Long-term inequalities in health among older Mexican adults: An outcome-wide analysis.

The relationship between socioeconomic level and health outcomes in older people has been widely studied, but less information about health inequalities associated with gender and place of residence exists. Also, there is scarce evidence of longitudinal inequalities, particularly in countries from the global south. This study aimed to describe the longitudinal patterns of health inequalities associated with wealth, gender, and residence area among older Mexican adults. We used data from two longitudinal studies in Mexico: The Study on Global AGEing and Adult Health (SAGE) and the Mexican Health and Aging Study (MHAS). Three domains to characterize health inequities were used: wealth, gender, and rurality. We conducted an outcome-wide analysis with nine health indicators assessing older adults' physical and cognitive function. The Slope Index of Inequality and the Relative Index of Inequality were used as inequality measurements. Our results indicate that the greatest inequalities are observed in relation to wealth and gender. Older adults with lower socioeconomic status demonstrated higher rates of depression, sarcopenia, falls, and limitations in both basic and instrumental activities of daily living compared to their wealthier counterparts, with increasing trends in physical functionality over time. Furthermore, women experienced higher rates of depression, sarcopenia, frailty, and physical limitations compared to men. The only significant difference related to rurality was a lower rate of frailty among rural older adults. Longitudinal trajectories revealed an increase in the gap of inequality for various health indicators, especially in terms of wealth and gender. Health inequalities in old age are one of the greatest challenges facing health systems globally. Actions like universal coverage of health services for older people and the empowerment of individuals and their communities to have control over their lives and circumstances must be guaranteed.

Rezago en desarrollo infantil temprano en México: un análisis de la desigualdad.

OBJETIVO: Estimar la desigualdad en el rezago de desarrollo infantil temprano (DIT) en la niñez de 24 a 59 meses. Material y métodos. Se evaluó el DIT mediante el índice de desarrollo infantil temprano 2030. Se estimaron los factores asociados con el rezago de DIT y su índice de concentración (IC), además de su descomposición para estimar la desigualdad entre los factores. RESULTADOS: La desigualdad se concentró más en la niñez con menor nivel de bienestar (IC= -0.09, p<0.01), con peores niveles en estados con marginación muy alta (-0.28, valor-p <0.01) y muy baja (-0.15, valor- p= 0.03). Los factores que más contribuyen a esta desigualdad son falta de acceso a libros y de apoyo al aprendizaje, además de residencia en municipios de alta marginación. Conclusión. Las políticas públicas deben enfocarse en priorizar a la niñez en riesgo de no lograr su máximo DIT, facilitar el acceso a oportunidades de aprendizaje y a libros infantiles.

Adolescent use of outpatient health services in Mexico: their health needs and associated factors.

OBJECTIVE: To estimate adolescent use of outpatient services, identifying their health needs and associated socioeconomic factors. MATERIALS AND METHODS: Using data from Ensanut 2018-2019, adolescents (ages 10-19) with health needs and those receiving care from health personnel (users) were identified. Needs were analyzed by sex and socioeconomic status (SES). Logistic models were used to assess the factors associated with the use of health care and choice of provider. RESULTS: 6% of adolescents reported health needs, of whom 64% used outpatient services. Respiratory and gastrointestinal infections were the principal health needs prompting use of services overall. However, by SES, motivations centered on pregnancy for the poor and accidental injuries for the wealthy. One in three adolescents with health needs, particularly the poorest, received no care. Living with a partner and having health insurance were the main predictors of use. Greater schooling among household heads and higher SES correlated with the use of private services. CONCLUSIONS: Despite being aware of their health needs, adolescents are the group that uses health services the least in Mexico. Promoting preventative and timely treatment for this population would encourage youths to seek care more often.

p16INK4a and pRb expression in laryngeal squamous cell carcinoma with and without infection by EBV or different genotypes of HPV: a retrospective study.

BACKGROUND: Laryngeal squamous cell carcinoma (LSCC) represents one of the principal tumors of the head and neck. Human papillomavirus (HPV) and Epstein-Barr virus (EBV) are considered risk factors for the development and the clinical prognosis of LSCC. High levels of p16INK4a are suggested as a surrogate marker of HPV or EBV infection in some head and neck tumors but in LSCC is still controversial. Furthermore, pRb expression may be considered an additional biomarker but it has not been clearly defined. This work aimed to compare the expression of pRb and p16INK4a as possible biomarkers in tumor tissues with and without infection by EBV or different genotypes of HPV from patients with LSCC. METHODS: Tumor samples from 103 patients with LSCC were previously investigated for the presence and genotypes of HPV using the INNO-LiPA line probe assay and for the infection of EBV by qPCR. p16 INK4a and pRb expression was assessed by immunohistochemistry. RESULTS: Of the 103 tumor samples, expression of p16INK4a was positive in 55 (53.4%) and of this, 32 (56.1%) were positive for HPV whereas 11 (39.3%) were EBV positive but both without a significantly difference (p > 0.05). pRb expression was positive in 78 (75.7%) and a higher frequency of this expression was observed in HPV negative samples (87.0%) (p = 0.021) and in high-risk HPV negative samples (85.2%) (p = 0.010). No difference was observed when comparing pRb expression and EBV infection status (p > 0.05). CONCLUSION: Our results support the suggestion that p16INK4a is not a reliable surrogate marker for identifying HPV or EBV infection in LSCC. On the other hand, most of our samples had pRb expression, which was more frequent in tumors without HPV, suggesting that pRb could indicate HPV negativity. However, more studies with a larger number of cases are required, including controls without LSCC and evaluating other molecular markers to determine the real role of p16INK4a and pRb in LSCC.

Life Table Parameters of Tetranychus merganser Boudreaux (Acari: Tetranychidae) on Five Host Plants.

The quality of the host plant affects the life history parameters of tetranychid mites. The biology and fertility life tables of Tetranychus merganser on five host plants (Carica papaya, Phaseolus vulgaris, Capsicum annuum var. glabriusculum, Helietta parvifolia, and Rosa hybrida) were assessed under laboratory conditions at 28 ± 1 °C and 70-80% relative humidity (RH) with a photoperiod of 12:12 h (L:D). The development period of immature females differed among the tested host plants and ranged from 9.32 days on P. vulgaris to 11.34 days on H. parvifolia. For immature males, it ranged from 9.25 days on P. vulgaris to 11.50 days on H. parvifolia. The female survival rate varied from 53.97% on H. parvifolia to 94.74% on P. vulgaris. The highest total fecundity rate was recorded on P. vulgaris (125.40 eggs/female) and the lowest on H. parvifolia (43.92 eggs/female). The intrinsic rate of increase (rm) varied from 0.271 (H. parvifolia) to 0.391 (P. vulgaris). The net reproductive rate (RO) was higher on P. vulgaris than on the other host plants. The longest mean generation time (GT) was calculated on C. annuum var. glabriusculum and the shortest on Rosa hybrida. The demographic parameters suggest the unsuitability of H. parvifolia as the host for the development of red spider mites, and the best performance of T. merganser was on P. vulgaris.

Use of Outpatient Health Services by Mexicans Aged 15 Years and Older, According to Ethnicity.

The aim of this study was to estimate the prevalence of health needs and use of outpatient services for indigenous (IP) and non-indigenous (NIP) populations aged ≥15 years, and to explore the associated factors and types of need. A cross-sectional study was conducted based on the 2018-19 National Health and Nutrition Survey. The population aged ≥15 years who had health needs and used outpatient services was identified. Logistic models were developed to explore the factors underlying the use of outpatient services. For both populations, being a woman increased the likelihood of using health services, and having health insurance was the most important variable in explaining the use of public health services. Compared to the NIP, a lower proportion of IP reported health needs during the month prior to the survey (12.8% vs. 14.7%); a higher proportion refrained from using outpatient services (19.6% vs. 12.6%); and a slightly higher proportion used public health services (56% vs. 55.4%). For the NIP, older age and belonging to a household that had received cash transfers from a social program, had few members, a high socioeconomic level, and a head with no educational lag, all increased the likelihood of using public health services. It is crucial to implement strategies that both increase the use of public health services by the IP and incorporate health-insurance coverage as a universal right.

The Characterization of Cardiac Explants Reveals Unique Fibrosis Patterns and a Predominance of CD8+ T Cell Subpopulations in Patients with Chronic Chagas Cardiomyopathy.

AIM: The present study aimed to characterize the histopathological findings and the phenotype of inflammatory cells in the myocardial tissue of patients with end-stage heart failure (ESHF) secondary to CCC in comparison with ESHF secondary to non-Chagas cardiomyopathies (NCC). METHODS: A total of 32 explanted hearts were collected from transplanted patients between 2014 and 2017. Of these, 21 were classified as CCC and 11 as other NCC. A macroscopic analysis followed by a microscopic analysis were performed. Finally, the phenotypes of the inflammatory infiltrates were characterized using flow cytometry. RESULTS: Microscopic analysis revealed more extensive fibrotic involvement in patients with CCC, with more frequent foci of fibrosis, collagen deposits, and degeneration of myocardial fibers, in addition to identifying foci of inflammatory infiltrate of greater magnitude. Finally, cell phenotyping identified more memory T cells, mainly CD8+CD45RO+ T cells, and fewer transitioning T cells (CD45RA+/CD45RO+) in patients with CCC compared with the NCC group. CONCLUSIONS: CCC represents a unique form of myocardial involvement characterized by abundant inflammatory infiltrates, severe interstitial fibrosis, extensive collagen deposits, and marked cardiomyocyte degeneration. The structural myocardial changes observed in late-stage Chagas cardiomyopathy appear to be closely related to the presence of cardiac fibrosis and the colocalization of collagen fibers and inflammatory cells, a finding that serves as a basis for the generation of new hypotheses aimed at better understanding the role of inflammation and fibrogenesis in the progression of CCC. Finally, the predominance of memory T cells in CCC compared with NCC hearts highlights the critical role of the parasite-specific lymphocytic response in the course of the infection.

Mediator effect of caregiver burden on the association between disability and quality of life among older adults.

OBJECTIVE: To estimate the association of disability and qual-ity of life considering the potential mediating role of caregiver burden among a sample of older Mexican adults and their caregivers. MATERIALS AND METHODS: Cross-sectional study with 93 dyads (elderly/caregivers) conducted in 2018 in five localities (urban and rural) of the State of Mexico. The quality of life (QoL) was determined using the WHOQoL (WHO Quality of Life) instrument. Disability was measured by assessing the basic activities of daily living (BADL), and the caregiver burden was evaluated by the Zarit Burden Interview (ZBI). RESULTS: The results showed that BADL disability is associated with a lower QoL (total effect: -14.3; 95%CI: -20.2,-8.4) and that a significant proportion of this associa-tion can be attributable to caregiver burden (25.0%; 95%CI: 17.9,43.2). CONCLUSIONS: Our findings show the need for designing effective interventions that prevent or ameliorate the adverse effects of caregiver burden.

Evaluation of Ethanolic Powdered Extract of Magnolia tamaulipana Vazquez against Oligonychus punicae Hirst (Trombidiformes: Tetranychidae).

Avocado bronze mite (ABM), Oligonychus punicae Hirst (Trombidiformes: Tetranychidae) has potential for development in several plant species of agricultural importance. ABM is one of the most economically important pests in avocado cultivars, causing major damage to fruit and defoliation. At present, the control of ABM depends mainly on agrochemicals. Therefore, it is necessary to find alternatives to agrochemicals that can help minimize environmental impact and health risks for humans and mammals. The aim of this research was to assess the effect of different concentrations (5, 10, 50, 100, 250, 500, 1000 µg/mL) of ethanolic powdered extract of M. tamaulipana leaves against adult ABM females. The different concentrations of M. tamaulipana extract did not cause mortality of O. punicae. Females treated with 5 and 1000 µg/mL of the extract showed a decrease in the number of eggs laid per female at 24 (5.17 and 1.27), 48 (5.07 and 1.17), and 72 h (4.97 and 0.80), compared to the control treatment (5.20, 6.60 and 6.87), respectively, which led to a reduction in the growth rate. Percentage of feeding damage decreased with the increasing concentration of the extract. The ethanolic powdered extract of M. tamaulipana leaf has potential to control O. punicae.

Evaluation of Resistance of Eleven Maize Races (Zea mays L.) to the Red Spider Mite (Tetranychus merganser, Boudreaux).

At least 59 maize races (Zea mays L.) have been registered in Mexico. The feeding damage caused by insects and mites to maize crops generates up to ~30% of maize yield losses. Spider-mite-resistant plants are needed. The red spider mite, Tetranychus merganser Boudreaux (Acari: Tetranychidae), is distributed in the United States, China, Mexico, and Thailand. It is considered a potential pest in Mexican agriculture. The aim of this study was to evaluate the resistance mechanisms (antixenosis and antibiosis) of 11 native maize populations, representative of each race of maize grown in Tamaulipas, Mexico, to T. merganser under laboratory conditions. The aim was also to obtain information on the chemical composition and some morphological characteristics of these maize races and to identify resistant maize races for incorporation into a breeding program. Antixenosis was assessed by non-preference for oviposition and feeding. Antibiosis was measured by growth rate (ri). The presence of secondary metabolites in the 11 maize races were different. In the 11 maize races, quantitative analysis of total phenol concentration, total flavonoid concentration, and antioxidant capacity were significantly different. The multivariate analysis of variance showed that there is evidence of antixenosis noted by maize race differences in egg laying and percentage feeding damage but not of antibiosis noted by growth rate. Red spider mites laid significantly more eggs on the Celaya (24 h: 25.67 ± 17.04, 48 h: 42.67 ± 26.86, 72 h: 49.33 ± 28.54) race than on Raton (24 h: 7.00 ± 5.00, 48 h: 12.67 ± 8.02, 72 h: 14.67 ± 9.29) and Elotes Occidentales × Tuxpeño (24 h: 9.67 ± 5.85, 48 h: 15.33 ± 10.69, 72 h: 17.67 ± 10.97) races. However, the growth rate and mortality of T. merganser in the 11 corn races were similar. The Vandeño (24 h: 11.67 ± 2.89, 48 h: 27.67 ± 7.64, 72 h: 30.00 ± 18.03) and Tabloncillo × Tuxpeño (24 h: 18.33 ± 7.64, 48 h: 25.00 ± 8.66, 72 h: 25.00 ± 8.66) races were the most resistant to red spider mite damage, whereas the most susceptible race was Celaya (24 h: 26.67 ± 15.28, 48 h: 48.33 ± 29.30, 72 h: 65.00 ± 30.00). Further analysis by PCA at 24, 48, and 72 h found the Celaya race positively correlated to growth rate and oviposition of T. merganser and to a lesser extent with the percentage of feeding damage, suggesting that the Celaya race was most susceptible to T. merganser. At 24 h, the Vandeño race was most resistant, given a negative correlation to growth rate and oviposition by T. merganser. The PCA at 48 and 72 h noted the Elotes Occidentales × Tuxpeño race was most resistant to red spider mite, with negative relationships to growth rate and oviposition and, to a lesser extent, to feeding damage. This resistance is due to the differences in both its morphological characteristics and the secondary metabolites present in their leaves.

[Job conditions and precarious work among Mexican physicians: an analysis based on a national survey]. / Condiciones de empleo y precariedad laboral de los médicos de México: análisis basado en una encuesta nacional.

The study aimed to describe the socioeconomic characteristics and job conditions of medical personnel in Mexico. This was a cross-sectional study based on the Mexican National Occupational and Employment Survey (ENOE) for all four quarters of 2019 and the first quarter of 2020. We included all physicians who had concluded their university training. The variable "cumulative precarious labor" was constructed as the sum of five binary variables related to minimum wage, workweek, and lack of employment contract, job security, and labor benefits. Using this unweighted sum, we classified their labor conditions as absence of (0) or low (1), medium (2 to 3), or high (4 to 5) precarious labor. In the public sector, 13.4% and 3.3% of physicians were engaged in medium or high precarious labor, respectively; the percentages were higher in the private sector, with 38.5% and 7.7% (p < 0.01), respectively, due mainly to the lack of formal contracts and medical insurance. These conditions were exacerbated in women working in medical offices in private-sector companies, where 75.2% and 6% worked in medium or high precarious conditions, respectively, while the proportions in men were 15.6% and 7.7%, respectively (p < 0.01). Precarious labor exists in the Mexican health sector; labor conditions for physicians are more precious in the private sector than in the public sector, especially in private-sector offices where female physicians are more exposed to precarious employment.

El objetivo fue describir las características socioeconómicas y condiciones de empleo del personal médico en México. Estudio transversal con base en la Encuesta Nacional de Ocupación y Empleo (ENOE) de México, de los 4 trimestres de 2019 y el primer trimestre de 2020. Incluimos a todos los médicos con estudios universitarios concluidos. La variable precariedad laboral acumulada fue construida como la suma de cinco variables binarias relacionadas con el salario mínimo, jornada laboral, carencias de contrato, de seguridad y de prestaciones sociales. Con esta suma no ponderada, clasificamos las condiciones laborales en baja (1), media (2 a 3), alta (4 a 5), y ausencia de precariedad laboral (0). En el sector público, 13,4% y 3,3% de los médicos tienen precariedad laboral media y alta, respectivamente; los porcentajes son mayores en el sector privado, 38,5% y 7,7% (p < 0,01), respectivamente, debido principalmente a las carencias de contrato escrito y seguro médico. Estas condiciones se exacerban en las mujeres que trabajan en los consultorios médicos de las empresas del sector privado donde 75,2% y 6% de ellas tienen precariedad media y alta, respectivamente, mientras que en los hombres los porcentajes son 15,6 y 7,7%, respectivamente, (p < 0,01). Existe precariedad laboral en el sector salud mexicano; las condiciones laborales de los médicos del sector privado son más precarias que en el sector público, particularmente en los consultorios del sector privado, donde las mujeres están más expuestas a empleos precarios.

O objetivo era descrever as características socioeconômicas e as condições de emprego dos médicos no México. Estudo transversal com base na Pesquisa Nacional de Ocupação e Emprego (ENOE) do México, nos quatro trimestres de 2019 e no primeiro trimestre de 2020. Incluímos todos os médicos com estudos universitários concluídos. A variável da precariedade laboral acumulada foi construída como a soma de cinco variáveis binárias relacionadas com o piso salarial, a jornada de trabalho, a falta de contrato, segurança e benefícios sociais. Com esta soma não ponderada, classificamos as condições de trabalho em baixa (1), média (2 a 3), alta (4 a 5), e ausência de precariedade laboral (0). No setor público, 13,4% e 3,3% dos médicos estão em situação de precariedade laboral média e alta, respectivamente; os percentuais são mais elevados no setor privado, com 38,5% e 7,7% (p < 0,01), respectivamente, devido principalmente à inexistência de contrato escrito e de seguro médico. Estas condições se agravam para as mulheres que trabalham nos consultórios médicos das empresas do setor privado, onde 75,2% e 6% delas sofrem precariedade média e alta, respectivamente, ao passo que para os homens, os percentuais são de 15,6% e 7,7%, respectivamente, (p < 0,01). Existe precariedade laboral no setor da saúde mexicano; as condições de trabalho dos médicos do setor privado são mais precárias do que no setor público, em especial, nos consultórios do setor privado onde as mulheres estão mais expostas a empregos precários.

Diversity and conservation of terrestrial vertebrates (birds, mammals, and reptiles) of Sierra Cucapá, Mexicali, Baja California, Mexico.

Knowledge about the biodiversity of Baja California has been obtained mainly from natural protected areas (NPAs), while some unprotected natural areas have been poorly studied. The Sierra Cucapá in the northeast of the peninsula is one example. The objectives of this study are 1) to integrate existing knowledge of bird, mammal, and reptile diversity in Cucapá from public databases, citizen science platforms, and information generated from fieldwork, 2) to identify the spatial distribution of records in the study area, 3) to compare the composition of vertebrate species of Cucapá with that of NPAs of northern part of the peninsula, and 4) to assess the biological conservation value of Cucapá. We obtained records of 150 species of native vertebrates (102 birds, 34 mammals, and 14 reptiles) of which 10 species of birds, four mammals, and seven reptiles are included in a risk extinction category. The different sources of information contributed in a complementary way to the species inventories. Large areas in western and northern Cucapá lack records. The total difference in species composition between Cucapá and nearby NPAs ranged between 58 and 69% for birds, 61 and 79% for mammals, and 69 and 87% for reptiles. The species richness of Cucapá, its particular species composition, the presence of species in risk extinction categories, and the number and size of unexplored areas indicate that this area represents an opportunity for biological conservation in the northern part of the Peninsula. This work provides compelling data for the protection of Cucapá.

The Resistance of Seven Host Plants to Tetranychus merganser Boudreaux (Acari: Tetranychidae).

Red spider mites, Tetranychus merganser Boudreaux (Acari: Tetranychidae), is an agricultural pest that causes economic losses in papaya and nopal crops in Mexico. The aim of this research was to assess antibiosis and antixenosis as resistance mechanisms in seven host plants (Thevetia ahouai, Carica papaya, Phaseolus vulgaris, Moringa oleifera, Pittosporum tobira, Helietta parvifolia, Capsicum annuum var. glabriusculum) to red spider mites. Antixenosis was evaluated by non-preference for oviposition and feeding, antibiosis by infinitesimal rate of increase, finite rate of increase and doubling time, and the percentage of spider mites mortality. Oviposition and damage by feeding of T. merganser were significantly greater on C. papaya than on the other host plants. The growth rate of the spider mite was significantly lower in P. tobira and T. ahouai than in the other host plants. The percentage of hatched eggs of T. merganser was significantly higher in P. vulgaris than in the other plant species. Based on the demographic parameters, survival, food intake, and oviposition, these results indicated that compared with C. papaya, P. tobira and T. ahouai were more resistant. These results may be due to the fact that they were plants species of different families. The resistant plants can be studied as alternatives in the management of T. merganser.

Condiciones de empleo y precariedad laboral de los médicos de México: análisis basado en una encuesta nacional / Job conditions and precarious work among Mexican physicians: an analysis based on a national survey / Condições de emprego e precariedade laboral dos médicos do México: análise baseada em pesquisa nacional

El objetivo fue describir las características socioeconómicas y condiciones de empleo del personal médico en México. Estudio transversal con base en la Encuesta Nacional de Ocupación y Empleo (ENOE) de México, de los 4 trimestres de 2019 y el primer trimestre de 2020. Incluimos a todos los médicos con estudios universitarios concluidos. La variable precariedad laboral acumulada fue construida como la suma de cinco variables binarias relacionadas con el salario mínimo, jornada laboral, carencias de contrato, de seguridad y de prestaciones sociales. Con esta suma no ponderada, clasificamos las condiciones laborales en baja (1), media (2 a 3), alta (4 a 5), y ausencia de precariedad laboral (0). En el sector público, 13,4% y 3,3% de los médicos tienen precariedad laboral media y alta, respectivamente; los porcentajes son mayores en el sector privado, 38,5% y 7,7% (p < 0,01), respectivamente, debido principalmente a las carencias de contrato escrito y seguro médico. Estas condiciones se exacerban en las mujeres que trabajan en los consultorios médicos de las empresas del sector privado donde 75,2% y 6% de ellas tienen precariedad media y alta, respectivamente, mientras que en los hombres los porcentajes son 15,6 y 7,7%, respectivamente, (p < 0,01). Existe precariedad laboral en el sector salud mexicano; las condiciones laborales de los médicos del sector privado son más precarias que en el sector público, particularmente en los consultorios del sector privado, donde las mujeres están más expuestas a empleos precarios.

The study aimed to describe the socioeconomic characteristics and job conditions of medical personnel in Mexico. This was a cross-sectional study based on the Mexican National Occupational and Employment Survey (ENOE) for all four quarters of 2019 and the first quarter of 2020. We included all physicians who had concluded their university training. The variable "cumulative precarious labor" was constructed as the sum of five binary variables related to minimum wage, workweek, and lack of employment contract, job security, and labor benefits. Using this unweighted sum, we classified their labor conditions as absence of (0) or low (1), medium (2 to 3), or high (4 to 5) precarious labor. In the public sector, 13.4% and 3.3% of physicians were engaged in medium or high precarious labor, respectively; the percentages were higher in the private sector, with 38.5% and 7.7% (p < 0.01), respectively, due mainly to the lack of formal contracts and medical insurance. These conditions were exacerbated in women working in medical offices in private-sector companies, where 75.2% and 6% worked in medium or high precarious conditions, respectively, while the proportions in men were 15.6% and 7.7%, respectively (p < 0.01). Precarious labor exists in the Mexican health sector; labor conditions for physicians are more precious in the private sector than in the public sector, especially in private-sector offices where female physicians are more exposed to precarious employment.

O objetivo era descrever as características socioeconômicas e as condições de emprego dos médicos no México. Estudo transversal com base na Pesquisa Nacional de Ocupação e Emprego (ENOE) do México, nos quatro trimestres de 2019 e no primeiro trimestre de 2020. Incluímos todos os médicos com estudos universitários concluídos. A variável da precariedade laboral acumulada foi construída como a soma de cinco variáveis binárias relacionadas com o piso salarial, a jornada de trabalho, a falta de contrato, segurança e benefícios sociais. Com esta soma não ponderada, classificamos as condições de trabalho em baixa (1), média (2 a 3), alta (4 a 5), e ausência de precariedade laboral (0). No setor público, 13,4% e 3,3% dos médicos estão em situação de precariedade laboral média e alta, respectivamente; os percentuais são mais elevados no setor privado, com 38,5% e 7,7% (p < 0,01), respectivamente, devido principalmente à inexistência de contrato escrito e de seguro médico. Estas condições se agravam para as mulheres que trabalham nos consultórios médicos das empresas do setor privado, onde 75,2% e 6% delas sofrem precariedade média e alta, respectivamente, ao passo que para os homens, os percentuais são de 15,6% e 7,7%, respectivamente, (p < 0,01). Existe precariedade laboral no setor da saúde mexicano; as condições de trabalho dos médicos do setor privado são mais precárias do que no setor público, em especial, nos consultórios do setor privado onde as mulheres estão mais expostas a empregos precários.

Immunomodulation and Antioxidant Activities as Possible Trypanocidal and Cardioprotective Mechanisms of Major Terpenes from Lippia alba Essential Oils in an Experimental Model of Chronic Chagas Disease.

In the late phase of Trypanosoma cruzi infection, parasite persistence and an exaggerated immune response accompanied by oxidative stress play a crucial role in the genesis of Chronic Chagasic Cardiomyopathy (CCC). Current treatments (Benznidazole (BNZ) and Nifurtimox) can effect only the elimination of the parasite, but are ineffective for late stage treatment and for preventing heart damage and disease progression. In vivo trypanocidal and cardioprotective activity has been reported for Lippia alba essential oils (EOs), ascribed to their two major terpenes, limonene and caryophyllene oxide. To investigate the role of antioxidant and immunomodulatory mechanisms behind these properties, chronic-T. cruzi-infected rats were treated with oral synergistic mixtures of the aforementioned EOs. For this purpose, the EOs were optimized through limonene-enrichment fractioning and by the addition of exogenous caryophyllene oxide (LIMOX) and used alone or in combined therapy with subtherapeutic doses of BNZ (LIMOXBNZ). Clinical, toxicity, inflammatory, oxidative, and parasitological (qPCR) parameters were assessed in cardiac tissue. These therapies demonstrated meaningful antioxidant and immunomodulatory activity on markers involved in CCC pathogenesis (IFN-γ, TNF-α, IL-4, IL-10, and iNOS), which could explain their significant trypanocidal properties and their noteworthy role in preventing, and even reversing, the progression of cardiac damage in chronic Chagas disease.

Bioacaricidal Potential of Moringa oleifera Ethanol Extract for Tetranychus merganser Boudreaux (Acari: Tetranychidae) Control.

The Tetranychidae family includes mites causing severe damage to agricultural fields. The red spider mite, Tetranychus merganser Boudreaux (Acari: Tetranychidae), causes severe damage to several plant species grown as cash crops. Current red spider mite control depends mainly on chemical insecticides. There is a need for alternate control measures that are environmentally friendlier than chemical pesticides. The aim of the study was to assess the effects of Moringa oleifera leaf ethanolic extract at different concentrations (0.1, 0.5, 1, 5, 10, 15, and 20% (v/v)) against T. merganser females. Such effects can serve as a basis to include this compound in integrated pest management programs for the control of red spider mites. Mites treated with 20% (v/v) killed 86.67%, 13.70%, and 96.30% at 24, 48, and 72 h, respectively, as compared to the control treatment. Oviposition, egg hatching, and the damage caused by red spider mites were all reduced at high concentrations. Moringa oleifera leaf ethanolic extract can be used as a powerful bioacaricide for the control of T. merganser.

Evaluation of Ethanol Extract of Moringa oleifera Lam. as Acaricide against Oligonychus punicae Hirst (Trombidiformes: Tetranychidae).

Tetranychidae family is a major group of mites causing serious damage in agricultural, vegetable and ornamental crops. Avocado bronze mite (ABM), Oligonychus punicae Hirst (Acari: Tetranychidae) causes major crop damage, defoliation and fruit abortion. At present, the control of this mite depends mainly on agrochemicals. Therefore it is necessary to find alternatives to synthetic pesticides that can help minimize environmental impact and health risks for the consumers. The aim of this research was to assess the effect of different concentrations (0.1, 0.5, 1, 5, 10, 15 and 20% (v/v)) of ethanolic extract of Moringa oleifera leaves against adult ABM females. Mites treated with 0.1 and 20% (v/v) of the extract showed mortality of 0.00% and 46.67%, 6.67% and 86.67%, 13.70% and 96.67%, at 24, 48 and 72 h, as compared to the control treatment, respectively. The number of eggs laid and hatch, as well as ABM feeding rates, depended on the extract concentration, which led to a reduction in the growth rate. M. oleifera leaf ethanolic extract has potential to control O. punicae.

Out-of-Pocket Healthcare Expenditures in Dependent Older Adults: Results From an Economic Evaluation Study in Mexico.

Background: Dependence is a significant health-related condition for older adults (OA) and implies that self-care is transferred to other people, the community or institutions. Recent studies have analyzed the relationship between out-of-pocket (OOP) healthcare expenditures and dependence. Nonetheless, these studies were not specifically designed to estimate the economic impact of dependence. Our aim was to estimate the total adjusted annual OOP healthcare expenditures in dependent older adults compared to independent ones. Additionally, we explore the potential combined effect of basic activities of daily living (ADL) and instrumental activities of daily living (IADL) dependence on OOP healthcare expenditures. Methods: Data comes from the cross-sectional study "Economic impact of physical dependence in older adults and the burden of informal care" conducted in 2018 with a sample of 735 community-dwelling older Mexican adults ages 60 and older. We used direct (medical and non-medical) and indirect costs to estimate the OOP healthcare expenditures associated with dependence. We applied the Katz scale to assess dependence in ADL and the Lawton scale to assess dependence in IADL. Two-Part regression models were used to analyze the relationship between dependence and OOP health expenditures. Results: Presence of ADL dependence represented a higher level of expenditure, 107% compared to non-dependent OA (ß = 1.07, CI95%: 0.43-1.71), and 97% for IADL dependence (ß = 0.97, CI95%: 0.49-1.45). The combined effect of ADL and IADL dependence (132%) was greater (ß = 1.32, CI95%: 0.74-1.90) than the effect of ADL or IADL dependence alone. In monetary terms, OA with ADL dependence had a total annualized mean OOP healthcare expenditure of $31,865 (Mexican pesos), OA with IADL $26,912, and combined ADL and IADL $39,520. Conclusions: ADL and IADL dependence are associated with the total annualized OOP healthcare expenditures. This association is even higher when both conditions are present together. These findings highlight the economic implications of the dependence for individuals, their families, and the health system. Given that current evidence on effective interventions to prevent dependence in OA is insufficient, future studies should be conducted to estimate their costs and determine what interventions work, as well as their effectiveness and cost-effectiveness in different sub-groups of the population, and how these might be appropriately implemented.

In Vitro Antibacterial Activity of Hibiscus sabdariffa L. Phenolic Extract and Its In Situ Application on Shelf-Life of Beef Meat.

Compounds from spices and herbs extracts are being explored as natural antibacterial additives. A plant extract used in traditional folk medicine is Hibiscus sabdariffa L., also known as Roselle. Therefore, the potential use of a phenolic hibiscus extract as antibacterial or natural food preservative was analyzed in vitro and in situ. A phenolic extract was obtained from hibiscus calyces and fractionated, and then the fractions were tested against foodborne pathogen bacteria. Liquid-liquid extraction and solid-phase extraction were used to fractionate the hibiscus extract, and HPLC was employed to analyze the fractions' phenolic composition. Minimum bactericidal concentration (MBC) and minimal inhibitory concentration (MIC) were calculated for brute hibiscus phenolic extract, each of the fractions and pure commercial phenolic compounds. Bacteria tested were Escherichia coli, Salmonella enterica serovar Typhimurium, Staphylococcus aureus, Listeria monocytogenes and Bacillus cereus. The fraction obtained after liquid-liquid extraction presented the best performance of MBC and MIC against the bacteria tested. Furthermore, a hibiscus ethanolic extract was employed as a natural preservative to extend the shelf-life of beef. Microbiological, color and sensory analyses were performed to the meat during the shelf-life test. The application of the phenolic hibiscus extract also showed an increase of the duration of the meat`s shelf life.

Síndrome pilórico causado por Linfoma No Hodgkin. Reporte de un caso / Pyloric syndrome caused by a Non-Hodgkin Lymphoma. A case report

El síndrome pilórico es un conjunto de síntomas y signos que se producen por una obstrucción total o parcial de la región pilórica que trae como consecuencia la dificultad para el vaciamiento gástrico y la consiguiente retención de su contenido. Se trata de un paciente que presentó vómitos postpandrial tardíos y dolor abdominal difuso después de ingerir alimentos sólidos. Pasado un mes de estos síntomas, los vómitos procedían ante la ingesta de líquidos, acompañado de astenia, anorexia y pérdida de peso. Se atiende en el servicio de cirugía del Hospital "Dr. Ernesto Guevara de la Serna". Se realizó endoscopia que observó obstrucción pilórica completa sin etiología precisada. La laparotomía exploratoria encontró dilatación gástrica con edema y endurecimiento del antro pilórico, múltiples tumoraciones y endurecimientos de un segmento de la unión yeyuno e íleon. Se efectuó antrectomía con gastroyeyunostomía y Brown, con resección de 60 cm de intestino delgado, que incluyó las tumoraciones encontradas. El diagnóstico histológico fue de Linfoma no Hodgkin Linfocitico bien diferenciado. (AU)

Pyloric syndrome is a set of symptoms and signs that are produced by a total or partial obstruction of the pyloric region that results in difficulty in gastric emptying and the consequent retention of its contents. This patient presented with late postpandrial vomiting and diffuse abdominal pain after ingesting solid food. After one month of these symptoms, vomiting was even caused by the intake of liquids, accompanied by asthenia, anorexia and weight loss. He is treated in the surgery service of Dr. "Ernesto Guevara de la Serna" Hospital. An endoscopy was performed which observed complete pyloric obstruction without precise aetiology. Exploratory laparotomy found gastric dilatation with edema and hardening of the pyloric antrum, multiple tumors and hardening of a segment of the jejunum-ion junction. Antrectomy was performed with gastrojejunostomy and Brown, with resection of 60 cm of small intestine, which included the tumors found. The histological diagnosis was well-differentiated Lymphocytic Non-Hodgkin's Lymphoma. (AU)