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Hoyos-Loya E, Pérez Navarro C, Burrola-Méndez S, Hernández-Cordero S, Omaña-Guzmán I, Sachse Aguilera M, Ancira-Moreno M. Barriers to promoting breastfeeding in primary health care in Mexico: a qualitative perspective. Front Nutr 2024; 10:1278280. [PMID: 38264191 PMCID: PMC10803647 DOI: 10.3389/fnut.2023.1278280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Objective This article aimed to identify the main barriers related to promoting and counseling breastfeeding (BF) at the Primary Health Care (PHC) in Mexico. Methodology A qualitative study with a phenomenological approach was carried out in 88 health centers of the Ministry of Health in the states of Chihuahua, Oaxaca, Chiapas, Veracruz, Mexico, and Yucatan. From September to November 2021, we interviewed 88 key health professionals (HPs) (physicians, nurses, nutritionists, and others) from the PHC of the Ministry of Health in Mexico and 80 parents of children under 5 years old. In addition, nine focus groups were conducted with parents and caregivers. The data obtained were triangulated with information from focus groups and semi-structured interviews. Results Of the total interviews, 43.2% (n = 38) were nurses, 29.5% (n = 26) were physicians, 19.3% (n = 17) were nutritionists, and the rest were other health professionals. In the group of users, 97.6% (n = 121) were women. We identified contextual barriers, such as the lack of well-trained health professionals and the scarcest nutrition professionals, as material resources in the health units, without mentioning the low user attendance at their control consultations. Furthermore, we identified barriers related to the orientation and promotion of breastfeeding in health units, including a lack of specific strategies, ineffective communication, and the recommendations of commercial milk formulas. Conclusion The results presented reflect the reality of Mexico in relation to BF, making it urgent to take immediate action to improve the quality of nutritional care related to the promotion and orientation of BF at the PHC.
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Affiliation(s)
- Elizabeth Hoyos-Loya
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
| | - Cecilia Pérez Navarro
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Soraya Burrola-Méndez
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
| | - Sonia Hernández-Cordero
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Isabel Omaña-Guzmán
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | | | - Mónica Ancira-Moreno
- Observatorio Materno Infantil (OMI), Universidad Iberoamericana, Mexico City, Mexico
- Health Department, Universidad Iberoamericana, Mexico City, Mexico
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Ancira-Moreno M, Burrola-Méndez S, Muñoz-Manrique C, Omaña-Guzmán I, Hoyos-Loya E, Trejo-Domínguez A, Hernández-Cordero S, Mazariegos M, Smith N, Tavano-Colaizzi L, Mier-Cabrera J, Avendaño-Álvarez F, Espino y Sosa S, Muciño-Sandoval K, Ibarra-González L, Medina-Avilés C. A scoping review and critical evaluation of the methodological quality of clinical practice guidelines on nutrition in the preconception. Front Nutr 2023; 10:1122289. [PMID: 37927499 PMCID: PMC10621738 DOI: 10.3389/fnut.2023.1122289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Clinical practice guidelines (CPGs) contain recommendations for specific clinical circumstances, including maternal malnutrition. This study aimed to identify the CPGs that provide recommendations for preventing, diagnosing, and treating women's malnutrition. Additionally, we sought to assess the methodological quality using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Methods An online search for CPGs was performed, looking for those that contained lifestyle and nutritional recommendations to prevent, diagnose and treat malnutrition in women during the preconception period using PubMed and different websites. The reviewers utilized the AGREE II instrument to appraise the quality of the CPGs. We defined high-quality guidelines with a final score of > 70%. Results The titles and abstracts from 30 guidelines were screened for inclusion, of which 20 guidelines were fully reviewed for quality assessment. The overall quality assessment of CPGs was 73%, and only 55% reached a high-quality classification. The domains in the guidelines classified as high-quality had the highest scores in "Scope and Purpose" and "Clarity of Presentation" with a median of 98.5 and 93%, respectively. Discussion Further assessment is needed to improve the quality of the guidelines, which is an opportunity to strengthen them, especially in the domains with the lowest scores.
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Affiliation(s)
- Mónica Ancira-Moreno
- Department of Health, Universidad Iberoamericana, Mexico City, Mexico
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Soraya Burrola-Méndez
- Department of Health, Universidad Iberoamericana, Mexico City, Mexico
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Cinthya Muñoz-Manrique
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Coordination of Nutrition and Bioprogramming, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Isabel Omaña-Guzmán
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Pediatric Obesity Clinic and Wellness Unit, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Elizabeth Hoyos-Loya
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Alejandra Trejo-Domínguez
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Sonia Hernández-Cordero
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Mexico City, Mexico
| | - Mónica Mazariegos
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Natalia Smith
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | | | - Jennifer Mier-Cabrera
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Fermín Avendaño-Álvarez
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Salvador Espino y Sosa
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Clinical Research Branch, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Karla Muciño-Sandoval
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
| | - Lizeth Ibarra-González
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Nutrition and Dietetics Service, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Cristina Medina-Avilés
- Maternal and Child Health and Nutrition Network (MaCHiNNe), Observatorio Materno Infantil, Universidad Iberoamericana, Mexico City, Mexico
- Sub-Direction of Gynecology and Obstetrics Instituto Nacional de Perinatología, Mexico City, Mexico
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Ancira-Moreno M, Omaña-Guzmán I, Bautista-Morales AC, Acosta-Ruiz O, Hernández Cordero S, Burrola-Méndez S, Vilar-Compte M, Monterrubio Flores E, Kaufer-Horwitz M, Pérez Navarro C, Muñoz-Manrique C, Mazariegos M, Trejo-Domínguez A, Sánchez Muzquiz B, Cajero A, Brero M, Sachse M, Cobo Armijo F. Development and validation of a new set of indicators to assess the quality of maternal and child nutritional care at the primary care. Front Med (Lausanne) 2022; 9:1011940. [PMID: 36569141 PMCID: PMC9769120 DOI: 10.3389/fmed.2022.1011940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Maternal and child malnutrition is a worldwide public health problem with short, medium, and long-term adverse consequences for both mother and child. In Mexico, maternal and child malnutrition represents a serious public health problem that must be urgently addressed. In this context, Primary Health Care (PHC) plays an important role in the prevention, detection, monitoring, and treatment of the different forms of maternal and child malnutrition. Assessing the quality of nutritional care offered at this level of care is necessary in order to improve it; however, there are no indicators for the evaluation of this quality. Therefore, this study aimed at developing a set of indicators to assess the quality of maternal and child nutritional care at PHC. Methods We developed indicators for different stages of life: preconception, pregnancy, infancy, and preschool age. A systematic review of the literature on clinical guidelines for the prevention, diagnosis, and treatment of the different forms of malnutrition was carried out; the recommendations of the guidelines evaluated with good quality were extracted. Results Based on these recommendations, 22 indicators were constructed. A pilot study was carried out to validate the indicators and 16 indicators were selected to assess the maternal and child nutritional care at PHC.
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Affiliation(s)
| | | | | | - Omar Acosta-Ruiz
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Sonia Hernández Cordero
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Mexico City, Mexico
| | | | - Mireya Vilar-Compte
- Department of Public Health, Montclair State University, Montclair, NJ, United States
| | - Eric Monterrubio Flores
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Martha Kaufer-Horwitz
- Clínica de Obesidad y Trastornos de la Conducta Alimentaria, Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Cinthya Muñoz-Manrique
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Mónica Mazariegos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | | | | | - Ariana Cajero
- Department of Health, Universidad Iberoamericana, Mexico City, Mexico
| | - Mauro Brero
- United Nations International Children’s Emergency Fund (UNICEF), Mexico City, Mexico
| | - Matthias Sachse
- United Nations International Children’s Emergency Fund (UNICEF), Mexico City, Mexico
| | - Fernanda Cobo Armijo
- United Nations International Children’s Emergency Fund (UNICEF), Mexico City, Mexico
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Hernández-Solano A, Pérez-Hernández V, Burrola-Méndez S, Aguirre A, Gallegos J, Teruel G. Using Household Expenditure Surveys for Comparable and Replicable Nutritional Analysis: Evidence from México. Nutrients 2022; 14:nu14173588. [PMID: 36079845 PMCID: PMC9460767 DOI: 10.3390/nu14173588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
In this study, we explore how to use household expenditures and income surveys (HEIS) to provide replicable and comparable measures of nutrients availability at the population level. Our method formalizes the common practice in the literature and consists of three steps: identification of relevant food categories, pairing of food contents food groups in HEIS data, and calculation of the typical amount of nutrients by food group. We illustrate the usage of the method with Mexican data and provide a publicly available data set to readily convert food purchases into six nutrients: calories, proteins, vitamins A and C, iron, and zinc. We perform a descriptive analysis of the evolution of nutrients intake among Mexican households between 2008 and 2020, considering differences by income level. Our results reflect the effect of the COVID-19 pandemic on nutrient availability in Mexican households, mainly driven by a substantial reduction in the expenditure in food consumed away from home, although for most nutrients the trend was stable over most of the period.
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Affiliation(s)
- Alan Hernández-Solano
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Prolongación Paseo de Reforma 880 Lomas de Santa Fe, Álvaro Obregón 01219, Ciudad de México, Mexico
| | - Víctor Pérez-Hernández
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Prolongación Paseo de Reforma 880 Lomas de Santa Fe, Álvaro Obregón 01219, Ciudad de México, Mexico
- Correspondence:
| | - Soraya Burrola-Méndez
- Departamento de Salud, Universidad Iberoamericana, Prolongación Paseo de Reforma 880 Lomas de Santa Fe, Álvaro Obregón 01219, Ciudad de México, Mexico
| | - Alejandra Aguirre
- Independent Researcher, Tlalnepantla 54060, Estado de México, Mexico
| | - Jesús Gallegos
- Independent Researcher, Cuautitlán Izcalli 54740, Estado de México, Mexico
| | - Graciela Teruel
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Prolongación Paseo de Reforma 880 Lomas de Santa Fe, Álvaro Obregón 01219, Ciudad de México, Mexico
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Vilar-Compte M, Hernández-Cordero S, Ancira-Moreno M, Burrola-Méndez S, Ferre-Eguiluz I, Omaña I, Pérez Navarro C. Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women. Int J Equity Health 2021; 20:110. [PMID: 33926471 PMCID: PMC8082937 DOI: 10.1186/s12939-021-01432-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background Breastfeeding can be affected by maternal employment. This is important considering that in 2019, 47.1% of women globally participated in the labor force. The aim of this study was to review workplace interventions to promote, protect and support breastfeeding practices among working mothers globally. Methods A systematic review was conducted following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational, experimental and qualitative peer-reviewed studies in English and Spanish, published between 2008 and 2019 were included. The review focused on working women who were pregnant, breastfeeding or who recently had a child, and women’s working environments. The outcomes of interest included breastfeeding intentions, initiation, exclusivity and duration, confidence in breastfeeding or breastmilk extraction, and perceived support at workplace. Quality was assessed according to National Institute for Health and Care Excellence (NICE) checklist for systematic reviews. It was registered on PROSPERO (#140624). Results Data was extracted from 28 quantitative and 9 qualitative studies. The most common interventions were designated spaces for breastfeeding or breastmilk extraction (n = 24), and the support from co-workers (n = 20). The least common interventions were providing breast pumps (n = 4) and giving mothers the flexibility to work from home (n = 3). Studies explored how interventions affected different breastfeeding outcomes including breastfeeding duration, breastfeeding exclusivity, confidence in breastmilk expression, and breastfeeding support. The evidence suggests that workplace interventions help increase the duration of breastfeeding and prevent early introduction of breastmilk substitutes. Having a lactation space, breastmilk extraction breaks, and organizational policies are key strategies. However, to achieve equitable working conditions for breastfeeding mothers, organizational and interpersonal changes need to occur as well. Conclusions The systematic review revealed that interventions at the workplace are important in protecting, promoting and supporting breastfeeding among working mothers. To achieve equitable work environments and fair nutritional opportunities for infants of working mothers, interventions should focus at the three ecological layers – individual, interpersonal, and organizational. The quality of studies can be improved. There is a need for studies assessing impacts of workplace interventions on infant feeding practices, mothers’ self-esteem and outcomes such productivity and abstentionism.
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Affiliation(s)
- Mireya Vilar-Compte
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Sonia Hernández-Cordero
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico.
| | - Mónica Ancira-Moreno
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Soraya Burrola-Méndez
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Isabel Ferre-Eguiluz
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Isabel Omaña
- Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| | - Cecilia Pérez Navarro
- Research Center for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico.,Department of Health, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
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Vilar-Compte M, Burrola-Méndez S, Lozano-Marrufo A, Ferré-Eguiluz I, Flores D, Gaitán-Rossi P, Teruel G, Pérez-Escamilla R. Urban poverty and nutrition challenges associated with accessibility to a healthy diet: a global systematic literature review. Int J Equity Health 2021; 20:40. [PMID: 33472636 PMCID: PMC7816472 DOI: 10.1186/s12939-020-01330-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is an increasing global trend towards urbanization. In general, there are less food access issues in urban than rural areas, but this "urban advantage" does not benefit the poorest who face disproportionate barriers to accessing healthy food and have an increased risk of malnutrition. OBJECTIVES This systematic literature review aimed to assess urban poverty as a determinant of access to a healthy diet, and to examine the contribution of urban poverty to the nutritional status of individuals. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology, our review included quantitative and qualitative studies published in English or in Spanish between 2000 and 2019. The articles were eligible if they focused on nutrition access (i.e. access to a healthy diet) or nutrition outcomes (i.e., anemia, overweight and obesity, micronutrient deficiency, micronutrient malnutrition) among urban poor populations. Articles were excluded if they did not meet pre-established criteria. The quality of the quantitative studies was assessed by applying Khan et al.'s methodology. Similarly, we assessed the quality of qualitative articles through an adapted version of the National Institute for Health and Care Excellence (NICE) methodology checklist. Finally, we systematically analyzed all papers that met the inclusion criteria based on a qualitative content and thematic analysis. RESULTS Of the 68 papers included in the systematic review, 55 used quantitative and 13 used qualitative methods. Through the analysis of the literature we found four key themes: (i) elements that affect access to healthy eating in individuals in urban poverty, (ii) food insecurity and urban poverty, (iii) risk factors for the nutritional status of urban poor and (iv) coping strategies to limited access to food. Based on the systematization of the literature on these themes, we then proposed a conceptual framework of urban poverty and nutrition. CONCLUSIONS This systematic review identified distinct barriers posed by urban poverty in accessing healthy diets and its association with poorer nutrition outcomes, hence, questioning the "urban advantage". A conceptual framework emerging from the existing literature is proposed to guide future studies and policies. SYSTEMATIC REVIEW REGISTRATION PROSPERO Registration number: CRD42018089788 .
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Affiliation(s)
- Mireya Vilar-Compte
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico.
| | - Soraya Burrola-Méndez
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico
| | - Annel Lozano-Marrufo
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico
| | - Isabel Ferré-Eguiluz
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico
| | - Diana Flores
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico
| | - Pablo Gaitán-Rossi
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico
| | - Graciela Teruel
- Research Institute for Equitable Development EQUIDE, Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219, Mexico City, Mexico
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Whittemore R, Vilar-Compte M, De La Cerda S, Delvy R, Jeon S, Burrola-Méndez S, Pardo-Carrillo M, Lozano-Marrufo A, Pérez-Escamilla R. ¡Sí, Yo Puedo Vivir Sano con Diabetes! A Self-Management Randomized Controlled Pilot Trial for Low-Income Adults with Type 2 Diabetes in Mexico City. Curr Dev Nutr 2020; 4:nzaa074. [PMID: 32368713 PMCID: PMC7186776 DOI: 10.1093/cdn/nzaa074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/28/2020] [Accepted: 04/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a worldwide epidemic and a leading cause of death in Mexico, with a prevalence of 15.9%, and >70% of diagnosed adults have poor glycemic control [glycated hemoglobin (HbA1c) >7.5%]. We developed a diabetes self-management education program contextualized to the study population, including dietary preferences, health literacy, and health system. OBJECTIVES We aimed to evaluate the efficacy of a self-management + text message program (¡Sí, Yo Puedo Vivir Sano con Diabetes!) on primary (HbA1c), and secondary behavioral (self-management), clinical, and psychosocial outcomes in adults with T2D in Mexico City. METHODS Participants were recruited at public primary healthcare centers (Seguro Popular), and randomly allocated to treatment (n = 26) or wait-list control groups (n = 21) with data collected at 3 and 6 mo. The program included 7 weekly sessions and 6 mo of daily text/picture messages. Descriptive statistics and a generalized linear mixed model with intent-to-treat analysis were calculated. RESULTS Participants were 55.5 ± 8.8 y of age (mean ± SD), 68% female, 88.6% overweight/obese, and 57% lived in food-insecure households. Mean ± SD T2D duration was 11.9 ± 7.8 y and HbA1c was 9.2% ± 1.5%. There was 89% attendance at sessions and 6.4% attrition across both groups at 6 mo. Group-by-time effects were seen in self-monitoring of blood glucose (P < 0.01) and diabetes self-efficacy (P < 0.04); and a trend for lower HbA1c was seen in the intervention group at 6 mo (P = 0.11). Significant improvements in dietary behavior (P < 0.01) were demonstrated in the intervention group over time, but this did not reach statistical significance compared with the control group. CONCLUSIONS The program was associated with clinically significant improvements in T2D self-management, self-efficacy, and HbA1c over time. Thus, T2D self-management skills, including diet, were improved in a vulnerable metropolitan population.This trial was registered at clinicaltrials.gov as NCT03159299.
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Affiliation(s)
| | - Mireya Vilar-Compte
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
| | - Selene De La Cerda
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
| | | | | | - Soraya Burrola-Méndez
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
| | - Mariana Pardo-Carrillo
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
| | - Annel Lozano-Marrufo
- Research Institute for Equitable Development (EQUIDE), Universidad Iberoamericana , Mexico City, Mexico
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8
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Whittemore R, Vilar-Compte M, Burrola-Méndez S, Lozano-Marrufo A, Delvy R, Pardo-Carrillo M, De La Cerda S, Pena-Purcell N, Pérez-Escamilla R. Development of a diabetes self-management + mHealth program: tailoring the intervention for a pilot study in a low-income setting in Mexico. Pilot Feasibility Stud 2020; 6:25. [PMID: 32082611 PMCID: PMC7023698 DOI: 10.1186/s40814-020-0558-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/27/2020] [Indexed: 11/12/2022] Open
Abstract
Background Type 2 diabetes (T2D) is a public health pandemic disproportionately affecting low- and middle-income countries. The purpose of this formative research was to adapt evidence-based diabetes self-management education programs to the context of Seguro Popular clinics in Mexico. A theory-based mHealth (pictorial text messaging) component was developed. Method Our formative research and development of the program protocol consisted of six phases: (1) interviews and focus groups with stakeholders on the challenges to T2D management, curriculum content needs, and the use of mHealth as a supplement to a DSME program; (2) review of the theoretical underpinning, curriculum, and interactive strategies of four evidence-based DSME programs and modification to meet the needs of adults with T2D and systems of care in Mexico City; (3) development of theory-based illustrated text messages; (4) evaluation of text messaging acceptability and access in adults with T2D via focus groups; (5) development of program manual; and (6) development of a training program for health care providers. Results The ¡Sí, Yo Puedo Vivir Sano Con Diabetes! included 7 group-based weekly lessons; simple, interactive content; weekly empowerment messages; video novellas; group activities; and goal setting. Adaptations to the cultural context of Mexico included content/activities on diabetes etiology (addressing cultural misconceptions), nutrition (indigenous foods and plate method), self-blood glucose monitoring, and diabetes-related stress/coping. We used the Health Action Process Approach to guide the text message development, which posits that adoption, initiation, and maintenance of health behaviors require the development of intentions, plans, coping, and self-efficacy. Our final text message bank consisted of 181 messages. There were approximately 20–30 messages for each process of behavior change (e.g., action planning, maintenance self-efficacy) and 30 messages for each content topic (e.g., eating healthy, physical activity). There were 96 messages that were illustrated. Training materials were also developed. Discussion We used a systematic approach, collaboration with stakeholders, and a well-established behavior change theory to develop an evidence-based intervention to an international context and system of care. Collectively, this process has the potential to enhance the feasibility, acceptability, and efficacy of the program.
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Affiliation(s)
- Robin Whittemore
- 1Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06516 USA
| | - Mireya Vilar-Compte
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Soraya Burrola-Méndez
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Annel Lozano-Marrufo
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Roberta Delvy
- 1Yale School of Nursing, 400 West Campus Drive, West Haven, CT 06516 USA
| | - Mariana Pardo-Carrillo
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Selene De La Cerda
- 2Universidad Iberoamericana, Prolongación Paseo de Reforma 880, Lomas de Santa Fé, 01219 Mexico City, Mexico
| | - Ninfa Pena-Purcell
- 3Texas A & M University, 2251 TAMU Mailstop, College Station, Texas 77845 USA
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Mier-Cabrera J, Aburto-Soto T, Burrola-Méndez S, Jiménez-Zamudio L, Tolentino MC, Casanueva E, Hernández-Guerrero C. Women with endometriosis improved their peripheral antioxidant markers after the application of a high antioxidant diet. Reprod Biol Endocrinol 2009; 7:54. [PMID: 19476631 PMCID: PMC2693127 DOI: 10.1186/1477-7827-7-54] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 05/28/2009] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Oxidative stress has been identified in the peritoneal fluid and peripheral blood of women with endometriosis. However, there is little information on the antioxidant intake for this group of women. The objectives of this work were 1) to compare the antioxidant intake among women with and without endometriosis and 2) to design and apply a high antioxidant diet to evaluate its capacity to reduce oxidative stress markers and improve antioxidant markers in the peripheral blood of women with endometriosis. METHODS Women with (WEN, n = 83) and without endometriosis (WWE, n = 80) were interviewed using a Food Frequency Questionnaire to compare their antioxidant intake (of vitamins and minerals). Then, the WEN participated in the application of a control (n = 35) and high antioxidant diet (n = 37) for four months. The high antioxidant diet (HAD) guaranteed the intake of 150% of the suggested daily intake of vitamin A (1050 microg retinol equivalents), 660% of the recommended daily intake (RDI) of vitamin C (500 mg) and 133% of the RDI of vitamin E (20 mg). Oxidative stress and antioxidant markers (vitamins and antioxidant enzymatic activity) were determined in plasma every month. RESULTS Comparison of antioxidant intake between WWE and WEN showed a lower intake of vitamins A, C, E, zinc, and copper by WEN (p < 0.05, Mann Whitney Rank test). The selenium intake was not statistically different between groups. During the study, the comparison of the 24-hour recalls between groups showed a higher intake of the three vitamins in the HAD group. An increase in the vitamin concentrations (serum retinol, alpha-tocopherol, leukocyte and plasma ascorbate) and antioxidant enzyme activity (superoxide dismutase and glutathione peroxidase) as well as a decrease in oxidative stress markers (malondialdehyde and lipid hydroperoxides) were observed in the HAD group after two months of intervention. These phenomena were not observed in the control group. CONCLUSION WEN had a lower intake of antioxidants in comparison to WWE. Peripheral oxidative stress markers diminished, and antioxidant markers were enhanced, in WEN after the application of the HAD.
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Affiliation(s)
- Jennifer Mier-Cabrera
- Departamento de Biología Celular, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Mexico City, Mexico
| | - Tania Aburto-Soto
- Departamento de Salud, Universidad Iberoamericana Campus Santa Fe, Mexico City, Mexico
| | - Soraya Burrola-Méndez
- Departamento de Salud, Universidad Iberoamericana Campus Santa Fe, Mexico City, Mexico
| | - Luis Jiménez-Zamudio
- Laboratorio de Inmunología Clínica I, Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Mari C Tolentino
- Subdirección de Investigación en Salud Pública, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Mexico City, Mexico
| | - Esther Casanueva
- Subdirección de Investigación en Salud Pública, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Mexico City, Mexico
| | - César Hernández-Guerrero
- Departamento de Biología Celular, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Mexico City, Mexico
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