Visceral adiposity index is a better predictor to discriminate metabolic syndrome than other classical adiposity indices among young adults.

BACKGROUND: Visceral adiposity index (VAI) has been identified as a cardiometabolic risk marker in children and adolescents which reflects abdominal fat distribution. The aim of the present study was to evaluated the predictive capacity of VAI, a body shape index (ABSI), atherogenic index of plasma (AIP), and triglycerides and glucose index (TyG index) compared with classical anthropometric measurements to discriminate metabolic syndrome (MetS). METHODS: This retrospective study included 1372 individuals. Anthropometric, clinical, and biochemical measurements were used to screen the prevalence of MetS components and to calculate VAI, ABSI, TyG index, and AIP. RESULTS: The discriminatory capacity among the variables was assessed by the area under the receiver operating characteristic (ROC) curve (AUC). VAI was the variable with the highest AUC with 0.932 CI 95% (0.917-0.948), followed by AIP with 0.914 CI 95% (0.897-0.931), and TyG index with 0.889 CI 95% (0.871-0.908). CONCLUSION: VAI is a promising tool to identify MetS in the late adolescence setting. Among the novel adiposity indexes VAI, AIP, TyG index are able to determine MetS presence, while ABSI is not capable.

Reproductive health education program for Mexican women.

Objective: Improve knowledge, attitudes and reproductive behaviours through an educational intervention aimed at reproductive health in two groups of Mexican women. Materials and methods: We carried out an education program targeting two segments, indigenous women and marginalised adolescents, with a pre-test, immediate post-test and post-test six months after it was carried out. Instruments used: a reproductive health history was established (pre-test and post-test six months) and a questionnaire of knowledge, attitude and conduct related to reproductive health and condom use (pre-test, immediate post-test and post-test six months). Results: Improved test scores in reproductive health and condom use - knowledge, attitude and conduct, were notable in the group of indigenous women (p < .05). However, in the group of adolescents there was a significant increase (p < .05) only in reproductive health - knowledge and attitude; in condom usage, increase was only noted in knowledge and conduct, not in attitude (pre-test vs immediate post-test). Six months after post-test results there was a decrease in test scores in comparison with the immediate post-test results. They were however, higher than the pre-test scores. Conclusions: Both groups significantly increased short-term knowledge, attitude and conduct related to reproductive health and condom use through the implementation of an education program. Results show that this education program can contribute to the development of an effective education program.

[Global prevalence of type 2 diabetes mellitus and its relationship with the Human Development IndexPrevalência mundial da diabetes mellitus tipo 2 e sua relação com o índice de desenvolvimento humano]. / Prevalencia mundial de la diabetes mellitus tipo 2 y su relación con el índice de desarrollo humano.

OBJECTIVE: To evaluate the relationship between the prevalence of type 2 diabetes mellitus (DM2) and the Human Development Index (HDI), by region of the world in the period 2010-2015. METHOD: International Diabetes Federation data were used for DM2 prevalence (2010-2015), together with HDI data (United Nations Development Program). Spearman linear correlations between HDI data and DM2 prevalence were analyzed, and linear regressions were done to estimate the relationship between the two. RESULTS: It was observed that lower HDI scores corresponded to lower DM2 prevalence rates, and higher HDI scores to higher DM2 prevalence. At the global level, the HDI explains the 8.6% variance of DM2 prevalence (P < 0.0001) and shows that the situation was different in each region of the world. CONCLUSIONS: While HDI score may be associated with DM2 prevalence, the relationship between them differs from region to region and from country to country, and depends on the particular year analyzed.

OBJETIVO: Avaliar a relação entre a prevalência de diabetes mellitus tipo 2 (DM2) e o índice de desenvolvimento humano (IDH) por região do mundo no período de 2010 a 2015. MÉTODOS: Foram utilizados dados da Federação Internacional de Diabetes para a prevalência da DM2 (2010­2015) e o IDH do Programa das Nações Unidas para o Desenvolvimento. Foram analisadas as correlações lineares de Spearman entre o IDH e a prevalência de DM2 e feitas regressões lineares para estimar a relação entre ambos. RESULTADOS: Observou-se que quanto mais baixo o IDH, menores são as prevalências de DM2, e quanto mais alto o IDH, maiores são prevalências de DM2. Ao nível mundial, o IDH explica 8,6% da variança da prevalência de DM2 (P < 0,0001) e este comportamento difere em cada região do mundo. CONCLUSÕES: O IDH pode influir na prevalência de DM2, embora a relação dependa de cada país, região e ano analisados.

[Overview of mortality in Mexico through four indicators from 1990 to 2012]. / Panorama de la mortalidad en México a través de cuatro indicadores de 1990 a 2012.

OBJECTIVE: To describe the behavior of mortality in Mexico through four indicators from 1990 to 2012. MATERIAL AND METHODS: The official mortality and population records of Mexico were used. RESULTS: An advance was achieved for children under five years of age, with a decrease in mortality, although there was an increase in the years of potential life lost (YPLL) from 2008 for this age group. For children under one year of age, there was no advance since 2002 in the index of YPLL and in the productive years of life lost (PYLL). Since 2008 there has been an increase in the rates of mortality, YPLL, and PYLL in the group from 10 to 29 years of age. There has been a sustained increase in YPLL in the age group from 40 to 69. CONCLUSIONS: It is relevant to evaluate the health policies in Mexico for the different age groups; even though there have been positive results in some of them, these are not across all the age groups, which could put some sectors of the population at risk, such as children and young people from 10 to 29 years of age.

Socio-Urban Spatial Patterns Associated with Dyslipidemia among Schoolchildren in the City of San Luis Potosi, Mexico.

The places where a child lives and attends to school are both major environmental and social determinants of its present and future health status. Noncommunicable diseases (NCDs) and some of their risk factors among child and adolescent populations are obesity and dyslipidemia, so finding the patterns of distribution of these risk factors by gender, type of school, area, and margination level is important to do health intervention focusing in their necessities to prevent diseases at younger ages. Because of that, a cross-sectional study was performed among elementary and junior high school students from public and private schools in six of the seven areas of the metropolitan zone of San Luis Potosi, Mexico. Biochemical dyslipidemia indicators (triglycerides, total cholesterol, and high-density lipoprotein) and anthropometric data (weight and height) were obtained. Seventeen public schools and five private schools with a total of 383 students were included. More than half of the studied population (53.0%) had elevated triglyceride levels. A total of 330 students (86.2%) had normal levels of total cholesterol with a mean value of 141.7 mg/dl, and 202 schoolchildren (52.8%) had lower than acceptable levels of high-density lipoprotein (HDL) with a mean value of 43.9 mg/dl. There were differences in the levels of high-density protein between the areas and the type of school where they had been studied. Finally, a total of 150 students (39.4%) had at least one altered lipid value and 103 participants (26.9%) had two altered values. Several students, despite their young age, showed a high prevalence of risk factors, so it is important to design programs according to their necessities.

[Knowledge and attitudes of teachers at a Medical School and the use of clinical practice guidelines]. / Conocimientos y actitudes de los docentes de una Facultad de Medicina y el uso de las guías de práctica clínica (GPC) nacionales.

INTRODUCTION: The National Center for Health Technology Excellence (CENETEC) has published 539 clinical practice guidelines (CPG) whose area of influence is nationwide. OBJECTIVE: To conduct an assessment of the knowledge and attitudes of teachers at a medical school and the use of CPGs. MATERIALS AND METHODS: We performed a cross-sectional study in 2012 among teachers at one medical school in San Luis Potosí, Mexico. RESULTS: Overall, 97.1% of medical school physicians (MDs) reported knowing the existence of CPGs and 94.9% had consulted them. The 87.6% of the MD knew where they could find the guidelines. However, only 15.9% mentioned the CENETEC website as a source, 30.4% The Ministry of Health website, and 7.3% both pages. CONCLUSIONS: It is necessary to develop programs that facilitate the implementation and adoption of clinical practice guidelines by a multidisciplinary team that specifically establishes the importance of their use.

[Prevalence of unsafe conditions associated to non-intentional needlestick injuries among trainee physicians]. / Prevalencia, condiciones y actos inseguros asociados a punciones accidentales de médicos en formación.

INTRODUCTION: Physicians in training face high-risk clinical situations for needlestick injuries during their training. OBJECTIVE: To determine the prevalence and establish behaviors associated with needlestick injuries. MATERIAL AND METHODS: A cross-sectional study was conducted during the 2012-2013 school year among undergraduate and graduate medical students of a Faculty of Medicine in Mexico. RESULTS: There were a total of 441 questionnaires completed, of which 56.7% of students reported having experienced at least one lesion, of which only 44.5% reported it. The conditions and unsafe acts associated were: female students had a greater risk for the first puncture, whereas male students correlated with three or more punctures; third year students, night shift rounds, the feeling of being rushed by someone else, and the presence of fatigue were risk factors for the first puncture (p < 0.05). CONCLUSIONS: The high prevalence and the underreporting of non-intentional punctures places students at a higher risk of transmissible diseases. Strategies focused on prevention, monitoring, and control of accidental punctures should be implemented by hospitals, schools, and medical schools.

The relationship between density of drug outlets, crime hot spots and family factors on the consumption of drugs and delinquent behaviour of male adolescent Mexican students.

This study examined the relationship between community risk factors (drug outlets density and crime hot spots) and family factors on the risk behaviours (drugs consumption and delinquent behaviour) of male adolescent Mexican students. Results were obtained based on data bank analysis and direct collection of information regarding family factors and risk behaviours of adolescents attending school. Spatial and statistical analysis was performed. The final sample was composed of 1450 male adolescents, from 11 secondary and high schools located in marginal and violent areas of Mexico. Spatial analysis revealed that when considering only the prevalence of the risk behaviours of the adolescents, the area of highest risk was the northwestern area of the city. However, after performing conjunct analysis of all evaluated variables using density point risk (aside from confirming that the northwestern area is still the one with the greatest risk), results indicated that the southern area has a high-density point risk. All densities of the variables showed a statistically significant positive association (p < 0.05). However, the results of the structural equation model indicated than only the family factors influenced the risk behaviours of adolescents (p < 0.05). The spatial distribution of the risk behaviours in male adolescent students and community risk variables surrounding the area where schools are located allows for the description of patterns and hotspot detection that facilitate the prioritization of where interventions must be directed. Besides, the interventions should target family factors.

[Prevalence of prediabetes and its comorbidities in the Mexican pediatric population]. / Prevalencia de la prediabetes y sus comorbilidades en la población pediátrica mexicana.

INTRODUCTION: Background: prediabetes is a state observed before type-2 diabetes. Nowadays the obesity epidemic could be due to a rise in the incidence of prediabetes. Mexico has public policies for the management of non-communicable diseases. However, obesity rates continue to increase. The aim of this study was to elaborate on a diagnosis of prediabetes in the pediatric Mexican population, and compare the proportions of comorbidities that children with and without prediabetes had. Methods: a cross-sectional study was performed with 569 participants of 4 to 19 years of age from public schools. Anthropometric (weight, height, and waist circumference), clinical (blood pressure), and biochemical (fasting glucose, lipidic profile, and uric acid) variables were collected. Results: in all, 8.6 % of the population had prediabetes. Variables with the highest altered prevalence included triglycerides and systolic blood pressure. Boys had higher rates of prediabetes, altered BP, and hyperuricemia than girls. Children with prediabetes had a greater risk of elevated waist circumference, blood pressure, and uric acid measures. Conclusions: the Mexican pediatric population had elevated rates of prediabetes. Furthermore, the group with prediabetes had a higher risk of presenting high values of triglycerides, blood pressure, uric acid, and total cholesterol.

INTRODUCCIÓN: Objetivo: la prediabetes es un estado que se observa antes de la diabetes de tipo 2. La actual epidemia de obesidad puede ser una causa del aumento de la incidencia de la prediabetes. En México existen políticas públicas para el manejo de las enfermedades no comunicables. Sin embargo, la obesidad continúa aumentando. Nuestro objetivo fue elaborar un diagnóstico de prediabetes en la población pediátrica mexicana y contrastar la proporción de comorbilidades que presentaban los niños con y sin prediabetes. Metodología: se realizó un estudio transversal analítico de 569 participantes de 4 a 19 años de edad procedentes de escuelas públicas. Se tomaron variables antropométricas (peso, talla y circunferencia de la cintura) y clínicas (presión arterial), así como indicadores bioquímicos (glucosa, perfil lipídico y ácido úrico). Resultados: el 8,6 % de la población presentaba prediabetes. Las variables de mayor prevalencia de alteración fueron los triglicéridos, seguidos de la presión arterial sistólica. Los hombres tenían prevalencias más altas de prediabetes, presión arterial elevada e hiperuricemia. Los niños con prediabetes tenían mayor riesgo de presentar cifras elevadas de circunferencia de la cintura, presión arterial y ácido úrico. Conclusiones: la población pediátrica mexicana tiene una prevalencia elevada de prediabetes. Además, se encontró que el grupo con prediabetes tiene mayor riesgo de presentar cifras elevadas de triglicéridos, presión arterial, ácido úrico y colesterol total.

Prevalence of skin diseases among hospitals in the public healthcare system of a developing country.

BACKGROUND: Skin diseases in the population are universal, common, and can cause significant economic burden. The impact of skin diseases in the national public healthcare system is complex and poorly studied. This study analyzes the prevalence of skin diseases in a hospital setting within the National Public Health System of Mexico and describes the main associated characteristics. METHODS: Information was obtained from the 2015 hospital discharge database of the public healthcare system of Mexico. Pathologies that result in a direct dermatological condition were included according to chapter XII of the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD - 10) and grouped according to the classification of the report, The burden of skin diseases in the United States. RESULTS: In 2015, a total of 9,230,968 hospital discharges were registered nationwide, of which 170,917 discharges (1.85%) reported a dermatological disease as the main diagnosis; five states account for 40.79% of the cases reported in Mexico. Half of all the cases corresponded to skin infections (32.08%, n = 54,843) and non-cancerous skin growths (27.80%, n = 47,515), and 59.71% were adult patients between 18 and 65 years of age. CONCLUSIONS: Understanding of the configuration of skin diseases in a hospital setting and public healthcare system is warranted to develop effective public policies and research for the development of effective, safe, high-quality care processes for the main groups of identified diseases.

[Costs of serious adverse events in a community teaching hospital, in Mexico]. / Costos de eventos adversos graves en un Hospital Comunitario de Enseñanza en México.

BACKGROUND: Serious adverse events during hospital care are a worldwide reality and threaten the safety of the hospitalised patient. OBJECTIVE: To identify serious adverse events related to healthcare and direct hospital costs in a Teaching Hospital in México. MATERIAL AND METHODS: A study was conducted in a 250-bed Teaching Hospital in San Luis Potosi, Mexico. Data were obtained from the Quality and Patient Safety Department based on 2012 incidents report. Every event was reviewed and analysed by an expert team using the "fish bone" tool. The costs were calculated since the event took place until discharge or death of the patient. RESULTS: A total of 34 serious adverse events were identified. The average cost was $117,440.89 Mexican pesos (approx. €7,000). The great majority (82.35%) were largely preventable and related to the process of care. Undergraduate medical staff were involved in 58.82%, and 14.7% of patients had suffered adverse events in other hospitals. CONCLUSIONS: Serious adverse events in a Teaching Hospital setting need to be analysed to learn and deploy interventions to prevent and improve patient safety. The direct costs of these events are similar to those reported in developed countries.

Are all skilled birth attendants created equal? A cluster randomised controlled study of non-physician based obstetric care in primary health care clinics in Mexico.

BACKGROUND: the great majority of births in Mexico are attended by physicians. Non-physician health professionals have never been evaluated or compared to the medical model of obstetric care. This study evaluates the relative strengths of adding an obstetric nurse or professional midwife to the physician based team in rural clinics. METHODS: we undertook a cluster-randomised trial in 27 clinics in 2 states with high maternal mortality. Twelve non-physician providers (obstetric nurses (4) and professional midwives (8)) were randomly assigned to clinics; 15 clinics served as control sites. Over an 18-month period in 2009-2010, we evaluated quality of care through chart review and monthly interviews with providers about last three deliveries performed. We analysed practices by creating indices using WHO care guidelines for normal labour and childbirth. Volume of care was assessed using administrative reporting forms. FINDINGS: two thousand two hundred fifty-four pregnancies were followed, and a total of 461 deliveries occurred in study sites. Intervention clinics were more likely to score highly on the index for favourable practices on admission (OR=3.6, 95% CI 2.3-5.8), and during labour, childbirth, and immediately post partum (OR=8.6, 95% CI 2.9-25.6) and less likely to use excessively used or harmful practices during labour, childbirth and immediately post partum (OR=0.2, 95% CI 0.1-0.4). There was a significant increase in volume of care in intervention clinics for antenatal visits (incidence rate ratio (IRR) 1.3, 95% CI 1.2-1.4), deliveries (IRR=2.5, 95% CI 1.7-3.7) and for postpartum visits (IRR=1.4, 95% CI 1.1-1.7). INTERPRETATION: the addition of non-physician skilled birth attendants to rural clinics in Mexico where they independently provided basic obstetric services led to improved care and higher coverage than clinics without. The potential value of including a professional midwife or obstetric nurse in all rural clinics providing obstetric care should be considered. FUNDING: Mexican National Institute for Women, Mexican National Center for Gender Equity and Reproductive Health, MacArthur Foundation, Bill and Melinda Gates Foundation.

Prevalencia mundial de la diabetes mellitus tipo 2 y su relación con el índice de desarrollo humano / Global prevalence of type 2 diabetes mellitus and its relationship with the Human Development Index / Prevalência mundial da diabetes mellitus tipo 2 e sua relação com o índice de desenvolvimento humano

RESUMEN Objetivo Evaluar la relación entre la prevalencia de diabetes mellitus tipo 2 (DM2) y el índice de desarrollo humano (IDH) por región del mundo en el período 2010-2015. Método Se utilizaron los datos de la Federación Internacional de Diabetes para la prevalencia de DM2 (2010-2015) y el IDH del Programa de las Naciones Unidas para el Desarrollo. Se analizaron correlaciones lineales de Spearman entre el IDH y la prevalencia de DM2 y se hicieron regresiones lineales para estimar la relación entre ambos. Resultados Se observó que a menor IDH menores son las prevalencias de DM2, y a mayor IDH, mayores son las prevalencias de DM2. A nivel mundial, el IDH explica 8,6% de la varianza de la prevalencia de DM2 (P < 0,0001) y que este comportamiento fue diferente en cada región del mundo. Conclusiones El IDH puede influir en la prevalencia de DM2, aunque la relación depende de cada país, región y año analizado.

ABSTRACT Objective To evaluate the relationship between the prevalence of type 2 diabetes mellitus (DM2) and the Human Development Index (HDI), by region of the world in the period 2010-2015. Method International Diabetes Federation data were used for DM2 prevalence (2010-2015), together with HDI data (United Nations Development Program). Spearman linear correlations between HDI data and DM2 prevalence were analyzed, and linear regressions were done to estimate the relationship between the two. Results It was observed that lower HDI scores corresponded to lower DM2 prevalence rates, and higher HDI scores to higher DM2 prevalence. At the global level, the HDI explains the 8.6% variance of DM2 prevalence (P < 0.0001) and shows that the situation was different in each region of the world. Conclusions While HDI score may be associated with DM2 prevalence, the relationship between them differs from region to region and from country to country, and depends on the particular year analyzed.

RESUMO Objetivo Avaliar a relação entre a prevalência de diabetes mellitus tipo 2 (DM2) e o índice de desenvolvimento humano (IDH) por região do mundo no período de 2010 a 2015. Métodos Foram utilizados dados da Federação Internacional de Diabetes para a prevalência da DM2 (2010-2015) e o IDH do Programa das Nações Unidas para o Desenvolvimento. Foram analisadas as correlações lineares de Spearman entre o IDH e a prevalência de DM2 e feitas regressões lineares para estimar a relação entre ambos. Resultados Observou-se que quanto mais baixo o IDH, menores são as prevalências de DM2, e quanto mais alto o IDH, maiores são prevalências de DM2. Ao nível mundial, o IDH explica 8,6% da variança da prevalência de DM2 (P < 0,0001) e este comportamento difere em cada região do mundo. Conclusões O IDH pode influir na prevalência de DM2, embora a relação dependa de cada país, região e ano analisados.