Trends in Teen Births in Mexico Spanning 25 Years: A Need for Regionally-directed Preventive Strategies.

AIM OF THE STUDY: We aimed to explore national and regional trends in teen births in Mexico from 1992-2016, ranking the states with the highest rates in 2016. METHODS: A cross-sectional analysis was conducted and the data on the total number of live births to teenage mothers were analyzed. The age-standardized rates (ASRs) per 1,000 adolescent girls were obtained and the annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated using the Poisson regression models. RESULTS: The national ASRs during the study period dropped from 2.11-1.74 in girls aged 10-14 years and from 86.04-70.82 in adolescents aged 15-19 years. Higher APC rates were documented for teenage girls under 15 years of age (‒0.6, 95% CI:-1.0, -0.3), when compared with older girls (-0.3, 95% CI:-0.6, -0.04). Heterogeneous APCs were observed in the stratified analysis and the overall declines were higher from 2011-2016. States with significantly increasing trends in teen births were also documented. The highest ASRs (per 1,000 girls aged 10-19 years) in 2016 were registered in the states of Coahuila de Zaragoza (49.45), Chiapas (46.24), and Guerrero (44.94). CONCLUSIONS: Teen birth rates decreased over the period of time analyzed. However, that decline has not been monotonic or homogeneous across Mexico, and recent (2011-2016) increasing rates were observed in some states in girls aged 14 years and younger. Teenage parenthood can negatively affect multiple dimensions of health, and therefore, regionally directed efforts focusing on its reduction must be strengthened.

Development of a concise clinical index for predicting chronic chikungunya arthritis.

OBJECTIVE: To evaluate the performance of an instrument for predicting chronic chikungunya arthritis (CCA) in adult patients. METHODS: A diagnostic test study was conducted and data from 217 confirmed cases of chikungunya virus (CHIKV) illness were analyzed. Two chronic chikungunya arthralgia scales (3-item CCAS-3 and 4-item CCAS-4) were constructed. RESULTS: Modest performance of the CCAS-3 scale was documented at the two given cut-off points. A CCAS-4 score ≥3 showed high sensitivity and specificity for predicting the persistence of CCA at 12 months after acute disease. CONCLUSIONS: If replicated in other populations, these results could be useful in the medical management of patients with symptomatic CHIKV infection.

Screening for Depressive Mood During Acute Chikungunya Infection in Primary Healthcare Settings.

Background: We aimed to screen for depressive mood experienced during acute chikungunya (CHIKV) infection, and to evaluate the association of several exposures with the risk of depressive symptoms. Methods: A cross-sectional analysis of a multicenter cohort study took place and data from 354 adult individuals with confirmed CHIKV infection were analyzed. Participants were recruited in primary health care settings and the Patient Health Questionnaire-2 (PHQ-2) was used. Prevalence odds ratios (OR) and 95% confidence intervals (CIs) estimated by means of logistic models were used. Results: Depressive mood (PHQ-2 score 3 or higher) was reported by 44.1% of individuals. Subjects with articular effusion (OR = 3.37, 95% CI 1.77⁻8.11), gastrointestinal manifestations (diarrhea, vomiting or abdominal pain, OR = 1.97, 95 CI 1.21⁻3.19), and higher length of severe arthralgia (reference ≤ 14 days: 15⁻30 days, OR = 3.38, 95% CI 1.78⁻6.41; ≥ 30 days, OR = 1.69, 95% CI 0.95⁻3.01) were more likely to self-report depressive mood. Increasing age (≥ 40 years old, OR = 0.55, 95% CI 0.31⁻0.95) and rash (OR = 0.54, 95% CI 0.30⁻0.98) were associated with a decreased risk of depressive mood. Conclusions: Depressive mood seemed to be a frequent event among analyzed individuals, and markers associated with its risk were identified.

Persistent Arthralgia and Related Risks Factors: A Cohort Study at 12 Months from Laboratory-Confirmed Chikungunya Infection.

AIM OF THE STUDY: To assess the cumulative incidence and clinical markers associated with persistent arthralgia (PA) at 12 months from acute chikungunya virus (CHIKV) infection. METHODS: A multicenter retrospective cohort study was conducted in the state of Colima, Mexico, and 217 serologically confirmed cases of CHIKV infection were enrolled. Participants aged 15 years and older were interviewed on 6 months basis from acute illness onset and the main binary outcome was self-reported PA at 12 months. To assess clinical markers associated with PA we used a generalized linear model. The 2-item Patient Health Questionnaire (PHQ-2) was used to screen for depressive symptoms among PA-positive individuals. RESULTS: The cumulative incidence of PA was 31.8%. In the generalized linear model, individuals ≥40 years of age (risk ratio (RR) = 1.68; 95% confidence interval (CI), 1.10-2.55) and those with 8 or more arthralgia sites (RR = 2.91, 95% CI 1.87-4.53) at acute disease had a significantly increased risk of PA at 12 months from CHIKV infection. Self-reported arthralgia (any site) at 3 months post-infection, a sub-chronic clinical marker, was also associated with a significantly increased risk of long-term articular manifestations (RR = 7.06, 95% CI 2.97-16.81). Depressive symptoms (PHQ-2 score ≥3) were reported by 33.3% of PA-positive participants. CONCLUSIONS: Our findings suggest that chronic CHKV-related articular manifestations were a frequent event in the study sample and the impact on functional status was potential. These results may be useful in health care settings in the risk-stratification of PA after CHIKV infection.

Disability-Adjusted Life Years for Cancer in 2010⁻2014: A Regional Approach in Mexico.

The disability-adjusted life years (DALYs) were used to estimate the regional (state of Colima, Mexico) cancer burden in 2010⁻2014. The years of life lost (YLL) were estimated with mortality data and years lived with disability (YLD) using incidence data. The DALYs were calculated as the arithmetic addition of YLL and YLD. Sex and cancer site-specific estimations were made and DALY rates were used to identify the leading causes of disease burden. Data from 2532 deaths were analyzed and, for all malignant tumors combined, 18,712.9 DALYs and 20,243.3 DALYs were estimated in males and females respectively. The overall contribution of YLL in DALY estimates was higher among females (93.7% vs. 87.4%). Age-standardized DALY rates (and 95% confidence intervals, CI) per 100,000 inhabitants were used to rank the leading causes of disease burden and, among males, malignant tumors from the prostate, lower respiratory tract, and colon and rectum accounted the highest rates (45.7, 95% CI 32.7⁻59.3; 37.6, 95% CI 25.7⁻49.9; and 25.9, 95% CI 16.0⁻36.1 DALYs). Breast, cervix uteri, and lower respiratory tract cancer showed the highest burden in females (66.0, 95% CI 50.3⁻82.4; 44.4, 95% CI 31.5⁻57.7; and 20.9, 95% CI 12.0⁻30.0 DALYs). The present study provides an indication of the burden of cancer at the regional level, underscoring the need to expand cancer prevention, screening, and awareness programs, as well as to improve early diagnosis and medical treatment.

Complications associated to percutaneous catheter in preterm and term born children / Complicaciones asociadas al catéter percutáneo en recién nacidos pretérmino y a término

Objective: Identify percutaneous catheter-related complications in preterm and term newborns. Methods: Comparative cross-section. Were included newborns whit percutaneous catheter insertion, blood culture results and distal catheter segment. Were formed two groups: Preterm and term. Results: Were analyzed the data of preterm (n = 50) and term (n = 50) newborn, the gestational age was 30 ± 3 and 40 ± 2 (p = 0.01). The frecuency in preterm and term newborn was respectively, sepsis catheter 36 and 18% (p = 0.02; OR: 2.56; 95% CI: 1.02-7.17), infected catheter 50 and 22% (p = 0.01; OR: 5.92; 95% CI: 1.66-23.12), colonized catheter of 24 and 14% (p = 0.01; OR: 3.58; 95% CI: 1.32-9.90), local infection 14 and 8% (p = 0.03; OR: 1.87; 95% CI: 1.45-8.29), infiltration 18 and 4% (p = 0.02; OR: 5.27; 95% CI: 1.17-59), accidental removal 6 and 22% (p = 0.02; OR: 0.23; 95% CI: 0.05-0.87) and catheter rupture 10 and 28% (p = 0.02; OR: 0.29; 95% CI: 0.08-0.98). Conclusions: We found a higher association of infections and infiltrations by percutaneous catheter in preterm and term prevailed in accidental removal and catheter rupture.

Objetivo: Identificar las complicaciones asociadas al catéter percutáneo en recién nacidos pretérmino y a término. Método: Estudio transversal comparativo. Se incluyeron recién nacidos que tenían insertado un catéter percutáneo, con resultados de cultivo de sangre y segmento distal del catéter. Se formaron dos grupos: pretérmino y a término. Se calcularon la razón de momios (RM) y el intervalo de confianza del 95% (IC 95%). Resultados: Se analizaron datos de 50 recién nacidos por grupo. En los pretérmino y a término se encontró un valor de la media de edad gestacional de 30 ± 3 y 40 ± 2, respectivamente (p = 0.01), y unos porcentajes de sepsis por catéter del 36 y el 18% (p = 0.02; RM: 2.56; IC 95%: 1.02-7.17), de catéter infectado del 50 y el 22% (p = 0.01; RM: 5.92; IC 95%: 1.66-23.12), de catéter colonizado del 24 y el 14% (p = 0.01; RM: 3.58; IC 95%: 1.32-9.90), de infección local del 14 y el 8% (p = 0.03; RM: 1.87; IC 95%: 1.45-8.29), de infiltración del 18 y el 4% (p = 0.02; RM: 5.27; IC 95%: 1.17-59), de retiro accidental del 6 y el 22% (p = 0.02; RM: 0.23; IC 95%: 0.05-0.87) y de rotura del catéter del 10 y el 28% (p = 0.02; RM: 0.29; IC 95%: 0.08-0.98). Conclusiones: Se encontró mayor asociación de infecciones e infiltraciones por catéter percutáneo en los pretérmino, y de retiro accidental y rotura del catéter en los nacidos a término.

[Depression prevalence among end stage renal disease patients in maintenance hemodialysis]. / Prevalencia de depresión entre pacientes con enfermedad terminal en hemodiálisis de mantenimiento.

BACKGROUND: Depression is a common morbidity in end- stage kidney disease (ESKD) patients and impacts negatively on treatment outcomes. This study aimed to assess the prevalence of depression among Mexican ESKD patients in maintenance hemodialysis (MHD) and to evaluate the relationship with elapsed time (< 1 year or ≥ 1 year) since the beginning of therapy. METHODS: A cross-sectional study took place in a urban hospital from the Mexican Institute of Social Security and 81 subjects aged 30 - 69 years old were enrolled. Beck depression inventory (BDI) was applied and a stratified analysis was made. RESULTS: The overall prevalence of depression (≥ 16 points, BDI) was 42.0 % and 35.6 % and 50.0 % in the group with < 1 and ≥ 1 year on treatment respectively (p = 0.191). CONCLUSIONS: Our findings suggest that depression prevalence is high among adult patients undergoing MHD and it seems to be independent from elapsed time since the beginning of therapy.

Introducción: la depresión es una morbilidad frecuente en pacientes con enfermedad renal terminal (ERT) e impacta negativamente en los resultados esperados del tratamiento. El objetivo de este estudio fue mediar la prevalencia de depresión entre pacientes mexicanos con ERT en hemodiálisis de mantenimiento (HDM) y evaluar la relación con el tiempo transcurrido (< 1 año o ≥ 1 año) desde el inicio de la terapia. Métodos: se realizó un estudio de tipo transversal en un hospital urbano del Instituto Mexicano del Seguro Social y 81 individuos de 30 ­ 69 años de edad fueron incluidos. El inventario de depresión de Beck (IDB) fue aplicado y se realizó un análisis estratificado. Resultados: la prevalencia general de depresión (≥ 16 puntos, IDB) fue 42.0 % y 35.6 % y 50.0 % en el grupo con < 1 año 0 ≥ 1 año en tratamiento respectivamente (p = 0.191). Conclusiones: nuestros hallazgos sugieren que la prevalencia de depresión es alta entre pacientes adultos en HDM y parece ser independiente del tiempo transcurrido desde el inicio de la terapia.

[Comparison of participative educative strategy versus traditional educative strategy in health personnel]. / Comparación de la estrategia educativa participativa con la tradicional en el desarrollo de aptitud clínica en reanimación neonatal en personal de salud.

OBJECTIVE: To compare the clinical aptitude in neonatal resuscitation with participative educative strategy versus traditional educative strategy in health personnel. MATERIAL AND METHODS: Quasi-experimental study design including physicians and nurses distributed in two groups: (i) participative educative strategies n=156, and (ii) traditional n=158, were imparted in 12 sessions. Evaluation of clinical aptitude evaluated with validated questionnaire. Descriptive and interferential statistical inter- and intragroup. RESULTS: Clinical aptitude median score before/after: participative educative strategy 25.0/36.5 (p=0.000) and traditional 24.5/31.0 (p=0.000); differences between intergroup p=0.040. Changes to higher category according to the score before/after in participative 114 (73%) vs. traditional 65 (41%); p=0.010. There were no significant differences in the intergroup results in the category of evaluation of clinical aptitude, but there were differences in the intragroup when we evaluated median before and after with both strategies. CONCLUSIONS: Increase of clinical aptitude in neonatal resuscitation in health personnel,with both educative strategies being higher with participative strategy.

[Clinical risk index for babies II (CRIB II) and weight to predict mortality in preterm infants less than 32 weeks treated with surfactant]. / Índice de riesgo clínico para bebés II (CRIB II) y peso para predecir mortalidad en recién nacidos pretérmino menores de 32 semanas tratados con surfactante.

OBJECTIVE: To determine the usefulness of the Clinical Risk Index for Babies II (CRIB II) and weight to predict mortality in preterm infants < 32 weeks treated with exogenous surfactant. MATERIAL AND METHODS: Design: cohort for diagnostic test. Preterm babies < 32 weeks who received exogenous surfactant in a third level of care were included. The cutoff for CRIB II was evaluated and considered as score > 10 and weight < 750 grams; monitoring was performed until discharge or death. RESULTS: RNP data analyzed 105 babies; 55/105 (52%) were female, the mean value ± 1.4 weight 2 grams and 29 + 2 weeks gestational age. Mortality was found in 16/105, of which 15/16 had a score > 10 on the CRIB II index. Survival was found in 89/105 and index > 10 points in 2/89. Based on these results we found: sensitivity 93%, specificity 98%, positive predictive value 88 "/o, negative predictive value 98"/o . With weight < 750 grams, mortality occurred in 10/16 and survival in 17189; sensitivity 62 "/o, specificity 81 "/o, positive predictive value 37%, and negative predictive value 92%. CONCLUSIONS: The CRIB II index is more useful than weight for predicting mortality in preterm infants less than 32 weeks treated with surfactant.

[Comparison of perinatal clinical profiles in newborns of adolescent and non-adolescent mothers]. / Comparación del perfil clínico perinatal de recién nacidos de madres adolescentes y no adolescentes.

Objective. To compare the clinical profiles in newborns of adolescent and non-adolescent mothers. Materials and Methods. Comparative cross-sectional study. Newborns selected by cluster sampling registered in the hospital. Two groups were formed according to the mother's age: adolescent and non-adolescent. The clinical profile was evaluated with: weight, length, Apgar score, gestational age, and presence of neonatal pathology. For the comparison between proportions, we used chi-squared test and student´s t-test between the mean. Results. Of the 2,155 clinical profiles of newborns analyzed, 819 (38%) were newborns of adolescent mothers and 1,336 (62%) of non-adolescent mothers. Differences between birth weight groups 2,859 ± 459 vs. 3,265 ± 486 grams (p = 0.000), male gender 518 (63%) vs. 725 (54%) female (p = 0.000); intrauterine growth restriction in full-term newborns 62 (7.5%) vs. 66 (4.9%) (p = 0.012); prematurity 171 (21%) vs. 213 (16%) (p = 0.003). Factors that favor the alteration of clinical profiles in newborns: adolescent mother OR: 1.58 (1.99-2.99), male gender OR: 1.80 (1.50-2.17), neonatal pathology OR: 3.73 (2.50-5.30), association of low birth weight in newborns of adolescent mothers OR: 2.4 (1.72-3.42). Conclusion. We found a high frequency of observing in newborns of adolescent mothers greater risk of prematurity, intrauterine growth restriction, and neonatal pathology. No differences were seen in length and Apgar score.

[Parental aptitude to prevent child sexual abuse after a participatory education intervention]. / Aptitud de padres para prevenir abuso sexual en menores después de una intervención educativa participativa.

OBJECTIVE: To evaluate the aptitude of parents regarding the educational impact of equity education for children to prevent child sexual abuse using participatory strategies. MATERIAL AND METHODS: Quasi-experimental design. Ninety-two parents with children in preschool were included in the study. The parents were given a course using participatory educational strategies for one hour daily over a period of 20 days. Prior to the course, a group of experts in child education and sexology prepared a questionnaire with 20 sentences. A Wilcoxon test was used to compare intergroup differences RESULTS: We found statistically significant differences in the parents' responses before and after the educational intervention, with a median (range) of 10(2-12)/18(6-20), p<0.01. CONCLUSIONS: A significant change in aptitude was noted when parents attended classes using a participatory strategy to learn about the impact of educational equity for the prevention of child sexual abuse. Thus, it is imperative to continue evaluating different educational strategies.

Aptitud de padres para prevenir abuso sexual en menores después de una intervención educativa participativa / Parental aptitude to prevent child sexual abuse after a participatory education intervention

OBJETIVO: Evaluar la aptitud en los padres sobre el impacto de educar con equidad a los menores, para prevenir abuso sexual infantil con una estrategia educativa participativa. MATERIAL Y MÉTODOS: Diseño cuasiexperimental. Se incluyó a 92 padres con hijos menores en preescolar que recibieron una intervención educativa con estrategia promotora participativa por una hora durante 20 días. Para evaluar el cambio de aptitud se construyó previamente un cuestionario estructurado con 20 enunciados, que fue validado por expertos en educación y sexología infantil. Para comparar la diferencia intragrupos se utilizó Wilcoxon. RESULTADOS: Se encontraron diferencias estadísticamente significativas en las respuestas de los padres antes/después de la intervención educativa con un valor en la mediana (rango) 10(2-12)/18(6-20), p<0.01. CONCLUSIÓN: Después de la intervención educativa participativa, se encontró un cambio de aptitud en los padres al adquirir un mayor aprendizaje sobre el impacto de educar con equidad a los menores para prevenir abuso. Es necesario continuar evaluando diferentes estrategias educativas.

OBJECTIVE: To evaluate the aptitude of parents regarding the educational impact of equity education for children to prevent child sexual abuse using participatory strategies. MATERIAL AND METHODS: Quasi-experimental design. Ninety-two parents with children in preschool were included in the study. The parents were given a course using participatory educational strategies for one hour daily over a period of 20 days. Prior to the course, a group of experts in child education and sexology prepared a questionnaire with 20 sentences. A Wilcoxon test was used to compare intergroup differences RESULTS: We found statistically significant differences in the parents' responses before and after the educational intervention, with a median (range) of 10(2-12)/18(6-20), p<0.01. CONCLUSIONS: A significant change in aptitude was noted when parents attended classes using a participatory strategy to learn about the impact of educational equity for the prevention of child sexual abuse. Thus, it is imperative to continue evaluating different educational strategies.

[Assessment of prenatal, perinatal, and postnatal factors for intraventricular hemorrage in premature newborns less than 33 weeks of gestational age]. / Evaluación de factores prenatales, perinatales y posnatales para hemorragia intraventricular en prematuros menores de 33 semanas de edad gestacional.

OBJECTIVE: Evaluation of risk factors for intraventricular hemorrhage in preterm less than 33 weeks gestational age (RNP). METHODS: CASE-control study. We included RNP from a tertiary care center classified by the results of transfontanellar sonography. CASE: presence of intraventricular hemorrhage. CONTROL: absence of intraventricular hemorrhage. We investigated prenatal history perinatal and postnatal. Logistic regression was used to adjust the variables associated with intraventricular hemorrhage; we calculated odds ratios (OR) with confidence intervals of 95% (95% CI). RESULTS: We analyzed the medical records of RNP 64; of these 32 were cases. The risk factors associated with intraventricular hemorrhage were: sepsis (OR: 18.45; 95% CI: 4.01-32.82; p = 0.01), respiratory distress syndrome (OR: 2.24; 95% CI: 1.07-4.95; p = 0.04), use with mechanical ventilation (OR: 3.60; 95% CI: 1.46-8.91; p = 0.01), and exogenous surfactant (OR: 2.32; 95% CI: 1.05-6.14; p = 0.03). CONCLUSIONS: The postnatal factors were associated with higher risk for intraventricular hemorrhage in RNR The transfontanellar sonography should be taken at different times to know with precision the risk factors for this pathology and try to avoid them.