Survival rates and worker compensation expenses in a national cohort of Mexican workers with permanent occupational disability caused by diabetes.

BACKGROUND: Permanent occupational disability is one of the most severe consequences of diabetes that impedes the performance of usual working activities among economically active individuals. Survival rates and worker compensation expenses have not previously been examined among Mexican workers. We aimed to describe the worker compensation expenses derived from pension payments and also to examine the survival rates and characteristics associated with all-cause mortality, in a cohort of 34,014 Mexican workers with permanent occupational disability caused by diabetes during the years 2000-2013 at the Mexican Institute of Social Security. METHODS: A cross-sectional analysis study was conducted using national administrative records data from the entire country, regarding permanent occupational disability medical certification, pension payment and vital status. Survival rates were estimated using the Kaplan-Meier method. Multivariate Cox proportional hazard model was used to estimate adjusted hazard ratios (HR) and 95 % confidence intervals (95 % CI) in order to assess the cohort characteristics and all-cause mortality risk. Total expenses derived from pension payments for the period were accounted for in U.S. dollars (USD, 2013). RESULTS: There were 12,917 deaths in 142,725.1 person-years. Median survival time was 7.26 years. After multivariate adjusted analysis, males (HR, 1.39; 95 % CI, 1.29-1.50), agricultural, forestry, and fishery workers (HR, 1.41; 95 % CI, 1.15-1.73) and renal complications (HR, 3.49; 95 % CI, 3.18-3.83) had the highest association with all-cause mortality. The all-period expenses derived from pension payments amounted to $777.78 million USD (2013), and showed a sustained increment: from $58.28 million USD in 2000 to $111.62 million USD in 2013 (percentage increase of 91.5 %). CONCLUSIONS: Mexican workers with permanent occupational disability caused by diabetes had a median survival of 7.26 years, and those with renal complications showed the lowest survival in the cohort. Expenses derived from pension payments amounted to $ 777 million USD and showed an important increase from 2000 to 2013.

[Health and globalization in the San Diego-Tijuana region]. / Globalización y salud en la región San Diego-Tijuana.

The international process of trading goods and services with significant reduction in barriers known as globalization is clearly observed at the San Diego-Tijuana region. This essay addresses issues arising at this unique geographical area associated with the globalization process and its public health consequences. Social, cultural and political aspects have very important implications on the health status of the U.S-Mexican population and in the health care systems on both sides of the border. One of the most powerful world economies borders a developing country resulting in a dramatic comparison that has negative outcomes such as health disparities, high prevalence of chronic diseases and new epidemiological risks. Poverty and migration are a few of the contributing factors triggering this asymmetrical relationship. Challenges in border health require a comprehensive binational participation and the solutions are yet to be determined.

Obesity and socioeconomic status in children of Tijuana.

BACKGROUND: Although obesity has been associated with socioeconomic status among Hispanics living in the United States, little is known about whether a similar association exists among Hispanics living in Mexico, particularly among those living along the U.S.-Mexico border. OBJECTIVE: To determine the prevalence of obesity and its association with socioeconomic status in Mexican schoolchildren attending public and private schools in Tijuana, Baja California. METHODS: Anthropometric measurements and socioeconomic status were assessed in a cross-sectional study of 1172 school children, aged 6 to 13 years from 55 schools in Tijuana in 2001-2002. Underweight (body mass index [BMI] for age 5th percentile or lower), risk of overweight (BMI at 85th percentile or higher), and overweight (BMI greater than 95th percentile) were assessed using charts published by the Centers for Disease Control and Prevention. RESULTS: Abnormalities in weight were found in 46.3% of 587 boys and 43.7% of 585 girls in the study. Undernutrition was found in 3.7% of the boys and 3.8% of the girls. The general prevalence of overweight was 23.2% for boys and 21.7% for girls. Children living in low-income neighborhoods had the thickest biceps skinfolds (p<0.01), while children living in moderate-income neighborhoods and attending public schools had the thickest triceps skinfolds (p<0.001). Although boys living in high socioeconomic status neighborhoods were at decreased risk for being overweight, boys and girls attending private schools had a 75% increased risk (odds ratio, 1.75; confidence interval, 1.22-2.52) of being overweight than children attending public schools. CONCLUSIONS: Adiposity varies by type of school and neighborhood socioeconomic status. The biphasic curve in risk for being overweight associated with neighborhood socioeconomic status suggests that Mexican children living along the U.S. border may be experiencing a nutrition transition with respect to an increased risk of obesity and related chronic disease.

[Diagnostic radiology in the technological era. Comparison between two models]. / Radiología diagnóstica en la era tecnológica. Comparación entre dos modelos.

Diagnostic Radiology is a medical specialty that has played a dynamic role in the medical arena during the last three decades of the XX century. As a part of the evolution of this specialty, medicine and society at large have received diverse benefits in areas of diagnosis and for the decision making process in the clinical practice. Modern radiology has provided numerous advances and refined tools that give more convenience speed and precise diagnosis in the current medical practice. At the present time, these technologies are part of the standard of care in the US and other industrialized countries, representing the ultimate desire or goal to reach for other healthcare systems in developing countries as well. Unfortunately, many of the clinical skills in the health care personal have not evolved at the same pace of those modern technologies, conditioning a reduction in the performance of sensitive areas to the patient's interest, such as the caring, compassion and quality of health care. It is unquestionable the value and benefits that technologies such as CAT and MRI scans have brought to the standard practice in the recent time. Nonetheless, it is desirable to maintain the highest possible level of clinical skills despite the extended use of modern technologies by the health personnel, without compromising the quality of care. Yet is pending the future role and rational use for those technologies in radiology, especially in times when delivering good, reliable health care have become a priority for many health institutions worldwide. This approach would be the ultimate goal to reach in times and circumstances where health for all is the highest precious value to obtain at global level.

[Globalization and bioethics in health resources]. / Globalización y bioética en los recursos para la salud.

Globalization is the term used to explain the exchange of goods and services around the globe. Economy, finances, technology, and information are diversified and spread all throughout the world at present. However, it is still being debated whether the global economic paradigm can be applied under considerations of justice and equity for healthcare systems or in the budget for research administration. This issue has become decisive, especially in countries where adequate development remains a pending public endeavor.

[The Nazis, guide of the International Conference of Harmonization and ethics committees]. / Los Nazis, la guía de la Conferencia Internacional de Armonización (ICH) y los comités de ética.

This article begins with the basic ethical principles in clinical research. The four moral principles of autonomy, beneficence, non-maleficence, and justice are reviewed. Likewise, a historical review of the participation of German physicians and the medical establishment that carried out the policies of the Third Reich is examined, and delineates several moral failures attributable to these physicians during the dark period of history known as the Holocaust. Medical ethics were completely ignored during that period, and thus, the Nuremberg Code was enacted for regulating human research by means of informed consent. A historical vision of the universal documents for ethics in clinical research has been reviewed from the Declaration of Helsinki in 1964 to the ICH Guideline (International Conference of Harmonisation) for Good Clinical Practice (GCP) in 1996. The ICH Guideline is an international ethical and scientific quality standard for designing, conducting, recording, and reporting trials that involve participation of human subjects. The guide was developed with consideration of the current GCP of the European Union, Japan, and the U.S. Finally, we establish the composition, functions, and operations of the Ethic Committees that ensure the rights, safety, well-being, and confidentiality statement of subjects who participate in clinical research studies and document that protection by reviewing and approving/rejecting a study protocol, and evaluate research personnel, the research site, and materials and methods used for obtaining and recording informed consent protocol from subjects participating in the study.

Prevalence of diabetes among Hispanics/Latinos from diverse backgrounds: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

OBJECTIVE: We examine differences in prevalence of diabetes and rates of awareness and control among adults from diverse Hispanic/Latino backgrounds in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). RESEARCH DESIGN AND METHODS: The HCHS/SOL, a prospective, multicenter, population-based study, enrolled from four U.S. metropolitan areas from 2008 to 2011 16,415 18-74-year-old people of Hispanic/Latino descent. Diabetes was defined by either fasting plasma glucose, impaired glucose tolerance 2 h after a glucose load, glycosylated hemoglobin (A1C), or documented use of hypoglycemic agents (scanned medications). RESULTS: Diabetes prevalence varied from 10.2% in South Americans and 13.4% in Cubans to 17.7% in Central Americans, 18.0% in Dominicans and Puerto Ricans, and 18.3% in Mexicans (P < 0.0001). Prevalence related positively to age (P < 0.0001), BMI (P < 0.0001), and years living in the U.S. (P = 0.0010) but was negatively related to education (P = 0.0005) and household income (P = 0.0043). Rate of diabetes awareness was 58.7%, adequate glycemic control (A1C <7%, 53 mmol/mol) was 48.0%, and having health insurance among those with diabetes was 52.4%. CONCLUSIONS: Present findings indicate a high prevalence of diabetes but considerable diversity as a function of Hispanic background. The low rates of diabetes awareness, diabetes control, and health insurance in conjunction with the negative associations between diabetes prevalence and both household income and education among Hispanics/Latinos in the U.S. have important implications for public health policies.

Ethnic differences in complementary and alternative medicine use among patients with diabetes.

OBJECTIVE: To evaluate the effect of ethnicity as a predictor of the use of complementary and alternative medicine (CAM) among patients with diabetes. DESIGN AND SETTINGS: A 16-item questionnaire investigating CAM use was distributed among patients attending the Taking Control of Your Diabetes (TCOYD) educational conferences during 2004-2006. Six TCOYD were held across the United States. Information of diabetes status and sociodemographic data was collected. CAM use was identified as pharmacologic (herbs and vitamins) and nonpharmacologic CAMs (e.g., prayer, yoga, and acupuncture). RESULTS: The prevalence of pharmacologic and non-pharmacologic CAMs among 806 participants with diabetes patients was 81.9% and 80.3%, respectively. Overall, CAM prevalence was similar for Caucasians (94.2%), African Americans (95.5%), Hispanics (95.6%) and Native Americans (95.2%) and lower in Pacific Islanders/others (83.9%) and Asians (87.8%). Pharmacologic CAM prevalence was positively associated with education (p=0.001). The presence of diabetes was a powerful predictor of CAM use. Several significant ethnic differences were observed in specific forms of CAM use. Hispanics reported using frequently prickly pear (nopal) to complement their diabetes treatment while Caucasians more commonly used multivitamins. CONCLUSIONS: Treatment with CAM widely used in persons with diabetes. Ethnic group differences determine a variety of practices, reflecting groups' cultural preferences. Future research is needed to clarify the perceived reasons for CAM use among patients with diabetes in clinical practice and the health belief system associated with diabetes by ethnic group.

Family history of diabetes, parental body mass index predict obesity in Latino children.

PURPOSE: The purpose of this study is to examine the association between family history of diabetes (FHD), body mass index (BMI), and acculturation with children's BMI status. METHODS: Baseline data from a randomized community intervention trial promoting healthy eating and physical activity were collected in children living in San Diego, California. A self-administered survey was completed by primary caregivers at each school assessing maternal diabetes, BMI, acculturation, and socioeconomic status (SES). Anthropometric data (height, weight, and BMI) from mothers and children were also collected. RESULTS: A total of 812 caregivers completed the baseline survey. Adjusting for maternal age, marital status, and socioeconomic level, women who had been diagnosed with diabetes or gestational diabetes or who received diabetes treatment were significantly more likely to have overweight children. Maternal BMI was also associated with children's weight. Maternal acculturation level was marginally associated with children's BMI. CONCLUSIONS: FHD, gestational diabetes, and BMI were associated with children's overweight status. More comprehensive interventions are needed to prevent obesity in Latino children and adults.

Globalización y salud en la región San Diego-Tijuana / Health and globalization in the San Diego-Tijuana region

En este ensayo se describen algunas las circunstancias de esta zona del mundo y sus consecuencias para la salud pública de Norteamérica. La globalización se define como el intercambio de bienes y servicios facilitado por la reducción de barreras en el mercado internacional. Un ejemplo de este proceso se encuentra en la frontera San Diego-Tijuana. Los efectos socioeconómicos y culturales regionales tienen un impacto profundo en los aspectos de la salud no solamente para la población de esta zona sino también para los sistemas de salud de México y Estados Unidos. En este punto se reúnen el poderío económico y el subdesarrollo al mismo tiempo, resultando desigualdades en la salud, aumento de enfermedades crónico-degenerativas, infecciosas y otras, en donde la pobreza y migración constituyen un detonante mayor. La solución a la problemática en esta realidad fronteriza de salud está aún por determinarse.

The international process of trading goods and services with significant reduction in barriers known as globalization is clearly observed at the San Diego-Tijuana region. This essay addresses issues arising at this unique geographical area associated with the globalization process and its public health consequences. Social, cultural and political aspects have very important implications on the health status of the U.S-Mexican population and in the health care systems on both sides of the border. One of the most powerful world economies borders a developing country resulting in a dramatic comparison that has negative outcomes such as health disparities, high prevalence of chronic diseases and new epidemiological risks. Poverty and migration are a few of the contributing factors triggering this asymmetrical relationship. Challenges in border health require a comprehensive binational participation and the solutions are yet to be determined.

Radiología diagnóstica en la era tecnológica: Comparación entre dos modelos / Diagnostic radiology in the technological era: Comparison between two models

La utilización de la tecnología como auxiliar en el diagnóstico y terapéutica médica tuvo su mayor desarrollo y esplendor durante las últimas décadas del siglo XX, debido a los beneficios directos que la radiología ofreció al proceso salud enfermedad, representando sin duda uno de los campos más dinámicos de la práctica médica. Sin embargo, en sociedades con alto desarrollo científico -económico (así como en algunas otras sociedades que intentan llegar a ese nivel) algunos de los valores humanos de la práctica médica como la compasión, la misericordia, calidez y algunas habilidades clínicas para el diagnóstico han sido desplazadas a menudo por el abuso de la tecnología, favoreciendo un empobrecimiento de la relación médico paciente, el encarecimiento de insumos, así como disminución en la satisfacción en los servicios de salud. Algunos medios de diagnóstico en la radiología actual como la tomografía axial computada (TAC), la resonancia magnética nuclear (RMN) o laboratorios de alta especialización, brindan eficiencia y velocidad en el diagnóstico y representan el ideal a seguir en muchos servicios de atención a la salud en diversos niveles de atención, en países en desarrollo. Sin embargo, esta visión de la práctica médica basada primordialmente en la ponderación de la tecnología también cuenta con numerosos claroscuros; por un lado, estos medios brindan el diagnóstico cercano a la verdad nosológica de la enfermedad con precisión asombrosa, pero de la misma manera si no son utilizados con mesura y reflexivamente dejan al descubierto aspectos delicados en el área afectiva del paciente y en la calidad en la relación con el prestador de servicios.

Diagnostic Radiology is a medical specialty that has played a dynamic role in the medical arena during the last three decades of the XX century. As a part of the evolution of this specialty, medicine and society at large have received diverse benefits in areas of diagnosis and for the decision making process in the clinical practice. Modern radiology has provided numerous advances and refined tools that give more convenience speed and precise diagnosis in the current medical practice. At the present time, these technologies are part of the standard of care in the US and other industrialized countries, representing the ultimate desire or goal to reach for other healthcare systems in developing countries as well. Unfortunately, many of the clinical skills in the health care personal have not evolved at the same pace of those modern technologies, conditioning a reduction in the performance of sensitive areas to the patient's interest, such as the caring, compassion and quality of health care. It is unquestionable the value and benefits that technologies such as CA T and MRI scans ha ve brought to the standard practice in the recent time. Nonetheless, it is desirable to maintain the highest possible level of clinical skills despite the extended use of modern technologies by the health personnel, without compromising the quality of care. Yet is pending the future role and rational use for those technologies in radiology, especially in times when delivering good, reliable health care have become a priority for many health institutions worldwide. This approach would be the ultimate goal to reach in times and circumstances where health for all is the highest precious value to obtain at global level.

Globalización y bioética en los recursos para la salud / Globalization and Bioethics in Health Resources

Globalización es el término que se usa en la actualidad para definir la diversidad con la que bienes y servicios de consumo se pueden intercambiar de manera directa alrededor del mundo. La economía, finanzas, tecnología e información se diversifican y hacen presentes en diferentes partes del mundo. Sin embargo, queda pendiente considerar si este paradigma global debe o no aplicarse en la administración de recursos y servicios para la atención y la investigación en salud, en países en donde el desarrollo es aún una asignatura pendiente.

Globalization is the term used to explain the exchange of goods and services around the globe. Economy, finances, technology, and information are diversified and spread all throughout the world at present. However, it is still being debated whether the global economic paradigm can be applied under considerations of justice and equity for healthcare systems or in the budget for research administration. This issue has become decisive, especially in countries where adequate development remains a pending public endeavor.

Reflexiones acerca de algunos dilemas en bioética para el próximo milenio / Reflections on some dilemas in bioethics for the next millennium

Con el fin del milenio se presenta una serie de propuestas para la sociedad mundial concernientes a la política, cultura y economía, en las que la globalización es el común denominador. La ciencia no puede aislarse de esta realidad.Los medios de información como Internet, favorecen la divulgación de información científica y no científica, que permite el intercambio y almace-namiento de conocimiento en cuestión de segundos. Existen, sin embargo, diferencias en la calidad y en la disponibilidad de la información a través de este medio en países en vías de desarrollo.Por otro lado, se aprecian rezagos en las áreas filosófico-humanísticas del quehacer científico médico respecto al apabullante desarrollo tecnológico, que obligan a acudir a los principios bioéticos para encarar dilemas ya conocidos como la eutanasia y la muerte asistida, y a nuevos como la muerte tecnificada, la reducción de recursos económicos para las instituciones de salud, la clonación y la manipulación genética, entre otras.

El estrés oxidativo. ¿Es necesario medirlo en el paciente diabético? / Oxidative Stress. Must it be measured in the diabetic patient?

El estrés oxidativo es definido como pérdida del equilibrio entre la producción de radicales libres o de especies reactivas de oxígeno y los sistemas de defensa antioxidante, y que tiene efectos deletéreos sobre los carbohidratos, los lípidos y las proteínas. Además, ha sido relacionado con la progresión de diferentes enfermedades crónicas y con la apoptosis.Se ha demostrado que la diabetes mellitus es una enfermedad que cursa con estrés oxidativo, a través de diferentes mecanismos bioquímicos como la gluco-silación excesiva de proteínas, la autoxidación de la glucosa y la activación de la vía de los polioles; estos mecanismos son desencadenados por la presencia de hiperglicemia. Este estado de estrés oxidativo pudiera estar implicado tanto en la patogenia de la aterosclerosis como de las complicaciones crónicas no aterosclerosas del diabético. La medición del estrés oxidativo puede ser útil para investigar su papel en la aparición y el desarrollo de las complicaciones crónicas diabéticas, así como de las maniobras para prevenirlas, incluyendo la adminis-tración de antioxidantes. Se han utilizado diferentes pruebas de laboratorio con el fin de obtener un método práctico, sensible, específico y accesible para la determinación de este estado en la práctica clínica. A pesar de que dicho método no se encuentra disponible aún, y de que la utilidad de los existentes necesita ser confirmada en la práctica diaria con el paciente diabético, se recomienda cuantificar los niveles de glutatión oxidado y reducido (GSSG/GSH) y de los compuestos reactivos al ácido tiobarbitúrico (TBARS).

Acerca de la prescripción de ejercicio en el paciente diabético / On the prescription of physical exercise for the patient with diabetes

En todo el mundo, existe una amplia evidencia epidemiológica sobre el incremento en la incidencia y prevalencia de la diabetes mellitus tipo 2, principalmente en poblaciones occidentales, con cifras de proporciones que se han considerado epidémicas. La diabetes mellitus tiene como los eventos más importantes de su morbi-mortalidad a la enfermedad coronaria y la vascular cerebral, las cuales tienen un elevado impacto social y económico.El tratamiento en esta enfermedad está orientado principalmente a obtener el control metabólico, disminuir la co-morbilidad, así como reducir la presencia de complicaciones agudas y crónicas que la caracterizan esta enfermedad. Esto se desea conseguir a través del control dietético, medicamentos hipoglucemiantes orales o insulina y la indicación de programas de actividad física. El presente documento plantea algunas reflexiones en torno a la problemática de la prescripción de la actividad física en el grupo de diabéticos, así como una propuesta para facilitar su indicación y realización, debido a la relevancia que tiene como instrumento que coadyuva al control metabólico de estos pacientes.