This paper reviews the methods and principles for quality of life assessment. The aging of the population and the improved survival of people with acute and chronic conditions have produced several levels of disability requiring long-term treatment and rehabilitation. In 1948 the World Health Organization defined health as not merely the absence of disease but rather a state of complete physical, mental, and social well being. This term evolved from its conceptual definition to the development of scales to measure the quality of life beyond physical status. Thus, quality of life assessment includes areas such as mental health, social support, and life satisfaction. It is recognized that the expectations, vitality, pain, disability, and personal experiences influence the perception of a person's general health. A composite measurement aimed to quantify health according to physical, mental, and social well being simultaneously would likely find people at different points on the three different continua, but in the midranges of the composite. The multidimensionality problems and the level of subjectivity involved in the assessment of the quality of life require valid and reliable instruments. This paper present an inventory of 126 questionnaires aimed to measure the quality of life for several diseases and populations. A better understanding of the methods to assess the quality of life will allow the incorporation of these instruments in the comprehensive assessment of patients, into clinical trials, and for health services research. The English version of this paper is available at: http://www.insp.mx/salud/index.html.
This paper discusses, on the basis of the Bruntland Report on development and environment, the relationship between population and development possibilities, and its consequences on natural and man made resources. The author emphasizes the need to design development policies in which the protection of the environment is a priority, specially in Latin American countries.
Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over seven years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, a wide range of datasets to assess the effect of this reform on different dimensions of the health system was used. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affilates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.
To measure the underregistry of mortality in children under five years old, and the coverage of the Birth Certificate (BC) in municipalities with very low human development index (HDI) in Mexico.
We studied all deaths of children under five years old occurred in 2007 and all births occurred in 2007 and 2008 in a sample of 20 municipalities with very low HDI in Mexico. We conducted an intentional search of births and deaths.
We identified 12 additional deaths not included in official registries, for an underregistration of 22.6%, and 68.1% of births did not have a BC. Lack of BC was more frequent if the mother did not speak Spanish, if she did not have Seguro Popular if the birth was attended by a traditional midwife. Conclusions. It is necessary to strengthen the registry of deaths and births in municipalities with very low HDI.
The nucleotide sequence of the human immunodeficiency virus (HIV-1) gp120 variable region (V3) was obtained by sequencing the product of the polymerase chain reaction (PCR) amplification of seven HIV-1 Mexican isolates from patients who had been infected either sexually or through blood products. Mexican isolates showed a 61.4% homology between them and three viral subtypes were demonstrated. One of these corresponds to three sexually infected patients, another to two hemophiliac patients infected through blood products or transfusions and the third subtype to either sexually or blood infected patients. The latter shows a great similarity to the HTLV-IIIb/LAV prototype strain. Antigenic profiles of this region show at least three neutralization patterns for these isolates as well as one virus that does not have a high predictive value epitope in the V3 region. Our data show that Mexico has a high heterogeneity of HIV-1 circulating strains, similar to that reported in other regions of the world.
To determine the association between overweight and obesity among Mexican school-aged children and participation in the Liconsa milk and the School Breakfast food assistance programs.
Data from 15 003 school-aged children included in the Mexican National Health and Nutrition Survey 2006 (ENSANUT 2006) were analyzed. Information on body mass index (BMI) and participation in food assistance programs was obtained. Descriptive analyses were conducted and logistic regression models were adjusted.
Prevalence of overweight and obesity was 17.3% and 9%, respectively. No significant association between overweight and obesity and participation in Liconsa was found. Among school-aged children in the middle socioeconomic status quintile, those enrolled in the School Breakfast program were more likely to be overweight than those not enrolled (OR= 1.6, 95% CI 1.1, 2.3).
We found no association between the Liconsa and the School Breakfast programs and overweight or obesity in school-aged children.
To assess the association between self-reported academic performance and tobacco experimentation and established tobacco use among adolescents and young adults in Morelos State, Mexico.
A population-based, cross-sectional study was carried out in 72 administrative areas from all 33 municipalities of Morelos State (urban, semi-urban and rural areas). A total of 13,293 adolescents and young adults aged 11 to 24 years were randomly selected from public schools. Data were collected using a self-administered questionnaire. Multinomial logistic regression models were fitted with smoking habit as the dependent variable with three categories (never a smoker, occasional smoker, and regular smokers).
The prevalence of occasional smokers was 14.9% (95% CI: 14.1-15.7) among females and 27.3% (95% CI: 26.1-28.4) among males. The corresponding figures for females and males for established smokers were 6.1% (95% CI: 5.6-6.6) and 13.1% (95% CI: 12.2-13.9), respectively. Academic performance self-reports were found to be inversely proportional to occasional or regular tobacco use. In women, the association with current tobacco consumption was 5.1 times higher (95% CI: 2.5-10.4) in women with a yearly grade average of six or less, in comparison to those with scores of ten or nine. The same pattern was observed in men (OR = 4.2; 95% CI: 2.7-6.7), with a significant linear trend both in both women and men.
These results evidence that tobacco consumption is related to low academic performance. This relationships is determined by complex lifestyle patterns of adolescents.
To describe the micronutrient nutritional status of a national sample of 1-11 year old Mexican children surveyed in 2006 in National Health and Nutrition Survey (ENSANUT 2006) and their association with dietary and sociodemographic factors.
Serum samples were used (n=5 060) to measure the concentrations of ferritin, transferrin receptor, zinc, copper and magnesium.
Prevalence of deficiencies in 1-4 and 5-11y old children were for iron (using low ferritin) 26.0 and 13.0%; zinc, 28.1 and 25.8%, respectively; and copper, ≈30% in both age groups. Magnesium low serum concentrations (MLSC), were found in 12.0% and 28.4% of the children, respectively. Being beneficiary of Liconsa (OR=0.32; C.I.95%, 0.17-0.61) or belonging to higher socioeconomic status (OR=0.63; C.I.95%, 0.41-0.97) were protective against iron deficiency. Increasing age (OR=0.59; C.I.95%, 1.19-1.32) and living in the Central Region (OR=0.59; C.I.95%, 0.36-0.97) were protective against MLSC.
Deficiencies of iron and zinc are serious public health problems in Mexican children.
The clinical and epidemiological importance of rubella relates to its teratogenic effects. When this disease occurs in children, adolescents and adults, it is usually benign. On the other hand, these age groups are source of disease transmission to pregnant women. The serology studies on rubella carried in Mexico prior to 1974, detected seropositivity levels from 87.1 to 97.7 percent in children younger than 14 years of age. In contrast, the National Seroepidemiology Survey (NSS) (1988) reported a much lower seropositivity (69.3%) in children of the same age group, and a rate of 80 percent in women of reproductive age. This situation is a particular problem for Mexico where a high proportion of the pregnancies occur during adolescence. While previous research has commented on descriptive measures of seroprevalences in women, this study, which is based on a logistic regression model, has the purpose of identifying the factors associated with the immunological status of girls between 10 and 14 years of age. The variable which showed the most evident relation to the antibody levels for rubella was years of schooling. The odds ratios (OR) for seropositivity among those who finished secondary schooling was 2.05 times (CI 1.28-2.56) that of the illiterate group. Other statistically significant variables were related to residence, urban vs rural (OR = 1.69; CI 1.48-2.12) and age, 10 vs 14 years (OR = 1.93; CL 1.69-2.42). Based on the multivariate model, it was observed that the girls with a greater risk of seropositivity were those who live in urban areas, attend secondary school, and are 14 years of age, with an OR = 4.05 (G = 6,756.4 and 5,580 gl; p less than .001). The study concludes with the following considerations: the immunological levels of girls from 10 to 14 years of age are low, and the results of the NSS suggest that Mexican public health authorities should evaluate the policy of vaccination against rubeola in the population potentially at risk, and that the factors associated with the disease, in descending order, are: years of schooling, age, and place of residence. It is also necessary to carry out analytic studies which will identify the risks and the etiology of congenital malformations which are likely to have been associated with the occurrence of rubeola virus during pregnancy.
To assess antibiotic use for upper respiratory infections (URI) treatment on patients under 16 years-old who are beneficiaries of a pre-paid health care scheme.
A database containing the record of all the medical prescriptions for URI treatment, from May 1997 to April 1998 was analyzed. Patients were under 16 years old and had been diagnosed with common colds, pharyngitis, bronchitis, sinusitis, otitis, and other unspecified upper respiratory tract infections. Three hundred and fifty-one physicians of seven different specialties who attended 25,300 beneficiaries wrote such prescriptions.
A total of 30,889 assorted medications were prescribed to 5,533 patients with the above diagnoses. Antibiotics were prescribed for 77.5% of all diagnoses, ranging from 58% for pharyngitis to 91% for laryngitis. The most frequently used antibiotics were: penicillin, cephalosporins, and macrolides.
This study presents the information of antibiotics prescription practices for URI in a pre-paid health plan in Mexico. These findings may be used to support specific campaigns for rational use of antibiotics among children attended at private ambulatory health care practices.
Mycoplasma genitalium has been associated with nongonococcal urethritis (NGU). Diagnosis by PCR has become the primary detection method for this organism. Thus, diagnosis by DNA amplification using the PCR technique should be utilized.
GMF/GMR and MgpF/MgpR primer pairs, complementary to the M. genitalium 16S rRNA and MgPa genes, respectively, were selected. Specificity and sensibility assays were conducted and clinical samples were studied.
The PCR with each primer pair was specific only for M. genitalium, and the sensibility was higher with the GMF/GMR primers. In the study of 34 clinical samples, 18,5% were positive for M. genitalium, with more positive samples when the MgpF/MgpR primers were used.
DNA amplification by PCR should be applied in clinical practice to the diagnosis of M. genitalium in patients with NGU should using.
Bernardino Ramazzini was a renowned physician and a prolific writer, born in Capri in 1633. He is considered the father of occupational medicine for having written the first paper on workers' diseases (De morbis artificum diatriba). His Treaty on Workers' diseases included 53 different professions, one particular and specific method of analysis, and a methodological proposal to prevent these diseases. This essay supports the approach taken by the father of occupational medicine and confirms that the principles established in his work are applicable to this day. A fair tribute is paid to the man and his writings in the third century after their publication. The English version of this paper is available at: http://www.insp.mx/salud/index.html.
To describe prevalences and trends of overweight and obesity/OW&OB in Mexican children from 1988 to 2006 at the national level and by relevant subpopulations.
Prevalences of OW&OB in children aged 2-18 years were estimated using body mass index data from three national surveys conducted in 1988, 1999 and 2006.
Prevalences of OW&OB are high in children of all ages, particularly among school-age and adolescent groups disaggregated by regions, socioeconomic status, urban and rural areas, and ethnic groups. The overall prevalence of OW&OB in children 2 to 18 years old in 2006 was 26.3%. Prevalences by age groups were 16.7% in preschool-age, 26.2% in school-age, and 30.9% in adolescents, using the IOTF classification system.
Upward trends were observed in school-age children and adolescents at the national level and in all subpopulations.
This article presents the latest results of a 18 months follow-up study with schizophrenic patients, with the purpose to assess psychosocial functioning in the community after being discharged from a psychiatric hospital. The patients reported a satisfactory level of psychosocial and global functioning: mean = 2.4 at discharge; mean = 2.8 at six months (p < 0.05) and mean = 2.7 at 18 months follow-up. The use of medication was reduced from 62 per cent at six months to 59 per cent at 18 months by the patients, and the level of rehospitalization increased from 10 per cent at six months to 40 per cent at 18 months. Patients with no medication (t-test = p .001) and also rehospitalized patients (t-test = p .05) reported lower levels of satisfactory psychosocial functioning in comparison with patients under medication and also without rehospitalization. These results might contribute to a better psychosocial handling of schizophrenic patients in the community. The need for longitudinal follow-up research in Mexican schizophrenic patients is noted.
To calculate the surgical site infection (SSI) rates with a surgical prospective surveillance program and postdischarge follow-up.
During a 18 months period (01/01/93 to 04/30/94), a surgical wound surveillance program followed on the surgeries practiced at the National Institute of Cancerology, a referral center situated in Mexico City. Rates per 100 surgeries were calculated for the surgical services and for each of the wound class strata. The SS's were classified according to the 1992 Center for Disease Control definitions for surgical infections.
Three thousand, three hundred and severity-two surgeries were assessed; 313 were diagnosed as infected: 140 (44.7%) were superficial incisional, 137 (43.7%) were deep incisional and 36 (11.5%) were organ and space infections. The SSI rate for this period was 9.28%; for the clean, clean-contaminated, contaminated and dirty surgeries the rates were 7.35, 10.5, 17.3 and 21.5% respectively. The rates for each service were: gastroenterology, 14.13%; breast tumors, 11.08%; mixed tumors, 10.98%; gynecology, 9.06%; urology, 7.38%; head and neck, 7.13%, and thoracic surgery, 1.81%. On average SSI were detected at 11.6 +/- 6.23 days, eighty-five (27.16%) were diagnosed while the patient was in-hospital, the remaining 228 (72.84%) were detected after discharge. In 134 (42.8%) patients a culture was obtained. The bacteria most frequently found were: E. coli, 38 (22.5%); coagulase negative Staphylococci, 23 (13.6%); Pseudomonas sp., 22 (13%); S. aureus, 16 (9.4%); and Enterococcus, 13 (7.7%).
The prospective surveillance program with a follow-up for 30 days increased by 400% the chance to identify a SSI. The SSI rate for clean and clean-contaminated surgeries are above the rates reported in the literature.