1. Introduction
Mexico is a country comprising 32 federal entities with a population of approximately 130 million [1]. Geographically, it ranks 13th worldwide and is currently the twelfth-largest economy in the world [2]. Cardiovascular, metabolic, and respiratory diseases dominate the morbidity and mortality profile in the country [3,4,5]. Approximately 90% of the population is served at the primary care level, where more than 300,000 daily family medicine consultations are conducted [6].
Despite the importance of family medicine in primary care and the provision of quality health services [7,8], research in this field in Mexico has historically been limited and unsystematized [9,10]. In the country, only three specialized family medicine journals serve as one of the main vehicles for disseminating knowledge in this specialty. However, there is a significant gap in the literature regarding the quality, scope, and scientific output reported in these journals, highlighting the need for a comprehensive evaluation to analyze these factors. This issue requires urgent attention, as a better understanding of scientific production in family medicine is crucial to improving the quality of research [11].
Bibliometric analyses are an option to approach the quantitative study of scientific production in various fields of knowledge, as they can be used to analyze research trends, study themes, methodological approaches, and the impact of publications in specific disciplines [12,13]. These analyses not only facilitate the understanding of how countries generate and disseminate knowledge but also allow for the identification of factors that influence the publication of results in specific areas, such as family medicine while highlighting the evolution toward more informative and accessible standards in scientific communication [14,15].
In the context of primary care, these analyses are essential for research in health and public policy. They also enable decision-makers to identify strengths and weaknesses in research areas relevant to the population’s health needs [16,17]. Furthermore, their accessibility makes them an effective tool for evaluating global and national issues, offering the ability to quantify, map, and analyze scientific production through key indicators without requiring significant resources or infrastructure [18,19]. In the specific case of Mexico, they can identify gaps impacting public health in the country and contribute to closing them, potentially promoting the development of public policies to address the identified issues, hence the importance of conducting such bibliometric analyses in specific geographical contexts.
Equally important, the critical appraisal of scientific articles plays a pivotal role in assessing the reliability, validity, and relevance of the findings. This process allows the identification of areas for improvement to enhance the quality of research and strengthen evidence-based decision making [20,21,22]. Integrating bibliometric analysis with critical appraisal promotes a deeper understanding of the research, which is essential to guide efforts and resources toward areas that benefit knowledge generation and medical practice.
Given the above, this study aimed to evaluate the quality of scientific production in family medicine in Mexico and identify gaps in the development of research in this medical discipline. To carry out this analysis, we focused on the three family medicine journals published in the country.
2. Materials and Methods
A cross-sectional study was conducted. We gathered information from the Atención Familiar, Archivos en Medicina Familiar, and Revista Mexicana de Medicina Familiar journals. We included original articles, reviews, case reports, and editorials conducted in Mexico from 2014 (the year Revista Mexicana de Medicina Familiar started publishing) to 2023; we excluded articles conducted in other countries, book reviews, news and cultural notes, supplements, and letters to the editor. For each article, data such as the year of publication, journal, title, type of article, subject, authors, location, institution of conduct, collaborating institutions, keywords—when applicable—, number of citations, funding sources, and adherence to guidelines for reporting study types (i.e., STROBE, SRQR, or CONSORT) were collected on Microsoft Excel 2022 sheets.
The articles were categorized into different study topics. The number of articles published by federal entities in the Mexican Republic was analyzed. Various bibliometric indicators such as productivity indices, transience, Lotka, and collaboration indices were calculated [23,24,25]. The most frequent keywords, along with the language of the references used and their validity, were analyzed; the isolation and Price indices were also identified [24,26].
Using Google Scholar on 28 December 2023, we obtained the number and type of documents (i.e., article, book, or thesis) that cited the articles published in the three journals. We also consulted the Scopus and Web of Science databases.
To evaluate the validity of the original articles, the study design, locality (unicentric or multicentric), sample size calculation, sampling type, and sample value were recorded. A simple random sampling method was employed to select 10% of the original articles, following these steps: identification of the total population, organization by year and journal, assignment of sequential numbers, generation of random numbers in Excel using =RANDOM(), and selection of the corresponding articles for evaluation. Once the articles were randomly selected, a critical appraisal was conducted using The Newcastle–Ottawa Quality Assessment Scale Checklist, adapted for cross-sectional studies, and the checklists from The Joanna Briggs Institute for quasi-experimental, case-control, qualitative, and cohort studies [27,28,29,30,31]. These checklists assess the quality of studies using criteria that assign one point for each fulfilled item, allowing for the identification of strengths, limitations, and a systematic evaluation of the robustness of the results. The Newcastle–Ottawa Scale evaluates the selection of participants, group comparability, and outcome measurement, while the JBI checklists review aspects such as bias minimization, variable control, and methodological rigor, depending on the study type. Ultimately, the scores obtained provide a structured assessment of the quality and reliability of the studies.
The critical appraisal was conducted independently by peers [I R.-M-P.; G.L-O.], and subsequently, Cohen’s Kappa was used to assess agreement between observers to verify homogeneity.
Since no work was conducted with patients or medical records and the information used was available on websites, the approval of this research by an ethics committee was not required.
3. Results
A total of 627 articles were analyzed; 317 (50.55%) were published in Atención Familiar, 157 (25.03%) in Revista Mexicana de Medicina Familiar, and 153 (24.40%) in Archivos en Medicina Familiar. When analyzing the output by institutions, it was identified that 330 (52.63%) articles were published by the Mexican Social Security Institute (IMSS), 86 (13.72%) by the National Autonomous University of Mexico (UNAM), and 62 (9.89%) by the Ministry of Health (SSA), while the remaining 23.76% involved councils and colleges of family medicine, universities, and public and private health institutions (Table 1).
Of all articles, 363 (57.89%) were original research, 123 (19.61%) were reviews, 107 (17.06%) were editorials, and 34 (5.42%) were clinical cases. Fifty-seven study topics were identified, diabetes mellitus was the most common (9.57%), which was followed by topics in family medicine (family medicine practice, family, family functionality, among others) at 8.93% and respiratory diseases and COVID-19 at 7.34%. Figure 1 displays the topics covered in 20 or more articles, comprising 67.78% of the total; the remaining percentage was classified under other study topics (Supplementary Table S1).
When analyzing the origin of the articles, Mexico City was the federal entity with the highest number of publications at 264 (42.10%). Of the remaining 31 federal entities, 28 published, on average, 12.67 articles each over ten years, with 12 of those publishing five or fewer articles. No publications were recorded in three federal entities (Campeche, Oaxaca, and Zacatecas) (Figure 2), whereas eight articles did not specify the place of origin but reported that they were conducted in Mexico.
A total of 2161 authors signed the articles. The total productivity index was 2.79. There were 380 (60.60%) publications written by a maximum of three authors (range 1–20). Eighteen were identified as large producers, 269 as intermediates, and 1053 as transients (Table 2), resulting in a transience index of 78.58%. The Lotka index for major producers ranged from 1 to 1.60 (Supplementary Table S2).
The collaboration index was 3.44; in 208 (33.17%) articles, at least two different institutions participated (range of 2–7). The institutions with the most inter-institutional collaborations were IMSS, which interacted with five universities and two healthcare entities, and UNAM, which interacted with four healthcare entities (Figure 3).
The most frequently mentioned keywords (≥10 mentions) included treatment, breast cancer, anxiety, and adolescence, which were each mentioned ten times. The terms Elderly, Family Medicine, and Type 2 Diabetes Mellitus were the most represented, with 32, 65, and 69 mentions, respectively (Figure 4).
When analyzing all the citations used in the published works (n = 11,550), 6243 were in Spanish, resulting in an isolation index of 54.05%; the remaining citations were in English. The median number of references used in the articles was 18 (IQR 12–24) with those older than five years having a median of 9 (IQR 4–15), while those five years old or less had a median of 6 references (IQR 3–12). In 50 (7.97%) articles; all references were >5 years old, while in 22 (3.50%) all citations were ≤5 years old. The overall Price index was 42.74%.
As of 28 December 2023, articles published in Atención Familiar had been cited 2537 times, followed by Archivos en Medicina Familiar with 401 citations and Revista Mexicana de Medicina Familiar with 75 (Table 3). According to Google Scholar, original articles received the most citations, with 2478 (82.24%), which was followed by reviews with 373 (12.37%), editorials with 154 (5.11%), and clinical cases with 8 (0.26%) citations. The majority of citations originated from theses (59.50%), which were followed by articles from Spanish-speaking medical journals (40.29%). Only fifty-six (8.93%) citations were identified in English-language articles in the Scopus and Web of Science databases.
Of all the articles, three (0.47%) reported having funding, and four (0.63%) indicated adherence to guidelines for reporting medical research.
Analysis of Original Articles
Of the 363 original articles analyzed, 211 (58.12%) were published in Atención Familiar, while Revista Mexicana de Medicina Familiar and Archivos en Medicina Familiar published 82 (22.58%) and 70 (19.28%), respectively.
When evaluating attributes of internal validity, it was identified that 337 (92.83%) of the original articles were observational; of these, 288 (79.33%) were cross-sectional: 164 (45.17%) were descriptive, and 124 (34.16%) were analytical. Thirty-one (8.53%) articles were multicentric, while in 153 (42.14%), a sample size calculation was performed; the sample size ranged from 2 to 14,770 participants, with a median of 134 (IQR 68.5–248), in 241 (66.39%) articles, the sample size was ≤200; in 44 (12.12%), probabilistic random sampling was conducted (Table 4).
Thirty-six articles were randomly selected, of which 24 (66.66%) were cross-sectional [32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55], 4 (11.11%) were quasi-experimental [56,57,58,59], 1 (2.77%) was a case-control [60], 4 (11.11%) were qualitative [61,62,63,64], and 3 (8.33%) had a cohort [65,66,67]. According to the Newcastle–Ottawa classification, the minimum score for cross-sectional studies was 2 points, and the maximum was 7. Overall, 15 (62.5%) of the articles were classified as unsatisfactory (4 or fewer points), 8 (33.33%) were satisfactory studies (5 to 6 points), and 1 (4.16%) was good (7 points or more). Sixteen (66.66%) articles had limitations in the selection categories and 18 (75%) had limitations in comparability (Supplementary Table S3).
In the analysis of quasi-experimental, case-control, qualitative, and cohort studies, it was identified that most did not reach half of the score indicated by the JBI checklists (Supplementary Table S4).
In the homogeneity analysis among evaluators of the original articles analyzed, a correlation of α = 0.73 was found. In the global evaluation of the original articles, it was identified that 23 (63.88%) showed significant deficiencies that compromised their quality. Table 5 summarizes the evaluation parameters identified in the referred studies.
4. Discussion
This work analyzed the scientific production of family medicine journals edited in Mexico. The IMSS published 330 (52.63%) articles (Table 1). While this figure represents a significant percentage, it contrasts with the number of family physicians working at that institution (n = 22,214) who provide more than 75 million annual consultations [6,68]. This scenario was similar in the rest of the institutions and organizations that reported publications during the study period.
On the other hand, publishing only 627 articles in ten years in the three journals is insufficient to systematically address Mexico’s primary care health challenges. In this regard, the country ranks among the top worldwide in obesity, diabetes mellitus, cardiovascular diseases, and metabolic syndrome, among other conditions [4]. In contrast to the number of articles reported, a bibliometric study conducted in the United States identified that, in 2015 alone, thirteen family medicine departments published 1052 articles [69]. This low productivity is not a problem exclusive to Mexico; various countries, both high- and low-income, face similar challenges due to the lack of infrastructure and funding for primary care research, which impacts the development of adequate strategies to address public health needs [70]. The low productivity can be attributed to the high demand for medical care and the educational, academic, and institutional limitations in research, which are factors that have been identified in previous studies [10,71,72]. This highlights the urgent need to improve medical training in research and strengthen the infrastructure that supports it [72,73].
The lack of development in primary care research has a significant global impact, affecting scientific output and the implementation of new strategies and evidence-based practices. Bibliometric analyses reveal that 80% of the articles published in the highest-impact journals related to general practice predominantly come from the United Kingdom and the United States [74,75]. Such analyses have also identified sustained growth in countries like Germany, France, and the Netherlands, suggesting a diversification dynamic in global scientific production in primary care [75].
This dominance in research development is also reflected in the number of journals edited by English-speaking countries, which occupy the top positions in family medicine and primary care [76]. In contrast, Mexico’s contribution to global scientific output in family medicine and primary care remains scarce, accounting for only ˂0.1–0.25% of publications worldwide [74,76]; this figure underscores a significant gap in research within an area that is crucial to public health in any nation for improving health outcomes and reducing inequalities in access to medical services.
The distribution of the topics in the analyzed publications (Figure 1) is related to Mexico’s morbidity and mortality profile. Of the nine categories of clinical topics in the published articles, 6 (66%) are part of the 20 main causes of morbidity, and 5 (55%) appear within the 10 main causes of mortality for the year 2023 [77,78].
The distribution of publications by federal entities in the Mexican Republic shows significant asymmetries (Figure 2); 51% of the scientific production was concentrated in Mexico City, State of Mexico, and Morelos despite these federal entities having only 12.1% of the IMSS family medicine units at the national level. On the other hand, the 12 federal entities with the lowest productivity (≤5 articles each in 10 years) contributed 5.6% of the total publications. This indicates a disconnection between research and medical care in different regions of the country. This may be one of the first points to intervene through a transdisciplinary and inter-institutional approach. Continuing with a dynamic in which scientific production is geographically and institutionally biased can impact different health contexts [79], compromising the quality of medical care.
Among the bibliometric indicators analyzed, the transience (78.58%) and isolation (54.05%) indices indicate a low rate of continuity and consolidation of work teams and a preference for information sources in Spanish, which may reflect limitations in integrating global advances in research [80,81,82,83]. Moreover, the Price index (42.74%) suggests that while there is a current knowledge base on which research is supported, it would be beneficial to intensify efforts to incorporate more recent research.
Regarding the frequency of citation of the articles published in the three journals, it was observed that most are cited in theses, indicating that a significant part of those who consult them are doctors in training. This trend suggests that journals play a role as vehicles of academic–scientific communication in the educational field and could partially explain the limited presence of citations in higher-impact databases such as Scopus and Web of Science.
Notably, the percentage of articles that reported having funding (0.47%) reflects the insufficient support to trigger research in this and other scientific disciplines in the country [84,85], as well as the lack of knowledge of incentives to develop this activity [10]. Regarding this, it has been identified that increasing the infrastructure and resources available to develop research in family medicine improves the quality of care [86].
Regarding the articles that adhered to guidelines for reporting medical research (0.63%), it is important that journals promote their adherence and the importance they have in increasing the quality and transparency of the reports made [87,88,89].
The original articles analyzed presented various methodological characteristics that can compromise their internal and external validity. The high percentage of observational studies (92.38%) prevents the establishment of risk associations due to confounding effects and bias control. In the same sense, the unicentric nature of most studies (88.9%), as well as limitations identified in the sample size calculation and the type of sampling (Table 4), affect the precision of the estimators and the representativeness of the population, all of which increase biases in the reported findings. Regarding this, it has been pointed out that the quality and precision in the reporting of observational studies vary considerably compared to other types of studies, such as randomized controlled clinical trials [90], so the promotion of the latter in the field of family medicine in the country must be a key point to intervene due to the impact they have on medical decision making [91].
When evaluating the quality of the original articles, using various checklists, it was identified that 6 out of 10 presented substantial deficiencies that impacted their quality (Table 5). This suggests that more than half of the articles published could present significant limitations that compromise the reliability of the findings reported. This aspect is not minor or characteristic of a particular medical specialty [92].
One of the main criticisms of the knowledge generated in medicine focuses on preventable methodological failures, statistical illiteracy, useless, false, irreproducible, and lack of transparency in their reporting [93,94,95,96,97]. These deficiencies can compromise the credibility of the research, raising serious concerns about the findings’ validity and utility.
Addressing these deficiencies by paying greater attention to methodological quality in the conduct and presentation of medical research is imperative. This includes promoting knowledge about the principles of study design, rigorous application of appropriate statistical methods, and adherence to transparent and complete reporting standards.
Since the origin of this specialty, the development of research in family medicine has been a persistent challenge [71]. Despite advances in this activity in various parts of the world, this progress is not reflected in several countries in Latin America, including Mexico [10]. For this reason, it is essential to know and disseminate various initiatives to strengthen this activity [98,99].
Among the key measures to address this lag should be the strengthening of teaching in research methodology and scientific writing, implementing studies with a higher level of evidence, promoting the training and consolidation of research groups, fostering collaboration between universities and health institutions, and increasing support for family medicine journals in the country. However, above all, it is important to generate greater awareness of what research implies in improving medical care [86]; these tasks must be irrevocable in all medical training and practice areas. It is reported that education in research and appraisal scientific evidence favors better medical decision making [100].
Finally, it is worth highlighting that although this research focused on Mexico as a case study, the results obtained can serve as a reference for comparing the quality and gaps in the development of research in family medicine and primary care, both locally and globally.
Limitations
One of the main limitations is that the analysis was restricted to three specific journals, so various research studies in family medicine were not included in this study. However, the journals analyzed here are one of the main means of reporting research on family medicine in the country [11]. They are edited by the university that started the residency and that trains the largest number of family physicians in Mexico (Atención Familiar) as well as by the Mexican Federation of Specialists and Residents in Family Medicine (Revista Mexicana de Medicina Familiar) and by the Pan-American Academic Association of Family Medicine (Archivos en Medicina Familiar). Furthermore, because all data capture was performed manually, there may have been notation problems.
5. Conclusions
The various parameters evaluated show limitations in the generation and dissemination of knowledge in family medicine in Mexico; given the implications that this medical specialty has in health systems worldwide, it is urgent to generate strategies to promote the development of more and higher-quality research. For this, it is necessary to strengthen the research infrastructure and develop policies incentivizing interinstitutional and multidisciplinary collaboration. It is crucial to prioritize increasing resources for family medicine research and supporting novice researchers. Additionally, educational programs that strengthen research skills and knowledge generation in this medical discipline should be implemented.
Conceptualization, I.R.M.-P., E.L.-O. and G.L.-O.; data collection, I.R.M.-P., R.D.-M. and G.L.-O.; data curation, I.R.M.-P., R.G.H.-L., R.D.-M. and G.L.-O.; data analysis, I.R.M.-P., E.L.-O., R.G.H.-L., L.F.R.-H., R.D.-M. and G.L.-O.; writing—original draft preparation, E.L.-O. and G.L-O.; writing—review and editing, I.R.M.-P., E.L.-O., R.G.H.-L., L.F.R.-H., R.D.-M. and G.L.-O. All authors have read and agreed to the published version of the manuscript.
Not applicable.
Not applicable.
The data generated and analyzed in this study are not publicly available, as they will be used in future research. However, reasonable requests for data access may be considered, subject to review and approval by the research team.
The authors declare no conflicts of interest.
Footnotes
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
Enlarge this image.Figure 3. Network of interinstitutional interactions. The thickness of the lines and numbers in blue represent the quantity and the count of interactions, respectively. The network design was created using Pajek version 5.18, with a random circular layout, and edited in Microsoft PowerPoint 2019. CMCMF: Mexican Council for Certification in Family Medicine. ANM: National Academy of Medicine. SSA: Ministry of Health. UNAM: National Autonomous University of Mexico. IMSS: Mexican Social Security Institute. ITESM: Monterrey Institute of Technology and Higher Education. ISSSTE: Institute of Social Security and Services for State Workers. HGT: General Hospital of Ticomán. UABC: Autonomous University of Baja California. UAG: Autonomous University of Guerrero; UAT: Autonomous University of Tamaulipas. HAL: Ángeles León Hospital. UG: University of Guanajuato. HGM: General Hospital of Mexico Eduardo Liceaga. UWH: West-Hill University.
Scientific production in the three family medicine journals published in Mexico according to participating institutions or associations.
| Institutions or Associations | Frequency | % |
|---|---|---|
| Mexican Social Security Institute | 330 | 52.63 |
| National Autonomous University of Mexico | 86 | 13.72 |
| Ministry of Health | 62 | 9.89 |
| Other public universities | 45 | 7.18 |
| Colleges or councils of Family Medicine | 22 | 3.51 |
| Institute of Security and Social Services for State Workers (ISSSTE) | 19 | 3.03 |
| Private universities | 12 | 1.91 |
| Private hospitals | 12 | 1.91 |
| Not specified | 11 | 1.75 |
| Naval Hospital | 9 | 1.44 |
| Social Security Institute of the State of Mexico and Municipalities (ISSEMyM) | 8 | 1.28 |
| National Polytechnic Institute | 6 | 0.96 |
| Other government institutions | 5 | 0.80 |
| Total | 627 | 100% |
Classification of producers according to the Lotka index.
| Number of Authors (n) | Number of Papers | (%) | Lotka’s Productivity Index (log(n)) | Classification |
|---|---|---|---|---|
| 1053 | 1 | 78.58 | 0.00 | Transient producers |
| 139 | 2 | 10.37 | 0.30 | Intermediate producers |
| 55 | 3 | 4.10 | 0.48 | |
| 26 | 4 | 1.94 | 0.60 | |
| 19 | 5 | 1.42 | 0.70 | |
| 13 | 6 | 0.97 | 0.78 | |
| 7 | 7 | 0.52 | 0.85 | |
| 5 | 8 | 0.37 | 0.90 | |
| 5 | 9 | 0.37 | 0.95 | |
| 6 | 10 | 0.45 | 1.00 | Large producers |
| 2 | 11 | 0.15 | 1.04 | |
| 2 | 12 | 0.15 | 1.08 | |
| 2 | 13 | 0.15 | 1.11 | |
| 1 | 14 | 0.07 | 1.15 | |
| 2 | 15 | 0.15 | 1.18 | |
| 2 | 18 | 0.15 | 1.26 | |
| 1 | 40 | 0.07 | 1.60 |
Cumulative citations for the three family medicine journals published in Mexico from 2014 to 2023.
| Atención Familiar | Archivos en Medicina Familiar | Revista Mexicana de Medicina Familiar | ||||
|---|---|---|---|---|---|---|
| Year | Papers (n) | Citations (n) | Papers (n) | Citations (n) | Papers (n) | Citations (n) |
| 2014 | 22 | 298 | 15 | 36 | 15 | 0 |
| 2015 | 26 | 538 | 5 | 0 | 22 | 4 |
| 2016 | 33 | 674 | 12 | 78 | 21 | 3 |
| 2017 | 31 | 375 | 23 | 138 | 16 | 3 |
| 2018 | 35 | 290 | 12 | 88 | 13 | 15 |
| 2019 | 32 | 199 | 6 | 12 | 10 | 3 |
| 2020 | 28 | 76 | 8 | 23 | 8 | 22 |
| 2021 | 37 | 59 | 13 | 8 | 16 | 4 |
| 2022 | 37 | 27 | 22 | 14 | 16 | 21 |
| 2023 | 36 | 1 | 37 | 4 | 20 | 0 |
| Total | 317 | 2537 | 153 | 401 | 157 | 75 |
Characteristics of the original articles (n = 363).
| Characteristic | Frequency | % |
|---|---|---|
| Study Design | ||
| Cross-sectional | 288 | 79.33 |
| Quasi-experimental | 23 | 6.34 |
| Case-control | 16 | 4.41 |
| Qualitative | 14 | 3.85 |
| Cohort | 9 | 2.48 |
| Validation | 7 | 1.93 |
| Clinical trial | 3 | 0.83 |
| Mixed | 3 | 0.83 |
| Study Center | ||
| Single-center | 323 | 88.98 |
| Multicenter | 31 | 8.54 |
| Not specified | 9 | 2.48 |
| Sample Size Calculation | ||
| Yes | 153 | 42.15 |
| Not specified | 108 | 29.75 |
| No | 64 | 17.63 |
| Entire population | 38 | 10.47 |
| Sample Size | ||
| 2–100 | 138 | 38.01 |
| 101–200 | 103 | 28.37 |
| >200 | 119 | 32.78 |
| Not specified | 3 | 0.82 |
| Type of Sampling | ||
| Non-probabilistic | 165 | 45.45 |
| Not specified | 154 | 42.42 |
| Probabilistic | 44 | 12.12 |
Average and range of the articles analyzed using checklists.
| Study Design | n | Score Checklist | Range |
|---|---|---|---|
| Cross-sectional | 24 | 4.2/10 | 2–7 |
| Quasi-experimental | 4 | 4/9 | 3–5 |
| Case-control | 1 | 3/10 | 3 |
| Qualitative | 4 | 4.75/10 | 2–7 |
| Cohort | 3 | 4.33/11 | 3–6 |
Supplementary Materials
The following supporting information can be downloaded at
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; López-Ortiz, Eduardo 1 ; Hernández-López, Rubí G 2 ; Romero-Henríquez, Luisa F 3 ; Dávila-Mendoza, Rocío 1 ; López-Ortiz, Geovani 1
1 Subdivisión de Medicina Familiar, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de Mexico 04510, Mexico;
2 Oficina de Análisis del Plan de Salud, Subgerencia Técnica de Plan de Salud, Gerencia de Administración del Plan de Salud, Banco de México, Ciudad de Mexico 06000, Mexico;
3 Facultad de Filosofía y Letras, Universidad Nacional Autónoma de México, Ciudad de Mexico 04510, Mexico;