Beyond direct exposure to violence: effects of living in disordered and violent communities on psychological distress in young Mexican people / Más allá de la exposición directa a la violencia: efectos de residir en comunidades desordenadas y violentas sobre el distrés psicológico entre jóvenes mexicanos / Além da exposição direta à violência: efeitos de viver em comunidades desordenadas e violentas sobre o estresse psicológico entre jovens mexicanos

Abstract: The association between community violence and mental health has been studied by reports of individual experiences, particularly in adolescents and youths, but little is known about the effect of living in disordered and violent communities. This study aims to determine the possible relation between living in disordered and violent community environments and psychological distress in Mexican adolescents and youths regardless of their individual experience of victimization and to assess the potential modifying effect of sex and age on this association. Data come from a cross-sectional survey with a representative sample of adolescents and youths living in Mexican municipalities, including 39,639 participants aged from 12 to 29 years. Disordered and violent community environments were assessed using reports from a secondary sample of adults who lived in the same communities as participants. Using exploratory factor analysis, three contextual variables related to disordered and violent community environment were created: social disorder, vandalism, and criminality. Multilevel linear regression models with random intercept were estimated. Adolescents and youths who lived in environments with higher social disorder had more psychological distress. Men in environments with greater vandalism had a higher level of psychological distress. Unexpectedly, women from communities with higher levels of crime had fewer symptoms. It is necessary to address the violence that exists in these communities, creating strategies that reduce not only crime, but also the social disorder and vandalism that could contribute to developing negative effects on mental health.

Resumen: La asociación entre la violencia comunitaria y la salud mental se ha evaluado mediante informes de experiencias individuales, especialmente de adolescentes y jóvenes, pero poco se sabe sobre el efecto de residir en comunidades desordenadas y violentas. El objetivo de este estudio fue comprobar si existe una relación entre residir en entornos comunitarios desordenados y violentos y el distrés psicológico en adolescentes y jóvenes mexicanos, independientemente de su experiencia individual de victimización, así como evaluar el posible efecto modificador del sexo y la edad en esta asociación. Los datos provienen de una encuesta transversal que tomó como muestra representativa a 39.639 adolescentes y jóvenes de entre 12 y 29 años, residentes en ciudades mexicanas. Los entornos comunitarios desordenados y violentos se evaluaron mediante informes de una muestra secundaria de adultos que residían en las mismas comunidades donde vivían los participantes. El análisis exploratorio de datos posibilitó crear tres variables contextuales relacionadas con el entorno comunitario desordenado y violento: desorden social, vandalismo y delincuencia. Se estimaron modelos de regresión lineal multinivel con intercepto aleatorio. Los adolescentes y jóvenes que residían en ambientes con mayor desorden social presentaron mayor distrés psicológico. Los varones en entornos con más vandalismo tenían un mayor nivel de distrés psicológico. Inesperadamente, las mujeres que viven en comunidades con mayores niveles de delincuencia tuvieron menos síntomas. Es necesario enfrentar la violencia existente en las comunidades para generar estrategias que reduzcan no solo la delincuencia, sino también el desorden social y el vandalismo que pueden contribuir al desarrollo de efectos negativos en la salud mental.

Resumo: A associação entre violência comunitária e saúde mental tem sido estudada por meio de relatos de experiências individuais, particularmente em adolescentes e jovens, mas pouco se sabe sobre o efeito de viver em comunidades desordenadas e violentas. O objetivo deste estudo é determinar se há relação entre viver em ambientes comunitários desordenados e violentos e estresse psicológico em adolescentes e jovens mexicanos, independentemente de sua experiência individual de vitimização, e avaliar o potencial efeito modificador do sexo e da idade sobre essa associação. Os dados são de uma pesquisa transversal com uma amostra representativa de adolescentes e jovens residentes em cidades mexicanas, incluindo 39.639 participantes com idades de 12 a 29 anos. Ambientes comunitários desordenados e violentos foram avaliados por meio de relatos de uma amostra secundária de adultos que viviam nas mesmas comunidades onde os participantes viviam. Por meio da análise exploratória de dados, foram criadas três variáveis contextuais relacionadas ao ambiente comunitário desordenado e violento: desordem social, vandalismo e criminalidade. Foram estimados modelos de regressão linear multinível com interceptação aleatória. Adolescentes e jovens que viviam em ambientes com maior desordem social apresentaram maior estresse psicológico. Homens em ambientes com mais vandalismo apresentaram maior nível de estresse psicológico. Inesperadamente, as mulheres de comunidades com níveis mais altos de criminalidade tiveram menos sintomas. É preciso enfrentar a violência existente nas comunidades, gerando estratégias que reduzam não só a criminalidade, mas também a desordem social e o vandalismo que possam contribuir para o desenvolvimento de efeitos negativos na saúde mental.

Efectividad del uso de la entrevista motivacional en la consulta de nutrición sobre el riesgo cardiometabólico de pacientes con trastorno bipolar / Effectiveness of the motivational interviewing on cardiometabolic indicators of patients with bipolar disorder

Resumen El propósito de este trabajo fue evaluar la efectividad de la entrevista motivacional en la consulta de nutrición sobre indicadores de riesgo cardiometabólico en pacientes con trastorno bipolar. Se realizó un estudio experimental en que el grupo control recibió orientación nutricional basada en planes de alimentación y el grupo de intervención recibió consulta nutricional incorporando los principios y habilidades de la entrevista motivacional. Los participantes fueron seguidos por tres meses y se realizaron evaluaciones de hábitos alimenticios, actividad física, riesgo cardiometabólico, composición corporal y calidad de vida. El grupo de entrevista motivacional redujo el consumo de carnes (B=-0.45, p=0.032) y embutidos (B=-0.60, p=0.002). Asimismo, la presión arterial diastólica (B=-6.97, p=0.029) y glucemia (B=-9.27, p=0.097) de estos pacientes tendieron a disminuir. La entrevista motivacional promueve cambios que pueden hacer una diferencia clínica; aun en reducidos periodos de tiempo. Los nutriólogos capacitados para su implementación disponen de una herramienta adicional para el manejo de comorbilidad cardiometabólica en población vulnerable.

Abstract The purpose of this work was to assess the effectiveness of the motivational interviewing in the nutrition consultation on indicators of cardiometabolic risk in patients with bipolar disorder. An experimental study was conducted in which the control group receives nutritional guidance based on feeding plans and the intervention group received nutritional consultation incorporating the principles and skills of the motivational interviewing. Participants were followed by three months and evaluations of eating habits, physical activity, cardiometabolic risk, body composition and quality of life were carried out. The motivational interviewing group reduced the consumption of meats (B=-0.45, p=0.032) and sausages (B=-0.60, p=0.002). Likewise, the diastolic blood pressure (B=-6.97, p=0.029) and glycemia (B=-9.27, p=0.097) of these patients tended to decrease. Motivational interviewing promotes changes that can make a clinical difference, even in short periods of time. Nutritionists trained for its implementation have an additional tool for the management of cardiometabolic comorbidity in a vulnerable population.

Diagnóstico y tratamiento de la obesidad en adultos mexicanos: cambios entre 2006 y 2018 / Diagnosis and treatment of obesity in Mexican adults: changes between 2006 and 2018

Introducción: A nivel global ha existido un incremento en el peso corporal. Ante ello, se han implementado programas para diagnosticar y tratar la obesidad. Se requiere documentar si dichos programas han propiciado que las personas con obesidad reciban diagnóstico y tratamiento eficaz. Objetivo: Determinar y comparar los cambios entre 2006 y 2018 en las prevalencias de diagnóstico y tratamiento de la obesidad y pérdida intencional de peso en adultos mexicanos e identificar si en este periodo existieron cambios en las disparidades sociales en dichos eventos. Materiales y métodos: Se analizaron las bases de datos de la Encuesta Nacional de Salud y Nutrición de México realizada en 2006 (N=26.738) y 2018 (N= 12.205), Los eventos fueron diagnóstico y tratamiento de obesidad y de pérdida intencional de peso en adultos mexicanos con IMC > 30. Las variables independientes fueron: sexo, edad, índice de masa corporal, nivel socioeconómico y región geográfica. Resultados: De 2006 a 2018, aumentó la prevalencia de personas con obesidad que recibieron diagnóstico (de 20,4% a 51,1%) o tratamiento (de 8,3% a 21,4%). La prevalencia de pérdida intencional de peso también aumentó (de 5,5% a 10,0%), pero esto básicamente ocurrió en las personas con nivel socioeconómico alto. En modelos multivariados se observó que, las mujeres, las personas con mayor IMC y quienes tenían mayor nivel socioeconómico tuvieron mayor probabilidad de recibir diagnóstico y tratamiento. Conclusiones: Aunque en México el acceso a diagnóstico y tratamiento a la obesidad se ha incrementado, la prevalencia de pérdida intencional de peso es baja, además, persisten disparidades socioeconómicas en estos eventos(AU)

Introduction: Worldwide, there has been an increase in body weight. Because of this, programs have been implemented to diagnose and treat obesity. It is required to document whether these programs have led people with obesity to receive effective diagnosis and treatment. Objective: To determine and compare the changes between 2006 and 2018 in the prevalences of diagnosis and treatment of obesity and intentional weight loss among Mexican adults and to identify whether there were changes in the social disparities in these events during this period. Materials and methods: The databases of the National Health and Nutrition Survey of Mexico carried out in 2006 (N=26,738) and 2018 (N= 12,205) were analyzed. The events were diagnosis and treatment of obesity and intentional weight loss in Mexican adults with BMI > 30. The independent variables were sex, age, body mass index, socioeconomic status, and geographic region. Results: From 2006 to 2018, the prevalence of people with obesity who received the diagnosis (from 20.4% to 51.1%) or treatment (from 8.3% to 21.4%) increased. The prevalence of intentional weight loss also increased (from 5.5% to 10.0%), but this was mainly in people with high socioeconomic status, Multivariate regression models revealed that, women, people with a higher BMI, and those with a higher socioeconomic status were more likely to receive diagnosis and treatment. Conclusions: Although in Mexico access to diagnosis and treatment of obesity has increased, the prevalence of intentional weight loss is low,In addition, socioeconomic disparities persist in these events(AU)

Changes in blood pressure according to stature in Mexican adults.

OBJECTIVE: To determine the possible existence of differences in blood pressure change over time according to stature in Mexican adults. METHODS: We analyzed the National Household Living Standards Survey databases following household members between 2005 and 2009. We selected participants who were between 20 and 40 years old (n = 7,130). We estimated multilevel models with random intercept to analyze differences in blood pressure changes according to stature. We adjusted the models for age, locality size, geographic region, per capita family income, waist-to-height ratio, physical activity, alcohol consumption, smoking, and use of antihypertensive drugs. RESULTS: In both sexes, baseline blood pressure tended to be lower as stature decreased. The differences were maintained in both the crude and adjusted models. In men, the increases in systolic pressure over time tended to be higher as stature increased. CONCLUSIONS: Contrary to what studies observed in high-income countries, in Mexico blood pressure was positively associated with stature.

Associations between Screen-Based Activities, Physical Activity, and Dietary Habits in Mexican Schoolchildren.

Screen-based activities are associated with increased risk of obesity and contribute to physical inactivity and poor dietary habits. The primary aim of this study was to examine the associations among screen-based activities, physical activity, and dietary habits in school-aged children in Guadalajara, Puerto Vallarta, and Mexico City, Mexico. The secondary aim was to examine these associations across sex. The School Physical Activity and Nutrition survey was used to assess screen-based activities (TV watching, video game use, computer use), physical activity, and dietary habits. Organized activity/sports participation, unhealthy dietary habits, and household income were correlated with screen-based activities. While TV watching was associated with decreased participation in organized activity/sports participation, computer and video game use was associated with increased organized activity/sports participation. Boys engaged in more TV watching and video game use compared to girls. All screen-based activities were associated with age among boys; whereas video game and computer use were associated with higher income among girls. These findings suggest a need for sex- and age-specific strategies that acknowledge the differential use of screen-based activities across sex and age. Future research should continue to identify underlying correlates linking screen-based activities with health behaviors to inform strategies to reduce screen-time in Mexican children.

Disordered eating behaviors and experiences of violence among Mexican youth with different sexual orientations: A population-based study / Conductas alimentarias de riesgo y experiencias de violencia entre jóvenes mexicanos con diferentes orientaciones sexuales: Un estudio de base poblacional

Abstract Introduction In high-income countries, sexual minorities are at a higher risk for disordered eating behaviors. It is not known whether these findings can be extrapolated to Mexico. Objective Determine whether there are any differences in disordered eating behaviors among Mexican youth according to sexual orientation and analyze the potential role of experiences of violence and discrimination as mediators of these differences. Method Data from a representative sample of Mexican youth (12 to 29 years old, n = 27,876) were analyzed. Three groups were identified: young people who were not in love (NIL), who were in love with people of the opposite sex (ILOS), or in love with people of the same sex (ILSS). Restrictive behaviors, secret eating, and self-induced vomiting were identified through a scale created for the survey. Results ILSS men had a higher risk of restrictive thoughts and behaviors (B = .31), secret eating (OR = 2.21), and self-induced vomiting (OR = 3.65) than ILOS youth. Among women, there was only a difference in self-induced vomiting (RM = 2.49). In both sexes, being a young ILSS had an indirect effect on restrictive behaviors through its association with experiences of violence, discrimination at school, and sexual violence. Discussion and conclusion . Mexican sexual minority men are at a higher risk of disordered eating behaviors, whereas sexual minority women are at a higher risk of purging. Part of the differences in restrictive behaviors were explained by the increased risk for experiences of prejudice faced by sexual minority youth.

Resumen Introducción En países de alto ingreso, las minorías sexuales tienen mayor riesgo de conductas alimentarias de riesgo. Se desconoce si esos hallazgos pueden ser extrapolados a México. Objetivo Determinar si existen disparidades en las conductas alimentarias de riesgo entre los jóvenes mexicanos según la orientación sexual y analizar el papel potencial de las experiencias de violencia y discriminación como mediadoras de tales disparidades. Método Se analizaron datos de una muestra representativa de jóvenes mexicanos (12 a 29 años, n = 27,876). Se identificaron tres grupos: jóvenes sin enamoramiento (sE), con enamoramiento por personas del otro sexo (cEOS) o con enamoramiento por personas del mismo sexo (cEMS). Las conductas restrictivas, comer a escondidas e inducirse vómito se identificaron a través de una escala creada para la encuesta. Resultados Los hombres cEMS tuvieron mayor riesgo de pensamientos y comportamientos restrictivos (B = .31), comer a escondidas (RM = 2.21) e inducirse vómito (RM = 3.65) en comparación con los jóvenes cEOS. Entre las mujeres, solo hubo diferencia en inducirse vómito (RM = 2.49). En ambos sexos, ser un joven cEMS tuvo un efecto indirecto sobre las conductas restrictivas a través su asociación con experiencias de violencia y discriminación escolares y violencia sexual. Discusión y conclusión Los hombres de minorías sexuales mexicanas tienen mayor riesgo de conductas alimentarias de riesgo, y las mujeres de minorías sexuales tienen mayor riesgo de una conducta de tipo purgativo. Parte de las disparidades en conductas restrictivas se explicaron por el mayor riesgo de experiencias de prejuicio que enfrentan los jóvenes de minorías sexuales.

Experiencias de homofobia y adherencia al tratamiento antirretroviral (TAR) en hombres que tienen sexo con hombres (HSH) / Experiences of homophobia and adherence to antiretroviral treatment (ART) in men who have sex with men (MSM)

Resumen El objetivo del estudio fue conocer la relación de las experiencias de homofobia con la adherencia al tratamiento anti-retroviral (TAR) en hombres que tienen sexo con hombres (HSH). Para ello, se realizó una encuesta transversal con una muestra por conveniencia de HSH que vivían con VIH (n=340) atendidos en dos instituciones públicas de salud de la Ciudad de México. La información sobre la adherencia al TAR en el mes previo de los participantes y sus experiencias de violencia, discriminación y homofobia internalizada se recopiló mediante un cuestionario. Entre 14% y 33% de los HSH reportaron alguna experiencia de discriminación y entre 41% y 60% experimentaron violencia. Cuando los HSH habían experimentado ambos tipos de estresores, el riesgo de baja adherencia TAR fue mayor (RP=6.49 para mes previo) que cuando habían experimentado sólo una de ellas (RP=4.36 para violencia y RP=5.67 para discriminación). Los profesionales de la salud deben ser sensibles a cómo el ambiente sociocultural puede afectar las prácticas de autocuidado de HSH, incluyendo la adherencia al TAR.

Abstract The aim of the study was to know the relationship of homophobic experiences with adherence to antiretroviral treatment (ART) in men who have sex with men (MSM) in Mexico City (CDMX). A cross-sectional study was conducted with a convenience sampling of MSM who lived with HIV, treated at two public health institutions at Mexico City (n=340). A questionnaire was applied to record information related to the adherence to ART of the participants and their experiences of violence and discrimination associated with homophobia and internalized homophobia. Between 14% and 33% of MSM reported experiences of discrimination and between 41% and 60% experienced violence. When participants had jointly experienced both types of stressors, the risk of low adherence to ART in the previous month was higher (RP=6.49) than when they had experienced only one of them (RP=4.36 for violence and RP=5.67 for discrimination). Health professionals must be sensitive to how the sociocultural environment can affect self-care among MSM including ART adherence.

Changes in blood pressure according to stature in Mexican adults / Cambios en la presión arterial de acuerdo con la estatura en adultos mexicanos

ABSTRACT OBJECTIVE: To determine the possible existence of differences in blood pressure change over time according to stature in Mexican adults. METHODS: We analyzed the National Household Living Standards Survey databases following household members between 2005 and 2009. We selected participants who were between 20 and 40 years old (n = 7,130). We estimated multilevel models with random intercept to analyze differences in blood pressure changes according to stature. We adjusted the models for age, locality size, geographic region, per capita family income, waist-to-height ratio, physical activity, alcohol consumption, smoking, and use of antihypertensive drugs. RESULTS: In both sexes, baseline blood pressure tended to be lower as stature decreased. The differences were maintained in both the crude and adjusted models. In men, the increases in systolic pressure over time tended to be higher as stature increased. CONCLUSIONS: Contrary to what studies observed in high-income countries, in Mexico blood pressure was positively associated with stature.

RESUMEN OBJETIVO: Determinar si existen diferencias en el cambio de la presión arterial a lo largo del tiempo de acuerdo con la estatura en adultos mexicanos. MÉTODOS: Se analizaron las bases de datos de la Encuesta Nacional de Niveles de Vida de los Hogares en la que se siguieron a los miembros de los hogares entre el 2005 y 2009. Se seleccionaron a los participantes que tenían entre 20 y 40 años (n = 7,130). Se estimaron modelos multinivel con intercepto aleatorio para analizar diferencias en los cambios de la presión arterial de acuerdo con la estatura. Los modelos fueron ajustados por edad, tamaño de localidad, región geográfica, ingreso familiar per cápita, índice cintura-estatura, actividad física, consumo de alcohol, tabaquismo y uso de antihipertensivos. RESULTADOS: En ambos sexos, la presión arterial inicial tendió a ser menor conforme la estatura fuese menor. Las diferencias se mantuvieron tanto en los modelos crudos como en los modelos ajustados. En los varones los incrementos de la presión sistólica a lo largo del tiempo tendieron a ser mayores conforme la estatura era más alta. CONCLUSIONES: Contrario a lo observado en países de altos ingresos, en México la presión arterial se asoció positivamente con la estatura.

Estigma percibido por VIH y adherencia al tratamiento retroviral en personas con VIH en la ciudad de México / HIV-related perceived stigma and adherence to treatment among people with HIV from Mexico city

INTRODUCCIÓN. Analizar la relación entre el estigma percibido por VIH y la adherencia al tratamiento antirretroviral (TAR) en personas con VIH en la ciudad de México. MATERIAL Y MÉTODOS. Se utilizó un diseño mixto incluyendo una encuesta transversal y entrevistas a profundidad. En la encuesta se aplicó un cuestionario a 557 personas con VIH de dos instituciones públicas. En el cuestionario se incluyó una escala de estigma asociado al VIH con dos variables: ocultamiento de su seroestado a personas no cercanas y revelación de su seroestado a familiares y amigos. Mediante modelos de regresión logística se evaluó la asociación del estigma percibido con la baja adherencia al TAR, i.e. la omisión de la toma de medicamentos antirretrovirales en el día, la semana y el mes previos. Las entrevistas a profundidad tuvieron la finalidad para explorar las experiencias respecto a las dificultades para adherirse al TAR. RESULTADOS. Las personas que ocultaban su enfermedad tuvieron mayor probabilidad de no adherencia (RM=2.33). Los entrevistados que no habían revelado su seroestado a personas cercanas también tuvieron una mayor probabilidad de no adherencia (RM=2.35). Coincidentemente, en las entrevistas se evidenció que las experiencias de discriminación o las expectativas de ser discriminado hacen que las personas oculten su enfermedad y esto propicia la omisión de toma de medicamentos. DISCUSIÓN. Es necesario promover acciones orientadas a eliminar el estigma asociado al VIH como una medida fundamental para incrementar la adherencia al TAR. (AU)

INTRODUCTION. To analyze the relationship between HIV-associated perceived stigma and adherence to antiretroviral therapy (ART) in people with HIV in Mexico City. MATERIAL AND METHODS. A mixed methods approach was used including in-depth interviews and a cross-sectional survey. In-depth interviews were conducted to explore barriers to ART adherence. In the survey, a questionnaire was given to 557 people with HIV treated in two public health institutions. The questionnaire included an assessment of HIV-associated perceived stigma; exploratory factor analysis demonstrated two outcomes: concealment of serostatus and revelation of the serostatus to family and friends. Logistic regression models were used to assess the association of HIV-associated stigma with low ART adherence on the previous day, week and month. RESULTS. People who concealed their disease had higher risk of non-adherence (RM=2.33). Participants who had not revealed their serostatus to friends or relatives also had a higher probability of non-adherence (RM= 2.35). Coincidentally, the interviews showed that the experiences of discrimination or the expectations of being discriminated against make people conceal their illness and are thus prone to non-adherence. DISCUSSION. It is necessary to promote actions aimed at eliminating HIV-related stigma as a fundamental measure to increase adherence to ART. (AU)

Clinical characteristics and severity of COVID-19 among Mexican adults.

INTRODUCTION: Obesity, diabetes, hypertension and age have been pointed at as factors that influence on the progression of COVID-19; however, evidence for other conditions is inconclusive. OBJECTIVE: To identify which clinical characteristics are related to COVID-19 severity and to determine whether age acts a modifier of the relationship between cardio-metabolic comorbidities (CMC) and COVID-19 progression. METHOD: Data on ≥ 20-year-old confirmed cases (n = 159,017) were analyzed. Hospitalization, development of pneumonia, intubation requirement, intensive care unit admission and death were the dependent variables in Poisson regression models estimation, whereas the interaction between age and different CMCs were the independent variables. RESULTS: Having CMCs, as well as other comorbidities, was directly related to COVID-19 progression, whereas chronic obstructive pulmonary disease was only related to an increase in the risk of dying. The risk for COVID-19 severity was lower as age was more advanced. Asthma and smoking were not risk factors for the progression of COVID-19. CONCLUSION: In the Mexican population, the risk of COVID-19 progression associated with comorbidities was higher in young adults.

INTRODUCCIÓN: Se ha señalado que factores como obesidad, diabetes, hipertensión y edad influyen en la progresión de COVID-19; sin embargo, la evidencia para otras condiciones no es concluyente. OBJETIVO: Identificar qué antecedentes clínicos están relacionados con la gravedad de COVID-19 y si la edad funge como un modificador de efecto de la relación entre comorbilidades cardiometabólicas (CCM) y progresión de COVID-19. MÉTODO: Se analizaron los datos de casos confirmados ≥ 20 años (n = 155 017). La hospitalización, el desarrollo de neumonía, el requerimiento de intubación, el ingreso a la unidad de cuidados intensivos y la muerte constituyeron las variables dependientes en la estimación de modelos de regresión de Poisson y la interacción entre edad y CCM, las independientes. RESULTADOS: Tener CCM, así como otras comorbilidades, se relacionó directamente con la progresión de COVID-19. El riesgo de gravedad de COVID-19 asociado a las CCM fue menor conforme la edad era mayor. El asma y el tabaquismo no fueron factores de riesgo para la progresión de COVID-19. CONCLUSIÓN: En la población mexicana, el riesgo de progresión de COVID-19 asociada a comorbilidades fue mayor en los adultos jóvenes.

Características clínicas y gravedad de COVID-19 en adultos mexicanos / Clinical characteristics and severity of COVID-19 among Mexican adults

Resumen Introducción: Se ha señalado que factores como obesidad, diabetes, hipertensión y edad influyen en la progresión de COVID-19; sin embargo, la evidencia para otras condiciones no es concluyente. Objetivo: Identificar qué antecedentes clínicos están relacionados con la gravedad de COVID-19 y si la edad funge como un modificador de efecto de la relación entre comorbilidades cardiometabólicas (CCM) y progresión de COVID-19. Método: Se analizaron los datos de casos confirmados ≥ 20 años (n = 155 017). La hospitalización, el desarrollo de neumonía, el requerimiento de intubación, el ingreso a la unidad de cuidados intensivos y la muerte constituyeron las variables dependientes en la estimación de modelos de regresión de Poisson y la interacción entre edad y CCM, las independientes. Resultados: Tener CCM, así como otras comorbilidades, se relacionó directamente con la progresión de COVID-19. El riesgo de gravedad de COVID-19 asociado a las CCM fue menor conforme la edad era mayor. El asma y el tabaquismo no fueron factores de riesgo para la progresión de COVID-19. Conclusión: En la población mexicana, el riesgo de progresión de COVID-19 asociada a comorbilidades fue mayor en los adultos jóvenes.

Abstract Introduction: Obesity, diabetes, hypertension and age have been pointed at as factors that influence on the progression of COVID-19; however, evidence for other conditions is inconclusive. Objective: To identify which clinical characteristics are related to COVID-19 severity and to determine whether age acts as a modifier of the relationship between cardio-metabolic comorbidities (CMC) and COVID-19 progression. Method: Data on ≥ 20-year-old confirmed cases (n = 155 017) were analyzed. Hospitalization, development of pneumonia, intubation requirement, intensive care unit admission and death were the dependent variables in Poisson regression models estimation, whereas the interaction between age and different CMCs were the independent variables. Results: Having CMCs, as well as other comorbidities, was directly related to COVID-19 progression. The risk for COVID-19 severity was lower as age was more advanced. Asthma and smoking were not risk factors for the progression of COVID-19. Conclusion: In the Mexican population, the risk of COVID-19 progression associated with comorbidities was higher in young adults.

Differences in blood pressure according to physical fitness and body mass in a sample of Mexican schoolchildren / Diferencias en la presión sanguínea de acuerdo con la condición física y masa corporal en una muestra de escolares mexicanos

Abstract Background: Physical fitness is the ability to perform activities of daily living without excessive fatigue. The potential protective role of fitness against high blood pressure in childhood is relevant to diminish the risk of hypertension in adulthood. A negative association between cardiorespiratory fitness (CRF) and hypertension has been found in the pediatric population. However, the role of body mass as a confounding variable of this association has not been evaluated. This study aimed to analyze whether the association between fitness and blood pressure in Mexican schoolchildren is independent of body mass. Methods: A cross-sectional study was conducted with a sample of 1010 children (574 females and 436 males) aged 9-12 years (mean age = 10.3 ± 0.9 years) from 13 elementary schools in Mexico City. Fitness was evaluated with tests from the FitnessGram® battery. Z-scores of body mass index (BMI)-for-age and height-for-age were estimated. Results: Low fitness showed a high prevalence (from 45.8% for trunk lift to 77.5% for push-ups). Children with poor CRF (assessed by the 20-m progressive aerobic cardiovascular endurance run test) and upper body strength (assessed by push-ups) showed a higher probability of hypertension (p < 0.05). However, these differences disappeared after adjusting for BMI. Conclusions: After considering the body mass, cardiorespiratory and musculoskeletal fitness were not independent predictors of blood pressure.

Resumen Introducción: La condición física es la habilidad de realizar actividades de la vida diaria sin fatiga excesiva. El potencial papel protector de una buena condición física contra la presión arterial elevada es relevante, ya que, si no se atiende, esta elevación en la presión arterial comúnmente conduce a hipertensión en la vida adulta. Se ha documentado una asociación negativa entre la condición cardiorrespiratoria con la hipertensión de la población pediátrica. Sin embargo, no se ha evaluado el papel de la masa corporal como una variable de confusión de esta asociación. El objetivo de este estudio fue evaluar si la asociación entre la condición física y la presión sanguínea es independiente de la masa corporal en escolares mexicanos. Métodos: Estudio transversal con una muestra de 1010 escolares (574 de sexo femenino y 436 de sexo masculino) de 9 a 12 años (edad promedio = 10.3 ± 0.9 años) de 13 escuelas de primaria de la Ciudad de México. La condición física se evaluó con la batería FitnessGram®. Se estimaron puntuaciones Z del índice de masa corporal (IMC) para la edad. Resultados: La prevalencia de baja condición física fue alta (de 45.8% en la prueba de levantamiento de tronco a 77.5% en la prueba de lagartijas). Los escolares con baja condición cardiorrespiratoria (evaluada con la carrera progresiva de resistencia cardiovascular aeróbica de 20 m) y fuerza superior del cuerpo (evaluada con la prueba de lagartijas) mostraron una mayor probabilidad de presentar hipertensión (p < 0.05). Sin embargo, estas diferencias desaparecieron al ajustar por el IMC. Conclusiones: Después de considerar la masa corporal, la condición cardiorrespiratoria y musculoesquelética no son predictores independientes de la presión sanguínea.

Factores sociodemográficos asociados con los modos de transporte en escolares y adolescentes mexicanos / Commuting to school among Mexican schoolchildren and adolescents

Resumen Introducción: Los modos activos de transporte (caminar o andar en bicicleta) tienen efectos benéficos para la salud, por lo cual deben identificarse factores que los promuevan. El objetivo de este estudio fue analizar la relación de los modos de transporte utilizados por la población pediátrica mexicana para acudir a la escuela con las características sociodemográficas, socioeconómicas y de inseguridad pública a nivel estatal. Métodos: Se estimó la frecuencia de los modos de transporte utilizados por los escolares y adolescentes para trasladarse a la escuela (con la base de la Encuesta Intercensal 2015). En un análisis ecológico (i.e., entidades federativas como unidades de observación) se obtuvieron correlaciones con estadísticas a nivel estatal con inseguridad alimentaria, nivel de urbanización y mortalidad por muertes violentas. Resultados: El modo de transporte más frecuente fue caminar (66.2%), seguido por el automóvil (16.2%) y el transporte público (15.3%). El transporte activo fue más frecuente en individuos del sexo masculino, escolares, personas de nivel socioeconómico bajo, zonas rurales, la región sur y aquellos cuyo traslado requería menos de 15 minutos. El transporte pasivo fue más frecuente en individuos del sexo femenino, adolescentes, personas de nivel socioeconómico alto y en zonas urbanas. En los estados más urbanizados fue menos frecuente el transporte activo y más prevalente el trasporte motorizado. La inseguridad pública se relacionó negativamente con el uso de bicicleta. Conclusiones: Se requiere mantener o incrementar el uso de modos de transporte activos en la población pediátrica mexicana mediante políticas públicas que mejoren el entorno y garanticen ambientes seguros.

Abstract Background: Active commuting (walking or cycling) is associated with benefits to health; thus, it is required to identify factors that promote it. The objective of this study was to analyze the relationship between the transport modes used by Mexican pediatric population to commute to school with sociodemographic and socioeconomic individual characteristics and public insecurity at the state level. Methods: The frequency of transport modes used by schoolchildren and adolescents to commute to school (walking, cycling, private car and public transport) were estimated using the database of the Encuesta Intercensal 2015. In an ecological analysis (i.e., states as observation units) correlations with food insecurity, urbanization level, and violent deaths statistics at state-level were obtained. Results: The most frequent transportation mode was walking (66.2%), followed by car (16.2%) and public transportation (15.3%). Active commuting (walking or cycling) was more frequent in males, schoolchildren, low socioeconomic status, living in rural or southern areas and those who spent <15 min to commute. Passive commute was more frequent among females, adolescents, high socioeconomic status, and living in urban areas. In the more urbanized states, active transportation was less frequent, but motorized transportation was more prevalent. Public insecurity was negatively related to cycling. Conclusions: Maintaining or increasing active commuting among Mexican pediatric population is necessary through public policies aimed to improve physical and social environment.

Contribution of Nova food groups to energy and nutrient supply in Mexican households / Contribución de los grupos de alimentos Nova a la disponibilidad de energía y nutrientes en los hogares mexicanos

Abstract: Objective: To analyze the contribution of natural, processed and ultra-processed foods to energy and nutrient supply in Mexican households. Materials and methods: The database of the National Household Expenditure Survey 2013 was analyzed (n=58 001), which is a cross-sectional survey. Food supply (g/adult equivalent/day) and energy, macro- and micro-nutrient supplies were estimated. Foods were classified following the Nova system. Households sociodemographic characteristics were analyzed as covariates. Results: Natural foods (NF) contributed with more energy (55.0%) followed by ultra-processed foods (UPF, 21.2%). NF were the main source of most nutrients. Processed culinary ingredients (PCI) and processed foods (PF) had high content of energy, total fats, and saturated fats, but low content of certain micronutrients. Sodium was mainly available in PF (34.6%) and UPF (31.4%). Sugar-sweetened beverages, fast foods, and biscuits and cookies were the main UPF in terms of energy supply. Conclusions; In Mexican households, the PCI, PF and UPF had low nutritional quality.

Resumen: Objetivo: Analizar la contribución de los alimentos naturales, procesados y ultraprocesados a la disponibilidad de energía y nutrientes en los hogares mexicanos. Material y métodos: Se analizó la base de datos de la Encuesta Nacional de Gasto de los Hogares 2013 (n= 58 001), la cual es una encuesta transversal. Se estimó la disponibilidad de alimentos (g/adulto equivalente/día), energía y nutrientes. Los alimentos fueron clasificados siguiendo el sistema Nova. Resultados: Los alimentos naturales (AN) y los ultraprocesados (AUP) contribuyeron con más energía. Los AN fueron la principal fuente de la mayoría de los nutrimentos. Los ingredientes culinarios procesados (ICP) y los alimentos procesados (AP) tenían alto contenido de energía, grasas totales y grasas saturadas pero bajo contenido de ciertos micronutrientes. El sodio estaba disponible principalmente en AP y AUP. Las bebidas azucaradas, comidas rápidas, galletas y panes fueron los principales AUP. Conclusión: En México, los ICP, AP y AUP tienen baja calidad nutricional.

La identidad latinoamericana: premisa martiana consustancial para la formación del estudiante universitario actual / The Latin American identity: Martian premise consubstantial for the formation of the current university student

RESUMEN El trabajo aborda una faceta dentro del humanismo martiano que refleja sus consideraciones en su bregar por tierras de América. Sus postulados constituyen un imprescindible legado para formar en los estudiantes universitarios valores éticos que los conviertan en mejores seres, humanos y profesionales. En su recorrido desde México hacia Guatemala, el Apóstol pretende resaltar la figura del negro de raza pura que allí vivía. Estas consideraciones se ofrecen a partir del texto Livingstone. El artículo tiene como objetivo develar algunas ideas que permitan un desarrollo político-ideológico, ético y estético integral donde se destaque el conocimiento y respeto por la historia, la autoctonía de los pueblos americanos y la cultura patrias.

ABSTRACT The work addresses a facet within Martian humanism that reflects its considerations in its struggle for the lands of America. Its postulates constitute an essential legacy to form in university students ethical values ​​that turn them into better beings, human beings and professionals. On his journey from Mexico to Guatemala, the Apostle pretends to highlight the figure of the black of pure race that lived there. These considerations are offered from the Livingstone text. The article aims to reveal some ideas that allow a political-ideological, ethical and integral aesthetic development where knowledge and respect for history, the autochthony of the American people and the patriotic culture are highlighted.

Equations based on anthropometry to predict body fat measured by absorptiometry in schoolchildren and adolescents / Equações com base na antropometria para prever a gordura corporal medida por absorciometria em crianças em idade escolar e adolescentes

Abstract Objective: To develop and validate equations to estimate the percentage of body fat of children and adolescents from Mexico using anthropometric measurements. Methods: A cross-sectional study was carried out with 601 children and adolescents from Mexico aged 5-19 years. The participants were randomly divided into the following two groups: the development sample (n = 398) and the validation sample (n = 203). The validity of previously published equations (e.g., Slaughter) was also assessed. The percentage of body fat was estimated by dual-energy X-ray absorptiometry. The anthropometric measurements included height, sitting height, weight, waist and arm circumferences, skinfolds (triceps, biceps, subscapular, supra-iliac, and calf), and elbow and bitrochanteric breadth. Linear regression models were estimated with the percentage of body fat as the dependent variable and the anthropometric measurements as the independent variables. Results: Equations were created based on combinations of six to nine anthropometric variables and had coefficients of determination (r2) equal to or higher than 92.4% for boys and 85.8% for girls. In the validation sample, the developed equations had high r2 values (≥85.6% in boys and ≥78.1% in girls) in all age groups, low standard errors (SE ≤ 3.05% in boys and ≤3.52% in girls), and the intercepts were not different from the origin (p > 0.050). Using the previously published equations, the coefficients of determination were lower, and/or the intercepts were different from the origin. Conclusions: The equations developed in this study can be used to assess the percentage of body fat of Mexican schoolchildren and adolescents, as they demonstrate greater validity and lower error compared with previously published equations.

Resumo Objetivo: Desenvolver e validar equações para estimar o percentual de gordura corporal (%GC) de crianças e adolescentes do México com medidas antropométricas. Métodos: Foi feito um estudo transversal com 601 crianças e adolescentes do México cinco e 19 anos. Os participantes foram divididos aleatoriamente nos seguintes dois grupos: a amostra de desenvolvimento (n = 398) e a amostra de validação (n = 203). A validade das equações publicadas anteriormente (por exemplo, Slaughter) também foi avaliada. O %GC foi estimado por absorciometria de dupla energia de raios X (raios X de dupla energia [DXA]). As medidas antropométricas incluíram estatura, altura sentado, peso, circunferências da cintura e do braço, dobras cutâneas (tríceps, bíceps, subescapular, suprailíaca e panturrilha) e larguras do cotovelo e bitrocantérica. Os modelos de regressão linear foram estimados com o %GC, a variável dependente e as medidas antropométricas como as variáveis independentes. Resultados: As equações foram criadas com base nas combinações de seis a nove variáveis antropométricas e apresentaram coeficientes de determinação (r2) iguais ou superiores a 92,4% para meninos e 85,8% para meninas. Na amostra de validação, as equações desenvolvidas apresentaram altos valores de r2 (≥ 85,6% em meninos e ≥ 78,1% em meninas) em todos os grupos, baixo nível de erros padrão (EP ≤ 3,05% em meninos e ≤ 3,52% em meninas) e os interceptos não foram diferentes da origem (p > 0,050). Com as equações publicadas anteriormente, os coeficientes de determinação foram menores e/ou os interceptos foram diferentes da origem. Conclusões: As equações desenvolvidas neste estudo podem ser usadas para avaliar o %GC das crianças em idade escolar e adolescentes mexicanos, pois têm uma maior validade e menor erro em comparação com as equações publicadas anteriormente.

El auto-reporte de actividad física y comportamientos sedentarios no concuerda con la acelerometría en escolares mexicanos / Accelerometry does not match with self-reported physical activity and sedentary behaviors in Mexican children

Resumen: Introducción: La evaluación precisa de la actividad física (AF) en escolares es necesaria para implementar estrategias que favorezcan estilos de vida activos. El objetivo del presente estudio fue evaluar la validez de un cuestionario autoadministrado de AF y actividades sedentarias y ligeras (ASL) desarrollado para escolares mexicanos, analizando las diferencias en la validez de acuerdo con el estado de nutrición. Métodos: Escolares de 8-12 años de edad contestaron un cuestionario autoaplicable en el cual se evaluaron las ASL y AF moderada y vigorosa (AFMV). Se determinaron los minutos a la semana dedicados a ASL y AFMV en niños que portaron un acelerómetro triaxial. La concordancia entre los dos métodos para detectar el tiempo que los niños invierten en ver televisión se evaluó mediante coeficientes de correlación intraclase y el método de Bland-Altman. Resultados: La estimación de AFMV por cuestionarios fue mayor que la de acelerometría por 117.6 min/semana, mientras que la estimación de ASL fue menor por 1,924.7 min/semana. No se detectó correlación entre el tiempo evaluado con acelerómetros y el reportado en el cuestionario para las ASL y AFMV. En niños con índice de masa corporal normal, se detectó una correlación baja entre el tiempo reportado y el medido por acelerometría para jugar videojuegos con las actividades sedentarias (ric = 0.29, p = 0.031). Conclusiones: Los escolares sobreestiman las AFMV y subestiman las ASL. El peso corporal puede ser un factor que influya en dichos sesgos.

Abstract: Background: An accurate assessment of physical activity in schoolchildren is necessary to implement strategies that promote active lifestyles. The objective of this study was to validate a self-administered questionnaire to assess physical activity and sedentary behaviors and to analyze differences in the validity according to nutritional status in Mexican schoolchildren. Methods: Schoolchildren of 8-12 years of age answered a self-report physical activity and sedentary behaviors questionnaire to evaluate sedentary and light physical activity (SLPA) and moderate to vigorous physical activity (MVPA). The data of children who wore a triaxial accelerometer days was analyzed. Concordance between both methods to determine the time schoolchildren spend watching television was assessed using intraclass correlation coefficients and Bland-Altman method. Results: The estimation of MVPA by questionnaires was higher than that of accelerometers by 117.6 minutes per week, and the estimation of SLPA was lower by 1,924.7 minutes per week. No correlation between the time assessed by accelerometers and the time reported in the questionnaires for SLPA and MVPA was detected. In normal-weighted children, a low correlation between the time dedicated to play videogames with sedentary activities (ric =0.29, p=0.031) assessed by accelerometers was observed. Conclusions: Schoolchildren over-estimate MVPA and under-estimate SLPA. Body weight can be a factor influencing such bias.

Inseguridad alimentaria y adherencia al tratamiento antirretroviral en personas con VIH de México / Food insecurity and adherence to antiretroviral treatment among people with HIV in Mexico

Resumen Los objetivos del artículo son: 1) Analizar la relación entre inseguridad alimentaria (IA) y adherencia al tratamiento antiretroviral (TAR) en personas con VIH/SIDA. 2) Evaluar la contribución de cuatro posibles mediadores (responsabilidades laborales y familiares, falta de recursos para cubrir necesidades, distrés psicológico y efectos secundarios del TAR) a dicha asociación. Estudio transversal con una muestra (n = 557) de personas con VIH atendidas en dos instituciones públicas de la ciudad de México. Las variables fueron indagadas mediante un cuestionario. Mediante modelos de regresión logística se evaluó si los mediadores explicaban la asociación entre IA y adherencia al TAR. Las personas con IA moderada tuvieron mayor probabilidad de omisión en el mes previo (OR = 2.10) y baja adherencia (OR = 3.35). La baja adherencia en las personas con IA fue explicada por los efectos secundarios (14.9%), las necesidades insatisfechas (12.5%), las responsabilidades (4.8%) y el distrés psicológico (2.0%). La IA puede limitar los beneficios de las políticas de acceso universal al TAR pues puede estar asociada con menor adherencia a ésta. Se requiere adecuar los servicios de salud para reducir el efecto de la IA.

Abstract The aims of this study are: 1) To analyze the relationship between food insecurity (FI) and adherence to antiretroviral therapy (ART) among people with HIV. 2) To evaluate the contribution of four possible mediators (lack of time due to work and family responsibilities, lack of resources to satisfy needs, psychological distress and side effects of ART) to differences in adherence according to the level of FI. A cross-sectional survey with a convenience sample (n = 557) of people with HIV attending two public institutions in Mexico City was conducted. Variables were assessed by a questionnaire. Logistic regression models were estimated. People with moderate FI were more likely to skip a dose (RM = 2.10) and reported low adherence during the last month (RM = 3.35). Poor adherence among people with FI was explained by the side effects of ART (14.9%), unsatisfied needs (12.5%), lack of time (4.8%) and psychological distress (2%). FI may curtail the benefits of universal access policies because it is associated with lower adherence to ART. An adjustment of health services to reduce the negative effects of FI on adherence to ART is required.

[Socioeconomic inequality and health in Mexico]. / Desigualdad socioeconómica y salud en México.

OBJECTIVE: To establish the relationship between socioeconomic inequality and health problems amongst Mexican population reviewing studies with national or regional representation. METHODS: A literature search was performed at national and international databases using the following keywords: health, disease, mental disorders, nutrition, food, social class, social status, unemployment, employment, occupation, income, wage, poverty and socioeconomic status. Reports of national or regional surveys conducted from the nineties were included. RESULTS: Mostly, diseases events were more common among people from low socioeconomic status: anencephaly, viral infections, anemia, transit accidents by run over, metabolic syndrome, hypertension, affective disorder, anxiety and substances abuse; some malignancies, difficulties to perform activities of daily living, and poor perceived health status. On the opposite, as it goes down in the social scale, are less frequent some protective factors (e.g. fruits or vegetables intake and physical activity) and there is less access to medical aid and preventive interventions (e.g. condom use or diagnosis and treatment for HIV infection, hypertension or obesity). CONCLUSIONS: Socioeconomic status affects all living conditions; therefore, its effects are not confined to certain diseases, but a general precarious state of health. The conceptual and public policy implications related with social inequalities in health are discussed.

Objetivo: establecer la relación entre la desigualdad socioeconómica y los problemas de salud en la población mexicana a partir de la revisión de estudios con representatividad nacional o regional. Métodos: la revisión bibliohemerográfica se realizó consultando bases de datos nacionales e internacionales, mediante el uso de las siguientes palabras clave: salud, enfermedad, trastornos mentales, nutrición, alimentación, clase social, estrato social, desempleo, empleo, ocupación, ingreso, salario, pobreza, nivel socioeconómico y estatus socioeconómico. Se incluyeron los reportes de encuestas nacionales y regionales realizados a partir de la década de los noventa. Resultados: la mayoría de los eventos de enfermedad fueron más comunes entre las personas de baja posición socioeconómica. Asimismo, conforme se desciende de la escala social, son menos frecuentes los factores protectores y es menor el acceso a la atención médica y a las medidas preventivas. Conclusiones: la posición socioeconómica afecta la totalidad de las condiciones de vida de las personas, por lo que sus efectos no se reducen únicamente a ciertas enfermedades, sino que condiciona un estado de salud precario. Las implicaciones conceptuales y en política pública de las desigualdades en salud son ampliamente discutidas.

[Disparities in mental health associated with sexual orientation among Mexican adolescents]. / Disparidades en salud mental asociadas a la orientación sexual en adolescentes mexicanos.

The aim of this study was to document disparities in mental health related to discrimination based on sexual orientation in Mexican adolescents. A representative national sample of secondary school students was analyzed. Criteria for homosexual orientation were having had a same-sex boyfriend or girlfriend and having had same-sex sexual relations. The events were: depression, low self-esteem, suicidal ideation, attempted suicide, smoking, alcohol abuse, and drug use. Teenagers with same-sex relationships or sexual relations had an increased risk of depressive symptoms, suicidal ideation, attempted suicide, and alcohol abuse. These differences were particularly related to having experienced violence in the family and in school. Despite institutional and legal progress in acknowledging the rights of the lesbian, bisexual, and gay population, health inequities persist due to discrimination based on sexual orientation.