Instituto Nacional De Neurologia Research Articles

Pre-hospitalization, hospitalization, and post-hospitalization costs of patients with neurocysticercosis treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City, Mexico.

ABSTRACTThe objective of this study was to estimate the direct costs associated with the diagnosis and treatment of neurocysticercosis (NCC) during pre-hospitalization, hospitalization, and post-hospitalization periods for 108 NCC patients treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City, Mexico. Information on clinical manifestations, diagnostic tests, hospitalizations, surgical procedures, prescription medication, and other treatments was collected via medical chart reviews. Uncertain values for costs and frequency of treatments were imputed using bootstrap techniques. The average per-patient pre-hospitalization and hospitalization costs were US$ 257 (95% CI: 185 – 329) and US$ 2,576 (95% CI: 2,244 – 2,908), respectively. Post-hospitalization costs tended to decrease over time, with estimates for the first five years post-hospitalization of US$ 475 (95% CI: 423 – 527), US$ 228 (95% CI: 167 – 288), US$ 157 (95% CI: 111 – 202), US$ 150 (95% CI: 106 – 204), and US$ 91 (95% CI: 27 – 154), respectively. NCC results in a significant economic burden for patients requiring hospitalization, with this burden continuing years post-hospitalization.

Estresores laborales del personal de enfermería de un Hospital de Alta Especialidad en México

Introducción: el profesional de enfermería se expone diariamente con situaciones que pueden ser generadoras de estrés como lo es la confrontación con la muerte, el sufrimiento de las personas, la carga de trabajo y los posibles conflictos con el personal interdisciplinario. La presente investigación se realizó en el Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez ubicado al sur de la Ciudad de México el cual brinda atención de tercer nivel. Objetivo: identificar el nivel de estrés y los estresores laborales a los que están expuestos los enfermeros. Metodología: se realizó un estudio transversal y descriptivo, la muestra fueron 50 enfermeros adscritos a los servicios de hospitalización los cuales contestaron un instrumento autoaplicacble conformado por 32 preguntas cerradas en escala de Lickert. Resultados: el 52% de los enfermeros tiene un nivel de estrés moderado, el 46% tiene un nivel de estrés bajo frente al 2% que tiene un nivel de estrés alto. Los tres agentes estresores con medias más altas fueron en primer lugar realizar procedimientos dolorosos para el paciente (X = 1.88), en segundo lugar mirar sufrir a un paciente y terminar adolorido después de una jornada de trabajo (X = 1.82), el tercer lugar lo ocupa la falta de personal adecuado para cubrir la unidad (X = 1.7). Conclusiones: en este estudio se logró identificar los agentes estresores laborales más comunes así como el nivel de estrés al que está expuesto el personal de enfermería de las áreas de hospitalización, el cual es producto de las situaciones que viven a diario para realizar sus intervenciones a favor del paciente esto lo expone a tener un nivel de estrés moderado, lo cual podría perjudicar su salud, pudiendo provocar una disminución en el desempeño sobre la calidad de las tareas que se realizan.

SA103. Compensatory Cognitive Training in High-Risk Latino Youth

Abstract Background: Latinos have more difficulty accessing mental health services and are less likely to obtain the necessary care when they do receive treatment. When Latinos obtain services for mental health disorders, they are significantly more likely than other clients to receive them in primary care settings rather than in specialized mental health settings. Our pilot randomized clinical trial (RCT) of an innovative Compensatory Cognitive Training (CCT) program for Latino individuals Compensatory Cognitive Training (CCT) is a novel treatment approach for Clinical High Risk (CHR). CCT has been used successfully in chronic schizophrenia, but studies of cognitive remediation are only beginning to be performed in the early period of illness. If successful, our RCT will provide empirical support for a lower risk, broad-spectrum treatment that could have important implications for public health by improving neurocognition and functional outcome and focusing on the underserved Latino population. Methods: All participants completed 12 weeks of CCT versus recreational therapy (RT) either at the University of California, San Diego, or Instituto Nacional de Neurologia y Neurocirugia (INNN). Feasibility was assessed based on the proportion of identified eligible participants versus enrolled participants and session attendance. Tolerability was assessed based on participant feedback. Results: UCSD identified 19 eligible participants of which 7 (37%) enrolled in the study and began groups. INNN identified 9 eligible participants, of which 4 (44%) enrolled in the study and began groups. Individuals at UCSD attended 75% of sessions while was 100% at INNN. Qualitative feedback from UCSD participants indicated groups were well tolerated. Participants who declined to enroll in the groups cited a lack of time and/or interest as their reason for declining. Conclusion: Identifying eligible and interested participants has limited the progress of the current study. This challenge supports the historical finding that Latino participants are less likely to seek treatment for mental health issues. However, those who did enroll showed consistent attendance and high engagement. The low enrollment may have been compounded by the stigmatization of mental health issues and treatment seeking. Previous studies have cited many issues with logistics as a barrier to accessing care, in our sample these were not reported as a reason to decline enrollment.

Cost of neurocysticercosis patients treated in two referral hospitals in Mexico City, Mexico.

To estimate annual costs related to the diagnosis, treatment and productivity losses among patients with neurocysticercosis (NCC) receiving treatment at two referral hospitals, the Instituto Nacional de Neurologia y Neurocirugia (INNN) and the Hospital de Especialidades of the Instituto Mexicano del Seguro Social (HE-IMSS), in Mexico City from July 2007 to August 2008. Information on presenting clinical manifestations, diagnostic tests, hospitalisations, surgical procedures and other treatments received by NCC outpatients was collected from medical charts, and supplemented by an individual questionnaire regarding productivity losses and out-of-pocket expenses related to NCC. The annual average per-patient direct costs were US$ 503 (95% CI: 414-592) and US$ 438 (95% CI: 322-571) for patients without a history of hospitalisation and/or surgery seen at the INNN and the HE-IMSS, respectively. These costs increased to US$ 2506 (95% CI: 1797-3215) and US$ 2170 (95% CI: 1303-3037), respectively, for patients with a history of hospitalisation and/or surgery. The average annual per-patient indirect costs were US$ 246 (95% CI: 165-324) and US$ 114 (95% CI: 51-178), respectively, using minimum salary wages for individuals not officially employed. The total annual cost for patients who had and had not been hospitalised and/or undergone a surgical procedure for the diagnosis or treatment of NCC corresponded to 212% and 41% of an annual minimum wage salary, respectively. The disease tends to affect rural socioeconomically disadvantaged populations and creates health disparities and significant economic losses in Mexico.

Depresión en personas con EVC en los Servicios de Hospitalización en el INNyN "Manuel Velasco Suárez"

La enfermedad vascular cerebral (EVC) ha sido relacionada con la depresión por diversos factores, a partir del tipo y localización en que se presenta y por las secuelas que sufren estos enfermos, modificando su calidad de vida y su bienestar. México se encuentra en el tercer lugar de mortalidad en complicaciones por diabetes e hipertensión, factor importante para desencadenar enfermedad vascular cerebral, lo que impide el autocuidado, teniendo como consecuencia periodos de depresión. Este padecimiento se va acrecentando con el tiempo; actualmente existen estudios que comprueban su presencia en el periodo de recuperación de los enfermos. Objetivo: Indagar si existe depresión en personas con enfermedad vascular cerebral, en los Servicios de Neurología, Neurocirugía, 2° Piso y Urgencias en el Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez" e identificar las causas principales desencadenantes de la depresión en los pacientes con EVC en los Servicios de Hospitalización, así como determinar la causa de mayor incidencia en los pacientes con EVC y aportar estrategias para la prevención y disminución de la depresión. Metodología: Estudio cuantitativo con diseño observacional, descriptivo y transversal. Se utilizó el inventario de Beck y se aplicó un breve cuestionario para cumplir con los objetivos planteados sobre la identificación de las causas de depresión. Finalmente, se hizo un análisis con el paquete estadístico SPSS versión 16, con prueba estadística de correlación biserial puntual. Conclusiones: Con este panorama, es necesario que la enfermería continúe su desarrollo en investigación, identificando los problemas actuales de salud. El conocimiento de dichos problemas nos beneficiará, evitando mayores complicaciones. Al mostrar en este estudio los factores que determinan la depresión en personas con EVC, se podrá mejorar la calidad de los cuidados brindados.

Neurocysticercosis, a Persisting Health Problem in Mexico

BackgroundThe ongoing epidemiological transition in Mexico minimizes the relative impact of neurocysticercosis (NC) on public health. However, hard data on the disease frequency are not available.MethodologyAll clinical records from patients admitted in the Instituto Nacional de Neurologia y Neurocirugia (INNN) at Mexico City in 1994 and 2004 were revised. The frequencies of hospitalized NC patients in neurology, neurosurgery and psychiatry services, as well as NC mortality from 1995 through 2009, were retrieved. Statistical analyses were made to evaluate possible significant differences in frequencies of NC patients' admission between 1994 and 2004, and in yearly frequencies of NC patients' hospitalization and death between 1995 and 2009.Principal FindingsNC frequency in INNN is not significantly different in 1994 and 2004. Between these two years, clinical severity of the cases diminished and the proportion of patients living in Mexico City increased. Yearly frequencies of hospitalization in neurology and psychiatry services were stable, while frequencies of hospitalization in neurosurgery service and mortality significantly decreased between 1995 and 2009.ConclusionsOur findings show a stable tendency of hospital cases during the last decade that should encourage to redouble efforts to control this ancient disease.

Landau-Kleffner Syndrome and Neurocysticercosis

A seven year old right-handed boy with a one year history of language disorder associated with clinical seizures and paroxysmal EEG is reported from the Division de Neurologia, Instituto Nacional de Neurologia Y Neurocirugia, Mexico, D.F.

Tube feeding and lethal aspiration in neurological patients: a review of 720 autopsy cases.

A study of 720 autopsy cases from the Instituto Nacional de Neurologia, SSA (INN) and the Centro Hospitalario 20 de Noviembre ISSTE (CH 20 N) was made in order to investigate the frequency of aspiration in postmortem material of neurological cases. Aspiration occurred in 12.5% and 6.5%, respectively, of the cases under study. The clinical features of both groups were quite similar, and slight differences could not account for the uneven proportion of aspiration. When correlating the presence or absence of aspiration in both groups with and without the use of a gastric tube, a significant correlation was found between the use of a tube and the postmortem finding of aspiration. Gastric tube (tube feeding) increases the risk of aspiration six times. Our results support the view that opposes the early, indiscriminate and incautious use of tube feeding in the comatose patient.