Francisco Franco-Marina

La carga de la enfermedad en países de América Latina

OBJETIVO. Describir los estudios de carga de la enfermedad realizados en la region e identificar las principales prioridades en salud a partir del indicador anos de vida saludable perdidos (AVISA). MATERIAL Y METODOS: Mediante el uso de AVISA, identificar la carga de enfermedad en los distintos paises. RESULTADOS: Los AVISA destacan la emergencia de los trastornos mentales, la diabetes mellitus en las mujeres y los trastornos por consumo de alcohol y lesiones en los hombres. CONCLUSIONES: America Latina es la region con mas estudios nacionales de carga de la enfermedad realizados con una metodologia estandarizada, que permiten identificar problemas de salud que estan presionando a los servicios de atencion; por ello estos resultados constituyen un elemento a tomar en cuenta en el establecimiento de politicas publicas en cada pais.

Breast cancer mortality in mexico: an age-period-cohort analysis

OBJECTIVE To assess the age, period and cohort effects on breast cancer (BC) mortality in Mexico. MATERIAL AND METHODS Age, period and cohort curvature trends for BC mortality were estimated through the Poisson Regression model proposed by Holford. RESULTS Nationally, BC death rates have leveled off since 1995 in most age groups. BC mortality trends are mainly determined by birth cohort and age effects in Mexico. Women born between 1940 and 1955 show the highest rate of increase in BC mortality. Women born afterwards still show an increasing trend but at a much lower rate. Mammography and adjuvant therapy have had a limited impact on mortality. Potential reasons for observed patterns are discussed. An increase in BC mortality in Mexico is expected in the following decades. CONCLUSIONS Mammography screening programs and timely access to effective treatment should be a national priority to reverse the expected increasing BC mortality trend.

Factores de riesgo de cáncer cervicouterino invasor en mujeres mexicanas

OBJETIVOS: Evaluar la asociacion entre cancer cervicouterino (CaCu) invasor y el virus del papiloma humano de alto riesgo (VPH-AR) (carga viral/tipo 16), asi como con factores ginecologicos y socioeconomicos. MATERIAL Y METODOS: Estudio de casos y controles pareado individualmente (215 casos con CaCu invasor y 420 controles). La poblacion de estudio se recluto entre los anos 2000 y 2001. Se evaluaron variables tradicionalmente asociadas con CaCu (ginecologicas y socioeconomicas) y dos variables asociadas con la presencia de VPH (carga viral y el tipo 16). La presencia de VPH-AR se determino mediante Captura de Hibridos II. La carga viral se midio a traves de unidades relativas de luz y picogramos por ml (1 RLU=1 pg/ml), divididas en cuatro categorias: negativa ( 499 pg/ml). El analisis estimo razones de momios (RM) ajustadas a traves de modelos de regresion logistica condicionada. RESULTADOS: La presencia de VPH-AR incrementa en 78 veces la probabilidad de presentar CaCu invasor; cuando el VPH es tipo 16, el incremento es mayor (RM= 429.7) comparado con otros tipos (RM=64.1). Se observo una tendencia importante en la RM al elevarse la carga viral (RM=46.6 carga baja; RM=250.7 intermedia y RM=612.9 alta). Finalmente, los factores demograficos y obstetricos conocidos, incrementaron la probabilidad de CaCu invasor. No se observo asociacion entre CaCu invasor y tabaquismo en la poblacion de estudio. CONCLUSIONES: Este estudio contribuye a la identificacion de las mujeres con alto riesgo de desarrollar CaCu invasor, entre las pacientes infectadas con VPH-AR. Por otra parte, confirma la importancia de la infeccion de VPH-AR y refleja la carga viral del VPH-AR como cofactor y posible promotor en el desarrollo de la enfermedad. Por ultimo, este biomarcador puede contribuir a mejorar la prevencion y la deteccion temprana de esta enfermedad.

Panorama epidemiológico de la mortalidad por cáncer en el Instituto Mexicano del Seguro Social: 1991-1995

Objective. This paper describes the global cancer mortality and the specific mortality patterns for the main neoplasms among adult members of the Mexican Institute of Social Security (IMSS). Material and methods. Using official death certificates and information about the population of the IMSS members during 1991-1995, national and regional annual global cancer mortality as well as specific mortality rates for the 10 most important malignant neoplasms by sex were estimated among people older than 20 years of age. The trends for these neoplasms during the study period were estimated by means of Poisson regression. The rate differences in specific cancer mortality by region and sex, for the two major neoplasms, were calculated subtracting specific regional rates from the respective national rate in 1995. Results. The global mortality rate for cancer among men increased from 76.2 in 1991 to 94.8 x 100 000 IMSS´members in 1995; and among women from 85.6 to 105.8 x 100 000 IMSS´members, representing an increment of 24.4 and 24% men and women, respectively, during the study period. Among men, neoplasm of kidney, leukemia, pancreas, prostate and lung showed the major increment; among women, neoplasm of colon, breast, pancreas, leukemia and liver showed the most significant increment. Conclusions. In the IMSS it is necessary the integration of a population based cancer registry. The registry will play a main role in disease surveillance and control; will give basic information over incidence and temporal variation, and could be the main source of information for epidemiologic research, as well as planning and evaluation of the quality of medical attention services such as prevention and early diagnosis and treatment.

Lactancia materna y diarrea aguda en los primeros tres meses de vida

OBJETIVO: Evaluar el efecto de la lactancia materna exclusiva y sus interacciones con algunos factores socioeconomicos, en relacion con la incidencia de diarrea aguda durante los primeros tres meses de la vida. MATERIAL Y METODOS: En la ciudad de Durango, Mexico, en 1994 se llevo a cabo un estudio de cohorte con tres meses de seguimiento; la muestra estuvo compuesta por 327 parejas de madre y recien nacido, residentes de la ciudad de Durango, durante el periodo abril-junio de 1994. Para el analisis se utilizaron tecnicas descriptivas, analisis bivariados y modelos multivariados de regresion logistica con efectos aleatorios. RESULTADOS: Los ninos que no reciben lactancia exclusiva al seno materno tienen un riesgo significativamente elevado de padecer diarrea aguda desde el inicio de la vida (RMlactancia mixta= 3.23; IC 95% 1.84-5.68 y RMlactancia artificial=4.36; IC 95% 2.32-8.19). Ademas, el efecto protector de la lactancia al seno materno es independiente del que tienen factores de riesgo tales como la educacion materna deficiente, la falta de apoyo social y el hecho de que la madre sea adolescente. Sin embargo, en el caso especial del saneamiento ambiental encontramos evidencia de una posible modificacion del efecto respecto al tipo de lactancia (deltaG=9.26; p=0.09), que se traduce en una razon de momios para la carencia de agua y drenaje mayor que la suma de las RM para cada condicion por separado (RMno agua/no drenaje = 2.58; IC 95% 1.10-6.03, en el modelo multivariante final). CONCLUSIONES: Al igual que estudios previos encontramos que la lactancia exclusiva al seno materno tiene una gran importancia, a pesar de que en el entorno persistan condiciones adversas ligadas a la pobreza y al subdesarrollo socioeconomico. En especial, parece que la proteccion que confiere la lactancia al seno es todavia mayor cuando se carece de las condiciones basicas de saneamiento, lo cual, a su vez, se traduce en oportunidades de intervencion como el aseguramiento de la provision de agua potable para el recien nacido.

Adult smoking trends in Mexico: an analysis of the Mexican National Addiction Surveys

OBJECTIVE: To describe and explain the recent trends of four smoking indicators in Mexico. MATERIALS AND METHODS: Comparable data from four national probabilistic household surveys (1988-1992) were analyzed using statistical techniques for survey data. The analysis was restricted to persons aged 18 to 65 years. Changes in indicators compare 2002 to 1988. RESULTS: The overall prevalence of never smokers increased by 10% and increased more in men. The prevalence of daily smokers shows a 16% reduction in men and reductions are concentrated in persons 45 and older. The average number of cigarettes smoked daily shows a 31% decrease in men and no decrease in women. The prevalence of heavy smokers (one pack or more) is 60% higher in women in 2002. CONCLUSIONS: Mexico does not closely follow the WHO model for the evolving tobacco epidemic. Nevertheless, the tobacco epidemic is in an advanced stage, with a decreasing prevalence in men and a rising one in women and the young. The improvement in the smoking situation was mainly due to the country’s economic stagnation during the analyzed period and to public awareness of the dangers of tobacco exposure rather than to a sound control policy on the part of the state.

Avances en los Objetivos de Desarrollo del Milenio 4 y 5 en Mesoamérica

OBJETIVOS: Presentar los avances realizados en la region mesoamericana en relacion con los Objetivos de Desarrollo del Milenio 4 y 5 por medio de su analisis y discutir las intervenciones mas relevantes para ayudar en el logro de estos objetivos o, por lo menos, en mantener su trayectoria. MATERIAL Y METODOS: Se utilizaron como fuentes las estimaciones de 1990-2008 sobre mortalidad en menores de cinco anos y materna, las coberturas de vacunacion contra difteria, tetanos y tosferina (DTP), atencion prenatal y atencion del parto por personal calificado, realizadas por el Instituto de la Metrica y Evaluacion en Salud y las causas de mortalidad en menores de cinco anos, realizadas por el Grupo de Referencia sobre Epidemiologia y Salud en la Infancia de la OMS (CHERG). RESULTADOS: La tendencia de la tasa de mortalidad de menores de cinco anos (ODM-4) muestra una reduccion anual de 4.2% en los ultimos 18 anos, comparada con la reduccion global de 2.1%. En contraste, la tasa de descenso de la mortalidad materna (ODM-5) es muy heterogenea y ninguno de los paises de la region alcanzara este objetivo. CONCLUSION: Los esfuerzos realizados por los paises en Mesoamerica han sido sustantivos en la reduccion de mortalidad en menores de cinco anos; sin embargo no han sido suficientes para alcanzar la meta programada por el ODM-5. Aunque la tendencia es correcta, el ritmo de descenso cumplira parcialmente con los compromisos adquiridos para erradicar la pobreza.OBJECTIVES To describe the advances made by countries in the Mesoamerican region towards reaching Millenium Development Goals (MDG) 4 and 5, and discuss the most useful tasks to help the region in accomplishing or keeping track of these objectives. MATERIAL AND METHODS The trend estimates of maternal and under 5 mortality from 1990 to 2008, the effective coverage of vaccination against diphteria, pertussis and tetanus (DPT), prenatal care and childbirth by qualified personnel were taken from the Institute of Health Metrics and Evaluation (IHME) and the causes of death for children under five were taken from the Childrens Health Epidemiology Reference Group of WHO (CHERG). RESULTS The regional trend in the rate of mortality for children under five (MDG-4) in the last 18 years shows an annual reduction of 4.2%, significantly above the global reduction of 2.1%. This suggests that countries of Mesoamerica will be able to fulfill this objective. In contrast, data for 2008 shows that the rate of reduction of maternal mortality is very heterogeneous and it is unlikely that any of the countries in the region will reach this goal. CONCLUSION Efforts made by countries in Mesoamerica have been substantial in controlling mortality in children under five years but insufficient to achieve MDG-5. Although the tendency is in the right track the reduction rate will only partially fulfill the acquired commitments to eradicate poverty.

Prevalencia y riesgos asociados con pacientes adultos con asma de 40 años o más de la Ciudad de México: estudio de base poblacional

OBJECTIVES: To determine the prevalence of asthma and the association between sociodemographic characteristics, spirometry, respiratory symptoms, quality of life and sleep in adults > 40 years. MATERIALS AND METHODS: This report is part of our study (Latin American Research Project Obstructive Pulmonary), held in Mexico City and the metropolitan area in 2003. We used logistic regression models adjusted for study design, where asthma was the dependent and independent variable respiratory symptoms, sociodemographic and clinical characteristics among others. RESULTS: The prevalence of physician-diagnosed asthma was: 3.3% in men and 6.2% in women. Decreased lung function in asthmatics was observed. In multivariate analysis, after adjusting for potential confounders, asthmatics had a higher risk of excessive daytime sleepiness more snoring [OR = 3.2 (95% CI 1.4-7.4), p= 0.008], and more frequent work absences due to respiratory problems [OR = 5.1 (95% CI 2.5-10.4), p<0.0001]. CONCLUSIONS: The prevalence of asthma was 5%. Asthmatics showed lower quality of life and lung function.

Una estimación indirecta de las desigualdades actuales y futuras en la frecuencia de la enfermedad renal crónica terminal en México

OBJETIVO. Describir las desigualdades actuales y futuras de la enfermedad renal cronica terminal (ERCT) en Mexico, que se presentan entre grupos de entidades federativas con diferentes grados de marginacion. MATERIAL Y METODOS. Partiendo de una estimacion indirecta de la incidencia, prevalencia, mortalidad y duracion promedio que realizamos en 2009, presentamos datos agrupados de acuerdo con el grado de marginacion estatal. Medimos la desigualdad con el Indice de Concentracion de Salud. RESULTADOS. Encontramos desigualdades crecientes entre 2005 y 2025 en las tasas de incidencia, prevalencia y mortalidad, asi como en la duracion promedio de los casos. CONCLUSION. Para 2025 esperamos importantes incrementos en la prevalencia de la ERCT que afectaran en mayor medida a los estados mas marginados, lo que aumentara la inequidad presente en este problema de salud y representara importantes retos para el financiamiento de los servicios de salud, si no se incide sobre las causas y la progresion hacia la ERCT.

Arsenic metabolism and cancer risk: A meta-analysis

Objective: To describe the studies that have reported association measures between risk of cancer and the percentage distribution of urinary inorganic arsenic (iAs) metabolites by anatomical site, in non‐ecological epidemiological studies. Methods: Studies were identified in the PubMed database in the period from 1990 to 2015. Inclusion criteria were: non‐ecological epidemiological study, with histologically confirmed cancer cases, reporting the percentage distribution of inorganic arsenic (iAs), monomethylated (MMA) and dimethylated (DMA) metabolites, as well as association measures with confidence intervals (CI) between cancer and %iAs and/or %MMA and/or %DMA. A descriptive meta‐analysis was performed by the method of the inverse of the variance for the fixed effects model and the DerSimonian and Lairds method for the random effects model. Heterogeneity was tested using the Q statistic and stratifying for epidemiological design and total As in urine. The possibility of publication bias was assessed through Beggs test. Results: A total of 13 eligible studies were found, most of them were performed in Taiwan and focused on skin and bladder cancer. The positive association between %MMA and various types of cancer was consistent, in contrast to the negative relationship between %DMA and cancer that was inconsistent. The summary risk of bladder (OR=1.79; 95% CI: 1.42, 2.26, n=4 studies) and lung (OR=2.44; 95% CI: 1.57, 3.80, n=2 studies) cancer increased significantly with increasing %MMA, without statistical heterogeneity. In contrast, lung cancer risk was inversely related to %DMA (OR=0.58; 95% CI: 0.36, 0.93, n=2 studies), also without significant heterogeneity. These results were similar after stratifying by epidemiological design and total As in urine. No evidence of publication bias was found. Conclusion: These findings provide additional support that methylation needs to be taken into account when assessing the potential iAs carcinogenicity risk. HighlightsIncreasing %MMA significantly increased bladder and lung cancer risk.Increasing %DMA significantly decreased lung cancer risk.%iAs was not related to cancer risk.Methylation needs to be taken into account when assessing the potential iAs carcinogenicity risk.