Influence of the informal primary caretaker on glycemic control among prepubertal pediatric patients with type 1 diabetes mellitus / Influência do cuidador familiar principal sobre o controle glicêmico entre pacientes pediátricos pré-púberes com diabetes mellitus tipo 1

Abstract Objectives: In prepubertal type 1 diabetic patients (DM1), the availability of an informal primary caregiver (ICP) is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified. Patients, materials, and methods: A comparative cross-sectional study was performed. Fifty-five patients with DM1 under the age of 11 years were included. The patient-related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP-related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire), family functionality (family APGAR), support of another person in patient care, stress (Perceived Stress Scale), and socioeconomic status (Bronfman questionnaire). Multivariate logistic and linear regression analyses were performed. Results: The patients' median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06-151.9, p = 0.001). While, according to the linear regression analysis it was found that lower level of education (β 0.991, 95% CI 0.238-1.743, p = 0.011) and stress (β 1.918, 95% CI 1.10-2.736, p = 0.001) in the ICP, as well as family dysfunction (β 1.256, 95% CI 0.336-2.177, p = 0.008) were associated with higher levels of glycated hemoglobin. Conclusions: Level of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients.

Resumo Objetivos: Em pacientes pré-púberes com diabetes tipo 1 (DM1), a disponibilidade de um cuidador familiar principal (CFP) é fundamental para tomar decisões de administração; neste estudo, foram identificados os fatores de risco relacionados a CFPs associados ao controle glicêmico. Pacientes, materiais e métodos: Foi feito um estudo transversal comparativo. Foram incluídos 55 pacientes com DM1 menores de 11 anos. Os fatores relacionados aos pacientes associados ao controle glicêmico avaliados foram atividade física, tempo de evolução da DM1 e adesão às indicações médicas. Os fatores relacionados a CFPs avaliados foram escolaridade, aspectos profissionais, traços de depressão (questionário de Beck), funcionalidade familiar (Apgar familiar), ajuda de outra pessoa no cuidado do paciente, estresse (Escala de Estresse Percebido) e situação socioeconômica (questionário de Bronfman). Foram feitas análises de regressão logística multivariada e de regressão linear. Resultados: A idade média dos pacientes era de oito anos; 29 pacientes apresentavam bom controle glicêmico e 26 não tinham controle. O principal fator de risco associado ao descontrole glicêmico foi o estresse no CFP (RC 24,8; IC de 95% 4,06-151,9, p = 0,001). Ao passo que, de acordo com a análise de regressão linear, constatamos que: o menor nível de escolaridade (0,991, IC de 95% 0,238-1,743, p = 0,011) e estresse (1,918, IC de 95% 1,10-2,736, p = 0,001) do CFP, bem como a disfunção familiar (1,256, IC de 95% 0,336-2,177, p = 0,008), foram associados a níveis maiores de hemoglobina glicosilada. Conclusões: O nível de escolaridade e o estresse do CFP e a disfunção familiar são fatores que influenciam a falta de níveis glicêmicos controlados entre pacientes pré-púberes com DM1.

Influence of the informal primary caretaker on glycemic control among prepubertal pediatric patients with type 1 diabetes mellitus.

OBJECTIVES: In prepubertal type 1 diabetic patients (DM1), the availability of an informal primary caregiver (ICP) is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified. PATIENTS, MATERIALS, AND METHODS: A comparative cross-sectional study was performed. Fifty-five patients with DM1 under the age of 11 years were included. The patient-related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP-related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire), family functionality (family APGAR), support of another person in patient care, stress (Perceived Stress Scale), and socioeconomic status (Bronfman questionnaire). Multivariate logistic and linear regression analyses were performed. RESULTS: The patients' median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06-151.9, p=0.001). While, according to the linear regression analysis it was found that lower level of education (ß 0.991, 95% CI 0.238-1.743, p=0.011) and stress (ß 1.918, 95% CI 1.10-2.736, p=0.001) in the ICP, as well as family dysfunction (ß 1.256, 95% CI 0.336-2.177, p=0.008) were associated with higher levels of glycated hemoglobin. CONCLUSIONS: Level of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients.

Local understandings of conservation in southeastern Mexico and their implications for community-based conservation as an alternative paradigm.

Since the 1990s national and international programs have aimed to legitimize local conservation initiatives that might provide an alternative to the formal systems of state-managed or otherwise externally driven protected areas. We used discourse analysis (130 semistructured interviews with key informants) and descriptive statistics (679 surveys) to compare local perceptions of and experiences with state-driven versus community-driven conservation initiatives. We conducted our research in 6 communities in southeastern Mexico. Formalization of local conservation initiatives did not seem to be based on local knowledge and practices. Although interviewees thought community-based initiatives generated less conflict than state-managed conservation initiatives, the community-based initiatives conformed to the biodiversity conservation paradigm that emphasizes restricted use of and access to resources. This restrictive approach to community-based conservation in Mexico, promoted through state and international conservation organizations, increased the area of protected land and had local support but was not built on locally relevant and multifunctional landscapes, a model that community-based conservation is assumed to advance.

Mass rearing history negatively affects mating success of male Anastrepha ludens (Diptera: Tephritidae) reared for sterile insect technique programs.

Mating competitiveness and sterility induction into cohorts of wild Anastrepha ludens (Loew) (Diptera: Tephritidae) was compared among wild and laboratory flies reared for use in the sterile insect technique Mexican program. Laboratory flies stemming from an 11-yr-old bisexual strain were either not irradiated, irradiated at 3 krad (low dose), or irradiated at 8 krad. In 30 by 30 by 30-cm Plexiglas cages, where a cohort of laboratory flies (male and female) irradiated at different doses (0, 3, and 8 krad) was introduced with a cohort of wild flies, males and females of each type mated randomly among themselves. Compared with nonirradiated laboratory and wild males, irradiated males, irrespective of dose (3 or 8 krad), induced shorter refractory periods and greater mating frequency in wild females. Nevertheless, laboratory flies irradiated at a low dose induced greater sterility into cohorts of wild flies than laboratory flies irradiated at a high dose. In a 3 by 3 by 3-m walk-in cage, wild males gained significantly more matings with wild females than nonirradiated and irradiated laboratory males a finding that revealed a strong effect of strain on mating performance. Mating incompatibility of the laboratory strain might have obscured the effect of reduced irradiation doses on male mating performance in the walk-in cage. Our results highlight an urgent need to replace the A. ludens strain currently used by the Mexican fruit fly eradication campaign and at least suggest that reducing irradiation doses result in an increase in sterility induction in wild populations.