To describe the relationship of blood lead levels to menopause and bone lead levels, we conducted a cross-sectional study on 232 pre- or perimenopausal (PreM) and postmenopausal (PosM) women who participated in an osteoporosis-screening program in Mexico City during the first quarter of 1995. Information regarding reproductive characteristics and known risk factors for blood lead was obtained using a standard questionnaire by direct interview. The mean age of the population was 54.7 years (SD = 9.8), with a mean blood lead level of 9.2 microg/dL (SD = 4.7/dL) and a range from 2.1 to 32.1 microg/dL. After adjusting for age and bone lead levels, the mean blood lead level was 1.98 microg/dL higher in PosM women than in PreM women (p = 0.024). The increase in mean blood lead levels peaked during the second year of amenorrhea with a level (10.35 microg/dL) that was 3.51 microg/dL higher than that of PreM women. Other important predictors of blood lead levels were use of lead-glazed ceramics, schooling, trabecular bone lead, body mass index, time of living in Mexico City, and use of hormone replacement therapy. Bone density was not associated with blood lead levels. These results support the hypothesis that release of bone lead stores increases during menopause and constitutes an internal source of exposure possibly associated with health effects in women in menopause transition.

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Objetivo. Documentar que las diferencias en el trato recibido por los usuarios de los servicios de salud en México dependen principalmente del proveedor, independientemente de lasCalidad de la atención de salud, investigación sobre servicios de salud, satisfacción del paciente, México. RESUMENEl término "sistema de salud" abarca a todos los actores y recursos vinculados con el financiamiento, la regulación y la prestación de servicios de salud. Estos servicios, a su vez, comprenden todas las actividades cuyo objetivo fundamental es mejorar, fomentar o restaurar la salud de la población (1). Si bien estos son los objetivos que siempre han sido el fundamento de los Palabras clavePuentes Rosas E, Gómez Dantés O, Garrido Latorre F. Trato a los usuarios en los servicios públicos de salud en México.

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