Variables sociofamiliares asociadas a mayor riesgo de sobrepeso y obesidad abdominal en niños escolares de un servicio de pediatría en Colima, México / Socio-family variables associated with a higher risk of overweight and abdominal obesity in school children from a pediatric service at Colima, Mexico

Con el fin de identificar la asociación entre factores familiares (estructura, funcionalidad y contexto socioeconómico) y la presencia de sobrepeso y obesidad abdominal en escolares, se realizó un estudio transversal analítico en 120 niños escolares (5-11 años) y sus madres que acudieron a un servicio de atención pediátrica en la ciudad de Colima, México. El sobrepeso se definió con el indicador IMC con un puntaje Z > +1 desviación estándar y la obesidad abdominal como circunferencia de cintura > del percentil 75 por sexo y edad. Se evaluó tamaño y tipo de familia, tipo de hogar, relación de los padres y funcionalidad familiar. Las asociaciones se analizaron con regresión logística múltiple. Se encontró 33% de sobrepeso y 33,7% de obesidad abdominal. El menor tamaño de la familia, la mayor marginalidad de la colonia (barrio) de residencia, la percepción de problemas en la economía familiar, el mayor peso al nacer y la mayor edad se asociaron con el sobrepeso. Mientras que el menor tamaño de la familia, el mayor peso al nacer y la mayor edad se asociaron con obesidad abdominal. Para programas de prevención de sobrepeso y obesidad abdominal, sugerimos incluir un enfoque de sistemas familiares que considere el tamaño de la familia y variables del contexto socioeconómico, ya que condicionan su dinámica de interacción(AU)

To identify the association between family factors (structure, functionality, and socioeconomic context) and the presence of overweight and abdominal obesity in school children, an analytical cross-sectional study was performed in 120 schoolchildren (5-11 years old) and their mothers assisting to a pediatric care service at Colima City, Mexico. Overweight was defined with the BMI indicator with a Z-score > +1 standard deviation and abdominal obesity as a waist circumference > 75th percentile by sex and age. Family size and type, type of home, parents' relationship, and family functionality were evaluated. Associations were analyzed with multiple logistic regression. Overweight was present in 33%, and abdominal obesity in 33.7% of the children. A smaller family size, greater neighborhood marginality, a perception of problems in the family economy, a larger birth weight and older age were associated with overweight. A smaller family size, higher birth weight and older age were associated with abdominal obesity. We suggest a family systems approach, including family size and variables of socioeconomic context -which determine their interaction dynamics-, in programs for overweight and abdominal obesity prevention(AU)

Obstetric complications of dengue and chikungunya in the pregnant patient: case-control study / Complicaciones obstétricas del dengue y la chikungunya en la paciente embarazada: estudio de casos y controles

Background: Dengue and chikungunya infections are transmitted by the Aedes aegypti vector; they can affect the pregnant woman and her gestation product. Objective: To identify if dengue and chikungunya infections during pregnancy are factors associated with the presence of obstetric complications, in Colima, Mexico. Methods: We included in this study 45 patients with obstetric complications and 90 without complications, selected by a two-stage sampling. We collected the sociodemographic, anthropometric, gynecological, and obstetric complications' data. Descriptive statistics, non-parametric significance tests and crude and adjusted risk estimates (odds ratio [OR] and 95% confidence intervals [95% CI]) were calculated. Results: Out of 135 patients included, 15 had a diagnosis of dengue and 20 of chikungunya. There were obstetric complications in 60% of infected patients with chikungunya, 46.7% with dengue and 26% of non-infected (p = 0.007). Chikungunya infection (adjusted OR = 1.6) and antecedents of abortion and cesarean section (adjusted OR = 2.2) were independent risk factors associated with the presence of complications. Dengue had an adjusted OR = 1.3 without a statistically significant difference. Conclusions: Chikungunya infection and antecedents of abortion and cesarean section are risk factors associated with obstetric complications. Their timely detection is a priority as a preventive strategy.

Introducción: las infecciones por dengue y chikungunya son transmitidas por el vector Aedes aegypti y pueden afectar a la mujer embarazada y al producto de su gestación. Objetivo: identificar si las infecciones por dengue y chikungunya durante el embarazo son factores asociados a la presencia de complicaciones obstétricas, en Colima, México. Material y métodos: se incluyeron 45 pacientes con complicaciones obstétricas y 90 sin complicaciones. Su selección fue por muestreo bietápico. Se recolectaron datos sociodemográficos, antropométricos, ginecoobstétricos y de complicaciones obstétricas. Se calcularon estadísticos descriptivos, pruebas de significación no paramétricas y estimaciones de riesgo crudas y ajustadas (razón de momios [RM] e intervalos de confianza al 95% [IC 95%]). Resultados: de 135 pacientes incluidas, 15 tuvieron diagnóstico de dengue y 20 de chikungunya. Hubo complicaciones obstétricas en 60% de pacientes infectadas con chikungunya, en 46.7% con dengue y en 26% de no infectadas (p = 0.007). La infección por chikungunya (RM ajustada = 1.6) y el antecedente de aborto y cesárea (RM ajustada = 2.2) fueron factores de riesgo independientes que estuvieron asociados a la presencia de complicaciones. El dengue tuvo una RM ajustada = 1.3 sin una diferencia estadísticamente significativa. Conclusiones: la infección por chikungunya y el antecedente de aborto y cesárea son factores de riesgo asociados a complicaciones obstétricas. Su detección oportuna es prioritaria como estrategia preventiva.

[Association of the network and social influence with tobacco use in high school students]. / Asociación de la red y la influencia social con el consumo de tabaco en estudiantes de bachillerato.

Objective: to associate network and social influence with tobacco use in high school students. Methods: comparative cross sectional study. Four hundred and eighty six students participated. A questionnaire about social networks and social influence on tobacco use was applied. Results: student tobacco users were less integrated to the student network than non-users and were perceived to be looking for greater popularity among their clasemates. Conclusions: a lower average of out closeness between the sender and the receptor and a higher average of perceived popularity were associated significantly with past and current tobacco use. Health promotion actions should include strategies encouraging greater integration of these users into the student network and change the popularity perception related to use in order to promote an environment of less consumption.

Objetivo: asociar la red e influencia social con el consumo de tabaco en estudiantes de bachillerato. Métodos: estudio transversal comparativo. Participaron 486 estudiantes en junio 2003. Se aplicó cuestionario de redes e influencia social y consumo de tabaco. Resultados: los estudiantes consumidores de tabaco estuvieron menos integrados a la red escolar que los no consumidores y percibieron buscar mayor popularidad entre sus pares. Conclusiones: el menor promedio de cercanía enviada y el mayor promedio de popularidad percibida se asociaron significativamente con el consumo alguna vez y actual de tabaco. Las acciones de promoción de la salud deberían incluir estrategias para favorecer la mayor integración de los consumidores a la red escolar y el cambio de su percepción de popularidad relacionada con el consumo a fin de promover un ambiente de menor consumo.

[Multivariate model to predict Streptococcus pyogenes tonsillitis]. / Modelo multivariado para predecir amigdaltis estreptócócica.

OBJECTIVE: to develop a multivariate model to predict the Streptococcus pyogenes isolation in patients with acute tonsillitis. METHODS: cross-sectional analytic study on patients with acute tonsillitis without a recent history of antimicrobial consumption. We evaluated 14 signs and 18 symptoms. A pharyngeal culture was realized on 5% sheep blood agar. Group A streptococci was identified by standard methods. STATISTICAL ANALYSIS: sensitivity, specificity, predictive values, chi2, Fisher's exact test, crude and adjusted odds ratio (OR) with 95% CI using dichotomical logistic regression with direct method and Hosmer and Lemeshow-goodness-fit test. RESULTS: there were 213 participants, 37% were males; a mean age of 14.9 years. We isolated Streptococcus pyogenes in 15%, and 84 % of them had received antimicrobials. We identified signs and symptoms associated with Streptococcus pyogenes isolation: painful swallowing (OR=4.45, 95% CI = 1.13-17.53); tonsils with exudates (OR=3.20, 95% CI = 1.22-8.43); smelly breath (OR=2.78, 95% CI = 1.09-7.10); painful neck nodes (OR=2.70, 95% CI = 1.05-6.96). The presence of nasal symptoms was a protective factor (OR=0.25, 95% CI = 0.09-0.71). CONCLUSIONS: the prevalence of Streptococcus pyogenes tonsillitis was similar to other reports. We found signs and symptoms associated to Streptococcus pyogenes isolation that allowed us to elaborate a decision algorithm.

Interpersonal relationships and group A streptococcus spread in a Mexican day-care center.

OBJECTIVE: To study the effect of different degrees of centrality on the carrying of identical group A streptococcus (GAS) clones in the nasopharynx of children from a Mexican public day-care center. MATERIAL AND METHODS: Nasopharyngeal cultures were performed in children from rooms B (RB) (n = 35) and C (RC) (n = 37). The Restriction Fragment Length Polymorphism (RFLP) patterns were compared among GAS isolates. A social networks questionnaire was filled out for each child and 10 classmates. Structure coefficients were compared among children with and without GAS. RESULTS: Four GAS clones were identified; clone I in five children from RC; clone II in two from RC and one from RB; clone III in one from RB and one from RC; and clone IV in one from RC. Social network structure: Density of RB and RC = 0.40 (+/- 0.87) and 0.35 (+/- 0.80), respectively. In RB, the homophily pattern of interaction was different in carriers (0.00), non-carriers (0.47) and both (0.47) p = 0.35. In RC, the homophily pattern was also different in carriers (0.46), non-carriers (0.68) and mixed (0.19), p = .001. In 4/5 with clone I, the values of degree, closeness and betweenness were above the group mean. In 3/3 with clone II, the values of degree and betweenness were also above the mean. In contrast, in those with clone III and IV, the values of degree, closeness and betweenness were below the group mean. CONCLUSION: The spread of specific GAS clones was associated with groups of children having a high proportion of ties and a high centrality level. This is evidence that spread of GAS strains among children attending day-care centers is not random but dependent on the degree of communication and physical contact between pairs.

Interpersonal relationships and group A streptococcus spread in a Mexican day-care center

OBJECTIVE: To study the effect of different degrees of centrality on the carrying of identical group A streptococcus (GAS) clones in the nasopharynx of children from a Mexican public day-care center. MATERIAL AND METHODS: Nasopharyngeal cultures were performed in children from rooms B (RB) (n = 35) and C (RC) (n = 37). The Restriction Fragment Length Polymorphism (RFLP) patterns were compared among GAS isolates. A social networks questionnaire was filled out for each child and 10 classmates. Structure coefficients were compared among children with and without GAS. RESULTS: Four GAS clones were identified; clone I in five children from RC; clone II in two from RC and one from RB; clone III in one from RB and one from RC; and clone IV in one from RC. Social network structure: Density of RB and RC = 0.40 (± 0.87) and 0.35 (± 0.80), respectively. In RB, the homophily pattern of interaction was different in carriers (0.00), non-carriers (0.47) and both (0.47) p = 0.35. In RC, the homophily pattern was also different in carriers (0.46), non-carriers (0.68) and mixed (0.19), p = .001. In 4/5 with clone I, the values of degree, closeness and betweenness were above the group mean. In 3/3 with clone II, the values of degree and betweenness were also above the mean. In contrast, in those with clone III and IV, the values of degree, closeness and betweenness were below the group mean. CONCLUSION: The spread of specific GAS clones was associated with groups of children having a high proportion of ties and a high centrality level. This is evidence that spread of GAS strains among children attending day-care centers is not random but dependent on the degree of communication and physical contact between pairs.

OBJETIVO: Evaluar el efecto de grados diferentes de centralidad con la presencia de clonas idénticas de estreptococo del grupo A (EGA) en la nasofaringe de niños de una guardería pública de México. MATERIAL Y MÉTODOS: Se realizaron cultivos nasofaríngeos en niños de los salones B (SB) (n = 35) y C (SC) (n = 37). El patrón de polimorfismos de longitud de fragmento por restricción (Restriction Fragment Length Polymorphism, RFLP) fue comparado entre aislamientos de EGA. Un cuestionario de redes sociales fue llenado para cada niño y 10 compañeros. Los coeficientes de estructura fueron comparados entre niños con y sin EGA. RESULTADOS: Se identificaron cuatro clonas de EGA. Clona I en cinco niños del SC; clona II en dos del SC y en uno del SB; clona III en uno del SB y uno del SC; y clona IV en uno del SC. Estructura de redes sociales: Densidad SB y SC = 0.40 (± 0.87) y 0.35 (± 0.80), respectivamente. En SB, el patrón de homofilia de la interacción fue distinto en portadores (0.00), no portadores (0.47) y ambos (0.47) p = 0.35. En SC, el patrón de homofilia fue distinto en portadores (0.46), no portadores (0.68) y mixto (0.19), p = .001. En 4/5 con la clona I, los valores de grado, cercanía e intermediación estuvieron por arriba de la media grupal. En 3/3 con la clona II, los valores de grado e intermediación estuvieron por arriba de la media grupal. En contraste, en los niños con clonas III y IV, los valores de grado, cercanía e intermediación estuvieron por debajo de la media grupal. CONCLUSIONES: La diseminación de clonas específicas de EGA se asoció a grupos de niños con gran proporción de lazos entre ellos y un alto nivel de centralidad. Esto evidencia que la transmisión de EGA entre niños de guardería no ocurre al azar sino que depende del grado de comunicación y contacto físico entre éstos.