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[Prostitution and AIDS in the city of Mexico].

Since 1987 The National AIDS Council in Mexico (CONASIDA), has conducted research projects among female commercial sex workers (CSW), who are seen at the AIDS Information Centers. Through these studies, we have been able to find out how different issues influence commercial sex work in Mexico City. Since the beginning of our own studies in 1989, HIV prevalence in this particular group has remained low (0.04%-0.2%). Factors found to be associated with condom use were: educational level, not having children, more experience in sex work and younger age. Condom use was reported by 88% of the women; however, qualitative information and high STD prevalence rates suggest a much lower condom use. Mandatory HIV testing is not useful as a preventive measure among sex workers. Persuasive and structural interventions must be implemented in accordance with local and legal situations.

Acquired Immunodeficiency Syndrome↗

[AIDS cases in the rural area in Mexico].

The objective of this paper is to describe the AIDS epidemic in rural areas of Mexico. Information from the National AIDS Registry and the 1990 XI National Census was used. Rural AIDS cases and urban cases were compared regarding notification time, sex, risk categories and migration information. Of the 19,090 AIDS cases reported to the first of July 1994, 699 (3.7%) were rural cases. The first five of these cases were reported in 1986, three years after the first cases had been reported in Mexico. The number of AIDS cases has been growing each year but in 1991. Cases have been reported by all Mexican states. The state with the highest prevalence was Nayarit with 102 cases per million inhabitants, followed by Morelos with 99, Jalisco with 90, and Colima and Tlaxcala with 84. A total of 25% of the rural cases are migrants who have been to the US, against 6.1% of cases from urban areas. The distribution by sex shows 21.3% of women affected against 14.4% of urban cases (p < 0.05). The rural female to male ratio is 1:4, while the urban ratio is 1:6. The prevalence rates are almost three times greater in men than in women. The rural AIDS pattern represents a problem not because of the number of people affected but because of the heterosexual way of transmission. We do not think that migration to the US is going to change. The rural AIDS epidemic is more recent and growing faster than that occurring in the urban setting.

Acquired Immunodeficiency Syndrome↗

[The epidemiological surveillance of dengue in Mexico].

The clinical behavior of dengue fever in Mexico has changed, now with the occurrence of hemorrhagic cases. In response to the emergence of such cases, a specific epidemiologic surveillance system has been designed and implemented. This system includes the means to monitor the factors involved in the evolution of the disease. The identification and analysis of these factors is necessary to implement prevention and control measures. This paper presents the main components and procedures of the epidemiologic surveillance system for common and hemorrhagic dengue fever in Mexico, emphasizing the usefulness of the risk approach to predict the pattern of this disease. The model includes the collaboration of a multidisciplinary group. The Epidemiologic Surveillance State Committee, coordinated by the National Health System, participates in the collection and analysis of epidemiologic data, particularly data related to the population, the individual, the vector, the viruses and the environment.

Aedes↗

[Humoral immune response to HIV-2 in Mexico].

OBJECTIVE: To study the reactions of Mexican HIV-1 positive sera to HIV-2 antigens, and their relation to the mode of transmission and the clinical status of infected individuals. MATERIAL AND METHODS: Six-hundred and fifty-four sera samples collected in Mexico were tested using HIV-2 immunoblot (IB) techniques; 492 samples were from HIV-1 positive cases and 162 from HIV-1 negative controls. RESULTS: Seventy-nine percent (388/492) of the HIV-1 reactive sera showed reactivity with at least one HIV-2 protein: 71% (352/492) recognized the capsid protein p24, 24% (119/492) the transmembrane glycoprotein and 9% (44/492) the external glycoprotein of HIV-2. Considering the transmission mechanism, HIV-2 reactivity occurred in 81% (324/401) of the sexually infected patients, and only in 39% (16/41) of people infected through blood products. Ten highly reactive gp32 HIV-2 sera samples were titrated and results showed that reactivity with HIV-1 gp41 was always higher than that to HIV-2 gp32. HIV-1-HIV-2 dual infection was discarded by negative results with the commercial assay Liatek HIV 1+2. CONCLUSIONS: We propose that the serological cross-reactivity found can be due to a possible initial introduction in Mexico of two different viral strains through the two main transmission routes and that the strains circulating in sexually infected individuals are more similar to the HIV-2 strains, at least with respect to their glycoproteins, than the HIV-1 strains predominant in other countries.

Acquired Immunodeficiency Syndrome↗

Clustering of metabolic disorders and hyperinsulinemia in Mexico City.

OBJECTIVE: To investigate the relationship between fasting insulin concentrations and several metabolic and anthropometric variables in the Mexico City population. DESIGN: Cross-sectional, randomized, stratified by age, sex and economically active and inactive. SUBJECTS: 700 healthy adults, older than 20 years, 396 males and 304 females. MEASUREMENTS: Body mass index, waist to hip ratio, systolic and diastolic blood pressure, insulin, glucose, triglycerides, total, HDL and LDL cholesterol and lipoprotein(a). RESULTS: Means for age were 39 +/- 13 years for men and 41 +/- 12 for women (p < 0.05). In males, the mean values of body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, triglycerides, glucose and LDL-cholesterol : HDL-cholesterol increased significantly with higher insulin levels. A significant inverse tendency was observed for the mean concentrations of HDL-cholesterol and lipoprotein(a). Age, total cholesterol and LDL-cholesterol were not related to the insulin levels. A similar pattern was observed in women, significance, however, was only obtained for the body mass index, triglycerides, glucose, HDL-cholesterol and lipoprotein(a). Age-adjusted multiple regression analysis showed that insulin was directly and independently associated to triglyceride levels and inversely with lipoprotein(a) concentrations for both sexes, and with HDL-C, only in males. CONCLUSIONS: The prevalence of insulin resistance related metabolic disorders was high in a random sample of the Mexico City population. Increased cardiovascular risk factors associated with the insulin resistance syndrome were observed with higher insulin levels, and lipoprotein(a) was inversely and significantly related to insulin. Preventive strategies are urgently needed to avoid the already increased incidence of morbidity and mortality associated to atherosclerotic disease.

Adult↗

[Chemical composition, dietary fiber and mineral content of frequently consumed foods in northwest Mexico].

Nutrient composition in foods is very important specially in evaluation of nutritional status in populations. In this study the proximate composition, dietary fiber (DF) and mineral content of 15 frequently consumed foods in Northwest Mexico were determined. The procedures used were AOAC (1984) official methods, chemical-enzymatic method for DF and atomic absorption spectrophometry for minerals. Foods were grouped into cereals, legumes, meat and dairy products, fat was the most variable component in all foods (0,41 to 21,1 g/100 g). Fired beans (Phaseolus vulgaris: variedad pinto) had the highest DF content (9,21 g/100g); as is basis). Sodium among the minerales was also highly variable mainly due to the addition of salt during preparation of foods, except in corn tortillas were salt is not added. In contrast wheat flour tortillas had the highest sodium content of the foods analysed. Fresh white cheese had the highest calcium content (563 mg/100g). The meat group had the highest content of Fe and Zn (2,4-5,4 and 4,2-5,4 mg/100 g respectively). This study has provided information with current analytical techniques of important foods in northwest Mexico that will contribute to food composition tables in Latin America.

Dietary Fiber↗

[The study of the smoking-related mortality in Jalisco, Mexico].

BACKGROUND: In recent years, tobacco consumption its associated health problems have increased in Mexico. This study aims to describe the effects of tobacco use on mortality in the State of Jalisco, Mexico, in 1990. METHODS: 22 smoking-related diseases, for which there are estimates of relative risks of death were selected; smoking-attributable mortality fractions for each disease per sex, were calculated. This made it possible to estimate smoking-attributable mortality rates, years of potential life lost (YPLL), due to tobacco uses and life expectancy at birth (LEB), excluding mortality due to smoking. RESULTS: Smoking-attributable deaths represent 8.7% of all registered deaths in 1990. Ab high proportion of theses deaths belonged to ancient people. The smoking-attributable rate was 4.91 per 10,000 inhabitans (6.33 for males and 3.58 for females); YPLL rates, due to tobacco use was 2.98 per 1,000 inhabitans younger than 65 years (3.99 for men and 2.02 for women). CONCLUSIONS: Smoking-attributable mortality PYLL rates were higher than those rates observed for infectious and parasitical diseases, and for endocrinal and digestive system disorders. Due to tobacco use, men die more frequently and at a younger age than women. In the absence of tobacco use, the LEB increase would be notorious.

Adolescent↗

A survey and bibliography of the mosquito fauna of Mexico (Diptera: Culicidae).

A revised list of the mosquito species known to occur in Mexico contains 20 genera, 37 subgenera, and 225 species. Several supraspecific categories have been described and species reassigned since the last list was published in 1956. Based on present knowledge, there are 29 species that are known only from Mexico. Eight species are deleted from the Mexican fauna. An extensive bibliography is included.

Aedes↗

Undiagnosed hypercholesterolemia: a serious health challenge. The Mexico City Diabetes Study.

In this report we present the results of a population based survey designed to characterize the prevalence of hypercholesterolemia (HCL: total cholesterol > or = 240 mg/dl) in a low income urban area of Mexico City (The Mexico City Diabetes Study). In an area of 15,532 inhabitants, 3505 (22.57%) were found to be study eligible (all 35-64 year-old men and nonpregnant women residing in the area permanently). A home interview was obtained in 2813 (80.26%) subjects. A physical exam and oral glucose tolerance test was performed on 2282 (81.2% of the individuals that gave the interview and 65.1% of all study eligibles, 941 men and 1341 women). The crude prevalence of HCL for men in this group was 12.3% and for women 12.5%. Severe HCL (total cholesterol > or = 260 mg/dl) was found in 6.6% of men and 6.5% of women. In the older age group (55-64 years) prevalence in women reached 21.1%. Of the individuals with HCL this abnormality was previously diagnosed in only 15.9% of men and in 7.8% of women. Despite having been diagnosed, the abnormality remained untreated in all cases. HCL was associated with higher mean systolic blood pressure (in women), higher mean diastolic blood pressure (in men) and higher mean fasting and 2 h post-glucose load glycemia as well as post-challenge insulinemia in both sexes. Mean TG was found high in both groups (with and without HCL), but in subjects with HCL the values were significantly higher. We conclude that HCL is very common in this population. The majority of the cases remained undiagnosed and of the small fraction of subjects that have been diagnosed, virtually none is under medical care. It is necessary to design and implement a national program to reduce the impact of this serious health problem.

Adult↗

Economic opportunity in Mexico and return migration from the United States.

I analyze the influence of the economic characteristics of origin area on trip duration for Mexican migrants in the United States. I argue that migrants from economically dynamic areas in Mexico with favorable opportunities for employment and small capital investment have a larger incentive to stay in the United States longer and to withstand the psychic costs of separation from family and friends than do migrants from economically stagnant areas in Mexico, where the productive uses of savings are severely limited. In line with this argument we should expect investment opportunities in migrants' origin areas to be associated positively with migrants' trip duration in the United States. To test this hypothesis I use individual- and household-level data on U.S. migration experience collected in 13 Mexican communities. Evidence from parametric hazards models supports the idea that economic characteristics of origin areas influence the motivations and strategies of Mexican migrants in the United States.

Adolescent↗

Hypertension in the San Antonio Heart Study and the Mexico City Diabetes Study: sociocultural correlates.

WE EXAMINED THE ASSOCIATION between sociocultural status (assimilation, modernization, and socioeconomic status) and blood pressure among people of Mexican origin living in San Antonio, Texas, and Mexico City. In San Antonio, higher levels of sociocultural status, especially education and structural assimilation, were generally associated with favorable blood pressure. In Mexico City, greater modernization had a consistently beneficial effect on blood pressure in women, but a consistently harmful effect in men. Higher education was associated with lower prevalence of hypertension and greater awareness, treatment, and control of hypertension in both sexes.

Adult↗

Ozone exposure and daily mortality in Mexico City: a time-series analysis.

Daily death counts in Mexico City were examined in relation to ambient ozone levels during 1990-1992 for the purpose of investigating the acute, irreversible effects of air pollution, with emphasis on ozone exposure. Air pollution data were obtained from nine monitoring stations operated by the Departamento del Distrito Federal. Mortality data were provided by the Instituto Nacional de Estadística, Geografía, e Informática. Increases in numbers of deaths were positively associated with elevated air pollution levels on the same day and on the previous day. The magnitude of the increases was small but statistically significant, after Poisson regression models were used to adjust for temperature and long-term trends. In models using data for a single pollutant, the "crude" ratio for total mortality associated with an increase of 100 parts per billion (ppb)* in one-hour maximum ozone concentration was 1.029 (95% CI 1.015, 1.044). A moving average of ozone showed a stronger association (rate ratio [RR] = 1.048, 95% CI 1.025, 1.070), and excess mortality (an increase in the number of deaths, relative to the average on days with low pollution levels) was more evident for persons over 65 years of age. Separate analyses of the effect of elevated ozone for different areas of the city showed similar results, but they were not statistically significant. Other pollutants also were related to mortality. The RR was 1.075 (95% CI 0.984, 1.062) per 100-ppb increase for sulfur dioxide and 1.049 (95% CI 1.030, 1.067) per 100 micrograms/m3 increase in total suspended particulates (TSP) when these pollutants were considered in separate models. However, when all three pollutants were considered simultaneously, only TSP remained associated with mortality, indicating excess mortality of 5% per 100 micrograms/m3 increase [RR = 1.052, 95% CI 1.034, 1.072]. The excess mortality associated with TSP is consistent with that observed in other cities in America and Europe. This study provides some evidence that ozone is associated with all-cause mortality and with mortality among the elderly after controlling for long-term cycles. However, ozone levels exhibited little or no effect on mortality rates when other air pollutants were considered simultaneously. Particulate matter appeared to be an important pollutant; it independently predicted changes in mortality. Nevertheless, because of the complexity and variability of the mixtures to which people are exposed, it is difficult to attribute the observed effects to a single pollutant. The technical feasibility and scientific validity of isolating the effect of single pollutants in such complex mixtures requires further research and careful consideration. Given the large population living in and exposed to ambient air pollution in Mexico City and other metropolises throughout the world, these small but significant associations of mortality with air pollution indices are of public health concern.

Adolescent↗

[Evaluation of a program for the early detection of cancer of the uterine cervix in Mexico City. A populational-based epidemiologic study of cases and controls].

Cervical cancer is still an important public health problem in Mexico; in spite of the development of various programs aimed at lowering mortality due to this disease, impact has not yet been achieved. In this study we present an evaluation of the Early Detection Program for Cervical Cancer in Mexico City. The authors carried out a case-control study with a populational base, in which a sample of cases obtained in eight hospitals and a sample of controls representative of the general population were included. We report a protective effect attributed to the program. The women with complete cytology showed 2.4 times less risk of cervical cancer. Nevertheless the effect of the program at a populational level is still limited because it covers only 20 per cent of the cases in the population. The results indicate the need for developing operative research programs in order to increase the demand for and the quality and efficiency of preventive services.

Adult↗

[Epidemiologic aspects of childhood asthma in Mexico. Asthma in the Child Study Group].

Asthma is one of the most frequent chronic diseases in children. Its epidemiological tendency is of great importance. In this study, we evaluated the statistical information available from 1987 to 1994 on childhood asthma from several medical institutions in Mexico. We found that: 1) the frequency of medical care provided to asthmatic children under the age of 15 in outpatient, emergency and within hospital settings, expressed as a percentage of the total care provided for each category, has remained unchanged in almost all of the institutions reviewed, whereas the national mortality rate due to asthma has decreased from 3.5/100,000 inhabitants in 1987 to 2.9 in 1993, 2) the frequency of healthcare provided to asthmatics decreases between the ages of 15 to 24; 3) the disease occurs more frequently among males under 15 and in females over that age, 4) from August to November there was a significant rise in care provided for asthmatics in outpatient, emergency and hospital settings in Mexico City and almost every state studied; and 5) the frequency of care for asthmatics increases according to an increase in geographical altitude levels.

Adolescent↗

[Incidence and fatality of the acute and chronic complications of diabetes mellitus in Mexico].

OBJECTIVE: To analyze the secular trend of the incidence and fatality rates of diabetic complications in Mexico. MATERIAL AND METHODS: All diabetes mellitus(DM)-related hospital records for the 1985-1994 period, from the Mexican Institute for Social Security were reviewed. RESULTS: An increasing trend in the incidence of diabetic complications was observed for the last decade. The most frequent complication is diabetes-related end-stage renal disease, followed by peripheral arterial disease. There is an important age effect in the occurrence of diabetic complications. Diabetic ketoacidosis is the most common complication in the early years of life. Fatality due to DM has decreased, mainly that due to acute complications. CONCLUSIONS: Diabetic complications have increased due to the increase in the incidence of DM and in the life expectancy of diabetics. There is a need to study the true incidence of DM and of diabetic complications in Mexico, and to insist in an adequate metabolic control to delay or avoid their occurrence.

Diabetes Complications↗

[Hazardous residues in Mexico. Evaluation of health risks].

In Mexico about 90% of the hazardous waste is not treated adequately. Thus, a sizable proportion of the waste is improperly disposed of and released into the environment, polluting rivers, deserts, etcetera. The present article describes the health effects of hazardous waste and the technological alternatives to tackle these problems. In order to assess the risks posed by hazardous waste sites, a new approach, adapted to the health conditions and scarce resources of the country, has to be developed. The health conditions include malnutrition and infectious diseases; the scarcity of resources refers to qualified environmental laboratories, human resources with expertise in environmental sciences, and funding for the evaluation of hazardous waste sites. Furthermore, a more direct participation of the Ministry of Health in issues related to hazardous waste is needed. These elements should be taken into account to create a National Program for the Study of Hazardous Waste in Mexico.

Hazardous Waste↗

[Burden of disease in the aged, Mexico, 1994].

OBJECTIVE: To estimate the disability adjusted life years lost (DALYs) in population over 60 years of age in Mexico during 1994. MATERIAL AND METHODS: Years of life lost due to premature mortality (YLL) and years lived with disability (YLD) were estimated for 108 diseases, both sexes, and 32 states of the Mexican Republic divided in rural and urban areas in the population over 60 years of age, using the methodology originally proposed by Murray and López adapted to specific local characteristics. The inputs used were: mortality statistics for 1994 (after corrections of under-registration and misclassification), statistics on incidence and prevalence from local epidemiological studies, national health surveys and estimates by the authors. RESULTS: During 1994 the Mexican population over 60 years of age lost 1.8 million DALYs, 59% of which were YLL while 41% were YLD. Most of the burden of disease is due to noncommunicable diseases. The principal health needs of the elderly in Mexico can be divided in two groups: a) those that traditionally are frequent in this age group, such as ischaemic heart disease, diabetes, stroke and b) disabling diseases such as dementia, falls and arthritis as the most important. CONCLUSIONS: The use of composite indicators such as DALYs to assess health needs in older adult can help decision-makers and planners to incorporate disabling and lethal diseases within the list of priority needs, thereby achieving greater equity in the assignment of resources to different health care, prevention and rehabilitation programs.

Age Factors↗

[An anthropometric study of a group of elderly men and women of Mexico City].

OBJECTIVE: The aim of the present study was to estimate basic anthropometric measurements in a group of elderly men and women from Mexico City. MATERIAL AND METHODS: A cross-sectional study was carried out among senior citizens registered in the National Institute of the Elderly and National Institute of Social security in Mexico City. Standardized protocols were used to measure the anthropometric characteristics of the study group. The analysis included Student t tests to detect differences in average values between men and women in general and in each age subgroup formed. In addition, Pearson correlation analysis of the body mass index (BMI) with anthropometric variables was performed; p < 0.05 was taken as the level of significance. RESULTS: A total of 508 people aged 60 or older participated in the study; 230 were males and 278 were females. The average age was 66.9-years-old in the male group and 67.3-years-old in the female group. Among men the average weight was 70.7 kg, standard deviation (SD 9.9), height was 164 cm (SD 6.5) and BMI was 26.4 (SD 3.7). Among women the average weight was 60.8 kg (SD 9.9), height was 150 cm (SD 5.9) and BMI was 27.1 (SD 4.0). The distribution of the BMI showed that 50.9% of men and 54% of women were between 25.0 and 29.9. A correlation coefficient over r 0.70 (p < 0.001) was found between BMI and waist and hip circumferences. CONCLUSIONS: Based on the BMI about three-quarters of the population was overweight or obese. It is possible that the assessment of being overweight and of obesity in elderly people needs to be adjusted considering revised normality values.

Age Factors↗