Calidad de los registros en programa de detección oportuna de cáncer cervicouterino / Quality of records in a timely screening program for cervical cancer

Resumen Introducción: El cáncer cervicouterino es un problema de salud pública en México, en 2012 se estimaron 528 000 nuevos casos. Una línea de investigación con relación al programa de cáncer cervicouterino, es la calidad de los registros en cuanto a su legibilidad, completitud y precisión. Objetivo: Evaluar la calidad de los registros realizados por el personal de salud en el servicio de Detección de Cáncer Cervicouterino. Materiales y Métodos: Estudio transversal, realizado en el Instituto Mexicano del Seguro Social de San Luis Potosí, México, entre agosto de 2012 a septiembre de 2013. Ante un universo de 4139 registros, hoja de solicitud y resultados de la citología cervical, realizados durante enero a noviembre de 2012, se aplicó un muestreo probabilístico estratificado (1115 registros). Se utilizó una lista de verificación con 32 ítems divididos en siete apartados. Para analizar los datos se utilizaron tres indicadores: precisión, legibilidad y completitud. Se estableció una escala ordinal con el puntaje obtenido: bajo (0-64), medio (65-128) y alto (129-192). Se aplicó la prueba t de student para comparar los puntajes en la calidad de los registros. Resultados: En legibilidad se obtuvo un nivel medio en la calidad de los registros (80,6%), en la completitud un 59,6% en el nivel alto y en la precisión un 40,4% en el nivel medio. El personal de enfermería obtuvo mejor calificación en la calidad de los registros que los cito-tecnólogos (p= 0,05). Conclusión: La calidad de los registros realizados por el personal de salud es media. MÉD.UIS. 2017;30(3):59-65.

ABSTRACT Introduction: Cervical cancer is a public health problem in Mexico, in 2012 528 000 new cases. One line of research related to the cervical cancer program is the quality of records in terms of readability, completeness, and accuracy. Objective: To evaluate the quality of the records made by the health personnel in the Cervical Cancer Detection Service. Materials and Methods: A cross-sectional study carried out at the Mexican Social Security Institute of San Luis Potosí, Mexico, from august 2012 to september 2013. The universe of records, application forms and results of cervical cytology performed during january to november of 2012 was 4139. A stratified probabilistic sampling (1 115 records) was applied. We used a checklist with 32 items divided into 7 sections. Three indicators were used to analyze the data: accuracy, readability and completeness. An ordinal scale was established with the score obtained: low (0-64), medium (65-128) and high (129-192). Student's t-test was used to compare scores on the quality of the records. Results: Readability reached a median level in the quality of the records (80.6%), in the completeness 59.6% in the high level and in the precision 40.4% in the average level. Nurses received better quality of records than cytotechnologists (p = 0.05). Conclusion: The quality of the records made by the health personnel is medium. MÉD.UIS. 2017;30(3):59-65.

[Effect of the DiabetIMSS program on cardiovascular risk, blood pressure and HDL cholesterol in patients with metabolic syndrome]. / Efecto de DiabetIMSS sobre el riesgo cardiovascular, la tensión arterial y el colesterol-HDL en pacientes con síndrome metabólico.

OBJECTIVE: The aim of this paper is to evaluate the effect of the DiabetIMSS program on cardiovascular risk, blood pressure and HDL cholesterol in patients with metabolic syndrome. METHODS: Quasi-experimental intervention study. Non-probabilistic convenience sampling. 35 subjects in the educational strategy one year were included. The following variables were collected: age, gender, smoking, total cholesterol, HDL cholesterol, systolic and diastolic blood pressure; cardiovascular risk calculator based on Framingham is calculated. Descriptive and inferential statistical percentages with Student t test was used. RESULTS: There was an increase in the proportion of subjects increased their subsequent figures HDL cholesterol intervention, there by generating an increase of protective factor (p < 0.05). Because of the blood pressure a marked improvement in all ranges of blood pressure (p < 0.05) was presented. CONCLUSIONS: The educational strategy for the control of diabetic patients presented a favorable performance in HDL-cholesterol and blood pressure, reducing the risk of cardiovascular patients.

Objetivo: evaluar el efecto del programa DiabetIMSS sobre el riesgo cardiovascular, la tensión arterial y colesterol-HDL en pacientes con síndrome metabólico. Métodos: estudio de intervención cuasiexperimental. Muestreo no probabilístico por conveniencia. Se incluyeron 35 sujetos que participaron en la estrategia educativa de un año de duración. Se recolectaron las siguientes variables: edad, género, tabaquismo, colesterol total, HDL, TA sistólica y diastólica; se calculó el riesgo cardiovascular con calculadora basada en Framingham. Se utilizó estadística descriptiva con porcentajes e inferencial con t de Student. Resultados: hubo una elevación de la proporción de sujetos que incrementaron sus cifras del colesterol-HDL posterior a la intervención, generando, por ende, un incremento del factor protector (p < 0.05). En razón de las cifras tensionales, se presentó una mejoría notable en todos los rangos de presión arterial (p < 0.05). Conclusiones: la estrategia educativa para el control del paciente diabético presentó un comportamiento favorable en el colesterol-HDL y tensión arterial, disminuyendo el riesgo cardiovascular de los pacientes.

Factores relacionados con la práctica de higiene de manos por personal de enfermería / Factors related to the practice of hand hygiene among nursing staff

Resumen:

Introducción: una atención segura en relación al cuidado de enfermería a pacientes hospitalizados comprende la información y utilización de los recursos para la higiene de manos con la técnica correcta, ya sea con agua y jabón o con alcohol gel. La OMS considera que la no adhesión a la práctica de higiene de las manos está asociada a las infecciones nosocomiales, las cuales son un problema mundial que implican los costos en la atención.

Objetivo: describir los factores relacionados con la práctica de la higiene de manos por personal de enfermería de un hospital de segundo nivel de atención.

Metodología: estudio transversal en una muestra conformada por un total de 103 enfermeras y enfermeros. Se incluyó personal auxiliar de enfermería y enfermera general de las áreas de hospitalización de 3 turnos, y enfermera especialista intensivista de la Unidad de Cuidados Intensivos. El instrumento se diseñó ex profeso y validó por expertos en el tema.

Resultados: del personal de enfermería encuestado el 70.7% cuenta con información correcta sobre la práctica de higiene de manos, el 71% percibe suficiencia de recursos humanos en los servicios, el 90% refiere la existencia de insumos materiales y el 40% la existencia de un sistema de evaluación.

Conclusiones: se identificó que la oportunidad de la información y la evaluación son los factores que favorecen la práctica de la higiene de manos por el personal de enfermería.

Abstract:

Introduction: Safe care in relation to nursing inpatient care includes the use of information and resources for hand hygiene with the right technique, either with soap and water or alcohol based sanitizers. WHO believes that non-adherence to the practice of hand hygiene is associated with nosocomial infections, which are a global problem that involves high costs of care.

Objective: To describe the factors related to the practice of hand hygiene by nurses of a secondary-level hospital.

Methods: Cross-sectional study in a sample of 103 nurses. Nursing assistant staff nurse, and general hospital areas 3 shifts, and intensive care nurse specialist in the Intensive Care Unit was included. The instrument was designed on purpose and validated by experts in the field.

Results: 70.7% of the surveyed nurses have correct information on the practice of hand hygiene, 71% perceived adequacy of human resources in services, 90% reported the existence of supplies and 40% the existence of an evaluation system.

Conclusions: It was identified that the timeliness of information and evaluation are the factors that favor the practice of hand hygiene for nurses.

[Impact of an educational institutional program in the control of the diabetic patient]. / Impacto de un programa institucional educativo en el control del paciente diabético.

OBJECTIVE: to assess the impact of an educational institutional program in the control of type 2 diabetic patient. METHODS: intervention educational study, with quasi-experimental and self-controlled subjects. A convenience non-probabilistic sample was used including 151 patients from the program for the integral care of diabetic patients. Demographic variables: gender, age, type of insurance, somatometric and metabolic profile. The assistance to a one-year length, educational program was necessary. Descriptive and inferential parametric statistics were used. RESULTS: 106 women and 45 men, with age range between 15 and 87 years, and with an average of 57.22 ± 11.47, were studied. A significant decrease in body mass index, waist circumference, venous glucose fasting and post-prandial values, cholesterol, systolic blood pressure, triglycerides and glycosylated hemoglobin (t Student semi-detached, p < 0.05) was observed. There were no changes in diastolic blood pressure (p = 0.334). CONCLUSIONS: one year afterwards, the strategy based on education for the control of the diabetic patient shown a favorable pattern in most of somatometric and metabolic parameters. We suggest to extend this study over a longer period to determine if the effects persist over time.

Objetivo: evaluar el impacto de un programa institucional educativo en el control del paciente diabético tipo 2. Métodos: estudio de intervención educativa cuasi experimental y sujetos como su propio control. Muestreo no probabilístico por conveniencia. Se incluyeron 151 pacientes del programa para la atención integral del paciente diabético. Variables demográficas: Género, edad, tipo de aseguramiento, somatometría y perfil metabólico. Se aplicó un programa educativo de un año de duración. Se utilizó estadística descriptiva e inferencial paramétrica. Resultados: se estudiaron 106 mujeres y 45 hombres cuyo rango de edad iba de 15 a 87 años, con una media de 57.22 ± 11.47. Se observó una disminución significativa en su índice de masa corporal, perímetro de cintura, glucosa venosa en ayuno, glucosa posprandial, colesterol, tensión arterial sistólica, triglicéridos y hemoglobina glucosilada (t de Student pareada, p < 0.05). No hubo cambios en la tensión arterial diastólica (p = 0.334). Conclusiones: la estrategia educativa para el control del paciente diabético presentó un comportamiento favorable en la mayoría de los parámetros somatométricos y metabólicos a un año de seguimiento. Se sugiere que se extienda el estudio a un periodo mayor para determinar si los efectos perduran con el tiempo.

[Parity and menarche as risk factors of osteoporosis in postmenopausal Mexican women]. / Paridad y menarquia como factores de riesgo de osteoporosis en mujeres posmenopáusicas mexicanas.

BACKGROUND: At the moment the studies lead at world-wide level and even in our country have thrown discrepant results about the relation between osteoporosis, parity and age of menarche. OBJECTIVE: To investigate the relation of osteoporosis in postmenopausal Mexican women with multiparity and age of menarche. PATIENTS AND METHOD: A retrospective and analytical cross-sectional study, with a non-probabilistic sampling technique in women rightful claimants of the IMSS, San Luis Potosi. In all of them the bone mineral density was measured with X-ray dual absorptiometry in the distal forearm. Reproductive history and age of menarche were obtained by the addition of these items to the previously validated Albrand questionnaire. Women were divided into groups according to the number of pregnancies in: normal parity (0 to 3 childbirths) conformed by 112 patients (46%) and multiparity (> or = 4 pregnancies), 131 women (54%). In relation to menarche with an average of 12.98 years, from this number we divided them in: early menarche (< 13 yrs) and late menarche (> or = 13 yrs). RESULTS: 243 women were studied, with an average of age of 55.92, rank 31 to 80 years. Using the criteria of the World Health Organization, 18% of postmenopausal women had osteoporosis, 39% had osteopenia and 43% had bone normality. No association was found between the number of pregnancies and osteoporosis. Additionally we observed that the women who had four or more children were older than the other women, average 57.42 against 54.16. Also there was significant negative correlation (r = -0.43) between age and densitometry. We found that an age greater to 13 years in the appearance of the menarche was related to osteoporosis (OR 4.46, p: 0.035). CONCLUSIONS: In postmenopausal women a menarche older than 13 years is a risk factor for osteoporosis.

[Sensitivity and specificity of a utility model of the detection of diabetic neuropathy]. / Sensibilidad y especificidad de un modelo de utilidad para la detección de neuropatía diabética.

OBJECTIVE: To determine whether a utility model can be used with acceptable sensitivity and specificity for the diagnosis of diabetic peripheral neuropathy (DPN). METHODS: Cross sectional study, non-probability sampling, in 381 type 2 diabetic patients with diabetic foot risk. To determine the DPN, it was evaluated the protective sensation in 10 sites on the foot. It was a positive diagnosis if three or more points showed insensitivity at the touch of the skin with Semmes-Weinstein monofilament (SWM). Monofilament was compared to the utility model (MMU); the diagnostic methods of application were the same for both. RESULTS: Mean age was 62 years, 11 years of development of DM, mean body mass index of 29 kg/m2, average glucose 129 mg/dL (78-264 mg/dL). With sensitivity of 73.68%, 97.67% of specificity, positive predictive value 77.78%, negative predictive value 97.10%, the positive likelihood ratio was 31.59 and the negative likelihood ratio 0.27. CONCLUSION: Currently, diagnostic devices for tactile sensory loss are not readily available in our country; therefore, the results of this research will help to make the diagnosis of the MMU timely, inexpensive and easily accessible.