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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.

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.

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: To evaluate the effect of the combination of Metarhizium anisopliae and Gliocladium virens, both with Aqua Reslin Super, on the oviposition, hatching and emergence of Aedes aegypti., Materials and Methods: Evaluations were carried out to determine the effect of treatments impregnated on filter paper and exposed within plastic containers on the oviposition, hatching and emergency of Aedes aegypti., Results: The results indicated that the fungus and insecticide combinations did not affect the oviposition behavior, but if the hatching of the eggs and the adult's emergency., Conclusions: With the results it can be concluded that the combination of fungi + insecticide can be a good option to be applied in oviposition sites with a view to the development of a lethal ovitrap., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

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.

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.

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.

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 facilitates the assessment of the government’s support actions to populations with lower economic capacities in the period 2012-2018.

Bisphenol A (BPA), found in plastics and epoxy resins, is one of the most studied chemicals. BPA is regarded as an endocrine disruptor and has been related to adverse health effects in humans. However, some regulatory agencies around the world have concluded that BPA is safe at current human exposure levels. As the scientific community attempts to settle the debate on BPA’s health effects, regulatory agen­cies have been put into a challenging public health policy situation. The United States has implemented no regulatory actions due to safety concerns, while Europe has used the precautionary principle to guide its regulation in the face of scientific uncertainty. In this paper, we explore the debate surrounding BPA regulation and the possibility for countries to introduce guidelines, using Mexico as an example. Policy change determinants analysis suggest that countries can and should impose regulations on BPA.

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 issue of Salud Pública de México on Health Equity in the Americas focuses on research studies and in­terventions related to this broad topic that reaches across the diverse populations of the Americas. These papers have the particular purpose of disseminating evidence to promote and accelerate equity within the area of can­cer prevention and control; they are the result of national and international collaborations between researchers and government and community organizations of the United States and Latin America.

Objective. Environmental and occupational agents are causes of cancer and disease worldwide while their control and the reduction of the associated disease burden remains complex. Materials and methods. This paper summarizes the current status of the burden of environmental and occupational causes of disease in the Americas based on presentations from a panel on environment, occupation and other environmental risk factors for cancer in the Americas, delivered in Panama, at the international conference Promoting Health Equity and Transnational Collaborations for the Prevention and Control of Cancer in the Americas. Results. Three case studies are presented to illustrate the impact of specific environmental and occupational agents and the challenge of control. Conclusions. There are still fully avoidable exposures to carcinogens, as well documented in the case of asbestos in Brazil. Thus, there are abundant targets for intervention to reduce cancer in the Americas.

Lung cancer is a major public health problem, yet the disease is highly stigmatized, which impairs the optimal treatment of these patients. Globally, as well as locally in Mexico, lung cancer is the main cause of cancer-related deaths. Despite this, it is the only one among the five deadliest cancers which is not covered by Popular Health Insurance. Lung cancer treatment is a complex algorithm which requires fully trained personnel to assess each patient in order to determine standard-of-care therapy based on several factors associated with the molecu­lar profile of the tumor, patient characteristics and financial possibilities. In the recent decade, several breakthrough therapies have been launched, shifting the outlook for cer­tain patient subgroups. None of these novel therapies are currently available to patients who have public-based health insurance. In this paper, we review the inequities present in the Mexican health system and highlight the importance of addressing these opportunities.

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.

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.

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.

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 describe the role of taste perception in the development of sweet taste habituation as well as its relationship to the development of obesity in children. Materials and methods. An initial search of scientific articles published in PubMed between January 1st, 2011 and March 20th, 2016 was performed in children between 0 and 12 years old. The algorithms used were (Obesity OR Overweight) AND(Taste perception, Satiation, Satiety response, Appetite, Appetite regulation Habituation, Taste receptors [MeSH]) and PROP phenotype. Subsequent searches included papers published before and after date of initial search (until May 2018). Results. Flavor preferences start as early as taste system development during pregnancy. Therefore, children who are exposed to sweet flavors in early childhood, increase their risk of habituation to them. Likewise, the hedonic experiences given by the ingestion of sweet foods and beverages, reinforce the consumption of these foods, perpetuating their selection in later stages. Preference for sweet taste has been associated with the development of obesity in children. Functional genetic variants related to taste perception can also contribute to the selection of certain types of foods and there is enough evidence that supports this idea. However, its contribution to a higher energy intake as well as a higher body weight has been poorly explored with inconsistent results. Conclusions. More evidence is required to understand the environmental and genetic interactions of taste perception, so in turn, it can be consider as a key factor for preventing child obesity.

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.

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. To determine the impact of Seguro Popular (SPS) on catastrophic and impoverishing household expenditures and on the financial protection of the Mexican health system. Materials 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 and Geography (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. Conclusion. 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.

Mental and substance use disorders account for 18.9% of years lived with disability worldwide. A rising prevalence of mental disorders was identified in the past decade and a call for global attention to this challenge was made. The purpose of this paper is to discuss new strategies to address mental health problems in developing nations aimed at dealing with them within the frame of the overall health system. Mainstreaming mental disorders implies five dimensions of integration: i) incorporating mental health interventions to the global strategy to address non-communicable diseases; ii) moving away both from the biological and sociological reduc­tionisms around mental health prevalent in the past century; iii) addressing the whole range of conditions related to mental health; iv) migrating from the idea that mental disorders have to be treated in secluded clinical spaces, and v) the use of a comprehensive approach in the treatment of these disorders.

Earthquakes are probably the scariest among the natural disasters that teach us about the forces of nature and their unpredictability. Knowing that there is nothing we can do to prevent the occurrence of an earthquake, we are forced to learn from our own experience. This paper systematizes the environmental, medical and public health impacts of earthquakes. Each is presented in a structured way, highlighting its most important aspects. The relationship between them and the affected environment and population; as well as the connection between these are emphasized during earthquakes. The environment at the place of occurrence of an earthquake is important for the survival of victims and also defines the particular medical and public health needs arising from its specificity. Every country needs good disaster management with specific protocols for the expected type of disaster. These protocols must incorporate environmental, medical and public health aspects and their implementation must be very efficient; they must include educating the inhabitants; training teams involved in rescue, (eventual) migration/evacuation, medical treatments and public health actions, and training and educating leaders.

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.

Recent literature indicates that people with Disorders of Intellectual Development (DID) experience health disparities in the pathologies that they present, and a worst access to health care. However, current evidence-based knowledge is still sparse outside the Anglo-Saxon countries. The POMONA-I and POMONA-II European projects aimed to collect information on the health status of people with DID in Europe. The POMONA-ESP project in Spain is meant to collect health information in a wide and representative sample of persons with DID. Also, there are studies that claim for the need of specialized services for people with DID at the public health system. There are also studies about the current state of the education and training about DID for students within the health sector. In this paper we review the latest evidences about the health of the persons with DID and we present the main research activities and care initiatives about this issue.

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 aretrospective 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.

Some interpretations frequently argue that three Disability Models (DM) (Charity, Medical/Rehabilitation, and Social) correspond to historical periods in terms of chronological succession. These views permeate a priori within major official documents on the subject in Mexico. This paper intends to test whether this association is plausible by applying a timeline method. A document search was made with inclusion and exclusion criteria in databases to select representative studies with which to depict milestones in the timelines for each period. The following is demonstrated: 1) models should be considered as categories of analysis and not as historical periods, in that the prevalence of elements of the three models is present to date, and 2) the association between disability models and historical periods results in teleological interpretations of the history of disability in Mexico.

Recent literature indicates that people with Disorders of Intellectual Development (DID) experience health disparities in the pathologies that they present, and a worst access to health care. However, current evidence-based knowledge is still sparse outside the Anglo-Saxon ountries. The POMONA-I and POMONA-II European projects aimed to collect information on the health status of people with DID in Europe. The POMONA-ESP project in Spain is meant to collect health information in a wide and representative sample of persons with DID. Also, there are studies that claim for the need of specialized services for people with DID at the public health system. There are also studies about the current state of the education and training about DID for students within the health sector. In this paper we review the latest evidences about the health of the persons with DID and we present the main research activities and care initiatives about this issue

The decreasing breastfeeding rate in México is of public health concern. In this paper we discus an innovative regulatory approach -Performance Based Regulation- and its application to improve breastfeeding rates. This approach, forces industry to take responsibility for the lack of breastfeeding and its consequences. Failure to comply with this targets results in financial penalties. Applying performance based regulation as a strategy to improve breastfeeding is feasible because: the breastmilk substitutes market is an oligopoly, hence it is easy to identify the contribution of each market participant; the regulation's target population is clearly defined; it has a clear regulatory standard which can be easily evaluated, and sanctions to infringement can be defined under objective parameters., Recommendations: modify public policy, celebrate concertation agreements with the industry, create persuasive sanctions, strengthen enforcement activities and coordinate every action with the International Code of Marketing of Breast-milk Substitutes.

The decreasing breastfeeding rate in México is of public health concern. In this paper we discus an innovative regulatory ap­proach -Performance Based Regulation- and its application to improve breastfeeding rates. This approach, forces industry to take responsibility for the lack of breastfeeding and its consequences. Failure to comply with this targets results in financial penalties. Applying performance based regulation as a strategy to improve breastfeeding is feasible because: the breastmilk substitutes market is an oligopoly, hence it is easy to identify the contribution of each market participant; the regulation’s target population is clearly defined; it has a clear regulatory standard which can be easily evaluated, and sanctions to infringement can be defined under objective parameters. Recommendations: modify public policy, celebrate concertation agreements with the industry, create persuasive sanctions, strengthen enforcement activities and coordinate every action with the International Code of Marketing of Breast-milk Substitutes.

Objective. This paper describes the study design and base- line characteristics of the study population, including the first 30 829 women who enrolled in the Forwarding Research for Improved Detection and Access for Cervical Cancer Screening and Triage (FRIDA Study). This is a large population based study that is evaluating the performance and cost-effective-ness of different triage strategies for high-risk HPV (hrHPV) positive women in Mexico. Materials and methods. The target population is more than 100 000 women aged 30 to 64 years who attend the Cervical Cancer Screening Program in 100 health centers in the state of Tlaxcala, Mexico. Since August 2013, all women in the region have been invited to enroll in the study. The study participants are evaluated to determine hrHPV infection using the Cobas 4800 HPV test. The HPV-16/18 genotyping and cytology triage strategies are performed as reflex tests in all hrHPV-positive participants. Women with a positive HPV-16/18 test and/or abnormal cytology (atypical squamous cells of undetermined significance or worse, ASCUS+) are referred for colposcopy evaluation, where a minimum of four biopsies and an endocervical sample are systematically collected. Histologic confirmation is performed by a standardized panel of pathologists. Results. Among the 30 829 women who have been screened, the overall prevalence of hrHPV is 11.0%. The overall prevalence of HPV16 and HPV18 are 1.5% and 0.7%, respectively. Cytological abnormalities (ASCUS+) were detected in 11.8% of the hrHPV-positive women. A total of 27.0% (920/3,401) of the hrHPV-positive women were referred to colposcopy because of a positive HPV16/18 test and/or abnormal reflex cytology, (31.6% had only ASCUS+, 53.6% were HPV16/18 positive with a normal cytology result, and 9.5% were positive to both triage tests). Conclusion. The results of this study will help policy makers and health service providers establish the best practices for triage in cervical cancer screening in Mexico and other countries. DOI: http://dx.doi.org/10.21149/spm.v58i2.7789

The right to health and its operational form, as an organized social response to health: the right to health protection, are the mainstay for the global push towards universal health coverage. The path to achieve this goal is particular to each country and relates to the baseline and specific context in relation to what is feasible. In practical terms, universal coverage involves the correlation between demand and supply of services (promotion, prevention, and care), expressed by the ability for each individual to make use of services when these are required. In those terms universal coverage is then effective access. The objective of the paper is to explore the conceptualization of effective access to health services and propose a definition that allows its operationalization thereof. This definition considers key elements of supply and demand of services, including the availability of resources and adequate provision (quality), as well as barriers to use them.

The right to health and its operational form, as an organized social response to health: the right to health protection, are the mainstay for the global push towards universal health coverage. The path to achieve this goal is particular to each country and relates to the baseline and specific context in relation to what is feasible. In practical terms, universal coverage involves the correlation between demand and supply of services (promotion, prevention, and care), expressed by the ability for each individual to make use of services when these are required. In those terms universal coverage is then effective access. The objective of the paper is to explore the conceptualization of effective access to health services and propose a definition that allows its operationalization thereof. This definition considers key elements of supply and demand of services, including the availability of resources and adequate provision (quality), as well as barriers to use them.

Listeriosis is caused by Listeria monocytogenes, an important food-borne disease due to its clinical forms, high mortality rate, and the economic impact in both clinical and food production industries. In Mexico, the lack of epidemiological surveillance systems leads to the need of accurate data on the incidence of listeriosis and its association with food-borne disease. In this paper, we present data about the presence of this bacterium in food, reports related to clinical cases of listeriosis, and information of diseases in which L. monocytogenes may be involved. However, in most of these cases the etiology was not established. Given this, there's a need to inform and warn the appropriate entities, to define strategies for the mandatory search of L. monocytogenes through the whole food production chain and clinical suspects, for the epidemiological importance and control of listeriosis in Mexico.

Listeriosis is caused by Listeria monocytogenes, an important food-borne disease due to its clinical forms, high mortality rate, and the economic impact in both clinical and food production industries. In Mexico, the lack of epidemiological surveillance systems leads to the need of accurate data on the incidence of listeriosis and its association with food-borne disease. In this paper, we present data about the presence of this bacterium in food, reports related to clinical cases of listeriosis, and information of diseases in which L. monocytogenes may be involved. However, in most of these cases the etiology was not established. Given this, there´s a need to inform and warn the appropriate entities, to define strategies for the mandatory search of L. monocytogenes through the whole food production chain and clinical suspects, for the epidemiological importance and control of listeriosis in Mexico.

Breast cancer is a major public health problem in Latin America (LA) and the most common form of cancer among women. An important variability according to ethnicity/race with respect to incidence/mortality, clinical characteristics, and prognosis is observed throughout LA. In addition, women are more likely to develop breast cancer (BC) at younger age and to be diagnosed at an advanced stage compared to western women. While little is known about specific risk factors, changes in reproductive pattern (parity, breastfeeding) and lifestyle factors including sedentary behaviours, unhealthy diet, and alcohol intake may contribute to the increase of BC incidence. In this paper we give an overview of the burden and patterns of BC, review the leading causes of BC and discuss the possible ways to improve BC prevention and control in LA.

Chikungunya fever (CHIK) is a viral disease transmitted to human beings by the same vector as dengue -the Aedes mosquito. Besides fever and severe pain in the joints, it produces other symptoms such as myalgias, headache, nausea, fatigue and exanthema. There is no specific treatment for it; the therapeutic management of patients focuses on symptom relief. Historically, outbreaks of large proportions have been reported; even since 2010 it was considered to be a potential emerging epidemic. In 2013 it was introduced into the islands of the Caribbean, and it has recently been reported in the American continent. This paper describes the first confirmed case of chikungunya in Mexico -in the municipality of Tlajomulco de Zúñiga, Jalisco, in May, 2014-, which was imported from the Caribbean island of Antigua and Barbuda by a 39 year-old woman.

Objective. To evaluate technical efficiency and potential presence of scale and scope economies in Mexican private medical units (PMU) that will improve management decisions. Materials and methods. We used data envelopment analysis methods with inputs and outputs for 2 105 Mexican PMU published in 2010 by the Instituto Nacional de Estadística y Geografía from the “Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A)” questionnaire. Results. The application of the models used in the paper found that there is a marginal presence of economies of scale and scope in Mexican PMU. Conclusions. PMU in Mexico must focus to deliver their services on a diversified structure to achieve technical efficiency.

his commentary addresses some of the diverse questions of current interest with regard to the health effects of air pollution, including exposure-response relationships, toxicity of inhaled particles and risks to health, multipollutant mixtures, traffic-related pollution, accountability research, and issues with susceptibility and vulnerability. It considers the challenges posed to researchers as they attempt to provide useful evidence for policy-makers relevant to these issues. This commentary accompanies papers giving the results from the ESCALA project, a multi-city study in Latin America that has an overall goal of providing policy-relevant results. While progress has been made in improving air quality, driven by epidemiological evidence that air pollution is adversely affecting public health, the research questions have become more subtle and challenging as levels of air pollution dropped. More research is still needed, but also novel methods and approaches to address these new questions.

Chikungunya fever (CHIK) is a viral disease transmitted to human beings by the same vector as dengue –the Aedes mosquito. Besides fever and severe pain in the joints, it produces other symptoms such as myalgias, headache, nausea, fatigue and exanthema. There is no specific treatment for it; the therapeutic management of patients focuses on symptom relief. Historically, outbreaks of large proportions have been reported; even since 2010 it was considered to be a potential emerging epidemic. In 2013 it was introduced into the islands of the Caribbean, and it has recently been reported in the American continent. This paper describes the first confirmed case of chikungunya in Mexico –in the municipality of Tlajomulco de Zúñiga, Jalisco, in May, 2014–, which was imported from the Caribbean island of Antigua and Barbuda by a 39 year-old woman.

Objective: . This paper aims at assessing the contribution of Chile's Health Care Integrating Councils (CIRA, Spanish acronym) to strengthening governance in health., Materials and Methods: A literature review on the official documents related to the process of creation and development of CIRA was carried out; an ad hoc questionnaire was applied to all 29 health services of the country; finally, 35 semi-structure in-depth interviews were carried on a sample of six CIRA., Results: The CIRAs have become a tool for functional integration and a valuable space for dialogue, cooperation and learning for all of the actors of the Chilean public health network., Conclusions: In this study, we conclude that there is room for improvements of CIRA's role regarding governance of the health care network as long as CIRA is authorized to deal with strategic topics, such as investment in infrastructure, technology and human resources, and budgeting.

Objective. This paper aims at assessing the contribution of Chile’s Health Care Integrating Councils (CIRA, Spanish acronym) to strengthening governance in health. Materials and methods. A literature review on the official documents related to the process of creation and development of CIRA was carried out; an ad hoc questionnaire was applied to all 29 health services of the country; finally, 35 semi-structure in-depth interviews were carried on a sample of six CIRA. Results. The CIRAs have become a tool for functional integration and a valuable space for dialogue, cooperation and learning for all of the actors of the Chilean public health network. Conclusions. In this study, we conclude that there is room for improvements of CIRA’s role regarding governance of the health care network as long as CIRA is authorized to deal with strategic topics, such as investment in infrastructure, technology and human resources, and budgeting.

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.

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

Objective: This paper presents the design and application in Cuba of a social construct to identify the social dimensions associated with discrimination attitudes towards people with positive diagnosis to HIV., Materials and Methods: A combination of qualitative and quantitative methodology was used for the measurement and validation of a construct, and also the K-mean procedure and factor analysis techniques. All these techniques were applied to "Survey on HIV prevention indicators" 2005, 2006 and 2009., Results: A tool for the identification of the most frequent discriminatory attitudes in a specific social context was validated. This instrument allows clustering the population into different typologies, by level of discrimination, and also, to distinguish some social dimensions of this phenomenon., Conclusions: The results allow distinguishing frequent discriminatory attitudes in any population, focusing the actions in the direction of gradually reducing them, and to evaluate the temporal behavior of this phenomenon.

Objective. This paper presents the design and application in Cuba of a social construct to identify the social dimensions associated with discrimination attitudes towards people with positive diagnosis to HIV. Materials and methods. A combination of qualitative and quantitative methodology was used for the measurement and validation of a construct, and also the K-mean procedure and factor analysis techniques. All these techniques were applied to “Survey on HIV prevention indicators” 2005, 2006 and 2009. Results. A tool for the identification of the most frequent discriminatory attitudes in a specific social context was validated. This instrument allows clustering the population into different typologies, by level of discrimination, and also, to distinguish some social dimensions of this phenomenon. Conclusions. The results allow distinguishing frequent discriminatory attitudes in any population, focusing the actions in the direction of gradually reducing them, and to evaluate the temporal behavior of this phenomenon.Keywords: HIV AIDS; discrimination; construct; CubaAutor de correspondencia: Dr. Humberto González Galbán. Departamento de Estudios de Población, El Colegio de la Frontera Norte. Carretera Tijuana-Ensenada, Km 18.5, San Antonio del Mar. 22560 Tijuana, Baja California, Mexico.Correo electrónico: hggalban@colef.mx

This paper presents theoretical reflections on health promotion in the Brazilian public health context. Some characteristics and problems of the international debate are highlighted, but our focus is the position of health promotion as it is discussed in the Brazilian health system. We follow the foucauldian perspective of biopower and resistence to discuss the selected texts and documents related to health promotion that were considered relevant for the purpose of this investigation. Health promotion is discussed as a field of discourses, practices, knowledge production and power. We concentrate our analysis on the debate proposed by collective health researchers on the repercussions of the Lalonde Report in the international Health Promotion Charts, and on the connexion between health promotion and the Brazilian health system. The discussion demonstrates that health promotion work requires constant attention and significant effort from managers, technicians, and health system users, and that each step forward reveals new challenges and calls for new actions.

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.