Association of Helicobacter pylori infection and height of Mexican children of low socioeconomic level attending boarding schools.

This study evaluated the association between Helicobacter pylori infection and height in a population of schoolchildren of a low socioeconomic level regarding growth-related micronutrient status. It was a cross-sectional study of 685 children 5-13 years of age. Height and weight were recorded, a (13)C urea breath test was performed for detection of H. pylori, and a blood sample was obtained for determination of micronutrient status. Helicobacter pylori infection was found to be associated with the height of children. Children with H. pylori infection are, on average, 1.32 cm lower (95% confidence interval [CI] = -2.22 to -0.42) in height than children without infection. There was an effect modification by age: for every one-year increase in age, height was 0.66 cm less (95% CI = -1.17 to -0.15) in children with H. pylori infection. This finding suggests that H. pylori infection has a negative effect on the growth of children.

[Gender based violence: knowledge and attitudes of health care providers in Nicaragua]. / Violencia de género: actitud y conocimiento del personal de salud de Nicaragua.

OBJECTIVE: To assess the knowledge and attitudes of health care personnel towards the identification and referral of gender-based violence victims (GBV). Also, to identify barriers to identification and referral of GBV, and to assess the levels of knowledge about Norms and Procedures for Intra-Family Violence Care by the health care personnel of the Nicaraguan's Minister of Health (MINSA, for its initials in Spanish). MATERIAL AND METHODS: A cross-sectional study was conducted among healthcare professionals, including physicians, nurses and nursing technical aides (n=213), in 5 of the 17 Local Systems of Integral Attention (SILAIS) from the Integral Program of Attention for Women, Children and Adolescence (AIMNA) in the primary level of attention in MINSA, from April to June 2003. Attitude was measured with a Likert scale and an awareness index was created for intra-family violence care guidelines. The information was obtained using a self-administered instrument, based on the questionnaire of the study made among the personnel of the Mexican Institute for Social Security (IMSS, for its initials in Spanish), Morelos, Mexico. A logistic regression model was used to evaluate the association between attitude and several factors, as well as with the knowledge of care guidelines. RESULTS: In our population, 76.06% showed an attitude opposing GBV. In the multivariate analysis, the factors associated with opposition to GBV were: medical profession (OR 6.5, 95%CI 2.70-15.82), having a middle (OR 4.3, 95%CI 1.87-10.26) or high level (OR 3.3, 95%CI 1.03-10.75) of knowledge about intra-family violence guidelines and the closeness to relatives or friends who were victims of gender violence (OR 3.2, 95%CI 1.56-6.80). The lack of training on the subject (59.9%), fear of getting involved in legal issues (52.6%), and the concept that violence is a private affair and not a social one (50.7%), constituted the most important barriers to providing medical care. CONCLUSIONS: The health care personnel generally were observed to have high values in regard to an attitude of rejection towards GBV. However, we found barriers that show persisting traditional beliefs, such as considering violence to be a personal issue. Therefore, in order, to ensure a substantial improvement, better training about this subject is needed in medical school curricula with an emphasis on the gender perspective. The finding of the present study will allow improvements in health care reforms at the first level of care in the health sector in Nicaragua.

Violencia de género: actitud y conocimiento del personal de salud de Nicaragua / Gender based violence: knowledge and attitudes of health care providers in Nicaragua

OBJETIVO: Determinar la actitud del personal de salud en la identificación y la referencia de las víctimas de violencia de género (VG), así como los factores relacionados con dicha actitud. Asimismo, conocer las barreras para tal identificación y referencia, y evaluar el nivel de conocimiento sobre las Normas y Procedimientos para la Atención de la Violencia Intrafamiliar entre el personal de salud del Ministerio de Salud de Nicaragua (MINSA). MATERIAL Y MÉTODOS: Se realizó un estudio transversal entre el personal de salud de 5 de los 17 Sistemas Locales de Atención Integral en Salud (SILAIS) de Nicaragua: médicos, enfermeras y auxiliares de enfermería (n=213) del Programa de Atención Integral a la Mujer, Niñez y Adolescencia en el primer nivel de atención del MINSA, durante los meses de abril a junio de 2003. La actitud se midió de acuerdo con una escala tipo Likert y se construyó un índice de conocimiento sobre las normas de atención. La información se obtuvo por medio de un instrumento de autoaplicación, basado en el cuestionario de un estudio que se realizó entre el personal del Instituto Mexicano de Seguro Social (IMSS) de Morelos, México. Se utilizó un modelo de regresión logística para evaluar la asociación de la actitud con diversos factores, así como con el conocimiento sobre las normas de atención. RESULTADOS: La actitud de rechazo hacia la VG fue de 76.06 por ciento. En el análisis multivariado, los factores asociados con la actitud de rechazo fueron la profesión médica (RM 6.5, IC 95 por ciento 2.70-15.82), al igual que los niveles medio (RM 4.3, IC 95 por ciento 1.87-10.26) y alto (RM 3.3, IC 95 por ciento 1.03-10.75) de conocimiento sobre las normas de atención y la cercanía de familiares o amigos que han sido víctimas de violencia (RM 3.2, IC 95 por ciento 1.56-6.80). La escasa capacitación sobre el tema (59.9 por ciento), el temor a involucrarse en asuntos legales (52.6 por ciento) y el carácter privado de la violencia (50.7 por ciento) constituyen las barreras más importantes para la identificación y la referencia de las víctimas. CONCLUSIONES: En general, el personal de salud presentó valores altos en la actitud de rechazo hacia la VG. Sin embargo, se identificaron barreras que indican la persistencia de creencias tradicionales como la de considerar el problema de la violencia un asunto privado...

[Factors related with the severity of injuries in public streets of an urban area in Cuernavaca, Morelos,Mexico]. / Factores asociados con la gravedad de lesiones ocurridas en la vía pública en Cuernavaca, Morelos, México.

OBJECTIVE: To identify risk factors associated with severity of injuries occurring in public streets of an urban area. MATERIAL AND METHODS: Between February and April 2001, a cross-sectional survey was conducted among injured people seeking emergency care at three hospitals in Cuernavaca, Morelos, Mexico. Information was also obtained for those who died on accident sites. Data on the following variables were collected: age, sex, alcohol intake, day and time of injury, prehospital care, external cause and nature of injury. The Abbreviated Injury Scale (AIS) was used to define severity of injuries. Data analysis consisted of descriptive, bivariate, and multivariate regression models. RESULTS: A total of 492 injured people were included in the study; 23 of them died on site. The main cause of injuries was road traffic accidents (52%); 72% of injuries were not severe. Variables associated with the severity of injuries were: Road traffic accidents (odds ratio [OR] 6.59, 95% confidence interval [CI] 2.52, 17.23), adjusted for age and schooling. CONCLUSION: Road traffic injuries are the main cause of severe injuries. TheAIS is useful to assess the frequency and distribution of injury severity.

Factores asociados con la gravedad de lesiones ocurridas en la vía pública en Cuernavaca, Morelos, México / Severity of injuries in public streets of an urban area in Mexico

OBJETIVO:Identificar los factores asociados con la gravedad de las lesiones ocurridas en la vía pública en personas que demandaron atención médica de urgencia en tres hospitales de la ciudad de Cuernavaca, Morelos, México. MATERIAL Y MÉTODOS: Estudio transversal efectuado en la ciudad de Cuernavaca, estado de Morelos, durante los meses de febrero a abril de 2001. Incluyó individuos lesionados que demandaron atención a hospitales o que fallecieron en el lugar del accidente. Variables: edad, sexo, ingesta de alcohol, día y hora de ocurrencia, atención pre-hospitalaria, causa externa, tipo de lesión y gravedad con base en la Escala Abreviada de Lesiones. Se utilizó análisis simple bivariado y multivariado. RESULTADOS: Se incluyeron 492 lesionados, de los cuales 23 fallecieron en el lugar. La principal causa externa fue accidentes de tránsito (52 por ciento), 72 por ciento de los lesionados fueron leves. La variable asociada con gravedad fue accidentes de tránsito (RM 6.59, IC95 por ciento 2.52-17.23), ajustada por edad y escolaridad. CONCLUSIONES: Los accidentes de tránsito de vehículos de motor son los que provocan el mayor número de lesionados graves. El uso de la Escala Abreviada de Lesiones facilita el estudio de su magnitud y distribución de gravedad.

[Evaluation of integrated management of childhood illness against malnutrition in urban areas of Nayarit, Mexico]. / Evaluación de una atención integrada contra la desnutrición infantil en áreas urbanas de Nayarit, México.

OBJECTIVE: To assess the association between coverage of the Integrated Management of Childhood Illness (IMCI) strategy and the prevalence of stunting in children 6 to 36 months of age. MATERIAL AND METHODS: A cross-sectional study was conducted in two urban areas of Nayarit, Mexico, in August 2002. Anthropometry, health care for mothers and their children, morbidity and socioeconomic data were collected by means of household interviews. Statistical analyses were performed with chi-squared tests, Fisher's exact test, and logistic regression. RESULTS: IMCI coverage rates were as follows: immunization 97%, vitamin A supplementation 66.9%, deworming with albendazole 91.5%, nutritional surveillance 50%, maternal health education 25.5%, maternal health care 24.4%, and 2.5% overall. The prevalence of stunting was 4.9%, and was statistically associated with incomplete courses of vitamin A supplementation and albendazole deworming. CONCLUSIONS: Coverage of IMCI components varied according to their feasibility and time of implementation. The associations between IMCI and failure to thrive highlight the importance of obtaining more information about its effects on the nutritional status of children. This will help to improve prevention strategies against child malnutrition.

Lactancia materna, destete y ablactación: una encuesta en comunidades rurales de México / A survey of breast feeding and other infant feeding practices in rural Mexico

Objetivo. Determinar las prevalencias de lactancia humana, uso de leches industrializadas y ablactación así como los factores asociados a la falta de alimentación al seno materno y al destete temprano. Material y métodos. Estudio transversal realizado por pasantes de medicina en servicio Social en 222 localidades rurales de México, mediante entrevistas estructuradas en 5409 familias con niños menores de un año. Resultados. Las proporciones de niños que nunca recibieron lactancia al seno materno fueron: en la zona norte (N) de 21.4 por ciento; en el Centro(C) de 7.6 por ciento y la sur (S) de 5.3 por ciento. Entre los niños que recibieron lactancia al seno materno, ésta continuó en forma exclusiva o mixta hasta el tercer trimestre de vida en 35.6 por ciento (N), 67.6 por ciento (C) y 77.5 por ciento (S); en el segundo trimestre de vida ya habían sido ablactados 67.2 por ciento (N), 40.9 por ciento (C) y 51.6 por ciento (S). En la región N se encontró que la falta de alimentación al seno materno se asoció con la atenció médica del parto, madres con escolaridad mínima de primaria o con menos de cuatro hijos, casa con piso de material permanente, dos o más enseres domésticos mayores y que el sostén económico no fuera el padre. El destete temprano se asoció con los mismos factores, incluyendo que el niño estuviera al cuidado de una persona distinta a la madre, la lactancia artificial decidida por los padres o por recomendación médica, la ablactación temprana y el uso de servicios médicos de seguridad social y/o privados. Conclusiones. La alimentación con sucedáneos de la leche y el destete temprano son propios de familias pequeñas, con mayor educación materna, mejores condiciones de la vivienda y la influencia de los médicos sobre todo en el norte del país. Además, la ablactación se efectúa antes del segundo semestre de vida, por lo que es recomendable elaborar programas que promuevan la alimentación al seno materno y la ablactación correcta en la población infantil de las comunidades rurales de México

Objective. To determine the prevalence of lactation, the use of industrialized milk and weaning, and the factors related to lack of breast-feeding and early weaning in young infants of rural communities. Material and methods. Transversal study performed by last year medical students doing Social Service in 222 rural communities in Mexico who applied structured interviews to 5 409 families with children younger than 1 year of age. Results. The percentages of children who were never breast-fed were: in the north (N) 21.4%, in the center (C) 7.6% and in the south (S) 5.3%. Children who were still being breast-fed, either exclusively or with mixed feeding by the third trimester were 35.6% (N), 67.6% (C) and 77.5% (S); in the second trimester, 67.2% (N), 40.9% (C) and 51.6% (S) had been weaned. In the N region it was observed that lack of breast-feeding was associated to the health personnel who attended delivery, mothers with six or more years of education and less than four children, dwellings with permanent material floors, two or more household commodities and a head of the family different from the father. Early weaning was essentially associated to the same factors; additionally, to the child being taken care of by someone different from the mother, artificial lactation by parental decision or due to medical recommendation and the use of health services provided by social security or private physicians. Conclusions. Artificial lactation and early weaning are typical of small families, with high educational level of the mother, better living conditions and contact with medical personnel, especially in the N of the country. Children are weaned before the second semester of life and it is therefore deemed neces sary to implement health programs which promote breast-feeding and gradual weaning after the sixth month of life among the infant population of Mexican rural communities.