Approach to verify the status of measles, rubella, and congenital rubella syndrome elimination in Costa Rica.

Costa Rica introduced the measles-mumps-rubella (MMR) vaccine in 1986. The Ministry of Health adopted the goal of eliminating endemic measles in 1991 by achieving and maintaining high vaccine coverage through routine delivery, mass campaigns and outreach activities, and the strengthening of expanded program on immunization (EPI) surveillance. Measles and rubella immunization strategies shifted susceptibility to older age groups, leading to the introduction of MMR2 in 1992, administered at age 7 years. In 2000, the goal of accelerated rubella control and congenital rubella syndrome prevention was established, and a nationwide vaccination campaign targeting men and women aged 15-39 was implemented to immunize the population of reproductive age. The last endemic case of measles was confirmed in 1999, and at the end of 2001 Costa Rica reported the last endemic cases of rubella and congenital rubella syndrome. Imported cases of measles and rubella were detected in 2003 and 2005, with no secondary cases detected. In 2008, Costa Rica established a National Committee of Experts, supported by technical teams, to collect the evidence required to verify the interruption of endemic transmission of the measles and rubella viruses. The evidence includes information on trends and epidemiologic analysis, molecular epidemiology, population immunity, the quality of surveillance, and the sustainability of the EPI program.

[Evaluation of a physical exercise and nutritional guidance program given to workers at a health institute]. / Evaluación de un programa de ejercicio fisico y orientación nutricional aplicado a empleados de una institución de salud en México.

OBJECTIVE: To report on the results of the first stage of the Pause for Your Health program, designed to promote physical exercise during the work journey day in addition to an eating plan to contribute to the employees' general well-being. MATERIAL AND METHODS: The participants were 36 employees of a national institute on health working at a research area. The indicators assessed before and after the program were: sedentary lifestyle, cardiovascular adaptation to exercise test, anthropometric measures, serico-lipoglycemic profile, blood pressure, perception of lifestyle and general well-being and finally opinion about program. RESULTS: Data showed significant changes in five anthropometric indicators, the most significant was waist circumference. As to clinical assessment, the most prominent change was observed in glucose level. The results also showed that people who were overweight at the start of the program at the end of it lost weight, which was statistically significant. CONCLUSIONS: Participants showed attitude of great involvement regarding physical activity and increased awareness of the best way to eat. One of the immediate benefits of using this program was that it allowed identifying risk factors among the employees and increased motivation to participate and to take specific measures regarding their health care.

Estimating the burden of congenital rubella syndrome in Costa Rica, 1996-2001.

BACKGROUND: The epidemiology of rubella in Costa Rica changed during recent decades, shifting the susceptible groups to the reproductive age. This study estimates the burden of congenital rubella syndrome (CRS) from 1996 to 2001 in this country. METHODS: Three methods to calculate CRS incidence were used. A retrospective search ("Observed cases") was conducted using hospital discharge records of children born from 1996 to 2001 with selected codes of ICD9 and ICD10 consistent with CRS and children <3 months of age with a positive serologic test for rubella IgM antibody at the National Children's Hospital (NCH). Cases were classified as either suspected, compatible or confirmed CRS and congenital rubella infection. "Expected" incidence of CRS was calculated using reported cases of rubella (women 15-45 years of age) and fertility rates, assuming CRS probability of 0.9 during the first trimester of pregnancy and 0.5 of asymptomatic rubella cases. "Estimated" CRS cases were calculated using incidence rates reported from modeling analysis during epidemic and endemic years. RESULTS: Of the 577 discharge charts reviewed and the 66 children reported as rubella IgM(+), 40 compatible CRS cases, 45 confirmed, and 4 with congenital rubella infection cases were identified. The range of annual incidence rate of CRS (per 1000 live births) was as follows: "Observed" = 0.00-0.33, "Expected" = 0.00-0.35 and "Estimated" = 0.5-1.5. Compared with the estimated number of CRS cases, only 27.2% of CRS cases were detected from the retrospective search and 10.1% would be expected when calculated using rubella reported cases. CONCLUSIONS: The under-detection of CRS cases using rubella reported cases in women of reproductive age and retrospective search of CRS reinforces the importance of suspecting CRS in the presence of a single compatible manifestation. Laboratory confirmation is indispensable to implement CRS elimination strategies and should be done in every suspected case.

Uso de drogas en la Ciudad de México: Sistema de Reporte de Información en Drogas (Srid)

Resumen: Introducción. El Sistema de Reporte de Información en Drogas (SRID) proporciona un panorama diagnóstico de los cambios ocurridos en el consumo de drogas en la Ciudad de México. Se actualiza dos veces al año (junio y noviembre), y sus resultados dan una estimación de la trayectoria del problema desde una perspectiva de salud. El SRID inició su funcionamiento en 1986 y sus resultados sirven además de fundamento para diseñar programas de prevención adecuados a la población mexicana. Objetivo. Presentar una síntesis de los resultados más relevantes del consumo de sustancias en la Ciudad de México recopilados por el SRID entre 1987 y 2005, en instituciones de salud y de justicia. Quienes se benefician de la información que se obtiene son: - Las autoridades a cargo de diseñar políticas y acciones de intervención en virtud de que el SRID funciona como un sistema de monitoreo permanente, así como de alerta temprana. - Los investigadores, dado que el SRID funciona como ventana para identificar las áreas donde es necesario mayor conocimiento desde una perspectiva de salud. - El público en general, para quien el SRID es una herramienta que describe la evolución y el estado actual de las tendencias de la farmacodependencia. Método. La información se obtiene de una cédula individual sobre consumo de drogas, que se aplica dos veces por año en 44 instituciones del sector salud y procuración de justicia. El diseño de la muestra es no probabilístico de tipo intencional. Resultados. La información analizada corresponde a 19350 casos identificados entre 1987 y 2005. Lo más destacado de las tendencias de consumo de sustancias ha sido el notable incremento de la cocaína durante el periodo evaluado. Igualmente significativa ha sido la tendencia a la baja del consumo de inhalables, que se hizo más evidente a partir de 1999. El consumo de mariguana, una de las tres drogas consumidas con más frecuencia en el país, ha mostrado cierta estabilidad al igual que el resto de las sustancias evaluadas. Conclusiones. El mayor número de usuarios de cocaína son adolescentes. Asimismo, respecto a los patrones de consumo, llama la atención que el perfil del usuario para todas las drogas estudiadas sea alto: 20 o más veces por mes, en 45% de los casos. Ambas situaciones son objeto de preocupación por los efectos físicos y emocionales de las sustancias, y porque no se observan indicadores que sugieran un decremento en el consumo.

Summary: Introduction. The Information Reporting System on Drugs (IRSD) provides diagnostic information about changes in drug use in Mexico City. This information is updated twice a year (June and November), and an estimation of the main trends of drug use is thus obtained. The IRSD was implemented in 1986, and its results offers grounds for the design of preventive programs suited for the Mexican population from a health perspective. Objetive. To present a synthesis of the most relevant results of substance use in México City compiled by the IRSD between 1987 and 2005. The following are the benefit from data obtained: - Authorities in charge of designing policies and intervention actions, by virtue of which the SRID works as a system of permanent monitoring and early warning. - Investigators, since the SRID works as a window to identify the areas where greater knowledge is necessary. From a health perspective, the public in general, for whom the SRID is a tool that describes the evolution and current state of drug tendencies. Method. The information is obtained from an individual schedule on drug use that is applied twice a year in 44 agencies of the health and law enforcement sector. The design of the sample is non probabilistic. Results. In the period 1987-2005, 19350 cases have been evaluated. The most outstanding trend in substance use has been the remarkable increase of cocaine from 1987 to 2005. Equally significant has been the decrease tendency of solvents-inhalants use, which has become more evident since 1999. Marihuana use is among the three most used drugs in the country. It shows a trend to remain stable as is the case for the other substances evaluted. Conclusions. Most cocaine users are adolescents. At the same time, 45% of the users of all the substances have a use pattern defined as "high": 20 or more times a month. Both situations are a matter of concern due to the important physical and psychological consequences of substance use. In addition, up to this moment, there is no indication suggesting that the level of use will decrease.

Uso de sustancias entre hombres y mujeres, semejanzas y diferencias. Resultados del sistema de reporte de información en drogas

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Abstract: Introduction and background Substance abuse in the world is reported higher among men than in women; nevertheless in different countries including mexico, use has increased among women during recent years. The distribution among male and female population is different according to each substance. Prevalence among both populations shows a preference for illegal drugs: mariguana, cocaine, solvent-inhalants and in a lesser degree, heroine. Meanwhile among women the mainly used substances are medical, such as sedatives and stimulants. Nevertheless in recent years there has been a higher involvement of female population in the use of illegal substances. In different countries it has been observed a high level of use among women and a trend of age of first use at earlier ages. In different countries research findings indicate a high level of use among young women that resembles the patterns of men; nevertheless among women who are older the levels of use are relatively low. At the same time there is more participation of women in delictive activities. The information reporting system on drugs (srid) of the national institute of psychiatry has evaluated the problem of drug use among men and women in the mexico city area from 1987 up to this date through a transversal study and carried out every 6 months. Results obtained, identify the most important trends of this problem and also describe its nature and evolution. Other different methodological approaches have been used to get a deeper understanding of the nature and extent of this problem. School population survey (ene) oriented to evaluate the prevalence during the autumn of 2003, among high school students, reveals that 9.6% of male students and 4.8% of females have ever used mariguana some time, 5.3% of males and 2.7% of females have ever used cocaine sometime. Women using tranquillisers constitute 5.3%, and solvent-inhalants 3.8%. The national survey on addictions (ena) carried out in 2002 among general population, reveals that substance abuse includes one woman out of every 4 men. According to this methodology 8.59% of men in general population and 2.11 of women have ever used some other drug, besides alcohol and tobacco. Mariguana (3.48%) and cocaine (1.23%) are the main used substances in the category ever used. Results of the system for epidemiological surveillance of addictions (sisvea) indicates that for year 2004 at national level 95.0% of males were in treatment due to mariguana and heroine use, followed by 93.0% of patients treated for cocaine. Female population used tranquillisers 13.8%, solvents - inhalants 7.6% and 7.0% cocaine. As it can be observed the above results support the existence of different patterns of substance use between men and women. Objective The objective of this communication is to analyze the results of the information reporting system on drugs considering similarities and differences between men and women regarding different variables associated to substance use such as sociodemographic profile, patterns of use, associated problems and trends of use. This information is a result for the second semester of 2004. Material and method Srid is a transversal study with two cross cut evaluations carried out twice a year. Information is gathered by means of a survey applied during an interview. Each evaluation gives a cross view of the problem in such moment of its history, and at present, information is available from 1987 to this date. The survey evaluates variables suggested by mexican research, experiences from other countries with information on systems for drugs already functioning, variables suggested by world health organization, and finally proposals obtained by discussion and agreement with experts of the participant health and justice agencies. The survey is applied during june and november each year and after the evaluation period, the information is compiled processed, analyzed and compiled in a report made by the national institute of psychiatry. This information is available for partici-pant agencies, state officers, and general public. Results The results from srid for november 2004 indicate that from 694 cases studied, 89% were males, 60% single and 64% of low socioeconomic level. Of the women surveyed 73.6% are single and 62.7% from low socio-economic level. The main age group for men is in the range of 30 and more years, for women it is between 15 to 19. Occupational status for men is employee and business (34.6%) and for women, student (34.7%). School level for men is high school completed (24.4%), for women it is 19.4% unfinished high school. Ever some time use of substances indicate that mariguana is employed by 70.7% males and 65.8% females. Cocaine among women and men is respectively 65% y 56.6%; solvent inhalants is 37.4% for men and 30.3% for women. Amphetamines and other stimulants report 6.6% for women and 5.5% for men; sedatives and tranquillisers reach 14.5% for women and 13.4% for men. Age of first use for men is 15 to 19 years and for women 12 to 14. Substance of first use for men is mariguana (45.3%), for women is solvent inhalants (45.0%), followed by cocaine: 19.0% for men and 10.0% for women. Problems preceding drug use regarding family are 15.9% for men, and 11.8% for women; nervous problems: 7.4% for men and 2.6% for women. Problems derived of drug use among women are those refer-ring to family interaction 57.9% and 49.4% for men; nervous problems: 30.3% and 26.5%; finally, psychological problems among women 39.5% and 23.5% each. Possible explanations for such results are the following: - Social devaluation towards women: women are subject to social pressures regarding child rising, household work, etc. This kind of work is seldom recognized and appreciated, and such situation could be a risk factor for substance use. The same is true for the pregnancy periods, because women are emotionally more vulnerable and as a result some substances are used as a tool to soothe personal, family and couple problems. - Social attitudes towards substance use are different for men and women. Substance use in the case of male population is regarded as an open, allowed and prestigious behaviour; never-theless for women it is hidden, prohibited and devaluatory. Thus for women substance use becomes a private behaviour, out of sight, denied; a sort of relief valve in face of the need to relax, feel pleasure and socialize. Substance use then becomes a "necessary" instrument to cope with tensions but at the same time excludes women of the social scene. - Among men and women the fantasy of solving everyday problems through the use of substances is frequent. This is a paradox since at the same time users perceive that problems become worse as a result of substance use. The clarification of such motivations is a matter for further research. Conclusions Further research is needed to explain the differences between patterns of substance use of men and women; this is so for motivation of onset and maintenance of substance use. Finally the information gathered by the srid has been a valuable tool as an early warning system on substance use, it is a diagnostic resource for decision and policy making as well as for intervention and treatment planning in mexico city.

Tendencias y uso de cocaína en adolescentes y jóvenes de la ciudad de México. Sistema de reporte de información en drogas

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Abstract: Introduction and antecedents The Information Reporting System on Drugs (IRSD) provides since 1986 an updated overview of the main trends and characteristics of drug use in Mexico City. It identifies the changes in patterns of use and provides information useful to estimate its future path. It is supported by the main health and justice agencies. Up to this date, it has carried out 34 evaluations and its data base includes 16377 cases. Research on illicit drug use among adolescents and young adults started in our country during the 1970's; in those days, the level of cocaine use was low. Nevertheless, its use has been increasing gradually. Up to this date, different research reports indicate that cocaine, marihuana and solvent-inhalants are the most used illicit substances, especially among adolescents and young adults. Based on a 2003 high school survey carried out in the Distrito Federal, the latest research results indicate that marihuana is the most used substance (7.2%), followed by solvent-inhalants (4.6%), tranquilizers (4.5%) and cocaine (4.0%). Results of the most recent household survey carried out in 2002 indicate that 215,634 adolescents, between 12 and 17 years old, have ever used drugs. Excluding alcohol and tobacco, the first ever used drug in this group is marihuana, followed by solvent-inhalants and cocaine. As it can be observed, these results highlight that cocaine use is an issue and a matter of concern due to its pharmacological characteristics, psychological and social implications, and also because it affects adolescents and young adults who conform the main population group of the country. Objective This paper presents results of the Information Reporting System on Drugs, which describe the trends of cocaine use for 1987 2003 among users between 15 and 24 years old in Mexico City. It also describes the results of the evaluation carried out by the IRSD in June 2003 which include the sociodemographic characteristics of users, pattern of use, associated problems and slang words used to refer to this substance, according to the reports of the evaluated cases. Material and method Instrument. The data collection instrument was the questionnaire "Informe Individual sobre Consumo de Drogas" (Individual Report on Drug Use). It gathers information about the sociodemo-graphic characteristics of users, the most used substances, their patterns of use, the new substances being used or the substances not being used anymore, the perception of the user about the problems associated to the drug use before and after the drug use life has started, among other variables. This instrument is applied through an interview to individuals attending the participating agencies during the admission procedure. Evaluations are carried out twice a year, during June and November. The cases are obtained from all the individuals attending the participating agencies during the evaluation periods, and who identify themselves as ever having used any substance without a prescription, and with the purpose of getting intoxicated; this is the case definition. Since the beginning of the IRSD, the instrument, case definition, data processing and analysis procedures have remain similar in order to make comparisons. Until June 2003, the IRSD carried out 34 evaluations and the data base includes 16377 cases. Results Cocaine use trends: From 1987 to 2003, 9,120 cocaine cases were identified in the level "ever used". They are between 15 and 24 years old and represent 55.6% of the total population of drug users identified during such period. The use of cocaine has been increasing in this group: in 1987 there were 3.1 cocaine users out of every 100 drug users in general; in 1992, this proportion increased to 9.0%. From this date, the level of use gradually increases, reaching 74.3% in November 1998; this is the highest level recorded. From this date up to 2003, cocaine use has maintained the highest level of use of all drugs, and its level of use has remained stable. Evaluation number 34, carried out in June 2003, studied 770 cases of drug users; 533 of them reported having ever used cocaine. From this group, 293 cases (55%) are between 15 and 24 years old. Sociodemographic characteristics: 89.7% of the cocaine users were male, 58.7% were between 15 and 19 years old and 41.3% were between 20 and 24; 81.7% were single, 61.9% belonged to the middle socioeconomic level; 45.3% completed high school. Occupational status includes both employed, 31.4%, and unemployed cases, 29.5%. Pattern of use: 64% of the cocaine users started this behavior between 15 and 19 years old. 39.4% of the cocaine users are "light" users. The most frequent type of user follows a pattern of use between 1 to 5 times a month. 20.8% are "heavy" users: they use cocaine more than 20 times a month. Most used drugs, besides alcohol and tobacco, were marihuana: 60.1%; solvent-inhalants: 39.9%; and sedative-tranquilizers: 15%. Gender differences: Men and women have similar preferences regarding substance use. Nevertheless, women have higher levels of use for almost all the substances studied. Associatedproblems: The users perceive problems associated to the onset of their drug use life, and also they perceive problems once this has started. Family problems are the most frequently reported ones, increasing in frequency after drug use behavior has settled. Excluding social problems, all the other problems also increase after the onset of the drug use life. Slang words: Names used in the subculture of cocaine use to designate this substance, reported in this evaluation were: "cocaine", "crack", "piedra", "cocaína piedra", "cocaína polvo", "blanca", "bote", "coca", and "inhalada". Conclusions As it has been indicated, IRSD provides twice a year an updated diagnosis of drug use in Mexico City. Results indicate that during the period 1987-2003 cocaine use has three moments. The first one goes until 1992 and is characterized by a low level of use, below marihuana and solvent-inhalants; from there till 1998, its level reached the highest peak: 74 cocaine users out of every 100 drug users in general, with marihuana and cocaine occupying the second and third places. From this date to 2003, cocaine has remained stable in the first place. The highest risk groups are adolescents and young adults, and this is true for the onset of use as well as for the chronic use. This substance is a matter of concern due to its emotional and physical effects, but also because there are no indicators suggesting that the level of use will decrease. The problem of cocaine use indicates the need of prevention programs starting during childhood and with a long-term vision. The goal should be to promote the development of social support networks to counteract the influence of drug use in general, as well as to promote healthy lifestyles non compatible with drugs.

Evolución del consumo de cocaína en México y su presencia entre las clases menores favorecidas / Evolution of cocaine use in Mexico among the less favoured social classes

El objetivo del presente trabajo es mostrar la evolución del consumo de cocaína, y conocer el uso de esta droga en los sectores menos favorecidos de la población de la ciudad de México. Se utrilizaron los datos recopilados por el Sistema de Reporte de Información de Drogas (SRID) a lo largo de 17 evaluaciones semestrales, correspondientes al período 1987-1995, en instituciones de atención a la salud y de procuración de justicia. Las instituciones que participan en el SRID captan principalmente a la población de nivel socioeconómico bajo y medio por ser instituciones de asistencia social. Debido a ello, el nivel socioeconómico alto se encuentra sub-representado en una muestra. La muestra total recopilada por el SRID durante este periodo fue de 5566 casos de usuarios de drogas. Los usuarios de cocaína son de particular interés para el presente estudio (N = 589). Se llevó a cabo un análisis para conocer las tendencias del consumo de cocaína a lo largo del periodo de estudio, y detectar los cambios ocurridos a lo largo del tiempo. Asimismo, se analizó la relación de la variable "nivel socioeconómico" con los patrones de consumo de drogas y las características sociodemográficas de estos usuarios comparados con el resto de la muestra. Los principales hallazgos, giran alrededor del aumento de casos registrados de esta droga a lo largo del periodo de estudio. La cocaína ocupa el cuarto lugar de consumo en todas las drogas investigadas. Sin embargo, como droga de inicio ocupa el segundo lugar en los nivel socioeconómicos medio alto, y el tercer lugar en el nivel socioeconómico bajo. Las características sociodemográficas de los usuarios de cocaína a lo largo de las 17 evaluaciones no mostraron diferencias. El análisis de estos mismos datos por nivel socioeconómico, señalan que los usuarios de cocaína a lo largo de las 17 evaluaciones no mostraron diferncias. El análisis de estos mismos datos por nivel socioeconómico medio y bajo. No obstante, hay que recordar que el nivel socioeconómico alto esta subrepresentado en esta muestra, por lo que es probable que hayan variaciones respecto a este indicador en otras poblaciones

Composición quimica y efectos de los thíneres: Ciudad de México / Chemical composition and effects of solvents: Mexico City

El presente trabajo describe la composición de los thíneres que son vendidos en tlapalería de la Ciudad de México así como los problemas y daños orgánicos asociados a su abuso. Se recopilaron muestras de thíneres que fueron analizadas por el Instituto Mexicano del Petróleo para determinar la composición química de cada muestra líquida y obtener una estimación de los ingredientes que permanecem en las muestras como resultado de la evaporación a temperatura ambiente de 20ºC. Se discuten los efectos que estos vapores pueden causar en los usuários