[Burden of disease in the aged, Mexico, 1994]. / El peso de la enfermedad en adultos mayores, México 1994.

OBJECTIVE: To estimate the disability adjusted life years lost (DALYs) in population over 60 years of age in Mexico during 1994. MATERIAL AND METHODS: Years of life lost due to premature mortality (YLL) and years lived with disability (YLD) were estimated for 108 diseases, both sexes, and 32 states of the Mexican Republic divided in rural and urban areas in the population over 60 years of age, using the methodology originally proposed by Murray and López adapted to specific local characteristics. The inputs used were: mortality statistics for 1994 (after corrections of under-registration and misclassification), statistics on incidence and prevalence from local epidemiological studies, national health surveys and estimates by the authors. RESULTS: During 1994 the Mexican population over 60 years of age lost 1.8 million DALYs, 59% of which were YLL while 41% were YLD. Most of the burden of disease is due to noncommunicable diseases. The principal health needs of the elderly in Mexico can be divided in two groups: a) those that traditionally are frequent in this age group, such as ischaemic heart disease, diabetes, stroke and b) disabling diseases such as dementia, falls and arthritis as the most important. CONCLUSIONS: The use of composite indicators such as DALYs to assess health needs in older adult can help decision-makers and planners to incorporate disabling and lethal diseases within the list of priority needs, thereby achieving greater equity in the assignment of resources to different health care, prevention and rehabilitation programs.

[The supply of physicians in Mexico: excess and shortage]. / La oferta de médicos en México: exceso y escasez.

The purpose of this paper is to find out whether a decrease in the number of medical undergraduates doing their social service has any influence on the quantity of medical services provided by health care institutions in Mexico. Spearman's Rank Test was used to correlate the number of medical undergraduates and the number of services. Data for analysis were taken from the statistical information bulletins of the Ministry of Health for the decade of the 1980's. The analysis found that there is a significant correlation between the number of medical undergraduate and the number of primary health care services provided, and that this correlation disappears in the cases of secondary and tertiary health care services. The results underscore the importance of reconsidering the adequate number of physicians required to satisfy the health care needs of the Mexican population.

[The use of the basic drug chart at the first level of care]. / Uso del cuadro básico de medicamentos en el primer nivel de atención.

This study presents the analysis of the prescriptions given 2,782 clinical encounters. These clinical encounters were directly observed and recorded by trained observers in 164 health centers of the Federal District and nine states of the Mexican Republic. It was found that 70.9 per cent of the patients received a drug prescription. Sixty per cent of the compounds prescribed did not belong to the basic list of drugs. An strong influence of advertising by medical agents was detected in the use of some poly-drugs. Some specific needs for training and continued education of the physicians in the first level of care.

[Policies for training and employment of physicians in Mexico 1917-1988]. / Políticas de formación y empleo de médicos en México 1917-1988.

In this article we analyze education and employment policies for medical doctors in Mexico, which have led to a situation characterized by unemployment, under-employment and multiple-employment in urban areas, as well as lack of services in several rural zones. The analysis is divided into four defined periods according to the modes of State participation in health care: 1917-1958 (creation and slow growth of health care institutions); 1959-1967 (growth of scientific medicine); 1968-1979 (crisis period); and 1980-1988 (reform). In each one of these periods the evolution of medical manpower is analysed through the actions of three main actors: the State, the universities and the medical profession. The general conclusion of this historical analysis is that the present imbalance in the medical labor market has derived from a lack of joint planning of supply and demand, where by the educational and health care institutions, could decide together the crucial aspects of the quantity and quality of doctors that the population requires.

[The quality of prescriptive behavior in primary care]. / La calidad de la conducta prescriptiva en atención primaria.

Quality of care was analyzed in 2,782 clinical appointments, focusing on the evaluation of the six basic steps of medical consultation: a) questionnaire, b) physical examination, c) diagnosis, d) prescription, e) information, and f) appointment management. Serious deficiencies were found, with variations depending on the motive of the visit, the type of unit in which the service was given, etc. In order to improve the quality of care a structural change is suggested, both in the health care services and in medical education.

[Advances in public health investigation. 5 years' work of the Center for Research in Public Health, 1984-1989]. / Avances en la investigación en salud pública. Cinco años de labores del Centro de Investigaciones en Salud Pública, 1984-1989.

Five years after the creation of the Center for Public Health Research (SPHR), this essay reviews its origins and evolution and points to the challenges it will face in the future. The seven basic organizational principles underlying the academic development of the Center are described. In the quantitative aspect, the institution's growth is reflected in the rapidly increasing trend in the number of researchers, projects and scientific publications, as well as in the volume of the external financial resources received. In the qualitative aspect, the article highlights the ever growing number of themes approached by the seven lines of research, the elaboration of conceptual models, the creation of data bases and the methodological development. Among the most important challenges of the CPHR in the future are: (1) solving existing organizational problems; (2) building links with the decision makers and (3) establishing an equilibrium between relevance and excellence in public health research.