Abstract Introduction: In 2017, INEGI reported 84,142 deaths from malignant tumors in Mexico, while the World Health Organization indicated that the breast cancer mortality rate in 2018 was 11.2 per 100,000 women. Objective: To show the trend of breast cancer mortality in women by municipality and health region of Jalisco in the 2010-2017 period. Method: Analytical study in which standardized mortality rates and relative risks of 3873 women were estimated by municipality of residence. Dispersion and central tendency spatial statistics were used. Results: The mortality rate increased from 10.7 to 13.0 per 100,000 women in the 2010-2017 period. The highest values were found in the municipalities of Chapala (21.2) and Guadalajara (19.5); the mortality rate increased in four out of every 10 municipalities, and relative risk was up to 50-fold higher in some of the western and central Jalisco municipalities. Conclusions: An annual increase of 1.0 % was observed, although it was territorially differentiated. The results represent an opportunity to improve timely detection and diagnostic processes, as well as to guarantee the coverage of services.

Resumen Introducción: En 2017, el INEGI reportó 84 142 defunciones por tumores malignos en México y la Organización Mundial de la Salud indicó que la tasa de mortalidad por cáncer de mama en 2018 fue de 11.2 por 100 mil mujeres. Objetivo: Mostrar la tendencia de la mortalidad por cáncer de mama en mujeres según municipio y región sanitaria de Jalisco en el periodo 2010-2017. Método: Estudio analítico en el que se estimaron tasas estandarizadas de mortalidad y riesgos relativos por municipio de residencia de 3873 mujeres. Se utilizó estadística espacial de dispersión y tendencia central. Resultados: La tasa de mortalidad aumentó de 10.7 a 13.0 por 100 mil mujeres en el periodo 2010-2017. Los valores más altos se encontraron en los municipios de Chapala (21.2) y Guadalajara (19.5), la tasa de mortalidad aumentó en cuatro de cada 10 municipios y el riesgo relativo fue hasta 50 veces mayor en algunos del occidente y centro de Jalisco. Conclusiones: Se observó un incremento de 1.0 % anual, aunque territorialmente diferenciado. Los resultados representan una oportunidad para mejorar los procesos de detección y diagnóstico oportunos, así como para garantizar la cobertura de los servicios.

Abstract. Homicide mortality in Mexico is still a priority public-health issue. In 2012, it was one of the most frequent causes of death in men aged 15-44 years. Some Mexican States, including the State of Jalisco, show homicide mortality rates significantly higher than others; 48% of the homicides recorded in the country during the period 1990-2017 were committed in Jalisco. Important local-level differences have also been documented within the State; up to 50% of the homicides reported by official sources are usually perpetrated in the Guadalajara Metropolitan Zone (AMG, for its acronym in Spanish). The importance of gathering evidence based on spatially referenced data to address this issue is being increasingly recognized, not only to evaluate homicide mortality, but also to identify population groups at risk and high-priority areas, examine epidemiological behavior, and identifying spatial or temporal trends. Public health and healthcare geography provide various analytical tools that can be useful for supporting decision-making to better focus interventions aimed at reducing and preventing homicide mortality. The objectives of this study were to estimate the magnitude and identify the spatial distribution and trends of homicides perpetrated in the years 2013 and 2018 in the AMG, comparing the results at municipal and neighborhood levels. There are two official sources of homicide statistics in Mexico: the Instituto Nacional de Estadística y Geografía (National Institute of Statistics and Geography; INEGI, for its acronym in Spanish), and the Secretariado Ejecutivo del Sistema Nacional de Seguridad Pública (Executive Secretariat of the National Public Security System; SESNSP). However, both provide data aggregated at State or municipal levels only. To overcome this limitation, INEGI statistics were supplemented with local newspaper reports to derive the following information for homicides in the AMG in 2013 (n = 465) and 2018 (n = 988): date, address, neighborhood, and municipality where each homicide was perpetrated. These data allowed examining the geographic distribution of homicides across the 1,710 neighborhoods in the six AMG municipalities (Guadalajara, Zapopan, San Pedro Tlaquepaque, Tonalá, El Salto, and Tlajomulco de Zúñiga). Geostatistical techniques were used to analyze the distribution and spatial trend of homicide incidence from the point location data. The frequency of homicides by neighborhood and municipality were also calculated to estimate and map homicide rates (number per 100,000 inhabitants) for comparison vs. the aggregated data reported by INEGI for the two years studied. According to the two official data sources, homicide mortality increased from 2013 to 2018 in most of the AMG, except for the municipality of Zapopan; the increase was particularly high in the municipalities of Tlajomulco de Zúñiga and San Pedro Tlaquepaque, where the homicide rate increased from 20.3 to 50.7 and 4.6 to 18.8 homicides per 100,000 inhabitants, respectively. The geographic analysis of point-location data showed a high concentration of homicides in low-, medium-, and high-marginalization areas of the north and southwest parts of the municipality of Zapopan (29.2% of the homicides reported in 2013), as well as in the center and northeast parts of Guadalajara (14%). By contrast, the zones with high concentration of homicides in 2018 (25.4%) shifted towards the low-marginalization neighborhoods located on the northeast, central, and south parts of Guadalajara, in the limits between the municipalities of Tonalá and San Pedro Tlaquepaque. The homicides perpetrated in 2013 were distributed in 16.8% of the neighborhoods that make up the AMG, whereas those perpetrated in 2018 took place in 24.4% of the neighborhoods. Mortality rates in 2013 ranged from 4 (at the low-marginalization Miramar neighborhood, Zapopan) to 223.3 (at the low-marginalization Revolucionaria neighborhood, Guadalajara) homicides per 100,000 inhabitants; and from 3.8 (in the very high-marginalization Santa Cruz de Las Flores neighborhood, Tlajomulco de Zúñiga) to 2,006 (in the very high-marginalization Toluquilla neighborhood, San Pedro Tlaquepaque) homicides per 100,000 inhabitants in 2018. Despite of having used different sources and territorial scales for the geographic analysis, we were able to identify consistent patterns in the increase in homicide mortality from 2013 to 2018 in the AMG. These results provide valuable information for guiding strategies and available resources to target priority areas where the magnitude, distribution, and spatial trends observed at neighborhood and municipality levels indicate a high incidence of homicides and, thus, reduce the risks facing the population (54%) in the AMG neighborhoods recording high homicide rates.

Resumen. Los homicidios son un problema prioritario de seguridad pública en México dada la magnitud e impacto que los caracteriza; sin embargo, rara vez se estudian las causa de muerte y los hechos violentos desde una perspectiva geográfica y de salud pública. A partir de fuentes secundarias se llevó a cabo un análisis comparativo de homicidios ocurridos en 2013 y 2018 por colonias y municipios del Área Metropolitana de Guadalajara (AMG), Jalisco. Los homicidios fueron georreferenciados considerando el lugar donde ocurrió la agresión y analizados mediante medidas de tendencia central y dispersión con el objetivo de determinar la magnitud, distribución y tendencia espacial. Como resultado, la cantidad de homicidios ocurridos en el AMG aumentó de 2013 (n= 465) a 2018 (n= 988), salvo en el municipio de Zapopan. En 2018 la tasa de homicidios osciló entre 6.2 (Tonalá) y 50.7 por cada 100 mil habitantes (Tlajomulco de Zúñiga), un incremento hasta 4 veces mayor respecto al 2013. Además, el total de homicidios se concentró en el 16% (2013) y 24% (2018) de las colonias que integran el AMG, caracterizadas por ser en su mayoría de baja y muy baja marginación, lo que implicó un desplazamiento del noroeste-sureste hacia el norte-sur, respectivamente. Los resultados contribuyeron a identificar la magnitud y tendencia espacial de los homicidios asociadas a colonias de mayor riesgo, por lo que se trata de zonas donde se requiere redirigir y mejorar las políticas públicas para modificar los factores de riesgo, las actividades o comportamientos ilícitos que, generalmente, preceden a la ocurrencia de los homicidios.

Abstract Official records indicate that in Jalisco, Mexico, the diagnosis of breast cancer (BC) in women is usually performed at advanced stages. Using geo-referenced data of patients treated at a third-level hospital, the magnitude and spatialtemporal variation associated with late clinical stage (IIb, IIIa, IIIb, IIIc, IV) by municipality of residence was identified during 2013-2015. The municipalities of Acatic, Atoyac and Zapotlanejo showed an increase in the estimated rate for this period, whose value was 44.6, 17.7 and 19.2 per hundred thousand women older than 20 years of age, respectively. In addition, the risk of late-stage breast cancer increased up to four times and in accordance to the patient’s municipality of residence. The results show the municipalities where it is required to improve the detection and diagnosis of BC and, especially, to guarantee an early treatment for women who reside in the places of higher risk, in compliance with the guidelines established in the NOM 041-SSA2-2011.

Resumen Los registros oficiales indican que, en Jalisco, México, el diagnóstico de cáncer de mama (Cama) en mujeres generalmente se realiza en fases avanzadas. Mediante datos georreferenciados de pacientes atendidas en un hospital de tercer nivel, se identificó la magnitud y variación espaciotemporal asociada a estadio clínico tardío (IIb, IIIa, IIIb, IIIc, IV) por municipio de residencia en el trienio 2013-2015. Los municipios Acatic, Atoyac y Zapotlanejo mostraron un incremento en la tasa estimada para este periodo, cuyo valor fue 44.6, 17.7 y 19.2 por cada cien mil mujeres mayores de 20 años, respectivamente. Además, el riesgo de estadio tardío se incrementó hasta cuatro veces según el municipio de residencia. Los resultados sugieren cuáles son los municipios donde se requiere mejorar la detección y diagnóstico de Cama, pero sobre todo garantizar un tratamiento oportuno para las mujeres que residen en los lugares de mayor riesgo, en apego a lineamientos establecidos en la NOM 041-SSA2-2011.

This paper discusses the gestation process, implementation methodology, and results obtained from the initiative to use e-learning to train human resources for health, six years after the launch of the Virtual Campus of Public Health of the University of Guadalajara (Mexico); the discussion is framed by Pan American Health Organization (PAHO) standards and practices. This is a special report on the work done by the institutional committee of the Virtual Campus in western Mexico to create an Internet portal that follows the guidelines of the strategic model established by Nodo México and PAHO for the Region of the Americas. This Virtual Campus began its activities in 2007, on the basis of the use of free software and institutional collaboration. Since the initial year of implementation of the node, over 500 health professionals have been trained using virtual courses, the node's educational platform, and a repository of virtual learning resources that are interoperable with other repositories in Mexico and the Region of the Americas. The University of Guadalajara Virtual Campus committee has followed the proposed model as much as possible, thereby achieving most of the goals set in the initial work plan, despite a number of administrative challenges and the difficulty of motivating committee members.

Este trabajo muestra, desde el punto de vista de la normatividad de la Organización Panamericana de la Salud (OPS), el proceso de gestación, la metodología de implementación y los resultados obtenidos de la iniciativa de formación de recursos humanos en salud vía e-learning a través del Campus Virtual de Salud Pública de la Universidad de Guadalajara, México, a seis años de su inicio. Se trata de un informe especial del trabajo realizado por el comité institucional del campus virtual en la región occidental de México para generar un portal de Internet que se ajustara a los lineamientos del Modelo Estratégico establecido por el Nodo México y la OPS para la Región de las Américas. Este Campus Virtual inició sus actividades en el año 2007. Su filosofía es el uso de software libre y la colaboración entre instituciones. El nodo fue implementado en un año y ha logrado capacitar a más de 500 profesionales de la salud a través de cursos virtuales, su plataforma educativa y un repositorio de recursos virtuales de aprendizaje con interoperabilidad con los repositorios de México y de la Región de las Américas. El comité del Campus Virtual de la Universidad de Guadalajara ha intentado respetar lo más posible al modelo propuesto, lo que ha permitido cumplir la mayoría de los objetivos fijados en el plan de trabajo inicial, aunque ha enfrentado una serie de dificultades administrativas y de motivación de sus integrantes.

Consumption of fruits from the genus Karwinskia may cause a flaccid paralysis that can be confused with the Guillan-Barré syndrome or poliomyelitis. Paralysis resulting from consumption of such fruit has emerged as a public health problem in certain regions of Mexico. The purpose of this study was to investigate geographical factors associated with this intoxication in the 72 cases reported in Mexico from 1990 to 1994. Location of cases coincides with the distribution of the 11 reported species of Karwinskia in the country. The majority of reported cases were related to the consumption of K. humboldtiana, with a smaller number involving K. mollis, K. parvifolia, K. johnstonii, and K. rzedowskii. Most cases were located in regions with dry climates (79.2%), arid vegetation (41.7%), and altitudes under 1,000 meters above sea level (54.1%). The study establishes three different risk areas: the Balsas river region in the southwestern central part of the country; the arid northern area; and the arid and dry central area. Cases were from rural communities with low levels of schooling and poor socioeconomic conditions

Las Parálisis Flácidas causadas por el consumo de los frutos de las plantas del género Karwinskia (tullidora) han emergido como un problema de salud pública en ciertas regiones de México. El objeto de este trabajo fue investigar los factores geográficos asociados a esta patología, en 72 casos reportados en México de 1990 a 1994. La distribución geográfica de casos coincide con las 11 especies reportadas de Karwinskia en México. La mayoría se relacionaron con la K. humboldtiana y, en menor medida, con K. mollis, K. parvifolia, K. johnstonii y K. rzedowskii. La presencia de casos es mayor en regiones con climas secos (79,2%), vegetación de Matorrales Aridos (41,7%) y altitudes menores de mil metros (54,1%). Se determinaron tres diferentes zonas de riesgo: la zona del río Balsas, la región norte del país, así como las zonas áridas y secas centrales de los estados de Puebla, Hidalgo, San Luis Potosí y Querétaro. Las comunidades menores de 2.500 habitantes y con niveles de bienestar y de educación bajos son las más afectadas

Consumption of fruits from the genus Karwinskia may cause a flaccid paralysis that can be confused with the Guillan-Barré syndrome or poliomyelitis. Paralysis resulting from consumption of such fruit has emerged as a public health problem in certain regions of Mexico. The purpose of this study was to investigate geographical factors associated with this intoxication in the 72 cases reported in Mexico from 1990 to 1994. Location of cases coincides with the distribution of the 11 reported species of Karwinskia in the country. The majority of reported cases were related to the consumption of K. humboldtiana, with a smaller number involving K. mollis, K. parvifolia, K. johnstonii, and K. rzedowskii. Most cases were located in regions with dry climates (79.2%), arid vegetation (41.7%), and altitudes under 1,000 meters above sea level (54.1%). The study establishes three different risk areas: the Balsas river region in the southwestern central part of the country; the arid northern area; and the arid and dry central area. Cases were from rural communities with low levels of schooling and poor socioeconomic conditions

Las Parálisis Flácidas causadas por el consumo de los frutos de las plantas del género Karwinskia (tullidora) han emergido como un problema de salud pública en ciertas regiones de México. El objeto de este trabajo fue investigar los factores geográficos asociados a esta patología, en 72 casos reportados en México de 1990 a 1994. La distribución geográfica de casos coincide con las 11 especies reportadas de Karwinskia en México. La mayoría se relacionaron con la K. humboldtiana y, en menor medida, con K. mollis, K. parvifolia, K. johnstonii y K. rzedowskii. La presencia de casos es mayor en regiones con climas secos (79,2%), vegetación de Matorrales Aridos (41,7%) y altitudes menores de mil metros (54,1%). Se determinaron tres diferentes zonas de riesgo: la zona del río Balsas, la región norte del país, así como las zonas áridas y secas centrales de los estados de Puebla, Hidalgo, San Luis Potosí y Querétaro. Las comunidades menores de 2.500 habitantes y con niveles de bienestar y de educación bajos son las más afectadas