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Objective. To assess breast-feeding (BF) practices and determinants of exclusive BF (EBF) <4 and <6 months (mo) among women and infants <23 mo in the NNS-1999. Material and Methods. BF practices from the day and night before the interview were ascertained, and median duration estimated. Determinants of EBF<4 and <6 mo were analysed by logistic regression models for complex surveys. Results. Prevalence of EBF<4 mo was 25.7%, and of <6 mo 20.3%. The overall rate of continued BF (second year) was 30.9%, median duration of BF 9 mo, and the national proportion of children ever breast-fed 92.3%. The probability (p) of EBF<4 mo was determined by infant age and sex, by maternal socio-economic level (SEL) and ethnicity, and by the interaction between infant sex and SEL. The pEBF<6 mo was determined by infant age and length, by maternal ethnicity, and employment. Conclusions. EBF rates and duration are low in Mexico and have improved only slightly in the last 20 y. Infant and maternal characteristics determine the pEBF. If improvements in infant health are a national priority, aggressive interventions to promote and protect BF are urgently needed in Mexico, as well as formal evaluation of current initiatives. The English version of this paper is available too at: http://www.insp.mx/salud/index.html Key words: breast-feeding practices; exclusive breast-feeding, breast-feeding duration; Mexico ResumenObjetivo. Evaluar las prácticas de lactancia y las determinantes de la lactancia exclusiva (LE) hasta <4 y <6 m, en mujeres con hijos menores de 24 m de la segunda Encuesta Nacional de Nutrición 1999. Material y métodos. Las prácticas de lactancia se estimaron del día y la noche anteriores a la entrevista. Los determinantes de LE<4m y LE<6m fueron analizados mediante regresión logística para muestras complejas. Resultados. La prevalencia de LE<4m fue 25.7%, y <6 m 20.3%. La tasa de lactancia continuada (segundo año) 30.9%, mediana de duración de lactancia 9 m, y proporción de amamantados alguna vez 92.3%. La probabilidad (p)LE<4m estuvo determinada por edad, y el sexo del infante, por el nivel socioeconómico y etnicidad maternas, y por la interacción entre el sexo y el nivel socioeconómico. La p LE<6m estuvo determinada por edad y la longitud del infante y por el empleo, etnicidad y nivel socioeconómico de la madre. Conclusiones. La duración y prevalencia de LE son bajas en México, poco mejores que hace 20 años. Las características del infante y de la madre determinan la p LME. Para promover la salud del niño, es urgente implementar programas agresivos de protección y promoción de la lactancia, así como evaluar y adecuar formalmente los existentes. El texto completo en inglés de este artículo también está disponible en: http://www.insp.mx/salud/index.html Palabras clave: prácticas de lactancia materna; lactancia materna exclusiva; duración de la lactancia materna; México

a b s t r a c t a r t i c l e i n f oBackground: Central venous catheterization is not the first choice of vascular access in neonates. Success depends on the size of the vessel and the skill of the health professional performing the procedure. The internal jugular vein provides a predictable path for central venous cannulation, although it is more difficult to cannulate infants than adults and even more difficult in smaller newborns. Methods: We conducted a prospective study in 100 newborns, in which a 4 Fr ultrasound-guided central venous catheter was placed in the right internal jugular vein (RIJV). The study population was low birth weight (LBW) newborns b 2500 g, very low birth weight (VLBW) newborns b 1500 g and extremely low birth weight (ELBW) newborns b1000 g. Results: There were 53% female patients, mean gestational age was 31 weeks, mean weight 1352 g and the CVC was placed at a mean of 12 days of extrauterine life. Birth weight distribution was 39% LBW; 33% VLBW and 28% ELBW. A mean of two (1-8) attempts were necessary with a procedure duration of 16.8 (10-40) minutes. Success of RIJV catheterization was 94%. One attempt was necessary in 50% and up to 5 attempts in 95.7%. Success by weight was VLBW, 97.2%; ELBW, 92.9%; LBW, 91.7%. A venous hematoma occurred in 5% of cases. Conclusions: Ultrasound-guided RIJV cannulation with real-time visualization to gain access to the central venous circulation in low birth weight newborns is effective and safe.

The aim of this study was to validate the paediatric Gait, Arms, Legs, Spine (pGALS) tool for Mexican Spanish to screen Mexican paediatric population for musculoskeletal (MSK) disorders. A cross-sectional study was performed in the Paediatric Hospital of the Mexican Social Security Institute in Guadalajara, Jalisco. The validation included children and adolescents aged 6-16 years, 87 patients with musculoskeletal disorders and 88 controls without musculoskeletal disorders. The cross-cultural validation followed the current published guidelines. The average pGALS administration time was 2.9 min (SD 0.54). The internal consistency score (Cronbach's α) was 0.90 (0.89 for inflammatory and 0.77 for non-inflammatory disorders) for MSK disorders, with a sensitivity of 97 % (95 % CI 92-99 %), a specificity of 93 % (95 % CI 86-97 %), a LR+ of 14.3, and a ROC curve of 0.95 (95 % CI 0.92-0.98 %). The inflammatory disorders group had a sensitivity of 97 % (95 % CI 86-99 %), a specificity of 93 % (95 % CI 86-97 %), a LR+ of 14.2, and a ROC curve of 0.95 % (95 % CI 0.91-0.99 %). The non-inflammatory disorders group had a sensitivity of 98 % (95 % CI 89-99 %), a specificity of 93 % (95 % CI 86-97 %), and a LR+ of 14.37, with a ROC curve of 0.95 % (95 % CI 0.92-0.98 %). pGALS is a valid screening tool, fast, easy to administer, and useful for detecting musculoskeletal disorders in Mexican children and adolescents.

This article aims to identify the strategies for coping with health and daily-life stressors of Mexican patients with chronic rheumatic disease.We analyzed the baseline data of a cohort of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout. Their strategies for coping were identified with a validated questionnaire. Comparisons between health and daily-life stressors and between the 3 clinical conditions were made. With regression analyses, we determined the contribution of individual, socioeconomic, educational, and health-related quality-of-life variables to health status and coping strategy.We identified several predominant coping strategies in response to daily-life and health stressors in 261 patients with RA, 226 with AS, and 206 with gout. Evasive and reappraisal strategies were predominant when patients cope with health stressors; emotional/negative and evasive strategies predominated when coping with daily-life stressors. There was a significant association between the evasive pattern and the low short-form health survey (SF-36) scores and health stressors across the 3 diseases. Besides some differences between diagnoses, the most important finding was the predominance of the evasive strategy and its association with low SF-36 score and high level of pain in patients with gout.Patients with rheumatic diseases cope in different ways when confronted with health and daily-life stressors. The strategy of coping differs across diagnoses; emotional/negative and evasive strategies are associated with poor health-related quality of life. The identification of the coping strategies could result in the design of psychosocial interventions to improve self-management.