ABSTRACT
BACKGROUND: there are few studies on breast symptoms (BS) in patients attended at primary care units in Mexico. The aim was to determine the frequency and types of BS overall and by age-group and establish which BS were related to diagnosis of breast cancer. METHODS: data from all female patients with a breast-disease-related diagnosis, attended from 2006 to 2010, at the Family Medicine Unit 38, were collected. The frequencies of BS were determined by four age-groups (< 19, 20-49, 50-69, > 70 years) and likelihood ratios for breast cancer for each breast-related symptom patient, with a 95 % confidence interval (CI). RESULTS: the most frequent BS in the study population were lump/mass (71.7 %) and breast pain (67.7 %) of all breast complaints, and they were more noted in women age group of 20-49 years. Overall, 120 women had breast cancer diagnosed with a median age of 53.51 + 12.7 years. Breast lump/mass had positive likelihood ratios for breast cancer 4.53 (95 % CI = 2.51-8.17) and breast pain had increased negative LR = 1.08 (95 % CI = 1.05-1.11). CONCLUSIONS: breast lump/mass was the predominant presenting complaint among females with breast symptoms in our primary care unit, and it was associated with elevated positive likelihood of breast cancer.
Introducción: en México, en las unidades del primer nivel hay pocos estudios sobre los síntomas mamarios. El objetivo fue determinar la frecuencia de los síntomas y los más asociados con el diagnóstico de cáncer. Métodos: se recabó información de las pacientes atendidas de 2006 a 2010 con enfermedad de mama de una unidad de medicina familiar. Se determinaron las frecuencias de los síntomas mamarios en los grupos etarios < 19, 20-49, 50-69, > 70 años y los cocientes de probabilidad (LR) de cáncer de mama para cada síntoma, con un intervalo de confianza (IC) de 95 %. Resultados: casi todas las quejas derivaron de una masa o tumoración (71.7 %) y dolor mamario (67.7 %). Presentaron cáncer de mama 120 mujeres, con un promedio de edad de 53.51 + 12.7 años. La tumoración/masa en el seno tuvo un LR+ para cáncer de mama de 4.53 (IC 95 % = 2.51-8.17) y un LR+ para dolor mamario de 1.08, 95 % (IC 95 % = 1.05-1.11). Conclusiones: la presentación de la tumoración/masa predominó como queja en nuestra unidad y estuvo asociada con un LR+ para cáncer de mama.
Subject(s)
Breast Diseases/diagnosis , Breast Neoplasms/diagnosis , Adult , Aged , Family Practice , Female , Humans , Middle Aged , Primary Health Care , Young AdultABSTRACT
OBJECTIVE: To compare the clinical aptitude in preeclampsy and eclampsy attention in medical personnel that work in first level of attention. MATERIALS AND METHODS: A cross-sectional, prospective comparative study was performed to compare the clinical aptitude in pre-eclampsy and eclampsy attention in family practice physicians. A questionnaire comprising four clinical real cases, that belong to maternal death cases developed in the previous year of the study, was applied to 77 doctors that work at a familiar medicine unit. This questionnaire was formed by 109 statements, 54 were true correct answers and 55 were false correct answers. To compare the clinical aptitude among the group of physicians evaluated, a Kruskal-Wallis and U Mann-Whitney tests were used. RESULTS: In general any difference were observed in the clinical aptitude in pre-eclampsy and eclampsy according to the obtained academic degree and the antiquity at work (p = NS). The clinical aptitude level identified was the mean level, with a medium of 57 to 74 of a theoretical total of 109. CONCLUSIONS: The development grade about clinical aptitude that present family practice physicians was not the desirable, for the optimal attention in this pathology.
Subject(s)
Clinical Competence , Eclampsia , Family Practice , Pre-Eclampsia , Cross-Sectional Studies , Female , Humans , Pregnancy , Prospective Studies , Surveys and QuestionnairesABSTRACT
Objetivo: Comparar la aptitud clínica del médico de las Unidades de Medicina Familiar, en la atención de la diabetes mellitus. Material y métodos: Diseño transversal y comparativo. Se aplicó un instrumento de evaluación validado previamente por un grupo de expertos, a 78 médicos familiares que se desempeñan en el primer nivel detención. Dentro de los indicadores explorados con el instrumento de evaluación se incluyen: I Reconocimiento de factores de riesgo,II Reconocimiento de signos y síntomas, III Utilización e interpretación de recursos de laboratorio y gabinete, IV Integración diagnóstica, V Utilización de medidas terapéuticas y VI Medidas de seguimiento. Para el análisis estadístico, se utilizó la prueba de Kruskall-Wallis y la Ji cuadrada con un nivel de significancia de 0.05Resultados: El puntaje que correspondió a lo explicable por efectos del azar fue < 24 en la calificación global. De acuerdo a la escala utilizada, el 64 % (IC 95 % de 53a 70 %) de los resultados de las calificaciones, se ubicó en la escala baja (49-73) En general no hubo diferencias significativas en los resultados de la aptitud clínica por indicador y grado académico. De acuerdo a los objetivos del estudio, la asociación entre grado académico y aptitud clínica utilizándola Ji cuadrada fue de 1.331 (p=NS).Conclusiones: No se encontró diferencia estadísticamente significativa en la aptitud clínica entre los médicos generales, especialistas en medicina familiar y especialistas certificados (AU)
Objective: to compare the clinic aptitude of the doctor in the unities of familiar medicine in the care of the diabetes mellitus. Material and Methods: Transversal and comparative pattern. A evaluation previously validated by a group of experts was apply to 78 specialist in familiar medicine who redeem in the first level of attention. The indicators explored in the evaluation are. I recognition of cause of risk. II recognition of signs and symptoms. III utilization and interpretation of laboratory studies and consultation studies. IV diagnostic integration. V utilization of terapeutic measures and VI following measures. For the statistical analysis, it was used the Kruskall-Wallis and chi-square with a level of important of 0.05 Results: the points to the explainable for effects of chance were of < 24 in global grade. According to the scale used, the 64 % (IC 95 % de 53 a 70 %) of the results in the grades was situated in the low scale (49-73). In general it didn´t appear significative differences in the results of clinic aptitude by indicator and academic degree. According to objetives of the study, the association between academic degree and the clinic aptitude using the chi-square was 1.331 (p = NS) Conclusions: We didn´t find statistically significative difference in the clinic aptitude among the general doctors, specialists in familiar medicine and certificated specialist (AU)
Subject(s)
Diabetes Mellitus/psychology , Aptitude , Education, Medical/methods , Education, Medical/trends , Primary Health Care/ethics , Primary Health Care/methods , Competency-Based Education/organization & administration , Competency-Based Education/standards , Education, Medical , Education, Medical/organization & administration , Primary Health Care , Primary Health Care/organization & administration , Primary Health Care/trends , Demography , Competency-Based Education/trendsABSTRACT
The Bochdaleck's hernia is an anatomical defect of posterolateral region of the diaphragm that lets abdominal structures go inside the thorax. It has an incidence of 1 in 2000 to 5000 of newborn alive, without difference of sex. This defect is very common in the neonatal period and rare in adult age. We present a case of a male patient 32 years old, with the definitive diagnosis of Bochdalek hernia. The diagnosis was made by radiographic findings, with a few digestive symptoms. Confirmatory diagnosis was made by axial tomography computerized that found part of bowel in right hemithorax and pulmonary hypoplasy, with liver in situs solitus. The patient received medical treated only. The patient did not receive surgical treatment because it is supposed that this kind of treatment has more risks than benefits.
