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Introduction: Sexual material online has represented, from its origins, an important role in the life of men who have sex with men. Internet, which has become a vehicle without restriction for its access, has favored an increase in the use of this material, and has had an impact on the sexual behavior of these men., Objective: To determine if the use of online sexual material influences safe sexual behavior in men who have sex with men., Material and Method: An analytical observational study was conducted, with a sample of 251 men who have sex with men from a city in northeastern Mexico. The respondent driven sampling was used, an ad hoc sociodemographic and sexuality data questionnaire was applied, and a questionnaire to measure the use of online sexual material and questionnaire on safe sexual behavior., Results: The simple linear regression model shows that the use of online sexual material negatively influences safe sexual behavior (R 2 =0.062; F [1,249] =16.937; p<0.01)., Conclusions: The findings provide the guideline to continue with studies in the investigation of said sociocultural variable and its consideration is proposed in the programs focused on the prevention of HIV in this population., (Copyright © 2018 Asociación Española de Andrología, Medicina Sexual y Reproductiva. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Sexual self-esteem has generated results that make clear their impact on sexual health, which is forged by interactions with other people. For this reason, the goal of this study is to evaluate if the variables time spent with the partner, number of sexual partners, support of the couple, sexual assertiveness and partner violence predict sexual self-esteem in women in Northeast Mexico., Material and Method: Predictive and correlational study. The sample consisted of 605 women users of primary health care centers. As inclusion criteria, it was considered that participants were between 18 and 40 years of age (M=27.68; TD=6.52), who maintained a relationship of at least three months and with sexual activity within that relationship., Results: Couple support, partner violence and sexual assertiveness behaved as predictive factors, accounting for 32% of sexual self-esteem in women (F=52.410, p<0.001)., Conclusions: Interpersonal factors are key elements in the understanding and evaluation of sexual self-esteem in women. These findings will support the improvement of the sexual health of this population, who are a vulnerable group to sexual problems in Mexico., (Copyright © 2018 Asociación Española de Andrología, Medicina Sexual y Reproductiva. Publicado por Elsevier España, S.L.U. All rights reserved.)

The perceived risk to HIV and the decisional balance (pros and cons) towards HIV testing are fundamental aspects for understanding the motivation of men who have sex with men to engage in behaviours that reduce or increase the risk of infection with the virus., Objectives: To describe the perceived risk of HIV and the decisional balance towards HIV testing and determine the association between perceived risk and the decisional balance towards HIV testing of men who have sex with men., Method: Descriptive correlational design, we used respondent-driven sampling, with which we recruited 202 men who have sex with men., Results: Mean age of 27.79 (SD=8.13), 66.3% reported low perceived risk to HIV. The most significant pros were: "If I had HIV I would not want to infect anyone else" (95%) and "I would like to be sure I did not have HIV to tell my sexual partner" (90.6%). The most significant cons were: "I am afraid of the needle used for the HIV test" (53%), "people could reject me if they had HIV" (78.7%). Finally, there was a correlation between the perceived risk and the decisional balance towards HIV testing (r s =.759, p<.001)., Conclusions: Given such data, in future interventions it is important to consider information about the importance of HIV testing on a regular basis, as well as actions to increase the perception of vulnerability to HIV in this population., (Copyright © 2018 Elsevier España, S.L.U. All rights reserved.)

Purpose: To test the effects of a physical-cognitive exercise intervention on gait parameters under dual-task conditions in community-dwelling older adults., Design: A repeated-measures quasi-experimental design, with control and exercise groups, was used., Setting: Study participants consist of a convenience sample recruited from senior citizens' centers in Monterrey, Mexico., Subjects: A total of 143 sedentary participants ages 65 to 92 years per group participated., Intervention: A combined 45- to 60-minute program of physical and cognitive exercises was conducted in three weekly sessions during 12 weeks for the exercise group. Measures . The spatial gait parameters of speed (cm/s), step width, and stride length (cm); and the temporal parameters of single and double support time, cadence (steps per minute), and swing time(s) were measured using the GaitRite. Counting backwards or naming animals represented cognitive performance., Analysis: Two (groups: exercise group vs. control group) by three (time: baseline, week 6, and week 12) repeated-measures multivariate analysis of variance (MANOVA) was applied., Results: Repeated-measures multivariate analysis of variance revealed a significant group effect (Wilks lambda F4,279 = 6.78, p < .001); univariate analysis showed significant differences for gait speed (m/s), stride length, cadence, step width, and double support time. Time-by-group interaction showed significance in gait speed and stride length., Conclusion: The exercise group participants showed increased gait speed, cadence, and stride length, and reduced their step width and time spent with both feet on the ground. Walking while simultaneously performing a cognitive task might prepare older adults for competing/interfering demands from their environments. The protective health benefits of this intervention remain to be investigated.

Background: The goal of a nutrition and food surveillance system is to examine the nutritional effect of food policies and nutritional programs and predict future trends., Purpose: To assess nutritional status of infants after implementing a nutritional and food surveillance system (SISVAN) in day care centers., Material and Methods: Study population consisted of 988 children between 45 days and 60 months of age registered in the SISVAN from april 2006 to May 2007; users of 18 day care centers located in 11 counties of the state of Nuevo Leon. Analysis consisted of descriptive statistics and paired t tests for comparison of Z Score (ZS) means of nutritional indicators such as weight for height (W/H), height for age (H/A) and weight for age (W/A), between 2006 and 2007. Malnutrition prevalence rates were also estimated for both years., Results: Fifty-two percent of infants were male. In 2006, W/I H ZS mean was -0.32 +/- 0.99 and in 2007, 0.01 +/- 0.83 (p < 0.05); H/A was -0.05 +/- 0.98 and 0.46 +/- 0.89 in 2006 and 2007, respectively (p < 0.05); and W/A was -0.37 +/- 0.94 and 0.17 +/- 0.91, respectively (p < 0.05). In 2006, undernourishment prevalence varied from 14.5 to 17.8% depending of the anthropometric indicator; and in 2007, from 10.0 to 11.6%. In 2006, overweight and obesity prevalence was between 8.8 and 14.3%, also depending of the anthropometric indicator, while in 2007 between 9.7 and 10.7%., Conclusions: The present study showed a positive result in malnutrition rates after one year of SISVAN implementation in children in day care centers.

Background: A better metabolic control is an important objective of health care in diabetes mellitus. This objective has been achieved elsewhere, incorporating group visits to the usual care of diabetic patients., Aim: To evaluate the effects of a primary care group visit model after 9 and 15 months of implementation, on the metabolic control of diabetic patients., Material and Methods: Two cohorts of type 2 diabetic patients, matched by sex, age and fasting plasma glucose (FPG) were studied. Group visits (monthly medical consultation and one hour sessions with group interaction on the same day) were implemented in 600 patients and routine visits (monthly one-to-one medical consultation) were implemented in 601 patients. The evolution on FPG, cholesterol, systolic (SBP) and diastolic blood pressure (DBF) and body mass index (BMI) were compared., Results: At 15 months of follow up, mean FPG was lower in patients with group visits compared to those in usual individual care (155.3 +/- 59.5 and 175.7 +/- 67.7 mg/dL respectively, p <0.01). SBP and DBF were also lower in patients on group visits (123.6 +/- 13.4 and 127.5 +/-12.8 mmHg, respectively for systolic pressure, p <0.01 and 73.5 +/-8.5 and 79.4 +/-6.3 mmHg, respectively for diastolic pressure, p <0.01). No differences between groups were observed for blood cholesterol or BMI., Conclusions: Incorporation of group visits in type 2 diabetic patients improved metabolic control and blood pressure, compared to the usual individual care model.

Objective: To quantify the technical efficiency of diabetes care in family practice settings, characterize the provision of services and health results, and recognize potential sources of variation., Material and Methods: We used data envelopment analysis with inputs and outputs for diabetes care from 47 family units within a social security agency in Nuevo Leon. Tobit regression models were also used., Results: Seven units were technically efficient in providing services and nine in achieving health goals. Only two achieved both outcomes. The metropolitan location and the total number of consultations favored efficiency in the provision of services regardless of patient attributes; and the age of the doctor, the efficiency of health results., Conclusions: Performance varied within and among family units; some were efficient at providing services while others at accomplishing health goals. Sources of variation also differed. It is necessary to include both outputs in the study of efficiency of diabetes care in family practice settings.

Background: The accessibility to health centers is a limitation to the use of preventive and curative health centers., Aim: To assess geographic accessibility using a parameter that integrates information about the use of preventive services and travelling time from home to the health center., Material and Methods: We analyzed target geographical areas of 10 community centers located at the Northeast of Mexico. A survey was conducted to collect information about the utilization of preventive services for detection of diabetes and hypertension within last year and in women, detection of cervical and breast cancer. The time required to travel between the health center and the farthest location point at every neighborhood of each geographic area, using public or private transportation, was calculated. Health service use and transportation time were condensed in a single parameter, called geographic accessibility index. Data was normalized using z scores., Result: Three geographical areas denominated 7, 8 and 10 had the lowest detection rates of chronic diseases, with values ranging from 45% to 48%. By car, area number 3 had the longest travelling time, corresponding to 14 minutes. The longest travelling times by public transportation were detected in areas 1 and 3, corresponding to 27 and 29 minutes, respectively The geographic accessibility index showed that the least favorable z scores travelling by car corresponded to areas 6 and 10 and, when travelling on public transportation, to areas 8 and 10., Conclusions: The geographic accessibility index identified areas that required improvements in accessibility.

Background: Integrated programs make the task of concentrating preventive actions for specific groups easier. However, health services must firstly be accessible, an essential condition for the population to use them. Hence, the objective of this study was to identify municipalities with the highest needs of accessibility of preventive actions through information synthesized in an accessibility index., Methods: This cross-sectional study considered eight metropolitan municipalities of Monterrey, Mexico and 323 individuals sampled at random. We measured attendance for at least one preventive action the year before the survey, including vaccination, diabetes or hypertension diagnosis, and cervical or breast cancer among women. The accessibility index consisted of use and access barriers, quality and resource indicators standardized using Z-scores., Results: Ninety-nine percent had attended health services for some preventive action. The municipality with the highest unmet need was Santa Catarina (Z -6.9) followed by Apodaca (Z -1.5) and Benito Juárez (Z -1.2). San Pedro registered the highest unmet need concerning economical access barriers (Z -3.5), whereas Apodaca was not good enough with quality perception (Z -4.7) and Santa Catarina with perception of sufficient physical, human and material resources (Z -4.9)., Conclusions: Three of the eight studied metropolitan municipalities registered the highest unmet need.

Objective: To determine the cost of caring for the diabetic-hypertensive patient in primary care., Design: A cost analysis carried out in family medicine units in Mexico., Setting: Family medicine units in Mexico., Participants: Patients with diabetes and hypertension., Measurements: Include the profile of use of the services and the cost of the care. The profile is defined as the average annual use of primary care services, the unit cost is calculated by reason for use in each of the services used, taking the fixed and variable consumables into account; the average cost by reason for care is calculated from use-cost ratio and the mean annual cost from the total average cost by reason for the care., Results: The mean annual cost in the family doctor clinic was euro180.65 (95% confidence interval [CI], 168.31-193), in the laboratory, euro48.99 (95% CI, 44.85-53.18), and in the rest of the primary care services, euro41.33 (95% CI, 30.19-52.46). The mean annual primary care cost per patient was euro271 (95% CI, 243.36- 298.65)., Conclusion: The primary care costs of the diabetic-hypertensive patient are concentrated in the family doctor and laboratory services.

Objective: to predict the probability of blood glucose control in patients with type-2 diabetes mellitus, exclusively treated with pharmacology therapy., Material and Methods: secondary analysis of a database to evaluate the therapeutic attachment in type-2 diabetics older than 60 years old. We interviewed 123 patients in their home to get information about sociodemographic aspects and diabetes characteristics. The blood glucose control was measured through glycated hemoglobin and the attachment to the pharmacological treatment was measured by the Morisky-Green test. The analysis included simple logistic regression; the calculation of probability of control for different levels of therapeutic attachment was estimated using the result of the regression equation (y) and applying the formula 1/1 + e(-y)., Results: Monotherapy was present in 82.1%, glibenclamide was prescribed alone in 77.2%, glycated hemoglobin average was 11.5 +/- 3.5 %, 18% of the population was controlled and 58.1% showed some attachment to the pharmacological treatment. With a total attachment to the pharmacological prescription, the control probability is 27%, and without it, it corresponds to 10%., Conclusion: Almost three out of ten patients with a total attachment to the pharmacological treatment have chances of being controlled.

Objective: Comparing unit cost variation between departments and reasons for consultation in outpatient health services provided by a social security company from Querétaro, Mexico., Methods: A study of costs (in US dollars) was carried out in outpatient health service units during 2004. Fixed unit costs were estimated per department and adjusted for one year's productivity. Material, physical and consumer resources were included. Weighting was assigned to resources invested in each department. Unit cost was estimated by using the micro cost technique; medicaments, materials used during treatment and reagents were considered to be consumer items. Unit cost resulted from adding fixed unit cost to the variable unit cost corresponding to the reason for consulting. Units costs were then compared between the medical units., Results: Unit cost per month for diabetic treatment varied from 34.8 US dollars, 32,2 US dollars to US 34 US dollars, pap smear screening test costs were 7,2 US dollars, 8,7 US dollars and 7,3 US dollars and dental treatment 27 US dollars, 33 US dollars, 6 and 28,7 US dollars., Conclusion: Unit cost variation was more important in the emergency room and the dental service.

Background: The objective was to compare the use of family planning methods during the immediate postpartum period and two years following childbirth among the adolescent females who had followed two different intervention programs during their pregnancies., Methods: A quasi-experimental study was designed. A total of 62 pregnant adolescents were selected to comprised two intervention groups, the PRECEDE model and the Health Belief model (MCS) groups. Non-parametric statistical tests were employed and 95% confidence intervals estimated., Results: The average starting knowledge in the MCS groups was 69.12 points (95% CI 63.27-74.97) and ending 89.71 points (95% CI 86.24-93.17), while the starting knowledge for the PRECEDE group was 49.39 points (95% Cl 42.24-56.54) and ending 75.25 points (95% CI 71.12-79.38). IN the immediate postpartum, 93% (95% CI 83.5-100) of the adolescents in the PRECED group accepted the use of a family planning method similar to that employed by the MCS group, of 94.2 (95% CI 86.3-100). As regards the continued use of the method, that is, two years later, the PRECEDE strategy had a greater effect that the MCS strategy, respectively 92% (95% Cl 82-100) and 72% (95% CI 56.9-87.1)., Conclusions: A difference was found to exist between models as regards the use of family planning methods 2 years following childbirth. The PRECEDE program is proposed as the education strategy for preventing a second pregnancy among adolescent females.

Objective: One of the biggest challenges of the Mexican Health System is to get results of the treatment goals in diabetic patients, which can be frustrated by physician and patient's attitudes. The present study evaluates divergence of attitude of health providers and diabetic patients according to health sectors: private, social security or State medical services., Material and Methods: They contributed 255 physicians and 255 diabetic patients in ambulatory care from three health sectors: private, social security and welfare (employees and patients were exclusive providers and patients of corresponding institutions). The Diabetes Attitude Scale 3 (DAS-3) was applied, a self-administered instrument used to compare attitudes between health care professionals and patients. Discrepancies were analyzed with t-tests, chi2, one-way ANOVA and post hoc multiple comparisons for observed means based on the Tukey test., Results: Physician and patient's attitudes differed in all scales except for psychosocial impact of diabetes, which was independent of the health sector. Attitudes were not alike with respect to severity of the disease, value of tight control of glucose levels and patient autonomy, with no distinction of health sector. Discrepancy of need for special training was the only attitude that varied by health sector (F = 4.1; p = 0.02); it was similar for the private and social security sector but different for the welfare sector., Conclusions: All health sectors should recognize attitude discrepancies between doctors and patients to favor collaborative strategies that benefit a better control of the disease.

Objective: To evaluate the impact of a triage system on waiting times and patient satisfaction of one secondary care hospital emergency department (ED)., Material and Methods: This was a quasiexperimental study. All patients > 15 years demanding emergency care of the selected hospital were included (n = 1,010); a sample was drawn for applying a satisfaction questionnaire (n = 198). The intervention, in charge of trained nurses, consisted of a classification system based on the national scale of the United Kingdom of five categories. The real waiting time was measured from registration to initiation of care. The analysis included descriptive statistics, the sign test and multiple logistic regression analysis., Results: Seventy-one percent of the patients attended the ED spontaneously. The first three categories, considered real emergencies, engaged more than half of the patients. Immediate care was received in category 1 similar to the standard (p > 0.05); the real waiting time in the rest of categories was less than the expected standard (p < 0.01). Sixty-three percent was very satisfied with the waiting time from triage to initiation of care and 74%, with overall care of the ED. Satisfaction with nursing care and waiting time from arrival to initiation of medical care were determinants for satisfaction with overall care, independent of sex and age., Conclusions: The triage system largely challenged the not easy ED demand and its waiting times in addition to patient satisfaction. This simple classification scale allows improvement in managing emergency services and cases, the benefits can be potentially extended to other health care services.

Background: Maternal health is a priority in the Mexican health system, the proper planning and organization of the resources, as well as the use of the maternity care services suited to the needs of pregnant women therefore being of importance. This study is aimed at determining the pattern of use of the prenatal, childbirth and puerperium care services at a Mexican social insurance institution., Methods: A descriptive study was conducted of 403 women involved in an obstetrical medical event, with the exception of those whose clinical file was not located or who were treated at a subdistrict hospital providing a low degree of coverage of obstetrical events and in a third-level hospital. An analysis was made as to the type and frequency of use of the healthcare services in the prenatal stage, the childbirth care provided up to the immediate puerperium and the advanced puerperium stage. The information was taken from the clinical file, both at the second-level hospital as well as in family medicine and, if required, at the third-level hospital., Results: 90.8% were women whose pregnancies ended in vaginal birth or cesarean section, their prenatal care visits averaging 6.2 +/- 4.1. Prenatal care was started during the first three months by 48.6%, whilst 27.3% came in for visits 7 or more times. A total 22.4% showed both characteristics. The average number of days of hospitalization was 1.8 +/- 0.9 days. During the puerperium, office visits averaged 1.2 +/- 0.4., Conclusions: Less than one fourth of the population studied kept the prenatal care appointments as should have been, mention being made of areas of opportunity in childbirth care.

Objective: To determine the impact of primary care on hospitalization of type 2 diabetics with equal conditions of health insurance., Design: A case-control study. Case = diabetic hospitalized by a disease related condition. Control = diabetic without hospitalization during the last 12 months., Setting: Urban primary care centers., Participants: Cases were consecutively selected from four out of five urban hospitals (n=123). Controls were chosen at random from primary care units matched by primary care source (n=135). Women with gestational diabetes were excluded as well as individuals with missing medical charts (approximately 15%)., Measurements: A primary care index was constructed with process and outcome indicators recommended by the American Medical Association, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, the American Diabetes Association and the Official Mexican Standards. Compliance to less than 60% of recommendations was considered unsatisfactory primary care., Results: The following were hospitalization risk factors: less than 2 visits to family physician during the last year (OR adjusted, 16,2; 95% CI, 1,5-174,2), glucose level (OR adjusted, 1,006; 95% CI, 1,002-1,010) and cognitive level (OR adjusted, 0,98; 95% CI, 0,96-0,99), in addition to exercising and year of diagnosis. Sixty-five percent of cases observed unsatisfactory primary care compared with 49,1% of controls (P=0,03). Unsatisfactory primary care increased 2,5 times the risk of hospitalization (95% CI, 1,2-5,0) (pseudo R2=0,279; P<0,001)., Conclusions: Primary care is a potential factor for reducing hospitalization of type 2 diabetics. Effective primary care programs would contribute to a better disease control and less unnecessary hospitalizations.

Objective: To assess the medical care costs of hypertension and their impact on the health care expenditures and on Mexico's Gross National Product (GNP)., Material and Methods: An ecological study was conducted from June to November 1999, at Instituto Mexicano del Seguro Social (Mexican Institute of Social Security, IMSS), in Monterrey, Nuevo Leon, Mexico. A random sample of medical charts of patients with hypertension was selected, to extract data on utilization of health services and unitary costs per care episode. The cost per care episode and per hypertensive patient was calculated by adjusting the unitary cost as a function of standard and extreme utilization of IMSS health services. The resulting figure was then projected to the total population of hypertensive patients and compared to the annual health care expenditures of Mexico., Results: The annual cost per patient with hypertension was $1,067 in the standard scenario and $3,913 in the extreme scenario. The annual expenditures from hypertension corresponded to 13.95% of the budget allocated to health care and to 0.71%, of Mexico's GNP. These figures changed to 51.17% and 2.61% in the extreme scenario, respectively., Conclusions: The costs of hypertension medical care account for a good portion of healthcare resources. This problem should be analyzed by multidisciplinary health teams in search of more efficient medical care alternatives.

Objective: To determine the extent and importance of unmet health needs of type 2 diabetic patients seen at primary care services., Material and Methods: A cross-sectional study was conducted in 1999, among rural and urban patients of the Mexican Institute of Social Security, in Nuevo Leon, Mexico. The study population consisted of 256 subjects selected at random, diagnosed with type-II diabetes for at least two years. Data were obtained by interview and complemented with medical charts and provider interviews. Five health areas and four health determinants were evaluated, through Mexican Official Standards and American Diabetes Association standards of medical care for diabetic patients. Analysis consisted of descriptive statistics and estimation of z scores., Results: Health needs were met in 49% of cases. A lower mean of health need satisfaction was found in rural regions as compared to urban regions (36.8% vs. 53.3%, p < .01). Nutrition was the most affected health area (z score = -6), followed by the physical exercise (z score = -1), the metabolic health area (z score = +1), the non-smoking health area (z score = +2), the prevention and early detection of complications health area (z score = +2), and the cognitive health area (z score = +3). The health determinant with the highest requirement corresponded to utilization (z score = -5), followed by resource availability (z score = -4), perceived health need (z score = +4), and access barriers (z score = +6)., Conclusions: Health need measurement allows evaluating the effectiveness of existing interventions, in addition to identifying areas with higher unmet health needs. These findings facilitate analysis and decision-making to devise specific health policies and actions directed at improving the quality of care for diabetic patients. The English version of this paper is available at: http://www.insp.mx/salud/index.html

Background: The objective of this study was to determine the cost of diabetes mellitus, its impact on health spending in Mexico, and its percentage of the gross domestic product (GDP)., Methods: There was a four-stage approach: identification of the epidemiology of the use of health services; estimate of treatment cost; determination of the diabetic population, and calculation of the percentage of health spending., Results: The average annual cost per diabetic patient was $708 U.S. dollars (USD), the total annual cost of diabetics was $2,618,000 USD, the percentage of health spending was 15.48%, and the percentage of the GDP was 0.79%., Conclusions: It is necessary to seek strategies that allow for a more efficient use of resources designated for type 2 diabetes treatment.

Objective: To assess health care access integrating the availability of resources, medical institution and the patient point of view., Setting: Nuevo León, México., Measurements and Main Results: A random sample of patients were interviewed about their perceptions on different barriers, which also were assessed for the institution utilizing the corresponding indicator. Availability of resources were also measured for every primary and secondary medical care unit of the greatest Mexican health care system in Nuevo León. It was observed a 70% access; 70% for primary care and 73% for secondary care. Availability of human resources was an important factor but barriers as observed by the institution were the most important (waiting time and traveling cost). Barriers were rated different by the institution and the patient., Conclusions: The combination of institutional barriers, patient barriers and resources for assessing health care access is discussed.

Objective: To determine nutritional risk factors in a population of patients with pulmonary tuberculosis (PT)., Material and Methods: During 1997, one-hundred and eighty-five patients with PT were chosen at random from two health institutions in Monterrey, Nuevo León, México. Variables analyzed were: anthropometric measures, socioeconomic status, utilization of the nutrition clinic, access to foodstuffs, adverse reactions to drugs, and disease attributable to malnutrition. Statistical analysis consisted of descriptive, bivariate, and multivariate logistic regression, in addition to prevalence ratios and 95% confidence intervals., Results: The mean age was 42.4 +/- 19.9 years. The mean body mass index was 19.8 +/- 3.2; 57% of patients presented malnutrition; 26% of them were referred to the nutrition clinic, 24.3% of whom actually attended it. Multivariate analysis showed that adverse reactions of tuberculosis drugs were risk factors for malnutrition, independent of age, gender, education, occupation, year of diagnosis and access to foodstuffs, disease attributable, and utilization of the nutrition clinic. (chi 2 = 10.58; p = 0.051, R2 = 0.42)., Conclusions: Nutritional risk in patients with pulmonary tuberculosis is both a patient and a health services issue. The high prevalence of malnutrition, the low utilization rate of nutritional services, and the effect of adverse reactions to therapeutic drugs, justify the need to focus attention on this particular group of patients.

Objective: To assess if work-related activities represented a threatening situation for nursing personnel through the correlation between the level of usual anxiety (trait-anxiety) and the level of anxiety present during working hours (state-anxiety). As well as, to determine state-anxiety risk factors., Material and Methods: The state-trait-anxiety inventory was administered to 285 nurses of a health care institution chosen at random., Results: The correlation coefficient was 0.53 (CI 95% = 0.43, 0.60, p = 0.001), after controlling for age, marital status, number of children, workload, service, category, level of care, years of service and personal relationships. Negative personal relationships and = 1 year of service influenced the level of anxiety present during working hours (beta = -0.21, beta = -0.24, p = 0.001, respectively)., Conclusions: Work-related activities represented a threatening situation and contributed to anxiety. It is necessary to recognize anxiety work-related risk factors for developing coping strategies and preventing well-being damage.

Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities.

Objective: To determine the quality of the Early Cervical Cancer Detection Program in the state of Nuevo León., Material and Methods: A random selection of 4791 cytologic reports were analyzed, emitted by the State Ministry of Health, the University Hospital and the Mexican Institute for Social Security early cervical cancer detection modules. Pap tests of women with hysterectomy, current pregnancy, menopause or positive result were excluded. Quality was measured with previously defined standards. Analysis included, besides univariate statistics, tests of significance for proportions and means., Results: The quality of the program was fairly satisfactory at the level of the State. The quality of the sampling procedure was low; 39.9% of the tests contained endocervical cells. Quality of coverage was low; 15.6% were women 25+years with first time Pap test. Quality of opportunity was high; 8.5 +/- 7 weekdays between the date of the pap smear and the interpretation date., Conclusions: Strategies are needed to increase the impact of the state program, such as improving the sampling procedure and the coverage quality levels.

Objective: To estimate the unit cost of 15 causes of demand for primary care per health clinic in an institutional (social security) health care system, and to determine the average cost at the state level., Material and Methods: The cost of 80% of clinic visits was estimated in 35 of 40 clinics in the social security health care system in the state of Nuevo Leon, Mexico. The methodology for fixed costs consisted of: departmentalization, inputs, cost, weights and construction of matrices. Variable costs were estimated for standard patients by type of health care sought and with the consensus of experts; the sum of fixed and variable costs gave the unit cost. A computerized model was employed for data processing., Results: A large variation in unit cost was observed between health clinics studied for all causes of demand, in both metropolitan and non-metropolitan areas. Prenatal care ($92.26) and diarrhea ($93.76) were the least expensive while diabetes ($240.42) and hypertension ($312.54) were the most expensive. Non-metropolitan costs were higher than metropolitan costs (p < 0.05); controlling for number of physician's offices showed that this was determined by medical units with only one physician's office., Conclusions: Knowledge of unit costs is a tool that, when used by medical administrators, allows adequate health care planning and efficient allocation of health resources.