Dental caries in Mexican schoolchildren : a comparison of 1988?1989 and 1998?2001 surveys

Objectives: To compare two surveys across seven states for the prevalence of dental caries among Mexican schoolchildren. Study D esign: Analysis of two cross-sectional surveys: Schoolchildren from 6 to 10 years of age were examined in the 1988?1989 survey and 6- to 10-year-old and 12-year-old students were included in the 1998?2001 survey. The baseline data of seven states were available for analysis. Representative probability samples were conducted statewide in both surveys. The World Health Organization (WHO) method was used to obtain the dental caries index (dmft, DMFT). At present, additional and more recent epidemiological data representative statewide in Mexico are unavailable. Results: The participants were 9798 schoolchildren in the 1988?1989 survey and 16882 schoolchildren in the 1998?2001 survey. The prevalence of caries in children ages 6 to 10 years was 86,6% in the first survey and 65,5% in the second survey, showing a 24,4% reduction. The primary teeth index in the first survey was dmft = 3,86 (IC95% 3,68 4,04) and in permanent teeth, it was DMFT = 1,03 (IC95% 0,95 1,11). In the second survey, the comparable values were dmft = 2,36 (IC95% 2,20 2,52) and DMFT = 0,35 (IC95% 0,29 0,40), corresponding to a reduction of 38,89% and 66,02% in the primary and permanent dentition, respectively. Treatment needs remain high: In the second survey, as 92,75% of the index DMFT was conformed as decayed teeth. Conclusion: Overall, we detected a downward trend in the dental caries indices, particularly in the permanent dentition. The increase in the availability of fluoride likely contributed to the observed decline in dental carie

Validación de la Escala de Asertividad en la Relación Paciente-Médico en mujeres embarazadas mexicanas

The medical model has put aside the paternalistic relationship between physician and patient to give way to the patient-centered model, where the patient occupies an active role in their health care, so the establishment of adequate communication becomes relevant. Assertiveness is a tool that favors effective communication and is also capable of being trained. Effective communication between the health professional and pregnant women is a key element for the optimal delivery of obstetric care. Objective: To analyze the psychometric properties of the Scale of Assertivity of Patients-Medical Personnel (SAPMP) in pregnant Mexican women. Method: 716 pregnant women aged between 13 and 46 years (M = 26.55; SD = 6.56) were recruited, who answered an identification form and the SAPMP. The construct validity of the SAPMP was assessed by exploratory and confirmatory factor analysis. Its internal consistency was determined by calculating Cronbach's α and McDonald's ω. Results: The validation of the SAPMP with Mexican pregnant women detected that it has a bifactorial structure, with uncorrelated factors, each one with an internal consistency from acceptable to very high, which together explain 64% of the variance. The two factors showed adequate discriminant validity, although the internal convergent validity was unacceptable. The internal consistency of the No assertiveness factor indicates the redundancy of some of its items. Conclusions: The SAPMP validated in pregnant Mexican women has adequate psychometric properties to evaluate assertive communication between the physician and the woman user of obstetrical-gynecological care services. However, new studies must be carried out in order to address the problem of internal convergent validity detected, as well as internal consistency for the No assertiveness factor.El modelo médico ha dejado de lado la relación paternalista entre médico y paciente para dar lugar al modelo centrado en el paciente, en donde este ocupa un lugar activo en el cuidado de su salud. Es así que toma relevancia el establecimiento de una adecuada comunicación. La asertividad es una herramienta que favorece la comunicación eficaz, siendo además susceptible de ser entrenada. Una comunicación efectiva entre el profesional de la salud y las mujeres embarazadas es un elemento clave para la óptima prestación de la atención obstétrica. Objetivo: Analizar las propiedades psicométricas de la Escala de Asertividad en la Relación Paciente-Médico (EARPM) en mujeres mexicanas embarazadas. Método: Se reclutó a 716 mujeres embarazadas cuya edad osciló entre 13 y 46 años (M = 26.55; DE = 6.56), quienes respondieron una ficha de identificación y la EARPM. La validez de constructo de la EARPM se evaluó mediante análisis factorial exploratorio y confirmatorio. Su consistencia interna se determinó por el cálculo del α de Cronbach y el ω de McDonald. Resultados: La validación de la EARPM con mujeres embarazadas mexicanas detectó que esta posee una estructura bifactorial, con factores no correlacionados, cada uno con una consistencia interna de aceptable a muy elevada, que en su conjunto explican el 64% de la varianza. Los dos factores mostraron adecuada validez discriminante, aunque la validez convergente interna fue inaceptable. La consistencia interna del factor No asertividad indica la redundancia de algunos de sus reactivos. Conclusiones: La EARPM validada en mujeres mexicanas embarazadas presenta adecuadas propiedades psicométricas para evaluar la comunicación asertiva entre el médico y la mujer usuaria de servicios de atención gineco obstetra. No obstante, nuevos estudios deber ser elaborados a fin de atender el problema de validez convergente interna detectado, así como de consistencia interna para el factor No asertividad

Anafilaxia en niños y adultos: prevención, diagnóstico y tratamiento

La anafilaxia es una condición que requiere asistencia inmediata para su resolución, se puede presentar en diferentes entornos: consultorio, hospital, escuela, hogar o en algún otro espacio público. La información aquí contenida forma parte de lineamientos conocidos sobre prevención, diagnóstico y tratamiento. Se abordan aspectos epidemiológicos, desencadenantes, factores de riesgo y cofactores; se explican de una manera didáctica los mecanismos fisiopatológicos que se traducen en fenotipos de presentación. Se enfatiza el diagnóstico clínico con base en criterios ya establecidos, se mencionan clasificaciones para evaluar la gravedad de la reacción, así como el rol de las pruebas clínicas o de laboratorio. Como aspectos de relevancia, se abordan el tratamiento de primera elección con adrenalina, instrucciones sobre autoinyectores y diferentes elementos para el tratamiento complementario y de segunda elección. También se refieren aspectos a considerar al dar de alta a un paciente y medidas de seguimiento, con un énfasis preventivo en la comunidad. Finalmente, se menciona el abordaje en el consultorio de alergia para decidir sobre opciones de inmunomodulación. ABSTRACT Anaphylaxis is a condition that requires immediate assistance for its resolution, it can occur in different settings: office, hospital, school, home or some other public space. The information contained herein forms part of known guidelines on prevention, diagnosis and treatment. Epidemiological aspects, triggers, risk factors and co-factors are addressed; physiopathological mechanisms that are translated into presentation phenotypes are explained in a didactic way. Clinical diagnosis is emphasized based on established criteria, classifications are mentioned to evaluate the severity of the reaction, as well as the role of clinical or laboratory tests. As relevant aspects, the first choice treatment with adrenaline, instructions on auto-injectors and different elements for the complementary and second choice treatment are dealt with. They also refer to aspects to consider when discharging a patient and followup measures, with a preventive emphasis on the community. Finally, the allergy clinic approach to deciding on immunomodulation options is mentione

Global impacts of Covid-19 on lifestyles and health and preparation preferences: an international survey of 30 countries

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics

A propósito del Día Mundial del Riñón

La enfermedad renal crónica (ERC) afecta a cerca de 10 % de la población mundial, suele ser progresiva, silenciosa y no presentar síntomas hasta etapas avanzadas, cuando las soluciones ya son altamente invasivas y costosas, lo que representa una elevada carga económica y de enfermedad para los sistemas de salud, las instituciones de seguridad social, además contribuye a ampliar la brecha de desigualdad en materia de salud que aparta a los pacientes del tratamiento que puede prolongar y salvar o al menos mejorar su calidad de vida en función de su nivel de pobreza

25 de noviembre: Día Mundial por la Eliminación de la Violencia contra las Mujeres

En el ámbito global 35% de las mujeres y las niñas sufren alguna forma de violencia física o sexual a lo largo de sus vidas y en algunos países esta cifra asciende a 70%, lo cual es consecuencia de la discriminación que sufren, tanto en las leyes como en la práctica y por la persistencia de desigualdades por razón de género. Además de los altos costos personales en salud, educación y empleo, la violencia contra las mujeres afecta o impide el avance de las sociedades en muchas áreas que incluyen el desarrollo económico y el combate a la pobreza; la lucha contra el VIH/SIDA y otras infecciones de transmisión sexual, y la paz y la seguridad

Duración del proceso arbitral en la queja médica

Introduction: The process of the medical complaint and the solution of the conflict is laborious and when they talk about awards, considered as the most complex complaint that is presented in the medical arbitration process. The objectives of the study were to describe the duration of the arbitration process of medical complaints that ended in awards and identify factors that could modify the duration. Material and Methods: We reviewed 362 cases during the years 2012-2016; five essential dates were analyzed during the process of the medical complaint and the resolution of the conflict: the occurrence of the incident that gave rise to the complaint, the date of the presentation of the complaint, as well as the date of beginning and conclusion of the arbitration process both in its conciliation and arbitration phase. Results: The average duration between the date of occurrence of the incident and the presentation, was 274 days. The duration of the conciliatory process was 171 days. For those complaints whose attention is resolved through medical arbitration, the average time was 286 days. Considering the time elapsed from the occurrence of the incident that originated the complaint until the conclusion of the award, the duration was 754 days. Conclusions: The duration of the arbitration process of medical complaints in very varied, having a maximum of up to 2 years and the related factors that could modify the duration were the age and condition of the user, as well as the care sector, medical speculation and pretension.Introducción: El proceso de la queja médica y la solución del conflicto es laborioso y cuando se hablan de laudos, considerados como la queja más compleja que se presenta en el proceso de arbitraje médico. Los objetivos del estudio fueron describir la duración del proceso arbitral de las quejas médicas que terminaron en laudos e identificar factores que pudieran modificar la duración. Material y Métodos: Se revisaron 362 casos durante los años 2012-2016; se analizaron cinco fechas esenciales durante el proceso de la queja médica y la solución del conflicto: la de ocurrencia del incidente que dio origen a la queja, la fecha de la presentación de la queja, así como la fecha de inicio y conclusión del proceso arbitral tanto en su fase de conciliación como de arbitraje. Resultados: La duración promedio entre la fecha de ocurrencia del incidente y la presentación, fue 274 días. La duración del proceso conciliatorio fue de 171 días. Para aquellas quejas cuya atención se resuelven a través del arbitraje médico, el tiempo promedio fue de 286 días. Considerando el tiempo transcurrido desde la ocurrencia del incidente que originó la queja hasta la conclusión del laudo, la duración fue de 754 días. Conclusiones: La duración del proceso arbitral de las quejas médicas en muy variado, teniendo un máximo de hasta 2 años y los factores relacionados que pudieron modificar la duración fueron la edad y padecimiento del usuario, así como el sector de atención, especuialidad médica y pretensión