RESUMO
BACKGROUND: Permanent occupational disability is one of the most severe consequences of diabetes that impedes the performance of usual working activities among economically active individuals. Survival rates and worker compensation expenses have not previously been examined among Mexican workers. We aimed to describe the worker compensation expenses derived from pension payments and also to examine the survival rates and characteristics associated with all-cause mortality, in a cohort of 34,014 Mexican workers with permanent occupational disability caused by diabetes during the years 2000-2013 at the Mexican Institute of Social Security. METHODS: A cross-sectional analysis study was conducted using national administrative records data from the entire country, regarding permanent occupational disability medical certification, pension payment and vital status. Survival rates were estimated using the Kaplan-Meier method. Multivariate Cox proportional hazard model was used to estimate adjusted hazard ratios (HR) and 95 % confidence intervals (95 % CI) in order to assess the cohort characteristics and all-cause mortality risk. Total expenses derived from pension payments for the period were accounted for in U.S. dollars (USD, 2013). RESULTS: There were 12,917 deaths in 142,725.1 person-years. Median survival time was 7.26 years. After multivariate adjusted analysis, males (HR, 1.39; 95 % CI, 1.29-1.50), agricultural, forestry, and fishery workers (HR, 1.41; 95 % CI, 1.15-1.73) and renal complications (HR, 3.49; 95 % CI, 3.18-3.83) had the highest association with all-cause mortality. The all-period expenses derived from pension payments amounted to $777.78 million USD (2013), and showed a sustained increment: from $58.28 million USD in 2000 to $111.62 million USD in 2013 (percentage increase of 91.5 %). CONCLUSIONS: Mexican workers with permanent occupational disability caused by diabetes had a median survival of 7.26 years, and those with renal complications showed the lowest survival in the cohort. Expenses derived from pension payments amounted to $ 777 million USD and showed an important increase from 2000 to 2013.
Assuntos
Complicações do Diabetes/economia , Pessoas com Deficiência/estatística & dados numéricos , Doenças Profissionais/economia , Taxa de Sobrevida , Indenização aos Trabalhadores/economia , Indenização aos Trabalhadores/estatística & dados numéricos , Adulto , Fatores Etários , Estudos de Coortes , Estudos Transversais , Complicações do Diabetes/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Doenças Profissionais/epidemiologia , Modelos de Riscos Proporcionais , Fatores SexuaisRESUMO
BACKGROUND: In recent years, medical practice has followed two different paradigms: evidence-based medicine (EBM) and values-based medicine (VBM). There is an urgent need to promote medical education that strengthens the relationship between these two paradigms. This work is designed to establish the foundations for a continuing medical education (CME) program aimed at encouraging the dialogue between EBM and VBM by determining the values relevant to everyday medical activities. METHODS: A quasi-experimental, observational, comparative, prospective and qualitative study was conducted by analyzing through a concurrent triangulation strategy the correlation between healthcare personnel-patient relationship, healthcare personnel's life history, and ethical judgments regarding dilemmas that arise in daily clinical practice.In 2009, healthcare personnel working in Mexico were invited to participate in a free, online clinical ethics course. Each participant responded to a set of online survey instruments before and after the CME program. Face-to-face semi-structured interviews were conducted with healthcare personnel, focusing on their views and representations of clinical practice. RESULTS: The healthcare personnel's core values were honesty and respect. There were significant differences in the clinical practice axiology before and after the course (P <0.001); notably, autonomy climbed from the 10th (order mean (OM) = 8.00) to the 3rd position (OM = 5.86). In ethical discernment, the CME program had an impact on autonomy (P ≤0.0001). Utilitarian autonomy was reinforced in the participants (P ≤0.0001). Regarding work values, significant differences due to the CME intervention were found in openness to change (OC) (P <0.000), self-transcendence (ST) (P <0.001), and self-enhancement (SE) (P <0.019). Predominant values in life history, ethical discernment and healthcare personnel-patient relation were beneficence, respect and compassion, respectively. CONCLUSIONS: The healthcare personnel participating in a CME intervention in clinical ethics improved high-order values: Openness to change (OC) and Self Transcendence (ST), which are essential to fulfilling the healing ends of medicine. The CME intervention strengthened the role of educators and advisors with respect to healthcare personnel. The ethical values developed by healthcare professionals arise from their life history and their professional formation.
Assuntos
Educação Médica Continuada/métodos , Medicina Baseada em Evidências/ética , Pessoal de Saúde , Aquisição Baseada em Valor/ética , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , México , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: Several studies in type 2 diabetes patients have shown significant associations between the SOD2 gene Val16Ala polymorphism and albuminuria, but this association has not been explored in the Mexican population. METHODS: We evaluated the association between the SOD2 gene Val16Ala polymorphism (rs4880) and macroalbuminuria in a sample of 994 unrelated Mexican type 2 diabetes patients. The study included 119 subjects with urinary albumin >300 mg/dL and 875 subjects with urinary albumin ≤ 30 mg/dL. Genotyping of the SOD2 gene Val16Ala SNP was carried out with Real-Time Polymerase Chain Reaction (RT-PCR). RESULTS: The frequency of the TT genotype was 6.7% higher in participants with macroalbuminuria than in the normoalbuminuria group (16.8% vs. 10.1%). Using a logistic regression analysis, we observed that individuals with the CC genotype had significantly lower risks of macroalbuminuria than those with the TT genotype (OR=0.42, p=0.034). We carried out a meta-analysis combining our data with data from four previous studies and estimated an odds ratio (95% CI) for the C allele (with respect to the reference T allele) of 0.65 (0.52-0.80, p<0.001). CONCLUSIONS: A significant association was found between the SOD2 Val16Ala polymorphism and macroalbuminuria in a sample of Mexican type 2 diabetes patients.
Assuntos
Albuminúria/genética , Diabetes Mellitus Tipo 2/genética , Superóxido Dismutase/genética , Idoso , Albuminúria/complicações , Alelos , Diabetes Mellitus Tipo 2/complicações , Feminino , Frequência do Gene , Genótipo , Humanos , Modelos Logísticos , Masculino , México/etnologia , Pessoa de Meia-Idade , Razão de Chances , Polimorfismo de Nucleotídeo ÚnicoRESUMO
BACKGROUND: The lower extremity amputations diminish the quality of life of patients with Diabetes Mellitus (DM). The aim of this study was to describe the lower extremity amputation rates in subjects with DM in the Mexican Social Security Institute (IMSS), comparing 2004 and 2013. METHODS: A comparative cross-sectional study was done. Amputations were identified from the hospital records of System of Medical Statistics (DataMart). The DM patient census was obtained from the System of Integral Attention to Health. Major and minor amputations rates were expressed per 100,000 DM patients. RESULTS: We observed 2 334 340 and 3 416 643 DM patients during 2004 and 2013, respectively. The average age at the time of the amputation was similar in 2004 and 2013 (61.7 and 65.6 years old for minor and major amputations respectively). The major amputations rates were 100.9 and 111.1 per 100 000 subjects with DM in during 2004 and 2013 (p = 0.001); while minor amputations rates were 168.8 and 162.5 per 100 000 subjects with DM in during 2004 and 2013 respectively (p = 0.069). CONCLUSIONS: The lower extremity amputations rates at IMSS are very high compared with that reported in developed countries. The major amputations rate increased in 2013 compared with 2004.
Introducción: las amputaciones de extremidades inferiores disminuyen la calidad de vida de los pacientes con diabetes mellitus (DM). El objetivo de este estudio fue describir el índice de amputaciones de extremidades inferiores (mayores y menores) en sujetos con DM adscritos al Instituto Mexicano del Seguro Social (IMSS), comparando los años 2004 y 2013. Métodos: estudio observacional transversal comparativo. Se evaluaron los registros hospitalarios de amputaciones obtenidos del Sistema de Estadísticas Médicas (DataMart) y del Censo de pacientes con DM obtenido del Sistema de Atención Integral a la Salud. Se calcularon los índices de amputaciones mayores y menores x 100,000 sujetos con DM adscritos a Medicina Familiar. Resultados: durante 2004 y 2013 se observaron 2 334 340 y 3 416 643 pacientes con DM adscritos a Medicina Familiar respectivamente. Los promedios de edad al momento de la amputación fueron similares en el año 2004 y 2013 (61.7 años para las amputaciones menores y 65.6 años para las amputaciones mayores). Los índices de amputaciones mayores fueron de 100.9 y de 111.1 x 100 000 sujetos con DM en 2004 y 2013; mientras que el índice de amputaciones menores de extremidades inferiores fue de 168.8 y de 162.5 x 100 000 sujetos con DM en el durante 2004 y 2013 respectivamente. Conclusiones: el índice de amputaciones de extremidades inferiores en el IMSS es muy alto comparado con lo reportado en países desarrollados. El índice de amputaciones mayores se incrementó para el año 2013, comparado con 2004.
Assuntos
Amputação Cirúrgica/tendências , Pé Diabético/cirurgia , Padrões de Prática Médica/tendências , Academias e Institutos , Adulto , Idoso , Amputação Cirúrgica/estatística & dados numéricos , Estudos Transversais , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Previdência SocialRESUMO
The knowledge of the molecular basis of diabetes mellitus physiopathology will allow improvements in treatment or prevention of the disease. Diabetes mellitus is a complex disease in which hyperglycemia leads to complications in several organs. In this condition, there is increase in reactive oxygen species (ROS) as a result of glucose autooxidation; its metabolism produces accumulation of metabolites such as fructose, sorbitol, and triose phosphate. The latter generates a oxoaldehydes with high capacity to produce protein glycation and oxidative stress. Moreover, there is an increase in synthesis of diacylglycerol from triosephosphate, which activates protein kinase C. On the other hand, alteration of normal ratio between reduced and oxidized niacinamide nucleotides leads to low efficiency of antioxidative systems. Finally, this metabolic dysregulation causes altered signal transduction, abnormal gene expression, and tissue damage, resulting in development of diabetic complications.
Assuntos
Diabetes Mellitus/fisiopatologia , Hiperglicemia/fisiopatologia , Humanos , Biologia Molecular , Estresse Oxidativo/fisiologiaRESUMO
BACKGROUND: We explored the imputation performance of the program IMPUTE in an admixed sample from Mexico City. The following issues were evaluated: (a) the impact of different reference panels (HapMap vs. 1000 Genomes) on imputation; (b) potential differences in imputation performance between single-step vs. two-step (phasing and imputation) approaches; (c) the effect of different INFO score thresholds on imputation performance and (d) imputation performance in common vs. rare markers. METHODS: The sample from Mexico City comprised 1,310 individuals genotyped with the Affymetrix 5.0 array. We randomly masked 5% of the markers directly genotyped on chromosome 12 (n=1,046) and compared the imputed genotypes with the microarray genotype calls. Imputation was carried out with the program IMPUTE. The concordance rates between the imputed and observed genotypes were used as a measure of imputation accuracy and the proportion of non-missing genotypes as a measure of imputation efficacy. RESULTS: The single-step imputation approach produced slightly higher concordance rates than the two-step strategy (99.1% vs. 98.4% when using the HapMap phase II combined panel), but at the expense of a lower proportion of non-missing genotypes (85.5% vs. 90.1%). The 1,000 Genomes reference sample produced similar concordance rates to the HapMap phase II panel (98.4% for both datasets, using the two-step strategy). However, the 1000 Genomes reference sample increased substantially the proportion of non-missing genotypes (94.7% vs. 90.1%). Rare variants (<1%) had lower imputation accuracy and efficacy than common markers. CONCLUSIONS: The program IMPUTE had an excellent imputation performance for common alleles in an admixed sample from Mexico City, which has primarily Native American (62%) and European (33%) contributions. Genotype concordances were higher than 98.4% using all the imputation strategies, in spite of the fact that no Native American samples are present in the HapMap and 1000 Genomes reference panels. The best balance of imputation accuracy and efficiency was obtained with the 1,000 Genomes panel. Rare variants were not captured effectively by any of the available panels, emphasizing the need to be cautious in the interpretation of association results for imputed rare variants.
Assuntos
Projeto HapMap , Modelos Estatísticos , Software , Frequência do Gene/genética , Marcadores Genéticos/genética , Genoma Humano/genética , Técnicas de Genotipagem , Humanos , México , Análise de Sequência com Séries de Oligonucleotídeos , Padrões de ReferênciaAssuntos
Proteção da Criança , Criança , Maus-Tratos Infantis/mortalidade , Maus-Tratos Infantis/estatística & dados numéricos , Creches/normas , Proteção da Criança/legislação & jurisprudência , Proteção da Criança/estatística & dados numéricos , Pré-Escolar , Feminino , Previsões , Prioridades em Saúde , Parto Domiciliar/estatística & dados numéricos , Jovens em Situação de Rua/estatística & dados numéricos , Direitos Humanos , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , México , Pobreza , Problemas SociaisAssuntos
Vacinação/normas , Vacinas/administração & dosagem , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Esquemas de Imunização , Lactente , Masculino , Pessoa de Meia-IdadeRESUMO
The aim of this study was to determine the frequency of drug resistance and the clonality of genotype patterns in M. tuberculosis clinical isolates from pediatric patients in Mexico (n = 90 patients from 19 states; time period-January 2002 to December 2003). Pulmonary disease was the most frequent clinical manifestation (71%). Children with systemic tuberculosis (TB) were significantly younger compared to patients with localized TB infections (mean 7.7 ± 6.2 years versus 15 ± 3.4 years P = 0.001). Resistance to any anti-TB drug was detected in 24/90 (26.7%) of the isolates; 21/90 (23.3%) and 10/90 (11.1%) were resistant to Isoniazid and Rifampicin, respectively, and 10/90 (11.1%) strains were multidrug-resistant (MDR). Spoligotyping produced a total of 55 different patterns; 12/55 corresponded to clustered isolates (n = 47, clustering rate of 52.2%), and 43/55 to unclustered isolates (19 patterns were designated as orphan by the SITVIT2 database). Database comparison led to designation of 36 shared types (SITs); 32 SITs (n = 65 isolates) matched a preexisting shared type in SITVIT2, whereas 4 SITs (n = 6 isolates) were newly created. Lineage classification based on principal genetic groups (PGG) revealed that 10% of the strains belonged to PGG1 (Bovis and Manu lineages). Among PGG2/3 group, the most predominant clade was the Latin-American and Mediterranean (LAM) in 27.8% of isolates, followed by Haarlem and T lineages. The number of single drug-resistant (DR) and multidrug-resistant (MDR-TB) isolates in this study was similar to previously reported in studies from adult population with risk factors. No association between the spoligotype, age, region, or resistance pattern was observed. However, contrary to a study on M. tuberculosis spoligotyping in Acapulco city that characterized a single cluster of SIT19 corresponding to the EAI2-Manila lineage in 70 (26%) of patients, not a single SIT19 isolate was found in our pediatric patient population. Neither did we find any shared type belonging to the EAI family which represents ancestral PGG1 strains within the M. tuberculosis complex. We conclude that the population structure of pediatric TB in our setting is different from the one prevailing in adult TB patient population of Guerrero.
RESUMO
La marginación social es multicausal, cambiante en el tiempo, prácticamente imposible de erradicar. Los niños son el sector más vulnerable y deficitario; el porvenir de la familia, la comunidad y la nación se califican a través del crecimiento y desarrollo de sus niños. La marginación social en los niños abarca diversas áreas, entre ellas la educación, la nutrición, la salud, la vivienda, etc. En nuestro país existen marcadas diferencias entre las diferentes entidades federativas. La condición de indígena en México está asociada con marginalidad persistente. Se deben hacer los cambios pertinentes para disminuir en lo posible la marginación social de los niños en nuestro país.
Social exclusion is changing over time. It is multicausal and virtually imposible to eradicate. Children are the most vulnerable population suffering from this deficit. The future of families, the community and the nation are evaluated by the growth and development of their children. Social exclusion among children covers several areas including education, nutrition, health, housing, etc. In our country there are marked differences among different federal entities. The indigenous Mexican status is associated with persistant marginalization. Changes are necessary to reduce social exclusion of Mexican children.
RESUMO
Se hace una breve descripción de los efectos que causaba la viruela en la población mundial para contextualizar históricamente los acontecimientos que dieron lugar a la evolución del concepto y de la práctica de la vacunación antivariolosa. A través del relato de diversos hechos de la vida de Jenner en relación con su estudio y ejercicio de la inoculación, se presentan y comentan las enseñanzas que han dejado la diseminación de la técnica y el desarrollo de programas y campañas de vacunación antivariolosa en todo el mundo. Se señala que el análisis del proceso que culminó con la erradicación de la viruela tiene actualidad ante los programas en marcha para controlar, eliminar y eventualmente erradicar algunas enfermedades. Finalmente, se destacan algunas de las enseñanzas que han sido aprovechas en exitosas capañas de vacunación nacionales, regionales o mundiales, en la lucha contra otras enfermedades transmisibles
A brief description of the effects that smallpox caused in the worldwide population places the events that gave rise to the evolution of the concept and practice of the smallpox vaccine in context. Through a description of various events in Jenner's life in relation to his study and use of inoculation, the lessons that have been learned from the dissemination of the technique and the development of smallpox vaccination campaigns and programs throughout the world are commented on. The article indicates that the analysis of the process that culminated in the eradication of smallpox has current applications in programs underway to control, eliminate and eventually eradicate certain diseases. Finally, some lessons are highlighted that have been used in successful national, regional and worldwide vaccination campaigns in the struggle against other infectious diseases.
Assuntos
Varíola/história , Varíola/prevenção & controle , Vacina Antivariólica/história , História do Século XVIII , História do Século XIX , História da MedicinaRESUMO
La atención médica siempre ha estado orientada a la solución del mayor número de problemas de salud, y el progreso de los conocimientos médicos ha sido guiado por la investigación, desde los niveles empíricos del pasado hasta la sistematización científica de los conocimientos clínicos y farmacológicos. En la segunda mitad del siglo XIX, la medicina alcanzó un caráter científico y comenzó a generar tecnologías propias. Ya en el siglo XX, los avances en nutrición, endocrinología, genética y terapéutica antimicrobiana abrieron paso a la Farmacología Clínica, seguida de un nuevo impulso a la investigación clínica que a la fecha sigue permitiendo la idenficación de padecimientos desconocidos. Para el incremento en la calidad de la atención, es necesario un control de la asistencia, de cuyos resultados deberán obtenerse evaluaciones rigurosas y diseñarse protocolos de investigación adecuados. Mención especial merecen los estudios en voluntarios humanos, por las implicaciones éticas que los limitan y por su considerable utilidad para el desarrollo del conocimiento médico
Assuntos
Pesquisa , Qualidade da Assistência à SaúdeRESUMO
El propósito de este trabajo es dar a conocer las bases moleculares de la fisiopatología de la diabetes mellitus, con el fin de prevenir la enfermedad o mejorar el tratamiento. La diabetes mellitus es una enfermedad compleja, donde la hiperglucemia crónica provoca complicaciones en distintos órganos. En esta condición aumentan las especies reactivas de oxígeno como resultado de su autooxidacción, por lo que su metabolismo propicia la acumulación de metabolitos como la fructosa, el sorbitol y las triosas fosfato. Éstos últimos generan α-oxoaldehídos reactivos con alta capacidad de unirse a proteínas y generar estrés oxidativo. Además, hay aumento de la síntesis de diacilgliceroles a partir de las triosas fosfato, las cuales activan a la pro teína cinasa C. Por otra parte, la alteración de la proporción normal entre los nucleótidos de niacinamida reducidos con respecto a los oxidados conduce a una baja eficiencia de los sistemas antioxidantes. Finalmente, estas desregulaciones metabólicas causan alteración en la transducción de la señal, en la expresión anormal de genes, además de daño tisular, lo que propicia complicaciones en los pacientes con diabetes.
The knowledge of the molecular basis of diabetes mellitus physiopathology will allow improvements in treatment or prevention of the disease. Diabetes mellitus is a complex disease in which hyperglycemia leads to complications in several organs. In this condition, there is increase in reactive oxygen species (ROS) as a result of glucose autooxidation; its metabolism produces accumulation of metabolites such as fructose, sorbitol, and triose phosphate. The latter generates α oxoaldehydes with high capacity to produce protein glycation and oxidative stress. Moreover, there is an increase in synthesis of diacylglycerol from triose phosphate, which activates protein kinase C. On the other hand, alteration of normal ratio between reduced and oxidized niacinamide nucleotides leads to low efficiency of antioxidative systems. Finally, this metabolic dysregulation causes altered signal transduction, abnormal gene expression, and tissue damage, resulting in development of diabetic complications.
Assuntos
Humanos , Diabetes Mellitus/fisiopatologia , Hiperglicemia/fisiopatologia , Biologia Molecular , Estresse Oxidativo/fisiologiaRESUMO
Se estudiaron los linfocitos CD3+ , CD4+ y CD8+ de 187 pacientes que viven con el VIH-1, con edades comprendidas entre 19 y 56 años, en estadios clínicos A 1, 2, 3 (67 asintomáticos) y con SIDA en estadios B 1, 2, 3 y C 1, 2, 3 (83 pacientes). Se usó un equipo compacto que utiliza sangre total y obvia la biometría hemática, ahorrando tiempo y costo. Al compararlos con 37 sujetos normales de las mismas edades, se encontró una marcada diferencia con los testigos de 1.78 ñ 0.65 y con el grupo asintomático A 1, 2, 3 de 0.37 ñ 0.23, al analizar las proporciones CD4+/CD8+ (ANOVA, F=<5 por ciento, >1 por ciento). Extendimos nuestra observación al análisis de los ángulos formados por la unión de los puntos de las proporciones CD4+/CD8+-CD4+/CD3+ y CD4+/CD3+-CD8+/CD3+ en papel milimétrico, a una distancia de 4 cm, graficando con el 0º a la izquierda y los 90º hacia arriba. El ángulo de las proporciones CD4+/CD3+-CD8+/CD3+ para los testigos fue de 199.59º ñ 10.87º, comparado con el grupo de asintomáticos que fue de 140.59º (ANOVA, F=<5 por ciento, >1 por ciento). El sobreponer en forma de diagrama los valores de los ángulos de las proporciones, tanto de los testigos como de los grupos problema en un círculo, facilita la interpretación al clínico
We propose that the ratios of lymphocyte subsets: CD4+/CD8+, CD4+/CD3+, and CD8+/CD3+, graphically displayed in this order, could be an easy way of immunophenotyping and a simple form of interpretation both for clinicians and patients. A total of 187 asymptomatic HIV-positive patients, -including 83 symptomatic patients with AIDS- and a normal comparative age group of 36 patients, were studied by flow cytometry. Ratios were graphically displayed on millimetric-grid paper, and a specific point was given to each obtained ratio. The points were connected by a line. The angles formed by the lines were measured and graphically displayed over a circle. The point of reference 0 was located on the left side of the circle, giving the corresponding 90 , 180 , and 240 angles. The graph of the control group shows a "beach chair" image. As soon as the CD4+ lymphocytes diminish and the CD8+ lymphocytes increase in HIV+ patients, "the chair's headrest" descends and the "chair's footpiece " swivels back. Given the ranks and fluctuations of the lymphocyte subsets, their graphic display provides a better representation of the immunological status.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Subpopulações de Linfócitos/imunologia , Subpopulações de Linfócitos/virologia , HIV , Citometria de Fluxo , Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/imunologia , Testes ImunológicosRESUMO
En este trabajo se describen las acciones de vacunación contra el sarampión por el método de aerosol inhaladado llevada a cabo en la República Mexicana entre 1988 y 1990. Se hace mención pormenorizada del equipo simplificado que se empleó, del personal, de su adiestramiento, de la promoción y de la estructura de las campañas correspondientes. También se precisa la vacuna usada: cepa Edmonston-Zagreb cultivada en células diploides, del Instituto Nacional de Virología de la Secretaría de Salud en México, con un título que varió, de 10 4.5 unidades formadoras de placa/ml (PFU/ml) a 10 4.8 PFU/ml, administrada en 30 segundos de inhalación, con un descarga del nebulizados, durante este lapso, de 2 800 a 4 000 PFU por niño, estimándose la dosis retenida en 25 por ciento , por ejemplo, 700 a 1 000 PFU. En total se tiene documentada la vacunación de 3 760 684 niños prescolares y escolares en 13 de las 32 entidades federativas del país. No se observaron efectos indeseables de gravedad y los estudios limitados que se realizaron, tanto serológicos como de campo, avalan la efectividad y seguridad de este método que es, por otra parte, mucho más barato, rápido y aceptable por la población que el de inyección subcutánea.