Cost-Effectiveness of a Technology-Enhanced Diabetes Care Management Program in Mexico.

BACKGROUND: The prevalence of diabetes has increased substantially in Mexico over the last 40 years, leading to significant impacts on population health and the healthcare system. Technology-based solutions may improve diabetes outcomes in areas where lack of efficient transportation creates barriers to care. OBJECTIVES: To estimate the lifetime cost-effectiveness of a technology-based diabetes care management program from the perspective of the Mexican healthcare system. METHODS: Clinical outcomes and cost data from a 3-arm randomized clinical trial of Dulce Wireless Tijuana, a diabetes care management program incorporating short-term mobile technology, were used as inputs in a validated simulation model for type 2 diabetes. Study arms included a control group (CG), Project Dulce diabetes care management (PD), and Project Dulce with technology enhancement (PD-TE). RESULTS: Intervention costs were $1448 for PD and $1740 for PD-TE compared with $740 for CG. Both intervention arms increased quality-adjusted life-years and costs. The incremental cost-effectiveness ratio for PD was $1635 and for PD-TE was $2220, both compared with CG. The incremental cost-effectiveness ratio for PD-TE versus PD was $4299. The results were sensitive to the time horizon. The PE and PD-TE interventions were cost-effective under time horizons of 15 to 20 years, but were not cost-effective under time horizons of 5 to 10 years. CONCLUSIONS: Both the PD and PD-TE were highly cost-effective from a Mexican health system perspective. Considering the economic impact of the diabetes epidemic and the widespread use of cellular technology in Mexico, implementation of PD-TE is warranted.

Overweight and obesity and factors associated with menopause.

This study aims to check the association between overweight and obesity and sociodemographic, behavioral and clinical factors in menopausal women. A cross-sectional study of a sample of 253 menopausal women who answered questions about socioeconomic and demographic factors, health in general, eating habits and behaviors. Body-mass index (BMI) was used to assess participant nutritional status. The Menopause Rating Scale (MRS) was used to assess quality of life. To assess sexual performance we used SQ-F (Sexual Quotient, Female Version). We used bivariate analysis and hierarchical multiple regression to identify the factors associated with being overweight during menopause. Using BMI we found that 30.8% of the sample was overweight and 35.2% obese, totaling 66% overweight women in the sample. In the multiple analysis, not owning a home, the severity of symptoms using MRS, use of continuous use medication and having been on any type of diet were associated with being overweight or obese. Nutritional intervention for weight control and changing behaviors could produce considerable benefits in terms of the health and quality of life of menopausal women.

Sobrepeso e obesidade e fatores associados ao climatério / Overweight and obesity and factors associated with menopause

Resumo O objetivo deste estudo é verificar a associação entre sobrepeso e obesidade e fatores sociodemográficos, comportamentais e clínicos em mulheres climatéricas. Estudo transversal, com amostra de 253 mulheres climatéricas, que responderam questões sobre fatores socioeconômicos e demográficos, saúde geral, hábitos alimentares e comportamentais. Para a avaliação do estado nutricional, foi utilizado índice de massa corpórea (IMC). Para avaliação da qualidade de vida foi utilizado a Menopause Rating Scale (MRS). Empregou-se o Quociente Sexual (QS-F)-Versão Feminina para a avaliação do desempenho sexual. Utilizou-se análise bivariada e regressão múltipla hierarquizada para identificar fatores associados ao sobrepeso e à obesidade no climatério. Pela análise do IMC, 30,8% apresentaram sobrepeso e 35,2%, obesidade, totalizando 66% de excesso de peso. Na análise múltipla, não possuir casa própria, gravidade de sintomas pela avaliação do MRS, uso de medicamento de forma contínua e ter feito algum tipo de dieta apresentaram associação com sobrepeso e obesidade. Intervenção nutricional, visando ao controle de peso e mudanças de hábitos de vida, poderá resultar em benefícios consideráveis relativos à saúde e qualidade de vida das mulheres climatéricas.

Abstract This study aims to check the association between overweight and obesity and sociodemographic, behavioral and clinical factors in menopausal women. A cross-sectional study of a sample of 253 menopausal women who answered questions about socioeconomic and demographic factors, health in general, eating habits and behaviors. Body-mass index (BMI) was used to assess participant nutritional status. The Menopause Rating Scale (MRS) was used to assess quality of life. To assess sexual performance we used SQ-F (Sexual Quotient, Female Version). We used bivariate analysis and hierarchical multiple regression to identify the factors associated with being overweight during menopause. Using BMI we found that 30.8% of the sample was overweight and 35.2% obese, totaling 66% overweight women in the sample. In the multiple analysis, not owning a home, the severity of symptoms using MRS, use of continuous use medication and having been on any type of diet were associated with being overweight or obese. Nutritional intervention for weight control and changing behaviors could produce considerable benefits in terms of the health and quality of life of menopausal women.

Dulce Wireless Tijuana: A Randomized Control Trial Evaluating the Impact of Project Dulce and Short-Term Mobile Technology on Glycemic Control in a Family Medicine Clinic in Northern Mexico.

BACKGROUND: The global epidemic of diabetes calls for innovative interventions. This study evaluated the effectiveness of the Project Dulce model, with and without wireless technology, on glycemic control and other clinical and self-reported outcomes in patients with poorly controlled type 2 diabetes in Mexico. SUBJECTS AND METHODS: Adults with type 2 diabetes and a glycated hemoglobin A1c (HbA1c) level of ≥8% were recruited from Family Medical Unit #27 of the Instituto Mexicano del Seguro Social (IMSS) in Tijuana, México, and randomly assigned to one of three groups: Project Dulce-only (PD); Project Dulce technology-enhanced with mobile tools (PD-TE); or IMSS standard of care/control group (CG). Clinical and self-reported outcomes were assessed at baseline, Month 4, and Month 10. Time-by-group interactions and within-group changes were analyzed. RESULTS: HbA1c reductions from baseline to Month 10 were significantly greater in PD-TE (-3.0% [-33 mmol/mol]) and PD (-2.6% [-28.7 mmol/mol]) compared with CG (-1.3% [-14.2 mmol/mol]) (P = 0.009 and 0.001, respectively). PD-TE and PD also exhibited significant improvement in diabetes knowledge when compared with CG (P < 0.05 for both). No statistically significant differences were detected between PD and PD-TE on these indicators (P = 0.54 and 0.86, respectively). Several within-group improvements were observed on other clinical and self-report indicators but did not vary significantly across groups. CONCLUSIONS: Project Dulce with and without wireless technology substantially improved glycemic control and diabetes knowledge in high-risk patients with type 2 diabetes in a Mexican family medical unit, suggesting that integrating peer-led education, nurse coordination, and 3G wireless technology is an effective approach for improving diabetes outcomes in high-risk populations.

Proyecto colaborativo Chile-Paraguay en formación de postgrado / A Chile - Paraguay collaborative project for postgraduate education

Resumen:

Objetivo: este artículo da a conocer el proyecto colaborativo entre la Escuela de Enfermería de la Pontificia Universidad Católica de Chile (PUC) y la Escuela de Enfermería de la Universidad Católica “Nuestra Señora de la Asunción” de Paraguay. El objetivo es el de mejorar la calidad del cuidado de la salud que se otorga a la población, a través del perfeccionamiento de enfermeras y enfermeros a nivel de postgrado. Metodología: se revisan los principales aspectos considerados en la creación y puesta en marcha del postgrado, y su estado actual a junio de 2014. La participación de la Escuela de Enfermería de la PUC en este proyecto responde al llamamiento de la Santa Sede “de fortalecer la red de universidades católicas” y es considerado un deber de contribuir con su experiencia y experticia al desarrollo de la enfermería de un país amigo. Resultados: como resultado de este proyecto se creó y puso en marcha, en el año 2007, un programa de magister en Enfermería desa­rrollado en la ciudad de Asunción, que en el año 2014 ha graduado a 29 profesionales y que están contribuyendo al desarrollo de la enfermería de Paraguay. Conclusión: el modelo diseñado para el desarrollo de este magister ha demostrado ser exitoso, como también el establecimiento de alianzas y colaboración entre las universidades, lo que aporta beneficios a las instituciones involucradas tanto en los ámbitos académicos y profesionales como personales.

Abstract:

Purpose: A collaborative project by Nursing School, Pontificia Universidad Católica, Chile (PUC) and Nursing School, Universidad Católica “Nuestra Señora de la Asunción”, Paraguay is described. The project is aimed at improving healthcare quality provided to the community by means of an improved postgraduate education for nurses.

Methods: The main aspects taken into account to create and develop postgraduate courses, along with their present condition in June 2014, are reviewed. The involvement of PUC's Nursing School in this project results from the Holy See's calling for "strengthening the Catholic Universities network"; and offering its experience and expertise to help nursing development in a friend country is considered to be a duty. Results: As a result from the project, in 2007 a Master Program in Nursing was created and implemented in Asunción city, with 29 professionals having achieved graduation in it until 2014; such professionals are currently contributing to nursing development in Paraguay. Conclusion: The model that was designed in order to develop this Master course has proved successful. Alliances and collaboration between universities have also been satisfactory, with benefits being obtained by involved institutions at academic, professional, and personal levels.

Introduçao: trabalho colaborador entre a Escola de Enfermagem da Pontifícia Universidade Católica de Chile (PUC) e a Escola de Enfermagem da Universidade Católica “Nossa Senhora da Assunção”, Paraguai. Objetivo: melhorar a qualidade do cuidado de saúde que se outorga a população, usando como estratégia o aperfeiçoamento de enfermeiras e enfermeiros em nível de pós-graduação. Resultado: como resultado deste projeto se criou e pôs em marcha, o ano de 2007, um Programa de Mestrado em Enfermagem desenvolvido na cidade de Assunção, que até 2014 havia graduado 29 profissionais que estão contribuindo ao desenvolvimento da Enfermagem de Paraguai.

Conclusão: o modelo desenhado deste Mestrado tem demonstrado ser exitoso, bem como também o estabelecimento de alianças e colaborações entre as universidades o que oferece contribuições benéficas ás instituições envolvidas tanto nos âmbitos acadêmicos, profissionais como pessoais.

[Prenatal care and hospital maternal mortality in Tijuana, Baja California, Mexico]. / Atención prenatal y mortalidad materna hospitalaria en Tijuana, Baja California.

OBJECTIVE: To describe the prenatal care (PC) received in women with maternal hospital deaths from 2005 to 2011 in Tijuana, Baja California, Mexico. MATERIALS AND METHODS: Were reviewed the medical chars and registrations of the maternal deaths by the local Committees of Maternal Mortality. RESULTS: There were 44 maternal hospital deaths. Thirty (68%) women assisted to PC appointments during pregnancy, the average number of PC visits was 3.8 and 18 (41%) had an adequate PC (≥ 5 visits). Six (14%) women didn't know they were pregnant; 19 (43%), 21 (48%) y 4 (9%) maternal deaths were due to direct, indirect obstetric cause or non-obstetric causes. Eighteen (18%), 2 (4 %) and 34 (77%) of the maternal deaths occurred during pregnancy, delivery or puerperium. CONCLUSIONS: It is necessary pregnancy women have an early, periodic and systematic PC to identify opportunely risk factors associated with pregnancy complications.

Atención prenatal y mortalidad materna hospitalaria en Tijuana, Baja California / Prenatal care and hospital maternal mortality in Tijuana, Baja California, Mexico

Objetivo. Describir la atención médica prenatal recibida en mujeres con mortalidad materna hospitalaria en el IMSS durante 2005-2012 en Tijuana, Baja California, México. Material y métodos. La información se obtuvo de los archivos de los Comités de Mortalidad Materna y revisión del expediente. Resultados. Hubo 44 muertes maternas (MM). Treinta (68%) asistieron a atención prenatal (AP), el promedio de citas fue de 3.8 y 18 (41%) tuvieron una AP adecuada (≥ 5 citas). Seis (14%) mujeres no sabían que estaban embarazadas; 19 (43%), 21 (48%) y 4 (9%) de las MM fueron por causa obstétrica directa, indirecta y no obstétrica. Ocho (18%), 2 (4 %) y 34 (77%) de las MM ocurrieron en el embarazo, parto y puerperio. Conclusiones. Es necesario que las mujeres embarazadas tengan una vigilancia prenatal temprana, periódica y sistemática que permita la identificación y el diagnóstico oportuno de pacientes con alto riesgo de desarrollar complicaciones durante su embarazo.

Objective. To describe the prenatal care (PC) received in women with maternal hospital deaths from 2005 to 2011 in Tijuana, Baja California, Mexico. Materials and methods. Were reviewed the medical chars and registrations of the maternal deaths by the local Committees of Maternal Mortality. Results. There were 44 maternal hospital deaths. Thirty (68%) women assisted to PC appointments during pregnancy, the average number of PC visits was 3.8 and 18 (41%) had an adequate PC (≥ 5 visits). Six (14%) women didn't know they were pregnant; 19 (43%), 21 (48%) y 4 (9%) maternal deaths were due to direct, indirect obstetric cause or non-obstetric causes. Eighteen (18%), 2 (4 %) and 34 (77%) of the maternal deaths occurred during pregnancy, delivery or puerperium. Conclusions. It is necessary pregnancy women have an early, periodic and systematic PC to identify opportunely risk factors associated with pregnancy complications.

Preliminary studies of bio-oil from fast pyrolysis of coconut fibers.

This work studied fast pyrolysis as a way to use the residual fiber obtained from the shells of coconut ( Cocos nucifera L. var. Dwarf, from Aracaju, northeastern Brazil). The bio-oil produced by fast pyrolysis and the aqueous phase (formed during the pyrolysis) were characterized by GC/qMS and GC×GC/TOF-MS. Many oxygenated compounds such as phenols, aldehydes, and ketones were identified in the extracts obtained in both phases, with a high predominance of phenolic compounds, mainly alkylphenols. Eighty-one compounds were identified in the bio-oil and 42 in the aqueous phase using GC/qMS, and 95 and 68 in the same samples were identified by GC×GC/TOF-MS. The better performance of GC×GC/TOF-MS was due to the possibility of resolving some coeluted peaks in the one-dimension gas chromatography. Semiquantitative analysis of the samples verified that 59% of the area on the chromatogram of bio-oil is composed by phenols and 12% by aldehydes, mainly furfural. Using the same criterion, 77% of the organic compounds in the aqueous phase are phenols. Therefore, this preliminary assessment indicates that coconut fibers have the potential to be a cost-effective and promising alternative to obtain new products and minimize environmental impact.

[Acceptance of the vaccine against human papilloma virus from mothers to daughters aged 9 to 13 years old]. / Aceptación de la vacuna contra el virus del papiloma humano por parte de madres de hijas entre 9 y 13 años de edad.

BACKGROUND: If you consider that at some point in life 50% of sexually active women have had an infection with the human papilloma virus is indisputable that any attempt to reduce the prevalence worth undertaking it. The vaccine to prevent HIV infection has not enjoyed the same degree of acceptance than others, hence the interest in knowing some of the reasons that has not achieved universal vaccination. OBJECTIVE: To examine human papillomavirus (HPV) vaccine acceptability among mothers with adolescents girls between 9 and 13 years old. METHODS: The mothers were interrogated about HVP vaccine acceptability, reasons provided for acceptance or non-acceptance and if mothers know that vaccine is offered free for public health institutions RESULTS: We interview a 250 mothers with 281 daughters, 38 daughters have already received the vaccine. Eighty nine percent of the mothers reacted positively to the possibility of vaccinating theirs daughters. The reasons of vaccine non-acceptance were because not knowing enough about infection, mother felt that their daughters were not at risk for acquiring HVP infection, the vaccine is new and mothers unknown side effects. Thirty nine percent of the mothers want to know more about the vaccine safety, 21% about length protection duration and 16% concerning about if the vaccine is effective. Fifty seven per cent of the mothers know that Health Secretary offers vaccine free. Mothers whom have been vaccinated their daughters, had daughters with lower age (9.8 +/- 0.9 vs 10.8 +/- 1.3 years, p = 0.0001), were more frequently married (79 vs 51%, p = 0.002) and more likely to report that they had heard about VPH vaccine from some source (100 vs 66%, p = 0.0001) that mothers have not yet vaccinated their daughters. CONCLUSIONS: The acceptability of VPH vaccine was 89%. Continued health education and propaganda is needed to promote a better knowledge of VPH vaccine.

[Severe periodontitis, edentulism and neuropathy in patients with type 2 diabetes mellitus]. / Periodontitis severa, edentulismo y neuropatía en pacientes con diabetes mellitus tipo 2.

UNLABELLED: Periodontitis is a frequent pathologic condition in diabetic patient, and has been associated with chronic complications like nephropathy, cardiovascular disease, peripheral artery disease or death. OBJECTIVE: To document the association between severe periodontitis and edentulism with the presence of sensory-motor neuropathy in diabetic patients. MATERIAL AND METHOD: Cross-sectional study in type 2 diabetic patients from the family medicine unit no. 27 of the IMSS in Tijuana, México. Patients were evaluated to identify periodontitis and sensory-motor neuropathy. Information was also obtained about sex, age, duration of diabetes, glycemic control, smoking and alcohol use. RESULTS: Four hundred and thirty-six patients completed all measurements. In 180 (41.3%) neuropathy was identified, and associated with age (p < 0.001); duration of diabetes (p < 0.001); fasting glucose (p < 0.001); severe periodontitis (OR: 2.7; IC 95%: 1.5-4.8);and with edentulism (OR: 4.4; IC 95%: 2.0-9.4). Logistic regression multivariable analysis kept as significative the association between severe periodontitis and edentulism with neuropathy (adjusted OR: 1.7; IC 95%: 1.1-2.6). CONCLUSIONS: Periodontitis and edentulism are associated with the presence of neuropathy in diabetic patients.

Spanish version of the Child and Adolescent Self-Care Performance Questionnaire: psychometric testing.

This methodological study sought to determine the psychometric properties of the Spanish version of the Child and Adolescent Self-Care Performance Questionnaire originally developed by Moore (1995). In this study, the questionnaire, written originally in English, was translated into Spanish, and some items were adapted for the Latin American culture. The instrument was administered to 536 children of moderate socioeconomic status, ages 10 to 15 years, living in Chile. Evidence for reliability and validity involved examining Coefficient Alpha for the total scale and each of the subscales, item analysis, and factor analysis with varimax rotation. Coefficient alpha for the total scale (35 items) was 0.82, similar to the reliability reported by Moore (1995) for the original instrument. Factor analysis supported eight factors. Use of the instrument in Central and South America may assist in determining self-care practices of Latin American children and the effect of interventions to improve such practices.

Analysis of tert-butyldimethylsilyl derivatives in heavy gas oil from Brazilian naphthenic acids by gas chromatography coupled to mass spectrometry with electron impact ionization.

Naphthenic acids, C(n)H(2n+Z)O(2), are a complex mixture of alkyl-substituted acyclic and cycle-aliphatic carboxylic acids. The content of naphthenic acids and their derivatives in crude oils is very small, which hinders their extraction from matrixes of wide and varied composition. In this work, liquid-liquid extraction, followed by solid phase extraction with an ion exchange resin (Amberlyst A-27) and ultrasound desorption were used to isolate the acid fraction from heavy gas oil of Marlim petroleum (Campos, Rio de Janeiro, Brazil). The analysis was accomplished through gas chromatography coupled to mass spectrometry with electron impact ionization, after derivatization with N-methyl-N-(tert-butyldimethylsilyl)trifluoracetamide (MTBDMSTFA). The results indicate the presence of carboxylic acids belonging to families of alicyclic and naphthenic compounds which contain up to four rings in the molecule.

Identification of alkyl carbazoles and alkyl benzocarbazoles in Brazilian petroleum derivatives.

Carbozoles are important compounds in crude oils, as they may be used as geochemical tracers, being the major type of nitrogen compounds in petroleum. At the same time, they are regarded as undesirable due to the problems they may cause in the refining process, such as catalyst poisoning, corrosion, gum or color formation in final products. As separation and identification of carbazoles are challenging goals, this work presents a chromatographic method, made of a pre-fractionation on neutral alumina followed by the separation and identification of two classes of carbazoles using FeCl(3)/Chromossorb W and gas chromatograph with mass spectrometer (GC/MS) (SIM-single ion monitoring mode) analysis. For the first time, a series of alkyl carbazoles and alkyl benzocarbazoles were identified in heavy gas oil (HGO) and atmospheric residue of distillation (ARD) obtained from Brazilian petroleum.

Ion-exchange resins in the isolation of nitrogen compounds from petroleum residues.

In this work, preparative liquid chromatography was used for the separation of the nitrogen compounds in a sample of heavy gas oil from a Brazilian petroleum. Initially it took place a pre-fractionation by neutral aluminium oxide and the compounds were separated in different classes such as: hydrocarbons, resins (compounds of low molecular mass and intermediate polarity) and asphalthenes (polar compounds with high molecular mass). A comparison of the fraction of resins was performed by re-fractionating with modified silica (with potassium hydroxide and hydrochloric acid), or with ion exchange resins (Amberlyst A-27 and A-15), being isolated the basic and neutral compounds, that were analyzed by GC-MS in the scan and selected ion monitoring modes. Quinolines, benzoquinolines, tetrahydroquinolines were found in the basic fraction and carbazoles derivatives were found in the neutral fraction.