ABO blood groups are not associated to gestational diabetes mellitus in Mexican women.

OBJECTIVES: Some studies show an increased risk of gestational diabetes mellitus for ABO blood groups. Others find a lower risk or do not identify any association. Inconsistencies may be due to the heterogeneity in the control for confounding variables. We determined the association between ABO blood groups and gestational diabetes mellitus in Mexican women, controlling for gravidity and age, pre-pregnancy body mass index, fasting glucose at the first trimester, and first-degree relative with diabetes. METHODS: This case-control study was conducted from February 2019 to December 2021 in Monterrey, Mexico, with 185 cases (women with gestational diabetes mellitus) and 530 controls. ABO blood groups and other variables were obtained from the clinical records. A multivariate binary logistic regression was used for estimating association. Two models were run, one for primigravidae and another for non-primigravidae. A p-value < 0.05 was significant. RESULTS: The ABO blood groups were O (69.4%), A (22.2%), B (6.7%), and AB (1.7%), with no differences between cases and controls (p = 0.884). No association was found between ABO blood groups and gestational diabetes mellitus, in primigravidae or non-primigravidae. CONCLUSION: ABO blood groups were not associated with an increased risk of gestational diabetes mellitus in Mexican women, independent of gravidity and well-known risk factors.

Association between ABO blood groups and preeclampsia.

OBJECTIVE: To determine the association between the ABO blood group and preeclampsia. METHODS: This is a case-control study that included patients with (n = 253) and without (n = 457) preeclampsia/eclampsia in Northeastern Mexico. Data were obtained from electronic medical records. Binary multiple logistic regression analysis was used for analyzing the association between the ABO blood group and preeclampsia according to parity status while adjusting for potential confounders. RESULTS: Blood groups A, B, and AB showed adjusted odds ratios of 0.6 (95%CI 0.3-1.0), 1.1 (95%CI 0.6-2.2), and 0.3 (95%CI 0.1-1.1) in multiparous women, respectively. No association was found in nulliparous women either. CONCLUSIONS: ABO blood groups were not associated with preeclampsia in Mexican women. [Figure: see text].

Cessation of Face Mask Use after COVID-19 Vaccination in Patients with Diabetes: Prevalence and Determinants.

Studies on the cessation of face mask use after a COVID-19 vaccine in patients with diabetes are not available, despite their greater predisposition to complications. We estimated the prevalence of cessation of face mask use after receiving the COVID-19 vaccine in patients with diabetes and identified which factor was most strongly associated with non-use. This was a cross-sectional study in patients with diabetes 18-70 years with at least one dose of vaccine against COVID-19 (n = 288). Participants were asked to respond face-to-face to a questionnaire in a primary care center. Descriptive statistics, chi-square tests, and multivariate binary logistic regression were used for analyzing the association between vulnerability, benefits, barriers, self-efficacy, vaccine expectations (independent variables), and cessation of use (dependent variable), controlling for sociodemographic, smoking, medical, vaccine, and COVID-19 history. The prevalence of cessation of face masks was 25.3% (95% CI 20.2, 30.5). Not feeling vulnerable to hospitalization increased the odds of non-use (adjusted OR = 3.3, 95% CI 1.2, 8.6), while perceiving benefits did the opposite (adjusted OR = 0.4, 95% CI 0.2, 0.9). The prevalence was low, and only two factors were associated with the cessation of face mask use after COVID-19 vaccination in patients with type 2 diabetes.

Idealistic, realistic, and unrealistic expectations of pharmacological treatment in persons with type 2 diabetes in primary care.

Introduction: Information on treatment expectations in diabetes is scarce for Mexican and Latino populations. We determined idealistic, realistic, and unrealistic expectations for metformin, insulin, and glyburide in primary care. We also explored the association between sociodemographic attributes, time since diagnosis, and expectations. Methods: This was a cross-sectional study conducted during 2020-2022 in governmental primary care centers. We consecutively included persons with type 2 diabetes aged 30-70 years under pharmacological medication (n = 907). Questions were developed using information relevant to expectation constructs. Data were collected by interview. We used descriptive statistics, a test of the difference between two proportions, and multivariate ordinal logistic regression. Results: A high percentage of participants would like to have fewer daily pills/injections or the option of temporarily stopping their medication. Realistic expectations ranged from 47% to 70%, and unrealistic expectations from 31 to 65%. More insulin users wished they could take a temporary break (p < 0.05) or would like to be able to change the route of administration (p < 0.001) than metformin users. More persons with diabetes on insulin expected realistic expectations compared to those on metformin or glyburide (p ≤ 0.01). Being able to interrupt medication upon reaching the glucose goal was higher in combined therapy users (p < 0.001). Conclusion: Time since diagnosis, place of residence, sex, and diabetes education were factors associated to expectations. Management of expectations must be reinforced in primary care persons with type 2 diabetes undergoing pharmacological medication.

Validation of the Spanish Version of the Copenhagen Burnout Inventory in Mexican Medical Residents.

BACKGROUND: Studies on the psychometric properties of the Copenhagen Burnout Inventory (CBI) in medical residents are scarce despite their susceptibility to burnout. Moreover, none of these studies were conducted in Spanish. AIM OF THE STUDY: To analyze the psychometric properties of the Spanish version of the CBI among Mexican medical residents. METHODS: This cross-sectional study was conducted online on medical residents from a public medical institution (n = 525). The English version of the CBI (19 items organized into three domains: personal-related burnout, work-related burnout, and patient-related burnout) was translated into Spanish and again into English. Content, convergent, discriminant, and concurrent validity were assessed, along with reliability. RESULTS: The CBI Spanish version showed acceptable content, convergent and concurrent validity. Exploratory factor analysis showed two factors, but confirmatory factor analysis showed three factors with adequate fit (Root Mean Square Error of Approximation = 0.08, Comparative Fit Index = 0.95, Tucker-Lewis Index = 0.94, and Standardized Root Mean Square Residual = 0.04). There was no good discrimination between personal-related and work-related burnout. Cronbach's alpha coefficients for the personal-related, work-related, and patient-related burnout domains were 0.94, 0.95, and 0.93, respectively. CONCLUSIONS: The Spanish version of the CBI in Mexican medical residents is reliable, and it meets adequate content, convergent and concurrent validity. The construct validity was not consistent. This should not diminish the importance of the CBI.

Anthropometric parameters to estimate body frame size in children and adolescents: A systematic review.

OBJECTIVE: To determine the most frequently body frame size (BFS) measurement and to compare the cut-off values used for classifying body size in children and adolescents. METHODS: This systematic review focused on primary studies and scientific reports published in Medline Ovid, EMBASE, Web of Science, or Scopus between January 1, 2007 and March 31, 2021. Eligible studies must have included at least one BFS parameter measured in healthy children or adolescents. A descriptive analysis and graphic comparison were performed when values of the body frame were available. RESULTS: A total of 26 studies involving 317 202 children and adolescents from all over the world were included. The report of Frame index predominated (46%). It was followed by the biacromial diameter single or combined with the bitrochanteric and biiliocristal diameter (27%), the wrist circumference (19%), and the grant index (12%). Fourteen studies reported percentile values of the BFS measurement, but only four presented cut-off values. CONCLUSIONS: There was no unified BFS measurement in children and adolescents neither reference cut-off values for categorization. The Frame index was the most frequently used. It is difficult to compare BFS statistics due to the diversity of measurements. It is necessary to standardize the use of the methods for measuring BFS.

Risk Factors for SARS-CoV-2 Infection, Pneumonia, Intubation, and Death in Northeast Mexico.

Despite the social distancing and mobility restriction measures implemented for susceptible people around the world, infections and deaths due to COVID-19 continued to increase, even more so in the first months of 2021 in Mexico. Thus, it is necessary to find risk groups that can benefit from more aggressive preventive measures in a high-density population. This is a case-control study of suspected COVID-19 patients from Nuevo León, Mexico. Cases were: (1) COVID-19-positive patients and COVID-19-positive patients who (2) developed pneumonia, (3) were intubated and (4) died. Controls were: (1) COVID-19-negative patients, (2) COVID-19-positive patients without pneumonia, (3) non-intubated COVID-19-positive patients and (4) surviving COVID-19-positive patients. ≥ 18 years of age, not pregnant, were included. The pre-existing conditions analysed as risk factors were age (years), sex (male), diabetes mellitus, hypertension, chronic obstructive pulmonary disease, asthma, immunosuppression, obesity, cardiovascular disease, chronic kidney disease and smoking. The Mann-Whitney U tests, Chi square and binary logistic regression were used. A total of 56,715 suspected patients were analysed in Nuevo León, México, with 62.6% being positive for COVID-19 and, of those infected, 14% developed pneumonia, 2.9% were intubated and 8.1% died. The mean age of those infected was 44.7 years, while of those complicated it was around 60 years. Older age, male sex, diabetes, hypertension, and obesity were risk factors for infection, complications, and death from COVID-19. This study highlights the importance of timely recognition of the population exposed to pre-existing conditions to prioritise preventive measures against the virus.

Multiple Unhealthy Behaviors Share Equivalent Profiles of Readiness for Change in Patients with Type 2 Diabetes.

Few studies have considered more than one behavior, despite the tendency towards multiple behaviors, and there are none that have focused on a Latino population. We determined the concurrence of four unhealthy behaviors related to glycemic control and identified common cognitive factors at advanced stages of readiness for change in patients with type 2 diabetes treated in primary care. A cross-sectional study was carried out during August-December 2018 in northeastern Mexico. We consecutively included patients between 20 and 70 years who were without medical contraindication, physical impediment against exercise, pregnancy and edentulism, among other selection criteria (n = 407). Stages of behavior were measured according to the Transtheoretical Model. Pros, cons, self-efficacy, susceptibility, and severity data were collected by interview. Statistical analysis consisted of descriptive statistics and multiple logistic regression. A total of 36.7% exhibited more than one unhealthy behavior in precontemplation or contemplation (no interest or some interest in changing consumption of refined sugars and saturated fats, exercise, or oral hygiene behavior). Cons (p < 0.05) and self-efficacy (p < 0.001) were common to all four unhealthy behaviors, independent of potential confounders. Studies like ours facilitate the recognition of individuals with multiple unhealthy behaviors who share equivalent profiles of readiness for change before implementing public health programs.

Cardiovascular risk assessment in primary care employees / Evaluación del riesgo cardiovascular en trabajadores de atención primaria

BACKGROUND: Despite the importance and availability of cardiovascular risk stratification (CVR) systems, few Latin American studies use them in health care workers. OBJECTIVE: To evaluate the CVR stratification based on type, number of risk factors and current blood pressure category in primary care employees. MATERIAL AND METHODS: Cross-sectional design study (n = 308). Through an interview, CVR, labor, contractual and sociodemographic profiles were collected. Weight, height, abdominal circumference, blood pressure, glucose and cholesterol were also measured. The CVR prevalence and prevalence ratio were estimated according to labor, contractual and sociodemographic characteristics. Difference in proportions tests were applied. RESULTS: Obesity and central obesity were present in 32.4% and 58.5% of participants, respectively. Blood pressure was high normal in 11.8% and grade 1 hypertension was in 7.2%. Nineteen percent had low, moderate or high CVR; and 53.9% registered ≥ 3 risk factors. The highest PR corresponded to have ≥ 7 years of service, followed by age ≥ 38 years, permanent hiring status, male sex and married status. CONCLUSIONS: The stratification system was practical and feasible. Planning preventive and corrective actions is of great importance for lowering cardiovascular events and lost productive years.

INTRODUCCIÓN: A pesar de la importancia y la disponibilidad de los sistemas de estratificación de riesgo cardiovascular (RCV), hay pocos estudios latinoamericanos que los utilicen en trabajadores de la salud. OBJETIVO: Evaluar el RCV estratificado según el tipo, el número de factores de riesgo y la categoría de presión arterial actual en trabajadores de atención primaria. MATERIAL Y MÉTODOS: Estudio de diseño transversal (n = 308). Mediante entrevista se colectó el perfil de RCV, laboral, contractual y sociodemográfico. Se midieron peso, talla, circunferencia abdominal, presión arterial, glucosa y colesterol. Se estimaron la prevalencia y la razón de prevalencia de RCV según las características laborales, contractuales y sociodemográficas. Se aplicaron pruebas de diferencia de proporciones. RESULTADOS: El 32.4% presentaba obesidad y el 58.5% obesidad central. El 11.8% estaba en categoría de presión arterial normal-alta y el 7.2% en hipertensión de grado 1. El 19% presentó RCV bajo, moderado o alto, y el 53.9% registró tres o más factores de riesgo. La razón de prevalencia más alta fue en antigüedad laboral ≥ 7 años; le siguieron la edad ≥ 38 años, la contratación definitiva, el sexo masculino y el estado civil con pareja. CONCLUSIONES: El sistema de estratificación fue práctico y factible. Es de gran trascendencia para planear acciones preventivas y correctivas para reducir la incidencia de eventos cardiovasculares y la pérdida de años de vida potencialmente productivos.

[Ultrasound-guided umbilical venous catheterisation: A cost-effectiveness analysis]. / Cateterización venosa umbilical guiada por ultrasonografía: un análisis de coste-efectividad.

INTRODUCTION: Although the use of ultrasound for the insertion of central catheters has proven to be cost-effective in adults, it is not known if this is the case in the neonatal population. This study compared the cost-effectiveness of ultrasound-guided umbilical venous catheterisation with conventional catheterisation in a neonatal intensive care unit of a Public University Hospital. PATIENTS AND METHODS: A retrospective observational study was conducted on newborns that required an umbilical venous catheter before completing their first 24hours of extra-uterine life. Two retrospective cohorts were formed, including one with ultrasound-guided catheterisation and the other with conventional catheterisation. The effectiveness was measured using 2 variables: placement of ideal position and insertion without complications. The cost of human and material resources (consumable and non-consumable), the cost-effectiveness ratio, and the incremental cost-effectiveness ratio were estimated, as well as carrying out a sensitivity analysis. RESULTS: Catheter obstruction was more frequent in guided catheterisation than in conventional catheterisation (7.7% vs. 0%, p=.04) and catheter dysfunction was higher in the latter (79% vs. 3.8%, p<.0001). The cost-effectiveness ratio of the guided catheterisation was €153.9, and €484.6 for the conventional one. The incremental cost-effectiveness ratio was €45.5. The sensitivity analysis showed a €2.6 increase in the cost-effectiveness ratio of the guided catheterisation and €47 in the conventional one. CONCLUSIONS: The use of ultrasound to guide umbilical catheterisation is more efficient than conventional catheterisation since, despite using more economic resources, it offers greater effectiveness.

Estimating and differentiating maternal feeding practices in a country ranked first in childhood obesity.

OBJECTIVE: Mexico ranks first in childhood obesity worldwide. However, little is known about the factors influencing maternal feeding practices. The present study aimed to estimate the prevalence of feeding practices and explore associations between weight concern, weight perception, sociodemographic characteristics and those feeding practices. DESIGN: Cross-sectional. SETTING: North-eastern Mexico. PARTICIPANTS: Mothers aged ≥18 years who were in charge of feeding a singleton child aged 2-6 years with no endocrine disease or visible genetic malformations (n 507). Information on six maternal feeding practices, concern and perception of the child's weight and demographics were collected by interview. The mother's and child's height and weight were measured. The feeding practices questionnaire was subject to content, construct and convergent validity analysis. Then, mean feeding scores were obtained and prevalence and 95 % CI were determined for scores ≥3; multivariate logistic regression was performed. RESULTS: Not modelling (63·5 %; 95 % CI 59·2, 67·8 %) and pressuring to eat (55·6 %; 95 % CI 51·2, 60·0 %) were the most frequent feeding practices, followed by easy access to unhealthy foods (45·4 %; 95 % CI 40·9, 49·8 %) and child control (43·2 %; 95 % CI 38·8, 47·6 %). They prevailed despite concern about the child's excess weight or a perception of the child as overweight/obese. Education was associated with the highest number of practices (educated mothers used more pressuring to eat, less regulation and less easy access; or monitoring was less absent). CONCLUSIONS: The frequency of certain feeding practices needs to be improved. Emphasis on the child's weight concern, obesity perception and maternal education is essential for optimizing intervention planning.

Discriminatory Accuracy of Preeclampsia Risk Factors in Primary Care.

BACKGROUND: Although it is common to use risk factors in the screening for preeclampsia, they do not always accurately identify patients who truly have this condition. AIM OF THE STUDY: To determine the discriminatory accuracy of known preeclampsia risk factors, both individually and in combination. METHODS: We studied patients undergoing prenatal care who were diagnosed with preeclampsia or eclampsia (n = 160 cases) in primary care and those who were not (n = 430 controls). Data on history of preeclampsia, type 2 diabetes, chronic hypertension, multiple gestation, first pregnancy, pregnancy interval ≥10 years, overweight/obesity, mean arterial pressure (MAP) ≥80 mmHg, and age (<20 years and ≥40 years) were obtained using a dichotomous scale. Discriminatory accuracy indicators were true-positive (TP) and false-positive (FP) rates, positive and negative likelihood ratios (LR+ and LR-), diagnostic odds ratio (DOR), and the area under the receiver-operating characteristic (AUROC) curve; stratified by parity. The case-control status was the reference standard. RESULTS: Certain combinations performed better than individual factors, independent of parity status. Among multiparous women, MAP ≥80 mmHg together with previous preeclampsia and overweight/obesity accumulated the greatest number of discriminatory accuracy indicators, with acceptable values: TP, 72.2%; FP, 1.5%; LR+, 48.4; LR-, 0.3; DOR, 171.6; and AUROC, 0.85. CONCLUSIONS: Discriminatory accuracy was low for almost all individual preeclampsia risk factors. However, the accuracy improved after some factors were combined. To the best of our knowledge, this is the first study to examine the discriminatory accuracy of preeclampsia risk factors used for screening high-risk pregnancies in primary care in Mexico.

Comparison of the discriminatory accuracy of four risk criteria for preeclampsia.

OBJECTIVES: Several criteria have been proposed to categorize the risk of preeclampsia, with notable differences between these criteria. We compared the discriminatory accuracy of criteria for categorizing preeclampsia risk established by four institutions, namely, the World Health Organization (WHO), National Institute for Health and Care Excellence (NICE), American College of Obstetricians and Gynecologists (ACOG), and National Center for Technological Excellence in Health (CENETEC), and estimated the concordance between these criteria. STUDY DESIGN: We performed a secondary data analysis of 590 Mexican obstetric patients who received prenatal care in primary care between 2016 and 2017; 160 had a diagnosis of preeclampsia. MAIN OUTCOME MEASURES: We estimated the true (TP) and false positive (FP) fractions, positive (PPV) and negative predictive values (NPV), positive (LR+) and negative (LR-) likelihood ratios, diagnostic odds ratio (DOR), area under the receiver operating characteristic curve (AUROC), and Kappa coefficient with corresponding 95% confidence intervals (CIs). RESULTS: Only the WHO criteria, followed by the NICE criteria, had the greatest number of accuracy indicators with ideal or acceptable results: TP 83.6%, PPV 60.5%, NPV 90.3%, DOR 14.3, and AUROC 0.79 and TP 84.5%, PPV 51.0%, NPV 90.3%, DOR 9.7, and AUROC 0.74, respectively. The Kappa coefficient between WHO and NICE criteria was 0.78 (95% CI 0.71-0.85). CONCLUSIONS: The discriminatory accuracies of the WHO and NICE criteria were superior to those of the ACOG and CENETEC criteria for classifying preeclampsia risk. Their concordance was good; thus, both criteria seem appropriate for screening preeclampsia in primary care.

Prevalence of Prediabetes Based on Fasting Plasma Glucose and Glycosylated Hemoglobin in an At-Risk Mexican Population.

BACKGROUND: In Latin America, there are no published studies of the prevalence of prediabetes using the glycosylated hemoglobin (HbA1c) criterion in addition to fasting plasma glucose (FPG). Therefore, here we determined the prevalence of prediabetes using FPG and/or HbA1c in a Mexican population at risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease. METHODS: This cross-sectional study included 384 primary care users without a known diagnosis of prediabetes or T2DM and with at least one risk factor for T2DM and cardiovascular disease. An FPG 100-125 mg/dL and/or an HbA1c 5.7-6.4% were considered positive for prediabetes. Point prevalence and 95% confidence intervals (CI) were estimated overall and stratified by age, sex, and nutritional status. Mann-Whitney and chi-squared tests were used. P values < 0.05 were considered significant. RESULTS: The prevalence of prediabetes was 74.7% (95% CI, 70.2%-78.8%) using FPG or HbA1c criteria for positivity, 60.4% using FPG alone (95% CI, 55.5%-65.3%), 49.8% using HbA1c alone (95% CI, 44.4-55.3%); and 32.9% using FPG and HbA1c (95% CI, 27.8%-38.0%). Prevalence was higher in patients ≥50 years old (p < 0.001) and in the overweight-obesity group (p = 0.04) using all criteria except for HbA1c alone. CONCLUSIONS: The prevalence of prediabetes in a Mexican population at risk for cardiovascular disease and/or T2DM was high. Prediabetes is definitely a public health problem. Future studies are needed to examine the effectiveness and efficiency of pragmatic strategies to reverse the status of prediabetes and, therefore, reduce the incidence of T2DM.

The effect of insulin resistance on breast cancer risk in Latinas of Mexican origin.

BACKGROUND: Conclusive evidence has yet to emerge regarding the association between markers of hyperinsulinemia and breast cancer. We determined the effect of insulin resistance (IR) on breast cancer risk in Latinas of Mexican origin who did not have a direct family history of breast cancer and had not been previously diagnosed with prediabetes or diabetes. METHODS: This was a case-control study in which a case (n=124) was defined as a patient with a recent histopathologic diagnosis of breast cancer and a control (n=197) was defined as a participant who had recently undergone a mammography and had either a Breast Imaging, Reporting & Data System (BI-RADS)-1 or a BI-RADS-2 score. Plasma glucose, insulin, and glycated hemoglobin (HbA1c) levels were measured. IR was determined by using the homeostasis model assessment (HOMA-IR) criterion. Odds ratios (OR) and 95% confidence intervals (CI) were determined using unconditional binary logistic regression analysis. RESULTS: IR was detected in 33.9% of cases and 41.6% of controls, based on a HOMA-IR ≥3.5. Although multivariate analysis did not show any association between IR and breast cancer risk (OR 0.56, 95% CI 0.31-1.01), it showed that an HbA1c ≥5.7% increased the risk of breast cancer (OR 3.41, 95% CI 1.93-6.01), regardless of menopausal status. CONCLUSIONS: The findings suggest that IR had no effect on breast cancer risk; however HbA1c increased the risk in Latinas of Mexican origin who had not been diagnosed previously with prediabetes or diabetes and had no direct family history of breast cancer. Prospective studies are required to establish the impact of IR over time.