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PubMed2002

High prevalence anti-Trypanosoma cruzi antibodies, among blood donors in the State of Puebla, a non-endemic area of Mexico.

Blood transfusion is the second most common transmission route of Chagas disease in many Latin American countries. In Mexico, the prevalence of Chagas disease and impact of transfusion of Trypanosoma cruzi-contaminated blood is not clear. We determined the seropositivity to T. cruzi in a representative random sample, of 2,140 blood donors (1,423 men and 647 women, aged 19-65 years), from a non-endemic state of almost 5 millions of inhabitants by the indirect hemagglutination (IHA) and enzyme linked immunosorbent assay (ELISA) tests using one autochthonous antigen from T. cruzi parasites, which were genetically characterized like TBAR/ME/1997/RyC-V1 (T. cruzi I) isolated from a Triatoma barberi specimen collected in the same locality. The seropositivity was up to 8.5% and 9% with IHA and ELISA tests, respectively, and up to 7.7% using both tests in common. We found high seroprevalence in a non-endemic area of Mexico, comparable to endemic countries where the disease occurs, e.g. Brazil (0.7%), Bolivia (13.7%) and Argentina (3.5%). The highest values observed in samples from urban areas, associated to continuous rural emigration and the absence of control in blood donors, suggest unsuspected high risk of transmission of T. cruzi, higher than those reported for infections by blood e.g. hepatitis (0.1%) and AIDS (0.1%) in the same region.

Adolescent↗
PubMed2004

First record of Lutzomyia evansi (Nuñez-Tovar 1924) in Mexico (Diptera: Psychodidae, Phlebotominae).

The phlebotomine sand fly Lutzomyia evansi is recorded in Mexico for the first time. This species is a suspected vector of Leishmania infantum in other parts of its geographical range and was captured in a focus of American visceral leishmaniasis where the principal vector, Lu. longipalpis sensu lato, was also found. The relative public health importance of the two species in the study area (Chiapas state, Southern Mexico) is discussed.

Animals↗
PubMed2004

Active transmission of human chagas disease in Colima Mexico.

Despite efforts to eradicate American trypanosomiasis (AT) and Chagas disease from the Americas, there are still areas of active transmission that can eventually become a source of reinfection in previously controlled regions. Mexico could be one of those areas, where there are no formal preventive control programs despite the presence of communities infested by Triatominae bugs infected with Trypanosoma cruzi. This study explored the prevalence of T. cruzi infection in 405 habitants of 17 communities in the state of Colima, on the Pacific Mexican coast, through a seroepidemiological probabilistic survey. The results revealed a point seroprevalence of 2.4% positive for anti-T. cruzi. In addition, 2 clinical cases of chronic and 2 of acute Chagas disease were detected in the explored communities. These findings confirm the risk of active transmission of AT in Western Mexico, especially in rural and suburban communities infested with intra-domestic triatominae, where control programs should be implemented.

Adolescent↗
PubMed2005

Morphometric analysis of Triatoma dimidiata populations (Reduviidae:Triatominae) from Mexico and Northern Guatemala.

Triatoma dimidiata is one of the major vectors of Chagas disease in Latin America. Its range includes Mexico, all countries of Central America, Colombia, and Ecuador. In light of recent genetic analysis suggesting that the possible origin of this species is the Yucatan peninsula, we have analyzed populations from the state of Yucatan, San Luis Potosi, and Veracruz in Mexico, and a population from the southern region of the Yucatan peninsula located in Northern Guatemala, the region of El Peten. Classical morphometry including principal component, discriminant, sexual dimorphism, and wing asymmetry was analyzed. San Luis Potosi and Veracruz populations were indistinguishable while clearly separate from Yucatan and Peten populations. Despite important genetic differences, Yucatan and Peten populations were highly similar. Yucatan specimens were the smallest in size, while females were larger than males in all populations. Only head characters were necessary to distinguish population level differences, although wing fluctuating asymmetry was present in all populations. These results are discussed in light of recent findings suggesting genetic polymorphism in most populations of Triatoma dimidiata south of Chiapas to Ecuador.

Animals↗
PubMed2006

Frequency of viruses associated with acute respiratory infections in children younger than five years of age at a locality of Mexico City.

A locality in the district of Tlalpan, Mexico City, was selected in order to identify the viral agents in children younger than 5 years of age with acute respiratory infection (ARI). A total of 300 children were randomly selected and were included in this study for a period of 13 months. During this period nasopharyngeal exudates were collected for the isolation of viral agents. Monoclonal fluorescent antibodies were used for viral identification after cell culture. Viral infection was detected in 65% of the specimens. The respiratory syncytial virus (RSV) was the most common virus agent detected. Children required an average of two consultations during the study period. Two high incidence peaks were observed, one during the summer and the other during winter; the most frequent viruses during these seasons were influenza A and RSV, respectively. The largest number of viruses was isolated in the group of children between 1 and 2 years of age and in the group between 4 and 5 years of age. This study demonstrated the presence of ARI and of different viruses in a period of 13 months, as well as the most frequent viruses in children younger than 5 years of age from a community of Mexico City.

Acute Disease↗
PubMed2006

Serogroups, K1 antigen, and antimicrobial resistance patterns of Aeromonas spp. strains isolated from different sources in Mexico.

A total of 221 strains of Aeromonas species isolated in Mexico from clinical (161), environmental (40), and food (20) samples were identified using the automated system bioMérieux-Vitek. Antisera for serogroups O1 to 044 were tested using the Shimada and Sakazaki scheme. The K1 antigen was examined using as antiserum the O7:K1C of Escherichia coli. Besides, we studied the antimicrobial patterns according to Vitek AutoMicrobic system. Among the 161 clinical strains 60% were identified as A. hydrophila, 20.4% as A. caviae, and 19.25% as A. veronii biovar sobria. Only A. hydrophila and A. veronii biovar sobria were found in food (55 and 90% respectively) and environmental sources (45 and 10% respectively). Using "O" antisera, only 42.5% (94/221) of the strains were serologically identified, 55% (121/221) were non-typable, and 2.5% (6/221) were rough strains. Twenty-two different serogroups were found, O14, O16, O19, O22, and O34 represented 60% of the serotyped strains. More than 50% of Aeromonas strain examined (112/221) expressed K1 encapsulating antigen; this characteristic was predominant among Aeromonas strains of clinical origin. Resistance to ampicillin/sulbactam and cephazolin was detected in 100 and 67% of Aeromonas strain tested for their susceptibility to antibiotics. In conclusion, antibiotic-resistant Aeromonas species that possess the K1 encapsulating antigen and represent serogroups associated with clinical syndrome in man are not uncommon among Aeromonas strains isolated from clinical, food and environmental sources in Mexico.

Aeromonas↗
PubMed2006

Chagas disease in Mexico: an analysis of geographical distribution during the past 76 years--a review.

Literature from 1928 through 2004 was compiled from different document sources published in Mexico or elsewhere. From these 907 publications, we found 19 different topics of Chagas disease study in Mexico. The publications were arranged by decade and also by state. This information was used to construct maps describing the distribution of Chagas disease according to different criteria: the disease, vectors, reservoirs, and strains. One of the major problems confronting study of this zoonotic disease is the great biodiversity of the vector species; there are 30 different species, with at least 10 playing a major role in human infection. The high variability of climates and biogeographic regions further complicate study and understanding of the dynamics of this disease in each region of the country. We used a desktop Genetic Algorithm for Rule-Set Prediction procedure to provide ecological models of organism niches, offering improved flexibility for choosing predictive environmental and ecological data. This approach may help to identify regions at risk of disease, plan vector-control programs, and explore parasitic reservoir association. With this collected information, we have constructed a data base: CHAGMEX, available online in html format.

Animals↗
PubMedDate not supplied

[Overpricing and affordability of drugs: the case of essential drugs in Mexico].

Accessibility and availability of drugs has been a matter of great concern for health services all over the world, especially for less developed countries. The World Health Organization has devoted considerable time to this matter, as evidenced in several documents and policies, such as model lists of essential drugs and the strategy "Health for All by the Year 2000". The WHO policy for essential drugs has been widely accepted, and the WHO List of Essential Drugs is now in the ninth revised edition. Although the essential drug policy has been well-accepted by health agencies and NGOs, the pharmaceutical industry has not proven willing to produce essential drugs at affordable prices. The purpose of this study is to examine price levels of essential drugs in Mexico. The evaluation was performed through a comparison of international and national prices for leading drugs in the respective therapeutic categories and included in the WHO model list of essential drugs. The study shows clearly that prices of essential brand-name drugs in Mexico are very high. Per capita consumption has remained stable despite a sharp decrease in the Mexican GDP since 1995. The article discusses the reasons for this and proposes measures to deal with the problem.

Costs and Cost Analysis↗
PubMedDate not supplied

[Income inequality, corruption, and life expectancy at birth in Mexico].

OBJECTIVE: To ascertain if the effect of income inequality on life expectancy at birth in Mexico is mediated by corruption, used as a proxy of social capital. MATERIAL AND METHODS: An ecological study was carried out with the 32 Mexican federative entities. Global and by sex correlations between life expectancy at birth were estimated by federative entity with the Gini coefficient, the Corruption and Good Government Index, the percentage of Catholics, and the percentage of the population speaking indigenous language. Robust linear regressions, with and without instrumental variables, were used to explore if corruption acts as intermediate variable in the studied relationship. RESULTS: Negative correlations with Spearman's rho near to -0.60 (p < 0.05) and greater than -0.66 (p < 0.05) between life expectancy at birth, the Gini coefficient and the population speaking indigenous language, respectively, were observed. Moreover, the Corruption and Good Government Index correlated with men's life expectancy at birth with Spearman's rho -0.3592 (p < 0.05). Regressions with instruments were more consistent than conventional ones and they show a strong negative effect (p < 0.05) of income inequality on life expectancy at birth. This effect was greater among men. CONCLUSION: The findings suggest a negative effect of income inequality on life expectancy at birth in Mexico, mediated by corruption levels and other related cultural factors.

Aged↗
PubMed1998

[Health status of the population in the vicinity of a waste recycling plant in Mexico].

This study was conducted in Mexico among residents of an area near a recycling plant for zinc and other metallic dusts to find out if these substances produce various adverse health effects in the population that may come in contact with them. The plant is in a municipality close to Monterrey, which is Mexico's third most populous and second most industrialized city. A cross-sectional comparative design was used for the research, which took place from September to November 1994. By means of quota sampling, houses were selected in two areas--one exposed, by virtue of its proximity to the plant, and the other unexposed, which served as a control--until the desired sample size was reached (621 individuals, an average of five per household). In each dwelling, a trained psychology student administered a questionnaire to one of the older family members to gather data on the presence of acute and chronic illnesses, problems during pregnancy, and congenital illnesses among the household members. In the exposed population, 127 questionnaires were completed, providing information on 596 persons; in the unexposed population, data on 743 persons were gathered via 147 questionnaires. The sex and age distributions were similar in the two populations, and the length of residence in their respective area was slightly longer among unexposed individuals. The most frequently reported health problems in the exposed population were irritation of the eyes and upper respiratory tract, allergies, sleep disturbances, bronchitis, fatigue, skin problems, ear infections, and anemia. The prevalence ratios for the exposed versus unexposed populations were significant with regard to skin eruptions and other skin diseases, fatigue, sleep disturbances, upper respiratory infections, ear infections, bronchitis, and allergies. Women from the two groups did not show significant differences in the prevalence of obstetric problems, miscarriages, or children born with congenital deformities or low birthweight. The sensitivity of the questionnaire used to detect health problems was poor, which could have resulted in an underestimation of some disorders. Nevertheless, various types of information bias were controlled, permitting the conclusion that the exposed population had a greater risk of suffering certain diseases and disorders than the unexposed population.

Air Pollutants↗
PubMed1998

[Risk of transmission of Trypanosoma cruzi by blood transfusion in Mexico].

Data from the late eighties indicate that 1.6% of the Mexican population was infected with Chagas' disease and that transmission by way of blood transfusion was taking place in nearly every state, in areas of different sizes. The risk of transmission via that route has seldom been documented in Mexico, and for this reason a sentinel survey was conducted in 1994 in 18 blood banks belonging to the Ministry of Health and located in various states. The purpose of the study was to determine the risk of transmission via blood transfusion and to calculate the national prevalence of infection among potential donors, so as to have a set of general indicators of the prevailing disease burden and of the importance of this transmission route. Participants were selected on the basis of operating criteria: all government-run transfusion centers with the capacity to screen blood donors for at least one year and persons seeking to donate blood (n = 64,969) who satisfied the Official Mexican Standards (Norma Official Mexicana) for the therapeutic use of human blood and blood products. For the analysis of the results the centers were grouped according to migration flow in order to detect any possible influence the latter may have had on Chagas' disease transmission within the country. Screening was done with indirect hemagglutination using a reagent produced by the Instituto Nacional de Diagnóstico y Referencia Epidemiológicos and donated to the blood banks. Positive cases were confirmed by indirect immunofluorescence. Positive results were detected in 996 persons, for a prevalence of 1.5% (95% CI: 1.44 to 1.63). Concordance between the final results obtained by local labs and by the central lab was given by a kappa index of 0.87 (95% CI: 0.862 to 0.877). Cities having the highest emigration rates had three times the risk of transmission as compared to cities that drew immigrants (odds ratio = 2.82; 95% CI: 2.18 to 3.65). We recommend that mandatory serologic screening be enforced throughout Mexico, since migration makes it difficult to determine which areas are endemic.

Animals↗
PubMed2000

[Susceptibility of Aedes aegypti larvae to parasitism by Romanomermis culicivorax in laboratory and field conditions in Oaxaca, Mexico].

In June 1996 in the state of Oaxaca, Mexico, larvae of the mosquito species Aedes aegypti were exposed to infective preparasites of the nematode Romanomermis culicivorax, Ross and Smith, in the laboratory and in the field. For the laboratory experiments larvae in instars I-IV were used; they had been collected in natural reservoirs. The laboratory experiments were carried out in triplicate, with 100 larvae of each larval stage per experiment. Three preparasite application dosage ratios were tested: 5, 10, or 15 preparasites per mosquito larva. For the field studies 13 A. aegypti outdoor breeding sites were used, with larvae in instars I-IV and a 15:1 preparasite dosage ratio. With the laboratory experiments, an increase was observed in the average infestation of the larvae as the preparasite application ratio was increased from 5:1 to 15:1. With a 10:1 ratio, the rates of parasitism were 100%, 100%, 85%, and 74% in the larvae in instars I, II, III, and IV, respectively; for the 15:1 preparasite ratio, parasitism rates were 100%, 100%, 90%, and 79%, respectively. The field tests with the 15:1 preparasite dosage ratio in the 13 outdoor reservoirs produced parasitism rates of 80% to 98%, thus demonstrating the susceptibility of this species of mosquito to parasitism by R. culicivorax in Oaxaca, Mexico.

Aedes↗
PubMed2001

[Exposure to fluorides from drinking water in the city of Aguascalientes, Mexico].

OBJECTIVE: Determine the fluoride content in all the wells that supply drinking water to the city of Aguascalientes, Mexico, in order to establish the population's degree of exposure. METHODS: The fluoride content of the 126 wells that supply drinking water to the city of Aguascalientes was determined, using the SPADNS method, in accordance with two Mexican regulations, NMX-AA-77-1982 and NMX-014-SSAI-1993. Using that data, we created fluoride isopleth maps showing the distribution of fluoride concentrations in the water supplies for the city of Aguascalientes. We also estimated exposure doses for the city's inhabitants. RESULTS: The mean analysis uncertainty was 3.9%. Seventy-three wells had a fluoride concentration of" 1.5 mg/L, which was the maximum permissible value set by the Mexican standards then in effect. All the maximum exposure doses surpassed the minimum risk level set by Agency for Toxic Substances and Disease Registry (ATSDR) of the Department of Health and Human Services of the United States of America. In the children under 1 year of age, even the minimum does was slightly higher than the ATSDR risk level. CONCLUSIONS: From estimating the fluoride exposure doses caused by water consumption in the city of Aguascalientes and comparing those doses with ones from other states in Mexico, we concluded that the fluoride intake in Aguascalientes represents a potential risk for inhabitants' health. The fluoride content of the city's drinking water should be reduced to 0.69 mg/L.

Environmental Exposure↗
PubMed2003

[The quality of outpatient services in health facilities in Hidalgo, Mexico, from the users' perspective].

OBJECTIVE: To identify and assess factors associated with the quality of health care in hospital outpatient services within the state of Hidalgo, Mexico, based on a user survey. METHODS: We performed a cross-sectional, comparative, analytical study of 15 public hospitals within the state of Hidalgo, Mexico. The sample, which was made up of 9 936 interviewees (power: 85%; significance level: 95%) was randomly selected among users of outpatient services between July 1999 and December 2000. We looked at the quality of care using a Likert-type scale. The statistical analysis consisted of inconditional logistic regression. RESULTS: The quality of care was perceived as being good by 71,37% of users surveyed and as bad by 28,63%. Poor quality was primarily perceived in institutions belonging to the social security system (39,41% vs. 19,42% in other institutions). Of those surveyed, 84,94% said they were satisfied with the care they received, and 49,2% said they expected to get better care. In all, 16% claimed they would return to the same hospital only because they had no other choice, and 2% said they would never return. A higher educational level and a better income showed a direct association with the perception of poor quality and discontent with the lenghty waiting period (odds ratio [OR]: 2,3; 95% CI: 2,02 to 2,82) and with the physician's discourteous attitude (OR: 4,22; 95% CI: 3,6-4,8). CONCLUSIONS: They main factors that determine poor quality in health care, according to users, are lengthy waiting times before being ushered in, incomplete physical examination and diagnosis, difficulty of getting an appointment, and poor treatment on the part of services staff.

Adult↗
PubMed2003

[Changes in the prevalence of dental caries in schoolchildren in three regions of Mexico: surveys from 1987-1988 and 1997-1998].

OBJECTIVE: To compare the prevalence and severity of dental caries found in epidemiological surveillance studies conducted in three areas of Mexico in two different periods, 1987-1988 and 1997-1998. METHODS: The 1987-1988 survey was done with representative samples of schoolchildren 6 to 10 years old in two states, Nuevo León and Tabasco, as well as in the country's Federal District (which includes Mexico City). The Federal District's 1987-1988 sample also included schoolchildren who were 12 years old. The total number of students examined in the 1987-1988 period was 7 590. The 1997-1998 survey included schoolchildren who were 6-10 years old and 12 years old, in all three of the areas. The total number of students included in the 1997-1998 survey was 8 164. To compare the prevalence and severity of dental caries in the two periods, the average value for the index of decayed, missing, and filled teeth (DMFT) was used with all of the age groups. RESULTS: The values of the DMFT indices were significantly lower in the 1997-1998 period for all of the age groups studied (P < 0.05 for all the age groups). In the 1997-1998 period both Tabasco and Nuevo León achieved the goal recommended by the World Health Organization of an average of no more than three decayed, missing, and filled teeth among the 12-year-olds, with DMFT indices of 2.67 and 1.72, respectively. However, in the Federal District in that 1997-1998 period the DMFT index exceeded the recommended level, with a value of 3.11. CONCLUSIONS: The reduction seen in the DMFT indices could be due to several factors, including the consumption of fluoridated salt, the use of dentifrices and fluoride rinses, and broader access to dental services.

Child↗
PubMed2003

[Educational strategy for improving patient compliance with the tuberculosis treatment regimen in Chiapas, Mexico].

OBJECTIVE: To implement a training program for physicians and patients and assess its effectiveness in terms of patient compliance with the pulmonary tuberculosis treatment regimen in the border region of Chiapas, Mexico. METHODS: A controlled intervention study was performed with patients over 15 years of age who had pulmonary tuberculosis diagnosed by direct microscopy (bacilloscopy) between 1 February 2001 and 31 January 2002 in health units randomly selected in the border region of Chiapas, Mexico. The sample was made up of patients who sought consultation at 23 and 25 health units over that period (intervention and control group, respectively). The intervention group took part in a training program for health personnel in which the following were discussed: the social, cultural, and economic aspects of tuberculosis; the theoretical and practical underpinnings of the diagnosis and treatment of the illness, and the establishment of self-help groups. Selfhelp groups were also created for all patients at the 23 units where the intervention group sought consultation. All patients were given a short-term treatment regimen with isoniazid, rifampin, pyrazinamide, and ethambutol for a total of 25 weeks, until completing a total of 105 doses. Patient follow-up was extended through December 2003. The intervention and control groups were compared by means of the chi square test, and Student's t test was used to compare means. The relative risk of non-compliance (RR) was calculated along with 95% confidence intervals (95% CI). RESULTS: Eighty-seven patients participated in the study; 44 were exposed to the intervention, and 43 made up the control group. Compliance with treatment was considerably greater in the intervention group than in the control group (97.7% vs. 81.4%, respectively; RR = 1.20; 95% CI: 1.03 to 1.39; P = 0.0015). It was noted that physicians in the border region of Chiapas gear their activities toward curative medicine, rather than preventive medicine or understanding the social determinants of disease. CONCLUSIONS: As a result of the educational activities that were part of the intervention, there was an increase in the proportion of patients who complied with treatment. Health services can improve tuberculosis control in Chiapas with the resources that are available to them at present. Physicians should be taught to view health problems in Chiapas as part of an integral set of conditions, and efforts should be made to improve the doctor-patient relationship. Steps should also be taken to incorporate educational activities and community participation in health services in order to address public health problems in a comprehensive way.

Adolescent↗
PubMed2004

[Analysis of risk factors for hypertension in Colima, Mexico].

OBJECTIVE: To evaluate the possible association that age, sex, excess weight, family history of hypertension, alcoholism, and sedentary lifestyle have with hypertension in the adult population of the city of Colima, Mexico. METHODS: This was a population-based analytic cross-sectional study. A structured survey was used with 280 adults older than 30 years of age who were living in the city of Colima in 2001 and 2002. The variables studied were sex, age, weight, height, family history of hypertension, engaging in physical exercise, smoking, and consuming alcohol. Blood pressure (BP) was measured with the auscultatory method. Borderline or doubtful measurements were checked again four or five days later. Hypertension was defined as systolic BP > or = 140 mm Hg and diastolic blood pressure > or = 90 mm Hg, or as the person being under antihypertensive treatment. The odds ratios (ORs) of the variables studied were calculated, along with their 95% confidence intervals (95% CIs). The association between the variables and hypertension was estimated through logistic regression, and their interaction through the coefficient of the interaction products. RESULTS: The overall prevalence of hypertension was 28.6%. The prevalence was higher in men than in women (42.1% vs. 19.2%; OR = 3.04, 95% CI: 1.8 to 5.2) and in people older than 49 years than in people 30 to 49 years old (36.8% vs. 21.9%; OR = 2.07, 95% CI: 1.22 to 3.50). A family history of hypertension and excess weight were associated with hypertension, while physical exercise had a protective effect (OR = 0.45; 95% CI: 0.23 to 0.86). There was interaction between hypertension and age > or = 50 years, a family history of hypertension, overweight, and physical exercise, especially among women. CONCLUSIONS: The prevalence of hypertension in Colima is very similar to that for Mexico as a whole. The strong association that hypertension had with male gender, regardless of the other variables, emphasizes the need for promoting prevention campaigns that focus more on men.

Adult↗
PubMed2006

Evaluating trauma care capabilities in Mexico with the World Health Organization's Guidelines for Essential Trauma Care publication.

OBJECTIVE: To identify affordable, sustainable methods to strengthen trauma care capabilities in Mexico, using the standards in the Guidelines for Essential Trauma Care, a publication that was developed by the World Health Organization and the International Society of Surgery to provide recommendations on elements of trauma care that should be in place in the various levels of health facilities in all countries. METHODS: The Guidelines publication was used as a basis for needs assessments conducted in 2003 and 2004 in three Mexican states. The states were selected to represent the range of geographic and economic conditions in the country: Oaxaca (south, lower economic status), Puebla (center, middle economic status), and Nuevo León (north, higher economic status). The sixteen facilities that were assessed included rural clinics, small hospitals, and large hospitals. Site visits incorporated direct inspection of physical resources as well as interviews with key administrative and clinical staff. RESULTS: Human and physical resources for trauma care were adequate in the hospitals, especially the larger ones. The survey did identify some deficiencies, such as shortages of stiff suction tips, pulse oximetry equipment, and some trauma-related medications. All of the clinics had difficulties with basic supplies for resuscitation, even though some received substantial numbers of trauma patients. In all levels of facilities there was room for improvement in administrative functions to assure quality trauma care, including trauma registries, trauma-related quality improvement programs, and uniform in-service training. CONCLUSIONS: This study identified several low-cost ways to strengthen trauma care in Mexico. The study also highlighted the usefulness of the recommended norms in the Guidelines for Essential Trauma Care publication in providing a standardized template by which to assess trauma care capabilities in nations worldwide.

Health Personnel↗