Cost to ambulatory care for schizophrenia in Family Medicine / Costo de la atención ambulatoria para esquizofrenia en Medicina Familiar

Background: The groups related to ambulatory care (GRAA, according to its initials in Spanish) are a classification of clinical diagnoses performed on patients receiving medical care in primary care; it is a comprehensive treatment for one year. Objective: To determine the costs of ambulatory care and sociodemographic characteristics of patients with schizophrenia attended in Family Medicine (FM). Material and methods: Cross-sectional study which included adult patients with complete electronic clinical record, who had confirmed diagnosis of schizophrenia and received medical attention in a FM unit from January to December 2017. The variables were: age, sex, sociodemographic data, drug addiction and employment status. To determine the annual cost of schizophrenia based on GRAA, the economic medical card was applied, which includes family medicine consultations, inter-consultations, medications, medical supplies, and the time of use of installed capacity for one year. Results: Out of all patients, 56.2% were men (n = 172). Age was 48.42 ± 14.4 years. Of women, 21.2% were married and 21.2% homemakers, 4.2% smokers, and 1.3% alcohol drinkers. Of men, 30.4% were unmarried, 15% unemployed, 13.1% smokers, and 6.9% alcohol drinkers. The total annual cost of schizophrenia for FGRAA-MH for men was $ 7 613 236.00. Conclusions: The use of FGRAA-MH revealed the total annual cost for the care of schizophrenia in the medical unit, which provides important information for better understanding the magnitude of this health problem in that area, and will improve planning and economic medical management.

Introducción: los grupos relacionados con la atención ambulatoria (GRAA) son una clasificación de diagnósticos clínicos que reciben los pacientes atendidos en consultorios de primer nivel; se trata de un tratamiento integral por un año. Objetivo: determinar los costos de atención ambulatoria y las características sociodemográficas de pacientes con esquizofrenia atendidos en Medicina Familiar (MF). Material y métodos: estudio transversal que incluyó pacientes adultos con expediente clínico electrónico completo y vigente, los cuales tuvieron diagnóstico de esquizofrenia y fueron atendidos en una unidad de MF de enero a diciembre de 2017. Las variables fueron: edad, sexo, datos sociodemográficos, toxicomanías y situación laboral. Para determinar el costo anual de la esquizofrenia con base en los GRAA se aplicó la cédula médico-económica, que incluye consultas de MF, interconsultas, medicamentos, insumos médicos y tiempos de uso de capacidad instalada durante un año. Resultados: 56.2% de los pacientes fueron hombres (n = 172). La edad fue 48.42 ± 14.4 años. De las mujeres, 21.2% eran casadas y 21.2% dedicadas al hogar; 4.2% fumaba y 1.3% consumía alcohol. De los hombres, 30.4% eran solteros, 15% desempleados, 13.1% fumadores y 6.9% consumían alcohol. El costo anual total de la esquizofrenia por FGRAA-SM para los hombres fue de $7 613 236.00. Conclusiones: el uso de los FGRAA-SM reveló el costo anual total para la atención de la esquizofrenia en la unidad médica, lo cual brinda información importante para conocer mejor la magnitud del problema de salud en la zona y permitirá mejorar la planeación y la gestión médico-económica.

Three-dimensional kinematic adaptations of gait throughout pregnancy and post-partum.

PURPOSE: The kinematic analysis of gait during pregnancy provides more information about the anatomical changes and contributes to exercise and rehabilitation prescription. The purposes were to describe and quantify the spatial, temporal and kinematic parameters in the joints of the lower limb during gait at the end of the first, second and third trimesters of pregnancy and in the postpartum period. METHODS: A three-dimensional analysis was performed in eleven pregnant women. Repeated measures ANOVA was performed for comparisons between periods. RESULTS: The longitudinal effect of pregnancy was not observed in spatial and temporal parameters. In joint kinematics the effect of pregnancy was observed in all joints for the three planes of motion. The hip joint and pelvis are the structures with more changes, and the results point to an increase in the anterior tilt of the pelvis as the pregnancy progresses, as well as a decrease of the amplitudes of the hip joint. The results suggested that pregnant women need to maintain the stability of the body, and become more efficient in locomotion. CONCLUSIONS: In general, the results retrieve the values from the beginning of pregnancy, indicating that the body was self-organized in order to overcome the morphological and physiological changes which women suffer during pregnancy, indicating that they have the ability to adapt depending on the demands, and after the effect of pregnancy is over, they return to values similar to those found in early pregnancy.

Influence of Body Composition on Gait Kinetics throughout Pregnancy and Postpartum Period.

Pregnancy leads to several changes in body composition and morphology of women. It is not clear whether the biomechanical changes occurring in this period are due exclusively to body composition and size or to other physiological factors. The purpose was to quantify the morphology and body composition of women throughout pregnancy and in the postpartum period and identify the contribution of these parameters on the lower limb joints kinetic during gait. Eleven women were assessed longitudinally, regarding anthropometric, body composition, and kinetic parameters of gait. Body composition and body dimensions showed a significant increase during pregnancy and a decrease in the postpartum period. In the postpartum period, body composition was similar to the 1st trimester, except for triceps skinfold, total calf area, and body mass index, with higher results than at the beginning of pregnancy. Regression models were developed to predict women's internal loading through anthropometric variables. Four models include variables associated with the amount of fat; four models include variables related to overall body weight; three models include fat-free mass; one model includes the shape of the trunk as a predictor variable. Changes in maternal body composition and morphology largely determine kinetic dynamics of the joints in pregnant women.

Three-Dimensional Kinetic Adaptations of Gait throughout Pregnancy and Postpartum.

Biomechanical adaptations that occur during pregnancy can lead to changes on gait pattern. Nevertheless, these adaptations of gait are still not fully understood. The purpose was to determine the effect of pregnancy on the biomechanical pattern of walking, regarding the kinetic parameters. A three-dimensional analysis was performed in eleven participants. The kinetic parameters in the joints of the lower limb during gait were compared at the end of the first, second, and third trimesters of pregnancy and in the postpartum period, in healthy pregnant women. The main results showed a reduction in the normalized vertical reaction forces, throughout pregnancy, particularly the third peak. Pregnant women showed, during most of the stance phase, medial reaction forces as a motor response to promote the body stability. Bilateral changes were observed in hip joint, with a decrease in the participation of the hip extensors and in the eccentric contraction of hip flexors. In ankle joint a decrease in the participation of ankle plantar flexors was found. In conclusion, the overall results point to biomechanical adjustments that showed a decrease of the mechanical load of women throughout pregnancy, with exception for few unilateral changes of hip joint moments.

Comparison between overweight due to pregnancy and due to added weight to simulate body mass distribution in pregnancy.

The assessment of biomechanical loading in the musculoskeletal system of the pregnant women is particularly interesting since they are subject to morphological, physiological and hormonal changes, which may lead to adaptations in gait. The purpose of this study was to analyze the effect of the increased mass in the trunk associated to pregnancy on the lower limb and pelvis, during walking, on temporal-distance parameters, joint range of motion and moments of force, by comparing a pregnant women group to a non-pregnant group, and to this group while carrying a 5 kg additional load located in the abdomen and breasts during walking, to understand which gait adaptations may be more related with the increased trunk mass, or if may be more associated with other factors such as the girth of the thigh. The subjects performed a previous 12 min training adaption to the added load. To calculate ankle, knee and hip joint angles and moments of force, a three-dimensional biomechanical model was developed. The inverse dynamics method was used to estimate net joint moments of force. The increased mass of the anterior trunk associated with second trimester of pregnancy may influence some gait variables such as the left step time, left and right stance times, double limb support time, maximum hip extension, maximum pelvic right obliquity, pelvic obliquity range of motion, maximum transversal left rotation and peak hip flexion moments of force.

Kinematic analysis of gait in the second and third trimesters of pregnancy.

The kinematic analysis of gait during pregnancy provides more information about the anatomical changes and contributes to exercise and rehabilitation prescription. The purposes were to quantify the lower limb kinematics of gait and to compare it between the second and third trimesters of pregnancy and with a control group. A three-dimensional analysis was performed in twenty-two pregnant women and twelve nonpregnant. Repeated Measures and Manova tests were performed for comparisons between trimesters and between pregnant and controls. The walking speed, stride width, right-/left-step time, cycle time and time of support, and flight phases remain unchanged between trimesters and between pregnant and controls. Stride and right-/left-step lengths decreased between trimesters. Double limb support time increased between trimesters, and it increased when compared with controls. Joint kinematics showed a significant decrease of right-hip extension and adduction during stance phase between trimesters and when compared with controls. Also, an increase in left-knee flexion and a decrease in right-ankle plantarflexion were found between trimesters. The results suggested that pregnant women need to maintain greater stability of body and to become more efficient in locomotion. Further data from the beginning of pregnancy anthropometric data may contribute to the analysis.

The natural shock absorption of the leg spring.

When a human being runs, muscles, tendons, and ligaments together behave like a single linear spring. This "leg spring" can be described remarkably well by spring/mass models. Although leg-stiffness during running (and logically, therefore, in hopping) has been shown to be adjusted in line with the individual characteristics of the external contact surface, the relative contribution of each of the sub-components of the leg spring to the mechanics of running is unclear. We proposed the three-degree-of-freedom leg spring chain in a position of stable equilibrium under the action of the leg stiffness. If the leg spring receives a displacement in hopping, the forces will no longer equilibrate, but the system will be exposed to the action of a force on a leg spring chain. We thus have two corresponding sets of modes, one set being the mode about which the chain is displaced, the other set for the forces which are evoked in consequence of the displacement. We found that if the leg has been displaced from a position of equilibrium about one of harmonic modes, then a vibration about this harmonic mode evokes a system of forces in the leg spring which in its turn tends to produce a motion on the original harmonic mode, and thus produce oscillation about the same harmonic mode. Our results suggest that the desired harmonic mode can be explained in terms of the natural shock absorption ability of the leg.