Svetlana Vladislavovna Doubova

Intestinal anti-spasmodic effect of a phytodrug of Psidium guajava folia in the treatment of acute diarrheic disease.

Ancestral medicinal use of guava (Psidium guajava L. Fam. Myrtaceae) is today supported by numerous biomedical studies concerning the properties of leaf extracts. However, insufficient clinical studies are reported on the use of this plant resource in the treatment of gastrointestinal ailments. The present work reports a randomized, double-blinded, clinical study performed to evaluate the safety and efficacy of a phytodrug (QG-5) developed from guava leaves, standardized in its content of quercetin and orally administered to a group of adult patients with acute diarrheic disease. Capsules containing 500 mg of the product were administered to 50 patients every 8 h during 3 days. Results obtained showed that the used guava product decreased the duration of abdominal pain in these patients.

Social network types and functional dependency in older adults in Mexico

BackgroundSocial networks play a key role in caring for older adults. A better understanding of the characteristics of different social networks types (TSNs) in a given community provides useful information for designing policies to care for this age group. Therefore this study has three objectives: 1) To derive the TSNs among older adults affiliated with the Mexican Institute of Social Security; 2) To describe the main characteristics of the older adults in each TSN, including the instrumental and economic support they receive and their satisfaction with the network; 3) To determine the association between functional dependency and the type of social network.MethodsSecondary data analysis of the 2006 Survey of Autonomy and Dependency (N = 3,348). The TSNs were identified using the structural approach and cluster analysis. The association between functional dependency and the TSNs was evaluated with Poisson regression with robust variance analysis in which socio-demographic characteristics, lifestyle and medical history covariates were included.ResultsWe identified five TSNs: diverse with community participation (12.1%), diverse without community participation (44.3%); widowed (32.0%); nonfriends-restricted (7.6%); nonfamily-restricted (4.0%). Older adults belonging to widowed and restricted networks showed a higher proportion of dependency, negative self-rated health and depression. Older adults with functional dependency more likely belonged to a widowed network (adjusted prevalence ratio 1.5; 95%CI: 1.1-2.1).ConclusionThe derived TSNs were similar to those described in developed countries. However, we identified the existence of a diverse network without community participation and a widowed network that have not been previously described. These TSNs and restricted networks represent a potential unmet need of social security affiliates.

Integrative health care model for climacteric stage women: design of the intervention.

BackgroundClimacteric stage women experience significant biological, psychological and social changes. With demographic changes being observed in the growing number of climacteric stage women in Mexico, it is important to improve their knowledge about the climacteric stage and its potential associated problems, encourage their participation in screening programs, and promote the acquisition of healthy lifestyles.At Mexican health care institutions the predominant health care model for climacteric stage women has a biomedical perspective. Medical doctors provide mostly curative services and have limited support from other health professionals. This study aims to design an integrative health care model (IHCM: bio-psycho-social, multidisciplinary and women-centered) applicable in primary care services aimed at climacteric stage women.Methods/DesignWe present the design, inclusion criteria and detailed description of an IHCM. The IHCM consists of collaborative and coordinated provision of services by a health team, which is involves a family doctor, nurse, psychologist, and the woman herself. The health team promotes the empowerment of women through individual and group counseling on the climacteric stage and health related self-care. The intervention lasts three months followed by a three-month follow-up period to evaluate the effectiveness of the model. The effectiveness of the model will be evaluated through the following aspects: health-related quality of life (HR-QoL), empowerment, self-efficacy and knowledge regarding the climacteric stage and health-related self-care activities, use of screening services, and improvement in lifestyles (regular leisure time physical activity and healthy diet).DiscussionParticipation in preventive activities should be encouraged among women in Mexico. Designing and evaluating the effectiveness of an integrative health care model for women at the climacteric stage, based on the empowerment approach and focus on health-related self-care to improve their HR-QoL is pertinent for current health conditions of this age group.Trial registrationThe study is registered at the ClinicalTrials.gov (NCT01272115).

Utilization of healthcare services among children members of Medical Insurance for a New Generation

OBJECTIVE To describe the utilization and associated factors for preventive and curative care utilization among children affiliated to the Medical Insurance for a New Generation (SMNG). MATERIALS AND METHODS Data from the 2009 National Survey of SMNG was analyzed. RESULTS The analysis represented 1,316,867 children; 25% of urban and 37.5% of rural mothers that took their children to well-child visits. Covariates associated with preventive care utilization were children <12 months, low-birth weight, history of infectious or other diseases, mother >35 years, mothers literacy level of bachelor degree, housewife, attendance at >7 antenatal care visits, and living in a rural area. Curative care: 12% attended emergency room services, 5.4% were hospitalized and 66% received ambulatory care. Covariates associated with curative care utilization: child history of frequent diseases, mother living with husband/partner, mothers literacy level of bachelor degree, attendance >7 antenatal care visits and having paid work. CONCLUSION It is needed to reinforce the programs encouraging mothers to seek preventive care regularly.

Atención integral de pacientes diabéticos e hipertensos con participación de enfermeras en medicina familiar

OBJETIVOS: Evaluar la efectividad de la participacion de enfermeras de atencion primaria en la atencion integral a pacientes con hipertension arterial (HTA) y diabetes mellitus tipo 2 (DM2). METODOS: Se realizo un estudio cuasi-experimental antes-despues, sin grupo control, en ocho clinicas de medicina familiar. Enfermeras capacitadas otorgaron atencion integral en coordinacion con un equipo formado por medico familiar, nutricionista, trabajadora social y estomatologo. La intervencion duro siete meses y utilizo como variables de resultado cambios en el indice de masa corporal, glucemia en ayunas, presion arterial, autopercepcion del estado de salud, adherencia terapeutica y solicitud de servicios de urgencias. El cambio se determino comparando la medicion basal y final mediante entrevistas y registro de las variables de interes. RESULTADOS: 1 131 pacientes completaron el seguimiento, de los cuales 44,9% fue diagnosticado con HTA, 27% con DM2 y 28,1% con ambos padecimientos. La proporcion de pacientes atendidos coordinadamente por el equipo de salud aumento; se observo incremento de casos con peso normal y sobrepeso, reduccion en la proporcion de obesos (P < 0,05) y aumento de hipertensos con presion arterial < 130/80mmHg (P < 0,05). No se modifico la proporcion de diabeticos con glucemia < 140 mg/dl; 18,2% notifico mejoria en la autopercepcion del estado de salud (P < 0,05); hubo mejoria en la adherencia terapeutica (P < 0,05) y reduccion de solicitud de atencion a urgencias en las clinicas (-4,5%) y en los hospitales (-6,8%) (P < 0,05). CONCLUSIONES: La atencion integral a pacientes con enfermedades cronicas mediante la participacion de enfermeras contribuye a mejorar los resultados de salud en servicios de atencion primaria.

Development and Use of Quality of Care Indicators for Obstetric Care in Women with Preeclampsia, Severe Preeclampsia, and Severe Morbidity

Objective: To develop indicators for evaluating the quality of care in managing preeclampsia. Methods: An expert group helped to develop and validate the following indicators for evaluating quality of care: availability of intensive care; completeness of laboratory tests; appropriateness of drug treatment at admission and before delivery (antihypertensive drugs, anticonvulsants, and dexamethasone); gestational age at which pregnancy should be interrupted; and type of delivery. By using these indicators, it was possible to evaluate the quality of care in 432 patients with preeclampsia. Results: A significant percentage of patients with preeclampsia and “near misses” received low quality of care, regardless of disease severity. Conclusion: A number of interventions are needed to increase the quality of care to help avert maternal deaths in patients with preeclampsia.

Quality of care for children with upper respiratory infections at Mexican family medicine clinics

BACKGROUND Upper respiratory infections are the principal cause of morbidity in children <5 years of age. The objectives of this study were (i) to develop quality-of-care indicators for evaluation of care for children with upper respiratory infections (URI) at the primary care level using data from the electronic health records and (ii) to evaluate the quality of URI care offered to children <5 years of age at family medicine clinics (FMCs). METHODS Development of indicators following the RAND-UCLA method was used. A cross-sectional analysis of quality of care provided for children with URI in four FMCs in Mexico City where 10,677 children <5 years of age with URI participated. The source of information was data from 2009 electronic health records. Quality of care was evaluated using six indicators developed in the first stage of this study. RESULTS The quality of care evaluation identified that only 15% of children had registries of intentional search of respiratory distress signs and 27% received information on warning signs. More than 61% of children diagnosed with uncomplicated and nonstreptococcal URI received antibiotic prescription during the first visit. In the case of children diagnosed with streptococcal pharyngitis or tonsillitis, 57.5% received the appropriate antibiotic. On average, the percentage of recommended care received was 47.2%. CONCLUSIONS It is reasonable to promote the use of electronic health records to routinely evaluate the quality of URI care. It is necessary to consider quality flaws that were found in order to endorse strategies aimed at strengthening the technical capacity of health personnel to exercise evidence-based clinical practice.

Conocimiento básico de los riesgos del uso de analgésicos no opioides en pacientes ambulatorios

Objective. To describe patients’ knowledge of non-opioid analgesics (NOA) and to identify factors associated with patients’ lack of basic knowledge (LBN) on this type of medi

Estudio de las necesidades de salud en atención primaria mediante el diagnóstico de salud de la familia

Objetivo Analizar las necesidades de salud en la poblacion adscrita al Instituto Mexicano del Seguro Social (IMSS). Diseno Estudio observacional, descriptivo y transversal. Emplazamiento La Unidad de Medicina Familiar numero 8 del IMSS en la ciudad de Tlaxcala, Mexico. Participantes Muestra de 1.200 familias por muestreo polietapico. El estudio se realizo entre octubre de 1999 y marzo de 2000. Mediciones principales Se ha aplicado el cuestionario «Diagnostico de salud de la familia», previamente elaborado y validado. Resultados El 19,2% de las familias tenia un nivel socioeconomico muy bajo y un 14,9% de los sujetos no tuvo derecho a la Seguridad Social. El 12,6% de las familias tenia al menos un miembro analfabeto. De acuerdo con el resultado del test de Apgar familiar, el 93% de las familias era functional y los dos tercios de las familias se clasificaron como nucleares. La cobertura de los programas de deteccion de cancer cervicouterino y de mama en las mujeres fue del 51,1 y el 36,9%, respectivamente. Solo en el 25% de la poblacion adulta se realizaron pruebas de deteccion de diabetes mellitus e hipertension arterial. El 10,9% de la poblacion refirio tener alguna enfermedad cronica. El 56,4% de las familias considero que la calidad de la atencion fue buena y solo el 18,13% estuvo satisfecho con la atencion recibida. Conclusiones El diagnostico de salud familiar es importante en el proceso de evaluacion de las necesidades de salud en la poblacion para la jerarquizacion de problemas, asi como para el desarrollo de los programas de salud que permitiran una mayor equidad en la atencion.

Magnitud de las brechas en el diagnóstico y consejería nutricional para niños de uno a 5 años de edad en medicina familiar en México: análisis de los datos del expediente electrónico

Durante las últimas décadas los países desarrollados tienen un incremento de obesidad en los niños preescolares1; en tanto los países en desarrollo están en etapa de transición nutricional caracterizada por la disminución de la desnutrición e incremento del sobrepeso y obesidad2. Durante la niñez, la desnutrición y el sobrepeso/obesidad tienen repercusiones inmediatas y mediatas, por lo que es prioritaria la identificación oportuna y el manejo apropiado de estos trastornos nutricionales. El buen estado nutricional contribuye a una niñez saludable e incrementa la expectativa de un mejor estado de salud en edades posteriores3. El problema de los trastornos nutricionales se ha reconocido mundialmente; no obstante, son escasos los estudios orientados a evaluar el desempeño de los servicios de salud en lo referente a su detección, prevención y manejo. Este trabajo analizó la frecuencia del diagnóstico y consejería para los trastornos nutricionales de niños de uno a 5 años atendidos en clínicas de medicina familiar en México.