Prevalence and development of a risk score for oral human papillomavirus infection in men who have sex with men in Mexico.

BACKGROUND: Men who have sex with men (MSM) are at high risk for oral human papillomavirus (HPV infection). There are no specific screening guidelines to facilitate the identification of people at risk for oral HPV infection. We aimed to estimate the prevalence of oral high-risk HPV and create a risk score to identify MSM at higher risk for prevalent oral HPV. METHODS: We collected baseline data from a clinical trial from a subsample of 500 MSM attending sexually transmitted disease treatment clinics; they provided an oral gargle sample for high-risk HPV detection. We calculated oral high-risk HPV prevalence and 95% confidence intervals (CIs), used a logistic regression model to identify factors associated with high-risk HPV infection, and created a risk score. RESULTS: The prevalence of any oral high-risk HPV among MSM was 11.1% (95% CI: 8.6-14.2), with a higher prevalence observed among men living with HIV (14.8%). Factors independently associated with oral high-risk HPV were age ≥40 years (OR = 2.71, 95% CI: 1.28-5.73 compared to <40 years), being HIV-positive with CD4 count 200-499 (OR = 2.76, 95% CI: 1.34-5.65 compared to HIV-negative), and recent recreational use of vasodilators (poppers/sildenafil) (OR = 2.02, 95% CI: 1.02-2.97). The risk score had good discriminatory power (AUC = 0.70, 95% CI: 0.63-0.77). CONCLUSIONS: MSM have specific predictors for prevalent oral high-risk HPV, and a risk score could be used by clinicians to target men with vaccine recommendations and counseling, and identify those who could benefit from primary interventions given the available resources, or for referral to dental services for follow-up when available.

Trends in the prevalence of metabolic syndrome and its components in Mexican adults, 2006-2018 / Tendencia en la prevalencia de síndrome metabólico y sus componentes en adultos mexicanos, 2006-2018

Abstract: Objective: To examine trends in the prevalence of metabolic syndrome (MS) and its components. Materials and methods: Data from 27 800 Mexican adults who participated in Ensanut 2006, 2012, 2016 and 2018 were analyzed. Linear regression was used across each Ensanut period to assess temporal linear trends in the prevalence of MS. Logistic regression models were obtained to calculate the percentage change, p-value for the trend and the association between the presence of MS and the risk of developing type 2 diabetes mellitus (T2DM) over 10 years using the Finnish Diabetes Risk Score (FINDRISC) and cardiovascular disease (CVD) using Globorisk. Results: The prevalence of MS in Mexican adults according to the harmonized definition was: 40.2, 57.3, 59.99 and 56.31%, in 2006, 2012, 2016 and 2018 respectively (p for trend <0.0001). In 2018, 7.62% of metabolic syndrome cases had a significant risk for incident DM2 and 11.6% for CVD. Conclusion: It is estimated that there are 36.5 million Mexican adults living with metabolic syndrome, of which 2 million and 2.5 million have a high risk of developing T2DM or cardiovascular disease respectively, over the next 10 years.

Resumen: Objetivo: Examinar las tendencias en la prevalencia del síndrome metabólico (SM) y de sus componentes. Material y métodos: Se analizaron datos de 27 800 adultos mexicanos que participaron en las Ensanut 2006, 2012, 2016 y 2018. Se utilizó regresión lineal en cada periodo de Ensanut para evaluar las tendencias lineales temporales en la prevalencia del SM. Se obtuvieron modelos de regresión logística para calcular el cambio porcentual, P para la tendencia y las asociaciones entre la SM con el riesgo de desarrollar en 10 años diabetes mellitus tipo 2 utilizando la Finnish Diabetes Risk Score (FINDRISC) y enfermedad cardiovascular utilizando Globorisk. Resultados: La prevalencia de SM en adultos mexicanos según la definición armonizada fue: 40.2, 57.3, 59.99 y 56.31%, en 2006, 2012, 2016 y 2018 respectivamente (p para tendencia <0.0001). En 2018, 7.62% de los casos de síndrome metabólico tenían un riesgo significativo de DM2 incidente y 11.6% de ECV. Conclusión: Se estima que los adultos mexicanos con síndrome metabólico son 36.5 millones; de ellos, dos millones tienen un alto riesgo de desarrollar DMT2 en los próximos 10 años y 2.5 millones enfermedades cardiovasculares.

Prevalence of diabetes and glycemic control in Mexico: national results from 2018 and 2020 / Prevalencia de diabetes y control glucémico en México: resultados nacionales 2018 y 2020

Abstract: Objective: To estimate the prevalence of diabetes (diagnosed and undiagnosed), glycemic control in Mexico, and its associated factors. Materials and methods: We used data from Ensanut 2018 (n=12 648) and 2020 (n=2 309). We defined diabetes as fasting glucose ≥126 mg/dl or HbA1c≥6.5% or previously diagnosed; glycemic control was defined as HbA1c<7%. We fitted Poisson regression models to assess the association between diabetes, glycemic control, and potential associated factors. Results: The total prevalence of diabetes was 16.8% in 2018 and 15.7% in 2020. In 2018, 38% of adults with diabetes were unaware of their disease, while in 2020 this figure was 29%. Glycemic control was observed in 42% of participants in 2018 and 39% in 2020. Longer disease duration was associated with lower glycemic control, while older age, having a diet, and being affiliated to IMSS, Pemex, Sedena, or private healthcare were associated with better control. Conclusion: Mexico is among the countries with the highest diabetes prevalence. A high proportion of adults with diabetes did not have a previous diagnosis, and the proportion with glycemic control is low. Strengthening screening to achieve a timely diagnosis, and improving glycemic control, should be key actions in the management of diabetes.

Resumen: Objetivo: Estimar la prevalencia de diabetes total (diagnosticada y no diagnosticada), control glucémico en México y sus factores asociados. Material y métodos: Se analizó información de la Ensanut 2018 (n=12 648) y 2020 (n=2 309). Se definió diabetes como glucosa en ayunas ≥126 mg/dl o HbA1c≥6.5% o diagnóstico previo; se consideró control glucémico si HbA1c<7%. Usando modelos de regresión de Poisson, se estimaron los factores asociados con diabetes y control glucémico. Resultados: La prevalencia de diabetes fue de 16.8% en 2018 y 15.7% en 2020. En 2018, 38% de los adultos con diabetes desconocían su enfermedad, en 2020 fue 29%. El control glucémico se observó en 42% de los participantes en 2018 y en 39% en 2020. Mayor tiempo de diagnóstico se asoció con descontrol glucémico mientras que mayor edad, seguir una dieta y estar afiliado al IMSS, Pemex/Sedena o privados se asoció con control glucémico. Conclusión: México se encuentra entre los países con mayor prevalencia de diabetes. Una alta proporción de adultos con diabetes no tenía un diagnóstico previo y la proporción con control glucémico es baja. Fortalecer la detección, el diagnóstico oportuno y el control glucémico es clave para el manejo de la diabetes.

Bases metodológicas de la medición de desarrollo infantil temprano en la Ensanut 100k / Methodological bases of the measurement of early childhood development in the Ensanut 100k survey

Resumen Objetivo: Presentar los métodos realizados para la inclusión del módulo de Desarrollo Infantil Temprano (DIT) en la Ensanut 100k. Material y métodos: Con dicho módulo y el cuestionario de menores de cinco años, se obtuvieron indicadores del estado de salud, desarrollo y bienestar de niñas/os en los primeros cinco años de vida. De noviembre a diciembre de 2017, se definió el diseño de la muestra, instrumentos y manuales, y se realizó una prueba piloto. Se capacitó y estandarizó al personal de campo. El levantamiento de información se realizó entre enero y junio de 2018. Resultados: Se estudió en el módulo DIT de la encuesta a 3 892 niños/as de 0 a 59 meses de edad. Conclusiones: La capacitación y estandarización del personal de campo, por parte de personal capacitado y estandarizado, minimiza los sesgos de información.

Abstract Objective: The methods that were carried out for the inclusion of the early childhood development module in the Ensanut 100k are presented. Materials and methods: With this module and the questionnaire for children under five years-old, indicators of the state of health, development and well-being of children in the first five years of life are obtained. From November to December 2017, the sample design, instruments and manuals were defined and a test was carried out. Field staff were trained and standardized. The information was collected between January and June 2018. Results: 3 892 children from 0 to 59 months of age were studied in the DIT Module of the Survey. Conclusions: Training and standardization of field personnel, by trained and standardized personnel, minimizes information biases.

Prevalencia de diabetes y descontrol glucémico en México: resultados de la Ensanut 2016 / Prevalence of diabetes and poor glycemic control in Mexico: results from Ensanut 2016

Resumen: Objetivo: Estimar la prevalencia de diabetes (total, diagnosticada y no diagnosticada), de descontrol glucémico en México y sus factores asociados. Material y métodos: Se analizaron 3 700 adultos participantes en la Encuesta Nacional de Salud y Nutrición de 2016. Se estimaron las prevalencias con ponderadores poblacionales y los factores asociados con diabetes total y descontrol glucémico con modelos de regresión de Poisson. Resultados: La prevalencia total de diabetes fue de 13.7% (9.5% diagnosticada, 4.1% no diagnosticada); 68.2% de los diagnosticados presentó descontrol glucémico. Mayor tiempo de diagnóstico, vivir en el centro/sur del país y ser atendido en farmacias se asoció con descontrol glucémico, mientras que ser atendido en los servicios de seguridad social se asoció con mejor control glucémico. Conclusión: Se requieren esfuerzos multisectoriales para fortalecer el tamizaje, diagnóstico oportuno y control de la enfermedad, considerando las diferencias por región y tipo de servicio de salud.

Abstract: Objective: To estimate the prevalence of total, diagnosed and undiagnosed diabetes, and the prevalence of poor glycemic control in Mexico, and its associated factors. Materials and methods: Data from 3 700 adult participants were analysed in the 2016 National Health and Nutrition Survey. Diabetes prevalences were estimated with population weights, and the factors associated with total diabetes and poor glycemic control with Poisson regression models. Results: The total prevalence of diabetes was 13.7% (9.5% diagnosed, 4.1% undiagnosed); 68.2% of people with diagnosed diabetes presented poor glycemic control. Longer disease duration, living in the centre or south of the country and being treated in pharmacies were associated with poor glycemic control. Being treated in a social security system was associated with better glycemic control. Conclusion: Multisectoral efforts are needed to strengthen screening, timely diagnosis and disease control, considering differences by region and type of health service.

[Population profiles associated with attendanceat preventive services to screeningtests. Ensanut 2018-19]. / Perfiles poblacionales asociadoscon la asistencia a servicios preventivospara tamizaje de diabetes e hipertensión. Ensanut 2018-19.

OBJECTIVE: We describe the profile of the population aged 20 years and over, who go for a diabetes and hypertension screening test. MATERIALS AND METHODS: Based on the information from Ensanut 2018-19, two multiple logistic regression models were obtained with variables associated with the detection of diabetes and hypertension. Profiles were generated based on combinations of the variables included in the model. Increases in probabilities were plotted according to profiles. RESULTS: Individuals with a family history of the disease, comorbidities or unhealthy lifestyles composed the group that seek for diabetes and hypertension screening. CONCLUSIONS: The health system should look for those with the highest risk of developing or having undiagnosed diabetes and hypertension, using risk questionnaires, type score. This population should undergo screening studies and, where appropriate, diagnoses.

OBJETIVO: Presentar el perfil de la población de 20 años o más que acude a realizarse una prueba de detección de diabetes y de hipertensión. MATERIAL Y MÉTODOS: Con información de la Encuesta Nacional de Salud y Nutrición 2018-19, se obtuvieron dos modelos de regresión logística múltiple con variables asociadas con la detección de diabetes e hipertensión. Se generaron perfiles basados en combina-ciones de las variables incluidas en el modelo. Se graficaron los incrementos de las probabilidades de acuerdo con los perfiles. RESULTADOS: La población cuyas probabilidades predichas son las más altas para acudir a detección corres-ponde a adultos con antecedente familiar de la enfermedad, con comorbilidad asociada y estilos de vida poco saludables. CONCLUSIONES: El sistema de salud debe buscar personas con el mayor riesgo de desarrollar o tener diabetes e hiper-tensión sin diagnóstico, mediante cuestionarios de riesgo tipo score. A esta población se les deberán hacer estudios de tamizaje y, en su caso, diagnósticos.

Perfiles poblacionales asociados con la asistencia a servicios preventivos para tamizaje de diabetes e hipertensión. Ensanut 2018-19 / Population profiles associated with attendance at preventive services to screening tests. Ensanut 2018-19

Resumen: Objetivo: Presentar el perfil de la población de 20 años o más que acude a realizarse una prueba de detección de diabetes y de hipertensión. Material y métodos: Con información de la Encuesta Nacional de Salud y Nutrición 2018-19, se obtuvieron dos modelos de regresión logística múltiple con variables asociadas con la detección de diabetes e hipertensión. Se generaron perfiles basados en combinaciones de las variables incluidas en el modelo. Se graficaron los incrementos de las probabilidades de acuerdo con los perfiles. Resultados: La población cuyas probabilidades predichas son las más altas para acudir a detección corresponde a adultos con antecedente familiar de la enfermedad, con comorbilidad asociada y estilos de vida poco saludables. Conclusiones: El sistema de salud debe buscar personas con el mayor riesgo de desarrollar o tener diabetes e hipertensión sin diagnóstico, mediante cuestionarios de riesgo tipo score. A esta población se les deberán hacer estudios de tamizaje y, en su caso, diagnósticos.

Abstract: Objective: We describe the profile of the population aged 20 years and over, who go for a diabetes and hypertension screening test. Materials and methods: Based on the information from Ensanut 2018-19, two multiple logistic regression models were obtained with variables associated with the detection of diabetes and hypertension. Profiles were generated based on combinations of the variables included in the model. Increases in probabilities were plotted according to profiles. Results: Individuals with a family history of the disease, comorbidities or unhealthy lifestyles composed the group that seek for diabetes and hypertension screening. Conclusions: The health system should look for those with the highest risk of developing or having undiagnosed diabetes and hypertension, using risk questionnaires, type score. This population should undergo screening studies and, where appropriate, diagnoses.

Tendencias en la prevalencia de IRA y EDA en la primera infancia y factores asociados: Ensanut 2012 y 100k / Trends in the prevalence of ARIs and ADDs in early childhood and associated factors: Ensanut 2012 and 100k

Resumen: Objetivo: Estimar y comparar las prevalencias de infecciones respiratorias agudas (IRA) y enfermedades diarreicas agudas (EDA) en menores de cinco años, residentes en localidades con menos de 100 000 habitantes, mediante análisis de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012 y la Ensanut 100k (2018). En la Ensanut 100k se evaluaron los factores asociados con IRA y EDA. Material y métodos: Análisis de ambas encuestas e información meteorológica de la Comisión Nacional del Agua. Resultados: La prevalencia global estimada de IRA fue de 45.1% en 2012 vs. 32.9% en 2018. La disminución fue significativa en hogares de medianas y mayores capacidades económicas (CE). No se observaron cambios significativos para las EDA. En hogares con menores CE, las IRA se asociaron con material del techo y temperatura y las EDA con privación de agua entubada. Conclusiones: Entre 2012 y 2018, la prevalencia de IRA disminuyó en hogares de medianas y mayores CE. Algunas condiciones de vivienda y meteorológicas se asocian con IRA y EDA.

Abstract: Objective: To compare the prevalence of acute respiratory infections (ARI) and acute diarrheal disease (ADD) among children younger than five years of age living in localities with less than 100 000 inhabitants in Encuesta Nacional de Salud y Nutrición (Ensanut) 2012 and Ensanut 100k (2018). In Ensanut 100k, we evaluate the associated factors. Materials and methods: Analysis of both surveys and of the Mexican Meteorological System. Results: The estimated prevalence of ARI was 45.1% in 2012 vs. 32.9% in 2018. The decrease was significant among medium and high-income households. There were no changes in trends for ADD. Among households with lower EC, ARI was associated with roofing material, temperature, and rainy precipitation while ADD was associated with lack of piped water. Conclusions: The estimated prevalence of ARI has decreased in medium and high income households. Some households and weather conditions are associated with ARI and ADD.

Atención médica y acciones de autocuidado en personas que viven con diabetes, según nivel socioeconómico / Medical care and self-care actions in people living with diabetes, according to socioeconomic level

Resumen: Objetivo: Caracterizar la atención médica y las acciones de autocuidado en población con diabetes, en localidades de menos de 100 000 habitantes. Material y métodos: Con información de la Encuesta Nacional de Salud y Nutrición 100k (Ensanut 100k), se obtuvieron dos modelos de regresión logística: no realizar las cinco acciones básicas en la última consulta médica y no realizar acciones prioritarias de autocuidado. Resultados: Tener baja escolaridad, pertenecer al estrato económico bajo y hablar lengua indígena incrementan las posibilidades de no realizar acciones de autocuidado. Por el contrario, al incrementarse la edad, se disminuyen las posibilidades de autocuidado en 3%. Pertenecer a un hogar indígena y al tercil bajo incrementan las posibilidades de que el personal de salud no realice las cinco acciones básicas durante la consulta. Conclusión: Es indispensable que se establezca un programa de control de diabetes que incluya educación a pacientes y cursos de actualización al personal médico.

Abstract: Objective: To characterize medical care and self-care actions in a population with diabetes in locations smaller than 100 000 inhabitants Materials and methods: With information from the Encuesta Nacional de Salud y Nutrición 100k (Ensanut 100k), two logistic regression models were obtained: not performing five basic actions in the last consultation and not taking priority self-care actions. Results: Having low schooling, belonging to the low economic stratum, and speaking indigenous language, increase the probability of not taking self-care actions. On the contrary, as age increases, the chances of self-care are reduced by 3%. Belonging to an indigenous household and the low tercile, increases the chances that health personnel will not perform the five basic actions during the consultation. Conclusions: It is essential that a diabetes control program be established that includes patient education and update courses for medical staff

[Lung cancer mortality in Mexico, 1990-2016: age-period-cohort effect]. / Mortalidad por cáncer de pulmón en México de 1990 a 2016: efecto edad-periodo-cohorte.

OBJECTIVE: To update information on the mortality trend due to lung cancer in Mexico from 1990 to 2016. MATERIALS AND METHODS: Age-adjusted rates were obtained using the direct method. The percentage of annual change in the mortality of lung cancer was obtained through joinpoint analysis at the national level, by region, sex and rural-urban stratum, and in the last two the age-cohort-period effect. RESULTS: There was an annual decrease in mortality rates due to this neoplasm in the last 10 years, significantly higher in men (-3.5% CI95% -4.0,-2.9) than in women (-1.9% CI95% -2.1,-1.7), and a generational gap between men and women and urban-rural stratum with a decreasing trend in the risk of death. CONCLUSIONS: Mortality trends due to lung cancer from 1993 to 2016 show a decrease in different magnitudes and specific periods.

OBJETIVO: Actualizar información sobre la tendencia de mortalidad por cáncer de pulmón en México de 1990 a 2016. MATERIAL Y MÉTODOS: Se obtuvieron tasas ajustadas por edad mediante el método directo. Se obtuvo el porcentaje de cambio anual de la mortalidad por cáncer de pulmón, mediante análisis joinpoint a nivel nacional, por región, sexo y estrato rural-urbano y, en estos dos últimos, el efecto de edad-periodo-cohorte. RESULTADOS: Se observó un decremento anual en las tasas de mortalidad por esta neoplasia en los últimos 10 años, significativamente mayor en los hombres (-3.5% IC95% -4.0,-2.9) que en las mujeres (-1.9% IC95% -2.1,-1.7), una brecha generacional entre hombres y mujeres y estrato urbano-rural con tendencia decreciente en el riesgo de muerte. CONCLUSIONES: Las tendencias de mortalidad por cáncer de pulmón de 1993 a 2016 presentan una disminución en diferentes magnitudes y periodos específicos.

Mortalidad por cáncer de pulmón en México de 1990 a 2016: efecto edad-periodo-cohorte / Lung cancer mortality in Mexico, 1990-2016: age-period-cohort effect

Resumen: Objetivo: Actualizar información sobre la tendencia de mortalidad por cáncer de pulmón en México de 1990 a 2016. Material y métodos: Se obtuvieron tasas ajustadas por edad mediante el método directo. Se obtuvo el porcentaje de cambio anual de la mortalidad por cáncer de pulmón, mediante análisis joinpoint a nivel nacional, por región, sexo y estrato rural-urbano y, en estos dos últimos, el efecto de edad-periodo-cohorte. Resultados: Se observó un decremento anual en las tasas de mortalidad por esta neoplasia en los últimos 10 años, significativamente mayor en los hombres (-3.5% IC95% -4.0,-2.9) que en las mujeres (-1.9% IC95% -2.1,-1.7), una brecha generacional entre hombres y mujeres y estrato urbano-rural con tendencia decreciente en el riesgo de muerte. Conclusión: Las tendencias de mortalidad por cáncer de pulmón de 1993 a 2016 presentan una disminución en diferentes magnitudes y periodos específicos.

Abstract: Objective: To update information on the mortality trend due to lung cancer in Mexico from 1990 to 2016. Materials and methods: Age-adjusted rates were obtained using the direct method. The percentage of annual change in the mortality of lung cancer was obtained through joinpoint analysis at the national level, by region, sex and rural-urban stratum, and in the last two the age-cohort-period effect. Results: There was an annual decrease in mortality rates due to this neoplasm in the last 10 years, significantly higher in men (-3.5% CI95% -4.0,-2.9) than in women (-1.9% CI95% -2.1,-1.7), and a generational gap between men and women and urban-rural stratum with a decreasing trend in the risk of death. Conclusion: Mortality trends due to lung cancer from 1993 to 2016 show a decrease in different magnitudes and specific periods.

[Development and validation of a screening score for prediabetes and undiagnosed diabetes.] / Diseño y validación de un score para detectar adultos con prediabetes y diabetes no diagnosticada.

OBJECTIVE: To develop and validate an easy-to-use risk score to detect prediabetes and undiagnosed diabetes in Mexican population. MATERIALS AND METHODS: Using information from the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán's cohort study of 10 234 adults, risk factors were identified and included in multiple logistic regression models stratified by sex. The beta coefficients of the final model were multiplied by 10, thus obtaining the weights of each variable in the score. RESULTS: The proposed score correctly classifies 55.4% of women with undiagnosed diabetes and 57.2% of women with prediabetes or diabetes. While for men it correctly classifies them at 68.6% and 69.9%, respectively. CONCLUSIONS: We present the design and validation of a risk score stratified by sex, to determine if an adult could have prediabetes or diabetes, in which case laboratory studies should be performed to confirm or not the diagnosis.

OBJETIVO: Diseñar y validar un score de riesgo de fácil aplicación para detectar prediabetes y diabetes no diagnosticada en población mexicana. MATERIAL Y MÉTODOS: Empleando la información del estudio de cohorte de 10 234 adultos del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), se identificaron factores de riesgo incluidos en modelos de regresión logística múltiple estratificados por sexo. Los coeficientes beta fueron multiplicados por 10 para obtener el peso de cada variable en el score. Una submuestra de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012 se usó para validar el score. RESULTADOS: El score propuesto clasificó correctamente 55.4% a las mujeres con diabetes no diagnosticada y 57.2% a las mujeres con prediabetes o diabetes. Por su parte, clasificó correctamente a los hombres en 68.6 y 69.9%, respectivamente. CONCLUSIONES: Presentamos el diseño y validación de un score de riesgo estratificado por sexo para determinar si un adulto podría tener prediabetes o diabetes, en cuyo caso deberán realizarse estudios de laboratorio para confirmar o descartar el diagnóstico.

Diseño y validación de un score para detectar adultos con prediabetes y diabetes no diagnosticada / Development and validation of a screening score for prediabetes and undiagnosed diabetes

Resumen: Objetivo: Diseñar y validar un score de riesgo de fácil aplicación para detectar prediabetes y diabetes no diagnosticada en población mexicana. Material y métodos: Empleando la información del estudio de cohorte de 10 234 adultos del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), se identificaron factores de riesgo incluidos en modelos de regresión logística múltiple estratificados por sexo. Los coeficientes beta fueron multiplicados por 10 para obtener el peso de cada variable en el score. Una submuestra de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2012 se usó para validar el score. Resultados: El score propuesto clasificó correctamente 55.4% a las mujeres con diabetes no diagnosticada y 57.2% a las mujeres con prediabetes o diabetes. Por su parte, clasificó correctamente a los hombres en 68.6 y 69.9%, respectivamente. Conclusiones: Presentamos el diseño y validación de un score de riesgo estratificado por sexo para determinar si un adulto podría tener prediabetes o diabetes, en cuyo caso deberán realizarse estudios de laboratorio para confirmar o descartar el diagnóstico.

Abstract: Objective: To develop and validate an easy-to-use risk score to detect prediabetes and undiagnosed diabetes in Mexican population. Materials and methods: Using information from the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán's cohort study of 10 234 adults, risk factors were identified and included in multiple logistic regression models stratified by sex. The beta coefficients of the final model were multiplied by 10, thus obtaining the weights of each variable in the score. Results: The proposed score correctly classifies 55.4% of women with undiagnosed diabetes and 57.2% of women with prediabetes or diabetes. While for men it correctly classifies them at 68.6% and 69.9%, respectively. Conclusions: We present the design and validation of a risk score stratified by sex, to determine if an adult could have prediabetes or diabetes, in which case laboratory studies should be performed to confirm or not the diagnosis.

Prevalencia de diabetes por diagnóstico médico previo en México / Prevalence of previously diagnosed diabetes mellitus in Mexico

Resumen: Objetivo: Comparar la prevalencia de diabetes por diagnóstico médico previo en 2016 con encuestas nacionales anteriores y describir su tratamiento y complicaciones. Material y métodos: Se utilizaron la Encuesta Nacional de Salud 2000, las Encuestas Nacionales de Salud y Nutrición 2006 y 20012, y la Encuesta Nacional de Salud y Nutrición de Medio Camino 2016. Para 2016 se obtuvieron modelos de regresión logística, así como medidas de tendencia central y dispersión. Resultados: La prevalencia de diabetes por diagnóstico médico en 2016 fue de 9.4%. El incremento de 2.2% respecto a 2012 no fue significativo y se observó únicamente en los mayores de 60 años. Aunque las acciones preventivas han aumentado, el acceso al tratamiento médico y los estilos de vida no han mejorado. Se observó un aumento en insulina y una diminución en hipoglucemiantes. Conclusión: El envejecimiento de la población, la insuficiencia de acciones de tamizaje y el aumento en las complicaciones de diabetes provocarán un aumento en la carga de enfermedad. Invertir en la prevención primaria y secundaria en diabetes es crucial.

Abstract: Objective: To compare the prevalence of previously diagnosed diabetes in 2016 with previous national surveys and to describe treatment and its complications. Materials and methods: Mexico's national surveys Ensa 2000, Ensanut 2006, 2012 and 2016 were used. For 2016, logistic regression models and measures of central tendency and dispersion were obtained. Results: The prevalence of previously diagnosed diabetes in 2016 was 9.4%. The increase of 2.2% relative to 2012 was not significant and only observed in patients older than 60 years. While preventive measures have increased, the access to medical treatment and lifestyle has not changed. The treatment has been modified, with an increase in insulin and decrease in hypoglycaemic agents. Conclusions: Population aging, lack of screening actions and the increase in diabetes complications will lead to an increase on the burden of disease. Policy measures targeting primary and secondary prevention of diabetes are crucial.

Population profiles associated with severe functioning difficulties and disability among two to four years old children in Mexico / Perfiles poblacionales asociados a dificultades severas de funcionamiento y discapacidad en niños de dos a cuatro años de edad en México

Abstract: Objective: To describe the prevalence and factors associated with severe child functioning difficulties and disability (CFD) among two to four year old children in Mexico, and estimates the probability of presenting CFD based on specific population profiles. Materials and methods: The sample consists of 5 104 children who participated in the National Survey of Children and Women 2015 (ENIM). We used post-estimation exploration by computing predicted values of CFD to interpret the logistic models for discrete combinations of the independent variables. Results: CFD prevalence is 2%, which means at least 130 000 two to four year-old children are at risk of experiencing severely limited participation in an unaccommodating environment. The probability of presenting CFD is dramatically higher in specific sub-groups of the population, in particular, male children of women with low education, who live in the poorest households. Conclusions: A significant proportion of Mexican children face important challenges due to functioning difficulties and disability. Public policies must be developed to accommodate the needs of these children and provide a proper environment for their development.

Resumen: Objetivo: Describir la prevalencia y los factores asociados con las dificultades severas de funcionamiento y discapacidad (CFD, por sus siglas en inglés) en niños de dos a cuatro años de edad en México y estimar la probabilidad de presentar CFD basada en perfiles poblacionales específicos. Material y métodos: La muestra fue conformada por 5 104 niños participantes de la Encuesta Nacional de los Niños, Niñas y Mujeres (ENIM) 2015. Se realizó una post-estimación calculando los valores predichos de CFD para interpretar los modelos logísticos a partir de combinaciones discretas de las variables independientes. Resultados: La prevalencia de CFD es de 2%, lo que significa que al menos 130 000 niños de 2 a 4 años de edad están en riesgo de experimentar una participación severamente limitada en un ambiente no adaptado a sus necesidades. La probabilidad de presentar CFD aumenta dramáticamente en subgrupos específicos de la población, en particular los hijos varones de mujeres con baja educación, que viven en los hogares más pobres. Conclusión: Una proporción importante de la población infantil mexicana enfrenta retos importantes derivados de las dificultades de funcionamiento y la discapacidad. Es necesario desarrollar políticas públicas que respondan a las necesidades específicas de este grupo poblacional, proporcionando un entorno apropiado para su desarrollo.

Population profiles associated with severe functional difficulties and disability among 5-17 years-old children in México / Perfiles poblacionales asociados con dificultades funcionales y discapacidad severa en niños de 5-17 años en México

Abstract: Objectives: To report the prevalence of severe functional difficulties and disability (SFD) in a nationally representative sample of children ages 5 to 17 in Mexico, to identify factors associated with SFD, and population profiles predictive of SFD. Materials and methods: Using data from the National Survey on Children and Women we estimated prevalence and 95% confidence intervals of SFD and risk factors. We fitted bivariate and multivariate logistic regression models. We then examined which combinations of the sociodemographic factors best predicted SFD. Results: The prevalence of SFD was 11.2%. The most prevalent SFD were on the socioemotional dimension (8.3%). The associated risk factors in the three dimensions were: living in a poor household, being a boy, having a mother with basic education or less, and non-indigenous background or living in an urban area. Conclusions: Identifying groups of the population at higher risk for SFD provides useful information for targeted intervention implementation.

Resumen: Objetivos: Reportar la prevalencia de dificultades funcionales y discapacidad severa (SFD) en una muestra nacional representativa de niños de 5 a 17 años en México; identificar los factores asociados con SFD; documentar los perfiles poblacionales que predicen SFD. Material y métodos: Se utilizaron los datos de la Encuesta Nacional de Niñas, Niños y Mujeres en México; se estimaron prevalencias e intervalos de confianza al 95%. Se ajustaron modelos bivariados y multivariados. Se examinaron las combinaciones de factores sociodemográficos que mejor predecían la SFD. Resultados: La prevalencia de SFD fue de 11.2%. Las SFD más prevalentes fueron en la dimensión socioemocional (8.3%). Los factores de riesgo asociados en las tres dimensiones fueron pobreza, ser hombre, tener una madre con educación primaria o menor, no ser indígena o vivir en zonas urbanas. Conclusiones: Identificar a los grupos con mayor riesgo de SFD dentro de la población proporciona información útil para el desarrollo de intervenciones.

Expected population weight and diabetes impact of the 1-peso-per-litre tax to sugar sweetened beverages in Mexico.

STUDY QUESTION: What effect on body mass index, obesity and diabetes can we expect from the 1-peso-per-litre tax to sugar sweetened beverages in Mexico? METHODS: Using recently published estimates of the reductions in beverage purchases due to the tax, we modelled its expected long-term impacts on body mass index (BMI), obesity and diabetes. Microsimulations based on a nationally representative dataset were used to estimate the impact of the tax on BMI and obesity. A Markov population model, built upon an age-period-cohort model of diabetes incidence, was used to estimate the impact on diagnosed diabetes in Mexico. To analyse the potential of tax increases we also modelled a 2-peso-per-litre tax scenario. STUDY ANSWER AND LIMITATIONS: Ten years after the implementation of the tax, we expect an average reduction of 0.15 kg/m2 per person, which translates into a 2.54% reduction in obesity prevalence. People in the lowest level of socioeconomic status and those between 20 and 35 years of age showed the largest reductions in BMI and overweight and obesity prevalence. Simulations show that by 2030, under the current implementation of 1-peso-per-litre, the tax would prevent 86 to 134 thousand cases of diabetes. Overall, the 2-peso-per-litre scenario is expected to produce twice as much of a reduction. These estimates assume the tax effect on consumption remains stable over time. Sensitivity analyses were conducted to assess the robustness of findings; similar results were obtained with various parameter assumptions and alternative modelling approaches. WHAT THIS STUDY ADDS: The sugar-sweetened beverages tax in Mexico is expected to produce sizable and sustained reductions in obesity and diabetes. Increasing the tax could produce larger benefits. While encouraging, estimates will need to be updated once data on direct changes in consumption becomes available.

Laboratory-based and office-based risk scores and charts to predict 10-year risk of cardiovascular disease in 182 countries: a pooled analysis of prospective cohorts and health surveys.

BACKGROUND: Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and without laboratory-based measurements, and the corresponding risk charts for 182 countries to predict 10-year risk of fatal and non-fatal CVD in adults aged 40-74 years. METHODS: Based on our previous laboratory-based prediction model (Globorisk), we used data from eight prospective studies to estimate coefficients of the risk equations using proportional hazard regressions. The laboratory-based risk score included age, sex, smoking, blood pressure, diabetes, and total cholesterol; in the non-laboratory (office-based) risk score, we replaced diabetes and total cholesterol with BMI. We recalibrated risk scores for each sex and age group in each country using country-specific mean risk factor levels and CVD rates. We used recalibrated risk scores and data from national surveys (using data from adults aged 40-64 years) to estimate the proportion of the population at different levels of CVD risk for ten countries from different world regions as examples of the information the risk scores provide; we applied a risk threshold for high risk of at least 10% for high-income countries (HICs) and at least 20% for low-income and middle-income countries (LMICs) on the basis of national and international guidelines for CVD prevention. We estimated the proportion of men and women who were similarly categorised as high risk or low risk by the two risk scores. FINDINGS: Predicted risks for the same risk factor profile were generally lower in HICs than in LMICs, with the highest risks in countries in central and southeast Asia and eastern Europe, including China and Russia. In HICs, the proportion of people aged 40-64 years at high risk of CVD ranged from 1% for South Korean women to 42% for Czech men (using a ≥10% risk threshold), and in low-income countries ranged from 2% in Uganda (men and women) to 13% in Iranian men (using a ≥20% risk threshold). More than 80% of adults were similarly classified as low or high risk by the laboratory-based and office-based risk scores. However, the office-based model substantially underestimated the risk among patients with diabetes. INTERPRETATION: Our risk charts provide risk assessment tools that are recalibrated for each country and make the estimation of CVD risk possible without using laboratory-based measurements. FUNDING: National Institutes of Health.

Prostate cancer mortality according to marginalization status in Mexican states from 1980 to 2013.

OBJECTIVE: To assess prostate cancer (PC) mortality in Mexico from 1980 to 2013, according to the state marginalization level. MATERIALS AND METHODS: Using age-adjusted rates in men ≥ 40 years old, we estimated trends and age-cohort-period effects of PC mortality from 1980-2013 according to state marginalization status by using a joinpoint regression model and a Poisson regression model proposed by Holford. RESULTS: The PC mortality risk has increased nationwide at a constant rate (2% annually) during the past 13 years. The highest annual increase was observed among states with very high (4.4%) and high (7.7%) marginalization rates. In contrast, states with very low levels of marginalization showed a significant reduction of 1.5% per year. The main changes were observed in the 1945-1950 birth year cohorts. CONCLUSIONS: Differences in PC mortality across regions of Mexico may reflect differences in the timing of the diagnosis and treatment of PC.

Effect of Passive Smoking on the Growth of Pulmonary Function and Respiratory Symptoms in Schoolchildren.

BACKGROUND: Environmental tobacco smoke affects the current and future health of children. OBJECTIVE: To determine whether schoolchildren aged 8-17 years old residing at an altitude of 2,240 m and exposed to tobacco smoke at home presented a reduction in the growth of pulmonary function and a greater problem of respiratory symptoms and infections compared with non-exposed children. MATERIALS AND METHODS: We followed, with questionnaires and spirometry, 1,632 boys and 1,555 girls from Mexico City and its metropolitan area (the Metropolitan Study to Evaluate the Chronic Effects of Pollution in School-age Children [EMPECE]) every six months for six years. The impact of passive smoking was estimated by mixed-effects models and Generalized Linear and Latent Mixed Models (GLLAMM), stratifying by gender and adjusting for age, height, weight, and ozone levels. RESULTS: Passive smoking (reported by one-half of participants) was associated with reduced spirometric lung function (log transformed or as Z-scores) and a higher frequency of self-reported respiratory symptoms and respiratory infections. Levels of forced expiratory volume in 1 second and forced vital capacity in individuals exposed to passive smoking were 6.8 and 14.1 ml, respectively, below those of non-exposed children, and these values decreased with increasing number of smokers at home and higher ozone levels. CONCLUSIONS: Passive smoking in children is a significant risk factor for respiratory disease and reduced lung function growth, which are additive with levels of air pollution, asthma, and the presence of respiratory symptoms.