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Objetivo. Describir el comportamiento de la mortalidad global por cáncer, así como la mortalidad específica para las principales neoplasias malignas en población adulta derechohabiente (DH) del Instituto Mexicano del Seguro Social (IMSS). Material y métodos. A partir de los registros oficiales de defunción y de la información sobre la población para los años 1991-1995, se estimaron las tasas anuales de mortalidad global y específica para las 10 principales neoplasias malignas por sexo, en mayores de 20 años. Asimismo, se estimaron las tendencias nacionales y estatales para las principales neoplasias malignas para cada sexo por medio de regresión de Poisson. Se calcularon las diferencias de tasas de mortalidad específica para las dos principales neoplasias por sexo restando las tasas estatales a su respectiva tasa nacional en 1995. Resultados. La mortalidad global por cáncer en los hombres se incrementó de 76.2 en 1991, a 94.8 por 100 000 DH en 1995; entre las mujeres, ésta se incrementó de 85.6 a 105.8 por 100 000 DH, representando un incremento de 24.4 y de 24% en hombres y mujeres, respectivamente, durante el periodo de estudio. Entre los hombres las neoplasias de riñón, leucemia, páncreas, próstata y pulmón; y entre mujeres las de colon, mama, páncreas, leucemias e hígado, mostraron los incrementos más significativos. Conclusiones. En el IMSS es impostergable la conformación de un registro poblacional de cáncer que permita una mejor vigilancia epidemiológica de las neoplasias y una evaluación permanente del impacto de programas específicos para la prevención y control de este padecimiento en las instituciones.

Down syndrome is the most common chromosomal abnormality in persons worldwide; prevalence is [approximately equal to]1/1,000 live births (1). It is characterized by a variety of dysmorphic features, congenital malformations, [...]

Abstract Background Frailty in the elderly can be regarded as nonspecific vulnerability to adverse health outcomes, caused by multiple factors. The aim was to analyze the relationships between the frailty index, age and mortality in a two year follow up study of Mexican elderly. Methods A frailty index was developed using 34 variables. To obtain the index, the mean of the total score for each individual was obtained. Survival analyses techniques were used to examine the risk ratios for the different levels of the frailty index. Kaplan-Meier estimates were obtained, adjusted for age and gender. Cox proportional hazards models were also built to obtain hazard ratio estimates. Results A total of 4082 participants was analyzed. Participants had an average age of 73 years and 52.5% were women. On average, participants were followed-up for 710 days (standard deviation = 111 days) and 279 of them died. Mortality increased with the frailty index level, especially in those with levels between .21 to .65, reaching approximately 17% and 21%, respectively. Cox proportional hazards models showed that participants with frailty index levels associated to increased mortality (.21 and higher) represent 24.0% of those aged 65-69 years and 47.6% of those 85 and older. Conclusion The frailty index shows the properties found in the other studies, it allows stratifying older Mexican into several groups different by the degree of the risk of mortality, and therefore the frailty index can be used in assessing health of elderly.

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Underdiagnosis of chronic obstructive pulmonary disease (COPD) in primary care can be improved by a more efficient screening strategy. AIMS: To evaluate a three-step method of screening for COPD consisting of an initial short questionnaire followed by measurement of forced expiratory volume in 1 s/forced expiratory volume in 6 s (FEV1/FEV6) using an inexpensive pocket spirometer in those with high risk, and diagnostic quality spirometry in those with a low FEV1/FEV6. METHODS: We analysed two related Mexico City cross-sectional samples. The 2003 Mexico City PLATINO survey (n = 542) was used to develop a short questionnaire to determine the risk of COPD and a 2010 survey (n = 737) additionally used a pocket spirometer. The discriminatory power of the two instruments was assessed with receiver operator characteristic (ROC) curves using three COPD definitions. RESULTS: The developed COPD scale included two variables from a simple questionnaire and, in ROC analysis, an area under the curve (AUC) between 0.64 and 0.77 was found to detect COPD. The pocket spirometer had an AUC between 0.85 and 0.88 to detect COPD. Using the COPD scale as a first screening step excluded 35-48% of the total population from further testing at the cost of not detecting 8-18% of those with COPD. Using the pocket spirometer and sending those with a FEV1/FEV6<0.80 for diagnostic quality spirometry is very efficient, and substantially improved the positive predictive value at the cost of not detecting one-third of COPD cases. CONCLUSIONS: A three-step screening strategy for COPD substantially reduces the need for spirometry testing when only a COPD scale is used for screening. [ABSTRACT FROM AUTHOR]

Objective: To assess whether an intervention based on nurse home visits including alert buttons (NV+AB) is effective in reducing frailty compared to nurse home visits alone (NV-only) and usual care (control group) for older adults. Design: Unblinded, randomized, controlled trial. Setting: Insured population covered by the Mexican Social Security Institute living in the city of Ensenada, Baja California, Mexico. Participants: Patients were aged over 60 years with a frailty index score higher than 0.14. Intervention: After screening and informed consent, participants were allocated randomly to the control, NV+AB, or NV-only groups. Measurements: The primary outcome was the frailty score 9 months later. Quality of life, depression, comorbidities, health status, and health service utilization were also considered. Results: The framing sample included 819 patients. Of those, 591 were not located because they did not have a landline/telephone (341 patients), they had died (107), they were ill (50), or they were not currently living in the city (28). A screening interview was applied to 228 participants, and 57 had a score ⩽0.14, 171 had ⩾0.14, and 16 refused to complete the baseline questionnaire. A home visit was scheduled for 155 patients. However, 22 did not complete the baseline questionnaire. The final 133 subjects were randomized into the NV+AB (n = 45), NV-only (n = 44), and control (n = 44) groups. There were no statistically significant differences in the baseline characteristics of the groups. The mean age overall was 76.3 years (standard deviation 4.7) and 45% were men. At the baseline, 61.65% were classified as frail. At end of follow-up the adjusted prevalence of frailty in NV+AB group was 23.3% versus 58.3% in the control group. Conclusion: An intervention based on NV+AB seems to have a positive effect on frailty scores. [ABSTRACT FROM AUTHOR]

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Salud Pública de México is the property of Instituto Nacional de Salud Publica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The Mini-mental State Examination (MMSE) is the most widely used cognitive test, both in clinical settings and in epidemiological studies. However, correcting its score for education may create ceiling effects when used for poorly educated people and floor effects for those with higher education. Methods: MMSE and a recent cognitive test, the seven minute screen (7MS), were serially administered to a community sample of Mexican elderly. 7MS test scores were equated to MMSE scores. MMSE-equated 7MS differences indicated ceiling or floor effects. An ordinal logistic regression model was fitted to identify predictors of such effects. Results: Poorly educated persons were more prevalent on the side of MMSE ceiling effects. Concentration (serial-sevens), orientation and memory were the three MMSE subscales showing the strongest relationship to MMSE ceiling effects in the multivariate model. Conclusion: Even when MMSE scores are corrected for educational level they still have ceiling and floor effects. These effects should be considered when interpreting data from longitudinal studies of cognitive decline. When an education-adjusted MMSE test is used to screen for cognitive impairment, additional testing may be required to rule out the possibility of mild cognitive impairment. [ABSTRACT FROM AUTHOR]

Objective. To assess the age, period and cohort effects on breast cancer (BC) mortality in Mexico. Material and Methods. Age, period and cohort curvature trends for BC mortality were estimated through the Poisson Regression model proposed by Holford. Results. Nationally, BC death rates have leveled off since 1995 in most age groups. BC mortality trends are mainly determined by birth cohort and age effects in Mexico. Women born between 1940 and 1955 show the highest rate of increase in BC mortality. Women born afterwards still show an increasing trend but at a much lower rate. Mammography and adjuvant therapy have had a limited impact on mortality. Potential reasons for observed patterns are discussed. An increase in BC mortality in Mexico is expected in the following decades. Conclusions. Mammography screening programs and timely access to effective treatment should be a national priority to reverse the expected increasing BC mortality trend. [ABSTRACT FROM AUTHOR]

We present a spatial analysis of residential radon concentrations in the Mexico City Metropolitan Area, which we intend to use to assign radon exposure in an ongoing case-control study. As part of a probabilistic household survey, carried out between May and June 1999, 501 dwellings were selected for indoor placement of solid state nuclear track detectors (LR 115) in a cup array over a period of approximately 90 days. As part of the sampling design, the city was grid partitioned into nine zones and a sample of dwellings was selected in each zone. All zones were simultaneously surveyed. The stratified sampling design allowed us to obtain radon geometric means, adjusted for household characteristics, week of detector placement and number of days of measurement for these zones. Additionally, adjusted geometric means were estimated for the 100 census tracts surveyed and this information was used to obtain a more detailed spatial distribution of residential radon levels through kriging interpolation and surface contouring. Radon levels depended on the room of placement, the floor level and the ventilation habits but not on building materials. Regarding the city zone, the highest adjusted geometric mean was found in the southwest (136 Bq m−3), where 46% of the households had an estimated radon level in excess of 200 Bq m−3. In the rest of the city, the geometric mean concentration ranged between 41 and 98 Bq m−3. A more detailed spatial distribution showed that, in general, most of the eastern and middle zones of the city had estimated radon geometric means below 74 Bq m−3, while the western ones had geometric means above this concentration. Very high geometric means, exceeding 111 Bq m−3 and even reaching 288 Bq m−3, are estimated for some areas located in the southern and western zones of Mexico City. The obtained spatial distribution shows that the areas with very high estimated residential radon concentrations are close to inactive volcanic mountains. We believe that the geo-statistical techniques, we have used, offer reasonably good estimates of the average spatial residential radon distribution in Mexico City under average ventilation in homes. The use of this indirect approach for radon exposure measurement in epidemiological studies is an inexpensive alternative to direct radon exposure measurement but may be subject to non-differential misclassification error. The effect of such error on the detection of a real increase in lung cancer risk from indoor radon remains to be determined. [Copyright &y& Elsevier]