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Abstract Background In Mexico, inappropriate prescription of drugs with potential interactions causing serious risks to patient health has been little studied. Work in this area has focused mainly on hospitalized patients, with only specific drug combinations analyzed; moreover, the studies have not produced conclusive results. In the present study, we determined the frequency of potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age, who used Mexican Institute of Social Security (IMSS) family medicine clinics. In addition, we aimed to identify the associated factors for these interactions. Methods We collected information on general patient characteristics, medical histories, and medication (complete data). The study included 624 ambulatory patients over 50 years of age, with non-malignant pain syndrome, who made ambulatory visits to two IMSS family medicine clinics in Mexico City. The patients received 7-day prescriptions for non-opioid analgesics. The potential interactions were identified by using the Thompson Micromedex program. Data were analyzed using descriptive, bivariate and multiple logistic regression analyses. Results The average number of prescribed drugs was 5.9 ± 2.5. About 80.0% of patients had prescriptions implying one or more potential drug-drug interactions and 3.8% of patients were prescribed drug combinations with interactions that should be avoided. Also, 64.0% of patients had prescriptions implying one or more potential drug disease interactions. The factors significantly associated with having one or more potential interactions included: taking 5 or more medicines (adjusted Odds Ratio (OR): 4.34, 95%CI: 2.76–6.83), patient age 60 years or older (adjusted OR: 1.66, 95% CI: 1.01–2.74) and suffering from cardiovascular diseases (adjusted OR: 7.26, 95% CI: 4.61–11.44). Conclusion The high frequency of prescription of drugs with potential drug interactions showed in this study suggests that it is common practice in primary care level. To lower the frequency of potential interactions it could be necessary to make a careful selection of therapeutic alternatives, and in cases without other options, patients should be continuously monitored to identify adverse events.

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims As a result of the accelerated growth of the elderly population, reconfiguration of families and member roles, and the increase of mental disorders, it is necessary to investigate the effects of this set of factors on the caregivers of patients with dementia in Mexico. Mental disorders of individuals have a negative impact on their physical and emotional quality of life, leading to greater dependence and making the caring experience a heavy burden. Several studies (none in Mexico) have used either the characteristics of the patient or caregiver to determine the burden, but few studies have included both profiles within a single study. The objective of the present study was to analyze the characteristics of the patients and caregivers associated with caregiver burden. Methods A multicenter study was carried out in six health institutions located in Mexico City, including 175 patients (and their caregivers) diagnosed with different types of dementia. We used the Spanish Caregiver Burden Screen. Descriptive analysis and logistic regressions were used to estimate the effect of the covariates on the caregiver burden. Results The results showed that patient variables have a greater impact on caregiver burden than caregiver-associated variables. Dysexecutive syndrome, sleep disorders, schooling and caregiver depression are associated with a higher level of caregiver burden. Conclusions Caregiver burden is a complex phenomenon. The results of the present study showed the need to implement multifactorial interventions targeting the caregiver to reduce the burden, strengthen the skills for patient management to avoid depression, improve patient health, and diminish functional dependence and future hospitalization. Geriatr Gerontol Int 2014; 14: 146-152. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to describe a strategy of social support in the recovery of functional capacity on basic activities of daily living (ADL), quality of life and ways to face stress in patients after a stroke. Methods: patients (56) with stroke, were integrated in support groups during the three months of rehabilitation. Outcomes were assessed through the Barthel Index, SF-36 questionnaire, and the Lazarus-Folkman. Results: there was an improvement in functional capacity, with an increase in the emotional support (p = 0.0191) and affectivity (p = 0.0085). There was no change in caregiver. In quality of life 13.3 % of patients met the floor values in the dimension of physical function, 40 % in physical role and emotional role 36.7%. The most frequently used facing strategy in patients and caregivers were magical thinking that led a positive facing in the area of passive facing or directed to emotion; while in active facing or directed to the problem more flexibility in the addressed problem was used. Conclusions: the social support strategies in the rehabilitation of patients with stroke reflected an improvement on functional recovery, and quality of life. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The care of elderly patients requires an evaluation that deserves a host of special considerations, like biological aspects of aging, those related to activities of daily living and functionality, neure-psychological conceptions, family dynamics and economic conditions. The growth of the aging population in our country is accompanied by an increase in chronic diseases and become individuals on greater vulnerability, requiring a more consumption of resources because of the high demand for services and requires the incorporation of specialized care in the institutional system, which has caused serious consequences in the current health system, privileging specialization and technology, with a loss integral and horizontal vision of the patient. Therefore it is necessary to develop a practical tool that allows the family physician and no familyr physician to identify and differentiate the geriatric population that requires specialized care from who does not, identifying problems that may improve and allow to design strategies to improve health status and maintain functional autonomy of the elderly. Comprehensive Geriatric Assessment (CGA) is a fundamental tool for clinical practice of any medical care to the elderly. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Saúde Pública is the property of Faculdade de Educacao da Universidade de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Medica del IMSS is the property of Direccion de Prestaciones Medicas - IMSS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The steady increase of cases and toll of deaths due to breast cancer in the last decades has prompted to analyze in depth current screening methods and their contributions to decrease mortality rates. A literature review was performed at the Ovid-Medline, Cochrane, Synergy, Medic latina, Science direct, Ebsco-e-journal services. The review focused on the epidemiology of breast cancer, its risk factors and the benefits and limitations of current screening methods. The literature review had the aim to contribute in updating primary care practitioners concerning effective screening methods to timely detect breast cancer. [ABSTRACT FROM AUTHOR]

The repercussion of health-disease state on social life or individual includes his/her work performance. In many countries, social security is one of the options for diffusing and buffering the impact of the disease. This paper is focused on the analysis of the unjustified prescription of temporary sick leave certificates (CITT), which combines the social security medical components and economic benefits (subsidies). The objective is to analyze the mechanism of prescription of CITT from the perspective of health economics and health care services. The detailed flow of CITT at the Mexican Institute of Social Security is described, as are some concepts of the health economics perspective that contribute to explain the prescription of CITT. Statistical data of sick leaves due to work-related and non-work-related diseases are presented from the institutional perspective. Finally, it is emphasized that although CITT are a medical prescription, it is advisable to take into account the economic perspective and its concepts in order to achieve an efficient use of resources. [ABSTRACT FROM AUTHOR]

To develop and validate a clinical tool to facilitate decision-making based on current best evidence for treating adults and children with vitiligo. Methods: Clinical questions were formulated and structured. We established a standardized sequence to search for practice guidelines for treatment of vitiligo. Three guides were found, two of which were used for this study. For those drugs not included in the guidelines taken as a reference search was conducted in PubMed and Cochrane Library Plus, Hinari and Ovid. The results were expressed as levels of evidence and grade of recommendation according to the characteristics of the study design and type. Conclusions: The recommendations in this guide will help evidence based decision-making standard for the treatment of vitiligo in order to increase the percentage of dermatologists that indicate a treatment based on current best evidence, stimulating scientific research. [ABSTRACT FROM AUTHOR]

Background: Cerebrovascular disease (CD) is considered a problem of huge social, economic and public health implications worldwide in adults and elderly. In Mexico, the information concerning the provision of services to people and their characteristics is limited. The objective is to describe the characteristics of patients with CV who attended the hospitals of the Instituto Mexicano del Seguro Social (IMSS) in Mexico City., Methods: It was carried out a cohort study of patients with ischemic or hemorrhagic CD who arrived to IMSS. Patients were recruited from seven IMSS general hospitals in Mexico City from June, 2013, to October, 2014., Results: We assigned 430 subjects with CD (78.14% had ischemic CD). There were no statistical differences regarding gender. The median age of patients was 74 years. During their first 72 hours of hospital stay, it was assessed language proficiency in 90%, the ability to walk in 16.3% and the ability to move extremities in 94%. The main risk factors were hypertension, 84%; diabetes mellitus, 46.3%; history of CD, 25.1%; smoking history, 13.7%. 80% of patients reported that their health was regular or poor., Conclusions: General characteristics of patients and vascular risk factors are similar to those reported by other studies. Secondary prevention strategies are performed in less time than that recommended by international standards. It is urgent to design strategies to build better ways of care during the acute phase of patients with CD.

The incidence of urethral stenosis in Mexico had not been documented. At the Centro Médico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial. It has a great negative impact for the patients and the recurrence reaches 85 %. The treatment consisted of an invasive approach (urethral dilations, endoscopy procedure) and open surgery (urethroplasty). The World Health Organization and World Alliance take the world challenge about the urinary tract infections associated with the attention of patients, focused on urethral stenosis. The objective of the following clinical guide is to offer to the health professional a clinical tool for making decisions in the handling of the hardship or masculine urethral stenosis, based on the best available evidence, carrying out in systematized form with bibliographical research using validated terms of the MeSH: urethral structures, in the databases Trip database, PubMed, Guideline Clearinghouse, Cochrane Library and Ovid.

Our objective was to develop a guide based on the best available evidence that allow family physicians to establish criteria for screening, diagnosis, prevention, treatment of disease, early detection and management of complications; to standardize the organizing processes of the diabetic patient's care in the primary care level; and to achieve lifestyle modification for patients and promote self-care. Clinical questions were stated according to the diagram and structured patient-intervention-comparison-outcome. We used a mixed methodology-adoption adjustment, and include 32 guides. For recommendations not included in these, the search process was conducted in PubMed and Cochrane Library Plus with these terms: diabetes mellitus type 2, epidemiology, detection and diagnosis, classification, drug therapy, effects, prevention, control and complication. The clinical practice guideline emphasizes the fundamental change in lifestyle (diet and exercise), self-care and proactive participation of the patient, in addition to the dynamic prescription of medications that would achieve metabolic control in order to reduce late complications.

The Instituto Mexicano del Seguro Social--always sensitive to the needs of health of the beneficiary population and to the demographic and epidemiological changes of the society--has developed and implemented DiabetlMSS, a program of attention to the diabetic patient. DiabetlMSS organizes care processes based on the needs and values of the patients, through simultaneous activities of individual consultation and group meetings granted by the multidisciplinary health team. These actions and activities are focused to affect patients' lifestyles positively. Through a plan of nutrition, physical activity, self-care and monitoring, this program increases the interaction between patients, by having an exchange of successful experiences about diabetes control. DiabetlMSS was created with the purpose that the patients achieve the metabolic control and identify complications early on, with the perspective of timely intervention that is reflected in the decrease of the catastrophic effects that causes the disease, both for patient's life expectancy and the quality of care provided by the Institute.

The care of elderly patients requires an evaluation that deserves a host of special considerations, such as biological aspects of aging, those related to activities of daily living and functionality, neuro-psychological conceptions, family dynamics and economic conditions. The growth of the aging population in our country is accompanied by an increase in chronic diseases and more individuals have greater vulnerability, requiring a more consumption of resources because of the high demand for services. This requires the incorporation of specialized care in the institutional system, which has caused serious consequences in the current health system, benefiting specialization and technology, but with a loss of an integrated and horizontal view of the patient. Therefore it is necessary to develop a practical tool that allows the family physician to identify and differentiate the geriatric population that requires specialized care from who does not, identifying problems that may improve and allow the design of strategies to improve health status and maintain functional autonomy of the elderly. Comprehensive Geriatric Assessment (CGA) is a fundamental tool for clinical practice of any medical care to the elderly.

Aim: To adapt the Quality of Life in Alzheimer's Disease (QOL-AD) scale to Spanish, as well as to evaluate its reliability and validity in Mexico., Subjects and Methods: The study involved a sample of 114 patients diagnosed with Alzheimer, vascular and mixed-type dementia, according to the criteria of the National Institute for Neurological and Communicative Disorders/Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA), the National Institute of Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) and the Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC), respectively. Their primary caregivers (n = 114) and a control group (n = 30) of persons aged 60 or over without dementia and their closest relatives were also evaluated., Results: The total group with dementia obtained a mean age and a standard deviation of 80.15 +/- 7.13. The Folstein minimental test was 18.55 +/- 4.99. We obtained a Cronbach's alpha of 0.88 for the patient version of the QOL-AD (QOL-ADp) and 0.82 for the caregiver version of the QOL-AD (QOL-ADc). The test-retest yielded an intraclass correlation coefficient of 0.9 (p < 0.001; 95% confidence interval, CI 95% = 0.58-0.91) for the QOL-ADp and 0.81 (p < 0.001; CI 95% = 0.78-0.95) for the QOL-ADc. Moreover, the QOL-ADp showed a significant correlation with the geriatric depression scale (r = -0.73; p < 0.001) and with the neuropsychiatric inventory (r = -0.44; p < 0.001). With the QOL-ADc, these correlations were r = -0.5 (p < 0.001) and r = -0.3 (p < 0.001), respectively. Both versions of the QOL-AD were able to distinguish between the group of subjects with dementia and the control group., Conclusions: The QOL-AD yielded satisfactory results in terms of internal and external reliability, validity between measurements and between known groups. Thus, we can recommend its use to evaluate the quality of life of patients with dementia.

Background: adolescent population is an important age group, with vulnerability and health needs not well known, especially for those living in urban slums. Our objective was to identify health risks for adolescents living in poor urban areas in five geographical regions of Mexico., Methods: a secondary data analysis from a nationwide adolescents ́ survey was carried out from population living in poor urban areas of the north, center, DF, south and southeast of Mexico. Cigarette smoking, alcohol and drug consumption, as well as frequency of accidents and violence, age at sexual initiation and use of contraception methods were analyzed., Results: the highest frequencies of consumption were: 27.8 % for cigarette smoking and 35.2 % for alcohol, both in adolescents from 16 to 19 years; accidents (5 %) and violence (1.7 %); age (median) at sexual initiation was 16 years, about 50 % of adolescents with regular sexual activity reported use of a contraception method., Conclusions: comparing our data with National Health Surveys; in poor urban areas, most adolescents health risks are higher than those found for same group age in the general population, however, presentation of accidents and violence are similar.

Objective: To understand the health needs of the population living in Mexico's marginalized urban areas., Methods: A population-based survey of families residing in poor, urban neighborhoods, in five geographic areas in Mexico (northern, central, southern, south-east, and Mexico City), selected through multistage sampling. Interviews were conducted and anthropometric measurements were taken in the home, and included all members of the participating family. Analysis was carried out on positive health factors, nutrition, reproductive health, health problems, and mental health, and results were disaggregated by age and sex., Results: In all, 24,707 individuals participated. The interviewees were found to have minimal schooling (6 years or less). Only 46.8% had health care coverage, be it public or private. Among the children, 19.8% were malnourished; overweight was prevalent from adolescence onwards. Of adolescents 12-19 years of age, 15.7% were sexually active, but only 57.7% of the males and 41.9% of the females in this age group were using some method of contraception. Of the adults, 5.9% suffered from diabetes and 11.5%, from high blood pressure. In the sample of adolescents, adults, and elderly adults, tobacco use was 21.2%; alcohol consumption, 36.0%; illicit drug use, 9.5%; and depression, 20.2%., Conclusions: The health needs of people living in Mexico's marginalized urban areas proliferate in the context of a young population with weak ties and little support from family and health services. They face crisis and disease--infant malnutrition, high-risk pregnancy, and addictions--the byproducts of disparities in social progress. The rate of chronic conditions was similar to that of the general population of Mexico.

The purpose of this guide is to provide for general practitioners or physicians of primary care a comprehensive, evidence based tool that permits them to take an adequate decision about the appropriate use of the non-opioid analgesics in the management of pain.

Objective: To describe an epidemiological study of one case of pertusis., Clinical Case: a five-year old boy was diagnosed with pneumonia and he had incomplete DPT vaccination scheme; pertusis was diagnosed by using the PCR technique and culture. An epidemiological study with family contacts was carried out, in which 20 samples for both tests were obtained. These were taken twice., Results: The average age of the family members was 26.5 years, 50 % were women, 62 % did not have social security and 30 % had three doses of DPT. 35 % were positive to PCR and, 20 % out of these had positive cultures., Conclusions: In children smaller than five years suffering from pneumonia, is relevant to ascertain about DPT vaccination status and to consider the possibility of carrying out an epidemiological study with the family.-

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 medication., Material and Methods: A total of 629 ambulatory patients older than 50 years of age, with non-malignant pain syndrome, attended to two family medicine clinics and received seven day prescriptions for NOA. The data on patients general characteristics, the information they received and their actual knowledge of NOA were analyzed using descriptive statistics and bivariate analysis., Results: A total of 64.2% had LBN; 28% did not know how to take NOA properly, and 48% knew that these drugs cause gastrointestinal adverse effects. The factors significantly associated with LBN on NOA included: failure to receive information on NOA (OR:2.22, 95%CI 1.32-3.70), education <7 years (OR:1.87, 95%CI 1.33-2.63) and pain duration <4 years (OR:1.70, 95%CI 1.22-2.37)., Conclusion: Patients lack knowledge and receive little information on NOA. It is important to encourage actions to tackle this problem.

Objective: To assess the quality of medication prescribing in ambulatory elderly patients attending to family medicine clinics due to non-malignant pain syndrome., Patients and Methods: By doing a secondary data analysis we evaluated the quality of medication prescribing in 495 subjects aged 60 or more years, which were seen due to non-malignant pain syndrome in family medicine clinics belonging to Instituto Mexicano del Seguro Social. The analyzed information included general patient characteristics, medical histories, and medication (complete data). The quality of medication prescribing was assessed by using the Beers criteria and the MAI. All data were analyzed by using descriptive statistics., Results: The total number of medicines prescribed was 3017, with an average number of prescribed drugs of 6 (+/- 2.5). About 35% of patients had prescriptions with at least one inappropriate medication according to the Beers criteria. The mean MAI score was 3.5 (+/- 4.3) for drug and 20.9 (+/- 10.7) per patient. According to MAI criteria, the most frequent errors were: failure to provide practical directions, prescription of drug combinations with potential drug-drug interactions, and inappropriate indications., Conclusion: Inappropriate prescription is a common problem in elderly patients with nonmalignant pain syndrome attending to primary care facilities.