Análisis de los argumentos recibidos en la consulta pública para el etiquetado frontal de advertencia mexicano.

OBJETIVO: Analizar los diferentes elementos en los argumentos recibidos durante la consulta pública del Proyecto de Modificación a la Norma Oficial Mexicana-051 (NOM-051), con énfasis en la protección de niñas, niños y adolescentes (NNA). Material y métodos. Se analizó la información de 1 095 argumentos, se identificó a los actores clave y se realizó un análisis de contenido para conocer la postura, a favor o en contra de los numerales relacionados con la protección a NNA. El análisis se hizo en el programa NVivo. RESULTADOS: Se identificaron 781 actores clave. Durante la consulta pública se identificaron cuatro tácticas del sector privado para interferir en el proceso de la NOM-051: a) grupos fachada que enviaron comentarios en contra de la NOM-051; b) cuestionar la evidencia científica sobre la relación del consumo de edulcorantes y el desarrollo de obesidad en escolares; c) cuestionar la efectividad del uso del etiquetado de advertencia para edulcorantes; d) responsabilizar a los individuos de su enfermedad. Conclusión. La interferencia del sector privado en el proceso de implementación de la NOM-051 fue evidente en los argumentos enviados durante la consulta pública.

Post-COVID-19 Conditions Among Children 90 Days After SARS-CoV-2 Infection.

Importance: Little is known about the risk factors for, and the risk of, developing post-COVID-19 conditions (PCCs) among children. Objectives: To estimate the proportion of SARS-CoV-2-positive children with PCCs 90 days after a positive test result, to compare this proportion with SARS-CoV-2-negative children, and to assess factors associated with PCCs. Design, Setting, and Participants: This prospective cohort study, conducted in 36 emergency departments (EDs) in 8 countries between March 7, 2020, and January 20, 2021, included 1884 SARS-CoV-2-positive children who completed 90-day follow-up; 1686 of these children were frequency matched by hospitalization status, country, and recruitment date with 1701 SARS-CoV-2-negative controls. Exposure: SARS-CoV-2 detected via nucleic acid testing. Main Outcomes and Measures: Post-COVID-19 conditions, defined as any persistent, new, or recurrent health problems reported in the 90-day follow-up survey. Results: Of 8642 enrolled children, 2368 (27.4%) were SARS-CoV-2 positive, among whom 2365 (99.9%) had index ED visit disposition data available; among the 1884 children (79.7%) who completed follow-up, the median age was 3 years (IQR, 0-10 years) and 994 (52.8%) were boys. A total of 110 SARS-CoV-2-positive children (5.8%; 95% CI, 4.8%-7.0%) reported PCCs, including 44 of 447 children (9.8%; 95% CI, 7.4%-13.0%) hospitalized during the acute illness and 66 of 1437 children (4.6%; 95% CI, 3.6%-5.8%) not hospitalized during the acute illness (difference, 5.3%; 95% CI, 2.5%-8.5%). Among SARS-CoV-2-positive children, the most common symptom was fatigue or weakness (21 [1.1%]). Characteristics associated with reporting at least 1 PCC at 90 days included being hospitalized 48 hours or more compared with no hospitalization (adjusted odds ratio [aOR], 2.67 [95% CI, 1.63-4.38]); having 4 or more symptoms reported at the index ED visit compared with 1 to 3 symptoms (4-6 symptoms: aOR, 2.35 [95% CI, 1.28-4.31]; ≥7 symptoms: aOR, 4.59 [95% CI, 2.50-8.44]); and being 14 years of age or older compared with younger than 1 year (aOR, 2.67 [95% CI, 1.43-4.99]). SARS-CoV-2-positive children were more likely to report PCCs at 90 days compared with those who tested negative, both among those who were not hospitalized (55 of 1295 [4.2%; 95% CI, 3.2%-5.5%] vs 35 of 1321 [2.7%; 95% CI, 1.9%-3.7%]; difference, 1.6% [95% CI, 0.2%-3.0%]) and those who were hospitalized (40 of 391 [10.2%; 95% CI, 7.4%-13.7%] vs 19 of 380 [5.0%; 95% CI, 3.0%-7.7%]; difference, 5.2% [95% CI, 1.5%-9.1%]). In addition, SARS-CoV-2 positivity was associated with reporting PCCs 90 days after the index ED visit (aOR, 1.63 [95% CI, 1.14-2.35]), specifically systemic health problems (eg, fatigue, weakness, fever; aOR, 2.44 [95% CI, 1.19-5.00]). Conclusions and Relevance: In this cohort study, SARS-CoV-2 infection was associated with reporting PCCs at 90 days in children. Guidance and follow-up are particularly necessary for hospitalized children who have numerous acute symptoms and are older.

Scaling Up Breastfeeding Programs in Mexico: Lessons Learned from the Becoming Breastfeeding Friendly Initiative.

BACKGROUND: Given the magnitude of the health and economic burden of inadequate breastfeeding practices in Mexico, there is an urgency to improve breastfeeding practices to increase the health and well-being of children and mothers. The Becoming Breastfeeding Friendly (BBF) Toolbox was recently developed to guide countries in assessing their readiness to and progress with scale-up of breastfeeding protection, promotion, and support and to develop policy recommendations to high-level decision makers. OBJECTIVE: The aim of this study was to document the BBF process in Mexico, which led to evidence-based recommendations for policymakers to improve breastfeeding protection, promotion, and support in the country. METHODS: We followed the BBF methodology. First, a group of experts, with the use of scientific and gray literature, face-to-face interviews, and their own experience, analyzed and assigned a score to each of the 8 gears from the BBF index and identified scaling-up gaps on the basis of the Breastfeeding Gear Model. Then, we developed and presented evidence-based recommendations to improve breastfeeding protection, promotion, and support. RESULTS: Mexico's BBF score was 1.4 out of a maximum total of 3 points, which indicates that there is a low to moderate scaling-up environment to protect, promote, and support breastfeeding. None of the gears were rated as "outstanding," and the legislation and policies gear was the only one rated as strong. CONCLUSIONS: The BBF initiative is a useful tool for assessing the environment for breastfeeding. The Mexican environment for breastfeeding is weak. On the basis of these results, it is strongly recommended to raise national awareness on breastfeeding, incorporate the Code of Marketing of Breastmilk Substitutes in the Mexican legislations, extend maternity leave to 6 mo, and strengthen evidence-based advocacy and hence the political will that is needed to secure stable funding and resources for a successful national strategy for the protection, promotion, and support of breastfeeding in Mexico.

Can "Becoming Breastfeeding Friendly" Impact Breastfeeding Protection, Promotion, and Support in Mexico? A Qualitative Study.

BACKGROUND: The Becoming Breastfeeding Friendly (BBF) initiative includes a guide that helps countries worldwide assess their readiness to scale up national breastfeeding programs. Country committees of breastfeeding experts across government, academia, and civil society engage with BBF by applying the BBF toolbox that includes (1) the BBF Index (BBFI) to measure and score a country's breastfeeding environment, (2) case studies that illustrate how countries have created enabling environments for breastfeeding, and (3) a 5-meeting process, during which country committees develop policy recommendations intended to improve breastfeeding outcomes based on the BBFI scores. OBJECTIVE: This study seeks to understand how the application of the BBF toolbox impacted plans to improve the enabling environment for breastfeeding in Mexico. METHODS: Semi-structured interviews were conducted with Mexico's 11 BBF country committee members about the 5-meeting process between May and June 2017. Audio recordings were transcribed and were coded and analyzed using a grounded theory approach. RESULTS: Three major themes emerged: (1) the unique enabling environment for breastfeeding consisted of obstacles and opportunities for improvement, (2) favorable country committee member dynamics positively affected the utility of the BBF toolbox, and (3) BBF revealed and shaped country committee members' shared vision of change that laid the foundation for a shared public policy agenda. CONCLUSIONS: Becoming Breastfeeding Friendly can generate multisectoral breastfeeding champions who can advance the public policy agenda to improve breastfeeding outcomes at the national level both in Mexico and elsewhere.

WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders.

This guidance details the needs of children, and the qualities of parenting that meet those needs. Parental mental disorders can damage the foetus during pregnancy through the action of drugs, prescribed or abused. Pregnancy and the puerperium can exacerbate or initiate mental illness in susceptible women. After their birth, the children may suffer from the social disadvantage associated with severe mental illness. The parents (depending on the disorder, its severity and its persistence) may have intermittent or prolonged difficulties with parenting, which may sometimes result in childhood psychological disturbance or child maltreatment. This guidance considers ways of preventing, minimizing and remedying these effects. Our recommendations include: education of psychiatrists and related professions about the effect of parental mental illness on children; revision of psychiatric training to increase awareness of patients as caregivers, and to incorporate relevant assessment and intervention into their treatment and rehabilitation; the optimum use of pharmacological treatment during pregnancy; pre-birth planning when women with severe mental illness become pregnant; development of specialist services for pregnant and puerperal women, with assessment of their efficacy; community support for parenting by mothers and fathers with severe mental disorders; standards of good practice for the management of child maltreatment when parents suffer from mental illness; the importance of multi-disciplinary teamwork when helping these families, supporting their children and ensuring child protection; the development of child and adolescent mental health services worldwide.