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El subdiagnostico y error diagnostico del asma y la enfermedad pulmonar obstructiva cronica es muy grande en todo el mundo, en parte, debido al pobre acceso y el uso medico de la espirometria. El objetivo fue evaluar el impacto de un curso-taller presencial en la competencia medica para el uso y la interpretacion de la espirometria. Metodo: Se desarrollo un curso de cinco horas que comprendio conferencias, un video tecnico y un taller de interpretacion de 16 espirometrias reales. Profesionales medicos de 31 estados completaron el curso y sus evaluaciones inicial y final. Resultados: Un total de 1,343 profesionales, 71.3% medicos generales y familiares, completaron el curso. Solo 37% de los participantes reconocieron de manera correcta a la espirometria con broncodilatador como la prueba de eleccion diagnostica y 11.1% fueron capaces de diagnosticar obstruccion al flujo aereo grave. Despues del curso, se observo una mejoria significativa en los conocimientos y 81.2% diagnosticaron de forma acertada la obstruccion grave. Conclusion: El nivel de conocimientos y competencia medica para el uso e interpretacion de la espirometria fue claramente insuficiente; sin embargo, un curso-taller de cinco horas fue bastante eficiente para fines de capacitacion dirigida a la competencia medica

espanolAntecedentes: una espirometria de 6 s con un espirometro de bolsillo economico selecciona de manera eficiente a los individuos para una espirometria de calidad diagnostica para la limitacion del flujo de aire, pero tambien podria ser util para identificar a los individuos con un patron restrictivo. Objetivos: Evaluamos un espirometro simplificado de bajo costo (enfermedad pulmonar obstructiva cronica [EPOC] -6) como herramienta de cribado para identificar anomalias espirometricas. Metodos: Encuesta poblacional en la Ciudad de Mexico, con 742 participantes realizando espirometria pre y post-BD y una espirometria de 6 s con tres maniobras (pre-BD) con EPOC-6. Se evaluo el volumen espiratorio forzado en 1 s (FEV 1 ), FEV 6 y FEV 1 / FEV 6 de la COPD-6, en bruto y expresado como el porcentaje de prediccion (% P), para discriminar la obstruccion del flujo aereo posbroncodilatador (FEV 1 / capacidad vital forzada [FVC] Resultados: El FEV 1 % P fue el mejor predictor para identificar anomalias ventilatorias pre y post-BD (mejor punto de corte 87% P, AUC 92% para patron restrictivo, 89% para patron obstructivo y 91% para cualquier anomalia espirometrica). Derivando a la espirometria clinica solo aquellos con Conclusiones: Un FEV 1 EnglishBackground: 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] 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 Conclusions: An FEV1

Objective To describe the studies that have reported association measures between risk of cancer and the percentage distribution of urinary inorganic arsenic (iAs) metabolites by anatomical site, in non-ecological epidemiological studies. Methods Studies were identified in the PubMed database in the period from 1990 to 2015. Inclusion criteria were: non-ecological epidemiological study, with histologically confirmed cancer cases, reporting the percentage distribution of inorganic arsenic (iAs), monomethylated (MMA) and dimethylated (DMA) metabolites, as well as association measures with confidence intervals (CI) between cancer and %iAs and/or %MMA and/or %DMA. A descriptive meta-analysis was performed by the method of the inverse of the variance for the fixed effects model and the DerSimonian and Laird's method for the random effects model. Heterogeneity was tested using the Q statistic and stratifying for epidemiological design and total As in urine. The possibility of publication bias was assessed through Begg's test. Results A total of 13 eligible studies were found, most of them were performed in Taiwan and focused on skin and bladder cancer. The positive association between %MMA and various types of cancer was consistent, in contrast to the negative relationship between %DMA and cancer that was inconsistent. The summary risk of bladder (OR=1.79; 95% CI: 1.42, 2.26, n=4 studies) and lung (OR=2.44; 95% CI: 1.57, 3.80, n=2 studies) cancer increased significantly with increasing %MMA, without statistical heterogeneity. In contrast, lung cancer risk was inversely related to %DMA (OR=0.58; 95% CI: 0.36, 0.93, n=2 studies), also without significant heterogeneity. These results were similar after stratifying by epidemiological design and total As in urine. No evidence of publication bias was found. Conclusion These findings provide additional support that methylation needs to be taken into account when assessing the potential iAs carcinogenicity risk.

Background In the Latin America countries (LAC), one in five breast cancer (BC) cases occur in women younger than 45 years, almost twice the frequency seen in developed countries. Most BC cases in younger women are premenopausal and are generally more difficult to detect at early stages and to treat than postmenopausal cancers. We employ data from four high quality population-based registries located in LAC and assess the extent to which the higher frequency of BC occurring in younger women is due to a younger population structure, compared to that of developed countries. Next, we analyze secular and generational trends of incidence rates in search for additional explanations. Methods Using data from the International Agency for Research on cancer, between 1988 and 2007, the age distribution of BC incident cases for registries located in Brazil, Colombia, Costa Rica, Ecuador is compared to that of USA and Canadian registries, both before and after removing differences in population age structure. An age-period-cohort modelling of incidence rates is also conducted in all compared registries to identify secular and generational effects. Results BC incident cases in the LAC registries present, on average, at an earlier age than in the USA and Canadian registries and for 2003–2007, between 20 and 27% of cases occur in women aged 20–44. About two thirds of the difference in age distribution between LAC and USA registries is attributable to the younger age distribution in the LAC base populations. The USA registries show the highest age-specific BC incidence rates of all compared aggregated registries, at all ages. However, in all the LAC registries incidence rates are rapidly increasing, fueled by a strong birth cohort effect. This cohort effect may be explained by important reduction in fertility rates occurring during the second half of the 20th century, but also by a greater exposure to other risk factors for BC related to the adoption of life styles more prevalent in developed countries. Conclusion The younger age at presentation of BC incident cases seen in the analyzed LAC registries, and possibly in many Latin American countries, is not only attributable to their relatively young population age structure but also to the low incidence rates in older women. As more recently born cohorts, with greater exposure to risk factors for postmenopausal BC, reach older age, incidence rates will be more similar to the rates seen in the USA and Canadian registries. There is a need for additional research to identify determinants of the higher BC rate among younger women in these countries.

Inorganic arsenic (iAs) exposure increases risk of several diseases, including cancer. Some nutrients such as flavonoids enhance glutathione activity, which in turn play a key role in iAs elimination. Our objective was to explore whether dietary non-soy flavonoids are associated with iAs metabolism. We hypothesized that the intake of flavonoids belonging to the following groups, flavan-3-ols, flavone, flavonol, flavanone, and anthocyanidin, is positively associated with urinary dimethylarsinic acid (DMA), which is the most soluble iAs metabolite excreted. We performed a cross-sectional study that included 1027 women living in an arsenic-contaminated area of northern Mexico. Flavonoid intake was estimated using a validated food frequency questionnaire. Concentration of urinary iAs and its metabolites (monomethylarsonic acid and DMA) were determined by high performance liquid chromatography ICP-MS. Results showed positive significant associations between DMA and the flavonoid groups flava-3-ols (β= 0.0112) and flavones (β= 0.0144), as well as the individual intake of apigenin (β= 0.0115), luteolin (β= 0.0138), and eriodictyol (β= 0.0026). Our findings suggest that certain non-soy flavonoids may improve iAs elimination; however, there is still very limited information available regarding the consumption of flavonoids and iAs metabolism.

Background: Worldwide almost no epidemiologic data are available on the mortality of interstitial lung diseases in the general population. Its epidemiology in Mexico has not been well characterized. Objectives: We aimed to analyze the trends in mortality age-stan- dardized by interstitial lung diseases from 2000 to 2010 in Mexico and the annual death rates by age and sex. Methods: The offi cial National Database of Mortality was used to establish date and cause of deaths (Instituto Nacional de Estadistica y Geografia (INEGI) from 2000 to 2010 in Mexico. Age-standardized rates were calculated by direct method; annual rates of death by sex in two age-groups (45-64 years old and 65 or more years old) were calculated. The codes of the International Statistical Classifi cation of Diseases and Related Health Problems 10th Revision (CIE-10) J60-J80, J82-J84 y J99.1 were analyzed. Results: Of 5,420,059 deaths registered, 22,600 were diagnosed as death of an interstitial lung disease between 2000 and 2010 (0.4%). The CIE-10 code with a higher percentage of deaths was J84: «other pulmonary interstitial diseases» with 80.2% (18,127/22,600). This code includes the rheumatic diseases and autoimmune diseases that exhibit a lung interstitial disease. The age-standardized mortality rates by lung interstitial diseases shown an increasing trend during 2000-2010, but men exhibited higher rates than women; the description of annual mortality shown that the rates specifi c by age and sex were increasing in both sex but higher in male than female. The age group more affected was of 65 or more years old. Conclusions: This article shows the relevance of interstitial lung diseases as a death cause in Mexico. In the next years will be required additional resources to medical care in these diseases.

The objective of this review was to determine if infl uenza AH1N1 (pandemic) in 2009 had an impact on the health of pregnant women and newborn. The review showed an association between infl uenza AH1N1 and a higher risk of hospitalization, admission to intensive care unit (ICU) and death in pregnant women; and low birth weight, premature birth and mortality in the newborn. Immunization against pan- demic infl uenza virus in pregnant women is easy to perform and prevent damage to the health of women and infants.

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. Keywords: Phthalates, Flavonoids, Breast cancer risk

Introduction Concentrations of inorganic arsenic (iAs) metabolites in urine present intra- and interindividual variations, which are determined not only by the magnitude of exposure to iAs, but also by differences in genetic, environmental and dietary factors. Objective To evaluate whether differences in dietary intake of selected micronutrients are associated with the metabolism of iAs. Methods The intake of 21 micronutrients was estimated for 1027 women living in northern Mexico using a food frequency questionnaire. Concentration of urinary metabolites of iAs was determined by high performance liquid chromatography inductively coupled plasma mass spectrometry (HPLC-ICP-MS) and the proportion of iAs metabolites was calculated (%iAs, monomethylarsonic acid [%MMA] and dimethylarsinic acid [%DMA]), as well as ratios corresponding to the first (MMA/iAs), second (DMA/MMA) and total methylation (DMA/iAs). Results After adjustment for covariates, it was found that methionine, choline, folate, vitamin B12, Zn, Se and vitamin C favor elimination of iAs mainly by decreasing the %MMA and/or increasing %DMA in urine. Conclusions Our results confirm that diet contributes to the efficiency of iAs elimination. Further studies are needed to assess the feasibility of dietary interventions that modulate the metabolism of iAs and the consequent risk of diseases related to its exposure.

Objectives. To determine the prevalence of asthma and the association between sociodemographic characteristics, spirometry, respiratory symptoms, quality of life and sleep in adults ≥ 40 years. Materials and methods. This report is part of our study (Latin American Research Project Obstructive Pulmonary), held in Mexico City and the metropolitan area in 2003. We used logistic regression models adjusted for study design, where asthma was the dependent and independent variable respiratory symptoms, sociodemographic and clinical characteristics among others. Results. The prevalence of physician-diagnosed asthma was: 3.3% in men and 6.2% in women. Decreased lung function in asthmatics was observed. In multivariate analysis, after adjusting for potential confounders, asthmatics had a higher risk of excessive daytime sleepiness more snoring [OR = 3.2 (95% CI 1.4-7.4), p= 0.008], and more frequent work absences due to respiratory problems [OR = 5.1 (95% CI 2.5-10.4), p

Background: The Mini-mental State Examination (MMSE) is the most widely used cognitive test, both in clinical settings and in epidemiological studies. However, correcting its score for education may create ceiling effects when used for poorly educated people and floor effects for those with higher education.Methods: MMSE and a recent cognitive test, the seven minute screen (7MS), were serially administered to a community sample of Mexican elderly. 7MS test scores were equated to MMSE scores. MMSE-equated 7MS differences indicated ceiling or floor effects. An ordinal logistic regression model was fitted to identify predictors of such effects.Results: Poorly educated persons were more prevalent on the side of MMSE ceiling effects. Concentration (serial-sevens), orientation and memory were the three MMSE subscales showing the strongest relationship to MMSE ceiling effects in the multivariate model.Conclusion: Even when MMSE scores are corrected for educational level they still have ceiling and floor effects. These effects should be considered when interpreting data from longitudinal studies of cognitive decline. When an education-adjusted MMSE test is used to screen for cognitive impairment, additional testing may be required to rule out the possibility of mild cognitive impairment.

Ageing and depression are associated with disability and have significant consequences for health systems in many other developing countries. Depression prevalence figures among the elderly are scarce in developing countries.To estimate the prevalence of depressive symptoms and their cross-sectional association with selected covariates in a community sample of Mexico City older adults affiliated to the main healthcare provider.Cross-sectional, multistage community survey.A total of 7,449 persons aged 60 years and older.Depression was assessed using the 30-item Geriatric Depression Scale (GDS); cognitive impairment, using the Mini-Mental State Examination; and health-related quality of life with the SF-36 questionnaire.The prevalence of significant depressive symptoms was estimated to be 21.7%, and 25.3% in those aged 80 and older. After correcting for GDS sensitivity and specificity, major depression prevalence was estimated at 13.2%. Comparisons that follow are adjusted for age, sex, education and stressful life events. The prevalence of cognitive impairment was estimated to be 18.9% in depressed elderly and 13.7% in non-depressed. SF-36 overall scores were 48.0 in depressed participants and 68.2 in non-depressed (adjusted mean difference = -20.2, 95% CI = -21.3, -19.1). Compared to non-depressed elderly, the odds of healthcare utilization were higher among those depressed, both for any health problem (aOR 1.4, 95% CI = 1.1, 1.7) and for emotional problems (aOR 2.7, 95% CI = 2.2, 3.2).According to GDS estimates, one of every eight Mexican older adults had major depressive symptoms. Detection and management of older patients with depression should be a high priority in developing countries.

Severe periodontal disease is a chronic inflammatory gingival process associated with systemic diseases.To determine the prevalence of severe periodontal disease and its association with respiratory diseases among hospitalized patients at the Institute of Respiratory Diseases "Ismael Cosio Villegas" (INER) in 2011.A cross-sectional study was developed. The severe periodontal disease was diagnosed by the Department of Stomatology. The International Classification of Diseases 10th revision was used. A multinomial logistic was fit to estimate relative-risk.Three thousand and fifty-nine patients were included; 772/3,059 (25.2%) had severe periodontal disease. After controlling for age, sex, inpatient days, death, and socioeconomic status, the infectious respiratory diseases that were significantly associated with severe periodontal disease were: HIV/AIDS (RR: 10.6; 95% CI: 9.1-23.3; p0.0001); pneumonia (RR: 2.6; 95% CI: 2.2-5.7; p0.0001); pulmonary tuberculosis and its sequels (RR: 2.1; 95% CI: 1.6-4.9; p0.0001); and lung abscess (RR: 2.6; 95% CI: 1.6-7.8; p = 0.002). Lung cancer and pleural diseases were also significantly associated with severe periodontal disease.High prevalence of severe periodontal disease was observed in the different respiratory diseases. Severe periodontal disease was associated with both infectious and non-infectious respiratory diseases. It is important to study an oral health intervention.

The vast majority of hip fractures in the 21st century will occur in the developing countries. The rates and life-time hip fracture risk are not known for Mexico, and for this reason, we studied the incidence of hip fractures, and the remaining life-time probability of having a hip fracture at the age of 50 years in Mexican men and women. All hip fracture cases registered during the year 2000 were collected at all the main tertiary-care hospitals in the two major health systems in México City, Instituto Mexicano del Seguro Social (IMSS) and Ministry of Health (SS), and the diagnosis was validated by chart review in all cases. The annual rates of hip fracture were 169 in women and 98 in men per 100,000 person-years. The life-time probability of having a hip fracture at 50 years of age was 8.5% in Mexican women and 3.8% in Mexican men. We conclude that hip fractures are an important health problem in Mexico and that Mexican health authorities should consider public health programs to prevent hip fractures.

To identify and reassign misclassified AIDS deaths in Mexico, reconstructing the time series of mortality from 1983 to 2012, by state, sex, age, and affiliation to social security.15.5 million deaths from 1979 to 2012 were analyzed. The HIV-AIDS mortality correction was done in three phases: a) those causes directly related to AIDS; b) by miscoded deaths, and c) AIDS deaths hidden in other underlying causes of death. Age-standardized rates of mortality (SMR) were calculated by sex, affiliation to social security, and state.107 981 AIDS deaths from 1983 to 2012 were accumulated, representing 11% of total deaths observed for the period. The SMR in men for all age groups begins to decline since 1996, while for women the decline started in 2008. A similar picture is observed for the population with / without social security. Heterogeneity is a feature for SMR by state.An easily replicable methodology for the correction of mortality from AIDS, which generates relevant information for decision making based on the evidence is presented.

In 1988, the General Directorate of Epidemiology and the Mexican Institute of Psychiatry conducted the first National Addiction Survey (ENA), providing regional and national data on alcohol, tobacco, and drug use. The ENA providing a subsample of women who have been pregnant at some time in their lives. There were 5,234 affirmative responses. Women were asked if they had suffered any of three adverse outcomes during their last pregnancy: spontaneous abortion, stillbirth, and congenital abnormalities. Prevalence of spontaneous abortion was 3.8%, stillbirth 1.2%, and congenital abnormalities 1.1 %. Multiple logistic-regression models were used to analyze the effect of alcohol consumption on these problems. Consumption during pregnancy was related only with the prevalence of congenital abnormalities, with prevalence odds of 3.4. Among habitual users during the last 12 months, oniy women in the highest use category showed an important relationship with the three problems mentioned. Follow-up studies on the Mexican population are recommended in order to obtain more conclusive findings. En l988 la Dirección General de Epidemiología y el Instituto Mexicano de Psiquiatría llevaron a cabo la primera Encuesta Nacional de Adicciones (ENA), que proporciona información a nível nacional y regional sobre el uso de alcohol, tabaco y drogas ilícitas. La ENA incluye una submuestra de mujeres que se embarazaron alguma vez en la vida. Se obtuvieron 5.234 respuestas afirmativas a la pregunta de se alguma vez se habían embarazado. A este grupo se les preguntó si en su último embarazo tuvieron un aborto espontáneo, un bebe nacido muerto o un bebe con anomalías congênitas. La prevalencia de aborto espontáneo fue de 3,8%, 1,2% de nascidos muertos y 1,1% de anomalías congénitas. Se utilizaron modelos de regressión logística múltiple para analizar el papel del consumo de bebidas alcohólicas sobre estos problemas. El consumo de alcohol durante el embarazo sólo se asoció con la prevalencia de anomalias congênitas, con una razón de prevalencia de 3,4. Entre las bebedoras habituales de alcohol en los últimos 12 meses, sólo las mujeres que se ubicaron en la más alta categoria de consumo mostraron relaciones importantes con los tres problemas mencionados. Se sugiere la necesidad de realizar estudios de seguimento para llegar a conclusiones más definitivas.

In 1988, the General Directorate of Epidemiology and the Mexican Institute of Psychiatry conducted the first National Addiction Survey (ENA), providing regional and national data on alcohol, tobacco, and drug use. The ENA providing a subsample of women who have been pregnant at some time in their lives. There were 5,234 affirmative responses. Women were asked if they had suffered any of three adverse outcomes during their last pregnancy: spontaneous abortion, stillbirth, and congenital abnormalities. Prevalence of spontaneous abortion was 3.8%, stillbirth 1.2%, and congenital abnormalities 1.1 %. Multiple logistic-regression models were used to analyze the effect of alcohol consumption on these problems. Consumption during pregnancy was related only with the prevalence of congenital abnormalities, with prevalence odds of 3.4. Among habitual users during the last 12 months, oniy women in the highest use category showed an important relationship with the three problems mentioned. Follow-up studies on the Mexican population are recommended in order to obtain more conclusive findings.En l988 la Dirección General de Epidemiología y el Instituto Mexicano de Psiquiatría llevaron a cabo la primera Encuesta Nacional de Adicciones (ENA), que proporciona información a nível nacional y regional sobre el uso de alcohol, tabaco y drogas ilícitas. La ENA incluye una submuestra de mujeres que se embarazaron alguma vez en la vida. Se obtuvieron 5.234 respuestas afirmativas a la pregunta de se alguma vez se habían embarazado. A este grupo se les preguntó si en su último embarazo tuvieron un aborto espontáneo, un bebe nacido muerto o un bebe con anomalías congênitas. La prevalencia de aborto espontáneo fue de 3,8%, 1,2% de nascidos muertos y 1,1% de anomalías congénitas. Se utilizaron modelos de regressión logística múltiple para analizar el papel del consumo de bebidas alcohólicas sobre estos problemas. El consumo de alcohol durante el embarazo sólo se asoció con la prevalencia de anomalias congênitas, con una razón de prevalencia de 3,4. Entre las bebedoras habituales de alcohol en los últimos 12 meses, sólo las mujeres que se ubicaron en la más alta categoria de consumo mostraron relaciones importantes con los tres problemas mencionados. Se sugiere la necesidad de realizar estudios de seguimento para llegar a conclusiones más definitivas.

Underdiagnosis of chronic obstructive pulmonary disease (COPD) in primary care can be improved by a more efficient screening strategy. To evaluate a three-step method of screening for COPD consisting of an initial short questionnaire followed by measurement of forced expiratory volume in 1s/forced expiratory volume in 6s (FEV1/FEV6) using an inexpensive pocket spirometer in those with high risk, and diagnostic quality spirometry in those with a low FEV1/FEV6. We analysed two related Mexico City cross-sectional samples. The 2003 Mexico City PLATINO survey (n=542) was used to develop a short questionnaire to determine the risk of COPD and a 2010 survey (n=737) additionally used a pocket spirometer. The discriminatory power of the two instruments was assessed with receiver operator characteristic (ROC) curves using three COPD definitions. The developed COPD scale included two variables from a simple questionnaire and, in ROC analysis, an area under the curve (AUC) between 0.64 and 0.77 was found to detect COPD. The pocket spirometer had an AUC between 0.85 and 0.88 to detect COPD. Using the COPD scale as a first screening step excluded 35–48% of the total population from further testing at the cost of not detecting 8–18% of those with COPD. Using the pocket spirometer and sending those with a FEV1/FEV6

Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms.Longitudinal study of community-dwelling elderly people (60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item geriatric depression scale, and a score of 11 was used as cut-off point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms.A number of 7882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR.971, p.001), chronic pain (OR 2.277, p.001) and higher locus of control (OR.581, p.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations.New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms.The study has not included clinical evaluations and nutritional assessments.

Jesús Favela,1 Luis A Castro,2 Francisco Franco-Marina,3 Sergio Sánchez-García,4 Teresa Juárez-Cedillo,4 Claudia Espinel Bermudez,4 Julia Mora-Altamirano,4 Marcela D Rodriguez,5 Carmen García-Peña41Center for Scientific Research and Higher Education of Ensenada, Ensenada, Baja California, Mexico; 2Sonora Institute of Technology, Ciudad Obregon, Mexico; 3National Institute of Respiratory Diseases, Mexican Ministry of Health, Mexico City, Mexico; 4Epidemiologic and Health Service Research Unit, Aging Area, XXI Century National Medical Center, Mexican Institute of Social Security, Mexico City, Mexico; 5School of Engineering, MyDCI, Autonomous University of Baja California, Mexicali, MexicoObjective: To assess whether an intervention based on nurse home visits including alert buttons (NV+AB) is effective in reducing frailty compared to nurse home visits alone (NV-only) and usual care (control group) for older adults.Design: Unblinded, randomized, controlled trial.Setting: Insured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico.Participants: Patients were aged over 60 years with a frailty index score higher than 0.14.Intervention: After screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups.Measurements: The primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered.Results: The framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients), they had died (107), they were ill (50), or they were not currently living in the city (28). A screening interview was applied to 228 participants, and 57 had a score ≤0.14, 171 had ≥0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete the baseline questionnaire. The final 133 subjects were randomized into the NV+AB (n = 45), NV-only (n = 44), and control (n = 44) groups. There were no statistically significant differences in the baseline characteristics of the groups. The mean age overall was 76.3 years (standard deviation 4.7) and 45% were men. At the baseline, 61.65% were classified as frail. At end of follow-up the adjusted prevalence of frailty in NV+AB group was 23.3% versus 58.3% in the control group.Conclusion: An intervention based on NV+AB seems to have a positive effect on frailty scores.Keywords: gerontechnology, frailty, elderly

In case-control studies with three exposure levels where disease risk is associated with exposure, the direction of bias in the odds ratios (ORs) from nondifferential misclassification depends on the risk level, misclassification rates, and exposure distributions. To extend these generalizations, we present a graphical analysis of bias from nondifferential misclassification assuming linear and nonlinear monotonic increasing exposure-risk patterns. In both middle and upper exposure levels, bias is usually toward the null, increasing in magnitude as the misclassification rates increase and as the skewness of the exposure distribution increases. In the middle exposure level, bias away from the null may occur when the misclassification rate is low in the reference level and moderate to high in the upper exposure level, and risk increases with exposure. Bias away from the null does not occur in the upper exposure level. In both excess risk levels, crossover bias (that is, a reversal of the OR) may occur when exposure classification is worse than chance. The magnitude of bias away from the null is constrained by the unbiased OR of the upper exposure level, whereas that of crossover bias is constrained by the inverse of the unbiased OR of the upper exposure level.

Objective. To determine the effect of altitude of residence on influenza A (H1N1). Materials and methods. We analyzed 207 135 officially notified of influenza-like illness (ILI) cases, 23 048 hospitalizations and 573 deaths during the first months of the novel pandemic influenza A H1N1 virus, to examine if residents of high altitude had more frequently these adverse outcomes. Results. Adjusted rates for hospitalization and hospital mortality rates increased with altitude, probably due to hypoxemia.

To determine the prevalence of asthma and the association between sociodemographic characteristics, spirometry, respiratory symptoms, quality of life and sleep in adults40 years.This report is part of our study (Latin American Research Project Obstructive Pulmonary), held in Mexico City and the metropolitan area in 2003. We used logistic regression models adjusted for study design, where asthma was the dependent and independent variable respiratory symptoms, sociodemographic and clinical characteristics among others.The prevalence of physician-diagnosed asthma was: 3.3% in men and 6.2% in women. Decreased lung function in asthmatics was observed. In multivariate analysis, after adjusting for potential confounders, asthmatics had a higher risk of excessive daytime sleepiness more snoring [OR = 3.2 (95% CI 1.4-7.4), p= 0.008], and more frequent work absences due to respiratory problems [OR = 5.1 (95% CI 2.5-10.4), p0.0001].The prevalence of asthma was 5%. Asthmatics showed lower quality of life and lung function.

There is evidence that geriatric services may be more effective in handling problems of the elderly in acute care. We therefore studied a cohort of matched triplets (age, gender and admission diagnosis), to assess the effect of a geriatric service on elderly problems (falls, pressure ulcers, delirium and functional decline). This is a follow up study; comparing a geriatric unit with an internal medicine unit at two hospitals of the Mexican Institute of Social Security (IMSS) in Mexico City. Socio-demographic characteristics, functionality, emotional state, cognitive status, delirium, co-morbidities, diagnosis, number of medications, presence of pressure ulcers and falls, were assessed. We developed a composite variable as a global end-point, including: delirium, falls, mortality, pressure sores and functional decline. 70 patients were included in the geriatric services and 140 in the internal medicine unit. Mean age =72.5±7 years (±S.D.), and 52.9% were women. At baseline, only illiteracy, quality of life and the number of medications were statistically different between each group. Fully adjusted multiple logistic conditional regression model found an odds ratio of 0.27 (95% CI 0.1–0.7) for the presence of the composite variable, favoring the geriatric unit. Geriatric units in acute care may be beneficial in different frequent end points in elderly.

To describe the advances made by countries in the Mesoamerican region towards reaching Millenium Development Goals (MDG) 4 and 5, and discuss the most useful tasks to help the region in accomplishing or keeping track of these objectives.The trend estimates of maternal and under 5 mortality from 1990 to 2008, the effective coverage of vaccination against diphteria, pertussis and tetanus (DPT), prenatal care and childbirth by qualified personnel were taken from the Institute of Health Metrics and Evaluation (IHME) and the causes of death for children under five were taken from the Children's Health Epidemiology Reference Group of WHO (CHERG).The regional trend in the rate of mortality for children under five (MDG-4) in the last 18 years shows an annual reduction of 4.2%, significantly above the global reduction of 2.1%. This suggests that countries of Mesoamerica will be able to fulfill this objective. In contrast, data for 2008 shows that the rate of reduction of maternal mortality is very heterogeneous and it is unlikely that any of the countries in the region will reach this goal.Efforts made by countries in Mesoamerica have been substantial in controlling mortality in children under five years but insufficient to achieve MDG-5. Although the tendency is in the right track the reduction rate will only partially fulfill the acquired commitments to eradicate poverty.

OBJETIVO. Describir las desigualdades actuales y futuras de la enfermedad renal cronica terminal (ERCT) en Mexico, que se presentan entre grupos de entidades federativas con diferentes grados de marginacion. MATERIAL Y METODOS. Partiendo de una estimacion indirecta de la incidencia, prevalencia, mortalidad y duracion promedio que realizamos en 2009, presentamos datos agrupados de acuerdo con el grado de marginacion estatal. Medimos la desigualdad con el Indice de Concentracion de Salud. RESULTADOS. Encontramos desigualdades crecientes entre 2005 y 2025 en las tasas de incidencia, prevalencia y mortalidad, asi como en la duracion promedio de los casos. CONCLUSION. Para 2025 esperamos importantes incrementos en la prevalencia de la ERCT que afectaran en mayor medida a los estados mas marginados, lo que aumentara la inequidad presente en este problema de salud y representara importantes retos para el financiamiento de los servicios de salud, si no se incide sobre las causas y la progresion hacia la ERCT.

Objetivo. Describir los estudios de carga de la enfermedad realizados en la región e identificar las principales prioridades en salud a partir del indicador años de vida saludable perdidos (AVISA). Material y métodos. Mediante el uso de AVISA, identificar la carga de enfermedad en los distintos países. Resultados. Los AVISA destacan la emergencia de los trastornos mentales, la diabetes mellitus en las mujeres y los trastornos por consumo de alcohol y lesiones en los hombres. Conclusiones. América Latina es la región con más estudios nacionales de carga de la enfermedad realizados con una metodología estandarizada, que permiten identificar problemas de salud que están presionando a los servicios de atención, por ello estos resultados constituyen un elemento a tomar en cuenta en el establecimiento de políticas públicas en cada país.

To describe the burden of disease studies made in the region, identify the main priorities in health from the indicator Disability Adjusted Life Years (DALYs).By the use of DALYs identify the burden of disease in the countries in the network.DALYs emphasize the emergency of mental disorders, diabetes mellitus in women and the disorders associated with alcohol consumption and injuries in men.Latin America is the region with more national studies of burden of disease, using a standardized methodology, that allows identifying new health priorities which are pressing to the health services; for that reason these results constitute an element to take into account in the establishment of public policies in each country.

To describe current and future health inequalities in End Stage Renal Disease in Mexico (ESRD) in Mexican states with varying degrees of marginality.Using results, obtained by us in 2009, of an indirect estimation of incidence, prevalence, and mortality rates, and of the average case duration, we grouped these data according to the social deprivation level of the Mexican states. We measured health inequalities using the Health Concentration Index.We found rising inequalities, between 2005 and 2025, in ESRD incidence, prevalence and mortality rates, as well as in the average duration of cases.We project an important increase in the prevalence of ESRD for 2025 which will be greater in the Mexican states with more marginality. This will increase health inequities already present and represent important challenges for health care financing, especially if no action is taken to control the causes and progression of ESRD.

To describe the changes in several smoking indicators occurred in Mexico over the past two decades and to explore if the tobacco control policies implemented in Mexico, since 2004, show a favorable impact on tobacco consumption by 2008.We analyze trends in comparable data on the prevalence of never and daily smokers, using the five National Addiction Surveys conducted between 1988 and 2008. The analysis is restricted to persons aged 18 through 65 years. Data are adjusted for age, sex and marginality index.Between 2002 and 2008 the percentage of never smokers has increased by 19.6% and the percentage of daily smokers has decreased by 24.8%. These changes were more important in men, but in women the average number of cigarettes consumed decreased by 21.1% over the compared period and there was also a 13.9% rise in the percentage of women attempting to quit. Daily smokers prevalence has declined more rapidly since 2005, coincidently with an increase in cigarette taxation.Over the past two decades there has been in Mexico an increase in the percentage of never smokers and a decline in the percentage of daily smokers. A positive impact is observed, few years after the implementation of more effective tobacco control policies in Mexico, notably higher taxation of tobacco products.

Objetivo. Describir las tendencias, durante las pasadas dos decadas, de varios indicadores de tabaquismo y explorar si las politicas de contencion de la epidemia de tabaquismo en Mexico, implantadas desde 2004, han tenido ya un impacto favorable hacia 2008. Material y metodos. Se analizan las tendencias de datos comparables sobre la prevalencia de nunca fumadores y de fumadores diarios, utilizando las cinco encuestas nacionales de adicciones realizadas entre 1988 y 2008. En el analisis se incluye a personas entre 18 y 65 anos de edad y se realizan ajustes por indice de marginacion, edad y sexo. Resultados. Entre 2002 y 2008 aumento en 19.6% el porcentaje de nunca fumadores y disminuyo 24.8% el porcentaje de fumadores diarios. Estos cambios fueron mas importantes en los hombres que en las mujeres, pero en estas ultimas se redujo en el mismo periodo en 21.1% el promedio de cigarrillos fumados a diario y se incremento en 13.9% el porcentaje que habia intentado dejar de fumar. La prevalencia de fumadores diarios se ha reducido mas aceleradamente desde 2005, lo que coincide con el incremento en los impuestos a los cigarrillos. Conclusiones. Se observa en Mexico, durante las dos ultimas decadas, una tendencia al incremento del porcentaje de nunca fumadores y a la reduccion del porcentaje de fumadores diarios. A pocos anos de haberse implantado en Mexico politicas de control del tabaquismo mas efectivas, en particular el incremento en los impuestos al tabaco, se observan ya resultados favorables.

Objective. To assess the age, period and cohort effects on breast cancer (BC) mortality in Mexico. Material and Methods. Age, period and cohort curvature trends for BC mortality were estimated through the Poisson Regression model proposed by Holford. Results. Nationally, BC death rates have leveled off since 1995 in most age groups. BC mortality trends are mainly determined by birth cohort and age effects in Mexico. Women born between 1940 and 1955 show the highest rate of increase in BC mortality. Women born afterwards still show an increasing trend but at a much lower rate. Mammography and adjuvant therapy have had a limited impact on mortality. Potential reasons for observed patterns are discussed. An increase in BC mortality in Mexico is expected in the following decades. Conclusions. Mammography screening programs and timely access to effective treatment should be a national priority to reverse the expected increasing BC mortality trend.