[Mortalidad por enfermedad de Alzheimer en México de 1980 a 2014].

BACKGROUND: Dementias are rarely considered to be a main cause of death; therefore there are only few studies on Alzheimer's mortality covering long periods. OBJECTIVE: To describe mortality from Alzheimer's disease in México for the period from 1980 to 2014. METHOD: Cross-sectional study where, with official mortality data in Mexico according to codes 331.0 and G30, respectively, of the 9th and 10th revisions of the International Statistical Classification of Diseases and Related Health Problems, crude and standardized Alzheimer's disease mortality rates were obtained, both nationally and by states. RESULTS: From almost being inexistent, deaths from Alzheimer's disease went to a rate of 65.12 per 1000 females and 43.66 per 1000 males in the 2010-2014 five-year period. Throughout the study period, the age group with highest mortality rates for this cause were those older than 80 years, with 0.29 per 100,000 population in 1980-1984 and 55.02 in 100,000 in the 2010-2014 period. The region with the highest mortality was the northwest, with rates higher than 2.28 per 100,000 population. CONCLUSIONS: Mortality from Alzheimer's disease is a public health problem in Mexico with a growing trend, especially among women and older adults. Early diagnostic measures and opportune treatment are required in primary care in order to reduce this problem.

INTRODUCCIÓN: Raramente se considera a las demencias como causa principal de muerte, por consiguiente existen pocos estudios sobre la mortalidad por Alzheimer a través de largos periodos. OBJETIVO: Describir la mortalidad por enfermedad de Alzheimer en México durante el periodo 1980-2014. MÉTODO: Estudio transversal en el que, con datos oficiales de mortalidad en México según los códigos 331.0 y G30 de la novena y décima revisiones de la Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados con la Salud, se obtuvieron tasas crudas y estandarizadas de mortalidad por enfermedad de Alzheimer, nacional y por entidad federativa. RESULTADOS: De ser casi inexistentes, en el quinquenio 2010-2014 se registraron tasas de 65.12 y 43.66 muertes por enfermedad de Alzheimer por cada 1000 mujeres y 1000 hombres, respectivamente. En todo el periodo estudiado, el grupo etario con las mayores tasas de mortalidad por esta causa fue el de mayores de 80 años, con 0.29 en 100 000 habitantes durante 1980-1984 y 55.02 durante 2010-2014. La región con mayor mortalidad fue la noroeste, con tasas mayores a 2.28 en 100 000 habitantes. CONCLUSIONES: La mortalidad por enfermedad de Alzheimer es un problema de salud pública en México con tendencia creciente, especialmente entre mujeres y adultos mayores. Se requieren medidas diagnósticas precoces y tratamiento oportuno en primer nivel para aminorar este problema.

[Falls mortality trends in México, 1979-2010]. / [Tendencia de mortalidad por caídas en México, 1979-2010].

AIM: To analyze the mortality trend by accidental falls in Mexico, from 1979 to 2010. MATERIAL AND METHODS: We used official mortality data in México. Variables included were mortality cause, place of lesion, age, sex, year of mortality registration, size of the town of occurrence, state, occupation, workplace falls. RESULTS: During that period, 124,509 deaths by accidental and intentional falls were registered; of these 77.03% were men. From 1989 (3.20 per 100,000) to 2010 (1.99 per 100,000), the mortality trend was falling (ß = -0.053/ 100,000, p ≤ 0.001). In the majority of states, we found a decreased between 1993-1997 and 2006 to 2010, except in Aguascalientes, Puebla, Baja California Sur, Durango and Nuevo León. CONCLUSIONS: This is the first study in México that showed the descending trend of mortality in accidental falls in the last two decades.

[Injuries in emergency rooms of urban areas in Mexico: prevalence and severity]. / Atención de lesiones por tipo de causa externa en salas de urgencia en tres ciudades de México: composición, frecuencia y gravedad.

OBJECTIVE: To identify frequency and severity of injuries by type of external cause in people attending emergency services for medical attention. MATERIAL AND METHODS: Cross-sectional study held in the cities of Guadalajara, Colima and Mexico City, from September 2007 to February 2008. All people requiring emergency medical attention due to injuries were included. VARIABLES: sex, age, anatomical area of the injury, type of injury, external cause, type of aggressor and severity according to the abbreviated injury scale. Statistical analysis was univariate simple and multivariate. RESULTS: 26.3% of the emergency medical attention was due to injuries, with the main cause being falls (49.3%). Individuals from 15 to 44 years (55.8%) reported a higher frequency, while those over 60 years presented the most serious injuries. Associated variables to severity were interpersonal aggression (OR 6.7, IC 95% 4.20-10.69) and road traffic injuries (OR 3.00, IC 95% 1.72-5.23). Conclusions. Accidental and intentional injuries represent an important demand of emergency medical attention; with interpersonal aggression and road traffic injuries being responsible for the highest number of serious injuries.

[Level of functionality among senior citizen packers in a chain of Mexican supermarkets]. / Estado de funcionalidad de adultos mayores empacadores en tiendas de autoservicio.

OBJECTIVE: To identify socio-demographic characteristics and general health conditions among senior citizens working as volunteer packers in a supermarket chain in Mexico. MATERIAL AND METHODS: From May to July 2008 we carried out a cross-sectional analysis in 416 volunteers aged 60 or more years. RESULTS: Mean age was 69.4 years, (range 60-87). Mean level of schooling was elementary school. Men's prior occupation was in the formal sector of the economy vs. women participants who were not. Men were mostly from lower middle class strata and women from lower strata. Most participant's self-perception of health was good although there was an inherent risk of developing obesity. Depression rating scale scores were within normal limits. They had sought work as packers due to financial constraints. CONCLUSIONS: Senior citizens working as paid volunteers seems to promote their physical, mental, social and financial well being. Our findings suggest gender differences within the context of a bleak socio-economic and epidemiological panorama.

[Taste sensitivity diminution in hyperglycemic type 2 diabetics patients]. / Disminución de la sensibilidad gustativa en diabéticos tipo 2 con hiperglucemia.

OBJECTIVE: To determine the relationship between fasting blood glucose (FBG) values and gustatory sensitivity alterations in type 2 diabetic patients (DM2) without peripheral neuropathy (PNP). METHODS: Assessment of the strength of association between FBG and detection and recognition taste thresholds for the four primary tastes measured by chemical gustometry were performed in 140 DM2 without PNP with evolution < 10 years. RESULTS: FBG values above 7.77 mmol/L (140 mg/dL) induce in a dependent manner, the increase in the detection and recognition taste thresholds only to sweetness; whereas, values above 16.65 mmol/L (300 mg/dL) did not cause further decreasing in taste acuity to sweet flavor. Statistically significant differences where found for detection and recognition, taste thresholds for sucrose between well controlled (HbA1c < or = 7 %) normoglycemic and hyperglycemic diabetics, as well as between alarming uncontrolled (HbA1c > 10 %) normoglycemic and hyperglycemic patients. CONCLUSIONS: Hyperglycemia induces a concentration-dependent impairment of sweet taste perception in DM2 patients as the result of an adaptation of the sensory cell to elevated circulating concentrations of glucose.

Urinary Pesticide Levels in Children and Adolescents Residing in Two Agricultural Communities in Mexico.

The use of pesticides in agricultural activities has increased significantly during the last decades. Several studies have reported the health damage that results from exposure to pesticides. In Mexico, hundreds of communities depend economically on agricultural activities. The participation of minors in this type of activity and their exposure to pesticides represents a potential public health problem. A cross-sectional study was conducted, in which urine samples (first-morning urine) were taken from children under 15 years of age in both communities. A total of 281 urine samples obtained in both communities were processed for the determination of pesticides with high-performance liquid chromatography together with tandem mass spectrometry. In 100% of the samples, at least two pesticides of the 17 reported in the total samples were detected. The presence of malathion, metoxuron, and glyphosate was remarkable in more than 70% of the cases. Substantial differences were detected regarding the other compounds. It is necessary to carry out long-term studies to determine the damage to health resulting from this constant exposure and to inform the health authorities about the problem in order to implement preventive measures.

Erratum: Sierra-Diaz, E.; Celis-de la Rosa, A.J.; Lozano-Kasten, F.; Trasande, L.; Peregrina-Lucano, A.A.; Sandoval-Pinto, E.; Gonzalez-Chavez, H. Urinary Pesticide Levels in Children and Adolescents Residing in Two Agricultural Communities in Mexico. Int. J. Environ. Res. Public Health 2019, 16, 562.

The authors would like to update some important data in the manuscript. In Table 4, the pesticide means were reported in µg/mL, which is incorrect. The correct units are ng/mL (nanograms/milliliter). The same typographical inaccuracy applies for data in the fourth paragraph of the discussion (with minimal values of 0.0020 µg/mL and maximal values of 2.63 µg/mL), where the correct units are also ng/mL [1]. [...].

Effect of symbiotic supplementation on fecal calprotectin levels and lactic acid bacteria, Bifidobacteria, Escherichia coli and Salmonella DNA in patients with cervical cancer.

BACKGROUND: patients with cervical cancer (CC) receiving chemotherapy and radiotherapy have several gastrointestinal adverse effects. OBJECTIVE: to evaluate the effect of dietary symbiotic supplementation on fecal calprotectin (FCP), bacterial DNA levels, and gastrointestinal adverse effects in patients with CC. METHODS: clinical, controlled, randomized, double-blind trial. Patients consumed symbiotics or placebo three times a day for seven weeks. FCP was assessed by Elisa method. DNA from probiotic and pathogenic bacteria were determined by quantitative real-time polymerase chain reaction. Diarrheal evacuations were evaluated with the Bristol stool form scale and nausea and vomiting were measured using the scale of the National Institute of Cancerology of the United States. RESULTS: after a seven-week treatment, FCP concentration was lower in the symbiotic group compared to the control group (p < 0.001). Stool consistency in the placebo and symbiotic groups was similar at baseline. A significant improvement in stool consistency was obtained in both groups at the end of the intervention (p < 0.001). The concentrations and total proportions of the probiotic and pathogenic bacteria were similar in both groups. Nausea significantly diminished in both groups (p < 0.001) at the end of the trial. Furthermore, the symbiotic group had a statistically significant decrease in the frequency and intensity of vomiting when compared to the control group (p < 0.001). CONCLUSIONS: the symbiotic treatment decreases significantly the FCP levels and the frequency and intensity of vomiting in patients with CC.

Non-Traditional Risk Factors of Albuminuria in the Pediatric Population: A Scoping Review.

The presence of albumin in urine has been used for more than four decades as a marker of renal and cardiovascular damage. Most of the information on this marker is related to adults. The prevalence of albuminuria in the pediatric population has been reported as being 2.2-12.8% in some countries. Most research in this field is related to albuminuria and diseases, such as diabetes and hypertension. Using the methodology described by Arksey and O'Malley in 2005, a scoping review was carried out to show that the presence of albumin in urine in the pediatric population might be associated with environmental, demographic, congenital, infectious, and non-infectious factors. The information collected is supported by 74 references present in PubMed. The results reveal the multiple causes associated with albuminuria in the pediatric population. This information can be very useful for clinical practice by adding knowledge about albuminuria behavior in children.

[Central venous-catheter related bacteremia: incidence and risk factors in a hospital in western México]. / Bacteriemia relacionada con catéter venoso central: incidencia y factores de riesgo en un hospital del occidente de México.

BACKGROUND: Central venous catheters (CVC) are needed for monitoring and treatment of critically ill patients; however, their use increases the risk of bacteremia. The aim of the study was to quantify the incidence of central venous catheter-related bacteremia (CVCRB) and to identify factors associated with this infection. METHODS: A prospective cohort study was conducted in a concentration hospital of western Mexico. The association of CVCRB and study variables was investigated using multivariate Cox regression analysis. RESULTS: Two hundred four patients with CVC were studied. The average age was 4.6 years; 66.2% were male. Insertion sites of the catheters were subclavian vein 72.5% (n = 148), jugular vein 20.1% (n = 41) and femoral vein 7.4% (n = 15). CVCRB incidence was 6.5 events/1,000 catheter days; microorganisms identified were gram-positive cocci 37.5% (n = 6), gram-negative bacilli 37.5% (n = 6) and Candida albicans 25% (n = 4). It was observed that the increase in catheter manipulations per day was associated with bacteremia (HR 1.14, 95% CI 1.06 - 1.23), whereas the use of intravenous antibiotics showed a protective effect (HR 0.84, 95% CI 0.76-0.92). CONCLUSIONS: In addition to strategies of maximum caution when placing or manipulating the catheter, we recommend decreasing, as much as possible, disconnects between the CVC and infusion line. Antibiotics showed a protective effect, but the outcome is uncertain and promotion of antimicrobial resistance should be considered.

[Epidemiologic profile of children with burns from the Civil Hospital of Guadalajara "Dr. Juan I. Menchaca", 2009-2011]. / Perfil epidemiológico de niños con quemaduras del Hospital Civil de Guadalajara Dr. Juan I. Menchaca, 2009-2011.

BACKGROUND: Burns are a public health problem, ranking among the 20 principal causes of morbidity in Mexico. Children are a more vulnerable group to suffer from these injuries. For that reason, we analyzed cases in order to gain a better comprehension and to propose preventive measures for this problem. The aim of the study was to determine the epidemiological profile of those injuries to allow us to plan and implement actions for burn prevention. METHODS: We conducted a cross-sectional study that included demographic characteristics of the child, the parents and the burn injuries from children treated at this Burn Unit. Statistical analysis was done to calculate amounts, proportions and 95% confidence intervals. RESULTS: The epidemiological profile of the injuries included males (63.4%) <5 years of age (65.2%) with educational level according to their age (56.2%). Parents of the included children were <35 years old with basic educational level. Burns were caused by hot water (56.2%) and occurred between noon and midnight (73.0%). The majority of the burns were shallow and deep second-degree or minor (69.2%) and affected <20% of body surface area (74.5%). CONCLUSIONS: This epidemiological profile paved the way for preventive actions beginning with scientific research to guide the actions in a progressive direction along with the cooperative actions of public and private institutions in the development of programs and strategies. The end result would be the establishment of a public policy for accidental injuries.

Interaction between mercury (Hg), arsenic (As) and selenium (Se) affects the activity of glutathione S-transferase in breast milk; possible relationship with fish and sellfish intake.

Breast milk is regarded as an ideal source of nutrients for the growth and development of neonates, but it can also be a potential source of pollutants. Mothers can be exposed to different contaminants as a result of their lifestyle and environmental pollution. Mercury (Hg) and arsenic (As) could adversely affect the development of fetal and neonatal nervous system. Some fish and shellfish are rich in selenium (Se), an essential trace element that forms part of several enzymes related to the detoxification process, including glutathione S-transferase (GST). The goal of this study was to determine the interaction between Hg, As and Se and analyze its effect on the activity of GST in breast milk. Milk samples were collected from women between day 7 and 10 postpartum. The GST activity was determined spectrophotometrically; total Hg, As and Se concentrations were measured by atomic absorption spectrometry. To explain the possible association of Hg, As and Se concentrations with GST activity in breast milk, generalized linear models were constructed. The model explained 44% of the GST activity measured in breast milk. The GLM suggests that GST activity was positively correlated with Hg, As and Se concentrations. The activity of the enzyme was also explained by the frequency of consumption of marine fish and shellfish in the diet of the breastfeeding women.

La leche materna es considerada como una fuente ideal de nutrientes para el crecimiento y el desarrollo de los recién nacidos, pero también puede ser una fuente potencial de contaminantes. Las madres pueden estar expuestas a diversos contaminantes como resultado de su estilo de vida y de la contaminación ambiental. Mercurio (Hg) y arsénico (As) pueden afectar negativamente el desarrollo del sistema nervioso fetal y neonatal. Algunos peces y mariscos son ricos en selenio (Se), un oligoelemento esencial que forma parte de diversas enzimas relacionadas con el proceso de desintoxicación, incluyendo glutatión S-transferasa (GST). El objetivo de este estudio fue determinar la interacción entre Hg, As y Se, así como analizar su efecto sobre la actividad de GST en la leche materna. Muestras de leche materna fueron obtenidas entre los días 7 y 10 después del parto. La actividad de la GST fue determinada espectrofotométricamente. Las concentraciones totales de Hg, As y Se fueron medidas por espectrometría de absorción atómica. Para explicar la posible asociación de las concentraciones de Hg, As y Se con la actividad de la GST en la leche materna, se construyeron modelos lineales generalizados. El modelo explicó el 44% de la actividad de GST medida en leche materna. El MLG sugiere que la actividad de GST se correlacionó positivamente con las concentraciones de Hg, As y Se. La actividad de la enzima se explica también por la frecuencia de consumo de peces marinos y mariscos en la dieta de las mujeres que se encuentran en periodo de lactancia.

[Mercury concentration in breast milk of women from northwest Mexico; possible association with diet, tobacco and other maternal factors]. / Concentraciones de mercurio en leche de mujeres del noroeste de México; posible asociación a la dieta, tabaco y otros factores maternos.

OBJECTIVE: To determine THg levels in milk of women from Northwest Mexico and its potential association with maternal factors such as diet and tobacco smoke. METHOD: The study was performed in 108 milk samples donated by women in Baja California Sur. Data were stratified into three groups of 36 donors by number of pregnancies. General data, smoking, exposure to environmental tobacco smoke and seafood intake were explored. THg levels were measured using atomic absorption spectrophotometry. The difference between groups was evaluated with non-parametric statistics. To explain the possible association of the different variables with THg concentrations in milk, generalized linear models were performed. RESULTS: THg levels ranged from 1.23 µg/L in single-pregnancy women (GI) to 2.96 µg/L for women with 3 or more pregnancies (GIII) (p = 0.07). In the GI group THg concentration was 175% higher (p = 0.02) in women who do not eat fish, compared to those who eat fish. In the generalized linear model to adjust THg concentrations, the variables were: age, number of pregnancies, breastfeeding duration and exposure to tobacco smoke (p ≤ 0.05). CONCLUSIONS: Fish consumption was the factor that better adjusted models, relative to THg levels. The contribution associated to this factor was low; therefore, consumption of fish from the coast of Baja California Sur is safe. Tobacco increased Hg concentrations in breast milk; it is necessary to avoid the smoking habit during pregnancy and breast-feeding.

Objetivo: Determinar los niveles de mercurio total (THg) en leche de mujeres del Noroeste de México y su posible asociación con factores maternos, la dieta y el tabaco. Método: El estudio se realizó en leches donadas por 108 mujeres de Baja California Sur. Se estratificaron en tres grupos de 36 donantes según el número de gesta. Se exploraron datos generales, hábito tabáquico, exposición al humo de tabaco ambiental, ingesta de mariscos y pescados. Los niveles de THg fueron cuantificados utilizando espectrofotometría de absorción atómica. La diferencia entres grupos se evaluó con estadística no paramétrica. Para explicar la posible asociación de las diferentes variables estudiadas y las concentraciones de THg en la leche, se realizaron modelos lineales generalizados. Resultados: Los niveles de THg fueron desde 1.23 ?g/L en las primigestas (GI) a 2,96 ?g/L para las mujeres con 3 o más gestas (GIII) (p = 0,07). En el grupo de GI encontramos una concentración del THg 175% mayor (p = 0,02) entre las mujeres que no comen pescado, en comparación con las que si comen pescado. En el modelo lineal generalizado ajustado por las concentraciones de THg, las variables fueron: edad, número de embarazos, duración de la lactancia y exposición al tabaco (p =?0,05). Conclusiones: El consumo de pescado fue el factor que mejor ajustó los modelos en relación a los niveles de THg. El aporte de Hg por la dieta que se pudo asociar fue bajo, por lo que el consumo de pescado de las costas de Baja California Sur es seguro. El tabaco, incrementa las concentraciones de Hg en la leche materna, por lo que debe de limitarse su hábito durante el embarazo y la lactancia.

Prescripción inadecuada de medicamentos: aportaciones de los paradigmas científicos a su conocimiento / Inadequate drugs prescription: contributions of scientific paradigms to your knowledge

Resumen Se realizó una revisión narrativa con análisis temático sobre las aportaciones de los paradigmas científicos al conocimiento de la prescripción inadecuada de medicamentos. Se buscaron artículos de acceso abierto indexados en PubMed© entre 2010-2014, y se sistematizó información sobre el paradigma, tipo de publicación, perspectiva teórica, objetivo, método y resultados. De los 992 artículos encontrados, se seleccionaron 118, y se tomó una muestra propositiva de 15, según su diseño, representando los cuatro paradigmas. Los artículos positivistas reportaron prevalencia, factores asociados, efectividad de intervenciones y criterios de evaluación; los interpretativos explicaron las causas del problema según los involucrados; los críticos denunciaron la influencia de la industria farmacéutica; y el participativo abordó el problema secundariamente y lo solucionó en un escenario para una enfermedad y grupo farmacológico específicos. Se concluyó que la prescripción inadecuada de medicamentos como problema de investigación en salud pública recibe aportes de los cuatro paradigmas, con dominio del positivismo, lo que se atribuye al carácter paradigmático de la ciencia desde la que se le aborda habitualmente, y que una perspectiva multi-paradigmática es el mejor abordaje.

Abstract This study conducted a narrative review with thematic analysis about contributions of scientific paradigms to knowledge of inadequate drugs prescription. We searched open access articles indexed in PubMed© between 2010 and 2014, and we systematized information about scientific paradigm, publication type, theoretical perspective, objective, method and results. From the 992 articles found, 118 were selected. From those, we chose a purposive sample of 15, according to the design of the studies, representing the four paradigms. The positivists articles reported prevalence, associated factors, effectiveness of interventions and evaluation criteria; the interpretive explained the causes of the problem according to those involved; the critics denounced the influence of pharmaceutical industry; and the participative addressed the problem secondarily and solved it in a scenario for a specific disease and pharmacological. We concluded that the inadequate drugs prescription as research problem in public health had contributions from the four paradigms, with dominance of positivism, which is attributed to the paradigmatic perspective of the science, from which it is usually studied, and that a multi-paradigmatic perspective is the best approach to the public health issue.

Efecto de una intervención educativa para promover ejercicios aeróbicos intradialíticos, sobre el estado funcional en pacientes en hemodiálisis de México / Effect of an educational intervention to promote intradialysis aerobic exercises on the functional state of hemodialysis patients from Mexico

INTRODUCCIÓN: La educación en salud busca influir sobre la actitud de las personas para mejorar su salud mediante el fomento de hábitos saludables. En pacientes en hemodiálisis, su capacidad funcional suele estar disminuida por la inactividad física. OBJETIVO: Evaluar el efecto de una intervención educativa en salud para la promoción del ejercicio aeróbico, sobre la capacidad funcional de pacientes en hemodiálisis de México. MATERIAL Y MÉTODOS: Estudio cuasiexperimental antes-después con grupo control en Unidades de Atención Médica Hospitalaria del Instituto Mexicano del Seguro Social, Delegación Jalisco, con un universo de 26 pacientes con hemodiálisis muestreados propositivamente, 14 en el Grupo "A" (experimental) y 12 en el "B" (control). Se incluyeron las variables: edad, sexo y capacidad funcional. La intervención consistió en un diálogo dirigido sobre factores biopsicosociales de enfermedad renal, capacidad funcional y nutrición, con acompañamiento en ejercicios aeróbicos de 30 minutos/semana durante 20 semanas. Se evaluó la capacidad funcional con el Test Delta, y se comparó la media antes y después usando T de Student (p ≤ 0,05). RESULTADOS: No hubo diferencias estadísticamente significativas entre la edad y sexo de los pacientes en los Grupos "A" y "B". Capacidad funcional media antes y después: Grupo "A" 14 ± 5 vs 8 ± 4 (p < 0,001), Grupo "B" 16 ± 4 vs 17 ± 5 (p = 0,405). Conclusiones: La educación en salud influyó favorablemente sobre la actividad física de los pacientes en hemodiálisis y mejoró su capacidad funcional. Es recomendable implementar programas de ejercicio aeróbico durante las sesiones de hemodiálisis

INTRODUCTION: Health education search to influence on persons' attitude for to improve your health by mean of healthy habits promotion. In patients with hemodialysis your functional capacity usually is diminished for physical inactivity. OBJECTIVE: To evaluate the effect of a health education intervention for aerobic exercise's promotion on the functional capacity in hemodialysis patients from Mexico. METHODS: Quasi-experimental study beforeafter with control group in Hospital Medical Care Units of the Mexican Institute of Social Security, Jalisco's Delegation, with a universe of 26 patients with hemodialysis purposively sampled, 14 in Group "A" (experimental) and 12 in Group "B" (control). It included variables: age, gender and functional capacity. The intervention consisted of directed dialogue on biopsychosocial factors of renal disease, functional capacity and nutrition, with accompaniment in aerobic exercises of 30 minutes/week for 20 weeks. It evaluated functional capacity with Delta Test and it compared means before and after with Student's T (p ≤ 0,05). Results: There were no statistically significant differences between age and gender of patients in the "A" and "B" Groups. Mean functional capacity before and after: Group "A" 14 ± 5 vs 8 ± 4 (p < 0,001), Group "B" 16 ± 4 vs 17 ± 5(p=0,405). CONCLUSIONS: The health education influenced favorably on the physical activity of patients with hemodialysis and improved your functional capacity. To implement aerobic exercise programs during hemodialysis sessions it advisable

Bacteriemia relacionada con catéter venoso central: incidencia y factores de riesgo en un hospital del occidente de México / Central venous-catheter related bacteremia: incidence and risk factors in a hospital in western México

Resumen: Introducción: El catéter venoso central (CVC) es necesario para la monitorización y tratamiento de pacientes en estado crítico; sin embargo, su uso incrementa el riesgo de bacteriemia. El objetivo del estudio fue cuantificar la incidencia de bacteriemia relacionada con catéter venoso central (BRCVC) e identificar los factores asociados con esta infección. Métodos: Se realizó un estudio de cohorte prospectivo en un hospital de concentración del occidente de México. Para conocer la asociación entre BRCVC y las variables en estudio, se realizó un análisis multivariado con regresión de Cox. Resultados: Se estudiaron 204 pacientes con CVC. La edad promedio fue de 4.6 años; el 66.2% fue del sexo masculino. Los sitios de inserción del catéter fueron la vena subclavia (72.5%, n = 148), la vena yugular (20.1%, n = 41) o la vena femoral (7.4%, n = 15). La incidencia de BRCVC fue de 6.5 eventos por 1,000 días catéter. Los microorganismos identificados fueron cocos Gram positivos (37.5%, n = 6), bacilos Gram negativos (37.5%, n = 6) y Candida albicans (25%, n = 4). Se observó que la mayor manipulación del catéter por día se asoció con bacteriemia (HR 1.14, IC95% 1.06-1.23), mientras que el uso de antibióticos intravenosos mostró un efecto protector (HR 0.84, IC95% 0.76-0.92). Conclusiones: Además de las medidas máximas de precaución al momento de colocar o manipular el catéter, es conveniente disminuir lo más posible las desconexiones entre el equipo de venoclisis y el CVC. Los antibióticos mostraron un efecto protector; sin embargo, se debe considerar el riesgo de favorecer resistencias antimicrobianas.

Abstract: Background: Central venous catheters (CVC) are needed for monitoring and treatment of critically ill patients; however, their use increases the risk of bacteremia. The aim of the study was to quantify the incidence of central venous catheter-related bacteremia (CVCRB) and to identify factors associated with this infection. Methods: A prospective cohort study was conducted in a concentration hospital of western Mexico. The association of CVCRB and study variables was investigated using multivariate Cox regression analysis. Results: Two hundred four patients with CVC were studied. The average age was 4.6 years; 66.2% were male. Insertion sites of the catheters were subclavian vein 72.5% (n = 148), jugular vein 20.1% (n = 41) and femoral vein 7.4% (n = 15). CVCRB incidence was 6.5 events/1,000 catheter days; microorganisms identified were gram-positive cocci 37.5% (n = 6), gram-negative bacilli 37.5% (n = 6) and Candida albicans 25% (n = 4). It was observed that the increase in catheter manipulations per day was associated with bacteremia (HR 1.14, 95% CI 1.06 - 1.23), whereas the use of intravenous antibiotics showed a protective effect (HR 0.84, 95% CI 0.76-0.92). Conclusions: In addition to strategies of maximum caution when placing or manipulating the catheter, we recommend decreasing, as much as possible, disconnects between the CVC and infusion line. Antibiotics showed a protective effect, but the outcome is uncertain and promotion of antimicrobial resistance should be considered.

Perfil epidemiológico de niños con quemaduras del Hospital Civil de Guadalajara Dr. Juan I. Menchaca, 2009-2011 / Epidemiologic profile of children with burns from the Civil Hospital of Guadalajara "Dr. Juan I. Menchaca", 2009-2011

ResumenIntroducción: Las quemaduras son un problema de salud pública ubicado dentro de las 20 principales causas de morbilidad en México. Uno de los grupos más vulnerables son los niños. Al realizar un análisis de los casos, se aporta para un mejor entendimiento del problema y pueden generarse medidas preventivas al respecto. El objetivo de este trabajo fue determinar el perfil epidemiológico de niños con quemaduras que ingresan a la Unidad de Niños con Quemaduras del Hospital Civil de Guadalajara Dr. Juan I. Menchaca.Métodos: Se realizó un estudio transversal que incluyó características demográficas del lesionado, de sus padres y de las quemaduras de niños atendidos durante 2009 a 2011. El análisis estadístico se llevó a cabo mediante el cálculo de frecuencias absolutas, proporciones e intervalos de confianza de 95%.Resultados: El perfil epidemiológico de los niños lesionados fue principalmente de varones (63.4%) menores de cinco años de edad (65.2%), con escolaridad de acuerdo con su edad (69.2%); hijos de padres menores de 35 años con escolaridad básica. Las lesiones fueron causadas por agua (56.2%) durante el lapso de las 12 p.m. a las 11:59 p.m. (73.0%) produciendo quemaduras de segundo grado superficial y profundo o menores (69.2%) que afectaron menos del 20% de la superficie corporal total (74.5%).Conclusiones: Este perfil epidemiológico permite ampliar el panorama de las acciones preventivas, iniciando con investigaciones científicas que orienten el rumbo que se debe seguir, trabajando conjuntamente con instituciones públicas y privadas en la elaboración de programas y estrategias, así como el establecimiento de una política pública para lesiones no intencionales.

AbstractBackground: Burns are a public health problem, ranking among the 20 principal causes of morbidity in Mexico. Children are a more vulnerable group to suffer from these injuries. For that reason, we analyzed cases in order to gain a better comprehension and to propose preventive measures for this problem. The aim of the study was to determine the epidemiological profile of those injuries to allow us to plan and implement actions for burn prevention.Methods: We conducted a cross-sectional study that included demographic characteristics of the child, the parents and the burn injuries from children treated at this Burn Unit. Statistical analysis was done to calculate amounts, proportions and 95% confidence intervals.Results: The epidemiological profile of the injuries included males (63.4%) <5 years of age (65.2%) with educational level according to their age (56.2%). Parents of the included children were <35 years old with basic educational level. Burns were caused by hot water (56.2%) and occurred between noon and midnight (73.0%). The majority of the burns were shallow and deep second-degree or minor (69.2%) and affected <20% of body surface area (74.5%).Conclusions: This epidemiological profile paved the way for preventive actions beginning with scientific research to guide the actions in a progressive direction along with the cooperative actions of public and private institutions in the development of programs and strategies. The end result would be the establishment of a public policy for accidental injuries.

Incremento de la temperatura ambiental y su posible asociación al suicidio en Baja California Sur (BCS) 1985-2008 / Environmental temperature increase and its possible association with suicide in the population of Baja California Sur (BCS) 1985-2008

Introduction During the last decade we have observed important climate changes, especially in environmental temperatures. There is considerable information linking the increase in hot weather and human health. For example, hot weather is associated with an increased risk of suicide in different countries around the world. Objective To evaluate the relationship between suicide rates and the environmental temperature in Baja California Sur, Mexico, from 1985 to 2008. Method Suicide mortality data for Baja California Sur (BCS) were obtained for the years 1985-2008 from the Instituto Nacional de Estadística, Geografía e Informática (INEGI). The selected codes were: E950-E959 (ICD-9) and X60-X84, Y87.0 (ICD-10) for BCS. The BCS weather data used was the maximum temperature from 1985 to 2008, obtained from the Extractor Rápido de Información Climatológica (ERIC III). Lineal and quadratic models were used to assess the annual rate changes of suicide and generalized lineal models (GLM) to assess the effect of the climatological variables to the suicide rate. The p≤0.05 was considered significant. Results In BCS, 582 suicide deaths were reported from 1985 to 2008. The 9% (53) of the total reported were women with a yearly average rate 1.6/100 000; 91% (529) were men with a yearly average rate 16.3/100 000. Lineal and quadratic models explained the tendency of the annual increment observed in the number of suicides in both seasons. The quadratic model better explained such increment during the warmer months (R²=0.64 p<0.01). The temperature was positively correlated with the rate of suicides in both seasons (p<0.01). Two predictive GLMs were created by season. Discussion These results suggest a potential link between an increase in environmental temperature and the rates of suicide during 24 years in BCS. This relationship is clear during the hot season; however, a positive trend was found during the cold season, perhaps due to the result of warmer winters.

Introducción Durante las últimas décadas se ha podido apreciar un cambio en las variables climáticas, en especial en la temperatura ambiental. Hay evidencias que asocian el aumento de la temperatura ambiental con el incremento en las tasas de mortalidad por suicidio. Objetivo Evaluar la relación entre la tasa de suicidio y la temperatura ambiental en Baja California Sur (BCS) durante los años 1985-2008. Método Los datos de suicidio fueron obtenidos de las bases de Mortalidad del INEGI de 1985-2008. Se tabularon los registros con códigos: E950-E959 CIE-9 y X60-X84, Y87.0 CIE-10 para BCS. En el análisis climático se usaron las temperaturas máximas de 1985 al 2008 para BCS del Extractor Rápido de Información Climatológica (ERIC III). Para evaluar la tendencia, se utilizaron modelos de regresión lineal y cuadráticos. Los modelos lineales generalizados (GLM) se utilizaron para evaluar el efecto de las variables ambientales sobre la tasa de suicidios, con una significancia de p≤0.05. Resultados Un total de 582 suicidios ocurrieron en BCS de 1985 a 2008. Las mujeres representaron el 9% (53), con tasa anual promedio de 1.6/100 000. Los hombres 91% (529), con tasa promedio anual de 16.3/100 000. La tendencia de incremento anual se explicó con modelos lineales simples y cuadráticos en ambas temporadas. En los meses cálidos el modelo cuadrático explicó mejor dicho incremento (R²=0.64 p<0.01). La temperatura se correlacionó positivamente con la tasa en ambas temporadas (p<0.01). Se generaron dos modelos GLM predictivos por temporada. Discusión En este trabajo se observó una posible relación entre el incremento de la temperatura ambiental y el número de suicidios registrados durante 24 años en BCS. Esta relación se encuentra bien definida en los meses cálidos, pero con una tendencia en aumento para los meses fríos.

[Air pollutants and their correlation with medical visits for acute respiratory infections in children less than five years of age in urban Guadalajara, Mexico]. / Contaminantes atmosféricos y su correlación con infecciones agudas de las vías respiratorias en niños de Guadalajara, Jalisco.

OBJECTIVE: To describe the correlation between the concentration levels of atmospheric air pollutants and the number of medical visits to IMSS, ISSSTE and of SSJ healthcare facilities of the Urban Area of Guadalajara between 2000-2002 by children under five years suffering from acute respiratory infections. MATERIAL AND METHODS: An ecological study was performed to describe the correlation between the interpolated monthly average modes, monthly mobile average of air pollutants: carbon monoxide, nitrogen dioxide, ozone, and particles with an aerodynamic diameter of less than 10 microns (PM10) and sulfur dioxide,and the number of medical visits per month due to acute respiratory infections in children under five years. RESULTS: The air pollutants: carbon monoxide and nitrogen dioxide show a significant correlation with the incidence of acute respiratory infections in children less than five years of age in the Urban Area of Guadalajara. The correlation coefficients were: CO (r= 0.05) and NO2 (r= 0.09). CONCLUSIONS: Although the concentrations of air pollutants stay below the official limit, carbon monoxide and nitrogen dioxide affect the health of the child population of the Urban Area of Guadalajara. Although the monthly average mode and monthly mobile average does not exceed the established legislation,the registered maximums do exceed it; this indicates that although throughout most of the day there is no latent risk of population exposure to the air pollutants, during some hours of certain days there is a risk for the population of breathing air contaminated with concentrations higher than the limit, which can cause the development of acute respiratory infections.

Estado de funcionalidad de adultos mayores empacadores en tiendas de autoservicio / Level of functionality among senior citizen packers in a chain of Mexican supermarkets

Objetivo: Identificar características demográficas, económicas y condiciones de salud en empacadores voluntarios de tiendas Soriana. Métodos: Diseño analítico transversal de 416 empacadores voluntarios con 60 años y más de edad, entrevistados entre mayo y julio de 2008. Resultados: Edad promedio de 69.4 años, rango 60 a 87; escolaridad nivel primaria. La mayoría de los hombres se había desempeñado en empleo formal; por su parte, la mayoría de las mujeres en el sector informal. El nivel socioeconómico de los hombres fue medio bajo; en las mujeres, bajo. La autopercepción de salud buena, aunque existió riesgo inherente a obesidad. En la escala de depresión, la mayoría normal. Las razones de la actividad como empacador fue la necesidad económica. Conclusiones: La incorporación y el apoyo a los ancianos en actividades laborales promueve el envejecimiento activo y benefician la salud física, mental social y económica. Los resultados de este estudio permiten apreciar diferencias entre hombres y mujeres, en medio de un panorama socioeconómico y epidemiológico poco alentador.

OBJECTIVE: To identify socio-demographic characteristics and general health conditions among senior citizens working as volunteer packers in a supermarket chain in Mexico. MATERIAL AND METHODS: From May to July 2008 we carried out a cross-sectional analysis in 416 volunteers aged 60 or more years. RESULTS: Mean age was 69.4 years, (range 60-87). Mean level of schooling was elementary school. Men's prior occupation was in the formal sector of the economy vs. women participants who were not. Men were mostly from lower middle class strata and women from lower strata. Most participant's self-perception of health was good although there was an inherent risk of developing obesity. Depression rating scale scores were within normal limits. They had sought work as packers due to financial constraints. CONCLUSIONS: Senior citizens working as paid volunteers seems to promote their physical, mental, social and financial well being. Our findings suggest gender differences within the context of a bleak socio-economic and epidemiological panorama.