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Background: Non-alcoholic fatty liver disease (NAFLD) has serious health implications and upward trends of the disease, accompanied by the obesity epidemic worldwide. Objective: To screen for fatty liver in overweight and obese children and evaluate the factors associated with an increased likelihood of presenting a positive-screen result. Material and methods: In a cross-sectional study, 102 children were recruited at a secondary care medical unit. Serum alanine aminotransferase (ALT) levels were quantified and hepatic ultrasounds were performed; multiple logistic regression models were used to evaluate factors associated with the increased odds of presenting with NAFLD (fatty infiltration on ultrasound and ALT > 52 U/L for boys and > 44 U/L for girls). Results: The overall prevalence of NAFLD was 10.8%. In multivariate analysis, a waist-to-hip ratio ≥ 1 was associated with increased odds of screening positive for NAFLD (odds ratio (OR) = 4.96, 95% CI 1.17-20.90). Conclusions: Our findings indicate that one out of ten children with overweight or obesity has data suggestive of NAFLD and is at risk of presenting its consequences on health.

Introducción: la enfermedad del hígado graso no alcohólico (EHGNA) tiene graves implicaciones para la salud y, asociada a la epidemia de obesidad, es una tendencia creciente. Objetivo: detectar la presencia de hígado graso en niños con sobrepeso y obesidad, así como evaluar los factores asociados con una mayor posibilidad de presentar un resultado positivo en la detección. Material y metódos: se realizó un estudio de tipo transversal en una unidad médica del segundo nivel de atención médica en el que fueron reclutados 102 niños. Los niveles séricos de alanina aminotransferasa (ALT) fueron cuantificados y se realizaron ecografías hepáticas. Modelos de regresión logística múltiple fueron utilizados para evaluar los factores asociados con la presencia de EHGNA (infiltración grasa en la ecografía y ALT > 52U/L para niños y > 44 U/L para niñas). Resultados: la prevalencia de EHGNA fue del 10.8%. En el análisis multivariante, una relación entre cintura y cadera ≥ 1 se asoció con una mayor posibilidad de EHNGA (razón de momios (RM) = 4.96, IC del 95%: 1.17 - 20.90). Conclusiones: nuestros hallazgos indican que uno de cada diez niños sobrepeso y obesidad tiene datos sugestivos de EHGNA y está en riesgo de presentar sus consecuencias para la salud.

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RESUMO

Introducción: la enfermedad del hígado graso no alcohólico (EHGNA) tiene graves implicaciones para la salud y, asociada a la epidemia de obesidad, es una tendencia creciente. Objetivo: detectar la presencia de hígado graso en niños con sobrepeso y obesidad, así como evaluar los factores asociados con una mayor posibilidad de presentar un resultado positivo en la detección. Metódos: se realizó un estudio de tipo transversal en una unidad médica del segundo nivel de atención médica en el que fueron reclutados 102 niños. Los niveles séricos de alanina aminotransferasa (ALT) fueron cuantificados y se realizaron ecografías hepáticas. Modelos de regresión logística múltiple fueron utilizados para evaluar los factores asociados con la presencia de EHGNA (infiltración grasa en la ecografía y ALT > 52U/L para niños y > 44 U/L para niñas). Resultados: la prevalencia de EHGNA fue del 10,8%. En el análisis multivariante, una relación entre cintura y cadera ≥ 1 se asoció con una mayor posibilidad de EHNGA (razón de momios (RM) = 4.96, IC del 95%: 1.17 - 20.90). Conclusiones: nuestros hallazgos indican que uno de cada diez niños sobrepeso y obesidad tiene datos sugestivos de EHGNA y está en riesgo de presentar sus consecuencias para la salud.

Background: Non-alcoholic fatty liver disease (NAFLD) has serious health implications and upward trends of the disease, accompanied by the obesity epidemic worldwide. Objective: To screen for fatty liver in overweight and obese children and evaluate the factors associated with an increased likelihood of presenting a positive-screen result. Methods: In a cross-sectional study, 102 children were recruited at a secondary care medical unit. Serum alanine aminotransferase (ALT) levels were quantified and hepatic ultrasounds were performed; multiple logistic regression models were used to evaluate factors associated with the increased odds of presenting with NAFLD (fatty infiltration on ultrasound and ALT > 52 U/L for boys and > 44 U/L for girls). Results: The overall prevalence of NAFLD was 10.8%. In multivariate analysis, a waist-to-hip ratio ≥ 1 was associated with increased odds of screening positive for NAFLD (odds ratio (OR) = 4.96, 95% CI 1.17-20.90). Conclusions: Our findings indicate that one out of ten children with overweight or obesity has data suggestive of NAFLD and is at risk of presenting its consequences on health.

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BACKGROUND: Palliative sedation has been used to refer to the practice of providing symptom control through the administration of sedative drugs. The objective of this article was to characterise palliative sedation use in inpatients at a medium-stay palliative care unit. MATERIAL AND METHODS: A cross-sectional study was conducted on 125 randomly selected patients (aged 15 or older) who had died in 2014. The Palliative Performance Scale was used to evaluate the functional status. RESULTS: Palliative sedation was documented in 34.4% of the patients and midazolam was the most commonly used sedative agent (86.0%). More than half (53.5%) of those who recieved sedation presented with delirium. Liver dysfunction was more frequent in the sedated patients (p=0.033) and patients with heart disease were less likely (p=0.026) to be sedated. CONCLUSION: Palliative sedation is an ethically accepted practice. It was commonly midazolam-induced, and differences were documented, among sedated and non-sedated patients, in terms of liver dysfunction and heart disease.

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AIM OF THE STUDY: We aimed to explore national and regional trends in teen births in Mexico from 1992-2016, ranking the states with the highest rates in 2016. METHODS: A cross-sectional analysis was conducted and the data on the total number of live births to teenage mothers were analyzed. The age-standardized rates (ASRs) per 1,000 adolescent girls were obtained and the annual percent changes (APCs) with 95% confidence intervals (CIs) were calculated using the Poisson regression models. RESULTS: The national ASRs during the study period dropped from 2.11-1.74 in girls aged 10-14 years and from 86.04-70.82 in adolescents aged 15-19 years. Higher APC rates were documented for teenage girls under 15 years of age (‒0.6, 95% CI:-1.0, -0.3), when compared with older girls (-0.3, 95% CI:-0.6, -0.04). Heterogeneous APCs were observed in the stratified analysis and the overall declines were higher from 2011-2016. States with significantly increasing trends in teen births were also documented. The highest ASRs (per 1,000 girls aged 10-19 years) in 2016 were registered in the states of Coahuila de Zaragoza (49.45), Chiapas (46.24), and Guerrero (44.94). CONCLUSIONS: Teen birth rates decreased over the period of time analyzed. However, that decline has not been monotonic or homogeneous across Mexico, and recent (2011-2016) increasing rates were observed in some states in girls aged 14 years and younger. Teenage parenthood can negatively affect multiple dimensions of health, and therefore, regionally directed efforts focusing on its reduction must be strengthened.

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