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PubMed1994

Sources of lead exposure in Mexico City.

Many countries, including Mexico, are facing a largely unrecognized epidemic of low-level lead poisoning. Mexico is the sixth largest lead-producing country in the world, and 40% of its production is used locally in different industrial processes that cause lead contamination of the environment. The major sources and pathways of lead exposure among the Mexican population are gasoline emissions, lead-glazed ceramics, leaded paint, and lead in canned foods and beverages. In this paper we present evidence for the presence of lead in different environmental media and its impact on blood lead levels of the Mexican population. Although during the last few years important measures have been implemented to decrease lead exposure, our findings suggest that lead poisoning is still an important problem in Mexico. There is an urgent need for regulatory policies that implement stricter control to protect the Mexican population. There is also a need to develop adequate programs to reduce the lead burden and the associated health effects in the population that has been chronically exposed.

Ceramics↗
PubMed1996

Environmental health and hazardous waste issues related to the U.S.-Mexico border.

Environmental health and environmental quality issues along the U.S.-Mexico border have been of concern for several years. The enactment of the North American Free Trade Agreement and the presence of the maquiladoras (foreign-owned industries using imported raw materials) have intensified those concerns recently. Efforts to assess these issues are complicated by the fact that many of the issues affecting the border region are within federal jurisdiction, but the problems are regional and local in nature. Thus, state and local governments become involved with public concerns about real and potential problems. One major problem is that environmental health data from this region are lacking, particularly from Mexico. Some new agencies such as the Border Environment Cooperation Commission, the United States-Mexico Border Health Commission, and the North American Commission on Environmental Cooperation have joined several existing agencies at the federal and state level to address environmental quality and health. Several studies have been initiated to determine air and water quality, but little is being done in the areas of hazardous waste and health assessment. Several problems are anticipated in the generation of such data, such as its format and accessibility. Data gaps and research needs are discussed.

Environmental Health↗
PubMed1991

Surveys that work and what they show in Mexico.

The drug abuse epidemiologic research program in Mexico does not differ from programs in other countries. At the same time some special features of the problem in Mexico influence the type of research undertaken, especially studies which help orient official policy. These features are related to the prevailing conceptions of drug abuse, the characteristics of the problem, the infrastructure available for conducting research, and human and economic resources. This paper includes a discussion of the conceptions of drug abuse and a description of the research strategies that have been used in Mexico over the past 15 years, their advantages, disadvantages and perspectives for the future, which are again linked to the characteristics of the problem and the available resources.

Adolescent↗
PubMed1989

Gay liberation and coming out in Mexico.

This article presents information on three sociocultural variables and relates it to gay liberation and the behavior of gay youth in Guadalajara, Mexico's second largest city. A detailed history of the gay liberation movement in Guadalajara is given because it provides an excellent example of the interaction of sociocultural variables and shows how different the outcome of liberation may be for gay people in Mexico. Brief life histories of the "coming out" of two Guadalajaran gay men further illustrate some of the unique ways in which gay identities change the lives of gay youth in Mexico.

Adaptation, Psychological↗
PubMed2006

New Mexico community voices: policy reform to reduce oral health disparities.

Using a socio-ecological framework to guide the initiative, New Mexico Community Voices developed, with state and local stakeholders, responsive oral health policies to address oral health disparities. Several policy objectives were achieved: increasing awareness of the public health importance of oral health; improving access to dental services for uninsured or underserved populations; enhancing dental services specialty care; and increasing sustainable oral health infrastructure through pipeline development of oral health providers to relieve service shortages and diversify the oral health workforce. Improving access to oral health and augmenting numbers of dental providers in rural areas were also successful. The governor has appointed the New Mexico Oral Health Advisory Council to address state oral health issues. The New Mexico partnerships have demonstrated how effective policy change can generate important incremental shifts in oral health care delivery and provide best practice models that diminish the oral health crisis faced by underserved populations.

Community Dentistry↗
PubMed2006

Access to health care for migrants returning to Mexico.

Continued migration from Mexico over the past several decades has created a large population of elderly Mexicans in the U.S. There is no system in Mexico for those Mexicans who would like to retire there to obtain health insurance during their retirement years. Using a nationally representative dataset of Mexican elders, we explore the current state of health insurance status for Mexican elders with a history of migration to the U.S. We find a robust negative association between years spent in the U.S. and the probability of being insured. Coordination between the U.S. and Mexico on policy options to insure Mexicans migrants may prove beneficial to the social security systems in both countries as well as to migrants themselves.

Aged↗
PubMedDate not supplied

Immunization coverage and Medicaid managed care in New Mexico: a multimethod assessment.

BACKGROUND: We wanted to examine the association between Medicaid managed care (MMC) and changing immunization coverage in New Mexico, a predominantly rural, poor, and multiethnic state. METHODS: As part of a multimethod assessment of MMC, we studied trends in quantitative data from the National Immunization Survey (NIS) using temporal plots, Fisher's exact test, and the Cochran-Armitage trend test. To help explain changes in immunization rates in relation to MMC, we analyzed qualitative data gathered through ethnographic observations at safety net institutions: income support (welfare) offices, community health centers, hospital emergency departments, private physicians' offices, mental health institutions, managed care organizations, and agencies of state government. RESULTS: Immunization coverage decreased significantly after implementation of MMC, from 80% in 1996 to 73% in 2001 for the 4:3:1 vaccination series (Fisher's exact test, P = .031). New Mexico dropped in rank among states from 30th for this vaccination series in 1996 to 50th in 2001. A significant decreasing trend (Cochran-Armitage P = .025) in coverage occurred between 1996 and 2001. Findings from the ethnographic study revealed conditions that might have contributed to decreased immunization coverage: (1) reduced funding for immunizations at public health clinics, and difficulties in gaining access to MMC providers; (2) informal referrals from managed care organizations and contracting physicians to community health centers and state-run public health clinics; and (3) increased workloads and delays at community health centers, linked partly to these informal referrals for immunizations. CONCLUSIONS: Medicaid reform in New Mexico did not improve immunization coverage, which declined significantly to among the lowest in the nation. Reduced funding for public health clinics and informal referrals may have contributed to this decline. These observations show how unanticipated and adverse consequences can result from policy interventions in complex insurance systems.

Anthropology, Cultural↗
PubMedDate not supplied

Impact of pesticides use on human health in Mexico: a review.

Pesticides having a high adverse effect on the health and environment of inhabitants of the Mexican Republic were studied to establish the main parameters to bear in mind for their use and application. The investigation showed that Mexico is the agricultural zone with the highest health damage to its population from pesticides. The valid regulation norms for the use and application of these agrochemicals were analyzed. Case histories recorded by the public health sector in Mexico were reviewed. In this way, a strong relation was found between the health problems and the pesticides applied. Finally, the study concludes that the various Mexican States appear as a risk zone because of contamination by pesticides that are permitted by the regulation norms and by others whose use is prohibited in other countries and in Mexico. This situation causes a serious effect on the health deterioration of people who are exposed to these agro-chemicals and, in some cases, leads to death.

Age Distribution↗
PubMed1988

Acculturation and drinking among people of Mexican descent in Mexico and the United States.

This article studies the relationships between acculturation and drinking and alcohol-related problems among people of Mexican descent in Mexico and the United States. Subjects in the United States were part of a national probability sample of the Hispanic household population 18 years of age and older. Subjects in Mexico were randomly selected from among adult residents of the city of Morelia and an adjoining rural county, Tarimbaro, both in the State of Michoacan. Both samples were interviewed using the same questionnaire. Response rates were 72% in the United States and 92% in Mexico. Results show that Mexican-American men drink more frequently than men in Michoacan, who, as a group, drink infrequently but consume more often five or more drinks at a sitting as compared with Mexican Americans. Mexican-American women have a lower rate of abstention and a higher rate of women who drink at least once a week and who consume five drinks at a sitting at least once a year than do women in Michoacan. Among men, changes in drinking seem to occur soon after coming to the United States--often within 5 years. Among women, drinking patterns are not related to length of residence in the United States. In spite of less drinking, respondents in Michoacan report more alcohol problems than do Mexican Americans.

Acculturation↗
PubMed1992

Validity of self-reported alcohol consumption in the emergency room: data from the United States, Mexico and Spain.

The validity of self-reported alcohol consumption within 6 hours prior to injury based on breath-analyzer readings obtained at the time of emergency room (ER) admission is compared among probability samples of ER patients in Contra Costa County, California (n = 450), Mexico City (n = 500) and Barcelona, Spain (n = 864). The same questionnaire, study design and methods were used in all three countries to maintain comparability for comparative analyses. The analysis was restricted to those breath analyzed within 6 hours of injury occurrence who reported no drinking following the event. Validity of self-reports was high in all three samples. The proportion of those reporting not drinking prior to injury who had positive breath-analyzer readings was .5% in the U.S., 1.5% in Spain and 3.3% in Mexico. Validity of self-reports was not associated with cause of injury in the United States. In Mexico those injured in motor vehicle accidents or by violence were most likely to deny drinking, while in Spain those injured in violent situations were most likely to report not drinking. Validity of self-reports in these studies is much higher than that found in other U.S. studies, but this may be partly due to the fact that self-reports were obtained after the patient had been breath analyzed.

Adolescent↗
PubMedDate not supplied

Time-trends and causes of infant, neonatal and postneonatal mortality in Mexico, 1980-1990.

OBJECTIVE: This article analyzes the time-trends and causes of infant, neonatal, and postneonatal mortality in Mexico during the 1980's. MATERIAL AND METHODS: Data on infant deaths came from yearly tabulations (1980 to 1990) published by the Mexican government. Time-trends of mortality rates were determined by simple linear regression models. The parallelism test was performed for evaluating similarities in trends in neonatal and postneonatal mortality rates by causes. RESULTS: During the 1980's, infant mortality rates in Mexico declined from 40.4 to 31.1/1000 (beta = -0.791). Postneonatal mortality rates showed a strong decrease (beta = -0.892), while neonatal mortality rates were almost stationary (beta = 0.089). Significant rate decreases were observed for intestinal infections, Pneumonia and influenza and All other causes while Certain perinatal problems, Congenital defects and Nutritional deficiencies increased. No changes were observed in Acute respiratory infections. The neonatal proportional mortality showed an incremental trend accounting for 37.6% in 1980 and ascending to 48.8% in 1990 of the mortality in the first year of life. CONCLUSIONS: This analysis indicates that the reduction in infant mortality in Mexico during the 1980's was due to declining postneonatal mortality while neonatal mortality rates remain almost unchanged.

Age Factors↗
PubMedDate not supplied

Toward better access to health insurance coverage for U.S. retirees in Mexico.

Many retirees from the United States of America have limited health insurance coverage while living in Mexico. Medicare and Medicaid benefits are not portable to other countries and Medigap (private insurance that supplements Medicare) is very limited. This causes economic and medical hardships and serves as a barrier to retirement to Mexico. Increasing numbers of U.S. retirees will be interested in moving to Mexico in the future because of the climate, the culture, and the lower cost of living. The numbers are increasing as a result of several factors such as aging "baby boomers" and the rapidly growing Mexican-origin population in the U.S.A. who are citizens or permanent residents but would like to return to their communities of origin after working in the U.S.A. There are several policy initiatives that could provide opportunities for improving health insurance coverage for these retirees that could be cost-effective.

Health Services Accessibility↗
PubMedDate not supplied

[A model for integrating mental health care resources in the rural population of Mexico].

OBJECTIVE: The purpose of this project was to identify behaviors of health service utilization to solve mental health-related problems among rural inhabitants of Mexico. A model of pathways to mental health services was built. Based on this model, an integration-intervention model is proposed to help improve access to mental health services and their quality. MATERIAL AND METHODS: In 1997, in-depth interviews were conducted among 21 adults (9 men and 12 women) and seven healthcare providers, in a rural community in Jalisco, Mexico. Women's age ranged from 23 to 44 years; ten were married and two single. Men were between 30 and 74 years old; eight were married and one was a widower. Healthcare providers in the same community were: a priest, a general physician, a pharmacy clerk, two nurses, and two traditional healers. RESULTS: The pathways models suggest that the first attempt a person does to solve a symptom is self-care. When such strategies are not sufficient to relief the symptom, the person turns to the members of his/her social network for help, who in addition to providing information about remedies, offer their emotional and instrumental support. If after consulting the social network, the symptom is not relieved, the individual seeks help from other external resources, such as the members of the ethnomedical local system. Inhabitants of rural communities tend to seek help from physicians, only when the symptom persists and the suffering associated with it seems to be out of the individual's control, or if members of the social network or the ethno-medical local system refer the patient to the physician. Seeking help from a specialist in mental health (psychiatrist or psychologist) is quite improbable among the rural inhabitants of Mexico, mostly due to difficulties in accessing these services, such as geographical location, distance, transportation, cost, and cultural distance between the health providers and the patient. CONCLUSIONS: In order to conduct successful intervention programs that are culturally sensitive for rural inhabitants, it is necessary first, to have detailed information derived from research and second, the active participation of all human and institutional resources, from professionals and truly multi-disciplinary researchers, to educators, social, religious, political leaders, and members of the communities and local institutions. The proposed model of integration of personal and community resources for healthcare requires establishing programs that sensitize, inform, and train community members, as well as members the ethno-medical system and the formal heath system.

Adult↗
PubMed2003

Cervical cancer, a disease of poverty: mortality differences between urban and rural areas in Mexico.

OBJECTIVE: To examine cervical cancer mortality rates in Mexican urban and rural communities, and their association with poverty-related factors, during 1990-2000. MATERIAL AND METHODS: We analyzed data from national databases to obtain mortality trends and regional variations using a Poisson regression model based on location (urban-rural). RESULTS: During 1990-2000 a total of 48,761 cervical cancer (CC) deaths were reported in Mexico (1990 = 4,280 deaths/year; 2000 = 4,620 deaths/year). On average, 12 women died every 24 hours, with 0.76% yearly annual growth in CC deaths. Women living in rural areas had 3.07 higher CC mortality risks compared to women with urban residence. Comparison of state CC mortality rates (reference = Mexico City) found higher risk in states with lower socio-economic development (Chiapas, relative risk [RR] = 10.99; Nayarit, RR = 10.5). Predominantly rural states had higher CC mortality rates compared to Mexico City (lowest rural population). CONCLUSIONS: CC mortality is associated with poverty-related factors, including lack of formal education, unemployment, low socio-economic level, rural residence and insufficient access to healthcare. This indicates the need for eradication of regional differences in cancer detection. This paper is available too at: http://www.insp.mx/salud/index.html.

Adult↗
PubMedDate not supplied

[Prehospital emergency care in Mexico City: the opportunities of the healthcare system].

Unintentional vehicle traffic injuries cause 1.2 million preventable deaths per year worldwide, mostly affecting the population in their productive years of life. In Mexico, unintentional vehicle traffic injuries are one of the main causes of death; in Mexico City they account for 8% of deaths. Prehospital systems are set up to provide hospital medical care to the population, by means of a complex network that includes transportation, communications, resources (material, financial and human), and public participation. These systems may be designed in a variety of ways, depending on availability, capacity and quality of resources, according to specific community needs, always abiding by laws and regulations. In Mexico, several institutions and organizations offer prehospital services without being overseen in terms of coordination, regulation and performance evaluation, despite the high rates of morbidity and mortality due to injuries and preventable conditions amenable to effective therapy during the prehospital period. Prehospital care may contribute to decrease the morbidity and mortality rates of injuries requiring prompt medical care. Emphasis is made on the importance of assessing the performance of prehospital care, as well as on identification of needs for future development.

Delivery of Health Care↗
PubMedDate not supplied

[HIV/AIDS care and prevention expenditures in Mexico: trends and estimations 1997-2002].

OBJECTIVE: This paper first presents the trend of HIV/AIDS expenditures in Mexico between 1997 and 2002. It then compares the allocation and magnitude of such expenditures within the international context and, in particular, how other countries in the region are allocating HIV/AIDS resources. MATERIAL AND METHODS: Since 1997, Mexico has developed and been utilizing a method for systematically and comprehensively analyze national resource and expenditure flows for HIV/AIDS prevention and care; an exhaustive study known as the National AIDS Account. Results. During this five year period, a systematic increase in real expenditures occurred (143% increase in total), most of which was allocated to the purchase of drugs for antiretroviral treatment. Nevertheless, compared with other countries in the region, Mexican expenditures for HIV/AIDS are less biased in their allocation between prevention and treatment. DISCUSSION: Mexico is committed to ensure universal coverage of AIDS treatment while maintaining and even increasing prevention efforts. These activities demand increasing amounts of resources. It is, therefore, important to track how efficiently such resources are being used in order to improve allocation and targeting of health resources.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Seasonal transmission of Leishmania (Leishmania) mexicana in the state of Campeche, Yucatan Peninsula, Mexico.

In the Yucatan Peninsula, Mexico, localized cutaneous leishmaniasis (LCL) caused by Leishmania (Leishmania) mexicana is a typical wild zoonosis restricted to the forest, and humans are only accidentally involved. The transmission of L. (L.) mexicana has been related to the patient's occupation: "chicleros" (gum collectors) and agricultural workers. The objective of this study was to document L. (L.) mexicana seasonally of transmission in endemic areas of LCL in the state of Campeche, Yucatan Peninsula, Mexico. The timing of incidence of LCL in humans during 1993-1994, as well as the rate and time of infection in rodents and sand flies between February 1993 and March 1995 were analyzed. Rodents and sand flies were found infected between November and March, when men carried out their field activities and are exposed. Based on results analyzed, it is concluded that L. (L.) mexicana in the endemic area of LCL in the state of Campeche, Yucatan Peninsula, Mexico, presents a seasonal transmission restricted to the months of November to March. The knowledge of the timing of the transmission cycle in an endemic area of leishmaniasis is very important because intervention measures on the high-risk focus and population might be restricted.

Animals↗
PubMed2005

Blood transfusion and iatrogenic risks in Mexico City. Anti-Trypanosoma cruzi seroprevalence in 43,048 blood donors, evaluation of parasitemia, and electrocardiogram findings in seropositive.

Iatrogenous transmission of Trypanosoma cruzi by blood transfusion was suggested as a potential risk by Pellegrino (1949). Seropositive blood donors in Mexico were first reported in 1978, however, limited information is available due to small sampling, the use of heterogeneous serologic assays, and geographically limited studies. A wide survey carried out in 18 out of the 32 states of Mexico, showed a national mean of 1.6% seropositive among 64,969 donors, ranging from 0.2 to 2.8%. In the present study, we have screened 43,048 voluntary blood donors in a period of five years at the Instituto Nacional de Cardiología I. Chávez, a concentration hospital located in Mexico city which serves mainly the metropolitan area and accepts from all over the country. Standardized ELISA and IIF were used to identify seropositive individuals in addition to hemoculture, PCR and standard 12 lead ECG tests that were applied to a group of seropositive patients (29/161). The result showed a seropositivity of 0.37% (161/43,048). From the group of seropositive individuals 40% (12/29) were potential carriers of T. cruzi at the donation time and 5/29 had subclinical ECG abnormalities. Parasitological tests performed in 70 erythrocyte and platelet fractions from seropositive units (70/161) showed negative results. Our findings strongly support T. cruzi screening in the transfusion medicine practice and identify subclinical heart disease among seropositive blood donors.

Adult↗