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1.
BMC Musculoskelet Disord ; 25(1): 91, 2024 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-38267883

RESUMEN

OBJECTIVES: To examine the association of current and childhood socioeconomic status (SES) with patient-reported functional status, quality of life and disability in patients with knee or hip osteoarthritis (OA). METHODS: Cross-sectional study amongst individuals seeking care for any medical reason in a primary care family-practice clinic in Mexico City. We included individuals with self-reported doctor-diagnosed arthritis, recruited through waiting-room posters and invitations by treating family physicians. We administered a survey using validated Spanish language versions of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Osteoarthritis of Lower Limbs and Quality of Life (AMICAL), and the Stanford Health Assessment Questionnaire-Disability Index (HAQ-DI). To estimate current and childhood SES, we collected data on education level and occupation type for both the patient and their parents, as well as using a validated tool to estimate income quintile. RESULTS: We recruited 154 patients and excluded 8 patients. There was a high correlation between outcome scores. Estimated income and education levels were correlated with WOMAC, AMICAL and HAQ-DI scores, and significant differences were found in all scores by occupation type. The associations for current SES variables and outcome scores remained significant independently of age, sex, BMI, and presence of diabetes or hypertension, and were largely explained by current income in mutually adjusted models. Childhood SES - in particular as measured through maternal education - was best correlated with AMICAL scores, though its effect seemed largely mediated by its association with current SES. CONCLUSIONS: Current Socioeconomic Status impacts functional status, quality of life and disability amongst OA patients in Mexico City. The WOMAC, AMICAL and HAQ-DI scores correlate with each other and are all potentially useful markers of disease severity. More research is needed to elucidate the relationships between childhood SES and OA outcomes. Awareness of life-course SES may be useful in identifying patients at risk for worse outcomes.


Asunto(s)
Osteoartritis de la Cadera , Niño , Humanos , Osteoartritis de la Cadera/diagnóstico , Osteoartritis de la Cadera/epidemiología , Estudios Transversales , México/epidemiología , Calidad de Vida , Extremidad Inferior , Evaluación de Resultado en la Atención de Salud
2.
J Clin Rheumatol ; 21(2): 57-62, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25710855

RESUMEN

BACKGROUND: The overall estimated prevalence of rheumatoid arthritis (RA) in Mexico is 1.6%, but there are major variations in different geographic areas of the country. OBJECTIVE: This study aimed to determine the impact of individual and regional variables on the geographic distribution of RA in Mexico. METHODS: This multilevel analysis used data from a cross-sectional study that investigated the prevalence of RA among 19,213 individuals older than 18 years throughout 5 geographic regions in Mexico. Logistic regression models were used to determine predictors of RA, including individual and regional variables as well as cultural factors. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were determined. RESULTS: The prevalence of RA varied from 0.77% to 2.8% across the 5 regions. Individual factors associated with RA were sex (OR, 2.32; 95% CI, 1.74-3.07), previous medical diagnosis of RA ( OR 3.3, 95%CI: 2919­5.1 [corrected]), disability (OR, 2.07; 95% CI, 1.48-2.93), and the 56- to 65-year age group (OR, 1.95; 95% CI, 1.08-3.74). The regional factor of speaking an indigenous language had an OR of 2.27 (95% CI, 1.13-4.55). CONCLUSIONS: Various individual and regional factors were associated with variations in the prevalence of RA in the Mexican population.


Asunto(s)
Artritis Reumatoide/epidemiología , Adulto , Anciano , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/terapia , Estudios Transversales , Cultura , Femenino , Humanos , Modelos Logísticos , Masculino , México/epidemiología , Persona de Mediana Edad , Análisis Multinivel , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Factores Socioeconómicos
3.
Rheumatol Int ; 34(9): 1299-309, 2014 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-24682426

RESUMEN

The purpose of the study is to validate a culturally sensitive adaptation of the community-oriented program for the control of rheumatic diseases (COPCORD) methodology in several Latin American indigenous populations. The COPCORD Spanish questionnaire was translated and back-translated into seven indigenous languages: Warao, Kariña and Chaima (Venezuela), Mixteco, Maya-Yucateco and Raramuri (Mexico) and Qom (Argentina). The questionnaire was administered to almost 100 subjects in each community with the assistance of bilingual translators. Individuals with pain, stiffness or swelling in any part of the body in the previous 7 days and/or at any point in life were evaluated by physicians to confirm a diagnosis according to criteria for rheumatic diseases. Overall, individuals did not understand the use of a 0-10 visual analog scale for pain intensity and severity grading and preferred a Likert scale comprising four items for pain intensity (no pain, minimal pain, strong pain, and intense pain). They were unable to discriminate between pain intensity and pain severity, so only pain intensity was included. For validation, 702 subjects (286 male, 416 female, mean age 42.7 ± 18.3 years) were interviewed in their own language. In the last 7 days, 198 (28.2 %) subjects reported having musculoskeletal pain, and 90 (45.4 %) of these had intense pain. Compared with the physician-confirmed diagnosis, the COPCORD questionnaire had 73.8 % sensitivity, 72.9 % specificity, a positive likelihood ratio of 2.7 and area under the receiver operating characteristic curve of 0.73. The COPCORD questionnaire is a valid screening tool for rheumatic diseases in indigenous Latin American populations.


Asunto(s)
Indio Americano o Nativo de Alaska/psicología , Asistencia Sanitaria Culturalmente Competente , Dimensión del Dolor , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Comprensión , Características Culturales , Femenino , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Reproducibilidad de los Resultados , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/etnología , Enfermedades Reumáticas/psicología , Índice de Severidad de la Enfermedad , Traducción , Adulto Joven
4.
BMJ Open ; 13(3): e069246, 2023 03 23.
Artículo en Inglés | MEDLINE | ID: mdl-36958782

RESUMEN

Syndemics are a framework that documents health inequities and vulnerabilities in populations with rheumatic diseases. Compared with other approaches, syndemics are able to conjunctly consider epidemiological, biological, sociodemographic and economic factors, and their interactions. OBJECTIVE: To estimate health inequity and vulnerability among Indigenous and non-Indigenous populations with rheumatic and musculoskeletal diseases (RMD) in Latin America using the syndemic approach. DESIGN: This is a secondary analysis of a previously published large-scale study on the prevalence of RMD. SETTING: Studies carried out in five Latin American countries (Argentina, Colombia, Ecuador, Mexico and Venezuela). Health inequity and vulnerability in RMD were identified through a syndemic approach using network and cluster analysis. PARTICIPANTS: A total of 44 560 individuals were studied: 29.78% self-identified as Indigenous, 60.92% were female, the mean age was 43.25 years. Twenty clusters were identified in the Indigenous population and 17 in the non-Indigenous population. RESULTS: The variables associated with RMD among Indigenous populations were rurality, public health system, high joint biomechanical stress, greater pain, disability and alcoholism; and among non-Indigenous people they were being a woman, urban origin, older age, private health system, joint biomechanical stress, greater pain and disability. We identified different health inequities among patients with RMD (ie, lower educational attainment, more comorbidities), associated with factors such as Indigenous self-identification and rural residence. CONCLUSIONS: A syndemic approach enables us to identify health inequities in RMD, as shown by higher prevalence of comorbidities, disability and socioeconomic factors like lower educational attainment. These inequities exist for the overall population of patients with RMD, although it is more evident in Indigenous groups with added layers of vulnerability.


Asunto(s)
Enfermedades Reumáticas , Sindémico , Humanos , Femenino , Adulto , Masculino , América Latina/epidemiología , Enfermedades Reumáticas/epidemiología , México , Dolor
5.
Ann Rheum Dis ; 70(6): 1020-4, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21378405

RESUMEN

OBJECTIVES: Screening for cardiovascular risk factors and treating hyperlipidaemia with statins are recommended to reduce the increased cardiovascular risk in individuals with rheumatoid arthritis (RA). However, poor compliance with statins may limit their therapeutic benefit. Our objective was to evaluate the impact of statin discontinuation on risk of acute myocardial infarction (AMI) among RA patients. METHODS: The authors conducted a population-based cohort study of RA patients with incident statin use followed from May 1996 to March 2006 using administrative health data. Primary exposure was statin discontinuation for ≥ 3 months at any time during therapy course. The authors used Cox's proportional hazards models and modelled statin discontinuation as a time-dependent variable, while adjusting for age, sex, comorbidities, use of other medications influencing cardiac risk, and proxy indicators of RA severity. RESULTS: During 15 669 person-years of follow-up in 4102 incident-statin users with RA, the authors identified 264 AMI events. Statin discontinuation was associated with 67% increased risk of AMI (adjusted HR 1.67; 95% CI 1.24 to 2.25). There was a 2% increase in risk of AMI with each 1-month increase in the duration of discontinuation (adjusted HR 1.02; 95% CI 1.01 to 1.03). These associations were not modified by timing of first statin prescription, prior AMI status, sex and age (p values for interactions >0.17). CONCLUSIONS: These population-based data indicate that RA patients who discontinue statins have increased risk of AMI. Findings emphasise the need to raise awareness, among health professionals and people with RA, of the importance of compliance with statin therapy in RA.


Asunto(s)
Artritis Reumatoide/complicaciones , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Cumplimiento de la Medicación/estadística & datos numéricos , Infarto del Miocardio/etiología , Adolescente , Adulto , Anciano , Artritis Reumatoide/epidemiología , Colombia Británica/epidemiología , Métodos Epidemiológicos , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/prevención & control , Adulto Joven
6.
J Rheumatol Suppl ; 86: 21-5, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21196595

RESUMEN

OBJECTIVE: To assess the prevalence of musculoskeletal (MSK) pain and rheumatic diseases in the southeastern Mexican state of Yucatán. METHODS: Using the Community Oriented Program in the Rheumatic Diseases (COPCORD) methodology, we performed a door-to-door, cross-sectional study generated through a multistage, stratified, randomized method on 3915 adult residents (age 42.7 ± 17.1 yrs; women 61.8%; urban setting 45.7%) of the Mexican state of Yucatán. We used universally accepted criteria for the diagnosis or classification of rheumatoid arthritis (RA), osteoarthritis (OA; knee and hand), fibromyalgia, systemic lupus erythematosus (SLE), gout, ankylosing spondylitis, regional rheumatic pain syndromes, and inflammatory back pain. RESULTS: Nontraumatic MSK pain in the last 7 days was present in 766 (19.6%; 95% CI 18.3-20.8) individuals. MSK pain was more prevalent in women (26.6%) versus men (12.2%; p < 0.01). Self-reported MSK disability occurred in 1.7%. Most MSK pain-related variables were consistently more prevalent in the urban setting. The prevalence of rheumatic disease was: OA 6.8% (95% CI 6.0-7.6); back pain 3.8% (95% CI 3.2-4.4); RA 2.8% (95% CI 2.2-3.3); rheumatic regional pain syndromes 2.3% (95% CI 1.9-2.8); inflammatory back pain 0.7% (95% CI 0.5-1.0); fibromyalgia 0.2% (95% CI 0.1-0.4); gout 0.1% (95% CI 0.07-0.3); and SLE 0.07% (95% CI 0.01-0.2). CONCLUSION: The prevalence of MSK pain was 19.6%. MSK pain was more prevalent in women and in the urban setting. A remarkably high prevalence of RA was found in this population, which suggests a role for geographic factors.


Asunto(s)
Planificación en Salud Comunitaria , Tamizaje Masivo/métodos , Dolor/epidemiología , Enfermedades Reumáticas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Demografía , Personas con Discapacidad , Femenino , Encuestas Epidemiológicas , Humanos , Agencias Internacionales , Masculino , México/epidemiología , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/complicaciones , Enfermedades Musculoesqueléticas/epidemiología , Enfermedades Musculoesqueléticas/fisiopatología , Dolor/etiología , Dolor/fisiopatología , Prevalencia , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/fisiopatología , Población Rural , Población Urbana , Adulto Joven
7.
J Rheumatol Suppl ; 86: 3-8, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21196592

RESUMEN

OBJECTIVE: To estimate the prevalence of musculoskeletal (MSK) disorders and to describe predicting variables associated with rheumatic diseases in 5 regions of México. METHODS: This was a cross-sectional, community-based study performed in 5 regions in México. The methodology followed the guidelines proposed by the Community Oriented Program for the Control of the Rheumatic Diseases (COPCORD). A standardized methodology was used at all sites, with trained personnel following a common protocol of interviewing adult subjects in their household. A "positive case" was defined as an individual with nontraumatic MSK pain of > 1 on a visual analog pain scale (0 to 10) during the last 7 days. All positive cases were referred to internists or rheumatologists for further clinical evaluation, diagnosis, and proper treatment. RESULTS: The study included 19,213 individuals; 11,602 (68.8%) were female, and their mean age was 42.8 (SD 17.9) years. The prevalence of MSK pain was 25.5%, but significant variations (7.1% to 43.5%) across geographical regions occurred. The prevalence of osteoarthritis was 10.5%, back pain 5.8%, rheumatic regional pain syndromes 3.8%, rheumatoid arthritis 1.6%, fibromyalgia 0.7%, and gout 0.3%. The prevalence of MSK manifestations was associated with older age and female gender. CONCLUSION: The prevalence of MSK pain in our study was 25.5%. Geographic variations in the prevalence of MSK pain and specific diagnoses suggested a role for geographic factors in the prevalence of rheumatic diseases.


Asunto(s)
Planificación en Salud Comunitaria , Tamizaje Masivo/métodos , Enfermedades Reumáticas/epidemiología , Adulto , Estudios Transversales , Recolección de Datos , Femenino , Encuestas Epidemiológicas , Humanos , Agencias Internacionales , Masculino , México/epidemiología , Dolor/epidemiología , Dolor/etiología , Dolor/fisiopatología , Prevalencia , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/fisiopatología
8.
J Rheumatol Suppl ; 86: 15-20, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21196594

RESUMEN

OBJECTIVE: To assess the prevalence of rheumatic regional pain syndromes (RRPS) in 3 geographical areas of México using the Community Oriented Program in the Rheumatic Diseases (COPCORD) screening methodology and validate by expert consensus on case-based definitions. METHODS: By means of an address-based sample generated through a multistage, stratified, randomized method, a cross-sectional survey was performed on adult residents (n = 12,686; age 43.6 ± 17.3 yrs; women 61.9%) of the states of Nuevo León, Yucatán, and México City. Diagnostic criteria for specific upper (Southampton group criteria) and lower limb (ad hoc expert consensus) RRPS were applied to all subjects with limb pain as detected by COPCORD questionnaire. RESULTS: The overall prevalence of RRPS was 5.0% (95% CI 4.7-5.4). The most frequent syndrome was rotator cuff tendinopathy (2.36%); followed by inferior heel pain (0.64%); lateral epicondylalgia (0.63%); medial epicondylalgia (0.52%); trigger finger (0.42%); carpal tunnel syndrome (0.36%); anserine bursitis (0.34%); de Quervain's tendinopathy (0.30%); shoulder bicipital tendinopathy (0.27%); trochanteric syndrome (0.11%); and Achilles tendinopathy (0.10%). There were anatomic regional variations in the prevalence of limb pain: Yucatán 3.1% (95% CI 2.5-3.6); Nuevo León 7.0% (95% CI 6.3-7.7); and México City 10.8% (95% CI 9.8-11.8). Similarly, the prevalence of RRPS showed marked geographical variation: Yucatán 2.3% (95% CI 1.8-2.8); Nuevo León 5.6% (95% CI 5.0-6.3); and México City 6.9% (95% CI 6.2-7.7). CONCLUSION: The overall prevalence of RRPS in México was 5.0%. Geographical variations raise the possibility that the prevalence of RRPS is influenced by socioeconomic, ethnic, or demographic factors.


Asunto(s)
Planificación en Salud Comunitaria , Síndromes de Dolor Regional Complejo/epidemiología , Tamizaje Masivo/métodos , Enfermedades Reumáticas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Síndromes de Dolor Regional Complejo/diagnóstico , Síndromes de Dolor Regional Complejo/etiología , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Agencias Internacionales , Masculino , México/epidemiología , Persona de Mediana Edad , Enfermedades Reumáticas/complicaciones , Enfermedades Reumáticas/diagnóstico , Adulto Joven
9.
J Rheumatol Suppl ; 86: 31-5, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21196597

RESUMEN

OBJECTIVE: Rheumatic diseases are vastly underdiagnosed and undertreated, particularly among minorities and those of low socioeconomic status. The WHO-ILAR Community Oriented Program in the Rheumatic Diseases (COPCORD) advocates screening of musculoskeletal complaints in the community. The objective of this study was to evaluate the performance of the COPCORD Core Questionnaire (CCQ) as a diagnostic tool for rheumatic diseases. METHODS: We conducted a cross-sectional study designed in parallel with a large COPCORD survey in Mexico. A subsample of 17,566 questionnaires, selected from 4 of the 5 states included in a national COPCORD survey were included in the analysis as a diagnostic test to evaluate sensitivity, specificity, receiver operating characteristics curve (ROC), and positive likelihood ratio (LR+) of the CCQ as a case-detection tool for rheumatic diagnosis and for the most frequent diagnoses identified in the survey, osteoarthritis, regional rheumatic pain syndromes, and rheumatoid arthritis (RA). Logistic regression with the questions with LR+ ≥ 1 was performed to identify the strength of association (OR) for each question. RESULTS: Pain in the last 7 days, high pain score (> 4), and previous diagnosis were the questions with highest LR+ for diagnosis, and for diagnosis of RA treatment with NSAID. The variables that contributed most to the model were pain in the last 7 days (OR 2.0, 95% CI 1.8-2.3), NSAID treatment (OR 3.3, 95% CI 3.0-3.7), a high pain score (OR 1.15, 95% CI 1.13-1.17), and having a previous diagnosis (OR 1.4, 95% CI 1.3-1.6). These 4 questions had R(2) = 0.24, p < 0.01, for detection of any rheumatic diagnosis. The single variable that explains 16% (OR 1.33, 95% CI 1.31-134) of variance was a high pain score in the last 7 days. CONCLUSION: Some variables were identified in the CCQ that could be combined in a brief version for case detection of rheumatic diseases in community surveys. The validity of this proposal has to be tested against the original version.


Asunto(s)
Encuestas Epidemiológicas , Dolor/clasificación , Enfermedades Reumáticas/clasificación , Encuestas y Cuestionarios , Planificación en Salud Comunitaria , Servicios de Salud Comunitaria , Estudios Transversales , Humanos , Agencias Internacionales , Modelos Logísticos , Tamizaje Masivo , México/epidemiología , Dolor/diagnóstico , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Enfermedades Reumáticas/diagnóstico
10.
Clin Rheumatol ; 39(9): 2715-2726, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32232735

RESUMEN

INTRODUCTION: Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. OBJECTIVE: To compare and assess clinical, socioeconomic, and geographic factors associated with LBP prevalence in low-income and upper-middle-income countries using syndemic and syndemogenesis frameworks based on network and cluster analyses. METHODS: Analyses were performed by adopting network and cluster design, whereby interrelations among the individual and social variables and their combinations were established. The required data was sourced from the databases pertaining to the six Latin-American countries. RESULTS: Database searches yielded a sample of 55,724 individuals (mean age 43.38 years, SD = 17.93), 24.12% of whom were indigenous, and 60.61% were women. The diagnosed with LBP comprised 6.59% of the total population. Network analysis showed higher relationship individuals' variables such as comorbidities, unhealthy habits, low educational level, living in rural areas, and indigenous status were found to be significantly associated with LBP. Cluster analysis showed significant association between LBP prevalence and social variables (e.g. Gender inequality Index, Human Development Index, Income Inequality). CONCLUSIONS: LBP is a highly prevalent condition in Latin-American populations with a high impact on the quality of life of young adults. It is particularly debilitating for women, indigenous individuals, and those with low educational level, and is further exacerbated by the presence of comorbidities, especially those in the mental health domain. Thus, the study findings demonstrate that syndemic and syndemogenesis have the potential to widen the health inequities stemming from LBP in vulnerable populations. Key points • Syndemic and syndemogenesis evidence health disparities in Latin-American populations, documenting the complexity of suffering from a disease such as low back pain that is associated with comorbidities, unhealthy habits, and the social and regional context where they live. • The use of network and cluster analyses are useful tools for documenting the complexity and the multifaceted impact in health in large populations as well as the differences between countries. • The variability and impact of socioeconomic indicators (e.g., Gini index) related to low back pain and comorbidities could be felt through the use of cluster analysis, which generates evidence of regional inequality in Latin America. • Populations can be studied from different models (network and cluster analysis) and grouping, presenting new interpretations beyond geographical groupings, such as syndemic and inequity in health.


Asunto(s)
Dolor de la Región Lumbar , Adulto , Análisis por Conglomerados , Femenino , Humanos , América Latina/epidemiología , Dolor de la Región Lumbar/epidemiología , Masculino , Calidad de Vida , Sindémico , Estados Unidos , Adulto Joven
11.
Rev Med Inst Mex Seguro Soc ; 47(6): 603-10, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-20602898

RESUMEN

OBJECTIVE: The aim of this study was to estimate health professional and patient satisfaction and to identify some of the factors that could impinge on health professional satisfaction. METHODS: A comparative cross-sectional study type survey was carried out at the outpatient setting from healthcare units at the Instituto Mexicano del Seguro Social. Two different questionnaires were employed: one to measure work satisfaction of health professionals (n = 797); and the second, to measure the satisfaction of patients (n = 948) with the quality of medical care received. RESULTS: In total, 402 (50.4 %) workers and 439 (46.3 %) patients were satisfied. The highest and the lowest numbers of satisfied workers were observed in family care units and second-level hospitals, respectively, while the greatest proportion of satisfied patients was found in the second level hospitals. No correlation was found between the number of health professionals and satisfied patients (r = 0.166, p = 0.363). CONCLUSIONS: The results of this study have a twofold goal: to illustrate the current status quality of care and to suggest that an effort on periodic measurements of the process of care should be made to improve the quality of care.


Asunto(s)
Personal de Salud , Satisfacción en el Trabajo , Satisfacción del Paciente , Calidad de la Atención de Salud/normas , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
12.
Cost Eff Resour Alloc ; 6: 21, 2008 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-19014495

RESUMEN

BACKGROUND: Osteoarthritis (OA) is one of the main causes of disability worldwide, especially in persons >55 years of age. Currently, controversy remains about the best therapeutic alternative for this disease when evaluated from a cost-effectiveness viewpoint. For Social Security Institutions in developing countries, it is very important to assess what drugs may decrease the subsequent use of medical care resources, considering their adverse events that are known to have a significant increase in medical care costs of patients with OA. Three treatment alternatives were compared: celecoxib (200 mg twice daily), non-selective NSAIDs (naproxen, 500 mg twice daily; diclofenac, 100 mg twice daily; and piroxicam, 20 mg/day) and acetaminophen, 1000 mg twice daily. The aim of this study was to identify the most cost-effective first-choice pharmacological treatment for the control of joint pain secondary to OA in patients treated at the Instituto Mexicano del Seguro Social (IMSS). METHODS: A cost-effectiveness assessment was carried out. A systematic review of the literature was performed to obtain transition probabilities. In order to evaluate analysis robustness, one-way and probabilistic sensitivity analyses were conducted. Estimations were done for a 6-month period. RESULTS: Treatment demonstrating the best cost-effectiveness results [lowest cost-effectiveness ratio $17.5 pesos/patient ($1.75 USD)] was celecoxib. According to the one-way sensitivity analysis, celecoxib would need to markedly decrease its effectiveness in order for it to not be the optimal treatment option. In the probabilistic analysis, both in the construction of the acceptability curves and in the estimation of net economic benefits, the most cost-effective option was celecoxib. CONCLUSION: From a Mexican institutional perspective and probably in other Social Security Institutions in similar developing countries, the most cost-effective option for treatment of knee and/or hip OA would be celecoxib.

13.
Rev Med Inst Mex Seguro Soc ; 46(1): 11-8, 2008.
Artículo en Español | MEDLINE | ID: mdl-18647567

RESUMEN

OBJECTIVE: to evaluate a personalized diet customize for present comorbidity, on metabolic control indicators and renal function. METHODS: a non-randomized clinical trial was conducted during a three-month period in a group of patients with microalbuminuria and in a group with macroalbuminuria. The patients received personalized dietary counseling customize to their comorbidity (obesity, hypertension, and dislypidemia). The effect of the diet was measured through metabolic control variables: body mass index (BMI), waist circumference, fasting glucose levels, glycated hemoglobin (HbA(1))c and lipids profile; the renal function variables were: glomerular filtration rate (GFR) and urine albumin excretion (UAE). Statistical analysis was done with t-paired test. RESULTS: thirty-nine patients were included (21 women and 18 men). After the intervention, the weight and waist circumference had significantly decreased (p = 0.01); the fasting glucose levels and HbA(1)c were significantly lower (p = 0.001). The HDL-cholesterol increased significantly (p = 0.009); UAE decreased significantly in patients with micro and macroalbuminuria; 123.0 +/- 73.4 to 105.3 +/- 61.3 mg/24-h; p = 0.040 and 1482.7 +/- 1200.6 to 1093.5 +/- 601.8 mg/24-h; p = 0.02. The GFR increased in both groups: 68.9 +/- 35.4 to 74.7 +/- 41.6 mL/min, p = 0.04; and 62.2 +/- 26.6 to 68.5 +/- 25.3 mL/min, p = 0.02. CONCLUSIONS: the dietary intervention improved the metabolic control and renal function in type 2 diabetes patients with comorbidity.


Asunto(s)
Albuminuria/dietoterapia , Diabetes Mellitus Tipo 2/dietoterapia , Nefropatías Diabéticas/dietoterapia , Dieta para Diabéticos , Adulto , Anciano , Albuminuria/fisiopatología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/fisiopatología , Ingestión de Energía , Femenino , Humanos , Hiperlipidemias/sangre , Hiperlipidemias/dietoterapia , Hipertensión/dietoterapia , Masculino , Persona de Mediana Edad , Obesidad/dietoterapia
14.
Arch Med Res ; 38(3): 354-9, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17350489

RESUMEN

BACKGROUND: We undertook this study to describe prescription practices and the degree of disease control in a large sample of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) treated by rheumatologists in Mexico. METHODS: Board-certified Mexican rheumatologists across the country were asked to assess consecutive RA and AS patients; 1208 patients completed a self-administered questionnaire with information on demographics, disease duration, co-morbidity, treatment, pain, disability and a validated Spanish version of instruments to measure physical function and quality of life. RESULTS: Of the 1096 RA patients, 88.1% were treated with nonsteroidal anti-inflammatory drugs (NSAIDs), 1020 (93.3%) with disease-modifying anti-rheumatic drugs (DMARDs), 365 (33.4%) with steroids, and 70 (6.4%) with biological agents. Their mean Health Assessment Questionnaire Disability Index (HAQ-Di) score was 1.21+/-0.80, Disease Activity Index, 28 joint count (DAS 28) 3.9+/-1.29, and Rheumatoid Arthritis Disease Activity Index (RADAI), 3.94+/-2.01. Regarding the 112 AS patients, 110 (98.2%) received NSAIDs, 90 (80.4%) were on DMARDs, 11 (9.8%) took steroids, and 11 (9.8%) received biological agents, their functional status shown as Bath Ankylosing Spondylitis Functional Index (BASFI) score of 4.4+/-2.5. Among the 1110 DMARD users, only 64 received one drug, and a great proportion used two or more DMARDs; 81 subjects (16.2%) were on biological agents, in any combination. RA patients more commonly used methotrexate, 791 (72%) cases, and hydroxychloroquine. Taking into account their diagnosis, the combination most prescribed was NSAIDs plus DMARDs in 660 subjects (54.7%). CONCLUSIONS: DMARDs in combination with other drug are the most frequently prescribed therapeutic scheme for RA and AS patients. These schemes used for both conditions by Mexican rheumatologists are in line with current international recommendations.


Asunto(s)
Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Prescripciones de Medicamentos , Médicos , Pautas de la Práctica en Medicina , Espondilitis Anquilosante/tratamiento farmacológico , Adulto , Estudios Transversales , Evaluación de la Discapacidad , Quimioterapia Combinada , Utilización de Medicamentos , Femenino , Humanos , México , Persona de Mediana Edad , Calidad de Vida , Reumatología , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios
15.
Clin Rheumatol ; 35 Suppl 1: 35-42, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-26689797

RESUMEN

This study aimed to estimate the prevalence of musculoskeletal (MSK) disorders and rheumatic diseases in the Chontal and Mixtec indigenous communities in the state of Oaxaca, Mexico, using the Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) methodology. After cross-culturally validating the COPCORD questionnaire for these communities, we conducted a cross-sectional, analytical, community-based census study using a house-to-house method. Positive cases of MSK disorders were assessed by primary care physicians and rheumatologists. The study population included participants aged ≥18 years from the indigenous communities of San Antonio Huitepec and San Carlos Yautepec. A total of 1061 persons participated in the study. Mean age was 46.9 years (standard deviation 19.9; age range 18-97 years); 642 (60.5 %) were women; 483 participants (45.5; 42.4-48.5 %) had MSK pain in the previous 7 days. Diagnoses were back pain 170 (16.0 %; 95 % confidence interval [CI] 13.8-18.3); osteoarthritis 157 (14.7 %; 95 % CI 12.7-17.0); rheumatic regional pain syndrome 53 (4.9 %; 95 % CI 3.7-6.4); rheumatoid arthritis 4 (0.3 %; 95 % CI 0.1-0.9); dermatomyositis 1 (0.09 %; 95 % CI 0.0-0.5); ankylosing spondylitis 1 (0.09 %; 95 % CI 0.0-0.5); systemic lupus erythematosus 1 (0.09 %; 95 % CI 0.02-0.5); and gout 1 (0.09 %; 95 % CI 0.0-0.5). 53.2 % had not received medical treatment for their disease. The prevalence of MSK disorders in indigenous communities in the Mixtec and Chontal regions is very high. The most common rheumatic diseases found were back pain and osteoarthritis. A high percentage of participants had not received medical care.


Asunto(s)
Dolor de Espalda/etnología , Indígenas Centroamericanos , Lupus Eritematoso Sistémico/etnología , Dolor Musculoesquelético/etnología , Enfermedades Reumáticas/clasificación , Enfermedades Reumáticas/etnología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Dimensión del Dolor , Encuestas y Cuestionarios , Adulto Joven
16.
Clin Rheumatol ; 35(1): 175-82, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25227770

RESUMEN

Multilevel studies have gained importance for highlighting social inequalities in health. These associations have been reported previously in diseases such as arthritis and chronic pain. We conducted a cross-sectional study using multilevel analysis to identify individual and contextual factors associated with the variation of prevalence of osteoarthritis (OA) in the Mexican population. The sample included 17,566 individuals of which 10,666 (60.7%) were women. The relationship between individual and contextual factors and OA were analyzed with a multilevel strategy. From the total population, 1,681 individuals had OA. Multilevel analysis showed that individual variables such as female gender (odds ratio (OR) = 1.3, 95% confidence interval (CI) 1.1, 1.4), age range 55-65 years (OR = 1.6, 95% CI 1.3, 2.0), musculoskeletal pain in the last 7 days (OR = 2.6, 95% CI 2.3, 3.0), and use of pain treatments (OR = 1.4, 95% CI 1.2, 1.7) were associated with OA. At the regional level, the Social Gap Index (SGIx) was associated with the diagnosis of OA (coefficient 0.5, 95% CI 0.2-1.1). The SGIx contextual variable was positively associated with the regional prevalence of OA and the variation in prevalence of OA in different regions. The larger the social gap, the greater the variation in OA prevalence. These factors were independently associated with the prevalence of OA: female gender, pain intensity, physical limitation, and the use of pain treatments were individual variables associated with OA. The association between OA prevalence and regional variations with SGIx reflects inequities in health provisions that should be considered in health programs.


Asunto(s)
Dolor Crónico/etiología , Disparidades en el Estado de Salud , Dolor Musculoesquelético/etiología , Osteoartritis/epidemiología , Anciano , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , México/epidemiología , Persona de Mediana Edad , Análisis Multinivel , Oportunidad Relativa , Dimensión del Dolor , Prevalencia , Factores de Riesgo , Índice de Severidad de la Enfermedad
17.
Reumatol Clin ; 11(5): 295-304, 2015.
Artículo en Inglés, Español | MEDLINE | ID: mdl-25639457

RESUMEN

BACKGROUND: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. OBJECTIVES: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphospholipid antibody syndrome (APS). METHODOLOGY: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and grading of recommendations, internal validation by peers, and external validation of the final document. The quality criteria of the AGREE II instrument were followed. RESULTS: The various panels answered the 37 questions related to maternal and fetal care in SLE, RA, and APS, as well as to the use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. We present the recommendations for pregnant women with SLE in this first part. CONCLUSIONS: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with SLE integrate the best available evidence for the treatment and follow-up of patients with these conditions.


Asunto(s)
Síndrome Antifosfolípido/terapia , Artritis Reumatoide/terapia , Lupus Eritematoso Sistémico/terapia , Complicaciones del Embarazo/terapia , Atención Prenatal/métodos , Cuidados Posteriores/métodos , Síndrome Antifosfolípido/diagnóstico , Artritis Reumatoide/diagnóstico , Femenino , Humanos , Lupus Eritematoso Sistémico/diagnóstico , México , Embarazo , Complicaciones del Embarazo/diagnóstico
18.
Reumatol Clin ; 11(5): 305-15, 2015.
Artículo en Inglés, Español | MEDLINE | ID: mdl-25683368

RESUMEN

BACKGROUND: Pregnancy in women with autoimmune rheumatic diseases is associated with several maternal and fetal complications. The development of clinical practice guidelines with the best available scientific evidence may help standardize the care of these patients. OBJECTIVES: To provide recommendations regarding prenatal care, treatment, and a more effective monitoring of pregnancy in women with lupus erythematosus, rheumatoid arthritis (RA) and antiphospholipid syndrome (APS). METHODOLOGY: Nominal panels were formed for consensus, systematic search of information, development of clinical questions, processing and staging of recommendations, internal validation by peers and external validation of the final document. The quality criteria of the AGREE II instrument were followed. RESULTS: The panels answered 37 questions related to maternal and fetal care in lupus erythematosus, RA and APS, as well as for use of antirheumatic drugs during pregnancy and lactation. The recommendations were discussed and integrated into a final manuscript. Finally, the corresponding algorithms were developed. In this second part, the recommendations for pregnant women with RA, APS and the use of antirheumatic drugs during pregnancy and lactation are presented. CONCLUSIONS: We believe that the Mexican clinical practice guidelines for the management of pregnancy in women with RA and APS integrate the best available evidence for the treatment and follow-up of patients with these conditions.


Asunto(s)
Síndrome Antifosfolípido/terapia , Artritis Reumatoide/terapia , Lupus Eritematoso Sistémico/terapia , Complicaciones del Embarazo/terapia , Atención Prenatal/métodos , Cuidados Posteriores/métodos , Síndrome Antifosfolípido/diagnóstico , Antirreumáticos/uso terapéutico , Artritis Reumatoide/diagnóstico , Toma de Decisiones Clínicas , Técnicas de Apoyo para la Decisión , Femenino , Humanos , Lupus Eritematoso Sistémico/diagnóstico , México , Embarazo , Complicaciones del Embarazo/diagnóstico
19.
Reumatol Clin ; 10(4): 241-7, 2014.
Artículo en Inglés, Español | MEDLINE | ID: mdl-24675155

RESUMEN

INTRODUCTION: Several generic questionnaires have been used to measure quality of life in patients with Osteoarthritis (OA) since few instruments have been developed specifically for OA and none was developed for Spanish speaking patients. The purpose of the study was to validate and adapt to Spanish the French questionnaire AMICAL to measure quality of life in patients with hip and knee OA. METHODS: Transversal, analytical study. The validation process was performed in phases: translation from French to Spanish, translated version analysis by a multidisciplinary expert team, application of a pilot test to patients to evaluate grammatical and content equivalence, blind back translation, and analysis. The questionnaire was applied to hip and knee OA patients, together with the SF-36 questionnaire, as well as the WOMAC and the Lequesne indexes. The reproducibility was evaluated applying the questionnaire after 72hours. The clinimetric analysis was calculated with SPSS 16.0. RESULTS: One hundred patients with hip OA and 100 patients with knee OA, radiological stages ii-iii, were included to evaluate homogeneity. Sixty-five patients with hip OA and 65 patients with knee OA were included to evaluate consistency. The final sample included 100 hip and 100 patients knee OA patients to estimate homogeneities and 65 patients were evaluated to estimate consistency. Mean (SD) age of patients with hip and knee OA, was 56.34 ± 13 and 60.1 ± 9.2, respectively. Sixty seven percent and 79.8% were female, respectively. Cronbach' alpha for AMICAL was 0.946 and 0.999, for hip OA and knee OA, respectively; and test-retest reliability using the intraclass correlation coefficients was 0.979 and 0.998, respectively. There was also a significant correlation with all the instruments (P<.05), except with the Lequesne index (r-0.383). CONCLUSIONS: The Spanish version of AMICAL questionnaire keep the clinimetric properties, homogeneity, and consistency, and has a good correlation with other instruments. Consequently, it is reliable, self-applicable, and includes domains beyond the functional capacity that better evaluate the quality of life.


Asunto(s)
Osteoartritis de la Cadera/diagnóstico , Osteoartritis de la Rodilla/diagnóstico , Calidad de Vida , Encuestas y Cuestionarios , Anciano , Estudios Transversales , Características Culturales , Femenino , Humanos , Lenguaje , Masculino , Persona de Mediana Edad , Traducciones
20.
Reumatol Clin ; 10(4): 227-40, 2014.
Artículo en Inglés, Español | MEDLINE | ID: mdl-24333119

RESUMEN

BACKGROUND: The pharmacologic management of rheumatoid arthritis has progressed substantially over the past years. It is therefore desirable that existing information be periodically updated. There are several published international guidelines for the treatment of rheumatoid arthritis that hardly adapt to the Mexican health system because of its limited healthcare resources. Hence, it is imperative to unify the existing recommendations and to incorporate them to a set of clinical, updated recommendations; the Mexican College of Rheumatology developed these recommendations in order to offer an integral management approach of rheumatoid arthritis according to the resources of the Mexican health system. OBJECTIVE: To review, update and improve the available evidence within clinical practice guidelines on the pharmacological management of rheumatoid arthritis and produce a set of recommendations adapted to the Mexican health system, according to evidence available through December 2012. METHODS: The working group was composed of 30 trained and experienced rheumatologists with a high quality of clinical knowledge and judgment. Recommendations were based on the highest quality evidence from the previously established treatment guidelines, meta-analysis and controlled clinical trials for the adult population with rheumatoid arthritis. RESULTS: During the conformation of this document, each working group settled the existing evidence from the different topics according to their experience. Finally, all the evidence and decisions were unified into a single document, treatment algorithm and drug standardization tables. CONCLUSIONS: This update of the Mexican Guidelines for the Pharmacologic Treatment of Rheumatoid Arthritis provides the highest quality information available at the time the working group undertook this review and contextualizes its use for the complex Mexican health system.


Asunto(s)
Artritis Reumatoide/tratamiento farmacológico , Algoritmos , Humanos
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