Potential savings in Mexico from screening and prevention for early diabetes and hypertension.

This study analyzes the potential economic benefits of identifying and treating patients with so-called prediabetes and prehypertension through the Mexican prevention program known by its Spanish acronym PREVENIMSS. The results show that for each US dollar invested in prevention, $84-$323 would be saved over a twenty-year period. For this and other reasons, providing preventive care for prediabetes and prehypertension patients is better than the current routine care model, in which care is provided in most cases when the disease has progressed substantially. Yet data show that screening and preventive care services are still not being used widely enough in Mexico, are provided too late, or are not sufficiently targeted to the most at-risk individuals. Investing in preventive care for patients with prediabetes and prehypertension is cost saving.

Effects of two educational programmes aimed at improving the utilization of non-opioid analgesics in family medicine clinics in Mexico.

OBJECTIVES: To develop and test two educational programmes (interactive and passive) aimed at improving family doctors' (FD) prescribing practices and patient's knowledge and use of non-opioid analgesics (NOA). METHODS: The educational programmes were conducted in two family medicine clinics by using a three-stage approach: baseline evaluation, design, and implementation of educational activities, and post-programme evaluation. An interactive educational programme (IEP) was compared with a passive educational programme (PEP); both were participated by FDs and patients. The IEP for FDs comprised of workshops, discussion groups, in-service training and guidelines, while for patients the IEP consisted of an interactive session with a video, leaflets and a discussion. The PEP consisted in delivering the guidelines to the FDs and the leaflets to patients. The effect of the programmes on the FDs was measured through the appropriateness of prescriptions and analysed using the differences-in-differences estimator (D-in-D), and on patients through changes in self-medication and in their knowledge about the proper use and adverse events by analysing the inter- and intra-group differences before and after the programmes. RESULTS: The IEP obtained better results to improve appropriate FDs prescription of NOA than PEP (D-in-D = 15%). Regarding the patients, the PEP group reached higher reduction of self-medication than the IEP group (13.4% vs. 9.1%); the knowledge of proper NOA use increased by 8.5% in both groups, whereas knowledge of NOA-related adverse events was better in the IEP (39.6%) than in the PEP group (9.2%). CONCLUSIONS: The IEP was better to improve the doctors' abilities to prescribe NOAs, and both programmes improved patients' knowledge.

Satisfaction of patients suffering from type 2 diabetes and/or hypertension with care offered in family medicine clinics in Mexico.

OBJECTIVE: To evaluate the satisfaction and the factors related to dissatisfaction in patients suffering from type 2 diabetes and/or hypertension with care offered in family medicine clinics. MATERIAL AND METHOD: A secondary data analysis was conducted. Main outcome measures were two indices of satisfaction: family doctor-patient relationship (FDPR) and clinic organizational arrangements (OA). RESULTS: Approximately half of patients (n=1 323) were satisfied with care. In the FDPR index the items 'kindness of the family doctor' (FD) scored high, while the lowest score was for the items: 'the FD allows the patient to give an opinion about his/her treatment,' 'the patient understands the information' and 'the FD spends enough time on the consultation.' As for satisfaction with OA, the items 'cleanliness of the clinic' and 'ease of administrative procedures' obtained the lowest scores. In the logistic regression analysis the covariate 'negative self-rated health' and 'type of institution' were associated with dissatisfaction. CONCLUSIONS: There are aspects of the FDPR and OA that reveal dissatisfaction of patients with chronic conditions.

Atención integral de pacientes diabéticos e hipertensos con participación de enfermeras en medicina familiar / Comprehensive diabetic and hypertensive patient care involving nurses working in family practice

OBJETIVOS: Evaluar la efectividad de la participación de enfermeras de atención primaria en la atención integral a pacientes con hipertensión arterial (HTA) y diabetes mellitus tipo 2 (DM2). MÉTODOS: Se realizó un estudio cuasi-experimental antes-después, sin grupo control, en ocho clínicas de medicina familiar. Enfermeras capacitadas otorgaron atención integral en coordinación con un equipo formado por médico familiar, nutricionista, trabajadora social y estomatólogo. La intervención duró siete meses y utilizó como variables de resultado cambios en el índice de masa corporal, glucemia en ayunas, presión arterial, autopercepción del estado de salud, adherencia terapéutica y solicitud de servicios de urgencias. El cambio se determinó comparando la medición basal y final mediante entrevistas y registro de las variables de interés. RESULTADOS: 1 131 pacientes completaron el seguimiento, de los cuales 44,9 por ciento fue diagnosticado con HTA, 27 por ciento con DM2 y 28,1 por ciento con ambos padecimientos. La proporción de pacientes atendidos coordinadamente por el equipo de salud aumentó; se observó incremento de casos con peso normal y sobrepeso, reducción en la proporción de obesos (P < 0,05) y aumento de hipertensos con presión arterial < 130/80mmHg (P < 0,05). No se modificó la proporción de diabéticos con glucemia < 140 mg/dl; 18,2 por ciento notificó mejoría en la autopercepción del estado de salud (P < 0,05); hubo mejoría en la adherencia terapéutica (P < 0,05) y reducción de solicitud de atención a urgencias en las clínicas (-4,5 por ciento) y en los hospitales (-6,8 por ciento) (P < 0,05). CONCLUSIONES: La atención integral a pacientes con enfermedades crónicas mediante la participación de enfermeras contribuye a mejorar los resultados de salud en servicios de atención primaria.

OBJECTIVES: To evaluate the effectiveness of involving primary care nurses in comprehensive care of patients with hypertension and diabetes mellitus type II (DM2). METHODS: A quasi-experimental, before-and-after study was conducted, without a control group, in eight family-practice clinics. Trained nurses offered comprehensive care in conjunction with a team made up of a family doctor, a nutritionist, a social worker, and a dentist. The intervention lasted seven months and its outcome variables were changes in body mass index, fasting blood glucose, blood pressure, self-perceived health status, treatment compliance, and emergency services requests. Any change was determined by comparing the baseline to the final measurement through interviews and recording the variables of interest in a spreadsheet. RESULTS: In all, 1 131 patients completed the follow-up, of which 44.9 percent were diagnosed with hypertension, 27 percent with DM2, and 28.1 percent with both conditions. The proportion of patients seen by the coordinated health teams increased; there was a rise in cases of normal weight and overweight; a decrease in the proportion of obese (P < 0.05); and an increase in hypertensives with high blood pressure (< 130/ 80mmHg) (P < 0.05). There was no change in the proportion of diabetics with high blood glucose (< 140 mg/dl); 18.2 percent reported improved self-perceived health status (P < 0.05); there was improved treatment compliance (P < 0.05); and a decrease in requests for emergency services at the clinics (-4.5 percent) and at the hospitals (-6.8 percent) (P < 0.05). CONCLUSIONS: Comprehensive care for chronically ill patients through the involvement of nurses contributes to improved health outcomes in primary care.

Satisfaction of patients suffering from type 2 diabetes and/or hypertension with care offered in family medicine clinics in Mexico / Satisfacción en pacientes con diabetes mellitus o hipertensión arterial atendidos en clínicas de medicina familiar en México

OBJECTIVE:To evaluate the satisfaction and the factors related to dissatisfaction in patients suffering from type 2 diabetes and/or hypertension with care offered in family medicine clinics. MATERIAL AND METHOD: A secondary data analysis was conducted. Main outcome measures were two indices of satisfaction: family doctor-patient relationship (FDPR) and clinic organizational arrangements (OA). RESULTS: Approximately half of patients (n=1 323) were satisfied with care. In the FDPR index the items "kindness of the family doctor" (FD) scored high, while the lowest score was for the items: "the FD allows the patient to give an opinion about his/her treatment," "the patient understands the information" and "the FD spends enough time on the consultation." As for satisfaction with OA, the items "cleanliness of the clinic" and "ease of administrative procedures" obtained the lowest scores. In the logistic regression analysis the covariate "negative self-rated health" and "type of institution" were associated with dissatisfaction. CONCLUSIONS:There are aspects of the FDPR and OA that reveal dissatisfaction of patients with chronic conditions.

OBJETIVO:Analizar la satisfacción y los factores relacionados con insatisfacción en pacientes con diabetes mellitus (DM) o hipertensión arterial (HTA) atendidos en clínicas de medicina familiar (MF). MATERIAL Y MÉTODOS:Se realizó análisis secundario de datos. Las variables de resultado fueron dos índices de satisfacción: relación médico familiar-paciente (RMFP) y aspectos organizacionales (AO). RESULTADOS:Aproximadamente la mitad de los pacientes (n=1 323) estuvieron satisfechos. Para la RMFP, "la amabilidad del MF" obtuvo la mayor calificación, y la más baja fue para "el MF permite la opinión del paciente sobre los tratamientos", "comprensión de la información" y "tiempo que el MF dedica al paciente". Para satisfacción con AO, "la limpieza de la clínica" y "fácil solución de los trámites administrativos" calificaron más bajo. En la regresión múltiple, la "autopercepción negativa de la salud" y "tipo de la institución" fueron relacionados con insatisfacción. CONCLUSIÓN: Existen aspectos de RMFP y AO que provocan mayor insatisfacción en los pacientes crónicos y requieren mayor atención.

[Guideline for integrated geriatric assessment]. / Guía para la evaluación gerontológica integral.

A clinical practice guideline was developed as a response to the increasing of elderly in Mexican population due to the epidemiological transition; this instrument allows the assessment of health conditions for people from 60 years of age and older, and it can be a tool for helping family physicians and nurses in providing care for the main health problems of this group of age. The guideline for gerontologic assessment includes six principal health priorities in older people (loss of vision, difficulty to hear, falls or problems walking, nutritional disorders, memory difficulties, and sleep disorders); additionally, another four components for assessment are revised (medication use, physical functionality, quality of life, and social support). Simple recommendations for detection, diagnosis and management of these problems in primary care settings are presented.

[Comprehensive diabetic and hypertensive patient care involving nurses working in family practice]. / Atención integral de pacientes diabéticos e hipertensos con participación de enfermeras en medicina familiar.

OBJECTIVES: To evaluate the effectiveness of involving primary care nurses in comprehensive care of patients with hypertension and diabetes mellitus type II (DM2). METHODS: A quasi-experimental, before-and-after study was conducted, without a control group, in eight family-practice clinics. Trained nurses offered comprehensive care in conjunction with a team made up of a family doctor, a nutritionist, a social worker, and a dentist. The intervention lasted seven months and its outcome variables were changes in body mass index, fasting blood glucose, blood pressure, self-perceived health status, treatment compliance, and emergency services requests. Any change was determined by comparing the baseline to the final measurement through interviews and recording the variables of interest in a spreadsheet. RESULTS: In all, 1 131 patients completed the follow-up, of which 44.9% were diagnosed with hypertension, 27% with DM2, and 28.1% with both conditions. The proportion of patients seen by the coordinated health teams increased; there was a rise in cases of normal weight and overweight; a decrease in the proportion of obese (P < 0.05); and an increase in hypertensives with high blood pressure (< 130/ 80mmHg) (P < 0.05). There was no change in the proportion of diabetics with high blood glucose (< 140 mg/dl); 18.2% reported improved self-perceived health status (P < 0.05); there was improved treatment compliance (P < 0.05); and a decrease in requests for emergency services at the clinics (-4.5%) and at the hospitals (-6.8%) (P < 0.05). CONCLUSIONS: Comprehensive care for chronically ill patients through the involvement of nurses contributes to improved health outcomes in primary care.

[Guide for appropriate using of the non-opioid analgesics in the management of pain]. / Guía para la utilización de analgésicos no opioides en el manejo del dolor.

The purpose of this guide is to provide for general practitioners or physicians of primary care a comprehensive, evidence based tool that permits them to take an adequate decision about the appropriate use of the non-opioid analgesics in the management of pain.

[Guideline for diagnosis and treatment of urinary incontinence in elderly]. / Guía para el diagnóstico y tratamiento de la incontinencia urinaria en adultos mayores.

Urinary incontinence is a frequent geriatric syndrome, characterized by involuntary urine losses that have a negatively influence on the health, their functionality and social relationships in whom suffered it. Nevertheless, most of these patients are not diagnosed and they do not receive treatment. The objective of this clinical guideline is to provide recommendations based on the best scientific evidence available for diagnosis and treatment of the urinary incontinence in the elderly, at primary care attention. Articles of clinical relevance were selected based on clinical evidence and analyzed by two family physicians, one geriatrician, one gerontologist and two experts in methods for elaboration of clinical guidelines. To verify comprehension and clinical applicability, 4 workshops including 35 family physicians were carried out, and the corresponding adjustments were made. The clinical guideline can be a tool for physicians at primary care attention to classify urinary incontinence and to provide pharmacologic and nonpharmacologic treatment. Additionally, the guideline presents recommendations for identification of patients who need specialized care.

Conocimiento básico de los riesgos del uso de analgésicos no opioides en pacientes ambulatorios / Basic knowledge of risks for non-opioid analgesics (NOA) in ambulatory patients

OBJETIVO: Evaluar el conocimiento básico de los pacientes acerca de los analgésicos no opioides (ANOP) e identificar los posibles factores relacionados con la falta de información sobre este tipo de analgésicos. MATERIAL Y MÉTODOS: Participaron 629 pacientes >50 años con síndrome doloroso de origen no oncológico y que recibieron ANOP. Se analizaron sus características generales, la información recibida y su conocimiento sobre ANOP. La variable dependiente fue la falta de conocimiento básico (FCB) sobre ANOP. Se realizó análisis descriptivo y bivariado. RESULTADOS: Del total de participantes, 64.2 por ciento tuvo FCB; 28 por ciento desconocía la forma correcta de tomar ANOP y 48 por ciento sabía que ocasionan trastornos gastrointestinales. Factores asociados con la FCB: no recibir información sobre ANOP (RM= 2.22; IC95 por ciento 1.32-3.70), escolaridad < 7 años (RM= 1.87; IC95 por ciento 1.33-2.63) y duración del dolor < 4 años (RM=1.70; IC95 por ciento 1.22-2.37). CONCLUSIONES: Los pacientes carecen de conocimiento y reciben poca información acerca de ANOP. Es indispensable promover acciones para solucionar este problema.

OBJECTIVE: To describe patients’ knowledge of non-opioid analgesics (NOA) and to identify factors associated with patients’ lack of basic knowledge (LBN) on this type of medication. MATERIAL AND METHODS: A total of 629 ambulatory patients older than 50 years of age, with non-malignant pain syndrome, attended to two family medicine clinics and received seven day prescriptions for NOA. The data on patients’ general characteristics, the information they received and their actual knowledge of NOA were analyzed using descriptive statistics and bivariate analysis. RESULTS: A total of 64.2 percent had LBN; 28 percent did not know how to take NOA properly, and 48 percent knew that these drugs cause gastrointestinal adverse effects. The factors significantly associated with LBN on NOA included: failure to receive information on NOA (OR:2.22, 95 percentCI 1.32-3.70), education <7 years (OR:1.87, 95 percentCI 1.33-2.63) and pain duration <4 years (OR:1.70, 95 percentCI 1.22-2.37). CONCLUSION: Patients lack knowledge and receive little information on NOA. It is important to encourage actions to tackle this problem.

Development and use of quality of care indicators for obstetric care in women with preeclampsia, severe preeclampsia, and severe morbidity.

OBJECTIVE: To develop indicators for evaluating the quality of care in managing preeclampsia. METHODS: An expert group helped to develop and validate the following indicators for evaluating quality of care: availability of intensive care; completeness of laboratory tests; appropriateness of drug treatment at admission and before delivery (antihypertensive drugs, anticonvulsants, and dexamethasone); gestational age at which pregnancy should be interrupted; and type of delivery. By using these indicators, it was possible to evaluate the quality of care in 432 patients with preeclampsia. RESULTS: A significant percentage of patients with preeclampsia and "near misses" received low quality of care, regardless of disease severity. CONCLUSION: A number of interventions are needed to increase the quality of care to help avert maternal deaths in patients with preeclampsia.

Violencia de pareja en mujeres embarazadas en la Ciudad de México / Partner violence against pregnant women in Mexico City

OBJETIVO: Analisar los factores relacionados a la violencia de pareja en mujeres embarazadas. MÉTODOS: Se recolectó la información de 383 mujeres derechohabientes del Instituto Mexicano del Seguro Social que acudieron a control prenatal en cinco Unidades de Medicina Familiar en la Ciudad de México entre septiembre del 2003 y agosto del 2004. Ellas respondieran a un cuestionario de violencia elaborado específicamente para el estudio. RESULTADOS: De las mujeres, 120 (31.1 por ciento) reportaron haber estado expuestas a la violencia psicológica y/o física, y/o sexual por parte de su pareja masculina durante el embarazo actual, el 10 por ciento reportaron violencia combinada y 21 por ciento violencia aislada. La violencia psicológica fue la más frecuentemente reportada (93 por ciento del grupo "había experimentado violencia"). Con relación a la percepción sobre la violencia no había diferencias significativas entre los grupos de mujeres con y sin violencia. Solo alrededor de 20 por ciento de las mujeres tenían conocimiento sobre los lugares donde atienden a las victimas de violencia. Los factores asociados significativamente a la violencia de pareja en las mujeres embarazadas fueron ser soltera (RM=3.02, IC 95 por ciento:1.17;7.83), vivir en unión libre (RM=2.22, IC 95 por ciento: 1.11;4.42), antecedentes de violencia en la infancia (RM=3.08, IC 95 por ciento:1.62;5.85), consumo de bebidas alcohólicas en la pareja (RM=1.87, IC 95 por ciento:1.02;3.42) y presencia de alteraciones emocionales (RM=4.17, IC 95 por ciento: 1.12;15.51). CONCLUSIONES: Los resultados refuerzan los hallazgos de otros estudios de que el problema de violencia en mujeres embarazadas en México sigue siendo un problema frecuente.

OBJECTIVE: To assess factors related to partner violence against pregnant women. METHODS: Data were collected from 383 pregnant women eligible attending five family medicine units of the Mexican institute of social security in Mexico City, Mexico, between September 2003 and August 2004. Data collection was carried out using a questionnaire developed for the study. RESULTS: Of all women interviewed, 120 (31.1 percent) reported that they had been exposed to psychological and/or physical and/or sexual violence perpetrated by their partners during the current pregnancy; 10 percent reported combined violence and 21 percent isolated violence. Psychological violence was most frequently reported (in 93 percent of the "experienced violence" group). As for their perception of violence there was not found any significant differences between those women who had experienced versus those who did not experience violence. Only about 20 percent of women had knowledge of centers for women victims of violence. The factors significantly associated with partner violence among pregnant women included: being single (OR=3.02; 95 percent CI: 1.17;7.83), being unmarried and living with a partner (OR=2.22; 95 percent CI: 1.11;4.42), history of violence during childhood (OR= 3.08; 95 percent CI: 1.62;5.85), alcohol consumption by the partner (OR=1.87; 95 percent CI: 1.02;3.42) and emotional distress among women (OR=4.17; 95 percent CI: 1.12;15.51). CONCLUSIONS: The study results stress other research findings that violence against pregnant Mexican women is still common.

OBJETIVO: Analisar os fatores relacionados à violência conjugal em mulheres grávidas. MÉTODOS: Analisaram-se dados de 383 mulheres seguradas do Instituto Mexicano del Seguro Social que procuraram o programa pré-natal em cinco unidades de medicina familiar da Cidade do México, entre setembro de 2003 e agosto de 2004. Essas mulheres responderam a um questionário de violência elaborado especificamente para o estudo. RESULTADOS: Das mulheres, 120 (31,1 por cento) relataram ter sido expostas à violência psicológica e/ou física, e/ou sexual por parte de seu parceiro durante a gravidez atual, 10 por cento reportaram violência combinada e 21 por cento violência isolada. A violência psicológica foi a mais freqüentemente relatada (93 por cento do grupo havia "sofrido violência"). Com relação à percepção sobre a violência, houve diferenças significativas entre o grupo que sofreu e o que não sofreu violência. Apenas 20,3 por cento tinham conhecimento sobre os lugares onde as vítimas de violência eram atendidas. Os fatores associados significativamente à violência conjugal em grávidas foram: ser solteira (OR=3,02; IC 95 por cento:1,17;7,83), viver em união livre (OR=2,22; IC 95 por cento: 1,11;4,42), antecedentes de violência na infância da mulher (OR=3,08; IC 95 por cento:1,62;5,85), consumo de bebidas alcoólicas pelo parceiro (OR=1,87; IC 95 por cento:1,02;3,42) e presença de alterações emocionais (OR=4,17; IC 95 por cento: 1,12;15,51). CONCLUSÕES: Os resultados reforçam os achados de outros estudos de que o problema de violência em mulheres grávidas no México continua sendo um problema freqüente.

[Breast cancer. Evidence and recommendations for the timely detection in primary care]. / Cáncer de mama. Detección oportuna en el primer nivel de atención.

The steady increase of cases and toll of deaths due to breast cancer in the last decades has prompted to analyze in depth current screening methods and their contributions to decrease mortality rates. A literature review was performed at the Ovid-Medline, Cochrane, Synergy, Medic Latina, Science Direct, EBSCO-e-Journal services. The review focused on the epidemiology of breast cancer, its risk factors and the benefits and limitations of current screening methods. The literature review had the aim to contribute in updating primary care practitioners concerning effective screening methods to timely detect breast cancer.

Health and working conditions of pregnant women working inside and outside the home in Mexico City.

BACKGROUND: To explore differences related to health and working conditions by comparing socio-demographic parameters, reproductive and prenatal care characteristics and working conditions among pregnant women who are employed outside the home (extra-domestic) while still performing a domestic workload versus those who perform exclusively domestic work in the home (intra-domestic). METHODS: A cross-sectional study was carried out at Family Medicine Unit N 31 of the Mexican Institute of Social Security (IMSS) in Mexico City between April and July 2003. Interviews were conducted with 537 pregnant women engaged in either extra-domestic work plus intra-domestic tasks, or those performing strictly intra-domestic work. Information was obtained regarding their demographic status, prenatal care, reproductive, work characteristics, and health during pregnancy. RESULTS: One hundred ninety-six (36.5%) of the interviewed women had paid jobs outside the home in addition to domestic tasks, while three hundred forty-one (63.5 %) engaged in exclusively intra-domestic occupations. Of the women with paid jobs, 78.6% worked as clerks. Among domestic tasks, we found that the greatest workload was associated with washing of clothes, and our micro-ergonomic analysis revealed that women who worked strictly inside the home had a higher domestic workload versus employed women (69.2 vs. 44.9%). When we analyzed the effect of work on health during pregnancy, we observed that women who worked strictly inside the home were at a higher risk for musculoskeletal and genitourinary symptoms than those employed outside the home. CONCLUSION: These findings suggest that the effect of intra-domestic work should not be ignored when considering women's health during pregnancy, and that greater attention should be paid to women's working conditions during intra and extra-domestic work.

[Basic knowledge of risks for non-opioid analgesics (NOA) in ambulatory patients]. / Conocimiento básico de los riesgos del uso de analgésicos no opioides en pacientes ambulatorios.

OBJECTIVE: To describe patients knowledge of non-opioid analgesics (NOA) and to identify factors associated with patients lack of basic knowledge (LBN) on this type of medication. MATERIAL AND METHODS: A total of 629 ambulatory patients older than 50 years of age, with non-malignant pain syndrome, attended to two family medicine clinics and received seven day prescriptions for NOA. The data on patients general characteristics, the information they received and their actual knowledge of NOA were analyzed using descriptive statistics and bivariate analysis. RESULTS: A total of 64.2% had LBN; 28% did not know how to take NOA properly, and 48% knew that these drugs cause gastrointestinal adverse effects. The factors significantly associated with LBN on NOA included: failure to receive information on NOA (OR:2.22, 95%CI 1.32-3.70), education <7 years (OR:1.87, 95%CI 1.33-2.63) and pain duration <4 years (OR:1.70, 95%CI 1.22-2.37). CONCLUSION: Patients lack knowledge and receive little information on NOA. It is important to encourage actions to tackle this problem.

Effect of a Psidii guajavae folium extract in the treatment of primary dysmenorrhea: a randomized clinical trial.

OBJECTIVE: To assess the efficacy of two different doses of a Psidii guajavae folium extract in the management of primary dysmenorrhea. METHODOLOGY: A double-blinded randomized clinical trial was conducted in 197 women with primary dysmenorrhea. Four intervention groups were defined: two extract doses (3 and 6 mg/day); ibuprofen (1200 mg/day); placebo (3mg/day). Participants were followed-up individually for 4 months. The main outcome variable was abdominal pain intensity measured according to a visual analogue scale (VAS). RESULTS: The average age of participants was 19 years; menarche occurred around age 12 years. Participants had menstrual cycles of 28 or 29 days, with menstruation lasting 5 days and mean of pain intensity of 8.2 on the VAS. During each successive treatment cycle, participants experienced a lower pain intensity score. Multiple regression analysis, after adjusting each cycle for baseline pain, treatment compliance and other variables, showed that the group receiving 6 mg/day extract had significantly reduced pain intensity (p<0.001). This effect was maintained in cycles 2 and 3, although the reduction in the mean of pain intensity was lower. The group receiving the 3mg/day extract did not show a consistent effect throughout the three cycles. CONCLUSION: At a dose of 6 mg/day, the standardized phyto-drug (Psidii guajavae folium extract) reduced menstrual pain significantly compared with conventional treatment and placebo.

[Quality of medication prescribing for elderly patients with non-malignant pain syndrome attending family medicine clinics]. / Calidad de la prescripción en los adultos mayores con síndrome doloroso de origen no oncológico usuarios de los servicios de medicina familiar.

OBJECTIVE: To assess the quality of medication prescribing in ambulatory elderly patients attending to family medicine clinics due to non-malignant pain syndrome. PATIENTS AND METHODS: By doing a secondary data analysis we evaluated the quality of medication prescribing in 495 subjects aged 60 or more years, which were seen due to non-malignant pain syndrome in family medicine clinics belonging to Instituto Mexicano del Seguro Social. The analyzed information included general patient characteristics, medical histories, and medication (complete data). The quality of medication prescribing was assessed by using the Beers criteria and the MAI. All data were analyzed by using descriptive statistics. RESULTS: The total number of medicines prescribed was 3017, with an average number of prescribed drugs of 6 (+/- 2.5). About 35% of patients had prescriptions with at least one inappropriate medication according to the Beers criteria. The mean MAI score was 3.5 (+/- 4.3) for drug and 20.9 (+/- 10.7) per patient. According to MAI criteria, the most frequent errors were: failure to provide practical directions, prescription of drug combinations with potential drug-drug interactions, and inappropriate indications. CONCLUSION: Inappropriate prescription is a common problem in elderly patients with nonmalignant pain syndrome attending to primary care facilities.

[Non steroidal anti-inflammatory analgesics in pain treatment. Orientation for primary care use]. / Analgésicos antiinflamatorios no esteroideos en la terapia del dolor. Orientación para su uso en el primer nivel de atención.

The high use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the current practice at the primary care level, and their frequently inappropriate prescription, due to ignorance in pharmacological side effects could cause devastating consequences for the patient's health. It was considered necessary to make a review of the more recent evidence about the NSAIDs, with the intention that medical doctors can be updated on the use of these drugs. The literature review was performed at the Ovid-Medline, Cochrane, Synergy, Medic latina, Science direct, Ebsco-e-journal services. In this article there is an emphasis about NSAIDS adverse effects, and actions suggested during their use.