Oscar Velázquez Monroy

Secretaría de Salud, Ciudad de México, The Federal District, Mexico

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Publications (16)12.11 Total impact

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    ABSTRACT: The current surveillance model used by the Malaria Control Program in a Mexican state was analyzed using a systematic evaluation of the model ("PAATI" programs, actions, activities, tasks and inputs) through a diagrammatic evaluation of all the components in the process. The actions, activities tasks and inputs of this surveillance model (based on active and passive malaria case detection using tick blood smears examination), as well as those of an innovative alternative model (based on passive malaria case detection using immunodiagnostic strips, with an overall sensitivity of 93.3% and specificity of 99.5%) were identified and evaluated. It was documented that although the same actions are carried out in both models, many more activities are necessary with more tasks and inputs (traditional: 19 activities and 55 tasks, alternative: 13 activities and 32 tasks) in the current one. Adjusting to a population of 10,000 inhabitants, 1000 prospective cases and 2 years of surveillance, the cost of diagnosing and treating one malaria case was of 8.97 US dollars in this model and of 6.34 US dollars in the alternative one.
    Health Policy 04/2007; 80(3):465-82. · 1.55 Impact Factor
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    ABSTRACT: Las enfermedades cardiovasculares representan la principal causa de morbilidad y mortalidad. El 25% de los fallecimientos por debajo de los 60 años de edad está relacionado con las enfermedades crónicas no transmisibles. Estos padecimientos son más frecuentes en países en vías de desarrollo; los cambios en los hábitos alimenticios con altos contenidos en grasas saturadas y grasas trans, así como el incremento del consumo de sodio, tabaco, alcohol y sedentarismo; incrementan el riesgo cardiovascular no sólo en la población adulta, sino también en los adolescentes y niños. El análisis realizado por la Dirección General de Epidemiología de la Secretaría de Salud en el período comprendido de 1998 al año 2000 revela que el porcentaje de defunciones por enfermedad coronaria fue de 55% para los hombres y de 45% de las mujeres; el síndrome coronario agudo fue el responsable del 83.5 y 76.8% de las defunciones en hombres y mujeres, respectivamente. Por lo que las estrategias de prevención primaria destinadas a la población en general y de manera especial en el adulto joven son un elemento indispensable para la disminución de las enfermedades crónicas no transmisibles y su impacto en la salud pública.
    Archivos de cardiología de México 03/2007; 77(1):31-39.
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    Salud publica de Mexico 01/2007; 49(2). · 0.94 Impact Factor
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    ABSTRACT: Cardiovascular diseases are the main cause of death and disability in México. 25% of deaths under 60 years of age are related to chronic degenerative diseases. These disorders are more common in developing countries and are caused by an excessive intake of fatty acids, sodium, alcohol, tobacco consumption and decrease in physical activity. The prevalence of risk factors is increasing not only in adult population but also in youth and children. Data from the Department of Epidemiology from the Mexican Ministry of Health in the period between 1998 and 2000 showed that the death caused by coronary artery disease was more frequent in men (55%) than women (45%) and acute coronary syndrome was responsible for deaths in 83.5% of men and 76.8% in women. Primary Prevention Programs are necessary to decrease the impact of cardiovascular diseases.
    Archivos de cardiología de México 01/2007; 77(1):31-9.
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    ABSTRACT: Objetivo. Identificar los factores de riesgo individuales determinantes para contraer paludismo en habitantes del foco residual de transmisión de paludismo localizado en la costa del Pacífico de Oaxaca. Material y métodos. Se realizó un estudio pareado de casos y controles, con base poblacional de enero de 2002 a julio de 2003, comparando la frecuencia de exposición a diversos factores de riesgo individuales en sujetos que presentaron un cuadro clínico de paludismo y controles no infectados. Un caso de paludismo fue definido como un individuo que vive en el área de estudio que presentó síntomas de paludismo y diagnosticado positivo a P. vivax en examen de gota gruesa de sangre, los controles fueron individuos negativos a parásitos y anticuerpos anti-P. vivax del mismo sexo y ± cinco años la edad del caso. Se usó un cuestionario estandarizado para registrar información de factores de riesgo individuales asociados a episodios de paludismo en casos y dos controles por caso. Resultados. El análisis en un modelo de regresión logística condicional múltiple, 18 de 99 variables fueron significativamente asociadas (p< 0.05) con el incremento en el riesgo de paludismo, incluyendo: nacer fuera de la localidad (RM 3.16, 95% IC 1.16-6.13); hablar sólo un idioma autóctono (RM= 2.48, 95% IC 1.19-3.77); pobre conocimiento de cómo se transmite y trata el paludismo (RM= 2.26 95% IC 1.10-4.66 P< 0.02); 95% IC 5.98-70.87, P< 0.000; RM= 3.78, 95% IC 1.21-11.80, para 60-100% y 30-59%, respectivamente); casas construidas con materiales perecederos (RM= 2.85, 95% IC 1.62-5.01); localización de la casa en la periferia de la localidad (RM= 6.23, 95% IC 3.50-11.0); dormir en el suelo (RM= 2.98, 95% IC 1.78-5.01); dormir con dos o más personas en la misma cama (RM= 1.85, 95% CI 1.09-3.14); no uso de mosquiteros (RM= 2.39, 95% IC 1.18-4.83, P< 0.003), uso de mosquiteros con agujeros (RM= 13.93, 95 IC 2.48-78.01); viajes fuera de la localidad de residencia (RM= 9.16, 95% IC 1.98-42.2); y casos previos de paludismo en la casa (RM= 5.84, 95% IC 3.33-10.22). Conclusiones. El riesgo para la infección de paludismo se asoció a factores socioculturales y ambientales que incrementan la exposición de los individuos a la picadura de mosquitos. Un riesgo mayor de infectarse por paludismo ocurrió en la periferia de la localidad y por transmisión intradomiciliaria probablemente a causa de los familiares asintomáticos con recaídas.
    Salud pública de México, ISSN 0036-3634, Vol. 49, Nº. 3, 2007, pags. 199-209. 01/2007;
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    ABSTRACT: En 1992 apareció en el sureste asiático un nuevo tipo de virus de la influenza, el cual ha ocasionado hasta la fecha más de 120 casos y un poco más de 60 defunciones en humanos en Camboya, Vietnam, Indonesia y Tailandia. Esta situación es considerada por los expertos como la probable génesis de una nueva pandemia de influenza, lo que podría traer graves consecuencias para la salud de la población, así como para la economía y el comercio mundial. Por lo anterior, la Organización Mundial de la Salud (OMS) ha instado a los países miembros a desarrollar planes de preparación y respuesta para hacer frente a esta eventualidad. En el marco del Comité Nacional para la Seguridad en Salud, México ha diseñado el Plan Nacional de Preparación y Respuesta ante una Pandemia de Influenza con objeto de proteger a la población mediante acciones efectivas y oportunas. El Plan utiliza una escala de riesgo y define cinco líneas de acción: Coordinación, Vigilancia Epidemiológica, Atención Médica, Difusión y Movilización Social, y Reserva Estratégica. Si bien es imposible predecir cuándo se presentará la próxima pandemia y su impacto, es fundamental que las autoridades de salud nacionales, estatales y locales establezcan los mecanismos para poner en marcha los componentes del Plan en forma oportuna y garantizar con ello la salud de la población en caso de influenza pandémica.
    Salud publica de Mexico 01/2006; · 0.94 Impact Factor
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    Salud pública de México, ISSN 0036-3634, Vol. 48, Nº. 1, 2006, pags. 72-79. 01/2006;
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    ABSTRACT: Propósito: A través de una Re–encuesta Nacional sobre Hipertensión Arterial Sistémica (HTAS) y Factores de Riesgo Cardiovascular, en población adulta con HTAS identificada en encuestas nacionales de salud del año 2000; Determinar: 1) Las tasas de morbilidad y mortalidad. 2) La incidencia e interrelación en el tiempo con otros factores de riesgo, tales como Obesidad, Dislipidemia, Diabetes y Tabaquismo. 3) Los principales factores de riesgo asociados a HTAS que influencian la aparición de complicaciones, necesidad y numero de días de hospitalización. 4) El grado de adherencia y tipo de medicación usada por el paciente hipertenso.
    Archivos de cardiología de México 03/2005; 75(1):96-111.
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    ABSTRACT: To evaluate the accomplishment of the treatment basic goals of every person with diabetes type 2 that attend the Mutual Help Groups (GAM) of the Mexican Ministry of Health (SS). This transversal comparative study was carried out in 15 Mexican states, through the accomplishment reports of the treatment basic goals of the GAM integrants by June of 2001, compared to the reported figures by the Health Information System for Open Population (SISPA), Ministry of Health on the same date. The studied variables are: age, sex, blood glucose, blood pressure, body mass index, physical activity and pharmacological treatment. The treatment basic goals accomplishment for 6, 958 people with diabetes was evaluated, all of them attended the Ministry of Health GAMs, in 15 of the 32 Mexican states including the Federal District. When comparing frequencies of patients with diabetes controlled by the GAM and the SISPA, a differential was appreciated, being observed a tendency that showed that people in the GAM were much more controlled; when analyzing with the test Student "t" the differences were even more significant (p < 0.005). The obese diabetics group had a higher risk of being uncontrolled, in relation to the group of non-obese diabetics (OR 1.8, CI: 1.06,1.32; p < 0.002). When comparing the sedentary to the non-sedentary group it was found that the sedentary diabetics presented 1.56 times higher risk of being uncontrolled, that those in the diabetes group that carried out physical activity (CI: 1.37,1.78; p < 0.001). The Mutual Help Groups are a fundamental strategy in the educational line for improving the disease control, since people with diabetes or hypertension and their relatives play an active role in treatment development accomplishment, as well as in the disease prevention and control. Unlike to that reported in the SISPA, the highest benefits of control, are achieved in people with diabetes or hypertension who attend the GAM.
    Archivos de cardiología de México 01/2004; 74(4):330-6.
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    ABSTRACT: To describe the clinical characteristics of the diabetic population that formed part of a population-based survey conducted in México. In 2000, information was obtained from 42,886 subjects aged > or =20 years using a multistage sampling procedure. Standardized questionnaires were used. Anthropometric measurements, blood pressure, and capillary glucose concentrations were taken. Type 2 diabetes was found in 3,597 subjects (age-adjusted prevalence 8.18%), of which 2,878 (80%) had previously been diagnosed. The average age of the diabetic participants was 55.2 +/- 13.5 years; 13% were <40 years of age. Nine percent had been diagnosed for >10 years. The average BMI was 29.2 +/- 5.7 kg/m(2); three-quarters of the cases had BMI >25 kg/m(2). The average waist circumference was 102 +/- 13.4 cm, and increased waist circumference was more common among women. Arterial hypertension was found in half of the cases and, of those on treatment, only one-third had a blood pressure <140/90 mmHg. Smoking was reported in 34% of the diabetic group, a higher rate than in the nondiabetic subjects. There was at least one modifiable coronary risk factor in 67.6% of the cases. Very few followed an exercise or dietary regimen and a small percentage used insulin. Diabetes affects a large proportion of Mexican adults (8.18%). This figure may be underestimated. The majority of the subjects had modifiable risk factors for the chronic complications of diabetes. Only a few achieved adequate blood pressure control and other treatment goals.
    Diabetes Care 07/2003; 26(7):2021-6. · 7.74 Impact Factor
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    ABSTRACT: Hypertension remains as a major cause of cardiovascular morbidity in México. The Health National Survey 2000 of México was performed to analyze the current status of the prevalence of some risk factors such as diabetes, hypertension (HTA), obesity, smoking, and proteinuria. A National Survey was carried out in México where 45,300 individuals between 20 to 69-y.o. were screened. The estimated sample size was calculated considering the total number of persons into the mentioned age; a minimal prevalence of 6% of the included risk factors, at a significance level of 0.05; a maximum relative error of 0.145, and a rate of response of at least 70%. Diagnosis of HTA was accepted in: previous medical diagnosis with prescription of antihypertensive drugs, or high blood pressure (> or = 140/90 mmHg) detected during the interview. Data were adjusted for the national distribution of age-groups and gender (established in 2000, INEGI). 38,377 (98.8%) individuals were correctly screened for blood pressure. The prevalence of hypertension in México was 30.05% (34.2% in men and 26.3% in women). The prevalence was directly related with age and gender. The percentage of mexicans with HTA after 50-y.o. is > 50%. The prevalence was greater in women after 50-y.o. Among persons with hypertension, treatment was detected in 46% and approximately 20% of them were controlled (< 140/90 mmHg). The percentage of mexicans with HTA who were unaware that they have high blood pressure was 61%. The total percentage of HTA controlled was 14.6%. The North states had the greater prevalence (approximately 34%) of HTA while South states had the lower prevalence (27%). The odds ratio (age/sex-adjusted) for HTA were: for diabetes 1.54(CI95%, 1.44-1.63); for obesity 2.3 (CI 95%, 2.22-2.43); for smoking 1.26 (CI 95%, 1.21-1.32). For proteinuria subjects, 40% had HTA. Around 15 millions of mexicans between 20 to 69-y.o. had hypertension, 60% of them are unaware. The prevalence of hypertension in México (30.05%) has increased. Among persons with hypertension -15% are controlled. The North of México has the higher prevalence of hypertension. Diabetes, smoking, and obesity increase the risk of hypertension. The 2000 National Survey of Health shows the epidemiological trend in several important chronic diseases in México and declare an urgent need of new strategies for detection, control and treatment of hypertension.
    Archivos de cardiología de México 01/2002; 72(1):71-84.
  • Salud publica de Mexico 49(2):83-4. · 0.94 Impact Factor
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    ABSTRACT: Based on a National Re-survey on Hypertension (HTA) and other cardiovascular risk factors performed in Mexico during 2003 and 2004 in the adult population with HTA, as identified in the 2000 National Survey of Health, this study was planed to determine: 1) morbidity and mortality rates; 2) the incidence and interrelation with other risk factors, such as overweight, obesity, dyslipidemia, nephropathy and diabetes; 3) the main risk factors associated to HTA involved in its complications, need for hospitalization and number of days; and, 4) the degree of therapeutical adhesion and the type of antihypertensive drugs used. The survey was of type III using the step by step method described by WHO. Sampling was weighed a priori taking into account a national prevalence average of HTA of 30.05% and its corresponding rate for each federal state. Permissible maximum error in the estimation = 0.28. Effect of design = 4.5; and, Rate of awaited answer (0.70). From the initial 14,567 interviewed patients, 1,165 (8%) subjects were considered non-hypertensive or false positives at the 2000 survey. From the 13,402 remaining patients, 335 died during the first 2 years of pursuit, which implies an annual mortality of approximately 1.15% in the hypertensive population. Thus, 13,067 survivors were subjected to the final analysis. The mean age at the re-survey was 45.6 +/- 12.6; 40.5% were men (n = 5,295). There was a statistically significant difference in height, but not in weight between both genders. The control HTA was raised 14.6% in the year 2000 and 19.2% in 2004. The prevalence of diabetes was duplicated from 16% to 30% (< .001). Fifty four percent of the whole population required hospitalization at least once during the period of study. The rates of overweight, obesity, and dyslipidemia rose significantly (p < 0.05) independently from age, federal state, and gender. RENAHTA shows the impact of hypertension on the morbidity and mortality during the 3.1 +/- 1.5 years of follow-up in Mexico. It alerts us on the need to reinforce the strategies of attention and prevention of this crucial risk factor and of screening the dynamic nonlinear interaction between the main cardiovascular risk factors in Mexico. New hypotheses are proposed for the metabolic syndrome.
    Archivos de cardiología de México 75(1):96-111.
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    ABSTRACT: To know the prevalence and the interaction among the principal cardiovascular risk factors such as hypercholesterolemia (HCL), hypertension (HTA), overweight, carbohydrates metabolism disturbances, and smoking, an urban survey was performed in the six Mexican Republic states, where the national population is more concentrated. This survey was transversally designed using the WHO type-III model in 120,005 adults from 6 highly populated urban centers (Mexico City, Guadalajara, León, Puebla, Monterrey andTijuana) were included. A blood sample from each person was obtained to quantify fasting glucose and cholesterol. Blood pressure, height and weight were measured using daily validated systems. Data were analyzed by a multicategorical conjunctive consolidation model and by multiple regression models. HCL global prevalence showed to be 43.3% for a population with an average age of 44.1 years. Female gender showed a slightly but statistically significant greater prevalence of HCL than male gender (44% vs 42.2%). From whole women population 33.2% declared to be in menopause, and 59.7% of them had HCL. In addition, HCL was directly related to body mass index (BMI). Thus, in those subjects with BMI < 25 showed a HCL prevalence 34.1%; while those with BMI was between 25 and 29.9, the HCL prevalence was 45.9%, and in those subjects with BMI > or = 30 Kg/m2, ranked a HCL prevalence of 47.3%. The prevalence of hypertension was 30.2% and 52.5% of them had HCL prevalence. Type-2 diabetes mellitus prevalence (DM-2) was 10.7%, 55.2% of them had HCL. In the group aged between 20 to 34 years old, the obesity was the principal determinant for higher HCL prevalence. The HCL prevalence showed to be quite similar in population with and without smoking. In conclusion, HCL prevalence shows 4 progressively increasing gradients associated with age, HTA, DM-2 and BMI.
    Archivos de cardiología de México 74(3):231-45.
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    ABSTRACT: Objetivo. Investigar la participación de factores demográficos, socio-económicos y ecológicos en la transmisión de la malaria en el foco de transmisión residual más importante en México, localizado en el estado de Oaxaca. Material y métodos. La extensión del foco se determinó por medio de un análisis espacio-temporal de la distribución de casos de malaria en el estado entre 1998 y 1999, usando un Sistema de Información Geográfico. Un índice de intensidad de transmisión de malaria (MTII, por sus siglas en inglés) se construyó basado en el número total de casos durante el periodo del estudio y la duración y frecuencia de brotes de transmisión dentro de las localidades. La relación de determinantes locales con el MTII se investigó por medio de modelos multinomiales logísticos. Resultados. La distribución de localidades según su MTII fue de 325 alto, 341 medio, 142 bajo y 717 sin transmisión. Localidades con MTII alto estuvieron asociadas a las áreas de clima tropical con lluvias en verano y evaporación baja. La mayoría de las localidades con MTII alto se localizaron a elevaciones entre 200 y 500 msnm, en el área alrededor de la ciudad de Pochutla. La cantidad de arroyos temporales en la vecindad de localidades tuvo una asociación positiva significativa con el MTII. La cercanía a carreteras de localidades con MTII alto fue significativa. Conclusiones. Los factores principales que determinan la transmisión de la malaria en el foco están relacionados con las condiciones favorables para la cría de mosquitos vectores. La participación de movimientos de población de rango cortos alrededor de Pochutla, la principal ciudad económicamente activa en el área, indica la necesidad de implementar un sistema de vigilancia epidemiológica para detener la dispersión de nuevos brotes.
    Salud pública de México, ISSN 0036-3634, Vol. 48, Nº. 5, 2006, pags. 405-417.
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