Characterization of 554 Mexican Patients With Nonsyndromic Cleft Lip and Palate: Descriptive Study.

Orofacial clefts are one of the most common birth defects and the most common craniofacial malformation worldwide. The most common orofacial clefts (OFCs) are congenital cleft lip with or without cleft palate (CL ± P) and isolated cleft palate (CP). The incidence of OFCs varies depending on region and ethnicity; however, it affects approximately 1 in 600 newborns worldwide. In most cases, CL ± P and CP are multifactorial congenital malformations, where both exogenous and genetic factors play an important role. The objective of this study was to describe the frequency of potential risk factors associated with the development of CL ± P and CP in Mexican population. Patients were referred for multisystemic treatment, from private and public institutions in different regions of the country (center, north, and south). Sociodemographic information, prenatal and parental history were obtained through direct interviews with the patients or the patients' mothers in the case of underaged patients. Referred patients were invited to participate in the study. No interventions were applied for this study. The relationship between these factors and the prevalence of CL ± P and CP was studied. A total of 554 patients were included, the majority with CLP (30% to 7%), statistically significant differences were found for folic acid ( P = 0.02) consumption. Familial aggregation did not reach statistical significance for first-degree family members ( P = 0.34) but was significant for second-degree family members ( P = 0.007). More risk factors associated with CL ± P and CP may still be unknown, prompting more epidemiological research and research in other little-studied areas, such as; specific genetic factors in Mexican population.

Factores de riesgo en pacientes con fisura de labio y paladar en México. Estudio en 209 pacientes / Risk factors associated with cleft lip and palate in Mexico. A 209 patient analysis

Introducción y objetivo: El labio hendido (con o sin paladar hendido asociado) y el paladar hendido aislado afectan a 1 de cada 600 recién nacidos en el mundo. Su etiología es multifactorial e intervienen factores de medioambiente, sociodemográficos y genéticos.El objetivo del presente estudio es establecer una relación entre los distintos tipos de fisuras labio-palatinas y diversos factores de riesgo asociados a su prevalencia en México.Material y método.Estudiamos 209 pacientes de diferentes edades con diagnóstico de labio y paladar hendido, atendidos en hospitales generales públicos y privados de las regiones del norte, centro y sur de la república mexicana. Obtuvimos los datos de los pacientes a través de entrevistas a madres o tutores en los menores de edad y por entrevista directa a los mayores de edad.Resultados.El 47.8% fueron mujeres. La edad promedio fue de 8.9 ± 7.3 años. Del total, 163 (78%) tenían diagnóstico de fisura labio-palatina, y 46 (22%) de fisura de labio o paladar aislados. La edad de la madre al momento del embarazo infuyó en la mayor prevalencia de la fisura labio-palatina. Los antecedentes familiares de fisuras labio-palatinas también determinaron mayor porcentaje de pacientes con labio + paladar hendido que con el padecimiento aislado (41.1% frente a 26.1% respectivamente).Conclusiones.Consideramos que, dado que la edad de la madre al momento del embarazo es un factor directamente asociado a la prevalencia de la fisura labio-palatina, los estudios derivados de Salud Pública son fundamentales, particularmente aquellos que tratan sobre el embarazo de alto riesgo (madre adolescente y madre de edad avanzada). (AU)

Background and objective: Cleft lip and palate are associated with several factors including demographic and genetic factors among others. The estimated prevalence of the disease is 1-600 worldwide.Our aim is to study the relationship between the prevalence of cleft lip and palate and several factors associated to the disease in Mexico.Methods.A total of 209 patients with cleft lip and palate (isolated or combined) were included. Patients were referred from both public and private hospitals. Data were collected through direct interview and questionnaire with patientes´ mother or parent.Results.In our study, 47.8% patients were female. Mean age was 8.9 ± 7.3 years old; 163 patients (78%) had a combined cleft-lip and palate, and 46 (22%) had an isolated cleft lip or palate. Mother´s age was directly associated with the prevalence of cleft lip and palate. The history of facial clefts in the family was also directly related to the presence of a combined cleft, in contrast to an isolated cleft. (41.1% vs 26.1% respectively).Conclusions.In our study, both cleft lip and palate were directly related to the age of the mother. Thus, we believe that future studies should address the importance of preventive measures and treatment in the woman with a high-risk pregnancy (such as adolescent teens with pregnancy and elderly women). (AU)

Prescription of Physical Activity: How Does the Internist Perceive it?

OBJECTIVE: To assess the meaning of a physical activity prescription (PAP) from the physician's point of view and to examine current PAP-related clinical practices and stage of change, including the factors that influence them. METHODS: Mixed methodology was applied to obtain valid, high-quality data. During the qualitative phase, the "free-listing" technique was used to explore the "cultural domain" of a physician's perception of PAP, as well as the construction of culturally relevant items used during the last phase of the study. A survey was conducted to evaluate clinical practices, attitudes, and physician state of change regarding PAP. The convenience sample of 58 (qualitative phase) and 350 internists (quantitative phase) who attended the International Congress of Internal Medicine was interviewed. RESULTS: A majority of internist reported having adequate knowledge, positive attitude, being in the maintenance phase with no barriers to prescribe physical activity (PA). Prescription was associated with physician training, their workplace, and experience. However, physicians do not satisfactorily evaluate the level of patient's PA nor recommend an adequate level of PA, which is necessary to achieve health goals. CONCLUSIONS: Physicians had great acceptance of PAP. However, there were low levels of knowledge of current PA guidelines, although most physicians thought they had sufficient knowledge. Training seems to be an excellent way to improve PAP.

[Optimism, family cohesion and treatment as predictors of quality of life in blood cancer diseases]. / Optimismo, cohesión familiar y tratamiento como predictores de la calidad de vida en padecimientos oncohematológicos.

BACKGROUND: Quality of life must be a part of the goals of care given to blood cancer patients and it must be used to assess the effectiveness of their treatment. The objective was to evaluate the quality of life of patients with leukemia and its relationship with psychological, familial and disease-related aspects. METHODS: An analytic cross-sectional study was carried out in patients with acute leukemia at different stages of treatment. We used SF-36, Optimism and Family Cohesion scales. RESULTS: Quality of life was affected physically and mentally in the treatment phases aimed to mitigate the active, and the advanced stage of this disease (50.6 ± 25.6, 62 ± 14.3; 46 ± 23.2, 53.8 ± 23.4, respectively), regardless of gender, age, level of optimism and family cohesion. Patients could carry out basic functions of self-care (bathing, feeding, etcetera), but not activities of daily living (shopping, household chores, etcetera), which require a greater effort. Although the patients perceived having been affected in the emotional health area-by the presence of anxiety and depression-they did not consider that these alterations limited their ability to carry out work and everyday activities. CONCLUSIONS: Quality of life was most affected at mental dimension and physical dimension, mainly in patients at induction and palliative treatment. The results showed that the objectives of care aimed to reduce symptoms and maintain patient comfort are not achieved.

Introducción: la calidad de vida debe ser parte de los objetivos de la atención a pacientes oncohematológicos y ser utilizada para evaluar la eficacia del tratamiento que se les brinda. El objetivo fue evaluar la calidad de vida en pacientes con leucemia y su relación con aspectos del padecimiento, psicológicos y familiares. Métodos: se realizó un estudio transversal analítico en pacientes con leucemia aguda en diferentes etapas de tratamiento. Se aplicaron las escalas SF-36, Optimismo y Cohesión Familiar. Resultados: la calidad de vida se vio afectada física y mentalmente en las fases del tratamiento dirigidas a combatir la enfermedad activa (50.6 ± 25.6; 62 ± 14.3) y avanzada (46 ± 23.2; 53.8 ± 23.4), independientemente del género, la edad, el nivel de optimismo y la cohesión familiar. Los pacientes podían llevar a cabo funciones básicas de autocuidado, no así actividades de la vida diaria y laborales que requieren mayor esfuerzo. Si bien los pacientes percibieron afectación en el área de salud emocional (por la presencia de ansiedad y depresión), no consideraron que estas alteraciones limitaban su capacidad para llevar a cabo actividades laborales y cotidianas. Conclusiones: la calidad de vida estuvo más afectada en la dimensión mental (Salud emocional) y física (Rol físico), principalmente en los pacientes en tratamiento paliativo y de inducción. Los resultados muestran que no se cubren los objetivos de los esfuerzos asistenciales dirigidos a aminorar los síntomas y mantener el confort del paciente.

[Physical activity and sedentary lifestyle: family and socio-demographic determinants and their impact on adolescents' health]. / Actividad física y sedentarismo: Determinantes sociodemográficos, familiares y su impacto en la salud del adolescente.

OBJECTIVE: Estimating whether adolescents' sedentary behaviour and their lack of physical activity is determined by family characteristics or socio-cultural aspects and their impact on health and adiposity level. MATERIAL AND METHODS: 932 adolescents were surveyed. Information regarding physical activity, sedentary behaviour, anthropometric index and family characteristics (structure, dynamics and functioning) was estimated by adolescents answering a questionnaire. RESULTS: The sample's average age was 16.07±1.09 years old, 56.3 % were female, 66.3 % had a low level of physical activity and 51.9 % were sedentary. A lack of physical activity occurred more frequently in females (56.8 % cf 41.5 %: p=0.000); family characteristics did not influence such risk behaviour. A relationship between physical activity and sedentary lifestyle with BMI could not be demonstrated, whilst waist circumference was associated with risky behaviour patterns. Teenagers in good health were more active (36.1 % cf 27 %) and less sedentary (49.3 % cf 59.4 %) than those for whom an unhealthy state was reported. CONCLUSION: Sedentary behaviour and a lack of physical activity were more determined by socio-demographic factors than family aspects, such behaviour pattern having a direct influence on the adolescents' health.

[The impact of family characteristics in sexual risk behaviour of teens]. / Impacto de la familia en las conductas sexuales de riesgo de los adolescentes.

OBJECTIVE: To assess risk sexual behaviour in adolescents and its relationship with family characteristics. METHODS: In a representative and random sample of 909 teenagers, their sex life, structure, satisfaction and family dynamics were evaluated. It was used chi-squared test, in order to compare the frequency of family negative characteristics between the groups of adolescents with and without risky sexual behaviors. RESULTS: The early onset of sexual life was more frequent in adolescents with dysfunctional expression of affection in their families, and single-parent or nuclear family structure. The lack of condom use was associated with a lack of affection, and a poor comunication within the family. Having more than three partners was related to the expression of affection and the degree of satisfaction of the teenager with his family. Unplanned pregnancies and sex transmission diseases were most frequent in adolescents belonging to extended families with a poor expression of affection. CONCLUSIONS: The level of communication, the monitoring of conduct, the warmth and proximity play a very important role as protectors of sexual risk behaviour in teens.

OBJETIVO: evaluar las conductas sexuales de riesgo del adolescente y su relación con las características familiares. MÉTODOS: en una muestra representativa y aleatoria de 909 adolescentes, se evaluó la vida sexual y la estructura, satisfacción y dinámica familiar. Las características familiares negativas en los grupos de adolescentes con y sin conductas sexuales de riesgo se compararon con chi-squared. RESULTADOS: el inicio temprano de la vida sexual fue más frecuente en los adolescentes con familias en las que la expresión del afecto es disfuncional y con una estructura monoparental y nuclear. La falta de uso de condón se relacionó con deficiente expresión del afecto y comunicación dentro de la familia. Tener más de tres parejas se relacionó con la expresión disfuncional del afecto y el grado de satisfacción del adolescente con su familia. Los embarazos no planeados y las enfermedades de transmisión sexual fueron más frecuentes en los adolescentes pertenecientes a familias extensas que tenían una expresión disfuncional del afecto. CONCLUSIONES: el nivel de comunicación, el monitoreo de la conducta, la calidez y la cercanía desempeñan un papel muy importante como protectores de las conductas sexuales de riesgo en los adolescentes.

Actividad física y sedentarismo: Determinantes sociodemográficos, familiares y su impacto en la salud del adolescente / Physical activity and sedentary lifestyle: Family and socio-demographic determinants and their impact on adolescents' health

Objetivo Determinar la asociación de las conductas sedentarias y falta de actividad física en adolescente con características de la familia y/o aspectos sociodemográficos. De manera secundaria, si estas conductas influyen sobre el estado de salud y su riesgo cardiovascular. Material y Métodos Se encuestó a una muestra aleatoria de adolescentes acerca de la frecuencia de actividad física y conductas sedentarias; estado de salud, índices antropométricos; estructura, dinámica y funcionalidad familiar. Resultados Fueron encuestados 932 adolescentes, promedio de edad 16.07±1.09 años, 56,3 % fueron mujeres. El 66,3 % tenía un nivel de actividad física menor al recomendado y el 51,9 % eran sedentarios. La falta de actividad física y las conductas sedentarias estuvieron asociada con el género (mujeres 56,8 % vs. 45,4 % hombres, p≤0.01, mujeres 56,8 % vs. 45,4 % hombres, p=0.000 respectivamente). Las características de la familia no influyeron sobre estas conductas de riesgo. No se pudo demostrar la relación entre la actividad física y sedentarismo con el IMC a diferencia de la medición de la circunferencia de la cintura la cual se encontró asociada a estas conductas de riesgo. Los adolescentes con buena salud fueron más activos (36,1 % vs. 27 %) y menos sedentarios (49,3 % vs. 59,4 %) que aquellos que reportaron un estado poco saludable. Conclusiones Las conductas sedentarias y la falta de actividad física están más determinadas por factores sociodemográficos que por aspectos familiares. Estas conductas tienen influencia en la salud de los adolescentes.

Objective Estimating whether adolescents' sedentary behaviour and their lack of physical activity is determined by family characteristics or socio-cultural aspects and their impact on health and adiposity level. Material and Methods 932 adolescents were surveyed. Information regarding physical activity, sedentary behaviour, anthropometric index and family characteristics (structure, dynamics and functioning) was estimated by adolescents answering a questionnaire. Results The sample's average age was 16.07±1.09 years old, 56.3 % were female, 66.3 % had a low level of physical activity and 51.9 % were sedentary. A lack of physical activity occurred more frequently in females (56.8 % cf 41.5 %: p=0.000); family characteristics did not influence such risk behaviour. A relationship between physical activity and sedentary lifestyle with BMI could not be demonstrated, whilst waist circumference was associated with risky behaviour patterns. Teenagers in good health were more active (36.1 % cf 27 %) and less sedentary (49.3 % cf 59.4 %) than those for whom an unhealthy state was reported. Conclusion Sedentary behaviour and a lack of physical activity were more determined by socio-demographic factors than family aspects, such behaviour pattern having a direct influence on the adolescents' health.

Satisfaction related factors of attendants to a medical research meeting / Factores asociados a insatisfacción de los asistentes a una reunión de investigación médica

Objetivo. Determinar la frecuencia y factores asociados a insatisfacción de los asistentes a una Reunión Nacional de Investigación Médica, en relación con la calidad científica y el nivel de discusión de los trabajos de investigación. Material y métodos. Mediante un cuestionario autoaplicado y anónimo, se solicitó la opinión de 400 médicos que asistieron a la Reunión de investigación como autores o colaboradores de al menos un trabajo de investigación en relación a la calidad científica de los trabajos presentados, el nivel de discusión alcanzado alrededor de los trabajos y el grado de satisfacción global obtenida con la asistencia a la Reunión. Resultados. La tasa de respuesta fue de 62 por ciento (n = 249). Se identificó aprobación con la calidad científica de la Reunión por parte de 224 de los asistentes (90 por ciento), en tanto que 203 se mostraron satisfechos con el nivel de discusión de los trabajos de investigación (88 por ciento) y 239 mencionaron estar satisfechos en forma global con la Reunión (96 por ciento). Los factores asociados a insatisfacción con la calidad científica de la Reunión fueron el sexo masculino (RM = 2.7, IC95 por ciento = 0.8 - 9.1, p = 0.06), contar con un grado de Maestría o Doctorado (RM = 2.3, IC95 por ciento = 0.9-5.5, p = 0.03) y haber acudido a la Reunión de investigación en más de dos ocasiones previas (RM = 5.0, IC95 por ciento = 1.5-18.4, p = 0.001). Conclusiones. La mayor parte de los asistentes se mostraron satisfechos con la calidad científica y con el nivel de discusión de los trabajos de investigación. El sexo masculino, tener grado de maestría o doctorado y la asistencia previa a la Reunión fueron factores asociados a insatisfacción con la calidad científica de la misma.