Patient dissatisfaction associated with physician-patient linguistic discordance in California clinics: an analytical cross-sectional study.

BACKGROUND: Patient satisfaction is considered as a product of two psychological processes, a cognitive one, including expectations and perceptions, and an emotional one resulting from the congruence between expectation and subjective perception of the user. The objective was to identify the factors associated with the level of perceived satisfaction in patients treated in 36 nonprofit health clinics that offer comprehensive health care services in four counties in the state of California, United States. METHODS: Cross-sectional analytical study in 14 clinics in four California counties. It consisted of the application of a 30-item questionnaire to determine the degree of patient satisfaction with the clinic. The factorial composition of the quality of care and clinic quality components was analyzed and two factors with an Eigen value greater than 1 were obtained. RESULTS: A total of 846 responses were registered. Factor analysis identified two underlying dimensions: Physician Attitude and Empathy. It was found that the discordance in language between the physician and the patient generates a difference in the perception of satisfaction. Patients who prefer to speak English have better satisfaction than those who speak Spanish. Spanish speakers who do not have interpreter have lower satisfaction than those who do (p < 0,01). CONCLUSIONS: The most important sociodemographic cofactor was language. Satisfaction decreased in Spanish-speaking patients who were not proficient in the use of English since they expressed fewer comments and doubts.

The burden of cardiovascular disease in Mexico 1990-2021. Summary of the Global Burden of Disease 2021 study.

BACKGROUND: Cardiovascular disease (CVD) is a major cause of mortality, with economic implications for the health system. OBJECTIVE: To characterize the burden of CVD in Mexico from 1990 to 2021 based on the Global Burden of Disease (GBD) study, to address the burden of health and disease, its implications for public health and for the development of the health care system. MATERIAL AND METHODS: CVD mortality in Mexico is described, and the extent to which population growth and aging explain the observed trends, sex differences, and geographic patterns is examined. RESULTS: CVD is the leading cause of mortality, mainly due to hypertensive heart disease, intracerebral hemorrhage, subarachnoid hemorrhage, ischemic heart disease and ischemic stroke. A change of trend was observed in men and women, with higher mortality in people older than 80 years and in the northern states of the country. CONCLUSIONS: Mexico must invest in public health programs to address modifiable risks, promote healthy aging, and reduce premature death due to CVD.

ANTECEDENTES: La enfermedad cardiovascular (ECV) es una causa importante de mortalidad, con implicaciones económicas para el sistema de salud. OBJETIVO: Caracterizar la carga de ECV en México de 1990 a 2021 con base en el estudio Global Burden of Disease (GBD), para abordar la carga de salud y enfermedad, sus implicaciones en la salud pública y el desarrollo del sistema de atención médica. MATERIAL Y MÉTODOS: Se describe la mortalidad de las ECV en México y se examina en qué medida el crecimiento y el envejecimiento de la población explican las tendencias, las diferencias por sexo y los patrones geográficos. RESULTADOS: Las ECV representan la primera causa de mortalidad, principalmente por cardiopatía hipertensiva, hemorragia intracerebral, hemorragia subaracnoidea, cardiopatía isquémica y accidente cerebrovascular isquémico. Se observó un cambio de tendencia en hombres y mujeres, mayor mortalidad en mayores de 80 años y en estados del norte del país. CONCLUSIONES: México debe invertir en programas de salud pública para abordar los riesgos modificables, promover el envejecimiento saludable y reducir la muerte prematura por ECV.

Effect of Omicron on the prevalence of COVID-19 in international travelers at the Mexico city international airport. December 16th, 2021 to January 31st, 2022.

INTRODUCTION: SARS-CoV-2 continues to have a high rate of contagion worldwide. The new variant of concern, Omicron, has mutations that decrease the effectiveness of vaccines and evade antibodies from previous infections resulting in a fourth wave of the pandemic. It was identified in Mexico in December 2021. METHODS: The Traveler's Preventive Care Clinic from the Faculty of Medicine UNAM at Mexico City International Airport has performed rapid antigen and PCR SARS CoV2 tests since January 2021 to comply with the new travel requirements. Demographic and clinical characteristics were collected from each passenger and the fourth wave of the pandemic in Mexico mainly caused by Omicron was analyzed in the travelers. RESULTS: A total of 5176 travelers attended the clinic between the second half of December 2021 and January 2022. Ten percent of all the tests performed were positive (13% of PCR and 9.3% of antigens, p = 0.001). Most of the SARS CoV2 positive cases were asymptomatic (78%), with a ratio of 3.5:1 over the symptomatic. By age groups, this ratio was higher for those under 20 years old (8.7:1). DISCUSSION: This study shows the rapid escalation of positivity that occurred in Mexico, detected in travelers, from the second half of December 2020 and throughout the month of January 2021. The incidence of COVID-19 was extremely high in travelers who were mostly asymptomatic for the period under study.

Panorama histórico de la enfermedad diarreica aguda en México y el futuro de su prevención / Historical overview of acute infectious diarrhea in Mexico and future preventive strategies

Resumen: Objetivo: Revisar los aspectos epidemiológicos de la enfermedad diarreica aguda (EDA) a través de la historia de México y analizar las estrategias que potencialmente podrán prevenir su aparición en la población mexicana. Material y métodos: Se realizó una búsqueda sistematizada utilizando los siguientes descriptores de las ciencias de la salud: diarrea, morbilidad, mortalidad, México y promoción de la salud de los últimos 20 años (1878-2018). Resultados: Se obtuvieron más de 8 600 artículos que fueron evaluados en función de los objetivos de la presente publicación. Conclusión: Como resultado de una revisión sistemática se observó que, gracias a las estrategias implementadas a lo largo del tiempo, se ha logrado graduar los matices de riesgo de la EDA; ello permite ahora plantear estrategias que guiarán a la prevención de ese padecimiento, de la mano de políticas que incluyan aspectos higiénico-dietéticos, innovaciones farmacéuticas y aplicaciones tecnológicas en medidas sanitarias.

Abstract: Objective: To analyze the epidemiological aspects of AID through Mexican history and the potential strategies to prevent AID in Mexican population. Materials and methods: A systematic review was performed exploring the key words, diarrhea, morbidity, mortality, Mexico, health promotion for the last 20 years (1978-2018). Results: Over 8 600 articles were obtained; all of them were evaluated to consider those follow the aim of the present work. Conclusion: The result of the performed systematic review denoted the influence of AID in Mexican public health policy the adopted actions diminished the AID's associated risks and allowed future strategies to prevent it; those actions must include hygienic and dietetic measures, pharmaceutical innovations and technological tools applied to health policies.

[Historical overview of acute infectious diarrhea in Mexico and future preventive strategies]. / Panorama histórico de la enfermedad diarreica aguda en México y el futuro de su prevención.

OBJECTIVE: To analyze the epidemiological aspects of AID through Mexican history and the potential strategies to pre- vent AID in Mexican population. MATERIALS AND METHODS: A systematic review was performed exploring the key words, diarrhea, morbidity, mortality, Mexico, health promotion for the last 20 years (1978-2018). RESULTS: Over 8 600 articles were obtained; all of them were evaluated to consider those follow the aim of the present work. CONCLUSIONS: The result of the performed systematic review denoted the influence of AID in Mexican public health policy; the adopted actions diminished the AID's associated risks and allowed future strategies to prevent it; those actions must include hygienic and dietetic measures, pharmaceutical innovations and technological tools applied to health policies.

OBJETIVO: Revisar los aspectos epidemiológicos de la enfermedad diarreica aguda (EDA) a través de la historia de México y analizar las estrategias que potencialmente podrán prevenir su aparición en la población mexicana. MATERIAL Y MÉTODOS: Se realizó una búsqueda sistematizada utilizando los siguientes descriptores de las ciencias de la salud: diarrea, morbilidad, mortalidad, México y promoción de la salud de los últimos 20 años (1878-2018). RESULTADOS: Se obtuvieron más de 8 600 artículos que fueron evaluados en función de los objetivos de la presente publicación. CONCLUSIONES: Como resultado de una revisión sistemática se observó que, gracias a las estrategias implementadas a lo largo del tiempo, se ha logrado graduar los matices de riesgo de la EDA; ello permite ahora plantear estrategias que guiarán a la prevención de ese padecimiento, de la mano de políticas que incluyan aspectos higiénico-dietéticos, innovaciones farmacéuticas y aplicaciones tecnológicas en medidas sanitarias.

Medición de drogas ilícitas en aguas residuales: estudio piloto en México / Assessing illicit drugs in wastewater: a pilot study in Mexico

Resumen: Objetivo: Monitorear el consumo de drogas a través de la medición de sus metabolitos en aguas residuales. Material y métodos: Se obtuvieron muestras de 31 plantas de tratamiento de agua residual y de 95 sitios con poblaciones específicas (38 escuelas, 42 unidades de tratamiento de adicciones y 15 centros de readaptación social). Usando cromatografía líquida de ultra-alta resolución, se midieron nueve metabolitos de seis drogas. Resultados: Ocho de nueve metabolitos de drogas fueron identificados en aguas residuales. Los metabolitos de marihuana (THC-COOH), cocaína (benzoilecgonina) y metanfetamina fueron identificados en escuelas, centros de readaptación social y de tratamiento de adicciones. En Nuevo Laredo, Culiacán y Torreón se encontraron los consumos per cápita más elevados de cocaína, marihuana, anfetamina y metanfetamina. Conclusiones: El monitoreo del uso de drogas a través de aguas residuales es factible en México y podría constituir un sistema de vigilancia para identificar cambios de su consumo en el tiempo.

Abstract: Objective: Monitor drug use through wastewater metabolite measurement. Materials and methods: Wastewater samples were obtained from 31 wastewater treatment plants and 95 sites with specific populations (38 schools, 42 units of addiction treatment and 15 penitentiaries). Using ultra high liquid chromatography, we measured nine metabolites from six drugs. Results: Eight out of nine drug metabolites were identified in the samples. Marijuana (THC-COOH), cocaine (benzoylecgonine) and methamphetamine were identified in schools, centers of addiction treatment and penitentiaries. Nuevo Laredo, Culiacan and Torreon had the highest consumption of cocaine, marijuana, amphetamine and methamphetamine. Conclusions: Monitoring drug use through wastewater is feasible in Mexico and could constitute a surveillance system to identify changes in the time.

[Assessing illicit drugs in wastewater: a pilot study in Mexico]. / Medición de drogas ilícitas en aguas residuales: estudio piloto en México.

OBJECTIVE: Monitor drug use through wastewater metabolite measurement. MATERIALS AND METHODS: Wastewater samples were obtained from 31 wastewater treatment plants and 95 sites with specific populations (38 schools, 42 units of addiction treatment and 15 penitentiaries). Using ultra high liquid chromatography, we measured nine metabolites from six drugs. RESULTS: Eight out of nine drug metabolites were identified in the samples. Marijuana (THC-COOH), cocaine (benzoylecgonine) and methamphetamine were identified in schools, centers of addiction treatment and penitentiaries. Nuevo Laredo, Culiacan and Torreon had the highest consumption of cocaine, marijuana, amphetamine and methamphetamine. CONCLUSIONS: Monitoring drug use through wastewater is feasible in Mexico and could constitute a surveillance system to identify changes in the time.

OBJECTIVE: Monitorear el consumo de drogas a través de la medición de sus metabolitos en aguas residuales. MATERIALS AND METHODS: Se obtuvieron muestras de 31 plantas de tratamiento de agua residual y de 95 sitios con poblaciones específicas (38 escuelas, 42 unidades de tratamiento de adicciones y 15 centros de readaptación social). Usando cromatografía líquida de ultra-alta resolución, se midieron nueve metabolitos de seis drogas. RESULTS: Ocho de nueve metabolitos de drogas fueron identificados en aguas residuales. Los metabolitos de marihuana (THC-COOH), cocaína (benzoilecgonina) y metanfetamina fueron identificados en escuelas, centros de readaptación social y de tratamiento de adicciones. En Nuevo Laredo, Culiacán y Torreón se encontraron los consumos per cápita más elevados de cocaína, marihuana, anfetamina y metanfetamina. CONCLUSIONS: El monitoreo del uso de drogas a través de aguas residuales es factible en México y podría constituir un sistema de vigilancia para identificar cambios de su consumo en el tiempo.

Seroprevalence of dengue in school children in Mexico ages 6-17 years, 2016.

Background: Dengue is the most important arboviral disease in the world. Seroprevalence has been proposed as a marker of endemicity, however, studies are scarce. Methods: We conducted a cross-sectional, stratified cluster, random sample study to measure the seroprevalence of antibodies to dengue virus (DENV) in Mexico. The target population was school children ages 6-17 y from 22 endemic states in Mexico, clustered in four regions: Pacific, South-Central, Southeast and Low. Results: A total of 2134 subjects provided blood samples for immunoglobulin G antibody detection in serum by enzyme-linked immunosorbent assay. Overall, the seroprevalence of antibodies against DENV was 33.5% (95% confidence interval [CI] 27.5 to 40.1). The Southeast had the highest regional seroprevalence, reaching 70.9% (95% CI 60.3 to 79.7). Seroprevalence was higher in older children in the Southeast region: 62.1% (95% CI 46.9 to 75.2) in children 6-8 y and 82.6% (95% CI 73.8 to 88.9) in 13-17 years old (y). However, this was not consistent in all regions. Seroprevalence was associated with dengue incidence. Conclusions: DENV seroprevalence in Mexico was found to be heterogeneous at the country, regional and state levels. Seroprevalence was linked to long-term exposure and did not adequately reflect recent patterns of transmission, suggesting that utilization of a single epidemiological indicator to define endemic regions should be avoided.

Terremotos y salud: la organización de los servicios de atención médica / Earthquakes and healthcare: the organization of the services of medical attention

Resumen Los sistemas de salud están expuestos a diversos desastres que pueden impactar en la eficacia y calidad de servicio que ofrecen. Por ello, es importante contar con elementos que les permitan tener una adecuada infraestructura y organización. Este texto delinea algunos de estos elementos y acciones, cuya incorporación en los hospitales permitirá brindar una respuesta oportuna en caso de desastre. Se expone el uso del triage como un instrumento que regula el ingreso de los pacientes a los hospitales y se analiza cómo el inadecuado uso de éste durante una situación de desastre puede cobrar la vida de las personas lesionadas. Por último, se propone la preparación de un hospital ante posibles desastres y se retoma la experiencia de otro en el marco de los sismos ocurridos en México en 2017.

Abstract Health care systems are exposed to several natural disasters that could affect the effectiveness and quality of the services they offer. For this reason it is important to bring out the necessary elements that allow them a suitable organization and infrastructure. In this context some of these elements are drafted as well as a specific set of actions whose inclusion in the hospitals will allow for an optimal answer in case of natural disaster. The use of the triage is analyzed as an instrument that regulates the patient admission to the hospitals. Also, it is shown how the inadequate use of this tool during an emergency situation can follow with casualties from injured patients. For this reason, an appropriate set up for these cases is formulated. Last, the staging of a hospital before feasible contingences is proposed and the experience of the events of the 9/19 earthquake disaster retaken for this purpose.

Association of socioeconomic status, problem behaviors, and disordered eating in Mexican adolescents: results of the Mexican National Health and Nutrition Survey 2006.

PURPOSE: To explore the association of socioeconomic status (SES) with disordered eating behaviors (DEB) in Mexican adolescents, and the coexistence of DEB and other problem behaviors. METHODS: Information about adolescents (10-19 years) was retrieved from the Mexican National Health and Nutrition Survey 2006 database. Associations were evaluated through ordinal regression. RESULTS: Higher SES was associated with DEB (odds ratio [OR]: 2.05, 95% confidence interval [CI]: 1.52-2.75). Use of tobacco (OR: 2.10, 95% CI: 1.58-2.81), alcohol (OR: 2.03, 95% CI: 1.51-2.56), and suicide intent (OR: 5.13, 95% CI: 3.46-7.60) were associated with DEB. CONCLUSION: DEB were more frequent among adolescents from higher SES households. The lack of association between SES and DEB reported by other studies might be because of the lack of variability in samples. The association of DEB and other problem behaviors highlights the importance of an integral approach to teenagers' mental health.

The relationship between remittances and health care provision in Mexico.

OBJECTIVES: We examined whether remittances sent from the United States to Mexico were used to access health care in Mexico. METHODS: Data were from a 2006 survey of 2 localities in the municipal city of Tepoztlán, Morelos, Mexico. We used logistic regression to determine whether household remittance expenditure on health care was associated with type of health insurance coverage. RESULTS: Individuals who lacked insurance coverage or who were covered by the Seguro Popular program were significantly more likely to reside in households that spend remittances on health care than were individuals covered by an employer-based insurance program. CONCLUSIONS: Improving the coverage and quality of care within Mexico's health care system will help ensure that remittances serve as a complement, and not a substitute, to formal access to care.

Colaboraciones exitosas entre tres instituciones mexicanas en el estudio de las dislipidemias, la obesidad y la diabetes / Succesful collaborations between three Mexican institutions for research on dislipidemias, obesity and diabetes

Objetivo: Describir las contribuciones de tres instituciones mexicanas (Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Universidad Nacional Autónoma de México y Centro de Encuestas Nacionales de Salud del Instituto Nacional de Salud Pública) en el estudio de las enfermedades crónico-degenerativas. Resultados: Entre las aportaciones destacan la descripción de un alelo de riesgo para tener diabetes y el síndrome metabólico (R230C del transportador ABC-A1) específico para la población mexicana, una herramienta para estimar la probabilidad de tener diabetes a siete años, la descripción de la epidemiología molecular de la hipercolesterolemia familiar en adultos mexicanos y la identificación de varias regiones cromosómicas asociadas con la hiperlipidemia familiar combinada, así como la contribución a la descripción de la epidemiología de la diabetes, el síndrome metabólico y las dislipidemias en nuestro país. Conclusiones: La conjunción de intereses y la visión complementaria de los investigadores de las tres instituciones han hecho posible una serie de colaboraciones exitosas. La información generada será de utilidad para el desarrollo de pruebas diagnósticas y para la planeación de programas preventivos.

OBJECTIVE: To describe the contributions ofthree Mexican institutions (Instituto Nacional de Ciencias Médicas y Nutrición [quot ]Salvador Zubirán[quot ], Universidad Nacional Autónoma de México and the Centro de Encuestas Nacionales de Salud of the Instituto Nacional de Salud Pública) in the study, of chronic degenerative disorders. RESULTS: The most relevant group contributions include: the identification of a risk allele for metabolic syndrome and diabetes, specific for the Mexican population (the R230C variant of the ABC-A1 transporter); the design and validation of a population-based definition of metabolic syndrome which is useful to predict the risk of incident diabetes; the description of the molecular epidemiology of familial hypercholesterolemia in Mexico and the identification of several loci associated with familial combined hyperlipidemia. In addition, members of these institutions have participated in the description of the epidemiology of diabetes, metabolic syndrome and lipid abnormalities. CONCLUSIONS: The complementary approach of these research groups has facilitated successful collaborations. Our results will be useful for the future development of diagnostic tests and preventive programs.

Lung function growth in children with long-term exposure to air pollutants in Mexico City.

RATIONALE: Although short-term exposure to air pollution has been associated with acute, reversible lung function decrements, the impact of long-term exposure has not been well established. OBJECTIVES: To evaluate the association between long-term exposure to ozone (O(3)), particulate matter less than 10 mum in diameter (PM(10)), and nitrogen dioxide (NO(2)) and lung function growth in Mexico City schoolchildren. METHODS: A dynamic cohort of 3,170 children aged 8 years at baseline was followed from April 23, 1996, through May 19, 1999. The children attended 39 randomly selected elementary schools located near 10 air quality monitoring stations and were visited every 6 months. Statistical analyses were performed using general linear mixed models. MEASUREMENTS AND MAIN RESULTS: After adjusting for acute exposure and other potential confounding factors, deficits in FVC and FEV(1) growth over the 3-year follow-up period were significantly associated with exposure to O(3), PM(10), and NO(2). In multipollutant models, an interquartile range (IQR) increase in mean O(3) concentration (IQR, 11.3 ppb) was associated with an annual deficit in FEV(1) of 12 ml in girls and 4 ml in boys, an IQR range (IQR, 36.4 microg/m(3)) increase in PM(10) with an annual deficit in FEV(1) of 11 ml in girls and 15 ml in boys, and an IQR range (IQR, 12.0 ppb) increase in NO(2) with an annual deficit in FEV(1) of 30 ml in girls and 25 ml in boys. CONCLUSIONS: We conclude that long-term exposure to O(3), PM(10), and NO(2) is associated with a deficit in FVC and FEV(1) growth among schoolchildren living in Mexico City.

[Succesful collaborations between three Mexican institutions for research on dislipidemias, obesity and diabetes]. / Colaboraciones exitosas entre tres instituciones mexicanas en el estudio de las dislipidemias, la obesidad y la diabetes.

OBJECTIVE: To describe the contributions ofthree Mexican institutions (Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Universidad Nacional Autónoma de México and the Centro de Encuestas Nacionales de Salud of the Instituto Nacional de Salud Pública) in the study, of chronic degenerative disorders. RESULTS: The most relevant group contributions include: the identification of a risk allele for metabolic syndrome and diabetes, specific for the Mexican population (the R230C variant of the ABC-A1 transporter); the design and validation of a population-based definition of metabolic syndrome which is useful to predict the risk of incident diabetes; the description of the molecular epidemiology of familial hypercholesterolemia in Mexico and the identification of several loci associated with familial combined hyperlipidemia. In addition, members of these institutions have participated in the description of the epidemiology of diabetes, metabolic syndrome and lipid abnormalities. CONCLUSIONS: The complementary approach of these research groups has facilitated successful collaborations. Our results will be useful for the future development of diagnostic tests and preventive programs.

Body mass index associated with hyperglycemia and alterations of components of metabolic syndrome in Mexican adolescents

OBJECTIVE: This research aims to describe the epidemiology of obesity and its association with alterations in some components of metabolic syndrome, such as serum concentrations of glucose, insulin, and some lipids in a sub-sample of the Mexican Health Survey (MHS) of youth ages 10 to 19 years. MATERIAL AND METHODS: This analysis is based on a randomly selected sub-sample of the MHS of 20 percent of the youth ages 10 to19 years (n=1977), carried-out in Mexico in the year 2000 and distinguishes differences between national, rural and urban areas as well as four geographical country regions. Serum concentrations of glucose, insulin, triglycerides (TG), total cholesterol (TC) and HDL-cholesterol (HDLc) were measured. The protocol was approved by the Ethics Committee of the Mexican National Institute of Public Health. RESULTS: Overall, 14.8 percent of the individuals were overweight, 6.7 percent were obese and 37.5 percent had a family history of type 2 diabetes mellitus (DM2). The overall mean concentrations of glucose, insulin, total cholesterol, and triglycerides were significantly higher and those of HDLc were significantly lower in obese subjects than in individuals with normal Body Mass Index (BMI) (p< 0.05-0.001). The probability ratio (PR) of being in quintile 5 for glucose distribution was significantly higher for obese males and females (RP=2.1, p<0.001) than for their non-obese counterparts. It was also higher for females with a history of DM2 (RP=1.12, p<0.02), but not for males. The PR of being in quintile 5 for insulin distribution was significantly higher for obese males (RP=3.51, p<0.001) and females (RP=3.3, p<0.001) than for non-obese counterparts. It was also higher for male (RP=1.28, p<0.02) and female (RP=1.27, p<0.02) subjects with a history of DM2. Finally, the PR for being in quintile 5 for TG distribution was significantly higher for obese males (RP=4.71, p<0.001) and females (RP=1.75, p<0.001) than for their non-obese...

OBJETIVO: Esta investigación tiene como objetivo describir la epidemiología de la obesidad y de su asociación con alteraciones de algunos componentes del síndrome metabólico, tales como las concentraciones séricas de glucosa, insulina y algunos lípidos en una muestra de jóvenes con edades entre 10-19 años estudiados en la Encuesta Nacional de Salud (ENSA). MATERIAL Y MÉTODOS: El presente análisis está basado en una submuestra de 20 por ciento de los sujetos de la ENSA, realizada en México en el año 2000, con edades entre 10-19 años (n=1977) seleccionada aleatoriamente, con poder para distinguir diferencias a nivel nacional, urbano rural y por cuatro regiones geográficas del país. Se midieron en el suero las concentraciones de glucosa, insulina, colesterol total (CT), triglicéridos (TG) y colesterol-HDL (cHDL). El protocolo fue aprobado por el Comité de Ética del Instituto Nacional de Salud Pública. RESULTADOS: El 14.8 por ciento de la muestra tuvieron sobrepeso, 6.7 por ciento obesidad y 37.5 por ciento tenían una historia familiar de diabetes mellitus tipo2 (DM2). La media de las concentraciones de glucosa, insulina, CT y TG fueron significativamente mayores y los de cHDL significativamente menores en los sujetos obesos que en los que tenían índice de Masa Corporal (IMC) normal (p<0.05-0.001). La razón de probabilidades (RP) de estar en el quintil 5 de la distribución de glucosa fue significativamente mayor para los hombres y mujeres con obesidad (RP=2.1, p<0.001) que para sus contrapartes no obesos, para la mujeres con historia familiar de DM2 (1.12, p<0.02), pero no para los hombres. La RP de estar en el quintil 5 de la distribución de insulina fue mayor para los hombres (RP=3.51, p<0.001) y para las mujeres (RP=3.3, p<0.001) con obesidad que para aquellos con IMC normal, así como para los hombres (RP=1.28, p<0.02) y las mujeres (RP=1.27, p<0.02) con historia familiar de DM2. La RP de estar en el quintil 5 de la distribución de triglicéridos...

Diabetes mellitus en adultos mexicanos: resultados de la Encuesta Nacional de Salud 2000 / Diabetes mellitus in Mexican adults: results from the 2000 National Health Survey

OBJETIVO: Mostrar la prevalencia de la diabetes mellitus (DM) y los factores asociados con esta enfermedad en adultos a partir de datos de la Encuesta Nacional de Salud 2000 (ENSA 2000). MATERIAL Y MÉTODOS: Se realizó una entrevista, entre noviembre de 1999 y junio de 2000, a 45 294 sujetos de 20 años de edad y mayores. Se obtuvieron valores de glucosa capilar, peso, talla y tensión arterial. Para el análisis estadístico se utilizaron los factores de expansión individuales, y para el cálculo de las varianzas se tomó en consideración el diseño complejo de la encuesta mediante SUDAAN 7.5.6. RESULTADOS: La prevalencia nacional de DM en adultos de 20 y más años de edad fue de 7.5 por ciento (IC95 por ciento 7.1-7.9). En las mujeres fue de 7.8 por ciento y en los hombres de 7.2 por ciento. La prevalencia aumentó en relación directa con la edad, 2.3 por ciento antes de los 40 años y 21.2 por ciento después de los 60. En la población urbana la prevalencia fue de 8.1 por ciento y en la rural de 6.5 por ciento. La enfermedad fue más frecuente en la región norte del país (8.4 por ciento) y en el área metropolitana de la Ciudad de México (8.1 por ciento). Asimismo, fue más frecuente en la población con menor escolaridad (9.9 por ciento), menor ingreso (8.1 por ciento), hipertensión arterial (13.7 por ciento), hipercolesterolemia (23.3 por ciento), microalbuminuria (15.5 por ciento) y enfermedad renal (12.3 por ciento). Mediante modelos de regresión logística multivariada, estratificados por sexo, se identificaron como variables asociadas con la presencia de DM la edad, la baja escolaridad, el antecedente familiar de DM y la coexistencia de hipertensión arterial, enfermedad renal o hipercolesterolemia en ambos sexos. La obesidad abdominal se relacionó con DM sólo en las mujeres; la residencia en una zona urbana se vinculó con DM exclusivamente en los hombres. Las acciones más fuertes se observaron con la edad, el antecedente familiar de DM y la...

OBJECTIVE: To show the prevalence of diabetes mellitus (DM) and its associated factors in adults, using data derived from the 2000 National Health Survey (NHS). MATERIAL AND METHODS: The 2000 NHS was conducted between November 1999 and June 2000. An adult questionnaire was administered to 45 294 subjects 20 years of age and older. Capillary glucose levels, weight, height and blood pressure were obtained. Individual weighted factors were considered in the statistical analysis, as was the survey's complex sampling design to obtain variances using SUDAAN 7.5.6. RESULTS: The national prevalence of DM in adults ages 20 years and older was 7.5 percent (95 percent CI: 7.1-7.9). The prevalence was 7.8 percent in women and 7.2 percent in men. It was higher according to age: 2.3 percent in adults 40 years or younger and 21.2 percent in those older than 60 years of age. In the urban population, prevalence was 8.1 percent and in the rural population it was 6.5 percent. The disease was more frequent in the northern region of the country (8.4 percent) and in the Mexico City metropolitan area (8.1 percent). DM was more frequent in the population with the least amount of schooling (9.9 percent), the lowest income (8.1 percent), high blood pressure (13.7 percent), hypercholesterolemia (23.3 percent) microalbuminuria (15.5 percent) and renal disease (12.3 percent). Using multivariate logistic regression, stratified by gender, variables associated with DM were identified: age, little schooling, family history of DM, high blood pressure, renal disease or hypercholesterolemia in both genders. Abdominal obesity was associated with DM in women only and living in an urban area was associated with DM only in men. The highest associations were observed with age, family history of DM, and microalbuminuria. CONCLUSION: Results from the 2000 NHS show that DM represents a serious public health problem in Mexico. The impact increases when DM affects populations with...

Dyslipidemias and obesity in Mexico

OBJECTIVE: To describe in a national sample 1) the mean total cholesterol (TC), HDL-cholesterol (HDLc) and triglyceride (TG) concentrations, 2) the prevalence of the most common lipid abnormalities and 3) the association between obesity and these conditions. MATERIAL AND METHODS: We analyzed the nationally representative, cross-sectional Me-xican Health Survey (2000). The final analytic sample used consisted of 2 351 individuals at fasting state. TC, HDLc and TG were determined. BMI was classified according to the WHO cut-off points. Sex-specific means and 95 percent confidence intervals (95 percentCI) were calculated by age group for TC, HDLc and TG. The prevalence of: a) hypercholesterolemia (HC), b) hypoalphalipoproteinemia (HA), c) hypertriglyceridemia (HT), d) HT with HA and e) HC with HT was calculated adjusting for age. Multivariate logistic regression models were estimated to analyze the association of obesity to the prevalence of dyslipidemias. RESULTS: The mean TC, HDLc, and TG concentrations were: 197.5 mg/dl (95 percent CI= 194.0, 201.1), 38.4 mg/dl (95 percent CI= 37.2, 39.5) and 181.7 mg/dl (95 percent CI= 172.7, 190.6), respectively. HC was present in 40.5 percent of the adult females (95 percent CI=35.5, 45.4) and 44.6 of the adult males (95 percent CI=37.7, 51.4); HA was the most prevalent form of dyslipidemia, present in 64.7 percent (95 percent CI=58.7, 70.8) and 61.4 percent (95 percent CI=54.4, 68.3) of females and males, respectively. Obesity increased ~1.4 times the probability ratio (PR) of having HC among women and 1.9 among men. CONCLUSION: TC concentrations from our study in Mexico were similar to those found for Mexican-Americans and the prevalence of HC was slightly lower than the one reported in the US; however, it increased ~26 percent from 1988 to 2000. HA was the most frequent lipid abnormality followed by HT. Regions showed no significant differences, contrary to what has been previously reported.

OBJETIVO: Describir en una muestra nacional las concentraciones de 1) colesterol total (CT), colesterol-HDL (cHDL) y triglicéridos, 2) la prevalencia de las anomalías lipídicas más comunes y 3) identificar la asociación entre obesidad y estas condiciones. MATERIAL Y MÉTODOS: Se analizó la Encuesta Nacional de Salud (2000), una encuesta representativa y transversal. La muestra analítica final consistió en 2 351 individuos en ayuno. Se determinaron las concentraciones de CT, cHDL y TG. El índice de masa corporal se clasificó de acuerdo con los puntos de corte de la OMS. Se calcularon las medias y el intervalo de confianza del 95 por ciento (IC95 por ciento) estratificado por sexo para CT, cHDL y TG. La prevalencia de a) hipercolesterolemia (HC), b) hipoalfalipoproteinemia (HA), c) hipertrigliceridemia (HT), d) HT con HA y e) HC con HT se calculó ajustando por edad. Se estimaron modelos de regresión logística mul-tivariada para analizar la asociación de la obesidad a la prevalencia de dislipidemias. RESULTADOS: Las medias de CT, cHDL y TG fueron: 197.5 mg/dl (IC95 por ciento= 194.0, 201.1), 38.4 mg/dl (IC95 por ciento= 37.2, 39.5) y 181.7 mg/dl (IC95 por ciento= 172.7, 190.6) respectivamente. La prevalencia de HC fue de 40.5 por ciento en mujeres (IC95 por ciento=35.5, 45.4) y 44.6 en hombres (IC95 por ciento=37.7, 51.4); HA fue la forma más prevalente de dislipidemia, presente en 64.7 por ciento (IC95 por ciento=58.7, 70.8) y 61.4 por ciento (IC95 por ciento=54.4, 68.3) de las mujeres y los hombres respectivamente. La obesidad aumentó ~1.4 veces la razón de probabilidad de tener HC en mujeres y 1.9 en hombres. CONCLUSION: Las concentraciones de CT de nuestro estudio fueron similares a las encontradas en mexicanos residentes en los EUA y la prevalencia de HC fue ligeramente menor que la reportada en dicho país; sin embargo aumentó ~26 por ciento de 1988 a 2000. Las HA fueron la anomalía lipídica más frecuente seguida de HT. Las regiones...

Concentraciones de proteína C reactiva en adultos mexicanos: alta prevalencia de un factor de riesgo cardiovascular / C-reactive protein concentrations in Mexican men and women: high prevalence of a cardiovascular risk factor

OBJETIVO: Examinar la distribución y variables relacionadas con las concentraciones de proteína C reactiva (CRP) en adultos mexicanos. MATERIAL Y MÉTODOS: Se estudió a 2 194 adultos que participaron en la ENSA 2000. La concentración de CRP en suero se midió por un método de alta sensibilidad. Se obtuvo información sobre características sociodemográficas, enfermedad crónica y hábitos. Se midieron glucosa en ayuno, presión arterial, peso, talla y circunferencia de cintura. RESULTADOS: Se estudió a 730 hombres y 1 464 mujeres no embarazadas. La edad promedio fue de 38.3±15.2 años. Los límites de CRP se hallaron entre 0.19 y 255 mg/l (mediana: 2.26; rango intercuartil (RI): 0.96, 5.83 mg/l). La concentración de CRP fue mayor en mujeres (mediana: 2.86; RI: 1.11, 6.68 mg/l) en comparación con los hombres (mediana: 1.63; RI: 0.8, 3.87 mg/l; p<0.001). El 31.2 por ciento de los individuos (mujeres, 35.1 por ciento; hombres, 23.3 por ciento) tuvo concentraciones de CRP >3.0-10 mg/l. En el análisis multivariado de regresión probit, la edad, el IMC, la circunferencia de cintura, la diabetes mellitus, la microalbuminuria y el uso de anticonceptivos hormonales se vincularon de forma positiva con el riesgo de concentraciones de CRP >1 mg/l. El sexo masculino y el consumo moderado de alcohol se relacionaron de modo negativo con el riesgo de concentraciones de CRP >3 mg/l (p<0.05). CONCLUSIONES: Existe una alta prevalencia de concentraciones de CRP >3.0-10 mg/l en adultos mexicanos, lo que indica una considerable proporción de individuos con alto riesgo cardiovascular, al margen de otros factores de riesgo.

OBJECTIVE: To examine the distribution and correlates of C-reactive protein (CRP) concentrations in Mexican adults. MATERIAL AND METHODS: Data was analyzed from 2 194 Mexican adults who participated in the 2000 National Health Survey (ENSA-2000). CRP concentrations were measured with a high-sensitivity assay. Information on sociodemographic characteristics, chronic disease and habits was obtained. Fasting blood glucose, blood pressure, weight, height and waist circumference were measured. RESULTS: A total of 730 men and 1 464 non-pregnant women were studied. Mean age was 38.3±15.2 years. CRP concentrations ranged from 0.19 to 255 mg/L (median: 2.26; interquartile range (FIR): 0.96, 5.83 mg/L). CRP concentrations were higher in women (median: 2.86; IR: 1.11, 6.68 mg/L) than men (median: 1.63; IR: 0.8, 3.87 mg/L; p<0.001). Thirty-one percent of individuals (35.1 percent women, 23.3 percent men) had CRP concentrations >3.0-10 mg/L. Multivariate probit regression analysis showed that age, BMI, waist circumference, diabetes, microalbuminuria and use of oral contraceptives were positively associated with CRP concentrations >1 mg/L. Male gender and moderate alcohol consumption were negatively associated with CRP concentrations >3 mg/L (p<0.05). CONCLUSION: There is a high prevalence of CRP concentrations in the range of >3.0-10 mg/l in Mexican adults, indicating a considerable proportion of individuals at risk for cardiovascular disease, independent of other risk factors.

Seroprevalencia de anticuerpos contra el poliovirus 1 en niños mexicanos / Seroprevalence of antibodies against poliovirus type 1 in Mexican children

OBJETIVO: Analizar la frecuencia y distribución de la prevalencia de anticuerpos contra el virus de la poliomielitis tipo 1 en niños menores de 10 años en México, además de contribuir a la evaluación del programa de vacunación. MATERIAL Y MÉTODOS: Se estudió la presencia de anticuerpos contra el poliovirus tipo 1 en una muestra de la Encuesta Nacional de Salud 2000. Los sueros se recolectaron entre noviembre de 1999 y junio de 2000 a nivel nacional. La muestra constó de 6 270 niños de uno a nueve años de edad y se utilizó la técnica de neutralización. RESULTADOS: La seropositividad fue de 99.3 por ciento (IC95 por ciento99.1-99.7). Se identificaron como factores de riesgo de susceptibilidad el analfabetismo (RM= 1.5, p= 0.002) y el bajo ingreso familiar (RM= 1.4, p= 0.0487) y como factor protector el acceso a la seguridad social (RM= 0.41, p=0.04). CONCLUSIONES: Las actividades del programa de vacunación que han llevado a cabo las instituciones de salud han dado resultados en el control y eliminación de la enfermedad. Sin embargo, los programas de vacunación no deben interrumpirse, incluso si se ha registrado 99.3 por ciento de seropositividad; no puede soslayarse que al convertir el 0.7 por ciento restante, se calcula que hay 190 000 niños susceptibles de contraer la enfermedad. Estos niños se localizan sobre todo en el sur del país.

OBJECTIVE: To analyze the frequency and distribution of the prevalence of antibodies against the poliomyelitis type 1 virus in children 1-9 years old in Mexico. MATERIAL AND METHODS: Antibodies against poliovirus type 1 (neutralization method) were studied in 6 270 sera selected from the 24 232 sera from children one to nine years old, collected by the 2000 National Health Survey (ENSA 2000) that was conducted from November 1999 to June 2000. RESULTS: Overall seroprevalence was 99.3 percent (95 percentCI: 99.1-99.7). Using bivariate analysis, absence of antibodies was shown to be associated with illiteracy (OR= 1.5, p=0.002) and low household income (OR= 1.4, p=0.0487), while those children having access to social security (OR= 0.41 p=0.04) had a higher likelihood of having protective antibodies. CONCLUSIONS: The vaccination program activities conducted by health institutions have been successful in the control and eradication of the disease. However, a note of caution is necessary since the expansion of data reveals that although seroprevalence of antibodies has an upper limit of 99.3 percent, 0.7 percent of children (roughly 190 000) are susceptible to developing the disease. Most of these children live in the southern regions of the country.

Encuesta serológica nacional del sarampión en niños: evidencias para su eliminación / Measles serologic survey in Mexican children: evidence for its elimination in Mexico

OBJETIVO: Analizar la distribución y frecuencia de anticuerpos protectores contra sarampión en una muestra representativa estatal en niños de 1-9 años, así como contribuir a la evaluación de los programas de vacunación contra este agente. MATERIAL Y MÉTODOS: Se estudió la presencia de anticuerpos contra el virus del sarampión en una muestra de la Encuesta Nacional de Salud 2000. Los sueros se recolectaron de noviembre de 1999 a junio de 2000. La muestra consta de 6 270 niños y se utilizó la técnica de reducción de placas por neutralización. RESULTADOS: La seropositividad (>120 UI/L) de los niños de 1-4 años fue menor que la de los niños de 5-9 años, 98.3 por ciento (IC95 por ciento 97.7-98.8) contra 99.4 por ciento (IC95 por ciento 99.2-99.6, p<0.001). Los niveles de seropositividad se incrementaron con el número de dosis de vacuna de sarampión o sarampión-rubeola-parotiditis y no dependen de género, residencia o nivel socioeconómico. CONCLUSIONES: Los resultados muestran que existe una cobertura adecuada en la vacunación; sin embargo, al expandir los datos se observó que existen 417 000 niños que presentaron títulos negativos de anticuerpos, por lo que son susceptibles de adquirir, transmitir el virus y contribuir a la generación de brotes de la enfermedad.

OBJECTIVE: To analyze the frequency and distribution of protective antibodies against measles in a sample of children from 1-9 years old representative of each of the 32 states in Mexico; to contribute to the evaluation of the measles vaccination programs. MATERIAL AND METHODS: Measles antibodies (plaque reduction neutralization (PRN) assay) were studied in 6 270 sera selected from the 24 232 sera from children 1-9 years of age, collected by the 2000 National Health Survey (ENSA 2000) that was conducted from November 1999 to June 2000. RESULTS: Proportion of seropositive samples (>120 IU/L) among 1-4 year-old children (98.3 percent [95 percentCI: 97.7-98.8]) was less than that of 5-9 year-old children (99.4 percent [95 percentCI: 99.2-99.6]; p<0.001). Seropositivity was associated with the number of measles and/or measles-rubella-mumps vaccine doses and was not associated with gender, place of residence or socio-economic status. CONCLUSIONS: The results show that there is adequate vaccination coverage. However, the expansion of data revealed that there are 417 000 children with negative antibody titers who are susceptible to acquiring the disease, transmitting the virus and causing outbreaks.