Measuring the adequacy of antenatal health care: a national cross-sectional study in Mexico

ObjectiveTo propose an antenatal care classification for measuring the continuum of health care based on the concept of adequacy: timeliness of entry into antenatal care, number of antenatal care visits and key processes of care.MethodsIn a cross-sectional, retrospective study we used data from the Mexican National Health and Nutrition Survey (ENSANUT) in 2012. This contained self-reported information about antenatal care use by 6494 women during their last pregnancy ending in live birth. Antenatal care was considered to be adequate if a woman attended her first visit during the first trimester of pregnancy, made a minimum of four antenatal care visits and underwent at least seven of the eight recommended procedures during visits. We used multivariate ordinal logistic regression to identify correlates of adequate antenatal care and predicted coverage.FindingsBased on a population-weighted sample of 9 052 044, 98.4% of women received antenatal care during their last pregnancy, but only 71.5% (95% confidence interval, CI: 69.7 to 73.2) received maternal health care classified as adequate. Significant geographic differences in coverage of care were identified among states. The probability of receiving adequate antenatal care was higher among women of higher socioeconomic status, with more years of schooling and with health insurance.ConclusionWhile basic antenatal care coverage is high in Mexico, adequate care remains low. Efforts by health systems, governments and researchers to measure and improve antenatal care should adopt a more rigorous definition of care to include important elements of quality such as continuity and processes of care.     

Correlates of Early versus Later Initiation into Sex Work in Two Mexico–U.S. Border Cities

PurposeTo examine correlates of early initiation into sex work in two Mexico–U.S. border cities.MethodsFemale sex workers (FSWs) ≥18 years without known HIV infection living in Tijuana and Ciudad Juarez who had recent unprotected sex with clients underwent baseline interviews. Correlates of initiation into sex work before age 18 were identified with logistic regression.ResultsOf 920 FSWs interviewed in Tijuana (N = 474) and Ciudad Juarez (N = 446), 9.8% (N = 90) were early initiators (<18 years) into sex work. Median age of entry into sex work was 26 years (range: 6–58). After adjusting for age, compared to older initiators, early initiators were more likely to use inhalants (21.1% vs. 9.6%, p = .002), initiate sex work to pay for alcohol (36.7% vs. 18.4%, p < .001), report abuse as a child (42.2% vs. 18.7%, p < .0001), and they were less likely to be migrants (47.8% vs. 62.3%, p = .02). Factors independently associated with early initiation included inhalant use (adjOR = 2.39), initiating sex work to pay for alcohol (adjOR = 1.88) and history of child abuse (adjOR = 2.92). Factors associated with later initiation included less education (adjOR = 0.43 per 5-year increase), migration (adjOR = 0.47), and initiating sex work for better pay (adjOR = 0.44) or to support children (adjOR = 0.03).ConclusionsDifferent pathways for entering sex work are apparent among younger versus older females in the Mexico–U.S. border region. Among girls, interventions are needed to prevent inhalant use and child abuse and to offer coping skills; among older initiators, income-generating strategies, childcare, and services for migrants may help to delay or prevent entry into sex work.     

The role of orthoses in knee osteoarthritis

Objectives: Taking into account that the role of orthoses in patients with knee osteoarthritis (OA) is unclear and controversial, the purpose of this article is to review recent literature with the aim of answering the following question: What is the current role of orthoses in the treatment of knee OA?

Methods: A Cochrane Library and PubMed (MEDLINE) search related to the role of orthoses in knee OA was performed.

Results: Unloader braces decrease the adduction moment of the knee. In patients with varus medial compartment knee OA bracing is beneficial for pain, stiffness, function and quality of life (low grade of evidence). Lateral wedge arch support insoles seem not to decrease knee load. Lateral wedge insoles appear inefficacious at attenuating structural changes in patients with medial knee OA.

Conclusions: The ideal option for an orthosis in patients with knee OA keeps on indeterminate, and long-run inferences are lacking.     

Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders

OBJECTIVE: Women with co-occurring mental health and substance use disorders frequently have a history of interpersonal violence, and past research has suggested that they are not served effectively by the current service system. The goal of the Women, Co-occurring Disorders, and Violence Study was to develop and test the effectiveness of new service approaches specifically designed for these women. METHODS: A quasi-experimental treatment outcome study was conducted from 2001 to 2003 at nine sites. Although intervention specifics such as treatment length and modality varied across sites, each site used a comprehensive, integrated, trauma-informed, and consumer-involved approach to treatment. Substance use problem severity, mental health symptoms, and trauma symptoms were measured at baseline, and follow-up data were analyzed with prospective meta-analysis and hierarchical linear modeling. RESULTS: A total of 2,026 women had data at the 12-month follow-up: 1,018 in the intervention group and 1,008 in the usual-care group. For substance use outcomes, no effect was found. The meta-analysis demonstrated small but statistically significant overall improvement in women's trauma and mental health symptoms in the intervention relative to the usual-care comparison condition. Analysis of key program elements demonstrated that integrating substance abuse, mental health, and trauma-related issues into counseling yielded greater improvement, whereas the delivery of numerous core services yielded less improvement relative to the comparison group. A few person-level characteristics were associated with increases or decreases in the intervention effect. These neither moderated nor supplanted the effects of integrated counseling. CONCLUSIONS: Outcomes for women with co-occurring disorders and a history of violence and trauma may improve with integrated treatment.     

Expression of Fgf19 in the developing chick eye

Fibroblast growth factor 19 (FGF19) is a new member of the FGF family of growth factors. Here, we describe the localization of Fgf19 mRNA in the developing chick retina and lens in stages from the Hamburger and Hamilton stage 15 (HH15) to postnatal day 30 (P30). Fgf19 was expressed in a transient manner in postmitotic neuroblasts during the migration from the ventricular surface to their final location. Moreover, from HH31 (embryonic day 7, E7) on, a subset of lined up Fgf19 expressing cells was distributed in the outer region of the presumptive INL. These cells were Pax6 immunoreactive horizontal cells. During the last third of embryogenesis, Fgf19 expression in the retina was progressively down-regulated and was not detected at P30. Also, it was transiently expressed in the equatorial region of the lens.     

Spermicidal activity of the crude ethanol extract of Sedum praealtum in mice

Ethanol extract of Sedum praealtum in intravaginal doses of 10, 20, 40, 50, 100 and 150 mg/kg body weight showed a toxic effect in spermatozoa viability after 24h of administration. Spermatozoa viability was 94, 83, 58 and 24%, respectively, for extract doses of 10, 20, 40 and 50mg/kg body weight, while only dead spermatozoa were found in the vagina of the treated female mice with doses of 100 and 150 mg/kg body weight.     

Frequency and determinants of vitamin A deficiency in children under 5 years of age with pneumonia

BACKGROUND: Vitamin A deficiency (VAD) has been closely related to acute respiratory infections (ARI), although information is still incomplete; for example, the frequency of VAD in children <5 years of age with pneumonia is not known, and the conditions associated with VAD have not been identified. This study was conducted to gain insight into the status of vitamin A in children with pneumonia. A secondary objective was to identify the sociodemographic, individual, and nutritional factors associated with VAD in these children. METHODS: A cross-sectional study was conducted in the Mexican state of Hidalgo, one of the poorest in the country. Children with community-acquired pneumonia treated at nine public hospitals were included. Information was obtained by interviewing mothers, and ascertainment of vitamin A status was performed with relative-dose-response (RDR) test. RESULTS: A total of 422 cases were included. VAD was identified in 17.8% of children; 50.3% showed normal results, 24.6% had liver reserve depletion, and 7.3% showed results attributable to the infectious process. Variables associated with VAD were as follows: age <2 months (OR 3.44, 95% CI: 1.84-9.24); children >6 months of age fed with formula (OR 0.37, 95% CI: 0.15-0.91), and affiliation with the Mexican Social Security Institute (IMSS) health system (OR 0.40, 95% CI: 0.22-0.72). CONCLUSIONS: The frequency of VAD in children with community-acquired pneumonia confirms that the problem of deficiency persists in Mexico. The associated factors for VAD found in this study can be taken into account when planning and evaluating vitamin A supplementation activities in populations with high risk for deficiency.     

Effects of trauma intervention on HIV sexual risk behaviors among women with co‐occurring disorders in substance abuse treatment

Women in substance abuse treatment often have co‐occurring mental health disorders and a history of trauma; they are also at high risk for HIV infection and other sexually transmitted diseases via unprotected sex. A quasi‐experimental study evaluated the effectiveness of trauma‐enhanced substance abuse treatment combined with HIV/AIDS prevention (N = 122) on reducing sexual risk behaviors compared to treatment with services‐as‐usual (N = 110). Participants in the services‐as‐usual condition were 2.8 times more likely to engage in unprotected sex at the 6‐month follow‐up and 4.5 times more likely to do so at the 12‐month follow‐up than those in the intervention program. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 895–908, 2007.     

Using machine learning to advance disparities research: Subgroup analyses of access to opioid treatment

ObjectiveTo operationalize an intersectionality framework using a novel statistical approach and with these efforts, improve the estimation of disparities in access (i.e., wait time to treatment entry) to opioid use disorder (OUD) treatment beyond race.Data sourceSample of 941,286 treatment episodes collected in 2015–2017 in the United States from the Treatment Episodes Data Survey (TEDS‐A) and a subset from California (n = 188,637) and Maryland (n = 184,276), states with the largest sample of episodes.Study designThis retrospective subgroup analysis used a two‐step approach called virtual twins. In Step 1, we trained a classification model that gives the probability of waiting (1 day or more). In Step 2, we identified subgroups with a higher probability of differences due to race. We tested three classification models for Step 1 and identified the model with the best estimation.Data collectionClient data were collected by states during personal interviews at admission and discharge.Principal findingsRandom forest was the most accurate model for the first step of subgroup analysis. We found large variation across states in racial disparities. Stratified analysis of two states with the largest samples showed critical factors that augmented disparities beyond race. In California, factors such as service setting, referral source, and homelessness defined the subgroup most vulnerable to racial disparities. In Maryland, service setting, prior episodes, receipt of medication‐assisted opioid treatment, and primary drug use frequency augmented disparities beyond race. The identified subgroups had significantly larger racial disparities.ConclusionsThe methodology used in this study enabled a nuanced understanding of the complexities in disparities research. We found state and service factors that intersected with race and augmented disparities in wait time. Findings can help decision makers target modifiable factors that make subgroups vulnerable to waiting longer to enter treatment.