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Silverman-Retana O, Brinks R, Hoyer A, Witte DR, Tönnies T. Using the illness-death model to estimate age- and sex-standardized incidence rates of diabetes in Mexico from 2003 to 2015. BMC Public Health 2024; 24:1882. [PMID: 39010051 PMCID: PMC11247887 DOI: 10.1186/s12889-024-19281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/26/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND We aimed to estimate the age-specific and age-standardized incidence rate of diabetes for men and women in Mexico between 2003 and 2015, and to assess the relative change in incidence of diabetes between 2003 and 2015. METHODS We use a partial differential equation describing the illness-death model to estimate the incidence rate (IR) of diabetes for the years 2003, 2009 and 2015 based on prevalence data from National Health Surveys conducted in Mexico, the mortality rate of the Mexican general population and plausible input values for age-specific mortality rate ratios associated with diabetes. RESULTS The age-standardized IR of diabetes per 1000 person years (pryr) was similar among men (IRm) and women (IRw) in the year 2003 (IRm 6.1 vs. IRw 6.5 1000/pryr), 2009 (IRm: 7.0 vs. IRw: 8.4 1000/pryr), and in 2015 (IRm 8.0 vs. IRw 10.6 1000/pryr). The highest incident rates were observed among men and women in the 60-69 age group. CONCLUSIONS Overall, the incidence rate of diabetes in Mexico between the years 2003 and 2015 remained stable. However, rates were markedly higher among women in the age group 40-49 and 50-59 in the year 2015 compared with rates in 2003.
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Affiliation(s)
- Omar Silverman-Retana
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | - Ralph Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich-Heine-University Duesseldorf, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany
- Chair for Medical Biometry and Epidemiology, Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Thaddäus Tönnies
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich-Heine-University Duesseldorf, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
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Moon J. The effect of the heatwave on the morbidity and mortality of diabetes patients; a meta-analysis for the era of the climate crisis. ENVIRONMENTAL RESEARCH 2021; 195:110762. [PMID: 33515577 DOI: 10.1016/j.envres.2021.110762] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION From the perspective of public health, the climate crisis is also causing many health problems worldwide. In contrast with the cardiovascular, respiratory, and urinary system, the adverse effects of heatwaves on the endocrine system, particularly in people with diabetes mellitus (DM), are not well established to date. In this study, the author investigated the morbidity and mortality changes of DM patients during heatwave periods, using the meta-analysis method. METHODS The author searched MEDLINE, EMBASE, and the Cochrane Library until March 12, 2020. The quality of each included study was assessed using the National Institutes of Health (NIH) Quality Assessment tools. The meta-analysis was conducted using the studies with a relative risk (RR) estimate and odds ratio (OR) estimate. The subgroup analysis and the meta-ANOVA analysis were conducted using various covariates, including lag days considered. RESULTS Only 36 articles were included in the meta-analysis. The pooled RR of mortality and of morbidity for diabetics under the heatwave were 1.18 (95% CI 1.13-1.25) and 1.10 (95% CI 1.06-1.14). For mortality studies, whether or not the lag days considered were 10 days or more was only a significant covariate for the meta-ANOVA analysis (Q = 3.17, p = 0.075). For morbidity studies, the definition of the heatwave (Q = 65.94, p < 0.0001), whether or not the maximum temperature was 40 °C or more (Q = 4.78, p = 0.0288), and the type of morbidity (Q = 60.23, p < 0.0001) were significant covariates for the analysis. DISCUSSION The mortality and morbidity risks of diabetes patients under the heatwave were mildly increased by about 18 percent for mortality and 10 percent for overall morbidity. The mortality risk of diabetics can increase more when lag days of 10 days or more are considered than when lag days of less than 10 days are considered. These valuable findings can be used in developing public health strategies to cope with heatwaves in the current era of aggravating global warming and climate crisis.
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Affiliation(s)
- Jinyoung Moon
- Seoul National University Graduate School of Public Health, Department of Environmental Health Science, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea; Department of Occupational and Environmental Medicine, Seoul Saint Mary's Hospital, Republic of Korea.
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Rodríguez LA, Barquera S, Aguilar-Salinas CA, Sepúlveda-Amor J, Sánchez-Romero LM, Denova-Gutiérrez E, Balderas N, Moreno-Loaeza L, Handley MA, Basu S, López-Arellano O, Gallardo-Hernández A, Schillinger D. Design of a cluster-randomized trial of the effectiveness and cost-effectiveness of metformin on prevention of type 2 diabetes among prediabetic Mexican adults (the PRuDENTE initiative of Mexico City). Contemp Clin Trials 2020; 95:106067. [PMID: 32580032 PMCID: PMC7484103 DOI: 10.1016/j.cct.2020.106067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Type 2 diabetes (T2D) is a global epidemic, and nations are struggling to implement effective healthcare strategies to reduce the burden. While efficacy studies demonstrate that metformin can reduce incident T2D by half among younger, obese adults with prediabetes, its real-world effectiveness are understudied, and its use for T2D prevention in primary care is low. We describe the design of a pragmatic trial to evaluate the incremental effectiveness of metformin, as an adjunct to a simple lifestyle counseling. METHODS The "Prevención de la Diabetes con Ejercicio, Nutrición y Tratamiento" [Diabetes Prevention with Exercise, Nutrition and Treatment; PRuDENTE, (Spanish acronym)] is a cluster-randomized trial in Mexico City's public primary healthcare system. The study randomly assigns 51 clinics to deliver one of two interventions for 36 months: 1) lifestyle only; 2) lifestyle plus metformin, to 3060 patients ages 30-65 with impaired fasting glucose and obesity. The primary endpoint is incident T2D (fasting glucose ≥126 mg/dL, or HbA1c ≥6.5%). We will also measure a range of implementation-related process outcomes at the clinic-, clinician- and patient-levels to inform interpretations of effectiveness and enable efforts to refine, adapt, adopt and disseminate the model. We will also estimate the cost-effectiveness of metformin as an adjunct to lifestyle counseling in Mexico. DISCUSSION Findings from this pragmatic trial will generate new translational knowledge in Mexico and beyond, both with respect to metformin's real-world effectiveness among an 'at-risk' population, and uncovering facilitators and barriers to the reach, adoption and implementation of metformin preventive therapy in public primary care settings. TRIAL REGISTRATION This trial is registered at Clinicaltrials.gov (NCT03194009).
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Affiliation(s)
- Luis A Rodríguez
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
| | - Simón Barquera
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Carlos A Aguilar-Salinas
- Division of Nutrition, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - Jaime Sepúlveda-Amor
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Edgar Denova-Gutiérrez
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Nydia Balderas
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Lizbeth Moreno-Loaeza
- Research Unit on Metabolic Diseases, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico; Medical, Dental and Health Sciences, National Autonomous University of Mexico, Mexico City, Mexico
| | - Margaret A Handley
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine at San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA; UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, USA
| | - Sanjay Basu
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | | | | | - Dean Schillinger
- Division of General Internal Medicine at San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA; UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, USA
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Cardiovascular disease in Mexico 1990-2017: secondary data analysis from the global burden of disease study. Int J Public Health 2020; 65:661-671. [PMID: 32382763 DOI: 10.1007/s00038-020-01377-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 02/08/2023] Open
Abstract
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.
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James E, Lajous M, Reich MR. The Politics of Taxes for Health: An Analysis of the Passage of the Sugar-Sweetened Beverage Tax in Mexico. Health Syst Reform 2020; 6:e1669122. [DOI: 10.1080/23288604.2019.1669122] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Erin James
- Yale Institute for Global Health, Yale University, New Haven, CT, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Martín Lajous
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Instituto Nacional de Salud Pública, Centro de Investigacion en Salud Poblacional, Cuernavaca, México
| | - Michael R. Reich
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Mendoza-Herrera K, Pedroza-Tobías A, Hernández-Alcaraz C, Ávila-Burgos L, Aguilar-Salinas CA, Barquera S. Attributable Burden and Expenditure of Cardiovascular Diseases and Associated Risk Factors in Mexico and other Selected Mega-Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4041. [PMID: 31652519 PMCID: PMC6843962 DOI: 10.3390/ijerph16204041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/13/2019] [Accepted: 10/17/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND This paper describes the health and economic burden of cardiovascular diseases (CVD) in Mexico and other mega-countries through a review of literature and datasets. METHODS Mega-countries with a low (Nigeria), middle (India), high (China/Brazil/Mexico), and very high (the U.S.A./Japan) human development index were included. The review was focused on prevalence of dyslipidemias and CVD economic impact and conducted according to the PRISMA statement. Public datasets of CVD indicators were explored. RESULTS Heterogeneity in economic data and limited information on dyslipidemias were found. Hypertriglyceridemia and hypercholesterolemia were higher in Mexico compared with other countries. Higher contribution of dietary risk factors for cardiovascular mortality and greater probability of dying prematurely from CVD were observed in developing countries. From 1990-2016, a greater decrease in cardiovascular mortality in developed countries was registered. In 2015, a CVD expense equivalent to 4% of total health expenditure was reported in Mexico. CVD ranked first in health expenditures in almost all these nations and the economic burden will remain significant for decades to come. CONCLUSIONS Resources should be assured to optimize CVD risk monitoring. Educational and medical models must be improved to enhance CVD diagnosis and the prescription and adherence to treatments. Long-term benefits could be attained by modifying the food system.
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Affiliation(s)
- Kenny Mendoza-Herrera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico.
| | - Andrea Pedroza-Tobías
- Institute for Global Health Sciences, University of California, San Francisco, CA 94158, USA.
| | - César Hernández-Alcaraz
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico.
| | - Leticia Ávila-Burgos
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico.
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabolicas, Mexico City 14080, Mexico.
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City 14080, Mexico.
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 64710, N.L., Mexico.
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico.
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Contreras-Manzano A, Villalpando S, García-Díaz C, Flores-Aldana M. Cardiovascular Risk Factors and Their Association with Vitamin D Deficiency in Mexican Women of Reproductive Age. Nutrients 2019; 11:nu11061211. [PMID: 31141980 PMCID: PMC6627884 DOI: 10.3390/nu11061211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/04/2019] [Accepted: 05/08/2019] [Indexed: 02/08/2023] Open
Abstract
Based on a nationally representative sample of young Mexican women aged 20 to 49 years (n = 3260), we sought to explore whether cardiovascular risk factors and acute myocardial infarction (AMI) were associated with vitamin D deficiency (VDD, defined as 25-OH-D <50 nmol/L). To this end, we obtained sociodemographic, serum and anthropometric data from the 2012 National Health and Nutrition Survey (ENSANUT 2012). Analyses were developed through logistic regression models adjusted for potential confounders. The prevalence of VDD was significantly higher in obese women (42.5%, 95% CI; 37.3–47.9) compared to women with a normal body mass index (29.9%, 95% CI; 23.5–37.1, p = 0.05), in those with high total cholesterol (TC) (45.6% 95% CI; 39.4–51.9) compared to those with normal TC levels (33.9%, 95% CI 30–38.1, p = 0.03), and in those with insulin resistance (IR) (44%, 95% CI; 36.9–51.7) or type 2 diabetes mellitus (T2DM) (58.6%, 95% CI 46.9–69.4) compared to those with normal glycemia (no insulin resistance: 34.7%, 95% CI; 30.9–38.8, p = 0.04 and no T2DM: 34.9%, 95% CI 31.4–38.6, p < 0.001). Utilizing individual models to estimate cardiovascular risk according to VDD, we found that the odds of being obese (odds ratio, OR: 1.53, 95% CI 1.02–2.32, p = 0.05), or having high TC levels (OR: 1.43, 95% CI; 1.05–2.01, p = 0.03), T2DM (OR: 2.64, 95% CI; 1.65–4.03, p < 0.001), or IR (OR: 1.48, 95% CI 1.04–2.10, p = 0.026) were significantly higher in women with VDD (p < 0.05). Odds were not statistically significant for overweight, high blood pressure, sedentarism, AMI, high serum concentration of triglycerides, homocysteine, or C-reactive protein models. In conclusion, our results indicate that young Mexican women with VDD show a higher prevalence of cardiovascular risk factors.
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Affiliation(s)
| | - Salvador Villalpando
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca 62100, Mexico.
| | - Claudia García-Díaz
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca 62100, Mexico.
| | - Mario Flores-Aldana
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca 62100, Mexico.
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Rojas-Martínez R, Escamilla-Núñez C, Gómez-Velasco DV, Zárate-Rojas E, Aguilar-Salinas CA. [Development and validation of a screening score for prediabetes and undiagnosed diabetes.]. SALUD PUBLICA DE MEXICO 2018; 60:500-509. [PMID: 30550111 DOI: 10.21149/9057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 01/25/2018] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To develop and validate an easy-to-use risk score to detect prediabetes and undiagnosed diabetes in Mexican population. MATERIALS AND METHODS Using information from the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán's cohort study of 10 234 adults, risk factors were identified and included in multiple logistic regression models stratified by sex. The beta coefficients of the final model were multiplied by 10, thus obtaining the weights of each variable in the score. RESULTS The proposed score correctly classifies 55.4% of women with undiagnosed diabetes and 57.2% of women with prediabetes or diabetes. While for men it correctly classifies them at 68.6% and 69.9%, respectively. CONCLUSIONS We present the design and validation of a risk score stratified by sex, to determine if an adult could have prediabetes or diabetes, in which case laboratory studies should be performed to confirm or not the diagnosis.
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Affiliation(s)
- Rosalba Rojas-Martínez
- Centro de Investigaciones en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Consuelo Escamilla-Núñez
- Centro de Investigaciones en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, México
| | - Donaji V Gómez-Velasco
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Ciudad de México, México
| | - Emiliano Zárate-Rojas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Ciudad de México, México
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Ciudad de México, México
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Barquera S, Schillinger D, Aguilar-Salinas CA, Schenker M, Rodríguez LA, Hernández-Alcaraz C, Sepúlveda-Amor J. Collaborative research and actions on both sides of the US-Mexico border to counteract type 2 diabetes in people of Mexican origin. Global Health 2018; 14:84. [PMID: 30134925 PMCID: PMC6104005 DOI: 10.1186/s12992-018-0390-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/29/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Type 2 Diabetes (T2D) is now a massive epidemic in both California and Mexico, with serious consequences for social and economic well-being. A large proportion of these populations share common ethnic backgrounds. Yet diverse environmental and social conditions across regions create unique opportunities to explore the ways that T2D risk, incidence, management and outcomes manifest. MAIN TEXT An action-oriented research consortium headed up by the University of California and Universidad Nacional Autónoma de Mexico was constituted to set priorities for bi-national translational research, in an attempt to implement and evaluate clinical, public health and policy actions to decrease the burden of T2D for people of Mexican origin. In this paper, we describe the epidemiology of T2D in Mexico and California, review current efforts to combat the epidemic, highlight gaps in knowledge and identify urgent areas of opportunity for collaboration. The group has developed a common research agenda and funding has been obtained to evaluate biological samples from the 2016 Mexican Health Survey, collaborate in a telemedicine-based retinopathy project, implement interventions in food banks, promote a communications campaign, and design a large-scale diabetes prevention effectiveness trial. CONCLUSIONS T2D has caused a state of emergency in Mexico and is a major health problem among Mexican populations on both sides of the border. Understanding the commonalities and differences between California and Mexico for those of Mexican origin with respect to T2D, when combined with a sharing of knowledge and advances, can produce a bi-national translational research agenda to inform relevant policy and practice. Amidst economic and political uncertainty and limited healthcare budgets, this collaboration can contribute to the development of scientific evidence to inform policies and interventions. This may provide a promising collaborative model that could be expanded to other health conditions and regions of the world.
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Affiliation(s)
- Simón Barquera
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Dean Schillinger
- UCSF Division of General Internal Medicine at San Francisco General Hospital, 1545 Divisadero St., First and Second Floors, San Francisco, CA 94115 USA
- UCSF Center for Vulnerable Populations, School of Medicine, Department of Medicine, 1001 Potrero Ave, San Francisco, CA 94110 USA
| | - Carlos A. Aguilar-Salinas
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No.15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan C.P, 14080 Ciudad de Mexico, Mexico
| | - Marc Schenker
- UC Davis School of Medicine, Department of Public Health Sciences, University of California Davis Medical Sciences 1-C, One Shields Avenue, Davis, CA 95616 USA
| | - Luis A. Rodríguez
- UCSF School of Medicine, Department of Epidemiology & Biostatistics, 550 16th St, San Francisco, CA 94158 USA
| | - Cesar Hernández-Alcaraz
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Jaime Sepúlveda-Amor
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
- UCSF School of Medicine, Department of Epidemiology & Biostatistics, 550 16th St, San Francisco, CA 94158 USA
- UCSF Institute for Global Health Sciences, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
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Gutierrez JP, Garcia-Saiso S, Aracena BM. Mexico's household health expenditure on diabetes and hypertension: What is the additional financial burden? PLoS One 2018; 13:e0201333. [PMID: 30052668 PMCID: PMC6063432 DOI: 10.1371/journal.pone.0201333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 07/13/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aimed to estimate the magnitude of the association between overall household health expenditures & the presence of members with a chronic disease in the household. RESEARCH DESIGN & METHODS This was a cross-sectional analysis of a probabilistic household survey, which gathered data on previously diagnosed type 2 diabetes mellitus and hypertension as well as health expenditure in Mexico. From an analytic sample of 44,000 households, we identified those having at least one member with diabetes or hypertension and determined their health expenditure. Using matching procedures, we compared these data with those of households lacking such individuals. RESULTS We found that 24% of the households had at least one member who had been diagnosed with diabetes, hypertension, or both. Households with such members reported health expenditures that were 25%-34% (P <0.01) higher than households without such individuals. Such differences were more pronounced among households at lower socioeconomic levels and among those with no or limited health insurance. CONCLUSIONS In addition to their impact on individual health, chronic ailments exert financial pressure on households. The additional health-care expenditure for households owing to such diseases leaves them financially exposed-especially households with lower income levels.
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Bello-Chavolla OY, Rojas-Martinez R, Aguilar-Salinas CA, Hernández-Avila M. Epidemiology of diabetes mellitus in Mexico. Nutr Rev 2017; 75:4-12. [PMID: 28049745 DOI: 10.1093/nutrit/nuw030] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Type 2 diabetes is the main health problem in Mexico. The large and growing number of cases and the remarkable economic impact of the disease support this statement. The condition is expressed at an earlier age and at a lower body mass index in Mexican mestizos compared with the age and body mass index reported in Caucasians. In addition, Mexican mestizos have an increased susceptibility to developing diabetic nephropathy. The Mexican health system needs major adjustments in order to prevent and treat type 2 diabetes. Treatment is not currently based on the needs and expectations of the patient. As a result, it is insufficient, belated, and costly. Close to 20% of the preventable deaths in Mexico are caused by diabetes and related metabolic diseases. Even a small decrease in this rate could result in substantial savings for the Mexican healthcare system.
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Affiliation(s)
- Omar Y Bello-Chavolla
- R. Rojas-Martinez and M. Hernández-Avila are with the Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico. O.Y. Bello-Chavolla and C.A. Aguilar-Salinas are with the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. O.Y. Bello-Chavolla is also the Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rosalba Rojas-Martinez
- R. Rojas-Martinez and M. Hernández-Avila are with the Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico. O.Y. Bello-Chavolla and C.A. Aguilar-Salinas are with the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. O.Y. Bello-Chavolla is also the Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- R. Rojas-Martinez and M. Hernández-Avila are with the Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico. O.Y. Bello-Chavolla and C.A. Aguilar-Salinas are with the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. O.Y. Bello-Chavolla is also the Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico.
| | - Mauricio Hernández-Avila
- R. Rojas-Martinez and M. Hernández-Avila are with the Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico. O.Y. Bello-Chavolla and C.A. Aguilar-Salinas are with the Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. O.Y. Bello-Chavolla is also the Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Granados-Silvestre MA, Ortiz-López MG, Granados J, Canizales-Quinteros S, Peñaloza-Espinosa RI, Lechuga C, Acuña-Alonzo V, Sánchez-Pozos K, Menjivar M. Susceptibility background for type 2 diabetes in eleven Mexican Indigenous populations: HNF4A gene analysis. Mol Genet Genomics 2017; 292:1209-1219. [PMID: 28688048 DOI: 10.1007/s00438-017-1340-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 06/20/2017] [Indexed: 12/30/2022]
Abstract
The genetic risk of developing type 2 diabetes (T2D) increases in parallel with the proportion of Native American ancestry. Mestizo Mexicans have a 70% Native Amerindian genetic background. The T130I polymorphism in the HNF4A gene has been associated with early-onset T2D in mestizo Mexicans. Thus, the aim of the present study was to evaluate the frequency and relationship of the T130I variant in the HNF4A gene with risk factors for developing T2D in eleven indigenous groups from Mexico. In two groups, all exons of the HNF4A gene were directly sequenced; in the remaining the T130I polymorphism was analyzed by restriction fragment length polymorphism. Ancestry informative markers were assessed to confirm the Amerindian component. An additional analysis of EHH was carried out. Interestingly, HNF4A gene screening revealed only the presence of the T130I polymorphism. The range frequency of the risk allele (T) in the indigenous groups was from 2.7 to 16%. Genotypic frequencies (T130I/I130I) were higher and significantly different from those of all of the populations included in the HapMap Project (P < 0.005). EHH scores suggest a positive selection for T130I polymorphism. Metabolic traits indicate a relationship between the T130I/I130I genotypes with high triglyceride concentrations in the indigenous groups (P < 0.005). These results strongly suggest that the high frequency of the T130I polymorphism and its biological relationship with dysfunction in lipid metabolism in Mexican indigenous groups is a risk factor for the developing of T2D in Mexicans.
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Affiliation(s)
- M A Granados-Silvestre
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Edif. F, 2o piso, Lab. 202, Av Universidad 3000, Circuito Interior S/N, Coyoacán, Cd. Universitaria, CP 04510, Mexico City, Mexico
| | - M G Ortiz-López
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Edif. F, 2o piso, Lab. 202, Av Universidad 3000, Circuito Interior S/N, Coyoacán, Cd. Universitaria, CP 04510, Mexico City, Mexico
- Laboratorio de Endocrinología Molecular, Hospital Juárez de México, Av. Instituto Politécnico Nacional 5160, Gustavo A. Madero, CP 07760, Mexico City, Mexico
| | - J Granados
- Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Belisario Domínguez Secc 16, CP 14080, Mexico City, Mexico
| | - S Canizales-Quinteros
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Edif. F, 2o piso, Lab. 202, Av Universidad 3000, Circuito Interior S/N, Coyoacán, Cd. Universitaria, CP 04510, Mexico City, Mexico
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química Universidad Nacional Autónoma de México, Instituto Nacional de Medicina Genómica, Periferico Sur 4809, Tlalpan, Arenal Tepepan, CP 14610, Mexico City, Mexico
| | - Rosenda I Peñaloza-Espinosa
- Unidad de Investigación Médica en Genética Humana, Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Av. Cuauhtémoc 300, Cuauhtémoc, CP 06720, Mexico City, Mexico
| | - C Lechuga
- Centro Cultural Universitario "Casa de las Diligencias", Universidad Autónoma del Estado de México, Av Benito Juárez Garcia Sur 114, Centro, CP 50000, Toluca, Mexico State, Mexico
| | - V Acuña-Alonzo
- Escuela Nacional de Antropología e Historia, Instituto Nacional de Antropología e Historia, Mexico City, Mexico
| | - K Sánchez-Pozos
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Edif. F, 2o piso, Lab. 202, Av Universidad 3000, Circuito Interior S/N, Coyoacán, Cd. Universitaria, CP 04510, Mexico City, Mexico
| | - M Menjivar
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Edif. F, 2o piso, Lab. 202, Av Universidad 3000, Circuito Interior S/N, Coyoacán, Cd. Universitaria, CP 04510, Mexico City, Mexico.
- Unidad de Genómica de Poblaciones Aplicada a la Salud, Facultad de Química Universidad Nacional Autónoma de México, Instituto Nacional de Medicina Genómica, Periferico Sur 4809, Tlalpan, Arenal Tepepan, CP 14610, Mexico City, Mexico.
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13
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Cruz C, Campuzano-Rincón JC, Calleja-Castillo JM, Hernández-Álvarez A, Parra MDS, Moreno-Macias H, Hernández-Girón C. Temporal Trends in Mortality from Ischemic and Hemorrhagic Stroke in Mexico, 1980-2012. J Stroke Cerebrovasc Dis 2017; 26:725-732. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/22/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022] Open
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Puchner KP, Lopez-Ridaura R, Ortiz-Panozo E, Vieitez I, Lajous M. Stature is inversely associated with self-reported diabetes in middle-aged Mexican women. Rev Panam Salud Publica 2017; 41:e32. [PMID: 31363354 PMCID: PMC6612735 DOI: 10.26633/rpsp.2017.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 06/02/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate whether stature is associated with two highly prevalent cardiom- etabolic disorders-diabetes mellitus (DM) and high blood pressure (HBP) -in middle-aged Mexican women. METHODS We conducted a cross-sectional analysis of a sample of 93 481 middle-aged Mexican female teachers, all participating in the Mexican Teachers Cohort (MTC, or ESMaestras) study. We used a multivariable regression model to investigate the association of stature quintiles with the self-reported outcomes of DM and HBP. RESULTS After adjusting for birth cohort, ethnicity, family history, birthweight, occupation of household's head during participant's childhood, menopausal status, and geographical region of birthplace, stature was inversely associated with DM, with the odds for DM being 9% higher in the lowest stature quintile when compared to the highest stature quintile. Stratification for location of residence resulted in confirmation of the above-mentioned findings only in partici- pants living in urban environments. CONCLUSIONS We found an inverse association of stature with DM but not with HBP. Our data suggest that urban setting might be an important effect modifier of this association, which merits further investigation since it might provide valuable insights into the epidemiological transition occurring in developing countries.
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Affiliation(s)
- Karl P Puchner
- Center for Population Health ResearchNational Institute of Public HealthCuernavacaMorelosMexicoCenter for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Ruy Lopez-Ridaura
- Center for Population Health ResearchNational Institute of Public HealthCuernavacaMorelosMexicoCenter for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Eduardo Ortiz-Panozo
- Center for Population Health ResearchNational Institute of Public HealthCuernavacaMorelosMexicoCenter for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Isabel Vieitez
- Center for Population Health ResearchNational Institute of Public HealthCuernavacaMorelosMexicoCenter for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Martín Lajous
- Center for Population Health ResearchNational Institute of Public HealthCuernavacaMorelosMexicoCenter for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
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15
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Thibault V, Bélanger M, LeBlanc E, Babin L, Halpine S, Greene B, Mancuso M. Factors that could explain the increasing prevalence of type 2 diabetes among adults in a Canadian province: a critical review and analysis. Diabetol Metab Syndr 2016; 8:71. [PMID: 27833664 PMCID: PMC5103368 DOI: 10.1186/s13098-016-0186-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/28/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prevalence of diabetes has increased since the last decade in New Brunswick. Identifying factors contributing to the increase in diabetes prevalence will help inform an action plan to manage the condition. The objective was to describe factors that could explain the increasing prevalence of type 2 diabetes in New Brunswick since 2001. METHODS A critical literature review was conducted to identify factors potentially responsible for an increase in prevalence of diabetes. Data from various sources were obtained to draw a repeated cross-sectional (2001-2014) description of these factors concurrently with changes in the prevalence of type 2 diabetes in New Brunswick. Linear regressions, Poisson regressions and Cochran Armitage analysis were used to describe relationships between these factors and time. RESULTS Factors identified in the review were summarized in five categories: individual-level risk factors, environmental risk factors, evolution of the disease, detection effect and global changes. The prevalence of type 2 diabetes has increased by 120% between 2001 and 2014. The prevalence of obesity, hypertension, prediabetes, alcohol consumption, immigration and urbanization increased during the study period and the consumption of fruits and vegetables decreased which could represent potential factors of the increasing prevalence of type 2 diabetes. Physical activity, smoking, socioeconomic status and education did not present trends that could explain the increasing prevalence of type 2 diabetes. During the study period, the mortality rate and the conversion rate from prediabetes to diabetes decreased and the incidence rate increased. Suggestion of a detection effect was also present as the number of people tested increased while the HbA1c and the age at detection decreased. Period and birth cohort effect were also noted through a rise in the prevalence of type 2 diabetes across all age groups, but greater increases were observed among the younger cohorts. CONCLUSIONS This study presents a comprehensive overview of factors potentially responsible for population level changes in prevalence of type 2 diabetes. Recent increases in type 2 diabetes in New Brunswick may be attributable to a combination of some individual-level and environmental risk factors, the detection effect, the evolution of the disease and global changes.
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Affiliation(s)
- Véronique Thibault
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500 boul. de l’Université, Sherbrooke, QC J1K 2R1 Canada
- Centre de formation médicale du Nouveau-Brunswick, 100 Des Aboiteaux St, Moncton, NB E1A 7R1 Canada
| | - Mathieu Bélanger
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500 boul. de l’Université, Sherbrooke, QC J1K 2R1 Canada
- Centre de formation médicale du Nouveau-Brunswick, 100 Des Aboiteaux St, Moncton, NB E1A 7R1 Canada
- Vitalité Health Network, 275 Main Street Suite 600, Bathurst, NB E2A 1A9 Canada
- 100 rue des Aboiteaux, Pavillon J.-Raymond Frenette, Moncton, NB E1A 3E9 Canada
| | - Emilie LeBlanc
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500 boul. de l’Université, Sherbrooke, QC J1K 2R1 Canada
- Centre de formation médicale du Nouveau-Brunswick, 100 Des Aboiteaux St, Moncton, NB E1A 7R1 Canada
| | - Lise Babin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500 boul. de l’Université, Sherbrooke, QC J1K 2R1 Canada
- Centre de formation médicale du Nouveau-Brunswick, 100 Des Aboiteaux St, Moncton, NB E1A 7R1 Canada
- Vitalité Health Network, 275 Main Street Suite 600, Bathurst, NB E2A 1A9 Canada
| | - Stuart Halpine
- New Brunswick Department of Health, 520 King Street, Fredericton, NB E3B 6G3 Canada
| | - Beverly Greene
- New Brunswick Department of Health, 520 King Street, Fredericton, NB E3B 6G3 Canada
| | - Michelina Mancuso
- New Brunswick Health Council, 100 des Aboiteaux Street, Suite 2200, Moncton, NB E1A 7R1 Canada
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16
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Sánchez-Romero LM, Penko J, Coxson PG, Fernández A, Mason A, Moran AE, Ávila-Burgos L, Odden M, Barquera S, Bibbins-Domingo K. Projected Impact of Mexico's Sugar-Sweetened Beverage Tax Policy on Diabetes and Cardiovascular Disease: A Modeling Study. PLoS Med 2016; 13:e1002158. [PMID: 27802278 PMCID: PMC5089730 DOI: 10.1371/journal.pmed.1002158] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/16/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Rates of diabetes in Mexico are among the highest worldwide. In 2014, Mexico instituted a nationwide tax on sugar-sweetened beverages (SSBs) in order to reduce the high level of SSB consumption, a preventable cause of diabetes and cardiovascular disease (CVD). We used an established computer simulation model of CVD and country-specific data on demographics, epidemiology, SSB consumption, and short-term changes in consumption following the SSB tax in order to project potential long-range health and economic impacts of SSB taxation in Mexico. METHODS AND FINDINGS We used the Cardiovascular Disease Policy Model-Mexico, a state transition model of Mexican adults aged 35-94 y, to project the potential future effects of reduced SSB intake on diabetes incidence, CVD events, direct diabetes healthcare costs, and mortality over 10 y. Model inputs included short-term changes in SSB consumption in response to taxation (price elasticity) and data from government and market research surveys and public healthcare institutions. Two main scenarios were modeled: a 10% reduction in SSB consumption (corresponding to the reduction observed after tax implementation) and a 20% reduction in SSB consumption (possible with increases in taxation levels and/or additional measures to curb consumption). Given uncertainty about the degree to which Mexicans will replace calories from SSBs with calories from other sources, we evaluated a range of values for calorie compensation. We projected that a 10% reduction in SSB consumption with 39% calorie compensation among Mexican adults would result in about 189,300 (95% uncertainty interval [UI] 155,400-218,100) fewer incident type 2 diabetes cases, 20,400 fewer incident strokes and myocardial infarctions, and 18,900 fewer deaths occurring from 2013 to 2022. This scenario predicts that the SSB tax could save Mexico 983 million international dollars (95% UI $769 million-$1,173 million). The largest relative and absolute reductions in diabetes and CVD events occurred in the youngest age group modeled (35-44 y). This study's strengths include the use of an established mathematical model of CVD and use of contemporary Mexican vital statistics, data from health surveys, healthcare costs, and SSB price elasticity estimates as well as probabilistic and deterministic sensitivity analyses to account for uncertainty. The limitations of the study include reliance on US-based studies for certain inputs where Mexico-specific data were lacking (specifically the associations between risk factors and CVD outcomes [from the Framingham Heart Study] and SSB calorie compensation assumptions), limited data on healthcare costs other than those related to diabetes, and lack of information on long-term SSB price elasticity that is specific to geographic and economic subgroups. CONCLUSIONS Mexico's high diabetes prevalence represents a public health crisis. While the long-term impact of Mexico's SSB tax is not yet known, these projections, based on observed consumption reductions, suggest that Mexico's SSB tax may substantially decrease morbidity and mortality from diabetes and CVD while reducing healthcare costs.
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Affiliation(s)
- Luz Maria Sánchez-Romero
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Joanne Penko
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.,UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America
| | - Pamela G Coxson
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.,UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America
| | - Alicia Fernández
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.,UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America
| | - Antoinette Mason
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.,UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America
| | - Andrew E Moran
- Division of General Internal Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Leticia Ávila-Burgos
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Michelle Odden
- Department of Epidemiology, Oregon State University, Corvalis, Oregon, United States of America
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Kirsten Bibbins-Domingo
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America.,UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, California, United States of America.,Division of General Internal Medicine, Columbia University Medical Center, New York, New York, United States of America.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
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Tapia-Conyer R, Saucedo-Martinez R, Mujica-Rosales R, Gallardo-Rincon H, Campos-Rivera PA, Lee E, Waugh C, Guajardo L, Torres-Beltran B, Quijano-Gonzalez U, Soni-Gallardo L. Enablers and inhibitors of the implementation of the Casalud Model, a Mexican innovative healthcare model for non-communicable disease prevention and control. Health Res Policy Syst 2016; 14:52. [PMID: 27443309 PMCID: PMC4957422 DOI: 10.1186/s12961-016-0125-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/24/2016] [Indexed: 11/27/2022] Open
Abstract
Background The Mexican healthcare system is under increasing strain due to the rising prevalence of non-communicable diseases (especially type 2 diabetes), mounting costs, and a reactive curative approach focused on treating existing diseases and their complications rather than preventing them. Casalud is a comprehensive primary healthcare model that enables proactive prevention and disease management throughout the continuum of care, using innovative technologies and a patient-centred approach. Methods Data were collected over a 2-year period in eight primary health clinics (PHCs) in two states in central Mexico to identify and assess enablers and inhibitors of the implementation process of Casalud. We used mixed quantitative and qualitative data collection tools: surveys, in-depth interviews, and participant and non-participant observations. Transcripts and field notes were analyzed and coded using Framework Analysis, focusing on defining and describing enablers and inhibitors of the implementation process. Results We identified seven recurring topics in the analyzed textual data. Four topics were categorized as enablers: political support for the Casalud model, alignment with current healthcare trends, ongoing technical improvements (to ease adoption and support), and capacity building. Three topics were categorized as inhibitors: administrative practices, health clinic human resources, and the lack of a shared vision of the model. Conclusions Enablers are located at PHCs and across all levels of government, and include political support for, and the technological validity of, the model. The main inhibitor is the persistence of obsolete administrative practices at both state and PHC levels, which puts the administrative feasibility of the model’s implementation in jeopardy. Constructing a shared vision around the model could facilitate the implementation of Casalud as well as circumvent administrative inhibitors. In order to overcome PHC-level barriers, it is crucial to have an efficient and straightforward adaptation and updating process for technological tools. One of the key lessons learned from the implementation of the Casalud model is that a degree of uncertainty must be tolerated when quickly scaling up a healthcare intervention. Similar patient-centred technology-based models must remain open to change and be able to quickly adapt to changing circumstances. Electronic supplementary material The online version of this article (doi:10.1186/s12961-016-0125-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roberto Tapia-Conyer
- Fundación Carlos Slim, Plaza Carso, Lago Zurich 245, Torre Carso, Piso 20, Mexico City, 11529, Mexico
| | - Rodrigo Saucedo-Martinez
- Fundación Carlos Slim, Plaza Carso, Lago Zurich 245, Torre Carso, Piso 20, Mexico City, 11529, Mexico.
| | - Ricardo Mujica-Rosales
- Fundación Carlos Slim, Plaza Carso, Lago Zurich 245, Torre Carso, Piso 20, Mexico City, 11529, Mexico
| | - Hector Gallardo-Rincon
- Fundación Carlos Slim, Plaza Carso, Lago Zurich 245, Torre Carso, Piso 20, Mexico City, 11529, Mexico
| | - Paola Abril Campos-Rivera
- Fundación Carlos Slim, Plaza Carso, Lago Zurich 245, Torre Carso, Piso 20, Mexico City, 11529, Mexico
| | - Evan Lee
- Eli Lilly and Company, Mexico City, Mexicoᅟ
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Lavalle-González FJ, Chiquete E. Patients' empowerment, physicians' perceptions, and achievement of therapeutic goals in patients with type 1 and type 2 diabetes mellitus in Mexico. Patient Prefer Adherence 2016; 10:1349-57. [PMID: 27555751 PMCID: PMC4968990 DOI: 10.2147/ppa.s107437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Physicians' perception may not parallel objective measures of therapeutic targets in patients with diabetes. This is an issue rarely addressed in the medical literature. We aimed to analyze physicians' perception and characteristics of adequate control of patients with diabetes. PATIENTS AND METHODS We studied information on physicians and their patients who participated in the third wave of the International Diabetes Management Practices Study registry in Mexico. This analysis was performed on 2,642 patients, 203 with type 1 diabetes mellitus (T1DM) and 2,439 with type 2 diabetes mellitus (T2DM), treated by 200 physicians. RESULTS The patients perceived at target had lower hemoglobin A1c (HbA1c) and fasting blood glucose than those considered not at target. However, overestimation of the frequency of patients with HbA1c <7% was 41.5% in patients with T1DM and 31.7% in patients with T2DM (underestimation: 2.8% and 8.0%, respectively). The agreement between the physicians' perception and the class of HbA1c was suboptimal (κ: 0.612). Diabetologists and endocrinologists tested HbA1c more frequently than primary care practitioners, internists, or cardiologists; however, no differences were observed in mean HbA1c, for both T1DM (8.4% vs 7.2%, P=0.42) and T2DM (8.03% vs 8.01%, P=0.87) patients. Nevertheless, insulin users perceived at target, who practiced self-monitoring and self-adjustment of insulin, had a lower mean HbA1c than patients without these characteristics (mean HbA1c in T1DM: 6.8% vs 9.6%, respectively; mean HbA1c in T2DM: 7.0% vs 10.1%, respectively). CONCLUSION Although there is a significant physicians' overestimation about the optimal glycemic control, this global impression and characteristics of patients' empowerment, such as self-monitoring and self-adjustment of insulin, are associated with the achievement of targets.
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Affiliation(s)
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Correspondence: Erwin Chiquete, Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlapan, Ciudad de México, Código Postal 14000, México, Tel +52 54 87 0900 ext 5052, Fax +52 56 55 1076, Email
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Mendez MA, González-Horta C, Sánchez-Ramírez B, Ballinas-Casarrubias L, Cerón RH, Morales DV, Terrazas FAB, Ishida MC, Gutiérrez-Torres DS, Saunders RJ, Drobná Z, Fry RC, Buse JB, Loomis D, García-Vargas GG, Del Razo LM, Stýblo M. Chronic Exposure to Arsenic and Markers of Cardiometabolic Risk: A Cross-Sectional Study in Chihuahua, Mexico. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:104-11. [PMID: 26068977 PMCID: PMC4710594 DOI: 10.1289/ehp.1408742] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/10/2015] [Indexed: 05/18/2023]
Abstract
BACKGROUND Exposure to arsenic (As) concentrations in drinking water > 150 μg/L has been associated with risk of diabetes and cardiovascular disease, but little is known about the effects of lower exposures. OBJECTIVE This study aimed to examine whether moderate As exposure, or indicators of individual As metabolism at these levels of exposure, are associated with cardiometabolic risk. METHODS We analyzed cross-sectional associations between arsenic exposure and multiple markers of cardiometabolic risk using drinking-water As measurements and urinary As species data obtained from 1,160 adults in Chihuahua, Mexico, who were recruited in 2008-2013. Fasting blood glucose and lipid levels, the results of an oral glucose tolerance test, and blood pressure were used to characterize cardiometabolic risk. Multivariable logistic, multinomial, and linear regression were used to assess associations between cardiometabolic outcomes and water As or the sum of inorganic and methylated As species in urine. RESULTS After multivariable adjustment, concentrations in the second quartile of water As (25.5 to < 47.9 μg/L) and concentrations of total speciated urinary As (< 55.8 μg/L) below the median were significantly associated with elevated triglycerides, high total cholesterol, and diabetes. However, moderate water and urinary As levels were also positively associated with HDL cholesterol. Associations between arsenic exposure and both dysglycemia and triglyceridemia were higher among individuals with higher proportions of dimethylarsenic in urine. CONCLUSIONS Moderate exposure to As may increase cardiometabolic risk, particularly in individuals with high proportions of urinary dimethylarsenic. In this cohort, As exposure was associated with several markers of increased cardiometabolic risk (diabetes, triglyceridemia, and cholesterolemia), but exposure was also associated with higher rather than lower HDL cholesterol. CITATION Mendez MA, González-Horta C, Sánchez-Ramírez B, Ballinas-Casarrubias L, Hernández Cerón R, Viniegra Morales D, Baeza Terrazas FA, Ishida MC, Gutiérrez-Torres DS, Saunders RJ, Drobná Z, Fry RC, Buse JB, Loomis D, García-Vargas GG, Del Razo LM, Stýblo M. 2016. Chronic exposure to arsenic and markers of cardiometabolic risk: a cross-sectional study in Chihuahua, Mexico. Environ Health Perspect 124:104-111; http://dx.doi.org/10.1289/ehp.1408742.
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Affiliation(s)
- Michelle A. Mendez
- Department of Nutrition, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Carolina Population Center, and
- Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carmen González-Horta
- Programa de Maestría en Ciencias en Biotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Blanca Sánchez-Ramírez
- Programa de Maestría en Ciencias en Biotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Lourdes Ballinas-Casarrubias
- Programa de Maestría en Ciencias en Biotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | | | | | | | - María C. Ishida
- Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - R. Jesse Saunders
- Department of Nutrition, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Zuzana Drobná
- Department of Nutrition, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- Curriculum in Toxicology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John B. Buse
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dana Loomis
- International Agency for Research on Cancer, Monographs Section, Lyon Cedex, France
| | | | - Luz M. Del Razo
- Departamento de Toxicología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, México DF, México
| | - Miroslav Stýblo
- Department of Nutrition, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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20
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García-Solano B, Gallegos-Cabriales EC, Gómez-Meza MV, García-Madrid G, Flores-Merlo M, García-Solano M. Hierarchical clusters in families with type 2 diabetes. SAGE Open Med 2015; 3:2050312115622957. [PMID: 27347419 PMCID: PMC4906675 DOI: 10.1177/2050312115622957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/10/2015] [Indexed: 11/17/2022] Open
Abstract
Families represent more than a set of individuals; family is more than a sum of its individual members. With this classification, nurses can identify the family health-illness beliefs obey family as a unit concept, and plan family inclusion into the type 2 diabetes treatment, whom is not considered in public policy, despite families share diet, exercise, and self-monitoring with a member who suffers type 2 diabetes. The aim of this study was to determine whether the characteristics, functionality, routines, and family and individual health in type 2 diabetes describes the differences and similarities between families to consider them as a unit. We performed an exploratory, descriptive hierarchical cluster analysis of 61 families using three instruments and a questionnaire, in addition to weight, height, body fat percentage, hemoglobin A1c, total cholesterol, triglycerides, low-density lipoprotein and high-density lipoprotein. The analysis produced three groups of families. Wilk's lambda demonstrated statistically significant differences provided by age (Λ = 0.778, F = 2.098, p = 0.010) and family health (Λ = 0.813, F = 2.650, p = 0.023). A post hoc Tukey test coincided with the three subsets. Families with type 2 diabetes have common elements that make them similar, while sharing differences that make them unique.
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Affiliation(s)
| | | | - Marco V Gómez-Meza
- Facultad de Economía, Universidad Autónoma de Nuevo León, Monterrey, México
| | | | - Marcela Flores-Merlo
- Facultad de Enfermería, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Mauro García-Solano
- Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, México
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21
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Bautista-Arredondo S, González A, Servan-Mori E, Beynon F, Juarez-Figueroa L, Conde-Glez CJ, Gras N, Sierra-Madero J, Lopez-Ridaura R, Volkow P, Bertozzi SM. A Cross-Sectional Study of Prisoners in Mexico City Comparing Prevalence of Transmissible Infections and Chronic Diseases with That in the General Population. PLoS One 2015; 10:e0131718. [PMID: 26192811 PMCID: PMC4508056 DOI: 10.1371/journal.pone.0131718] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 06/04/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To describe patterns of transmissible infections, chronic illnesses, socio-demographic characteristics and risk behaviors in Mexico City prisons, including in comparison to the general population, to identify those currently needing healthcare and inform policy. MATERIALS AND METHODS A cross-sectional study among 17,000 prisoners at 4 Mexico City prisons (June to December 2010). Participation was voluntary, confidential and based on informed consent. Participants were tested for HIV, Hepatitis B & C, syphilis, hypertension, obesity, and, if at risk, glucose and cholesterol. A subset completed a questionnaire on socio-demographic characteristics and risk behaviors. Positive results were delivered with counseling and treatment or referral. RESULTS 76.8% (15,517/20,196) of men and 92.9% (1,779/1,914) of women participated. Complete data sets were available for 98.8%. The following prevalence data were established for transmissible infections: HIV 0.7%; syphilis: Anti-TP+/VDRL+ 2.0%; Hepatitis B: HBcAb 2.8%, HBsAg 0.15%; Anti-HCV 3.2%. Obesity: 9.5% men, 33.8% women. Compared with national age- and sex-matched data, the relative prevalence was greater for HIV and syphilis among women, HIV and Hepatitis C in men, and all infections in younger participants. Obesity prevalence was similar for women and lower among male participants. The prevalence of previously diagnosed diabetes and hypertension was lower. Questionnaire data (1,934 men, 520 women) demonstrated lower educational levels, increased smoking and substance use compared to national data. High levels of non-sterile tattooing, physical abuse and histories of sexual violence were found. CONCLUSION The study identified that health screening is acceptable to Mexico City prisoners and feasible on a large-scale. It demonstrated higher prevalence of HIV and other infections compared to national data, though low rates compared to international data. Individual participants benefited from earlier diagnosis, treatment and support. The data collected will also enable the formulation of improved policy for this vulnerable group.
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Affiliation(s)
| | | | | | | | | | | | | | - Juan Sierra-Madero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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22
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Delgado-Sánchez G, García-García L, Castellanos-Joya M, Cruz-Hervert P, Ferreyra-Reyes L, Ferreira-Guerrero E, Hernández A, Ortega-Baeza VM, Montero-Campos R, Sulca JA, Martínez-Olivares MDL, Mongua-Rodríguez N, Baez-Saldaña R, González-Roldán JF, López-Gatell H, Ponce-de-León A, Sifuentes-Osornio J, Jiménez-Corona ME. Association of Pulmonary Tuberculosis and Diabetes in Mexico: Analysis of the National Tuberculosis Registry 2000-2012. PLoS One 2015; 10:e0129312. [PMID: 26075393 PMCID: PMC4468212 DOI: 10.1371/journal.pone.0129312] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 05/07/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a public health problem in Mexico while the incidence of diabetes mellitus type 2 (DM) has increased rapidly in recent years. OBJECTIVE To describe the trends of incidence rates of pulmonary TB associated with DM and not associated with DM and to compare the results of treatment outcomes in patients with and without DM. MATERIALS AND METHODS We analysed the National Tuberculosis Registry from 2000 to 2012 including patients with pulmonary TB among individuals older than 20 years of age. The association between DM and treatment failure was analysed using logistic regression, accounting for clustering due to regional distribution. RESULTS In Mexico from 2000 to 2012, the incidence rates of pulmonary TB associated to DM increased by 82.64%, (p<0.001) in contrast to rates of pulmonary TB rate without DM, which decreased by 26.77%, (p<0.001). Patients with a prior diagnosis of DM had a greater likelihood of failing treatment (adjusted odds ratio, 1.34 (1.11-1.61) p<0.002) compared with patients who did not have DM. There was statistical evidence of interaction between DM and sex. The odds of treatment failure were increased in both sexes. CONCLUSION Our data suggest that the growing DM epidemic has an impact on the rates of pulmonary TB. In addition, patients who suffer from both diseases have a greater probability of treatment failure.
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Affiliation(s)
- Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Lourdes García-García
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- * E-mail:
| | - Martín Castellanos-Joya
- Dirección de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Andrés Hernández
- Departamento de Epidemiología, Instituto Nacional de Enfermedades Respiratorias, México, Distrito Federal, México
| | - Victor Manuel Ortega-Baeza
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - José Antonio Sulca
- Dirección de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Ma. de Lourdes Martínez-Olivares
- Dirección de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Norma Mongua-Rodríguez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Renata Baez-Saldaña
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Jesús Felipe González-Roldán
- Dirección General, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Hugo López-Gatell
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - María Eugenia Jiménez-Corona
- Dirección General Adjunta de Epidemiología, Dirección General de Epidemiología, México, Distrito Federal, México
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Garcia-Garcia MR, Morales-Lanuza MA, Campos-Perez WY, Ruiz-Madrigal B, Maldonado-Gonzalez M, Vizmanos B, Hernandez-Cañaveral I, Yañez-Sanchez I, Roman S, Panduro A, Martinez-Lopez E. Effect of the ADIPOQ Gene -11391G/A Polymorphism Is Modulated by Lifestyle Factors in Mexican Subjects. JOURNAL OF NUTRIGENETICS AND NUTRIGENOMICS 2015; 7:212-24. [PMID: 25790965 DOI: 10.1159/000371801] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/23/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Single nucleotide polymorphisms (SNPs) in the ADIPOQ gene could explain the adiponectin level. However, the knowledge about the influence of genetic and lifestyle factors is not sufficient. The aim was to analyze whether the effect of the -11391G/A SNP in the ADIPOQ gene is modulated by lifestyle factors in Mexican subjects. METHODS A cross-sectional study was performed in which 394 participants were analyzed. Genetic, anthropometric, biochemical, dietary, clinical and physical activity parameters were measured. Statistical analysis was performed with SPSSv19 software. RESULTS The distribution of the -11391G/A SNP genotypes was 55.6 and 44.4% for GG and AG, respectively. The adiponectin level was modulated by the -11391G/A SNP in response to the body mass index (BMI); A allele carriers showed a higher adiponectin level compared to G homozygous carriers but only in the minor BMI tertile group (p=0.032). Adiponectin level variability was explained by gender [(r)=1.5, 95% CI 1.1-1.9, p=0.000], insulin resistance [(r)=-1.2, 95% CI -0.8 to -1.6, p=0.000], physical activity [(r)=0.6, 95% CI 0.2-0.9, p=0.002] and monounsaturated fat intake [(r)=0.5, 95% CI 0.38-1.0, p=0.047]. CONCLUSIONS The adiponectin level was modulated by the interaction between BMI and -11391G/A SNP; this suggests that the lifestyle rather than genetic factors modulates serum adiponectin.
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Affiliation(s)
- Maritza Roxana Garcia-Garcia
- Deparment of Molecular Biology in Medicine, Civil Hospital of Guadalajara 'Fray Antonio Alcalde', Guadalajara, Jalisco, Mexico
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Lopez-Jaramillo P, Gomez-Arbelaez D, Sotomayor-Rubio A, Mantilla-Garcia D, Lopez-Lopez J. Maternal undernutrition and cardiometabolic disease: a Latin American perspective. BMC Med 2015; 13:41. [PMID: 25858591 PMCID: PMC4346113 DOI: 10.1186/s12916-015-0293-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/12/2015] [Indexed: 02/07/2023] Open
Abstract
The current epidemic of obesity and cardiometabolic diseases in developing countries is described as being driven by socioeconomic inequalities. These populations have a greater vulnerability to cardiometabolic diseases due to the discrepancy between the maternal undernutrition and its consequence, low-birth weight progeny, and the subsequent modern lifestyles which are associated with socioeconomic and environmental changes that modify dietary habits, discourage physical activity and encourage sedentary behaviors. Maternal undernutrition can generate epigenetic modifications, with potential long-term consequences. Throughout life, people are faced with the challenge of adapting to changes in their environment, such as excessive intake of high energy density foods and sedentary behavior. However, a mismatch between conditions experienced during fetal programming and current environmental conditions will make adaptation difficult for them, and will increase their susceptibility to obesity and cardiovascular diseases. It is important to conduct research in the Latin American context, in order to define the best strategies to prevent the epidemic of cardiometabolic diseases in the region.
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25
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Albrecht SS, Barquera S, Popkin BM. Exploring secular changes in the association between BMI and waist circumference in Mexican-origin and white women: a comparison of Mexico and the United States. Am J Hum Biol 2014; 26:627-34. [PMID: 24917415 PMCID: PMC4138229 DOI: 10.1002/ajhb.22573] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/29/2014] [Accepted: 05/28/2014] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES BMI and waist circumference (WC) tend to be highly correlated, but changes in lifestyle behaviors may promote greater accumulation of abdominal fat for the same BMI in recent years. We examined secular shifts in BMI and WC distributions, and investigated whether WC for a given BMI has changed over time among Mexican-origin women in Mexico and the US, and in US white women as a comparison. METHODS Nationally representative surveys for women aged 20-49 years from Mexico (1988, 1999, and 2012) (n = 37,116) and the US (1988-1994, 1999-2002, and 2007-2010) (n = 6,985) were used. Quantile regressions estimated age-adjusted changes in BMI and WC across years; linear regression tested changes in mean WC over time, adjusting for age and BMI. RESULTS In all women, BMI and WC at most centiles increased over time. WC was also significantly higher over time for the same BMI, though the increase was largest in Mexican women. For example, WC was 6.7 cm (standard error (SE): 0.17, P < 0.0001) higher in 2012 than in 1999 among Mexican women, holding age and BMI constant. Estimates were smaller in magnitude for Mexican-American and white women (∼3 cm, P < 0.01), even when comparing over a longer timeframe (1988-1994 to 2007-2010). In all groups, WC adjusted for BMI increased to a larger extent among younger cohorts. CONCLUSION WC for the same BMI has increased in Mexican-American, white, and Mexican women of reproductive age. These patterns may have implications for future cardio-metabolic burden in Mexico and the US.
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Affiliation(s)
- Sandra S. Albrecht
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Barry M. Popkin
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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26
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Salas R, Bibiloni MDM, Ramos E, Villarreal JZ, Pons A, Tur JA, Sureda A. Metabolic syndrome prevalence among Northern Mexican adult population. PLoS One 2014; 9:e105581. [PMID: 25141255 PMCID: PMC4139369 DOI: 10.1371/journal.pone.0105581] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/24/2014] [Indexed: 12/04/2022] Open
Abstract
Background and Aims Dietary habits in the Mexican population have changed dramatically over the last few years, which are reflected in increased overweight and obesity prevalence. The aim was to examine the prevalence of metabolic syndrome (MetS) and associated risk factors in Northern Mexican adults aged ≥16 years. Methods and Results The study was a population-based cross-sectional nutritional survey carried out in the State of Nuevo León, Mexico. The study included a sub-sample of 1,200 subjects aged 16 and over who took part in the State Survey of Nutrition and Health–Nuevo León 2011/2012. Anthropometric measurements, physical activity, blood pressure and fasting blood tests for biochemical analysis were obtained from all subjects. The prevalence of MetS in Mexican adults aged ≥16 years was 54.8%, reaching 73.8% in obese subjects. This prevalence was higher in women (60.4%) than in men (48.9%) and increased with age in both genders. Multivariate analyses showed no evident relation between MetS components and the level of physical activity. Conclusions Obese adults, mainly women, are particularly at risk of developing MetS, with the associated implications for their health. The increasing prevalence of MetS highlights the need for developing strategies for its early detection and prevention.
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Affiliation(s)
- Rogelio Salas
- Faculty of Public Health Nutrition, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Maria del Mar Bibiloni
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands and CIBERobn (Physiopathology of Obesity and Nutrition), Palma de Mallorca, Spain
| | - Esteban Ramos
- Faculty of Public Health Nutrition, Autonomous University of Nuevo León, Monterrey, Mexico
| | | | - Antoni Pons
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands and CIBERobn (Physiopathology of Obesity and Nutrition), Palma de Mallorca, Spain
| | - Josep A. Tur
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands and CIBERobn (Physiopathology of Obesity and Nutrition), Palma de Mallorca, Spain
- * E-mail:
| | - Antoni Sureda
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands and CIBERobn (Physiopathology of Obesity and Nutrition), Palma de Mallorca, Spain
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Ortiz-Mendoza CM, de-la-Fuente-Vera TA, Pérez-Chávez E. Metabolic syndrome in Mexican women survivors of breast cancer: a pilot study at a general hospital. Med Arch 2014; 68:19-21. [PMID: 24783905 PMCID: PMC4272473 DOI: 10.5455/medarh.2014.68.19-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: According to developed countries’ studies, in breast cancer survivors there is a high prevalence of metabolic syndrome; however, in Mexico data is lacking about this issue. Goal: To explore if metabolic syndrome occurs in Mexican women survivors of breast cancer. Material and methods: At a second-level general hospital, women with breast cancer with a surviving >2 years were studied. The analysis involved their demographic and anthropometric features, blood pressure measurement, time of surviving, besides fasting blood levels of lipids and glucose. Results: The sample consisted of 100 women; 42% were obese (body mass index ≥30 kg/m2). The sample´s mean age was 60 years with a mean surviving time of 6.5 years. Their mean glucose level was 122 mg/dL and triglycerides 202 mg/dL. There were 33% with blood pressure ≥130/85mm Hg or diagnosis of hypertension. Fifty-seven percent had glucose >99 mg/dL or diagnosis of diabetes mellitus, and 58% had triglycerides >149 mg/dL. Metabolic syndrome occurred in 57% of obese women. Conclusion: Our results suggest that metabolic syndrome occurs in more than 50% of obese Mexican women survivors of breast cancer.
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Affiliation(s)
- Carlos Manuel Ortiz-Mendoza
- Department of Surgery, School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City
- Corresponding author: Carlos Manuel Ortiz-Mendoza, MD. Servicio de Oncología Quirúrgica, Hospital General Tacuba, ISSSTE, Lago Ontario 119, Colonia Tacuba, CP 11410, Delegación Miguel Hidalgo, México DF. Telephone and fax: (01 55) 52 65 29 49, E-mail:
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Dajer-Fadel WL, Ibarra-Pérez C, Sánchez-Velázquez LD, Borrego-Borrego R, Navarro-Reynoso FP, Argüero-Sánchez R. Descending necrotizing mediastinitis below the tracheal carina. Asian Cardiovasc Thorac Ann 2013; 22:176-82. [PMID: 24585789 DOI: 10.1177/0218492313485589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Descending necrotizing mediastinitis is a dreadful disease with a high mortality rate, particularly when below the tracheal carina. This study describes the epidemiologic, clinical, and paraclinical features of patients treated for this condition. METHODS We performed a single-center retrospective descriptive review of 60 patients with descending necrotizing mediastinitis below the tracheal carina, who were treated during a 7-year period, the largest study in the last 50 years. Demographic, clinical, paraclinical, and therapeutic variables were analyzed. RESULTS 43 (71.7%) patients were male. The mean age was 41.2 ± 14.7 years. Mean hospital length of stay was 25.0 ± 19.8 days. Comorbidities were present in 46.7% of patients, diabetes mellitus being the most common. Odontogenic infections (45%) were the most frequent source of descending necrotizing mediastinitis. Cultures showed Gram-negative bacilli in 68.3%, Gram-positive cocci in 38.3%, and fungi in 6.7%. Mortality was 35% (21 patients); risk factors for mortality were age (>35 years), diabetes mellitus among other comorbidities, and associated complications. CONCLUSIONS In this low socioeconomic status patient population, descending necrotizing mediastinitis below the carina causes high morbidity and mortality, the latter particularly associated with age, complications, diabetes mellitus and other comorbidities.
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Muniz LC, Cascaes AM, Wehrmeister FC, Martínez-Mesa J, Barros AJD, Menezes AMB. Trends in self-reported arterial hypertension in Brazilian adults: an analysis of data from the Brazilian National Household Sample Survey, 1998-2008. CAD SAUDE PUBLICA 2013; 28:1599-607. [PMID: 22892979 DOI: 10.1590/s0102-311x2012000800018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 02/28/2012] [Indexed: 01/13/2023] Open
Abstract
This study investigated the time trend in self-reported arterial hypertension from 1998 to 2008 in individuals older than 20 years in Brazil. Data were analyzed on prevalence of hypertension from the National Household Sample Survey (PNAD) for the years 1998, 2003, and 2008. The analysis considered the sampling complexity and included 203,419, 238,591, and 257,816 individuals in the years 1998, 2003, and 2008, respectively. The time trend in hypertension was analyzed by sex, family income, geographic regions of Brazil, and area of residence (urban versus rural), and the prevalence rates were adjusted for age. Prevalence of self-reported hypertension was 12.5% in 1998, 13% in 2003, and 13.9% in 2008, with an annual increase of 1.07%. The highest increases occurred in the Southeast Region (1.41%), in men (1.82%), and in urban areas (1.15%). The study showed a rise in the prevalence of self-reported hypertension in all income brackets and with increasing age. Knowledge of the prevalence of hypertension is essential for backing activities to prevent and control the problem, especially among the more vulnerable subgroups.
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Affiliation(s)
- Ludmila Correa Muniz
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Brasil.
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Doubova SV, Mino-León D, Pérez-Cuevas R. Linking quality of healthcare and health-related quality of life of patients with type 2 diabetes: an evaluative study in Mexican family practice. Int J Qual Health Care 2013; 25:664-72. [PMID: 24058002 PMCID: PMC3842123 DOI: 10.1093/intqhc/mzt062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective To assess the association between quality of care and health-related quality of life among type 2 diabetes patients. Design A cross-sectional study assessing the association between quality of care and quality of life using multiple linear regression analysis. Setting Family medicine clinics (FMC) (n = 39) of the Mexican Institute of Social Security (IMSS) in Mexico City. Participants Type 2 diabetes patients (n = 312), older than 19 years. Main Outcome Measure(s) Health-related quality of life was measured using the MOS Short-Form-12 (SF-12); quality of healthcare was measured as the percentage of recommended care received under each of four domains: early detection of diabetes complications, non-pharmacological treatment, pharmacological treatment and health outcomes. Results The average quality of life score was 41.4 points on the physical component and 47.9 points on the mental component. Assessment of the quality of care revealed deficiencies. The average percentages of recommended care received were 21.9 for health outcomes and 56.6 for early detection of diabetes complications and pharmacological treatment; for every 10 percent additional points on the pharmacological treatment component, quality of life improved by 0.4 points on the physical component (coefficient 0.04, 95% confidence intervals 0.01–0.07). Conclusions There was a positive association between the quality of pharmacological care and the physical component of quality of life. The quality of healthcare for type 2 diabetes patients in FMC of the IMSS in Mexico City is not optimal.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Ave. Cuauhtemoc 330, Col. Doctores, Mexico DF 06726, México.
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Jacques PF, Cassidy A, Rogers G, Peterson JJ, Meigs JB, Dwyer JT. Higher dietary flavonol intake is associated with lower incidence of type 2 diabetes. J Nutr 2013; 143:1474-80. [PMID: 23902957 PMCID: PMC3743276 DOI: 10.3945/jn.113.177212] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Substantial experimental evidence suggests that several flavonoid classes are involved in glucose metabolism, but few clinical or epidemiologic studies exist that provide supporting human evidence for this relationship. The objective of this study was to determine if habitual intakes of specific flavonoid classes are related to incidence of type 2 diabetes (T2D). We followed 2915 members of the Framingham Offspring cohort who were free of T2D at baseline from 1991 to 2008. Diabetes was defined by either elevated fasting glucose (≥7.0 mmol/L) or initiation of hypoglycemic medication during follow-up. Dietary intakes of 6 flavonoid classes and total flavonoids were assessed using a validated, semiquantitative food frequency questionnaire. We observed 308 incident cases of T2D during a mean follow-up period of 11.9 y (range 2.5-16.8 y). After multivariable adjusted, time-dependent analyses, which accounted for long-term flavonoid intake during follow-up, each 2.5-fold increase in flavonol intake was associated with a 26% lower incidence of T2D [HR = 0.74 (95% CI: 0.61, 0.90); P-trend = 0.003] and each 2.5-fold increase in flavan-3-ol intake was marginally associated with an 11% lower incidence of T2D [HR = 0.89 (95% CI: 0.80, 1.00); P-trend = 0.06]. No other associations between flavonoid classes and risk of T2D were observed. Our observations support previous experimental evidence of a possible beneficial relationship between increased flavonol intake and risk of T2D.
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Affiliation(s)
- Paul F. Jacques
- Jean Mayer USDA Human Nutrition Research Center on Aging, and,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA,To whom correspondence should be addressed. E-mail:
| | - Aedin Cassidy
- Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Gail Rogers
- Jean Mayer USDA Human Nutrition Research Center on Aging, and
| | - Julia J. Peterson
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - James B. Meigs
- General Medicine Division, Massachusetts General Hospital, Boston, MA; and,Department of Medicine, Harvard Medical School, Boston, MA
| | - Johanna T. Dwyer
- Jean Mayer USDA Human Nutrition Research Center on Aging, and,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Juárez-Herrera Ú, Jerjes-Sánchez C. Risk factors, therapeutic approaches, and in-hospital outcomes in Mexicans with ST-elevation acute myocardial infarction: the RENASICA II multicenter registry. Clin Cardiol 2013; 36:241-8. [PMID: 23494467 DOI: 10.1002/clc.22107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 01/26/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Ischemic heart disease is a growing health problem in Latin America. We aimed to analyze risk factors, acute management, and short-term outcome of Mexicans with ST-elevation myocardial infarction (STEMI). HYPOTHESIS Modifiable risk factors are associated with the occurrence of STEMI in Mexicans, and potentially preventable acute complications are responsible for most short-term deaths. METHODS Among 8600 patients enrolled in Registro Nacional de los Síndromes Coronarios Agudos II (RENASICA II) with a suspected acute coronary syndrome, we analyzed 4555 patients (56%; age 21-100 y) with confirmed STEMI who presented within 24 hours from symptoms' onset. RESULTS Smoking (66%), hypertension (50%), and diabetes (43%) were the main risk factors. Most patients (74%) presented with Killip class I (class IV in 4%). Anterior-located STEMI occurred in 56% of cases, and posterior-inferior in 40% of cases. Significant Q waves were present in 43%, right bundle branch block in 7%, left bundle branch block in 5%, first-degree atrioventricular block in 2%, and high-degree atrioventricular block in 2%. A total of 1685 (37%) patients received fibrinolytic therapy (streptokinase, 82%; alteplase, 17%; tenecteplase, 1%), with 31% of patients receiving therapy in <2 hours, 36% in 2-4 hours, 19% in 4-6 hours, and 15% in >6 hours. Thirty percent of patients received either percutaneous coronary intervention or coronary artery bypass grafting during hospitalization. Major adverse cardiovascular events were recurrent ischemia (12%), reinfarction (4%), cardiogenic shock (4%), and stroke (1%). The main predictors of 30-day mortality (10%) in multivariate analysis were age ≥65 years (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.94-3.13), Killip class IV (OR: 10.60, 95% CI: 6.09-18.40), and cardiogenic shock (OR: 18.76, 95% CI: 10.60-33.20). CONCLUSIONS Largely modifiable risk factors and preventable short-term complications are responsible for most STEMI cases and outcomes in this Mexican population.
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Affiliation(s)
- Úrsulo Juárez-Herrera
- Coronary Unit, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico.
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Lavalle-González FJ, Chiquete E, de la Luz J, Ochoa-Guzmán A, Sánchez-Orozco LV, Godínez-gutiérrez SA. Achievement of therapeutic targets in Mexican patients with diabetes mellitus. ACTA ACUST UNITED AC 2012; 59:591-8. [DOI: 10.1016/j.endonu.2012.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 06/25/2012] [Accepted: 07/03/2012] [Indexed: 11/26/2022]
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Pérez-Cuevas R, Doubova SV, Suarez-Ortega M, Law M, Pande AH, Escobedo J, Espinosa-Larrañaga F, Ross-Degnan D, Wagner AK. Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico. BMC Med Inform Decis Mak 2012; 12:50. [PMID: 22672471 PMCID: PMC3437217 DOI: 10.1186/1472-6947-12-50] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 06/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several low and middle-income countries are implementing electronic health records (EHR). In the near future, EHRs could become an efficient tool to evaluate healthcare performance if appropriate indicators are developed. The aims of this study are: a) to develop quality of care indicators (QCIs) for type 2 diabetes (T2DM) in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCIs using the IMSS EHR data; and c) to evaluate the quality of care (QC) provided to IMSS patients with T2DM. METHODS We used a three-stage mixed methods approach: a) development of QCIs following the RAND-UCLA method; b) EHR data extraction and construction of indicators; c) QC evaluation using EHR data from 25,130 T2DM patients who received care in 2009. RESULTS We developed 18 QCIs, of which 14 were possible to construct using available EHR data. QCIs comprised both process of care and health outcomes. Several flaws in the EHR design and quality of data were identified. The indicators of process and outcomes of care suggested areas for improvement. For example, only 13.0% of patients were referred to an ophthalmologist; 3.9% received nutritional counseling; 63.2% of overweight/obese patients were prescribed metformin, and only 23% had HbA1c <7% (or plasma glucose≤130 mg/dl). CONCLUSIONS EHR data can be used to evaluate QC. The results identified both strengths and weaknesses in the electronic information system as well as in the process and outcomes of T2DM care at IMSS. This information can be used to guide targeted interventions to improve QC.
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Affiliation(s)
- Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Inter-American Development Bank, Washignton, USA
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, México, DF, Mexico
| | - Magdalena Suarez-Ortega
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, México, DF, Mexico
| | - Michael Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Aakanksha H Pande
- Department of Population Medicine and WHO Collaborating Center in Pharmaceutical Policy, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jorge Escobedo
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional 1 Carlos MacGregor Sánchez Navarro, IMSS, México, DF, México
| | | | - Dennis Ross-Degnan
- Department of Population Medicine and WHO Collaborating Center in Pharmaceutical Policy, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Anita K Wagner
- Department of Population Medicine and WHO Collaborating Center in Pharmaceutical Policy, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Ramírez-Silva I, Villalpando S, Moreno-Saracho JE, Bernal-Medina D. Fatty acids intake in the Mexican population. Results of the National Nutrition Survey 2006. Nutr Metab (Lond) 2011; 8:33. [PMID: 21651771 PMCID: PMC3125198 DOI: 10.1186/1743-7075-8-33] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 06/08/2011] [Indexed: 12/22/2022] Open
Abstract
Background There is growing evidence that quality, rather that quantity of fat is the determinant of cardiovascular risk. The objective of the study is to describe quantitatively the intake and adequacy of fatty acid classes among the Mexican population aged 5-90 years from a probabilistic survey. Methods Dietary intake of individual and classes of fatty acids was computed from the dataset of the 2006 Mexican National Health and Nutrition Survey (ENSANUT2006), collected by a food frequency questionnaire. Adequacy was calculated in reference to authoritative recommendations. Results The mean intake of total fatty acids (TFA ≈ 25%E) fell within WHO recommendations; the intakes of saturated fatty acids (SFA) among all age-groups (45-60%) and of trans fatty acids (TrFA) in 30% of school-age children and adolescents and 20% of adults exceeded international recommendations. The mean intake of polyunsaturated fatty acids (PUFA) and particularly of n6 and n3 PUFAS, was inadequately insufficient in 50% of the sample. Conclusions The main public health concerns are the high intake of SFA and the suboptimal intake of PUFA in Mexican population. The TrFA intake represents a low public health risk.
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Affiliation(s)
- Ivonne Ramírez-Silva
- Centro de Investigación en Nutrición y Salud. Instituto Nacional de Salud Pública, Cuernavaca Mor, México
| | - Salvador Villalpando
- Centro de Investigación en Nutrición y Salud. Instituto Nacional de Salud Pública, Cuernavaca Mor, México
| | - Jessica E Moreno-Saracho
- Centro de Investigación en Nutrición y Salud. Instituto Nacional de Salud Pública, Cuernavaca Mor, México
| | - Daniel Bernal-Medina
- Centro de Investigación en Nutrición y Salud. Instituto Nacional de Salud Pública, Cuernavaca Mor, México
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Abstract
PURPOSE OF REVIEW Description of the epidemiology, etiological factors, and consequences of the metabolic syndrome in Latin America. RECENT FINDINGS Latin American populations exhibit a high prevalence of abdominal obesity, and some genetic variations exacerbated by environmental factors have been claimed as main etiological factors of this condition. SUMMARY Actually, the Latin American populations exhibit a high prevalence of abdominal obesity and metabolic syndrome, similar or even higher than developed countries. It is attributed to changes in their lifestyle, migration from rural to urban areas and a higher susceptibility to accumulate abdominal fat and develop more insulin resistance compared to other ethnically different populations. Some genetic factors and metabolic adaptations during fetal life can be claimed as etiological factors of this condition. Consequently, a greater burden of type 2 diabetes and cardiovascular disease is expected to occur in the near future. Thus, it is important to establish scientific-based criteria for the diagnosis of metabolic syndrome in the region to implement the best preventive and therapeutical strategies to combat this epidemic disease.
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Affiliation(s)
- Ada Cuevas
- Department of Clinical Nutrition, Clinica Las Condes, Santiago, Chile.
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Reynoso-Noverón N, Mehta R, Almeda-Valdes P, Rojas-Martinez R, Villalpando S, Hernández-Ávila M, Aguilar-Salinas CA. Estimated incidence of cardiovascular complications related to type 2 diabetes in Mexico using the UKPDS outcome model and a population-based survey. Cardiovasc Diabetol 2011; 10:1. [PMID: 21214916 PMCID: PMC3023678 DOI: 10.1186/1475-2840-10-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 01/07/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To estimate the incidence of complications, life expectancy and diabetes related mortality in the Mexican diabetic population over the next two decades using data from a nation-wide, population based survey and the United Kingdom Prospective Diabetes Study (UKPDS) outcome model. METHODS The cohort included all patients with type 2 diabetes evaluated during the National Health and Nutrition Survey (ENSANut) 2006. ENSANut is a probabilistic multistage stratified survey whose aim was to measure the prevalence of chronic diseases. A total of 47,152 households were visited. Results are shown stratified by gender, time since diagnosis (> or ≤ to 10 years) and age at the time of diagnosis (> or ≤ 40 years). RESULTS The prevalence of diabetes in our cohort was 14.4%. The predicted 20 year-incidence for chronic complications per 1000 individuals are: ischemic heart disease 112, myocardial infarction 260, heart failure 113, stroke 101, and amputation 62. Furthermore, 539 per 1000 patients will have a diabetes-related premature death. The average life expectancy for the diabetic population is 10.9 years (95%CI 10.7-11.2); this decreases to 8.3 years after adjusting for quality of life (CI95% 8.1-8.5). Male sex and cases diagnosed after age 40 have the highest risk for developing at least one major complication during the next 20 years. CONCLUSIONS Based on the current clinical profile of Mexican patients with diabetes, the burden of disease related complications will be tremendous over the next two decades.
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Affiliation(s)
- Nancy Reynoso-Noverón
- Oficina del Subsecretario de Salud, Secretaria de Salud, (Lieja 7, Colonia Juárez), México City (06600) México
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Ramos DC, Mehta R, De La Luz Castro J, Limones RC, Rubí EG, Aguilar-Salinas CA. Awareness of Abdominal Adiposity as a Cardiometabolic Risk Factor (The 5A Study): Mexico. Diabetes Metab Syndr Obes 2011; 4:107-17. [PMID: 21660294 PMCID: PMC3107693 DOI: 10.2147/dmso.s16592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Awareness of Abdominal Adiposity as a Cardiometabolic Risk Factor Study assesses the prevalence of cardiometabolic risk factors in adults with abdominal obesity (waist circumference ≥90 cm in men and ≥80 cm in women) and evaluates how physicians manage these patients. METHODS This is an observational cross-sectional study. Internists, cardiologists, and endocrinologists contributed patients to the study. A standardized questionnaire was completed and registered demographics, anthropometric measurements, lab results from the medical files, and any treatment utilized to manage dyslipidemia, arterial hypertension, diabetes, and cardiovascular disease. RESULTS A total of 1312 patients was included. The mean age was 49.3 ± 14.6 years and 834 (63.6%) were female. The primary reason for the physician consultation was treatment of obesity (47.5%), followed by management of arterial hypertension (27.7%), diabetes (18.3%), dyslipidemia (14.2%), and cardiovascular disease (7.1%). The majority of patients identified excess body weight as a health problem (81.4%). However, patients had lost a mean of 4.3 ± 3.5 kg. Only 63.4% of patients with arterial hypertension were on drug therapy. Few of them had reached target values for diastolic (24.1%) and systolic/diastolic (13.3%) pressure. Less than half of the patients with dyslipidemia were receiving lipid-lowering medication. Only 32.2% were at their target low-density lipoprotein cholesterol levels. In patients with type 2 diabetes, mean fasting plasma glucose level (8.9 ± 3.4 mmol/L) was above the threshold recommended by current guidelines. CONCLUSIONS The study describes the medical care given to individuals with abdominal obesity during daily clinical practice by general practitioners, cardiologists, and endocrinologists in urban Mexico. Our data confirm that a large proportion of patients are undertreated. Only a small percentage of patients with obesity-related comorbidities reach treatment targets. Interventions proven to be effective in the prevention of chronic complications have in general not been implemented.
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Affiliation(s)
- Daniel Cuevas Ramos
- Department of Endocrinology, Instituto Nacional de Ciencias Medicas y Nutricion “Salvador Zubiran” (INCMNSZ)
| | - Roopa Mehta
- Department of Endocrinology, Instituto Nacional de Ciencias Medicas y Nutricion “Salvador Zubiran” (INCMNSZ)
| | | | - Rutila Castañeda Limones
- Clinical Epidemiology Research Unit, Hospital General Regional No 1 Dr Carlos Mac Gregor Sánchez Navarro
| | - Ernesto García Rubí
- Department of Endocrinology, Hospital Angeles Metropolitano, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Department of Endocrinology, Instituto Nacional de Ciencias Medicas y Nutricion “Salvador Zubiran” (INCMNSZ)
- Correspondence: Carlos A Aguilar-Salinas, Instituto Nacional de Ciencias Medicas, y Nutricion “Salvador Zubiran”, Vasco de Quiroga 15, Seccion XVI, Tlalpan 14000, Mexico City, Mexico, Tel +52 55 5513 3891, Fax +52 55 5513 3891, Email
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Glassman A, Gaziano TA, Bouillon Buendia CP, Guanais de Aguiar FC. Confronting The Chronic Disease Burden In Latin America And The Caribbean. Health Aff (Millwood) 2010; 29:2142-8. [DOI: 10.1377/hlthaff.2010.1038] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Amanda Glassman
- Amanda Glassman ( ) is director of the Global Health Policy Program at the Center for Global Development, in Washington, D.C
| | - Thomas A. Gaziano
- Thomas A. Gaziano is a physician at Brigham and Women’s Hospital and Harvard Medical School, in Boston, Massachusetts
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