Screening Tool for Restrictive and Obstructive Ventilatory Abnormalities in a Population-Based Survey.

BACKGROUND: A 6 s spirometry with an inexpensive pocket spirometer efficiently selects individuals for a diagnostic-quality spirometry for airflow limitation, but could also be useful to identify individuals with a restrictive pattern. OBJECTIVES: We evaluated an inexpensive simplified spirometer (chronic obstructive pulmonary disease [COPD]-6) as a screening tool to identify spirometric abnormalities. METHODS: A population-based survey in Mexico City, with 742 participants performing pre- and post-BD spirometry and a three-maneuver 6 s spirometry (pre-BD) with a COPD-6. We evaluated forced expiratory volume in 1 s (FEV1), FEV6, and FEV1/FEV6 from the COPD-6, crude and expressed as the percentage of predicted (%P), to discriminate post-bronchodilator airflow obstruction (FEV1/forced vital capacity [FVC] < 5th percentile) or restriction (FVC or FEV1 <5th percentile with normal FEV1/FVC) through receiver operating characteristics and their area under the curve (AUC). RESULTS: FEV1%P was the best predictor to identify pre- and post-BD ventilatory abnormalities (best cutoff point 87%P, AUC 92% for restrictive pattern, 89% for obstructive pattern, and 91% for any spirometric abnormality). Deriving to clinical spirometry only those with < 87%P (26% of the sample) missed only 12% of spirometric abnormalities most of the latter mild. CONCLUSIONS: An FEV1 < 87%P from a pre-BD 6 s spirometry correctly identified individuals with spirometric ventilatory defects, either obstructive or restrictive.

Arsenic metabolism and cancer risk: A meta-analysis.

OBJECTIVE: To describe the studies that have reported association measures between risk of cancer and the percentage distribution of urinary inorganic arsenic (iAs) metabolites by anatomical site, in non-ecological epidemiological studies. METHODS: Studies were identified in the PubMed database in the period from 1990 to 2015. Inclusion criteria were: non-ecological epidemiological study, with histologically confirmed cancer cases, reporting the percentage distribution of inorganic arsenic (iAs), monomethylated (MMA) and dimethylated (DMA) metabolites, as well as association measures with confidence intervals (CI) between cancer and %iAs and/or %MMA and/or %DMA. A descriptive meta-analysis was performed by the method of the inverse of the variance for the fixed effects model and the DerSimonian and Laird's method for the random effects model. Heterogeneity was tested using the Q statistic and stratifying for epidemiological design and total As in urine. The possibility of publication bias was assessed through Begg's test. RESULTS: A total of 13 eligible studies were found, most of them were performed in Taiwan and focused on skin and bladder cancer. The positive association between %MMA and various types of cancer was consistent, in contrast to the negative relationship between %DMA and cancer that was inconsistent. The summary risk of bladder (OR=1.79; 95% CI: 1.42, 2.26, n=4 studies) and lung (OR=2.44; 95% CI: 1.57, 3.80, n=2 studies) cancer increased significantly with increasing %MMA, without statistical heterogeneity. In contrast, lung cancer risk was inversely related to %DMA (OR=0.58; 95% CI: 0.36, 0.93, n=2 studies), also without significant heterogeneity. These results were similar after stratifying by epidemiological design and total As in urine. No evidence of publication bias was found. CONCLUSION: These findings provide additional support that methylation needs to be taken into account when assessing the potential iAs carcinogenicity risk.

Dietary micronutrient intake and its relationship with arsenic metabolism in Mexican women.

INTRODUCTION: Concentrations of inorganic arsenic (iAs) metabolites in urine present intra- and interindividual variations, which are determined not only by the magnitude of exposure to iAs, but also by differences in genetic, environmental and dietary factors. OBJECTIVE: To evaluate whether differences in dietary intake of selected micronutrients are associated with the metabolism of iAs. METHODS: The intake of 21 micronutrients was estimated for 1027 women living in northern Mexico using a food frequency questionnaire. Concentration of urinary metabolites of iAs was determined by high performance liquid chromatography inductively coupled plasma mass spectrometry (HPLC-ICP-MS) and the proportion of iAs metabolites was calculated (%iAs, monomethylarsonic acid [%MMA] and dimethylarsinic acid [%DMA]), as well as ratios corresponding to the first (MMA/iAs), second (DMA/MMA) and total methylation (DMA/iAs). RESULTS: After adjustment for covariates, it was found that methionine, choline, folate, vitamin B12, Zn, Se and vitamin C favor elimination of iAs mainly by decreasing the %MMA and/or increasing %DMA in urine. CONCLUSIONS: Our results confirm that diet contributes to the efficiency of iAs elimination. Further studies are needed to assess the feasibility of dietary interventions that modulate the metabolism of iAs and the consequent risk of diseases related to its exposure.

[Correcting for misclassified HIV/aids deaths in Mexico: Retrospective analysis, 1983-2012]. / Corrección de la mala clasificación de las muertes por sida en México: Análisis retrospectivo de 1983 a 2012.

OBJECTIVE: To identify and reassign misclassified AIDS deaths in Mexico, reconstructing the time series of mortality from 1983 to 2012, by state, sex, age, and affiliation to social security. MATERIALS AND METHODS: 15.5 million deaths from 1979 to 2012 were analyzed. The HIV-AIDS mortality correction was done in three phases: a) those causes directly related to AIDS; b) by miscoded deaths, and c) AIDS deaths hidden in other underlying causes of death. Age-standardized rates of mortality (SMR) were calculated by sex, affiliation to social security, and state. RESULTS: 107 981 AIDS deaths from 1983 to 2012 were accumulated, representing 11% of total deaths observed for the period. The SMR in men for all age groups begins to decline since 1996, while for women the decline started in 2008. A similar picture is observed for the population with / without social security. Heterogeneity is a feature for SMR by state. CONCLUSION: An easily replicable methodology for the correction of mortality from AIDS, which generates relevant information for decision making based on the evidence is presented.

[Prevalence of severe periodontal disease and its association with respiratory disease in hospitalized adult patients in a tertiary care center]. / Prevalencia de enfermedad periodontal grave (EPG) y su asociación con enfermedades respiratorias en pacientes adultos hospitalizados en un centro de tercer nivel.

BACKGROUND: Severe periodontal disease is a chronic inflammatory gingival process associated with systemic diseases. OBJECTIVE: To determine the prevalence of severe periodontal disease and its association with respiratory diseases among hospitalized patients at the Institute of Respiratory Diseases "Ismael Cosio Villegas" (INER) in 2011. MATERIAL AND METHODS: A cross-sectional study was developed. The severe periodontal disease was diagnosed by the Department of Stomatology. The International Classification of Diseases 10th revision was used. A multinomial logistic was fit to estimate relative-risk. RESULTS: Three thousand and fifty-nine patients were included; 772/3,059 (25.2%) had severe periodontal disease. After controlling for age, sex, inpatient days, death, and socioeconomic status, the infectious respiratory diseases that were significantly associated with severe periodontal disease were: HIV/AIDS (RR: 10.6; 95% CI: 9.1-23.3; p < 0.0001); pneumonia (RR: 2.6; 95% CI: 2.2-5.7; p < 0.0001); pulmonary tuberculosis and its sequels (RR: 2.1; 95% CI: 1.6-4.9; p < 0.0001); and lung abscess (RR: 2.6; 95% CI: 1.6-7.8; p = 0.002). Lung cancer and pleural diseases were also significantly associated with severe periodontal disease. CONCLUSIONS: High prevalence of severe periodontal disease was observed in the different respiratory diseases. Severe periodontal disease was associated with both infectious and non-infectious respiratory diseases. It is important to study an oral health intervention.

The impact of altitude on hospitalization and hospital mortality from pandemic 2009 influenza A (H1N1) virus pneumonia in Mexico.

OBJECTIVE: To determine the effect of altitude of residence on influenza A (H1N1). MATERIALS AND METHODS: We analyzed 207 135 officially notified of influenza-like illness (ILI) cases, 23 048 hospitalizations and 573 deaths during the first months of the novel pandemic influenza A H1N1 virus, to examine if residents of high altitude had more frequently these adverse outcomes. RESULTS: Adjusted rates for hospitalization and hospital mortality rates increased with altitude, probably due to hypoxemia.

[Burden of disease, injuries, risk factors and challenges for the health system in Mexico]. / La carga de enfermedad, lesiones, factores de riesgo y desafíos para el sistema de salud en México.

OBJECTIVE: To present the results of the burden of disease, injuries and risk factors in Mexico from 1990 to 2010 for the principal illnesses, injuries and risk factors by sex. MATERIALS AND METHODS: A secondary analysis of the study results published by the Global Burden of Disease 2010 for Mexico performed by IHME. RESULTS: In 2010, Mexico lost 26.2 million of Disability adjusted live years (DALYs), 56 % were in male and 44 % in women. The main causes of DALYs in men are violence, ischemic heart disease and road traffic injuries. In the case of women the leading causes are diabetes, chronic kidney disease and ischemic heart diseases. The mental disorders and musculoskeletal conditions concentrate 18% of health lost. The risk factors that most affect men in Mexico are: alcohol consumption, overweight/obesity, high blood glucose levels and blood pressure and tobacco consumption (35.6 % of DALYs lost). In women, overweight and obesity, high blood sugar and blood pressure, lack of physical activity and consumption of alcohol are responsible for 40 % of DALYs lost. In both sexes the problems with diet contribute 12% of the burden. CONCLUSIONS: The epidemiological situation in Mexico, demands an urgent adaptation and modernization of the health system.

[National consensus of diagnosis and treatment of non-small cell lung cancer]. / Consenso nacional de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas.

Mexican specialists in oncology, oncologic surgery, thoracic surgery, pneumology, pathology, molecular biology, anesthesiology, algology, psychology, nutrition, and rehabilitation (all of them experts in lung cancer treatment) in order to develop the National Consensus on Lung Cancer. The consensus has been developed as an answer to the need of updated Mexican guidelines for the optimal treatment of the disease, as well as to the requirements that such guidelines be established by multidisciplinary panel, depicting the current attention given to cancer lung cases in Mexico. Thus, this paper analyses the epidemiological review, screening, diagnosis, staging, pathology, translational medicine, and the suitable therapies for early, locally advanced, and metastatic disease in the first, second, and third lines of management, as well as rehabilitation and palliative measures.

[Adult asthma in Mexico City: a population-based study]. / Prevalencia y riesgos asociados con pacientes adultos con asma de 40 años o más de la Ciudad de México: estudio de base poblacional.

OBJECTIVES: To determine the prevalence of asthma and the association between sociodemographic characteristics, spirometry, respiratory symptoms, quality of life and sleep in adults > 40 years. MATERIALS AND METHODS: This report is part of our study (Latin American Research Project Obstructive Pulmonary), held in Mexico City and the metropolitan area in 2003. We used logistic regression models adjusted for study design, where asthma was the dependent and independent variable respiratory symptoms, sociodemographic and clinical characteristics among others. RESULTS: The prevalence of physician-diagnosed asthma was: 3.3% in men and 6.2% in women. Decreased lung function in asthmatics was observed. In multivariate analysis, after adjusting for potential confounders, asthmatics had a higher risk of excessive daytime sleepiness more snoring [OR = 3.2 (95% CI 1.4-7.4), p= 0.008], and more frequent work absences due to respiratory problems [OR = 5.1 (95% CI 2.5-10.4), p<0.0001]. CONCLUSIONS: The prevalence of asthma was 5%. Asthmatics showed lower quality of life and lung function.

Demand for care and nosocomial infection rate during the first influenza AH1N1 2009 virus outbreak at a referral hospital in Mexico City.

OBJECTIVE: Comparison of routine hospital indicators (consults at the Emergency Room (ER) and hospital admissions) during the 2009 pandemic of the influenza AH1N1 virus at the national referral hospital for respiratory diseases in Mexico City. MATERIAL AND METHODS: The outbreak was from April to mid-May 2009 and two control periods were used:2009 (before and after the outbreak),and during April-May from 2007 and 2008. RESULTS: During the outbreak total consultation at the ER increased six times compared with the 2007-2008 control period and 11 times compared with the 2009 control period. Pneumonia- or influenza-related ER consultations increased 23.2 and 15.3%, respectively. The rate of nosocomial infection during the outbreak was 13.6 and that of nosocomial pneumonia was 6 per/100 hospital discharges, a two-fold and three-fold increase compared to the control periods respectively. CONCLUSIONS: During the outbreak,mean severity of admitted patients increased,with a rise in in-hospital mortality and nosocomial infections rate, including nosocomial pneumonia.

[Progress on the Millenium Development Goals 4 and 5 in Mesoamerica]. / Avances en los Objetivos de Desarrollo del Milenio 4 y 5 en Mesoamérica.

OBJECTIVES: To describe the advances made by countries in the Mesoamerican region towards reaching Millenium Development Goals (MDG) 4 and 5, and discuss the most useful tasks to help the region in accomplishing or keeping track of these objectives. MATERIAL AND METHODS: The trend estimates of maternal and under 5 mortality from 1990 to 2008, the effective coverage of vaccination against diphteria, pertussis and tetanus (DPT), prenatal care and childbirth by qualified personnel were taken from the Institute of Health Metrics and Evaluation (IHME) and the causes of death for children under five were taken from the Children's Health Epidemiology Reference Group of WHO (CHERG). RESULTS: The regional trend in the rate of mortality for children under five (MDG-4) in the last 18 years shows an annual reduction of 4.2%, significantly above the global reduction of 2.1%. This suggests that countries of Mesoamerica will be able to fulfill this objective. In contrast, data for 2008 shows that the rate of reduction of maternal mortality is very heterogeneous and it is unlikely that any of the countries in the region will reach this goal. CONCLUSION: Efforts made by countries in Mesoamerica have been substantial in controlling mortality in children under five years but insufficient to achieve MDG-5. Although the tendency is in the right track the reduction rate will only partially fulfill the acquired commitments to eradicate poverty.

[Burden of disease in Latin America]. / La carga de la enfermedad en países de América Latina.

OBJECTIVE: To describe the burden of disease studies made in the region, identify the main priorities in health from the indicator Disability Adjusted Life Years (DALYs). MATERIAL AND METHODS: By the use of DALYs identify the burden of disease in the countries in the network. RESULTS: DALYs emphasize the emergency of mental disorders, diabetes mellitus in women and the disorders associated with alcohol consumption and injuries in men. CONCLUSIONS: Latin America is the region with more national studies of burden of disease, using a standardized methodology, that allows identifying new health priorities which are pressing to the health services; for that reason these results constitute an element to take into account in the establishment of public policies in each country.

[An indirect estimation of current and future inequalities in the frequency of end stage renal disease in Mexico]. / Una estimación indirecta de las desigualdades actuales y futuras en la frecuencia de la enfermedad renal crónica terminal en México.

OBJECTIVE: To describe current and future health inequalities in End Stage Renal Disease in Mexico (ESRD) in Mexican states with varying degrees of marginality. MATERIAL AND METHODS: Using results, obtained by us in 2009, of an indirect estimation of incidence, prevalence, and mortality rates, and of the average case duration, we grouped these data according to the social deprivation level of the Mexican states. We measured health inequalities using the Health Concentration Index. RESULTS: We found rising inequalities, between 2005 and 2025, in ESRD incidence, prevalence and mortality rates, as well as in the average duration of cases. CONCLUSION: We project an important increase in the prevalence of ESRD for 2025 which will be greater in the Mexican states with more marginality. This will increase health inequities already present and represent important challenges for health care financing, especially if no action is taken to control the causes and progression of ESRD.

Pandemic (H1N1) 2009 virus and Down syndrome patients.

We compared prevalence of hospitalization, endotracheal intubation, and death among case-patients with and without Down syndrome during pandemic (H1N1) 2009 in Mexico. Likelihoods of hospitalization, intubation, and death were 16-fold, 8-fold, and 335-fold greater, respectively, for patients with Down syndrome. Vaccination and early antiviral drug treatment are recommended during such epidemics.

The Mini-mental State Examination revisited: ceiling and floor effects after score adjustment for educational level in an aging Mexican population.

BACKGROUND: The Mini-mental State Examination (MMSE) is the most widely used cognitive test, both in clinical settings and in epidemiological studies. However, correcting its score for education may create ceiling effects when used for poorly educated people and floor effects for those with higher education. METHODS: MMSE and a recent cognitive test, the seven minute screen (7MS), were serially administered to a community sample of Mexican elderly. 7MS test scores were equated to MMSE scores. MMSE-equated 7MS differences indicated ceiling or floor effects. An ordinal logistic regression model was fitted to identify predictors of such effects. RESULTS: Poorly educated persons were more prevalent on the side of MMSE ceiling effects. Concentration (serial-sevens), orientation and memory were the three MMSE subscales showing the strongest relationship to MMSE ceiling effects in the multivariate model. CONCLUSION: Even when MMSE scores are corrected for educational level they still have ceiling and floor effects. These effects should be considered when interpreting data from longitudinal studies of cognitive decline. When an education-adjusted MMSE test is used to screen for cognitive impairment, additional testing may be required to rule out the possibility of mild cognitive impairment.

[Adult smoking trends in Mexico between 1988 and 2008]. / Tendencias del tabaquismo en adultos en México entre 1988 y 2008.

OBJECTIVE: To describe the changes in several smoking indicators occurred in Mexico over the past two decades and to explore if the tobacco control policies implemented in Mexico, since 2004, show a favorable impact on tobacco consumption by 2008. MATERIALS AND METHODS: We analyze trends in comparable data on the prevalence of never and daily smokers, using the five National Addiction Surveys conducted between 1988 and 2008. The analysis is restricted to persons aged 18 through 65 years. Data are adjusted for age, sex and marginality index. RESULTS: Between 2002 and 2008 the percentage of never smokers has increased by 19.6% and the percentage of daily smokers has decreased by 24.8%. These changes were more important in men, but in women the average number of cigarettes consumed decreased by 21.1% over the compared period and there was also a 13.9% rise in the percentage of women attempting to quit. Daily smokers prevalence has declined more rapidly since 2005, coincidently with an increase in cigarette taxation. CONCLUSIONS: Over the past two decades there has been in Mexico an increase in the percentage of never smokers and a decline in the percentage of daily smokers. A positive impact is observed, few years after the implementation of more effective tobacco control policies in Mexico, notably higher taxation of tobacco products.

A frailty index to predict the mortality risk in a population of senior Mexican adults.

BACKGROUND: Frailty in the elderly can be regarded as nonspecific vulnerability to adverse health outcomes, caused by multiple factors. The aim was to analyze the relationships between the frailty index, age and mortality in a two year follow up study of Mexican elderly. METHODS: A frailty index was developed using 34 variables. To obtain the index, the mean of the total score for each individual was obtained. Survival analyses techniques were used to examine the risk ratios for the different levels of the frailty index. Kaplan-Meier estimates were obtained, adjusted for age and gender. Cox proportional hazards models were also built to obtain hazard ratio estimates. RESULTS: A total of 4082 participants was analyzed. Participants had an average age of 73 years and 52.5% were women. On average, participants were followed-up for 710 days (standard deviation = 111 days) and 279 of them died. Mortality increased with the frailty index level, especially in those with levels between .21 to .65, reaching approximately 17% and 21%, respectively. Cox proportional hazards models showed that participants with frailty index levels associated to increased mortality (.21 and higher) represent 24.0% of those aged 65-69 years and 47.6% of those 85 and older. CONCLUSION: The frailty index shows the properties found in the other studies, it allows stratifying older Mexican into several groups different by the degree of the risk of mortality, and therefore the frailty index can be used in assessing health of elderly.

Breast cancer mortality in Mexico: an age-period-cohort analysis.

OBJECTIVE: To assess the age, period and cohort effects on breast cancer (BC) mortality in Mexico. MATERIAL AND METHODS: Age, period and cohort curvature trends for BC mortality were estimated through the Poisson Regression model proposed by Holford. RESULTS: Nationally, BC death rates have leveled off since 1995 in most age groups. BC mortality trends are mainly determined by birth cohort and age effects in Mexico. Women born between 1940 and 1955 show the highest rate of increase in BC mortality. Women born afterwards still show an increasing trend but at a much lower rate. Mammography and adjuvant therapy have had a limited impact on mortality. Potential reasons for observed patterns are discussed. An increase in BC mortality in Mexico is expected in the following decades. CONCLUSIONS: Mammography screening programs and timely access to effective treatment should be a national priority to reverse the expected increasing BC mortality trend.

Depressive symptoms among older adults in Mexico City.

BACKGROUND: Ageing and depression are associated with disability and have significant consequences for health systems in many other developing countries. Depression prevalence figures among the elderly are scarce in developing countries. OBJECTIVE: To estimate the prevalence of depressive symptoms and their cross-sectional association with selected covariates in a community sample of Mexico City older adults affiliated to the main healthcare provider. DESIGN: Cross-sectional, multistage community survey. PARTICIPANTS: A total of 7,449 persons aged 60 years and older. MEASUREMENTS: Depression was assessed using the 30-item Geriatric Depression Scale (GDS); cognitive impairment, using the Mini-Mental State Examination; and health-related quality of life with the SF-36 questionnaire. MAIN RESULTS: The prevalence of significant depressive symptoms was estimated to be 21.7%, and 25.3% in those aged 80 and older. After correcting for GDS sensitivity and specificity, major depression prevalence was estimated at 13.2%. Comparisons that follow are adjusted for age, sex, education and stressful life events. The prevalence of cognitive impairment was estimated to be 18.9% in depressed elderly and 13.7% in non-depressed. SF-36 overall scores were 48.0 in depressed participants and 68.2 in non-depressed (adjusted mean difference = -20.2, 95% CI = -21.3, -19.1). Compared to non-depressed elderly, the odds of healthcare utilization were higher among those depressed, both for any health problem (aOR 1.4, 95% CI = 1.1, 1.7) and for emotional problems (aOR 2.7, 95% CI = 2.2, 3.2). CONCLUSIONS: According to GDS estimates, one of every eight Mexican older adults had major depressive symptoms. Detection and management of older patients with depression should be a high priority in developing countries.

Dietary flavonoids improve urinary arsenic elimination among Mexican women.

Inorganic arsenic (iAs) exposure increases risk of several diseases, including cancer. Some nutrients such as flavonoids enhance glutathione activity, which in turn play a key role in iAs elimination. Our objective was to explore whether dietary non-soy flavonoids are associated with iAs metabolism. We hypothesized that the intake of flavonoids belonging to the following groups, flavan-3-ols, flavone, flavonol, flavanone, and anthocyanidin, is positively associated with urinary dimethylarsinic acid (DMA), which is the most soluble iAs metabolite excreted. We performed a cross-sectional study that included 1027 women living in an arsenic-contaminated area of northern Mexico. Flavonoid intake was estimated using a validated food frequency questionnaire. Concentration of urinary iAs and its metabolites (monomethylarsonic acid and DMA) were determined by high performance liquid chromatography ICP-MS. Results showed positive significant associations between DMA and the flavonoid groups flava-3-ols (ß= 0.0112) and flavones (ß= 0.0144), as well as the individual intake of apigenin (ß= 0.0115), luteolin (ß= 0.0138), and eriodictyol (ß= 0.0026). Our findings suggest that certain non-soy flavonoids may improve iAs elimination; however, there is still very limited information available regarding the consumption of flavonoids and iAs metabolism.