Prevalencia y factores asociados a la adherencia al tratamiento no farmacológico en pacientes con hipertensión y diabetes en servicios de baja complejidad / Prevalence and factors associated with adherence to non-pharmacological treatment of hypertensive and diabetic patients at low complexity services / Prevalência e fatores associados à aderência ao tratamento não-farmacológico em pacientes com hipertensão e diabete em serviços de baixa complexidade

OBJETIVO: determinar la prevalencia y los factores relacionados con la adherencia no farmacológica en pacientes con hipertensión arterial (HTA) y diabetes mellitus (DM). METODOLOGIA: estudio observacional transversal en pacientes adultos mayores de 35 años con diagnóstico de HTA o DM, atendidos en un programa de Renoprotección en cuidado primario en Cali, Colombia. Se excluyeron aquellos pacientes con enfermedad renal crónica en estadío KDOQI 4-5, los que presentaran comorbilidades adicionales que deterioraran la función renal o con trastornos neuropsiquiátricos diagnosticados previamente. La adherencia no farmacológica se determinó mediante un cuestionario de autoreporte y los factores asociados a la misma se determinaron mediante regresión de Poisson con varianza robusta. RESULTADOS : la prevalencia de la adherencia no farmacológica fue de 9,4%. La inactividad física estuvo presente en 75% de los pacientes, y más del 19% de la población consumía sal frecuentemente. Entre los diabéticos, 18% consumía carbohidratos con frecuencia. Los hombres mostraron ser menos adherentes que las mujeres (RP: 0,21; p = 0,002). Los factores asociados positivamente con la adherencia no farmacológica fueron: estar estudiando, desempleado o pensionado (RP: 4,42; p = 0,019), recibir apoyo del equipo de salud (RP: 3,17; p = 0,032), tener diagnóstico de diabetes (RP: 7,79; p = 0,000) y la función renal en KDOQI-3 (RP: 5,14; p = 0,008). CONCLUSION: la adherencia no farmacológica fue muy baja en la población de estudio, en particular en relación con la inactividad física. Los factores asociados positivamente a la adherencia fueron el sexo femenino, tener una ocupación diferente al hogar, diagnostico de diabetes, enfermedad renal en KDOQI-3 y contar con apoyo del equipo de salud.

OBJECTIVE: To determine the prevalence and factors associated with adherence to non-pharmacological treatment in patients with high blood pressure (HBP) and diabetes mellitus (DM). METHODOLOGY: A cross-sectional and observational study conducted with adult patients older than 35, diagnosed with HBP or DM and receiving health care in a primary care renal protection program in Cali, Colombia. Patients with chronic kidney disease at the KDOQI 4-5 stage, additional comorbidities which impair the renal function or with previously diagnosed neuropsychiatric disorders were excluded. Adherence to non-pharmacological treatment was determined using a self-report questionnaire. Factors associated with adherence were obtained through a Poisson regression with robust variance. RESULTS : The prevalence of patient adherence was 9.4%.Physical inactivity was present in 75% of the patients and 19% of the population often consumed salt. Among the diabetics, 18% often consumed carbohydrates. Men showed less adherence than women (RP: 0.21; p = 0.002). Factors positively associated with adherence to non-pharmacological treatment were: being a student, unemployed or retired(RP: 4.42; p = 0.019), getting help from the health care team (RP: 3.17; p = 0.032), being diagnosed with diabetes (RP: 7.79; p = 0.000) and having the renal function in the KDOQI-3 stage (RP: 5.14; p = 0.008). CONCLUSION: Adherence to non-pharmacological treatment was very low in the studied population, particularly in relation to physical inactivity. The factors positively associated with treatment adherence were being female, not being a housewife, having diabetes, having a renal disease at the KDOQI-3 stage and having the support of a health care team.

OBJETIVO: Determinar a prevalência e os fatores ligados à aderência não-farmacológica em pacientes com hipertensão arterial (HTA) e diabetes mellitus (DM). METODOLOGIA: Estudo observacional transversal em pacientes adultos maiores de 35 anos com diagnóstico de HTA ou DM, atendidos em um programa de Renoproteção em cuidado primário em Cali, Colômbia.Foram excluídos aqueles pacientes com doença renal crônica em etapa KSOQI 4-5, aqueles com comorbilidades adicionais que deterioram a função renal ou com transtornos neuropsiquiátricos diagnosticados previamente.A aderência não farmacológica foi determinada por meio de um questionário de auto-relato e os fatores associados a ela foram determinados por meio de regressão de poisson com variância robusta. RESULTADOS: A prevalência da aderência não farmacológica foi de 9.4%.A inatividade física esteve presente em 75% dos pacientes e mais de 19% da população consumia sal frequentemente.Entre os diabéticos 18% consumia frequentemente carboidratos. Os homens mostraram ser menos aderentes do que as mulheres (RP: 0,21; p = 0,002). Os fatores associados positivamente à aderência não farmacológica foram os fatos de estarem estudando, desempregados ou aposentados(RP: 4,42; p = 0,019), receber apoio da equipe de saúde (RP: 3,17; p = 0,032), ter diagnóstico de diabetes (RP: 7,79; p = 0,000) e a função renal em KDOQI-3 (RP: 5,14; p = 0,008). CONCLUSÃO: Aderência não farmacológica foi muito baixa na população analisada, em particular em relação com a atividade física.Os fatores associados positivamente à aderência foram o gênero feminino, ter uma ocupação diferente do lar, diagnóstico de diabetes, doença renal em KDOQI-3 e contar com apoio da equipe de saúde.

¿Sería útil la depuración de los trastornos mentales comunes en pacientes hiperfrecuentadores de servicios de salud en cuidado primario? / Would the screening of common mental disorders in primary-care health services hyper-frequent patients be useful?

La hiperfrecuentación de servicios de salud constituye un problema para los pacientes, la familia y las instituciones. Este trabajo busca determinar la frecuencia y las características de los trastornos mentales comunes en pacientes hiperfrecuentadores de servicios que acudieron con síntomas y signos imprecisos a una institución prestadora de servicios de cuidado primario en la ciudad de Cali (Colombia) en 2007. Método: Estudio descriptivo transversal. Mediante una encuesta telefónica, que incluyó varios módulos del instrumento PRIME MD, se detectaron los trastornos mentales más frecuentes en pacientes hiperfrecuentadores. Resultado: Los hiperfrecuentadores de servicios son, en general, mujeres laboralmente activas, con edad promedio de 38,7 años. Acuden fundamentalmente por cefalea, pero tienen una alta prevalencia de trastornos mentales comunes (somatización, depresión y ansiedad), que no son fácilmente diagnosticados por los médicos en cuidado primario. Los valores monetarios de las actividades adicionales en salud que generan estos pacientes se atribuyen fundamentalmente a las consultas médicas y a los procedimientos que se les realizan. Conclusión: Considerar a los híper frecuentadores de servicios de salud como un grupo de riesgo para trastornos mentales comunes plantea su tamización como una estrategia eficiente para evitar el abuso de servicios y mejorar la satisfacción con la atención recibida...

Hyper-frequentation in health services is a problem for patients, their families and the institutions. This study is aimed at determining the frequency and characteristics of common mental disorders in hyper-frequent patients showing vague symptoms and signs at a primary healthcare service during the year 2007 in the city of Cali (Colombia). Methodology: Cross sectional. The most frequent mental disorders in hyper-frequent patients were detected through a telephone interview which included several modules of the PRIME MD instrument. Results: In general, healthcare service hyper-frequenters are working women, 38,7-year old in average. Basically, the consultation is due to cephalalgia but they also exhibit a high prevalence of common mental disorders (somatization, depression and anxiety) not easily diagnosed by physicians in primary care. Expenses for additional health activities generated by these patients are attributed basically to medical consultation and required procedures. Conclusion: Considering hyper-frequenters in health care services as a risk group in terms of common mental disorders involves screening as an efficient strategy to prevent abuse in service use and to improve satisfaction with the attention received...

Prevalencia de trastornos mentales en una población que demanda servicios de salud en una IPS de baja complejidad y su asociación con la ideación suicida y la discapacidad percibida / Prevalence of mental disorders in a population requesting health services at a primary health care center and its association with suicidal ideation and perceived disability

Objetivo: conocer los trastornos mentales más frecuentes y el impacto en la percepción de discapacidad e ideación suicida en una Institución prestadora de servicios de salud de baja complejidad en Cali. Metodología: se realizó un estudio transversal con 254 pacientes a los que se les aplicó el instrumento prime-md. En el análisis se utilizó estadística descriptiva para determinar los trastornos más frecuentes y un análisis múltiple por regresiones logística y de Poisson con varianza robusta para determinar la influencia de los trastornos mentales en la discapacidad e ideación suicida. Resultados: la mayoría de los pacientes eran del sexo femenino, adultos jóvenes y maduros. La depresión estuvo presente en 66.8% de los casos, seguido del trastorno de somatización y la ansiedad. Casi la mitad de los pacientes habían tenido ideas suicidas alguna vez en la vida y 3 de cada 4 refirieron algún tipo de discapacidad. Después de ajustar por covariables, los trastornos ansiosos-depresivos mostraron una alta asociación con la ideación suicida y la discapacidad percibida, que es sobrestimada por la regresión logística. Conclusión: la depresión y la ansiedad son los trastornos mas frecuentes y tienen una alta asociación con la ideación suicida y la discapacidad y es por esto necesario realizar tamizaciones en la atención del adulto en servicios de baja complejidad. Se recomienda considerar el uso de la regresión de Poisson con varianza robusta en los estudios transversales en los servicios de salud.

OBJECTIVE: this study's goal was to determine the most prevalent mental disorders and the impact on the perception of disability and suicidal ideation among the population from a primary health care center in the city of Cali.METHODOLOGY: a cross sectional study was conducted on 254 patients who were screened with the PRIME–MD instrument. Descriptive statistics was used in the analysis to determine the most frequent disorders. Similarly, a multiple analysis with logistic and Poisson regressions using robust variance was conducted to determine the influence of mental disorders on disability and suicidal ideation.RESULTS: most patients were female, young, and mature adults. Depression was present in 66,8% of all cases, followed by somatization disorder and anxiety. Half of the patients had had suicidal ideations at some point in their lives, and three out of four patients claimed to suffer from some kind of disability. Upon adjusting for the covariables, depression and anxiety disorders had a strong association with suicidal ideation and perceived disability that was overestimated by the logistic regression.CONCLUSION: depression and anxiety were the most common disorders and showed a strong association with suicidal ideation and disability. This is why it is necessary to screen for those disorders among adults using primary health care services. Likewise, we suggest considering Poisson regression with robust variance in cross–sectional studies in health services.

[Would the Screening of Common Mental Disorders in Primary-Care Health Services Hyper-Frequent Patients Be Useful?]. / ¿Sería útil la depuración de los trastornos mentales comunes en pacientes hiperfrecuentadores de servicios de salud en cuidado primario?

UNLABELLED: Hyper-frequentation in health services is a problem for patients, their families and the institutions. This study is aimed at determining the frequency and characteristics of common mental disorders in hyper-frequent patients showing vague symptoms and signs at a primary healthcare service during the year 2007 in the city of Cali (Colombia). METHODOLOGY: Cross sectional. The most frequent mental disorders in hyper-frequent patients were detected through a telephone interview which included several modules of the PRIME MD instrument. RESULTS: In general, healthcare service hyper-frequenters are working women, 38,7-year old in average. Basically, the consultation is due to cephalalgia but they also exhibit a high prevalence of common mental disorders (somatization, depression and anxiety) not easily diagnosed by physicians in primary care. Expenses for additional health activities generated by these patients are attributed basically to medical consultation and required procedures. CONCLUSION: Considering hyper-frequenters in health care services as a risk group in terms of common mental disorders involves screening as an efficient strategy to prevent abuse in service use and to improve satisfaction with the attention received.

[Physical and chemical characterization of industrial nixtamalized corn flour for human consumption in Central America]. / Caracterización física y química de harinas industriales nixtamalizadas de maíz de consumo humano en América Central.

The objective of this study was the characterization of industrial nixtamalized maize flour for human consumption and which are marketed in Central America for some selected physical and chemical properties which may contribute to food composition information and help nutrition and micronutrient fortification programs. A total of 12 brands purchased in triplicate were obtained from supermarkets in Guatemala, El Salvador and Honduras. These samples were kept under refrigeration until analyzed. The physical parameters measured and results were the following: particle size with most samples having a high percentage of particles greater than 60 mesh, pH (5.4-7.5), water absorption index (WAI) (3.4-4.0 g gel/g sample), water soluble index (WSI) (4.8-7.8 g/100 g) and flour density (0.410-0.547 g/ml). The differences were statistically significant for all parameters measured, except for WAI. The chemical characteristics included, moisture, protein, fat, ash and dietetic fiber. Differences between flour samples were statistically significant except for fat content. Protein content was low, ranging between 6.7-8.1 g/100 g and total dietary fiber varied between 7.7-12.0 g/100 g. The samples were analyzed for phytic acid with a variation from 632 to 903 mg/100 g, with statistical significant differences. The samples were also analyzed for total and soluble (pH 7.5) iron, phosphorus, calcium, potassium, zinc, copper, manganese, and magnesium. The difference in the iron and calcium content between flour samples were statistically significant. The physical and chemical variability found between flour samples of nixtamalized maize was relatively high and it is recommended to establish quality standards through raw material and process standardization for greater effectiveness of nutrition programs and activities on micronutrient fortification which may be pursued in the future.