Katia Gallegos-Carrillo

Hacia una base normativa mexicana en la medición de calidad de vida relacionada con la salud, mediante el Formato Corto 36

Objective. To present the results of the application of the short format 36 instrument (SF-36) in the Mexican states of Sonora and Oaxaca. The levels of quality of life were compared with those from Canada and the United States. Material and Methods. The data were obtained using a survey on health service access, usage, and quality. The SF-36 is composed of 36 questions, which represent eight different domains on the health-related quality of life. These domains are used to estimate the physical and mental components of health. Data analysis was performed to calculate the average scores for each domain for the total sample, by gender and age groups in each state. The regional differences were assessed by the difference of means. Results. The total response was 98.5% of the 4200 selected households. The percent response values were similar between the two states. A total of 5961 subjects older than 25 years of age completed the questionnaire. Males scored higher than females in all domains and in both components. Regardless of sex, the highest variation was observed in adults up to 64 years of age mainly in three domains: overall health, social function, and mental health; in the 65-74 year age group occurred mostly in social function and mental health; and in adults older than 75 years only in mental health. The young adult age group (25 to 44 years) showed variation in a greater number of domains, while women exhibited more variation in the “extreme” age groups, 25 to 34 years and 75 years and older. The mean scores in our sample were higher than Duran-Arenas L, Gallegos-Carrillo K, Salinas-Escudero G, Martinez-Salgado H. Hacia una base normativa mexicana en la medicion de calidad de vida relacionada con la salud, mediante el Formato Corto 36. Salud Publica Mex 2004;46:306-315. El texto completo en ingles de este articulo esta disponible en: http://www.insp.mx/salud/index.html

Role of depressive symptoms and comorbid chronic disease on health-related quality of life among community-dwelling older adults.

OBJECTIVE This study examined the influence of depressive symptoms on health-related quality of life (HRQOL) among community-dwelling older adults suffering from various categories of chronic comorbidity. METHODS A population-based survey in adults aged 60 years or more was conducted within a random sample of 1085 beneficiaries of the Mexican Institute of Social Security in Mexico City. Depressive symptoms were evaluated with the 15-item Geriatric Depression Scale, and chronic comorbidity was determined with self-reports concerning prior medical diagnoses and the HRQOL Short Form-36 health survey. We carried out a stratified analysis by comorbidity category, evaluating the impact of depressive symptoms on HRQOL through an analysis of variance and modeling the independent association of depression symptoms with HRQOL using multiple linear regression analyses adjusted for comorbidity and other covariables. RESULTS HRQOL scores were low in the presence of depressive symptoms, while their impact increased when chronic diseases were also present. The group with the poorest HRQOL was older adults suffering from both depressive symptoms and two or more chronic diseases (P<.05). The stratified analysis by comorbidity and multivariate analysis, adjusted for covariables, indicated that depressive symptoms and comorbidity had cumulative negative effects on HRQOL. CONCLUSION The HRQOL of older adults deteriorated when depressive symptoms were present and decreased even further with the simultaneous occurrence of chronic illnesses. Identifying depression symptoms-either alone or along with chronic conditions-is crucial for implementation of measures aimed at improving elderly peoples HRQOL.

Physical activity and risk of Metabolic Syndrome in an urban Mexican cohort

BackgroundIn the Mexican population metabolic syndrome (MS) is highly prevalent. It is well documented that regular physical activity (PA) prevents coronary diseases, type 2 diabetes and MS. Most studies of PA have focused on moderate-vigorous leisure-time activity, because it involves higher energy expenditures, increase physical fitness, and decrease the risk of MS. However, for most people it is difficult to get a significant amount of PA from only moderately-vigorous leisure activity, so workplace activity may be an option for working populations, because, although may not be as vigorous in terms of cardio-respiratory efforts, it comprises a considerable proportion of the total daily activity with important energy expenditure. Since studies have also documented that different types and intensity of daily PA, including low-intensity, seem to confer important health benefits such as prevent MS, we sought to assess the impact of different amounts of leisure-time and workplace activities, including low-intensity level on MS prevention, in a sample of urban Mexican adults.MethodsThe study population consisted of 5118 employees and their relatives, aged 20 to 70 years, who were enrolled in the baseline evaluation of a cohort study. MS was assessed according to the criteria of the National Cholesterol Education Program, ATP III and physical activity with a validated self-administered questionnaire. Associations between physical activity and MS risk were assessed with multivariate logistic regression models.ResultsThe prevalence of the components of MS in the study population were: high glucose levels 14.2%, high triglycerides 40.9%, high blood pressure 20.4%, greater than healthful waist circumference 43.2% and low-high density lipoprotein 76.9%. The prevalence of MS was 24.4%; 25.3% in men and 21.8% in women. MS risk was reduced among men (OR 0.72; 95%CI 0.57–0.95) and women (OR 0.78; 95%CI 0.64–0.94) who reported an amount of ≥30 minutes/day of leisure-time activity, and among women who reported an amount of ≥3 hours/day of workplace activity (OR 0.75; 95%CI 0.59–0.96).ConclusionOur results indicate that both leisure-time and workplace activity at different intensity levels, including low-intensity significantly reduce the risk of MS. This finding highlights the need for more recommendations regarding the specific amount and intensity of leisure-time and workplace activity needed to prevent MS.

Psychometric properties of the General Oral Health Assessment Index (GOHAI) and dental status of an elderly Mexican population

OBJECTIVES To evaluate the psychometric properties of the Geriatric/General Oral Health Assessment Index, Spanish version (GOHAI-Sp) and their relationship with the dentition status of an elderly Mexican population as a discriminatory validation. METHODS A cross-sectional study was conducted among persons over 60 years of age. A Spanish version the GOHAI-Sp validated in Spain in institutionalized geriatric patients was used. Clinical evaluation was done in order to determine experience with coronal and root caries. RESULTS Measurement of internal consistency of the GOHAI gave a Cronbach alpha coefficient of 0.77 for the 12 items. In factorial analysis, one factor alone was capable of explaining 30.6 percent of the total variance. The factor that was most apparent in the factorial analysis of the GOHAI had coefficients > 0.30 for the 12 items. The Kaiser-Meyer-Olkin measure of simple adequacy was 0.81 and the Bartletts sphericity test was 1,748.55 with 66 degrees of freedom (P < 0.001). There was a statistically significant difference in the GOHAI scores between the responses to self-perception of oral and general health (P < 0.001). Also, there was a statistically significant low correlation coefficient between the missing and filled components of the DMFT index and the number of healthy and functional teeth (P < 0.05). CONCLUSIONS The GOHAI has acceptable psychometric properties, discriminates between self-perception of oral health and self-perception of general health, and correlates with past caries experience measured by the DMFT index.

Self-perceived health status: an approach of the elderly in Mexico

OBJECTIVE To evaluate health status of the elderly in Mexico through their self-perception and to describe social, organizational and health-related factors. METHODS A study was carried out on secondary data from the 2000 National Health Survey in Mexico. Multiple logistic regression models were used. The dependent variable health status was measured through self-perception. The independent variables included were: sociodemographic characteristics, risk behaviors, accidents, disease diagnosis and clinical measures. RESULTS A total of 7,322 adults aged 60 years and older were studied, which represents 7% of the total population in that age group in Mexico. Of them, 19.8% reported poor or very poor health status. Factors found to be associated to poor health were age, female sex, having no social security, being divorced, homemaker, disabled, unemployed, tobacco consumption, having a health condition, accidents and diagnosed with chronic diseases. CONCLUSIONS The study allowed to identifying factors that may contribute to poor health status in the elderly. These findings could be taken into account in the development of actions and health care programs for this population in Mexico.

Association between Dietary Patterns and Insulin Resistance in Mexican Children and Adolescents

Background/Objective: Insulin resistance (IR) is a metabolic disorder that is increasing worldwide and has been associated with several negative health outcomes. The aim of this study was to evaluate the relationship between different dietary patterns and IR among Mexican children and adolescents. Methods: We performed a cross-sectional analysis on baseline data from Mexican children and adolescents aged 7–18 years participating in the Health Workers Cohort Study. We included 916 children and adolescents of both sexes. Fasting serum glucose and insulin levels were determined by standardized methods. We defined IR using the homeostasis model assessment (HOMA) as ≥3.5. Factor analysis was used to identify dietary patterns. The associations of interest, those between IR and dietary patterns, were analyzed with multiple logistic regression models. Results: IR prevalence was 20.3% among girls and boys aged 7–18 years, for whom the prevalence of overweight and obesity was 29.7%. We identified 3 major dietary patterns in this group: ‘Western’, ‘prudent’ and ‘high protein/fat’. For the purposes of this analysis we compared the upper versus the lower quintile of each dietary pattern. Independently of other covariates, participants in the highest quintile of the Western pattern had 92% greater odds of IR (OR 1.92, 95% CI: 1.08–3.43) compared with those in the lowest quintile. Conclusions: These findings support the hypothesis that high carbohydrate diets like our Western dietary pattern may increase IR in young people. This result emphasizes the importance of preventive nutrition interventions geared toward Mexican children and adolescents.

Physical activity and reduced risk of depression: results of a longitudinal study of Mexican adults.

OBJECTIVE To evaluate the effect of physical activity (PA) on the risk of depression among Mexican adults over a 6-year follow-up period. METHOD We evaluated longitudinal data from the Health Worker Cohort Study, which follows employees of the Mexican Institute for Social Security in Morelos State, Mexico, over time. Depressive symptoms and PA were assessed at baseline and at a follow-up measurement 6 years later. The study population was free of depressive symptomatology at baseline, as assessed by the Center for Epidemiological Studies-Depression Scale (CES-D). After 6 years, the CES-D was completed once again by the participants to estimate their risk of depression based on the different PA patterns they reported during the follow-up period. PA was estimated using a questionnaire that has been applied in similar longitudinal studies and has been validated in Spanish, with metabolic equivalents (METs) as the unit of measurement. We identified three PA patterns: highly active, moderately active, and inactive. The relative risk of depression (CES-D score ≥ 16 points) was estimated using multivariate logistical regression analysis according to the PA patterns at a follow-up measurement 6 years later. RESULTS The incidence of depression after 6 years was higher among inactive participants (16.5%) than among those with an active PA pattern (10.6%). We found that more active PA patterns have an important protective effect against depression. The odds ratio (OR) for the more active PA patterns was 0.46, 95% confidence interval (CI) [0.25, 0.87], and for individuals with a moderately active PA pattern, the OR was 0.57, 95% CI [0.34, 0.93]. These ORs were obtained after adjusting for confounding variables and baseline PA levels. CONCLUSION Our results indicate that PA may reduce risk of depression in Mexican adults. These findings have potential applications for depression prevention programs in target populations with similar social and cultural contexts.

Health care utilization and health-related quality of life perception in older adults: a study of the Mexican Social Security Institute

OBJECTIVE To establish how health care service utilization patterns are associated with health-related quality of life (HRQL) perception in older adults. MATERIAL AND METHODS A cross-sectional study in adults aged 60 years or more was conducted in a random sample of 1150 beneficiaries of the Mexican Social Security Institute (IMSS) in Mexico City during 2003. Health care services utilization was categorized as preventive or curative, which generated six usage profiles. HRQL was measured by means of the SF-36 questionnaire. Analyses of variance and multiple linear regressions were conducted to evaluate the relationship between health care services utilization and HRQL. RESULTS The use of preventive and curative services has a positive association with HRQL levels. Usage profiles with a prevalence of preventive services have a stronger positive association with HRQL scales. CONCLUSIONS This study suggests a positive association between use patterns for primarily preventive health care services and a better HRQL perception among older adults.

A workplace physical activity program at a public university in Mexico can reduce medical costs associated with type 2 diabetes and hypertension

OBJECTIVE To assess the impact of a workplace leisure physical activity program on healthcare expenditures for type 2 diabetes and hypertension treatment. MATERIAL AND METHODS We assessed a workplace programs potential to reduce costs by multiplying the annual healthcare costs of patients with type 2 diabetes and hypertension by the population attributable risk fraction of non-recommended physical activity levels. Feasibility of a physical activity program was assessed among 425 employees of a public university in Mexico. RESULTS If 400 sedentary employees engaged in a physical activity program to decrease their risk of diabetes and hypertension, the potential annual healthcare cost reduction would be 138 880 US dollars. Each dollar invested in physical activity could reduce treatment costs of both diseases by 5.3 dollars. CONCLUSIONS This research meets the call to use health economics methods to re-appraise health priorities, and devise strategies for optimal allocation of financial resources in the health sector.

Exercise-referral scheme to promote physical activity among hypertensive patients: design of a cluster randomized trial in the Primary Health Care Units of Mexico's Social Security System.

BackgroundAlthough the benefits of physical activity (PA) on to prevent and manage non-communicable diseases are well known, strategies to help increase the levels of PA among different populations are limited. Exercise-referral schemes have emerged as one effective approach to promote PA; however, there is uncertainty about the feasibility and effectiveness of these schemes in settings outside high-income countries. This study will examine the effectiveness of a scheme to refer hypertensive patients identified in Primary Health Care facilities (PHCU) of the Mexican social security institution to a group PA program offered in the same institution.Methods and designWe will describe the methods of a cluster randomized trial study designed to evaluate the effectiveness of an exercise referral scheme to increasing physical activity in hypertensive patients compared to a non-referral scheme. Four PHCU were selected for the study; the PHCU will take part as the unit of randomization and sedentary hypertensive patients as the unit of assessment. 2 PHCU of control group (GC) will provide information to hypertensive patients about physical activity benefits and ways to increase it safely. 2 PHCU of intervention group (IG) will refer patients to sports facilities at the same institution, to follow a group-based PA program developed to increase the PA levels with a designed based on the Transtheoretical Model and Social Cognitive Theory. To evaluate the effects of the intervention as well as short-term maintenance of the intervention’s effects, PA will be assessed at baseline, at 24 and 32 weeks of follow-up.The main outcome will be the difference before and after intervention in the percentage of participants meeting recommended levels of PA between and within intervention and control groups. PA will be measured through self-report and with objective measure by accelerometer.DiscussionThis study will allow us to evaluate a multidisciplinary effort to link the primary care and community-based areas of the same health care system. Our findings will provide important information about the feasibility and effectiveness of an exercise-referral scheme and will be useful for decision-making about the implementation of strategies for increasing PA among hypertensive and other clinical populations in Mexico and Latin America.Trial registrationClinicaltrials.gov Identifier: NCT01910935. Date of registration: 07/05/2013.