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PubMed2006

Utilization and purchase of medical care services in Mexico by residents in the United States of America, 1998-1999.

OBJECTIVES: We assessed self-reported frequency of purchase of medications and medical care services in Mexico by southern New Mexico (United States, [U.S.]) residents in relation to their medical insurance coverage. METHODS: We analyzed data obtained in 1998 and 1999 from a health interview survey of residents in a six-county region of southern New Mexico, using prevalence and logistic regression methods for complex survey data. RESULTS: About 22% of southern New Mexico residents had purchased medications and 11% had sought medical care in Mexico at least once during the year preceding the survey. When we adjusted for the effects of other variables, persons able to pay for services out of pocket and those who were uninsured were more likely than persons who were fully covered to purchase medications or medical care in Mexico. CONCLUSIONS: Large numbers of people residing near the border in New Mexico traveled south to Mexico to purchase medications and medical care. Lack of medical insurance was associated with higher frequencies of these purchases. There seems to be a need to establish relationships between U.S. private and public care plans and Mexican medical care providers to identify appropriate mechanisms for U.S. residents to purchase medical care in Mexico.

Adolescent↗

PubMedDate not supplied

The prehospital emergency care system in Mexico City: a system's performance evaluation.

INTRODUCTION: Mexico City has one of the highest mortality rates in Mexico, with non-intentional injuries as a leading cause of death among persons 1-44 years of age. Emergency medical services (EMS) in Mexico can achieve high levels of efficiency by offering high quality medical care at a low cost through adequate system design. OBJECTIVE: The objective of this study was to determine whether the prehospital EMS system in Mexico City meets the criteria standards established by the American Ambulance Association Guide for Contracting Emergency Medical Services (AAA Guide) for highly efficient EMS systems. METHODS: This retrospective, descriptive study, evaluated the structure of Mexico City's EMS system and analyzed EMS response times, clinical capacity, economic efficiency, and customer satisfaction. These results were compared with the AAA guide, according to the soc ial, economic, and political context in Mexico. This paper describes the healthcare system structure in Mexico, followed by a description of the basic structure of EMS in Mexico City, and of each tenet described in the AAA guide. The p aper includesdata obtained from official documents and databases of government agencies, and operative and administrative data from public and private EMS providers. RESULTS: The quality of the data for response times (RT) were insufficient and widely varied among providers, with a minimum RT of 6.79 minutes (min) and a maximum RT of 61 min. Providers did not define RT clearly, and measured it with averages, which can hide potentially poor performance practices. Training institutions are not required to follow a standardized curriculum. Certifications are the responsibility of the individual training centers and have no government regulation. There was no evidence of active medical control involvement in direct patient care, and providers did not report that quality assurance programs were in place. There also are limited career advancement opportunities for EMS personnel. Small economies of scale may not allow providers to be economically efficient, unit hours are difficult to calculate, and few economic data are available. There is no evidence of customer satisfaction data. CONCLUSIONS: Emergency medical services in Mexico City did not meet the AAA requirements for high-quality, prehospital, emergency care. Coordination among EMS providers is difficult to achieve, due, in part, to the lack of: (1) an authoritative structure; (2) sound system design; and (3) appropriate legislation. The government, EMS providers, stakeholders, and community members should work together to build a high quality EMS system at the lowest possible cost.

Efficiency, Organizational↗

PubMed2002

Incidence of aplastic anemia in a defined subpopulation from Mexico City.

Aplastic anemia (AA) is a hematological disease characterized by the deficient production of blood cells. The incidence of AA worldwide is low (1-5 new cases per 10(6) individuals per year). In contrast to other countries, no current reports exist on the incidence of this disorder in Mexico. In the present study, we have determined the incidence of AA in a defined subpopulation from Mexico City during the period 1996-2000. For the purpose of this study, we focused on the experience from a single medical institution: the Mexican Institute of Social Security (IMSS), which covers around 50% of Mexico's population. The incidence of AA was determined based on the actual number of patients diagnosed with this disease at the IMSS in Mexico City in a given year and the total number of individuals registered at the IMSS in Mexico City in the same year. Considering the IMSS population as a whole, the annual incidence of AA was 3.9 new cases per 10(6) individuals per year. In the pediatric population, the annual incidence was 4.2 new cases per 10(6) individuals per year, whereas in people 15-years-old and older the incidence was 3.8 new cases per 10(6) individuals per year. These incidences were higher than those reported in most studies from the USA, Europe and Israel. Compared to the incidence in Thailand, the incidence we observed in children was considerably higher, whereas the one in adults was similar to the one in that country. The results of the present study suggest that the incidence of AA in Mexico City is one of the highest worldwide, particularly in terms of the pediatric population; however, these results must be taken with caution since this study comprises only a subpopulation from Mexico City and not the entire population. Thus, further studies including a broader population, both in Mexico City and other urban and rural areas of this country, will be necessary in order to obtain better and more complete estimates of the actual incidence of AA in Mexico.

Adolescent↗

PubMed1995

Myocardial infarction and cardiovascular risk factors in Mexico City and San Antonio, Texas.

Because the epidemiology of cardiovascular disease in Mexico is largely unknown, we examined the prevalence of cardiovascular risk factors and myocardial infarction (MI) in adults from low-income colonias in Mexico City. Data were collected as part of the Mexico City Diabetes Study, a population-based survey of diabetes and cardiovascular disease conducted between 1987 and 1992. Results were compared with those obtained from a comparable survey conducted previously among low-income Mexican Americans in San Antonio, Tex. A total of 2271 individuals between the ages of 35 and 64 years from Mexico City and 1143 adults of the same age range from San Antonio were studied. Despite being leaner and having lower levels of total cholesterol, Mexicans in Mexico City had markedly higher levels of triglycerides (P < .001) and lower levels of HDL cholesterol (P < .001) than Mexican Americans in San Antonio. MI was assessed by Minnesota-coded electrocardiograms and by a self-reported history of physician-diagnosed heart attack. In men, the prevalence of self-reported heart attack was significantly higher in San Antonio than in Mexico City (odds ratio, 5.85; P < .001), and in women, the prevalence of electrocardiogram-documented MI was significantly higher in San Antonio than Mexico City (odds ratio, 2.51; P < .001). The apparent excess of MI in San Antonio relative to Mexico City could be due to higher case-fatality in Mexico City or to a higher incidence in San Antonio.

Adult↗

PubMed1997

Moderate-to-severe diabetic retinopathy is more prevalent in Mexico City than in San Antonio, Texas.

OBJECTIVE: To compare the prevalence of diabetic retinopathy (DR) between low-income Mexicans from Mexico City and Mexican-Americans from San Antonio, Texas. RESEARCH DESIGN AND METHODS: We designed a cross-sectional population-based study in low-income neighborhoods of Mexico City and San Antonio. The men and non-pregnant women included in the study had NIDDM and were between 35 and 64 years of age. Ophthalmologic evaluation was performed in 414 patients, 204 in San Antonio and 210 in Mexico City. Seven field standard stereophotographs of each eye were obtained, adapting the Early Treatment Diabetic Retinopathy Study protocol, and graded at the Fundus Photograph Reading Center of the University of Wisconsin. RESULTS: Early nonproliferative DR occurred in 37 (17.6%) and 39 (19.1%) patients in Mexico City and San Antonio, respectively. Moderate-to-severe nonproliferative DR occurred in 55 (26.2%) and 37 (18.1%) patients in Mexico City and San Antonio, respectively, and proliferative DR occurred in 12 (5.7%) and 7 (3.4%) patients in Mexico City and San Antonio, respectively. Using univariate and multivariate logistic regression analysis with DR as the dependent variable, age, duration of disease, and fasting glucose concentration were positively and significantly associated with retinopathy, whereas city, systolic blood pressure, and other selected metabolic variables were not. We defined moderate-to-severe DR to include the categories of moderate-to-severe nonproliferative and proliferative DR. For this combined category, Mexico City patients with diabetes had a significantly higher prevalence (P < 0.01) than those from San Antonio when analyzed by multiple logistic regression analysis (odds ratio for Mexico City/San Antonio, 1.72; 95% CI 1.10-2.70). CONCLUSIONS: Overall prevalence of DR is similar in both cities. However, moderate-to-severe DR is significantly higher in Mexico City.

Adult↗

PubMedDate not supplied

The role of commercial plasmapheresis banks on the AIDS epidemic in Mexico.

OBJECTIVE: To characterize the circumstances underlying the epidemic of AIDS associated with blood transfusion in Mexico and to explore the possible mechanisms for its dissemination. METHODS: A retrospective analysis comparing the total number of AIDS cases and transfusion-associated AIDS cases and the male:female ratio reported in Mexico and the U.S. from 1981 to 1996 was done. We analyzed the relationship between the location of plasmapheresis banks and the geographic distribution of transfusion-associated AIDS cases and AIDS cases among paid donors in order to assess the possible role of plasmapheresis banks in its dissemination. RESULTS: The proportion of transfusion-associated AIDS in the total number of cases was significantly higher in Mexico than in the U.S. from 1987 through 1996 (p < .0001). A rapid drop in the male:female ratio of AIDS was observed in Mexico but not in the U.S. coinciding with a growing number of transfusion associated cases; transfusion has been the main risk factor for AIDS in women in our country. In 1986, seven States and Mexico City had plasmapheresis banks: they reported 90% of the cases associated to paid donation and 75% of those associated to transfusion, despite the fact that commercial blood banks without plasmapheresis facilities existed in 23 of the other 24 States. CONCLUSION: There was a difference on the frequency of transfusion associated AIDS between Mexico and the U.S. which reached epidemic proportions in Mexico. We believe that plasmapheresis banks played a major role in the dissemination of the infection in Mexico as paid donors provided a third of the blood used in Mexico in 1986. These findings highlight important implications for the prevention of AIDS in developing countries where commercial plasmapheresis practices are still in operation.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Persistent pesticides in Mexico.

As part of the recent increase in the international interest in persistent organic pollutants and their environmental and health hazards, it was found that although most of them have been severely controlled in developed countries, in most developing countries--including Mexico--their import, use, and in some cases production have continued up to the present without sufficient or adequate controls. Despite the large and continuing use of persistent organic chemicals in Mexico in agriculture, public health, and industry, data on their import, production, use, disposal, and the presence of their residues in the environment, food, and human tissues are extremely scarce and widely dispersed. This review is devoted only to the use of persistent pesticides in Mexico; it is the first effort to locate, gather, and analyze this information and to summarize and discuss the past and current situation of the control of these chemicals in Mexico. This review discusses the general background for the use of these pesticides in the country, including historical development, the reasons for substitution by less persistent products in crops intended for export, and the undesirable effect of this substitution on the health of migratory agricultural workers. The current status of the legal framework for the control of pesticides in Mexico is presented with emphasis on its slow and haphazard development; the legal, technical, and administrative reasons for the insufficient enforcement and oversight of the existing regulations and standards are highlighted. The low priority of this research area for the Mexican science and technology authorities and the negative consequences of this low priority on the existence of sufficient reliable data on pesticide residues in the environment and humans in Mexico are also discussed. The available data on production and uses of persistent pesticides in Mexico are presented, and the existing information on their residues in the environment, biota, food, and human tissues in the country is summarized; maps with the location of the main studies are included to stress the lack of information for most of the country, especially for remote areas and regions of agriculture devoted to crops for local, domestic, or self-consumption. The major characteristics of these studies are discussed in specific sections and, on this basis, a general comment on the current situation and forecast for the near future is made. The conclusions summarize the information presented, with particular emphasis on the need to improve and update the legal framework and strengthen the technical and administrative infrastructure essential for the oversight and control of the regulations. The urgency of carrying out new studies, in particular interdisciplinary studies, to establish the current pattern for pollution by these chemicals in Mexico is stressed.

Animals↗

PubMedDate not supplied

Grassroots efforts pursue alcohol policy reform: refocusing upstream in New Mexico.

ORGANIZATION SETTING. The New Mexico Alcohol Issues Consortium (NMAIC) originated in January 1989 as a grassroots effort to focus on the reduction of driving-while-intoxicated (DWI) in New Mexico. It was the brainchild of three state health department officials and grew to include in its membership representatives from education, medicine, law enforcement, neighborhood associations, business, and local and state government. RATIONALE. New Mexico ranks at or near the top in several alcohol-related statistics, including motor vehicle fatalities, cirrhosis, and alcoholism. Furthermore, the 'alcohol environment' in New Mexico included the allowance for the purchase of alcoholic beverages at drive-up windows, lax enforcement of DWI laws, and even state legislators with DWI records. Theoretical bases upon which NMAIC goals and strategies were based include the public health model, the public health/dynamic systems, model of alcohol and other drug use, and 'refocusing upstream,' all of which give attention to the environment as a determinant of health status. IMPLEMENTATION. While the NMAIC's activities addressed a variety of alcohol-related problems in New Mexico, the bulk of the organization's efforts for four years were directed toward increasing the excise tax on alcohol, either as a statewide measure or via county-level local option referenda. Strategies which were enacted to support this legislative activity included collaboration with other programs and organizations with similar DWI-prevention goals, and staged media events to solicit public support. IMPACT. In four years, the NMAIC had established itself as a credible organization which was successful in publicly and systematically challenging existing alcohol policies in New Mexico. The NMAIC was also instrumental in empowering individuals and communities to speak and act against the alcohol problems in their own communities. Finally, during the 1993 New Mexico Legislative Session, a bill was passed which mandated a statewide excise tax increase on alcohol. For its efforts, the NMAIC has won one national level award and one state level award for its contribution to the public health of New Mexico. DISCUSSION. The NMAIC is now pursuing passage of the local option version of the excise tax increase bill, because it could generate up to three times as much revenue as the new statewide increase. Additionally, Consortium members have escalated discussions regarding nonprofit status for the NMAIC, and developing a more formal mechanism for determining leadership. Members continue their participation in trainings on community organizing, media advocacy, and alcohol policy reform.

Accidents, Traffic↗

PubMedDate not supplied

Molecular heterogeneity of glucose-6-phosphate dehydrogenase deficiency in Mexico: overall results of a 7-year project.

Several years ago, a project aiming to determine (i) the molecular basis of G-6-PD deficiency, (ii) the distribution of four different mutant alleles previously detected, and (iii) the whole of polymorphic alleles that account for the overall prevalence of G-6-PD deficiency in Mexico was implemented. Nearly 5000 individuals-from the general population and patients with hemolytic anemia-belonging to at least 14 States were screened for G-6-PD deficiency. Seventy-six G-6-PD-deficient subjects were detected and the prevalence of G-6-PD deficiency in 4777 individuals from the general population was 0.71%. Screening for both mutations associated with enzyme deficiency and silent polymorphisms at the G-6-PD gene was performed in the enzyme-deficient individuals by PCR-SSCP combined with restriction enzyme analysis; the silent polymorphisms as well as the nondeficient variant G-6-PD A(376G) were also investigated in 366 G-6-PD normal individuals from the general population. In 88% of the enzyme-deficient individuals it was possible to define the mutation responsible and the type G-6-PD A- variants were the more common in both individuals from the general population and patients with hemolytic anemia. G-6-PD deficiency is heterogeneous at the DNA level in Mexico and up to date 10 different variants-8 in the present project and 2 previously-have been observed: G-6-PD A(-202A/376G), G-6-PD A(-376G/968C), G-6-PD Santamaria(376G/542T), G-6-PD Vanua Lava(383C), G-6-PD Tsukui(del561-563), G-6-PD "Mexico City"(680A), G-6-PD Seattle(844C), G-6PD Guadalajara(1159T),G-6-PD Nashville(1178A), and G-6-PD Union(1360T). The G-6-PD A(-) variants have a relatively homogeneous distribution and along with G-6-PD Santamaria(376G/542T), they account for 82% of the overall prevalence of G-6-PD deficiency in Mexico; all other seven variants represent 9% of the mutant alleles examined, and in the rest of the chromosomes the mutation responsible for the enzyme deficiency remains to be defined. Several of the variants observed in Mexico are common in Africa, South Europe, and Southeast Asia. The prevalence for the variant G-6-PD A(376G) was 1.64%. From 256 possible haplotypes only 14 were observed and haplotype analysis suggests that some of the G-6-PD variants probably were imported to Mexico by population flow from South Europe, Africa, and Southeast Asia. This work (i) identified the G-6-PD variants prevalent in Mexico, (ii) defines their geographical distribution, (iii) contributes to the knowledge of the genetic structure of the Mexican population, and (iv) will facilitate the molecular analysis of the G-6-PD gene in enzyme-deficient Mexican individuals.

DNA Mutational Analysis↗

PubMed2005

Lower hypertension risk in Mexico City than in San Antonio.

BACKGROUND: We examined the effects of blood pressure (BP), weight, and weight gain on hypertension risk in two similar ethnic origin populations, subjects in Mexico City and Mexican Americans in San Antonio. METHODS: The Mexico City Diabetes Study and San Antonio Heart Study are population-based, epidemiologic studies with identical survey protocols. Incident hypertension (BP > or = 140/90 mm Hg or current antihypertensive treatment) was analyzed in subjects aged 35 to 64 years of Mexican ethnicity living in low-income neighborhoods (n = 1467 in Mexico City, n = 628 in San Antonio). RESULTS: In Mexico City, 10.6% of men and 13.1% of women developed hypertension in a 6.5-year period; in San Antonio, 28.6% and 28.7% in a 7.5-year period, respectively. Poisson regression analysis demonstrated a greater hypertension risk in San Antonio for both men (risk ratio [RR] = 1.75, 95% confidence interval [CI]: 1.19-2.56) and women (RR = 1.40, 95% CI: 1.05-1.86). In a multiple linear regression analysis, systolic BP change was associated with weight gain in Mexico City (P < .001 in men and women) and San Antonio (P = .045 in men, and P = .027 in women) independently of age, BP, obesity, alcohol consumption, cigarette smoking, diabetes, and antihypertensive treatment. These covariates did not fully explain greater increments of systolic BP in San Antonio than in Mexico City (P < .001 in men and women). CONCLUSIONS: Hypertension risk is lower in Mexico City than in San Antonio. Systolic BP increases with weight gain, independently of other determinants of hypertension.

Adult↗

PubMedDate not supplied

Epidemiologic panorama of stomach cancer mortality in Mexico.

BACKGROUND: Annually, there are more than 6 million deaths from a type of malignant neoplasia worldwide. In developing countries, the highest rates of incidence of malignant neoplasias are uterine cervical cancer, stomach, lung, esophagus, pharynx, and liver cancers. Recent estimates on the incidence of cancer worldwide show that, in 1990, stomach cancer (SC) was the second most frequent type of cancer (900,000 new cases annually). Rates of incidence have decreased consistently in nearly all areas of the world. In Mexico, however, rates of incidence and mortality have increased gradually between 1980 and 1997; in 1995, 4,685 people died of SC in Mexico. This report presents a descriptive analysis of SC mortality in Mexico. METHODS: A mortality database edited from the electronic files of the National Institute of Informatics, Statistics and Geography (INEGI) in Mexico was used; population denominators were edited by the Mexican National Population Council (Conapo). Adjusted mortality rates, taking as standard of reference the population of Mexico City by sex, year, and 10-year age groups were calculated as well as the sex ratio for the 1980-1997 period. To evaluate the magnitude of risks by state, the standardized mortality ratio (SMR) was calculated; prematurity was evaluated through the potential lost-life years index (PLLYI). The analysis was carried out using the Excel and Stata 5.0 software programs. RESULTS: During the years from 1980 to 1997, in Mexico the total number of deaths from SC was 76,315. The male:female ratio was 1.2:1.0. SMR by state showed that the states of Yucatán, Sonora, Zacatecas, Michoacán, and Chiapas had higher mortality rates. The PLLYI was higher for males in the states of Chiapas, Sonora, Chihuahua, Zacatecas, and Southern Baja California, and higher for females in Chiapas, Oaxaca, Yucatán, Puebla, and Campeche. CONCLUSIONS: World statistics on mortality caused by SC suggest a decreasing trend. Findings for this study show an increase in the adjusted mortality rates by SC during the 1980-1997 period in Mexico. However, when analyzing the different indicators that reveal risks, magnitude, and prematurity of mortality, there is a differential trend in mortality by sex that includes regional patterns probably related to different socioeconomic levels.

Adolescent↗

PubMed1997

The cervical cancer screening program in Mexico: problems with access and coverage.

A cross-sectional study was carried out in two geographic regions of Mexico - Oaxaca (rural area) and Mexico City (urban area) - to determine the main factors for predicting participation in Cervical Cytology Screening Programs (CCSP), in populations with high mortality due to cervical cancer. We included 4,208 women aged between 15 and 49 years, randomly selected through a national household-sample frame. Knowledge of what the Pap test is used for strongly predisposes use of CCSP in Mexico City (odds ratio [OR] = 46.1, 95 percent confidence interval [CI] = 33.1-64.1) and Oaxaca state (OR = 61.5, CI = 42.0-89.9), as well as high socioeconomic level (Mexico: OR = 2.0, CI = 1.1-7.6; Oaxaca: OR = 4.1, CI = 3.1-5.3), high education level (Mexico: OR = 3.6, CI = 1.5-8.8; Oaxaca: OR = 5.3, CI = 2.8-10.0), and access to social security (Mexico: OR = 1.7, CI = 1.4-2.2; Oaxaca: OR = 2.2, CI = 1.8-2.7). Low coverage of the CCSP is confirmed as an important problem in Mexico.

Adolescent↗

PubMed2005

The impact on rural New Mexico of a family medicine residency.

PURPOSE: To determine the impact on rural New Mexico of the large, decentralized University of New Mexico (UNM) family medicine residency. METHOD: A cross-sectional study was conducted of all 317 residency's graduates from 1974 to 2004. Location of current practice was correlated with the residents' gender, ethnicity, medical school of origin, and whether most training took place in the urban program or one of three rural programs. The residency's impact on rural communities was assessed. RESULTS: There was no significant gender difference between graduates who went into urban or rural practice. Compared with non-minority graduates, a significantly greater percentage of ethnic minority graduates were in rural and urban New Mexico practices and fewer in out-of-state practices. A greater percentage of graduates who had been medical students in New Mexico practiced in both rural and urban New Mexico areas compared with graduates of out of state medical schools. Finally, a greater percentage of graduates from the three rural family medicine residencies remained in the state and practiced in rural areas compared with graduates from the urban program. The graduates' contributions to the school of medicine and to rural New Mexico are described. CONCLUSIONS: Graduates of UNM's family medicine residency have contributed significantly to the state's rural health workforce. Ethnic minority status, graduation from New Mexico's medical school, and training in one of the three rurally based residencies favored in-state and rural retention, while gender had no significant effect. The rural orientation of the residencies offered rural communities economic benefits.

Career Choice↗

PubMedDate not supplied

Chlamydia trachomatis infection among Hispanic women in the California-Mexico border area, 1993: establishing screening criteria in a primary care setting.

BACKGROUND: Chlamydia prevalence and transmission patterns in California-Mexico border communities are unknown, and selective screening strategies for Hispanic populations have not been evaluated. GOAL OF THIS STUDY: To determine chlamydia prevalence among Hispanic women in the California-Mexico border area and established screening criteria. STUDY DESIGN: This was a cross-sectional prevalence survey of family planning/prenatal Hispanic clients (n = 2378) in San Diego and Imperial Counties, California, and Tijuana, Mexico. RESULTS: Overall, chlamydia prevalence was 3.2% (3.3% in California; 2.1% in Mexico). Women born in Mexico or those who visited Mexico for at least 1 week in the recent past had a prevalence rate similar to women without those characteristics. Multivariate analysis showed that young age (less than 25 years old), unmarried status, or having clinical signs of a chlamydia syndrome (primarily cervicitis) or vaginosis independently predicted chlamydia infection. Applying minimum screening criteria recommended by the Centers for Disease Control would require screening less than half of the clients. However, only 69% of infections would be identified. Using survey-based criteria (less than 25 years old, unmarried, and clinical signs of a chlamydia syndrome) would require screening 64% of clients, but would identify 92% of those infected. CONCLUSION: Chlamydia prevalence among Hispanic women seeking reproductive healthcare was similar (< 5%) on both sides of the California-Mexico border. Among Hispanic women, using easily obtained demographic data (age and marital status) and clinical signs (primarily cervicitis), an effective selective screening strategy can be implemented.

Adult↗

PubMed1996

Ultrasonographically assessed maximum carotid artery wall thickness in Mexico City residents and Mexican Americans living in San Antonio, Texas. Association with diabetes and cardiovascular risk factors.

Measurements of carotid artery wall thickness are often used as a surrogate for atherosclerosis. However, few studies have performed these measurements in populations of Mexican origin. Since Mexicans in Mexico City consume high-carbohydrate diets and have carbohydrate-induced dyslipidemia (high triglyceride and low HDL cholesterol levels) compared with Mexican Americans living in San Antonio, Tex, we questioned whether they also had more atherosclerosis than San Antonio Mexican Americans. Mean maximum intimal-medial thickness (IMT) of the common (CCA) and internal (ICA) carotid arteries were measured in 867 subjects aged 35 to 64 years (40% men) in two Mexican-origin populations, one from San Antonio (n = 202) and the other from Mexico City (n = 665). IMT's in the two cities were compared, and their associations with cardiovascular risk factors were analyzed. Older age, male sex, high levels of total cholesterol, low levels of HDL cholesterol, and high systolic blood pressure were positively associated with both CCA IMT and ICA IMT. Cigarette smoking was significantly associated with ICA IMT. CCA and ICA IMTs in diabetic subjects were thicker than in nondiabetic subjects in both men and women (all P < = .05). CCA IMT was thicker in the San Antonio than the Mexico City subjects after adjustment for cardiovascular risk factors (0.81 versus 0.76 mm in men and 0.77 versus 0.71 mm in women; P < .001 for city difference). San Antonio men also had thicker ICA IMT than their counterparts in Mexico City (0.88 versus 0.83 mm), but the reverse was true for women (0.73 versus 0.77 mm; interaction between sex and city, P < .05). Our results indicate that men had higher carotid IMTs than women. CCA IMT was thicker in San Antonio Mexican Americans than in Mexico City residents. The differences in ICA IMTs between San Antonio and Mexico City were inconsistent. Thus, since Mexico City residents consume high-carbohydrate diets, the data do not support an atherogenic effect of such diets. The interaction between sex and city on ICA IMT deserves further study.

Cardiovascular Diseases↗

PubMed2005

Incidence of leukemias in children from El Salvador and Mexico City between 1996 and 2000: population-based data.

BACKGROUND: There are very few studies that report the incidence of acute leukemias in children in Latin America. This work assesses the incidence of acute leukemias, between 1996 and 2000, in children from 0-14 years old who were attended at the Mexican Social Security Institute in Mexico City and in children from 0-11 years old in El Salvador. METHODS DESIGN: Population-based data. Hospitals: In San Salvador, El Salvador, Hospital Nacional de Niños "Benjamin Bloom", the only center in El Salvador which attends all children, younger than 12 years, with oncologic disease. The Pediatric Hospital and the General Hospital of the Mexican Social Security Institute in Mexico City, the only centers in Mexico City which attend all those children with acute leukemia who have a right to this service. DIAGNOSIS: All patients were diagnosed by bone marrow smear and were divided into acute lymphoid leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and unspecified leukemias (UL). The annual incidence rate (AIR) and average annual incidence rate (AAIR) were calculated per million children. Cases were stratified by age and assigned to one of four age strata: 1) <1 year; 2) 1-4 years; 3) 5-9 years, or 4) 10-14 or 10-11 years, for Mexico City and El Salvador, respectively. RESULTS: The number of cases was 375 and 238 in El Salvador and Mexico City, respectively. AAIRs in Mexico City were 44.9, 10.6, 2.5, 0.5, and 58.4 per million children for ALL, AML, CML, UL, and total leukemias, respectively. The AAIRs in El Salvador could not be calculated because the fourth age stratum in El Salvador included children only from 0-11 years old. The incidence rates for the Salvadorian group of 0-11 year olds were 34.2, 7.1, 0.6, 0.2, and 43.2 per million children for ALL, AML, CML, UL, and total leukemias, respectively. CONCLUSION: Reported AIRs for each age group in El Salvador were similar to those from other American countries. The AAIR of ALL in Mexico City is one of the highest reported for North America.

Adolescent↗

PubMed2004

Tuberculosis along the United States-Mexico border, 1993-2001.

OBJECTIVES: Tuberculosis (TB) is a leading public health problem and a recognized priority for the federal Governments of both Mexico and the United States of America. The objectives of this research, primarily for the four states in the United States that are along the border with Mexico, were to: (1) describe the epidemiological situation of TB, (2) identify TB risk factors, and (3) discuss tuberculosis program strategies. METHODS: We analyzed tuberculosis case reports collected from 1993 through 2001 by the tuberculosis surveillance system of the United States. We used those data to compare TB cases mainly among three groups: (1) Mexican-born persons in the four United States border states (Arizona, California, New Mexico, and Texas), (2) persons in those four border states who had been born in the United States, and (3) Mexican-born persons in the 46 other states of the United States, which do not border Mexico. RESULTS: For the period from 1993 through 2001, of the 16 223 TB cases reported for Mexican-born persons in the United States, 12 450 of them (76.7%) were reported by Arizona, California, New Mexico, and Texas. In those four border states overall in 2001, tuberculosis case rates for Mexican-born persons were 5.0 times as high as the rates for persons born in the United States; those four states have 23 counties that directly border on Mexico, and the ratio in those counties was 5.8. HIV seropositivity, drug and alcohol use, unemployment, and incarceration were significantly less likely to be reported in Mexican-born TB patients from the four border states and the nonborder states than in patients born in the United States from the four border states (P < 0.001). Multivariate analysis revealed that among pulmonary tuberculosis patients who were 18-64 years of age and residing in the four border states, the Mexican-born patients were 3.6 times as likely as the United States-born patients were to have resistance to at least isoniazid and rifampin (i. e., to have multidrug-resistant TB) and twice as likely to have isoniazid resistance. Mexican-born TB patients from the four border states and the nonborder states were significantly more likely to have moved or to be lost to follow-up than were the TB patients born in the United States from the four border states (P < 0.001). CONCLUSIONS: Increased collaborative tuberculosis control efforts by the federal Governments of both Mexico and the United States along the border that they share are needed if tuberculosis is to be eliminated in the United States.

Adolescent↗

PubMedDate not supplied

[Seroepidemiologic study of Lyme's borreliosis in Mexico City and the northeast of the Mexican Republic].

OBJECTIVE: To detect serological evidence of B burgdorferi infection in individuals from Mexico City and from the Northeast Region of the country. MATERIAL AND METHODS: A representative sample size of serum from Mexico City and the states of the Northeast of Mexico were taken from serum samples corresponding to the 1987-1988 national survey were obtained from the National Serum Bank. Antibodies against B burgdorferi were detected by ELISA and confirmed with Western blot (WB) assays. Data were analyzed using descriptive statistics. RESULTS: A total of 2,346 serum samples were tested; 297 (12.6%) were positive for ELISA, and 122 of 297 were confirmed by WB. Seroprevalence was 3.43% in Mexico City and 6.2% in the Northeast region of the country. Tamaulipas was the state with the highest seroprevalence. CONCLUSIONS: The prevalence of seropositive cases shows that borrelial infection is present in the northeast of Mexico and Mexico City. Identification of clinical cases and infected tick vectors is necessary to confirm the presence of Lyme disease in Mexico.

Borrelia burgdorferi↗