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Aim: To determine the association between family functionality and mild cognitive impairment in the family with the elderly., Methodology: Analytical cross-sectional design in families with geriatric patients. A family with a geriatric patient was considered when at least one of its members was over 60years of age. The comparison groups were the family with a geriatric patient without cognitive impairment and the family with a geriatric patient with mild cognitive impairment determined with the MoCA instrument. Family functionality was evaluated with the family APGAR instrument, which identifies three categories: family functionality, moderate family dysfunction, and severe family dysfunction. Statistical analysis included Chi square and Mann-Whitney test., Results: In the family with a geriatric patient, in the group without cognitive impairment the prevalence of family functionality is 89.7% and in the group with mild cognitive impairment the prevalence of family functionality is 59.3% (MW=4.87, P<.000)., Conclusion: There is an association between family functionality and mild cognitive impairment., (Copyright © 2023 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The medical care paradigm is face-to-face; however, technological development has led to the digital modality., Objective: To determine cost-effectiveness of digital care and face-to-face care at the first level of care., Material and Methods: Cost-effectiveness study. 2 groups were integrated: the digital service and the face-to-face service. The sample size was calculated with the percentage formula for 2 groups, and the result was 217 per group. The effectiveness was evaluated in 3 dimensions: the satisfaction of the patient, of the doctor and of the medical assistant. In all 3 cases the Visual analogue scale was used. The cost corresponded to the fixed unit cost estimated with the technique of times and movements adjusted for the duration of care. The statistical analysis included averages, percentages and cost-effectiveness ratio., Results: The cost of digital attention is $343.83 and face-to-face attention is $171.91 (all estimated in Mexican pesos). From the patient's perspective, the effectiveness in digital care is $9.47 and in face-to-face is $9.25. The cost to reach effectiveness of 10 in face-to-face care is $185.85 and in digital care $363.20. From the physician's perspective, the cost to achieve effectiveness of 10 is $419.13 in digital care and $184.52 in face-to-face care. From the perspective of the medical assistant, to achieve effectiveness of 10, the cost in digital care is $468.43 and in face-to-face $179.83., Conclusions: Currently, the best cost-effectiveness ratio corresponds to face-to-face care; however, digital care is an option that will have to evolve., (Licencia CC 4.0 (BY-NC-ND) © 2024 Revista Médica del Instituto Mexicano del Seguro Social.)

Background: Type 2 diabetes has economic implications involving family income and out-of-pocket spending., Objective: Determine family out-of-pocket expenditure for type 2 diabetes mellitus care and percentage of family income., Material and Methods: Study of family out-of-pocket spending in families with patients with type 2 diabetes treated at primary care level. Out-of-pocket expenses included expenses for transportation, food-drinks, and external medications. Family income corresponded to the total economic income contributed by family members. The percentage of out-of-pocket spending in relation to family income was identified with the relationship between these two variables. Statistical analysis included averages and percentages., Results: The annual family out-of-pocket expenditure on transportation was $2,621.24, the family out-of-pocket expenditure on food and beverages was $1,075.67, and the family out-of-pocket expenditure on external medications was $722.08. The total annual family out-of-pocket expense was $4,418.89 and corresponds to 4.73% of family income., Conclusion: The family out-of-pocket expense in the family with a patient with diabetes mellitus 2 was $4,418.89 and represents 4.73% of the family income., (Copyright: © 2024 Permanyer.)

Background: Rheumatoid arthritis affects approximately between 0.3 and 1.2% of the world population. In Latin America, different studies have estimated a prevalence between 0.2 and 0.5% in the population over 16 years of age., Objective: To identify the epidemiological profile of rheumatoid arthritis., Material and Methods: Descriptive cross-sectional design carried out in an urban population of a social security institution in Mexico. The information of the clinical file of 373 patients was studied. The epidemiological profile included the sociodemographic dimension, family history, health, clinical, therapeutic, biochemical, extra-articular manifestations and complications. Statistical analysis percentages, means, confidence intervals for percentages and confidence intervals for averages were calculated., Results: The wrists were the most affected joints with 44.6% (95% CI: 39.5-49.6%). The extra-articular manifestation with the highest prevalence was asthenia with 9.9% (95% CI: 6.9-12.9%); predominant diagnosis according to ICD-10 was seropositive rheumatoid arthritis with 59.8% (95% CI: 54.8-64.8%), and the rheumatoid factor was highly positive in 78.3% (95% CI: 74.1-82.5%); predominant treatment was with combined therapy at diagnosis in 97.6% (95% CI: 96.0-99.1%). The duration of treatment was > 10 years in 34.1% (95% CI: 29.2-38.8%)., Conclusion: This work has described the epidemiological profile of the patient with rheumatoid arthritis in different dimensions., (Licencia CC 4.0 (BY-NC-ND) © 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

Background: The COVID-19 pandemic has had repercussions in the social, economic, psychological and health spheres, for which risk and exposure groups have been identified. Health workers are distinguished from the rest of the population by constant contact with patients carrying the SARS-CoV-2 virus., Objetive: To determine the difference in the incidence of COVID-19 in health workers who remain in work activity and those who shelter at home., Material and Methods: Cohort study in health workers from March 2020 to January 2021. Two groups were integrated, the exposed group made up of workers who remained working in the health unit (n = 4650) and the non-exposed group, those who carried out home protection (n = 337). When the groups were integrated, none had a diagnosis of COVID-19, they were followed up for 11 months and when COVID-19 was diagnosed, it was done with a PCR test. Statistical analysis included incidence rate, confidence intervals, Chi square, relative risk, and confidence interval for relative risk., Results: The incidence of COVID-19 in workers in home shelter was 39.8% (95% CI: 34.6-45.0) and in workers who remained in the medical unit 16.0% (95% CI: 14.9-17.1). The relative risk was 0.40 (95% CI: 0.34-0.47) for workers who remained working in the health unit., Conclusion: The incidence of COVID-19 was higher in health workers with home protection than in those who continued with normal activities in the medical unit., (© 2022 Revista Medica del Instituto Mexicano del Seguro Social.)

Objective: Compare disease beliefs and medication beliefs with adherence to treatment in patients with hypertension without diabetes mellitus., Method: Comparative transverse design in hypertensive population, a group of 137 adherent patients and a group of 129 non-adherent patients. The beliefs of the disease and beliefs about the medication were evaluated. The statistical analysis included chi squared, odds ratio and confidence interval for odds ratio., Results: In the group of adherent patients, 71.5% have an adequate belief of the disease and in the group of non-adherent patients, 43.4% also have an adequate belief of the disease (p = 0.000). When the belief of the disease and beliefs about the medication are grouped, there is an association with adherence to treatment in hypertensive patients., Conclusions: There is an association between beliefs about the disease and medication with adherence to antihypertensive treatment.

Objective: To determine the relative risk of a lethal outcome associated with chronic degenerative conditions in patients with COVID-19., Methods: A cohort study was conducted using electronic medical records belonging to patients who tested positive for COVID-19 on RT-PCR while receiving care as outpatients or inpatients in a social security system facility between March 2020 and March 2021. Two study groups were formed. The exposed group was divided into four subgroups, each of which was diagnosed with one and only one chronic condition (diabetes, hypertension, obesity, or chronic kidney disease); the unexposed group was obtained from the medical records of patients without comorbidities. A total of 1 114 medical records were examined using simple random sampling. Once the minimum sample size was reached, the relative risk was calculated for each chronic condition. Combinations of two, three, and four conditions were created, and each of them was included in the analysis., Results: In the absence of a chronic degenerative condition, the prevalence of a lethal outcome from COVID-19 is 3.8%; in the presence of type 2 diabetes mellitus, 15.8%; in the presence of arterial hypertension, 15.6%; and in the presence of obesity, 15.0%. For diabetes and hypertension combined, the prevalence of a lethal outcome is 54.1%; for diabetes and obesity combined, 36.8%, and for obesity and hypertension combined, 28.1%., Conclusion: In patients with COVID-19, the relative risk of a lethal outcome is 4.17 for those with diabetes, 4.13 for those with hypertension, and 3.96 for those with obesity. For two chronic conditions combined, the relative risk doubles or triples. The relative risk of a lethal outcome is 14.27 for diabetes plus hypertension; 9.73 for diabetes plus obesity, and 7.43 for obesity plus hypertension. Chronic conditions do not present alone; they generally occur together, hence the significance of the relative risks for lethal outcomes presented in this paper.

The aim of this study was to determine the epidemiological profile of the family with systemic arterial hypertension. A descriptive cross-sectional study was carried out in 268 families with this disease, the epidemiological profile included seven dimensions, sociodemographic, economic, family functionality, life cycle, family roles, health and use of services. The mean age of the families was 49.09 (SD: 15.57) years; 47.0% of the families had paid economic activity, 65.0% were functional, 52.4% were in the retirement and death stages, 43.1% presented obesity, in 50.0% the predominant role of the hypertensive patient was assumed by the mother, and the average annual number of family medicine consultations was 10.37 (SD: 4.31). The family with arterial hypertension is functional, although most of them are in the stage of retirement and death.

Background: Iron deficiency prevalence in infants is high. Therefore, iron supplementation has been recommended and specified as a program. This study aimed to determine the characteristics of the prescription of ferrous sulfate as a preventive therapy for iron deficiency anemia in young infants., Methods: We conducted a descriptive cross-sectional study of clinical records of young infants with eight visits per year. We analyzed a total of 287 records. The prescription characteristics included five criteria prescription indication, age at prescription, dosage, periodicity, and time. These characteristics were scored as follows 1 point when it was considered adequate and 0 when it was considered inadequate; the minimum possible score was 0, and the maximum possible score was 5 points. Statistical analysis included percentages and 95% confidence intervals (CI)., Results: The prescription pattern of ferrous sulfate as preventive therapy in infants under one year of age was indicated in 100% of the records reviewed. All five criteria were met in 18.1% of the reviewed records (95%CI 13.6-22.6). The lowest compliance corresponded to adequate dosage (29.2%; 95%CI 23.9-34.5). Age at prescription was correct in 75.9% (95%CI 70.9-80.9); duration of prescription was correct in 44.2% (95%CI 38.4-50.0), and periodicity was proper in 31.1% (95%CI 25.9-36.7) of the files reviewed., Conclusions: Compliance with the prescription of ferrous sulfate as a preventive measure for anemia in infants was not as expected; interventions are needed to reverse this behavior., (Copyright: © 2022 Permanyer.)

Background: Growth and development reflect the child's health condition. Currently, child care is supported in daycare centers. In this context, this article aimed to identify the differences in growth and psychomotor development in children according to their attendance at daycare centers., Methods: We conducted an analytical cross-sectional study in children aged 25 to 48 months. Two groups were identified: 68 children attended daycare, and 68 children did not attend daycare. Growth was assessed with weight-for-height curves, and psychomotor development was evaluated with the child developmental assessment instrument (psychosocial, language, psychomotor, and cognitive area). The X 2 test was used for statistical analysis., Results: The percentage of daycare children with ideal weight was higher than those not attending in daycare (p = 0.035). Psychomotor development was significantly higher in daycare children: in the psychosocial (p = 0.000), language (p = 0.000), motor (p = 0.000), and cognitive development (p = 0.000) areas., Conclusions: The psychomotor development of children attending daycare centers is superior to that of children not in daycare centers., (Copyright: © 2021 Permanyer.)

Objective: To determine the disability adjusted life years in arterial hypertension without diabetes mellitus., Method: Disability adjusted life years was determined from chronic disability (chronic kidney disease, heart disease and cerebral vascular event), acute disability (hypertensive crisis and hypertensive emergency) and premature death. Age of diagnosis, age of the complication, prevalence of the complication, duration of the acute event, number of acute events, time lived with hypertension, age of death and life expectancy were identified. In all cases a 3% discount rate was applied, the estimate was made per 100,000., Results: When the total of women was used as a reference, the disability adjusted life years in women is 198,498.28. In men, using the total number of men as a reference, the value is 204,232.13. If the referent is the total population, in women the disability adjusted life years is 102,028.11 and in men 99,256.98., Conclusions: The disability adjusted life years in arterial hypertension without diabetes is different for men and women; the topic has many edges that must be studied.

Background: Chronic kidney disease cost is considered high for health systems due to the amount of supplies required for treatment and increasing prevalence., Objective: Determine institutional cost of hemodialysis in chronic kidney disease., Method: Cost design from the institutional perspective, in patients with chronic kidney disease managed with hemodialysis. The sample size was 269 and the sample technique for consecutive cases. Annual fixed average cost (times and movements technique) and annual variable average cost (microcosting technique) adjusted by use of services, helped to identify annual average cost by function of production and service, the sum of these resulted in annual cost of care. Statistical analysis included averages and projections., Results: The average annual cost of the patient with chronic kidney disease on hemodialysis varies between $223,183 and $257,000; the cost in life is $1,198,968. The institutional total cost it corresponds to between 1.47% and 1.73% of the budget., Conclusions: Hemodialysis cost in chronic kidney disease is high for the institution, however, hemodialysis allows the survival of the patient., (Copyright: © 2020 Revista Medica del Instituto Mexicano del Seguro Social.)

Objective: To determine the cost of medical care in patients with gonarthrosis., Material and Methods: Cost study in patients over 40 years of age with gonarthrosis, diagnosed according to the radiological classification of Kellgren and Lawrence. The average annual cost (euros) was estimated taking the unit cost plus average use of services such as family medicine, imaging, laboratory, electrodiagnosis, orthopedics, hospitalization, physical therapy, surgery, nutrition, preoperative assessment and medication. Projections based on assumptions were made for three scenarios., Results: Grade 2 gonarthrosis predominated at 39.7% (95% confidence interval, 33.8 - 45.6). The annual cost of care for a patient with gonarthrosis was €108.87 in the intermediate scenario, €86.73 in the lower cost scenario and €132.60 in the higher cost scenario. For a population of 119,530,753 inhabitants, with 10,937,064 gonarthrosis patients, the annual cost in the intermediate scenario was €1,190,685,273 and represented 4.48% of the health expenditure., Conclusion: The average annual cost of gonarthrosis is relatively low, but when related to prevalence and prevalence trends, it can become a serious problem for health services., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.)

Background: The incidence of acute kidney injury in hospitalized elderly is a frequent event that makes them prone to complications and can even lead to death. Therefore, identifying risk factors for developing acute kidney injury becomes a priority in the process of care of the elderly., Objective: To identify the main risk factors for acute kidney injury in hospitalized elderly and, on the basis of those risk factors, calculate the probability of presentation., Methods: Case-control study nested in a cohort, which included patients of 60 years or older, admitted to the Internal Medicine service at an institution of social security in Querétaro, Mexico. Patients with acute kidney injury were identified as cases and patients without acute kidney injury were included in the control group. Acute kidney injury was diagnosed when there was an increased creatinine level ≥ 0.3 mg/dL (≥ 26.4 mmol/L) in a period < 48 hours., Results: Hypovolemia and infection were identified as risk factors for acute kidney injury and they were included into the model of multiple logistic regression (y = 1,111 + 1,063 [infection] + 1.422 [hypovolemia]), (p = 0.002). The highest probability of having acute kidney injury was 80%., Conclusions: Two factors for acute kidney injury and a prediction model were identified.

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.

Objective: To determine the health status of patients 60 years of age or over in Primary Health Care practices using an integral geriatric assessment., Design: Descriptive cross-sectional study., Location: Five primary care units, Instituto Mexicano del Seguro Social; México., Participants: Elderly patient aged 60 years of age or over, who were seen in primary health care practices. Previously signed informed consent was given, with exclusion criteria being non-completion of the integral geriatric assessment. A technical sample of conglomerates and quota was used., Main Measurements: Medical dimension variables: visual, hearing (Hearing Handicap Inventory for the Elderly), urinary incontinence (Consultation in Incontinence Questionnaire), nutritional condition (Mini Nutritional Assessment), personal clinical history, polypharmacy; mental impairment (Mini Mental State Examination), depression (Yesavaje); functional: basic (Katz) and instrumental (Lawton and Brody) activities of daily living, mobility (Up and go) and social (Social sources scale). The analysis included percentages and confidence intervals., Results: In the medical dimensions; 42.3% with visual impairment, 27.7% hearing, 68.3% urinary incontinence, 37.0% malnutrition, and 54.7% polypharmacy. In the mental dimension: 4.0% severe mental impairment, and 11% depression: functional dimension: 2.0% total dependence of activities of daily living; 14.3% instrumental activities impairment; 29.0% mobility impairment, and 48.0% had moderately deteriorated social resources., Conclusion: The health status of the elderly seen in primary health care practices is characterized by independent patients with different levels of alterations in the medical dimensions, low levels in mental alteration, and moderately deteriorated social resources., (Copyright © 2013 Elsevier España, S.L.U. All rights reserved.)

Objective: to determine the cost of institutional and familial care for patients with chronic kidney disease replacement therapy with continuous ambulatory peritoneal dialysis., Methods: a study of the cost of care for patients with chronic kidney disease treated with continuous ambulatory peritoneal dialysis was undertaken. The sample size (151) was calculated with the formula of the averages for an infinite population. The institutional cost included the cost of outpatient consultation, emergencies, hospitalization, ambulance, pharmacy, medication, laboratory, x-rays and application of erythropoietin. The family cost included transportation cost for services, cost of food during care, as well as the cost of medication and treatment materials acquired by the family for home care. The analysis included averages, percentages and confidence intervals., Results: the average annual institutional cost is US$ 11,004.3. The average annual family cost is US$ 2,831.04. The average annual cost of patient care in continuous ambulatory peritoneal dialysis including institutional and family cost is US$ 13,835.35., Conclusion: the cost of chronic kidney disease requires a large amount of economic resources, and is becoming a serious problem for health services and families. It's also true that the form of patient management in continuous ambulatory peritoneal dialysis is the most efficient in the use of institutional resources and family.

Objective: To build a model that explains the natural history of breast cancer diagnostic procedures., Methods: Descriptive cross-sectional study of 245 women between 40 and 69 years of age, selected by simple random sampling, who underwent a mammography and met the requirements of the breast cancer diagnostic procedure. Diagnosis was made by biopsy. For the diagnostic procedure, an estimate was made of the percentage of patients seen by each service, the total number of patients per service, and the total number of consultations in each service, with 95% confidence intervals., Results: Of the patients who initiated the breast cancer diagnostic procedure in preventive medicine services, 20% underwent a mammography; 23.7% were seen in family medicine services and of these patients, 70.9% were referred to a breast clinic, where 7.3% underwent a harpoon biopsy. The prevalence of breast cancer confirmed by biopsy was 0.48% (95%CI: 0.0-1.3). Per 1 000 patients who initiated the procedure, 47.4 were seen in family medicine services and 33.6 in a breast clinic, and open biopsies were performed on 2.4. Per 1 000 patients who initiated the procedure, there were 211.4 consultations in radiology services, 51.6 in family medicine services, and 54.6 in a breast clinic., Conclusions: The model described here may be useful in planning and evaluation activities.

Objective: to determine the prevalence of the physical exploration and morbidity on pelvic members in the type 2 diabetic patient., Methodology: cross-sectional study; 189 files of diabetic family medicine patients were analyzed. The sample was considered with the formula of proportions for a finite population. Sampling units were chosen by convenience and they were taken up again from each one of the family medicine physician's offices. Sociodemographic variables, pathologies, time of evolution of diabetes, glycemic control and consultations along a year were studied. Physical explorations were made and signs explored by the physicians. Descriptive statistic for the analysis of data was used., Results: average age 58.89 years (CI 95 %, 57.1-60.7); women predominated with 61.9 % (CI 95 %, 55.0-68.8), mean time of evolution 10.60 years ± 7.29. In 74.1 % some sign in pelvic members was explored, and in 14.3 % some added problem was detected. Of these, 9 % suffered from onychomycosis., Conclusion: physical exploration of pelvic members it is not to be performed in all type 2 diabetic patients.

Objective: to quantify the economic cost of polypharmacy in the elderly., Methods: cost study design, made in two first-level medical units. The study was conducted in 131 older adult patients with polypharmacy, chronic degenerative disease and at least one medical visit per year. The sample was calculated using the formula of finite population averages. The cost of polypharmacy was assessed in medical consultation, medicine and pharmacy services. The evaluation of the medical cost included the number of visits per year for the same unit cost, the cost of medicine considered the amount of drug per year for the same unit cost, and the cost of the service pharmacy took into account the number of times the pharmacy occupies the unit cost of the same. The statistical analysis included means, percentages and confidence intervals., Results: in family practice the average annual cost is $1,263.26. In pharmacy the average annual cost is $229.91. The average time drug use is 4.37 months per year (95 % CI = 0.9-7.9), the annual average cost drugs is $708.00. Considering the three dimensions the annual cost of polypharmacy in the elderly is $2,201.17., Conclusions: the cost of polypharmacy is high and represents a significant economic impact.

Introduction: Osteoarthritis is a chronic joint disease; isometric exercise leads to the development of mechanical work and isokinetic exercise leads to better joint mobility., Objectives: To compare the effectiveness of isometric versus isokinetic therapeutic exercises in patients with knee osteoarthritis., Material and Methods: Quasiexperimental study in a population of 45 to 75 year old patients with a diagnosis of knee osteoarthritis. Group 1 (experimental) was put under isokinetic exercises and group 2 (control) under isometric exercises. The sample size was of 33 patients per group; the allocation to the experimentation or control group was nonrandom, but stratified by degrees of knee osteoarthritis. The effectiveness of the exercise was measured in three dimensions: muscle strength, joint range and pain. The intervention lasted eight weeks and the physical activity was carried out every third day. The statistical analysis included averages, standard deviation, percentage, Chi square test, z test for two populations, t test for two independent populations and twin t test., Results: The analysis of muscle strength comparing the categories independently demonstrates differences at 8 weeks; 33.3% of the isokinetic exercise is in the normal category and 15.2% in the isometric exercise (p= 0.04). There was not difference of joint range between groups, despite finding a stage I range in 100.0% of the isokinetic group and 97.0% in the isometric (p> 0.05) group. Pain was milder in the isokinetic exercise group at 8 weeks (p= 0.01), Conclusions: Isokinetic exercises have a greater effectiveness than isometric exercises for muscle strength and pain in patients with knee osteoarthritis. However, other studies with randomized designs are needed., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

The objective of this study is to identify the annual cost per capita by gender in first level of attention. It is a cost study in Family Physician Units in Mexico. The information corresponded to the year of 2004 and the study divided in the use profile and cost attention. USE PROFILE OF SERVICES: it was studied 1,585 clinical registries of patients, use profile defined by average and attention reasons by department, gender and age group. COST ATTENTION: considered in American dollars it included fixed unit cost (departmentalization adjusted by productivity), variable unit cost (micro cost technical), department unite cost by type attention, and department unit cost by age and gender. The life expectancy was of 73 years for men and 78 for women. Three scenes were identified. The annual cost per capita is superior among woman [US$73.24 (IC 95% $11.38 - $197.49)] than in man [$ 53.11 (IC 95% 2.51 - 207.71)]. The conclusion found that in the first level of attention the cost per capita is greater in woman than in man.

Objective: To identify the risk factors and to estimate the probability to develop dental decay., Methods: A study of cases and controls in 4-year-old children, with a sample of 102 patients selected by quota was done. The oral hygiene habit, consumption of cariogenic food, annual oral evaluation and topical application of fluorine were studied as risk factors. The statically analysis included bivariated and multiple regression logistic, and estimation of the probability to develop decay., Results: The oral hygiene habit was identified like the main risk factor with the greatest influence (OR=15.27) in the multiple model integrated with the variable mentioned, consumption of cariogenic food and oral annually evaluation. It turned out to be significant (p=0.00). The highest probability to present decay was of 76% and the lowest of 5%., Conclusions: Hygienic habit was the most important risk factor to develop dental decay.

Objective: To determine the opportunity cost for men who seek care in the family medicine units (FMU) of the Mexican Social Security Institute (IMSS, Instituto Mexicano del Seguro Social) in the city of Querétaro., Methods: A sample was selected of 807 men, ages 20 to 59 years, who sought care through the family medicine, laboratory, and pharmacy services provided by the FMU at the IMSS in Querétaro. Patients referred for emergency services and those who left the facilities without receiving care were excluded. The sample (n = 807) was calculated using the averages for an infinite population formula, with a confidence interval of 95% (CI95%) and an average opportunity cost of US$5.5 for family medicine, US$3.1 for laboratory services, and US$2.3 for pharmacy services. Estimates included the amount of time spent on travel, waiting, and receiving care; the number of people accompanying the patient, and the cost per minute of paid and unpaid job activities. The opportunity cost was calculated using the estimated cost per minute for travel, waiting, and receiving care for patients and their companions., Results: The opportunity cost for the patient travel was estimated at US$0.97 (CI95%: 0.81-1.15), while wait time was US$5.03 (CI95%: 4.08-6.09) for family medicine, US$0.06 (CI95%: 0.05-0.08) for pharmacy services, and US$1.89 (CI95%: 1.56-2.25) for laboratory services. The average opportunity cost for an unaccompanied patient visit varied between US$1.10 for pharmacy services alone and US$8.64 for family medicine, pharmacy, and laboratory services. The weighted opportunity cost for family medicine was US$6.24., Conclusions: Given that the opportunity cost for men who seek services in FMU corresponds to more than half of a minimum salary, it should be examined from an institutional perspective whether this is the best alternative for care.

Objective: To determine SOHDi program cost-effectiveness (S = overweight, O = obesity, H = hypertension, Di = diabetes) in type 2 diabetes patients (DM2) without hypertension., Methods: Sample included 32 patients. The effectiveness was measured by the blood glucose values. The SOHDi intervention cost included physician medical attention cost (PMAC), laboratory cost (LC), education group cost and individual evaluation cost. The cost of the traditional alternative medical attention (TAMA) contemplated PMAC and LC. The analysis cost-effectiveness included different intervals measurements, equal or smaller than 140 mg/dL blood glucose levels., Results: The percentage of population with equal or smaller than 140 mg/dL blood glucose (effectiveness) in SOHDi was 23.3%, in TAMA was 44.8%. The average cost in SOHDi was $2202.22; in TAMA $1930.79. In the cases with blood glucose equal or smaller to 140 mg/dL the cost of effectiveness of 50% was $4726 in SOHDi and $2155 in TAMA. In this same situation the effectiveness by $1000 was 10.58% in SOHDi and 23.20% in TAMA., Conclusions: The SOHDi group is not the best alternative, at least not in the present operational conditions.

Objective: To identify to the life style as a risk factor after the strategy of facing the disease in type 2 diabetic patients., Methods: A study of cases and controls was made in patients with type 2 diabetes of five primary care units in the metropolitan area of Queretaro city. The sample size was of 48 patients by group. They were chosen by quota in the waiting room. Sociodemographic variables and health aspects were included in the questionnaire. The life style was investigated by the Instrument to Measure the Style of Life in Diabetics (IMEVID). For the evaluation of type of facing the scale of Strategy of Facing was used as opposed to extreme risks. Measures of central tendency, χ² and odds ratio were included., Results: The type of active facing was a risk factor for the style of life with a p = 0.0001., Conclusions: The strategy of active facing disease is a risk factor for the style of life in the type 2 diabetic patient.

Objective: To determine the cost-effectiveness of the previous appointment., Design: Cost-effectiveness study., Setting: Family Medicine Unit in the Mexican Public Health System, in March and April 2008., Participants: All Family Medicine outpatient clinic offices who use the appointment system were included (n=32)., Measurements: The productivity, doctor and user dimensions were analysed in the two shifts (morning and evening) operated by the Unit. Productivity included the percentage of appointments (appointment requested more than 12h before the visit), spontaneous users, those seen and cancellations; the cost was adjusted for productivity. Effectiveness was measured using doctor and patient satisfaction, on a scale from 1 to 10. The cost-effectiveness analysis took into account the perspective of the patient and the doctor in the different scenarios that considered the percentage of previous appointments. The evaluation included an incremental analysis., Results: For the doctor, the best cost-effectiveness is in the scenario of 60% previous appointments, and the worst with 50% previous appointments. The cost differences in the incremental analysis by scenarios is 15,019 euro and 76,611 euro. From the perspective of the patient (n=96), the best cost-effectiveness is in the 70% previous appointment scenario, while the worst is the one with 50%. The incremental analysis with differences by scenarios is 5,248 euro and 330,293 euro., Conclusions: The best cost-effectiveness of the previous appointment is achieved with appointment percentages between 60 and 70%.

Background: To determine the relationship between functional social support and vital satisfaction of the elder retirement adult., Methods: Comparative cross-sectional study in retired adults aged 60 years and more. Two groups were integrated (high and low satisfaction) evaluated with Moral Scale of Satisfaction of the Geriatric Center of Philadelphia modified and validated by Montorio. The sample size was calculated with comparative cross-sectional studies formula, presence of the social support of 80 % in the group of high satisfaction and 50 % in the one of low satisfaction (n = 29). The selection was made at random using the payroll listing of retirees. Social demographic variables were studied. Relationship between the retirement and functional social support was evaluated with the scale of Functional Social Support of Duker-UNC-11., Results: Sociodemographic characteristics and those related to the retirement did not present significant statistical differences (p > 0.05) in the groups of high and low satisfaction. There was an association between the functional social support and the vital satisfaction with odds ratio of 3.00 (95%CI = 1.08-8.32)., Conclusions: Functional social support and vital satisfaction in the elderly were associated.

Objective: to predict the probability of blood glucose control in patients with type-2 diabetes mellitus, exclusively treated with pharmacology therapy., Material and Methods: secondary analysis of a database to evaluate the therapeutic attachment in type-2 diabetics older than 60 years old. We interviewed 123 patients in their home to get information about sociodemographic aspects and diabetes characteristics. The blood glucose control was measured through glycated hemoglobin and the attachment to the pharmacological treatment was measured by the Morisky-Green test. The analysis included simple logistic regression; the calculation of probability of control for different levels of therapeutic attachment was estimated using the result of the regression equation (y) and applying the formula 1/1 + e(-y)., Results: Monotherapy was present in 82.1%, glibenclamide was prescribed alone in 77.2%, glycated hemoglobin average was 11.5 +/- 3.5 %, 18% of the population was controlled and 58.1% showed some attachment to the pharmacological treatment. With a total attachment to the pharmacological prescription, the control probability is 27%, and without it, it corresponds to 10%., Conclusion: Almost three out of ten patients with a total attachment to the pharmacological treatment have chances of being controlled.