Malaquías López-Cervantes

Diabetes and Cause-Specific Mortality in Mexico City

BACKGROUNDnMost large, prospective studies of the effects of diabetes on mortality have focused on high-income countries where patients have access to reasonably good medical care and can receive treatments to establish and maintain good glycemic control. In those countries, diabetes less than doubles the rate of death from any cause. Few large, prospective studies have been conducted in middle-income countries where obesity and diabetes have become common and glycemic control may be poor.nnnMETHODSnFrom 1998 through 2004, we recruited approximately 50,000 men and 100,000 women 35 years of age or older into a prospective study in Mexico City, Mexico. We recorded the presence or absence of previously diagnosed diabetes, obtained and stored blood samples, and tracked 12-year disease-specific deaths through January 1, 2014. We accepted diabetes as the underlying cause of death only for deaths that were due to acute diabetic crises. We estimated rate ratios for death among participants who had diabetes at recruitment versus those who did not have diabetes at recruitment; data from participants who had chronic diseases other than diabetes were excluded from the main analysis.nnnRESULTSnAt the time of recruitment, obesity was common and the prevalence of diabetes rose steeply with age (3% at 35 to 39 years of age and >20% by 60 years of age). Participants who had diabetes had poor glycemic control (mean [±SD] glycated hemoglobin level, 9.0±2.4%), and the rates of use of other vasoprotective medications were low (e.g., 30% of participants with diabetes were receiving antihypertensive medication at recruitment and 1% were receiving lipid-lowering medication). Previously diagnosed diabetes was associated with rate ratios for death from any cause of 5.4 (95% confidence interval [CI], 5.0 to 6.0) at 35 to 59 years of age, 3.1 (95% CI, 2.9 to 3.3) at 60 to 74 years of age, and 1.9 (95% CI, 1.8 to 2.1) at 75 to 84 years of age. Between 35 and 74 years of age, the excess mortality associated with previously diagnosed diabetes accounted for one third of all deaths; the largest absolute excess risks of death were from renal disease (rate ratio, 20.1; 95% CI, 17.2 to 23.4), cardiac disease (rate ratio, 3.7; 95% CI, 3.2 to 4.2), infection (rate ratio, 4.7; 95% CI, 4.0 to 5.5), acute diabetic crises (8% of all deaths among participants who had previously diagnosed diabetes), and other vascular disease (mainly stroke). Little association was observed between diabetes and mortality from cirrhosis, cancer, or chronic obstructive pulmonary disease.nnnCONCLUSIONSnIn this study in Mexico, a middle-income country with high levels of obesity, diabetes was common, glycemic control was poor, and diabetes was associated with a far worse prognosis than that seen in high-income countries; it accounted for at least one third of all deaths between 35 and 74 years of age. (Funded by the Wellcome Trust and others.).

Assessing phytochemical intake in a group of Mexican women

OBJECTIVEnIdentify the content of selected phytochemicals (PHYs) in Mexican foods and evaluate the reliability of a food frequency questionnaire (FFQ) in assessing PHYs intake among Mexican women.nnnMATERIAL AND METHODSnValues for PHYs content were obtained from four different data sets. PHYs intake was assessed in 50 women of reproductive age enrolled in a longitudinal cohort study. Values were obtained from a FFQ administered twice, one year apart in order to evaluate its reliability. Selected PHYs included flavonol (FOL), flavones (FES), flavanol (FAL), secoisolariciresinol (SE), matairesinol (MA), lariciresinol (LA), pinoresinol (PI), cynamic acid (CA) and coumestrol (CU).nnnRESULTSnDaily PHYs intake ranged from 1.3 microg +/- 0.9 for MA to 116.3 +/- 43.8 mg for CA. The adjusted correlation coefficients ranged from 0.17 for FAL to 0.47 for LA. Pinto beans, oranges, hot sauce, broccoli, apples and onions were the main sources of the selected PHYs daily intake.nnnDISCUSSIONnThe results of this study contribute to our understanding of the consumption of PHYs in the Mexican diet, and would help evaluate their potential health impact.

Cervical cancer: a qualitative study on subjectivity, family, gender and health services

BackgroundIn 2002, cervical cancer was one of the leading causes of death in Mexico. Quantitative techniques allowed for the identification of socioeconomic, behavioral and biological characteristics that are part of its etiology.However such characteristics, are inadequate to explain sufficiently the role that emotions, family networks and socially-constructed categories such as gender play in the demand and utilization of health services for cervical cancer diagnosis and treatment and neither the timely undertaking of preventive actions, such as getting a PAP smear or seeking adequate and continuons treatment.MethodsA qualitative study was carried out to analyze the role of different social and cultural factors in the timely detection of cervical cancer. As part of a multi-level, multi-method research effort, this particular study was based on individual interviews with women diagnosed with cervical cancer (identified as the cases), their female friends and relatives (identified as the controls) and the cases husbands.ResultsThe results showed that both: denial and fear are two important components that regulate the behavior of both the women and their partners. Women with a small support network may have limited opportunities for taking action in favor of their own health and wellbeing.ConclusionWomen tend not to worry about their health, in general and neither about cervical cancer in particular, as a consequence of their conceptualizations regarding their body and feminine identify – both of which are socially determined. Furthermore, it is necessary to improve the quality of information provided in health services.

Una estimación indirecta de las desigualdades actuales y futuras en la frecuencia de la enfermedad renal crónica terminal en México

OBJETIVO. Describir las desigualdades actuales y futuras de la enfermedad renal cronica terminal (ERCT) en Mexico, que se presentan entre grupos de entidades federativas con diferentes grados de marginacion. MATERIAL Y METODOS. Partiendo de una estimacion indirecta de la incidencia, prevalencia, mortalidad y duracion promedio que realizamos en 2009, presentamos datos agrupados de acuerdo con el grado de marginacion estatal. Medimos la desigualdad con el Indice de Concentracion de Salud. RESULTADOS. Encontramos desigualdades crecientes entre 2005 y 2025 en las tasas de incidencia, prevalencia y mortalidad, asi como en la duracion promedio de los casos. CONCLUSION. Para 2025 esperamos importantes incrementos en la prevalencia de la ERCT que afectaran en mayor medida a los estados mas marginados, lo que aumentara la inequidad presente en este problema de salud y representara importantes retos para el financiamiento de los servicios de salud, si no se incide sobre las causas y la progresion hacia la ERCT.

Costos directos de la hemodiálisis en unidades públicas y privadas

OBJETIVO. Estimar y comparar el costo por sesion de hemodialisis dentro del sector publico y privado en la Ciudad de Mexico. MATERIAL Y METODOS. Se calcularon los costos de los insumos utilizados en las hemodialisis de cuatro hospitales publicos y dos privados de la Ciudad de Mexico, mediante la estrategia de micro-costeo denominada PAATI. Para la obtencion de los datos se utilizo el metodo de sombra; ademas, se empleo Excel para elaborar cedulas en las que se determina el PAATI para cada sesion. RESULTADOS. El costo anual promedio directo en el sector publico por el tratamiento de un individuo en hemodialisis es de

Likelihood ratios of clinical, laboratory and image data of pancreatic cancer: Bayesian approach

158 964.00 M. N., y el costo de atender a la poblacion que podria demandar terapia de reemplazo renal se estima en

Relación del personal de salud con los pacientes en la Ciudad de México

10 921 788 072.00 M. N. CONCLUSION. La disponibilidad de recursos humanos e infraestructura en el pais es muy limitada para el campo de la nefrologia en general y, en particular, para ofrecer servicios de hemodialisis, por lo que seria necesario inyectar mas recursos para poder responder ante la demanda por insuficiencia renal terminal.

Adiposity and Blood Pressure in 110 000 Mexican Adults.

PURPOSEnThe diagnosis of pancreatic cancer (PC) is most frequently established in advanced stages. The aim of this study is to estimate the likelihood ratios (LRs) of diagnostic data with regards to PC that could be used to approach an earlier diagnosis.nnnMETHODSnA case-control study of 300 patients - 150 histological diagnosed cases of PC and 150 age-matched controls hospitalized for study of jaundice, abdominal pain, weight loss and/or chronic pancreatitis - was conducted. Bayesian probabilities in the form of LRs were estimated for PC predictions.nnnRESULTSnProbability of PC was associated with jaundice [odds ratio (OR) 2.89; confidence interval (CI) 1.71-4.85], glycemic disturbance (OR 5.64; CI 2.36-13.46), tobacco index >20 (OR 2.11; CI 1.08-4.09) and tumour marker CA 19-9 (OR 9.33; CI 1.36-63.95). Computed tomography showed the highest test performance with regards to PC when comparing with other diagnostic tests. LRs for variables relevant to PC were estimated, among the most relevant: jaundice LR + 1.92, CA 19-9 LR + 5.36 and computed tomography LR + 4.15. The prediction model with an endoscopic retrograde cholangiopancreatography at a tertiary referral hospital determined a 67% probability of detecting PC.nnnCONCLUSIONSnThrough a Bayesian approach we can combine clinical, laboratory and imaging data to approximate to an earlier diagnosis of PC.

Health care reform and the labor market

OBJECTIVEnTo assess quality of the relationship between inpatients and health providers.nnnMETHODSnA qualitative study was carried out in a tertiary care hospital in the Mexico City, Mexico, between February and July 2005. In-depth interviews were conducted with 40 inpatients. The following categories of analysis were used to explore the respondents perception of care: attitudes and actions of medical and nursing providers, effective communication, level of knowledge of patients and their family on the diagnosis, clinical treatment, and evolution.nnnRESULTSnOverall the level of satisfaction with health care was high. Inpatients perceived everyday (non-clinical) interactions with medical and nursing providers as inadequate due to lack of confidence to request information on their condition. In addition, this perception was reinforced by excessive use by providers of technical terminology.nnnCONCLUSIONSnThe routine relationship between health providers and their patients is perceived as inadequate showing that clinical effectiveness does not mean high quality of care. There is a need to bring together technical-scientific efficiency and patients needs and expectations of non-clinical interactions.OBJETIVO: Analisar a qualidade da relacao da equipe de saude com os pacientes hospitalizados. METODOS: Estudo qualitativo realizado de fevereiro a julho de 2005, na Cidade do Mexico. Foram realizadas entrevistas em profundidade com 40 pacientes em internacao prolongada. As categorias de analise para explorar a percepcao de trato entre os informantes foram as seguintes: atitudes e acoes do pessoal medico e de enfermaria, comunicacao efetiva, grau de conhecimento do paciente e/ou familiares sobre o diagnostico, tratamento clinico, evolucao do agravo. RESULTADOS: Em geral, observou-se um alto grau de satisfacao com a atencao medica. Entretanto, os pacientes hospitalizados perceberam como inadequado o trato cotidiano (nao-clinico) realizado pelo pessoal medico e de enfermagem do hospital, relacionado a falta de confianca para solicitar informacao sobre sua enfermidade. O uso excessivo de termos tecnicos por parte do prestador de servicos reforcou esta percepcao de trato inadequado. CONCLUSOES: A percepcao do trato inadequado pelo pessoal de saude foi de âmbito tecnico, mostrando que a efetividade clinica nao significa uma plena qualidade de atencao e que e necessario incorporar as necessidades e expectativas de trato nao-clinico dos pacientes a eficiencia tecnica e cientifica.OBJETIVO: Analizar la calidad de la relacion del personal de salud con los pacientes hospitalizados. METODOS: Estudio cualitativo realizado de febrero a julio del 2005, en la Ciudad de Mexico. Se aplicaron 40 entrevistas a profundidad a pacientes internados en un hospital de tercer nivel. Las categorias de analisis para explorar la percepcion del trato entre los informantes fueron las siguientes: actitudes y acciones del personal medico y de enfermeria, comunicacion efectiva, grado de conocimiento del paciente y/o familiares sobre el diagnostico, tratamiento clinico, evolucion del agravo. RESULTADOS: En general, se encontro un alto grado de satisfaccion con la atencion medica. No obstante, los pacientes hospitalizados percibieron como inadecuado el trato cotidiano (no clinico) del personal medico y de enfermeria del hospital, relacionado con la falta de confianza para solicitar informacion acerca de su padecimiento. El uso excesivo de tecnicismos por parte del prestador de servicios reforzo esta percepcion de trato inadecuado. CONCLUSIONES: La percepcion del trato inadecuado por el personal de salud fuera del ambito tecnico, mostro que la efectividad clinica no significa una plena calidad de la atencion y que es necesario incorporar las necesidades y expectativas de trato no clinico de los pacientes a la eficiencia tecnica y cientifica.

Tendencia de la mortalidad por cáncer en niños y adolescentes según grado de marginación en México (1990-2009)

Previous studies have reached differing conclusions about the importance of general versus central markers of adiposity to blood pressure, leading to suggestions that population-specific adiposity thresholds may be needed. We examined the relevance of adiposity to blood pressure among 111u2009911 men and women who, when recruited into the Mexico City Prospective Study, were aged 35 to 89 years, had no chronic disease, and were not taking antihypertensives. Linear regression was used to estimate the effects on systolic and diastolic blood pressure of 2 markers of general adiposity (body mass index and height-adjusted weight) and 4 markers of central adiposity (waist circumference, hip circumference, waist:hip ratio, and waist:height ratio), adjusted for relevant confounders. Mean (SD) adiposity levels were: body mass index (28.7±4.5 kg/m2), height-adjusted weight (70.2±11.2 kg), waist circumference (93.3±10.6 cm), hip circumference (104.0±9.0 cm), waist:hip ratio (0.90±0.06), and waist:height ratio (0.60±0.07). Associations with blood pressure were linear with no threshold levels below which lower general or central adiposity was not associated with lower blood pressure. On average, each 1 SD higher measured adiposity marker was associated with a 3 mmu2009Hg higher systolic blood pressure and 2 mmu2009Hg higher diastolic blood pressure (SEs <0.1 mmu2009Hg), but for the waist:hip ratio, associations were only approximately half as strong. General adiposity associations were independent of central adiposity, but central adiposity associations were substantially reduced by adjustment for general adiposity. Findings were similar for men and women. In Mexican adults, often overweight or obese, markers of general adiposity were stronger independent predictors of blood pressure than measured markers of central adiposity, with no threshold effects.