A national serosurvey was conducted in Mexico from March to October 1986 to identify predictors of dengue transmission and target areas at high risk of severe annual epidemics. A total of 3,408 households in 70 localities with populations less than 50,000 were randomly sampled, and serology was obtained from one subject under age 25 years in each household. When comparing exposure and infection frequencies across the 70 communities, the authors found that median temperature during the rainy season was the strongest predictor of dengue infection, with an adjusted fourfold risk in the comparison of 30 degrees C with 17 degrees C. High temperatures increase vector efficiency by reducing the period of viral replication in mosquitoes. The proportion of houses in a community with larva on the premises was significantly associated with the community proportion infected (odds ratio (OR)adj = 1.9; 95% confidence interval (CI) 1.4-2.5), as was the proportion of households with uncovered water containers present (ORadj = 1.9; 95% CI 1.4-2.7). Because these factors have effects beyond the individual household and subjects infected from them create a risk for other subjects, both analyses of effects and organization of control efforts must be at the community level. A predictive model was constructed using the community level risk factors to classify communities as being at high, medium, or low risk of experiencing an epidemic; 57% of these communities were correctly classified using this model.

Objective. This article presents and overview of the main results and conclusions from the Mexican National Nutrition Survey 1999 (NNS-1999) and the principal nutrition policy implications of the findings. Material and Methods. The NNS-1999 was conducted on a national probabilistic sample of almost 18 000 households, representative of the national, regional, as well as urban and rural levels in Mexico. Subjects included were children <12 years and women 12-49 years. Anthropometry, blood specimens, diet and socioeconomic information of the family were collected. Results. The principal public nutrition problems are stunting in children < 5 years of age; anemia, iron and zinc deficiency, and low serum vitamin C concentrations at all ages; and vitamin A deficiency in children. Undernutrition (stunting and micronutrient deficiencies) was generally more prevalent in the lower socioeconomic groups, in rural areas, in the south and in Indigenous population. Overweight and obesity are serious public health problems in women and are already a concern in school-age children. Conclusions. A number of programs aimed at preventing undernutrition are currently in progress; several of them were designed or modified as a result of the NNS-1999 findings. Most of them have an evaluation component that will inform adjustments or modifications of their design and implementation. However, little is being done for the prevention and control of overweight and obesity and there is limited experience on effective interventions. The design and evaluation of prevention strategies for controlling obesity in the population, based on existing evidence, is ur-

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El artículo examina los efectos que causaron los sismos sobre la salud de la población y sobre la infraestructura de los servicios de salud en México, así como su incidencia sobre el desarrollo de la reforma  planteada para ese sector por la actual administración. Para ello se analizan las características generales de dicha reforma, los obstáculos que enfrentaba y los problemas que surgieron a raíz de los sismos. Se concluye que a pesar de que el sector salud fue el más afectado por la pérdida –sin precedentes en la historia nacional y mundial– de profesionales, instalaciones y equipo, la catástrofe permitió profundizar la reforma del sector y coadyuvar a una mejor distribución de los recursos para la atención médica.Los sismos de septiembre de 1985 tuvieron un gran impacto sobre la estructura de los servicios de salud en México. Más de 10% de las vidas que cobró el desastre se perdieron en los hospitales derruidos,  mientras que en un solo día dejó de existir una cuarta parte del total de la capacidad hospitalaria del sector público en la zona metropolitana. Estos hechos se insertan a su vez en el contexto de una profunda crisis económica, a la cual el sector salud intentaba hacer frente por medio de una reforma estructural sin precedentes. Es pertinente entonces examinar los efectos que han tenido y tendrán los sismos de septiembre sobre el desarrollo de la reforma al sistema de salud en México. Se aborda este problema analizando las características generales de la reforma propuesta a principios del sexenio, los problemas que ya de por sí enfrentaba y los daños que los sismos produjeron en la infraestructura de servicios. Se trata de demostrar que, no obstante la destrucción y el evidente desgaste que representa la reconstrucción, los sismos abrieron nuevas oportunidades para la reforma y literalmente allanaron el camino para su profundización. Se analiza también el grado al que esta coyuntura ha sido favorable para los propósitos del régimen, examinando los obstáculos y problemas que se le presentaron.

El consumo de tabaco en la Región Americana: elementos para un programa de acción. Salud Publica Mex 2002;44 supl 1: S125-S135. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html

Access to universal HAART has had relative success in Mexico. The heterogeneity of HIV/AIDS mortality by employment status, gender, and state of residence highlight urgent needs to improve health equity with pro-poor and gender-responsive programs and a call for country-specific operational research in HIV/AIDS prevention and treatment. Our results may apply to other countries seeking to implement universal access to antiretroviral therapy.

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