Occurrence of scorpion sting and associated factors in a highly marginalized municipality in Guerrero, Mexico: A cross-sectional study.

BACKGROUND: Scorpion sting is a neglected public health problem, despite a global estimate of 1.2 million scorpion stings and some 3,250 deaths annually. METHODS: This cross-sectional study estimates the occurrence of scorpion stings and identifies associated factors in seven communities in the highly marginalized municipality of Chilapa, in the Mexican state of Guerrero. After informed consent, 1,144 households provided information on 4,985 residents. The questionnaire collated sociodemographic data, characteristics of the dwelling, efforts to avoid scorpion stings, and individual information of scorpion stings suffered in the last year. Cluster-adjusted (acl), bivariate and multivariate analysis relied on the Mantel-Haenszel procedure. RESULTS: The overall period prevalence of scorpion stings in the year prior to the study was 4.4% (218/4985), 5.4% in men (126/2320), and 3.5% in women (92/2665), p<0.01. The majority occurred at home 68.3% (149/218), followed by agricultural fields 26.6% (58/218), street 2.8% (6/218), and work 2.3% (5/218). Factors associated with scorpion sting were carrying firewood (OR 2.1; CI95%acl 1.40-3.09), keeping free-range hens around of the home (OR 1.9; CI95%acl 1.19-2.85), residing in a rural area (OR 1.7; CI95%acl 1.04-2.78), being male (OR 1.6; CI95%acl 1.18-2.28), and helping with housework (OR 1.6; CI95%acl 1.04-2.40). CONCLUSION: This study confirms scorpion bites are a public health problem in these marginalized communities in Guerrero State, with risk factors related to living conditions and the work process at home and in the fields. Almost all risk factors identified could be reduced with low-cost interventions implemented by the communities themselves.

Utility of a Pulmonary Oedema Score for Predicting the Need for Mechanical Ventilation in COVID-19 Patients in a General Hospital.

BACKGROUND: The Radiographic Assessment of Lung Edema (RALE) score has been used to estimate the extent of pulmonary damage in patients with acute respiratory distress syndrome and might be useful in patients with COVID-19. AIM OF THE STUDY: To examine factors associated with the need for mechanical ventilation in hospitalized patients with a clinical diagnosis of COVID-19, and to estimate the predictive value of the RALE score. METHODS: In a series of patients admitted between April 14 and August 28, 2020, with a clinical diagnosis of COVID-19, we assessed lung involvement on the chest radiograph using the RALE score. We examined factors associated with the need for mechanical ventilation in bivariate and multivariate analysis. The area under the receiver operating curve (AUC) indicated the predictive value of the RALE score for need for mechanical ventilation. RESULTS: Among 189 patients, 90 (48%) were judged to need mechanical ventilation, although only 60 were placed on a ventilator. The factors associated with the need for mechanical ventilation were a RALE score >6 points, age >50 years, and presence of chronic kidney disease. The AUC for the RALE score was 60.9% (95% CI 52.9-68.9), indicating it was an acceptable predictor of needing mechanical ventilation. CONCLUSIONS: A score for extent of pulmonary oedema on the plain chest radiograph was a useful predictor of the need for mechanical ventilation of hospitalized patients with COVID-19.

Caries en primeros molares permanentes y factores asociados a esta en escolares de Acapulco / Caries in permanent first molars and associated factors with its in schoolchildren from Acapulco

Introducción: La caries es una de las enfermedades bucodentales más frecuentes y, por ser las primeras en emerger, los primeros molares permanentes son las piezas más susceptibles a esta afección. Objetivo: Estimar la prevalencia de caries y factores asociados a esta en los primeros molares permanentes en escolares de segundo grado de primaria. Métodos: Estudio transversal, en estudiantes de segundo grado en 17 de 67 escuelas públicas de Acapulco, Guerrero. Un cuestionario autoadministrado se utilizó para obtener datos sociodemográficos y hábitos de higiene dental. La caries y la presencia de placa dentobacteriana se midieron a través de índices epidemiológicos, el CPOD (diente cariado, obturado y perdido) y el O'Leary. Se estimó la razón de momios e intervalo de confianza de 95 por ciento, ajustada por conglomerado, como medida de la fuerza de asociación mediante análisis multivariado. Resultados: Se revisaron 3332 primeros molares permanentes, el 21 por ciento tuvo caries, el 6 por ciento tuvo obturaciones y el 1 por ciento ya se había extraído. El índice CPOD de caries grupal fue 0,27. Cinco factores estuvieron asociados a la caries de los primeros molares permanentes: higiene dental deficiente (RMa = 2,87), técnica de cepillado dental inadecuada (RMa = 1,70), tomar alguna bebida dulce antes de ir a dormir (RMa = 1,68), visitar al dentista (RMa = 0,67) y aplicación de flúor (RMa = 0,61). Conclusiones: La prevalencia de caries en los primeros molares permanentes fue 21 por ciento dentro del rango reportado en otros estudios. Fueron identificados cinco factores asociados a la caries: higiene dental deficiente, técnica de cepillado inadecuado, consumo de azúcares antes de dormir, visitas al dentista y aplicación de flúor. Estos factores orientan sobre qué medidas preventivas se deben promover en los escolares para la preservación de sus piezas dentales(AU)

Introduction: Caries is the most frequent oral disease and the first permanent molars are very susceptible to this condition because they are the first teeth to emerge. Objective: To estimate the prevalence of caries its associated factors in the first permanent molars in second grade primary school children. Methods: A cross-sectional study was carried out in second grade students in 17 out of 67primary public schools in Acapulco, Guerrero. We applied a self-administered questionnaire to obtain sociodemographic data and dental hygiene habits. Caries and the presence of dentobacterial plaque were measured through epidemiological indices, CPOD (decayed, blocked and lost tooth) and O'Leary index. The odds ratio and 95 percent confidence interval, adjusted by cluster, were estimated as a measure of strength of association through multivariate analysis. Results: We reviewed 3 332 permanent first molars, 21 percent had cavities, 6 percent had seals and 1 percent had already been removed. The CPOD index of group caries was 0,27. We found five factors associated with caries of the first permanent molars: deficient dental hygiene (RMa=2,87), inadequate tooth brushing technique (RMa=1,70), drinking a sweet drink before bedtime (RMa=1,68), visiting the dentist (RMa=0,67) and fluoride application (RMa=0,61). Conclusions: Prevalence of caries in the first permanent molars was 21 percent, within the range reported in other studies. Five factors associated with caries were identified: poor dental hygiene, inadequate brushing technique, consumption of sugars before going to sleep, visits to the dentist and application of fluoride. These factors guide what preventive measures should be promoted in schoolchildren for the preservation of their teeth(AU)

Utility of entomological indices for predicting transmission of dengue virus: secondary analysis of data from the Camino Verde trial in Mexico and Nicaragua.

Dengue vector entomological indices are widely used to monitor vector density and disease control activities. But the value of these indices as predictors of dengue infection is not established. We used data from the impact assessment of a trial of community mobilization for dengue prevention (Camino Verde) to examine the associations between vector indices and evidence of dengue infection and their value for predicting dengue infection levels. In 150 clusters in Mexico and Nicaragua, two entomological surveys, three months apart, allowed calculation of the mean Container Index, Breteau index, Pupae per Household Index, and Pupae per Container Index across the two surveys. We measured recent dengue virus infection in children, indicated by a doubling of dengue antibodies in paired saliva samples over the three-month period. We examined the associations between each of the vector indices and evidence of dengue infection at household level and at cluster level, accounting for trial intervention status. To examine the predictive value for dengue infection, we constructed receiver operating characteristic (ROC) curves at household and cluster level, considering the four vector indices as continuous variables, and calculated the positive and negative likelihood ratios for different levels of the indices. None of the vector indices was associated with recent dengue infection at household level. The Breteau Index was associated with recent infection at cluster level (Odds ratio 1.36, 95% confidence interval 1.14-1.61). The ROC curve confirmed the weak predictive value for dengue infection of the Breteau Index at cluster level. Other indices showed no predictive value. Conventional vector indices were not useful in predicting dengue infection in Mexico and Nicaragua. The findings are compatible with the idea of sources of infection outside the household which were tackled by community action in the Camino Verde trial.

Factors Associated with Chikungunya Relapse in Acapulco, Mexico: A Cross-Sectional Study.

Objective: To estimate the occurrence of self-reported chikungunya relapse and identify associated factors. Materials and Methods: A cross-sectional study in December 2015 included 1305 homes in eight urban clusters considered representative of Acapulco in southern Mexico. Administered questionnaires collated information on 5870 individuals, including sociodemographic variables, a history of chronic conditions, and the self-reporting of chikungunya. Bivariate and multivariate analyses relied on a cluster-adjusted Mantel-Haenszel procedure to identify the factors associated with chikungunya and its relapse. Results: Some 66% (3531/5870) of the population reported suffering chikungunya and 31.1% (1098/3531) reported a relapse. Factors associated with relapse included the severity of the chikungunya case (odds ratio [OR]: 3.35; clusters adjusted 95% confidence interval [95% CIca]: 3.16-3.55); history of arthralgia (OR: 2.96; 95% CIca: 2.27-3.86); age 30 years or older (OR: 1.85; 95% CIca: 1.72-1.98); female (OR: 1.64; 95% CIca: 1.42-1.90); and higher education households (OR: 1.18; 95% CIca: 1.11-1.27). Conclusions: The high occurrence of chikungunya and its relapse are a public health problem. The factors associated with relapse do not immediately suggest specific prevention strategies but emphasize the dire need for effective approaches to vector control.

Body image and obesity in children from public primary schools in Acapulco, Mexico: A cross-sectional study.

Background: Childhood obesity is a global problem, causing social and psychological damage, as well as physical health risks. This study estimated the occurrence of body image dissatisfaction in primary schoolchildren aged 9-13 years and investigated its association with obesity and other factors. Methods: A cross-sectional study was conducted, for which 533 students attending three public primary schools in Acapulco were recruited. Students completed a facilitated self-administered questionnaire about their age, sex, socioeconomic level, body image satisfaction, and perception of their parents' body image. We registered anthropometry of the students and calculated body mass index (BMI). We examined the associations of BMI category and other factors with body image dissatisfaction, calculating the cluster-adjusted odds ratio and 95% confidence intervals. Results: From the total number of participants, 75% (181/243) of girls and 73% (170/232) of boys were dissatisfied with their body image and wanted a slimmer body. About half were overweight or obese: 45% (121/271) of girls and 52% (135/262) of boys. Overweight or obese children were much more likely to be dissatisfied with their body image (cluster adjusted: 6.73; 95% CI: 5.42-8.36). No other factors were significantly associated with body image dissatisfaction. One-third of the girls (32%, 86/271) and 17% (45/261) of the boys reported an underweight desired body image. Conclusions: The high level of obesity is a cause for concern and an even higher level of body image dissatisfaction as well. The high dissatisfaction among children suggests that boys, as well as girls in Mexico, may now be subjected to intense social pressure about desirable body image.

Introducción: La obesidad infantil es un problema global que causa daños sociales, psicológicos y en la salud física. Se estimó la ocurrencia de insatisfacción con la imagen corporal en escolares de 9 a 13 años, y su asociación con la obesidad y otros factores. Métodos: Se realizó un estudio transversal en 533 estudiantes de tres escuelas primarias públicas en Acapulco, México. Se aplicó un cuestionario autoadministrado sobre edad, sexo, nivel socioeconómico, satisfacción con la imagen corporal y percepción de la imagen corporal de los padres. Se midieron el peso y la talla, y se calculó el índice de masa corporal (IMC). Se examinaron las asociaciones entre el IMC y otros factores con la insatisfacción con la imagen corporal, y se calculó la razón de momios ajustada por conglomerado y sus intervalos de confianza del 95% (IC 95%). Resultados: El 75% (181/243) de niñas y el 73% (170/232) de niños estaban insatisfechos con su imagen corporal; casi todos deseaban un cuerpo más delgado. El 45% (121/271) de las niñas y el 52% (135/262) de los niños presentaba sobrepeso u obesidad, lo que se asoció con la insatisfacción con su imagen corporal (ajustado por clúster: 6.73; IC 95%: 5.42-8.36). Ningún otro factor se asoció significativamente con la insatisfacción con la imagen corporal. El 32% (86/271) de las niñas y el 17% (45/261) de los niños reportaron una imagen corporal deseada con bajo peso. Conclusiones: El alto nivel de obesidad y el mayor nivel de insatisfacción con la imagen corporal son motivo de preocupación. La insatisfacción sugiere que los niños y las niñas en México pueden verse sometidos a una fuerte presión social sobre la imagen corporal deseable.

Body image and obesity in children from public primary schools in Acapulco, Mexico: A cross-sectional study / Imagen corporal y obesidad en escolares de primarias públicas en Acapulco, México: un estudio transversal

Abstract Background: Childhood obesity is a global problem, causing social and psychological damage, as well as physical health risks. This study estimated the occurrence of body image dissatisfaction in primary schoolchildren aged 9-13 years and investigated its association with obesity and other factors. Methods: A cross-sectional study was conducted, for which 533 students attending three public primary schools in Acapulco were recruited. Students completed a facilitated self-administered questionnaire about their age, sex, socioeconomic level, body image satisfaction, and perception of their parents’ body image. We registered anthropometry of the students and calculated body mass index (BMI). We examined the associations of BMI category and other factors with body image dissatisfaction, calculating the cluster-adjusted odds ratio and 95% confidence intervals. Results: From the total number of participants, 75% (181/243) of girls and 73% (170/232) of boys were dissatisfied with their body image and wanted a slimmer body. About half were overweight or obese: 45% (121/271) of girls and 52% (135/262) of boys. Overweight or obese children were much more likely to be dissatisfied with their body image (cluster adjusted: 6.73; 95% CI: 5.42-8.36). No other factors were significantly associated with body image dissatisfaction. One-third of the girls (32%, 86/271) and 17% (45/261) of the boys reported an underweight desired body image. Conclusions: The high level of obesity is a cause for concern and an even higher level of body image dissatisfaction as well. The high dissatisfaction among children suggests that boys, as well as girls in Mexico, may now be subjected to intense social pressure about desirable body image.

Resumen Introducción: La obesidad infantil es un problema global que causa daños sociales, psicológicos y en la salud física. Se estimó la ocurrencia de insatisfacción con la imagen corporal en escolares de 9 a 13 años, y su asociación con la obesidad y otros factores. Métodos: Se realizó un estudio transversal en 533 estudiantes de tres escuelas primarias públicas en Acapulco, México. Se aplicó un cuestionario autoadministrado sobre edad, sexo, nivel socioeconómico, satisfacción con la imagen corporal y percepción de la imagen corporal de los padres. Se midieron el peso y la talla, y se calculó el índice de masa corporal (IMC). Se examinaron las asociaciones entre el IMC y otros factores con la insatisfacción con la imagen corporal, y se calculó la razón de momios ajustada por conglomerado y sus intervalos de confianza del 95% (IC 95%). Resultados: El 75% (181/243) de niñas y el 73% (170/232) de niños estaban insatisfechos con su imagen corporal; casi todos deseaban un cuerpo más delgado. El 45% (121/271) de las niñas y el 52% (135/262) de los niños presentaba sobrepeso u obesidad, lo que se asoció con la insatisfacción con su imagen corporal (ajustado por clúster: 6.73; IC 95%: 5.42-8.36). Ningún otro factor se asoció significativamente con la insatisfacción con la imagen corporal. El 32% (86/271) de las niñas y el 17% (45/261) de los niños reportaron una imagen corporal deseada con bajo peso. Conclusiones: El alto nivel de obesidad y el mayor nivel de insatisfacción con la imagen corporal son motivo de preocupación. La insatisfacción sugiere que los niños y las niñas en México pueden verse sometidos a una fuerte presión social sobre la imagen corporal deseable.

Occult renal failure and associated factors in patients with chronic conditions.

INTRODUCTION: Timely diagnosis and early therapeutic intervention reduce premature mortality associated with chronic renal failure. OBJECTIVE: To identify the prevalence and factors associated with occult renal failure in patients with chronic diseases. METHOD: Cross-sectional study of 1268 patients with type 2 diabetes mellitus and systemic arterial hypertension. A measuring instrument with questions about associated factors such as osteoarthritis, treatment of chronic conditions, smoking, analgesic consumption, alcoholism, body mass index, physical activity and serum glucose, cholesterol and triglyceride levels was used. RESULTS: The prevalence of occult renal failure was 13.2 % (167/1,268), 13.4 % in diabetic patients (117/876) and 14.9 % in hypertensive patients (150/1,010). In the multivariate analysis, the factors associated with occult renal failure were being older than 60 years (aOR = 1.96, 95 % CI = 1.22-2.49), belonging to the female gender (aOR = 2.17, 95 % CI = 1.30-2.82), suffering from systemic arterial hypertension (aOR = 1.96, 95% CI = 1.22-2.50) and not having overweight/obesity (aOR = 0.49, 95 % CI = 0.41-0.8). CONCLUSIONS: The prevalence of occult renal failure was 13 %. Female patients older than 60 years with overweight/obesity and systemic arterial hypertension should be examined in detail by the family doctor for occult renal failure early detection.

INTRODUCCIÓN: El diagnóstico oportuno y la intervención terapéutica temprana disminuyen la mortalidad prematura asociada con insuficiencia renal crónica. OBJETIVO: Identificar la prevalencia y factores asociados con insuficiencia renal oculta en pacientes con enfermedades crónicas. MÉTODO: Estudio transversal de 1268 pacientes con diabetes mellitus tipo 2 e hipertensión arterial sistémica. Se usó un instrumento de medición con preguntas sobre factores asociados como artrosis, tratamiento de padecimiento crónico, tabaquismo, ingesta de analgésicos, alcoholismo, índice de masa corporal, actividad física y niveles séricos de glucosa, colesterol y triglicéridos. RESULTADOS: La prevalencia de insuficiencia renal oculta fue de 13.2 % (167/1268), 13.4 % en pacientes diabéticos (117/876) y 14.9 % en hipertensos (150/1010). En el analisis multivariado, los factores asociados con insuficiencia renal oculta fueron edad > 60 años (RMa = 1.96, IC 95 % = 1.22-2.49), sexo femenino (RMa = 2.17, IC 95 % = 1.30-2.82), padecer hipertensión arterial sistémica (RMa = 1.96, IC 95 % = 1.22-2.50) y no tener sobrepeso u obesidad (RMa = 0.49, IC 95 % = 0.41-0.8). CONCLUSIONES: La prevalencia de insuficiencia renal oculta fue de 13 %. Los pacientes mayores de 60 años, con sobrepeso u obesidad e hipertensión arterial sistémica deben ser examinados detalladamente por el médico familiar para la detección temprana de insuficiencia renal oculta.

Insuficiencia renal oculta y factores asociados en pacientes con enfermedades crónicas / Occult renal failure and associated factors in patients with chronic conditions

Resumen Introducción: El diagnóstico oportuno y la intervención terapéutica temprana disminuyen la mortalidad prematura asociada con insuficiencia renal crónica. Objetivo: Identificar la prevalencia y factores asociados con insuficiencia renal oculta en pacientes con enfermedades crónicas. Método: Estudio transversal de 1268 pacientes con diabetes mellitus tipo 2 e hipertensión arterial sistémica. Se usó un instrumento de medición con preguntas sobre factores asociados como artrosis, tratamiento de padecimiento crónico, tabaquismo, ingesta de analgésicos, alcoholismo, índice de masa corporal, actividad física y niveles séricos de glucosa, colesterol y triglicéridos. Resultados: La prevalencia de insuficiencia renal oculta fue de 13.2 % (167/1268), 13.4 % en pacientes diabéticos (117/876) y 14.9 % en hipertensos (150/1010). En el analisis multivariado, los factores asociados con insuficiencia renal oculta fueron edad > 60 años (RMa = 1.96, IC 95 % = 1.22-2.49), sexo femenino (RMa = 2.17, IC 95 % = 1.30-2.82), padecer hipertensión arterial sistémica (RMa = 1.96, IC 95 % = 1.22-2.50) y no tener sobrepeso u obesidad (RMa = 0.49, IC 95 % = 0.41-0.8). Conclusiones: La prevalencia de insuficiencia renal oculta fue de 13 %. Los pacientes mayores de 60 años, con sobrepeso u obesidad e hipertensión arterial sistémica deben ser examinados detalladamente por el médico familiar para la detección temprana de insuficiencia renal oculta.

Abstract Introduction: Timely diagnosis and early therapeutic intervention reduce premature mortality associated with chronic renal failure. Objective: To identify the prevalence and factors associated with occult renal failure in patients with chronic diseases. Method: Cross-sectional study of 1268 patients with type 2 diabetes mellitus and systemic arterial hypertension. A measuring instrument with questions about associated factors such as osteoarthritis, treatment of chronic conditions, smoking, analgesic consumption, alcoholism, body mass index, physical activity and serum glucose, cholesterol and triglyceride levels was used. Results: The prevalence of occult renal failure was 13.2 % (167/1,268), 13.4 % in diabetic patients (117/876) and 14.9 % in hypertensive patients (150/1,010). In the multivariate analysis, the factors associated with occult renal failure were being older than 60 years (aOR = 1.96, 95 % CI = 1.22-2.49), belonging to the female gender (aOR = 2.17, 95 % CI = 1.30-2.82), suffering from systemic arterial hypertension (aOR = 1.96, 95% CI = 1.22-2.50) and not having overweight/obesity (aOR = 0.49, 95 % CI = 0.41-0.8). Conclusions: The prevalence of occult renal failure was 13 %. Female patients older than 60 years with overweight/obesity and systemic arterial hypertension should be examined in detail by the family doctor for occult renal failure early detection.

Social capital is associated with lower mosquito vector indices: secondary analysis from a cluster randomised controlled trial of community mobilisation for dengue prevention in Mexico.

BACKGROUND: Control of the Aedes aegypti mosquito is central to reducing the risk of dengue, zika, chikungunya, and yellow fever. Randomised controlled trials, including the Camino Verde trial in Mexico and Nicaragua, demonstrate the convincing impact of community mobilisation interventions on vector indices. These interventions might work through building social capital but little is known about the relationship between social capital and vector indices. METHODS: A secondary analysis used data collected from 45 intervention clusters and 45 control clusters in the impact survey of the Mexican arm of the Camino Verde cluster randomised controlled trial. Factor analysis combined responses to questions about aspects of social capital to create a social capital index with four constructs, their weighted averages then combined into a single scale. We categorised households as having high or low social capital based on their score on this scale. We examined associations between social capital and larval and pupal vector indices, taking account of the effects of other variables in a multivariate analysis. We report associations as odds ratios and 95% confidence intervals. RESULTS: The four social capital constructs were involvement, participation, investment, and communication. Among the 10,112 households, those in rural communities were much more likely to have a high social capital score (OR 4.51, 95% CIca 3.26-6.26). Households in intervention sites had higher social capital, although the association was not significant at the 5% level. Households with high social capital were more likely to be negative for larvae or pupae (OR 1.38, 95% CIca 1.12-1.69) and for pupae specifically (OR 1.37, 95% CIca 1.08-1.74). There was interaction between intervention status and social capital; in multivariate analysis, a combined variable of intervention/high social capital remained associated with larvae or pupae (ORa l.56, 95% CIca 1.19-2.04) and with pupae specifically (ORa 1.65, 95% CIca 1.20-2.28). CONCLUSION: This is the first report of an association of high social capital with low vector indices. Our findings support the idea that the Camino Verde community mobilisation intervention worked partly through an interaction with social capital. Understanding such interactions may help to maximise the impact of future community mobilisation interventions.

Factores asociados con la picadura de alacrán en escolares: estudio transversal en dos comunidades rurales de Guerrero, México / Factors associated with scorpion stings in schoolchildren: cross-sectional study from two rural communities of Guerrero, Mexico

Resumen Introducción: La intoxicación por picadura de alacrán es un problema de salud pública en las regiones de América Latina y América del Norte. El objetivo de este estudio fue identificar especies de alacrán de importancia médica, estimar la ocurrencia de accidentes por picadura de alacrán y factores asociados en la población de edad escolar. Métodos: Estudio transversal en dos comunidades rurales de Guerrero, México, en dos fases: el estudio entomológico para estimar índices escorpionológicos y la encuesta a escolares que incluyó las características de sus viviendas, la tenencia de aves, los antecedentes de picadura de alacrán y variables relevantes. Se estimó la razón de momios ajustada (RMa) como medida de asociación al accidente por picadura de alacrán en los escolares mediante análisis multivariado. Resultados: Las especies de importancia médica fueron Centruroides limpidus y Centruroides balsasensis. El reporte de accidente por picadura de alacrán en los últimos 6 meses en escolares fue del 12 % (171/1,437). Siete de cada diez escolares requirió de atención médica. Fueron identificados cuatro factores asociados con el reporte de accidente por picadura de alacrán: tener patos en la vivienda (razón de momios ajustada [RMa]: 1.98; intervalo de confianza [IC] 95 %: 1.2-4.29), falta de aseo en la vivienda (RMa: 1.84; IC 95 %: 1.02-4.16), ayudar en la labor del campo (RMa: 1.53; IC 95 %: 1.13-2.46) y viviendas con material del techo no permanente (RMa: 1.42; IC 95 %: 1.04-2.18). Conclusiones: Centruroides limpidus fue la especie de importancia médica más relevante. Fueron identificados dos factores asociados que son potencialmente modificables: mejorar el material del techo de la vivienda y asear la vivienda.

Abstract Introduction: Scorpion stings represent a public health problem in Latin America and North America. The aim of this study was to identify species of medical importance, as well as to estimate the frequency of scorpion sting and the associated risk and protective factors in schoolchildren. Methods: Cross-sectional study in two rural communities in the Mexican state of Guerrero, in two phases: an entomological study that estimated the scorpion density and overcrowding index; a survey to document housing characteristics, poultry ownership, and history of scorpion sting in schoolchildren. Adjusted odds ratio (ORa) was used as a measure of association with scorpion sting in a multivariate analysis. Results: The species of medical importance were Centruroides limpidus and Centruroides balsasensis. Twelve percent (171/1,437) of school children reported scorpion sting in the last six months, of whom seven out of ten required medical care. Four factors were associated with the report of scorpion sting: having ducks in the dwelling (ORa: 1.98; CI 95%: 1.2-4.29), lack of cleanliness in the dwelling (ORa: 1.84; CI 95%: 1.02-4.16), farming as an occupation (ORa: 1.53; CI 95%: 1.13-2.46) and dwelling with uncovered infrastructure of the roof, those made of wood/iron sheet or cardboard (ORa: 1.42; CI 95%: 1.04-2.18). Conclusions: The most relevant species was Centruroides limpidus. Two factors might be particularly relevant to prevention: improvement of household roofing material and attention to housekeeping.

Factores asociados con la picadura de alacrán en escolares: estudio transversal en dos comunidades rurales de Guerrero, México.

Introduction: Scorpion stings represent a public health problem in Latin America and North America. The aim of this study was to identify species of medical importance, as well as to estimate the frequency of scorpion sting and the associated risk and protective factors in schoolchildren. Methods: Cross-sectional study in two rural communities in the Mexican state of Guerrero, in two phases: an entomological study that estimated the scorpion density and overcrowding index; a survey to document housing characteristics, poultry ownership, and history of scorpion sting in schoolchildren. Adjusted odds ratio (ORa) was used as a measure of association with scorpion sting in a multivariate analysis. Results: The species of medical importance were Centruroides limpidus and Centruroides balsasensis. Twelve percent (171/1,437) of school children reported scorpion sting in the last six months, of whom seven out of ten required medical care. Four factors were associated with the report of scorpion sting: having ducks in the dwelling (ORa: 1.98; CI 95%: 1.2-4.29), lack of cleanliness in the dwelling (ORa: 1.84; CI 95%: 1.02-4.16), farming as an occupation (ORa: 1.53; CI 95%: 1.13-2.46) and dwelling with uncovered infrastructure of the roof, those made of wood/iron sheet or cardboard (ORa: 1.42; CI 95%: 1.04-2.18). Conclusions: The most relevant species was Centruroides limpidus. Two factors might be particularly relevant to prevention: improvement of household roofing material and attention to housekeeping.

Introducción: La intoxicación por picadura de alacrán es un problema de salud pública en las regiones de América Latina y América del Norte. El objetivo de este estudio fue identificar especies de alacrán de importancia médica, estimar la ocurrencia de accidentes por picadura de alacrán y factores asociados en la población de edad escolar. Métodos: Estudio transversal en dos comunidades rurales de Guerrero, México, en dos fases: el estudio entomológico para estimar índices escorpionológicos y la encuesta a escolares que incluyó las características de sus viviendas, la tenencia de aves, los antecedentes de picadura de alacrán y variables relevantes. Se estimó la razón de momios ajustada (RMa) como medida de asociación al accidente por picadura de alacrán en los escolares mediante análisis multivariado. Resultados: Las especies de importancia médica fueron Centruroides limpidus y Centruroides balsasensis. El reporte de accidente por picadura de alacrán en los últimos 6 meses en escolares fue del 12% (171/1,437). Siete de cada diez escolares requirió de atención médica. Fueron identificados cuatro factores asociados con el reporte de accidente por picadura de alacrán: tener patos en la vivienda (razón de momios ajustada [RMa]: 1.98; intervalo de confianza [IC] 95%: 1.2-4.29), falta de aseo en la vivienda (RMa: 1.84; IC 95%: 1.02-4.16), ayudar en la labor del campo (RMa: 1.53; IC 95%: 1.13-2.46) y viviendas con material del techo no permanente (RMa: 1.42; IC 95%: 1.04-2.18). Conclusiones: Centruroides limpidus fue la especie de importancia médica más relevante. Fueron identificados dos factores asociados que son potencialmente modificables: mejorar el material del techo de la vivienda y asear la vivienda.

Prevalencia de caries y factores asociados: estudio transversal en estudiantes de preparatoria de Chilpancingo, Guerrero, México / Prevalence of dental caries and associated risk factors: a cross-sectional study among preparatory (high school) students from Chilpancingo, Guerrero, Mexico

RESUMEN Introducción: La caries dental es el principal problema bucal que afecta a casi toda la población. La niñez y juventud son etapas cruciales para adquirir el hábito de higiene bucal adecuada y evitar daños a la cavidad oral en la edad adulta. Objetivo: Estimar la prevalencia de caries y los factores asociados en estudiantes de educación media superior de la Universidad Autónoma de Guerrero. Material y métodos: Estudio transversal en estudiantes de tres escuelas preparatorias de Chilpancingo, Gro. Un cuestionario autoadministrado preguntó sobre datos sociodemográficos, hábitos de higiene dental y la presencia de caries se definió a partir del índice CPOD (diente cariado, perdido y obturado). Se estimó razón de momios e intervalo de confianza de 95% como medida de asociación de los factores de riesgo. La estimación de las asociaciones en el análisis multivariado fue ajustada por el efecto del conglomerado. Resultados: La prevalencia de caries fue 91% (1,300/1,424), 18% (245/1,424) de los estudiantes tuvo obturados, 5% (67/1,424) tuvo una o más piezas dentales perdidas. El índice CPOD fue 5.31. Dos factores se asociaron con la presencia de caries: consumo de frituras, refrescos y golosinas (RMa 2.43, IC 95% 1.45-4.09), y la poca importancia dada a la salud bucal (RMa 1.48, IC 95% 1.01-2.18). Conclusiones: La prevalencia encontrada está en el rango de los reportes internacionales. Los dos factores asociados con la caries dental orientan qué acciones deben promoverse para el cuidado de la salud bucal en los estudiantes de educación media superior de la UAGro.

ABSTRACT Introduction: Tooth decay is the most important oral health problem affecting almost the whole population. Childhood and youth are crucial stages to acquire habits of proper oral hygiene to prevent damage to the oral cavity in adulthood. Objective: To measure the prevalence of dental caries and associated risk factors in students of middle education (preparatory school) at the Autonomous University of Guerrero (UAGro). Methods: Cross-sectional study including students from three preparatory schools (high schools) in Chilpancingo, Guerrero. A self-administered questionnaire collected sociodemographic and dental hygiene information; the presence of caries was defined according to the DMFT index (decayed, filled, and missing teeth). Odds ratio and 95% confidence intervals were estimated as measures of association for risk factors. Estimated associations in the multivariate analysis were adjusted by cluster effect. Results: The prevalence of caries was 91% (1,300/1,424); 18% (245/1,424) of students had filled teeth and 5% (67/1,424) had one or more missing teeth. A DMFT index score of 5.31 was found. Two factors were associated with the presence of caries: intake of snacks, sweets, and soft drinks (OR 2.43, 95% CI 1.45-4.09) and little attention to oral health (OR 1.48, 95% CI 1.01-2.18). Conclusions: The caries prevalence is in the range of international reports. The two factors associated with tooth decay should guide the actions to be implemented for promoting oral health among UAGro students of middle education.

Factores asociados a epilepsia en niños en México: un estudio caso-control / Factors associated with epilepsy in children in Mexico: A case-control study

Resumen: Introducción: La epilepsia es la enfermedad neurológica crónica más común en el mundo. En México es considerada dentro de las principales enfermedades vinculadas a la mortalidad por enfermedades no infecciosas de la población infantil. El objetivo del estudio fue identificar los factores asociados a epilepsia en niños derechohabientes del Instituto Mexicano del Seguro Social (IMSS), en Acapulco, México. Métodos: Estudio de casos y controles realizado entre abril de 2010 y abril de 2011. Fueron seleccionados 118 casos de la consulta externa de neurología pediátrica, con criterios diagnósticos de epilepsia de acuerdo a la Liga Internacional Contra la Epilepsia, con máximo dos años de evolución. Los controles fueron seleccionados de las Unidades de Medicina Familiar de donde procedieron los casos. En una encuesta a las madres, se obtuvo información sobre antecedentes heredofamiliares, prenatales, perinatales y posnatales. El análisis bivariado y multivariado se realizó mediante el procedimiento de Mantel-Haenszel. Resultados: Tres factores estuvieron asociados con la epilepsia: el antecedente familiar de epilepsia en familiares de primer grado (Razón de Momios ajustada (RMa) 2.44, IC95% 1.18 - 5.03), la asfixia al nacimiento (RMa 2.20, IC95% 1.16-34.18) y la infección de la vía urinaria en la etapa prenatal (RMa, 1.80 IC95% 1.0 - 3.24). Conclusiones: La asfixia al nacimiento y el reporte de infecciones de vías urinarias durante la gestación fueron factores asociados a epilepsia independientemente del antecedente de epilepsia en familiares de primer grado.

Abstract: Background: Epilepsy is the most common chronic neurological disease in the world. In Mexico, epilepsy is among the diseases more related to mortality due to non-infectious diseases in children. The objective of the study was to identify the factors associated with epilepsy in children entitled to the Mexican Social Security Institute (IMSS), in Acapulco, Mexico. Methods: We carried out a case-control study from April 2010 to April 2011. We selected 118 cases from the database of outpatient pediatric neurology with epilepsy diagnostic with two year of evolution according to the International League Against Epilepsy criteria. We selected 118 controls from the same Medical Units where cases were detected. Data collected throughout an interview with the mothers included information on history of epilepsy among relatives, prenatal, perinatal and postnatal history. Bivariate and multivariate analysis was performed using Mantel-Haenszel process. Results: Multivariate analysis identified three factors associated with epilepsy: family history of epilepsy in first-degree relatives (adjusted Odds ratio (ORa) 2.44, 95%CI 1.18 -5.03), birth asphyxia (ORa 2.20, 95%CI 1.16-34.18), and urinary tract infection in the prenatal stage (ORa, 1.80, 95%CI 1.0 - 3.24). Conclusions: Preventing birth asphyxia and urinary tract infections during pregnancy reduces the risk of epilepsy regardless of the history of epilepsy in first-degree relatives.

Pupal productivity in rainy and dry seasons: findings from the impact survey of a randomised controlled trial of dengue prevention in Guerrero, Mexico.

BACKGROUND: The follow-up survey of a cluster-randomised controlled trial of evidence-based community mobilisation for dengue control in Nicaragua and Mexico included entomological information from the 2012 rainy and dry seasons. We used data from the Mexican arm of the trial to assess the impact of the community action on pupal production of the dengue vector Aedes aegypti in both rainy and dry seasons. METHODS: Trained field workers inspected household water containers in 90 clusters and collected any pupae or larvae present for entomological examination. We calculated indices of pupae per person and pupae per household, and traditional entomological indices of container index, household index and Breteau index, and compared these between rainy and dry seasons and between intervention and control clusters, using a cluster t-test to test significance of differences. RESULTS: In 11,933 houses in the rainy season, we inspected 40,323 containers and found 7070 Aedes aegypti pupae. In the dry season, we inspected 43,461 containers and counted 6552 pupae. All pupae and entomological indices were lower in the intervention clusters (IC) than in control clusters (CC) in both the rainy season (RS) and the dry season (DS): pupae per container 0.12 IC and 0.24 CC in RS, and 0.10 IC and 0.20 CC in DS; pupae per household 0.46 IC and 0.82 CC in RS, and 0.41 IC and 0.83 CC in DS; pupae per person 0.11 IC and 0.19 CC in RS, and 0.10 IC and 0.20 CC in DS; household index 16% IC and 21% CC in RS, and 12.1% IC and 17.9% CC in DS; container index 7.5% IC and 11.5% CC in RS, and 4.6% IC and 7.1% CC in DS; Breteau index 27% IC and 36% CC in RS, and 19% IC and 29% CC in DS. All differences between the intervention and control clusters were statistically significant, taking into account clustering. CONCLUSIONS: The trial intervention led to significant decreases in pupal and conventional entomological indices in both rainy and dry seasons. TRIAL REGISTRATION: ISRCTN27581154 .

Dengue occurrence relations and serology: cross-sectional analysis of results from the Guerrero State, Mexico, baseline for a cluster-randomised controlled trial of community mobilisation for dengue prevention.

BACKGROUND: The Mexican arm of the Camino Verde trial of community mobilisation for dengue prevention covered three coastal regions of Guerrero state: Acapulco, Costa Grande and Costa Chica. A baseline cross-sectional survey provided data for community mobilisation and for adapting the intervention design to concrete conditions in the intervention areas. METHODS: Trained field teams constructed community profiles in randomly selected clusters, based on observation and key informant interviews. In each household they carried out an entomological inspection of water containers, collected information on socio-demographic variables and cases of dengue illness among household members in the last year, and gathered paired saliva samples from children aged 3-9 years, which were subjected to ELISA testing to detect recent dengue infection. We examined associations with dengue illness and recent dengue infection in bivariate and then multivariate analysis. RESULTS: In 70/90 clusters, key informants were unable to identify any organized community groups. Some 1.9% (1029/55,723) of the household population reported dengue illness in the past year, with a higher rate in Acapulco region. Among children 3-9 years old, 6.1% (392/6382) had serological evidence of recent dengue infection. In all three regions, household use of anti-mosquito products, household heads working, and households having less than 5 members were associated with self-reported dengue illness. In Acapulco region, people aged less than 25 years, those with a more educated household head and those from urban sites were also more likely to report dengue illness, while in Costa Chica and Costa Grande, females were more likely to report dengue illness. Among children aged 3-9 years, those aged 3-4 years and those living in Acapulco were more likely to have evidence of recent dengue infection. CONCLUSIONS: The evidence from the baseline survey provided important support for the design and implementation of the trial intervention. The weakness of community leadership and the relatively low rates of self-reported dengue illness were challenges that the Mexican intervention team had to overcome. The higher dengue illness occurrence among women in Costa Grande and Costa Chica may help explain why women participated more than men in activities during the Camino Verde trial.

[Factors associated with epilepsy in children in Mexico: A case-control study]. / Factores asociados a epilepsia en niños en México: un estudio caso-control.

BACKGROUND: Epilepsy is the most common chronic neurological disease in the world. In Mexico, epilepsy is among the diseases more related to mortality due to non-infectious diseases in children. The objective of the study was to identify the factors associated with epilepsy in children entitled to the Mexican Social Security Institute (IMSS), in Acapulco, Mexico. METHODS: We carried out a case-control study from April 2010 to April 2011. We selected 118 cases from the database of outpatient pediatric neurology with epilepsy diagnostic with two year of evolution according to the International League Against Epilepsy criteria. We selected 118 controls from the same Medical Units where cases were detected. Data collected throughout an interview with the mothers included information on history of epilepsy among relatives, prenatal, perinatal and postnatal history. Bivariate and multivariate analysis was performed using Mantel-Haenszel process. RESULTS: Multivariate analysis identified three factors associated with epilepsy: family history of epilepsy in first-degree relatives (adjusted Odds ratio (ORa) 2.44, 95%CI 1.18 -5.03), birth asphyxia (ORa 2.20, 95%CI 1.16-34.18), and urinary tract infection in the prenatal stage (ORa, 1.80, 95%CI 1.0 - 3.24). CONCLUSIONS: Preventing birth asphyxia and urinary tract infections during pregnancy reduces the risk of epilepsy regardless of the history of epilepsy in first-degree relatives.

Prevalencia de gingivitis y factores asociados en estudiantes de la Universidad Autónoma de Guerrero, México / Prevalence of gingivitis and associated factors among students from the Autonomous University of Guerrero, Mexico

Introducción: la gingivitis es la enfermedad más común del periodonto, la medida profiláctica más efectiva y económica es la higiene bucal. Objetivos: estimar la prevalencia de gingivitis e identificar factores de riesgo asociados en universitarios de primer ingreso. Métodos: se realizó un estudio transversal de septiembre a diciembre de 2012. Se encuestó a 1 387 estudiantes de licenciatura de la Universidad Autónoma de Guerrero en Acapulco, México. No se estimó tamaño de la muestra porque se encuestó a todos los inscritos. Los instrumentos para la recolección de datos fue un cuestionario autoadministrado, formatos para inspección bucal y levantamiento de índice de higiene oral de Green y Vermillion simplificado, e índices de placa y gingivitis de Löe y Silness simplificados. El diagnóstico de gingivitis se hizo con los valores clínicos del índice de Löe y Silness considerando los puntajes de 0 a 0,09 como sano. La variable resultado fue gingivitis y las de causa: placa dentobacteriana, mala higiene bucal, tártaro, detritos, diastemas, aparatos de ortodoncia, apiñamiento dental y desgastes cervicales. Resultados: la prevalencia de gingivitis ponderada por conglomerado de escuelas fue 74,5 por ciento, de la cual 62,8 por ciento fue leve, 11,5 por ciento moderada, y 0,2 por ciento intensa. El 16 por ciento de los estudiantes, según el índice de Green y Vermillion, tuvo mala higiene y 87,3 pore ciento tuvo placa según criterio de Löe y Silness. Ajustando por conglomerados y los demás factores, cuatro factores fueron asociados a gingivitis: mala higiene bucal (OR 2,58 IC 95 por ciento 1,32-5,05), detritos (OR 2,62 IC 95 por ciento 1,49-4,58), diastemas (OR 1,72; IC 95 por ciento 1,13-2,64) y desgastes en cervical (OR 0,49; IC 95 por ciento 0,24-1,00). Conclusiones: la prevalencia de gingivitis se encontró dentro del rango reportado en otros estudios. La mala higiene bucal, detritos y diastemas fueron los factores de riesgo asociados a gingivitis(AU)

Introduction: gingivitis is the most common periodontal disease. The most effective prophylactic measure against this condition is oral hygiene. Objectives: estimate the prevalence of gingivitis and identify associated risk factors among first year university students. Methods: across-sectional study was conducted from September to December 2012 based on a survey applied to 1 387 students from the Autonomous University of Guerrero in Acapulco, Mexico. Sample size was not estimated because all the students registered were surveyed. The data collection tools used were a self-applied questionnaire, oral examination forms, the simplified Green and Vermillion oral hygiene index, and the simplified Löe and Silness plaque and gingivitis indices. Gingivitis was diagnosed with values on Löe and Silness indices, where scores from 0 to 0.09 were considered healthy. The result variable studied was gingivitis. Cause variables were dental plaque, poor oral hygiene, tartar, detritus, diastema, orthodontic appliances, dental crowding and cervical wear. Results: prevalence of gingivitis estimated by school cluster was 74.5 percent, of which 62.8 percent was mild, 11.5 percent was moderate and 0.2 percent was severe. According to the Green and Vermillion index, 16 percent of the students had poor hygiene, and according to the Löe and Silness indices 87.3 percent had plaque. Adjustment by clusters and other variables revealed four factors associated with gingivitis: poor oral hygiene (OR 2.58; CI 95 percent; 1.32-5.05), detritus (OR 2.62; CI 95 percent; 1.49-4.58), diastema (OR 1.72; CI 95 percent; 1.13-2.64) and cervical wear (OR 0.49; CI 95 percent; 0.24-1.00). Conclusions: prevalence of gingivitis was found to be within the range reported by other studies. Poor oral hygiene, detritus and diastema were the risk factors associated with gingivitis(AU)

Satisfacción de usuarios con los servicios de salud bucal y factores asociados en Acapulco, México / User satisfaction with dental services and associated factors in Acapulco, Mexico

Introducción: la medición de los niveles de satisfacción de los usuarios es parte fundamental para evaluar la calidad de los servicios de salud bucal. Objetivo: estimar la frecuencia de satisfacción y sus factores asociados en los usuarios de los servicios odontológicos en una jurisdicción sanitaria de Guerrero, México. Métodos: se realizó estudio transversal analítico en una muestra de 493 usuarios de los servicios de salud bucal mayores de 18 años de edad, a los que se aplicó cuestionario estructurado de 51 preguntas posterior a la atención dental. Se obtuvo información sobre datos sociodemográficos, satisfacción (variable resultado) y percepción del servicio odontológico recibido. Resultados: dos variables tuvieron efecto sobre la satisfacción: trato del estomatólogo y de la enfermera. La mayor fuerza de asociación (OR 7,37, cl IC 95 por ciento 3,73 ­ 35,78, RD 0,4 827 con cl IC 95 por ciento 0,3 332-0,6 322, ganancia 26/1 000) y ganancia se observó en la variable trato del estomatólogo. Tres variables tuvieron efecto sobre expectativa del usuario: trato del estomatólogo, comodidad de la sala de espera y del sillón de dental. La mayor fuerza de asociación (OR a 8,54, cl IC 95 por ciento 2,43 ­ 30,15) se observó en la variable trato del estomatólogo. La mayor ganancia la obtuvo comodidad del sillón dental (RD 0,2 924, cl IC 95 por ciento 0,1 894 ­ 0,3 855, ganancia 63/1 000). Se encontró alto nivel de satisfacción (88 por ciento, 434/493) con el servicio recibido, y un cumplimiento de la expectativa de los usuarios de 59 por ciento (285/484). Conclusión: el trato otorgado por el personal de salud es el principal aspecto donde las autoridades deberán implementar acciones para incrementar los niveles de satisfacción de los usuarios de los servicios dentales. El mejoramiento del trato a los usuarios por el equipo de salud bucal, estomatólogo y enfermera, deben considerarse dentro de los programas de mejora continua de estos servicios(AU)

Introduction: measurement of user satisfaction levels is an essential aspect of the quality evaluation of dental services. Objective: estimate the frequency of satisfaction and associated factors among users of dental services in a health area of Guerrero, Mexico. Methods: a analytical cross-sectional study was conducted of a sample of 493 users of dental services aged over 18 years who answered a structured questionnaire containing 51 questions after receiving dental care. Data were obtained about sociodemographics, satisfaction (variable result) and perception of the dental service received. Results: two variables had an effect on user satisfaction: attitude of the dentist and the nurse. The strongest association (OR 7.37, cl CI 95 percent; 3.73-35.78, RD 0.4827 with cl CI 95 percent; 0.3332-0.6322, gain 26/1 000) and gain were found in the variable attitude of the dentist. Three variables had an effect on user expectations: attitude of the dentist, comfort in the waiting room and comfort of the dental chair. The strongest association (OR 8.54, cl CI 95 percent; 2.43-30.15) was found in the variable attitude of the dentist. The greatest gain was obtained by comfort of the dental chair (RD 0.2924, cl CI 95 percent; 0.1894-0.3855, gain 63/1 000). Satisfaction with the service received was found to be high (88 percent, 434/493). Fulfillment of user expectation was 59 percent (285/484). Conclusion: authorities should implement actions aimed at improving the attitude of health personnel toward patients, with a view to raising the level of user satisfaction with dental services. Improvement in the attitude of dental care personnel, dentist and nurse, toward patients should be included in programs for the continued development of these services(AU)

[Hepatitis B vaccination coverage and associated factor for vaccine acceptance: a cross-sectional study in health workers of the Acapulco General Hospital, Mexico]. / Cobertura de vacunación contra el virus de la hepatitis B (VHB) y factores asociados: un estudio transversal en trabajadores del Hospital General de Acapulco, México.

BACKGROUND: Vaccination is a key current prophylactic measure for occupational risk of hepatitis B virus (HBV) infection. This study measures HBV vaccination coverage among health personnel in a Mexican hospital, and identifies factors associated with completion of the vaccination schedule. METHODS: A cross-sectional study in workers of the Acapulco General Hospital, Mexico. Interviews documented vaccination history against HBV, number of doses received, and date of vaccination. Health workers with complete vaccination were considered those with at least three doses of vaccine received at intervals of two months between first and second doses, and six months to a year in the third dose. RESULTS: Some 52% of workers (436/834) reported at least one vaccination during their professional life and only 5.5% (46/834) completed the HBV vaccination schedule. Factors associated with completion were academic degree, perception of infection risk at work, and knowledge of vaccine efficacy and the need for a complete schedule. CONCLUSIONS: In line with hospitals in other studies, few hospital workers were fully vaccinated. Evidence from this study can inform efforts to increase HBV vaccination coverage.