Prevalence and risk factors of chronic kidney disease in the comprehensive care program DiabetIMSS / Prevalencia de enfermedad renal crónica y factores de riesgo en el programa de atención DiabetIMSS

BACKGROUND: The aim of this paper is to determine prevalence and risk factors of chronic kidney disease (CKD) in the comprehensive care program DiabetIMSS. METHODS: Cross-sectional study in 488 patients with type 2 diabetes mellitus (DM2) included in the program DiabetIMSS. Sociodemographic, clinical, biochemical, and kidney function variables were collected. RESULTS: Prevalence of CKD was 32% [early nephropathy (EN) 19% and overt nephropathy (ON) 13%]. Patients with more severe nephropathy significantly (p < 0.05) had: older age [normal kidney function (NKF) 54±11, EN 54±10, ON 63±9, years)], cardiovascular disease (NKF 1%, EN 5%, ON 11%), hypertension (NKF 65%, EN 63%, ON 85%), longer duration of DM2 (NKF 5%, EN 5%, ON 9%,) and of hypertension (NKF 5%, EN 6%, ON 9%), glycemic lack of control (NKF 46%, EN 62%, ON 60%), hyperuricemia (NKF 7%, EN 13%, ON 23%), anemia (NKF 1%, EN 4%, ON 10%) and metabolic syndrome (NKF 79%, EN 82%, ON 93%). Uncontrolled hypertension and DM2, cardiovascular disease and hyperuricemia significantly predicted the presence of nephropathy CONCLUSIONS: A third of patients attending to DiabetIMSS had CKD and has not been previously diagnosed. Multiple risk factors are present in this high-risk population; their identification and control are extraordinarily important. Moreover, educative interventions for primary health-care professionals to improve health of this kind of patients are needed.

INTRODUCCIÓN: el objetivo de este trabajo es determinar la prevalencia de enfermedad renal crónica (ERC) e identificar factores de riesgo para nefropatía en el programa DiabetIMSS. MÉTODOS: estudio transversal analítico en 488 pacientes con diabetes mellitus tipo 2 (DM2) atendidos en el programa de atención integral DiabetIMSS. Se recolectaron variables sociodemográficas, clínicas, bioquímicas y de función renal. RESULTADOS: la prevalencia de ERC fue 32% [nefropatía temprana (NT) 19% y nefropatía establecida (NE) 13%]. A nefropatía más avanzada, los pacientes tenían significativamente (p < 0.05): mayor edad [función renal normal (FRN) 54 ± 11, NT 54 ± 10, NE 63 ± 9 años)], enfermedad cardiovascular (FRN 1%, NT 5%, NE 11%), hipertensión (FRN 65%, NT 63%, NE 85%), mayor evolución de DM2 (FRN 5%, NT 5%, NE 9%,) y de hipertensión (FRN 5%, NT 6%, NE 9%), descontrol glucémico (FRN 46%, NT 62%, NE 60%), hiperuricemia (FRN 7%, NT 13%, NE 23%), anemia (FRN 1%, NT 4%, NE 10%) y síndrome metabólico (FRN 79%, NT 82%, NE 93%). La hipertensión y DM2 descontroladas, la enfermedad cardiovascular y la hiperuricemia predijeron significativamente la presencia de nefropatía. CONCLUSIONES: un tercio de los pacientes atendidos en DiabetIMSS tenían ERC y no habían sido identificados. Múltiples factores de riesgo están presentes en esta población de alto riesgo; su identificación y control son de extraordinaria importancia. Son necesarias, además, intervenciones educativas para el personal del primer nivel de atención médica para mejorar la salud de este tipo de pacientes.

[Family factors associated with co-dependency in nurses at a hospital in Cancun, Quintana Roo, México]. / Factores familiares asociados a codependencia en enfermeras de un hospital de Cancún, Quintana Roo, México.

OBJECTIVE: Identifying family factors associated with the presence of co-dependency in nurses of a regional hospital in Cancún, Quintana Roo, Mexico. DESIGN: Cross-sectional, comparative study. LOCATION: City of Cancun (México). PARTICIPANTS: A random sample of 200nurses who met the inclusion criteria (having a partner for over a year, to be at work on the day of the interview), and who gave informed consent, completed three questionnaires during different shifts. MAIN MEASUREMENTS: Age, educational level, socioeconomic status, type of family structure, life cycle stage, co-dependency and family functioning. RESULTS: A total of 200nurses, with mean age of 36±8years, took part. The most common socioeconomic status was high (48%), and 47.5% had graduate studies. A co-dependency level of 20.5% (95%CI: 15-26.5) was found. Family factors associated with the presence of co-dependency were; family dysfunction, prevalence ratio (PR)=9.62 (95%CI: 3.47-27.3), stage of independence, PR=3.41 (95%CI: 1.44-7.86), single parent, PR=6.35 (95%CI: 2.41-16.68), and time with partner less than 5 years, PR=3.41 (95%CI: 1.54-7.85). CONCLUSIONS: It was found that family dysfunction and being a single parent were significantly associated with co-dependency in hospital nurses, therefore, on being able to identify these factors, family physicians can improve their dynamics and functioning by family study, and improving effective communication with nursing staff and their families.

Calidad de vida en mujeres durante su climaterio / Quality of life in women during their climacteric

Objetivo: Determinar la calidad de vida que presenta una población femenina en etapa de climaterio que asiste a consulta externa de atención primaria en Tapachula Chiapas. Material y métodos: Estudio descriptivo transversal, prospectivo de mujeres con sintomatología climatérica de 45-59 años de edad; se registraron variables sociodemográficas y familiares. Se aplicaron el índice de Kupperman para evaluar la gravedad de los síntomas menopáusicos y climatéricos, y el Cuestionario Específico de Calidad de Vida para la Menopausia (MENQOL). Se realizó estadística descriptiva, prueba de F para diferencias entre los promedios de las dimensiones de ambos cuestionarios, c2 para diferencia de proporciones, valor de p e intervalos de confianza para significancia estadística. Resultados: Se entrevistaron 499 mujeres, la media de edad fue 50.3 años. De acuerdo al índicé de Kupperman los reactivos con media mayor fueron sofocaciones-sudoraciones, irritabilidad-nerviosismo, insomnio, parestesias y melancolía. La gravedad de la sintomatología climatérica fue 71.15% con síntomas leves, el 24.85% síntomas moderados y 4% síntomas graves. En el Cuestionario Específico de Calidad de Vida para la Menopausia las medias mayores corresponden a las dimensiones físicas y psicosocial, mientras que las medias menores corresponden a las dimensiones sexuales y vasomotoras. Conclusiones: Se encontró una correlación positiva entre el puntaje total del índice de Kupperman para sintomatología climatérica y menopáusica en relación al Cuestionario Específico de Calidad de Vida para la Menopausia (p = 000), las dimensiones de calidad de vida más afectadas fueron vasomotor y físico.

Objective: To determine quality of life level in women at climacteric stage, in a primary care treatment center at Tapachula Chiapas. Material and methods: This is a tranversal, descriptive, prospective study, realized in female population with climacteric criteria from 45 to 59 years; variables were registered as socio demographic and familiar. We practice Kupperman Index to estimate the strictness of the climateric symptoms and the specific menopause quality of life questionnaire (MENQOL). We made statistical descriptive analysis. F-test to determine differences between mean's dimensions, chi-square to proportion differences, p value and confidence intervals for statistical significance. Results: We interviewed 499 women with inclusion criteria; the average age was 50.3 years. In concordance to Kupper-man Index those with a highest stage in the items lack of oxygen-sweat, bad temper, anxiety, insomnia, paresthesias and melancholy. The strictness of the climacteric symptoms were vale as 71.15% of the population were staged at slight symptoms, 24.85% modered symptoms and 4% severe symptoms. In specific menopause quality of life questionnaire, we found that major average where associated to physical and psycho-social dimensions, while minor averages corresponds on sexual and vasomotor dimensions. Conclusions: We found a positive correlation between Kupperman index at the field of climateric symptomatology and specific menopause quality of life questionnaire (p=000), most affected dimensions were vasomotor alterations and physical.

[Alcohol consumption in women and its relation with the psychopathology in primary health care]. / Consumo de alcohol en mujeres y síntomas psicopatológicos en atención primaria.

OBJECTIVE: To determine the frequency of alcohol consumption in women and their relation with symptom of psychopathology. METHODS: Cross-sectional, correlation descriptive study, in a sample of 374 women between 18 to 65 years that were attended at an unit of family medicine. Sociodemographic variables (age, marital status, occupation, schooling, socioeconomic level) were obtained; Test AUDIT (Alcoholism Use Disorders Identification Test) and Symptom Check List 90 (SCL-90) items to measure psychopathology were also applied. It was realized univariate and bivariate analysis. RESULTS: The average age was 34.68 ± 11.84 years, 11.2 % with elevated risk of alcohol consumption; 47.6 % with positive alcohol consumption; 72.4 % with a partner; 85.6 % secondary school and more; 48.7 % occupation housewife. Low and very low socioeconomic level in 21.9 %. The dimensions with majors values were somatitation (0.563), depression (0.526), obsession-compulsions (0.525) and phobic anxiety (0.511). There is an important increase in averages SCL-90 for the patients with elevated risk of alcohol consumption, these differences were significative (p = 0.00005). CONCLUSIONS: The average of nine dimensions of SCL-90 was greater for patients with elevated risk of alcohol consumption.

[Clinical and social factors related with a long labor disability]. / Factores sociales y clínicos en incapacidad prolongada por accidente de trabajo.

OBJECTIVE: To determine the factors associated with a longer labor disability (LLD) due to a labor accident. METHODS: A cases and controls study was made. All the patients who presented a disability certificate for over thirty days due to a labor accident were included. The socio-demographic, labor characteristics and diagnoses were analyzed. A bivariate statistical analysis was made. RESULTS: There were 32 cases; average age was 34 years; 27 were men (84.4%) and 5 women (15.6%); the predominant schooling was the upper middle level in 40%, the economical level was poor in 40%, the 19.1% worked as a store assistant. The anatomic region most affected was the wrist-hand in 19 cases (27.9%) and the more frequent diagnoses were: injuries 33%, fractures 32.4% and inadequate skills 23.5%. Associated factors were the lack of training (OR: 1.6 IC: 1.08-2.47), working in the afternoon or at night shift (OR: 4.19 CI: 1.04-20 .07) and being a man (OR: 1.4 CI: 0.66-2.9). CONCLUSIONS: It was observed that sex, not training and the schedule of working were associated with a LLD.

[Peripheral neuropathy caused by leflunomide. A case reported with a brief review]. / Neuropatía periférica por leflunomida. Informe de un caso y revisión de la literatura.

BACKGROUND: Leflunomide (LEF) is an immunomodulator derived from isoxazole It is an approved drug in the rheumatoid arthritis (RA). The peripheral neuropathy (PN) is a recognized side effect of some medications. CLINICAL CASE: A 48 years old woman with diabetes type 2 (DM2) and RA; with serum negative rheumatoid factor. She got nonsteroidal anti-inflammatories drugs, corticosteroid, methotrexate, sulfasalazine and chloroquine. Despite this, she was clinically within the functional class III and data of osteopenia. The treatment was switched to LEF, chloroquine and prednisone. After four months, she began with dysesthesia in the left cubital area, paresthesias in her right knee; and then in a progressive pattern others paresthesias, hyporeflexia and a decrease in the muscular strength. She was treated with cholestyramine, but her neuropathy did not improve. Severe segmental demyelination polyneuropathy and retrograde axonal degeneration with predominance of the thoracic members over the pelvic members was reported in the electroneurophysiological and electromyography studies. CONCLUSIONS: It is advisable to perform electrophysiological studies in patients' with DM2 before they get treatment with LEF.

[Quality indicators in the early detection of cervicouterine-cancer in primary health care units]. / Indicadores de calidad en la detección oportuna de cáncer cervicouterino en unidades de primer nivel de atención.

BACKGROUND: to determine the quality of a prompt cervical cancer detection program (TDC CC) according to the indicators for prevention and diagnosis. METHODS: cross-sectional and comparative study conducted in four primary care units. We selected 400 patients who attended preventive services to participate in the study of cervical cytology (Pap). The evaluation of the Program of TDC CC was obtained by the degree of fulfillment of quality and productivity outlined by an institutional program. The seven indicators were measured by the same scale. A descriptive statistics, adjusted kappa, and chi square with a level of significance of 95 % confidence interval was used. RESULTS: the average age was 40 ± 12.6 years. Most women (92.5 %) had information about the Pap screening method in CC, even thought only 25.3 % had this test done in the last three years. The inter-observer agreement was scored low by three cytotechnologists. The degree of compliance according to indicators of the 4 units was 35.7 %, and was rated as moderate. The best indicators were great productivity among cytotechnologists, the number and proportion of re-examined cytologies. CONCLUSIONS: most indicators were below the expected values.

[Dental characteristics of patients with temporomandibular disorders]. / Características bucodentales de pacientes con trastornos temporomandibulares.

OBJECTIVE: to describe the dental characteristics of patients with temporomandibular disorders (TMD). METHODS: a survey in 130 out patients from a Clinic of Maxilofacial Surgery Service, who fulfilled the selection criteria. The social and demographic data were reported in other paper. It was used a questionnaire to identify factors of risk for TMD according to the Research Diagnostic Criteries/Temporomandibular Disorders proposed by Dworkin. It was registered the Angle to molar bilaterally and canine, the presence of canine guides and incisal margin, the dental lost organs and previous surgical removal of third molars. Unvaried and bivariate statistical analysis was made. RESULTS: the clinical manifestations in patients with TMD which they appear in the upheavals temporomandibular were: pain to articulate, muscular pain, noises you will articulate with statistically significant differences (p < 0.05) in the variables class to molar and canine of Angle, absence of canine guides and incisal margin, previous retirement of third molars, parafunctions, mandibulars deviations at rest, number of dental absences. CONCLUSIONS: the physiomechanical conditions in the oral cavity of the patients of upheavals temporomandibular are considered a risk factor condition.

[Temporo-mandibular disorders and family functioning]. / Trastornos temporomandibulares y funcionamiento familiar.

OBJECTIVE: To compare family functionality of patients with and without temporomandibular disorders (TMD). METHODS: A comparative cross-sectional study was conducted with 130 patients attending to a maxillofacial surgery service. SELECTION CRITERIA: patient with or without TMD, age between 18 and 60 years, able to read and write and accepted to participate in the study. We registered sociodemographic variables, and we applied a questionnaire to identify risk factors for TMD, and finally intensity of pain was measure by a visual analogous scale. All patients were clinically evaluated to ascertain TMD according to the research diagnostic criteria for TMD proposed by Dworkin in 1992. The Family Adaptability and Cohesion Scale III (FACES-III) was used to evaluate family functionality. RESULTS: The mean of age was 34 +/- 10 years, ratio women : men, was 2 : 1; 67.7% were married or had a partner; the mean of education was 14 +/- 3.5 years; 56 % of women had TMD; 67.6 % had familiar dysfunction. CONCLUSIONS: Families of patients with TMD were dysfunctional more frequently and this suggests a relation.

[Progressive multifocal leukoencephalopathy in a patient with prolonged survival: a case report]. / Leucoencefalopatía multifocal progresiva. Caso clínico con sobrevida prolongada.

BACKGROUND: The progressive multifocal leukoencephalopathy (PML) is a disease histological anatomy characterized by the presence of multifocal areas of demyelization spread out over the central nervous system.The PML is caused by the polyomavirus, a papovavirus. CLINICAL CASE: A female patient with 27 years aged began with malaise, musculosqueletal pain, paresthetic, hyperthermia and diaphoresis; 72 hours later she presented quadriplegic with neurological damage that progressed to stupor and generalized clonic-tonic seizures. The spinal fluid showed no infection signs. The simple and contrasted computed tomography (CT) was normal. The magnetic resonance imaging (MRI) from encephalon reported lesion in white substance in hemispheres, callosal corpus, cerebellum and tallus. Angioresonance showed an increased number of hyperdense areas in the white substance. Final pathological diagnosis was: progressive multifocal leukoencephalopathy. There was no confirmation of immunological disease after the exhaustive studies realized. The patient's survival was two years after the diagnosis was made.

[Dental caries and periodontal disease in type-2 diabetic patients]. / Caries dental y enfermedad periodontal en pacientes diabéticos tipo 2.

OBJECTIVE: To determine the frequency of dental caries and periodontal disease in type-2 diabetic patients. MATERIAL AND METHODS: Cross-sectional study. A survey with sociodemographic, clinical and nutritional variables was applied to diabetic patients who met the criteria of selection. The rates of dental caries, periodontal disease (Russell's) and oral hygiene were applied through oral examination. Statistical univaried and bivaried analysis was made. RESULTS: 100 diabetics with an average age of 49 +/- 8 years old were interviewed, the proportion between women and men was of 1.9:1; 85% of the interviewed people had a couple; 56% were housewives and 74% belonged to a low socioeconomic level. The average of metabolic control was of 182 +/- 102; 31% of the diabetics had three years or more of evolution of the disease; 99% brushed their teeth daily, but only 31% did it three times a day; in 85 % the brushing technique was inadequate. The rate of oral hygiene was 3.2 +/- 1; of dental caries was 0.52 +/- .13, and of Russell's periodontal disease was 2.77 +/- 1.1. Gender made no difference at all in the rates. CONCLUSIONS: The rate of dental caries was similar to the reported by other studies, but the rate of Russell's periodontal disease was greater to the one provided by literature, which shows that education in dental hygiene must be redefined.

[Level of knowledge of the family physician about preventive stomatology]. / Conocimiento que tiene el médico familiar en estomatología preventiva.

OBJECTIVE: To determine the level of knowledge of the family physician on preventive stomatology. MATERIAL AND METHODS: Cross-sectional comparative, from 1999 to 2000 with convenience sample (70 family physicians) that fulfilled the criteria of selection. With a previous informed consent, a questionnaire with two sections was applied: one of them measures sociodemographic variables; and the second one, which explores the level of knowledge on the program of preventive odontology (POP), consists of 20 questions with three options of answer. This questionnaire was validated by means of judgment of experts, and it was made to analyze the extension and the level of understanding of the questions. The statistical analysis was made with measures of central tendency and deviation for quantitative variables, percentages and proportions for qualitative variables, chi2 for differences, as well as p value and intervals of confidence to 95% for statistical significance. RESULTS: Sample with an average age of 44 years old +/- 6.8; 44 of them (63%) were men, proportion of 2:1 men/1 woman; 42 of them (60%) had a good level of knowledge. 70% of the interviewed people had a specialty on Family Medicine; 19 of them (27%) practice privately; the average of labor antiquity was of 14 years +/- 5.89. There were no differences found in the level of knowledge and the fact of having a specialty on Family Medicine versus only having the Medicine degree (p > 0.05). CONCLUSIONS: Even though the level of knowledge on the Preventive Stomatology Program was average and good in a great percentage, it is necessary to make more studies on the subject, in order to establish improvement strategies.

Frecuencia de caries y estado nutricio en preescolares / The frequency of caries and the nutrition state of preschool aged children

Objetivo: identificar la frecuencia de caries y estado nutricio en niños preescolares de 3 a 6 años, adscritos a centros de educación preescolar de Cuitláhuac, Veracruz.Material y métodos: se realizó un estudio observacional y transversal en 147 preescolares. Se investigaron variables sociodemográficas y antropométricas, así como estado nutricio y frecuencia de caries en los niños. El análisis estadístico se realizó mediante estadística descriptiva. Resultados: de 147 preescolares estudiados, 54 por ciento correspondió al género masculino; se encontró caries en 66 por ciento; 61 por ciento presentó obesidad o sobrepeso; 8.8 por ciento mostró desnutrición y 69 por ciento de éste, caries; 65.7 por ciento de los nutridos tenía caries. El tipo de caries más frecuente fue el de primer grado y el índice de dientes cariados, perdidos y obturados más común fue 20.Discusión: se encontró una prevalencia de caries menor comparada con la obtenida en el estudio realizado por Irigoyen Camacho (90.5 por ciento); la desnutrición fue de 8.8 por ciento, menor a la indicada en el estudio de Lastra Escudero (41.13 por ciento).Conclusiones: se sugiere realizar más estudios en la entidad referida para verificar la consistencia de los datos obtenidos

Mortalidad neonatal en un hospital general de zona / Neonatal mortality at a zone General hospital

Con el objeto de conocer las causas que acompañan a la mortalidad neonatal y las características socioeconómicas de este grupo, se realizó estudio prospectivo descriptivo en el Hospital General de Zona 8 de Córdoba, Veracruz, del 1 de febrero de 1997 al 30 de enero de 1998. Se encontró que durante el periodo referido en ese hospital nacieron 4107 infantes, de ellos 337 ingresaron a la sección de neonatología, de los cuales a su vez fallecieron 39; 31 fueron motivo del informe. El nivel socioeconómico deficiente se encontró en 41.9 por ciento de las familias estudiadas. Las causas de la mortalidad fueron sel índrome de dificultad respiratoria tipo 1 en 14 niños (45.1 por ciento), asfixia perinatal severa en 13 (41.9 por ciento), encefalopatía hipóxico-isquémica en nueve (29 por ciento), septicemia en nueve (29 por ciento) y síndrome de aspiración de meconio en tres (9.6 por ciento). La tasa de mortalidad neonatal fue de 9.49 por cada mil nacidos vivos.