[Association of family support and knowledge about the disease with glycemic control in diabetic patients]. / Asociación del control glicémico con el apoyo familiar y el nivel de conocimientos en pacientes con diabetes tipo 2.

BACKGROUND: Family interventions may improve glycemic control among diabetic patients AIM: To evaluate the association of glycemic control with family support and level of knowledge in patients with type 2 diabetes. MATERIAL AND METHODS: Patients with type 2 diabetes completed a demographic survey. Glycosylated hemoglobin (HbA1c) was determined and glycemic control was defined as a value < 6,5%. Two validated instruments were applied to evaluate family support, stratifying it in three categories (low, medium and high) and the level of knowledge about diabetes. RESULTS: We studied 81 patients aged 32 to 65 years (53 females). Thirty six percent had an adequate glycemic control. Participants with a medium family support had three times greater risk of having an uncontrolled blood glucose than subjects with high family support. No significant association was found between the level of knowledge and glycemic control. CONCLUSIONS: Family support but not knowledge about the disease is associated with a better glycemic control of patients with type 2 diabetes.

[Growth in weight and height in children less than two years old in the IMSS]. / Crecimiento en peso y longitud de los niños menores de dos años atendidos en el IMSS.

OBJECTIVE: To describe the physical growth in weight and height of children less than two years of age cared for the Mexican Institute of Social Security (IMSS). MATERIAL AND METHOD: A population-based National Survey, which was also regional representative, was carried out in Ordinary Regime (RO) and the IMSS-Oportunidades Program (IO). In two years (2000-2002) the study gathered data on 17,502 children from the RO and 9872 from IO. The measures of weight and length were made by nurses, according to WHO criteria. Growth is reported as weight and length for each month of age and gender, in tables and percentile curves derived from quintile regressions, using a third degree polynomial to smooth out the lines. RESULTS: The trends of the means of weight and height in the first two years of life in children cared by Instituto Mexicano del Seguro Social show a pattern similar to those described in healthy children in other populations. However, the values are lower than those obtained in developed countries. CONCLUSIONS: Children's growth at two years of age at the Instituto Mexicano del Seguro Social shows a curve that is lower than that of the reference population recommended by the World Health Organization as an international standard.

The social construction of anemia in school shelters for indigenous children in Mexico.

Indigenous children in school shelters in Mexico suffer from anemia in spite of food that is subsidized, prepared, and served to them. Economically and biomedically centered strategies to reduce anemia have achieved only partial and short-term success. An interdisciplinary team investigated the food security system of the school shelters and collected data through interviews and participant observation. The analysis revealed that the children's nutrition depends on a frail chain of events in which a single link's failure can lead to nutritional insecurity. The authors conclude that the social actors involved in the process are mainly considering the economic aspects of nutrition, but anemia persists as a social construction of the faulty relationship between the institution that runs the shelters and the indigenous culture. The authors make suggestions for an intervention that empowers the community by involving it actively in solving the problem.

[Hospital practice in neonatal period to prevent infant sudden death syndrome]. / Síndrome de muerte súbita del lactante. Prevención en la práctica hospitalaria.

OBJECTIVE: To describe hospital care for newborns in the Instituto Mexicano del Seguro Social (IMSS), as well as all the recommendations given to parents to prevent sudden infant death syndrome (SIDS) at home. MATERIAL AND METHODS: There were twenty-eight IMSS hospitals randomly selected from four geographical areas of the country, under a stratified sampling method according to the number of births per year. The method used was newborns direct observation in the neonatal care areas, and to fill out a questionnaire applied by trained observers. This questionnaire was adapted from the Maternity Advice Study that includes hospital care for newborns and all the recommendations that parents have to do for newborns at home. RESULTS: The newborns in neonatal areas used to sleep in lateral position (80 and 67%). Baby cradles with medium firmness and elevated head-rest were predominant in the areas surveyed. Babies were generally wrapped-up from the neck to down, tightly enough that it prevented arm and leg movement. Parents received information on how to prevent SIDS at home, and up to 21% of them received no information at all. CONCLUSIONS: There were no specific practices at all the hospitals in this survey to diminish SIDS. It is necessary to organize specific health actions to diminish the risk of SIDS at home.

[Dietary intake and nutritional status of pregnant women enrolled in the Mexican Institute of Social Security, living in a peri-urban area of Mexico City]. / Alimentación y estado nutricio de mujeres embarazadas derechohabientes del Instituto Mexicano del Seguro Social en un area suburbana de la Ciudad de México.

OBJECTIVE: To identify the combinations and type of foods consumed, energy intake, nutrients and nutritional status in pregnant women. METHODOLOGY: One hundred and twelve primiparous women, who attended prenatal care at a primary care clinic located in the metropolitan area of Mexico City were included. Information about dietary intake was collected through a 24-hour recall questionnaire. Energy intake, nutritional intake and appropriateness of nutritional intake were assessed. Nutritional status was evaluated through expected weight for height according to gestational age. RESULTS: Average age was of 22 +/- 4.1 years and mean duration of pregnancy of 28 weeks. There was an adequate intake of energy, thiamine, riboflavin and calcium; whereas a low intake of iron, folate and zinc was observed, 47% of pregnant women were overweighted. CONCLUSIONS: A poor variety in dietary intake was identified, as well as inadequacies in mineral and vitamin intake; additionally, an inadequate nutritional status was found in more than 50% of pregnant women.

[Iodine deficiency and other potential goitrogens in the persistence of endemic goiter in Mexico]. / Deficiencia de yodo y otros posibles bociógenos en la persistencia del bocio endémico en México.

OBJECTIVE: To measure the frequency of goiter and the presence of potential goitrogens in a sample of school-age children and pregnant women. METHODS: Cross-sectional study in a purposive sample in three regions, one with known high prevalence of goiter (Huejutla), one with unknown prevalence (Ixmiquilpan) and one with no expected deficiency (Pachuca). Children were sampled from schools and pregnant women from rural reference hospitals. Goiter was evaluated by manual exam and ultrasound. RESULTS: Goiter prevalence in 673 children between 6 and 14 years old was 8% in Pachuca, 9% in Ixmiquilpan, and 14% in Huejutla. In 300 pregnant women, goiter prevalence was 19% in Pachuca, 20% in Ixmiquilpan, and 52% in Huejutla. In 936 interviews on salt consumption, 98% of families consumed table salt, but only 50% of the samples were adequately iodized. Twenty-four percent of families obtained water from wells contaminated with arsenicum and mercury in Pachuca and Ixmiquilpan, and with colibacilli in Ixmiquilpan. CONCLUSIONS: Even at the end of the millenium, endemic goiter is still a public health problem in this sample of school-age children and pregnant women. Despite consumption of iodized salt, ingestions of goitrogens may be contributing to the persistence of this problem.

[Practice clinical guideline. Prevention, diagnosis and treatment of overweight and obesity]. / Guía de práctica clínica. Prevención, diagnóstico y tratamiento del sobrepeso y la obesidad exógena.

Excess body weight (overweight and obesity) is currently recognized as one of the most important challenges of public health in the world, due to its size, speed of growth and the negative effect on health. Currently, Mexico and United States have the highest prevalence of obesity in the adult population (30 %), which is nearly ten times higher than that of Japan or Korea (4 %). In our country, the trends of overweight and obesity in different national surveys show steady increase in prevalence over time. According to the results of the National Survey of Health and Nutrition 2012 (ENSANUT, according to its initials in Spanish), the combined prevalence of overweight or obese (BMI = 25 kg/m(2)) in the population over 20 years is higher in women (73.0 %) than men (69.4 %), while the prevalence of obesity (BMI = 30 kg/m(2)) is almost higher in females than in males. Global experience shows that proper care of obesity and overweight requires formulating and coordinating comprehensive and efficient multilevel strategies for enhancing protective factors to health, particularly to modify individual, family and community behavior. It is unlikely that a single intervention can modify the incidence or natural history of overweight and obesity.

El exceso de peso corporal es uno de los problemas más importantes de salud pública en el mundo. En la actualidad, México y Estados Unidos ocupan los primeros lugares de prevalencia mundial de obesidad en la población adulta (30 %), la cual es casi diez veces mayor que la de países como Japón y Corea (4 %). En nuestro país, las tendencias de sobrepeso y obesidad en las diferentes encuestas nacionales muestran un incremento constante de la prevalencia a lo largo del tiempo: de acuerdo con los resultados de la ENSANUT 2012, la prevalencia combinada de sobrepeso u obesidad (IMC = 25 kg/m2), en la población mayor de 20 años, es mayor en las mujeres (73.0 %) que en los hombres (69.4 %), mientras que la prevalencia de obesidad (IMC = 30 kg/m2) es más alta en el sexo femenino que en el masculino. La experiencia global indica que la atención correcta de la obesidad y el sobrepeso requiere formular y coordinar estrategias multisectoriales integrales y eficientes que permitan potenciar los factores de protección a la salud, particularmente para modificar el comportamiento individual, familiar y comunitario. El IMSS desarrolla programas y proyectos de interés social para otorgar atención integral de calidad a los derechohabientes con sobrepeso y obesidad, con el propósito de limitar las consecuencias metabólicas de la enfermedad, mejorar la calidad de vida de aquellos y lograr mayor eficiencia en el uso de los recursos.

Iodine deficiency and its association with intelligence quotient in schoolchildren from Colima, Mexico.

OBJECTIVE: To determine the prevalence of iodine deficiency, its causes and its association with intelligence quotient (IQ) in Mexican schoolchildren. DESIGN: Cross-sectional analytical study, in which determinations of thyroid gland size, urinary iodine excretion, IQ, iron nutritional status, physical anthropometry, family consumption of goitrogenic foods, type/origin and iodine saturation of salt consumed at home and coliform organisms in drinking water were performed, and the association of each variable with IQ scores was evaluated by multiple regression analyses. SETTING: Municipality of Cuauhtémoc, in Colima, Mexico (altitude: 600-2700 m above sea level). Sea salt is extracted manually nearby and often used for human consumption. Goitre remains present in the region despite over half a century of mandatory salt iodination in the country. SUBJECTS: Three hundred and three children, similar proportions of boys and girls, mean age 9.3 years, randomly selected from 19 public elementary schools. RESULTS: Overall goitre rate was 21.4%; low urinary iodine excretion was found in 19.5% of the children, high urinary iodine excretion in 32.0%. IQ scores were transformed into percentile values, with the following categorisation: < or = P5 (low IQ), 48.5%; > P5 to < or = P25 (below average), 24.2%; > P25 to < P75 (average), 18.8%; > or = P75 to < P95 (above average), 3.6%; > or = P95 (high IQ), 4.9%. Ninety-two per cent of the population used iodinated salt, but deficient iodine saturation (<50 ppm) was found in 86.8% of salt samples. The main goitrogenic foods consumed were peanuts (by 31.5% of the sample), cabbage (30.1%), broccoli (27.7%) and cauliflower (25.7%). Median counts of coliform organisms (colony-forming units/100 ml of drinking water) were: 207.5 (well water), 151 (cisterns), 52 (private homes), 25 (elementary schools) and 12 (kindergartens). Moderate iodine deficiency was associated (P < 0.05) with a 4.26 times higher risk of low IQ. CONCLUSIONS: There is a perturbing negative impact of these findings on human capital acquisition for the region and the country. More attention is needed to ensure effective salt iodination processes, particularly in regions where goitrogens may contribute to the negative effects of iodine deficiency on the intellectual development of children.

Asociación del control glicémico con el apoyo familiar y el nivel de conocimientos en pacientes con diabetes tipo 2 / Association of family support and knowledge about the disease with glycemic control in diabetic patients

Background: Family interventions may improve glycemic control among diabetic patients Aim: To evaluate the association of glycemic control with family support and level of knowledge in patients with type 2 diabetes. Material and Methods: Patients with type 2 diabetes completed a demographic survey. Glycosylated hemoglobin (HbA1c) was determined and glycemic control was defined as a value < 6,5%. Two validated instruments were applied to evaluate family support, stratifying it in three categories (low, medium and high) and the level of knowledge about diabetes. Results: We studied 81 patients aged 32 to 65 years (53 females). Thirty six percent had an adequate glycemic control. Participants with a medium family support had three times greater risk of having an uncontrolled blood glucose than subjects with high family support. No significant association was found between the level of knowledge and glycemic control. Conclusions: Family support but not knowledge about the disease is associated with a better glycemic control of patients with type 2 diabetes.