ABSTRACT
OBJECTIVE: To analyze the frequency and costs of hospitalary care due to fractures in postmenopausal period occurred in Instituto Mexicano del Seguro Social (IMSS). MATERIAL AND METHOD: Study about hospitalary discharges in IMSS, among 2000-2001, with diagnosis of hip, distal forearm and vertebral fractures, with an analysis by sex and age groups. To estimate hospitalary costs, we utilized the data of Grupos Relacionados de Diagnóstico (GRD) used in IMSS. The cost for each case was $46,965.30 mexican pesos ($5,101.63 U.S.D.). RESULTS: It were registered 22,157 (8.2%) were fractures of the selected types. Of this number, 15,925 ocurred in persons of 50 years and more y 11,084 (69.6%) in postmenopausal women. The mentioned fractures were more frequent in men before 50 years with a proportion of 1.9 to 1. This proportion changed from 2 to 1 in women after 50 years. These differences were statistically significant. The cost of hospitalary care of hip fracture in postmenopausal women was $336,658.097 mexican pesos ($36' 593,271 U.S.D.) in the two years of the study. CONCLUSION: It is convenient to make costs-benefits evaluation about preventive resources, as widespread use of HRT, to reduce the frequency of fractures in postmenopausal women, due its high actual costs of hospitalary care.
Subject(s)
Fractures, Spontaneous/economics , Fractures, Spontaneous/therapy , Postmenopause , Adult , Aged , Aged, 80 and over , Costs and Cost Analysis , Cross-Sectional Studies , Female , Fractures, Spontaneous/epidemiology , Hospitalization/economics , Humans , Mexico , Middle Aged , Social SecurityABSTRACT
OBJECTIVE: To analyze the level of knowledge concerning climateric and menopause among family physicians and gynecologists and obstetricians of the Instituto Mexicano del Seguro Social (IMSS), after a training process in institutional technical guidelines and in educational content for population. We also analyze possible changes in frequency of medical attention for climateric and menopause in the first level of medical care. MATERIAL AND METHODS: Prospective and descriptive study on 1) results of the knowledge evaluation by means of 23 questions with multiple answers, and 2) analysis of rates of medical care for menopausal and perimenopausal disturbances (N95 code, X Revision, IDC) from 1995 to 2000. RESULTS: The percentage of correct answers prior to training was 62.2 for family physicians and 65.9 for gynecologists and obstetricians; after training, 79.3 and 81.4, respectively. Both groups had on increase in knowledge levels (p < 0.001) but there were no differences among them. An increase was registered in medical care rates for menopausal and perimenopausal disturbances in the group from 45 to 64 years of age in the period from 1995 to 2000. CONCLUSIONS: All physicians had on increase in knowledge on climateric and menopause issues but without differences among them, probably because the care of this health problem is referred to specialized services and as well as to more attention on other more frequent problems in women's health. In addition, we did not find changes yet in the rates of medical attentions attributable to training and information to population.
Subject(s)
Climacteric , Clinical Competence , Menopause , Family Practice , Female , Gynecology , Humans , Mexico , Obstetrics , Prospective Studies , Social Security , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To analyze the level of knowledge concerning climateric and menopause among family physicians and gynecologists and obstetricians of the Instituto Mexicano del Seguro Social (IMSS), after a training process in institutional technical guidelines and in educational content for population. We also analyze possible changes in frequency of medical attention for climateric and menopause in the first level of medical care. MATERIAL AND METHODS: Prospective and descriptive study on 1) results of the knowledge evaluation by means of 23 questions with multiple answers, and 2) analysis of rates of medical care for menopausal and perimenopausal disturbances (N95 code, X Revision, IDC) from 1995 to 2000. RESULTS: The percentage of correct answers prior to training was 62.2 for family physicians and 65.9 for gynecologists and obstetricians; after training, 79.3 and 81.4, respectively. Both groups had on increase in knowledge levels (p < 0.001) but there were no differences among them. An increase was registered in medical care rates for menopausal and perimenopausal disturbances in the group from 45 to 64 years of age in the period from 1995 to 2000. CONCLUSIONS: All physicians had on increase in knowledge on climateric and menopause issues but without differences among them, probably because the care of this health problem is referred to specialized services and as well as to more attention on other more frequent problems in women's health. In addition, we did not find changes yet in the rates of medical attentions attributable to training and information to population.
Subject(s)
Female , Humans , Climacteric , Clinical Competence , Menopause , Family Practice , Gynecology , Mexico , Obstetrics , Prospective Studies , Surveys and Questionnaires , Social SecurityABSTRACT
Objetivo: Investigar experiencias y conocimientos sobre climaterio y menopausia, en mujeres derechohabientes del Instituto Mexicano del Seguro Social (IMSS), con el fin de obtener información para planear estrategias educativas que incrementen la demanda de atención en estos periodos.Material y métodos: estudio transversal y descriptivo mediante encuestas, en una muestra aleatoria simple de 495 mujeres de 50 a 59 años, usuarias de los servicios de medicina familiar en el Distrito Federal, representativa de esta población y ámbito con un nivel de confianza del 95 por ciento.Resultados: La edad promedio a la menopausia fue de 47.8 años. Los síntomas más frecuentes fueron bochornos (70.9 por ciento), depresión (60.2 por ciento), insomnio (53.5 por ciento) e irregularidades menstruales (37.8 por ciento); 51.1 por ciento de las mujeres solicitaron atención médica; solo 12.1 por ciento estaba recibiendo actualmente tratamiento, que consistía en hormonales en 81.6 por ciento.Alguna vez habían usado tratamiento 14.9 por ciento de las encuestadas, hormonales en 87.8 por ciento. El 83.8 por ciento de las mujeres conocía los síntomas del climaterio; 90.1 por ciento a la osteoporosis como una complicación postmenopáusica y 37.2 por ciento declaró saber del riesgo de enfermedad cardiovascular.La prevención de la osteoporosis y de la enfermedad coronaria la asociaron con calcio y ejercicio, pero solo 1 por ciento con el uso de hormonales.Conclusiones: Existe aceptable información sobre climatérico y osteoporosis postmenopáusica, pero menor en cuanto a enfermedad cardiovascular. La información declarada parece ser producto de la información comercial por medios masivos de comunicación más que de la educación en salud que proporcionan las instituciones.
Subject(s)
Humans , Female , Middle Aged , Cities , Climacteric , Health Knowledge, Attitudes, Practice , Menopause , Mexico , Health Education , Health Services Needs and Demand , Social Security , Health StrategiesABSTRACT
Objetivo: debido a la elevada frecuencia de cesáreas en el IMSS, se realizó un estudio para conocer indicaciones y justificación.Material y método: estudio transversal y retrospectivo en una muestra al azar simple nacional de 3,232 cesáreas entre junio de 1997 y junio de 1999. Resultados: las indicaciones más frecuentes fueron desproporción cefalopélvica (29.6 por ciento), cesárea previa (20.9 por ciento), sufrimiento fetal agudo (14.1 por ciento), cesárea iterativa (11.9 por ciento) y ruptura prematura de membranas (10.7 por ciento). En casos de desproporción cefalopélvica (DCP) el peso promedio de los productos al nacer fue 3,430g., 70.6 por ciento tenía contractilidad irregular y 21.7 por ciento recibió oxitocina; 78.2 por ciento tuvieron membranas íntegras y dilatación cervical de 4 cm o menor. En los casos de cesárea previa y DCP, el peso de los recién nacidos fue de 3,425 g; 81.7 por ciento de las pacientes tenían contractilidad irregular y 4.8 por ciento recibieron oxitocina. En las cesáreas por sufrimiento fetal agudo, 94.9 por ciento de los productos tuvieron Apgar de 8 o más a los 5 minutos.Conclusión: las indicaciones de cesárea en el IMSS son similares a lo informado en México y el mundo, pero con los datos existentes en los expedientes clínicos de este estudio, en la mayoría de los casos no se justifican.
