Prescription for antiresorptive therapy in Mexican patients with rheumatoid arthritis: is it time to reevaluate the strategies for osteoporosis prevention?

Glucocorticoids are frequently used in rheumatoid arthritis (RA) in order to alleviate symptoms of joint inflammation, retard erosions and to treat extra-articular manifestations, although these drugs may increase the risk of bone mineral loss and osteoporotic fractures. To date, in Mexico there are no studies that identify the frequency of patients with RA with corticosteroids, receiving therapy for osteoporosis. Therefore, we evaluated the prevalence and factors related to the prescription of antiresorptives in 520 Mexican patients with RA. We used a multivariate model to identify variables associated with antiresorptives prescription. We identified that although 79% of patients were under treatment with glucocorticoids, only 13% received antiresorptive agents as preventive therapy for osteoporosis. The multivariate analysis identified that higher proportions of antiresorptive drugs prescriptions were associated with female patients (OR 11.40, 95% CI: 1.5-84.3, P = 0.02), an age of 40 years or more (OR 3.22, 95% CI: 1.3-8.3, P = 0.02) and to consume a lower number of cointerventions with other drugs (OR 1.09, 95% CI: 1.0-1.2, P = 0.03). Corticosteroid treatment was not associated with the prescription of antiresorptives (P = 0.31). In conclusion, a low proportion of Mexicans with RA receive antiresorptive therapy independently regardless of whether they consume or not chronically corticosteroids. Additional strategies should be evaluated to encourage the prevention and early treatment for osteoporosis in patients with RA.

Family physicians clinical aptitude for the nutritional management of type 2 diabetes mellitus in Guadalajara, Mexico.

There are 180,000 new Diabetes Mellitus cases in Mexico each year (1). This chronic, complex and multifactor disease requires an adequate nutritional management plan to be prescribed by family physicians. They should be trained to identify the potential difficulties in the patient's dietary schedule and orientate their management from an integrative point of view. The purpose of this study was to detect and measure family physician's clinical aptitudes for the nutritional management of Type 2 diabetes, in a representative family physician's sample from five Family Medicine Units of the Mexican Institute of Social Security in Guadalajara, Jalisco, Mexico. A structured and validated instrument was applied to 117 physicians from a total of 450 in Guadalajara, Jalisco. The main study variable was clinical aptitude for nutritional management of Type 2 diabetes. Aptitude levels were defined by an ordinal scale and related to the other variables using the median, Mann-Whitney's U test and Kruskal Wallis (KW) test. Global results showed a median of 30 points that relates to a low and a very low aptitude level for the 72% of physicians without statistical significance (KW: p>0.05) with the rest of variables. These results reflect family physician's difficulties to orientate the nutritional management of Type 2 diabetes, as well as the lack of work environments that facilitate case reflection and formative educational strategies.

Correlates of cognitive impairment in elderly residents of long term care institutions in the metropolitan area of Guadalajara, Mexico.

AIM: To determine the prevalence of cognitive impairment and to examine the correlation between demographic and social factors, the activities of daily living (ADL), and depression with cognitive function in elderly Mexicans living in nursing homes. DESIGN: Cross-sectional. SETTING: Fourteen nursing homes in Guadalajara. PARTICIPANTS: Data were drawn from a random sample of 451 elderly, aged 60-104 years. MEASUREMENTS: The Spanish versions of MMSE (Folstein), ADL index (Barthel), and the Geriatric Depression Screening (GDS) (Yesavage); demographic factors were obtained. RESULTS: The prevalence of cognitive impairment was 52.3%, with a cut-off of 19/20 (Bohnstedt). Cognitive impairment was significantly related to gender, educational level, activity participation, pension, ADL, and depression. CONCLUSION: The results indicate a higher prevalence of cognitive impairment than in other Mexican studies. The data are consistent with previous findings that cognitive impairment in the elderly is more common among females, those with a low level of education, the lack of participation in social/leisure activities, ADL dependencies, and depression.

Caesarean sections in Mexico: are there too many?

This paper seeks to quantify the magnitude of caesarean sections in Mexican public health-care institutions in recent years, to characterize the evolution of caesarean section rates (CSR) during the last decade, and to estimate the possible economic cost caused by the excess of caesareans performed in these institutions. The study is based on data obtained from the health sector, both for Mexico in the 5-year period 1993-97 and for the Mexican State of Jalisco between 1983 and 1998. Linear regression analysis was used to evaluate time series, and "excess of caesareans" was considered the number of caesarean deliveries performed above the admissible 15% CSR. The results reflect that on the national level, more than one-quarter of the deliveries handled by public institutions ended in caesarean section for each analyzed year, and if the deliveries performed in private institutions are included, the national rate is around 30%. A marked increase in CSR can be observed in Jalisco between 1983 and 1998 (almost 50%); and the cost for the nation of this CSR excess in financial terms is highly significant: several millions of dollars--obtained from public funds--are spent annually and unnecessarily by health services. The findings suggest that the increase in CSR is a public health problem that has not been satisfactorily faced by the health sector authorities. Many unnecessary caesareans would undoubtedly be avoided if the policies of these public health-care institutions were to consider, as a priority, both the known higher risk implicit in a caesarean for the health of the mother and child, and the economic impact on the country and its health institutions of the excessive number of caesareans performed yearly.

[Effect of oral administration of ascorbic acid on insulin sensitivity and lipid profile in obese individuals]. / Efecto de la administración oral de ácido ascórbico sobre la sensibilidad a la insulina y el perfil de lípidos en individuos con obesidad.

BACKGROUND: The aim of this study was to identify the effect of an oral ascorbic acid (AA) supplement on lipid profile and insulin sensitivity in obese people. RESEARCH DESIGN AND METHODS: A randomized double-blind clinical trial placebo controlled was performed in 16 obese male volunteers [body mass index (BMI) 30-40 kg/m2]. Eight received orally 1 g of AA daily for four weeks and the other eight volunteers received placebo by the same scheme and period of time. Before and after the pharmacological intervention were measured total cholesterol, high-density-lipoprotein (HDL) cholesterol, triglycerides, glucose, creatinine and uric acid. Low-density-lipoprotein (LDL) cholesterol and very-low-density-lipoprotein (VLDL) triglycerides were calculated using formulas. In order to assess insulin sensitivity before and after the intervention, the steady-state glucose (SSG) was calculated from the insulin suppression test modified with octreotide. RESULTS: There were not significant differences in clinical characteristics between both groups. Basal metabolic profile and SSG were similar between both groups. There were not significant differences in both groups between before and after the intervention in metabolic profile and insulin sensitivity. CONCLUSION: AA did not modify the lipid profile nor insulin sensitivity in the group of obese people studied.

[Effects of an educational intervention on plasma levels of LDL cholesterol in type 2 diabetics]. / Efectos de una intervención educativa sobre los niveles plasmáticos de LDL-colesterol en diabéticos tipo 2.

OBJECTIVE: To prove the benefit of an educational intervention for controlling LDL cholesterol levels in LDL cholesterol. MATERIAL AND METHODS: A quasi-experimental study was conducted; diabetic patients were randomly allocated to an experimental and a control group. The experimental group consisted of 25 patients and the control group of 24 patients. The educational intervention was organized through a reflection-action process. LDL cholesterol levels were measured at baseline and monthly during the nine months of the study. The groups were controlled for age and sex. Statistical analysis included Wilcoxon's test for ordinal variables. RESULTS: The intervention group had a mean value of LDL cholesterol of 148.4 +/- 21.3, compared to 185 +/- 24.1 in the control group (p < or = 0.05). CONCLUSIONS: The participative educational intervention contributed to improving the levels of LDL cholesterol, by promoting a lifestyle change in type-2 diabetic patients.

Effects of behavior-modifying education in the metabolic profile of the type 2 diabetes mellitus patient.

To demonstrate the advantages of behavior-modifying education in the metabolic profile of the type-2 diabetes mellitus patient. A quasi-experimental study was performed with a control group. The experimental group was made up of 25 type-2 diabetic patients and the control group consisted of 24. The type of education carried out was a behavior modification. Baseline measurements and subsequent monthly measurements of serum glucose, total cholesterol and triglycerides were carried out during 9 months after the intervention. The groups were controlled according to age and sex. The statistical analysis was performed using the Student's and Wilcoxon's test to determine the difference. The experimental group in comparison with the control group in the measurement after the intervention achieved a mean difference in serum glucose of 64.2 mg/dl (p=0.001), in the cholesterol of 31.6 (p=0.008), and in the triglycerides of 50.8 (p=0.006). The behavior-modifying education is a better option than traditional intervention for metabolic control in type-2 diabetes mellitus patients.

Using logistic regression to describe the length of breastfeeding: a study in Guadalajara, Mexico.

This study seeks, through a logistic regression model, to describe the pattern of breastfeeding duration in Guadalajara, Mexico, during 1993. A multistage random sample of children under 1 year of age (n = 1036) was studied; observational data regarding breastfeeding duration, obtained through a "status quo" procedure, were compared with prevalence rates obtained from the logistic regression model. Modeling the duration of breastfeeding during the first year of life rather than only analyzing observational data helps researchers to understand this process in a dynamic and quantitative way. For example, uncommon indicators of breastfeeding were derived from the model. These indicators are impossible to obtain from observational data. The prevalence curve estimated through the logistic model was adequately fitted to observed data: there were no significant differences between the number or distribution of breastfed infants observed and those predicted by the model. Moreover, the model revealed that less than 40% of the children were breastfed in the fourth month of life; the median age for weaning was 39.3 days; 55% of the potential breastfeeding in the first 4 months did not occur; and the greatest abandonment of breastfeeding in the first 4 months was observed in the first 60 days. Thus, logistic regression seems a suitable option to construct a population-based model that describes breastfeeding duration during the first year of life. The indicators derived from the model offer health care providers valuable information for developing programs that promote breastfeeding.

PIP: This study describes the pattern of breast-feeding duration in Guadalajara, Mexico, in 1993, using a logistic regression model. A multistage random sample of children under 1 year of age (n = 1036) was studied; observational data regarding breast-feeding duration, obtained through a "status quo" procedure, were compared with prevalence rates obtained from the logistic regression model. Modeling the duration of breast-feeding during the first year of life rather than only analyzing observational data helps researchers to understand this process in a dynamic and quantitative way. For example, uncommon indicators of breast-feeding were derived from the model. These indicators are impossible to obtain from observational data. The prevalence curve estimated through the logistic model was adequately fitted to observe data: there were no significant differences between the number or distribution of breast-fed infants observed and those predicted by the model. Moreover, the model revealed that less than 40% of the children were breast-fed in the fourth month of life. The median age for weaning was 39.3 days and about 55% of potential breast-feeding in the first 4 months did not occur. Lastly, the highest abandonment of breast-feeding in the first 4 months was observed in the first 60 days. Thus, logistic regression seems a suitable option to construct a population-based model that describes breast-feeding duration during the first year of life.

Educación para la salud en derechohabientes del primer nivel de atención médica / Health education for insured patients ar the first level of medical attention

Se efectuó un estudio en la población derechohabiente mayor de 15 años que demandaba los servicios médicos en una unidad de atención a la salud del primer nivel de atención del Instituto Mexicano del Seguro Social (IMSS) en la zona metropolitana de Guadalajara, Jalisco. El propósito fue identificar el nivel de educación para la salud de usuarios de los servicios y analizar el modelo de práctica educativa institutcional recibida por el derechohabiente. Mediante este proyecto de investigación se puede señalar que 27.1 por ciento de la población derechohabiente demandante tiene un adecuado nivel de educación para la salud, que la práctica educativa recibida se basa en la acumulación de información, y que ésta ha sido otorgada por un equipo disciplinario en salud, el cual refleja limitaciones en los métodos y técnicas de educación en salud.

Ambiente de trabajo en una Unidad de Medicina Familiar / Work milieu at a family medical unit

Se efectuó una investigación por encuesta de tipo prospectivo en trabajadores del Instituto Mexicano del Seguro Social en una Unidad de medicina Familiar del área metropolitana de Guadalajara Jalisco. El propósito, por medio de la Comisión Mixta de Mejoramiento del Ambiente Laboral, fue identificar las condiciones de trabajo a través de la valoración de la satisfacción de sus necesidades; se recolectaron los datos por medio de un instrumento estructurado y codificado que abarcó las variables de estudio mediante un censo que incluyó a la totalidad de los trabajadores. El número de encuestados fue de 167 y como promedio general de las variables se encontró que 66 por ciento aceptó haber cubierto sus necesidades, señalando que existen otras variables en donde la moda alcanza niveles más significativos, lo que permitió perfilar el nivel taxonómico de satisfacción de sus necesidades

[Knowledge, attitudes and dietary practices in patients with diabetes mellitus type II]. / Conocimientos, actitudes y prácticas dietéticas en pacientes con diabetes mellitus II.

The profile of type-II non-insulin dependent diabetic patients is characterized by overweight; exogenous obesity originates from inadequate nourishment habits and, among other things, educational, cultural, and psychological conditions. With regard to metabolic deficiency control, the explanation is centered fundamentally on the patient's not getting a complete diet. This could be due to a lack of information about their illness, thus becoming a determining factor in their treatment. The purpose of this study was to analyze the level of knowledge, attitudes, and dietary education practices by means of a survey using the likert scale. This was applied by means of a direct and codified interview directed to patients in a Primary Care Health Unit from the Mexican Social Security Institute (IMSS) in Guadalajara, Jalisco, Mexico. 201 Type II diabetic patients, selected from a systematic sample, were studied. The average age was 54 and predominantly female (a ratio of 1.7 to 1). The sample had an academic background not surpassing the elementary school level, and their occupation was that of housewife. Their central glycemia level was, on the average, 191 mg/dl with a standard deviation of 120. The average number of years of having suffered from the illness was 5.5 with a standard deviation of 5. Ninety per cent of the diabetic patients take oral hypoglucemiants. Although there does exist a high level of knowledge and attitudes about dietary education, there exists a low level of educational practices. We observed that only 10 per cent of the diabetic patients have both an acceptable metabolic control (CMA) and a high value in knowledge, attitudes, and practices (CAP).(ABSTRACT TRUNCATED AT 250 WORDS)