The Household Water Insecurity Experiences Scale: answer patterns and cutoffs in Mexico.

OBJECTIVE: To investigate the degree in which answer patterns in the Household Water Insecurity Experiences Scale (HWISE) relate to scores aiming at identifying latent groups with different water insecurity levels in a nationwide representative sample of the Mexican population. MATERIALS AND METHODS: Based on data from the 2021 National Survey on Health and Nutrition (Estudio Nacional de Salud y Nutrición 2021, Ensanut 2021), sequence data representations, and a latent class analysis (LCA), in this article we estimate the likely misclassification errors of different cutoffs proposed for the HWISE scoring system. RESULTS: The main results suggest that a 5-item subset of the HWISE may exhibit a more reliable and cost-effective behavior than the complete 12-item set for a 2-level partition of the sample. CONCLUSIONS: Our methodological approach provides new insights regarding the efficiency and likely errors in distinguishing between levels of water insecurity based on the Mexican chapter of the HWISE.

On the comparability of frailty scores under the accumulation of deficits approach.

BACKGROUND: While the cumulative deficit model is arguably the most popular instrument for population-level frailty screening, several questions remain unanswered regarding the comparability of the resulting scores across subpopulations. METHODS: Based on data from the five waves of the Mexican Health and Aging Study (MHAS) we draw upon the alignment method to test for measurement invariance of frailty scores as per the accumulation of deficits approach. RESULTS: Our results show that adjusting for measurement non-invariance not only improves predictive validity of our frailty measures, but resulting scores are more consistent with what is theoretically expected from them in longitudinal research. CONCLUSIONS: There are clear potential benefits of measurement invariance testing as a general analytical framework from which to tackle with issues of comparability in frailty research.

An Entropy-Based Approach to Measuring Diet Adherence.

The aim of this study is to put forward an approach designed to calculate and sum up discrepancies between the actual food acquisition or intake and any standard or norm. Based on secondary analysis of cross-sectional data from the Mexican National Survey of Household Income and Expenditure, our proposed method to produce classes of entropy-based Diet Adherence Indices generates a Food Basket Adherence Index (FBAI) for Mexico City (2129 households). Findings suggest that it is possible to measure and decompose diet adherence using a cross entropy measure. Using food expenditure data and a normative food basket for Mexico City results, we show households' deviations from the suggested norm for different food groups. The average FBAI was 0.44, far above the minimum score of 0 which would indicate full adherence to the normative food basket. Our measure has a distribution wide enough to detect meaningful changes and distinguish between groups with known differences, providing important new insights on the linkages between home food environments and income distribution, and food insecurity and household distribution.

Single Dose of Tranexamic Acid Effectively Reduces Blood Loss in Patients Undergoing Spine Surgery: A Prospective Randomized Controlled Trial.

OBJECTIVE: To evaluate the efficacy of oral administration of tranexamic acid (TXA) in spine surgery to achieve blood loss reduction. METHODS: Sixty patients undergoing major surgery of the spine were randomly assigned into 2 groups. Group 1 was assigned as the control group and the other group comprised patients who received oral administration of TXA 2 hours before surgery. Outcome measures included intraoperative blood loss, postoperative blood loss, hematologic parameters, blood transfusion needed, and surgical complications. RESULTS: Sixty patients linked up with the inclusion criteria. Intraoperative blood loss was significantly lower in the TXA oral group than in the control group; total blood loss in the TXA group was 930.66 ± 614 mL, which was lower than in the control group, with 1075.66 ± 956.11 mL. The mean reduction of hemoglobin was almost the same in both groups. Similarly, the total transfusion package received was lower, and the number of complications and length of stay were akin in both groups. A logistic regression model was performed with patients who had blood loss >1000 mL and surgery time >230 minutes. This result was related to the risk of bleeding, with an odds ratio of 1.31, 95% confidence interval, 1.004-1.023, P = 0.004, independent of the group. CONCLUSIONS: Oral TXA is as an effective measure for reducing total blood loss among patients undergoing elective spine surgery.

Living arrangement dynamics of older adults in Mexico: Latent class analysis in an accelerated longitudinal design.

BACKGROUND: Because living arrangements have many implications for the well-being of older adults, knowledge regarding typical age-related developmental changes in living arrangements is of a major concern for public health policymakers, particularly in low- and middle-income countries dealing with growing aging populations. However, the much-needed empirical analysis of living arrangement dynamics is hindered by a lack of proper data. OBJECTIVE: To exploit often-available short-term longitudinal data in the study of long-term phenomena, in this paper we accelerate the Mexican Health and Aging Study (MHAS) panel as a means to explore, over a broad age span, the household dynamics of Mexican older adults. METHODS: Instead of working with a priori definitions of different household structures when analyzing transitions between them, we introduce a novel approach that estimates latent classes of developmental trends in the household composition of older people as they age. RESULTS: We show how accelerated longitudinal designs, coupled with latent class analysis, can offer new insights into living arrangement dynamics. Our findings suggest that in Mexico the typical living arrangements at 50 years old serve as an important predictor of future living arrangements, and that typical living-arrangement trajectories are strongly gendered in Mexico. This new approach may prove to be indispensible when determining the social support needed by high-risk population groups and as a means to better anticipate the necessary financial resources to do so.

The roll-out of a health insurance program and its impact on the supply of healthcare services: a new method to evaluate time-varying continuous interventions.

BACKGROUND: We analyze the effects of the Mexican universal health insurance program, Seguro Popular, on key variables associated with the provision of healthcare services. Given that the program was introduced gradually over a period that lasted more than a decade, the dynamics of the roll-out of the program and its reaction to the expansion of healthcare services it caused should be accounted for when evaluating the program. METHODS: We present a new semiparametric procedure to analyze time-varying continuous interventions. This is accomplished by bringing together the literatures on continuous and on dynamic treatments. Our approach allows the researcher to estimate mean and quantile dose-response functions by applying local regression methods to appropriately weighted samples that control for time-dependent confounding. RESULTS: Using administrative data, we show compelling evidence that Seguro Popular has incremented the human and physical resources available for healthcare services over the period 2001-2013. Moreover, we show that these effects have been heterogeneously distributed. CONCLUSIONS: The program has proven most helpful in less vulnerable territories, leaving behind those in greater need.