[Ecological correlation between consumption of alcoholic beverages and liver cirrhosis mortality in Mexico]. / Correlación ecológica entre consumo de bebidas alcohólicas y mortalidad por cirrosis hepática en México.

OBJECTIVE: To determine the correlation between alcohol consumption and mortality from liver cirrhosis in Mexico. MATERIAL AND METHODS: Analysis of the ecological correlation between the patterns of alcohol consumption determined by the National Addiction Survey in 1993 and mortality by liver cirrhosis, in the period between 1971-1993, in the eight regions in which the country was divided. To determine level of correlation, the Pearson and Spearman coefficients were calculated. RESULTS: Significant correlations were only found with the prevalence of spirits and pulque drinkers; with beer drinkers the correlation was negative. CONCLUSIONS: The correlation with pulque is interesting, since pulque consumption is considered to be low scale in some rural areas. The negative correlation with beer may indicate that beer drinking is nor a good indicator of alcoholism. Results, though limited to the possibilities of an ecological study, reveal the necessity of effective actions in the regions where spirits and pulque are consumed in excess.

[Liver cirrhosis mortality in Mexico. I. Relevant epidemiological characteristics]. / La mortalidad por cirrosis hepática en México. I. Características epidemiológicas relevantes.

Previous studies have emphasized the impact of alcoholism on public health, especially on the incidence of liver cirrhosis, which ranks among one of the main causes of death in Mexico. Accordingly, the epidemiologic features of liver cirrhosis mortality (LCM) are examined, highlighting its historical trends, its geographical distribution and other risk factors like age and sex. The data show a consistently high LCM rate over time, male rates moving slightly up and female rates down. Proportional mortality has been increasing. The significant risk increment with age has determined LCM to be the leading cause of death for both sexes in the 30-64 years age group. A particularly interesting finding relates to the continuous excess of LCM seen in Mexico City and four surrounding states; on the contrary, in the northern states, LCM is considerably low. This difference is valid for women too. Comparing all states, a gradient of LCM rates from high to low mortality areas is observed. The social and health implications of LCM regional distribution demand the conduction of epidemiological studies to identify possible explanatory variables related to the pattern of alcohol consumption or other risk factors. Nonetheless, these data alone justify the implementation of an effective action plan in the high-risk areas to deal with this health problem, inherently associated with individual and social behaviors.

[Liver cirrhosis mortality in Mexico. II. Excess mortality and pulque consumption]. / La mortalidad por cirrosis hepática en México. II. Exceso de mortalidad y consumo de pulque.

Over the years high cirrhosis mortality rates have been reported in Mexico City and in the surrounding states (Hidalgo, Tlaxcala, Puebla and the State of Mexico); on the contrary, well defined areas, such as the northern states, have shown a considerably lower mortality rate. This situation may indicate that some factors such as the pattern of alcoholic intake and other environmental characteristics could explain this striking difference. To determine the role of alcohol, the availability and consumption of alcohol at regional and state level were compared with cirrhosis mortality rates. A high and statistically significant correlation was found with pulque availability and consumption (r = 72-92%, p less than 0.01) in all periods of time under examination. On the contrary, a statistically significant negative association was observed with beer consumption and a positive, but not significant correlation, with distilled alcoholic beverages. Infectious hepatitis incidence, prevalence of exclusive use of native languages (as an indirect index of ethnic background) and nutritional deficiencies were also studied as possible risk factors. Nutritional deficiencies and the prevalence of exclusive use of náhuatl and otomí languages were positively correlated. These results can be useful to conduct further epidemiological studies still needed to determine the etiologic role of pulque consumption as well as of the other risk factors. Nonetheless, the current data stress the need to implement public health programs to reduce alcohol consumption, especially pulque, and to minimize the impact of these risk factors in high mortality areas.

[The development of public health research]. / Desarrollo de la investigación en salud pública.

The overall assessment of the public health research (PHR) development in Mexico is a previous condition to promote PHR at a national scale. This assessment has been delayed because standard PHR identification criteria within the health research field have been missing. In this paper the guidelines to determine the PHR fields of application are presented, as well as the bibliometric indices to determine its current stage of development; a PHR methodological classification scheme is also proposed. To estimate the PHR production in Mexico, the above criteria were used to analyze the content of a data base created from two national data bases (Biblat and Periódica), and from one international data base on biomedical literature (Medline); a manual search was implemented to identify studies missing studies in the data bases but published in Salud Pública de México, the most prominent national journal in this field. The review period in Medline extended from 1979 to 1986. About 2,269,905 international scientific references were recorded, 5,189 of which belonged to national authors. Approximately 180,000 papers were related to the PHR; in 552 of these works, the main author was from Mexico. After adding up to this figure, the number of articles found in the manual search and after correcting for any misclassification error, the PHR data base contained 971 papers; approximately half of them were not investigation reports, but commentaries, reviews and position papers. Outbreak studies were 3 per cent and mortality 2.2 per cent; prevalence works were the most common (8.4%), but analytic studies were very infrequent (4%). Communicable diseases, noncommunicable diseases and mental health ranked among the main topics of interest; all other topics were infrequent or absent. These results highlight the need to carry out four main tasks to promote nationally the PHR in the short term.

[Changes in the professional expectations and attitudes of medical students toward the preventive and social aspects of education and medical practice]. / Cambios en las aspiraciones profesionales y en las actitudes de los estudiantes de medicina hacia los aspectos preventivos y sociales de la enseñanza y del ejercicio médicos.

A prospective review was made of the occupational aspirations of a group of Mexican medical students and of their attitudes toward the preventive and social aspects of medical education and practice in order to determine whether they had changed in any way. In the pattern of their occupational aspirations, no changes were seen in their preference for specialization versus general medicine; the trend toward research and private practice had declined, but not toward full-time job in a public institution. In regard to their attitudes, there was increased recognition of the importance of social factors and a loss of respect for the public health disciplines and the effectiveness of preventive measures. As a possible explanation for this development, it is posited that the education process is not designed to reinforce attitudes in favor of prevention. Finally, recommendations are made for the ongoing study of these matters as of central importance to the planning and evaluation of the education process.

Cambios en las aspiraciones profesionales y en las actitudes de los estudiantes de medicina hacia los aspectos preventivos y sociales de la enseñanza y del ejercicio médicos / Changes in the professional expectations and attitudes of medical students toward the preventive and social aspects of education and medical practice

A prospective review was made of the occupational aspirations of a group of Mexican medical students and of their attitudes toward the preventive and social aspects of medical education and practice in order to determine whether they had changed in any way. In the pattern of their occupational aspirations, no changes were seen in their preference for specialization versus general medicine; the trend toward research and private practice had declined, but not toward full-time job in a public institution. In regard to their attitudes, there was increased recognition of the importance of social factors and a loss of respect for the public health disciplines and the effectiveness of preventive measures. As a possible explanation for this development, it is posited that the education process is not designed to reinforce attitudes in favor of prevention. Finally, recommendations are made for the ongoing study of these matters as of central importance to the planning and evaluation of the education process (Au)

La vigilancia epidemiologica de las alteraciones mentales / Epidemiologic surveillance in mental disorders

En la primera parte del trabajo se presenta la estructura del Programa de Vigilancia Epidemiologica recientemente instalado por la Direccion General de Salud Mental y se describen los elementos y caracteristicas de los tres sistemas que lo integran 1 Registro y recoleccion; 2. Procesamiento y analisis; 3. Respuesta y retroalimentacion Se hace enfasis en la necesidad de disponer de datos confiables y representativos de los servicios de salud mental.En la segunda parte se analizan las observaciones en el tercer nivel de atencion correspondientes a un periodo de seis anos y que se utilizaran como linea basal para futuras comparaciones. Tambien se contrastan las caracteristicas de las principales alteraciones de la consulta externa y hospitalizacion, formulandose algunas explicaciones sobre las diferencias observadas.Finalmente se describen los multiples beneficios de este programa para la planeacion, evaluacion e implementacion de acciones a favor de la salud mental

[Family planning in a suburban development of Mexico City]. / Planificación familiar en una colonia marginada de la cuidad de México.

PIP: To study the prevalence of contraceptive use among women in reproductive age, 15-50, and living in urban slums, the female population of Colonia Ajusco was surveyed. Colonia Ajusco is situated south of Mexico City; 70% of its population comes from the interior of the country; there is no drinkable water and no sewage system; housing conditions and urban services are very poor. 606 women were investigated; 58% of them were below age 36, and 53.5% were parity 4 and over. 56.4% used contraception; of these 36.7% used the IUD, 23.1% the pill, and 16.7% had been sterilized. The contraceptive method used seemed to be strictly related to the type of medical services used; women using the IUD were mostly patients of the Social Security medical services, while women using the pill were mostly clients of private physicians. There was no association between age and the method used. 88.4% of women not using contraception did not have easy availability of medical services. The percentage of women using contraception, 56.4% seems high in relation to other Latin American countries, but it is very low in relation to the percentage of contraceptive users in more developed countries (93% in England). The use of the IUD as the method of choice can be explained by several factors: the massive national advertising campaign, low cost, ease of insertion, and no need for sustained motivation to use contraception. From all studies on contraceptive prevalence in Mexico it appears that women start to regulate their fertility after the 1st child, or even after the 4th child. Women below 20 still tend to resort to illegal abortion.^ieng

[Attitude of medical students to the preventive and social aspects of medical education and practice]. / La actitud de los estudiantes de medicina hacia los aspectos preventivos y sociales de la enseñanza y del ejercicio médicos.

This paper reports on a study carried out in the Faculty of Medicine of the Autonomous National University of Mexico to discover the attitudes of a group of students toward the preventive and social aspects of medicine, and their own professional aspirations. It was found that these students were aware of the importance of these aspects, and that they inclined by preference to the practice of a clinical specialty. No correlation was found between the patterns of the students' professional aspirations and their attitudes. The authors feel this could mean that attitudes are determined by the overall influence of the society, but the aspirations by the structure of the labor market and the prevailing medical practice model. It is suggested that a similar survey be done of the same group of students at the completion of their studies to determine the possible effects of the educational process on their attitudes. Comments are made and recommendations put forward for solving methodological problems that arise in studies of this type.

La actitud de los estudiantes de medicina hacia los aspectos preventivos y sociales de la enseñanza y del ejercicio médicos / Attitude of medical students to the preventive and social aspects of medical education and practice

This paper reports on a study carried out in the Faculty of Medicine of the Autonomous National University of Mexico to discover the attitudes of a group of students toward the preventive and social aspects of medicine, and their own professional aspirations. It was found that these students were aware of the importance of these aspects, and that they inclined by preference to the practice of a clinical specialty. No correlation was found between the patterns of the students' professional aspirations and their attitudes. The authors feel this could mean that attitudes are determined by the overall influence of the society, but the aspirations by the structure of the labor market and the prevailing medical practice model. It is suggested that a similar survey be done of the same group of students at the completion of their studies to determine the possible effects of the educational process on their attitudes. Comments are made and recommendations put forward for solving methodological problems that arise in studies of this type (Au)

La actitud de los estudiantes de medicina hacia los aspectos preventivos y sociales de la ensenanza y del ejercicio medicos. / Attitude of medical students toward preventive and social aspects of medical education and practice

En este trabajo se da cuenta de una investigacion realizada en la Faculdad de Medicina de la Universidad Nacional Autonoma de Mexico para conocer las actitides de un grupo de alumnos hacia los aspectos preventivos y sociales de la medicina, asi como sus aspiraciones profesionales. Se observo que los estudiantes reconocen la importancia de estos aspectos y que se inclinan prefeitamente por la practica de una especialidad clinica. No se encontro una relacion entre el patron de aspiraciones profesionales y las actitudes de los alumnos. Los autores consideran que esto pudiera indicar que las actitudes estarian determinadas por la influencia global de la sociedad, pero que las aspiraciones serian resultado de la estructura del mercado de trabajo y del modelo de practica media vigente. Se sugiere la realizacion de una investigacion similar con el mismo grupo de estudiantes al termino de su carrera para determinar el posible efecto del proceso educativo sobre el cambio en sus actitudes. Tambien se formulan comentarios y recomendaciones para resolver problemas metodologicos que surgen en estudios de este tipo