Juan Garduño-Espinosa

Factors associated with therapy noncompliance in type-2 diabetes patients

OBJECTIVE To identify the frequency and factors associated with therapy noncompliance in type-2 diabetes mellitus patients. MATERIAL AND METHODS A cross-sectional study was carried out in 79 patients with type-2 diabetes mellitus seen in major hospitals of Mexico City. Patients were visited at home, from March 1998 to August 1999, to measure compliance with prescribed therapy. Complying patients were defined as those taking at least 80% of their pills or 80% of their corresponding insulin dose. The degree of compliance with therapy components (diet, amount of exercise, and keeping appointments) was measured. RESULTS The average age of study subjects was 59 years (SD 11 years); 73% (n = 58) were female subjects. The overall frequency of noncompliance was 39%. Noncompliance rates were: 62% for dietary recommendations, 85% for exercise, 17% for intake of oral hypoglycemic medication, 13% for insulin application, and 3% for appointment keeping. Hypertension plus obesity was the only factor significantly associated with noncompliance (OR 4.58, CI 95% 1.0, 22.4, p = 0.02). CONCLUSIONS The frequency of therapy noncompliance was very high, especially for diet and exercise.

Epidemiología descriptiva de las neoplasias malignas en niños

El objetivo de este estudio es presentar la epidemiologia descriptiva del cancer en los ninos menores de 15 anos a nivel mundial y nacional. Se realizo una revision de la literatura internacional y nacional de los articulos publicados sobre cancer en los ninos, seleccionando aquellos que trataran los aspectos epidemiologicos de tiempo, lugar y persona y analizandose tanto la incidencia como la mortalidad por cancer en ninos. La incidencia mundial es de 100 a 150 casos x 10(6) ninos/ano. La incidencia especifica varia de acuerdo al tipo cancer, el pais o region que se estudie. El patron latinoamericano de neoplasias lo constituyen las leucemias, los linfomas y los tumores del sistema nervioso central (TSNC); en el norteamericano y europeo los TSNC ocupan el segundo lugar; y en el africano predominan los linfomas. La incidencia es mayor en los menores de 5 anos en el medio urbano y existe un incremento de 1% anual de canceres en los ninos de Estados Unidos de America. La mortalidad por cancer en ninos ha disminuido de forma importante principalmente en los paises desarrollados, como Estados Unidos e Inglaterra; en los subdesarrollados permanece estable o hay una leve disminucion. La incidencia es mayor en paises desarrollados; sin embargo, en los paises subdesarrollados puede estar subestimada. Aun hay muchos datos que se desconocen sobre la epidemiologia del cancer en el nino, por lo que son necesarios mas estudios.The object of this study is to present the descriptive epidemiology of cancer in children at the world and national levels. The international and national literature published on cancer in children was comprehensively reviewed, with emphasis on reports treating epidemiological aspects of time, place and person. For practical reasons and with the aim of integrating the information, only the more relevant publications were included. Incidence and child mortality were analyzed. Overall incidence is between 100 and 150 (annual rates = cases x 10(6) children). Specific incidence varies according to the type of cancer, the region and the country. The Latin American pattern of neoplasms is constituted by leukemias, lymphomas, and central nervous system tumors (CNST); in the Northamerican/European pattern the CNST appear in second place and in the African pattern, lymphomas show predominance. Incidence is higher among the younger than 5 year olds, from urban environments, and there is a 1% annual increase of cancer in Northamerican children. Child mortality has diminished remarkably, mainly in developed countries, whereas in developing or underdeveloped countries, incidence remains stable or shows a slight fall. The incidence of cancer in children is greater in developed countries, but in underdeveloped countries it may be underestimated. These countries have not managed to reduce the incidence of child mortality caused by cancer, as have the United States or Great Britain. Further studies on the epidemiology of cancer in children are necessary, since many data remain unknown.

Cost-effectiveness analysis for joint pain treatment in patients with osteoarthritis treated at the Instituto Mexicano del Seguro Social (IMSS): Comparison of nonsteroidal anti-inflammatory drugs (NSAIDs) vs. cyclooxygenase-2 selective inhibitors

BackgroundOsteoarthritis (OA) is one of the main causes of disability worldwide, especially in persons >55 years of age. Currently, controversy remains about the best therapeutic alternative for this disease when evaluated from a cost-effectiveness viewpoint. For Social Security Institutions in developing countries, it is very important to assess what drugs may decrease the subsequent use of medical care resources, considering their adverse events that are known to have a significant increase in medical care costs of patients with OA. Three treatment alternatives were compared: celecoxib (200 mg twice daily), non-selective NSAIDs (naproxen, 500 mg twice daily; diclofenac, 100 mg twice daily; and piroxicam, 20 mg/day) and acetaminophen, 1000 mg twice daily. The aim of this study was to identify the most cost-effective first-choice pharmacological treatment for the control of joint pain secondary to OA in patients treated at the Instituto Mexicano del Seguro Social (IMSS).MethodsA cost-effectiveness assessment was carried out. A systematic review of the literature was performed to obtain transition probabilities. In order to evaluate analysis robustness, one-way and probabilistic sensitivity analyses were conducted. Estimations were done for a 6-month period.ResultsTreatment demonstrating the best cost-effectiveness results [lowest cost-effectiveness ratio

Preferences of Mexican anesthesiologists for vecuronium, rocuronium, or other neuromuscular blocking agents: a survey

17.5 pesos/patient (

The hospital appropriateness evaluation protocol in elderly patients: a technique to evaluate admission and hospital stay

1.75 USD)] was celecoxib. According to the one-way sensitivity analysis, celecoxib would need to markedly decrease its effectiveness in order for it to not be the optimal treatment option. In the probabilistic analysis, both in the construction of the acceptability curves and in the estimation of net economic benefits, the most cost-effective option was celecoxib.ConclusionFrom a Mexican institutional perspective and probably in other Social Security Institutions in similar developing countries, the most cost-effective option for treatment of knee and/or hip OA would be celecoxib.

Cost-effectiveness analysis of the use of palivizumab in the prophylaxis of preterm patients in Mexico

BackgroundSeveral neuromuscular blocking (NMB) agents are available for clinical use in anesthesia. The present study was performed in order to identify preferences and behaviors of anesthesiologists for using vecuronium, rocuronium or other NMB agents in their clinical practice.Material and methodsThe cross-sectional survey was applied at the Updated Course of the Colegio Mexicano de Anestesiología performed last year. Of 989, 282 (28.5%) surveys were returned.ResultsMost anesthesiologists were working at both public and private hospitals, performed anesthetic procedures for hospitalized and ambulatory patients, and anesthetized children as well as adults. Respondents did not consider mechanomyography as the gold standard method for neuromuscular monitoring. The T25 was not recognized as a pharmacodynamic parameter that represents the clinical duration of the neuromuscular block. Most answered that vecuronium induces less histamine release than rocuronium, had never used any neuromuscular monitor, did not know the cost of vecuronium and rocuronium, and preferred rocuronium in multiple-sampling vials and vecuronium in either a vial for single or multiple sampling. Rocuronium was preferred for emergency surgery in patients with full stomach only. Almost all of anesthesiologists that conserve the unused drug did it without refrigeration and more than 30% conserve the unused drug in one syringe for further use.ConclusionVecuronium was preferred for most clinical situations, and the decision for this choice was not based on costs. Storage of unused drugs without refrigeration in a single syringe for purpose of future use in several patients represented a dangerous common practice.

Design of the 2009 evaluation of the Medical Insurance for a New Generation program

BACKGROUND Aging of the population represents one of the main challenges for health systems because of the increase in the demand for hospital services. To be able to count on tools that allow an objective evaluation of hospital-resource use becomes indispensable for health systems. OBJECTIVE To evaluate the reliability and validity of the Appropriateness Evaluation Protocol (AEP) regarding the appropriateness of admissions and hospital stays in elderly patients. In a scenario of scarce resources, to have a valid instrument will make it possible to evaluate the process of care in our growing elderly population in a standardized way. METHODS We carried out a retrospective study of 144 randomly chosen elderly patients admitted to the hospital with 394 even-numbered hospital-stay days. For the reliability analysis between the pair of nurses with the AEP and the pair of specialists, the details of the hospital admissions and the stay days were obtained from the clinical files. Criteria validity was conducted by pairs of physicians, including two internists, two general surgeons and two geriatricians. Only the agreements were compared with agreements of the AEP-trained nurses. Disagreements were excluded from the final analysis. RESULTS Inter-rater (inter-reviewer) agreement of hospital admissions and days spent by the patient presented a kappa coefficient of >0.70, while these admissions and hospital-stay days was >0.70. Sensitivity and positive predictor value to detect inappropriate admissions were not calculated because no agreement existed on inappropriate admissions. Specificity and negative predictive value to detect appropriate admission was >94.0% and >98.0%. Sensitivity and positive predictor value to detect inappropriate hospital-stay days was >44.0% and >10.0%, while specificity and negative predictor value for detecting appropriate hospital-stay days was >79.0% and >88.0%. CONCLUSIONS AEPs high-reliability and moderate-validity results with regard to clinical judgement positions it as a useful instrument for appropriate hospitalization screening in elderly patients.

Economic evaluation of the use of exogenous pulmonary surfactants in preterm newborns in a Mexican population

OBJECTIVE The study evaluated the incremental cost-effectiveness ratio (ICER) of the prophylaxis of palivizumab, for the reduction of complications associated to the respiratory syncytial virus in preterm patients in Mexico. MATERIAL AND METHODS A decision tree was developed in preterm groups [<29 and 29-32 weeks of gestational age (wGA)], by using epidemiological and cost local data; the effectiveness was obtained with a systematic review. Patients were evaluated according to their life expectancy. Mexican Health System perspective was used. Effectiveness measures employed were LYG and QALYs. The costs are reported in USD 2009. RESULTS ICERs per LYG resulted on values of USD

Potential drug-drug interactions and their risk factors in pediatric patients admitted to the emergency department of a tertiary care hospital in Mexico

25,029 and USD

Medical interventions for cancer treatment-induced symptoms in children: an overview

29,637 for <29 wGA and 29-32 wGA respectively, whereas ICERs per QALYs obtained in the model accounted for USD