Prevalence of mental disorder and impact on quality of life in inflammatory bowel disease.

INTRODUCTION: Different studies have described psychiatric comorbidities in inflammatory bowel disease (IBD) patients, but most of them focus mainly on depression and anxiety. Even though major mental disorders are considered one of the main factors that decrease quality of life (QoL), its role in IBD patients remains unclear. We sought to identify the prevalence of different mental disorders as well as its relationship with QoL. PATIENTS AND METHODS: Subjects were recruited from the IBD Clinic. IBD Questionnaire 32 and structured clinical interview (SCID) for DMS-IV Text Revision were applied. Demographic and clinical data were collected via self-report questionnaires and medical records. The correlation between mental disorders and QoL (IBDQ-32 score) was evaluated using the Spearman correlation test. RESULTS: In all, 104 patients were recruited, 12 with Crohn's disease, and 92 with ulcerative colitis. The prevalence of any major mental disorder was 56.7%: anxiety (44.2%), mood (27.9%), substance use (12.2%), and other psychiatric diagnoses (17.3%), and 29.8% of the patients presented three or more comorbid diagnoses. Mental Disorder (p=0.005), mood disorder (p=0.004), anxiety disorder (p=0.009), were found to be significantly associated with lower QoL. Substance use disorder was associated with lower Digestive QoL (p=0.01). Major depressive disorder (p=0.004), social phobia (p=0.03), PTSD (p=0.02), and Generalized Anxiety Disorder (p<0.001), were found to be significantly associated with lower QoL. CONCLUSIONS: IBD patients had important psychiatric comorbidity that significantly affects their QoL. These results warrant a systematic evaluation of psychiatric conditions in IBD patients.

Public and Private Hospital Care Disparities of Ischemic Stroke in Mexico: Results from the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) Study.

BACKGROUND AND AIMS: Mortality and bad outcome by stroke are higher in developing countries than in industrialized countries. Health-care system efficiency could explain these disparities. Our objective was to identify the impact on short- and middle-term outcomes of patients with acute ischemic stroke (AIS) among public and private Mexican medical care. METHODS: We analyzed data from patients with AIS included in the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) study. Transient ischemic attacks (TIAs) and ambulatory patients were excluded. Mortality and good outcome were assessed by the modified Rankin Scale (mRS) and analyzed at 1, 3, and 12 months of follow-up. RESULTS: From 1246 patients with AIS included in the registry, 1123 were hospitalized, either in public (n = 881) or in private (n = 242) hospitals. There were no significant differences regarding age and gender. In private settings, patients had a higher educational level, a major frequency of dyslipidemia, a previous stroke and TIA, less overweight and obesity, a sedentary lifestyle, and diabetes; stroke severity, the rate of systemic complications, the length of stay, and in-hospital mortality were also lower; a major frequency of thrombolysis was observed when compared with public hospitals. Our study showed a better outcome (mRS score ≤2) in private scenarios and a higher mortality in patients treated in public hospitals at short- and middle-term follow-ups. CONCLUSIONS: A polarized medical practice was observed in the AIS care in this large multicenter cohort of Mexico. There is evidence of an advantage for private scenarios, possibly related with an optimal infrastructure or with a strong patient's economic status.

[Multicenter international registry to evaluate the clinical practice delivered to patients with type 2 diabetes mellitus: a sub-analysis of the experience in Mexico]. / Registro multicéntrico internacional para evaluar la práctica clínica en pacientes con diabetes mellitus tipo 2: subanálisis de la experiencia en México.

BACKGROUND: There is a lack of information on the characteristics of the medical attention delivered to Mexican patients with type 2 diabetes (T2D). Our aim was to describe the current state on the medical management of T2D in Mexico. METHODS: Among 17,232 patients included in the International Diabetes Management Practices Study (IDMPS), 2,620 (15%) corresponded to Mexico. Information regarding clinical, demographics and management characteristics, as well as the impact of T2D in the patient is clinical and social condition was registered. The metabolic control and achievement of therapeutic goals were also analyzed. RESULTS: Diagnosis of T2D was performed by the general practitioner in 76% of cases. Only about a quarter of the cohort had a blood pressure goal of < 130/80 mmHg, although 97% had anti-hypertensive treatment. Management of T2D was with diet and exercise exclusively in 5%, with oral glucose-lowering drugs (OGLD) in 66% (alone or combined), with OGLD and insulin in 18%, and with insulin alone in 11%. Only 31% of patients reached the goal of HbA1c < 7. Self-monitoring was practiced in 50% of patients and 26% received education on diabetes. The managing physician is personal impression about the quality of the metabolic control was not in accordance with HbA1c. Eight percent of patients had work absences in the last 3 months due to complications of T2D (mean of 15 days lost). CONCLUSIONS: In Mexico, quality of metabolic control of T2D patients could have important deficiencies. The personal impression of the physician on the patient is metabolic control is not consistent with objective data.