Síndrome de intestino irritable en estudiantes de medicina / Irritable bowel syndrome in medical students

Objetivo: Estimar la prevalencia del síndrome de intestino irritable (SII) en estudiantes de medicina; determinar la asociación con ansiedad, depresión y estrés, y el impacto en su rendimiento académico. Materialy métodos: Se diseñó un estudio transversal analítico, comparativo, donde fue utilizado un muestreo probabilístico de tipo polietápico para la selección de los estudiantes, independientemente de edad y sexo; las fuentes de información fueron la historia clínica, el inventario de ansiedad, la escala de depresión de Beck, escala de eventos de la vida y el historial académico. Resultados: Se eligieron 219 estudiantes, 58% fueron mujeres, la prevalencia del SII fue del 24.7%, la prevalencia de ansiedad fue del 94%, depresión 38% y para el estrés fue del 60%, del que las mujeres fueron las más afectadas (p < 0.05). El promedio de calificaciones en los alumnos con SII fue de 8.25 ± 0.37 y de materias reprobadas fue de 2.68 ± 2.26 (p > 0.05). Se asoció el estrés al SII con una razón de momios (RM) = 6.6, índice de confianza (IC) 95%: 3.2-13.7; ansiedad RM = 38.6, IC 95%: 11.4-199.2, y depresión RM = 49, IC 95%: 2.2-11.1. Conclusiones: El SII se encuentra asociado a la ansiedad, depresión y estrés. Se encontraron diferencias significativas entre varones y mujeres, la enfermedad no afecta el rendimiento académico de los estudiantes.

Objective: To estimate the prevalence of IBS in medical students and calculate both its association with anxiety, depression and stress, and its impact on students' academic performance. Material and methods: Resea rch design: a compa rative, analytical cross-sectional study. Probabilistic multistage sampling for the selection of students regardless of age and sex was used. Clinical history, anxiety record, Beck depression inventory, life event records and the academic record were used as data sources. Results: 219 students were chosen; 58% of them were women in which the prevalence of IBS was 24.7. The prevalence of anxiety was 94%, depression 38% and stress 60%. Women were the most affected (P<0.05). The grade point average of student who suffered from IBS was 8.25+0.37 and the average of failed subjects was 2.68+2.26 (P>0.05). Stress was associated with IBS OR=6.6 with IC95% 3.2-13.7; anxiety OR=38.6 with IC95% 11.4-199.2; and depression OR=49 with IC95% 2.2-11.1. Conclusions: IBS is associated with anxiety, depression and stress. Meaningful differences were found between women and men. IBS does not affect the students' academic performance.

[User satisfaction among fifteen hospitals in Hidalgo, Mexico]. / Satisfacción de los usuarios de 15 hospitales de Hidalgo, México.

BACKGROUND: Quality assessment measures include user and performance evaluations. User satisfaction comprises one of the most important variables in this evaluation. This study is aimed at evaluating the degree of satisfaction among the users of institutional healthcare services by way of the opinions provided thereby. METHODS: A cross-sectional study conducted at fifteen hospitals in Hidalgo, Mexico by means of an anonymous, confidential survey. The chi-square test, the t-Student test, the min./max. value and the Dixon methods, the Kolmogorov-Smimov (K-S) normalcy test and unconditional logic regression were used. RESULTS: The degree of satisfaction was 15.06%. The perception of poor quality related to this dissatisfaction was 10.8% (P<0.05). A total of 18.5% stated dissatisfaction, wishing not to request care at the same hospital again in the future, 65% thereof being related to poor quality (p<0.05). Dissatisfaction is related to information being omitted concerning their ailments. Odds ratio 1.87 CI 95% 1.59-2.26), physician's less than friendly attitude (Odds ratio 3.36 CI 95% 2.82 -3.74) complicated office visit process (Odds ratio 2.49, CI 2.11-5.41), perception of poor quality (Odds ratio 4.16 IC 3.6- 4.8), being subsequent user (Odds ratio 1.53, CI 1.19-1.92), no restroom in the waiting room (Odds ratio 2.37 CI 2.05-2.74). CONCLUSIONS: Patient dissatisfaction is related to the omissions in the office visit process, a poor attitude on the part of the attending physician and, the perception of poor care quality, these being aspects which would suggest the need of delving deeper into the study of the user viewpoint within the framework of qualitative evaluations.

Consulta externa en instituciones de salud de Hidalgo, México, según la opinión de los usuarios / The quality of outpatient services in health facilities in Hidalgo, Mexico, from the users' perspective

OBJETIVO: Identificar y evaluar los factores asociados con la calidad de la atención en las consultas externas de los hospitales del sector público en el estado de Hidalgo, México, mediante la opinión que manifiestan los usuarios. MATERIAL Y MÉTODOS: Se aplicó un diseño transversal, comparativo y analítico en 15 hospitales públicos del estado de Hidalgo, México. La muestra, compuesta por 9 936 encuestados (con un poder de 85 por ciento y un nivel de significación de 95 por ciento), fue seleccionada mediante muestreo aleatorio simple entre las personas atendidas en las consultas externas de julio de 1999 a diciembre de 2000. Se analizó la calidad de la atención según la escala de Likert. Para el análisis estadístico se empleó la regresión logística no condicional. RESULTADOS: La calidad de la atención fue percibida como buena por 71,37 por ciento de los encuestados y como mala por 28,63 por ciento. La mala calidad se percibió mayormente en las instituciones de la seguridad social (39,41 por ciento frente a. 19,42 por ciento). Se observó satisfacción en 84,94 por ciento de los encuestados, de los cuales 49,2 por ciento esperaban una mejor atención. El 16 por ciento refirió que regresaría al mismo hospital por no tener otra opción para su atención y 2 por ciento manifestó que no regresaría. La mayor escolaridad y los ingresos económicos superiores se asociaron con la percepción de mala calidad y la desaprobación del tiempo de espera (razón de posibilidades [RP]: 2,3; IC95 por ciento: 2,02 a 2,82), del tiempo que duró la consulta (RP: 2,3; IC95 por ciento: 2,02 a 2,82) y del mal trato por parte del médico (RP: 4,22; IC95 por ciento: 3,6 a 4,8). CONCLUSIONES: Los principales elementos que definen la mala calidad de la atención, según los usuarios, son los largos tiempos de espera, las omisiones en las acciones de revisión y diagnóstico, la complejidad de los trámites de consulta y el maltrato por parte del personal que presta los servicios

Objective. To identify and assess factors associated with the quality of health care in hospital outpatient services within the state of Hidalgo, Mexico, based on a user survey. Methods. We performed a cross-sectional, comparative, analytical study of 15 public hospitals within the state of Hidalgo, Mexico. The sample, which was made up of 9 936 interviewees (power: 85%; significance level: 95%) was randomly selected among users of outpatient services between July 1999 and December 2000. We looked at the quality of care using a Likert-type scale. The statistical analysis consisted of inconditional logistic regression. Results. The quality of care was perceived as being good by 71,37% of users surveyed and as bad by 28,63%. Poor quality was primarily perceived in institutions belonging to the social security system (39,41% vs. 19,42% in other institutions). Of those surveyed, 84,94% said they were satisfied with the care they received, and 49,2% said they expected to get better care. In all, 16% claimed they would return to the same hospital only because they had no other choice, and 2% said they would never return. A higher educational level and a better income showed a direct association with the perception of poor quality and discontent with the lenghty waiting period (odds ratio [OR]: 2,3; 95% CI: 2,02 to 2,82) and with the physician's discourteous attitude (OR: 4,22; 95% CI: 3,6­4,8). Conclusions. They main factors that determine poor quality in health care, according to users, are lengthy waiting times before being ushered in, incomplete physical examination and diagnosis, difficulty of getting an appointment, and poor treatment on the part of services staff

[Frequency and some mortality risk factors in the state of Hidalgo, Mexico, due to neural tube closure defects]. / Frecuencia y algunos factores de riesgo de mortalidad en el estado de Hidalgo, México, por defectos de cierre del tubo neural.

OBJECTIVE: To calculate the risk of fetal death due to neural tube defects and estimate associated factors in the state of Hidalgo, Mexico. MATERIAL AND METHODS: Data were abstracted from death certificates registered during 1990-1995 in the state of Hidalgo, Mexico. The design was a proportional mortality study, which is considered as a variant of the case control design. Cases were deaths with any type of neural tube defect, and controls were fetal deaths due to other causes. RESULTS: A total of 3,673 fetal death certificates were analyzed; 8.06% had neural tube defects and the remaining died of other causes. Fetal death was associated with fetal weight less than 2500 grams (OR 5.0, 95% CI 3.6-6.8), being female (OR 1.7, 95% CI 1.3-2.3), and death during the late fetal period (OR 5.5, 95% CI 3.8-8.1). CONCLUSIONS: Results show that the risk of fetal death due to neural tube defects is greater among low birth weight babies, females, and during the late fetal period.

Frecuencia y algunos factores de riesgo de mortalidad en el estado de Hidalgo, México, por defectos de cierre del tubo neural / Frequency and some mortality risk factors in the state of Hidalgo, Mexico, due to neural tube closure defects

OBJECTIVE: To calculate the risk of fetal death due to neural tube defects and estimate associated factors in the state of Hidalgo, Mexico. MATERIAL AND METHODS: Data were abstracted from death certificates registered during 1990-1995 in the state of Hidalgo, Mexico. The design was a proportional mortality study, which is considered as a variant of the case control design. Cases were deaths with any type of neural tube defect, and controls were fetal deaths due to other causes. RESULTS: A total of 3,673 fetal death certificates were analyzed; 8.06 had neural tube defects and the remaining died of other causes. Fetal death was associated with fetal weight less than 2500 grams (OR 5.0, 95 CI 3.6-6.8), being female (OR 1.7, 95 CI 1.3-2.3), and death during the late fetal period (OR 5.5, 95 CI 3.8-8.1). CONCLUSIONS: Results show that the risk of fetal death due to neural tube defects is greater among low birth weight babies, females, and during the late fetal period.