Health care utilization of mexican patients with medically unexplained physical symptoms.

OBJECTIVE: To determine the prevalence of medically unexplained physical symptoms and the characteristics and use of health services in a group of patients with medically unexplained physical symptoms and a group of patients with other illnesses. METHODS: This was a cross-sectional, retrospective and multicenter study. We included 1,043 patients over 18 years of age from 30 primary care units of a government health institution, in 11 states of Mexico, attended by 39 family physicians. The prevalence of medically unexplained physical symptoms was determined and both groups with or without symptoms were compared with regard to drug use, laboratory and other studies, leaves of absence, and referrals in the last six months. The group with medically unexplained physical symptoms was diagnosed using the Patient Health Questionnaire and the diagnostic criteria of Reid et al. Emergency or terminal illnesses were excluded. The chi square test was used with a statistical significance of p < 0.05. RESULTS: Medically unexplained physical symptoms was diagnosed in 73 patients (7.0%). The majority were women (91.8%); their predominant symptom was from the gastrointestinal system in 56 (76.7%). This group had a greater use of clinical studies and referrals to other services (mean 1.1 vs. 0.5; p <0.0001 and 0.6 vs. 0.8; p < 0.01, respectively). CONCLUSIONS: The prevalence of medically unexplained physical symptoms was low, but with a greater impact on some health services. This could represent an overload in medical costs. OBJETIVO: Determinar la prevalencia de Síntomas Físicos Medicamente No Explicables y las características y uso de los servicios de salud entre el grupo de pacientes con Síntomas Físicos Medicamente No Explicables, y el grupo con otras enfermedades. MÉTODOS: Estudio transversal, retroprospectivo y multicéntrico. Se incluyeron a 1,043 pacientes mayores de 18 años, en 30 unidades de atención primaria de una institución gubernamental en salud, en 11 estados de la República Mexicana, atendidos por 39 médicos familiares. Se estimó la prevalencia de Síntomas Físicos Medicamente No Explicables y se compararon los dos grupos con y sin estos síntomas, en cuanto al uso de medicamentos, estudios de laboratorio, de gabinete, incapacidades y referencias en los últimos seis meses. El grupo de Síntomas Físicos Medicamente No Explicables fue diagnosticado por el Patient Health Questionnaire (son los síntomas físicos más comúnmente referidos por estos pacientes en el primer nivel de atención), además de criterios diagnósticos de Reid et al. Se excluyeron urgencias o con enfermedad terminal. Se utilizó prueba Chi cuadrada con p <0.05 para significancia estadística. RESULTADOS: El 7.0% (73) se diagnosticó como Síntomas Físicos Medicamente No Explicables, la mayoría mujeres (91.8%); el síntoma predominante pertenece al sistema gastrointestinal con 76.7% (56). Este grupo demandó mayor uso de estudios de gabinete y referencias a otros servicios (media 1.1 vs. 0.5; p <0.0001 y 0.8 vs 0.6; p <0.01, respectivamente). CONCLUSIONES: La prevalencia de Síntomas Físicos Medicamente No Explicables fue baja, pero con impacto significativo en el uso de algunos servicios de salud. Esto pudiera representar un mayor costo comparado con otro grupo de pacientes.

Health care utilization of mexican patients with medically unexplained physical symptoms / Uso de los servicios de salud de pacientes mexicanos con síntomas físicos medicamente inexplicables

Abstract Objective: To determine the prevalence of medically unexplained physical symptoms and the characteristics and use of health services in a group of patients with medically unexplained physical symptoms and a group of patients with other illnesses. Methods: This was a cross-sectional, retrospective and multicenter study. We included 1,043 patients over 18 years of age from 30 primary care units of a government health institution, in 11 states of Mexico, attended by 39 family physicians. The prevalence of medically unexplained physical symptoms was determined and both groups with or without symptoms were compared with regard to drug use, laboratory and other studies, leaves of absence, and referrals in the last six months. The group with medically unexplained physical symptoms was diagnosed using the Patient Health Questionnaire and the diagnostic criteria of Reid et al. Emergency or terminal illnesses were excluded. The chi square test was used with a statistical significance of p < 0.05. Results: Medically unexplained physical symptoms was diagnosed in 73 patients (7.0%). The majority were women (91.8%); their predominant symptom was from the gastrointestinal system in 56 (76.7%). This group had a greater use of clinical studies and referrals to other services (mean 1.1 vs. 0.5; p <0.0001 and 0.6 vs. 0.8; p < 0.01, respectively). Conclusions: The prevalence of medically unexplained physical symptoms was low, but with a greater impact on some health services. This could represent an overload in medical costs....au

Resumen Objetivo: Determinar la prevalencia de Síntomas Físicos Medicamente No Explicables y las características y uso de los servicios de salud entre el grupo de pacientes con Síntomas Físicos Medicamente No Explicables, y el grupo con otras enfermedades. Métodos: Estudio transversal, retroprospectivo y multicéntrico. Se incluyeron a 1,043 pacientes mayores de 18 años, en 30 unidades de atención primaria de una institución gubernamental en salud, en 11 estados de la República Mexicana, atendidos por 39 médicos familiares. Se estimó la prevalencia de Síntomas Físicos Medicamente No Explicables y se compararon los dos grupos con y sin estos síntomas, en cuanto al uso de medicamentos, estudios de laboratorio, de gabinete, incapacidades y referencias en los últimos seis meses. El grupo de Síntomas Físicos Medicamente No Explicables fue diagnosticado por el Patient Health Questionnaire (son los síntomas físicos más comúnmente referidos por estos pacientes en el primer nivel de atención), además de criterios diagnósticos de Reid et al. Se excluyeron urgencias o con enfermedad terminal. Se utilizó prueba Chi cuadrada con p <0.05 para significancia estadística. Resultados: El 7.0% (73) se diagnosticó como Síntomas Físicos Medicamente No Explicables, la mayoría mujeres (91.8%); el síntoma predominante pertenece al sistema gastrointestinal con 76.7% (56). Este grupo demandó mayor uso de estudios de gabinete y referencias a otros servicios (media 1.1 vs. 0.5; p <0.0001 y 0.8 vs 0.6; p <0.01, respectivamente). Conclusiones: La prevalencia de Síntomas Físicos Medicamente No Explicables fue baja, pero con impacto significativo en el uso de algunos servicios de salud. Esto pudiera representar un mayor costo comparado con otro grupo de pacientes...au

[Demographic factors and comorbidity associated to prehypertension]. / Factores demográficos y de comorbilidad asociados a prehipertensión arterial.

BACKGROUND: prehypertension is the category established in JNC-7, which designates the individuals that present diastolic blood pressure of 80-89 mm Hg and systolic blood pressure of 120-139 mm Hg, and it is associated to high rates of cardiovascular disease. The purpose of the study was to identify prevalence rates and their correlation with sociodemographic factors and comorbidity in a sample of a population of Veracruz, Mexico. METHODS: a cross-sectional and representative survey was chosen by means of probability sampling. Sociodemographic factors, lifestyle and anthropometric characteristics were assessed. Odds ratios and 95 % confidence intervals were obtained. RESULTS: the prehypertension prevalence found was 33.8 %, with an average age of 40.9 ± 14.2 years in prehypertensive subjects, and 50.6 ± 12.7 in hypertension subjects (p < 0.05). In relation with prehypertension, males presented a 1.48 (1.18-1.86) OR. Also, those who had more than 40 years had an OR of 1.9 (1.51-2.38); the ones with basic schooling, an OR of 1.73 (1.38-2.17); subjects with hyperglycemia, OR 3.0 (1.5-3.75); with overweight, OR 1.41 (1.01-1.68); and those with other comorbidities an OR of 1.61 (1.09-2.36). CONCLUSIONS: a high prevalence of prehypertension was found in the sample, and it was associated to male gender subjects, aged above 40 years, with basic schooling and relevant comorbidities, such as diabetes and cardiovascular disease.

Introducción: la prehipertensión arterial es la categoría establecida en el JNC-7 para definir las cifras de presión arterial diastólica de 80-89 y sistólica de 120-139 mm Hg que se asocian a riesgo cardiovascular. El objetivo del estudio fue determinar su prevalencia y su asociación con factores sociodemográficos y de comorbilidad en una muestra representativa de la población del estado de Veracruz. Métodos: por medio de muestreo probabilístico y una encuesta transversal, se registraron variables sociodemográficas, estilo de vida, antropometría, presión arterial y glucosa. Se obtuvieron razones de momios (RM) e intervalos de confianza (IC) del 95 % para los factores de riesgo mencionados. Resultados: la prevalencia de prehipertensión fue de 33.8 %, con edad promedio de 40.9 ± 14.2 años en prehipertensos y 50.6 ± 12.7 en hipertensos (p < 0.05). Para prehipertensión, el sexo masculino presentó RM de 1.48 (1.18-1.86). Asimismo, aquellos mayores de 40 años tuvieron una RM de 1.9 (1.51-2.38); los que tenían escolaridad básica, RM de 1.73 (1.38-2.17); aquellos con hiperglucemia de ayuno, RM de 3.0 (1.5-3.75); con sobrepeso, RM de 1.41 (1.01-1.68); y con otras comorbilidades, una RM de 1.61 (1.09-2.36). Conclusiones: se encontró una elevada prevalencia de prehipertensión en esta muestra de la población y su asociación de riesgo fue con las personas de sexo masculino que eran mayores de 40 años y que tenían escolaridad básica y comorbilidades como diabetes y enfermedad cardiovascular.

[Clinical effect of lifestyle modification on cardiovascular risk in prehypertensives: PREHIPER I study]. / Eficacia clínica de la modificación del estilo de vida en el riesgo cardiovascular en prehipertensos: estudio PREHIPER I.

The objective was to determine the effect of lifestyle modification on cardiovascular risk in individuals with prehypertension, which is defined as a systolic blood pressure between 120 mmHg and 139 mmHg and a diastolic pressure between 80 mmHg and 89 mmHg. A randomized clinical trial was carried out in prehypertensives to compare those who took part in a program involving dietary modification, physical activity and educational sessions with those who followed normal recommendations. Cardiovascular risk was evaluated using the Framingham risk score and the chi-squared test, the Mann-Whitney U-test and the Friedman test. The mean Framingham score in the intervention group decreased from 5 (rank, -10 to 12) to 3.5 (rank, -11 to 10; P< .05) and the probability of a cardiovascular event at 10 years decreased from 5.29+/-3.88 to 4.24+/-2.86 (P< .05). This improvement was associated with a relative risk of 0.30 (95% confidence interval, 0.11 to 0.83) and a relative risk reduction of -69.8% (95% confidence interval -89% to -16.9%). There was no change in control subjects. Lifestyle modification decreased cardiovascular risk in individuals with prehypertension.

Eficacia clínica de la modificación del estilo de vida en el riesgo cardiovascular en prehipertensos: estudio PREHIPER I / Clinical effect of lifestyle modification on cardiovascular risk in prehypertensives: PREHIPER I study

El objetivo del estudio es determinar la eficacia de modificar el estilo de vida en el riesgo cardiovascular de los prehipertensos (pacientes con presión arterial sistólica entre 120 y 139 mmHg y diastólica entre 80 y 89 mmHg). Se realizó un ensayo clínico aleatorizado en prehipertensos sometidos a programa de dieta, actividad física y sesiones educativas, y se lo comparó con las recomendaciones habituales. El riesgo cardiovascular se evaluó con las tablas de Framingham y se utilizó las pruebas de la c2, de la U de Mann-Whitney y de Friedman. La puntuación de Framingham disminuyó en el grupo experimental de 5 (rango de -10 a 12) a 3,5 (-11 a 10) (p < 0,05) y la probabilidad de eventos cardiovasculares a 10 años, de 5,29 ± 3,88 a 4,24 ± 2,86 (p < 0,05), RR = 0,3 (IC del 95%, 0,11-0,83), RRR = -69,8% (IC del 95%, -89% a -16,9%). En los controles no se modificó. La modificación del estilo de vida disminuyó el riesgo cardiovascular en prehipertensos (AU)

The objective was to determine the effect of lifestyle modification on cardiovascular risk in individuals with prehypertension, which is defined as a systolic blood pressure between 120 mmHg and 139 mmHg and a diastolic pressure between 80 mmHg and 89 mmHg. A randomized clinical trial was carried out in prehypertensives to compare those who took part in a program involving dietary modification, physical activity and educational sessions with those who followed normal recommendations. Cardiovascular risk was evaluated using the Framingham risk score and the chi-squared test, the Mann-Whitney U-test and the Friedman test. The mean Framingham score in the intervention group decreased from 5 (rank, -10 to 12) to 3.5 (rank, -11 to 10; P<.05) and the probability of a cardiovascular event at 10 years decreased from 5.29±3.88 to 4.24±2.86 (P<.05). This improvement was associated with a relative risk of 0.30 (95% confidence interval, 0.11 to 0.83) and a relative risk reduction of -69.8% (95% confidence interval -89% to -16.9%). There was no change in control subjects. Lifestyle modification decreased cardiovascular risk in individuals with prehypertension (AU)

[Quality life in climateric women with and without hormonal replacement therapy?]. / Calidad de vida en mujeres climatéricas con y sin terapia hormonal de reemplazo.

OBJECTIVE: To compare quality of life in climacterical women with and without hormone replacement therapy. MATERIAL AND METHODS: A cross-sectional analytical study was carried out in the Family Medicine Unit number 61 in Veracruz, Veracruz. There were chosen 102 women between 40 and 60 years old. There were two groups: the first one with 51 patients with hormone replacement therapy during the last year; the second one with 51 patients who are not in hormone replacement therapy. Coop/wonca charts were used to measure quality of life. A complementary questionnaire related to climacteric period and menopause was answered by both groups. Statistical test with chi2 was carried out. RESULTS: Health condition and satisfactory sexual life were improved in patients with hormone replacement therapy (30 versus 19, p = 0.007; and 40 cases versus 30, p = 0.04, respectively). No significantly differences were found in six from seven coop/wonca charts. CONCLUSIONS: There were no impact results in climacteric and menopause women. However, a better health condition and satisfactory sexual life were observed in patients with hormonal replacement therapy.