Medications obtained in Mexico by patients in southern New Mexico

Many health care providers practicing near the border between the United States and Mexico have serious concerns about their patients' using medications obtained in Mexico. Despite these concerns, the extent of this problem is not known. A survey administered in a publicly funded rural clinic and an urban private practice in southern New Mexico assessed this problem. The survey revealed that 87% of the rural clinic patients and 6% of the urban private practice patients had purchased medications in Mexico within the past two months. Further, 91% of the clinic patients and 56% of the private practice patients stated that they had, at some time, used medications from Mexico. Although many of these medications are fairly innocuous, their easy accessibility and lack of regulation can lead to serious health hazards.     

Terrorism in Mexico

Even though Mexico is considered internationally as a pacifist country, its economic, social, and geopolitical characteristics during the last half of the 20th century have resulted in internal events that can be considered acts of terrorism. Most of the acts of terrorism during the last 15 years have had to do either with political movements or drug-dealing actions. After the 11 September 2001 attacks in the United States, Mexican Health Authorities have strengthened the epidemiological surveillance system. More than 1,372 calls asking for information or reporting suspicious envelopes were received between 16 October and 21 October 2001. Following the earthquake in 1985 that caused great damage and many deaths in Mexico, the National Civil Protection System was created in 1986. This protection system is led by the President and the Secretary of Government. It was developed to improve preparedness for disaster coordination more than for terrorism responses. In addition, the emergency medical systems continue to lack organization, even though some states have shown significant progress in their emergency medical system.     

Diabetes mellitus in Mexico

Diabetes in Mexico is a public health problem with considerable medical, social, and economic consequences. Although detailed data on the prevalence of diabetes and its complications are not available, health services utilization data of the Social Security organization (Instituto Mexicano del Seguro Social) indicate increasing use of primary and tertiary care for diabetes over a recent 10-yr period. A health interview survey conducted in 1988 indicated that, in different areas, from 3.5 to 12.7% of people aged greater than or equal to 65 yr are believed to have diabetes, and that rates are higher in many of the states bordering the United States. Diabetes ranks among the leading 10 causes of death throughout the country. Although the ranking varies from state to state and the diagnosis may not appear on the death certificate when death results from a complication of the disease, in 1983 diabetes was the leading cause of death in Mexico and the first or second leading cause in many of the states bordering the U.S. Gestational diabetes contributes to perinatal mortality, and in view of the high birth rates, represents an important facet of the disease in Mexico. The impact of specific complications of diabetes on morbidity and mortality in Mexico are not well delineated. The relative frequency and impact of insulin-dependent and non-insulin-dependent diabetes in Mexico are not known.     

Palliative sedation: Clinical practice challenges in Mexico and development of a national protocol for Mexico

Abstract

Background

Palliative sedation (PS) involves the administration of sedative medications and analgesics with the purpose of reducing level of consciousness for patients with refractory suffering in the setting of imminent dying and terminal illness. Although the merits of PS, as well as potential concerns, have been raised frequently in the literature in the past two decades, the clinical utilization and acceptance of PS (and of palliative care in general) have been sparse in Mexico.

Discussion

As a relatively new treatment option for medical care providers in Mexico, palliative care and the appropriate use of PS are being slowly and cautiously introduced into clinical practice. However, acceptance of the ethical, moral, and legal permissibility of PS remains variable, as is the understanding of appropriate use or integration of palliative care into clinical practice in Mexico.

Summary

Given changes to Mexican law that have called for provision of adequate palliative care for all patients in Mexico, and advance care planning laws that allow patients to refuse medical treatments that are not consistent with their goals of care, this paper seeks to frame commonly articulated positions regarding PS, explores these challenges in Mexico, and suggests putative guidelines for safe and appropriate implementation of PS. At the urging the Ministry of Health in Mexico, we present a cogent, evidence-based, and internationally vetted protocol outlining the indications for PS and suggested clinical practice guidelines for safe and effective implementation of PS in Mexico for appropriate patients.     

Health precautions for travelers to Mexico

After Canada, Mexico is the most popular destination for Americans traveling outside the United States. As a developing country, Mexico presents numerous health hazards to American visitors, including the prevalent travelers' diarrhea (turista), from which 40% will suffer, and the less common typhoid, dengue, rabies, malaria, taeniasis, cysticercosis, and trichinosis. Environmental hazards, including sun, heat, high altitude, motion sickness, and accidents, also threaten the unwary traveler. In the event of illness or injury, Americans may find medical facilities unfamiliar and less well equipped than those in the United States. Utilizing both an individualized risk assessment for each traveler and readily available references, physicians, in partnership with local public health agencies, can develop comprehensive preventive health plans for their patients traveling to Mexico.     

Tuberculosis and diabetes in southern Mexico

OBJECTIVE: To determine the impact of diabetes on the rates of tuberculosis in a region where both diseases are prevalent. RESEARCH DESIGN AND METHODS: Data from a population-based cohort of patients with pulmonary tuberculosis undergoing clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing, and IS6110-based genotyping and spoligotyping) were linked to the 2000 National Health Survey (ENSA2000), a national probabilistic, polystage, stratified, cluster household survey of the civilian, noninstitutionalized population of Mexico. RESULTS: From March 1995 to March 2003, 581 patients with Mycobacterium tuberculosis culture and fingerprint were diagnosed, 29.6% of whom had been diagnosed previously with diabetes by a physician. According to the ENSA2000, the estimated prevalence of diabetes in the study area was 5.3% (95% CI 4.1-6.5). The estimated rates of tuberculosis for the study area were greater for patients with diabetes than for nondiabetic individuals (209.5 vs. 30.7 per 100000 person-years, P < 0.0001). CONCLUSIONS: In this setting, the rate of tuberculosis was increased 6.8-fold (95% CI 5.7-8.2, P < 0.0001) in patients with diabetes due to increases in both reactivated and recently transmitted infection. Comorbidity with diabetes may increase tuberculosis rates as much as coinfection with human immunodeficiency virus (HIV), with important implications for the allocation of health care resources.