Chromosomal evolution, environmental heterogeneity, and migration drive spatial patterns of species richness in Calochortus (Liliaceae).

We used nuclear genomic data and statistical models to evaluate the ecological and evolutionary processes shaping spatial variation in species richness in Calochortus (Liliaceae, 74 spp.). Calochortus occupies diverse habitats in the western United States and Mexico and has a center of diversity in the California Floristic Province, marked by multiple orogenies, winter rainfall, and highly divergent climates and substrates (including serpentine). We used sequences of 294 low-copy nuclear loci to produce a time-calibrated phylogeny, estimate historical biogeography, and test hypotheses regarding drivers of present-day spatial patterns in species number. Speciation and species coexistence require reproductive isolation and ecological divergence, so we examined the roles of chromosome number, environmental heterogeneity, and migration in shaping local species richness. Six major clades-inhabiting different geographic/climatic areas, and often marked by different base chromosome numbers (n = 6 to 10)-began diverging from each other ~10.3 Mya. As predicted, local species number increased significantly with local heterogeneity in chromosome number, elevation, soil characteristics, and serpentine presence. Species richness is greatest in the Transverse/Peninsular Ranges where clades with different chromosome numbers overlap, topographic complexity provides diverse conditions over short distances, and several physiographic provinces meet allowing immigration by several clades. Recently diverged sister-species pairs generally have peri-patric distributions, and maximum geographic overlap between species increases over the first million years since divergence, suggesting that chromosomal evolution, genetic divergence leading to gametic isolation or hybrid inviability/sterility, and/or ecological divergence over small spatial scales may permit species co-occurrence.

Intrinsic capacity trajectories and socioeconomic inequalities in health: the contributions of wealth, education, gender, and ethnicity.

BACKGROUND: Life-long health inequalities exert enduring impacts and are governed by social determinants crucial for achieving healthy aging. A fundamental aspect of healthy aging, intrinsic capacity, is the primary focus of this study. Our objective is to evaluate the social inequalities connected with the trajectories of intrinsic capacity, shedding light on the impacts of socioeconomic position, gender, and ethnicity. METHODS: Our dynamic cohort study was rooted in three waves (2009, 2014, 2017) of the World Health Organization's Study on Global AGEing and Adult Health in Mexico. We incorporated a nationally representative sample comprising 2722 older Mexican adults aged 50 years and over. Baseline measurements of socioeconomic position, gender, and ethnicity acted as the exposure variables. We evaluated intrinsic capacity across five domains: cognition, psychological, sensory, vitality, and locomotion. The Relative Index of Inequality and Slope Index of Inequality were used to quantify socioeconomic disparities. RESULTS: We discerned three distinct intrinsic capacity trajectories: steep decline, moderate decline, and slight increase. Significant disparities based on wealth, educational level, gender, and ethnicity were observed. Older adults with higher wealth and education typically exhibited a trajectory of moderate decrease or slight increase in intrinsic capacity. In stark contrast, women and indigenous individuals were more likely to experience a steeply declining trajectory. CONCLUSIONS: These findings underscore the pressing need to address social determinants, minimize gender and ethnic discrimination to ensure equal access to resources and opportunities across the lifespan. It is imperative for policies and interventions to prioritize these social determinants in order to promote healthy aging and alleviate health disparities. This approach will ensure that specific demographic groups receive customized support to sustain their intrinsic capacity during their elder years.

Geographic isolation and long-distance gene flow influence the genetic structure of the blue fan palm Brahea armata (Arecaceae).

The formation of the Baja California Peninsula (BCP) has impacted the microevolutionary dynamics of different species in ways that depend on biological traits such as dispersal capacity. Plants with relatively low levels of vagility have exhibited high genetic divergence between the BCP and Continental mainland. Brahea armata (Arecaceae) is a palm species inhabiting the northern part of the BCP and Sonora; its distribution occurs in isolated oases of vegetation. We aimed to evaluate the influence of the formation of the BCP on the genetic structure of B. armata using nuclear microsatellites and chloroplast markers (cpDNA) to compare patterns of genetic diversity and structure with previous published studies. Because gene flow through seeds is usually more limited compared to pollen flow, we expect to find stronger genetic structure at (cpDNA) than at nuclear markers. Moreover, larger genetic structure might also be explained by the smaller effective population size of cpDNA. We analyzed six microsatellite markers and two cpDNA regions. The main results indicated high levels of genetic differentiation among isolated populations located in the BCP, while low genetic differentiation was found between southern populations of the BCP and Sonora, suggesting long distance gene flow. In contrast, chloroplast markers indicated high levels of genetic structure between BCP and Sonora populations, suggesting asymmetrical gene flow between pollen (measured by nuclear microsatellites) and seed (cpDNA markers). This study provides valuable information on genetic diversity of B. armata that can be relevant for conservation and management; and develops microsatellites markers that can be transferred to other Brahea species.

Preferences for Conditional Economic Incentives to Improve Pre-exposure Prophylaxis Adherence: A Discrete Choice Experiment Among Male Sex Workers in Mexico.

Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV but requires sustained adherence. Conditional economic incentives (CEIs) can improve medication-taking behaviors, yet preferences for programs that employ CEIs to increase PrEP use among male sex workers (MSWs) have not been investigated. We conducted a discrete choice experiment in Mexico City to elicit stated preferences for a CEI-based PrEP adherence program among MSWs. Respondents expressed their preferences for different program characteristics: incentive amount; incentive format; incentive type; and adherence-verification method. We used a random utility logit model to estimate the relative importance of each attribute and estimated willingness-to-pay. MSWs preferred a higher, fixed incentive, with PrEP adherence measured via hair sampling. MSWs were willing to forego up to 21% of their potential maximum CEI amount to ensure receipt of a fixed payment. MSWs are highly willing to accept a CEI-based intervention for PrEP adherence, if offered along with fixed payments.

RESUMEN: La profilaxis previa a la exposición (PrEP) es muy eficaz para prevenir el VIH, pero requiere una adherencia sostenida. Los incentivos económicos condicionales (IEC) pueden mejorar los comportamientos de toma de medicamentos, sin embargo, no se han investigado las preferencias por los programas que emplean IEC para aumentar el uso de PrEP entre los trabajadores sexuales masculinos (TSM). Realizamos un experimento de elección discreta con TSM en la Ciudad de México para obtener preferencias declaradas para un programa de adherencia a la PrEP basado en IEC. Los participantes expresaron sus preferencias en cuanto a diferentes características: monto del incentivo; formato del incentivo; tipo de incentivo; y método de verificación de la adherencia. Utilizamos un modelo logit de utilidad aleatoria para estimar la importancia relativa de cada atributo y la disposición a pagar estimada (DAP). Los TSM prefirieron un incentivo fijo más alto, con la adherencia a la PrEP medida a través de muestras de cabello. Los TSM estaban dispuestos a renunciar hasta el 21% de su monto máximo potencial de IEC para garantizar la recepción de un pago fijo. Los TSM están muy dispuestos a aceptar una intervención basada en IEC para la adherencia a la PrEP, si se ofrece junto con pagos fijos.

Serum retinol levels are associated with cognitive function among community-dwelling older Mexican adults.

BACKGROUND: Vitamin A (VA) provides neuroprotection against oxidative stress and brain inflammation. VA deficiency (VAD) increases the risk of neurodegeneration in animal models, but results are inconclusive in humans: particularly in the older adult (OA) population which is at higher risk for micronutrient deficiencies and cognitive impairment. OBJECTIVE: To estimate the association between serum retinol levels and cognitive function (CF) in older Mexican adults. METHODS: Cross-sectional study with 803 adults aged ≥60 years with fasting blood sample from the southern region of Mexico, collected in summer of 2015. Low serum retinol (LSR) was defined if serum retinol ≤20 µg/dl. CF was evaluated using Semantic Verbal Fluency Test (SVFT). Mild cognitive impairment (MCI) was defined using normative values for SVFT. Linear and logistic regression models were used to estimate the association of LSR with CF and MCI, respectively. RESULTS: Prevalence of MCI was 9.35% and LSR 3.36%. OA with LSR evoked less words in the SVFT (ß = -2.8, CI95% -4.6, -0.9) and had higher probability of MCI (OR = 2.7, CI95% 0.9, 7.7). Associations remained significant when considered IL-6. CONCLUSION: Frequency of LSR in older Mexican adults was low, but strongly associated with MCI. This result suggests that VA plays a role in maintaining CF in the elderly population. Since VAD is a reversible condition, further studies are needed in order to identify the main causes of LSR and prevent MCI in populations which are at higher risk for malnutrition.Trial registration: ClinicalTrials.gov identifier: NCT04820465.

Is there an association between inflammatory markers and lower physical performance in older adults?

BACKGROUND: Maintenance of physical performance is essential for achievement of healthy aging. A few studies have explored the association between inflammatory markers and physical performance in older adults with inconclusive results. Our aim was to analyze the association of tumor necrosis factor-alpha (TNF-α), Interleukin-10 (IL-10), and C-reactive protein (CRP) with physical performance in a sample of older adults in rural settings of Mexico. METHODS: Our study comprised 307 community-dwelling older men and women who participated in the third wave of the Rural Frailty Study. We assessed the physical performance with the Short Physical Performance Battery (SPPB) and classified older adults as low performance if SPPB scored ≤8. Inflammatory markers were ascertained using serum by immunodetection methods. Logistic regression models were used to estimate the associations between inflammatory markers and physical performance. RESULTS: In comparison with the normal physical performance group, low physical performance individuals mainly were female (P <  0.01), older (P <  0.01), more illiterate (P = 0.02), more hypertensive (P < 0.01), fewer smokers (P = 0.02), and had higher CRP levels (P < 0.01). The logistic model results showed a significant association between the 3rd tertile of CRP and low physical performance (OR = 2.23; P = 0.03). IL-10 and TNF-α levels did not show a significant association. CONCLUSIONS: The results of this study were mixed, with a significant association of physical performance with higher CRP levels but nonsignificant with IL-10 and TNF-α. Further studies with improved designs are needed by incorporating a broader set of inflammatory markers.

Changes Among Mexican Adults in Physical Activity and Screen Time During the COVID-19 Lockdown Period and Association With Symptoms of Depression, Anxiety, and Stress, May 29-July 31, 2020.

INTRODUCTION: We examined the association between changes in physical activity and leisure screen time and mental health outcomes during the early stages of the recommended COVID-19 stay-at-home period in a national sample of Mexican adults aged 18 years or older. METHODS: A cross-sectional online survey conducted from May 29 through July 31, 2020, among 1,148 participants, reported time spent in physical activity and leisure screen time during a typical week before (retrospectively) and a week during the COVID-19 stay-at-home period. Mental health outcomes during this period were measured with the Depression, Anxiety and Stress Scale (DASS-21). Linear regression models were used to estimate the associations between changes in physical activity and leisure screen time and mental health outcomes by socioeconomic status (SES), adjusting for potential confounders. RESULTS: Compared with maintaining high levels of physical activity or increasing them, decreasing physical activity was associated with higher stress scores overall, and among people of high SES, with higher scores for DASS-21, depression, and anxiety. Among participants of low and medium SES only, increasing screen time was associated with higher DASS-21, depression, anxiety, and stress scores compared with maintaining low or decreasing leisure screen time. CONCLUSION: Results highlight the potential protective effect of physical activity and limited leisure screen time on mental health in the context of COVID-19 stay-at-home restrictions.

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.

Sleep duration and incident frailty: The Rural Frailty Study.

BACKGROUND: The association between sleep duration and frailty remains unconclusive since most of the studies have been cross-sectional. Therefore, this study aimed to analyze the association between sleep duration, sleep complaints, and incident frailty. METHODS: A community-based cohort study from rural areas in Mexico with 309 older adults aged 70 and over. Data from waves two and three of the Rural Frailty Study were used. We operationalized the Fried frailty phenotype to describe prevalent and incident frailty at two consecutive waves. Sleep duration was classified as: ≤ 5 h, 6 h, 7-8 h, and ≥ 9 h; and the self-reported sleep complaints as a dichotomous variable. Analyses were performed using Poison regression models. RESULTS: The average age was 76.2 years and 55.3% were women; the incidence of frailty was 30.4%; 13.3% slept ≤5 h, and 38.5% ≥ 9 h. Compared with the group that slept 7-8 h, the risk of frailty at 4.4 years of follow-up was significantly higher among those who slept ≤5 h (adjusted RR 1.80, 95% CI: 1.04-3.11) and among those who slept ≥9 h (adjusted RR 1.69, 95% CI: 1.10-2.58). Sleep complaints were not associated with incident frailty (adjusted RR 1.41, 95% CI: 0.94-2.12). CONCLUSIONS: Our results show that short and long sleep duration are associated with the incidence of frailty. Studies that objectively evaluate sleep duration are needed to clarify whether meeting the recommended hours of sleep decreases frailty incidence.

A deep neural-network classifier for photograph-based estimation of hearing protection attenuation and fit.

Occupational and recreational acoustic noise exposure is known to cause permanent hearing damage and reduced quality of life, which indicates the importance of noise controls including hearing protection devices (HPDs) in situations where high noise levels exist. While HPDs can provide adequate protection for many noise exposures, it is often a challenge to properly train HPD users and maintain compliance with usage guidelines. HPD fit-testing systems are commercially available to ensure proper attenuation is achieved, but they often require specific facilities designed for hearing testing (e.g., a quiet room or an audiometric booth) or special equipment (e.g., modified HPDs designed specifically for fit testing). In this study, we explored using visual information from a photograph of an HPD inserted into the ear to estimate hearing protector attenuation. Our dataset consists of 960 unique photographs from four types of hearing protectors across 160 individuals. We achieved 73% classification accuracy in predicting if the fit was greater or less than the median measured attenuation (29 dB at 1 kHz) using a deep neural network. Ultimately, the fit-test technique developed in this research could be used for training as well as for automated compliance monitoring in noisy environments to prevent hearing loss.

Inflammation and central adiposity as mediators of depression and uncontrolled diabetes in the study on global AGEing and adult health (SAGE).

OBJECTIVES: Diabetes and depression are commonly present in the same individuals, suggesting the possibility of underlying shared physiological processes. Inflammation, as assessed with the biomarker C-reactive protein (CRP), has not consistently explained the observed relationship between diabetes and depression, although both are associated with inflammation and share proposed inflammatory mechanisms. Central adiposity has also been associated with both conditions, potentially by causing increased inflammation. This study uses the World Health Organization's Study on global AGEing and adult health (SAGE) Mexico Wave 1 biomarker data (n = 1831) to evaluate if inflammation and central adiposity mediate the relationship between depression and diabetes. METHODS: Depression was estimated using a behavior-based diagnostic algorithm, inflammation using venous dried blood spot (DBS) CRP, central adiposity using waist-to-height ratio (WHtR), and uncontrolled diabetes using venous DBS-glycated hemoglobin (HbA1c). RESULTS: The association between depression and uncontrolled diabetes was partially mediated by CRP before but not after WHtR was considered. When WHtR was added to the model, it partially mediated the relationship between diabetes and depression while fully mediating the relationship between depression and CRP. CONCLUSIONS: These findings suggest that central adiposity may be a more significant mediator between diabetes and depression than inflammation and account for the relationship between these disorders and inflammation. Depression may cause an increase in central adiposity, which then may lead to diabetes, but the increase in known systemic inflammatory pathways caused by central adiposity may not be the key pathological mechanism.

[Health conditions, geriatric syndromes andnutritional status of older adults in Mexico.] / Condiciones de salud, síndromes geriátricos y estado nutricional de los adultos mayores en México.

OBJECTIVE: To generate an updated diagnosis of the health conditions, geriatric syndromes, and nutritional status of older Mexican adults. MATERIALS AND METHODS: Descriptive study with a sample of 9 047 older adults aged 60 years and over with national representativeness. We analyzed indicators related to health conditions, geriatric syndromes, and nutritional status, obtaining prevalence as well as tests of differences in proportions and means. RESULTS: Oldest older adults, women, and residents of rural areas showed the highest prevalence of chronic conditions, geriatric syndromes, and poor nutrition. CONCLUSIONS: The results of this study offer an updated insight of the health conditions, geriatric syndromes, and nutritional status of older Mexican adults, and show the main health needs that this age group faces, which in turn represent a challenge for the health system in Mexico.

OBJETIVO: Generar un diagnóstico actualizado de las con-diciones de salud, síndromes geriátricos y estado nutricional de los adultos mayores mexicanos. MATERIAL Y MÉTODOS: Estudio descriptivo con una muestra de 9 047 adultos mayo-res de 60 años o más con representatividad nacional. Se ana-lizaron indicadores relacionados con las condiciones de salud, síndromes geriátricos y el estado nutricional. Se reportan las principales prevalencias así como pruebas de diferencias de proporciones y medias. RESULTADOS: Los adultos mayores con mayor edad, mujeres y residentes de áreas rurales mos-traron las mayores prevalencias de padecimientos crónicos, síndromes geriátricos y mala nutrición. CONCLUSIONES: Los resultados de este estudio ofrecen un panorama actualizado de las condiciones de salud, síndromes geriátricos y estado nutricional de los adultos mayores mexicanos, y muestran las principales necesidades de salud que este grupo etario enfrenta, las cuales a su vez representan un reto para el sistema de salud en México.

Polypharmacy is associated with multiplem health-related outcomes in Mexican community-dwelling older adults.

OBJECTIVE: To determine the association between polypharmacy and multiple health-related outcomes in older adults. MATERIALS AND METHODS: We carried out a cross-sectional analysis with 274 community-dwelling older adults aged ≥60 years in Mexico City. We used the following health-related outcomes: frailty, dementia, functional capacity, falls, disability, and quality of life. The main exposure was polypharmacy (chronic use of six or more drugs). Ordinal logistic regression, binary logistic regression, Poisson regression, and linear regression models were used to estimate the association between polypharmacy and the outcomes analyzed. RESULTS: Polypharmacy was present in 45% of the sample. Polypharmacy was significantly associated with frailty status, and marginally, with dementia. We also observed significant associations for instrumental activities of daily living, falls, disability, and quality of life. CONCLUSIONS: Given that polypharmacy has reached levels of a global epidemic, it is necessary to take radical actions to reduce the concomitant problems of the use of multiple drugs.

OBJETIVO: Determinar la asociación entre la polifarmacia y múltiples resultados relacionados con la salud de los adultos mayores. MATERIAL Y MÉTODOS: Se llevó a cabo un análisis transversal con 274 adultos mayores que residen en comunidad, edad ≥60 años, en la Ciudad de México. Se utilizaron los siguientes resultados relacionados con la salud: fragilidad, demencia, capacidad funcional, caídas, discapacidad y calidad de vida. La exposición principal fue la polifarmacia (uso crónico de seis o más fármacos). Se utilizaron modelos de regresión logística ordinal, regresión logística binaria, regresión de Poisson y regresión lineal para estimar la asociación entre la polifarmacia y los resultados analizados. RESULTADOS: La polifarmacia estuvo presente en 45% de la muestra. La polifarmacia se asoció significativamente con el estado de fragilidad y marginalmente con la demencia. También se observaron asociaciones significativas para actividades instrumentales de la vida diaria, caídas, discapacidad y calidad de vida. CONCLUSIONES: Dado que la polifarmacia ha alcanzado niveles de epidemia global, es necesario tomar medidas radicales para reducir los problemas concomitantes del uso de múltiples medicamentos.

YUCCA4 overexpression modulates auxin biosynthesis and transport and influences plant growth and development via crosstalk with abscisic acid in Arabidopsis thaliana.

Auxin regulates a plethora of events during plant growth and development, acting in concert with other phytohormones. YUCCA genes encode flavin monooxygenases that function in tryptophan-dependent auxin biosynthesis. To understand the contribution of the YUCCA4 (YUC4) gene on auxin homeostasis, plant growth and interaction with abscisic acid (ABA) signaling, 35S::YUC4 seedlings were generated, which showed elongated hypocotyls with hyponastic leaves and changes in root system architecture that correlate with enhanced auxin responsive gene expression. Differential expression of PIN1, 2, 3 and 7 auxin transporters was detected in roots of YUC4 overexpressing seedlings compared to the wild-type: PIN1 was down-regulated whereas PIN2, PIN3 and PIN7 were up-regulated. Noteworthy, 35S::YUC4 lines showed enhanced sensitivity to ABA on seed germination and post-embryonic root growth, involving ABI4 transcription factor. The auxin reporter genes DR5::GUS, DR5::GFP and BA3::GUS further revealed that abscisic acid impairs auxin responses in 35S::YUC4 seedlings. Our results indicate that YUC4 overexpression influences several aspects of auxin homeostasis and reveal the critical roles of ABI4 during auxin-ABA interaction in germination and primary root growth.

Spatio-temporal evolution of climbing habit in the Dahlia-Hidalgoa group (Coreopsidae, Asteraceae).

In this paper we focus on Hidalgoa, a small genus distributed in cloud forest from Mexico to Colombia with the uncommon climbing habit of enlarging its petioles. This genus belongs to tribe Coreopsideae (Asteraceae), a group mostly from the Neotropics with a few taxa in Oceania and Polynesia. The phylogenetic position of Hidalgoa has not yet been determined though it will most probably be closely related to Dahlia. The aim of this paper is to understand the ecological and evolutionary consequences of the shift to a climbing growth form using a spatio-temporal approach to phylogenetic analyses, and by testing evolutionary models for ecological niche. Our results identified that Hidalgoa formed a sub- clade in a grade with Dahlia, with divergence occurring in the Pliocene. The ancestral life form for this clade was cryptophytic (e.g. geophytes). Analyses using the climate variables most important to the elements of the Dahlia-Hidalgoa clade indicate that they share the same preferences. Moreover, visualization by traitgrams of the significant climate variables shows no departure among clades. These results suggest that no evolutionary or ecological consequences have yet manifested, and that Hidalgoa can be considered a climbing Dahlia.

Socioeconomic inequalities in health and nutrition among older adults in Mexico.

OBJECTIVE: To analyze the socioeconomic inequalities in health among the population of older adults in Mexico. MATERIALS AND METHODS: Analysis of two national health surveys in Mexico (Ensanut 2012 and Ensanut 100k) in which inequality gradients are estimated for various health and nutrition outcomes of older adults over 60 years, using the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII). RESULTS: Older adults with lower socioeconomic status had worse levels of cognition, instrumental activities of daily living, depressive symptoms, muscle mass, low weight, and anemia. CONCLUSIONS: Substantial socioeconomic inequalities in health were observed in this study. Given the rapid growth of the population of older adults in Mexico, our results indicate that urgent actions are necessary to achieve health equity in this population group, particularly universal access to health, as well as universal coverage of health services.

OBJETIVO: Analizar las desigualdades socioeconómicas en salud entre la población de adultos mayores en México. MATERIAL Y MÉTODOS: Análisis de dos encuestas nacionales de salud en México (Ensanut 2012 y Ensanut 100k) en las que se estiman los gradientes de desigualdad para diversos desenlaces en salud y nutrición de los adultos mayores de 60 años en adelante, usando el Índice Relativo de Desigualdad (RII) y el Índice de la Pendiente de Desigualdad (SII). RESULTADOS: Los adultos mayores con menor nivel socioeconómico tuvieron peores niveles de cognición, actividades instrumentales de la vida diaria, síntomas depresivos, masa muscular y anemia. CONCLUSIONES: Se observaron desigualdades socioeconómicas en salud sustanciales. Dado el rápido crecimiento de la población de adultos mayores en México, nuestros resultados indican que son necesarias acciones urgentes para lograr la equidad en salud en este grupo poblacional, particularmente lograr el acceso universal a la salud, así como la cobertura universal de los servicios de salud.

Social determinants of health and frailty are associated with all-cause mortality in older adults.

OBJECTIVE: To examine the longitudinal association between the social determinants of health (SDH) and frailty status with all-cause mortality in older Mexican adults. MATERIALS AND METHODS: Longitudinal study with a sample of adults aged 60 and over of Study on Global AGEing and Adult Health (SAGE) in Mexico. A Cox proportional hazard model was used to estimate the SDH and frailty-related hazard ratios (HR) for mortality over the study period. RESULTS: Overall mortality rate was 16.9%. Higher education, having a higher frequency of inter-personal contacts (HR=0.96; p<0.01) reduced the risk of dying, after adjusting for potential confounders. While, not counting on someone to trust (HR= 1.59; p<0.03) and having a sense a lack of control over important decisions in life increased the mortality risk. CONCLUSIONS: Given that frailty and the SDH affect health using independent pathways, public health systems in Mexico could benefit from increasing the capacity of identifying frail and isolated older adults and providing a risk-stratified health care accordingly.

OBJETIVO: Examinar la asociación longitudinal entre los determinantes sociales en salud (DSS) y la fragilidad con la mortalidad por todas las causas en adultos mayores mexicanos. MATERIAL Y MÉTODOS: Estudio longitudinal con una muestra de adultos mayores de 60 años o más del estudio Envejecimiento Global y Salud de los Adultos (SAGE, por sus siglas en inglés) en México. Se utilizó el modelo riesgos proporcionales de Cox para estimar la asociación entre DSS y la fragilidad en la mortalidad. RESULTADOS: La tasa de mortalidad general fue 16.9%. Tener mayor educación y una mayor frecuencia de contactos interpersonales (HR= 0.96, p<0.01) reducen el riesgo de morir, después de ajustar por covariables. Mientras tanto, no contar con alguien en quien confiar (HR= 1.59; p<0.03) y tener una sensación de falta de control sobre las decisiones importantes en la vida aumentan el riesgo de mortalidad. CONCLUSIONES: Dado que la fragilidad y los DSS inciden sobre la salud usando vías independientes, el sistema de salud de México se beneficiaría al incrementar su capacidad para detectar a los adultos mayores frágiles y con aislamiento social, para proveer cuidados a la salud.

The Relationship Between Psychological Temporal Perspective and HIV/STI Risk Behaviors Among Male Sex Workers in Mexico City.

Men who have sex with men (MSM) face a disproportionate burden of HIV incidence and HIV prevalence, particularly young men who have sex with men. The aim of this article was to analyze the relation between a psychological temporal perspective and HIV/sexually transmitted infection (STI) risk behaviors among male sex workers (MSWs), a potentially highly present-oriented group of MSM. A total sample of 326 MSWs were included and responded to a validated psychological scale: the Zimbardo's Time Perspective Inventory; they also reported how frequently they engaged in protective behaviors against HIV and other STI risks behaviors, including condom use with casual and regular partners, as well as prior HIV testing. We adjusted structural equation models to analyze the relation between a psychological temporal perspective and HIV/STI risk behaviors. We found that orientation toward the past was correlated with decreased condom use with casual partners (ß = - 0.18; CI95% - 0.23, - 0.12). Future orientation was not associated with condom use with casual partners. Regarding condom use with regular partners, past and present orientation were related to lower likelihood of condom use (ß = - 0.23; CI95% - 0.29, - 0.17; ß = - 0.11; CI95% - 0.19, - 0.02), whereas future orientation increased the likelihood of condom use with regular partners (ß = 0.40; CI95% 0.31, 0.50). Time orientation (past, present, or future) did not predict the probability of having an HIV test. The design of HIV/STI prevention programs among vulnerable populations, such as MSM and MSWs, should consider specific time-frame mechanisms that can importantly affect sexual risk behavior decisions.

Repair of a Giant Omphalocele in an Infant With a Pericardial Implant Crosslinked With Oligourethane.

The giant omphalocele (GO) represents a challenge for the pediatric surgeon in its management and wall abdominoplasty. Here, we report the outcome of a case in which a GO in a newborn patient was repaired with an implant derived from decellularized bovine pericardium crosslinked with oligourethane. The implantation time was extended for 6 months. This was then followed up by the retrieval of the implant and the subsequent reconstruction in a second surgical time by the closure of the abdominal wall fascia. A short hospital stay, early integration into the patient's family environment, as well as early onset of the oral route without special care of the implant or reconstructed wall nor food restrictions were observed. The reduced presence of the complications described in the literature after application of surgical meshes suggests that this implant can be an effective and safe alternative method in the treatment of abdominal wall defects such as GO.

Disability, quality of life and all-cause mortality in older Mexican adults: association with multimorbidity and frailty.

BACKGROUND: Multimorbidity and frailty are relevant conditions among older adult population. There is growing evidence about their association with poor health outcomes like disability, worst quality of life, and death. Nonetheless, the independent associations of both conditions have been studied, and few evidence exists about an interaction between them. Our aims were to assess the association of frailty and multimorbidity with the disability, quality of life and all-cause mortality as well as to analyze a potential interaction between these conditions. METHODS: Analytical samples included 1410 respondents for disability and quality of life, and 1792 for mortality. We performed a longitudinal analysis with older Mexican adults aged 50, using data collected from the WHO's Study on global AGEing and Adult Health Waves 1 and 2. Disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), and quality of life using the WHOQOL (WHO Quality of Life) instrument. All-cause mortality was determined by reviewing death certificates. Associations of frailty and multimorbidity with disability, quality of life and mortality were estimated using linear regression and Cox proportional hazards models. RESULTS: Multimorbidity assessed through three patterns (cardiopulmonary, vascular-metabolic, and mental-musculoskeletal) was associated with the three outcomes in this study. Cardiopulmonary and mental-musculoskeletal patterns increased the WHODAS mean score (ß = 5.05; p < 0.01 and ß = 5.10; p < 0.01, respectively) and decreased WHOQOL score (ß = - 1.81; p < 0.01 and ß = - 2.99; p < 0.01, respectively). Vascular-metabolic was associated with mortality (HR = 1.47; p = 0.04), disability (ß = 3.27; p < 0.01) and quality of life (ß = - 1.30; p = 0.02). Frailty was associated with mortality (pre-frail: HR = 1.48; p = 0.02 and frail: HR = 1.68; p = 0.03), disability (pre-frail: ß = 5.02; p < 0.01; frail: ß = 13.29; p < 0.01) and quality of life (pre-frail: ß = - 2.23; p < 0.01; frail: ß = - 4.38; p < 0.01). Interaction terms of frailty and multimorbidity were not statistically significant. CONCLUSIONS: Multimorbidity and frailty are important predictors of poor health outcomes. These results highlight the importance of carrying out health promotion and prevention actions as well as specific interventions aimed at older adults who suffer from multimorbidity and frailty, in such a way that deleterious effects on health can be avoided.