[Evaluation of a program led by community workers to promote cardiometabolic health in adults in a highly marginalized Mexican municipality]. / Evaluación de un programa dirigido por trabajadores comunitarios para promover la salud cardiometabólica en adultos de un municipio mexicano de alta marginación.

Introduction: Objective: to evaluate the impact of a group program of nutrition education implemented by community workers on food consumption, physical activity and cardiometabolic risk. Material and methods: a randomized trial by conglomerates was performed. The intervention group (n = 246) participated in a program of nine group sessions of nutrition education delivered by community workers and focused on giving healthy habits options and evocation of motivations. The control group (n = 183) received printed information on healthy eating and physical activity. At the beginning of the study and after one year of follow-up, anthropometric measurements of blood pressure, heart rate, lipid profile and glucose were assessed. A questionnaire was applied to collect sociodemographic data, food consumption and physical activity. Results: in multilevel regression models it was observed that the intervention group reported an increase in the frequency of consumption of fruits, vegetables and legumes, increased body mass index and its probability of increasing recreational physical activity was higher; in addition, it reduced its consumption of sweetened cereals, and decreased the probability of hyperglycemia compared to the control group. Resting heart rate increased in both groups, but the increase was lower in the intervention group. Conclusions: nutrition education guided by community workers can have positive effects on cardiometabolic risk, so it would be an alternative to traditional education focused on providing information.

Introducción: Objetivo: evaluar el impacto de un programa grupal de orientación alimentaria implementado por trabajadores comunitarios sobre el consumo de alimentos, actividad física y riesgo cardiometabólico. Material y métodos: se realizó un ensayo aleatorizado por conglomerados. El grupo de intervención (n = 246) participó en un programa de nueve sesiones grupales de orientación alimentaria impartido por trabajadores comunitarios y centrado en dar opciones de hábitos saludables y en la evocación de motivaciones. El grupo control (n = 183) recibió información impresa sobre alimentación saludable y actividad física. Al inicio del estudio y después de un año de seguimiento se realizaron mediciones antropométricas, de presión arterial, frecuencia cardiaca, perfil de lípidos y glucosa; además se aplicó un cuestionario que recabó información sociodemográfica, consumo de alimentos y actividad física. Resultados: en modelos de regresión multinivel se observó que el grupo de intervención reportó aumento en la frecuencia de consumo de frutas, verduras y leguminosas, aumentó el índice de masa corporal y su probabilidad de incrementar la actividad física recreativa fue mayor; además, redujo su consumo de cereales altos en azúcar y grasa, y disminuyó la probabilidad de hiperglucemia comparado con el grupo control. La frecuencia cardiaca aumentó en ambos grupos, pero el aumento fue menor en el grupo de intervención. Conclusiones: la orientación alimentaria guiada por trabajadores comunitarios puede tener efectos positivos en el riesgo cardiometabólico, por lo cual sería una alternativa a la educación en salud enfocada a dar información.

Diagnóstico y tratamiento de la obesidad en adultos mexicanos: cambios entre 2006 y 2018 / Diagnosis and treatment of obesity in Mexican adults: changes between 2006 and 2018

Introducción: A nivel global ha existido un incremento en el peso corporal. Ante ello, se han implementado programas para diagnosticar y tratar la obesidad. Se requiere documentar si dichos programas han propiciado que las personas con obesidad reciban diagnóstico y tratamiento eficaz. Objetivo: Determinar y comparar los cambios entre 2006 y 2018 en las prevalencias de diagnóstico y tratamiento de la obesidad y pérdida intencional de peso en adultos mexicanos e identificar si en este periodo existieron cambios en las disparidades sociales en dichos eventos. Materiales y métodos: Se analizaron las bases de datos de la Encuesta Nacional de Salud y Nutrición de México realizada en 2006 (N=26.738) y 2018 (N= 12.205), Los eventos fueron diagnóstico y tratamiento de obesidad y de pérdida intencional de peso en adultos mexicanos con IMC > 30. Las variables independientes fueron: sexo, edad, índice de masa corporal, nivel socioeconómico y región geográfica. Resultados: De 2006 a 2018, aumentó la prevalencia de personas con obesidad que recibieron diagnóstico (de 20,4% a 51,1%) o tratamiento (de 8,3% a 21,4%). La prevalencia de pérdida intencional de peso también aumentó (de 5,5% a 10,0%), pero esto básicamente ocurrió en las personas con nivel socioeconómico alto. En modelos multivariados se observó que, las mujeres, las personas con mayor IMC y quienes tenían mayor nivel socioeconómico tuvieron mayor probabilidad de recibir diagnóstico y tratamiento. Conclusiones: Aunque en México el acceso a diagnóstico y tratamiento a la obesidad se ha incrementado, la prevalencia de pérdida intencional de peso es baja, además, persisten disparidades socioeconómicas en estos eventos(AU)

Introduction: Worldwide, there has been an increase in body weight. Because of this, programs have been implemented to diagnose and treat obesity. It is required to document whether these programs have led people with obesity to receive effective diagnosis and treatment. Objective: To determine and compare the changes between 2006 and 2018 in the prevalences of diagnosis and treatment of obesity and intentional weight loss among Mexican adults and to identify whether there were changes in the social disparities in these events during this period. Materials and methods: The databases of the National Health and Nutrition Survey of Mexico carried out in 2006 (N=26,738) and 2018 (N= 12,205) were analyzed. The events were diagnosis and treatment of obesity and intentional weight loss in Mexican adults with BMI > 30. The independent variables were sex, age, body mass index, socioeconomic status, and geographic region. Results: From 2006 to 2018, the prevalence of people with obesity who received the diagnosis (from 20.4% to 51.1%) or treatment (from 8.3% to 21.4%) increased. The prevalence of intentional weight loss also increased (from 5.5% to 10.0%), but this was mainly in people with high socioeconomic status, Multivariate regression models revealed that, women, people with a higher BMI, and those with a higher socioeconomic status were more likely to receive diagnosis and treatment. Conclusions: Although in Mexico access to diagnosis and treatment of obesity has increased, the prevalence of intentional weight loss is low,In addition, socioeconomic disparities persist in these events(AU)

Estigma percibido por VIH y adherencia al tratamiento retroviral en personas con VIH en la ciudad de México / HIV-related perceived stigma and adherence to treatment among people with HIV from Mexico city

INTRODUCCIÓN. Analizar la relación entre el estigma percibido por VIH y la adherencia al tratamiento antirretroviral (TAR) en personas con VIH en la ciudad de México. MATERIAL Y MÉTODOS. Se utilizó un diseño mixto incluyendo una encuesta transversal y entrevistas a profundidad. En la encuesta se aplicó un cuestionario a 557 personas con VIH de dos instituciones públicas. En el cuestionario se incluyó una escala de estigma asociado al VIH con dos variables: ocultamiento de su seroestado a personas no cercanas y revelación de su seroestado a familiares y amigos. Mediante modelos de regresión logística se evaluó la asociación del estigma percibido con la baja adherencia al TAR, i.e. la omisión de la toma de medicamentos antirretrovirales en el día, la semana y el mes previos. Las entrevistas a profundidad tuvieron la finalidad para explorar las experiencias respecto a las dificultades para adherirse al TAR. RESULTADOS. Las personas que ocultaban su enfermedad tuvieron mayor probabilidad de no adherencia (RM=2.33). Los entrevistados que no habían revelado su seroestado a personas cercanas también tuvieron una mayor probabilidad de no adherencia (RM=2.35). Coincidentemente, en las entrevistas se evidenció que las experiencias de discriminación o las expectativas de ser discriminado hacen que las personas oculten su enfermedad y esto propicia la omisión de toma de medicamentos. DISCUSIÓN. Es necesario promover acciones orientadas a eliminar el estigma asociado al VIH como una medida fundamental para incrementar la adherencia al TAR. (AU)

INTRODUCTION. To analyze the relationship between HIV-associated perceived stigma and adherence to antiretroviral therapy (ART) in people with HIV in Mexico City. MATERIAL AND METHODS. A mixed methods approach was used including in-depth interviews and a cross-sectional survey. In-depth interviews were conducted to explore barriers to ART adherence. In the survey, a questionnaire was given to 557 people with HIV treated in two public health institutions. The questionnaire included an assessment of HIV-associated perceived stigma; exploratory factor analysis demonstrated two outcomes: concealment of serostatus and revelation of the serostatus to family and friends. Logistic regression models were used to assess the association of HIV-associated stigma with low ART adherence on the previous day, week and month. RESULTS. People who concealed their disease had higher risk of non-adherence (RM=2.33). Participants who had not revealed their serostatus to friends or relatives also had a higher probability of non-adherence (RM= 2.35). Coincidentally, the interviews showed that the experiences of discrimination or the expectations of being discriminated against make people conceal their illness and are thus prone to non-adherence. DISCUSSION. It is necessary to promote actions aimed at eliminating HIV-related stigma as a fundamental measure to increase adherence to ART. (AU)

Experiencias de homofobia y adherencia al tratamiento antirretroviral (TAR) en hombres que tienen sexo con hombres (HSH) / Experiences of homophobia and adherence to antiretroviral treatment (ART) in men who have sex with men (MSM)

Resumen El objetivo del estudio fue conocer la relación de las experiencias de homofobia con la adherencia al tratamiento anti-retroviral (TAR) en hombres que tienen sexo con hombres (HSH). Para ello, se realizó una encuesta transversal con una muestra por conveniencia de HSH que vivían con VIH (n=340) atendidos en dos instituciones públicas de salud de la Ciudad de México. La información sobre la adherencia al TAR en el mes previo de los participantes y sus experiencias de violencia, discriminación y homofobia internalizada se recopiló mediante un cuestionario. Entre 14% y 33% de los HSH reportaron alguna experiencia de discriminación y entre 41% y 60% experimentaron violencia. Cuando los HSH habían experimentado ambos tipos de estresores, el riesgo de baja adherencia TAR fue mayor (RP=6.49 para mes previo) que cuando habían experimentado sólo una de ellas (RP=4.36 para violencia y RP=5.67 para discriminación). Los profesionales de la salud deben ser sensibles a cómo el ambiente sociocultural puede afectar las prácticas de autocuidado de HSH, incluyendo la adherencia al TAR.

Abstract The aim of the study was to know the relationship of homophobic experiences with adherence to antiretroviral treatment (ART) in men who have sex with men (MSM) in Mexico City (CDMX). A cross-sectional study was conducted with a convenience sampling of MSM who lived with HIV, treated at two public health institutions at Mexico City (n=340). A questionnaire was applied to record information related to the adherence to ART of the participants and their experiences of violence and discrimination associated with homophobia and internalized homophobia. Between 14% and 33% of MSM reported experiences of discrimination and between 41% and 60% experienced violence. When participants had jointly experienced both types of stressors, the risk of low adherence to ART in the previous month was higher (RP=6.49) than when they had experienced only one of them (RP=4.36 for violence and RP=5.67 for discrimination). Health professionals must be sensitive to how the sociocultural environment can affect self-care among MSM including ART adherence.

Equations based on anthropometry to predict body fat measured by absorptiometry in schoolchildren and adolescents / Equações com base na antropometria para prever a gordura corporal medida por absorciometria em crianças em idade escolar e adolescentes

Abstract Objective: To develop and validate equations to estimate the percentage of body fat of children and adolescents from Mexico using anthropometric measurements. Methods: A cross-sectional study was carried out with 601 children and adolescents from Mexico aged 5-19 years. The participants were randomly divided into the following two groups: the development sample (n = 398) and the validation sample (n = 203). The validity of previously published equations (e.g., Slaughter) was also assessed. The percentage of body fat was estimated by dual-energy X-ray absorptiometry. The anthropometric measurements included height, sitting height, weight, waist and arm circumferences, skinfolds (triceps, biceps, subscapular, supra-iliac, and calf), and elbow and bitrochanteric breadth. Linear regression models were estimated with the percentage of body fat as the dependent variable and the anthropometric measurements as the independent variables. Results: Equations were created based on combinations of six to nine anthropometric variables and had coefficients of determination (r2) equal to or higher than 92.4% for boys and 85.8% for girls. In the validation sample, the developed equations had high r2 values (≥85.6% in boys and ≥78.1% in girls) in all age groups, low standard errors (SE ≤ 3.05% in boys and ≤3.52% in girls), and the intercepts were not different from the origin (p > 0.050). Using the previously published equations, the coefficients of determination were lower, and/or the intercepts were different from the origin. Conclusions: The equations developed in this study can be used to assess the percentage of body fat of Mexican schoolchildren and adolescents, as they demonstrate greater validity and lower error compared with previously published equations.

Resumo Objetivo: Desenvolver e validar equações para estimar o percentual de gordura corporal (%GC) de crianças e adolescentes do México com medidas antropométricas. Métodos: Foi feito um estudo transversal com 601 crianças e adolescentes do México cinco e 19 anos. Os participantes foram divididos aleatoriamente nos seguintes dois grupos: a amostra de desenvolvimento (n = 398) e a amostra de validação (n = 203). A validade das equações publicadas anteriormente (por exemplo, Slaughter) também foi avaliada. O %GC foi estimado por absorciometria de dupla energia de raios X (raios X de dupla energia [DXA]). As medidas antropométricas incluíram estatura, altura sentado, peso, circunferências da cintura e do braço, dobras cutâneas (tríceps, bíceps, subescapular, suprailíaca e panturrilha) e larguras do cotovelo e bitrocantérica. Os modelos de regressão linear foram estimados com o %GC, a variável dependente e as medidas antropométricas como as variáveis independentes. Resultados: As equações foram criadas com base nas combinações de seis a nove variáveis antropométricas e apresentaram coeficientes de determinação (r2) iguais ou superiores a 92,4% para meninos e 85,8% para meninas. Na amostra de validação, as equações desenvolvidas apresentaram altos valores de r2 (≥ 85,6% em meninos e ≥ 78,1% em meninas) em todos os grupos, baixo nível de erros padrão (EP ≤ 3,05% em meninos e ≤ 3,52% em meninas) e os interceptos não foram diferentes da origem (p > 0,050). Com as equações publicadas anteriormente, os coeficientes de determinação foram menores e/ou os interceptos foram diferentes da origem. Conclusões: As equações desenvolvidas neste estudo podem ser usadas para avaliar o %GC das crianças em idade escolar e adolescentes mexicanos, pois têm uma maior validade e menor erro em comparação com as equações publicadas anteriormente.

Inseguridad alimentaria y adherencia al tratamiento antirretroviral en personas con VIH de México / Food insecurity and adherence to antiretroviral treatment among people with HIV in Mexico

Resumen Los objetivos del artículo son: 1) Analizar la relación entre inseguridad alimentaria (IA) y adherencia al tratamiento antiretroviral (TAR) en personas con VIH/SIDA. 2) Evaluar la contribución de cuatro posibles mediadores (responsabilidades laborales y familiares, falta de recursos para cubrir necesidades, distrés psicológico y efectos secundarios del TAR) a dicha asociación. Estudio transversal con una muestra (n = 557) de personas con VIH atendidas en dos instituciones públicas de la ciudad de México. Las variables fueron indagadas mediante un cuestionario. Mediante modelos de regresión logística se evaluó si los mediadores explicaban la asociación entre IA y adherencia al TAR. Las personas con IA moderada tuvieron mayor probabilidad de omisión en el mes previo (OR = 2.10) y baja adherencia (OR = 3.35). La baja adherencia en las personas con IA fue explicada por los efectos secundarios (14.9%), las necesidades insatisfechas (12.5%), las responsabilidades (4.8%) y el distrés psicológico (2.0%). La IA puede limitar los beneficios de las políticas de acceso universal al TAR pues puede estar asociada con menor adherencia a ésta. Se requiere adecuar los servicios de salud para reducir el efecto de la IA.

Abstract The aims of this study are: 1) To analyze the relationship between food insecurity (FI) and adherence to antiretroviral therapy (ART) among people with HIV. 2) To evaluate the contribution of four possible mediators (lack of time due to work and family responsibilities, lack of resources to satisfy needs, psychological distress and side effects of ART) to differences in adherence according to the level of FI. A cross-sectional survey with a convenience sample (n = 557) of people with HIV attending two public institutions in Mexico City was conducted. Variables were assessed by a questionnaire. Logistic regression models were estimated. People with moderate FI were more likely to skip a dose (RM = 2.10) and reported low adherence during the last month (RM = 3.35). Poor adherence among people with FI was explained by the side effects of ART (14.9%), unsatisfied needs (12.5%), lack of time (4.8%) and psychological distress (2%). FI may curtail the benefits of universal access policies because it is associated with lower adherence to ART. An adjustment of health services to reduce the negative effects of FI on adherence to ART is required.

Equations based on anthropometry to predict body fat measured by absorptiometry in schoolchildren and adolescents.

OBJECTIVE: To develop and validate equations to estimate the percentage of body fat of children and adolescents from Mexico using anthropometric measurements. METHODS: A cross-sectional study was carried out with 601 children and adolescents from Mexico aged 5-19 years. The participants were randomly divided into the following two groups: the development sample (n=398) and the validation sample (n=203). The validity of previously published equations (e.g., Slaughter) was also assessed. The percentage of body fat was estimated by dual-energy X-ray absorptiometry. The anthropometric measurements included height, sitting height, weight, waist and arm circumferences, skinfolds (triceps, biceps, subscapular, supra-iliac, and calf), and elbow and bitrochanteric breadth. Linear regression models were estimated with the percentage of body fat as the dependent variable and the anthropometric measurements as the independent variables. RESULTS: Equations were created based on combinations of six to nine anthropometric variables and had coefficients of determination (r2) equal to or higher than 92.4% for boys and 85.8% for girls. In the validation sample, the developed equations had high r2 values (≥85.6% in boys and ≥78.1% in girls) in all age groups, low standard errors (SE≤3.05% in boys and ≤3.52% in girls), and the intercepts were not different from the origin (p>0.050). Using the previously published equations, the coefficients of determination were lower, and/or the intercepts were different from the origin. CONCLUSIONS: The equations developed in this study can be used to assess the percentage of body fat of Mexican schoolchildren and adolescents, as they demonstrate greater validity and lower error compared with previously published equations.

[Socioeconomic inequality and health in Mexico]. / Desigualdad socioeconómica y salud en México.

OBJECTIVE: To establish the relationship between socioeconomic inequality and health problems amongst Mexican population reviewing studies with national or regional representation. METHODS: A literature search was performed at national and international databases using the following keywords: health, disease, mental disorders, nutrition, food, social class, social status, unemployment, employment, occupation, income, wage, poverty and socioeconomic status. Reports of national or regional surveys conducted from the nineties were included. RESULTS: Mostly, diseases events were more common among people from low socioeconomic status: anencephaly, viral infections, anemia, transit accidents by run over, metabolic syndrome, hypertension, affective disorder, anxiety and substances abuse; some malignancies, difficulties to perform activities of daily living, and poor perceived health status. On the opposite, as it goes down in the social scale, are less frequent some protective factors (e.g. fruits or vegetables intake and physical activity) and there is less access to medical aid and preventive interventions (e.g. condom use or diagnosis and treatment for HIV infection, hypertension or obesity). CONCLUSIONS: Socioeconomic status affects all living conditions; therefore, its effects are not confined to certain diseases, but a general precarious state of health. The conceptual and public policy implications related with social inequalities in health are discussed.

Objetivo: establecer la relación entre la desigualdad socioeconómica y los problemas de salud en la población mexicana a partir de la revisión de estudios con representatividad nacional o regional. Métodos: la revisión bibliohemerográfica se realizó consultando bases de datos nacionales e internacionales, mediante el uso de las siguientes palabras clave: salud, enfermedad, trastornos mentales, nutrición, alimentación, clase social, estrato social, desempleo, empleo, ocupación, ingreso, salario, pobreza, nivel socioeconómico y estatus socioeconómico. Se incluyeron los reportes de encuestas nacionales y regionales realizados a partir de la década de los noventa. Resultados: la mayoría de los eventos de enfermedad fueron más comunes entre las personas de baja posición socioeconómica. Asimismo, conforme se desciende de la escala social, son menos frecuentes los factores protectores y es menor el acceso a la atención médica y a las medidas preventivas. Conclusiones: la posición socioeconómica afecta la totalidad de las condiciones de vida de las personas, por lo que sus efectos no se reducen únicamente a ciertas enfermedades, sino que condiciona un estado de salud precario. Las implicaciones conceptuales y en política pública de las desigualdades en salud son ampliamente discutidas.

Satisfaction with Healthcare Services and Adherence to Antiretroviral Therapy among Patients with HIV Attending Two Public Institutions.

BACKGROUND: Discontinuation of antiretroviral therapy has adverse consequences in HIV patients and is a major public health problem. We analyzed the relationship between satisfaction with healthcare services and adherence to antiretroviral therapy among patients with HIV in Mexico City. MATERIAL AND METHODS: We conducted a cross-sectional study with patients with HIV (n = 557) who were treated in two public institutions. An ad hoc questionnaire was used to assess perceived satisfaction with healthcare services (i.e. physician/patient relationship, performance of services, and administrative aspects with focus on specific areas) and adherence to HIV treatment (i.e. failure to take antiretroviral therapy on previous day, week, and month). RESULTS: The higher prevalence of non-adherence to antiretroviral therapy was during the previous month (23.5%). Dissatisfied patients with the relationship with their physician were more likely to have low adherence during the previous month (OR: 1.90; p < 0.05). Those who were dissatisfied with the care provided in specific clinical areas had low adherence (OR: 1.67; p = 0.051), but the difference disappeared (OR: 1.26; p = 0.443) after adjusting for satisfaction with physician/patient relationship. CONCLUSIONS: The quality of the relationship between physician and patients is an aspect that impacts on adherence to antiretroviral therapy. It is necessary to promote effective communication between health personnel and patients with HIV.

Factores sociodemográficos asociados a la satisfacción con los servicios públicos de salud entre personas con VIH/SIDA / Sociodemographic correlates of satisfaction with public health services among people living with HIV / Fatores sociodemográficos associados à satisfação com os serviços públicos de saúde entre pessoas com VIH/SIDA

Objetivo: evaluar la satisfacción de personas con VIH con la atención que reciben en los servicios de salud. Material y métodos: se evaluó la satisfacción del usuario y las características sociodemográficas de personas con VIH/SIDA atendidas en dos instituciones públicas de la ciudad de México (n = 557). Para conocer si existían diferencias se estimaron modelos de regresión logística. Resultados: los hombres homosexuales tuvieron mayor probabilidad de insatisfacción con la relación médico-paciente y con el funcionamiento del servicio. Las personas con seguridad social tuvieron mayor probabilidad de insatisfacción con el funcionamiento del servicio y con la atención de las diferentes áreas de la clínica. Los hombres, las personas solteras y quienes tenían mayor escolaridad presentaron mayor insatisfacción con los aspectos administrativos. Conclusiones: se identificaron aspectos de los servicios públicos que pueden ser mejorados, lo cual podría modificar la opinión que las personas con VIH tuvieron sobre ellos.

Objectives: To evaluate the satisfaction of people with HIV/AIDS with the care received from public health services. Material and methods: The user satisfaction and socio-demographic characteristics of people with HIV/AIDS who were treated at two public institutions in Mexico City (n = 557) were assessed. To know whether there were any differences, logistic regression models were estimated. Results: Homosexual males were more likely to be dissatisfied with physician-patient relationship and with services operation. People with social security had higher probability of dissatisfaction with service operation and with the attention received from different areas. Dissatisfaction with administrative aspects was more frequent among men, single people and those who had higher education higher. Conclusions: There were aspects of public services that can be improved, which could result in the improvement of the opinion that people with HIV had of them.

Objetivo: avaliar a satisfação de pessoas com o VIH, atendidos em serviços de saúde. Material e métodos: avaliou-se a satisfação do utente e as características sociodemográficas do pessoal com o VIH/SIDA atendidas em duas instituições públicas da cidade de México (n = 557). Para conhecer se existiam diferenças foram estimados modelos de regressão logística. Resultados: os homes homossexuais tiveram maior probabilidade de insatisfação na relação médico-paciente e com o funcionamento do serviço. As pessoas com previdência social tiveram maior probabilidade de insatisfação com o funcionamento do serviço e a atenção das diferentes áreas da clínica. Os homes, as pessoas solteiras e quem teve maior escolaridade apresentou maior insatisfação com os aspetos administrativos. Conclusões: identificaram-se aspectos dos serviços públicos que podem se melhorar, o qual poderia modificar a opinião das pessoas com VIH.

Diagnosis and treatment of obesity among Mexican adults.

OBJECTIVES: To quantify the access to diagnosis and treatment of obesity and intentional weight loss among obese adults in Mexico and to identify the sociodemographic factors related to these events. METHODS: The 2006 Mexican National Health and Nutrition Survey - representative of the adults aged 20 to 64 years - was analyzed. Whether people had received diagnosis and treatment from health professionals and whether they had intentional weight loss were explored. The independent variables were: sex, age, socioeconomic position, locality size, and body weight perception. Analyses were carried out for obese people only (BMI ≥ 30 kg/m(2), N = 8,545). RESULTS: Among obese people, just 20.2% were diagnosed with such condition, only 8.0% undertook treatment, and barely 5.6% had lost weight intentionally. Individuals with a higher BMI, older individuals, people with higher education, those living in wealthier households, and those living in metropolitan areas were more likely to receive diagnosis and treatment for obesity. Women and people who had been diagnosed as obese were more likely to lose weight. CONCLUSION: There is an urgent need to increase access to diagnosis and treatment of obesity in Mexico, particularly for men and for lower socioeconomic groups.

Estrategias para afrontar la inseguridad alimentaria en hogares mexicanos jefaturados por madres solteras / Strategies to coping food insecurity in single mother households from Mexico

Fundamentos: En México 45% de la población experimenta algún grado de inseguridad alimentaria. El objetivo del presente estudio fue conocer las acciones que son llevadas a cabo por mujeres solteras para reducir los efectos de la falta de acceso a alimentos. Métodos: Se utilizó la metodología cualitativa de grupos focales con 44 mujeres que eran jefas de familia y que participaban en un programa gubernamental dirigido a población en situación de pobreza. Resultados: Las estrategias mencionadas por las participantes fueron agrupadas en tres categorías: la primera de ellas estuvo relacionada con la adquisición y manejo de los alimentos (e.g. comprar alimentos económicos), la segunda con la obtención de recursos económicos (e.g. incorporarse al mercado de trabajo, casi siempre informal) y la tercera correspondió a acudir a redes sociales de apoyo (e.g. pedir ayuda a familiares). Conclusiones: Se verificó que las experiencias de este grupo de mujeres mexicanas son similares a las observadas en otras sociedades, lo cual da validez al modelo conceptual de la inseguridad alimentaria, de acuerdo al cual las familias manejan esta situación tratando de reducir sus efectos (AU)

Background: In Mexico 45% of the population experiences some degree of food insecurity. The aim of this study was to determine the actions that are undertaken by single women to reduce the effects of lack of access to food on their Families. Methods: Focus groups were carried out with 44 women who were heads of family and participating in a governmental program aimed at people in poverty. Results: The strategies mentioned by participants were grouped into three categories: the first one was related to food acquisition and management (e.g. buy cheap food), the second with the acquisition of financial resources (e.g. entering the informal labor market) and the third corresponded to the attendance to social support networks (e.g. to get help from family members). Conclusions: Validating the conceptual model of food insecurity (e.g. families handle this situation by trying to reduce its effects), the experiences of this group of Mexican women are similar to those observed in other societies (AU)

[Food advertising in Mexican television: are children more exposed?]. / Publicidad de alimentos en la programación de la televisión mexicana: ¿los niños están más expuestos?

OBJECTIVE: To evaluate food advertisements on broadcast television channels in Mexico City. MATERIAL AND METHODS: Between July and October, 2007 programming by the 11 broadcast channels (N=11) in Mexico City was recorded during one weekday and one weekend day. The length of advertisements (N = 9178), types of products, and nutritional content of foods advertised were analyzed. RESULTS: The time devoted to food products advertising was greater during children's television than during programming targeted to the general audience (25.8 vs. 15.4%). The foods more frequently advertised were sweetened beverages, sweets and cereals with added sugar. Calorie, carbohydrate and fat contents were higher in foods advertised during children's shows. The two most common marketing strategies were to offer some kind of gift and to link the item to positive emotions. CONCLUSION: The findings of this research indicate the need for an effective system to regulate advertising directed towards children and adolescents.

[Harassment experiences among students of health-related professional careers in Mexico]. / Experiencias de acoso en estudiantes del área de la salud de la ciudad de México.

OBJECTIVE: This study focuses on the frequency with which students of health-related professional careers have perceived themselves as victims of sexual harassment, how this has occurred, and the characteristics of those students associated with that experience. METHODS: Cross-sectional descriptive study, with a sample of 530 students from health-related schools at the Universidad Autónoma Metropolitana Xochimilco in Mexico City. Statistical analysis was stratified by sex, age, race, perception of physical attractiveness, transgression of gender stereotypes, and sexual orientation. Experiences of sexual harassment were assessed based on a scale of 19 questions. Five components were identified by factor analysis: verbal and/or physical harassment by inadequate staring/glancing, inadequate proposals, and comments. RESULTS: In general, women were more harassed by inadequate staring/glancing; those who perceived themselves as being more physically attractive were more verbally harassed, whereas those who transgressed gender stereotypes were more exposed to physical harassment and harrassing glances as compared to men who were seen themselves as being less attractive and who did not transgressed the gender stereotype. CONCLUSIONS: Sexual harassment is an existing situation occurring among students. It is necessary to detect and recognize the forms of presentation of gender inequalities to avoid imposing sanctions on conducts that are not adhered to gender stereotypes.

Publicidad de alimentos en la programación de la televisión mexicana: ¿los niños están más expuestos? / Food advertising in Mexican television: are children more exposed?

OBJETIVOS: Evaluar la publicidad relacionada con alimentos transmitida en los canales gratuitos de televisión de la Ciudad de México. MATERIAL Y MÉTODOS: Se grabó la transmisión, un día entre semana y uno en fin de semana, de los 11 canales gratuitos de televisión de la Ciudad de México, entre julio y octubre de 2007. Se analizó la duración de los comerciales (N= 9178), los productos anunciados, el valor nutrimental de los alimentos anunciados, así como las estrategias publicitarias utilizadas. RESULTADOS: La publicidad de alimentos fue mayor durante los programas infantiles que durante la programación dirigida a la audiencia general (25.8 vs. 15.4 por ciento). Los alimentos anunciados con mayor frecuencia fueron bebidas con azúcar añadida y dulces, así como cereales con azúcar añadida. Los alimentos anunciados en programas infantiles tuvieron mayor contenido de calorías, grasa y carbohidratos. Las estrategias publicitarias más utilizadas fueron las promociones y asociar productos con emociones positivas. CONCLUSIÓN: Esta investigación ofrece evidencia sobre la necesidad de contar con un sistema de regulación efectiva de la publicidad dirigida a niños y adolescentes.

OBJECTIVE: To evaluate food advertisements on broadcast television channels in Mexico City. MATERIAL AND METHODS: Between July and October, 2007 programming by the 11 broadcast channels (N=11) in Mexico City was recorded during one weekday and one weekend day. The length of advertisements (N = 9178), types of products, and nutritional content of foods advertised were analyzed. RESULTS: The time devoted to food products advertising was greater during children's television than during programming targeted to the general audience (25.8 vs. 15.4 percent). The foods more frequently advertised were sweetened beverages, sweets and cereals with added sugar. Calorie, carbohydrate and fat contents were higher in foods advertised during children's shows. The two most common marketing strategies were to offer some kind of gift and to link the item to positive emotions. CONCLUSION: The findings of this research indicate the need for an effective system to regulate advertising directed towards children and adolescents.

Utilidad de siluetas corporales en la evaluación del estado nutricional en escolares y adolescentes de la Ciudad de México / Usefulness of body silhouettes to assess the nutritional status of school-age children and adolescents in Mexico City

Introducción. En México, el sobrepeso y la obesidad se han convertido en un problema de salud pública. Para diagnosticar estas enfermedades por lo regular se recurre a indicadores antropométricos. Sin embargo, en algunas situaciones o lugares no se dispone del equipo que se requiere para medir las dimensiones antropométricas. El objetivo de este estudio fue validar la utilización de siluetas corporales para evaluar el estado de nutrición en escolares y adolescentes mexicanos de zonas urbanas. Métodos. Se realizó un estudio transversal con sujetos de 6 a 18 años de edad de la Ciudad de México (n =1862). Fueron validadas 2 tipos de siluetas corporales (Stunkard y KEDS) tomando como estándar el índice de masa corporal para edad estimado a partir del peso y la talla medidos. Se utilizó la metodología de la curva ROC (receiver operating characteristic) para evaluar la exactitud de los diagnósticos derivados de las siluetas, estimándose el área bajo la curva (ABC) y el mejor punto de corte (MPC) para cada tipo de silueta. Resultados. La mayor exactitud para diagnosticar obesidad se obtuvo con la evaluación realizada por las entrevistadoras utilizando las siluetas de Stunkard (ABC =0.94), con las cuales se puede considerar que existe obesidad cuando las personas se ubican de la silueta V en adelante. Conclusiones. Cuando no se dispone de recursos para medir el peso y la estatura, es posible utilizar las siluetas de Stunkard para tener una aproximación al estado de nutrición de escolares y adolescentes.

Background. In México, overweight and obesity have become a public health problem. Anthropometric measurements are generally used to diagnose these illnesses. However, in some situations or places there is no equipment available to measure these anthropometric indicators. The aim of the present study is to validate the body silhouette to assess the nutritional status of school-age children and adolescents. Methods. A cross-sectional study was carried out with 6- to 18-year-old subjects from México City (n =1862). Two types of body silhouettes (Stunkard and KEDS) were validated. Body mass index for age estimated by mean height and weight was used as standard. To assess the accuracy of the diagnosis with the body silhouette, ROC curve (receiver operating characteristic) method was used. The area under the curve (AUC) and optimal cut-off (OC) were estimated. Results. The most accurate assessment for diagnosing obesity was obtained by the interviewers who used the Stunkard silhouettes (AUC = 0.94). The fifth silhouette was the OC. Conclusions. When necessary equipment for measuring weight and height are unavailable, the Stunkard silhouettes can be used as a proxy indicator of the nutritional status of school-age children and adolescents.