Realización de la autoexploración mamaria posterior a la atención preventiva integrada en mujeres adscritas a una Unidad de Medicina de Familia / Breast self-examination after integrated preventive care in women served by a Family Medicine Unit

Resumen:

Introducción: el cáncer de mama es la neoplasia maligna más frecuente en las mujeres. El autoexamen de mama es la principal medida preventiva, ya que el 95% de los tumores de mama son detectados por la propia mujer a través de esta técnica. La enfermera es el profesional que está estrechamente relacionado con la educación para llevar a cabo el procedimiento correctamente. Objetivo: determinar la realización correcta de la autoexploración de mamas (AEM) posterior a la atención preventiva integrada (API). Método: mujeres que asistieron a PREVENIMSS para su API y recibieron la técnica demostrativa de AEM. Resultados: 500 mujeres, en 84 (17%) la AEM se realizó correctamente. Mujeres con una realización adecuada de la AEM tuvieron mayor escolaridad (9,3+2,7 8,0+5,8 años, p= 0,001) y más frecuentemente se les había enseñado la AEM de forma demostrativa junto con la enfermera (59% vs 46%, p= 0,02). Conclusiones: preferentemente la AEM debe llevarse a cabo con la técnica demostrativa con la enfermera para que se realice correctamente.

Isolation of IgG antibodies to Toxocara in ankylosing spondylitis patients with acute anterior uveitis.

PURPOSE: Since few reports had been published on the prevalence of toxocariasis in ankylosing spondylitis (AS) patients with acute non-granulomatous anterior uveitis (ANGAU), the aim of this work was to determine the presence of antibodies against Toxocara canis in AS patients with ANGAU. METHODS: Thirty-six patients (14 female and 22 male) with AS were enrolled in the study. The history of ANGAU was accepted only if diagnosed by an ophthalmologist. The detection of IgG antibodies to T. canis was determined by enzyme-linked immunosorbent assay. In addition, antibodies to Ascaris lumbricoides were also tested to verify non-specific reactions. RESULTS: The prevalence of ANGAU in the AS patients was 58% (21 / 36), and 38% (8 / 21) of the patients with ANGAU were positive for antibodies to Toxocara, while 7% (1 / 15) of AS patients without ANGAU were positive for T. canis (p = 0.038, two tails; mid-p exact). No antibodies were detected to A. lumbricoides antigens in the serum samples of patients with AS. CONCLUSIONS: These data suggest that the seroprevalence of antibodies to T. canis is high in Mexican patients with AS-associated uveitis, suggesting a chronic asymptomatic toxocariosis, which could be associated with the pathogenesis of ANGAU; however, further larger-scale studies are needed to confirm this observation.

[Prenatal care and hospital maternal mortality in Tijuana, Baja California, Mexico]. / Atención prenatal y mortalidad materna hospitalaria en Tijuana, Baja California.

OBJECTIVE: To describe the prenatal care (PC) received in women with maternal hospital deaths from 2005 to 2011 in Tijuana, Baja California, Mexico. MATERIALS AND METHODS: Were reviewed the medical chars and registrations of the maternal deaths by the local Committees of Maternal Mortality. RESULTS: There were 44 maternal hospital deaths. Thirty (68%) women assisted to PC appointments during pregnancy, the average number of PC visits was 3.8 and 18 (41%) had an adequate PC (≥ 5 visits). Six (14%) women didn't know they were pregnant; 19 (43%), 21 (48%) y 4 (9%) maternal deaths were due to direct, indirect obstetric cause or non-obstetric causes. Eighteen (18%), 2 (4 %) and 34 (77%) of the maternal deaths occurred during pregnancy, delivery or puerperium. CONCLUSIONS: It is necessary pregnancy women have an early, periodic and systematic PC to identify opportunely risk factors associated with pregnancy complications.

Tiempo entre comienzo de síntomas, acudir al médico e inicio de fármacos modificadores de la enfermedad en pacientes con artritis reumatoide / The lag time between onset of symptoms, medical encounter, and initiation of disease modifying antirheumatic drugs in patients with rheumatoid arthritis

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Atención prenatal y mortalidad materna hospitalaria en Tijuana, Baja California / Prenatal care and hospital maternal mortality in Tijuana, Baja California, Mexico

Objetivo. Describir la atención médica prenatal recibida en mujeres con mortalidad materna hospitalaria en el IMSS durante 2005-2012 en Tijuana, Baja California, México. Material y métodos. La información se obtuvo de los archivos de los Comités de Mortalidad Materna y revisión del expediente. Resultados. Hubo 44 muertes maternas (MM). Treinta (68%) asistieron a atención prenatal (AP), el promedio de citas fue de 3.8 y 18 (41%) tuvieron una AP adecuada (≥ 5 citas). Seis (14%) mujeres no sabían que estaban embarazadas; 19 (43%), 21 (48%) y 4 (9%) de las MM fueron por causa obstétrica directa, indirecta y no obstétrica. Ocho (18%), 2 (4 %) y 34 (77%) de las MM ocurrieron en el embarazo, parto y puerperio. Conclusiones. Es necesario que las mujeres embarazadas tengan una vigilancia prenatal temprana, periódica y sistemática que permita la identificación y el diagnóstico oportuno de pacientes con alto riesgo de desarrollar complicaciones durante su embarazo.

Objective. To describe the prenatal care (PC) received in women with maternal hospital deaths from 2005 to 2011 in Tijuana, Baja California, Mexico. Materials and methods. Were reviewed the medical chars and registrations of the maternal deaths by the local Committees of Maternal Mortality. Results. There were 44 maternal hospital deaths. Thirty (68%) women assisted to PC appointments during pregnancy, the average number of PC visits was 3.8 and 18 (41%) had an adequate PC (≥ 5 visits). Six (14%) women didn't know they were pregnant; 19 (43%), 21 (48%) y 4 (9%) maternal deaths were due to direct, indirect obstetric cause or non-obstetric causes. Eighteen (18%), 2 (4 %) and 34 (77%) of the maternal deaths occurred during pregnancy, delivery or puerperium. Conclusions. It is necessary pregnancy women have an early, periodic and systematic PC to identify opportunely risk factors associated with pregnancy complications.

Nivel de dependencia al tabaco en enfermeras y médicos de un hospital general regional / Smoking dependence level in nurses and doctors at a Regional General Hospital in Tijuana, Mexico

Resumen:

Introducción: la Organización Mundial de la Salud (OMS) promueve en forma prioritaria que el personal médico y paramédico deje de fumar, porque ellos desempeñan una importante función como educadores en la promoción de comportamientos saludables en la población general. Objetivo: determinar el nivel de dependencia al tabaco, de acuerdo a la escala de Fagerström, en el personal sanitario fumador, del turno vespertino y nocturno, Hospital General Regional (HGR) Nº 20, Instituto Mexicano del Seguro Social (IMSS), Tijuana, Baja California (BC). Métodos: se realizó un estudio descriptivo transversal en 264 (médicos y enfermeras) trabajadores del turno vespertino y nocturno durante Mayo a Julio del 2011 en un Hospital General Regional del IMSS, Tijuana, BC. Resultados: la edad promedio fue de 36,67±8,931, un 66% fueron mujeres, el 81% enfermeras y un 19% médicos. Ochenta y un trabajadores (30,7%) eran fumadores actuales (71 fumadores fueron enfermeras y 10 médicos) con un promedio de años fumando, de 10,8±8,5. El nivel de dependencia fue baja al tabaco en (55,6%), moderada (39,5 %) y alta (5%). Conclusión: el consumo de tabaco, en profesionales de la salud del IMSS Tijuana, BC, mostró una dependencia baja en el 50% de los trabajadores. Es necesario continuar con programas para desalentar el consumo y concentrar esfuerzos en promover el abandono del consumo de cigarrillos en las personas que presentan dependencia a la nicotina.

[Acceptance of the vaccine against human papilloma virus from mothers to daughters aged 9 to 13 years old]. / Aceptación de la vacuna contra el virus del papiloma humano por parte de madres de hijas entre 9 y 13 años de edad.

BACKGROUND: If you consider that at some point in life 50% of sexually active women have had an infection with the human papilloma virus is indisputable that any attempt to reduce the prevalence worth undertaking it. The vaccine to prevent HIV infection has not enjoyed the same degree of acceptance than others, hence the interest in knowing some of the reasons that has not achieved universal vaccination. OBJECTIVE: To examine human papillomavirus (HPV) vaccine acceptability among mothers with adolescents girls between 9 and 13 years old. METHODS: The mothers were interrogated about HVP vaccine acceptability, reasons provided for acceptance or non-acceptance and if mothers know that vaccine is offered free for public health institutions RESULTS: We interview a 250 mothers with 281 daughters, 38 daughters have already received the vaccine. Eighty nine percent of the mothers reacted positively to the possibility of vaccinating theirs daughters. The reasons of vaccine non-acceptance were because not knowing enough about infection, mother felt that their daughters were not at risk for acquiring HVP infection, the vaccine is new and mothers unknown side effects. Thirty nine percent of the mothers want to know more about the vaccine safety, 21% about length protection duration and 16% concerning about if the vaccine is effective. Fifty seven per cent of the mothers know that Health Secretary offers vaccine free. Mothers whom have been vaccinated their daughters, had daughters with lower age (9.8 +/- 0.9 vs 10.8 +/- 1.3 years, p = 0.0001), were more frequently married (79 vs 51%, p = 0.002) and more likely to report that they had heard about VPH vaccine from some source (100 vs 66%, p = 0.0001) that mothers have not yet vaccinated their daughters. CONCLUSIONS: The acceptability of VPH vaccine was 89%. Continued health education and propaganda is needed to promote a better knowledge of VPH vaccine.

[Financial expenses incurred by herniated disk in health professionals]. / Costo del subsidio por diagnóstico de hernia de disco en trabajadores del Instituto Mexicano del Seguro Social.

BACKGROUND: Long-term sick leave by illeness is cause of financial expences and worker's loss of productivity. OBJECTIVE: To evaluate the financial expense incurred by spinal disk herniation in health professionals. METHODS: 3000 health professionals of the Instituto Mexicano del Seguro Social work in Tecate, Tijuana and Rosarito, cities of Baja California, Mexico. During 2009-2011, 1070 health professionals had long sick leave certificates and 48 had a cervical or lumbar disk herniation. We evaluated the total days of absenteeism in comparison with the absenteeism days suggested by the Medical Disability Advisor. RESULTS: Of the 48 spinal herniated disks, 54% were cervical and 65% had surgical management. The mean (± SD) days of absence was 125 ± 84 and 24 (50%) of the spinal herniated disks exceeded the Medical Disability Advisor disability duration parameters, in 6 (26%), 12 (52%), and 5 (22%) patients due to no diagnostic concordance, diagnosis delay and residual pain, respectively. The total cost of the spinal herniated disks that extended outside of the Medical Disability Advisor disability duration parameters was 683,026 pesos versus 367,081 pesos of the spinal herniated disks that did not exceed the Medical Disability Advisor disability duration parameters. After 12 months of follow-up, 9 (18.8%) continue with sick leave and 2 (4%) had permanent disability. CONCLUSIONS: In patients with a spinal herniated disk, the costs of subsidies were two-fold more due principally to a not diagnostic agreement.

Antecedentes: las incapacidades prolongadas no sólo tienen un alto costo económico sino también repercusiones en la productividad debido a la ausencia del trabajador. Objetivo: evaluar el costo del subsidio pagado por el Instituto Mexicano Seguro Social (IMSS) a los trabajadores que incapacita por hernia de disco. Material y métodos: estudio observacional, descriptivo, transversal y retrospectivo efectuado con trabajadores del IMSS a quienes se incapacita para no laborar por más de 14 días. El estudio se efectuó mediante la revisión de los registros asentados entre 2009-2011 de 1,070 trabajadores con incapacidad prolongada de los que 48 tuvieron diagnóstico de hernia de disco. Se cuantificaron los días totales de incapacidad, días subsidiados por incapacidad versus los días sugeridos por el consejero médico de incapacidades. Resultados: de los 48 pacientes con hernias de disco, 54% fueron cervicales y 65% recibieron tratamiento uirúrgico. Los días totales promedio de incapacidad por hernias de disco fueron 125 ± 84 y 24 (50%), respectivamente. De las que rebasaron las recomendadas por el consejero médico, 6 (26%) fueron por concordancia diagnóstica, 12 (52%) por diferimiento en el diagnóstico y 5 (22%) por dolor residual. El costo de las incapacidades laborales originadas por hernias de disco que rebasaron las sugeridas por el consejero médico fue de 683,026 pesos en comparación con 367,081 pesos que no rebasaron la recomendación de éste. Después de 12 meses de seguimiento, 9 casos (18.8%) seguían con incapacidad y 2 (4%) tuvieron pensión por invalidez. Conclusiones: el costo en subsidio por incapacidades a pacientes con hernia de disco se duplicó principalmente por diferimiento en el diagnóstico.