Fentanyl is used in Mexico's northern border: current challenges for drug health policies.

BACKGROUND AND AIMS: Results from a recent study among 750 heroin users in three Mexico's northern border cities revealed an increase in white powder availability (also known as China white) and preference for this product among heroin users, as well as a general perception of increased overdose cases among this population. Here, we questioned whether those findings reflect an increased presence of heroin laced with fentanyl, which is associated with greater risks of overdose but that, until now, has not been described in Mexico. DESIGN: We tested fentanyl using highly sensitive test strips in syringe plungers, metal cookers and drug wrappings associated with heroin use. SETTING: Three injection sites in Tijuana, Baja California, México. PARTICIPANTS: Eighty-nine heroin users who interchanged paraphernalia for new syringes. MEASUREMENTS: We tested 59 residues of 'pure' white powder. The rest were white powder with black tar (n = 5) or white powder with crystal meth (n = 9), black tar with crystal meth (n = 1), black tar only (n = 13) and crystal meth only (n = 2). FINDINGS: Users believed that they consumed either white powder heroin, white powder heroin with crystal meth, white powder with black tar heroin or black tar heroin only. Analyses revealed that 93% (n = 55) of the 'pure' white powder samples had fentanyl. All (n = 9) the white powder samples mixed with crystal meth and 40% (n = 2) of the white powder with black tar were also laced with fentanyl. CONCLUSIONS: In a sample of 89 heroin users in Mexico, most white powder heroin users were unknowingly exposed to fentanyl, with fentanyl detected in 93% of white powder samples.

[The National Medical Arbitration Commission: 20 years]. / La Comisión Nacional de Arbitraje Médico: 20 años.

Cuando la Secretaría de Salud todavía tenía el logotipo azul que decía SSA, corrían tiempos difíciles porque no había dinero y la idea de crear nuevas instituciones era recibida con reservas, no sólo por el Presidente Zedillo, siempre generoso y atento a las necesidades de salud de la población, sino también, como ya es costumbre, por el secretario de Hacienda, responsable de cuidar el erario público. Y es que la idea de hacer crecer el gasto corriente del gobierno se percibía, no sin razón, como un acto que podía infligir el riesgo de fomentar estructuras administrativas ineficaces y obesas. No ha sido el caso de la Comisión Nacional de Arbitraje Médico (CONAMED), pues sus aproximadamente 200 trabajadores siguen realizando una labor inmensa con una estructura ligera.

[The impact of globalization on mental health]. / Impactos de la globalización en la salud mental.

Psychosis, dementias, anxiety, depression, suicide and suicide attempts, as well as psychiatric disorders associated to violence and poverty have increased the global burden of disease. Other related problems associated to special diets, body image, compulsive use of computers and mobile phones, and those frequently observed in migrants subjected to intense distress are reviewed as well. Information and communication technologies may have undesirable side effects affecting some individuals in their conduct and social interactions.

Assessing the ecological risks from the persistence and spread of feral populations of insect-resistant transgenic maize.

One source of potential harm from the cultivation of transgenic crops is their dispersal, persistence and spread in non-agricultural land. Ecological damage may result from such spread if the abundance of valued species is reduced. The ability of a plant to spread in non-agricultural habitats is called its invasiveness potential. The risks posed by the invasiveness potential of transgenic crops are assessed by comparing in agronomic field trials the phenotypes of the crops with the phenotypes of genetically similar non-transgenic crops known to have low invasiveness potential. If the transgenic and non-transgenic crops are similar in traits believed to control invasiveness potential, it may be concluded that the transgenic crop has low invasiveness potential and poses negligible ecological risk via persistence and spread in non-agricultural habitats. If the phenotype of the transgenic crop is outside the range of the non-transgenic comparators for the traits controlling invasiveness potential, or if the comparative approach is regarded as inadequate for reasons of risk perception or risk communication, experiments that simulate the dispersal of the crop into non-agricultural habitats may be necessary. We describe such an experiment for several commercial insect-resistant transgenic maize events in conditions similar to those found in maize-growing regions of Mexico. As expected from comparative risk assessments, the transgenic maize was found to behave similarly to non-transgenic maize and to be non-invasive. The value of this experiment in assessing and communicating the negligible ecological risk posed by the low invasiveness potential of insect-resistant transgenic maize in Mexico is discussed.

[Local impact of health global problems. Introduction]. / Problemas globales de salud de impacto local. Introducción.

During the last 3 years the National Academy of Medicine, the School of Medicine and the Ministry of Health have analyzed several global health issues with local impact. The group of articles presented in this symposium is focused on the health systems. The Mexican health system has evolved through the years facing different challenges and showing its strengths as well as several inconsistencies, flaws and limitations. The subjects analyzed deal with several alternatives to face the health challenges. All health systems are under constant change and financial resources as well as conceptual clarity, human resources, coordination, and leadership are needed.

Supercritical CO2 extraction of oilseeds: review of kinetic and equilibrium models.

Mass transfer models on supercritical carbon dioxide (SC-CO2) extraction of vegetable oils are reviewed, that may facilitate the scale-up of laboratory data for industrial design purposes. Reviewed mechanisms of oil transport within the solid matrix include the desorption from the solid, the formation of a shrinking core of condensed oil in a non-adsorbing porous matrix, and diffusion in a homogenous medium. Analyzed simplificat ions of a general mass transfer model include external control of mass transfer rates, internal control of mass transfer rates, consideration of a linear driving force, and steady state approximations, among others. More complex two-stage models, and critical comparisons of some of the proposed models are also included. Trends for the external mass transfer coefficient and effective diffusivity in the solid matrix from studies on SC-CO2 extraction of oil from vegetable substrates are thoroughly discussed and contrasted with those obtained using simpler model systems. The possible effect of the axial dispersion on the rate of extraction is also discussed. Finally, the high-pressure vegetable oil-CO2 phase equilibrium is discussed in connection with its influence on the mass transfer process. Special emphasis is given to the role of the solid matrix on high-pressure phase equilibrium.

[The future of medical investigation in Mexico]. / El futuro de la investigación médica en México.

The current situation of clinical research in Mexico is analyzed. The main findings are as follows: 10% of total number of researchers in Mexico are engaged in medical research; there is a highly centralized distribution in the Mexico City metropolitan area; there exists unequal academic development among disciplines, and there is an overwhelming number of researchers in public educational and health institutions. A substantial increase in medical publications during the last 15 years with reasonable citation impact was also found. Several urgent matters to attend were identified, such as financing problems, effect of health services descentralization completed in 1997, and the need to selectively support certain research areas such as accidents, mental health, addictions, geriatrics and chronic diseases.

El futuro de la investigación médica en México / The Future of Medical Investigation in Mexico

Se hace un análisis del estado que guarda la investigación médica en México. Destacamos el desigual desarrollo científico de las disciplinas médicas, el centralismo que prevalece en el área metropolitana y la abrumadora mayoría de los investigadores en instituciones publicas del sector salud y del educativo. Se analiza el incremento en la producción científica, en los últimos 15 años y su impacto en la literatura internacional. Concluimos que contamos con una comunidad de investigación médica productiva, aunque todavía pequeña para el país. Se señalan cuestiones urgentes de atender como: el agudo problema del financiamiento, los efectos de la descentralización de los servicios de salud y la necesidad de apoyar, por su importancia epidemiológica, áreas como las de accidentes, salud mental, adicciones, geriatría y enfermedades crónico degenerativas.

The current situation of clinical research in México is analyzed. The main findings are as follows: 10% of total number of researchers in Mexico are engaged in medical research; there is a highly centralized distribution in the Mexico City metropolitan area; there exists unequal academic development among disciplines, and there is an over whelming number of researchers in public educational and health institutions. A substantial increase in medical publications during the last 15 years with reasonable citation impact was also found. Several urgent matters to attend were identified, such as financing problems, effect of health services descentralization completed in 1997, and the need to selectively support certain research areas such as accidents, mental health, addictions, geriatrics and chronic diseases.