Introduction of non-scalpel vasectomy at the Mexican Social Security Institute

Since government approval of the Mexican Family Planning Program in 1977, the Mexican Social Security Institute (IMSS) has been one of the major family planning service providers in Mexico. No-scalpel vasectomy, a refined surgical vasectomy technique developed and widely used in China, has been introduced in 20 countries, including Mexico. This paper will describe the experience of the IMSS in introducing the no-scalpel vasectomy technique into its service delivery system, and will review the clinical and programmatic experience, and the impact of no-scalpel vasectomy on client and provider attitudes toward vasectomy.

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Resumen Desde que gobierno aprobó el programa de planificación familiar mexicano en 1977, el Instituto Mexicano de Seguridad Social (IMSS) ha sido uno de los principales organismos que proporcionan servicios de planificación familiar en México. Una técnica quirúrgica refinada de vasectomía sin bisturi desarrollada y ampliamente utilizada en China fue introducida en 20 países, entre ellos México. Esta monografía describirá la experiencia del IMSS en la introducción de la técnica de vasectomía sin bisturí en su servicio de asistencia práctica, y examinará la experiencia clínica, su programa y el impacto de la vasectomía sin bisturí sobre el paciente, así como las actitudes del propio servicio respecto de esta intervención.

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Resumé Depuis que le gouvernement a approuvé le programme de planning familial mexicain en 1977, l'Institut de sécurité sociale du Mexique (IMSS) a été l'un des organismes principaux qui fournissent des services de planning familial dans le pays: Une technique chirurgicale affinée de vasectomie sans bistouri mise au point et largement utilisée en Chine a été introduite dans 20 pays, dont le Mexique. Cet exposé décrit l'expérience de l'IMSS lors de l'introduction de cette technique dans son service d'assistance pratique. Il passe également en revue l'expérience clinique, son programme, et l'impact de la vasectomie sans bistouri sur le patient, ainsi que les attitudes du service même à l'égard de cette intervention.

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This paper is based on a presentation given at the Seventh International Meeting of the Society for the Advancement of Contraception, which was held in Singapore on 4–11 November, 1990.     

Level of knowledge of patients with type II diabetes mellitus in primary care

A personal interview to 148 patients was carried out with the aim of getting to know the level of information of type II diabetic patients at an Urban Health Center in Santander. A validated questionnaire made up of 14 questions on general aspects of diabetis, dietetic habits and capability to handle complications was used. The Cronbach's alpha coefficient of questionnaire was 0.69. The correct answer average was 6.3 (IC = 5.9-6.5). Patients were best informed about general aspects and had much less information with regard to the handling of complications and to their diet. The differences among these three sections of questions were significative (p less than 0.001). The patients under diet treatment obtained worse results than those treated with oral hipoglucemiants and insulin. Our results are worse than those reported by other similar populations at a national level. Also, and due to the differences in knowledge within this group, we believe that the establishment of groups and subgroups when educating diabetic patients is possible and also highly recommended.     

Chronic pain in type 2 diabetic patients: A cross-sectional study in primary care setting

Background: Although diabetes mellitus (DM) is often associated with painful neuropathic syndromes, a significant number of DM patients suffer from non-neuropathic (nociceptive) pain. Unfortunately, there is insufficient data on the epidemiology of nociceptive pain in DM patients and its effect on their quality of life.

Objective: To characterize pain in type 2 DM patients, and assess its effect on their quality of life.

Methods: The study population included 342 type 2 DM patients, 18 years of age and above (mean age 70.7 ± 9.7), who reported having pain. The study questionnaires included the Brief Pain Inventory (BPI), the S-LANSS scale to assess pain with neuropathic features, life impact, and socio-demographic data.

Results: One hundred and fifty-five DM patients (46.5%) reported having pain of predominantly neuropathic origin. Almost 75% of patients with neuropathic pain were females, compared to 57.8% of patients with nociceptive pain (P = 0.002). More patients with neuropathic pain reported constant daily pain (57.6% vs. 42.4%, P < 0.0001), and worse pain during the night (53.3% vs. 46.7%, P = 0.045). The pain affected daily activities, walking capacity, and mood. Patients with neuropathic pain reported a greater negative effect of pain on their quality of life than those with nociceptive pain (41.0% vs. 15.3%, P < 0.0001).

Conclusion: The impact of neuropathic pain in DM patients is much more significant than nociceptive pain and affects their quality of life and daily function to a greater degree.     

The Mexican Social Security counterreform: pensions for profit.

The social security counterreform, initiated in 1997, forms part of the neoliberal reorganization of Mexican society. The reform implies a profound change in the guiding principles of social security, as the public model based on integrality, solidarity, and redistribution is replaced by a model based on private administration of funds and services, individualization of entitlement, and reduction of rights. Its economic purpose is to move social services and benefits into the direct sphere of private capital accumulation. Although these changes will involve the whole social security system--old-age and disability pensions, health care, child care, and workers' compensation--they are most immediately evident in the pension scheme. The pay-as-you-go scheme is being replaced by privately managed individual retirement accounts which especially favor the big financial groups. These groups are gaining control over huge amounts of capital, are authorized to charge a high commission, and run no financial risks. The privatization of the system requires decisive state intervention with a legal change and a sizable state subsidy (1 to 1.5 percent of GNP) over five decades. The supposed positive impact on economic growth and employment is uncertain. A review of the new law and of the estimates of future annuities reveals shrinking pension coverage and inadequate incomes from pensions.     

Cholesterol treatment practices of primary care physicians.

The active involvement of primary care physicians is necessary in the diagnosis and treatment of elevated blood cholesterol. Empirical evidence suggests that primary care physicians generally initiate dietary and pharmacological treatment at threshold values higher than is currently recommended. To determine current treatment thresholds and establish factors that distinguish physicians who are more likely to initiate therapy at lower cholesterol values, 119 primary care physicians in four northern California communities were surveyed. Data collection included their demographic factors, treatment of hypothetical patients, self-efficacy regarding counseling patients about cholesterol reduction and personal health behaviors, outcome expectations, and cholesterol knowledge and attitudes. Results indicated that 59 percent of respondents would not start dietary treatment on a middle-aged female patient with a cholesterol of 215 milligrams per deciliter (mg per dl). Only 44 percent of respondents indicated that they would initiate pharmacological therapy for a middle-aged man with a cholesterol of 276 mg per dl. Logistic regression models were used to determine characteristics that influenced dietary and pharmacological treatment practices. Younger physicians, those who had had their own cholesterol checked, and those who personally ate a low-fat diet, were more likely to recommend diet therapy to patients with modest elevations of cholesterol. Willingness to use lipid lowering medications at more marked elevations was associated only with increased self-efficacy regarding use of drugs to lower cholesterol. These results indicate that physicians' personal health behaviors and self-efficacy should be addressed in interventions to modify cholesterol-related practice behavior.     

Childhood immunization practices of primary care physicians.

OBJECTIVE: To assess if immunization utilization practices differ between rural and urban primary care physicians in Kentucky. DESIGN: Survey of 200 primary care physicians. PARTICIPANTS: Pediatricians, family physicians, and general practitioners in Kentucky. SELECTION PROCEDURES: Participants completed a 20-item questionnaire that surveyed selected demographics with regard to the physician and practice, immunizations offered to children, and reasons why the responding physicians did not offer immunizations and where they referred patients for this service. RESULTS: Physicians practicing in rural counties offered immunizations to their patients less frequently than did urban physicians (54% vs 77%). Rural and urban physicians cited immunization costs to patients as the chief reason that immunizations were not used more often and referred patients primarily to county health departments. CONCLUSIONS: Rising costs have limited physician use of immunizations in rural areas to a greater extent than that seen in urban areas. This may make access to immunizations more difficult for children living in rural areas.     

Improved knowledge of diabetic patients through education of primary care staff.

A sample of 142 diabetic patients was interviewed twice, in 1984 and 1986, following an educational program administered to primary care staff. Positive changes were recorded regarding several aspects. (a) Process of care - the percentage of untreated patients decreased from 15% to 4%; the proportion of patients on diet only increased from 36% to 41%, while the insulin-treated proportion decreased from 12% to 8%; the percentage of patients treated with oral drugs went up from 36% to 46%. (b) Patient knowledge - an improvement in various aspects, such as diet and exercise. (c) Patient behavior - an improvement in adherence to diet and in compliance with medications.     

Oral health service utilization by elderly beneficiaries of the Mexican Institute of Social Security in México city

Background  

The aging population poses a challenge to Mexican health services. The aim of this study is to describe recent oral health services utilization and its association with socio-demographic characteristics and co-morbidity in Mexican Social Security beneficiaries 60 years and older.     

The well-being and treatment satisfaction of diabetic patients in primary care

Background  

The quality of life in patients with diabetes is reduced and emotional coping with the disease has great impact on patient well-being.     

Nutritional problems of patients with COVID-19 receiving dietetic treatment in primary care

Background

The nutritional problems of patients who are hospitalised for COVID-19 are becoming increasingly clear. However, a large group of patients have never been hospitalised and also appear to experience persistent nutritional problems. The present study describes the nutritional status, risk of sarcopaenia and nutrition-related complaints of patients recovering from COVID-19 receiving dietetic treatment in primary care.

Methods

In this retrospective observational study, data were collected during dietetic treatment by a primary care dietitian between April and December 2020. Both patients who had and had not been admitted to the hospital were included at their first visit to a primary care dietitian. Data on nutritional status, risk of sarcopaenia and nutrition-related complaints were collected longitudinally.

Results

Data from 246 patients with COVID-19 were collected. Mean ± SD age was 57 ± 16 years and 61% of the patient population was female. At first consultation, two thirds of patients were classified as overweight or obese (body mass index >25 kg m^–2). The majority had experienced unintentional weight loss because of COVID-19. Additionally, 55% of hospitalised and 34% of non-hospitalised patients had a high risk of sarcopaenia. Most commonly reported nutrition-related complaints were decreased appetite, shortness of breath, changed or loss of taste and feeling of being full. Nutrition-related complaints decreased after the first consultation, but remained present over time.

Conclusions

In conclusion, weight changes, risk of sarcopaenia and nutrition-related complaints were prevalent in patients with COVID-19, treated by a primary care dietitian. Nutrition-related complaints improved over time, but remained prevalent until several months after infection.     

Physician-nurse practitioner interaction patterns in primary care practices

A new method is presented which describes and measures the problem-solving and collaborative efforts between physicians and nurse practitioners on primary care teams. Application of the method would allow the relationship between team interaction and outcomes of health care to be studied. The method relates clinical problem-solving between team members to a measure of collaboration. Team interaction data were collected in a two-stage process for the purpose of tool development and refinement. Six nurse practitioner-physician teams practicing in three primary care settings participated. Audiotapes of team interactions were analyzed for initiation of interaction, character of the decision-making process that led to the interaction between providers, and characteristics of the exchange between physician and nurse practitioner. Inter-rater agreement was 0.80 for scoring of the rationale for interaction and 0.70 for collaborative scores. The findings suggest that this method is an uncomplicated clinically relevant means of allowing professionals in primary care practices to examine their own practice patterns. Trends in the data reveal little interaction between practitioners, and minimal physician initiation of exchange on the team.     

No-shows to primary care appointments: subsequent acute care utilization among diabetic patients

ABSTRACT: BACKGROUND: Patients who no-show to primary care appointments interrupt clinicians' efforts to provide continuity of care. Prior literature reveals no-shows among diabetic patients are common. The purpose of this study is to assess whether no-shows to primary care appointments are associated with increased risk of future emergency department (ED) visits or hospital admissions among diabetics. METHODS: A prospective cohort study was conducted using data from 8,787 adult diabetic patients attending outpatient clinics associated with a medical center in Indiana. The outcomes examined were hospital admissions or ED visits in the 6 months (182 days) following the patient's last scheduled primary care appointment. The Andersen-Gill extension of the Cox proportional hazard model was used to assess risk separately for hospital admissions and risk of ED visits. Adjustment was made for variables associated with no-show status and acute care utilization such as gender, age, race, insurance and co-morbid status. The interaction between utilization of the acute care service in the six months prior to the appointment and no-show was computed for each model. RESULTS: The six-month rate of hospital admissions following the last scheduled primary care appointment was 0.22 (s.d. = 0.83) for no-shows and 0.14 (s.d. = 0.63) for those who attended (p < 0.0001). No-show was associated with greater risk for hospitalization only among diabetics with a hospital admission in the prior six months. Among diabetic patients with a prior hospital admission, those who no-showed were at 60% greater risk for subsequent hospital admission (HR = 1.60, CI = 1.17--2.18) than those who attended their appointment. The six-month rate of ED visits following the last scheduled primary care appointment was 0.56 (s.d. = 1.48) for no-shows and 0.38 (s.d. = 1.05) for those who attended (p < 0.0001); after adjustment for covariates, no-show status was not significantly related to subsequent ED utilization. CONCLUSIONS: No-show to a primary care appointment is associated with increased risk for hospital admission among diabetics recently hospitalized.