RESUMO
BACKGROUND: Hospitalizations for ambulatory care sensitive conditions (ACSC) incur substantial costs on the health system that could be partially avoided with adequate outpatient care. Complications of chronic diseases, such as diabetes mellitus (DM), are considered ACSC. Previous studies have shown that hospitalizations due to diabetes have a significant financial burden. In Mexico, DM is a major health concern and a leading cause of death, but there is limited evidence available. This study aimed to estimate the direct costs of hospitalizations by DM-related ACSC in the Mexican public health system. METHODS: We selected three hospitals from each of Mexico's main public institutions: the Mexican Social Security Institute (IMSS), the Ministry of Health (MoH), and the Institute of Social Security and Services for State Workers (ISSSTE). We employed a bottom-up microcosting approach from the healthcare provider perspective to estimate the total direct costs of hospitalizations for DM-related ACSC. Input data regarding length of stay (LoS), consultations, medications, colloid/crystalloid solutions, procedures, and laboratory/medical imaging studies were obtained from clinical records of a random sample of 532 hospitalizations out of a total of 1,803 DM-related ACSC (ICD-10 codes) discharges during 2016. RESULTS: The average cost per DM-related ACSC hospitalization varies among institutions, ranging from $1,427 in the MoH to $1,677 in the IMSS and $1,754 in the ISSSTE. The three institutions' largest expenses are LoS and procedures. Peripheral circulatory and renal complications were the major drivers of hospitalization costs for patients with DM-related ACSC. Direct costs due to hospitalizations for DM-related ACSC in these three institutions represent 1% of the gross domestic product (GDP) dedicated to health and social services and 2% of total hospital care expenses. CONCLUSIONS: The direct costs of hospitalizations for DM-related ACSC vary considerably across institutions. Disparities in such costs for the same ACSC among different institutions suggest potential disparities in care quality across primary and hospital settings (processes and resource utilization), which should be further investigated to ensure optimal supply utilization. Prioritizing preventive measures for peripheral circulatory and renal complications in DM patients could be highly beneficial.
Assuntos
Assistência Ambulatorial , Diabetes Mellitus , Hospitalização , Humanos , México , Diabetes Mellitus/terapia , Diabetes Mellitus/economia , Assistência Ambulatorial/economia , Masculino , Feminino , Pessoa de Meia-Idade , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Adulto , Custos Hospitalares/estatística & dados numéricos , Idoso , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Adolescente , Adulto JovemRESUMO
OBJECTIVES: To estimate and identify the variations in rates of Avoidable Hospitalization for Ambulatory Care Sensitive Conditions (AH-ACSC) in public institutions of the Mexican health system during the period 2010-2017. METHODS: Secondary analysis of the hospital discharge database of the Ministry of Health (MoH) from 2010 to 2017. AH for ACSC was calculated by age group and sex per 100,000. Variations per year between institutions were calculated with the extreme quotient (EQ), coefficient of variation (CV) and systematic component of variance (SCV). Adjusted AH rates were calculated by group of causes (acute, chronic and preventable by vaccination). Adjusted AH trend rates were analyzed by Join Point Regression. RESULTS: For the period 2010-2017, the number of AH for ACSC decreased from 676,705 to 612,897, going from almost 13% to 10.7% of hospital discharges. There is consistency in terms of relative variance magnitude. But, with regards to SCV, the change remained constant, and in a second period of 2015-2017, high variation was observed by SCV ≥ 3. All-cause AH is diminishing in all institutions. AH rates for diabetes are the highest, but like other chronic diseases, there was a decline in the period from 2010 to 2017. The relative reduction varied from 15% for heart failure to 38% for complications from diabetes or hypertension, to 75% for angina. CONCLUSIONS: AH for ACSC is an indirect indicator of quality and access to first-level care. Variations by institutions are observed. This variation in CV and SCV across subsystems and states may be due to inequities in the provision of services. The factors that contribute to the burden of AH for ACSC in the Mexican Health System require detailed analysis.
Assuntos
Assistência Ambulatorial , Diabetes Mellitus , Hospitalização , Humanos , México/epidemiologia , Saúde PúblicaRESUMO
This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated. We used thematic content and descriptive analyses to analyse the data. We found that QoC foundations, evaluation and improvement activities pose essential challenges for the Mexican health sector. Governance for QoC is weakly aligned across MoH, IMSS and ISSSTE. Each institution follows its own agenda of evaluation and improvement programmes and has distinct QoC indicators and information systems. The institutions share similar barriers to strengthening QoC: poor organizational structure at a facility level, scarcity of financial resources, lack of training in QoC for executive/managerial staff and health professionals and limited public participation. In conclusion, a stronger legal framework and policy dialogue is needed to foster governance by the MoH, to define and align health sector-wide QoC policies, and to set common goals and articulate QoC improvement actions among institutions. Robust QoC organizational structure with designated staff and clarity on their responsibilities should be established at all levels of healthcare. Investment is necessary to fund formal and in-service QoC training programmes for health professionals and to reinforce quality evaluation and improvement activities and quality information systems. QoC evaluation results should be available to healthcare providers and the population. Active public participation in the design and implementation of improvement initiatives should be strengthened.
Assuntos
Pesquisa sobre Serviços de Saúde/organização & administração , Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Atenção à Saúde/organização & administração , Mão de Obra em Saúde/normas , Humanos , México , Setor Público , Qualidade da Assistência à Saúde/legislação & jurisprudência , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Cerebrovascular disease (CD) is considered a problem of huge social, economic and public health implications worldwide in adults and elderly. In Mexico, the information concerning the provision of services to people and their characteristics is limited. The objective is to describe the characteristics of patients with CV who attended the hospitals of the Instituto Mexicano del Seguro Social (IMSS) in Mexico City. METHODS: It was carried out a cohort study of patients with ischemic or hemorrhagic CD who arrived to IMSS. Patients were recruited from seven IMSS general hospitals in Mexico City from June, 2013, to October, 2014. RESULTS: We assigned 430 subjects with CD (78.14% had ischemic CD). There were no statistical differences regarding gender. The median age of patients was 74 years. During their first 72 hours of hospital stay, it was assessed language proficiency in 90%, the ability to walk in 16.3% and the ability to move extremities in 94%. The main risk factors were hypertension, 84%; diabetes mellitus, 46.3%; history of CD, 25.1%; smoking history, 13.7%. 80% of patients reported that their health was regular or poor. CONCLUSIONS: General characteristics of patients and vascular risk factors are similar to those reported by other studies. Secondary prevention strategies are performed in less time than that recommended by international standards. It is urgent to design strategies to build better ways of care during the acute phase of patients with CD.
INTRODUCCIÓN: la enfermedad vascular cerebral (EVC) es un problema de grandes implicaciones a nivel mundial en población adulta y adultos mayores. Es limitada la información en México sobre la provisión de servicios a población con EVC y sus características. El objetivo es presentar las características de la población con EVC que acude a unidades hospitalarias del Instituto Mexicano del Seguro Social (IMSS) en la Ciudad de México. MÉTODOS: estudio de cohorte en pacientes con EVC isquémica o hemorrágica que llegaron a los servicios de urgencias de hospitales del IMSS. Los pacientes fueron reclutados de siete hospitales generales de zona en la Ciudad de México, de junio del 2013 a octubre del 2014. RESULTADOS: fueron 430 sujetos con EVC (78.14% presentó EVC isquémica). No hubo diferencias estadísticas entre hombres y mujeres. La mediana de edad fue 74 años. Durante las primeras 72 horas de su estancia hospitalaria, en 90% se evaluó la capacidad del lenguaje, en 16.3% la capacidad para caminar y en 94% la capacidad para mover las extremidades. Los factores de riesgo fueron hipertensión arterial (84%), diabetes mellitus (46.3%), antecedentes de EVC (25.1%), antecedentes de tabaquismo (13.7%). El 80% reï¬rió que su salud era regular o mala. CONCLUSIONES: las características generales de los pacientes y los factores de riesgo vascular son similares a los reportados en otros estudios. Las estrategias de prevención secundaria se hacen en menos tiempo que el recomendado por los estándares internacionales. Es importante diseñar estrategias para mejorar la atención en la fase aguda de los pacientes con EVC.
Assuntos
Acidente Vascular Cerebral/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Gerais , Hospitais Urbanos , Humanos , Masculino , México , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/etiologiaRESUMO
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.
Assuntos
Guias de Prática Clínica como Assunto/normas , Academias e Institutos , Conflito de Interesses , Ética Clínica , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , México , Previdência SocialRESUMO
BACKGROUND: Clinical practice guidelines are tools that have been able to streamline decisions made in health issues and to decrease the gap between clinical action and scientific evidence. OBJECTIVE: The objective of the study is to share the experience in the development and to update the guidelines by the National Health System of Mexico. MATERIAL AND METHODS: The methodology in the development of the guidelines consists of 5 phases: prioritisation, establishment of work groups, development by adoption of international guidelines of de novo, validation and integration in the Master catalogue of clinical practice guidelines for its dissemination. RESULTS: The Master catalogue of clinical practice guidelines contains 664 guidelines, distributed in 42% Internal Medicine, 22% Surgery, 24% Pediatrics and 12% Gynecology. From the total of guidelines coverage is granted at an 85% of the Universal catalogue of health services, an 84% of the Catastrophic expenses protection fund and a 61% of the XXI Century Medical Insurance of the National Commission of Social Protection in Health. DISCUSSION: The result is the sum of a great effort of coordination and cooperation between the institutions of the National Health System, political wills and a commitment of 3,477 health professionals that participate in guidelines' development and update. CONCLUSION: Master catalogue guidelines' integration, diffusion and implantation improve quality of attention and security of the users of the National Health System.
Assuntos
Atenção à Saúde , Guias de Prática Clínica como Assunto , Humanos , México , Guias de Prática Clínica como Assunto/normasRESUMO
The need to use clinical practice guidelines (CPG) arises from the health conditions and problems that public health institutions in the country face. CPG are informative documents that help improve the quality of care processes and patient safety; having among its objectives, to reduce the variability of medical practice. The Instituto Mexicano del Seguro Social designed a strategic plan for the dissemination, implementation, monitoring and control of CPG to establish an applicable model in the medical units in the three levels of care at the Instituto. This paper summarizes some of the strategies of the plan that were made with the knowledge and experience of clinicians and managers, with which they intend to promote the adoption of the key recommendations of the guidelines, to promote a sense of belonging for health personnel, and to encourage changes in organizational culture.
La necesidad de utilizar las guías de práctica clínica (GPC) surge de las condiciones y problemáticas de salud a las que se enfrentan las instituciones públicas de salud del país. Las GPC constituyen documentos informativos que contribuyen a mejorar la calidad de los procesos de atención y la seguridad del paciente; teniendo entre sus objetivos, reducir la variabilidad de la práctica médica. El Instituto Mexicano del Seguro Social diseñó un plan estratégico para la difusión, implementación, monitorización y control de GPC, a fin de instituir un modelo aplicable en las unidades médicas en los tres niveles de atención del Instituto. En este documento se resumen algunas de las estrategias del plan que fueron elaboradas con el conocimiento y experiencia de clínicos y gestores, con las que, se pretende impulsar la adopción de las recomendaciones clave de las guías y promover el sentido de pertenencia del personal de la salud, así como favorecer cambios en la cultura organizacional.
Assuntos
Fidelidade a Diretrizes/organização & administração , Guias de Prática Clínica como Assunto , Academias e Institutos , Atitude do Pessoal de Saúde , Pessoal de Saúde/organização & administração , Humanos , México , Cultura Organizacional , Previdência SocialRESUMO
Post-menopause is the period of life where a deep decline occurs in circulating estrogen levels, inducing the appearance of psycho and somatic symptoms. The classification to understand the chronology of reproductive aging in women (known as STRAW) determines the clinical and endocrine changes contemplating menstrual cycles, symptoms, measurements of FSH, LH, inhibin B, anti-Mullerian hormone , and follicular account. The diagnosis of menopause is established by the absence of menstruation for 12 months or more. The most frequent clinical manifestations of the climacteric syndrome transition to menopause are menstrual disorders, vasomotor symptoms (flushes and/or sweats) and genitourinary manifestations. The assessment of women in the peri- or postmenopause aims to develop: cervicovaginal cytology , lipid profile , serum glucose, basal Mammography at least a year before, pelvic ultrasound, urinalysis, serum TSH, Densitometry in patients older than 60 years if there is no recourse can be applied and FRAX. Drug therapy for the treatment of disorders of the transition to menopause or menopause is divided into: hormone therapy (HT) based estrogens and progestin hormone not being the most recommended the serotonin reuptake inhibitors and norepinephrine, clonidine, gabapentin or veralipride.
La posmenopausia es el periodo de la vida en el que ocurre un profundo descenso en las concentraciones circulantes de estrógenos, lo cual induce la aparición de los síntomas psico y somáticos. La clasificación para entender la cronología del envejecimiento reproductivo en la mujer (reconocida como STRAW) determina los cambios clínicos y endocrinos a partir de examinar los ciclos menstruales, los síntomas, las mediciones de FSH, LH, inhibina B, hormona antimulleriana y la cuenta folicular. El diagnóstico de menopausia se establece por la ausencia de menstruación por 12 meses o más. Las manifestaciones clínicas más frecuentes del síndrome climatérico o transición a la menopausia son los trastornos menstruales, los síntomas vasomotores (bochornos o sudoraciones) y las manifestaciones genitourinarias. La evaluación de la mujer en la peri o la postmenopausia contempla la realización de citología cervicovaginal, perfil de lípidos, glucosa sérica, mastografía basal (por lo menos un año antes), ultrasonido pélvico, examen general de orina, TSH sérica, densitometría (ver la Guía de práctica clínica de osteoporosis) en pacientes mayores de 60 años (y si no se cuenta con el recurso se puede aplicar el FRAX). El tratamiento farmacológico para las alteraciones de la menopausia (o de la transición a esta) se divide en: tratamiento hormonal (TH) con base en estrógenos o progestágenos, y tratamiento no hormonal; los más recomendados son los inhibidores de recaptura de serotonina y norepinefrina, clonidina, gabapentina o veraliprida.
Assuntos
Doenças Urogenitais Femininas , Fogachos , Menopausa/fisiologia , Distúrbios Menstruais , Osteoporose Pós-Menopausa , Feminino , Doenças Urogenitais Femininas/diagnóstico , Doenças Urogenitais Femininas/etiologia , Doenças Urogenitais Femininas/terapia , Fogachos/diagnóstico , Fogachos/etiologia , Fogachos/terapia , Humanos , Distúrbios Menstruais/diagnóstico , Distúrbios Menstruais/etiologia , Distúrbios Menstruais/terapia , Osteoporose Pós-Menopausa/diagnóstico , Osteoporose Pós-Menopausa/terapia , Pós-Menopausa/fisiologia , SíndromeRESUMO
AIMS: As a result of the accelerated growth of the elderly population, reconfiguration of families and member roles, and the increase of mental disorders, it is necessary to investigate the effects of this set of factors on the caregivers of patients with dementia in Mexico. Mental disorders of individuals have a negative impact on their physical and emotional quality of life, leading to greater dependence and making the caring experience a heavy burden. Several studies (none in Mexico) have used either the characteristics of the patient or caregiver to determine the burden, but few studies have included both profiles within a single study. The objective of the present study was to analyze the characteristics of the patients and caregivers associated with caregiver burden. METHODS: A multicenter study was carried out in six health institutions located in Mexico City, including 175 patients (and their caregivers) diagnosed with different types of dementia. We used the Spanish Caregiver Burden Screen. Descriptive analysis and logistic regressions were used to estimate the effect of the covariates on the caregiver burden. RESULTS: The results showed that patient variables have a greater impact on caregiver burden than caregiver-associated variables. Dysexecutive syndrome, sleep disorders, schooling and caregiver depression are associated with a higher level of caregiver burden. CONCLUSIONS: Caregiver burden is a complex phenomenon. The results of the present study showed the need to implement multifactorial interventions targeting the caregiver to reduce the burden, strengthen the skills for patient management to avoid depression, improve patient health, and diminish functional dependence and future hospitalization.
Assuntos
Atividades Cotidianas , Esgotamento Profissional/etiologia , Cuidadores/psicologia , Depressão/reabilitação , Transtorno Depressivo/etiologia , Exposição Ocupacional/efeitos adversos , Transtornos do Sono-Vigília/etiologia , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/psicologia , Depressão/epidemiologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/psicologia , Inquéritos e Questionários , SíndromeRESUMO
We reported the experience of hemophilia camps which was accomplished with patients from hospitals of the Instituto Mexicano del Seguro Social. The aim was to prepare the families and patients regarding the disease treatment, in order to promote the self sufficiency and to know the impact of the program on the course of the disease. Surveys were applied about treatment items and personal opinions were collected. The results of the national hemophilia camp were: group of 56 patients, average 14 years, 2 % women, 51 % severe hemophilia and 43 % had hemophilic brothers. Benefits: patients increased their knowledge about earlier bleeding identification and the self-infusion method; they became aware on their responsibility in self care, timely treatment and duties at home. Hemophilia camps with patients are an option for attitude change before disease complications. Social network creation and the increase in self-sufficiency are other benefits.
Se informa la experiencia con los campamentos de hemofilia que incluyen a pacientes de un hospital del Instituto Mexicano del Seguro Social en la Ciudad de México y de otros hospitales en el país, realizados con el objetivo de capacitar a los enfermos y a sus familiares en los cuidados de la enfermedad y de promover la autosuficiencia. Se aplicaron cuestionarios sobre los temas tratados y se recabaron las opiniones personales. De la experiencia con el primer campamento nacional de hemofilia se observó que en el grupo de 56 pacientes (promedio de edad de 14 años, 2 % mujeres, 51 % con hemofilia severa, 43 % con hermanos con hemofilia) se incrementaron los conocimientos en la identificación de los sangrados y la técnica de autoinfusión. De igual forma, los pacientes se concientizaron acerca de su responsabilidad en el autocuidado, el tratamiento oportuno y los deberes en el hogar. De tal forma, se señala que los campamentos son una opción para el cambio de actitud ante la enfermedad, para crear redes sociales y favorecer la autosuficiencia.
RESUMO
Non-communicable diseases are a public health problem in México. Coronary heart disease and diabetes mellitus are the first and second cause of death in the country, followed by thrombotic cerebrovascular events. Cardiovascular diseases are the leading cause of death; one primary risk factor is hypercholesterolemia. The detection and treatment of lipid abnormalities is the key to the prevention and management of chronic non-communicable diseases. Two nationally representative surveys have shown that lipid abnormalities are the most common risk factors in Mexican adults. The purpose of this guide is to provide a basis for identifying dyslipidemia in a timely manner, and to systematize the criteria for diagnosis and treatment in the first and second level of care.
Las enfermedades crónicas no transmisibles son un problema de salud pública en México; entre ellas, la enfermedad coronaria y la diabetes son la primera y la segunda causa de muerte en el país, seguidas de los eventos vasculares cerebrales embólicos. Entre los principales factores de riesgo se encuentra la hipercolesterolemia. La detección y el tratamiento de las alteraciones de los lípidos son clave para la prevención y manejo de las enfermedades crónicas no transmisibles. Dos encuestas nacionales representativas han mostrado que las anormalidades de los lípidos son los factores de riesgo más comunes en los adultos mexicanos. El propósito de esta guía es servir de base para identificar de manera oportuna las dislipidemias, además de sistematizar los criterios para el diagnóstico y tratamiento en el primer y segundo nivel de atención.
RESUMO
The incidence of urethral stenosis in Mexico had not been documented. At the Centro Médico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial. It has a great negative impact for the patients and the recurrence reaches 85 %. The treatment consisted of an invasive approach (urethral dilations, endoscopy procedure) and open surgery (urethroplasty). The World Health Organization and World Alliance take the world challenge about the urinary tract infections associated with the attention of patients, focused on urethral stenosis. The objective of the following clinical guide is to offer to the health professional a clinical tool for making decisions in the handling of the hardship or masculine urethral stenosis, based on the best available evidence, carrying out in systematized form with bibliographical research using validated terms of the MeSH: urethral structures, in the databases Trip database, PubMed, Guideline Clearinghouse, Cochrane Library and Ovid.
En México no está documentada la incidencia de la estenosis de uretra en forma consistente. En 2010, en el Centro Médico Nacional La Raza se reportaron 629 pacientes en consulta externa, 85 % de uretra anterior y 15 % de uretra posterior. La estenosis uretral es una enfermedad crónica, de etiología variada y manejo controvertido, con gran impacto negativo para los pacientes y recurrencia hasta de 85 %. El tratamiento puede ser instrumentado (dilataciones, cirugía endoscópica) y por cirugía abierta (uretroplastia). La Organización Mundial de la Salud y Alianza Mundial la consideran un reto de la atención de la salud. El objetivo de la siguiente guía es ofrecer al profesional de la salud, una herramienta clínica para la toma de decisiones en la atención de la estenosis uretral masculina, basada en la mejor evidencia identificada mediante la búsqueda bibliográfica sistematizada en las bases de datos Tripdatabase, PubMed, Guideline Clearinghouse, Cochrane Library y Ovid.
Assuntos
Uretra/lesões , Estreitamento Uretral/diagnóstico , Estreitamento Uretral/terapia , Algoritmos , Humanos , Masculino , Guias de Prática Clínica como Assunto , Inquéritos e Questionários , Estreitamento Uretral/etiologiaRESUMO
Our objective was to develop a guide based on the best available evidence that allow family physicians to establish criteria for screening, diagnosis, prevention, treatment of disease, early detection and management of complications; to standardize the organizing processes of the diabetic patient's care in the primary care level; and to achieve lifestyle modification for patients and promote self-care. Clinical questions were stated according to the diagram and structured patient-intervention-comparison-outcome. We used a mixed methodology-adoption adjustment, and include 32 guides. For recommendations not included in these, the search process was conducted in PubMed and Cochrane Library Plus with these terms: diabetes mellitus type 2, epidemiology, detection and diagnosis, classification, drug therapy, effects, prevention, control and complication. The clinical practice guideline emphasizes the fundamental change in lifestyle (diet and exercise), self-care and proactive participation of the patient, in addition to the dynamic prescription of medications that would achieve metabolic control in order to reduce late complications.
Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Algoritmos , Humanos , Guias de Prática Clínica como AssuntoRESUMO
The Instituto Mexicano del Seguro Social--always sensitive to the needs of health of the beneficiary population and to the demographic and epidemiological changes of the society--has developed and implemented DiabetlMSS, a program of attention to the diabetic patient. DiabetlMSS organizes care processes based on the needs and values of the patients, through simultaneous activities of individual consultation and group meetings granted by the multidisciplinary health team. These actions and activities are focused to affect patients' lifestyles positively. Through a plan of nutrition, physical activity, self-care and monitoring, this program increases the interaction between patients, by having an exchange of successful experiences about diabetes control. DiabetlMSS was created with the purpose that the patients achieve the metabolic control and identify complications early on, with the perspective of timely intervention that is reflected in the decrease of the catastrophic effects that causes the disease, both for patient's life expectancy and the quality of care provided by the Institute.
Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Academias e Institutos , Humanos , MéxicoRESUMO
OBJECTIVE: to describe a strategy of social support in the recovery of functional capacity on basic activities of daily living (ADL), quality of life and ways to face stress in patients after a stroke. METHODS: patients (56) with stroke, were integrated in support groups during the three months of rehabilitation. Outcomes were assessed through the Barthel Index, SF-36 questionnaire, and the Lazarus-Folkman measure. RESULTS: there was an improvement in functional capacity, with an increase in the emotional support (p = 0.0191) and affectivity (p = 0.0085). There was no change in caregiver. In quality of life 13.3 % of patients met the floor values in the dimension of physical function, 40 % in physical role and emotional role 36.7%. The most frequently used facing strategy in patients and caregivers were magical thinking that led a positive facing in the area of passive facing or directed to emotion; while in active facing or directed to the problem more flexibility in the addressed problem was used. CONCLUSIONS: the social support strategies in the rehabilitation of patients with stroke reflected an improvement on functional recovery, and quality of life.
Assuntos
Pessoas com Deficiência/reabilitação , Apoio Social , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/complicações , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Stroke is considered a big public health problem in adults and older adults. Increased life expectancy is one of the greatest achievements of development; however it is also a great challenge because of the implications with regard to increasing chronic disease that it will lead complications such as stroke. Stroke is the leading cause of disability worldwide in adulthood and the second leading cause of dementia. In developing countries, it is estimated that the costs of care for stroke are from 6000 to 8000 euros, as well as the social costs of informal care and changes in family dynamics around patients. So the purpose of this clinical practice guideline is to define recommendations based on the best available evidence for the standardization of health care of patients with stroke.
Assuntos
Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Algoritmos , Isquemia Encefálica/prevenção & controle , HumanosRESUMO
Our objective was to develop clinical guidelines based on the best clinical evidence to help the staff of medical setting of all levels (first, second and third medical attention levels) to provide evidence based care and diagnosis of hypothyroidism in adults nationwide. The guidelines were built using structured and relevant clinical questions. A strategy was developed to identify the main clinical guidelines for hypothyroidism in adult patient. The working group selected six documents. For aspects not considered in those documents, structured searches using Pubmed, Medical Disability Advisor, and Cochrane Library Plus were done. The results were qualified according its level of evidence and grade of recommendation. The diagnosis of hypothyroidism should be done precisely and without delay. Specialized care should be used rationally, using primary care units as the main resource for the treatment of hypothyroidism. This is the reason why the first primary care physicians should understand and apply a guideline for the diagnosis and treatment of hypothyroidism in adulthood.
Assuntos
Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Adulto , Algoritmos , HumanosRESUMO
OBJECTIVE: to describe the clinical data associated to maternal deaths due to fetomaternal bleeding. METHODS: we analyzed 32 of 135 cases of maternal deaths that occurred in the Instituto Mexicano del Seguro Social (IMSS) during 2011. The main inclusion feature was the presence of severe hemorrhage during pregnancy, childbirth or puerperium. RESULTS: obstetric hemorrhage as the underlying cause of maternal death was presented in 65.6 % and in 34.4 % severe obstetric hemorrhage occurred due to different underlying cause of maternal death. The age group with the highest maternal deaths by massive bleeding was the group of 30 to 39 years. The resolution of the pregnancy was by cesarean in most cases. The cases of placenta accrete and uterine atony were others maternal death causes. CONCLUSIONS: the massive bleeding during pregnancy, birth and/or postpartum continues as the second leading cause of maternal mortality in the IMSS. It is necessary to continue training for improving (the performance) in the management of the pregnancy woman with hemorrhage.