BackgroundIn Mexico, over 60% of the population is uninsured and not able to afford private healthcare services. Women with autoimmune rheumatic diseases (ARDs) are a high-risk group during pregnancy. Morbidity associated with ARDs and pregnancy can include lower birth weight, increased preterm delivery, and more emergency cesarean sections than pregnant women without ARDs. Close monitoring and multidisciplinary care are necessary to prevent and timely treat complications, on the other hand these health interventions are not available to all women with ARDs because of the high prices that it represents.ObjectivesThe aim of this study was to estimate the cost of prenatal care in women with ARDs without health insurance in Northeast Mexico.MethodsTo assess the costs of prenatal care of women with ARDs in the Northeast of Mexico from the perspective of a women without any health insurance, we estimated only the direct costs of the mandatory medical follow-up. Direct costs are all healthcare costs that are directly related to the consultations with a multidisciplinary team, serological and immune laboratory test, and ultrasounds per trimester. All costs and medical fees were obtained from a university hospital in Monterrey, Mexico. To assess the impact of prenatal care in real life, we compared the health expenditure per trimester reported by the pregnancy and rheumatic diseases clinic from the same institution. The data is presented in USD. We were not able to assess indirect costs related to health coverage (like transportation) and specific medical treatment (antirheumatic drugs or other interventions).ResultsThe mean cost for medical consultations and ultrasounds per trimester was $184-277 USD. The average cost of immune test and general lab test ranges from $424-428 USD. The total cost per trimester was from $608 to 705 USD, and the direct cost per three trimesters was $1824-2115 USD.The average family income per month was $614.23 USD and the average health expenditure (per month) was 105.71 USD; which represents 16.21% of the family income. The average family health expenditure per trimester was $317.13 USD.ConclusionThe total cost for prenatal care per trimester was calculated in $608 to 705 USD. The cost of prenatal care per trimester is 193.69% higher than the average health expenditure per trimester for uninsured women with ARDs. More and new strategies are needed to solve and reduce inequalities in access to health.Table 1.Average cost of prenatal care per trimesterMedical consultations and ultrasoundsMedical ConsultationsCosts (USD)FrecuencyCOST PER TRIMESTER $184-277 USDRheumatologist$13MonthlyGenetics$49At least oneObtetrician$14MonthlyUS 1st Trimester$54Only one timeUS 2nd Trimester$49Only one timePsychologist$39If neededNutritionist$5If neededClinical testClinical testCosts (USD)FrecuencyCOST PER TRIMESTER $188 USDComplete Blood Count$9One per trimesterBlood Chemistry$38One per trimesterVitamin D (25-OH)$59One per trimesterThyroid profile test$16One per trimesterPT, TTP$36One per trimesterProtein C reactive$20One per trimesterErythrocyte sedimentation rate$5One per trimesterUrine general test$5One per trimesterImmune lab test (For patients with rheumatoid arthritis and spondylarthritis)Immune lab testCosts (USD)FrecuencyCOST PER TRIMESTER $240 USDRheumatoid factor$24One per trimesterAnti-CCP$33One per trimesterAnti SS-A/RO$19One per trimesterAnti-SS-B/LA$19One per trimesterAnticardiolipins$33One per trimesterBeta-2-glycoprotein$66One per trimesterLupus anticoagulant$46One per trimesterImmune lab test (For patients with lupus, antiphospholipid syndrome, Sjogren’s syndrome, vasculitis, and others) (Others: rheumatic skin and muscle diseases,)Immune lab testCosts (USD)FrecuencyCOST PER TRIMESTER $236 USDAnti-SS-A/RO$21One per trimesterAnti-SS-B/LA$21One per trimesterAnticardiolipins$33One per trimesterBeta-2-glycoprotein$66One per trimesterLupus anticoagulant$46One per trimesterAnti-DNA$24One per trimesterAntinuclear antibodies$25One per trimesterDisclosure of InterestsNone declared
Background:Gender violence is a prevalent issue worldwide. In Mexico, four out of ten women suffer any kind of violence. The factors that make women even more vulnerable to domestic violence are pregnancy, socioeconomic status, educational level, and the presence of chronic health problems. Violence represents a major risk factor for depression, anxiety, poor adherence to medical treatment, and obstetric adverse events.Objectives:The aim of this study is to determine the frequency of domestic violence in pregnant and postpartum women with autoimmune rheumatic diseases (ARD) and to compare with childbearing age women with ARD.Methods:Pregnant and postpartum women (PPW) with rheumatic disease evaluated at the Pregnancy and Rheumatic Diseases Clinic from the University Hospital “Dr. José E. González” in Monterrey, México from August to October 2020 were invited to participate. To compare, we enrolled childbearing age women with ARD without previous pregnancies. The Spanish validated version of the Hurt, Insulted, Threatened with Harm, Screamed scale (HITS) was applied via telephonic interview. The HITS scale evaluates in 4 questions the presence and frequency of violence by their intimate partners in the last 12 months. A score ≥ 10 points is considered as positive for violence.Results:A total of 48 women were included, 24 patients each group. The pregnant-postpartum group was divided in 6 (25) pregnant and 18 (75) postpartum women. Most of them were housewives (54.1%) with >10 years of education and with not formalized marital status 41% (common-law marriage). In the childbearing age group, most of them were employees (70.8), with >10 years of education with a current marital status of single (66.6%). The HITS scale was positive in the pregnant-postpartum group in 4 women (16.6%). Two of them had been victims of sexual assault and 2 reported physical/verbal violence. While in childbearing age group only 1 (4.16) reported physical/verbal violence.Conclusion:The 16% of the pregnant-postpartum group in our sample were suffering from domestic violence by their intimate partners, in contrast to the childbearing age group with only 1 patient reported violence. We found that postpartum and pregnancy women had more prevalence of violence. Screening for domestic violence followed by counseling and early referral are necessary to mitigate the physical and psychological consequences of domestic violence.References:Moreira DN, Pinto da Costa M. The impact of the Covid-19 pandemic in the precipitation of intimate partner violence. Int J Law Psychiatry. 2020;71:101606. doi:10.1016/j.ijlp.2020.101606.Jackson CL, Ciciolla L, Crnic KA, Luecken LJ, Gonzales NA, Coonrod DV. Intimate partner violence before and during pregnancy: related demographic and psychosocial factors and postpartum depressive symptoms among Mexican American women. J Interpers Violence. 2015;30(4):659-679. doi:10.1177/0886260514535262.Table 1.Sociodemographic characteristics and scale resultsPostpartum and pregnancy womenn= 24Childbearing age womenn= 24Age, years, mean27.527.08Occupation, n (%)Housewive13 (54.1)5 (20.8)Employee7 (29.1)17 (70.8)Student4 (16.6)2 (8.3)Education years, n (%)Less than 10 years11 (45.8)7 (29.1)More than 10 years13 (54.1)17 (70.8)Marital status, n (%)Common-law marriage10 (41.6)-Married8 (33.3)8 (33.3)Single6 (24.9)16 (66.6)Status, n (%)Postpartum18 (75)-Pregnancy6 (25)-Results of the HITS scaleTotal, mean5.374.37Score per ranges, n (%)0 – 9 points20 (83.3)23 (95.8)10 – 20 points4 (16.6)1 (4.1)Disclosure of Interests:None declared
BackgroundSocial workers (SW) interventions are fundamental in health care; the main objective is to identify and mitigate social determinants of the patient’s health. The socioeconomic study (SES) is the core assessment of SW; it analyzes the demographic structure and population dynamics.ObjectivesDescribe the sociodemographic and social security characteristics in pregnant patients with autoimmune rheumatic diseases.MethodsA cross-sectional and retrospective study was conducted in a pregnancy and rheumatic diseases outpatient clinic from the university hospital in Monterrey, México. The data from the SES database was collected. The sociodemographic information, family’s monthly income and expenses, expenditures related to healthcare, type of social security, family nucleus (FN) and socioeconomic level (SL) were analized. The rheumatic diagnosis was retrieved from the medical records.The SL is classified in 7 levels (according to the score obtained in the SES); each level represents a percentage of the total cost of the healthcare received. Level 1 to 3 correspond to 0 - 28% percentage while levels 4 to 7 go from 53 to 100% of total payment that is due. To evaluate the health expenditure, the monthly limit expenditure per Mexican family is 98.39 dollars (the limit expenditure was taken from the Organization for Economic Co-operation and Development “OECD” 2019 report). For statistical analysis, the sociodemographic and clinical characteristics of the sample are presented as frequencies and percentages.ResultsFrom 2019 to 2021, 54 patients were interviewed. The mean age was 28.46 years(SD=6.69). The rheumatic diagnoses can be found in Table 1. The most common occupation was unemployment(n=34, 62.96%) and only completed basic levels of education(n=37,68.51%).Table 1.Sociodemographic characteristicsn=54Demographic DataAge, mean(SD)28.46(6.69)Occupation, n(%)Unemployed34(62.96)Employed17(31.48)Self-Employed3(5.55)Marital Status, n(%)Married/Cohabitating38(70.37)Single16(29.62)Level of Education, n(%)Basic education37(68.51)Higher education17(31.48)Family StructureFamily members, n(%)0-536(66.66)6-1118(33.32)Number of children, n(%)136(66.66)213(24.07)35(9.25)Family Nucleus, n(%)Nuclear27(50)Multi-nuclear26(48.14)Extended1(1.85)Rheumatic Disease, n (%)Rheumatoid arthritis29(53.7)Lupus9(16.66)Antiphospholipid syndrome8(14.81)Sjögren syndrome1(1.85)Health Expenditure, n(%)Active health insuranceNone39(72.22)Public health services (governmental and state workers)8(14.81)Private health insurance7(12.96)Average monthly family income (USD)$614.23Average monthly health expenditure (USD)$105.71Percentage of expenses in patient’s health16.21%SD:Standard deviationThe most frequent SL was level 3 (46.29%) and the predominant FN was the nuclear family (50%) (couple and their dependent children). Most of them were not under any health coverage(n=39, 72.22%). The average family income was $614.23 USD and the average health expenditure was 105.71 USD; which represents 16.21% of the family income (per month).ConclusionSW play a key role understanding basic needs and identifying health determinants that decreases the odds of access of healthcare. Women with autoimmune rheumatic diseases have an important burden of the main determinants of health like low income, unemployment, basic education, and poor health coverage.In addition, the average health expenditure is higher than the recommended by OECD. Different strategies are needed for childbearing age patients with rheumatic diseases to decrease the impact of health determinants.References[1]Sagrario, M. et al. (2006). El apoyo del trabajador social al paciente reumático. Epica, 28(6),6-8.[2]Silva, M. et al. (2015). Validez y Confiabilidad del Estudio Socioeconómico. Dgapa, UNAM. ISBN 978-607-02-7296-7[3]OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing. DOI: 10.1787/4dd50c09-enDisclosure of InterestsNone declared
BackgroundChronic rheumatic diseases (CRD) have a strong impact on psychosocial development of pediatric patients. There are several factors associated with psychiatric disorders (PD) in these children; physical disability, complex treatments, long-term follow-up, and flares, are the most cited in literature.Juvenile Idiopathic Arthritis (JIA) is the first cause of disability in children with CRD, on the other hand, Major Depressive Disorder (MDD) and Dysthymia are the third cause. Some PD, mostly MDD, appear as a consequence of disability caused by CRD, but immune pathways might be implicated in pathogenesis as well.Adolescents with CRD need to transition to an adult-centered care while deal with emotional and physical changes. This implies a difficult situation in which patients could be in higher risk for develop PD. There are a lack of information on how this process affects emotional health in this population.ObjectivesThe aim of the study is to calculate the prevalence of PD in adolescents with CRD during transitional care and their relationship with clinical and social factors.MethodsPatients older than 16 years with an established CRD, who were in transitional care during the period between July 2017 and January 2019 were included in this transversal study.We used MINI KID assessment tool to characterize PD in our patients. Each patient performs an interview with both a clinical psychologist and a pediatric psychiatrist to confirm psychiatric/emotional diagnosis. Clinical, social and demographic data were collected from medical records.Descriptive statistics with frequencies or measures of central tendency and dispersion, depending on variable characteristics were used. Comparisons and correlations were performed with parametric and non-parametric tests as appropriate.ResultsForty patients were recruited during study period, aged 18 (IQR 16 - 19) years old, 31 female, and most diagnosed with JIA (22, 55%) and Systemic Lupus Erythematosus (SLE, 7, 17.5%). Time since diagnosis were 5.5 (IQR 0.5 - 13) years and half of the patients presented with an active disease.After psychiatric evaluations, 24 (60%) patients presented a PD, 7 (17.5%) were identified with MDD, while minor disorders (specific phobia and anxiety) were notice in 11 (27.5%). Two patients presented alcohol dependence, and 11 (27.5%) were diagnosed with more than one PD.PD were more frequently in patients with SLE (71%) and in those with active disease regardless underlying diagnosis (54% vs 45%, P = .490). Other significant factors related with more prevalence of PD were female gender (66% vs 44%, P < .001), having a couple (90% vs 57%, P < .001), have a single parent (83% vs 60%, P = .005), and sex activity (71% vs 61%, P = .002).ConclusionWe found a higher prevalence of PD in adolescents during transitional care, especially in those with active disease. It is priority to involve a multidisciplinary team to transition adolescents from pediatric to adulthood care to prevent and detect PD in this population.References[1] Ravelli A, Martini A. Ju...
Background:Cognition is the ability to learn, process and remember information to be used later.(1) Cognitive impairment reflects a decrease in one or more cognitive domains: memory, language, reasoning, among others.(2) It has been reported in rheumatic diseases such as systemic lupus erythematosus, rheumatoid arthritis, fibromyalgia, and it is frequently found in young patients during the first years of their illness correlating the disease progression.(3) This condition can lead to anxiety and depression, compromising the quality of life. Given the lack of consensus regarding the best test to diagnose cognitive impairment, multiple tools have been used to address this problem.Objectives:To describe the systematical assessment in a Cognitive Evaluation and Rehabilitation Clinic in rheumatic patients from a University Hospital in Mexico.Methods:Observational and descriptive study. A multidisciplinary team met for 6 months to establish the structure a Cognitive Evaluation and Rehabilitation Clinic in a University Hospital in Mexico (Figure 1). As a pilot group we included outpatients from a Rheumatology clinic, referred by their physician (Table 1). The following psychological tests were used: Montreal Cognitive Assessment (MoCA) and Neurobehavioral Cognitive Status Examination (NCSE). After results (Table 2), the team decided to extend the evaluation with Automated Neuropsychological Assessment Metrics (ANAM), Wechsler Adult Intelligence Scale (WAIS-IV) and International Neuropsychiatric Interview (MINI) (Figure 2). Statistical analysis was performed with SPSS v.24, descriptive statistic were used with measures of central frequency trend.Table 1.Demographic characteristicsN=21Age, mean (SD)43.62 (14.68)Female, n (%)14 (66.66)Years of education, mean (SD)15.24 (2.70)Psychiatric disorderDepression, n (%)4 (19.04)Rheumatic diagnosisSystemic lupus erythematosus, n (%)13 (61.90)Rheumatoid arthritis, n (%)3 (14.30)Others, n (%)5 (23.80)Table 2.Comparison of MoCA and NCSE results.MoCAN=21NCSE N=21Total score, mean (SD)24.24 (3.49)38.52 (1.69)Level of cognitive impairmentNormal, n (%)7 (33.3)17 (81)Mild, n (%)13 (61.9)1 (4.8)Moderate, n (%)1(4.8)3 (14.2)Severe, n (%)0 (0)0 (0)MoCA, Montreal Cognitive Assessment; NCSE, Neurobehavioral Cognitive Status Examination.Figure 1.Pilot program of the Neurocognitive AssessmentFigure 2.Final Program of the Neurocognitive AssessmentResults:We evaluated 21 patients (66% females) with an average age of 43.62 years (SD 14.6) (Table 1). The total number of patients with cognitive impairment was 15 (71%), 14 (66%) diagnosed with MoCA, 6 (28%) with NCSE and a coincidence of both tests in 4 (19%) patients (Table 2).Conclusion:A high percentage of patients with cognitive impairment was found, also a discrepancy between the MoCA and NCSE results. We realized those tests were not enough to get a detail cognitive functioning, for this reason it was decided to make a more extensive evaluation adding ANAM, WAIS-IV and MINI. Neuropsychological evaluation should be performed as part of a multidisciplinary management for the patient and the rheumatologist should be aware of this manifestation and the importance of cognitive testing.References:[1]Gutierrez Rodriguez J, Guzman Gutierrez G. Definition and prevalence of mild cognitive impairment. Rev Esp Geriatr Gerontol. 2017;52 Suppl 1:3-6.[2]Quijano JP-CyTdS. Evaluación Neuropsicológica y Funcional de la Demencia. Barcelona1996.[3]Wijbrandts CA, Tak PP. Prediction of Response to Targeted Treatment in Rheumatoid Arthritis. Mayo Clin Proc. 2017;92(7):1129-43.Disclosure of Interests:None declared
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