Encuesta Nacional de Salud y Nutrición Continua 2022: recomendaciones de política pública.

El 21 de julio de 2023, en un seminario interno de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, se presentaron los resultados de la Encuesta Nacional de Salud y Nutrición Continua 2022 (Ensanut Continua 2022). Junto con expertos del más alto nivel, se plantearon recomendaciones con el fin de apoyar la salud de la población mexicana. Dichas recomendaciones giran en torno a las temáticas incluidas en la Ensanut Continua 2022, como vacunación, salud de niños y adolescentes, salud mental y dificultades de funcionamiento y estado de nutrición y enfermedades crónicas en adultos, entre otras. Los logros de este esfuerzo realizado para obtener información de manera continua son cruciales para saber cómo hacer frente a los factores que afectan a nuestra salud y poder tomar mejores decisiones de política pública en esta materia, bajo la premisa de que los problemas públicos requieren ser medidos y monitoreados permanentemente.

Declaración de Cuernavaca.

Los Institutos Nacionales de Salud (INS) miembros de la Red Regional Latinoamericana de la Asociación Internacional de Institutos Nacionales de Salud Pública, reunidos en forma presencial en la sede del Instituto Nacional de Salud Pública de México, en la Ciudad de Cuernavaca, los días 5 al 7 de octubre de 2022, contando con la participación de los directores o representantes de los INS de (...).

Espacios cardioprotegidos en México: acciones para prevenir la muerte súbita cardiaca. Una postura de profesionales de la salud.

La muerte súbita cardiaca es un problema de salud pública a nivel mundial. Aunque su incidencia no es conocida, se estima que causa hasta 50% de la mortalidad de origen cardíaco y hasta 20% de la mortalidad total en los adultos. En México, estimaciones previas sugieren que causa en promedio 33 000 muertes al año; sin embargo, los datos no son precisos. La  mitad de los eventos por muerte súbita cardiaca se deben a un paro cardiaco súbito extrahospitalario que, de no ser atendido oportunamente, deriva en una muerte súbita cardiaca. Por tanto, la capacidad de responder pronta y adecuadamente a estos eventos con las maniobras y equipos necesarios mejora la sobrevida de las víctimas. Para atender este problema, en algunos estados del país se han creado espacios cardioprotegidos que permiten realizar maniobras de reanimación cardiopulmonar y desfibrilación cardiaca de acceso público oportunamente. Como objetivo, los profesionales de la salud establecen la importancia de implementar espacios cardioprotegidos y crear políticas públicas al respecto en todo el país.

Perception of parents' physical activity as a positive model on physical activity of adolescents.

Physical activity (PA) promotes an adequate level of health in adolescents. The PA behaviors moderation is led by the adolescents' perception of their parents. We suppose that higher adolescents' perception of their parents' physical activity influences the physical activity spent in adolescents. The objective of this study was to determine the association between adolescents' perception of their parents' PA practice with adolescent's PA in a sample of public schools in the Morelos state of Mexico. We analyzed the information of 4625 adolescents from the baseline of a cohort study of students in public schools in Mexico. We evaluated adolescents' perceptions of their parents PA and PA practice of the adolescents. A logistic regression analysis stratified by sex was carried out to evaluate the association between adolescents' perceptions of their parents PA, and adolescents' PA. We found that the PA of female adolescents was associated with their perceptions' of both parents' PA (OR = 2.48; IC95% 1.84-3.35). Adolescents' perceptions of their mother's PA was associated with their PA (daughters OR = 1.69; IC95% 1.33-2.15; sons OR = 1.87 IC95% 1.41-2.45). In conclusion, adolescents' perceptions of their parents' PA practice were associated with higher adolescents' PA. Higher adolescents' perception of their parents PA may play an important role as a positive model for the adolescent's PA practice (p < 0.001). Finally, parental PA and the perceptions that adolescents have of their parents' PA must be considered in devising general PA programs.

Risk of recurrent Helicobacter pylori infection 1 year after initial eradication therapy in 7 Latin American communities.

IMPORTANCE: The long-term effectiveness of Helicobacter pylori eradication programs for preventing gastric cancer will depend on recurrence risk and individual and community factors. OBJECTIVE: To estimate risk of H. pylori recurrence and assess factors associated with successful eradication 1 year after treatment. DESIGN, SETTING, AND PARTICIPANTS: Cohort analysis of 1463 randomized trial participants aged 21 to 65 years from 7 Latin American communities, who were treated for H. pylori and observed between September 2009 and July 2011. INTERVENTIONS: Randomization to 1 of 3 treatment groups: 14-day lansoprazole, amoxicillin, and clarithromycin (triple therapy); 5-day lansoprazole and amoxicillin followed by 5-day lansoprazole, clarithromycin, and metronidazole (sequential); or 5-day lansoprazole, amoxicillin, clarithromycin, and metronidazole (concomitant). Participants with a positive (13)C-urea breath test (UBT) 6 to 8 weeks posttreatment were offered voluntary re-treatment with 14-day bismuth-based quadruple therapy. MEASUREMENTS: Recurrent infection after a negative posttreatment UBT and factors associated with successful eradication at 1-year follow-up. RESULTS: Among participants with UBT-negative results who had a 1-year follow-up UBT (n=1091), 125 tested UBT positive, a recurrence risk of 11.5% (95% CI, 9.6%-13.5%). Recurrence was significantly associated with study site (P = .03), nonadherence to initial therapy (adjusted odds ratio [AOR], 2.94; 95% CI, 1.31-6.13; P = .01), and children in the household (AOR, 1.17; 95% CI, 1.01-1.35 per child; P = .03). Of the 281 with positive posttreatment UBT results, 138 completed re-treatment, of whom 93 tested UBT negative at 1 year. Among the 1340 who had a 1-year UBT, 80.4% (95% CI, 76.4%-83.9%), 79.8% (95% CI, 75.8%-83.5%), and 77.8% (95% CI, 73.6%-81.6%) had UBT-negative results in the triple, sequential, and concomitant groups, respectively (P = .61), with 79.3% overall effectiveness (95% CI, 77.1%-81.5%). In a single-treatment course analysis that ignored the effects of re-treatment, the percentage of UBT-negative results at 1 year was 72.4% (95% CI, 69.9%-74.8%) and was significantly associated with study site (P < .001), adherence to initial therapy (AOR, 0.26; 95% CI, 0.15-0.42; P < .001), male sex (AOR, 1.63; 95% CI, 1.25-2.13; P < .001), and age (AOR, 1.14; 95% CI, 1.02-1.27 per decade; P = .02). One-year effectiveness among all 1463 enrolled participants, considering all missing UBT results as positive, was 72.7% (95% CI, 70.3%-74.9%). CONCLUSIONS AND RELEVANCE: One year after treatment for H. pylori infection, recurrence occurred in 11.5% of participants who had negative posttreatment UBT results. Recurrence determinants (ie, nonadherence and demographics) may be as important as specific antibiotic regimen in determining the long-term success of H. pylori eradication interventions. Study findings are relevant to the feasibility of programs for the primary prevention of gastric cancer in high-incidence regions of Latin America. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01061437.

14-day triple, 5-day concomitant, and 10-day sequential therapies for Helicobacter pylori infection in seven Latin American sites: a randomised trial.

BACKGROUND: Evidence from Europe, Asia, and North America suggests that standard three-drug regimens of a proton-pump inhibitor plus amoxicillin and clarithromycin are significantly less effective for eradication of Helicobacter pylori infection than are 5-day concomitant and 10-day sequential four-drug regimens that include a nitroimidazole. These four-drug regimens also entail fewer antibiotic doses than do three-drug regimens and thus could be suitable for eradication programmes in low-resource settings. Few studies in Latin America have been done, where the burden of H pylori-associated diseases is high. We therefore did a randomised trial in Latin America comparing the effectiveness of four-drug regimens given concomitantly or sequentially with that of a standard 14-day regimen of triple therapy. METHODS: Between September, 2009, and June, 2010, we did a randomised trial of empiric 14-day triple, 5-day concomitant, and 10-day sequential therapies for H pylori in seven Latin American sites: Chile, Colombia, Costa Rica, Honduras, Nicaragua, and Mexico (two sites). Participants aged 21-65 years who tested positive for H pylori by a urea breath test were randomly assigned by a central computer using a dynamic balancing procedure to: 14 days of lansoprazole, amoxicillin, and clarithromycin (standard therapy); 5 days of lansoprazole, amoxicillin, clarithromycin, and metronidazole (concomitant therapy); or 5 days of lansoprazole and amoxicillin followed by 5 days of lansoprazole, clarithromycin, and metronidazole (sequential therapy). Eradication was assessed by urea breath test 6-8 weeks after randomisation. The trial was not masked. Our primary outcome was probablity of H pylori eradication. Our analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, registration number NCT01061437. FINDINGS: 1463 participants aged 21-65 years were randomly allocated a treatment: 488 were treated with 14-day standard therapy, 489 with 5-day concomitant therapy, and 486 with 10-day sequential therapy. The probability of eradication with standard therapy was 82·2% (401 of 488), which was 8·6% higher (95% adjusted CI 2·6-14·5) than with concomitant therapy (73·6% [360 of 489]) and 5·6% higher (-0·04% to 11·6) than with sequential therapy (76·5% [372 of 486]). Neither four-drug regimen was significantly better than standard triple therapy in any of the seven sites. INTERPRETATION: Standard 14-day triple-drug therapy is preferable to 5-day concomitant or 10-day sequential four-drug regimens as empiric therapy for H pylori infection in diverse Latin American populations. FUNDING: Bill & Melinda Gates Foundation, US National Institutes of Health.

Human papillomavirus incidence and risk factors among Mexican female college students.

OBJECTIVE: To determine the factors associated with high-risk human papillomavirus (HR-HPV) and its incidence in a cohort of female college students, with particular emphasis on the use of condoms. METHODS: A cohort was created during 2001 to 2005. The students signed informed consent, answered a questionnaire, and provided a vaginal scrape to detect HR-HPV. Incidences were estimated and risk factors were evaluated using Cox proportional risk model. The variable condom use was constructed based on the following 3 measurements: relative frequency throughout one's lifetime, use during the first sexual relationship, and use during the last sexual relationship. RESULTS: A total of 237 women participated, providing 395.6 person-years of follow-up. An incidence of 15.9 HR-HPV infection per 100 person-years was estimated and the factors associated with HR-HPV infection were found to be self-reported sexually transmitted infections (RR = 2.7), use of emergency contraception pill (ECP) (RR = 2.0), and having 2 or more sexual partners (RR = 1.9). University students using the ECP demonstrated more risky sexual behavior than nonusers. Women with 2 or more sexual partners who reported inconsistent condom use had 3.8 times the rate of HR-HPV infection. CONCLUSIONS: The incidence for HR-HPV in this cohort of Mexican female college students is comparable to that found in the United States and Canada. The results suggest that the consistent use of condoms is a protective factor against HR-HPV, especially for women with multiple sexual partners and/or those who use the ECP.

Pathogenicity island cag, vacA and IS605 genotypes in Mexican strains of Helicobacter pylori associated with peptic ulcers.

BACKGROUND: Helicobacter pylori is associated with chronic gastritis, peptic ulcers, and gastric cancer. Two major virulence factors of H. pylori have been described: the pathogenicity island cag (cag PAI) and the vacuolating cytotoxin gene (vacA). Virtually all strains have a copy of vacA, but its genotype varies. The cag PAI is a region of 32 genes in which the insertion of IS605 elements in its middle region has been associated with partial or total deletions of it that have generated strains with varying virulence. Accordingly, the aim of this work was to determine the cag PAI integrity, vacA genotype and IS605 status in groups of isolates from Mexican patients with non-peptic ulcers (NPU), non-bleeding peptic ulcers (NBPU), and bleeding peptic ulcers (BPU). METHODS: The cag PAI integrity was performed by detection of eleven targeted genes along this locus using dot blot hybridization and PCR assays. The vacA allelic, cag PAI genotype 1 and IS605 status were determined by PCR analysis. RESULTS: Groups of 16-17 isolates (n = 50) from two patients with NPU, NBPU, and BPU, respectively, were studied. 90% (45/50) of the isolates harbored a complete cag PAI. Three BPU isolates lacked the cag PAI, and two of the NBPU had an incomplete cag PAI: the first isolate was negative for three of its genes, including deletion of the cagA gene, whereas the second did not have the cagM gene. Most of the strains (76%) had the vacA s1b/m1 genotype; meanwhile the IS605 was not present within the cag PAI of any strain but was detected elsewhere in the genome of 8% (4/50). CONCLUSION: The patients had highly virulent strains since the most of them possessed a complete cag PAI and had a vacA s1b/m1 genotype. All the isolates presented the cag PAI without any IS605 insertion (genotype 1). Combined vacA genotypes showed that 1 NPU, 2 NBPU, and 1 BPU patients (66.6%) had a mixed infection; coexistence of H. pylori strains with different cag PAI status was observed in 1 NBPU and 2 BPU (50%) of the patients, but only two of these patients (NBPU and BPU) had different vacA genotypes.

Synergistic action of folate intake and testosterone associated with breast cancer risk.

The amount of irreparable DNA damage is a function of the rate of cell division, and the association between sex hormones and the risk of breast cancer has been explained by an increase in cell division. Folate intake insufficiency leads to disturbances in DNA replication and DNA repair. We hypothesized that folate intake insufficiency and high serum concentrations of sex hormones act synergistically on the risk of breast cancer. The aim of this study was to investigate the interaction between sex hormones (exposure of interest A) and dietary folate intake (exposure of interest B) on the risk of breast cancer. We included 342 breast cancer primary postmenopausal cases and 294 controls obtained from a large population-based case-control study. Multiple conditional logistic regression models were used for the analysis and interactions were tested. The joint effect of the lowest dietary folate intake (T1 < 259.40 mg/d) and the highest serum concentration of testosterone (T3 ≥ 0.410 on the risk of breast cancer was odds ratio = 9.18 (95% confidence interval 2.56-32.88) when compared to the lowest-risk category, namely, the group of women with the highest dietary folate intake (T3 > 381.29 mg/d) and the lowest serum concentration of testosterone (T1 ≤ 0.25 pg/mL). There were some indications that the estimated join effect was greater than the product of the estimated effects alone (P = .001). These findings have important public health implications with respect to reducing the risk of the most frequent cancer in women worldwide.

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

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

Intra-familial physical violence among Mexican and Egyptian youth.

OBJECTIVE: To determine the prevalence of experiencing intra-familial violence among Mexican and Egyptian youth and to describe its associated risk factors. METHODS: Data from questionnaires applied to 12,862 Mexican and 5,662 Egyptian youth, aged 10 to 19, who attended public schools were analyzed. Biviarate and logistic regression analysis were used to determine the relationship between socio-demographics, the experience of intra-familial violence and violence perpetration. RESULTS: The prevalence of having experienced intra-familial violence was comparable across the Mexican and Egyptian populations (14% and 17%, respectively). In Mexico, young men were more likely to have experienced such violence (OR=2.36) than women, whereas in Egypt, young women were at slightly greater risk than young men (OR=1.25). Older age, male gender and urban residence were independent correlates of experiencing intra-familial violence among Mexican youth. For Egyptian adolescents, in contrast, younger age, female gender and having non-married parents were independent correlates of victimization. Intra-familial violence victims were also more likely than non-victims to perpetrate violence (Mexico: OR=13.13; Egypt: OR=6.58). CONCLUSIONS: Mexican and Egyptian youth experienced intra-familial violence at a relatively low prevalence when compared with youth of other countries. A strong association was found between experiencing intra-familial violence and perpetrating violence.

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

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

[Cervical cancer screening: knowledge of Pap smear benefits and utilization in Mexico]. / Tamizaje en cáncer cervical: conocimiento de la utilidad y uso de citología cervical en México.

OBJECTIVE: To identify and evaluate the predisposing factors regarding the utilization of the Pap smears in the population seen in the Cervical Cancer Screening Program in Mexico METHODS: A cross-sectional study was conducted from January 1997 through December 1998 in Mexico city. A questionnaire was applied to a total of 2,107 women of reproductive age who attended a family planning program and data was collected regarding the following topics: social-demographics, reproductive risk factors associated with cervical cancer, sexual behavior and partner history, birth control, knowledge about Pap smear' benefits, and its utilization. Statistic analysis was conducted using Student' s test and non-conditional multiple logistic regression model for determining significance. RESULTS: The predisposing factors were: knowledge about Pap smear's benefits (OR=6.00, CI 95% 4.70-7.67), history of using at least two birth control methods (OR=2.38, CI 95% 1.75-3.24), previous history of vaginal infection (OR=2.18, CI 95% 1.73-2.75), sexual partner's approval of gynecological examinations (OR=1.56, CI 95% 1.07-2.29). CONCLUSIONS: Educational programs on cancer prevention in this population should include the benefits of screening tests. Pap smears for Mexican women of reproductive age are mostly offered opportunely. The previous use of health services is a determinant factor for the utilization of the Cervical Cancer Screening Program. These results show the need to strengthen health promotion programs to women at high risk of cervical cancer and their sexual partners.

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

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

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

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

Susceptibility to smoking among adolescents and its implications for Mexico's tobacco control programs. Analysis of the Global Youth Tobacco Survey 2003-2004 and 2006-2007.

Smoking prevention efforts should either prevent target groups from becoming susceptible to smoking or prevent susceptible adolescents from progressing to becoming regular smokers. To describe the prevalence of susceptibility to smoking among never smoker students from cities that applied the GYTS in 2003 and 2006. The GYTS uses a two-stage cluster sample survey design that produces representative samples of students aged 12-15 years enrolled in public, private, and technical schools. The survey was undertaken at 399 schools in 9 cities. The GYTS surveyed 33,297 students during the academic years 2003-04 and 2006-07. Among never smokers, about 25% are likely to initiate smoking in the next 12 months. There are no differences in susceptibility to smoking by gender. When comparing results from 2003 and 2006, the susceptibility index has not changed, but for one city. The GYTS results are useful for monitoring susceptibility to smoking among adolescents and provide evidence for strengthening the efforts of tobacco control programs in Mexico.

Comparative study of correlates of early age at menarche among Mexican and Egyptian adolescents.

We compared the median age at menarche in two developing countries to determine whether early age at menarche varies across body mass index (BMI), socioeconomic level, and urban/rural residence in Mexican and Egyptian adolescents. Questionnaire data and weight and height measurements were collected from 4,143 Mexican and 493 Egyptian adolescent girls (age, 10-19 years). Statistical analysis included Pearson chi-squared, Student t-test, and multiple logistic regression models. Median age at menarche was 12 years (range, 8-19 years) for Mexican girls and 13 years (range, 9-16) for Egyptian girls. In both countries, the odds of undergoing menarche at an earlier age were higher among adolescents with the following characteristics: overweight or obesity, as compared to those with a normal BMI (Mexican adolescents, OR = 1.45, 95% CI 1.25-1.69; Egyptian adolescents, OR = 2.20, 95% CI 1.21-4.03); living in urban versus rural areas (OR = 1.38, 95% CI 1.19-1.61 and OR = 1.38, 95% CI 0.74-2.59, respectively); high socioeconomic level versus the lowest level (OR = 1.46, 95% CI 1.22-1.74 and OR = 1.41, 95% CI 0.67-2.98, respectively). The associations between early age at menarche and urban residence or high socioeconomic level were statistically significant only in Mexican adolescents. Menarche at an earlier age was most strongly associated with overweight and obesity in both Mexican and Egyptian adolescents, while urban residence and high socioeconomic level were significantly associated only in Mexican adolescents.

[Prevalence of smoking and low school performance, among students 11-24 years of age in the state of Morelos, Mexico]. / Prevalencia de tabaquismo y bajo desempeño escolar, en estudiantes de 11 a 24 años de edad del estado de Morelos, México.

OBJECTIVE: To assess the association between self-reported academic performance and tobacco experimentation and established tobacco use among adolescents and young adults in Morelos State, Mexico. MATERIAL AND METHODS: A population-based, cross-sectional study was carried out in 72 administrative areas from all 33 municipalities of Morelos State (urban, semi-urban and rural areas). A total of 13,293 adolescents and young adults aged 11 to 24 years were randomly selected from public schools. Data were collected using a self-administered questionnaire. Multinomial logistic regression models were fitted with smoking habit as the dependent variable with three categories (never a smoker, occasional smoker, and regular smokers). RESULTS: The prevalence of occasional smokers was 14.9% (95% CI: 14.1-15.7) among females and 27.3% (95% CI: 26.1-28.4) among males. The corresponding figures for females and males for established smokers were 6.1% (95% CI: 5.6-6.6) and 13.1% (95% CI: 12.2-13.9), respectively. Academic performance self-reports were found to be inversely proportional to occasional or regular tobacco use. In women, the association with current tobacco consumption was 5.1 times higher (95% CI: 2.5-10.4) in women with a yearly grade average of six or less, in comparison to those with scores of ten or nine. The same pattern was observed in men (OR = 4.2; 95% CI: 2.7-6.7), with a significant linear trend both in both women and men. CONCLUSIONS: These results evidence that tobacco consumption is related to low academic performance. This relationships is determined by complex lifestyle patterns of adolescents.

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

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

[Low yield of HPV DNA determination in the distal region of the male urethra]. / La baja utilidad de la determinación del ADN del VPH en la región distal de la uretra masculina.

OBJECTIVE: To assess the prevalence of Human Papillomavirus (HPV) Deoxyribonucleic acid (DNA), and of clinical and subclinical condilomatosis in men whose sex partners had been diagnosed with cervical intraepithelial neoplasia. MATERIAL AND METHODS: A cross-sectional study was conducted from October 1997 to August 1998, among 200 men aged 17 to 64 years referred to the Oncology Department of the National Institute of Perinatology in Mexico City. A physical examination of the penis (penoscopy) was performed after applying 3-5% acetic acid. A colposcope was used to identify acetowhite areas and vascular abnormalities associated with HPV infection. HPV DNA was detected by PCR and reverse line hybridization. The exploratory and univariant statistical analysis was made with the package Stata V6.0. RESULTS: The beta-globin gene was present in 93.5% (n = 187) of the 200 urethral exfoliated cell samples collected. HPV DNA was detected in only 2% (4/187) of the study subjects. Penoscopy data showed the presence of acetowhite areas in 43% (81/187) of subjects. CONCLUSIONS: Study findings show that the presence of HPV DNA in urethra is uncommon, as has been reported in several previous studies. Research is needed to evaluate the presence of HPV DNA in the coronal sulcus, as compared with the distal urethral region. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

[Smoking and its association to heart ischemic disease]. / El tabaquismo y su fracción atribuible en la enfermedad isquémica cardiaca.

OBJECTIVE: To assess the impact of cigarette smoking on coronary heart disease (CHD) and to propose a simple and efficient method to estimate its attributable fraction (AF). MATERIAL AND METHODS: A matched case-control study was conducted in the Regional Hospital of Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) in Morelos State, Mexico, from May to June-2000. Cases were 80 prevalent and incident patients with CHD. One-hundred-sixty controls matched by sex and age were randomly selected from the outpatient clinic. The attributable fraction was obtained through summary estimators, variances, and confidence intervals for matched designs with more than one control per case. RESULTS: The prevalence of cigarette smoking previous to the coronary event was 80%, compared to 62.1% in controls. Mantel-Haenszel odds ratios showed a positive association of cigarette smoking with CHD (OR, 6.7; 95% CI, 3.2-13.8). The attributable fraction among the exposed was 85% (95% CI, 74-95) while the population attributable fraction was 56% (95% CI, 45-66). The AF in exposed was 65% for males (95% CI, 53-77) and 31% for females (95% CI 14-47). CONCLUSIONS: The long-term smoking AF on CHD is greater than 85%. Such a high AF should be countered with the implementation of primary prevention measures to encourage smoking cessation and with smoking cessation clinics for active smokers. These are the two most important public health interventions to prevent CHD and a variety of chronic diseases.