Sub-oclusión intestinal y desnutrición severa en esclerosis sistémica sin esclerodermia

La esclerosis sistémica sin escleroderma es una forma no común de compromiso sistémico de esta enfermedad, con ausencia de manifestaciones cutáneas. Presentamos el caso de una mujer de 71 años con índice de masa corporal (IMC) en 16,9 kg/m2, con historia de hipotiroidismo y estreñimiento crónico, quien acude a emergencia por dolor y distensión abdominal, asociado a náuseas. Se realizó una tomografía abdomino-pélvica encontrándose cámara gástrica colapsada, asas intestinales con algunos segmentos distendidos, con signos de fecalización de asa delgada. La colonoscopía describió dolicocolon severo. Se observaron placas induradas en codo derecho y en ambos glúteos. Los exámenes auxiliares: ANA 1/640 patrón centromérico, anticuerpos anticentrómero = 227 U/mL (valor normal - VN: 0-25), Anti SCL-70 = 1,9 U/mL (VN 0-25) y anti RNP = 0,1 U/mL (VN 0-25). La capilaroscopía de borde ungueal a 200x mostró megacapilares. El diagnóstico clínico fue esclerosis sistémica sin esclerodermia. Se inició tratamiento con dieta rica en fibra y nutrición parenteral por 1 semana. La evolución de la paciente fue favorable.

Systemic sclerosis sine Scleroderma is an uncommon form of systemic compromise of this disease, in the abscense of cutaneous manifestations. We present the case of a 71 years-old woman, body mass index (BMI) in 16.9 kg/m2, with history of hypothyroidism and chronic constipation, who goes to the emergency with pain, abdominal bloating, and nausea. An abdominopelvic tomography was made, reporting a collapse of the gastric chamber, some segments of intestinal loops distended with signs of fecalization in the small intestine. A colonoscopy described severe dolicocolon. We observed indurated plaques in left elbow and in both buttocks. Lab tests: ANA 1/640 with anticentromeric pattern, anticentromere antibodies = 227 U/mL (0-25), Anti-SCL-70 = 1.9 U/mL (0-25), anti-RNP = 0.1 U/mL (0-25). Peri-ungueal cappilaroscopy 200x showed mega capillaries. Clinical diagnosis was systemic sclerosis sine scleroderma. We initiated treatment with a high-fiber diet and parenteral nutrition for a week. The patient evolution was favorable.

Asociación entre procrastinación y estrés académico en estudiantes peruanos de segundo año de medicina

Introducción: Los estudiantes universitarios de la carrera de medicina son una población expuesta a una alta carga académica, alta exigencia, gran demanda de tiempo y existen factores que pueden afectar la eficacia del desempeño académico, tales como el estrés y la procrastinación. Objetivo: Evaluar la asociación entre estrés y procrastinación en una muestra piloto de estudiantes de medicina en una universidad de Lima-Perú. Material y métodos: Se realizó un estudio analítico transversal, en donde se reclutó a estudiantes de medicina del curso Metodología de la Investigación en una universidad de la capital peruana. En ellos se midió el estrés y la procrastinación, ambos con test validados previamente, luego se relacionó estas variables y se las ajustó por su sexo y edad. Para la estadística analítica se utilizó los modelos lineales generalizados y se consideró a los valores p ≤ 0,05 como estadísticamente significativos. Resultados: Al realizar el análisis multivariado se encontró que hubo relación entre la procrastinación y el género masculino de los encuestados (p = 0,001), la edad (p = 0,035) y el estrés (p = 0,022). Conclusiones: La procrastinación mantiene en la muestra estudiada una importante asociación con el estrés que tienen los estudiantes, así como, con su género y edad(AU)

Introduction: University medical students are a population exposed to a high academic load, high level of exigency, high demand of time and there are factors that can affect the effectiveness of academic performance, such as stress and procrastination. Objective: Evaluate the association between stress and procrastination in a pilot sample of medical students at a university in Lima, Peru. Material and methods: A cross-sectional analytical study was conducted, where medical students from the Research Methodology course were recruited at a university in the Peruvian capital. In them, stress and procrastination were measured, both with previously validated tests, then these variables were related and adjusted according to their sex and age. For analytical statistics, generalized linear models were used and p-values ≤ 0.05 were considered statistically significant. Results: When performing the multivariate analysis, it was found that there was a relationship between procrastination and male gender (p = 0.001), age (p = 0.035) and stress (p = 0.022) of the respondents. Conclusions: Procrastination maintains in the sample studied an important association with the stress that students have, as well as with their gender and age(AU)

Atención colaborativa para depresión y prevención de suicidio: una intervención viable en el sistema de salud mexicano / Collaborative care for depression and suicide prevention: a feasible intervention within the Mexican health system

Resumen: México enfrenta un enorme desafío para atender los trastornos mentales, con la depresión como uno de los principales contribuyentes a los años de vida ajustados por discapacidad (AVAD) y el aumento de las tasas de suicidio. Estos desafíos se combinan con la escasez de recursos y asignación ineficiente de fondos. Si bien no hay una solución mágica a corto plazo, discutimos experiencias actuales que podrían usarse para brindar una mejor atención primaria en salud mental. Nos centramos en depresión y conducta suicida argumentando que la atención colaborativa es un modelo factible y replicable, enfatizando la capacitación del personal no especializado para que se convierta en administrador de casos y brinde atención primaria en salud mental. México está experimentando un proceso de cambios, incluido el surgimiento de la atención médica universal, por lo que es el momento para que la atención en salud mental sea más transversal, disponible y científicamente probada.

Abstract: Mexico faces an enormous challenge in attending mental health disorders with depression rising as one of the five main contributors to disability adjusted life years (DALYs) and increasing suicide rates. These challenges are coupled with a dearth of resources and an inefficient allocation of the meager funds. While no magical bullet is available to ameliorate this situation in the short term, here we discuss current concepts and experiences that could be used in Mexico to deliver better primary mental health care. We focus on depression and suicidal behavior and argue that collaborative care is a feasible and replicable model, emphasizing the importance of training non-specialized primary care personnel to become case managers and provide primary mental health care. Mexico is currently undergoing a process of changes, including the emergence of universal health care. The time seems right to make mental health care more transversal, widely available and scientifically proven.

Comunicación abierta entre profesionales de la salud mental y padres de pacientes con discapacidad intelectual / Open communication between mental health professionals and parents of patients with intellectual disabilities

Resumen Objetivo: Estimar los factores asociados con la comunicación abierta entre profesionales de la salud mental y padres de pacientes con discapacidad intelectual y otros trastornos del neurodesarrollo. Material y métodos: Encuesta transversal en 759 profesionales de la salud mental. Se estimó la asociación entre el patrón de comunicación abierto y los atributos de la comunicación a través de un modelo logístico, ordinal y multivariado. Resultados: La prevalencia del patrón de comunicación abierta en profesionales de la salud mental fue de 30.6% (IC95% 27.4-34.0). Los factores asociados fueron menor edad (RM=2.42, IC95% 1.57-3.75), especialidad (RM=1.56, IC95% 1.09-2.23), alto valor a la verdad (RM=4.95, IC95% 3.21-7.65), bajo paternalismo (RM=10.93, IC95% 7.22-16.52) y cursos de bioética (RM=1.45, IC95% 1.01-2.09), ajustando por variables confusoras. Conclusión: Los profesionales de la salud mental reportaron bajos niveles de comunicación abierta con los padres de personas con trastornos del neurodesarrollo, por lo que priorizar el valor a la verdad, promover un menor paternalismo y el respeto a la autonomía de los pacientes puede contribuir a cambiar estos patrones de comunicación en la práctica clínica en México.

Abstract Objective: To estimate the factors associated with open communication between mental health professionals and parents of patients with intellectual disabilities and other neurodevelopmental disorders. Materials and methods: Cross-sectional survey in 759 mental health professionals. The association between the pattern of open communication and the attributes of communication was estimated through a logistic, ordinal, multivariate model. Results: The prevalence of the pattern of open communication in mental health professionals was 30.6% (95%CI 27.4-34.0). The associated factors were younger age (RM=2.42, 95% CI 1.57-3.75), specialty (RM= 1.56, 95%CI 1.09-2.23), high value to the truth (RM= 4.95, 95% CI 3.21-7.65), low paternalism (RM= 10.93, 95%CI 7.22-16.52) and courses in bioethics (RM= 1.45, 95%CI 1.01-2.09), adjusted for confusing variables. Conclusion: Mental health professionals reported low levels of open communication with parents of people with neurovelopmental disorders, so prioritizing the value to the truth, promoting less paternalism, and respecting the autonomy of patients, can contribute to changing these patterns of communication in clinical practice in Mexico.

Conocimiento sobre trastornos del neurodesarrollo asociado con la aceptación del modelo de educación inclusiva en docentes de educación básica / Knowledge about neurodevelopmental disorders associated with the acceptance of the inclusive education model, in basic education teachers

Resumen Objetivo: Describir la prevalencia del conocimiento sobre trastornos del neurodesarrollo (TdN) y el nivel de aceptación de los modelos de educación inclusiva (MEI) en docentes. Material y métodos: Estudio transversal multicéntrico en México y Centroamérica. Aplicación de un instrumento de autorreporte a docentes de nivel básico sobre conocimiento en TdN y aceptación de los MEI. Resultados: Se obtuvo la respuesta de 511 docentes. La prevalencia de alta aceptación de MEI fue de 28.6%. De los 120 docentes que refirieron tener un amplio conocimiento sobre discapacidad intelectual, 3.8% estuvieron en el percentil más bajo de aceptación de MEI, 19.5% en el percentil de aceptación promedio y 55.5% de ellos se encontraron en el percentil de mayor aceptación (p<0.001). Entre los docentes, un mayor conocimiento sobre los TdN se mostró asociado con la aceptación de MEI: trastornos del aprendizaje RM 3.76 (IC95% 2.13-6.62); trastornos por déficit de atención con hiperactividad RM 2.24 (IC95% 1.31-3.84) y discapacidad intelectual RM 3.84 (IC95% 2.46-5.99). Conclusión: La aceptación docente de MEI puede favorecerse con una mayor y mejor capacitación de los profesionales de la educación sobre los diferentes TdN.

Abstract Objective: To describe the prevalence of knowledge about neurodevelopment disorders (NDDs) and the level of acceptance of models of inclusive education (IEM) in teachers. Materials and methods: A multicenter crosssectional study in Mexico and Central America. A self-report instrument to teachers of basic level on knowledge in NDDs and acceptance of the IEM. Results: The response of 511 teachers was obtained. The prevalence of high acceptance of the IEM was 28.6%. Of the 120 teachers who reported having extensive knowledge about intellectual disability, 3.8% were in the lowest percentile of acceptance of the IEM, 19.5% in the average percentile of acceptance and 55.5% of them were in the highest percentile acceptance (p<0.001). Among teachers, a greater knowledge about NDDs was associated with the acceptance of IEM: learning disorders RM 3.76 (95%CI 2.13-6.62); attention deficit disorders with hyperactivity RM 2.24 (95%CI 1.31-3.84) and intellectual disability RM 3.84 (95%CI 2.46-5.99). Conclusion: The teaching acceptance of IEM can be favored with greater and better training of education professionals on the different NDDs.

Necesidades de atención en salud mental y uso de servicios en población mexicana con trastornos mentales graves / Mental health care needs and use of services in Mexican population with serious mental disorders

Resumen: Objetivo: Analizar las demandas de atención de los trastornos mentales graves (TMG) y factores asociados con la utilización de servicios en México. Material y métodos: Se llevó a cabo un estudio analítico transversal en dos fases: la primera con una base de datos nacional de servicios disponibles y su utilización; la segunda, una muestra de registros médicos de un hospital psiquiátrico. Resultados: La esquizofrenia es el TMG más prevalente; más de 50% de hospitalizados fueron hombres, con edad promedio 37 años. La utilización de servicios estuvo asociada con la edad (β=1.062; p=.000), ingreso familiar (β=1.000, p=.000) y no tener ocupación (β=3.407; p=.000). La población con esquizofrenia tiene cuatro veces más la probabilidad de requerir estar exenta de pago (β=4.158; p=.000). Conclusiones: La población con TMG es más vulnerable por la discapacidad funcional y social asociada; requiere de intervenciones específicas de salud acompañadas de una política de protección financiera adaptada a sus necesidades de atención.

Abstract: Objective: To analyze the mental health care needs of the serious mental disorders (SMD) and factors associated with the use of services in Mexico. Materials and methods: A cross-sectional analytical study was conducted in two phases, the first with a national database of available services and its utilization; the second, a sample of medical records of a psychiatric hospital. Results: Schizophrenia is the most prevalent MDS; more than 50% of those hospitalized were male, with an average age of 37 years. The use of services was associated with age (β=1.062, p=.000), family income (β=1.000, p=.000) and no laboral occupation (β=3.407, p=.000). The population with schizophrenia is four times more likely to require to be exempt from payment (β=4.158, p=.000). Conclusions: The population with SMD as schizophrenia is more vulnerable due to the associated functional and social disability and it requires specific heath interventions and a financial protection policy adapted to their mental health care needs.

Detección de patógenos periodontales de una población con Periodontitis Agresiva en Uruguay mediante metodología convencional y molecular / Detection of periodontal pathogens in a Uruguayan population with aggressive periodontitis using conventional and molecular methods

Las enfermedades periodontales representan un importante problema de salud que afecta los tejidos de soporte de las piezas dentarias. Dentro de ellas, las Periodontitis Agresivas se caracterizan por su rápida progresión, agregación familiar, pacientes sistémicamente sanos1 subdividiéndose en localizadas y generalizadas según la extensión del cuadro. Los microorganismos juegan un papel importante en su etiopatogenia, entre los cuales se encuentran Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, Fusobacterium nucleatum. El propósito de este trabajo fue estudiar cuáles de estos microorganismos estaba presente en 50 pacientes uruguayos con Periodontitis Agresiva. La detección se realizó con técnica convencional bacteriológica y PCR. En los cuadros generalizados se observó mayor prevalencia de F. nucleatum y P. intermedia seguido de P. gingivalis y T. forsythia. En los cuadros localizados destacaron P. intermedia, F. nucleatum y A. actinomycetemcomitans. En nuestro país se presentó una flora similar a los que figuran en otras localizaciones geográficas

Periodontal diseases are a major health problem affecting tooth-supporting tissues. Among them, aggressive periodontitis is characterized by rapid progression, family aggregation, systemically healthy patients, and is subdivided into localized and generalized according to the extent of the disease. Microbiota plays a major role in the etiopathogenesis of these diseases, including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Fusobacterium nucleatum. The aim of this work was to study the prevalence of these microorganisms in 50 Uruguayan patients with aggressive periodontitis. Detection was conducted with conventional bacteriological techniques and PCR. In the generalized disorders, a higher prevalence of F. nucleatum and P. intermedia was observed, although P. gingivalis and T. forsythia were also important. In the localized disorders, P. intermedia, F. nucleatum and A. actinomycetemcomitans were the main ones. A similar flora to other geographical locations was present in our country

Effectiveness of augmented Individual Placement and Support interventions for competitive employment in people with schizophrenia: Systematic review and meta-analysis / Revisión sistemática y metaanálisis de la efectividad de intervenciones aumentadas de IPS para la obtención de empleo competitivo en personas con esquizofrenia

Abstract: Background: It has been estimated that over 70% of people living with a diagnosis of schizophrenia wish to work. The Individual Placement and Support (IPS) model has proven to be highly effective in enhancing competitive employment in people with schizophrenia. However, the efficacy of augmented IPS interventions, in other words, those that incorporate a psychosocial intervention into the model, has not been evaluated in this population. Objective: To assess the efficacy of augmented IPS interventions designed to obtain competitive employment in people with schizophrenia. Method: A systematic review of the literature on randomized clinical trials of augmented IPS interventions, published in English between 2007 and 2017, was conducted in the electronic databases of PubMed, Science Direct, and EBSCO. Risk of bias and competitive employment rates were calculated. A meta-analysis was performed using the random effects method to estimate the effect of augmented IPS interventions. Results: Twelve articles were identified in which 10 augmented IPS interventions were compared with other interventions. In eight studies conducted on people with schizophrenia, the intervention was based on IPS + social skills/work skills/cognitive remediation vs. IPS or modified IPS. No general effect favoring augmented interventions (RR = 1.37, 95% CI [.97, 1.95], I2 = 52%) was found. Augmented IPS interventions tend to be more effective when they are implemented during the first psychotic episode. Discussion and conclusion: It is not possible to conclude that augmented IPS interventions have a significant effect over standard IPS interventions in obtaining competitive employment in people with schizophrenia.

Resumen: Antecedentes: Se ha estimado que más del 70% de las personas que viven con diagnóstico de esquizofrenia desean trabajar. El modelo Individual Placement and Support (IPS) ha mostrado efectividad para que las personas con esquizofrenia consigan un empleo competitivo. Sin embargo, en esta población no se ha evaluado la eficacia de las intervenciones aumentadas de IPS -es decir, aquellas que añaden al modelo una intervención psicosocial. Objetivo: Evaluar la eficacia de las intervenciones aumentadas de IPS dirigidas a la obtención de empleo competitivo en personas con esquizofrenia. Método: Se realizó una revisión sistemática de la literatura de ensayos clínicos aleatorizados sobre intervenciones aumentadas de IPS publicados en inglés entre 2007 y 2017, en las bases de datos electrónicas de PubMed, Science Direct y EBSCO. Se calcularon el riesgo de sesgo y las tasas de empleo competitivo. Se realizó un metaanálisis mediante el método de efectos aleatorios para estimar el efecto de las intervenciones aumentadas de IPS. Resultados: Se identificaron 12 artículos en los que se comparaban 10 intervenciones aumentadas de IPS con alguna otra intervención. En ocho estudios realizados en personas con esquizofrenia, la intervención se basó en IPS + habilidades sociales/habilidades laborales/remediación cognitiva vs. IPS o IPS modificadas, sin que se encontrara un efecto general en favor de las intervenciones aumentadas (RR = 1.37, 95% IC [.97, 1.95], I2 = 52%). Las intervenciones aumentadas de IPS tienden a ser más efectivas cuando se llevan a cabo en el primer episodio psicótico. Discusión y conclusión: No se puede concluir que las intervenciones aumentadas de IPS tengan un mayor efecto sobre las intervenciones estándar de IPS para la obtención de empleo competitivo en personas con esquizofrenia.

Factores Psicológicos y Relaciónales Asociados a Episodios de Embriaguez en Adolescentes Escolares de Guadalajara, México / Psychological and Related Factors Associated with Drunkenness Episodes in Adolescent Students in Guadalajara, Mexico / Fatores Psicológicos e Relações Associados a Episódios de Embriaguez em Adolescentes Escolares de Guadalajara, México

Resumen El objetivo de este estudio fue asociar factores psicológicos y relaciónales vinculados a episodios de embriaguez en 1134 adolescentes escolares de Guadalajara, México. Se evaluaron diez factores psicológicos y relacionales. La variable de desenlace fue episodios de embriaguez durante el último mes. Se encontró una prevalencia de embriaguez de 26.5% con mayor consumo en hombres. Después del análisis de regresión logística los factores asociados a embriaguez fueron tabaquismo, alta autoestima, alta impulsividad, bajo locus de control interno, la presencia de estrés cotidiano y relación distante con el padre. La investigación concluye que los factores psicológicos y relacionales asociados a episodios de embriaguez hicieron referencia a un perfil de omnipotencia altamente influenciable, y al desapego emocional, por lo que el consumo excesivo de alcohol parece perfilarse como una estrategia de seguridad.

Abstract The aim of this study was to identify psychological and related factors linked with drunkenness episodes in 1134 adolescent students in Guadalajara, Mexico. The study evaluated ten psychological and related factors. The outcome variable was the number of episodes of drunkenness in the last month. We found 26.5% more episodes of drunkenness in men. A logistic regression analysis indicated that factors associated with drunkenness were smoking, high self-esteem, high impulsiveness, low self-control, presence of daily stress and distant relationship with father. The study concluded that the psychological and related factors associated with drunkenness episodes were related to a highly impressionable omnipotence profile and emotional indifference, with excessive consumption of alcohol as a safety strategy.

Resumo O objetivo deste estudo foi associar fatores psicológico e relações vinculados a episódios de embriaguez em 1134 adolescentes escolares de Guadalajara, México. Avaliaram-se dez fatores psicológicos e relacionais. A variável de desenlace foi episódios de embriaguez de 26.5 % com maior consumo em homens. Depois da análise de regressão logística, os fatores associados à embriaguez foram tabaquismo, alta autoestima, alta impulsividade, baixo lócus de controle interno, presença de estresse cotidiano e relação distante com o pai. A pesquisa conclui que os fatores psicológicos e relacionais associados a episódios de embriaguez fizeram referência a um perfil de onipotência altamente influenciável e ao desapego emocional; nesse sentido, o consumo excessivo de álcool parece perfilar-se como uma estratégia de segurança.

Caracterización de los compuestos activos de ugni molinae (murtilla) y sus potenciales efectos hipoglicemiantes, anti-inflamatorios y antioxidantes / Characterization of the active compounds of ugni molinae (murtilla) and its potential hypoglycemic, anti-inflammatory and antioxidant effects

En esta tesis se observó que los extractos seriados de acetato de etilo (EAE) y etanol (EET) de las hojas de Ugni molinae Turcz. (murtilla) son fuente de los ácidos, asiático, alfitólico, corosólico, betulínico, oleanólico, ursólico, madecásico y maslínico, presentes en diferentes concentraciones. Siendo estos dos últimos triterpenoides identificados por primera vez en esta especie. Se obtuvo desde el EET una fracción enriquecida en triterpenoides (SAE), la cual concentró alrededor de 3 veces la cantidad de los ácidos madecásico, asiático, corosólico y maslínico. SAE (1 mg/oreja) demostró tener efecto anti-inflamatorio tópico significativo de un 43,3 ± 4,2% en el modelo de edema de oreja de ratón inducido por TPA. Este efecto fue atribuible en parte a la presencia del ácido madecásico (DE50 0,11 µmol/oreja). SAE (1 y 10 µg/mL) y los ácidos madecásico (1 y 10 µM), corosólico (1 µM) y alfitólico (10 µM) redujeron significativamente la cantidad de IL-6 liberada desde adipocitos maduros expuestos a TNF-α. Tanto EAE como SAE redujeron significativamente el nivel de especies reactivas de oxígeno intracelulares (EROic) inducidas por TNF-α en macrófagos y células ß pancreáticas, debiéndose este efecto tanto a los triterpenoides como a los compuestos fenólicos presentes. Los ácidos madecásico, asiático, corosólico, maslínico, alfitólico, ursólico y oleanólico (1 y 10 µM) fueron capaces de disminuir el nivel de EROic inducidas por TNF-α tanto en macrófagos como en células ß pancreáticas, siendo el efecto más potente en estas últimas células. Tanto SAE como EAE (10 µg/mL) inhiben el proceso de diferenciación de adipocitos debido en gran parte a sus triterpenoides. Éstos, a una concentración de 10 µM, mostraron un importante efecto inhibitorio. EET, EAE y SAE (60 µg/mL) inhiben la glicógeno fosforilasa a, observándose actividades inhibitorias de 45,9 ± 4,3, 92,2 ± 1,1 y 91,6 ± 1,2%, respectivamente. Tanto triterpenoides como flavonoides estarían involucrados en este efecto.

Modelo integrativo de la calidad de vida laboral percibida a partir de la inseguridad laboral, la jornada laboral y el salario, para hombres y mujeres trabajadores de empresas de la ciudad de Bogotá en diferentes rangos de edad / Integrative model of quality of working life perceived of job insecurity, working hours and wages, for men and women workers in enterprises of the city of Bogotá in different age ranges

El estudio de la calidad de vida laboral percibida (CVLP) ha estado dirigido a examinar aspectos aislados de las diferentes variables que determinan su percepción. La presente investigación tuvo por objetivo la integración de tres variables de reconocida importancia en la literatura científica: la inseguridad laboral, la jornada laboral y el salario, a fin de establecer en qué grado su combinación explica la CVLP. Para ello se tomó una muestra de 100 personas que laboraban en 3 empresas del sector de servicios de la ciudad de Bogotá y se les aplicaron dos instrumentos: la prueba PCVL, diseñada por Gómez (2007) y un cuestionario de aspectos socio-laborales diseñado para efectos de la presente investigación. Los datos fueron analizados bajo el modelo de ecuaciones estructurales e indicaron que solo el salario en su atributo de cuantía predice y explica de manera significativa la CVLP en toda la muestra. También se encontró que la edad y el género tienen un efecto significativo para moderar el efecto de las tres variables de estudio sobre la CVLP y algunas de sus dimensiones. El estudio en general muestra que el modelo inicial debe continuar replanteándose para mejorar su capacidad explicativa.

Perceived Work Quality of Life (PWQL) research had been focused to examine isolated topics about different variables that determine its perception. The present research had like goal to integrate three variables more recognized in scientific literature: work insecurity, working day and salary, to establish the grade these link variables explaining PWQL. With these objective a sample of 100 people who worked in three service's sector enterprises of Bogotá were taken to applied them two test: PWQL Test, designed by Gómez (2007) and Work Social Topics Questionnaire designed to present research.. Outputs were analyzed under Structural Equation Model and these showed that just salary's amount of attribute predicts and explain meaningful PWQL in all sample. Age and gender have significant effect to moderate three study variable's effect about PWQL and some dimensions of this was founded too. Study in general way shows that initial model must continue rethinking to improve explanatory capacity.

Efecto de una intervención antitabaco en estudiantes de enseñanza media superior en Guadalajara, México / Effect of an anti-tobacco intervention in high school students from Guadalajara, Mexico

Introduction Recent data, both domestic and from the world over, have shown that the epidemiologic impact of tobacco consumption has a higher increase rate among adolescent population, particularly women, than in the general population. This has highlighted the need to implement preventive intervention programs focused on young people. The school environment seems to be the most adequate space to achieve such a goal. Most school intervention reports aimed at reducing tobacco consumption among students have been carried out in the United States and have both had a positive effect and proven to be cost-effective. In Mexico, there is only one antecedent of a successful prevention program conducted in an elementary school. Results from this suggest that behavioural abilities acquisition reduces the prevalence of tobacco experimentation and promotes cessation among those already using it. Given the lack of educational interventions and the fact that tobacco consumption tends to increase among Mexican high school students, we conducted this study aiming to implement an educational intervention on tobacco consumption among adolescent high school students from the Universidad de Guadalajara, Mexico. Later on we proceeded to evaluate its effect. Material and methods Based on a diagnostic and a literature review from successful anti-tobacco consumption programs, we devised a campaign called <>. This lasted for half a school year and included parents, teachers and non-smoking peers. Parents participated in five sessions aimed at promoting abstinence from tobacco consumption at home. Forty-two teachers, trained as campaign mediators, participated. A manual describing the contents from each session was elaborated for quality control purposes. Students themselves participated in four monthly sessions, were given anti-tobacco messages, watched anti-tobacco educational documentaries -under the supervision and discussion of a professor-, and exchanged cigarettes for chewing gum with non-smoking peers. In addition, a Tobacco Clinic was established, a mouth-teeth exam was carried out, and an anti-tobacco poster was displayed at the school. The poster message was changed each month. School measures regarding the ban on cigarettes sale on the school premises were likewise reinforced. Right before starting the campaign and immediately after finishing it, tobacco consumption rates, the type of consumption, the likelihood of using tobacco in the near future and the level of understanding as to the harmful effects on health of tobacco consumption were all evaluated using validated and standardized surveys. All measurements were carried out with an electronic questionnaire. The intervention effect evaluation was carried out with two independent samples: a base sample and a final sample before the campaign conclusion. Calculation of the sample size required for both surveys was based on data from a diagnostic study conducted at the same school. Participants were randomly selected. The project was approved by an Ethics and Research Committee from the Instituto Mexicano del Seguro Social (National Social Security Institute) and all the students participated in the educational intervention. Results Whereas 621 adolescents participated in the base evaluation, a total of 524 of them took part in the final evaluation. Parental attendance at the various sessions changed from 90% to 20%. A total of 2675 mouth-teeth exams were carried out. At these, tooth cavities decay, lack of dental hygiene and gengivitis were detected. In turn, this resulted in suggestions to attend regular health care services for treatment. At the Tobacco Clinic, a group of 20 family parents was formed for treatment. The once-in-a-lifetime, in the last 12 months, and in the last previous month tobacco consumption prevalence accounted to 43.6%, 23.0%, and 24.3%, respectively. Experimental versus regular tobacco consumption were 34.9% and 7.2%. Nonsmoking population was 57.8%. In the same base evaluation, 9.7% of the students considered it was very likely they would smoke in the future, 46.9% considered it barely likely, and 43.5% considered they would never smoke in the future. The positive effect of the campaign was reflected in the type of tobacco consumption as there was a reduction in the rate of experimental smokers, as well as an increase in the number of non-smokers in the final evaluation compared to the base one. The rate of regular smokers did not change from one evaluation to the other. The once-in-a-lifetime, in the last twelve months, and in the last month frequency of consumption, together with the likelihood of smoking in the near future, showed no changes in the final evaluation compared to the base one. In the base evaluation, a high level of understanding about the harmful effects of tobacco on the pulmonary system and a moderate level of understanding about the harmful effects of tobacco on the heart and the female reproductive system, as well as on the stomach and liver, were observed, while there was a low level of understanding about the harmful effects of tobacco on the rest of the organic systems. In the final evaluation, it was observed that the understanding level of organic systems about which it was moderate or high remained the same. In addition, a significant increase of the understanding about the harmful effects of tobacco on the ocular system and the urinary tracts was observed. The level of understanding about the harmful effects of tobacco on the rest of the organic system remained also the same.

Introducción La mayor parte de los reportes de intervenciones escolares para reducir el consumo de tabaco en estudiantes han sido realizados en Estados Unidos y han mostrado un impacto positivo además de que son costo/efectivas. En México solamente existe el antecedente de un estudio exitoso de un programa de prevención de tabaco realizado en primaria, cuyos resultados sugieren que el desarrollo de habilidades conductuales reduce la prevalencia de la experimentación de tabaco y promueve el cese en quienes ya lo consumen. Ante la falta de intervenciones educativas y la tendencia hacia el aumento del consumo de tabaco en adolescentes escolares de educación media superior en México, realizamos el presente estudio con el objetivo de implementar y evaluar el efecto de una intervención educativa sobre el consumo de tabaco en adolescentes de una preparatoria de la Universidad de Guadalajara, en la ciudad de Guadalajara, capital del Estado de Jalisco, México. Material y métodos Basándose en un diagnóstico previo se diseño una campaña antitabaco, dirigida a adolescentes fumadores, con una duración de un semestre escolar, que incluyó la participación de padres de familia, maestros y pares no fumadores. Antes del inicio e inmediatamente después de finalizar la campaña se evaluaron, mediante dos muestras independientes por medio de encuestas validadas y estandarizadas, la frecuencia de consumo de tabaco, el tipo de consumo, la probabilidad de consumir tabaco en un futuro cercano y el nivel de conocimientos sobre los efectos nocivos para la salud que produce su consumo. Resultados El efecto positivo de la campaña se apreció en el tipo de consumo de tabaco puesto que hubo una reducción de la proporción de fumadores leves así como un incremento del número de no fumadores en la evaluación final con respecto a la basal; la proporción de fumadores moderados no se modificó en ambas evaluaciones. La frecuencia de consumo una vez en la vida, en los últimos doce meses, en el último mes, así como la probabilidad de fumar en un futuro cercano no mostró modificaciones en la evaluación final con respecto a la basal. Discusión La intervención educativa antitabaco tuvo efectos positivos sobre el tipo de consumo de tabaco en los adolescentes de la escuela sede, que se evidenciaron en la disminución de la proporción de fumadores leves, en el incremento de no fumadores y en el incremento del nivel de conocimientos sobre los efectos nocivos del consumo de tabaco sobre la salud. Creemos que la explicación se vinculó a tres aspectos: 1) por haber diseñado la intervención a partir de un diagnóstico escolar, 2) por haber tomado en cuenta las diferentes influencias sociales al incorporar la participación de maestros, pares no fumadores y padres de familia, 3) por la inclusión de sugerencias de programas exitosos en la modificación actitudinal. La intervención implementada resultó ineficaz para fumadores moderados, por lo que se tendría mayor efecto preventivo si se aplicaran en estudiantes de educación básica y media básica, en quienes el consumo de tabaco aún tiene un impacto inicial. A partir de la falta de interés mostrado por los padres, hipotetizamos que en ellos parece prevalecer una actitud permisiva en el consumo de tabaco de sus hijos y parecen subestimar la posibilidad de influir en su consumo. Se considera que los padres representan un contexto preventivo importante en el tabaquismo del adolescente. A partir de esto se plantean hipótesis y nuevas preguntas para ser investigadas. El estudio presenta limitaciones al no haberse incluido un grupo control y por haber limitado la evaluación de la intervención al periodo inmediato posterior. Sin embargo, pensamos que a pesar de estas limitaciones la intervención educativa antitabaco es efectiva para la reducción del consumo de tabaco experimental y en el incremento del nivel de conocimientos de los efectos deletéreos sobre la salud.

Estudio químico y farmacológico de un extracto activo de Buddleja globosa hope, buddlejaceae, matico y diseño de la metodología analítica / Chemical and pharmacological study of an active extract of Buddleja globosa hope, buddlejaceae, matico and design of analytical methodology

La evaluación farmacológica y estudios químicos de Buddleja globosa, matico, realizados anteriormente en nuestro laboratorio y la importancia terapéutica en el tratamiento de afecciones a la piel que un extracto alcohólico fraccionado ha mostrado en estudios clínicos preliminares, nos impulsaron a desarrollar un estudio químico y farmacológico detallado que permita la estandarización de este extracto, además de identificar aquellos compuestos que posean la responsabilidad farmacológica de sus actividades antiinflamatoria y analgésica. El análisis cualitativo de los extractos alcohólicos seriados de hojas recolectadas en verano y otoño (EMAT-1, ETMATverano y ETMATotoño) por cromatografía en capa fina y HPLC permitió evidenciar la presencia de cuatro compuestos mayoritarios, siendo los más abundantes verbascósido (feniletanoide) y el 7-Oglucósido de luteolina (flavona), seguido por otros dos que se denominaron MAT-3 y MAT-5. La actividad analgésica de los dos compuestos mayoritarios fue evaluada en ratones mediante los ensayos del latigazo de la cola (vía tópica y oral) y de las contorsiones abdominales inducidas por ácido acético como métodos térmicos y químicos de dolor agudo a concentraciones y dosis equimolares al EC25 ó ED25 del ibuprofeno y del naproxeno sódico, utilizados como fármacos de referencia. El verbascósido mostró un 30,25 ± 7,29% y un 27,47 ± 3,81% de actividad tópica y oral, mientras que el 7-O-glucósido de luteolina presentó 24,46 ± 3,61% y un 28,24 ± 4,99% respectivamente en el ensayo del latigazo de la cola, en su mayoría levemente superiores al ibuprofeno y al naproxeno sódico. En el ensayo de las contorsiones abdominales el efecto del verbascósido fue muy superior al de la flavona (67,6 ± 2,6% y un 27,0 ± 9,1% respectivamente). Los resultados obtenidos permitirían atribuirle, en gran parte, a estos metabolitos la propiedad analgésica de los diferentes extractos alcohólicos. Ensayos preliminares para evaluar la actividad analgésica tópica (latigazo de la cola) de dos formulaciones dermatológicas que se someterán a estudios clínicos (gel y crema conteniendo un 1% de EMAT-1) mostraron similar efecto analgésico: 47,93 ± 4,23% y 45,87 ± 6,07% respectivamente. Para la estandarización química del extracto fue necesario desarrollar una metodología analítica que permita la cuantificación de sus metabolitos activos. Se logró establecer una metodología analítica por cromatografía líquida de alta resolución (HPLC) obteniendo el perfil cromatográfico bajo las condiciones definidas. Se seleccionaron los patrones primarios ácido cafeico y rutina para expresar feniletanoides y flavonoides, respectivamente. Éstos permitieron la cuantificación de los principales compuestos presentes en el extracto, mediante el establecimiento de curvas de calibración. En los extractos se encontró respectivamente para verbascósido y 7-Oglucósido de luteolina: 11,43 ± 0,34% y 1,20 ± 0,03% para ETMATotoño, 24,50 ± 0,14% y 1,23 ± 0,01% para ETMATverano, 25,45 ± 0,32% y 1,26 ± 0,04% para EMAT-1 y 18,12 ± 0,10 y 1,23 ± 0,02% para un extracto metanólico global (EMG). Con estos resultados se pudo apreciar que existe variación estacional en la composición de los extractos de los feniletanoides sin variar la cantidad de flavonoides, que no existe diferencia al usar metanol o etanol en la elaboración de los extractos y la importancia de obtener extractos alcohólicos seriados al ver la disminución de la concentración de los componentes activos en el EMG, el cual no corresponde a un extracto seriado. Analizando los métodos espectrofotométricos actualmente empleados para el control de calidad de extractos de B. globosa, se comparó el método de Glories (adaptado en trabajos previos) y el de Folin-Ciocalteu con el método HPLC. Esta comparación confirmó las ventajas que posee la metodología HPLC sobre los métodos espectrofotométricos, puesto que el método de Glories presenta una baja exactitud en la expresión de los resultados debido a la interferencia que los feniletanoides generan sobre los flavonoides y que el método de Folin-Ciocalteu sólo entrega la concentración de fenoles totales hidrosolubles sin valorar particularmente a aquellos metabolitos activos de interés farmacológico.

La adicción ¿vicio o enfermedad? Imágenes y uso de servicios de salud en adolescentes usuarios y sus padres

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Abstract: Introduction Through time, the concept underlying drug consumption has been a matter of much controversy in the health sciences field. Here, it has been referred to using different definitions, but society seems to perceive it mostly as a vice, associated to socially unacceptable behavior. The addiction-vice notion implies a moral concept which goes beyond health issues and induces affective reactions that seem to hinder the use of health care services. In contrast, when addiction is considered as a disease and the inability to control consumption is acknowledged, it all seems to lead to an intervention meant to solve the problem. Does the temí "addiction" -as used by drug users to refer either to a disease or vice- have any influence on stopping or promoting the use of health care services? And if so: Which are the cognitive processes supporting the images of addiction-vice and addiction-disease? Reports from different studies agree on the fact that adolescents and their parents only look for the help of health care services when they feel frustrated because they find themselves unable to control the drug use and feel at risk because of certain beliefs, attitudes or intentions. The study of images comes from the socalled "French social psychology", where Moscovici proposed using the concept of images to define a more complex and logical structure than that of attitudes and/or evaluation results. He considers images as an inner representation of an external reality, as constructions similar to visual experiences: a sort of mental sensations or impressions of objects and persons. According to him, images persist because they are lodged in the memory where they reinforce the sense of both a continuity of the environment and individual and collective experiences. From this theoretical perspective, the following were the aims of this study: to describe addiction-related images built both by adolescent users of illegal drugs, who were undergoing treatment at the time, and their parents. Method Based on the theory of social representation, a qualitative study was devised. The sample was composed by fifteen 13 to 19 year-old adolescents, who were users of multiple illegal drugs and were undergoing treatment in the Centros de Integración Juvenil in Guadalajara, Jalisco, Mexico, in 2002, together with their respective accompanying parents. The data were compiled using in-depth recorded interviews. The interpretations consisted of thematic encoding, classification and interpretative analyses. Ethical steps were taken in order to protect the participants' identity and to obtain their informed consent. Results In the accounts of both the adolescents and their parents, addiction was consistently referred to as a vice. Here, the voluntary use pathway put forward by the subjects' stood out; so, a voluntary decision would also be required to stop using drugs. In addition, parents perceived addiction as something wrong. Only when drug users started having drug consumption-related difficulties, was this redefined as a problem that they could not solve by their own means. It is worth mentioning here that adolescents did try to avoid the influence of friends and the environment when using drugs. Parents thought willpower alone would suffice to stop their offspring from using drugs. This was so because parents were not sensitive enough to the influence of tolerance and abstinence regarding the problem. Consequently, there were reasoning processes that redefined addiction as a problem needing the help of specialists. This cognitive re-definition turned the image of addiction-vice into that of addiction-disease. On the one hand, to look for help in the health care services under the stigma of the vice image meant to be openly recognized as a dissolute person and to be thus socially excluded. On the other, having a disease implied the possibility of solving the mistake of drug-taking and thus being rehabilitated and reinserted into a productive life. Nevertheless, in the addiction-disorder image, drug consumption-related problems still prevailed, such as the inability to control using drugs, together with family, school and work problems. Redefining addiction as a disease did not seem to be stable or permanent in their minds for there were still traces of the vice image. This finding suggests the disease image acted as a sort of link between addiction-vice and the access to treatment when trying to stop the use by their own means failed. Instead of rejecting the vice image, it seems that the subjects' appropriation of the disorder image represented by health care services in order to look for a specialized treatment was used as an important expectation. This was the case even when in their minds the use of drugs was a vice influenced by willpower and environment. Drugs and addiction-vice and addiction-disease are not antagonistic images in social reasoning, but are a part of a continuum where they coexist. Discussion Our findings show that the adolescents interviewed had in their minds an image of addiction-vice as a pathway to drug use. It was also an image where drug use-related problems appeared, and thus they defined addiction as a disease without completely disassociating it from the notion of vice. Although these findings agree partially with those reported on this matter, there is a more elaborated and useful construction giving the problem a continuance in society, and to which Moscovici referred to as "image". An image has three characteristics accounting for its stability, consistency and continuance in social groups: 1. marginal elements, such as beliefs, cognitions, and judgements, which act as safeguards to protect; 2. the key element of the image, which is in this case addiction as vice, and 3. the social function accomplished by the image. We believe that the latter is the most important characteristic, a feature which was also emphasized by Moscovici. According to the common sense of the adolescents and parents under study, the function of the addiction-vice image was to reject a behavior considered deviant from accepted social norms. On the other hand, we detected that the addiction-disease image was not stable in the social mind, because this was not an image made up by the population under study, but one that they had appropriated and where health services were included. It is a construction circulating outside these particular social actors, and which is appropriated to carry out the purpose of gaining access to treatment. The images composing the voluntary use pathway seem to be antagonistic and mutually excluding, and they seem to coexist in the mind's continuum when addiction is redefined as a problem deserving help. Consequently, using drugs can be at times viewed either as a vice or disease, or vicedisease, depending on the purpose it fulfills in a given situation. Only common sense can accept such exclusions and alternations, because the reasoning underlying it does not need any verifications regarding its validity. From this viewpoint, addiction represents a big challenge for health services because of the several elements it involves. Results from this study point out to the reasoning used to examine the ideas of both the adolescents and their parents and to explain decisions regarding drug use. The degree of knowledge about the way these individuals think, communicate and take decisions will enable health services professionals to develop more efficient interventions. To a certain extent, we believe the reasoning behind the vice image is accurate enough because, although the use pathway was voluntary, willpower is also important to stop consumption and look for help in the health care services. Finally, we think that it would be appropriate to study these images in populations from other regions in order to evaluate if the same or similar images prevail or not. Further research of these images would help to develop longitudinal studies which would also evaluate, on the one hand, the images through the therapeutic process and, on the other, their link with the effectiveness of any given treatment.

Prevalencia y factores asociados al consumo de tabaco en adolescentes de una preparatoria de Guadalajara, Jalisco, México

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Abstract Introduction. The prevalence of tobacco use among students is apparently higher than in the general population. Several studies carried out in school population have found an increasing tendency in tobacco consumption, proportionally higher in women, which allows to identify similar consumption patterns in men and women. One of these studies estimated that the consumption frequency increases between 0.7% and 7% in three years. Nonetheless, another study points out to the fact that the Latin American and Caribbean youth population structure is an element that will favor the increase of the rate of smokers in the next years. Some of the risk factors identified are the tobacco consumption by other family members, a low perception of consumption risk, inclination towards tobacco use, to not deem the possibility of becoming a regular smoker, social tolerance, high availability and access to cigarettes, low school performance, to have friends that smoke, the search of a social image, a means of weigh control, search for a glamorous behavior, assert the transition between childhood and adulthood, the constant tobacco publicity in the media, the low supervision and the low monitoring by parents. Objective. To determine the prevalence and influence of the family and school environmental factors on tobacco use by adolescent students in Highschool No. 5 of the University of Guadalajara, Jalisco, Mexico, which has both an outstanding academic excellence and extracurricular program. Method. A cross sectional, prolective, and comparative study was performed. The population survey included 3,056 students enrolled at the above mentioned highschool in the 2004 term (36% men and 64% women); of the total population surveyed, 60.5% attended the morning shift and 39.5% the evening shift, their average age was 16.1+1.1 years. Due to the fact the previous studies report different prevalences between men and women, the size of the sample was estimated separately. For men, for whom a tobacco use of 27% has been estimated (and expecting a maximum deviation of 5% from the population prevalence) the required sample number was 190 subjects. Regarding women, of which a 16% prevalence was estimated (and expecting a maximum deviation of 3% from the population prevalence) the required sample number was 327 subjects. The subjects were recruited by drawing lots and their selection was carried-out by an aleatory numbers table. Each selected subject was located in its corresponding classroom and shift, and was invited to participate in this survey. They were asked to give an informed consent and there was a 100% rate of acceptance. The National Addictions Survey questionnaire was used to obtain the data, which assessed the socio-demographic data, consumption once in a lifetime, age of first use, number of times of consumption in a lifetime, time of use since the first time, use in the past 12 months, consumption in the last month, and number of cigarettes smoked daily. The tobacco consumption by the mother, father, siblings, and friends, was also included. The current tobacco addiction was defined by the consumption in the last month. The use pattern was considered experimental when it referred to one to 99 instances of consumption, and regular when it referred to more than 100 instances of use. For the statistical analysis, the categorical varia-bles were compared using the square Ji simple tests with Yates adjustment or Fisher's exact test according to requirement. The numerical variables were compared using the test for independent samples. A model of logistic regression was used to analyze the independent association of factors linked to the present consumption of tobacco use. Results. The prevalence of consumption once in a lifetime was 58.2%; in the last 12 months, 32.4%; and in the last month, 23.9% (IC of 95%: 20.4-27.6). The average age of first pathway of consumption was 13.9± years (limits 5-18). The subjects with present tobacco use were older (16.4± 1.0 years of age) than the non tobacco users (16.1±1.1 years of age, p=0.002) and they also had a lower school perfor-mance in the previous semester (81.1±6 versus 86.0±7 p<0.0001). We did not found any difference between the prevalence of tobacco use among men (45/194; 24.7%) and women (83/353; 23.5%; p=0.41). The assessment of the prevalence according to the consumption pattern showed that 48% of students had an experimental use, while 10% of the adolescents studied already had a regular tobacco consumption pattern. Using the univaried analysis, the presence of a regular tobacco consumption pattern had a statistical association with the performance in semesters at highschool, the tobacco use by the mother, father, siblings, and groups of friends, as well as the fact of studying in the evening shift, studying and also working, and being an irregular student. Likewise, in the case of present tobacco use, in the univaried analysis were associated the performance in semesters at highschool, studying in the evening shift, being an irregular student, studying and also working, tobacco use by the father (not the mother), siblings, and friends. After the logistic regression analysis, only studying in the evening shift, tobacco use by the father and friends, and being an irregular student kept their statistical association regarding present tobacco use. Discussion. The prevalence of tobacco consumption by adolescent students found in this survey was high in experimentation (48.2%) and regularity (10%) in view of the characteristics of the highschool where this survey was carried out. Nevertheless, this prevalence is lower than those reported on other recent surveys that were done in high school students from similar settings. One of them, the 2003 National Student's Survey found a 68.4% prevalence of tobacco use. This figure is 20% higher than the prevalence found in our study. We believe that those differences can be explained because the school where we performed our study has been awarded as an academic excellence high school. Another unexpected result was the absence of any differences in the consumption pattern in men and women, which also agree with the results of another recent study. This similarity in the behavior of men and women should be explored qualitatively. One contribution of our study is the fact that the father's use but not the mother's or siblings, has implications on adolescents consumption. Previous studies had reported the family's consumption as a risk factor, without identifying the above mentioned differences. Nonetheless, further studies regarding the influence of the father figure or image should be carried-out. Meanwhile, as a working hypothesis, we consider that the father's consumption defined attitudes of tolerance that are cognitively significant due to the cultural image of authority that he represents in the family. Even if the adolescent seeks to separate himself from family bond, and is more susceptible to the influence of the social environment, most of the family behavior has already been impressed on them. In the population studied by us, having friends that use tobacco was the most important association factor for its consumption. These findings have also been reported previously; nevertheless, the dynamics of use and their relationship with consumption should be further studied, as well as the social conceptualization attributed to friendship. The fact that studying in the evening shift was present in the unvaried analysis as well as in the logistic regression may be due to older students, lower performance and consequently, higher use probability. In short, the prevalence of tobacco use in our population of highschool adolescents was rather high, and we found no difference in the consumption pattern of men and women. The independent factors associated to tobacco use were tobacco consumption by the father and friends, as well as being in the evening shift. Finally, we consider that this study could represent the basis for: 1) Studies regarding new issues using qualitative tools in order to understand the social conceptualization concerning consumption and thus design more efficient educational actions; and 2) Having a baseline that will allow the assessment of the modification of risk factors on the decrease of tobacco consumption.

Evaluación económica de los tratamientos farmacológicos para las infecciones vaginales en Cuba / Economic evaluation of the pharmacological treatments for vaginal infections in Cuba

Se realizó una evaluación farmacoeconómica de los diferentes esquemas de tratamientos para las infecciones vaginales, según terapéuticas fundamentadas en metodologías establecidas por los organismos internacionales que permita obtener una utilización racional de los medicamentos, con mayor efectividad y menos costos en la estrategia de tratamiento de la infección genital, aspecto que tiene una alta prioridad para el Sistema Nacional de Salud. Se señala que actualmente no existe el mejor conocimiento médico de los tratamientos farmacológicios y del enfoque sindrómico de las infecciones vaginales, aspecto que conspira con una adecuada prescripción de los medicamentos, y por ende, con la curación de la enfermedad. Para darle solución a esta problemática, se demuestra retrospectivamente la eficiencia farmacoterapéutica de las alternativas de tratamientos seleccionados, lo que permitirá una actualización del formulario nacional de medicamentos para las infecciones vaginales, así como establecer las líneas de investigación de nuevos fármacos para engrosar el arsenal terapéutico del país. Se establece un esquema por orden de prioridad de los tratamientos farmacológicos para las distintas infecciones vaginales, teniendo en cuenta el criterio farmacoeconómico como vía para la elaboración de una política al nivel nacional en el empleo de estos medicamentos, y que esté en concordancia con la situación farmacoepidemiológica, y de los niveles de resistencia de los antibióticos para su prescripción generalizada a nuestra población en el nivel primario de atención de salud

Guía para la práctica clínica de las infecciones vaginales / Guide for the clinical practice of vaginal infections

Se establecen recomendaciones para el manejo terapéutico adecuado de pacientes con infección vaginal, así como contribuir al enfoque multidisciplinario de las mismas, situaciones que favorecen su aparición, formas de presentación, recomendaciones generales y criterios terapéuticos a seguir según las manifestaciones en niñas, mujeres embarazadas y no embarazadas

Factores que inciden en la anemia ferropénica de la embarazada / Factors influencing on iron-deficiency anemia in pregnant women

Se realizó un estudio transversal descriptivo en 292 gestantes del municipio Marianao, de ellas 145 anémicas (hemoglobina < 110 g/L) y 147 no anémicas (grupo control), desde marzo de 1999 a mayo de 2000. Se evaluó la hemoglobina al inicio y a partir de las 20 semanas de la gestación, variables asociadas con el suplemento ôPrenatalö, y factores epidemiológicos pregestacionales y gestacionales que influyen en la anemia ferropénica. Se concluyó que la hemoglobina disminuyó significativamente para ambos grupos; las variables con mayor influencia sobre la hemoglobina actual del grupo de anémicas fueron la nutrición regular (78,6 porciento), las semanas de gestación con un mayor porcentaje con ferropenia entre las 20 y las 34 semanas, la parición y el espacio intergenésico inferior a 2 años. En cuanto al ôPrenatalö influyeron significativamente la no ingestión sistemática del suplemento y la forma y momento no adecuados de la administración