ETHNICITY AND INCOME IMPACT ON BMI AND STATURE OF SCHOOL CHILDREN LIVING IN URBAN SOUTHERN MEXICO.

Obesity affects quality of life and increases the risk of morbidity and mortality. Mexico, a middle-income country, has a high prevalence of overweight and obesity among urban children. Merida is the most populated and growing city in southern Mexico with a mixed Mayan and non-Maya population. Local urbanization and access to industrialized foods have impacted the eating habits and physical activity of children, increasing the risk of overweight and obesity. This study aimed to contribute to the existing literature on the global prevalence of overweight and obesity and examined the association of parental income, ethnicity and nutritional status with body mass index (BMI) and height in primary school children in Merida. The heights and weights of 3243 children aged 6-12 from sixteen randomly selected schools in the city were collected between April and December 2012. Multinomial logistic regression models were used to examine differences in the prevalence of BMI and height categories (based on WHO reference values) by ethnicity and income levels. Of the total students, 1648 (50.9%) were overweight or obese. Stunting was found in 227 children (7%), while 755 (23.3%) were defined as having short stature. Combined stunting and overweight/obesity was found in 301 students (9.3%) and twelve (0.4%) were classified as stunted and of low weight. Having two Mayan surnames was inversely associated with having adequate height (OR=0.69, p<0.05) and the presence of two Maya surnames in children increased the odds of short stature and stunting. Children from lower income families had twice the odds of being stunted and obese. Overweight, obesity and short stature were frequent among the studied children. A significant proportion of Meridan children could face an increased risk of developing cardiovascular disease and its associated negative economic and social outcomes unless healthier habits are adopted. Action is needed to reduce the prevalence of obesity among southern Mexican families of all ethnic groups, particularly those of lower income.

"You are not fat, you are hermosa": Mexican caregivers share their perceptions about their role supporting their morbidly obese children.

This qualitative study reports the findings from 6 focus groups conducted at a clinic in Southern Mexico with caregivers of morbidly obese children. This study was developed with the purpose of gaining a further understanding of caregivers' perceived role in addressing their children's obesity within the family context and identifying topics that could be considered when providing health care in similar sociocultural environments. We identified that although caregivers acknowledge the role of modifiable factors in obesity prevention and treatment, they held beliefs about determinism in obesity. In addition, diet was the more frequently identified means of reducing the impact of obesity. The importance of role modeling and promoting healthy behaviors in the family context are topics that could be addressed in clinical practice.

The impact of public expenditure on undernourishment distribution in Mexico.

The status of undernourishment in children under the age of five in Mexico is open to debate. Linked to poverty, underweight and stunting, the rates of undernourishment are reported to be diminishing, although poverty remains an incessant problem. This study was done to determine whether there is an association between public expenditure and underweight and stunting distribution in Mexico based on data from the 2006 health and population census and from macroeconomic, social, and demographic variables. We used principal component analysis to reduce the number of variables and analyze their behavior. Multiple regressions showed that underweight and stunting are significantly associated with the marginalization index, support from the Sistema Nacional para el Desarrollo Integral de la Familia (DIF) supplies and breakfast program, the gross domestic product per capita, and expenditure from the Opportunities program. Further, public expenditure aimed to combat undernourishment is inadequately oriented to address the needs of the poor.

Political and social context of not attaining the Millennium Development Goal to reduce poverty.

OBJECTIVE: Eradication of poverty is Target 1 of the first of eight Millennium Development Goals, which were adopted by world leaders at the United Nations General Assembly in the year 2000. This study aims to explore the influence of political and social context in the achievement of poverty eradication. METHODS: A retrospective ecological study was carried out to explore associations between progress towards the achievement of Target 1 in 2002 and political and social context variables. The study contained cross-sectional estimates in 1990, 1995, 2000 and 2002. The analysis and observation unit was the countries (n = 88). A descriptive analysis was made, as well as simple and multiple analyses with logistic regression. FINDINGS: Of the 88 countries studied, 71 (80.7%) are not on track to achieving the target of eradicating poverty. The factor most associated with non-attainment of this goal was reduced government consumption per capita (odds ratio, OR: 13.8; 95% confidence interval, CI: 2.92-65.26). In the multiple regression analysis, the most significant factors are: reduced government consumption per capita (OR: 9.8; 95% CI: 1.82-52.75), losses in the balance between imports and exports (OR: 5.3; 95% CI: 1.32-21.54) and more inequality in family income (OR: 4.7; 95% CI: 1.12-20.01). CONCLUSION: Progress towards achievement of Target 1 seems to be hindered, fundamentally, by the significant reduction in government consumption in certain countries and the absence of redistribution policies. To understand the political determinants of poverty, more attention must be paid to the national and international political milieu, which seem to have a relevant impact on this problem and hence on population health.

Gender progress and government expenditure as determinants of femicide.

PURPOSE: We sought to explore the effect of economic/political factors and gender progress on femicide. METHODS: An ecological and retrospective study was undertaken that focused on 61 countries and analyzed the relationships of femicide with the following statistics from the period 1990 to 1999: economic indicators (domestic consumption, gross capital formation, imports and exports per capita, unemployment rate and percentage of urban population), political indicators (government final consumption expenditure, GINI coefficient--a summary measure of the extent to which the actual distribution of income or consumption expenditure or a related variable differs from a hypothetical distribution in which each person receives an identical share--civil liberties and political rights index), and gender progress indicators (female and male unemployment rates, percentage of girls in primary education, gender ratio for primary and secondary education, and percentage of parliamentary seats occupied by women). Bivariate and multivariate logistic regression analyses (likelihood ratio) were performed to explore the relationships between these variables. RESULTS: The bivariate analysis revealed strong links between reductions in government final consumption expenditure per capita (odds ratio [OR] 20.83;95% confidence interval [95% CI] 5.622-77.205), domestic consumption and gross capital formation (both with OR 16.67, 95% CI 4.715-58.911), and the civil liberties and political rights index (OR 7.91, 95% CI 2.526-24.747). In the multivariate stage, statistically significant associations were only observed between government expenditure per capita (OR 61.75;95% CI 7.064-539.81) and occupation of parliamentary seats by women (OR 10.95;95% CI 1.26-95.06). CONCLUSION: The reduction in government final consumption expenditure and democratic backwardness in terms of gender equality appear to be relevant factors in deaths caused by gender-based violence. To fight femicide effectively, gender-related structural, political, and economic responses should be considered.

Influencias y hegemonías en la orientación de la investigación de las reformas de salud / Influences and hegemonies in health reform research

Analizamos la evolución de las publicaciones, incluidas en MEDLINE, LILACS y Sociological Abstracts, sobre las Reformas de Salud en el mundo y las influencias que determinan su orientación y distribución en el período de 1990-2004. En total se seleccionaron 8.729 publicaciones. Los principios de "Sostenibilidad" y "Calidad y Efectividad" son los más atendidos, existiendo distintos patrones de atención, dependiendo de regiones y países. De 199 países, el 61 por ciento tiene referencia sobre sus procesos de reforma, siendo Estados Unidos y Gran Bretaña los que agrupan la mayor cantidad. Se observó que existen fuertes influencias para el estudio de las Reformas de Salud, provenientes de los patrones Británico y Norteamericano de atención a los Principios de Reforma. Esto puede estar limitando la visibilidad científica de cuestiones como la equidad, participación y eficiencia.

The authors analyze the evolution in publications indexed in MEDLINE, LILACS, and Sociological Abstracts concerning health reforms around the world and the determinants of their orientation and distribution from 1990 to 2004. A total of 8,729 publications were selected. The principles of "sustainability" and "quality and effectiveness" were dealt with most frequently, with different patterns of attention, depending on the regions and countries. Of 199 countries, 61 percent included references as to their health reform processes, with the largest numbers in the United States and the Great Britain. The British and U.S. standards for attention to health reform principles displayed strong influences on the study of health reforms elsewhere. This may limit the scientific visibility of issues like equity, participation, and efficiency.

[Influences and hegemonies in health reform research]. / Influencias y hegemonías en la orientación de la investigación de las reformas de salud.

The authors analyze the evolution in publications indexed in MEDLINE, LILACS, and Sociological Abstracts concerning health reforms around the world and the determinants of their orientation and distribution from 1990 to 2004. A total of 8,729 publications were selected. The principles of "sustainability" and "quality and effectiveness" were dealt with most frequently, with different patterns of attention, depending on the regions and countries. Of 199 countries, 61% included references as to their health reform processes, with the largest numbers in the United States and the Great Britain. The British and U.S. standards for attention to health reform principles displayed strong influences on the study of health reforms elsewhere. This may limit the scientific visibility of issues like equity, participation, and efficiency.