Asthma control and quality of life of asthmatic children and their caregivers. / Control del asma y calidad de vida en niños asmáticos y sus cuidadores.

BACKGROUND: Uncontrolled asthma impacts on quality of life of patients, but also in the one of caregivers; therefore, adequate asthma control is the main goal in the treatment of asthma. OBJECTIVE: To assess how the asthma control and other environmental factors are associated to the quality of life in asthmatic children and their caregivers. METHOD: The Asthma Control Test was administered to patients, and a questionnaire on quality of life was given to patients and their caregivers. Odds ratio prevalence (ORP) association of demographic and environmental factors, use of medications, among other factors, was estimated. RESULTS: 431 patients were included, with an average age of 10.55 years, and 65.2% were males. 93% of caregivers were women. Patients had a prevalence of poor quality of life of 57.3%, associated with inappropriate drugs use (ORP: 23.05; 95% confidence interval [95% CI]: 1.54-345.16), and uncontrolled asthma (ORP: 6.8; 95% CI: 3.48-13.5). There was poor quality of life in 73.3% of caregivers, associated with female gender and patient's poor quality of life. CONCLUSIONS: We observed poor quality of life in over half of the patients, mainly associated to an inadequate use of medications and uncontrolled asthma. In caregivers the poor quality of life was related to female gender and to patient's poor quality of life.

INTRODUCCIÓN: El asma no controlada impacta en la calidad de vida de los pacientes, pero también en la de los cuidadores; por ello, el control adecuado del asma es la meta principal del tratamiento. OBJETIVO: Evaluar cómo el control del asma de los niños asmáticos y otros factores ambientales influyen en la calidad de vida de los pacientes y de sus cuidadores. MÉTODO: Se aplicó el cuestionario Asthma Control Test a los pacientes y otro cuestionario sobre calidad de vida a los pacientes y a sus cuidadores. Se estimó la razón de momios de prevalencia (RMP) de factores sociodemográficos, ambientales, uso de medicamentos y otros factores. RESULTADOS: Se incluyeron 431 pacientes con asma, con una edad promedio de 10.55 años y el 65.2% de sexo masculino. Los cuidadores fueron mujeres en el 93% de los casos. Encontramos mala calidad de vida en el 57.3% de los pacientes, asociada principalmente con el uso inadecuado de medicamentos (RMP: 23.05; intervalo de confianza del 95% [IC95%]: 1.54-345.16) y el asma no controlada (RMP: 6.8; IC95%: 3.48-13.5). Hubo mala calidad de vida en el 73.3% de los cuidadores, asociada al sexo femenino y a la mala calidad de vida del paciente. CONCLUSIONES: Identificamos mala calidad de vida en la mitad de los pacientes, principalmente por el uso inadecuado de medicamentos y por el asma no controlada. La mala calidad de vida de los cuidadores se asoció al sexo femenino y a la mala calidad de vida del paciente.

High burden of cardiovascular disease risk factors in Mexico: An epidemic of ischemic heart disease that may be on its way?

BACKGROUND: Whereas developed nations have witnessed a drop in the occurrence and mortality of ischemic heart disease, developing nations have recorded a constant rise. The burden of cardiovascular disease risk factors may explain this increase. METHODS: We conducted a population-based cross-sectional survey to estimate the prevalence of cardiovascular risk factors in the population protected by the Mexican Social Security Institute. A total of 20,062 Mexicans, aged >or=20 years, 43.5% (8,727) male and 56.5% (11,335) female, randomly selected in a 4-stage stratified population-based sampling process were included. RESULTS: The most prevalent cardiovascular risk factor in men was smoking (31.9%), whereas in women, it was obesity (26.6%) and central obesity (49.7%). A similar high age-adjusted prevalence was observed in women and men for hypertension (29.7% and 28.8%), diabetes (12.94% and 12.66%), and hypercholesterolemia (13.81% and 12.36%). There was a clear age effect on the prevalence of diabetes, hypertension, and hypercholesterolemia, with increasing prevalence with aging. Smoking also had an age effect, but its prevalence increases as age diminishes. More than half of the subjects in reproductive age (20-44 years old) have at least 1 cardiovascular risk factor, mainly smoking. CONCLUSIONS: Cardiovascular risk factors are highly prevalent in the Mexican population, which seems to be between the second and third stages of the tobacco epidemic. The increased prevalence of risk factors clustering indicates the need for comprehensive integrated management of cardiovascular risk factors in Mexicans, with special emphasis on individuals at younger ages.

[ENCOPREVENIMSS 2003, 2004 and 2005. 1. Methodology and studied population]. / ENCOPREVENIMSS 2003, 2004 y 2005. 1. Metodología y población estudiada.

In order to assess the progress of preventive health programs by measuring the coverage and other health indicators, ENCOPREVENIMSS (Health National Surveys) 2003, 2004 and 2005 were carried out. These surveys were applied nationwide to population affiliated to the Mexican Institute of Social Security, and were representative at a state level. The sampling frame was stratified, with several stages, by clusters, and had a minimum sample of 328 people per program group in each delegation. The applied questionnaires were previously designed and evaluated through a pilot test. They included specific questions for each program component per age group. In 2004, two sections were added, based on validated instruments to evaluate frequency of food intake and physical activity. A total of 79,797 people were surveyed: 117,884 in 2004, and 122,380 in 2005. A third of the population was insured, while the rest was beneficiary; about half the population was between 20 and 59 years old, and the proportion of people older than 60 increased almost 2% from 2003 to 2005. More than 90% of those who claimed to have a paid job were factory workers or employees. More than 90% of the population were assigned to a family physician in all the assessed years. The information obtained from ENCOPREVENIMSS is a valuable tool to conduct institutional policies for public health.

[ENCOPREVENIMSS 2003. Prevalence of low weight, overweight, general obesity and central obesity]. / ENCOPREVENIMSS 2003. 4. Prevalencia de peso bajo, sobrepeso, obesidad general y obesidad central.

OBJECTIVE: to estimate the prevalence of malnutrition in the population attending the Mexican Institute of Social Security. MATERIAL AND METHODS: we studied a 25% subset of the National Survey of Coverage of Integrated Health Programs performed in 2003 to estimate weight and height with standardized procedures; in adults over 20, waist circumference was also measured. We considered central obesity as waist circumferences larger than 88 cm for females and 102 cm for males. Based on weight and height, the prevalence of low weight, overweight and general obesity was estimated; based on waist circumference, central obesity was assessed. RESULTS: the prevalence of low weight in men and women was, respectively, of 5.3 and 6.4% in children; 6 and 8.2% in adolescents; almost none in adults, and of 11.7 and 3.6% in seniors. On the other hand, we observed that the prevalence of overweight and obesity increased progressively in both sexes since the first decade of life up to 87% in females between 50 and 59 years old and 82% in males between 40 and 49. The risk of central obesity was very high in women older than 20 in all decades of life (36.6 to 74.2%). In men, this risk had lower prevalence (12 to 31.7%). In the northern part of the country, women presented more central obesity, while in the southeast, men did. CONCLUSION: this report highlights the alarming prevalence of malnutrition in the Mexican Institute of Social Security population. This information is relevant for future strategies aiming to prevent these serious health problems.

[ENCOPREVENIMSS 2004. 5. Intake of healthy or potentially unhealthy food]. / ENCOPREVENIMSS 2004. 5. Consumo de alimentos saludables o con riesgo para la salud.

OBJECTIVE: to know the prevalence of healthy or potentially unhealthy food intake in the population insured by the Mexican Institute of Social Security. MATERIAL AND METHODS: food intake was obtained from frequency questionnaires classified as healthy (HF) or potentially unhealthy food (PUF), and according to its nature and frequency consumption. The prevalences according to age groups were obtained for <1 year old and every five years until 19; then, they were recorded by decades, sex, location and place of residence, with or without coast. RESULTS: in the first year of age, the consumption of HF is low, and the intake of PUF starts, with industrialized juices and soft drinks. Between the first and the ninth year of age, the consumption of HF increases; however, the intake of PUF increases too; there is not a significant intake of red meat, eggs and fish. Throughout adolescence, HF intake and diversity increases, although PUF consumption is higher too. In adults and senior citizens, the kind of HF most frequently consumed were cereals and leguminous plants, but they barely ate fruits and vegetables. The HF of greatest consumption were those of animal origin, and the riskiest ones were very greasy daily products with saturated fat, as well as soft drinks. We found that the population living in the Pacific coast consumes more sea food than the one living in the Gulf coast. We also found that, as people get older, the intake of PUF decreases. CONCLUSION: in the first years of life, the proper intake of meat, eggs and fish should be promoted, as well as the consumption of HF and the decrease of food with refined sugar, saturated fat or salt.

[ENCOPREVENIMSS 2004. 6. Men and women's pattern of physical activity]. / Encoprevenimss 2004. 6. Patrones de actividad física de la mujer y del hombre.

OBJECTIVE: to determine the prevalence of physical activity in population from 20 to 59 years old covered by the Mexican Institute of Social Security. MATERIAL AND METHODS: the prevalence of physical activity was estimated, classifying it according to its intensity, frequency and duration. Recommended physical activity was considered when moderate activity was done at least five days a week, for 30 minutes, or when vigorous activity was done three days a week, for 20 minutes. Insufficient activity was that with lower frequency or duration than recommended, and inactivity, when no activity was done. RESULTS: the sample included 30,270 women and 25,237 men. The global prevalence of recommended physical activity was 17.7%; the one of insufficient physical activity, 65.5%, and the one of physical inactivity, 16.8%. The prevalence of physical inactivity in men and women was 13.8 and 19.4%, respectively. The most frequently reported activities in men and women with recommended or insufficient activity levels were walking (44.3%), running or jogging (34.2%) and soccer (10%). Women and men who watched television very often had a prevalence of physical inactivity of 30.9 and 20.5%, respectively. CONCLUSIONS: the prevalence of recommended physical activity is low and that of inactivity is high. Some measures of intervention are needed in order to promote physical activity in adults.

[ENCOPREVENIMSS 2003. Reproductive health]. / Encoprevenimss 2003. 7. Salud reproductiva.

OBJECTIVE: to analyze the current situation of some aspects of reproductive health in population covered by the Mexican Institute of Social Security (IMSS), based on the results of the National Survey of Coverage of Integrated Health Programs (ENCOPREVENIMSS) 2003. MATERIAL AND METHODS: we collected and analyzed data on fertility, contraceptive practice and prenatal and puerperal care. For this purpose, we made specific files as follows: 5823 adolescents from 15 to 19 years old, 16,275 men from 20 to 59 years old and 16 866 women from 20 to 49 years old, of the total sample of 79,797 questionnaires of ENCOPREVENIMSS 2003. RESULTS: the specific fertility rate in adolescent females was registered in 40 live births for every thousand women in this age group. About 70% of men and 41.7% of women said they used some kind of contraceptive method in their first intercourse. The prevalence of contraceptive use among female adolescents was 56% and among women from 20 to 49 years old, it was 76.5%, with the largest proportions of definitive or high-continuity contraceptive methods: 50.1% for tubal occlusion and 19.9% for intrauterine device. Global fertility rate for the whole population covered by IMSS was 2.56. Prenatal care coverage was 97.1% in adolescents and 98.2% in women from 20 to 49 years old. CONCLUSIONS: the data of ENCOPREVENIMSS 2003 confirm a high prevalence of contraceptive use in female population covered by IMSS, very similar to what was observed in other national surveys and in the population covered by IMSS. Besides, women attending IMSS show a reduction of fertility that gets them closer to demographic replacement rates.

Chlamydia trachomatis como factor de riesgo de algunas complicaciones del embarazo / Chlamidya trachomatis as a risk factor of some complications of pregnancy

De marzo a septiembre de 1994, se realizó un estudio transversal en el Hospital Rural de Solidaridad de Tlacolula, Oaxaca, para evaluar la relación existente entre la infección endocervical por Chlamydia trachomatis y la presentación de aborto, muerte fetal e hijos con bajo peso al nacer. Se incluyeron mujeres mayores de 15 años de edad con al menos un embarazo en su vida y que asistieran a demandar consulta o fueran con acompañantes. Les fue realizado un cuestionario que incluyó algunas complicaciones durante sus embarazos y se les tomó una muestra endocervical para valorar la presencia de Chlamydia trachomatis, la cual fue procesada por medio de inmunofluorescencia directa. Un total de 40 mujeres tuvieron un resultado positivo a la prueba. La prevalencia de la infección fue de 12.2 por ciento en las mujeres de 15 a 24 años (IC 95 por ciento 6.7-17.7), disminuyendo en los grupos de mayor edad. Las participantes que iniciaron su vida sexual entre los 15 y los 19 años mostraron una ocurrencia de 9.3 por ciento (IC 95 por ciento 6.1-12.6). Quienes tenían antecedentes de algún aborto o muerte fetal, mostraron una prevalencia de 13.3 y 18.2 por ciento, respectivamente. El bajo peso al nacer estuvo presente en el 33.3 por ciento de las pacientes infectadas. Este estudio mostró que las mujeres con infección por Chlamydia trachomatis presentaron mayor frecuencia de complicaciones durante sus embarazos

Hipertensión arterial, obesidad y herencia en la ocurrencia de la diabetes mellitus no dependiente de insulina / Arterial hypertension, obesity and family history in non-insuline dependent diabetes mellitus

Recientemente se ha postulado la existencia de un síndrome de resistencia a la insulina caracterizado, entre otros eventos, por diabetes mellitus no dependiente de insulina (DMNDI), obesidad, hipertensión arterial, cardiopatía isquémica y dislipidemia. Para estudiar la asociación existente entre DMNDI, cardiopatía isquémica y dislipidemia, obesidad, hipertensión arterial entre éstos y los antecedentes familiares de diabetes se realizó un estudio transversal con los registros del programa de detección oportuna de diabetes de la Unidad de Medicina Familiar No. 21 del Instituto Mexicano del Seguro Social. Se estudiaron 26,069 pacientes. Los hipertensos tuvieron dos veces mayor riesgo de padecer DMNDI (Razón de momio (RM) 2.1; IC 95 por ciento 1.4-3.3) similar a lo observado en los obesos (RM 1.6;IC 95 por ciento 1.0-2.8), y en aquéllos con historia familiar de diabetes (RM 1.8;IC 95 por ciento 1.2-2.7). La DMNDI es muy frecuente en la población mexicana, probablemente por una mayor predisposición genética al síndrome de resistencia a la insulina