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PubMed1992

[Decentralization of the health sector in Mexico. Scope and limitations of local health systems].

This paper is a product of the reflection on the decentralization and sectorization experiences in Mexico since 1917 with particular emphasis on the 1980s. The historical analysis included the creation of an analytical model designed to identify the relationship between the distinct sanitary policies implemented in Mexico and the tendencies towards decentralization and integration. This analysis is combined with a critical review of the recent decentralization experiences undertaken in the states of Guerrero, Oaxaca and Nuevo León. While comparing Guerrero and Oaxaca, restitution and deconcentration under similar socio-economic conditions were discussed. The comparison between Guerrero and Nuevo Leon allowed the discussion of the benefits and limits of restitution under different socio-economic conditions. In addition, with this model the author discusses a few generalizations regarding the possible future of decentralization.

Catchment Area, Health↗
PubMed2003

Neuroleptic malignant syndrome in Mexico.

BACKGROUND: Neuroleptic Malignant Syndrome (NMS) is an uncommon but potentially fatal complication of antipsychotic and neuroleptic drug treatment. OBJECTIVES: This study estimated the frequency, clinical presentation, and outcome of NMS in a referral center for neurological, neurosurgical and psychiatric disorders in Mexico. METHODS: The authors conducted a thorough search of psychiatry, neurology, neurosurgery and intensive care unit records for cases of NMS during the 10-year period between 1990 and 1999. They examined the clinical features, course and treatment of the NMS episodes, and performed a follow-up survey for residual symptoms and clinical outcome. The mean time to follow-up assessment was 36 months. RESULTS: A total of eight of 4831 neuroleptic-treated patients had an episode of NMS (incidence 0.165%). Seven of the eight patients were treated with haloperidol. Other neuroleptics agents associated with NMS were depot pipotiazine palmitate and levomepromazine maleate. One patient received lithium concomitantly. No fatal outcome was found. Only one patient developed persistent clinical sequelae, consisting of extrapyramidal and cerebellar symptoms, three years after the NMS episode. CONCLUSIONS: The slightly low frequency of NMS found in this study compared with studies conducted in other countries may be attributable to the advent and use of newer atypical antipsychotics in Mexico, the rigorous demands for NMS diagnostic criteria and the lack of familiarity with the diagnosis between physicians.

Adolescent↗
PubMed2003

Under-performance evaluation and rehabilitation strategy for waste stabilization ponds in Mexico.

Fourteen high altitude (> 2,500 m amsl) small Waste Stabilisation Pond systems (WSPs) commissioned during the last 12 years in the State of Mexico in Mexico, were built to a common 3-stage design. Each system is comprised of 2 parallel series of bio-digesters, anaerobic and facultative ponds. All fourteen WSP systems produce poor quality effluents, and eight studied in more detail did not meet any of the national standards for discharge to rivers or the standards required for reuse. The under-performance of these WSPs is underlined by the anaerobic condition of the upper reaches of the Lerma river which receives the sewage from the towns served by these treatment plants. Preliminary surveillance diagnostics identified fundamental operational problems in all eight WSP systems located in the upper Lerma catchment. The results of an intensive secondary diagnostic performance evaluation on one system were used to identify the reasons for under-performance. Under-performance was caused by under-design, hydraulic short-circuiting, adverse environmental conditions and poor operation and maintenance. A strategy for improvement of design and operation to meet national standards is presented.

Altitude↗
PubMedDate not supplied

[Mortality from neural tube defects in Mexico, 1980-1997].

OBJECTIVE: To describe the mortality due to neural tube defects (NTD) in Mexico for the 1980-1997 period. MATERIAL AND METHODS: The annual NTD mortality rates per 10000 liveborn infants were calculated by state and for the country. The time trend was evaluated with the annual percent change (APC) obtained using a Poisson regression model. The NTD mortality ratio was calculated using the average national rate as reference. NTD mortality rates and ratios were graphically displayed on maps. RESULTS: During the 1980-1997 period the gross NTD mortality rate was 5.8 per 10000 live-born infants. Anencephaly (International Classification of Diseases ICD-9 740.0) was the most frequent type of NTD (37.7%), followed by spina bifida without hydrocephaly (CIE9 741.9) (31.6%). The national trend of NTD mortality increased between 1980 and 1990 (APC 7.5 95% CI 6.5, 8.6) and decreased between 1990 and 1997 (APC-2.3 95% CI-3.6, -0.9). CONCLUSIONS: The high NTD mortality rates were related to the high frequency of anencephaly. Also, the increase observed is not only attributable to diagnostic factors or to improved reporting. In Mexico, the influence of some NTD-associated factors such as specific genetic polymorphisms, folic acid deficit, maternal obesity, occupational exposure to pesticides, and poverty, should be assessed in specific studies.

Humans↗
PubMed2003

Bacteria and disinfection byproducts in water from southern Mexico City.

Disinfection byproducts and microorganisms present in drinking water may have deleterious effects on human health. The authors examined bacterial indicators (enterobacteria and Helicobacter pylori [H. pylori]), physicochemical parameters, and trihalomethane (THM) levels to conduct a water quality evaluation in Mexico City, where little is known about disinfection byproducts and microbial counts. Analyses were performed by standard membrane filtration for the enumeration of total coliforms, fecal coliforms, fecal streptococci, and Vibrio species. Other testing consisted of polymerase chain reaction (PCR) for H. pylori, physicochemical parameters by selective electrodes, and THMs by head-space with the use of a gas chromatograph. Indicator bacteria and enterobacteria were detected in 23% of samples, with significant differences between total coliforms, fecal coliforms, and fecal streptococci before and after chlorination. H. pylori was detected in 69% of samples prior to chlorination and 57% postchlorination. THM levels were < 200 microg/l. Chlorine concentrations ranged from < 0.05 mg/l to 35 mg/l. Disinfection at the well does not ensure good water quality for the Mexico City population. The next step will be the monitoring of water quality in the distribution system that supplies dwellings, as well as water obtained directly from the tap.

Chlorine↗
PubMed1992

The costing out of operational expenses between the Veterans Administration and the Air Force at the New Mexico Regional Federal Medical Center.

The purpose of this pilot study was to identify the cost of providing care to Veterans Administration (VA) and Department of Defense (DOD) patients eligible for care in the Emergency Department of the New Mexico Regional Federal Medical Center in Albuquerque, New Mexico. Medical records for the Emergency Department (N = 456) were reviewed for individual medical supply item and medication usage. Cost data were then tabulated for each item and each group, respectively. The results indicated that the DOD and VA shared equally in the consumption of expendable medical supply and medication funds in the Emergency Department.

Emergency Service, Hospital↗
PubMed2003

[Blood lead levels and exposure factors in children of Morelos state, Mexico].

OBJECTIVE: To assess blood lead levels and lead exposure factors in children living in Morelos State, Mexico. MATERIAL AND METHODS: A cross-sectional study was conducted between June and October 1996, in 232 children aged 1-12 years, at Hospital del Niño Morelense de Cuernavaca, Morelos, Mexico. Blood lead levels were measured by anodic voltameter, and exposure factors were collected by questionnaire. The lead concentration value was log transformed for statistical analysis. Odds ratios were obtained for some risk factors. The statistical significative risk factors were later analyzed with ANOVA. RESULTS: A total of 232 children were recruited (50% female); 73% resided in Cuernavaca City. The geometric mean blood lead level was 6.7 micrograms/dl; 29.7% of the children had levels over 10 micrograms/dl; 66% reported use of lead glazed pottery for cooking, 36% for storing food, and 19% for drinking. CONCLUSIONS: Blood lead levels were similar to those reported in other Mexican children studies, after the reduction of lead in gasoline. The main risk factors were use of lead glazed pottery and vehicle traffic intensity near the household. These results will be useful for future prevention and control interventions. This paper is available too at: http://www.insp.mx/salud/index.html.

Child↗
PubMedDate not supplied

[The importance of pollinosis in the Valley of Mexico].

The climatic conditions and the vegetation in the valley of Mexico are analyzed in virtue of their modification during the last few years which have consequently altered the surrounding ecological systems. In this article, we were particularly interested in describing the botanical characteristics of the gimnospermas, an abundant vegetation in Mexico.

Geography↗
PubMedDate not supplied

[Increase in frequency of asthma in school children from Villahermosa, Tabasca, Mexico].

BACKGROUND: There is evidence that the worldwide prevalence of asthma is increasing, particularly in children. OBJECTIVE: To compare the cumulative prevalence of medical diagnosis of asthma among Mexican schoolchildren in two surveys 12 years apart. MATERIAL AND METHODS: The study populations of the two comparable cross sectional surveys comprise six to twelve years old public and private schoolchildren in Villahermosa, Tabasco, Mexico. Sample sizes in 1986 and 1998 were 6,465 and 6,073 children and response rates were 72 and 85%, respectively. The sampling frame and sampling method were identical in both surveys. The prevalence of medical diagnosis was expressed by sex and age comparing 1986 to 1998. An analysis of contingency tables was used to asses the differences in the prevalence rates. RESULTS: Cumulative prevalence of medical diagnosis of asthma in 1986 and 1998 were 8.74 and 12.63%, respectively, 45% of increase. We found a significant increase in lifetime of asthma (p = 0.001). The observed increases were independent of sex and age. CONCLUSION: As it has come to pass all over, our results support a significant increase in the cumulative prevalence in the last 12 years among schoolchildren in Villahemosa, Tabasco, Mexico.

Asthma↗
PubMed2004

Polymerase chain reaction monitoring of transmission of Onchocerca volvulus in two endemic states in Mexico.

To investigate the impact of mass ivermectin treatments in Mexico on Onchocerca volvulus transmission, entomologic surveys were carried out in the two endemic states of Oaxaca and Chiapas. The data suggest that substantial progress towards the goal of elimination has been made. A comparison pre- and post-ivermectin data from a community in Southern Chiapas showed a 97% decrease in seasonal transmission potential, but some level of polymerase chain reaction positivity was still detectable. In other communities from northern Chiapas and Oaxaca where there are no baseline data, there was an absence or near absence of infective flies. Residual transmission was not evenly distributed because differences were seen in the infection and infective rates from different catch points. These findings suggest that while substantial progress towards elimination has been made in Mexico, it may be necessary to modify ivermectin distribution strategies to eliminate transmission in areas where transmission persists.

Animals↗
PubMed2003

[Social representation of AIDS among students of Mexico City].

OBJECTIVE: To analyze the social representation of AIDS in a group of high school students aged 16 to 23 years in Mexico City. MATERIAL AND METHODS: A non-probabilistic, cross-sectional research was carried out in a public high school in Mexico City. Students of all grades were invited to participate in the study, which took place between 1999 and 2000. Forty-six students participated; 28% male and 72% female. This exploratory field study consisted of three phases, each to address one of three dimensions: cognitive using free association techniques, representational field using semi-structured interviews; and context attitude by means of two discussion groups. In the latter, the information was previously collected for discussion. RESULTS: The cognitive nucleus on AIDS included the association between sex, disease, and death. The representational field of AIDS is constructed around the transmission-prevention unit. Construct elements are virus, contagion, sex, protection, and condom. An ambivalent attitude was identified towards HIV prevention and transmission: "We are only half responsible". Situations such as "rape, blood transfusions, infected syringes" were prominent in the discussion group, deemed beyond their control to prevent transmission, thus explaining the group's ambivalent attitude towards prevention. The usefulness of condoms was associated with prevention of pregnancy rather than with prevention of sexually transmitted infections. CONCLUSIONS: The social representation of HIV/AIDS in young students conforms a multidimensional corpus where different elements of scientific order and common sense converge and interact, such as beliefs, myths, taboos, and fears. All of these contribute to construct the meaning of AIDS. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Diagnosis and treatment of gout in Mexico City. Results from a physicians survey].

UNLABELLED: The diagnosis and proper treatment for gout were described decades ago but these guides are not always realized in all the patients. OBJECTIVES: To evaluate by a mail survey sent to general physicians (GP), internal medicine physicians (IM), orthopedists (OP) and rheumatologists (RP) from Mexico city, the way they diagnose and treat gouty patients. SUBJECTS AND METHODS: The survey was anonymous and included 20 questions, it was sent by mail to 1,836 physicians (640 GP, 640 OP, 423 IM and 133 RP) living in Mexico city. RESULTS: The response was 6.8% OP, 10.4% IM, 10.8% GP and 41.4% RP. Eighty two to 95% of them attend gouty patients. Diclofenac was the drug most frequently used as the treatment for acute attacks, although a high frequency of glucocorticoids and allopurinol prescription for acute gout attacks was detected (28% OP and 49% GP respectively). Allopurinol is the drug more frequently used for the chronic treatment, it is also used for asymptomatic hyperuricemia by 43-84% of the physicians. Twenty five percent do not adjust initial allopurinol doses to glomerular filtration rate. The prophylactic treatment is used in only some cases and the dietetic restrictions were variable. Some points regarding the treatment of these patients are not according those recommended in the literature. CONCLUSIONS: We need to increase the knowledge between physicians about gout diagnosis and proper treatment. The adequate treatment is in most of the cases safe, cheap and effective.

Acute Disease↗
PubMedDate not supplied

[The surgery and its teaching in Mexico. Historical review 1325-2000].

OBJECTIVE: To relate the outstanding events in the surgical teaching in Mexico since 1325 to 2000. DESIGN: Historic review. SETTING: Third level health care hospital. RESULTS: The teaching of surgical procedures has been pretty much alike in many cultures around the world, even though this did not happened at the same time in all places; a very good example of this are surgical teachings in ancient Egypt, Greece and Mexico separated by 4,300 and 1,900 years respectively whose surgical methods and its teaching are quite similar. Afterwards the influence of Spanish, French, German and American medical cultures developed faster and efficient changes with the main objective of obtain every time better surgeons.

Colonialism↗
PubMedDate not supplied

[Liver cirrhosis mortality in Mexico. I. Relevant epidemiological characteristics].

Previous studies have emphasized the impact of alcoholism on public health, especially on the incidence of liver cirrhosis, which ranks among one of the main causes of death in Mexico. Accordingly, the epidemiologic features of liver cirrhosis mortality (LCM) are examined, highlighting its historical trends, its geographical distribution and other risk factors like age and sex. The data show a consistently high LCM rate over time, male rates moving slightly up and female rates down. Proportional mortality has been increasing. The significant risk increment with age has determined LCM to be the leading cause of death for both sexes in the 30-64 years age group. A particularly interesting finding relates to the continuous excess of LCM seen in Mexico City and four surrounding states; on the contrary, in the northern states, LCM is considerably low. This difference is valid for women too. Comparing all states, a gradient of LCM rates from high to low mortality areas is observed. The social and health implications of LCM regional distribution demand the conduction of epidemiological studies to identify possible explanatory variables related to the pattern of alcohol consumption or other risk factors. Nonetheless, these data alone justify the implementation of an effective action plan in the high-risk areas to deal with this health problem, inherently associated with individual and social behaviors.

Adult↗
PubMedDate not supplied

[Liver cirrhosis mortality in Mexico. II. Excess mortality and pulque consumption].

Over the years high cirrhosis mortality rates have been reported in Mexico City and in the surrounding states (Hidalgo, Tlaxcala, Puebla and the State of Mexico); on the contrary, well defined areas, such as the northern states, have shown a considerably lower mortality rate. This situation may indicate that some factors such as the pattern of alcoholic intake and other environmental characteristics could explain this striking difference. To determine the role of alcohol, the availability and consumption of alcohol at regional and state level were compared with cirrhosis mortality rates. A high and statistically significant correlation was found with pulque availability and consumption (r = 72-92%, p less than 0.01) in all periods of time under examination. On the contrary, a statistically significant negative association was observed with beer consumption and a positive, but not significant correlation, with distilled alcoholic beverages. Infectious hepatitis incidence, prevalence of exclusive use of native languages (as an indirect index of ethnic background) and nutritional deficiencies were also studied as possible risk factors. Nutritional deficiencies and the prevalence of exclusive use of náhuatl and otomí languages were positively correlated. These results can be useful to conduct further epidemiological studies still needed to determine the etiologic role of pulque consumption as well as of the other risk factors. Nonetheless, the current data stress the need to implement public health programs to reduce alcohol consumption, especially pulque, and to minimize the impact of these risk factors in high mortality areas.

Alcohol Drinking↗
PubMedDate not supplied

[Contraceptive practices among adolescents and youths of the metropolitan area of Mexico City].

The purpose of this article is to provide a brief description of the information that the adolescent and youth population of Mexico City has concerning the knowledge and use of contraceptive methods, as well as the reasons why they do not adopt some contraceptive method during their sexual relations. The data obtained from the Survey on Adolescent and Youth Reproductive Behavior in the Metropolitan Area of Mexico City serves as a basis for pointing out several behavior patterns of the male and female population from 10 to 25 years of age. Of those interviewed, 32.7 per cent had had at least one sexual contact; the average age at which sexual relations had begun was 16 years for males and 17 for females. A total of 33.8 per cent of those who had had sexual contact stated that they had used some form of contraception, the principal methods used during first sexual intercourse being rhythm (36.9%); withdrawal (23.6%), and condoms (12.3%). The reasons for not using any contraceptive method were as follows: lack of knowledge regarding the methods, how to use them or where to obtain them (39.4%), and unplanned sexual intercourse (28.9%). During the last sexual contact they had, 70.5 per cent had used a contraceptive. The methods most frequently used were hormonal contraceptives and IUD (40.9%); rhythm (23.8%), and withdrawal and condoms. The reasons why no contraceptive was used in the last sexual contact were: neither partner thought that pregnancy would occur (27.1%) and the sexual contact was unplanned.

Adolescent↗
PubMedDate not supplied

[Supply of medical equipment in Mexico].

This article covers the report on Supply of Medical Equipment in Mexico, presented during the Second National Congress of Public Health. The results are part of an investigation that dealt with the general conditions that currently prevail in the production and distribution of medical equipment. The information was obtained by means of a survey applied to 208 companies that comprised the sample study. The facts indicate that of the companies that correspond to this industrial sector in Mexico, 3.8 per cent are manufacturers, 69.7 per cent distributors, 19.2 per cent manufacturer-distributors, and the remaining 7.2 per cent correspond to corrective and preventive maintenance. Also, these companies pose serious problems of external dependence with regard to production costs and the commercialization of products. Furthermore, it became evident that there is a substantial need for financial support to optimally satisfy the demands of various institutions in the country's health sector.

Equipment and Supplies↗
PubMed2004

Search for poliovirus carriers among people with primary immune deficiency diseases in the United States, Mexico, Brazil, and the United Kingdom.

OBJECTIVE: To estimate the rate of long-term poliovirus excretors in people known to have B-cell immune deficiency disorders. METHODS: An active search for chronic excretors was conducted among 306 persons known to have immunoglobulin G (IgG) deficiency in the United States, Mexico, Brazil, and the United Kingdom, and 40 people with IgA deficiency in the United States. Written informed consent or assent was obtained from the participants or their legal guardians, and the studies were formally approved. Stool samples were collected from participants and cultured for polioviruses. Calculation of the confidence interval for the proportion of participants with persistent poliovirus excretion was based on the binomial distribution. FINDINGS: No individuals with long-term excretion of polioviruses were identified. Most participants had received oral poliovirus vaccine (OPV) and almost all had been exposed to household contacts who had received OPV. Polioviruses of recent vaccine origin were transiently found in four individuals in Mexico and Brazil, where OPV is recommended for all children. CONCLUSION: Although chronic poliovirus excretion can occur in immunodeficient persons, it appears to be rare.

Adolescent↗