Physicians In Mexico Research Articles

Training and professional practice of the Sports Physician in Mexico

Training and professional practice of the Sports Physician in Mexico

Prostate cancer early detection among primary care physicians in Mexico: A cross-sectional study

Prostate cancer early detection among primary care physicians in Mexico: A cross-sectional study

Abstract P1-05-10: Referral pathways for breast cancer diagnosis and treatment in Mexico: a physicians’ survey

Abstract Background: Clinical stage at diagnosis is one of the most relevant prognostic factors for breast cancer (BC). In Mexico, more than half of BC patients are diagnosed at stage III-IV due to delays in referral, diagnosis, and treatment. The median time between symptom presentation and treatment initiation is 7 months; with the longest delay occurring between the first consultation and treatment start. The cause of this delay is not well defined. Our objective is to investigate if physicians in Mexico are aware of referral pathways in their respective institutions for patients with clinical suspicion and confirmation of BC. Methods: Physicians were asked to answer an anonymous and voluntary survey that included 20 questions aimed at collecting general sociodemographic data, their plan of action when BC is suspected or diagnosed, and the perception of delays and barriers in breast cancer care. The survey was promoted on exclusive social networks of Mexican health professionals. Results: In total, 802 surveys were collected. Of these, 98% were physicians, with the highest proportion (50%) being gynecologists, family, and general practitioners. The average age was 41 years, and 36% reported practicing in the public sector, 35% in the private sector, and 29% in both sectors. When faced with clinical signs and symptoms suggestive of BC, 41% of physicians in the public sector would request a breast imaging study and refer to another specialist. In contrast, 39% of specialists in the private sector preferred to request a breast imaging study and reevaluate the results. Specialties to which physicians refer patients when suspicious in public and private sectors were gynecology 41% and 29%, surgical oncology 24% and 36%, and medical oncology 17% and 19%, respectively. In the case of a confirmed BC diagnosis, physicians preferred to refer patients to oncologic surgery in 40% and 45%, medical oncology in 40% and 32%, and gynecology in 9% and 10%, respectively. Of the healthcare professionals that were surveyed, 36% in the public sector and 67% in the private sector ignored the existence of referral pathways for BC clinical suspicion and confirmation in their institution. Regarding the time interval from the onset of symptoms to treatment initiation, 64% of the private practice physicians estimated a waiting time of < 30 days. In contrast, only 22% considered this time interval in the public sector, 30% answered between 31-90 days, and 17% replied > 90 days. Most respondents from the private sector considered factors associated with the patient as the main cause for this delay. Respondents from the public sector added to this opinion that factors related to the public health services were a contributor to the delays (Table 1). Lack of knowledge about the referral pathways was significantly associated with perceiving greater delays in care (p <0.001). Conclusion: The results of this study indicate that there is no consensus among healthcare professionals in Mexico about an action plan when breast cancer is suspected or diagnosed. Although a proportion of the respondents acknowledge the presence of established referral pathways, long waiting times and delays persist between the first evaluation and the start of treatment. Associated factors include the saturation and limited resources of public health services. The development of a universal program and its promotion among all health professionals is imperative to improve BC care in Mexico. Table 1. Factors associated of delay in the care of clinical suspicion and confirmation of BC. Citation Format: Daniela Vazquez-Juarez, Raul Andrade-Moreno, Cynthia Villareal Garza. Referral pathways for breast cancer diagnosis and treatment in Mexico: a physicians’ survey [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-10.

Knowledge and Attitude Among Patients and Physicians on Allergic Rhinitis (KAPPA): An International Survey.

Our study compared knowledge of, and attitudes towards, allergic rhinitis (AR) among patients and physicians in: Brazil, Japan, Korea, Mexico, Saudi Arabia, Spain, United Arab Emirates, and the United Kingdom. Patients with AR were recruited via probability-based sampling. Data were captured via telephone interview, personal interview, or self-administered online survey. Physicians were recruited from an online physician panel and interviewed by self-administered online survey. In total, 1436 patients and 1637 physicians were surveyed. Most patients (76.9%) reported moderate-to-severe AR, whereas physicians reported more mild (mean cases ranging from 57.0-68.2) than moderate-to-severe AR (mean cases ranging from 31.8-43.0). Overall, most physicians (85.4%) and patients (77.5%) agreed AR could be controlled with treatment. Physicians preferred prescribing oral antihistamines (OAHs) for mild AR (from 45.3% of physicians in Brazil to 73.6% of physicians in Mexico). For moderate and severe AR, more physicians preferred prescribing intranasal corticosteroids (INCSs) and OAHs for moderate and severe AR than other available treatments (from 48.5% of physicians in the UK to 69.5% of physicians in Spain). Patients preferred OAHs to INCSs for treating AR (62.0%). Patients also reported a range of comorbidities: overall, sinus infections were the most common (24.7%), and comorbid asthma was present in 12.9% of patients. Per country, Saudi Arabia had the highest proportion (53.5%) and Mexico had the lowest proportion (8.0%) of patients with comorbid asthma. Patient and physician perceptions of AR mostly differed between and within countries, although there was generally agreement that AR could be controlled with treatment. Differing attitudes towards AR among patients and physicians suggests a need for improved education in and communication between these groups, with subsequent implications for optimizing disease management.

MY YEARS AS COEDITOR OF THE REVISTA DE INVESTIGACIóN CLíNICA AND THE 1993-1998 READERS OF OUR JOURNAL.

Some information on our readers during my years as coeditor of the Revista de Investigación Clínica are presented on the basis that readers, unlike editors, have no conflict of interest in evaluating scientific publications. The information provided is restricted to the past 6 years (1993-1998) of my 11 years as coeditor since the number of reader visits to our on-line articles began in 1993. The nearly 500 articles published in the 6-year lapse were visited by more than 1 million readers with an outstanding 1998 year of almost 100 articles and near a quarter of a million visits. These figures suggest that our journal became at the end of the 20th Century a valuable information source for physicians in Mexico. It was the original idea that led Salvador Zubirán to launch this journal in 1948.

Results from a cross-sectional, observational study to assess inadequate pain relief in patients with knee and/or hip osteoarthritis in Mexico

Introduction and objectivesThere is limited data that characterizes osteoarthritis (OA) patients who experience moderate to severe pain despite analgesic treatment in Mexico. In this study, we estimate the real-world prevalence of inadequate pain relief (IPR) among individuals with knee and/or hip OA who have been prescribed analgesic therapy and characterize this patient population for each country separately. Materials and methodsThis is a multinational, multi-site, cross-sectional, observational study. Participating physicians enrolled patients over 50 years of age with diagnosed knee and/or hip OA who had been prescribed topical and/or oral pain medication for at least 30 days prior to study visit, extracted data from their medical charts, and collected patient data using established questionnaires. Results301 patients treated by 35 physicians in Mexico were enrolled in the study. More than half of the patients (53%) met the definition of IPR. Patients with IPR were significantly older (66.8 vs. 63.5 years, p=0.002) and were more likely to be obese (24.2% vs. 11.9%, p=0.006). Patients in the IPR group were more likely to report moderate/severe problems across all 5 dimensions of the EQ-5D and reported higher scores, indicating worse outcomes, on all three WOMAC subscales. Patients in the IPR group also reported reduced work productivity and greater treatment dissatisfaction compared to patients without IPR. Discussion and conclusionsIPR is highly prevalent among individuals with knee and/or hip OA in Mexico. Patients with IPR experience decreased health-related quality of life HRQoL and work productivity, impaired function, and poor treatment satisfaction. Health care professionals need to be aware of the high prevalence of IPR, work toward improving OA patient management, and facilitate early intervention or changes in drug and other treatment modalities.

Results from a cross-sectional, observational study to assess inadequate pain relief in patients with knee and/or hip osteoarthritis in Mexico

There is limited data that characterizes osteoarthritis (OA) patients who experience moderate to severe pain despite analgesic treatment in Mexico. In this study, we estimate the real-world prevalence of inadequate pain relief (IPR) among individuals with knee and/or hip OA who have been prescribed analgesic therapy and characterize this patient population for each country separately. This is a multinational, multi-site, cross-sectional, observational study. Participating physicians enrolled patients over 50 years of age with diagnosed knee and/or hip OA who had been prescribed topical and/or oral pain medication for at least 30 days prior to study visit, extracted data from their medical charts, and collected patient data using established questionnaires. 301 patients treated by 35 physicians in Mexico were enrolled in the study. More than half of the patients (53%) met the definition of IPR. Patients with IPR were significantly older (66.8 vs. 63.5 years, p=0.002) and were more likely to be obese (24.2% vs. 11.9%, p=0.006). Patients in the IPR group were more likely to report moderate/severe problems across all 5 dimensions of the EQ-5D and reported higher scores, indicating worse outcomes, on all three WOMAC subscales. Patients in the IPR group also reported reduced work productivity and greater treatment dissatisfaction compared to patients without IPR. IPR is highly prevalent among individuals with knee and/or hip OA in Mexico. Patients with IPR experience decreased health-related quality of life HRQoL and work productivity, impaired function, and poor treatment satisfaction. Health care professionals need to be aware of the high prevalence of IPR, work toward improving OA patient management, and facilitate early intervention or changes in drug and other treatment modalities.

Bioethics and the Law in Mexico

The results of an empirical study show that,taken as a group, physicians in Mexico do not know what is legal and what is not legal with respect to certain areas of clinical practice. A number of legal cases are cited showing the ways in which the legal system is ineffective with respect to providing guidance on bioethicalissues. We conclude that physicians in Mexico do not know what is legal and what is illegal with respect to bioethics because they cannot know (the law is unclear) and because they do not need to know (there is no effective legal precedent or enforcement). We suggest that the way forward must be through institutional policies establishing standards that depend only upon the traditional contract for medical care.

Medical training as a transformative experience: an analysis of doctorhood to question the professional identity formation paradigm

ABSTRACT This paper questions the Professional Identity Formation (PIF) paradigm by posing an alternative approach to medical students’ transformative experience using the hidden curriculum framework and Lindemann’s account of personal identity. The aim is to ascertain what is the social identity of physicians that actually operates in the students’ transformation in Mexico. By using a combination of qualitative research methods (26 semi-structured interviews, virtual ethnography, and autoethnographic materials), this research explores Mexican students’ transformative experience as a process through which they acquire a new social identity, doctorhood. The study results show that doctorhood is represented by socially shared narratives that portray physicians by comparing them to gods and superheroes, setting requirements on how students and physicians should perform this identity during social interaction. As a consequence, becoming a physician implies turning tougher and expressing it in different ways: preferably through an authoritarian, unbreakable and detaching character, but not through the evil character that some physicians perform by being bad-tempered, dishonest, demotivated, and insensitive. The conclusion is that doctorhood is a two-edged sword that can explain both professional and unprofessional behaviors among medical students and physicians in Mexico. This presents new possibilities to redirect the PIF paradigm around the world.

Epidemiological study on atopic dermatitis in Mexico

There is limited epidemiological information on the treatment of atopic dermatitis (AD) from specialist physicians in Mexico. To know the criteria that is used by specialists in Mexico to diagnose and treat AD. An observational, descriptive and cross-sectional study, which was authorized by the ethics committee, was carried out through an electronic survey. 114 surveys were carried out; 56% of the participants were allergists, 38% were dermatologists and 5% were pediatricians. It was identified that 54% used clinical criteria for the diagnosis of AD and 42% used the criteria of Hanifin-Rajka as a diagnostic complement; 38% requested total and/or specific IgE, blood biometry and blood chemistry tests. They recount that 90% of patients under the age of 18 had mild AD, 8% had moderate AD and 2% had severe AD; and, in patients over the age of 18, 89% had mild AD, 6% had moderate AD and 5% had severe AD. The patients' care was multidisciplinary, since 57% of the survey respondents requested assessments combined with ophthalmology, dermatology and allergology. Knowledge of the disease will lead to a better control of the disease. The challenge is to have a patient registry, update treatment guidelines, consider comorbidities and have therapeutic options for its control.

Chronic venous disease treated with sulodexide: a survey among primary care physicians in Mexico.

Sulodexide is a glycosaminoglycan approved for the treatment of chronic venous disease (CVD). It has been available in Mexico since 2012. The aim of the study was to understand the clinical experience of primary care physicians in the treatment of CVD with sulodexide. Clinical data collection forms were distributed among general practitioners. Data was collected for up to four follow-up consultations. All signs and symptoms were rated with the Likert Scale at each examination: 0 to 5 (where 0 means none, and 5 very severe). Both the patient's and the physician's opinions of the effects of the treatment were recorded. Data were collected from 1599 patients at different clinical stages of CVD, 52% of which were at advanced stages (C4-C6). A total of 434 cases were followed up with four examinations (median of thirty days between each examination). In these cases, the overall sign and symptom score decreased significantly at each examination (P<0.01). At the fourth examination, 98.9% of the patients felt better or much better than at the first examination, and 99.7% were better or much better in the physician's opinion (P<0.01). The only adverse effect was nausea, reported in two cases. Sulodexide was effective and well tolerated in the treatment of CVD.

Vivencias y experiencias de médicos residentes mexicanos durante su primer año de formación académica

IntroductionResearch into the academic training of resident physicians in Mexico has steadily grown. However, there are very few qualitative studies on the experiences of future medical specialists, particularly during the first year of academic training when there are a variety of situations that challenge the adaptability of students. ObjectiveTo determine, describe and interpret the experiences of medical residents during their first year of training and the influence on their welfare and health. MethodPhenomenological study that included 18 depth interviews was conducted on 13 medical residents. Data collection was completed to obtain saturation. The Atlas.ti® program for qualitative data analysis was used. ResultsTraining of medical residents was characterised by work overload, absence of control, and ambiguity in roles to play, lack of support, and scarcity of resources. There were also, imposing, threatening, humiliating, and power relationships with their superiors, as well as discrediting by general practitioners, damage to personal life, stress, and burnout. ConclusionsThe impact that academic training can have on the health of medical residents was manifested differently if one has to move to another city. They need to be offered psychological support during their training and treated as persons deserving support and respect.

Projections of specialist physicians in Mexico: a key element in planning human resources for health.

Projections are considered a useful tool in the planning of human resources for health. In Mexico, the supply and demand of specialist doctors are clearly disconnected, and decisions must be made to reduce labour market imbalances. Thus, it is critical to produce reliable projections to assess future interactions between supply and demand. Using a service demand approach, projections of the number of specialist physicians required by the three main public institutions were calculated using the following variables: a) recent recruitment of specialists, b) physician productivity and c) retirement rates. Two types of scenarios were produced: an inertial one with no changes made to current production levels and an alternative scenario adjusted by recommended productivity levels. Results show that institutions must address productivity as a major policy element to act upon in future contracting of specialist physicians. The projections that adjusted for productivity suggest that the hiring trends for surgeons and internists should be maintained or increased to compensate for the increase in demand for services. In contrast, due to the decline in demand for obstetric and paediatric services, the hiring of new obstetrician-gynaecologists and paediatricians should be reduced to align with future demand.

A study of the impact of the 21-gene breast cancer assay on the use of adjuvant chemotherapy in women with breast cancer in a Mexican public hospital.

The majority of breast cancer patients in Mexico are treated through the public health system and >80% receive adjuvant chemotherapy. The aim of this prospective study was to characterize the impact of the Oncotype DX assay on adjuvant therapy decision making and the confidence in those decisions amongst public sector physicians in Mexico. Ninety-eight consecutive patients with ER+, HER2-, stage I-IIIa, N0/N1-3 node-positive breast cancer from the Instituto Nacional de Cancerología were eligible for the study. The primary endpoint was the overall change in treatment recommendations after receiving the assay results. Of 96 patients, 48% received a chemohormonal therapy recommendation prior to testing. Following receipt of results, treatment decisions changed for 31/96 (32%) patients, including 17/62 (27%) node-negative patients and 14/34 (41%) node-positive patients. The proportion of patients with a chemotherapy-based recommendation decreased from 48% pre- to 34% post-assay (P=0.024). 92% of physicians agreed that they were more confident in their treatment recommendation after ordering the assay. These results suggest that use of the 21-gene assay in the Mexican public health system has a meaningful impact on adjuvant treatment recommendations that may reduce the overall use of chemotherapy.

A tribute to josé maría ("chema") cantú.

José María ("Chema") Cantú (1938-2007), born in Mexico, was a pioneering, loved and respected leader in medical and human genetics and bioethics in Latin America. He graduated as a physician in Mexico and then trained in medical and human genetics in France and the United States. He was instrumental in developing a first-rate research, training and genetic services program in medical and human genetics in Guadalajara, in northwestern Mexico. He acted forcefully at national, regional and international levels to promote scientific development through collaboration and education in science and humanities, while he simultaneously strived for justice, peace, love and human rights. He attained some of the highest honors a scientist and humanist could aspire to as well as the recognition of the communities he served. Hundreds of disciples throughout Latin America and the world have been inspired by his vision of a better world through the conjunction of science, respect for humankind, ethics and love.

Surgery Versus Snacking as Treatment of Insulinoma

From the Department of Internal Medicine, University of Oklahoma, Tulsa. A 19-year-old man presented with a generalized tonic-clonic seizure and serum glucose of 19 mg/dL. The seizure was aborted with dextrose and resolution of hypoglycemia. The patient had begun experiencing episodes of lightheadedness, fatigue, and seizures at age 16. Physicians in Mexico attributed his symptoms to poor nutritional intake and instructed him to increase his meal frequency and intake of soda and candy. He remained symptomatic for 3 years despite consuming 8 to 12 sodas daily supplemented by candy bars. Laboratory testing showed elevated serum insulin (200.8 mlU/mL), C-peptide (13.7 ng/ mL), proinsulin (296 pmol/L), and betahydroxybutyrate (0.3 mg/dL) levels. The sulfonylurea panel results were negative, and the serum calcium, intact parathyroid hormone, corticotropin, thyrotropin, and cortisol levels were within the normal range. A 72-hour fast revealed a glucose level of 30 mg/dL at 5 hours without neuroglycopenic or adrenergic symptoms. Computed tomography of the abdomen

Resident physicians in Mexico: tradition or humiliation

Medwave es una revista electrónica revisada por pares y de acceso gratuito, que contiene artículos originales de revisión sobre determinantes clínicos, sociales, políticos y económicos en salud, y de investigación en el ámbito clínico y biomédico. Medwave is an online-only, peer-reviewed and open Access biomedical general journal with original review articles con clinical, social, political and economic determinants of health, and research articles on clinical and biomedical aspects.

Facing Death in Clinical Practice: A View from Physicians in Mexico

Physicians' decisions and actions, once they know that their patients' death is inevitable, will influence how patients are going to live their last moments. The purpose of the present study was to explore the views of physicians about death in their clinical practices. Physicians who work at four high-specialty public hospitals and two private hospitals in Mexico City provided responses to the Physicians' Views about Death Questionnaire, which was developed for this study. Four hundred thirteen physicians were surveyed. The majority treat terminally ill patients (73.3%), but only 28% received training regarding death. Nearly half of the physicians reported a personal formative experience related to death which, together with the experience of being exposed to terminally ill patients, appear to be the manner in which the majority of physicians learn to deal with death. The great majority of participants (90.6%) would personally like to know the truth if they were going to die. Younger physicians, those with <6 years of medical practice, those with no death-related personal formative experience, no death-related academic training, and no experience treating terminally ill patients were most likely to avoid telling patients about their imminent death. Death is an important topic for physicians in Mexico. There is a relation between lack of information, experience, and formal training, and the withholding of information from dying patients. This suggests a possible value for interventions to enhance and develop coping skills for professionals who deal with end-of-life situations.

Uninsurance, Underinsurance, and Health Care Utilization in Mexico by US Border Residents

Using data from the 2008 Cross-Border Utilization of Health Care Survey, we examined the relationship between United States (US) health insurance coverage plans and the use of health care services in Mexico by US residents of the US-Mexico border region. We found immigrants were far more likely to be uninsured than their native-born counterparts (63 vs. 27.8 %). Adults without health insurance coverage were more likely to purchase medications or visit physicians in Mexico compared to insured adults. However, adults with Medicaid coverage were more likely to visit dentists in Mexico compared to uninsured adults. Improving health care access for US residents in the southwestern border region of the country will require initiatives that target not only providing coverage to the large uninsured population but also improving access to health care services for the large underinsured population.

289P - A Study of the Impact of the 21-Gene Breast Cancer Assay on the Use of Adjuvant Chemotherapy in Women With Breast Cancer in a Mexican Public Hospital

ABSTRACT Background The majority of early stage breast cancer patients in Mexico are treated through the public health system, and >80% are treated with chemotherapy (CT). The 21-gene assay (Oncotype DX®) is available in Mexico but has been utilized primarily within the private health system. There are no data that describe the potential impact of the assay on adjuvant treatment decision-making for public sector patients. The aim of this study is to characterize how assay results impact the decision-making process and confidence of public sector physicians in Mexico to determine adjuvant therapy. This is the first decision impact study of the Oncotype DX assay in Latin America. Methods At total of 98 consecutive patients with ER + , HER2-, stage I-IIIa, N0/N1-3 breast cancer from the Instituto Nacional de Cancerologia in Mexico City, Mexico, were enrolled in the study. Via consensus discussion in multidisciplinary team meetings, physicians completed pre- and post-assay questionnaires regarding adjuvant treatment recommendations for each enrolled patient. The primary endpoint was the overall change in physician treatment recommendations resulting from the addition of the Recurrence Score® result in the decision-making process. Results Pre- and post-assay results were available for 96 patients. Treatment decisions changed for 31/96 (32%: 95% CI 23%-43%) patients; 17/62 (27%; 95% CI 17%-40%) N0 and 14/34 (41%; 95% CI 25%-59%) N1-3 patients. Post-assay, 8/50 (16%) of patients initially recommended hormonal therapy (HT) were recommended chemohormonal therapy (CHT) or CT, and 21/46 (46%) of patients initially recommended CHT/CT were recommended HT alone. The proportion of patients recommended CT decreased from 48% pre- to 34% post-assay (p = 0.024), a decrease of 14% overall, 6% in N0, and 26% in N1-3 patients. Conclusions These results suggest that use of the 21-gene assay in the Mexican public health system has an impact on adjuvant treatment recommendations and may reduce the use of chemotherapy. Post-Assay Pre-Assay Adjuvant Therapy HT alone CT + HT CT alone Total HT alone 42 (44%) 7 (7%) 1 (1%) 50 (52%) CT + HT 21 (22%) 23 (24%) 2 (2%) 46 (48%) Total 63 (66%) 30 (31%) 3 (3%) 96 Disclosure C. Yoshizawa: Genomic Health- Employment and Stockholder. E. Burke: Genomic Health- Employment and Stockholder. C. Chao: Genomic Health- Employment and Stockholder. All other authors have declared no conflicts of interest.