Don't take the context out of the picture: Contextually shaped parents' and children's obesogenic behaviors in a marginalized area of Mexico City.

Santa Fe Gully zone is a marginalized area of Mexico City where nearly 39% of children live with either overweight or obesity. Despite the extensive research on obesogenic behaviors, studies frequently overlook the contexts where such behaviors occur. This qualitative study described individual and familial obesogenic behaviors among children with obesity from Santa Fe Gully, and explained how these behaviors might be contextually shaped. We used a grounded theory approach to investigate the process of development/maintenance of obesity in our sample. Fifteen participants (seven 10-year-olds with overweight or obesity and their parents) participated in nine art-based focus groups, and parents completed individual semi-structured interviews. Data were analyzed using a structured thematic content analysis. Results showed children's weight status was part of their identity, providing children with a familial 'fitting' sense while increasing psychosocial difficulties, leading to emotional overeating as a coping strategy. Parents' use of controlling and low-structured parenting practices reinforced children's emotional overeating and failed to regulate children's dietary and physical activity behaviors. Some low-structured parenting practices were guilt-motivated or fostered by socioeconomic and cultural factors (e.g., limited food access, unhealthy food exposure, community unsafety). Future interventions in Santa Fe Gully aimed at modifying obesogenic behaviors should incorporate systemic and ecological approaches to help participants navigate through contextual obstacles, as their behaviors should be analized considering the context where they occur.

Cut-off points for serum ferritin to identify low iron stores during the first year of life in a cohort of Mexican infants.

The aim of this study was to identify serum ferritin (SF) cut-off points (COPs) in a cohort of healthy full-term normal birth weight infants who had repeated measurements of SF and haemoglobin every 3 months during the first year of life. The study included 746 full-term infants with birth weight ≥2,500 g, having uncomplicated gestations and births. Participants received prophylactic iron supplementation (1 mg/day of iron element) from the first to the 12th month of life and did not develop anaemia during the first year of life. Two statistical methods were considered to identify COPs for low iron stores at 3, 6, 9 and 12 months of age: deviation from mean and cluster analysis. According to the K-means cluster analysis results by age and sex, COPs at 3 and 6 months for girls were 39 and 21 µg/L and for boys 23 and 11 µg/L, respectively. A single COP of 10 µg/L was identified, for girls and boys, at both 9 and 12 months. Given the physiological changes in SF concentration during the first year of life, our study identified dynamic COPs, which differed by sex in the first semester. Adequate SF COPs are necessary to identify low iron stores at an early stage of iron deficiency, which represents one of the most widespread public health problems around the world, particularly in low- and middle-income countries.

Childhood obesity in Mexico: A critical analysis of the environmental factors, behaviours and discourses contributing to the epidemic.

Mexico has the highest prevalence globally for children who are overweight. We conducted a qualitative study to understand childhood obesity in Mexico and the complex factors at play. Data were collected at three elementary schools in a low socio-economic area in Mexico City. Semi-structured interviews were conducted with 60 children, 24 parents and 28 teachers. The children interviewed were between the ages of 8 and 12 years old. Interview texts were analysed using NVivo 9 and 10 and thematic discourse analysis was used. Findings revealed how children's choices around nutrition and physical activity were constrained by their environment and discursive constructions.

Energy imbalance and psychosocial imbalance in the construction of child obesity in a marginalized area of Mexico City / Desbalance energético y desbalance psicosocial en la construcción de la obesidad infantil en una zona marginada de la Ciudad de México

Abstract Introduction Child obesity is a growing phenomenon and marginalized communities in Mexico City are not exempt from it. The results achieved by frequent preventive and remedial interventions are still unacceptable. Objective To contribute to the understanding of the growing problem of child obesity and overweight through a community health approach capable of transcending the biological perspective in order to improve interventions. Method We observed and interviewed a sample of school children, some overweight, some obese, and some with a normal BMI. All observations and interviews were carried out in the children's daily environment. We also interviewed some of their mothers. Together with our field notes, we analyzed these testimonies to construct the Grounded Theory that is the output of the present study. Results We found the children and their families immersed in a toxic environment that, through several mechanisms, fosters the consumption of high-density foods and discourages physical activity. We also found that the resources and competencies that families could use to fend off this environment are, at present, very limited. Discussion and conclusion We concluded that the energy imbalance in overweight and obese children's bodies corresponds to an abysmal psychosocial imbalance between the forces that foster obesity and the resources of the families affected by it. Any intervention aimed at preventing obesity must take this psychosocial imbalance into account.

Resumen Introducción La obesidad infantil es un fenómeno creciente del cual no quedan exentas las comunidades marginales de la Ciudad de México. Las intervenciones preventivas y remediales son frecuentes, pero sus impactos todavía no son aceptables. Objetivo Contribuir a la comprensión del fenómeno creciente de la obesidad y el sobrepeso infantil con una visión de salud comunitaria, que trascienda la visión biológica del problema y mejore las intervenciones. Método En su entorno escolar y comunitario observamos y entrevistamos a escolares, unos con obesidad o sobrepeso y otros con índice de masa corporal normal. También entrevistamos a las madres de algunos de ellos. Analizamos estos testimonios y nuestras notas de campo para construir la Teoría Fundamentada producto de este estudio. Resultados Encontramos a los niños y sus familias inmersos en un ambiente tóxico que, por múltiples mecanismos, promueve el consumo de alimentos de alta densidad e inhibe la actividad física. Encontramos también que los recursos y habilidades con que las familias podrían resistir a este ambiente son, por lo pronto, muy reducidos. Discusión y conclusión Concluimos que el desbalance energético en el cuerpo de los niños con sobrepeso corresponde a un enorme desbalance psicosocial entre las fuerzas que promueven la obesidad y los recursos de las familias que la sufren. Toda intervención preventiva debe tomar en cuenta este desequilibrio psicosocial.

Estudio sobre la experiencia de hombres atendidos en centros residenciales de ayuda mutua para la atención de las adicciones / Study on the experience of men treated in mutual aid residencial substance abuse attention centers

Addictive disorders and behaviors have increased in the past years in Mexico. These behaviors and disorders are considered a public health issue because of the social and economic strains they generate. However, the state is unprepared to attend such high demands. Non government organizations have arisen in order to fulfill this demand, but it is known that many of them do not regard federal health regulations and often they have infringed the basic human rights. The present study has for objective to analyze the experience of men who have been atended in self-help residential substance abuse attention centers. Fifteen focalized interviews were carried out with men of different characteristics, all of them having been attended in at least two centers. The results help to understand the consumption dynamic, usually linked to family abandonment and anger. It further analyzes the unhealthy and inhuman services offered in many of these centers such as poor feeding and hygiene services; many of the men are admitted violently and against their will. It is concluded that even though these centers respond to the demand that addictive disorders have, they do not professionally and skillfully support a rehabilitation process. It is thus of utter importance to guarantee the training and proffessionalization of these centers' staff through an observation and regulation process.

Los trastornos y conductas adictivas se han incrementado en México en los últimos años. Estas conductas y trastornos son considerados un problema de salud pública debido a los estragos sociales y económicos que implican. Sin embargo, la demanda de atención ha rebasado las capacidades del Estado, por lo que han surgido organizaciones civiles que buscan responder a dicha problemática, aunque en muchas ocasiones esto suele hacerse sin atender a la reglamentación federal para la atención de la salud y las adicciones, por lo que existen casos en los que se han violentado los derechos humanos básicos. El presente estudio tuvo por objetivo analizar la experiencia de hombres atendidos en centros residenciales de ayuda mutua para la atención de las adicciones. Se llevaron a cabo 15 entrevistas focalizadas con hombres de diferentes características, que habían sido internados en al menos dos de estos centros. Los resultados ayudan a comprender la dinámica de consumo, que usualmente está ligada al abandono familiar y al enojo. Además, se analiza el uso de servicios de estos centros, como alimentación e higiene. Se encontró que muchos de estos hombres fueron ingresados de manera involuntaria y se vieron expuestos a diversas formas de abuso. Se concluye que a pesar de que estos centros responden a una necesidad de la sociedad para atender los problemas de salud que generan las adicciones, es imprescindible garantizar el respeto a los derechos humanos, asegurando la regulación y reglamentación de los centros.

A contrast between mothers' assessments of child malnutrition and physical anthropometry in rural Mexico: a mixed methods community study.

OBJECTIVE: To compare mothers' assessments of nutritional status with anthropometric measures and gain further insights into mothers' reasons for their judgment. DESIGN: Each mother was asked to assess the nutritional status of her child and 2 other children and to compare all 3. Rates for "hits" and "misses" between mothers' assessment and physical anthropometry were analyzed using the binomial test. The rationale for the mothers' assessments was explored through open-ended questions. SETTING: A rural clinic in an indigenous area of Mexico. PARTICIPANTS: 31 mothers of children 1-5 years of age. MAIN OUTCOME MEASURES: Physical anthropometry and mothers' assessments. RESULTS: A significant proportion (P

Prevalence of anemia and deficiency of iron, folic acid, and zinc in children younger than 2 years of age who use the health services provided by the Mexican Social Security Institute.

BACKGROUND: In Mexico, as in other developing countries, micronutrient deficiencies are common in infants between 6 and 24 months of age and are an important public health problem. The objective of this study was to determine the prevalence of anemia and of iron, folic acid, and zinc deficiencies in Mexican children under 2 years of age who use the health care services provided by the Mexican Institute for Social Security (IMSS). METHODS: A nationwide survey was conducted with a representative sample of children younger than 2 years of age, beneficiaries, and users of health care services provided by IMSS through its regular regimen (located in urban populations) and its Oportunidades program (services offered in rural areas). A subsample of 4,955 clinically healthy children was studied to determine their micronutrient status. A venous blood sample was drawn to determine hemoglobin, serum ferritin, percent of transferrin saturation, zinc, and folic acid. Descriptive statistics include point estimates and 95% confidence intervals for the sample and projections for the larger population from which the sample was drawn. RESULTS: Twenty percent of children younger than 2 years of age had anemia, and 27.8% (rural) to 32.6% (urban) had iron deficiency; more than 50% of anemia was not associated with low ferritin concentrations. Iron stores were more depleted as age increased. Low serum zinc and folic acid deficiencies were 28% and 10%, respectively, in the urban areas, and 13% and 8%, respectively, in rural areas. The prevalence of simultaneous iron and zinc deficiencies was 9.2% and 2.7% in urban and rural areas. Children with anemia have higher percentages of folic acid deficiency than children with normal iron status. CONCLUSION: Iron and zinc deficiencies constitute the principal micronutrient deficiencies in Mexican children younger than 2 years old who use the health care services provided by IMSS. Anemia not associated with low ferritin values was more prevalent than iron-deficiency anemia. The presence of micronutrient deficiencies at this early age calls for effective preventive public nutrition programs to address them.

[Growth in weight and height in children less than two years old in the IMSS]. / Crecimiento en peso y longitud de los niños menores de dos años atendidos en el IMSS.

OBJECTIVE: To describe the physical growth in weight and height of children less than two years of age cared for the Mexican Institute of Social Security (IMSS). MATERIAL AND METHOD: A population-based National Survey, which was also regional representative, was carried out in Ordinary Regime (RO) and the IMSS-Oportunidades Program (IO). In two years (2000-2002) the study gathered data on 17,502 children from the RO and 9872 from IO. The measures of weight and length were made by nurses, according to WHO criteria. Growth is reported as weight and length for each month of age and gender, in tables and percentile curves derived from quintile regressions, using a third degree polynomial to smooth out the lines. RESULTS: The trends of the means of weight and height in the first two years of life in children cared by Instituto Mexicano del Seguro Social show a pattern similar to those described in healthy children in other populations. However, the values are lower than those obtained in developed countries. CONCLUSIONS: Children's growth at two years of age at the Instituto Mexicano del Seguro Social shows a curve that is lower than that of the reference population recommended by the World Health Organization as an international standard.

Descriptive ethics: a qualitative study of local research ethics committees in Mexico.

OBJECTIVE: To describe how local research ethics committees (LRECs) consider and apply research ethics in the evaluation of biomedical research proposals. DESIGN: A qualitative study was conducted using purposeful sampling, focus groups and a grounded theory approach to generate data and to analyse the work of the LRECs. SETTING AND PARTICIPANTS: 11 LRECs of the Mexican Institute of Social Security (IMSS). RESULTS: LRECs considered ethics to be implicit in all types of research, but that ethics reviews were only necessary for projects that included the direct participation of human beings. The LRECs appeared to understand the importance of consent, as in the completion of a consent form, but did not emphasise the importance of the process of acquiring 'informed' consent. The committees considered their main roles or functions to be: (a) to improve the methodological quality of research and to verify - if applicable - the ethical aspects; (b) to encourage personnel to undergo research training; (c) to follow-up research to oversee the adherence to norms and compliance with a specified research timetable. CONCLUSIONS: This study provides a valuable insight into how these LRECs understand the ethical review process. The emphasis of the committees was on rules, regulations, improving research methodology and research training, rather than a focus on efforts to protect the rights and well being of research subjects. The results encourage further normative and descriptive lines of investigation concerning education and the development of LRECs.

The social construction of anemia in school shelters for indigenous children in Mexico.

Indigenous children in school shelters in Mexico suffer from anemia in spite of food that is subsidized, prepared, and served to them. Economically and biomedically centered strategies to reduce anemia have achieved only partial and short-term success. An interdisciplinary team investigated the food security system of the school shelters and collected data through interviews and participant observation. The analysis revealed that the children's nutrition depends on a frail chain of events in which a single link's failure can lead to nutritional insecurity. The authors conclude that the social actors involved in the process are mainly considering the economic aspects of nutrition, but anemia persists as a social construction of the faulty relationship between the institution that runs the shelters and the indigenous culture. The authors make suggestions for an intervention that empowers the community by involving it actively in solving the problem.

Infant feeding practices and early flavor experiences in Mexican infants: an intra-cultural study.

OBJECTIVES: The study explored the maternal beliefs and practices related to pregnancy, breastfeeding, and infant feeding among women living in several regions in Mexico. We hypothesized that, despite the culinary diversity within Mexico, there would be similar patterns in the types of flavors and foods eaten by mothers and fed to infants. DESIGN: A structured interview was conducted through personal interviews with mothers during routine visits to their local family medical units. The units were located in four regions in Mexico that represent the diversity of culinary practices characteristic of the country. SUBJECTS: A random sample of 101 women whose infants ranged in age from 6 days to 9 months. RESULTS: Although the vast majority of mothers knew of its benefits and nursed their infants, breastfeeding during the first week of life was not exclusive; approximately one third of the infants were also fed teas, water, and/or formula. The feeding of teas continued throughout infancy in three of the regions, but the flavor of the tea differed. There were also regional similarities in the foods chosen and avoided during pregnancy and lactation and the type of first foods offered to the infants. CONCLUSIONS: The similarities in the types of foods fed to infants and eaten more of by mothers during pregnancy suggest that these cultural and regional practices contribute to the development of strong preferences for regional cuisines. The foods eaten by the mother during pregnancy and lactation form the basis of the child's weaning patterns.

[Beliefs and knowledge of a group of doctors about the nutritional management of the child with acute diarrhea]. / Creencias y conocimientos de un grupo de médicos sobre el manejo de la alimentación del niño con diarrea aguda.

OBJECTIVE: To identify the beliefs and knowledge of a group of rural physicians on the dietary management of children under five years of age, with acute diarrhea. Physicians' dietary management was compared with that recommended by the World Health Organization. MATERIAL AND METHODS: A cognitive anthropology study was carried out from July to December 1998, on ten physicians that care for the infant population ascribed to Hospital Rural IMSS-Solidaridad of San Juanito Bocoyna, Chihuahua, Mexico. Data were collected through focus groups, case vignettes, free listing, pile sorting, and a semi-structured questionnaire, and then cross-referred. RESULTS: The physicians recognized the negative impact of diarrhea on the nutritional state of the child, but not all of them evaluated this state. Prevailing interventions were antibiotic therapy, fluid management, and feeding recommendations. Among the latter, the most consistent were breastfeeding, delayed feeding, and gradual feeding. CONCLUSIONS: The obtained information is in conflict with WHO's recommendations, specially with that of sustained feeding. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Creencias y conocimientos de un grupo de médicos sobre el manejo de la alimentación del niño con diarrea aguda / Beliefs and knowledge of a group of doctors about the nutritional management of the child with acute diarrhea

OBJECTIVE: To identify the beliefs and knowledge of a group of rural physicians on the dietary management of children under five years of age, with acute diarrhea. Physicians' dietary management was compared with that recommended by the World Health Organization. MATERIAL AND METHODS: A cognitive anthropology study was carried out from July to December 1998, on ten physicians that care for the infant population ascribed to Hospital Rural IMSS-Solidaridad of San Juanito Bocoyna, Chihuahua, Mexico. Data were collected through focus groups, case vignettes, free listing, pile sorting, and a semi-structured questionnaire, and then cross-referred. RESULTS: The physicians recognized the negative impact of diarrhea on the nutritional state of the child, but not all of them evaluated this state. Prevailing interventions were antibiotic therapy, fluid management, and feeding recommendations. Among the latter, the most consistent were breastfeeding, delayed feeding, and gradual feeding. CONCLUSIONS: The obtained information is in conflict with WHO's recommendations, specially with that of sustained feeding.

The acceptability of self-collected samples for HPV testing vs. the pap test as alternatives in cervical cancer screening.

OBJECTIVE: To explore the acceptability of the self-collection of samples for human papillomavirus (HPV) testing in comparison with that of the Pap test. METHODS: The study population consisted of 1069 women 20 years and older who were eligible for coverage through the Mexican Institute of Social Security (IMSS). These women were randomly selected among participants in a larger study to evaluate the use of HPV testing as an alternative in cervical cancer screening. All participants provided a self-collected vaginal sample for HPV testing according to explicit instructions and underwent a Pap test. Afterwards, each woman was interviewed about her experience and opinion regarding the two procedures. Acceptability was measured by a calculated score based on discomfort, pain, embarrassment, privacy, perception of personal treatment during the Pap test, and understanding of how to perform the self-sampling method. RESULTS: Ninety-three percent of women experienced sufficient privacy with the Pap test, whereas 98% of women reported that privacy with the self-sampling procedure was acceptable. The Pap test consistently provoked more discomfort, pain, and embarrassment than self-sampling. Sixty-eight percent of the women who indicated a test preference chose self-sampling. Preference for this method was positively associated with monthly household income. Women reported a preference for self-sampling because it is more comfortable (71.2%) and causes less embarrassment (55.8%). CONCLUSIONS: Self-sampling is more acceptable than the Pap test and could improve coverage rates of early detection programs. The incorporation of self-collected samples to detect HPV could encourage participation in screening programs among those women who reject the Pap test because of the necessary pelvic examination.