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We examined the association between physical activity and reproductive factors with bone density among 313 Mexican women, aged 26-83 years. Bone mineral density (BMD) was measured with a HOLOGIC QRD 1000 w, DXA densitometer at the lumbar spine and femoral region. We explored the relation between BMD and parity, age, body mass index (BMI), type of menopause, and level of exercise. Multiple regression models examining determinants of bone density at the lumbar and femoral regions showed that increasing age and lack of exercise were statistically significant predictors of bone demineralization. The number of pregnancies also had a deletereous effect on bone density, especially for lumbar spine, as well as BMI <20 kg/m2. Our results suggest that physical activity, parity, and BMI are important determinants of bone density in this population. [ABSTRACT FROM AUTHOR]

OBJETIVO: Evaluar los niveles de plomo en sangre de niños morelenses y sus factores de exposición. MATERIAL Y MÉTODOS: Estudio transversal para analizar, por voltametría anódica, los niveles de plomo en sangre de 232 niños de 1 a 12 años de edad, que acudieron de junio a octubre de 1996 al Hospital del Niño Morelense de Cuernavaca, Morelos, México. Los factores de exposición se indagaron por cuestionario. El valor de concentración de plomo se transformó al logaritmo natural; se estimó la razón de momios para algunos factores de exposición que se incorporaron a un modelo de ANOVA. RESULTADOS: Se reclutaron 232 niños (50% mujeres); 73% residentes en Cuernavaca. La media geométrica de plomo en sangre fue 6.7 µg/dl; 29.7% rebasaron los 10 µg/dl; 66% tenían antecedente de cocinar alimentos en barro vidriado; 36% de almacenar alimentos, y 19%, consumo de líquidos en ese material. CONCLUSIONES: Los niveles encontrados son similares a los reportados en otras poblaciones pediátricas mexicanas en los últimos años. Entre los principales factores de exposición destacan el uso de barro vidriado para consumo de alimentos o líquidos y la intensidad del tráfico donde viven. Este es el primer estudio que documenta los niveles de plomo en sangre en población infantil de Morelos, México, y sus resultados son punto de partida para acciones futuras de control y prevención.

Objetivo. Evaluar las diferencias en los niveles de ozono (O3) y bióxido de nitrógeno (NO2) en el interior y el exterior de una escuela en el suroeste de la Ciudad de México. Material y métodos. Se midieron diariamente estos contaminantes dentro y fuera del salón, de enero a abril de 1990, mediante monitoreo manual. Resultados. El NO2 adentro y afuera no sobrepasó la norma mexicana (0.21 ppm). El coeficiente de correlación entre las concentraciones máximas de NO2 de la estación de monitoreo local de la ciudad y el exterior del salón fue de 0.82 (p< 0.001). En relación con el O3, la concentración máxima fuera del salón fue de 0.29 ppm, y adentro, de 0.17 ppm (se colocaron en promedio por debajo de 0.06 ppm); entre el interior y el exterior del salón hubo una correlación de 0.72 y se observó que, por cada 1.7 ppm en el exterior, hay 1.0 ppm en el interior (p< 0.05). Conclusiones. Las mayores concentraciones de O3 en el exterior se presentaron entre las 11:00 y las 14:00 horas, por lo que se recomienda tener el descanso previamente a este horario.

Objetivo. Modelar la variabilidad en el número de consultas infantiles diarias por motivos respiratorios como consecuencia de los cambios diarios en los niveles de contaminación ambiental, observada en los servicios de urgencias y medicina familiar de un hospital de especialidades del Instituto Mexicano del Seguro Social ubicado en la zona suroeste de la Ciudad de México durante 1993. Material y métodos. Se estudió la correlación entre la presencia de infecciones respiratorias altas y bajas con la exposición a ozono y bióxido de nitrógeno. Para modelar esta asociación se utilizó la técnica de regresión Poisson aplicada sobre modelos de riesgo lineal y no lineal con periodos de latencia entre las mediciones ambientales y la consulta de uno, dos y tres días, así como el promedio de las mediciones de los tres, cinco y siete días previos a la consulta. Resultados. El modelo utilizado estima que un incremento de 50 ppb en el promedio horario de ozono de un día ocasionaría, al día siguiente, un incremento del 9.9% en las consultas de urgencias por infecciones respiratorias altas en el periodo invernal, pudiendo incrementarse hasta en un 30% si el incremento se diera en cinco días consecutivos como promedio. Conclusiones. Los resultados sugieren que la exposición de los menores de 15 años al ozono y bióxido de nitrógeno inciden significativamente sobre el número de consultas ocasionadas por motivos respiratorios en esta zona de la Ciudad de México.

Objetivo. Determinar el costo beneficio de la reorganización del Programa de Detección Oportuna del Cáncer Cervicouterino (PDOC) mediante intervenciones de garantía de calidad. Material y métodos. Se siguieron tres etapas: a) identificación y cuantificación de costos; b) identificación y cuantificación de beneficios, y c) evaluación económica del costo beneficio. Resultados. El costo unitario de operación por citología -obtención, fijación, el traslado al centro de lectura, su tinción e interpretación y la notificación de resultados- se estimó en USD$ 11.6. En conjunto, las intervenciones en calidad al PDOC elevarían el costo de cada citología en 32.7%. Sin embargo, la nueva organización generaría una razón beneficio/costo de 2 y un beneficio neto de 88 millones de dólares para los próximos cinco años. Conclusiones. La operación del programa propuesto resulta socialmente deseable, siempre y cuando las modificaciones se lleven a cabo, particularmente la capacitación, la notificación personalizada de los casos positivos, el incremento de cobertura, la introducción de mecanismos de control de calidad, el monitoreo contínuo y el tratamiento en mujeres con anormalidades detectadas.

El tabaquismo es uno de los problemas de salud pública más importantes del siglo pasado y del presente. Lo paradójico de la práctica de la salud pública es que el tabaquismo es un evento totalmente prevenible que ha estado presente en el desarrollo de la sociedad, contribuyendo de manera importante en la morbilidad y mortalidad, aun a costa de la evolución que ha tenido la salud pública mundial. En el caso de México, al contrario que en otras partes del mundo, la ola epidémica del tabaquismo se encuentra en su primera fase, expresada en la morbilidad y mortalidad asociadas, como el cáncer pulmonar, así como por las mínimas actividades preventivas instrumentadas; pero un buen avance ha sido el reconocimiento que como problema prioritario de salud se ha dado por los trabajadores de la salud pública y la sociedad. Se han iniciado las acciones de intervención tendientes a disminuir el consumo de tabaco entre la población y, con ello, dejar sembrado el camino de la prevención para futuras generaciones libres de tabaco. Frente a estas acciones de intervención se encuentran la industria tabacalera y los mecanismos de reproducción del mercado que opera para mantener el consumo de tabaco como un hábito de vida poblacional. El presente trabajo revisa los mecanismos de producción del tabaco, en especial de los cigarrillos, así como la comercialización, estructura del mercado y penetración del producto en la población mexicana, para contribuir con elementos de comprensión de la epidemia mexicana de tabaquismo para la implantación de medidas preventivas exitosas, presentes y futuras, para el control de la epidemia.

Background: Given the limited understanding of individuals' positive gains, this study aimed to identify these gains that could be leveraged by policymakers to enhance future health and societal resilience., Methods: We used a global qualitative approach to survey adults over 18 from 30 countries across six World Health Organization (WHO) regions, who detailed up to three personal positive gains from COVID-19 pandemic via an open-ended question. Inductive thematic analysis was employed to identify main themes, and quantitative methods were used for demographic and regional comparisons based on the percentage of responses for each theme., Results: From 35 911 valid responses provided by 13 853 participants, six main themes (one negative theme), 39 subthemes, and 673 codes were identified. Five positive gain themes emerged, ordered by response frequency: 1) improved health awareness and practices; 2) strengthened social bonds and trust; 3) multi-dimensional personal growth; 4) resilience and preparedness building; 5) accelerated digital transformation. The percentage of responses under these themes consistently appeared in the same order across various demographic groups and economic development levels. However, there were variations in the predominant theme across WHO regions and countries, with either Theme 1, Theme 2, or Theme 3 having the highest percentage of responses. Although our study primarily focused on positive gains, unexpectedly, 12% of responses (4304) revealed 'negative gains', leading to an unforeseen theme: 'Distrust and emerging vulnerabilities.' While this deviates from our main topic, we retained it as it provides valuable insights. Notably, these 'negative gains' had a higher percentage of responses in areas like Burundi (94.1%), Rwanda (31.8%), Canada (26.9%), and in the African Region (37.7%) and low-income (43.9%) countries, as well as among non-binary individuals, those with lower education, and those facing employment challenges., Conclusions: Globally, the identified diverse positive gains guide the domains in which health policies and practices can transform these transient benefits into enduring improvements for a healthier, more resilient society. However, variations in thematic responses across demographics, countries, and regions highlights need for tailored health strategies., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2025 by the Journal of Global Health. All rights reserved.)

Background: We aimed to identify the central lifestyle, the most impactful among lifestyle factor clusters; the central health outcome, the most impactful among health outcome clusters; and the bridge lifestyle, the most strongly connected to health outcome clusters, across 29 countries to optimise resource allocation for local holistic health improvements., Methods: From July 2020 to August 2021, we surveyed 16 461 adults across 29 countries who self-reported changes in 18 lifestyle factors and 13 health outcomes due to the pandemic. Three networks were generated by network analysis for each country: lifestyle, health outcome, and bridge networks. We identified the variables with the highest bridge expected influence as central or bridge variables. Network validation included nonparametric and case-dropping subset bootstrapping, and centrality difference tests confirmed that the central or bridge variables had significantly higher expected influence than other variables within the same network., Results: Among 87 networks, 75 were validated with correlation-stability coefficients above 0.25. Nine central lifestyle types were identified in 28 countries: cooking at home (in 11 countries), food types in daily meals (in one country), less smoking tobacco (in two countries), less alcohol consumption (in two countries), less duration of sitting (in three countries), less consumption of snacks (in five countries), less sugary drinks (in five countries), having a meal at home (in two countries), taking alternative medicine or natural health products (in one country). Six central health outcomes were noted among 28 countries: social support received (in three countries), physical health (in one country), sleep quality (in four countries), quality of life (in seven countries), less mental burden (in three countries), less emotional distress (in 13 countries). Three bridge lifestyles were identified in 19 countries: food types in daily meals (in one country), cooking at home (in one country), overall amount of exercise (in 17 countries). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05)., Conclusions: In 29 countries, cooking at home, less emotional distress, and overall amount of exercise emerged as common central lifestyle, health outcome, and bridge lifestyle factors, respectively. However, notable regional variations necessitate tailored interventions and resource allocations to effectively address unique local key variables and promote holistic health in each locale. The study's cross-sectional design and self-reported data may limit generalisability, emphasising the need for cautious interpretation and further longitudinal research., Keywords: global; across-country comparisons; lifestyle; health outcomes; network analysis., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2025 by the Journal of Global Health. All rights reserved.)

Background: In this study, we assessed the general population's fears towards various diseases and events, aiming to inform public health strategies that balance health-seeking behaviours., Methods: We surveyed adults from 30 countries across all World Health Organization (WHO) regions between July 2020 and August 2021. Participants rated their fear of 11 factors on an 11-point Likert scale. We stratified the data by age and gender and examined variations across countries and regions through multidimensional preference analysis., Results: Of the 16 512 adult participants, 62.7% (n = 10 351) were women. The most feared factor was the loss of family members, reported by 4232 participants (25.9%), followed by cancer (n = 2248, 13.7%) and stroke (n = 1416, 8.7%). The highest weighted fear scores were for loss of family members (mean (x̄) = 7.46, standard deviation (SD) = 3.04), cancer (x̄ = 7.00, SD = 3.09), and stroke (x̄ = 6.61, SD = 3.24). The least feared factors included animals/insects (x̄ = 3.72, SD = 2.96), loss of a mobile phone (x̄ = 4.27, SD = 2.98), and social isolation (x̄ = 4.83, SD = 3.13). Coronavirus disease 2019 (COVID-19) was the sixth most feared factor (x̄ = 6.23, SD = 2.92). Multidimensional preference analyses showed distinct fears of COVID-19 and job loss in Australia and Burundi. The other countries primarily feared loss of family members, cancer, stroke, and heart attacks; this ranking was consistent across WHO regions, economic levels, and COVID-19 severity levels., Conclusions: Fear of family loss can improve public health messaging, highlighting the need for bereavement support and the prevention of early death-causing diseases. Addressing cancer fears is crucial to encouraging the use of preventive services. Fear of non-communicable diseases remains high during health emergencies. Top fears require more resources and countries with similar concerns should collaborate internationally for effective fear management., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements., Methods: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test., Findings: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05)., Conclusion: To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences., Methods: An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic., Results: Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction)., Conclusions: Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2023 by the Journal of Global Health. All rights reserved.)

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic., Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels., Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised., Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2023 by the Journal of Global Health. All rights reserved.)

Background: The expression of empathy improves the quality of health care, which is why its instruction is suggested during the years of academic training of medical students. However, expressing empathy can also cause anxiety and impair psychological well-being., Objective: To identify profiles that describe the relationship between empathy, anxiety and psychological well-being in Mexican medical students., Method: Cross-sectional study in Mexican medical students completed the Multidimensional Empathy Scale, the Beck Anxiety Inventory, and the Psychological Well-Being Scale for Adults., Results: Women presented greater empathy and anxiety and lower psychological well-being (p < 0.01). Anxiety in students of the last year of training was lower compared to students of the first and second year (p < 0.01). Four profiles were detected: 1) men, minimal anxiety, low empathy; 2) first-year students, moderate to severe anxiety, low psychological well-being, high empathy; 3) last year of training, mild anxiety, adequate psychological well-being, medium empathy; 4) women, second and third year of training, very high empathy., Conclusions: Medical students in their first year of training constitute a population at risk. Attention strategies are necessary for this student group., (Copyright: © 2023 Permanyer.)

Objective: To identify the association between general empathy and medical empathy. Detect predictors of the level of medical empathy from general empathy. To determine the psychosocial profile that describes the relationship between general empathy, medical empathy, and demographic and academic characteristics in medical students., Method: Descriptive cross-sectional design. Medical students completed the Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Physician Empathy-student version (JSPE-S)., Results: Relatively high levels of general and medical empathy were detected. The total score of the IRI and the JSPE-S and their dimensions correlated positively (r = 0.14-0.52), except for the dimension personal distress of the IRI. The score of the IRI dimension empathic concern was the best predictor of the JSPE-S score and its dimensions (b = 0.27-0.54). Four profiles were detected: 1) men, preference for technology-oriented specialty, less empathy; 2) pre-clinical period students, less empathy; 3) students of the clinical period, greater empathy; and 4) women, preference for patient-oriented specialty, greater empathy., Conclusions: General and medical empathy are associated. Differentiated empathic profiles will allow the design of instructional strategies in empathy according to the specific needs of each one., (Copyright: © 2022 Permanyer.)

Introduction: Medical students report higher levels of anxiety than students from other majors. Knowledge about their psychological well-being is scarce., Objective: To identify sociodemographic and academic factors that predict the level of anxiety and psychological well-being in Mexican medical students., Method: Cross-sectional study of Mexican medical students of first (n = 59), third (n = 43) and fifth semester (n = 59), who answered a sociodemographic questionnaire, Beck Anxiety Inventory, the Psychological Well-being Scale for adults and the Family Adaptability and Cohesion Evaluation Scale., Results: Females showed higher levels of anxiety (p < 0.01). Anxiety in males was similar in the different semesters (p > 0.05); women of third and fifth semesters were more anxious than those at first semester (p < 0.01). Anxiety and psychological well-being were negatively correlated (p < 0.001). The "Less anxiety, higher level of well-being" and "More anxiety, lower level of well-being" subgroups were characterized, and a logistic regression identified that being a woman (OR = 4.70) and not practicing any religion (OR = 2.49) are predictive factors of higher levels of anxiety., Conclusions: Female medical students constitute a population at risk for higher levels of anxiety and less psychological well-being, which compromises their learning, quality of life and future professional practice., (Copyright: © 2019 Permanyer.)

The interest on cannabinoids became evident between the 1940 and 1950 decades. Although the active substance of the plant was not known, a series of compounds with cannabinomimetic activity were synthesized, which were investigated in animals and clinically. The most widely tested was Δ6a, 10a-THC hexyl. Δ6a, 10a-THC dimethylheptyl (DMHP) antiepileptic effects were studied in several children, with positive results being obtained in some cases. DMHP differs from sinhexyl in that its side chain is DMHP instead of n-hexyl. The first cannabinoid isolated from Cannabis sativa was cannabinol, although its structure was correctly characterized several years later. Cannabidiol was isolated some years later and was subsequently characterized by Mechoulam and Shvo. In 2013, the National Academy of Medicine and the Faculty of Medicine of the National Autonomous University of Mexico, through the Seminar of Studies on Entirety, decided to carry out a systematic review on a subject that is both complex and controversial: the relationship between marijuana and health. In recent years, studies have been conducted with cannabis in several diseases: controlled clinical trials on spasticity in multiple sclerosis and spinal cord injury, chronic, essentially neuropathic, pain, movement disorders (Gilles de Latourette, dystonia, levodopa dyskinesia), asthma and glaucoma, as well as non-controlled clinical trials on Alzheimer's disease, neuroprotection, intractable hiccups, epilepsy, alcohol and opioid dependence and inflammatory processes., (Copyright: © 2019 SecretarÍa de Salud.)

In Mexico there is a proliferation of "centers for aesthetic medicine" that offer different treatments with laser beam, mesotherapy and hyaluronic acid and botulinum toxin injections. In numerous centers of this type, offered and performed by medical personnel that are neither trained or certified to ensure the quality of services. The National Academy of Medicine of Mexico and the National Normative Council for Medical Specialties (CONACEM) communicate their posture on this matter., (Copyright: © 2018 SecretarÍa de Salud.)

In recent years, the use of stem cells for therapeutic purposes has received attention from research groups. In Mexico, the Mexican Official Standard 260-SSAI-2015 regarding the use of stem and progenitor cells for therapeutic and research purposes is in the process of authorization. Even when this has not been approved, an increasing number of establishments are offering medical services involving the use of stem cells for therapeutic purposes without official regulatory authorization. The Mexican Academy of Medicine of Mexico makes its position public in favor of regulating the use of stem cells and embryos for therapeutic and research purposes., (Copyright: © 2018 SecretarÍa de Salud.)

There are decisions at the end of life that currently are relevant as humanistic values. Respect for human life and dignity are part of human rights. The National Academy of Medicine of Mexico declares its posture about end-of-life decisions that include treatment refusal, limitation of the therapeutic effort, advance directives and palliative sedation, among others, with the purpose to favor a peaceful death., (Copyright: © 2018 SecretarÍa de Salud.)

As a consequence of the Presidential Decree that reforms and additions the General Statute of Health with regard to medicinal and scientific use of tetrahydrocannabinol, its isomers and stereochemical variants, the National Academy of Medicine of Mexico declares its position in favor of regulating investigation and national production thereof., (Copyright: © 2018 SecretarÍa de Salud.)

Background: Latin America has among the highest gastric cancer incidence rates in the world, for reasons that are still unknown. In order to identify region-specific risk factors for gastric cancer, we conducted a meta-analysis summarizing published literature., Methods: Searches of PubMed and regional databases for relevant studies published up to December 2011 yielded a total of 29 independent case-control studies. We calculated summary odds ratios (OR) for risk factors reported in at least five studies, including socioeconomic status (education), lifestyle habits (smoking and alcohol use), dietary factors (consumption of fruits, total vegetables, green vegetables, chili pepper, total meat, processed meat, red meat, fish, and salt), and host genetic variants (IL1B-511T, IL1B-31C, IL1RN*2, TNFA-308A, TP53 codon 72 Arg, and GSTM1 null). Study-specific ORs were extracted and summarized using random-effects models., Results: Chili pepper was the only region-specific factor reported in at least five studies. Consistent with multifactorial pathogenesis, smoking, alcohol use, high consumption of red meat or processed meat, excessive salt intake, and carriage of IL1RN*2 were each associated with a moderate increase in gastric cancer risk. Conversely, higher levels of education, fruit consumption, and total vegetable consumption were each associated with a moderately decreased risk. The other exposures were not significantly associated. No prospective study data were identified., Conclusion: Risk factor associations for gastric cancer in Latin America are based on case-control comparisons that have uncertain reliability, particularly with regard to diet; the specific factors identified and their magnitudes of association are largely similar to those globally recognized. Future studies should emphasize prospective data collection and focus on region-specific exposures that may explain high gastric cancer risk.

In the US, Mexican immigrant women often have better health outcomes than non-Hispanic white women despite a greater health risk profile. This cross-sectional pilot study compared women living in Chavinda, Michoacán (n = 102) to women who had migrated from Mexico to Madera, California (n = 93). The interview gathered information on acculturation and risk behaviors including smoking, alcohol use and number of sexual partners. The results suggest that more acculturated women living in the US are more likely to consume alcohol. US residence and higher acculturation level was marginally associated with having more than one sexual partner. There were no differences between odds of smoking among Chavinda and Madera women. While results with acculturation are not consistently significant due to small sample sizes, the results are suggestive that acculturation among immigrant Hispanic women in the US may be associated with adverse health behaviors, and selective migration seems less likely to account for these differences.

Objective: To describe the relationship between blood lead levels (BLL) and poor school performance., Material and Methods: A cross-sectional study was carried out in 1996 among 792 schoolchildren aged 7-14 years, who attended the outpatient units of five pediatric hospitals of Mexico City. BLL was measured together with lead exposure and academic performance., Results: Reported BLL and geometric means (GM) were 8.6 microg/dL and 7.7 microg/dL, respectively. The main source of exposure was the use of glazed pottery (difference of use =-1.182; p = 0.000). Among schoolchildren who failed any school year, GM of the BLL was 8.1 microg/dL, compared with children who did not fail (GM = 7.6 microg/dL; p = 0.240). The risk of failing a school year between the 1st and 3rd grade with a BLL greater than 10 microg/dL was 1.73 (p = 0.012, IC 95% 1.13-2.66) and from 1st to 4th grade was 1.62 (p = 0.021, IC 95% 1.07-2.46)., Conclusions: Blood lead levels, among other conditions, may contribute to the failure in school performance observed in the children participating in this study.

Objective: To characterize tobacco use according to level of poverty in a random, nationally representative sample of adolescents (10 to 21 years old), living in urban areas with less than 50,000 inhabitants. The study was done in 2001 as part of the baseline assessment of the evaluation of the governmental program, Oportunidades., Material and Methods: A questionnaire was applied to 29,548 adolescents living in 30 000 selected households and it included specific questions on individual tobacco use among other questions., Results: The prevalence of smokers was 3.5% (95% CI: 3.3%-3.7%) and experimenters 9.9% (95% CI: 9.6%-10.2%). A logistic regression model for clustered data was constructed in order to evaluate the associated factors that distinguish a smoker from an experimenter. After adjusting for level of poverty of the household and use of alcohol and drugs, a significant association (OR = 1.5, p <0.01) was found with having a paid job and a differential association was found between gender and age group., Conclusions: The results of this study suggest that the additional availability of money that an adolescent has, could increase the prevalence of tobacco smoking and that the program Oportunidades should include prevention campaigns directed specifically at this population group.

Objective: This study presents findings from the Global Youth Tobacco Survey (GYTS) regarding current cigarette smoking and other tobacco epidemic indicators., Material and Methods: The GYTS used a two-stage cluster sample survey to generate representative samples of students aged 12 to 15 years old enrolled in public, private and technical schools. The survey was undertaken at 492 schools in 21 cities. The GYTS surveyed 42,024 students between the years 2003 and 2005. A logistic regression model was applied and crude and adjusted odds ratios were estimated., Results: The overall current smoking rate during the 30 days preceding the survey was 19.96% (95% CI 18.1-21.8). Among those who never smoked, 25% were likely to begin smoking in the following year. Sixty percent of current smokers who bought their cigarettes in stores were not refused purchase because of their age. Exposure to advertising in outside areas was 86 and 54% of students reported to have been exposed to smoke in public places., Conclusion: Comprehensive tobacco control programs should prevent access by minors to cigarettes, make it more difficult to smoke, and prohibit all forms of tobacco advertising. In addition, options should be provided for those who wish to quit smoking and adolescents and their families should be educated with respect to the dangers of smoking.

Objective: To assess the extent of exposure for Volatile Organic Compounds (VOCs) among nonoccupationally exposed commuters in Mexico City., Material and Methods: Blood concentrations of benzene, toluene, ethylbenzene, m-/p-xylene, o-xylene and methyl tert-butyl ether were determined on samples collected from participants after the morning commute., Results: Median blood concentrations of benzene (0.11 microg/l), ethylbenzene (0.081 microg/l), m-/p-xylene (0.32 microg/l) and toluene (0.56 microg/l) in the Mexico City participants were all approximately two times higher than in a nonsmoking subset of the Third National Health and Nutrition Examination Survey population of the United States. On the other hand, median VOC blood levels were similar to medians observed in other studies involving commuters in specific U.S. cities, despite the fact that only half the Mexico City study participants commuted by personal vehicles compared with all U.S. commuters., Conclusions: These results reflect the extent of the air pollution problem in Mexico City. The surrounding topography exacerbates the problems caused by heavy vehicular traffic, poor emission-control devices on older vehicles, and poor maintenance practices. Elevated levels of gasoline components in the blood of nonoccupationally exposed commuters emphasize the need for regulatory initiatives and mass-transit options to reduce hydrocarbon emissions and thus reduce the risk for nonoccupational exposure for the residents of Mexico City.

Objective: To assess blood lead levels and lead exposure factors in children living in Morelos State, Mexico., Material and Methods: A cross-sectional study was conducted between June and October 1996, in 232 children aged 1-12 years, at Hospital del Niño Morelense de Cuernavaca, Morelos, Mexico. Blood lead levels were measured by anodic voltameter, and exposure factors were collected by questionnaire. The lead concentration value was log transformed for statistical analysis. Odds ratios were obtained for some risk factors. The statistical significative risk factors were later analyzed with ANOVA., Results: A total of 232 children were recruited (50% female); 73% resided in Cuernavaca City. The geometric mean blood lead level was 6.7 micrograms/dl; 29.7% of the children had levels over 10 micrograms/dl; 66% reported use of lead glazed pottery for cooking, 36% for storing food, and 19% for drinking., Conclusions: Blood lead levels were similar to those reported in other Mexican children studies, after the reduction of lead in gasoline. The main risk factors were use of lead glazed pottery and vehicle traffic intensity near the household. These results will be useful for future prevention and control interventions. This paper is available too at: http://www.insp.mx/salud/index.html.

Smoking is presently one of the most important public health problems worldwide. Even though smoking is a preventable cause of morbidity and mortality, it still contributes importantly to the burden of disease. In Mexico, contrary to what is happening in other parts of the world, the smoking epidemic is in an early phase, as evidenced by the low number of lung cancer cases or deaths, and by the minimal public health efforts to control tobacco consumption. One of the most important advances is its recognition as a priority public health problem by public health workers and society in general. Effective interventions to reduce tobacco consumption have been launched to render the country free of tobacco. These public health interventions are being countered by the tobacco industry and the market forces that strive to preserve smoking as a life style of the population. The present work reviews the production means of the Mexican tobacco industry, particularly those of cigarettes, the market structure, and the product expansion in the Mexican population. This information should be useful to frame effective preventive measures, in the short and long term, to control this epidemic.

Objective: To evaluate the differences between indoor and outdoor ozone (O3) and nitrogen dioxide (NO2) levels at a school located in southwest Mexico City., Material and Methods: Indoor and outdoor O3 and NO2 levels were measured daily between January and April 1990 by manual monitoring., Results: Indoor and outdoor concentrations of nitrogen dioxide did not surpass the Mexican standard (0.21 ppm). The correlation coefficient between maximum NO2 concentrations measured by the city's local monitoring station and those measured outside the classroom was 0.82 (p < 0.001). Regarding ozone, its maximum outdoor concentration was 0.29 ppm and indoor concentrations were on average below 0.06 ppm (maximum = 0.17 ppm). The indoor/outdoor correlation coefficient was 0.72, and for every 1.7 ppm outside, there was 1.0 ppm inside (p < 0.05)., Conclusions: Since the highest outdoors O3 concentrations were observed between 11:00 and 14:00 hrs, it is recommendable to have recess before this time.

Objective: To model the variability of medical visits by children for respiratory reasons as a consequence of the daily changes in environmental pollution observed in the emergency and family medicine departments of a hospital of the Instituto Mexicano del Seguro Social located in the southwest of Mexico City during 1993., Materials and Methods: The correlation between the presence of upper and lower respiratory tract infections and exposure to ozone and nitrogen dioxide was studied. To model this association, the authors used multivariate Poisson regression models with linear and non-linear risk, with lag periods between the environmental measurements and the medical visits of one, two and three days, as well as the average of the measurements of three, five and seven days previous to the visit., Results: The model estimates that an increment of 50 ppb in the daily average of ozone would cause an increase of 9.9% in emergency visits due to high respiratory tract infections during the winter, which could rise to 30% if the increment would last five consecutive days in average., Conclusions: Results suggest that exposure of children younger than 15 years of age to ozone and nitrogen dioxide significantly affect the number of medical visits for respiratory causes in this part of Mexico City.

Objective: Previous researches pointed out the critical changes needed to increase the efficiency of the National Screening Programme of Cervical Cancer in Mexico. These changes were assessed through a cost-benefit analysis. This paper presents the results of that appraisal. Figures are presented as US Dollars of 1996 valued as 7.5 pesos for each dollar., Results: The operational unitary cost of the integral process of the cytology-the obtention of the Pap smear, its transportation to the interpretation centre, its analysis, and the notification of results to users-was estimated in US$ 11.6. If the proposed changes are operated, the cost of each citology would increase by 32.7%. The benefit/cost ratio would be 2 and the net benefit of 88 millions of US dollars for the next five years., Conclusions: The operation of the proposed changes is socially desirable, but should be supported the training activities of the personnel, the increase of the coverage of women at risk, the quality control activities, the monitoring of the program and the communication with women detected as positive cases.

We developed a panel study to evaluate the association between intermittent exposure to ozone and acute attack of asthma. The population study consists in 136 asthmatic children residents in the southwest and northeast of Mexico City. They were attended in the allergic services of the two main Pediatric Hospital of Mexico City. In this paper we present the methodological issues following in the study and the results of the descriptive analysis of the relation between ozone exposure and acute attack of asthma.

We report the injuries for "E" code in 10191 subjects attending four general hospitals of Mexico City. Seventy-nine per cent of them were males and 29.1 per cent were females. THe highest utilization rate of the care unit was during weekends. Only 14 per cent of the study population were admitted to the hospital. People classified as drunk were more likely to have more severe injuries and to be admitted to the hospital and female drinkers had the highest risk of hospitalization (RR = 3.03; IC = 1.85-5.04). Only in 49 per cent of the cases was the external cause of injury coded The main causes were gunshots and stabbing with knife or cutting weapon. In this study we found a greater proportion of fractures in women than in men, pointing toward the possible presence of osteoporosis in the female population.

The epidemiological study of measles needs a critical perspective in addition to a descriptive study of variables in time, place and person. The goal of this critical and methodological study of measles is to evaluate the coverage and efficacy of the vaccine in the affected population. These indicators will provide an indirect evaluation of the preventable services. This document presents a general view of the epidemiological design of cohorts and case-control studies and their immediately application to the study of measles. It describe the mathematical procedures for calculating the coverage and efficacy of the measles vaccine in community and hospital outbreaks.