RESUMEN

Diarrhea is a leading cause of death in children globally, mostly due to inadequate sanitary conditions and overcrowding. Poor housing quality and lack of tenure security that characterize informal settlements are key underlying contributors to these risk factors for childhood diarrhea deaths. The objective of this study is to better understand the physical attributes of informal settlement households in Latin American cities that are associated with childhood diarrhea. We used data from a household survey (Encuesta CAF) conducted by the Corporación Andina de Fomento (CAF), using responses from sampled individuals in eleven cities. We created a household deprivation score based on household water and sewage infrastructure, overcrowding, flooring and wall material, and security of tenure. We fitted a multivariable logistic regression model to estimate odds ratios (OR) and 95% confidence intervals (95% CI) to test the association between the deprivation score and its individual components and childhood diarrhea during the prior 2 weeks. We included a total of 4732 households with children, out of which 12.2% had diarrhea in the 2-week period prior to completing the survey. After adjusting for respondent age, gender, and city, we found a higher risk of diarrhea associated with higher household deprivation scores. Specifically, we found that the odds of diarrhea for children living in a mild and severe deprived household were 1.04 (95% CI 0.84-1.28) and 3.19 times (95% CI 1.80-5.63) higher, respectively, in comparison to households with no deprivation. These results highlight the connections between childhood health and deprived living conditions common in informal settlements.

Asunto(s)

RESUMEN

BACKGROUND: The association of the built environment and the structural availability of services/amenities with adolescent birth rates (ABR) has been overlooked in Latin America. We investigated the association of the availability, and changes in the availability, of services/amenities with ABR in 92 Mexican cities. METHODS: We estimated ABR using data on live birth registration linked to municipality of residence at the time of birth from 2008-2017. The number of services/amenities were obtained from the National Statistical Directory of Economic Units in 2010, 2015, and 2020 and grouped as follows: education, health care, pharmacies, recreation, and on- and off-premises alcohol outlets. Data were linearly interpolated to obtain yearly estimates. We estimated densities per square km by municipality. We fitted negative binomial hybrid models, including a random intercept for municipality and city, and adjusted for other social environment variables. RESULTS: After adjustment a 1-unit increase in the density of recreation facilities, pharmacies, and off-premises alcohol outlets within municipalities was associated with a 5%, 4% and 12% decrease in ABR, respectively. Municipalities with higher density of education, recreational and health care facilities had a lower ABR; in contrast, municipalities with a higher density of on-premises alcohol experienced a higher ABR. CONCLUSION: Our findings highlight the importance of economic drivers and the need to invest in infrastructure, such as pharmacies, medical facilities, schools, and recreation areas and limit the availability of alcohol outlets to increase the impact of current adolescent pregnancy prevention programs.

Asunto(s)

RESUMEN

Gender, violence, and migration structurally impact health. The Venezuelan humanitarian crisis comprises the largest transnational migration in the history of the Americas. Colombia, a post-conflict country, is the primary recipient of Venezuelans. The Colombian context imposes high levels of violence on women across migration phases. There is little information on the relationship between violence and HIV risk in the region and how it impacts these groups. Evidence on how to approach the HIV response related to Venezuela's humanitarian crisis is lacking. Our study seeks to 1) understand how violence is associated with newly reported HIV/AIDS case rates for women in Colombian municipalities; and 2) describe how social violence impacts HIV risk, treatment, and prevention for Venezuelan migrant and refugee women undergoing transnational migration and resettlement in Colombia. We conducted a concurrent mixed-methods design. We used negative binomial models to explore associations between social violence proxied by Homicide Rates (HR) at the municipality level (n = 84). The also conducted 54 semi-structured interviews with Venezuelan migrant and refugee women and key informants in two Colombian cities to expand and describe contextual vulnerabilities to HIV risk, prevention and care related to violence. We found that newly reported HIV cases in women were 25% higher for every increase of 18 homicides per 100,000, after adjusting for covariates. Upon resettlement, participants cited armed actors' control, lack of government accountability, gender-based violence and stigmatization of HIV as sources of increased HIV risk for VMRW. These factors impose barriers to testing, treatment and care. Social violence in Colombian municipalities is associated with an increase in newly reported HIV/AIDS case rates in women. Violence hinders Venezuelan migrant and refugee women's access and engagement in available HIV prevention and treatment interventions.

RESUMEN

BACKGROUND: Gender inequality is high in Latin America (LA). Empowering girls and young women and reducing gender gaps has been proposed as a pathway to reduce adolescent pregnancy. We investigated the associations of urban measures of women's empowerment and gender inequality with adolescent birth rates (ABR) in 366 Latin American cities in nine countries. METHODS: We created a gender inequality index (GII) and three Women Achievement scores reflecting domains of women's empowerment (employment, education, and health care access) using censuses, surveys, and political participation data at city and sub-city levels. We used 3-level negative binomial models (sub-city-city-countries) to assess the association between the GII and scores, with ABR while accounting for other city and sub-city characteristics. RESULTS: We found within country heterogeneity in gender inequality and women's empowerment measures. The ABR was 4% higher for each 1 standard deviation (1-SD) higher GII (RR 1.04; 95%CI 1.01,1.06), 8% lower for each SD higher autonomy score (RR 0.92; 95%CI 0.86, 0.99), and 12% lower for each SD health care access score (RR 0.88; 95%CI 0.82,0.95) after adjustment for city level population size, population growth, homicide rates, and sub-city population educational attainment and living conditions scores. CONCLUSION: Our findings show the key role cities have in reducing ABR through the implementation of strategies that foster women's socioeconomic progress such as education, employment, and health care access.

Asunto(s)

RESUMEN

Background: Cesarean section (CS) is a surgical procedure that, when medically justified, can help reduce maternal and infant morbidity and mortality. Worldwide CS rates (CSR) have been increasing; Latin America has rates that are among the highest in the world. Aim: Describe the variability of CSR across cities in Brazil, Colombia, Guatemala, Mexico, and Peru and examine the relationship of individual-level, sub-city, and city-level socioeconomic status (SES) with CSR. Methods: We used individual level data from vital statistics over the period 2014-2016 (delivery method, mother's age and education), census data to characterize sub-city SES and city GDP per capita from other sources compiled by the SALURBAL project. We fitted multilevel negative binomial regression models to estimate associations of SES with CSR. Results: 11,549,028 live births from 1,101 sub-city units in 305 cities of five countries were included. Overall, the CSR was 52%, with a wide range across sub-cities (13-91%). Of the total variability in sub-city CSRs, 67% was within countries. In fully adjusted model higher CSR was associated with higher maternal education [(PRR (CI95%) 0.81 (0.80-0.82) for lower educational level, 1.32 (1.31-1.33) for higher level (ref. medium category)], with higher maternal age [PRR (CI95%) 1.23 (1.22-1.24) for ages 20-34 years, and 1.48 (1.47-1.49) for ages ≥ 35 years (ref. ≤19 years], higher sub-city SES [(PRR (CI95%) 1.02 (1.01-1.03) per 1SD)], and higher city GDP per capita [(PRR (CI95%): 1.03 (1.00-1.07) for GDP between 10,500-18,000, and 1.09 (1.06-1.13) for GDP 18,000 or more (ref. <10,500)]. Conclusion: We found large variability in CSR across cities highlighting the potential role of local policies on CSR levels. Variability was associated in part with maternal and area education and GDP. Further research is needed to understand the reasons for this pattern and any policy implications it may have.

RESUMEN

INTRODUCTION: Latin America has the second-highest adolescent birth rate (ABR) worldwide. Variation between urban and rural areas and evidence linking country development to ABR points towards upstream factors in the causal pathway. We investigated variation in ABR within and between cities, and whether different features of urban social environments are associated with ABR. METHODS: We included 363 cities in 9 Latin American countries. We collected data on social environment at country, city and subcity levels and birth rates among adolescents (ages 15-19). We investigated variation in ABR within and between countries and cities along with associations between social environment and ABR by fitting three-level negative binomial models (subcities nested within cities nested within countries). RESULTS: The median subcity ABR was 58.5 per 1000 women 15-19 (IQR 43.0-75.3). We found significant variability in subcity ABR between countries and cities (37% of variance between countries and 47% between cities within countries). Higher homicide rates and greater population growth in cities were associated with higher ABR (rate ratio (RR) 1.09; 95% CI 1.06 to 1.12 and RR 1.02; 95% CI 1.00 to 1.04, per SD, respectively), while better living conditions and educational attainment in subcities were associated with lower ABR after accounting for other social environment characteristics (RR 0.95; 95% CI 0.92 to 0.98 and 0.78; 95% CI 0.76 to 0.79, per SD, respectively). CONCLUSIONS: The large heterogeneity of ABR found within countries and cities highlights the key role urban areas have in developing local policies. Holistic interventions targeting education inequalities and living conditions are likely important to reducing ABR in cities.

Asunto(s)

RESUMEN

BACKGROUND: Extreme temperatures may lead to adverse pregnancy and birth outcomes, including low birthweight. Studies on the impact of temperature on birthweight have been inconclusive due to methodological challenges related to operationalizing temperature exposure, the definitions of exposure windows, accounting for gestational age, and a limited geographic scope. METHODS: We combined data on individual-level term live births (N≈15 million births) from urban areas in Brazil, Chile, and Mexico from 2010 to 2015 from the SALURBAL study (Urban Health in Latin America) with high-resolution daily air temperature data and computed average ambient temperature for every month of gestation for each newborn. Associations between full-term birthweight and average temperature during gestation were analyzed using multi-level distributed lag non-linear models that adjusted for newborn's sex, season of conception, and calendar year of child's birth; controlled for maternal age, education, partnership status, presence of previous births, and climate zone; and included a random term for the sub-city of mother's residence. FINDINGS: Higher temperatures during the entire gestation are associated with lower birthweight, particularly in Mexico and Brazil. The cumulative effect of temperature on birthweight is mostly driven by exposure to higher temperatures during months 7-9 of gestation. Higher maternal education can attenuate the temperature-birthweight associations. INTERPRETATION: Our work shows that climate-health impacts are likely to be context- and place-specific and warrants research on temperature and birthweight in diverse climates to adequately anticipate global climate change. Given the high societal cost of suboptimal birthweight, public health efforts should be aimed at diminishing the detrimental effect of higher temperatures on birthweight. FUNDING: The Wellcome Trust.

Asunto(s)

RESUMEN

INTRODUCTION: Modeling studies have estimated the potential impact and cost effectiveness of interventions to reduce obesity; few have focused on their equity across socioeconomic groups. This study aims to compare the equitability of individual- and population-level interventions to reduce obesity in Mexico. METHODS: Mathematical models were implemented to estimate the expected effect of 2 sugar-sweetened beverage tax scenarios (10% and 20%) and bariatric surgery, pharmacotherapy, and dietary advice as individual interventions to reduce body weight. Individual interventions were modeled using meta-analytical weight change, inclusion and exclusion criteria, and the probability of access to healthcare services. For the tax, investigators obtained the baseline consumption of sugar-sweetened beverages from the National Health Survey 2012 and applied the reduction in sales observed in 2016 to estimate the caloric change and weight reduction. Implementation costs and cost per person, per kilogram, and equity were calculated for all interventions over a 1-year timeframe. RESULTS: The 20% tax produced the largest estimated increase (4.50%) in normal BMI prevalence, was the most cost effective, and had the largest and most equitable decrease in obesity across socioeconomic categories. Pharmacotherapy and bariatric surgery produced sizable decreases in obesity prevalence (3.68% and 1.18%), particularly among the middle and high socioeconomic groups, whereas dietary advice had the lowest impact on normal and obese categories. CONCLUSIONS: Individual interventions were effective in reducing obesity; yet, they were more expensive and less equitable than population interventions. Obesity in Mexico affects all socioeconomic groups; available interventions need to be carefully analyzed to tailor a national strategy that is both effective and equitable.

Asunto(s)

RESUMEN

BACKGROUND: Childhood is considered the most important phase of human development; within it the period from birth to 5 years of age is particularly critical, given the speed at which changes occur. The context where children live can influence early childhood developmnent (ECD) by providing or limiting opportunities to learn, play and establish social interactions. This study explored the associations between characteristics of the urban environment and ECD in 2,194 children aged 36 to 59 months living in urban municipalities in Mexico. METHODS: We obtained ECD information from the 2015 Survey of Boys, Girls, and Women (ENIM, for its Spanish acronym), measured with the Early Childhood Development Index. The urban environment was evaluated at the municipal level, considering variables from five environment domains: physical, social, service, socioeconomic, and governance. Multilevel logistic models were fitted to assess the association between urban environment characteristics and the inadequacy of ECD in general and by specific development domains: learning, socio-emotional, physical, and alpha-numeric. RESULTS: Inadequate ECD was inversely associated with the availability of libraries (OR = 0.55, 95% CI: 0.43, 0.72), and positively associated with population density (OR = 1.01, 95% CI: 1.01-1.02). For the specific ECD domains, inadequate socio-emotional development was inversely associated with the availability of libraries (OR = 0.66, 95% CI: 0.51, 0.85). Inadequate literacy-numeracy knowledge was associated inversely with the availability of daycare centers (OR = 0.56, 95% CI: 0.32, 0.97), and directly associated with the number of hospitals and clinics (OR = 1.87, 95% CI: 1.29, 2.72). Finally, the marginalization index was positively associated with inadequacy in the learning domain (OR = 1.80, 95% CI: 1.06, 3.03). CONCLUSIONS: Some aspects of the urban environment associated with ECD, suggest that intervening in the urban context could improve overall child development. Investment in resources oriented to improve socio-emotional development and literacy (such as libraries and daycare), could foster ECD in Mexico.

Asunto(s)

RESUMEN

OBJECTIVE: Using newly harmonised individual-level data on health and socio-economic environments in Latin American cities (from the Salud Urbana en América Latina (SALURBAL) study), we assessed the association between obesity and education levels and explored potential effect modification of this association by city-level socio-economic development. DESIGN: This cross-sectional study used survey data collected between 2002 and 2017. Absolute and relative educational inequalities in obesity (BMI ≥ 30 kg/m2, derived from measured weight and height) were calculated first. Then, a two-level mixed-effects logistic regression was run to test for effect modification of the education-obesity association by city-level socio-economic development. All analyses were stratified by sex. SETTING: One hundred seventy-six Latin American cities within eight countries (Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico and Peru). PARTICIPANTS: 53 186 adults aged >18 years old. RESULTS: Among women, 25 % were living with obesity and obesity was negatively associated with educational level (higher education-lower obesity) and this pattern was consistent across city-level socio-economic development. Among men, 18 % were living with obesity and there was a positive association between education and obesity (higher education-higher obesity) for men living in cities with lower levels of development, whereas for those living in cities with higher levels of development, the pattern was inverted and university education was protective of obesity. CONCLUSIONS: Among women, education was protective of obesity regardless, whereas among men, it was only protective in cities with higher levels of development. These divergent results suggest the need for sex- and city-specific interventions to reduce obesity prevalence and inequalities.

RESUMEN

BACKGROUND: Diabetes prevalence continues to increase in urban areas of low-income and middle-income countries (LMIC). Evidence from high-income countries suggests an inverse association between educational attainment and diabetes, but research in LMIC is limited. We investigated educational differences in diabetes prevalence across 232 Latin American (LA) cities, and the extent to which these inequities vary across countries/cities and are modified by city socioeconomic factors. METHODS: Using harmonised health survey and census data for 110 498 city dwellers from eight LA countries, we estimated the association between education and diabetes. We considered effect modification by city Social Environment Index (SEI) as a proxy for city-level development using multilevel models, considering heterogeneity by sex and country. RESULTS: In women, there was an inverse dose-response relationship between education and diabetes (OR: 0.80 per level increase in education, 95% CI 0.75 to 0.85), consistent across countries and not modified by SEI. In men, Argentina, Brazil, Colombia, Chile and Mexico showed an inverse association (pooled OR: 0.92; 95% CI 0.86 to 0.99). Peru, Panama and El Salvador showed a positive relationship (pooled OR 1.24; 95% CI 1.04 to 1.49). For men, these associations were further modified by city-SEI: in countries with an inverse association, it became stronger as city-SEI increased. In countries where the association was positive, it became weaker as city-SEI increased. CONCLUSION: Social inequities in diabetes inequalities increase as cities develop. To achieve non-communicable disease-related sustainable development goals in LMIC, there is an urgent need to develop policies aimed at reducing these educational inequities.

Asunto(s)

RESUMEN

BACKGROUND: In 2010, sugar sweetened beverages (SSBs) were estimated to cause 12% of all diabetes, cardiovascular disease (CVD) and obesity-related cancer deaths in Mexico. Using new risk estimates for SSBs consumption, we aimed to update the fraction of Mexican mortality attributable to SSBs, and provide subnational estimates by region, age, and sex. METHODS: We used an established comparative risk assessment framework. All-cause mortality estimates were calculated from a recent pooled cohort analysis. Age- and sex-specific relative risks for SSBs-disease relationships were obtained from updated meta-analyses. Demographics and nationally representative estimates of SSBs intake were derived from the National Health and Nutrition Survey 2012; and mortality rates, from the National Institute of Statistics and Geography. Attributable mortality was calculated by estimating the population attributable fraction of each disease, with uncertainty in data inputs propagated through Monte Carlo probabilistic sensitivity analyses. RESULTS: In Mexican adults 20 years and older, 6.9% (95%UI: 5.4-8.5) of all cause-mortality was attributable to SSBs, representing 40,842 excess deaths/year (95%UI: 31,950-50,138). Furthermore, 19% of diabetes, CVD and obesity-related cancer mortality was attributable to SSBs (95%UI: 11.0-26.5), representing 37,000 excess deaths/year (95%UI 21,240-51,045). Of these, 35.6% were diabetes-related (95%UI 16.4-52.0). Proportional burden was highest in the South (22.8%), followed by the Center (18.0%) and North (17.4%). Men aged 45-64-years in the Center region had highest proportional mortality (37.2%), followed by 20-44-year-old men living in the South (35.7%) and both men and women aged 20-44 living in the Center (34.4%). CONCLUSIONS: Utilizing current evidence linking SSBs to cardiometabolic disease and obesity-related cancers, earlier estimates of Mexican mortality attributable to SSBs could have been underestimated. Mexico urgently needs stronger policies to reduce SSBs consumption and reduce these burdens.

Asunto(s)

RESUMEN

This study estimates the contribution of second and higher-order births to the adolescent fertility rate in Mexico from 2006 to 2014. We used data from nationally representative surveys for 2006, 2009, and 2014 to estimate the adolescent fertility rate, and the first, second, and higher-order birth components for the triennium prior to each survey at the national and state level. Our results showed that the second and higher-order component was 16.3 births per 1,000 women in 2003-05, 14.9 in 2006-08, and 16.9 in 2011-13. Second and higher-order births represented 25.9 percent of all teen births in 2003-05, 21.6 percent in 2006-08, and 21.9 percent in 2011-13. Second and higher-order births were heterogeneous across states. We found that second and higher-order births are highly prevalent and important contributors to the adolescent fertility rate. Postponing second and higher-order births would benefit both mothers and children. Monitoring them provides crucial information on the demand of targeted health system strategies that address the reproductive health needs of adolescent mothers. Interventions to prevent second and higher-order pregnancies must be developed and implemented.

Asunto(s)

RESUMEN

[This corrects the article DOI: 10.1371/journal.pmed.1002664.].

RESUMEN

BACKGROUND: Several strategies have been proposed to reduce the intake of added sugars in the population. In Mexico, a 10% sugar-sweetened beverages (SSBs) tax was implemented in 2014, and the implementation of other nutritional policies, such as product reformulation to reduce added sugars, is under discussion. WHO recommends that all individuals consume less than 10% of their total energy intake (TEI) from added sugars. We propose gradually reducing added sugars in SSBs to achieve an average 10% consumption of added sugars in the Mexican population over 10 years and to estimate the expected impact of reformulation in adult body weight and obesity. METHODS AND FINDINGS: Baseline consumption for added sugars and SSBs, sex, age, socioeconomic status (SES), height, and weight for Mexican adults were obtained from the 2012 Mexico National Health and Nutrition Survey (ENSANUT). On average, 12.6% of the TEI was contributed by added sugars; we defined a 50% reduction in added sugars in SSBs over 10 years as a reformulation target. Using a dynamic weight change model, sugar reductions were translated into individual expected changes in body weight assuming a 43% caloric compensation and a 2-year lag for the full effect of reformulation to occur. Results were stratified by sex, age, and SES. Twelve years after reformulation, the TEI from added sugars is expected to decrease to 10%, assuming no compensation from added sugars; 44% of the population would still be above WHO recommendations, requiring further sugar reductions to food. Body weight could be reduced by 1.3 kg (95% CI -1.4 to -1.2) in the adult population, and obesity could decrease 3.9 percentage points (pp; -12.5% relative to baseline). Our sensitivity analyses suggest that the impact of the intervention could vary from 0.12 kg after 6 months to 1.52 kg in the long term. CONCLUSIONS: Reformulation to reduce added sugars in SSBs could produce large reductions in sugar consumption and obesity in the Mexican adult population. This study is limited by the use of a single dietary recall and by data collected in all seasons except summer; still, these limitations should lead to conservative estimates of the reformulation effect. Reformulation success could depend on government enforcement and industry and consumer response, for which further research and evidence are needed.

Asunto(s)

RESUMEN

BACKGROUND: Article 10 of the World Health Organization Framework Convention on Tobacco Control states the need for industry disclosure of tobacco contents and emissions. Currently, the profiles of key tobacco compounds in legal and illegal cigarettes are largely unknown. We aimed to analyze and compare concentrations of nicotine, nitrosamines, and humectants in legal and illegal cigarettes collected from a representative sample of smokers. METHODS: Participants of the International Tobacco Control cohort provided a cigarette pack of the brand they smoked during the 2014 wave. Brands were classified as legal or illegal according to the Mexican legislation. Nicotine, nitrosamines, glycerol, propylene glycol, and pH were quantified in seven randomly selected packs of each brand. All analyses were done blinded to legality status. Average concentrations per brand and global averages for legal and illegal brands were calculated. Comparisons between legal and illegal brands were conducted using t tests. RESULTS: Participants provided 76 different brands, from which 6.8% were illegal. Legal brands had higher nicotine (15.05 ± 1.89 mg/g vs 12.09 ± 2.69 mg/g; p < 0001), glycerol (12.98 ± 8.03 vs 2.93 ± 1.96 mg/g; p < 0.001), and N-nitrosanatabine (NAT) (1087.5 ± 127.0 vs 738.5 ± 338 ng/g; p = 0.006) concentrations compared to illegal brands. For all other compounds, legal and illegal brands had similar concentrations. CONCLUSION: Compared to illegal cigarettes, legal brands seem to have higher concentrations of nicotine, NAT, and glycerol. Efforts must be made to implement and enforce Article 10 of the Framework Convention on Tobacco Control to provide transparent information to consumers, regulators, and policy-makers; and to limit cigarette engineering from the tobacco industry.

Asunto(s)

RESUMEN

Introducción: El bajo peso neonatal (< 2.5 kg o < percentil 10) se atribuye a causas constitucionales (pequeño para la edad gestacional [PEG]) o a la restricción en el crecimiento intrauterino (RCIU), con riesgos posnatales diferentes. En ausencia de una valoración fetal-placentaria prenatal adecuada, resulta difícil establecerlo. El conocer los antecedentes maternos de enfermedades gestacionales (AMEG): hipertensión arterial (HTA), hipotiroidismo, Diabetes Mellitus (DM) gestacional y otra; pudiera orientar a la diferenciación y el manejo. El objetivo de este trabajo fue determinar si la presencia de AMEG se asocia a complicaciones neonatales en productos de bajo peso neonatal. Métodos: Se realizó un estudio de cohorte retrospectivo en un grupo de 349 recién nacidos vivos de término (≥ 37 semanas de edad gestacional [SEG]), PEG, en cunero fisiológico y agrupados según los AMEG. Se determinó la frecuencia de dificultad respiratoria (DR), hipoglucemia (HG) e hiperbilirrubinemia (HBr). Resultados: El 16.6% (58/349) presentó AMEG (58.6% HTA y 41.3% hipotiroidismo, solos o combinados). Los neonatos con AMEG fueron más limítrofes (37 SEG, 55.2% vs. 35.1%; p = 0.037). Los de 37 SEG con menor peso (diferencia de ≈100 g; p = 0.028), más riesgo de HG (13.6%; intervalo de confianza al 95% [IC 95%]: -4.08-31.2) pero menos DR (diferencia de -4.7%; IC 95%: -20.6-11.05). La HG en los de 39 SEG solo se presentó en neonatos sin AMEG (diferencia 12.7%; IC 95%: 3.9 a 31.5) igual que la HBr (tres casos). Conclusiones: Indagar sobre los AMEG en un producto PEG parece ser útil en la inferencia de RCIU. Sin embargo, es insuficiente, por lo que en conjunto con otras herramientas nos ayuda a estimar posibles complicaciones y acciones preventivas. Background: Low-birth-weight (LWB < 2.5 kg or <10 percentile) could be caused by constitutional matters or by intrauterine growth restriction (IUGR), both with different neonatal complications. Without an adequate prenatal evaluation is hard to stablish those conditions. Knowing the maternal history for gestational diseases (MHGD) such as hypertension (HTA), hypothyroidism or diabetes, among others could help clarify that difference. The aim of this work was to determine if having a MHGD is associated to neonatal complications in newborns with LWB. Methods: Retrospective cohort study, which included 349 with LWB at term (≥ 37 weeks of gestation [WG]) grouped into those with or without MHGD at a hospital nursery. The frequency of respiratory distress, hypoglycemia, and hyperbilirubinemia was determined. Results: 16.6% (58/349) had MHGD (58.6% for HTA and 41.3% hypothyroidism alone or combined). The neonate with MHGD were more borderline term (37 WGA, 55.2% vs. 35.1%; p = 0.037), and had lower weight (difference of ≈100 g; p = 0.028), had more cases with hypoglycemia (13.6%; CI 95%: −4.08 to 31.2%) but developed less respiratory distress (RD) (difference of −4.7%; CI 95%: −20.6 to 11.05%). Hypoglycemia in 39 WGA was only seen among neonates without MHGD (difference 12.7%; CI95%: 3.9 to 31.5%) just as for the hyperbilirubinemia cases (three). Conclusions: Inquiring about the MHGD on LBW term babies could be useful in the inference of IUGR, although we need other tools so that altogether can help to predict possible complications and to plan preventive actions.

Asunto(s)

RESUMEN

Resumen Introducción: El bajo peso neonatal (< 2.5 kg o < percentil 10) se atribuye a causas constitucionales (pequeño para la edad gestacional [PEG]) o a la restricción en el crecimiento intrauterino (RCIU), con riesgos posnatales diferentes. En ausencia de una valoración fetal-placentaria prenatal adecuada, resulta difícil establecerlo. El conocer los antecedentes maternos de enfermedades gestacionales (AMEG): hipertensión arterial (HTA), hipotiroidismo, Diabetes Mellitus (DM) gestacional y otra; pudiera orientar a la diferenciación y el manejo. El objetivo de este trabajo fue determinar si la presencia de AMEG se asocia a complicaciones neonatales en productos de bajo peso neonatal. Métodos: Se realizó un estudio de cohorte retrospectivo en un grupo de 349 recién nacidos vivos de término (≥ 37 semanas de edad gestacional [SEG]), PEG, en cunero fisiológico y agrupados según los AMEG. Se determinó la frecuencia de dificultad respiratoria (DR), hipoglucemia (HG) e hiperbilirrubinemia (HBr). Resultados: El 16.6% (58/349) presentó AMEG (58.6% HTA y 41.3% hipotiroidismo, solos o combinados). Los neonatos con AMEG fueron más limítrofes (37 SEG, 55.2% vs. 35.1%; p = 0.037). Los de 37 SEG con menor peso (diferencia de ≈100 g; p = 0.028), más riesgo de HG (13.6%; intervalo de confianza al 95% [IC 95%]: −4.08-31.2) pero menos DR (diferencia de −4.7%; IC 95%: −20.6-11.05). La HG en los de 39 SEG solo se presentó en neonatos sin AMEG (diferencia 12.7%; IC 95%: 3.9 a 31.5) igual que la HBr (tres casos). Conclusiones: Indagar sobre los AMEG en un producto PEG parece ser útil en la inferencia de RCIU. Sin embargo, es insuficiente, por lo que en conjunto con otras herramientas nos ayuda a estimar posibles complicaciones y acciones preventivas.

Abstract Background: Low-birth-weight (LWB < 2.5 kg or <10 percentile) could be caused by constitutional matters or by intrauterine growth restriction (IUGR), both with different neonatal complications. Without an adequate prenatal evaluation is hard to stablish those conditions. Knowing the maternal history for gestational diseases (MHGD) such as hypertension (HTA), hypothyroidism or diabetes, among others could help clarify that difference. The aim of this work was to determine if having a MHGD is associated to neonatal complications in newborns with LWB. Methods: Retrospective cohort study, which included 349 with LWB at term (≥ 37 weeks of gestation [WG]) grouped into those with or without MHGD at a hospital nursery. The frequency of respiratory distress, hypoglycemia, and hyperbilirubinemia was determined. Results: 16.6% (58/349) had MHGD (58.6% for HTA and 41.3% hypothyroidism alone or combined). The neonate with MHGD were more borderline term (37 WGA, 55.2% vs. 35.1%; p = 0.037), and had lower weight (difference of ≈100 g; p = 0.028), had more cases with hypoglycemia (13.6%; CI 95%: −4.08 to 31.2%) but developed less respiratory distress (RD) (difference of −4.7%; CI 95%: −20.6 to 11.05%). Hypoglycemia in 39 WGA was only seen among neonates without MHGD (difference 12.7%; CI95%: 3.9 to 31.5%) just as for the hyperbilirubinemia cases (three). Conclusions: Inquiring about the MHGD on LBW term babies could be useful in the inference of IUGR, although we need other tools so that altogether can help to predict possible complications and to plan preventive actions.

Asunto(s)

RESUMEN

Background Video games are widely used by children and adolescents and have become a significant source of exposure to sexual content. Despite evidence of the important role of media in the development of sexual attitudes and behaviours, little attention has been paid to monitor sexual content in video games. METHODS: Data was obtained about sexual content and rating for 23722 video games from 1994 to 2013 from the Entertainment Software Rating Board database; release dates and information on the top 100 selling video games was also obtained. A yearly prevalence of sexual content according to rating categories was calculated. Trends and comparisons were estimated using Joinpoint regression. RESULTS: Sexual content was present in 13% of the video games. Games rated 'Mature' had the highest prevalence of sexual content (34.5%) followed by 'Teen' (30.7%) and 'E10+' (21.3%). Over time, sexual content decreased in the 'Everyone' category, 'E10+' maintained a low prevalence and 'Teen' and 'Mature' showed a marked increase. Both top and non-top video games showed constant increases, with top selling video games having 10.1% more sexual content across the period of study. CONCLUSION: Over the last 20 years, the prevalence of sexual content has increased in video games with a 'Teen' or 'Mature' rating. Further studies are needed to quantify the potential association between sexual content in video games and sexual behaviour in children and adolescents.

Asunto(s)