Homicide in children under ten years old in México: A 20-year study / Homicidio en menores de 10 años en México: 20 años de estudio

Abstract Background: In a society, children are the most vulnerable members of the population. Violence experienced in Mexico during the last decade has also affected children under ten years of age. Objective: Analyze the trend of homicides in children under ten years from 1998 to 2017. Methods: A longitudinal study of homicides in children under ten years of age was conducted in Mexico from 1998 to 2017. Several analytic techniques were applied to study the mortality tendency during the study period in this population. Results: 5,188 homicides occurred in children under ten years during the study period, 57% were in boys and 70% were in children under five years of age. Hanging and strangulation were the most common types of homicides for girls under one year of age. The home was the most frequently reported place of occurrence. Children between 5-10 years old were 3.1 times more likely to die from a firearm injury than those under 0-5 years old. It was also found that minors who resided in the Northern region of the country had a 2.7 times higher risk of firearm mortality compared to those who resided in the central region. Conclusions: It is important to implement protective measures, especially for those under one year, along with the need to create multi sectorial interventions that ensure protective environments for children. Moreover, observatory programs could be used to improve the quality of administrative records for decision-making.

Resumen Antecedentes: En una sociedad, los niños son los miembros más vulnerables de la población. La violencia vivida en México durante la última década también ha afectado a personas menores de 10 años. Objetivo: Analizar la tendencia de los homicidios en niños menores de 10 años de 1998 a 2017. Métodos: Se realizó un estudio longitudinal de homicidios en niños menores de 10 años en México de 1998 a 2017. Se aplicaron diversas técnicas analíticas para estudiar la tendencia de la mortalidad durante el período de estudio. Resultados: De los 5,188 homicidios ocurridos, el 57% fueron en niños y el 70% en menores de cinco años; el ahorcamiento y el estrangulamiento fueron los principales mecanismos de homicidio de niñas menores de 1 año. El hogar fue el lugar de mayor ocurrencia de homicidios. Los niños entre 5 y 10 años murieron 3.1 veces más por arma de fuego que los menores de 0 a 4 años. Los menores que residían en el norte del país tenían 2.7 veces más riesgo de mortalidad por armas de fuego en comparación con los que residían en la región central. Conclusiones: Es importante implementar medidas de protección, especialmente para los menores de un año, junto con la necesidad de crear intervenciones multisectoriales que aseguren ambientes de protección para los niños. Además, los observatorios podrían utilizarse como una estrategia para mejorar la calidad de los registros administrativos y focalizar la toma de decisiones.

Homicide in children under ten years old in México: A 20-year study.

Background: In a society, children are the most vulnerable members of the population. Violence experienced in Mexico during the last decade has also affected children under ten years of age. Objective: Analyze the trend of homicides in children under ten years from 1998 to 2017. Methods: A longitudinal study of homicides in children under ten years of age was conducted in Mexico from 1998 to 2017. Several analytic techniques were applied to study the mortality tendency during the study period in this population. Results: 5,188 homicides occurred in children under ten years during the study period, 57% were in boys and 70% were in children under five years of age. Hanging and strangulation were the most common types of homicides for girls under one year of age. The home was the most frequently reported place of occurrence. Children between 5-10 years old were 3.1 times more likely to die from a firearm injury than those under 0-5 years old. It was also found that minors who resided in the Northern region of the country had a 2.7 times higher risk of firearm mortality compared to those who resided in the central region. Conclusions: It is important to implement protective measures, especially for those under one year, along with the need to create multi sectorial interventions that ensure protective environments for children. Moreover, observatory programs could be used to improve the quality of administrative records for decision-making.

Antecedentes: En una sociedad, los niños son los miembros más vulnerables de la población. La violencia vivida en México durante la última década también ha afectado a personas menores de 10 años. Objetivo: Analizar la tendencia de los homicidios en niños menores de 10 años de 1998 a 2017. Métodos: Se realizó un estudio longitudinal de homicidios en niños menores de 10 años en México de 1998 a 2017. Se aplicaron diversas técnicas analíticas para estudiar la tendencia de la mortalidad durante el período de estudio. Resultados: De los 5,188 homicidios ocurridos, el 57% fueron en niños y el 70% en menores de cinco años; el ahorcamiento y el estrangulamiento fueron los principales mecanismos de homicidio de niñas menores de 1 año. El hogar fue el lugar de mayor ocurrencia de homicidios. Los niños entre 5 y 10 años murieron 3.1 veces más por arma de fuego que los menores de 0 a 4 años. Los menores que residían en el norte del país tenían 2.7 veces más riesgo de mortalidad por armas de fuego en comparación con los que residían en la región central. Conclusiones: Es importante implementar medidas de protección, especialmente para los menores de un año, junto con la necesidad de crear intervenciones multisectoriales que aseguren ambientes de protección para los niños. Además, los observatorios podrían utilizarse como una estrategia para mejorar la calidad de los registros administrativos y focalizar la toma de decisiones.

Prostate cancer mortality according to marginalization status in Mexican states from 1980 to 2013.

OBJECTIVE: To assess prostate cancer (PC) mortality in Mexico from 1980 to 2013, according to the state marginalization level. MATERIALS AND METHODS: Using age-adjusted rates in men ≥ 40 years old, we estimated trends and age-cohort-period effects of PC mortality from 1980-2013 according to state marginalization status by using a joinpoint regression model and a Poisson regression model proposed by Holford. RESULTS: The PC mortality risk has increased nationwide at a constant rate (2% annually) during the past 13 years. The highest annual increase was observed among states with very high (4.4%) and high (7.7%) marginalization rates. In contrast, states with very low levels of marginalization showed a significant reduction of 1.5% per year. The main changes were observed in the 1945-1950 birth year cohorts. CONCLUSIONS: Differences in PC mortality across regions of Mexico may reflect differences in the timing of the diagnosis and treatment of PC.

Prostate cancer mortality according to marginalization status in Mexican states from 1980 to 2013 / Comportamiento de la mortalidad por cáncer de próstata en México de acuerdo al índice de marginación estatal, de 1980 a 2013

Abstract Objective: To assess prostate cancer (PC) mortality in Mexico from 1980 to 2013, according to the state marginalization level. Materials and methods: Using age-adjusted rates in men ≥ 40 years old, we estimated trends and age-cohort-period effects of PC mortality from 1980-2013 according to state marginalization status by using a joinpoint regression model and a Poisson regression model proposed by Holford. Results: The PC mortality risk has increased nationwide at a constant rate (2% annually) during the past 13 years. The highest annual increase was observed among states with very high (4.4%) and high (7.7%) marginalization rates. In contrast, states with very low levels of marginalization showed a significant reduction of 1.5% per year. The main changes were observed in the 1945-1950 birth year cohorts. Conclusions: Differences in PC mortality across regions of Mexico may reflect differences in the timing of the diagnosis and treatment of PC.

Resumen Objetivo: Evaluar la mortalidad por cáncer de próstata (CP) en México de acuerdo con la marginación estatal de 1980 a 2013. Material y métodos: Mediante el método directo se estimaron las tasas de mortalidad por CP ajustadas por edad en hombres ≥ 40 años; se analizaron las tendencias y el efecto de edad-cohorte-periodo de la mortalidad por esta causa a nivel nacional y por nivel de marginación estatal, utilizando modelos joinpoint y de regresión de Poisson propuesto por Holford. Resultados: En los últimos 13 años, la mortalidad por CP a nivel nacional mostró un incremento constante (2% anual), principalmente en los estados de muy alta (4.4%) y alta marginación (7.7%), mientras que en los de muy baja hubo una reducción de 5% anual. Los principales cambios se observaron en las cohortes de nacimiento de 1945-1950. Conclusiones: Los resultados posiblemente reflejan las diferencias regionales, en la oportunidad del diagnóstico y tratamiento del CP.

Methodological proposal for implementing an intervention to prevent pedestrian injuries, a multidisciplinary approach: the case of Cuernavaca, Morelos, Mexico.

OBJECTIVE: To describe the process for implementing an intervention to prevent pedestrian injuries in Cuernavaca, Mexico, using a multidisciplinary and evidence-based approach. METHODOLOGY: This study included two phases with several stages. The first was an overall assessment of pedestrian mortality in Cuernavaca that included a comparison of pedestrian mortality between Cuernavaca and the rest of Morelos State (1998-2007), an analysis and geocoding of pedestrian injuries (2008-2009), and a description of techniques for selecting and analysing clustered events using road audits. The second phase focused on selecting an intervention through a review of the literature seeking the 'best evidence' adaptable to the local context and a methodological evaluation for implementation including techniques for cluster randomisation and for the evaluation of possible effects of the intervention. RESULTS: Between 2008 and 2009, in Cuernavaca there were 620 pedestrian injury events: 59.4% were men, the mean age was 36.3 years, 70% occurred during daylight hours, 55% had mild severity and there were no differences by sex (p>0.05). We generated evidence, that when combined with the results from a systematic search of the literature, provided sufficient information for the implementation of a pedestrian injury prevention intervention. CONCLUSIONS: A combination of strategies and disciplines makes it possible to comprehensively address this public health problem, allowing interventions to strengthen aspects of pedestrian safety while accounting for characteristics of the local context; the promotion of local measures, of low cost and high impact, with modifications to the road infrastructure, are more effective in addressing pedestrian vulnerabilities.

The status of diabetes care in Mexican population: are we making a difference? Results of the National Health and Nutrition Survey 2006.

OBJECTIVE: Examine clinical indicators to evaluate diabetes care in Mexico. MATERIAL AND METHODS: Diabetics (self reported, with therapy) were examined with standardized questionnaires, anthropometry, glucose, lipids and glycohemoglobin. Data were analyzed statistically. RESULTS: There were 2 644 patients, 677 cases without access to medical care (73% women), most lived in rural communities and spoke aboriginal dialect. Prevalence of obesity for private access group was 21.2%, for other or non access group was between 31 and 65%. The group without or basic education was most common, 76% of the cases had HDL <40 mg/dl and 36% had hypertriglyceridemia. Only 6.6% of patients had HbA1c <7%. There was no significant difference between HbA1c values observed in the group with or without access. Most patients were treated with oral agents. A significant group was without therapy. Assessments for complications was infrequent. CONCLUSIONS: Current model for diabetes care in Mexico is inefficacious and a paradigm change is necessary.

The status of diabetes care in Mexican population: are we making a difference? Results of the National Health and Nutrition Survey 2006 / El cuidado de la diabetes en población mexicana: ¿estamos siguiendo la estrategia correcta? Resultados de la Encuesta Nacional de Salud y Nutrición 2006

OBJECTIVE: Examine clinical indicators to evaluate diabetes care in Mexico. MATERIAL AND METHODS: Diabetics (self reported, with therapy) were examined with standardized questionnaires, anthropometry, glucose, lipids and glycohemoglobin. Data were analyzed statistically. RESULTS: There were 2 644 patients, 677 cases without access to medical care (73 percent women), most lived in rural communities and spoke aboriginal dialect. Prevalence of obesity for private access group was 21.2 percent, for other or non access group was between 31 and 65 percent. The group without or basic education was most common, 76 percent of the cases had HDL <40 mg/dl and 36 percent had hypertriglyceridemia. Only 6.6 percent of patients had HbA1c <7 percent. There was no significant difference between HbA1c values observed in the group with or without access. Most patients were treated with oral agents. A significant group was without therapy. Assessments for complications was infrequent. CONCLUSIONS: Current model for diabetes care in Mexico is inefficacious and a paradigm change is necessary.

OBJETIVO: Examinar indicadores para evaluar la atención de diabetes en México. MATERIAL Y MÉTODOS: Se examinaron diabéticos (autorreportados, con tratamiento) con cuestionario estandarizado, antropometría, glucosa, lípidos y hemoglobina glucosilada. Los datos se analizaron estadísticamente. RESULTADOS: De 2 644 casos, 677 no tenían acceso a atención médica (73 por ciento mujeres), la mayoría eran de comunidades rurales y hablaban un dialecto indígena. La prevalencia de obesidad en el grupo con acceso privado fue 21,2 por ciento; en personas con otro o sin acceso, fue entre 31 y 65 por ciento. El grupo sin o con educación básica fue el más común. El 76 por ciento de los casos tenían colesterol HDL <40 mg/dl y 36 por ciento tenía hipertrigliceridemia. Sólo 6.6 por ciento tenían la HbA1c <7 por ciento. No hubo diferencias entre valores de HbA1c en el grupo con o sin acceso. La mayoría recibían hipoglucemiantes orales, muchos sin tratamiento. La evaluación de complicaciones fue infrecuente. CONCLUSIONES: El modelo de atención de diabetes en México es ineficaz y es preciso cambiar de paradigma.

[Body mass index and body image perception in a Mexican adult population: the accuracy of self-reporting]. / Indice de masa corporal y percepción de la imagen corporal en una población adulta mexicana: la precisión del autorreporte.

OBJECTIVE: To evaluate the accuracy of the self-reported body mass index and body image perception in a population of Mexican adults. MATERIAL AND METHODS: In 1998, in the state of Morelos, Mexico, participants in the longitudinal study of Mexican Social Security Institute workers "IMSS Cohort Study" responded to a baseline, self-administered questionnaire designed to collect a large variety of lifestyle risk factors for chronic diseases. Participants self-reported their body image by selecting the silhouette that best portrayed them, from a set of silhouettes ranked from 1 to 9. Participants also self-reported their current weight and height, unaware that direct measurements of weight and height were to follow. Four to eight months later participants were weighed and their heights were measured using standardized procedures. Spearman correlations were computed to analyze the correlation between self-reported and measured data. The Kruskal-Wallis test was used to evaluate the magnitude of difference between measured and self-reported height, weight and body mass index (BMI) (measured minus self-reported), by educational level and categories of age. Robust regression was used to evaluate the potential effect of specific individual characteristics on differences between measured and self-reported weight and height. Logistic regression analysis was used to evaluate the sensitivity, specificity, and predictive values for BMI. RESULTS: The study included 934 subjects, of which 62.6% were female. Females had a mean measured height of 1.55 m (SD 0.06) and weight of 65.4 kg (SD 10.9), while males had a mean height of 1.67 m (SD 0.06) and weight of 77.7 kg (SD 12.5). The mean BMI was 27.4 kg/m2 (SD 4.3) (females: 27.2 kg/m2 +/- 4.45; males: 27.8+/-3.87). The median of body image perception (BIP) was 5 (25th percentile=4; 75th percentile=6). Correlations between measured and self-reported height, weight, and BMI for all subjects were 0.94, 0.96, and 0.90, respectively. The correlation between BMI and BIP was 0.64 (0.67 for females and 0.59 for males). Self-reported mean varied no more than 1.3 cm from measured height and no more than 3.17 kg from measured weight. Error estimations of height, weight, and BMI decreased with educational level. Sensitivity and specificity before adjusting self-reported BMI with overweight and obesity categories that were collapsed into one were 94.8 and 83.0%, respectively; for BIP, those values were 87.6 and 48.9%. CONCLUSIONS: The results suggest that self-reported BMI and BIP can be useful indicators of an overweight condition in Mexican adults. The sensitivities and specificities associated with corrected self-reported BMI categories could be used to adjust odds ratios and relative risks, calculated from BMI levels derived from the self-reported BMI. Body image perception made it possible to correctly classify individuals with BMI > or = 25, showing that it may be a valid estimate for use in epidemiological surveys.

Indice de masa corporal y percepción de la imagen corporal en una población adulta mexicana: la precisión del autorreporte / Body mass index and body image perception in Mexican adult population: The accuracy of self-reporting

OBJETIVO: Evaluar la precisión del autorreporte de índice de masa corporal y de la percepción de la imagen corporal en población adulta mexicana. MATERIAL Y MÉTODOS: En 1998, en el estado de Morelos, México, trabajadores del Instituto Mexicano del Seguro Social participaron en el "Estudio de cohorte del IMSS", de tipo longitudinal, y respondieron un cuestionario autoaplicado, diseñado para recabar una gran variedad de factores de riesgo para enfermedades crónicas con base en estilos de vida. Los participantes autorreportaron su imagen corporal seleccionando la silueta que mejor les representaba, entre un juego de siluetas numeradas del 1 al 9. Asimismo, informaron su peso y talla actuales, sin saber que posteriormente habría un seguimiento de medidas directas de peso y talla. Entre 4 y 8 meses después se pesó y midió a los participantes bajo procedimientos estandarizados. Se calcularon correlaciones Spearman para analizar la correlación entre los datos autorreportados y las medidas tomadas. Se utilizó la prueba Kruskal-Wallis para evaluar la magnitud de la diferencia entre la talla, el peso y el IMC reportados y los medidos (medido menos autorreportado), por nivel de educación y por rango de edad. Se utilizó regresión robusta para evaluar el efecto potencial de las características específicas individuales de la diferencia del peso y de la talla, tanto en los medidos como en los reportados. Se hizo análisis de regresión logística para evaluar la sensibilidad, especificidad y valores predictivos para el índice de masa corporal. RESULTADOS: El estudio incluyó a 934 individuos, de los cuales 62.6 por ciento fueron mujeres; éstas tuvieron una media de talla de 1.55 m ±0.06 y un peso de 65.4 kg ±10.9, mientras que en los hombres la media de talla fue de 1.67 m ±0.06 y el peso de 77.7 kg ±12.5. La media del IMC fue de 27.4 kg/m² ± 4.3 (mujeres: 27.2 kg/m² ±4.45; hombres: 27.8±3.87). La mediana de la percepción de la imagen corporal fue 5 (percentil 25= 4; percentil 75= 6). Las correlaciones entre la talla, el peso y el IMC medidos y autorreportados para todos los sujetos fueron de 0.94, 0.96, y 0.90, respectivamente. La correlación entre el IMC y la percepción de la imagen corporal fue de 0.64 (0.67 para las mujeres, y 0.59 para los hombres). La media de lo autorreportado no tuvo variación mayor de 1.3 cm con la talla medida, y no más de 3.17 kg con el peso medido...