Estimation of fetal radiation absorbed dose during the prophylactic use of aortic occlusion balloon for abnormally invasive placenta.

PURPOSE: Abnormally invasive placenta is an important cause of maternal morbidity, and its primary complication is massive bleeding. Strategies for preventing bleeding include arterial endovascular occlusion. One concern with the use of intra-arterial occlusion balloons is radiation exposure to the fetus, which occurs while determining balloon position. In this study, we sought to determine the radiation absorbed dose by the fetus during intra-aortic occlusion balloon placement in patients with abnormally invasive placenta. MATERIALS AND METHODS: We estimated the fetal absorbed dose and the entrance skin dose in the vaginal fundus and lumbar skin, respectively, using thermoluminescent dosimeter crystals, during intra-aortic balloon positioning using the mobile X-ray image intensifier system (C-arm) in digital radiography mode, directly in surgery room, without transfer to angiographic suite. We also performed a mannequin-based simulation to validate the entrance skin dose measurement technique. RESULTS: Ten women undergoing surgical management of an abnormally invasive placenta, in whom the location of the intra-aortic occlusion balloon was verified using plain radiography with C-arm in the surgery room, were included in the study. Following maternal and fetal radiation exposure, the entrance skin dose and radiation absorbed dose by the fetus were 1.31 ± 0.96 mGy and 0.27 ± 0.28 mGy, respectively, with radiation exposure durations of <1 s. CONCLUSIONS: There were no complications with the use of REBOA, the radiation absorbed dose by the fetus, entrance skin dose, and duration of radiation exposure during intra-aortic occlusion balloon placement were lower than those reported for other vascular occlusion techniques, being this a safe procedure.

The vitamin B12 analog cobinamide is an effective hydrogen sulfide antidote in a lethal rabbit model.

BACKGROUND AND PURPOSE: Hydrogen sulfide (H2S) is a highly toxic gas for which no effective antidotes exist. It acts, at least in part, by binding to cytochrome c oxidase, causing cellular asphyxiation and anoxia. We investigated the effects of three different ligand forms of cobinamide, a vitamin B12 analog, to reverse sulfide (NaHS) toxicity. METHODS: New Zealand white rabbits received a continuous intravenous (IV) infusion of NaHS (3 mg/min) until expiration or a maximum 270 mg dose. Animals received six different treatments, administered at the time when they developed signs of severe toxicity: Group 1-saline (placebo group, N = 9); Group 2--IV hydroxocobalamin (N = 7); Group 3--IV aquohydroxocobinamide (N = 6); Group 4--IV sulfitocobinamide (N = 6); Group 5--intramuscular (IM) sulfitocobinamide (N = 6); and Group 6-IM dinitrocobinamide (N = 8). Blood was sampled intermittently, and systemic blood pressure and deoxygenated and oxygenated hemoglobin were measured continuously in peripheral muscle and over the brain region; the latter were measured by diffuse optical spectroscopy (DOS) and continuous wave near infrared spectroscopy (CWNIRS). RESULTS: Compared with the saline controls, all cobinamide derivatives significantly increased survival time and the amount of NaHS that was tolerated. Aquohydroxocobinamide was most effective (261.5 ± 2.4 mg NaHS tolerated vs. 93.8 ± 6.2 mg in controls, p < 0.0001). Dinitrocobinamide was more effective than sulfitocobinamide. Hydroxocobalamin was not significantly more effective than the saline control. CONCLUSIONS: Cobinamide is an effective agent for inhibiting lethal sulfide exposure in this rabbit model. Further studies are needed to determine the optimal dose and form of cobinamide and route of administration.

Few-cycle laser-driven electron acceleration.

We report on an electron accelerator based on few-cycle (8 fs full width at half maximum) laser pulses, with only 40 mJ energy per pulse, which constitutes a previously unexplored parameter range in laser-driven electron acceleration. The produced electron spectra are monoenergetic in the tens-of-MeV range and virtually free of low-energy electrons with thermal spectrum. The electron beam has a typical divergence of 5-10 mrad. The accelerator is routinely operated at 10 Hz and constitutes a promising source for several applications. Scalability of the few-cycle driver in repetition rate and energy implies that the present work also represents a step towards user friendly laser-based accelerators.

Novel method for characterizing relativistic electron beams in a harsh laser-plasma environment.

Particle pulses generated by laser-plasma interaction are characterized by ultrashort duration, high particle density, and sometimes a very strong accompanying electromagnetic pulse (EMP). Therefore, beam diagnostics different from those known from classical particle accelerators such as synchrotrons or linacs are required. Easy to use single-shot techniques are favored, which must be insensitive towards the EMP and associated stray light of all frequencies, taking into account the comparably low repetition rates and which, at the same time, allow for usage in very space-limited environments. Various measurement techniques are discussed here, and a space-saving method to determine several important properties of laser-generated electron bunches simultaneously is presented. The method is based on experimental results of electron-sensitive imaging plate stacks and combines these with Monte Carlo-type ray-tracing calculations, yielding a comprehensive picture of the properties of particle beams. The total charge, the energy spectrum, and the divergence can be derived simultaneously for a single bunch.

Ivan IV, el Terrible, ¿padeció de un síndrome del lóbulo temporal? / The possible temporal lobe syndrome of Ivan IV the Terrible

Ivan IV "The Terrible" was the first Tsar of all Russias and was crowned in 1547. He extended Russian territories and opened the route to Siberia in successful campaigns against Tartars. He increased his personal power to the point of generating an autocracy that isolated him progressively from the council of Boyars. He had a complex personality and his acts were impregnated by a profound religiousness, episodes of rage, mood changes and a sense of "personal fate". All these traits configure the controversial "temporal lobe personality". The possible association between these personality traits and the eventual epilepsy that Ivan IV could suffer, is discussed. This association is called "temporal lobe syndrome". Considering the mood changes, with severe irritability and episodes of control loss alternated with feelings of guilt, sadness and isolation, another possibility is that the Tsar had an affective bipolar disorder or, less probably, a personality disorder.

[The possible temporal lobe syndrome of Ivan IV the Terrible]. / Ivan IV, el Terrible, ¿padeció de un síndrome del lóbulo temporal?

Ivan IV "The Terrible" was the first Tsar of all Russias and was crowned in 1547. He extended Russian territories and opened the route to Siberia in successful campaigns against Tartars. He increased his personal power to the point of generating an autocracy that isolated him progressively from the council of Boyars. He had a complex personality and his acts were impregnated by a profound religiousness, episodes of rage, mood changes and a sense of "personal fate". All these traits configure the controversial "temporal lobe personality". The possible association between these personality traits and the eventual epilepsy that Ivan IV could suffer, is discussed. This association is called "temporal lobe syndrome". Considering the mood changes, with severe irritability and episodes of control loss alternated with feelings of guilt, sadness and isolation, another possibility is that the Tsar had an affective bipolar disorder or, less probably, a personality disorder.

Epidemiologic Study of Pseudomonas aeruginosa in critical patients and reservoirs.

BACKGROUND: Pseudomonas aeruginosa is a common cause of nosocomial infections, particularly in intensive care units (ICUs). The aim of this study was to characterize P. aeruginosa clinical isolates by comparing antimicrobial susceptibility patterns with the presence of plasmids and to establish the clonal relatedness by pulsed-field gel electrophoresis (PFGE) typing. METHODS: The patients included those with isolation of P. aeruginosa hospitalized for more than 48 h in the ICU from April to May 1998. Environmental and staff cultures were obtained simultaneously. Minimal inhibitory concentrations, plasmid DNA profiles, and PFGE genomic patterns of enzyme restriction chromosomal DNA were compared. RESULTS: Sixty P. aeruginosa isolates were obtained from 197 clinical specimens, 178 environmental samples, and 47 hand cultures of personnel. Antimicrobial resistance was as follows: tobramycin 100%; ticarcillin, cefotaxime, ceftriaxone, ceftazidime, and gentamicin 80%; cefepime 60%; amikacin, ticarcillin/clavulanate, imipenem, and meropenem 40%; piperacillin and norfloxacin 20%; carbenicillin 12%, and ciprofloxacin 0%. Plasmids were detected in 11 isolates (18%). PFGE typing showed that 23 isolates belonged to a common clone (pattern A), identified from five patients, two nurses, and 10 environmental samples. Ten isolates were grouped in four clusters and 27 isolates had unrelated genomic patterns. There was no relationship among DNA genomic patterns, plasmid profiles, and susceptibility patterns. CONCLUSIONS: PFGE demonstrated the existence of a common clone in a critical care area. Reinforcement of infection control measures is needed to avoid horizontal transmission and severe infections.

Laparoscopic biliopancreatic diversion with a duodenal switch for morbid obesity: a feasibility study in pigs.

BACKGROUND AND PURPOSE: Biliopancreatic diversion with a duodenal switch is an emerging open procedure that appears as effective as other bariatric operations. Our goal was to determine the safety and feasibility of performing this procedure using a laparoscopic approach in a porcine model. MATERIALS AND METHODS: Six 50-kg pigs underwent surgery. Intake was restricted with a sleeve gastrectomy, and malabsorption was obtained by creating a Roux-en-Y. The Roux limb served as a 150-cm alimentary channel following anastomosis to a transected proximal duodenum, while the other limb, or biliopancreatic channel, transported digestive juices. Where the two limbs joined, a 100-cm common channel was formed. RESULTS: The operation was completed in a mean time of 4.5 hours. Two of the six pigs had an intraoperative duodenoenterostomy anastomotic leak detected on methylene blue testing. This leakage was thought to be related to pig anatomy and is not expected to be a problem in humans. At necropsy, all anastomoses were patent, and there were no enteroenterostomy leaks or mesenteric torsions. CONCLUSION: On the basis of the porcine model, laparoscopic biliopancreatic diversion with a duodenal switch is anticipated to be feasible and safe in humans. Substantial weight loss combined with the benefits of laparoscopic surgery can be expected.

[Fatty acids in sardine canned in tomato sauce from different fishing areas of the Mexican Pacific]. / Acidos grasos en sardina en salsa de tomate de diferentes zonas pesqueras del Pacifico mexicano.

Numerous investigations have pointed out the importance that the fatty acids have in the process health-illness, and that the marine resources are excellent sources of the series omega 3 and omega 6. In Mexico, the sardine is a product of marine origin of wide consumption due to its high readiness and low cost. The objective of the present study was to determine the fatty acids profile (FA) in sardine canned in tomato sauce coming from different fishing areas (A) of the Mexican Pacific. There were randomly obtained 8 commercial mark (5 cans of each mark) of sardine canned in tomato sauce; they were classified in sardine of South Baja California Sur (A1), Sonora (A2) and Sinaloa (A3). The samples without draining were liquified and thereafter were obtained the methyl esters of fatty acids that were analyzed by gas chromatography with a flame ionization detector. In all the areas they were identified and quantified as 3 FA omega 3 (linolenic, EPA and DHA) and 2 AG omega 6 (linoleic and arachidonic); this source is rich in FA monounsaturated and also presents a considerable quantity of trans FA (18:1n9t and 18:2n6t). The DHA was the most abundant AG in all the areas (3064-4704 mg/100 g); finally, the relationships omega 3/omega 6 were from 3.5 (A1) up to 8.9 (A3). In conclusion, sardine canned in tomato sauce of the mexican Pacific is a rich food in omega-3 and omega-6 FA, independently of the processing area.

[Fatty acids of the tuna of different fishing areas of the Mexican Pacific, canned in oil and water]. / Acidos grasos del atún de diferentes zonas pesqueras del Pacífico mexicano, en aceite y agua.

A direct relationship exists between the state of health and the diet, and inside this some components, such as the fatty acids (FA), influence mostly in the prevention of certain illnesses (coronary heart disease, hypertension, rheumatoid arthritis, inflammatory answer, and arterial pressure). One of the main sources of essential FA are the marine products; the tuna is a marine food of wide consumption in Mexico due its readiness and low cost. The objective of this work was to determine the profile of fatty acids (FA) in tuna canned in oil and in water coming from three fishing areas of the Mexican Pacific. There were randomly obtained 7 oil-tuna commercial marks (AA) and 5 water- tuna (AW) coming from the next fishery areas: Baja California Sur (L1), Colima (L2) and Mazatlán (L3). The samples without draining were liquefied and thereafter it was obtained the methyl esters of fatty acids that were analyzed by gas chromatography with a flame ionization detector. In all the areas were identified 20 FA (mg/100 g); three AG omega 3 (EPA, DHA and linolenic) and two omega 6 (linoleic and arachidonic). In the AA of the three areas the most abundant saturated FA were estearric and palmitic acids, the most abundant monounsaturated fatty acid was the cis-vaccenic, followed by the oleic acid. The behavior of those omega 3 in the AA of the three areas were similar: with the less quantity was the linolenic acid (447-755), continued by the EPA (979-1323) and finally high concentrations of DHA (1862-3327). In the AW the DHA was the most abundant fatty acid in all the areas (1086-4456), the most abundant monounsaturated fatty acid was the palmitic (640-3809). It was observed the presence of trans fatty acids in high quantities in AW: linolelaidic (1394-1495) and elaidic (377-1234). The relationship omega 3/omega 6 in the AA was similar in L1 and L2, and lower in L3; in AW was higher in L2 and L3. In conclusion, evident variation exists in the content of FA among areas; it could be considered that the AA of L3 and AW of L2 as the richest in omega-3 and omega-6 FA. In general, the tuna in water is a richer food in FA omega 3 and omega 6 that the tuna in oil, independently of the fishery area.

Primary and acquired resistance of Mycobacterium tuberculosis in Western Mexico.

Resistance of Mycobacterium tuberculosis to antimycobacterial agents is a worldwide problem. The proposite of this study was to analyze the current resistance patterns of patients with initial episodes, as well as relapses, due to M. tuberculosis in western Mexico. From January 1993 to February 1999 a total of 237 strains of M. tuberculosis (120 from initial cases and 117 from relapse cases) were analyzed. Two hundred and four (86%) strains were isolated from the lower respiratory tract, and 33 strains (14%) from extrapulmonary sites. Twenty-three percent of M. tuberculosis isolated from patients with initial episodes were resistant to both isoniazid and rifampin, and 52% of M. tuberculosis isolated from relapse cases were also resistant to both isoniazid and rifampin.

Asymptomatic bacteriuria and inflammatory response to urinary tract infection of elderly ambulatory women in nursing homes.

BACKGROUND: Bacteriuria > or = 10(5) CFU/ml is evidence of urinary tract infection in the absence of associated signs or symptoms. The presence of pyuria with asymptomatic bacteriuria established the response of elderly women against microorganisms capable of causing invasiveness or tissue injury of the urinary tract. METHODS: The association between bacteriuria and pyuria was determined in 178 elderly, ambulatory women without symptoms of urinary tract infection in seven nursing homes. Urine culture results were subsequently analyzed in conjunction with absolute leukocyte count in urine. In this cross-sectional study, asymptomatic bacteriuria in elderly women was classified with and without pyuria. RESULTS: The prevalence of asymptomatic bacteriuria was found in 44 (24.7%) elderly women. The presence of pyuria had a sensitivity of 63.6% for bacteriuria and a specificity of 91%. The positive predictive value for the presence of pyuria predicting those with bacteriuria was 70%, and the negative predictive value for the absence of pyuria predicting those without bacteriuria was 88.4%. Escherichia coli was the most common organism isolated in 81.8% of the women. CONCLUSIONS: Bacteriuria > or 10(5) CFU/ml associated with pyuria was detected in 77% of elderly women with asymptomatic urinary tract infections. Bacteriuria of < 10(5) CFU/ml with pyuria proves less sensitive as an indicator of urinary tract infection. Elderly women with pyuria but without bacteriuria should be studied for other causes of urinary tract inflammation.

[Vitamins and minerals from sardine in tomato sauce, from the Mexican Pacific fish zones]. / Vitaminas y minerales de sardina en salsa de tomate, colectada en las zonas pesqueras del Pacífico mexicano.

Sardine is a sea food widely consumed in Mexico due to it's abundance and very low price. Its content in vitamins, minerals and chemical composition were evaluated in its canned presentation in tomato sauce. Samples proceeded from 3 fishery areas of the Mexican Pacific: (L1) Baja California Sur, (L2) Sonora and (L3) Sinaloa. The proximal chemical analysis was carried out by the AOAC methods; mineral content (Ca, Mg, Na, K, Fe, Zn, Cu, Cd, Cr, Pb) was determined by atomic absorption spectrophotometry and vitamins A, B1, B2 and niacin were quantified by HPLC. Results showed a high moisture content from 69 to 82%, ether extract ranged between 7.8% (L2) and 10.2% (L3) and crude protein content between 10.6% (L3) and 14.6% (L1). Vitamin A (IU/100 g) was similar for all samples: L1 (63-66); thiamin (mg/100 g) was high in L1 (0.13) and low in L3 (0.09); riboflavin was high in L1 (0.15) and showed values of 0.13 for both L2 and L3; niacin content was high in all samples: L1 (2.24), L2 (1.48) and L3 (1.75). Minerals were abundant (mg/100 g) in Na, K, and P; L1 showed a great variation for Na (363-636) compared with L2 and L3 (250); K was very variable among the samples: L1 (597), L2 (100) and L3 (57). Phosphorous and magnesium had small variations: P (229, 243 and 212) and Mg (28, 23 and 23) for L1, L2 and L3. Iron was more abundant in L1 (5.5) and L3 (4.3); Zn was higher in L2 (3.4) and similar in L1 (2.5) and L3 (2.2). Copper showed a great variation in L2 (0.21-0.48) but the averages were similar (0.37, 0.35, 0.33, for L1, L2 and L3 respectively). Finally, heavy metal content was lower than 0.002 mg/100 g. In conclusion, there are some variation in Ca, Na, K, thiamin and niacin content in canned sardine with tomato sauce, depending upon the fishing area.

Colitis ulcerosa y embarazo / Evolution of ulcerative colitis in pregnancy

Background: The evolution of ulcerative colitis in pregnancy is far from clear. While some authors state that the disease aggravates during this period, others do not share this opinion. Aim: To assess the evolution of ulcerative colitis in pregnancy. Patients and methods: A paired case-control design was used in which 15 women, with diagnosed ulcerative colitis at the moment of becoming pregnant, were followed for 12 months and the activity of the disease was compared with that of the 12 months preceding the pregnancy. The activity of the disease in the period preceding the pregnancy was gathered retrospectively from the patient's charts. Results: The mean age of the first ulcerative colitis crisis was 24 years. It was moderate in 49 percent and severe in 35 percent of women. During pregnancy 55 percent of women did not have a crisis, compared with 26.7 percent during the period preceding pregnancy (relative risk of not having a crisis during pregnancy of 1.7). During both periods, seven women had digestive complications, whereas extra digestive complications were not observed in 60 percent of patients during pregnancy and 11.8 percent of patients during the preceding period. Perinatal results were similar to those of the general population. Conclusions: In our group of patients the evolution of ulcerative colitis was better during pregnancy, reflected by a lower number of crisis

Mortalidad por accidentes de tránsito en Chile, 1994: una aproximación epidemiológica / Mortality due to traffic accidents in Chile during 1994: an epidemiological approach

Traffic accidents are one of the most important public health problems in the world and produce social, work and human resources losses. Data were obtained from death certificates in which the cause of death was a traffic acciden. All death certificates obtained by the National Institute of Statistics during 1994 were used. Social, demographic and seasonal variable were recorded. During 1994 there were 1679 deaths due to traffic accidents (81 percent male), with a rate of 19.6 per 100,000 inhabitants. Gender specific risks were 19.62 and 4.48 for men and women, respectively. Mean age at the moment of death was 39 years old. Fifty three percent of deceased people were single, 42 percent married and 5 percent widowers. Ten percent had not formal education, 48 percent had basic education, 23 percent college education and 6.5 percent university education. Seventy seven percent of fatalities ocurred in urban areas. The risk of death of traffic accidents was 7.02 per 100,000 inhabitants in the metropolitan region. The information obtained in the present study may help to generate preventive strategies to control deaths caused by traffic accidents

The pigment of melanosis coli: a lectin histochemical study.

BACKGROUND: The compositional nature of the pigment of melanosis coli is essentially unknown. Previous histochemical studies suggested that this pigment has certain similarities with lipofuscin (i.e., age-dependent pigment) and ceroids (i.e., pathologically derived pigments) and that it may contain, therefore, polymerized glycolipids and glycoproteins. However, the saccharide composition of this pigment was never explored by lectin histochemical procedures, which was the main object of this study. METHODS: Colonoscopic biopsy specimens from eight patients with melanosis coli and from three normal control subjects were studied by fluorescent microscopy and by standard and lectin histochemistry. The number of apoptoses in the lining colonic epithelium was also evaluated histologically. RESULTS: Apoptotic bodies were significantly more numerous in patients with melanosis coil than in control subjects. The pigment that accumulates in macrophages of the lamina propia showed autofluorescence, sudanophilia, acid-fastness, and positiveness to PAS and Schmorl's reactions, all of which are common to lipofuscin and ceroids, plus an intense argentaffin reaction abolished by bleaching, indicative of a melanic substance. Lectin histochemistry showed, in decreasing order of frequency, the presence of alpha-D-mannose, sialic acid, beta-D-galactose (lactose), gal-beta-(1-3)acetyl-galactosamine, alpha-D-galactose, and alpha-L-fucose, but no terminal alpha-D-acetyl-galactosaminyl residues. CONCLUSIONS: The significant increase of apoptotic bodies in the lining colonic epithelium indicated that this type of cell death is not due to the natural programmed cell renewal, but to the action of laxatives. Because the autofluorescent pigment of melanosis coli contains melanin (as well as glycoconjugates) and is not dependent on age but on the use of anthranoid laxatives, it should be categorized as a "melanized ceroid." The lectin affinities of this pigment indicated that it contains a substantial number of saccharide residues almost similar to those found in the ceroid pigment of human aortic atheromas. These findings and considerations on the metabolism and pharmacokinetics of anthranoids suggested that the apoptotic epithelial cells, rather than the laxatives, may be the source of the pigment saccharides, whereas the precursors of the melanic substance may be derived from the anthranoids.

[Prevalence of hepatitis B and C virus markers among medical staff at a third-level hospital]. / Prevalencia de marcadores de virus de hepatitis B y C en personal médico de un hospital de tercer nivel.

OBJECTIVE: To determine the prevalence of HBV and HCV serologic markers in serum samples of physicians working in "Hospital de Especialidades" of "Centro Medico Nacional de Occidente (HE-CMNO)". MATERIAL AND METHODS: The presence of hepatitis B surface antigen (HBsAg) and total hepatitis B core antibodies (HBcAc) were determined by hepanostika immunoassay, and anti-HCV by ELISA method (2nd. generation). RESULTS: Sixty-two physicians from medical or surgical services were included Fifty-one males (82%) and 11 females (18%). The participants mean age was 28 years (range 25-66) and their average length of practice was 8 years (range 2-44). Four physicians (6%) had a positive pattern of HBV serologic markers indicating post HBV infection. All of them were negative for HBsAg. One physician (2%) was positive for anti-HCV. The prevalence in physicians with multiple percutaneous injuries was 25%, for those in surgical services 14%, and 24% in physicians with more than 10 years of clinical practice. CONCLUSIONS: A higher prevalence of hepatitis virus infection was observed in medical doctors with more than 10 years of clinical activity working in surgical services and those suffering multiple percutaneous injuries.

[Influence of physical activity upon bone mineralization of school age children of both sexes]. / Influencia de la actividad física en la mineralización ósea de escolares de ambos sexos.

Obtention of an optimal peak bone mass decreases the risk of osteoporosis in adult life. An increase of physical activity favors bone mineralization in adults. However, in teenagers sports that could delay puberty can delay bone mineralization, while sports with a normal caloric intake favor mineralization. The objective of this study was to evaluate the effect of intensity of physical activity and the type of sport, upon bone mineralization before and during puberty. A sample of 144 normal school age children of both sexes aged 7 to 14 years, practicing various degrees of physical activity, was selected. Bone mineral density (BMD) of whole body, spine and hip was measured with a dual photon absorptiometry densitometer and compared with values of normal school children of similar ages. A better adequation of BMD of whole body and spine in school age children with increased physical activity was detected. Prepuberal female gymnasts had decreased BMD of whole body. Puberal school age children with decrease physical activity had diminished BMD. These results led us conclude that physical activity favors bone mineralization in spine and hip, specially during puberty.

Educación para la salud en derechohabientes del primer nivel de atención médica / Health education for insured patients ar the first level of medical attention

Se efectuó un estudio en la población derechohabiente mayor de 15 años que demandaba los servicios médicos en una unidad de atención a la salud del primer nivel de atención del Instituto Mexicano del Seguro Social (IMSS) en la zona metropolitana de Guadalajara, Jalisco. El propósito fue identificar el nivel de educación para la salud de usuarios de los servicios y analizar el modelo de práctica educativa institutcional recibida por el derechohabiente. Mediante este proyecto de investigación se puede señalar que 27.1 por ciento de la población derechohabiente demandante tiene un adecuado nivel de educación para la salud, que la práctica educativa recibida se basa en la acumulación de información, y que ésta ha sido otorgada por un equipo disciplinario en salud, el cual refleja limitaciones en los métodos y técnicas de educación en salud.