Depresión materna como mediadora en el desarrollo de sobrepeso y obesidad infantil: una revisión integrativa / Maternal depression as a mediator in the development of childhood overweight and obesity: an integrative review

Introducción: la depresión materna interfiere en la crianza y la alimentación de los hijos a través de conductas de alimentación infantil. Objetivo: examinar cómo la depresión materna predispone al desarrollo de sobrepeso y obesidad infantil. Metodología: revisión integrativa empleando la metodología de Whittemore y Knafl, y la declaración PRISMA, en PubMed y CONRICyT, utilizando los descriptores "depression", "depressive symptoms","mothers" y "childhood obesity", e incluyendo artículos con metodología cuantitativa publicados entre 2013 y 2020 cuyos indicadores fueran peso y conductas en la población infantil. Resultados: en 22 artículos se identificaron vías conductuales, como conductas maternas de alimentación, estilos de alimentación, prácticas de alimentación infantil, inseguridad alimentaria y recurrencia de la depresión. Conclusión: seis vías conductuales poco aptas para la alimentación y el desarrollo se identificaron como mediadoras entre la depresión y el aumento de peso infantil.

Introduction: Maternal depression interferes with raising and feeding children through infant feeding behaviors. Objective: To examine how maternal depression predisposes to the development of childhood overweight and obesity. Methods: An integrative review with the Whittemore & Knafl methodology and the PRISMA background in PubMed and CONRICyT, using descriptors "depression","depressive symptomatology","mothers" and "childhood obesity". Articles with a quantitative methodology, from 2013 to 2020, with analysis of weight or behavior indicators in the child population were included. Results: In 22 articles, behavioral pathways were identified, such as: maternal eating behaviors, feeding styles, feeding practices, food insecurity and recurrence of depression. Conclusions: Six behavioral pathways unsuitable for eating and development were identified as mediators between depression and infant weight gain.

Cost to ambulatory care for schizophrenia in Family Medicine / Costo de la atención ambulatoria para esquizofrenia en Medicina Familiar

Background: The groups related to ambulatory care (GRAA, according to its initials in Spanish) are a classification of clinical diagnoses performed on patients receiving medical care in primary care; it is a comprehensive treatment for one year. Objective: To determine the costs of ambulatory care and sociodemographic characteristics of patients with schizophrenia attended in Family Medicine (FM). Material and methods: Cross-sectional study which included adult patients with complete electronic clinical record, who had confirmed diagnosis of schizophrenia and received medical attention in a FM unit from January to December 2017. The variables were: age, sex, sociodemographic data, drug addiction and employment status. To determine the annual cost of schizophrenia based on GRAA, the economic medical card was applied, which includes family medicine consultations, inter-consultations, medications, medical supplies, and the time of use of installed capacity for one year. Results: Out of all patients, 56.2% were men (n = 172). Age was 48.42 ± 14.4 years. Of women, 21.2% were married and 21.2% homemakers, 4.2% smokers, and 1.3% alcohol drinkers. Of men, 30.4% were unmarried, 15% unemployed, 13.1% smokers, and 6.9% alcohol drinkers. The total annual cost of schizophrenia for FGRAA-MH for men was $ 7 613 236.00. Conclusions: The use of FGRAA-MH revealed the total annual cost for the care of schizophrenia in the medical unit, which provides important information for better understanding the magnitude of this health problem in that area, and will improve planning and economic medical management.

Introducción: los grupos relacionados con la atención ambulatoria (GRAA) son una clasificación de diagnósticos clínicos que reciben los pacientes atendidos en consultorios de primer nivel; se trata de un tratamiento integral por un año. Objetivo: determinar los costos de atención ambulatoria y las características sociodemográficas de pacientes con esquizofrenia atendidos en Medicina Familiar (MF). Material y métodos: estudio transversal que incluyó pacientes adultos con expediente clínico electrónico completo y vigente, los cuales tuvieron diagnóstico de esquizofrenia y fueron atendidos en una unidad de MF de enero a diciembre de 2017. Las variables fueron: edad, sexo, datos sociodemográficos, toxicomanías y situación laboral. Para determinar el costo anual de la esquizofrenia con base en los GRAA se aplicó la cédula médico-económica, que incluye consultas de MF, interconsultas, medicamentos, insumos médicos y tiempos de uso de capacidad instalada durante un año. Resultados: 56.2% de los pacientes fueron hombres (n = 172). La edad fue 48.42 ± 14.4 años. De las mujeres, 21.2% eran casadas y 21.2% dedicadas al hogar; 4.2% fumaba y 1.3% consumía alcohol. De los hombres, 30.4% eran solteros, 15% desempleados, 13.1% fumadores y 6.9% consumían alcohol. El costo anual total de la esquizofrenia por FGRAA-SM para los hombres fue de $7 613 236.00. Conclusiones: el uso de los FGRAA-SM reveló el costo anual total para la atención de la esquizofrenia en la unidad médica, lo cual brinda información importante para conocer mejor la magnitud del problema de salud en la zona y permitirá mejorar la planeación y la gestión médico-económica.

[Implementation of the academic day for undergraduate interns]. / Implementación del día académico en médicos internos de pregrado.

BACKGROUND: Medical internship is an important period in the formation of a general (or medical) practitioner, in which the student becomes a member of the "health community" and also applies all the knowledge he or she has received during the university lectures. The present study aims to evaluate the impact of the implementation of the academic day programme designed for undergraduate medical interns within the Mexican second level healthcare Hospital General Regional No. 6 "Dr. Ignacio García Téllez". METHODS: A comparative and also a prospective study were applied to a sample of 56 medical interns who participated in the academic day implementation. The impact of the scheme was assessed using the notes of the different exams at the beginning and end of the medical internship. The non-parametrical Wilcoxon test was used for the statistical analysis for comparison between the initial and final notes. RESULTS: A positive difference was observed in the notes of the modules of internal medicine, pediatrics, gynecology, emergency, general surgery, and family medicine applied at the beginning and end of the implementation of the academic day (p=0.000). CONCLUSIONS: Basic guidelines should be established for educational training from an active-participative perspective as the academic day scheme; these rules should significatively increase the medical intern learning process and, as a logical consequence would have a positive influence on healthcare quality.

Introducción: el internado médico de pregrado es una etapa fundamental en la formación del médico general, en la cual el alumno pasa a ser integrante del equipo de salud y pone en práctica los conocimientos adquiridos durante los primeros años de la carrera. El objetivo fue evaluar el impacto de la implementación del día académico en médicos internos de pregrado del Hospital General Regional No. 6 "Dr. Ignacio García Téllez" de segundo nivel de atención médica. Métodos: estudio comparativo y prospectivo efectuado en una muestra de 56 médicos internos de pregrado que participaron en la implementación del día académico. El impacto de este día fue evaluado por la calificación obtenida en el examen de los diferentes módulos aplicado al inicio y al finalizar el internado de pregrado. Para el análisis estadístico se utilizó la prueba no paramétrica de Wilcoxon para la comparación intragrupo de los resultados iniciales con los finales. Resultados: en las calificaciones obtenidas en el examen aplicado al inicio y al final de la implementación del día académico se observó una diferencia positiva en los módulos de Medicina Interna, Pediatría, Ginecología y Obstetricia, Urgencias, Cirugía General y Medicina Familiar al término del día académico (p = 0.000). Conclusiones: se deben establecer las líneas para realizar intervenciones educativas desde la perspectiva activo-participativa, como el día académico, para incrementar el desarrollo del aprendizaje significativo que repercutirá positivamente en la calidad de la atención de los pacientes.

Female breast symptoms in patients attended in the family medicine practice.

BACKGROUND: there are few studies on breast symptoms (BS) in patients attended at primary care units in Mexico. The aim was to determine the frequency and types of BS overall and by age-group and establish which BS were related to diagnosis of breast cancer. METHODS: data from all female patients with a breast-disease-related diagnosis, attended from 2006 to 2010, at the Family Medicine Unit 38, were collected. The frequencies of BS were determined by four age-groups (< 19, 20-49, 50-69, > 70 years) and likelihood ratios for breast cancer for each breast-related symptom patient, with a 95 % confidence interval (CI). RESULTS: the most frequent BS in the study population were lump/mass (71.7 %) and breast pain (67.7 %) of all breast complaints, and they were more noted in women age group of 20-49 years. Overall, 120 women had breast cancer diagnosed with a median age of 53.51 + 12.7 years. Breast lump/mass had positive likelihood ratios for breast cancer 4.53 (95 % CI = 2.51-8.17) and breast pain had increased negative LR = 1.08 (95 % CI = 1.05-1.11). CONCLUSIONS: breast lump/mass was the predominant presenting complaint among females with breast symptoms in our primary care unit, and it was associated with elevated positive likelihood of breast cancer.

Introducción: en México, en las unidades del primer nivel hay pocos estudios sobre los síntomas mamarios. El objetivo fue determinar la frecuencia de los síntomas y los más asociados con el diagnóstico de cáncer. Métodos: se recabó información de las pacientes atendidas de 2006 a 2010 con enfermedad de mama de una unidad de medicina familiar. Se determinaron las frecuencias de los síntomas mamarios en los grupos etarios < 19, 20-49, 50-69, > 70 años y los cocientes de probabilidad (LR) de cáncer de mama para cada síntoma, con un intervalo de confianza (IC) de 95 %. Resultados: casi todas las quejas derivaron de una masa o tumoración (71.7 %) y dolor mamario (67.7 %). Presentaron cáncer de mama 120 mujeres, con un promedio de edad de 53.51 + 12.7 años. La tumoración/masa en el seno tuvo un LR+ para cáncer de mama de 4.53 (IC 95 % = 2.51-8.17) y un LR+ para dolor mamario de 1.08, 95 % (IC 95 % = 1.05-1.11). Conclusiones: la presentación de la tumoración/masa predominó como queja en nuestra unidad y estuvo asociada con un LR+ para cáncer de mama.

Hepatic steatosis and type 2 diabetes mellitus in health workers.

BACKGROUND: patients with type 2 diabetes mellitus (T2DM) appear to have an increased risk of developing nonalcoholic fatty liver disease (NAFLD) and have higher risk to develop hepatic fibrosis and cirrhosis. The aim was to determine the prevalence of NAFLD in health workers with T2DM by liver ultrasound. METHODS: health workers with T2DM attended at the Family Medicine Unit No. 77, Madero City, Tamaulipas, Mexico, were screened. Risk factors, BMI, % of body fat (% BF), fat mass, waist circumference (WC), blood pressure, HbA1C and lipid profile, were evaluated. The patients were categorized into two groups according to NAFLD status. Differences between groups were assessed by independent t test and χ(2) test. RESULTS: the NAFLD prevalence found in females on ultrasound examination was 40 % and 17.1 % in males. NAFLD patients were more obese (p < 0.001) and they had significantly higher values of % BF (p < 0.001), fat mass (p < 0.01) and WC (p < 0.01). They also had significantly higher values of HbA1C (p < 0.04) and triglycerides (p < 0.03) than patients without NAFLD. CONCLUSIONS: NAFLD is common among health workers with T2DM. It is important to prevent NAFLD progression.

Body composition by bioelectrical impedance analysis and prevalence of obesity in a school-age children.

BACKGROUND: the interest in the direct assessment of adiposity is increasing. The aim was to assess fat mass and lean mass by bioelectrical impedance, and to analyze the correlation between percentage Body Fat-body mass index and percentage Body Fat-WC, and determine the prevalence of overweight and obesity in a sample of school-age children. METHODS: a cross-sectional study was performed in 360 children; differences between the sexes were assessed by independent t-test. Prevalence of overweight and obesity were calculated according to body mass index and two percentage body fat-based cutoffs. RESULTS: there was no significant gender difference in body mass index (p = 0.91), while the boys were both taller and presented more abdominal obesity but with lower mean percentage body fat (p < 0.00). The body mass index criteria show a higher prevalence for overweight and obesity in boys (12.7 % and 17.7 %) than girls (12 % and 13.9 %). CONCLUSIONS: it is an urgent need to implement preventive actions among school children to decrease the prevalence of childhood obesity, which constitutes an important health problem in Mexico.

[Elevated liver enzymes, impaired fasting glucose and undiagnosed diabetes]. / Enzimas hepáticas elevadas, glucosa anormal de ayuno y diabetes no diagnosticada en medicina familiar.

BACKGROUND: emerging evidence suggests that elevated liver enzymatic activity is associated with diabetes. The purpose was to investigate the prevalence of elevated liver enzymes and its relationship between impaired fasting glucose (IFG) and undiagnosed diabetes in family medicine practice. METHODS: a cross-sectional prospective analytic study was conducted in a representative sample of 100 patients aged 25 to 60 years who underwent to a screening for diabetes. Risk factors, BMI, waist circumference, blood pressure, fasting glucose, lipid profile, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT) and C-reactive protein were evaluated. The relationships between liver enzymes, undiagnosed diabetes and IFG were analyzed through c(2) and Student's t test to identify differences in continuous variables. RESULTS: the prevalence found in undiagnosed diabetes were ALT 16.9 %, AST 15.8 % and GGT 20.6 % and in IFG were 76.3 %, 68.4 % and 77.8 % respectively. The relationships between elevated ALT (0.001) and GGT (0.000) with undiagnosed diabetes and IFG were statistically significant. CONCLUSION: elevated ALT or GGT raise the possibility of undiagnosed type 2 diabetes mellitus in family practice.

Changes on craniofacial structures in children with growth-hormone-deficiency.

OBJECTIVE: To describe the growth of craniofacial structures in growth-hormone deficiency (GHD) children during growth-hormone therapy (GHT). METHODS: A cross-sectional sample of 46 subjects (n = 14 girls, 32 boys) aged 4-18 years was obtained. They were categorized into two paired groups: the reference group, for comparing the cephalograms, consisted in 23 healthy subjects, and the study group (23 patients) with GHD under GHT. Differences between groups were assessed by independent t-tests. RESULTS: The boys showed smaller measurements for all facial structures presenting significant differences in total mandibular length (Co-Pg p < 0.03), lower anterior facial height (ANS-Me p < 0.03) and total anterior facial height (N-Me p < 0.02) as well as retrognathic facial type. In girls the posterior cranial base length was shortened (S-Ba 29.14 ± 3.02 mm) and show a high mandibular plane angle (40 ± 5.50°) a wide relation anterior maxillo-mandibular (5.86 ± 1.57°) with a statistical difference (p < 0.05 and p < 0.04) compared with the reference group. CONCLUSIONS: We suggest considering the cephalometric morphology at the beginning of GHT.

[Right Bochdalek hernia and liver situs solitus in an adult. A clinical case]. / Hernia de Bochdalek derecha del adulto con situs solitus de hígado. Presentación de un caso.

The Bochdaleck's hernia is an anatomical defect of posterolateral region of the diaphragm that lets abdominal structures go inside the thorax. It has an incidence of 1 in 2000 to 5000 of newborn alive, without difference of sex. This defect is very common in the neonatal period and rare in adult age. We present a case of a male patient 32 years old, with the definitive diagnosis of Bochdalek hernia. The diagnosis was made by radiographic findings, with a few digestive symptoms. Confirmatory diagnosis was made by axial tomography computerized that found part of bowel in right hemithorax and pulmonary hypoplasy, with liver in situs solitus. The patient received medical treated only. The patient did not receive surgical treatment because it is supposed that this kind of treatment has more risks than benefits.