The Relationship Between Depression and Cognitive Deterioration in Elderly Persons / A Relação Entre Depressão e Comprometimento Cognitivo em Idosos Institucionalizados / La Relación Entre Depresión y Deterioro Cognitivo en Personas Mayores Institucionalizadas en Residencias Españolas

Abstract The objective of this research is to describe the relationship between depressive disorder and cognitive deterioration in residentialized elderly people. This is a descriptive and correlational study with 70 elderly. The variables have been assessed with a Psychosocial Variables Questionnaire, CAMCOG and GDS. Depression was significantly correlated with cognitive level in the non-assisted elderly sample (r=0.471, p=0.004). Participants' age is negatively associated with the score obtained in the CAMCOG of non-assisted sample (r=-0.352, p=0.038). Depression is more frequent in institutions that care for older people when they are more dependent.

Resumo O objetivo deste trabalho é determinar a relação entre transtorno depressivo e comprometimento cognitivo na população idosa institucionalizada. Foi realizado um estudo descritivo e correlacional com 70 idosos espanhóis. Para a medição das variáveis, foi utilizado um Questionário de Variáveis Psicossociais, o CAMCOG do CAMDEX e GDS. A depressão se correlaciona significativamente com o nível cognitivo na maioria dos adultos não dependentes (r=−0,471; p=0.004). A idade está significativamente associada e inversamente para a pontuação obtido no CAMCOG na faixa dependente (r=−0,352; p=−0,038). A depressão está ligada às instituições que atendem prefeitos quando são muito dependentes.

Resumen El objetivo del presente trabajo es determinar la relación entre el trastorno depresivo y el deterioro cognitivo en una población mayor institucionalizada. Se ha realizado un estudio descriptivo y correlacional con 70 mayores españoles. Para la medida de las variables se ha usado un Cuestionario de Variables Psicosociales propio, el CAMCOG del CAMDEX y la GDS. La depresión se correlaciona significativamente con el nivel cognitivo en la muestra de mayores no dependientes (r=−0.471; p=0.004). La edad se asocia elocuentemente y de forma inversa con la puntuación obtenida en el CAMCOG en la muestra de dependientes (r=−0.352; p=−0.038). La depresión está vinculada a las instituciones que atienden a mayores cuando éstos son más dependientes.

Transoral CO2 Laser Microsurgery Outcomes for Early Glottic Carcinomas T1-T2

Abstract Introduction Transoral laser microsurgery (TLM) has won territory in larynx oncology, establishing itself as an effective option in treatment of glottic, supraglottic, and hypopharynx tumors. Its advantages include limited resections, a reduction in number of tracheostomies, and the use of nasogastric tubes. Moreover, its oncological benefits are similar to those from open surgery in patients with early or advanced stages, when correctly selected. Objective The objective of this study is to review oncologic outcomes obtained with the treatment of a series of glottic tumors, treated by TLM. Methods Retrospective analysis of patients previously untreated, diagnosed with squamous cell carcinoma of the glottis (T1a, T1b, T2) in a tertiary university hospital. Endpoints for analysis were local control, overall and disease-specific survival, and larynx preservation rate. Results The study group included 58 patients that met the inclusion criteria: 57 (98.3%) men and 1 (1.7%) woman. Mean age was 65.5 10.7 years (Min: 46/Max: 88). The tumor stages of the patients included were 30 T1a, 11 (19%) T1b, and 17 (29.3%) T2. Three-year overall survival rate was 89.7% (Fig. 1), and three-year disease-specific survival rate was 96.5%, three-year local control rate was 98.3%, and three-year organ preservation rate was 98.3%. Conclusion TLM is a safe and effective option in the treatment of glottis carcinomas, associated with less morbidity and a high percentage of local control, overall survival, specific survival, and organ preservation.

Complications in CO2 Laser Transoral Microsurgery for Larynx Carcinomas

Abstract Introduction Transoral laser microsurgery (TLM) has established itself as an effective option in the management of malignant tumors of the glottis, supraglottis, and hypopharynx. Nonetheless, TLM is not a harmless technique. Complications such as bleeding, dyspnea, or ignition of the air may appear in this type of surgery. Objective The aim of this study is to describe the complications that occurred in a group of patients treated for glottic and supraglottic carcinomas in all stages by TLM. Methods This study is a retrospective analysis of patients diagnosed with squamous cell carcinoma of the glottis and supraglottis for all stages (T1, T2, T3, T4), N -/ + , M -/+ treated with TLM between January 2009 and March 2012 in a tertiary hospital. Results Ninety-eight patients met the inclusion criteria, which had undergone a total of 131 interventions. Ninety-four (95.9%) patients were male and 4 (4.1%) were female. The mean age was 64.2 years ( 10.7 years =min 45; max 88). The presence of intraoperative complications was low, affecting only 2% of patients. Immediate postoperative complications occurred in 6.1%, whereas delayed complications affected 13.2% of patients, without any of them being fatal. Conclusion TLM has shown good oncologic results and low complication rate compared with traditional open surgery during intervention, in the immediate and delayed postoperative period and in the long-term with respect to radiotherapy.

Lactancia materna exclusiva y enfermedades prevalentes de la infancia en menores de seis meses / Exclusive breastfeeding and childhood illness in under six months infants

Objetivo: Determinar la asociación entre lactancia materna exclusiva (LME) y enfermedades prevalentes de la infancia en niños menores de seis meses en Perú el año 2012. Métodos: Análisis secundario de la Encuesta Demográfica de Salud Familiar (ENDES) 2012. Se definen variables y establece asociación de LME con enfermedad diarreica aguda (EDA), infecciones respiratorias agudas (IRA), infección inespecífica (fiebre) y problema de salud infeccioso. Análisis estad¡stico univariado, bivariado con Chi-cuadrado, OR (IC95%) y multivariado con regresión logística binaria con p<0,05 en SPSS 20, según procedimiento de ponderación del INEI. Resultados: Se incluyó a 829 niños peruanos menores de seis meses. 97,4% de niños se encontraba actualmente lactando, solo 48,7 % recib¡a LME. Se encontró un OR ajustado (ORa) de 0,37 IC95% 0,22 – 0,62) entre LME y EDA, ORa de 0,57 (IC95% 0,37 – 0,89) entre LME e infección inespecífica y ORa de 0,46 (IC95% 0.31 – 0.69) entre LME y problema de salud infeccioso en comparación a quienes no recib¡an LME. No se encontró asociación entre LME e IRA. Conclusiones: La lactancia materna exclusiva se asoció a menor probabilidad de presentar enfermedad diarreica aguda, infección inespecífica y algún problema de salud infeccioso en niños peruanos menores de seis meses.

Objective: To determine the association between exclusive breastfeeding (EBF) and infectious diseases in infants younger than 6 months in Peru in 2012. Methods: Secondary analysis of “Encuesta Demogr fica de Salud Familiar” (ENDES) survey database of 2012. Variables were defined on the database and association established based between EBF and fever (non-specific infection), acute diarrhea (AD), respiratory tract infections (RTI) and infectious health problem. Univariate and bivariate analysis performed with Chi-squared test and Odds Ratio (IC95%); multivariate analysis with binary logistic regression, p<0.05 using SPSS 20, according to weighing procedures of INEI. Results: 829 peruvian children under 6 months were included in the study. 97,4% of infants received breastfeeding, and only 48,7% received EBF. Compared with non-EBF infants, EBF infants presented lower risks of AD (adjusted OR [aOR]= 0,38; 95%CI 0,23-0,63); non-specific infection (aOR=0,60; 95%CI 0,39-0,93) and infectious health disease (aOR=0,47; 95%CI 0,32-0,69). No association was found between RTI and EBF. Conclusion: Exclusive breastfeeding was associated with lower risk of presenting acute diarrhea, non-specific infection and infectious health problems.

Predictors of adverse events after percutaneous transluminal coronary angioplasty in a group of Hispanic patients

OBJECTIVE: To identify predictors of adverse events after PTCA during hospitalization and after hospital discharge in a private hospital in Puerto Rico. BACKGROUND: A review of the literature shows limited information about predictors of adverse events associated to percutaneous transluminal coronary angioplasty (PTCA) in Hispanic patients. METHODS: This is a non-concurrent prospective study. Baseline variables were analyzed using multivariate logistic regression to identify predictors of adverse events. Data were collected from medical charts and telephone reports from referring physicians. RESULTS: Data from 197 subjects undergoing PTCA were analyzed for this study. Median age of patients was 65 years, and 62.9 of patients were male. Angiographic success rate was 81.6. A total of 8.1 of patients had at least one in-hospital adverse event, and 39.8 had at least one adverse event after hospital discharge. After multivariate analysis, a statistically significant association was found between the presence of at least one lesion with residual stenosis of 50 or greater and the risk of developing adverse events in-hospital (RO 11.75; 95 CI 4.32-31.97). A marginally significant association was found between family history of heart disease (RO 2.75; 95 CI 0.93-8.11) and the risk of adverse events during hospitalization. Family history of heart disease (RO 1.41; 95 CI 0.98-2.04) and the presence of at least one lesion with residual stenosis of 50 or greater (RO 2.87; 95 CI 0.82-10.01) showed marginally significant associations with increased risk for adverse events after discharge. CONCLUSIONS: These findings suggest that the presence of at least one lesion with residual stenosis of 50 or greater and family history of heart disease may be risk factors for adverse events after PTCA during hospitalization and after discharge.

Descripción del estado de salud y la capacidad funcional de la población de 65 años o más residente en la Región Universitaria de Salud de Puerto Rico / Description of health status and functional capacity of the 65-years-old and older population residing in the University Region of Health of Puerto Rico

This study intended to describe the health and functional status of the population 65 years and over resident in the Puerto Rico University Health Region (municipalities of Canóvanas, Loiza, Carolina and Trujillo Alto, Puerto Rico). Four ninety one hundred elderly subjects selected from a random sample of households, were interviewed. A questionnaire was designed to gather data of the following variables: health conditions, functional capacity, health services utilization, social support and preventive measures. Descriptive measures and chi-square were utilized for the statistical analysis. Findings revealed a population composed mostly of women with a higher prevalence of health conditions than their male counterparts. More than half of the sample report visual problems, arthritis or hypertension. Almost a quarter had diabetes mellitus. The prevalence of these conditions was higher in the age group over 75, with the exception of diabetes. Thirty percent of the sample was classified as functionally dependent, condition that increased with the subject's age. Findings evidence the need of an early assessment in this population in order to intervene with potentially modifiable factors to prevent future disability and improve quality of life of the aged.

Condiciones de salud y limitaciones funcionales en la poplación de edad avanzada de la Región Universitaria de la Salud de Puerto Rico: aspectos metodológicos y estimación de prevalencias / Health status and functional limitations in the elderly population of the University Region of Health of Puerto Rico: methodologic aspects and prevalence estimates

In order to plan the health services for the elderly population, it is necessary to quantify their health status and their functional capacity. In Puerto Rico, few epidemiological studies have been conducted regarding functional capacity and chronic diseases in the elderly population. One of the difficulties to undertake these studies is the high cost and risks to move this population for clinical exams, in addition to the methodology limitation of self-report in the elderly population. This study shows the use of logistic regression to estimate the prevalence of chronic diseases and functional capacity, when the observed data are not consisted with the planed sampling scheme. Four hundred and eighty-seven elderly persons (65 yr. and over) were interviewed in the municipalities of Canóvanas, Carolina, Loíza and Trujillo Alto in Puerto Rico, using a cross-sectional design. More than half of the elderly had visual problems (IC 95 percent: 54.8 percent, 63.8 percent), arthritis (IC 95 percent: 52.7 percent, 61.5 percent) and hypertension (IC 95 percent: 47.3 percent, 56.3 percent). In the case of hypertension, significant differences (p < 0.05) by sex were observed, where women reported a higher prevalence than men. One of the higher prevalence in the functional capacity status was with urine accidents. More than one-third of the population is estimated to have this problem (IC 95 percent: 34.7 percent, 43.4 percent). One-fourth of the population had limitations with going out for shopping (IC 95 percent: 23.9 percent, 31.9 percent) and using public and private transportation (IC 95 percent: 19.5 percent, 26.9 percent). We conclude that the applied methodology was consistent with the estimation presented in the literature and statistics from the Puerto Rico Health Department. However, it is necessary to continue assessing the design and analytical methodology, in order to undertake consistent and periodic evaluations of the elderly population.

Prevencion del dano intestinal mediante la utilizacion de un antagonista del factor de activacion plaquetaria en el trasplante intestinal / Prevention of intestinal damage through the utilization of an antagonist of the platelet activating factor in intestine transplantation

Se realiza un estudio comparativo en ratas singenicas de la cepa Wistar con objeto de valorar los efectos de preservacion del injerto al utilizar el antagonista del factor de activacion plaquetaria, WEB-2086. en la valoracion ultraestructural se ha podido comprobar los efectos de esta sustancia al nivel de las celulas epiteliales de intestino trasplantado

Prevalence of tuberculin reactivity and risk factors for the development of active tuberculosis admission to a nursing home

A total of 118 nursing home admissions were studied to determine the prevalence of M. tuberculosis infection and the prevalence of risk factors for the development of active tuberculosis. The overall prevalence of positive tests was 22.5 per cent. The most prevalent risk factors for development of active tuberculosis were diabetes mellitus (42.4 per cent), being more than 10 per cent below ideal body weight (41.5 per cent), and alcohol abuse (12.7 per cent). Thirty-four percent of admissions had albumin levels below 3.5 g/dl. No associations were found when logistic regression was used to determine the impact of age and poor nutritional status on the prevalence of positive PPD tests on admission. These results show a substantial difference between the prevalence of positive PPD tests found upon nursing home admissions (22.5 per cent) and the prevalence found previously among residents in the same in nursing home (42.9 per cent).

Prevalence of tuberculin reacting and prevalence of risk factors for the development of active tuberculosis in a nursing home in Puerto Rico

A total of 91 nursing home patients were evaluated to determine the prevalence of tuberculous infection and the prevalence of risk factors for active TB in those with positive tuberculin reactions. Overall prevalence rate for positive PPD was 42.9 percent No association was found between revalence of positive PPD and time since admission to the nursing home. The most prevalent risk factors for active TB among PPD positive patients were diabetes mellitus (38.5percent), being 10 percent below ideal body weight (25.6 percent), chest X ray with fibrotic changes (13.2 percent), and carcinoma of oropharynx (5.1 percent). Twenty-one patients (53.8 percent) of patients with positive test) met criteria for prophylactic treatment with isoniazid. This study detected a high prevalence of positive PPD reactions in this nursing home population and a high prevalence of risk factors for the development of active TB in the group with positive reaction to PPD. Due to the high risk for the development of active tuberculosis in this population, aggressive screening and preventive therapy are mandatory

Prevalence of cognitive and functional impairment in an elderly Puerto Rican population

Data from the Gurabo census of the elderly, 1987-1988 (n = 1890)were analyzed to determine the prevalence rates for cognitive and functional impairment in that population. Besides socio-demographic questions, the census questionnaire included the Short Portable Mental Status Questionnaire to determine cognitive dysfunction, and the modified Katz Scale to detect functional impairment. The overall prevalence rates were 18.5 percent and 18.4 percent for cognitive and functional dysfunction respectively. After multiple logistic regression analysis, cognitive impairment was found to be associated with poor education (OR = 4.0, CI = 2.31-6.93), older age (OR = 2.67, C.I. = 2.00-3.58), functional decline (OR = 2.44, C.I. = 1.83-3.25), female sex (OR = 1.82, C.I. = 1.39-2.40) and low income (OR = 1.49, C.I. = 113-1.98). Functional impairment was found to be associated with cognitive dysfunction (OR = 2.45, C.I. = 1.84-3.27) and older age (OR = 2.08, C.I.-1.59 = 2,72). These findings suggest that a substantial proportion of the elderly in Puerto Rico may require assistance to deal with the consequences of these impairments

Perfil sociodemográfico y medidas del crecimiento físico en pacientes pediátricos con el síndrome de inmunodeficiencia adquirida seguidos en el Hospital Municipal de San Juan: 1986-1990 / The sociodemographic profile and physical growth patterns of pediatric patients with the acquired immunodeficiency syndrome followed at the the San Juan City Hospital: 1986-1990

Puerto Rico ocupó el tercer lugar en el número de casos diagnosticados de SIDA pediátrico en Estados Unidos entre los meses de septiembre de 1989 y agosto de 1990. El mayor número de casos de SIDA pediátrico ha sido identificado en áreas metropolitanas de alto riesgo. Usualmente el SIDA afecta a niños nacidos a madres drogadictas. Este trabajo pretende describir el perfil sociodemográfico y el crecimiento físico de os casos de SIDA pediátrico al presente atendidos en el Instituto de SIDA de San Juan durante los años de 1986 a 1990. En este estudio de naturaleza descriptiva, la muestra consistió de los 40 pacientes vivos con el diagnóstico de SIDA que constituían el universo al realizar la presente investigación. La fuente principal de transmisión fue por vía perinatal (90.0 por ciento) y el factor de riesgo, la drogadicción endovenosa en la madre (67.5 por ciento). El 42.4 por ciento de las madres sostenían una relación consensual. El 70.0 por ciento de los casos nacieron a término (38 semanas) con un peso promedio de 2,954 gramos y talla promedio de 50.9 centímetros. Al momento de presentar síntomas dentro de alguna categoría P2 según criterios del CDC, el 67.7 por ciento estaban debajo de la 50ma. percentila en peso; y el 86.9 por ciento de los casos estaban por debajo de la 50ma. percentila en talla

Differences in patient mix: a partial explanation for the excessive medicare mortality observed in some Pueto Rican hospitals

Data from a census in a Puerto Rican community were used to retrospectively compare patients admitted to government hospitals in terms of demographic variables, mental status and functional status in the community prior to admission. A total of 268 patients admitted to a hospital at least once during the study period were identified. Patients admitted to government hospitals were poorer, less educated, less functional and had a higher level of mental impairment. However, in comparison to private hospitals, stratified analysis showed consistently higher in-hospital mortality rates among patients admitted to government hospitals when other variables were taken into account

Increased alanine aminotransferase (ALT-SGPT) activity in Puerto Rican blood donors

Se obtuvieron datos de 4,189 expedientes de donaciones de sangre procedentes de dos bancos de sangre en Puerto Rico para determinar si los puertorriqueños tienden a tener niveles en sangre de ALT-SGPT más altos en comparación con donantes de sangre de otros grupos étnicos. El promedio general de ALT-SGPT fue de 36.84 u/l (alcance 1-910, desviación estandard 37.8). El logarítmo de ALT FUE DE 1.47 (alcance 1-2.96, desviación estandard). Analisis de cada banco de sangre en dos períodos de tiempo demostraba promedios de ALT-SGPT consistentemente altos aún cuando excluían donaciones positivas para hepatitis B, H. I. V. y sífilis. Aunque las causas de estos hallazgos no estan claras, factores ambientales como el consumo de alcohol deben considerar-se como posibles explicaciones

Factores asociados a la admisión hospitalaria en una población geriátrica / Factors associated with the hospitalary admission of a geriatric population

El estudio investiga los patrones de utilización hospitalaria en personas mayores de 64 años. La determinación de deficiencia intelectual y discapacidad de 1,353 personas mayores de 64 años y acogidos a Medicare fue obtenida de un censo de la población mayor de 59 año realizado en el municipio de Gurabo, Puerto Rico, entre 1987 y 1988. Examinando los datos de hospitalización del programa Medicare en Puerto Rico se encontró que un total de 105 de estas personas fueron hospitalizadas por lo menos una vez durante ese período de tiempo. Para el grupo con deficiencia intelectual y discapacidad la tasa de hospitalización fue de 13.5%. Los que presentan solamente discapacidad tuvieron una tasa de 9.4%. El grupo con deficiencia intelectual solamente tuvo una tasa de 8.8%. La menor tasa de 6,8%, correspondió a los sujetos sin deficiencia intelectual ni discapacidad. Estos datos sugieren una relación entre la presencia de dichas disfunciones y la probabilidad de ser hospitalizado. No obstante, es necesaria más investigación para dilucidar si dicho efecto es independiente de la edad

A physical fitness program for health professionals and students

Durante las últimas décadas, se han desarrollado un gran interés en la utilizacíon del ejercicio como un instrumento importante en el mantenimiento de una buena salud. El propósito de este estudio fue medir varias respuestas fisiológicas y nivel de acondicionamiento, antes y después de un programa de ejercicio por un período de 8 semans a razón de 3 sesiones por semana. Los participantes, un grupo de catorce varones, empleados y estudiantes del Recinto de ciencias Médicas, Universidad de Puerto Rico, seguieron una prescripción de ejercicio que incluía un período de calentamiento (5-10 mins.), entrenamiento aeróbico por 20 minutos a una intensidad del 60-80% del ritmo cardíaco máximo, ejercicios de resistencia progresiva y un período de enfriamiento (5-10 mins.). Evidenciaron una disminución en el ritmo cardíaco al descanso y presión sistólica al descanso, mejoría en la capacidad aeróbica estimada, aumento en la fuerza de agarre y disminución en el porciento de grasa. Estos resultados encontraron su comparables aquellos descritos por la literatura que fue revisada

El envejeciente de Guarabo: un perfil biosicosocial del envejeciente en una comunidad de Puerto Rico / The aging person in Gurabo: a bio-psychosocial profile of the aging person in a community in Puerto Rico

The Department of Family Medicine of the University of Puerto Rico Medicine School performed a census of the inhabitants 60 years and older in the community of Gurabo. A total of 1,890 elderly were interviewed 51% were female and 49% male. Sixty percent were married and twenty-five percent were widowed. Eighty two percent still lived within a family setting and only seventeen percent lived alone 86% owned their own home despite ninety percent reporting incomes below $400.00 per month. Ninety five percent have access to medical services but 63% receive services in multiples sites. Eighteen percent were functionally impaired, fourteen percent intelectually impaired and five percent had impairment in both areas. Preliminary data show that the latter group had an annual mortality rate of 15% compared to only 3.6% and 1.3% respectively in the other two group. We concluded that: 1) functional and mental impairment are indicators of increased mortality. 2) although access to health care is not a problem this health care is episodic and interrupted being provided in multiple different sites

Artritis crónica juvenil: estudio de 60 casos / Juvenile chronic arthritis: study of 60 cases

Se practicó un análisis de 60 pacientes con diagnótico comprobado de A.C.J. La relación en cuanto al sexo fue de 36 hembras y 24 varones.(3/2). La edad promedio fue de 9,25 años; las formas de comienzo fueron las poliarticular (55%) seguida de la oligoarticular (31,6%) y la aguda febril (13,3%) respectivamente. Las articulaciones más frecuente afectadas fueron: rodilla, tibio-tarsianas, codo, pequeñas articulaciones de las manos y columna cervical. El cuadro clínico se asoció a diversas manifestaciones extraarticulares (fiebre, adenopatías, esplenomegalia, exantema, pericarditis, etc.). Uveitis solamente fue hallada en tres casos (5%). Ningun caso de amiloidosis fue encontrado en la muestra analizada. Anemia, leucitosis y velocidad de sedimentación elevada constitulleron los hallasgos de laboratorio más frecuentes. El látex fue positivo en 16 pacientes y negativo en 37. El estudio histológico sinovial solo permitio demostrar la presencia de una sinovitis inespecífica. Las alteraciones radiológicas principales, estuvieron representadas por edema de partes blandas, osteopenia. Las erociones fueron de baja incidencia en el 10,5%de los casos se pudo comprobar la presencia en el anquilosis ósea. En 6 pacientes de desmostraron alteraciones radiológicas a nivel de la columna cervical. La cadera se afecto en 7 enfermos, dos de ellos con anquilosis ósea. El pronóstico a largo plazo, resultó ser faborable, sólo el 16%de los pacientes estaban incluidos en los grupos funcionales III y IV de la clasificación de Steinbroker. Se considera que la A.C.J. debe ser estudiada mejor en nuestro medio, única forma de lograr un mayor conosimiento de la enfermedad, un dianóstico preciso, una terapeutica oportuna y eficaz y una conducción acertada del paciente que contribuya a prevenir deformidades, mejorarlas o corregirlas

Patología quirúrgica diagnosticada en atención primaria de salud / Surgical pathology diagnosis in primary health care

Se hizo una revisión retrospectiva de 3.753 historias de Atención Primaria de Salud (APS), correspondiente al trimestre enero-marzo de 1987. A 204 pacientes (5.43%) se les hizo el diagnóstico o venían referidos de otros centros por alguna patología quirúrgica. se agruparon estas entidades según categorias codificadas por la Clasificación Internacional de Enfermedades. Se presentan las patologías quirúrgicas de acuerdo con su frecuencia por aparatos y sistemas, edad, sexo y referencia justificada a un servicio de Cirugia General. los resultados se expresan en porcentajes. Las Consultas del Primer Nivel de Atención Médica del Centro de APS en el A-HUC, constituye una asistencia médica importante, que permite el diagnóstico precoz y la clasificación de los problemas de salud del usuario según estados morborsos, edad y sexo, facilitando la selección de los pacientes que en forma justificada ameriten tratamiento en un segundo o tercer nivel de atención