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In Mexico, suicidal behavior is a matter of concern because, although the rates of death by suicide are below global mean (11.4 vs. 4.1 x 100,000 population), between 1970 and 2007 they increased by 175 %, especially among young people, in whom it is the third leading cause of death. For this reason, several preventive actions have been developed but have not had the expected success, because they are poorly designed. They lack a uniform and clear case definition. Their approach is reductionist, it focuses only on the public health aspect and does not go beyond traditional plans of primary, secondary and tertiary prevention. This review aims to offer different options, such as adopting the case definition provided by Atlanta's Centers for Disease Control and Prevention (CDC). It aims to broaden the vision in order to include philosophical, psychosocial and psychiatric aspects, as well as to include, as a theoretical framework, the "diathesis-stress" psychological model and propose a population-based intervention preventive strategy.En México la conducta suicida es una preocupación porque, aunque las tasas de suicidio consumado están por debajo de la media mundial (11.4 vs. 4.1 x 100,000 habitantes), entre 1970 y 2007 aumentaron un 175%, sobre todo a expensas de los jóvenes, en los cuales es la tercera causa de muerte. Por tal motivo, se han elaborado varias acciones preventivas que no han tenido el éxito esperado, porque están mal planteadas. Carecen de una definiciones de caso uniforme y clara. Su enfoque es reduccionista, se apega solo al de la salud pública y no salen del esquema tradicional de prevención primaria, secundaria y terciaria. La presente revisión pretende ofrecer una opciones diferentes. Adoptar como definición de caso la de los Centros para el Control y la Prevención de la Enfermedades (CCD) de Atlanta. Ampliar la visión incluyendo aspectos filosóficos, psicosociales y psiquiátricos. Incluir como marco teórico el modelo psicológico «diátesis-estrés» y proponer como estrategia preventiva «las intervenciones por poblaciones».

Whilst the last decades have seen a clear shift in emphasis from managing natural hazards to managing risk, the majority of natural-hazard risk research still focuses on single hazards. Internationally, there are calls for more attention for multi-hazards and multi-risks. Within the European Union (EU), the concepts of multi-hazard and multi-risk assessment and management have taken centre stage in recent years. In this perspective paper, we outline several key developments in multi-(hazard-)risk research in the last decade, with a particular focus on the EU. We present challenges for multi-(hazard-)risk management as outlined in several research projects and papers. We then present a research agenda for addressing these challenges. We argue for an approach that addresses multi-(hazard-)risk management through the lens of sustainability challenges that cut across sectors, regions, and hazards. In this approach, the starting point is a specific sustainability challenge, rather than an individual hazard or sector, and trade-offs and synergies are examined across sectors, regions, and hazards. We argue for in-depth case studies in which various approaches for multi-(hazard-)risk management are co-developed and tested in practice. Finally, we present a new pan-European research project in which our proposed research agenda will be implemented, with the goal of enabling stakeholders to develop forward-looking disaster risk management pathways that assess trade-offs and synergies of various strategies across sectors, hazards, and spatial scales.

This report is the first output of Work Package 1: Diagnosis of the MYRIAD-EU project: Handbook of Multi-hazard, Multi-Risk Definitions and Concepts. The aim of the task was to (i) acknowledge the differences and promote consistency in understanding across subsequent work packages in the MYRIAD-EU project, (ii) improve the accessibility of our work to a broad array of stakeholders and (iii) strengthen consensus across the hazard and risk community through a common understanding of multi-hazard, multi-risk terminology and concepts. The work encompassed a mixed-methods approach, including internal consultations and data-generating exercises; literature reviews; external stakeholder engagement; adopting and building on a rich existing body of established glossaries. 140 terms are included in the glossary, 102 related to multi-hazard, multi-risk, disaster risk management and an additional 38 due to their relevance to the project, acknowledging the need for a common understanding amongst an interdisciplinary project consortium. We also include extended definitions related to concepts particularly of relevance to this project deliverable, including ‘multi-hazard’, ‘hazard interrelationships’, ‘multi-risk’ and ‘direct and indirect loss and risk’. Underpinned by a literature review and internal consultation, we include a specific section on indicators, how these might be applied within a multi-hazard and multi-risk context, and how existing indicators could be adapted to consider multi-risk management. We emphasise that there are a number of established glossaries that the project (and risk community) should make use of to strengthen the impact of the work we do, noting in our literature review a tendency in papers and reports to define words afresh. We conclude the report with a selection of key observations, including terminology matters – for all aspects of disaster risk management, for example communication, data collection, measuring progress and reporting against Sendai Framework targets. At the same time, we discuss when is it helpful to include ‘multi-‘ as a prefix, questioning whether part of the paradigm shift needed to successfully address complex challenges facing an interconnected world is through inherently seeing vulnerability, exposure and disaster risk through the lens of multiple, interrelated hazards. We emphasise that there is likely to be an evolution of the terminology throughout the project lifetime as terms are emerge or shift as the project evolves. Finally, we propose a roadmap for developing and testing draft multi-risk indicators in MYRIAD-EU. The WP1 team would like to acknowledge all the contributions of the consortium on this task and the feedback from the External Advisory Board, in particular the chair of the board Virginia Murray, Head of Global Disaster Risk Reduction at the UK Health Security Agency, and the contribution of Jenty Kirsch-Wood, Head of Global Risk Management and Reporting at UNDRR, for her reflections on the findings of this work.

La generación de conocimiento científico y la difusión de los resultados de investigación son tareas fundamentales aunque no suficientes para alcanzar una atención sanitaria adecuada. Uno de los principales retos a los que se enfrentan los servicios de salud se refiere a las dificultades para aplicar de manera sistemática la mejor evidencia científica disponible. En este contexto, la “transferencia del conocimiento” (en inglés, knowledge translation) sería el proceso dinámico que puede contribuir a la utilización de la evidencia científica en los procesos de toma de decisiones. Sin embargo, existen diversos factores que contribuyen a dificultar que se observen en la práctica los efectos esperados de las intervenciones sanitarias.

Background:Intensive care unit (ICU)–acquired infections with antibiotic-resistant bacteria have been associated with substantial health and economic costs. Moreover, southern Europe has historically reported high levels of antimicrobial resistance.Objectives:We estimated the attributable economic burden of ICU-acquired infections due to resistant bacteria based upon hospital excess length of stay (LOS) in a selected sample of southern European countries.Methods:We studied a cohort of adult patients admitted to the ICU who developed an ICU-acquired infection related to an invasive procedure in a sample of Spanish, Italian, and Portuguese hospitals between 2008 and 2016, using data from The European Surveillance System (TESSy) released by the European Centers for Disease Control (ECDC). We analyzed the association between infections with selected antibiotic-resistant bacteria of public health importance and excess LOS using regression, matching, and time-to-event methods. We controlled for several confounding factors as well as time-dependent biases. We also computed the associated economic burden of excess resource utilization for each selected country.Results:In total, 13,441 patients with at least 1 ICU-acquired infection were included in the analysis: 4,106 patients (30.5%) were infected with antimicrobial-resistant bacteria, whereas 9,335 patients (69.5%) were infected with susceptible bacteria. The unadjusted association between resistance status and excess LOS was 7 days (95% CI, 6.13–7.87; P < .001). Fully adjusted models yielded significantly lower estimates: 2.76 days (95% CI, 1.98–3.54; P < .001) in the regression model, 2.60 days (95% CI, 1.66–3.55; P < .001) in the genetic matching model, and a hazard ratio of 1.15 (95% CI, 1.11–1.19; P < .001) in the adjusted Cox regression model. These estimates, alongside the prevalence of resistance, translated into direct hospitalization attributable costs per ICU-acquired infection of 5,224€ (95% CI, 3,691–6,757) for Spain, 4,461€ (95% CI, 1,948–6,974) for Portugal, and 4,320€ (95% CI, 1,662–6,977) for Italy.Conclusions:ICU-acquired infections associated with antibiotic-resistant bacteria are substantially associated with a 15% increase in excess LOS and resource utilization in 3 southern European countries. However, failure to appropriately control for significant confounders inflates estimates by ∼2.5-fold.

Marketing of new and existing drugs with new indications used alone or in combination is increasing. To identify the advantages and disadvantages of indication-based pricing (IBP) systems for such drugs from the standpoint of economic theory, practical applications and international experiences. We conducted a systematic review of published articles and reports using six bibliographic databases: PubMed, ASCO, Scopus, DARE, HTA and NHS EED. We also conducted a search of gray literature in Google Scholar. The same search terms were used as in Towse et al. (The debate on indication-based pricing in the U.S. and five major European countries. OHE Consulting Report, London, 2018). Articles and reports published from 1 January 2000 to 30 September 2018 were included. A total of 26 studies met the inclusion criteria. There are three main types of IBP: different brands with different prices for each indication, an averaged single price for all indications and a single price with differential discounts. The studies indicate that IBP systems are premised on the idea that charging a different price for different indications reflects the differences in their value and in social willingness to pay for each one and for the investment in R&D based on the indication’s incremental clinical benefit. Some argue that a uniform price reduces access and increases the price for lower-value indications, while others contend that if IBP sets prices at the maximum threshold of social willingness to pay for each indication, all surplus is transferred to the producer and consumer surplus is reduced to zero. No practical applications of pure IBP were found. Single pricing for drugs is the most prevalent approach. The system that most closely approximates an IBP model consists of agreements that are generally confidential and linked to risk-sharing agreements. There are no applications of pure IBP systems and their practical consequences are therefore unknown. More economic theory-based assessments of the pros and cons of IBP and studies different from reviews are needed to capture their intricacies and specificities.

Identifying spatial patterns of soil and plant properties can be an efficient method for site-specific management in areas with homogeneous characteristics (i.e., management zones, MZs). In this study, the use of soil apparent electrical conductivity (ECa) is proposed as the main information source for evaluating the spatial variability of soil and plant properties when using this variability to determine potential MZs. This study was conducted in a commercial hedgerow olive grove. Spatial distribution maps of the main soil properties and normalized difference vegetation index (NDVI) were generated by regression-kriging in which ECa was used as a secondary variable. According to the results obtained by the validation process, all maps were accurate. Soil and plant properties and ECa were subjected to principal component analysis (PCA). Two MZs were determined using a fuzzy cluster classification. The MZ map was validated using data related to soil samples, yield, and NDVI. Establishing different MZs was useful for adapting the irrigation strategies to the soil conditions of the plot, which resulted in increased productivity of the hedgerow olive grove. Keywords: Fuzzy c-means, Principal components analysis, Regression-kriging, Spatial prediction.

Writing a prescription or indicating a treatment is usually the last part of medical consultation. This crucial process can be undermined by multiple factors such as limited prescriptive ability, overwork, and lack of reflection or time. Insufficient information about the patient or the treatment affects the prescriptive process and leads to errors that can be serious for patient health. The National Academy of Medicine, in line with the World Health Organization, emphasizes the relevance of making the prescriptive process a reflective exercise. Extender una receta o indicar un tratamiento suele ser la ultima parte de la consulta medica. Este proceso crucial puede desvirtuarse debido a multiples factores como capacidad prescriptiva limitada, exceso de trabajo y falta de reflexion o tiempo. La informacion insuficiente acerca del paciente o del tratamiento afecta el proceso prescriptivo y propicia errores que pueden ser graves para la salud del enfermo. La Academia Nacional de Medicina, en consonancia con la Organizacion Mundial de la Salud, hace enfasis en hacer del proceso prescriptivo un ejercicio de reflexion.

The implementation of an essential medicines list in health institutions allows acquiring and administering a long list of drugs that offers treatment alternatives to physicians, as well as a collegiate academic description of indications, doses, side effects, interactions and cost-benefit analyses, thus facilitating medical prescription and administration of health products. The Committee of Ethics and Transparency in the Physician-Industry Relationship issues several recommendations for optimizing the benefits generated by essential medicines lists. La implementacion en instituciones de salud de un cuadro basico permite adquirir y administrar una larga lista de medicamentos que presenta a los medicos las alternativas de tratamiento, asi como la descripcion academica colegiada de indicaciones, dosis, efectos secundarios, interacciones y analisis de costo-beneficio, con lo que se facilita la prescripcion medica y la administracion de insumos para la salud. El Comite de Etica y Transparencia en la Relacion Medico-Industria emite diversas recomendaciones para la optimizacion de los beneficios generados por los cuadros basico de medicamentos.

Self-medication and self-prescription are actions undertaken by patients; the former, as an element of self-care that involves over-the-counter drugs, and the latter, as a violation of the Statute of Health, since it includes drugs that can only be dispensed with a medical prescription. All the drawbacks that have been attributed to self-medication are actually associated with self-prescription. La automedicacion y la autoprescripcion son acciones de los pacientes; la primera como elemento del autocuidado que involucra medicamentos de venta libre y la segunda como una violacion a la ley de salud, pues comprende medicamentos que solo pueden expenderse con receta. Todos los inconvenientes que se han atribuido a la automedicacion en realidad lo son de la autoprescripcion.

Precision irrigation aims at improving productivity and sustainability by addressing spatial as well as temporal variability of soil and crop water status. This chapter presents three case studies from south-eastern USA, Israel and Spain which relate to different attributes of precision irrigation: (1) type of precision: whether it targets the spatial variability by using variable-rate irrigation (VRI) system or the temporal variability by using automatic triggering of the irrigation, (2) type of irrigation system, and (3) type of data the system uses for irrigation decisions. Each of the case studies addresses a unique combination of attributes and together they draw a more complement picture of precision irrigation. All case studies have shown that well-timed data provides decision support for VRI management, i.e. soil moisture sensor-data (south-eastern USA and Spain) and thermal aerial imagery (Israel). The three case studies showed that precision irrigation treatments performed better than uniform irrigation. Yield increased by 4.3–12% and water-use efficiency (WUE) was improved by 14–40%. The reliance on point-sensor data in the case studies from south-eastern USA and Spain dictated the use of pre-determined irrigation management zones (IMZ), yet, enabled adaptive in season irrigation management. In season remotely sensed images can be further used for adaptive IMZ, i.e. to modify their boundaries, yet it currently suits VRI in drip irrigation. From these case studies, it can be seen that full VRI implementation, which adapts for spatial and temporal changes, faces “site-specific” challenges, i.e. every irrigation system is unique, and thus requires tailored solutions.

A novel chapter in current medical settings is the promotion and attention of esthetic aspects rather than health issues by health professionals. The human aspiration related to the search for personal beauty has generated new scenarios in medical practice. The Committee on Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine of Mexico has analyzed this phenomenon and has issued recommendations directed both to medical professionals and to producers and potential consumers of esthetic procedures.Un capítulo novedoso es la atención y promoción por parte de médicos especialistas de aspectos relacionados con procedimientos estéticos, más que con la salud. La aspiración humana de la búsqueda de la belleza personal ha generado nuevos escenarios en la labor médica. El Comité de Ética y Transparencia en la Relación Médico Industria (CETREMI) de la Academia Nacional de México ha revisado esta circunstancia y emite recomendaciones tanto a los médicos como a los productores y potenciales consumidores de procedimientos estéticos.

espanolUn capitulo novedoso es la atencion y promocion por parte de medicos especialistas de aspectos relacionados con procedimientos esteticos, mas que con la salud. La aspiracion humana de la busqueda de la belleza personal ha generado nuevos escenarios en la labor medica. El Comite de Etica y Transparencia en la Relacion Medico Industria (CETREMI) de la Academia Nacional de Mexico ha revisado esta circunstancia y emite recomendaciones tanto a los medicos como a los productores y potenciales consumidores de procedimientos esteticos. EnglishA novel chapter in current medical settings is the promotion and attention of esthetic aspects rather than health issues by health professionals. The human aspiration related to the search for personal beauty has generated new scenarios in medical practice. The Committee on Ethics and Transparency in the Physician-Industry Relationship (CETREMI) of the National Academy of Medicine of Mexico has analyzed this phenomenon and has issued recommendations directed both to medical professionals and to producers and potential consumers of esthetic procedures.

Conflicts of interest are situations in which judgment and integrity of medical decisions or actions are influenced by a secondary interest, often of an economic nature. The Committee of Ethics and Transparency in the Physician-Industry Relationship of the National Academy of Medicine of Mexico recognizes that these conflicts occur in health professionals' daily life, but also in public and private institutions that provide health services, as well as in the academy and in research activities. Therefore, it is necessary to identify conflicting situations and always act in accordance with the patient's interest.

Recent technological advances have made possible automated irrigation scheduling using decision-support tools. These tools help farmers to make better decisions in the management of their irrigation system, thus increasing yields while preserving water resources. The aim of this study is to evaluate in a commercial plot an automated irrigation system combined with remote-sensing techniques and soil mapping that allows the establishment of regulated deficit irrigation (RDI) strategies. The study was carried out over 3 years (2015&ndash, 2017) in a commercial hedgerow olive orchard of the variety &lsquo, Arbequina&rsquo, located in Alvarado (Extremadura, Spain). An apparent electrical conductivity (ECa) map and a normalized difference vegetation index (NDVI) map were generated to characterize the spatial variability of the plot and classify the zones in homogeneous areas. Then, reference points were selected to monitor the different irrigation sectors. In 2015, the plot was irrigated according to the farmer&rsquo, s technical criteria throughout the plot. In 2016 and 2017, two different areas of the plot were irrigated applying an RDI strategy, one under expert supervision and the other automatically. The results show that in a heterogeneous plot the use of new technologies can be useful to establish the ideal location for an automatic irrigation system. Furthermore, automatic irrigation scheduling made it possible to establish an RDI strategy recommended by an expert, resulting in the homogenization of production throughout the plot without the need for human intervention.

Background Infections with multidrug resistant (MDR) bacteria in hospital settings have substantial implications in terms of clinical and economic outcomes. However, due to clinical and methodological heterogeneity, estimates about the attributable economic and clinical effects of healthcare-associated infections (HAI) due to MDR microorganisms (MDR HAI) remain unclear. The objective was to review and synthesize the evidence on the impact of MDR HAI in adults on hospital costs, length of stay, and mortality at discharge. Methods and findings Literature searches were conducted in PubMed/MEDLINE, and Google Scholar databases to select studies that evaluated the impact of MDR HAI on economic and clinical outcomes. Eligible studies were conducted in adults, in order to ensure homogeneity of populations, used propensity score matched cohorts or included explicit confounding control, and had confirmed antibiotic susceptibility testing. Risk of bias was evaluated, and effects were measured with ratios of means (ROM) for cost and length of stay, and risk ratios (RR) for mortality. A systematic search was performed on 14th March 2019, re-run on the 10th of June 2019 and extended the 3rd of September 2019. Small effect sizes were assessed by examination of funnel plots. Sixteen articles (6,122 patients with MDR HAI and 8,326 patients with nonMDR HAI) were included in the systematic review of which 12 articles assessed cost, 19 articles length of stay, and 14 mortality. Compared to susceptible infections, MDR HAI were associated with increased cost (ROM 1.33, 95%CI [1.15; 1.54]), prolonged length of stay (ROM 1.27, 95%CI [1.18; 1.37]), and excess in-hospital mortality (RR 1.61, 95%CI [1.36; 1.90]) in the random effects models. Risk of publication bias was only found to be significant for mortality, and overall study quality good. Conclusions MDR HAI appears to be strongly associated with increases in direct cost, prolonged length of stay and increased mortality. However, further comprehensive studies in this setting are warranted., GLC: unrestricted grant for the study of the consequences of antimicrobial resistance. Angelini SpA.The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Hace más de 15 años que en Gaceta Sanitaria se publicó el artículo titulado «¿Qué es una tecnología sanitaria eficiente en España?». El creciente interés por fijar el precio de las nuevas tecnologías en función del valor que estas proporcionan a los sistemas de salud y la experiencia acumulada por los países de nuestro entorno hacen oportuno revisar qué es una intervención sanitaria eficiente en España en el año 2020. El análisis de coste-efectividad sigue siendo el método de referencia para maximizar los resultados en salud de la sociedad con los recursos disponibles. La interpretación de sus resultados requiere establecer unos valores de referencia que sirvan de guía sobre lo que constituye un valor razonable para el sistema sanitario. Los umbrales de eficiencia deben ser flexibles y dinámicos, y actualizarse periódicamente. Su aplicación debe estar basada en la gradualidad y la transparencia, considerando, además, otros factores que reflejen las preferencias sociales. Aunque la fijación de los umbrales corresponde a los decisores políticos, en España puede ser razonable utilizar unos valores de referencia como punto de partida que podrían estar comprendidos entre los 25.000 y los 60.000 euros por año de vida ajustado por calidad. No obstante, en la actualidad, más que la determinación de las cifras exactas de dicho umbral, la cuestión clave es si el Sistema Nacional de Salud está preparado y dispuesto a implantar un modelo de pago basado en el valor, que contribuya a lograr la gradualidad en las decisiones de financiación y, sobre todo, a mejorar la previsibilidad, la consistencia y la transparencia del proceso. Fifteen years ago, Gaceta Sanitaria published the article entitled “What is an efficient health technology in Spain?” The growing interest in setting the price of new technologies based on the value they provide to health systems and the experience accumulated by the countries in our environment make it opportune to review what constitutes an efficient health intervention in Spain in 2020. Cost-effectiveness analysis continues to be the reference method to maximize social health outcomes with the available resources. The interpretation of its results requires establishing reference values that serve as a guide on what constitutes a reasonable value for the health care system. Efficiency thresholds must be flexible and dynamic, and they need to be updated periodically. Its application should be based on and transparency, and consider other factors that reflect social preferences. Although setting thresholds is down to political decision-makers, in Spain it could be reasonable to use thresholds of 25,000 and 60,000 Euros per QALY. However, currently, in addition to determining exact figures for the threshold, the key question is whether the Spanish National Health System is able and willing to implement a payment model based on value, towards achieving gradual financing decisions and, above all, to improve the predictability, consistency and transparency of the process.

IntroductionIn Catalonia caesarean rates have always been analysed as a single percentage. The objective is to estimate caesarean section rates using the Robson classification in publicly funded hospitals in Catalonia between 2013 and 2017, considering sociodemographic, institutional and obstetric characteristics.Materials and methodsCross-sectional population-based study in Catalonia including all women delivering within publicly funded hospitals between 2013-2017 (n = 210 020). The modified Robson classification distribution was estimated, the caesarean rate and the overall contribution, analysed for each year, and by confounders, through logistic regression models.ResultsCS rates decreased steadily between 2013 and 2017 in Catalonia within publicly funded hospitals from 24.3% to 22.8% (cOR 0.92, 95% CI; 0.89 to 0.95). Once adjusted for changes in sociodemographic, institutional and obstetric characteristics the observed decline was even more pronounced (aOR 0.87, 95% CI; 0.84 to 0.90). Within the different groups of Robson once adjusted for confounders, groups 1+2 (aOR 0.88, 95% CI; 0.83 to 0.93), 3+4 (aOR 0.83, 95% CI; 0.78 to 0.89) and 10 (aOR 0.78, 95% CI; 0.68 to 0.90) presented a reduction in caesarean section rates, whereas group 5 showed no significant decrease (aOR 0.95, 95% CI; 0.87 to 1.03%).ConclusionsThe decrease in caesarean section rates in Catalonia is more pronounced when adjusted for known confounders, suggesting retrospective overutilization of caesarean section and percentages of (in)adequacy in the past. In any case, it remains above the recommended by experts. Further efforts should be made to achieve optimum rates, including improvement on obstetric data collection.

Over the last decade, precision medicine (PM) has received considerable attention and investment in research in many countries. PM aims to create new therapies, learn more about the etiology of diseases, and prevent the onset of diseases before the first symptoms arise in each individual. However, this prevailing narrative has been strongly criticized by some authors, due to the excessive emphasis on the responsibility of each individual in health matters, at the expense of existing public health measures that have a greater impact on population health. Furthermore, today many of the PM approaches lack a sound scientific basis, and it is uncertain whether precision public health (PPH) will substantially improve population health, or conversely it will exacerbate the existing health inequities within, and between countries. In this chapter, we discuss several important limitations of the PM paradigm and comment on some recent advances on PM applied to cancer patients (i.e., lung cancer).

Conflicts of interest are situations in which judgment and integrity of medical decisions or actions are influenced by a secondary interest, often of an economic nature. The Committee of Ethics and Transparency in the Physician-Industry Relationship of the National Academy of Medicine of Mexico recognizes that these conflicts occur in health professionals' daily life, but also in public and private institutions that provide health services, as well as in the academy and in research activities. Therefore, it is necessary to identify conflicting situations and always act in accordance with the patient's interest.Los conflictos de interés son situaciones en las que el juicio y la integridad de las decisiones o acciones médicas son influidas por un interés secundario, frecuentemente de tipo económico. El Comité de Ética y Transparencia en la Relación Médico-­Industria de la Academia Nacional de Medicina de México reconoce que estos conflictos ocurren en la vida diaria de los profesionales de la salud, pero también en las instituciones de servicios de salud públicas y privadas, así como en la academia y en la investigación. Por ello, es necesario identificar situaciones de conflicto y actuar siempre de acuerdo con el interés del paciente.