Effect of an intervention based on child-care centers to reduce risk behaviors for obesity in preschool children

AbstractBackgroundPreschool age is a critical stage for health promotion and prevention of obesity, which is an emerging public health problem in children. The aim of this study was to design and evaluate the effect of a multifaceted intervention based on child-care centers to reduce risk behaviors for obesity among preschool children.MethodsA 12-month cluster-randomized community trial was conducted in 16 Mexican Institute of Social Security child-care centers in Mexico City. Children between 2 and 4 years of age enrolled in the selected child-care centers participated in the study. Intervention comprised 12 weekly curriculum sessions for the children, and six family workshops. Changes in children’s dietary and physical activity, food availability at home, and maternal feeding styles were determined after 6 and 12 months. Changes within groups among stages, and between groups by stage were analyzed through X2 test.ResultsThe intervention showed a decrease of home availability for some non-recommended foods and an increase in physical activity in the intervention group compared to the control group.ConclusionsImprovement in physical activity can be effective in the long term; innovative strategies aimed to modify family dietary risk behaviors are required

Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City

<p>Abstract</p> <p>Background</p> <p>In Mexico, inappropriate prescription of drugs with potential interactions causing serious risks to patient health has been little studied. Work in this area has focused mainly on hospitalized patients, with only specific drug combinations analyzed; moreover, the studies have not produced conclusive results. In the present study, we determined the frequency of potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age, who used Mexican Institute of Social Security (IMSS) family medicine clinics. In addition, we aimed to identify the associated factors for these interactions.</p> <p>Methods</p> <p>We collected information on general patient characteristics, medical histories, and medication (complete data). The study included 624 ambulatory patients over 50 years of age, with non-malignant pain syndrome, who made ambulatory visits to two IMSS family medicine clinics in Mexico City. The patients received 7-day prescriptions for non-opioid analgesics. The potential interactions were identified by using the Thompson Micromedex program. Data were analyzed using descriptive, bivariate and multiple logistic regression analyses.</p> <p>Results</p> <p>The average number of prescribed drugs was 5.9 ± 2.5. About 80.0% of patients had prescriptions implying one or more potential drug-drug interactions and 3.8% of patients were prescribed drug combinations with interactions that should be avoided. Also, 64.0% of patients had prescriptions implying one or more potential drug disease interactions. The factors significantly associated with having one or more potential interactions included: taking 5 or more medicines (adjusted Odds Ratio (OR): 4.34, 95%CI: 2.76–6.83), patient age 60 years or older (adjusted OR: 1.66, 95% CI: 1.01–2.74) and suffering from cardiovascular diseases (adjusted OR: 7.26, 95% CI: 4.61–11.44).</p> <p>Conclusion</p> <p>The high frequency of prescription of drugs with potential drug interactions showed in this study suggests that it is common practice in primary care level. To lower the frequency of potential interactions it could be necessary to make a careful selection of therapeutic alternatives, and in cases without other options, patients should be continuously monitored to identify adverse events.</p

Factores socioeconómicos y desigualdad en la distribución de médicos y enfermeras en México

OBJETIVO: Describir los recursos humanos en salud y analizar la desigualdad en su distribución en México. MÉTODOS: Estudio transversal basado en la Encuesta Nacional de Ocupación y Empleo del cuarto trimestre de 2018 en México. Se consideraron como recursos humanos en salud médicos y enfermeras con licenciatura, y personal de enfermería auxiliar/técnica con estudios concluidos. Se agrupó a los estados por grado de marginación y se estimó densidades de recursos humanos en salud por 1.000 habitantes, Índices de Disimilitud e Índices de Concentración (IC) como medidas de desigualdad en la distribución. RESULTADOS: La densidad de recursos humanos en salud fue de 4,6 por 1.000 habitantes; se observó heterogeneidad entre los estados con que van 2,3 hasta 10,5 por 1.000 habitantes. La desigualdad fue mayor en los estados con muy bajo grado de marginación (IC = 0,4) que en los estados de muy alto grado (IC = 0,1), y fue mayor la desigualdad en la distribución de los médicos (IC = 0,5) que en las enfermeras profesionales (IC = 0,3) entre los estados. Para que todos los estados tuvieran una densidad igual a la nacional de 4,6, se tendrían que distribuir alrededor de 12,6% de los recursos humanos en salud entre los estados que estuvieron por debajo de la densidad nacional. Adicionalmente, 17 estados tuvieron una densidad superior al umbral de 4,5 por 1.000 habitantes propuesto en la Estrategia Global en Recursos Humanos para la Salud. Eso implica un déficit de casi 60 mil recursos humanos en salud entre los 15 estados por debajo del umbral. CONCLUSIONES: En México existe desigualdad en la distribución de recursos humanos en salud, diferenciada en los estados. Mecanismos gubernamentales a través de una política de recursos humanos podrían incentivar el equilibrio en el mercado de laboral de los médicos y enfermeras.OBJECTIVE: To describe the human resources for health and analyze the inequality in its distribution in Mexico. METHODS: Cross-sectional study based on the National Occupation and Employment Survey (ENOE in Spanish) for the fourth quarter of 2018 in Mexico. Graduated physicians and nurses, and auxiliary/technician nurses with completed studies were considered as human resources for health. States were grouped by degree of marginalization. Densities of human resources for health per 1,000 inhabitants, Index of Dissimilarity (DI) and Concentration Indices (CI) were estimated as measures of unequal distribution. RESULTS: The density of human resources for health was 4.6 per 1,000 inhabitants. We found heterogeneity among states with densities from 2.3 to 10.5 per 1,000 inhabitants. Inequality was higher in the states with a very low degree of marginalization (CI = 0.4) than those with high marginalization (CI = 0.1), and the inequality in the distribution of physicians (CI = 0.5) was greater than in graduated nurses (CI = 0.3) among states. In addition, 17 states showed a density above the threshold of 4.5 per 1,000 inhabitants proposed in the Global Strategy on Human Resources for Health. That implies a deficit of nearly 60,000 human resources for health among the 15 states below the threshold. For all states, to reach a density equal to the national density of 4.6, about 12.6% of human health resources would have to be distributed among states that were below national density. CONCLUSIONS: In Mexico, there is inequality in the distribution of human resources for health, with state differences. Government mechanisms could support the balance in the labor market of physicians and nurses through a human resources polic

Simulación de los niveles máximos de ozono en la ciudad de Puebla por medio del método kernel

En este artículo se presenta una propuesta para reemplazar los datos faltantes de una base de datos, basado en la simulación de una variable aleatoria teórica que tendría los niveles máximos de ozono en la ciudad de Puebla de la República Mexicana, ciudad con problemas ambientales y deficiencia en el monitoreo de la calidad del aire. La metodología planteada está basada en el método kernel, que se utiliza para la aproximación de una función de densidad a partir de una muestra independiente. Se presenta una propuesta de algoritmo para el reemplazo de datos faltantes, así como una prueba que valida su utilidad y por último su aplicación a los datos de niveles de ozono de la estación de monitoreo automática Agua Santa ubicada en la ciudad de Puebla

Perceptions of childcare staff for preventing overweight in Mexican preschool children: A SWOT analysis

Objective. To identify strengths, weaknesses, opportunities, and threats (SWOT) perceived by childcare staff for prevent­ing childhood overweight. Materials and methods. Qualitative study using an interpretative phenomenological approach; 18 in-depth, semi-structured interviews and 12 focus groups with 89 key informants working in six Mexican public childcare centers (CCC) were conducted. Through content and SWOT analyses, experts further ranked fifty-nine recurrent perceptions regarding healthy feeding and physical activity (PA), using the Delphi method. Results. Strengths: Acknowledgement of the CCC’s responsibility in fostering healthy feeding, availability of organizational regulations, and access to PA infrastructure/indoor activities. Weaknesses: Disregard of preschool overweight as a health problem, nu­tritional misperceptions, and perceived risk of child injuries while conducting PA. Opportunities: Willingness to reduce children’s access to junk foods, and parental active play with children during weekends. Threats: Limited family nutritional education, and restricted parental time/economic constraints/ access to safe public spaces for PA. Conclusion. The identi­fied SWOT must be considered when developing obesity-prevention interventions targeted at CCC

Investigación Educativa en las Ciencias Sociales

El libro se organiza en cinco grandes secciones, cada una con diferentes capítulos: La primera de ellas, rescata dos temas vinculados con aspectos teórico metodológicos de la Investigación Educativa; La segunda sección recoge algunos planteamientos del nivel básico; en tanto que la tercera, concentra dos capítulos de investigación en el nivel superior; la cuarta parte recupera y muestra dos aportes de nivel posgrado y, finalmente, se cierra con una quinta sección donde se concentran, distintos capítulos, de tópicos diversos

Oral health service utilization by elderly beneficiaries of the Mexican Institute of Social Security in México city

<p>Abstract</p> <p>Background</p> <p>The aging population poses a challenge to Mexican health services. The aim of this study is to describe recent oral health services utilization and its association with socio-demographic characteristics and co-morbidity in Mexican Social Security beneficiaries 60 years and older.</p> <p>Methods</p> <p>A sample of 700 individuals aged 60+ years was randomly chosen from the databases of the Mexican Institute of Social Security (IMSS). These participants resided in the southwest of Mexico City and made up the final sample of a cohort study for identifying risk factors for root caries in elderly patients. Sociodemographic variables, presence of cognitive decline, depression, morbidity, medication consumption, and utilization of as well as reasons for seeking oral health services within the past 12 months were collected through a questionnaire. Clinical oral assessments were carried out to determine coronal and root caries experience.</p> <p>Results</p> <p>The sample consisted of 698 individuals aged 71.6 years on average, of whom 68.3% were women. 374 participants (53.6%) had made use of oral health services within the past 12 months. 81% of those who used oral health services sought private medical care, 12.8% sought social security services, and 6.2% public health services. 99.7% had experienced coronal caries and 44.0% root caries. Female sex (OR = 2.0), 6 years' schooling or less (OR = 1.4), and caries experience in more than 22 teeth (OR = 0.6) are factors associated with the utilization of these services.</p> <p>Conclusion</p> <p>About half the elderly beneficiaries of social security have made use of oral health services within the past 12 months, and many of them have to use private services. Being a woman, having little schooling, and low caries experience are factors associated with the use of these services.</p

Autopercepción del estado de salud en climatéricas derechohabientes del Instituto Mexicano del Seguro Social Self-rated health among climacteric women affiliated to Instituto Mexicano del Seguro Social

OBJETIVO: Evaluar la autopercepción del estado de salud positivo (APES +) o negativo (APES -) de mujeres climatéricas e identificar los factores relacionados con la APES-. MATERIAL Y MÉTODOS: Se analizó la información de 9 248 mujeres de 40 a 59 años. Las variables dependientes fueron la APES y las independientes las características generales, antecedentes ginecoobstétricos, enfermedades crónicas, actividad física, participación en programas de detección y educación. Se realizó un análisis descriptivo, bivariado y multivariado. RESULTADOS: Una proporción de 42% de las mujeres refirió APES+ y 58% APES-. Los factores vinculados con APES- fueron primaria completa o menos (RM=1.78; IC95% 1.62-1.95), no tener trabajo remunerado (RM=1.20; IC95% 1.09-1.33), menopausia (RM=1.22; IC95% 1.11-1.33), diabetes (RM=1.88; IC95% 1.65-2.13), hipertensión (RM=2.01; IC95% 1.82-2.22), actividad física irregular (RM=1.30; IC95% 1.12-1.50), sedentarismo (RM=1.395; IC95% 1.23-1.57), falta de integridad de detección (RM=0.82; IC95% 0.75-0.89) y de información sobre el climaterio por parte de los servicios de salud (RM=1.17; IC95% 1.07-1.28). CONCLUSIÓN: Los factores relacionados con APES- son múltiples y algunos, como la información acerca del climaterio y la actividad física, deben fortalecerse.OBJECTIVE: To evaluate self-rated health (SRH) in climacteric women and to identify the factors associated with negative SRH. MATERIAL AND METHODS: Information from 9 248 women aged 40 to 59 years was analyzed. SRH was the dependent variable. Independent variables were demographic characteristics, history of reproductive and chronic diseases, physical activity, and participation in screening and health education programs. Data were analyzed using descriptive statistics, bivariate analysis, and logistic regression modeling. RESULTS: Forty-two percent of women reported positive SRH and 58% reported negative SRH. Factors associated with negative SRH were: low literacy level (OR 1.78, CI95% 1.62-1.95), unemployment (OR 1.20, CI95% 1.09-1.33), menopause (OR 1.22, CI95% 1.11-1.33), type 2 diabetes (OR 1.88, CI95% 1.65-2.13) hypertension (OR 2.01, CI95% 1.82-2.22), irregular physical exercise (OR 1.30, CI95% 1.12-1.50), sedentarism (OR 1.395, CI95% 1.23-1.57), lack of information about climacteric (OR 1.17, CI95% 1.07-1.28) and lack of screening for chronic diseases (OR 0.82, CI95% 0.75-0.89). CONCLUSIONS: Factors associated with negative SRH such as lack of information and physical activity should be strengthened

Evaluación de un programa de educación médica continua para la atención primaria en la prescripción de hipoglucémicos An evaluation of a continuing medical education program for primary care services in the hypoglycemic agent&#146;s prescription in diabetes mellitus type 2

OBJETIVO: Evaluar el efecto en la prescripción de hipoglucémicos de un programa de educación médica continua en unidades de medicina familiar (UMF). MATERIAL Y MÉTODOS: Se realizó un estudio observacional que comparó dos grupos (con y sin programa) con dos cortes transversales (antes y después). La unidad de análisis fue la consulta. El periodo de análisis comprendió seis meses anteriores y seis posteriores a la institución del programa. La principal variable de resultado fue la prescripción adecuada, evaluada mediante dos criterios: elección e indicación correctas. El análisis incluyó modelos de regresión logística, se aplicó la técnica de dobles diferencias y se ajustó por variables relativas al paciente, la consulta y la UMF; las más relevantes fueron sexo, obesidad, otras afecciones, número de consultas, número de medicamentos, tamaño de la clínica, grupo y etapa. RESULTADOS: Se obtuvo un incremento atribuible al programa de 0.6% en la probabilidad de prescripción adecuada y de 11% en la elección correcta en pacientes obesos.OBJECTIVE: To evaluate the impact of a continuing medical education program on family doctors to improve prescription of hypoglycemic drugs. MATERIAL AND METHODS: An observational study was conducted with two groups of comparison (with-without program) and before-after periods. The unit of analysis was the visit. The period of evaluation comprised six months before and six after implementing the program. The outcome variable was the appropriateness of prescription that was based upon two criteria: appropriate selection and proper indication of the drug. Logistic regression models and the double differences technique were used to analyze the information. Models were adjusted by independent variables related with the patient, the visit and the PCC, the more relevant ones were: sex, obesity, conditions other than diabetes, number of visits in the analyzed period, number of drugs prescribed, size of the PCC and period. RESULTS: the program increases 0.6% the probability of appropriate prescription and 11% the probability of appropriate choice of the hypoglycemic drug in obese patients