Interaction between FTO rs9939609 and the Native American-origin ABCA1 rs9282541 affects BMI in the admixed Mexican population.

BACKGROUND: The aim of this study was to explore whether interactions between FTO rs9939609 and ABCA1 rs9282541 affect BMI and waist circumference (WC), and could explain previously reported population differences in FTO-obesity and FTO-BMI associations in the Mexican and European populations. METHODS: A total of 3938 adults and 636 school-aged children from Central Mexico were genotyped for both polymorphisms. Subcutaneous and visceral adipose tissue biopsies from 22 class III obesity patients were analyzed for FTO and ABCA1 mRNA expression. Generalized linear models were used to test for associations and gene-gene interactions affecting BMI, WC and FTO expression. RESULTS: FTO and ABCA1 risk alleles were not individually associated with higher BMI or WC. However, in the absence of the ABCA1 risk allele, the FTO risk variant was significantly associated with higher BMI (P = 0.043) and marginally associated with higher WC (P = 0.067), as reported in Europeans. The gene-gene interaction affecting BMI and WC was statistically significant only in adults. FTO mRNA expression in subcutaneous abdominal adipose tissue according to ABCA1 genotype was consistent with these findings. CONCLUSIONS: This is the first report showing evidence of FTO and ABCA1 gene variant interactions affecting BMI, which may explain previously reported population differences. Further studies are needed to confirm this interaction.

[Utilization patterns of prevention and early diagnosis for cancer in women]. / Patrones de utilización de programas de prevención y diagnóstico temprano de cáncer en la mujer.

OBJECTIVE: To estimate the utilization patterns of cancer prevention programs in women during the period 2000-2012 in Mexican women who participated in three national surveys. MATERIALS AND METHODS: We analyzed data from the ENSA 2000, ENSANUT 2006 and ENSANUT 2012 that are representative of the Mexican population. Prevalences were obtained, trend tests and Poisson regression were used to determine the possibility of having more coverage. RESULTS: The coverage of Papanicolaou use in the last 12 months in 2012 was 45.5%, HPV testing in the last four years was 11.9% and mammography use in the past two years was 29.4% and 17.2% in women aged 50-69 years and 40-49 years, respectively. CONCLUSIONS: Although there was an increase in the coverage of screening programs, there should be a boost in the service quality and universal coverage.

Health care utilization and health-related quality of life perception in older adults: a study of the Mexican Social Security Institute.

OBJECTIVE: To establish how health care service utilization patterns are associated with health-related quality of life (HRQL) perception in older adults. MATERIAL AND METHODS: A cross-sectional study in adults aged 60 years or more was conducted in a random sample of 1150 beneficiaries of the Mexican Social Security Institute (IMSS) in Mexico City during 2003. Health care services utilization was categorized as preventive or curative, which generated six usage profiles. HRQL was measured by means of the SF-36 questionnaire. Analyses of variance and multiple linear regressions were conducted to evaluate the relationship between health care services utilization and HRQL. RESULTS: The use of preventive and curative services has a positive association with HRQL levels. Usage profiles with a prevalence of preventive services have a stronger positive association with HRQL scales. CONCLUSIONS: This study suggests a positive association between use patterns for primarily preventive health care services and a better HRQL perception among older adults.

Early use of the HPV 2-dose vaccination schedule: Leveraging evidence to support policy for accelerated impact.

Although human papillomavirus (HPV) vaccines were initially licensed based on efficacy after three-dose regimens in women aged 15-26 years, it was recognized early in clinical development that comparable immunogenicity could be obtained after just two doses when administered to younger girls. In both Canada and Mexico, public health authorities made the decision to administer two doses 6 months apart with a planned additional dose at 60 months, while simultaneously doing further study to determine if the third dose would confer meaningful additional benefit. This delayed third dose approach permitted a more cost-effective program with opportunities for improved compliance while minimizing injections and leaving open the opportunity to provide a full three-dose vaccination series. It required close cooperation across many governmental and civil society leadership bodies and real-time access to emerging data on HPV vaccine effectiveness. Although still limited, there is increasing evidence that even one-dose vaccination is sufficient to provide prolonged protection against HPV infection and associated diseases. Ongoing clinical trials and ecological studies are expected to consolidate existing data regarding one dose schedule use. However, to accelerate the preventive effect of HPV vaccination some jurisdictions, in particular those with limited resources may already consider the initiation of a one dose vaccination with the possibility of giving the second dose later in life if judged necessary. Such an approach would facilitate vaccination implementation and might permit larger catch-up vaccination programs in older girls (or as appropriate, girls and boys), thereby accelerating the impact on cervical cancer and other HPV-associated diseases.

[Unhealthy behavior associated with the development of high blood pressure in adolescents]. / Conducta no saludable asociada con el desarrollo de presión arterial elevada en adolescentes.

This article aims to evaluate the association between unhealthy behavior pattern and prevalence and incidence of high blood pressure in adolescents. Based on data from a cohort study with a baseline population of 2,813 adolescents enrolled in a public school system, the study measured the baseline prevalence and incidence of high blood pressure as a function of smoking, alcohol and illegal drug use, and physical activity. These variables were used to build a model called "unhealthy behavior pattern", and its relationship was evaluated in relation to high blood pressure in adolescents, using multiple logistic regression models. Prevalence of high blood pressure was 8.67%. Accumulated incidence of high blood pressure was 7.58%. In the multivariate analysis of high blood pressure adjusted by degree of adiposity, there was an association with the unhealthy behavior pattern in males (OR = 3.13; 95%CI: 1.67-5.84). The association between incidence of high blood pressure and unhealthy behavior pattern was observed in females (OR = 2.34; 95%CI: 1.11-4.95). In conclusion, high blood pressure is present in the adolescent population, associated with unhealthy behaviors like smoking, alcohol and illegal drug use, and physical inactivity, independently of the degree of adiposity.

Characteristics of respondents to a cervical cancer screening program in a developing country.

BACKGROUND: Characteristics associated with the response to a personalized, mailed invitation for the Papanicolaou (Pap) test vary among women. This study assesses the relationship between selected characteristics (e.g., demographic, obstetric, Pap history) and the response to a letter of invitation to undergo a Pap test among Mexican women affiliated with the Mexican Social Security Institute (IMSS). METHODS: Study subjects were 328 women affiliated with the IMSS who received and responded to a mailed letter of invitation, and 247 age- and clinically matched controls who received but did not respond to the letter of invitation. Statistical analysis consisted of multivariate conditional regression model. RESULTS: Having better housing conditions was one of the factors associated with letter response (medium level vs. low level, odds ratio [OR] = 3.17, 95% confidence interval [95% CI] = 2.46-4.09; high level vs. low level, OR = 2.65, 95% CI = 2.06-3.41). Other factors positively associated with letter response were greater number of pregnancies, previous Pap testing, being pleased at receipt of the letter of invitation, and knowing another woman who had received the invitation. Factors associated negatively to letter response were 7 or more years of formal education (> or =7 years vs. 0-6 years, OR = 0.50, 95% CI = 0.40-0.63), having a current job, availability of other medical services in addition to the IMSS, and willingness to receive Pap results by mail. CONCLUSIONS: Low educational level is not a limitation for cervical cancer screening call and recall among women affiliated with the IMSS.

Predictors of bone mineral density in female workers in Morelos State, Mexico.

BACKGROUND: Although several studies have identified factors associated with bone mineral density (BMD), little research is available on Mexican women. METHODS: A cross-sectional study was conducted in 1,622 female workers between 20 and 80 years of age at the Mexican Social Security Institute (IMSS), an integral part of the Mexican health system. It was carried out in Morelos, a Mexican state that borders Mexico City. Women were recruited to participate in this study from their workplaces. Body mass index (BMI) was measured and BMD was assessed using dual-energy x-ray absorptiometry of dominant forearm. Predictors of BMD (age, reproductive factors, BMI, diet, and physical activity) in pre- and postmenopausal women were assessed by questionnaire and analyzed using generalized additive models. RESULTS: In premenopausal women, older age, higher BMI, younger age at menarche, and greater vitamin D intake were associated with higher BMD (R(2)=0.06, null deviance reduction=6.9%). In postmenopausal women, determinants of BMD were older age, higher BMI, greater height, later initiation of menopause, longer time of use of hormonal replacement therapy (HRT), and greater calcium intake from dairy products (R(2)=0.39, null deviance reduction=40.7%). CONCLUSIONS: As observed in other populations, age, BMI, height, age at menopause, time of use of HRT, and calcium intake derived from dairy products in these Mexican women are factors associated with higher forearm BMD during postmenopausal period. Age, BMI, age at menarche, and vitamin D are associated with higher forearm BMD in premenopausal women. Some of these factors are not linearly associated with BMD. This was a limited population study carried out in a large group of female healthcare workers whose reproductive and lifestyle factors potentially agreed with those of female workers from urban areas of Mexico.

Association between serum concentration of apolipoproteins A-I and B with gallbladder disease.

BACKGROUND: A total of 1,255 subjects attending a private health care facility in Mexico City were studied to evaluate the association of serum concentration of Apo A-I and Apo B with presence of gallbladder disease (gallstones or cholecystectomy). METHODS: A cross-sectional study was carried out. All participants provided data on sociodemographic status and previous diagnoses of type 2 diabetes, hypertension, cardiovascular events, alcohol consumption, and smoking habits. Women additionally reported their obstetric-gynecologic history. Weight and height were measured; liver and biliary tract ultrasound assessed gallbladder disease. Plasma levels of total cholesterol, triglycerides, high-density lipoproteins (HDL) cholesterol, and apolipoproteins A-I (Apo A-I) and B (Apo B) were determined after a 12-h fasting period. RESULTS: In multivariate models, Apo A-I > or = 120 mg/dL was positively associated with gallbladder disease with odds ratio (OR) = 1.64, 95% confidence interval (95% CI) = 1.03-2.62, whereas Apo B > or = 120 mg/dL showed an inverse association (OR = 0.71, 95% CI = 0.48-1.05). Ratio of Apo B/Apo A-I > or = 1 was inversely associated with risk of gallbladder disease (OR = 0.54, 95% CI = 0.37-0.80). All models were adjusted for age, gender, body mass index (BMI), previous diagnosis of type 2 diabetes, triglycerides, alcohol consumption, tobacco, and contraceptive use, as well as for total cholesterol in HDL-cholesterol and Apo A-I models. CONCLUSIONS: Our results suggested the relationship between serum concentration of apolipoproteins and gallbladder disease. These findings support the hypothesis of increased biliary catabolism of cholesterol in subjects with gallbladder disease characterized by lower Apo B and higher Apo A-I serum concentrations.

Interleukin-6 polymorphisms are associated with obesity and hyperglycemia in Mexican adolescents.

BACKGROUND AND AIMS: Interleukin-6 is an inflammatory response mediator used as a metabolic marker of obesity. Polymorphisms IL6 -597C>A, -572G>C, and -174G>C modify the production of this protein. The associations between these haplotypes and obesity or metabolic markers have not been studied in adolescents, so an analysis of these associations was performed. METHODS: The cross-sectional study included 745 apparently healthy 14- to 19-year-old adolescents. Obesity, serum glucose, insulin, triglycerides, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol (HDL-C), and high-sensitivity C-reactive protein (hs-CRP) were evaluated, and IL6 -597G>A, -572G>C and -174G>C polymorphisms determined. The associations were analyzed using multivariate logistic regression models. RESULTS: The allele frequencies were 0.15 for -597A and -174C and 0.30 for -572C. Genotypes were in Hardy-Weinberg equilibrium. IL-6(-597/-572/-174) haplotypes GGG, GCG, and AGC comprised 99.74% of the total haplotypes. The associations were significant between genotype GCG/GCG and hyperglycemia (OR = 2.86, 95% CI = 1.02-7.97); between GCG/GCG and high hs-CRP (OR = 6.17, 95% CI = 1.13-33.77); between AGC/AGC and obesity (OR = 4.42, 95% CI = 1.40-14.01); and between GGG/GCG and low HDL-C (OR = 1.53, 95% CI = 1.03-2.28). CONCLUSIONS: Genotypes of the IL6(-597/-572/-174) polymorphisms are associated with metabolic risk factors in Mexican adolescents.

Conducta no saludable asociada con el desarrollo de presión arterial elevada en adolescentes / Unhealthy behavior associated with the development of high blood pressure in adolescents / Conduta não saudável associada com o desenvolvimento da pressão arterial elevada em adolescentes

El artículo tiene como objetivo evaluar la asociación entre el patrón de conducta no saludable sobre la prevalencia y la incidencia de la presión arterial elevada en adolescentes. A partir de la información de un estudio de cohorte con una población en la medición basal de 2.813 adolescentes del sistema de educación pública, se determinó la prevalencia (basal) e incidencia de la presión arterial elevada, junto con el consumo de tabaco, alcohol, drogas ilegales y las variables de actividad física. Con estas variables, se construyó un modelo llamado "patrón de conducta no saludable" y se evaluó su relación con la presión arterial elevada en los adolescentes, utilizando modelos de regresión logística múltiple. Entre los resultados, se observa que la prevalencia de la presión arterial elevada fue 8,67%. La incidencia acumulada de la presión arterial elevada fue 7,58%. En el análisis múltiple de la prevalencia de presión arterial elevada, ajustado por grado de adiposidad, hubo asociación con un alto patrón de conducta no saludable en el grupo de los hombres (OR = 3,13; IC95%: 1,67-5,84). La asociación de la incidencia de la presión arterial elevada y alto patrón de conducta no saludable se observa en el grupo de las mujeres, (OR = 2,34; IC95%: 1,11-4,95). Se concluye que la presión arterial elevada está presente en la población adolescente, asociado a conductas no saludables en ellos, como el tabaquismo, el alcohol, las drogas ilegales y la escasa actividad física, independientemente del grado de adiposidad.

This article aims to evaluate the association between unhealthy behavior pattern and prevalence and incidence of high blood pressure in adolescents. Based on data from a cohort study with a baseline population of 2,813 adolescents enrolled in a public school system, the study measured the baseline prevalence and incidence of high blood pressure as a function of smoking, alcohol and illegal drug use, and physical activity. These variables were used to build a model called "unhealthy behavior pattern", and its relationship was evaluated in relation to high blood pressure in adolescents, using multiple logistic regression models. Prevalence of high blood pressure was 8.67%. Accumulated incidence of high blood pressure was 7.58%. In the multivariate analysis of high blood pressure adjusted by degree of adiposity, there was an association with the unhealthy behavior pattern in males (OR = 3.13; 95%CI: 1.67-5.84). The association between incidence of high blood pressure and unhealthy behavior pattern was observed in females (OR = 2.34; 95%CI: 1.11-4.95). In conclusion, high blood pressure is present in the adolescent population, associated with unhealthy behaviors like smoking, alcohol and illegal drug use, and physical inactivity, independently of the degree of adiposity.

O artigo objetivou avaliar a associação entre o padrão de conduta não saudável sobre a prevalência e incidência da pressão arterial elevada em adolescentes. A partir das informações de um estudo de coorte, com uma população na medição basal de 2.813 adolescentes do sistema de ensino público, foi determinada a prevalência (basal) e incidência da pressão arterial elevada, junto com o consumo de cigarro, bebidas alcoólicas, drogas ilegais e as variáveis de atividade física. Com estas variáveis, foi construído um modelo chamado "padrão de conduta não saudável" e foi avaliada sua relação com a pressão arterial elevada nos adolescentes, usando modelos de regressão logística múltipla. Entre os resultados, foi observado que a prevalência da pressão arterial elevada foi 8,67%. A incidência acumulada da pressão arterial elevada foi 7,58%. Na análise múltipla de prevalência da pressão arterial elevada, ajustado por graus de gordura, houve associação com um padrão alto de conduta não saudável no grupo dos homens (OR = 3,13; IC95%: 1,67-5,84). A associação da incidência da pressão arterial elevada e um alto padrão de conduta não saudável foram observados também no grupo das mulheres, (OR = 2,34; IC95%: 1,11-4,95). Concluímos que a pressão arterial elevada está presente na população adolescente, associada a condutas não saudáveis entre elas: o tabagismo, o álcool, as drogas ilegais e a insuficiente atividade física, independentemente do grau de gordura corporal.

Patrones de utilización de programas de prevención y diagnóstico temprano de cáncer en la mujer / Utilization patterns of prevention and early diagnosis for cancer in women

Objetivo. Estimar los patrones de utilización de los programas preventivos de cáncer en la mujer durante el periodo 2000-2012 en mujeres mexicanas que participaron en tres encuestas nacionales. Material y métodos. Se analizó información de la ENSA 2000 y de las ENSANUT 2006 y 2012 que son representativas de la población del país. Se obtuvieron prevalencias y se aplicaron pruebas de tendencia y regresión de Poisson para determinar las posibilidades de tener una mayor cobertura. Resultados. La cobertura de uso de Papanicolaou en los últimos 12 meses en 2012 fue de 45.5%, de prueba de VPH en los últimos cuatro años fue de 11.9% y de mastografía en los últimos dos años fue de 29.4 y de 17.2% en mujeres de 50 a 69 años y de 40 a 49 años, respectivamente. Conclusiones. Aunque se observa un incremento en la cobertura de los programas de detección se debe impulsar la calidad de los servicios y la cobertura universal.

Objective. To estimate the utilization patterns of cancer prevention programs in women during the period 2000-2012 in Mexican women who participated in three national surveys. Materials and methods. We analyzed data from the ENSA 2000, ENSANUT 2006 and ENSANUT 2012 that are representative of the Mexican population. Prevalences were obtained, trend tests and Poisson regression were used to determine the possibility of having more coverage. Results. The coverage of Papanicolaou use in the last 12 months in 2012 was 45.5%, HPV testing in the last four years was 11.9% and mammography use in the past two years was 29.4% and 17.2% in women aged 50-69 years and 40-49 years, respectively. Conclusions. Although there was an increase in the coverage of screening programs, there should be a boost in the service quality and universal coverage.

[Screening and follow-up for cervical cancer prevention in rural Mexico using visual inspection]. / Detección y seguimiento con inspección visual del cérvix para la prevención del cáncer cervicouterino en las zonas rurales de México.

OBJECTIVE: To compare the standard cervical cancer screening procedure--the Papanicolaou test or Pap smear--with detection through visual inspection using acetic acid (VIA), and visual inspection with acetic acid assisted by Aviscope (VIAM). MATERIAL AND METHODS: The study was conducted between October 1998 and December 2000, in two Mixteca regions in Oaxaca, Mexico. A field trial design was used to randomize the two regions to either of the two inspection methods. In one region 2,240 women received VIA; in the other, 2,542 women received VIAM. Women positive to visual inspection and a subsample of women with negative results were referred for colposcopy and, if necessary, cervical biopsy. Statistical data analysis consisted of descriptive statistics and comparison of groups using chi-squared tests. Diagnostic values were obtained for VIA and VIAM, using as gold standards colposcopy and biopsy. RESULTS: VIAM identified a higher proportion of women with a cervical abnormality (16.3%) than VIA (3.4%), as well as normal women (58.5% vs. 53.8%).VIA identified a higher proportion of women with benign changes (41.2%) than VIAM (19.6%).VIAM had a greater sensitivity (p>0.05) but lower specificity (p<0.05) than VIA, using as gold standards colposcopy and biopsy. CONCLUSIONS: The two study groups were comparable for age, parity and cytological results; however, visual inspection results were different between the groups: VIAM identified more lesions confirmed by biopsy. The diagnostic utility of VIAM and VIA was lower than expected. Training of clinical personnel in visual inspection is critical to improve the effectiveness of these screening methods.

[Smoking among health professionals of the Mexican Social Security Institute, Morelos]. / Tabaquismo en profesionales de la salud del instituto Mexicano del Seguro Social, Morelos.

OBJECTIVE: To assess the prevalence of tobacco smoking by work type among healthcare workers of Instituto Mexicano del Seguro Social (Mexican Institute of Social Security, IMSS), in Morelos State, Mexico. MATERIAL AND METHODS: A cross-sectional was conducted in 3,133 healthcare workers in the 23 medical units of IMSS Morelos District, from October 1998 to March 2000. Data were collected using a self-applied questionnaire on tobacco smoking for different life-stages, some demographic characteristics, and work type. The prevalence rates of smoking and 95% confidence intervals (95% CI) were estimated by age groups, gender, and work type. RESULTS: A total of 3,133 employees participated; 53.4% (95% CI 50.8-56.8) of men and 27.4% (95% CI 25.4-29.3) of women reported having smoked tobacco some time in their lives. The prevalence of current smoking was 28.3% (95% CI 25.6-31.0) and 14.4% (95% CI 12.8-15.9) in men and women, respectively. Among men, physicians have a lower prevalence (20.9%) of current smoking than that of other workers; for example, the prevalence was 26.6% among technicians and 33% among administrative personnel. Women in general had a lower prevalence than men in all categories, and in nurses it was still lower t(12.5%) than that of female physicians (16%). CONCLUSIONS: The prevalence of tobacco smoking in healthcare workers of IMSS Morelos was lower than that of the general population. Nevertheless, it is necessary to keep working on tobacco control programs to encourage smoking cessation among healthcare workers and make them aware of the positive role they may play in promoting programs to stop tobacco smoking and nicotine addiction.

Prevalence and determinants of male partner violence against Mexican women: a population-based study.

OBJECTIVE: To determine the prevalence of and risk factors for violence against women, inflicted by their male partners, in a representative sample of women residing in the metropolitan area of Cuernavaca Morelos, Mexico. MATERIAL AND METHODS: A population-based study was conducted from June to September 1998, among 1,535 women aged 15 to 49 years. Principal components analysis was used to determine the domains of violence that served as the dependent variable. Polynomial logistic regression models were used to estimate odds ratios (OR), with 95% confidence intervals (CI). RESULTS: Prevalence of low-moderate level violence was 35.8%, while prevalence of severe violence was 9.5%. The lifetime prevalence of reported rape was 5.9%. The main factors associated with violence were socio-economic status (OR=0.57; 95% CI=0.34-0.95); education level, both of the women studied (test for trend p=0.01) and of the male partner (test for trend p=0.002); number of years living with partner (OR=2.63; 95% CI=1.55-4.45), alcohol use (OR=2.56; 95% CI=2.02-3.25), illegal drug use by partner (OR=6.17; 95% CI=2.37-16.03); violence during childhood (OR=3.40; 95% CI=2.23-5.18), and a history of rape (OR=5.89; 95% CI=2.78-12.5). CONCLUSIONS: Study findings confirm that violence against women is a prevalent phenomenon in Mexico. Awareness-raising campaigns about male partner violence should bring this important issue to the front of public discussion. Such efforts will help assure that future generations do not experience partner violence to the extent that contemporary Mexican women do.

[Violence against women: knowledge and attitudes of the the medical staff at the Mexican Institute of Social Security, Morelos, Mexico]. / Violencia contra la mujer: conocimiento y actitud del personal médico del Instituto Mexicano del Seguro Social, Morelos, México.

OBJECTIVE: To asses the affective, cognitive, and behavioral attitudes of healthcare providers at the Mexican Institute of Social Security (MISS) in Morelos, Mexico; to identify the institutional and medical practice barriers that hinder screening and reference of battered women. MATERIAL AND METHODS: A cross-sectional study was conducted between September and December 1999. A self-administered questionnaire was applied to 269 general practitioners, specialists, and pre- and postdoctoral students working in 30 primary and secondary level of healthcare units in Morelos State. The data collection instrument was designed to assess healthcare providers' knowledge of and attitudes towards domestic violence during medical office visits. A knowledge index was constructed and analyzed using multivariate regression methods. RESULTS: Ninety percent of healthcare providers had never received training on violence against women. Healthcare providers' affective and cognitive attitudes after receiving training on the subject matter were more favorable compared to those with no training. Favorable attitudes were directly related to the number of training sessions. Most participants (63%) showed a moderate degree of knowledge on the subject, whereas 21% were slightly knowledgeable and 16% were highly knowledgeable. Medical personnel with a moderate or high level of knowledge were 2.1 and 6 times more likely, respectively, to have favorable attitudes than those with a low degree of knowledge. Female physicians showed more favorable attitudes towards identifying and referring battered women. Medical personnel interested in further training on the subject of violence against women were 7.6 times more likely to show favorable attitudes than personnel not interested on the subject. CONCLUSIONS: Healthcare providers were not sufficiently able to assess and manage battered women. General and family practitioners were more interested in being trained, as compared with specialist physicians. Training on violence against women should be included in graduate medical, nursing, social service, psychology, and other public health areas. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Health care utilization and health-related quality of life perception in older adults: a study of the Mexican Social Security Institute / Utilización de servicios de salud y percepción de calidad de vida relacionada a la salud en adultos mayores: un estudio en el Instituto Mexicano del Seguro Social

OBJECTIVE: To establish how health care service utilization patterns are associated with health-related quality of life (HRQL) perception in older adults. MATERIAL AND METHODS: A cross-sectional study in adults aged 60 years or more was conducted in a random sample of 1150 beneficiaries of the Mexican Social Security Institute (IMSS) in Mexico City during 2003. Health care services utilization was categorized as preventive or curative, which generated six usage profiles. HRQL was measured by means of the SF-36 questionnaire. Analyses of variance and multiple linear regressions were conducted to evaluate the relationship between health care services utilization and HRQL. RESULTS: The use of preventive and curative services has a positive association with HRQL levels. Usage profiles with a prevalence of preventive services have a stronger positive association with HRQL scales. CONCLUSIONS: This study suggests a positive association between use patterns for primarily preventive health care services and a better HRQL perception among older adults.

OBJETIVO: Determinar cómo distintos patrones de utilización de servicios están asociados con calidad de vida relacionada a la salud (CVRS) de adultos mayores. MATERIAL Y MÉTODOS: Estudio transversal en adultos de 60 años y mayores con muestra aleatoria de 1150 derechohabientes del Instituto Mexicano del Seguro Social (IMSS) en la Ciudad de México en 2003. El uso de los servicios se clasificó en preventivos y curativos, lo que generó seis perfiles de utilización de servicios. La CVRS se midió con el SF-36. Para evaluar la asociación del uso de servicios con CVRS se realizaron análisis de varianza y regresión lineal múltiple. RESULTADOS: La utilización de servicios preventivos y curativos muestra una asociación positiva con CVRS. Los perfiles en que predominan servicios preventivos tienen una asociación positiva más fuerte con escalas de CVRS. CONCLUSIONES: Este estudio sugiere una asociación positiva de los perfiles de uso de servicios predominantemente preventivos con una mejor percepción de CVRS en adultos mayores.

Detección y seguimiento con inspección visual del cérvix para la prevención del cáncer cervicouterino en las zonas rurales de México / Screening and follow-up for cervical cancer prevention in rural Mexico using visual inspection

OBJETIVO: Se comparan los nuevos métodos de detección de lesiones preneoplásicas del cérvix-inspección visual con ácido acético (IVAA) e inspección visual con ácido acético y magnificación (IVAM) con el aparato AviScopeMR- y el método tradicional de detección por citología. MATERIAL Y MÉTODOS: El estudio se llevó a cabo entre octubre de 1998 y diciembre de 2000, en dos zonas de la región de La Mixteca, en Oaxaca, México. El diseño de estudio fue de tipo ensayo comunitario. El IVAA correspondió a un brazo del estudio y el IVAM a otro; ambos métodos de detección se practicaron en mujeres que tenían entre 20 y 65 años de edad. Se incluyeron 2 240 mujeres en el brazo IVAA y 2 542 en el brazo IVAM. Las mujeres en las que la inspección visual dio un resultado positivo y una submuestra de las mujeres con resultado negativo, fueron referidas a colposcopía y, en caso de ser necesario, a biopsia de tejido cervicouterino. El análisis estadístico se presenta descriptivamente y los grupos se compararon con la prueba de Ji-cuadrada. Se presentan además los resultados de los valores diagnósticos de IVAA e IVAM, comparados con el diagnóstico por colposcopía y biopsia. RESULTADOS: El método IVAM detectó un mayor porcentaje de mujeres identificadas con alguna anomalía (16.3 por ciento) que el IVAA (3.4 por ciento), así como de mujeres normales (58.5 por ciento vs. 53.8 por ciento, respectivamente). Por otra parte, el método IVAA identificó a más mujeres con cambios benignos (41.2 por ciento) que el IVAM (19.6 por ciento). Este último tuvo una mayor sensibilidad (p>0.05) y una menor especificidad (p<0.05) que IVAA, usando como estándar de oro la colposcopía y la biopsia. CONCLUSIONES: Ambas poblaciones de estudio presentaron características similares en cuanto a edad, paridad y resultados citológicos; sin embargo, los hallazgos a partir de la inspección visual fueron muy distintos entre los dos grupos; el grupo IVAM identificó más lesiones confirmadas por biopsia. La utilidad diagnóstica de IVAM e IVAA fue menor que la esperada. La capacitación práctica del personal clínico en inspección visual es crítica para la efectividad de este método.

Violencia contra la mujer: conocimiento y actitud del personal médico del Instituto Mexicano del Seguro Social, Morelos, México / Violence against women: knowledge and attitudes of healthcare providers at the Mexican Institute of Social Security in Morelos, Mexico

OBJETIVO: Evaluar la actitud afectiva, cognoscitiva y conductual del personal médico del Instituto Mexicano del Seguro Social del estado de Morelos, México, hacia la identificación y canalización de mujeres maltratadas que acuden a consulta médica, así como identificar las barreras institucionales y de la práctica médica que dificultan el manejo dentro de los servicios de salud de las mujeres maltratadas. MATERIAL Y MÉTODOS: De septiembre a diciembre de 1999 se realizó un estudio transversal mediante un cuestionario de autoaplicación que se proporcionó a 269 médicos y médicas generales, especialistas y estudiantes de pre y posgrado que laboran en 30 unidades de salud, de primer y segundo nivel de atención, del Instituto Mexicano del Seguro Social del estado de Morelos. El instrumento se diseñó para evaluar el nivel de conocimiento sobre violencia doméstica y la actitud del personal médico hacia la atención, en la consulta, de mujeres maltratadas. Se construyó un índice de conocimiento, además de un análisis multivariado de los datos. RESULTADOS: El 90 por ciento de los entrevistados nunca ha recibido capacitación en violencia contra la mujer. La actitud afectiva y cognoscitiva del personal médico que recibió capacitación sobre el tema fue más favorable hacia la identificación y atención de mujeres maltratadas que llegan a consulta médica, en comparación con los que no la recibieron. Sobre el nivel de conocimiento acerca del tema, 21 por ciento de los entrevistados mostró un nivel bajo, 63 por ciento medio y 16 por ciento alto. En el personal médico, con nivel de conocimiento medio y alto, se observó 2.1 y 6 veces -respectivamente- una actitud afectiva más favorable respecto a la identificación y canalización de casos de mujeres maltratadas en comparación con el personal con nivel de conocimiento bajo. Las médicas mostraron 2.3 veces mejor actitud para identificar y canalizar mujeres maltratadas. El personal médico con interés por capacitarse...

OBJECTIVE: To asses the affective, cognitive, and behavioral attitudes of healthcare providers at the Mexican Institute of Social Security (MISS) in Morelos, Mexico; to identify the institutional and medical practice barriers that hinder screening and reference of battered women. MATERIAL AND METHODS: A cross-sectional study was conducted between September and December 1999. A self-administered questionnaire was applied to 269 general practitioners, specialists, and pre- and postdoctoral students working in 30 primary and secondary level of healthcare units in Morelos State. The data collection instrument was designed to assess healthcare providers' knowledge of and attitudes towards domestic violence during medical office visits. A knowledge index was constructed and analyzed using multivariate regression methods. RESULTS: Ninety percent of healthcare providers had never received training on violence against women. Healthcare providers' affective and cognitive attitudes after receiving training on the subject matter were more favorable compared to those with no training. Favorable attitudes were directly related to the number of training sessions. Most participants (63 percent) showed a moderate degree of knowledge on the subject, whereas 21 percent were slightly knowledgeable and 16 percent were highly knowledgeable. Medical personnel with a moderate or high level of knowledge were 2.1 and 6 times more likely, respectively, to have favorable attitudes than those with a low degree of knowledge. Female physicians showed more favorable attitudes towards identifying and referring battered women. Medical personnel interested in further training on the subject of violence against women were 7.6 times more likely to show favorable attitudes than personnel not interested on the subject. CONCLUSIONS: Healthcare providers were not sufficiently able to assess and manage battered women. General and family practitioners were more interested in being...

Prevalence and determinants of male partner violence against Mexican women: a population-based study

OBJETIVO: Determinar la prevalencia y los factores de riesgo en violencia contra mujeres por parte de sus parejas, en una muestra representativa de aquéllas residentes en el área metropolitana de Cuernavaca, Morelos, México. MATERIAL Y MÉTODOS: De junio a septiembre de 1998 se realizó un estudio con base poblacional en 1 535 mujeres, de 15 a 49 años de edad. Para construir la variable dependiente se realizó análisis de componentes principales y, adicionalmente, análisis de regresión logística politómica, de lo cual se obtuvieron estimadores de razón de momios (RM), con intervalos de confianza (IC 95%). RESULTADOS: La prevalencia de violencia leve-moderada fue de 35.8%, y de severa 9.5%. La prevalencia de violación fue de 5.9%. Los principales factores asociados con violencia fueron los siguientes: nivel socioeconómico (RM= 0.57; IC 95%= 0.34-0.95); nivel educativo en ambas mujeres (prueba de tendencia p=0.01) y sus parejas (prueba de tendencia p= 0.002); años de convivir con la pareja (RM= 2.63; IC 95%= 1.55-4.45), uso de alcohol y drogas ilegales (RM= 2.56; IC 95%= 2.02-3.25, RM= 6.17; IC 95%= 2.37-16.03, respectivamente); violencia durante la niñez (RM= 3.40; IC 95%= 2.23-5.18) e historia de violación (RM= 5.89; IC 95%= 2.78-12.5). CONCLUSIONES: Este estudio confirma cómo la violencia en contra de las mujeres es un fenómeno prevalente en México. Las campañas de concienciación sobre violencia masculina se deben llevar a discusión pública. Los esfuerzos ayudarán a asegurar que las futuras generaciones de mujeres no experimenten violencia de pareja.