Dietary Inflammatory Index and Type 2 Diabetes Mellitus in Adults: The Diabetes Mellitus Survey of Mexico City

Diet and inflammation are both associated with type 2 diabetes mellitus (T2DM). In the present study, we aimed to assess the relation between the dietary inflammatory index (DII) and the presence of T2DM in Mexican adults participating in the Diabetes Mellitus Survey administered in Mexico City (DMS-MC). The study involved 1174 subjects (48.5% men) between 20–69 years of age. A validated semi-quantitative food frequency questionnaire was employed to evaluate dietary intake and to compute DII. The DII is based on scientific evidence about the association between dietary compounds and six established inflammatory biomarkers. Multivariate logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) of DII in relation to T2DM. Our results suggest that subjects in the highest quintile of the DII had higher odds of T2DM (OR = 3.02; 95% CI: 1.39, 6.58; p = 0.005) compared to subjects in the lowest quintile of DII scores. Assessing possible effect modification, an association with T2DM was evident when comparing DII quintile 5 to quintile 1 for participants aged ≥ 55 years (OR = 9.77; 95% CI: 3.78, 25.50; p = 0.001). These results suggest that a pro-inflammatory diet is associated with significantly higher odds of T2DM among adult Mexicans

Hospitales verdes : un nuevo desafío para América Latina

286 páginas : tablas, gráficos ; 28 cm.Con el presente libro, de una manera práctica y gracias a los autores, se ha querido llevar a los lectores una visión amplia y clara del tema de los hospitales verdes. Los temas que a continuación están desarrollados presentan la base fundamental de lo que es un hospital verde, desde un panorama amplio de los hospitales verdes, las características que debe tenerse en cuenta en el momento de la construcción de uno de estos hospitales, su impacto en la salud, así como experiencias exitosas de estos. El lector encontrará un libro de consulta para adentrarse en el tema de los hospitales verdes saludables, el cual podrá servirle de guía para ampliar su conocimiento sobre el asunto y cómo este concepto de contribuye al mejoramiento del medio ambiente y la conservación del mismo.Panorama de la salud ambiental hospitalaria y política ambiental en instituciones de salud. --Hospitales sustentables: criterios generales para el diseño. -- Hospitales sustentables: construcción y operación. -- Hospitales verdes: ¿aporte real a la salud pública?. -- La cultura verde como estrategia para la gestión ambiental de los hospitales. -- Relación de las acciones de los hospitales verdes en el marco de las dimensiones del desarrollo sostenible. -- Análisis de experiencias de gestión hídrica en las instituciones vinculadas a la Red Global de Hospitales Verdes en Colombia. -- Posicionamiento ambiental de la Red Hospitalaria Española y su relación con Salud sin Daño: hospitales verdes y saludables. -- Proyecto Eco-hospital Guadarrama, España. -- Acciones de cultivos saludables reportadas por los miembros de la Red Global de Hospitales Verdes y Saludables. -- Avances de la vinculación del componente ambiental y hospitales verdes en carreras de ciencias de la salud

Educación & Retorno post pandemia: SARS-CoV-2, autocuidado, bioseguridad, salud emocional y compasión consciente

Proyecto de continuidad del P-100 Innova-Docencia UCM/2019 (Conviviendo en positivo: educación en salud, atención consciente, compasión activa y resiliencia). Extensión en la Universidad Nacional de Villa María (UNVM, Argentina), de la intervención desarrollada online durante la fase cero del periodo de confinamiento para facilitar conexión y respuesta adaptativa frente al impacto emocional generado por la situación sobrevenida por la declaración del estado de emergencia sanitaria ante la COVID-19. En el ámbito universitario, el miedo a nuevos rebrotes que saturasen el sistema sanitario, impuso incorporar cambios organizativos institucionales y normalizar nuevas formas de agrupamiento e interacción interpersonal, con dos escenarios posibles de presencialidad adaptada. Bajo estas nuevas condiciones de bioseguridad, el retorno post pandemia al curso académico crea un nuevo escenario de aprendizaje en convivencia positiva, ante un estado normalizado de serodiscordancia, potencialmente generadora de resiliencia. En cada uno de nosotros hay recursos excepcionales para reaccionar ante este estado excepcional, del mejor modo. Desde este paradigma, el programa “Presencia ante el estrés y gestión emocional”, surge ante la necesidad de incorporar intervenciones educativas no formales e innovadoras, que ayuden a los estudiantes a tener una visión global de la situación sanitaria que estamos atravesando, a identificar y normalizar las reacciones adaptativas que estamos experimentando, y para dotar a estudiantes y docentes de estrategias eficaces que les ayuden a gestionar mejor el impacto emocional derivado por la crisis sanitaria y económica. Medidas de seguridad en el entorno académico que entran en conflicto no solo con la convivencia no segura e insolidaria en ambientes de ocio, sino con la imposibilidad de mantenerlas durante desplazamientos en medios de transporte público; lo cual genera frustración y agotamiento. La crisis económica y la necesidad de estudiar/trabajar en remoto, nos lleva a entrar en modo “multitareas”. La invasión de las TIC en nuestro modo de vida, son un arma de “distracción masiva” que alimentan estados de “atención dispersa”, cuyo resultado es mayor presión, mayores errores y menor satisfacción. Todo esto genera mayor estrés mantenido y sus efectos: miedo, frustración, ira, tristeza, angustia, soledad y ansiedad. Un antídoto podría ser, desarrollar la atención consciente y cultivar la compasión. Si de modo transversal, se logra integrar en nuestras vidas formas de lucha y resistencia activa frente a otros virus (normalizando la convivencia en serodiscordancia y las pruebas diagnósticas rutinarias, no discriminando y desestigmatizando), al minimizarse la aparición de nuevos casos con diagnóstico tardío, podremos bloquear el avance y vencer definitivamente a otras pandemias. La transmisión del VIH es posible pararla entre todas y todos: pacientes diagnosticados y medicados, con niveles de virus indetectables e intransmisibles (objetivo 2030 OMS: el fin de la pandemia SIDA)

Maternal dietary patterns and acute leukemia in infants: results from a case control study in Mexico

BackgroundChildhood cancer is the leading cause of disease-related mortality among children aged 5–14 years in Mexico, with acute leukemia being the most common cancer among infants. Examining the overall dietary patterns allows for a comprehensive assessment of food and nutrient consumption, providing a more predictive measure of disease risk than individual foods or nutrients. This study aims to evaluate the association between maternal dietary patterns during pregnancy and the risk of acute leukemia in Mexican infants.MethodsA hospital-based case–control study was conducted, comparing 109 confirmed acute leukemia cases with 152 age-matched controls. All participants (≤24 months) were identified at hospitals in Mexico City between 2010 and 2019. Data on a posteriori dietary patterns and other relevant variables were collected through structured interviews and dietary questionnaires. Multivariate logistic regression was employed to estimate the association between maternal dietary patterns during pregnancy and the risk of acute leukemia in infants.ResultsThe “Balanced & Vegetable-Rich” pattern, characterized by a balanced consumption of various food groups and higher vegetable intake, exhibited a negative association with acute leukemia when compared to the “High Dairy & Cereals” Pattern (adjusted odds ratio [OR] = 0.51; 95% confidence interval [CI]: 0.29, 0.90). We observed that mothers who gave birth to girls and adhered to a healthy dietary pattern during pregnancy exhibited significantly lower odds of their children developing AL compared to those who gave birth to boys [OR = 0.32 (95% CI 0.11, 0.97)]. Our results underscore the significance of maternal nutrition as a modifiable factor in disease prevention and the importance of prenatal health education

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Dietary Patterns, Bone Mineral Density, and Risk of Fractures: A Systematic Review and Meta-Analysis

The aim of this systematic review was to assess the evidence on the relation between dietary patterns, bone mineral density (BMD), and risk of fracture in different age groups. Medline and Embase were searched for articles that identified dietary patterns and related these to BMD or risk of fracture through May 2018. Multivariable adjusted odds ratios (ORs) and 95% confidence intervals (95%CI) comparing the lowest and highest categories of dietary pattern were combined by using a random effects meta-analysis. In total, 31 studies were selected for review, including 18 cohorts, 1 case-control, and 12 cross-sectional studies, in the meta-analysis of Prudent/healthy and Western/unhealthy dietary pattern, BMD, and risk of fracture. There was evidence of a lower risk of fracture when intakes in the highest categories were compared with the lowest categories of Prudent/healthy dietary pattern (OR = 0.81; 95%CI: 0.69, 0.95; p = 0.01). In contrast, when intakes in the highest categories were compared with the lowest categories of Western/unhealthy dietary pattern, a greater risk of fracture (OR = 1.10; 95%CI: 1.02, 1.19; p = 0.01) was observed among men. The present systematic review and meta-analysis provides evidence of an inverse association between a Prudent/healthy dietary pattern and risk of low BMD and a positive relation between Western/unhealthy dietary pattern and risk of low BMD

High Vitamin D Consumption Is Inversely Associated with Cardiovascular Disease Risk in an Urban Mexican Population

<div><p>Background</p><p>Vitamin D deficiency is a major global public health problem. Recent epidemiological studies have assessed the relationship between vitamin D and multiple outcomes, including cardiovascular disease. However, this evidence is limited and inconclusive. Our purpose in this study was to evaluate the association between dietary vitamin D intake and cardiovascular disease risk in adult Mexican population.</p><p>Methods</p><p>We conducted a cross-sectional analysis with the baseline data from 6294 men and women aged 20–80 years participating in the Health Workers Cohort Study. Data on sociodemographic, lifestyle, and medical history factors were collected with a self-administered questionnaire. Dietary intake was evaluated by using a semi-quantitative food-frequency questionnaire. Cardiovascular disease risk was calculated using a recalibration of the Framingham heart disease prediction score. To evaluate the association between vitamin D intake and 10-year cardiovascular disease risk, odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using multiple logistic regression analysis.</p><p>Results</p><p>A total of 6294 subjects (1820 men and 4474 women) with a mean age of 42 years, were included. Of these, subjects in the highest quintile of vitamin D intake presented lower levels of triglycerides 14.6 mg/dL (<i>P</i> for trend = 0.001); 2.0 cm less in waist circumference (<i>P</i> for trend = 0.001) and 0.8 points less in the Framingham cardiovascular disease risk score (<i>P</i> for trend = 0.002) compared with the subjects in the lower quintile of vitamin D intake. Additionally, participants in the highest quintile of vitamin D consumption were less likely to develop elevated 10-year cardiovascular disease risk, compared with those in the lowest quintile (OR = 0.51; 95%CI: 0.33, 0.77; <i>P</i> for trend = 0.007).</p><p>Conclusion</p><p>Our data suggest that higher consumption of vitamin D is associated with a reduced risk of cardiovascular disease in Mexican population.</p></div

Baseline characteristics by categories of total vitamin D intake in the Health Workers Cohort Study.

<p>Baseline characteristics by categories of total vitamin D intake in the Health Workers Cohort Study.</p

Joint association of dietary vitamin D (quintiles) and body mass index (<25 kg/m² and ≥ 25 kg/m²) with the predicted cardiovascular disease risk.

<p>Reference group for comparisons were subjects in lowest quintile of vitamin D intake with body mass index < 25 kg/m². Odds ratio were adjusted for: age (years), sex, multivitamin use (yes or not), BMI (continuous), physical activity (quintiles), alcohol (quintiles), saturated and polyunsaturated fats (quintiles), fiber, energy (quintiles), glycemic load (quintiles), place of residence, season, postmenopausal hormone use (yes or not) and history of myocardial infarction (yes or not).</p