó la participación de estos últimos en el Instituto Mexicano del Seguro Social (IMSS).Material y métodosEstudio observacional, retrospectivo de reportes de urgencia obstétrica enviados por tecnología móvil y correo electrónico a la Unidad de Atención Médica del IMSS durante 2013. Se utilizó el programa Excel 2010 para estadística descriptiva.ResultadosUn total de 164,250 mensajes se recibieron (promedio 425 mensajes/día); el 32.2% correspondió a urgencia obstétrica que requirió apoyo de los Equipos de Respuesta Inmediata Directivo-Delegacional-Central. Por correo electrónico, hubo 73,452 casos de morbilidad obstétrica extrema (promedio de 6 casos/día). Se realizaron en total 480 simulacros (uno/mes) en los hospitales.Los factores facilitadores fueron la oportuna sincronización de los mensajes entre los directivos de los diferentes niveles de mando, el registro preciso de la urgencia obstétrica y los simulacros realizados por el personal operativo.La urgencia obstétrica más común fue preeclampsia-eclampsia con 3,351 reportes, y hemorragia obstétrica con 2,982 casos.DiscusiónLa sincronización adecuada de comunicación por mensajes entre el equipo de respuesta inmediata de los diferentes niveles de mando permitió mayor rapidez en la gestión médica-administrativa así como la participación del equipo médico hospitalario en el proceso de la atención de la urgencia obstétrica.ConclusiónEl uso de la tecnología móvil en el funcionamiento del equipo de respuesta inmediata en el IMSS, ha permitido mayor rapidez en la gestión médico-administrativa en la atención de la urgencia obstétrica; sin embargo, es necesario realizar estudios comparativos para determinar la significación estadística.AbstractBackgroundThere are barriers and enablers for the implementation of Rapid Response Teams in obstetric hospitals. The enabling factors were determined at Instituto Mexicano del Seguro Social (IMSS)Material and methodsAn observational, retrospective study was conducted by analysing the emergency obstetric reports sent by mobile technology and e-mail to the Medical Care Unit of the IMSS in 2013. Frequency and mean was obtained using the Excel 2010 program for descriptive statistics.ResultsA total of 164,250 emergency obstetric cases were reported, and there was a mean of 425 messages per day, of which 32.2% were true obstetric emergencies and required the Rapid Response team. By e-mail, there were 73,452 life threatening cases (a mean of 6 cases per day). A monthly simulation was performed in hospitals (480 in total).Enabling factors were messagés synchronisation among the participating personnel,the accurate record of the obstetrics, as well as the simulations performed by the operational staff.The most common emergency was pre-eclampsia-eclampsia with 3,351 reports, followed by obstetric haemorrhage with 2,982 cases.DiscussionThe enabling factors for the implementation of a rapid response team at IMSS were properly timed communication between the central delegation teams, as they allowed faster medical and administrative management and participation of hospital medical teams in the process.ConclusionMobile technology has increased the speed of medical and administrative management in emergency obstetric care. However, comparative studies are needed to determine the statistical significance.

Background There are barriers and enablers for the implementation of rapid response teams in obstetric hospitals. The enabling factors were determined at Instituto Mexicano del Seguro Social (IMSS). Materials and methods An observational, retrospective study was conducted by analysing the emergency obstetric reports sent by mobile technology and e-mail to the Medical Care Unit of the IMSS in 2013. Frequency and mean was obtained using the Excel 2010 program for descriptive statistics. Results A total of 164,250 emergency obstetric cases were reported, and there was a mean of 425 messages per day, of which 32.2% were true obstetric emergencies and required the rapid response team. By e-mail, there were 73,452 life threatening cases (a mean of 6 cases per day). A monthly simulation was performed in hospitals (480 in total). Enabling factors were message's synchronisation among the participating personnel, the accurate record of the obstetrics, as well as the simulations performed by the operational staff. The most common emergency was preeclampsia–eclampsia with 3351 reports, followed by obstetric haemorrhage with 2982 cases. Discussion The enabling factors for the implementation of a rapid response team at IMSS were properly timed communication between the central delegation teams, as they allowed faster medical and administrative management and participation of hospital medical teams in the process. Conclusion Mobile technology has increased the speed of medical and administrative management in emergency obstetric care. However, comparative studies are needed to determine the statistical significance.

Background. P rimary health care is the best framework for implementing actions for the prevention and control of non-communicable diseases at an appropriate scale. In 2002, the Mexican Institute for Social Security (IMSS), which provides health care to half of the Mexican population, implemented a primary care-based integrated program that included the improvement of the family health care practice and a preventive strategy called PREVENIMSS, to reduce the burden of disease. Objective. T o asess the impact of this program on selected non-communicable chronic diseases. Methods. Morbidity and mor tality were compared before and after implementation of the program and time trends in IMSS affiliates and non-affiliates using the difference-in-differences (DD) method. Results. Incidence rates of diabetes and h ypertension increased whereas those of cervical cancer, breast cancer and other cerebrovascular diseases decreased from 2000 to 2013. The DD in mortality rates, expressed per 100 0 00 persons, showed a decrease of 49.4 for diabetes mellitus, 9.1 for hypertensive disease, 42.9 for ischemic heart disease, 17.4 for cerebrovascular disease, 7.5 for cervical cancer and 5.8 for breast cancer. Conclusions. The reductions in mortality rates could be explained by both changes in incidence rates and changes in case fatality rates associated with early detection and treatment. These initial findings can be interpreted as the potential impact of integrated programs based on primary health care in a developing country.

Resumen Introduccion Actualmente se dispone de un registro institucional de pacientes con dialisis en desarrollo. Objetivo general Identificar aspectos epidemiologicos de la insuficiencia renal cronica (IRC) en el Instituto Mexicano del Seguro Social. Material y metodos Cohorte retrospectiva que incluye los datos obtenidos de las 35 delegaciones que constituyen el segundo nivel de atencion medica al mes de diciembre de 2013. Resultados Un total de 56.430 pacientes, el 0,1% de la poblacion usuaria; 32.190 varones (57%) y 24.240 mujeres (43%), con edad promedio 62 anos (rango: 18 a 90). Las causas primarias de la IRC fueron diabetes (29.661; 52,6%), hipertension arterial (19.862;35,2%) y las glomerulopatias cronicas (4.089; 7,2%). Un total de 33.754 (60%) pacientes tuvieron dialisis peritoneal (DP) y 22.676 (40%) hemodialisis (HD). La mayor prevalencia se observo en Jalisco, Edo. de Mexico Oriente y Distrito Federal Sur; y la menor en Campeche, Baja California Sur y Zacatecas. La incidencia general fue de 124 casos por cada mil usuarios. Las delegaciones con mayor incidencia fueron Tlaxcala, Morelos e Hidalgo; las de menor, Zacatecas, Sinaloa y Norte del Distrito Federal. Las complicaciones mas frecuentes en DP fueron peritonitis, sobrecarga hidrica y complicacion mecanica del cateter; en HD, retencion hidrica, descontrol hipertensivo e hipercalemia. Las salidas definitivas en las 2 terapias fueron infarto miocardico, sepsis, insuficiencia cardiaca y trastornos del equilibrio acido base. Conclusiones Estos resultados seran un marco referencial y brindaran la pauta para dar inicio a lineas especificas de prevencion, tratamiento e investigacion que permitan mejorar la calidad de vida del paciente con dialisis y optimizar los recursos institucionales.

The IMSS performs systematically the data updating of patients with renal replacement therapy (RRT) by an electronic record management referred as: Census patients with Chronical Renal Failure (CIRC) which aims to meet the prevalence of patients with chronic renal failure and the behavior of RRTat the IMSS.A retrospective study includes 212 secondary hospitals with dialysis programs, with both pediatric and adult patients. CIRC data obtained from January to December 2014, number and nominal bonds of peritoneal dialysis (PD) and hemodialysis (HD). Prevalence of patients and therapies by delegation, distribution by gender and age, cause of kidney disease, morbidity and mortality were identified.55,101 patients, of whom 29,924 were male (54 %) and 25,177 women (46 %), mean age was 62.1 years (rng: 4-90); 20,387 were pensioners (36.9 %). The causes of renal failure were: diabetes 29,054 (52.7 %), hypertension 18,975 (34.4 %), chronic glomerulopathies 3,951 (7.2 %), polycystic kidneys 1,142 (2.1 %), congenital 875 (1.6 %) and other 1,104 (2 %). HD was given in 41 % of patients, and the remaining 59 % DP; the annual cost was 5,608,290,622 pesos.The increased prevalence of diabetes mellitus and hypertension affect the onset of RRT, which show a catastrophic financial outlook for the Institute.Introducción: el IMSS realiza de manera sistemática la actualización de datos de los pacientes en terapias sustitutivas de la función renal (TSFR) mediante un registro electrónico denominado: Censo de administración de pacientes con Insuficiencia Renal Crónica (CIRC), cuyo objetivo es conocer la prevalencia de pacientes con insuficiencia renal crónica y el comportamiento de las TSFR en el IMSS. Métodos: estudio retrospectivo, incluye 212 hospitales de segundo nivel con programas de diálisis, pacientes pediátricos y adultos. Datos obtenidos del CIRC de enero a diciembre de 2014, cédulas numeral y nominal de diálisis peritoneal (DP) y hemodiálisis (HD). Se identifica prevalencia de pacientes y terapias por delegación, distribución por género y edad, causa de la enfermedad renal, la morbilidad y mortalidad. Resultados: 55 101 pacientes, de los cuales fueron 29 924 masculinos (54 %) y 25 177 femeninos (46 %); edad promedio 62.1 años (rng: 4 a 90); pensionados 20 387 (36.9 %). Las causas de la insuficiencia renal fueron: diabetes 29 054 (52.7 %), hipertensión arterial 18 975 (34.4%), glomerulopatías crónicas 3951 (7.2 %), riñones poliquísticos 1142 (2.1 %), congénitos 875 (1.6 %), y otras 1104 (2 %). La HD se otorgó en 41 % de los pacientes y la DP al 59 % restante; el costo anual fue de 5 608 290 622 pesos. Conclusiones: la prevalencia incrementada de diabetes mellitus e hipertensión arterial repercuten en el inicio de una TSFR, las cuales muestran un panorama financiero catastrófico para el Instituto.

The lower extremity amputations diminish the quality of life of patients with Diabetes Mellitus (DM). The aim of this study was to describe the lower extremity amputation rates in subjects with DM in the Mexican Social Security Institute (IMSS), comparing 2004 and 2013.A comparative cross-sectional study was done. Amputations were identified from the hospital records of System of Medical Statistics (DataMart). The DM patient census was obtained from the System of Integral Attention to Health. Major and minor amputations rates were expressed per 100,000 DM patients.We observed 2 334 340 and 3 416 643 DM patients during 2004 and 2013, respectively. The average age at the time of the amputation was similar in 2004 and 2013 (61.7 and 65.6 years old for minor and major amputations respectively). The major amputations rates were 100.9 and 111.1 per 100 000 subjects with DM in during 2004 and 2013 (p = 0.001); while minor amputations rates were 168.8 and 162.5 per 100 000 subjects with DM in during 2004 and 2013 respectively (p = 0.069).The lower extremity amputations rates at IMSS are very high compared with that reported in developed countries. The major amputations rate increased in 2013 compared with 2004.Introducción: las amputaciones de extremidades inferiores disminuyen la calidad de vida de los pacientes con diabetes mellitus (DM). El objetivo de este estudio fue describir el índice de amputaciones de extremidades inferiores (mayores y menores) en sujetos con DM adscritos al Instituto Mexicano del Seguro Social (IMSS), comparando los años 2004 y 2013. Métodos: estudio observacional transversal comparativo. Se evaluaron los registros hospitalarios de amputaciones obtenidos del Sistema de Estadísticas Médicas (DataMart) y del Censo de pacientes con DM obtenido del Sistema de Atención Integral a la Salud. Se calcularon los índices de amputaciones mayores y menores x 100,000 sujetos con DM adscritos a Medicina Familiar. Resultados: durante 2004 y 2013 se observaron 2 334 340 y 3 416 643 pacientes con DM adscritos a Medicina Familiar respectivamente. Los promedios de edad al momento de la amputación fueron similares en el año 2004 y 2013 (61.7 años para las amputaciones menores y 65.6 años para las amputaciones mayores). Los índices de amputaciones mayores fueron de 100.9 y de 111.1 x 100 000 sujetos con DM en 2004 y 2013; mientras que el índice de amputaciones menores de extremidades inferiores fue de 168.8 y de 162.5 x 100 000 sujetos con DM en el durante 2004 y 2013 respectivamente. Conclusiones: el índice de amputaciones de extremidades inferiores en el IMSS es muy alto comparado con lo reportado en países desarrollados. El índice de amputaciones mayores se incrementó para el año 2013, comparado con 2004.

The current scenario of health services in Mexico reveals as a priority the implementation of strategies that allow us to better respond to the needs and expectations of individuals and society as a whole, through the provision of efficient and effective alternatives for the prevention, diagnosis and treatment of diseases. In this context, clinical practice guidelines constitute an element of management in the health care system, whose objective is to establish a national bechmark for encouraging clinical and management decision making, based on recommendations from the best available evidence, in order to contribute to the quality and effectiveness of health care. The purpose of this document is to show the methodology used for the development and updating of clinical practice guidelines that the Instituto Mexicano del Seguro Social has developed in line with the sectorial model in order to serve the user of these guidelines.El escenario actual de los servicios de salud en México revela como una prioridad implementar estrategias que nos permitan dar una mejor respuesta a las necesidades y expectativas de los individuos y de la sociedad en su conjunto, a través de la oferta de alternativas eficientes y efectivas para la prevención, el diagnóstico y el tratamiento de las enfermedades. En este contexto, las guías de práctica clínica (GPC) constituyen un elemento de rectoría en la atención médica, cuyo objetivo es establecer un referente nacional para favorecer la toma de decisiones clínicas y gerenciales, basadas en recomendaciones sustentadas en la mejor evidencia disponible, a fin de contribuir a la calidad y la efectividad de la atención médica. El propósito de este documento es mostrar la metodología utilizada para el desarrollo y la actualización de las GPC que ha elaborado el Instituto Mexicano del Seguro Social (IMSS), metodología alineada con el modelo sectorial para que sirva al usuario de las guías como punto de partida para su comprensión y para que apoye su utilización.

Objective. To estimate the disease burden of cancer in the affiliate population of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS) in 2010 by delegation. Materials and methods. The Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability/Disease (YLD) for 21 specific cancers and a subgroup of other malignant neoplasms were calculated based on the methodology of the Global Burden of Disease Study (GBD) for each of the 35 delegations of the IMSS. Results. In 2010, cancer represented the fifth overall leading cause of disease burden in IMSS affiliates (16.72 DALYs/1000 affiliates). A total of 75% of the cancer disease burden in each delegation is due to ten specific cancers, particularly breast cancer, which ranks first in 82% of the delegations. Prostate cancer; tracheal, bronchial, and lung cancers; leukemia, and colorectal and stomach cancers occupy the second to fourth positions in each delegation. With the exception of breast and prostate cancer, for which the contribution of YLD to the DALYs was higher than 50%, the greatest contribution to the DALYs of the other cancers was premature mortality, which accounted for more than 90% of the DALYs in some cases. Conclusion. The results obtained in this study allow for the identification of intervention priorities with regard to cancer at the institutional level and also for the focus at the delegation level to be placed on cancers ranking in the top positions for disease burden.

Objective. To analyze cancer mortality in affiliates of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social -IMSS) and time trends in the risk of death due to cancer from 1989 to 2013. Materials and methods. A descriptive analysis of cancer mortality trends in beneficiaries of the IMSS was performed. Age and sex adjusted mortality rates were obtained using direct standardization with the WHO population. Changes in the risk of death due to cancer over time were evaluated using Poisson regression. Results. The absolute number of deaths due to cancer doubled from 1989 to 2013 due to increasing age of the affiliate population. The risk of death among affiliates decreased for the majority of cancers except for colon and rectal cancer. Conclusion. The risk of dying from cancer among IMSS affiliates showed a marked decrease, which may be due to an increase in detection and opportune treatment. DOI: http://dx.doi.org/10.21149/spm.v58i2.7784

Excess body weight (overweight and obesity) is currently recognized as one of the most important challenges of public health in the world, given its size, speed of growth and the negative effect it has on the health of the population that suffers. Overweight and obesity significantly increases the risk of chronic no communicable diseases, premature mortality and the social cost of health. An estimated 90 % of cases of type 2 diabetes mellitus attributable to overweight and obesity. Today, Mexico is second global prevalence of obesity in the adult population, which is ten times higher than that of countries like Japan and Korea. With regard to children, Mexico ranks fourth worldwide obesity prevalence, behind Greece, USA and Italy. In our country, over 70 % of the adult population, between 30 and 60 years are overweight. The prevalence of overweight is higher in men than females, while the prevalence of obesity is higher in women than men. Until 2012, 26 million Mexican adults are overweight and 22 million obese, which represents a major challenge for the health sector in terms of promoting healthy lifestyles in the population and development of public policies to reverse this scenario epidemiology. Mexico needs to plan and implement strategies and action cost effective for the prevention and control of obesity of children, adolescents and adults. Global experience shows that proper care of obesity and overweight, required to formulate and coordinate multisectoral strategies and efficient for enhancing protective factors to health, particularly to modify individual behavior, family and community.El exceso de peso corporal (sobrepeso y obesidad) se reconoce actualmente como uno de los retos más importantes de la Salud Pública a nivel mundial debido a su magnitud, la rapidez de su incremento y el efecto negativo que ejerce sobre la salud de la población que la padece. El sobrepeso y la obesidad, incrementan significativamente el riesgo de padecer enfermedades crónicas no trasmisibles, la mortalidad prematura y el costo social de la salud. Se estima que 90 % de los casos de diabetes mellitus tipo 2 se atribuyen al sobrepeso y la obesidad. México ocupa el segundo lugar de prevalencia mundial de obesidad en la población adulta, la cual es diez veces mayor que la de países como Japón y Corea. Respecto a la población infantil, México ocupa el cuarto lugar de prevalencia mundial de obesidad, superado por Grecia, Estados Unidos e Italia. En nuestro país, más del 70 % de la población adulta tiene exceso de peso. La prevalencia de sobrepeso es más alta en hombres que en mujeres, mientras que la prevalencia de obesidad es mayor en las mujeres que en los hombres. Por lo tanto, es necesario planear e implementar estrategias y líneas de acción costo efectivas, dirigidas a la prevención y control de la obesidad del niño, el adolescente y el adulto. La experiencia global indica que la atención correcta de la obesidad y el sobrepeso, requiere formular y coordinar estrategias multisectoriales y eficientes, que permitan potenciar los factores de protección hacia la salud, particularmente para modificar el comportamiento individual, familiar y comunitario.

Chikungunya fever is an emerging disease caused by an alphavirus belonging to the Togaviridae family, transmitted by the bite of Aedes genus species: Aedesaegypti and Aedesalbopictus. In 2013, PAHO/WHO received confirmation of the first cases of indigenous transmission of chikungunya in the Americas. This disease may be acute, subacute and chronic, affecting all age groups. Following an incubation period from three to seven days, the patient usually begins with a high fever (greater than 39 °C), arthralgia, back pain, headache, nausea, vomiting, arthritis, rash, and conjunctivitis (acute phase: 3-10 days). Most patients recover fully, but in some cases, joint involvement may persist chronically and cause discapacity and affect life quality. Serious complications are rare, however, attention must be focused on vulnerable populations (the elderly, children and pregnant women). So far, there is no specific antiviral treatment or effective vaccine, so it is giving priority symptomatic and supportive treatment for the acute phase and make an early diagnosis of atypical and severe forms, and to implement effective prevention and control measures. Given the eco-epidemiological conditions and distribution of vectors in the region of the Americas, the spread of the virus to other countries is likely, so that health professionals should be aware of and identify risk factors and major clinical manifestations, allow timely prevention and safe and effective treatment of this disease.La fiebre chikunguña es una enfermedad emergente producida por un alfavirus de a la familia Togaviridae. Se transmite por la picadura de Aedes aegypti y Aedes albopictus. En 2013, la OPS/OMS recibieron confirmación de los primeros casos de transmisión autóctona de chikunguña en América. Esta enfermedad puede cursar de forma aguda, subaguda y crónica, afectando a todos los grupos de edad. Después de un periodo de incubación de tres a siete días, el paciente generalmente padece fiebre elevada (superior a 39 oC), artralgias, lumbalgia, cefalea, náusea, vómito, poliartritis, erupción cutánea y conjuntivitis (fase aguda de tres a 10 días). La mayoría de los pacientes se recuperan totalmente, pero la afectación articular puede persistir de manera crónica, ocasionar discapacidad y afectar la calidad de vida. Las complicaciones graves no son frecuentes, pero se debe tener especial atención en grupos vulnerables (adultos mayores, niños y embarazadas). Hasta el momento, no existe un tratamiento antiviral específico, por lo que es prioritario otorgar tratamiento sintomático y de soporte para la fase aguda, así como identificar las formas atípicas y graves e implementar las medidas de prevención y control efectivas. Dadas las condiciones ecoepidemiológicas y la distribución de los vectores en América, la diseminación del virus a otros países es probable, por lo que los profesionales de la salud deben identificar los factores de riesgo y las manifestaciones clínicas, para la prevención oportuna y el tratamiento efectivo y seguro de esta enfermedad.

There are barriers and enablers for the implementation of Rapid Response Teams in obstetric hospitals. The enabling factors were determined at Instituto Mexicano del Seguro Social (IMSS) MATERIAL AND METHODS: An observational, retrospective study was conducted by analysing the emergency obstetric reports sent by mobile technology and e-mail to the Medical Care Unit of the IMSS in 2013. Frequency and mean was obtained using the Excel 2010 program for descriptive statistics.A total of 164,250 emergency obstetric cases were reported, and there was a mean of 425 messages per day, of which 32.2% were true obstetric emergencies and required the Rapid Response team. By e-mail, there were 73,452 life threatening cases (a mean of 6 cases per day). A monthly simulation was performed in hospitals (480 in total). Enabling factors were messagés synchronisation among the participating personnel,the accurate record of the obstetrics, as well as the simulations performed by the operational staff. The most common emergency was pre-eclampsia-eclampsia with 3,351 reports, followed by obstetric haemorrhage with 2,982 cases.The enabling factors for the implementation of a rapid response team at IMSS were properly timed communication between the central delegation teams, as they allowed faster medical and administrative management and participation of hospital medical teams in the process.Mobile technology has increased the speed of medical and administrative management in emergency obstetric care. However, comparative studies are needed to determine the statistical significance.

The Surgical Medical Meetings Program aims to make highly specialized medical services to the marginalized rural population. Surgical Medical Encounters highlight the experience and results of an innovative strategy characterized by continuous improvement and the desire to continue transcending health for the most vulnerable populations. During 17 years of its inception, it is interesting to describe the evolution and achievements of the program.El programa Encuentros Médico Quirúrgicos tiene la finalidad de poner a disposición de la población de zonas rurales marginadas servicios médicos de alta especialidad. Los Encuentros Médico Quirúrgicos ponen de relieve la experiencia y los resultados de una estrategia innovadora, caracterizada por la mejora continua y el afán de seguir trascendiendo a favor de la salud de la población más desprotegida. A 17 años de su inicio, resulta interesante describir la evolución y los logros del programa.

A recrudescent wave of pandemic influenza A/H1N1 affected Mexico during the winter of 2013-2014 following a mild 2012-2013 A/H3N2 influenza season.We compared the demographic and geographic characteristics of hospitalizations and inpatient deaths for severe acute respiratory infection (SARI) and laboratory-confirmed influenza during the 2013-2014 influenza season compared to previous influenza seasons, based on a large prospective surveillance system maintained by the Mexican Social Security health care system.A total of 14,236 SARI hospitalizations and 1,163 inpatient deaths (8.2%) were reported between October 1, 2013 and March 31, 2014. Rates of laboratory-confirmed A/H1N1 hospitalizations and deaths were significantly higher among individuals aged 30-59 years and lower among younger age groups for the 2013-2014 A/H1N1 season compared to the previous A/H1N1 season in 2011-2012 (χ(2) test, p0.001). The reproduction number for the winter 2013-2014 influenza season in central Mexico was estimated at 1.3-1.4, in line with that reported for the 2011-2012 A/H1N1 season but lower than during the initial waves of pandemic A/H1N1 activity in 2009.We documented a substantial increase in the number of A/H1N1-related hospitalizations and deaths during the period from October 2013-March 2014 in Mexico and a proportionate shift of severe disease to middle-aged adults, relative to the preceding A/H1N1 2011-2012 season. In the absence of clear antigenic drift in globally circulating A/H1N1 viruses in the post-2009 pandemic period, the gradual change in the age distribution of A/H1N1 infections observed in Mexico suggests a slow build-up of immunity among younger populations, reminiscent of the age profile of past pandemics.

Javier D avila-Torres, Gerardo Chowell, V ictor H. Borja-Aburto, C ecile Viboud, Concepci on Grajalez-Mu~niz, Mark A. Miller Direction of Medical Benefits, Mexican Institute of Social Security, Mexico City, Mexico Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA Mathematical, Computational and Modeling Sciences Center, School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA Coordination of Epidemiological Surveillance and Contingency Support, Mexican Institute of Social Security, Mexico City, Mexico

El programa Encuentros Médico Quirúrgicos tiene la finalidad de poner a disposición de la población de zonas rurales marginadas servicios médicos de alta especialidad. Los Encuentros Médico Quirúrgicos ponen de relieve la experiencia y los resultados de una estrategia innovadora, caracterizada por la mejora continua y el afán de seguir trascendiendo a favor de la salud de la población más desprotegida. A 17 años de su inicio, resulta interesante describir la evolución y los logros del programa.

The politics as an activity oriented to the decision making process, seeks to achieve specific objectives, and it is a fundamental tool for the transformation of the National Health System (NHS). It is important to point out that there are different elements, interest and participants that take part in the design and implementation of these policies. Therefore, it should be considered the presence of the health care institutions in the development of the health policies, as well as the participation of the Congress where each political party presents and defends their proposals, negotiate the approval and assignation of the financial budget, among others. Nowadays, there are elements with a relevant presence on these policies and in the transformation process of the NHS such as the media and laboral force represented by the unions. Finally, some general statements are expressed to contribute with the advances in the integration process for a stronger NHS. This should consider the economic, demographic and social changes in the country; furthermore it should focus on universal coverage and provision of a better health care for the Mexican population.