La etapa de los bienes globales en salud, una perspectiva nacional The age of public goods in health, a national perspective

Los efectos adversos del tabaquismo sobre la salud han sido ampliamente reconocidos desde tiempo atrás. A pesar de todo, el tabaquismo no parece disminuir, con las inevitables consecuencias sobre la morbilidad y la mortalidad de millones de personas. Tan sólo en este año la OMS calcula que cinco millones de personas morirán por esta causa. En México, 26.2% de la población entre 15 y 65 años fuma con regularidad y el consumo se incrementa entre los jóvenes y las mujeres. La OMS adoptó el Convenio Marco para el Control del Tabaco, ratificado por México, lo que llevó a la creación de la Ley General para el Control del Tabaco, un importante hito en la política sanitaria mexicana, que próximamente será promulgada y que se espera tendrá un efecto notable en la contención de la epidemia de tabaquismo en el país.Adverse health effects from smoking have been widely known for a long time. Nevertheless, tobacco use does not appear to decrease, and with it the inevitable consequences on morbidity and mortality for millions of people continue. This year alone, the WHO calculates that five million people will die from tobacco use. In Mexico, 26.2% of the population between the ages of 15 and 65 smoke regularly and consumption increases among youth and women. The WHO adopted the Framework Convention on Tobacco Control, ratified by Mexico, which brought about the General Law for Tobacco Control, an important milestone in Mexican sanitary policy. This law will soon be in force and is expected to have a notable effect on containing the smoking epidemic in the country

Flaws in the design of the Examen Nacional para Aspirantes a Residencias Médicas produce inequity

Objective. To assess the assumption of ‘equity’ of Mexico’s resident-selection assessment tool, the Examen Nacional para Aspirantes a Residencias Médicas (ENARM). Materials and methods. Official ENARM-2016 and -2017 databases were analyzed. Differences in the absolute number of correct answers (multivariable linear regression) and the number of applicants reaching their specialty minimum score (SMS) per test day (odds ratio [OR]) were calculated. Applicants affected by test-day inequity were estimated. Results. There were 36 114 applicants in 2016, and 38 380 in 2017. In 2016, day-2 applicants had significantly higher scores and more reached the SMS than on days 1-3-4 (OR 1.55), and 5 (OR 3.8); 3 565 non-passing applicants were affected by inequity (equivalent to 44.64% of those selected). In 2017, day-1 and -2 applicants had significantly higher scores and more reached the SMS than on days 3-4 (OR 1.85), and 5 (OR 4.04); 3,155 non-passing applicants were affected by inequity (37.2% of those selected). Conclusion. Analysis of official ENARM databases does not support the official attribution of equity, suggesting the test should be redesigned

Perfil epidemiológico de la mortalidad por influenza humana A (H1N1) en México Epidemiological profile of mortality due to human influenza A (H1N1) in Mexico

OBJETIVO: Efectuar el análisis epidemiológico de 122 defunciones por influenza A (H1N1) confirmadas por laboratorio y contribuir a mejorar el diagnóstico y atención oportuna de casos. MATERIAL Y MÉTODOS: Se Analizaron 122 expedientes de pacientes fallecidos por influenza A (H1N1). RESULTADOS: Una proporción de 51% correspondió a mujeres y 49% a varones. Hasta 45.1% ocurrió entre los 20 y 39 años. La letalidad general fue de 2.2% y varió entre 0.3% en el grupo de 10 a 19 años y 6.3% en el de 50 a 59. Una cifra de 43% de las defunciones se concentró en dos de las 32 entidades federativas y 5l% se atendió en instituciones de seguridad social. Sólo 17% recibió atención hospitalaria en las primeras 72 horas y 42% falleció en las primeras 72 horas de hospitalización. En 58.2% de los fallecidos había algún padecimiento asociado. DISCUSIÓN: El Nuevo virus A (H1N1) produce mayor mortalidad en personas jóvenes, al contrario de lo que sucede con la influenza estacional que muestra un mayor impacto en niños pequeños y personas de edad avanzada. El retraso de la atención médica y la morbilidad asociada fueron factores relevantes del fallecimiento.OBJECTIVE: To carry out the epidemiological analysis of 122 influenza A (H1N1) deaths confirmed by laboratory and help to improve the diagnosis and timely managing of cases. MATERIAL AND METHODS: A total of 122 clinical records were analyzed of patients with confirmed influenza A (H1N1) virus infection who died. RESULTS: Fifty-one percent of patients were female and 49% were male. A total of 45.l% who died were between 20 and 39 years old. Overall fatality was 2.2% and ranged between 0.3% for the l0 to l9 year-old group to 6.3% for the 50 to 59 year-old group. Forty-three percent of deaths were concentrated in only two of the thirty-two states and 5l% received medical attention in social security institutions. Only l7% received hospital attention within 72 hours and 42% died within 72 hours of hospital attention. DISCUSSION: Novel Influenza A (H1N1) virus produces higher mortality in young people whereas seasonal influenza has a greater impact on young children and older people. Delay in medical care and the associated morbidity were relevant factors for death

Las enfermedades crónicas no transmisibles en México: sinopsis epidemiológica y prevención integral Chronic non-communicable diseases in Mexico: epidemiologic synopsis and integral prevention

El gobierno federal desarrolla acciones para reducir la mortalidad por las "enfermedades crónicas no transmisibles" (ECNT). Una de ellas es la creación de unidades médicas de especialidad (Uneme) diseñadas para el tratamiento especializado de las ECNT (sobrepeso, obesidad, riesgo cardiovascular y diabetes). La intervención se basa en la participación de un grupo multidisciplinario entrenado ex profeso, la educación del paciente sobre su salud, la incorporación de la familia al tratamiento y la resolución de las condiciones que limitan la observancia de las recomendaciones. El tratamiento está indicado con base en protocolos estandarizados. La eficacia de la intervención se evalúa en forma sistemática mediante indicadores cuantitativos predefinidos. Se espera que las Uneme resulten en ahorros para el sistema de salud. En suma, este último desarrolla mejores medidas de control para las ECNT. La evaluación del desempeño de las Uneme generará información para planear acciones preventivas futuras.<br>The federal government has implemented several strategies to reduce mortality caused by chronic non-communicable diseases (CNTD). One example is the development of medical units specialized in the care of CNTD (i.e. overweight, obesity, cardiovascular risk and diabetes), named UNEMES (from its Spanish initials). These units -consisting of an ad-hoc, trained, multi-disciplinary team- will provide patient education, help in the resolution of obstacles limiting treatment adherence, and involve the family in patient care. Treatment will be provided using standardized protocols. The efficacy of the intervention will be regularly measured using pre-specified outcomes. We expect that these UNEMES will result in significant savings. In summary, our health care system is developing better treatment strategies for CNTD. Evaluating the performance of the UNEMES will generate valuable information for the design of future preventive actions

The genomic landscape of Mexican Indigenous populations brings insights into the peopling of the Americas

Indigenous populations, including in those in Mexico are underrepresented in genetic studies. Here, the authors perform a population genetics study of indigenous peoples in Mexico to explore demographic histories of the region in the context of geography and cultural influences