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Objective. To determine the relative risk of a lethal outcome associated with chronic degenerative conditions in patients with COVID-19. Methods. A cohort study was conducted using electronic medical records belonging to patients who tested positive for COVID-19 on RT-PCR while receiving care as outpatients or inpatients in a social security system facility between March 2020 and March 2021. Two study groups were formed. The exposed group was divided into four subgroups, each of which was diagnosed with one and only one chronic condition (diabetes, hypertension, obesity, or chronic kidney disease); the unexposed group was obtained from the medical records of patients without comorbidities. A total of 1 114 medical records were examined using simple random sampling. Once the minimum sample size was reached, the relative risk was calculated for each chronic condition. Combinations of two, three, and four conditions were created, and each of them was included in the analysis. Results. In the absence of a chronic degenerative condition, the prevalence of a lethal outcome from COVID-19 is 3.8%; in the presence of type 2 diabetes mellitus, 15.8%; in the presence of arterial hypertension, 15.6%; and in the presence of obesity, 15.0%. For diabetes and hypertension combined, the prevalence of a lethal outcome is 54.1%; for diabetes and obesity combined, 36.8%, and for obesity and hypertension combined, 28.1%. Conclusion. In patients with COVID-19, the relative risk of a lethal outcome is 4.17 for those with diabetes, 4.13 for those with hypertension, and 3.96 for those with obesity. For two chronic conditions combined, the relative risk doubles or triples. The relative risk of a lethal outcome is 14.27 for diabetes plus hypertension; 9.73 for diabetes plus obesity, and 7.43 for obesity plus hypertension. Chronic conditions do not present alone; they generally occur together, hence the significance of the relative risks for lethal outcomes presented in this paper. [ABSTRACT FROM AUTHOR]

This paper considers the implications that distinct organizing principles for health systems have for the control of infectious diseases. The paper takes the health systems in Mexico and Cuba as examples of neighboring but widely divergent systems, producing different pubic health outcomes. The paper will look at the dissimilar organizing principles of these two systems, along with their programs and outcomes in relation to five of the most important and dangerous infectious diseases. The paper will then consider what broader lessons might be drawn from the experiences in Cuba and Mexico. Mexico has pursued a federal and neoliberal system, based on tripartite social insurance (State, employer, and employee contributions), private "partnerships" (private-for-profit investment in public services), and competitive service provision (competitive rather than coordinated services). On the other hand, Cuba has maintained a public system, with guaranteed free and universal access, universal patient registration, assignment of all persons to a family doctor, and centralized public coordination of services. How have these two health systems approached tuberculosis, HIV/AIDS, diarrhea, measles, and malaria? In recent decades both countries have made substantial progress in dealing with these five diseases, but Cuba has maintained a superior performance, despite having a lower income per capita and less total Government funding available. This at first seems to contradict the broad international correlation between income levels and health outcomes. It also poses questions for the "pro-poor" policies that the Organization for Economic Cooperation and Development (OECD) (the wealthy countries' club) suggests for developing countries. Those policies emphasize "scaling up resources and private investment," including with competitive service provision and expanded "choice" in health services (1, 2). Important research (3) has demonstrated that general income growth has less correlation with reductions in major categories of mortality and with other major advances in public health than do the education of women and the implementation of appropriate technology. The question of the contribution of other social and organizational factors in reducing mortality and morbidity levels is left open. However, it is well established, for example, that major reductions in maternal mortality are much more strongly linked to the presence of a skilled birth assistant than to expensive facilities or high technology (4). What then of infectious disease? In most poor and developing countries, epidemics of tuberculosis, HIV/AIDS, diarrhea, measles, and malaria are major killers. While highly controlled in most wealthy or "low-mortality" countries, these five diseases each kill many hundreds of thousands of people worldwide every year, as do poor maternal-infant health conditions and nutritional disorders. In 2002, for example, HIV/AIDS killed 2.8 million persons worldwide, tuberculosis 1.6 million, diarrheal diseases 1.8 million, malaria 1.2 million, and measles 760 000 (5). Beyond the bland demands for "broad-based economic growth" (6), how might the organization of health policy be linked to substantial advances in combating these diseases? Most of the serious infectious diseases that affect developing countries are no longer the primary health problems of the more wealthy countries. Nor are infectious diseases the main problems of Mexico and Cuba. In recent years, these two countries have been wrestling with these "preventable" diseases and, to varying degrees, have overcome them. Because of their divergent systems and their differing outcomes with infectious diseases, it seems that a comparative study of Mexico and Cuba might be enlightening. [ABSTRACT FROM AUTHOR]

Objective. To determine the level of stability or change in topic areas published by public health journals in Latin America and the Caribbean, using Keywords: and co-word analysis, in order to support evidence-based research planning. Methods. Keywords: were extracted from papers indexed in Scopus® that were published by the Revista de Salud Pública (RSP; Colombia), the Salud Pública de México (SPM; Mexico), and the Revista Peruana de Medicina Experimental y Salud Pública (RPMESP; Peru) for three periods: 2005 - 2007, 2008 - 2010, and 2011 - 2013. Co-word analysis was used to examine keywords extracted. Textual information was analyzed using centrality measures (inbetweenness and closeness). The hypothesis of stability/change of thematic coverage was tested using the Spearman's rho correlation coefficient. VOSviewer was used to visualize the co-word maps. Results. A moderate level of change in thematic coverage was observed in 2005 - 2010, as evidenced by the correlation coefficients for two of the 3-year periods, 2005 - 2007 and 2008 - 2010: 0.545 for RSP and 0.593 for SPM. However, in 2008 - 2013, more keywords remained constant from one period to the next, given the size of the correlation coefficients for the last 3-year periods: 2008 -- 2010 and 2011 - 2013: 0.727 for RSP and 0.605 for SPM. Conclusion. The research hypothesis was partially accepted given that just two consecutive 3-year periods showed a statistically-significant degree of stability in thematic coverage in public health studies. In that sense, this study provides compelling evidence of the effectiveness of using a combined approach for examining the dynamics of thematic coverage: centrality measures for identifying the main keywords and visual inspection for detecting the structure of textual information. [ABSTRACT FROM AUTHOR]

This paper discusses the gestation process, implementation methodology, and results obtained from the initiative to use e-learning to train human resources for health, six years after the launch of the Virtual Campus of Public Health of the University of Guadalajara (Mexico); the discussion is framed by Pan American Health Organization (PAHO) standards and practices. This is a special report on the work done by the institutional committee of the Virtual Campus in western Mexico to create an Internet portal that follows the guidelines of the strategic model established by Nodo México and PAHO for the Region of the Americas. This Virtual Campus began its activities in 2007, on the basis of the use of free software and institutional collaboration. Since the initial year of implementation of the node, over 500 health professionals have been trained using virtual courses, the node’s educational platform, and a repository of virtual learning resources that are interoperable with other repositories in Mexico and the Region of the Americas. The University of Guadalajara Virtual Campus committee has followed the proposed model as much as possible, thereby achieving most of the goals set in the initial work plan, despite a number of administrative challenges and the difficulty of motivating committee members. [ABSTRACT FROM AUTHOR]

In Ciudad Juarez, Chihuahua, Mexico, morbidity and mortality from injuries have increased alarmingly since 2008. This paper aims to examine the changes in the number of hospital discharges for external injuries recorded during the 2008-2010 period in a hospital in Ciudad Juarez. A descriptive retrospective study conducted at the Ciudad Juarez General Hospital looked at the incidence of external injuries as the reason for hospital discharges during the period under analysis. The average proportion of hospital discharges attributed to external injuries was 27%, with the 25-44-year-old age group being the most affected. More than half of the discharges were for fractures. The incidence rate of hospital discharges attributed to injuries in Ciudad Juarez was almost four times greater than that reported at the national level. [ABSTRACT FROM AUTHOR]

This paper reviews and discusses the main procedures and policies that need to be followed when designing and implementing a binational survey such as the United States of America (U.S.)-Mexico Border Diabetes Prevalence Study that took place between 2001 and 2002. The main objective of the survey was to determine the prevalence of diabetes in the population 18 years of age or older along U.S.-Mexico border counties and municipalities. Several political, administrative, financial, legal, and cultural issues were identified as critical factors that need to be considered when developing and implementing similar binational projects. The lack of understanding of public health practices, implementation of existing policies, legislation, and management procedures in Mexico and the United States may delay or cancel binational research, affecting the working relation of both countries. Many challenges were identified: multiagency/multifunding, ethical/budget clearances, project management, administrative procedures, laboratory procedures, cultural issues, and project communications. Binational projects are complex; they require coordination between agencies and institutions at federal, state, and local levels and between countries and need a political, administrative, bureaucratic, cultural, and language balance. Binational agencies and staff should coordinate these projects for successful implementation. [ABSTRACT FROM AUTHOR]

Objectives. To determine the prevalence of Trypanasoma cruzi antibodies among the population under 18 years of age in the state of Veracruz, Mexico, and to identify risk factors associated with housing conditions and vector presence and distribution. Methods. A cross-sectional, epidemiological study of the population under 18 years of age living in 10 of the 11 health districts of the state of Veracruz, Mexico, from 2000 to 2001. Presence of T. cruzi antibodies was determined by hemagglutination inhibition test (HAl) and enzyme-linked immunosorbent assays (ELISA) of serum samples spotted on filter paper, and confirmed by HAl, ELISA, and indirect immunofluorescence assay (IFA) on serum samples. A questionnaire was administered to determined housing conditions, and entomological indices for triatomines were calculated for both the intra- and peridomiciliary areas. The results were analyzed using bifactorial and multifactorial unconditional logistic regression. Results. Of the 150 individuals presenting an initial reaction, 14 were confirmed positive (5 by HAl, ELISA and IFA; 6 by HAl and ELISA, and 3 by ELISA and IFA), for a total prevalence rate of 0.91% (95% CI: 0.85–0.94). All of the confirmed-positive cases were from five of 14 health districts, with the Tuxpan district having the highest prevalence rate: 5.2% (95%CI: 1.2–9.0). Risk factors included having noticed cracks in the house walls and gaps in the roof. The only species of vector captured was Triotoma dimidiata. The entomologic indices for infestation, colonization, and natural infection were: 10.9%, 50.0%, and 9.0%, respectively. Conclusions. Active, vector-borne transmission of T. cruzi was confirmed in the state of Veracruz, Mexico, with an overall antibody seroprevalence rate of 0.19% among the population under 18 years of age. Seroprevalence rates among this segment of the population, which serves as a sentinel group, should be closely monitored to determine if more stringent methods of vector control and epidemiological surveillance are needed. [ABSTRACT FROM AUTHOR]