[Mortalidad por enfermedad de Alzheimer en México de 1980 a 2014].

BACKGROUND: Dementias are rarely considered to be a main cause of death; therefore there are only few studies on Alzheimer's mortality covering long periods. OBJECTIVE: To describe mortality from Alzheimer's disease in México for the period from 1980 to 2014. METHOD: Cross-sectional study where, with official mortality data in Mexico according to codes 331.0 and G30, respectively, of the 9th and 10th revisions of the International Statistical Classification of Diseases and Related Health Problems, crude and standardized Alzheimer's disease mortality rates were obtained, both nationally and by states. RESULTS: From almost being inexistent, deaths from Alzheimer's disease went to a rate of 65.12 per 1000 females and 43.66 per 1000 males in the 2010-2014 five-year period. Throughout the study period, the age group with highest mortality rates for this cause were those older than 80 years, with 0.29 per 100,000 population in 1980-1984 and 55.02 in 100,000 in the 2010-2014 period. The region with the highest mortality was the northwest, with rates higher than 2.28 per 100,000 population. CONCLUSIONS: Mortality from Alzheimer's disease is a public health problem in Mexico with a growing trend, especially among women and older adults. Early diagnostic measures and opportune treatment are required in primary care in order to reduce this problem.

INTRODUCCIÓN: Raramente se considera a las demencias como causa principal de muerte, por consiguiente existen pocos estudios sobre la mortalidad por Alzheimer a través de largos periodos. OBJETIVO: Describir la mortalidad por enfermedad de Alzheimer en México durante el periodo 1980-2014. MÉTODO: Estudio transversal en el que, con datos oficiales de mortalidad en México según los códigos 331.0 y G30 de la novena y décima revisiones de la Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados con la Salud, se obtuvieron tasas crudas y estandarizadas de mortalidad por enfermedad de Alzheimer, nacional y por entidad federativa. RESULTADOS: De ser casi inexistentes, en el quinquenio 2010-2014 se registraron tasas de 65.12 y 43.66 muertes por enfermedad de Alzheimer por cada 1000 mujeres y 1000 hombres, respectivamente. En todo el periodo estudiado, el grupo etario con las mayores tasas de mortalidad por esta causa fue el de mayores de 80 años, con 0.29 en 100 000 habitantes durante 1980-1984 y 55.02 durante 2010-2014. La región con mayor mortalidad fue la noroeste, con tasas mayores a 2.28 en 100 000 habitantes. CONCLUSIONES: La mortalidad por enfermedad de Alzheimer es un problema de salud pública en México con tendencia creciente, especialmente entre mujeres y adultos mayores. Se requieren medidas diagnósticas precoces y tratamiento oportuno en primer nivel para aminorar este problema.

[Effectiveness of interventions for improving drug prescribing in Primary Health Care]. / Efectividad de las intervenciones para mejorar la prescripción de medicamentos en atención primaria.

OBJECTIVE: To determine the effectiveness of interventions for improving drug prescribing in Primary Health Care units. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Searches were made in MedLine©, ScienceDirect©, Springer©, SciELO©, Dialnet©, RedALyC© and Imbiomed©, in Spanish, English and Portuguese, using keywords "drug prescribing", "intervention studies" and "primary health care", indexed in each data base up to August 2014. SELECTION OF STUDIES: Experimental and quasi-experimental studies were included that had a CASP-score>5 and that evaluated effect of any type intervention on the quality of drug prescription in Primary Health Care. RESULTS: A total of 522 articles were found, and an analysis was performed on 12 that reported 17 interventions: 64.7% educational, 23.5% incorporating pharmacists into the health team, and 11.8% on the use of computer applications. The strong "intervention/improvement" associations were educational interventions OR=2.47 (95% CI; 2.28 - 2.69), incorporation of pharmacists OR=3.28 (95% CI; 2.58 4.18), and use of computer applications OR=10.16 (95% CI; 8.81 -11.71). CONCLUSIONS: The use of interventions with computer applications showed to be more effective than educational interventions and incorporation pharmacists into the health team. Future studies are required that include economic variables such as, implementation costs, drug costs and other expenses associated with health care and treatment of diseases.

Clinical competence of Guatemalan and Mexican physicians for family dysfunction management.

OBJECTIVE: To evaluate the clinical competence of Mexican and Guatemalan physicians to management the family dysfunction. METHODS: Cross comparative study in four care units first in Guadalajara, Mexico, and four in Guatemala, Guatemala, based on a purposeful sampling, involving 117 and 100 physicians, respectively. Clinical competence evaluated by validated instrument integrated for 187 items. Non-parametric descriptive and inferential statistical analysis was performed. RESULTS: The percentage of Mexican physicians with high clinical competence was 13.7%, medium 53%, low 24.8% and defined by random 8.5%. For the Guatemalan physicians'14% was high, average 63%, and 23% defined by random. There were no statistically significant differences between healthcare country units, but between the medium of Mexicans (0.55) and Guatemalans (0.55) (p = 0.02). CONCLUSION: The proportion of the high clinical competency of Mexican physicians' was as Guatemalans.

[Clinical competence measurement in Mexican resident physicians for diagnosis and treatment of Chagas disease]. / Evaluación de la competencia clínica en médicos residentes mexicanos para el diagnóstico y tratamiento de la enfermedad de Chagas.

OBJECTIVE: Evaluate clinical competence of a mexican resident physicians sample for diagnosis and treatment of Chagas disease. MATERIAL AND METHODS: Cross-sectional and analytic study in 122 resident physicians of epidemiology, family medicine and internal medicine specialty, assigned to a third level medical unit from Guadalajara, Jalisco, Mexico, taking a sample for convenience. An instrument was designed and validated for to evaluate clinical competence in five dimensions: risk factors identification, clinical data identification, diagnostic test interpretation, diagnostic integration and therapeutic resources utilization; that classified competence level in four strata: random defined, low, medium and high, with 89% of reliability accord to Kunder-Richardson test. Descriptive and no parametric inferential statistics were obtained. RESULTS: A total of 122 physicians, 55.7% males (n = 68) and 44.3% females (n = 54). Random defined clinical competence 4.9% (n = 6), low 49.2% (n = 60), medium 44.3% (n = 54) and high 1.6% (n = 2). Median significantly higher in epidemiologists (p = 0.03). CONCLUSIONS: Improve clinical competence level of resident physicians for diagnosis and treatment of Chagas disease is necessary. Intervention studies are required.

[Impact of homicide on male life expectancy in Mexico]. / Impacto de la violencia homicida en la esperanza de vida masculina de México.

OBJECTIVE: To determine the impact of homicide on male life expectancy in Mexico and its 32 states during the three-year periods 1998-2000 and 2008-2010 and the weight of the different age groups in years of life expectancy lost (YLEL) due to this cause. METHODS: Based on official death and population data, abridged tables for male mortality in Mexico as a whole and its states were created for the three-year periods studied. Health-adjusted life expectancy and YLEL for men aged 15 to 75 were calculated by selected causes (homicide, diabetes mellitus, and traffic accidents) and age groups in each three-year period. RESULTS: In the years between the 1998-2000 and 2008-2010 periods, YLEL due to homicide increased both nationally and in 19 states. In four states, the YLEL in 2008-2010 exceeded two, with the state of Chihuahua standing out at 5.2 years. In 14 of the 18 states where health-adjusted life expectancy among men declined between the two three-year periods, the YLEL due to homicide increased. From 2008 to 2010, homicides were the leading cause of YLEL among men aged 20-44. YLEL due to homicide among those aged 15-44 increased between the two three-year periods. CONCLUSIONS: The increase in the rate of homicidal violence, especially among young people, is impeding an increase in male life expectancy in Mexico. In several states, such as Chihuahua and Durango, this violence appears to be the main reason for the decline in life expectancy among men aged 15 to 75.

Myostatin Levels and the Risk of Myopenia and Rheumatoid Cachexia in Women with Rheumatoid Arthritis.

Background: Myostatin is a regulator of muscle size. To date, there have been no published studies focusing on the relation between myostin levels and myopenia in rheumatoid arthritis (RA). Objective: Evaluate the value of serum myostatin as a biomarker of cachexia and low skeletal muscle mass (LSMM) in RA patients, along with whether high serum myostatin is associated to these conditions after adjusting for potential confounders. Methods: This cross-sectional study included 161 female RA patients and 72 female controls. In the RA group, we assessed several potential risk factors for LSMM and rheumatoid cachexia. Dual-energy X-ray absorptiometry was used to quantify the skeletal muscle mass index (SMMI) (considering LSMM ≤ 5.5 kg/m2) and the presence of rheumatoid cachexia (a fat-free mass index ≤ 10 percentile and fat mass index ≥ 25 percentile of the reference population). Serum myostatin concentrations were determined by ELISA. To identify a cut-off for high serum myostatin levels, we performed ROC curve analysis. Multivariable logistic regression analysis was used to identify the risk factors for LSMM and rheumatoid cachexia. The risk was expressed as odds ratios (ORs) and their 95% confidence intervals (95% CIs). Results: Compared to the controls, the RA group had a higher proportion of LSMM and exhibited high serum myostatin levels (p < 0.001). ROC curve analysis showed that a myostatin level ≥ 17 ng/mL was the most efficient cut-off for identifying rheumatoid cachexia (sensitivity: 53%, specificity: 71%) and LSMM (sensitivity: 43%, specificity: 77%). In the multivariable logistic regression, RA with high myostatin levels (≥17 ng/mL) was found to increase the risk of cachexia (OR = 2.79, 95% CI: 1.24-6.29; p = 0.01) and LSMM (OR = 3.04, 95% CI: 1.17-7.89; p = 0.02). Conclusions: High serum myostatin levels increase the risk of LSMM and rheumatoid cachexia. We propose that high myostatin levels are useful biomarkers for the identification of patients in risk of rheumatoid cachexia and myopenia.

[A comparative study between two academic working environments in residents of family medicine]. / Satisfacción de los residentes de medicina familiar con el ambiente académico laboral.

OBJECTIVE: To compare the satisfaction level in the academic working environments (AWE) between the residents of two training primary care units. METHODS: Observational, transversal and comparative study. A previously constructed and validated instrument was applied, it included 30 items that evaluated the AWE with the following indicators: support, satisfaction, participation and respect; the reliability index's instrument was high (Cronbach's alpha is 0.88). The statistical analysis was made with the Mann-Whitney U test, and χ2 test for proportions. RESULTS: Regarding the AWE, 4.28% of the residents obtained a really inappropriate environment; 8.57% very appropriate and 14% inappropriate environment. However the 72% was between intermediate environments. No statistical significant difference was found between the three measurements. CONCLUSIONS: Our results are consistent with other national studies results where the "respect" indicator was the one with higher rank. The environment along with "participation," and "support," creates a favorable relationship among residents, teachers and the staff. However, the "imposition" and "rigidity" produces a decrease in the collective participation.

[Risk factors in cesarean section]. / Factores de riesgo en la operación cesárea.

BACKGROUND: Improvement of surgical techniques, innovation, and technological development have increased the frequency of cesarean section. OBJECTIVE: To identify the sociodemographics, obstetrical, attention and medical practice factors of risk most frequently associated to cesarean section. PATIENTS AND METHOD: From January to June 2007, we carried out a study of cases and controls with 222 cases of cesarean section and 358 controls of vaginal childbirth in Hospital General no. 6 of Ciudad Juárez. We compared frequency of sociodemographics, obstetrical, attention, and medical practice variables, by means of chi2 and Fisher exact tests; association among these variables and cesarean section was considered with odds ratio. In all cases chosen confidence interval was 95%. RESULTS: Risk factors associated with cesarean section were: maternal age over 28 years, previous cesarean section, complicated pregnancy, fetal suffering, cephalopelvic disproportion, deficient prenatal care; fetal podalic version, oxytocin administration, abnormal amniotic fluid, double- or triple-circle umbilical cord; patient attended by a gynecologist with more than 16 years of experience and by a resident; and medical care in evening shift. There was no association with age, menarche, beginning of sexual relationships, body mass index, smoking, or addictions. CONCLUSIONS: Risk factors associated with cesarean section were: previous cesarean section and patient attended by a gynecologist with more than 16 years of experience and by a resident.

[Differentiated consumption of macronutrients according to sex and age in higher education students]. / Consumo diferenciado de macronutrientes según sexo y edad en estudiantes de educación superior.

OBJECTIVE: To analyze the intake of macronutrients and its relationship with age and sex in higher education students. MATERIALS AND METHODS: A cross-sectional study was carried out with 218 higher education students, aged between 18 and 30 years. A validated and reliable instrument was used to measure macronutrient consumption. RESULTS: Regarding the intake of macronutrients, a statistical difference by sex was observed in favor of men (p>0.05), except for the consumption of proteins in students older than 25 years. In the group under 20 years of age, men showed better protein intake. Finally, in students between 20 and 25 years, the consumption of macronutrients is similar among men and women. DISCUSSION: The results show that the percentage of consumption with respect to ideal value of the estimated requirement for light activity according to FAO/WHO/UN 2004 is below the recommendations, with a macronutrient consumption deficit that ranges between 20% and 60%.

OBJETIVO: Analizar la ingesta de macronutrientes y su relación con la edad y sexo en estudiantes de educación superior. MÉTODOS: Se realizó un estudio transversal conformado con 218 estudiantes de educación superior de 18 a 30 años. Se utilizó un instrumento validado y confiable, para medir el consumo de macronutrientes. RESULTADOS: Respecto a la ingesta de consumo de macronutrientes se observa que hay diferencia estadística por sexo, a favor de los hombres (p>0,05), excepto en el consumo de proteínas en los estudiantes mayores de 25 años. En el grupo etario menor a 20 años, los hombres tienen un mejor consumo de proteínas. En estudiantes de 20 a 25 años el consumo de macronutrientes es parecido entre hombres y mujeres. DISCUSIÓN: Los resultados evidencian que el porcentaje de consumo respecto del valor ideal de requerimiento estimado para actividad ligera según FAO/OMS/ONU 2004, está por debajo, con un déficit de consumo de macronutrientes que oscila entre el 20% y el 60%.

Dimensiones culturales del concepto pie diabético en personas con diabetes mellitus y en estudiantes de medicina mexicanos / Cultural Dimensions of the Diabetic Foot Concept in People with Diabetes Mellitus and in Mexican Medical Students

RESUMEN Objetivo: Analizar las dimensiones culturales del concepto pie diabético en personas con diabetes mellitus y en estudiantes de medicina. Material y métodos: Estudio descriptivo exploratorio con base en los fundamentos de la antropología cognitiva y la teoría del consenso cultural. Participaron 40 personas (20 personas con diabetes y 20 estudiantes de medicina de séptimo semestre). El estudio se realizó en Guadalajara (México), en un hospital de segundo nivel, en los primeros tres meses de 2019. Se utilizaron listados libres y pile sort para identificar el contenido y la organización de las dimensiones. En el caso de los valores agregados, las matrices fueron analizadas mediante conglomerados jerárquicos. En el caso de los valores individuales, las matrices fueron analizadas mediante un modelo de consenso cultural. Resultados: Para las personas con diabetes, el concepto de pie diabético se conformó por las dimensiones de consecuencias y prevención. Para los estudiantes de medicina, el concepto de pie diabético se conformó por las dimensiones consecuencias y complicaciones. Se encontró consenso cultural en ambos grupos (Razón F1:F2, personas con diabetes: 3.14; estudiantes de medicina: 6.73). Las dimensiones tuvieron valores de ajuste adecuados: stress 0.21 en las personas con diabetes y 0.13 en los estudiantes. Conclusiones: Gracias a los resultados y acercamiento hacia ambos grupos, se pudieron reconocer elementos claves para la futura aplicación de programas de prevención para la salud, y una atención más integral para las personas con diabetes mellitus.

ABSTRACT Objective: Analyze the cultural dimensions of the diabetic foot concept in people with diabetes mellitus and in medical students. Material and Methods: Exploratory descriptive study based on the foundations of cognitive anthropology and the theory of cultural consensus. Forty people participated (20 people with diabetes and 20 medical students in the seventh semester). The study was conducted in Guadalajara, Mexico, in a second level hospital, in the first three months of the year 2019. Free lists and pile sort were used to identify the content and the organization of the dimensions. In the case of the aggregated values, hierarchical conglomerates analyzed the matrices. In the case of individual values, the matrices were analyzed using a cultural consensus model. Results: People with diabetes mellitus conformed the concept of diabetic foot by the dimensions of consequences and complications, whereas the medical students conformed the concept by the dimensions of consequences and complications. The cultural consensus was found in both groups with the following reasons F1:F2, people with diabetes: 3.14; medical students: 6.73. The dimensions had adequate values with the stress of 0.21 for the people with diabetes, and of 0.13 for the medical students. Conclusions: Gratefully, these results and the approach towards these two groups' key elements could be found for a future application of programs of health prevention and deeper and integral treatment process for the people with diabetes mellitus.

[Clinical aptitude of family doctors in the management of patients with diabetes type two with initial nephropathy]. / Valoración global de la aptitud clínica de médicos familiares en el manejo de la diabetes mellitus con nefropatía inicial.

The diabetic nephropathy in initial phase requires an opportune identification by family physicians. Indeed, they should be qualified to interpret the data that suggesting that a patient be going through that phase of the illness, in order to orientate the management and processing of the same one, from an integrative perspective. The purpose of this work was to measure the aptitude of the family doctors to interpret, to judge and to propose in front of sick patients with diabetes type two with initial nephropathy. We made this with a representative sample of family physicians in five Family Medicine Units of the Instituto Mexicano del Seguro Social in the city of Guadalajara, Jalisco, Mexico. The main variable of the study was the clinical aptitude of the doctors: interpretation, judgment and proposals carried out in the practice of their profession; and through an ordinal scale, levels of aptitude' were defined, which related to the remainder of variables using the medium, Kruskal Wallis stadiometer and chi2.

[Mortality due to traffic injuries and its impact on life expectancy: a comparison between Mexico and Spain]. / Mortalidad por lesiones de tráfico y su impacto en la esperanza de vida: comparativa entre México y España.

OBJECTIVE: To determine the impact of mortality due to motor vehicle traffic injuries (MVTI) compared with other causes of death on life expectancy in Mexico and Spain during the three-year periods 2000-2002 and 2010-2012 and the weight of the different age groups in years of life expectancy lost (YLEL) due to this cause. METHODS: Based on official death and population data, abridged life tables in Mexico and Spain were constructed for the three-year periods studied. Temporary life expectancy and YLEL for persons aged 15 to 75 years were calculated by selected causes (MVTI, diabetes mellitus, malignant neoplasms and ischemic heart diseases) and age groups in each three-year period. RESULTS: In Spain, YLEL decreased in both sexes from all the causes studied, especially MVTI; this reduction was greater in the younger ages. In addition, temporary life expectancy increased. In Mexico, YLEL due to MVTI increased in men, mainly in young people, and remained unchanged among women. Temporary life expectancy declined in men but increased slightly among women. CONCLUSIONS: The reduction in YLEL due to MVTI in Spain has contributed to increased life expectancy. By contrast, the increase in YLEL due to MVTI among Mexican men has contributed to the decline in male life expectancy.

[Impact of participatory education on body mass index and blood glucose in obese type-2 diabetics]. / Impacto de la educación participativa en el índice de masa corporal y glicemia en individuos obesos con diabetes tipo 2.

Exogenous obesity increases morbidity and mortality risk and has been associated with nutritional habits, which in turn can be affected by health education. Health education aims to promote patient participation in achieving behavior change and healthy lifestyles. The objective of this study is to show the advantages of participatory education in the modification of body mass index (BMI) in obese type-2 diabetics. A quasi-experimental study was performed with random allocation of two patient groups. The educational intervention was organized through a reflection-action process. BMI was measured at baseline and then monthly for 9 months during the intervention. The groups were analyzed by age and sex. Statistical analysis used the Student t test, with the mean difference for related groups. The control group showed a mean BMI of 33.89 + 1.96 and a final BMI of 33.2 +/- 2.15 (t:22.4; p:0.16). The experimental group had an initial value of 33.63 +/- 2.12 and a final BMI of 31.54 +/- 1.71; statistical difference: (t:11.55; p:0.003). The participatory educational intervention thus helped improve the BMI in obese type-2 diabetics.

[Evaluation of two strategies for nutritional education using radio programs in Guadalajara, Mexico]. / Evaluación de dos estrategias de educación nutricional vía radio en Guadalajara, México.

Modifying knowledge and attitudes through persuasive communication in health via radio has produced encouraging results for public health planners. This study's objective was to measure the effect of an educational strategy on knowledge and attitudes towards nutrition in two marginalized communities in Guadalajara, Mexico. Two communities were randomly selected. In each community a group of individuals was invited to be exposed to radio broadcasts. Using a coded and structured instrument, knowledge and attitudes towards the contents of nutritional education for health were measured before and after the intervention in both groups. Group A (n = 37) was organized and exposed to the dynamics of the radio forum throughout the 4 months during which the project lasted. Group B (n = 33) was not organized, and listened to the radio program according to its own cultural dynamics. Median knowledge and attitudes (KA) for group A was 56.8 in the pre-test and 74.1 in the post-test (W: p = -0.05). In group B the KA results were 53.0 and 59.2, respectively (W: p = -0.05). The results emphasize the advantages of the radio forum as a health communications strategy for human nutrition.

Structure and content of the maternal representations of Mexican teenagers during their first pregnancy / Estructura y contenido de las representaciones maternas de adolescentes mexicanas durante su primer embarazo

Abstract Objectives: understand the structure and content of the maternal representations of Mexican teenagers during their first pregnancy. Methods: a study was carried out with qualitative methodology based on the concept of maternal representation and the theory of social representations with 30 adolescents who attended prenatal control at the Civil Hospital of Guadalajara "Fray Antonio Alcalde", in Jalisco, Mexico. The participants were interviewed with the consent of their tutors. Classical content analysis techniques were used to obtain codes and thematic categories to develop a conceptual map that explains maternal representations. Results: the maternal representation was identified: "Pregnant but reunited, a legitimated bad decision", which was composed of social meanings towards adolescent pregnancy, family dynamics, expectations towards motherhood, and the feelings experienced by the adolescent during the pregnancy. The content of the representations was heterogeneous for most of the identified categories; however, it is identified that the desire for pregnancy guides the expectations of the adolescent about her future way of being as a mother. Conclusions: the desire of women for pregnancy, the level of participation of the couple, and the social meanings of adolescent pregnancy, have an outstanding role in the development of models of maternal representations.

Resumen Objetivos: comprender la estructura y contenido de las representaciones maternas de adolescentes mexicanas durante su primer embarazo. Métodos: se llevó a cabo un estudio con metodología cualitativa basado en el concepto de representación materna y la teoría de las representaciones sociales con 30 adolescentes que asistieron a control prenatal al Hospital Civil de Guadalajara "Fray Antonio Alcalde", ubicado en Jalisco, México. Las participantes fueron entrevistadas con previo consentimiento de sus tutores. Se utilizaron técnicas de análisis de contenido clásico para obtener códigos y categorías temáticas para desarrollar un mapa conceptual que explique las representaciones maternas. Resultados: se identificó la representación materna: "Embarazada pero juntada, una mala decisión legitimada", la cual se compuso de significados sociales hacia el embarazo adolescente, la dinámica familiar, las expectativas hacia la maternidad, y los sentimientos vividos por la adolescentedurante el embarazo. El contenido de la representación materna fue heterogéneo, empero, se identificó que el deseo por el embarazo guía las expectativas de la adolescente sobre su futura manera de ser madre. Conclusiones: el deseo de la mujer por el embarazo, el nivel de participación de la pareja, y los significados sociales del embarazo adolescente, tienen un papel sobresaliente en el desarrollo de las representaciones maternas.

Riesgo para el desarrollo de trastorno depresivo mayor al existir alteraciones en la sintomatología menopaúsica en mujeres de Guadalajara, Jalisco / Risk for the development of major depressive disorder when there are alterations in menopausal symptoms in women from Guadalajara, Jalisco

RESUMEN Antecedentes: El Trastorno Depresivo Mayor (TDM) puede presentarse durante el inicio de la menopausia, variando su prevalencia de acuerdo a diferentes factores de riesgo clínicos y sociodemográficos; presentándose una mayor asociación al existir alteraciones en la sintomatología menopaúsica. Ante esto, se buscará determinar el riesgo para desarrollar TDM al presentar alteraciones en la sintomatología menopaúsica. Metodología: Es un diseño transversal analítico que incluyó a 252 mujeres iniciando su menopausia (48±1.7 años), atendidas en centros de salud de Guadalajara, Jalisco. Las variables analizadas fueron antecedentes sociodemográficos, utilizando el Inventario de Depresión de Beck para identificar el TDM y la Escala de Valoración de la Menopausia para determinar alteraciones en los principales dominios sintomatológicos de la menopausia. Se realizaron análisis descriptivos y de asociación por medio de Odds Ratio (OR), aplicando finalmente una regresión logística. Resultados: La prevalencia de TDM fue de 40.5%, teniendo asociación con el antecedente de uso de anticonceptivos y con el agravamiento en la sintomatología menopaúsica. El análisis ajustado determinó que hay más riesgo de presentar TDM cuando existen alteraciones en los dominios sintomatológicos, tales como en el somático (OR 3.96, IC95% 1.58-9.95), el urogenital (OR 4.29, IC95% 2.13-8.65) y el psicológico (OR 13.55, IC95% 3.97-46.30). Conclusión: La presencia de alteraciones en la sintomatología menopaúsica se encuentra asociado con un mayor riesgo de presentar TDM, sobre todo si el dominio psicológico está afectado, por lo cual es necesario que el personal de salud identifique estas alteraciones y brinde un manejo temprano en esta etapa de la vida.

ABSTRACT Background: Major Depressive Disorder (MDD) can occur during the onset of the menopause, varying its prevalence according to different clinical and sociodemographic risk factors; presenting a greater association with the existence of alterations in the menopausal symptomatology. Given this, we will seek to determine the risk to develop MDD by presenting alterations in the menopausal symptoms Methodology: It is an analytical cross-sectional design that included 252 women beginning their menopause (48±1.7 years old), and who were attended in health centers of Guadalajara, Jalisco. The analyzed variables were their sociodemographic background, using the Beck Depression Inventory to identify the MDD and the Menopause Rating Scale to determine alterations in the main symptomatological domains of the menopause. Descriptive and association analyzes were performed by means of Odds Ratio (OR), subsequently applying a logistic regression model. Results: The prevalence of MDD was 40.5%, with significant associations with the history of contraceptive use and the worsening of menopausal symptoms. The adjusted analysis allowed us to determine that there is more risk for developing MDD when there were alterations in the symptomatological domains, such as in the somatic (OR 3.96, 95% CI 1.58-9.95), the urogenital (OR 4.29, IC95% 2.13-8.65) and in the psychological (OR 13.55, IC95% 3.97-46.30). Conclusion: The presence of alterations in the menopausal symptomatology is associated with an increased risk of developing MDD, especially if the psychological domain is affected, which is why it is necessary for health personnel to identify these alterations and provide early management in this stage of live.

Consumo diferenciado de macronutrientes según sexo y edad en estudiantes de educación superior / Differentiated consumption of macronutrients according to sex and age in higher education students

RESUMEN Objetivo Analizar la ingesta de macronutrientes y su relación con la edad y sexo en estudiantes de educación superior. Métodos Se realizó un estudio transversal conformado con 218 estudiantes de educación superior de 18 a 30 años. Se utilizó un instrumento validado y confiable, para medir el consumo de macronutrientes. Resultados Respecto a la ingesta de consumo de macronutrientes se observa que hay diferencia estadística por sexo, a favor de los hombres (p>0,05), excepto en el consumo de proteínas en los estudiantes mayores de 25 años. En el grupo etario menor a 20 años, los hombres tienen un mejor consumo de proteínas. En estudiantes de 20 a 25 años el consumo de macronutrientes es parecido entre hombres y mujeres. Discusión Los resultados evidencian que el porcentaje de consumo respecto del valor ideal de requerimiento estimado para actividad ligera según FAO/OMS/ONU 2004, está por debajo, con un déficit de consumo de macronutrientes que oscila entre el 20% y el 60%.(AU)

ABSTRACT Objective To analyze the intake of macronutrients and its relationship with age and sex in higher education students. Materials and Methods A cross-sectional study was carried out with 218 higher education students, aged between 18 and 30 years. A validated and reliable instrument was used to measure macronutrient consumption. Results Regarding the intake of macronutrients, a statistical difference by sex was observed in favor of men (p>0.05), except for the consumption of proteins in students older than 25 years. In the group under 20 years of age, men showed better protein intake. Finally, in students between 20 and 25 years, the consumption of macronutrients is similar among men and women. Discussion The results show that the percentage of consumption with respect to ideal value of the estimated requirement for light activity according to FAO/WHO/UN 2004 is below the recommendations, with a macronutrient consumption deficit that ranges between 20% and 60%.(AU)

Prescripción inadecuada de medicamentos: aportaciones de los paradigmas científicos a su conocimiento / Inadequate drugs prescription: contributions of scientific paradigms to your knowledge

Resumen Se realizó una revisión narrativa con análisis temático sobre las aportaciones de los paradigmas científicos al conocimiento de la prescripción inadecuada de medicamentos. Se buscaron artículos de acceso abierto indexados en PubMed© entre 2010-2014, y se sistematizó información sobre el paradigma, tipo de publicación, perspectiva teórica, objetivo, método y resultados. De los 992 artículos encontrados, se seleccionaron 118, y se tomó una muestra propositiva de 15, según su diseño, representando los cuatro paradigmas. Los artículos positivistas reportaron prevalencia, factores asociados, efectividad de intervenciones y criterios de evaluación; los interpretativos explicaron las causas del problema según los involucrados; los críticos denunciaron la influencia de la industria farmacéutica; y el participativo abordó el problema secundariamente y lo solucionó en un escenario para una enfermedad y grupo farmacológico específicos. Se concluyó que la prescripción inadecuada de medicamentos como problema de investigación en salud pública recibe aportes de los cuatro paradigmas, con dominio del positivismo, lo que se atribuye al carácter paradigmático de la ciencia desde la que se le aborda habitualmente, y que una perspectiva multi-paradigmática es el mejor abordaje.

Abstract This study conducted a narrative review with thematic analysis about contributions of scientific paradigms to knowledge of inadequate drugs prescription. We searched open access articles indexed in PubMed© between 2010 and 2014, and we systematized information about scientific paradigm, publication type, theoretical perspective, objective, method and results. From the 992 articles found, 118 were selected. From those, we chose a purposive sample of 15, according to the design of the studies, representing the four paradigms. The positivists articles reported prevalence, associated factors, effectiveness of interventions and evaluation criteria; the interpretive explained the causes of the problem according to those involved; the critics denounced the influence of pharmaceutical industry; and the participative addressed the problem secondarily and solved it in a scenario for a specific disease and pharmacological. We concluded that the inadequate drugs prescription as research problem in public health had contributions from the four paradigms, with dominance of positivism, which is attributed to the paradigmatic perspective of the science, from which it is usually studied, and that a multi-paradigmatic perspective is the best approach to the public health issue.

[Hypothyroidism incidence and thyrotropin serum levels in newborns]. / Incidencia de hipotiroidismo y niveles séricos de la tirotropina en neonatos.

BACKGROUND: congenital hypothyroidism is the third sub-clinic hereditary disease in Mexico. Infants with total or partial underactive thyroid gland presented at birth showed high levels of thyrotropin. This allows identifying patients at risk for developing it through screening tests. The aim was to determinate the incidence of neonatal congenital hypothyroidism in newborns in our hospital as well as set the cut-off value in screening test. METHODS: samples from 4049 cord blood of newborns were processed. TSH was measurement by ELISA. Probands with high values subsequently underwent to confirmatory testing TSH micro-particle immunoassay. RESULTS: the results showed incidence of hypothyroidism of 1.2 per 1000 newborns. The cut-off value obtained in the screening test was 26.63 mUI/L. CONCLUSIONS: TSH values showed a different distribution compared with previous studies in the Mexican population and also a higher hypothyroidism incidence.

Introducción: el hipotiroidismo congénito ocupa el tercer lugar de las enfermedades hereditarias subclínicas en México. Los neonatos con hipofunción total o parcial de la glándula tiroides presentan concentraciones altas de la tirotropina, lo que permite identificar los casos probables con riesgo para desarrollar hipotiroidismo mediante las pruebas de tamiz. El objetivo de esta investigación fue determinar la incidencia de hipotiroidismo congénito neonatal en los recién nacidos y establecer el valor de corte en el ensayo de la prueba de tamiz. Métodos: se procesaron 4049 muestras de sangre de cordón umbilical de recién nacidos. Se cuantificó la hormona estimulante de la tiroides mediante ELISA. A los niños con valores elevados se les realizó la prueba confirmatoria mediante ensayo inmunoenzimático de micropartículas. Resultados: se identificó una incidencia de hipotiroidismo de 1.2 por cada 1000 recién nacidos. El valor de corte para la hormona estimulante de la tiroides fue de 26.63 mUI/L en la prueba de tamiz. Conclusiones: los valores de la hormona estimulante de la tiroides mostraron una distribución diferente a los de otras investigaciones en población mexicana, así como una incidencia más elevada de hipotiroidismo.

Clinical competencies for primary health care of climacteric in a group of Mexican physicians / Competências clínicas para cuidados de saúde primários de climatério em um grupo de médicos Mexicanos

Objective: Measure clinical competence for female climacteric diagnosis and treatment in physicians from a Mexican social security system. Methods: Cross-sectional and multi-centric study in 78 physicians from five primary health care units from the Mexican Institute of Social Security in Guadalajara City, Jalisco, Mexico. We measured clinical competence with an instrument specially designed and validated (reliability p = 0.92 accord to Kuder­Richardson test). We obtained descriptive statistics and compared proficiency level accord to labor, demographic and academic characteristics using no-parametric statistic. Results: Clinical competencies medians in five primary health care units were 8­21 points in a scale with maximum value of 108. We do not found significant differences to compare medical unit, gender, specialty, previous training in female climacteric symptoms, contract type, workshift and medical certifications (p > 0.05). Conclusions: Climacteric clinical competence is null or very low in primary health care physicians from Guadalajara City. Educational interventions are required.(AU)

Objetivo: Medir competência clínica para o diagnóstico e tratamento do climatério feminino nos médicos a partir de um sistema de segurança social mexicano. Métodos: Estudo transversal e multicêntrico com 78 médicos de cinco unidades básicas de saúde do Instituto Mexicano de Segurança Social na Cidade de Guadalajara, Jalisco, México. Medimos competência clínica com um instrumento especialmente concebido e validado (confiabilidade p = 0,92 de acordo com o teste de Kuder-Richardson). Obtivemos estatística descritiva e comparação do nível de proficiência no trabalho de acordo com as características demográficas e acadêmicas com o uso do método não paramétrico. Resultados: Competências clínicas medianas em cinco unidades básicas de saúde foram de 8 a 21 pontos em uma escala com valor máximo de 108. Não se encontraram diferenc¸as significativas para comparar unidade médica, sexo, especialidade, treinamento prévio em sintomas do climatério feminino, tipo de contrato, turno de trabalho e certificações médicas (p > 0,05). Conclusões: Competência clínica para o diagnóstico e tratamento do climatério é nula ou muito baixa em cuidados médicos primários de saúde na Cidade de Guadalajara. Intervenções educativas são necessárias.(AU)