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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 strengthen up and remain as an integral part of the national strategy to reduce obesity and chronic diseases in Mexico.

OBJETIVO: Elaborar un diagnóstico sobre la aplicación de la perspectiva de género en el campo de la investigación en salud en cuatro revistas mexicanas de los institutos nacionales de salud. MATERIAL Y MÉTODOS: Se revisaron 999 artículos publicados en cuatro revistas científicas (2000-2003), con dos niveles de análisis: a) desagregación de datos por sexo, que permite describir las diferencias entre mujeres y hombres; y b) análisis de estas diferencias desde la perspectiva de género. RESULTADOS: De los artículos revisados, 25.4% desagregó sus resultados por sexo, de los cuales el mayor porcentaje se publicó en Salud Pública de México (48.8%) y el menor en la Revista de Investigación Clínica (16.1%). Solamente 4.2% de los artículos aplicó la perspectiva de género, y los temas mayormente abordados fueron las adicciones, el comportamiento sexual y la violencia. CONCLUSIONES: Este es el primer estudio en México que evalúa la aplicación de la perspectiva de género en la investigación en salud. Al igual que en otros países, es baja la proporción de artículos que analizan las diferencias por sexo y aplican la perspectiva de género. Esto destaca la importancia de promover la investigación interdisciplinaria que ayude a comprender los orígenes biológicos y sociales, o la combinación de ambos, que determinan la salud desigual entre mujeres y hombres.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.

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.

According to the World Health Organization, coronary heart disease (CHD)-caused deaths accounted for one-fifth of the total deaths in Mexico in 2017. Researches done in the past have confirmed the association between dietary trans-fatty acids (TFA) and CHD. Dietary TFA are mostly derived from industrial-hydrogenated oils, milk products, and meat fats. This paper is a build on of a policy paper done on international policies for TFA in low-to-middle income countries, using Mexico as the case study. This write up, however, aims to critically analyse the TFA regulation policy process in Mexico, evaluating the strength of evidence proposed and identifying the barriers preventing the usage of the evidence for a TFA regulation policy implementation. Although evidence abounds for TFA regulation policy, lack of effective collaboration and communication among the major actors (researchers, policy­makers, and consumers) in Mexico remains a major setback in its implementation.

Objective. The feasibility of the use of WHO impregnated paper and biochemical assays to determine lethal concentra­tions (LC50 and LC99) and insecticide metabolic enzyme levels of Triatoma dimidiata. Materials and methods. LC50 and LC99 were calculated with WHO papers impregnated at differ­ent concentrations of malathion, propoxur and deltamethrin; the percentage of insensitive acetylcholinesterase (iAChE); and the levels of esterases, glutathione S-transferases, and monooxygenases in laboratory nymphs of the first stage (5 to 7 days), were undertaken using the WHO biochemical assays. Results. Respectively the LC50 and LC99 μg/cm2 obtained for malathion were 43.83 and 114.38, propoxur 4.71 and 19.29, and deltamethrin 5.80 and 40.46. A 30% of the population had an iAChE, and only a few individuals had high P450 and β-eterase levels. Conclusion. Impregnated papers and bio­chemical tests developed by WHO for other insects, proved to be feasible methods in monitoring insecticide resistance and metabolic enzymes involved in T. dimidiata.

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.

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.Kew words: School of Public Health of Mexico; training in public healthAutor de correspondencia: Dr. Octavio Gómez-Dantés. Genovevo de la O, 103 A, col. Santa María Ahuacatitlán. 62100 Cuernavaca, Morelos, México. Correo electrónico: ocogomez@yahoo.com

La depresión constituye un problema importante de salud pública. En el mundo, representa la cuarta causa de discapacidad en cuanto a la pérdida de años de vida saludables. En México ocupa el primer lugar de discapacidad para las mujeres y el noveno para los hombres. La depresión tiene una alta co-ocurrencia con otros trastornos como la ansiedad, el consumo de sustancias, la diabetes y las enfermedades cardiacas. Pese al impacto que tiene este trastorno, una gran proporción de personas no acude a tratamiento, retrasa mucho la búsqueda de ayuda, o bien no recibe la asistencia adecuada. El propósito de este ensayo es exponer el resultado de una breve revisión de investigaciones que permiten ubicar la depresión como un problema de salud pública en México. Se abordan la prevalencia y los factores asociados, las brechas de atención, el uso de servicios y los tratamientos disponibles. Al final se plantean algunas de las implicaciones para la investigación y para las políticas públicas.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: This paper explores the impact of contextual variables at the neighborhood level on a health marker in the city of Hermosillo, Mexico and discusses the importance of collaboration between planners and health professional to minimize the negative effect of contextual factors on urban health. MATERIALS AND METHODS: Few studies in Mexico have assessed health outcomes at the intra-urban scale and their interaction with neighborhood-level contextual variables. Using spatial analysis and geographical information systems, the paper explores the association between infant mortality and an index of socio-environmental vulnerability used to measure urban contextual factors. RESULTS: Two high infant mortality clusters were detected within neighborhoods characterized by relatively good environmental conditions and one in a neighborhood with a poor environment. CONCLUSIONS: Our results show the clustering of high infant mortality areas and some association with built environment factors in Hermosillo. The results support the need to reconnect public health and urban planning as a way to create healthier environments in Mexican cities.OBJETIVO: Este artículo explora el papel de factores contextuales a nivel de colonia sobre un marcador de salud en la ciudad de Hermosillo, México y discute la importancia de la colaboración entre planificadores urbanos y profesionales de la salud para minimizar el impacto negativo de factores contextuales sobre la salud de la población urbana. MATERIAL Y MÉTODOS: Pocos estudios en México han evaluado las condiciones de salud a escala intra-urbana y su interacción con variables contextuales a nivel de colonia. Utilizando análisis espacial y sistemas de información geográfica, el artículo explora la relación entre mortalidad infantil y un índice de vulnerabilidad socio-ambiental construido para medir factores contextuales urbanos. RESULTADOS: Dos conglomerados de alta mortalidad infantil fueron detectados dentro de colonias caracterizadas por condiciones ambientales relativamente buenas y uno en una colonia con un ambiente pobre. CONCLUSIONES: Los resultados indican la formación de conglomerados de alta mortalidad infantil y una conexión moderada con factores del medio ambiente construido en Hermosillo. Estos resultados apoyan la necesidad de reconectar la salud pública y la planeación urbana como un método para crear ambientes más sanos en las ciudades de México.

OBJETIVO: Examinar críticamente la producción bibliográfica sobre la investigación cualitativa en salud (ICS) en México. MATERIAL Y MÉTODOS: Revisión de 128 trabajos publicados en la década del 2000 al 2009. Su búsqueda y recuperación se hizo mediante consulta de índices, buscadores y bases de datos, así como consultando a académicos. Se hizo análisis de frecuencias y de contenido. RESULTADOS: La producción en este campo se incrementa notoriamente en el periodo analizado, se difunde a nivel nacional e internacional y aparece mayoritariamente en revistas de salud pública y medicina social. Su consolidación, no obstante, dista de ser realidad dada su concentración institucional, territorial y temática, su dependencia de la teoría fundamentada, su olvido de temas sanitarios y actores importantes y su impacto marginal en el campo científico. CONCLUSIONES: La investigación cualitativa en salud logra avances en México pero enfrenta serios desafíos para consolidarse. Varias propuestas se presentan para fortalecerla.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.

En este trabajo se reflexiona acerca de la utilización de la categoría de género en los estudios de alimentación y nutrición en México y se destaca la importancia de las mujeres como responsables de la salud y la nutrición familiar. Además, se hace una breve revisión acerca de la manera en que las mujeres han sido analizadas en las diferentes encuestas de nutrición y alimentación y se concluye que, o bien son "invisibilizadas", al igual que los hombres, como parte de los promedios per cápita, o únicamente se les considera como parte de su rol reproductor. Se destaca la importancia de incluir el género y la perspectiva de género en los estudios alimentarios, con el objeto de profundizar en el conocimiento sobre las desigualdades en alimentación entre hombres y mujeres en las diferentes etapas del proceso alimentario: decisión, provisión, preparación, distribución y consumo de alimentos, así como de las prácticas y significados que tienen los alimentos para las mujeres. Se concluye haciendo énfasis en la importancia de introducir el tema de género en los currículos académicos de las diferentes escuelas de nutrición, enfermería y medicina.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.

OBJECTIVE: To review health research conducted among indigenous populations in Latin America during the period 1995-2004. Material and methods. The search strategy was purposely broad to ensure the identification of all relevant studies indexed in the PubMed and Lilacs databases. RESULTS: Six-hundred ninety citations were included. One hundred fifty-nine (23.0%) papers dealt with indigenous populations in Central America and 509 (73.8%) papers with South American populations. Three hundred two (43.8%) of the studies were quantitative, 39 (5.7%) qualitative, 259 (37.5%) mainly based on laboratory work and 24 (3.5%) dealt with policy analyses. The most common researched theme was human biology with 200 (29.0 %) papers, followed by communicable diseases (150 papers, 21.7 %). CONCLUSIONS: There is a special need for policy studies in the field of indigenous health. An increased commitment to resources and capacity building will be the real challenge for indigenous health research in the nearest future.OBJETIVO: Revisar la investigación en salud realizada en poblaciones indígenas de Latinoamérica, de 1995 a 2004. MATERIAL Y MÉTODOS: La estrategia de búsqueda fue amplia para asegurar la identificación de todos aquellos estudios relevantes catalogados en las bases de datos PubMed y Lilacs. RESULTADOS: Se incluyeron 690 citaciones; de ellas, 509 (73.8%) artículos trataron sobre poblaciones indígenas sudamericanas y 159 (23.0%) sobre poblaciones indígenas de Centroamérica. Trescientos dos (43.8%) de los estudios fueron cuantitativos, 39 (5.7%) cualitativos, 259 (37.5%) basados principalmente en trabajo de laboratorio y 24 (3.5%) trataron sobre análisis de políticas de salud. El tema de investigación más estudiado fue el de biología humana con 200 artículos (29.0%), seguido de enfermedades transmisibles (150 artículos, 21.7%). CONCLUSIONES: Existe una necesidad especial de estudios de políticas de salud en el campo de la salud indígena. Un mayor compromiso de recursos y formación de capacidades son los grandes desafíos para la investigación de la salud indígena en un futuro próximo.

OBJETIVO: Presentar los principales motivos de consulta con terapeutas tradicionales de la Ciudad de México. MATERIAL Y MÉTODOS: Se tomó como base los relatos de 16 médicos tradicionales de la Ciudad de México y 22 usuarios de este tipo de medicina. Los métodos utilizados para la recolección y análisis de los datos son de corte cualitativo. El trabajo de campo se realizó en dos etapas. Durante la primera fase se hicieron observaciones con enfoque etnográfico; y en la segunda, se realizaron entrevistas focalizadas. RESULTADOS: De acuerdo con la percepción de los entrevistados, entre los principales motivos de consulta se encuentran los problemas amorosos, conflictos familiares, apuros económicos, estrés, tensión, nervios y angustias espirituales. Estos motivos de consulta no se pueden englobar como enfermedades en un sentido estricto, todos son problemas de salud que se manifiestan como padecimientos y solamente algunos se ubican en la categoría biomédica de enfermedades. Las personas que acuden con los terapeutas tradicionales no solamente buscan curarse de sus males, también desean obtener consejos acerca de sus problemas personales. DISCUSIÓN: La información analizada en este trabajo permite señalar que existen diversas razones para explicar no solamente la supervivencia de la medicina tradicional, sino además su éxito en la vida actual, donde la ciencia y la tecnología han obtenido resultados sobresalientes, pero a cambio, la biomedicina ha olvidado la complejidad de la vida humana cotidiana y el valor de la atención personal, la compasión, la comprensión, la empatía y el uso del mundo simbólico para la solución de los conflictos y problemas de salud propios de la humanidad.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.

Complex interventions are needed to effectively tackle non-communicable diseases. However, complex interventions can contain a mix of effective and ineffective actions. Process evaluation (PE) in public health research is of great value as it could clarify the mechanisms and contextual factors associ­ated with variation in the outcomes, better identify effective components, and inform adaptation of the intervention. The aim of this paper is to demonstrate the value of PE through five case studies that span the research cycle. The interven­tions include using digital health, salt reduction strategies, use of fixed dose combinations, and task shifting. Insights of the methods used, and the implications of the PE findings to the project, were discussed. PE of complex interventions can refute or confirm the hypothesized mechanisms of action, thereby enabling intervention refinement, and identifying implementation strategies that can address local contextual needs, so as to improve service delivery and public health outcomes.

Reducing salt intake is one of the most cost-effective interventions to improve population health due to the subsequent reductions in blood pressure. Countries are introducing programs to lower salt consumption. Such programs usually focus on reducing salt in packaged foods and meals alongside campaigns to change consumer behavior. Thus, this paper provides an overview of the rationale for and evidence supporting the use of salt substitutes. Cur­rent approaches to salt reduction are insufficient, and more innovative solutions need to be identified. There is good evidence that salt substitutes, where some of the sodium is replaced with potassium, are effective to lower sodium total intake. The main challenge is to understand the pathways to market for salt substitutes. How do we implement programs to promote salt substitutes in different countries? What levels of government intervention are required? With more research and government investment, salt substitutes could be a game changer for increasing the impact of strategies to reduce population salt intake.

Los trastornos mentales, incluyendo los trastornos del uso de sustancias, hacen ya parte del panorama epidemiológico de México y seguirán en el escenario nacional por las próximas décadas, incrementando incluso su presencia como causa de enfermedad, discapacidad y muerte en nuestro país. Por lo tanto, el manejo epidemiológico de estos problemas se hace urgente. Este trabajo busca plantear el campo de estudio de la epidemiología de los trastornos mentales y sus limitaciones, haciendo énfasis en los elementos comunes de ésta con otras áreas más tradicionales de la epidemiología y en las aportaciones particulares de este campo epidemiológico a la psiquiatría en general y a la epidemiología en particular. Planteamos a continuación los diseños y problemas más comunes en este campo de la epidemiología, su utilidad para acciones de prevención, y señalamos los retos que nos esperan en el futuro. Una característica distintiva de esta área es que los trastornos mentales se manifiestan en dos niveles, como conducta (por ejemplo, una conducta compulsiva de lavarse las manos) y como elemento de la vida mental del sujeto (por ejemplo, el pensamiento obsesivo sobre las bacterias que se encuentran presentes en todos lados y que son una fuente constante de amenaza para algunos sujetos). Debido a esto, mucho de lo que sabemos sobre estos fenómenos proviene del autorreporte que el sujeto es capaz de hacer sobre sus sentimientos (introspección), ya sea en una conversación con un clínico entrenado o expresándolos al endosar reactivos en un cuestionario estandarizado. Otro aspecto importante a resaltar es la necesidad de hablar en plural al referirnos a los trastornos mentales. Este campo de la epidemiología presenta también un carácter particular, bifacético: por un lado, este es un problema en sí mismo, que produce sufrimiento y motiva la búsqueda de atención especializada, con manifestaciones clínicas particulares. Por otro lado, esta epidemiología también se orienta hacia un dominio particular de determinantes (como el uso, abuso o dependencia hacia las drogas) y cómo estas variables independientes afectan determinados procesos y enfermedades (como los accidentes, el homicidio, el suicidio, la cirrosis hepática, etc.) Por último, la epidemiología de los trastornos mentales se ha caracterizado también por su interés en una serie de procesos que no parecen constituir síndromes propiamente dichos, pero que son a todas luces de interés sanitario, siendo el ejemplo más claro de esto el problema de la violencia. La epidemiología de los trastornos mentales se enfrenta a enormes retos en el nuevo milenio. Debe hacer frente a un panorama epidemiológico complejo y cambiante. Los aspectos más importantes de su desarrollo futuro se vinculan con los siguientes puntos: medición de los trastornos mentales y de los factores de riesgo, el diseño y métodos de muestreo más eficientes, la relación entre la investigación biológica, la genética, las disciplinas sociales y la epidemiología, y la interfase entre la epidemiología y la evaluación de los tratamientos y los servicios.Mental disorders, including substance abuse, are part of the Mexican epidemiologic scenario and will remain so during several decades. They may even become more prominent as causes of disease, disability, and death in our country. It is thus imperative to frame appropriate management strategies to curb these problems without delay. This paper aims at outlining epidemiology of mental diseases as a field of study, and to identify its limitations. Emphasis is made on common elements shared with other more traditional fields of epidemiology, as well as on the specific contributions made by this particular field to epidemiology and to psychiatry in general. This paper describes the main study designs and problems in this field of epidemiology, its usefulness in prevention actions, and future challenges. A unique characteristic of mental disorder epidemiology is that its target diseases manifest in two levels: behaviorally (for example, compulsive hand-washing) and as an element of the individual's mental life (e.g., obsession with bacteria being a constant, omnipresent health threat). It follows that much of the knowledge currently available on the phenomena of mental disorders in general is based on the self-reported insight of individuals. Trained clinicians have collected such reports by interview or with standardized questionnaires. This field of epidemiology is characterized by having two-sides: a mental disorder is a problem in and of itself, causing suffering and prompting the search for specialized care, as it has peculiar clinical manifestations. On the other hand, mental disorder epidemiology also focuses on determining factors (drug use, abuse, or addiction) and on the way these independent variables result in certain processes and outcomes (such as accidents, homicide, suicide, liver cirrhosis, etc.). Finally, the epidemiology of mental disorders has also been set apart by its focus in series of processes that are not suitably classified as syndromes, but which are germane to public health, for example, violence. The epidemiology of mental disorders faces great challenges in the new millennium, including a complex, changing epidemiologic scenario. Several important issues will influence the future development of mental disorder epidemiology: measurement of mental disorders and risk factors, more efficient sampling design and methods, the relationships among biological research, genetics, social studies, and epidemiology, and the interface between epidemiology and the evaluation of therapies and health services.

En los Estados Unidos de América se ha logrado una disminución de la exposición a plomo de la población en general, gracias al establecimiento de diversas normas. En este artículo se destaca parte de los conocimientos adquiridos a través de la experiencia obtenida en este país en materia de plomo, en particular respecto al aire y al agua. Uno de los aspectos fundamentales es la posibilidad de contar con una base científica sólidamente establecida y claramente entendida, a partir de la cual se tomarán las medidas correspondientes. Los efectos secundarios de ciertas normas concernientes al aire ponen de manifiesto de qué manera los esfuerzos orientados a solucionar un problema pueden aportar beneficios en otras áreas, si bien pueden surgir consecuencias no deseadas, debido a la falta de previsión y de evaluación. Asimismo, en este documento se discuten las diferencias entre los enfoques centralizados y los descentralizados para el manejo de la exposición a plomo.Lead regulations and standards have resulted in a lower exposure to lead in the general population of the United States of America. This paper highlights some of the know-how developed through lead-containing experiences, particularly regarding lead content in air and water. The availability of a solid and clear scientific knowledge is central to the success of these policies. Collateral effects of some air-related standards show the extent to which problem-oriented efforts may be beneficial in other areas, inasmuch as they may have untoward consequences if careful planning and evaluation are not considered. Finally, this paper presents a discussion of the differences between centralized and decentralized approaches to lead exposure control.