Search

In 2014 the Mexican government implemented taxes to reduce the consumption of sugar-sweetened beverages and nonessential energy-dense foods. In this manuscript, we analyze the scientific evidence linking the consumption of these products to chronic diseases, and summarize the studies that have evaluated the observed and expected impact of food taxes in Mexico. The implementation of taxes to unhealthy foods has reduced purchases of sugar-sweetened beverages in 7.6% and nonessential energy-dense foods in 7.4%. A reduction in consumption could decrease obesity prevalence by 2.5%; prevent 20 000 cardiovascular disease events; 189 000 diabetes cases; and 20 000 cardiovascular deaths. Additionally, this impact could save nearly 1 173 million dollars from healthcare costs. Taxes to unhealthy foods should be strengthened up and remain as an integral part of the national strategy to reduce obesity and chronic diseases in Mexico., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Objective: The objective of this study was to determine the application of gender perspective in public health papers in four journals published by the Mexican National Health Institutes., Material and Methods: A total of 999 papers published in the four journals between 2000 and 2003 was reviewed. Two levels of analysis were considered: (a) data presented by sex, providing description of differences between women and men, and (b) the analysis of these differences from gender perspective., Results: One quarter (25.4%) of the articles described results by sex. The largest percentage was published in Salud Pública de México (48.8%) and the smallest in Revista de Investigación Clínica (16.1%). Gender perspective was used in only 4.2% of papers; of these, drug addictions, health behaviour and violence were the topics that occurred most frequently., Conclusions: This is the first study to assess the application of gender perspective in Mexican health articles. Similarly to other countries, a very small percentage of authors analyzed sex differences, and a smaller proportion applied gender perspective. Results demonstrate the importance of promoting interdisciplinary research that may promote the elucidation of health inequalities between men and women.

AIDS and human rights are closely related issues. This paper describes the relationship between AIDS and human rights, the impact and consequences of discrimination and the importance of the defense of human rights as a cornerstone strategy in AIDS prevention. Some general ethical aspects are addressed and two dilemmas which have been raised by the epidemic are discussed: the apparent conflict between individual and community rights and the reactions of intolerance and repression from those who claim that only through coercive strategies will the epidemic be brought under control. Specific problems in Mexico are described based on data collected at CONASIDA's Human Rights Department between 1992 and 1994. Finally some conclusions are stated emphasizing that, in the AIDS epidemic, the defense of human rights is the cornerstone of any public health strategy.

This paper discusses the situation of healthcare in Mesoamerica before and immediately after 1519. In the first 50 years after the Conquest, the Spaniards made extensive use of Nahuatl medicine. However, the influence of this medical tradition was limited due to the rapid imposition of a very different medical system which took little advantage of, among other things, the therapeutic wealth of pre-Hispanic healing traditions., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Objective: To describe the methodological design of the National Health and Nutrition Survey in localities with less than 100 000 inhabitants (Ensanut 100k)., Materials and Methods: The Ensanut 100k is a probabilistic survey that over-represents households with less economic capabilities. This paper describes the scope of the survey, sampling procedures, measurement and inference and logistics organization., Results: 10 461 home interviews and 26 161 individual interviews were obtained. The household response rate was 89 and 92% from individuals., Conclusions: The probabilistic design of the Ensanut 100k allows to make valid statistical inferences about parameters of interest for public health in localities with less than 100 000 inhabitants, localities where 52% of the population lives according to the 2010 census. The comparability of the results with the Ensanut 2012 faci- litates the assessment of the government's support actions to populations with lower economic capacities in the period 2012-2018., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

This paper describes the creation of the legal framework and the origin, growth and consolidation of the institutions and interventions (initiatives, programs and policies) that nourished public health in Mexico in the past century. It also discusses the recent efforts to guarantee universal social protection in health. This quest, which lasted a century, developed through three generations of reform that gave birth to a health system that offers protection against sanitary risks, protection of health care quality and financial protection to all the population in the country., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

In the Mexican health scenario, the hepatitis C virus epidemic is present, along with its comorbidities and premature mortality. Acting immediately will allow its containment in short term with the proper implementation of the current available tools for prevention, diagnosis and highly effective pharmacological therapies. The Coalition for the study of hepatitis C in Mexico has developed a position paper that takes advantage of these containment measures and presents the development of a National program for the detection, timely treatment and follow-up of patients with hepatitis C., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

The Mexican Ministry of Health requested the National Institute of Public Health to constitute a group of independent, free of conflict-of-interest academic experts on front-of-pack labelling (FOP). This group was instructed to created a positioning paper to contribute to the development of a FOP system for industrialized products that offers useful information for purchase decision making. This position paper uses the best available scientific evidence, and recommendations from experts of international organizations. The FOP proposal focuses on the contents of energy, nutrients, ingredients and components that if consumed in excess on the diet, can be harmful to people's health, such as added sugars, sodium, total fat, saturated fat and energy. The academic expert group recommends the implementation of a FOP that provides an easy way to quickly assess the quality of a product. It is essential that this FOP provides direct, simple, visible and easily understandable information., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Objective: To determine the impact of Seguro Popular (SPS) on catastrophic and impoverishing household expenditures and on the financial protection of the Mexican health system., Material and Methods: The propensity score matching (PSM) method was applied to the population affiliated to SPS to determine the program's attributable effect on health expenditure. This analysis uses the National Household Income and Expenditure Survey (ENIGH) during 2004-2012, conducted by Mexico's National Institute of Statistics andGeography (INEGI)., Results: It was found that SPS has a significant effect on reducing the likelihood that households will incur impoverishing expenditures. A negative effect on catastrophic expenditures was also found, but it was not statistically significant., Conclusions: This paper shows the effect that SPS, in particular health insurance, has as an instrument of financial protection. Future studies using longer periods of ENIGH data should analyze the persistence of high out-of-pocket expenditure., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Objective: People with intellectual developmental disorders (IDD) have worse health statuses in comparison with general population. The objective of this paper is to compare access and hospital morbimortality in people with IDD and general population., Material and Methods: We conducted a retrospective cross-sectional analytical study and analyzed data on admissions and discharges between IDD patients and the rest of them, in Ciudad Real, España., Results: Out of 51 325 hospital admissions, 441 (0.9%) belonged to the group of persons with IDD. The IDD group had fewer programmed hospitalization than the general population and fewer surgical interventions. They presented more admissions for mental disorders and respiratory system diseases., Conclusions: The data presented confirm TDI population have different patterns of disease. Furthermore, this study reveal potential difficulties in access to health care in this population.

In this paper we discuss the recent efforts to modernize the School of Public Health of Mexico (ESPM). In the first part we analyze the conditions in which the ESPM operated at the beginning of the 1980s. In part two we describe the changes introduced in the ESPM between 1983 and 1986, up until its incorporation into the National Institute of Public Health (INSP). In part three we discuss the conceptual renovation which built the platform for the new academic programs introduced by the School between 1987 and 1995. In the fourth part we discuss the construction of the new facilities of INSP and the process of moving to the city of Cuernavaca. The main message of this paper is that the transformations witnessed by the ESPM in the final decades of the past century turned it into a true academic institution which uses research as the motor for training of human resources in public health.

Unlike many other Latin American countries Mexico has no coherent and explicit national pharmaceutical policy (NPP). Other national challenges are: high out-of-pocket expenditure on medicines despite the implementation of universal health care coverage through Seguro Popular, high prices of medicines in the private sector in comparison to other countries when adjusted for income level, and the lack of clear strategies to improve safety and efficiency in the use of medicines, in particular interventions aimed at private physicians, pharmacies and consumers. The aim of this paper is to describe the challenges and opportunities to (1) consolidate the processes of formulating, implementing and evaluating NPP, and (2) define the policy content with regard to access and use of medicines.

Objective: This paper focuses on public and private healthcare utilization among dependents living in Mexico of Mexican migrants in California, analyzing the link between remittances and enrollment in Seguro Popular, a social health insurance plan., Materials and Methods: We surveyed 1353 migrants who visited the Mexican consulate of Los Angeles in 2010., Results: 53.9% sent remittances; 72.2% of households receiving remittances used a share of remittances for health care and 74.4% of them were covered by Seguro Popular. The annual median with private health care expenditure was USD 825, compared to USD 293 for public providers. The main predictors remittances utilization for healthcare were having a sick dependent, purchase of prescription drugs, experiencing problems paying for health care and time of U.S. residence., Conclusions: Seguro Popular increases healthcare utilization with public providers, which provides an opportunity to reallocate the use of migrant's remittances for health purposes.

This paper describes a plan for the attention of addictions from a public health perspective; it defines strengths of this perspective and its limitations to face the special challenges that the problem represents for social policies; adopts a wider perspective that includes the integration of health and social issues in measuring policy results having as a main aim the benefit of the person and of the communities with a perspective of the populations well being. It describes the challenge the country faces as producer, route of traffic and rates of consumption, analyzes briefly the evidence of public policies and makes a series of recommendations.

Depression is an important public health problem. It is the fourth cause of disease in the world in terms of lost years of healthy life. In Mexico, it ranks first in terms disability for women and ninth for men. There is a high comorbidity between depression and other mental disorders such as anxiety and substance abuse, as well as other serious and chronic physical conditions (e.g. diabetes, and heart disease). Despite the impact of depressive disorders in the quality of life of the population, there is a large proportion of people who don't get treatment, delaying seeking help and thus don't receive adequate assistance. The aim of this paper is to present an analysis of depression status in the Mexican population from a public health perspective; it includes prevalence and associated factors, gaps in care, characteristics of the use of services and treatments available. The paper concludes with a presentation of the implications for research and mental health policy in Mexico.

Objective: To determine the prevalence of congenital cytomegalovirus infection in newborn infants included in the neonatal screening program coordinated by the State Health Services in San Luis Potosí., Material and Methods: We evaluated the presence of cytomegalovirus in blood samples stored in filter paper., Results: Cytomegalovirus was detected in 10 (0.68%) of the 1,457 samples included in the study. There were no differences in the characteristics of infants with congenital infection compared to those without infection., Conclusions: It is necessary to increase awareness of health professionals regarding the prevalence and impact of congenital cytomegalovirus infection.

Objective: This paper critically examines recent work on qualitative health research (QHR) in Mexico., Material and Methods: A review was conducted of 128 articles published between 2000 and 2009. A literature search was done drawing together a verse of indexes, search engine, data bases and citations, as well as interviewing researchers. A frequency and content analysis was carried out., Results: QHR has expanded significantly, both nationally and internationally, and papers published in public health and social medicine journals. However, several factors impede its consolidation: the institutional, territorial and thematic concentration of studies, the dependency on grounded theory, the selective nature of the research topics and populations; and its marginal scientific impact., Conclusions: QHR has grown in México, but its consolidation faces serious challenges. Several proposals are discussed that could strengthen the field.

The discovery of genes BRCA1 and BRCA2 has led to the introduction of genetic tests more complex every time for the evaluation of the hereditary cancer risk, among others. In the present paper we explore the criteria to decide when to run the testing for the genes, as well as the implications for the treatment of patients who are identified with them.

Since the Salud Mesoamerica 2015 initiative (SM-2015) aim is to improve health and nutrition conditions of those most vulnerable in Mesoamerica, the goal of the evaluation is to generate evidence of the joint effectiveness of a package of interventions designed to improve the health conditions. We propose a mix design for the evaluation, which will allow to know the magnitude of changes attributable to the interventions, as well as the meanings of these changes for the target population, taking into account the specificities of each country. The main axis of this design is a locality panel where information about individuals, households, and health facilities (first and second level) will also be collected. The evaluation design described in this paper was developed between June and December, 2009, and it was integrated during workshops in Cuernavaca (Mexico), Managua (Nicaragua), and San Jose (Costa Rica). The proposed design will allow to generate evidence about the joint effectiveness of the package of interventions proposed for the SM-2015. The success of this design rests on the political commitment of countries and donors.

Breast cancer is a serious threat to the health of women globally and an unrecognized priority in middle-income countries. This paper presents data from Mexico. It shows that breast cancer accounts for more deaths than cervical cancer since 2006. It is the second cause of death among women aged 30 to 54 and affects all socioeconomic groups. Data on detection, although underreported, show 6000 new cases in 1990 and a projected increase to over 16500 per year by 2020. Further, the majority of cases are self-detected and only 10% of all cases are detected in stage I. Mexico s social security systems cover approximately 40 to 45% of the population and include breast cancer treatments. Since 2007 the rest of the population has had the right to breast cancer treatment through Seguro Popular. Despite these entitlements, services are lacking and interventions for early detection, particularly mammography, are very limited. As of 2006 only 22% of women aged 40 to 69 reported having a mammography in the past year. Barriers exist on both the demand and supply sides. Lobbying, education, awareness building and an articulated policy response will be important to ensure extended coverage, access to and acceptance of both treatment and early detection.

Breast Cancer is a significant public health problem associated with epidemiological and demographic transitions that are currently taking place in Mexico. Aging and increased exposure to risk factors are thought to increase breast cancer incidence, having great relevance for the society and health services. Under this scenario, the health system must respond to the growing needs for better breast cancer screening services. In this paper we present an update of breast cancer mortality, general international recommendations for breast cancer screening programs and key aspects of the Mexico Action Program for Breast Cancer Screening and Control 2007-2012. Breast cancer policies are aimed at organizing and increasing the infrastructure to develop a National Program for Detection, Diagnosis and Treatment of Breast Cancer with optimal quality, friendliness and respect for patient's rights.

Objective: To initiate a statewide expanded metabolic screening program in neonates with the purpose of identifying the most common inborn errors of metabolism., Material and Methods: From March 2002 through February 2004, a blood sample was obtained between 24 and 48 hours after delivery from every consecutive child born in public hospitals in Nuevo León. It was spotted on filter paper and analyzed by tandem mass spectrometry for expanded metabolic screening., Results: A total of 42 264 samples were analyzed. Were obtained seven positive results, one for each disorder: homocystinuria, hyperphenylalaninemia, citrulinemia, transient tyrosinemia, 3-methylcrotonyl CoA carboxylase deficiency, 3-hydroxy-3-methylglutaryl CoA deficiency, and classic galactosemia., Conclusions: The estimated incidence of inborn errors of metabolism is 1:5 000, with a false positive rate of 0.22%. The program permitted the identification of metabolic disorders in the newborn, allowing an early intervention and prevention of life-threatening events and permanent neurological damage.

Not always public policies for the advocacy of citizen rights meet their goal, among other things, because between their formulation and their implementation there is a lack of appropriate structures to generate, articulate and execute these policies. This has been the case of Mexico regarding the advocacy of the rights of non smokers. Very few has been achieved in this matter in the past. This article lists some of the potential causes of the lack of implementation of public policies. At the same time, explores the highly dynamic nature of the health care system at the present and towards the future. The magnitude of the challenges faced by the health care system requires concerted actions of many actors, not only from the very health care system but also from outside. Thus, public policies have to be considered not just at the governmental level but at the state level. Therefore, the main argument of this paper is that given the need to respond to complex challenges to protect the health of the population and their rights in a very complex context, there is a need to formulate and implement state policies that require the intervention of the appropriate state structures to make sure that the design and execution leads to the expected achievements. One such structure at the state level, among others, is the General Health Council, an organization established in 1841, that was incorporated within the Mexican Constitution in 1917, depending directly from the President of Mexico as Head of State. This Council has been reinforced to improve its assigned role to better participate, along other state structures, in the formulation and implementation of public policies such as those for the advocacy of citizen rights.

The present paper reflects on utilization of the gender category in food and nutrition studies in Mexico. It highlights women's important role as caretakers of family health and nutrition. Briefly the authors review how women have been analysed in the different food an nutrition surveys; how gender has been effaced in the "mean per capita", and how women have been taken into account only as far as their reproductive role. This paper also outlines the importance of including the gender category and gender approach in food and nutrition studies; in order to clearly visualize the feeding inequities among men and women throughout the stages of the feeding process, i.e. decision, provision, preparation, distribution and intake. Moreover, improved understanding of women's nutrition practices and meanings that foods convey to women is advocated. In the conclusion the absolute need to articulate the gender issue in nutrition, nursing and medical academic curricula is stated.

During the past six years, Mexico has undergone a large-scale transformation of its health system. This paper provides an overview of the main features of the Mexican reform experience. Because of its high degree of social inequality, Mexico is a microcosm of the range of problems that affect countries at all levels of development. Its health system had not kept up with the pressures of the double burden of disease, whereby malnutrition, common infections, and reproductive health problems coexist with non-communicable disease and injury. With half of its population uninsured, Mexico was facing an unacceptable paradox: whereas health is a key factor in the fight against poverty, a large number of families became impoverished by expenditures in health care and drugs. The reform was designed to correct this paradox by introducing a new scheme called Popular Health Insurance (Seguro Popular). This innovative initiative is gradually protecting the 50 million Mexicans, most of them poor, who had until now been excluded from formal social insurance. This paper reports encouraging results in the achievement of the ultimate objective of the reform: universal access to high-quality services with social protection for all.

Despite having achieved an average life expectancy of 75 years, much the same as that of more developed countries, Mexico entered the 21st century with a health system mared by its failure to offer financial protection in health to more than half of its citizens; this was both a result and a cause of the social inequalities that have marked the development process in Mexico. Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance), the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances.

Objective: To describe the prevalence of iron deficiency anemia in the past 66 years among Mexican women on reproductive age, and to analyze the efficacy of interventions implemented for its prevention and control., Material and Methods: Observational and clinical epidemiological studies as well as federal intervention programs published between 1939 and 2005 having original data related to anemia were reviewed using electronic databases (Medline and Artemisa) and manual searches. Keywords were anemia, iron deficiency, women, and Mexico. The quality of clinical trials was evaluated using the Jadad scale. Anemia prevalence tendency was analyzed using a linear regression weighted according to the sample size., Results: Forty-six research studies were included, nine corresponded to clinical trials and four to federal-operative programs. Seventeen papers reported anemia prevalence in non-pregnant women and twenty-three in pregnant women. In the first group, weighted anemia prevalence had decreased from 39.6 to 15.5%, whereas in pregnant women it decreased from 35 to 25%. Of the clinical trials, 55% were considered to be good quality studies., Conclusions: Anemia in women on reproductive age, particularly in pregnant women, is still a public health problem in Mexico. If the current conditions continue, it would take 57 years to eradicate anemia in non-pregnant and 121 years in pregnant women. It is necessary to evaluate intervention policies and conduct consistent studies in order to enable appropriate steps to be taken to control anemia.

Violence against women by partners (VAWP) has been systematically studied in Mexico in the past 15 years. The aim of this paper is to reflect on the contributions on this topic in Mexico. The discussion focuses on the magnitude of this phenomenon, stressing its theoretical, methodological, and technical implications; the relationship between violence and a variety of factors; and the outcomes of VAWP on women themselves. The manuscript features the main contributions from quantitative and qualitative studies.

Objective: The aim of this paper is to describe the main reasons why people consult traditional healers in Mexico City., Material and Methods: The narrative of 16 traditional healers and 22 users of this type of medicine is the main source of information. This study used a qualitative approach. The field work was carried out in two stages. The first phase involved a series of observations with an ethnographic approach. During the second phase, focused interviews were held with selected informants., Results: According to participants, the main reasons for consulting traditional healers were problems with romance and love, family conflicts, economic hardships, stress,tension, nervousness and spiritual distress. These motives cannot be considered diseases in a strict sense; they were all health problems manifested as illnesses that caused suffering and only some of them could be classified as diseases within the biomedical model. People go to traditional healers not only to cure their diseases but also to obtain advice about their personal problems. As a result, traditional medicine becomes an additional option for treating human suffering, not only physical, but moral and psychological as well., Discussion: The information analyzed in this paper indicates that diverse reasons exist which explain not only the survival of traditional medicine, but also its importance in present life,where science and technology have obtained outstanding results, but biomedical medicine has forgotten the complexity of daily human life and the importance of personal attention, compassion, understanding, empathy and the use of the symbolic world to solve the conflicts and health problems characteristic to humanity.

Objective: To document trends in financial protection in the health care system in Mexico between 1992 and 2004, applying a series of indicators that measure catastrophic and impoverishing health spending and the Index of Fairness in Financial Contributions. MATERIALS Y METHODS: This study uses the biannual time series of the Survey of Household Income and Expenditures (ENIGH) spanning the period 1992 to 2004. The methodologies seek to measure the level and distribution of the burden of health care finance on households, and the financial protection offered to them by the health care system. Four indicators are presented: 1) the Index of Fairness in Financial Contributions, 2) the proportion of households with catastrophic health expenditure, 3) the proportion of households with impoverishment due to health spending and 4) the sum of the proportion of households with catastrophic or impoverishing health spending, which is referred to as excessive health spending. The analysis presented in this document is descriptive, leaving for later studies a deeper analysis of causal aspects., Results: The number of families that suffer impoverishment due to health spending increased from 5.2% in 1992, reached a high of 9.9% in 1996, and then gradually declined to 1.8% by 2004. The proportion of households with catastrophic expenses began at 2.8% in 1992, increased to 4.2% in 1998 and then fell to a level of 2.6% in 2004. The improvements from 2000 on are concentrated among the uninsured population, families affiliated to Popular Health Insurance, and households in the poorest two quintiles of the income distribution., Conclusions: The patterns over time in excessive health spending reflect a worsening during periods of economic crisis, post-crisis recovery, and a sustained improvement beginning in the year 2000. The data suggest that part of the reduction in the number of households with excessive health spending is due to the extension of financial protection for Mexican families through the Popular Health Insurance, while another part is associated with a decline in poverty. In addition,this paper documents an important relationship between economic trends and catastrophic and impoverishing health spending, suggesting the importance of financially protecting families through health insurance. Financial protection assists in guaranteeing that when economic crisis--of a country or of a family--coincides with illness, health care payments do not become the cause of a long or permanent period of impoverishment for households.

Objective: This paper first presents the trend of HIV/AIDS expenditures in Mexico between 1997 and 2002. It then compares the allocation and magnitude of such expenditures within the international context and, in particular, how other countries in the region are allocating HIV/AIDS resources., Material and Methods: Since 1997, Mexico has developed and been utilizing a method for systematically and comprehensively analyze national resource and expenditure flows for HIV/AIDS prevention and care; an exhaustive study known as the National AIDS Account. Results. During this five year period, a systematic increase in real expenditures occurred (143% increase in total), most of which was allocated to the purchase of drugs for antiretroviral treatment. Nevertheless, compared with other countries in the region, Mexican expenditures for HIV/AIDS are less biased in their allocation between prevention and treatment., Discussion: Mexico is committed to ensure universal coverage of AIDS treatment while maintaining and even increasing prevention efforts. These activities demand increasing amounts of resources. It is, therefore, important to track how efficiently such resources are being used in order to improve allocation and targeting of health resources.

Objective: To assess the seroprevalence, household risk factors, and entomological indicators, in order to frame control measures in 11 Sanitary Jurisdictions of the state., Material and Methods: This study included 281 towns, 2 526 households, and 9782 individuals. Data were collected using a questionnaire. Blood was obtained in filter paper and a search for triatomines was conducted inside of and around dwellings. Prevalence rates were used to quantify exposure to risk factors and seropositivity. Odds ratios with 95% confidence intervals and Mantel-Haenszel chi-squared tests were obtained. Multivariate analysis was performed with unconditional logistic regression,variables included in the model were those that had a p-value up to 0.20 in the bivariate analysis. The etiologic fraction in the exposed was also obtained., Results: The prevalence of Chagas disease was between 0 and 2.8%. Jurisdictions at a higher risk wereTuxpan, Panuco and Cordoba; Orizaba showed no risk. The main household risk factors were palma/zacate (palm-tree, grass leaves) roof and walls, dirt floor, the presence of the vector, and ventilation., Conclusions: Epidemiological surveillance should emphasize health education, housing improvement, and use of insecticides.

Bacterial meningitis constitutes a significant global public health problem. In particular, Neisseria meningitidis continues to be a public health problem among human populations in both developed and developing countries. Meningococcal infection is present as an endemic and an epidemic disease. Meningococcal disease is manifested not only as meningitis, but also as meningococcemia. The latter is usually fulminant. The global persistence of N. meningitidis is due to the significant number of carriers and the dynamics of transmission and disease. Approximately 500 million people worldwide are carriers of the bacterium in their nasopharynx. Multiple factors have been identified that predispose to the transmissibility of N. meningitidis, including active or passive inhalation tobacco smoking, upper viral respiratory tract infections, drought seasons, and overcrowding. These factors explain the frequent occurrence of outbreaks in military barracks, schools, prisons, and dormitories. Some of the determinants of invasiveness of the bacteria include nasopharyngeal mucosal damage in colonized individuals, virulence of the strains, absence of bactericidal antibodies, and deficiencies of the complement system. During both endemic and epidemic scenarios of meningococcal disease, control measures should include treating the cases with appropriate antimicrobial therapy (penicillin, ceftriaxone, or chloramphenicol); providing chemoprophylactic drugs to contacts (rifampin or ciprofloxacin), and close observation of contacts. Nevertheless, the key to effective control and prevention of meningococcal disease is immunoprophylaxis. Available vaccines include the polysaccharide monovalent, bivalent (serogroups A, C), or tetravalent (A, C, Y, W-135 serogroups) vaccines; conjugate vaccine (serogroup C); and the combined vaccine with outer membrane proteins and polysaccharide (serogroups B, C). Due to a recent increase in case reporting of serogroup C N. meningitidis in Mexico, we have developed a national response strategy that includes availability of vaccines and medications for chemoprophylaxis. This review aims at providing health care workers with updated information regarding the epidemiological, clinical, and preventive aspects of meningococcal disease. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objective: To assess the equity and fairness of the Mexican health system reform that occurred in the late 1990's., Material and Methods: The Mexican reform process was evaluated using the benchmark-system designed by Daniels et al. This benchmark system was adapted to the Mexican setting by adding specific indicators. A documentary review of the Mexican reform process was conducted to score its performance for each benchmark., Results: Except for housing and nutrition components, the reform included few actions related to health determinants. For health care, the main reform initiatives were those related to extending the coverage of essential health services and decentralizing health care provision to the states. Reform initiatives included few activities related to fair financing, tiering, emphasis on second and third level care, accountability, and transparency., Conclusions: The late nineties reform of the Mexican health system had some positive effect on access of the poor to health care and administrative efficiency, but little impact on fair financing, quality of care, and democratic governance. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objective: To identify the changes brought about by various national and international factors in an intercultural hospital of the municipality of Cuetzalán, Puebla., Material and Methods: A case study was conducted during 2000 and 2001 in two Intercultural Hospitals of Mexico; the Cuetzalán Hospital in Puebla and the Jesús María Hospital in Nayarit State. Data were collected by means of 72 semi-structured interviews with allopathic therapists, indigenous therapists, and authorities of the different health care levels. Moreover, documental research was carried out on national policies for indigenous peoples as well as on indigenist policies. These policies were related with the five organizational stages of the hospital. State authorities gave their permission and interviewees signed informed consent., Results: The hospital was created in 1958 by the Ministry of Health as a biomedical institution, in agreement with the integrationist indigenist policies going on at the time. It remained so during the beginning of the administration by the National Indigenist Institute. In 1990, the new participative indigenist policy trends and the creativity and sensitivity of some authorities, under the influence of international strategies, helped to transform the hospital into an Intercultural Hospital (offering both types of medicine, indigenous and allopathic) with regional coverage. In 2000, the devolution of the hospital to the State Ministry of Health, based on financial rather than socio-cultural considerations, caused the temporary loss of its intercultural character. The last stage as an Integral Hospital with Traditional Medicine (from 2003 onwards) was due to a combination of state official initiatives and the new political stance acquired by the Mexican indigenous movement. The hospital is now part of a regional project of five such hospitals officially denominated Integral Hospitals with Traditional Medicine, to be financed by the Puebla-Panama Plan of regional development., Conclusions: Our results confirmed that health organizations follow a historical process in which selected national and international forces open opportunities to promote intercultural health models that respond to the needs of indigenous populations. Despite the formerly held belief that traditional and scientific medicines were incompatible, this study demonstrates the viability of intercultural health care models that may become a real possibility in the country, based on new conventions to establish alternative and intercultural health services, thereby setting an example for other regions and countries. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objective: To estimate the prevalence of early onset depression in the Mexican population and compare its natural history, comorbidity and treatment latency between early onset and adult onset depression., Material and Methods: The National Survey of Psychiatric Epidemiology (ENEP) is representative of the Mexican urban population aged 18 to 65. The diagnostic instrument is the Composite International Diagnostic Interview (CIDI). Statistical analysis was performed with descriptive and logistic regression analyses, considering the multistage, stratified and weighted sample design of the survey., Results: Two percent of the Mexican population has suffered from depression as children or adolescents, with an average 7 episodes during their lifetime (compared with 3 episodes for adult onset); the first episode lasted a mean of 31 months (compared with 16 for adult onset) and generally did not receive any treatment., Conclusions: The longer duration of the first episode and the greater number of lifetime episodes for subjects with early onset is attributed to the lack of early detection and of timely treatment of depression in Mexican youth. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objective: To compare the cost of maternal and child health care (current model) to that of the WHO Mother-Baby Package if it were implemented., Material and Methods: A pilot cross-sectional case study was conducted in September 2001 in Sanitary District No. III, Morelos State, Mexico. Two rural health centers, an urban health center, and a general hospital, all managed by the Ministry of Health, were selected for the study. The Mother-Baby Package Costing Spreadsheet was used to estimate the total cost and cost per intervention for the current model and for the Mother-Baby Package model., Results: The total cost of the Mother-Baby Package was twice the cost of the current model. Of the 18 interventions evaluated, the highest proportion of total costs corresponded to antenatal care and normal delivery. Personnel costs represented more than half of the total costs., Conclusions: The Mother-Baby Package Costing Spreadsheet is a practical tool to estimate and compare costs and is useful to guide the distribution of financial resources allocated to maternal and child healthcare. However, this model has limited application unless it is adapted to the structure of each healthcare system. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objective: To present the results of the application of the short format 36 instrument (SF-36) in the Mexican states of Sonora and Oaxaca. The levels of quality of life were compared with those from Canada and the United States., Material and Methods: The data were obtained using a survey on health service access, usage, and quality. The SF-36 is composed of 36 questions, which represent eight different domains on the health-related quality of life. These domains are used to estimate the physical and mental components of health. Data analysis was performed to calculate the average scores for each domain for the total sample, by gender and age groups in each state. The regional differences were assessed by the difference of means., Results: The total response was 98.5% of the 4200 selected households. The percent response values were similar between the two states. A total of 5961 subjects older than 25 years of age completed the questionnaire. Males scored higher than females in all domains and in both components. Regardless of sex, the highest variation was observed in adults up to 64 years of age mainly in three domains: overall health, social function, and mental health; in the 65-74 year age group occurred mostly in social function and mental health; and in adults older than 75 year only in mental health. The young adult age group (25 to 44 years) showed variation in a greater number of domains, while women exhibited more variation in the "extreme" age groups, 25 to 34 years and 75 years and older. The mean scores in our sample were higher than those found in Canada and the United States in five domains and in the two summary components. Canada showed higher scores in the other three domains (overall health, social function, and mental health)., Conclusions: SF-36 data are not available at the national level; hence, the authors recommend that their study results may serve as the normative reference for SF-36 in Mexico. Researchers using the SF-36 could compare their results with our reference, adjusted by gender and age in population-based studies. Considering that the study regions have contrasting social and economic characteristics, the data from the more developed state, Sonora, may be used as the normative standard. Data from Oaxaca would be used as the reference for less-developed states. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objective: To assess the differences in the prevalence of muscarinic and nicotinic type symptoms and the level of erythrocytic cholinesterase, prior to pesticide exposure, in male and female migrant agricultural workers., Material and Methods: A cross-sectional study was carried out in 2001 in Sinaloa State, Mexico, among 488 migrant workers. A questionnaire was applied and erythrocytic cholinesterase levels were measured before the beginning of the agricultural season. The differences by sex were compared using the "t" test for continuous variables and chi2 test for categorical variables. Prevalence odds ratios were also estimated. Statistical significance was assessed using p-values <0.05 and 95% confidence intervals., Results: Significant differences were found by age, migration type, place of origin, education, and migration time (p=0.000). Women were six times more likely to have anemia and asthma, twice more likely to have parasites and respiratory and gastrointestinal diseases and 38% more likely to suffer from heart disease. They were also at greater prevalence in thirteen of nineteen investigated symptoms. The average cholinesterase level was within normal limits (4.22 U/ml+/-0.77) and it was similar to the levels reported using the Magnotti method., Conclusions: The prevalence of symptoms, illnesses and cholinesterase levels found in this study may serve as baseline values for future comparisons of the health effects of pesticide exposure. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objective: To identify factors associated with utilization of breast clinical examination (BCE) and their relationship with institutional medical practice., Material and Methods: This is a qualitative study conducted between 1996 and 1997 in medical units of Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) and Secretaria de Salud (Ministry of Health). Eight focus groups were included: four groups of female users and four groups of health professionals; in total, 47 users and 29 physicians and nurses participated. Interpretations of information were based on the organizational ability to respond to the user's expectations, "ability/knowledge" within the organization and the institutional medical practice, at the light of the Grounded Theory., Results: Service demand was conditioned on the perception of poor quality of care, lack of trust in physicians, and organizational aspects. When providing care, male physicians were not interested and felt uneasy about performing the BCE. Female physicians seemed more interested and were well accepted by users., Conclusions: Psychological, cultural, social, and institutional barriers exist in the access and utilization of BCE. Identifying these barriers and their origins could support the development of actions to improve the physician-patient relationship. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objective: To identify the factors associated with complaints of patients against physicians who work at general hospitals of the Mexican Institute of Social Security (MISS)., Material and Methods: All the medical complaint files in a three-year period at the nine general hospitals of Mexico State MISS East District were examined. For each complaint filed, two control files were selected from the same hospital and clinical area. Associations were assessed using odds ratios and logistic regression., Results: A total of 130 complaint cases and 260 controls were included. Seven out of 14 risk factors were selected: complications during hospitalization (OR 2.8, 95% CI 1.3-5.8), diagnostic error (OR 3.18, 95% CI 1.7-5.6), use of diagnostic tests (OR 3.7, 95% CI 1.2-11.3), insufficient information given by physicians (OR 2.64, 95% CI 1.22-5.7), voluntary hospital discharge (OR 7.2, 95% CI 2.22-23.6), lack of clinical monitoring during hospitalization (OR 19.12, 95% CI 2.25-162.6), and multiple vaginal revisions during labor (OR 5.17, 95% CI 1.5 17.07). Complaints were filed more often when there was a poor patient-physician relationship, deficient monitoring during labor, therapeutic error, and delay in surgery. Statistical significance was not attained., Conclusions: Complaints against Mexico State MISS hospital physicians were associated with diagnostic technical factors, as well as with the patients' perception of receiving deficient information and care during hospitalization. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objective: To describe a nosocomial outbreak of scabies occurred in August 1999, resulting from exposure to an undiagnosed Norwegian scabies case, in Mexico City., Material and Methods: After reviewing the index case, we isolated the patient and identified secondary scabies cases among employees working in the affected ward, their relatives, and inpatients. Only individuals complaining from skin lesions and pruritus were included as infested cases. Control measures as contact isolation, proper handling of contaminated clothes, and topical treatment were implemented., Results: A patient with AIDS (index case) with a severe water and electrolyte imbalance was admitted to the Hospital de Infectologia (Infectious Diseases Hospital) of the Centro Medico Nacional La Raza (La Raza National Medical Center) in Mexico City from July 19 to August 20, 1999. Twenty-eight days after the index case admission, scabies cases occurred among health workers. Norwegian scabies was suspected and confirmed by microscopic evidence of the mites on a specimen of scabs from the index case. We identified 48 secondary cases with clinical scabies: 71% health workers, mainly nurses (79%); 23% health workers' relatives; and 6% inpatients. The mean incubation period was 15 days (range 12 to 27). Skin rashes commonly involved the upper extremities (60%) but not the hands., Conclusions: This paper highlights the difficulties in diagnosing Norwegian scabies in an immunosuppressed host, as well as the importance of ensuring that health workers follow standard precautions at all times. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objective: To assess the potential under-registration of work-related accidents in the Mexican Institute of Social Security., Material and Methods: A countrywide cross-sectional study was carried out with information collected from 27 district offices of the Mexican Institute of Social Security (MISS), on workers seen at MISS emergency rooms during November 2001 because of a probable accident at work. We compared these reports to official records of work-related accidents to estimate the proportion of incomplete reports. Data analysis consisted of descriptive statistics for each variable; the annual estimation of incomplete reporting proportions was made by multiplying by twelve months; 95% confidence intervals were estimated using Poisson's exact method for a proportion., Results: Data from 27 out of 37 MISS district offices revealed that 7211 cases were not recognized as work accidents, accounting for an underestimation of 26.3%, ranging between 0 and 68% among the different district offices. The accidents that were most frequently left unregistered were mild and blunt injuries., Conclusions: Under-registration can affect worker compensation plans and the financial balance of the institution's occupational risk insurance. Research is needed to investigate and eliminate the causes of under-registration. Employers, the industry, and health institutions should be involved in this effort. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objective: The objective of this study was to validate, in Mexico, the French coping scale "Echelle Toulousaine de Coping"., Material and Methods: In the fall of 2001, the scale questionnaire was applied to 209 subjects living in different areas of Mexico, exposed to five different types of extreme natural or industrial risks. The discriminatory capacity of the items, as well as the factorial structure and internal consistency of the scale, were analyzed using Mann-Whitney's U test, principal components factorial analysis, and Cronbach's alpha., Results: The final scale was composed of 26 items forming two groups: active coping and passive coping. Internal consistency of the instrument was high, both in the total sample and in the subsample of natural and industrial risks., Conclusions: The coping scale is reliable and valid for the Mexican population. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Objective: To assess the satisfaction level attained by prenatal care users in primary health services in Mexico, and to compare the level of satisfaction according to characteristics of the provider and the service., Material and Methods: A cross-sectional survey was conducted to analyze data from 217 care provider-user pairs. Interviews were carried out in 95 primary care units in eight Mexican states. The information was collected through a) direct observation of the medical encounter, b) interviews with providers and users, and c) a questionnaire and knowledge examination to providers. Users' satisfaction was analyzed according to providers' clinical ability and the treatment received during the visit. Summary and dispersion measures of the main issues were calculated, as well as bivariate and trends analysis., Results: User satisfaction in prenatal care is associated with the treatment received during the visit and to the waiting time before being attended, but not with the provider's clinical ability, nor with his or her age or gender. The treatment received during the visit was also associated with the user's socioeconomic level, where the poorer users received the worst treatment., Conclusions: Health services should assess users' satisfaction according with the type of medical encounter, particularly where resources are scarce and where economic disparities are present. In such cases, the provision of healthcare services may intensify inequality, with greater impact on the poorest. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Objective: To determine the ultraviolet radiation dose received by children and adolescents at elementary, middle, or high school., Material and Methods: A cohort study was conducted in the City of San Luis Potosí between May 2001 and April 2002. The study population consisted of 80 school male and female children, selected at random, aged 6 to 19 years of age. The dose was quantitated during an entire schoolyear by recording the time each student was exposed to sunlight. Ultraviolet radiation was simultaneously monitored with terrestrial radiometry equipment. Holidays and weekends were excluded. Data were analyzed using univariate analysis and comparative analysis by sex and months of exposure. A regression model was fit to explain the dose of solar exposure., Results: The erythemally weighted UV dose for Mexican schoolchildren averaged 16,456 J/m2/year. Differences by gender were found: 14,264 J/m2/year in females vs. 18,648 J/m2/year in males (Kolmogorov-Smirnov, p = 0.003). No significant differences were found among groups. Significant differences were found among months of exposure (Kruskal-Wallis, p = < 0.0001). Stepwise regression models were fit to find the best model, using generalized linear modeling and the Akaike information criterion, to explain the radiation dose according to month of exposure; the final equation was 587.20 + 438.45(gender)0.16(month)-49.65(month2). The results showed higher radiation doses between March and September., Conclusions: A theoretical framework is advanced to formulate policies aimed at protecting children in Mexican schools from solar overexposure. Implementing prevention measures at least during the months of greatest exposure (March to June) is in order since 51% of the annual ultraviolet radiation dose is received in this period. By avoiding exposure 8 minutes daily, the radiation dose could be decreased in 39,495 J/m2, which is the dose accumulated in two years. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Objective: To asses the affective, cognitive, and behavioral attitudes of healthcare providers at the Mexican Institute of Social Security (MISS) in Morelos, Mexico; to identify the institutional and medical practice barriers that hinder screening and reference of battered women., Material and Methods: A cross-sectional study was conducted between September and December 1999. A self-administered questionnaire was applied to 269 general practitioners, specialists, and pre- and postdoctoral students working in 30 primary and secondary level of healthcare units in Morelos State. The data collection instrument was designed to assess healthcare providers' knowledge of and attitudes towards domestic violence during medical office visits. A knowledge index was constructed and analyzed using multivariate regression methods., Results: Ninety percent of healthcare providers had never received training on violence against women. Healthcare providers' affective and cognitive attitudes after receiving training on the subject matter were more favorable compared to those with no training. Favorable attitudes were directly related to the number of training sessions. Most participants (63%) showed a moderate degree of knowledge on the subject, whereas 21% were slightly knowledgeable and 16% were highly knowledgeable. Medical personnel with a moderate or high level of knowledge were 2.1 and 6 times more likely, respectively, to have favorable attitudes than those with a low degree of knowledge. Female physicians showed more favorable attitudes towards identifying and referring battered women. Medical personnel interested in further training on the subject of violence against women were 7.6 times more likely to show favorable attitudes than personnel not interested on the subject., Conclusions: Healthcare providers were not sufficiently able to assess and manage battered women. General and family practitioners were more interested in being trained, as compared with specialist physicians. Training on violence against women should be included in graduate medical, nursing, social service, psychology, and other public health areas. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Objective: To isolate and identify the fungi in specimens collected from immunocompromised patients seen in Mexico City hospital, and to assess their association with mycosis., Material and Methods: A total of 268 specimens from 108 patients were processed for mycological study, including direct examination, smears, cultures, and microcultures in specific media, in addition to biochemical tests. Most of the patients had been diagnosed with pulmonary tuberculosis and Acquired Immunodeficiency Syndrome (AIDS)., Results: One hundred and eighty-three yeasts and 66 mycelial fungi were isolated. Forty-five mycoses were diagnosed; the most frequent mycosis was pulmonary candidosis (32 cases). Candida albicans and C parapsilosis were the predominant species associated with mycotic infection. Five Cryptococcus neoformans var. neoformans, one C albidus, three Histoplasma capsulatum and one Geotrichum candidum isolates were associated with mycosis., Conclusions: Of the studied patients, 41.6% showed a mycotic infection, principally associated with AIDS and pulmonary tuberculosis. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Objective: To assess the differences in the blood concentration levels of the thyroid stimulating hormone and their possible use as an indicator of iodine sufficiency, in a sample of Mexican newborns., Material and Methods: A cross-sectional study was conducted from September 1999 to August 2000, among 25,427 Mexican newborns in the Ministry of Health clinics from 5 states. A total of 8,095 heel-prick and 17,332 umbilical cord blood samples were analyzed. Blood samples were collected in filter paper and processed by enzyme-linked immunosorbent assay. The Mann-Whitney U test and the Kruskal-Wallis test were used for statistical analyses., Results: Hyperthyrotropinemia was found in 9.95% of heel samples and in 24.27% of umbilical cord samples (TSH > 5 microUl/ml)., Conclusions: The percentage of hyperthyrotropinemia observed in this study was higher than that expected in a population with sufficient iodine intake; these findings could be due to poor maternal iodine intake.