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.

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.

[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.

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.

[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.

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

Objetivo Analizar la asociación del grado de conocimiento sobre Papillomavirus Humano y la aceptación de la auto-toma vaginal como prueba diagnóstica para la detección de cáncer cervical en mujeres mexicanas que ya han tenido la experiencia de una auto-toma vaginal en casa. Métodos Cuestionario estructurado de 22 preguntas a 690 mujeres del estado de Morelos que se realizaron la auto-toma vaginal en casa para explorar el nivel de conocimientos sobre transmisión del Papillomavirus Humano, identificación del virus como causa necesaria para cáncer cervicouterino, manifestaciones clínicas de la infección y tratamiento. Se construyó un índice de conocimientos identificando su asociación con la aceptación de la auto-toma y la confianza que las mujeres tienen en ella. El análisis estadístico incluyó regresión logística con estimación de medidas de asociación y sus respectivos intervalos de confianza al 95%. Resultados El nivel de conocimientos sobre Papillomavirus Humano presentó una asociación positiva con el grado de aceptación de la auto-toma vaginal (OR 2.9 IC 95% 1.0-5.01) y con el nivel de confianza de las mujeres (OR 2.9 IC 95% 1.8-4.67). El nivel de conocimientos se incrementa con el grado de escolaridad y es mayor en las mujeres más jóvenes. Conclusiones Para lograr una participación continuada de las mujeres con mayor riesgo de cáncer cervicouterino en la auto-toma vaginal es necesario informarlas ampliamente sobre los aspectos generales del virus, en especial a aquellas mujeres de edad avanzada, de nivel escolar y socioeconómico bajos.(AU)

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.(AU)

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.

[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.

[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.

Estrategias de reforma y protección social en salud en México, primera parte: efectos en financiamiento y gobernanza del sistema de salud / Health system reform strategies and health social protection in Mexico, first part: financing effects and health system governance

Objetivo: Identificar los efectos de las reformas en servicios de salud sobre indicadores de financiamiento y gobernanza en sistemas de salud. Material y métodos: Se diseño una investigación evaluativa basada en el método “rapid assesment”. El universo de estudio fue el sistema de salud para no asegurados en México y la población de estudio se delimito a seis estados seleccionados bajo diferentes criterios de factibilidad técnica, política y financiera. Para los datos primarios se realizaron entrevistas a profundidad con informantes clave de los estados participantes; para los datos secundarios se utilizaron estadísticas oficiales y los resultados del proyecto macro sobre reformas, políticas de salud, equidad, financiamiento y gobernanza en México, 1999-2006. El procesamiento y análisis de datos se realizó con 2 paquetes de software: ATLAS Ti y POLICY MAKER. Resultados/Conclusiones: A partir de las reformas se han registrado importantes incrementos en los montos del financiamiento en salud, estos cambios también han coincidido con ganancia en los índices de corresponsabilidad financiera; Existe una nueva fórmula de asignación de recursos, donde el nivel estatal ha jugado un rol protagónico en su revisión, ajustes y aplicación para las adecuaciones sobre los recursos asignados y sobre el modelo de atención a la salud que cada estado adopta en función de sus necesidades; La estrategia de protección financiera en salud en algunos estados ha disminuido gastos catastróficos en salud y por consecuente el mayor empobrecimiento de las familias más vulnerables; La rendición de cuentas en el nivel federal, aunque no está ausente, se mantiene con un carácter prescriptivo, mientras que en los estados y municipios aún está ausente un sistema de rendición de cuentas y de transparencia en la asignación de recursos.

Objective: To identify effects of health system reform on heath financing and health governance. Methods and data sources: A design of evaluative research based on rapid assessment was developed. The research object it was the health system for uninsured population in Mexico, focusing on six States selected considering technical, political and financial feasibility. For primary data gathering structured interviews with key informants of selected States were done; for secondary data, official statistical data and research results of the macro project on heath reform, health policy, equity, financing and health governance, 1999-2006. Information processing and analysis were done by using Atlas-Ti and Policy Maker software. Results / Conclusions: Health system reforms have showed strong influence in financing amounts and important gains in financial co-responsibility. An actualized formula for resources allocation was identified; this formula has involved States and local levels on its revision, adjustments and appliances on allocated resources and health services provision model adopted for the States in relation with their health needs. Financial protection strategy has reported protection versus catastrophic health expenditure and vulnerable families’ impoverishment in some States. Accountability in federal government it is not absent, but it functions as a prescriptive policy, while transparency and accountability mechanisms at the States and municipalities are absent.

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

Introducción El proceso de transición epidemiológica propuesto por Omhran, a principio de la década de los 70s, disminución de tasa de fecundidad y aumento de esperanza de vida, aunado a las modificaciones en estilos de vida, y dieta, muestra un incremento en la mortalidad por causas crónico degenerativo. Considerando lo anterior, en este ensayo se discutirán y analizarán comparativamente algunas de las diferentes corrientes de pensamiento, tomando como hilo conductor el análisis de cambios epidemiológicos, identificados en diferentes eras o estadios y su relación con algunos de los modelos o marcos conceptuales de la salud pública. Desarrollo La discusión sobre los paradigmas en Salud Pública, origina una recapitulación histórica sobre los modelos conceptuales, desde las concepciones mágico-religiosas hasta los modelos ecológicos y socio médicos. Se retoma la propuesta de M. Susser, en su discurso sobre el futuro de la epidemiología, en el que propone tres eras en la evolución de esta disciplina. Conclusión Los cambios epidemiológicos analizados a través de diferentes enfoques, constituyen elementos de análisis que todos los modelos discutidos en este ensayo, incluyen para delimitar los aportes y variables que los determinan.

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.