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Jorge Salmerón

Publications and source records attributed to Jorge Salmerón.

16 recordsLinked to original sources
PubMed2006

Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis.

BACKGROUND: The safety and efficacy of an attenuated G1P[8] human rotavirus (HRV) vaccine were tested in a randomized, double-blind, phase 3 trial. METHODS: We studied 63,225 healthy infants from 11 Latin American countries and Finland who received two oral doses of either the HRV vaccine (31,673 infants) or placebo (31,552 infants) at approximately two months and four months of age. Severe gastroenteritis episodes were identified by active surveillance. The severity of disease was graded with the use of the 20-point Vesikari scale. Vaccine efficacy was evaluated in a subgroup of 20,169 infants (10,159 vaccinees and 10,010 placebo recipients). RESULTS: The efficacy of the vaccine against severe rotavirus gastroenteritis and against rotavirus-associated hospitalization was 85 percent (P<0.001 for the comparison with placebo) and reached 100 percent against more severe rotavirus gastroenteritis. Hospitalization for diarrhea of any cause was reduced by 42 percent (95 percent confidence interval, 29 to 53 percent; P<0.001). During the 31-day window after each dose, six vaccine recipients and seven placebo recipients had definite intussusception (difference in risk, -0.32 per 10,000 infants; 95 percent confidence interval, -2.91 to 2.18; P=0.78). CONCLUSIONS: Two oral doses of the live attenuated G1P[8] HRV vaccine were highly efficacious in protecting infants against severe rotavirus gastroenteritis, significantly reduced the rate of severe gastroenteritis from any cause, and were not associated with an increased risk of intussusception. (ClinicalTrials.gov numbers, NCT00139347 and NCT00263666.)

Administration, Oral↗
PubMed2005

Incidence rates and life-time risk of hip fractures in Mexicans over 50 years of age: a population-based study.

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.

Age Distribution↗
PubMed2005

High-risk human papillomavirus detection and related risk factors among pregnant and nonpregnant women in Mexico.

BACKGROUND: Significant differences in human papillomavirus (HPV) prevalence between pregnant and nonpregnant women have been reported. Some studies suggest that physiological processes during pregnancy modify the host-immune response, increasing detectability of high-risk HPV infection as a result of viral reactivation. It remains uncertain, however, whether pregnancy has an effect on HPV DNA positivity as a result of a general lack of data and based on contradictory results found in previous epidemiologic studies. We conducted an epidemiologic study to identify differences in the prevalence of HPV infection between pregnant and nonpregnant women in Mexico. We also investigated the relationship of HPV DNA positivity with socioeconomic, gynecologic, and obstetric risk factors. METHODOLOGY: We screened pregnant and age-matched nonpregnant women for high-risk HPV infection. The study population was clients of the family medicine healthcare services of the Mexican Institute of Social Security in Cuernavaca, Morelos, Mexico. A total of 274 pregnant and 1060 nonpregnant study participants were screened for the presence of high-risk HPV DNA in self-collected specimens by the Hybrid Capture 2 test (HC2; Digene Corp., Gaithersburg, MD). RESULTS: High-risk HPV DNA was detected in 37.2% (95% confidence interval [CI], 31-43%) of pregnant women and in 14.2% (95% CI, 12-16%) of nonpregnant women. Combining both groups for the multivariate analysis, pregnancy was associated with an increased risk for HPV infection (odds ratio, 3.5; CI, 2.7-4.9). CONCLUSIONS: Our results are consistent with other studies reporting increased high-risk HPV detection rates among pregnant women. HPV-positive status in pregnant and nonpregnant women appears to be influenced by age. The decrease in HPV positivity by number of pregnancies in both currently pregnant and nonpregnant women is consistent with a possible effect of immune protection as a result of earlier HPV infections. Despite lack of information about a woman's history of sexual behavior, these data support the hypothesis that an alteration of immunologic responses during pregnancy may be associated with an increased risk of HPV acquisition or reactivation.

Adolescent↗
PubMed2005

Variable designs of clinical trials of neuromuscular blocking agents: an example of studies comparing rocuronium and vecuronium.

BACKGROUND: Published clinical trials on neuromuscular blocking (NMB) agents are being reported with large variations in their protocols and conflictiing results may emerge from these differences. Because they have been compared in several clinical trials, the study was focused on rocuronium and vecuronium in order to evaluate whether these NMB agents were compared under homogeneous conditions. MATERIAL/ METHOD: A search was made in PubMed, Embase Drugs and Pharmacology, Cochrane Controlled Trials Register, and Cochrane Database of Systematic Reviews. Studies on the neuromuscular response at the adductor pollicis to an i.v. bolus dose of rocuronium or vecuronium in humans were included. Quality of all reports was assessed by means of the 3-item Jadad et al. scale. Twenty-five studies met our inclusion criteria and all were retrieved. RESULTS: Randomization was performed in 21 (80.8%) studies. Blinding procedure for drug administration was mentioned in only one study without clarifying the procedure. Induction was most commonly performed with thiopental, followed by propofol. Two studies were performed in children and two in elderly patients. Withdrawals or dropouts were not mentioned in any paper. Electromyography and mechanomyography were the most common monitoring procedures. The time to maximal response, the maximum effect and the time to reach 25% recovery of neuromuscular function were the most used pharmacodynamic parameters. CONCLUSIONS: Clinical trials on neuromuscular blocking agents, e.g. vecuronium versus rocuronium, are being performed with large variability and without following established guidelines.

Adolescent↗
PubMed2004

Undocumented drug utilization and drug waste increase costs of pediatric anesthesia care.

The present study was performed in order to identify the cost of drugs used without documenting them in the patients' file and the wastage of drugs in a pediatric anesthesiology ward. In a prospective, blinded, observational design, drug utilization of 610 consecutive patients, undergoing an elective or emergency surgical procedure was evaluated. The number of undocumented drugs per 100 requested units and the number of wasted drugs per 100 requested units were computed and multiplied by its corresponding unitary cost. The median undocumented cost was 92.4 US dollars (95% CI 17.2-216.6 dollars) per 100 requested units. Succinylcholine (40 mg/2 mL) was the main undocumented drug; its use was not documented in approximately 50% cases in which this neuromuscular blocking agent was requested. However, rocuronium and nalbuphine had the highest unjustified cost, 770.6 dollars and 847.0 dollars per 100 requested units, respectively. Ketorolac, diclofenac, metamizol, furosemide, methylprednisolone, sodium bicarbonate, and cisatracurium were requested and documented. The median cost of wasted drug was 141.8 dollars (95% CI 55.8-448.2 dollars) per 100 requested drugs. More than 80% of adrenaline, naloxone, flunitrazepam, ephedrine, and cisatracurium were wasted. However, the highest cost of wasted drugs was for ondansetron, cisatracurium, methylprednisolone, and rocuronium. The uncontrolled availability and use of drugs may represent an important amount of resources wasted without any awareness of the staff in a department of pediatric anesthesia.

Adolescent↗
PubMed2003

Comparison of HPV-based assays with Papanicolaou smears for cervical cancer screening in Morelos State, Mexico.

OBJECTIVE: To compare the performance of human papillomavirus (HPV) assays with conventional Pap cytology for cervical cancer (CC) screening in Mexico. METHODS: Pap smears, self-collected vaginal specimens (SS) for HPV testing, and clinician-collected cervical specimens (CS) for HPV testing were obtained from 7868 women, aged 15-85 years old, attending CC screening at the Mexican Institute of Social Security (IMSS) between May and October, 1999. SS and CS specimens were screened for oncogenic HPV DNA by Hybrid Capture 2. Women who received cytological interpretations of atypical squamous cells of undetermined significance (ASCUS), and/or a positive HPV test were referred for colposcopy and histologic studies. The relative estimates for sensitivity, specificity and predictive values of each test were calculated using histological diagnoses of cervical intraepithelial neoplasia (CIN) grades 2 or 3, or CC histological diagnosis. RESULTS: Oncogenic HPV detection rate was 11.6% for SS, and 9.3% for CS. Pap smear abnormalities were observed in 2.4% of the women. Of 1147 women who had at least one abnormal test result, 88.5% underwent colposcopy, and 101 biopsy-confirmed CIN2/3 or cancer cases were identified. The relative sensitivity estimates for the Pap test, SS and CS were 59.4% (95% CI: 49.2-68.9), 71.3% (95% CI: 61.3-79.6), and 93.1% (95% CI: 85.8-96.9), respectively, while the specificities were 98.3% (95% CI: 98.0-98.6), 89.2% (95% CI: 88.5-89.9), and 91.8% (95% CI: 91.2-92.4), respectively. The positive predictive values of Pap, SS and CS were 36.1, 9.1 and 14.9, the colposcopy referrals needed to detect a case of CIN2/3 or cancer were 2.8, 11.0 and 6.7, respectively. DISCUSSION: Both HPV assays detected more cases of CIN2/3 or CC than Pap cytology alone. However, the HPV assays increased the number of colposcopy referrals. Our study suggests that HPV testing could be an effective way to improve the performance of CC screening.

Adolescent↗
PubMed2003

Improving cervical cancer screening in Mexico: results from the Morelos HPV Study.

OBJECTIVE: The purpose of this paper is to describe some of the results of the Morelos HPV Study. The main objective of the Morelos HPV Study is to evaluate the use of human papillomavirus (HPV) DNA testing, as compared to the Papanicolaou (Pap) test, for cervical cancer (CC) screening. MATERIAL AND METHODS: The Morelos HPV Study is currently being conducted in Mexico, to examine the possibility of using HPV testing for CC screening. The HPV testing of self-collected vaginal and clinician-collected cervical specimens was evaluated as part of this study. The acceptability of the HPV testing of self-collected specimens was compared to that of the Pap test. A cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA) was also performed. RESULTS: The Morelos HPV Study results indicate that HPV testing has a greater sensitivity to detect cervical intraepithelial neoplasia (CIN) 2/3 and CC than the Pap test. Our results also indicate an over-all lower acceptability of the Pap test as compared to the self-collected procedure. The results of the CEA and CBA indicate that screening women between the ages of 20-80 for CC using some type of HPV testing is always more cost-effective than screening for CC using the Pap test. CONCLUSIONS: Our results suggest that self- and clinician-collected HPV testing could be used in CC prevention programs, as an effective complement or substitute for the Pap test. This paper is available too at: http://www.insp.mx/salud.index.html.

Adolescent↗
PubMed2002

The acceptability of self-collected samples for HPV testing vs. the pap test as alternatives in cervical cancer screening.

OBJECTIVE: To explore the acceptability of the self-collection of samples for human papillomavirus (HPV) testing in comparison with that of the Pap test. METHODS: The study population consisted of 1069 women 20 years and older who were eligible for coverage through the Mexican Institute of Social Security (IMSS). These women were randomly selected among participants in a larger study to evaluate the use of HPV testing as an alternative in cervical cancer screening. All participants provided a self-collected vaginal sample for HPV testing according to explicit instructions and underwent a Pap test. Afterwards, each woman was interviewed about her experience and opinion regarding the two procedures. Acceptability was measured by a calculated score based on discomfort, pain, embarrassment, privacy, perception of personal treatment during the Pap test, and understanding of how to perform the self-sampling method. RESULTS: Ninety-three percent of women experienced sufficient privacy with the Pap test, whereas 98% of women reported that privacy with the self-sampling procedure was acceptable. The Pap test consistently provoked more discomfort, pain, and embarrassment than self-sampling. Sixty-eight percent of the women who indicated a test preference chose self-sampling. Preference for this method was positively associated with monthly household income. Women reported a preference for self-sampling because it is more comfortable (71.2%) and causes less embarrassment (55.8%). CONCLUSIONS: Self-sampling is more acceptable than the Pap test and could improve coverage rates of early detection programs. The incorporation of self-collected samples to detect HPV could encourage participation in screening programs among those women who reject the Pap test because of the necessary pelvic examination.

Adult↗
PubMedDate not supplied

Meta-analysis of the differences in the time to onset of action between rocuronium and vecuronium.

1. The aim of the present study was to conduct a meta-analysis of the magnitude of differences in the onset of action (T(max)) between rocuronium and vecuronium. 2. A search was made in PubMed, EMBASE Drugs and Pharmacology, Cochrane Controlled Trials Register and Cochrane Database on Systematic Reviews. Studies comparing the T(max) at the adductor policies between rocuronium and vecuronium administered as an intravenous bolus were included in the study. Twenty-nine effect sizes obtained from 21 studies were included. 3. The result of the meta-analysis of differences was -57.9 s (95% confidence interval -71.4 to -44.3 s), favouring rocuronium over vecuronium. The smallest difference in T(max) between these neuromuscular-blocking agents was observed in children (-19.1 s). The difference in T(max) between rocuronium and vecuronium in female patients was -38.7 s. The difference in T(max) between rocuronium and vecuronium measured by electromyography was approximately 50% shorter than that determined by acceleromyography or mechanomyography. In a subanalysis between rocuronium 600 mg/kg versus vecuronium 100 mg/kg, the difference in T(max) between them was very similar to that obtained in the general meta-analysis. 4. According to subanalyses of patient age and sex, drug dose and neuromuscular monitoring systems, the T(max) of rocuronium was approximately 20-70 s faster than that of vecuronium.

Adult↗
PubMedDate not supplied

Design and methods of the evaluation of an HPV-based cervical cancer screening strategy in Mexico: The Morelos HPV Study.

OBJECTIVE: The purpose of this paper is to describe the design and methodology of the Morelos HPV Study. The main objective of this study is to examine the use of two different methods for obtaining HPV DNA specimens, self-collected vaginal and clinician-collected cervical, to detect pre-invasive cervical lesions and cancer. MATERIAL AND METHODS: This study was conducted within the regular population-based framework of the Mexican Institute of Social Security (IMSS) cervical cancer screening program in Morelos. A total of 7,868 women were recruited between May and October 1999 and are representative of the population of women attending cervical cancer screening services at the 23 IMSS clinics in the state of Morelos in 1999. Women were provided with a detailed description of the study before signing an informed consent form. Basic data were obtained from all participants using a standard IMSS registration form. During the initial recruitment visit, a randomly selected subsample of 1,069 participants were interviewed to collect additional information about cervical cancer risk factors, acceptability of the HPV and Pap tests, as well as patient costs. Before the pelvic exam, participants were asked to provide a self-collected vaginal specimen for HPV testing. All participants underwent a pelvic examination that involved collecting a cervical sample for the Pap smear and a clinician-collected HPV specimen. Data were evaluated from 7,732 women with complete information for the three tests. The 1,147 women who received at least one positive result (Pap, self- and/or clinician-HPV tests) were invited to return for a colposcopic examination. During colposcopy, biopsies were taken as appropriate, to histologically confirm a diagnosis of cervical intraepithelial neoplasia (CIN) 2/3 or invasive cancer. A total of 1,015 women attended colposcopy, and 101 women received a histologically-confirmed CIN 2/3 or cervical cancer diagnosis. CONCLUSIONS: The initial enrollment activities of the Morelos HPV study are the basis for a prevalent case-control study and a prospective cohort study that will investigate the natural history of HPV infections and determine if an HPV-based screening strategy is a safe and cost-effective alternative to Pap screening. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Adenocarcinoma↗
PubMedDate not supplied

[The prevalence of high-risk HPV infection in pregnant women from Morelos, México].

OBJECTIVE: Some studies suggest the possibility that the physiological process of pregnancy modifies certain characteristics of the mother, increasing the risk of both, infection and persistence of infection with HPV. This association, however, has not been firmly established. This study seeks to determine the prevalence of oncogenic HPV infecton in a sample of pregnant Mexican women and its possible risk factors. MATERIAL AND METHODS: A cross-sectional study was conducted using a sample of 274 pregnant women sought first level of care services during the year 2000 at the antenatal clinic of the Mexican Institute of Social Security (IMSS) in Cuernavaca, Morelos, Mexico. Samples of vaginal cells were obtained through self-collected specimens, for the high-risk HPV DNA test using the Hybrid Capture 2 test (HC2). A structured questionnaire was administered regarding sociodemographic, gynecologic, obstetric and sexual behavior characteristics. RESULTS: The mean age was 25.7 years. The average time of pregnancy when the study was conducted was 6 months. The principal risk factors associated with high-risk HPV infection were: ages between 20 and 29 (OR= 2.82; CI 95% 1.02-7.76)), age 30 and over (OR= 6.85,CI 95% 1.22-38.2); partners having sexual relations with other partners (OR= 2.05; CI 95% 1.2-3.7)); schooling less than 6 years (OR= 1.68 CI 95% 0.7-4.3); number of lifetime sexual partners > 2 (OR= 1.54 CI 95% 0.7-3.4); and current smoking (OR= 1.6 CI 95% 0.6-5.0). CONCLUSIONS: Our findings show a higher prevalence of high-risk HPV infection in pregnant women, more than double, that reported in studies of non-pregnant women. The associated risk factors are similar to those of the non-pregnant population. Follow-up in these women is recommended in order to evaluate the persistence or regression of the infection.

Adolescent↗
PubMedDate not supplied

[Body mass index and body image perception in a Mexican adult population: the accuracy of self-reporting].

OBJECTIVE: To evaluate the accuracy of the self-reported body mass index and body image perception in a population of Mexican adults. MATERIAL AND METHODS: In 1998, in the state of Morelos, Mexico, participants in the longitudinal study of Mexican Social Security Institute workers "IMSS Cohort Study" responded to a baseline, self-administered questionnaire designed to collect a large variety of lifestyle risk factors for chronic diseases. Participants self-reported their body image by selecting the silhouette that best portrayed them, from a set of silhouettes ranked from 1 to 9. Participants also self-reported their current weight and height, unaware that direct measurements of weight and height were to follow. Four to eight months later participants were weighed and their heights were measured using standardized procedures. Spearman correlations were computed to analyze the correlation between self-reported and measured data. The Kruskal-Wallis test was used to evaluate the magnitude of difference between measured and self-reported height, weight and body mass index (BMI) (measured minus self-reported), by educational level and categories of age. Robust regression was used to evaluate the potential effect of specific individual characteristics on differences between measured and self-reported weight and height. Logistic regression analysis was used to evaluate the sensitivity, specificity, and predictive values for BMI. RESULTS: The study included 934 subjects, of which 62.6% were female. Females had a mean measured height of 1.55 m (SD 0.06) and weight of 65.4 kg (SD 10.9), while males had a mean height of 1.67 m (SD 0.06) and weight of 77.7 kg (SD 12.5). The mean BMI was 27.4 kg/m2 (SD 4.3) (females: 27.2 kg/m2 +/- 4.45; males: 27.8+/-3.87). The median of body image perception (BIP) was 5 (25th percentile=4; 75th percentile=6). Correlations between measured and self-reported height, weight, and BMI for all subjects were 0.94, 0.96, and 0.90, respectively. The correlation between BMI and BIP was 0.64 (0.67 for females and 0.59 for males). Self-reported mean varied no more than 1.3 cm from measured height and no more than 3.17 kg from measured weight. Error estimations of height, weight, and BMI decreased with educational level. Sensitivity and specificity before adjusting self-reported BMI with overweight and obesity categories that were collapsed into one were 94.8 and 83.0%, respectively; for BIP, those values were 87.6 and 48.9%. CONCLUSIONS: The results suggest that self-reported BMI and BIP can be useful indicators of an overweight condition in Mexican adults. The sensitivities and specificities associated with corrected self-reported BMI categories could be used to adjust odds ratios and relative risks, calculated from BMI levels derived from the self-reported BMI. Body image perception made it possible to correctly classify individuals with BMI > or = 25, showing that it may be a valid estimate for use in epidemiological surveys.

Adolescent↗
PubMedDate not supplied

Triglycerides and high-density lipoprotein cholesterol are associated with insulinemia in adolescents.

OBJECTIVE: The aim of this study was to evaluate the association between lipids and insulin concentration in adolescents. MATERIAL AND METHODS: A cross-sectional study of 350 adolescents aged 14-19 years old from a public high school in Guadalajara, in the state of Jalisco, Mexico, was conducted. Fasting insulin concentration was determined using microparticle enzyme immunoassay; total cholesterol and triglycerides were detected by standard enzymatic procedures;and low- and high-density lipoproteins were found using standard precipitation methods. Statistical analysis included linear multivariate regression. RESULTS: Serum triglycerides were associated positively with insulin fasting (beta = 0.003, p = 0.0001) and high-density lipoprotein cholesterol was negatively associated with insulin fasting in male adolescents 18-19 years old (beta = -0.03, p = 0.012). CONCLUSIONS: The relationships between triglycerides and insulin and between high-density lipoprotein cholesterol and insulin are already present in adolescence.

Adolescent↗
PubMedDate not supplied

Reproductive and lifestyle factors associated with early menopause in Mexican women.

OBJECTIVE: The purpose of this study was to evaluate the relationship between certain reproductive and lifestyle factors and the occurrence of early natural menopause. MATERIAL AND METHODS: A case/control study was conducted on a basal population of 2510 women participating in the "Mexican Institute of Social Security health workers cohort study". Cases were defined as those women for whom natural menopause presented by age 47. Information was obtained through a self-administered questionnaire. RESULTS: The risk of early menopause is associated with short menstrual cycles [<26 days, OR = 3.79 (IC 95% 1.37-10.52)], a short period of oral contraceptives use [<1 year, OR = 2.63 (IC 95% 1.10-6.29)], a lower number of pregnancies [<2, OR = 1.63 (IC 95% 1.03-2.57)], low body mass index [< or =27 kg/m2, OR = 1.64 (IC 95% 1.10-2.43)], low schooling level [<6 years, OR = 3.02 (IC 95% 1.26-7.23)], smoking history [>15 cigarettes/day, OR = 2.7 (IC 95% 1.00-7.30)], and birth cohorts [> or =950, OR = 4.09 (IC 95% 2.62-6.39)]. CONCLUSIONS: The findings of this study suggest that both reproductive and lifestyle factors are significant elements in the occurrence of early menopause in Mexican women.

Adult↗