Assessing the relationship between multimorbidity, NCD configurations, frailty phenotypes, and mortality risk in older adults.

BACKGROUND: Older adults are increasingly susceptible to prolonged illness, multiple chronic diseases, and disabilities, which can lead to the coexistence of multimorbidity and frailty. Multimorbidity may result in various noncommunicable disease (NCD) patterns or configurations that could be associated with frailty and death. Mortality risk may vary depending on the presence of specific chronic diseases configurations or frailty. METHODS: The aim was to examine the impact of NCD configurations on mortality risk among older adults with distinct frailty phenotypes. The population was analyzed from the Costa Rican Longevity and Healthy Aging Study Cohort (CRELES). A total of 2,662 adults aged 60 or older were included and followed for 5 years. Exploratory factor analysis and various clustering techniques were utilized to identify NCD configurations. The frequency of NCD accumulation was also assessed for a multimorbidity definition. Frailty phenotypes were set according to Fried et al. criteria. Kaplan‒Meier survival analyses, mortality rates, and Cox proportional hazards models were estimated. RESULTS: Four different types of patterns were identified: 'Neuro-psychiatric', 'Metabolic', 'Cardiovascular', and 'Mixt' configurations. These configurations showed a higher mortality risk than the mere accumulation of NCDs [Cardiovascular HR:1.65 (1.07-2.57); 'Mixt' HR:1.49 (1.00-2.22); ≥3 NCDs HR:1.31 (1.09-1.58)]. Frailty exhibited a high and constant mortality risk, irrespective of the presence of any NCD configuration or multimorbidity definition. However, HRs decreased and lost statistical significance when phenotypes were considered in the Cox models [frailty + 'Cardiovascular' HR:1.56 (1.00-2.42); frailty + 'Mixt':1.42 (0.95-2.11); and frailty + ≥ 3 NCDs HR:1.23 (1.02-1.49)]. CONCLUSIONS: Frailty accompanying multimorbidity emerges as a more crucial indicator of mortality risk than multimorbidity alone. Therefore, studying NCD configurations is worthwhile as they may offer improved risk profiles for mortality as alternatives to straightforward counts.

Trends and effect of marginalization on diabetes mellitus-related mortality in Mexico from 1990 to 2019.

Diabetes mellitus (DM) is currently one of the leading causes of mortality worldwide. However, the disease evolves differently across countries. This study intends to characterize the trends and assess the potential effects of marginalization on DM mortality between 1990 and 2019 in Mexico. We analyzed death certificates that listed DM as the underlying cause of death (N = 1,907,173), as well as the extent to which DM mortality changes were associated with marginalization through an age-period-cohort analysis. DM mortality increased in Mexico between 1990 and 2019; the change was faster in the first half and slowed down after 2004. The highest marginalization quintiles drove the changes in DM mortality trends during the study period, with a higher risk of dying in these quintiles as age increased. In recent cohorts, the highest marginalization quintiles doubled the risk of dying from DM as compared to the lowest. Renal complications was the main death driver among persons with DM, with a marked increase between 1999 and 2001. In conclusion, Mexico continues to have a substantially high DM mortality, but its pace slowed over time. Moreover, subnational differences in marginalization can partially explain such a trend.

The utility of the Edmonton Obesity Staging System for the prediction of COVID-19 outcomes: a multi-centre study.

BACKGROUND: Patients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes. METHODS: 1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category. RESULTS: The risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02-1.97 and 2.78, 95% CI 1.83-4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06-2.74, and 2.62, 95% CI 1.65-4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42-0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03-2.42). In patients with a BMI ≥ 25 kg/m2, the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50-3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight. CONCLUSIONS: EOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.

Fibroblast growth factor 21 is associated with increased serum total antioxidant capacity and oxidized lipoproteins in humans with different stages of chronic kidney disease.

Background and aims: Oxidative stress (OS) induces the production of fibroblast growth factor 21 (FGF21). Previous data have revealed that FGF21 protects cells from OS injury and death, making it a potential therapeutic option for many diseases with increased OS. However, the association of this growth factor with OS markers in humans with chronic kidney disease (CKD) remains unknown. This study aims to evaluate the association of serum FGF21 with serum total antioxidant capacity (TAC) and oxidized low-density lipoproteins (OxLDL) in subjects in different stages of kidney disease. Methods: This is a cross-sectional study that included 382 subjects with different stages of CKD, irrespective of type 2 diabetes (T2D) diagnosis. Associations of serum FGF21 with OxLDL, TAC, sex, age, body mass index (BMI), fasting plasma glucose, estimated glomerular filtration rate (eGFR), T2D, and smoking, were evaluated through bivariate and partial correlation analyses. Independent associations of these variables with serum FGF21 were evaluated using multiple linear regression analysis. Results: Serum FGF21 was significantly and positively correlated with age (r = 0.236), TAC (lnTAC) (r = 0.217), and negatively correlated with eGFR (r = -0.429) and male sex (r = -0.102). After controlling by age, sex, BMI, T2D, smoking, and eGFR; both TAC and OxLDL were positively correlated with FGF21 (r = 0.117 and 0.158 respectively, p < 0.05). Using multiple linear regression analysis, eGFR, male sex, T2D, OxLDL, and TAC were independently associated with serum FGF21 (STDß = -0.475, 0.162, -0.153, 0.142 and 0.136 respectively; p < 0.05 for all) adjusted for age, BMI, smoking, and fasting plasma glucose. Conclusion: A positive association between serum FGF21 and OS has been found independently of renal function in humans. Results from the present study provide novel information for deeper understanding of the role of FGF21 in OS in humans with CKD and T2D; mechanistic studies to explain the association of serum FGF21 with oxidative stress in CKD are needed.

Desigualdad social en México en el uso de servicios de tamizaje en adultos: un análisis de las encuestas nacionales de salud 2006 y 2012 / Social inequality in the use of screening tests in Mexico: an analysis of the national health surveys 2006 and 2012

Resumen Objetivo: Medir la desigualdad en el uso de servicios de tamizaje en adultos de 20 a 59 años, a partir de las encuestas nacionales de salud y nutrición 2006 y 2012. Material y métodos: A partir de la selección de cinco indicadores de tamizaje en adultos (detección de diabetes, hipertensión y cánceres de mama, cérvicouterino y de próstata) se estimaron el índice de Kuznets, el índice de desigualdad de la pendiente y el índice de concentración de salud, considerando como indicadores sociales la escolaridad, etnicidad, desempleo, nivel socioeconómico y tipo de protección en salud. Resultados: Las coberturas de las cinco pruebas se incrementaron, sin embargo, la desigualdad observada disminuyó únicamente en las intervenciones en mujeres; en el caso de la detección de cáncer de próstata se incrementó. Conclusión: Si bien es importante monitorear el desempeño de los servicios curativos, persiste el reto de asegurar el acceso efectivo y equitativo a servicios de diagnóstico temprano.

Abstract Objective: To measure health inequality in the use of screening services in adults from 20 to 59 years of age from the 2006 and 2012 national health and nutrition surveys. Materials and methods: Considering the selection of five indicators of screening in adults (detection of diabetes, hypertension, breast cancer, cervical cancer and prostate cancer), the Kuznets index, the slope inequality index and the health concentration index were estimated. Considering as social indicators schooling, ethnicity, unemployment, socioeconomic level and type of health protection. Results: The coverage of the five tests increased, but the inequality observed only decreased in the interventions in women; and in the case of the detection of prostate cancer it was increased. Conclusions: While it is important to monitor the performance of curative services, the challenge remains to ensure effective and equitable access to early diagnosis services.

[Social inequality in the use of screening tests in Mexico: an analysis of the national health surveys 2006 and 2012]. / Desigualdad social en México enel uso de servicios de tamizaje en adultos: un análisis de las encuestas nacionales de salud 2006 y 2012.

OBJECTIVE: To measure health inequality in the use of screen-ing services in adults from 20 to 59 years of age from the 2006 and 2012 national health and nutrition surveys. MATERIALS AND METHODS: dults (detection of diabetes, hypertension, breast cancer, cervical cancer and prostate cancer), the Kuznets index, the slope inequality index and the health concentration index were estimated. Considering as social indicators schooling, ethnicity, unemployment, socioeconomic level and type of health protection. RESULTS: The coverage of the five tests increased, but the inequality observed only decreased in the interventions in women; and in the case of the detection of prostate cancer it was increased. CONCLUSIONS: While it is important to monitor the performance of curative services, the challenge remains to ensure effective and equitable access to early diagnosis services.

OBJETIVO: Medir la desigualdad en el uso de servicios de tamizaje en adultos de 20 a 59 años, a partir de las encuestas nacionales de salud y nutrición 2006 y 2012. MATERIAL Y MÉTODOS: A partir de la selección de cinco indicadores de tamizaje en adultos (detección de diabetes, hipertensión y cánceres de mama, cérvicouterino y de próstata) se estimaron el índice de Kuznets, el índice de desigualdad de la pendiente y el índice de concentración de salud, considerando como indicadores sociales la escolaridad, etnicidad, desempleo, nivel socioeconómico y tipo de protección en salud. RESULTADOS: Las coberturas de las cinco pruebas se incrementaron, sin embargo, la desigualdad observada disminuyó únicamente en las intervenciones en mujeres; en el caso de la detección de cáncer de próstata se incrementó. CONCLUSIONES: Si bien es importante monitorear el desempeño de los servicios curativos, persiste el reto de asegurar el acceso efectivo y equitativo a servicios de diagnóstico temprano.

Seroprevalence of HPV serotypes 6, 11, 16 and 18 in unvaccinated children from Mexico City.

Data regarding humoral immunity against HPV infection are scarce. Most analyses focus on the identification of viruses on mucous membranes and primarily refer to women of reproductive age. The aim of this work was to estimate the seroprevalence of antibodies against HPV serotypes 6, 11, 16 and 18 among unvaccinated boys living in Mexico City. A cross-sectional study of 257 male students from 48 public primary schools in Mexico City, whose ages fluctuated between 9 and 14 years, was carried out. Immunological status was assessed by applying the competitive Luminex Immunoassay of HPV (cLIA). Among the study population, we initially found that 38.52% (n = 99) of the children tested positive against one or more of the HPV 6, 11, 16 and/or 18 serotypes. The most commonly found serotype was isolated HPV 18 or in combination with other serotypes (22% and 31%, respectively), followed by HPV 6 with frequencies of 4.7% and 11%, respectively; however, lower frequencies were estimated for HPV 16 (2%; 6%) and isolated HPV 11, 4%. If a second set of cut-off points for seropositivity is applied, the overall prevalence for any serotype is reduced to 15.2%. As it appears that a significant sector of the study population has had basal contact with an HPV serotype, we recommend considering the possibility of vaccination against HPV at earlier ages.

An anthropometry-based equation of fat mass percentage as a valid discriminator of obesity.

OBJECTIVE: To develop a new predictive equation for fat mass percentage (%FM) based on anthropometric measurements and to assess its ability to discriminate between obese and non-obese individuals. DESIGN: Cross-sectional study. SETTING: Mexican adults.ParticipantsAdults (n 275; 181 women) aged 20-63 years with BMI between 17·4 and 42·4 kg/m2. RESULTS: Thirty-seven per cent of our sample was obese using %FM measured by air-displacement plethysmography (BOD POD®; Life Measurement Instruments). The fat mass was computed from the difference between weight and fat-free mass (FFM). FFM was estimated using an equation obtained previously in the study from weight, height and sex of the individuals. The %FM estimated from the obtained FFM showed a sensitivity of 90·3 (95 % CI 86·8, 93·8) % and a specificity of 58·0 (95 % CI 52·1, 63·8) % in the diagnosis of obesity. Ninety-three per cent of participants with obesity and 65 % of participants without obesity were correctly classified. CONCLUSIONS: The anthropometry-based equation obtained in the present study could be used as a screening tool in clinical and epidemiological studies not only to estimate the %FM, but also to discriminate the obese condition in populations with similar characteristics to the participant sample.

Economic impact of dengue in Mexico considering reported cases for 2012 to 2016.

BACKGROUND: Given that dengue disease is growing and may progress to dengue hemorrhagic fever (DHF), data on economic cost and disease burden are important. However, data for Mexico are limited. METHODOLOGY/PRINCIPAL FINDINGS: Burden of dengue fever (DF) and DHF in Mexico was assessed using official databases for epidemiological information, disabilities weights from Shepard et al, the reported number of cases and deaths, and costs. Overall costs of dengue were summed from direct medical costs to the health system, cost of dengue to the patient (out-of-pocket expenses [medical and non-medical], indirect costs [loss of earnings, patient and/or caregiver]), and other government expenditures on prevention/surveillance. The first three components, calculated as costs per case by a micro-costing approach (PAATI; program, actions, activities, tasks, inputs), were scaled up to overall cost using epidemiology data from official databases. PAATI was used to calculate cost of vector control and prevention, education, and epidemiological surveillance, based on an expert consensus and normative construction of an ideal scenario. Disability-adjusted life years (DALYs) for Mexico in 2016 were calculated to be 2283.46 (1.87 per 100,000 inhabitants). Overall economic impact of dengue in Mexico for 2012 was US$144 million, of which US$44 million corresponded to direct medical costs and US$5 million to the costs from the patient's perspective. The estimated cost of prevention/surveillance was calculated with information provided by federal government to be US$95 million. The overall economic impact of DF and DHF showed an increase in 2013 to US$161 million and a decrease to US$133, US$131 and US$130 million in 2014, 2015 and 2016, respectively. CONCLUSIONS/SIGNIFICANCE: The medical and economic impact of dengue were in agreement with other international studies, and highlight the need to include governmental expenditure for prevention/surveillance in overall cost analyses given the high economic impact of these, increasing the necessity to evaluate its effectiveness.

Seroprevalence of dengue in school children in Mexico ages 6-17 years, 2016.

Background: Dengue is the most important arboviral disease in the world. Seroprevalence has been proposed as a marker of endemicity, however, studies are scarce. Methods: We conducted a cross-sectional, stratified cluster, random sample study to measure the seroprevalence of antibodies to dengue virus (DENV) in Mexico. The target population was school children ages 6-17 y from 22 endemic states in Mexico, clustered in four regions: Pacific, South-Central, Southeast and Low. Results: A total of 2134 subjects provided blood samples for immunoglobulin G antibody detection in serum by enzyme-linked immunosorbent assay. Overall, the seroprevalence of antibodies against DENV was 33.5% (95% confidence interval [CI] 27.5 to 40.1). The Southeast had the highest regional seroprevalence, reaching 70.9% (95% CI 60.3 to 79.7). Seroprevalence was higher in older children in the Southeast region: 62.1% (95% CI 46.9 to 75.2) in children 6-8 y and 82.6% (95% CI 73.8 to 88.9) in 13-17 years old (y). However, this was not consistent in all regions. Seroprevalence was associated with dengue incidence. Conclusions: DENV seroprevalence in Mexico was found to be heterogeneous at the country, regional and state levels. Seroprevalence was linked to long-term exposure and did not adequately reflect recent patterns of transmission, suggesting that utilization of a single epidemiological indicator to define endemic regions should be avoided.

Stature in adults as an indicator of socioeconomic inequalities in Mexico

[ABSTRACT]. Objective. To estimate the association between stature in Mexican adults and some sociodemographic factors. Methods. We studied a sample of 30 970 subjects, using anthropometric data from the 2012 National Health and Nutrition Survey (ENSANUT 2012). The first quartile was used as the cutoff to define short stature. We analyzed differences among stature strata for sociodemographic variables by using the Kruskal-Wallis test. We estimated odds ratios to measure the association between stature and sociodemographic variables, controlling for potential confounders. Results. Persons from the southern region of the country were some three times as likely to be of short stature than were subjects in the northern region. The stature difference between the Mexican states with the highest and the lowest average stature was larger than the average difference in stature between Mexico and the United States of America. Adults who had had less than six years of schooling presented the highest prevalence of short stature, regardless of sex, region of the country, place of residence (rural or urban), or the proportion of indigenous language speakers in a state. In addition, the stratum with the highest marginalization (percentage of the population lacking education and services, with a low income, and living in a small community) showed the highest prevalence of short stature. Conclusion. In Mexico, adults who are of short stature have unequal living conditions when compared to those of average or high stature, and this could drive increases in health inequity.

[RESUMEN]. Objetivo. Establecer la asociación entre la estatura de los mexicanos adultos y algunos factores sociodemográficos. Métodos. Sobre la base de datos antropométricos de la Encuesta Nacional de Salud y Nutrición de 2012 (ENSANUT 2012), estudiamos una muestra de 30 970 sujetos. Para definir la estatura baja, el umbral se estableció en el primer cuartil. Analizamos las diferencias entre los distintos estratos de estatura en relación con variables sociodemográficas utilizando la prueba de Kruskal-Wallis. Calculamos las razones de posibilidades para medir la asociación entre la estatura y las variables sociodemográficas, con control de posibles factores de confusión. Resultados. Las personas de la zona meridional del país tenían alrededor de tres veces más probabilidades de ser de estatura baja que las personas de la zona septentrional. La diferencia entre los estados mexicanos con la estatura promedio más alta y la estatura promedio más baja fue mayor que la diferencia promedio respecto de la estatura entre México y los Estados Unidos de América. La prevalencia más alta de estatura baja se registró en los adultos con menos de seis años de escolaridad, independientemente del sexo, la zona del país, el lugar de residencia (rural o urbano) y la proporción de hablantes de lenguas indígenas en un estado. Además, la prevalencia más alta de estatura baja se observó en el estrato de población más marginada (porcentaje de habitantes sin escolaridad ni servicios, con ingresos bajos y que vivían una comunidad pequeña). Conclusiones. En México, las condiciones de vida de los adultos de estatura baja son más desfavorables que las de los adultos de estatura media o alta, y esto podría contribuir a aumentar la inequidad en materia de salud.

[RESUMO]. Objetivo. Estimar a associação entre a estatura em adultos mexicanos e fatores sociodemográficos. Métodos. Foi estudada uma amostra de 30.970 indivíduos com base em dados antropométricos obtidos da Pesquisa Nacional sobre Saúde e Nutrição de 2012 (ENSANUT 2012). O primeiro quartil foi usado como valor de corte para definir baixa estatura. Foram analisadas as diferenças entre os estratos de estatura para as variáveis sociodemográficas com o uso do teste de Kruskal- Wallis. Foram estimados os odds ratios para medir a associação entre a estatura e as variáveis sociodemográficas, controlando-se os potenciais fatores de confusão. Resultados. Os indivíduos da região sul do país apresentaram uma chance quase três vezes maior de ter baixa estatura em comparação aos indivíduos da região norte. A diferença de estatura entre os estados mexicanos com a estatura média maior e a estatura média menor foi maior que a diferença média em estatura entre o México e os Estados Unidos. Os adultos com menos de seis anos de escolaridade apresentaram a prevalência mais elevada de baixa estatura, independentemente do sexo, região do país, zona de residência (rural ou urbana) ou proporção de falantes de línguas indígenas em um estado. Além disso, o estrato com maior marginação (porcentagem de habitantes com carência de educação e serviços, de baixa renda e vivendo em uma pequena comunidade) apresentou a prevalência mais elevada de baixa estatura. Conclusão. No México, os adultos com baixa estatura têm condições de vida desiguais comparados aos adultos com estatura média ou alta, contribuindo para maior iniquidade em saúde.

Stature in adults as an indicator of socioeconomic inequalities in Mexico.

OBJECTIVE: To estimate the association between stature in Mexican adults and some sociodemographic factors. METHODS: We studied a sample of 30 970 subjects, using anthropometric data from the 2012 National Health and Nutrition Survey (ENSANUT 2012). The first quartile was used as the cutoff to define short stature. We analyzed differences among stature strata for sociodemographic variables by using the Kruskal-Wallis test. We estimated odds ratios to measure the association between stature and sociodemographic variables, controlling for potential confounders. RESULTS: Persons from the southern region of the country were some three times as likely to be of short stature than were subjects in the northern region. The stature difference between the Mexican states with the highest and the lowest average stature was larger than the average difference in stature between Mexico and the United States of America. Adults who had had less than six years of schooling presented the highest prevalence of short stature, regardless of sex, region of the country, place of residence (rural or urban), or the proportion of indigenous language speakers in a state. In addition, the stratum with the highest marginalization (percentage of the population lacking education and services, with a low income, and living in a small community) showed the highest prevalence of short stature. CONCLUSION: In Mexico, adults who are of short stature have unequal living conditions when compared to those of average or high stature, and this could drive increases in health inequity.

Terremotos y salud en México: atención de la emergencia en el Istmo de Tehuantepec / Earthquakes and health in Mexico: emergency care in the Isthmus of Tehuantepec

Resumen El día 7 de septiembre del 2017 se registró un sismo de intensidad 8.2 grados en la escala de Richter, con mayor afectación en la región del Istmo de Tehuantepec. El mecanismo de respuesta por parte del sector salud fue implementado de manera inmediata a través del Operativo para la Seguridad en Salud. Las acciones prioritarias estuvieron enfocadas en el restablecimiento de la capacidad local de atención médica, en la identificación de enfermedades prevalentes y en llevar a cabo acciones de salud pública. Sin embargo, pese a las experiencias obtenidas en 1985, aún se vislumbra escasez de planeación y asignación de responsabilidades.

Abstract On September 7, 2017, an earthquake measuring 8.2 on the Richter scale recorded, with the greatest impact in the Isthmus of Tehuantepec region. The response mechanism by the health sector implemented immediately through the Health Security Operative. The priority actions were focused on restoring the local capacity of medical attention, in the identification of prevalent diseases, and in carrying out public health actions. However, despite the experiences obtained in 1985, there is still a glimpse of a shortage of planning and assignment of responsibilities.

Stature in adults as an indicator of socioeconomic inequalities in Mexico / La estatura de los adultos como indicador de las desigualdades socioeconómicas en México / Estatura em adultos como indicador das desigualdades socioeconômicas no México

ABSTRACT Objective To estimate the association between stature in Mexican adults and some sociodemographic factors. Methods We studied a sample of 30 970 subjects, using anthropometric data from the 2012 National Health and Nutrition Survey (ENSANUT 2012). The first quartile was used as the cutoff to define short stature. We analyzed differences among stature strata for sociodemographic variables by using the Kruskal-Wallis test. We estimated odds ratios to measure the association between stature and sociodemographic variables, controlling for potential confounders. Results Persons from the southern region of the country were some three times as likely to be of short stature than were subjects in the northern region. The stature difference between the Mexican states with the highest and the lowest average stature was larger than the average difference in stature between Mexico and the United States of America. Adults who had had less than six years of schooling presented the highest prevalence of short stature, regardless of sex, region of the country, place of residence (rural or urban), or the proportion of indigenous language speakers in a state. In addition, the stratum with the highest marginalization (percentage of the population lacking education and services, with a low income, and living in a small community) showed the highest prevalence of short stature. Conclusion In Mexico, adults who are of short stature have unequal living conditions when compared to those of average or high stature, and this could drive increases in health inequity.

RESUMEN Objetivo Establecer la asociación entre la estatura de los mexicanos adultos y algunos factores sociodemográficos. Métodos Sobre la base de datos antropométricos de la Encuesta Nacional de Salud y Nutrición de 2012 (ENSANUT 2012), estudiamos una muestra de 30 970 sujetos. Para definir la estatura baja, el umbral se estableció en el primer cuartil. Analizamos las diferencias entre los distintos estratos de estatura en relación con variables sociodemográficas utilizando la prueba de Kruskal-Wallis. Calculamos las razones de posibilidades para medir la asociación entre la estatura y las variables sociodemográficas, con control de posibles factores de confusión. Resultados Las personas de la zona meridional del país tenían alrededor de tres veces más probabilidades de ser de estatura baja que las personas de la zona septentrional. La diferencia entre los estados mexicanos con la estatura promedio más alta y la estatura promedio más baja fue mayor que la diferencia promedio respecto de la estatura entre México y los Estados Unidos de América. La prevalencia más alta de estatura baja se registró en los adultos con menos de seis años de escolaridad, independientemente del sexo, la zona del país, el lugar de residencia (rural o urbano) y la proporción de hablantes de lenguas indígenas en un estado. Además, la prevalencia más alta de estatura baja se observó en el estrato de población más marginada (porcentaje de habitantes sin escolaridad ni servicios, con ingresos bajos y que vivían una comunidad pequeña). Conclusiones En México, las condiciones de vida de los adultos de estatura baja son más desfavorables que las de los adultos de estatura media o alta, y esto podría contribuir a aumentar la inequidad en materia de salud.

RESUMO Objetivo Estimar a associação entre a estatura em adultos mexicanos e fatores sociodemográficos. Métodos Foi estudada uma amostra de 30.970 indivíduos com base em dados antropométricos obtidos da Pesquisa Nacional sobre Saúde e Nutrição de 2012 (ENSANUT 2012). O primeiro quartil foi usado como valor de corte para definir baixa estatura. Foram analisadas as diferenças entre os estratos de estatura para as variáveis sociodemográficas com o uso do teste de Kruskal- Wallis. Foram estimados os odds ratios para medir a associação entre a estatura e as variáveis sociodemográficas, controlando-se os potenciais fatores de confusão. Resultados Os indivíduos da região sul do país apresentaram uma chance quase três vezes maior de ter baixa estatura em comparação aos indivíduos da região norte. A diferença de estatura entre os estados mexicanos com a estatura média maior e a estatura média menor foi maior que a diferença média em estatura entre o México e os Estados Unidos. Os adultos com menos de seis anos de escolaridade apresentaram a prevalência mais elevada de baixa estatura, independentemente do sexo, região do país, zona de residência (rural ou urbana) ou proporção de falantes de línguas indígenas em um estado. Além disso, o estrato com maior marginação (porcentagem de habitantes com carência de educação e serviços, de baixa renda e vivendo em uma pequena comunidade) apresentou a prevalência mais elevada de baixa estatura. Conclusão No México, os adultos com baixa estatura têm condições de vida desiguais comparados aos adultos com estatura média ou alta, contribuindo para maior iniquidade em saúde.

Empoderamiento y apoyo social en pacientes con enfermedad renal crónica: estudio de caso en Michoacán, México / Empowerment and social support for patients with chronic kidney disease: case study in Michoacán, Mexico / Empoderamento e apoio social de pacientes com nefropatia crônica: estudo de caso em Michoacán, México

[RESUMEN]. Objetivo. Identificar el nivel de empoderamiento y las características del apoyo social de los individuos con enfermedad renal crónica (ERC). Métodos. Estudio transversal en personas con enfermedad renal crónica que habitan en el municipio de Hidalgo, Michoacán, México, y que asisten a la Asociación de Enfermos del Riñón, Asociación Civil (A.C.). Se indagó sobre el perfil sociodemográfico y las características personales asociadas a la enfermedad, el nivel de empoderamiento, el nivel de apoyo social y el funcionamiento familiar. Resultados. Cerca de 90% de la muestra cuenta con apoyo social suficiente, mientras que 40% de los participantes pertenece a familias semirrelacionadas o relacionadas. El puntaje de empoderamiento global fue de 117,5 ± 14,3; el empoderamiento comunitario fue más alto en el grupo de mayor edad (P < 0,05). La interacción social positiva es el componente del apoyo social que correlaciona con mayor fuerza con el nivel de empoderamiento (r = 0,333; P < 0,01). Conclusiones. El empoderamiento está determinado por, y es un determinante del apoyo social y ha facilitado el acceso a la terapia de reemplazo renal en esta comunidad.

[ABSTRACT]. Objective. Identify the degree of empowerment and the characteristics of the social support for individuals with chronic kidney disease (CKD). Methods. Cross-sectional study of people with chronic kidney disease living in the municipality of Hidalgo, Michoacán, Mexico, who belong to the Association of Kidney Patients, Civil Association. The study examined the sociodemographic profile and personal characteristics associated with the disease, the degree of empowerment, the degree of social support, and family functioning. Results. Close to 90% of the sample receives sufficient social support, while 40% of the participants belong to semi-cohesive or cohesive families The overall empowerment score was 117.5 ± 14.3; community empowerment was higher in the older group (P < 0.05). Positive social interaction is the social support component most strongly correlated with the degree of empowerment (r = 0.333; P < 0.01). Conclusions. Empowerment is determined by, and is a determinant of, social support and has facilitated access to renal replacement therapy in this community.Objective. Identify the degree of empowerment and the characteristics of the social support for individuals with chronic kidney disease (CKD).

[RESUMO]. Objetivo. Identificar o nível de empoderamento e apoio social de pacientes com nefropatia crônica. Métodos. Estudo transversal realizado com pacientes com nefropatia crônica residentes no município de Fidalgo, Michoacán, México, que participavam de uma associação civil de pacientes renais crônicos (Asociación de Enfermos del Riñón). Foram investigados aspectos pessoais e sociodemográficos dos pacientes associados à doença, nível de empoderamento e apoio social e funcionamento familiar. Resultados. Cerca de 90% da amostra estudada dispõem de uma rede de apoio social satisfatória e 40% pertencem a famílias com boa coesão ou coesão média. A pontuação global de empoderamento foi de 117,5 ± 14,3 e o empoderamento comunitário foi maior no grupo com idade mais avançada (P < 0,05). Interação social positiva é o componente da rede de apoio social com correlação mais forte com o nível de empoderamento (r = 0,333; P < 0,01). Conclusões. O empoderamento é determinado pela rede de apoio social, sendo também um determinante deste apoio, e facilita o acesso à terapia renal substitutiva nesta comunidade.

The emergence and evolution of the research fronts in HIV/AIDS research.

In this paper, we have identified and analyzed the emergence, structure and dynamics of the paradigmatic research fronts that established the fundamentals of the biomedical knowledge on HIV/AIDS. A search of papers with the identifiers "HIV/AIDS", "Human Immunodeficiency Virus", "HIV-1" and "Acquired Immunodeficiency Syndrome" in the Web of Science (Thomson Reuters), was carried out. A citation network of those papers was constructed. Then, a sub-network of the papers with the highest number of inter-citations (with a minimal in-degree of 28) was selected to perform a combination of network clustering and text mining to identify the paradigmatic research fronts and analyze their dynamics. Thirteen research fronts were identified in this sub-network. The biggest and oldest front is related to the clinical knowledge on the disease in the patient. Nine of the fronts are related to the study of specific molecular structures and mechanisms and two of these fronts are related to the development of drugs. The rest of the fronts are related to the study of the disease at the cellular level. Interestingly, the emergence of these fronts occurred in successive "waves" over the time which suggest a transition in the paradigmatic focus. The emergence and evolution of the biomedical fronts in HIV/AIDS research is explained not just by the partition of the problem in elements and interactions leading to increasingly specialized communities, but also by changes in the technological context of this health problem and the dramatic changes in the epidemiological reality of HIV/AIDS that occurred between 1993 and 1995.

Adiposity and Blood Pressure in 110 000 Mexican Adults.

Previous studies have reached differing conclusions about the importance of general versus central markers of adiposity to blood pressure, leading to suggestions that population-specific adiposity thresholds may be needed. We examined the relevance of adiposity to blood pressure among 111 911 men and women who, when recruited into the Mexico City Prospective Study, were aged 35 to 89 years, had no chronic disease, and were not taking antihypertensives. Linear regression was used to estimate the effects on systolic and diastolic blood pressure of 2 markers of general adiposity (body mass index and height-adjusted weight) and 4 markers of central adiposity (waist circumference, hip circumference, waist:hip ratio, and waist:height ratio), adjusted for relevant confounders. Mean (SD) adiposity levels were: body mass index (28.7±4.5 kg/m2), height-adjusted weight (70.2±11.2 kg), waist circumference (93.3±10.6 cm), hip circumference (104.0±9.0 cm), waist:hip ratio (0.90±0.06), and waist:height ratio (0.60±0.07). Associations with blood pressure were linear with no threshold levels below which lower general or central adiposity was not associated with lower blood pressure. On average, each 1 SD higher measured adiposity marker was associated with a 3 mm Hg higher systolic blood pressure and 2 mm Hg higher diastolic blood pressure (SEs <0.1 mm Hg), but for the waist:hip ratio, associations were only approximately half as strong. General adiposity associations were independent of central adiposity, but central adiposity associations were substantially reduced by adjustment for general adiposity. Findings were similar for men and women. In Mexican adults, often overweight or obese, markers of general adiposity were stronger independent predictors of blood pressure than measured markers of central adiposity, with no threshold effects.

Analysis of spatial mobility in subjects from a Dengue endemic urban locality in Morelos State, Mexico.

INTRODUCTION: Mathematical models and field data suggest that human mobility is an important driver for Dengue virus transmission. Nonetheless little is known on this matter due the lack of instruments for precise mobility quantification and study design difficulties. MATERIALS AND METHODS: We carried out a cohort-nested, case-control study with 126 individuals (42 cases, 42 intradomestic controls and 42 population controls) with the goal of describing human mobility patterns of recently Dengue virus-infected subjects, and comparing them with those of non-infected subjects living in an urban endemic locality. Mobility was quantified using a GPS-data logger registering waypoints at 60-second intervals for a minimum of 15 natural days. RESULTS: Although absolute displacement was highly biased towards the intradomestic and peridomestic areas, occasional displacements exceeding a 100-Km radius from the center of the studied locality were recorded for all three study groups and individual displacements were recorded traveling across six states from central Mexico. Additionally, cases had a larger number of visits out of the municipality´s administrative limits when compared to intradomestic controls (cases: 10.4 versus intradomestic controls: 2.9, p = 0.0282). We were able to identify extradomestic places within and out of the locality that were independently visited by apparently non-related infected subjects, consistent with houses, working and leisure places. CONCLUSIONS: Results of this study show that human mobility in a small urban setting exceeded that considered by local health authority's administrative limits, and was different between recently infected and non-infected subjects living in the same household. These observations provide important insights about the role that human mobility may have in Dengue virus transmission and persistence across endemic geographic areas that need to be taken into account when planning preventive and control measures. Finally, these results are a valuable reference when setting the parameters for future mathematical modeling studies.