Alberto González Pedraza Avilés

Infección de vías urinarias por especies de Candida

Objetivo Determinar la frecuencia y las caracteristicas de la candidiasis urinaria en pacientes diabeticos (con y sin sintomatologia urinaria) y compararla con un grupo de pacientes sin dicha afeccion (con y sin sintomatologia). Diseno Estudio longitudinal, descriptivo y observacional. Emplazamiento Trabajo realizado en la Clinica de Medicina Familiar Dr. Ignacio Chavez ISSSTE. Participantes Se incluyo a 2 tipos de pacientes: a) pacientes con diagnostico de diabetes mellitus (DM) con y sin cuadros clinicos de probable infeccion de vias urinarias (IVU), y b) un segundo tipo sin DM y con o sin cuadro clinico de probable IVU. Mediciones principales Se realizaron un urocultivo y un cuestionario confidencial para reconocer la sintomatologia urinaria y los probables factores de riesgo del paciente asociados con el proceso infeccioso. Para asociar estos ultimos se utilizo el metodo estadistico de la χ 2 , con significancion del 95%, y la prueba exacta de Fisher para frecuencias pequenas; se utilizo el programa EpiInfo version 6.0. Resultados Se incluyo a 237 pacientes de 28-82 anos; la prevalencia de candidiasis urinaria fue del 5,1%, pero solo el 33% fue C. albicans . No se encontro ninguna asociacion entre la candidiasis y factores como la edad, el sexo o la presencia de DM, pero si con tratamientos previos, IVU previas y el tiempo de evolucion de la DM. Conclusiones Se considera importante la busqueda intencionada, tanto por el medico como por el laboratorio, de estos microorganismos como causales de IVU, principalmente en los pacientes con factores de riesgo que parecen condicionar su presencia.

Estilos educativos parentales y embarazo en adolescentes

Objective: to compare parental educational styles of families with pregnant and non-pregnant teenage daughters. Methods: observational, descriptive, cross-sectional and comparative study. It included pregnant and non-pregnant adolescents, between 15 and 19 years old, from the ti Bekal Health Care Center of the Health Services in Mexico City. It was made an identification card, as well as a scale to evaluate the parental educational of adolescents. Using inferential statistics with the t test of Student from independent samples, 0.05 significance level and the statistical program spss v. 18. Results: the study included 16 pregnant teenagers and 28 non-pregnant; whose age averaged 17.88 ±1. 45 years and 16.68 ±1.12 years old, respectively, in the dimensions of the scale, pregnant women showed best results in affection and communication, humor and psychological control, in this last dimension it was showed statistically significant differences in pregnant teenagers (p=0.010); on the other hand, the non-pregnant women obtained best averages in control behavior with significant differences (p=0.036) in autonomy and revelation. Conclusions: there was no predominance of better results between the two study groups in the different dimensions of the scale, however, in the control behavioral dimension, which defines the permissive style of parents; pregnant adolescents scored much lower with difference statistically significant in favor of a relaxed or permissive education.

Factores de riesgo asociados al uso de medicamentos potencialmente inapropiados en ancianos de una clínica de medicina familiar

Objective: determine the frequency and risk factors related to the prescription of potentially inappropriate medications (pim) in the elderly. Material and methods: descriptive and cross-sectional study. Records of patients from a Gerontological section of the issste (Institute of Security and Social Services for the State Workers) “Dr. Ignacio Chavez” Family Medicine Clinic (fmc) in Mexico City were reviewed. The prescription of a pim was evaluated with the Beers criteria. It was made a simple randomized sample and size for descriptive studies. Statistical analysis: variance analysis and t of student, level of significance 0.05. Statistical program spss v 18. Results: 300 records were analyzed, in 19 cases (6.3%) there was no pim prescribed, 67 (22.3%) registered at least one. When they were classified into two groups: regardless of the diagnosis, 38.3% received a prescription for a medication, and 43% depended on the diagnosis. Conclusions: the high frequency of prescription of pim in the elderly is a real health problem in the field of Family Medicine.

Nivel de empatía en médicos del servicio de urgencias de un hospital público de la ciudad de México

Objective: to identify the level of empathy in the doctor-patient relationship of interns, residents and affiliated physicians assigned to an emergency room of a public hospital. Methods: observational, descriptive and cross-sectional study carried out between September and October 2014. Non-randomized sample by convenience in the total population of physicians assigned to the Emergency Room. Under informed consent, it was applied the validated and translated into Spanish instrument, the Jefferson scale of empathy in its Student version to physicians assigned to the Emergency Room of a public hospital of the Ministry of Health in Mexico City. For the statistical inferential analysis the non-parametric test of Kruskal-Wallis and U of Mann-Whitney were used; the significance level was α=0.05 for both; the statistical program spss v. 18 was used. Results: according to the Jefferson scale, 17 of the 51 physicians included in the study, did not show empathy (33.3%), 10 were moderately empathetic (19.6%) and 24 were completely empathetic (47.1%). Conclusions: about half of the 51 interviewed physicians presented empathy in the doctor-patient relationship.

Percepción de apoyo en la pareja reconstituida: el camino al ensamblaje *

Objective: to evaluate the perception of support in reconstituted couples in a Health Care Centre. Methods: descriptive, observational, cross-sectional study carried out from August to December 2014 in the “Dr. Jose Castro Villagrana” Health Care Center in Mexico City. Non-randomized sample by convenience, in couples in their second marriage or common-law union (in at least one of the members of the couple). The Basic Certificate of Family Identification (Cebif-5) with the items of identification, demographic factors and family apgar was applied, after previous informed consent. The Kruskall-Wallis test, with 0.05 of significance level, and the spss v. 18 program were used. Results: 30 heterosexual couples living in common-law union or remarried were included. The age ranged from 23 to 64 years in men and from 23 to 61 in women. There were five couples (16.7%) with low perception, eight (26.7%) with media perception and 17 couples (56.7%) with high perception. It was only obtained a relationship with statistical significance between the level of perception and the age for both sexes, in which: older showed better perception. Conclusions: more than half of the couples obtained a high level perception, however, the age influenced in the satisfaction level as well as support perception. The couple’s relationship is a challenge to improve as human beings, as well as to prevent difficulties such as divorce. There should be a substantive part of the clinical work in Family Doctors practice addressing these problems.

Prevalencia de Burnout en trabajadores de un centro de salud

Objective: to determine prevalence of Burnout among workers of a Health Care Center. Methods: observational, descriptive and cross-sectional study. All the workers of the “Dr. Gerardo Varela Mariscal” Health Care Center t-iii, in the sanitary jurisdiction of Tlalpan, Health Services in Mexico City, were included; from August to November, 2014. It was applied Identification card and the Maslash inventory modified in 16 questions, moreover it was made the Pearson coefficient of correlation, a factor anova and t of Student independent samples, the significance level was 0.05 and the statistical spss v. 18 program was used. Results: a total of 53 workers are included. 22.5% showed a high and very high level of burnout for “cynicism”; 20.6% in the same categories for “personal inefficiency” and 24.4% for “exhaustion”. The only correlation with significance found was between “job inefficiency” and “couple relationship” variable (p=0.036), as well as “sense of demand” and “job Burnout” (p=0.012). Conclusions: it is important the prevalence of the burnout syndrome among health workers, as approximately a quarter of the staff personnel studied in this research showed it.

Estrategias educativas para la formación de investigadores en Medicina Familiar en México

Introduccion Es indudable que en Mexico existe una clara conciencia sobre la importancia de la investigacion, la cual ya no esta limitada a ciertos circulos universitarios, sino que se ha extendido a los organos decisivos del poder, asi como a la mayoria de las instituciones educativas, del sector salud, e incluso, a empresas productivas de vanguardia, en especial del area social. La pregunta que se genera es ?los esfuerzos por desarrollar investigacion cientifica y tecnologica tienen aun sentido y podran sacar al pais del circulo vicioso de la dependencia? Es obvio que la respuesta radica en el fortalecimiento de la investigacion, al buscar espacios que permitan construir un sistema de investigacion cientifica y tecnologica mas solido y menos dependiente. Es en este contexto que la formacion de investigadores cobra una importancia decisiva y estrategica. Si investigar es en la actualidad un quehacer tan importante, formar para la investigacion efectiva debe ser una politica de alcance no solo academico sino tambien social.1 En este sentido, uno de los retos es la formacion de investigadores, que permita producir proyectos relevantes, pertinentes, con calidad metodologica y apegada a los principios eticos. Con este proposito se creo el “Diplomado de metodologia en investigacion en salud” en la Subdivision de Medicina Familiar de la Division Estudios de Posgrado (dep), Facultad de Medicina, Universidad Nacional Autonoma de Mexico (unam), como estrategia educativa para introducir a los profesionales de la salud en el campo de la investigacion aplicada. Existen, sin duda, multiples metodologias para la formacion de investigadores, no obstante, debemos ser conscientes acerca de la necesidad de hacer de la investigacion un proceso pedagogico.2 La mediacion pedagogica como estrategia alternativa se mueve dentro de ciertas coordenadas que hacen posible que el modelo tematico de formacion avance en la direccion y profundizacion del modelo pedagogico. Las coordenadas mas pertinentes son las siguientes: 1. Todo lo que se haga en el proceso de formacion de investigadores debe tener sentido para el investigador 2. Es precisamente el realizar investigacion, la forma idonea para que se aprenda a desarrollar y perfeccionar las capacidades propias del investigador 3. La intuicion debe constituirse como el punto de arranque y la fuerza propulsora del proceso de investigacion 4. La investigacion como proceso, y no tanto como logro de resultados, desarrolla y perfecciona la capacidad de investigar

Valoración gerontogeriátrica integral: comparación diagnóstica entre el módulo gerontológico y la consulta externa

Objetivo: comparar la valoracion gerontogeriatrica integral (vgi) contra la asistencia medica tradicional. Material y metodos: estudio retrospectivo, comparativo, observacional y analitico. Muestreo probabilistico de 300 expedientes clinicos de pacientes que tenian 60 o mas anos de edad y eran atendidos en el modulo gerontologico (grupo 1). Muestreo no probabilistico de 400 expedientes de pacientes de consultorios de medicina familiar (grupo 2). Se utilizo una cedula de recoleccion disenada ex profeso. Todas las variables fueron categorizadas como presencia o ausencia diagnostica e incluyeron las referentes a las cuatro areas: biologica, psicologica, social y funcional. Analisis estadistico: χ2 de homogeneidad, nivel de significancia de 0.05. Programa estadistico spss 15. Resultados: se presentaron diferencias con significancia estadistica entre los dos grupos en practicamente todas las diagnosticas de las cuatro areas. Al realizar el analisis en funcion de los grupos etarios, en el de los muy viejos y centenarios practicamente no existieron diferencias entre diagnosticas. Conclusiones: las diferencias en los porcentajes diagnosticos hacen necesario realizar la vgi en el primer nivel de atencion medica, toda vez que es el sitio donde se concentra el mayor numero de poblacion de adultos mayores y que son atendidos en forma inicial.

Ansiedad, depresión y calidad de vida en un grupo de médicos residentes de la ciudad de México

Objective: to determine the levels of anxiety and depression in medical residents, as well as the relation with their quality of life. Material and methods: observational, descriptive, cross-sectional and scholar study. 77 medical residents of “stem” specialties of a regional hospital and of the Family Medicine specialty, corresponding to the first level health care clinics of the Institute of Security and Social Services for State Employees (issste) were included. Not randomized sample. It was applied the Beck inventory for anxiety and depression and the Coop-Wonca vignettes for quality of life related to health. It was used Kruskall Wallis, analysis of variance as a factor and coefficient of correlation of Spearman, significance level of 0.05, as well as the statistical program spss version 18. Results: 12 students, 15.5% of the total, presented some degree or level of anxiety and depression. In quality of life, the dimension with lowest average was pain (1.94%), while the highest was in feelings (2.51%). Relating anxiety and depression with quality of life in most dimensions statistical significance was obtained. Conclusions: it is evident that this two mental health disorders can produce significant impacts on the quality of life related to health, such as observed in the studied group of residents.