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BACKGROUND: Primary health care is the best framework for implementing actions for the prevention and control of non-communicable diseases at an appropriate scale. In 2002, the Mexican Institute for Social Security (IMSS), which provides health care to half of the Mexican population, implemented a primary care-based integrated program that included the improvement of the family health care practice and a preventive strategy called PREVENIMSS, to reduce the burden of disease. OBJECTIVE: To asess the impact of this program on selected non-communicable chronic diseases. METHODS: Morbidity and mortality were compared before and after implementation of the program and time trends in IMSS affiliates and non-affiliates using the difference-in-differences (DD) method. RESULTS: Incidence rates of diabetes and hypertension increased whereas those of cervical cancer, breast cancer and other cerebrovascular diseases decreased from 2000 to 2013. The DD in mortality rates, expressed per 100000 persons, showed a decrease of 49.4 for diabetes mellitus, 9.1 for hypertensive disease, 42.9 for ischemic heart disease, 17.4 for cerebrovascular disease, 7.5 for cervical cancer and 5.8 for breast cancer. CONCLUSIONS: The reductions in mortality rates could be explained by both changes in incidence rates and changes in case fatality rates associated with early detection and treatment. These initial findings can be interpreted as the potential impact of integrated programs based on primary health care in a developing country.

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Objetivos. Caracterizar el comportamiento del Sistema Nacional de Salud (SNS) de México en la tarea de reducir el número de muertes por malformaciones congénitas mediante el análisis de la tendencia de las tasas de mortalidad infantil específicas por esas afecciones. Métodos. Análisis de series de tiempos de las defunciones de niños y niñas menores de 1 año entre 1980 y 2005, según las bases de datos nacionales anuales de mortalidad de la Secretaría de Salud de México. Se calcularon las tasas de mortalidad infantil específicas (TMIe) pormalformaciones congénitas graves más frecuentes en México: defectos del tubo neural, hernia diafragmática congénita, exonfalos (onfalocele y gastrosquisis) y malformaciones cardíacas y del tubo digestivo, agrupadas según el grado de urgencia y de sofisticación tecnológica que demanda su tratamiento y el desenlace más frecuente. Resultados. Entre 1980 y 2005, la tasa de mortalidad infantil en México descendió de 40,7 a 16,9 por 1 000 nacimientos (b = –0,86; P < 0,001); en cambio, la tasa de mortalidad específica por malformaciones congénitas creció de 2,2 a 3,5 por 1 000 nacimientos (b = 0,05; P < 0,001). La hipertrofia pilórica y la atresia anorrectal, malformaciones con buen pronóstico y tratamiento programable en unidades con equipamiento básico, fueron las únicas que mostraron una tendencia descendente en su TMIe (b = –0,01 a –0,09; P < 0,001), mientras que las que requieren tratamiento urgente en unidades especializadas mostraron TMIe crecientes (b = 0,03 a 0,05; P < 0,001).Conclusiones. El desarrollo del SNS de México entre 1980 y 2005 no se ha traducido en una reducción en la mortalidad por malformaciones congénitas; esta ineficacia fue más notoria en las enfermedades cuyo tratamiento es urgente y requiere tecnología sofisticada.

Objectives. To evaluate the role that Mexico’s National Health System (Sistema Nacional de Salud–SNS) has played in the task of reducing the number of deaths due to congenital malformations through a trends analysis of cause-specific infant mortality rates (IMRcs). Methods. Time-series analysis of deaths of boys and girls under 1 year of age from 1980–2005, according to databases of national and annual mortality maintained by the Secretariat of Health of Mexico. Cause-specific mortality rates were calculated for themost frequently occurring, severe, congenital malformations in Mexico: neural tube defects, diaphragmatic hernias, exomphalos (omphalocele and gastroschisis), and heart and digestive tract defects, grouped according to severity, degree of technologicalsophistication required for treatment, and most frequent outcome. Results. From 1980–2005, the infant mortality rate in Mexico decreased from 40.7 to16.9 per 1 000 births (â = –0.86; P < 0.001); however, the mortality rate for congenital malformations rose from 2.2 to 3.5 per 1 000 births (â = 0.05; P < 0.001). Only infantile hypertrophic pyloric stenosis and anorectal atresia, anomalies with good prognoses and treatments available in minimally-equipped facilities, exhibited downward trends in their IMRcs (â = –0.01 to –0.09; P < 0.001); while malformations requiring immediate treatment in specialized facilities showed rising IMRcs (â = 0.03 to 0.05; P < 0.001).Conclusions. The development of Mexico’s SNS from 1980–2005 has not translated into a reduction of mortality from congenital malformations; this deficiency was more pronouncedfor anomalies that require immediate treatment and sophisticated technology.

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BACKGROUND: Despite certain contradictions, an association has been identified between adherence to drug treatment and the quality of life in patients with type 2 diabetes. The contradictions observed emphasize the importance of using different methods to measure treatment adherence, or the association of psychological precursors of adherence with quality of life. For this reason, we have used an indirect method to measure adherence (pill count), as well as two adherence behaviour precursors (attitude and knowledge), to assess the association between adherence and the quality of life in type 2 diabetes patients. METHODS: A cross-sectional comparative study on a random sample of 238 type 2 diabetic patients was carried out over one year in four family medicine units of the Mexican Institute of Social Security (IMSS) in Aguascalientes, Mexico. Treatment adherence was measured using the indirect method of pill count to assess adherence behaviour, obtaining information at two home visits. In the first we recorded the medicine prescribed and in the second, we counted the medicine remaining to determine the proportion of the medicine taken. We also assessed two adherence behaviour precursors: the patients' knowledge regarding their medical prescription measured through a structured questionnaire; and attitudes to treatment adherence using a Likert scale. Quality of life was measured through the WHOQOL-100 (the WHO Quality of Life questionnaire). Information concerning both knowledge and attitude was obtained through interviews with the patients. A multiple linear regression model was constructed to establish the relationship between each quality of life domain and the variables related to adherence, controlling for covariates. RESULTS: There was no association between quality of life and treatment adherence behaviour. However, the combination of strong knowledge and a positive attitude was associated with five of the six quality of life domains. CONCLUSION: The results suggest that it is important to explore psychological precursors of treatment adherence behaviour in type 2 diabetic patients. Indeed, we consider that it will be useful to carry out interventions that change negative attitudes towards treatment adherence and that promote medical prescription knowledge, which may help to improve the quality of life of such patients.

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BACKGROUND: Epidemiological data on impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) based on a representative Mexican sample are not available; thus, the objectives of this study were to determine the prevalence and distribution of IFG and IGT, and to establish its relationship with obesity in Mexican adults. METHODS: We performed a cross-sectional population-based study on a representative sample of Mexican adults aged 30 to 65 years. Anthropometric measurements of obesity that included waist circumference (WC) and total body fat percentage were collected and the body mass index calculated. All subjects also underwent an oral glucose tolerance test. Diagnosis of glucose metabolism disorders was based on criteria of the American Diabetes Association. RESULTS: Prevalence of IFG, IGT, and IFG+IGT was 24.6%, 8.3%, and 10.3%, respectively. The age-adjusted prevalence of IFG (49.5% and 50.5%), IGT (49.1% and 50.9%), and IFG+IGT (57.3% and 42.7%) was similar in men and women. Prevalence of obesity was 45.9% with predominance in women (48.8% versus 42.1%, P = 0.01). A total of 394 (31.0%) individuals were overweight. Among the 550 prediabetic normal weight subjects, 70 (22.4%), 15 (14.2%), and 7 (5.3%) had IFG, IGT, or IFG+IGT. The odds ratio (OR) between WC and IFG (OR 3.1, CI(95%) 1.4-9.7), IGT (OR 3.2, CI(95%) 1.2-9.1), and IFG+IGT (OR 2.8, CI(95%) 1.3-8.2) was higher than the OR of other measurements of obesity. CONCLUSIONS: Prevalence of prediabetes in the Mexican adult population is high. WC is the measure of obesity more strongly associated with metabolic glucose disorders. A high proportion of subjects with normal weight exhibit prediabetes.

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BACKGROUND: Cardiovascular (CV) risk factors are influenced by behavioral, cultural, and social factors, suggesting that acculturation plays a significant role in the emergency and growth of chronic disease. The objective of this study was to determine the relation between CV risk factors and the main components of acculturation, in Yaquis and Tepehuanos Indians from Mexico. METHODS: This was a cross-sectional population-based study in Yaquis and Tepehuanos communities from the Yaqui Valley in Sonora and the Sierra Madre Occidental Mountains in Durango, in northwest Mexico. Acculturation status is different in both ethnic groups, with Tepehuanos living in small and remote communities retaining their traditional lifestyle and Yaquis living in well-communicated communities that have assumed Westernized lifestyles. RESULTS: A total of 278 indigenous (120 Tepehuanos and 158 Yaquis) were randomly enrolled. Prevalence of obesity (48.1 and 6.7%, p <0.001), diabetes (18.3 and 0.83%, p <0.001), hypertriglyceridemia (43.0 and 15.0%, p <0.001), alcohol consumption (46.8 and 26.6%, p >0.001), and smoking (29.7 and 15.0%, p = 0.006) were significantly higher in Yaquis Indians. High blood pressure (6.3 and 3.3%, p = 0.40) and low HDL-cholesterol (42.4 and 34.2%, p = 0.22) were similar between Yaquis and Tepehuanos. Multivariate regression analysis adjusted by sex and age showed a significant association between calorie intake from saturated fat, but not other nutrients of customary diet, with hyperglycemia (OR 7.4, 95% CI 2.6-20.1), hypertriglyceridemia (OR 3.1, 95% CI 1.5-6.3), and obesity (OR 3.4, 95% CI 1.6-10.1). CONCLUSIONS: Among the components of acculturation, intake of saturated fat is the most strongly associated with the development of CV risk factors.

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OBJECTIVES: To evaluate the role that Mexico's National Health System (Sistema Nacional de Salud-SNS) has played in the task of reducing the number of deaths due to congenital malformations through a trends analysis of cause-specific infant mortality rates (IMRcs). METHODS: Time-series analysis of deaths of boys and girls under 1 year of age from 1980-2005, according to databases of national and annual mortality maintained by the Secretariat of Health of Mexico. Cause-specific mortality rates were calculated for the most frequently occurring, severe, congenital malformations in Mexico: neural tube defects, diaphragmatic hernias, exomphalos (omphalocele and gastroschisis), and heart and digestive tract defects, grouped according to severity, degree of technological sophistication required for treatment, and most frequent outcome. RESULTS: From 1980-2005, the infant mortality rate in Mexico decreased from 40.7 to 16.9 per 1 000 births (beta = -0.86; P < 0.001); however, the mortality rate for congenital malformations rose from 2.2 to 3.5 per 1 000 births (beta = 0.05; P < 0.001). Only infantile hypertrophic pyloric stenosis and anorectal atresia, anomalies with good prognoses and treatments available in minimally-equipped facilities, exhibited downward trends in their IMRcs (beta = -0.01 to -0.09; P < 0.001); while malformations requiring immediate treatment in specialized facilities showed rising IMRcs (beta = 0.03 to 0.05; P < 0.001). CONCLUSIONS: The development of Mexico's SNS from 1980-2005 has not translated into a reduction of mortality from congenital malformations; this deficiency was more pronounced for anomalies that require immediate treatment and sophisticated technology.

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Se realizó un estudio prospectivo multicéntrico en diversas ciudades de la República Mexicana utilizando pantoprazol para el tratamiento de la enfermedad ácido-péptica. Se incluyeron 1,696 pacientes con diagnóstico de enfermedad ácido-péptica. Se recabaron datos personales y relacionados con la enfermedad, método de diagnóstico, tratamiento y resultado al final del mismo. Se encontró que la media de edad en los pacientes del sexo masculino fue 43.9 años y en las mujeres 42.4 años (p = 0.041). El porcentaje de hombres y mujeres fue de 49.6 respectivamente. Existe correlación entre el consumo de alcohol, el diagnóstico de úlcera péptica (p = 0.032) y el dolor epigástrico en ayunas (p = 0.004). De los diagnósticos establecidos, la gastritis tuvo la mayor proporción (21.19 por ciento). Al final del tratamiento, 68 por ciento (1.157 casos) reportaron ausencia total de los síntomas que los motivaron a buscar atención médica. El 96.26 por ciento de los tratamientos se ajustaron a la dosis diaria recomendada de 40 mg. La evaluación global sobre el tratamiento con pantoprazol en relación con los casos tratados fue que 96 por ciento de los investigadores lo consideraron excelente o bueno. Los resultados obtenidos demuestran la efectividad del pantoprazol en el tratamiento de la enfermedad ácido-péptica, con la dosis recomedada de 40 mg al día. En sólo dos casos se suspendió el tratamiento por probables reacciones adversas al medicamento

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Com a intençäo de apoiar a tomada de decisöes e melhorar o benefício, ao priorizar necessidades, discute o modelo de inversäo-produçäo-consumo (IPC), o qual tenta medir o impacto socioeconômico da mortalidade. Esse tipo de avaliaçäo toma em conta a idade ao morrer e a futura produtividade potencial, gerando perdas ou ganhos à sociedade, dependendo da etapa da vida quando ocorreu a morte. Ilustra para o México o impacto das diferentes causas de morte e compara com a importância relativa, partindo da ordenaçäo com as taxas da mortalidade e o indicador de anos de vida perdidos (IVAPP). Ao ordenar por taxas, observa que as doenças do coraçäo, acidentes e tumores säo as primeiras causas. Entretanto, o tradicional indicador de anos de vida potencialmente perdidos demonstra que estäo em primeiro lugar as causas de morte em idades menores. O IAVPPipc entretanto, dá maior importância às infecçöes, aos acidentes e aos homicídios, partindo do ponto de vista da produçäo e consumo

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Con el objeto de describir la frecuencia de la desnutricón como causa múltiple de muerte, se realizó un análisis de los certificados de defunción de los niños menores de cinco años que fallecieron en los meses de abril y mayo de 1985 en el Distrito Federal, México. Mediante un diseño de mortalidad proporcional e incluyendo todas las causas listadas en el certificado de defunción, se estudió la asociación entre desnutrición e infección. Se encontró que la frecuencia de la enfermedad infecciosa como causa básica de muerte fue casi ocho veces mayor cuando coexistió la desnutrición como causa múltiple que cuando no se reportó como tal, resultando estadísticamente significativa la diferencia (RM = 7.9, IC 95 por ciento 5.0 - 12.7, p = 0.00000). Se discute la relevancia de estudiar otras causas consignadas en el certificado de defunción, principalmente aquellas que son frecuentes entre la población pero que no se registran comúnmente como causa básica de muerte

With the purpose of describing the role of malnutrition at death time, an analysis of multiple causes of death in children under five years-old was performed on deaths which ocurred during April and May 1985 in Mexico City. A proportional mortality analysis was done taking in consideration all the causes listed on the death certificate, not only the underlying causes. The number of deaths associated to malnutrition was greater by multiple cause than by underlying cause (OR = 7.9, 95% CI 5.0 - 12.7, p = 0.00000). The importance of considering multiple causes of death, mainly when there are frequent diseases which are some times recorded as underlying cause of death, is also discussed.

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