Reduction in contraceptive use during the COVID-19 pandemic among women in an indigenous Mexican community: a retrospective crossover study.

Background: Being indigenous, being a woman, and living in poverty are social determinants that contribute to reduced access to healthcare, including reproductive health services. The COVID-19 pandemic might have exacerbated this lag. Objective: This study explored how the COVID-19 pandemic affected the contraceptive use of a group of indigenous Mexican women and adolescents in their community. Methods: Between June and December of 2021, 158 indigenous Mexican women who had experienced recurrent pregnancies were interviewed at two health centers in San Cristóbal de las Casas, Chiapas. Participants were either pregnant when they completed the questionnaire or had been pregnant during the COVID-19 pandemic. Women were asked about their contraceptive practices before and during the pandemic. The change in contraceptive practice was estimated using a logistic model. Results: The COVID-19 pandemic reduced contraceptive use by 50%. Among women who wanted contraception, 58% did not receive it. During the pandemic, 77% of previous contraceptive users reported difficulty obtaining contraception, and only 23% sought family planning assistance. Conclusion: During the COVID-19 pandemic, indigenous women in the studied community used fewer contraceptive methods and did not use intrauterine devices. Additionally, there was a decline in the percentage of women using contraceptives. These results highlight the impact on indigenous populations and the difficulties they could face in accessing reproductive health services during health emergencies.

Sociodemographic and Personal Predictors of Exclusive Breastfeeding in Pregnant Mexican Women Using Public Health Services.

Exclusive breastfeeding (EBF) is a cost-effective healthy behavior for the mother-child dyad. Globally, rates of EBF are low. Little research has been conducted on the joint role of modifiable and nonmodifiable variables in pregnant women's decision-making. The aim was to develop and test a model that used personal and sociodemographic factors to predict whether pregnant women who use public healthcare services plan to breastfeed. In a nonprobabilistic sample of 728 pregnant Mexican women, self-efficacy, the planned behavior theory constructs, and the intention to breastfeed (BFI) were measured. A total 60% of the sample was randomly chosen to develop a predictive multivariate logistic regression model. The model was validated in the remaining 40%. Women in the highest tertiles of attitudes and self-efficacy had fourfold increased chances of having a high BFI (OR 4.2, 95% CI [2.4, 7.4]). Working was associated with a decreased intention to exclusively breastfeed (OR 0.61, 95% CI [0.37, 0.98]). The model predicted BFI with a sensitivity of 38.3% and specificity of 82.2%. While personal variables predict the BFI, working decreases women's chances of breastfeeding. The results can be utilized to develop primary prevention strategies to help mothers who use public health services to breastfeed.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud.

La creciente epidemia de obesidad ha sido uno de los retos más importantes de salud pública en México durante los últimos años. Con apoyo de la Federación Mundial de Obesidad, en 2021 formamos un grupo de profesionales para identificar y resumir las acciones prioritarias en las que puede enfocarse nuestro país para hacer frente a esta epidemia. Al proceso de desarrollo y discusión de este grupo se sumaron más de 1 000 profesionales de la salud para retomar recomendaciones de documentos y guías de alto nivel previamente publicados. En conmemoración del Día Mundial de la Obesidad, en este 2022 se presenta esta postura como insumo para el desarrollo de acciones en el ámbito profesional y de los diferentes sectores, en la que se incluyen 10 recomendaciones de acción, desde la perspectiva poblacional hasta la atención individualizada, y se enfatiza en la importancia de la participación social, de las intervenciones integrales con visión centrada en la persona y de la sostenibilidad planetaria, además de mejorar la educación y las campañas de difusión, propiciar un ambiente promotor de entornos activos y blindar de conflictos de interés los esfuerzos de prevención y control. La postura hace un llamado para abordar la obesidad de manera seria, con base en la evidencia científica, oportuna e integral, con enfoque de curso de vida, de forma ética y sensible, y sin perpetuar las barreras del estigma de peso en la sociedad.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

resumen está disponible en el texto completo

Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

Barreras para la atención de las conductas suicidas en Ciudad de México: experiencias del personal de salud en el primer nivel de atención / Barriers to Care of Suicidal Behavior in Mexico City: Health Personnel Experiences at the First Level of Care / Barreiras para a atenção das condutas suicidas na Cidade do México: experiências dos profissionais de saúde na atenção básica

Resumen Objetivo: Identificar las barreras que existen para la atención de las conductas suicidas, desde la perspectiva de las/los profesionales de la salud mental del primer nivel de atención de la Ciudad de México. Metodología: Estudio cualitativo exploratorio, basado en 35 entrevistas semiestructuradas, dirigidas a personal de salud de dos unidades de salud mental de referencia nacional. El análisis de la información se hizo mediante el Framework Analysis. Resultados: Las/los participantes consideraron que las conductas suicidas no han sido definidas como una prioridad dentro de los trastornos de salud mental. La ausencia de políticas públicas, la sobrecarga de trabajo, la falta de seguimiento a las/los pacientes, entre otras, fueron identificadas como barreras para una atención adecuada y oportuna. Conclusiones: Los programas de prevención de las conductas suicidas deben tomar en cuenta el contexto socioeconómico de la población y las características de los servicios de salud, así como las necesidades de las personas prestadoras de servicios de salud. Se requiere ampliar el entrenamiento profesional y mejorar el sistema de referencia y contrarreferencia entre los distintos niveles de atención.

Abstract Objective: To identify the existing barriers to the care of suicidal behavior from the perspective of mental health professionals at the first level of care in Mexico City. Methodology: Qualitative exploratory study based on 35 semi-structured interviews conducted on health personnel from two national reference mental health facilities. The data were analyzed with Framework Analysis. Results: The participants considered that suicidal behavior has not been prioritized among mental health disorders. The absence of public policies, work overload, lack of patient follow-up, among others, were identified as barriers to adequate and timely care. Conclusions: Suicidal behavior prevention programs should consider the socioeconomic context of the population, the characteristics of health services, and the needs of health care providers. Professional training should be enhanced, and the referral and counter-referral system across levels of care should be improved.

Resumo Objetivo: Identificar as barreiras existentes para a atenção das condutas suicidas, desde a perspectiva dos profissionais de saúde mental de atenção básica da Cidade do México. Metodologia: Estudo qualitativo exploratório, baseado em 35 entrevistas semiestruturadas, dirigidas a profissionais de saúde de duas unidades de saúde mental de referência nacional. A análise da informação foi feita através do Framework Analysis. Resultados: Os participantes consideraram que as condutas suicidas não têm sido definidas como uma prioridade dentro dos transtornos de saúde mental. A ausência de políticas públicas, a sobrecarga de trabalho, a falta de seguimento aos pacientes, entre outras, foram identificadas como barreiras para uma atenção adequada e oportuna. Conclusões: Os programas de prevenção das condutas suicidas devem considerar o contexto socioeconômico da população e as características dos serviços de saúde, além das necessidades dos profissionais de saúde. É necessário ampliar o treinamento profissional e melhorar o sistema de referência e contrarreferência entre os diferentes níveis de atenção.

The utility of the Edmonton Obesity Staging System for the prediction of COVID-19 outcomes: a multi-centre study.

BACKGROUND: Patients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes. METHODS: 1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category. RESULTS: The risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02-1.97 and 2.78, 95% CI 1.83-4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06-2.74, and 2.62, 95% CI 1.65-4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42-0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03-2.42). In patients with a BMI ≥ 25 kg/m2, the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50-3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight. CONCLUSIONS: EOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.

Sociodemographic and Clinical Factors Associated with Severe Obesity in Adults.

BACKGROUND: In the last decades, obesity in general, including severe obesity (BMI ≥40 kg/m2), has increased disproportionately around the world, especially in low-income and lower-middle income regions. AIMS: To analyze sociodemographic and clinical characteristics of people with severe obesity in Mexico, as well as their associated factors. METHODS: A secondary analysis was carried out from the 2018-19 National Health and Nutrition Survey. Descriptive statistics and bivariate analyses by sex were used. Logistic models were estimated to identify the main factors associated with severe obesity. RESULTS: Of the total number of people with obesity in the country (2.2 million people), 3.6% had severe obesity, with an average age of 48.2. There were statistically significant differences by sex in the variables of age group, education, socioeconomic status, health insurance, hypertension, myocardial infarction, and heart failure. Being a woman, having hypertension, and hypertension/diabetes increased the odds of severe obesity. These associations were maintained when comparing people with a BMI <40 kg/m2, with those with a BMI ≥30 kg/m2 and a BMI <40 kg/m2. CONCLUSIONS: Severe obesity must appear on the Mexican political agenda. Data must be produced that can direct decision-making around the promotion of healthy lifestyles, and obesity prevention, treatment, and follow-up, based in people-centered care and through intersectoral strategies, multidisciplinary management, and holistic approaches.

Health care trajectories and barriers to treatment for patients with end-stage renal disease without health insurance in Mexico: a mixed methods approach.

BACKGROUND: Mexico has the sixth-highest premature death rate from chronic kidney disease (CKD) in the world. From 1990 to 2017, the age-standardized CKD mortality rate jumped from 28.7 to 58.1 per 100,000 inhabitants, making it the second-leading cause of death that year. Medical care for the disease is inequitable, as those without health insurance have limited access to renal replacement therapy (RRT). The objective of this study is to describe the healthcare trajectories of patients with end-stage renal disease (ESRD) in a public hospital in Mexico City and the barriers they face in receiving peritoneal dialysis and haemodialysis. METHODS: This study uses a convergent mixed methods approach and is predominantly qualitative. Patients completed 199 surveys, and 42 semi-structured interviews with patients having ESRD and their families were conducted. The quantitative data were analysed using descriptive statistics, and the qualitative data were processed using a phenomenological approach. RESULTS: It was found that 76.9% of the patients received peritoneal dialysis or haemodialysis as their first RRT. Over 30% began their treatment at least a month after a health professional prescribed it. Almost 50% had been hospitalized for complications related to the disease in the previous year, and 36% had uncertainties about their treatment. Close to 64% of the haemodialysis patients received treatment intermittently. Barriers to accessing treatment, information, contact with health services, and treatment availability were identified. Patients and their families encountered economic and emotional difficulties at every phase of their search for medical care and treatment. CONCLUSION: Mexico urgently needs to implement public policies related to CKD that are primarily directed at its prevention but should also implement policies directed at slowing its progression, reducing its complications, and providing funding for uninsured patients who require RRT. These policies must be based on the perspectives of human rights and equality, and the perspectives of patients, their families and the general population should be included in the policy creation process.

Overview of the burden of chronic kidney disease in Mexico: secondary data analysis based on the Global Burden of Disease Study 2017.

OBJECTIVE: To describe the evolution of the burden of chronic kidney disease (CKD) in Mexico by states, sex and subtypes from 1990 to 2017. DESIGN: Secondary data analysis based on the Global Burden of Disease Study (GBD) 2017. PARTICIPANTS: Mexico and its 32 states. Data were publicly available and de-identified and individuals were not involved. METHODS: We analysed age-standardised mortality rates, years of life lost (YLL) due to premature death, years lived with disability (YLD) and disability-adjusted life years (DALY), as well as the percentage of change of these indicators between 1990 and 2017. RESULTS: From 1990 to 2017, the number of deaths, YLL, YLD and DALY due to CKD increased from 12 395 to 65 033, from 330 717 to 1 544 212, from 86 416 to 210 924 and from 417 133 to 1 755 136, respectively. Age-standardised rates went from 28.7 to 58.1 for deaths (% of change 102.3), from 601.2 to 1296.7 for YLL (% of change 115.7), from 158.3 to 175.4 for YLD (% of change 10.9) and from 759.4 to 1472.2 for DALY (% of change 93.8). The highest burden of CKD was for Puebla and the lowest for Sinaloa. It was also greater for men than women. By subtypes of CKD, diabetes and hypertension were the causes that contributed most to the loss of years of healthy life in the Mexican population. CONCLUSIONS: Mexico has experienced exponential and unprecedented growth in the burden of CKD with significant differences by states, sex and subtypes. Data from the GBD are key inputs to guide decision-making and focus efforts towards the reduction of inequities in CKD. These results should be considered a valuable resource that can help guide the epidemiological monitoring of this disease and prioritise the most appropriate health interventions.

Intención de Lactar exclusivamente con Leche Materna: Un Estudio Basado en la Teoría de la Conducta Planeada / Intention to breastfeed exclusively: A study based on the Theory of Planned Behavior

La lactancia materna exclusiva (LME) aporta diversos beneficios a la salud del niño y de la madre. La Teoría de la Conducta Planeada (TCP) es un modelo enfocado en la predicción de algunas conductas relacionadas con la salud, como la LME. El objetivo de este estudio fue identificar la relación de las variables de la TCP con la intención de dar LME. Se llevó a cabo un estudio transversal con 442 mujeres embarazadas de la Ciudad de México. Las variables de la TCP se midieron con instrumentos previamente validados. Un análisis de regresión logística múltiple, ajustado por paridad y edad materna, identificó asociaciones significativas entre la intención de amamantar y la norma subjetiva, OR = 1.07 (IC 95% [1.01, 1.14]), y el control conductual percibido, OR = 1.05 (IC 95% [1.01, 1.11]), con la intención. Como conclusión, en esta muestra se asociaron dos constructos de la TCP con la intención de lactar de forma exclusiva

Breastfeeding provides health benefits to children and mothers. WHO recommends it be exclusive until 6 months of age. The Theory of Planned Behavior (TPB) focus on the prediction of health-related behaviors, such as breastfeeding. The objective of this study was to identify the relationship of attitudes, subjective norm, and perceived behavioral control with the intention of exclusively breastfeeding in a sample of Mexican pregnant women. A cross-sectional study was carried out with 442 pregnant women from Mexico City. Psychosocial variables were measured with a set of scales previously validated. A multiple logistic regression analysis, adjusted for the number of previous children and maternal age, identified significant associations between intention to breastfeed and one dimension of the subjective norm (participants' mothers opinions), OR = 1.07 (IC 95% [1.01, 1.14]), as well as perceived behavioral control, OR = 1.05 (IC 95% [1.01, 1.11]). In the case of this sample, TCP constructs associated to the intention to exclusively breastfeed

Compliance of school food guidelines in primary schools in Mexico City

Childhood obesity is a major public health issue in Mexico. Schools are important settings to promote healthy eating habits. The aim of this study was to assess the extent of compliance with 2010 and 2014 Mexican school food guidelines in six public primary schools in Mexico City. The instruments for this study included semi-structured interviews (n=17) with principals, food vendors and members of the School Vending Committee, focus groups (n=10) with teachers and with parents, observation of six schools' environments, questionnaires applied to 325 schoolchildren from 4th, 5th and 6th grades and their parents, and a food analysis of items sold at school vending. Guidelines' compliance was assessed using all instruments accordingly. It was low in every dimension: 1) Acknowledgment of school food guidelines: None of the participants were familiar with the 2014 guidelines. 2) Healthy environment enhancement: Children lacked free access to safe drinking water. Children had up to five opportunities to eat during school day besides breakfast at home. Most children (67.7%) ate three to four times. 3) Operability of food and beverages sale and consumption: The only training provided to stakeholders was an annual session on hygiene to school food vendors. The majority of food and beverages offered at school vending exceeded energy, sodium, fat and added sugar content as established. Children sold energy-dense foods for school fundraising. Lack of dissemination and acknowledgment of the guidelines, defined roles and policy procedures, as well as training and capacity building for stakeholders impeded school food guidelines'proper implementation(AU)

La obesidad infantil es un problema de salud pública en México. La escuela es un lugar importante para promover hábitos saludables. El propósito del estudio fue evaluar el cumplimiento de los lineamientos escolares de alimentos de 2010 y 2014 en seis escuelas primarias públicas de la Ciudad de México. Los instrumentos incluyen entrevistas semi-estructuradas (n=17) con directores, vendedores de alimentos y miembros del Comité del Establecimiento de Consumo Escolar, grupos focales (n=10) con padres y con profesores, observación del entorno escolar, cuestionarios aplicados a 325 niños de 4º, 5º y 6º grado y a sus padres, y un análisis de los alimentos ofrecidos en la venta escolar. El cumplimiento de los lineamientos fue bajo en cada dimensión: 1) Conocimiento de los lineamientos: Ninguno de los participantes conocía los lineamientos de 2014. 2) Promoción de un ambiente saludable: No se tenía acceso libre a agua simple potable. Los niños tenían cinco oportunidades para comer durante la jornada escolar además del desayuno en casa. La mayoría de los niños (67.7%) comía de 3 a 4 veces. 3) Operatividad de la venta y consumo de alimentos y bebidas: La única capacitación fue una sesión anual de higiene a los vendedores. La mayoría de los alimentos y bebidas excedía los límites establecidos de calorías, sodio, grasa y azúcar añadida. Los niños vendían alimentos densos en energía para recaudar fondos. La falta de difusión de las guías, roles y políticas no definidos y una mínima capacitación obstaculizaron la implementación de los lineamientos(AU)

An anthropometry-based equation of fat mass percentage as a valid discriminator of obesity.

OBJECTIVE: To develop a new predictive equation for fat mass percentage (%FM) based on anthropometric measurements and to assess its ability to discriminate between obese and non-obese individuals. DESIGN: Cross-sectional study. SETTING: Mexican adults.ParticipantsAdults (n 275; 181 women) aged 20-63 years with BMI between 17·4 and 42·4 kg/m2. RESULTS: Thirty-seven per cent of our sample was obese using %FM measured by air-displacement plethysmography (BOD POD®; Life Measurement Instruments). The fat mass was computed from the difference between weight and fat-free mass (FFM). FFM was estimated using an equation obtained previously in the study from weight, height and sex of the individuals. The %FM estimated from the obtained FFM showed a sensitivity of 90·3 (95 % CI 86·8, 93·8) % and a specificity of 58·0 (95 % CI 52·1, 63·8) % in the diagnosis of obesity. Ninety-three per cent of participants with obesity and 65 % of participants without obesity were correctly classified. CONCLUSIONS: The anthropometry-based equation obtained in the present study could be used as a screening tool in clinical and epidemiological studies not only to estimate the %FM, but also to discriminate the obese condition in populations with similar characteristics to the participant sample.

[A front-of-pack labelling system for food and beverages for Mexico: a strategy of healthy decision-making.] / Sistema de etiquetado frontal de alimentos y bebidas para México: una estrategia para la toma de decisiones saludables.

The Mexican Ministry of Health requested the National Institute of Public Health to constitute a group of independent, free of conflict-of-interest academic experts on front-of-pack labelling (FOP). This group was instructed to created a positioning paper to contribute to the development of a FOP system for industrialized products that offers useful information for purchase decision making. This position paper uses the best available scientific evidence, and recommendations from experts of international organizations. The FOP proposal focuses on the contents of energy, nutrients, ingredients and components that if consumed in excess on the diet, can be harmful to people's health, such as added sugars, sodium, total fat, saturated fat and energy. The academic expert group recommends the implementation of a FOP that provides an easy way to quickly assess the quality of a product. It is essential that this FOP provides direct, simple, visible and easily understandable information.

La Secretaría de Salud solicitó al Instituto Nacional de Salud Pública la conformación de un grupo de expertos académicos en etiquetado de alimentos y bebidas, independientes y libres de conflictos de interés, que tuvieran la encomienda de emitir una postura para contribuir al desarrollo de un sistema de etiquetado frontal para productos industrializados que proporcione información útil para facilitar la decisión de compra. La postura utiliza la mejor evidencia científica disponible y recomendaciones de expertos convocados por organismos internacionales. Así, la propuesta de etiquetado frontal se centra en el contenido de energía, nutrimentos, ingredientes y componentes cuyo exceso en la dieta puede ser perjudicial para la salud, como azúcares añadidos, sodio, grasas totales, grasas saturadas y energía. El grupo recomienda implementar un etiquetado frontal que, de forma sencilla, permita evaluar de manera rápida la calidad de un producto al momento de realizar una compra; por ello, es indispensable que éste proporcione información directa, sencilla, visible y fácil de entender.

Seroprevalence of dengue in school children in Mexico ages 6-17 years, 2016.

Background: Dengue is the most important arboviral disease in the world. Seroprevalence has been proposed as a marker of endemicity, however, studies are scarce. Methods: We conducted a cross-sectional, stratified cluster, random sample study to measure the seroprevalence of antibodies to dengue virus (DENV) in Mexico. The target population was school children ages 6-17 y from 22 endemic states in Mexico, clustered in four regions: Pacific, South-Central, Southeast and Low. Results: A total of 2134 subjects provided blood samples for immunoglobulin G antibody detection in serum by enzyme-linked immunosorbent assay. Overall, the seroprevalence of antibodies against DENV was 33.5% (95% confidence interval [CI] 27.5 to 40.1). The Southeast had the highest regional seroprevalence, reaching 70.9% (95% CI 60.3 to 79.7). Seroprevalence was higher in older children in the Southeast region: 62.1% (95% CI 46.9 to 75.2) in children 6-8 y and 82.6% (95% CI 73.8 to 88.9) in 13-17 years old (y). However, this was not consistent in all regions. Seroprevalence was associated with dengue incidence. Conclusions: DENV seroprevalence in Mexico was found to be heterogeneous at the country, regional and state levels. Seroprevalence was linked to long-term exposure and did not adequately reflect recent patterns of transmission, suggesting that utilization of a single epidemiological indicator to define endemic regions should be avoided.

Diseño y validación de un instrumento para medir la autoeficacia para lactar de mujeres embarazadas mexicanas / Design and validation of a scale to measure breastfeeding self-efficacy in Mexican pregnant women

Resumen La lactancia materna exclusiva (LME) es una de las conductas saludables con mayor valor protector para la salud del niño y de la madre. La autoeficacia es un predictor de diferentes conductas saludables. El objetivo de esta investigación fue diseñar y validar un instrumento para medir la autoeficacia para lactar en mujeres embarazadas. Se realizó un estudio instrumental con usuarias de dos centros de salud de primer nivel de atención, seleccionadas a través de un muestreo no probabilístico. Se excluyeron aquellas mujeres que fueran analfabetas o tuvieran alguna condición médica que contraindicara la LME. Se utilizaron análisis descriptivos, bivariados y multivariados para obtener las propiedades psicométricas del instrumento. Participaron 369 mujeres. A través de un análisis factorial exploratorio se obtuvo una estructura unidimensional de 15 reactivos que explicó el 83% de la varianza total del instrumento (alfa de Cronbach = .93). Además, la autoeficacia para lactar se asoció (p <.05) con la intención para lactar, la edad y la escolaridad. El instrumento de autoeficacia para lactar obtenido mostró propiedades psicométricas adecuadas por lo que puede ser útil para identificar a las mujeres que están en riesgo de no iniciar la LME desde el nacimiento de su hijo, además, parece ser el primer instrumento de autoeficacia para lactar en México.

Abstract Exclusive breastfeeding (EB) is a health behavior with a greatest health protective value for children and mothers. Self-efficacy is a predictor of different health behaviors. The objective of this research was to design and validate an instrument to measure self-efficacy to breastfeed in pregnant women. An instrumental study was conducted with users of two primary health care centers, selected through a non-probabilistic sampling. Those women who were illiterate or had a medical condition that contraindicated EB were excluded. Descriptive, bivariate and multivariate analysis were used to obtain the psychometric properties of the instrument. 369 women participated. An exploratory factorial analysis resulted in a 15 items unidimensional structure that explained 83% of the total variance of the scale (Cronbach's alpha = .93). In addition, self-efficacy for breastfeeding was associated (p<.05) with intention to breastfeed, age and scholarship. The breastfeeding self-efficacy scale obtained showed adequate psychometric properties. So, it can be useful to identify women who may be at risk of not initiate breastfeeding from birth, as well as, it seems to be the first breastfeeding self-efficacy scale in Mexico.

Stature in adults as an indicator of socioeconomic inequalities in Mexico

[ABSTRACT]. Objective. To estimate the association between stature in Mexican adults and some sociodemographic factors. Methods. We studied a sample of 30 970 subjects, using anthropometric data from the 2012 National Health and Nutrition Survey (ENSANUT 2012). The first quartile was used as the cutoff to define short stature. We analyzed differences among stature strata for sociodemographic variables by using the Kruskal-Wallis test. We estimated odds ratios to measure the association between stature and sociodemographic variables, controlling for potential confounders. Results. Persons from the southern region of the country were some three times as likely to be of short stature than were subjects in the northern region. The stature difference between the Mexican states with the highest and the lowest average stature was larger than the average difference in stature between Mexico and the United States of America. Adults who had had less than six years of schooling presented the highest prevalence of short stature, regardless of sex, region of the country, place of residence (rural or urban), or the proportion of indigenous language speakers in a state. In addition, the stratum with the highest marginalization (percentage of the population lacking education and services, with a low income, and living in a small community) showed the highest prevalence of short stature. Conclusion. In Mexico, adults who are of short stature have unequal living conditions when compared to those of average or high stature, and this could drive increases in health inequity.

[RESUMEN]. Objetivo. Establecer la asociación entre la estatura de los mexicanos adultos y algunos factores sociodemográficos. Métodos. Sobre la base de datos antropométricos de la Encuesta Nacional de Salud y Nutrición de 2012 (ENSANUT 2012), estudiamos una muestra de 30 970 sujetos. Para definir la estatura baja, el umbral se estableció en el primer cuartil. Analizamos las diferencias entre los distintos estratos de estatura en relación con variables sociodemográficas utilizando la prueba de Kruskal-Wallis. Calculamos las razones de posibilidades para medir la asociación entre la estatura y las variables sociodemográficas, con control de posibles factores de confusión. Resultados. Las personas de la zona meridional del país tenían alrededor de tres veces más probabilidades de ser de estatura baja que las personas de la zona septentrional. La diferencia entre los estados mexicanos con la estatura promedio más alta y la estatura promedio más baja fue mayor que la diferencia promedio respecto de la estatura entre México y los Estados Unidos de América. La prevalencia más alta de estatura baja se registró en los adultos con menos de seis años de escolaridad, independientemente del sexo, la zona del país, el lugar de residencia (rural o urbano) y la proporción de hablantes de lenguas indígenas en un estado. Además, la prevalencia más alta de estatura baja se observó en el estrato de población más marginada (porcentaje de habitantes sin escolaridad ni servicios, con ingresos bajos y que vivían una comunidad pequeña). Conclusiones. En México, las condiciones de vida de los adultos de estatura baja son más desfavorables que las de los adultos de estatura media o alta, y esto podría contribuir a aumentar la inequidad en materia de salud.

[RESUMO]. Objetivo. Estimar a associação entre a estatura em adultos mexicanos e fatores sociodemográficos. Métodos. Foi estudada uma amostra de 30.970 indivíduos com base em dados antropométricos obtidos da Pesquisa Nacional sobre Saúde e Nutrição de 2012 (ENSANUT 2012). O primeiro quartil foi usado como valor de corte para definir baixa estatura. Foram analisadas as diferenças entre os estratos de estatura para as variáveis sociodemográficas com o uso do teste de Kruskal- Wallis. Foram estimados os odds ratios para medir a associação entre a estatura e as variáveis sociodemográficas, controlando-se os potenciais fatores de confusão. Resultados. Os indivíduos da região sul do país apresentaram uma chance quase três vezes maior de ter baixa estatura em comparação aos indivíduos da região norte. A diferença de estatura entre os estados mexicanos com a estatura média maior e a estatura média menor foi maior que a diferença média em estatura entre o México e os Estados Unidos. Os adultos com menos de seis anos de escolaridade apresentaram a prevalência mais elevada de baixa estatura, independentemente do sexo, região do país, zona de residência (rural ou urbana) ou proporção de falantes de línguas indígenas em um estado. Além disso, o estrato com maior marginação (porcentagem de habitantes com carência de educação e serviços, de baixa renda e vivendo em uma pequena comunidade) apresentou a prevalência mais elevada de baixa estatura. Conclusão. No México, os adultos com baixa estatura têm condições de vida desiguais comparados aos adultos com estatura média ou alta, contribuindo para maior iniquidade em saúde.

Stature in adults as an indicator of socioeconomic inequalities in Mexico.

OBJECTIVE: To estimate the association between stature in Mexican adults and some sociodemographic factors. METHODS: We studied a sample of 30 970 subjects, using anthropometric data from the 2012 National Health and Nutrition Survey (ENSANUT 2012). The first quartile was used as the cutoff to define short stature. We analyzed differences among stature strata for sociodemographic variables by using the Kruskal-Wallis test. We estimated odds ratios to measure the association between stature and sociodemographic variables, controlling for potential confounders. RESULTS: Persons from the southern region of the country were some three times as likely to be of short stature than were subjects in the northern region. The stature difference between the Mexican states with the highest and the lowest average stature was larger than the average difference in stature between Mexico and the United States of America. Adults who had had less than six years of schooling presented the highest prevalence of short stature, regardless of sex, region of the country, place of residence (rural or urban), or the proportion of indigenous language speakers in a state. In addition, the stratum with the highest marginalization (percentage of the population lacking education and services, with a low income, and living in a small community) showed the highest prevalence of short stature. CONCLUSION: In Mexico, adults who are of short stature have unequal living conditions when compared to those of average or high stature, and this could drive increases in health inequity.

Stature in adults as an indicator of socioeconomic inequalities in Mexico / La estatura de los adultos como indicador de las desigualdades socioeconómicas en México / Estatura em adultos como indicador das desigualdades socioeconômicas no México

ABSTRACT Objective To estimate the association between stature in Mexican adults and some sociodemographic factors. Methods We studied a sample of 30 970 subjects, using anthropometric data from the 2012 National Health and Nutrition Survey (ENSANUT 2012). The first quartile was used as the cutoff to define short stature. We analyzed differences among stature strata for sociodemographic variables by using the Kruskal-Wallis test. We estimated odds ratios to measure the association between stature and sociodemographic variables, controlling for potential confounders. Results Persons from the southern region of the country were some three times as likely to be of short stature than were subjects in the northern region. The stature difference between the Mexican states with the highest and the lowest average stature was larger than the average difference in stature between Mexico and the United States of America. Adults who had had less than six years of schooling presented the highest prevalence of short stature, regardless of sex, region of the country, place of residence (rural or urban), or the proportion of indigenous language speakers in a state. In addition, the stratum with the highest marginalization (percentage of the population lacking education and services, with a low income, and living in a small community) showed the highest prevalence of short stature. Conclusion In Mexico, adults who are of short stature have unequal living conditions when compared to those of average or high stature, and this could drive increases in health inequity.

RESUMEN Objetivo Establecer la asociación entre la estatura de los mexicanos adultos y algunos factores sociodemográficos. Métodos Sobre la base de datos antropométricos de la Encuesta Nacional de Salud y Nutrición de 2012 (ENSANUT 2012), estudiamos una muestra de 30 970 sujetos. Para definir la estatura baja, el umbral se estableció en el primer cuartil. Analizamos las diferencias entre los distintos estratos de estatura en relación con variables sociodemográficas utilizando la prueba de Kruskal-Wallis. Calculamos las razones de posibilidades para medir la asociación entre la estatura y las variables sociodemográficas, con control de posibles factores de confusión. Resultados Las personas de la zona meridional del país tenían alrededor de tres veces más probabilidades de ser de estatura baja que las personas de la zona septentrional. La diferencia entre los estados mexicanos con la estatura promedio más alta y la estatura promedio más baja fue mayor que la diferencia promedio respecto de la estatura entre México y los Estados Unidos de América. La prevalencia más alta de estatura baja se registró en los adultos con menos de seis años de escolaridad, independientemente del sexo, la zona del país, el lugar de residencia (rural o urbano) y la proporción de hablantes de lenguas indígenas en un estado. Además, la prevalencia más alta de estatura baja se observó en el estrato de población más marginada (porcentaje de habitantes sin escolaridad ni servicios, con ingresos bajos y que vivían una comunidad pequeña). Conclusiones En México, las condiciones de vida de los adultos de estatura baja son más desfavorables que las de los adultos de estatura media o alta, y esto podría contribuir a aumentar la inequidad en materia de salud.

RESUMO Objetivo Estimar a associação entre a estatura em adultos mexicanos e fatores sociodemográficos. Métodos Foi estudada uma amostra de 30.970 indivíduos com base em dados antropométricos obtidos da Pesquisa Nacional sobre Saúde e Nutrição de 2012 (ENSANUT 2012). O primeiro quartil foi usado como valor de corte para definir baixa estatura. Foram analisadas as diferenças entre os estratos de estatura para as variáveis sociodemográficas com o uso do teste de Kruskal- Wallis. Foram estimados os odds ratios para medir a associação entre a estatura e as variáveis sociodemográficas, controlando-se os potenciais fatores de confusão. Resultados Os indivíduos da região sul do país apresentaram uma chance quase três vezes maior de ter baixa estatura em comparação aos indivíduos da região norte. A diferença de estatura entre os estados mexicanos com a estatura média maior e a estatura média menor foi maior que a diferença média em estatura entre o México e os Estados Unidos. Os adultos com menos de seis anos de escolaridade apresentaram a prevalência mais elevada de baixa estatura, independentemente do sexo, região do país, zona de residência (rural ou urbana) ou proporção de falantes de línguas indígenas em um estado. Além disso, o estrato com maior marginação (porcentagem de habitantes com carência de educação e serviços, de baixa renda e vivendo em uma pequena comunidade) apresentou a prevalência mais elevada de baixa estatura. Conclusão No México, os adultos com baixa estatura têm condições de vida desiguais comparados aos adultos com estatura média ou alta, contribuindo para maior iniquidade em saúde.

Efectividad de una intervención educativa semipresencial para la formación docente en el área de salud pública / Effectiveness of a blended learning education intervention for the teaching training in the Public Health area

Introducción. La formación docente debe orientarse a la actualización en contenidos específicos de una asignatura y en aspectos pedagógicos según los cambios educativos globales. En la Facultad de Medicina de la UNAM se imparten cursos dirigidos a estudiantes de pregrado que se formarán como docentes. El objetivo de este estudio fue diseñar, implementar y evaluar un curso-taller semipresencial de formación docente, dirigido a estudiantes con interés en profesionalizarse en una materia de salud pública. Sujetos y métodos. Ejes del curso: fundamentos de la asignatura y bases pedagógicas (impartido en 60 horas, 40 presenciales y 20 en línea). Se evaluó el avance con un test pre-postintervención, un instrumento de escenarios simulados y una rúbrica de presentación frente a grupo. Se calcularon medidas de resumen, pruebas de diferencias de medianas y dos modelos MANOVA para las calificaciones pre-post. Resultados. 49 participantes; un 73% concluyó el curso. La mediana de edad fue de 20 años, y la razón hombre-mujer, de 0,65. Medianas de calificaciones: preintervención, 4,53; postintervención, 7,24 (p < 0,05); bases pedagógicas, 9; presentación frente a grupo, 8,8. En ambos modelos MANOVA se observó que pertenecer a años avanzados de la carrera se relaciona con mayores puntuaciones (p < 0,05). El 16% de los participantes fueron seleccionados como docentes en formación para formar parte de la plantilla académica de la institución. Conclusiones. Este estudio puede considerarse como un referente para propiciar el reporte detallado de otros cursos, considerando el diseño instruccional, la evaluación de su impacto y su éxito en la incorporación temprana de estudiantes como profesores (AU)

Introduction. Teacher training must focus on updating specific contents of a subject and on pedagogical aspects according to global educational changes. At the Faculty of Medicine in UNAM there are courses addressed to undergraduate students who will be trained as teachers. The aim of the study was to design, implement and assess a blended learning course workshop in teacher training for medical students with an interest in specializing in Public Health subject. Subjects and methods. Course's axes: subject's foundations and pedagogical basis (taught in 60 hours, 40 on-site class and 20 online). The advancement was assessed with a pre- and post-test, a simulated scenario tool and a rubric for in front of a group presentation. Summary measurements were calculated, median differences tests and two MANOVA models for pre- and post-test grades. Results. 49 participants; 73% concluded the course. The age range was 20 years old and the male-female ratio was 0.65. Grades' median: pre-intervention, 4.53; post-intervention, 7.24 (p < 0.05); pedagogical bases, 9; in front of a group presentation, 8.8. In both MANOVA models it was observed that being at advanced levels of the career was related with higher scores (p < 0.05). Sixteen percent of the participants were chosen as 'teachers in training' to conform the academic board of our institution. Conclusions. This study may be considered as a referent to promote a detained report of other teacher training courses for students, considering the instructional design, the impact of its assessment and the success in an early incorporation of students as teachers (AU)

Asociación del índice de masa corporal y el autocontrol con la calidad de vida relacionada con la salud en personas con sobrepeso/obesidad / Association of body mass index and self-control with healthrelated quality of life in overweight/obese people

El propósito de este trabajo fue identificar la asociación del autocontrol con la calidad de vida relacionada con la salud y el papel que en ella pudiera tener el Índice de Masa Corporal (imc). Se realizó un estudio transversal predictivo. Participaron 273 adultos, usuarios de un centro de primer nivel de atención a la salud de la Ciudad de México, entre 18 y 65 años de edad, con un imc mayor a 25 unidades. Se aplicó el SF12 v1 y la escala de autocontrol de Tangney, Baumeister y Boone. Se identificó una asociación significativa entre el autocontrol y la calidad de vida física y mental; el imc se asoció con la calidad de vida física, pero no con la calidad de vida mental, ni con el autocontrol. No se identificó un efecto mediador del imc en la relación del autocontrol con la calidad de vida. Los resultados sugieren que una persona con sobrepeso u obesidad con mayor autocontrol, tiene mejor percepción de bienestar en aspectos físicos y emocionales, independientemente del imc.

The aim of this study was to identify the association of self-control with health-related quality of life and the possible mediation of the Body Mass Index (BMI). A predictive cross-sectional study was conducted. Participated 273 adults, users of a primary health care center in Mexico City, aged 18 to 65 years, with a BMI greater than 25. The SF-12 V1 and the Tangney, Baumeister and Boone's Self-Control Scale were applied. The results showed a significant association between self-control to physical and mental health quality of life; BMI was associated with physical quality of life. No associations were found between BMI to mental quality of life and self-control. There were no evidence of a mediation effect of BMI on the relationship between self-control and health-related quality of life. The results suggest that an overweight or obese person with greater self-control has better perception of physical and emotional well-being, independently of BMI.