[Use of antibiotics, in a pediatric hospital, for respiratory infection and diarrheal disease]. / Uso de antibióticos, en hospital pediátrico, para infección respiratoria y enfermedad diarreica.

Background: The World Health Organization (WHO) reports an increasing unjustified use of antibiotics in the treatment of Acute Respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) in children under five years of age. This has generated problems such as polypharmacy and the inappropriate use of antibiotics; characterized by incorrect dosage, use in viral infections, prescription inconsistent with clinical guidelines. Objective: To analyze the prescription of antibiotics, their diagnostic-therapeutic congruence, as well as the correct filling of the medical prescription, in a tertiary level hospital in Mexico. Material and methods: Observational, descriptive cross-sectional study. The electronic medical prescriptions made during the period January-December 2017 with a clinical diagnosis of ARI and EDA were analyzed. Results: Of a total of 21,446 boys and girls under five years of age, 10,233 prescriptions were issued for the treatment of ARI and ADD diagnoses. 80% of the prescriptions complied with the items indicated in the electronic file. Conclusions: The prescription of antibiotics showed a prudent use of antibiotics both in the management of acute diarrheal diseases and in the management of acute respiratory diseases. Diagnostic-therapeutic congruence was found in most of the cases in the prescriptions analyzed.

Introducción: la Organización Mundial de Salud (OMS) reporta un creciente uso injustificado de antibióticos en el tratamiento de las infecciones respiratorias agudas (IRA) y las enfermedades diarreicas agudas (EDA) en menores de cinco años de edad. Lo anterior ha generado problemas como la polifarmacia y el uso inapropiado de antibióticos, caracterizado por dosis incorrectas, uso en infecciones virales y prescripción incongruente con las directrices clínicas. Objetivo: analizar la prescripción de antibióticos, su congruencia diagnóstico-terapéutica, así como el correcto llenado de la receta médica, en un hospital de tercer nivel de México. Material y métodos: estudio transversal observacional, descriptivo. Se analizó las recetas médicas electrónicas realizadas durante el periodo enero-diciembre de 2017 con diagnóstico clínico de IRA y EDA. Resultados: de un total de 21,446 niños y niñas menores de cinco años se otorgaron 10, 233 recetas para el tratamiento de los diagnósticos de IRA y EDA. El 80% de las recetas cumplieron con de los rubros indicados en el expediente electrónico. Conclusiones: la prescripción de antibióticos mostró un uso prudente de antibióticos tanto en el manejo de las enferdades diarreicas agudas como en el manejo de las enfermedades respiratorias agudas. Se encontró, en la mayoría de los casos, congruencia diagnóstico-terapéutica en las prescripciones analizadas.

Latent Class Analysis of Polysubstance Use and Sexual Risk Behaviors among Men Who Have Sex with Men Attending Sexual Health Clinics in Mexico City.

Men who have sex with men (MSM) are more likely to use drugs and other substances compared to their heterosexual peers. No studies have evaluated patterns of substance use among MSM adults in Mexico. We used latent class analysis (LCA) to identify MSM subgroups with specific substance use patterns and their associations with sexual behaviors. METHODS: Data from 1850 adult MSM were collected at HIV clinics in Mexico City between September 2018 and December 2019. The structural equation modeling approach was used to estimate a LC model to identify patterns of substance use by self-report of substance use (i.e., cigarette smoking, alcohol, and drugs). To evaluate LC membership, we included HIV status, condomless anal sex (CAS), and serosorting, while controlling for demographic variables. RESULTS: 30.3% were under the age of 22. Alcohol use in last 30 days (76.2%), binge drinking (29.2%), marijuana (29.4%), sex-drugs (23.9%), stimulants (13.7%), and depressants (6.3%). MSM reported engaging in CAS (55.9%) and serosorting (13.5%) behaviors, and 40% reported being HIV positive. LCA indicated three general categories of MSM substance users: Class 1 (49.0%), Class 2 (29.8%), and Class 3 (20.4%). Members of Class 3 were younger: 23-28 age years (aOR = 1.86) and 29-33 age years (aOR = 1.86), more educated: completed graduate studies (aOR = 1.60), had a high probability of polysubstance use and were more likely to engage in CAS and serosorting. CONCLUSIONS: Attempts to detect alcohol and problematic use of substances are needed for MSM followed by culturally competent approaches that address alcohol and drug use disorders.

Uptake of the HPV vaccine among people with and without HIV, cisgender and transgender women and men who have sex with men and with women at two sexual health clinics in Mexico City.

Our aim was to better understand Human Papillomavirus (HPV) vaccine acceptance among Mexican adults including people with and without HIV, cisgender men who have sex with men (MSM) or with women (MSW), cisgender and transgender women. A computer-assisted, self-administered questionnaire was completed by healthcare users and participants recruited through community organizations, and the first dose of the quadrivalent HPV vaccine was offered at no cost at a large sexual health clinic in Mexico City, from May to December 2018. Socio-demographic characteristics and factors associated with HPV vaccine acceptance were analyzed using logistic regression.The sample of 1915 participants included 1341 cisgender men (70.9%, 1247 MSM and 94 MSW), 396 (20.7%) cisgender women and 178 (9.3%) transwomen; 615 people (32.1%) were HIV positive. Uptake of the HPV vaccine was higher in men and transwomen (91.5% and 87%, respectively) than among cisgender women (81.8%; p < .001). Cisgender women (OR 0.43, 95%CI 0.30-0.61, p < .05) were less likely to accept HPV vaccination than men. Married/partnered people were less likely to accept HPV vaccination compared to those who were single (OR 0.70, 95%CI 0.51-0.97). People living with HIV were not significantly more likely to accept HPV vaccination (OR 1.7; 95%CI 0.86-1.61).HPV vaccine acceptance was high among adult Mexican study participants; it may be higher than among other Mexican adults given most of these individuals are engaged in care. Modifications will be needed in national and international recommendations on HPV vaccination in adults if healthcare personnel are to recommend the vaccine to the population groups studied.

HPV vaccine acceptance is high among adults in Mexico, particularly in people living with HIV / Aceptación de la vacuna contra VPH es alta entre adultos en México, especialmente en personas con VIH

Abstract: Objective. To measure HPV vaccine acceptance in diverse Mexican adult popula­tions, taking into account HIV status. Materials and methods: A total of 1 329 men and women, with and without HIV, participated in one of three intervention studies, offering HPV vaccination, carried out in the states of Morelos, Tlaxcala and Mexico City; either the bivalent (Morelos n=103, Tlaxcala n=127) or quadrivalent HPV-vaccine (Mexico City n=1 099) was offered. Results: HPV vaccine was accepted by 80.3% of participants; acceptance was higher in people living with HIV than those without (84.4 vs. 78%, p=0.004). Women had greater HPV infection knowledge (p<0.0001) than men and slightly higher (p=0.4) vaccine acceptance. The main reason for vaccine non-acceptance among HIV-positive participants was their doctor recommended they not get vaccinated. Conclusion: Acceptance of HPV-vaccine was high in men and women regardless of HIV status. Even higher rates of acceptability may be achieved by educating healthcare providers to recommend HPV vaccine to their patients.

Resumen: Objetivo. Medir la aceptación de la vacuna de VPH en una muestra diversa de población adulta mexicana, teniendo en cuenta su estado de VIH. Material y métodos: 1 329 hombres y mujeres con y sin VIH participaron en tres estudios de intervención, realizados en los estados de Morelos, Tlaxcala y Ciudad de México. Se ofreció la vacuna bivalente (Morelos n=103, Tlaxcala n=127) o la cuadrivalente (Ciudad de México n=1 099) contra VPH. Resultados: La vacuna fue aceptada por 80.3% de los participantes; la aceptación fue mayor en personas que viven con VIH que en aquéllas que no (84.4 vs. 78%, p=0.004). Las mujeres (p<0.0001) tenían mayor conocimientos sobre VPH que los hombres y una aceptación de la vacuna ligeramente mayor (p=0.4). El motivo principal de la no aceptación de la vacuna entre personas con VIH fue que su médico recomendó que no se vacunaran. Conclusión: La aceptación de la vacuna contra el VPH fue alta en hombres y mujeres, independientemente del estado de VIH. Se pueden lograr mayores tasas de aceptabilidad educando a los proveedores de atención médica para que recomienden la vacuna contra el VPH a sus pacientes.

Prevention and control of neoplasms associated with HPV in high-risk groups in Mexico City: The Condesa Study / Prevención y control de neoplasias asociadas a VPH en grupos de alto riesgo de la Ciudad de México: el Estudio Condesa

Abstract: Objective: To evaluate the effectiveness of a combined strategy of human papillomavirus virus (HPV) vaccination and high-risk HPV screening to reduce the occurrence of anogenital and oropharyngeal neoplasms among men who have sex with men, people with HIV, homeless people, transgender women, female sex workers and rape victims. Materials and methods: This mixed methods study evaluates the effectiveness of a combined vaccination-screening strategy to reduce HPV prevalence/incidence and occurrence of cervical intraepithelial neoplasms grade 2+ and/or anal intraepithelial neoplasms grade 2+, using Kaplan-Meier. The time-to-event method will evaluate time from positive results for specific anogenital HPV to incidence of anogenital lesions containing that HPV type. Results: People vaccinated against HPV and screened for HPV as a primary test will have lower prevalence and incidence of HPV infection and consequently lower frequency of HPV-related anogenital and oropharyngeal lesions. Conclusions: This study will generate scientific evidence on effectiveness of a combined vaccination-screening strategy to reduce the burden of HPV-associated neoplasms.

Resumen: Objetivo: Evaluar la efectividad de una estrategia combinada de vacunación contra el virus de papiloma humano (VPH) y tamizaje de VPH de alto riesgo para reducir neoplasias anogenitales y orofaringeas entre hombres que tienen sexo con hombres, personas con VIH, personas en situación de calle, mujeres transgénero, trabajadoras sexuales y víctimas de violación. Material y métodos: Este estudio evaluará la efectividad de una estrategia combinada de vacunación y tamizaje para reducir la ocurrencia de neoplasias intraepiteliales cervicales grado 2+ o neoplasias intraepiteliales anales grado NIA2+ utilizando Kaplan-Meier. Se evaluará tiempo de resultados positivos para tipos específicos de VPH anogenital a incidencia de lesiones anogenitales con ese tipo de VPH. Resultados: Las personas vacunadas contra VPH y con tamizaje de VPH tendrán menor prevalencia e incidencia de infecciones por VPH y por ende menor frecuencia de lesiones anogenitales y orofaringeas relacionadas con VPH. Conclusiones: Este estudio generará evidencia científica sobre la efectividad de una estrategia combinada de vacunación y tamizaje para reducir la carga de neoplasias asociadas al VPH.

HPV vaccine acceptance is high among adults in Mexico, particularly in people living with HIV.

OBJECTIVE: To measure HPV vaccine acceptance in diverse Mexican adult popula-tions, taking into account HIV status. MATERIALS AND METHODS: A total of 1 329 men and women, with and without HIV, participated in one of three intervention studies, offering HPV vaccination, carried out in the states of Morelos, Tlaxcala and Mexico City; either the bivalent (Morelos n=103, Tlaxcala n=127) or quadrivalent HPV-vaccine (Mexico City n=1 099) was offered. RESULTS: HPV vaccine was accepted by 80.3% of participants; acceptance was higher in people living with HIV than those without (84.4 vs. 78%, p=0.004). Women had greater HPV infection knowledge (p<0.0001) than men and slightly higher (p=0.4) vaccine acceptance. The main reason for vaccine non-acceptance among HIV-positive participants was their doctor recommended they not get vaccinated. CONCLUSIONS: Acceptance of HPV-vaccine was high in men and women regardless of HIV status. Even higher rates of acceptability may be achieved by educating healthcare providers to recommend HPV vaccine to their patients.

OBJETIVO: Medir la aceptación de la vacuna de VPH en una muestra diversa de población adulta mexicana, teniendo en cuenta su estado de VIH. MATERIAL Y MÉTODOS: 1 329 hombres y mujeres con y sin VIH participaron en tres estudios de intervención, realizados en los estados de Morelos, Tlaxcala y Ciudad de México. Se ofreció la vacuna bivalente (Morelos n=103, Tlaxcala n=127) o la cuadrivalente (Ciudad de México n=1 099) contra VPH. RESULTADOS: La vacuna fue aceptada por 80.3% de los participantes; la aceptación fue mayor en personas que viven con VIH que en aquéllas que no (84.4 vs. 78%, p=0.004). Las mujeres (p<0.0001) tenían mayor conocimientos sobre VPH que los hombres y una aceptación de la vacuna ligeramente mayor (p=0.4). El motivo principal de la no aceptación de la vacuna entre personas con VIH fue que su médico recomendó que no se vacunaran. CONCLUSIONES: La aceptación de la vacuna contra el VPH fue alta en hombres y mujeres,independientemente del estado de VIH. Se pueden lograr mayores tasas de aceptabilidad educando a los proveedores de atención médica para que recomienden la vacuna contra el VPH a sus pacientes.

Prevention and control of neoplasms associated with HPV in high-risk groups in Mexico City: The Condesa Study.

OBJECTIVE: To evaluate the effectiveness of a combined strategy of human papillomavirus virus (HPV) vaccination and high-risk HPV screening to reduce the occurrence of anogenital and oropharyngeal neoplasms among men who have sex with men, people with HIV, homeless people, transgender women, female sex workers and rape victims. MATERIALS AND METHODS: This mixed methods study evaluates the effectiveness of a combined vaccination-screening strategy to reduce HPV prevalence/incidence and occurrence of cervical intraepithelial neoplasms grade 2+ and/or anal intraepithelial neoplasms grade 2+, using Kaplan-Meier. The time-to-event method will evaluate time from positive results for specific anogenital HPV to incidence of anogenital lesions containing that HPV type. RESULTS: People vaccinated against HPV and screened for HPV as a primary test will have lower prevalence and incidence of HPV infection and consequently lower frequency of HPV-related anogenital and oropharyngeal lesions. CONCLUSIONS: Thisstudy will generate scientific evidence on effectiveness of a combined vaccination-screening strategy to reduce the burden of HPV-associated neoplasms.

OBJETIVO: Evaluar la efectividad de una estrategia combinada de vacunación contra el virus de papiloma humano (VPH) y tamizaje de VPH de alto riesgo para reducir neoplasias anogenitales y orofaringeas entre hombres que tienen sexo con hombres, personas con VIH, personas en situación de calle, mujeres transgénero, trabajadoras sexuales y víctimas de violación. MATERIAL Y MÉTODOS: Este estudio evaluará la efectividad de una estrategia combinada de vacunación y tamizaje para reducir la ocurrencia de neoplasias intraepiteliales cervicales grado 2+ o neoplasias intraepiteliales anales grado NIA2+ utilizando Kaplan-Meier. Se evaluará tiempo de resultados positivos para tipos específicos deVPH anogenital a incidencia de lesiones anogenitales con ese tipo de VPH. RESULTADOS: Las personas vacunadas contra VPH y con tamizaje de VPH tendrán menor prevalencia e incidencia de infecciones por VPH y por ende menor frecuencia de lesiones anogenitales y orofaringeas relacionadas con VPH. CONCLUSIONES: Este estudio generará evidencia científica sobre la efectividad de una estrategia combinada de vacunación y tamizaje para reducir la carga de neoplasias asociadas al VPH.

Validity of self-reported anthropometry in adult Mexican women.

OBJECTIVE:: To compare direct and self-reported anthropometry in Mexican women. MATERIALS AND METHODS:: Women aged 30-72 years, participating in the Mexican Teachers' Cohort, completed a questionnaire with their anthropometric data in 2006-2008. After eleven months (median time), technicians performed anthropometry in 3756 participants. We calculated correlations and multivariable-adjusted mean differences between direct and self-reported anthropometric measures. RESULTS:: Correlations between direct and self-reported anthropometric measures ranged from 0.78 (waist circumference) to 0.93 (weight). On average, women over-reported their height by 2.2 cm and underreported their weight, body mass index (BMI) and waist and hip circumferences by 1.3 kg, 1.3 kg/m2, 1.8 cm and 1.9 cm, respectively. Errors in self-reported anthropometry increased with rising measured BMI and were also independently associated with age, education and socioeconomic status. CONCLUSION:: Self-reported anthropometry is sufficiently valid for epidemiological purposes in adult Mexican women. Errors in self-reported anthropometry might result in underestimation of the prevalence of overweight and obesity.

Validity of self-reported anthropometry in adult Mexican women / Validez de la antropometría autorreportada en mujeres mexicanas adultas

Abstract: Objective: To compare direct and self-reported anthropometry in Mexican women. Materials and methods: Women aged 30-72 years, participating in the Mexican Teachers' Cohort, completed a questionnaire with their anthropometric data in 2006-2008. After eleven months (median time), technicians performed anthropometry in 3756 participants. We calculated correlations and multivariable-adjusted mean differences between direct and self-reported anthropometric measures. Results: Correlations between direct and self-reported anthropometric measures ranged from 0.78 (waist circumference) to 0.93 (weight). On average, women over-reported their height by 2.2 cm and underreported their weight, body mass index (BMI) and waist and hip circumferences by 1.3 kg, 1.3 kg/m2, 1.8 cm and 1.9 cm, respectively. Errors in self-reported anthropometry increased with rising measured BMI and were also independently associated with age, education and socioeconomic status. Conclusion: Self-reported anthropometry is sufficiently valid for epidemiological purposes in adult Mexican women. Errors in self-reported anthropometry might result in underestimation of the prevalence of overweight and obesity.

Resumen: Objetivo: Comparar antropometría directa y autorreportada en mujeres mexicanas. Material y métodos: Participantes de la cohorte ESMaestras completaron un cuestionario con sus datos antropométricos en 2006-2008. Once meses después (tiempo mediano), técnicos realizaron antropometría (n=3 756). Se calcularon correlaciones y diferencias de medias ajustadas entre medidas antropométricas directas y autorreportadas. Resultados: Las correlaciones entre medidas antropométricas directas y autorreportadas variaron entre 0.78 (circunferencia de cintura) y 0.93 (peso). En promedio, las mujeres sobrerreportaron su estatura en 2.2 cm y subreportaron su peso, índice de masa corporal (IMC) y circunferencias de cintura y cadera en 1.3 kg, 1.3 kg/m2, 1.8 cm y 1.9 cm, respectivamente. Los errores en la antropometría autorreportada se incrementaron a mayor IMC medido y se asociaron de manera independiente con edad, escolaridad y nivel socioeconómico. Conclusión: La antropometría autorreportada es suficientemente válida para fines epidemiológicos en mujeres mexicanas. Los errores en la antropometría autorreportada podrían originar subestimación de la prevalencia de sobrepeso y obesidad.

Conocimiento y creencias de mujeres del estado de Morelos sobre el virus del papiloma humano / Knowledge and beliefs of women from the state of Morelos about the human papilloma virus

Introducción: una enfermedad de transmisión sexual que afecta a un alto porcentaje de mujeres jóvenes de todo el mundo es la infección producida por virus papiloma humano. La falta de información asociada a diversos factores culturales, favorece el desarrollo de creencias que dificultan la prevención y diagnóstico oportunos. Objetivo: identificar el nivel de conocimiento y las creencias que tienen las mujeres del Estado de Morelos, México, sobre la transmisión, detección y tratamiento de la infección por virus del papiloma humano de acuerdo con la edad y el grado de escolaridad. Métodos: estudio descriptivo transversal a partir de un cuestionario aplicado a 690 mujeres en el estado de Morelos. Resultados: el nivel de conocimientos entre la mayoría de la población femenina fue de nivel medio, se incrementa en mujeres jóvenes y con mayor escolaridad. La creencia de que la detección de infección implica mayor gasto económico se presenta sin distinción de edad o nivel escolar. Conclusiones: los aspectos más conocidos sobre la infección por virus papiloma humano, es que es una infección de transmisión sexual, asociada a la aparición de verrugas en genitales y causante de cáncer cérvico uterino. Los menos conocidos son: que la infección es asintomática y que no existe tratamiento para eliminarla(AU)

Introduction: A sexually transmitted disease affecting a high percentage of young women worldwide in the infection produced by the human papilloma virus (HPV). The lack of information associated with different cultural factor favors the development of beliefs that limit timely prevention and diagnosis. Objective: Identify the level of knowledge and beliefs of women from the state of Morelos, Mexico, about the transmission, detection and treatment of HPV infection in accordance with their age and school level. Methods: Cross-sectional, descriptive study with a survey conducted on 690 women on the state of Morelos. Results: The level of knowledge among most of the female population was average, increased in young women and those with higher school level. The belief that infection detection implies higher economic spends is present regardless age and school level. Conclusions: The most known aspects about HPV are that it is a sexually transmitted infection, associated to the onset of genital warts and causing cervical cancer. The least known are that the infection is asymptomatic and that there is no treatment to eliminate it(AU)

Conocimiento y creencias de mujeres del estado de Morelos sobre el virus del papiloma humano / Knowledge and beliefs of women from the state of Morelos about the human papilloma virus

Introducción: una enfermedad de transmisión sexual que afecta a un alto porcentaje de mujeres jóvenes de todo el mundo es la infección producida por virus papiloma humano. La falta de información asociada a diversos factores culturales, favorece el desarrollo de creencias que dificultan la prevención y diagnóstico oportunos. Objetivo: identificar el nivel de conocimiento y las creencias que tienen las mujeres del Estado de Morelos, México, sobre la transmisión, detección y tratamiento de la infección por virus del papiloma humano de acuerdo con la edad y el grado de escolaridad. Métodos: estudio descriptivo transversal a partir de un cuestionario aplicado a 690 mujeres en el estado de Morelos. Resultados: el nivel de conocimientos entre la mayoría de la población femenina fue de nivel medio, se incrementa en mujeres jóvenes y con mayor escolaridad. La creencia de que la detección de infección implica mayor gasto económico se presenta sin distinción de edad o nivel escolar. Conclusiones: los aspectos más conocidos sobre la infección por virus papiloma humano, es que es una infección de transmisión sexual, asociada a la aparición de verrugas en genitales y causante de cáncer cérvico uterino. Los menos conocidos son: que la infección es asintomática y que no existe tratamiento para eliminarla(AU)

Introduction: A sexually transmitted disease affecting a high percentage of young women worldwide in the infection produced by the human papilloma virus (HPV). The lack of information associated with different cultural factor favors the development of beliefs that limit timely prevention and diagnosis. Objective: Identify the level of knowledge and beliefs of women from the state of Morelos, Mexico, about the transmission, detection and treatment of HPV infection in accordance with their age and school level. Methods: Cross-sectional, descriptive study with a survey conducted on 690 women on the state of Morelos. Results: The level of knowledge among most of the female population was average, increased in young women and those with higher school level. The belief that infection detection implies higher economic spends is present regardless age and school level. Conclusions: The most known aspects about HPV are that it is a sexually transmitted infection, associated to the onset of genital warts and causing cervical cancer. The least known are that the infection is asymptomatic and that there is no treatment to eliminate it(AU)

Assessment of the Validity and Reproducibility of the Pap Smear in Mexico: Necessity of a Paradigm Shift.

BACKGROUND AND AIMS: An assessment was performed of the quality of Pap readings in 19 cytology laboratories (CLs) in Mexico from the Cervical Cancer Screening Program. METHODS: Nine CLs were affiliated with the Health Ministry (SSA), and ten were affiliated with the Mexican Social Security Institute (IMSS). Two sets of 200 cervical cytology specimens were prepared, one set for each institution. Fourteen percent of the specimens were positive and six were inappropriate for diagnosis (3%). All cervical cytology specimens were processed in the cytopathology laboratory at the General Hospital of Mexico, and histopathology was available for each positive case. RESULTS: Thirty percent of the SSA reading centers had a sensitivity of at least 80%; however, not one of the ten IMSS laboratories evaluated reached this figure. Some reading centers had a sensitivity <65%, meaning that nearly half of the specimens with a cytology consistent with cervical neoplasm were not identified. DISCUSSION: Given these results, it is a priority to effect a paradigm shift combining various screening tests to improve adherence to standards and enhanced cost-effectiveness of the early detection of cervicouterine cancer (CC) in Mexico.

[Validity and reliability of mammographic interpretation by Mexican radiologists, using the BI-RADS system]. / Validez y reproducibilidad de la interpretación de la mamografía por radiólogos mexicanos, mediante el sistema BI-RADS.

OBJECTIVE: Mammographic interpretation using the BI-RADS system determines if a patient will continue in the regular screening program or needs additional studies for breast cancer diagnosis, hence the importance of its evaluation. Sensitivity, specificity, diagnostic accuracy of mammographic interpretation and inter- and intra-observer variation, were assessed in a random sample of 29 radiologists from the Mexican Ministry of Health. MATERIAL AND METHODS: Eighty diagnostic and screening mammographic studies were selected from the National Cancer Institute in Mexico City. Under the same conditions, two interpretations using the BI-RADS system were performed by each of the participating radiologists. RESULTS: Sensitivity in the first and second measurement was 72 and 74% respectively, while the specificity was 80% for the first and 82% for second. Multivariate analysis showed a positive association between the last year number of interpreted mammograms, the number of courses taken and diagnostic accuracy (beta=0.00002, 95% CI 0.000004, 0.00003, p=0.02, beta=0.005, CI 95% -0.0004, 0.01, p=0.07, respectively). Inter-observer agreement was low in both measurements (kappa=0.24, kappa=0.25, respectively). However, after combining BI-RADS categories in 2, agreement increased to 0.46 for both measurements. The intra-observer agreement was good (kappa=0.67). CONCLUSIONS: The number of mammographic studies interpreted the previous year is a good measure of the experience of the radiologist and is reflected in the diagnostic accuracy of mammographic interpretation. Courses on mammographic interpretation also have a positive impact on performance.

[Emergency contraception in Mexican students]. / Anticoncepción de emergencia en estudiantes mexicanos.

OBJECTIVE: To evaluate emergency contraception (EC) knowledge and use as well as identify factors associated to correct EC knowledge among public schools students in Morelos, Mexico. MATERIAL AND METHODS: Cross-sectional study conducted in 2003-2004 in a sample of 1,550 students (ages 14-24). Logistic regression was used to identify factors associated to EC correct knowledge. RESULTS: Among all, 40% were men and 60% women with an average age of 19 years. Sixty percent have heard about EC, nevertheless, only 45% have correct knowledge about it; 3% of sexually active students (43%) reported its use. Factors associated to EC correct knowledge are: being a woman (OR=1.66; CI 1,33, 2,06), being sexually active (OR=1.77; CI 1,43, 2,18), middle income (OR=1.87; CI 1,04, 3,37), living in a semi-urban zone (OR=1.34; CI 1,02, 1,77), drinking alcohol (OR=1.78; CI 1,42, 2,22). CONCLUSIONS: In Morelos, adolescents' knowledge of EC is scarce. Specific messages regarding its correct use are necessary.

Anticoncepción de emergencia en estudiantes mexicanos / Emergency contraception in mexican students

OBJETIVO: Evaluar el conocimiento y uso de anticoncepción de emergencia (AE), y factores asociados en estudiantes de escuelas públicas en Morelos, México. MATERIAL Y MÉTODOS: Estudio transversal realizado entre 2003-2004 con 1550 estudiantes de 14-24 años. Se utilizó regresión logística para identificar factores asociados al conocimiento correcto sobre AE. RESULTADOS: El 40 por ciento fueron hombres y 60 por ciento mujeres con edad promedio de 19 años. El 60 por ciento ha escuchado sobre AE pero únicamente 45 por ciento tiene conocimiento correcto; 3 por ciento de los estudiantes sexualmente activos la ha usado. Factores asociados al conocimiento correcto: ser mujer (RM=1.66; IC 1.33, 2.06), haber tenido relaciones sexuales (RM=1.77; IC 1.43, 2.18), nivel socioeconómico medio (RM=1.87; IC 1.04, 3.37), vivir en zona semi-urbana (RM=1.34; IC 1.02, 1.77), tomar alcohol (RM=1.78; IC 1.42, 2.22). CONCLUSIONES: En Morelos, el conocimiento de los adolescentes sobre la AE es escaso. La transmisión de mensajes claros sobre su forma precisa de uso resulta necesaria.

OBJECTIVE: To evaluate emergency contraception (EC) knowledge and use as well as identify factors associated to correct EC knowledge among public schools students in Morelos, Mexico. MATERIAL AND METHODS: Cross-sectional study conducted in 2003-2004 in a sample of 1550 students (ages 14-24). Logistic regression was used to identify factors associated to EC correct knowledge. RESULTS: Among all, 40 percent were men and 60 percent women with an average age of 19 years. Sixty percent have heard about EC, nevertheless, only 45 percent have correct knowledge about it; 3 percent of sexually active students (43 percent) reported its use. Factors associated to EC correct knowledge are: being a woman (OR=1.66; CI 1,33, 2,06), being sexually active (OR=1.77; CI 1,43, 2,18), middle income (OR=1.87; CI 1,04, 3,37), living in a semi-urban zone (OR=1.34; CI 1,02, 1,77), drinking alcohol (OR=1.78; CI 1,42, 2,22). CONCLUSIONS: In Morelos, adolescents' knowledge of EC is scarce. Specific messages regarding its correct use are necessary.

Decreasing cervical cancer mortality in Mexico: effect of Papanicolaou coverage, birthrate, and the importance of diagnostic validity of cytology.

BACKGROUND: The reduction in cervical cancer mortality in developed countries has been attributed to well-organized, population-based prevention and control programs that incorporate screening with the Papanicolaou (Pap) smear. In Mexico, there has been a decrease in cervical cancer mortality, but it is unclear what factors have prompted this reduction. METHODS: Using data from national indicators, we determined the correlation between cervical cancer mortality rates and Pap coverage, birthrate, and gross national product, using a linear regression model. We determined relative risk of dying of cervical cancer according to place of residence (rural/urban, region) using a Poisson model. We also estimated Pap smear coverage using national survey data and evaluated the validity and reproducibility of Pap smear diagnosis. RESULTS: An increase in Pap coverage (beta= -0.069) and a decrease in birthrate (beta=0.054) correlate with decreasing cervical cancer mortality in Mexico. Self-reported Pap smear rates in the last 12 months vary from 27.4% to 48.1%. Women who live in the central (relative risk, 1.04) and especially the southern (relative risk, 1.47) parts of Mexico have a greater relative risk of dying of cervical cancer than those who live in the north. There is a high incidence of false negatives in cervical cytology laboratories in Mexico; the percentage of false negatives varies from 3.33% to 53.13%. CONCLUSIONS: The decrease in cervical cancer mortality observed in Mexico is proportional to increasing Pap coverage and decreasing birthrate. Accreditation of cervical cytology laboratories is needed to improve diagnostic precision.

Reproductive and lifestyle factors associated with early menopause in Mexican women.

OBJECTIVE: The purpose of this study was to evaluate the relationship between certain reproductive and lifestyle factors and the occurrence of early natural menopause. MATERIAL AND METHODS: A case/control study was conducted on a basal population of 2510 women participating in the "Mexican Institute of Social Security health workers cohort study". Cases were defined as those women for whom natural menopause presented by age 47. Information was obtained through a self-administered questionnaire. RESULTS: The risk of early menopause is associated with short menstrual cycles [<26 days, OR = 3.79 (IC 95% 1.37-10.52)], a short period of oral contraceptives use [<1 year, OR = 2.63 (IC 95% 1.10-6.29)], a lower number of pregnancies [<2, OR = 1.63 (IC 95% 1.03-2.57)], low body mass index [< or =27 kg/m2, OR = 1.64 (IC 95% 1.10-2.43)], low schooling level [<6 years, OR = 3.02 (IC 95% 1.26-7.23)], smoking history [>15 cigarettes/day, OR = 2.7 (IC 95% 1.00-7.30)], and birth cohorts [> or =950, OR = 4.09 (IC 95% 2.62-6.39)]. CONCLUSIONS: The findings of this study suggest that both reproductive and lifestyle factors are significant elements in the occurrence of early menopause in Mexican women.

Reproductive and lifestyle factors associated with early menopause in Mexican women

OBJETIVO : Evaluar la relación entre factores reproductivos, estilo de vida y la ocurrencia de menopausia natural temprana.MATERIAL Y MÉTODOS : Un estudio de casos y controles fue conducido en una población basal de 2 510 mujeres participantes en la "Cohorte de trabajadores IMSS".Los casos fueron definidos como aquellas mujeres que presentaron la menopausia natural a los 47 años o menos.La información fue colectada a través de cuestionarios autoapicables.RESULTADOS: El riesgo de menopausia temprana está asociado con ciclos menstruales cortos [<26 días, RM=3.79 (IC 95%1.37-10.52)], poco tiempo de uso de anticonceptivos orales [<1 año, RM=2.63 (IC 95% 1.10-6.29)], bajo número de embarazos [<2, RM=1.63 (IC 95% 1.03-2.57)], índice de masa corporal bajo [< 27 kg/m2, RM=1.64 (IC 95% 1.10-2.43)], baja escolaridad [<6 años, RM=3.02 (IC 95% 1.26-7.23)], tabaquismo [>15 cigarros/día, RM=2.7 (IC 95% 1.00-7.30)], y cohorte de nacimiento [>1950, RM=4.09 (IC 95% 2.62-6.39)].CONCLUSIONES: Los hallazgos sugieren que tanto factores reproductivos como de estilo de vida son elementos significantes en la ocurrencia de la menopausia a edad temprana en mujeres mexicanas.