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The first level of medical care provides the largest number of consultations for the most frequent diseases at the community level, including acute pharyngitis (AP), acute diarrhoea (AD) and uncomplicated acute urinary tract infections (UAUTIs). The inappropriate use of antibiotics in these diseases represents a high risk for the generation of antimicrobial resistance (AMR) in bacteria causing community infections. To evaluate the patterns of medical prescription for these diseases in medical offices adjacent to pharmacies, we used an adult simulated patient (SP) method representing the three diseases, AP, AD and UAUTI. Each person played a role in one of the three diseases, with the signs and symptoms described in the national clinical practice guidelines (CPGs). Diagnostic accuracy and therapeutic management were assessed. Information from 280 consultations in the Mexico City area was obtained. For the 101 AP consultations, in 90 cases (89.1%), one or more antibiotics or antivirals were prescribed; for the 127 AD, in 104 cases (81.8%), one or more antiparasitic drugs or intestinal antiseptics were prescribed; for the scenarios involving UAUTIs in adult women, in 51 of 52 cases (98.1%) one antibiotic was prescribed. The antibiotic group with the highest prescription pattern for AP, AD and UAUTIs was aminopenicillins and benzylpenicillins [27/90 (30%)], co-trimoxazole [35/104 (27.6%)] and quinolones [38/51 (73.1%)], respectively. Our findings reveal the highly inappropriate use of antibiotics for AP and AD in a sector of the first level of health care, which could be a widespread phenomenon at the regional and national level and highlights the urgent need to update antibiotic prescriptions for UAUTIs according to local resistance patterns. Supervision of adherence to the CPGs is needed, as well as raising awareness about the rational use of antibiotics and the threat posed by AMR at the first level of care.
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The rise in antimicrobial resistance (AMR) has complicated the management of urinary tract infections (UTIs). The objective of this study was to evaluate the antimicrobial susceptibility patterns of Escherichia coli and Klebsiella pneumoniae. Design: prospective observational study. Bacteria were classified as susceptible or resistant to ampicillin-sulbactam, amikacin, gentamicin, ciprofloxacin, norfloxacin, nitrofurantoin, trimethoprim-sulfamethoxazole (TMP/SMZ), ertapenem, meropenem, and fosfomycin. The sensitivity to fosfomycin and chloramphenicol was evaluated by the disk diffusion method. Statistical analysis: the chi-square test and Fisher's exact test were used to compare differences between categories. A p value < 0.05 was considered statistically significant. Isolates were collected from January 2019 to November 2020 from 21 hospitals and laboratories. A total of 238 isolates were received: a total of 156 E. coli isolates and 82 K. pneumoniae isolates. The majority were community-acquired infections (64.1%). Resistance was >20% for beta-lactams, aminoglycosides, fluoroquinolones, and TMP/SMZ. For E. coli isolates, resistance was <20% for amikacin, fosfomycin, and nitrofurantoin; for K. pneumoniae, amikacin, fosfomycin, chloramphenicol, and norfloxacin. All were susceptible to carbapenems. K. pneumoniae isolates registered a higher proportion of extensively drug-resistant bacteria in comparison with E. coli (p = 0.0004). In total, multidrug-resistant bacteria represented 61% of all isolates. Isolates demonstrated high resistance to beta-lactams, fluoro-quinolones, and TMP/SMZ.
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BACKGROUND: On January 23, 2020, China imposed a quarantine on the city of Wuhan to contain the SARS-CoV-2 outbreak. Regardless of this measure, the new infection has spread to several countries around the world. OBJECTIVE: We developed a method to study the dissemination of this infection by airline routes and provide estimations of the time of arrival of the outbreak to different cities. METHODS: Using the Kermack and McKendrick model complemented with diffusion on a graph composed of nodes and edges, we made an analysis of COVID-19 dispersion to other cities by air travel. RESULTS: The estimation was accurate in that it was possible to predict in the middle of February 2020 the arrival of the first outbreak in Mexico, which eventually occurred between March 20 and 30. This estimation was robust with respect to small changes in epidemiological parameters at the other nodes. CONCLUSIONS: The estimation of the time of arrival of the outbreak from its epicenter, allows for a time period to implement and strengthen preventive measures aimed at the general population as well as to strengthen hospital infrastructure and training of human resources. In the present study, this estimation was accurate, as observed from the real data of the beginning of the outbreak in Mexico City up to April 6, 2020.
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Viagem Aérea , Betacoronavirus , Infecções por Coronavirus/transmissão , Pandemias , Pneumonia Viral/transmissão , Doença Relacionada a Viagens , COVID-19 , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Geografia Médica , Humanos , México/epidemiologia , Modelos Teóricos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , SARS-CoV-2 , Fatores de Tempo , Saúde da População UrbanaRESUMO
ABSTRACT Background: On January 23, 2020, China imposed a quarantine on the city of Wuhan to contain the SARS-CoV-2 outbreak. Regardless of this measure, the new infection has spread to several countries around the world. Objective: We developed a method to study the dissemination of this infection by airline routes and provide estimations of the time of arrival of the outbreak to different cities. Methods: Using the Kermack and McKendrick model complemented with diffusion on a graph composed of nodes and edges, we made an analysis of COVID-19 dispersion to other cities by air travel. Results: The estimation was accurate in that it was possible to predict in the middle of February 2020 the arrival of the first outbreak in Mexico, which eventually occurred between March 20 and 30. This estimation was robust with respect to small changes in epidemiological parameters at the other nodes. Conclusions: The estimation of the time of arrival of the outbreak from its epicenter, allows for a time period to implement and strengthen preventive measures aimed at the general population as well as to strengthen hospital infrastructure and training of human resources. In the present study, this estimation was accurate, as observed from the real data of the beginning of the outbreak in Mexico City up to April 6, 2020.
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Humanos , Pneumonia Viral/transmissão , Infecções por Coronavirus/transmissão , Pandemias/prevenção & controle , Viagem Aérea , Betacoronavirus , Doença Relacionada a Viagens , Pneumonia Viral/epidemiologia , Fatores de Tempo , China/epidemiologia , Saúde da População Urbana , Surtos de Doenças/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/epidemiologia , Geografia Médica , SARS-CoV-2 , COVID-19 , México/epidemiologia , Modelos TeóricosRESUMO
Irritable bowel syndrome (IBS) is the most frequent functional gastrointestinal disorder, worldwide, with a high prevalence among Mestizo Latin Americans. Because several inflammatory disorders appear to affect this population, a further understanding of host genomic background variants, in conjunction with colonic mucosa dysbiosis, is necessary to determine IBS physiopathology and the effects of environmental pressures. Using a simple polygenic model, host single nucleotide polymorphisms (SNPs) and the taxonomic compositions of microbiota were compared between IBS patients and healthy subjects. As proof of concept, five IBS-Rome III patients and five healthy controls (HCs) were systematically studied. The human and bacterial intestinal metagenome of each subject was taxonomically annotated and screened for previously annotated IBS, ulcerative colitis, and Crohn's disease-associated SNPs or taxon abundance. Dietary data and fecal markers were collected and associated with the intestinal microbiome. However, more than 1,000 variants were found, and at least 76 SNPs differentiated IBS patients from HCs, as did associations with 4 phyla and 10 bacterial genera. In this study, we found elements supporting a polygenic background, with frequent variants, among the Mestizo population, and the colonic mucosal enrichment of Bacteroides, Alteromonas, Neisseria, Streptococcus, and Microbacterium, may serve as a hallmark for IBS.
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Bactérias/classificação , Colo/microbiologia , Etnicidade , Microbioma Gastrointestinal , Síndrome do Intestino Irritável/genética , Síndrome do Intestino Irritável/microbiologia , Herança Multifatorial , Adulto , Bactérias/genética , Encéfalo/metabolismo , Dieta , Etnicidade/genética , Fezes/microbiologia , Feminino , Frequência do Gene , Humanos , Imunidade/genética , Mucosa Intestinal/microbiologia , Masculino , Metagenoma , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Adulto JovemRESUMO
Abstract: Objective: To establish the current situation of antimicrobial resistance and antibiotic consumption in Mexican hospitals. Materials and methods: Antimicrobial susceptibility data from blood and urine isolates were collected. Defined daily dose (DDD) of antibiotic consumption/100 occupied beds (OBD) was calculated. Results: Study period: 2016 and 2017. Of 4 382 blood isolates, E. coli and K. pneumoniae were most frequently reported, with antimicrobial resistance >30% for most drugs tested, only for carbapenems and amikacin resistance were <20%. A. baumannii had antimicrobial resistance >20% to all drugs. Resistance to oxacillin in S. aureus was 20%. From 12 151 urine isolates, 90% corresponded to E. coli; resistance to ciprofloxacin, cephalosporins and trimethoprim/sulfamethoxazole was >50%, with good susceptibility to nitrofurantoin, amikacin and carbapenems. Global median antimicrobial consumption was 57.2 DDD/100 OB. Conclusions: This report shows a high antimicrobial resistance level in Gram-negative bacilli and provides an insight into the seriousness of the problem of antibiotic consumption.
Resumen: Objetivo: Establecer la situación actual de la resistencia antimicrobiana y el consumo de antibióticos en hospitales mexicanos. Material y métodos:F Se colectaron datos de susceptibilidad antimicrobiana de aislamientos de sangre y orina. Se calculó la dosis diaria definida (DDD) del consumo de antibióticos/100 estancias. Resultados: Periodo de estudio de 2016 a 2017. De 4 382 aislamientos en sangre, E. coli y K. pneumoniae fueron las más frecuentes, con resistencia >30% a la mayoría de las drogas evaluadas; sólo para carbapenémicos y amikacina la resistencia fue <20%. A. baumannii tuvo resistencia >20% a todos los fármacos. La resistencia a oxacilina en S. aureus fue de 20%. De 12 151 aislamientos en urocultivos, 90% correspondió a E. coli; la resistencia a ciprofloxacina, cefalosporinas y trimetoprima/sulfametoxazol fue >50%, con buena susceptibilidad a nitrofurantoína, amikacina y carbapenémicos. La mediana del consumo global de antibióticos en DDD/100 estancias fue de 57.2. Conclusiones: Este reporte muestra el nivel elevado de resistencia en bacilos Gram-negativos y brinda una perspectiva de la gravedad del problema del consumo de antibióticos.
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Humanos , Farmacorresistência Bacteriana , Hospitais/estatística & dados numéricos , Antibacterianos/uso terapêutico , Staphylococcus aureus/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Intervalos de Confiança , Estudos Retrospectivos , Enterococcus faecium/efeitos dos fármacos , Enterobacter cloacae/efeitos dos fármacos , Acinetobacter baumannii/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Hospitais/classificação , Klebsiella pneumoniae/efeitos dos fármacos , MéxicoRESUMO
OBJECTIVE: To establish the current situation of antimicrobial resistance and antibiotic consumption in Mexican hospitals. MATERIALS AND METHODS: Antimicrobial susceptibility data from blood and urine isolates were collected. Defined daily dose (DDD) of antibiotic consumption/100 occupied beds (OBD) was calculated. RESULTS: Study period: 2016 and 2017. Of 4 382 blood isolates, E. coli and K. pneumoniae were most frequently reported, with antimicrobial resistance >30% for most drugs tested, only for carbapenems and amikacin resistance were <20%. A. baumannii had antimicrobial resistance >20% to all drugs. Resistance to oxacillin in S. aureus was 20%. From 12 151 urine isolates, 90% corresponded to E. coli; resistance to ciprofloxacin, cephalosporins and trimethoprim/sulfamethoxazole was >50%, with good susceptibility to nitrofurantoin, amikacin and carbapenems. Global median antimicrobial consumption was 57.2 DDD/100 OB. CONCLUSIONS: s. This report shows a high antimicrobial resistance level in Gram-negative bacilli and provides an insight into the seriousness of the problem of antibiotic consumption.
OBJETIVO: Establecer la situación actual de la resistencia antimicrobiana y el consumo de antibióticos en hospitales mexicanos. MATERIAL Y MÉTODOS: Se colectaron datos de susceptibilidad antimicrobiana de aislamientos de sangre y orina. Se calculó la dosis diaria definida (DDD) del consumo de antibióticos/100 estancias. RESULTADOS: Periodo de estudio de 2016 a 2017. De 4 382 aislamientos en sangre, E. coli y K. pneumoniae fueron las más frecuentes, con resistencia >30% a la mayoría de las drogas evaluadas; sólo para carbapenémicos y amikacina la resistencia fue <20%. A. baumannii tuvo resistencia >20% a todos los fármacos. La resistencia a oxacilina en S. aureus fue de 20%. De 12 151 aislamientos en urocultivos, 90% correspondió a E. coli; la resistencia a ciprofloxacina, cefalosporinas y trimetoprima/sulfametoxazol fue >50%, con buena susceptibilidad a nitrofurantoína, amikacina y carbapenémicos. La mediana del consumo global de antibióticos en DDD/100 estancias fue de 57.2. CONCLUSIONES: Este reporte muestra el nivel elevado de resistencia en bacilos Gram-negativos y brinda una perspectiva de la gravedad del problema del consumo de antibióticos.
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Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Hospitais/estatística & dados numéricos , Acinetobacter baumannii/efeitos dos fármacos , Intervalos de Confiança , Enterobacter cloacae/efeitos dos fármacos , Enterococcus faecium/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Hospitais/classificação , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , México , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Staphylococcus aureus/efeitos dos fármacosRESUMO
Background: On May 2016, anticipating the rainy season from June to October in Mexico, we expected an increase in cases of Zika virus (ZIKV) infections. With the goal of identifying cases of GBS associated with ZIKV infection, a prospective joint study was conducted by a reference center for neurological patients and the Secretary of Health in Mexico City from July 2016 to November 2016. Methods: Serum, cerebrospinal fluid, urine, and saliva were tested by RT-PCR for ZIKV, dengue virus, and chikungunya virus in patients referred from states with reported transmissions of ZIKV infection, and with clinical symptoms of GBS according to the Brighton Collaboration criteria. Clinical, electrophysiological, and long-term disability data were collected. Results: In the year 2016 twenty-eight patients with GBS were diagnosed at our institute. In five hospitalized patients with GBS, RT-PCR was positive to ZIKV in any collected specimen. Dengue and chikungunya RT-PCR results were negative. All five patients had areflexic flaccid weakness, and cranial nerves affected in three. Electrophysiological patterns were demyelinating in two patients and axonal in three. Three patients were discharged improved in 10 days or less, and two patients required intensive care unit admission, and completely recovered during follow-up. Conclusion: Our results are similar to those reported from the state of Veracruz, Mexico, in which out of 33 samples of urine of patients with GBS two had a positive RT-PCR for ZIKV. Simultaneous processing of serum, CSF, urine, and saliva by RT-PCR may increase the success of diagnosis of GBS associated to ZIKV.
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BACKGROUND: Psoriasis is an autoimmune skin disease that may be associated with articular manifestations, and the most common clinical presentation is the variety "in plaques". In Mexico, in the Centro Dermatológico Pascua, it is the eighth leading cause of consultation. The aim of this study was to determine the diagnostic process of patients in a reference center for diseases of the skin. METHODS: Performing an analytical cross-sectional study that included 100 patients where the diagnostic process was questioned, clinimetric scales were applied and evaluated anthropometric. RESULTS: It was found that 70% of patients had taken over a month to get medical care (median: 3 months; IQR: 11 months), having consulted in 61% to a general physician as a doctor of first contact and 89% being diagnosed by a dermatologist. Eighty-eight percent of the patients were overweight or obese. We found as a factor of delay, a partnership with the variable of having an Institutional Medical Service (p = 0.019; U = 695.5). CONCLUSION: it is necessary to design a system to shorten the diagnostic process, not only in psoriasis, in addition to emphasizing dermatological education.
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Diagnóstico Tardio/estatística & dados numéricos , Psoríase/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Fatores de TempoRESUMO
Influenza is a viral respiratory disease capable of causing epidemics that represent a threat for global security. Mexico was the first country to notify the WHO of an outbreak of what later became the first influenza pandemic of the 21st Century, caused by the virus A(H1N1)2009. Before this event Mexico had a national pandemic influenza preparedness plan, which included seasonal influenza vaccination, stockpiles of personal protection equipment and strategic drugs, and risk communication strategies. During the epidemic, the national public health laboratory network and case surveillance systems were strengthened together with surge capacities for intensive care and delivery of antiviral drugs. Risk communication was conducted for people to comply with implemented measures regarding social distancing (workplace and school closures, household quarantine). This report describes the Mexican experience during the 2009 influenza pandemic and the lessons that this experience provides to public health preparedness for future pandemics.
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Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Pandemias , Política de Saúde , Humanos , Vacinas contra Influenza , México/epidemiologia , Estações do AnoRESUMO
BACKGROUND: Hypertension ranks first medical care in first level units. It is estimated that half of the patients with hypertension are uncontrolled. The purpose of this document is to provide recommendations to guide diagnosis and treatment of arterial hypertension in primary care, which have been considered key to the process of care, in order to help health professionals in the clinical decision-making. METHODS: The guide is integrated with recommendations of international guidelines and evidence of published studies indicated the changes regarding the management and treatment of hypertension, as well as differences between the target populations of the guide. Searching for information it is performed by means of a standardized sequence in PubMed and Cochrane Library Plus, from the questions asked. The key recommendations were chosen by a consensus of a group of professionals and health managers. CONCLUSIONS: The key recommendations evidence-based standardized help you make decisions about prevention, diagnosis and treatment in patients with hypertension, and will contribute to reducing cardiovascular risk, promote changes in lifestyle, control the disease and reduce complications.
Introducción: la hipertensión arterial (HA) ocupa el primer lugar de atención en unidades médicas de primer nivel. La mitad de los pacientes con HA no están controlados. El objetivo de este documento es proporcionar las recomendaciones de la guía de diagnóstico y tratamiento de HA en el primer nivel de atención que han sido consideradas clave para el proceso de atención, con el fin de ayudar a los profesionales de la salud, en la toma de decisiones clínicas. Métodos: la guía se integró con recomendaciones de guías internacionales y evidencias de estudios publicados que señalaron los cambios ocurridos en el abordaje y tratamiento de la HA, así como las diferencias entre los grupos poblacionales blanco de la guía. La búsqueda de información se realizó por medio de una secuencia estandarizada en Pubmed y Cochrane Library Plus. Las recomendaciones clave se eligieron por consenso de un grupo de profesionales y gestores de la salud. Conclusiones: las recomendaciones clave, basadas en evidencias, ayudarán a tomar decisiones estandarizadas sobre prevención, diagnóstico y tratamiento en pacientes con HA, y coadyuvarán a disminuir el riesgo cardiovascular, impulsar cambios en el estilo de vida, controlar la enfermedad y reducir las complicaciones.
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Hipertensão , Atenção Primária à Saúde , Assistência ao Convalescente/métodos , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial , Terapia Combinada , Promoção da Saúde/métodos , Humanos , Hipertensão/diagnóstico , Hipertensão/terapiaRESUMO
An important piece of improvement in public health standards, medicine achievements, and development is based on the impressive effect of vaccines and antibiotics on infectious diseases. However, the last three or so decades have witnessed how an unsound use of antibiotics has resulted in antibiotic multi-resistant clones in hospitals and community environments. It also has been said that antibiotic research and the development pipeline has crashed, leading to no new antibiotic molecules to be tested at a time of treatment failure, manifest with unacceptable frequency as an increased economic and human cost in lives. Like the name of the series, antibiotic resistance is a global problem with clear evolutionary roots and a broad local impact. In that sense, this review explores the interaction among resistant mechanisms, underlying motives of expansion and actual trends in antibiotic resistance upgrade to limit the problem. Conceivably, only the involvement of players at every level, and coordinated actions accordingly constitute the necessary elements for effectively intervention.
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Resistência Microbiana a Medicamentos , Saúde Global , Humanos , Saúde PúblicaRESUMO
Eradication of poliomyelitis seems to be more feasible than ever. During recent years the strategy has reached milestone goals, faced new challenges, and re-configured by itself. In this text we describe the current situation of the polio eradication efforts worldwide and present an analysis of the potential implications and needs regarding vaccination in the coming years.
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Surtos de Doenças/prevenção & controle , Poliomielite/epidemiologia , Poliomielite/prevenção & controle , Vacina Antipólio Oral/administração & dosagem , Vacinação/estatística & dados numéricos , Surtos de Doenças/economia , Saúde Global/estatística & dados numéricos , Humanos , Esquemas de ImunizaçãoRESUMO
We undertook this study to review attitudes, beliefs and practices of healthcare workers (HCW) toward pandemic influenza A vaccine (H1N1) 2009 reported in the literature. Relevant papers published from 2009-2011 reporting attitudes, beliefs and practices of HCW towards pandemic influenza vaccine were identified. Variables such as age, gender, profession, work place area, and previous vaccination uptake were analyzed. In this study, 30 articles regarding attitudes and beliefs toward pandemic influenza vaccination, vaccine uptake and intention to accept vaccine were analyzed. Most studies were cross-sectional in design. Vaccination intention and uptake varies among different countries, 13.5-89.0% and 7.5-63.0%, respectively. Most common reasons for rejection were fear of adverse events, doubt regarding efficacy, not feeling as belonging to a high-risk group and believing that influenza is not a serious illness. Physicians show more favorable attitudes compared to nurses. The main predictor of vaccine uptake was having received previous influenza vaccination. Pandemic influenza uptake was low in most countries. The main reason among HCW for rejection was concern regarding side effects. It is necessary to establish educational programs to provided reliable information and raise awareness of HCW about vaccine use so that they can act as vaccine promoters among the general population.
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Pessoal de Saúde/psicologia , Vírus da Influenza A Subtipo H1N1/imunologia , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Atitude do Pessoal de Saúde , Estudos Transversais , HumanosRESUMO
The pandemic of HIV and AIDS has existed for almost 30 years in the clinical setting. Although there was a surprising reaction during the early years in global public health, for the last 14 years, mainly due to the creation of the Joint United Nations Programme on HIV/AIDS (UNAIDS), a systematic epidemiological surveillance of this disease has refined the available data and has allowed the evolution of the epidemic to be monitored more or less in detail. In Mexico, something similar has occurred. In addition to programs of assistance for persons with HIV/AIDS, epidemiological surveillance systems now have robust software platforms that provide data to define the incidence and prevalence of this epidemic reliably. This article presents the most current official information, and a review of the behavior and current situation of HIV/AIDS in the world and in Mexico.
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Infecções por HIV/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Saúde Global , Infecções por HIV/prevenção & controle , HumanosRESUMO
OBJECTIVE: To evaluate the association of 2008-9 seasonal trivalent inactivated vaccine with cases of influenza A/H1N1 during the epidemic in Mexico. DESIGN: Frequency matched case-control study. SETTING: Specialty hospital in Mexico City, March to May 2009. PARTICIPANTS: 60 patients with laboratory confirmed influenza A/H1N1 and 180 controls with other diseases (not influenza-like illness or pneumonia) living in Mexico City or the State of Mexico and matched for age and socioeconomic status. MAIN OUTCOME MEASURES: Odds ratio and effectiveness of trivalent inactivated vaccine against influenza A/H1N1. RESULTS: Cases were more likely than controls to be admitted to hospital, undergo invasive mechanical ventilation, and die. Controls were more likely than cases to have chronic conditions that conferred a higher risk of influenza related complications. In the multivariate model, influenza A/H1N1 was independently associated with trivalent inactivated vaccine (odds ratio 0.27, 95% confidence interval 0.11 to 0.66) and underlying conditions (0.15, 0.08 to 0.30). Vaccine effectiveness was 73% (95% confidence interval 34% to 89%). None of the eight vaccinated cases died. CONCLUSIONS: Preliminary evidence suggests some protection from the 2008-9 trivalent inactivated vaccine against pandemic influenza A/H1N1 2009, particularly severe forms of the disease, diagnosed in a specialty hospital during the influenza epidemic in Mexico City.
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Surtos de Doenças/prevenção & controle , Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Influenza Humana/complicações , Influenza Humana/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Resultado do Tratamento , Vacinas de Produtos InativadosRESUMO
OBJECTIVE: To determine the problems that were the sources of the complaints most frequently received at the National Commission of Medical Arbitration (CONAMED) in Mexico, as well as the diagnoses most frequently related, the institutions involved, and the populations affected. DESIGN: From all complaints received from 1 January 1998 to 31 December 2000, we chose a random sample of 639 complaints and carried out our study using a cross-sectional design. SETTING: CONAMED receives complaints from Mexico City and the surrounding areas. PARTICIPANTS: Patients attending public and private health institutions from the three levels of medical attention who submitted a complaint to the CONAMED in Mexico. MAIN OUTCOME MEASURES: Assessment of health care quality (good practice or malpractice). Type of malpractice (negligence, lack of skill, or deceit). Main motives of complaint. RESULTS: We analyzed 639 complaints; 57.6% were submitted by women, average age 41.0 years. Surgical treatment was the main cause of complaint. Most frequent diagnoses were diseases of the digestive system. Evaluation of medical practice revealed 36.5% of malpractice. Lack of skill accounted for 67.4% of those cases. CONCLUSIONS: Malpractice was identified in a third of the complaints, and lack of skill was the main reason for malpractice. Surgical patients were the most frequently affected. The other two-thirds of the complaints were related to lack of communication between patients and physicians. These results suggest potential points of intervention to decrease the risk and the conflict.