[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.

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.

[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.

[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.

[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.

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.

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

Resumen 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.

Abstract 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.

[Unit cost variation in a social security company in Querétaro, México]. / Variación del costo unitario en una institución de seguridad social en Querétaro, México.

OBJECTIVE: Comparing unit cost variation between departments and reasons for consultation in outpatient health services provided by a social security company from Querétaro, Mexico. METHODS: A study of costs (in US dollars) was carried out in outpatient health service units during 2004. Fixed unit costs were estimated per department and adjusted for one year's productivity. Material, physical and consumer resources were included. Weighting was assigned to resources invested in each department. Unit cost was estimated by using the micro cost technique; medicaments, materials used during treatment and reagents were considered to be consumer items. Unit cost resulted from adding fixed unit cost to the variable unit cost corresponding to the reason for consulting. Units costs were then compared between the medical units. RESULTS: Unit cost per month for diabetic treatment varied from 34.8 US dollars, 32,2 US dollars to US 34 US dollars, pap smear screening test costs were 7,2 US dollars, 8,7 US dollars and 7,3 US dollars and dental treatment 27 US dollars, 33 US dollars, 6 and 28,7 US dollars. CONCLUSION: Unit cost variation was more important in the emergency room and the dental service.

[Probability of control of the patient with diabetes exclusively treated with pharmacological therapy]. / Control de los pacientes con diabetes tratados sólo con esquema farmacológico.

OBJECTIVE: to predict the probability of blood glucose control in patients with type-2 diabetes mellitus, exclusively treated with pharmacology therapy. MATERIAL AND METHODS: secondary analysis of a database to evaluate the therapeutic attachment in type-2 diabetics older than 60 years old. We interviewed 123 patients in their home to get information about sociodemographic aspects and diabetes characteristics. The blood glucose control was measured through glycated hemoglobin and the attachment to the pharmacological treatment was measured by the Morisky-Green test. The analysis included simple logistic regression; the calculation of probability of control for different levels of therapeutic attachment was estimated using the result of the regression equation (y) and applying the formula 1/1 + e(-y). RESULTS: Monotherapy was present in 82.1%, glibenclamide was prescribed alone in 77.2%, glycated hemoglobin average was 11.5 +/- 3.5 %, 18% of the population was controlled and 58.1% showed some attachment to the pharmacological treatment. With a total attachment to the pharmacological prescription, the control probability is 27%, and without it, it corresponds to 10%. CONCLUSION: Almost three out of ten patients with a total attachment to the pharmacological treatment have chances of being controlled.

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.

Asociación entre Preeclampsia y Enfermedad Renal Crónica / Association between Preeclampsia and Chronic Kidney Disease

RESUMEN Introducción: La prevalencia de preeclampsia es 2 a 8%, escenario que puede suponer el inicio de alteraciones vasculares y metabólicas futuras, entre ellas, enfermedad renal crónica. Objetivo: Determinar la preeclampsia como factor asociado a enfermedad renal crónica. Material y métodos: Estudio de casos y control en mujeres con antecedente de embarazo. El tamaño de muestra fue de 60 casos y 40 controles. El grupo de casos lo integraron pacientes con enfermedad renal crónica (tasa de filtrado glomerular menor a 60 ml/min/1.73m2, fórmula CKD-EPI), el grupo de control conformado por pacientes sin enfermedad renal crónica. El diagnóstico de preeclampsia se determinó por el antecedente médico. El análisis estadístico incluyó prueba de Chi-cuadrado (X2), razón de momios, regresión logística y cálculo de probabilidad de ocurrencia del evento. Resultados: En pacientes con enfermedad renal crónica el 80% refiere antecedente de preeclampsia, y en pacientes sin enfermedad renal crónica el 35% también tiene este antecedente (p=0.00). El tiempo de evolución entre el antecedente de preeclampsia y el diagnóstico de enfermedad renal crónica es 7.50 años (IC 95%; 7.10-7.89). El modelo que mejor explica la enfermedad renal crónica incluye la preeclampsia y la edad del paciente (p=0.000), y = -3.444 + 1.794 (antecedente de preeclampsia) + 0.082 (edad del paciente). Si existe antecedente de preeclampsia y la edad del paciente es 35 años, la probabilidad de enfermedad renal crónica es 0.7721. Conclusión: La preeclampsia es un factor asociado a enfermedad renal crónica.

ABSTRACT Introduction: With a prevalence of 2-8%, preeclampsia constitutes a scenario that may imply the beginning of future vascular and metabolic alterations, among which we could mention chronic kidney disease. Objective: To establish preeclampsia as a factor associated with chronic kidney disease. Methods: Case-control study covering women who had been pregnant. The population sample included 60 subjects in the case group and 40 in the control group. The case group included patients with chronic kidney disease (glomerular filtration rate lower than 60 ml/min/1.73m2, CKD-EPI formula); the control group included patients who did not suffer from chronic kidney disease. Preeclampsia diagnosis was established according to medical history. The statistical analysis comprised the chi-squared test (X2), odds ratio, logistic regression and event occurrence probability. Results: Among the chronic kidney disease patients, 80% reported a history of preeclampsia; 35% of subjects who did not suffer from chronic kidney disease also had a similar history (p=0.00). The time of evolution between preeclampsia and the diagnosis of chronic kidney disease was 7.5 years (95% CI: 7.10-7.89). The model which best explains chronic kidney disease includes preeclampsia and patient's age (p=0.000), y=-3.444 + 1.794 (history of preeclampsia) + 0.082 (patient's age). If the patient is 35 years old and has a history of preeclampsia, the probability of chronic kidney disease is 0.7721. Conclusion: Preeclampsia is a factor associated with chronic kidney disease.

Efecto de la técnica de respiración profunda en el nivel de ansiedad en adultos mayores / Effect of the deep breathing technique on the level of anxiety in older adults

Resumen

Introducción: los adultos mayores están expuestos a múltiples factores que pueden ocasionar ansiedad. Existen diversas técnicas psicoafectivas, una de las cuales es la técnica de respiración profunda, que ayudará a los adultos mayores a disminuir su ansiedad.

Objetivo: determinar el efecto de la técnica de respiración profunda en el nivel de ansiedad de los adultos mayores.

Metodología: estudio cuasi experimental en el que se incluyeron adultos mayores de 60 años o más. Se trató de una muestra no probabilística por cuota (96) en la que se incluyeron variables sociodemográficas y de ansiedad. La intervención técnica de respiración profunda y ansiedad se midió a través del instrumento IDARE.

Resultados: el rango de edad predominante fue de 65 a 69 años (29.7%); el género, femenino (74.3%). En la preintervención el 58.1% tuvo ansiedad moderada y 5.4%, grave. En la postintervención 9.5% presentó ansiedad moderada y ningún caso con ansiedad grave. Se observó asociación pre- y postintervención (p = 0.000).

Conclusiones: la respiración profunda como parte de la intervención de enfermera-paciente logró cambios positivos y disminuyó niveles de ansiedad en el adulto mayor.

Abstract

Introduction: Older adults are exposed to multiple factors that can lead to the development of anxiety. There are several psycho-affective techniques, among which is the deep breathing technique, which can be useful to decrease the anxiety in older adults.

Objective: To determine the effect of the deep breathing technique on the level of anxiety in older adults.

Methods: Quasi experimental study which included adults of 60 years or older. The sample was no probabilistic by quota (96), in which socio-demographic and anxiety variables were included. Deep breathing technique and anxiety were measured through the IDARE instrument.

Results: The main range of age was 65 to 69 years (29.7%); 74.3% were women. In the pre-intervention, 58.1% had moderate anxiety and 5.4% severe anxiety; in the post-intervention, 9.5% had moderate anxiety and 0% severe anxiety. We observed an association between pre- and postintervention (p = 0.000).

Conclusions: As a part of the nursing intervention, using the deep breathing technique obtained positive changes, since it decreased anxiety levels in older adults.

[Physical exploration and morbidity of pelvic members in the diabetic patient type 2]. / Exploración física y morbilidad de miembros pélvicos en el paciente diabético tipo 2.

OBJECTIVE: to determine the prevalence of the physical exploration and morbidity on pelvic members in the type 2 diabetic patient. METHODOLOGY: cross-sectional study; 189 files of diabetic family medicine patients were analyzed. The sample was considered with the formula of proportions for a finite population. Sampling units were chosen by convenience and they were taken up again from each one of the family medicine physician's offices. Sociodemographic variables, pathologies, time of evolution of diabetes, glycemic control and consultations along a year were studied. Physical explorations were made and signs explored by the physicians. Descriptive statistic for the analysis of data was used. RESULTS: average age 58.89 years (CI 95 %, 57.1-60.7); women predominated with 61.9 % (CI 95 %, 55.0-68.8), mean time of evolution 10.60 years ± 7.29. In 74.1 % some sign in pelvic members was explored, and in 14.3 % some added problem was detected. Of these, 9 % suffered from onychomycosis. CONCLUSION: physical exploration of pelvic members it is not to be performed in all type 2 diabetic patients.

Objetivo: determinar la prevalencia de exploración física y morbilidad de miembros pélvicos en el paciente diabético tipo 2. Métodos: estudio transversal descriptivo. Se analizaron 189 expedientes de pacientes diabéticos de medicina familiar. La muestra se estimó con la fórmula de proporciones para población finita. Las unidades muestrales se eligieron por conveniencia y se retomaron de cada uno de los consultorios de medicina familiar. Se estudiaron variables sociodemográficas y de salud (patologías agregadas, tiempo de evolución de la diabetes, control glucémico y consultas al año). Del servicio se estudiaron exploraciones físicas realizadas y signos explorados por el médico en un año. Se utilizó estadística descriptiva para el análisis de datos. Resultados: edad promedio de 58.89 años (IC 95 %, 57.1-60.7), predominó el sexo femenino con 61.9 % (IC 95 %, 55.0-68.8), el promedio de tiempo de evolución fue de 10.60 ± 7.29 años. La mayoría tenía descontrol glucémico. En el 74.1 % se exploró algún signo en miembros pélvicos, al 14.3 % se le detectó algún problema agregado; de estos, 9.0 % padecía onicomicosis. Conclusión: la exploración física de los miembros pélvicos no se realiza en la totalidad de los pacientes diabéticos tipo 2.

[Economic cost of polypharmacy in the elderly in primary health care]. / Costo económico de la polifarmacia en el adulto mayor en el primer nivel de atención.

OBJECTIVE: to quantify the economic cost of polypharmacy in the elderly. METHODS: cost study design, made in two first-level medical units. The study was conducted in 131 older adult patients with polypharmacy, chronic degenerative disease and at least one medical visit per year. The sample was calculated using the formula of finite population averages. The cost of polypharmacy was assessed in medical consultation, medicine and pharmacy services. The evaluation of the medical cost included the number of visits per year for the same unit cost, the cost of medicine considered the amount of drug per year for the same unit cost, and the cost of the service pharmacy took into account the number of times the pharmacy occupies the unit cost of the same. The statistical analysis included means, percentages and confidence intervals. RESULTS: in family practice the average annual cost is $1,263.26. In pharmacy the average annual cost is $229.91. The average time drug use is 4.37 months per year (95 % CI = 0.9-7.9), the annual average cost drugs is $708.00. Considering the three dimensions the annual cost of polypharmacy in the elderly is $2,201.17. CONCLUSIONS: the cost of polypharmacy is high and represents a significant economic impact.

Objetivo: determinar el costo económico de la polifarmacia en el adulto mayor. Métodos: estudio de costos en dos unidades de medicina familiar. Se estudió una muestra de 131 adultos mayores con polifarmacia, enfermedades crónicas degenerativas y con al menos una consulta al año. La muestra se calculó con la fórmula de población finita para promedios. El costo de polifarmacia fue evaluado en tres dimensiones: consulta médica, medicamentos y servicio de farmacia. La evaluación de la consulta médica incluyó el número de atenciones al año por el costo unitario de la misma; el costo de medicamentos, la cantidad anual de este por el costo unitario del mismo y el costo del servicio de farmacia, el número de ocasiones que se ocupa la farmacia por el costo unitario de las mismas. Resultados: el costo anual de la consulta médica fue de $1263.26 y el de farmacia, de $229.91. El tiempo de uso de medicamentos fue de 4.37 meses al año y el costo anual en fármacos, de $708.00. El costo anual de la polifarmacia en el adulto mayor fue de $2201.17. Conclusiones: la polifarmacia representa un importante costo e impacto económico.

Prevalencia de los factores asociados a la no coincidencia del método de planificación familiar electo en la atención prenatal y el aplicado post-evento obstétrico / Prevalence of the factors associated with the non-coincidence of the method of elected family planning in prenatal care and applied post-event obstetric

RESUMEN Marco teórico: La atención prenatal tiene varios objetivos y entre ellos está el fomentar y sentar bases para una decisión adecuada sobre planificación familiar con base en las condiciones clínicas de la mujer. Es frecuente encontrar en la atención de puerperio que la paciente no haya recibido un método de planificación familiar por distintos factores. Objetivo: Identificar la prevalencia de los factores asociados a la no coincidencia del método de planificación familiar electo en la atención prenatal y el aplicado post-evento obstétrico. Metodología: Diseño transversal descriptivo en pacientes en puerperio inmediato cuyo método de planificación familiar solicitado en consentimiento informado firmado en la atención prenatal no coincidió con el aplicado post-evento obstétrico. Se midieron factores intrínsecos y extrínsecos Resultados: El factor intrínseco más importante fue el cambio de decisión personal 59.0% (IC 95%; 53.10-64.90) y el factor extrínseco la falta de insumos en el 31.20% (IC 95%; 25.60-36.80). Cuando se realizó la evaluación conjunta la prevalencia del cambio de decisión personal se modificó a 35.20% (IC 95%; 29.4-41.0) y la falta de insumos a 12.6% (IC95%; 8.6-16.6) Conclusión: Los factores intrínsecos y extrínsecos asociados a la no coincidencia del método de planificación familiar con mayor prevalencia son el cambio de decisión por la paciente y la falta de insumos respectivamente.

ABSTRACT Background: Prenatal care has several objectives and among them is to promote and lay the groundwork for an adequate decision on family planning based on the clinical conditions of women. It is common to find in puerperium care that the patient has not received a family planning method due to different factors. Objective: To identify the prevalence of the factors associated with the non-coincidence of the method of family planning elected in prenatal care and the post-obstetric event applied. Methods: Descriptive cross-sectional design in patients in the immediate puerperium whose family planning method requested in signed informed consent in prenatal care did not coincide with the applied post-obstetric event. Intrinsic and extrinsic factors were measured Results: The most important intrinsic factor was the change of personal decision 59.0% (95% CI, 53.10-64.90) and the extrinsic factor the lack of inputs in 31.20% (95% CI, 25.60-36.80). When the joint evaluation was carried out, the prevalence of the personal decision change was modified to 35.20% (95% CI, 29.4-41.0) and the lack of inputs to 12.6% (95% CI, 8.6-16.6). Conclusion: The intrinsic and extrinsic factors associated with the non-coincidence of the family planning method with the highest prevalence are the change of decision by the patient and the lack of inputs, respectively.