Impact of the 'Seguro Médico Siglo XXI' medical insurance programme on neonatal and infant mortality in Mexico, 2006-14: an ecological approach to estimation.

The 'Seguro Médico Siglo XXI' (SMSXXI), a universal coverage medical insurance programme for children under 5 years of age, started in 2006 to help avoid catastrophic health expenditures in poor families without social security in Mexico. The study used information from the National Health Information System for the 2006-14 period. An ecological approach was followed with a panel of the 2457 municipalities of Mexico as the units of analysis. The outcome variables were the municipality-level neonatal mortality and infant mortality rates in population without access to social security. The programme variable was the coverage of the SMSXXI programme at the municipality level, expressed as a proportion. Demographic and economic variables defined at the municipality level were included as covariates. Impact was estimated by fitting a fixed-effects negative binomial regression model. Results reveal that the SMSXXI significantly reduced both infant and neonatSal mortality in the target population, although in a non-linear fashion, with minimum mortality levels found around the 70% coverage range. The effect is mostly given by the transition from the first quintile to the fourth quintile of coverage (<13% vs 70.5-93.7% coverage), and it is attenuated significantly at coverage levels very close to or at 100%. The observed risk reduction amounted to an estimated total of 11 358 infant deaths being avoided due to the SMSXXI during the 2006-14 period, of which 48% were neonatal. In conclusion, we found a significant impact of the SMSXXI programme on both infant mortality and neonatal mortality. An attenuation of the effect of the insurance on mortality rates at levels close to 100% coverage may reflect the saturation of health units in detriment of the quality of care.

Reference values for areal bone mineral density among a healthy Mexican population.

OBJECTIVE: Compare the influence of ethnicity in the prevalence of osteopenia and osteoporosis in various Mexican populations using two normal dual X-ray absorptiometry (DXA) reference databases: manufacturer's incorporating US Hispanic population and a normal mestizo Mexican population. MATERIAL AND METHODS: MMP included 9 946 subjects participating in an ongoing long-term cohort study focusing on lifestyle and chronic diseases, of which 6 487 MMP males and females aged 7 to 80 years were the normal subjects used to determine bone density T- and Z-scores, following WHO criteria, and peak bone mass values. Abnormal bone mass density values estimated by the manufacturer's and peak bone mass reference values were compared. RESULTS AND CONCLUSIONS: Our results show that by using the manufacturer's T-score values in the mestizo Mexican population we are underestimating the number of abnormal bone mass BMD populations.

Connecting humans and health through health information exchange.

To address healthcare quality, efficiency and safety, a national health information technology (IT) initiative was announced by the President of the United States in 2004 to make Electronic Health Records (EHR) available to most Americans within 10 years. The National Health IT Agenda has advanced with recognition of interoperability standards for Personal Health Records (PHR) and Population Health information exchange. This session will illustrate the national processes, timeline, stakeholders and benefits of adoption of interoperability standards to enable health information exchange.

Nurses exchanging information: understanding electronic health record standards and interoperability.

The complexity in adopting health information technology (IT) standards is not from lack of standards. Rather, there are a vast number of standards that overlap and some that are missing. The objective of this article is to provide nurses with an understanding of the importance of the National Health IT Agenda and be empowered to influence the processes to ensure nursing is represented. Several aspects include harmonization and adoption of standards necessary to achieve interoperability, and the strategies for nursing leaders to advocate for adoption of those standards.

Adiponectin is associated with low bone mineral density in elderly men.

OBJECTIVE: Recent evidence suggests that adiponectin may play a role in bone metabolism. Previous studies demonstrated that the adiponectin levels had a negative correlation with bone mineral density (BMD) in women. However, little is known about the relationship between adiponectin and BMD in men. The aim of this study was to determinate the relationship between the adiponectin levels and BMD in elderly men. DESIGN: Cross-sectional study including 92 healthy men aged 60-80 years. METHODS: Main outcome measures were the adiponectin levels estimated by RIA and BMD at lumbar spine and femoral neck using dual energy X-ray absorptiometry. Results The negative correlation between adiponectin and BMD at the spine was r=-0.209, (P<0.05) and at the femoral neck was r=-0.237, (P<0.001). These correlations disappeared after adjustment for body mass index (BMI). When stratified by BMI, the relationship between BMD and adiponectin remained significant in the subgroup of participants with BMI >27 kg/m(2), but disappeared in men with BMI 27. CONCLUSION: BMD is negatively associated with the adiponectin levels in men older than 60 years and this relationship is greater in those men with BMI >27, which suggests a plausible connection between bone and fat tissue.

The association between type of confidant and depressive symptomology in a sample of Mexican youth / Jóvenes mexicanos y depresión: el rol de confidentes

Background The current lifetime prevalence of depression among females in Mexico is 9.1% and 2.9% among males. The overall lifetime prevalence of depression is 6.2% among the general population of Mexico. Individuals that experience depressive symptomology at a young age are more likely to experience a depressive episode later in life. The risk of recurrence 24 months after the first episode of depression is 37.3%. There is scarce information about the prevalence of depression among adolescents in Mexico. However, a study of adults in Mexico City by Benjet et al. found that 2.8% of females and 1.1% of males experienced a depressive episode during adolescence. Research indicates that adolescents are especially vulnerable to mental and physical health problems. During the developmental transition, females are more vulnerable to these problems than males, including depression. The ways in which adolescents adapt and become adults can either protect or put them at risk for depressive symptomology and subsequent mental and physical disorders. The act of disclosure (talking to a confidant), which involves the sharing of personal thoughts and ideas with others, is an important mechanism through which adults and children form intimate relationships and develop good mental health. Objectives The objective of this study was to determine the association between type of confidant and depressive symptomology, and to identify some potential risk and protective factors of depression, including differences by gender, among a sample of Mexican youth. We hypothesized that not having a confidant would be associated with greater levels of depressive symptomology, and that this would differ by gender. Methods We used cross-sectional data obtained from 1,079 youths and adolescents aged 11 to 20 who were recruited to participate in the Health Worker Cohort Study (HWCS) between the years of 2004 and 2006. The HWCS included children and relatives of workers from the Instituto Mexicano del Seguro Social (IMSS) in Morelos and from Instituto Nacional de Salud Pública, both located in Cuernavaca. Participants were also selected from a similar sample of workers from the Universidad Autónoma del Estado de México (UAEM) in Toluca, capital of the State of Mexico. The participants from all three study sites are being followed in an ongoing cohort study of lifestyle and health. A self-reported questionnaire was administered to obtain information on lifestyle factors, socio-demographic data, health status, and quality of life. Bivariate and multivariate analyses were conducted to determine the association between confidant type and levels of depressive symptomology while controlling for demographic factors. Stratified analyses were also carried out, as it was hypothesized that the effect of disclosure to a confidant would vary by gender. Results In our study population, males had significantly lower levels of depressive symptomology than females; the mean BDI score for males was 5.6 and for females it was 8.7. Among both males and females, having only peer confidants is associated with higher levels of depressive symptomology, and having family confidants is associated with lower levels of depression. Males with peer confidants have the highest levels of depressive symptomology followed by those with no confidants, and those with family and peer confidants, as compared to males who reported having only a family confidant. Females with no confidant or with only peer confidants have higher levels of depressive symptomology than females with only family confidants. Among females, depressive symptomology increases with age, with females aged 17-20 having the highest levels of depressive symptomology. Financial symptomology predicts depressive symptomology among both males and females. Conclusions Our study shows that having a family member to talk to may be a protective factor against depressive symptomology among this sample of Mexican youth. Adolescents with a family confidant were found to have significantly lower levels of depressive symptomology than those who have only peer or no confidants. In the transition to adulthood, the presence of a family confidant positively influences the emotional well-being of boys and girls. Interventions that address the different disclosure needs of male and female adolescents may help reduce or prevent depressive symptomology among this population.

Antecedentes La prevalencia actual de depresión en México es de 9.1% en las mujeres y de 2.9% entre los hombres. En conjunto, la prevalencia de depresión entre la población general de México es de 6.2% durante el transcurso de la vida. Diversos estudios señalan que los individuos que presentan a edades tempranas un trastorno depresivo es más probable que más tarde en su vida sufran un episodio depresivo. El riesgo de presentar una recurrencia de depresión 24 meses después del primer episodio es de 37.3%. En México hay escasa información sobre la prevalencia de depresión entre los adolescentes. Las investigaciones señalan que los adolescentes son vulnerables a padecer problemas de salud tanto físicos como mentales. Durante la transición del desarrollo de la adolescencia, las mujeres son más vulnerables que los hombres a padecer este tipo de problemas, entre los que se encuentra la depresión. Las formas en que los adolescentes se adaptan y se convierten en adultos pueden protegerlos o ponerlos en riesgo de presentar trastornos depresivos y subsecuentes trastornos físicos y mentales. El acto de divulgar (platicar con un confidente) implica compartir pensamientos e ideas personales con otros y es un importante mecanismo por medio del cual los adultos y los niños forman relaciones cercanas y desarrollan una buena salud mental. Objetivos El objetivo de este estudio fue determinar la asociación entre el tipo de confidente y el trastorno depresivo e identificar algunos riesgos potenciales y factores protectores de depresión en una muestra de jóvenes mexicanos. Planteamos la hipótesis de que no contar con un confidente podría estar asociado con niveles más altos de sintomatología depresiva, asociación que podría ser distinta de acuerdo con el sexo. Métodos Se utilizaron los datos transversales recabados en 1079 jóvenes y adolescentes de 11 a 20 años, quienes fueron reclutados para participar en el Estudio Cohorte de Trabajadores (ECT) entre los años de 2004 a 2006. El ECT incluye niños y familiares de trabajadores del Instituto Mexicano del Seguro Social (IMSS) en Morelos y del Instituto Nacional de Salud Pública, ambos localizados en la ciudad de Cuernavaca. También se seleccionó una muestra similar de participantes de los trabajadores de la Universidad Autónoma del Estado de México (UAEM) en Toluca, capital del Estado de México. Los participantes de las tres sedes están en seguimiento en el estudio de cohorte prospectivo sobre salud y estilos de vida. Se administró un cuestionario autoaplicado para obtener información sobre datos sociodemográficos, estilos de vida, estado de salud y calidad de vida. Se realizaron análisis bivariados y multivariados para determinar la asociación entre el tipo de confidente y niveles de sintomatología depresiva controlando por factores sociodemográficos. Adicionalmente, se realizaron análisis estratificados bajo la hipótesis de que el efecto de divulgación a un confidente (platicar con un confidente) podría variar por sexo. Resultados En nuestra población de estudio, los hombres reportaron niveles significativamente más bajos de trastorno depresivo que las mujeres; la media de la puntuación del Inventario de Depresión de Beck (BDI) fue de 5.6 para hombres y de 8.7 para las mujeres. Entre ambos, tanto hombres como mujeres, contar sólo con amigos como confidentes se asocia con altos niveles de trastorno depresivo y contar con familiares como confidentes se asocia con menores niveles de depresión. Los hombres que cuentan con amigos como sus confidentes tienen los niveles más altos de sintomatología depresiva, seguidos por aquellos que cuentan con confidentes y de quienes cuentan como confidentes a amigos y familiares. Las mujeres que no tienen confidentes o que sólo cuentan con amigos como confidentes tienen niveles más altos de sintomatología depresiva que las que sólo cuentan con familiares como confidentes. Entre las mujeres, la sintomatología depresiva se incrementa con la edad; como lo señalan nuestros resultados las mujeres de 17 a 20 años presentaron los niveles más altos de sintomatología depresiva. En relación con otros factores asociados, encontramos que, tanto en hombres como en mujeres, el estrés financiero es un predictor de sintomatología depresiva. Conclusiones Nuestro estudio señala que contar con un miembro de la familia con quien platicar es un factor protector contra el trastorno depresivo en esta muestra de jóvenes mexicanos. Los adolescentes que cuentan con un familiar como confidente presentan niveles de sintomatología depresiva significativamente menores que aquellos que sólo cuentan con amigos o quienes no tienen confidentes. En la transición hacia la adultez, la presencia de un familiar como confidente influye positivamente en el bienestar emocional de niñas y niños. Las intervenciones que toman en cuenta las diferentes necesidades de divulgación de los adolescentes (de contar con un confidente) podrían ayudar a reducir o prevenir la sintomatología depresiva en esta población.

Reference values for areal bone mineral density among a healthy Mexican population / Valores de referencia para la densidad mineral ósea expresada en área para una población mexicana sana

OBJECTIVE: Compare the influence of ethnicity in the prevalence of osteopenia and osteoporosis in various Mexican populations using two normal dual X-ray absorptiometry (DXA) reference databases: manufacturer's incorporating US Hispanic population and a normal mestizo Mexican population. MATERIAL AND METHODS: MMP included 9 946 subjects participating in an ongoing long-term cohort study focusing on lifestyle and chronic diseases, of which 6 487 MMP males and females aged 7 to 80 years were the normal subjects used to determine bone density T- and Z-scores, following WHO criteria, and peak bone mass values. Abnormal bone mass density values estimated by the manufacturer's and peak bone mass reference values were compared. RESULTS AND CONCLUSIONS: Our results show that by using the manufacturer's T-score values in the mestizo Mexican population we are underestimating the number of abnormal bone mass BMD populations.

OBJETIVO: Comparar la influencia de la etnicidad en la prevalencia de osteopenia y osteoporosis en varias poblaciones mexicanas utilizando dos bases de referencia normal de densitometría de rayos X (DXA): referencia del fabricante que incorpora hispanos en Estados Unidos y datos de una población mestiza mexicana. MATERIAL Y MÉTODOS: Un total de 9 946 sujetos de población mestiza mexicana participantes en una cohorte de largo plazo dirigida al estudio de estilos de vida y ocurrencia de enfermedades crónicas; de los cuales 6 487 sujetos sanos de ambos sexos, con edad entre los 7 y los 80 años, fueron utilizados para determinar los valores T, Z, de acuerdo a los criterios de la OMS, así como a los valores de masa ósea pico. Se compararon los casos de densidad mineral ósea anormal de acuerdo a los valores de referencia del fabricante y los valores de masa ósea pico de la población mestiza. RESULTADOS Y CONCLUSIÓN: Las bases de referencia del fabricante subestima significativamente el número de casos con densidad mineral ósea anormal en la población mestiza mexicana.

Atresia pulmonar con tabique interventricular íntegro: presentación del caso de una paciente de siete años de edad / Pulmonary atresia with intact ventricular septum: presentation of the case of a seven year old patient

Se presenta el caso de un paciente femenino de siete años, quien fue atendido por primera vez en el Instituto Nacional de Pediatría a los 13 meses de edad por meningoencefalitis bacteriana. Se halló que tenía una cardiopatía congénita. Se efectuó cateterismo cardiaco y se encontro artresia pulmonar con tabique interventricular a la neuroinfección, por ello no se consideró conveniente realizar una intervención quirúrgica. Vivó hasta los siete, cuando en forma accidental falaleció por broncoaspiración