Validity assessment of self-reported weight and its correction process among Mexican adult women of reproductive age.

OBJECTIVE: We aimed to evaluate the agreement between self-reported weight (SRW) and measured weight (MW) in adult women of reproductive age, identify characteristics associated with the difference between SRW and MW (DW), and develop a correction procedure for SRW. METHODS: We used data from 3,452 non-pregnant or non-lactating adult women who participated in the Mexican Family Life Survey. Standardized personnel asked women about their weight before measuring weight and height. We conducted a Bland-Altman analysis for agreement and adjusted linear regression models for sociodemographic characteristics. RESULTS: Mean DW was -0.59±3.21 kg. Difference varied according to Body Mass Index (BMI) and region of residence (p< 0.05). Correction model for log-MW, included the log-SRW, age group (18-34 and 35-49 years), interaction term (age × SRW), log-height, Southern region, and living with a partner. Based on self-reported weight, we observed an overestimation of underweight/normal weight prevalence and an underestimation of overweight or obesity prevalence. CONCLUSION: SRW has limitations to be considered as an alternative to MW among women of reproductive age with specific characteristics. Our proposed correction equation may decrease SRW imprecision improving the estimation of overweight and obesity. We suggest that studies consider and adjust the possible bias associated with weight misreporting on health outcomes.

Usual Intake of Added Sugars and Saturated Fats Is High while Dietary Fiber Is Low in the Mexican Population.

BACKGROUND: The Mexican National Health and Nutrition Survey (ENSANUT) was carried out in 2012. Information from the survey is used to design and evaluate food and nutrition policies in Mexico. OBJECTIVE: The objective of this study was to estimate the usual intake of energy and macronutrients in the Mexican population by using the ENSANUT 2012. METHODS: Twenty-four-hour recall interviews were administered to a nationally representative subsample of 10,096 individuals aged ≥1 y from the ENSANUT 2012. Usual intake distributions and the prevalence of inadequate intakes were estimated by using the Iowa State University method. Student's t tests and tests on the equality of proportions were used to compare usual intakes and prevalence of inadequacy across socioeconomic status, area (rural or urban), and region of residence (North, Center, or South). RESULTS: Energy and macronutrient intakes and indicators of dietary adequacy are presented for children (ages 1-4 y and 5-11 y), adolescents (12-19 y), and adults (≥20 y). At the national level, the estimated mean fiber intake was below the Adequate Intake for all population subgroups, suggesting inadequacies. The estimated proportion with a usual added sugars intake of >10% of total energy intake was >64% in all age groups. The proportion with a usual saturated fat intake of >10% of total energy intake was estimated to be >78% in children, >66% in adolescents, and >50% in adults. Overall, fiber intake was lower and intakes of saturated fat and added sugars were higher in urban compared with rural areas, in the North compared with South regions, and among those with high compared with low socioeconomic status (P < 0.05). CONCLUSIONS: Fiber intake is lower and added sugar and saturated fat intakes are higher than recommended for >50% of the Mexican population aged ≥1 y. These results highlight the importance of improving the diets of the overall population to reduce the risk of noncommunicable chronic diseases.

A Multisite Study of Environmental Correlates of Active Commuting to School in Mexican Children.

BACKGROUND: Mexican children often use active commuting to school (ACS). In order to maintain high levels of ACS it is important to understand correlates of ACS in this population. However, most evidence comes from high-income countries (HICs). We examined multilevel correlates of ACS in children attending public schools in 3 Mexican cities. METHODS: Information on 1191 children (grades 3 to 5) attending 26 schools was retrieved from questionnaires, neighborhood audits, and geographic information systems data. Multilevel logistic modeling was used to explore individual and environmental correlates of ACS at 400-m and 800-m buffers surrounding schools. RESULTS: Individual positive correlates for ACS included age (6-8 years vs 9-11 years, odds ratio [OR] = 1.5; 6-8 years vs ≥12 years: OR = 2.1) and ≥ 6 adults at home (OR = 2.0). At the 400-m buffer, more ACS was associated with lower walkability (OR = 0.87), presence of posted speed limits (< 6% vs > 12%: OR = 0.36) and crossing aids (< 6% vs 6-20%: OR = 0.25; > 20%: OR = 0.26), as well as higher sidewalk availability (< 70% vs > 90%: OR = 4.5). Similar relationships with speed limits and crossing aids were observed at the 800m buffer. CONCLUSIONS: Findings contrast with those reported in HICs, underscoring the importance of considering the local context when developing strategies to promote ACS. Future studies are needed to replicate these relationships and investigate the longitudinal impact of improving active transportation infrastructure and policies.

Global Overview of the Epidemiology of Atherosclerotic Cardiovascular Disease.

Atherosclerotic cardiovascular disease (ACD) is the leading cause of mortality worldwide. The objective of this paper is to provide an overview of the global burden of ACD and its risk factors and to discuss the main challenges and opportunities for prevention. Publicly available data from the Global Burden of Disease Study were analyzed for ischemic heart disease (IHD), ischemic stroke and ACD risk factors. Data from the WHO Global Health Observatory were used to describe prevalence of diverse cardiometabolic risk factors. World Bank Gross Domestic Product per capita (GDPc) information was used to categorize countries according to income level. Cardiovascular mortality decreased globally from 1990-2010 with important differences by GDPc; during 1990 there was a positive association between IHD mortality and GDPc. Higher-income countries had higher rates compared to those of lower-income countries. High levels of body mass index (BMI), blood pressure, glucose and cholesterol have a differential contribution to mortality by income group over time; high-income countries have been able to reduce the contribution from these risk factors in the last 20 years, whereas lower/middle income countries show an increasing trend in mortality attributable to high BMI and glucose. Although age-adjusted ACD mortality rate trends decreased globally, the absolute number of ACD deaths is increasing in part due to the growth of the population and aging, as well as to important lifestyle and food-system changes that likely attenuate gains in prevention. Population and individual level preventable causes of ACD must be aggressively and efficiently targeted in countries of lower economic development in order to reduce the growing burden of disease due to ACD.

Factors associated with inadequate diagnosis of COPD: On-Sint cohort analysis.

BACKGROUND: The purpose of this study was to evaluate the frequency of inadequate diagnosis and factors predictive of this in patients with chronic obstructive pulmonary disease (COPD) participating in the On-Sint study. METHODS: The On-Sint cohort was recruited for a multicenter observational study in which 356 physicians (71.6% from primary care) included adult patients who had been diagnosed with COPD. Patients' clinical and functional information since diagnosis and details for the recruiting physicians were collected from patient files and at the inclusion visit. We performed a multivariate analysis to evaluate the influence of these variables on diagnostic inadequacy (absence of postbronchodilator forced expiratory volume in one second/forced vital capacity [FEV1/FVC] <0.70 or, if this value was missing, prebronchodilator FEV1/FVC <0.70). RESULTS: In total, 1,214 patients were included in the study. The patients had a mean age of 66.4±9.7 years and 78.8% were male. In total, 51.3% of patients did not have an obstructive spirometry performed, and 21.4% had a normal or non-obstructive spirometry pattern. Patient-related factors associated with inadequate diagnosis were: years since diagnosis (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05), number of exacerbations in the previous year (OR 1.01, 95% CI 1.01-1.02), comorbidities (OR 1.05, 95% CI 1.01-1.015), and obesity (OR 1.06, 95% CI 1.02-1.10 per kg/m(2) of body mass index), while a longer smoking history (OR 0.98, 95% CI 0.97-0.99 for each pack/year) and short-acting or long-acting bronchodilator therapy (OR 0.61, 95% CI 0.44-0.76 and OR 0.46, 95% CI 0.27-0.76, respectively) were inversely related. With regard to physician-related variables, being followed up by primary care physicians (OR 3.0, 95% CI 2.11-4.34) and in rural centers (OR 1.63, 95% CI 1.12-2.38) were positively associated with an inadequate diagnosis, while having regular follow-ups in the most severe cases (OR 0.66, 95% CI 0.46-0.93) and use of quality of life questionnaires (OR 0.55, 95% CI 0.40-0.76) were negatively associated. CONCLUSION: Diagnosis of COPD was inadequate in half of the patients from the On-Sint cohort. There were multiple factors, both patient-related and physician-related, associated with this misdiagnosis.

Asociación entre la ingesta de calcio dietético y el índice de masa corporal elevado en adultos mexicanos de 20 a 59 años de edad: estudio de corte transversal / Dietary calcium intake and higher body mass index in Mexican adults aged 20 to 59 years old: cross-sectional study

Antecedentes: Aunque, el balance energético es el principal factor que regula el peso corporal, estudios recientes sugieren que el metabolismo del calcio puede modificar el balance energético y actuar en la regulación del mismo. Objetivo: Evaluar la asociación entre la ingesta de calcio dietético y el índice de masa corporal elevado en adultos mexicanos de 20 a 59 años. Material y métodos: Estudio secundario de tipo analítico, derivado de la Encuesta Nacional de Salud y Nutrición 2006. Se analizó la información del cuestionario de frecuencia de alimentos a 16.494 adultos. Después de eliminar valores biológicamente inadmisibles o casos con información incompleta, la muestra final fue de 15.662 adultos que se agruparon según su índice de masa corporal. Se utilizó regresión lineal para estimar la asociación entre ingesta de calcio dietético y el índice de masa corporal. Resultados: Hubo asociación inversa entre el consumo de calcio dietético e índice de masa corporal. Los sujetos con índice de masa corporal normal consumieron 903,9 mg/d versus 832,0 mg/d de calcio en obesos (p < 0,0001). Conclusión: Este estudio corrobora la evidencia existente de asociación inversa entre la ingesta de calcio dietético y el índice de masa corporal elevado.

Background. Although energy balance is the main factor that regulates body weight, recent studies suggest that calcium metabolism can modify the energy balance and help regulate body weight. Objective. To evaluate the association between the calcium intake in the diet and high body mass index in Mexican adults in the 20-59 age group. Material and methods. A cross-sectional secondary analytical study was conducted based on the 2006 Mexican National Health and Nutritional Survey (ENSANUT 2006). Food intake questionnaires applied to 16,494 adults were analyzed. After removing biologically implausible values or incomplete information, we arrived at a final sample of 15,662 adults grouped according to their body mass index. Linear regression was used to assess association between daily dietary calcium intake and body mass index. Results. There was an inverse association between dietary calcium consumption and a high body mass index. The mean calcium intake in subjects with normal body mass index was 903.9 mg/day versus 832.0 mg/day in obese subjects (p < 0.0001). Conclusion. The study corroborates existing evidence of an inverse association between the dietary calcium intake and a high body mass index.

Salud mental en el hospital general: resultados del Cuestionario de Salud del Paciente (PHQ) en cuatro servicios de atención / Mental health in the general hospital: results of the patient health questionnaire (PHQ) in four hospital services

Introducción: Pocas personas tienen acceso a tratamientos de trastornos mentales, en parte porque no son adecuadamente detectados. Como es más frecuente consultar servicios de salud por condiciones médicas, la atención primaria en salud constituye una puerta de entrada útil de detección de problemas de salud mental. Objetivo: Detectar la frecuencia de problemasde salud mental en cuatro servicios de la Fundación Santa Fe de Bogotá: consulta externa, hospitalización, urgencias y atención primaria, mediante un cuestionario breve, el Cuestionario de Salud del Paciente (PHQ), así como los índices de comorbilidad. Método: Estudio de corte transversal de pacientes que asistieron a los cuatro servicios, a quienes se les aplicó un Cuestionario de Datos Demográficos y el PHQ. Resultados: De los pacientes que asistieron a los servicios entre septiembre del 2010 y mayo del 2011, un total de 1094 seleccionados aleatoriamente participaron en el estudio. Los problemas de salud mental más frecuentes fueron trastorno depresivo mayor (7,3%), abuso de alcohol (14,4%) y algún trastorno de ansiedad (7,7%) y se observaron con una mayor frecuencia en urgencias. Conclusiones: Se reafirma la utilidad de un cuestionario breve (PHQ) para detectar problemas de salud mental en el medio hospitalario y se analiza la necesidad de diseñar programas de atención en salud mental en el hospital general. Se recomienda repetir este estudio en otros centros y realizar más investigación…

Introduction: Few individuals have access to mental health services due in part to underdetection. As it is more likely to consult for medical conditions, primary care may be a useful gateway for early detection of mental health problems. Objective: Detection of the frequency of mental health problems in four hospital services at the Fundación Santa Fe de Bogotá: Outpatient unit, hospitalization, emergency department, and primary care through a brief detection questionnaire, the Patient Health Questionnaire (PHQ). Method: Cross-sectional study of patients seen at the four services who answered a Demographic Data Questionnaire and the PHQ together with information gathered about current medical diagnosis, history of visits, and hospitalizations during the last year. Results: 1094 patients seen at the four hospital services between September 2010 and May 2011 were selected at random. A mental health problem was detected in 36.7% of the total sample. Major depressive disorder (7.3%), alcohol abuse (14.4%), and any anxiety disorder (7.7%) showed the highest prevalence with the emergency department showing the highest frequency of detection. Conclusions: The usefulness of a brief detection questionnaire such as the PHQ in hospital settings is demonstrated and implications in the design of mental health programs in the general hospital are discussed. The need to replicate this study in other settings and to undertake further research is outlined…

[Mental Health in the General Hospital: Results of the Patient Health Questionnaire (PHQ) in Four Hospital Services]. / Salud mental en el hospital general: resultados del Cuestionario de Salud del Paciente (PHQ) en cuatro servicios de atención.

INTRODUCTION: Few individuals have access to mental health services due in part to underdetection. As it is more likely to consult for medical conditions, primary care may be a useful gateway for early detection of mental health problems. OBJECTIVE: Detection of the frequency of mental health problems in four hospital services at the Fundación Santa Fe de Bogotá: Outpatient unit, hospitalization, emergency department, and primary care through a brief detection questionnaire, the Patient Health Questionnaire (PHQ). METHOD: Cross-sectional study of patients seen at the four services who answered a Demographic Data Questionnaire and the PHQ together with information gathered about current medical diagnosis, history of visits, and hospitalizations during the last year. RESULTS: 1094 patients seen at the four hospital services between September 2010 and May 2011 were selected at random. A mental health problem was detected in 36.7% of the total sample. Major depressive disorder (7.3%), alcohol abuse (14.4%), and any anxiety disorder (7.7%) showed the highest prevalence with the emergency department showing the highest frequency of detection. CONCLUSIONS: The usefulness of a brief detection questionnaire such as the PHQ in hospital settings is demonstrated and implications in the design of mental health programs in the general hospital are discussed. The need to replicate this study in other settings and to undertake further research is outlined.

Energy intake from beverages is increasing among Mexican adolescents and adults.

Little is understood about the patterns and trends in adolescent and adult beverage intake in Mexico or most other countries. Here, we used nationally representative dietary intake, income, and food expenditure surveys, which included 416 adolescents (aged 12-18 y) and 2180 adults (aged >or=19 y) from the 1999 Mexican Nutrition Survey and 7464 adolescents and 21,113 adults from the 2006 Mexican Health and Nutrition Survey. We measured the volume and energy per day contributed by all beverages consumed by the sample subjects. In 2006, Mexican adolescents and adults obtained 20.1 and 22.3%, respectively, of their energy intake from energy-containing beverages. Whole milk, carbonated and noncarbonated sugar-sweetened beverages, fruit juice with various sugar and water combinations added, and alcohol represented the 4 major categories of beverage intake. The trends from the dietary intake surveys showed very large increases in the intake of energy-containing beverages among adolescents and adults between 1999 and 2006. Income elasticities showed a high likelihood that intakes will increase as Mexican incomes continue to rise. Whereas the own-price elasticities for whole milk and sodas were both modest, intakes of these were increasing and higher than those for all other food groups. Energy intake trends and current levels of beverage intakes in Mexico are the highest recorded in a nationally representative survey and present major challenges for public health authorities.

[New diagnosis tools for tuberculosis laboratory network in Latin America]. / Consideraciones sobre la implementación de nuevas herramientas diagnósticas en las redes de laboratorios de tuberculosis de Latinoamérica.

Feasibility of rapid and sustainable diagnostic methods that provide useful and timely results to guide the clinical control of tuberculosis patients was analyzed. However, policies guiding the insertion of new diagnostics in the laboratory services that support the tuberculosis control are lacking in developing countries. The introduction of these methods in developing countries laboratories requires rational policies guiding the application of these technologies. In the last few years, some automated systems for culture and molecular testing in laboratory services for tuberculosis diagnosis, which offered accuracy and speed, have been reported. However, their implementation is restricted because of costly resources, logistics and infrastructure. Recently, various economically feasible tests have demonstrated to be applicable in poor-resource labs. The detection of adenosine desaminase (ADA) in pleural fluid is a valuable low-cost approach to the diagnosis of tuberculosis. On the other hand, the microscopic detection of Mycobacterium tuberculosis using thin layer agar is a moderate cost alternative method. Drug susceptibility testing to antituberculous drugs can be expedited by the nitrate reduction assay in tuberculosis laboratories using routine procedures for tuberculosis diagnosis.