[Outpatient medical attention demand due to diabetes mellitus in the health primary care]. / Demanda de atención médica por diabetes mellitus en el primer nivel de atención.

Outpatient visits for medical attention because of Diabetes mellitus in the Instituto Mexicano del Seguro Social became very important for the magnitude that it represents. There is a clear increasing tendency for the coming years. The available data indicates a higher frequency and increased demand of women. Higher number of patients is observed between 40 and 59 years old. However, earlier age groups present considerable amount of cases. Having the number of patients allows knowing the average of consultations per patient, this parameter allows having an estimate of the follow up by the physician and it must be part of the evaluation of the medical attention programs. Diabetes mellitus is strongly associated with obesity, this condition affects a high percentage of diabetic patients in the Institution and weight loss must be encouraged.

[Mortality from the HIV/AIDS in the Instituto Mexicano del Seguro Social]. / Mortalidad por VIH/SIDA en el Instituto Mexicano del Seguro Social.

Mortality is an indicator that allow us to evaluate HIV infection control programs. From the middle of the last decade, mortality presents a tendency to decrease in the population covered by the Instituto Mexicano del Seguro Social). In relation to gender and age group the most affected are men between 25 to 44 years of age with mortality rates ranging from 30 to 12 by 100,000 men (1995 to 2009 respectively). In 2009, at least half of the Delegaciones (administrative units by State) present larger mortality rates than the institutional average, particularly Campeche with 14.9 by 100,000 men. It is clear that introduction of control measures against the disease from infected people represents a modification in the course of the illness in the population covered by IMSS.

[Smoking habits in beneficiaries of the social security]. / Consumo de tabaco en derechohabientes del IMSS.

OBJECTIVE: To determine the prevalence of tobacco consumption (TC) and frequency according to demographics and health aspects. METHODS: A cross-sectional study from the Mexican Family Life Survey Project was conducted. The past and present TC according to sociodemo-graphic variables and the presence of chronic diseases (CD) were achieved. RESULTS: The prevalence of TC in the past was 21.4 % with a male/female ratio of 2.5. Nowadays TC was 15.2 % and the ratio between male/female was 2.6 (23.0: 8.9); exposure levels by age decreased at present. Out of the total smokers in the past 71 % continue with the habit, 75 % began TC before the age of 20. In the 15 to 19 years group, 50 % of them started before the age of 14. The highest cigarette pack consumption mean was 2.5 per week and for the present smokers was 1.8; the prevalence for CD in the smoking population was above 20 %; present smoking diminished in those with a history of CD, especially cancer and heart disease. CONCLUSIONS: The prevalence of past and present TC is lower than that reported in other studies in the Mexican population, because of how the exposure to TC was measure.

[Hemorrhagic dengue without hemorrhaging: a novel diagnostic category?]. / Dengue hemorrágico sin hemorragias: otra categoría?

OBJECTIVE: Compare the clinical course of Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF). MATERIAL AND METHODS: Cross-sectional study among seropositive cases reported by the Northern Veracruz District IMSS Office in 2004. We analyzed the epidemiology, symptomology, clinical findings and disease progression. We calculated frequencies, proportions and averages. Clinical data and disease progression were compared. RESULTS: We studied 404 patients, divided into three groups: 75 with CD, 120 DHF and 212 cases with no hemorrhagic data although displaying Dengue with Thrombocytopenia (DwT). General symptoms were much less common among Dengue cases. Abdominal pain, hepatomegaly and splenomegaly were more frequent among patients with DHF. Fluid leakage and hemorrhaging were observed in 75% and 46%, respectively, of the latter group. The history of prior infection was proportional. All patients presenting DHF showed thrombocytopenia, though only 3% showed hemoconcentration. The mean value for hematocrit was low (p=0.02) and the platelet count greater (p<0.001) among Dengue cases. Hemoglobin concentration showed no difference. The average time between disease onset and appearance of thrombocytopenia was similar in DHF cases (4.3+/- 1.6 days) and Dengue with Thrombocytopenia (4.3+/-1.6); even though, contrary to these, in the first group fluid leakage (3.7+/-1.8) and hemorrhaging (3.4+/-1.7) were previously identified. CONCLUSIONS: Our results confirm the presence of cases showing atypical disease course, without external hemorrhaging data but showing significant thrombocytopenia that may go unnoticed and worsen disease progression.

Dengue hemorrágico sin hemorragias: otra categoría? / Hemorrhagic dengue without hemorrhaging: a novel diagnostic category?

Objetivo: Comparar el comportamiento clínico del dengue clásico (DC) y dengue hemorrágico (DH). Material y métodos: Estudio transversal en casos seropositivos de la Delegación Veracruz Norte del Instituto Mexicano del Seguro en 2004. Se analizaron antecedentes epidemiológicos, sintomatología, parámetros clínicos y evolución. Se obtuvieron frecuencias, proporciones y promedios. Se compararon datos clínicos y tiempos de evolución. Resultados: Estudiamos 404 pacientes integrados en tres grupos: 75 con DC, 120 con DH y 212 sin datos hemorrágicos pero con plaquetopenia (DcP). Los síntomas generales fueron menos frecuentes en los casos de dengue; el dolor abdominal, hepatomegalia y esplenomegalia fueron más comunes en los que presentaron hemorragias. El escape de líquidos y hemorragias ocurrieron en 75 y 46% de este último grupo. Los antecedentes de infección previa fueron semejantes. Todos los enfermos de DH presentaron plaquetopenia y 3%, hemoconcentración. La media del hematócrito fue menor (p=0.02) y el conteo plaquetario mayor (p<0.01) en los de DC. La hemoglobina no mostró diferencias. El promedio entre el inicio de la enfermedad y la aparición de plaquetopenia fue similar en los casos con DH (4.3±1.6 días) y DcP (4.3±1.6); aunque, a diferencia de éstos, en los primeros el escape de líquidos (3.7±1.8) y hemorragias (3.4±1.7) se identificaron previamente. Conclusiones: Los resultados demuestran la presencia de casos con una evolución atípica, sin datos hemorrágicos externos pero con trombocitopenia importante que puede pasar desapercibida y predisponer el agravamiento del cuadro.

OBJECTIVE: Compare the clinical course of Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF). MATERIAL AND METHODS: Cross-sectional study among seropositive cases reported by the Northern Veracruz District IMSS Office in 2004. We analyzed the epidemiology, symptomology, clinical findings and disease progression. We calculated frequencies, proportions and averages. Clinical data and disease progression were compared. RESULTS: We studied 404 patients, divided into three groups: 75 with CD, 120 DHF and 212 cases with no hemorrhagic data although displaying Dengue with Thrombocytopenia (DwT). General symptoms were much less common among Dengue cases. Abdominal pain, hepatomegaly and splenomegaly were more frequent among patients with DHF. Fluid leakage and hemorrhaging were observed in 75% and 46%, respectively, of the latter group. The history of prior infection was proportional. All patients presenting DHF showed thrombocytopenia, though only 3% showed hemoconcentration. The mean value for hematocrit was low (p=0.02) and the platelet count greater (p<0.001) among Dengue cases. Hemoglobin concentration showed no difference. The average time between disease onset and appearance of thrombocytopenia was similar in DHF cases (4.3+/- 1.6 days) and Dengue with Thrombocytopenia (4.3+/-1.6); even though, contrary to these, in the first group fluid leakage (3.7+/-1.8) and hemorrhaging (3.4+/-1.7) were previously identified. CONCLUSIONS: Our results confirm the presence of cases showing atypical disease course, without external hemorrhaging data but showing significant thrombocytopenia that may go unnoticed and worsen disease progression.

[Osteoporosis and osteopenia in female health workers from Mexico City]. / Osteoporosis y osteopenia en mujeres trabajadoras de la salud en la Ciudad de Mexico.

INTRODUCTION: The prevalence of osteoporosis (OP) in Mexican population is not well known. This disease constitutes a risk factor for fractures due to OP, which result in disability, poor quality of life and increased mortality rates. OBJECTIVES: To determine prevalence of OP and osteopenia in a group of female health workers from Mexico City using central densitometry (Dual X Ray Absorptiometry-DXA); to compare the Hispanic reference database from the LUNAR DPX L unit vs. the study population; to determine the age at which the peak bone mass is reached and to explore the relationship between some well known factors for osteoporosis and bone mass. MATERIAL AND METHODS: In this prolective, cross-sectional observational study 588 healthy females older than 18 years were selected at different stages and a hip and spine densitometry (DXA) was undertaken with a LUNA DPX L unit. To determine the prevalence of osteoporosis and osteopenia we used the criteria of the Committee of Experts on Osteoporosis from the World Health Organization. RESULTS: The mean age of our study population was 42.3 years +/- 9.6 (20-65); the weight 66 kg +/- 12.1 (41-139) and height 153.9 cm +/- 5.7 (138-177). The prevalence of osteoporosis on the lumbar spine was 13.5% (IC 95%: 10.5-16) and osteopenia 27.7 (IC 95%: 24-31). On the femoral neck, the prevalence of osteoporosis was 2% (IC 95%: 1.0-3) and osteopenia 26.1% (IC 95%: 22-29). The peak bone mass on the femoral neck was found between 31 to 35 years and in the lumbar spine between 26-30 years. In these groups, the bone mineral density falls as age rises. When we compare our results to reference population from the LUNAR densitometer database and to our same study group, there is an overestimation of the prevalence of OP and osteopenia on the lumbar spine and osteopenia on the femoral neck. We found a prevalence of overweight and obesity higher to reported at the Mexican National Survey of Nutrition.

[Violence in Mexican women using public health services]. / La violencia en las mujeres usuarias de los servicios de salud en el IMSS y la SSA.

OBJECTIVE: To compare the prevalence of violence and determine its risk factors among women who use Mexican Social Services (IMSS) clinics and do not have access to social security services. MATERIAL AND METHODS: Sociodemographic data linked to domestic violence reported by women attending the Mexican Institute of Social Security (IMSS) health services was analyzed. Bivariate and multivariate analysis was performed using STATAV.7. RESULTS: Psychological violence in IMSS women was 18% followed by physical violence (9.1%), sexual (6.7%) and economic (5%). Prevalence of violence in women with no social security care was psychological (21.4%), physical (10.5%), sexual (7.5%) and economical (5%). Women between 25 and 44 years of age with basic schooling and married and with family background of violence were the most affected. The daily consumption of alcohol by their partners was an important predictor of domestic violence. CONCLUSION: Violence in women with no social security is higher. Partner's alcohol intake pattern is an important risk factor. Detection of domestic violence in the clinical setting is necessary to recognize its real magnitude as a social problem.

[Diabetes mellitus in an adult population of the IMSS (Mexican Institute of Social Security). Results of the National Health Survey 2000]. / Diabetes mellitus en población adulta del IMSS. Resultados de la Encuesta Nacional de Salud 2000.

OBJECTIVE: To describe the prevalence and control of diabetes in the adult population served by the Instituto Mexicano del Seguro Social according to data from the National Health Survey 2000 (ENSA-2000). MATERIAL AND METHODS: The data for adults from the National Health Survey 2000 was used to estimate and describe the prevalence of diabetes in the population that belongs to the social security system in Mexico. Criteria used to define diabetes mellitus were the medical diagnosis of the disease (MDDM) and the glucose measurement from capillary blood (>126 mg/dL fasting sample and 200 mg/dL in casual blood sample). If diabetes was confirmed only through blood sample, the diabetes case was define as survey finding (SF). Prevalences were estimated for both groups, while means and medians were estimated for the four possible combination groups (SF+, MDDM+, SF+, MDDM-, SF-, MDDM+, SF-, MDDM-). Sampling results were adjusted for population estimates according to the methods established in the ENSA-2000. Diabetes is described according to age, sex, education level, geographic region, background of diabetes in the family, body mass index (BMI), abdominal perimeter. A logistic regression method was used to estimate potential associations with different risk factors. RESULTS: Overall prevalence was 8.7%; for MDDM, it was 7.1%, and for SF, only 1.5%. Glycemia was highest in SF+ and MDDM-, median 292 mg/dL and in MDDM+ but SF-, median 289 mg/dL. Major risk factors were background of diabetes in both parents, abdominal obesity, low educational level age (coef. = 0.5943 per decade) and BMI (coef. = 0.0133). CONCLUSIONS: Diabetes in social security population is higher than in the rest of the population, while genetic background, age, educational level, high BMI and abdominal perimeter have important influences in diabetes prevalence in this population. Glucose control is suboptimal even in patients under medical supervision.

La violencia en las mujeres usuarias de los servicios de salud en el IMSS y la SSA / Violence in Mexican women using public health services

OBJETIVO: Comparar la prevalencia y determinar los factores de riesgo asociados a la violencia entre las mujeres derechohabientes del IMSS y sin servicios de seguridad social (SSS). MATERIAL Y MÉTODOS: Se analizó la información sobre violencia doméstica de la ENVIM notificada por las mujeres usuarias de los servicios de salud del IMSS y de la población femenina sin servicios de seguridad social SSA y seguro popular. El análisis bivariado y multivariado se realizó en STATA V.7. RESULTADOS: La prevalencia en mujeres derechohabientes del IMSS de violencia psicológica fue 18 por ciento; seguida por la física (9.1 por ciento); la sexual (6.7 por ciento) y la económica (5 por ciento). En mujeres sin seguridad social fue: psicológica (21.4 por ciento); física (10.5 por ciento); sexual (7.5 por ciento) y económica (5.2 por ciento). Las mujeres entre 25 y 44 años, con nivel secundaria o menor instrucción educativa, casadas, sufren de mayor violencia doméstica en ambas poblaciones. Los factores de riesgo identificados para los cuatro tipos de violencia fueron el consumo de alcohol en la pareja, las edades jóvenes, el estar casadas o en unión libre y el antecedente de violencia ejercida por los padres u otros miembros de la familia. CONCLUSIONES: La violencia es ligeramente mayor en mujeres sin seguridad social. El consumo diario de alcohol por su pareja es un factor de riesgo muy importante para cualquier tipo de violencia, en particular cuando el consumo es diario o casi habitual. La detección de la violencia doméstica en los servicios de salud es indispensable para conocer su magnitud como problema social.

OBJECTIVE: To compare the prevalence of violence and determine its risk factors among women who use Mexican Social Services (IMSS) clinics and do not have access to social security services. MATERIAL AND METHODS: Sociodemographic data linked to domestic violence reported by women attending the Mexican Institute of Social Security (IMSS) health services was analyzed. Bivariate and multivariate analysis was performed using STATA V.7. RESULTS: Psychological violence in IMSS women was 18 percent followed by physical violence (9.1 percent), sexual (6.7 percent) and economic (5 percent). Prevalence of violence in women with no social security care was psychological (21.4 percent), physical (10.5 percent), sexual (7.5 percent) and economical (5 percent). Women between 25 and 44 years of age with basic schooling and married and with family background of violence were the most affected. The daily consumption of alcohol by their partners was an important predictor of domestic violence. CONCLUSION: Violence in women with no social security is higher. Partner's alcohol intake pattern is an important risk factor. Detection of domestic violence in the clinical setting is necessary to recognize its real magnitude as a social problem.

Obesity and overweight in IMSS female workers in Mexico City.

OBJECTIVE: To estimate the prevalence and risk factors for overweight (OW) and obesity (OB) in women working at the Mexican Social Security Institute (IMSS, per its abbreviation in Spanish) in Mexico City, using two different classification criteria. MATERIAL AND METHODS: A cross-sectional study was performed from July 1999 to September 2000. It included 588 women 20 to 65 years of age and who were working at the IMSS. The criteria used to estimate the prevalence of OW and OB were the WHO criteria and the Mexican Official Norm (NOM) for the integrated management of obesity in Mexico. RESULTS: The frequency of OB, according to WHO criteria, was 27.6% (26% adjusted) and for OW 43.2% (40.2% adjusted). According to the NOM, the levels of OB in those with short height (< 1.50 m) increased to 75% and to 52.2% for those with height > 1.50 m. Comparison of BMI between the two height groups showed no differences. The risk factor associated with OB and OW was age. Education and exercise were protective factors. CONCLUSIONS: The high prevalences detected in this particular working group highlight the importance of prevention and control of OB in health personnel because it can result in a high number of disability and premature retirement due to disease. The use of the NOM criteria for the identification of women at risk may be useful for early detection of high-risk groups.

Clinical profile of dengue hemorrhagic fever cases in Mexico.

OBJECTIVE: Dengue hemorrhagic fever is a public health problem in Mexico since 1994. With four serotypes circulating the risk of epidemic dengue hemorrhagic fever is increasing. MATERIAL AND METHODS: We describe the clinical features of confirmed cases in the social security health system (IMSS) from 1995 to 2003. Clinical picture and epidemiological features were compared and a multivariate model was fitted to evaluate associations. RESULTS: Cases were divided into two groups: 438 patients with dengue fever, including 109 cases with hemorrhagic manifestations without thrombocytopenia, and 977 cases with dengue hemorrhagic fever, including 79 deaths. The main risk factors associated with mortality were hematemesis (RR 2.6; CI 95% 1.4-4.6) and melena (RR 2.2; Cl 95% 1.2-3.7). CONCLUSIONS: Our results characterize the clinical profile of dengue hemorrhagic fever cases in Mexico and identify prognostic factors to alert clinician for the prevention of a fatal evolution.

Obesity and overweight in IMSS female workers in Mexico City

OBJETIVO: Estimar la prevalencia de obesidad (OB) y sobrepeso (SP) en mujeres trabajadoras del IMSS en la Ciudad de México, aplicando dos criterios de clasificación y su asociación con algunos factores de riesgo. MATERIAL Y MÉTODOS: Estudio transversal realizado entre julio de 1999 y septiembre de 2000 que incluyó a 588 mujeres trabajadoras en el IMSS entre 20 y 65 años. Los criterios utilizados para medir la prevalencia de OB y SP fueron los propuestos por la OMS y la Norma Oficial Mexicana para el manejo integral de la obesidad (NOM).RESULTADOS: La frecuencia de OB fue 27.6% (26% ajustada) y de SP de 43.2% (40.2% ajustada) al aplicar los criterios de la OMS. Conforme a la NOM, los niveles de OB en el grupo de talla baja (<1.50 m) se elevaron a 75% y en el de talla mayor a 1.50 m a 52.2%. Sin embargo, al comparar el índice de masa corporal de talla baja y talla normal no se aprecian diferencias. El factor de riesgo para OB y SP fue la edad. En forma protectora resultaron la educación y el ejercicio. CONCLUSIONES: Las altas prevalencias de OB y SP en la población estudiada constituyen un riesgo importante para la salud de este grupo de población, que se puede traducir en altos niveles de discapacidad y pensiones con un alto costo para la Institución. Estos resultados demandan la realización de intervenciones que permitan identificar precozmente a mujeres con índices de masa corporal de riesgo. Los rangos propuestos por la NOM pueden ser de utilidad para la identificación precoz de las mujeres en riesgo.

Clinical profile of dengue hemorrhagic fever cases in Mexico

OBJETIVO: El dengue hemorrágico en México es una enfermedad emergente desde 1994. La circulación de los cuatro serotipos incrementa el riesgo de epidemias de dengue hemorrágico. MATERIAL Y MÉTODOS: Se reportan los datos clínicos y epidemiológicos de los casos de dengue hemorrágico confirmados y notificados por el IMSS de 1995 a 2003. Se analizaron las características clínicas y epidemiológicas entre grupos. Para el control y la evaluación final de las variables se utilizó un modelo multivariado. RESULTADOS: Los casos fueron asignados en dos grupos: 438 con dengue clásico, que incluye 109 casos con manifestaciones hemorrágicas sin trombocitopenia, y 977 casos de dengue hemorrágico con 79 defunciones. Los factores de riesgo asociados a las defunciones fueron: hematemesis (RR 2.6; IC 95 por ciento 1.4-4.6) y melena (RR 2.2; IC 95 por ciento 1.2-3.7). CONCLUSIONES: El cuadro clínico descrito para la población del Instituto Mexicano del Seguro Social permite identificar factores pronósticos que ayuden al clínico a prevenir y manejar adecuadamente los casos severos de dengue hemorrágico.

Seroprevalence of hepatitis B in pregnant women in Mexico.

OBJECTIVE: To determine the seroprevalence of hepatitis B in pregnant women from several regions of Mexico, as well as the risk factors associated with its occurrence. MATERIAL AND METHODS: A cross-sectional study was conducted between May and August 2000. It included 9,992 pregnant women attending the health services of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social-IMSS) in five cities: Tijuana, Ciudad Juarez, Acapulco, Cancun, and Mexico City (northeast and southeast regions). RESULTS: The overall prevalence for confirmed cases was 1.65% (165/9,992). The prevalences for individual cities were as follows: Tijuana, 1.27%; Ciudad Juarez, 1.46%; Acapulco, 2.47%; Cancun, 0.93%; northeastern Mexico City, 1.20%, and southeastern Mexico City, 2.52%. The risk factors found to be associated with HBsAg were: age, age at first sexual intercourse, city (Acapulco and southeastern Mexico City), and marital status (single or divorced). CONCLUSIONS: The prevalence of HBsAg in pregnant women (1.65%) was greater than that reported in previous studies and showed geographical differences. This high prevalence suggests that a considerable amount of cases of hepatitis B occurs perinatally and through contact with carriers in the general population. Vaccination of newborns of high-risk pregnant women should be considered.

Seroprevalence of hepatitis B in pregnant women in Mexico

OBJECTIVE: To determine the seroprevalence of hepatitis B in pregnant women from several regions of Mexico, as well as the risk factors associated with its occurrence. MATERIAL AND METHODS: A cross-sectional study was conducted between May and August 2000. It included 9 992 pregnant women attending the health services of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social-IMSS) in five cities: Tijuana, Ciudad Juarez, Acapulco, Cancun, and Mexico City (northeast and southeast regions). RESULTS: The overall prevalence for confirmed cases was 1.65 percent (165/9 992). The prevalences for individual cities were as follows: Tijuana, 1.27 percent; Ciudad Juarez, 1.46 percent; Acapulco, 2.47 percent; Cancun, 0.93 percent; northeastern Mexico City, 1.20 percent, and southeastern Mexico City, 2.52 percent. The risk factors found to be associated with HBsAg were: age, age at first sexual intercourse, city (Acapulco and southeastern Mexico City), and marital status (single or divorced). CONCLUSIONS: The prevalence of HBsAg in pregnant women (1.65 percent) was greater than that reported in previous studies and showed geographical differences. This high prevalence suggests that a considerable amount of cases of hepatitis B occurs perinatally and through contact with carriers in the general population. Vaccination of newborns of high-risk pregnant women should be considered

Factores de riesgo para cardiopatía isquémica en México: un estudio de casos clínicos y testigos / Risk factors for coronary heart disease in Mexico: A case control study

Con el objeto de conocer la fuerza de asociación de los factores de riesgo modificables con la ocurrencia de cardiopatía isquémica en población mexicana, se realizó un estudio de casos clínicos y testigos. Se estudiaron 284 casos incidentes de infarto agudo del miocardio y 284 controles hospitalarios de primer ingreso, pareados por edad y sexo. En todos los sujetos se obtuvo información sobre variables sociodemográficas, tabaquismo, antecedentes de diabetes mellitus e hipertensión, obesidad y colesterol sérico. En un modelo de reqresión logística condicionada se encontró que la diabetes mellitus, la hipertensión arterial, el tabaquismo, la hipercolesterolemia y la obesidad, explican la ocurrencia de cardiopatía isquémica en la población estudiada. El riesgo de infarto agudo del miocardio se incrementa considerablemente en los valores extremos de exposición, y llega a ser seis veces mayor en aquellos que fuman más de 20 cigarrillos al día, y hasta ocho veces más alto en quienes tienen colesterol sérico superior a 240 mg/dl. Dado el incremento en la ocurrencia de cardiopatía isquémica en México, y su fuerte asociación con factores de riesgo modificables, se justifica la elaboración de programas de salud pública dirigidos a disminuir la prevalencia de dichos factores de riesgo