Abstract The recommendations in which the Mexican Society of Cardiology (SMC) in conjunction with the National Association of Cardiologists of Mexico (ANCAM) as well as different Mexican medical associations linked to cardiology are presented, after a comprehensive and consensual review and analysis of the topics related to cardiovascular diseases in the COVID-19 pandemic. Scientific positions are analyzed and responsible recommendations on general measures are given to patients, with personal care, healthy eating, regular physical activity, actions in case of cardio-respiratory arrest, protection of the patient and health personnel as well as precise indications in the use of non-invasive cardiovascular imaging, prescription of medications, care in specific topics such as systemic arterial hypertension, heart failure, arrhythmias and acute coronary syndromes, in addition to emphasizing electrophysiology, interventionism, cardiac surgery and in cardiac rehabilitation. The main interest is to provide the medical community with a general orientation on what to do in daily practice and patients with cardiovascular diseases in the setting of this unprecedented epidemiological crisis of COVID-19.

Resumen Se presentan las recomendaciones en las cuales la Sociedad Mexicana de Cardiología (SMC) en conjunto con la Asociación Nacional de Cardiólogos de México (ANCAM), así como diferentes asociaciones médicas mexicanas vinculadas con la cardiología, después de una revisión y análisis exhaustivo y consensuado sobre los tópicos relacionados con las enfermedades cardiovasculares en la pandemia de COVID-19, se analizan posturas científicas y se dan recomendaciones responsables sobre medidas generales a los pacientes, con cuidados personales, alimentación saludable, actividad física regular, acciones en caso de paro cardiorrespiratorio, la protección del paciente y del personal de salud así como las indicaciones precisas en el uso de la imagen cardiovascular no invasiva, la prescripción de medicamentos, cuidados en tópicos específicos como en la hipertensión arterial sistémica, insuficiencia cardiaca, arritmias y síndromes coronarios agudos, además de hacer énfasis en los procedimientos de electrofisiología, intervencionismo, cirugía cardiaca y en la rehabilitación cardiaca. El interés principal es brindar a la comunidad médica una orientación general sobre el quehacer en la práctica cotidiana y pacientes con enfermedades cardiovasculares en el escenario esta crisis epidemiológica sin precedentes de COVID-19.

Abstract Introduction Parenting practices refer to specific behaviours used by parents and caretakers of children to guide childhood development and socialization goals. These practices are associated with children’s health, psychological, and physical development. Objective To determine the psychometric properties of the Parenting Practices Inventory (PPI) among a group of child caregivers in Mexico City. Method The PPI was applied to 443 caregivers of children and adolescents, who attended a general health care centre in Mexico City. For the psychometric evaluation of the instrument, the full distribution and discrimination of the items was analysed first. Then, the validity of the construct was tested through an exploratory factor analysis and a confirmatory analysis with structural equation modelling. Results The internal consistency of the PPI showed α = .867 and 41.25% of variance explained for all four dimensions of interest. The confirmatory factor analysis showed that the model had goodness of fit. It included twenty-four items with adequate consistency and validity indices. Discussion and conclusion The PPI is therefore a potentially useful psychometric measure for evaluating parenting practices among this type of population and could have major implications for the development of interventions and preventive programmes. It provides scientific bases for diagnostic decision-making and primary health care from the moment of initial contact to specialized medical care.

Resumen Introducción Las prácticas de crianza se refieren a comportamientos específicos utilizados por los padres y cuidadores de niños para guiar su desarrollo y metas de socialización infantil. Estas prácticas están asociadas con la salud, el desarrollo psicológico y físico de los niños. Objetivo Determinar las propiedades psicométricas del Inventario de Prácticas de Crianza (IPC) entre un grupo de cuidadores de niños en la Ciudad de México. Método El IPC se aplicó a 443 cuidadores de niños y adolescentes, que asistieron a consulta médica general en un Centro de salud en la Ciudad de México. Para la evaluación psicométrica del instrumento se analizó la distribución total y la discriminación de los reactivos. La validez de constructo se probó a través de análisis factorial exploratorio y análisis confirmatorio con modelos de ecuaciones estructurales. Resultados El IPC mostró α = .867 y 41.25% de la varianza explicada para las cuatro dimensiones de interés. El análisis factorial confirmatorio mostró que el modelo tuvo buena bondad de ajuste. Incluyó veinticuatro ítems con una consistencia e índices de validez adecuados. Discusión y conclusión El IPC es una medida psicométrica potencialmente útil para evaluar las prácticas de crianza en esta población y podría tener implicaciones importantes para el desarrollo de intervenciones y programas preventivos. Esto brinda bases científicas para la toma de decisiones en la atención primaria de la salud desde el momento del contacto inicial hasta la atención médica especializada en caso de ser requerida.

Antecedents When a family member suffers from a mental disorder, such as schizophrenia, and a relative takes on the role of caregiver, social support is crucial to successfully addressing family functionality and the problems this may cause. Objective Determine the factors of social and structural support associated with the perception of family functionality in persons with a mental disorder and family caregivers. Material and method This is a descriptive, corelational, cross-sectional, non-probabilistic study, with sequential participation. Subjects were divided into two groups: 72 outpatients diagnosed with a mental health disorder, and 66 kinship caregivers. Three instruments were used: an MOS Questionnaire, an APGAR-Family Questionnaire and a Duke-UNC-11 Questionnaire. Results 58.2% of the patients perceived family functionality (APGAR); 19.4%, severe dysfunctionality, and 22.2%, slight dysfunctionality. Among relatives, 66.7% perceived family functionality; 10.6%, severe dys-functionality, and 22.7%, slight dysfunctionality. In the Structural Support Report (MOS), a statistically significant difference was observed (t=2.478, gl=136, p=0.014) in the perception of instrumental support among patients (̅x=11.68) and relatives; the latter perceiving the least instrumental support (̅x=9.91). In functional social support (Duke-UNC-11) no difference (t=1.170; gl= 136, p=.244) was indicated between relatives (̅x=40.36) and patients (̅x=38.07). The linear regression model showed that patients with the longest period of evolution and diagnosis of schizophrenia predict dysfunctionality, whereas social support predicts functionality (p<.001). Among relatives, longer periods of evolution indicated dysfunctionality, while social support predicted functionality (p<.001). Conclusion It is clear that social support plays an important role in family functionality in patients suffering from mental problems and kinship caregivers. In patients, it was observed that the greater the AS, the higher the degree of family functionality. Among relatives, structural support showed an increased perception of family functionality, which reduces the likelihood of relapses and hospitalization.

Antecedentes Cuando algún miembro de la familia presenta un padecimiento mental como la esquizofrenia, y un familiar asume el rol de cuidador, el apoyo social es elemental para afrontar con éxito la funcionalidad familiar y los problemas que ocasionan. Objetivo Determinar los factores de apoyo social y estructural asociados con la percepción de funcionalidad familiar en las personas con trastorno mental y los familiares cuidadores. Material y método Estudio descriptivo, correlacional, transversal, no probabilístico, de participación secuencial, en dos grupos: 72 pacientes ambulatorios diagnosticados con un trastorno de salud mental y 66 familiares cuidadores. Se utilizaron tres instrumentos: el Cuestionario MOS, el Cuestionario APGAR-Familiar y el Cuestionario Duke-UNC-11. Resultados La Funcionalidad familiar (APGAR) es percibida por 58.3% de los pacientes; el 19.4%, disfuncionalidad severa y 22.2%, disfuncionalidad leve. En los familiares, 66.7% percibe funcionalidad familiar; 10.6%, disfuncionalidad severa y 22.7%, disfuncionalidad leve. En el reporte del apoyo estructural (MOS) se observó una diferencia estadísticamente significativa (t=-2.478, gl=136, p=0.014) en la percepción de apoyo instrumental entre los pacientes (̅x=11.68) y los familiares. Estos últimos percibieron menor apoyo instrumental (̅x=9.91). En cuanto al apoyo funcional social (Duke-UNC-11) no se indica diferencia (t=1.170, gl=136, p=.244) entre los familiares (̅x=40.36) y los pacientes (̅x=38.07). El modelo de regresión lineal mostró que los pacientes con mayor tiempo de evolución y con diagnóstico de esquizofrenia predicen disfuncionalidad; en cambio el apoyo social predice funcionalidad (p<.001). En los familiares, a mayor tiempo de evolución se pronostica disfuncionalidad en tanto que el apoyo social predijo funcionalidad (p<.001). Conclusión Es evidente que en la funcionalidad familiar el apoyo social juega un papel importante en pacientes que padecen problemas mentales y en los familiares cuidadores. En los pacientes se observó que a mayor AS perciben mayor funcionalidad familiar. En los familiares el apoyo estructural demostró una mejor percepción de funcionalidad familiar, lo que permite disminuir la probabilidad de recaídas y hospitalización.

Summary: Introduction. The Information Reporting System on Drugs (IRSD) provides diagnostic information about changes in drug use in Mexico City. This information is updated twice a year (June and November), and an estimation of the main trends of drug use is thus obtained. The IRSD was implemented in 1986, and its results offers grounds for the design of preventive programs suited for the Mexican population from a health perspective. Objetive. To present a synthesis of the most relevant results of substance use in México City compiled by the IRSD between 1987 and 2005. The following are the benefit from data obtained: - Authorities in charge of designing policies and intervention actions, by virtue of which the SRID works as a system of permanent monitoring and early warning. - Investigators, since the SRID works as a window to identify the areas where greater knowledge is necessary. From a health perspective, the public in general, for whom the SRID is a tool that describes the evolution and current state of drug tendencies. Method. The information is obtained from an individual schedule on drug use that is applied twice a year in 44 agencies of the health and law enforcement sector. The design of the sample is non probabilistic. Results. In the period 1987-2005, 19350 cases have been evaluated. The most outstanding trend in substance use has been the remarkable increase of cocaine from 1987 to 2005. Equally significant has been the decrease tendency of solvents-inhalants use, which has become more evident since 1999. Marihuana use is among the three most used drugs in the country. It shows a trend to remain stable as is the case for the other substances evaluted. Conclusions. Most cocaine users are adolescents. At the same time, 45% of the users of all the substances have a use pattern defined as "high": 20 or more times a month. Both situations are a matter of concern due to the important physical and psychological consequences of substance use. In addition, up to this moment, there is no indication suggesting that the level of use will decrease.

Resumen: Introducción. El Sistema de Reporte de Información en Drogas (SRID) proporciona un panorama diagnóstico de los cambios ocurridos en el consumo de drogas en la Ciudad de México. Se actualiza dos veces al año (junio y noviembre), y sus resultados dan una estimación de la trayectoria del problema desde una perspectiva de salud. El SRID inició su funcionamiento en 1986 y sus resultados sirven además de fundamento para diseñar programas de prevención adecuados a la población mexicana. Objetivo. Presentar una síntesis de los resultados más relevantes del consumo de sustancias en la Ciudad de México recopilados por el SRID entre 1987 y 2005, en instituciones de salud y de justicia. Quienes se benefician de la información que se obtiene son: - Las autoridades a cargo de diseñar políticas y acciones de intervención en virtud de que el SRID funciona como un sistema de monitoreo permanente, así como de alerta temprana. - Los investigadores, dado que el SRID funciona como ventana para identificar las áreas donde es necesario mayor conocimiento desde una perspectiva de salud. - El público en general, para quien el SRID es una herramienta que describe la evolución y el estado actual de las tendencias de la farmacodependencia. Método. La información se obtiene de una cédula individual sobre consumo de drogas, que se aplica dos veces por año en 44 instituciones del sector salud y procuración de justicia. El diseño de la muestra es no probabilístico de tipo intencional. Resultados. La información analizada corresponde a 19350 casos identificados entre 1987 y 2005. Lo más destacado de las tendencias de consumo de sustancias ha sido el notable incremento de la cocaína durante el periodo evaluado. Igualmente significativa ha sido la tendencia a la baja del consumo de inhalables, que se hizo más evidente a partir de 1999. El consumo de mariguana, una de las tres drogas consumidas con más frecuencia en el país, ha mostrado cierta estabilidad al igual que el resto de las sustancias evaluadas. Conclusiones. El mayor número de usuarios de cocaína son adolescentes. Asimismo, respecto a los patrones de consumo, llama la atención que el perfil del usuario para todas las drogas estudiadas sea alto: 20 o más veces por mes, en 45% de los casos. Ambas situaciones son objeto de preocupación por los efectos físicos y emocionales de las sustancias, y porque no se observan indicadores que sugieran un decremento en el consumo.

Abstract: Introduction: Currently, there are a number of methodological alternatives to find out the dynamics, the extension and the levels of drug use in the general population. The trends on drug use in our country llave registered important variations in the last 25 years. Among the most outstanding of these trends are: the high and stable use of marijuana, the increase in cocaine use and a decrease in the use of inhalants. Recently an increase in the use of these stimulants has been registered. The different studies show that these trends present some variations, since different group populations with different characteristics have been studied. This is the case of the data obtained by the Drug Information Reporting System -IRSD-which detects users with specific characteristics (regular drug users and advanced cases of addiction). Based on the facts mentioned above, the intention of this article is to present the main trends on drug use in Mexico City within the period between 1986 and 2003, according to the drug Information reporting System -DIRS- and to analyze these trends compared to other studies with different types of population. Background: The Information Reporting System on Drugs IRSD is a mechanism used to obtain data coming from diverse agencies that are related to the problem of the use of drugs; such agencies belong to the health sector or to the agencies of law enforcement. The main advantages of this type of systems are a low cost of operation -since it works with the infrastructure of the institutions that mainly conform the system- its easy application and that it provides current and fast information on the phenomenon. The continuous operation of the IRSD allows the accumulation of data with a sequence which makes possible the analysis of the trends on drug use, the identification of new groups at high risk and new drugs in the market. It also allows to identify the design of the preventive actions derived from the continuous analysis of information coming from its data bases. Mexico City has its own Drug Information Reporting System -IRSD- since 1986 coordinated by the National Institute of Psychiatry Ramon de la Fuente. Its objective is to count on a periodic and homogenous source of information which can be used as a diagnosis tool to design suitable programs of prevention appropriate to the Mexican population from a health perspective. The IRSD carries out semester evaluations of the phenomenon and has done now a total of 34. Method: Sample description: IRSD information between 1986 and June 2003 was used. This data base is conformed by 16,377 studied cases. It is a considered as «case» any person who recognizes to have consumed at least once in life some drug with the deliberate purpose of being intoxicated. The cases are also excluded from accidental or occupational exhibition and when only alcohol and tobacco have been consumed. Instrument: The Information is obtained from an individual scale applied twice a year, in health and justice agencies. This schedule collects information on the following aspects: socio-demographic profiles of the users, the reason for entering the institution, problems associated with the drug use and patterns of consumption of 12 drugs. For this article, only the information corresponding to the pattern of consumption was used to identify the trends. The analysis includes the information compiled by the IRSD during the period of 1986 and the first semester of 2003. Procedure: The instrument is applied twice a year, in periods of 30 days, during the months of June and November to any one who uses drugs and has entered the health and justice agencies for such reason. Once the period of information gathering is over, the applied instruments are sent by all the participant institutions to the National Institute of Psychiatry for their processing and analysis. Finally, the results are reintegrated into a report which is distributed among the participant institutions and people interested in this problem. Results: The analysis of the trends on drug use observed by the IRSD during the period 1986-2003 shows the following: Marijuana and inhalants reach the level of higher consumption for all drugs until the second semester of 1997. In the following years there is a decrease for these substances, particularly for inhalants. The trend of cocaine use shows significant changes. The first important increase in the levels of use was observed between the years of 1993 and 1997. At the end of this period the use of cocaine was reported by every 40 of 100 users. The following year this proportion went up to 63, which represents an increase of more than 50 per cent. From this year and up to date the trend shows a stable behavior with similar levels of use. In regard to hallucinogens low levels of consumption have been observed, during the 15 years of evaluation by the IRSD. Approximately five of 100 cases report their use by semester. Sedatives and tranquilizers show the highest increase during the first semester of 1993, with 28 users for every 100 cases; since then a decrease in consumption has been observed. The consumption of stimulants has presented a very irregular trend through the evaluations. For heroin use a very low percentage of consumption is observed with one out of every 100 cases. There was a slight increase only in two evaluations during the first semester of 1992 and 1993. Conclusions: The most outstanding results regarding the tendencies of consumption of addictive substances is the increase of cocaine use at the beginning of the nineties and has always showed a tendency do increase. In the last evaluation certain stability in its consumption, is observed, at least in the last two years. It is important to emphasize that the increase in the consumption of cocaine may probably be associated to its availability in Mexico as well as that for its derivatives. Equally significant within this period of evaluation is the decrease of inhalant consumption, specially during 1999. Some studies show a possible substitution of these substances by cocaine and or its derivatives. The trends of drug use provided by the IRSD must be interpreted taking into account that the drug user population included in the evaluations belongs to a sector that does not represent the whole universe of users in the general population. However the trends of drug use reported by the IRSD are in agreement with those reported by the surveys in general and school population, where marijuana, cocaine and inhalants were reported as the drugs of greater use among the Mexican population. It is important to note that when the lack of financial and or human resources become real obstacles to carry out sophisticated, extensive periodic studies to evaluate drug use, a system of this type is a valuable alternative for the developing countries.

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OBJECTIVE: To determine the prevalence of cigarette smoking at the National Institutes of Health in Mexico (NIHM). MATERIAL AND METHODS: A survey was performed among workers who voluntarily answered a questionnaire. Smokers were identified with two specific questions, and type of employment was classified as physicians, administrative staff, investigators and support personnel. RESULTS: Total prevalence smoking was 28% (of 4 422 answered questionnaires). It was significantly higher among females, among administrative staff, and common-law and separated workers. It was significantly higher at the Mexican Institute of Psychiatry than at the remaining Institutes, even after adjusting for confounding. The prevalence was also higher among physicians from the same Institute. Of the smokers, 46% do so in their work areas and 78% of them would like to quit. CONCLUSIONS: The prevalence of smokers at the NIHM is as high as in the general population and a broad educational program for tobacco control and prevention is needed.

OBJETIVO: Determinar la prevalencia de tabaquismo en los trabajadores de institutos nacionales de salud en México (Insalud). MATERIAL Y MÉTODOS: Se realizó una encuesta entre trabajadores que voluntariamente contestaron un cuestionario; se identificó al fumador con dos preguntas específicas y se indagó la actividad laboral clasificada en médicos, administradores, investigadores y servicios generales. RESULTADOS: La prevalencia de fumadores fue de 28% (4 422 cuestionarios respondidos). Fue significativamente mayor en trabajadores del sexo femenino, administradores, trabajadores que viven en unión libre y separados. El Instituto Mexicano de Psiquiatría (IMP) mostró la prevalencia más elevada, aun después de un ajuste por confusores. También fue mayor entre los médicos del Instituto Mexicano de Psiquiatría. De los fumadores, 46% fuma en sus áreas de trabajo, y 78% de los fumadores quiere dejar de fumar. CONCLUSIONES: La prevalencia de tabaquismo en los Insalud es tan alta como la de la población general y se requiere un programa educativo amplio para el control y prevención del hábito de tabaco.