[Chronic degenerative conditions as risk factors for lethal COVID-19Doenças crônicas degenerativas como fator de risco para letalidade por COVID-19]. / Enfermedades crónicas degenerativas como factor de riesgo de letalidad por COVID-19 en México.

Objective: To determine the relative risk of a lethal outcome associated with chronic degenerative conditions in patients with COVID-19. Methods: A cohort study was conducted using electronic medical records belonging to patients who tested positive for COVID-19 on RT-PCR while receiving care as outpatients or inpatients in a social security system facility between March 2020 and March 2021. Two study groups were formed. The exposed group was divided into four subgroups, each of which was diagnosed with one and only one chronic condition (diabetes, hypertension, obesity, or chronic kidney disease); the unexposed group was obtained from the medical records of patients without comorbidities. A total of 1 114 medical records were examined using simple random sampling. Once the minimum sample size was reached, the relative risk was calculated for each chronic condition. Combinations of two, three, and four conditions were created, and each of them was included in the analysis. Results: In the absence of a chronic degenerative condition, the prevalence of a lethal outcome from COVID-19 is 3.8%; in the presence of type 2 diabetes mellitus, 15.8%; in the presence of arterial hypertension, 15.6%; and in the presence of obesity, 15.0%. For diabetes and hypertension combined, the prevalence of a lethal outcome is 54.1%; for diabetes and obesity combined, 36.8%, and for obesity and hypertension combined, 28.1%. Conclusion: In patients with COVID-19, the relative risk of a lethal outcome is 4.17 for those with diabetes, 4.13 for those with hypertension, and 3.96 for those with obesity. For two chronic conditions combined, the relative risk doubles or triples. The relative risk of a lethal outcome is 14.27 for diabetes plus hypertension; 9.73 for diabetes plus obesity, and 7.43 for obesity plus hypertension. Chronic conditions do not present alone; they generally occur together, hence the significance of the relative risks for lethal outcomes presented in this paper.

Objetivo: Determinar o risco de letalidade conferido por doenças crônicas degenerativas em pacientes com COVID-19. Métodos: Foi realizado um estudo de coorte em prontuários eletrônicos de pacientes com RT-PCR positivo para COVID-19 em atendimento ambulatorial ou hospitalar em uma instituição de previdência social, no período de março de 2020 a março de 2021. Foram constituídos dois grupos de estudo. O grupo exposto foi dividido em quatro subgrupos, cada um com diagnóstico único e exclusivo de uma doença crônica (diabetes, hipertensão, obesidade ou doença renal crônica). O grupo não exposto foi constituído por prontuários de pacientes sem comorbidades. Foram revisados 1.114 prontuários no total, utilizando técnica de amostragem aleatória simples. Uma vez obtido o tamanho mínimo da amostra, foi calculado o risco relativo para cada doença crônica. Foram realizadas combinações de 2, 3 e 4, tendo sido feita a análise com cada uma delas. Resultados: Na ausência de doença crônica degenerativa, a prevalência de letalidade na COVID-19 é de 3,8%; na presença de diabetes mellitus tipo 2, a letalidade é de 15,8%; na presença de hipertensão arterial, 15,6%; e na presença de obesidade, 15%. Quando tanto diabetes como hipertensão estão presentes, a letalidade é de 54,1%; com diabetes e obesidade, 36,8%; e obesidade com hipertensão, 28,1%. Conclusões: Em pacientes com COVID-19, o risco relativo de letalidade é de 4,17 naqueles com diabetes; 4,13 naqueles com hipertensão; e 3,96 naqueles com obesidade. Quando duas doenças crônicas são combinadas, o risco relativo dobra ou triplica. Para diabetes e hipertensão, o risco relativo de letalidade é 14,27; para diabetes e obesidade, 9,73; e para obesidade e hipertensão, 7,43. As doenças crônicas não ocorrem sozinhas (geralmente estão associadas), e nessa perspectiva os riscos relativos de letalidade apresentados neste artigo tornam-se relevantes.

[Health status of the elderly in primary health care practices using an integral geriatric assessment]. / Estado de salud en el adulto mayor en atención primaria a partir de una valoración geriátrica integral.

OBJECTIVE: To determine the health status of patients 60 years of age or over in Primary Health Care practices using an integral geriatric assessment. DESIGN: Descriptive cross-sectional study. LOCATION: Five primary care units, Instituto Mexicano del Seguro Social; México. PARTICIPANTS: Elderly patient aged 60 years of age or over, who were seen in primary health care practices. Previously signed informed consent was given, with exclusion criteria being non-completion of the integral geriatric assessment. A technical sample of conglomerates and quota was used. MAIN MEASUREMENTS: Medical dimension variables: visual, hearing (Hearing Handicap Inventory for the Elderly), urinary incontinence (Consultation in Incontinence Questionnaire), nutritional condition (Mini Nutritional Assessment), personal clinical history, polypharmacy; mental impairment (Mini Mental State Examination), depression (Yesavaje); functional: basic (Katz) and instrumental (Lawton and Brody) activities of daily living, mobility (Up and go) and social (Social sources scale). The analysis included percentages and confidence intervals. RESULTS: In the medical dimensions; 42.3% with visual impairment, 27.7% hearing, 68.3% urinary incontinence, 37.0% malnutrition, and 54.7% polypharmacy. In the mental dimension: 4.0% severe mental impairment, and 11% depression: functional dimension: 2.0% total dependence of activities of daily living; 14.3% instrumental activities impairment; 29.0% mobility impairment, and 48.0% had moderately deteriorated social resources. CONCLUSION: The health status of the elderly seen in primary health care practices is characterized by independent patients with different levels of alterations in the medical dimensions, low levels in mental alteration, and moderately deteriorated social resources.

[Natural history of breast cancer diagnostic procedures]. / Historia natural del proceso diagnóstico del cáncer de mama.

OBJECTIVE: To build a model that explains the natural history of breast cancer diagnostic procedures. METHODS: Descriptive cross-sectional study of 245 women between 40 and 69 years of age, selected by simple random sampling, who underwent a mammography and met the requirements of the breast cancer diagnostic procedure. Diagnosis was made by biopsy. For the diagnostic procedure, an estimate was made of the percentage of patients seen by each service, the total number of patients per service, and the total number of consultations in each service, with 95% confidence intervals. RESULTS: Of the patients who initiated the breast cancer diagnostic procedure in preventive medicine services, 20% underwent a mammography; 23.7% were seen in family medicine services and of these patients, 70.9% were referred to a breast clinic, where 7.3% underwent a harpoon biopsy. The prevalence of breast cancer confirmed by biopsy was 0.48% (95%CI: 0.0-1.3). Per 1 000 patients who initiated the procedure, 47.4 were seen in family medicine services and 33.6 in a breast clinic, and open biopsies were performed on 2.4. Per 1 000 patients who initiated the procedure, there were 211.4 consultations in radiology services, 51.6 in family medicine services, and 54.6 in a breast clinic. CONCLUSIONS: The model described here may be useful in planning and evaluation activities.

[Association between family functionality and mild cognitive impairment in the family with the elderly]. / Asociación entre funcionalidad familiar y deterioro cognitivo leve en la familia con adulto mayor.

AIM: To determine the association between family functionality and mild cognitive impairment in the family with the elderly. METHODOLOGY: Analytical cross-sectional design in families with geriatric patients. A family with a geriatric patient was considered when at least one of its members was over 60years of age. The comparison groups were the family with a geriatric patient without cognitive impairment and the family with a geriatric patient with mild cognitive impairment determined with the MoCA instrument. Family functionality was evaluated with the family APGAR instrument, which identifies three categories: family functionality, moderate family dysfunction, and severe family dysfunction. Statistical analysis included Chi square and Mann-Whitney test. RESULTS: In the family with a geriatric patient, in the group without cognitive impairment the prevalence of family functionality is 89.7% and in the group with mild cognitive impairment the prevalence of family functionality is 59.3% (MW=4.87, P<.000). CONCLUSION: There is an association between family functionality and mild cognitive impairment.

[Epidemiological profile of rheumatoid arthritis]. / Perfil epidemiológico de la artritis reumatoide.

Background: Rheumatoid arthritis affects approximately between 0.3 and 1.2% of the world population. In Latin America, different studies have estimated a prevalence between 0.2 and 0.5% in the population over 16 years of age. Objective: To identify the epidemiological profile of rheumatoid arthritis. Material and methods: Descriptive cross-sectional design carried out in an urban population of a social security institution in Mexico. The information of the clinical file of 373 patients was studied. The epidemiological profile included the sociodemographic dimension, family history, health, clinical, therapeutic, biochemical, extra-articular manifestations and complications. Statistical analysis percentages, means, confidence intervals for percentages and confidence intervals for averages were calculated. Results: The wrists were the most affected joints with 44.6% (95% CI: 39.5-49.6%). The extra-articular manifestation with the highest prevalence was asthenia with 9.9% (95% CI: 6.9-12.9%); predominant diagnosis according to ICD-10 was seropositive rheumatoid arthritis with 59.8% (95% CI: 54.8-64.8%), and the rheumatoid factor was highly positive in 78.3% (95% CI: 74.1-82.5%); predominant treatment was with combined therapy at diagnosis in 97.6% (95% CI: 96.0-99.1%). The duration of treatment was > 10 years in 34.1% (95% CI: 29.2-38.8%). Conclusion: This work has described the epidemiological profile of the patient with rheumatoid arthritis in different dimensions.

Introducción: la artritis reumatoide afecta aproximadamente entre 0.3 y 1.2% de la población mundial. En Latinoamérica diferentes estudios han estimado una prevalencia entre 0.2 y 0.5% en población mayor de 16 años de edad. Objetivo: identificar el perfil epidemiológico de la artritis reumatoide. Material y métodos: diseño transversal descriptivo llevado a cabo en población urbana de una institución de seguridad social en México. Se estudió la información del expediente clínico de 373 pacientes. El perfil epidemiológico incluyó la dimensión sociodemográfica, antecedentes heredofamiliares, de salud, clínicos, terapéuticos, bioquímicos, de manifestaciones extraarticulares y de complicaciones. Se calcularon porcentajes, promedios, e intervalos de confianza para porcentajes y promedios. Resultados: las muñecas fueron las articulaciones más afectadas con 44.6% (IC 95%: 39.5-49.6%). La manifestación extraarticular con más alta prevalencia fue la astenia con 9.9% (IC 95%: 6.9-12.9%); el diagnóstico predominante de acuerdo con el CIE-10 fue la artritis reumatoide seropositiva con 59.8% (IC 95%: 54.8-64.8%) y se encontró el factor reumatoide positivo alto en un 78.3% (IC 95%: 74.1%-82.5%); el tratamiento predominante fue con terapia combinada al diagnóstico en un 97.6%, (IC 95%: 96.0-99.1%). La duración del tratamiento fue > 10 años en el 34.1% (IC 95%: 29.2-38.8%). Conclusión: este trabajo ha descrito el perfil epidemiológico del paciente con artritis reumatoide en diferentes dimensiones.

Family with systemic arterial hypertension: epidemiological profile. / Familia con hipertensión arterial sistémica: perfil epidemiológico.

The aim of this study was to determine the epidemiological profile of the family with systemic arterial hypertension. A descriptive cross-sectional study was carried out in 268 families with this disease, the epidemiological profile included seven dimensions, sociodemographic, economic, family functionality, life cycle, family roles, health and use of services. The mean age of the families was 49.09 (SD: 15.57) years; 47.0% of the families had paid economic activity, 65.0% were functional, 52.4% were in the retirement and death stages, 43.1% presented obesity, in 50.0% the predominant role of the hypertensive patient was assumed by the mother, and the average annual number of family medicine consultations was 10.37 (SD: 4.31). The family with arterial hypertension is functional, although most of them are in the stage of retirement and death.

El objetivo fue determinar el perfil epidemiológico de grupos familiares con hipertensión arterial sistémica. Se realizó un estudio transversal descriptivo en 268 familias con esta enfermedad, el perfil epidemiológico incluyó siete dimensiones: sociodemográfico, económico, funcionalidad familiar, ciclo de vida, roles familiares, salud y uso de servicios. La edad promedio de las familias fue de 49,09 (DE: 15,57) años. El 47,0% de las familias tuvieron actividad económica remunerada; el 65,0% son funcionales; en el 52,4% predominó la etapa de jubilación y muerte; en el 50,0% la madre asumió el rol predominante del paciente con hipertensión; el 43,1% de las familias presentaron obesidad y el promedio anual de consultas de medicina familiar fue de 10,37 (DE: 4,31). La familia con hipertensión arterial es funcional, no obstante la mayoría se encuentra etapa de jubilación y muerte.

Disease belief, medication belief and adherence to treatment in patients with high blood pressure / Creencias de enfermedad, creencias de medicación y adherencia al tratamiento en pacientes con hipertensión arterial

Objective: Compare disease beliefs and medication beliefs with adherence to treatment in patients with hypertension without diabetes mellitus. Method: Comparative transverse design in hypertensive population, a group of 137 adherent patients and a group of 129 non-adherent patients. The beliefs of the disease and beliefs about the medication were evaluated. The statistical analysis included chi squared, odds ratio and confidence interval for odds ratio. Results: In the group of adherent patients, 71.5% have an adequate belief of the disease and in the group of non-adherent patients, 43.4% also have an adequate belief of the disease (p = 0.000). When the belief of the disease and beliefs about the medication are grouped, there is an association with adherence to treatment in hypertensive patients. Conclusions: There is an association between beliefs about the disease and medication with adherence to antihypertensive treatment.

Objetivo: Comparar las creencias de enfermedad y las creencias de medicación con la adherencia al tratamiento en pacientes con hipertensión arterial. Método: Diseño transversal comparativo en población hipertensa sin diabetes mellitus, grupo de 137 pacientes adherentes y grupo de 129 pacientes no adherentes. Se evaluaron las creencias de la enfermedad y las creencias de la medicación. El análisis estadístico incluyó prueba de ji al cuadrado, razón de momios e intervalo de confianza para razón de momios. Resultados: En el grupo de pacientes adherentes, el 71.5% tienen creencias adecuadas de la enfermedad, y en el grupo de pacientes no adherentes el 43.4% también tienen creencias adecuadas de la enfermedad (p = 0.000). Cuando se agrupan las creencias de la enfermedad y las creencias sobre la medicación existe una asociación con la adherencia al tratamiento en los pacientes hipertensos. Conclusiones: Existe asociación entre las creencias de la enfermedad y las creencias de la medicación con la adherencia al tratamiento antihipertensivo.

[Incidence of COVID-19 in health workers. Work activity and home protection]. / Incidencia de COVID-19 en trabajadores de salud. Actividad laboral y resguardo domiciliario.

Background: The COVID-19 pandemic has had repercussions in the social, economic, psychological and health spheres, for which risk and exposure groups have been identified. Health workers are distinguished from the rest of the population by constant contact with patients carrying the SARS-CoV-2 virus. Objetive: To determine the difference in the incidence of COVID-19 in health workers who remain in work activity and those who shelter at home. Material and methods: Cohort study in health workers from March 2020 to January 2021. Two groups were integrated, the exposed group made up of workers who remained working in the health unit (n = 4650) and the non-exposed group, those who carried out home protection (n = 337). When the groups were integrated, none had a diagnosis of COVID-19, they were followed up for 11 months and when COVID-19 was diagnosed, it was done with a PCR test. Statistical analysis included incidence rate, confidence intervals, Chi square, relative risk, and confidence interval for relative risk. Results: The incidence of COVID-19 in workers in home shelter was 39.8% (95% CI: 34.6-45.0) and in workers who remained in the medical unit 16.0% (95% CI: 14.9-17.1). The relative risk was 0.40 (95% CI: 0.34-0.47) for workers who remained working in the health unit. Conclusion: The incidence of COVID-19 was higher in health workers with home protection than in those who continued with normal activities in the medical unit.

Introducción: la pandemia por COVID-19 ha repercutido en el ámbito social, económico, psicológico y de la salud, por lo que se han identificado grupos de riesgo y de exposición. Los trabajadores de la salud se distinguen del resto de la población por el contacto constante con pacientes portadores del virus SARS-CoV-2. Objetivo: determinar la diferencia de incidencia de COVID-19 en trabajadores de la salud que permanece en actividad laboral y los que se resguardan en domicilio. Material y métodos: estudio de cohorte en trabajadores de la salud de marzo 2020 a enero 2021. Se integraron dos grupos: el grupo expuesto compuesto por trabajadores que permanecieron laborando en la unidad de salud (n = 4650) y el grupo no expuesto, que realizaron resguardo domiciliario (n = 337). Cuando se integraron los grupos ninguno tenía diagnóstico de COVID-19, se siguieron durante 11 meses y cuando se diagnosticó COVID-19 se realizó con prueba de PCR. El análisis estadístico incluyó tasa de incidencia, Intervalos de confianza, Chi cuadrada, riesgo relativo e intervalo de confianza para riesgo relativo. Resultados: la incidencia de COVID-19 de trabajadores en resguardo domiciliario fue de 39.8% (IC95%: 34.6-45.0) y en trabajadores que permanecieron en la unidad médica de 16.0% (IC95%: 14.9-17.1). El riesgo relativo fue de 0.40 (IC95%: 0.34-0.47) para trabajadores que permanecieron laborando en la unidad de salud. Conclusión: la incidencia de COVID-19 fue superior en trabajadores de la salud con resguardo domiciliario que en aquellos que continuaron con actividades normales en la unidad médica.

Evaluation of the prescription pattern of ferrous sulfate as a therapy for preventing iron deficiency anemia in infants.

BACKGROUND: Iron deficiency prevalence in infants is high. Therefore, iron supplementation has been recommended and specified as a program. This study aimed to determine the characteristics of the prescription of ferrous sulfate as a preventive therapy for iron deficiency anemia in young infants. METHODS: We conducted a descriptive cross-sectional study of clinical records of young infants with eight visits per year. We analyzed a total of 287 records. The prescription characteristics included five criteria prescription indication, age at prescription, dosage, periodicity, and time. These characteristics were scored as follows 1 point when it was considered adequate and 0 when it was considered inadequate; the minimum possible score was 0, and the maximum possible score was 5 points. Statistical analysis included percentages and 95% confidence intervals (CI). RESULTS: The prescription pattern of ferrous sulfate as preventive therapy in infants under one year of age was indicated in 100% of the records reviewed. All five criteria were met in 18.1% of the reviewed records (95%CI 13.6-22.6). The lowest compliance corresponded to adequate dosage (29.2%; 95%CI 23.9-34.5). Age at prescription was correct in 75.9% (95%CI 70.9-80.9); duration of prescription was correct in 44.2% (95%CI 38.4-50.0), and periodicity was proper in 31.1% (95%CI 25.9-36.7) of the files reviewed. CONCLUSIONS: Compliance with the prescription of ferrous sulfate as a preventive measure for anemia in infants was not as expected; interventions are needed to reverse this behavior.

INTRODUCCIÓN: Debido a que la prevalencia de deficiencia de hierro en el lactante es alta, el aporte de hierro se ha recomendado como suplemento y se ha concretado como programa. El objetivo del estudio fue determinar las características de la prescripción de sulfato ferroso como terapia de prevención de anemia ferropénica en el lactante menor. MÉTODOS: Se llevó a cabo un estudio descriptivo con diseño transversal de expedientes clínicos de lactantes menores con ocho consultas al año. Se analizaron 287 expedientes. Las características de prescripción incluyeron cinco criterios: indicación de prescripción, edad de indicación, dosificación, periodicidad y tiempo. Se calificó con 1 punto cuando la característica se consideró adecuada y con 0 cuando se consideró inadecuada; la puntuación mínima posible fue 0 y la puntuación máxima posible de 5 puntos. El análisis estadístico incluyó porcentajes e intervalos de confianza (IC) al 95%. RESULTADOS: El patrón de prescripción del sulfato ferroso como terapia preventiva en el menor de un año se encontró indicado en 100% de los expedientes revisados. Se cumplió exactamente con los cinco criterios en el 18.1% de los expedientes revisados (IC95% 13.6-22.6); el cumplimiento más bajo correspondió a la dosificación adecuada (29.2%; IC95% 23.9-34.5). La edad de inicio fue correcta en el 75.9% (IC95% 70.9-80.9); la duración de la prescripción fue correcta en el 44.2% (IC95% 38.4-50.0) y la periodicidad fue correcta en el 31.1% (IC95% 25.9-36.7) de los expedientes revisados. CONCLUSIONES: El cumplimiento de la prescripción de sulfato ferroso como medida preventiva de la anemia en lactantes no fue el esperado, por lo que se requiere adoptar intervenciones para revertir este comportamiento.

[Risk factors and the probability of developing dental decay in four-year-old children]. / Factores de riesgo y probabilidad de caries en niños de 4 años de edad.

OBJECTIVE: To identify the risk factors and to estimate the probability to develop dental decay. METHODS: A study of cases and controls in 4-year-old children, with a sample of 102 patients selected by quota was done. The oral hygiene habit, consumption of cariogenic food, annual oral evaluation and topical application of fluorine were studied as risk factors. The statically analysis included bivariated and multiple regression logistic, and estimation of the probability to develop decay. RESULTS: The oral hygiene habit was identified like the main risk factor with the greatest influence (OR=15.27) in the multiple model integrated with the variable mentioned, consumption of cariogenic food and oral annually evaluation. It turned out to be significant (p=0.00). The highest probability to present decay was of 76% and the lowest of 5%. CONCLUSIONS: Hygienic habit was the most important risk factor to develop dental decay.

Comparison of growth and psychomotor development in daycare centers attended by professionals.

BACKGROUND: Growth and development reflect the child's health condition. Currently, child care is supported in daycare centers. In this context, this article aimed to identify the differences in growth and psychomotor development in children according to their attendance at daycare centers. METHODS: We conducted an analytical cross-sectional study in children aged 25 to 48 months. Two groups were identified: 68 children attended daycare, and 68 children did not attend daycare. Growth was assessed with weight-for-height curves, and psychomotor development was evaluated with the child developmental assessment instrument (psychosocial, language, psychomotor, and cognitive area). The X2 test was used for statistical analysis. RESULTS: The percentage of daycare children with ideal weight was higher than those not attending in daycare (p = 0.035). Psychomotor development was significantly higher in daycare children: in the psychosocial (p = 0.000), language (p = 0.000), motor (p = 0.000), and cognitive development (p = 0.000) areas. CONCLUSIONS: The psychomotor development of children attending daycare centers is superior to that of children not in daycare centers.

INTRODUCCIÓN: La salud del niño se puede evaluar a partir de su crecimiento y desarrollo. En la sociedad actual, el cuidado de los hijos se comparte con las guarderías infantiles. En este contexto, el objetivo del artículo fue identificar las diferencias de crecimiento y desarrollo psicomotor en niños de acuerdo con su asistencia a las guarderías. MÉTODOS: Se llevó a cabo un estudio transversal analítico en niños de 25 a 48 meses de edad. Se identificaron dos grupos: 68 niños atendidos en guarderías y 68 niños no atendidos en guarderías. El crecimiento se evaluó con las curvas de peso para la talla y el desarrollo psicomotor, con el instrumento de evaluación del desarrollo del niño (área psicosocial, lenguaje, psicomotriz, y cognitiva). Se utilizó la prueba de X2 para el análisis estadístico. RESULTADOS: El porcentaje de niños de guardería con peso ideal es superior al de los no atendidos en guardería (p = 0.035). El desarrollo psicomotor es significativamente mayor en los niños de guardería: en el área psicosocial (p = 0.000), en lenguaje (p = 0.000), en el área motriz (p = 0.000) y en desarrollo cognitivo (p = 0.000). CONCLUSIONES: El desarrollo psicomotor de los niños atendidos en guardería es superior al de los niños no atendidos en guardería.

[Opportunity cost for men who visit family medicine units in the city of Querétaro, Mexico]. / Costo de oportunidad en hombres que acuden a las unidades de medicina familiar en la ciudad de Querétaro, México.

OBJECTIVE: To determine the opportunity cost for men who seek care in the family medicine units (FMU) of the Mexican Social Security Institute (IMSS, Instituto Mexicano del Seguro Social) in the city of Querétaro. METHODS: A sample was selected of 807 men, ages 20 to 59 years, who sought care through the family medicine, laboratory, and pharmacy services provided by the FMU at the IMSS in Querétaro. Patients referred for emergency services and those who left the facilities without receiving care were excluded. The sample (n = 807) was calculated using the averages for an infinite population formula, with a confidence interval of 95% (CI95%) and an average opportunity cost of US$5.5 for family medicine, US$3.1 for laboratory services, and US$2.3 for pharmacy services. Estimates included the amount of time spent on travel, waiting, and receiving care; the number of people accompanying the patient, and the cost per minute of paid and unpaid job activities. The opportunity cost was calculated using the estimated cost per minute for travel, waiting, and receiving care for patients and their companions. RESULTS: The opportunity cost for the patient travel was estimated at US$0.97 (CI95%: 0.81-1.15), while wait time was US$5.03 (CI95%: 4.08-6.09) for family medicine, US$0.06 (CI95%: 0.05-0.08) for pharmacy services, and US$1.89 (CI95%: 1.56-2.25) for laboratory services. The average opportunity cost for an unaccompanied patient visit varied between US$1.10 for pharmacy services alone and US$8.64 for family medicine, pharmacy, and laboratory services. The weighted opportunity cost for family medicine was US$6.24. CONCLUSIONS: Given that the opportunity cost for men who seek services in FMU corresponds to more than half of a minimum salary, it should be examined from an institutional perspective whether this is the best alternative for care.

[Cost-effectiveness analysis in type 2 diabetes patients without hypertension]. / Costo-efectividad de SOHDi en pacientes con diabetes tipo 2 sin hipertensión.

OBJECTIVE: To determine SOHDi program cost-effectiveness (S = overweight, O = obesity, H = hypertension, Di = diabetes) in type 2 diabetes patients (DM2) without hypertension. METHODS: Sample included 32 patients. The effectiveness was measured by the blood glucose values. The SOHDi intervention cost included physician medical attention cost (PMAC), laboratory cost (LC), education group cost and individual evaluation cost. The cost of the traditional alternative medical attention (TAMA) contemplated PMAC and LC. The analysis cost-effectiveness included different intervals measurements, equal or smaller than 140 mg/dL blood glucose levels. RESULTS: The percentage of population with equal or smaller than 140 mg/dL blood glucose (effectiveness) in SOHDi was 23.3%, in TAMA was 44.8%. The average cost in SOHDi was $2202.22; in TAMA $1930.79. In the cases with blood glucose equal or smaller to 140 mg/dL the cost of effectiveness of 50% was $4726 in SOHDi and $2155 in TAMA. In this same situation the effectiveness by $1000 was 10.58% in SOHDi and 23.20% in TAMA. CONCLUSIONS: The SOHDi group is not the best alternative, at least not in the present operational conditions.

[To face up the disease strategy as a risk factor for the life style in type 2 diabetics]. / Estrategia de afrontamiento de la diabetes como factor de riesgo para el estilo de vida.

OBJECTIVE: To identify to the life style as a risk factor after the strategy of facing the disease in type 2 diabetic patients. METHODS: A study of cases and controls was made in patients with type 2 diabetes of five primary care units in the metropolitan area of Queretaro city. The sample size was of 48 patients by group. They were chosen by quota in the waiting room. Sociodemographic variables and health aspects were included in the questionnaire. The life style was investigated by the Instrument to Measure the Style of Life in Diabetics (IMEVID). For the evaluation of type of facing the scale of Strategy of Facing was used as opposed to extreme risks. Measures of central tendency, χ² and odds ratio were included. RESULTS: The type of active facing was a risk factor for the style of life with a p = 0.0001. CONCLUSIONS: The strategy of active facing disease is a risk factor for the style of life in the type 2 diabetic patient.

Institutional cost of the patient with chronic kidney disease managed with hemodialysis. / Costo institucional del paciente con enfermedad renal crónica manejada con hemodiálisis.

BACKGROUND: Chronic kidney disease cost is considered high for health systems due to the amount of supplies required for treatment and increasing prevalence. OBJECTIVE: Determine institutional cost of hemodialysis in chronic kidney disease. METHOD: Cost design from the institutional perspective, in patients with chronic kidney disease managed with hemodialysis. The sample size was 269 and the sample technique for consecutive cases. Annual fixed average cost (times and movements technique) and annual variable average cost (microcosting technique) adjusted by use of services, helped to identify annual average cost by function of production and service, the sum of these resulted in annual cost of care. Statistical analysis included averages and projections. RESULTS: The average annual cost of the patient with chronic kidney disease on hemodialysis varies between $223,183 and $257,000; the cost in life is $1,198,968. The institutional total cost it corresponds to between 1.47% and 1.73% of the budget. CONCLUSIONS: Hemodialysis cost in chronic kidney disease is high for the institution, however, hemodialysis allows the survival of the patient.

INTRODUCCIÓN: El costo de la enfermedad renal crónica es alto para los sistemas de salud debido a los insumos y la prevalencia. OBJETIVO: Determinar el costo institucional del tratamiento del paciente con enfermedad renal crónica en manejo con hemodiálisis. MÉTODO: Estudio de costos desde la perspectiva institucional, realizado en pacientes con enfermedad renal crónica manejada con hemodiálisis. El tamaño de muestra fue de 269 y la técnica muestral fue por casos consecutivos. El costo promedio fijo anual (técnica de tiempos y movimientos) y el costo promedio variable anual (técnica de microcosteo) ajustado por el perfil de uso de servicios identificaron el costo promedio anual por función de producción y servicio, y la suma de estos, el costo anual de la atención. El análisis estadístico incluyó promedios y proyecciones. RESULTADOS: El costo promedio anual del paciente con enfermedad renal crónica manejado con hemodiálisis varía entre $223,183 y $257,000; el costo en la vida es de $1,198,968. El costo total para la institución supone entre el 1.47% y el 1.73% del presupuesto. CONCLUSIONES: El costo de la hemodiálisis en la enfermedad renal crónica es alto para la institución; sin embargo, la hemodiálisis permite la supervivencia de los pacientes.

Disability adjusted life years lost due to acute, chronic disability and premature death in arterial hypertension / Vida saludable perdida por discapacidad aguda, crónica y muerte prematura en hipertensión arterial

Objective: To determine the disability adjusted life years in arterial hypertension without diabetes mellitus. Method: Disability adjusted life years was determined from chronic disability (chronic kidney disease, heart disease and cerebral vascular event), acute disability (hypertensive crisis and hypertensive emergency) and premature death. Age of diagnosis, age of the complication, prevalence of the complication, duration of the acute event, number of acute events, time lived with hypertension, age of death and life expectancy were identified. In all cases a 3% discount rate was applied, the estimate was made per 100,000. Results: When the total of women was used as a reference, the disability adjusted life years in women is 198,498.28. In men, using the total number of men as a reference, the value is 204,232.13. If the referent is the total population, in women the disability adjusted life years is 102,028.11 and in men 99,256.98. Conclusions: The disability adjusted life years in arterial hypertension without diabetes is different for men and women; the topic has many edges that must be studied.

Objetivo: Determinar la vida saludable perdida por hipertensión arterial sin diabetes mellitus. Método: La vida saludable perdida se determinó a partir de la discapacidad crónica (enfermedad renal crónica, cardiopatía y evento vascular cerebral), la discapacidad aguda (crisis hipertensiva y emergencia hipertensiva) y la muerte prematura. Se identificaron la edad del diagnóstico, la edad de la complicación, la prevalencia de la complicación, la duración del evento agudo, el número de eventos agudos, el tiempo vivido con hipertensión, la edad de la muerte y la esperanza de vida. En todos los casos se aplicó una tasa de descuento del 3%. La estimación se realizó por 100,000. Resultados: Cuando se utilizó como referencia el total de mujeres, la vida saludable perdida en ellas es de 198,498.28. Empleando como referencia el total de hombres, el valor para ellos es de 204,232.13. Si el referente es el total de la población, para las mujeres la vida saludable perdida es de 102,028.11 y para los hombres es de 99,256.98. Conclusiones: La vida sWaludable perdida por hipertensión arterial sin diabetes es diferente en hombres y mujeres; no obstante, tiene muchas aristas que deben abordarse.

[Relationship between functional social support and vital satisfaction in the elderly]. / Relación entre apoyo social funcional y satisfacción vital del adulto mayor jubilado.

BACKGROUND: To determine the relationship between functional social support and vital satisfaction of the elder retirement adult. METHODS: Comparative cross-sectional study in retired adults aged 60 years and more. Two groups were integrated (high and low satisfaction) evaluated with Moral Scale of Satisfaction of the Geriatric Center of Philadelphia modified and validated by Montorio. The sample size was calculated with comparative cross-sectional studies formula, presence of the social support of 80 % in the group of high satisfaction and 50 % in the one of low satisfaction (n = 29). The selection was made at random using the payroll listing of retirees. Social demographic variables were studied. Relationship between the retirement and functional social support was evaluated with the scale of Functional Social Support of Duker-UNC-11. RESULTS: Sociodemographic characteristics and those related to the retirement did not present significant statistical differences (p > 0.05) in the groups of high and low satisfaction. There was an association between the functional social support and the vital satisfaction with odds ratio of 3.00 (95%CI = 1.08-8.32). CONCLUSIONS: Functional social support and vital satisfaction in the elderly were associated.

Direct cost of medical care in patients with gonarthrosis. / Costo directo de la atención médica en pacientes con gonartrosis.

OBJECTIVE: To determine the cost of medical care in patients with gonarthrosis. MATERIAL AND METHODS: Cost study in patients over 40 years of age with gonarthrosis, diagnosed according to the radiological classification of Kellgren and Lawrence. The average annual cost (euros) was estimated taking the unit cost plus average use of services such as family medicine, imaging, laboratory, electrodiagnosis, orthopedics, hospitalization, physical therapy, surgery, nutrition, preoperative assessment and medication. Projections based on assumptions were made for three scenarios. RESULTS: Grade 2 gonarthrosis predominated at 39.7% (95% confidence interval, 33.8 - 45.6). The annual cost of care for a patient with gonarthrosis was €108.87 in the intermediate scenario, €86.73 in the lower cost scenario and €132.60 in the higher cost scenario. For a population of 119,530,753 inhabitants, with 10,937,064 gonarthrosis patients, the annual cost in the intermediate scenario was €1,190,685,273 and represented 4.48% of the health expenditure. CONCLUSION: The average annual cost of gonarthrosis is relatively low, but when related to prevalence and prevalence trends, it can become a serious problem for health services.

Risk factors for developing acute kidney injury in elderly patients / Factores de riesgo para desarrollar lesión renal aguda en pacientes ancianos

Background: The incidence of acute kidney injury in hospitalized elderly is a frequent event that makes them prone to complications and can even lead to death. Therefore, identifying risk factors for developing acute kidney injury becomes a priority in the process of care of the elderly. Objective: To identify the main risk factors for acute kidney injury in hospitalized elderly and, on the basis of those risk factors, calculate the probability of presentation. Methods: Case-control study nested in a cohort, which included patients of 60 years or older, admitted to the Internal Medicine service at an institution of social security in Querétaro, Mexico. Patients with acute kidney injury were identified as cases and patients without acute kidney injury were included in the control group. Acute kidney injury was diagnosed when there was an increased creatinine level ≥ 0.3 mg/dL (≥ 26.4 mmol/L) in a period < 48 hours. Results: Hypovolemia and infection were identified as risk factors for acute kidney injury and they were included into the model of multiple logistic regression (y = 1,111 + 1,063 [infection] + 1.422 [hypovolemia]), (p = 0.002). The highest probability of having acute kidney injury was 80%. Conclusions: Two factors for acute kidney injury and a prediction model were identified.

Introducción: la lesión renal aguda en pacientes ancianos hospitalizados es un evento frecuente que los predispone a complicaciones e incluso a la muerte. Es así que al atender a un anciano es prioritario identificar los factores de riesgo para presentar tal evento. Objetivo: identificar los principales factores de riesgo para lesión renal aguda en el anciano hospitalizado y a partir de ellos, calcular la probabilidad de presentación. Métodos: estudio de casos y controles anidado en una cohorte que incluyó pacientes de 60 años o más, ingresados en el servicio de medicina interna de una institución de seguridad social en Querétaro, México. Se identificó como caso al paciente con lesión renal aguda y como control al paciente sin lesión renal aguda. La lesión renal aguda se diagnosticó cuando existió un incremento de la creatinina ≥ 0.3 mg/dL (≥ 26.4 mmol/L) en un tiempo < 48 horas. Resultados: se identificaron como factores de riesgo para lesión renal aguda la hipovolemia y la infección, se integraron al modelo de regresión logística múltiple (y = −1.111 + 1.063 [infección] + 1.422 [hipovolemia]) p = 0.002. La probabilidad más alta de presentar lesión renal aguda fue de 80%. Conclusiones: se identificaron dos factores para lesión renal aguda y un modelo de predicción.

Costo y porcentaje de gasto en salud por COVID-19 en primer nivel de atención / Cost and percentage of health spending by COVID-19 at the first level of care

Antecedentes. Ante la pandemia de COVID-19 el sistema de salud reasignó recursos económicos para la atención. Objetivo. Determinar el costo de la atención y el porcentaje del gasto en salud por COVID-19 en una unidad de medicina familiar de primer nivel de atención. Metodología. Estudio de costo y porcentaje de gasto en COVID-19 en una unidad de primer nivel de atención. Se identificaron los servicios generales y finales, para construir el costo fijo se utilizó la técnica de tiempos y movimientos, se identificaron el total de partidas presupuestales ejercidas en la unidad médica para cada uno de los servicios, para desagregar el gasto de los servicios generales a los finales se construyeron ponderadores. El costo variable se realizó con la técnica consenso de expertos y microcosteo. El costo promedio se relacionó con la productividad por servicio y con el total de pacientes atendidos por COVID-19, el resultado se relacionó con el presupuesto ejercido de la unidad. Resultados. El costo anual de la atención de COVID-19 en módulo respiratorio fue 158.597,25 dólares americanos, en medicina familiar fue 192.549,36 dólares americanos, el costo total ejercido en el año 2021 para atención de SARS COV 2 en una unidad de primera atención fue 351.146,61 dólares americanos. Esta cantidad representa el 9,6 % del gasto en salud. Conclusión. El costo en atención de COVID-19 y el porcentaje del gasto en salud en primer nivel de atención es elevado (AU)

Background. In the COVID-19 pandemic, the health system reallocated financial resources for care. Objetive. To determine the cost of care and the percentage of health spending due to COVID-19 in a first level care family medicine unit. Metodology. Study of the cost and percentage of spending on COVID-19 in a first-level care unit. The general and final services were identified, to construct the fixed cost, the technique of times and movements was used, the total budget items exercised in the medical unit for each of the services were identified, to disaggregate the expense of general services to the endings were constructed weights. Variable costing was performed using the expert consensus technique and microcosting. The average cost was related to productivity per service and to the total number of patients treated for COVID-19, the result was related to the budget used by the unit. Results. The annual cost of COVID-19 care in the respiratory module was 158.597,25 US dollars, in family medicine it was 192.549,36 US dollars, the total cost incurred in 2021 for SARS COV 2 care in a unit of first attention was 351.146,61 US dollars. This amount represents 9,6% of health spending. Conclusion. The cost of COVID-19 care and the percentage of health spending at the first level of care is high (AU)