RESUMEN

INTRODUCTION: Subclinical thyroid dysfunction is a possible risk factor for cognitive impairment in old age, but results are inconsistent. Aim of the present study was to evaluate the prevalence of thyroid dysfunction among older community-dwelling adults and to see whether thyroid function impacts the cognitive status of the elderly. METHODS: We included 1750 participants from the Study on Aging and Dementia in Mexico (SADEM). All subjects were evaluated clinically via specific interviews. TSH levels were analyzed by chemiluminescent immunometry assay. We classified participants into five thyroid state groups: (1) normal TSH levels (0.40-4.0 IU/L) were considered euthyroid; (2) Overt hyperthyroidism: TSH <0.3 IU/l and FT4 >23 pmol/l; (3) Overt hypothyroidism: TSH >4.8 IU/l, FT4 <13 pmol/l; (4) Subclinical hyperthyroidism: TSH <0.3 IU/l, FT4: 13-23 pmol/l; (5) Subclinical hypothyroidism: TSH >4.8 IU/l, FT4: 13-23 pmol/l. RESULTS: The overall estimated prevalence of thyroid dysfunction in Mexican population was 23.7% (95% CI, 22.66-26.77). Of these, 15.4% older adults were classified as subclinical hypothyroidism, 7.2% overt hypothyroidism, 0.5% subclinical hyperthyroidism, and 0.6% overt hyperthyroidism. The association of thyroid dysfunction with cognitive impairment was most evident in overt hypothyroidism OR = 1.261 (1.185-1.343). CONCLUSIONS: The present study demonstrated a high prevalence of thyroid dysfunction in Mexican elderly people living in the community. A relationship between cognitive impairment and the presence of hypothyroidism was also shown, and to a lesser degree in hyperthyroidism.

Asunto(s)

Envejecimiento/psicología , Cognición/fisiología , Demencia/epidemiología , Demencia/psicología , Enfermedades de la Tiroides/epidemiología , Enfermedades de la Tiroides/psicología , Anciano , Anciano de 80 o más Años , Envejecimiento/sangre , Escalas de Valoración Psiquiátrica Breve , Trastornos del Conocimiento/sangre , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/psicología , Demencia/sangre , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Enfermedades de la Tiroides/sangre , Glándula Tiroides/metabolismo

RESUMEN

OBJECTIVE: The aim of this survey was to assess the correlation between leptin and insulin sensitivity (IS) in cases of diffuse toxic goiter. DESIGN, PATIENTS, MEASUREMENTS: This is a descriptive study on patients with diffuse toxic goiter (DTG) assessing their body mass index (BMI), serum leptin concentrations, circulating insulin (area under the curve (AuC) of insulin), average insulin level, thyroid hormones, thyroid stimulating hormone (TSH), glycemia and IS (using a hyperinsulinemic-euglycemic clamp and the homeostasis model for assessment of insulin resistance (HOMA-IR) before and after euthyroidism induced with metimazol. RESULTS: The average patient age was 35 years old (range 31-40 years), height was 157 cm (range 151-160 cm), glycemia was 4.3 +/- 0.3 mmol/L and TSH 0.1 +/- 0.1 microU/mL. Average leptin level was 11.3 +/- 2.8 ng/dL, the average insulin level was 10.13 +/- 3.7 mIU/mL and the AuC for insulin was 50.6 +/- 18 microIU x min/mL. No correlation was found between leptin and BMI, thyroid hormones and glycemia. While controlling for the BMI effect, a correlation was found between leptin and TSH (r = -0.77, p = 0.042), as well as between leptin and insulinemia (r = 0.93, r2 = 0.86, p = 0.001) independently from the state of thyroid function. There was a tendency for a high correlation between leptin and the insulin AuC (hyperthyroidism: r = 0.89, p = 0.056; euthyroidism: r = 0.99, p = 0.056). A negative correlation was found between IS and the insulin AuC (rho = -0.58, p = 0.18). There was a high tendency for correlation between leptin and IS when the BMI effect (HOMA-IR: r = 0.70, p = 0.12; PHE: r = -0.55, p = 0.26) was taken into consideration. CONCLUSIONS: There is a high tendency for a negative correlation between leptin and IS when the BMI effect is controlled. There is a high tendency for a positive correlation between leptin and insulin and TSH.

Asunto(s)

Bocio/sangre , Resistencia a la Insulina , Leptina/sangre , Adulto , Glucemia/metabolismo , Composición Corporal , Índice de Masa Corporal , Humanos , Insulina/sangre , Hormonas Tiroideas/sangre , Tirotropina/sangre

RESUMEN

A cross-sectional survey of the seroprevalence of hepatitis B virus (HBV) markers among healthy people was conducted in San Juanito, a rural community in the northern state of Chihuahua, Mexico. The overall prevalence in 970 people was 6.6% for antibody to hepatitis B core antigen. There was an age effect on the prevalence of HBV infection, and a gradual increase in prevalence was observed in patients up to the age of 40 years. Those subjects with a history of dental procedures had a 2-fold higher risk for HBV infection (odds ratio [OR], 2.4; 95% confidence intervals [CI], 1.01-5.86), and there was a 74% increased risk for each blood product transfusion (OR, 1.74; 95% CI, 1.09-2.77). Horizontal transmission seems to be the major source of endemicity in San Juanito because no woman was a chronic carrier. To lower HBV transmission rate, an adequate active screening program for blood donors should be implemented, together with a universal infant immunization program.

Asunto(s)

Antígenos del Núcleo de la Hepatitis B/sangre , Hepatitis B/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Estudios Transversales , Transmisión de Enfermedad Infecciosa , Femenino , Hepatitis B/transmisión , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Factores de Riesgo , Salud Rural , Estudios Seroepidemiológicos , Encuestas y Cuestionarios

RESUMEN

BACKGROUND: Silent myocardial ischemia is a growing world health problem. It has been related to factors that promote an increase in myocardial oxygen demand or affect coronary vasomotor tone. Coronary artery disease has shown an increasing trend in Mexico in this century. HYPOTHESIS: The aim of the study was to estimate the strength of the association between some risk factors and the occurrence of silent myocardial ischemia. METHODS: A cross-sectional study was conducted and 249 individuals were screened by 24-h Holter electrocardiogram. Silent myocardial ischemia was diagnosed in patients with painless transient ST-segment depression. All subjects were interviewed for coronary risk factors and total serum cholesterol was measured. RESULTS: Silent ischemia was diagnosed in 115 patients (46%), who were older (59 +/- 9 vs. 57 +/- 11 years; p = 0.01). In a logistic regression analysis, a lower risk for silent ischemia was found in patients with thrombolysis [odds ratio (OR) 0.28; 95% confidence interval (CI 95%) 0.14-0.53], or those who followed their medical treatment (OR 0.16; CI 95% 0.04-0.68). The major risk factors were hypercholesterolemia (OR 1.6; CI 95% 0.9-2.9) and more severe coronary artery disease (OR 2.5; CI 95% 1.1-5.7). CONCLUSIONS: Some coronary risk factors are related to silent ischemia. It is still important to diagnose this entity, but modification of its related risk factors should be kept in mind to diminish its occurrence and its severe consequences.

Asunto(s)

Isquemia Miocárdica/epidemiología , Colesterol/sangre , Angiografía Coronaria , Estudios Transversales , Electrocardiografía Ambulatoria , Femenino , Humanos , Incidencia , Masculino , México/epidemiología , Persona de Mediana Edad , Isquemia Miocárdica/sangre , Isquemia Miocárdica/diagnóstico , Oportunidad Relativa , Factores de Riesgo , Encuestas y Cuestionarios

RESUMEN

OBJECTIVE: To analyze the association of hypertension and upper body fat distribution on the occurrence of non-insulin-dependent diabetes mellitus in Mexicans. MATERIAL AND METHODS: It was a population-based cross-sectional study in Cuajimalpa, a district of Mexico City. A total of 1066 subjects were home interviewed, and attended our clinic for fasting plasma glucose sampling, blood pressure and anthropometric measurements. Diabetes was defined according to the World Health Organization criteria, and hypertension as a blood pressure equal to or greater than 140/90. The ratio of upper to lower body skinfolds was used to estimate body fat distribution. RESULTS: The prevalence of diabetes was 12.0%. There was a significant positive trend in the age and sex adjusted prevalence of diabetes according to the magnitude of hypertension (p = 0.0006) and upper body fat distribution (p = 0.007). The age and sex adjusted prevalence in normotensive subjects with lower body fat distribution was 7.1% (95% confidence interval 5.9-8.2) whereas it was 19.9% (CI 17.0-22.8) in those with hypertension and upper body fat distribution. The prevalence of diabetes in Mexicans was high and it may be related to a genetic susceptibility for an insulin resistance syndrome. CONCLUSIONS: These results indicate that there is a dose response effect in the association of hypertension and upper body fat distribution with diabetes in Mexicans, and that there may be an interaction in the effect of hypertension and body fat distribution in this syndrome.

Asunto(s)

Tejido Adiposo/anatomía & histología , Diabetes Mellitus Tipo 2/epidemiología , Hipertensión/epidemiología , Somatotipos , Adulto , Anciano , Glucemia , Presión Sanguínea , Índice de Masa Corporal , Comorbilidad , Estudios Transversales , Diabetes Mellitus Tipo 2/genética , Femenino , Humanos , Hipertensión/genética , Resistencia a la Insulina , Masculino , México/epidemiología , Persona de Mediana Edad , Obesidad/epidemiología , Prevalencia , Factores de Riesgo , Grosor de los Pliegues Cutáneos , Síndrome

RESUMEN

OBJECTIVE: To determine the prevalence of tobacco consumption among the active insured population of the Mexican Social Security Institute. MATERIAL AND METHODS: A cross-sectional study in which the active insured population from the 36 political delegations was interviewed by means of a structured and self-applicable questionnaire on tobacco consumption, age of initiation, amount of cigarettes consumed and suspension. RESULTS: The sample consisted of 45 117 subjects, of which approximately half were men and half women. Smoking prevalence in men was 40% and in women, 17.6%. Prevalence was highest in the north of the country. There is an effect of age on tobacco consumption and more than half started smoking during adolescence. CONCLUSIONS: Smoking prevalence was found to be high, however, the average number of cigarettes is low. Suspension index is low. Public health measures are necessary to diminish this addiction.

Asunto(s)

Fumar/epidemiología , Seguridad Social , Adolescente , Adulto , Distribución por Edad , Anciano , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Distribución por Sexo , Cese del Hábito de Fumar/estadística & datos numéricos , Seguridad Social/estadística & datos numéricos , Encuestas y Cuestionarios

Asunto(s)

Portador Sano/parasitología , Entamoeba histolytica/fisiología , Entamebiasis/epidemiología , Absceso Hepático Amebiano/epidemiología , Animales , Entamebiasis/mortalidad , Interacciones Huésped-Parásitos , Humanos , Incidencia , Absceso Hepático Amebiano/mortalidad , México/epidemiología , Prevalencia

Asunto(s)

Anticuerpos Antiprotozoarios/análisis , Entamoeba histolytica/inmunología , Entamebiasis/epidemiología , Inmunoglobulina A/análisis , Proteínas y Péptidos Salivales/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Preescolar , Estudios Transversales , Entamebiasis/diagnóstico , Entamebiasis/inmunología , Estudios de Evaluación como Asunto , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Salud Rural

RESUMEN

Prognosis after an acute myocardial infarction is closely related to the severity of coronary obstruction, and the residual functionality of left ventricle, which may be evaluated by the ejection fraction. To evaluate the utility of the ejection fraction and some cardiovascular risk factors, as predictors of a second myocardial infarction and delayed death, in those patients with a first acute myocardial infarction, 161 hospitalized patients were included in the study. The occurrence of a second myocardial infarction or death after the first month was evaluated. All patients were followed for 1 to 51 months, and the ejection fraction through a transthoracic echocardiogram was measured. 119 men and 42 women were included in the study, with a total of 3802 person-months of follow-up. The incidence rate for a second myocardial infarction was 0.01052 month,-1 and the mortality rate was 0.00342 month-1. In a Cox survival analysis model, ejection fraction was a major prognostic index and those subjects with an ejection fraction below 40% had a seven fold higher risk for a second myocardial infarction. Diabetes mellitus and hypertension were major predictors of a delayed death after a first myocardial infarction. Ejection fraction is the most related variable to the occurrence of a second myocardial infarction, and together with a history of diabetes and hypertension are good predictors of a delayed death after a first myocardial infarction. The identification of subjects with a poor prognosis may allow to establish specific preventive measures. Ejection fraction is useful to categorize patients according to their prognosis.

Asunto(s)

Enfermedad Coronaria/fisiopatología , Infarto del Miocardio/fisiopatología , Enfermedad Aguda , Adulto , Anciano , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/mortalidad , Complicaciones de la Diabetes , Ecocardiografía , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/mortalidad , Pronóstico , Factores de Riesgo , Volumen Sistólico , Análisis de Supervivencia

RESUMEN

The occurrence non-insulin dependent diabetes mellitus has increased during the second half of this century in Mexico as well as in other countries. American Indians have one of the highest prevalences in the world, but there are few studies that have estimated the occurrence of diabetes in Mexican Indians. The authors conducted a cross-sectional study in Huautla, Oaxaca, Mexico, to estimate the prevalence of diabetes in Mexican Mazatecos Indians, as well as its related risk factors. A total of 798 subjects were interviewed, and 16 diabetics were found, the prevalence of diabetes was 2.01%. The prevalence increased with age, but declined in those 65 years of age or older, mainly in women. The prevalence was slightly higher in women (2.2%) than in men (1.6%). There was a relation of diabetes with obesity, central body fat distribution, a family history of diabetes and hypertension. The prevalence is low if compared with the notified prevalence in the country, but there are certain age groups where its occurrence is similar to those living in an urban area. There is a need of intervention measures to prevent an epidemic such as the one seen nowadays among American Indians.

Asunto(s)

Diabetes Mellitus Tipo 2/epidemiología , Indígenas Norteamericanos , Adolescente , Adulto , Factores de Edad , Anciano , Estudios Transversales , Diabetes Mellitus Tipo 2/etnología , Femenino , Humanos , Hiperglucemia/complicaciones , Hipertensión/complicaciones , Modelos Logísticos , Masculino , México/epidemiología , México/etnología , Persona de Mediana Edad , Obesidad/complicaciones , Factores de Riesgo , Población Rural , Factores Sexuales

RESUMEN

BACKGROUND: Amebiasis still remains as a major public health problem in the world. It is one of the most common reasons for medical consult. There are more than half a million cases of amebiasis just at the Mexican Institute of the Social Security. There is still a lack of epidemiologic information on amebiasis in Mexico. AIM: To describe the secular trend fro amebiasis and for amebic liver abscess in the Mexican population, as well as in those covered by IMSS Solidaridad. METHOD: An ecologic trend study was carried on. Incidence rate of amebiasis in all of its forms of presentation, and of amebic liver abscess, were plotted against each year for the 1986-1994 period. RESULTS: Amebiasis incidence in all of its forms of presentation showed a stable trend in this period, as it was seen with amebic liver abscess. Amebiasis is more common in the first years of life. On the contrary, amebic liver abscess showed an inverted 'J' pattern; its occurrence is higher in the extreme years of life. Fatality rates have shown a descendent trend. CONCLUSIONS: Amebiasis reflects socioeconomic conditions in Mexico and the fact that Mexican is still an endless culture. There is a need to promote health education, better diagnostic procedures and detection of asymptomatic carriers. Health policies for mothers that are asymptomatic carriers should be reviewed, due to the high rates of amebiasis and amebic liver abscess in children under one year of age.

Asunto(s)

Amebiasis/epidemiología , Absceso Hepático Amebiano/epidemiología , Salud Pública , Adolescente , Adulto , Factores de Edad , Anciano , Amebiasis/prevención & control , Portador Sano/epidemiología , Niño , Preescolar , Femenino , Educación en Salud , Humanos , Lactante , Recién Nacido , Absceso Hepático Amebiano/prevención & control , Masculino , México/epidemiología , Persona de Mediana Edad , Factores Socioeconómicos

RESUMEN

OBJECTIVE: To analyze the secular trend of the incidence and fatality rates of diabetic complications in Mexico. MATERIAL AND METHODS: All diabetes mellitus(DM)-related hospital records for the 1985-1994 period, from the Mexican Institute for Social Security were reviewed. RESULTS: An increasing trend in the incidence of diabetic complications was observed for the last decade. The most frequent complication is diabetes-related end-stage renal disease, followed by peripheral arterial disease. There is an important age effect in the occurrence of diabetic complications. Diabetic ketoacidosis is the most common complication in the early years of life. Fatality due to DM has decreased, mainly that due to acute complications. CONCLUSIONS: Diabetic complications have increased due to the increase in the incidence of DM and in the life expectancy of diabetics. There is a need to study the true incidence of DM and of diabetic complications in Mexico, and to insist in an adequate metabolic control to delay or avoid their occurrence.

Asunto(s)

Complicaciones de la Diabetes , Diabetes Mellitus/epidemiología , Diabetes Mellitus/mortalidad , Coma Diabético/epidemiología , Coma Diabético/mortalidad , Cetoacidosis Diabética/epidemiología , Cetoacidosis Diabética/mortalidad , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/mortalidad , Femenino , Humanos , Incidencia , Masculino , México/epidemiología , Enfermedades Vasculares/epidemiología , Enfermedades Vasculares/mortalidad

RESUMEN

BACKGROUND AND OBJECTIVES: In rural and suburban populations in developing countries, there is a lack of knowledge about the occurrence of Chlamydia trachomatis infection and the risk factors involved. Knowledge of the prevalence of infection is necessary to develop screening policies. GOALS: To estimate the prevalence of C. trachomatis infection in a rural and a suburban area of Oaxaca, Mexico, and to identify behavioral and demographic risk factors, as well as clinical findings, that may be related to this disease. STUDY DESIGN: A cross-sectional survey was conducted among 559 women attending the Rural Hospital of Tlacolula, Oaxaca in 1994. Genitourinary signs and symptoms were recorded using a structured questionnaire and a speculum examination of the cervix. Endocervical specimens were obtained for the direct immunofluorescent diagnosis of chlamydial infection. RESULTS: Results for 41 women (7.3%) were positive for chlamydia. The prevalence was the same in rural and suburban women. In a multiple logistic regression analysis, chlamydial infection was correlated highly with young age (OR, 2.3; 95% CI, 1.2 to 4.6), oral contraceptives (OR, 2.2; 95% CI, 0.7 to 6.9), number of sex partners, and genitourinary signs or symptoms. The simultaneous presence of mucopurulent cervical discharge, cervix friability, inflammatory signs of the cervix, and urinary symptoms had the highest specificity (99.6%) and positive predictive value (86.7%) for chlamydial infection detection. CONCLUSION: C. trachomatis infection is a common sexually transmitted disease in rural and suburban women in Mexico. Nearly 1 of 8 women 15 to 25 years of age may be infected. A risk factor-based screening program should be implemented in rural and urban populations in Mexico. In rural settings, women with mucopurulent cervical discharge should be treated for chlamydial infection, even without a laboratory diagnosis.

Asunto(s)

Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/etiología , Chlamydia trachomatis , Pobreza , Salud Rural , Salud Suburbana , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , México/epidemiología , Vigilancia de la Población , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios

RESUMEN

An age- and sex-matched case-control study was conducted to evaluate the relation of obesity and body fat distribution with the occurrence of coronary heart disease in mexicans. Obesity was measured in 150 couples by bioelectrical impedance with an EZ comp 1000 computer (body composition), and by estimating the body mass index. Skinfold anthropometry was used to assess central fat distribution. Two fat distribution indices were calculated, a ratio of central to peripheral skinfolds (central pattern) and a ratio of upper to lower body skinfolds (android pattern). Those subjects who had a percentage of body fat, by bioelectrical impedance, greater than 20%, had a 20 fold higher risk to develop acute myocardial infarction. The risk of coronary heart disease was also high in those with a central fat distribution and even higher in those with an android pattern. Both obesity and abdominal fat distribution are closely related to coronary heart disease. There is a need to promote life-styles changes and to reduce obesity, to prevent the occurrence of coronary heart disease in Mexico.

Asunto(s)

Composición Corporal , Constitución Corporal , Isquemia Miocárdica/epidemiología , Obesidad/epidemiología , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Isquemia Miocárdica/etiología , Obesidad/complicaciones , Factores de Riesgo , Población Urbana/estadística & datos numéricos

RESUMEN

A case control study was developed in order to assess the strength of the association of modifiable risk factors and the occurrence of coronary heart disease in Mexicans. A total of 284 incident cases of acute myocardial infarction and 284 age and sex matched hospitalized controls were included in the study. Information was obtained in all subjects regarding socio-demographic variables, history of diabetes, hypertension, smoking, obesity and serum cholesterol. A conditional logistic regression model, showed that diabetes mellitus, hypertension, smoking, hypercholesterolemia and obesity, explained the occurrence of coronary heart disease in the studied population. The risk of an acute myocardial infarction heavily increases in the extreme levels of exposure; and this risk is six fold higher in those who daily smoke more than 20 cigarettes, and it is eight fold higher in those subjects with a serum cholesterol greater than 240 mg/dl. Due to the increase in the occurrence of coronary heart disease in Mexico, and the strength of the association observed with these modifiable risk factors, a public health program to decrease its prevalence, is justified.

Asunto(s)

Enfermedad Coronaria/epidemiología , Adulto , Factores de Edad , Anciano , Estudios de Casos y Controles , Estudios Transversales , Complicaciones de la Diabetes , Femenino , Humanos , Hipercolesterolemia/complicaciones , Hipertensión/complicaciones , Modelos Logísticos , Masculino , México/epidemiología , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Obesidad/complicaciones , Factores de Riesgo , Factores Sexuales , Fumar/efectos adversos

RESUMEN

To document the existence of an epidemiologic and a health care transition in Mexico, diabetes mellitus (DM) mortality was analyzed. Age and sex adjusted mortality rates were estimated for each one of the states of Mexico, as well as the mean age at death, the number of years of potential life lost, and their percent distribution. The geographic distribution of these variables was plotted in maps according to tertiles or quartiles. The proportion of deaths due to acute and chronic complications of DM was classified according to community size. Polarized patterns of DM mortality as well as in the percentage contribution of deaths due to its acute and chronic complications were observed, in agreement with the postulated transitional process.

Asunto(s)

Diabetes Mellitus/mortalidad , Enfermedad Aguda , Adulto , Distribución por Edad , Causas de Muerte , Enfermedad Crónica , Complicaciones de la Diabetes , Femenino , Humanos , Masculino , México/epidemiología , Mortalidad/tendencias , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos

RESUMEN

In order to evaluate the contribution of hypertension, diabetes, smoking and serum cholesterol on coronary heart disease mortality in Mexico, an ecologic study was developed. Mortality rates of coronary heart disease (CHD), diabetes and hypertension; the proportion of people smoking six or more cigarettes daily; and the mean serum cholesterol levels, were recorded for each of the states of Mexico. All variables were included in a multiple linear regression model, taking CHD mortality as the dependent variable. All variables explained more than two thirds of the occurrence of CHD mortality. However either using a backward or a forward method, only serum cholesterol and diabetes mortality had a significative contribution on CHD mortality (re = 0.65; F = 27; p < 0.0001). Coronary heart disease mortality in Mexico has shown an increasing trend in the last 50 years. Mexican-americans in the United States have a high prevalence of major risk factors, but few studies have done to assess its contribution in Mexicans living in Mexico. This increase may be explained by an increase in the occurrence of diabetes and the still denied importance of high serum cholesterol.

Asunto(s)

Colesterol/sangre , Enfermedad Coronaria/mortalidad , Complicaciones de la Diabetes , Enfermedad Coronaria/sangre , Enfermedad Coronaria/complicaciones , Diabetes Mellitus/mortalidad , Humanos , Hipertensión/complicaciones , Modelos Lineales , México , Factores de Riesgo , Fumar

RESUMEN

Amebiasis is one of the most common parasite-related diseases and one of those with the greatest impact on health. At the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security-IMSS) approximately half a million cases per year are currently treated. Of these, more than 2500 correspond to the form which invades the liver. Within the process of epidemiologic transition which Mexico is undergoing, a progressive reduction has been observed in incidence of, and mortality due to, invading amebiasis in all its clinical forms. In turn, there is a significant decrease in its fatality rate. The social and economic development and improved sanitary conditions observed in Mexico, particularly in the second half of this century, may have conditioned this process. The improvement in availability, accessibility and utilization of medical care services could also explain the reduction which has been noted in its fatality rate and mortality. The model for epidemiologic transition proposed by Omran and adapted for Mexico by Frenk, offers a plausible explanation for the changes observed in the occurrence and mortality of invading amebiasis in Mexico.

Asunto(s)

Amebiasis/epidemiología , Amebiasis/mortalidad , Amebiasis/fisiopatología , Humanos , Incidencia , México/epidemiología

RESUMEN

Non-insulin-dependent diabetes mellitus (NIDDM) is a chronic disabling disease, that shortens length of life and implies a high burden for a community. Its prevalence goes from 0 per cent in Papua, New Guinea to 34 per cent in Pima Indians. There are very few prevalence studies in Mexico, and the strength of association of the known risk factors with the occurrence of the disease is not established. A prevalence cross sectional study was carried out with users of a first level medical care unit, with a meter measure of capillary glucose levels. Those with a previous diagnosis of diabetes or whose capillary glucose level were 200 mg or over were considered diabetics. Hyperglycemia was when the levels were recorded between 121 and 199 mg. The crude prevalence of NIDDM was 5.6 per cent (CI 95% 4.5-6.8), With almost no sex difference. Hyperglycemia prevalence was 2.9 per cent (CI 95% 2.0-3.7). Age was the main risk factor for the development of NIDDM. Those between 40 and 59 years showed a high risk (OR 10.8; CI 95% 5.4-22.0; p < 0.0001), and it was greater for the 60 years or elder (OR 20.6; CI 95% 9.8-44.1; p < 0.0001). Weight was also an important risk factor, with a 2.7 fold greater risk for obese persons (CI 95% 1.6-4.6; p < 0.0001). Other, risk factors were familiar history of diabetes (OR 1.5; CI 95% 0.9-2.3; p = 0.096), and overcrowding (OR 1.9; CI 95% 1.0-3.4; p = 0.03). In order to analyze independently each variable, a logistic regression model was applied, and a similar strength of association was observed for the crude model, but for obesity whose effect was modified by age. When only new cases were analyzed in the former model, the association with obesity was maintained. There is a need to develop prevalence studies of NIDDM in Mexico and to measure the strength of association with the known and the not jet well known risk factors of this disease in order to establish health policies according to the Mexican reality.

Asunto(s)

Diabetes Mellitus Tipo 2/epidemiología , Población Urbana/estadística & datos numéricos , Adulto , Distribución por Edad , Glucemia/análisis , Diabetes Mellitus Tipo 2/sangre , Femenino , Humanos , Modelos Logísticos , Masculino , México/epidemiología , Persona de Mediana Edad , Obesidad/sangre , Obesidad/epidemiología , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Distribución por Sexo

RESUMEN

One hundred rural patient with pulmonary tuberculosis and 74 urban patients were included in the study in order to study the main causes of non-compliance. Crude cumulative incidencia was 42% (73/164). Those factors with the strongest association with non-compliance, independently of its association with other factors, were to live in rural areas (OR 0 10.4; p < 0.001), had not gone to school (analfabet) (OR = 4.5; p < 0.001), and last more than an hour to reach the medical care unit (protector) (OR = 0.40; p = 0.07). No association was found with socioeconomic factors, neither with the patient's knowledge of the disease. Identifying those factors related to non-compliance is important, since non-compliance occurs in the very firsts days of treatment, when the shortage of treatment or giving fewer pills do not work at all. To get a better medial control may be a good way to reach the expected control of the disease.

Asunto(s)

Negativa del Paciente al Tratamiento , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , México , Persona de Mediana Edad , Estudios Retrospectivos , Población Rural , Población Urbana