Fat gain with physical detraining is correlated with increased glucose transport and oxidation in periepididymal white adipose tissue in rats

As it is a common observation that obesity tends to occur after discontinuation of exercise, we investigated how white adipocytes isolated from the periepididymal fat of animals with interrupted physical training transport and oxidize glucose, and whether these adaptations support the weight regain seen after 4 weeks of physical detraining. Male Wistar rats (45 days old, weighing 200 g) were divided into two groups (n=10): group D (detrained), trained for 8 weeks and detrained for 4 weeks; and group S (sedentary). The physical exercise was carried out on a treadmill for 60 min/day, 5 days/week for 8 weeks, at 50-60% of the maximum running capacity. After the training protocol, adipocytes isolated from the periepididymal adipose tissue were submitted to glucose uptake and oxidation tests. Adipocytes from detrained animals increased their glucose uptake capacity by 18.5% compared with those from sedentary animals (P<0.05). The same cells also showed a greater glucose oxidation capacity in response to insulin stimulation (34.55%) compared with those from the S group (P<0.05). We hypothesize that, owing to the more intense glucose entrance into adipose cells from detrained rats, more substrate became available for triacylglycerol synthesis. Furthermore, this increased glucose oxidation rate allowed an increase in energy supply for triacylglycerol synthesis. Thus, physical detraining might play a role as a possible obesogenic factor for increasing glucose uptake and oxidation by adipocytes.

Health Promotion in Obstructive Sleep Apnea Syndrome

Introduction Obstructive sleep apnea syndrome (OSAS), which is commonly underdiagnosed, has a high occurrence in the world population. Health education concerning sleep disorders and OSAS should be implemented. Objectives The objective was to identify studies related to preventive actions on sleep disorders, with emphasis on OSAS. Data Synthesis A literature review was conducted using Lilacs, Medline, PubMed, and Scopus by combining the following keywords: "Health Promotion," "Sleep Disorders," "Primary Prevention," "Health Education," and "Obstructive Sleep Apnea Syndromes." Initially, 1,055 papers, from 1968 to 2013, were located, with the majority from the Scopus database. The inclusion criteria were applied, and four articles published between 2006 and 2012 were included in the present study. Conclusions The studies on preventive actions in sleep disorders, with emphasis on OSAS, involved the general population and professionals and students in the health field and led to increased knowledge on sleep disorders and more appropriate practices. .

Quercetin protects the retina by reducing apoptosis due to ischemia-reperfusion injury in a rat model / Quercetina protege a retina reduzindo a apoptose consequente à lesão por isquemia e reperfusão em um modelo de rato

Purpose: This study aimed to investigate the effect of quercetin on apoptotic cell death induced by ischemia-reperfusion (I/R) injury in the rat retina. Methods: Twenty-four rats were divided into four equal groups: control, ischemic, solvent, and quercetin. I/R injury was achieved by elevating the intraocular pressure above the perfusion pressure. Intraperitoneal injections of 20 mg/kg of quercetin and dimethyl sulfoxide (DMSO) were performed in the quercetin and solvent groups, respectively, immediately prior to I/R injury, and the researchers allowed for the retinas to be reperfused. Forty-eight hours after injury, the thicknesses of the retinal ganglion cell layer (RGCL), inner nuclear layer (INL), inner plexiform layer (IPL), outer plexiform layer (OPL), and outer nuclear layer (ONL) were measured in all groups. Moreover, the numbers of terminal deoxynucleotidyl transferase dUTP nick-end-labeled [TUNEL (+)] cells and caspase-3 (+) cells in both INL and ONL were evaluated in all groups. Results: The administration of quercetin was found to reduce the thinning of all retinal layers. The mean thickness of INL in the quercetin and ischemic groups was 21 ± 5.6 µm and 16 ± 6.4 µm, respectively (P<0.05). Similarly, the mean thickness of ONL in the quercetin and ischemic groups was 50 ± 12.8 µm and 40 ± 8.7 µm, respectively (P<0.05). The antiapoptotic effect of quercetin in terms of reducing the numbers of both TUNEL (+) cells and caspase-3 (+) cells was significant in INL. The mean number of TUNEL (+) cells in INL in the ischemic and quercetin groups was 476.8 ± 45.6/mm2 and 238.72 ± 251/mm2, respectively (P<0.005). The mean number of caspase-3 (+) cells in INL of ischemic and quercetin groups was 633.6 ± 38.7/mm2 and 342.4 ± 36.1/mm2, respectively (P<0.001). Conclusion: The use of quercetin may be beneficial in the treatment of retinal I/R injury because of its antiapoptotic effect on the retinal layers, particularly in INL. .

Objetivo: O objetivo deste estudo é investigar o efeito da quercetina, contra a morte celular por apoptose induzida por lesão consequente à isquemia-reperfusão (I/R) na retina de ratos. Método: Vinte e quatro ratos foram divididos em quatro grupos iguais: controle, isquêmico, solvente e quercetina. O modelo lesão por I/R foi realizado por meio da elevação da pressão intraocular acima da pressão de perfusão, em todos os grupos. Injecções intraperitoneais de 20 mg/kg de quercetina ou sulfóxido de dimetilo (DMSO) foram realizadas nos grupos quercetina e solvente, respectivamente, imediatamente antes da lesão por I/R, permitindo que as retinas fossem reperfundidas. Quarenta e oito horas após a lesão, as espessuras de camada de células ganglionares da retina (RGCL), camada nuclear interna (INL), camada plexiforme interna (IPL), camada plexiforme externa (OPL), e a camada nuclear externa (ONL) foram medidas em todos os grupos. Além disso, o número de células TUNEL (+) e caspase-3 (+) tanto na camada nuclear interna quanto na camada nuclear externa foi avaliada em todos os grupos. Resultados: A administração de quercetina diminuiu o afinamento de todas as camadas da retina em comparação com o grupo isquêmico. A espessura média da camada nuclear interna nos grupos quercetina e isquêmico foi de 21 ± 5,6 µm e 16 ± 6,4 µm, respectivamente (p<0,05). A espessura média da camada nuclear externa no grupo quercetina e isquêmico foi 50 ± 12,8 µm e 40 ± 8,7 µm, respectivamente (p<0,05). O efeito anti-apoptótico de quercetina em termos de redução do número de células TUNEL (+) e caspase-3 (+) foi significativa na INL. O número médio de células TUNEL (+) da camada nuclear interna no grupo isquêmico e quercetina foi 476,8 ± 45,6/mm2 e 238,72 ± 251/mm2, respectivamente (p<0,005). O médio número de células de caspase-3 (+) na INL do grupo isquêmico e quercetina foi 633,6 ± 38,7/mm2 e 342,4 ± 36,1/mm2, respectivamente (p<0,001). Conclusão: A utilização ...

Validation of the Portuguese version of the Evidence-Based Practice Questionnaire / Validação da versão portuguesa do Questionário de Eficácia Clínica e Prática Baseada em Evidências / Validación de la versión portuguesa del Cuestionario de Eficacia Clínica y Práctica Basada en Evidencias

OBJECTIVES: to describe the process of translation and linguistic and cultural validation of the Evidence Based Practice Questionnaire for the Portuguese context: Questionário de Eficácia Clínica e Prática Baseada em Evidências (QECPBE). METHOD: a methodological and cross-sectional study was developed. The translation and back translation was performed according to traditional standards. Principal Components Analysis with orthogonal rotation according to the Varimax method was used to verify the QECPBE's psychometric characteristics, followed by confirmatory factor analysis. Internal consistency was determined by Cronbach's alpha. Data were collected between December 2013 and February 2014. RESULTS: 358 nurses delivering care in a hospital facility in North of Portugal participated in the study. QECPBE contains 20 items and three subscales: Practice (α=0.74); Attitudes (α=0.75); Knowledge/Skills and Competencies (α=0.95), presenting an overall internal consistency of α=0.74. The tested model explained 55.86% of the variance and presented good fit: χ2(167)=520.009; p = 0.0001; χ2df=3.114; CFI=0.908; GFI=0.865; PCFI=0.798; PGFI=0.678; RMSEA=0.077 (CI90%=0.07-0.08). CONCLUSION: confirmatory factor analysis revealed the questionnaire is valid and appropriate to be used in the studied context. .

OBJETIVOS: descrever o processo de tradução e validação linguística e cultural para o contexto português do Questionário de Eficácia Clínica e Prática Baseada em Evidências (QECPBE). MÉTODO: desenvolveu-se um estudo metodológico e transversal. Foi efetuada tradução e retroversão, de acordo com os padrões usuais. Na determinação das características psicométricas do QECPBE utilizou-se a Análise de Componentes Principais com rotação ortogonal, segundo o método Varimax, seguida de análise fatorial confirmatória. A consistência interna foi determinada pelo valor alfa de Cronbach. A coleta de dados ocorreu entre dezembro de 2013 e fevereiro de 2014. RESULTADOS: participaram 358 enfermeiros que exercem a prática clínica num centro hospitalar do norte de Portugal. O QECPBE apresenta 20 itens e três subescalas: Práticas (α=0,74); Atitudes (α=0,75); Conhecimentos/Habilidades e Competências (α=0,95), apresentando consistência interna global de α=0,74. No modelo testado obteve-se variância explicada de 55,86%. O modelo demonstrou um bom ajuste: χ2(167)=520,009; p=0,0001; χ2df=3,114; CFI=0,908; GFI=0,865; PCFI=0,798; PGFI=0,678; RMSEA=0,077 (IC90%=0,07-0,08). CONCLUSÃO: através da análise fatorial confirmatória realizada demonstrou-se que o questionário é válido e adequado para utilização no contexto estudado. .

OBJETIVOS: describir el proceso de traducción y validación lingüística y cultural para el contexto portugués del Cuestionario de Eficacia Clínica y Práctica Basada en Evidencias (CECPBE). MÉTODO: se desarrolló un estudio metodológico y transversal. Fue efectuada traducción y retroversión de acuerdo con los estándares usuales. En la determinación de las características psicométricas del CECPBE se utilizó el Análisis de Componentes Principales con rotación ortogonal, según el método Varimax, seguido por análisis factorial confirmatorio. La consistencia interna fue determinada por el valor alfa de Cronbach. La recolección de datos ocurrió entre diciembre de 2013 y febrero de 2014. RESULTADOS: participaron 358 enfermeros que ejercían la práctica clínica en un centro hospitalario en el norte de Portugal. El CECPBE presenta 20 ítems y tres subescalas: Prácticas (α=0,74); Actitudes (α=0,75); Conocimientos/Habilidades y Competencias (α=0,95), presentando consistencia interna global de α=0,74. En el modelo probado se obtuvo variancia explicada de 55,86%. El modelo demostró un buen ajuste: χ2(167)=520,009; p=0,0001; χ2df=3,114; CFI=0,908; GFI=0,865; PCFI=0,798; PGFI = 0,678; RMSEA = 0,077 (IC90%=0,07-0,08). CONCLUSIÓN: a través del análisis factorial confirmatorio se demostró que el cuestionario es válido y adecuado para utilización en el contexto estudiado. .

Las generaciones de inmigrantes y sus descendientes y el riesgo de diabetes en la población de los Estados Unidos de origen o ascendencia mexicana: el Estudio sobre Envejecimiento en Latinos del Área de Sacramento (estudio SALSA) / Immigrant generation and diabetes risk among Mexican Americans: the Sacramento Area Latino Study on Aging

OBJETIVO: Se investigó si la aculturación de los inmigrantes y sus descendientes y la generación a la que pertenecen, un marcador de la asimilación, se relacionan con el riesgo de diabetes en una población de adultos mayores de ascendencia u origen mexicano. MÉTODOS: Se analizaron los datos sobre 1 789 adultos de 60 a 101 años de edad del Estudio sobre Envejecimiento en Latinos del Área de Sacramento (estudio SALSA). Se determinó la presencia de diabetes tipo 2 con base en el uso de medicamentos antidiabéticos, la mención por el paciente del diagnóstico de un médico, o una glucosa en ayunas de 126 mg/dl o mayor. Se aplicó un modelo de regresión logística para la prevalencia de diabetes. RESULTADOS: Tras ajustar por edad y sexo, se observaron asociaciones significativas pero divergentes entre las generaciones de inmigrantes y sus descendientes, la aculturación y el riesgo de diabetes. En relación con los adultos de la primera generación, los de la segunda tuvieron una razón de posibilidades (odds ratio, OR) de padecer diabetes de 1,8 (intervalo de confianza [IC] de 95% = 1,4, 2,4) y los adultos de la tercera generación tuvieron una OR de 2,1 (IC de 95% = 1,4, 3,1). Sin embargo, una mayor aculturación a los Estados Unidos se relacionó con una tasa ligeramente menor de diabetes. En el modelo completo, tras la incorporación de ajustes para tener en cuenta los factores socioeconómicos y del modo de vida, la relación entre la generación y la diabetes seguía siendo significativa, no así la relación de esta última con la aculturación. CONCLUSIONES: El presente estudio respalda la idea, anteriormente cuestionada, de que la asimilación se relaciona con un mayor riesgo de diabetes entre los inmigrantes de origen mexicano. Los investigadores deben analizar más detalladamente la presencia de una relación causal entre la asimilación y la salud.

OBJECTIVE: We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican origin population. METHODS: We analyzed data on 1789 adults aged 60 to 101 years from the Sacramento Area Latino Study on Aging. We ascertained type 2 diabetes on the basis of diabetic medication use, self-report of physician diagnosis, or a fasting glucose of 126 milligrams/deciliter or greater. Logistic regression modeled prevalent diabetes. RESULTS: Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio (OR) of 1.8 (95% confidence interval [CI] = 1.4, 2.4) and third-generation adults had an OR of 2.1 (95% CI = 1.4, 3.1) of having diabetes. Greater US acculturation, however, was associated with a slightly decreased diabetes rate. In the full model adjusting for socioeconomic and lifestyle factors, the association between generation (but not acculturation) and diabetes remained significant. CONCLUSIONS: Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants. Researchers should examine the presence of a causal link between assimilation and health more closely.

Experiencias de mujeres mexicanas migrantes indocumentadas en California, Estados Unidos, en su acceso a los servicios de salud sexual y reproductiva: estudio de caso / Experiences of undocumented Mexican migrant women when accessing sexual and reproductive health services in California, USA: a case study / Experiências de mulheres mexicanas migrantes sem documentação na Califórnia, Estados Unidos, no acesso aos serviços de saúde sexual e reprodutiva: estudo de caso

This study focuses on the experience of Mexican women migrants in California, USA, with the use of formal health services for sexual and reproductive health issues. The authors used a qualitative interpretative approach with life histories, interviewing eight female users of healthcare services in California and seven key informants in Mexico and California. There were three main types of barriers to healthcare: immigration status, language, and gender. Participants reported long waiting times, discriminatory attitudes, and high cost of services. A combination of formal and informal healthcare services was common. The assessment of quality of care was closely related to undocumented immigration status. Social support networks are crucial to help solve healthcare issues. Quality of care should take intercultural health issues into account.

El objetivo de este estudio fue conocer la experiencia de mujeres mexicanas migrantes en California, Estados Unidos, en torno a la utilización de los servicios formales de salud para resolver problemas relacionados con su salud sexual y reproductiva. El diseño fue cualitativo, con enfoque teórico metodológico de antropología interpretativa. Las técnicas utilizadas fueron historias de vida con mujeres usuarias de los servicios de salud en California y entrevistas breves con informantes clave. Se encontraron tres tipos de barreras principales para el acceso al sistema de salud: condición migratoria, idioma y género. Los tiempos de espera, actitudes discriminatorias y costo del servicio se expresaron como características que más incomodaron a las migrantes. La percepción de calidad de atención estuvo relacionada con la condición de ilegalidad migratoria. La red de apoyo tanto en México, como en California, colabora en la resolución de enfermedades. Se debe incorporar la perspectiva intercultural en los servicios.

O objetivo deste estudo foi conhecer a experiência de mulheres imigrantes mexicanas na Califórnia, Estados Unidos, sobre a utilização de serviços formais de saúde para resolver problemas relacionados com a saúde sexual e reprodutiva. O desenho foi qualitativo, com enfoque teórico-metodológico da Antropologia Interpretativa. As técnicas utilizadas foram relatos de histórias de vida de mulheres usuárias dos serviços de saúde na Califórnia e entrevistas breves com informantes-chave. Encontraram-se três tipos de barreiras principais para o acesso ao serviço de saúde: condições de imigração, idioma e gênero. Tempo de espera, atitudes discriminatórias e custo do serviço foram as características que mais incomodaram as imigrantes. A percepção de qualidade da atenção esteve relacionada com a condição de ilegalidade migratória. A rede de apoio, tanto no México quanto na Califórnia, colabora na resolução das enfermidades. Deve-se incorporar a perspectiva intercultural nos serviços de saúde.

Targeting children's dietary behaviors in a family intervention: 'Entre familia: reflejos de salud' / Enfoque en hábitos alimenticios de los hijos en una intervención familiar: 'Entre familia: reflejos de salud'

Objective. This intervention sought to promote healthy eating with the ultimate goal of reducing childhood obesity risk. Materials and methods. Three hundred and sixty-one Latino families living on the US-Mexico border with at least one child between 7-13 years of age were eligible to participate. Families randomly assigned to the four-month intervention received 14 contacts with a promotora (community health worker), consisting of 11 home visits and three telephone calls; the control condition was a delayed treatment intervention. Children reported on their dietary intake at baseline, immediately post-intervention and at the six month follow-up visit. Results. The intervention reduced weekly consumption of fast food (p<0.05). A dose-response relationship was observed such that for every seven hours of promotora contact, monthly variety of fruits (p<0.01) and vegetables (p<0.01) increased by one. No other intervention effects were observed. Conclusions. Family-based interventions can improve children's eating habits, with the amount of contact with the promotora being key to success.

Objetivo. Promover una alimentación saludable con el objetivo final de reducir el riesgo de obesidad infantil. Material y métodos. Trescientas sesenta y una familias latinas que viven en la frontera de EU y México, y que cuentan con por lo menos un hijo entre 7 y 13 años, fueron elegibles para participar. Las familias asignadas al azar a la intervención de cuatro meses tuvieron contacto 14 veces (11 visitas familiares y tres llamadas telefónicas) con una promotora; el grupo de control recibió el tratamiento de intervención al final del programa. Los niños reportaron su ingesta alimenticia al inicio, inmediatamente después de la intervención y en la visita de seguimiento a los seis meses. Resultados. La intervención redujo el consumo semanal de comida rápida (p<0.05). Se observó una relación dosis-respuesta tal que por cada siete horas de contacto con la promotora, la variedad mensual de frutas (p<0.01) y verduras (p<0.01) tuvo un incremento de uno. No se observaron otros efectos de intervención. Conclusiones. Las intervenciones basadas en la familia pueden mejorar los hábitos alimenticios de los niños, siendo la cantidad de contacto con la promotora clave para el éxito.

Informing public policy toward binational health insurance: Empirical evidence from California / Información para las políticas públicas sobre seguros binacionales de salud: evidencia empírica de California

Objective. To estimate reimbursement rate differences between Mexico and US based physicians reimbursed by a binational health insurance (BHI) plan and US payers, respectively; and show the relationship between plan benefit designs and health care utilization in Mexico. Materials and methods. Data include 33 841 and 53 909 HMO enrollees in California from Sistemas Médicos Nacionales (SIMNSA) and Salud con Health Net, respectively. We use descriptive statistical methods. Results. SIMNSA's physician reimbursement rates averaged 50.7% (95% CI: 34.5%-67.0%) of Medi-Cal's, 28.3% (95% CI: 19.6%-37.0%) of Medicare's, and 22% of US private plans'. Each year, 99.4% of SIMNSA enrollees but only 0.1% of Salud con Health Net enrollees obtained care in Mexico. Conclusion. SIMNSA only covers emergency and urgent care in the US, while Salud con Health Net covers comprehensive care with higher patient cost sharing than in Mexico. To realize potential savings, plans need strong incentives to increase utilization in Mexico.

Objetivo. Estimar diferencias en tasas de reembolso y utilización de servicios médicos cubiertos por seguros binacionales de salud (SBS) y aquellos de planes públicos y privados de EUA. Material y métodos. Con métodos estadísticos descriptivos se analizan datos de 33 841 afiliados a Sistemas Médicos Nacionales (SIMNSA) y 53 909 de Salud con Health Net en California. Resultados. Las tasas de reembolso de SIMNSA son en promedio 50.7% (95% IC: 34.5%-67.0%) de aquellas de Medi-Cal, 28.3% (95% IC: 19.6%-37.0%) de Medicare, y 22% de los planes privados de EUA. Cada año, 99.4% de afiliados a SIMNSA, pero sólo 0.1% de Salud con Health Net obtienen atención en México. Conclusión. SIMNSA sólo cubre gastos de emergencia y atención urgente en EUA, mientras que Salud con Health Net cubre servicios de atención integrales. Los planes de SBS pueden lograr ahorros importantes con más incentivos para que la atención ocurra en México.

Current depression among women in California according to residence in the California—Mexico border region / Depresión actual en las mujeres en California según el lugar de residencia en la región fronteriza entre California y México

Objective. To estimate the prevalence of current depression; examine the relationshipbetween current depression and immigration, health status, health care access, and healthbehaviors; and assess differences by California–Mexico border region (Imperial and San DiegoCounties) among women in California.Methods. Using a cross-sectional, representative sample of adult women from the CaliforniaWomen's Health Survey (n = 13 454), a statewide telephone survey, prevalence of currentdepression and predictors of depression were examined in California and according to borderregion residence. Depression was assessed with the eight-item Patient Health Questionnaire.Results. The prevalence of current depression for women in California was 12.0%. It wassimilar in the border (13.0%) and the nonborder (11.9%) regions. Odds of current depressionin women were lower among recent immigrants (< 5 years or 5 to < 10 years in the UnitedStates) than in women born in the United States and in immigrants who had been living inthe United States for 10 to < 15 years or longer (P < 0.05). Odds ratios for current depressionand health status, health care access, and binge drinking were larger in the border region thanoutside the border region.Conclusions. Similar prevalences of current depression were observed among those wholive in the border region of California and in those who do not, but the relationship betweendepression and health status, health care access, and binge drinking varied by border regionresidence. Ideally, future surveillance of depression and its predictors along the Mexico–California border will be conducted binationally to inform interventions and tracking such asthe Healthy Border Program's objectives.

Support for disease management, depression, self-care, and clinical indicators among Hispanics with type 2 diabetes in San Diego County, United States of America / Indicadores clínicos y apoyo para el manejo de la enfermedad, la depresión, el autocuidado en hispanos que padecen diabetes tipo 2 en el Condado de San Diego, Estados Unidos

This study used a social-ecological framework to examine predictors of depression, diabetes self-management, and clinical indicators of health risk among Hispanics with type 2 diabetes residing in the United States (U.S.)-Mexico border region in San Diego County, California, United States of America. Important links were observed between greater social-environmental support for disease management and less depression, better diabetes self-management, and lower body mass index and serum triglyceride concentrations. Less depressive symptomatology was also related to lower hemoglobin A1c levels. Findings suggest that programs aiming to improve diabetes self-management and health outcomes in Hispanics with type 2 diabetes should consider multilevel, social, and environmental influences on health, behavior, and emotional well-being.

En este estudio se utilizó un marco socioecológico para analizar los factores predictivos de la depresión, la autogestión de la diabetes y los indicadores clínicos de riesgo para la salud en hispanos que padecen diabetes tipo 2 residentes en la zona fronteriza entre México y los Estados Unidos del Condado de San Diego en California. Se observaron vínculos importantes entre un mayor apoyo socioambiental para el manejo de la enfermedad y una presencia menor de la depresión, una mejor autogestión de la diabetes, y menores índices de masa corporal y concentraciones de triglicéridos séricos. La presencia menor de síntomas depresivos también se relacionó con niveles inferiores de hemoglobina A1c. Estos resultados indican que los programas dirigidos a mejorar la autogestión de la diabetes y los resultados en materia de salud en los hispanos que padecen diabetes tipo 2 deben tener en cuenta las influencias sociales y ambientales sobre la salud, el comportamiento y el bienestar emocional.

Globalización y salud en la región San Diego-Tijuana / Health and globalization in the San Diego-Tijuana region

En este ensayo se describen algunas las circunstancias de esta zona del mundo y sus consecuencias para la salud pública de Norteamérica. La globalización se define como el intercambio de bienes y servicios facilitado por la reducción de barreras en el mercado internacional. Un ejemplo de este proceso se encuentra en la frontera San Diego-Tijuana. Los efectos socioeconómicos y culturales regionales tienen un impacto profundo en los aspectos de la salud no solamente para la población de esta zona sino también para los sistemas de salud de México y Estados Unidos. En este punto se reúnen el poderío económico y el subdesarrollo al mismo tiempo, resultando desigualdades en la salud, aumento de enfermedades crónico-degenerativas, infecciosas y otras, en donde la pobreza y migración constituyen un detonante mayor. La solución a la problemática en esta realidad fronteriza de salud está aún por determinarse.

The international process of trading goods and services with significant reduction in barriers known as globalization is clearly observed at the San Diego-Tijuana region. This essay addresses issues arising at this unique geographical area associated with the globalization process and its public health consequences. Social, cultural and political aspects have very important implications on the health status of the U.S-Mexican population and in the health care systems on both sides of the border. One of the most powerful world economies borders a developing country resulting in a dramatic comparison that has negative outcomes such as health disparities, high prevalence of chronic diseases and new epidemiological risks. Poverty and migration are a few of the contributing factors triggering this asymmetrical relationship. Challenges in border health require a comprehensive binational participation and the solutions are yet to be determined.