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PubMedDate not supplied

[The regulation of medical practice in Mexico].

The recent evolution and present situation of the regulation of medical practice in Mexico is discussed. In part one the regulation function is defined in the context of the main functions of a health system. In part two, sanitary regulation and health care regulation are distinguished and discussed. Finally, the present situation of the regulation of medical practice in Mexico is discussed in detail in part three, more specifically, two of the most developed forms of regulation: i) legal regulation and ii) regulation through licensing and certification of general practitioners and medical specialists, respectively. A set of measures to develop a mixed and participatory regulatory system is presented in the section on conclusions.

Certification↗
PubMed1999

[Iron, zinc and copper content of foods commonly consumed in Mexico].

Nutrient composition in foods is necessary for the determination of nutrient intake. Food composition tables used for dietary studies in Mexico do not have information of zinc, iron and copper; when present the values have been extrapolated from laboratory analysis carried out with foods in other countries and regions of the world. In this study zinc, iron, and copper content of 104 plant foods and 32 animal foods was determined. The procedure used was atomic absorption spectrophotometry for the minerals. Foods were grouped into cereals, vegetables, fruits, legumes and animal foods. Zinc content ranged from 0.018 mg/100 g for strawberry to 9.193 mg/100 g for beef. Iron content ranged from 0.113 mg/100 g for yogurt to 19.82 mg/100 g for a commercial cereal which had minerals added during processing. In some foods copper was not found and the highest content was 3.371 mg/100 g in beef liver. This study has provided information on zinc, iron and copper content of the most commonly consumed foods in Mexico.

Animals↗
PubMed2000

The gender composition of the medical profession in Mexico: implications for employment patterns and physician labor supply.

The gender composition of the medical profession is changing rapidly in many parts of the world, including Mexico. We analyze cross-sectional and longitudinal data on sex differences in physician employment from household employment surveys. The results suggest that Mexico is a particularly interesting example of the feminization of physician employment. Female enrollment in medical school increased from 11% in 1970 to about 50% in 1998. The increased participation of women in medicine seems to be accompanied by differences in employment patterns that could generate significant reductions in the total supply of physician hours of service. Women physicians are unemployed at a much higher rate than men and hence account for half of underused physician human capital. The results suggest that improved educational opportunities do not translate automatically into equal employment opportunities.

Adult↗
PubMed1999

Monogeneans of freshwater fishes from cenotes (sinkholes) of the Yucatan Peninsula, Mexico.

During a survey of the parasites of freshwater fishes from cenotes (sinkholes) of the Yucatan Peninsula the following species of monogeneans were found on cichlid, pimelodid, characid and poeciliid fishes: Sciadicleithrum mexicanum Kritsky, Vidal-Martinez et Rodriguez-Canul, 1994 from Cichlasoma urophthalmus (Günther) (type host), Cichlasoma friedrichsthali (Heckel), Cichlasoma octofasciatum (Regan), and Cichlasoma synspilum Hubbs, all new host records; Sciadicleithrum meekii Mendoza-Franco, Scholz et Vidal-Martínez, 1997 from Cichlasoma meeki (Brind); Urocleidoides chavarriai (Price, 1938) and Urocleidoides travassosi (Price, 1938) from Rhamdia guatemalensis (Günther); Urocleidoides costaricensis (Price et Bussing, 1967), Urocleidoides heteroancistrium (Price et Bussing, 1968), Urocleidoides anops Kritsky et Thatcher, 1974, Anacanthocotyle anacanthocotyle Kritsky et Fritts, 1970, and Gyrodactylus neotropicalis Kritsky et Fritts, 1970 from Astyanax fasciatus; and Gyrodactylus sp. from Gambusia yucatana Regan. Urocleidoides chavarriai, U. travassosi, U. costaricensis, U. heteroancistrium, U. anops, Anacanthocotyle anacanthocotyle and Gyrodactylus neotropicalis are reported from North America (Mexico) for the first time. These findings support the idea about the dispersion of freshwater fishes and their monogenean parasites from South America through Central America to southeastern Mexico, following the emergence of the Panamanian isthmus between 2 and 5 million years ago.

Animals↗
PubMedDate not supplied

[Geographical factors in the epidemiology of intoxication with Karwinskia (tullidora) in Mexico].

Consumption of fruits from the genus Karwinskia may cause a flaccid paralysis that can be confused with the Guillan-Barré syndrome or poliomyelitis. Paralysis resulting from consumption of such fruit has emerged as a public health problem in certain regions of Mexico. The purpose of this study was to investigate geographical factors associated with this intoxication in the 72 cases reported in Mexico from 1990 to 1994. Location of cases coincides with the distribution of the 11 reported species of Karwinskia in the country. The majority of reported cases were related to the consumption of K. humboldtiana, with a smaller number involving K. mollis, K. parvifolia, K. johnstonii, and K. rzedowskii. Most cases were located in regions with dry climates (79.2%), arid vegetation (41. 7%), and altitudes under 1,000 meters above sea level (54.1%). The study establishes three different risk areas: the Balsas river region in the southwestern central part of the country; the arid northern area; and the arid and dry central area. Cases were from rural communities with low levels of schooling and poor socioeconomic conditions.

Child↗
PubMedDate not supplied

[Prevalence of Chlamydia trachomatis infection in registered prostitutes in the city of Durango, Mexico].

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis infection among registered prostitutes of Durango City and to establish whether there is a correlation between epidemiological factors and infection. MATERIAL AND METHODS: Two-hundred-and-forty-seven registered prostitutes of Durango city were studied. Endocervical samples and epidemiological data were obtained. C.trachomatis antigen was detected with the Chlamydiazyme test (Abbott Laboratories, USA.) RESULTS: Forty-one (16.6%) out of 247 prostitutes were positive to C. trachomatis. Thirty-seven out of the 41 positive women had had sexual activity on several States of Mexico (95.1%), as compared to only 109 out of 206 negative women (53.0%) (p < .0001). Prostitutes positive to C. trachomatis (39/41, 95.1%) were more likely to belong to low socioeconomic level than negatives (171/206, 83%) (p = 0.05). CONCLUSIONS: The prevalence of C. trachomatis infection was 16.6%. C. trachomatis infection was associated with sexual activity in multiple States of Mexico, and had a tendency to be associated with low socioeconomic level.

Adolescent↗
PubMed2000

Predictors of death from pulmonary tuberculosis: the case of Veracruz, Mexico.

OBJECTIVES: To identify factors (particularly social, economic and cultural), associated with the risk of death from pulmonary tuberculosis in Mexico. METHODS: A case-control study of patients receiving medical attention from the official health services of Veracruz, Mexico. Cases were deaths from pulmonary tuberculosis in 1993. Controls were survivors randomly selected from the State Tuberculosis Case Registry. Next of kin provided information for both cases and controls. RESULTS: Multivariate analysis of 161 cases and 161 controls showed an increased risk of dying for those patients who withdrew from treatment (odds ratio [OR] = 3.52), who were refused medical attention during some period of time in any health center (OR = 4.45), and who had a concomitant disease at the time of diagnosis (OR = 2.62). A linear trend with age was observed (OR = 1.02 per year), as well as a lower risk for those patients who were compliant with treatment and optimistic about surviving the disease (OR = 0.17). The risk of death was not associated with the presence of a health care unit in the town, time spent to get to the health center, or the residence of a patient in an urban area. CONCLUSIONS: These findings indicate that deaths due to tuberculosis in this area are not related to the geographical distribution of health services but to delays in treatment after the onset of disease and to the low adherence of patients to the treatment regimen.

Adult↗
PubMedDate not supplied

Increasing frequency of gastric lymphoma in two national institutes of health in Mexico.

BACKGROUND: Some studies performed in developed countries with caucasian population have suggested an increase in the frequency of primary gastric lymphoma (PGL) in the past two decades. OBJECTIVE: To establish the frequency of PGL in two National Institutes of Health in Mexico in an interval of 18 years. METHODS: We reviewed 1,854 gastric malignant neoplasms diagnosed between 1979-1996 in mestizo patients seen at two different institutions. One of them (INC) is an oncological hospital, whereas the other one (INN) is a general hospital which treats patients with benign as well as malignant gastrointestinal diseases. RESULTS: A hundred and sixty three (8.8%) gastric lymphomas were identified from 1,854 gastric malignant tumors. The incidence of PGL showed a two to three-fold increase in the last years of the study in both institutions. The increased frequency was highly significant when compared to the initial rate. This increase does not appear to be due to patient selection criteria nor to the number of malignant gastric tumors in our institutions. CONCLUSIONS: Our results indicate an increased frequency of PGL the patient population of two National Institutes of Health in Mexico during the last years. Additional studies are necessary in order to define in the increase in PGL is limited to certain geographical areas or ethnic groups.

Humans↗
PubMed2000

[Breast cancer in Mexico. Is it a young women disease?].

Breast cancer in México has the second place in frequency in general population (10.6%) as well as in females (16.4%). There has been found an increase in mortality from 3.6, in 1985, to 6 x 100,000 inhabitants, in 1994. Breast cancer diagnosis is made in advanced stages (III, IV, N.C.) in two out of three of our patients and a great proportion of them are younger than 50 years old. In order to know if age at diagnosis of breast cancer women in Mexico is similar of that of women of other countries, and in consequence, if breast screening has to be done as they have determined, we analyzed the age at diagnosis of 29,075 mexican women with breast cancer from 1993 to 1996. We found that median age of our patients was 51 years, one decade younger than that of European or white American women (60-64 years), and 45.5% of Mexican women are less than 50 years old at diagnosis of breast cancer, therefore, breast cancer screening indications adopted in Mexico, do not cover, not even theoretically, almost 50% of our women. It is mandatory to determine indications of breast screening according to our reality.

Adult↗
PubMedDate not supplied

[Hypersensitivity pneumonitis in Mexico City].

OBJECTIVE: To investigate the association between the urban area of origin of patients and the prevalence of hypersensitivity pneumonitis (HP), induced by avian antigens. MATERIAL AND METHODS: A case-control study was conducted in 1999 at the National Institute of Respiratory Diseases (NIRD). Cases were 109 consecutive HP patients and controls were 184 patients: 39 with idiopathic pulmonary fibrosis (IPF), 63 with pulmonary tuberculosis (PTB), and 82 with asthma. Mexico City and surrounding counties (SC) were divided into 5 geographical areas: 1) Downtown; 2) North-East (NE); 3) South-East (SE); 4) North-West (NW) and 5) South-West (SW). Statistical analysis consisted of calculation of disease prevalence by urban area; associations were assessed with odds ratios and 95% confidence intervals. Multivariate analysis with multiple logistic regression was performed to adjust for age, gender and socioeconomic level. RESULTS: Eighty HP cases were located in the NE southernmost and SE northernmost areas of Mexico City (48 and 32, respectively) (OR = 3.86; 95% CI 2.17-6.96). Thirty-six controls with asthma came from the SW area, (where NIRD is located) (p < 0.05), and four from SC. Controls with PTB and IPF were scattered throughout the study area. CONCLUSIONS: The NE southernmost and SE northernmost areas were associated with HP. The cause of HP may not be geographical; a garbage dump used to be located in this area, suggesting that exposure to organic particles might contribute to the development of HP in susceptible individuals.

Adult↗
PubMedDate not supplied

[A review of the epidemiology of multiple sclerosis in Mexico].

OBJECTIVE: To review the epidemiological information on multiple sclerosis in Mexico. DEVELOPMENT AND CONCLUSIONS: The results of the few epidemiological studies on multiple sclerosis show a prevalence of 1.5/100,000 inhabitants, a figure which is not in concordance with studies carried out by institutions, which indicates an increase in the frequency of new cases. This information is not necessarily due to a true increase in prevalence. Possibly this increase is related to improved methodology for clinical and paraclinical diagnosis, especially the use of magnetic resonance. There is a need for descriptive and analytical epidemiological studies to obtain precise data on this. At present, the Mexican Group for the study of Multiple Sclerosis and The Mexican Association for the study of Multiple Sclerosis are using a questionnaire designed and validated for Mexico in order to determine the clinical characteristics and the prevalence of multiple sclerosis. The results will be available in the near future to improve knowledge regarding the epidemiology of this disorder and its economic impact on the Mexican health systems.

Humans↗
PubMed2000

Clinical features of spontaneous intracerebral hemorrhage in Hispanics and non-Hispanic Whites in New Mexico: a community study.

OBJECTIVES: To compare clinical features of spontaneous intracerebral hemorrhage (ICH) between Hispanics and non-Hispanic Whites in Albuquerque, New Mexico, occurring during the year 1993. DESIGN: Analysis of data collected during a study of ICH incidence in a community. METHODS: Review medical records with multiple relevant cerebrovascular diagnostic discharge codes in all 9 acute care hospitals in Albuquerque, and in the records of the State Medical Examiner. All suspected cases were verified by cerebral computed tomography or autopsy. Vascular risk factors, test results, and acute outcome were abstracted. RESULTS: There were 38 Hispanics and 46 non-Hispanic Whites with ICH. We found no statistically significant differences between these two ethnic groups in the prevalence of hypertension or diabetes mellitus, in hematoma volume, in seasonal fluctuation of ICH incidence, or in acute mortality. However, based on our sample size, only large differences in the prevalence of risk factors between these two ethnic groups could be detected with statistical significance (>20-30 percentage points). There was a trend toward a higher proportion of subcortical ICH (centered in the basal ganglia, brainstem, or cerebellum) in Hispanics (82%) than in non-Hispanic Whites (62%, P=.09). CONCLUSIONS: The higher proportion of subcortical ICH among the Hispanics suggests that chronic hypertension may play a greater role as a risk factor for ICH in this ethnic group than in non-Hispanic Whites in New Mexico. Our findings should be confirmed by larger community studies.

Aged↗
PubMed2001

Risk factors for pre-eclampsia/eclampsia among working women in Mexico City.

This study examined risk factors for pre-eclampsia/eclampsia in a population-based sample of pregnant working women in Mexico City. Over a 3-month period, all women who gave birth at three major hospitals and who had worked for at least 3 months during pregnancy were interviewed. After excluding mothers with multiple gestations or infants with birth defects, and previous diagnoses of hypertension, chronic renal disease or diabetes, 131 of 2,436 women (5.4%) had been diagnosed with pre-eclampsia and/or eclampsia. The frequency was much higher among women of low socio-economic status: 12% of uninsured women (SSA) compared with 4.2% of private sector employees (IMSS) and 1.3% of public sector employees (ISSSTE). After adjusting for education, women working in services (OR = 1.68, 95% CI = 1.01, 2.81) and in retail (OR = 1.99, 95% CI = 1.18, 3.37), primiparae (OR = 2.64, 95% CI = 1.65, 4.21) and women whose pregestational weight was > or = 55 kg (OR = 2.02, 95% CI = 1.34, 3.04) were at increased risk. Efforts to develop and evaluate intervention programmes should target hospitals serving the uninsured (SSA) if reduction in the number of preventable maternal deaths in Mexico is to be achieved. Such programmes should also target service and retail workers and identify women with poor glycaemic control early in pregnancy.

Eclampsia↗
PubMed2001

Drug-resistant tuberculosis in foreign-born persons from Mexico, the Philippines, and Vietnam-United States, 1993-1997.

SETTING: Foreign-born persons in the United States represent a growing proportion of the nation's tuberculosis (TB) cases. OBJECTIVE: To characterize drug resistance patterns in foreign-born TB patients from the three most common birth countries. DESIGN: A descriptive analysis of national TB surveillance data for 1993-1997. TB case reports for foreign-born persons who were at least 15 years old and born either in Mexico (6221), the Philippines (3624), or Vietnam (3351) were included. RESULTS: Among those with no prior history of TB, the proportions with isoniazid-resistant TB and MDR-TB (resistance to at least isoniazid and rifampin) were 9.2% and 1.6% for persons from Mexico, 13.7% and 1.4% for those from the Philippines, and 17.8% and 1.4% for those from Vietnam. Levels of isoniazid resistance and MDR-TB did not change during the 5-year study period. Levels of isoniazid resistance decreased with older age for persons with no prior TB from all three countries; however, rates of MDR-TB did not vary with age. Persons with <1 year of residence in the US were more likely to have MDR-TB; however, duration of residence in the US was not associated with isoniazid resistance. CONCLUSION: Increased drug resistance in younger and more recent arrivals suggests that vigorous efforts to prevent further development of MDR-TB in the three countries are essential.

Adolescent↗
PubMedDate not supplied

Prevalence of self-reported illnesses in elderly Hispanic and non-Hispanic Whites in New Mexico.

OBJECTIVE: To report on the prevalences of self-reported illnesses from the New Mexico Elder Health Survey. DESIGN: Randomized community-based cross-sectional survey of elderly (> or = 65 years of age) Hispanics and non-Hispanic Whites. METHOD: Analysis of data from the 883 participants in the New Mexico Elder Health Survey. RESULTS: Complete data on 848 subjects were available for this analysis: Hispanic males, 212; Hispanic females, 189; non-Hispanic White males, 236; non-Hispanic White females, 211. The mean age was 74 years (age range 65-98). Hispanics had fewer years of school and lower income. Hispanics reported a significantly (P<.05) higher prevalence of type 2 diabetes; leg ulcers/pressure sores; and Parkinson's Disease. Non-Hispanic Whites reported a significantly (P<.05) higher prevalence of asthma; circulatory problems; stomach (not ulcers), intestinal or gallbladder disease; urinary tract disorders (other than kidney disease); and cancer. Prevalence odds ratios and confidence intervals were calculated. Hispanic males reported a higher prevalence of type 2 diabetes (OR 1.88, CI 1.10-3.26, P = .02), and lower prevalences of asthma (OR 0.43, CI 0.18-0.93, P = .04); urinary tract disorders, other than kidney disease (OR 0.59, CI 0.38-0.91, P = .01); and cancer (OR 0.31, CI 0.13-0.68, P = .005). Hispanic females reported a higher prevalence of diabetes (OR 3.01, CI 1.48-6.50, P = .003), and a lower prevalence of glaucoma (OR 0.48, CI 0.22-1.00, P = .05). These differences remained significant after adjustment for age, education, income, and language. CONCLUSION: There are significant differences in the prevalences of self-reported illnesses between Hispanic and non-Hispanic White elderly.

Aged↗
PubMed2001

[Cave-associated acute pulmonary histoplasmosis in two Japanese returning from Mexico].

We report cases of cave-associated acute pulmonary histoplasmosis that occurred in two Japanese returning from Yucatan, Mexico. Patient 1 is a 35-year-old woman who worked in a bat-infested cave in Mexico for about 3 weeks. Almost all her colleagues had developed cough, fever and headache after 5 days in the cave. She was asymptomatic but her chest radiograph showed multiple nodules 5-10 mm in diameter throughout both lungs. The histoplasmal mycelial-phase complement fixation titer on admission was 1:16, and 1:128 one month later. Patient 2, the 53-year-old husband of patient 1, was also infected by histoplasma in the cave, and similar nodules were observed in his chest radiograph. His histoplasmal complement fixation titer did not elevate. To date, about 20 cases of pulmonary histoplasmosis have been reported in Japan. The number of imported mycoses in Japan is increasing, and histoplasmosis should be considered in the differential diagnosis of pulmonary nodules in travelers returning from endemic areas.

Acute Disease↗
PubMed2001

A comparison of substance use and injury among Mexican American emergency room patients in the United States and Mexicans in Mexico.

BACKGROUND: Emergency room (ER) studies have found differences in the association of alcohol with injury (intentional and unintentional) across cultures. These differences may be due to differences in drinking patterns across cultures. Few comparative data have been reported on associations of alcohol and injury between Mexican American ER patients and ER patients living in Mexico, and general population studies suggest that Mexican Americans may adopt more frequent heavy drinking patterns after migrating to the United States. METHODS: A comparative analysis of drinking, drug use, and injury was performed in probability samples of 550 ER patients from Santa Clara County (San Jose, CA) and 1417 ER patients in Pachuca (Hidalgo), Mexico. RESULTS: Both injured and uninjured (i.e., medical conditions) patients in Pachuca were less likely to report heavy drinking, drug use, drunkenness, or alcohol-related problems compared with those in Santa Clara. Those scoring high on level of acculturation in Santa Clara were more likely to report both drinking and drug use before the event, and heavy drinking, drug use, and consequences related to drinking in the last year compared with those scoring lower. Those scoring low on acculturation were similar on substance use variables to those in the Pachuca sample. CONCLUSIONS: Findings suggest that alcohol's association with injury may not just reflect typical drinking patterns in a culture. Among Mexican Americans, this association my vary by acculturation, and those migrating to the United States may be at increased risk for alcohol-related injury as their drinking patterns undergo change to those of the dominant culture. The ER, in this context, may take on increasing importance as a site for health services providers to implement intervention and prevention services for alcohol-related consequences in this ethnic group.

Adolescent↗