Hortensia Reyes-Morales

Intestinal anti-spasmodic effect of a phytodrug of Psidium guajava folia in the treatment of acute diarrheic disease.

Ancestral medicinal use of guava (Psidium guajava L. Fam. Myrtaceae) is today supported by numerous biomedical studies concerning the properties of leaf extracts. However, insufficient clinical studies are reported on the use of this plant resource in the treatment of gastrointestinal ailments. The present work reports a randomized, double-blinded, clinical study performed to evaluate the safety and efficacy of a phytodrug (QG-5) developed from guava leaves, standardized in its content of quercetin and orally administered to a group of adult patients with acute diarrheic disease. Capsules containing 500 mg of the product were administered to 50 patients every 8 h during 3 days. Results obtained showed that the used guava product decreased the duration of abdominal pain in these patients.

Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City.

BackgroundIn Mexico, inappropriate prescription of drugs with potential interactions causing serious risks to patient health has been little studied. Work in this area has focused mainly on hospitalized patients, with only specific drug combinations analyzed; moreover, the studies have not produced conclusive results. In the present study, we determined the frequency of potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age, who used Mexican Institute of Social Security (IMSS) family medicine clinics. In addition, we aimed to identify the associated factors for these interactions.MethodsWe collected information on general patient characteristics, medical histories, and medication (complete data). The study included 624 ambulatory patients over 50 years of age, with non-malignant pain syndrome, who made ambulatory visits to two IMSS family medicine clinics in Mexico City. The patients received 7-day prescriptions for non-opioid analgesics. The potential interactions were identified by using the Thompson Micromedex program. Data were analyzed using descriptive, bivariate and multiple logistic regression analyses.ResultsThe average number of prescribed drugs was 5.9 ± 2.5. About 80.0% of patients had prescriptions implying one or more potential drug-drug interactions and 3.8% of patients were prescribed drug combinations with interactions that should be avoided. Also, 64.0% of patients had prescriptions implying one or more potential drug disease interactions. The factors significantly associated with having one or more potential interactions included: taking 5 or more medicines (adjusted Odds Ratio (OR): 4.34, 95%CI: 2.76–6.83), patient age 60 years or older (adjusted OR: 1.66, 95% CI: 1.01–2.74) and suffering from cardiovascular diseases (adjusted OR: 7.26, 95% CI: 4.61–11.44).ConclusionThe high frequency of prescription of drugs with potential drug interactions showed in this study suggests that it is common practice in primary care level. To lower the frequency of potential interactions it could be necessary to make a careful selection of therapeutic alternatives, and in cases without other options, patients should be continuously monitored to identify adverse events.

Estado de la dentición y sus efectos en la capacidad de los ancianos para desempeñar sus actividades habituales

OBJECTIVE: The aim of this study was to evaluate the effect of dental state on the capacity of elderly individuals to carry out their daily activities during the previous six months. MATERIAL AND METHODS: A transversal study was conducted in the Mexican Institute of Social Security (IMSS) with insured elderly persons residing in southwestern Mexico City. Home interviews were conducted to gather sociodemographic data, data on the use of oral health services, problems in carrying out daily activities, and their relationship with the state of dentition over the past six months, utilizing the Oral Impacts on Daily Performance (OIDP) index. Later, three oral health professionals trained in determining the state of dentition according to World Health Organization (WHO) criteria performed a clinical examination on each elderly subject. RESULTS: A total of 540 elderly individuals were studied. The prevalence of elderly persons with problems in carrying out their daily activities was 21.5%. The main problems in daily activities were eating (14.4%), speaking (8.7%), not becoming irritated (5.4%), brushing their teeth(5%), and inability to enjoy contact with people (4.4%). There is a positive OIDP correlation between number of teeth lost and the decayed, missing, filled teeth(DMFT) index (p<0.05) and a negative correlation with the number of functional and filled teeth. CONCLUSIONS: The state of dentition in the elderly has repercussions on the capacity to carry out daily activities, with quality of life most seriously affected with regard to eating and enjoying food, as well as with respect to correct pronunciation.

Design and Validation of a Critical Pathway for Hospital Management of Patients With Severe Traumatic Brain Injury

BACKGROUND Critical pathways for the management of patients with severe traumatic brain injury (STBI) may contribute to reducing the incidence of hospital complications, length of hospitalization stay, and cost of care. Such pathways have previously been developed for departments with significant resource availability. In Mexico, STBI is the most important cause of complications and length of stay in neurotrauma services at public hospitals. Although current treatment is designed basically in accordance with the Brain Trauma Foundation guidelines, shortfalls in the availability of local resources make it difficult to comply with these standards, and no critical pathway is available that accords with the resources of public hospitals. The purpose of the present study was to design and to validate a critical pathway for managing STBI patients that would be suitable for implementation in neurotrauma departments of middle-income level countries. METHODS The study comprised two phases: design (through literature review and design plan) and validation (content, construct, and appearance) of the critical pathway. RESULTS The validated critical pathway for managing STBI patients entails four sequential subprocesses summarizing the hospitals care procedures, and includes three components: (1) nodes and criteria (in some cases, indicators are also included); (2) health team members in charge of the patient; (3) maximum estimated time for compliance with recommendations. CONCLUSIONS This validated critical pathway is based on the current scientific evidence and accords with the availability of resources of middle-income countries.

A simplified caries risk test in stimulated saliva from elderly patients.

OBJECTIVES To evaluate and compare lactobacilli species (LB) and mutans streptococci (MS) caries risk identification by means of a Caries Risk Test Bacteria (CRT Bacteria test), with a conventional laboratory test (CLT), as well as their correlation with the dental caries experience [(decayed-missing-filled teeth (DMFT index)] in subjects 60 years of age and older. DESIGN Cross-sectional study. SETTING Epidemiologic and Health Service Research Unit, Aging Area. XXI Century National Medical Center; Mexican Institute of Social Security (IMSS). SUBJECTS A total of 696 elderly subjects residing in southwestern Mexico City. METHODS The DMFT index was determined in 696 subjects and saliva collected by stimulation. This was processed with a CRT Bacteria test and a CLT (the gold standard) test. Subjects with high [> or =10(5) colony forming units (CFU)/ml] and low caries risk (<10(5) CFU/ml) were assessed. RESULTS The CRT Bacteria test sensitivity (Sen) and specificity (Spe) were 0.97 and 0.86 for LB, respectively, with positive and negative predictor values of 0.92 and 0.95 respectively. For MS, Sen and Spe was 0.92 and 0.90, and 0.96 and 0.81 respectively. The receiver operating characteristic area under the curve (ROC area) in LB and MS was 0.94 and 0.89, respectively; thus, a correlation existed between the caries experience and the LB and MS caries risk, similar to that present with the CLT test. CONCLUSION The CRT Bacteria test shows similar results to those of the CLT test in subjects 60 years of age and over.

A prediction model for root caries in an elderly population

OBJECTIVES To identify factors associated with root caries development in a 12- month period, in an elderly Mexican population, so as to develop a prediction model for the occurrence of root caries. METHODS A case-cohort study was carried out with 698 randomly selected beneficiaries of the Mexican Institute of Social Security (IMSS), residing in the southeast of Mexico City. Initially, base line (t₀) data regarding sociodemographic variables, general health, general and oral healthy habits, salivary conditions, cariogenic microorganisms and oral health clinical indicators were collected. Twelve months from the date of the first clinical evaluation (t₁), a new examination was carried out to determine the root caries increment. Variables that showed a significant association (P ≤ 0.05) with the root caries increment were included in the prediction model. RESULTS Six hundred and ninety-eight elderly subjects were included in the cohort (t₀), with 76.1% (n = 531) of the elderly patients followed up at 12 months (t₁). Incidence of root caries was 21.7% (n = 115), a mean root caries increase of 0.4 (1.0) surfaces. The variables, DLBA limitations (Yes), smoking (Yes), mouthwash (No), Mutans streptococci (≥10⁵ CFU/ml), healthy root surfaces (≥6) and Root Caries Index (≥8%), showed a statistically significant association (P < 0.05). This model showed a correct classification in 80.0% (n = 425) and an area under the Receiver Operating Characteristic curve of 0.75. CONCLUSIONS This is a good prediction model for the 12 months root caries increment in this population of elderly Mexicans.

¿Qué se hace para no morir de hambre? Dinámicas domésticas y alimentación en la niñez en un área rural de extrema pobreza de México

Objective. To describe and compare household dynamics in terms of structure, beliefs and nutrition-related behavior in the homes of malnourished and well-nourished children less than five years of age. Material and Methods. The authors carried out a qualitative ethnographic study using participant observation, and in depth interviews. Interviews were conducted with the child’s caretaker or key informants, prior oral informed consent. Child care and childhood feeding practices at home and in the community were the focus of observations. The study included two periods of field work conducted in 2001, in three rural municipalities from the Rio Balsas region, in Guerrero state, Mexico. The study’s ethical and methodological aspects were approved by the National Research Commission of the Mexican Institute of Social Security. Results. Households were differentially characterized by number of members, composition, type of relationship, source of income, and interactions among household members and with the community. Conclusions. Monoparental structures, in an early stage of the household cycle, give rise to conditions that render the child prone to malnutrition. Extended family structure represented more favorable household dynamics.

Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012)

Background The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico. Methods We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change. Results Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control. Conclusions Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care.

Measuring the adequacy of antenatal health care: a national cross sectional study in Mexico

Abstract Objective To propose an antenatal care classification for measuring the continuum of health care based on the concept of adequacy: timeliness of entry into antenatal care, number of antenatal care visits and key processes of care. Methods In a cross-sectional, retrospective study we used data from the Mexican National Health and Nutrition Survey (ENSANUT) in 2012. This contained self-reported information about antenatal care use by 6494 women during their last pregnancy ending in live birth. Antenatal care was considered to be adequate if a woman attended her first visit during the first trimester of pregnancy, made a minimum of four antenatal care visits and underwent at least seven of the eight recommended procedures during visits. We used multivariate ordinal logistic regression to identify correlates of adequate antenatal care and predicted coverage. Findings Based on a population-weighted sample of 9 052 044, 98.4% of women received antenatal care during their last pregnancy, but only 71.5% (95% confidence interval, CI: 69.7 to 73.2) received maternal health care classified as adequate. Significant geographic differences in coverage of care were identified among states. The probability of receiving adequate antenatal care was higher among women of higher socioeconomic status, with more years of schooling and with health insurance. Conclusion While basic antenatal care coverage is high in Mexico, adequate care remains low. Efforts by health systems, governments and researchers to measure and improve antenatal care should adopt a more rigorous definition of care to include important elements of quality such as continuity and processes of care.

Necesidades de salud en áreas urbanas marginadas de México

OBJETIVO: Evaluar las necesidades de salud de la poblacion residente en areas urbanas marginadas de Mexico. METODOS: Encuesta poblacional a familias residentes en colonias urbanas pobres de cinco regiones geograficas de Mexico (Norte, Centro, Sur, Sureste y Ciudad de Mexico), seleccionadas mediante un muestreo polietapico. Se realizaron entrevistas y mediciones antropometricas en sus domicilios a todos los integrantes de las familias seleccionadas y se analizaron las caracteristicas de salud positiva, nutricion, salud reproductiva, danos a la salud y salud mental por grupos de analisis formados por edad y sexo. RESULTADOS: Participaron 24 707 personas. En los entrevistados se observo una baja escolaridad (6 anos o menos) y solo 46,8% tuvo cobertura de servicios de salud, ya fuera en instituciones publicas o privadas. De los ninos, 19,8% presentaba desmedro y el sobrepeso predomino a partir de la adolescencia. En los adolescentes de 12 a 19 anos, 15,7% tenia vida sexual activa, pero solo 57,7% de los hombres y 41,9% de las mujeres de ese grupo de edad usaban algun metodo anticonceptivo. De los adultos, 5,9% padecia diabetes y 11,5% hipertension arterial. En la muestra de adolescentes, adultos y adultos mayores, el tabaquismo fue de 21,2%, el consumo de alcohol de 36,0%, el uso de drogas de 9,5% y la depresion de 20,2%. CONCLUSIONES: La vulnerabilidad sanitaria de las personas que viven en las areas urbanas marginadas de Mexico se manifiesta en la existencia de una poblacion joven, con pocas redes de apoyo familiar y de servicios de salud, que sufre trastornos y enfermedades, como la desnutricion infantil, el alto riesgo reproductivo y las adicciones en adolescentes y adultos, producto del rezago en el desarrollo social. La prevalencia de enfermedades cronicas fue similar a la de la poblacion mexicana no marginada.