Oferta de servicios de salud sexual y reproductiva a personas migrantes centroamericanas en Tijuana / Provision of sexual and reproductive health services to Central American migrants in Tijuana / Oferta de serviços de saúde sexual e reprodutiva para migrantes da América Central em Tijuana

RESUMEN Objetivo. Caracterizar la oferta de servicios en salud sexual y reproductiva (SSR) para la población migrante centroamericana que se encuentra en albergues de Tijuana, México; e, identificar las barreras y facilitadores del acceso a estos servicios para esta población, desde la perspectiva de los proveedores. Métodos. Se realizó un estudio con un diseño observacional, mixto, transversal. Se consideró una triangulación de técnicas de recolección de información que consistió en 16 entrevistas semiestructuradas a proveedores de servicios de SSR de la sociedad civil para población en movilidad, y observación directa en 10 albergues de Tijuana. Se realizó una doble codificación, abierta y selectiva. El tipo de análisis fue de contenido con un enfoque interpretativo a partir de cinco dimensiones: accesibilidad, aceptabilidad, disponibilidad, asequibilidad y oportunidad. Resultados. El tipo de oferta de servicios en SSR se compone de cuatro elementos: población objetivo, orientación de las asociaciones y organizaciones (religiosa o laica), servicios ofertados y lugar de atención. Las principales barreras durante el proceso de acceso son: la condición migratoria irregular, la escasa prioridad al cuidado de la SSR y la discrepancia entre las preferencias de usuarios y los servicios ofertados. Entre los elementos facilitadores destaca la orientación laica de proveedores y la coordinación interinstitucional. Conclusiones. La oferta de servicios de SSR por parte de asociaciones y organizaciones civiles es amplia y heterogénea. Abarca servicios de atención estrictamente médica y otros que indirectamente inciden en la SSR con miras a la integralidad de la atención. Esto, representa una oportunidad en términos de aspectos facilitadores de acceso.

ABSTRACT Objective. To characterize the sexual and reproductive health (SRH) services on offer to the Central American migrant population residing in shelters in Tijuana, Mexico, and identify barriers and facilitators of access to these services by this population, from the provider perspective. Methods. An observational, mixed, cross-sectional study was conducted. Different information collection techniques—consisting of 16 semi-structured interviews with civil-society providers of SRH services to the migrant population, as well as direct observation in 10 shelters in Tijuana—were employed and triangulated. A two-stage, open, selective coding process was carried out. Content analysis was then performed, using an interpretive approach based on five dimensions: approachability, acceptability, availability, affordability, and appropriateness. Results. The provision of SRH services is composed of four elements: target population, nature of providing organization (religious or secular), services offered, and venue of care. The main barriers to access involve irregular migrant status, the low priority given to SRH services, and the discrepancy between user preferences and the services offered. Among facilitating elements, lay/secular orientation of providers and inter-institutional coordination stood out. Conclusions. The provision of SRH services by civil society organizations is wide-ranging and heterogeneous. It ranges from strictly medical attention to other services that affect SRH indirectly, with a view to providing comprehensive care. This represents an opportunity in terms of aspects to facilitate access.

RESUMO Objetivo. Caracterizar a oferta de serviços de saúde sexual e reprodutiva (SSR) para a população migrante da América Central residente em abrigos em Tijuana, México; e identificar as barreiras e os facilitadores de acesso a esses serviços, para essa população, partindo da perspectiva dos prestadores. Métodos. Foi utilizado um delineamento observacional, misto e transversal. Diferentes técnicas de coleta de informações - consistindo em 16 entrevistas semiestruturadas com prestadores de serviços de SSR da sociedade civil para a população migrante, bem como observação direta em 10 abrigos em Tijuana - foram utilizadas e trianguladas. A codificação dos dados foi realizada em duas etapas, aberta e seletiva. Seguiu-se uma análise de conteúdo com uma abordagem interpretativa baseada em cinco dimensões: acessibilidade, aceitabilidade, disponibilidade, exequibilidade e oportunidade. Resultados. O tipo de oferta de serviços de SSR é composto por quatro elementos: população-alvo, orientação das associações e organizações prestadoras (religiosa ou laica), serviços oferecidos e local de atendimento. As principais barreiras durante o processo de acesso relacionam-se com a situação migratória irregular, a baixa prioridade dada à atenção à SSR e a discrepância entre as preferências dos usuários e os serviços ofertados. Entre os elementos facilitadores, destacaram-se a orientação leiga dos prestadores e a coordenação interinstitucional. Conclusões. A oferta de serviços de SSR por associações e organizações da sociedade civil é ampla e heterogênea. Abrange desde serviços assistenciais estritamente médicos até outros que incidem indiretamente na SSR, com vistas à integralidade do cuidado. Isso representa uma oportunidade em termos de aspectos facilitadores do acesso.

Interrupción voluntaria del embarazo y salud sexual y reproductiva en mujeres migrantes en Barranquilla / Voluntary interruption of pregnancy and sexual and reproductive health in migrant women in Barranquilla / Interrupção voluntária da gravidez e saúde sexual e reprodutiva em mulheres migrantes em Barranquilla

RESUMEN Objetivo. Identificar el conocimiento y las barreras para acceder efectivamente a la interrupción voluntaria del embarazo (IVE), y en general a los servicios sexuales y reproductivos (SSR), entre mujeres provenientes de Venezuela (migrantes venezolanas y colombianas retornadas). Métodos. Estudio cualitativo de 20 entrevistas semiestructuradas en mujeres provenientes de Venezuela, residentes en Barranquilla que ejecutan acciones de liderazgo en comunidades o que participan (o se benefician) de las actividades. Las entrevistas comprendieron dimensiones sobre opiniones y experiencias relacionadas con el acceso a IVE, y en general a SSR, y sugerencias para mejorar el acceso para las mujeres migrantes. Se exploró la relación del acceso a estos servicios con el proceso migratorio y el papel de las organizaciones sociales. Resultados. Se identificó la falta de información sobre derechos en SSR como principal barrera para acceso a la IVE. Otras barreras identificadas fueron: actitud hacia la IVE, exceso de trámites para atención médica, dificultades para la inclusión al sistema de seguridad social, falta de capacitación y atención en SSR y xenofobia en hospitales. Las entrevistadas manifestaron desconocer el marco legal en Colombia y las rutas para la atención de un aborto seguro. Conclusiones. Pese a los esfuerzos institucionales y de cooperación internacional, las mujeres migrantes venezolanas en Barranquilla se encuentran en una situación de vulnerabilidad debido a la falta de acceso a los SSR incluida la IVE. Implementar estrategias para atención integral a migrantes, permitirá mejorar condiciones de salud actual y el goce efectivo de los derechos en SSR.

ABSTRACT Objective. Identify knowledge about and barriers to effective access to voluntary interruption of pregnancy (VIP), and to sexual and reproductive health (SRH) services in general, among women from Venezuela (Venezuelan migrants and Colombian returnees). Methods. Qualitative study of 20 semi-structured interviews with women from Venezuela who are residents of Barranquilla and who carry out leadership activities in communities or who participate in or benefit from those activities. The interviews included opinions and experiences related to access to VIP, and to SRH in general, as well as suggestions for improving access for migrant women. The relationship between access to these services and the migration process was explored, as well as the role of social organizations. Results. A lack of information on SRH-related rights was identified as the main access barrier to VIP. Other identified barriers were: attitude towards VIP, excessive steps involved in accessing medical care, difficulties in admission to the social security system, lack of training and care in SRH, and xenophobia in hospitals. The interviewees said they did not understand the legal framework in Colombia and did not know the channels for safe abortion care. Conclusions. Despite the efforts of institutions and international cooperation, Venezuelan migrant women in Barranquilla are in a situation of vulnerability due to their lack of access to sexual and reproductive health, including voluntary interruption of pregnancy. Implementing strategies for comprehensive care for migrants will improve current health conditions and the effective enjoyment of SRH-related rights.

RESUMO Objetivo. Identificar os conhecimentos e as barreiras para o acesso efetivo das mulheres provenientes da Venezuela (migrantes venezuelanas e retornadas colombianas) à interrupção voluntária da gravidez (IVG) e aos serviços de saúde sexual e reprodutiva (SSR) em geral. Métodos. Estudo qualitativo de 20 entrevistas semiestruturadas com mulheres provenientes da Venezuela, residentes em Barranquilla, que atuam na liderança comunitária ou que participam (ou se beneficiam) das atividades. As entrevistas compreenderam as dimensões de opiniões e experiências relacionadas ao acesso à IVG e aos serviços de SSR em geral, e sugestões para melhorar o acesso das mulheres migrantes. Explorou-se a relação do acesso a esses serviços com o processo migratório e o papel das organizações sociais. Resultados. Identificou-se a falta de informações sobre direitos em SSR como a principal barreira para o acesso à IVG. Outras barreiras identificadas foram: atitude em relação à IVG, excesso de burocracia para obter atenção médica, dificuldades para inclusão no sistema de seguridade social, falta de capacitação e atenção em SSR e xenofobia nos hospitais. As entrevistadas declararam desconhecer o enquadramento jurídico na Colômbia e os trâmites para obter atenção ao aborto seguro. Conclusões. Apesar dos esforços institucionais e de cooperação internacional, as mulheres migrantes venezuelanas em Barranquilla estão em situação de vulnerabilidade por falta de acesso aos serviços de SSR, incluindo a IVG. A implementação de estratégias para atenção integral a migrantes possibilitará a melhoria das condições atuais de saúde e a efetiva fruição dos direitos em SSR.

Utilización de anticonceptivos en población migrante: el caso de las gestantes migrantes venezolanas en dos ciudades receptoras de la costa norte de Colombia / Contraceptive use in the migrant population: the case of pregnant Venezuelan migrants in two receiving cities on the north coast of Colombia / Uso de anticoncepcionais em população migrante: O caso das gestantes migrantes venezuelanas em duas cidades receptoras do litoral norte da Colômbia

Resumen Objetivo: Describir la utilización de métodos anticonceptivos de gestantes migrantes venezolanas, en dos ciudades de la costa norte de Colombia (Barranquilla y Riohacha), entre 2018 y 2019. Metodología: Se diseñó un estudio descriptivo de corte transversal. Las participantes se seleccionaron mediante muestreo sistemático en hospitales y muestreo en bola de nieve en la comunidad. Un cuestionario estandarizado permitió la recolección de variables sociodemográficas, de migración, de uso de anticonceptivos, entre otras. Resultados: Fueron encuestadas 552 mujeres gestantes provenientes de Venezuela, principalmente jóvenes, casadas o en unión libre; la minoría de los embarazos fueron planificados (37,7 %), aun cuando las mujeres conocían sobre métodos de anticoncepción. El preservativo (condón) y la píldora fueron los métodos más conocidos (94,7 y 96,1 %, respectivamente). Conclusión: Casi todas las mujeres conocen métodos anticonceptivos y los lugares dónde obtenerlos; no obstante, solo la mitad logró conseguirlos la última vez que los buscó; así, la mayoría de los embarazos fueron no planificados. La garantía de los derechos sexuales y reproductivos, incluyendo la satisfacción de necesidades de planificación familiar, debe ser una prioridad en las acciones de atención a la población migrante, en el marco del fenómeno migratorio colombo-venezolano.

Abstract Objective: To describe the use of contraceptive methods by pregnant Venezuelan migrants in two cities on the north coast of Colombia (Barranquilla and Riohacha), between 2018 and 2019. Methodology: A descriptive cross-sectional study was designed. Participants were selected through systematic sampling in hospitals and snowball sampling in the community. A standardized questionnaire allowed the sociodemographic, migration, contraceptive use and other variables to be collected. Results: 552 pregnant, mainly young, women from Venezuela who are married or living with their partner were surveyed. The minority of pregnancies were planned (37.7%), even though the women knew about contraception methods. The condom and the pill were the most well-known methods (94.7 and 96.1%, respectively). Conclusion: Nearly all of the women knew about birth control and where it can be accessed. However, only half managed to get them the last time they looked for them, meaning that most of the pregnancies were unplanned. Guaranteed sexual and reproductive rights, including satisfactory family planning requirements, must be a priority in actions aimed at the migrant population, within the framework of the Colombian-Venezuelan migratory phenomenon.

Resumo Objetivo: Descrever o uso de métodos anticoncepcionais de gestantes migrantes venezuelanas, em duas cidades do litoral norte da Colômbia (Barranquilla e Riohacha), entre 2018 e 2019. Metodologia: Foi desenhado um estudo de corte transversal descritivo. As participantes foram selecionadas através de uma amostragem sistemática em hospitais e amostragem em bola de neve feita na comunidade. Um questionário padrão permitiu a coleta de variáveis sócio demográficas, de informação relacionada à migração, ao uso de anticoncepcionais, entre outras. Resultados: O questionário foi aplicado a 552 mulheres gestantes vindas da Venezuela, principalmente jovens, casadas ou em união estável; a minoria das gestações foi planejada (37,7%), mesmo conhecendo os métodos anticoncepcionais. O preservativo (camisinha) e a pílula foram os métodos mais identificados (94,7 e 96,1% respectivamente). Conclusão: Quase todas as mulheres conhecem métodos anticoncepcionais e os lugares onde podem obtê-los; porém somente a metade delas conseguiu adquiri-los quando procuraram pela última vez; assim que a maioria das gestações não foi planejada. A garantia dos direitos sexuais e reprodutivos, incluindo a satisfação das necessidades de planejamento familiar, deve ser uma prioridade nos programas de atenção à população migrante, dentro do marco do fenômeno migratório colombo-venezuelano.

Situación de salud de gestantes migrantes venezolanas en el Caribe colombiano: primer reporte para una respuesta rápida en Salud Pública / Health situation of Venezuelan pregnant migrants in the Colombian Caribbean: first report for a rapid response in Public Health

Resumen Introducción: En el fenómeno migratorio desde Venezuela hacia Colombia, las mujeres representan una proporción significativa entre los migrantes irregulares; de ellas, las gestantes han sido priorizadas por sus condiciones particulares de vulnerabilidad. Sin embargo, se desconocen sus condiciones de salud. Objetivos: Caracterizar multidimensionalmente la situación de salud de las gestantes venezolanas migrantes irregulares, residentes en las principales ciudades receptoras del Caribe colombiano: Barranquilla y Riohacha. Metodología: Estudio descriptivo de corte transversal en 520 gestantes venezolanas migrantes irregulares, captadas por muestreo sistemático en hospitales públicos, y comunitariamente a través de búsqueda activa en bola de nieve entre agosto de 2018 y mayo de 2019. Con un cuestionario estandarizado se evaluaron los principales problemas de salud, estado nutricional, seguridad alimentaria, presencia de síntomas depresivos, accesibilidad y satisfacción con los servicios de salud. Resultados: La mitad percibía su salud durante el embarazo como buena o muy buena (53,4%). El 51,3% presentó anemia ferropénica y la mayoría algún grado de inseguridad alimentaria (87,5%). La prevalencia de síntomas depresivos clínicamente significativos fue del 32,1%. Una alta proporción reportó algún tipo de violencia por parte de su pareja (90,2%). El 25,9% requirió atención sanitaria por urgencias independiente de la atención prenatal. El 62,7% calificó la atención por urgencias como muy buena o buena, mientras que el 73,1% piensa que le brindaron la atención necesaria para su problema de salud. Conclusiones: Los principales problemas de salud en gestantes que participaron en el estudio corresponden a la inseguridad alimentaria, anemia, síntomas depresivos, violencia de pareja y ausencia de controles prenatales. Su situación de salud debe considerarse en el marco del proceso migratorio y desde los determinantes sociales de la salida, tránsito, llegada y retorno. Las medidas de atención primaria para esta población deben seguir siendo fortalecidas por el sistema de salud a nivel territorial y basadas en evidencia.

Abstract Introduction: In the current migration from Venezuela to Colombia, women represent a significant proportion of the irregular migrant population, and those who are pregnant have been a priority given their particularly vulnerable condition. Nevertheless, their health conditions are not known. Objectives: To obtain a multi-dimensional characterization of the health situation of irregular Venezuelan migrants who are pregnant and residing in the main receiving the Caribbean region of Colombia: Barranquilla and Riohacha. Methods: We carried out a descriptive, cross-sectional study with 520 pregnant women surveyed from August 2018 to May 2019 with a systematic sampling in public hospitals and an active community search using snowball sampling. We used a standardized questionnaire to evaluate the main health problems, nutritional status, food security, presence of depressive symptoms and accessibility/ satisfaction with health services. Results: Half of the participants perceived their health during pregnancy as good or very good (53.4%), 51.3% presented iron deficiency anemia, and the majority (87.5%) experienced some lack of food security. The prevalence of clinically significant depressive symptoms was 32.1%. A high proportion reported some type of intimate partner violence (90.2%). 25.9% required urgent medical care, irrespective of the prenatal care they received. With regard to quality of care in the emergency service, 62.7% rated it as very good or good, and 73.1% reported that they received the care that was needed for their health problem. Conclusions: Food insecurity, anemia, depressive symptoms, violence committed by the partner and lack of prenatal care were the main health problems for pregnant women who participated in the study. Their health situation should be viewed in the context of the migration process, based on the social determinants of emigration, transit, arrival, and return. The health care system should continue to strengthen primary care measures for this population at the local level and based on the evidence.

Variables associated with disordered eating behaviors among freshman students from Mexico City / Variables asociadas con conductas alimentarias de riesgo en estudiantes de la Ciudad de México

Abstract: Objective: To estimate the prevalence of disordered eating behaviors (DEB) and identify their associations with demographic and psychological variables among freshman students at a public university in Mexico City. Materials and methods: A sample of 892 subjects participated in the study. Bivariate and multinomial models were performed to determine associations between DEB and covariates. Results: Of those surveyed, 6.8% of the women and 4.1% of the men exhibited DEB (p<0.05). The variables increasing the risk of eating disorders (ED) for women were internalization of the aesthetic thin ideal (IATI), body mass index (BMI), self-esteem and physical activity, while for men they were IATI, drive for muscularity, and self-esteem. Conclusions: The frequency of DEB among women and men and the internalization of the thin ideal in both sexes suggest the possibility of a change in the precursor conditions for eating disorders, particularly for men, who exhibit increased risk of such behaviors.

Resumen: Objetivo: Estimar la prevalencia de conductas alimentarias de riesgo (CAR) e identificar asociaciones con variables sociodemográficas y psicológicas en estudiantes de nuevo ingreso de una universidad pública de la Ciudad de México. Material y métodos: Se aplicó una encuesta a 892 estudiantes de ambos sexos. Para analizar asociaciones entre CAR y sus covariables se emplearon modelos bivariados y multivariados. Resultados: Se estimó que 6.8% de las mujeres y 4.1% de los hombres presentaron CAR (p>0.05). Entre las mujeres las variables que aumentaron el riesgo de CAR fueron interiorización del ideal estético de la delgadez (IIED), índice de masa corporal (IMC), autoestima y actividad física. Entre los hombres, las variables que sobresalieron fueron IIED, deseo por un cuerpo musculoso y autoestima. Conclusiones: La frecuencia de CAR entre mujeres y hombres, así como la IIED en ambos sexos sugiere un cambio en las condiciones de riesgo, especialmente entre los varones.

Deported Mexican migrants: health status and access to care / Migrantes mexicanos deportados: exploração do estado de saúde e acesso a serviços de saúde

OBJECTIVE To describe the health status and access to care of forced-return Mexican migrants deported through the Mexico-United States border and to compare it with the situation of voluntary-return migrants. METHODS Secondary data analysis from the Survey on Migration in Mexico’s Northern Border from 2012. This is a continuous survey, designed to describe migration flows between Mexico and the United States, with a mobile-population sampling design. We analyzed indicators of health and access to care among deported migrants, and compare them with voluntary-return migrants. Our analysis sample included 2,680 voluntary-return migrants, and 6,862 deportees. We employ an ordinal multiple logistic regression model, to compare the adjusted odds of having worst self-reported health between the studied groups. RESULTS As compared to voluntary-return migrants, deportees were less likely to have medical insurance in the United States (OR = 0.05; 95%CI 0.04;0.06). In the regression model a poorer self-perceived health was found to be associated with having been deported (OR = 1.71, 95%CI 1.52;1.92), as well as age (OR = 1.03, 95%CI 1.02;1.03) and years of education (OR = 0.94 95%CI 0.93;0.95). CONCLUSIONS According to our results, deportees had less access to care while in the United States, as compared with voluntary-return migrants. Our results also showed an independent and statistically significant association between deportation and having poorer self-perceived health. To promote the health and access to care of deported Mexican migrants coming back from the United States, new health and social policies are required. .

OBJETIVO Analisar o estado de saúde e o acesso aos serviços de saúde de imigrantes mexicanos deportados na fronteira entre México e Estados Unidos. MÉTODOS Foram analisados dados secundários do Inquérito sobre Migração na Fronteira do Norte do México de 2012. O inquérito é contínuo e desenhado para descrever fluxos migratórios na fronteira entre México e Estados Unidos com amostra de população móvel. Foram analisados indicadores de saúde e de acesso aos serviços de saúde dos imigrantes deportados em comparação aos imigrantes que retornaram voluntariamente. Nossa amostra análise incluiu 2.680 migrantes de retorno voluntário, e 6.862 deportados. Foi utilizado modelo de regressão logística ordinal para comparar as probabilidades da pior autopercepção de saúde entre os grupos estudados. RESULTADOS Em comparação com os migrantes de retorno voluntário, deportados foram menos propensos a ter seguro médico em os Estados Unidos (OR = 0,05, IC95% 0,04;0,06). No modelo de regressão uma pior saúde auto-percebida foi associado com ser deportado (OR = 1,71, IC95% 1,52;1,92), bem como a idade (OR = 1,03, IC95% 1,02;1,03) e os anos de escolaridade (OR = 0,94, IC95% 0,93;0,95). CONCLUSÕES De acordo com nossos resultados, deportados tinha menos acesso aos cuidados, enquanto em os Estados Unidos, em comparação com os migrantes de retorno voluntário. Nossos resultados também mostraram uma associação independente e estatisticamente significativa entre a deportação e ter pior saúde auto-percebida. Novas políticas de saúde pública são necessárias para promover a saúde e o acesso aos serviços de saúde nos imigrantes mexicanos deportados dos Estados Unidos. .

Diseño y aplicación en Cuba de un constructo para identificar dimensiones sociales de la discriminación por VIH/sida / Design and application in Cuba of a construct to identify social dimensions associated with HIV/AIDS discrimination

Objetivo. Diseñar un instrumento que permita identificar dimensiones sociales de la discriminación contra las personas con VIH y mostrar su aplicación en Cuba. Material y métodos. Combinación de metodología cualitativa y cuantitativa para la operacionalización de un constructo; inserción del instrumento en las encuestas de prevención del VIH aplicadas en Cuba en 2005, 2006 y 2009 y desarrollo de las técnicas estadísticas de análisis factorial y de las K-medias, para conocer dimensiones sociales de la discriminación. Resultados. Se construyó un instrumento que permitió obtener un diagnóstico sobre las actitudes discriminatorias más frecuentes contra las personas con VIH en el ámbito de la vida social cotidiana de los cubanos, clasificar dicha población según niveles de actitudes discriminatorias y conocer algunas de las dimensiones sociales de este fenómeno. Conclusiones. Es posible disponer de una herramienta que posibilite dictaminar actitudes discriminatorias en una población determinada, focalizar acciones y evaluar tendencias sobre su comportamiento.

Objective. This paper presents the design and application in Cuba of a social construct to identify the social dimensions associated with discrimination attitudes towards people with positive diagnosis to HIV. Materials and methods. A combination of qualitative and quantitative methodology was used for the measurement and validation of a construct, and also the K-mean procedure and factor analysis techniques. All these techniques were applied to "Survey on HIV prevention indicators" 2005, 2006 and 2009. Results. A tool for the identification of the most frequent discriminatory attitudes in a specific social context was validated. This instrument allows clustering the population into different typologies, by level of discrimination, and also, to distinguish some social dimensions of this phenomenon. Conclusions. The results allow distinguishing frequent discriminatory attitudes in any population, focusing the actions in the direction of gradually reducing them, and to evaluate the temporal behavior of this phenomenon.

Aplicación del análisis estadístico de datos censurados para el manejo de respuestas incompletas en la escala CES-D / Application of censored-data analysis for managing CES-D incomplete responses

Purpose To provide an example of censored data analysis in the management of CED-S missing data, using a data set of a study conducted with Mexican rural women. Material and Methods Data used for this exercise were collected in a cross-sectional study with 416 women in the Mexican region known as the Mixteca Baja. Using a Survival Analysis (SA) focus we present a general description of the scores, along with the estimation of association patterns between those scores and the independent variables departing from Cox's proportional risk model. A comparison is made of these results and those obtained through a regression analysis. Results Using only the information from observations with complete data, the average CES-D score was 11.0 and the prevalence of symptoms above the cut-off point (16) was 23.2%. Twenty-six percent of the women did not respond to at least one item. When conducting the SA, the estimated mean score of the scale was 14.0. Survival above the cut-off point corresponded to an estimated prevalence of 21%. Conclusions SA is useful in the management of data sets with missing data in scales such as the CES-D. In this example, the increased percentage of observations with missing data produced a loss of precision in the estimators. The differences in mean item scores between observation with complete and incomplete data suggested a non-random, no-response pattern, if this is not taken into consideration it could bias the estimation in the scale mean and its association with other variables. Conducting SA we were able to use the information of most women participating in the study, including those who did not respond to all items in the scale.

Objetivo Ejemplificar el uso del análisis de datos censurados en el manejo de datos incompletos de la CES-D utilizando una base de datos de un estudio con mujeres rurales de México. Material y Método Los datos analizados se recogieron en un estudio transversal con 416 mujeres de la Mixteca Baja, al sur de México. Con un enfoque de Análisis de Supervivencia (AS), se presenta una descripción general del comportamiento de las puntuaciones de la CES-D junto con la estimación de patrones de asociación entre esos puntajes y variables independientes a partir del modelo de riesgos proporcionales de Cox, y se hace una comparación entre estos resultados y los obtenidos de un modelo de regresión lineal. Resultados Utilizando sólo la información de las observaciones con datos completos, la puntuación promedio de la CES-D fue de 11.0 y la preva-lencia de síntomas por arriba del punto de corte (16) fue de 23.2%. El 25.2% de las mujeres no contestó al menos un reactivo. Al hacer el AS, el promedio estimado de la puntuación fue de 14.8. La supervivencia por encima del punto de corte corresponde a una prevalencia estimada del 21%. Conclusiones El AS es útil en el manejo de bases que presentan datos faltantes por ejemplo en escalas como CES-D. En nuestro ejemplo, el elevado porcentaje de observaciones con respuestas faltantes ocasionó una pérdida de precisión en los estimadores. Las diferencias de puntuaciones promedio por reactivo entre observaciones con datos perdidos y completos sugieren un patrón de no-respuesta que no es aleatorio, y que de no tomarse en cuenta podría sesgar la estimación, tanto del promedio de la escala como de su asociación con otras variables. El AS utilizó la información de casi la totalidad de las participantes en el estudio incluyendo aquellas que no respondieron todos los reactivos de la escala.

Percepción de competencias en epidemiología en México y Colombia durante la epidemia de influenza A (H1N1) entre estudiantes de salud pública / Perception of epidemiological competencies by public health students in Mexico and Colombia during the influenza A (H1N1) epidemic

OBJETIVO: Conocer la percepción que los estudiantes de salud pública en México y en Colombia tuvieron sobre el manejo de la epidemia de influenza A (H1N1), como una forma para indagar qué contenidos curriculares pueden ser mejorados en la formación en epidemiología. MÉTODOS: Encuesta durante la epidemia, entre junio y agosto de 2009, a estudiantes de posgrado. Se evaluaron las 30 competencias epidemiológicas del Council of State and Territorial Epidemiologists para "epidemiólogos intermedios". Se describieron los resultados estratificando por covariables, y se identificaron las competencias con menor desarrollo mediante análisis factorial exploratorio. RESULTADOS: Participaron 154 estudiantes, de los cuales 55,8 por ciento estaban en México. Se observaron diferencias importantes en el perfil de los estudiantes de ambos países, lo cual explica parcialmente la percepción de respuesta a la epidemia. En el análisis factorial el primer factor, que explica 21,5 por ciento de la varianza, presentó menores puntajes y se asoció con competencias relacionadas con el vínculo entre el personal sanitario y la comunidad, donde resultan relevantes conocimientos de ciencias sociales y habilidades de comunicación. CONCLUSIONES: Los estudiantes percibieron que la respuesta frente a la epidemia podría haber sido mejor. Se sugiere incorporar en la educación de los recursos humanos en salud pública temáticas sobre cultura y sus efectos sobre conductas y pensamientos, el reconocimiento de los prejuicios de los expertos, la comunicación efectiva con las comunidades, y la habilidad para adaptarse ante nuevas situaciones. El "experimento natural" de la epidemia facilitó la identificación de áreas de oportunidad para mejorar la enseñanza de la epidemiología ante contingencias sanitarias.

OBJECTIVE: Learn about the perception of public health students in Mexico and Colombia regarding the management of the influenza A (H1N1) epidemic to determine which curriculum contents in epidemiological education can be improved. METHODS: Survey administered to graduate students during the epidemic, from June to August 2009. The 30 epidemiological competencies for "intermediate epidemiologists" of the Council of State and Territorial Epidemiologists were evaluated. The results were described through stratification by covariables, and the less developed competencies were identified through exploratory factor analysis. RESULTS: A total of 154 students participated, 55.8 percent of whom were in Mexico. Significant differences in the student profile from each country were observed, which partially explains the perception of response to the epidemic. The first factor, which explains 21.5 percent of the variance, had lower scores in the factor analysis. This factor was associated with competencies related to the links between health personnel and the community, in which knowledge of the social sciences and communication skills are relevant. CONCLUSIONS: The students perceived that the response to the epidemic could have been better. It is suggested that public health human resources education include subjects related to the impact of culture on behavior and thinking, recognition of the prejudices of experts, effective community-level communication, and the ability to adapt to new situations. The "natural experiment" of the epidemic facilitated the identification of areas of opportunity to improve the teaching of epidemiology to health personnel.

Las conductas alimentarías de riesgo no se asocian con deficiencias de micronutrimentos en mujeres en edad reproductiva de la Ciudad de México / Abnormal eating behaviours are not associated with micronutrient deficiencies among women of childbearing age from Mexico City

El objetivo de este trabajo fue evaluar la asociación entre las conductas alimentarias de riesgo (CAR) y las deficiencias de vitaminas y nutrimentos inorgánicos en una muestra de mujeres en edad reproductiva. Participaron 282 mujeres de 12 a 49 años (21.9 por ciento adolescentes) no embarazadas ni lactando, muestreadas de manera sistemática con arranque aleatorio en 6 colonias del poniente del Distrito Federal. Se evaluaron las concentraciones de las vitaminas A, C, E, B12 y ácido fólico así como de hemoglobina, ferritina y hierro y zinc séricos. Para las CAR se usó un cuestionario validado en la población mexicana. La información se analizó con estadística descriptiva y la prueba de Fisher. Aproximadamente el 68 por ciento de la muestra fue de nivel socioeconómico medio-bajo o inferior. El 14.8 por ciento tuvo un puntaje de riesgo para las CAR, sin diferencias entre adolescentes y adultas. Las CAR más frecuentes fueron la preocupación por engordar y comer demasiado. El 10 por ciento de las mujeres, aproximadamente, usaron diuréticos o laxantes durante el trimestre anterior a la encuesta. Las deficiencias más importantes fueron las de Vitamina E, zinc y hierro, que afectan al 47 por ciento, 44 por ciento y 27 por ciento de la población, respectivamente. No hubo asociación significativa entre las CAR y las deficiencias de micronutrimentos de manera global ni al analizar por conductas aisladas. A pesar de ello, y dada la alta prevalencia de las CAR y la obesidad en esta población, es necesario hacer campañas para promover la adopción de conductas saludables que permitan alcanzar un peso adecuado.

The aim of this study was to evaluate the association between the risk of abnormal eating behaviors (AEB) and vitamin and mineral deficiencies among women. Women of childbearing age (n=282) were systematically sampled with a random start (21.9 percent adolescents) in 6 suburbs in the west side of Mexico City, they were non pregnant or breastfeeding. Vitamin A, C, E, B12, folic acid, hemoglobin, ferritin, cupper, iron and zinc concentrations were measured. A questionnaire validated in the Mexican population was used for screening AEB. Data were analyzed by descriptive statistics and by using Fisher´s test. Approximately 68 percent of the sample belonged to a mid-low or lower socioeconomic status. 14 percent had risk of AEB, without statistical differences between adults and teenagers. 10 percent used diuretics or laxatives to reduce weight within the trimester preceding the survey. Vitamin E, zinc and iron were the most widespread deficiencies affecting 47 percent, 44 percent and 27 percent of the population, respectively. There was no association between the AEB and micronutrient deficiencies neither when AEB were analyzed globally nor individually. Considering these results and the high prevalence of the AEB and overweight in this population, it is important to promote the adoption or healthy behaviors to achieve an adequate weight.

Características psicométricas de la Escala Center for Epidemiological Studies-depression (CES-D), versiones de 20 y 10 reactivos, en mujeres de una zona rural mexicana / Psychometric characteristics of the Center for Epidemiological Studies-depression Scale (CES-D), 20-and 10-item versions, in women from a Mexican rural area

Depressive symptoms constitute a common mental health problem, with a relevant social and personal impact. These symptoms are present not only among the urban population in more economically developed countries, but also in rural areas in poor and middle development countries. In order to obtain reliable information on the frequency of depressive symptoms, their risk factors or the impact of preventive and clinical measures, valid measurement instruments are needed. Radloff's Center for Epidemiological Studies - Depression scale (CES-D) was originally developed for the study of depressive symptoms in an open population. While the CES-D is not useful for the evaluation of depressive disorders according to psychiatric criteria, it can still yield useful information about the presence of depressed mood, feelings of guilt and worthlessness, feelings of helplessness and hopelessness, psychomotor retardation, and somatic complaints, which constitute dimensions of depression. The instrument has been shown to be valid in culturally diverse groups. It has also been shown to correlate with the clinical diagnosis of depression, with sensibility as high as 100%, while its specificity has been reported as 57-88%. Shorter versions of the CES-D have been developed. Their advantages include a more easy inclusion in ample questionnaires, and their being less tiresome for respondents. The main objective of this study was to evaluate the psychometric properties of CES-D, both the original, 20- item version, and the 10-item version by Andresen et al., in women living in the Mixteca, a poor rural area which includes part of the states of Guerrero, Oaxaca and Puebla, in southern Mexico. The instrument was applied as part of a comprehensive survey on health and migration in three rural municipalities in the Mixteca. The sampling design included cluster, proportional to size sampling of localities, and systematic selection of households. At each household, one woman of between 15 and 49 years of age responded a questionnaire which included the CES-D. A total of 468 women were included in the sample (median 35 years, interquartile range 28, 42). Of these, 89% were married or had a stable partner, 5% were single, 13% separated, and 12% widowed. The majority (65%) had only six years of schooling, while 1 6% had no formal education. The statistical analysis was conducted on the 343 questionnaires with complete answers to the CES-D (73% of the sample). The mean score in CES-D-20 was 11.3 (standard deviation 8.8). The mean score in CES-D-10 was 6.3 (standard deviation 5.0). According to the respective cut-off points, prevalence of depressive symptoms was 24.5% for the CES-D-20 and 22.3% for CES-D-1 0. A descriptive statistical analysis of the scores in each item and in the complete scales was conducted. In order to evaluate the internal consistency of CES-D, both 1 0- and 20- item versions, inter-item and item-total correlations were calculated. Cronbach's alpha coefficient was also obtained. Factor analysis was employed to determine if the actual aggregation of the items was coherent with the theoretical dimensions they were intended to measure. Another way to prove validity was through the analysis of the association between the score in the CES-D and the answers to questions about <>, an ethnical syndrome well recognized in the region and sharing characteristics with depression. Also, the association of scores with other variables known to be related to depressive symptoms, such as being chronically ill or the educational level, was investigated. In order to evaluate CES-D-10 capacity to identify depressive symptoms, taking the CES-D-20 as reference, Spearman's correlation coefficient between the scores in both scales was calculated. The kappa statistic was employed to evaluate the concordance between scales in the classification of individuals according to their respective cut-off points. For CES-D-20, Cronbach's alpha value was 0.84 and for CES-D-10 it was 0.74. For CES-D-20, four factors with eigen values over 1 were extracted, accounting for 50.6% of variance. The first one included items which, according to Radloff's original solution, are part of the dimensions depressed affect, retarded activity, and positive affect. The second one included items from the depressed affect, retarded activity, and interpersonal dimensions. The fourth factor included only two items, both from the positive affect dimension. A scree plot showed that a two factor solution could also be adequate. For CES-D-10, two factors were extracted, accounting for 46.5% of variance. As for convergent validity, women who reported having <> had a median CES-D-20 score of 13.5 (IQR 8.8, 22), while those who did not report the illness had a median score of 9 (IQR 4, 14). Women without a formal education had a median CES-D-20 score of 1 2 (IQR 8, 20), those who had completed elementary school had a median score of 10 (IQR 5, 15), and those with junior high or over had a median of 8 (IQR 3, 15). Those who reported having a chronic illness had a median score of 12 (IQR 8, 18), while those without a chronic illness had a median of 8 (IQR 4, 13). Similar results were observed for the CES-D-10. Spearman's correlation coefficient between CES-D-20 and CES-D-10 was 0.94 (p<.0001). Kappa value for concordance between both versions of the scale was of 0.80. In comparison to the longer version, CES-D-10 had a sensibility of 79.8% and a specificity of 97.3% for the detection of those over cut-off point. The results show that both scales had good reliability and validity in relation to measures of other variables related to depressive symptoms. The factorial grouping of the items was different from the original, as has been observed by other authors. A similar, unimodal distribution centered in 0 and with a positive skew was observed for the answers to all items, except for two items with a bimodal distribution. Those two items were also different to the rest in their presence (having the symptom at least on day during the past week) and persistence (having the symptom everyday during the past week). These differences suggest that items 4 and 8 of the CES-D could have validity problems in this population. In conclusion, both versions of the CES-D were found to have good psychometric properties in this sample, with the shorter one having the advantage of being easier to include in questionnaires for more comprehensive studies. However, further studies with the use of qualitative methods should clarify the true cross-cultural validity of the CES-D in rural areas in Mexico.

Los síntomas depresivos son un problema de salud mental frecuente e importante en cuanto a sus consecuencias personales y sociales, que afecta no solamente a la población urbana de los países más desarrollados, sino también a los habitantes de zonas rurales en los países pobres. Para obtener información confiable acerca de la frecuencia de síntomas depresivos, así como de sus factores de riesgo o el éxito de las medidas preventivas y de atención, es necesario contar con instrumentos de medición confiables y válidos. El instrumento Center for Epidemiological Studies - Depression (CES- D), de Radloff, fue desarrollado originalmente para el estudio de síntomas depresivos en población abierta. Si bien no es útil para evaluar la presencia de trastornos depresivos del estado de ánimo tal como son definidos en la nosología psiquiátrica, este instrumento permite estudiar la de un rango de manifestaciones basadas en dimensiones de la depresión consideradas en la bibliografía clínica. El objetivo principal de este estudio fue evaluar las propiedades psicométricas del CESD en mujeres de una zona rural de alta marginación, tanto en su versión original como en la versión de 1 0 reactivos de Andresen et al. La información para este estudio se recabó en la zona mixteca, en tres municipios rurales en los cuales se llevó a cabo un muestreo por conglomerados de localidades y sistemático de hogares. Se aplicó el CES-D a 468 mujeres de entre 1 5 y 49 años en los hogares seleccionados. Se hizo un análisis descriptivo de los resultados de puntuación en cada reactivo, así como de los de la escala completa. Para evaluar la consistencia interna del CES-D en sus versiones de 10 y 20 preguntas, se calcularon las correlaciones entre reactivos, y de cada reactivo con la puntuación en la escala completa, así como el coeficiente de alfa de Cronbach. Se llevó a cabo un análisis factorial con el fin de determinar si la agrupación de los reactivos correspondía a sus dimensiones teóricas. Otra medida de la validez de constructo consistió en analizar la relación entre la puntuación en el CES-D y los resultados en preguntas acerca de los <>, un padecimiento reconocido en la tradición étnica de la región. Se observó también la asociación con la presencia de enfermedades crónicas y con el nivel educativo, dos variables que han mostrado estar asociadas a los síntomas depresivos. Para evaluar la capacidad del CES-D-10 de medir los síntomas depresivos, en comparación con la versión de 20 reactivos, se calculó el coeficiente de correlación de Spearman entre las puntuaciones en ambas escalas. Se calculó también el estadístico kappa para evaluar la concordancia entre las versiones larga y corta en la clasificación de individuos por encima del punto de corte. El valor de alfa de Cronbach del CES-D-20 fue de 0.84 y el del CES-D-1 0 de 0.74. Para el CES-D-20, se extrajeron cuatro factores con valores propios mayores a 1, que explicaron en conjunto 50.6% de la varianza. El gráfico de sedimentación mostró que una solución en dos factores también hubiera sido adecuada. Para el CES-D-1 0, se extrajeron dos factores que explicaron en conjunto 46.5% de la varianza. La correlación de Spearman entre el CES-D-20 y el CES-D-10 fue de 0.94 (p<.0001). El valor del estadístico kappa para la concordancia entre ambas formas de la escala fue de 0.80. Se observó un comportamiento similar en la distribución de las respuestas a todos los reactivos, a excepción de dos, los cuales difirieron también en su presencia y persistencia en comparación con el resto, por lo que se sugiere que estos dos reactivos podrían estar presentando problemas de validez.

Depressive symptoms among poor older adults in Mexico: prevalence and associated factors / Síntomas depresivos en adultos mayores pobres de México: prevalencia y factores asociados

OBJECTIVE: To describe the presence of depressive symptoms (DS) and factors associated with them among poor Mexican older male and female adults (OA). METHODS: A survey was conducted among OA enrolled in a governmental poverty relief program (Oportunidades) in Mexico. Participants completed a short version of the Center for Epidemiologic Studies Depression Scale and answered questions about health and life conditions. RESULTS: The prevalence of DS over the cutoff point was 43 percent (confidence interval (CI) 39.5-46.4). DS were associated with different variables among male and female participants. For men, difficulties in performing daily life activities were associated with DS over the cutoff point (odds ratio (OR) 2.62, CI 1.58-4.34) and literacy was associated with less DS (OR 0.46, CI 0.31-0.68). For women, difficulties with daily life activities were associated with more DS (OR 2.50, CI 1.57-3.97), and being head of the family was also positively associated (OR 1.81, CI 1.11-2.93). CONCLUSIONS: DS were frequent among this sample of poor OA. The differences between men and women in variables associated with DS highlight the importance of considering the gendered aspects of growing old.

OBJETIVO: Describir la presencia de síntomas depresivos (SD) y los factores asociados con ellos en adultos y adultas mayores pobres de México. MÉTODOS: Se realizó una encuesta a adultos y adultas mayores registrados en un programa gubernamental de alivio de la pobreza (Oportunidades) en México. Los participantes completaron una versión abreviada de la Escala de Depresión del Centro de Estudios Epidemiológicos y respondieron preguntas sobre su salud y condiciones de vida. RESULTADOS: La prevalencia de SD por encima del nivel de corte fue de 43 por ciento (intervalo de confianza de 95 por ciento [IC95 por ciento]: 39,5 a 46,4). Los SD se asociaron con diversas variables en los hombres y mujeres participantes. En hombres, la dificultad para realizar actividades de la vida diaria se asoció con la presencia de SD por encima del nivel de corte (razón de posibilidades [odds ratio, OR] = 2,62; IC95 por ciento: 1,58 a 4,34) y saber leer se asoció con menos SD (OR = 0,46; IC95 por ciento: 0,31 a 0,68). En las mujeres, la dificultad para realizar actividades de la vida diaria se asoció con más SD (OR = 2,50; IC95 por ciento: 1,57 a 3,97), al igual que ser la cabeza de la familia (OR = 1,81; IC95 por ciento: 1,11 a 2,93). CONCLUSIONES: Los SD fueron frecuentes en esta muestra de adultos mayores pobres. Las diferencias entre hombres y mujeres en cuanto a las variables asociadas con los SD subrayan la importancia de tomar en cuenta los aspectos de género asociados con el envejecimiento.

Validación del Eating Disorder Inventory en una muestra de mujeres mexicanas con trastorno de la conducta alimentaria

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Abstract: The Eating Disorder Inventory (EDI) is a psychometric instrument developed by Garner et al. for the evaluation of psychological traits in patients with eating disorders. The questionnaire offers an integral evaluative approach that includes other psychological characteristics besides those of fear of fatness. It consists of 64 items in 8 subscales: 1) Drive for Thinness, 2) Bulimia, 3) Body Dissatisfaction, 4) Ineffectiveness, 5) Perfectionism, 6) Interpersonal Distrust, 7) Interoceptive Awareness, 8) Maturity Fears. The EDI is an instrument widely used for the exploration of eating disorders (ED). Nevertheless, the use of psychometric scales in a population other than the one in which they were originally developed, requires careful adaptation. Items should be phrased in a culturally significant way, and even after that, constructs still could have different meanings in different contexts. The factorial grouping of the EDI in open populations has been reported as different from the results in clinical samples. Also, Lee and cols. reported a low correlation of the EDI subscales that measure weight preoccupation and the General Health Questionnaire - 12, concluding that fear of fatness is not related with emotional distress in their sample. In Mexico City, Alvarez and Franco conducted a validation study, finding good reliability and discriminative power, and a factorial grouping close to the original. On the other hand, in a sample of teenage girls from a semi-rural area, the factorial grouping was very different. Although we already have data about the EDI's specificity and sensitivity in Mexican ED patients, there are no studies of the validity and reliability of the test in this population. Therefore, our main objective in this work was to validate the EDI in a sample of Mexican ED patients. Also, the score information provided could be used for comparison purposes with other clinical samples. A non-probabilistic sample was obtained of all subsequent patients attending the ED Clinic at the National Institute of Psychiatry Ramón de la Fuente (INPRF) in the period 1997 2002 (n=523). Patients were diagnosed according to DSM-IV criteria in a clinical interview. They also completed other questionnaires, such as the Symptom Check List (SCL90) and the Coopersmith's Self-esteem Inventory. According to diagnosis, the sample was composed of compulsive/purging type anorexia nervosa, 5.7%; restrictive anorexia nervosa, 8%; purging type bulimia nervosa 45.1% and eating disorders not otherwise specified 41.3%. Mean age was 19.9 years (s.d.=3.9), within a rank of 13 to 39 years. Mean age at the beginning of ED was 16 years (s.d.=3.1). Mean educational level was 12 years (s.d.=3), i.e. high-school level. The sample included single women 93.9%, married 4.8% and divorcees, 1.4%. Mean Body Mass Index was 21 (s.d. = 5.5). Participants completed the EDI, SCL90, and Coopersmith's self-esteem inventory during their first visit to the Clinic. They were assured of the voluntary nature and confidentiality of their participation. Completing the tests took them about 60 minutes. An internal reliability analysis was conducted, followed by a factorial analysis of main components with Varimax rotation. Pearson correlations were made to assess the concurrent validity of EDI and other instruments. Analysis of variance was employed to compare between diagnostic groups. Data were captured and analysed in the SPSS software, versión 10.0. The first step of the analysis was the item-total correlation, considering as valid correlations equal or over 0.28. This step eliminated 12 items that were not included in further analyses. Cronbach's alpha was 0.93. Most of the items in the Perfectionism subscale disappeared in this step. Second step was factorial analysis. We found 6 factors with a minimum of 3 items included with factorial charges equal or over .40. Then a second analysis was conducted with only the 40 items that had been grouped in the 6 factors. Factor 1 included items from Bulimia and Interoceptive Awareness; factor 2, from Drive for Thinness and Body Dissatisfaction; factor 3, from Interoceptive Awareness; factor 4, from Ineffectiveness; factor 5, from Maturity Fears; and factor 6, from Body Dissatisfaction. The resulting factorial structure explained 56% of total variance. Cronbach's alpha of the final version was 0.92. Correlation analysis showed a positive and significant correlation of EDI with SCL-90, and a negative and significant correlation of EDI with Coopersmith's self-esteem inventory. Comparisons between diagnostic groups showed that bulimia nervosa patients had the highest scores in the EDI. Patients with restrictive AN had the lowest scores in all sub-scales except for Maturity Fears. Bulimia nervosa and compulsive/purging type AN patients were different from restrictive AN and EDNOS patients in the total score of Interoceptive Awareness and Ineffectiveness subscales. Bulimia nervosa was different from the other groups in Bulimia and Drive for Thinness subscales. The results show that, in this sample, many of the EDI items have a poor correlation with the scale, and factorial grouping is different from the original. However, once non-correlated items are eliminated, a version of the EDI remains that is valid and reliable. Items from the Perfectionism subscale were eliminated because of low correlation with the rest of the EDI. This supports the findings in Bulgaria, rural Mexico, and Mexico City. Maturity Fears, which also had dubious results in other studies, grouped correctly in this sample, although it did not distinguish among diagnostic groups. Analysis of variance showed that subscales were able to differentiate the Bulimia nervosa patients. Also, most of the variance explained corresponded to the Bulimia subscale, suggesting that EDI can detect bulimic attitudes, and so is a useful complement to instruments that are more capable of detecting anorexia nervosa, such as the Eating Attitudes Test. However, this could also be an effect of the sample's composition, with more than half of it being bulimic patients. Another important segment of variance was explained by Interoceptive Awareness, Ineffectiveness and Maturity Fears subscales, psychological traits that are not necessarily related to ED. In this sample, psychological subscales correlated with eating and weight attitude subscales, showed that Mexican patients do present ED according to the way they are conceptualized in the DSM-IV. Our results show that the EDI is adequate for the evaluation of psychological traits of ED patients in Mexico. Perfectionism and Interpersonal Distrust subscales are an exception, that requires further investigation.

Validación de un cuestionario breve para medir conductas alimentarias de riesgo / Validation of a brief questionnaire to measure the risk of abnormal eating behaviors

OBJETIVO: Mostrar los resultados de confiabilidad y validez de un cuestionario para identificar conductas alimentarias de riesgo. MATERIAL Y MÉTODOS: El cuestionario se aplicó a una muestra de mujeres con diagnóstico de trastorno alimentario, en tratamiento en la Clínica de Trastornos de la Conducta Alimentaria, del Instituto Nacional de Psiquiatría, en el periodo septiembre-diciembre de 2002, y a una muestra de mujeres estudiantes de nivel medio y medio superior en la Ciudad de México, en octubre del mismo año. Se hizo análisis de consistencia interna (alfa de Cronbach) y análisis factorial de componentes principales con rotación oblicua; mediante tablas de 2 x 2 se determinaron el punto de corte, la sensibilidad, la especificidad y los valores predictivos del cuestionario. RESULTADOS: El instrumento tiene una alta confiabilidad (alfa=0.83) y una estructura interna de tres factores con una varianza explicada de 64.7 por ciento. El análisis discriminante mostró que casi 90 por ciento de los casos fueron correctamente agrupados. CONCLUSIONES: El instrumento presentado es una opción confiable y válida para la evaluación de conductas alimentarias de riesgo en la población de las muestras estudiadas.

OBJETIVE: To assess the validity and reliability of a questionnaire for the screening of risk eating behaviors. MATERIAL AND METHODS: The questionnaire was applied to female high school students in Mexico City in October2002, as well as to a sample of eating disorder patients seen at the Eating Disorders Unit of the National Institute of Psychiatry between September and December 2002. Statistical methods included internal consistency analysis (Cronbach's alpha) and factor and principal component analysis with oblique rotation. The cutoff point, sensitivity, specificity, and predictive values of the questionnaire were determined using 2 x 2 tables. RESULTS: The questionnaire showed a high reliability (·=0.83) and a three-factor structure with 64.7 percent of the total explained variance. A discriminant analysis showed that almost 90 percent of cases were correctly classified. CONCLUSIONS: This questionnaire is reliable and valid for assessing risk eating behaviors in the study population.