Internalizing and externalizing behaviors in high school adolescents in a northern border city of Mexico and their type of family / Conductas internalizantes y externalizantes en adolescentes de una escuela preparatoria en una ciudad fronteriza al norte de México y su tipo de familia

Objective: Identify externalizing and internalizing behaviors in high school adolescents in three schools in a northern border city in Mexico and their type of family. Design: Cross-sectional survey. Location: Three schools in the city of Tijuana, Mexico: two public and one private. Participants: 454 baccalaureate students 14–19 years old. Main measurements: We utilized Youth Self Report Scale, adapted and validated in Spanish, that measure internalization behaviors (anxiety, depression, isolation or somatic complaints), and externalization behaviors (verbal aggressiveness, delinquent behavior and attention-seeking). For dichotomous discrimination between deviant and nondeviant scores, we use the borderline clinical range by classifying YSR scale's T scores≥60, and to analyze the relationship between behavior problems or competencies and living or not in a nuclear family we utilized multiple logistic regression. Results: 55% were female, mean age 16.4 years±0.98, and 62.3% came from a nuclear family. Prevalence of internalizing behaviors was 15.6%, and externalizing behaviors 14.8%. Women had statistically higher mean scores in depressive, anxious and verbally aggressive behavior, somatic complaints, and thought problems. The prevalence of internalizing behaviors in adolescents with nuclear family was 11.7% (n=33), and for adolescents with another type of family was 22.2% (n=38), OR 2.17 (CI 95% 1.30–3.61, p=0.003), but no differences was observed for externalizing behaviors and family type. When adjusted for sex, age, and public or private school, internalizing behaviors and specifically depressive behavior remained significant. Conclusions: We detected a moderate prevalence of internalizing behaviors in Mexican adolescents, predominantly among women, and also observed that not living with a nuclear family increases the odds of presenting internalizing behaviors...(AU)

Objetivo: Identificar conductas internalizantes y externalizantes en adolescentes de escuelas preparatorias en una ciudad fronteriza al norte de México y su tipo de familia. Diseño: Encuesta transversal. Emplazamiento: Tres escuelas de la ciudad de Tijuana, México: dos públicas y una privada. Participantes: 454 estudiantes de preparatoria de 14-19 años de edad. Principales mediciones: Se utilizó la escala Youth Self Report validada al español, que mide conductas internalizantes (ansiedad, depresión, aislamiento y quejas somáticas) y externalizantes (agresión verbal, conducta delictiva y búsqueda de atención). Para la discriminación dicotómica entre puntajes desviados y no desviados, usamos el rango clínico límite al clasificar los T scores de ≥ 60 de la escala YSR, y para analizar la relación entre problemas de comportamiento o competencias y vivir o no en una familia nuclear utilizamos regresión logística múltiple. Resultados: El 55% eran mujeres, la media de edad fue de 16.4 años±0.98, y el 62.3% procedían de familias nucleares. La prevalencia de conductas internalizantes fue de 15.6% y de conductas externalizantes de 14.8%. Las mujeres tenían puntuaciones medias estadísticamente más altas en conducta depresiva, ansiosa y verbalmente agresiva, quejas somáticas y problemas de pensamiento. La prevalencia de conductas internalizantes en adolescentes con familia nuclear fue de 11.7% (n=33), y para adolescentes con otro tipo de familia fue de 22.2% (n=38), OR 2.17 (IC 95% 1.30-3.61, p=0.003), pero no se observaron diferencias para conductas externalizantes y tipo de familia. Al ajustar por sexo, edad y escuela pública o privada, las conductas internalizantes y específicamente la conducta depresiva se mantuvieron significativas...(AU)

Internalizing and externalizing behaviors in high school adolescents in a northern border city of Mexico and their type of family.

OBJECTIVE: Identify externalizing and internalizing behaviors in high school adolescents in three schools in a northern border city in Mexico and their type of family. DESIGN: Cross-sectional survey. LOCATION: Three schools in the city of Tijuana, Mexico: two public and one private. PARTICIPANTS: 454 baccalaureate students 14-19 years old. MAIN MEASUREMENTS: We utilized Youth Self Report Scale, adapted and validated in Spanish, that measure internalization behaviors (anxiety, depression, isolation or somatic complaints), and externalization behaviors (verbal aggressiveness, delinquent behavior and attention-seeking). For dichotomous discrimination between deviant and nondeviant scores, we use the borderline clinical range by classifying YSR scale's T scores≥60, and to analyze the relationship between behavior problems or competencies and living or not in a nuclear family we utilized multiple logistic regression. RESULTS: 55% were female, mean age 16.4 years±0.98, and 62.3% came from a nuclear family. Prevalence of internalizing behaviors was 15.6%, and externalizing behaviors 14.8%. Women had statistically higher mean scores in depressive, anxious and verbally aggressive behavior, somatic complaints, and thought problems. The prevalence of internalizing behaviors in adolescents with nuclear family was 11.7% (n=33), and for adolescents with another type of family was 22.2% (n=38), OR 2.17 (CI 95% 1.30-3.61, p=0.003), but no differences was observed for externalizing behaviors and family type. When adjusted for sex, age, and public or private school, internalizing behaviors and specifically depressive behavior remained significant. CONCLUSIONS: We detected a moderate prevalence of internalizing behaviors in Mexican adolescents, predominantly among women, and also observed that not living with a nuclear family increases the odds of presenting internalizing behaviors. It is important that parents, teachers, and healthcare workers remain vigilant to detect these problems in a timely manner and develop interventions to improve the mental health and well-being of adolescents.

Efecto del contexto, rutinas y funcionamiento en la salud de familias mexicanas con diabetes tipo 2

RESUMEN Objetivo: Explicar el efecto del contexto, rutinas y funcionamiento familiar en la salud de familias mexicanas donde un integrante padece Diabetes mellitus tipo 2 (DM2). Material y Métodos: Diseño transversal-correlacional; previo consentimiento informado el reclutamiento y recogida de datos fue entre enero a abril de 2015; participaron 60 díadas familiares (n=120), conformadas por persona con DM2 y cuidador familiar, entre 18 a 66 años, sin distinción de género, que hubieran convivido bajo el mismo techo al menos por un año y asistían a consulta en una institución de salud en México durante el 2015. El contexto familiar se midió con una cédula, dos escalas midieron rutinas, funcionamiento y salud familiar. Resultados: Predominaron las mujeres (64,2%), de 47,5 (±11,5) años de edad, con escolaridad de 7,2 años (± 4,4), los enfermos diagnosticados hace 11,5 años (± 8,4), con tratamiento desde hace 9,2 años (± 8,6). Se encontraron interrelaciones significativas entre las variables del contexto (edad, años de estudio, tiempo de diagnóstico y tratamiento), rutinas y funcionamiento con la salud familiar (todas entre p≤ ,0001 y p ≤ ,005). El funcionamiento explicó el 39,1% y las rutinas el 18,8% de la varianza de la salud familiar (R2 ajustada= , 391; F(1,118)= 77,4; p≤ ,0001; R2ajustada= ,188; F(1,118)= 28,6; p≤ ,0001). El funcionamiento explicó la varianza de rutinas en 19,3% (R2= ,193; F(1,118)= 28,1 p≤ ,0001). Conclusiones: La salud familiar se relaciona significativamente con el contexto, rutinas y funcionamiento de las díadas familiares que viven con diabetes tipo 2; además la salud familiar está influida significativamente por rutinas y funcionamiento familiar.

ABSTRACT Objective: To explain the effect of the context, routines and family functioning on the health of Mexican families where a member suffers from Type 2 Diabetes mellitus. Materials and Methods: Cross-correlational design; after prior informed consent, recruitment and data collection were carried out between January and April 2015. The sample included 60 family dyads (n = 120), consisting of a person with 2DM and a family caregiver, between 18 and 66 years old, without gender distinction, who had lived in the same home for at least one year and attended a consultation in a health institution in Mexico during 2015. The family context was measured with a card, two scales measured routines, family functioning and health. Results: There were more women (64.2%), aged 47.5 (± 11.5), with 7.2 years (± 4.4) of schooling; patients diagnosed 11.5 years ago (± 8.4), under treatment for 9.2 years (± 8.6). Significant interrelations were found between the context variables (age, years of study, diagnosis and treatment time), routines, and functioning regarding family health (all between p≤ .0001 and p ≤ .005). Functioning explained 39.1% and routines 18.8% of the family health variance (adjusted R2= .391; F (1.118) = 77.4 p≤ .0001; adjusted R2= .188; F (1.118) = 28.6 p≤ .0001). Functioning also explained the variance of routines in 19.3% (R2 = .193; F (1.118) = 28.1 p≤ .0001). Conclusions: Family health is significantly related to the context, routines and functioning of family dyads living with type 2 diabetes. In addition, family health is significantly influenced by routines and family functioning.

RESUMO Objetivo: Explicar o efeito do contexto, rotinas e funcionamento na saúde de famílias mexicanas onde um membro sofre de Diabetes mellitus Tipo 2 (DM2). Material e Métodos: Desenho transversal-correlacional; com consentimento informado prévio o recrutamento e coleta dos dados foram entre janeiro e abril de 2015; participaram 60 díades familiares (n = 120), formadas por pessoa com DM2 e cuidador familiar, entre 18 e 66 anos, sem distinção de gênero, que moraram na mesma casa por pelo menos um ano e que assistiam a uma consulta em uma instituição de saúde no México durante 2015. O contexto familiar foi medido com um cartão, duas escalas avaliaram as rotinas, o funcionamento e a saúde familiar. Resultados: Predominaram as mulheres (64,2%), de 47,5 (±11,5) anos, com escolaridade de 7,2 anos (± 4,4), as pessoas diagnosticadas há 11,5 anos (± 8,4), com tratamento há 9,2 anos (± 8,6). Foram encontradas inter-relações significativas entre as variáveis do contexto (idade, anos de estudo, tempo de diagnóstico e de tratamento), rotinas e funcionamento com a saúde familiar (todas entre p≤ ,0001 e p≤ ,005). O funcionamento explicou o 39,1% e as rotinas o 18,8% da variância da saúde familiar (R2ajustada= ,391; F(1,118)= 77,4 p≤ ,0001; R2 ajustada= ,188; F(1,118)= 28,6 p≤ ,0001). O funcionamento explicou a variância das rotinas em 19,3% (R2= ,193; F(1,118)= 28,1 p≤ ,0001). Conclusões: A saúde familiar está significativamente relacionada ao contexto, rotinas e funcionamento das díades familiares que vivem com diabetes tipo 2; além disso, a saúde familiar está significativamente influenciada por rotinas e funcionamento familiar.

Obesity, physical activity and prediabetes in adult children of people with diabetes.

OBJECTIVES: Determine prevalence of obesity / overweight, physical activity (PA) and prediabetes in adult children of parents with type 2 diabetes; identify differences according to sociodemographic variables, and describe the relationship of obesity/overweight with fasting glucose (FG) and glycosylated hemoglobin (A1C). METHODS: Cross-sectional study in 30 Mexican families with 53 participating adult children. Obesity / overweight was determined with Body Mass Index (BMI), Waist Circumference (WC) and body fat percentage (BFP); PA with the short International Physical Activity Questionnaire (IPAQ), and prediabetes with FG. RESULTS: 64% of participants presented obesity / overweight, 32% low PA, and 19% prediabetes. Men had higher WC than women (U= 219, p= 0.03). Women showed more BFP than men (U= 142, p <0.01). Blood glucose was related to BFP (rs= 0.336, p < 0.05), the A1C with the BMI (rs= 0.417, p <0.01), WC (rs= 0.394, p<0.01), BFP (rs= 0.494, p<0.01) and intense PA (rs= - 0.285, p<0.05). CONCLUSIONS: High prevalence of obesity / overweight and low PA were found. The FG was related only to BFP and A1C, in addition to BMI, WC and inversely with intense BP. It is recommended to modify the educational strategies of nursing at a family level.

Obesity, physical activity and prediabetes in adult children of people with diabetes / Obesidade, atividade física e pré-diabetes em filhos de pessoas com diabetes / Obesidad, actividad física y prediabetes en hijos de personas con diabetes

ABSTRACT Objectives: Determine prevalence of obesity / overweight, physical activity (PA) and prediabetes in adult children of parents with type 2 diabetes; identify differences according to sociodemographic variables, and describe the relationship of obesity/overweight with fasting glucose (FG) and glycosylated hemoglobin (A1C). Methods: Cross-sectional study in 30 Mexican families with 53 participating adult children. Obesity / overweight was determined with Body Mass Index (BMI), Waist Circumference (WC) and body fat percentage (BFP); PA with the short International Physical Activity Questionnaire (IPAQ), and prediabetes with FG. Results: 64% of participants presented obesity / overweight, 32% low PA, and 19% prediabetes. Men had higher WC than women (U= 219, p= 0.03). Women showed more BFP than men (U= 142, p <0.01). Blood glucose was related to BFP (rs= 0.336, p < 0.05), the A1C with the BMI (rs= 0.417, p <0.01), WC (rs= 0.394, p<0.01), BFP (rs= 0.494, p<0.01) and intense PA (rs= - 0.285, p<0.05). Conclusions: High prevalence of obesity / overweight and low PA were found. The FG was related only to BFP and A1C, in addition to BMI, WC and inversely with intense BP. It is recommended to modify the educational strategies of nursing at a family level.

RESUMO Objetivos: Determinar a prevalência de obesidade/sobrepeso, atividade física (AF) e pré-diabetes em filhos de pessoas com diabetes mellitus tipo 2; identificar diferenças de acordo com variáveis sociodemográficas e descrever a relação de obesidade/sobrepeso com a glicose em jejum (GJ) e a hemoglobina glicosilada (HbA1c). Métodos: Estudo transversal em 30 famílias mexicanas com 53 filhos participantes. A obesidade/sobrepeso foi determinada por meio do Índice de Massa Corporal (IMC), Circunferência da Cintura (CC) e percentual de gordura corporal (GC); a AF com o Questionário Internacional de Atividade Física curto (IPAQ) e pré-diabetes com a GJ. Resultados: 64% dos participantes apresentaram obesidade/sobrepeso, 32% baixa AF e 19% pré-diabetes. Os homens tiveram maior CC do que as mulheres (U= 219, p= 0.03). As mulheres mostraram mais GC do que os homens (U= 142, p <0.01). A glicose sanguínea esteve relacionada com a GC (rs= 0.336, p < 0.05), a HbA1c com o IMC (rs= 0.417, p <0.01), CC (rs= 0.394, p<0.01), GC (rs= 0.494, p<0.01) e AF intensa (rs= - 0.285, p<0.05). Conclusões: Foram encontradas altas prevalências de obesidade/sobrepeso e baixa AF. A GJ esteve relacionada somente com a GC e a HbA1c, além da GC, teve relação com o IMC, CC e de maneira inversa com a AF intensa. Recomenda-se modificar as estratégias educativas de enfermagem a nível familiar.

RESUMEN Objetivos: Determinar prevalencia de obesidad/sobrepeso, actividad física (AF) y prediabetes en hijos de personas con diabetes tipo 2; identificar diferencias de acuerdo a variables sociodemográficas y describir la relación de obesidad/sobrepeso con glucosa en ayuno (GA) y hemoglobina glucosilada (A1c). Métodos: Estudio transversal en 30 familias mexicanas con 53 hijos participantes. La obesidad/sobrepeso se determinó con Índice de Masa Corporal (IMC), Circunferencia de Cintura (CC) y porcentaje de grasa corporal (GC); la AF con el cuestionario IPAQ corto y prediabetes con GA. Resultados: 64% de los participantes presentó obesidad/sobrepeso, 32% baja AF y 19% prediabetes. Los hombres tuvieron mayor CC que las mujeres (U= 219, p= 0.03). Las mujeres mostraron más GC que los hombres (U= 142, p <0.01). La glucosa sanguínea estuvo relacionada con la GC (rs= 0.336, p < 0.05), la A1c con el IMC (rs= 0.417, p <0.01), CC (rs= 0.394, p<0.01), GC (rs= 0.494, p<0.01) y AF intensa (rs= - 0.285, p<0.05). Conclusiones: Se encontraron altas prevalencias de obesidad/sobrepeso y baja AF. La GA estuvo relacionada sólo con GC y la A1c además con el IMC, CC y de manera inversa con la AF intensa. Se recomienda modificar las estrategias educativas de enfermería a nivel familiar.

La precisión en la validación de escalas: un proceso continuo y perfectible

Estimado editor, En nuestro artículo (1), mostramos el proceso de adaptación cultural y validación que debería seguir cualquier traducción de escalas antes de que estas sean utilizadas en otro idioma y en otra población, siguiendo los procedimientos recomendados por diversos autores. Coincidimos en la importancia de promover y actualizar este tipo de metodologías para obtener mediciones más confiables, de modo que en el proceso de validación de la Escala de Competencia en el Cuidado del Pie y Comportamientos en el Cuidado de los Pies (FCC/FCB por sus siglas en inglés) realizamos un análisis factorial (AF) cuyo propósito fue valorar si la versión en español era un instrumento válido y confiable en la población que vive con diabetes y, al mismo tiempo comparar si esta versión obtenía puntuaciones psicométricas consistentes con la escala original en idioma inglés. En ese análisis reportamos que emergieron dos factores para el constructo de autoeficacia y seis para el de conductas...

Acculturative trajectories descriptions and implications for health among 12 Mexican deported women who inject drugs / Descripción de trayectorias aculturativas y sus implicaciones en salud en 12 mujeres deportadas que se inyectan drogas

INTRODUCTION: Between 1999-2007, the U.S. deported 4.8 million migrants to Mexico; of these, 1.1 million migrants were deported to the border city of Tijuana, Baja California. Deportees are often returned to unfamiliar communities where they may experience emotional and socioeconomic stressors that may raise their risk for engaging in unsafe behaviors. OBJECTIVE: This exploratory study describes adaptation to the post-deportation environment among Mexican-born injection drug-using women. METHOD: In 2008, we conducted qualitative interviews in Tijuana with 12 women reporting U.S. deportation. Our analytic framework focused on acculturation stress, adaptation and social capital in relation to HIV risk, considering a gender perspective. RESULTS: We found that the stress caused by the deportation experience and acclimating to the post-deportation community may have contributed to the women's participation in high-risk HIV behaviors (e.g., unprotected sex, sex work). Female deportees reported limited access to post-deportation social capital resources (e.g., social support, healthy social networks). Social factors (e.g., discrimination, lack of a government identification) challenged women's resettlement and likely contributed to economic and health vulnerabilities. DISCUSSION AND CONCLUSION: These preliminary findings suggest that deportees may benefit from organized services at repatriation, including mental health screening. Macro-level interventions that address stigma and facilitate deportees' economic integration may help stem engagement in risk behaviors.

INTRODUCCIÓN: Entre 1999-2007, EE.UU. deportó a 4.8 millones de migrantes a México; de éstos, 1.1 millones fueron deportados a la ciudad fronteriza de Tijuana, B.C. Los deportados a menudo son devueltos a comunidades desconocidas donde pueden experimentar factores estresantes, emocionales y económicos, que pueden aumentar la probabilidad de involucrarse en conductas de riesgo. OBJETIVO: Este estudio exploratorio describe las experiencias de mujeres mexicanas que se inyectan drogas en su proceso de adaptación y su ambiente posterior a su deportación. MÉTODO: En 2008, se realizaron entrevistas cualitativas en Tijuana a 12 mujeres deportadas de EE.UU. El marco teórico utilizado para el análisis de las entrevistas fue el estrés aculturativo y el capital social relacionado con el riesgo para adquirir VIH tomando en cuenta la perspectiva de género. RESULTADOS: Encontramos que la experiencia del estrés aculturativo causado por la deportación de las mujeres entrevistadas pudo condicionar su participación en conductas de alto riesgo para VIH (ejemplo: sexo sin protección, trabajo sexual). Las mujeres reportaron posteriormente, a su deportación un acceso limitado para apoyo social y redes sociales sanas. La discriminación o la falta de una identificación oficial desafiaron el reasentamiento de las mujeres y probablemente contribuyeron a sus vulnerabilidades económicas y de salud. DISCUSIÓN Y CONCLUSIÓN: Estos resultados preliminares sugieren que los deportados podrían beneficiarse de los servicios organizados de repatriación, incluidos los exámenes de salud mental. Intervenciones a nivel macro que aborden el estigma y faciliten la integración económica de los deportados podrían ayudar a impedir su participación en conductas de riesgo.

Validity of the Mexican version of the combined Foot Care Confidence / Foot-Care Behavior scale for diabetes.

OBJECTIVE: To 1) translate / transculturally adapt the original (English-language) combined Foot Care Confidence Scale / Foot-Care Behavior instrument (FCCS-FCB) to produce a Mexican-Spanish version and 2) determine its validity and reliability in a population with diabetes in Tijuana, Mexico. METHODS: The original FCCS-FCB was translated (and back-translated), the content validated (by a group of health professional experts), and the instrument applied to 304 patients 23-78 years old in diabetes support groups in Tijuana, Mexico. Internal consistency for the study constructs ("self-efficacy," and risk / preventive foot self-care behaviors) was measured using Cronbach's alpha. The constructs were validated using principal component factor analysis. RESULTS: The Cronbach's alpha values for internal consistency were 0.782 for self-efficacy and 0.505 for behaviors. Based on the analysis, two factors explained 49.1% of the total variance for self-efficacy, and six factors explained 57.7% of the total variance for behaviors. The results were consistent with those for the original (English) version of the FCCS-FCB. CONCLUSIONS: The Mexican version of the FCCS-FCB is a reliable and valid instrument recommended for use with Mexican-Spanish-speaking patients with diabetes.

Validity of the Mexican version of the combined Foot Care Confidence / Foot-Care Behavior scale for diabetes / Validez de la versión mexicana del instrumento combinado de las escalas Foot Care Confidence Scale y Foot Care Behavior para la diabetes

OBJECTIVE: To 1) translate / transculturally adapt the original (English-language) combined Foot Care Confidence Scale / Foot-Care Behavior instrument (FCCS-FCB) to produce a Mexican-Spanish version and 2) determine its validity and reliability in a population with diabetes in Tijuana, Mexico. METHODS: The original FCCS-FCB was translated (and back-translated), the content validated (by a group of health professional experts), and the instrument applied to 304 patients 23-78 years old in diabetes support groups in Tijuana, Mexico. Internal consistency for the study constructs ("self-efficacy," and risk / preventive foot self-care behaviors) was measured using Cronbach's alpha. The constructs were validated using principal component factor analysis. RESULTS: The Cronbach's alpha values for internal consistency were 0.782 for self-efficacy and 0.505 for behaviors. Based on the analysis, two factors explained 49.1% of the total variance for self-efficacy, and six factors explained 57.7% of the total variance for behaviors. The results were consistent with those for the original (English) version of the FCCS-FCB. CONCLUSIONS: The Mexican version of the FCCS-FCB is a reliable and valid instrument recommended for use with Mexican-Spanish-speaking patients with diabetes.

OBJETIVO: 1) traducir o adaptar transculturalmente el instrumento original combinado (en inglés) de las escalas Foot Care Confidence Scale (Escala de Competencia en el Cuidado del Pie) y Foot Care Behavior (Comportamientos del Cuidado del Pie) (FCCS-FCB) para crear una versión en español de México, y 2) determinar su validez y fiabilidad en una población de personas con diabetes de Tijuana, México. MÉTODOS: Se tradujo al español la escala original FCCS-FCB (y se volvió a traducir al inglés), su contenido fue validado (por un grupo de expertos), posteriormente se aplicó el instrumento a 304 pacientes de 23 a 78 años de edad, pertenecientes a grupos de apoyo al control de la diabetes de Tijuana, México. Mediante el alfa de Cronbach, se midió la coherencia interna de los constructos ("competencia personal" y "comportamientos de riesgo o preventivos de autocuidado del pie"). Los constructos fueron validados mediante análisis factorial de componentes principales. RESULTADOS: El valor de alfa de Cronbach correspondiente a competencia personal fue de 0,782 y de 0,505 para los comportamientos. En el análisis factorial, dos factores explicaron el 49,1% de la variancia total para la competencia personal, y seis factores explicaron el 57,7% de la variancia total para los comportamientos. Los resultados concordaron con los de la versión original (en inglés) del FCCS-FCB. CONCLUSIONES: La versión mexicana del FCCS-FCB es un instrumento fiable y válido recomendado para su empleo en pacientes mexicanos de habla hispana con diabetes.

Validity of the Mexican version of the combined Foot Care Confidence / Foot-Care Behavior scale for diabetes / Validez de la versión mexicana del instrumento combinado de las escalas Foot Care Confidence Scale y Foot Care Behavior para la diabetes

Objective. To 1) translate / transculturally adapt the original (English-language) combined Foot Care Confidence Scale / Foot-Care Behavior instrument (FCCS-FCB) to produce a Mexican-Spanish version and 2) determine its validity and reliability in a population with diabetes in Tijuana, Mexico. Methods. The original FCCS-FCB was translated (and back-translated), the content validat-ed (by a group of health professional experts), and the instrument applied to 304 patients 23–78 years old in diabetes support groups in Tijuana, Mexico. Internal consistency for the study constructs (“self-efficacy,” and risk / preventive foot self-care behaviors) was measured using Cronbach’s alpha. The constructs were validated using principal component factor analysis. Results. The Cronbach’s alpha values for internal consistency were 0.782 for self-efficacy and 0.505 for behaviors. Based on the analysis, two factors explained 49.1% of the total variance for self-efficacy, and six factors explained 57.7% of the total variance for behaviors. The results were consistent with those for the original (English) version of the FCCS-FCB. Conclusions. The Mexican version of the FCCS-FCB is a reliable and valid instrument recommended for use with Mexican-Spanish–speaking patients with diabetes.

Objetivo. 1) traducir o adaptar transculturalmente el instrumento original combi¬nado (en inglés) de las escalas Foot Care Confidence Scale (Escala de Competencia en el Cuidado del Pie) y Foot Care Behavior (Comportamientos del Cuidado del Pie) (FCCS-FCB) para crear una versión en español de México, y 2) determinar su validez y fiabilidad en una población de personas con diabetes de Tijuana, México. Métodos. Se tradujo al español la escala original FCCS-FCB (y se volvió a traducir al inglés), su contenido fue validado (por un grupo de expertos), posteriormente se aplicó el instrumento a 304 pacientes de 23 a 78 años de edad, pertenecientes a grupos de apoyo al control de la diabetes de Tijuana, México. Mediante el alfa de Cronbach, se midió la coherencia interna de los constructos (“competencia personal” y “comporta¬mientos de riesgo o preventivos de autocuidado del pie”). Los constructos fueron validados mediante análisis factorial de componentes principales. Resultados. El valor de alfa de Cronbach correspondiente a competencia personal fue de 0,782 y de 0,505 para los comportamientos. En el análisis factorial, dos factores explicaron el 49,1% de la variancia total para la competencia personal, y seis factores explicaron el 57,7% de la variancia total para los comportamientos. Los resultados concordaron con los de la versión original (en inglés) del FCCS-FCB. Conclusiones. La versión mexicana del FCCS-FCB es un instrumento fiable y válido recomendado para su empleo en pacientes mexicanos de habla hispana con diabetes.

Do Glazed Ceramic Pots in a Mexico-US Border City Still Contain Lead?

In order to identify the presence of lead in glazed ceramic pots in a Mexico-US border city, 41 clay pots were sampled. The pots were purchased in several establishments located in different geographical areas of the city. The presence of lead was determined using LeadCheck Swabs. Most (58.5%) of the pots were from the State of Jalisco and 24.4% were of unknown origin. Only 4 pots did not contain varnish and were lead-negative. Thirty-seven (81.1%) of the glazed pots were lead positive. Among the lead-negative pots, 4 showed the label "this pot is lead-free." Thus, if we consider the remaining 33 glazed pots without the "Lead-Free" label, 90.9% were lead-positive and only 9.1% were lead-negative. We also found that earthenware glazed utensils without the "Lead-Free" label were 1.6 times more likely to contain lead (OR: 1.6, 95% CI 1.0-2.5), P = 0.003. We concluded that lead was detected in almost all acquired food containers. Government interventions in Mexico have focused on training manufacturers to make lead-free glazed ceramics but it has been difficult to eradicate this practice. Educational interventions to make and acquire lead-free glazed ceramics should be targeted to both sellers and buyers.

Profiles, perceptions and motivations of Community Health Workers of NGOs in a border city of US-Mexico.

To analyze the profile, perceptions and motivations of Community Health Workers (CHWs) from non-governmental organizations (NGOs) in the border city of US-Mexico and to describe the type of community interventions they perform. we surveyed 121 CHWs from 9 NGOs participating in a monthly meeting between May and July of 2009. Each participating CHW answered a structured questionnaire. Furthermore, two focus groups were held, in which 10 and 8 CHWs participated, respectively. Qualitative and quantitative analyses were carried out on the data obtained. 70% of the CHWs had 9 years or less of formal education. With respect to community work, 61% volunteered between 1 and 5 h weekly; only 40% received some form of economic support. The most commonly reported activities were distribution of informational materials (59.5%) and promotion of health fairs (52.9%). Analysis of focus group discussions lead to the development of four conceptual categories: personal development, motivation, perception of their community participation and institutional relationship, some of the testimonies are "…just because the people do not respond does not mean we give up. No, we must work, persist, promote and raise awareness of the people…", "…when they compensate us, it is not really a payment. We are there because we get results, we do it happily… It is voluntary…" CHWs are an important human resource for communities. Institutions focusing on primary care should view these community players as social capital, which could improve the effectiveness of prevention strategies and achieve greater coverage of health services.

Pacientes pediátricos con VIH/sida en Baja California, México: alteraciones bucales relacionadas / Pediatric patients with HIV/AIDS in Baja California, Mexico: oral disorders related

Antecedentes: Baja California, México, ocupa el cuarto lugar nacional en casos reportados de VIH/sida. Por ser los pacientes pediátricos la población más vulnerable, el odontólogo debe diagnosticarlos y canalizarlos oportunamente para una adecuada atención. Objetivo: describir las alteraciones dentales y de mucosa oral asociadas más frecuentes en pacientespediátricos con diagnóstico de VIH/sida en Baja California. Metodología: se realizó un estudioclínico de corte transversal a pacientes pediátricos diagnosticados antes de los 12 años de edad, registrados en los Departamentos de Epidemiología del estado hasta agosto del 2006. Se aplicó un cuestionario para registrar variables sociodemográficas, antecedentes heredofamiliares, patológicos, concentraciones de CD4 y cargas virales. Posteriormente, demanera calibrada y siguiendo los índices establecidos por la OMS, se realizó exploración intraoral y de estructuras extraorales. Cuando se identificó la presencia de manifestaciones orales asociadas al VIH/sida, se realizaron frotis. Resultados: se revisaron 46 pacientes VIH positivos, con edad media de 6,4 ± 4,4 años, 57% de sexo masculino, 50% en categoríaclínica sintomática ligera y 67% sin supresión, 50% tenía antecedentes de hospitalizaciones por enfermedades como tuberculosis y neumonía, 63% presentaba caries y 44% lesionesen la mucosa oral, siendo la candidosis oral la de mayor frecuencia. El índice CPO-d fue de 5,2 ± 4,9. Conclusiones: este estudio describe lesiones orales en una población infantil condiagnóstico de VIH/sida en Baja California. Ya que no existen estudios previos, el valor del trabajo radica en que aporta información para el desarrollo de programas odontológicos y provee una base de comparación para futuros trabajos...

Background: Baja California, Mexico, ranks fourth nationally in reported cases of HIV/AIDS. Since paediatric patients are the most vulnerable population, the dentist must do awell-timed diagnosis and channel them for adequate care. Objective: To describe the most frequent dental and oral mucosa alterations associated with HIV/AIDS in diagnosed pediatricpatients from Baja California. Methods: A cross-sectional clinical study was carried out with pediatric patients diagnosed with HIV/AID before age 12, who were registered atEpidemiology Departments of the state until August 2006. A questionnaire including sociodemographic variables, family history, pathology, CD4 and viral load levels was applied. Later, calibrated observers registering the indicators determined by the WHO performed intraoral and extraoral examination. When an oral alteration associated with HIV/AIDS was identified, tissues smears were obtained. Results: 46 HIV positive patients with a mean of 6.4 ± 4.4 years of age were examined. 57% were male, 50% were in light symptomatic clinical category and 67% did not have suppression, 50% reported a history of hospitalizations for diseases such as Tuberculosis and Pneumonia, 63% had caries and 44% oral mucosal lesions, of which oral candidiasis was the most frequent. The DMF-T index was 5.2 ± 4.9. Conclusion: The population studied presented lesions associated with HIV/AIDS; they may be markers of immune status in which they are, so that immediate oral care, supervision and monitoring must accompany immunosuppression therapy...

Condom access: Associations with consistent condom use among female sex workers in two northern border cities of Mexico.

To determine whether condom access is associated with consistent condom use among female sex workers (FSWs) in Tijuana and Ciudad Juarez, between 2004 and 2006 we administered a questionnaire to 924 FSWs who reported unprotected sex with a client in the past 2 months. Of these women, 43% reported consistent ("often" or "always") condom use, 74% said condoms were available, and 38% reported having access to free condoms. In a logistic regression, factors positively associated with consistent condom use were condom availability (adjusted odds ratio [AOR] = 2.00; 95% confidence interval [CI]: 1.32-3.03), condom affordability (AOR = 1.72; 95% CI: 1.25-2.38) and self-efficacy (AOR = 2.16; 95% CI: 1.54-3.04). Factors inversely associated with consistent condom use included poor financial status (AOR = 0.65; 95% CI: 0.47-0.90), methamphetamine use (AOR = 0.58; 95% CI: 0.40-0.83), alcohol use (AOR = 0.68; 95% CI: 0.49-0.96), and recent injection drug use (AOR = 0.62; 95% CI: 0.39-0.97). While increased condom availability may improve condom use among FSWs in general, interventions to broaden condom use among lower income and drug-using FSWs are critically needed.

[Teen pregnancy in migrants: socioeconomic, gynecobstetric, and neonatal variables]. / Embarazo en adolescentes migrantes: características sociodemográficas, ginecoobstétricas y neonatales.

OBJECTIVE: Identify and correlate characteristics of adolescent mothers in a border city of Mexico with their migratory status. METHODS: We surveyed post partum adolescent mothers in the discharge rooms of two public hospitals in Tijuana, Mexico. We assessed obstetric, gynecologic, socioeconomic and neonatal variables. Mothers living fewer than 5 years in the area were designated as 'migrant.' RESULTS: 324 adolescent mothers were identified; 86% had healthy babies; 27% had previous pregnancies; age of onset of sexual activity was 15.5 +/- 1.4 years. 115 (36%) were identified as 'migrant,' among whom we found they had interrupted their studies (24% vs. 33%; OR 2.62: CI 95% 1.39-4.94), had a higher incidence of failure to use contraception (74% vs. 62%; OR 1.79: C.I. 95% 1.07-3.01) and a lower incidence of prenatal care (28% vs. 38%; OR 1.8: C.I. 95% 1.04-3.15). A larger percentage of migrant adolescents already lived with their partner (39% vs. 24%; OR 2.00: C.I. 95% 1.21-3.30) and expressed a desire to become pregnant (55% vs. 37%; OR 2.10: C.I. 95% 1.31-3.37). The observed association persisted in multivariate analysis. We did not observe differences between other ob-gyn and neonatal variables. CONCLUSIONS: Being a female migrant should be considered a risk factor in the reproductive health of adolescent mothers.

Oral lesions in HIV+/AIDS adolescents perinatally infected undergoing HAART

Objective: To assess the prevalence of the oral lesions related to HIV-infection (HIV-OL) in HIV+/AIDS adolescents(=13 years old), and the differences with HIV+/AIDS children (=3 - <13 years old) perinatally infected.Material and methods: 25 HIV+/AIDS adolescents and 62 HIV+/AIDS children, undergoing Highly Active AntiretroviralTherapy, were orally examined. HIV-OL was diagnosed in accordance with EC-Clearinghouse-World Health Organization. The patients were classified with respect to their immune status in relation with the CD4+cell counts as moderately immunodeficient; mildly immunodeficient and severely immunodeficient in accordance to the revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18months and for HIV infection and AIDS among children aged 18 months to <13 years (CDC-USA). The virological status was established in relation to the copies of RNA-HIV-1/mL as follows: with undetectable viral load(UDVL); with low viral load and with high viral load. A chi-square test was performed (p<0.05IC95%).Results: The prevalence of HIV-OL in HIV+/AIDS adolescents was 20% while in HIV/AIDS children was 30.6%(p>0.05). Oral candidiasis was the most prevalent oral lesion in both groups. Association (p <0.05) of a high prevalence of HIV-OL and oral candidiasis with a high viral load was observed in both study groups.Conclusions: Adolescents perinatally HIV-infected have a high prevalence of HIV-OL. Oral candidiasis still is the most frequent oral opportunistic infection. Oral lesions could have association to viral failure in HIV+/AIDS adolescents undergoing HAART (AU)