Perfil epidemiológico del dolor secundario a neuropatía periférica moderada diabética / Epidemiological profile of pain secondary to moderate diabetic peripheral neuropathy

Antecedentes y objetivo: La neuropatía diabética es una complicación de la diabetes tipo 2. Afecta el entorno individual, familiar y social. El objetivo es identificar el perfil epidemiológico del dolor secundario a neuropatía periférica moderada diabética. Materiales y métodos: Estudio transversal descriptivo del dolor utilizando como fuente de información el paciente con neuropatía periférica moderada secundaria a diabetes tipo 2. La severidad de la neuropatía periférica diabética fue establecida con la escala de Michigan. El tamaño de la muestra fue 145. El perfil epidemiológico del dolor evaluado con el cuestionario multidimensional de McGill, alfa de Cronbach de 0,88, evalúa la intensidad de dolor en tres categorías independientes (índice de valoración total -dimensión sensorial, afectiva y evolutiva-, intensidad total general e intensidad total actual) y al interior identifica las características específicas del dolor. El análisis estadístico incluyó promedios, desviación estándar, intervalo de confianza para promedios y porcentajes. Resultados: Índice de valoración total de dolor 9,74 ± 1,40 (IC 95 %; 9,51-9,97), dimensión sensorial 5,02 ± 0,84 (IC 95 %; 4,88-5,16), dimensión afectiva 3,75 ± 0,94 (IC 95 %; 3,59-3,90) y dimensión evolutiva 0,96 ± 0,18 (IC 95 %; 0,93-1,00). Las características de la valoración total de dolor identifican sacudida 35,2 %, ardiente/quemante 31,0 %, sofocante 40,0 %, agotador 33,1 %, deprimente 29,7 % y constante 35,2 %. Intensidad total general de dolor 7,70 ± 1,29 (IC 95 %; 7,49-7,91). Intensidad total actual 40,7 % "intenso". Conclusión: El perfil epidemiológico del dolor es de intensidad elevada, quemante, penetrante, tirante fijo o difuso, acompañado de picor generalmente constante, con repercusión emocional negativa, entre ellas sentimiento de ansiedad, secundario a dolor deprimente, agotador, sofocante y mortificante.(AU)

Background and objective: Diabetic neuropathy is a complication of type 2 diabetes, it´s present in 95 % of patients, affecting the individual, family and social environment. The objective is to identify the epidemiological profile of pain secondary to moderate diabetic peripheral neuropathy. Materials and methods: Descriptive cross-sectional study of pain using as a source of information the patient with moderate peripheral neuropathy secondary to type 2 diabetes. The severity of diabetic peripheral neuropathy was established with the Michigan scale. The sample size was 145 patients. The epidemiological profile of pain evaluated with the McGill multidimensional questionnaire, Cronbach's alpha 0.88; it is assesses the intensity of pain in three independent categories (total pain assessment index [sensory, affective and evolutionary dimension], overall total intensity and current total intensity) and within each of them identifies the specific characteristics of pain. Statistical analysis included means, standard deviation, confidence interval for means, and percentages. Results: Total pain assessment index 9.74 ± 1.40 (95 % CI; 9.51-9.97), sensory dimension 5.02 ± 0.84 (95 % CI; 4.88-5.16), affective dimension 3.75 ± 0.94 (95 % CI; 3.59-3.90), and evolutionary dimension 0.96 ± 0.18 (95 % CI; 0.93-1.00). Specific characteristics of the total pain assessment Index identify shaking 35.2 %, burning 31.0 %, suffocating 40.0 %, exhausting 33.1 %, depressing 29.7 % and constant 35.2 %. Total general intensity of pain 7.70 ± 1.29 (95 % CI;7.49-7.91). Current total intensity 40.7 % "intense". Conclusion: The epidemiological profile of pain is of high intensity, burning, penetrating, fixed or diffuse, accompanied by generally constant itching, with negative emotional repercussions, including feelings of anxiety, secondary to depressing, exhausting, suffocating and mortifying pain.(AU)

Seguridad del paciente: percepción de estudiantes de una universidad pública / Patient safety: Perceptions of students in a public university / Segurança do paciente: percepção de estudantes de uma universidade pública

RESUMEN Introducción: La seguridad del paciente es una prioridad mundial para los sistemas de salud. Las instituciones educativas formadoras de recursos humanos deben incluir la temática en su currículo. Objetivo: Identificar la percepción sobre la seguridad del paciente en los estudiantes de licenciatura en enfermería. Metodología: Estudio descriptivo y transversal. Población total de 516 alumnos de licenciatura en enfermería de la Universidad Autónoma de Tamaulipas, México. Se utilizó el cuestionario APQS-III y se diseñó una cédula con variables sociodemográficas. Resultados: La mayoría de los participantes son mujeres, edad promedio: 20 años. La mitad de los alumnos no tiene cursos que avalen sus conocimientos sobre seguridad del paciente. En la dimensión entrenamiento recibido, 63.5 % concuerda que la formación de pregrado los capacita para entender las causas de un evento adverso por enfermería, los habilita para prevenir errores y desarrollar una adecuada comprensión en materia de seguridad. 50.3 % está totalmente de acuerdo en la dimensión confianza en el reporte del error y es semejante la proporción en la dimensión horas de trabajo como causas de error. Discusión: La identificación positiva de la percepción que se tiene acerca de la seguridad del paciente por parte de los estudiantes, favorece desde el pregrado la creación de una cultura de seguridad que fomenta la confianza y el interés de estos para desarrollar un enfoque integrado en el tema estudiado. Conclusiones: Los estudiantes en su mayoría refieren actitudes positivas confiados en que su entrenamiento sobre seguridad los prepara para entender y prevenir las causas de errores en seguridad del paciente.

ABSTRACT Introduction: Patient safety is a priority of health systems worldwide and therefore, the education institutions responsible for the formation of human resources for health must address this goal in detail. Objective: To identify the perceptions of baccalaureate nursing students regarding patient safety. Methodology: This is a descriptive and transversal study on 516 baccalaureates in nursing students from the Universidad Autónoma de Tamaulipas, Mexico. The APQS-III and a specific social-demographic data questionnaire were used. Results: The majority of the participants were female. The average age was 20 years old. Nearly half of the students do not have enough courses to strengthen their knowledge on patient safety. Regarding the training received, 63.5 % of the participants agree that the baccalaureate level formation prepares them to understand the causes of adverse events in nursing, to prevent errors, and to have an adequate understanding of security. 50.3 % of the participants approved the dimension's confidence approach regarding error reporting. Many participants considered that the excessive long hours working dimension is a cause of errors. Discussion: The perception of patient safety as being very important favors and further promotes a culture of security. Conclusions: The majority of the students trust their training regarding patient safety and know how to prevent possible causes of errors.

RESUMO Introdução: A segurança do paciente é uma prioridade mundial para os sistemas de saúde. As instituições educacionais formadoras de recursos humanos devem incluir a temática em seu currículo. Objetivo: Identificar a percepção sobre a segurança do paciente nos estudantes de graduação em enfermagem. Metodologia: Estudo descritivo e transversal. População total de 516 alunos de graduação em enfermagem da Universidad Autónoma de Tamaulipas, México. Foi utilizado o questionário APQS-III e realizou-se um questionário com variáveis sociodemográficas. Resultados: A maioria dos participantes são mulheres, idade média: 20 anos. Metade dos estudantes não tem cursos que avaliem seus conhecimentos sobre segurança do paciente. Na dimensão do treinamento recebido, 63,5 % concordam que a formação de graduação os treina para entender as causas de um evento de enfermagem adverso, lhes permite prevenir erros e desenvolver uma compreensão adequada da segurança. 50,3 % concordam fortemente sobre a dimensão de confiança no relatório dos erros e a proporção e da mesma forma sobre a dimensão das horas de trabalho como causa dos erros. Discussão: A identificação positiva da percepção que se tem sobre a segurança do paciente por parte dos alunos, favorece desde a graduação a criação de uma cultura de segurança que fomente a confiança e o interesse destes em desenvolver uma abordagem integrada na o assunto estudado. Conclusões: A maioria dos alunos relata atitudes positivas, confiantes de que seu treinamento em segurança os prepara para compreender e prevenir as causas dos erros na segurança do paciente.

Costo efectividad de insulina lispro protamina (NPL) vs. combinación de insulina NPH + insulina rápida / Cost effectiveness of lispro protamine insulin (NPL) vs combination of NPH insulin + rapid insulin

OBJETIVO: La estrategia farmacológica en el manejo de la diabetes tipo 2 incluye la insulina lispro protamina (NPL) vs. combinación de insulina NPH + insulina rápida. El análisis costo efectividad aborda el aspecto económico y el epidemiológico en el proceso de elección entre dos o más alternativas. El objetivo fue determinar el costo efectividad de la insulina lispro protamina (NPL) vs. combinación de insulina NPH + insulina rápida. MÉTODOS: Estudio de costo efectividad en pacientes con diabetes tipo 2. Alternativa 1, usuarios de insulina lispro protamina (NPL), y 2, usuarios de insulina NPH + insulina rápida. Tamaño de muestra de 62 por grupo, técnica muestral aleatoria simple. El costo incluyó, costo unitario, intensidad de uso del servicio, costo promedio por insumo, costo promedio por servicio, y costo por tipo de alternativa (incluyó medicina familiar, laboratorio y medicamentos). La efectividad se determinó con el promedio de los resultados de glucosa realizados durante todo el año. El plan de análisis incluyó análisis costo efectividad y análisis costo efectividad incremental. RESULTADOS: Costo promedio (estimado en pesos mexicanos) de la alternativa lispro protamina (NPL) $6,146.30 y NPH + insulina rápida $2,671.02. La NPH + insulina rápida tiene menor costo y mayor efectividad. El costo efectividad incremental identifica que con la alternativa NPH + insulina rápida existe ahorro de $158.98 por cada miligramo de glucosa por decilitro en relación a la alternativa  lispro protamina (NPL). CONCLUSION: El resultado, bajo nuestras limitantes, sugiere mejor relación costo efectividad en insulina NPH + insulina rápida

OBJECTIVE: Pharmacological strategies for the management of patients with type 2 diabetes include lispro protamine insulin (NPL) and NPH insulin + rapid insulin. The cost-effectiveness study addresses the economic and epidemiological aspects in the process of choosing between two or more alternatives. The objective is to determine the cost effectiveness of lispro protamine insulin (NPL) vs combination of NPH insulin + rapid insulin. METHODS: Cost effectiveness study in patients with type 2 diabetes. Alternative 1: lispro protamine insulin (NPL) and alternative 2: NPH insulin + rapid insulin. Sample size 62 per group, simple random sampling technique. Cost (estimated in Mexican pesos) included, unit cost, intensity of use of the service, average cost per input, average cost per service, and cost per type of alternative (including family medicine, laboratory and medication.) Effectiveness was determined with the average glucose results carried out throughout the year. Analysis plan included cost effectiveness analysis and incremental cost effectiveness analysis. RESULTS: The total average cost of lispro protamine insulin (NPL) and NPH insulin + rapid insulin mixture was $6,146.30 and $2,671.02, respectively. The NPH insulin + rapid insulin mixture alternative has lower cost and greater effectiveness. According to the cost effectiveness analysis, with the NPH insulin + rapid insulin mixture alternative, there was a saving of $159.98 for each milligram of glucose per deciliter comparing to the lispro protamine insulin (NPL) alternative. CONCLUSION: According with our results, a better cost-effectiveness ratio was obtained in NPH insulin + rapid insulin

[Cost of family planning care in 10-19 years old teenagers]. / Costo de atención por servicios de planificación familiar a adolescentes de 10-19 años.

Objetives: To identify the costs of family planning care in adolescents. Material and methods: Longitudinal study of the cost of care for family planning carried out in 2015 in a group of individuals with age limits of 10 and 19 years in a unit first level of health care in the state of Queretaro, Mexico. The profile of use of family planning (FP) was created for the teen was performed services through counseling, provision of contraception and review of intrauterine device (IUD) in a year; cost projections for the population of adolescents and different coverage scenarios between 5 and 100% were made. Results: The average annual cost was 228.84 Mexican pesos. Ideally the identified cost was 2,708.94 pesos. The projection with 20 % coverage was 207,251,330 pesos. The average annual family planning consultations was 0.9. The most commonly used method was with medroxyprogesterone-estradiol at doses of 25 and 5 mg. Conclusion: The cost of planning in adolescents is low, taking into account the costs that the care of high-risk pregnancies and associated comorbidities.

Rotación de residentes de medicina familiar en Unidad de Investigación Epidemiológica y en Servicios de Salud (experiencia de cinco años) / Clerkship of family medicine residents in a Unit of Epidemiological Research (five years experience)

Introducción. Se presenta la experiencia de cinco años del Programa de Rotación del Residente de Medicina Familiar en la Unidad de Investigación. Materiales y métodos. El programa fue diseñado por los investigadores de la Unidad de Investigación Epidemiológica y en Servicios de Salud Querétaro, México, y los profesores de la Residencia de Medicina Familiar de la Unidad de Medicina Familiar n.º 16. Durante el segundo año de residencia, se estableció la rotación por la unidad de investigación con una duración de dos meses, en la que se incluyó el desarrollo de un proyecto de investigación operativa. El programa de trabajo incluyó los contenidos teóricos de metodología de investigación cursados durante el primer año de residencia. La difusión se realizó al personal directivo en forma oral y por escrito, con la elaboración de la síntesis ejecutiva y del artículo científico. Resultados. Después de cinco años y cuatro meses, han asistido40 médicos residentes. Se han desarrollado 39 protocolos de investigación, 23 seminarios, 39 síntesis ejecutivas, dos artículos publicados, un libro con 16 capítulos y otro en prensa. Las presentaciones en congresos incluyeron 34delegacionales, 16 regionales y 7 nacionales. Conclusión. A cinco años de implementado el Programa de Rotación de Residente de Medicina Familiar en Unidad de Investigación, se puede afirmar que es productivo. Los resultados a corto y medio plazo así lo demuestran (AU)

Introduction. The proposal is to present five years experience of Family Medicine Student in the Research Unit. Material sand methods. Program was designed by Researchers of Epidemiological and Health Services Unit of Querétaro, México and Professors of Family Medicine Residence No 16.Rotation was specified for the second year of the Residence, duration was defined in two months, included theoretical and practical aspect, an operative research project was a requirement. The program contemplated oral presentation to directive personnel and executive synthesis. Results. After five years and four months, 40 Medical Residents have rotated, 39 whit research projects, 23 academic sessions, 39executive synthesis, two papers, one book, 16 books chapters and one book in press, 34 presentations in local congress,16 regional and seven national. Conclusion. After five years of Family Medicine Student in research unit, it is possible to affirm that it is productive. Short and medium term results therefore demonstrate (AU)

[Preventive practices of the residents over 25 years of age in Monterrey and its metropolitan area (Mexico)]. / Prácticas preventivas de los habitantes mayores de 25 años en Monterrey y su zona metropolitana (México).

BACKGROUND: Chronic and degenerative disorders are the leading causes of morbidity-mortality in Mexico, as a result of which the Health Sector has implemented preventive and suitable detection measures. The use of the health services is a dynamic behavior on the part of the population. In order for people to use these preventive measures, the barriers to accessing these services must be lessened. Hence, the objective of this study was that of ascertaining the use of the services for the detection of diabetes mellitus, high blood pressure, cervical-uterine and breast cancer and tetanus and diphtheria toxoide vaccinations. METHODS: The sample size was that of 254 individuals age 25 and over living in Monterrey or in the greater Monterrey metropolitan area. Those having employed preventive measures during the year immediately prior to the study were taken into account with regard to the use of preventive measures. The analysis consisted of descriptive statistics and bivariate analysis. RESULTS: Over 60% of the population was female, the average age being 42.3 + 14 years of age, three fourths of the population being on the social security rolls. A total 37% mentioned having undergone the diabetes test, and 44.5 the test for high blood pressure, while 31.1% had been vaccinated with the tetanus and diphtheria toxoide. Regarding specifically female checkups, 34.3% of all females had undergone the corresponding cervical-uterine cancer test, 29.5% having been screened for breast cancer. No relationship was found to exist between the use of measures and family histories and the perception of the importance of the checks. CONCLUSIONS: The use of preventive measures fall below some international standards. Individuals exposed to the risk must be sought in order to fittingly detect any chronic disorder.

Prácticas preventivas de los habitantes mayores de 25 años en Monterrey y su zona metropolitana (México) / Preventive Practices of the Inhabitants of Monterrey, México

Fundamento: Los padecimientos crónicos y degenerativos son las primeras causas de morbi-mortalidad en México, por lo que el Sector Salud ha implementado acciones de prevención y detección oportuna. El uso de los servicios de salud es una conducta dinámica de la población. Para que la gente utilice estas acciones de prevención es necesario que se reduzcan barreras de acceso. Así, el objetivo del estudio fue determinar la utilización de los servicios de detección de diabetes mellitus, hipertensión arterial, cáncer cérvicouterino y mamario y aplicación del toxoide tetánico diftérico. Métodos: El tamaño de la muestra fue de 254 personas de 25 años y más, que habitaban en Monterrey y su zona metropolitana. En el uso de acciones preventivas se consideró a las personas que las habían usado el año anterior. El análisis consistió en estadística descriptiva y análisis bivariado. Resultados: Más del 60 por ciento de la población correspondió al sexo femenino, la edad promedio fue de 42,3 añosñ14 años y tres cuartas partes de la población contó con seguridad social. Un 37 por ciento mencionó haberse realizado la detección de diabetes y un 44,5 por ciento de hipertensión, mientras que le aplicaron el toxoide tetánico diftérico a un 31,1 por ciento. En las detecciones propias de la mujer, a un 34,3 por ciento de la población femenina le practicaron la correspondiente a cáncer cérvicouterino en tanto que a un 29,5 por ciento, la de cáncer mamario. No hubo relación entre uso de acciones con antecedentes familiares y percepción de importancia de la detección. Conclusiones: El uso de las acciones preventivas está por debajo de algunos estándares internacionales. Es necesaria la búsqueda de personas expuestas al riesgo para detectar oportunamente cualquier padecimiento crónico (AU)

[Impact of primary care on hospitalization of type 2 diabetics with equal conditions of health insurance]. / Impacto de la atención ambulatoria del primer nivel de atención en la hospitalización de población asegurada con diabetes mellitus tipo 2.

OBJECTIVE: To determine the impact of primary care on hospitalization of type 2 diabetics with equal conditions of health insurance. DESIGN: A case-control study. Case = diabetic hospitalized by a disease related condition. Control = diabetic without hospitalization during the last 12 months. SETTING: Urban primary care centers. PARTICIPANTS: Cases were consecutively selected from four out of five urban hospitals (n=123). Controls were chosen at random from primary care units matched by primary care source (n=135). Women with gestational diabetes were excluded as well as individuals with missing medical charts (approximately 15%). MEASUREMENTS: A primary care index was constructed with process and outcome indicators recommended by the American Medical Association, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, the American Diabetes Association and the Official Mexican Standards. Compliance to less than 60% of recommendations was considered unsatisfactory primary care. RESULTS: The following were hospitalization risk factors: less than 2 visits to family physician during the last year (OR adjusted, 16,2; 95% CI, 1,5-174,2), glucose level (OR adjusted, 1,006; 95% CI, 1,002-1,010) and cognitive level (OR adjusted, 0,98; 95% CI, 0,96-0,99), in addition to exercising and year of diagnosis. Sixty-five percent of cases observed unsatisfactory primary care compared with 49,1% of controls (P=0,03). Unsatisfactory primary care increased 2,5 times the risk of hospitalization (95% CI, 1,2-5,0) (pseudo R2=0,279; P<0,001). CONCLUSIONS: Primary care is a potential factor for reducing hospitalization of type 2 diabetics. Effective primary care programs would contribute to a better disease control and less unnecessary hospitalizations.

Impacto de la atención ambulatoria del primer nivel de atención en la hospitalización de población asegurada con diabetes mellitus tipo 2 / Impact of primary care on hospitalization of type 2 diabetics with equal conditions of health insurance

Objetivo. Determinar el impacto de atención ambulatoria del primer nivel de atención en la hospitalización del diabético tipo 2 en una población con condiciones iguales de aseguramiento. Diseño. Estudio de casos y controles. Los casos son pacientes diabéticos hospitalizados por enfermedad relacionada con el padecimiento, y los controles son pacientes diabéticos sin antecedente de hospitalización en el último año. Emplazamiento. Centros de atención primaria urbanos. Participantes. Los casos fueron seleccionados consecutivamente en 4 de 5 hospitales generales urbanos (n = 123). Los controles fueron elegidos al azar en la unidad de atención primaria de donde provenía el caso (n = 135). Se excluyó a las mujeres con diabetes gestacional y a todos los que no contaban con expediente localizable (aproximadamente un 15 por ciento).Mediciones. Se construyó un índice de atención primaria según las recomendaciones de la Asociación de Médicos Norteamericanos, la Comisión Conjunta de Acreditación de Organizaciones de Salud, el Comité Nacional de Aseguramiento para la Calidad, la Asociación Norteamericana de Diabetes y la Norma Oficial Mexicana. Se consideró que un cumplimiento menor al 60 por ciento correspondía a una atención subóptima. Resultados. Los factores de riesgo para la hospitalización fueron los siguientes: menos de 2 vistas al médico de familia en el último año (OR ajustada, 16,2; IC del 95 por ciento, 1,5-174,2), valor de glucosa (OR ajustada, 1,006; IC del 95 por ciento, 1,002-1,010) y nivel de conocimientos sobre la enfermedad (OR ajustada, 0,98; IC del 95 por ciento, 0,96-0,99), además de la práctica de ejercicio y el tiempo de diagnóstico. La atención primaria subóptima se registró en el 65,3 por ciento de los casos y el 49,1 por ciento de los controles (p = 0,03) e incrementó 2,5 veces el riesgo de hospitalización (IC del 95 por ciento, 1,2-5,0; seudo R2 = 0,279; p < 0,001).Conclusiones. La evidencia disponible indica que la atención primaria puede ser un factor potencial para reducir la tasa de hospitalización por diabetes mellitus tipo 2. Los programas de manejo efectivos contribuirían a evitar hospitalizaciones innecesarias (AU)

[Health needs of the diabetic user of primary care]. / Necesidades en salud del diabético usuario del primer nivel de atención.

OBJECTIVE: To determine the extent and importance of unmet health needs of type 2 diabetic patients seen at primary care services. MATERIAL AND METHODS: A cross-sectional study was conducted in 1999, among rural and urban patients of the Mexican Institute of Social Security, in Nuevo Leon, Mexico. The study population consisted of 256 subjects selected at random, diagnosed with type-II diabetes for at least two years. Data were obtained by interview and complemented with medical charts and provider interviews. Five health areas and four health determinants were evaluated, through Mexican Official Standards and American Diabetes Association standards of medical care for diabetic patients. Analysis consisted of descriptive statistics and estimation of z scores. RESULTS: Health needs were met in 49% of cases. A lower mean of health need satisfaction was found in rural regions as compared to urban regions (36.8% vs. 53.3%, p < .01). Nutrition was the most affected health area (z score = -6), followed by the physical exercise (z score = -1), the metabolic health area (z score = +1), the non-smoking health area (z score = +2), the prevention and early detection of complications health area (z score = +2), and the cognitive health area (z score = +3). The health determinant with the highest requirement corresponded to utilization (z score = -5), followed by resource availability (z score = -4), perceived health need (z score = +4), and access barriers (z score = +6). CONCLUSIONS: Health need measurement allows evaluating the effectiveness of existing interventions, in addition to identifying areas with higher unmet health needs. These findings facilitate analysis and decision-making to devise specific health policies and actions directed at improving the quality of care for diabetic patients. The English version of this paper is available at: http://www.insp.mx/salud/index.html

[Accessibility of health services for users]. / Accesibilidad de los servicios de salud en población usuaria.

OBJECTIVE: To measure the accessibility to health services and determine a model to explain this accessibility. MATERIALS AND METHODS: All states of the Mexican Republic were included. The measurement of accessibility considers the availability of resources and the perception of barriers. Place of residence, education, participation in the work forces and household conditions were included in the model. RESULTS: The average of availability resources was 64.59% sd 15.68 (range 42 to 100) and the average corresponding to perception of barriers, 87.61% SD 4.04 (range 79.23 to 95.65). Accessibility was 71.50% SD 10.74 (range 56 to 96). The states with highest accessibility were the Federal District and Baja California Sur and the lowest, Chiapas and Oaxaca. The model included education and labor participation (R2 = 0.67, p < 0.05). CONCLUSIONS: Accessibility was determined by socioeconomic factors.

[Nutritional risk in patients with pulmonary tuberculosis: the patient's or the health services' problem?]. / Riesgo nutricional en pacientes con tuberculosis pulmonar: cuestión del paciente o de los servicios de salud?

OBJECTIVE: To determine nutritional risk factors in a population of patients with pulmonary tuberculosis (PT). MATERIAL AND METHODS: During 1997, one-hundred and eighty-five patients with PT were chosen at random from two health institutions in Monterrey, Nuevo León, México. Variables analyzed were: anthropometric measures, socioeconomic status, utilization of the nutrition clinic, access to foodstuffs, adverse reactions to drugs, and disease attributable to malnutrition. Statistical analysis consisted of descriptive, bivariate, and multivariate logistic regression, in addition to prevalence ratios and 95% confidence intervals. RESULTS: The mean age was 42.4 +/- 19.9 years. The mean body mass index was 19.8 +/- 3.2; 57% of patients presented malnutrition; 26% of them were referred to the nutrition clinic, 24.3% of whom actually attended it. Multivariate analysis showed that adverse reactions of tuberculosis drugs were risk factors for malnutrition, independent of age, gender, education, occupation, year of diagnosis and access to foodstuffs, disease attributable, and utilization of the nutrition clinic. (chi 2 = 10.58; p = 0.051, R2 = 0.42). CONCLUSIONS: Nutritional risk in patients with pulmonary tuberculosis is both a patient and a health services issue. The high prevalence of malnutrition, the low utilization rate of nutritional services, and the effect of adverse reactions to therapeutic drugs, justify the need to focus attention on this particular group of patients.

[Assessment of accessibility to health services facilities]. / Evaluación de la accesibilidad en los servicios de salud.

OBJECTIVE: To assess health care access integrating the availability of resources, medical institution and the patient point of view. SETTING: Nuevo León, México. MEASUREMENTS AND MAIN RESULTS: A random sample of patients were interviewed about their perceptions on different barriers, which also were assessed for the institution utilizing the corresponding indicator. Availability of resources were also measured for every primary and secondary medical care unit of the greatest Mexican health care system in Nuevo León. It was observed a 70% access; 70% for primary care and 73% for secondary care. Availability of human resources was an important factor but barriers as observed by the institution were the most important (waiting time and traveling cost). Barriers were rated different by the institution and the patient. CONCLUSIONS: The combination of institutional barriers, patient barriers and resources for assessing health care access is discussed.

Risk factors of breast cancer in Mexican women.

OBJECTIVE: To investigate the association between family history (FH) of neoplasia, gyneco-obstetric factors and breast cancer (BC) in a case-control study. In cases, to analyze those variables in relation with early onset of BC, the manner of detection (self-examination, prompted by pain, or casual), the size of tumor, and the elapsed time to seek medical attention. MATERIAL AND METHODS: Data from 151 prevalent BC cases and 235 age-matched controls were analyzed by multiple logistic regression, to assess the influence of BC risk factors. RESULTS: Ten per cent of patients and 1% of controls had first-degree relatives (FDR) with BC. Family history of FDR with BC (OR, 11.2; 95% CI 2.42-51.92) or with gastric or pancreatic cancer (OR, 17.7; 95% CI 2.2-142.6) was associated with BC risk. Breastfeeding at or under 25 years of age was protective against BC (OR, 0.40; 95% CI 0.24-0.66). The manner of tumor detection did not influence its size at the time of diagnosis. CONCLUSIONS: Our study confirms that FH of BC and/or of gastric or pancreatic carcinoma are risk factors for BC, while lactation at 25 years of age or earlier is protective.

Evaluación de la accesibilidad en los servicios de salud / Access. Barriers. Availability of resources

Objetivo. Evaluar la accesibilidad de los servicios de salud integrando la disponibilidad de recursos, el punto de vista de la institución médica y del paciente. Emplazamiento. Zona metropolitana del estado de Nuevo León, México. Mediciones y resultados principales. Una muestra de pacientes elegida al azar fue entrevistada sobre percepciones a distintas barreras, las mismas que fueron evaluadas para la institución utilizando el indicador correspondiente. La disponibilidad de recursos fue también identificada para todas las unidades médicas de primero y segundo nivel del sistema de salud mexicano más grande en Nuevo León. La accesibilidad fue limitada, 70 por ciento para atención primaria y 73 por ciento para atención en segundo nivel. La disponibilidad de recursos humanos fue importante, pero las barreras observadas por la institución fueron las principales (tiempo de espera y coste de traslado). Las barreras fueron evaluadas de diferente manera por los usuarios y la institución. Conclusiones. La determinación de la accesibilidad a través de la integración de la medición de los recursos, de las barreras evaluadas por la institución y las percibidas por el usuario es discutida (AU)

The cost of diabetes mellitus and its impact on health spending in Mexico.

BACKGROUND: The objective of this study was to determine the cost of diabetes mellitus, its impact on health spending in Mexico, and its percentage of the gross domestic product (GDP). METHODS: There was a four-stage approach: identification of the epidemiology of the use of health services; estimate of treatment cost; determination of the diabetic population, and calculation of the percentage of health spending. RESULTS: The average annual cost per diabetic patient was $708 U.S. dollars (USD), the total annual cost of diabetics was $2,618,000 USD, the percentage of health spending was 15.48%, and the percentage of the GDP was 0.79%. CONCLUSIONS: It is necessary to seek strategies that allow for a more efficient use of resources designated for type 2 diabetes treatment.

[Work-related anxiety among nursing personnel]. / Ansiedad laboral en personal de enfermería.

OBJECTIVE: To assess if work-related activities represented a threatening situation for nursing personnel through the correlation between the level of usual anxiety (trait-anxiety) and the level of anxiety present during working hours (state-anxiety). As well as, to determine state-anxiety risk factors. MATERIAL AND METHODS: The state-trait-anxiety inventory was administered to 285 nurses of a health care institution chosen at random. RESULTS: The correlation coefficient was 0.53 (CI 95% = 0.43, 0.60, p = 0.001), after controlling for age, marital status, number of children, workload, service, category, level of care, years of service and personal relationships. Negative personal relationships and = 1 year of service influenced the level of anxiety present during working hours (beta = -0.21, beta = -0.24, p = 0.001, respectively). CONCLUSIONS: Work-related activities represented a threatening situation and contributed to anxiety. It is necessary to recognize anxiety work-related risk factors for developing coping strategies and preventing well-being damage.

[Costs of maternal-infant care in an institutionalized health care system]. / Costo de la atención materno infantil en un sistema de salud institucionalizado.

Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities.

[Quality of the Early Cervical Cancer Detection Program in the State of Nuevo León]. / Calidad del Programa de Detección Oportuna de Cáncer Cervicouterino en el estado de Nuevo León.

OBJECTIVE: To determine the quality of the Early Cervical Cancer Detection Program in the state of Nuevo León. MATERIAL AND METHODS: A random selection of 4791 cytologic reports were analyzed, emitted by the State Ministry of Health, the University Hospital and the Mexican Institute for Social Security early cervical cancer detection modules. Pap tests of women with hysterectomy, current pregnancy, menopause or positive result were excluded. Quality was measured with previously defined standards. Analysis included, besides univariate statistics, tests of significance for proportions and means. RESULTS: The quality of the program was fairly satisfactory at the level of the State. The quality of the sampling procedure was low; 39.9% of the tests contained endocervical cells. Quality of coverage was low; 15.6% were women 25+years with first time Pap test. Quality of opportunity was high; 8.5 +/- 7 weekdays between the date of the pap smear and the interpretation date. CONCLUSIONS: Strategies are needed to increase the impact of the state program, such as improving the sampling procedure and the coverage quality levels.

[Cost at the first level of care]. / Costo en el primer nivel de atención.

OBJECTIVE: To estimate the unit cost of 15 causes of demand for primary care per health clinic in an institutional (social security) health care system, and to determine the average cost at the state level. MATERIAL AND METHODS: The cost of 80% of clinic visits was estimated in 35 of 40 clinics in the social security health care system in the state of Nuevo Leon, Mexico. The methodology for fixed costs consisted of: departmentalization, inputs, cost, weights and construction of matrices. Variable costs were estimated for standard patients by type of health care sought and with the consensus of experts; the sum of fixed and variable costs gave the unit cost. A computerized model was employed for data processing. RESULTS: A large variation in unit cost was observed between health clinics studied for all causes of demand, in both metropolitan and non-metropolitan areas. Prenatal care ($92.26) and diarrhea ($93.76) were the least expensive while diabetes ($240.42) and hypertension ($312.54) were the most expensive. Non-metropolitan costs were higher than metropolitan costs (p < 0.05); controlling for number of physician's offices showed that this was determined by medical units with only one physician's office. CONCLUSIONS: Knowledge of unit costs is a tool that, when used by medical administrators, allows adequate health care planning and efficient allocation of health resources.