Neck circumference cut-offs for overweight and obesity in a group of Mexican adolescents.

BACKGROUND/OBJECTIVES: Neck circumference (NC) has been used for screening overweight/obesity for its high correlation with age, weight, body mass index (BMI), and waist circumference (WC). Cut-offs should be population specific. The aim of the study was to obtain cut-offs of NC for overweight/obesity in Mexican adolescents and to correlate them with anthropometric indicators. SUBJECTS/METHODS: Weight, height, BMI, NC, WC, and mid-upper arm circumference (MUAC) of 465 12-14-year-old Mexican-mestizo students attending a public school in Mexico City were assessed. Using receiver operating characteristics analyses, neck cut-offs were obtained according to the WHO age and sex criteria for overweight/obesity. RESULTS: NC cut-offs with the highest sensitivity and specificity for males and females, respectively, were as follows: 30.0 and 29.3 cm for 12-year-olds; 31.9 and 30.4 cm for 13-year-olds; and, 33.5 and 30.7 cm for 14-year-old adolescents. Overweight/obesity was identified with NC cut-offs in 80% of males and 86% of females, and showed significant correlations (p < 0.01) in males and females with weight (r = 0.821 and r = 0.840, respectively), BMI (r = 0.649 and r = 0.819, respectively), WC (r = 0.710 and r = 0.813, respectively) and MUAC (r = 0.736 and r = 0.815, respectively). CONCLUSIONS: Neck circumference may be used as a first-stage screening tool or jointly with BMI to identify overweight/obesity in 12-14-year-old Mexican adolescents.

Violencia en la formación médica / Violence in Medical Training

Resumen: El propósito del trabajo es aportar elementos de análisis que ayuden a comprender, de una manera más amplia, la violencia dentro de la formación médica, ya que la mayoría de los trabajos sobre el tema se enfocan en las consecuencias de esta, por ejemplo, las afecciones físicas y psicológicas de los hechos violentos sobre el médico en formación. El artículo parte de los conceptos de violencia propuestos por Galtung, quien identifica la violencia directa, la estructural y la cultural. Después se describe el modelo médico hegemónico como escultor de la cultura médica y su efecto sobre la práctica médica y la enseñanza de la medicina. Posteriormente, se puntualiza sobre el habitus médico y el currículum oculto, como elementos de la cultura médica; el primero considerado como una forma de pensamiento de ese personal que justifica el uso de la violencia; y el segundo, como aquel aprendizaje sobre la estructura, la organización y la función de las instituciones de salud. Después se nombran las características de las instituciones como espacios donde se cristaliza una práctica médica organizada de manera rígida, jerárquica y vertical, y nos detenemos en el conflicto trabajador-estudiante. Todas ellas son, en conjunto, condiciones necesarias para la aparición de la violencia directa en la formación médica.

Abstract: The purpose of this work is to provide elements to understand, in a broad way, the violence within medical training, since most of the work on the subject focuses on its consequences: for example, the physical and psychological conditions of violent acts in the medical training. The article begins with the concept of violence proposed by Galtung, that points out direct violence, structural violence and cultural violence. Then, it describes the hegemonic medical model as a sculptor of medical culture and its effect on medical practice and medical education. Afterwards, it describes the medical habitus and the hidden curriculum, two elements of the medical culture. The first one refers to how the medical personnel justifies the use of violence, the second one refers to what is taught about the structure, organization and function of the health institutions. Then, the article reviews the characteristics of the health institutions as spaces where an organized medical practice is crystallized in a rigid, hierarchical and vertical manner. We then focus on the worker/student conflict. These conditions are necessary for the appearance of direct violence in the medical training.