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)

Gasto de bolsillo en salud en la familia con diabetes-hipertensión durante la pandemia del covid-19 / Out-of-pocket health spending in the family with diabetes-hypertension during the covid-19 pandemic

Determinar el gasto de bolsillo en salud en las familias con diabetes mellitus y/o hipertensión arterial y el porcentaje del ingreso familiar durante la pandemia del Covid-19. Estudio de gasto de bolsillo en salud que incluyó muestreo consecutivo de 268 familias de México. El ingreso trimestral familiar se definió como la suma de ingresos de cada uno de los integrantes de la familia, el gasto en salud se definió como el total de erogaciones que tuvo la familia para cubrir los diferentes servicios de salud, y porcentaje de gasto en salud se definió como la relación del gasto total trimestral y el gasto corriente del hogar, valores expresados en pesos mexicanos. El promedio trimestral del gasto de bolsillo en salud en la familia con diabetes mellitus y/o hipertensión arterial en la dimensión consulta fue $975,82 y en la dimensión medicamentos $1,371.22; el gasto promedio total trimestral fue $3,133.08. El ingreso trimestral de la familia después de la pandemia del covid-19 fue $85,348.86 lo que representa 5,93% menos del ingreso trimestral antes de la pandemia. El gasto trimestral en salud fue $3,133.08, lo cual corresponde a 3,45% y 3,67% del ingreso trimestral familiar antes y después de la pandemia del Covid-19 respectivamente (AU)

Determine out-of-pocket health spending in families with diabetes mellitus and/or high blood pressure and the percentage of family income during the Covid-19 pandemic. Study of out-of-pocket health spending that included consecutive sampling of 268 families in Mexico. The quarterly family income was defined as the sum of income of each of the family members, health spending was defined as the total expenses that the family had to cover the different health services, and percentage of health spending. It was defined as the relationship between total quarterly expenditure and current household expenditure, values expressed in Mexican pesos. The quarterly average of out-of-pocket health expenditure in the family with diabetes mellitus and/or arterial hypertension in the consultation dimension was $975.82 and in the medication dimension $1,371.22; The average total quarterly expense was $3,133.08. The family's quarterly income after the covid-19 pandemic was $85,348.86, which represents 5.93% less than the quarterly income before the pandemic. The quarterly health expenditure was $3,133.08, which corresponds to 3.45% and 3.67% of the family's quarterly income before and after the Covid-19 pandemic respectively (AU)

[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.

Costo del retiro anticipado de métodos de planificación familiar / Cost of early removal of family planning methods

Resumen OBJETIVO: Determinar el costo del retiro anticipado de los métodos de planificación familiar. MATERIALES Y MÉTODOS: Estudio de costo efectuado con base en los expedientes de usuarias de métodos de planificación familiar en una institución de salud del estado de Querétaro, México (2018 a 2021). La unidad de observación fue el expediente de mujeres que se retiraron anticipadamente los métodos: dispositivo intaruterino T de cobre (DiuTcu), Diu Mirena (DiuM) e implante subdérmico (IMSD). Se definió como retiro anticipado al sucedido antes del tiempo estimado de uso. Se analizaron todos los expedientes en donde estaba registrado el retiro anticipado. Se incluyó a toda la población, de ahí que no fue necesario establecer el tamaño de muestra. El costo del retiro anticipado se identificó a partir del costo unitario del método, tiempo esperado de uso y tiempo de no uso. El análisis estadístico incluyó: promedios, porcentajes, intervalos de confianza y proyecciones, para esto se utilizaron supuestos. RESULTADOS: Se estudiaron 1361 expedientes. El costo unitario del retiro anticipado del DiuTcu fue de 5.59 pesos (IC95%: 5.04 a 6.14), del DiuM de 1210.73 pesos (IC95%: 1029.58 a 1391.87) y del IMSD de 658.41 pesos (IC95%: 557.37 a 759.44). La proyección a la población mexicana del costo del retiro anticipado de los métodos de planificación familiar es 219,272,470 de pesos. CONCLUSIÓN: El costo del retiro anticipado de los métodos de planificación familiar es alto.

Abstract OBJECTIVE: To determine the cost of early removal of family planning methods. MATERIALS AND METHODS: Cost study realized in records of women users of family planning method in a health institution in Querétaro, Mexico from 2018 to 2021. The unit of observation was considered to be the records of women who had early removal of the copper IUD, Mirena IUD and subdermal implant methods. Early removal was defined as the retirement of the method before the estimated time of use. Work was done with the total number of records (1361), with early removal in 148 (83 copper IUDs, 28 Mirena IUDs, 37 subdermal implants). The entire population was included, so no sampling technique was used. The cost of early removal was identified from the unit cost of the method, expected time of use, time of non-use. The statistical analysis plan included averages, percentages, confidence intervals and projections for which assumptions were used. RESULTS: The unit cost of early removal of copper IUD was $5.59 (95% CI; 5.04-6.14), Mirena IUD $1210.73 (95% CI; 1029.58 - 1391.87) Subdermal implant $658.41 (95% CI; 557.37- 759.44). The projection to the Mexican population of the cost of early removal of family planning methods is $359, 384,161. CONCLUSION: The cost of early removal of family planning methods is high.

[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.

Enfermedades crónicas degenerativas como factor de riesgo de letalidad por COVID-19 en México

[RESUMEN]. Objetivo. Determinar el riesgo de letalidad de las enfermedades crónicas degenerativas en pacientes con COVID-19. Métodos. Se realizo un estudio de cohorte, en expedientes clínicos electrónicos de pacientes con RT-PCR positiva para COVID-19 en atención ambulatoria o intrahospitalaria en una Institución de Seguridad Social de marzo 2020 a marzo 2021. Se integraron 2 grupos de estudio, el grupo expuesto se dividió en cuatro subgrupos, cada uno con diagnóstico único y exclusivo de una patología crónica (diabetes, hipertensión, obesidad o enfermedad renal crónica); el grupo no expuesto lo integraron expedientes de pacientes sin comorbilidades. Se revisaron 1 114 expedientes en total utilizando técnica muestral aleatoria simple, una vez obtenido el tamaño mínimo de muestra se calculó el riesgo relativo para cada enfermedad crónica, se realizaron combinaciones de 2, 3 y 4, con cada uno de ellos se realizó el análisis. Resultados. En ausencia de enfermedad crónica degenerativa la prevalencia de letalidad en COVID-19 es 3,8%; en presencia de diabetes mellitus tipo 2 la letalidad es 15,8; en hipertensión arterial de 15,6%; y en obesidad 15,0%. Cuando se combinan diabetes e hipertensión la letalidad es 54,1%; en diabetes y obesidad 36,8%; y en obesidad e hipertensión 28,1%. Conclusiones. En pacientes con COVID-19 el riesgo relativo para letalidad de letalidad en diabetes es 4,17; en hipertensión 4,13; y en obesidad 3,96. Cuando se combinan dos enfermedades crónicas el riesgo relativo se duplica o triplica, para diabetes e hipertensión el riesgo relativo para letalidad es 14,2; para diabetes y obesidad 9,73; y para obesidad e hipertensión 7,43. Es verdad que las enfermedades crónicas no se presentan solas, generalmente se encuentra asociadas, y desde esa perspectiva los riesgos relativos para letalidad ofrecidos en este artículo adquieren relevancia.

[ABSTRACT]. 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.

[RESUMO]. 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.

[Systematization of a comprehensive intervention for strengthening the COVID-19 medical care]. / Sistematización de una intervención gerencial integral para fortalecer la atención médica por COVID-19.

The COVID-19 pandemic established a new challenge for health services in Mexico, which is why these services faced the challenge of responding to the affected people, by providing them services with opportunity, efficiency, effectiveness and safety. The Instituto Mexicano del Seguro Social (IMSS, Mexican Institute for Social Security) gave medical attention to the larger number of affected people: towards the end of September, 2022, 3,335,552 patients were registered, who represented 47% of the total (7,089,209) of confirmed COVID-19 cases since the beginning of the pandemic in 2020. Of all the cases treated, 295,065 (8.8%) required hospitalization. In addition of new scientific evidence and the implementation of best practices in medical care and directive management (with the general objective of improvement of the processes in hospital attention, even without an effective treatment at the time), we presented an evaluation, supervision method with a comprehensive (involving the three levels of health services) and analytic (structure, process, result and directive management components) approach. The achievement of specific goals and lines of action was established in a technical guideline with health policies for the COVID-19 medical care. These guidelines were instrumented with a standardized evaluation tool, a result dashboard and a risk assessment calculator, improving the quality of medical care and directive management by the multidisciplinary health team.

La pandemia por COVID-19 puso a prueba la prestación de servicios de los sistemas de salud en México, por lo que estos enfrentaron el reto de responder a la necesidad de las personas afectadas al otorgar servicios oportunos, eficientes, eficaces y seguros. El Instituto Mexicano del Seguro Social (IMSS) atendió el mayor número de personas afectadas: al cierre de septiembre del 2022, se registraron 3,335,552 pacientes atendidos, quienes representaron 47% del total (7,089,209) de casos confirmados desde el inicio de la pandemia en 2020. De los casos notificados por el IMSS, 295,065 (8.8%) requirieron hospitalización. Mediante un atento seguimiento de la evolución de la evidencia científica (que permitió identificar y adoptar las mejores prácticas de atención médica y gestión directiva para fortalecer los procesos sustantivos en la atención hospitalaria, aun sin un tratamiento eficaz), se integró un método de evaluación, supervisión y asesoría, con enfoque integral (que involucró los tres niveles de atención médica) y analítico (componentes de estructura, proceso, resultado y gestión directiva). Los objetivos de la atención y las líneas de acción se describieron en una guía técnica que estableció las políticas de atención médica al COVID-19. Asimismo, fue instrumentado con una cédula de evaluación estandarizada, un tablero de control de resultados y una herramienta de estratificación del riesgo. Con ello se mejoró la calidad de atención por medio de la participación del personal directivo y de equipos multidisciplinarios de salud, los cuales permitieron la toma de decisiones clínicas y gerenciales.

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

RESUMEN Objetivo. Determinar el riesgo de letalidad de las enfermedades crónicas degenerativas en pacientes con COVID-19. Métodos. Se realizo un estudio de cohorte, en expedientes clínicos electrónicos de pacientes con RT-PCR positiva para COVID-19 en atención ambulatoria o intrahospitalaria en una Institución de Seguridad Social de marzo 2020 a marzo 2021. Se integraron 2 grupos de estudio, el grupo expuesto se dividió en cuatro subgrupos, cada uno con diagnóstico único y exclusivo de una patología crónica (diabetes, hipertensión, obesidad o enfermedad renal crónica); el grupo no expuesto lo integraron expedientes de pacientes sin comorbilidades. Se revisaron 1 114 expedientes en total utilizando técnica muestral aleatoria simple, una vez obtenido el tamaño mínimo de muestra se calculó el riesgo relativo para cada enfermedad crónica, se realizaron combinaciones de 2, 3 y 4, con cada uno de ellos se realizó el análisis. Resultados. En ausencia de enfermedad crónica degenerativa la prevalencia de letalidad en COVID-19 es 3,8%; en presencia de diabetes mellitus tipo 2 la letalidad es 15,8; en hipertensión arterial de 15,6%; y en obesidad 15,0%. Cuando se combinan diabetes e hipertensión la letalidad es 54,1%; en diabetes y obesidad 36,8%; y en obesidad e hipertensión 28,1%. Conclusiones. En pacientes con COVID-19 el riesgo relativo para letalidad de letalidad en diabetes es 4,17; en hipertensión 4,13; y en obesidad 3,96. Cuando se combinan dos enfermedades crónicas el riesgo relativo se duplica o triplica, para diabetes e hipertensión el riesgo relativo para letalidad es 14,2; para diabetes y obesidad 9,73; y para obesidad e hipertensión 7,43. Es verdad que las enfermedades crónicas no se presentan solas, generalmente se encuentra asociadas, y desde esa perspectiva los riesgos relativos para letalidad ofrecidos en este artículo adquieren relevancia.

ABSTRACT 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.

RESUMO 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.

Prevalencia del uso de medicina tradicional herbolaria y el perfil de uso en pacientes con diabetes tipo 2 de una zona urbana

RESUMEN En México la interculturalidad en salud se plantea como una integración de dos sistemas de conocimiento, el conocimiento ancestral carente de bases científicas y que se transmite a través de las generaciones, y el modelo médico convencional. En múltiples estudios se describe que existe un gran porcentaje de médicos que han recibido pacientes que hacen uso de esta terapéutica. El objetivo fue identificar la prevalencia del uso de medicina tradicional herbolaria y el perfil de uso en pacientes con diabetes tipo 2 en una zona urbana. Se realizó un estudio observacional, transversal descriptivo en pacientes con diagnóstico de diabetes mellitus tipo 2, pertenecientes a un sistema de seguridad social de la ciudad de Querétaro, en un periodo mayor a 6 meses. El plan de análisis estadístico incluyó promedios, porcentajes, intervalos de confianza para promedios e intervalos de confianza para porcentajes. Se identificó que la prevalencia de uso de la medicina tradicional herbolaria era de 22.2%, con una edad promedio de 60.98 años, con predominio en el sexo femenino y una escolaridad secundaria o menos, la planta más utilizada fue moringa en un 45%, el uso más frecuente para el control glucémico en un 97% y su consumo era como agua de tiempo en la mayoría de las plantas. En este estudio se pudo describir la prevalencia de uso en una zona urbana, así como el perfil de las personas que hacen uso de esta terapéutica, con la finalidad de generar nuevas informaciones y promover el estudio de estas prácticas.

ABSTRACT In Mexico the interculturality in health is posed as an integration of the two systems of knowledge, the ancient knowledge lacking scientific bases which is transmitted through generations, and the conventional medical model. In multiple studies, the existence of a great percentage of medical doctors that have received patients using this therapy is described. The objective was to identify the prevalence of the use of herbal traditional medicine and the profile of use in patients with diabetes type 2 in an urban zone. This was an observational, transversal descriptive study performed in patients with diagnostic of diabetes mellitus type 2, belonging to a system of social security in Queretaro city, in a period greater than 6 months. The plan of statistical analysis included averages, percentages, confidence intervals for averages and percentages. The prevalence of use of the herbal traditional medicine was 22.2% with and average age of 60.98 years old, with predominance of the female sex and a scholarship of middle school or less, the plant mostly used was moringa in a 45%, the most frequent use was the glycemic control in 97% and the consumption was as natural water in most plants. In this study, it was described the prevalence of the use in an urban zone, as well as the profile of the people that use this therapy, with the purpose of generate new information and promote the study of these practices.

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.

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.

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.

Cost of medical attention in patients with Chronic Obstructive Pulmonary Disease / Costo de la atención médica en pacientes con enfermedad pulmonar obstructiva crónica

Background: The chronic obstructive pulmonary disease is a preventable entity, when it develops the patient suffers severe complications, with a high economic impact for the patient and for health services. Objetive: To determine the cost of medical care in patients with chronic obstructive pulmonary disease (COPD). Methods: Using a cost design, the files of patients with COPD who attended the pulmonology clinic were analyzed. The size of the sample (n = 265) was calculated with the formula of averages of a finite population. The sample units were captured with the simple random technique. The study variables were: sociodemographic characteristics, characteristics of COPD, annual use profile, unit cost per service, total cost per service and total cost of medical care. The analysis plan included averages, percentages, confidence intervals and health expenditure projections. Results: The average annual cost of patient care with COPD was $ 89 479.08, of which $ 61 267.63 corresponded to medications. With a COPD prevalence of 25% in a population of 46 million, the calculated cost of care was $ 347 805 183 960. Conclusion: The cost of medical care in patients with COPD was high, at the expense of medications.

Introducción: la enfermedad pulmonar obstructiva crónica es una entidad prevenible, cuando se desarrolla, el enfermo sufre complicaciones severas, con un alto impacto económico para el paciente y para los servicios de salud. Objetivo: determinar el costo de la atención médica en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Métodos: con un diseño de costos se analizaron los expedientes de pacientes con EPOC que acudieron a consulta de neumología. El tamaño de la muestra (n = 265) se calculó con la fórmula de promedios de una población finita. Las unidades muestrales se capturaron con la técnica aleatoria simple. Las variables de estudio fueron: características sociodemográficas, características de la EPOC, perfil de uso anual, costo unitario por servicio, costo total por servicio y costo total de la atención médica. El plan de análisis incluyó promedios, porcentajes, intervalos de confianza y proyecciones del gasto en salud. Resultados: el costo promedio anual de la atención del paciente con EPOC fue $89 479.08, de los cuales $61 267.63 correspondieron a medicamentos. Con una prevalencia de EPOC de 25% en una población de 46 millones, el costo calculado de la atención fue $347 805 183 960. Conclusión: el costo de la atención médica en pacientes con EPOC fue alto en buena medida a expensas de los medicamentos.

Impacto económico institucional del programa Receta Resurtible con pacientes diabéticos / Institutional economic impact of the Receta Resurtible (Resupply Prescription) program in diabetic patients

Objetivo: determinar el impacto económico institucional del programa Receta Resurtible con pacientes diabéticos. Material y métodos: estudio de costos antes y después del programa Receta Resurtible con pacientes diabéticos. El costo promedio incluyó perfil de uso y costo unitario. El perfil de uso se determinó para Consulta externa, Farmacia y medicamentos. En el análisis se plantearon escenarios y se adoptaron supuestos. Resultados: el promedio de consultas antes y después se ubica en 6.45 y 4.73, respectivamente. La dotación de medicamentos fue 55.8% y 99%. El impacto del programa para una unidad de medicina familiar con 6400 pacientes diabéticos, de los cuales 18% se encuentra en el programa Receta Resurtible, permite un ahorro de $ 490 366 en la consulta de Medicina familiar y atención en Farmacia, sin embargo existe un incremento de $112 100 por consumo de medicamentos, el ahorro total en este escenario es de $378 266. Conclusión: el impacto económico del programa Receta Resurtible es benéfico para la institución.

Objective: To determine the institutional economic impact of the Resupply Prescription program in diabetic patients. Material and methods: Study of costs before and after the Resupply Prescription program with diabetic patients. The average cost included usage profile and unit cost. The profile of use was determined for External consultation, Pharmacy and medication. In the analysis, scenarios were raised and assumptions were adopted. Results: The average of before and after consultations is located at 6.45 and 4.73, respectively. The medication provision was 55.8 and 99%. The impact of the program for a Family Medicine Unit with 6400 diabetic patients, of which 18% is in the Resupply Prescription program, allows a saving of $ 490 366 in the consultation of Family Medicine and Pharmacy, however there is a increase of $ 112 100 for drug consumption, the total saving in this scenario is $ 378 266. Conclusion: The economic impact of the Resupply Prescription program is beneficial for the institution.

Los grupos educativos para la salud y los motivos de abandono de los pacientes / Health educational groups and the reasons patients drop out

Introduction: Patients and health professionals in educational groups have contrasting views of the institutional world, its objectives and the role played by each group of people in health care. Objective: To investigate the reasons why patients drop out of the Educational Strategy Groups for self-care in a social security institution. Materials and methods: Qualitative phenomenological design. A total of 29 patients were interviewed. They had a diagnosis of overweight, obesity, hypertension or diabetes and were sent to educational groups. Some never appeared, some dropped out after just one educational session, while others attended the four sessions. The interviews were transcribed and analyzed using the Giorgi method. During the analysis the following categories were established: a) power to choose, b) need to be heard, c) perceptions of institutional functions. Results: The main drop-out motive for patients is dissatisfaction as they perceive that their needs or expectations for health care are not being met by the institution. The patients look for other services or activities that, in their own view, can solve their problem. They build this choosing power through the perception and definition they make of themselves, their health concepts and the institutional functions. Conclusion: An educational group is not considered to be a first option to solve the patient's health problem since it breaks the healing function assigned to the institutions through their appointments with their family doctor, the medicines, surgeries and visits to specialists

Introducción: En la interacción personal que se suscita entre los pacientes y el personal de salud en los grupos educativos se oponen visiones diferentes sobre el mundo institucional, sus objetivos y el papel que desempeñan ambos en el cuidado de la salud. Objetivo: Indagar los motivos de los pacientes para abandonar los grupos con estrategia educativa para el autocuidado de la salud de una institución de seguridad social. Materiales y métodos: Diseño cualitativo fenomenológico. Se entrevistó un total de 29 pacientes con diagnóstico médico de sobrepeso, obesidad, hipertensión y diabetes, referidos a grupos con sesiones educativas que nunca se insertaron en los grupos o que abandonaron el grupo después de haber tenido alguna sesión educativa o que terminaron las cuatro sesiones educativas. Para analizar los datos, se transcribieron y analizaron las entrevistas con el método de Giorgi. Durante el análisis se establecieron las siguientes categorías: a) poder de elección, b) necesidad de ser escuchado, c) percepción sobre la función institucional. Resultados: El principal motivo del paciente para abandonar las sesiones educativas es la insatisfacción que siente al percibir que sus necesidades o expectativas de atención a la salud no son cubiertas por la institución. El paciente busca otros espacios que, a su consideración, pueden solucionar su problema. El paciente construye este poder de elección a través de la percepción y definición que hace sobre sí mismo, su concepto de salud y las funciones institucionales para tal evento. Conclusiones: Los grupos con sesiones educativas no son considerados como primera opción por el paciente, ya que rompe con el concepto de función curativa que le asigna a las instituciones a través de las consultas con su médico familiar, el empleo de fármacos, los eventos quirúrgicos y las consultas con los especialistas

Costo de la atención médica de pacientes con síndrome de fragilidad vs. pacientes con pre-fragilidad / Cost of patients care with fragility syndrome vs. pre-frailty patients

Introducción: el síndrome clínico de fragilidad se ha relacionado con eventos adversos como caídas, discapacidad, el estado cognitivo, hospitalizaciones e incluso la muerte, implicando con ello un mayor uso de los servicios de salud y de recursos. Objetivo: determinar el costo de la atención médica de pacientes con síndrome de fragilidad vs. pre-fragilidad. Métodos: estudio de costos en pacientes adultos mayores adscritos a tres unidades de medicina familiar que recibieron atención de enero 2011 a mayo de 2013. Se incluyeron expedientes de pacientes adultos mayores. Se integraron dos grupos: frágiles y pre-frágiles. El tamaño de la muestra (n=64) se calculó con la fórmula de promedios para dos poblaciones. La técnica muestral fue aleatoria estratificada, empleando como marco de muestra el listado de pacientes adultos mayores. Se estudiaron características sociodemográficas, de salud, perfil de uso de los servicios de medicina familiar, rayos x y laboratorio, y costos (costo unitario, costo promedio y costo promedio total). El análisis estadístico incluyó promedios y porcentajes. Resultados: la prevalencia de la hipertensión arterial en el grupo de pre-frágiles es 80,7 % y en el grupo frágil 95,5 %. La enfermedad con mayor tiempo de evolución en el grupo de pacientes con pre-fragilidad es la hipertensión arterial con 12,13 años y en el grupo de fragilidad la diabetes con promedio de 15,50. En pacientes frágiles el promedio de glucosa es de 156,67 mg/dl. El costo promedio total en el paciente con fragilidad es de $1 911,02 y en el paciente pre-frágil de $1 802,48. Conclusiones: el costo promedio total en ambos grupos presenta mínima diferencia, y su costo se relaciona con la inclusión del tratamiento de las enfermedades crónicas.

Introduction: the clinical syndrome of frailty has been linked to adverse events such as falls, disability, cognitive status, hospitalization and even death, implying greater use of health services and resources. Objective: determine the care cost of fragility syndrome patients vs. pre-frailty patients. Methods: acost study was conducted on elderly patients assigned to three family medicine units that received attention from January 2011 to May of 2013. Elderly patients' records were included. Two groups were formed: Pre-frail and fragile. The sample size (n = 64) was calculated with the average formula for two populations. The stratified random sampling technique was used as a framework for the list of elderly patients. Socio-demographic characteristics and other variables were studied: health, usage profile of family medicine services, x-rays and lab, and costs (unit cost, average cost and average total cost). Statistical analysis included averages and percentages. Results: the prevalence of hypertension is 80.7% in pre-frail group and 95.5% in the fragile group. Hypertension has the longest history in the pre- fragility group of patients with 12-13 years and diabetes has the longest history in the fragility group with average of 15, 50. In frail patients average glucose is 156.67 mg / dl. The total average cost in patients with fragility is $ 1 911.02 and $ 1 802.48 in pre-frail patients. Conclusions: the total average cost in both groups has minimal difference and its cost is related to the inclusion of treatment of chronic diseases.

[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.

Institutional and familial cost of patients in continuous ambulatory peritoneal dialysis.

OBJECTIVE: to determine the cost of institutional and familial care for patients with chronic kidney disease replacement therapy with continuous ambulatory peritoneal dialysis. METHODS: a study of the cost of care for patients with chronic kidney disease treated with continuous ambulatory peritoneal dialysis was undertaken. The sample size (151) was calculated with the formula of the averages for an infinite population. The institutional cost included the cost of outpatient consultation, emergencies, hospitalization, ambulance, pharmacy, medication, laboratory, x-rays and application of erythropoietin. The family cost included transportation cost for services, cost of food during care, as well as the cost of medication and treatment materials acquired by the family for home care. The analysis included averages, percentages and confidence intervals. RESULTS: the average annual institutional cost is US$ 11,004.3. The average annual family cost is US$ 2,831.04. The average annual cost of patient care in continuous ambulatory peritoneal dialysis including institutional and family cost is US$ 13,835.35. CONCLUSION: the cost of chronic kidney disease requires a large amount of economic resources, and is becoming a serious problem for health services and families. It's also true that the form of patient management in continuous ambulatory peritoneal dialysis is the most efficient in the use of institutional resources and family.

Institutional and familial cost of patients in continuous ambulatory peritoneal dialysis / Custo institucional e da família do paciente em diálise peritoneal ambulatorial contínua

Objective: to determine the cost of institutional and familial care for patients with chronic kidney disease replacement therapy with continuous ambulatory peritoneal dialysis. Methods: a study of the cost of care for patients with chronic kidney disease treated with continuous ambulatory peritoneal dialysis was undertaken. The sample size (151) was calculated with the formula of the averages for an infinite population. The institutional cost included the cost of outpatient consultation, emergencies, hospitalization, ambulance, pharmacy, medication, laboratory, x-rays and application of erythropoietin. The family cost included transportation cost for services, cost of food during care, as well as the cost of medication and treatment materials acquired by the family for home care. The analysis included averages, percentages and confidence intervals. Results: the average annual institutional cost is US$ 11,004.3. The average annual family cost is US$ 2,831.04. The average annual cost of patient care in continuous ambulatory peritoneal dialysis including institutional and family cost is US$ 13,835.35. Conclusion: the cost of chronic kidney disease requires a large amount of economic resources, and is becoming a serious problem for health services and families. It's also true that the form of patient management in continuous ambulatory peritoneal dialysis is the most efficient in the use of institutional resources and family. .

Objetivo: determinar o custo da atenção institucional e familiar do paciente com doença renal crônica terminal em tratamento substitutivo com diálise peritoneal ambulatorial contínua. Métodos: foi desenvolvido um estudo de custo da atenção com pacientes com doença crônica renal em tratamento com diálise peritoneal ambulatorial contínua. A amostra foi de 151 pessoas, calculada com a fórmula das médias para população infinita. No custo institucional foi incluído o custo da consulta externa, urgências, internamento, ambulância, farmácia, medicamentos, laboratório, raios X e administração de eritropoetina. No custo da família foi considerado o custo do traslado para receber os serviços, o custo das refeições durante a atenção, além do custo dos medicamentos e do material para curativos comprados pela família no atendimento domiciliar. A análise foi com médias, porcentagens e intervalo de confiança. Resultados: o custo anual institucional é US$11.004,3. O custo anual da família foi em média de US$2.381,04. O custo anual, em média, da atenção do paciente com diálise peritoneal ambulatorial contínua, incluindo o custo institucional e familiar, é de US$13.835,35. Conclusão: o custo da doença renal crônica requer uma grande quantidade de recursos econômicos, convertendo-se em um sério problema para os serviços de saúde e a família. .

Iodine nutrition in elementary state schools of Queretaro, Mexico: correlations between urinary iodine concentration with global nutrition status and social gap index.

OBJECTIVE AND METHODS: To estimate median urinary iodine concentration (UIC), and to correlate it with global nutrition indicators and social gap index (SGI) in 50 elementary state schools from 10 municipalities in the State of Queretaro, Mexico. RESULTS: 1,544 students were enrolled and an above of requirements of iodine intake was found (median UIC of 297 µg/L). Iodine status was found as deficient, adequate, more than adequate and excessive in 2, 4, 19 and 25 schools, respectively. Seventy seven percent of table salt samples showed adequate iodine content (20-40 ppm), while 9.6% of the samples had low iodine content (< 15 ppm). Medians of UIC per school were positively correlated with medians of body mass index (BMI) by using the standard deviation score (SDS) (r = 0.47; p < 0.005), height SDS (r = 0.41; p < 0.05), and overweight and obesity prevalence (r = 0.41; p < 0.05). Medians of UIC per school were negatively correlated with stunting prevalence (r = -0.39; p = 005) and social gap index (r = -0.36; p < 0.05). Best multiple regression models showed that BMI SDS and height were significantly related with UIC (p < 0.05). CONCLUSIONS: There is coexistence between the two extremes of iodine intake (insufficient and excessive). To our knowledge, the observed positive correlation between UIC and overweight and obesity has not been described before, and could be explained by the availability and consumption of snack food rich in energy and iodized salt.