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PubMed2000

Awareness campaigns: experience in Mexico.

The current total of AIDS cases in Mexico is 37,000 of which 86% have occurred in men. The major route of transmission is sexual. The campaign to prevent AIDS has fallen into four phases, and has now been extended to other sexually transmitted diseases, including hepatitis B. The first phase (1985-1989) was based around question and answer brochures, which increased awareness but did not remove misconceptions. A mass media campaign addressed these misconceptions and stressed preventive measures. The campaign was halted by opposition to the promotion of condom use on the grounds that it encouraged promiscuity. The second phase (1989-1992) used more conservative messages, but these were too obscure and failed to reach the target audience. A poster campaign using popular lottery characters was widely accepted. In the third phase (1992-1994), a combination of messages was targeted at different populations, including parents and women, and general public sympathy for social support for people with AIDS was encouraged. In the fourth phase (1996-2000), a mass media campaign was aimed at teenagers, with parents and teachers as support groups. The campaign was widened to include HBV infection, and posters and brochures for teenagers were produced. These are distributed as part of a collaboration with non-governmental organizations providing sex education. The private medical sector is being encouraged to provide facilities for hepatitis B vaccination. So far the campaign has only been established in Mexico City, but it is hoped that this will be extended nationwide. Hepatitis B vaccination has been recently included in the National Immunization Programme for infants in the first year of life and it is officially recommended for at-risk populations.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Beyond health gain: the range of health system benefits expressed by social groups in Mexico and Central America.

Current health reform proposals in most developing countries stress health gain as the chief evaluation criterion. Essential service packages are formulated using cost-effectiveness methods for the selection of interventions without sufficient regard for other factors that are significant for successful implementation and acceptance by the needy. This paper presents the results of research undertaken in Mexico and Central America to test the hypothesis that population groups view health gain as only one among several benefits derived from health systems. The goal at this stage was two-fold: (a) to identify through qualitative methods the range of benefits that are significant for a wide cross-section of social groups and (b) to classify such benefits in types amenable to be used in the development of instruments to measure the benefits intended and actually produced by health systems. Fourteen focus groups were undertaken in Costa Rica, El Salvador, Guatemala, Mexico and Nicaragua representing diverse age, gender, occupation and social conditions. Six major types of health system benefits were identified besides health gain: reassurance/uncertainty reduction, economic security, confidence in health system quality, financial benefits derived from the system, health care process utility and health system fairness. Benefits most often mentioned can be classed under health care process utility and confidence in system quality. They also have the most consensus across social groups. Other benefits mentioned have an affinity with social conditions. Human resource-derived utility stands out by its frequency in the range of benefits mentioned. Health systems and health sector reform proposals must emphasise those aspects of quality related to human resources to be in accord with population expectations.

Adolescent↗
PubMed2002

Prevalence of battering among 1780 outpatients at an internal medicine institution in Mexico.

Violence against women has recently drawn attention in the medical community as a leading cause of preventable morbidity and mortality. Specific algorithms designed to identify women at risk can be applied to create an opportunity for screening, diagnosis and treatment during medical care initiated for common conditions. This study investigated the incidence and history of battering among women seeking general medical care, and looked for potential risk factors and associations with presenting symptoms. We used a self-administered, anonymous survey to question 1780 adult female outpatients visiting a tertiary care internal medicine teaching hospital in Mexico City. We calculated current abuse (physical and/or sexual abuse by a partner within the past year), abuse during pregnancy, childhood abuse, and lifetime abuse. We found levels of violence against women in Mexico comparable to those reported from other countries. 152 women (9%) reported current physical and/or sexual abuse. An identical number also reported abuse during pregnancy. Lifetime prevalence was 41%. Women currently or previously abused reported more physical symptoms in the last six months than did non-abused participants. Pelvic pain, depression, headache and substance abuse were frequent among abused women. Currently abused women also scored higher (p<0.01) on indicators of depression. Current abuse correlated strongly with a childhood history of physical and/or sexual abuse, with low educational level of the victim, with substance abuse by the partner or by the woman herself, and with higher parity.

Adolescent↗
PubMed2003

Home-birth emergencies in the US and Mexico: the trouble with transport.

Proponents of the global Safe Motherhood Initiative stress that primary keys to safe home birth include transport to the hospital in cases of need and effective care on arrival. In this article, which is based on interviews with American direct-entry midwives and Mexican traditional midwives, I examine what happens when transport occurs, how the outcomes of prior transports affect future decision-making, and how the lessons derived from the transport experiences of birthing women and midwives in the US and Mexico could be translated into improvements in maternity care. My focus is on home birth in urban areas in Mexico and the US. In both countries, biomedicine and home-birth midwifery exist in separate cultural domains and are based on distinctively different knowledge systems. When a midwife transports a client to the hospital, she brings specific prior knowledge that can be vital to the mother's successful treatment by the hospital system. But the culture of biomedicine in general tends not to understand or recognize as valid the knowledge of midwifery. The tensions and dysfunctions that often result are displayed in midwives' transport stories, which I identify as a narrative genre and analyze to show how reproduction can go unnecessarily awry when domains of knowledge conflict and existing power structures ensure that only one kind of knowledge counts. This article describes: (1) disarticulations that occur when there is no correspondence of information or action between the midwife and the hospital staff; and (2) fractured articulations of biomedical and midwifery knowledge systems that result from partial and incomplete correspondences. These two kinds of disjuncture are contrasted with the smooth articulation of systems that results when mutual accommodation characterizes the interactions between midwife and medical personnel. The conclusion links these American and Mexican transport stories to their international context, describing how they index crosscultural markers, and suggest solutions, for "the trouble with transport."

Adult↗
PubMed2003

Pedestrian injuries in Mexico: a multi-method approach.

UNLABELLED: Studies of road traffic injuries should identify social determinants amenable to intervention, and should attend to the problems of individual drivers and pedestrians. This is especially true in developing nations like Mexico, where traffic fatality rates are high and interventions ineffective. OBJECTIVE: Combine qualitative and quantitative methods to analyze pedestrian injuries from motor vehicles in Mexico City, and identify their social, contextual and environmental determinants. Methods included (1). a cross-sectional analysis of mortality, producing crude and specific mortality rates and standardized mortality ratios (95% CI) by region; (2). Spatial analysis using a geographic information system to generate maps at different aggregation levels; (3). Observation with cameras to identify traffic patterns, spaces, behaviors, and patterned violations of regulations; and 4). Semi-structured in-depth interviews of pedestrians and drivers involved in an accident. RESULTS: The overall crude mortality rate was 7.14/100000, (CI 6.85-7.42), with differences by sex and region. The highest concentration of deaths was observed in 10 neighborhoods, at specific types of street environments. The high-risk environments have wide avenues with abundant vehicular traffic, where spaces supposedly reserved for pedestrians are invaded by cars and vendors. Many pedestrians have never driven a motor vehicle, few know the traffic signs, and almost all events were "hit and run" cases. CONCLUSIONS: The combination of quantitative and qualitative methods allows us to see the specific importance of some determinants of pedestrian injuries. Spatial, epidemiological, and social perspectives help point out the local accident characteristics which must be considered before defining preventive interventions.

Accidents, Traffic↗
PubMed1998

Medicinal plants in Mexico: healers' consensus and cultural importance.

Medicinal plants are an important element of indigenous medical systems in Mexico. These resources are usually regarded as part of a culture's traditional knowledge. This study examines the use of medicinal plants in four indigenous groups of Mexican Indians, Maya, Nahua, Zapotec and - for comparative purposes - Mixe. With the first three the methodology was similar, making a direct comparison of the results possible. In these studies, the relative importance of a medicinal plant within a culture is documented using a quantitative method. For the analysis the uses were grouped into 9-10 categories of indigenous uses. This report compares these data and uses the concept of informant consensus originally developed by Trotter and Logan for analysis. This indicates how homogenous the ethnobotanical information is. Generally the factor is high for gastrointestinal illnesses and for culture bound syndromes. While the species used by the 3 indigenous groups vary, the data indicate that there exist well-defined criteria specific for each culture which lead to the selection of a plant as a medicine. A large number of species are used for gastrointestinal illnesses by two or more of the indigenous groups. At least in this case, the multiple transfer of species and their uses within Mexico seems to be an important reason for the widespread use of a species. Medicinal plants in other categories (e.g. skin diseases) are usually known only in one culture and seem to be part of its traditional knowledge.

Culture↗
PubMed1998

Family responses to HIV/AIDS in Mexico.

This paper presents findings from a qualitative study of household and community responses to HIV/AIDS in Mexico. Fieldwork took place in two contrasting settings: (a) Ciudad Netzahualcóyotl, a socially marginalized urban community and (b) the homosexual community of Mexico City, a sexually marginalized social network. 113 in-depth interviews were conducted with people with HIV/AIDS, their relatives and members of their social networks. This paper describes findings from interviews conducted with family members of persons with AIDS. Four stages of response are identified and characterized within each community: (i) life before AIDS, (ii) life during the discovery of AIDS, (iii) living with a person with AIDS and (iv) surviving those who have died from AIDS. The social marginalization of both communities is central in explaining how families respond to the disease. In Ciudad Netzahualcoyotl, social support derives from a local culture of kinship. In the gay community, on the other hand, solidarity arises out of friendship. Between social support and discrimination, many more "ambivalent" behaviours (neither fully supportive nor discriminating) are displayed by family members and friends. Fear, pre-existing family conflicts and prejudice nurture these negative responses. Family responses and the processes to which they give rise, also differ depending on whether or not a male or female household member is affected. Policy recommendations are made concerning how best to promote positive family and household responses to persons with HIV/AIDS and how to inhibit negative ones.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Serological survey of Neospora caninum infection in dairy cattle herds in Aguascalientes, Mexico.

A serological survey for antibody activity to Neospora caninum was carried out in Aguascalientes, a state in the central part of Mexico. One-hundred and eighty-seven serum samples from 13 dairy herds were tested by the ELISA test. The herd prevalence was 100% and the overall prevalence was 59% (n=110). Seventy-six of 97 seropositive cows had previous records of abortion. There was a statistically significant difference between the groups (P<0.05). However, the odds ratio was 1.4, suggesting an association between abortion and seropositivity. Neosporosis in dairy cattle appears to be widespread in Mexico, warranting more epidemiological studies to determine the distribution of the causative protozoan.

Abortion, Veterinary↗
PubMed2003

The prevalence of Toxocara cati in domestic cats in Mexico City.

The faeces of 520 domestic cats, resident in the 16 municipal authorities of Mexico City, were analysed using the method of centrifuging with zinc sulphate (at 33%). Three hundred and ninety-nine animals lived in houses, 121 in apartments. For the purpose of this study they were divided into seven age groups, of 6 months each. Toxocara cati eggs were found in the faeces of 42.5% of the animals. 20.7% of apartment cats and 49.1% of house cats were infected. This difference in the rate of infection is statistically significant (P<0.002.) for the house cats. T. cati was found in all the age groups although most infection was found in animals less than 1 year old. The fact that infection occurred in the whole age range of the cats and in all the municipal authorities means that the risk of being contaminated with this helminth in Mexico City is high. As a consequence, the possibility of developing illness as a result of becoming a host to larva migrans is also high.

Aging↗
PubMed2003

Factors affecting the prevalence of mange-mite infestations in stray dogs of Yucatán, Mexico.

The aim of the present study was to determine the factors affecting the prevalence of mange-mite infestations in stray dogs of Yucatán, Mexico. The study was carried out in 200 stray dogs of Mérida capital city of Yucatán, Mexico. Four samples (head, thoracic-abdominal area, extremities and ear) were taken from each animal by skin scraping and examined microscopically in 10% KOH solution to detect the presence of mites. Mites were also collected from the external ear canal of dogs using cotton-tipped swabs. The prevalence of different mite species was calculated. A primary screening was performed using 2xK contingency tables of exposure variables. All variables with P< or =0.20 were analyzed by a logistic-binomial regression. The overall prevalence was 34%. Demodex canis (23.0%) was the most frequent mite, followed by Sarcoptes scabei var. canis (7.0%) and Otodectes cynotis (3.5%). The following factors were found: body condition (bad, OR: 5.35, CI 95%: 1.66-17.3; regular, OR: 3.72, CI 95%: 1.39-9.99) and the presence of macroscopic lesions of dermatosis (OR: 42.80, CI 95%: 13.65-134.24).

Age Factors↗
PubMed2002

Brucellosis in Mexico: current status and trends.

Traditionally, Mexico has been recognized as endemic with brucellosis. The improvements in diagnostics techniques and vaccination strategies and the enforcement of a national eradication policy have contributed significantly to making progress in the control of brucellosis. The current status of brucellosis and its risk factors, in the different production species as well as in human population is reviewed. Also the trends in control and eventual eradication strategies and perspectives for the near future of Mexico are presented.

Animals↗
PubMed2003

Sources of information and HRT prescribing practices among gynecologists in Puebla, Mexico.

OBJECTIVE: The purpose of this study was to determine the sources of information and hormone replacement therapy (HRT) prescribing practices of gynecologists in the capital city of Puebla, Mexico. METHODS: Practicing gynecologists (n=44) in 29 colonias (neighborhoods) in the city of Puebla completed a self-administered standardized questionnaire. Survey topics included primary sources of information about HRT, discussion of patient health practices, awareness of alternative medicines, and HRT prescribing practices. RESULTS: Medical journals, hospital presentations, and textbook manuals were rated as the primary sources of information about HRT by 69-73% of physicians. Patients were rated as a primary source of information by 25% of physicians, and pharmaceutical representatives by 16% of physicians. Almost all physicians reported a willingness to discuss diet, smoking habits and other health issues with their patients. Natural and herbal medications were recommended by 25% of physicians. Contrary to studies in the US, more male than female physicians reported recommending hormones to 90-100% of their menopausal patients (60 vs. 33%, n.s.). CONCLUSIONS: This study revealed that physicians utilize a wide range of information about HRT, including patients and pharmaceutical representatives. Physicians' willingness to list patients as a source of information about HRT indicates the degree to which patients are involved in the medicalization of menopause. Reasons given for prescribing HRT (e.g. prevention of osteoporosis) were similar to those identified in studies in the US and Canada. Some variation in physician attitudes and practices related to HRT was apparent within the city of Puebla, Mexico.

Adult↗
PubMed2002

Usefulness of telephone risk factor surveys in the New Mexico border region.

BACKGROUND: We sought to assess prevalence of behavioral risk factors and evaluate the usefulness of survey data gathered by telephone in the New Mexico border region. METHODS: This study compared behavioral risk factor data gathered from two probability sample surveys administered in 1998-1999, one by means of a telephone interview and the second face to face. Prevalence estimates for medical care access, injury, and chronic disease risk factors were compared by survey mode, overall, and stratified by income level. RESULTS: Risk factor prevalence estimates based on telephone interviews resemble estimates obtained from face-to-face interviews. Although risk factor prevalence estimated from face-to-face interviews were in general slightly greater than those from telephone interviews, none of these differences reached statistical significance. When data for each respective survey were examined by income level, prevalence estimates for comparable income groups in both surveys were in general agreement and estimates within survey increased with declining income. CONCLUSION: In the New Mexico border region, telephone survey data appear to be reasonably valid and offer opportunities for population-based health research.

Adolescent↗
PubMed1998

Changes in the costs of antihypertensive medications in a developing country: a study in Mexico comparing 1990 and 1996.

In developing countries, the cost of antihypertensive medications is one of the principal limiting factors when trying to treat patients with high blood pressure. To determine the changes in cost (in US dollars) of these medications and in the percentage of the minimum wage needed to purchase them, two cost studies (1990 and 1996) done in Mexico were compared. The yearly cost of a treatment with hydrochlorothiazide was US $13.80 in 1990; in 1996 it was US $10.92. Both figures represent 1.1% of the minimum wage that was in effect at the time. Propranolol hydrochloride cost US $50.52 for a year's treatment in 1990, and US $66.12 for the same in 1996. These figures represented, respectively, 4.2% and 6.7% of the minimum wage of 1990 and 1996. The annual cost for nifedipine was US $176.76 in 1990 (14.7% of the minimum wage) and US $242.16 in 1996 (24.8% of the minimum wage). The yearly cost of enalapril was US $233.04 in 1990 and US $433.20 in 1996; these costs represented, respectively, 19.4% and 44.2% of the minimum wage. The comparison of these two cost studies (1990 and 1996) shows why Mexico's population is finding it more difficult to purchase antihypertensive medications. Higher costs and reduced purchasing power seem to be the two principal factors causing this. This is probably affecting the population's health, as it is more difficult to control high blood pressure without proper treatment.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2002

Clandestine abortion in Mexico: a question of mental as well as physical health.

This paper reports on research carried out in Mexico City in 1995-1996 on the meaning of motherhood, contraception, an unwanted pregnancy or child, and the experience of illegal, clandestine abortion, as described by 12 women of different ages, class, education and marital status who had one or more clandestine abortions. A priest, two doctors from the public health system, a group of gynaecologists and nurses and a health social worker were also interviewed. The data show that it is the illegal and clandestine nature of abortion that has a negative effect on women in Mexico. Although terminating a pregnancy can also be a difficult experience in itself, it became traumatic for most (though not all) of the women interviewed due to the dominant Catholic church doctrine that abortion is a sin, and because of the criminal law punishing those who have abortions, which forces women to have the procedure in high risk conditions, all of which adversely affected their mental and physical health. In spite of this, all the women considered abortion a personal decision that they had to make. Even those who believed that termination of pregnancy was the transgression of a divine commandment also believed that it was a rightful and necessary decision, given their circumstances.

Abortion, Illegal↗
PubMed2004

Policy implications of a national public opinion survey on abortion in Mexico.

In Mexico, recent political events have drawn increased public attention to the subject of abortion. In 2000, using a national probability sample, we surveyed 3000 Mexicans aged 15-65 about their knowledge and opinions on abortion. Forty-five per cent knew that abortion was sometimes legal in their state, and 79% felt that abortion should be legal in some circumstances. A majority of participants believed that abortion should be legal when a woman's life is at risk (82%), a woman's health is in danger (76%), pregnancy results from rape (64%) or there is a risk of fetal impairment (53%). Far fewer respondents supported legal abortion when a woman is a minor (21%), for economic reasons (17%), when a woman is single (11%) or because of contraceptive failure (11%). In spite of the influence of the Church, most Mexican Catholics believed the Church and legislators' personal religious beliefs should not factor into abortion legislation, and most supported provision of abortions in public health services in cases when abortion is legal. To improve safe, legal abortion access in Mexico, efforts should focus on increasing public knowledge of legal abortion, decreasing the Church's political influence on abortion legislation, reducing the social stigma associated with sexuality and abortion, and training health care providers to offer safe, legal abortions.

Abortion, Induced↗
PubMed2002

Detection of pulmonary tuberculosis in Chiapas, Mexico.

PURPOSE: To estimate the prevalence of undiagnosed pulmonary tuberculosis (PTB) and the sensitivity of bacilloscopy in the border region of Chiapas, Mexico. METHODS: We actively sought individuals aged 15 years or more with chronic cough from the Border Region of Chiapas, Mexico in three settings: one regional hospital, seven Primary Care Centers (PCC), and 32 communities. Individuals (a total of 899) reporting chronic cough were asked to provide three samples of sputum for acid-fast smears and cultures. The quality of acid-fast smears was evaluated using culture as the gold standard. RESULTS: We obtained sputum specimens from 590 of 899 individuals with chronic cough. A diagnosis of PTB was confirmed in 78. A conservative estimate of the overall prevalence of PTB at the population level was 151 per 100,000 (95% CI: 88 to 241). In the regional hospital, the estimated case detection rate was 66% (29/44). The proportion of candidates for PTB therapy that were actually on treatment was 50% (14/28) at the PCC and 11% (2/19) in the communities. The sensitivity of the bacilloscopy was about 90% in the hospital, and slightly lower than 50% in the PCC and the communities. CONCLUSION: Improved procedures for PTB detection are required in the studied area to adequately control the disease and to provide therapy to affected patients.

Adolescent↗
PubMed2001

Prevalence of acanthosis nigricans and its association with hyperinsulinemia in New Mexico adolescents.

PURPOSE: To determine whether the association between acanthosis nigricans (AN) and hyperinsulinemia is independent of obesity and other variables. METHODS: A convenience sample of 675 New Mexico middle school students was screened to determine the presence of AN, obesity, and other variables, including: ethnicity, parental history of diabetes, and level of physical activity. Fasting glucose and insulin levels were drawn on 233 students to determine the association between risk factors and hyperinsulinemia. RESULTS: Acanthosis nigricans (AN) was present in 18.9% of students screened. Twenty-one percent of the subsample had hyperinsulinemia. Based on these results, the estimated prevalence of hyperinsulinemia among all middle school students in New Mexico was 8.9%. Forty-seven percent (47.2%) of students who had AN and were obese had hyperinsulinemia, compared with 2.4% of students who did not have either of these conditions. In multiple logistic regression analysis, AN and obesity were independently and positively associated with hyperinsulinemia, whereas physical activity was protective. CONCLUSIONS: The high prevalence of risk factors in this population makes diabetes prevention a priority for public health action. AN screening is an easily performed, noninvasive method for identifying adolescents at risk for type 2 diabetes.

Acanthosis Nigricans↗