Developing a collaborative international partnership for cancer control in Mexico.

In 2014, a partnership was established between the Univer-sity of California and Mexico, which subsequently catalyzed formation of collaborations between cancer researchers at University of California, San Francisco and in Mexico. Over the past two decades cancer burden has dramatically increased in Mexicans on both sides of the California - Mexico border. Together, we face a growing burden of cancer in the context of globalized economies, diverse migration patterns, and dynamic immigration policies. Our partnership aims to: (1) understand the life course impact of cancer risk factors and interactions with changing environments; (2) address cancer disparities within Mexico, in Mexican migrants to the United States, and in naturalized Mexican-Americans; and (3) identify effective cancer screening strategies and cancer control policies that are tailored to existing healthcare systems and social and cultural factors. Herein, we describe the principles of partner-ship and early successes and challenges of this collaboration.

Developing a collaborative international partnership for cancer control in Mexico / Desarrollo de una alianza internacional colaborativa para el control del cáncer en México

Abstract: In 2014, a partnership was established between the University of California and Mexico, which subsequently catalyzed formation of collaborations between cancer researchers at University of California, San Francisco and in Mexico. Over the past two decades cancer burden has dramatically increased in Mexicans on both sides of the California - Mexico border. Together, we face a growing burden of cancer in the context of globalized economies, diverse migration patterns, and dynamic immigration policies. Our partnership aims to: 1) understand the life course impact of cancer risk factors and interactions with changing environments; 2) address cancer disparities within Mexico, in Mexican migrants to the United States, and in naturalized Mexican-Americans; and 3) identify effective cancer screening strategies and cancer control policies that are tailored to existing healthcare systems and social and cultural factors. Herein, we describe the principles of partnership and early successes and challenges of this collaboration.

Resumen: En 2014, se estableció un convenio de colaboración colaboración entre la Universidad de California y México, que posteriormente catalizó colaboraciones específicas entre investigadores en cáncer en la Universidad de California, San Francisco y en México. En las últimas dos décadas, la carga del cáncer ha aumentado drásticamente en mexicanos de ambos lados de la frontera entre California y México. Juntos, enfrentamos una carga creciente de cáncer en un contexto de economías globalizadas y diversos patrones y políticas de migración dinámicas. Nuestra colaboración tiene como objetivo: 1) entender el impacto a lo largo de la vida de factores de riesgo de cáncer y sus interacciones en un entorno cambiante; 2) abordar disparidades del cáncer dentro de México, en os migrantes mexicanos a los Estados Unidos y en los mexicoamericanos naturalizados; y 3) identificar estrategias efectivas de detección del cáncer y políticas de control del cáncer que se adapten a sistemas de salud existentes y a factores sociales y culturales. Aquí describimos los principios de esta colaboración y los primeros éxitos y retos de la misma.

[Subsample for the analysis of chronic diseases with biomarkers, National Survey of Health and Nutrition 2016]. / Submuestra para el análisis de enfermedades crónicas con biomarcadores, Encuesta Nacional de Salud y Nutrición 2016.

OBJECTIVE: To describe the adult subsample for the analysis of biomarkers of chronic diseases, as well as the sample sizes (n) and representativity of the Encuesta Nacional de Salud y Nutrición (Ensanut) 2016. MATERIALS AND METHODS: An adult subsample with national representativity was calculated to obtain blood, serum and urine samples. The prevalence of variables of interest was compared for each subsample. RESULTS: The n for at least one serum biomarker and urine samples were 4 000 and 3 782, respectively. The n varied depending on the grouping of biomarkers and fasting time selection. No differences were observed in the distribution of variables between the whole sample, urine and blood biomarkers samples. CONCLUSIONS: The weighted subsamples of urine, serum and blood biomarkers are comparable to the weighted sample of adults in the survey. The data of the subsample will allow to monitor the distribution of chronic diseases in Mexico, including altered function of liver and kidney, and sodium intake.

OBJETIVO: Describir la submuestra de adultos para el análisis de biomarcadores de enfermedades crónicas, así como los tamaños de muestra (n) y la representatividad de las mismas en la Encuesta Nacional de Salud y Nutrición 2016. MATERIAL Y MÉTODOS: Se calculó una submuestra con representati-vidad nacional para la obtención de sangre, suero y orina en adultos. Se comparó la prevalencia de variables de interés para las submuestras. RESULTADOS: Las n obtenidas de suero y orina fueron de 4 000 y 3 782 adultos con al menos un valor en algún marcador bioquímico sérico y marcadores de orina, respectivamente. Esta n varió con el agrupamiento de marcadores y selección por horas de ayuno. No se observa-ron diferencias en la distribución de las variables de interés entre las muestras de hogar, sangre y orina. CONCLUSIONES: Los datos ponderados de las submuestras de marcadores en orina, suero y sangre son comparables con la muestra total de adultos de la encuesta. Los datos de las submuestras permiti-rán monitorear la distribución de enfermedades crónicas en México, incluidas las alteraciones en función hepática, renal, y consumo de sodio.

Submuestra para el análisis de enfermedades crónicas con biomarcadores, Encuesta Nacional de Salud y Nutrición 2016 / Subsample for the analysis of chronic diseases with biomarkers, National Survey of Health and Nutrition 2016

Resumen Objetivo: Describir la submuestra de adultos para el análisis de biomarcadores de enfermedades crónicas, así como los tamaños de muestra (n) y la representatividad de las mismas en la Encuesta Nacional de Salud y Nutrición 2016. Material y métodos: Se calculó una submuestra con representatividad nacional para la obtención de sangre, suero y orina en adultos. Se comparó la prevalencia de variables de interés para las submuestras. Resultados: Las n obtenidas de suero y orina fueron de 4 000 y 3 782 adultos con al menos un valor en algún marcador bioquímico sérico y marcadores de orina, respectivamente. Esta n varió con el agrupamiento de marcadores y selección por horas de ayuno. No se observaron diferencias en la distribución de las variables de interés entre las muestras de hogar, sangre y orina. Conclusión: Los datos ponderados de las submuestras de marcadores en orina, suero y sangre son comparables con la muestra total de adultos de la encuesta. Los datos de las submuestras permitirán monitorear la distribución de enfermedades crónicas en México, incluidas las alteraciones en función hepática, renal, y consumo de sodio.

Abstract Objective: To describe the adult subsample for the analysis of biomarkers of chronic diseases, as well as the sample sizes (n) and representativity of the Encuesta Nacional de Salud y Nutrición (Ensanut) 2016. Materials and methods: An adult subsample with national representativity was calculated to obtain blood, serum and urine samples. The prevalence of variables of interest was compared for each subsample. Results: The n for at least one serum biomarker and urine samples were 4 000 and 3 782, respectively. The n varied depending on the grouping of biomarkers and fasting time selection. No differences were observed in the distribution of variables between the whole sample, urine and blood biomarkers samples. Conclusion: The weighted subsamples of urine, serum and blood biomarkers are comparable to the weighted sample of adults in the survey. The data of the subsample will allow to monitor the distribution of chronic diseases in Mexico, including altered function of liver and kidney, and sodium intake.

Design of a cluster-randomized trial of the effectiveness and cost-effectiveness of metformin on prevention of type 2 diabetes among prediabetic Mexican adults (the PRuDENTE initiative of Mexico City).

INTRODUCTION: Type 2 diabetes (T2D) is a global epidemic, and nations are struggling to implement effective healthcare strategies to reduce the burden. While efficacy studies demonstrate that metformin can reduce incident T2D by half among younger, obese adults with prediabetes, its real-world effectiveness are understudied, and its use for T2D prevention in primary care is low. We describe the design of a pragmatic trial to evaluate the incremental effectiveness of metformin, as an adjunct to a simple lifestyle counseling. METHODS: The "Prevención de la Diabetes con Ejercicio, Nutrición y Tratamiento" [Diabetes Prevention with Exercise, Nutrition and Treatment; PRuDENTE, (Spanish acronym)] is a cluster-randomized trial in Mexico City's public primary healthcare system. The study randomly assigns 51 clinics to deliver one of two interventions for 36 months: 1) lifestyle only; 2) lifestyle plus metformin, to 3060 patients ages 30-65 with impaired fasting glucose and obesity. The primary endpoint is incident T2D (fasting glucose ≥126 mg/dL, or HbA1c ≥6.5%). We will also measure a range of implementation-related process outcomes at the clinic-, clinician- and patient-levels to inform interpretations of effectiveness and enable efforts to refine, adapt, adopt and disseminate the model. We will also estimate the cost-effectiveness of metformin as an adjunct to lifestyle counseling in Mexico. DISCUSSION: Findings from this pragmatic trial will generate new translational knowledge in Mexico and beyond, both with respect to metformin's real-world effectiveness among an 'at-risk' population, and uncovering facilitators and barriers to the reach, adoption and implementation of metformin preventive therapy in public primary care settings. TRIAL REGISTRATION: This trial is registered at Clinicaltrials.gov (NCT03194009).

Collaborative research and actions on both sides of the US-Mexico border to counteract type 2 diabetes in people of Mexican origin.

BACKGROUND: Type 2 Diabetes (T2D) is now a massive epidemic in both California and Mexico, with serious consequences for social and economic well-being. A large proportion of these populations share common ethnic backgrounds. Yet diverse environmental and social conditions across regions create unique opportunities to explore the ways that T2D risk, incidence, management and outcomes manifest. MAIN TEXT: An action-oriented research consortium headed up by the University of California and Universidad Nacional Autónoma de Mexico was constituted to set priorities for bi-national translational research, in an attempt to implement and evaluate clinical, public health and policy actions to decrease the burden of T2D for people of Mexican origin. In this paper, we describe the epidemiology of T2D in Mexico and California, review current efforts to combat the epidemic, highlight gaps in knowledge and identify urgent areas of opportunity for collaboration. The group has developed a common research agenda and funding has been obtained to evaluate biological samples from the 2016 Mexican Health Survey, collaborate in a telemedicine-based retinopathy project, implement interventions in food banks, promote a communications campaign, and design a large-scale diabetes prevention effectiveness trial. CONCLUSIONS: T2D has caused a state of emergency in Mexico and is a major health problem among Mexican populations on both sides of the border. Understanding the commonalities and differences between California and Mexico for those of Mexican origin with respect to T2D, when combined with a sharing of knowledge and advances, can produce a bi-national translational research agenda to inform relevant policy and practice. Amidst economic and political uncertainty and limited healthcare budgets, this collaboration can contribute to the development of scientific evidence to inform policies and interventions. This may provide a promising collaborative model that could be expanded to other health conditions and regions of the world.

Implementation and Operational Research: Effect of Universal Access to Antiretroviral Therapy on HIV/AIDS Mortality in Mexico 1990-2011.

INTRODUCTION: Universal coverage of highly active antiretroviral therapy (HAART) for HIV/AIDS in Mexico was achieved in a staggered fashion. First, HAART was made available in 1997 for employees in the formal sector and subsequently, in 2003, for informal sector workers and the unemployed population. We evaluated the impact of this free universal HAART program on HIV/AIDS mortality in the Mexican population aged 15 years or older. METHODS: Time-series cross-sectional data analysis of standardized HIV/AIDS mortality rates (1990-2011) using marginal linear models with inflection points at 1994, 1997, and 2003. RESULTS: Men employed in the formal sector experienced the greatest effect of access to HAART, with a 32% reduction in mortality from 1997 to 2011 (P < 0.01). For men in this sector, mortality increased from 1990 to 2003, then stabilizing at 7 deaths per 100,000. For women in the informal sector, mortality increased from 1990 to 2011. We found large between-state variability: mortality decreased by 59% in Mexico City while it increased by 245% in Tabasco during the study period. Six of 32 states achieved statistically significant reductions in mortality while 5 states continued to experience increasing mortality rates despite universal HAART. CONCLUSIONS: Access to universal HAART has had relative success in Mexico. The heterogeneity of HIV/AIDS mortality by employment status, gender, and state of residence highlight urgent needs to improve health equity with pro-poor and gender-responsive programs and a call for country-specific operational research in HIV/AIDS prevention and treatment. Our results may apply to other countries seeking to implement universal access to antiretroviral therapy.

[Automated geospatial model for health services strategic planning]. / Modelo geoespacial automatizado para la regionalización operativa en planeación de redes de servicios de salud.

OBJECTIVE: To develop an automated model for the operational regionalization needed in the planning of the health service networks proposed by the new Mexican health care model (Modelo Integrador de Servicios de Salud MIDAS). MATERIAL AND METHODS: Using available data for México during 2005 and 2007, a geospatial model was developed to estimate potential catchment areas around health facilities based on access travel time. The results were compared with an operational regionalization (ERO) study manually carried out in Oaxaca with 2005 data. RESULTS: The ERO assigned 48% of villages to health care centers further away than those assigned by the geospatial model, and 23% of these health centers referred patients to more distant hospitals. CONCLUSIONS: The model calculated by this study generated a more efficient regionalization than the ERO model, minimizing travel time to access health services. This model has been adopted by the General Department of Health Planning and Development of the Mexican Ministry of Health for the implementation of the Health Sector Infrastructure Master Plan.

Modelo geoespacial automatizado para la regionalización operativa en planeación de redes de servicios de salud / Automated geospatial model for health services strategic planning

Objetivo. Desarrollar un modelo automatizado de regionalización operativa para la planeación de las redes de servicios de salud propuestas en el Modelo Integrador de Atención a la Salud (MIDAS). Material y métodos. Con información disponible para México en 2005 y 2007 se realizó un modelo geoespacial para estimar el área potencial de influencia alrededor de cada unidad de atención médica, con base en el menor tiempo de viaje. Los resultados se compararon con un Estudio de Regionalización Operativa (ERO) para Oaxaca llevado a cabo en 2005. Resultados. Comparado con el modelo geoespacial, el ERO asignó 48 por ciento de las localidades a centros de salud más lejanos y 23 por ciento de los centros de salud a hospitales más lejanos. Conclusiones. El modelo calculado en este estudio generó una regionalización más eficiente que el ERO de Oaxaca, minimizando el tiempo de viaje para el acceso a los servicios de salud. Este modelo ha sido adoptado por la Dirección General de Planeación y Desarrollo en Salud para la instrumentación del Plan Maestro Sectorial de Recursos para la Atención de la Salud.

Objective. To develop an automated model for the operational regionalization needed in the planning of the health service networks proposed by the new Mexican health care model (Modelo Integrador de Servicios de Salud MIDAS). Material and Methods. Using available data for México during 2005 and 2007, a geospatial model was developed to estimate potential catchment areas around health facilities based on access travel time. The results were compared with an operational regionalization (ERO) study manually carried out in Oaxaca with 2005 data. Results. The ERO assigned 48 percent of villages to health care centers further away than those assigned by the geospatial model, and 23 percent of these health centers referred patients to more distant hospitals. Conclusions. The model calculated by this study generated a more efficient regionalization than the ERO model, minimizing travel time to access health services. This model has been adopted by the General Department of Health Planning and Development of the Mexican Ministry of Health for the implementation of the Health Sector Infrastructure Master Plan.

Immunologic studies of specific mucosal and systemic immune responses in Mexican school children after booster aerosol or subcutaneous immunization with measles vaccine.

The purpose of the present study was to compare serum and mucosal immune responses following either aerosol (Aer) or subcutaneous (SQ) measles immunization of Mexican school children. A cohort of 49 children from 6 to 7 years of age received either Aer ( n = 22) or SQ ( n = 27) Edmonston-Zagreb (EZ) measles vaccine. Serum and nasal secretions were collected prior to (Pre), 1 and 3 months (mos) intervals and analyzed for immunoglobulin (Ig) concentrations and measles specific Ig isotype-associated antibody by enzyme immunoassay (EIA). Serum and nasal IgG and IgA antibody responses were stimulated following immunization with live, attenuated EZ measles vaccine administered either by SQ or Aer routes but these responses were significantly greater by the Aer compared to the SQ route. These studies also suggest that the level of antibody in these secretions may serve as an important marker of immunity to measles and lend further support for aerosol immunization as an effective alternative vaccine delivery strategy for measles eradication.

Nutritional status of indigenous children younger than five years of age in Mexico: results of a national probabilistic survey.

OBJECTIVE: To compare the prevalence of undernutrition and anemia in indigenous and non-indigenous children < 5 years of age at the national level, by region and by urban and rural areas, and to evaluate the degree to which the socioeconomic condition of the family predicts the differences. MATERIAL AND METHODS: A national probabilistic survey was conducted in Mexico in 1999. Indigenous families were identified as those in which at least one woman 12-49 years of age in the household spoke a native language. The prevalence of undernutrition (stunting, wasting and underweight) and anemia was compared between indigenous and non-indigenous children. Probability ratios (PR) were used to compare prevalences in indigenous and non-indigenous children adjusting for socioeconomic status (SES) of the family and for other covariates. RESULTS: The prevalences of stunting and underweight were greater in indigenous than in non-indigenous children. At the national level and in urban areas the prevalences were three times greater and in rural areas approximately 2 times greater (p < 0.05). No differences were found in the prevalence of wasting (p > 0.05). The prevalence of anemia in indigenous children was one third greater than in non-indigenous children at the national level (p < 0.05) and was between 30 and 60% greater in urban areas and in the regions studied (p < 0.05) but was not statistically significant (p > 0.05) in rural areas. These differences were reduced to about half when adjusting for SES but remained significantly higher in indigenous children (p < 0.05). CONCLUSIONS: Indigenous children have higher probabilities of stunting and underweight than non-indigenous children. The differences are larger in urban areas and in higher socioeconomic geographic regions and are explained mostly by socioeconomic factors. The overall difference in the probability of anemia is small, is higher only in urban relative to rural areas, and is explained to a lesser degree by socioeconomic factors. Policy and programs should be designed and implemented to reduce the dramatic differences in nutritional status between indigenous and non-indigenous children in Mexico. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Factors associated with overweight and obesity in Mexican school-age children: results from the National Nutrition Survey 1999.

OBJECTIVE: The objective of the study was to measure the prevalence of overweight and obesity in Mexican school-age children (5-11 years) in the National Nutrition Survey 1999 (NNS-1999). MATERIAL AND METHODS: Overweight and obesity (defined as an excess of adipose tissue in the body) were evaluated through the Body Mass Index (BMI) in 10,901 children, using the standard proposed by the International Obesity Task Force. Sociodemographic variables were obtained using a questionnaire administered to the children's mothers. RESULTS: The national prevalence of overweight and obesity was reported to be 19.5%. The highest prevalence figures were found in Mexico City (26.6%) and the North region (25.6%). When adjusting by region, rural or urban area, sex, maternal schooling, socioeconomic status, indigenous ethnicity and age, the highest prevalences of overweight and obesity were found among girls. The risks of overweight and obesity were positively associated with maternal schooling, children's age and socioeconomic status. CONCLUSIONS: Overweight and obesity are prevalent health problems in Mexican school-age children, particularly among girls, and positively associated with socioeconomic status, age, and maternal schooling. This is a major public health problem requiring preventive interventions to avoid future health consequences. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Methods of the National Nutrition Survey 1999.

OBJECTIVE: To describe the methods and analyses of the 1999 National Nutrition Survey (NNS-99). MATERIAL AND METHODS: The 1999 National Nutrition Survey (NNS-99) is a probabilistic survey with nationwide representativity. The NNS-99 included four regions and urban and rural areas of Mexico. The last sampling units were households, selected through stratified cluster sampling. The study population consisted of children under five years of age, school-age children (6-11 years), and women of childbearing age (12-49 years). Data were collected on anthropometric measurements, hemoglobin levels, morbidity and its determinants, and socioeconomic and demographic characteristics. In addition, data on diet and micronutrients intakes (iron, zinc, vitamin A, folic acid, vitamin C, and iodine) were obtained in a sub-sample of subjects. RESULTS: The response rate for the NNS-99 was 82.3%; the non-response rate was 5.9% and the remaining did not participate due to uninhabited houses. CONCLUSIONS: This survey updates the information on nutritional status in Mexico and should serve as the basis for food and nutrition policy-making and priority program design. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Conclusions from the Mexican National Nutrition Survey 1999: translating results into nutrition policy.

OBJECTIVE: This article presents and overview of the main results and conclusions from the Mexican National Nutrition Survey 1999 (NNS-1999) and the principal nutrition policy implications of the findings. MATERIAL AND METHODS: The NNS-1999 was conducted on a national probabilistic sample of almost 18,000 households, representative of the national, regional, as well as urban and rural levels in Mexico. Subjects included were children < 12 years and women 12-49 years. Anthropometry, blood specimens, diet and socioeconomic information of the family were collected. RESULTS: The principal public nutrition problems are stunting in children < 5 years of age; anemia, iron and zinc deficiency, and low serum vitamin C concentrations at all ages; and vitamin A deficiency in children. Undernutrition (stunting and micronutrient deficiencies) was generally more prevalent in the lower socioeconomic groups, in rural areas, in the south and in Indigenous population. Overweight and obesity are serious public health problems in women and are already a concern in school-age children. CONCLUSIONS: A number of programs aimed at preventing undernutrition are currently in progress; several of them were designed or modified as a result of the NNS-1999 findings. Most of them have an evaluation component that will inform adjustments or modifications of their design and implementation. However, little is being done for the prevention and control of overweight and obesity and there is limited experience on effective interventions. The design and evaluation of prevention strategies for controlling obesity in the population, based on existing evidence, is urgently needed and success stories should be brought to scale quickly to maximize impact. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Nutritional status of indigenous children younger than five years of age in Mexico: results of a national probabilistic survey

OBJETIVO: Comparar las prevalencias de desnutrición y anemia en niños indígenas y no indígenas menores de cinco años de edad en el ámbito nacional, por región, por zonas urbanas y rurales, y evaluar en qué medida la condición socioeconómica de la familia predice las diferencias. MATERIAL Y MÉTODOS: Se realizó una encuesta nacional probabilística en 1999 en México. Las familias indígenas fueron identificadas como aquellas en las cuales al menos una mujer entre 12 y 49 años de edad en el hogar hablara una lengua indígena. Las prevalencias de desnutrición (baja talla, emaciación y bajo peso) y anemia fueron comparadas entre niños indígenas y no indígenas. Se utilizaron razones de probabilidad para comparar prevalencias ajustando por las condiciones socioeconómicas de la familia y por otras variables. RESULTADOS: Las prevalencias de baja talla y de bajo peso fueron mayores en indígenas que en no indígenas. En el ámbito nacional y en zonas urbanas las prevalencias fueron casi tres veces mayores, mientras que en zonas rurales fueron +/- 2 veces mayores (p<0.05). No se encontraron diferencias en las prevalencias de emaciación (p>0.05). La prevalencia de anemia en indígenas fue un tercio mayor que en no indígenas en el ámbito nacional (p <0.05) y entre 30 y 60 por ciento mayor en áreas urbanas y en las regiones estudiadas (p<0.05), pero no fue estadísticamente significativa en áreas rurales (p>0.05). Estas diferencias se redujeron aproximadamente a la mitad al ajustar por las condiciones socioeconómicas, pero continuaron siendo significativamente superiores en niños indígenas (p<0.05). CONCLUSIONES: Los niños indígenas tienen mayor probabilidad de presentar baja talla y bajo peso que los no indígenas. Las diferencias son mayores en áreas urbanas y en las regiones geográficas con mejores condiciones de vida, y se explican principalmente por factores socioeconómicos. La probabilidad de anemia entre poblaciones fue sólo modestamente mayor en zonas urbanas que en zonas rurales, y las diferencias son explicadas en menor grado por factores socioeconómicos. Se recomienda el diseño y aplicación de políticas y programas para eliminar las diferencias abismales en estado nutricio entre niños indígenas y no indígenas en México.

Factors associated with overweight and obesity in Mexican school-age children: results from the National Nutrition Survey 1999

OBJETIVO: Documentar las prevalencias de sobrepeso y obesidad en niños mexicanos en edad escolar (5 a 11 años de edad) obtenidas de la Encuesta Nacional de Nutrición en 1999 (ENN-1999).MATERIAL Y MÉTODOS: El sobrepeso y la obesidad (definida como un exceso de tejido adiposo en el organismo) se evaluaron a través del Indice de Masa Corporal (IMC) en 10 901 niños, tomando como patrón de referencia el propuesto por el International Obesity Task Force. Las variables sociodemográficas se obtuvieron a partir de un cuestionario aplicado a la madre del niño. RESULTADOS: La prevalencia nacional de sobrepeso y obesidad fue de 19.5 por ciento. Las prevalencias más altas se encontraron en la Ciudad de México (26.6 por ciento) y en la región norte (25.6 por ciento). Al ajustar por región, zona rural o urbana, sexo, escolaridad de la madre, nivel socioeconómico, edad e indigenismo, los mayores riesgos de sobrepeso y obesidad se encontraron en niñas; el riesgo de obesidad y sobrepeso se asoció positivamente con la escolaridad de la madre, con el nivel socioeconómico y con la edad de los escolares. CONCLUSIONES: El sobrepeso y obesidad son problemas de salud de alta prevalencia en niños en edad escolar en México, especialmente en niñas, y se asocia positivamente con el nivel socioeconómico, la edad de los escolares y la escolaridad de las madres. Este es un problema de salud pública que requiere acciones de prevención para evitar riesgos en la salud en un futuro.

Methods of the National Nutrition Survey 1999

OBJETIVO: Describir la metodología y análisis de la Encuesta Nacional de Nutrición 1999 (ENN-99). MATERIAL Y MÉTODOS: La ENN-99 es probabilística, con representatividad nacional de cuatro regiones y estratos urbano/rural. Las unidades últimas de muestras son los hogares seleccionados por muestreo estratificado y por conglomerados. La población de estudio fueron los niños menores de cinco años de edad, los niños 6-11 años (escolares) y las mujeres de 12-49 años, en quienes se obtuvieron mediciones antropométricas, niveles de hemoglobina, información sobre morbilidad y sus determinantes, datos socieconómicos y demográficos, y en una submuestra se determinaron micronutrimentos (hierro, zinc, vitamina A, ácido fólico, vitamina C, yoduria) y se obtuvo información sobre dieta. RESULTADOS: La Encuesta obtuvo una tasa de respuesta de 82.3 por ciento, la no respuesta se asoció en 5.9 por ciento a no respuesta del informante y el resto fue ocasionado por no estar habitadas las viviendas seleccionadas. CONCLUSIONES: La información obtenida a través de esta encuesta actualiza la información existente en nuestro país y es la base para la formulación de políticas y programas prioritarios.

Conclusions from the Mexican National Nutrition Survey 1999: translating results into nutrition policy

OBJETIVO: Este artículo presenta una visión general de los resultados y conclusiones más importantes de la Encuesta Nacional de Nutrición realizada en México en 1999 (ENN-1999) y sus principales implicaciones para políticas públicas sobre nutrición. MATERIAL Y MÉTODOS: La ENN-1999 fue realizada en una muestra probabilística de cerca de 18 000 hogares, representativa de los ámbitos nacional, regional y de zonas urbanas y rurales en México. Se incluyó a niños menores de 12 años y mujeres de 12 a 49 años. Se obtuvieron mediciones antropométricas, muestras de sangre, dieta e información socioeconómica de los hogares. RESULTADOS: Los principales problemas de nutrición pública en México son baja talla en menores de 5 años; anemia, deficiencia de hierro y zinc y concentraciones séricas bajas de vitamina C en todas las edades; y deficiencia de vitamina A en niños. La desnutrición (baja talla y deficiencia de micronutrimentos) fue más prevalente en los grupos con bajo nivel socioeconómico, en zonas rurales, el sur y en población indígena. El sobrepeso y la obesidad son serios problemas de salud pública en mujeres y ya constituyen motivo de preocupación en niños de edad escolar. CONCLUSIONES: Un importante número de programas dirigidos a prevenir la desnutrición se aplican actualmente; varios de ellos fueron diseñados o modificados como resultado de los hallazgos de la ENN-1999. La mayor parte de ellos tienen un componente de evaluación que guiará ajustes y modificaciones de su diseño e implementación. Sin embargo poco se está haciendo para la prevención y control de sobrepeso y obesidad y hay experiencia limitada sobre intervenciones efectivas. Se necesita urgentemente el diseño y evaluación de estrategias para controlar la obesidad en la población, con base en evidencia existente y las acciones exitosas deben convertirse en programas de gran escala rápidamente con el propósito de maximizar su impacto.

Aerosolized measles and measles-rubella vaccines induce better measles antibody booster responses than injected vaccines: randomized trials in Mexican schoolchildren.

OBJECTIVE: To compare antibody responses and side-effects of aerosolized and injected measles vaccines after revaccination of children enrolling in elementary schools. METHODS: Vaccines for measles (Edmonston-Zagreb) or measles-rubella (Edmonston-Zagreb with RA27/3) were given by aerosol or injection to four groups of children. An additional group received Schwarz measles vaccine by injection. These five groups received vaccines in usual standard titre doses. A sixth group received only 1000 plaque-forming units of Edmonston-Zagreb vaccine by aerosol. The groups were randomized by school. Concentrations of neutralizing antibodies were determined in blood specimens taken at baseline and four months after vaccination from randomized subgroups (n = 28-31) of children in each group. FINDINGS: After baseline antibody titres were controlled for, the frequencies of fourfold or greater increases in neutralizing antibodies did not differ significantly between the three groups that received vaccine by aerosol (range 52%-64%), but they were significantly higher than those for the three groups that received injected vaccine (range 4%-23%). Mean increases in titres and post-vaccination geometric mean titres paralleled these findings. Fewer side-effects were noted after aerosol than injection administration of vaccine. CONCLUSION: Immunogenicity of measles vaccine when administered by aerosol is superior to that when the vaccine is given by injection. This advantage persists with aerosolized doses less than or equal to one-fifth of usual injected doses. The efficacy and cost-effectiveness of measles vaccination by aerosol should be further evaluated in mass campaigns.

Cobertura geográfica del sistema mexicano de salud y análisis espacial de la utilización de hospitales generales de la Secretaría de Salud en 1998 / Geographical coverage of the Mexican Healthcare System and a spatial analysis of utilization of its General Hospitals in 1998

Objetivo. Determinar la cobertura geográfica del Sistema Mexicano de Salud y analizar la utilización en 1998 de los hospitales de la Secretaría de Salud (SSA). Material y métodos. Se desarrolló un Sistema de Información Geográfica (SIG) con información sociodemográfica por localidad y ubicación espacial de unidades de atención de todo el sector salud, así como el registro de egresos por hospital de la SSA. Se determinó la utilización en 217 hospitales generales de la SSA mediante un modelo de estimación de máxima verosimilitud, que incluyó información sobre los recursos humanos, la infraestructura adicional y la población 25 km a la redonda. Resultados. En 1998, 10 806 localidades con 72 millones de habitantes contaban con al menos una unidad de atención de salud del sector público y 97.2 por ciento de la población se encontraba a menos de 50 km de una, pero más de 18 millones de personas vivían en localidades rurales sin unidades de atención. El promedio de ocupación fue de 48.5±28.5 por cada 100 camas/año, con gran variabilidad intra e interestatal. La utilización se asoció significativamente con el número de los médicos en la unidad, y en unidades del Instituto Mexicano del Seguro Social con la infraestructura adicional e índice de marginación. Conclusiones. La utilización del SIG eleva la capacidad analítica y proporciona estimadores más realistas de la cobertura y utilización de hospitales del sector