Contribución de los autores:Ambos autores contribuyeron a la concepción y el diseño del ensayo, el análisis y la interpretación de las fuentes originales, así como a la redacción y la aprobación de la versión final. Multimorbilidad: bases conceptuales, modelos epidemiológicos y retos de su mediciónJulián A. Fernández-Niño 1 , Eduardo Bustos-Vázquez 2 1 Centro de Información para Decisiones en Salud Pública, Instituto Nacional de Salud Pública, Cuernavaca, México 2 Escuela de Salud Pública de México, Instituto Nacional de Salud Pública, Cuernavaca, México El incremento continuo de pacientes con perfiles clínicos complejos debidos a enfermedades crónicas ha favorecido el uso cada vez más extendido del término multimorbilidad. Es indispensable disponer de una medición apropiada de esta condición, dado que representa un reto para el manejo clínico de los pacientes, los sistemas de salud y la investigación epidemiológica. En este ensayo se revisan las propuestas conceptuales subyacentes a la medición de la multimorbilidad y se discuten los retos metodológicos involucrados, tomando como referencia las definiciones clásicas de comorbilidad, sus diferencias con el concepto de multimorbilidad y su papel en los estudios epidemiológicos, así como los distintos modelos conceptuales de los que se derivan las definiciones operativas y las estrategias de medición de dicha variable. Se pudo determinar que hay una brecha importante entre el desarrollo del concepto de multimorbilidad y las definiciones operativas, a pesar del significativo avance teórico que ha permitido trascender la concepción clásica de comorbilidad para llegar al concepto actual de multimorbilidad. Sin embargo, las estrategias de medición no se han desarrollado al mismo ritmo del concepto, por lo que se requieren nuevas propuestas metodológicas que permitan obtener información sobre su verdadero impacto en la salud de las personas y sus implicaciones para la salud pública.Palabras clave: comorbilidad, enfermedad crónica, modelos teóricos, estudios epidemiológicos, sesgo (epidemiología), envejecimiento. doi: http://dx.doi.org/10.7705/biomedica.v36i2.2710 Multimorbidity: conceptual basis, epidemiological models and measurement challengesThe growing number of patients with complex clinical profiles related to chronic diseases has contributed to the increasingly widespread use of the term 'multimorbidity'. A suitable measurement of this condition is essential to epidemiological studies considering that it represents a challenge for the clinical management of patients as well as for health systems and epidemiological investigations. In this context, the present essay reviews the conceptual proposals behind the measurement of multimorbidity including the epidemiological and methodological challenges it involves. We discuss classical definitions of comorbidity, how they differ from the concept of multimorbidity, and their roles in epidemiological studies. The various conceptual models that contribute to the operational definitions and strategies to measure this vari...

Contribución de los autores:Julián Alfredo Fernández-Niño: análisis estadísticos Todos los autores contribuyeron en el diseño del estudio, el análisis e interpretación de la información y la escritura del manuscrito. Introducción. La autopercepción de la salud es una concepción individual y subjetiva que resulta de la intersección entre factores biológicos, sociales y psicológicos, y proporciona una evaluación única e inestimable del estado general de salud de una persona. Objetivo. Proponer y evaluar un modelo conceptual simple para entender la autopercepción de la salud y su relación con la presencia de comorbilidades, discapacidad y síntomas depresivos en adultos mayores mexicanos. Materiales y métodos. Se hizo un estudio transversal basado en una muestra representativa nacional de 8.874 adultos de 60 y más años. Se determinó la autopercepción positiva de la salud mediante una escala de tipo Likert con la pregunta: "¿Cómo considera que es su estado actual de salud?", así como de las variables intermedias de presencia de comorbilidades, discapacidad y síntomas depresivos, y variables exógenas dicotómicas (sexo, tener pareja, percepción de la participación en las decisiones del hogar y pobreza). Para validar el modelo conceptual propuesto, se diseñó un modelo generalizado de ecuaciones estructurales con función de enlace logit para la autopercepción positiva de la salud.Resultados. Se encontró una asociación de vías directas entre la presencia de comorbilidades y la autopercepción positiva de la salud (odds ratio, OR=0,48; IC 95% 0,42-0,55), entre la discapacidad y la autopercepción positiva de la salud (OR=0,35; IC 95% 0,30-0,40),y entre los síntomas depresivos y la autopercepción positiva de la salud (OR=0,38; IC 95% 0,34-0,43). El modelo también validó asociaciones indirectas entre discapacidad y síntomas depresivos (OR=2,25; IC 95% 2,01-2,52), presencia de comorbilidades y síntomas depresivos (OR=1,79; IC 95% 1,61-2,00), y presencia de comorbilidades y discapacidad (OR=1,98; IC 95% 1,78-2,20). Conclusiones. Se hizo la evaluación empírica de un modelo teórico parsimonioso, lo cual permitió determinar asociaciones directas e indirectas con la autopercepción positiva de la salud.Palabras clave: autoevaluación; estado de salud; comorbilidad; depresión; envejecimiento; determinantes sociales de la salud; México.doi: http://dx.doi.org/10.7705/biomedica.v37i3.3070 Self-rated health, multimorbidity and depression in Mexican older adults: Proposal and evaluation of a simple conceptual modelIntroduction: Self-rated health is an individual and subjective conceptualization involving the intersection of biological, social and psychological factors. It provides an invaluable and unique evaluation of a person's general health status. Objective: To propose and evaluate a simple conceptual model to understand self-rated health and its relationship to multimorbidity, disability and depressive symptoms in Mexican older adults. Materials and methods:We conducted a cross-sectional study based on a national representative sample...

Background: The outbreak of SARS-CoV-2 abruptly disseminated in early 2020, overcoming the capacity of health systems to respond the pandemic. It was not until the vaccines were launched worldwide that an increase in survival was observed. The objectives of this study were to analyse the characteristics of survivors and their relationship with comorbidities. We had access to a database containing information on 16,747 hospitalized patients from Mexico, all infected with SARS-CoV-2, as part of a regular follow-up. The descriptive analysis looked for clusters of either success or failure. We categorized the samples into no comorbidities, or one and up to five coexisting with the infection. We performed a logistic regression test to ascertain what factors were more influential in survival. The main variable of interest was survival associated with multimorbidity factors. The database hosted information on hospitalized patients from Mexico between March 2020 through to April 2021. Categories 2 and 3 had the largest number of patients. Survival rates were higher in categories 0 (64.8%), 1 (57.5%) and 2 (51.6%). In total, 1741 (10.5%) patients were allocated to an ICU unit. Mechanical ventilators were used on 1415 patients, corresponding to 8.76%. Survival was recorded in 9575 patients, accounting for 57.2% of the sample population. Patients without comorbidities, younger people and women were more likely to survive.

INTRODUCTION: Chagas disease is considered the most serious parasitosis in America, forgotten and neglected in the world, with a characteristic that has its maximum expression in the difficulties and limitations for its diagnosis and treatment. OBJECTIVE: To assess the status of seropositivity of Chagas disease in Mexico, in addition to monitoring the effectiveness of treatment in infected patients. MATERIAL AND METHODS: Systematic reviews were conducted, with searches in Crossref, Google Scholar, Scielo, PubMed and the inclusion of guides and manuals of related health programs was evaluated based on their titles, news and relevance. RESULTS: for seropositivity, the data coincide with 100% in the characterization of the risk factors, as well as in the evaluations in the Blood Transfusion Centers of the country, finding captive cases in each state that explain the persistence of the disease . When monitoring treatments and evidence of effectiveness, the following difficulties arise: prolonged duration and side effects, adding the lack of reliable healing criteria, with an effectiveness of 60-75% in acute cases and in 100% of acute congenital cases, and in chronic cases a variation of between 15 and 30 years was found. CONCLUSIONS: Although the achievements have been commendable in reducing rates, the territory has factors that allow the redistribution of the infection, the evidence on the effectiveness is scarce, there is no evidence of epidemiological follow-up of cases in Mexico with respect to healing indicator.

Background The growing number of patients with complex clinical profiles has contributed to the increasingly deaths. The aim is to estimate survival and risk factors associated with hospitalized COVID-19 patients with multimorbidity in the state of Hidalgo, Mexico during 2020 to April 2021. Material and Methods An observational, longitudinal, prospective and analytical study was carried out in 11,955 hospitalized COVID-19 patients with multimorbidity from the Epidemiological Surveillance System for Respiratory Disease of Hidalgo. The variables of interest were survival of hospital stay per day and multimorbidity adjusted for age, sex, occupation, days of demand for care, and days of mechanical ventilation use. Kapplan-Meiner estimators, Log-Rank tests and Cox proportional hazard method were using. Results Hospitalized COVID-19 patients with multimorbidity survival was 53.5%. The probability of survival is reduced to 50% from day 17 of hospital stay. The shortest survival rate corresponds to cases with Hypertension + Chronic Kidney Disease (RR: 9.46, 95% CI 2.63-37.92), Diabetes + Hypertension + Chronic Kidney Disease (RR: 1.83, 95% CI 1.52-2.20), Diabetes + Hypertension + Obesity (RR: 1.35, 95% CI 1.16-1.57) and Diabetes + Hypertension (RR: 1.31, 95% CI 1.19-1.45). The use of mechanical ventilation for more than 14 days increases the survival rate (RR: 0.53, 95% CI 0.49-0.57). The survival rate from occupation increase in employees, students and health workers compared to the unemployed. Conclusions Multimorbidity increases the effect of the clinical and epidemiological interrelationships of the coexistence of multiple diseases in the same individual and reduces the survival of COVID-19 in hospitalized patients.