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Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The World Kidney Day was founded in 2003 by doctor Joel D. Kopple, American nephrologist, who in the session in the Congress of the International Federation of Kidney Foundations explained the need to implement the celebration on a day that alludes to this organ, in order to direct preventive actions for kidney disease and raise awareness in the medical community and the general population on the importance of caring for the kidneys. 3 years later, the proposal was accepted and as of 2006 World Kidney Day is celebrated. The diffusion is found throughout the world and in each place there are talks, courses, workshops, cultural activities and even marathons related to the prevention, diagnosis and treatment of kidney disease. Chronic kidney disease (CKD) is a disorder with a chronic, degenerative, and lethal evolution. Managing CKD requires a large amount of human, financial, and infrastructure resources. It impairs the quality of life and negatively affects survival. On the other hand, it leads to dialysis and kidney transplant treatments, which are expensive enough to put any health institution at financial risk, especially those most vulnerable. The main idea of these non-profit international organizations is to promote the well-being and improve the quality of life of people with CKD with and without dialysis, and to promote kidney transplantation as the first treatment option. [ABSTRACT FROM AUTHOR]

In the context of the 80th anniversary of the Mexican Institute for Social Security (Instituto Mexicano del Seguro Social, IMSS), there are several health problems and challenges to be faced in relation to user population, which currently represents 42% of Mexico's population. Among these issues, once five waves of COVID-19 infections have passed and mortality rates have decreased, mental and behavioral disorders stand out as a reemerging problem that should be prioritized. In response to this, in 2022 the Mental Health Comprehensive Program (MHCP, 2021-2024) took place, which represents, for the first time, the opportunity to provide health services that address mental disorders and addictions of the user population of IMSS, under the Primary Health Care model, i.e., prioritizing health promotion, risk factors prevention, screening, timely diagnosis, and not just hospitalization and drug supply. Among the MHCP strategies, which motivated the writing of this document, we highlight the availability of reliable data, through the census of mental and behavioral disorders, related to important characteristics in terms of population, state, hospital, prevalence of disorders, in order to act accordingly through the infrastructure and human resources available at IMSS, with emphasis on the first level of care. [ABSTRACT FROM AUTHOR]

Two years after the onset of the COVID-19 pandemic, the Mexican Institute for Social Security (IMSS, according to its initials in Spanish) rethought new projects focused on the new needs of the population and social security organizations and institutions. The Institute, as a cornerstone in the search for the wellbeing of Mexicans, aligned with the National Development Plan and the Strategic Health for Wellbeing Program, sought to direct its transformation towards a preventive, resilient, comprehensive, innovative, sustainable, modern and accessible IMSS. For this reason, the Medical Services Director designed the PRIISMA Project, as the one that over the next three years could make possible to innovate and improve its medical care processes, starting with the recovery of medical services and identifying those groups of beneficiaries who experience the most vulnerable circumstances. The PRIISMA project consisted of five sub-projects: 1. Vulnerable groups; 2. Efficient and effective care; 3. Prevent IMSS plus; 4 IMSS University and 5. Recovery of medical services. The strategies of each project seek to improve medical care for all IMSS beneficiaries and users with a human rights perspective and by priority groups; the goal is reducing the gaps in access to health care, leaving no one behind and leaving no one out; and to surpass the goals for medical services provided before the pandemic. This document provides an overview of strategies and progress of the PRIISMA sub-projects achieved during 2022. [ABSTRACT FROM AUTHOR]

Since 2015, the Instituto Mexicano del Seguro Social (IMSS) has developed and implemented the Infarction Code emergency care protocol, with the aim of improving the diagnosis and treatment of acute myocardial infarction and thus eventually reducing mortality. In the context of the federalization and implementation of the new IMSSBienestar care model in several states, the possibility of increasing the coverage and extension of the protocol service networks is presented, not only to eligible population but also to those who do not have social security and resides in contexts of social marginalization, to comply with article 4o. constitutional. This document describes how the proposal was made to extend and increase the service network of the Infarction Code care protocol, based on material, human and infrastructure resources of the IMSS ordinary regime and IMSS-Bienestar. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic established a new challenge for health services in Mexico, which is why these services faced the challenge of responding to the affected people, by providing them services with opportunity, efficiency, effectiveness and safety. The Instituto Mexicano del Seguro Social (IMSS, Mexican Institute for Social Security) gave medical attention to the larger number of affected people: towards the end of September, 2022, 3,335,552 patients were registered, who represented 47% of the total (7,089,209) of confirmed COVID-19 cases since the beginning of the pandemic in 2020. Of all the cases treated, 295,065 (8.8%) required hospitalization. In addition of new scientific evidence and the implementation of best practices in medical care and directive management (with the general objective of improvement of the processes in hospital attention, even without an effective treatment at the time), we presented an evaluation, supervision method with a comprehensive (involving the three levels of health services) and analytic (structure, process, result and directive management components) approach. The achievement of specific goals and lines of action was established in a technical guideline with health policies for the COVID-19 medical care. These guidelines were instrumented with a standardized evaluation tool, a result dashboard and a risk assessment calculator, improving the quality of medical care and directive management by the multidisciplinary health team. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Mortality from Chronic Kidney Disease (CKD) has increased particularly in the Americas, the trend of wich could also be observed in Mexico, mainly due to the magnitude that Diabetes Mellitus and Arterial Hypertension have reached as the main causal factors. Objective: To examine the behavior and patterns associated with the demand for medical consultations for Kidney Disease (KD) in the IMSS during the period 2011-2020. Material and methods: According to the medical consultations for KD, general and adjusted rates were estimated by year and population assigned to first-level medical unit (UMF). Through geographic information systems and spatial statistics, the magnitude, behavior and patterns associated with the estimated indicators were analyzed. Results: From 2011 to 2020, the demand for KD medical consultations increased 45.8%; the behavior was unusually higher only in 1 out of 5 UMF (p < 0.05), up to 550.2 medical consultations per 1000 persons, wich were located mainly in Jalisco, Veracruz and Chiapas. The unusually higher pattern for medical consultations (p < 0.05) was observed in the same areas during each year of study. Conclusions: The demand for medical consultations by KD has increased in IMSS and has been significantly higher in UMF located in the west, east and southeast border of Mexico, which could indicate endemic areas of KD and require the development of epidemiological research to elucidate the causality of the disease. [ABSTRACT FROM AUTHOR]

Nowadays, mental health has acquired greater relevance and attention as a consequence mainly of the COVID-19 pandemic, to which is attributed a negative impact on the development of life, work and social coexistence of people, along with the magnitude derived from non-communicable diseases. This is why the Instituto Mexicano del Seguro Social (IMSS, Mexican Institute for Social Security) developed the Mental Health Comprehensive Program 2021-2024, whose main purpose was to establish strategies and lines of action for the prevention, early detection and timely management regarding mental health and addictions. Based on this, different actions have been carried out, for example, the identification of the material and human resources available at IMSS to meet the mental health issue; the training of healthcare professionals at the three levels of care; the integration of a census that has reported a prevalence of anxiety and depressive episodes in the users of 39.9 and 3%, respectively, as well as the evaluation of instruments for screening mental disorders. Therefore, this document describes what has been done at IMSS in relation to the user's mental health in the context of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Noncommunicable diseases (NCD) cause more than 41 million deaths each year, equivalent to 71% of all deaths globally. The main types of NCD are: cardiovascular diseases (heart attack or cerebrovascular infarction), diabetes, cancer and chronic respiratory diseases (chronic obstructive pulmonary disease and asthma). In Mexico, NCD are responsible of more than three-quarters of deaths. This supplement describes a novel strategy by the Instituto Mexicano del Seguro Social (IMSS) to confront chronic diseases, known as Comprehensive Care Protocols, which aim to be a simple and easy-to-interpret reference document, but at the forefront of national and international knowledge, based on scientific evidence and normative documents. In addition, they specify the indispensable, optional actions and those that have to be avoided by the expanded health team. Therefore, this tool will guide our actions according to scientific advances and social needs. [ABSTRACT FROM AUTHOR]

The Mexican Social Security Institute, the most prominent social security institution in Mexico, plays a significant role in Mexican health care. Throughout almost eight decades of existence, it has faced significant challenges, whose experiences have contributed to the generation of health policies in the country. Recently, the health emergency caused by COVID-19 evidenced a strong impact of the epidemiological transition associated with the high prevalence of chronic-degenerative diseases, which meant an increased risk of complications and death when facing emerging diseases. The institute is transformed through changes in its policies and forms of health care for the population to provide innovative responses and fulfill the commitment to provide social security to our country. [ABSTRACT FROM AUTHOR]

Background: The Pierde Peso, Gana Vida (Lose Weight, Gain Life) strategy is granted to patients with overweight or obesity, it started in 2022 with the purpose of ordering, integrating and making efficient actions in the care of overweight and obesity, however, its effectiveness is unknown., Objective: To analyze the changes in the following parameters: body weight, waist circumference, glucose, cholesterol and triglycerides in patients who received the strategy in the 35 IMSS state offices during the two semesters of 2022., Material and Methods: A retrospective cohort study was conducted including 76,760 patients incorporated into the strategy in the two semesters of 2022. Trend analysis was performed before and after each semester of intervention. Analytical statistics were used for related samples with Student's t-test. SPPSS v25 software was used for data analysis., Results: Patients who received this strategy in each semester presented significant decrease in the parameters: body weight, waist circumference, glucose, cholesterol and triglycerides., Conclusions: The Pierde Peso, Gana Vida strategy makes the actions in obesity care efficient and allows achieving good results in the beneficiaries., (Licencia CC 4.0 (BY-NC-ND) © 2024 Revista Médica del Instituto Mexicano del Seguro Social.)

Background: The SARS-CoV-2 pandemic challenged health systems worldwide. In Mexico, the Public Health Incident Management Command (COISS) strategy was implemented to improve health care for patients with COVID-19 who required hospitalization., Aim: To evaluate the impact of the COISS strategy on case fatality rates (CFR) and years of life lost (YLL) in hospitalized patients with COVID-19., Materials and Methods: The COISS strategy included eight actions implemented in states with high epidemic risk (COISS states). A secondary analysis of the public database from the Mexican Ministry of Health was performed considering patients with confirmed diagnoses of SARS-CoV-2 infection. The COISS strategy effectiveness was evaluated by its impact on in-hospital CFR and YLL at the beginning (T0) and end (T1) of the third wave, and at the end of the fourth wave (T2) and compared to states without intervention (non-COISS states)., Results: At T0, COISS states showed a higher CFR for hospitalized patients than non-COISS states, which decreased after the strategy implementation. After correction for baseline conditions, lower relative CFR at T1 and T2, compared to T0, and a protective effect in different age groups, especially in those ≥65 years, were found in hospitalized patients in COISS states. The COISS strategy was associated with lower CFR in hospitalized patients with COVID-19 at both T1 and T2. At T0, YLLs were higher in COISS states, but there were no significant differences at T1 and T2., Conclusions: COISS interventions effectively reduced CFR in hospitalized patients with COVID-19, providing protection to vulnerable patients and reducing the YLL gap., Competing Interests: Conflict of Interest Célida Duque-Molina was the General Director of the Archives of Medical Research during the submission period; however, the editorial processes and decisions are independent. Célida Duque-Molina, Gabriel García-Rodríguez, Zoe Robledo-Aburto, and Jorge Alcocer-Varela declare that they participated in the design and implementation of the COISS strategy., (Copyright © 2024 Instituto Mexicano del Seguro Social (IMSS). Published by Elsevier Inc. All rights reserved.)

Background: Primary care level close monitoring of mild COVID-19 patients has shown to provide a risk reduction in hospitalization and death. We aimed to compare the risk of all-cause death among COVID-19 ambulatory patients who received and did not receive telephonic follow-up in primary health care settings., Methods: A secondary database analysis, 2-group comparative study, was conducted with data from the medical information systems of the Mexican Institute of Social Security. A total of 1,498,808 ambulatory patients aged 20 years old and over and with laboratory confirmed SARS-CoV-2 by PCR or rapid antigen test were analyzed. Of them, 535,898 (35.8%) where followed by telephonic calls. The cases were attended from October 14, 2020, to April 10, 2022. Death incidence was evaluated. To assess the association between death and telephonic follow-up we calculated risk ratio using a multivariate logistic model., Results: Case fatality rate was 1.29% in the patients who received telephonic follow-up and 2.95% in the cases who did not receive phone calls. Medical history of chronic kidney disease, COPD, cardiovascular disease, tobacco consumption and diabetes were associated with increased risk of death. In the multivariate model, telephonic follow-up was associated with lower risk of all-cause death, with an adjusted risk ratio of 0.61 (95% confidence interval from 0.59, 0.64)., Conclusion: Our data suggest that telephonic follow-up is associated with a risk of death reduction in adult outpatients with mild COVID-19, in the context of a multimodal strategy in the primary health care settings., Competing Interests: Conflict of interest: None., (© Copyright by the American Board of Family Medicine.)

The COVID-19 pandemic established a new challenge for health services in Mexico, which is why these services faced the challenge of responding to the affected people, by providing them services with opportunity, efficiency, effectiveness and safety. The Instituto Mexicano del Seguro Social (IMSS, Mexican Institute for Social Security) gave medical attention to the larger number of affected people: towards the end of September, 2022, 3,335,552 patients were registered, who represented 47% of the total (7,089,209) of confirmed COVID-19 cases since the beginning of the pandemic in 2020. Of all the cases treated, 295,065 (8.8%) required hospitalization. In addition of new scientific evidence and the implementation of best practices in medical care and directive management (with the general objective of improvement of the processes in hospital attention, even without an effective treatment at the time), we presented an evaluation, supervision method with a comprehensive (involving the three levels of health services) and analytic (structure, process, result and directive management components) approach. The achievement of specific goals and lines of action was established in a technical guideline with health policies for the COVID-19 medical care. These guidelines were instrumented with a standardized evaluation tool, a result dashboard and a risk assessment calculator, improving the quality of medical care and directive management by the multidisciplinary health team., (© 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

In diabetes, obtaining optimal control is key to reducing chronic complications. Unfortunately, not all patients achieve the recommended goals. Therefore, the challenges to develop and evaluate comprehensive care models are enormous. In October 2008, the Diabetic Patient Care Program (DiabetIMSS) was designed and implemented in family medicine. Its principal component is the multidisciplinary team (doctor, nurse, psychologist, dietitian, dentist, and social worker) that offers coordinated health care; monthly medical consultation and individual, family and group education on self-care and prevention of complications for 12 months. Due to the COVID-19 pandemic, the percentage of attendance at the DiabetIMSS modules decreased significantly. This is how the Medical Director considered it necessary to strengthen them, and the Diabetes Care Centers (CADIMSS) arose. In addition to providing medical care with a comprehensive and multidisciplinary approach, the CADIMSS encourages the co-responsibility of the patient and his family. It consists of monthly medical consultation and nursing staff provides monthly educational sessions for 6 months. Pending tasks remain and there are still areas of opportunity to modernize and reorganize services that contribute to improving the health of the population with diabetes., (© 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

Background: The third wave of COVID-19 in Mexico produced a high demand for hospital care, which is why it was created a multidisciplinary group to optimize decision-making: the Interinstitutional Command for the Health Sector (COISS, according to its initials in Spanish). So far, there is no scientific evidence of the COISS processes or their effect on the behavior of epidemiological indicators and the hospital care needs of the population in the context of COVID-19 in the entities involved., Objectives: To analyze the trend on epidemic risk indicators throughout the COISS group's management in the third wave of COVID-19 in Mexico., Material and Methods: Mixed study: 1) non-systematic review of information from technical documents issued by COISS, 2) secondary analysis of open-access institutional databases through the description of healthcare needs of cases notified with COVID-19 symptoms, and an ecological analysis by each Mexican state on the behavior of hospital occupancy, RT-PCR positivity, and COVID-19 mortality in two-time points., Results: The COISS activity in identifying states with epidemic risk generated actions aimed at a reduction in hospital occupancy of beds, positivity by RT-PCR, and mortality from COVID-19. Conclusions: The decisions of the COISS group reduced the indicators of epidemic risk. Continuing the work of the COISS group is an urgent need., Conclusions: The decisions of the COISS group reduced the indicators of epidemic risk. Continuing the work of the COISS group is an urgent need., (© 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

Twenty years after its launch, the most ambitious preventive program implemented at the institutional level in Mexico called PREVENIMSS focuses on new challenges and moves towards relaunching. This paper reviews the foundations and design of PREVENIMSS and its evolution throughout these two decades. The PREVENIMS coverage assessment through national surveys set a relevant precedent in evaluating programs at the Mexican Institute of Social Security. PREVENIMSS has shown progress in preventing vaccine-preventable diseases. However, given the current epidemiological profile, there is still a need to provide more effective primary and secondary prevention of chronic noncommunicable diseases. New digital resources and orientation of PREVENIMSS towards a more comprehensive approach that contemplates secondary prevention and rehabilitation can help to face the growing challenges that the program still faces., (© 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

In the context of the 80th anniversary of the Instituto Mexicano del Seguro Social (IMSS), there are several health problems and challenges to be faced in relation to user population, which currently represents 42% of Mexico´s population. Among these issues, once five waves of COVID-19 infections have passed and mortality rates have decreased, mental and behavioral disorders stand out as a re-emerging and priority problem. In response to this, in 2022 the Mental Health Comprehensive Program (MHCP, 2021-2024) materialized, which represents, for the first time, the opportunity to provide health services that address mental disorders and addictions of user´s population IMSS, under the Primary Health Care model. That is, prioritizing health promotion, risk factors prevention, screening, timely diagnosis, and not just hospitalization and drug supply. Among the MHCP strategies, which motivated the writing of this document, we highlight the availability of reliable data, through the census of mental and behavioral disorders, related to important characteristics in terms of population, state, hospital, prevalence of disorders, in order to act accordingly through the infrastructure and human resources available at the IMSS, with emphasis on the first level of care., (© 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

Two years after the onset of the COVID-19 pandemic, the Mexican Institute for Social Security (IMSS, according to its initials in Spanish) rethought new projects focused on the new needs of the population and social security organizations and institutions. The Institute, as a cornerstone in the search for the wellbeing of Mexicans, aligned with the National Development Plan and the Strategic Health for Wellbeing Program, sought to direct its transformation towards a preventive, resilient, comprehensive, innovative, sustainable, modern and accessible IMSS. For this reason, the Medical Services Director designed the PRIISMA Project, as the one that over the next three years could make possible to innovate and improve its medical care processes, starting with the recovery of medical services and identifying those groups of beneficiaries who experience the most vulnerable circumstances. The PRIISMA project consisted of five sub-projects: 1. Vulnerable groups; 2. Efficient and effective care; 3. Prevent IMSS plus; 4 IMSS University and 5. Recovery of medical services. The strategies of each project seek to improve medical care for all IMSS beneficiaries and users with a human rights perspective and by priority groups; the goal is reducing the gaps in access to health care, leaving no one behind and leaving no one out; and to surpass the goals for medical services provided before the pandemic. This document provides an overview of strategies and progress of the PRIISMA sub-projects achieved during 2022., (© 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

Undoubtedly, great advances have been made in terms of maternal and infant morbidity and mortality. However, in Mexican Social Security System, the quality of maternal care is questionable, as reflected in proportions of cesarean births three times higher than those recommended by WHO, abandonment of exclusive breastfeeding and the fact that up to one in three women is a victim of abuse during delivery. Given this, the IMSS decides to implement the model called Integral Maternal Care AMIIMSS, focused on users experience and based on friendly obstetric care, along different stages of the reproductive process. Four pillars underpin the model, women's empowerment, infrastructure adaptation, training and adaptation of processes and standards. Although there are advances, with 73 pre-labor rooms enabled and 14,103 friendly attentions granted, there are pending tasks and challenges. In terms of empowerment, the birth plan needs to be included as an institutional practice. In terms of infrastructure adequacy, a budget is required to build and adapt friendly spaces. In addition, it is necessary to update the staffing tables and include new categories, for an adequate operation of the program. On training, the adaptation of academic plans for doctors and nurses is pending. In terms of processes and regulations, there is a lack of qualitative evaluation of the impact of the program on people's experience and satisfaction and elimination of obstetric violence., (© 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

Since 2015, the Instituto Mexicano del Seguro Social (IMSS) has developed and implemented the Infarct Code emergency care protocol, with the aim of improving the diagnosis and treatment of acute myocardial infarction and thus eventually reducing mortality. In the context of the federalization and implementation of the new IMSS Bienestar care model in several states, the possibility of increasing the coverage and extension of the protocol service networks is presented, not only to eligible population but also to those who do not have social security and resides in contexts of social marginalization, to comply with article 4o. constitutional. This document describes how the proposal was made to extend and increase the service network of the Infarct Code care protocol, based on material, human and infrastructure resources of the IMSS Ordinario and Bienestar., (© 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

Background: Mortality from Chronic Kidney Disease (CKD) has increased particularly in the Americas, the trend of wich could also be observed in Mexico, mainly due to the magnitude that Diabetes Mellitus and Arterial Hypertension have reached as the main causal factors., Objective: To examine the behavior and patterns associated with the demand for medical consultations for Kidney Disease (KD) in the IMSS during the period 2011-2020., Material and Methods: According to the medical consultations for KD, general and adjusted rates were estimated by year and population assigned to first-level medical unit (UMF). Through geographic information systems and spatial statistics, the magnitude, behavior and patterns associated with the estimated indicators were analyzed., Results: From 2011 to 2020, the demand for KD medical consultations increased 45.8%; the behavior was unusually higher only in 1 out of 5 UMF (p < 0.05), up to 550.2 medical consultations per 1000 persons, wich were located mainly in Jalisco, Veracruz and Chiapas. The unusually higher pattern for medical consultations (p < 0.05) was observed in the same areas during each year of study., Conclusions: The demand for medical consultations by KD has increased in IMSS and has been significantly higher in UMF located in the west, east and southeast border of Mexico, which could indicate endemic areas of KD and require the development of epidemiological research to elucidate the causality of the disease., (© 2022 Revista Médica del Instituto Mexicano del Seguro Social.)

Background: In a context where the prevalence of Diabetes Mellitus and Hypertension has increased significantly in recent years, kidney diseases become important for the potential demand for specialized health care and resources required., Objective: To analyze the geographical distribution of Diabetic Nephropathy (DN) and Renal Insufficiency (RI) based on the medical consultations given in first-level units of IMSS during 2019, to identify the medical units with the highest burden of care., Material and Methods: Ecological-exploratory study in which indicators were estimated for every thousand persons in relation to medical consultations given by ND and RI according to service time, first-level medical unit (UMF) and representation to analyze the magnitude and geographic distribution at the national level., Results: 45% of medical consultations were by ND and 52.4% by RI. The highest burden per DN was registered in UMF No. 50 Cd. Juarez (Chihuahua) and No. 49 Gabino Barreda (Veracruz Sur), with 1.7 first-time medical consultations and 148.3 subsequent medical consultations per 1,000 persons, respectively. While in UMF No. 40 Manlio Fabio Altamirano and No. 25 Cotaxtla, in Veracruz Norte, the highest burden was for RI, with 4.9 first-time medical consultations and 134.2 subsequent medical consultations per 1000 persons, respectively., Conclusions: The results could contribute to strengthening of medical units where it is necessary and the efficient allocation of resources available to meet the demand for health services of ND and RI in IMSS., (© 2022 Revista Medica del Instituto Mexicano del Seguro Social.)

Background: Hypertension is the most common cardiovascular risk factor that is responsible for complications such as cerebrovascular events, heart failure, acute myocardial infarction, kidney failure, arrhythmias and blindness. About 30% of the adult population older than 20 years is a carrier. 40% of carriers are unaware of suffering from it since its onset is generally asymptomatic. Unfortunately, of those who are already known to be hypertensive, only half take drug treatment and of these, only half achieve control figures (<14/90 mmHg). For several decades it has not been possible to forcefully modify the natural history of this disease despite the advancement of therapeutic drugs. The Mexican Institute of Social Security launches the initiative of the Integrated Care Protocols (PAI) of the main diseases. This protocol shows how the three levels of medical care are concatenated, the role of each of the members of the multidisciplinary team for medical care, including: doctor, nurse, social work, psychologist, nutritionist, among others and, to patient sharing. The main changes in diagnostic criteria, in-office and out-of-office blood pressure measurement, drug therapy (monotherapy, dual therapy and triple therapy) and non-drug therapy, and follow-up are presented. The diagnostic-therapeutic approach using algorithm as well as the diagnostic approach to secondary hypertension and special forms of hypertension such as in pregnancy, hypertensive crisis, hypertension in the elderly, ischemic or nephropathy patients., (© 2022 Revista Medica del Instituto Mexicano del Seguro Social.)