[Evaluation of four methods for detecting methicillin-resistant Staphylococcus aureus isolates from clinical specimens at a regional hospital in Mexico]. / Evaluación de cuatro métodos para la detección de Staphylococcus aureus meticilino-resistente de muestras clínicas en un hospital regional.

OBJECTIVE: To estimate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in clinical isolates and to compare different methods for detection of MRSA in a lab with limited available personnel and resources. MATERIAL AND METHODS: 140 Staphylococcus aureus strains isolated from patients in several departments were assayed for ß-lactamase production, MIC-Vitek 2 oxacillin, ChromID MRSA, disk diffusion in agar for cefoxitin 30 µg and PBP2a detection. The results of conventional tests were compared with the "gold standard" PCR test for mecA gene. Cohen´s kappa index was also calculated in order to evaluate the intra assay agreement between the used methods. RESULTS: The found prevalence was 90.7%. Sensitivity and specificity were: disk diffusion for cefoxitin 97 and 92% respectively, MIC Vitek 2-XL 97 and 69%, ChromoID MRSA 97 and 85%, and PBP2a detection 98 and 100%. CONCLUSIONS: All methods are very good for detecting MRSA, choosing a method to use will depend on each laboratory infrastructure.

[Myopia prevalence among school-age children in a suburban population]. / Prevalencia de miopía en escolares de una zona suburbana.

OBJECTIVE: an epidemiological study was carried out to assess the prevalence of myopia among school age children of suburban population. METHODS: a cross sectional and descriptive study was applied, we stratified a randomized clusters of samples, using a representative proportion of the population. There were 1138 students enrolled, including 612 boys and 524 girls. Visual acuity with Snellen card was assessed; the refractive status and corneal radius of each student were measured with an autorefractometer which did not include cycloplegic refraction. All status refractive values were confirmed by another optometrist. Specific questionnaires were used in order to collect data on the refractive condition of students. The criterion for classifying the myopia status was > or = 0.5 diopters. RESULTS: the mean age was 10.2 + or - 2.43 years; lower prevalence rates were found significatively in male subjects. CONCLUSIONS: the myopia prevalence was 33.0 %, and the probability of myopia increases with age, sex, parental history of myopia, and history of premature children and low birth weight.

[Risk factors and incidence of relapse in lung tuberculosis patients]. / Incidencia de recaída y factores de riesgo asociados en pacientes con tuberculosis pulmonar.

OBJECTIVE: To determine the incidence of relapse in patients with lung tuberculosis and its associated risk factors. METHODS: A follow up study was conducted with 237 patients who were cured after receiving treatment in rural medical facilities from the State of Chiapas. RESULTS: The global incidence of relapse was 1.04 cases per 100 month/person. The risk factors for relapse were lack of knowledge about treatment (OR = 2.28; 95% CI = 1.06-4.89); drug adverse effects (OR = 2.78; 95% CI = 1.31-5.90), waiting time for more than 15 minutes to receive medical care (OR = 3.07; 95% CI = 1.06-12.94) and lack of medical supervision (OR = 4.77; 95% CI = 1.30-17.41). CONCLUSIONS: Most of the risk factors for relapse are susceptible to modification and are related with the quality of medical care provided to lung tuberculosis patients.

[Return to work in patients with heart disease after cardiac rehabilitation]. / Reincorporación laboral en trabajadores cardiópatas posterior a rehabilitación cardiaca.

BACKGROUND: Cardiac rehabilitation is a secondary prevention strategy which it includes a set of activities that would assure cardiac patients a place as normal as it could be into the society, being also essential for going back to work, by improving their quality of life and reducing costs for institutions. METHODS: A non-randomized clinical study was conducted at the "Siglo XXI" Cardiology Hospital; We included patients with the diagnosis of ischemic heart disease and/or valve disease, the response variables were: percentage of patients going back to work and disability time upon return to duty. Cardiac rehabilitation program was applied for 1 month and followed up at 2 months and 1 year. RESULTS: Two groups were formed, the ones who received cardiac rehabilitation, N = 40 (experimental group) against a control group, N = 25. The percentage of patients going back to work with a cardiac rehabilitation was 75 % versus 60 % of the group did not receive cardiac rehabilitation, p = 0.2, with a mean of 68 days of disability in the experimental group against 128 in the control group, p = 0.001. CONCLUSIONS: The experimental group showed a higher percentage of patients who returned to work, working time reentry (in days) was lower compared to the control group.

Introducción: en un estudio observacional, retrospectivo evaluamos la frecuencia, presentación clínica y tratamiento de linfocele en pacientes pediátricos con trasplante renal. Métodos: de enero de 2004 a enero de 2009 se realizaron 242 trasplantes renales, 197 de donantes vivos y 45 trasplantes de donantes cadavéricos. La técnica quirúrgica utilizada fue la habitual y la de los implantes uretrales fue la técnica Ricard modificada. El tratamiento fue por punción cutánea y drenajes internos mediante una ventana peritoneal laparoscópica. Resultados: se diagnosticaron siete pacientes con linfoceles (2.9 % con un IC 95 % 0.6-5.2 %). Una paciente del sexo femenino y seis del sexo masculino, todos fueron sometidos a drenajes por punción cutánea, seis pacientes fueron recidivados y tratados exitosamente por drenaje interno mediante una ventana peritoneal laparoscópica. Conclusiones: nuestra frecuencia es igual a la reportada en otros estudios (0.6-18 %). El drenaje interno mediante la ventana peritoneal laparoscópica parece ser lo más apropiado en pacientes pediátricos.

Differential Immune Profiles in Two Pandemic Influenza A(H1N1)pdm09 Virus Waves at Pandemic Epicenter.

BACKGROUND AND AIMS: Severe influenza A(H1N1)pdm2009 virus infection cases are characterized by sustained immune activation during influenza pandemics. Seasonal flu data suggest that immune mediators could be modified by wave-related changes. Our aim was to determine the behavior of soluble and cell-related mediators in two waves at the epicenter of the 2009 influenza pandemic. METHODS: Leukocyte surface activation markers were studied in serum from peripheral blood samples, collected from the 1(st) (April-May, 2009) and 2(nd) (October 2009-February 2010) pandemic waves. Patients with confirmed influenza A(H1N1)pdm2009 virus infection (H1N1), influenza-like illness (ILI) or healthy donors (H) were analyzed. RESULTS: Serum IL-6, IL-4 and IL-10 levels were elevated in H1N1 patients from the 2(nd) pandemic wave. Additionally, the frequency of helper and cytotoxic T cells was reduced during the 1(st) wave, whereas CD69 expression in helper T cells was increased in the 2(nd) wave for both H1N1 and ILI patients. In contrast, CD62L expression in granulocytes from the ILI group was increased in both waves but in monocytes only in the 2(nd) wave. Triggering Receptor Expressed on Myeloid cells (TREM)-1 expression was elevated only in H1N1 patients at the 1(st) wave. CONCLUSIONS: Our results show that during the 2009 influenza pandemic a T cell activation phenotype is observed in a wave-dependent fashion, with an expanded activation in the 2(nd) wave, compared to the 1(st) wave. Conversely, granulocyte and monocyte activation is infection-dependent. This evidence collected at the pandemic epicenter in 2009 could help us understand the differences in the underlying cellular mechanisms that drive the wave-related immune profile behaviors that occur against influenza viruses during pandemics.

[Healthy life expectancy in older adults with social security]. / Esperanza de vida saludable en adultos mayores con seguridad social.

BACKGROUND: Population aging increases the prevalence of chronic diseases. This morbidity impacts on the relatively high mortality levels and has disabling effects. Classic health indicators -life expectancy at birth and gross mortality rate- are complemented by the disability-free life expectancy (DFLE), whose advantage is a standardization of concepts, sources of information and calculation methods. In this investigation, the healthy life expectancy in adult older population with social security in Mexico is estimated. METHODS: Life expectancy was estimated from the mortality analysis and by constructing life tables of the population affiliated to the Mexican Institute of Social Security. Chiang's method was used and the disability prevalence-adjusted life table was modified using Sullivan's method. The healthy life expectancy, life expectancy free of disability and life expectancy with disability in the older adult analysis was highlighted. RESULTS: Life expectancy free of disability was estimated at 66.5 years. In females, it was 16 years and, in men, 15.2 years, indicating that from this age on they live less time with a healthy life. CONCLUSIONS: Healthy life expectancy is an indicator that can be useful to build scenarios to support the planning, administration and strategic management of healthy aging programs.

INTRODUCCIÓN: El envejecimiento poblacional incrementa la prevalencia de enfermedades crónicas. Esta morbilidad incide en los niveles de mortalidad relativamente altos y tiene efectos discapacitantes. Los indicadores clásicos de salud ­esperanza de vida al nacer y tasa bruta de mortalidad­ se complementan con la esperanza de vida libre de discapacidad (EVLD), cuya ventaja es la estandarización de los conceptos, las fuentes de información y los métodos de cálculo. En esta investigación se estima la esperanza de vida saludable en población adulta mayor con seguridad social en México. MÉTODOS: la esperanza de vida se estimó a partir del análisis de la mortalidad y construcción de tablas de vida de la población derechohabiente del Instituto Mexicano del Seguro Social. Se utilizó el método de Chiang y se modificó la tabla de vida ajustada por la prevalencia de discapacidad mediante el método de Sullivan. Se resaltó el análisis de la esperanza de vida saludable, esperanza de vida libre de discapacidad y esperanza de vida con discapacidad en el adulto mayor. RESULTADOS: la esperanza de vida libre de discapacidad se estimó en 66.5 años. En las mujeres fue de 16 años y en los hombres de 15.2 años, lo que indica que a partir de esta edad viven menos tiempo con vida saludable. CONCLUSIONES: la esperanza de vida saludable es un indicador que puede ayudar a construir escenarios para sustentar la planeación, administración y gestión estratégica de programas de envejecimiento saludable.

[Coronary heart disease morbidity and mortality trends at the Instituto Mexicano del Seguro Social. An ecological study of trends]. / "Morbilidad y mortalidad por cardiopatía isquémica en el Instituto Mexicano del Seguro Social. Estudio ecológico de tendencias en población amparada por el Instituto Mexicano del Seguro Social entre 1990 y 2008"

OBJECTIVE: To analyze secular trends of coronary heart disease morbidity and mortality in Mexicans protected by the Mexican Institute of Social Security. METHODS: An ecological trend analysis study was conducted on coronary heart disease morbidity and mortality in the Mexican population protected by the Institute. All deaths were adjusted for miscoding and misclasification and rates were age - adjusted according to the age distribution proposed by the World Health Organization. Hospital discharges, as well as the number of patients seeking medical care for coronary heart disease, were analyzed as an indirect incidence measure. Fatality rates and the mean number of hospitalization days were also estimated. RESULTS: Coronary heart disease mortality has shown a stable trend at the end of last century and a descending trend in the in the first year of this century, both in males (r=0.84;r2=0.70; p <0.001) as in females (r = -0.76; r2 =0.57; p <0.001). There is an age-effect on mortality; mortality is higher in males, mainly at younger ages (male-female rate = 3.44). Fatality rates have progressively decreased and the mean age of death has increased by four years in the last two decades. CONCLUSIONS: The stable trend and later descent on coronary heart disease mortality may be best explained by an increase in the quality of health care and secondary prevention. Nevertheless, there is a need to strengthen primary prevention by modifying exposure to major cardiovascular risk factors in Mexicans.

[Premature death and disability profile in the population affiliated to the Mexican Institute of Social Security (IMSS)]. / Muerte prematura y discapacidad en los derechohabientes del Instituto Mexicano del Seguro Social.

OBJECTIVE: To carry out estimations of the burden of disease for 129 causes in order to identify health priorities in the different geographic regions of the country and to present comparative data between 1995 and 2000. MATERIAL AND METHODS: Indicators such as disability-adjusted life years (DALYs) and disability adjusted life expectancy (DALE) were analyzed for the population covered by IMSS in 1995 and 2000; for both years, the methodology proposed by the Burden of Disease Worldwide Study was applied. Data corresponding to 1995 were analyzed in 1997, while data corresponding to 2000 were analyzed in 2001. The comparative study was carried out in 2006 by IMSS, Mexico. RESULTS: The higher proportion of DALYs was due to chronic diseases, although the 2000 rate is 1.5 times higher than that of 1995. Priorities that were identified were diabetes mellitus, ischemic cardiopathy, and cerebrovascular disease, with a loss that is mainly accounted for by premature death, as well as by diseases related to disability with an important burden of disease, such as AIDS or depression. Epidemiological backlogs can still be observed. CONCLUSION: The population covered by IMSS is still in a phase of epidemiologic transition, favoring polarization in health conditions. Health policies need to be directed toward bringing about an improved response and reversing the trend in diseases that represent an institutional risk for the financing of health care.

Evaluación de cuatro métodos para la detección de Staphylococcus aureus meticilino-resistente de muestras clínicas en un hospital regional / Evaluation of four methods for detecting methicillin-resistant Staphylococcus aureus isolates from clinical specimens at a regional hospital in Mexico

OBJETIVO: Investigar la prevalencia de Staphylococcus aureus meticilino-resistente (MRSA) en aislados clínicos y determinar la concordancia entre los métodos de detección de MRSA en un laboratorio con recursos y personal limitado. MATERIAL Y MÉTODOS: Se analizaron 140 cepas de Staphylococcus aureus aisladas de muestras clínicas de diferentes departamentos mediante pruebas convencionales: producción de β-lactamasa, sensibilidad a oxacilina con MIC-Vitek 2-XL, ChromID MRSA, difusión en agar para discos de 30 μg de cefoxitina, detección de PBP2a y PCR para el gen mecA. Se determinó el índice kappa de Cohen, para evaluar la concordancia entre los diferentes métodos utilizados. RESULTADOS: La prevalencia encontrada fue de 90.7 por ciento. La sensibilidad y especificidad para los diferentes métodos de detección fue: difusión en disco para cefoxitina 97 y 92 por ciento respectivamente, MIC Vitek 2-XL 97 y 69 por ciento, ChromoID MRSA 97 y 85 por ciento y detección de PBP2a 98 y 100 por ciento. CONCLUSIONES: Todos los métodos son muy buenos para la detección de MRSA; la elección en el uso de cada método dependerá de la infraestructura de cada laboratorio.

OBJETIVE: To estimate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in clinical isolates and to compare different methods for detection of MRSA in a lab with limited available personnel and resources. MATERIAL AND METHODS: 140 Staphylococcus aureus strains isolated from patients in several departments were assayed for β-lactamase production, MIC-Vitek 2 oxacillin, ChromID MRSA, disk diffusion in agar for cefoxitin 30 μg and PBP2a detection. The results of conventional tests were compared with the "gold standard" PCR test for mecA gene. Cohen´s kappa index was also calculated in order to evaluate the intra assay agreement between the used methods. RESULTS: The found prevalence was 90.7 percent. Sensitivity and specificity were: disk diffusion for cefoxitin 97 and 92 percent respectively, MIC Vitek 2-XL 97 and 69 percent, ChromoID MRSA 97 and 85 percent, and PBP2a detection 98 and 100 percent. CONCLUSIONS: All methods are very good for detecting MRSA, choosing a method to use will depend on each laboratory infrastructure.

Morbilidad y mortalidad por cardiopatía isquémica en el Instituto Mexicano del Seguro Social. Estudio ecológico de tendencias en población amparada por el Instituto Mexicano del Seguro Social entre 1990 y 2008 / Coronary heart disease morbidity and mortality trends at the Instituto Mexicano del Seguro Social. An ecological study of trends

Objetivo. Analizar el comportamiento secular de la morbilidad y mortalidad por cardiopatía isquémica en la población amparada por el Instituto Mexicano del Seguro Social. Métodos. Se realizó un estudio ecológico de tendencias de la mortalidad y morbilidad por cardiopatía isquémica en los derechohabientes del Instituto. Las defunciones se corrigieron por la clasificación inapropiada y las tasas se ajustaron por edad con la distribución por edad propuesta por la Organización Mundial de la Salud. Se analizaron los egresos hospitalarios y la demanda de atención por cardiopatía isquémica e infarto, como medición indirecta de la incidencia. Se estimó la letalidad y el promedio de días de estancia hospitalaria. Resultados. La mortalidad por cardiopatía isquémica mostró una estabilización en los últimos años del siglo pasado y una tendencia al descenso en los primeros años de este siglo tanto en hombres (r = -0.84; r² =0.70; p <0.001) como en mujeres (r = -0.76; r² =0.57; p <0.001). La mortalidad tiene un efecto de edad y es mayor en hombres, sobre todo a edades tempranas (razón hombre-mujer = 3.44). La letalidad ha disminuido progresivamente y la edad promedio de muerte se ha incrementado en cuatro años en las dos últimas décadas. Conclusiones. La estabilización y posterior descenso de la mortalidad por cardiopatía isquémica probablemente se explique por mejoría en la atención y en la prevención secundaria. No obstante, es necesario fortalecer la prevención primaria modificando la exposición a los principales factores de riesgo cardiovascular.

Objective: To analyze secular trends of coronary heart disease morbidity and mortality in Mexicans protected by the Mexican Institute of Social Security. Methods: An ecological trend analysis study was conducted on coronary heart disease morbidity and mortality in the Mexican population protected by the Institute. All deaths were adjusted for miscoding and misclassification and rates were age-adjusted according to the age distribution proposed by the World Health Organization. Hospital discharges, as well as the number of patients seeking medical care for coronary heart disease, were analyzed as an indirect incidence measure. Fatality rates and the mean number of hospitalization days were also estimated. Results: Coronary heart disease mortality has shown a stable trend at the end of last century and a descending trend in the first years of this century, both in males (r= -0.84; r²=0.70; p <0.001) as in females (r = -0.76; r² =0.57; p <0.001). There is an age-effect on mortality; mortality is higher in males, mainly at younger ages (male-female rate = 3.44). Fatality rates have progressively decreased and the mean age of death has increased by four years in the last two decades. Conclusions: The stable trend and later descent on coronary heart disease mortality may be best explained by an increase in the quality of health care and secondary prevention. Nevertheless, there is a need to strengthen primary prevention by modifying exposure to major cardiovascular risk factors in Mexicans.

Muerte prematura y discapacidad en los derechohabientes del Instituto Mexicano del Seguro Social / Premature death and disability profile in the population affiliated to the Mexican Institute of Social Security (IMSS)

OBJETIVO: Realizar estimaciones de la carga de la enfermedad para 129 causas a fin de identificar prioridades de salud en cada una de las delegaciones y presentar datos comparativos entre 1995-2000. MATERIAL Y MÉTODOS: Se analizaron los indicadores años de vida saludables perdidos (AVISA) y esperanza de vida saludable (EVISA) de los años 1995 y 2000 en la población derechohabiente del Instituto Mexicano del Seguro Social (IMSS); en ambos estudios se utilizó la metodología del Estudio Mundial de Carga de Enfermedad. Los datos de 1995 se analizaron en 1997, y los datos de 2000, en 2001. El estudio comparativo se llevó a cabo en 2006 en el IMSS, México. RESULTADOS: La mayor proporción de AVISA perdidos se debió a enfermedades crónicas, si bien la tasa en 2000 es 1.5 veces mayor respecto de 1995. Las prioridades identificadas fueron diabetes mellitus, cardiopatía isquémica y la enfermedad cerebrovascular con pérdidas principalmente por muerte prematura, así como padecimientos asociados con discapacidad con una importante carga de enfermedad, tales como el SIDA o la depresión. Aún se observan rezagos epidemiológicos. CONCLUSION: La población derechohabiente se encuentra aún en fase de transición epidemiológica, lo que favorece una polarización en las condiciones de salud. Es necesario que las políticas de salud se orienten a dar una mejor respuesta y a revertir las tendencias de padecimientos que representan un riesgo institucional para el financiamiento de la atención de los derechohabientes.

OBJECTIVE: To carry out estimations of the burden of disease for 129 causes in order to identify health priorities in the different geographic regions of the country and to present comparative data between 1995 and 2000. MATERIAL AND METHODS: Indicators such as disability-adjusted life years (DALYs) and disability adjusted life expectancy (DALE) were analyzed for the population covered by IMSS in 1995 and 2000; for both years, the methodology proposed by the Burden of Disease Worldwide Study was applied. Data corresponding to 1995 were analyzed in 1997, while data corresponding to 2000 were analyzed in 2001. The comparative study was carried out in 2006 by IMSS, Mexico. RESULTS: The higher proportion of DALYs was due to chronic diseases, although the 2000 rate is 1.5 times higher than that of 1995. Priorities that were identified were diabetes mellitus, ischemic cardiopathy, and cerebrovascular disease, with a loss that is mainly accounted for by premature death, as well as by diseases related to disability with an important burden of disease, such as AIDS or depression. Epidemiological backlogs can still be observed. CONCLUSION: The population covered by IMSS is still in a phase of epidemiologic transition, favoring polarization in health conditions. Health policies need to be directed toward bringing about an improved response and reversing the trend in diseases that represent an institutional risk for the financing of health care.

Esperanza de vida saludable en la población mexicana con seguridad social / Disability adjusted life expectancy in mexican population with social security

Objetivo: Estimar la esperanza de vida saludable para ambos sexos, y por delegación, y aportar algunos aspectos metodológicos para la construcción del indicador. Material y método: Con base en la información de mortalidad correspondiente al año 2000, se realizó el análisis de las defunciones y construcción de la tabla de vida de la población derechohabiente del Instituto Mexicano del Seguro Social (IMSS), con la finalidad de conocer la Esperanza de Vida (EV) de esa población, tanto nacional como por delegaciones, para ello se utilizó el método de Chiang. Posteriormente se realizó modificación a la tabla de vida ajustada por la prevalencia de discapacidad, a través del método de Sullivan, para el cálculo de años de vida libre de discapacidad. Resultados: Se calculó una esperanza de vida en población asegurada que fue de 77.4 años. La esperanza de vida saludable se estimó en promedio para la población derechohabiente en 65.8 años y la esperanza de vida con discapacidad en 10.5 años. Conclusión: La población asegurada muestra un perfil demográfico que aún esta en transición, ya que los estados del centro y sur del país aún muestran rezagos en materia de salud, que impactan en una menor esperanza de vida, y en la esperanza libre de discapacidad, a diferencia de los demás que ya se encuentran en transición avanzada. Esto refleja el perfil de salud y las demandas que el sistema de salud deberá de enfrentar en el futuro. La tabla de vida es una herramienta que puede ayudar a los tomadores de decisiones a apoyar la construcción de escenarios y facilitar las actividades de planeación estratégica.

Objective: Estimate the disability adjusted life years for both sex and state and include the methodology that let it to build the indicator. Material and methods: We shown the build of life table elaborated for the Mexican population with Social Security in order to know the life expectancy (LE). We made the Chiang's Method with information about population and death certificate for the year 2000 after we modified the table of life Sullivan's method. Results: We calculate the life expectancy in social security population in 77.36 years and the life expectancy free of disability around 65.8 years and life expectative with disability in 10.5 years, this reference is a population ageing in transition process. Conclusion: With health profile that will give upper demands to health system. This is a tool that can help to build scene and to give facilities for the strategic administration.

Prevalencia y factores asociados a violencia familiar en adultos mayores de Ocozocoautla (Chiapas, México) / Prevalence of familial elder abuse and associated factors in Ocozocoautla (Chiapas, Mexico)

Introducción: considerado inicialmente un problema de bienestar social, la violencia familiar en adultos mayores es ahora una cuestión de salud pública. El objetivo de este estudio fue determinar la prevalencia y los factores asociados a violencia familiar en adultos mayores de un área rural de México. Material y métodos: se realizó un estudio transversal seleccionando aleatoriamente a adultos mayores de 60 años y más adscritos al Hospital Rural IMSS-Oportunidades de Ocozocoautla (Chiapas, México). Mediante una entrevista domiciliaria, se recabó información sobre: características sociodemográficas, función familiar, red social, presencia de enfermedades, estado cognitivo, función física y violencia familiar. El análisis incluye frecuencias simples, χ2, odds ratio (OR) con intervalos de confianza (IC) del 95% y regresión logística. Resultados: se entrevistó a 1.078 adultos mayores. La prevalencia global de violencia familiar fue de 8,1% (IC del 95%, 6,4-9,7). La distribución por tipo de violencia fue la siguiente: física, 3,4%; psicológica, 7%; sexual, 0,6%; y económica, 2,2%. Diversas mediciones estuvieron fuertemente asociadas a la violencia familiar: analfabetismo (OR = 2,15; IC del 95%, 1,26-3,66; p = 0,005), dependencia de vivienda (OR = 1,78; IC del 95%, 1,06-2,99; p = 0,030), red social disfuncional (OR = 5,98; IC del 95%, 3,56-10,04; p ≤ 0,001), presencia de alguna enfermedad (OR = 3,96; IC del 95%, 2,35-6,67; p ≤ 0,001) y dependencia física (OR = 1,66; IC del 95%, 0,99-2,80; p = 0,055). Conclusiones: este estudio demuestra que la prevalencia de violencia familiar en el medio rural no es despreciable (8,1%). Los factores que se encontraron asociados a este episodio permiten crear un esquema de ayuda al personal que trabaja con adultos mayores, ya sea en el nivel de los servicios sociales o los sanitarios

Introduction: initially considered a social welfare problem, familial elder abuse is now a question of public health. The objective of this study was to estimate the prevalence of familial elder abuse and to determine associated risk factors in a rural area of Mexico. Material and methods: a cross sectional study was conducted. A random sample of individuals aged 60 years old and older registered in community-based services in the IMSS-Oportunidades Rural Hospital of Ocozocoautla, Chiapas was selected. A home interview was carried out and information was obtained on sociodemographic characteristics, family function, social network, the presence of disease, cognitive status, physical function, and family violence. Statistical analysis of the data included simple frequencies, the chi-square test, odds ratios (OR) with 95% confidence intervals (CI), and a logistic regression model. Results: we interviewed 1,078 older people. The overall prevalence of family violence in the elderly was 8.1% (95% CI, 6.4-9.7). Distribution was as follows: physical abuse 3.4%, psychological abuse 7%, sexual abuse 0.6%, and financial abuse 2.2%. Several factors were strongly associated with family violence: illiteracy (OR = 2.15; 95% CI, 1.26-3.66; p = 0.005), housing dependence (OR = 1.78, 95% CI, 1.06-2.99; p = 0.030), dysfunctional social network (OR = 5.98; 95% CI, 3.56-10.04; p ≤ 0.001), the presence of at least one disease (OR = 3.96; 95% CI, 2.35-6.67; p ≤ 0.001), and physical dependence (OR = 1.66; 95% CI, 0.99-2.80; p = 0.055). Conclusions: this study shows that the prevalence of family violence in the rural setting is not negligible (8.1%). The associated factors identified allow schemes to be designed that would help personnel working with older people, whether in the social or health services, to be designed

Factores predictores de sobrevida o de un segundo evento coronario en pacientes con un promer infarto agudo del miocardio / Predictive factors survival and for a second coronary event in patients with acute myocardial infarction

El pronóstico de los pacientes con un infarto agudo del miocardio está en relación a la gravedad de la obstrucción coronaria y al estado funcional residual del ventrículo izquierdo, que puede evaluarse a través de la fracción de expulsión. Con el fin de evaluar la utilidad de la fracción de expulsión y de algunos factores de riesgo cardiovascular, como predictores de un segundo infarto o de muerte tardía en los pacientes que han sufrido un primer infarto, se estudiaron 161 pacientes. Se investigó la ocurrencia de un segundo infarto o de muerte después del primer mes. Se siguieron a los pacientes durante 1 a 51 meses, y se les midió la fracción de expulsión por ecocardiograma transtorácico. La muestra incluyó 119 hombres y 42 mujeres, que contribuyeron con 3802 meses persona de seguimiento. La tasa de incidencia de segundo infarto fuede 0.01052 mes-1, y la de la mortalidad de 0.00342 mes-1. En el análisisi de sobrevida de Cox, la fracción de expulsión fue un adecuado indicador pronóstico y los sujetos con menos de 40 por ciento tuvieron un riesgo siete veces mayor de presentar un segundo infarto. La diabetes mellitus e hipertensión fueron los principales indicadores de muerte tardía. La fracción de expulsión es la variable más relacionada con la ocurrencia de un segundo infarto y junto con la historia de diabetes mellitus y de hipertensión predice en forma adecuada la mortalidad tardía posterior a un primer infarto del miocardio. La identificación de sujetos con mal pronóstico permite establecer acciones preventivas específicas. La fracción de expulsión es útil para categorizar a los sujetos en función a su pronóstico.