Search

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. To describe and update to 2002 the prevalence of lead poisoning in the population of children 1-4 years old in Mexico and describe sources of environmental and paraoccupational exposure, and use of lead-glazed ceramics (LGC). Materials and methods. Study in a sample of children who participated in the Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022). The capillary blood lead levels (BLL) were measured. A questionnaire was applied to inquire about sources of lead exposure. Results. BLL were measured in 1 158 under 1-4 years. The national prevalence of lead poisoning (≥5.0 μg/dl) was 16.8% (95%CI:13.6,20.5). The proportion of households that reported exposure to an exclusive source was 21.2, 17.7 and 7.4% for LGC, environmental and paraoccupational exposure respectively. The prevalence of lead poisoning of those exposed to a single source was 21.5%; and this figure increases to 24.2% among those who reported combined exposure to the three types of sources. Conclusion. The national prevalence of lead poisoning remained stable with respect to the same indicator in Ensanut 2018-19. The use of LGC is a relevant source of exposure, but it is not the only one. An important contribution was identified by environmental exposure and to the lesser extent of paraoccupational exposure. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Rapid early weight gain has been associated with increased risk of obesity and cardiometabolic alterations, but evidence in low and middle-income countries is inconclusive.Objective: We evaluated the relation between relative weight gain from 1 to 48 mo with adiposity and cardiometabolic risk factors at 4-5 y of age, and determined if adiposity is a mediator for cardiometabolic alterations.Methods: We studied 428 Mexican children with anthropometric and blood pressure (BP) information from birth to 5 y of age from POSGRAD (Prenatal Omega-3 fatty acid Supplementation and child GRowth And Development), of whom 334 provided measures of adiposity and cardiometabolic risk markers at 4 y. We estimated relative weight gain by means of conditional weight-for-height z scores for the age intervals 1-6, 6-12, 12-24, and 24-48 mo. Associations between relative weight gain and adiposity and cardiometabolic risk markers (lipid profile, triglycerides, insulin, glucose, and BP) were analyzed by multivariate multiple linear models and path analysis.Results: A 1-unit increase in conditional weight-for-height z score within each age interval was positively associated with adiposity at 5 y, with coefficients of 0.43-0.89 for body mass index (BMI) z score, 1.08-3.65 mm for sum of skinfolds, and 1.21-3.87 cm for abdominal circumference (all P < 0.01). Positive associations were documented from ages 6 to 48 mo with systolic BP (coefficient ranges: 1.19-1.78 mm Hg; all P < 0.05) and from ages 12 to 48 mo with diastolic BP (1.28-0.94 mm Hg; P < 0.05) at 5 y. Conditional weight-for-height z scores at 12-24 and 24-48 mo of age were more strongly associated with adiposity and BP relative to younger ages. A unit increase in conditional weight-for-height z scores from 12 to 24 mo was associated with 14% higher insulin levels (P < 0.05) at 4 y. Path analyses documented that the associations of conditional weight gain with BP were mediated by BMI and sum of skinfolds.Conclusion: Relative weight gain at most periods during the first 4 y of life was associated with greater adiposity and higher systolic and diastolic BP at 5 y. These associations with BP were mediated by adiposity. Relative weight gain from 12 to 24 mo was associated with increased serum insulin concentrations at 4 y, but there were no associations with lipid profiles or glucose concentration. [ABSTRACT FROM AUTHOR]

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. Determine Vaccination Coverage (VC) among adults 60 years of age and older (EP), for influenza, pneumococcal and tetanus vaccines, association with socio-demographic characteristics and heterogeneity at state level. Material and Methods. Cross-sectional analysis based on information from 18 015 households visited in a national survey. General and vaccine information (self-report) for a randomly selected elder in each household is available. Results. The national VC level was found to be 56.5% (±0.97) for influenza, 44.3% (±0.98) for pneumococcus and 61.8% (±0.96) for tetanus. The VC was significantly lower for EP without health social services and higher for women. Almost 20.0% of EP recognized not having vaccines at all, due mainly that they didn't know it was a duty. Conclusions. Important improvements are shown in vaccination coverage among elderly in Mexico. Differentials suggest the need to intensify information campaigns and actions that could improve the accessibility to vaccines for this population. [ABSTRACT FROM AUTHOR]

Objective To evaluate if selected phthalate exposure and flavonoid intake interact on breast cancer (BC) risk. Material and methods Interviews and urine samples were obtained from 233 women with histologically confirmed BC and 221 healthy controls matched by age and place of residence, from various states of northern Mexico. Urinary metabolites concentrations of diethyl phthalate (DEP), butyl benzyl phthalate (BBzP) and dioctyl phthalate (DOP) were determined by solid-phase extraction coupled with high-performance liquid chromatography/isotope dilution/tandem mass spectrometry. Using a semiquantitative food frequency questionnaire, consumption of five types of flavonoids (anthocyanidins, flavan-3-ols, flavanones, flavones and flavonols) was estimated according to three food groups: vegetables, fruits and legumes-oil seeds. Results A higher intake of anthocyanidins and flavan-3-ols (from vegetables), synergistically increased the negative association between BBzP and BC. No other significant flavonoid-phthalate multiplicative interactions on the risk for BC were found. Conclusion The consumption of some flavonoids may interact with exposure to phthalates on the risk of BC. Epidemiological and underlying mechanisms information is still insufficient and requires further investigations. [ABSTRACT FROM AUTHOR]

• Mex-Cog is a data source for cognitive aging in Mexico linked to the larger MHAS. • Combines measurements of multiple domains of cognition and informant interviews. • Cross-walking to the MHAS extends the scope with longitudinal data and biomarkers. • Mex-Cog forms part of a multi-country Harmonized Cognitive Aging Protocol (HCAP). • Supports cross-national population-based research on cognitive aging and dementia. Describe the protocol sample and instruments of the Cognitive Aging Ancillary Study in Mexico (Mex-Cog). The study performs an in-depth cognitive assessment in a subsample of older adults of the ongoing Mexican Health and Aging Study (MHAS). The Mex-Cog is part of the Harmonized Cognitive Assessment Protocol (HCAP) design to facilitate cross-national comparisons of the prevalence and trends of dementia in aging populations around the world, funded by the National Institute on Aging (NIA). The study protocol consists of a cognitive assessment instrument for the target subject and an informant questionnaire. All cognitive measures were selected and adapted by a team of experts from different ongoing studies following criteria to warrant reliable and comparable cognitive instruments. The informant questionnaire is from the 10/66 Dementia Study in Mexico. A total of 2,265 subjects aged 55-104 years participated, representing a 70% response rate. Validity analyses showed the adequacy of the content validity, proper quality-control procedures that sustained data integrity, high reliability, and internal structure. The Mex-Cog study provides in-depth cognitive data that enhances the study of cognitive aging in two ways. First, linking to MHAS longitudinal data on cognition, health, genetics, biomarkers, economic resources, health care, family arrangements, and psychosocial factors expands the scope of information on cognitive impairment and dementia among Mexican adults. Second, harmonization with other similar studies around the globe promotes cross-national studies on cognition with comparable data. Mex-Cog data is publicly available at no cost to researchers. [ABSTRACT FROM AUTHOR]

With global C-section rates rising, understanding potential consequences is imperative. Previous studies suggested links between birth mode and psychological outcomes. This study evaluates the association of birth mode and neurodevelopment in young children across two prospective cohorts, using repeated psychometric assessments. Data from the ELEMENT (Early Life Exposures in Mexico to Environmental Toxicants) and PROGRESS (Programming Research in Obesity, Growth, and Environment and Social Stress) cohorts, comprising 7158 and 2202 observations of 1402 children aged 2 to 36 months, and 726 children aged 5 to 27 months, respectively, were analyzed. Exclusion criteria for the cohorts were maternal diseases such as preeclampsia, renal or heart disease, gestational diabetes, and epilepsy. Neurodevelopment was gauged via Bayley's Scales of Infant Development: 2nd edition for ELEMENT and 3rd edition for PROGRESS. Mixed-effects models longitudinally estimated associations between birth mode and neurodevelopment scores, adjusting for cofounders. In ELEMENT, psychomotor development composite scores were significantly affected by birth mode from ages 2 to 8 months; the largest estimate within this range was at 2 months (β =-1.93; 95% CI: [-3.64, -0.22], reference: vaginal delivery). For PROGRESS, a negative association was found with motor development composite scores over all the studied age range (β=-1.91; 95% CI: [-3.01, -0.81]). The association was stronger between ages 6 to 18 months, with the strongest estimate at 11 months (β=-2.58; 95% CI: [-4.37, -0.74]). A negative impact of C-section on language scores in girls was estimated for the PROGRESS cohort (β=-1.92; 95% CI: [-3.57, -0.27]), most marked in ages 22 to 25 months (largest β at 24.5 months=-3.04; 95% CI: [-5.79, -0.30]). Children born by C-section showed lower motor and language development scores during specific age windows in the first three years of life. Further research is necessary to understand the complexities and implications of these findings., (© 2024. The Author(s).)

Objective: To evaluate the associations of pre-gestational body mass index (BMI) and gestational weight gain (GWG) with the risks of overweight, obesity, and adiposity in the first seven years of life in the offspring of a cohort of pregnant women., Methods: Analysis of 751 mothers and their children participating in the PROGRESS cohort. These women were recruited in Mexico City between 2007 and 2010. Pre-gestational BMI was classified as normal, overweight, and obesity according to the WHO. GWG was calculated as the difference between the last reported pre-pregnancy weight and the pre-gestational weight and categorized as inadequate, adequate, or excessive, according to US IOM recommendations. Children's anthropometry was evaluated at 4-5 and 6-7 years of age. Adiposity was classified into three groups: normal (BMI z-score and waist circumference), overweight (BMI z-score>1), and overweight plus abdominal obesity (OW+AO). A generalized structural equation model (GSEM) was constructed to account for the temporal relationship between variables and to assess direct and indirect effects., Results: A total of 49.3% of the women had excessive (13.8 ± 4.2 kg) and 19.8% inadequate (3.15 ± 3.4 kg) GWG. Women with pre-gestational overweight or obesity were more likely to have excessive GWG (OR 1.9 [95% CI: 1.32, 2.74] and 3.50 [95% CI: 1.83, 6.69], respectively). In the GSEM, excessive GWG was directly associated with OW+AO at 4-5 years. At 6-7 years, pre-gestational obesity was associated with OW+AO., Conclusion: Pre-gestational obesity and excessive GWG were independent predictors of childhood obesity., Competing Interests: Disclosure The authors declare that they have no actual or potential competing financial interests. Completed disclosure of interest forms are available to view online as supporting information., (Copyright © 2024. Published by Elsevier Inc.)

The prevalence of childhood obesity has increased rapidly in Mexico, with significant consequences for the population's health in the future. Little is known about the prevalence of obesity in children under two years of age, even though this life stage is fundamental to prevent this condition. This study aims to determine the magnitude, distribution, and trends of overweight and obesity in children under 24 months of age using the Mexican National Health and Nutrition Surveys (ENSANUT) conducted in the last 10 years. The data presented here are derived from four ENSANUTs, carried out in Mexico in 2012, 2016, 2018, and 2020. They include 6,719 infants under 24 months with complete anthropometric data (weight/height) by age, gender, Indigeneity, area of residence, and socioeconomic status. The risk of overweight levels and overweight + obesity rates were calculated according to World Health Organization guidelines. We identified that infants < 12 months currently have a higher prevalence of overweight + obesity (10.3%) and that those aged 12 to 23 months are generally at a higher risk of overweight (26.1%). The most relevant findings of this study, linking weight trends to sex, region, socioeconomic status, and indigeneity, show that overweight and obesity prevalences vary across the Mexican population, without presenting a specific behavior. There is a high prevalence of overweight and obesity among Mexican infants and a slight trend toward increased obesity in infants < 12 months. Weight monitoring and obesity prevention interventions focused on the first 1,000 days of life are essential.

Background and Aim: An association between lead (Pb) exposure and antisocial behaviors has been documented, but findings have been inconclusive. We aimed to estimate the association between prenatal, early childhood, and preadolescent/adolescent (periadolescent) Pb exposure and aggression and conduct problems in periadolescent residents of Mexico City., Methods: Using information from the ELEMENT cohort study, we assessed prenatal Pb exposure through maternal patella Pb (MPPb) measurement during the puerperium, early childhood (birth to 5 years of age) exposure through a cumulative blood lead index (CBLI), and periadolescent exposure through a blood Pb (BPb) measurement concurrent with the evaluation of the outcomes. Outcomes were assessed during periadolescence using the parent-reported scales of aggression and conduct problems of the Behavioral Assessment System for Children-2nd version (BASC-2). We modeled the association between Pb exposure at each stage and each outcome (defined as a T-score ≥60 in the corresponding behavioral scale) using logistic regression, adjusting for sex, maternal age at delivery, maternal education, and household socioeconomic status (SES). The differential effect by sex was assessed with an interaction term in the models., Results: 743, 704, and 595 participants were respectively eligible for inclusion in final models of prenatal, early childhood, and periadolescent Pb exposure. Median Pb exposure at each stage was 9.9 µg/g for MPPb (prenatal), 5.19 µg/dl for CBLI (early childhood), and 2.62 µg/dl for concurrent BPb (periadolescence). 12 % of participants met the criterion for aggression, and 15 % for conduct problems. In adjusted models, a one interquartile range increase in MPPb increased the odds of conduct problems (OR:1.31; 95 % CI: 1.01, 1.70) and aggression (OR=1.24; 95 % CI: 0.93, 1.65) during periadolescence. Pb exposure during early childhood or periadolescence was not associated with either outcome. We found no evidence of interactions by sex., Conclusions: Exposure to Pb during the prenatal stage was associated with aggression and conduct problems during periadolescence., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: To evaluate the associations of pregestational BMI, gestational weight gain (GWG) and breast-feeding at 1 month postpartum with four patterns of weight change during the first year after delivery: postpartum weight retention (PPWR), postpartum weight gain (PPWG), postpartum weight retention + gain (PPWR + WG) and return to pregestational weight., Design: In this secondary analysis of a prospective study, we categorised postpartum weight change into four patterns using pregestational weight and weights at 1, 6 and 12 months postpartum. We evaluated their associations with pregestational BMI, GWG and breast-feeding using multinomial logistic regression. Results are presented as relative risk ratios (RRR) and 95 % CI., Setting: Mexico City., Participants: Women participating in the Programming Research in Obesity, Growth, Environment and Social Stressors pregnancy cohort., Results: Five hundred women were included (53 % of the cohort). Most women returned to their pregestational weight by 1 year postpartum (57 %); 8 % experienced PPWR, 14 % PPWG and 21 % PPWR + WG. Compared with normal weight, pregestational overweight (RRR 2·5, 95 % CI 1·3, 4·8) and obesity (RRR 2·2, 95 % CI 1·0, 4·7) were associated with a higher risk of PPWG. Exclusive breast-feeding, compared with no breast-feeding, was associated with a lower risk of PPWR (RRR 0·3, 95 % CI 0·1, 0·9). Excessive GWG, compared with adequate, was associated with a higher risk of PPWR (RRR 3·3, 95 % CI 1·6, 6·9) and PPWR + WG (RRR 2·4, 95 % CI 1·4, 4·2)., Conclusions: Targeting women with pregestational overweight or obesity and excessive GWG, as well as promoting breast-feeding, may impact the pattern of weight change after delivery and long-term women's health.

Objective: To estimate de magnitude of Pb poisoning (≥5μg/dL blood) in 1-4 year old children and to identify the contribution of lead-glazed ceramics use (LGC) as a source of exposure in the 32 Mexican states., Materials and Methods: Using the results from a sample of capillary blood lead (BPb) we estimated the prevalence of Pb poisoning, it's association with LGC and national distribution., Results: The national prevalence of Pb poisoning was 17.4% representing 1.4 million children. The prevalence was 30.7% among LGC users and 11.8% in non-users. In 17 states the prevalence of Pb poisoning was ≥10%, in 11 states between 5-10%, and in 4 states <5%., Conclusions: There is a geographic differential distribution of the problem; confirming the association with LGC and estimating the contribution of other Pb exposure sources. This information offers a guide to implement preven-tion and control actions in Mexico., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Objective: To describe the prevalence of obesity in Mexican adults stratifying by physical and sociodemographic conditions and to analyze trends., Materials and Methods: The data of 16 256 adults who participated in Ensanut 2018-19 was analyzed. Obesity (WHO), abdominal adiposity (IFD) and short stature (NOM-008-SSA3-2017) were classified. Logistic regression models were performed to analyze the association between obesity and risk factors. ENSA-2000 and Ensanut (2006, 2012, 2018-19) were used to assess trends., Results: The prevalence of overweight was 39.1%, obesity 36.1%, and abdominal adiposity 81.6%. Adults >40-50y and women had the highest prevalence. There was no difference by socio-economic level. Between 2000-2018, the prevalence of obesity increased 42.2% and morbid obesity 96.5%. Women with short stature had a higher risk (RM=1.84) of being obese than women without this condition, while in men the risk was lower (RM=0.79)., Conclusions: In Mexico the prevalence of obesity continues to increase regardless of socio-economic level, region or locality., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Objective: We aimed to evaluate the agreement between self-reported weight (SRW) and measured weight (MW) in adult women of reproductive age, identify characteristics associated with the difference between SRW and MW (DW), and develop a correction procedure for SRW., Methods: We used data from 3,452 non-pregnant or non-lactating adult women who participated in the Mexican Family Life Survey. Standardized personnel asked women about their weight before measuring weight and height. We conducted a Bland-Altman analysis for agreement and adjusted linear regression models for sociodemographic characteristics., Results: Mean DW was -0.59±3.21 kg. Difference varied according to Body Mass Index (BMI) and region of residence (p< 0.05). Correction model for log-MW, included the log-SRW, age group (18-34 and 35-49 years), interaction term (age × SRW), log-height, Southern region, and living with a partner. Based on self-reported weight, we observed an overestimation of underweight/normal weight prevalence and an underestimation of overweight or obesity prevalence., Conclusion: SRW has limitations to be considered as an alternative to MW among women of reproductive age with specific characteristics. Our proposed correction equation may decrease SRW imprecision improving the estimation of overweight and obesity. We suggest that studies consider and adjust the possible bias associated with weight misreporting on health outcomes., Competing Interests: The authors have declared that no competing interests exis.

Pregnancy is a contributor to the obesity epidemic in women, probably through postpartum weight retention (PPWR), weight gain (PPWG), or a combination of both (PPWR + WG). The contribution of these patterns of postpartum weight change to long-term maternal health remains understudied. In a secondary analysis of 361 women from the prospective cohort PROGRESS, we evaluated the associations between patterns of weight change one year after delivery and cardiometabolic risk factors at six years postpartum. Using principal component analysis, we grouped cardiometabolic risk factors into: (1) body mass index (BMI), waist circumference (WC), homeostatic model assessment of insulin resistance (HOMA-IR), high-density lipoprotein cholesterol (HDL-c), triglycerides (TG), and glucose; (2) systolic (SBP) and diastolic blood pressure (DBP); and (3) low-density lipoprotein cholesterol and total cholesterol. Using path analysis, we studied direct (patterns of weight change-outcomes) and indirect associations through BMI at six years postpartum. Around 60% of women returned to their pregestational weight (reference) by one year postpartum, 6.6% experienced PPWR, 13.9% PPWG, and 19.9% PPWR + WG. Women with PPWR + WG, vs. the reference, had higher BMI and WC at six years (2.30 kg/m 2 , 95% CI [1.67, 2.93]; 3.38 cm [1.14, 5.62]). This was also observed in women with PPWR (1.80 kg/m 2 [0.80, 2.79]; 3.15 cm [-0.35, 6.65]) and PPWG (1.22 kg/m 2 [0.53, 1.92]; 3.32 cm [0.85, 5.78]). PPWR + WG had a direct association with HOMA-IR (0.21 units [0.04, 0.39]). The three patterns of weight change, vs. the reference, had significant indirect associations with HOMA-IR, glucose, TG, HDL-c, SBP, and DBP through BMI at six years. In conclusion, women with PPWR + WG are at high-risk for obesity and insulin resistance. Interventions targeting women during pregnancy and the first year postpartum may have implications for their long-term risk of obesity and cardiovascular disease., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Objective: To estimate the prevalence of elevated (≥5.0μg /dL) blood lead levels (BLL) and its association with the use of lead glazed ceramics (LGC)., Materials and Methods: In 2018, we measured capillary BLL in a representative sample of children 1 to 4 years old residing in Mexican localities under 100 000 inhabitants (Ensanut 100k). We inquired about use of LGC for food preparation and consumption. To estimate its association with BLL, multinomial logit models stratified by region were generated., Results: The prevalence of elevated BLL levels was 21.8%. For the North, Central and South regions, the prevalence were 9.8, 20.7 and 25.8%, respectively. The association with use and frequency of LGC was highly significant and differential by region., Conclusions: Lead exposure remains a public health problem in Mexico, particularly in the Central and South regions, and is strongly associated with the use of LGC., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Background: Phthalates are known endocrine disruptors and peroxisome proliferator-activated receptor (PPAR) activators, potentially capable of promoting an obesogenic effect. Pregnant women are especially vulnerable to phthalate exposure due to physiological and metabolic changes during pregnancy, including those related to the metabolism of xenobiotics. Phthalate exposure during pregnancy has been associated with early gestational weight gain, however, its effect on long-term weight gain remains unclear. The aim of the present study was to evaluate the association between phthalate exposure during pregnancy and long-term changes in weight among women., Methods: Urinary phthalate concentrations, socioeconomic, anthropometry and information on diet and socioeconomic status were collected during pregnancy from 178 women from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) birth cohort. Maternal body weight and diet information was also collected up to 5 times in the first year postpartum and twice during follow-up visits 5.2-10.7 years later. A path analysis was performed to assess associations between urinary phthalate metabolite levels during pregnancy and change in weight (kg) per year after delivery, including age, education, living with/without partner, parity, daily energy intake and breastfeeding duration., Results: The mean age at pregnancy was 27.3 ± 5.9 years and mean body mass index during the first postpartum year was 27.07 ± 4.22 kg/m 2 . On average, women gained 3.48 kg (0.52 ± 0.84 kg/year). A unit increase in log-transformed mono-3-carboxypropyl phthalate (MCPP) was associated with 0.33 kg (95% CI: 0.09, 0.56) higher weight gain per year, and mono-benzyl phthalate (MBzP) with 0.21 kg (95% CI: -0.38, -0.03) lower weight gain per year., Conclusion: Exposure to certain phthalates during pregnancy may be associated with long-term weight change in women. More studies on the effects of phthalate exposure during pregnancy on women's long-term health are required., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: The overall estimated prevalence of rheumatoid arthritis (RA) in Mexico is 1.6%, but there are major variations in different geographic areas of the country., Objective: This study aimed to determine the impact of individual and regional variables on the geographic distribution of RA in Mexico., Methods: This multilevel analysis used data from a cross-sectional study that investigated the prevalence of RA among 19,213 individuals older than 18 years throughout 5 geographic regions in Mexico. Logistic regression models were used to determine predictors of RA, including individual and regional variables as well as cultural factors. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were determined., Results: The prevalence of RA varied from 0.77% to 2.8% across the 5 regions. Individual factors associated with RA were sex (OR, 2.32; 95% CI, 1.74-3.07), previous medical diagnosis of RA ( OR 3.3, 95%CI: 2919–5.1 [corrected]), disability (OR, 2.07; 95% CI, 1.48-2.93), and the 56- to 65-year age group (OR, 1.95; 95% CI, 1.08-3.74). The regional factor of speaking an indigenous language had an OR of 2.27 (95% CI, 1.13-4.55)., Conclusions: Various individual and regional factors were associated with variations in the prevalence of RA in the Mexican population.

This study aims to evaluate the structural validity of the Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) core instrument as a screening tool for rheumatoid arthritis (RA) by means of assessing the existence of domains in the questionnaire. The Mexican version of the COPCORD instrument was applied to individuals over18 years of age in five regions of the country through a probabilistic/convenience household survey. Clinical confirmation of RA diagnosis was used. The variables analyzed included self-reported comorbidities and manifestations of the disease, as well as sociodemographic characteristics. The statistical approach was based on polychoric exploratory factor analysis and confirmatory factor analysis by means of probit structural equation models. A total of 19,213 subjects were included in the analysis. The average age for the total sample was 42.89 years old; 40.64 % of the subjects were older than 45 years of age and 20.42 % older than 55. More than 80 % of the variation was related to three underlying factors: recent pain, historical pain, and disability. The findings verified the usefulness of the COPCORD instrument as a screening tool for RA. The results also allowed to characterize how the variation in terms of manifestations of the disease could be accounted for diagnosing the disease in the Mexican context and examined the capabilities of the instrument to measure correctly the main characteristics of patients suffering from RA.

Objective: To estimate the prevalence of acute respiratory infection (ARI) during the two weeks previous to the interview among children <5 years of age and to describe the frequency of identification of alarm signs by parents or caregivers (PC)., Materials and Methods: Analysis of data from the National Health and Nutrition Surveys 2012 and 2006 and of National Health Survey 2000., Results: ARI prevalence decreased from 2006 to 2012 (47.0-44.8%), particularly in the lower socioeconomic strata and children <1 year of age. 2012 Survey revealed highest prevalence for <1 year children. Fever was the main pneumonia-associated alarm sign (28.6%) in contrast to "breathes rapidly" (10.2%) or "unable to breathe" (20.9%)., Conclusions: Results show that the magnitude of the problem has decreased in recent years, mainly among the more vulnerable groups, such as smaller children and those belonging to the lowest socioeconomic strata. However, training is required, particularly at the community level.

Objective: To assess vaccination coverage of children and adolescents., Materials and Methods: Study based on National Health and Nutrition Survey 2012., Results: Coverage in <1 year infants olds infants was <70% for 3 vaccines and <50% for 5. In 15-23 months-olds infants coverage was 59.8% for four vaccines and 51% for six. In 6-year-olds coverage was 93.2% for 1 dose of MMR, and was below 50% for three vaccines in adolescents. Proportion of non-vaccinated individuals was 4.7% in <1-year-olds, 0.2% in 15-23-month-olds, 6.8% in 6-year-olds and 37% in adolescents. Coverage for BCG, HB, and Pneumococcal vaccines in <1-year-olds, and MMR in 15-23-month-olds was >80%. No health insurance and maternal or adolescent illiteracy were explanatory variables for incomplete schema., Conclusions: Results suggest it is necessary to strengthen information systems, health promotion, training, and daily vaccination without restrictive schedules, ensuring timely and adequate supply of vaccines.

Objective: To estimate vaccination coverage in adults 20 years of age and older., Materials and Methods: Analysis of data obtained from the National Health and Nutrition Survey 2012., Results: Among adults 20-59 years old coverage with complete scheme, measles and rubella (MR) and tetanus toxoid and diphtheria toxoid (Td) was 44.7,49. and 67.3%, respectively. Coverage and percentage of vaccination were significantly higher among women than men. Among women 20-49 years coverages with complete scheme, MR and Td were 48.3, 53.2 and 69.8%, respectively. Among adults 60-64 years old, coverage with complete scheme, Td and influenza vaccine were 46.5, 66.2 and 56.0%, respectively. Among adults >65 years coverages for complete scheme, Td, influenza vaccine and pneumococcal vaccine were 44.0, 69.0, 63.3 and 62.0%, respectively., Conclusion: Vaccination coverage among adult population as obtained from vaccination card or self-report is below optimal values although data may be underestimated. Recommendations for improvements are proposed.

Objectives: The aim of the present study was to estimate the incidence and spontaneous clearance rate of Helicobacter pylori infection and the effect of some variables on these outcomes in schoolchildren., Methods: From May 2005 to December 2010, 718 schoolchildren enrolled in 3 public boarding schools in Mexico City participated in the follow-up. At the beginning of the study and every 6 months thereafter, breath samples were taken to detect H pylori infection; blood samples and anthropometric measurements were taken to evaluate nutritional status. Data on sociodemographic characteristics were collected., Results: The prevalence of H pylori infection was 38%. The incidence rate was 6.36%/year. Schoolchildren with anemia or iron deficiency at the beginning of the study (who received iron supplements) showed a higher infection acquisition rate than those with normal iron nutritional status, hazard ratio (HR) 12.52 (95% confidence interval [CI] 4.01%-39.12%), P < 0.001 and HR 2.05 (95% CI 1.09%-3.87%), P = 0.027, respectively. The spontaneous clearance rate of the infection was 4.74%/year. The spontaneous clearance rate was higher in children who had iron deficiency (who received iron supplements), HR 5.02 (95% CI 1.33%-18.99%), P = 0.017, compared with those with normal nutritional iron status. It was lower in schoolchildren with ≥ 2 siblings compared with schoolchildren with 1 or no siblings, HR 0.23 (95% CI 0.08%-0.63%), P = 0.004., Conclusions: H pylori infection status is dynamic in schoolchildren. Variables related to health status and infection transmission, such as iron status and number of siblings, are important for the incidence and spontaneous clearance of H pylori infection.

Objective: Determine Vaccination Coverage (VC) among adults 60 years of age and older (EP), for influenza, pneumococcal and tetanus vaccines, association with socio-demographic characteristics and heterogeneity at state level., Material and Methods: Cross-sectional analysis based on information from 18 015 households visited in a national survey. General and vaccine information (self-report) for a randomly selected elder in each household is available., Results: The national VC level was found to be 56.5% (±0.97) for influenza, 44.3% (±0.98) for pneumococcus and 61.8% (±0.96) for tetanus. The VC was significantly lower for EP without health social services and higher for women. Almost 20.0% of EP recognized not having vaccines at all, due mainly that they didn't know it was a duty., Conclusions: Important improvements are shown in vaccination coverage among elderly in Mexico. Differentials suggest the need to intensify information campaigns and actions that could improve the accessibility to vaccines for this population.

Background: The Mexican government is currently implementing strategies to improve and expand comprehensive treatment for people living with HIV. Limited data, however, are available on the benefits obtained and costs incurred by these strategies., Objective: To estimate the effects of highly active antiretroviral therapy (HAART) on a cohort of people living with HIV and to estimate the cost of extending patients' lives., Methods: A survival analysis was used to follow a dynamic cohort of 797 people receiving AIDS treatment in Mexico from 1982 to 2006. The Kaplan-Meier method was applied to estimate the probability of survival for different lengths of time starting on the date of diagnosis. The Cox's proportional hazards regression model was used to assess differences in AIDS mortality by antiretroviral therapy regimen, age and sex., Results: The probability of survival after diagnosis without antiretroviral therapy (ART) was approximately 0.73 (95% CI 0.69-0.77) after the first year, 0.36 (95% CI 0.32-0.40) at 5 years, 0.28 (95% CI 0.24-0.33) at the tenth year, 0.26 (95% CI 0.21-0.31) at the fifteenth year and 0.22 (95% CI 0.14-0.30) thereafter. The results showed a longer life expectancy when patients took HAART (as opposed to monotherapy or dual therapy) from the beginning of their treatment. Results from the Cox model showed that those who started and continued on HAART were 7.1 (P < 0.01) times more likely to survive than those who received no treatment. Extending the length of life beyond 15 years after the initial diagnosis represents an accumulated cost of more than US$280,000.00 per individual.