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Design and results of the USA-Mexico border human papillomavirus (HPV), cervical dysplasia, and Chlamydia trachomatis study.

OBJECTIVE: Mexico has one of the highest mortality rates of invasive cervical cancer in the world. This is particularly true for the states in northern Mexico that border on the United States of America. In addition, Hispanics in the United States have higher rates than do non-Hispanics in the country. Therefore, a binational team was formed to focus on this problem and to determine the risk factors and prevalence of cervical dysplasia and human papillomavirus (HPV) infection, the sexually transmitted disease (STD) known to cause cervical cancer. Chlamydia trachomatis infection, a common STD and potential HPV cofactor, was also assessed. METHODS: Research was conducted in 1997 and 1998 in the border region of two states, Arizona in the United States and Sonora in Mexico, applying a cross-sectional study of women attending clinics for routine gynecologic care. Clinical measurements included Pap smears, HPV infection by both polymerase chain reaction (PCR) and Hybrid Capture (HC), and C. trachomatis status by HC and enzyme-linked immunoassay (EIA). A total of 2,436 women were enrolled (mean age 33.3 years +/- 10.3 years). RESULTS: The overall prevalence of abnormal cytology was 9.3%, with a significant difference in the prevalence in Mexico (11.4%) vs. the United States (6.6%). Of the participants, 14.5% of them tested positive for HPV by PCR, with no significant difference between the two countries, in spite of a lower behavioral risk profile for the Mexican women. Overall prevalence of C. trachomatis was found to be greater by HC than by EIA (8.2% vs. 3.0%), and in Mexico higher by both methods. CONCLUSIONS: An important accomplishment of the project was the implementation of a quality control program for Pap smear collection, which resulted in a significant reduction in inadequate smears in Mexico. Despite numerous potential logistical barriers, the binational team successfully conducted a large-scale study in the border area and developed an infrastructure for future research.

Adolescent↗

Respiratory tract toxicity in rats exposed to Mexico City air.

The rat has been used extensively as a health sentinel, indicator, or monitor of environmental health hazards, but this model has not been directly validated against human exposures. Humans in Mexico City show upper respiratory tract lesions and evidence of pulmonary damage related to their environmental inhalation exposure. In this study, male and female F344 rats were exposed (23 hr/day) in Mexico City to local Mexico City air (MCA)* for up to seven weeks. Controls were maintained at the same location under filtered air. Prior to these exposures, several steps were taken. First, the nasal passages of normal male rats shipped from the United States and housed in Mexico City were examined for mycoplasma infection; no evidence of infection was found. In addition, a mobile exposure and monitoring system was assembled and, with an ozone (O3) exposure atmosphere, was tested along with supporting histopathology techniques and analysis of rat nasal and lung tissues. Last, the entire exposure model (equipment and animals) was transported to Mexico City and validated for a three-week period. During the seven-week study there were 18 one-hour intervals during which the average O3 concentration of MCA in the exposure chamber exceeded the US National Ambient Air Quality Standard (NAAQS) of 0.120 ppm 03 (hourly average, not to be exceeded more than once per year). This prolonged exposure of healthy F344 rats to MCA containing episodically low to moderate concentrations of 03 (as well as other urban air pollutants) did not induce inflammatory or epithelial lesions in the nasal airways or lung as measured by qualitative histologic techniques or quantitative morphometric techniques. These findings agree with those of previous controlled O3 inhalation studies, but they are in contrast to reports indicating that O3-polluted MCA causes significant nasal mucosal injury in adults and children living in southwestern Mexico City. Taken together, these findings may suggest that human airways are markedly more susceptible to the toxic effects of MCA than are the airways of the F344 rat.

Air Pollutants↗

Human papillomavirus infection at the United States-Mexico border: implications for cervical cancer prevention and control.

The United States-Mexico border is a region comprised of a country with one of the highest rates of invasive cervical cancer (Mexico) and a country with one of the lowest rates (United States). Recent evidence clearly indicates that human papillomavirus (HPV) infection is the cause of cervical cancer. The distribution of specific types of HPV is known to vary in different regions of the world, as do the cofactors that may inhibit or promote HPV carcinogenesis. Estimating the prevalence of oncogenic HPV is needed for guiding vaccine development. The purpose of this study was to determine the prevalence of oncogenic and nononcogenic HPV types and risk factors for HPV among women residing along the United States-Mexico border. A cross-sectional study of 2319 women, ages 15-79 years, self-referring for gynecological care was conducted between 1997 and 1998. HPV was detected by PCR using the PYGMY 09/11 L1 consensus primer, and HPV genotyping was conducted using the reverse line blot method. Overall, the HPV prevalence was 14.4% with no significant differences observed by country after adjustment for age. HPV 16 was the most commonly detected HPV type in both the United States and Mexico. Among women with high-grade squamous intraepithelial lesions, HPV types 58, 45, 51, 31, 35, 55, and 73 were most common in Mexico, and HPV types 18, 31, 35, 51, 52, and 58 were most common in the United States. In both countries, HPV prevalence declined linearly with age from 25% among women ages 15-19 years to 5.3% among women 56-65 years. Factors significantly independently associated with HPV infection were older age [adjusted odds ratio (AOR) = 0.15 for ages 56-65 years compared with those 15-19 years], a marital status other than married (AOR = 1.58-3.29), increased numbers of lifetime male partners (AOR = 3.8 for > or =10 partners compared with 1 partner), concurrent infection with Chlamydia trachomatis (AOR = 1.79), ever use of Norplant (AOR = 2.69), and current use of injectable contraceptives (AOR = 2.29). Risk factors for HPV infection did not differ by country. Results from this study suggest that in addition to HPV 16 and 18, HPV types 31, 45, 51, and 58 should be considered for inclusion in an HPV prevention vaccine for distribution in Mexico.

Adolescent↗

Pedestrian and hypothermia deaths among Native Americans in New Mexico. Between bar and home.

OBJECTIVE: To determine the nature of excess injury mortality among Native Americans in New Mexico. DESIGN: Retrospective review of death certificates for deaths from unintentional injuries. SETTING: The state of New Mexico. SUBJECTS: New Mexico residents who died of unintentional injuries between January 1, 1980, and December 31, 1989. MAIN OUTCOME MEASURE: Cause-specific mortality rates. RESULTS: Over half of the excess mortality from all unintentional injuries among Native Americans resulted from hypothermia and from pedestrian-motor vehicle crashes. New Mexico Native Americans were nearly eight times more likely to die in pedestrian--motor vehicle crashes and were 30 times more likely to die of hypothermia compared with other New Mexico residents. At death, 90% of those Native Americans tested were highly intoxicated (median blood alcohol concentrations of 0.24 and 0.18 g/dL [corrected] for pedestrian and hypothermia deaths, respectively). Despite the fact that most Native Americans in New Mexico live on reservations, most deaths occurred at off-reservation sites in border towns and on roads leading back to the reservation. CONCLUSIONS: The possession and sale of alcohol is illegal on many Native American reservations. This policy forces Native Americans who want to drink to travel long distances to obtain alcohol. These data suggest that this policy is also the likely explanation for the markedly increased risk of death from hypothermia and pedestrian-motor vehicle crashes in this population.

Accidents, Traffic↗

American travel deaths in Mexico. Causes and prevention strategies.

About 3 to 4 million Americans travel to Mexico every year, yet their mortality experience has never been analyzed. Fatalities among US travelers to Mexico during the years 1975 and 1984 were examined using a previously unanalyzed data source. The leading cause of death to all US travelers to Mexico was injuries (51%), with 18% of deaths resulting from motor vehicle crashes. Of all travelers' deaths, 37% were due to circulatory diseases and less than 1% were due to infectious diseases. While the proportion of all deaths from motor vehicle crashes was similar for US citizens traveling in Mexico and US residents, travelers had significantly higher proportions of injury deaths due to aircraft crashes and drowning. Injury, rather than infectious diseases, appears to pose the greatest risk of death to travelers to Mexico. Physicians and travel clinics need to place greater emphasis on injury prevention when giving advice to clients traveling to Mexico.

Accidents, Traffic↗

Microsatellite and mitochondrial DNA analyses of the genetic structure of blacktip shark (Carcharhinus limbatus) nurseries in the northwestern Atlantic, Gulf of Mexico, and Caribbean Sea.

Abstract We investigated the genetic structure of blacktip shark (Carcharhinus limbatus) continental nurseries in the northwestern Atlantic Ocean, Gulf of Mexico, and Caribbean Sea using mitochondrial DNA control region sequences and eight nuclear microsatellite loci scored in neonate and young-of-the-year sharks. Significant structure was detected with both markers among nine nurseries (mitochondrial PhiST = 0.350, P < 0.001; nuclear PhiST = 0.007, P < 0.001) and sharks from the northwestern Atlantic, eastern Gulf of Mexico, western Gulf of Mexico, northern Yucatan, and Belize possessed significantly different mitochondrial DNA haplotype frequencies. Microsatellite differentiation was limited to comparisons involving northern Yucatan and Belize sharks with nuclear genetic homogeneity throughout the eastern Gulf of Mexico, western Gulf of Mexico, and northwestern Atlantic. Differences in the magnitude of maternal vs. biparental genetic differentiation support female philopatry to northwestern Atlantic, Gulf of Mexico, and Caribbean Sea natal nursery regions with higher levels of male-mediated gene flow. Philopatry has produced multiple reproductive stocks of this commercially important shark species throughout the range of this study.

Animals↗

A biometric and ecologic comparison between Artemia from Mexico and Chile.

BACKGROUND: A preliminary biometric and ecologic database for the brine shrimp Artemia from Mexico and Chile is presented. The area abounds in small and seasonal ponds and large inland lakes, the latter mainly located in Mexico, although relatively large and isolated lakes are found in complex hydrological settings in pre-high plateau areas of Chile. This paper summarizes research efforts aimed at the localization, characterization, and evaluation of the aquaculture potential of Artemia populations in Mexico and Chile, which exhibit great habitat diversity (ponds, salterns, coastal lagoons, sea arms, coastal and inland lakes), contrasting weather conditions and different levels of isolation and human intervention. RESULTS: This study covered locations between 29 degrees north latitude (Baja California, Mexico) to 50 degrees south latitude (Puerto Natales, Chile). Biological characteristics considered are species name, reproductive mode, cyst diameter, chorion thickness, and nauplius length, whereas ecological data include pond size, pH, salinity, temperature, and water ionic composition. Artemia franciscana is the only species found in Mexico, it exists together with A. persimilis in Chile, though separated geographically. Ecological differences in habitat exist between both regions but also within countries, a pattern particularly clear with regard to water composition. Surprisingly, a Mexican (Cuatro Ciénegas, A. franciscana) and a Chilean location (Torres del Paine, A. persimilis) share habitat characteristics, at least for the period when data were collected. The discriminant analysis for cyst diameter and nauplius length shows that Artemia from only one location match in cyst diameter with those from San Francisco Bay (SFB) (Point Lobos), and one (Marquez) is far apart from SFB and all the others. The Chilean locations (Pampilla, Cejar, Cahuil, Llamara, Yape) share cyst diameter, but tend to differ from SFB. The remaining Mexican locations (Juchitan, Ohuira, Yavaros) are well separated from all the others. With regard to nauplii length, populations tend to distribute in a relatively random manner, being Marquez the location differing the most in cyst diameter from SFB. CONCLUSION: This database will contribute to the knowledge of radiation centers and serves as a baseline for further biogeographic studies, population characterization, management, and monitoring of Artemia biodiversity. Likewise, the impact of colonization and translocations for aquaculture purposes can be better assessed with a baseline for reference. Mexico and Chile exemplify the need to increase and further integrate regional information to tackle fundamental problems underlying practical utilization of Artemia.

Journal Article↗

[Public and private: insurance companies and medical care in Mexico].

During the late 70's and early 80's in Mexico, as in the rest of Latin-America, sanitary policies were directed to support the growth of the private sector of health care at the expense of the public sector. This work analyzes the evolution of the health insurance market as a part of the privatization process of health care. The analysis based on economic data, provides the political profile behind the privatization process as well as the changes in the relations between the State and the health sector. The central hypothesis is that the State promotes and supports the growth of the private market of medical care via a series of legal, fiscal and market procedures. It also discusses the State roll in the legal changes related to the national insurance activity. A comparative analysis is made about the evolution of the insurance industry in Argentina, Brazil, Chile and Mexico during the period 1986-1992, with a particular enfasis in the last country. One of the principal results is that the Premium/GNP and Premium/per capita, display a general growth in the 4 countries. This growth is faster for Mexico for each one) because the privatization process occurred only during the most recent years. For the 1984-1991 period in Mexico the direct premium as percentage of the GNP raised from 0.86% to 1.32%. If one focussed only in the insurance for health and accidents branches the rice goes form 8.84% in 1984 to 19.08% in 1991. This indicates that the insurance industry is one of the main targets of the privatization process of the health care system in Mexico. This is also shown by the State support to fast expansion of the big medical industrial complex of the country. Considering this situation in the continuity of the neoliberal model of Mexico, this will profound the inequity and inequality.

English Abstract↗

Prevalence and predictors of home and automobile smoking bans and child environmental tobacco smoke exposure: a cross-sectional study of U.S.- and Mexico-born Hispanic women with young children.

BACKGROUND: Detrimental effects of environmental tobacco smoke (ETS) exposure on child health are well documented. Because young children's primary exposure to ETS occurs in homes and automobiles, voluntary smoking restrictions can substantially reduce exposure. We assessed the prevalence of home and automobile smoking bans among U.S.- and Mexico-born Hispanics in the southwestern United States, and examined the influence of mother's country of birth and smoking practices on voluntary smoking bans and on child ETS exposure. METHODS: U.S.- and Mexico-born Hispanic mothers of children aged 2 through 12 years were systematically sampled from health clinics in Albuquerque, New Mexico. In-person interviews were conducted with 269 mothers (75.4% response rate) to obtain information on main study outcomes (complete versus no/partial home and automobile smoking bans; child room and automobile ETS exposure) and risk factors (mother's country of birth, maternal and household smoking behaviors). Data were analyzed with chi square tests and logistic regression models. RESULTS: Three-fourths (74-77%) of U.S.-born and 90-95% of Mexico-born mothers reported complete automobile and home smoking bans. In multivariate analyses, mother's U.S nativity, mother's current smoking, and presence of other adult smokers in the home were associated with significantly increased odds of not having a complete home or automobile smoking ban. Mother's smoking was associated with child ETS exposure both indoors (odds ratio [OR] = 3.31) and in automobiles (OR = 2.97). Children of U.S.-born mothers had increased odds of exposure to ETS indoors (OR = 3.24; 95% confidence interval [CI]: 1.37-7.69), but not in automobiles. Having complete smoking bans was associated with substantially reduced odds of child ETS exposure both indoors (OR = 0.10; 95% CI: 0.04-0.27) and in automobiles (OR = 0.14; 95% CI: 0.05-0.36). CONCLUSION: This study of Hispanic mothers in the southwestern U.S. indicates that there are substantial differences between U.S.- and Mexico-born mothers in the prevalence of home and automobile smoking bans, and resulting child ETS exposure. Tobacco interventions to increase smoke-free environments for U.S. Hispanic children should focus on both home and automobile smoking practices, especially among U.S.-born mothers, and utilize strategies that impact smoking practices of all household members.

Adult↗

Preventing and controlling tuberculosis along the U.S.-Mexico border.

Converging factors contribute to elevated tuberculosis (TB) incidence and complicate case management in the U.S. states bordering Mexico. These factors include a) Mexico's higher TB rate; b) low socioeconomic status and limited access to health care in the border area; c) frequent border crossings and travel in the United States for employment, commerce, health services, and leisure; d) language and sociocultural differences; and e) lack of coordinated care across health jurisdictions on both sides of the U.S.-Mexico border. Prevention and control efforts that address the challenges created by border-crossing populations require collaboration among local, state, and national TB control programs in both countries. In June 1999, to facilitate future discussions with Mexican counterparts, CDC convened a meeting of TB control officials from the four U.S. states bordering Mexico (i.e., California, Arizona, New Mexico, and Texas) to address TB prevention and control in the border area. Focus areas included a) surveillance needs, b) case management and therapy completion, c) performance indicators and program evaluation, and d) research needs. Meeting participants' deliberations and resulting proposals for action by CDC and state and local TB control programs are detailed in this report.

Antitubercular Agents↗

Assessment of torture and ill treatment of detainees in Mexico: attitudes and experiences of forensic physicians.

CONTEXT: International and Mexican human rights organizations have documented torture of detainees (ie, those held and indicted but not sentenced) in all 31 states and the Federal District of Mexico, but little is known about the attitudes and experiences of forensic physicians examining detainees. OBJECTIVE: To assess forensic physicians' experiences with and attitudes toward the nature and extent of torture and ill treatment among detainees examined in the previous year. DESIGN, SETTING, AND PARTICIPANTS: With the support of the Mexican Office of the Federal Attorney General, as part of a larger initiative to implement governmental reforms to eradicate torture in Mexico, an anonymous, self-administered, written, 80-item survey designed to assess correspondence of physician practices and attitudes with international standards on forensic investigation and documentation of torture was distributed to all federal forensic physicians (n = 115) and a convenience sample of state forensic physicians (n = 99) in Mexico in 2002. MAIN OUTCOME MEASURES: Estimates of the numbers of federal detainees medically evaluated and numbers of cases of suspected, alleged, and documented torture or ill treatment among federal detainees; factors interfering with documentation of forensic evidence; physicians' attitudes toward torture; measures that would help them document torture; and recommendations for reform. RESULTS: Survey responses were received from 93 (81%) federal and 91 (92%) state forensic physicians. Forty-nine percent of federal physicians and 58% of state physicians reported that torture is a severe problem for detainees in Mexico. Federal physicians estimated that they had conducted 26 445 to 30 650 or more medical evaluations of the 13 000 federal detainees in the past year and that between 1658 and 4850 of these detainees had alleged torture; these physicians also estimated that they had documented evidence of torture in a range of 285 to 1090 cases. Forty percent of respondents had suspected torture and/or ill treatment of detainees examined during the previous year, 64% had examined detainees who alleged these practices had occurred, and 49% had documented forensic evidence of torture among these detainees. Respondents reported that lack of photographic equipment and services (58%), inadequate monitoring and accuracy of medical examinations (36%), inadequate documentation of torture (29%), limitations in their training (28%), fear of reprisals for documenting torture (23%), and fear of coercion by police officials (18%) are factors that interfere with documentation of torture and ill treatment of detainees. Respondents further reported the need for additional training (98%), standardized protocols and documentation procedures for use in cases of alleged or suspected torture and/or ill treatment (81%), and monitoring to ensure the quality and accuracy of medical evaluations (95%). CONCLUSIONS: Torture and ill treatment of detainees is a major problem in Mexico facilitated by multiple medical and legal factors. Mexican forensic physicians support measures to improve forensic documentation of torture and ill treatment of detainees.

Attitude of Health Personnel↗

Year 2000 status of MRI in Mexico.

The development of clinical magnetic resonance imaging in Mexico has followed a different course from that in the U.S. and Europe. The first clinical unit was installed in Mexico in the late 1980s at the very beginning of clinical applications worldwide. Since then, installations have proceeded at a sedate pace that now brings the installed total to 66 imagers. The largest fraction of these units (28, or 42%) is in Mexico City, with a broad distribution across the remaining 23 Mexican states. There is a noticeable increase of the number of units (20, or 30%) in the states bordering the U.S., while the states bordering nations to the south have no units. More than half the units (38, or 58%) are 0.5 T units, while a further 35% are 1.0 T or higher. Slower addition of units in Mexico relative to the U.S. is attributed to the higher fraction of public-funded hospitals and the inherent conservatism of such institutions when considering new technologies. Present public planning for health care development suggests that the coming decade will see more rapid installation of units to meet growing demand in Mexico for the latest medical technology. Experience over the past two decades indicates the need for more systematic training of technical and clinical personnel to implement these additions. The National University (Universidad Nacional Autónoma de México (UNAM) and the Metropolitan University (Universidad Autónoma Metropolitana (UAM) are collaborating with diverse clinical facilities to create such a program. J. Magn. Reson. Imaging 2001;13:813-817.

Developing Countries↗

Environmental lead in Mexico.

From the data presented here, it can be concluded that environmental exposure to lead is a particularly severe problem in Mexico. As has been shown, there are very important sources of exposure to this metal: (a) for rural populations who manufacture and/or utilize lead-glazed pottery, (b) for urban populations who are exposed to high air lead concentrations due to the continued use of lead fuel additives, (c) for workers of several industries, mainly those of batteries and pigments, (d) for consumers who routinely eat canned foods such as hot peppers and fruit products, and (e) for the general population living in the vicinity of smelters, refineries and other industries that emit lead. Therefore, in Mexico only those native populations living in very primitive communities, far away from all civilized life, could be expected to be free from this exposure. At the same time, and despite the relatively few data available, it can be stated that the exposure to lead of populations in Mexico could be approaching levels that might be highly hazardous, in particular for the neuropsychological health of children. Regarding the presence of lead in the environment, despite the fact that the available studies are not enough, it is evident that pollution by this metal is widespread and that there is a serious lack of studies for most regions of the country, including several that might be expected to be highly polluted. At the same time, it is evident that the official attention paid to the problem, either in regulations, support of further studies, or implementation of effective control measures has been far from the level needed according to the available data. Lead in gasoline is still used at very high concentrations in all the country, with the exception of Mexico City and its surrounding area, while no studies have been carried out to determine the potential health and environmental impact of this practice in regions outside Mexico City. Despite the fact that the Torreón smelter is one of the largest in Latin America, and although it is located less than two km from downtown Torreón, with the predominant winds blowing in the direction from the smelter towards the residential and central areas of the city, no large scale study has been carried out on the impact of this source on the health of its residents.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Differential attraction of Heliothis subflexa males to synthetic pheromone lures in Eastern US and Western Mexico.

The mate attraction signal of Heliothis subflexa (Hs) females consists of a multicomponent sex pheromone blend. In this study, we assessed the intraspecific importance of three groups of compounds found in Hs pheromone glands: three acetate esters (Z7-16:OAc, Z9-16:OAc, and Z11-16:OAc), two 14-carbon aldehydes (14:Ald and Z9-14:Ald), and one 16-carbon alcohol (Z11-16:OH). Because the relative importance of pheromone components may vary in different regions, we conducted experiments in Eastern US (North Carolina) and Western Mexico (Jalisco). Our experiments in Eastern US showed that when the acetates were omitted from a 7-component blend in rubber septa, fewer males were caught in cone traps. Subsequent experiments conducted both in Eastern US and Western Mexico indicated that the addition of Z9-16:OAc alone does not increase attraction of male Hs, while Z11-16:OAc does. The Hs male response to Z7-16:OAc differed between the two regions. In Eastern US, significantly more males were attracted to a minimal three-component blend to which Z7-16:OAc was added, but this was not the case in Western Mexico. The two 14-carbon aldehydes also showed differential attraction between the two regions. 14:Ald and Z9-14:Ald appeared not to play any role in the sexual communication of Hs in Eastern US, but reduced trap catches in Western Mexico. The alcohol Z11-16:OH was tested in two concurrent dose-response studies with Hs males in Western Mexico, one using a minimal blend and one using a complete blend. The minimal three-component blend provided a more discriminating tool for delineating dose-response effects of Z11-16:OH than the seven-component blend. In the minimal blend, the optimal dose of Z11-16:OH was 1%, while in the complete blend similar numbers of males were caught when the alcohol ranged from 1 to 25%.

Acetates↗

Performance of semiquantitative food frequency questionnaires in international comparisons. Mexico City versus San Antonio, Texas.

International dietary comparisons present a number of methodologic difficulties. We developed two semiquantitative food frequency questionnaires for use in Mexico City and San Antonio, Texas. The Mexico City questionnaire contained 85 food items and the San Antonio questionnaire contained 108. Thirty-six items were common to both questionnaires. The questionnaires were administered to 128 Mexican Americans, 35 to 64 years old, residing in a low-income barrio neighborhood of San Antonio and to 644 similarly aged Mexicans residing in a low-income "colonia" of Mexico City. Major differences in fat and carbohydrate intake as a percent of total kilocalories were observed between the two study groups, with Mexico City residents consuming approximately 18 to 21% of calories from fat and 68 to 72% from carbohydrate compared to 29 to 33% from fat and 48 to 52% from carbohydrate for Mexican Americans from San Antonio. Both of these differences were highly statistically significant (P < 0.001). A number of arguments support the validity of these findings. First, the distribution of high- and low-fat foods was similar on both questionnaires. Also, of the top-ten foods (as contributors to total kilocalorie intake) in San Antonio, seven were high in fat (> 30% of kilocalories), whereas this was true of only three of the top-ten foods in Mexico City.

Adult↗

When half of the population died: the epidemic of hemorrhagic fevers of 1576 in Mexico.

During the 16th century, Mexico suffered a demographic catastrophe with few parallels in world's history. In 1519, the year of the arrival of the Spaniards, the population in Mexico was estimated to be between 15 and 30 million inhabitants. Eighty-one years later, in 1600, only two million remained. Epidemics (smallpox, measles, mumps), together with war, and famine have been considered to be the main causes of this enormous population loss. However, re-evaluation of historical data suggests that approximately 60-70% of the death toll was caused by a series of epidemics of hemorrhagic fevers of unknown origin. In order to estimate the impact of the 1576 epidemic of hemorrhagic fevers on the population we analyzed the historical record and data from the 1570 and 1580 censuses of 157 districts. The results identified several remarkable aspects of this epidemic: First, overall, the population loss for these 157 districts was 51.36%. Second, there was a clear ethnic preference of the disease, the Spanish population was minimally affected whereas native population had high mortality rate. Third, the outbreak originated in the valleys of central Mexico whence it evolved as an expansive wave. Fourth, a positive correlation between altitude and mortality in central Mexico was found. Fifth, a specific climatic sequence of events was associated with the initiation and dissemination of the hemorrhagic fevers. Although the last epidemic of hemorrhagic fevers in Mexico ended in 1815, many questions remain to be answered. Perhaps the most relevant ones are whether there is a possible reemergence of the hemorrhagic fevers and how vulnerable we are to the disease.

Disease Outbreaks↗

Discrimination between epidemiological cycles of rabies in Mexico.

BACKGROUND: The design of efficient rabies control programs within a geographic area requires an appropriate knowledge of the local epidemiological cycles. In Latin America, there is a geographical overlap of the two main epidemiological cycles: (a) the terrestrial cycle, where the dog is the main terrestrial vector and the principal cause of human transmission; and (b) the aerial cycle, in which the vampire bat Desmodus rotundus is representative in Mexico. This bat is the major sylvatic rabies vector transmitting rabies to cattle. The purpose of this study was to distinguish between the epidemiological cycles of rabies virus (aerial and terrestrial) circulating in Mexico, using restriction fragment length polymorphism (RFLP). METHODS: Thirty positive rabies isolates were obtained from different species (including humans, domestic, and wildlife animals) and geographical regions. The methodology included the extraction of RNA, and synthesis of cDNA, PCR, and RFLP using four restriction endonucleases. To determine the aerial cycle, BsaW I and BsrG I were utilized, and for terrestrial cycle, BamH I and Stu I. Most of the samples belonged to the aerial and terrestrial cycles, except for two skunk isolates from Northwestern Mexico, which were not cut by any of the enzymes. RESULTS: Three different migration patterns were detected: (a) the first was observed in six amplicons, which were cut by BsaW I and BsrG I (aerial cycle); (b) 19 amplified samples were digested with BamH I and Stu I enzymes (terrestrial cycle); and (c) two skunk isolates from Northwest Mexico, were not cut by any of the enzymes utilized in the experiments (hypervariable cycle). CONCLUSIONS: This concludes that RFLP can be used for the classification of rabies field samples in epidemiological studies. Moreover, it has demonstrated its usefulness, not only for differentiating between the main epidemiological rabies cycles present in Mexico, but also to detect new cycles in wildlife species.

Animals↗

Geography of diabetes mellitus mortality in Mexico: an epidemiologic transition analysis.

BACKGROUND: The worldwide prevalence of diabetes mellitus (DM) will increase from 135 to 300 million cases by the year 2025. In Mexico, DM is the third cause of general mortality and the primary cause of mortality in the 55- to 64-year-old age group. The purpose of this study was to analyze the characteristics of DM mortality trends in Mexico from 1980 to 2000 in the context of this epidemiologic transition. METHODS: Age-adjusted mortality rates were estimated for DM as underlying cause of death using World Health Organization (WHO) reference population. To evaluate magnitude of risks, standardized mortality ratio (SMR) was calculated; prematurity of mortality was evaluated by means of potential lost life years index (PLLYI). Diabetes mortality trends in the U.S. were calculated with information from the Centers for Disease Control (CDC) public registry and were age-adjusted for comparison. RESULTS: Total number of deaths due to DM during the period was 582,826. Standardized mortality ratio by state showed higher mortality in the northern Mexican states; PLLYI was higher in the northern states. Mortality trends in Mexico showed a rapid increase during the 1980s followed by a less acute increment in the 1990s. Age-adjusted mortality rate trends in the U.S. were lower than those in Mexico. CONCLUSIONS: This study shows an increase in DM age-adjusted mortality trends during the years 1980-2000 in Mexico. The observed pattern of mortality varies widely throughout the country, probably due to differences in socioeconomic conditions and in access to healthcare.

Cause of Death↗