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1.
Aten Primaria ; 56(4): 102773, 2024 Apr.
Artículo en Español | MEDLINE | ID: mdl-38043175

RESUMEN

OBJECTIVE: To analyse predictor variables of contraceptive method use in young people. DESIGN: Systematic review. DATA SOURCES: PubMed, CINAHL, Scopus, Cuiden Plus, LILACS and IME databases were consulted. STUDY SELECTION: An assessment of the quality of studies was carried out by two researchers in parallel. As a result, a total of 5 primary research studies were selected. DATA EXTRACTION: Information was extracted on the selected study population, contraceptive method studied and predictor variables identified. RESULTS: Seven predictor variables were identified that specifically explain the use of the male condom, contraceptive pill or emergency contraceptive pill. The most relevant variables were the level of knowledge and attitudes towards contraceptive use, therefore high knowledge and positive attitudes increase the likelihood of contraceptive use. Another notable finding was the presence of a formative bias with women having higher knowledge of hormonal contraceptive options and more positive attitudes. CONCLUSION: Future training programs should be oriented towards assessing behavioral changes through the development of positive attitudes towards contraceptive use by gaining knowledge of contraceptive options.


Asunto(s)
Anticoncepción , Anticonceptivos , Humanos , Masculino , Femenino , Adolescente , Anticoncepción/métodos , Condones , Conocimientos, Actitudes y Práctica en Salud
2.
Gac Med Mex ; 160(1): 17-22, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38753570

RESUMEN

BACKGROUND: Frailty has been related to adverse outcomes, but evidence on its association with the use of health services is still scarce. OBJECTIVE: The purpose of this work was to determine the association of frailty with the use of health services in Mexican adults older than 60 years. MATERIAL AND METHODS: Analysis of the Mexican Health and Aging Study for the years 2015 (baseline) and 2018 (follow-up). Frailty was defined with the frailty index. The following outcomes were included: hospitalization, medical visits, major surgery, minor surgical procedures, and dental visits. Competing risk and count analyses (negative binomial regression) were performed. RESULTS: A total of 8,526 individuals were included, whose average age was 70.8%; 55.8% corresponded to the female gender. According to the results, hospitalization days and the number of minor procedures were associated with frailty. CONCLUSIONS: Frailty could be useful in the planning of health services for older adults. On the other hand, its evaluation would allow prioritizing care for those who are at higher risk of adverse outcomes.


ANTECEDENTES: La fragilidad se ha relacionado con desenlaces adversos, pero aún es escasa la evidencia sobre su asociación con el uso de servicios de salud. OBJETIVO: Evidenciar la asociación de la fragilidad con el uso de servicios de salud en adultos mexicanos mayores de 60 años. MATERIAL Y MÉTODOS: Análisis del Estudio Nacional sobre Salud y Envejecimiento en México para 2015 (basal) y 2018 (seguimiento). La fragilidad se definió con el índice de fragilidad. Fueron incluidos los siguientes desenlaces: hospitalización, visitas médicas, cirugía mayor, procedimientos quirúrgicos menores y visitas al dentista. Se utilizaron modelos de riesgos competitivos y de número de eventos (regresión negativa binomial). RESULTADOS: Se incluyeron 8526 individuos, cuya edad promedio fue de 70.8 %; 55.8 % correspondió al sexo femenino. De acuerdo con los resultados, los días de hospitalización y el número de procedimientos menores se asociaron a fragilidad. CONCLUSIONES: La fragilidad podría ser un parámetro útil en la planeación de los servicios de salud para los adultos mayores. Por otro lado, su evaluación permitiría priorizar la atención a quienes presenten mayor riesgo de desenlaces adversos.


Asunto(s)
Fragilidad , Hospitalización , Humanos , México , Femenino , Masculino , Anciano , Fragilidad/epidemiología , Hospitalización/estadística & datos numéricos , Persona de Mediana Edad , Anciano de 80 o más Años , Anciano Frágil/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos
3.
Artículo en Inglés, Español | MEDLINE | ID: mdl-37741326

RESUMEN

BACKGROUND: This study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients. METHODS: A prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 75-79 years old; group 2: 80-84 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality. RESULTS: Overall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients). CONCLUSIONS: No significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications.

4.
Aten Primaria ; 55(6): 102623, 2023 06.
Artículo en Español | MEDLINE | ID: mdl-37086593

RESUMEN

OBJECTIVE: To analyze the presence of vascular risk factors (VRF) among young adult and older adult patients with ischemic stroke, with and without follow-up in primary care after hospital discharge. DESIGN: Observational, retrospective, multicenter study. SETTING: Primary care health centers and Hospital Verge de la Cinta, Tortosa, Spain. PARTICIPANTS: Patients with ischemic stroke of two age groups (≤55 and ≥65years) distributed in two groups (GroupA: without follow-up in primary care; and GroupB: with follow-up in primary care), between 2011-2020. MAIN MEASUREMENTS: Sociodemographic, clinical, and VRF data coded according to the International Classification of Diseases (ICD-10). Descriptive, and inferential statistics. RESULTS: Data from 2054 participants were analyzed. In the young adult group, 94.9% of the participants in groupA had between 1-2VRFs, compared to 60% in groupB. In the older adult group, 84.4% of groupA had between 1-2VRFs, compared to 43,9% of groupB. The most frequent VRFs among younger and older adult patients with ischemic stroke were hypertension and dyslipidemia in both follow-up groups. There were no records of obesity, smoking, or alcohol consumption in groupA. There was a significant association between being followed up in primary care after stroke and being a young adult and presenting between 3-4 VRFs (P<0.001). CONCLUSIONS: The results reinforce the need for continuity of care and follow-up in people with acute stroke in primary care and the need to improve the quality of registries.


Asunto(s)
Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Adulto Joven , Humanos , Anciano , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Fumar/efectos adversos , Fumar/epidemiología
5.
Gac Med Mex ; 159(1): 32-37, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36930548

RESUMEN

INTRODUCTION: Whether vitamin B12 deficiency is associated with cognitive impairment remains controversial. OBJECTIVE: To determine the association between vitamin B12 serum levels and cognitive performance. METHODS: Two-hundred and forty-one adults aged ≥ 60 years who had serum vitamin B12 serum levels measurement were included. Physical and cognitive evaluation was carried out, and three groups were formed: normal cognition (NC), mild cognitive impairment (MCI) and dementia. Vitamin B12 levels were classified as sufficiency (> 400 pg/mL), subclinical deficiency (201-400 pg/mL), and absolute deficiency (≤ 200 pg/mL). Multivariate linear regression analysis was used to evaluate the association between cognitive function and vitamin B12 levels after controlling for confounding variables. RESULTS: Mean age was 81.4 ± 8.0 years; 68% were females; 17.8 % and 39.8% had absolute and subclinical vitamin B12 deficiency, respectively; 80 individuals (33%) met the criteria for MCI, and 70 (29%), for dementia. Those with MCI and dementia had lower vitamin B12 levels in comparison with those with NC after adjusting for age, gender and educational level (p = 0.019). CONCLUSIONS: A statistically significant association was observed between global cognitive performance and levels of vitamin B12.


INTRODUCCIÓN: Aún es controversial si la deficiencia de vitamina B12 se asocia a alteraciones cognitivas. OBJETIVO: Conocer la asociación entre los niveles séricos de vitamina B12 y el desempeño cognitivo. MÉTODOS: Se incluyeron 241 personas ≥ 60 años con medición de niveles séricos de vitamina B12. Se realizó evaluación física y cognitiva y se formaron tres grupos: cognición normal (CN), deterioro cognitivo leve (DCL) y demencia. Los niveles de vitamina B12 se clasificaron en suficiencia (> 400 pg/mL), deficiencia subclínica (201-400 pg/mL) y deficiencia absoluta (≤ 200 pg/mL). Se realizó análisis de regresión lineal multivariado para evaluar la asociación entre función cognitiva y niveles de vitamina B12 después de controlar las variables confusoras. RESULTADOS: La media de edad fue 81.4 ± 8.0 años; 68 % fue del sexo femenino; 17.8 y 39.8 % presentaron deficiencia absoluta y subclínica de vitamina B12; 80 individuos (33 %) cumplieron los criterios de DCL y 70 (29 %), de demencia. Después de ajustar por edad, sexo y escolaridad, los sujetos con DCL y demencia tuvieron niveles más bajos de vitamina B12 comparados con aquellos con CN (p = 0.019). CONCLUSIONES: Se observó asociación estadísticamente significativa entre el desempeño cognitivo global y los niveles bajos de vitamina B12.


Asunto(s)
Trastornos del Conocimiento , Disfunción Cognitiva , Demencia , Femenino , Humanos , Anciano , Anciano de 80 o más Años , Masculino , Vitamina B 12 , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Cognición , Demencia/epidemiología , Demencia/etiología , Vitaminas
6.
Aten Primaria ; 54 Suppl 1: 102462, 2022 10.
Artículo en Español | MEDLINE | ID: mdl-36435581

RESUMEN

The update of the preventive activities for this year 2022 in the field of infectious diseases is of special relevance due to the importance that prevention has gained and more specifically, vaccination as a tool to control the pandemic caused by the SARS-CoV-2 virus declared on March 11, 2020. The pandemic has focused much of the prevention efforts on its containment, but the importance of maintaining high vaccination coverage of the rest of the recommended vaccines to maintain good control of vaccine-preventable diseases and avoid complications in particularly vulnerable patients should not be forgotten. In this year's review we present a practical document with the aim of providing tools to primary care professionals who work with adults, to make the indication of each vaccine whether it is systematically recommended or if it is because the patient belongs to some risk group due to their condition or underlying pathology. In this way, throughout the document, we will comment on the most innovative aspects of systematic vaccination (flu, pneumococcus, meningococcal vaccines and vaccines against the human papillomavirus [HPV]), the new vaccines (pandemic vaccines against COVID-19, vaccines against herpes zoster of subunits, vaccines against monkeypox) and the recommended vaccines according to risk condition (pregnancy and lactation, travelers, patients with immunosuppression or underlying pathology).


Asunto(s)
COVID-19 , Vacunas , Adulto , Embarazo , Femenino , Humanos , Vacunas contra la COVID-19 , COVID-19/prevención & control , SARS-CoV-2 , Vacunación
7.
Gac Med Mex ; 158(6): 343-348, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36657111

RESUMEN

INTRODUCTION: In older adults, the association of frailty and sarcopenia with vitamin D deficiency is well known, but the association of the components of frailty syndrome has been poorly studied. OBJECTIVE: To determine the association of the components of frailty and sarcopenia with vitamin D insufficiency in older adults. METHODS: Adults were studied, in whom age, education, marital status, history of fractures, hospitalizations, anthropometric indicators, sarcopenia, Charlson index, polypharmacy, Fried's frailty phenotype, and plasma vitamin D were recorded; figures < 30 ng/mL were considered indicative of vitamin D insufficiency. Descriptive and inferential statistics were used for statistical analysis. The association was determined by binary logistic regression. RESULTS: One-hundred and seventy-five adults with a mean age of 71.7 ± 6.7 years (95% CI = 60-90 years) were studied. Binary logistic regression showed that the variables associated with vitamin D deficiency were exhaustion (OR = 2.6, 95% CI = 1.0-6.5, p = 0.03), frailty (OR = 9.2, 95% CI = 2.5-34.1, p = 0.001) and pre-frailty (OR = 4.6, 95% CI = 2.1-10.0, p < 0.001). CONCLUSION: The frail and pre-frail phenotypes, as well as exhaustion, are associated with vitamin D insufficiency.


INTRODUCCIÓN: En adultos mayores, la asociación de fragilidad y sarcopenia con deficiencia de vitamina D es conocida, pero poco se ha estudiado la asociación de los componentes del síndrome de fragilidad. OBJETIVO: Determinar la asociación entre los componentes de fragilidad, sarcopenia e insuficiencia de vitamina D en adultos mayores. MÉTODOS: Se estudiaron adultos de quienes se registró edad, escolaridad, estado civil, antecedentes de fracturas, hospitalizaciones, indicadores antropométricos, sarcopenia, índice de Charlson, polifarmacia, fenotipo de fragilidad de Fried y vitamina D plasmática; cifras < 30 ng/mL se consideraron indicativas de insuficiencia de vitamina D. Para el análisis estadístico se utilizó estadística descriptiva e inferencial. La asociación fue determinada mediante regresión logística binaria. RESULTADOS: Se estudiaron 175 adultos con un promedio de edad de 71.7 ± 6.7 años (IC 95 % = 60-90 años). La regresión logística binaria demostró que las variables asociadas a insuficiencia de vitamina D fueron agotamiento (RM = 2.6, IC 95 % = 1.0-6.5, p = 0.03), fragilidad (RM = 9.2, IC 95 % = 2.5-34.1, p = 0.001) y prefragilidad (RM = 4.6, IC 95 % = 2.1-10.0, p < 0.001). CONCLUSIÓN: Los fenotipos frágil, prefrágil y agotamiento se asocian a insuficiencia de vitamina D.


Asunto(s)
Fragilidad , Sarcopenia , Deficiencia de Vitamina D , Humanos , Anciano , Fragilidad/epidemiología , Fragilidad/etiología , Sarcopenia/epidemiología , Sarcopenia/etiología , Anciano Frágil , Estudios Transversales , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/epidemiología , Vitamina D , Vitaminas
8.
Gac Med Mex ; 157(2): 127-132, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34270533

RESUMEN

BACKGROUND: The literature refers that falls are of multifactorial origin, and some authors have proposed to classify risk factors as intrinsic and extrinsic. OBJECTIVE: To estimate the risk of falls and their association with some intrinsic and extrinsic factors in older adults who receive medical care at the Mexican Institute of Social Security. METHODS: Case-control study that included individuals of both genders aged ≥ 60 years. Cases were patients who were admitted to the emergency department of a secondary care hospital diagnosed with injury or fracture secondary to a fall; the controls were patients who attended family medicine units. Descriptive, bivariate and multivariate statistical analysis was carried out. The SPSS program, version 22.0, was used. RESULTS: Three-hundred and forty-two patients were included (171 cases and 171 controls). Mean age was 76.1 ± 8.8 years, 66 % were women and 97.1 % had self-reported chronic diseases. Differences were observed in body mass index, in the proportion of cases with cognitive impairment, use of walking devices and dependence to perform basic and instrumental activities of daily living. Adjusted multivariate analysis revealed an association between the fall event and cognitive impairment and dependence to perform instrumental activities of daily living. CONCLUSIONS: Cognitive impairment and dependence to perform instrumental activities of daily living were associated with the risk of falling.


ANTECEDENTES: Las caídas tienen un origen multifactorial. OBJETIVO: Estimar el riesgo de caídas y su asociación con algunos factores intrínsecos y extrínsecos en adultos mayores. MÉTODOS: Estudio de casos y controles que incluyó pacientes de ambos sexos con edades ≥ 60 años. Los casos fueron pacientes que ingresaron al servicio de urgencias de un hospital de segundo nivel, con diagnóstico de lesión o fractura secundaria a una caída; los controles fueron pacientes que acudieron a unidades de medicina familiar. El análisis estadístico que se realizó fue descriptivo, bivariante y multivariante. Se utilizó el programa SPSS versión 22.0. RESULTADOS: Se incluyeron 342 pacientes (171 casos y 171 controles). La edad promedio fue 76.1 ± 8.8 años, el 66 % fueron mujeres y por autorreporte el 97.1 % tenían enfermedades crónicas. Se observaron diferencias en el índice de masa corporal, en la proporción de casos con deterioro cognitivo, uso de dispositivos para caminar y dependencia para realizar actividades básicas e instrumentales de la vida diaria. El análisis multivariante ajustado reveló asociación entre el evento caída con deterioro cognitivo y dependencia para realizar actividades instrumentales de la vida diaria. CONCLUSIONES: El deterioro cognitivo y la dependencia para realizar actividades instrumentales de la vida diaria se asociaron al riesgo de caer.


Asunto(s)
Accidentes por Caídas , Actividades Cotidianas , Disfunción Cognitiva/complicaciones , Heridas y Lesiones/etiología , Anciano , Análisis de Varianza , Índice de Masa Corporal , Bastones , Estudios de Casos y Controles , Servicio de Urgencia en Hospital , Femenino , Fracturas Óseas/etiología , Humanos , Vida Independiente , Masculino , México , Persona de Mediana Edad , Limitación de la Movilidad , Factores de Riesgo , Andadores
9.
Fam Process ; 59(1): 257-272, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-30414327

RESUMEN

Current research supports clear relationships between parental psychopathology, parental maltreatment, and emerging adult child psychopathology. Less research has examined how the role of the parent-child relationship influences these existing associations. The current study tested two models that examined the moderating effect of parent-child relationship quality on parental psychopathology and emerging adult mental health as well as the effect on parental maltreatment and emerging adult mental health. It was expected that high parent-child relationship quality would buffer against the negative effects of parental psychopathology and maltreatment while enhancing the effects of functional parenting characteristics. Participants included 1,452 emerging adults, predominantly Caucasian (73.3%) college students who completed surveys on their mental health, recent experienced maltreatment, and their parents' mental health problems. Results suggested lowest rates of mental health problems for emerging adults were associated with higher parent-child relationship quality and lower parental psychological problems, whereas negative outcomes were associated with higher parental psychopathology, regardless of parent-child relationship quality. Additionally, physical maltreatment was associated with lower rates of mental health concerns in the context of higher mother-daughter relationship quality. Results emphasize the continuing impact of the parent-child relationship, particularly the mother-daughter relationship, on emerging adults' mental health. Moreover, the current study demonstrates the continuing influence of parents on their emerging adult children.


Las investigaciones actuales respaldan las relaciones claras entre la psicopatología parental, el maltrato parental y la psicopatología del niño adulto emergente. Pocas investigaciones han analizado cómo el rol de la relación entre padres e hijos influye en estas asociaciones existentes. El presente estudio evaluó dos modelos que analizaron el efecto moderador de la calidad de la relación entre padres e hijos en la psicopatología parental y la salud mental del adulto emergente, así como el efecto en el maltrato parental y la salud mental del adulto emergente. Se esperaba que una alta calidad de la relación entre padres e hijos amortiguara los efectos negativos del maltrato y la psicopatología parental y a su vez mejorara los efectos de las características funcionales de crianza. Los participantes fueron 1452 estudiantes universitarios adultos emergentes predominantemente caucásicos (73,3%) que contestaron encuestas sobre su salud mental, el maltrato sufrido recientemente y los problemas de salud mental de sus padres. Los resultados sugirieron que los índices más bajos de problemas de salud mental en los adultos emergentes estuvieron asociados con una mejor calidad de la relación entre padres e hijos y menos problemas psicológicos de los padres, mientras que los resultados negativos estuvieron asociados con una psicopatología parental más alta, independientemente de la calidad de la relación entre padres e hijos. Además, el maltrato físico estuvo asociado con índices más bajos de preocupaciones sobre la salud mental en el contexto de una mejor calidad de la relación entre madre e hija. Los resultados destacan el efecto permanente de la relación entre padres e hijos, particularmente de la relación entre madre e hija, en la salud mental de los adultos emergentes. Además, el presente estudio demuestra la influencia continua de los padres en sus hijos adultos emergentes.


Asunto(s)
Hijos Adultos , Adultos Sobrevivientes del Maltrato a los Niños , Hijo de Padres Discapacitados , Trastornos Mentales , Relaciones Padres-Hijo , Adolescente , Femenino , Humanos , Masculino , Adulto Joven , Hijos Adultos/psicología , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Maltrato a los Niños/psicología , Hijo de Padres Discapacitados/psicología , Composición Familiar , Padres/psicología , Psicopatología , Estudiantes/psicología
10.
Fam Process ; 59(2): 651-665, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-31128079

RESUMEN

Recent studies have argued that Oppositional Defiant Disorder (ODD) problems continue into emerging adulthood; however, few studies have examined ODD problems in this population. Moreover, previous studies have found that corporal punishment mediated the relationship between maternal anxiety/depression and child ODD problems in young children and that parental psychopathology is likely to affect child ODD. This study examined how maternal as well as paternal maltreatment (i.e., psychological and physical) mediated the relationship between parental anxiety/depressive problems and emerging adult ODD problems (i.e., irritability and defiance). Furthermore, child and parent gender were examined as moderators (i.e., moderated mediation). Participants included 1,012 emerging adults who completed questionnaires about parental psychological and physical maltreatment, parental anxiety and depression, and affective and behavioral ODD symptoms. Results suggested that mediation occurred for the father-daughter dyad along the perceived paternal depressive problems â†’ psychological and physical maltreatment â†’ irritability paths and for the mother-son dyad along the perceived maternal depressive and anxiety problems â†’ psychological maltreatment â†’ defiance paths. Given that mediation occurred for only these gender dyads, moderated mediation was suggested.


Estudios recientes han argumentado que los problemas del Trastorno negativista desafiante (ODD por sus siglas en inglés) continúan en la adultez emergente; sin embargo, son pocos los estudios que han examinado problemas de ODD en esta población. Más aun, estudios previos han encontrado que el castigo corporal mediaba la relación entre la ansiedad/depresión maternal y los problemas infantiles de ODD en niños jóvenes y que la psicopatología parental probablemente afecta el ODD del niño. Este estudio examina cómo el maltrato maternal, así como el paternal (es decir, psicológico y físico) mediaron la relación entre problemas parentales de ansiedad/depresión y problemas de ODD en adultos emergentes (es decir, irritabilidad y desafío). Además, se examinó el género de niños y padres como moderadores (es decir, mediación moderada). Los participantes incluyeron a 1012 adultos emergentes que llenaron cuestionarios acerca del maltrato parental psicológico y físico, ansiedad y depresión parentales, y síntomas afectivos y conductuales de ODD. Los resultados sugirieron que la mediación ocurre con la díada padre-hijo por las vías de problemas paternales percibidos de depresión → maltrato psicológico y físico → irritabilidad, y con la díada madre-hijo por las vías de problemas maternales percibidos de depresión y ansiedad → maltrato psicológico → desafío. Dado que la mediación solo ocurrió para estas díadas de género, se sugirió una mediación moderada.


Asunto(s)
Hijos Adultos/psicología , Adultos Sobrevivientes del Maltrato a los Niños/psicología , Ansiedad , Déficit de la Atención y Trastornos de Conducta Disruptiva/psicología , Depresión , Adolescente , Adulto , Niño , Maltrato a los Niños/psicología , Femenino , Humanos , Masculino , Análisis de Mediación , Relaciones Padres-Hijo , Responsabilidad Parental/psicología , Padres/psicología , Factores Sexuales , Encuestas y Cuestionarios , Adulto Joven
11.
Aten Primaria ; 52 Suppl 2: 70-92, 2020 11.
Artículo en Español | MEDLINE | ID: mdl-33388119

RESUMEN

Vaccine development is one of the fastest growing sectors in medicine now and in the future, as we are living with the emergency health care for the SARS-CoV-2 coronavirus. The semFYC PAPPS program biannually publishes the recommendations of the group and, in this edition, special emphasis is placed on the common vaccination proposed by the Ministry of Health, where, at last, it no longer discriminates between paediatrics and adults, and proposes a calendar throughout life. The main novelties in the field of vaccinology today are focused on the consolidation of the nonavalent vaccine against the human papilloma virus and in the change of the dose of monovalent meningitis vaccine C for the tetravalent one, ACWY, at age 12. The pandemic we are experiencing has led to the postponement of most preventive activities. On the return to «normality¼, the vaccination calendar must be examined, and completed if necessary.


Asunto(s)
Esquemas de Inmunización , Atención Primaria de Salud/normas , Vacunación/normas , Vacunas/normas , Virosis/prevención & control , Adulto , COVID-19/prevención & control , Niño , Humanos , Atención Primaria de Salud/métodos , Vacunación/métodos , Vacunas/administración & dosificación
12.
Gac Med Mex ; 156(5): 373-381, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33372930

RESUMEN

INTRODUCTION: Obesity, diabetes, hypertension and age have been pointed at as factors that influence on the progression of COVID-19; however, evidence for other conditions is inconclusive. OBJECTIVE: To identify which clinical characteristics are related to COVID-19 severity and to determine whether age acts a modifier of the relationship between cardio-metabolic comorbidities (CMC) and COVID-19 progression. METHOD: Data on ≥ 20-year-old confirmed cases (n = 159,017) were analyzed. Hospitalization, development of pneumonia, intubation requirement, intensive care unit admission and death were the dependent variables in Poisson regression models estimation, whereas the interaction between age and different CMCs were the independent variables. RESULTS: Having CMCs, as well as other comorbidities, was directly related to COVID-19 progression, whereas chronic obstructive pulmonary disease was only related to an increase in the risk of dying. The risk for COVID-19 severity was lower as age was more advanced. Asthma and smoking were not risk factors for the progression of COVID-19. CONCLUSION: In the Mexican population, the risk of COVID-19 progression associated with comorbidities was higher in young adults.


INTRODUCCIÓN: Se ha señalado que factores como obesidad, diabetes, hipertensión y edad influyen en la progresión de COVID-19; sin embargo, la evidencia para otras condiciones no es concluyente. OBJETIVO: Identificar qué antecedentes clínicos están relacionados con la gravedad de COVID-19 y si la edad funge como un modificador de efecto de la relación entre comorbilidades cardiometabólicas (CCM) y progresión de COVID-19. MÉTODO: Se analizaron los datos de casos confirmados ≥ 20 años (n = 155 017). La hospitalización, el desarrollo de neumonía, el requerimiento de intubación, el ingreso a la unidad de cuidados intensivos y la muerte constituyeron las variables dependientes en la estimación de modelos de regresión de Poisson y la interacción entre edad y CCM, las independientes. RESULTADOS: Tener CCM, así como otras comorbilidades, se relacionó directamente con la progresión de COVID-19. El riesgo de gravedad de COVID-19 asociado a las CCM fue menor conforme la edad era mayor. El asma y el tabaquismo no fueron factores de riesgo para la progresión de COVID-19. CONCLUSIÓN: En la población mexicana, el riesgo de progresión de COVID-19 asociada a comorbilidades fue mayor en los adultos jóvenes.


Asunto(s)
COVID-19/diagnóstico , Adulto , Factores de Edad , COVID-19/complicaciones , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Adulto Joven
13.
Gastroenterol Hepatol ; 42(10): 595-603, 2019 Dec.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31519387

RESUMEN

INTRODUCTION: In Europe, gastric adenocarcinoma (GADC) is commonly regarded as a disease of the elderly. This study aims to assess the proportion, characteristics, and survival of patients diagnosed with GADC under the age of 60. MATERIALS AND METHODS: This is a retrospective, multicentric, and analytical study conducted at four tertiary Spanish hospitals. All patients diagnosed with GADC between 2008 and 2015 were included. Demographic, clinical, endoscopic, histologic, and survival data were retrieved. A multivariate analysis was performed to compare GADC in young (age≤60 years) and elderly patients. RESULTS: A total of 1374 patients with GADC were included. The mean age was 74 years (SD:11.1); 62.2% were males. There were 177 patients under the age of 60 (12.9%, 95% CI: 11.2-14.8%). GADC was frequently encountered as a metastatic disease in both young and elderly patients (Stage IV: 45.7% and 41%, respectively). In the multivariate analysis, alcohol abuse, ASA functional status I-II, diffuse subtype, neoadjuvant, and palliative therapy were independently associated (P<0.05) with age ≤60 years. No differences were found in 2-year survival (GADC ≤60: 39% vs. 35%, P=0.45). Curative-intent surgery, TNM stage I-II, body mass index<30kg/m2, and better functional status at diagnosis were independent predictors of survival in GADC under the age of 60. CONCLUSIONS: One out of eight cases of GADC were diagnosed under the age of 60. Metastatic disease was frequent at diagnosis and overall survival was poor regardless of age. Factors associated with localized disease correlated with improved survival in younger patients. Our results underline the need for early diagnosis strategies in our country.


Asunto(s)
Adenocarcinoma , Neoplasias Gástricas , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidad , Adenocarcinoma/terapia , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/terapia , Análisis de Supervivencia , Tasa de Supervivencia
16.
Infant Ment Health J ; 39(6): 625-641, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30395356

RESUMEN

The historic publication of the "consensus statement" on not using the "D/disorganized" category in the infant Strange Situation (M. Ainsworth, M. Blehar, E. Waters, & S. Wall, 1978) for case-specific child protection work (P. Granqvist et al., 2017) opens the door for a broader discussion of different branches of attachment theory and different attachment classificatory systems applied to infants, young children, and their parents. We agree with the consensus authors that Strange Situation classifications alone, regardless of coding method, are insufficient for decision-making. The authors, however, have acknowledged that the Dynamic-Maturational Model of Attachment and Adaptation (DMM; Crittenden, 2016) offers a different perspective on classifying Strange Situations. The DMM is a branch of attachment theory that expands the Ainsworth A and C classifications across the life span to reflect the complex attachment strategies that some individuals use in dangerous contexts. We contrast the DMM to the D classification, both for the Strange Situation for infants and its adaptation for young children and also for the Adult Attachment Interview (AAI; C. George, N. Kaplan, & M. Main, 1984-1996) for their parents. We initiate a scientific dialogue by addressing three points: (a) "Attachment" does not imply or require a model that includes a D/disorganization category nor is the D/disorganized category the only clinical expansion of Mary Ainsworth's (1978) original work; (b) the DMM method for classifying Strange Situations may be better attuned to parental inadequacy and child protection than is the D/disorganized category; and (c) with attention to guidelines, DMM classifications from the Strange Situation with both infants and preschool-aged children can be used in a case-specific manner in both treatment and forensic settings. The same is true for other DMM assessments of attachment, including the AAI. We close by suggesting steps that could further understanding and application of Ainsworth's great accomplishment: individual differences in attachment relationships.


Asunto(s)
Servicios de Protección Infantil , Protección a la Infancia/legislación & jurisprudencia , Relaciones Padres-Hijo/legislación & jurisprudencia , Adulto , Servicios de Protección Infantil/métodos , Servicios de Protección Infantil/organización & administración , Preescolar , Psiquiatría Forense/métodos , Humanos , Lactante , Apego a Objetos , Teoría Psicológica , Trastorno de Vinculación Reactiva/psicología
17.
Rev Argent Microbiol ; 50(3): 280-284, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29223920

RESUMEN

Streptococcus agalactiae or group B streptococcus (GBS) is a frequent pathogen in immunocompromised adults. The aim of this study was to determine the relative frequency, clinical presentation, antimicrobial susceptibility profile, and risk factors associated with GBS bacteremia in non-pregnant adult patients. We conducted a retrospective analysis of blood cultures performed in two hospitals between the years 2009-2013. From 1110 bacteremia episodes, 13 were caused by GBS, all of which were susceptible to ampicillin. GBS bacteremia was more frequent in females and in patients older than 60 years of age. The most frequent comorbidities were chronic kidney disease, cardiac failure and neoplasia. History of appendectomy was detected in 53.8% of the patients, being the most relevant comorbidity for GBS bacteremia in the multivariate analysis (OR 4.13, p=0.012). The main presentations were primary bacteremia and soft tissue infection. GBS bacteremia was infrequent in our institution, and a history of appendectomy might be related to bacteremia occurrence.


Asunto(s)
Bacteriemia , Hospitales de Enseñanza , Infecciones Estreptocócicas , Streptococcus agalactiae , Adulto , Bacteriemia/microbiología , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Infecciones Estreptocócicas/complicaciones , Streptococcus agalactiae/aislamiento & purificación
18.
Aten Primaria ; 50(7): 398-405, 2018.
Artículo en Español | MEDLINE | ID: mdl-28935381

RESUMEN

AIM: To explore the association between gender-role attitudes and the recognition of abuse among adolescents and young adults during dating relationships. DESIGN: Cross-correlation study. LOCATION: 57 schools of secondary education, vocational education and university in five provinces of Spain (Huelva, Seville, A Coruña, Pontevedra and Asturias). PARTICIPANTS: 4,337 students aged between 15 and 26 years (40.6% males and 59.4% female) who had a dating relationship that lasted more than a month. MAIN MEASUREMENTS: The Gender Role Attitudes Scale was used, which consists of 20 indicators of egalitarian or sexism attitudes at the family, social and occupational level. The students also reported whether they suffered from recognized abuse (RA), unperceived abuse (UPA), or not abused (NA). RESULTS: In the whole sample, 68.6% declared themselves NA, 26.4% were under a situation of UPA, and 5.0% were RA. The RA group was more frequent among the females (6.3%), ≥18 years (6.4%) and university students (6.9%). UPA was more common in males (30.2%). The most sexist attitudes were found in the occupational dimension and especially in men and adolescents (15-17 years). Less sexist attitudes were associated with a lower probability of experiencing UPA (odds ratio=.71; P-trend<.001). CONCLUSIONS: Sexism seems to hinder the recognition of abuse. Achieving gender equity in adolescence and youth is imperative. Public health efforts should focus on men, as they constitute the group with more sexist attitudes and with higher prevalence of UPA.


Asunto(s)
Identidad de Género , Relaciones Interpersonales , Sexismo/estadística & datos numéricos , Estudiantes/estadística & datos numéricos , Violencia/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Estudios Transversales , Femenino , Humanos , Masculino , Instituciones Académicas/estadística & datos numéricos , Factores Sexuales , Sexismo/psicología , España , Estudiantes/psicología , Encuestas y Cuestionarios/estadística & datos numéricos , Universidades/estadística & datos numéricos , Violencia/clasificación , Violencia/psicología , Lugar de Trabajo/estadística & datos numéricos , Adulto Joven
19.
Gastroenterol Hepatol ; 40(5): 331-338, 2017 May.
Artículo en Inglés, Español | MEDLINE | ID: mdl-28010892

RESUMEN

INTRODUCTION: Dyspepsia is a common disorder in both Primary (PC) and Specialised Care (SC). Gastroscopy is recommended at the start of the study if there are warning signs, although it is not always available in PC. OBJECTIVES AND METHODS: We developed a pilot project establishing an early gastroscopy programme for patients with dyspepsia and warning signs in PC, subsequently extending it to the entire healthcare area. The aim was to evaluate the requirements, impact and opinion of this service at the PC level. Demographic, symptomatic and endoscopic variables on the patients referred to SC from the pilot centre were recorded. A satisfaction survey was conducted among the PC physicians. RESULTS: The one-year pilot study and the first year of implementation of the programme were evaluated. A total of 355 patients were included (median age 56.4 years; IQR 45.5-64.3); 61.2% (56.1-66.3%) were women. The waiting time for examination was 1.5 weeks (IQR 1.5-2.5). Gastroscopy was correctly indicated in 82.7% (78.4-86.3%) of patients. The median number of requests per month was 1.1 per 10,000 adults (range 0.8-1.6). Monthly referrals to SC clinics from the pilot centre fell by 11 subjects (95% CI 5.9-16) with respect to the previous median of 58 (IQR 48-64.5). Almost all those polled (98.4%) considered the programme useful in routine practice. CONCLUSIONS: The availability of an early gastroscopy programme in PC for patients with dyspepsia and warning signs reduced the number of referrals to SC.


Asunto(s)
Dispepsia/diagnóstico , Diagnóstico Precoz , Gastroscopía , Atención Primaria de Salud/métodos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Dispepsia/epidemiología , Dispepsia/etiología , Esofagitis/complicaciones , Esofagitis/diagnóstico , Esofagitis/epidemiología , Gastritis/complicaciones , Gastritis/diagnóstico , Gastritis/epidemiología , Neoplasias Gastrointestinales/complicaciones , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/epidemiología , Gastroscopía/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Proyectos Piloto , Guías de Práctica Clínica como Asunto , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Factores de Riesgo , Evaluación de Síntomas , Adulto Joven
20.
Neurologia ; 32(4): 205-212, 2017 May.
Artículo en Inglés, Español | MEDLINE | ID: mdl-26749191

RESUMEN

INTRODUCTION: Adult chronic idiopathic hydrocephalus (ACIH) is a cause of dementia that can be treated by implanting a ventriculo-peritoneal shunt (VPS). We aim to study clinical and functional outcomes in patients with ACIH corrected with a VPS. SUBJECTS AND METHODS: Observational cohort study of patients diagnosed with probable ACIH (Japan Neurosurgical Society guidelines) and undergoing shunt placement between 2008 and 2013 in a centre of reference for neurosurgery in Spain. Clinical improvement was classified in 4 categories (resolution, partial improvement, equivocal improvement, and no improvement); functional outcome was assessed on the modified Rankin scale (mRS). RESULTS: The study included 29 patients with a mean age of 73.9 years; 62.1% were male and 65.5% had hypertension. Clinical improvement (complete or partial) was observed in 58% after one year and in 48% by the end of the follow-up period (mean follow-up time was 37.8 months). Older age, presence of hypertension, and surgery-related complications were more prevalent in the group responding poorly to treatment. One patient died, 20.7% experienced severe complications, and 69% were dependent (mRS ≥ 3) by the end of the follow-up period. Age at diagnosis was independently associated with poorer clinical response at one year and a higher degree of dependency by the end of follow-up. CONCLUSION: Symptomatic benefits offered by VPS were partial and transient; treatment was associated with a high complication rate and poor functional outcomes in the long term, especially in the oldest patients.


Asunto(s)
Hidrocefalia/cirugía , Derivación Ventriculoperitoneal/métodos , Factores de Edad , Anciano , Femenino , Humanos , Hidrocefalia/complicaciones , Hipertensión/etiología , Estudios Longitudinales , Masculino , Estudios Prospectivos , Factores de Riesgo , España , Resultado del Tratamiento
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