Global Dialysis Perspective: Mexico

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Health care trajectories and barriers to treatment for patients with end-stage renal disease without health insurance in Mexico: a mixed methods approach

Background

Mexico has the sixth-highest premature death rate from chronic kidney disease (CKD) in the world. From 1990 to 2017, the age-standardized CKD mortality rate jumped from 28.7 to 58.1 per 100,000 inhabitants, making it the second-leading cause of death that year. Medical care for the disease is inequitable, as those without health insurance have limited access to renal replacement therapy (RRT). The objective of this study is to describe the healthcare trajectories of patients with end-stage renal disease (ESRD) in a public hospital in Mexico City and the barriers they face in receiving peritoneal dialysis and haemodialysis.

Methods

This study uses a convergent mixed methods approach and is predominantly qualitative. Patients completed 199 surveys, and 42 semi-structured interviews with patients having ESRD and their families were conducted. The quantitative data were analysed using descriptive statistics, and the qualitative data were processed using a phenomenological approach.

Results

It was found that 76.9% of the patients received peritoneal dialysis or haemodialysis as their first RRT. Over 30% began their treatment at least a month after a health professional prescribed it. Almost 50% had been hospitalized for complications related to the disease in the previous year, and 36% had uncertainties about their treatment. Close to 64% of the haemodialysis patients received treatment intermittently. Barriers to accessing treatment, information, contact with health services, and treatment availability were identified. Patients and their families encountered economic and emotional difficulties at every phase of their search for medical care and treatment.

Conclusion

Mexico urgently needs to implement public policies related to CKD that are primarily directed at its prevention but should also implement policies directed at slowing its progression, reducing its complications, and providing funding for uninsured patients who require RRT. These policies must be based on the perspectives of human rights and equality, and the perspectives of patients, their families and the general population should be included in the policy creation process.

Cardiovascular disease in Mexico 1990-2017: secondary data analysis from the global burden of disease study

OBJECTIVES

Cardiovascular diseases (CVD) are a major cause of death and a public health threat. To report the burden of CVD in Mexico at a national and subnational scale from 1990 to 2017 as well as risk factors driving these changes.

METHODS

Following the 2017 global burden of disease study, mortality, disability-adjusted life-years (DALYs), and risk factors of CVD were examined according to 10 subcategories.

RESULTS

The CVD burden of disease decreased between 1990 and 2017 in Mexico as a whole and in all states, with the higher decrease located in the north and central regions. Ischemic heart disease accounted for almost two-thirds of the total number of deaths from CVD and caused the highest DALY rate. The leading CVD risk factors were high systolic blood pressure, dietary risks, high LDL cholesterol, high BMI, and high fasting plasma glucose level.

CONCLUSIONS

These results allow the establishment of priorities, policy development, and implementation to decrease the CVD burden and can provide a benchmark for states to focus on key risk factors, improve the quality of health care, and reduce health care costs.

Overview of the burden of chronic kidney disease in Mexico: secondary data analysis based on the Global Burden of Disease Study 2017

OBJECTIVE

To describe the evolution of the burden of chronic kidney disease (CKD) in Mexico by states, sex and subtypes from 1990 to 2017.

DESIGN

Secondary data analysis based on the Global Burden of Disease Study (GBD) 2017.

PARTICIPANTS

Mexico and its 32 states. Data were publicly available and de-identified and individuals were not involved.

METHODS

We analysed age-standardised mortality rates, years of life lost (YLL) due to premature death, years lived with disability (YLD) and disability-adjusted life years (DALY), as well as the percentage of change of these indicators between 1990 and 2017.

RESULTS

From 1990 to 2017, the number of deaths, YLL, YLD and DALY due to CKD increased from 12 395 to 65 033, from 330 717 to 1 544 212, from 86 416 to 210 924 and from 417 133 to 1 755 136, respectively. Age-standardised rates went from 28.7 to 58.1 for deaths (% of change 102.3), from 601.2 to 1296.7 for YLL (% of change 115.7), from 158.3 to 175.4 for YLD (% of change 10.9) and from 759.4 to 1472.2 for DALY (% of change 93.8). The highest burden of CKD was for Puebla and the lowest for Sinaloa. It was also greater for men than women. By subtypes of CKD, diabetes and hypertension were the causes that contributed most to the loss of years of healthy life in the Mexican population.

CONCLUSIONS

Mexico has experienced exponential and unprecedented growth in the burden of CKD with significant differences by states, sex and subtypes. Data from the GBD are key inputs to guide decision-making and focus efforts towards the reduction of inequities in CKD. These results should be considered a valuable resource that can help guide the epidemiological monitoring of this disease and prioritise the most appropriate health interventions.

Incidence of diabetes mellitus in Spain as results of the nation-wide cohort di@bet.es study

Our aim was to determine the incidence of type 2 diabetes mellitus in a nation-wide population based cohort from Spain (di@bet.es study). The target was the Spanish population. In total 5072 people older than 18 years,were randomly selected from all over Spain). Socio-demographic and clinical data, survey on habits (physical activity and food consumption) and weight, height, waist, hip and blood pressure were recorder. A fasting blood draw and an oral glucose tolerance test were performed. Determinations of serum glucose were made. In the follow-up the same variables were collected and HbA1c was determined. A total of 2408 subjects participated in the follow-up. In total, 154 people developed diabetes (6.4% cumulative incidence in 7.5 years of follow-up). The incidence of diabetes adjusted for the structure of age and sex of the Spanish population was 11.6 cases/1000 person-years (IC95% = 11.1–12.1). The incidence of known diabetes was 3.7 cases/1000 person-years (IC95% = 2.8–4.6). The main risk factors for developing diabetes were the presence of prediabetes in cross-sectional study, age, male sex, obesity, central obesity, increase in weight, and family history of diabetes. This work provides data about population-based incidence rates of diabetes and associated risk factors in a nation-wide cohort of Spanish population.

Is unemployment less important than expected for suicide attempted in developing regions? Occupational profile of suicide attempts in Jujuy, north westernmost Argentina

BACKGROUND

Mental health practices consider unemployment as a suicide main risk factor, based on models built for populations of developed countries.

AIM

This study assesses the association between the occupational risk factor and suicidal behaviors, by considering sex, age and temporal distribution, in a Latin American Andean population from north westernmost Argentina.

METHODS

Data include 481 suicide attempt cases assisted by emergency service psychologists at a head hospital in the Jujuy Province, northern Argentina, during two biennials. General categories and specific types of occupational situation, sex, age and temporal distribution were analyzed.

RESULTS

83.58% of cases corresponded to the with occupation category, but without occupation characterized male cases (p-value = .01). The type no referred occupation (19.15%) mainly contributed to this association (p-value = .02). Unemployed only represented 1.6%. These features revealed independent from the biennial period of assistance (p-value = .96 (general), p-value = .86 (specific)). Associations by age ranges did not seem to be specific of suicidal attempts.

CONCLUSION

The present contribution provides an occupational characterization of suicide attempts in an Andean population from north westernmost Argentina. Unemployment is not associated with suicidal behavior in this population, suggesting that dissimilar patterns underlie suicidal behavior of populations from developed and developing regions.

The adult mortality profile by cause of death in 10 Latin American countries (2000-2016)

Objective

To investigate the adult mortality profile from eight causes of death in 10 Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Paraguay, Peru, and Uruguay) from 2000 to 2016.

Methods

The cause of death effect in adult mortality was calculated as the hypothetical gain in the average number of years lived in adulthood (15 to 60 years old), in a cause-deleted life table. Mortality information by cause, sex, and age group came from the World Health Organization.

Results

Although the adult mortality levels are very different among the 10 countries, the pattern of mortality by cause of death is very similar. All the countries are in the intermediate stages of the epidemiological transition, with chronic degenerative diseases being predominant. Among males, circulatory system diseases and external causes are the most important causes of death in terms of the average number of years lived in adulthood. Among females, the leading causes are circulatory system diseases and neoplasms.

Conclusions

Some studies have pointed out that Latin America exhibits severe difficulties in moving through some epidemiological transition phases, given the continuing high mortality from chronic diseases and violent deaths. However, between 2000 and 2016, there was a convergence among the 10 analyzed countries around the theoretical limit in the average number of years lived in adulthood. Countries that include Brazil, Colombia, Ecuador, Mexico, Paraguay, and Peru are still further away from this limit, but they have an enormous potential to increase the number of years lived in adulthood in the future.

Investigating high blood pressure, type-2 diabetes, dislipidemia, and body mass index to determine the health status of people over 30 years

INTRODUCTION

Over the past decades, the pattern of diseases in human societies had changed from infectious diseases to noncommunicable diseases (NCDs), and according to the report by the World Health Organization, the highest burden of disease is attributed to NCDs. The study was conducted to determine the status of hypertension, type-2 diabetes, lipid disorders, and body mass index (BMI) among the patients aged over 30 years admitted to health centers of Karaj, Iran.

MATERIALS AND METHODS

In this cross-sectional study, the population included 2947 men and women aged 30 years and above admitted to six health-care centers in Karaj. The questionnaire includes demographic characteristics and had the questions on hypertension, diabetes and their risk factors, like lipid disorders and BMI was administered. The data were analyzed in SPSS, version 23, software using descriptive (frequency, percentage, mean, and standard deviation) and analytical (Chi-square and analysis of variance) tests (P < 0.01).

RESULTS

About 10% of the participants had diabetes and 15% of the participants had hypertension. About 32% of the participants had dyslipidemia and 87% of the participants were overweight or obese and over 35% were obese. Furthermore, with the increase in BMI, the prevalence of lipid disorder, hypertension, and type-2 diabetes increased in the studied population (P < 0.01).

CONCLUSION

According to the results, a high percentage of people had hypertension, type-2 diabetes, hyperlipidemia, and BMI in the population. Gender segregation showed that lipid disorders, overweight, and obesity in women were more than in men and percentage of people with hypertension among male were significantly higher than in females. In the case of type-2 diabetes, the results showed no statistically significant differences between men and women. The results may be helpful in developing educational strategies and prevention and control of these diseases.

Avoidable, amenable, and preventable mortalities in South Korea, 2000-2017: Age-period-cohort trends and impact on life expectancy at birth

This study aimed to estimate age-period-cohort effects on avoidable mortality and quantify the impact of avoidable mortality changes on life expectancy (LE) at birth in the South Korean population aged 0-74 years. Using death certificate and resident population data from 2000 to 2017, trends in age-standardized avoidable mortality rates were analyzed with joinpoint regression. Intrinsic estimator regression analysis was conducted to estimate age-period-cohort effects on avoidable mortality. Arriaga's method was used to measure the contributions of avoidable causes to changes in LE gaps between adjacent three-year periods by age and avoidable cause of death groups. Avoidable mortality decreased annually by 4.6% between 2000 and 2017. There were strong age and cohort effects and a weak period effect on avoidable mortality. In the overall decreasing trend, avoidable mortality declined less in cohorts born after the 1950-1953 Korean War and economic recession in the 1970s, with further reductions in cohorts born after the 1987 democratic reform and 1997-1998 economic crisis. Avoidable mortality was reduced after implementation of major health policies, but the decrease stagnated during the 2008-2009 financial crisis. Avoidable mortality reduction resulted in LE gains of 3.1 years, which accounted for 80% of total LE gains. Contribution to LE gains by causes of death was the largest for cerebrovascular disease. Major social changes and health policies influenced the avoidable mortality trend through cohort and period effects. Health care and public health policies implemented since the 2000s might have contributed substantially to gains in LE.

The trend in mortality due to suicide in urban and rural areas of Colombia, 1979-2014

Introduction: Suicide is a serious social and public health problem that affects the population in most countries in the world. Differences in suicide rates in rural and urban areas have been previously described. Objective: To study the trend of mortality rates by suicide in Colombia, in rural and urban areas by gender, age group, and suicide method during the years 1979-2014. Materials and methods: We conducted a temporal trend ecologic study using death certificates from the Departamento Administrativo Nacional de Estadística, DANE. Specific and adjusted by age and gender mortality rates were calculated. We estimated negative binomial and inflection point regression models to study the trends in mortality rates stratified by gender, age group, and suicide method. Results: A total of 56,448 suicides was reported in Colombia between 1979 and 2014. The risk of suicide was higher in urban areas for men, individuals between 25 and 44 years, and 65 and over; and for those who used hanging as the suicide method. Also, the risk of suicide was higher in the rural area for men between 45 and 64 years old, and those who used firearms, sharp weapons, hanging, and others as suicide methods. The trend of suicide rates in urban areas showed its maximum peak in 1999 and in the rural ones in 2000. Then, in the two areas, there was a gradual decrease. Hanging in both areas presented a tendency to rise in men. Conclusions: Suicide has shown a tendency toward reduction after the year 2000, with differences between urban and rural areas.

Trends and differences in homicide mortality in Colombia and Mexico, 1990-2016: Two Realities, One Problem

Colombia and Mexico are among the countries in the region with the highest rates of homicide mortality and are also the drug traffickers in the world. The objective of this study was to analyze the trends and differences in homicide mortality in Colombia and Mexico between 1990 and 2016. Using data from the Global Burden of Disease Study, we report mortality rates and trends in years of life lost to homicides. This study looked at injuries occurring because of interpersonal violence, which was divided into three types (firearm, sharp object, and others). The homicide mortality rate steadily decreased since 1992 in Colombia, while in Mexico, it varied over time. This rate in Colombia has not been reduced to Mexico's level, and in turn, Mexico has not had a mortality rate as high as Colombia's. Throughout the period, in both countries, the years of life lost rate decreased (52% in Colombia and 18.6% in Mexico); however, between 2002 and 2016, the years of life lost rate from homicides was reduced in all age groups in Colombia, and in Mexico, they increased notably, mainly between 15 and 54 years of age. Public health plays a central role in abating interpersonal violence through the prevention of risk factors, and through making information available so that decision-makers can create public policies using evidence-based arguments. The Global Burden of Disease Study is a crucial resource that can be used to define, describe, and evaluate the consequences of homicides and help direct efforts and resources to the most vulnerable groups.

Development and validation of a predictive model for incident type 2 diabetes in middle-aged Mexican adults: the metabolic syndrome cohort

BACKGROUND

Type 2 diabetes mellitus (T2D) is a leading cause of morbidity and mortality in Mexico. Here, we aimed to report incidence rates (IR) of type 2 diabetes in middle-aged apparently-healthy Mexican adults, identify risk factors associated to ID and develop a predictive model for ID in a high-risk population.

METHODS

Prospective 3-year observational cohort, comprised of apparently-healthy adults from urban settings of central Mexico in whom demographic, anthropometric and biochemical data was collected. We evaluated risk factors for ID using Cox proportional hazard regression and developed predictive models for ID.

RESULTS

We included 7636 participants of whom 6144 completed follow-up. We observed 331 ID cases (IR: 21.9 per 1000 person-years, 95%CI 21.37-22.47). Risk factors for ID included family history of diabetes, age, abdominal obesity, waist-height ratio, impaired fasting glucose (IFG), HOMA2-IR and metabolic syndrome. Early-onset ID was also high (IR 14.77 per 1000 person-years, 95%CI 14.21-15.35), and risk factors included HOMA-IR and IFG. Our ID predictive model included age, hypertriglyceridemia, IFG, hypertension and abdominal obesity as predictors (Dxy = 0.487, c-statistic = 0.741) and had higher predictive accuracy compared to FINDRISC and Cambridge risk scores.

CONCLUSIONS

ID in apparently healthy middle-aged Mexican adults is currently at an alarming rate. The constructed models can be implemented to predict diabetes risk and represent the largest prospective effort for the study metabolic diseases in Latin-American population.

["Armed juvenicide": youth homicides and firearms in Latin America]

This article analyzes the impact of firearms in the homicides of young people in Latin America today. A cross-sectional descriptive epidemiological study was carried out based on data from the Pan American Health Organization. There were 14,427 deaths due to assaults with firearms in young people, that is, a rate of 14.3 per 100,000 young people for the year 2014 in Latin America. Thus, 80% of all homicides in young people between 10 to 19 years of age in the region were committed with firearms. This especially affects young males, with a rate of 26.5 per 100,000 deaths due to assault with firearms, although it should not be overlooked that the deaths among women are largely femicides. In addition, 1,828 deaths of undetermined intent with firearms (especially in Argentina and Venezuela) and 284 deaths with firearms in legal interventions (showing higher policy lethality among young people) were registered. The corrected rate is therefore 16.4 young people killed by others with firearms per 100,000 youth in Latin America. The need for gun control and disarmament policies, de-stigmatization campaigns and youth development programs is discussed, in order to reduce the current conditions that foster and invisibilize the so-called "armed juvenicide" in Latin America.

Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies

BACKGROUND

With global survival increasing for children younger than 5 years of age, attention is required to reduce the approximately 1 million deaths of children aged 5-14 years occurring every year. Causes of death at these ages remain poorly documented. We aimed to explore trends in mortality by causes of death in India, China, Brazil, and Mexico, which are home to about 40% of the world's children aged 5-14 years and experience more than 200 000 deaths annually at these ages.

METHODS

We examined data on 244 401 deaths in children aged 5-14 years from four nationally representative data sources that obtained direct distributions of causes of death: the Indian Million Death Study, the Chinese Disease Surveillance Points, mortality data from the Mexican Instituto Nacional de Estadística y Geografía, and mortality data from the Brazilian Institute of Geography and Statistics. We present data on 12 main disease groups in all countries, with breakdown by communicable and nutritional diseases, non-communicable diseases, injuries, and ill-defined causes. To calculate age-specific and sex-specific death rates for each cause, we applied the national cause of death distribution to the UN mortality envelopes for 2005-16 for each country.

FINDINGS

Unlike Brazil, China, and Mexico, communicable diseases still account for nearly half of deaths in India in children aged 5-14 years (73 920 [46·1%] of 160 330 estimated deaths in 2016). In 2016, India had the highest death rates in nearly every category, including from communicable diseases. Fast declines among girls in communicable disease mortality narrowed the gap by 2016 with boys in India (32·6 deaths per 100 000 girls vs 26·2 per 100 000 boys) and China (1·7 vs 1·5). In China, injuries accounted for the greatest proportions of deaths (20 970 [53·2%] of 39 430 estimated deaths, in which drowning was a leading cause). The homicide death rate at ages 10-14 years was higher for boys than for girls in Brazil, increasing annually by an average of 0·7% (0·3-1·1). In India and China, the suicide death rates were higher for girls than for boys at ages 10-14 years. By contrast, in Mexico it was higher for boys than for girls, increasing annually by an average of 2·8% (2·0-3·6). Deaths from transport injuries, drowning, and cancer are common in all four countries, with transport accidents among the top three causes of death for both sexes in all countries, except for Indian girls, and cancer in the top three causes for both sexes in Mexico, Brazil, and China.

INTERPRETATION

Most of the deaths that occurred between 2005 and 2016 in children aged 5-14 years in India, China, Brazil, and Mexico arose from preventable or treatable conditions. This age group is important for extending some of the global disease-specific targets developed for children younger than 5 years of age. Interventions to control non-communicable diseases and injuries and to strengthen cause of death reporting systems are also required.

FUNDING

WHO and the University of Toronto Connaught Global Challenge.

Youth homicide in Mexico and its impact in male life expectancy: geographical variations and associated factors

This study analyzes the impact of youth homicide (between 15 and 29 years of age) on male life expectancy in Mexico and its 32 states in the periods 2004-2006 and 2014-2016, and identifies the factors that best explain the variations in the years of male life expectancy lost (YMLEL) due to youth homicide at the state level in 2014-2016. Based on official data, male temporary life expectancy (MTLE) between 0 to 85 years of age and years of male life expectancy lost, in total and due to youth homicide, were calculated in each three-year period. Through a linear regression analysis, factors associated with the variations of the years of male life expectancy lost due to youth homicide among states were identified. The male temporary life expectancy decreased between the three-year periods in the country and in 25 states; years of male life expectancy lost due to youth homicide increased in 31 states, in eight of them with a figure higher than 0.5 years in the 2014-2016 period. Factors such as the presence of drug trafficking, illegal firearms and the perception of insecurity explain the variations in the years of male life expectancy lost due to youth homicide within the Mexican states in the 2014-2016 period.

Reported diabetes mellitus: incidence and determinants in cohort of community dwelling elderly people in São Paulo City, Brazil: SABE study, health, wellness and aging

To verify the association between the incidence of DM and predictors, in a cohort of elderly people. Elderly people (≥ 60 y) were analyzed, of both genders, participants of the SABE Survey, carried out in the city of São Paulo, Brazil, in 2000 (n = 2,143) and 2006 (n = 1,115). The study variables were: DM; demographic (gender, age group, education level, companionship in the residence), nutritional status (risk for obesity, body obesity, and high abdominal fat), clinical (number of reported diseases), and lifestyle (alcohol consumption, smoking, intake of meat and fruit and vegetables). Multiple logistic regression (p < 0.05) was used to verify the association between variables of this study, with the statistical software Stata/SE 10.1. In 2006, 914 subjects, survivors of 2000, were analyzed and 72 were identified as new cases of DM (7.7/1.000 person-years). It was found that body obesity (OR = 1.67, CI = 1.00 to 2.81) and high abdominal fat (OR = 2.32, CI = 1.47 to 3.67) were predictors of the incidence of DM in the elderly (p < 0.000). It was concluded that body obesity and abdominal fat are the variables which contribute to the development of DM in the elderly.

Influence of obesity, parental history of diabetes, and genes in type 2 diabetes: A case-control study

Obesity, parental history (PH) of type 2 diabetes (T2D), and genes play an important role in T2D development. However, the influence of each factor on T2D variability is unclear. This study aimed to investigate the influence of obesity (body mass index [BMI], waist/hip ratio), PH, and 16 single-nucleotide polymorphisms (SNPs) associated with T2D on T2D variability in Mexico, comparing 1234 non-diabetic controls and 1219 diabetic patients. To replicate the data, a case-control (n = 2904) and a cross-sectional (n = 1901) study were also included. In a multivariate logistic regression model, all factors accounted for only 27.3% of T2D variability: SNPs (8.4%); PH (11.8%) and obesity (7.1%). These factors contributed more in men (33.2%) than in women (25%), specifically when the disease was diagnosed before the age of 46 (46.7% vs. 30%). Genes played a substantially more important role in men than in women (14.9% vs. 5.5%), while obesity and PH played a similar role in both genders. Genes and PH appeared to play a greater role than obesity in T2D. However, obesity contribution was calculated at the time of recruitment and may be underestimated in patients because the BMI decreased linearly with the number of years with the disease. The data suggest that sexual hormones may play important roles in genes that are associated with T2D.

Trends in suicide rates in Brazil from 1997 to 2015

OBJECTIVES

To analyze time trends of suicide rates in Brazil overall and in Brazilian states and compare the estimated suicide rates projected for 2020 with the World Health Organization (WHO) Mental Health Action Plan target.

METHODS

This was an ecological time-series study from 1997 to 2015, stratified by Brazilian states, specific age groups, and sex. Data were obtained from the Mortality Information System (Sistema de Informações sobre Mortalidade [SIM]) of the Brazilian Ministry of Health. Polynomial regression models were used to analyze the trends in suicide rates and to project suicide rates for 2020.

RESULTS

Considering 224 units of analysis, 21 (9.4%) showed a decreasing trend, 108 (48.2%) were stable, and 95 (42.4%) showed an increasing trend. Thus, 67% of units of analysis will not meet the WHO target in 2020. Mean suicide rates were higher in males than in females. People aged 60 years and older presented the highest suicide rates, while 84.7% of total deaths by suicide occurred among 15-to-59-year-olds.

CONCLUSION

Overall, 90.6% of units of analysis had a stable or increasing trend in suicide rates from 1997 to 2015. If these trends remain, most of Brazil will fail to achieve the WHO-recommended reduction in suicide rates by 2020.

Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia

BACKGROUND

Intermediate hyperglycaemia (IH) is characterised by one or more measurements of elevated blood glucose concentrations, such as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and elevated glycosylated haemoglobin A1c (HbA1c). These levels are higher than normal but below the diagnostic threshold for type 2 diabetes mellitus (T2DM). The reduced threshold of 5.6 mmol/L (100 mg/dL) fasting plasma glucose (FPG) for defining IFG, introduced by the American Diabetes Association (ADA) in 2003, substantially increased the prevalence of IFG. Likewise, the lowering of the HbA1c threshold from 6.0% to 5.7% by the ADA in 2010 could potentially have significant medical, public health and socioeconomic impacts.

OBJECTIVES

To assess the overall prognosis of people with IH for developing T2DM, regression from IH to normoglycaemia and the difference in T2DM incidence in people with IH versus people with normoglycaemia.

SEARCH METHODS

We searched MEDLINE, Embase, ClincialTrials.gov and the International Clinical Trials Registry Platform (ICTRP) Search Portal up to December 2016 and updated the MEDLINE search in February 2018. We used several complementary search methods in addition to a Boolean search based on analytical text mining.

SELECTION CRITERIA

We included prospective cohort studies investigating the development of T2DM in people with IH. We used standard definitions of IH as described by the ADA or World Health Organization (WHO). We excluded intervention trials and studies on cohorts with additional comorbidities at baseline, studies with missing data on the transition from IH to T2DM, and studies where T2DM incidence was evaluated by documents or self-report only.

DATA COLLECTION AND ANALYSIS

One review author extracted study characteristics, and a second author checked the extracted data. We used a tailored version of the Quality In Prognosis Studies (QUIPS) tool for assessing risk of bias. We pooled incidence and incidence rate ratios (IRR) using a random-effects model to account for between-study heterogeneity. To meta-analyse incidence data, we used a method for pooling proportions. For hazard ratios (HR) and odds ratios (OR) of IH versus normoglycaemia, reported with 95% confidence intervals (CI), we obtained standard errors from these CIs and performed random-effects meta-analyses using the generic inverse-variance method. We used multivariable HRs and the model with the greatest number of covariates. We evaluated the certainty of the evidence with an adapted version of the GRADE framework.

MAIN RESULTS

We included 103 prospective cohort studies. The studies mainly defined IH by IFG5.6 (FPG mmol/L 5.6 to 6.9 mmol/L or 100 mg/dL to 125 mg/dL), IFG6.1 (FPG 6.1 mmol/L to 6.9 mmol/L or 110 mg/dL to 125 mg/dL), IGT (plasma glucose 7.8 mmol/L to 11.1 mmol/L or 140 mg/dL to 199 mg/dL two hours after a 75 g glucose load on the oral glucose tolerance test, combined IFG and IGT (IFG/IGT), and elevated HbA1c (HbA1c5.7: HbA1c 5.7% to 6.4% or 39 mmol/mol to 46 mmol/mol; HbA1c6.0: HbA1c 6.0% to 6.4% or 42 mmol/mol to 46 mmol/mol). The follow-up period ranged from 1 to 24 years. Ninety-three studies evaluated the overall prognosis of people with IH measured by cumulative T2DM incidence, and 52 studies evaluated glycaemic status as a prognostic factor for T2DM by comparing a cohort with IH to a cohort with normoglycaemia. Participants were of Australian, European or North American origin in 41 studies; Latin American in 7; Asian or Middle Eastern in 50; and Islanders or American Indians in 5. Six studies included children and/or adolescents.Cumulative incidence of T2DM associated with IFG5.6, IFG6.1, IGT and the combination of IFG/IGT increased with length of follow-up. Cumulative incidence was highest with IFG/IGT, followed by IGT, IFG6.1 and IFG5.6. Limited data showed a higher T2DM incidence associated with HbA1c6.0 compared to HbA1c5.7. We rated the evidence for overall prognosis as of moderate certainty because of imprecision (wide CIs in most studies). In the 47 studies reporting restitution of normoglycaemia, regression ranged from 33% to 59% within one to five years follow-up, and from 17% to 42% for 6 to 11 years of follow-up (moderate-certainty evidence).Studies evaluating the prognostic effect of IH versus normoglycaemia reported different effect measures (HRs, IRRs and ORs). Overall, the effect measures all indicated an elevated risk of T2DM at 1 to 24 years of follow-up. Taking into account the long-term follow-up of cohort studies, estimation of HRs for time-dependent events like T2DM incidence appeared most reliable. The pooled HR and the number of studies and participants for different IH definitions as compared to normoglycaemia were: IFG5.6: HR 4.32 (95% CI 2.61 to 7.12), 8 studies, 9017 participants; IFG6.1: HR 5.47 (95% CI 3.50 to 8.54), 9 studies, 2818 participants; IGT: HR 3.61 (95% CI 2.31 to 5.64), 5 studies, 4010 participants; IFG and IGT: HR 6.90 (95% CI 4.15 to 11.45), 5 studies, 1038 participants; HbA1c5.7: HR 5.55 (95% CI 2.77 to 11.12), 4 studies, 5223 participants; HbA1c6.0: HR 10.10 (95% CI 3.59 to 28.43), 6 studies, 4532 participants. In subgroup analyses, there was no clear pattern of differences between geographic regions. We downgraded the evidence for the prognostic effect of IH versus normoglycaemia to low-certainty evidence due to study limitations because many studies did not adequately adjust for confounders. Imprecision and inconsistency required further downgrading due to wide 95% CIs and wide 95% prediction intervals (sometimes ranging from negative to positive prognostic factor to outcome associations), respectively.This evidence is up to date as of 26 February 2018.

AUTHORS' CONCLUSIONS

Overall prognosis of people with IH worsened over time. T2DM cumulative incidence generally increased over the course of follow-up but varied with IH definition. Regression from IH to normoglycaemia decreased over time but was observed even after 11 years of follow-up. The risk of developing T2DM when comparing IH with normoglycaemia at baseline varied by IH definition. Taking into consideration the uncertainty of the available evidence, as well as the fluctuating stages of normoglycaemia, IH and T2DM, which may transition from one stage to another in both directions even after years of follow-up, practitioners should be careful about the potential implications of any active intervention for people 'diagnosed' with IH.

Risk factors for liver disease among adults of Mexican descent in the United States and Mexico

AIM

To compare the prevalence of chronic liver disease (CLD) risk factors in a representative sample of Mexican-Americans born in the United States (US) or Mexico, to a sample of adults in Mexico.

METHODS

Data for Mexican-Americans in the US were obtained from the 1999-2014 National Health and Nutrition Examination Survey (NHANES), which includes persons of Mexican origin living in the US (n = 4274). The NHANES sample was restricted to Mexican-American participants who were 20 years and older, born in the US or Mexico, not pregnant or breastfeeding, and with medical insurance. The data in Mexico were obtained from the 2004-2013 Health Worker Cohort Study in Cuernavaca, Mexico (n = 9485). The following known risk factors for liver disease/cancer were evaluated: elevated aminotransferase levels (elevated alanine aminotransferase was defined as > 40 IU/L for males and females; elevated aspartate aminotransferase was defined as > 40 IU/L for males and females), infection with hepatitis B or hepatitis C, metabolic syndrome, high total cholesterol, diabetes, obesity, abdominal obesity, and heavy alcohol use. The main independent variables for this study classified individuals by country of residence (i.e., Mexico vs the US) and place of birth (i.e., US-born vs Mexico-born). Regression analyses were used to investigate CLD risk factors.

RESULTS

After adjusting for socio-demographic characteristics, Mexican-American males were more likely to be obese, diabetic, heavy/binge drinkers or have abdominal obesity than males in Mexico. The adjusted multivariate results for females also indicate that Mexican-American females were significantly more likely to be obese, diabetic, be heavy/binge drinkers or have abdominal obesity than Mexican females. The prevalence ratios and prevalence differences mirror the multivariate analysis findings for the aforementioned risk factors, showing a greater risk among US-born as compared to Mexico-born Mexican-Americans.

CONCLUSION

In this study, Mexican-Americans in the US had more risk factors for CLD than their counterparts in Mexico. These findings can be used to design and implement more effective health promotion policies and programs to address the specific factors that put Mexicans at higher risk of developing CLD in both countries.

Household wellbeing and health risks in Mexican households with and without migrants: a cross-sectional analysis

BACKGROUND

Migration between Mexico and the USA constitutes the world's largest migration corridor with more than 13 million movements of people in 2016. Furthermore, Mexico has a complex migration profile, being a country of origin, transit, destination, and return. While there has been discussion on the relationship between migration and development of origin communities, evidence on social and health issues faced by origin households is limited. This case study is a first attempt at documenting, through analyzing a national representative health survey of Mexican households (n = 9474), the relationship between international migration from Mexico and origin household health characteristics.

CASE PRESENTATION

Mexican international migration moves largely (90% of migrants) toward the USA. Migration has passed from being mostly circular (from the early to late 1990s) to a permanent pattern of residence in the destination country due to changes in migration policies that have progressively restricted the irregular entrance of immigrants making re-entry more difficult.The present case study compares the socioeconomic, demographic, and health characteristics of households in Mexico with and without emigrants using data from a national representative health survey. Accordingly, in 2016, 5.8% (n = 1,802,980) of all Mexican households reported having a member living abroad.Households with members living abroad were found to more likely be headed by a female (45.8%), have Seguro Popular health insurance, and not to be among the poorest household population. In terms of health profile, a higher frequency of adults with a reported diagnosis of diabetes and/or hypertension (33.9 vs 21.7% for households with vs without emigrants, respectively; p = 0.067), and a higher severity of diabetes reflected a higher probability of hospitalization.

CONCLUSIONS

Results showed that socioeconomic, demographic, and health conditions differed between households with and without emigrants. These differences were determined as not being attributable to migration and cannot be considered as predisposing factors of migration.

Changes in life expectancy due to avoidable and non-avoidable deaths in Argentina, Chile, Colombia and Mexico, 2000-2011

The objective of this study was to analyze the level and trend of avoidable deaths and non-avoidable deaths and their contribution to the change in life expectancy in Latin America by studying the situations in Argentina, Chile, Colombia and Mexico between the years 2000 and 2011, stratified by sex and 5-year age groups. The information source used in this study was the mortality vital statistics, and the population data were obtained from censuses or estimates. The proposal by Nolte & McKee (2012) was used to calculate the standardized mortality rates and the influence from avoidable and non-avoidable causes in the change in life expectancy between 0 and 74 years. In Argentina, Chile and Colombia, all the rates declined between the years 2000 and 2011, whereas in Mexico, the avoidable deaths and non-avoidable deaths rates increased slightly for men and decreased for women. In all the countries, the non-avoidable death rates were higher than the avoidable death rates, and the rates were higher for men. The largest contributions to changes in life expectancy were explained by the non-avoidable deaths for men in all countries and for women in Argentina; in contrast, in Chile, Colombia and Mexico, the gains in years of life expectancy for women were mainly a result of avoidable causes. The results suggest there have been reductions in mortality from these causes that have resulted in gains in years of life expectancy in the region. Despite these achievements, differences between countries, sex and age groups are still present, without any noticeable progress in the reduction of these inequalities until now.

Risk Factors and Prevalence of Suicide Attempt in Patients with Type 2 Diabetes in the Mexican Population

BACKGROUND

It has been proposed that the risk of death by suicide is higher in patients with diabetes than in the general population. Therefore, it is necessary to investigate the risk factors of suicidal behavior in patients with type 2 diabetes. The aim of the present study was to analyze the prevalence of suicide attempt and determine the risk factors of suicide attempt, in patients with type 2 diabetes in a Mexican population.

METHODS

Clinic characteristics, anthropometric measurements, biochemical levels, depression, and suicidal behavior were evaluated in 185 Mexican patients with type 2 diabetes. A multivariate logistic regression analysis was performed to find predictive factors of suicide attempt.

RESULTS

11.4% of patients reported previous suicide attempts n = 21). Younger patients (OR: 3.63, 95% CI: 1.29⁻10.19), having depression (OR: 3.33, 95% CI: 1.13⁻9.76) and normal BMI (OR: 3.14, 95% CI: 1.11⁻8.83), were predictive factors of suicide attempt. No other variables in the study showed statistical significance.

CONCLUSIONS

Our results showed a high prevalence of suicidal behavior in patients with type 2 diabetes. We found that younger age, depression and normal BMI could be risk factors of suicide attempt in these patients. Therefore, psychiatric interventions to prevent depression and suicidal behavior in this population are necessary. New studies using larger samples are necessary to replicate and confirm these results.

Violence deaths and its impact on life expectancy: a comparison between Mexico and Brazil

Using official data, this study analyzed violent deaths (homicide, suicide, events of undetermined intent and deaths due to legal intervention) in Brazil and Mexico in the three-year periods 2002-2004 and 2012-14, the impact of these causes of death on life expectancy in both countries and the role of the different age groups in years of life expectancy lost (YLEL). Abridged life tables were constructed for both countries for both periods. Temporary life expectancy and YLEL between zero and 80 years by selected causes and age groups were calculated for each triennium. The leading cause of YLEL among men was homicide in both periods in Brazil (1.5 years) and in the second period in Mexico (one year). Violent deaths (VD) accounted for around 16% of YLEL in Brazil and 13% in Mexico in 2012-2014. Among women, YLEL due to homicides and suicides showed the greatest relative increase in both countries, although VD accounted for barely 3% of total YLEL. The highest percentage of YLEL due to VDwas found among the 15 to 29 year age groups in both countries and for both sexes. The increase in rates of VD in Mexico, above all among young people, has curbed further increases in life expectancy in recent years, especially among men. Likewise, the high rates of VD in Brazil in both periods have hindered the growth of life expectancy.

Occupational and leisure time physical inactivity and the risk of type II diabetes and hypertension among Mexican adults: A prospective cohort study

There is a lack of longitudinal data linking physical inactivity and chronic diseases among Mexicans. Objective. To examine the relationship between total, leisure and occupational moderate-to-vigorous physical activity (MVPA) and incidence of type II diabetes (T2D) and hypertension in the Mexico City Diabetes Study. Study design and population. A prospective cohort study was conducted from 1989 to 2009 among 2282 men and non-pregnant women residing in six low-income neighborhoods in Mexico City. Main outcome. Incidence of T2D and hypertension. Results. After controlling for confounders, <1 MET/min/week of MVPA during leisure time was associated with higher risk of hypertension (HR 1.29, CI 95% 1.01, 1.66) and T2D (HR 1.31 CI 95% 1.00, 1.74). In addition, accumulating <1 MET/min/week of occupational MVPA was associated with higher risk of hypertension (HR 1.47, CI 95% 1.13, 1.90). Conclusion. The absence of leisure and occupational MVPA was associated with an increased risk of hypertension. However, no associations were found between occupational MVPA and T2D.

[Analysis of the trend and impact of mortality due to external causes: Mexico, 2000-2013]

The objective of this study was to analyze mortality due to the main external causes of death (traffic accidents, other accidents, homicides and suicides) in Mexico, calculating the years of life lost between 0 and 100 years of age and their contribution to the change in life expectancy between 2000 and 2013, at the national level, by sex and age group. Data came from mortality vital statistics of the Instituto Nacional de Estadística y Geografía (INEGI) [National Institute of Statistics and Geography]. The biggest impact in mortality due to external causes occurred in adolescent and adult males 15-49 years of age; mortality due to these causes remained constant in males and slightly decreased in females. Mortality due to traffic accidents and other accidents decreased, with a positive contribution to life expectancy, but this effect was canceled out by the increase in mortality due to homicides and suicides. Mortality due to external causes can be avoided through interventions, programs and prevention strategies as well as timely treatment. It is necessary to develop multidisciplinary studies on the dynamics of the factors associated with mortality due to these causes.

Diabetes Cultural Beliefs and Traditional Medicine Use Among Health Center Patients in Oaxaca, Mexico

Type II diabetes mellitus is currently the leading cause of death in Mexico. Oaxaca is one of the poorest states in Mexico with the largest concentration of indigenous people in the country. Despite the alarming increase of diabetes rates in this region, little is known about the indigenous populations' cultural understandings and related practices for this chronic disease. This study examined diabetes cultural beliefs and traditional medicine use among a sample of 158 adults with and without diabetes in Oaxaca, Mexico. Individuals with and without diabetes did not differ in their traditional culture beliefs regarding diabetes in this study. Younger age (OR = 1.04) and stronger beliefs in punitive and mystical retribution (OR = 5.42) regarding diabetes causality increased the likelihood of using traditional medicine (p < .05). Findings may aid in the development of culturally tailored programs to address diabetes prevention and management efforts in the region.

Occupational group, educational level, marital status and deleterious habits among individuals with maxillofacial fractures: retrospective study

Background

To investigate the occupational profile, educational level, marital status and deleterious habits to the health of patients with maxillofacial fractures of a population of northeastern Brazil.

Material and Methods

A retrospective study of patients records admitted to the Division of Oral and Maxillofacial Surgery at the Walter Cantídio University Hospital (Fortaleza, Brazil) who sustained maxillofacial fractures was conducted in the period between 2006 and 2015.

Results

A total of 338 patients rendered 355 fractures. Males were the most affected (p<0.001), with prevalence in the third decade of life (p<0.001). There was a predominance of motorcycle accidents (p<0.001), home workers (p<0.001), low educational status (p = 0.032), and no cigarette use (p<0.001) or alcohol (p = 0.023). Fractures of the zygomatic-orbital complex were the most prevalent in the sample (p<0.001).

Conclusions

The sociodemographic profile exerted a significant influence on the epidemiological profile of maxillofacial fractures in a Brazilian population during the study period.

Key words:Epidemiological studies, trauma, facial bones.

Demographic and Clinical Characteristics of Completed Suicides in Mexico City 2014-2015

Objective: To analyze sex differences in demographic and clinical characteristics of individuals who died by suicide in Mexico City. Method: Statistical analysis of residents of Mexico City whose cause of death was suicide, during two years period from January 2014 to December 2015, with a coroner's report. Suicide mortality rates were calculated by age, sex, and location within the city. The Chi-squared test was used to assess statistical differences. Results: From January 2014 to December 2015, 990 residents of Mexico City died by suicide (men: 78.28%, women: 21.72%). Among males, the highest mortality rates were among the groups of 20-24 and 75-79 years old, whereas in women, the group with the highest mortality rate was 15 to 19 years old. 74% of the sample used hanging as suicide method. However, men had higher rates of a positive result in the toxicology test (40%) (p < 0.05). There was no concordance between male and female suicide by city jurisdictions. Conclusion: Our results provide evidence that the characteristics of Mexico City's residents who committed suicide had significant sex-related differences, including where they used to live. Understanding the contributory factors associated with completed suicide is essential for the development of effective preventive strategies.

Gender differences of suicides in children and adolescents: Analysis of 167 suicides in a Mexican population from 2003 to 2013

Suicide is the second cause of death in youth population. The aim of the present study was to analyze demographic characteristics and suicide methods used, as well as to identify gender differences among Mexican children and adolescents (aged 10-17 years) that committed suicide. Between January 2003 and December 2013, 167 suicides of children and adolescents between 10 and 17 years of age were documented by the Secretary of Health of the state of Tabasco, Mexico. All sociodemographic characteristics were compared according to gender. Our sample included 67.7% males and 32.3% females (male to female 2.1:1). The predominant marital status was single (89.6%) and hanging (93.7%) was the principal method of suicide used. Both female and male adolescents were predominantly students (50%); however, female adolescents were more frequently married (17%) and were housewives (26.4%). Our results identified that hanging is the principal suicide method used by children and adolescents in Mexican population; we also detected main gender differences in terms of poisoning/drug toxicity as the method used, occupation and marital status. These results should be taken into consideration when designing suicide prevention programs due to the differences found by gender.

From Sea to Shining Sea and the Great Plains to Patagonia: A Review on Current Knowledge of Diabetes Mellitus in Hispanics/Latinos in the US and Latin America

The past two decades have witnessed many advances in the prevention, treatment, and control of diabetes mellitus (DM) and its complications. Increased screening has led to a greater recognition of type 2 diabetes mellitus (type 2 DM) and prediabetes; however, Hispanics/Latinos, the largest minority group in the US, have not fully benefited from these advances. The Hispanic/Latino population is highly diverse in ancestries, birth places, cultures, languages, and socioeconomic backgrounds, and it populates most of the Western Hemisphere. In the US, the prevalence of DM varies among Hispanic/Latino heritage groups, being higher among Mexicans, Puerto Ricans, and Dominicans, and lower among South Americans. The risk and prevalence of diabetes among Hispanics/Latinos are significantly higher than in non-Hispanic Whites, and nearly 40% of Hispanics/Latinos with diabetes have not been formally diagnosed. Despite these striking facts, the representation of Hispanics/Latinos in pharmacological and non-pharmacological clinical trials has been suboptimal, while the prevalence of diabetes in these populations continues to rise. This review will focus on the epidemiology, etiology and prevention of type 2 DM in populations of Latin American origin. We will set the stage by defining the terms Hispanic, Latino, and Latin American, explaining the challenges identifying Hispanics/Latinos in the scientific literature and databases, describing the epidemiology of diabetes-including type 2 DM and gestational diabetes mellitus (GDM)-and cardiovascular risk factors in Hispanics/Latinos in the US and Latin America, and discussing trends, and commonalities and differences across studies and populations, including methodology to ascertain diabetes. We will discuss studies on mechanisms of disease, and research on prevention of type 2 DM in Hispanics/Latinos, including women with GDM, youth and adults; and finalize with a discussion on lessons learned and opportunities to enhance research, and, consequently, clinical care oriented toward preventing type 2 DM in Hispanics/Latinos in the US and Latin America.

Trends in premature mortality due to chronic non-communicable diseases in Brazilian federal units

Chronic non-communicable diseases (NCDs) have a high mortality rate, mainly in lower and middle income countries. The major groups are cardiovascular disease (CVD), chronic respiratory disease (CRD), cancer and diabetes. The Action Plan to reduce NCDs in Brazil, 2011-2022 established a 2% yearly reduction in the NCD premature mortality rate as a goal. The aim of the study was to analyze trends in premature mortality rates and also show goal achievement scenarios for each Federal Unit (FU). A time series analysis of the standardized mortality rate between 2000-2011 was performed using the linear regression model. The average annual rate of increase and the 95% confidence interval were estimated. Each FU was classified as being likely or unlikely to achieve the goal. The FUs likely to achieve the goal were: for CVD - Federal District, Santa Catarina, Mato Grosso, Rio Grande do Sul, Minas Gerais, Bahia, Espírito Santo and Paraná states; for CRD - Amazonas, Federal District and Paraná. For neoplasms and diabetes, none of the FUs are likely to achieve the goal. The articulation of the three levels of government will allow the strengthening of interventions to reduce the determinants of NCDs and to improve access and quality in health care.

Elevated incidence rates of diabetes in Peru: report from PERUDIAB, a national urban population-based longitudinal study

OBJECTIVE

A recent report from a non-nationally representative, geographically diverse sample in four separate communities in Peru suggests an unusually high diabetes incidence. We aimed to estimate the national diabetes incidence rate using PERUDIAB, a probabilistic, national urban population-based longitudinal study.

RESEARCH DESIGN AND METHODS

662 subjects without diabetes, selected by multistage, cluster, random sampling of households, representing the 24 administrative and the 3 (coast, highlands and jungle) natural regions across the country, from both sexes, aged 25+ years at baseline, enrolled in 2010-2012, were followed for 3.8 years. New diabetes cases were defined as fasting blood glucose ≥126 mg/dL or on medical diabetes treatment.

RESULTS

There were 49 cases of diabetes in 2408 person-years follow-up. The weighted cumulative incidence of diabetes was 7.2% while the weighted incidence rate was estimated at 19.5 (95% CI 13.9 to 28.3) new cases per 1000 person-years. Older age, obesity and technical or higher education were statistically associated with the incidence of diabetes.

CONCLUSION

Our results confirm that the incidence of diabetes in Peru is among the highest reported globally. The fast economic growth in the last 20 years, high overweight and obesity rates may have triggered this phenomenon.

High Incidence of Diabetes Mellitus Among a Middle-Aged Population in Iran: A Longitudinal Study

OBJECTIVES

There are few data concerning the incidence rates of diabetes in Iran. This study aimed to determine the incidence of diabetes and its risk factors in a middle-aged population in Iran.

METHODS

All of the people who participated in the first phase of the Shahroud eye cohort study were invited to the study in 2014; after signing informed consent forms, a total of 4737 people 45 to 69 years of age were enrolled in the second phase of the study (participation rate: 91.3%). The 5-year incidence rate of diabetes was determined by age and sex, and we used the binomial logistic regression model to calculate the risk ratio.

RESULTS

The prevalence of diabetes in the second phase was 20.19% in men, 26.45% in women and 23.89% in the total group. The 5-year incidence of diabetes was 11.19% in men, 15.55% in women and 13.73% in both sexes. With increases in age, the incidence of diabetes rose in both sexes. Age (risk ratio [RR]: 1.02; CI 95%: 1.01 to 1.03) hypertension (RR: 1.41; CI 95%: 1.15 to 1.74), being overweight (RR: 2.17; CI 95%: 1.64 to 2.88) and obesity (RR: 3.4; CI 95%: 2.53 to 4.41) were associated with increased risks for the incidence of diabetes.

CONCLUSIONS

This study is 1 of the few studies in Iran that has reported the incidence of diabetes. Because the incidence of diabetes was high in the studied population, it is necessary for the health system to design and implement emergency intervention to prevent further spread of diabetes and its complications.

Type 2 diabetes: A 21st century epidemic

Around 415 million people around the world have diabetes (9% of adults), and the vast majority live in low- and middle-income countries. Over the next decade, this number is predicted to increase to 642 million people. Given that diabetes is a major cause of mortality, morbidity, and health care expenditures, addressing this chronic disease represents one of the greatest global health challenges of our time. The objectives of this article are three-fold: (1) to present data on the global burden of type 2 diabetes (which makes up 87-91% of the total diabetes burden), both in terms of prevalence and incidence; (2) to give an overview of the risk factors for type 2 diabetes, and to describe obesity and the developmental origins of disease risk in detail; and (3) to discuss the implications of the global burden and point out important research gaps.

Longitudinal association of obesity, metabolic syndrome and diabetes with risk of elevated aminotransferase levels in a cohort of Mexican health workers

OBJECTIVE

In Mexico, chronic liver disease have been increasingly found along with the rapidly growing prevalence of obesity, diabetes and metabolic syndrome (MS). We aimed to investigate the longitudinal association between these three factors and risk of elevated alanine aminotransferase (ALT) levels (>40 U/L), a marker for liver damage, in a cohort of Mexican adults.

METHODS

Data were obtained from two separate waves of the Mexican Health Worker Cohort Study: Wave 1 (2004-2006) and Wave 2 (2011-2013). Unconditional logistic regression models were employed to determine the cross-sectional and longitudinal association between these risk factors and elevated ALT levels.

RESULTS

The prevalence of elevated ALT was significantly higher among men, individuals aged under 60 years, those who were overweight or obese, diabetic, with MS or heavy/binge drinkers. The longitudinal results indicated that weight gain between waves that resulted in a change in body mass index, along with remaining overweight or obese, were significantly associated with an increased risk of elevated ALT levels. A significantly increased risk of developing elevated ALT was also observed among those who acquired diabetes or MS from Wave 1 to Wave 2.

CONCLUSIONS

Weight gain and acquiring diabetes or MS are associated with a significant risk of having elevated ALT. These results, within the context of the rapid increase in global obesity rates, call urgently for programs to help to prevent chronic liver disease.

Años de Vida Perdidos (AVP) atribuibles al consumo de alcohol en la ciudad de México

Resumen El objetivo de este artículo es estimar los AVP atribuibles al consumo de alcohol en la Ciudad de México durante 2006 – 2012. Se utilizaron las estadísticas vitales de mortalidad del INEGI atribuibles al consumo de alcohol para obtener los AVP, se obtuvieron ademas promedios de edad de muerte respecto a intervalos de edad por sexo. Se estimaron 168,607 AVP, con una pérdida promedio de 18.32 años para los hombres y 17.54 en mujeres. Se encontró una mayor proporción de AVP en hombres que en mujeres. De acuerdo a la CIE-10 se observó que las enfermedades del hígado atribuibles al alcohol, aportan más del 80% de los AVP al total. Existe una tendencia cíclica en los AVP entre 2006 a 2012. Los AVP atribuibles al alcohol apuntan a que el consumo es un problema de salud pública que implican pérdidas en la productividad y costos económicos, mientras la baja en los AVP podría ser explicada por una disminución en el ingreso provocada por la crisis económica de 2008 al igual que el aumento por la mejoría en el 2012.

Analysis of the impact of mortality due to suicides in Mexico, 2000-2012

The objective of this study was to analyze the burden of disease due to suicide in Mexico using years of life lost (YLL) between 2000 and 2012 by sex, age group (for those under 85 years of age) and jurisdiction. Vital statistics on mortality and population estimates were used to calculate standardized mortality rates and years of life lost due to suicide. Between 2000 and 2012 a sustained increase in the suicide mortality rate was observed in Mexico. The age group with the highest rate was 85 years of age or older for men, and 15-19 years of age for women. The highest impact in life expectancy due to suicide occurred at 20 to 24 years of age in men and 15 to 19 years of age in women. The states with the highest mortality due to suicide were located in the Yucatan Peninsula (Yucatan, Quintana Roo and Campeche). Mortality due to suicide in Mexico has increased continually. As suicides are preventable, the implementation of health public policies through timely identification, integral prevention strategies and the detailed study of associated risk factors is imperative.

ASSOCIATION OF TOTAL AND DIFFERENTIAL WHITE BLOOD CELL COUNTS TO DEVELOPMENT OF TYPE 2 DIABETES IN MEXICAN AMERICANS IN CAMERON COUNTY HISPANIC COHORT

OBJECTIVE

To evaluate the relationship between total and differential White Blood Cell (WBC) counts with time to transition to type 2 diabetes in Mexican Americans using prospective data from the Cameron County Hispanic Cohort (CCHC).

RESULTS

Multivariable Cox proportional hazards regression models revealed that obese Mexican-American cohort participants whose total WBC or granulocyte count increased over time had 1.39 and 1.35 times higher risk respectively of transition to type 2 diabetes when compared to overweight participants. The granulocyte or total WBC count in participants with BMI≥35 were significant risk factors for transition to type 2 diabetes.

CONCLUSIONS

Increased total WBC and WBC differential counts, particularly lymphocytes and granulocytes, are associated with risk of transition to type 2 diabetes in obese Mexican Americans, after adjusting for other potential confounders. Screening and monitoring the WBC counts, including lymphocytes and granulocytes can help with monitoring potential transition to type 2 diabetes.

One Egg per Day Improves Inflammation when Compared to an Oatmeal-Based Breakfast without Increasing Other Cardiometabolic Risk Factors in Diabetic Patients

There is concern that egg intake may increase blood glucose in patients with type 2 diabetes mellitus (T2DM). However, we have previously shown that eggs reduce inflammation in patients at risk for T2DM, including obese subjects and those with metabolic syndrome. Thus, we hypothesized that egg intake would not alter plasma glucose in T2DM patients when compared to oatmeal intake. Our primary endpoints for this clinical intervention were plasma glucose and the inflammatory markers tumor necrosis factor (TNF)-α and interleukin 6 (IL-6). As secondary endpoints, we evaluated additional parameters of glucose metabolism, dyslipidemias, oxidative stress and inflammation. Twenty-nine subjects, 35–65 years with glycosylated hemoglobin (HbA1c) values <9% were recruited and randomly allocated to consume isocaloric breakfasts containing either one egg/day or 40 g of oatmeal with 472 mL of lactose-free milk/day for five weeks. Following a three-week washout period, subjects were assigned to the alternate breakfast. At the end of each period, we measured all primary and secondary endpoints. Subjects completed four-day dietary recalls and one exercise questionnaire for each breakfast period. There were no significant differences in plasma glucose, our primary endpoint, plasma lipids, lipoprotein size or subfraction concentrations, insulin, HbA1c, apolipoprotein B, oxidized LDL or C-reactive protein. However, after adjusting for gender, age and body mass index, aspartate amino-transferase (AST) (p < 0.05) and tumor necrosis factor (TNF)-α (p < 0.01), one of our primary endpoints were significantly reduced during the egg period. These results suggest that compared to an oatmeal-based breakfast, eggs do not have any detrimental effects on lipoprotein or glucose metabolism in T2DM. In contrast, eggs reduce AST and TNF-α in this population characterized by chronic low-grade inflammation.

[Burden of mortality due to diabetes mellitus in Latin America 2000-2011: the case of Argentina, Chile, Colombia, and Mexico.]

OBJECTIVE

To analyze trends in mortality in Argentina, Chile, Colombia and Mexico, between 2000 and 2011, by sex and 5-year age groups (between 20 and 79 years of age).

MATERIAL AND METHODS

Mortality vital statistics and census data or projected population estimates were used for each country. Age-specific mortality rates and the years of life lost were calculated.

RESULTS

Among the countries analyzed, Mexico had the highest mortality rate and lost the most years of life due to diabetes. Between 2000 and 2011, Mexicans lost an average of 1.13 years of life, while Colombia (0.24), Argentina (0.21) and Chile (0.18) lost considerably fewer life years. In general, deaths from diabetes were higher in men than in women except in Colombia. Nearly 80% of years of life lost due to diabetes occurred between 50 and 74 years of age in the four countries.

DISCUSSION

Diabetes is a huge challenge for Latin America, especially in Mexico where mortality due to diabetes is accelerating. Even though the proportion of deaths due to diabetes in Argentina, Chile and Colombia is smaller, this disease figures among the main causes of death in these countries.

Reported Diabetes Mellitus Prevalence Rates in the Colombia Healthcare System from 2009 to 2012: Analysis by Regions Using Data of the Official Information Sources

The objective of this study was to describe the reported diabetes mellitus (DM) prevalence rates of the 20-79-year-old population in Colombia from 2009 to 2012 reported by the healthcare system. Information on number of patients treated for DM was obtained by the Integral Information System of Social Protection (SISPRO), the registry of the Ministry of Health and Social Protection, and the High Cost Account (CAC), an organization to trace high expenditure diseases. From both sources age-standardized reported DM prevalence rates per 100.000 inhabitants from 2009 to 2012 were calculated. Whereas the reported DM prevalence rates of SISPRO revealed an increase from 964/100.000 inhabitants (2009) to 1398/100.000 inhabitants in 2012 (mean annual increase 141/100.000; p value: 0.001), the respective rates in the CAC register were 1082/100.000 (2009) and 1593/100.000 in 2012 (mean annual increase 165/100.000; p value: 0.026). The number of provinces reporting not less than 19% of the highest national reported DM prevalence rates (1593/100.000) increased from two in 2009 to ten in 2012. Apparently, the registries and the information retrieving system have been improved during 2009 and 2012, resulting in a greater capacity to identify and report DM cases by the healthcare system.

The stagnation of the Mexican male life expectancy in the first decade of the 21st century: the impact of homicides and diabetes mellitus

OBJECTIVES

In the first decade of the 21st century, the Mexican life expectancy changed from a long trend of increase to stagnation. These changes concur with an increase in deaths by homicides that the country experienced in that decade, and an obesity epidemic that had developed over the last decades of the 20th century. We quantify the impact of causes of death on life expectancy from 2000 to 2010.

METHODS

Two approaches to analyse causes of death are used: the number of life years lost due to each of the causes of death in a given year, and cause-decomposition techniques for comparisons of life expectancy from 2000 to 2010.

RESULTS

The apparent stagnation in life expectancy is the result of an increase in deaths by homicides and diabetes mellitus on the one hand, and the positive improvements observed in other causes of death on the other. The negative impact of homicides is particularly observed for ages 15 and 50, and for that of diabetes mellitus at ages above 45 years.

CONCLUSIONS

There is little basis for optimism regarding the future scenarios of the health of the Mexican population based on the first decade of the 21st century. Male life expectancy would have increased by 2 years if deaths by homicides and diabetes mellitus had been avoided.

10-year incidence of diabetes and associated risk factors in Greece: the ATTICA study (2002-2012)

BACKGROUND

The incidence of diabetes in the general population is increasing world-wide. The increase is attributed to the consumption of saturated fatty acids, obesity, lack of physical activity, genetic predisposition, and other factors, but knowledge about the reasons, biological mechanisms, and late complications is insufficient. It is therefore important to clarify the reasons more exactly through long-term clinical trials to stop the rise of diabetes and its complications.

AIM

To evaluate the 10-year incidence of type 2 diabetes in apparently healthy Greek adults.

METHODS

In 2001-2002, a random sample of 1514 men (18-87 years old) and 1528 women (18-89 years old) was selected to participate in the ATTICA study. During 2011-2012, the 10-year follow-up was performed. Patients diagnosed with diabetes at baseline (n = 210) and those lost at the 10-year follow-up (n = 1347) were excluded, yielding a final sample of 1485 participants.

RESULTS

During the period of investigation, diabetes was diagnosed in 191 cases corresponding to a 12.9% incidence (95%CI: 10.4-15.4), with 13.4% (95%CI: 10.8-16) in men and 12.4% (95%CI: 10.1-14.7) in women. A relative increase was observed in the second half of the 10-year follow-up when age became significant. Multiple logistic regression analysis revealed that age (OR = 1.14, 95%CI: 1.09-1.19), abnormal waist-to-height ratio (OR = 3.27, 95%CI: 1.07-10.0), fasting blood glucose (OR per 1 mg/dl = 0.05, 95%CI: 1.02-1.08), energy intake (OR per 500 kcal = 1.02, 95%CI: 1.01-1.35), and family history of diabetes (OR = 2.8, 95%CI: 1.30-6.03) were the most significant baseline predictors for diabetes, after adjusting for potential confounders. Waist-to-height ratio showed the best explanatory power of all anthropometric variables. Physical activity exerts an effect on risk factors. Being active was found to eliminate the aggravating effect of diabetes family history and fasting blood glucose.

CONCLUSIONS

The findings confirm the escalating increase of type 2 diabetes incidence in Greece, which is in line with global trends. A lifestyle change in individuals at risk of developing diabetes towards healthier eating and increased physical activity would be an effective and inexpensive means of reducing diabetes.

Binocular visual processing in the owl's telencephalon

Single neurons recorded from the owl's visual Wulst are surprisingly similar to those found in mammalian striate cortex. The receptive fields of Wulst neurons are elaborated, in an apparently hierarchical fashion, from those of their monocular, concentrically organized inputs to produce binocular interneurons with increasingly sophisticated requirements for stimulus orientation, movement and binocular disparity. Output neurons located in the superficial laminae of the Wulst are the most sophisticated of all, with absolute requirements for a combination of stimuli, which include binocular presentation at a particular horizontal binocular disparity, and with no response unless all of the stimulus conditions are satisfied simultaneously. Such neurons have the properties required for 'global stereopsis', including a receptive field size many times larger than their optimal stimulus, which is more closely matched to the receptive fields of the simpler, disparity-selective interneurons. These marked similarities in functional organization between the avian and mammalian systems exist in spite of a number of structural differences which reflect their separate evoluntionary origins. Discussion therefore includes the possibility that there may exist for nervous systems only a very small number of possible solutions, perhaps a unique one, to the problem of stereopsis.