Impact of social disadvantages in the presence of diabetes at old age.

BACKGROUND: Social disadvantages that start during childhood and continue into the later stages in life may be linked to the presence of diabetes during adulthood. OBJECTIVE: To analyze whether the presence of social disadvantages in childhood and in the present affects the presence of diabetes in older adults. METHODS: The present study was based on longitudinal data from the third and fourth Mexican Health and Aging Study (MHAS) waves (2012 and 2015). Data on diabetes diagnosis, past (e.g. "no shoes during childhood") and present (e.g. self-perception of economic status) social disparities, and other covariables were analyzed. RESULTS: From 8,848 older adults, 21.5% (n = 1903) were classified as prevalent cases (PG), 5.2% (n = 459) as incident cases (IG) and 77.4% (n = 6,486) were free of disease (NDG). The predictor variable "no shoes during childhood" was statistically significant in the model incident versus no diabetes group. Hypertension and body mass index (BMI) were the most relevant covariates as they were statistically significant in the three groups (PG, IG and NDG). CONCLUSIONS: Not having shoes during childhood, an indicator of social disadvantages, is associated with the incidence and prevalence of diabetes in older adults. This suggests that social disadvantages can be a determinant for the presence of chronic diseases in adulthood.

[Family medicine in Mexico: Present and future]. / La medicina familiar en México: presente y futuro.

Analyzing the challenges and the future scenario of Family Medicine is a priority to address challenges such as the reduction of benefits granted by social security; to adapt their practice to the changing health profile; and to curb demand for specialized services and contain the high costs of care in the second and third level. The program is aimed at three professional roles: medical care, research, and education. It is imperative review these in the light of changing demographic conditions, the type of health needs arising from new social determinants, the public expectations for greater participation in their care, and the evolution of the health system itself with the advancement of technology and a variety of organizational options with frequently limited resources. For primary care, as the core of a health system that covers principles of equity, solidarity, universality, participation, decentralization, and intra- and inter-sectorial coordination, it is necessary to put at the center of the primary care team the family doctor and not an administrator, who plays an important role in supporting the care team, but can not take the lead.

[Behavior of hypertensive renal diseases in Mexico between 1998-2009. A growing problem]. / Comportamiento de la mortalidad por enfermedad renal crónica hipertensiva en la República Mexicana entre 1998-2009. Un problema creciente.

INTRODUCTION: High blood pressure (HBP) is a risk factor for chronic diseases. Worldwide, 20-25% of adults have hypertension, with 70% of them living in developing countries. Hypertensive renal disease (HRD) is a complication of insufficiently controlled hypertension. This study aims to analyze the behavior of HRD mortality in Mexico between 1998 and 2009. METHODS: Longitudinal study with secondary analysis of HRD records from the databases provided by INEGI, which analyzes the specific rates by age and sex and standardized mortality ratio (SMR) by states and regions. Georeferencing methods are used statewide. RESULTS: In Mexico from 1998 to 2009 there were 48,823 deaths from HRD. The standardized mortality rate rose from 3.35/100,000 inhabitants to 6.74 (p < 0.01). The specific rates by age and sex showed an increase in incidence after 50 years of age. States with higher SMR by HDR were DF, Estado de Mexico, Morelos, Jalisco, and Colima. CONCLUSIONS: HRD is a major microvascular complication of hypertension and its prevalence is increasing. We should strengthen the processes of early detection, care, and appropriate follow-up of people with hypertension to control this potentially preventable complication.

[Case crossover studies: a conceptual and methodological approach]. / Estudio epidemiológico de casos y autocontroles: una aproximación conceptual y metodológica.

Case crossover studies are considered as a variant of case control studies, and they have been included in the scientific literature since approximately eighteen years ago. They have also been used in epidemiological research on acute or intermittent exposures that may lead to a number of events including heart attack or cardiac arrest, injuries, asthma, etc. Application of this particular study design requires defining concepts such as: triggers, induction time, case period and control period. Its use is limited in studies on chronic exposures. On the other hand, this type of design may reduce selection and misclassification bias, confounding, and overmatching. Another advantage is that it requires a small sample size because the same case can be used as its own control in one or several periods. Nevertheless, sample size calculation must be assessed as a matched case-control study. This is a type of study in which theoretical principles are accomplished in a sui generis manner.

The challenge of asymptomatic carriers of COVID-19: A rapid review of literature.

OBJECTIVES: To describe the epidemiological and sociodemographic characteristics of asymptomatic carriers reported in the literature, and to review the strategies used for diagnosis and control. METHODS: Systematic literature review approach. As inclusion criteria, all studies published between January 1 and June 26, 2020, conducted in humans, that reported people who remained asymptomatic of COVID-19. Descriptors were adapted to the interfaces of eight bibliographic databases were configured: PubMed, Ovid, SciELO, Ebsco, Scopus, LILACS, Epistemonikos and Embase. RESULTS: About 45% of the articles reported adult population, thirteen reported mixed population (adult and pediatric). 3 525 asymptomatic people were reported, with an average of 37,1 years [0.5-82 years]. Although the effectiveness of the control and prevention measures was not reported, the identification, isolation and follow-up of contacts stands out as a potential effective mechanism to prevent the transmission. CONCLUSIONS: The use of this information could be relevant to guide evidence-based public health policies and the protection of populations and the improvement of health care that contributes to stopping this pandemic.

Long-Term Effectiveness of Polymerized-Type I Collagen Intra-Articular Injections in Patients with Symptomatic Knee Osteoarthritis: Clinical and Radiographic Evaluation in a Cohort Study.

OBJECTIVE: Polymerized-type I collagen (polymerized-collagen) is a downregulator of inflammation and a tissue regenerator. The aim was to evaluate the effect of intra-articular injections (IAIs) of polymerized-collagen among patients with symptomatic knee osteoarthritis (OA) in delaying or preventing joint replacement surgery. Patients and Methods. This was a cohort study of 309 patients with knee OA. Patients with mild-to-moderate disease were treated weekly with IAIs of 2 mL of polymerized-collagen for six weeks (n = 309). Follow-up was for 6-60 months. The primary endpoints included the following determinations: (1) therapeutic effect; (2) survival from total knee replacement surgery (TKR); (3) Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and pain (visual analogue scale, VAS). Clinical improvement was defined as a decrease in pain exceeding 20 mm on the VAS and the achievement of at least 20% improvement from baseline with respect to the WOMAC score. Radiographic analysis was performed at baseline and 60 months. The joint space width in the medial, lateral, and patellofemoral compartments was calculated. RESULTS: Patients who received IAIs of polymerized-collagen had a statistically significant improvement in the primary criteria (p < 0.05). Kaplan-Meier survival analysis of the therapeutic effect demonstrated 98.8% survival at 60 months with TKR as the endpoint. There was no significant reduction in joint space in any compartment based on the analyzed radiographs. No serious adverse events were recorded. CONCLUSION: Polymerized-collagen increased the time to TKR by at least 60 months, modifying the disease course, improving functional disability, and decreasing pain.

Association of anthropometric indicators to evaluate nutritional status and cardiometabolic risk in Mexican teenagers.

INTRODUCTION: Introduction: anthropometric indicators (AIs) such as waist circumference (WC), body mass index (BMI), waist/hip index (WHpI), waist/height index (WHtI) and body fat percentage (BFP) are useful tools for the diagnosis of nutritional status (NS) in adolescents. Each of these parameters has advantages and disadvantages. The purpose of the present study was to analyze the association of these AIs (WC, BMI, WHpI, WHtI, and BFP) to evaluate nutritional status and estimate the cardiometabolic risk (CMR) in Mexican adolescents. Material and method: in a cross-sectional descriptive study, the NS was analyzed through various AIs and CMR with the WHtI criteria. Nine hundred and seventeen adolescents between 15 and 17 years old participated in the study, of whom 488 (52.9%) were female and 429 (47.1%) male, all students of middle school in Tuxtla Gutiérrez, Chiapas, Mexico. Results and conclusion: women presented a higher prevalence of obesity according to most indicators. The WHtI was the parameter that detected the highest prevalence of obesity (31%), correlating with the BMI and the BFP. Moreover, there was evidence of a significant relation between NS (assessed by all the anthropometric indicators) and CMR. The WHtI could be considered as an adequate tool for the diagnosis of obesity associated with CMR in adolescents.

INTRODUCCIÓN: Introducción: los indicadores antropométricos (IA) como la circunferencia de cintura (CC), el índice de masa corporal (IMC), el índice cintura/cadera (ICC), el índice cintura/talla (ICT) y el porcentaje de grasa corporal (PGC) son herramientas útiles para el diagnóstico del estado nutricional (EN) en los adolescentes. Sin embargo, cada uno de estos IA presentan ventajas y desventajas. El propósito del presente estudio fue analizar la asociación de los IA (IMC, CC, ICC, ICT y PGC) para evaluar el EN y estimar el riesgo cardiometabólico (RCM) en adolescentes mexicanos. Material y método: el diseño del estudio fue descriptivo transversal. Se analizó el EN a través de diversos IA y el RCM bajo los criterios de ICT. Este estudio fue conducido en 917 adolescentes de entre 15 y 17 años, de los cuales 488 (52,9%) eran mujeres y 429 (47,1%) varones, todos estudiantes de nivel medio superior de Tuxtla Gutiérrez, Chiapas, México. Resultados y conclusión: las mujeres presentaron mayor prevalencia de obesidad con la mayoría de los IA utilizados. El ICT fue el IA que detectó mayor prevalencia de obesidad (31%), correlacionándose con el IMC y el PGC. Además, se evidenció una asociación significativa entre el EN valorado por todos los IA y el RCM. El ICT podría ser considerado como una herramienta adecuada para el diagnóstico de obesidad asociada a RCM en adolescentes.

Mortalidad comparativa por diabetes mellitus y factores sociodemográficos asociados entre México y Colombia

Introducción: La diabetes mellitus es un importante problema de salud pública que afecta de manera importante a varios países de América Latina, es para México y Colombia una de las principales causas de mortalidad. Objetivo: Analizar las tendencias y algunos factores de riesgo potencialmente asociados a la mortalidad por diabetes mellitus entre Colombia y México. Métodos: Estudio epidemiológico, observacional-analítico de fuentes secundarias, tipo ecológico, que compararon las tendencias de mortalidad entre Colombia y México entre 2000 a 2017. Se estimaron tasas de mortalidad por país, sexo y año de ocurrencia; mediante modelo de análisis múltiple se determinaron factores sociodemográficos potencialmente asociados a la mortalidad. Resultados: Para el período de estudio, hubo un incremento en el riesgo de mortalidad por diabetes mellitus en México. Se encontró un 28 % más de posibilidad de muerte por diabetes mellitus en hombres mexicanos en comparación con los colombianos; un 45 % más de riesgo de muerte en mexicanos de 40 a 59 años, en comparación con los colombianos. Según el área de residencia, los mexicanos del área rural tuvieron 4 veces más posibilidad de morir que aquellos que habitaban la zona urbana, en comparación con los colombianos; todas estas diferencias fueron estadísticamente significativas (p < 0,05). Conclusiones: Esta investigación brinda información relevante sobre la mortalidad por DM, al estimar la magnitud del fenómeno y realizar comparaciones durante cerca de dos décadas en dos países de América Latina. El impacto de la diabetes mellitus se observó, fundamentalmente, en México, donde actualmente es la principal causa de mortalidad.

Introduction: Diabetes mellitus, an important public health problem that significantly affects several Latin American countries, is one of the main causes of mortality for Mexico and Colombia. Objective: To analyze the trends and some risk factors potentially associated with mortality from diabetes mellitus between Colombia and Mexico. Methods: An epidemiological, observational-analytical study of secondary sources, ecological type, comparing mortality trends among Colombia and Mexico between 2000 and 2017. Mortality rates were estimated by country, sex, and year of occurrence; multiple analysis models were used to determine sociodemographic factors potentially associated with mortality. Results: During the study period, there was an increased risk of mortality from diabetes mellitus in Mexico. A 28% higher chance of death from diabetes mellitus was found in Mexican men compared to Colombians; and a 45% higher risk of death in Mexicans aged 40 to 59, compared to Colombians. According to the area of residence, Mexicans in rural areas were 4 times more likely to die than those who lived in urban areas, compared to Colombians. All these differences were statistically significant (p < 0.05). Conclusions: This research provides relevant information on mortality from DM, by estimating the magnitude of the phenomenon and making comparisons over nearly two decades in two Latin American countries. The impact of diabetes mellitus was observed mainly in Mexico, where it is currently the leading cause of mortality.

Grupos de Alimentos Asociados Atención Dental por Caries y por Gingivitis en Escuelas Públicas, México

RESUMEN: Asociar grupos de alimentos con "atención dental por caries" y "por gingivitis" en adolescentes de entre 12 y 24 años de edad de escuelas públicas en Morelos, México. Las variables dependientes: "atención dental por caries" y "por gingivitis" se definieron por auto-reporte. Los grupos de alimentos se obtuvieron de un cuestionario de consumo en el último año. La ingesta diaria se estimó calculando cada peso correspondiente a la frecuencia de consumo del alimento ajustado al tamaño de la porción utilizando tablas de alimentos y después fueron sumados según al grupo que pertenecían (lácteos, frutas, verduras, leguminosas, cereales, carne y huevo, pescados y mariscos, comida rápida, bebidas carbonatadas y jugos embotellados y golosinas). Para el análisis se utilizaron modelos logísticos multinivel para mediciones repetidas para identificar as ociaciones (RM) entre ingesta de cada grupo de alimentos con cada variable dependiente por separado. En el análisis ajustado "atención dental por caries" se asoció con: frutas (RM 1.70), bebidas carbonatadas y jugos embotellados (RM 1.38) y golosinas (RM 1.44), mientras que cereales se mantuvo en el nivel marginal (RM 1.34). No se encontró asociación con "por gingivitis". Los alimentos con altos contenidos de hidratos de carbono refinados son determinantes para acudir a servicios dentales por caries.

ABSTRACT: Associate food groups with "dental caries care" and "for gingivitis" in adolescents between 12 and 24 years of age from public schools in Morelos, México. The dependent variables: "dental care for caries" and "for gingivitis" were defined by self-report. The food groups were obtained from a consumption questionnaire in the last year. The daily nutritional intake was estimated calculating each nutritional content of the foods using food tables and then they were added according to the group they belonged to (dairy, fruits, vegetables, legumes, cereals, meat and eggs, fish and seafood, carbonated drinks and bottled juices and sweets. Multilevel logistic models for repeated measurements were used for the analysis to identify associations (OR) between intake of each food group with "dental caries care" and "for gingivitis". In the adjusted analysis, "dental caries care" was associated with: fruits (OR 1.70), carbonated drinks and bottled juices (OR 1.38) and sweets (OR 1.44), while cereals remained at the marginal level (OR 1.34). No association with "for gingivitis" found. Foods high in refined carbohydrates are essential to go to dental services for dental caries.

Farmacogenética en el cáncer de mama: implicaciones de los genes del citocromo p450 en la supervivencia libre de la enfermedad en las mujeres jóvenes / Pharmacogenetics in breast cancer: Implications of cytochrome p450 genes in disease-free survival in young women

Las mujeres jóvenes (≤40 años) con cáncer de mama suelen tener un peor pronóstico que las mujeres posmenopáusicas, con repercusiones reproductivas y familiares importantes. El tratamiento quimioterapéutico, así como la hormonoterapia, pueden mejorar el pronóstico y la supervivencia libre de enfermedad (SLE); sin embargo, la capacidad individual de metabolizar los fármacos puede modificar la respuesta al tratamiento. Las diferencias interpersonales de esta capacidad tienen una explicación en las variaciones de los genes que codifican las enzimas que metabolizan los quimioterapéuticos y las hormonas endógenas y exógenas. Los genes del citocromo P450 (CYP450), CYP3A4, CYP2B6, CYP2D6 y CYP2C19, están involucrados en el metabolismo de los estrógenos y la ciclofosfamida, los taxanos y el tamoxifeno. La presente revisión expone la evidencia científica del efecto de los polimorfismos funcionales de estos genes sobre la SLE, y sus implicaciones, en las mujeres jóvenes con cáncer de mama. (AU)

Breast cancer prognosis tends to be worse in young women (≤40 years) than in postmenopausal women, with significant reproductive and family repercussions. Both chemotherapy and hormonal therapy can improve prognosis and disease-free survival but treatment response may be influenced by the individual's ability to metabolize drugs. Individual differences in metabolic ability can be explained by variations in the genes encoding the enzymes that metabolize chemotherapeutic agents and hormones. The cytochrome P450 genes CYP3A4, CYP2B6, CYP2D6 and CYP2C19 are involved in the metabolism of estrogen, cyclophosphamide, taxanes, and tamoxifen. This review discusses the scientific evidence of the effect of functional polymorphisms in these genes on disease-free survival and overall survival and its implications for young women with breast cancer. (AU)

Multimorbilidad y resultados clínicos de una población pediátrica con sospecha de COVID-19 atendida en un hospital mexicano / Multimorbidity and clinical results of a pediatric population with suspected COVID-19 treated in a Mexican hospital

Resumen Introducción: Datos de varios países del mundo sugieren que los niños con COVID-19 podrían presentar síntomas diferentes y menos graves que los adultos. Sin embargo, los patrones epidemiológicos y clínicos en este grupo poblacional son poco claros. Métodos: El presente es un estudio observacional, con una caracterización inicial transversal-analítica, y con un componente longitudinal o de seguimiento a un grupo de menores con sospecha y/o diagnóstico confirmado de COVID-19, que presentaron desenlaces como mejoría, traslado a un nivel superior de atención o defunción por sintomatología respiratoria. Los niños recibieron atención médica en el Hospital General Regional con Medicina Familiar N.° 1 (HGR C/MF N.° 1), y se les realizó prueba de reacción en cadena de la polimerasa en tiempo real (RT-PCR). Resultados: Se estudiaron 98 niños como casos sospechosos para COVID-19, a quienes se les realizó RT-PCR. Del total, 24 resultaron positivos y 74 fueron negativos. La mediana de edad de los participantes fue 64,4 meses (0 a 203 meses), 55 menores eran de sexo masculino, 59 niños tuvieron manejo ambulatorio, y de estos, 14 presentaron resultado positivo. Entre los que requirieron manejo hospitalario (39), 10 niños dieron positivo para SARS-CoV-2, 84,7% alcanzaron mejoría y fueron dados de alta, 4 fueron trasladados a hospitales de nivel superior de atención. De los 98 niños en estudio, 11 fallecieron, 7 con resultado negativo y 4 con resultado positivo para SARS-CoV-2. Conclusiones: Los principales síntomas de la población pediátrica en este estudio fueron fiebre, tos y malestar general. De los niños que fallecieron, 4 presentaron resultado positivo para SARS-CoV-2, no obstante, estos presentaban otras comorbilidades.

Abstract Introduction: Data from several countries around the world suggest that children with COVID-19 may present different and less severe symptoms than adults. However, the epidemiological and clinical patterns in this population group have been unclear. Methods: This is an observational study, with an initial cross-analytical characterization, and with a longitudinal or follow-up component in a group of minors with suspected and or confirmed case of COVID-19, which have outcomes such as improvement, transfer to a higher level of care or death due to respiratory symptoms. The children received medical attention at the Regional General Hospital with Family Medicine No 1 (HGR C / MF No 1), and underwent a Real Time Polymerase Chain Reaction test (RT-PCR). Results: 98 children were studied as suspected cases for COVID-19, who underwent RT-PCR. Of the total 24 were positive and 74 were negatives. The median age was 64.4 months (0 to 203 months), 55 minors were male, 59 children had outpatient management, and of these, 14 had a positive result. Among those who required hospital management (39), 10 children were positive for SARS-CoV-2, 84.7% achieved improvement and were discharged, and four were transferred to a higher level of care hospital. Of the 98 children in the study, 11 died, seven had a negative result and four a positive result for SARS-CoV-2. Conclusions: The main symptoms of the pediatric population in this study were fever, cough and general discomfort. Four of those who died had a positive result for SARS-CoV-2, however, they had other comorbidities.

The challenge of asymptomatic carriers of COVID-19: A rapid review of literature / El desafío de los portadores asintomáticos de COVID-19: una revisión rápida de la literatura

ABSTRACT Objectives To describe the epidemiological and sociodemographic characteristics of asymptomatic carriers reported in the literature, and to review the strategies used for diagnosis and control. Methods Systematic literature review approach. As inclusion criteria, all studies published between January 1 and June 26, 2020, conducted in humans, that reported people who remained asymptomatic of COVID-19. Descriptors were adapted to the interfaces of eight bibliographic databases were configured: PubMed, Ovid, SciELO, Ebsco, Scopus, LILACS, Epistemonikos and Embase. Results About 45% of the articles reported adult population, thirteen reported mixed population (adult and pediatric). 3 525 asymptomatic people were reported, with an average of 37,1 years [0.5-82 years]. Although the effectiveness of the control and prevention measures was not reported, the identification, isolation and follow-up of contacts stands out as a potential effective mechanism to prevent the transmission. Conclusions The use of this information could be relevant to guide evidence-based public health policies and the protection of populations and the improvement of health care that contributes to stopping this pandemic.

RESUMEN Objetivos Describir las características epidemiológicas y sociodemográficas de los portadores asintomáticos reportadas en la literatura y revisar las estrategias utilizadas para el diagnóstico y control. Métodos Se realizó una revisión sistemática de la literatura. Se incluyeron todos los estudios publicados entre el 1.° de enero y el 26 de junio de 2020 realizados en humanos que informaron personas que permanecieron asintomáticas por COVID-19. Se adaptaron descriptores a las interfaces de ocho bases de datos bibliográficas: Pub-Med, Ovid, SciELO, Ebsco, Scopus, LILACS, Epistemonikos y Embase. Resultados Aproximadamente el 45% de los artículos reportaron población adulta, trece estudios informaron población mixta (adultos y pediátricos). Se identificaron 3 525 personas asintomáticas, con un promedio de 37,1 años [0,5-82 años]. Si bien no se reportó efectividad de medidas de control y prevención, la identificación, aislamiento y seguimiento de los contactos se destaca como un potencial mecanismo efectivo para prevenir la transmisión. Conclusiones El uso de esta información podría ser relevante para orientar las políticas de salud pública basadas en la evidencia y la protección de las poblaciones y la mejora de la atención médica que contribuya a detener esta pandemia.

The challenge of asymptomatic carriers of COVID-19: A rapid review of literature / El desafío de los portadores asintomáticos de COVID-19: una revisión rápida de la literatura

ABSTRACT Objectives To describe the epidemiological and sociodemographic characteristics of asymptomatic carriers reported in the literature, and to review the strategies used for diagnosis and control. Methods Systematic literature review approach. As inclusion criteria, all studies published between January 1 and June 26, 2020, conducted in humans, that reported people who remained asymptomatic of COVID-19. Descriptors were adapted to the interfaces of eight bibliographic databases were configured: PubMed, Ovid, SciELO, Ebsco, Scopus, LILACS, Epistemonikos and Embase. Results About 45% of the articles reported adult population, thirteen reported mixed population (adult and pediatric). 3 525 asymptomatic people were reported, with an average of 37,1 years [0.5-82 years]. Although the effectiveness of the control and prevention measures was not reported, the identification, isolation and follow-up of contacts stands out as a potential effective mechanism to prevent the transmission. Conclusions The use of this information could be relevant to guide evidence-based public health policies and the protection of populations and the improvement of health care that contributes to stopping this pandemic.

RESUMEN Objetivos Describir las características epidemiológicas y sociodemográficas de los portadores asintomáticos reportadas en la literatura y revisar las estrategias utilizadas para el diagnóstico y control. Métodos Se realizó una revisión sistemática de la literatura. Se incluyeron todos los estudios publicados entre el 1.° de enero y el 26 de junio de 2020 realizados en humanos que informaron personas que permanecieron asintomáticas por COVID-19. Se adaptaron descriptores a las interfaces de ocho bases de datos bibliográficas: Pub-Med, Ovid, SciELO, Ebsco, Scopus, LILACS, Epistemonikos y Embase. Resultados Aproximadamente el 45% de los artículos reportaron población adulta, trece estudios informaron población mixta (adultos y pediátricos). Se identificaron 3 525 personas asintomáticas, con un promedio de 37,1 años [0,5-82 años]. Si bien no se reportó efectividad de medidas de control y prevención, la identificación, aislamiento y seguimiento de los contactos se destaca como un potencial mecanismo efectivo para prevenir la transmisión. Conclusiones El uso de esta información podría ser relevante para orientar las políticas de salud pública basadas en la evidencia y la protección de las poblaciones y la mejora de la atención médica que contribuya a detener esta pandemia.

Applying the Fuzzy Delphi Method for determining socio-ecological factors that influence adherence to mammography screening in rural areas of Mexico.

In Mexico, regular participation in mammography screening is low, despite higher survival rates. The objective of our research is to highlight healthcare procedures to be optimized and target areas to encourage investment and to raise awareness about the benefits of early diagnosis. Those socio-ecological factors (community, interpersonal and individual) were collected through a review of literature and based on the spatial interaction model of mammography use developed by Mobley et al. The opinion of diverse groups of experts on the importance of those factors was collected by survey. The Fuzzy Delphi Method helped to solve the inherent uncertainty of the survey process. Our findings suggest that population health behaviors, proximity-density to facilities/ physicians and predisposing factors are needed to increase the screening rate. Variations in expert group size could affect the accuracy of the conclusions. However, the application of the enhanced aggregation method provided a group consensus that is less susceptible to misinterpretation and that weighs the opinion of each expert according to their clinical experience in mammography research.

Association of anthropometric indicators to evaluate nutritional status and cardiometabolic risk in Mexican teenagers / Asociación de indicadores antropométricos para evaluar el estado nutricional y el riesgo cardiometabólico en adolescentes mexicanos

Introduction: anthropometric indicators (AIs) such as waist circumference (WC), body mass index (BMI), waist/hip index (WHpI), waist/height index (WHtI) and body fat percentage (BFP) are useful tools for the diagnosis of nutritional status (NS) in adolescents. Each of these parameters has advantages and disadvantages. The purpose of the present study was to analyze the association of these AIs (WC, BMI, WHpI, WHtI, and BFP) to evaluate nutritional status and estimate the cardiometabolic risk (CMR) in Mexican adolescents. Material and method: in a cross-sectional descriptive study, the NS was analyzed through various AIs and CMR with the WHtI criteria. Nine hundred and seventeen adolescents between 15 and 17 years old participated in the study, of whom 488 (52.9%) were female and 429 (47.1%) male, all students of middle school in Tuxtla Gutiérrez, Chiapas, Mexico. Results and conclusion: women presented a higher prevalence of obesity according to most indicators. The WHtI was the parameter that detected the highest prevalence of obesity (31%), correlating with the BMI and the BFP. Moreover, there was evidence of a significant relation between NS (assessed by all the anthropometric indicators) and CMR. The WHtI could be considered as an adequate tool for the diagnosis of obesity associated with CMR in adolescents

Introducción: los indicadores antropométricos (IA) como la circunferencia de cintura (CC), el índice de masa corporal (IMC), el índice cintura/ cadera (ICC), el índice cintura/talla (ICT) y el porcentaje de grasa corporal (PGC) son herramientas útiles para el diagnóstico del estado nutricional (EN) en los adolescentes. Sin embargo, cada uno de estos IA presentan ventajas y desventajas. El propósito del presente estudio fue analizar la asociación de los IA (IMC, CC, ICC, ICT y PGC) para evaluar el EN y estimar el riesgo cardiometabólico (RCM) en adolescentes mexicanos. Material y método: el diseño del estudio fue descriptivo transversal. Se analizó el EN a través de diversos IA y el RCM bajo los criterios de ICT. Este estudio fue conducido en 917 adolescentes de entre 15 y 17 años, de los cuales 488 (52,9%) eran mujeres y 429 (47,1%) varones, todos estudiantes de nivel medio superior de Tuxtla Gutiérrez, Chiapas, México. Resultados y conclusión: las mujeres presentaron mayor prevalencia de obesidad con la mayoría de los IA utilizados. El ICT fue el IA que detectó mayor prevalencia de obesidad (31%), correlacionándose con el IMC y el PGC. Además, se evidenció una asociación significativa entre el EN valorado por todos los IA y el RCM. El ICT podría ser considerado como una herramienta adecuada para el diagnóstico de obesidad asociada a RCM en adolescentes

Social epidemiology of a large outbreak of chickenpox in the Colombian sugar cane producer region: a set theory-based analysis.

There are few social epidemiologic studies on chickenpox outbreaks, although previous findings suggested the important role of social determinants. This study describes the context of a large outbreak of chickenpox in the Cauca Valley region, Colombia (2003 to 2007), with an emphasis on macro-determinants. We explored the temporal trends in chickenpox incidence in 42 municipalities to identify the places with higher occurrences. We analyzed municipal characteristics (education quality, vaccination coverage, performance of health care services, violence-related immigration, and area size of planted sugar cane) through analyses based on set theory. Edwards-Venn diagrams were used to present the main findings. The results indicated that three municipalities had higher incidences and that poor quality education was the attribute most prone to a higher incidence. Potential use of set theory for exploratory outbreak analyses is discussed. It is a tool potentially useful to contrast units when only small sample sizes are available.

Evidencias para la prevención y control de lesiones en motociclistas / Evidence for the prevention and control of injuries in motorcyclists

Los accidentes del tránsito representan una de las principales causas de mortalidad, lesiones y discapacidad en personas a nivel mundial. Este fenómeno no es ajeno al contexto colombiano, con la particularidad del aumento del parque automotor durante las últimas dos décadas con mayor número de motocicletas, que representan más del 50 por ciento de las lesiones y muertes en los accidentes de tránsito. El trabajo fue autorizado por el comité de ética e investigación, su propósito es identificar las estrategias más efectivas que contribuyan a la prevención y control de las lesiones causadas por el tránsito de motocicletas. Se realizó una revisión sistemática de la literatura que incluyó estudios observacionales, investigación cualitativa y estudios econométricos. Se recopilaron 30 artículos publicados entre el 2002 y el 2013. Estos estudios muestran la implementación del uso del casco, de medidas de visibilidad, control de comportamientos de riesgo y la aplicación de leyes donde se restringe la ingesta de alcohol, como las principales prácticas orientadas a la prevención de accidentes en los motociclistas. El presente estudio resalta la robustez del uso del casco como la principal medida para la prevención y control de estos accidentes, reconoce la complejidad del fenómeno y la necesidad en consecuencia de la sinergia entre métodos cualitativos y cuantitativos para darleuna mayor explicación; supone una base conceptual sólida para la generación de políticas públicas pertinentes que busquen la disminución de la morbilidad, mortalidad y discapacidad asociada a este tipo de siniestros viales(AU).

Traffic accidents represent one of the main causes of mortality, injuries and disabilities worldwide. This phenomenon is also present in the Colombian setting where its main feature is related to the significant increase of the car fleet over the past two decades, with greater number of motorcycles, accounting for more than 50 percent of the lesions and deaths from road traffic accidents. The ethics and research committee authorized the presentation of this paper. Its objective was to identify the more effective strategies that will contribute to the prevention and control of injures from motorcycle traffic accidents. A systematic literature review including observational, qualitative and econometric studies was made. Thirty studies published from 2002 to 2013 were gathered. These studies showed the implementation of the use of helmet provisions, visibility measures, control of risky behaviors and application of laws on alcohol consumption as the main practices aimed at the prevention of motorcycle accidents. The present study underlined the soundness of the helmet use as the main measure for the prevention and control of accidents. It also recognized the complexity of this phenomenon and the need of synergy between qualitative and quantitative methods to provide broader explanation. This paper represents a sound conceptual basis for the generation of relevant public policies in search of the reduction of morbidity, mortality and disability associated to this type of road disasters(AU).

Safety of botulinum toxin type A among children with spasticity secondary to cerebral palsy: a systematic review of randomized clinical trials.

OBJECTIVE: To assess the safety of botulinum toxin type A for children with cerebral palsy using data from randomized clinical trials. DATA SOURCES: A search was conducted of MEDLINE database for the period January 1990 to February 2008. A complementary search was carried out of references from previous reviews. From 122 articles, 20 randomized clinical trials were selected for the review. REVIEW METHODS: Two authors independently assessed eligibility of the studies and methodological quality of those according to CONSORT guidelines. For each adverse effect, relative risk was calculated, and when more than one study reported adverse effects, a meta-analysis was carried out. Sensitivity analyses with different continuity corrections factors were performed when zero cases were reported in a study arm. RESULTS: There were 882 participants in the 20 studies included in the meta-analysis. Six studies reported zero adverse effects. Thirty-five different adverse events were reported. Botulinum toxin type A use was related to respiratory tract infection, bronchitis, pharyngytis, asthma, muscle weakness, urinary incontinence, falls, seizures, fever and unspecified pain. Two deaths were reported in the study with higher person-time follow-up (relative risk (RR) 4.69, 95% confidence interval (CI) 0.23-95). CONCLUSIONS: Botulinum toxin type A has a good safety profile during the first months of use. However the occurrence of adverse events is more frequent among children with cerebral palsy than individuals with other conditions. Severe adverse events are potentially related with the use of botulinum toxin type A, but data are sparse and additional study is required to clarify the causal relation.