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Objective: To describe the mixed-method approach to evaluate the Medical Insurance for a New Generation (Seguro Médico para una Nueva Generación, SMNG)., Materials and Methods: The program has been comprehensively evaluated. It has four key domains: 1) SMNG design; 2) children's health status and socio-demographic characteristics; 3) performance by measuring coverage, efficiency and productivity; 4) family health expenditure. Quantitative and qualitative research approaches have been used. This included reviews of existing databases and clinical charts, collection of empirical data through in-depth interviews with healthcare providers, and a nation-wide household survey., Conclusion: The results should serve as baseline data of the health status of SMNG children and the current staus of the program.

Objective: To describe the Medical Insurance for a New Generation (SMNG) as key public policy aimed at improving health care services for children under the age of five years in Mexico., Materials and Methods: This paper analyzes interrelated aspects of public policies to provide health care to Mexican children: a) the demographic and health status of children, with emphasis on the wide disparities between children of varying demographics; b) the relationship of the main functions of a health care system: financing, equity, access and quality, with the provision of health care for children; c) the architecture of the Medical Insurance for a New Generation., Conclusion: SMNG is a program that can be instrumental in lowering infant mortality and alleviating the burden of families to care for sick children by improving access, quality of care and equity.

The first evaluation of the Medical Insurance for a New Generation program (SMNG) was conducted in 2009. A mixed-method approach was used to obtain a comprehensive picture of SMNG members and the program itself. The evaluation comprised: 1) Program design; 2) Social and health conditions of its members; 3); Evaluation of SMNG's performance by measuring coverage, productivity and efficiency; 4) Families health expenditures. The lessons learned for the program are that SMNG is focused on a vulnerable segment of the population with pervasive unmet health needs; prevalence of malnutrition, anemia and other conditions remains high. Further efforts are necessary to deploy the program where it is most needed, particularly in rural areas; most of its members are urban dwellers. However, more needs to be done to educate members about the importance of preventive care and to build the capability of health providers to provide high quality care. Families are still experiencing hardship to provide medical care to their children, so additional efforts are needed to decrease out-of-pocket and catastrophic expenditures. The lessons learned for the evaluation allow concluding that this first evaluation set the groundwork for better-targeted subsequent interventions and evaluations aimed at showing the impact of SMNG to bridge existing gaps in equity, access, coverage, and health status of Mexican children.

Objective: To evaluate the structure and processes of care of neonatal intensive care units (NICU) providing health care to neonates with respiratory insufficiency, and financed by Seguro Popular., Materials and Methods: A cross-sectional design was used; 21 NICU were included. Information was collected from four sources: Seguro Popular database, self-applicable interviews to medical staff, structure and processes format, and reviews of clinical charts., Variables: structure, processes of care, drug supplies, training, and neonates' clinical conditions., Results: The analysis of the database included 9 679 newborns. The respiratory disorders were transitory tachypnea, non-specific respiratory insufficiency, respiratory distress syndrome, (RDS) perinatal asphyxia, and meconium aspiration syndrome. 90% of NICU'S directors considered that drug supply was good, whereas only 16% of neonatologist had this opinion. 58.5% of neonates with RDS had <37 gestation weeks. 34.2% with RDS were prescribed alveolar surfactant; 51% received dosages above recommended standards., Conclusions: Recommendations to improve infrastructure and care processes are issued.

Unlabelled: Gastroesophageal reflux (GER) is a common disease in children less one year old. It is present around 10% of unselected infant population. 40-50% have abnormal 24 h pH monitoring. An early diagnosis and treatment should be done in order to avoid complications., Aim: To establish the consensus for the diagnosis and treatment of children with GER, to rule out similar diseases avoid the use of unnecessary drugs and the secondary side effects as well as unnecessary surgery., Method: The consensus was done with the participation of general pediatricians, pediatrics gastroenterologist, pediatric surgeons, radiologist and endoscopist. An initial paper was done by pediatric surgeon and pediatric gastroenterologist who submitted to the rest of participants. Second stage: the paper was review through E-mail for all participants who send their suggestions and modifications. A new paper was done and discussed by medical and surgery area. During the Congress of Pediatric Surgery, in an open session was discuss again with the participation of the main authors and all the audience present. Finally, a paper was done and review for the main authors.

Objective: To explore the opinion of physicians about euthanasia and the treatment of dying patients., Design: A comparative survey., Material and Methods: We interviewed 38 family physicians (FP), 38 specialty physicians (SP) and 38 medical students (MS). The survey had 30 items, five of them about experience with terminal patients which were not used for the students., Analysis: Descriptive statistics and chi 2 or Fisher test to compare proportions between groups., Results: One hundred and two (89%) of the interviewed had a correct concept of euthanasia; 105 (92%) thought that life is holy and untouchable; 29 (25%) agreed there are persons more valuable than others, and four (4%) consider that some should die in certain situations. In relation to patients with brain death, 79 (69%) believed they should not receive futile treatment, but 42 (37%) said they should be attended until cardiac arrest occurred. All agreed with the need of the patients to receive comfort and peace, but only 49/76 (64%) of the physicians and 28 (74%) of the students were in favor of sending dying patients to their home. Nine FP (23%) and 14 SP (36%) stated that in many occasions they lacked elements to solve ethical dilemmas. Thirty six (32%) agreed with the use of passive euthanasia and 21 (18%) with active euthanasia; the latter was more frequent among students. Nine FP (24%) and 13 SP (34%) said they had exceeded therapy sometimes and 23 (61%) of the FP and 19 (50%) of the SP considered they had stopped treatment too early in some cases. We found no differences in regard to euthanasia between physicians and students (chi 2 = 0.32, p = 0.71) nor between the physicians with frequent vs occasional contact with terminal patients (Fisher = 0.13)., Conclusions: A third of the physicians agreed with some form of euthanasia but this frequency is smaller than that in other countries.

Objective: To evaluate the tuberculin reactivity among medical students and the utility of RT-23 (2 tuberculin unit [TU] purified protein derivative [PPD]) produced in Mexico., Design: A blind and comparative study was conducted in a school of medicine using simultaneously RT-23 and an American product (5 TU PPD) randomly assigned to each forearm and read 48 hours later. Ninety eight volunteers were included, 69 from the first year and 29 from the fifth year as medical students., Results: Using 5 TU PPD, 16% of first year students and 41% of fifth grade students were positive (induration > or = 10 mm). The RT-23 worked well and showed a sensitivity of 87% and a specificity of 92%. There was a large difference in the positivity of fifth versus first year students (x2 = 6.00, P = 0.014) with an estimated annual conversion of 5.1%. The high tuberculin conversion rate urges the need to establish preventive and early diagnosis programs for tuberculosis. The utility of RT-23 was found to be comparable to 5 TU PPD in our population.

We decided to undergo a study looking for normal liver size in relation with other anthropometric measures. Fifty healthy, appropriate for gestational age term-babies, born at the Hospital de Ginecopediatría Número 48, Centro Médico Nacional del IMSS, León, Guanajuato, México, were examined by hepatic ultrasound. The vertical diameter was 6.0 +/- 0.75 cm, transverse 8.26 +/- 0.72 cm, AP 5.44 +/- 0.5 cm. The longitudinal cross section area was 16.21 +/- 2.5 cm2, and the transverse cross section area 22.53 +/- 3.4 cm2. We found most important correlation between vertical diameter and longitudinal cross section area with the anthropometric measures. The hepatic measures correlate better with the weight. Ultrasound provides a rapid, accurate and convenient method for study the liver size and morphology in the neonate.

Ultrasound is the best non-invasive study to evaluate renal morphology in the neonate; so we decided to undergo a study looking for normal renal size in relation with other anthropometric measures. We performed renal ultrasounds in 50 healthy, appropriate for gestational age, term-babies. We found correlation between several anthropometric measures, but the most significant were weight and height. In most cases the left similar to others. It is important to know normal renal dimensions in newborns, since there are diseases that not only are associated with an increased incidence of renal malformations, but also with a reduced renal size such as Down syndrome, or increased renal size such as Beckwith-Wiedemann syndrome. Renal sonogram; term newborn babies; anthropometric correlation.

Purpose: To identify current concepts and practices to treat a folk illness "empacho" in Leon, Guanajuato and a critical appraisal of risk involved., Design: Prospective cross sectional survey., Framework: General population., Patients: A random sample of 519 families., Measurements: Socioeconomic stratum, the point of view on empacho, the type and kind of treatment undertook and the clinical course observed were recorded., Results: The 45.9% of the families considered empacho as a serious condition, though the prevalence of the concept was less in the high socioeconomic group. The most frequent (44.1%) concept on empacho was "something stuck in the gut" and it use to be deal with abdominal massage and herb infusions. Cooking oil was used in 34.7%, bismuth powder in 36.5%, and an unknown powder in a further 7.9% of cases. The remedy was "prescribed" by the mother herself in 48.3% of patients, whilst in the remaining someone else did it. Simultaneous medical treatment was received by 44.2% of children and 95% of them improved., Conclusions: There is a high prevalence of the concept of empacho in the general population, mainly in the low and medium socioeconomic strata. In its treatment, dangerous practices are used, which can results in lipidic pneumonia or poisoning and according to their intensity can produce lose of life or deterioration in the respiratory or neurologic functions or both.

From June 1st, 1989 to May 31st, 1990, 16,987 consecutive newborns were examined at the No. 48 Gynecological Pediatric Hospital of the IMSS National Medical Center, looking for external congenital malformations including esophageal atresias, anorectal malformations and congenital hip luxations, all easily detected during a routine exploration. Each deformed newborn assigned two control patients the following two newborn babies showing no birth defects. 308 deformed newborns were detected, an incidence of 1.81%. Among the most frequent defects were midline flat hemangiomas, polyotia, Down syndrome, congenital hip luxation and myelomeningocele. The only significant statistical difference found with respect to the control group was a greater family history of defects in the case group (P less than 0.0001). When comparing our results with those from other studies, including a study done locally 15 years ago, we found differences among specific malformations: congenital hip malformation, polydactylia, foot deformities, flat hemangiomas, nevus and polyotias. Yet, the overall frequency of defects found was similar.