HSV-2 seroincidence among Mexican college students: the delay of sexual debut is not enough to avoid risky sexual behaviours and virus transmission.

OBJECTIVES: Early sexual debut is a behaviour that has been associated with acquiring sexually transmitted infections. Higher schooling may delay sexual debut, thus the university population is categorised with low-risk sexual behaviours. The rate ratio of herpes simplex virus type 2 (HSV-2) seroincidence according to demographic characteristics and sexual behaviour was estimated for a cohort of university students. METHODS: A dynamic cohort of university students was followed at the Autonomous University of Morelos, in central Mexico, during the years 2001-5. After obtaining informed consent, information was gathered annually regarding demographic characteristics and sexual behaviour and blood samples were obtained to determine HSV-2 antibodies. Seroincidence was estimated and the incidence rate ratio was evaluated using the Poisson regression model. RESULTS: A total of 404 students participated, with 669.2 person-years of follow-up. An incidence of 4.2 cases per 100 person-years was estimated. The variables delayed sexual debut (≥18 years) and multiple sexual partners (two or more sexual partners during the past year) had a rate ratio of 4.1 (95% CI 1.2 to 14.3) and 2.5 (95% CI 1.1 to 5.6), respectively. Incidence for students with delayed sexual debut and multiple partners is estimated to be 10.3 cases per 100 person-years. CONCLUSIONS: Delayed sexual debut was a risk factor for acquiring HSV-2, due to a subgroup with sexual debut at 18 years of age or older that had multiple sexual partners; therefore, in the university population that tends to delay sexual debut, it is necessary to implement prevention programmes to promote the decrease of other risky sexual behaviours, as well as the promotion of the consistent use of condoms.

Risk factors for gastric precancerous and cancers lesions in Latin American counties with difference gastric cancer risk.

OBJECTIVE: To evaluate the risk factors associated with pre-neoplastic lesions and gastric cancer in countries with different cancer risk in Latin America. METHODS: 1222 questionnaires of risk factors related to pre-neoplastic lesions and gastric cancer were obtained from patients from Mexico (N = 559), Colombia (N = 461) and Paraguay (N = 202), who were treated at the gastroenterology or oncology service of participant hospitals. In addition, biopsies specimens to establish histological diagnosis and blood to detect IgG antibodies against Helicobacter-pylori (H. pylori) whole-cell antigens and CagA protein using an ELISA were collected. These consisted of 205 gastric cancer, 379 pre-neoplastic (intestinal metaplasia (IM) / atrophic gastritis) and 638 control (normal /non-atrophic gastritis) cases. The odds ratio (OR) and 95% confidence intervals (CI) associated with potential risk factors were estimated by polynomial logistic regression model. RESULTS: Seropositivity to H. pylori was associated with risk of pre-neoplastic lesions, with OR = 1.9 (CI 95% 1.2-2.9; p = 0.006). Grain / cereal intake (OR = 1.6, 95% CI 1.0-2.5 ; p = 0.049) and egg intake (OR = 1.7 95% CI 1.1-2.6 ; p = 0.021) were related to gastric cancer. Among, people who did not developed gastric cancer, smoking more than five cigarette per day had the highest risk of being infected by H. pylori (OR = 1.9; CI 95% 1.1-3.3 ; p = 0.028). CONCLUSION: The present study in Latin American countries confirmed that similar environmental factors such as smoking and grain/cereal consumption were associated with H. pylori infection and its induced gastric lesions as reported in other regions where dominant H. pylori strains differ.

Uptake of the HPV vaccine among people with and without HIV, cisgender and transgender women and men who have sex with men and with women at two sexual health clinics in Mexico City.

Our aim was to better understand Human Papillomavirus (HPV) vaccine acceptance among Mexican adults including people with and without HIV, cisgender men who have sex with men (MSM) or with women (MSW), cisgender and transgender women. A computer-assisted, self-administered questionnaire was completed by healthcare users and participants recruited through community organizations, and the first dose of the quadrivalent HPV vaccine was offered at no cost at a large sexual health clinic in Mexico City, from May to December 2018. Socio-demographic characteristics and factors associated with HPV vaccine acceptance were analyzed using logistic regression.The sample of 1915 participants included 1341 cisgender men (70.9%, 1247 MSM and 94 MSW), 396 (20.7%) cisgender women and 178 (9.3%) transwomen; 615 people (32.1%) were HIV positive. Uptake of the HPV vaccine was higher in men and transwomen (91.5% and 87%, respectively) than among cisgender women (81.8%; p < .001). Cisgender women (OR 0.43, 95%CI 0.30-0.61, p < .05) were less likely to accept HPV vaccination than men. Married/partnered people were less likely to accept HPV vaccination compared to those who were single (OR 0.70, 95%CI 0.51-0.97). People living with HIV were not significantly more likely to accept HPV vaccination (OR 1.7; 95%CI 0.86-1.61).HPV vaccine acceptance was high among adult Mexican study participants; it may be higher than among other Mexican adults given most of these individuals are engaged in care. Modifications will be needed in national and international recommendations on HPV vaccination in adults if healthcare personnel are to recommend the vaccine to the population groups studied.

Relevance of Helicobacter pylori virulence factors for vaccine development.

Helicobacter pylori infection increases the risk for a wide spectrum of clinical outcomes, ranging from peptic ulcer disease to gastric cancer. However, the infection induces gastric and duodenal ulceration or gastric cancer in only a minority of infected subjects because H. pylori strains are genetically diverse and express different virulence factors. Individuals infected with strains that express these virulence factors probably develop severe diseases such as gastric cancer. Nevertheless, the ancient relationship between H. pylori and humans suggests that some strains could be beneficial to human health, which means that generalized administration of antibiotic therapy could eventually cause problems. The development of vaccines based on virulence factors that provide long-term protection is the best strategy for control and/or elimination of pathogenic strains. The different immunization schemes and formulations designed to evaluate the vaccines based on virulence factors in animal models have offered promising results. However, it is necessary to determine whether or not these results can be reproduced in humans. This article reviews recent vaccination studies that explore this possibility: oral vaccines using urease or inactivated whole cells plus LT as adjuvant and urease expressed in Salmonella spp. vectors, as well as a parenteral multicomponent vaccine plus aluminum hydroxide as adjuvant. Although these studies have achieved limited success, they have established support for the development of an effective vaccine against this infection.

[Overuse of colposcopy service in Mexico]. / Sobreutilización del servicio de colposcopia en México.

BACKGROUND: Cervicouterine cancer is one of the main public health problems in Mexico. Several problems related to the low effectiveness of the Program of Opportune Detection of Cervicouterine Cancer have been identified, among them: low cover of the disease detection and absence of quality control in the detection, diagnosis and treatment of it. In Mexico the quality control problem in cytology has been taken with success, but the opposite occurs with colposcopy practice. For that reason this service is overused by patients with low risk cancer and is not accessible for the high risk population. OBJECTIVE: To evaluate the association between cervicouterine cancer knowledge and satisfaction with the service regarding the use and intention of adherence to it for the follow-up and treatment, as well as analyze the resources used for this attention. PATIENTS AND METHODS: A transversal study was done from May to December, 2002. It included all the patients who went to the Colposcopy Service in three hospitals. 1,606 patients were interviewed, from them 443 cases were first-time visits and 1,163 were subsequent ones. RESULTS: In a multivariate model we observed that the real utility knowledge of cervicovaginal cytology increases the probability that women come back to the Colposcopy Service (OR 2.0, Cl 95%: 1.57, 2.54). Patients who know their diagnosis when it is dysplasia or cancer are more likely to become attached to their follow-up than those who do not know it. 91% of the users (1,463) had two or more cervicovaginal cytolgies done, and 49% (787) had eight or more. Patients who know the purpose and utility of the biopsy had a 4.4 fold probability of become subsequent than those that do not know such information (Cl 95%: 1.72 to 11.35). CONCLUSIONS: Nowadays colposcopy clinics treat 70% of the patients who are subsequent and that have normal reports of cytology. This shows us an overuse of the service, with the consequent service, monetary and opportunity costs for women. More studies should be done to reformulate the rule that controls the treatment of these patients, and incorporate follow-up guidelines according to the natural history of the disease in Mexican women.

Predictors of bone mineral density in female workers in Morelos State, Mexico.

BACKGROUND: Although several studies have identified factors associated with bone mineral density (BMD), little research is available on Mexican women. METHODS: A cross-sectional study was conducted in 1,622 female workers between 20 and 80 years of age at the Mexican Social Security Institute (IMSS), an integral part of the Mexican health system. It was carried out in Morelos, a Mexican state that borders Mexico City. Women were recruited to participate in this study from their workplaces. Body mass index (BMI) was measured and BMD was assessed using dual-energy x-ray absorptiometry of dominant forearm. Predictors of BMD (age, reproductive factors, BMI, diet, and physical activity) in pre- and postmenopausal women were assessed by questionnaire and analyzed using generalized additive models. RESULTS: In premenopausal women, older age, higher BMI, younger age at menarche, and greater vitamin D intake were associated with higher BMD (R(2)=0.06, null deviance reduction=6.9%). In postmenopausal women, determinants of BMD were older age, higher BMI, greater height, later initiation of menopause, longer time of use of hormonal replacement therapy (HRT), and greater calcium intake from dairy products (R(2)=0.39, null deviance reduction=40.7%). CONCLUSIONS: As observed in other populations, age, BMI, height, age at menopause, time of use of HRT, and calcium intake derived from dairy products in these Mexican women are factors associated with higher forearm BMD during postmenopausal period. Age, BMI, age at menarche, and vitamin D are associated with higher forearm BMD in premenopausal women. Some of these factors are not linearly associated with BMD. This was a limited population study carried out in a large group of female healthcare workers whose reproductive and lifestyle factors potentially agreed with those of female workers from urban areas of Mexico.

Chronic disease risk factors among healthy adolescents attending public schools in the state of Morelos, Mexico.

BACKGROUND: Little research (and fewer interventions) has been done on longitudinal exposure to risk factors for chronic diseases in young people in Latin America, including Mexico, although chronic diseases constitute the first cause of death in Mexico. Our objective was to document the prevalence of chronic disease risk factors among adolescents as a baseline measurement for a cohort study and to develop educational interventions. METHODS: Questionnaires, blood samples, and anthropometric measurements were collected from 13,293 public school students of both sexes, ages 11-24 years in Morelos, Mexico. This constitutes the baseline measurement for a cohort study. Twenty focus groups and 10 in-depth interviews were done with girls aged 12-17 years. Two educational interventions promoting physical activity and sexual health were designed. RESULTS: Prevalence of obesity was 21.2%. On average, participants spent 0.5 h/day on vigorous physical activity and 3.7 h/day watching television. Sexual initiation was reported by 14.5% (girls = 9.1%, boys = 21.5%); 52.3% of whom reported using condoms. Young women demonstrated correct condom use and perceived themselves at risk for HIV/AIDS but did not have condom negotiation skills. Prevalence of experimenting with tobacco was 15.1% (girls = 10.4%, boys = 21.1%); current smoking was 14.4% (girls = 10.6%) and boys = 19.2%), while 6.3% of participants reported monthly intoxication with alcohol, and 4.5% reported past and 2.1% reported current illegal drug use. CONCLUSIONS: Results indicate substantial exposure to risk factors for chronic diseases and reproductive health problems in this population. The study will generate interventions and constitutes initiation of a longitudinal study able to explore causal associations between risk factors and chronic diseases in this population.

The positive experience of screening quality among users of a cervical cancer detection center.

BACKGROUND: Our objective was to determine the main factors associated with increased utilization of a cervical cancer screening program (CCSP) in a population with a high mortality rate due to cervical cancer. METHODS: A population-based study was carried out in the Mexican state of Morelos, Mexico. The study population included 3,197 women between the ages of 15 and 49 years who were selected at random using a State Household Sampling Framework in the State of Morelos's 33 municipalities. The sample included 2,094 women with a history of a previous Papanicolaou (Pap) test. RESULTS: A previous experience of good screening quality is strongly associated with greater use of the CCSP (OR = 4.2; 95% confidence interval [CI], 1.6-10.9). The educational level of the head of the family is related to more frequent use of Pap smear services. Women whose husbands have 13 or more years of education (OR = 1.8; 95% CI 1.1-2.9) were more likely to have been screened. Similarly, women who had used two or more family planning methods (OR = 1.6; 95% CI 1.2-2.1) and those who knew why the Pap test was given (OR = 3.0; 95% CI 2.1-4.3) had a better history of Pap screening. CONCLUSIONS: In areas where coverage of cervical cancer screening is low, a CCSP that guarantees the quality of all the different elements of care is essential if obstacles to cervical cancer prevention are to be eliminated. It is of particular importance to take into account and satisfy the perceptions and expectations of the women at risk.

Prediction of alterations in glucose metabolism by glucose and insulin measurements in early pregnancy.

BACKGROUND AND AIMS: Abnormal dysglycemia during pregnancy increases morbimortality in women and newborns. This study evaluated early markers for that event. We undertook this study to estimate the incidence of dysglycemic events during pregnancy and to evaluate fasting glycemia, insulin and HOMA-IR index in early pregnancy as their predictors in order to compare their predictive capability for gestational diabetes (GD). METHODS: This was a prospective cohort that included 450 women seeking prenatal care at the Mexican Social Security Institute (IMSS). Subjects were ≥19 years old, in early pregnancy, without previous dysglycemia or hypertension, and with fasting glycemia <126 mg/dL. Insulin and HOMA-IR were measured. At 24-36 weeks of gestation, a 3-h 100 g oral glucose tolerance test (OGTT) was performed, applying the modified Carpenter-Coustan criteria. Multiple logistic regression models including an offset term as indicator of time in risk allowed us to estimate the risk of developing glucose intolerance (GI), GD, or hyperglycemia 1-h after the glucose load (HG-1). Areas under the ROC curve allowed comparison of the models' predictive capability. RESULTS: Incidence of dysglycemic events was 20.7%. The risk of GD was higher for the highest glycemia (RR = 4.1, 95% CI 1.6-10.6), insulin (RR = 4.1, 95% CI 1.2-14.2), and HOMA-IR (RR = 6.4, 95% CI 1.9-21.9). A higher risk of GI was found for the highest values of glycemia (RR = 2.6, 95% CI 1.3-5.3). Higher glycemia (RR = 3.9, 95% CI 1.6-9.2), insulin (RR = 2.8, 95% CI 1.0-7.5) and HOMA-IR (RR = 3.8, 95% CI 1.4-10.2) were associated with HG-1. Areas under the ROC curve for adjusted models with glycemia, insulin, or HOMA-IR were 0.749, 0.715, and 0.747, respectively (p = 0.4). CONCLUSIONS: Fasting glycemia was the best adjusted predictor of GD in early pregnancy, having equal predictive capability compared to insulin and HOMA-IR.

Relevance of Helicobacter pylori virulence factors for vaccine development / Relevancia de los factores de virulencia de helicobacter pylori para el desarrollo de vacunas

Helicobacter pylori infection increases the risk for a wide spectrum of clinical outcomes, ranging from peptic ulcer disease to gastric cancer. However, the infection induces gastric and duodenal ulceration or gastric cancer in only a minority of infected subjects because H. pylori strains are genetically diverse and express different virulence factors. Individuals infected with strains that express these virulence factors probably develop severe diseases such as gastric cancer. Nevertheless, the ancient relationship between H. pylori and humans suggests that some strains could be beneficial to human health, which means that generalized administration of antibiotic therapy could eventually cause problems. The development of vaccines based on virulence factors that provide long-term protection is the best strategy for control and/or elimination of pathogenic strains. The different immunization schemes and formulations designed to evaluate the vaccines based on virulence factors in animal models have offered promising results. However, it is necessary to determine whether or not these results can be reproduced in humans. This article reviews recent vaccination studies that explore this possibility: oral vaccines using urease or inactivated whole cells plus LT as adjuvant and urease expressed in Salmonella spp. vectors, as well as a parenteral multicomponent vaccine plus aluminum hydroxide as adjuvant. Although these studies have achieved limited success, they have established support for the development of an effective vaccine against this infection.

La infección por Helicobacter pylori incrementa el riesgo de un amplio espectro de cuadros clínicos, que van de la úlcera péptica al cáncer gástrico. Sin embargo, la infección sólo induce ulceración gástrica y duodenal o cáncer gástrico en la minoría de los sujetos infectados debido que las cepas de H. pylori son genéticamente diversas y expresan diferentes factores de virulencia. Así, los individuos infectados por cepas que expresan estos factores de virulencia probablemente desarrollan enfermedades severas como el cáncer gástrico. Sin embargo, la ancestral relación entre H. pylori y los humanos sugiere que algunas cepas pueden ser beneficiosas para la salud humana. Por lo tanto, la administración generalizada de tratamientos con antibiótico podría eventualmente causar problemas. El desarrollo de vacunas con base en factores de virulencia que confieran protección a largo plazo es la mejor estrategia para el control y/o eliminación de cepas patógenas. Los diferentes esquemas y formulaciones de inmunización diseñados para evaluar las vacunas con base en factores de virulencia en modelos animales han dado resultados prometedores. Sin embargo, ha sido necesario probar si estos resultados pueden ser reproducidos en humanos. Este trabajo revisa los recientes estudios de vacunación que han explorado esta posibilidad: vacunas orales usando ureasa o células completas-inactivadas con LT como adyuvante y ureasa expresada en vectores de Salmonella spp.; además de una vacuna intramuscular multicomponente con hidróxido de aluminio como adyuvante. Aunque estos estudios han logrado limitado éxito han establecido las bases para el desarrollo de una vacuna eficaz contra esta infección.

Cáncer de mama. Un hilo conductor histórico presente y futuro / Breast cancer: a historical account, present and future

Se describen los modelos que tradicionalmente han sido utilizados en la construcción teórica del conocimiento de cáncer de mama (CM); es decir, el biologicista, el higienista-preventivo y el epidemiológico. Se incluye además -en forma anecdótica- el modelo hipocrático. El CM se perfila como una amenaza letente en países como México a consecuencia del aumento importante de la esperanza de vida; de la reducción de la tasa de crecimiento total anual, al inicio de lo que hoy conocemos como el proceso de envejecimiento de la población; de cambios en los estilos de vida, particularmente la práctica cada vez menor de la lactancia y la disminución de tasas de fertilidad; así como de la escasa eficiencia y efectividad de los programas de detección oportuna del CM. En este contexto, uno de los principales retos en relación con este padecimiento es la práctica de la salud pública con fundamento multidisciplinario. Al final de este ejercicio, se propone el modelo sociomédico, que postula la integración de diversas áreas del conocimiento y permite dar una respuesta efectiva a uno de los principales desafíos en materia de enfermedades crónicas de los próximos años

This essay describes the different theoretical constructions of breast cancer models, such as the biological, hygienist-preventive and epidemiological. An anecdotical account of the Hippocratic model is also presented. This disease will be one of the major challenges posed by noncommunicable diseases in coming years, due to a significant increase of life expectancy and to a decrease of the overall annual growth rate -resulting in the ageing of the population-, as well as to lifestyle changes -particularly the considerable decrease of fertility rates and breastfeeding practices-, and to the poor efficiency and effectiveness of breast cancer screening programs. In this context, one of the main challenges for breast cancer control is to secure the multidisciplinary approach offered by public health. After analyzing the different models, we favor the sociomedical model as the one that incorporates several areas of knowledge to formulate an effective response to breast cancer.

La epidemia de cáncer de mama en México. ¿Consecuencia de la tarnsición demográfica? / Breast cancer epidemy in Mexico. Demographic transition consecuence?

Objetivo. Analizar la relación entre la disminución de la fecundidad y el aumento de la mortalidad por cáncer de mama, entre los estados de la República Mexicana, para periodo 1979-1994. Material y métodos. Se utilizaron las tasa específicas de fecundidad y las tasas de mortalidad por cáncer de mama de los estados del país. Para establecer de manera formal la relación, se utilizó el análisis de componentes principales y el análisis de clasificación. Resultados. La evolución de la fecundidad muestra una disminución importante, conservándose diferencias regionales: los estados del norte tienen niveles más bajos que los del sur. Estas diferencias regionales coinciden con las diferencias, en sentido inverso, que se observan en cuanto al aumento de la mortalidad por cáncer de mama entre los estados, es decir: los del norte presentan niveles más importantes que los del sur. Conclusiones. El aumento de la mortalidad debida al cáncer de mama y su relación con la disminución de la fecundidad ponen de manifiesto la importancia del aspecto preventivo de los servicios de salud, ya que en el futuro las mujeres mexicanas tedrán un comportamiento reproductivo similar al de las mujeres de países desarrollados

Panorama epidemiológico de la mortalidad por cáncer en el Instituto Mexicano del Seguro Social: 1991-1995 / Epidemiologic panorama of cancer mortality in the Mexican Institute of Social Security: 1991-1995

Objetivo. Describir el comportamiento de la mortalidad global por cáncer, así como la mortalidad específica para las principales neoplasias malignas en población adulta derechohabiente (DH) del Instituto Mexicano del Seguro Social (IMSS). Material y métodos. A partir de los registros oficiales de defunción y de la información sobre la población para los años 1991-1995, se estimaron las tasas anuales de mortalidad global y específica para las 10 principales neoplasias malignas por sexo, en mayores de 20 años. Asimismo, se estimaron las tendencias nacionales y estatales para las principales neoplasias malignas para cada sexo por medio de regresión de Poisson. Se calcularon las diferencias de tasas de mortalidad específica para las dos pricipales neoplasias por sexo restando las tasas estatales a su respectiva tasa nacional en 1995. Resultados. La mortalidad global por cáncer en los hombres se incrementó de 76.2 en 1991, a 94.8 por 100000 DH en 1995; entre las mujeres, ésta se incrementó de 85.6 a 105.8 por 100000 DH, representando un incrmento de 24.4 y de 24 por ciento en hombres y mujeres, respectivamente, durante el periodo de estudio. Entre los hombres las neoplasias de riñón, leucemia, páncreas, próstata y pulmón; y entre mujeres las de colon, mama, páncreas, leucemias e hígado, mostraron los incrementos más significativos. Conclusiones. En el IMSS es impostergable la conformación de un registro poblacional de cáncer que permita una mejor vigilancia epidemiológica de las neoplasias y una evaluación permanente del impacto de programas específicos para la prevención y control de este padecimiento en las instituciones

Análisis costo beneficio del Programa de Detección Oportuna del Cáncer Cervicouterino / Cost benefit analysis of the Cervical Cancer Screening Program

Objetivo. Determinar el costo beneficio de la reorganización del Programa de Detección Oportuna del Cáncer Cervicouterino (PDOC) mediante intervenciones de garantía de calidad. Material y métodos. Se siguieron tres estapas: a) identificación y cuantificación de costos; b) identificación y cuantificación de beneficios, y c) evaluación económica del costo beneficio. Resultados. El costo unitario de operación por citología -obtención, fijación, el traslado al centro de lectura, su tinción e interpretación y la notificación de resultados- se estimó en USD$ 11.6. En conjunto, las intervenciones en calidad al PDOC elevarían el costo de cada citología en 32.7 por ciento. Sin embargo, la nueva organización generaría una razón beneficio/costo de 2 y un beneficio neto de 88 millones de dólares para los próximos cinco años. Conclusiones. La operación del programa propuesto resulta socialmente deseable, siempre y cuando las modificaciones se lleven a cabo, particularmente la capacitación, la notificación personalizada de los casos positivos, el incremento de cobertura, la introducción de mecanismos de control de calidad, el monitoreo contínuo y el tratamiento en mujeres con anormalidades detectadas

Factores que determinan la participación en el tamizaje de cáncer cervical en el estado de Morelos / Factors which determine participation in an early detection program of cervical cancer in the state of Morelos

Objetivo. Determinar los principales factores relacionados con la participación en un programa de detección oportuna de cáncer (DOC) en una población con elevada mortalidad por cáncer cervical (CACU). Material y métodos. En el estado de Morelos se desarrolló un estudio con base poblacional que incluyó 3 197 mujeres de entre 15 y 49 años de edad seleccionadas aleatoriamente de un marco muestral de viviendas de los 33 municipios que componen dicha entidad. Resultados. El conocimiento de la utilidad de la prueba de Papanicolaou (Pap) (RM 29.6, IC95 por ciento 23.6-37) y la historia previa de síntomas ginecológicos (RM 1.7; IC95 por ciento 1.2-2-4) predisponen a utilizar el programa de DOC. Los factores asociados a la utilización de la prueba de Pap fueron que las mujeres tuvieran antecedentes en la utilización de uno (RM 1.4; IC95 por ciento 1.1-18), dos ó más métodos de planificación familiar (RM 2.1; IC95 por ciento 1.6-2.8). Conclusiones. En el estado de Morelos, Mexico, el tamizaje en CACU se ofrece predominantemente en forma oportunista, por lo que el antecedente de utilización de los servicios de salud constituye el principal determinante para la utilización del programa de DOC. Estos resultados revelan la necesidad de establecer estrategias alternativas para integrar a las mujeres que no tienen acceso a dichos servicios de atención médica, ya que constituyen el grupo de más alto riesgo para contraer CACU

Programa de detección oportuna de cáncer en instituciones de seguridad social. Una alternativa organizacional / Early detection program of cencer in social security institutions: An organizational alternative

La experiencia de países desarrollados ha permitido mostrar que la mejor opción para el control de la mortalidad por cáncer cervical es la detección y el tratamiento oportuno de lesiones presursoras y lesiones malignas por medio de programas de detección oportuna del cáncer. Si bien, en nuestro país, las principales instituciones de salud cuentan con un programa estructurado de detección oportuna de cáncer cervical, sus resultados han sido muy pobres y la incidencia de cáncer cervical en etapas avanzadas continúa siendo uno de los principales problemas de salud en la mujer. Actualmente, el programa de detección oportuna de cáncer cervical en instituciones de seguridad social muestra deficiencias muy serias. Estas deficiencias son evidentes a muy distintos niveles de la ejecución del programa como son: falla en aspectos normativos sobre procedimientos de detección y manejo; bajo cobertura, mala calidad en la obtención del espécimen y en los procedimientos diagnósticos de Papanicolaou; falta de procedimientos adecuados de referencia y seguimiento de casos; escasa uniformidad en la aplicación de normas y criterios terapéuticos; así como ausencia de procedimientos de evaluación sistemática del impacto del programa. En este artículo se realiza una propuesta de reorganización del programa de prevención de cáncer cervical que incluye: 1) El desarrollo de un programa permanente de educación y sensibilización para usuarios y prestadores de servicios encaminado a fomentar la utilización del programa y mejorar la adherencia al mismo, con el fin de incrementar la cobertura; 2) Establecimiento de mecanismos de capacitación y acreditación del personal encargado de la toma de espécimen para Papanicolaou, así como de la interpretación diagnóstica del mismo aunado a un sistema de control de calidad de estos procedimientos; y 3) Crear un sistema automatizado de vigilancia epidemiológica para el seguimiento de la población en riesgo, que permita el monitoreo continuo y la evaluación sistemática del programa

Necesidades de salud: una reflexión epidemiológica y antropológica / Health needs: epidemiology and anthropologic perspective

En este ensayo se describe la convergencia entre el concepto de necesidades de salud desde el punto de vista epidemiológico y el que abordan las ciencias sociales desde una perspectiva antropológica. La propuesta es integrar diversas disciplinas del conocimiento, para comprender mejor el proceso de salud en la población, con el principal objetivo de involucrarlas en la planificación e investigación en salud pública. En este contexto, la investigación en necesidades de salud es un punto de encuentro integrador de muchas disciplinas, donde confluyen lo individual y lo colectivo, lo biológico y lo social, lo cuantitativo y lo cualitativo. Al final de este documento se señala la necesidad de investigaciones multidisciplinarias en Salud Pública para realizar propuestas integrales en el estudio del proceso salud-enfermedad

Cervical cancer screening in developing countries: why is it ineffective? The case of Mexico

Background. Mexico established a national cervical cancer-screening program in 1974. Despite the implementation of the program, there was a steady mortality trend of 16 per 1000,000 women over 15 years. Methods. A diagnostic procedure of the pitfalls was applied to the following steps of the screening procedure: Pap sampling quality; cytological diagnosis validity; compliance of women; and determinants of non-participation. Results. The low effictiveness of screening on cervical cancer is principally due to factors associated with quality and coverage. Pap quality is deficient; 64 percent of a random sample of specimens lacked endocervical cells Reading center presented false negative indices of between 10 and 54 percent. Women seek screening in a late stage of disease (55 percent with cervical cancer seek care because they have symptoms). In addition, coverage is low; in women between 15 and 49 years of age in Mexico City, 64.2 percent have a history of Pap, compared with 30 percent in rural areas. Knowledge of what the Pap in used for strongly determines the use of screening. In rural areas, only 40 percent of women are informed about the purpose of the Pap test. Conclusions. A proposal to reorganize Mexico's screening program includes the following five main strategies: (a) increased coverage; (b) improved quelity control of how cervical smears are taken; (c) better interpretation of Pap test; (d) guaranteed treatment for those whose tests show abnormalities, and (e) improved follow-up

Cáncer de cuello uterino: una perspectiva histórica / Cervical cancer: a historical perspective

En este ensayo, a través de la descripción de los modelos o patrones establecidos acerca del conocimiento del cáncer cervical (CACU) en particular, se trata de establecer el hilo conductor histórico que se desarrolla durante la construcción teórica del conocimiento de esta enfermedad. Durante este proceso la reformulación de hechos considerados reveladores ha necesitado de terminarse con mayor precisión, y ha sido resultado del trabajo empírico, el que se observa implícitamente en cada modelo de salud pública descrito, entre los que se encuentran el modelo biomédico, higienista-preventivo, epidemiológico, ecológico y el finalmente propuesto que es el sociomédico. Al final de este ejercicio se establece la necesidad de reorientar el paradigma existente para dar una respuesta social organizada en el control de la neoplasia cervical

Concordancia diagnóstica en citología ginecológica / Diagnostic agreement in cervical cytology

Objetivo. Determinar la concordancia de la lectura de citología ginecológica (PAP) en patólogos y citotecnólogos que asistieron a un congreso mexicano de patología, mediante la estimación del coeficiente kappa. Métodos. Se realizó una evaluación de fuentes de variación diagnóstica con relación a cambios celulares del epitelio cervical y su variación morfológica en 20 especímenes de PAP. participaron 20 patólogos y 7 citotecnólogos asistentes al XXXVII Concreso de la Asociación Mexicana de Patólogos en 1994. Se estimó la concodrancia intraclase entre los observadores, así como en relación al diagnóstico emitido por un experto. Resultados. La mayor concordancia con relación a la emitida por el experto fue en el diagnóstico morfológico de diatesis tumoral (patólogos Kappa=0.36, citotecnólogos kappa=0.35), coilocitos (citotecnólogos kappa=0.55, patólogos kappa=0.36). La menor concordancia se observó en anisonucleosis (kappa=0.11 en patólogos y 0.002 en citotecnólogos), hipercromasia nuclear (kappa=0.11 en patólogos y citotecnólogos), y en disqueratocitos (kappa=0.11 en patólogos y 0.16 en citotecnólogos). La concordancia en diagnóstico de lesión cervical fue baja, y la de cáncer cervical invasor fue 0.30. Existió una gran variabilidad interobservadores y puso en evidencia que 13 (34 por ciento) de los participantes tuvieran concordancia nula con el resto de observadores. Conclusiones. Existió escasa concordancia en el diagnóstico de PAP. Parece conveniente buscar maneras de mejorar el diagnóstico citológico en México. Una manera podría ser con el uso de una clasificación diagnóstica más acorde con el conocimiento actual de la neoplasia cervical