Number of colony-forming unit-Hill colonies among children and teenagers with obesity, dyslipidemia and breastfeeding history.

BACKGROUND AND AIMS: The number of colony-forming unit (CFU)-Hill colonies has been proposed as a biomarker of vascular function and cardiovascular risk in adults but information about its role in children is scarce. This study evaluates the associations between obesity, cardiovascular risk factors and breastfeeding history with the numbers of CFU-Hill colonies in a sample of young people. METHODS AND RESULTS: We selected 49 children and teenagers between ages 10 and 17 (65.3% boys) from Mexican Health Care system. Physical activity and Anthropometric measures data were registered. CFU-Hill colonies were cultured from mononuclear cells obtained from venous blood. We detected inverse associations between the formation of CFU-Hill colonies and body mass index (BMI; ß = -1.53; 95% confidence interval [CI], -1.92, -1.13), triglycerides (ß = -0.26; 95%CI = -0.34, -0.18), total cholesterol (ß = -0.13; 95%CI = -0.17, -0.08), Low Density Lipoprotein (LDL) (ß = -0.20; 95%CI = -0.31, -0.09) and glucose (ß = -0.37; 95%CI = -0.55, -0.18) using multivariate models. Breastfeeding duration showed a 1.46-colony increase for each month of breastfeeding (95%CI = 0.73, 2.18). CONCLUSIONS: CFU-Hill colony-forming capacity in children and teenagers was inversely associated with obesity, dyslipidemia and high blood levels of glucose. In contrast a longer breastfeeding duration was directly associated with an increased number of CFU-Hill colonies. However these results must be confirmed with further studies. Our findings support the importance of promoting breastfeeding and monitoring nutritional and metabolic status at an early age to prevent chronic disease development.

Common variants in the CRP gene are associated with serum C-reactive protein levels and body mass index in healthy individuals in Mexico.

Variants in the C-reactive protein (CRP) gene have been found to be associated with various phenotypic traits. We evaluated the effect of four SNPs in the CRP gene on serum levels of protein and body mass index (BMI) in 150 unrelated Mexican subjects from 18 to 25 years old, without hypertension, non-overweight, and without inflammatory diseases, non-smoking and non-consumers of alcohol. Subjects were measured for BMI, waist circumference, blood pressure, and serum glucose and triglycerides. The identification of SNPs was performed by PCR-RFLP. Three of the four SNPs were associated with variation in serum levels of CRP, increased in TT (rs1130864) and GG (rs2794521) genotypes, and decreased in the AA genotype of rs1205. The TT genotype was associated with a significant increase in BMI (ß = 1.1 kg/m², P = 0.04). Two haplotypes were significantly associated with increased serum levels of CRP, but not with BMI. We conclude that variation in the CRP gene affects serum protein levels.

Dietary factors and endometrial cancer risk. Results of a case-control study in Mexico.

Daily diet factors that could potentially be related to endometrial cancer (EC) in Mexico are still unknown. This study aims to evaluate the association between EC and Mexican dietary factors. A case-control study in Mexico City was conducted during 1995-1997 in a social security hospital, using 85 incident cases of EC and 629 controls. A validated questionnaire with 116 items about the frequency and type of food intake was used. The analysis of nutrients was performed using the residual method, adjusting by predictor variables through logistic regression methods. In addition, partitional models estimated total caloric intake for other sources. We found no association between EC risk and consumption of animal or vegetable proteins, saturated, monounsaturated, or polyunsaturated fat, although high intake of nutrients such as lactose (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.21-1.01, P for trend = 0.004), vitamin D (OR, 0.38; 95% CI, 0.18-0.82, P= 0.003), and calcium (OR, 0.39; 95% CI, 0.17-0.89, P= 0.02) were inversely associated with EC. Our results suggest that dietary vitamin D and calcium play an important role in the development of EC, although the mechanisms postulated should be explained with additional studies with large populations.

Perceptions of nurses with regard to doctor-patient communication.

The objective of this study was to evaluate nurses' perceptions of communication between doctors and patients with cancer, AIDS and rheumatoid arthritis. A cross-sectional study was conducted with 741 nurses in 12 hospitals. Nurses received a self-questionnaire that included questions on personal value and attitudes. The answers were used in constructing affective variables (religious beliefs, attitude towards death, paternalism). The prevalence of explicit communication in 'nurse perception of doctor-patient communication' in the case of cancer was 4.5%, with AIDS 30%, and with rheumatoid arthritis 41.8%. When the value of communication was evaluated, it became evident that the likelihood of a nurse perceiving explicit communication in reference to a diagnosis of cancer was 6.5 time greater when communication was considered to be of greater value (CI 95% 2.6-6.6). For nurses who accept the possibility of death, the likelihood of perceiving explicit communication in the case of AIDs was 7.4 times greater than for nurses who deny this possibility (CI 95% 3.7-14.7), and when nurses displayed a deeply religious attitude, the likelihood of perceiving explicit communication was 80% greater than for nurses without this attitude (CI 95% 1.1-2.9). Nurses participate actively in the process of attending to patients with cancer and other disabling illnesses. Thus, there is a need for health professionals who provide compassionate attention, which will improve the various interrelationships between nurses and patients.

Factors associated with non-epithelial ovarian cancer among Mexican women: a matched case-control study.

The purpose of this study was to identify risk factors associated with the development of non-epithelial ovarian cancer in Mexican women. A case-control study was carried out on women registered with the Mexican Institute of Social Security in Mexico City over a period of two years (1995-97). Twenty-eight new cases were recruited from the Gynecology and Obstetrics Hospital no. 4, "Luis Castelazo Ayala", and were matched by age with 84 controls selected randomly. Eighteen (64.3%) cases of germ cell tumors and 10 (35.7%) stromal sex cord tumors were found. The number of full term pregnancies was associated inversely to development of stromal sex cord tumors with lower risk in women with more than three full term pregnancies (odds ratio, 0.02: 95% confidence interval, 0.001-0.56) compared to nulliparous women. No associations were found respecting to germ cell tumors. Parity was inversely associated to development of stromal sex cord tumors, probably as a result of the endocrine system's influence on the ovaries. The development of germ cell tumors could be associated to factors not evaluated in this study.

Prognostic factors related to cervical cancer survival in Mexican women.

OBJECTIVE: To identify prognostic survival factors among Mexican women with cervical cancer. METHODS: A total of 378 women with cervical cancer admitted from 1984 to 1996 to our referral hospital were evaluated, using survival analysis (Kaplan-Meier and Cox proportional hazards method). We designed a symptom index which included asymptomatic conditions, severity of symptoms and comorbidity. RESULTS: Overall 5-year survival was 66.6%. The shortest survival time was for FIGO stage IV (21.5%, P<0.001) and adenosquamous histologic type (53.1%, P=0.15). The main prognostic factors were primary symptoms (RR, 2.6; 95% CI, 1.02-6.66); systemic symptoms (RR, 3.3; 95% CI, 1.23-9.01); FIGO stage IV (RR, 5.5; 95% CI, 2.36-12.96); and oncogenic symptoms (prognostic comorbidity present) (RR, 2.3; 95% CI, 1.08-4.89). CONCLUSIONS: Our findings show that clinical stage and several types of symptoms influence CC survival. This present strategy to assess morphological and clinical characteristics may be a more accurate indicator of survival rate and potentially an efficient indicator of new therapeutic alternatives.

Control de calidad interno en citología cérvico-vaginal mediante revisión rápida: evaluación de la capacidad del personal del laboratorio para utilizar el procedimiento / Rapid rescreening as internal quality control in cervical citology. Personal proficiency testing of the laboratory personnel

Entre los procedimientos de control interno de calidad para evitar falsos negativos en citología ginecológica, la segunda revisión rápida de todos los casos negativos ha demostrado su eficacia. Para poner en práctica el procedimiento, antes de utilizarlo evaluamos la capacidad del personal del laboratorio. Se estudiaron 66 casos escogidos aleatoriamente revisándose cada laminilla en un tiempo de 30, 50 segundos, utilizando el objetivo 10x; las laminillas anormales, se separaron para ser evaluadas posteriormente. Hubo tres casos anormales que correspondieron, por diagnóstico de consenso, a cambios atípicos de etiología incierta, favoreciendo una lesión escamosa intraepitelial de bajo grado. Un observador, discrepó de los resultados obtenidos por el resto del grupo, ya que sólo identificó uno de los tres caso anormales; por esta razón, nuestros valores globales promedio disminuyeron: la sensibilidad fue de 91.6 por ciento, la especificidad de 100 por ciento, el valor predictivo positivo fue de 100 por ciento y el negativo de 99.6 por ciento, la tasa global de falsos negativos subió a 8.3 por ciento. Este estudio identifica al personal del laboratorio que está capacitado para poner en práctica el procedimiento, por lo que el observador que falló en sus apreciaciones deberá tener un adiestramiento ulterior.

Case-control study of diabetes, obesity, physical activity and risk of endometrial cancer among Mexican women.

OBJECTIVES: Obesity, hypertension and diabetes are closely associated with endometrial cancer (EC). This study evaluates the relationship between diabetes and risk of EC on the basis of obesity. METHODS: A case control study was carried out in Mexico City from 1995 to 1997. Eighty-five histologically confirmed cases were compared with 668 population-based controls obtained through frequency matching. Diabetes status, weight, height and other factors were determined through personal interviews among both cases and controls. RESULTS: Compared to women without diabetes, those with diabetes had an adjusted odds ratio of 3.6 (95% CI = 1.7, 7.4) for EC. This association was modified by body mass index (p interaction < 0.001). Compared to non-overweight and non-diabetic women, non-overweight (OR = 3.9. 95% CI = 0.88, 18.0) and overweight (OR = 5.9, 95% CI = 1.6, 21.1) diabetic women had a non-significant elevated risk of EC. However, elevated risk estimates were observed for obese diabetic women (OR = 8.0, 95% CI = 2.8, 22.7). CONCLUSIONS: Our results strongly suggest an interaction effect between obesity and diabetes that significantly increases the risk of EC. This, in turn, may explain the growing number of new EC cases recently observed in developing countries with reduced birth rates and an increased incidence of both obesity and diabetes mellitus.

[Knowledge of health professionals about the prevention of cancer the cervix. Alternatives to medical education]. / El conocimiento de profesionales de la salud sobre la prevención del cáncer cervical. Alternativas de educación médica.

OBJECTIVE: Several studies have shown the importance of health care professionals as predictors of the use of cervical cancer screening (CCS). MATERIAL AND METHODS: A cross-sectional study of 520 health care professionals in the State of Morelos during 1998, in order to evaluate and quantify their level of knowledge on the impact, etiology, screening, diagnosis and treatment of cervical cancer. A 1 to 10 scale questionnaire was given, and the sample included family medicine specialists, general practitioners, specialist and general nurses, and social workers. Statistical analysis included analysis of variance and 95% confidence intervals. RESULTS: A knowledge mean of 4.74 (95% CI 4.57-4.88) was observed for a scale of 10; specialist physicians scored higher (mean 5.21, 95% CI 4.81-5.60) than social workers (mean 3.07, 95% CI 2.31-3.82). Periodicity of the Pap test in most cases was less than 1 year and there was poor consensus about the age period during which the Pap test should be obtained. The knowledge level was lower when trying to identify etiologic aspects and treatment perspectives. CONCLUSIONS: The results of this study show that, besides the improvement of undergraduate academic programs, it is necessary to improve educational interventions for health care professionals through the updating, recycling, training, health education, and continuing medical education, among others, to promote professional competence and thus improve the quality of medical care.

Reproductive factors of ovarian and endometrial cancer risk in a high fertility population in Mexico.

A case-control study was carried out in Mexico City during 1995-1997 among women with epithelial ovarian cancer (84 cases) and endometrial cancer (85 cases). The control group consisted of 668 healthy women, matched according to age categories. In a multivariate analysis, the reproductive risk factors for ovarian and endometrial cancer are similar. The risk of ovarian cancer was inversely related to the number of full-term pregnancies; the odds ratio (OR) was 0.17 and the 95% confidence interval (CI) was 0.05-0.54 when comparing nulliparous women versus those with more than seven pregnancies. For endometrial cancer, a similar association was observed (OR, 0.11; 95% CI, 0.04-0.34). The use of oral contraceptive hormones was inversely associated with both ovarian (OR, 0.36; 95% CI, 0.15-0.83) and endometrial cancer risk (OR, 0.36; 95% CI, 0.14-0.90). In women with a history of more than 8.7 years without ovulation, the risk of ovarian cancer decreased four times (OR, 0.23; 95% CI, 0.10-0.50), and that of endometrial cancer decreased more than five times (OR, 0.17; 95% CI, 0.08-0.35). These two neoplasms are clearly typified as hormone dependent, and it is possible to establish that "ovulation" and "exfoliative" mechanisms jointly determine the level of risk for both ovarian and endometrial cancer.

[Epidemiologic panorama of cancer mortality in the Mexican Institute of Social Security: 1991-1995]. / Panorama epidemiológico de la mortalidad por cáncer en el Instituto Mexicano del Seguro Social: 1991-1995.

OBJECTIVE: This paper describes the global cancer mortality and the specific mortality patterns for the main neoplasms among adult members of the Mexican Institute of Social Security (IMSS). MATERIAL AND METHODS: Using official death certificates and information about the population of the IMSS members during 1991-1995, national and regional annual global cancer mortality as well as specific mortality rates for the 10 most important malignant neoplasms by sex were estimated among people older than 20 years of age. The trends for these neoplasms during the study period were estimated by means of Poisson regression. The rate differences in specific cancer mortality by region and sex, for the two major neoplasms, were calculated subtracting specific regional rates from the respective national rate in 1995. RESULTS: The global mortality rate for cancer among men increased from 76.2 in 1991 to 94.8 x 100000 IMSS' members in 1995; and among women from 85.6 to 105.8 x 100000 IMSS' members, representing an increment of 24.4 and 24% men and women, respectively, during the study period. Among men, neoplasm of kidney, leukemia, pancreas, prostate and lung showed the major increment; among women, neoplasm of colon, breast, pancreas, leukemia and liver showed the most significant increment. CONCLUSIONS: In the IMSS it is necessary the integration of a population based cancer registry. The registry will play a main role in disease surveillance and control; will give basic information over incidence and temporal variation, and could be the main source of information for epidemiologic research, as well as planning and evaluation of the quality of medical attention services such as prevention and early diagnosis and treatment.

Conservative surgery for ovarian cancer and effect on fertility.

OBJECTIVE: A survey that compared two alternatives (conservative and radical surgery) is presented on ovarian cancer treatment evaluating its effect on progression-free survival and fertility, in a 10-year time period, in Mexican women. METHODS: 72 women between 11 and 58 years old with unilateral ovarian cancer in different stages were studied. Several methods were analyzed: (1) progression-free survival, using Mantel and Haenzsel test to compare in terms of life curves and the Kaplan-Meier method. The exposure variable was surgery type, using the Mantel-Cox test to evaluate the difference in life curves by clinical stages and by surgery type; (2) fertility was evaluated in women who received conservative surgery, considering the cumulative pregnancy rate in women successfully pregnant after surgical and/or adjuvant treatment. RESULTS: There were no difference in survival curves when evaluating progression-free survival, in either group (Z = 1.09 and Pr > (z) = 0.27). During the study period, we found that 87.5% of patients were alive with no evidence of disease. There were no differences in survival curves when evaluating progression-free survival according to surgery type and clinical stage (chi 2 = 0.66, P = 0.88). Restart of menstruation in patients with conservative surgery occurred before 6 months in 89% of the sample, 22 women with possible parity had a 59.1% cumulative pregnancy rate. CONCLUSION: The outcomes from this survey carried out in Mexico show that conservative treatment of ovarian cancer in early clinical stages is an efficient alternative to preserve reproductive function in young women, and does not show differences in progression-free survival compared to radical surgery.