Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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).</p> <p>Conclusion</p> <p>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.</p

Bordetella pertussis em estudantes adolescentes da Cidade do México

OBJECTIVE: To estimate seroprevalence of Bordetella pertussis in students and their community. METHODS: A total of 12,273 adolescent students aged 12 to 15 years from 14 public high schools in Mexico City were studied from September 2002 to March 2003. Nasopharyngeal samples were collected from those adolescents with whooping cough for more than 14 days. Infection was confirmed using polymerase chain reaction (PCR). All students, school staff and family exposed to PCR-confirmed cases were tested. RESULTS: Whooping cough rate was 5 to 1,000 students. Of those students (61) who were identified with whooping cough for more than 14 days, 20 (32.8%) were positive to Bordetella pertussis. Of 152 people exposed (contacts) to these cases, 16 (10.6%) were positive and only eight (50%) had whooping cough. One of these exposed (contacts) was the principal of a school that had more than 60% positive cases (12/20) and who was also a teacher of 10 infected students. Of 29 family members tested, eight (27.6%) were positive and from three different families. CONCLUSIONS: The study results show a similar rate of whooping cough in adolescents as seen in other countries. Since persistent cough is not always clinically seen in all infected individuals, there may be asymptomatic cases of Bordetella infection.OBJETIVO: Estimar la seroprevalencia a Bordetella pertussis en escolares y sus contactos escolares y familiares. MÉTODOS: Un total de 12.273 estudiantes de 12 a 15 años de edad, de 14 escuelas secundarias públicas de la Ciudad de México fueron estudiados durante los meses de Septiembre 2002 a Marzo 2003. Se tomó muestra de exudado nasofaríngeo en adolescentes con tos de más de 14 días de evolución. La infección fue confirmada por la técnica de reacción en cadena de polimerasa. Se realizó estudio de contactos escolares y familiares. RESULTADOS: La incidencia de tos fue de 5 para 1.000 estudiantes. De los 61 estudiantes con tos incluidos en la muestra, 20 (32,8%) fueron positivos para Bordetella. De los 152 contactos escolares, 16 (10,6%) resultaron positivos, y ocho tenían tos. Uno de esos contactos fue el director de una de las escuelas responsable de más del 60% de los casos positivos (12/20), quien también dio lecciones a diez de los estudiantes infectados. De los 29 familiares, ocho (27,6%) fueron positivos, pertenecientes a tres familias. CONCLUSIONES: Los resultados muestran que la frecuencia de la enfermedad fue similar al comunicado en la población adolescente de otros países. Sin embargo, este trastorno no tiene necesariamente signos clínicos de la tos persistente y está sujeto a la existencia de infectados asintomáticos con Bordetella.OBJETIVO: Estimar a soroprevalência a Bordetella pertussis em escolares e seus contatos. MÉTODOS: Foram examinados 12.273 alunos entre 12 e 15 anos de idade, de 14 escolas secundárias públicas da Cidade do México, de setembro de 2002 a março de 2003. Amostras de exudado nasofaríngeo foram coletadas de adolescentes com tosse por mais de 14 dias. A infecção foi confirmada por reação em cadeia da polimerase. Todos os alunos e funcionários dos colégios dos casos confirmados por reação em cadeia da polimerase e seus familiares foram testados. RESULTADOS: A incidência de tosse foi de 5 para 1.000 alunos. Dos 61 alunos com tosse amostrados, 20 (32,8%) foram positivos para Bordetella. Dos 152 contatos desses alunos, 16 (10,6%) foram positivos, dos quais oito apresentavam tosse. Um desses contatos foi a diretora de uma das escolas responsável por mais de 60% dos casos positivos (12/20), que também deu aulas a dez desses alunos infectados. Dos 29 familiares testados, oito (27,6%) foram positivos, pertencentes a três famílias. CONCLUSÕES: Os resultados mostram que a freqüência do agravo foi semelhante à reportada na população adolescente em outros países. Todavia, este agravo não tem necessariamente manifestações clínicas de tosse persistente, sendo possível a existência de sujeitos assintomáticos infectados com Bordetella

Violencia de pareja en mujeres embarazadas en la Ciudad de México

OBJETIVO: Analisar los factores relacionados a la violencia de pareja en mujeres embarazadas. MÉTODOS: Se recolectó la información de 383 mujeres derechohabientes del Instituto Mexicano del Seguro Social que acudieron a control prenatal en cinco Unidades de Medicina Familiar en la Ciudad de México entre septiembre del 2003 y agosto del 2004. Ellas respondieran a un cuestionario de violencia elaborado específicamente para el estudio. RESULTADOS: De las mujeres, 120 (31.1%) reportaron haber estado expuestas a la violencia psicológica y/o física, y/o sexual por parte de su pareja masculina durante el embarazo actual, el 10% reportaron violencia combinada y 21% violencia aislada. La violencia psicológica fue la más frecuentemente reportada (93% del grupo "había experimentado violencia"). Con relación a la percepción sobre la violencia no había diferencias significativas entre los grupos de mujeres con y sin violencia. Solo alrededor de 20% de las mujeres tenían conocimiento sobre los lugares donde atienden a las victimas de violencia. Los factores asociados significativamente a la violencia de pareja en las mujeres embarazadas fueron ser soltera (RM=3.02, IC 95%:1.17;7.83), vivir en unión libre (RM=2.22, IC 95%: 1.11;4.42), antecedentes de violencia en la infancia (RM=3.08, IC 95%:1.62;5.85), consumo de bebidas alcohólicas en la pareja (RM=1.87, IC 95%:1.02;3.42) y presencia de alteraciones emocionales (RM=4.17, IC 95%: 1.12;15.51). CONCLUSIONES: Los resultados refuerzan los hallazgos de otros estudios de que el problema de violencia en mujeres embarazadas en México sigue siendo un problema frecuente.OBJETIVO: Analisar os fatores relacionados à violência conjugal em mulheres grávidas. MÉTODOS: Analisaram-se dados de 383 mulheres seguradas do Instituto Mexicano del Seguro Social que procuraram o programa pré-natal em cinco unidades de medicina familiar da Cidade do México, entre setembro de 2003 e agosto de 2004. Essas mulheres responderam a um questionário de violência elaborado especificamente para o estudo. RESULTADOS: Das mulheres, 120 (31,1%) relataram ter sido expostas à violência psicológica e/ou física, e/ou sexual por parte de seu parceiro durante a gravidez atual, 10% reportaram violência combinada e 21% violência isolada. A violência psicológica foi a mais freqüentemente relatada (93% do grupo havia "sofrido violência"). Com relação à percepção sobre a violência, houve diferenças significativas entre o grupo que sofreu e o que não sofreu violência. Apenas 20,3% tinham conhecimento sobre os lugares onde as vítimas de violência eram atendidas. Os fatores associados significativamente à violência conjugal em grávidas foram: ser solteira (OR=3,02; IC 95%:1,17;7,83), viver em união livre (OR=2,22; IC 95%: 1,11;4,42), antecedentes de violência na infância da mulher (OR=3,08; IC 95%:1,62;5,85), consumo de bebidas alcoólicas pelo parceiro (OR=1,87; IC 95%:1,02;3,42) e presença de alterações emocionais (OR=4,17; IC 95%: 1,12;15,51). CONCLUSÕES: Os resultados reforçam os achados de outros estudos de que o problema de violência em mulheres grávidas no México continua sendo um problema freqüente.OBJECTIVE: To assess factors related to partner violence against pregnant women. METHODS: Data were collected from 383 pregnant women eligible attending five family medicine units of the Mexican institute of social security in Mexico City, Mexico, between September 2003 and August 2004. Data collection was carried out using a questionnaire developed for the study. RESULTS: Of all women interviewed, 120 (31.1%) reported that they had been exposed to psychological and/or physical and/or sexual violence perpetrated by their partners during the current pregnancy; 10% reported combined violence and 21% isolated violence. Psychological violence was most frequently reported (in 93% of the "experienced violence" group). As for their perception of violence there was not found any significant differences between those women who had experienced versus those who did not experience violence. Only about 20% of women had knowledge of centers for women victims of violence. The factors significantly associated with partner violence among pregnant women included: being single (OR=3.02; 95% CI: 1.17;7.83), being unmarried and living with a partner (OR=2.22; 95% CI: 1.11;4.42), history of violence during childhood (OR= 3.08; 95% CI: 1.62;5.85), alcohol consumption by the partner (OR=1.87; 95% CI: 1.02;3.42) and emotional distress among women (OR=4.17; 95% CI: 1.12;15.51). CONCLUSIONS: The study results stress other research findings that violence against pregnant Mexican women is still common

Experiencia del Sistema Nacional de Salud Mexicano en el desarrollo de guías de práctica clínica

ResumenAntecedentesLas guías de práctica clínica son herramientas que han demostrado hacer más racionales las decisiones en salud y disminuir la brecha entre la acción clínica y la evidencia científica.ObjetivoEl estudio tiene como objetivo compartir la experiencia en el desarrollo y actualización de guías por el Sistema Nacional de Salud de México.Material y métodosLa metodología en el desarrollo de guías consta de 5 fases: priorización, conformación de grupos de trabajo, desarrollo por adopción de guías internacionales o de novo, validación e integración en el Catálogo maestro de guías de práctica clínica para su difusión.ResultadosEl Catálogo maestro de guías de práctica clínica aloja 664 guías, distribuidas de la siguiente forma: 42% son de Medicina Interna, 22% de Cirugía, 24% de Pediatría y el 12% de Ginecología y Obstetricia. Del total de las guías, se da cobertura al 85% del Catálogo universal de servicios de salud, al 84% del Fondo de protección contra gastos catastróficos y al 61% del Seguro Médico Siglo XXI de la Comisión Nacional de Protección Social en Salud.DiscusiónEl resultado es la suma de un esfuerzo de coordinación y cooperación de las instituciones del Sistema Nacional de Salud, de las voluntades políticas y del compromiso de 3,477 profesionales de la salud que participan en el desarrollo y actualización de las guías.ConclusionesLa integración, difusión e implantación de las guías del Catálogo maestro mejora la calidad de la atención y seguridad de los usuarios del Sistema Nacional de Salud.AbstractBackgroundClinical practice guidelines are tools that have been able to streamline decisions made in health issues and to decrease the gap between clinical action and scientific evidence.ObjectiveThe objective of the study is to share the experience in the development and to update the guidelines by the National Health System of Mexico.Material and methodsThe methodology in the development of the guidelines consists of 5 phases: prioritisation, establishment of work groups, development by adoption of international guidelines of de novo, validation and integration in the Master catalogue of clinical practice guidelines for its dissemination.ResultsThe Master catalogue of clinical practice guidelines contains 664 guidelines, distributed in 42% Internal Medicine, 22% Surgery, 24% Pediatrics and 12% Gynecology. From the total of guidelines coverage is granted at an 85% of the Universal catalogue of health services, an 84% of the Catastrophic expenses protection fund and a 61% of the XXI Century Medical Insurance of the National Commission of Social Protection in Health.DiscussionThe result is the sum of a great effort of coordination and cooperation between the institutions of the National Health System, political wills and a commitment of 3,477 health professionals that participate in guidelines’ development and update.ConclusionMaster catalogue guidelines’ integration, diffusion and implantation improve quality of attention and security of the users of the National Health System

Health and working conditions of pregnant women working inside and outside the home in Mexico City

BACKGROUND: To explore differences related to health and working conditions by comparing socio-demographic parameters, reproductive and prenatal care characteristics and working conditions among pregnant women who are employed outside the home (extra-domestic) while still performing a domestic workload versus those who perform exclusively domestic work in the home (intra-domestic). METHODS: A cross-sectional study was carried out at Family Medicine Unit N 31 of the Mexican Institute of Social Security (IMSS) in Mexico City between April and July 2003. Interviews were conducted with 537 pregnant women engaged in either extra-domestic work plus intra-domestic tasks, or those performing strictly intra-domestic work. Information was obtained regarding their demographic status, prenatal care, reproductive, work characteristics, and health during pregnancy. RESULTS: One hundred ninety-six (36.5%) of the interviewed women had paid jobs outside the home in addition to domestic tasks, while three hundred forty-one (63.5 %) engaged in exclusively intra-domestic occupations. Of the women with paid jobs, 78.6% worked as clerks. Among domestic tasks, we found that the greatest workload was associated with washing of clothes, and our micro-ergonomic analysis revealed that women who worked strictly inside the home had a higher domestic workload versus employed women (69.2 vs. 44.9%). When we analyzed the effect of work on health during pregnancy, we observed that women who worked strictly inside the home were at a higher risk for musculoskeletal and genitourinary symptoms than those employed outside the home. CONCLUSION: These findings suggest that the effect of intra-domestic work should not be ignored when considering women's health during pregnancy, and that greater attention should be paid to women's working conditions during intra and extra-domestic work

Conocimiento básico de los riesgos del uso de analgésicos no opioides en pacientes ambulatorios Basic knowledge of risks for non-opioid analgesics (NOA) in ambulatory patients

OBJETIVO: Evaluar el conocimiento básico de los pacientes acerca de los analgésicos no opioides (ANOP) e identificar los posibles factores relacionados con la falta de información sobre este tipo de analgésicos. MATERIAL Y MÉTODOS: Participaron 629 pacientes >50 años con síndrome doloroso de origen no oncológico y que recibieron ANOP. Se analizaron sus características generales, la información recibida y su conocimiento sobre ANOP. La variable dependiente fue la falta de conocimiento básico (FCB) sobre ANOP. Se realizó análisis descriptivo y bivariado. RESULTADOS: Del total de participantes, 64.2% tuvo FCB; 28% desconocía la forma correcta de tomar ANOP y 48% sabía que ocasionan trastornos gastrointestinales. Factores asociados con la FCB: no recibir información sobre ANOP (RM= 2.22; IC95% 1.32-3.70), escolaridad 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