Survival After Ischemic and Hemorrhagic Stroke: A 4-Year Follow-Up at a Mexican Hospital.

BACKGROUND: Overall, 75.2% of deaths from stroke occur in low- and middle-income countries. Mexico is a middle-income country with little information about the prognosis of early and late postischemic and hemorrhagic stroke. OBJECTIVE: To evaluate the factors associated with post-stroke survival in the Mexican population. METHODS: Observational study of consecutive stroke cases involving a first-ever hemorrhagic or ischemic stroke, with patients who received care at the National Institute of Neurology and Neurosurgery, in Mexico City, between 2009 and 2012. Patients were followed for up to 4 years after the index event. Exploratory analysis of survival was carried out with Kaplan-Meier and log-rank tests. Factors associated with survival time were determined using Cox models. RESULTS: A total of 300 out of 544 (55.15%) patients had a hemorrhagic stroke, 135 of 544 (24.82%) patients died during the entire follow-up period, and 56 of 544 (10.29%) died in the first 30 days post-stroke (early mortality). Early mortality after stroke was associated with age ≥ 65 years (Adjusted Hazard Ratio - AHR = 2.07, P = .02) and ≥ 2 in-hospital medical complications (AHR = 46.13, P < .01). Late mortality was associated with age ≥ 65 years (AHR = 3.43, P < .01), ≥2 in-hospital medical complications (AHR = 2.55, P < .01), high comorbidity (AHR = 5.43, P < .01), and recurrence (AHR = 1.90, P = .01). CONCLUSIONS: Patients with hemorrhagic and ischemic stroke who presented in-hospital medical complications, high comorbidity, and were over 65 years old had higher rates of early and late mortality.

Temporal Trends in Mortality from Ischemic and Hemorrhagic Stroke in Mexico, 1980-2012.

BACKGROUND: Over the past decades, the decline in mortality from stroke has been more pronounced in high-income countries than in low- and middle-income countries. We evaluated changes in temporal stroke mortality trends in Mexico according to sex and type of stroke. METHODS: We assessed stroke mortality from Mexico's National Health Information System for the period from 1980 to 2012. We analyzed age-adjusted mortality rates by sex, type of stroke, and age group. The annual percentage change and the average annual percentage change (AAPC) in the slopes of the age-adjusted mortality trends were determined using joinpoint regression models. RESULTS: The age-adjusted mortality rates due to stroke decreased between 1980 and 2012, from 44.55 to 33.47 per 100,000 inhabitants, and the AAPC (95% confidence interval [CI]) was -.9 (-1.0 to -.7). The AAPC for females was -1.1 (-1.5 to -.7) and that for males was -.7 (-.9 to -.6). People older than 65 years showed the highest mortality throughout the period. Between 1980 and 2012, the AAPC (95% CI) for ischemic stroke was -3.8 (-4.8 to -2.8) and was -.5 (-.8 to -.2) for hemorrhagic stroke. For the same period, the AAPC for intracerebral hemorrhage (ICH) was -.7 (-1.6 to .2) and that for subarachnoid hemorrhage (SAH) was 1.6 (.4-2.8). CONCLUSIONS: The age-adjusted mortality rates of all strokes combined, ischemic stroke, hemorrhagic stroke, and ICH, decreased between 1980 and 2012 in Mexico. However, the increase in SAH mortality makes it necessary to explore the risk factors and clinical management of this type of stroke.

The marginalization index and its association with selected services within the comprehensive care offered to breast cancer patients.

PURPOSE: There is little information on the supportive care offered to breast cancer patients. We investigated the association between the marginalization index and selected services offered by health professionals. METHODS: We used data from a cross-sectional parent study performed in Mexico from 2007 to 2009. We analyzed data from 832 women between 35 and 69 years of age with a histopathological diagnosis of breast cancer. This study was performed in hospitals in 5 states. We used frequencies, measures of central tendency, and logistic regression. We used the svy package of STATA statistical software v17. RESULTS: Overall, 15.6% of the study population reported that health professionals offered them selected services. The offer of two or more selected services was greater among women living in states with a very high marginalization index (21.8%) than among those living in states with a very low marginalization index (13.8%). Among women living in states with high marginalization, the odds of receiving a selected service offer were 2.03 times higher than those living in states with low marginalization (Odds ratio (OR) = 2.03, 95% CI 1.08-3.83). For women in the highest tertile of the asset index, the odds of receiving a selected service offer were 2.7 times greater than the odds for women in the lowest tertile (OR = 2.66, 95% CI 1.03-6.88). CONCLUSION: The prevalence of comprehensive care offered to breast cancer patients is low in Mexico and varies according to the marginalization index and the asset index.

[Hormonal contraception as a risk factor for developing cervical cancer: biological, epidemiological and immunological evidence]. / La anticoncepción hormonal como factor de riesgo para cáncer cervicouterino: evidencias biológicas, inmunológicas y epidemiológicas.

BACKGROUND: Cervical cancer has been extensively studied, as well as the various risk factors for that cancer. One such factor is the prolonged use of hormonal contraceptives. OBJECTIVE: To report the biological, immunological and epidemiological findings arising from the use of oral contraceptives and their relation to cervical cancer. MATERIAL AND METHODS: Retrospective study based on information published in national and international literature. CONCLUSIONS: Controversy persists between the epidemiological data and experimental biological association between hormonal contraceptives and cancer induced by HPV. It is important to consider the biological findings because in Mexico the use of hormonal contraceptives is very broad and the number of cases of cervical cancer and only extensive epidemiological studies will clarify this controversy.

[Risk factors associated with maternal mortality in the State of Morelos, Mexico]. / Factores de riesgo asociados con mortalidad materna en el estado de Morelos, México.

INTRODUCTION: Maternal mortality is a public health issue. The causes of maternal mortality are directly related to accessibility, opportunity, costs and quality of obstetric and perinatal services. OBJECTIVE: To describe the characteristics of maternal deaths and analyze the risk factors associated with these deaths in the State of Morelos (Mexico). MATERIAL AND METHOD: a cross-sectional epidemiological, observational, descriptive, retrospective study of 94 cases of maternal deaths registered in the Morelos health services, from 2000 to 2004. Hospitalized and non-hospitalized maternal deaths characteristics were compared. RESULTS: Of 94 maternal deaths, 81.9% were classified as hospitalized (66.7% in public hospitals) and 13.8% as non-hospitalized. 73 (77.6%) deaths occurred during the postpartum period. Most women did not have any medical service (76.7%). There were 77 cases (81.9%) of direct maternal death and 12 (18.1%) indirect. The risk of non-hospitalized maternal death in women 35 to 40 years old was three times higher, with incomplete primary education or none 10.9 and without medical service 3.6 times. CONCLUSIONS: Most deaths were in hospitals, the main causes were hypertensive disorders of pregnancy, childbirth and postpartum and obstetric hemorrhage, events related to the quality of health services. It is necessary to develop more efficient prenatal programs, with focus in maternal and child risk.

Trastornos de la coagulación: factor V Leiden, panorama biológico, clínico y epidemiológico / Coagulation Disorders: Factor V Leiden, Biological, Clinical, and Epidemiological Overview

Resumen El sistema de coagulación mantiene la sangre en estado fluido en todo momento y, por tanto, está incesantemente activa durante toda la vida. Sin embargo, en el momento en que ocurre una lesión del sistema vascular, el sistema de coagulación inmediatamente gira 180° y transforma la sangre en un cuerpo sólido perfectamente localizado, al que llamamos coágulo. Este proceso, mediante el cual se forma un coágulo, se conoce como hemostasia, que es uno de los componentes del sistema de coagulación. La importancia de la mutación Leiden del factor V se basa en lo siguiente: el factor V de la coagulación es una proteína que se sintetiza en el hígado y el gen que lo codifica está situado en la región 23 del brazo largo del cromosoma 1, este factor circula en sangre periférica de manera inactiva hasta que interactúa con el factor X activado, formando un complejo que convierte al factor II (protrombina) en trombina, que va a tener su acción sobre el fibrinógeno convirtiéndolo en fibrina. La regulación del factor V activado se da por la actividad de la proteína C activada, cuando el factor V tiene una mutación (nombrada Leiden) que es ocasionada por el cambio de una adenina por una guanina en el nucleótido 1691 del factor V (G1691A), que causa que se sustituya una arginina por una glutamina en el residuo 506 de la proteína factor V; la proteína resultante es un factor V anómalo, mismo que no puede inactivarse por la proteína C activada, por lo que el factor V continúa activado y no puede impedir que el proceso de coagulación se detenga. En nuestro país (considerando varias afecciones) se ha descrito en diversas publicaciones de investigadores mexicanos que las mutaciones Leiden del factor V y la G20210A de la protrombina no son frecuentes, como lo son en los países europeos.

Abstract The coagulation system always keeps the blood in a fluid state and is therefore incessantly active throughout life. However, the moment an injury to the vascular system occurs, the coagulation system immediately rotates 180° and transforms the blood into a perfectly localized solid body, which we call a clot. This process, by which a clot forms, is known as hemostasis, which is one of the components of the coagulation system. The importance of the Leiden mutation of factor V is based on the following: coagulation factor V is a protein that is synthesized in the liver and the gene that encodes it is located in region 23 of the long arm of chromosome 1, this factor circulates in peripheral blood inactively until it interacts with activated factor X forming a complex that converts factor II (prothrombin) into thrombin, which will have its action on fibrinogen turning it into fibrin. The regulation of activated factor V is given by the activity of activated protein C, when factor V has a mutation (named Leiden) that is caused by the exchange of an adenine for a guanine in the nucleotide 1691 of factor V (G1691A), which causes arginine to be replaced by a glutamine in the 506 residue of the factor V protein, the resulting protein is an abnormal factor V, which cannot be inactivated by activated protein C, so factor V remains activated and cannot prevent the clotting process from stopping. In our country (considering several conditions) it has been described in various publications of Mexican researchers that Leiden mutations of factor V and G20210A of prothrombin are not frequent, as they are in European countries.

[Use of family planning services and its relationship with women's decision-making and support from their partner]. / Uso de servicios de planificación familiar de la Secretaría de Salud, poder de decisión de la mujer y apoyo de la pareja.

OBJECTIVE: To identify the influence of reproductive characteristics and women empowerment with the use of family planning services. MATERIAL AND METHODS: Cases and non-cases design with neighborhood controls (147 users and 146 non-users of family planning services during 2003), in Guanajuato State, Mexico. Various indexes were constructed to evaluate women's empowerment and its relationship with family planning use. RESULTS: The use of family planning services was positively and significantly associated with the woman's power to make decisions (High: OR 3.2, CI95% 1.4-7.4), a high level of communication with her partner on contraceptive use (OR 3.5, CI95% 1.4-9.3); and a greater number of pregnancies (> 6 children: OR 4.4, CI95% 1.4-13.8). CONCLUSION: Factors such as a high level of female decision-making and more partner support for contraceptive use are related to the use of family planning services. Therefore, developing strategies that involve men and support female empowerment could contribute to increasing the use of family planning services.

[Obesity, physical activity and inactivity among adolescents in Morelos, Mexico: a longitudinal study]. / Obesidad, actividad e inactividad física en adolescentes de Morelos, Mexico: un estudio longitudinal.

The prevalence of obesity in childhood and adolescence has increased in Mexico. This increase can be explained partly by a decrease in physical activity. The objective of this study was to assess the association between the prevalence of obesity and overweight with physical activity and inactivity among Mexican adolescents. We analyzed data from a longitudinal study with baseline and follow-up measures in 446 adolescents 12 to 17 years old, attending public schools in Cuernavaca, Morelos, Mexico. We collected information on weight, physical activity and demographic characteristics. Obesity and overweight were determined using as indicador the body mass index, and the cutoff points proposed by the International Obesity Task Force. The baseline prevalence of obesity or overweight was 37.22% (42.99% for males and 30.95% for females), and in the final measure 34.30% (38.46% for males and 32.28% for females). The median time of TV viewing was 3.90 h/d, with 0.73 h/d dedicated to vigorous physical activity and 0.58 h/d to moderate physical activity. Using logistic regression, after adjustment for obesity in the baseline measure, sex and clustering by school, we found no significant associations between the prevalence of obesity or overweight with time dedicated to TV viewing, vigorous or moderate physical activity. However, when conducting the analysis with an interaction term by sex, we found significantly lower risk of obesity or overweight associated with an increase in vigorous physical activity among males only (beta = 0.22, 95% CI (0.05, 0.89). Results suggest that vigorous physical activity may reduce the risk of obesity or overweight among male adolescents.

[Violence and mental health issues among Mexican adolescents that have considered or attempted cross-border migration]. / Violencia y salud mental asociados a pensar o haber intentado emigrar internacionalmente por adolescentes mexicanos.

The aim of this study was to estimate the role of victimization by violence among Mexican adolescents that have considered or attempted migrating to the United States, including mental health variables (emotional self-esteem, self-esteem in school, depression, suicidal ideation, and attempted suicide) as mediators of the effects. The study used a cross-sectional design with a stratified cluster sample of 13,198 adolescents from the 2nd Mexican National Survey on Exclusion, Intolerance, and Violence in public schools in 2009. The analysis used the regression models proposed by Baron & Kenny. Prevalence of having considered or attempted cross-border migration was 23.1%. Mean age was 16.36 years. Female adolescents constituted 54.9% of the sample, and 56% were lower-income. Mental health variables that acted as partial mediators were suicidal ideation (35.9%), depression (19.2%), attempted suicide (17.7%), emotional self-esteem (6.2%), and self-esteem in school (3.4%) for moderate family violence, and emotional self-esteem (17.5%) for social rejection in school and suicidal ideation (8.1%) for physical harm in school. Female adolescents showed greater impact from mediators than men in considering or having attempted cross-border migration. The study discusses the importance of incorporating the prevention of violence in the social contexts studied here and incorporating mental health in dealing with violence in adolescents and in public health programs in transit areas for illegal migrants.

Cigarette Smoking, Alcohol Consumption and Overweight in Multiple Sclerosis: Disability Progression.

BACKGROUND: The rate at which disability progresses in multiple sclerosis (MS), and its severity, have been associated with modifiable lifestyle habits. OBJECTIVE: To investigate the risk of disability progression in MS patients according to tobacco and alcohol consumption and to the presence of overweight. METHODS: This was a follow-up of MS cases from a concluded case-control study (National Institute of Neurology and Neurosurgery, Mexico 2010-2013). The evolution in EDSS (Expanded Disability Scale Score) units was followed through a medical record review. Kaplan Meier statistics and multivariate Cox regression analysis were performed. RESULTS: Of 181 cases, 63.5% were women and 82.5% had relapsing remitting MS. Study duration was 19.95 ± 15.24 months. The disease progressed faster in daily smokers than in non-smokers (p = 0.0168). In overweight patients, disability progressed faster than in normal weight patients (p = 0.0249). Ex-consumers of alcohol had lower risk of progression than current consumers (HR = 0.33 CI 95% = 0.14-0.83, p = 0.019) and both daily and ex-smokers presented higher risk of progression than non-smokers (HR = 2.32 CI 95% = 1.14-4.72, p = 0.020 and HR = 3.56, CI 95% = 1.21-10.46, p = 0.021). Stratifying by gender, the effects of smoking and overweight were only found in men. CONCLUSIONS: Smoking is associated with rapid disability progression in MS. Our results suggest that cessation of tobacco and alcohol consumption could be clinically beneficial. Although there is association between overweight and disability progression in men, a further exploration of gender differences is necessary to corroborate this finding.

Vitamin D receptor gene polymorphisms are associated with multiple sclerosis in Mexican adults.

BACKGROUND: Multiple sclerosis (MS) is the most prevalent autoimmune inflammatory demyelinating disease of the central nervous system (CNS) in young adults. More than 50 genomic regions have been associated with MS susceptibility. Due the important immune-modulating properties of Vitamin D, Vitamin D receptor (VDR) gene polymorphisms - which interfere with the actions of Vitamin D- could be related to increased risk of MS. METHODS: We studied 120 patients fulfilling the McDonald criteria for MS (81 females and 39 males) and 180 healthy unrelated controls, nested in a case-Control study, and were recruited from the National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez in Mexico City. Genotyping of VDR gene polymorphisms BsmI (rs1544410) and TaqI (rs731236) was performed using TaqMan SNP Genotyping Assay which consists of a predesigned mix of unlabeled polymerase chain reaction (PCR) primers and the TaqMan minor groove binding group (MGB) probe (FAM dye-labeled). RESULTS: There was a statistically significant, positive association between MS and the T/T genotype of BsmI polymorphism (OR=4.15; 95%CI 1.83-9.39), showing also a significant positive trend across genotypes (p<0.01). This association was also present evaluating the recessive inheritance model of the polymorphism (OR=3.91; 95%CI 1.77-8.64). When evaluating the association by alleles, the statistically significant positive association seen by genotypes was confirmed in the T allele carriers, showing an OR of 1.83 (95%CI 1.27-2.65) for MS. CONCLUSIONS: We found a positive association of the genetic VDR polymorphisms TaqI (rs731236) and BsmI (rs1544410), with the risk of MS in a sample of Mexican adults.

[Prevalence of sexually transmitted infections and associated risk factors among female commercial sex workers in Cuautla, Morelos]. / Prevalencia de infecciones de transmisión sexual y factores de riesgo concomitantes en sexo servidoras de Cuautla, Morelos.

OBJECTIVE: To determine the prevalence of sexually transmitted infections (STI) among female commercial sex workers in Cuautla, Morelos, Mexico. MATERIAL AND METHODS: A cross-sectional survey was conducted in 1998, in the red-light district of Cuautla, Morelos, Mexico. It included 100 female commercial sex workers who labored permanently in bars and night clubs. Data were collected using two questionnaires, one on socio-demographic characteristics, and the other on commercial sex, risk perception, and knowledge on preventive measures and contagion of sexually transmitted diseases/AIDS. Blood and cervicovaginal specimens were also collected to assess the prevalence of sexually transmitted and reproductive system infections (RSI). Outcome variables were STI (syphilis and chlamydiasis) and RSI (vaginosis and candidiasis). RESULTS: Sexually transmitted prevalence was of 11%, reproductive system infections prevalence was of 39%. When candidiasis was included in the sexually transmitted infections group, prevalence was of 31%. The main factors associated with sexually transmitted infections were: who instructed on condom use, time having intercourse with partner, and years of commercial sex work. Factors related to reproductive system infections were: illiteracy, use of condom with partner, who instructed on condom use, and years of commercial sex work. Multivariate analysis showed an increased likelihood of acquiring a sexually transmitted infection and/or reproductive system infection with illiteracy, instruction on condom use by a person other than a healthcare worker, and lack of condom use. CONCLUSIONS: Regular use of condoms during intercourse is the most important preventive measure to avoid and control STI and RSI. Study findings pinpoint spatial and temporal factors that contribute to infection. Intervention measures directed at these factors should strengthen preventive and educational programs to improve medical care for these infections.

[Polyunsaturated fatty acids for multiple sclerosis treatment: scientific evidence]. / Ácidos grasos poliinsaturados en el tratamiento de la esclerosis multiple: evidencia científica.

INTRODUCTION: Fatty acids have an important role in structure and function of the nervous system. Recently, epidemiologic studies on neurodegenerative disorders have evaluated the usefulness of polyunsaturated fatty acids on multiple sclerosis. OBJECTIVE: To examine recent studies, clinical trials, and reviews on the therapeutic effect of polyunsaturated fatty acids in multiple sclerosis. METHODS: We conducted a search in MEDLINE/PubMed and Cochrane Library with the terms "fatty acids", "omega-3" and "omega-6" in combination with "multiple sclerosis". Articles were selected according to their relevance on the topic. RESULTS: Epidemiologic studies have shown benefits of dietary supplementation with polyunsaturated fatty acids--especially omega-3--in relation to inflammatory, autoimmune and neurodegenerative disorders. In contrast, the studies do not show a beneficial effect of polyunsaturated fatty acids in multiple sclerosis. However, there are limitations related to design and sample issues in these studies. CONCLUSIONS: There is some evidence of a protective effect of polyunsaturated fatty acids on the risk of multiple sclerosis. Despite this, to date controlled trials have not produced definite results on the benefits of supplementation with polyunsaturated fatty acids in patients with multiple sclerosis. Any potential benefit will have to be confirmed in the long term.

INTRODUCCIÓN: Los ácidos grasos son conocidos por jugar un papel en la estructura y actividad del sistema nervioso. Recientemente los resultados de estudios epidemiológicos en enfermedades neurodegenerativas como la esclerosis múltiple se han dirigido a la evaluación de la utilidad de los ácidos grasos poliinsaturados sobre esta enfermedad. OBJETIVO: Examinar estudios recientes de ensayos clínicos aleatorizados y estudios de revisión sobre el efecto terapéutico de los ácidos grasos poliinsaturados en la esclerosis múltiple. MÉTODOS: Se realizó una búsqueda de artículos en MEDLINE/PubMed y la Biblioteca Cochrane con los términos "ácidos grasos", "omega-3" y "omega-6" en combinación con "esclerosis múltiple" que posteriormente fueron revisados y verificados por su contenido relevante. RESULTADOS : Estudios epidemiológicos han confirmado los beneficios de la suplementación de la dieta con ácidos grasos poliinsaturados, especialmente con omega-3, en enfermedades inflamatorias, autoinmunes y neurodegenerativas. En contraste, no se demuestra un efecto beneficioso de este tratamiento en la esclerosis múltiple pero muchos estudios tienen varias limitaciones tanto en el diseño del estudio como en la muestra. CONCLUSIONES : Hay algunos indicios de que el consumo de ácidos grasos poliinsaturados tiene un efecto protector sobre el riesgo de esclerosis múltiple, pero los estudios controlados realizados hasta la fecha no han producido resultados definitivos con respecto a los posibles beneficios de la suplementación con ácidos grasos poliinsaturados en los pacientes con esclerosis múltiple. Para admitir estos posibles beneficios, cualquier resultado positivo deberá ser seguido a largo plazo.

[Antioxidant use as dietary therapy in patients with multiple sclerosis]. / Uso de antioxidantes como terapia dietética en pacientes con esclerosis múltiple.

INTRODUCTION: Multiple sclerosis is an immune-mediated disease that produces chronic inflammation and neural degeneration. The disease progresses with acute attacks that result in myelin inflammation. This in turn increases oxidative stress and favors the appearance of reactive oxygen species. Reactive oxygen species damage neural cells causing apoptosis. The etiology of multiple sclerosis remains unknown and current therapy is aggressive and expensive. Recently, complementary and alternative medicine therapies have been proposed to control pathogenesis and symptoms of this disease. It is believed that these therapies help slow the progression of multiple sclerosis and improve survival. METHODS: We conducted a MEDLINE/PubMed search using the following MeSH terms: diet, multiple sclerosis, antioxidants. We selected the main articles containing multiple sclerosis and diet. RESULTS: We analyzed three case control studies that evaluated different dietary approaches in multiple sclerosis. For this review, we also included five experimental studies that studied the efficacy of lipoic acid in humans and rodents in diseases like multiple sclerosis, experimental autoimmune encephalomyelitis, and breast cancer.

INTRODUCCIÓN: La esclerosis múltiple se caracteriza por una respuesta inmune, inflamación crónica y degeneración neurológica, así como ataques agudos a lo largo del desarrollo de la enfermedad. Se ha observado que en dichos ataques se genera una inflamación de la mielina aumentando el estrés oxidativo y con ello la generación de especies reactivas de oxígeno. Dichas sustancias ocasionan un daño en la estructura y composición de las células neuronales, resultando en apoptosis celular. La etiología de la esclerosis múltiple sigue siendo desconocida y los tratamientos suelen ser agresivos y muy costosos. Recientemente se han propuesto alternativas para el control de la patogénesis y los síntomas de la enfermedad, como la medicina alternativa complementaria. Éstas podrían ayudar al paciente a retrasar la progresión de la esclerosis múltiple y mejorar la supervivencia de los pacientes. MÉTODOS: Se realizó una búsqueda bibliográfica en MEDLINE/PubMed, utilizando términos del MeSH, con las palabras clave: dieta, esclerosis múltiple y antioxidantes. Se seleccionaron los principales artículos sobre esclerosis múltiple y dieta. RESULTADOS: Se analizaron tres estudios de casos y controles que evaluaron diferentes alternativas dietéticas. Además de cinco artículos más de tipo experimental, en los cuales se estudió en humanos y roedores la eficacia del ácido lipoico en casos como esclerosis múltiple, encefalomielitis autoinmune experimental y cáncer de mama. El antioxidante con mayor evidencia científica que promete una importante efectividad en el tratamiento de la esclerosis múltiple es el ácido lipoico.

[Perinatal mortality associated factors in a general hospital of Chiapas, Mexico]. / Factores asociados a mortalidad perinatal en el hospital general de Chiapas, México.

OBJECTIVE: To identify socioeconomic, gynecological-obstetric and fetal factors associated with perinatal mortality. METHODS: A matched case-control study was carried out. Cases were newborns (born live or dead) that were born and died between 28 weeks gestation and 7 days of life. Controls were live newborns between 28 weeks gestation and 7 days of life. A total of 99 cases and 197 controls were studied. Data were obtained from the corresponding medical charts. Statistical analysis was performed using Stata 6.0 software. RESULTS: Mean maternal age was 24.82 years and mean newborn age was 37.78 weeks gestation with an average birth weight of 2,760 grams. Factors associated with perinatal mortality were: father's occupation as a farmer (adjusted odds ratio (OR)=3.31; 95% CI=1.26-8.66); high obstetric risk index (adjusted OR=10.57; 95% CI=2.82-39.66), cesarean birth (adjusted OR=2.75; 95% CI=1.37-5.51), five or more prenatal visits (adjusted OR=4.43; 95% CI=1.86-10.54) and preterm fetal maturity indices (PEG, APG, GEG) (adjusted OR=9.20; 95% CI=4.39-19.25). CONCLUSIONS: The risk factors associated with perinatal mortality found in the study are consistent with the findings reported in the international literature. These results show that prevention and control measures should be implemented to identify at risk pregnant women in order to lower perinatal mortality.

[Knowledge of human papilloma virus (HPV) and acceptance of vaginal self-sampling among Mexican woman]. / Conocimientos sobre virus del papiloma humano (VPH) y aceptación de auto-toma vaginal en mujeres mexicanas.

OBJECTIVE: To analyze the relationship between the level of knowledge about human papilloma virus and the acceptance of vaginal self-sampling as a cervical cancer diagnostic test among Mexican women who have already experienced vaginal self-sampling at home. METHODS: A structured questionnaire consisting of 22 questions was applied to 690 women in the state of Morelos who had taken a vaginal self-sample at home. The aspects explored were the level of knowledge about transmission of the human papilloma virus, identification of the virus as a necessary cause of cervical cancer, and clinical manifestations of infection and treatment. A knowledge index was constructed, identifying the relationship between the index and the women's acceptance of self-sampling, and their degree of trust in the procedure. The statistical analysis included a logistic regression with estimates of measures of association and their respective 95% confidence intervals. RESULTS: The level of knowledge about human papillomavirus showed a positive association with the degree of acceptance of vaginal self-sampling (OR 2.9; 95% CI 1.0-5.01) and the women's level of confidence (OR 2.9; 95% CI 1.8-4.67). The level of knowledge increased with level of education and was higher in younger women. CONCLUSIONS: In order for women with an increased risk of cervical cancer to continue participating in vaginal self-sampling, they must be well informed about the virus. This is especially true for older women, those with lower levels of education, and those in lower socioeconomic levels.

[Public health conceptual models and paradigms]. / Modelos conceptuales y paradigmas en salud pública.

INTRODUCTION: The epidemiological transition model proposed by Omhran at the beginning of the 1970s (decreased fecundity rate and increased life expectancy), together with modifications in lifestyles and diet, showed increased mortality due to chronically degenerative causes. This essay thus discusses and makes a comparative analysis of some currents of thought, taking as its common thread an analysis of epidemiological change identified in different eras or stages and relationships with some public health models or conceptual frameworks. DISCUSSION: Discussing public health paradigms leads to a historical recapitulation of conceptual models ranging from magical-religious conceptions to ecological and socio-medical models. M. Susser proposed 3 eras in this discipline's evolution in his speech on the future of the epidemiology. CONCLUSION: The epidemiological changes analysed through different approaches constitute elements of analysis that all models discussed in this essay include to delimit the contributions and variables so determining them.

Tendencia de la mortalidad por trastornos mentales: un panorama epidemiológico en México (1980-2011) / Tendency of mortality due to mental disorders: an epidemiologic view (Mexico, 1980-2011)

Resumen Se presentan resultados que buscan caracterizar el panorama epidemiológico sobre la tendencia de la mortalidad derivada de enfermedades mentales, específicamente psicosis alcohólica, ocurrido en los últimos 30 años, en la República Mexicana.

Abstract Here we present the results that show the tendency in mortality due to mental disorders, specifically alcohol-related psychosis, in the last 30 years in Mexico.