***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Adverse drug reactions ( ADR 's ) could be expected more frequently in pregnant women . This study was performed in order to identify ADR 's to tocolytic drugs in hospitalised pregnant women . Methods A prospect i ve cohort study was performed in two General Hospitals of the Instituto Mexicano del Seguro Social ( IMSS ) in Mexico City . Two hundred and seven women undergoing labor , premature labor , threatened abortion or suffering any obstetric related disease were included . Drug prescription and signs and symptoms of any potential ADR were registered daily during the hospital stay . Any potential ADR to tocolytic drugs was evaluated and classified by three of the authors using the Kramer 's algorithm . Results Of the 207 patients , an ADR was positively classified in 25 cases ( 12.1 % , CI95 % 8.1 to 17.5 % ) . All ADR 's were classified as minor reactions . Grouping patients with diagnosis of threatened abortion , premature labor or under labor ( n= 114 ) , 24 ADR 's were related to terbutaline , accounting for a rate of 21.1 ADR 's per 100 obstetric patients . Obstetric patients suffering an ADR were older than obstetric patients without any ADR . However , the former received less drugs/day × patient-1 and had a shorter hospital stay ( p < 0.05 ) whereas the dose of terbutaline was similar between the two groups . Terbutaline  inhibited uterine motility in women with and without any ADR at a similar rate , 70 and 76 % respectively ( x2 = 0.07 ; p = 0.8 ) . Conclusion Terbutaline , used as a tocolytic drug , was related to a high frequency of minor ADRs and to a high rate of effcicacy Objectives : People in developing countries often seek medical advice for common ailments from pharmacies . As one example , pharmacists routinely diagnose and treat symptomatic sexually transmitted infections ( STIs ) . We aim ed to assess the quality of advice provided in Mexico City pharmacies by presenting hypothetical STI related syndromes and recording pharmacy attendants ’ suggested diagnoses and treatments . Methods : We interviewed the first available attendant in each of a 5 % r and om sample of Mexico City ’s pharmacies . We inquired about the training , age , and experience of the attendant and about the typical number of clients coming for treatment of suspected STIs . After considering three hypothetical case studies , attendants recommended diagnoses , treatments , and , sometimes , physician follow up . Results : Most Mexico City “ pharmacists ” are actually clerks , with trained pharmacists rarely available on the premises . The average pharmacy attendant was 32 years old , with a median of 5 years ’ experience at that pharmacy , but very limited ( if any ) training . 62 % reported seeing 10 or more clients with genital or vaginal infections per month . Depending on the case study , attendants provided appropriate diagnoses in 0–12 % of cases , recommended appropriate treatments in 12–16 % of cases , and suggested physician follow up for 26–67 % of cases . Conclusions : In general , surveyed pharmacy personnel were unable to diagnose accurately or offer appropriate treatment advice when presented with classic , common STI symptoms . Given the volume of clients seeking advice from this source , training pharmacy attendants could significantly help to reduce the burden of disease associated with STIs in Mexico City A prospect i ve cohort study was conducted to analyze factors associated with  antibiotic noncompliance  and waste among patients suffering acute respiratory infection ( ARI ) and acute diarrhea ( AD ) . The study took place in four primary health care clinics in Mexico City , two belonging to the Ministry of Health ( MoH ) and two to the Mexican Social Security Institute ( IMSS ) . Two hundred twenty-two patients with ARI and 155 with AD were included . Data about study variables and the assessment of compliance were obtained through patient interviews and direct observation . Factors associated with noncompliance were assessed through a multiple logistic regression procedure . Noncompliance was 60 % for ARI and 55.5 % for AD in both health care systems . Prescription of an antibiotic was justified only in 13.5 % of cases . Associated factors were : increased duration of illness ( OR 2.95 ; 95 % CI , 1.17 - 7.41 ) ; complexity of the treatment : 3 or more doses per day ( OR 2.47 ; 95 % CI , 1.56 - 3.92 ) , and treatment for more than 7 days ( OR 1.94 ; 95 % CI , 1.16 - 3.26 ) ; younger age of patient ( OR 1.89 ; 95 % CI , 1.18 - 3.02 ) ; and an inadequate physician-patient relationship ( OR 1.87 ; 95 % CI , 1.16 - 3.02 ) . Antibiotic waste was higher in IMSS ( ARI 39.3 % , AD 32.6 % ) , than in the MoH ( ARI 21.2 % , AD 16.4 % ) . Educational strategies to modify physician prescribing practice s and strengthen physician-patient relationships might improve compliance and decrease drug waste In developing countries , antibiotics are the most common drugs sold , and some data suggest that they are frequently misused . In order to describe the pattern of antibiotic use in a periurban community in Mexico City , 1659 r and omly-selected households were visited and an interview with the housewife was carried out . Six local drugstores also were selected at r and om . A social worker made six visits to each pharmacy , observed the events during the purchase of the drug and applied a structured question naire to the customer immediately after the transaction . Of 8279 individuals , 425 ( 5 % ) said that they had used at least one antimicrobial in the preceding 2 weeks and antibiotics were the majority ( 29 % ) of the drug sales . The main perceived reasons for drug use were acute respiratory tract ailments and gastroenteritis . Interviewees reported that antibiotic therapy was given in 27 % of respiratory diseases and in 37 % of all diarrheal episodes . The drugs most commonly reported were : penicillins , erythromycin , metronidazole , neomycin , cotrimoxazole and tetracyclines . While self-medication and drug purchases without medical prescription were common , the majority of antibiotics were prescribed by a physician . Approximately two thirds of individuals using an antibiotic said they had used it for less than 5 days and 72 % of the purchases were for insufficient quantities of drugs . Our data suggest that antibiotics are frequently misused and they support the need to assess the determinants of self-medication , health-seeking behavior and physician prescribing practice s. The need for effective educational programs to improve prescribers ' decisions is stressed CONTEXT In Mexico , oral contraceptives ( OCs ) are available to women over-the-counter in pharmacies . While past research has suggested that nonmedical providers , such as pharmacy workers , are capable of screening women for contraindications to OCs , little is known about their practice s. METHODS After selecting a 10 % r and om sample of all pharmacies in Mexico City ( n = 108 ) , we surveyed the first available pharmacy worker to learn more about pharmacy workers ' screening practice s when selling OCs over-the-counter to women . RESULTS While nearly all of the pharmacy workers surveyed had sold OCs without a prescription , only 31 % reported asking women any questions before selling pills . Among those who asked questions , the most commonly asked questions were about other medications a woman was taking , about blood pressure and about alcohol intake . Pharmacy workers did not ask these questions consistently to all clients . CONCLUSION Training pharmacy workers might be one strategy to improve screening of women for pill contraindications . However , pharmacy workers may lack the time and motivation to carry out such screening . An alternative strategy might be to better inform women to self-screen for pill contraindications To improve prescribing practice s for rhinopharyngitis , an interactive educational intervention and a managerial intervention were carried out in 18 primary care facilities in metropolitan Mexico City . Four family medicine clinics of the Mexican Social Security Institute ( IMSS ) and 14 health centres of the Ministry of Health ( SSA ) were included . A quasi-experimental design was employed . One hundred and nineteen physicians ( IMSS 68 , SSA 51 ) participated . Sixty-five physicians ( IMSS 32 , SSA 33 ) were in the study group , while 54 were in the control group ( IMSS 36 , SSA 18 ) . The study had four stages : ( I ) baseline , to evaluate the physicians ' prescribing behaviour for rhinopharyngitis ; ( II ) intervention , using an interactive educational workshop and a managerial peer review committee ; ( III ) post-intervention evaluation of short-term impact ; and ( IV ) follow-up evaluation of long-term effect 18 months after the workshop . The control group did not receive any intervention but was evaluated at the same time as the study group . At baseline , most patients in both institutions received antibiotic prescriptions ( IMSS 85.2 % , SSA 68.8 % ) . After the workshop , the percentage of patients receiving antibiotic prescriptions in the IMSS went from 85.2 % to 48.1 % , while in the SSA it went from 68.8 % to 49.1 % . Appropriateness of treatment was analyzed using the physician as the unit of analysis . At baseline , 30 % of IMSS physicians in the study group treated their patients appropriately . After the intervention , this percentage increased to 57.7 % , and at the 18-month follow-up it was 54.2 % . The SSA study group increased the appropriate use of antibiotics from 35.7 % to 46.2 % , with this percentage falling to 40.9 % after the 18-month follow-up period . In the control group there were no significant changes in prescribing patterns with respect to either the prescribing of antibiotics or the appropriateness of treatment . The intervention strategies were successful in both institutions . Forty per cent of physicians improved their prescribing practice s after the workshop , with this change remaining in 27.5 % of them throughout the follow-up period . On the other h and , 42.5 % of the physicians did not change their prescribing practice s after the intervention . The rest ( 17.5 % ) showed appropriate prescribing practice s during all the stages of the study . We conclude that it is possible to improve the physicians ' prescribing practice s through interactive educational strategies and managerial interventions . This type of intervention can be an affordable way to provide continuing medical education to primary care physicians who do not have access to continuing educational activities , and to improve the quality of care they provide BACKGROUND The impact of nosocomial infections and multidrug resistance on mortality is a topic of considerable controversy . METHODS A prospect i ve , nested case control study was conducted in four intensive care units ( ICUs ) in Mexico to measure the impact of antibiotic resistance on and identify the main risk factors for mortality in critically ill patients with nosocomial infections . RESULTS One hundred thirteen patients developed 119 nosocomial infections . Multivariate analysis identified two variables that were significantly and independently associated with mortality : ventilator-associated pneumonia ( p = 0.0041 , odds ratio [ OR ] = 7.7 ) and inadequate antibiotic treatment ( p < 0.0001 , OR = 70.5 ) . Although antibiotic resistance in Gram-negative rods was not an independent risk factor for mortality , there was a strong association between antibiotic resistance and inadequate treatment ( chi2 for linear trend = 29.3 , p < 0.00001 ) . For patients with ventilator-associated pneumonia , predicted mortality calculated by APACHE II score was 23 % compared to an observed mortality of 71 % . CONCLUSIONS In this study the major risk factors for mortality were inadequate antibiotic treatment and development of ventilator-associated pneumonia . Multidrug resistance significantly increased the probability of receiving inadequate antibiotic treatment . The striking differences between observed and predicted mortality in these four ICUs indicate the need for further research and a re assessment of the current programs for prevention and control of nosocomial infections in Mexico Based on previous community-oriented studies an irrational use of antibiotics , particularly in developing countries , has been suggested . In order to describe the pattern of antibiotic use in a periurban community in Mexico City , 1659 r and omly selected households were visited and an interview to the housewife was carried out . Of 8279 individuals 425 ( 5 % ) had used at least one antimicrobial in the preceding two weeks . Main perceived reasons for drug use were : respiratory tract ailments ( 58 % ) and acute diarrhea ( 25 % ) . Antibiotic therapy was given in 27 % of respiratory diseases and in 37 % of all diarrheal episodes . Most commonly used drugs were : penicillins ( 43 % ) , erythromycin ( 13 % ) , metronidazole ( 9 % ) , neomycin ( 6 % ) , cotrimoxazole ( 6 % ) and tetracyclines ( 6 % ) . While self-medication was common ( 19 % ) the majority of antibiotics were prescribed by a physician ( 81 % ) . Approximately two thirds of individuals using an antibiotic did it for less than five days . Our data suggest a frequent misuse of antibiotics and support the future assessment , in this community , of physician prescribing practice s , the determinants of self-medication as well as the impact of this drug use on the selection of resistant bacterial strains OBJECTIVE To evaluate if the histamine H2 
    Output:
    
This review identified two priorities for Mexico 's pharmaceutical policy and strategies : tackling the irrational use of medicines and the inadequate access of medicines .