Jorge Salmerón-Castro

Case-control study of diabetes, obesity, physical activity and risk of endometrial cancer among Mexican women.

AbstractObjectives: Obesity, hypertension and diabetes are closely associated with endometrial cancer (EC). This study evaluates the relationship between diabetes and risk of EC on the basis of obesity. Methods: A case–control study was carried out in Mexico City from 1995 to 1997. Eighty-five histologically confirmed cases were compared with 668 population-based controls obtained through frequency matching. Diabetes status, weight, height and other factors were determined through personal interviews among both cases and controls. Results: Compared to women without diabetes, those with diabetes had an adjusted odds ratio of 3.6 (95% CI = 1.7, 7.4) for EC. This association was modified by body mass index (p interaction < 0.001). Compared to non-overweight and non-diabetic women, non-overweight (OR = 3.9, 95% CI = 0.88, 18.0) and overweight (OR = 5.9, 95% CI = 1.6, 21.1) diabetic women had a non-significant elevated risk of EC. However, elevated risk estimates were observed for obese diabetic women (OR = 8.0, 95% CI = 2.8, 22.7). Conclusions: Our results strongly suggest an interaction effect between obesity and diabetes that significantly increases the risk of EC. This, in turn, may explain the growing number of new EC cases recently observed in developing countries with reduced birth rates and an increased incidence of both obesity and diabetes mellitus.

Prevalence and determinants of male partner violence against Mexican women: a population-based study

OBJECTIVE To determine the prevalence of and risk factors for violence against women, inflicted by their male partners, in a representative sample of women residing in the metropolitan area of Cuernavaca Morelos, Mexico. MATERIAL AND METHODS A population-based study was conducted from June to September 1998, among 1,535 women aged 15 to 49 years. Principal components analysis was used to determine the domains of violence that served as the dependent variable. Polynomial logistic regression models were used to estimate odds ratios (OR), with 95% confidence intervals (CI). RESULTS Prevalence of low-moderate level violence was 35.8%, while prevalence of severe violence was 9.5%. The lifetime prevalence of reported rape was 5.9%. The main factors associated with violence were socio-economic status (OR=0.57; 95% CI=0.34-0.95); education level, both of the women studied (test for trend p=0.01) and of the male partner (test for trend p=0.002); number of years living with partner (OR=2.63; 95% CI=1.55-4.45), alcohol use (OR=2.56; 95% CI=2.02-3.25), illegal drug use by partner (OR=6.17; 95% CI=2.37-16.03); violence during childhood (OR=3.40; 95% CI=2.23-5.18), and a history of rape (OR=5.89; 95% CI=2.78-12.5). CONCLUSIONS Study findings confirm that violence against women is a prevalent phenomenon in Mexico. Awareness-raising campaigns about male partner violence should bring this important issue to the front of public discussion. Such efforts will help assure that future generations do not experience partner violence to the extent that contemporary Mexican women do.

Violencia contra la mujer: conocimiento y actitud del personal médico del Instituto Mexicano del Seguro Social, Morelos, México.

Objective. To asses the affective, cognitive, and behavioral attitudes of healthcare providers at the Mexican Institute of Social Security (MISS) in Morelos, Mexico; to identify the institutional and medical practice barriers that hinder screening and reference of battered women. Material and Methods. A cross-sectional study was conducted between September and December 1999. A self-administered questionnaire was applied to 269 general practitioners, specialists, and pre- and postdoctoral students working in 30 primary and secondary level of healthcare units in Morelos State. The data collection instrument was designed to assess healthcare providers’ knowledge of and attitudes towards domestic violence during medical office visits. A knowledge index was constructed and analyzed using multivariate regression methods. Results. Ninety percent of healthcare providers had never received training on violence against women. Healthcare providers’ affective and cognitive attitudes after receiving training on the subject matter were more favorable compared to those with no training. Favorable attitudes were directly related to the number of Mendez-Hernandez P, Valdez-Santiago R, Viniegra-Velazquez L, Rivera-Rivera l, Salmeron-Castro J. Violencia contra la mujer: conocimiento y actitud del personal medico del Instituto Mexicano del Seguro Social, Morelos, Mexico. Salud Publica Mex 2003;45;472-482. El texto completo en ingles de este articulo esta disponible en: http://www.insp.mx/salud/index.html

Panorama epidemiológico de la mortalidad por cáncer en el Instituto Mexicano del Seguro Social: 1991-1995

Objective. This paper describes the global cancer mortality and the specific mortality patterns for the main neoplasms among adult members of the Mexican Institute of Social Security (IMSS). Material and methods. Using official death certificates and information about the population of the IMSS members during 1991-1995, national and regional annual global cancer mortality as well as specific mortality rates for the 10 most important malignant neoplasms by sex were estimated among people older than 20 years of age. The trends for these neoplasms during the study period were estimated by means of Poisson regression. The rate differences in specific cancer mortality by region and sex, for the two major neoplasms, were calculated subtracting specific regional rates from the respective national rate in 1995. Results. The global mortality rate for cancer among men increased from 76.2 in 1991 to 94.8 x 100 000 IMSS´members in 1995; and among women from 85.6 to 105.8 x 100 000 IMSS´members, representing an increment of 24.4 and 24% men and women, respectively, during the study period. Among men, neoplasm of kidney, leukemia, pancreas, prostate and lung showed the major increment; among women, neoplasm of colon, breast, pancreas, leukemia and liver showed the most significant increment. Conclusions. In the IMSS it is necessary the integration of a population based cancer registry. The registry will play a main role in disease surveillance and control; will give basic information over incidence and temporal variation, and could be the main source of information for epidemiologic research, as well as planning and evaluation of the quality of medical attention services such as prevention and early diagnosis and treatment.

El conocimiento de profesionales de la salud sobre la prevención del cáncer cervical. Alternativas de educación médica

Objective. Several studies have shown the importance of health care professionals as predictors of the use of cervical cancer screening (CCS). Material and methods. A cross- sectional study of 520 health care professionals in the State of Morelos during 1998, in order to evaluate and quantify their level of knowledge on the impact, etiology, screening, diagnosis and treatment of cervical cancer. A 1 to 10 scale questionnaire was given, and the sample included family medicine specialists, general practitioners, specialist and general nurses, and social workers. Statistical analysis included analysis of variance and 95% confidence intervals. Results. A knowledge mean of 4.74 (95% CI 4.57-4.88) was observed for a scale of 10; specialist physicians scored higher (mean 5.21, 95% CI 4.81-5.60) than social workers (mean 3.07, 95% CI 2.31-3.82). Periodicity of the Pap test in most cases was less than 1 year and there was poor consensus about the age period during which the Pap test should be obtained. The knowledge level was lower when trying to identify etiologic aspects and treatment perspectives. Conclusions. The results of this study show that, besides the improvement of undergraduate academic programs, it is necessary to improve educational interventions for health

Epidemiologic panorama of colorectal cancer in Mexico, 1980-1993.

INTRODUCTION: Colorectal cancer is the third cause of cancer-related death in the world, with 468,000 estimated deaths in 1993. In some countries mortality rates have started to decline, and survival rates have increased. In this study performed in Mexico, information is presented on the increase in mortality from this form of cancer, especially in more economically developed areas. METHODS: The mortality trend for colorectal cancer was evaluated and standardized by five-year age groups in the period 1980 to 1993. Also, the standardized mortality ratio was calculated for Mexicos 32 states, as was the possible association between mortality and indicators of rurality level and fertility rates in the different regions of Mexico. RESULTS: In the period studied, 18,962 deaths were officially reported. The average age of death was 66 years. The mortality rate among women (1.8) was significantly higher than among men (1.55 per 100,000 inhabitants). Mortality from colorectal cancer grew by 100 percent in both genders (β=0.089;P<0.001), especially in the age group 34 and younger, in the 45 to 49 age group, and in the older than 75 age group (P<0.05). The standardized mortality ratio was greater in the states in the north of Mexico. Finally, an inverse correlation was observed throughout Mexico between the rurality index (r=−0.60;P<0.001) and the fertility rates (r=−0.43;P<0.05) and mortality from colorectal cancer. CONCLUSIONS: In this study, there is evidence that mortality from this cancer is higher in geographic areas with greater socioeconomic development, similar to regional patterns observed in other countries. In Mexico, the coming years will see a serious epidemic in mortality from this disease; therefore, immediate attention must be given to identifying the profile of high-risk subjects and implementing early cancer detection measures.

Weight, Physical Activity, and Smoking as Determinants of Insulinemia in Adolescents

BACKGROUND It is known that insulinemia is the result of the interaction among several factors, such as weight, body fat pattern distribution, and physical activity as well as ethnicity. There is little information regarding this question among Mexican adolescents. The association among fasting insulin levels, weight, fat distribution, physical activity, and cigarette smoking was studied in Mexican adolescents. METHODS Cross-sectional data were collected from 352 Mexican adolescents aged 14-19 years (response rate 41.5%). Fasting insulin levels were measured by microparticle enzyme immunoassay; body mass index (BMI), waist-to-hip ratio (WHR), and waist circumference (WC) were determined using standardized techniques, while physical activity was determined by 7-day Stanford physical activity inventory. Cigarette smoking was defined as number of cigarettes/year. RESULTS Increased BMI and waist circumference, low physical activity, younger age, and non-smoking were associated with high insulin levels. Non-smokers had higher fasting insulin levels compared to smokers (57.8 pmol +/- 1.84 vs. 49.7 pmol/L +/- 2.8; p = 0.034). However, adjusted odds ratio (OR) between insulin and smoking status was not significant. Multivariate analysis showed the following: insulin increased 1.06 pmol/L for each unit of change in BMI; increased 1.02 pmol/L for each unit of change in waist circumference; increased 1.16 pmol/L for non-smoking, and decreased 1.07 pmol/L for each 250 kcal/day of energy expenditure. CONCLUSIONS Our results support the concept that Mexican adolescents who are overweight have abdominal fat distribution and physical inactivity, and significant hyperinsulinemia. The relationship between smoking and lower insulinemia found in this research warrants further study.

Tabaquismo en profesionales de la salud del Instituto Mexicano del Seguro Social, Morelos

Objective. To assess the prevalence of tobacco smoking by work type among healthcare workers of Instituto Mexicano del Seguro Social (Mexican Institute of Social Security, IMSS), in Morelos State, Mexico. Material and Methods. A cross-sectional was conducted in 3 133 healthcare workers in the 23 medical units of IMSS Morelos District, from October 1998 to March 2000. Data were collected using a self-applied questionnaire on tobacco smoking for different life-stages, some demographic characteristics, and work type. The prevalence rates of smoking and 95% confidence intervals (95% CI) were estimated by age groups, gender, and work type. Results. A total of 3 133 employees participated; 53.4% (95% CI 50.8-56.8) of men and 27.4% (95% CI 25.4-29.3) of women reported having smoked tobacco some time in their lives. The prevalence of current smoking was 28.3% (95% CI 25.6-31.0) and 14.4% (95% CI 12.8-15.9) in men and women, respectively. Among men, physicians have a lower prevalence (20.9%) of current smoking than that of other workers; for example, the prevalence was 26,6% among technicians and 33% among administrative personnel. Women in general had a lower prevalence than men in all categories, and in nurses it was still lower t(12,5%) than that of female physicians (16%). Conclusions. The prevalence of tobacco smoking in healthcare workers of IMSS

Recomendaciones para la definición de la política de vacunación contra el virus del papiloma en México

(1) Instituto Nacional de Salud Publica. Mexico. (2) Instituto Mexicano del Seguro Social. Mexico. (3) Instituto Nacional de Cancerologia de Mexico. (4) Instituto de Investigaciones Biomedicas de la Universidad Nacional Autonoma de Mexico. (5) Instituto Nacional de Perinatologia. Mexico. (6) Centro Nacional para la Salud de la Infancia y la Adolescencia. Mexico. (7) Centro Nacional de Equidad de Genero y Salud Reproductiva. Mexico.

Interleukin-6 Polymorphisms Are Associated with Obesity and Hyperglycemia in Mexican Adolescents

BACKGROUND AND AIMS Interleukin-6 is an inflammatory response mediator used as a metabolic marker of obesity. Polymorphisms IL6 -597C>A, -572G>C, and -174G>C modify the production of this protein. The associations between these haplotypes and obesity or metabolic markers have not been studied in adolescents, so an analysis of these associations was performed. METHODS The cross-sectional study included 745 apparently healthy 14- to 19-year-old adolescents. Obesity, serum glucose, insulin, triglycerides, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol (HDL-C), and high-sensitivity C-reactive protein (hs-CRP) were evaluated, and IL6 -597G>A, -572G>C and -174G>C polymorphisms determined. The associations were analyzed using multivariate logistic regression models. RESULTS The allele frequencies were 0.15 for -597A and -174C and 0.30 for -572C. Genotypes were in Hardy-Weinberg equilibrium. IL-6(-597/-572/-174) haplotypes GGG, GCG, and AGC comprised 99.74% of the total haplotypes. The associations were significant between genotype GCG/GCG and hyperglycemia (OR = 2.86, 95% CI = 1.02-7.97); between GCG/GCG and high hs-CRP (OR = 6.17, 95% CI = 1.13-33.77); between AGC/AGC and obesity (OR = 4.42, 95% CI = 1.40-14.01); and between GGG/GCG and low HDL-C (OR = 1.53, 95% CI = 1.03-2.28). CONCLUSIONS Genotypes of the IL6(-597/-572/-174) polymorphisms are associated with metabolic risk factors in Mexican adolescents.