City features related to obesity in preschool children: a cross-sectional analysis of 159 cities in six Latin American countries.

Background: Childhood obesity is a rising global health problem. The rapid urbanization experienced in Latin America might impact childhood obesity through different pathways involving urban built and social features of cities. We aimed to evaluate the association between built and social environment features of cities and childhood obesity across countries and cities in Latin America. Methods: Cross-sectional analysis of data from 20,040 children aged 1-5 years living in 159 large cities in six Latin American countries. We used individual-level anthropometric data for excess weight (overweight or obesity) from health surveys that could be linked to city-level data. City and sub-city level exposures included the social environment (living conditions, service provision and educational attainment) and the built environment (fragmentation, isolation, presence of mass transit, population density, intersection density and percent greenness). Multi-level logistic models were used to explore associations between city features and excess weight, adjusting for age, sex, and head of household education. Findings: The overall prevalence of excess weight among preschool children was 8% but varied substantially between and within countries, ranging from 4% to 25%. Our analysis showed that 97% of the variability was between individuals within sub-city units and around 3% of the variance in z-scores of weight for height was explained by the city and sub-city levels. At the city-level, a higher distance between urban patches (isolation, per 1 SD increase) was associated with lower odds of excess weight (OR 0.90, 95% CI 0.82-0.99). Higher sub-city education was also associated with lower odds of excess weight, but better sub-city living conditions were associated with higher odds of excess weight. Interpretation: Built and social environment features are related to excess weight in preschool children. Our evidence from a wide range of large Latin American cities suggests that urban health interventions may be suitable alternatives towards attaining the goal of reducing excess weight early in the life course. Funding: The SALURBAL project (Salud Urbana en América Latina, Urban Health in Latin America) is funded by Wellcome [205177/Z/16/Z].

Women's empowerment and infant mortality in Latin America: evidence from 286 cities.

Levels of women's empowerment (WE) can contribute to differences in infant mortality rates (IMRs) across cities. We used a cross-sectional multilevel study to examine associations of WE with IMRs across 286 cities in seven Latin American countries. We estimated IMRs for 2014-2016 period and combined city socioeconomic indicators into factors reflecting living conditions and service provision. WE was operationalized: (1) in cities, by using scores for women's labor force participation (WLFP) and educational attainment among women derived from education and employment indicators disaggregated by sex; (2) in countries, by including a scale of enforcements of laws related to women's rights. We estimated adjusted percent differences in IMRs associated with higher WE scores across all cities and stratified by country GDP. We found substantial heterogeneity in IMRs and WE across cities. Higher WLFP was associated with lower IMRs. Higher women's educational attainment was associated with lower IMRs only in cities from countries with lower GDP. Poorer national enforcement of laws protecting women's rights was associated with higher IMRs in all countries. Women's empowerment could have positive implications for population health. Fostering women's socioeconomic development and girls' education should be part of strategies to reduce IMRs in cities of Global South.

Características demográficas de las madres e hijos sometidos a técnicas de reproducción asistida en el Hospital Español de México en 2016 / Demographic characteristics of mothers and children undergoing assisted reproduction techniques at Hospital Español de México in 2016

Resumen Introducción La infertilidad es una enfermedad caracterizada por la incapacidad de lograr un embarazo después de 12 meses o más de relaciones sexuales no protegidas. En México, la reproducción asistida se encuentra a la par de cualquier país, siendo la tercera nación de Latinoamérica con mayor número de centros de reproducción. Objetivo Determinar las características demográficas de las madres e hijos sometidos a técnicas de reproducción asistida (TRA) en el Hospital Español de México en 2016. Material y métodos Se trata de un estudio descriptivo, retrospectivo que incluyó a los recién nacidos producto de TRA del Hospital Español de México en 2016. Se obtuvo información sobre el método de interrupción del embarazo, el número de productos, las semanas de gestación al nacimiento, peso y talla al nacimiento y si requirieron ingreso a la UCIN, así como las complicaciones presentadas. Resultados Se incluyeron 292 pacientes sometidas a TRA. De las complicaciones maternas asociadas, las más prevalentes fueron las infecciones durante el embarazo. Se obtuvieron datos de 373 recién nacidos. Se describen las complicaciones en estos pacientes; las más frecuentes fueron las respiratorias. Conclusiones Las TRA son tratamientos cada vez más utilizados. Hay que ser cuidadosos a la hora de informar a los futuros padres acerca de las complicaciones asociadas, teniendo en cuenta la variabilidad de datos disponibles.

Abstract Introduction Infertility is a disease characterized by the inability to achieve a pregnancy after 12 months or more of unprotected sex. In Mexico, assisted reproduction is on par with any country, being the third nation in Latin America with the largest number of reproduction centers. Objective To determine the demographic characteristics of mothers and children undergoing assisted reproduction techniques (ART) at the Hospital Español de México in 2016. Material and methods This is a descriptive, retrospective study that included newborns product of ART performed in the Hospital Español de México in 2016. Information was obtained on the method of delivery, number of products, weeks of gestation at birth, birth weight and height, and if they required admission to the NICU, as well as the complications presented. Results 292 patients undergoing ART were included. Of the associated maternal complications, the most prevalent were infections during pregnancy. Data were obtained from 373 newborns. The complications in these patients are described, the most frequent being respiratory. Conclusions ART are increasingly used treatments. Care must be taken when informing prospective parents about associated complications, taking into account the variability of the available data.

Severe functional difficulties and disabilities in children and adolescents and the Sustainable Development Goals.

OBJECTIVE: To report prevalence of severe child functional difficulties and disability (CFD) in a nationally representative sample of 2 to 17 year-old children in Mexico and describe the inequities faced by children with CFD in relation to a set of Sustainable Development Goals (SDG)-related outcomes. MATERIALS AND METHODS: Using data from the National Survey of Children and Women (ENIM 2015) we estimate prevalence with 95% confidence intervals for the selected indicators. We use chi-square test and confidence intervals inspection to report significant differences between children with and without CFD. RESULTS: 8% of children present at least one CFD. CFD is associated with higher prevalence of underweight and child labor and lower prevalence of adequate early child development. Conclusion. Children with CFD present worst outcomes and require targeted efforts to ensure they meet health and wellbeing targets in the frame of the SDGs.

Severe functional difficulties and disabilities in children and adolescents and the Sustainable Development Goals / Dificultades funcionales severas y discapacidades en niños y adolescentes frente a los Objetivos de Desarrollo Sostenible

Abstract: Objective: To report prevalence of severe child functional difficulties and disability (CFD) in a nationally representative sample of 2 to 17 year-old children in Mexico and describe the inequities faced by children with CFD in relation to a set of Sustainable Development Goals (SDG)-related outcomes. Materials and methods: Using data from the National Survey of Children and Women (ENIM 2015) we estimate prevalence with 95% confidence intervals for the selected indicators. We use chi-square test and confidence intervals inspection to report significant differences between children with and without CFD. Results: 8% of children present at least one CFD. CFD is associated with higher prevalence of underweight and child labor and lower prevalence of adequate early child development. Conclusion. Children with CFD present worst outcomes and require targeted efforts to ensure they meet health and wellbeing targets in the frame of the SDGs.

Resumen: Objetivo: Reportar la prevalencia de problemas severos de funcionamiento y discapacidad (CFD) en una muestra representativa de niños y niñas de 2 a 17 años en México y describir las inequidades enfrentadas por los niños y niñas con CFD respecto a un conjunto de indicadores relacionados con los objetivos de desarrollo sustentable (ODS). Material y métodos: A partir de datos de la Encuesta Nacional de Niñas, Niños y Mujeres en México (ENIM 2015), se estiman prevalencias e intervalos de confianza al 95% para indicadores seleccionados. Se usa prueba de ji cuadrada e intervalos de confianza para reportar diferencias significativas entre niños/as con y sin CFD. Resultados: 8% de los niños presentan al menos un CFD. Los CFD se asocian con mayor prevalencia de bajo-peso y trabajo infantil, y con menor prevalencia de desarrollo infantil temprano adecuado. Conclusión: Los niños con CFD presentan resultados desventajosos, y requieren esfuerzos enfocados que garanticen el alcance de las metas de salud y bienestar en el contexto de los ODS.