Instituto Mexicano Del Seguro Social Research Articles

Alterations to embryonic development and teratogenic effects induced by a hospital effluent on Cyprinus carpio oocytes

Hospital functioning generates a great quantity of contaminants, among which organic materials, heavy metals, and diverse pharmaceuticals are noteworthy that can affect organisms if they are not properly removed from the effluents. The hospital effluent evaluated in the present study came from IMSS (Instituto Mexicano del Seguro Social) Clinic 221 in downtown Toluca, State of Mexico, a secondary care facility. The contaminants identified in hospitals have been associated with deleterious effects on aquatic organisms; however, it is necessary to continue with more studies in order to be able to regulate the production of said contaminants which are generally dumped into the city sewage system. The present study had the purpose of evaluating the alterations to embryonic development and teratogenic effects on oocytes Cyprinus carpio after exposure to different proportions of hospital effluent. For said purpose, the physicochemical properties of the effluent were determined. Concentrations of the main microcontaminants were also determined. An embryolethality study out and the determination of the main alterations to embryonic development and teratogenic effects produced, due to exposure of C. carpio at different proportions of the effluent, were carried out. The results showed that the physicochemical properties were within the values permitted by Mexican regulation; however, the presence of contaminants such as NaClO, metals, anti-biotics, anti-diabetics, non-steroidal anti-inflammatory drugs, hormones and beta-blockers, was detected. Lethal concentration 50 was 5.65% and the effective concentration for malformations was 3.85%, with a teratogenic index of 1.46. The main teratogenic alterations were yolk deformation, scoliosis, modified chorda structure, tail malformation, fin deformity and mouth hyperplasia. A high rate of hatching delay was observed. The results suggest that the hospital effluent under study is capable of inducing embryotoxicity and teratogenicity in oocytes of C. carpio.

Health-Related Quality of Life and Satisfaction With Health Care: Relation to Clinical Stage in Mexican Patients With Multiple Myeloma.

Multiple myeloma (MM) is characterized by bone pain, pathologic fractures, bone destruction, and secondary hypercalcemia, all these conditions impact on health-related quality of life of patients. The objective was to evaluate the global health state and health-related quality of life in a group of patients with MM who attended a tertiary health-care center of the Instituto Mexicano del Seguro Social in Mexico, through the questionnaires designed by European Organization for Research and Treatment of Cancer (EORTC) quality of life group. Exploratory cross-sectional study in patients with MM treated in a Department of Hematology in a High-Specialty Medical Unit was conducted. Patients older than 18 years of age, men and women, were selected, and their informed written consent was obtained. We included all consecutive cases treated from January 2012 to December 2014. Questionnaires EORTC QLQ-C30, EORTC QLQ-MY20, and EORTC IN-PATSAT-32 were used. We studied 37 patients, 19 (51%) men and 18 women. The mean age was 61.9 years. Twenty-two (59.46%) patients presented with clinical stage III. The mean time for diagnosis was 33.11 months. The most used first-line treatment schedule was melphalan/prednisone/thalidomide (15; 40%). The global health median was 66.67, and symptoms showed a median score of 22.22. Treatment side effects score was 16.67; for general satisfaction, the median score was 75. In conclusion, the patients showed an advanced clinical stage and poor prognosis but had scores higher than 50 in functional scales and lower than 50 for symptom scales. The scores for symptom scales were related to age, renal failure, and disease-free survival. Identification of quality of life and satisfaction of care markers allow for early therapeutic intervention and efficiency and enable a change in quality of life and perception of care in Health Services.

22q11.2 deletion detected by in situ hybridization in Mexican patients with velocardiofacial syndrome-like features.

Introduction: Deletion 22q11.2 occurs in 1:4,000-1:6,000 live births while 10p13p14 deletion is found in 1:200,000 newborns. Both deletions have similar clinical features such as congenital heart disease and immunological anomalies. Objective: We looked for a 22q11.2 deletion in Mexican patients with craniofacial dysmorphisms suggestive of DiGeorge or velocardiofacial syndromes and at least one major phenotypic feature (cardiac anomaly, immune deficiency, palatal defects or development delay). Methods: A prospective study of 39 patients recruited in 2012-2015 at the Instituto Mexicano del Seguro Social at Guadalajara, Mexico. The patients with velocardiofacial syndrome-like features or a confirmed tetralogy of Fallot (TOF) or complex cardiopathy were studied by G-banding and fluorescence in situ hybridization (FISH) with a dual TUPLE1(HIRA)/ARSA or TUPLE1(22q11)/22q13(SHANK3) probe, six patients without the 22q11.2 deletion (arbitrarily selected) were tested with the dual DiGeorge II (10p14)/D10Z1 probe. Results: Twenty-two patients (7 males and 15 females) had the 22q11.2 deletion and 17/39 did not have it; no patient had a 10p loss. Among the 22 deleted patients, 19 had congenital heart disease (mostly TOF). Twelve patients without deletion had heart defects such as TOF (4/12), isolate ventricular septal defect (2/12) or other disorders (6/12). Conclusion: In our small sample about ~56% of the patients, regardless of the clinical diagnosis, had the expected 22q11.2 deletion. We remark the importance of early cytogenetic diagnosis in order to achieve a proper integral management of the patients and their families.

22q11.2 deletion detected by in situ hybridization in Mexican patients with velocardiofacial syndrome-like features.

Introduction: Deletion 22q11.2 occurs in 1:4,000-1:6,000 live births while 10p13p14 deletion is found in 1:200,000 newborns. Both deletions have similar clinical features such as congenital heart disease and immunological anomalies.Objective: We looked for a 22q11.2 deletion in Mexican patients with craniofacial dysmorphisms suggestive of DiGeorge or velocardiofacial syndromes and at least one major phenotypic feature (cardiac anomaly, immune deficiency, palatal defects or development delay). Methods: A prospective study of 39 patients recruited in 2012-2015 at the Instituto Mexicano del Seguro Social at Guadalajara, Mexico. The patients with velocardiofacial syndrome-like features or a confirmed tetralogy of Fallot (TOF) or complex cardiopathy were studied by G-banding and fluorescence in situ hybridization (FISH) with a dual TUPLE1(HIRA)/ARSA or TUPLE1(22q11)/22q13(SHANK3) probe, six patients without the 22q11.2 deletion (arbitrarily selected) were tested with the dual DiGeorge II (10p14)/D10Z1 probe. Results: Twenty-two patients (7 males and 15 females) had the 22q11.2 deletion and 17/39 did not have it; no patient had a 10p loss. Among the 22 deleted patients, 19 had congenital heart disease (mostly TOF). Twelve patients without deletion had heart defects such as TOF (4/12), isolate ventricular septal defect (2/12) or other disorders (6/12). Conclusion: In our small sample about ~56% of the patients, regardless of the clinical diagnosis, had the expected 22q11.2 deletion. We remark the importance of early cytogenetic diagnosis in order to achieve a proper integral management of the patients and their families.

The serum arachidonic acid/eicosapentaenoic acid ratio in children with healthy weight and obesity

The western diet is characterized by a high consumption of n-6 polyunsaturated fatty acids (PUFAs) and reduced n-3PUFAs, this phenomenon has been parallel to the increase in the prevalence of obesity. The studies that have analyzed the association between serum PUFAs and the influence on the development of adiposity in children is limited and the findings are controversial. The present study compared the ARA/EPA (arachidonic/eicosapentaenoic) PUFA ratio in children with healthy weight vs. obesity in a cross-sectional study. Thirty children were diagnosed with obesity and 32 children with healthy weight determined through the age-specific body mass index (BMI) Z score, according to the WHO. The variables included were weight, BMI, waist circumference (WC), and the serum ARA/EPA ratio. The Student’s t test and Pearson correlation were performed and statistical significance was set at a p <0.05. The project was approved by the local ethics committee of the hospital Instituto Mexicano del Seguro Social. The serum ARA/EPA ratio was significantly higher in children with obesity compared with healthy weight (9.0 vs 5.4; p = 0.012). A statistically significant difference was observed between healthy weight boys and obese boys (p=0.003). Furthermore, the ARA/EPA ratio correlated positively with weight (r=0.336; p=0.008), BMI (r=0.373; p=0.003), WC (r=0.319; p=0.012) and cardio-metabolic risk (r=0.302; p=0.017). When performing a multivariate regression analysis, we identified that BMI was the only variable that remained significant and predicted the ARA/EPA ratio. In conclusion, the serum ARA/EPA ratio differed significantly in relation to weight and was higher in the obese children.

Modification of the Coping and the Emotional Comorbidity in Patients Candidates to Cardiac Surgery

Objective: To evaluate the effectiveness of a program of psychological preparation for invasive procedures in patients with heart disease, candidates for cardiac surgery, to reduce emotional morbidity and improve perception of health related quality of life. Methods: A Quasi-experimental design was used. The study included a non-probabilistic randomized sample of 110 patients treated in the Division of Cardiac Surgery Centro Medico Nacional Siglo XXI Instituto Mexicano del Seguro Social IMSS. They were divided in two groups: Experimental group (n = 44) and Control group (n = 66). Instruments: CHIP Coping Questionnaire, HADS Anxiety and Depression Hospital Scale, Health Related Quality of Life Questionnaire and a Visual Analogue Scale (VAS) to measure postoperative pain. Results: The experimental group showed an increase in instrumental coping style compared to pre (M = 24.55) and post evaluation (M = 25.93); statistically significant differences were found in the variables of stress (p = 0.042), anxiety (p = 0.001), depression (p = 0.056) and health related quality of life (p = 0.000); while in the control group, the distraction coping style (pre M = 25.80, post M = 26.73) is the one that increased; there were no statistically significant differences in the variables stress (p = 0.274), anxiety (p = 0.671) and depression (p = 0.850), except for the health related quality of life (p = 0.000). This study is the first in Mexico to manage emotional comorbidity in this type of population.

Racial i(nter)dentification: The racialization of maternal health through the Oportunidades program and in government clinics in México.

Using an ethnographic approach, this article examines the role of racialization in health-disease-care processes specifically within the realm of maternal health. It considers the experiences of health care administrators and providers, indigenous midwives and mothers, and recipients of conditional cash transfers through the Oportunidades program in Mexico. By detailing the delivery of trainings of the Mexican Social Security Institute (IMSS) [Instituto Mexicano del Seguro Social] for indigenous midwives and Oportunidades workshops to indigenous stipend recipients, the article critiques the deployment of "interculturality" in ways that inadvertently re-inscribe inequality. The concept of racial i(nter)dentification is offered as a way of understanding processes of racialization that reinforce discrimination without explicitly referencing race. Racial i(nter)dentification is a tool for analyzing the multiple variables contributing to the immediate mental calculus that occurs during quotidian encounters of difference, which in turn structures how individuals interact during medical encounters. The article demonstrates how unequal sociohistorical and political conditions and differential access to economic resources become determinants of health.

Infant Scale of Selective Attention: A Proposal to Assess Cognitive Abilities

<p>El objetivo de la presente investigación fue probar la Escala de Evaluación de la Atención Selectiva (EEAS) en lactantes sanos sin sospecha de daño neurológico, con la finalidad de obtener parámetros iniciales de normalidad para el uso del instrumento. La muestra estuvo integrada por 200 lactantes con un rango de edad entre dos y ocho meses, adscritos al sistema de guarderías del Instituto<br />Mexicano del Seguro Social. Para obtener los parámetros iniciales de normalidad se utilizó estadística descriptiva para calcular la media, la desviación estándar, puntajes máximos y mínimos y percentiles. La EEAS permite identificar retrasos en el desarrollo del proceso de atención al comparar un puntaje individual contra su grupo de edad en tablas. Los hallazgos de este estudio sugieren que la EEAS es un instrumento útil para evaluar el desarrollo del proceso de atención durante la infancia.</p>

Prognostic factors for survival in patients with resectable advanced gastric adenocarcinoma

Abstract Background Patients under 45 years with gastric cancer are associated with a poor prognosis. Recent studies report that the 5-year survival is better in younger patients after curative resection. Objective To determine if prognostic factors such as age under 45 years old, anaemia, weight loss, tumour differentiation, histological sub-type, depth of invasion, and lymph node involvement, reduce the survival of patients with resectable advanced gastric adenocarcinoma undergoing gastrectomy with limited and extended lymphadenectomy. Materials and methods This study included a cohort of consecutive cases treated in the Sarcomas Department of the Oncology Hospital of the Centro Medico Nacional Siglo XXI, of the Instituto Mexicano del Seguro Social, during the period between January 2000 and December 2006. Results Of the total of 588 patients evaluated, 112 (19%) were under 45 years, 43% classified as Borrmann IV, and 36% as Borrmann III. Metastatic disease was present in 39.3%, localised diffuse in 12.5%; lower resectability 52.7 vs. 61.3% in older than 45 years. At the end of the study 29.5% of patients under 45 years were alive; no recurrence in 26.8%, with an overall survival of 58.6±4.3 months, compared with 18.3% of patients alive over 45 years, 17.9% disease-free, and with overall survival 35.2±4.3 months resectable disease. Conclusions Patients under 45 years have a better survival after a two-year disease-free period.

Esófago de Barrett como riesgo de adenocarcinoma esófagico: presentación de una serie de casos de 10 años en Hidalgo, México

Barrett's esophagus is considered a major risk factor for esophageal adenocarcinoma, however, that risk has not been studied in the Mexican population. AimsTo determine in a number of cases with Barrett‘s esophagus the incidence of esophageal adenocarcinoma after 10 years of endoscopical follow-up. Material and methodsA retrospective, observational, longitudinal and descriptive study of 2673 upper GI endoscopy from the Hospital General de Zona y Medicina Familiar 1 of Instituto Mexicano del Seguro Social, between January 1, 2002 and December 31, 2012, of which we followed those that counted with endoscopically suspected of Barret's esophagus with histological confirmation. Finally, follow-up endoscopic studies were reviewed during 10 years to assess the incidence of adenocarcinoma. ResultsWe reviewed a total of 36 patients (1.3%) confirmed with Barrett's esophagus, with an average follow-up of 5.4 years and a total of 196 years/patient. Over the course of 10 years, each patient received between 2and 4follow-up endoscopies, from which none reported adenocarcinoma. ConclusionThe prevalence of Barrett's esophagus in this series was 1.3%, lower than that reported in the English literature. The incidence of adenocarcinoma in this 10 years’ series was null.

Identification of Mycobacterium tuberculosis in the cerebrospinal fluid of patients with meningitis using nested PCR.

Tuberculous meningitis (TBM) is the most severe form of tuberculosis. It is caused by Mycobacterium tuberculosis(M.tuberculosis; MT) and it is very difficult to diagnose. The symptoms are similar to other infectious neurological diseases, such as neurocysticercosis, neuroborreliosis, or herpes viral infection. The aim of this study was to identify tuberculosis(TB) in cases of meningitis with clinical and laboratory evidence suggestive of TBM, and to confirm our findings with molecular tests for TB infection. We recruited patients with neurological symptoms who were examined at the neurology services of Hospitals of Instituto Mexicano del Seguro Social(IMSS) in MexicoCity. A total of 144consecutive patients with suggestive infectious meningitis were initially included; 94cases of meningitis with clinical and laboratory evidence suggestive of TBM were included, but only50 of these cases fulfilled the criteria for probable TBM. As the controls, we included 50cases of meningitis with clinical and laboratory evidence suggestive of non-TBM. Cerebrospinal fluid(CSF) was collected from all 100patients (cases and controls) and tested for TB by multiplex and nested PCR analyses. Nested PCR detected 0.1fg of M.tuberculosis DNA. TB infection was confirmed with molecular tests in 49patients from the 50cases suggestive of TBM and in 1of the50non-TBM cases. The analysis exhibited a sensitivity of98.0%, a specificity of 92.0%, a positive predictive value of88.0% and a negative predictive value of98.0%. The use CSF for the analyses proved to be effective for the rapid diagnosis of TBM using a developed system of multiplex and nested PCR analyses in patients presenting neurological symptoms.

Cutting Cárdenas: Revising the Revolutionary Family in 1980s Mexico

In 1987 the historical telenovela Senda de gloria (Path of Glory) debuted to the delight of audiences and illustrated a fundamental link between telenovelas and national identity. The series, a coproduction between Televisa, Mexico’s largest media conglomerate, and the Instituto Mexicano del Seguro Social (IMSS), weaves the melodramatic tale of the Alvarez family into the backdrop of the 1910 Mexican Revolution, specifically from the 1917 constitution to Lazaro Cardenas’s nationalization of oil in 1938. This article employs the discourse of the “revolutionary family” to understand both the plot and the production of Senda de gloria , as well as the political context of 1980s Mexico. Furthermore, the article explores IMSS as part of the revolutionary family and its involvement in the production of relatively costly telenovelas. Senda demonstrates how Mexican heroes and villains were recast in the neoliberal turn after 1988, and in this political and economic transition, the very history that the PRI employed to legitimize its power instead discredited the party and underscored its illegitimacy.

Avaliação do desempenho de enfermagem em um programa de previdência social

Resumo Objetivo Avaliar o desempenho da enfermagem no controle do diabetes de pacientes ambulatoriais do IMSS (Instituto Mexicano de Seguro Social) - hospital Prospera número 44 em Tamazunchale, San Luis Potosi, México. Métodos Estudo quantitativo, transversal e descritivo, com amostra de 30 enfermeiros recrutados de agosto de 2014 a abril de 2015. Foi utilizado um guia de observação de desempenho que avaliou as funções administrativas, assistenciais, de ensino e de comunicação. O desempenho foi classificado como bom, razoável e ruim por meio de estatísticas descritivas. Resultados Um total de 93.3% da amostra consistiu de mulheres, auxiliares de enfermagem certificadas; 70% com estudo de nível técnico. As medidas globais das funções administração, assistencial, de ensino e de comunicação indicaram que 6,7% apresentaram desempenho bom, 40% desempenho razoável e 53,3% desempenho ruim. Conclusão As funções de cuidar e ensinar mostraram oportunidades significativas para melhorar o autocuidado ao paciente. A avaliação do desempenho de enfermagem forneceu evidências para a gestão dos serviços no programa de diabetes.

Telemonitoring System for Patients with Chronic Kidney Disease Undergoing Peritoneal Dialysis

Elderly people with chronic diseases are becoming more numerous in our country. In Mexico, a chronic disease that is among the top ten causes of mortality overall, according to the Instituto Mexicano del Seguro Social (IMSS), is Chronic Kidney Disease (CKD). People who suffer CKD must be on constant review to maintain disease control and monitoring. In this work, we proposed the analysis, design and implementation of a telemonitoring system, to carry out a continuous control and remote monitoring of patients with CKD undergo a Peritoneal Dialysis (PD) treatment. The proposed system consists of a native app for Android, where the patient records his dialysis baths and other relevant data, and a mobile web app in which the medical staff can monitor the patient condition and give recommendations. Some core services our system provides are: data record either about CAPD (Continuous Ambulatory Peritoneal Dialysis) or APD (Automated Peritoneal Dialysis) dialysis sessions, alerts generation by detecting biomedical indices outside ranges established by the doctor, sending emails and text messages with the patient's location and details of why that warning occurred, report generation and data query.

Factores pronóstico de sobrevida en adenocarcinoma gástrico avanzado resecable

BackgroundPatients under 45 years with gastric cancer are associated with a poor prognosis. Recent studies report that the 5-year survival is better in younger patients after curative resection. ObjectiveTo determine if prognostic factors such as age under 45 years old, anaemia, weight loss, tumour differentiation, histological sub-type, depth of invasion, and lymph node involvement, reduce the survival of patients with resectable advanced gastric adenocarcinoma undergoing gastrectomy with limited and extended lymphadenectomy. Materials and methodsThis study included a cohort of consecutive cases treated in the Sarcomas Department of the Oncology Hospital of the Centro Médico Nacional Siglo XXI, of the Instituto Mexicano del Seguro Social, during the period between January 2000 and December 2006. ResultsOf the total of 588 patients evaluated, 112 (19%) were under 45 years, 43% classified as Borrmann IV, and 36% as Borrmann III. Metastatic disease was present in 39.3%, localised diffuse in 12.5%; lower resectability 52.7 vs. 61.3% in older than 45 years.At the end of the study 29.5% of patients under 45 years were alive; no recurrence in 26.8%, with an overall survival of 58.6±4.3 months, compared with 18.3% of patients alive over 45 years, 17.9% disease-free, and with overall survival 35.2±4.3 months resectable disease. ConclusionsPatients under 45 years have a better survival after a two-year disease-free period.

Omega 3 Fatty Acids Supplementation and Oxidative Stress in HIV-Seropositive Patients. A Clinical Trial.

HIV-seropositive patients show high incidence of coronary heart disease and oxidative stress has been described as relevant key in atherosclerosis development. The aim of this study was to assess the effect of omega 3 fatty acids on different markers of oxidative stress in HIV-seropositive patients. We performed a randomized parallel controlled clinical trial in The Instituto Mexicano del Seguro Social, a public health hospital. 70 HIV-seropositive patients aged 20 to 55 on clinical score A1, A2, B1 or B2 receiving highly active antiretroviral therapy (HAART) were studied. They were randomly assigned to receive omega 3 fatty acids 2.4 g (Zonelabs, Marblehead MA) or placebo for 6 months. At baseline and at the end of the study, anthropometric measurements, lipid profile, glucose and stress oxidative levels [nitric oxide catabolites, lipoperoxides (malondialdehyde plus 4-hydroxialkenals), and glutathione] were evaluated. Principal HAART therapy was EFV/TDF/FTC (55%) and AZT/3TC/EFV (15%) without difference between groups. Treatment with omega 3 fatty acids as compared with placebo decreased triglycerides (-0.32 vs. 0.54 mmol/L; p = 0.04), but oxidative stress markers were not different between groups.Trial RegistrationClinicalTrials.gov NCT02041520

Experience in training in emergencies, División de Proyectos Especiales en Salud, Instituto Mexicano del Seguro Social

Abstract Background There has been interest in the Division de Proyectos Especiales en Salud to offer the Instituto Mexicano del Seguro Social personnel resources for training and quality thereby respond to potential contingencies. Presented here is their experience in this field. Objective To describe and analyse the productivity in different training programmes in emergencies and disasters developed by the Division de Proyectos Especiales en Salud, Instituto Mexicano del Seguro Social. Material and methods Observational study in which different training activities conducted by the Division de Proyectos Especiales en Salud between 1989 and 2014 are described. Descriptive statistics were used. Results In these 25 years have trained 20,674 participants; 19,451 IMSS and 1223 other health institutions. The most productive courses were life support (BLS/ACLS) (47.17%), distance courses «Hospital medical evacuation plans and units» (14.17%), the workshop-run «Evacuation of hospital units with an emphasis on critical areas» (5.93%) and course «Programme Evaluators of Hospital Insurance» (8.43%). Conclusions Although the Division de Proyectos Especiales en Salud has primarily operational functions, it nevertheless has neglected its responsibility to maintain constantly trained and updated institute staff that every day is in a position to face any type of emergency and disaster. This increases the chance that the answer to any contingency is more organised and of higher quality, always to the benefit of the population.

Cancer mortality in the Mexican Social Security Institute, 1989-2013.

Objetive: To analyze cancer mortality in affiliates of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social - IMSS) and time trends in the risk of death due to cancer from 1989 to 2013. A descriptive analysis of cancer mortality trends in beneficiaries of the IMSS was performed. Age- and sex-adjusted mortality rates were obtained using direct standardization with the WHO population. Changes in the risk of death due to cancer over time were evaluated using Poisson regression. The absolute number of deaths due to cancer doubled from 1989 to 2013 due to increasing age of the affiliate population. The risk of death among affiliates decreased for the majority of cancers except for colon and rectal cancer. The risk of dying from cancer among IMSS affiliates showed a marked decrease, which may be due to an increase in detection and opportune treatment.

Experiencia en capacitación en emergencias de la División de Proyectos Especiales en Salud, Instituto Mexicano del Seguro Social

BackgroundThere has been interest in the Division of Special Projects in Health to offer the Instituto Mexicano del Seguro Social personnel resources for training and quality thereby respond to potential contingencies. Presented here is their experience in this field. ObjectiveTo describe and analyse the productivity in different training programs in emergencies and disasters developed by the Division of Special Projects in Health, Mexican Social Security Institute (IMSS). Material and methodsObservational study in which different training activities conducted by the Division of Special Projects in Health between 1989 and 2014 are described. Descriptive statistics were used. ResultsIn these 25 years have trained 20,674 participants; 19.451 IMSS and 1,223 other health institutions. The most productive courses were life support (BLS/ACLS) (47.17%), distance courses «Hospital medical evacuation plans and units» (14.17%), the workshop-run «Evacuation of hospital units with an emphasis on critical areas» (5.93%) and course «Programme Evaluators of Hospital Insurance» (8.43%). ConclusionsAlthough the Special Projects Division Health has primarily operational functions, it nevertheless has neglected its responsibility to maintain constantly trained and updated institute staff that every day is in a position to face any type of emergency and disaster. This increases the chance that the answer to any contingency is more organised and of higher quality, always to the benefit of the population.

Rapid Response Obstetrics team at Instituto Mexicano del Seguro Social, enabling factors

Abstract Background There are barriers and enablers for the implementation of rapid response teams in obstetric hospitals. The enabling factors were determined at Instituto Mexicano del Seguro Social (IMSS). Materials and methods An observational, retrospective study was conducted by analysing the emergency obstetric reports sent by mobile technology and e-mail to the Medical Care Unit of the IMSS in 2013. Frequency and mean was obtained using the Excel 2010 program for descriptive statistics. Results A total of 164,250 emergency obstetric cases were reported, and there was a mean of 425 messages per day, of which 32.2% were true obstetric emergencies and required the rapid response team. By e-mail, there were 73,452 life threatening cases (a mean of 6 cases per day). A monthly simulation was performed in hospitals (480 in total). Enabling factors were message's synchronisation among the participating personnel, the accurate record of the obstetrics, as well as the simulations performed by the operational staff. The most common emergency was preeclampsia–eclampsia with 3351 reports, followed by obstetric haemorrhage with 2982 cases. Discussion The enabling factors for the implementation of a rapid response team at IMSS were properly timed communication between the central delegation teams, as they allowed faster medical and administrative management and participation of hospital medical teams in the process. Conclusion Mobile technology has increased the speed of medical and administrative management in emergency obstetric care. However, comparative studies are needed to determine the statistical significance.