Key lifestyles and health outcomes across 16 prevalent chronic diseases: A network analysis of an international observational study.

Background: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test. Findings: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05). Conclusion: To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies.

Key lifestyles and interim health outcomes for effective interventions in general populations: A network analysis of a large international observational study.

Background: The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences. Methods: An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic. Results: Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction). Conclusions: Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation.

Global impacts of COVID-19 on lifestyles and health and preparation preferences: An international survey of 30 countries.

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics.

Propiedades Psicométricas de la Escala de Bienestar Psicológico para Adultos (BIEPS-A) en población Mexicana / Psychometric Properties of the Psychological Well-Being Scale for Adults (BIEPS-A) in a Mexican Sample

Resumen Introducción: El bienestar psicológico favorece el funcionamiento de la vida personal y social. Para su evaluación, es necesario contar con instrumentos válidos y confiables que permitan decidir y valorar las acciones necesarias para promoverlo. Objetivo: Evaluar las propiedades psicométricas de la Escala de Bienestar Psicológico para Adultos (BIEPS-A) en una muestra mexicana. Método: Se aplicó la escala BIEPS-A y la Escala de Autoestima de Rosenberg (EAR) a 188 estudiantes universitarios y 94 participantes de población general. Resultados: Un análisis paralelo detectó un factor único en la escala BIEPS-A, estructurado mediante análisis factorial exploratorio (componentes principales, rotación oblicua) que retuvo 9 reactivos y explicó el 54% de la varianza. La consistencia interna fue de aceptable (α de Cronbach = .78) a elevada (alfa ordinal = .90). El análisis de curva ROC identificó un punto de corte equivalente a la mediana (ABC = .72, p < .01) y otro al percentil 75 (ABC = .80, p < .01), y ser mujer, tener entre 18 y 25 años y bajo o leve nivel de autoestima como predictores de bajo nivel de bienestar psicológico. La escala BIEPS-A mostró validez concurrente (r = .57) y predictiva con la EAR (β = .63). Discusión y conclusiones: La escala BIEPS-A es un instrumento válido y confiable para evaluar el bienestar psicológico en población mexicana; sin embargo, las diferencias respecto a su estructura original indican la necesidad de una escala de bienestar psicológico diseñada específicamente para población mexicana.

Abstract Introduction: Psychological well-being favors the functioning of personal and social life. Valid and reliable instruments are necessary for its evaluation that allow deciding and assessing the actions necessary to promote it. Objective: To evaluate the psychometric properties of the Scale of Psychological Well-being for Adults (BIEPS-A) in a Mexican sample. Methods: The BIEPS-A scale and the Rosenberg Self-Esteem Scale (RSES) were administered to 188 university students and 94 participants from the general population. Results: A parallel analysis detected a single factor in the BIEPS-A scale, structured by exploratory factor analysis (main components, oblique rotation) that retained 9 items and explained 54% of the variance. Internal consistency ranged from acceptable (Cronbach's α = .78) to high (ordinal alpha = .90). ROC curve analysis identified a cut-off point equivalent to the median (AUC = .72, p <.01) and another to the 75th percentile (AUC = .80, p <.01). The latter identified as a woman, between 18 and 25 years old with a low or slight level of self-esteem as predictors of a low level of psychological well-being. The BIEPS-A scale showed concurrent (r = .57) and predictive (β = .63) validity with the EAR. Discussion and conclusions: The BIEPS-A scale is a valid and reliable instrument to assess psychological well-being in the Mexican population. However, the differences with respect to its original structure indicate the need for a psychological well-being scale designed specifically for the Mexican population.

Psychometric properties of the Hospital Anxiety and Depression Scale in Mexican pregnant women / Propiedades psicométricas de la Escala Hospitalaria de Ansiedad y Depresión en mujeres embarazadas mexicanas

Abstract Introduction Anxiety and depression in pregnant women are a public health problem. Their adequate detection requires valid and reliable instruments that are also useful for prevention and treatment. Objective To identify the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in a sample of Mexican pregnant women. Method The HADS was applied to 716 pregnant women between 13 and 46 years old (M = 26.55; SD = 6.56) attended in a public hospital in Mexico City. Results With a sample of 358 participants, a parallel analysis indicated a bifactorial structure for HADS, identified by exploratory factor analysis (Factor 1: anxiety, Factor 2: depression). The factors explained 53% of the variance and correlated positively (r = .36). The global internal consistency (Cronbach's α = .81; ordinal α = .93) and by factor (anxiety: Cronbach's α = .79; ordinal α = .88; depression: Cronbach's α = .79; ordinal α = .87) was acceptable. With data from the remaining 358 participants, a confirmatory factor analysis showed an acceptable fit for the structure detected (χ2/gl = 2.72; RMSEA = .06 [IC .05, .08]; GFI = .93; AGFI = .90; TLI = .90; CFI = .92). Discussion and conclusions The Hospital Anxiety and Depression Scale has adequate psychometric properties to be used in pregnant Mexican women. Its use in routine pregnancy controls would be useful to prevent, detect, and timely treat these conditions.

Resumen Introducción La ansiedad y la depresión en gestantes representan un problema de salud pública. Su adecuada detección requiere de instrumentos válidos y confiables que también sirvan para su prevención y tratamiento. Objetivo Identificar las propiedades psicométricas de la Escala Hospitalaria de Ansiedad y Depresión (HADS) en una muestra de mujeres embarazadas mexicanas. Método Se aplicó la HADS a 716 gestantes de entre 13 y 46 años (M = 26.55; DE = 6.56), atendidas en un hospital público en la Ciudad de México. Resultados Con una muestra de 358 participantes, un análisis paralelo indicó una estructura bifactorial para la HADS, identificada mediante análisis factorial exploratorio (Factor 1: ansiedad, Factor 2: depresión). Los factores explicaron el 53% de la varianza y correlacionaron positivamente (r = .36). La consistencia interna global (α de Cronbach = .81, α ordinal = .93) y por factor (ansiedad: αde Cronbach = .79, α ordinal = .88; depresión: α de Cronbach = .79, α ordinal = .87) fue aceptable. Con los datos de las 358 participantes restantes, un análisis factorial confirmatorio mostró un ajuste aceptable para la estructura detectada (χ2/gl = 2.72; RMSEA = .06 [IC .05, .08]; GFI = .93; AGFI = .90; TLI = .90; CFI = .92). Discusión y conclusión La Escala Hospitalaria de Ansiedad y Depresión posee adecuadas propiedades psicométricas para su empleo en mujeres embarazadas mexicanas. Su uso en controles rutinarios del embarazo sería útil para prevenir, detectar y atender oportunamente estos padecimientos.

Dental caries in Mexican schoolchildren: a comparison of 1988-1989 and 1998-2001 surveys.

OBJECTIVES: To compare two surveys across seven states for the prevalence of dental caries among Mexican schoolchildren. STUDY DESIGN: Analysis of two cross-sectional surveys: Schoolchildren from 6 to 10 years of age were examined in the 1988-1989 survey and 6- to 10-year-old and 12-year-old students were included in the 1998-2001 survey. The baseline data of seven states were available for analysis. Representative probability samples were conducted statewide in both surveys. The World Health Organization (WHO) method was used to obtain the dental caries index (dmft, DMFT). At present, additional and more recent epidemiological data representative statewide in Mexico are unavailable. RESULTS: The participants were 9798 schoolchildren in the 1988-1989 survey and 16882 schoolchildren in the 1998-2001 survey. The prevalence of caries in children ages 6 to 10 years was 86.6% in the first survey and 65.5% in the second survey, showing a 24.4% reduction. The primary teeth index in the first survey was dmft=3.86 (IC95% 3.68 4.04) and in permanent teeth, it was DMFT=1.03 (IC95% 0.95 1.11). In the second survey, the comparable values were dmft=2.36 (IC95% 2.20 2.52) and DMFT=0.35 (IC95% 0.29 0.40), corresponding to a reduction of 38.89% and 66.02% in the primary and permanent dentition, respectively. Treatment needs remain high: In the second survey, as 92.75% of the index DMFT was conformed as decayed teeth. CONCLUSION: Overall, we detected a downward trend in the dental caries indices, particularly in the permanent dentition. The increase in the availability of fluoride likely contributed to the observed decline in dental caries.

Oseltamivir-resistant pandemic (H1N1) 2009 virus, Mexico.

During May 2009-April 2010, we analyzed 692 samples of pandemic (H1N1) 2009 virus from patients in Mexico. We detected the H275Y substitution of the neuraminidase gene in a specimen from an infant with pandemic (H1N1) 2009 who was treated with oseltamivir. This virus was susceptible to zanamivir and resistant to adamantanes and oseltamivir.

Prevalencia de uso de la prueba de Papanicolaou en mujeres de 15 a 49 años en México / Prevalence in the use of the Papanicolaou test in Mexico among women from 15-49 years old

Se presentan las prevalencias de uso del examen Papanicolaou en 64,762 mujeres entrevistadas por la Encuesta Nacional de Cobertura de Vacunación en la República Mexicana. La población de estudio fueron mujer de 15 a 49 años de edad, entre las cuales más del 90 por ciento fueron mayores de 25 años. La prevalencia de utilización de Papanicolaou fue de 126.79 por cada 100,000 mujeres de 15 a 49 años, y estas prevalencias son diferentes de acuerdo con la edad, la escolaridad y el acceso a la seguridad social. Los resultados muestran que el Programa de Detección de Cáncer Cervical de México incide en mayor proporción en mujeres que potencialmente se encuentran en una situación de riesgo bajo de enfermedad y, por el contrario, la prevalencia de utilización de la población objetivo del programa es baja. Las tasas de prevalencia estatal más bajas del antecedente de uso de Papanicolaou alguna vez en la vida se registraron en Aguascalientes (0.64 mujeres de 15 a 49 años que alguna vez tuvieron Papanicolaou), Oaxaca (1.31 mujeres de 15 a 49 años que alguna vez tuvieron Papanicolaou), Baja California (1.41 mujeres de 15 a 49 años que alguna vez tuvieron Papanicolaou) y Tlaxcala (1.47 mujeres de 15 a 49 años que alguna vez tuvieron Papanicolaou). Comparando estos resultados con la Encuesta Nacional de Salud II, la prevalencia de uso de Papanicolaou no ha cambiado en el patrón de utilización de la mujeres mexicanas y confirma que el Programa de Prevención y Control del Cáncer requiere de una mayor intervención

Maternal mortality regionalization and trend in Mexico (1937-1995)

Background. The objetives were to establish regions by level of maternal mortality in order to evaluate its trend from 1937-1995 and to analyze characteristics of cases which occurred from 1990-1995. Methods. Regionalization of the country by maternal mortality level was carried out using Poisson regression. Level and mortality trends were analyzed globally and compared by regions using Poisson and linear regression. Characteristics of cases were analyzed from 1990-1995 using proportions and X² test. Results. Four well-differentiated and independent regions were established. Low and medium maternal mortality rate regions were found in northern and northwestern Mexico. High and very high maternal mortality regions were found in the Southeast of the country. Even when maternal mortality had descended, the speed of the descent has decreased and in the last few years, maternal mortality has increased. The quality of health care is a challenge for regions with low mortality rates, while the problem of accessibility is present in those with very high mortality rates. Conclusion. The employment of this regionalization approach in maternal mortality analysis would be useful to determine specific problems for each region. The establishment of programs according to this analysis could contribute to decrease in maternal mortality cases in Mexico

La medicina privada en México: resultados del Censo Nacional de Unidades Hospitalarias Privadas / Private medicine in Mexico: results from the National Census on Private Hospitalization Units

El objetivo de este estudio fue cuantificar los recursos de la medicina privada mediante un censo de unidades médicas con servicio de hospitalización, realizado en el primer trimestre de 1994 con base en la información jurisdiccional. Se registraron en todo el país 2 723 unidades médicas del sector privado con camas de hospitalización. En el Distrito Federal y los estados de México, Guanajuato, Michoacán, Baja California y Veracruz se concentra cerca de la mitad de las unidades. El total de camas censables registradas en el país de 33 937, de tal manera que la medicina privada es el principal proveedor de camas de hospitalización del Sistema Nacional de Salud; se encontraron resultados similares en cuanto al resto de recursos materiales humanos

A census of private health establishments was carried out by the Secretary of Health, in order to quantify its resources and to describe their geographical distribution. The census, conducted in 1994, was limited to private units which offered hospitalization services, and the reference period was the previous year. Results showed that there are 2 723 private hospitalization units in Mexico, and nearly a half of the units are concentrated in the Federal District, and the states of Mexico, Guanajuato, Michoacan, Baja California and Veracruz. The number of private hospitalization beds registered in the country are 33 937, these figures indicate that private medicine is the main hospital care provider in the national health system. Similar results were obtained regarding other material and human resources. It is important to stress the need for further research regarding the role of private medicine in Mexico, including aspects related to the quality of the services being provided.

Fibrosis quística en México: análisis de sus principales aspectos epidemiológicos / Cystic fibrosis in Mexico: an analysis of main epidemiological aspects

El objetivo principal del presente estudio fue el de establecer un panorama epidemiológico de la fibrosis quística en México, analizando la edad promedio de diagnóstico y la sobrevida tanto a partir del nacimiento como del diagnóstico. Se revisaron los datos de 351 pacientes registrados en la Asociación Mexicana de Fibrosis Quística de 1982 a 1991. La edad promedio en 244 casos disponibles para el análisis fue de casi diez años para ambos sexos. Destacamos que la edad promedio de diagnóstico fue alta (4.4 años), encontrando una diferencia estadística significativa en favor del sexo masculino (P<0.05). Esto se reflejó en una pobre esperanza de vida, ya que el 49.2 por ciento de los pacientes incluidos en esta serie apenas alcanzaron los nueve años, no mostrando diferencias significativas por sexo. Finalmente es importante señalar que la tasa de mortalidad en el primer año de vida de nuestra serie fue de 0.062 y solamente el 51.7 por ciento de los 242 casos analizados apenas alcanzaron el cuarto año de vida posterior al diagnóstico sin diferencia significativa por sexo (P>0.05). Los resultados de nuestro estudio suponen la existencia de factores que en forma categórica determinan la pobre sobrevida de los pacientes estudiados, sobresaliendo en forma importante el diagnóstico tardío de esta entidad nosológica

Evaluación del programa de mejoramiento de servicios de salud México-BID: 1991 / Evaluation of the improvement health services program México-DIB: 1991

Evaluación del Programa de Mejoramiento de Servicios de Salud México-BID 1991, aplicado en México por la Secretaría de Salud, donde se dan a conocer los resultados en materia de: I. Población y cobertura II. Disponibilidad de recursos III. Productividad IV. Segundo Nivel de Atención V. Satisfacción del usuario VI. Organización y participación comunitaria VII. Construcción y equipamiento de unidades VIII. Disponibilidad de servicios básicos y condiciones de las unidades IX. Financiamiento X. Conservación y mantenimiento XI. Comentarios y conclusiones

Memorias del V curso internacional: "Avances en enfermedad diarreíca y desequilibrio hidroelectrolitico" / Memories of the V internationational course: \"Advances in diarrheic disease and hydroelectrolitical unbalance\"

"La humanidad reconoce a las diarreas como uno de sus grandes azotes; la história identífica pandemias de enfermedades diarreicas aguda que constaron miles de vidas". En 1987 la O.M.S. y la U.N.I.C.E.F. estimaron que ocurrieron mil millones de episodios de diarreas en niños en los países en desarrollo, que ocasionaron la muerte a 3.3 millones de ellos. En México, hasta 1976 las diarreas ocupaban el primer lugar como causa de morbilidad; a partir de 1977 se encuentran en el segungo lugar. En 1988 se encuentran como segunda causa de morbilidad en todos los grupos de edad. Uno de cada cuatro casos que se registra corresponde a diarrea aguda. El grupo más afectado es el de los menores de un año en tanto que el cinco a catorce años es el menos afectado. La tendencia de la morbilidad para el periodo 1961-1989 es ascendente, el cual se debe al mejoramiento de captación de información. La enfermedad diarreica es un padecimiento que muestra claramente su incidencia estacional de tal forma que el canal endémico registra un notorio incremento de casos a partir del mes de mayo, alcanzando el maximo en los meses de julio a agosto, y la declinación se observa a partir de septiembre. En 1988 los Estados con mayor morbilidad fueron: Yucatán, Baja California Sur y Quintana Roo; y con menor incidencia, el Estado de México, Chiapas y Sinaloa. La mortalidad por diarrea aguda estuvo dentro de las diez principales causas de defunción en todos los grupos de edad, en 1986. Sin embargo, gracias a las acciones que se han venido desarrollando, La tendencia de la mortalidad es descendente; la tasa muestra un reducción del 35.6% en el período 1961-1986. Las acciones que en el país se han emprendido para el control de la enfermedad diarreíca aguda, han cubierto en todas las unidades operativas del Sistema Nacional de Salud las etapas de introducción, difusión y consolidación para, abatir la mortalidad mediante la terapia simplificada de hidratación oral; es necesario ahora iniciar actividades para abatir la morbilidad"

Años de vida potencial perdidos: su utilidad en el análisis de la mortalidad en México / Years of potential life lost: advantages for mortality analysis in Mexico

La evolución de la epidemiología de la mortalidad en los países en desarrollo requiere del uso de indicadores complementarios o alternativos a las tasas específicas para el análisis de la mortalidad por causa. Este trabajo presenta las principales causas de mortalidad en México durante 1983 por sexo, a través del indicador años de vida potencial perdidos. Se utilizaron y discutieron diversas alternativas de construcción del indicador. La aplicación del indicador a los datos del país demostró utilidad para evaluar el impacto de la mortalidad por enfermedades infecciosas y causas violentas. Asimismo, las diferencias en magnitud entre los sexos y los diferentes intervalos de edad permitieron identificar la fracción de los años de vida potencial perdidos atribuible a grupos de población determinados. Se considera que el indicador provee información valiosa para el análisis epidemiológico de la mortalidad por causas