[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.

Cumulative incidence, prevalence, seroconversion, and associated factors for SARS-CoV-2 infection among healthcare workers of a University Hospital in Bogotá, Colombia.

This study aimed to determine the cumulative incidence, prevalence, and seroconversion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and its associated factors among healthcare workers (HCWs) of a University Hospital in Bogotá, Colombia. An ambispective cohort was established from March 2020 to February 2021. From November 2020 to February 2021, SARS-CoV-2 antibodies were measured on two occasions 14-90 days apart to determine seroprevalence and seroconversion. We used multivariate log-binomial regression to evaluate factors associated with SARS-CoV-2 infection. Among 2,597 HCWs, the cumulative incidence of infection was 35.7%, and seroprevalence was 21.5%. A reduced risk of infection was observed among those aged 35-44 and ≥45 years (adjusted relative risks [aRRs], 0.84 and 0.83, respectively), physicians (aRR, 0.77), those wearing N95 respirators (aRR, 0.82) and working remotely (aRR, 0.74). Being overweight (aRR, 1.18) or obese (aRR, 1.24); being a nurse or nurse assistant (aRR, 1.20); working in the emergency room (aRR, 1.45), general wards (aRR, 1.45), intensive care unit (aRR, 1.34), or COVID-19 areas (aRR, 1.17); and close contact with COVID-19 cases (aRR, 1.47) increased the risk of infection. The incidence of SARS-CoV-2 infection found in this study reflects the dynamics of the first year of the pandemic in Bogotá. A high burden of infection calls for strengthening prevention and screening measures for HCWs, focusing especially on those at high risk.

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)

Seroprevalence and seroconversion rates to SARS-CoV-2 in interns, residents, and medical doctors in a University Hospital in Bogotá, Colombia / Tasas de seroprevalencia y seroconversión al SARS-CoV-2 en internos, residentes y médicos en un Hospital Universitario de Bogotá, Colombia

Abstract Objectives: To determine the prevalence of antibodies to SARS-CoV-2 and the incidence of seroconversion in the first month of follow-up among interns, residents, and medical doctors attending patients at a University Hospital in Bogota (Colombia). Design or methods: A cross-sectional and a prospective study were performed during June, July, and August 2020 to assess seroprevalence and seroconversion rates using CLIA IgG for SARS-CoV-2. LFA IgG and IgM and ELFA IgM were also determined to explore concordance with CLIA IgG. Results: At baseline, 8 (2.28% 95%CI 1.16-4.43%) participants were IgG positive for SARS-CoV-2 by CLIA. At the end of the study, 21 (5.98% 95%CI 3.94-8.97%) individuals seroconverted by CLIA IgG. In all, 29 individuals had IgG by CLIA and of these 11 (3.13% 95%CI 1.76-5.52%) were asymptomatic. No associations with risk factors for infection were identified. CLIA IgG had moderate concordance (>962 samples) with LFA IgG and ELFA IgM, but minimal with LFA IgM. Conclusions: Our report is the first in Latina America on seroprevalence and seroconversion rates in medical healthcare workers. The relatively high rate (>3%) of asymptomatic health care workers with evidence of previous SARS-CoV-2 infection underscores the need to screen this population for infection to prevent infection/disease spread.

Resumen Objetivos: Determinar la prevalencia de anticuerpos frente al SARS-CoV-2 y la incidencia de seroconversión en el primer mes de seguimiento en internos, residentes y médicos que atienden pacientes en un Hospital Universitario de Bogotá (Colombia). Diseño y métodos: Se realizó un estudio transversal y prospectivo durante junio, julio y agosto de 2020 para evaluar las tasas de seroprevalencia y seroconversión utilizando CLIA IgG para SARS-CoV-2. También se determinaron LFA IgG e IgM y ELFA IgM para explorar la concordancia con CLIA IgG. Resultados: Al inicio del estudio, 8 (2,28% IC del 95% 1,16-4,43%) participantes fueron IgG positivos para SARS-CoV-2 por CLIA. Al final del estudio, 21 (5,98% IC 95% 3,94-8,97%) individuos seroconvirtieron por CLIA IgG. En total, 29 individuos tenían IgG por CLIA y de estos 11 (3,13% 95% IC 1,76-5,52%) eran asintomáticos. No se identificaron asociaciones con factores de riesgo de infección. El CLIA IgG tuvo una concordancia moderada (> 962 muestras) con LFA IgG y ELFA IgM, pero mínima con el LFA IgM. Conclusiones: Nuestro informe es el primero en América Latina sobre tasas de seroprevalencia y seroconversión en trabajadores médicos de la salud. La tasa relativamente alta (> 3%) de trabajadores de la salud asintomáticos con evidencia de infección previa por SARS-CoV-2 resalta la necesidad de realizar pruebas de detección de infección en esta población para prevenir la propagación de la infección.

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.

Mesenchymal stromal cells represent a therapeutic option for systemic sclerosis patients / Células estromales mesenquimales representan una opción terapéutica en pacientes con esclerosis sistémica

ABSTRACT The mesenchymal stromal cells (MSCs) are hematopoietic stem cells with high capacity of differentiation to other cellular lineages, depending on the microenvironment in which they live as well as on the interaction and signaling pathways they establish with the extracellular matrix. Several properties have been described in these cells: proangiogenic, antifibrotic and immunomodulatory. These properties are being studied as a therapeutic approach for autoimmune diseases such as cutaneous systemic sclerosis (SSc). SSc is a systemic chronic disease, with an approximate prevalence of 35.6 cases per 100,000 inhabitants in North America and of 0.02% in Colombia in 2018. There are two different clinical variants, diffuse and localized. In both variants an important skin involvement and a rapidly deterioration of organs is present, which can overshadow the clinical prognosis and increase the mortality. Options for the treatment of advanced diffuse SSc are scarce mainly targeting symptomatic control with little impact on the progression and mortality. Therefore, there is an increasing interest in new therapies like advanced cellular therapy with hematopoietic stem cells and stromal mesenchymal cells. This article reviews the information related to the use of stromal mesenchymal cells in patients with this disease.

RESUMEN Las células mesenquimales estromales son células madre no hematopoyéticas pluripotenciales con alta capacidad de derivación a diferentes linajes celulares, dependiendo tanto del microambiente en el que se encuentren, como de la interacción y señalización que establezcan con la matriz extracelular del entorno, esto ha permitido describir un potencial proangiogénico, antifibrótico e inmunomodulador, que ha sido blanco de investigación en enfermedades autoinmunes como la esclerosis sistêmica cutánea. Considerando que la esclerosis sistêmica cutánea es una enfermedad inflamatoria crónica, con una prevalencia estimada de 35,6 casos por cada 100.000 habitantes en Norte América y de 0,02% en nuestro país para el 2018, se caracteriza por presentar dos variables clínicas principalmente; una variante limitada y una variante difusa, presentando en ambas un compromiso extenso de piel y órganos que puede ser rápidamente progresivo y deteriorar el pronóstico de los pacientes que la padecen aumentando su mortalidad. Debido a que las opciones terapéuticas en esta entidad son limitadas y buscan únicamente el control de síntomas, pero con poco impacto en progresión y mortalidad, terapias celulares avanzadas han surgido como nuevas opciones terapéuticas incluyendo el trasplante de células madre hematopoyéticas y las células mesenquimales estromales. A continuación, se revisará acerca de la utilidad y evidencia de células mesenquimales estromales en pacientes con esta enfermedad.

Factors associated with mortality in Infections caused by Carbapenem-resistant Enterobacteriaceae.

INTRODUCTION: There is little information about weigh of factors possibly associated with mortality, in infections caused by Carbapenem-resistant Enterobacteriaceae (CRE) in Latin America. METHODOLOGY: A case-controls study nested in a historical cohort was performed including all patients with CRE infections diagnosed between June 2013 and December 2018 at Hospital Universitario San Ignacio in Bogotá, Colombia. Univariate and multivariate analysis were performed to compare cases of mortality within the first month after the infection diagnosis with surviving patients. RESULTS: A total of 131 patients were included. The overall 30-day mortality rate was 38.17%. In the multivariate analysis, a direct association was found between mortality and septic shock (OR 26.7 CI6.6-107.3 p < 0.01), post-chemotherapy febrile neutropenia (OR 3.3 CI1.06-10.8 p = 0.04) and Charlson Index ≥ 3 (OR 5.5 CI 1.5-20.06 p < 0.01). An inverse association was found with interventions to control the infectious focus (OR 0.3 CI0.1-0.7 p < 0.01). The MIC of different antibiotics and the use of combined antibiotic therapy (triple therapy vs. double therapy or monotherapy) were not associated with mortality. CONCLUSIONS: In patients with CRE infections, septic shock, a Charlson comorbidity index ≥ 3, and post-chemotherapy febrile neutropenia are independently related to an increase in mortality. The control of the infectious focus is a protective factor. A rapid identification of these patients, and the implementation of measures to control infectious focus and to detect CRE colonization in patients who are going to be taken to myelosuppressive chemotherapy could impact positively the prognosis of these patients.

Non-synonymous polymorphisms in candidate gene associated with growth traits in Channel catfish (Ictalurus punctatus, Rafinesque, 1818).

Resequencing of Myostatin, Growth Hormone, Follistatin-A-like, Insulin-like Growth Factor I (IGF-I) and Myogenin (MYOG) genes was completed to discover novel genetic variations and assess non synonymous (ns) polymorphisms (SNPs) effect on growth related traits of channel catfish. Wild and farmed animals were used as a discovering population. Resequencing lead to the identification of 59 new variants in the five analyzed genes; 66% found in introns and 34% in coding regions. From coding regions, 14 variants were synonyms and six were ns variations. A mutation rate of one in 129 bp was estimated. Four ns variations were selected for validation and association analysis. In IGF-I two ns polymorphisms, at IGF-I19 the G wild type allele was fixed in population and for IGF-I63 the C allele had a frequency of 0.972 and for mutate allele G of 0.027. In MYOG two ns SNPs were assessed. MYOG131 presented a frequency of alleles T and A, of 0.754 and 0.246, respectively and MYOG233, with a frequency of G and C of 0.775 and 0.225, respectively. Only MYOG131 (g.529T>A) was significantly associated (P < 0.04) to some growth traits. Results suggest MYOG131 g.529T>A as candidate locus for genetic enhancement of growth traits in channel catfish.

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.

Effect of input data variability on estimations of the equivalent constant temperature time for microbial inactivation by HTST and retort thermal processing.

UNLABELLED: Consumer demand for food safety and quality improvements, combined with new regulations, requires determining the processor's confidence level that processes lowering safety risks while retaining quality will meet consumer expectations and regulatory requirements. Monte Carlo calculation procedures incorporate input data variability to obtain the statistical distribution of the output of prediction models. This advantage was used to analyze the survival risk of Mycobacterium avium subspecies paratuberculosis (M. paratuberculosis) and Clostridium botulinum spores in high-temperature short-time (HTST) milk and canned mushrooms, respectively. The results showed an estimated 68.4% probability that the 15 sec HTST process would not achieve at least 5 decimal reductions in M. paratuberculosis counts. Although estimates of the raw milk load of this pathogen are not available to estimate the probability of finding it in pasteurized milk, the wide range of the estimated decimal reductions, reflecting the variability of the experimental data available, should be a concern to dairy processors. Knowledge of the C. botulinum initial load and decimal thermal time variability was used to estimate an 8.5 min thermal process time at 110 °C for canned mushrooms reducing the risk to 10⁻9 spores/container with a 95% confidence. This value was substantially higher than the one estimated using average values (6.0 min) with an unacceptable 68.6% probability of missing the desired processing objective. Finally, the benefit of reducing the variability in initial load and decimal thermal time was confirmed, achieving a 26.3% reduction in processing time when standard deviation values were lowered by 90%. PRACTICAL APPLICATION: In spite of novel technologies, commercialized or under development, thermal processing continues to be the most reliable and cost-effective alternative to deliver safe foods. However, the severity of the process should be assessed to avoid under- and over-processing and determine opportunities for improvement. This should include a systematic approach to consider variability in the parameters for the models used by food process engineers when designing a thermal process. The Monte Carlo procedure here presented is a tool to facilitate this task for the determination of process time at a constant lethal temperature.

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.