The Trend in the Prevalence of Diabetes Mellitus in the Mexican Indigenous Population From 2000 to 2018.

Introduction: Diabetes is a worldwide public health problem. In Mexico, diabetes was the third leading cause of death in the total population in 2020. The indigenous people in Mexico are approximately 6%. This study aims to estimate the trends in diabetes prevalence from 2000 to 2018 in the group of Mexican indigenous language speakers and to analyze the main sociodemographic (e.g., age, educational and socioeconomic level, and the urbanicity of the area of residence) and clinical (e.g., age of diabetes onset, years with diabetes, and BMI) characteristics of this group. Methods: This cross-sectional study included participants aged ≥20 years from 4 National Health Surveys, 2000-2018. We presented the analyses for indigenous and nonindigenous strata. Logistic models adjusted were used to estimate the trend of diabetes in the study period. Results: We found a significant increase in the prevalence of diabetes in the indigenous group. This trend in the ORs was maintained when adjusting for age, sex, waist circumference, and area of residence. For the study period, the prevalence change in diagnosed diabetes in the indigenous group was greater than that in the nonindigenous group (OR=6.4, 95% CI=4.1, 8.8 and OR=3.3, 95% CI=2.5, 4.1, respectively). We also found a significant prevalence change in undiagnosed diabetes for the indigenous group (OR=7.7, 95% CI=1.3, 14.6). Conclusions: In contrast to the results in nonindigenous populations, our main result reveals an increasing probability of being diabetic in the indigenous population from 2006 to 2018. It is necessary to clarify the origin of the accelerated change in diabetes prevalence among the indigenous population in Mexico.

Screening tool for restrictive and obstructive ventilatory abnormalities in a population-based survey

Abstract Background: A 6 s spirometry with an inexpensive pocket spirometer efficiently selects individuals for a diagnostic-quality spirometry for airflow limitation, but could also be useful to identify individuals with a restrictive pattern. Objectives: We evaluated an inexpensive simplified spirometer (chronic obstructive pulmonary disease [COPD]-6) as a screening tool to identify spirometric abnormalities. Methods: A population-based survey in Mexico City, with 742 participants performing pre- and post-BD spirometry and a three-maneuver 6 s spirometry (pre-BD) with a COPD-6. We evaluated forced expiratory volume in 1 s (FEV1), FEV6, and FEV1/FEV6 from the COPD-6, crude and expressed as the percentage of predicted (%P), to discriminate post-bronchodilator airflow obstruction (FEV1/forced vital capacity [FVC] <5th percentile) or restriction (FVC or FEV1 <5th percentile with normal FEV1/FVC) through receiver operating characteristics and their area under the curve (AUC). Results: FEV1%P was the best predictor to identify pre- and post-BD ventilatory abnormalities (best cutoff point 87%P, AUC 92% for restrictive pattern, 89% for obstructive pattern, and 91% for any spirometric abnormality). Deriving to clinical spirometry only those with <87%P (26% of the sample) missed only 12% of spirometric abnormalities most of the latter mild. Conclusions: An FEV1 <87%P from a pre-BD 6 s spirometry correctly identified individuals with spirometric ventilatory defects, either obstructive or restrictive.

Knowledge and stigma of latent tuberculosis infection in Brazil: implications for tuberculosis prevention strategies.

BACKGROUND: Tuberculosis (TB) elimination requires treatment of millions of persons with latent M. tuberculosis infection (LTBI). LTBI treatment acceptance depends on population-wide TB knowledge and low stigma, but limited data are available on the relationship between stigma and knowledge. We assessed knowledge of TB disease and LTBI throughout Brazil and examined their association with TB stigma and incidence. METHODS: We performed a nationwide survey with multi-stage probability design through AmericasBarometer from April-May 2017; the sample was representative of Brazil at regional and national levels. Knowledge of and stigma toward TB were assessed by validated survey questions. RESULTS: Survey-weighted responses of 1532 individuals suggest that 57% of the population knew LTBI can occur, and 90% would seek treatment for it. Regarding active TB, 85% knew TB symptoms, 70% reported they should avoid contact with someone with active TB, and 24% had stigma toward persons with TB (i.e., thought persons with tuberculosis should feel ashamed, or deserved their illness). In regression models adjusting for clinical and demographic variables, knowledge of LTBI was associated with increased stigma toward persons with TB (adjusted odds ratio [OR] = 2.13, 95% confidence interval [CI]: 1·25-3.63, for "should feel ashamed"; OR = 1·82, 95% CI: 1·15-2·89, for "deserve illness"). Adjusting for regional TB incidence did not affect this association. CONCLUSIONS: High proportions of this representative Brazilian population had knowledge of LTBI and were willing to seek treatment for it. However, such knowledge was associated with TB-specific stigma. Strategies to educate and implement treatment of latent tuberculosis must include efforts to decrease TB stigma.

Population-Based Study of Trachoma in Guatemala.

PURPOSE: A prevalence survey for active trachoma in children aged under 10 years and trichiasis in women aged 40 years and older was carried out in four districts in the Sololá region in Guatemala, which is suspected of still having a trachoma problem. METHODS: Population-based surveys were undertaken in three districts, within 15 randomly selected communities in each district. In addition, in a fourth district that borders the third district chosen, we surveyed the small northern sub-district, by randomly selecting three communities in each community, 100 children aged under 10 years were randomly selected, and all females over 40 years. Five survey teams were trained and standardized. Trachoma was graded using the World Health Organization simplified grading scheme and ocular swabs were taken in cases of clinical follicular or inflammatory trachoma. Prevalence estimates were calculated at district and sub-district level. RESULTS: Trachoma rates at district level varied from 0-5.1%. There were only two sub-districts where active trachoma approached 10% (Nahualá Costa, 8.1%, and Santa Catarina Costa, 7.3%). Trichiasis rates in females aged 40 years and older varied from 0-3%. Trachoma was likely a problem in the past. CONCLUSIONS: Trachoma is disappearing in the Sololá region in Guatemala. Health leadership may consider further mapping of villages around the areas with an especially high rate of trachoma and infection, and instituting trichiasis surgery and active trachoma intervention where needed.

Triagem sorológica para doença celíaca em adolescentes / Serologic screening of celiac disease in adolescents

OBJETIVO: Este estudo objetivou identificar a soroprevalência da doença celíaca em adolescentes de escolas públicas da cidade de Salvador, Bahia. MÉTODO: Trata-se de um estudo transversal com amostra probabilística de 1.213 adolescentes de 11 a 17 anos, de ambos os sexos. O índice de massa corporal foi utilizado para o diagnóstico do estado nutricional, adotando-se os percentis segundo idade e sexo, propostos pela World Health Organization. O anticorpo anti-transglutaminase humana da classe imunoglobulina A (anti-tTG-IgA) foi adotado como teste sorológico para triagem da doença celíaca e foi determinado pela técnica do ensaio imunoabsorvente ligado à enzima (ELISA). Foi realizada análise descritiva, utilizando-se a proporção e a média (desvio padrão). RESULTADOS: O sexo feminino predominou entre os adolescentes, e a maioria encontrava-se com adequado estado nutricional. O anticorpo anti-tTG-IgA foi positivo em 6/1.213 (0,49%) adolescentes. CONCLUSÃO: A soroprevalência de doença celíaca entre os adolescentes estudados foi 0,49%. Novas investigações são necessárias para confirmar a prevalência de doença celíaca nessa faixa etária. .

OBJECTIVE: This study aimed to identify the seroprevalence of celiac disease in adolescents from public schools in the city of Salvador, Bahia. METHODS: This was a cross-sectional study with probabilistic sample of 1,213 adolescents, aged 11 to 17 years old, of both genders. The body mass index was used to determine the participants' nutritional status based on the percentiles for age and gender recommended by the World Health Organization. Measurement of the anti-human transglutaminase immunoglobulin A (anti-tTG-IgA) antibody was established as the specific screening test for celiac disease, which involved an enzyme-linked immunosorbent assay (ELISA). Descriptive analysis was performed using proportions and means (standard deviation). RESULTS: The female gender prevailed in the sample, and most of the participants had normal weights. The anti-tTG-IgA antibody was positive in 6/1,213 (0.49%) adolescents. CONCLUSION: The seroprevalence of celiac disease was 0.49% in the investigated adolescents. Further studies are necessary to establish the prevalence of celiac disease in this age range. .

Polifarmácia entre idosos do Município de São Paulo - Estudo SABE / Polypharmacy among the elderly in the city of São Paulo, Brazil - SABE Study

Foi avaliado o uso de cinco ou mais medicamentos (polifarmácia) e seus fatores associados por idosos do município de São Paulo. Realizou-se estudo transversal de base populacional: Estudo SABE - Saúde, Bem-estar e Envelhecimento, no ano de 2006. A amostra foi composta por 1.115 idosos com 65 anos e mais, que correspondiam a 422.377 indivíduos do Município de São Paulo. Utilizou-se regressão logística múltipla. A prevalência de polifarmácia foi de 36%. Sexo feminino (OR = 1,7; IC 95%: 1,0; 2,9), idade igual ou superior a 75 anos (OR = 1,9; IC 95%: 1,3; 2,7), maior renda (OR = 1,8; IC 95%: 1,2; 2,8), estar trabalhando (OR = 1,8; IC 95%: 1,1; 2,9), auto avaliação de saúde regular (OR = 1,6; IC 95%: 1,1; 2,3) ou ruim (OR = 2,6; IC 95%: 1,4; 4,9), hipertensão (OR = 2,0; IC 95%: 1,4; 2,9), diabetes (OR = 4,1; IC 95%: 2,2; 7,5), doença reumática (OR = 2,3; IC 95%: 1,5; 3,6) e problemas cardíacos (OR = 2,9; IC 95%: 1,9; 4,5) apresentaram associação positiva com polifarmácia. Usar apenas o sistema público de saúde (OR = 0,5; IC 95%: 0,3; 0,7) associou-se inversamente à polifarmácia. Os medicamentos mais utilizados foram os de ação no sistema cardiovascular e trato alimentar e metabolismo. No âmbito da farmacoepidemiologia, o conhecimento dos fatores associados a polifarmácia, como os identificados nesse estudo, pode ser útil para alertar os profissionais da saúde quanto à importância de identificar e monitorar os grupos de idosos mais vulneráveis a polifarmácia.

Polypharmacy for the elderly and associated factors were assessed. A cross-sectional study was conducted using data from the SABE Study (Health, Well-being and Aging), 2006. 1,115 individuals representing 422,377 elderly aged 65 or more, living in São Paulo City, were interviewed. Polypharmacy was defined as the use of five or more medications. A multivariate regression logistics was used. Polypharmacy prevalence was 36%. Female (OR = 1.7; IC 95%: 1.0; 2.9), age over 75 years (OR = 1.9; CI 95%: 1.3; 2.7), higher income (OR = 1.8; CI 95%: 1.2; 2.8), working (OR = 1.8; CI 95%: 1.1; 2.9), regular self assessed health (OR = 1.6; CI 95%: 1.1; 2.3) or poor (OR = 2.6; CI 95%: 1.4; 4.9), hypertension (OR = 2.0; CI 95%: 1.4; 2.9), diabetes (OR = 4.1; CI 95%: 2.2; 7.5), rheumatic diseases (OR = 2.3; CI 95%: 1.5; 3.6) and cardiac problems (OR = 2.9; CI 95%: 1.9; 4.5) were associated positively with polypharmacy. Using only the public health system (OR = 0.5, 95% CI: 0.3; 0.7) was inversely associated with polypharmacy. Medicines for the cardiovascular system and for the alimentary tract and metabolism were the most used. The knowledge of factors associated with polypharmacy, such as those identified in this study, may be useful to alert health professionals about the importance of identifying and monitoring the elderly groups most vulnerable to polypharmacy.