[Results of surveys to users of IMSS children daycare centers during the COVID-19 pandemic]. / Resultados de encuestas a usuarios de guarderías IMSS durante la pandemia por COVID-19.

Background: Studies carried out in Mexico show that the COVID-19 pandemic has negatively impacted families in every field. Confinement has generated problems and economic, social and health instability in a large sector of the population, especially in the most vulnerable, to which children and adolescents are part of. Objective: To identify the impact of the confinement and closure of children daycare centers from the Instituto Mexicano del Seguro Social (IMSS) derived from the COVID-19 pandemic. Material and methods: Three questionnaire-type surveys were implemented via email for workers who were users of IMSS children daycare centers from September to November 2020. The surveys had a perception design, one- and two-stage, simple random and with results by segments. Results were obtained for independent proportions. The z-test was applied at 95% confidence. Results: Effects on workers and child users of the service derived from the closure of children daycare centers were observed, and it was greater in entities with closed children daycare centers than with those ones in operation (p < 0.0001). Conclusions: The negative impact derived from the closure of children daycare centers due to the confinement by COVID-19 in workers who use the service and their children was identified. The spheres with the greatest impact were the economic, the working environment, as well as the children's health (and their families).

Introducción: : estudios realizados en México muestran que la pandemia por COVID-19 ha impactado de forma negativa a las familias en todos los ámbitos. El confinamiento ha generado problemas e inestabilidad económica, social y en la salud en un gran sector de la población, especialmente en el más vulnerable, donde se encuentran los niños y adolescentes. Objetivo: identificar el impacto del confinamiento y el cierre de guarderías del Instituto Mexicano del Seguro Social (IMSS) derivado de la pandemia por COVID-19. Material y métodos: se aplicaron vía correo electrónico tres encuestas tipo cuestionario a trabajadores usuarios del servicio de guardería del IMSS de septiembre a noviembre de 2020. Las encuestas tenían diseño de percepción uni y bietápico, aleatorio simple y con resultados por segmentos. Se obtuvieron resultados para proporciones independientes. Se aplicó el z-test con un 95% de confianza. Resultados: se observó afectación en los trabajadores y en los niños usuarios del servicio derivado del cierre de las guarderías del IMSS, la cual fue mayor en las entidades con guarderías cerradas que en aquellas en operación (p < 0.0001). Conclusiones: se identificó el impacto negativo derivado del cierre de guarderías IMSS por el confinamiento por COVID-19 en trabajadores usuarios del servicio y sus hijos. Los ámbitos con más afectación fueron el económico, el laboral, así como la salud de los niños (y sus familias).

Risk factors for COVID-19 hospitalisations and deaths in Mexican children and adolescents: retrospective cross-sectional study.

OBJECTIVE: To describe the epidemiology and risk factors for hospitalisation and death in Mexican children under 18 years of age with COVID-19. DESIGN: Retrospective, cross-sectional and analytical study. SETTING: Mexican Ministry of Health open databases with COVID-19 cases occurred from 7 March 2020 to 30 September 2021. PARTICIPANTS: Mexican children under 18 years of age with COVID-19. MAIN OUTCOME MEASURES: COVID-19 hospitalisations and deaths were characterised by age group, sex, presence of pneumonia and comorbidities, intubation and intensive care unit admission, and institution that provided medical care. Cumulative incidence, mortality, case fatality rates and ORs for hospitalisation and death were estimated by age group. RESULTS: 5.5% (204 641) of national COVID-19 cases were children under 18 years of age: 2.9% under 1 year, 12.5% from 1 to 5 years, 15% from 6 to 9 years and 69.4% from 10 to 17 years. 4.6% of all cases were hospitalised, from which 54.6% were male, 35.3% were children under 1 year old, 39.6% were adolescents and 34% had pneumonia. Pneumonia developed in 2.3% of cases, from which 50% were adolescents. Case fatality rate was higher in children less than 1 year old (4.2%). Risk analyses showed that male sex (OR 1.16-1.28), history of pneumonia (OR 29.7-65.4), immunosuppression (OR 5.3-42.9), cardiovascular disease (OR 4.4-14.6) and other comorbidities (OR 5.4-19.1), as well as age less than 1 year (OR 20.1, 95% CI 18.8 to 21.4), confer a greater risk of hospitalisation; in addition to comorbidities, age less than 1 year (OR 16.6, 95% CI 14.1 to 19.6), history of pneumonia (OR 14.1-135.1) and being an adolescent from an indigenous community (OR 2.6, 95% CI 1.23 to 5.54, p=0.012) increase the risk of death. CONCLUSIONS: In Mexico, children less than 1 year old with COVID-19 have higher risk of hospitalisation and death than older children. Adolescents with COVID-19 in association with comorbidities develop adverse outcomes more frequently.

Impacto poblacional a 10 años de la vacunación contra rotavirus en México / Population impact of rotavirus vaccination in Mexico after 10 years

Resumen: Objetivo: Evaluar el impacto de la vacunación contra rotavirus (RV) a 10 años de su universalización sobre la morbimortalidad por enfermedad diarreica aguda (EDA) en niños mexicanos menores de cinco años. Material y métodos: Se compararon las medianas anuales de casos nuevos, defunciones y hospitalizaciones por EDA del periodo pre y posuniversalización; se calcularon reducciones absolutas y relativas, considerando significativos valores de p<0.05. Resultados: La mortalidad, hospitalizaciones y casos nuevos por EDA en menores de cinco años disminuyeron 52.6, 46 y 15.5% respectivamente, en el periodo posuniversalización. Durante la temporada de RV las reducciones en la mortalidad, hospitalizaciones y casos nuevos fueron de 66.9, 64.7 y 28.7%, respectivamente. Conclusiones: A partir de la universalización de la vacuna de RV en México, se aprecian reducciones importantes y sostenidas en la mortalidad, hospitalizaciones e incidencia por EDA, con menor impacto en esta última. El mayor impacto se observa durante la temporada de RV.

Abstract: Objective: To evaluate the impact of rotavirus (RV) vaccination after 10 years of it´s universalization on morbidity and mortality from Acute Diarrheal Disease (ADD) in mexican children under five years of age. Materials and methods: Annual median numbers for ADD new cases, hospitalizations and deaths were compared between pre and post universalization periods; absolute and relative reductions were calculated, considering p<0.05 values as significant. Results: Mortality, hospitalizations and new cases from ADD in children under five decreased 52.6, 46, and 15.5% respectively, in the posuniversalization period. During rotavirus seasons, reduction in mortality, hospitalizations and new cases was 66.9, 64.7, and 28.7% respectively. Conclusions: As of the universal introduction of RV vaccination in Mexico, significant and sustained reductions are appreciated for mortality and hospitalizations from ADD, less so for incidence. A most prominent effect is observed during the winter season.

[Population impact of rotavirus vaccination in Mexico after 10 years]. / Impacto poblacional a 10 años de la vacunación contra rotavirus en México.

OBJECTIVE: To evaluate the impact of rotavirus (RV) vaccination after 10 years of it´s universalization on morbidity and mortality from Acute Diarrheal Disease (ADD) in mexican children under five years of age. MATERIALS AND METHODS: Annual median numbers for ADD new cases, hospitalizations and deaths were compared between pre and post universalization periods; absolute and relative reductions were calculated, considering p<0.05 values as significant. RESULTS: Mortality, hospitalizations and new cases from ADD in children under five decreased 52.6, 46, and 15.5% respectively, in the posuniversalization period. During rotavirus seasons, reduction in mortality, hospitalizations and new cases was 66.9, 64.7, and 28.7% respectively. CONCLUSIONS: As of the universal introduction of RV vaccination in Mexico, significant and sustained reductions are appreciated for mortality and hospitalizations from ADD, less so for incidence. A most prominent effect is observed during the winter season.

OBJETIVO: Evaluar el impacto de la vacunación contra rotavirus (RV) a 10 años de su universalización sobre la morbimortalidad por enfermedad diarreica aguda (EDA) en niños mexicanos menores de cinco años. MATERIAL Y MÉTODOS: Se compararon las medianas anuales de casos nuevos, defunciones y hospitalizaciones por EDA del periodo pre y posuniversalización; se calcularon reducciones absolutas y relativas, considerando significativos valores de p<0.05. RESULTADOS: La mortalidad, hospitalizaciones y casos nuevos por EDA en menores de cinco años disminuyeron 52.6, 46 y 15.5% respectivamente, en el periodo posuniversalización. Durante la temporada de RV las reducciones en la mortalidad, hospitalizaciones y casos nuevos fueron de 66.9, 64.7 y 28.7%, respectivamente. CONCLUSIONES: A partir de la universaliza- ción de la vacuna de RV en México, se aprecian reducciones importantes y sostenidas en la mortalidad, hospitalizaciones e incidencia por EDA, con menor impacto en esta última. El mayor impacto se observa durante la temporada de RV.

Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS: We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS: From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION: Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING: Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

[Social determinants of infant mortality in socioeconomic deprived rural areas in Mexico]. / Determinantes sociales de la mortalidad infantil en municipios de bajo índice de desarrollo humano en México.

BACKGROUND: The aim of this study was to identify determinants of infant mortality in rural areas in Mexico and recommend strategies for its decrease. METHODS: A study was conducted in a sample of 16 municipalities among those with the lowest index of human development. Infant deaths were identified through official data, records and through interviews with civil authorities, health workers and community leaders. Mothers of children who died were also interviewed. RESULTS: In most cases, deaths were related with intermediate social determinants (living conditions and health services converged). The most important critical factors were the prevention programs and delays in receiving healthcare. Deficiencies in intersectorial policies to guarantee effective access to health services were found. CONCLUSIONS: To decrease infant mortality in rural areas of Mexico, geographic access has to be improved as well as investment in resources and training health personnel in intercultural competence and primary health care skills.

[Towards the eradication of poliomyelitis: Mexico's achievements and challenges]. / Hacia la erradicación de la poliomielitis: logros y retos en México.

Since the strategies to eradicate polio were implemented, the incidence of paralytic polio has dropped dramatically. Four main strategies have greatly contributed: a) High immunization coverage rate with oral polio vaccine (OPV), b) Supplementary immunization activities during the National Immunizations Days c) An effective epidemiological surveillance system for acute flaccid paralysis (AFP) and d) Intensified immunization activities in high risk areas. Three countries remain polio endemic, nevertheless, any country has a potential risk of the virus importation from one of these endemic areas; an accidental release of poliovirus from a research or clinical laboratory, or from having a circulating vaccine-derived poliovirus in the environment. The present document aims to provide an historical background that made possible the disease elimination in Mexico. Moreover, we discuss the challenges that every country needs to face in order to achieve a polio-free world.

Tos ferina, un problema vigente de salud pública en México: Planteamiento de la necesidad para introducir una nueva vacuna / Shaping a new strategy against B. pertussis: a public health problem in Mexico

A pesar de la vacunación contra B. pertussis, se sigue reportando un gran número de muertes por tos ferina a nivel mundial. La pérdida de la inmunidad a través de los años y el incremento de la incidencia en adolescentes y adultos han sustentado el papel de estos grupos de edad en la transmisión de la enfermedad. Diversos países han implementado nuevas estrategias de vacunación con la finalidad de reducir su transmisión y significado clínico. En México, la tos ferina es un problema de salud pública vigente, y su control presenta algunos obstáculos, como la sospecha clínica fuera de la etapa del lactante, la confirmación del diagnóstico, los esquemas de vacunación tardíos o incompletos y la dificultad para limitar su transmisibilidad. La introducción de nuevas estrategias de vacunación en adolescentes y adultos, así como en las mujeres embarazadas, contribuirían al control de la enfermedad y limitarían sus complicaciones.

Despite vaccination against pertussis, there are still a large number of pertussis deaths worldwide. Waning vaccine-induced immunity and the gradual increase in reported incidence among adolescents and adults have supported the role of these age groups in the transmission. Several countries have implemented a booster vaccination in order to reduce transmission and clinical significance. Pertussis is a current public health problem in Mexico. The clinical suspicion in toddlers, adolescents and adults, delayed or incomplete vaccination series and diagnosis confirmation are the most important challenges for pertussis control. The introduction of new vaccination strategies in adults and adolescents as well as pregnant women should improve disease control.

Congenital syphilis, a reemergent disease in Mexico: its epidemiology during the last 2 decades.

OBJECTIVE: To describe the epidemiologic profile of congenital syphilis in Mexico between 1990 and 2009. METHODS: The database of the General Direction of Epidemiology at the Ministry of Health in Mexico about congenital syphilis was reviewed. Data corresponding to the period between 1990 and 2009 were analyzed in every state of the Mexican republic. RESULTS: A total of 1717 cases of congenital syphilis were reported during the study period. A 16.6% increase was observed between 2005 and 2009 and the quinquennium between 2000 and 2004. A trend toward increase in the incidence of congenital syphilis was observed with 2.9 new cases for each 100,000 babies born alive. The states that displayed significant positive trends were as follows: Baja California, Colima, Chihuahua, Jalisco, Nayarit, Sinaloa, and Zacatecas. CONCLUSIONS: An increase in the number of cases of congenital syphilis is observed; the northern states are the ones that contribute the most to the statistics. There is a real need to refine the epidemiologic operations to detect and treat the cases of maternal and congenital syphilis in the country.

[Analysis of the mortality due to diarrhea in younger children, before and after the introduction of rotavirus vaccine]. / Mortalidad por enfermedad diarreica en menores, antes y después de la introducción de la vacuna contra el rotavirus.

OBJECTIVE: To analyze the mortality due to acute diarrhea in children younger than five years old, before and after the introduction of rotavirus vaccine in Mexico. MATERIAL AND METHODS: Number of deaths and mortality rates due to acute diarrhea were compared by children's age and states' vaccine status using annual percentage differences before (2000-2005) and after (2006-2007) the introduction of the HRV. RESULTS: From 2000-2007, deaths due to acute diarrhea in children under five years of age dropped 42%. In those states that received the HRV early in 2006, diarrhea mortality decreased between 2006-2007 15.8% in children younger than one year old and 22.7% in children 1-4 years old. DISCUSSION: The observed reduction in mortality due to acute diarrhea in children under five years of age after 2005 can be, in part, attributed to the HRV.

Mortalidad por enfermedad diarreica en menores, antes y después de la introducción de la vacuna contra el rotavirus / Analysis of the mortality due to diarrhea in younger children, before and after the introduction of rotavirus vaccine

Objetivo. Analizar la mortalidad por diarrea en menores de cinco años en México, antes y después de la vacunación contra el rotavirus. Material y métodos. Se compararon defunciones y mortalidad por diarrea mediante diferencias porcentuales anuales por grupo etario, antes (2000-2005) y después (2006-2007) de la vacunación. Resultados. Entre 2000 y 2007 la mortalidad por diarrea disminuyó 42%. En los estados con vacunación, la mortalidad se redujo 15.8 y 27.7% en menores de uno y de uno a cuatro años, respectivamente, en el periodo de 2006 a 2007. Discusión. La reducción observada en la mortalidad por diarrea en menores de cinco años después de 2005 puede atribuirse en parte a la vacunación contra el rotavirus.

Objective. To analyze the mortality due to acute diarrhea in children younger than five years old, before and after the introduction of rotavirus vaccine in Mexico. Material and Methods. Number of deaths and mortality rates due to acute diarrhea were compared by children’s age and states’ vaccine status using annual percentage differences before (2000-2005) and after (2006-2007) the introduction of the HRV. Results. From 2000-2007, deaths due to acute diarrhea in children under five years of age dropped 42%. In those states that received the HRV early in 2006, diarrhea mortality decreased between 2006-2007 15.8% in children younger than one year old and 22.7% in children 1-4 years old. Discussion. The observed reduction in mortality due to acute diarrhea in children under five years of age after 2005 can be, in part, attributed to the HRV.

Discrepancia entre los diagnósticos clínicos y por autopsia en un hospital pediátrico de tercer nivel / Discrepancy between clinical diagnoses versus autopsy findings in a third-level pediatric hospital

Introducción. La utilidad de la autopsia ha sido reconocida ampliamente para fines de educación médica y en la evaluación de la calidad diagnóstica y terapéutica. Desde 1972 hasta 2002, no se ha demostrado un descenso en el número de discrepancias entre los diagnósticos clínicos y de autopsia. El presente estudio permite determinar la concordancia entre los diagnósticos clínicos y de autopsia en una institución pediátrica de tercer nivel, como una herramienta para mejorar la calidad de atención médica. Los objetivos fueron: 1. Obtener el porcentaje de discordancia entre los diagnósticos clínicos y por autopsia en el Hospital Infantil de México Federico Gómez en el período de un año. 2. Determinar, de acuerdo a la clasificación de Goldman modificada por Battle, cuáles son las discrepancias más frecuentes. 3. Calcular la posible asociación entre número de ingresos, tiempo de hospitalización, edad del médico tratante y edad del paciente con el grado de discordancia entre los diagnósticos. Material y métodos. Se efectuó un estudio retrospectivo, observacional, comparativo y transversal. Se analizaron todos los casos de autopsia atendidos entre el 1 de enero y el 31 de diciembre de 2004. Las variables estudiadas fueron: edad, género, número de ingresos y su duración, principal servicio tratante, tipo de autopsia, diagnóstico clínico principal, probable causa de muerte clínica y por autopsia. Resultados. En 2004 se registraron 209 defunciones, con 62 autopsias (29.7%). Hubo discrepancia en 15 casos (24.6%), y de acuerdo a los criterios de Goldman modificados por Battle, se encontró error clase I en 5 casos (8.2%) y clase II en 4 casos (6.6%). No hubo diferencias estadísticamente significativas entre los tipos de error cuando se compararon los pacientes por grupo de edad, duración de la hospitalización, número de ingresos y edad del médico tratante. Conclusión. El mayor número de discrepancias entre diagnósticos clínicos y por autopsia se observó en casos con enfermedades infecciosas. Esta discordancia es similar a la reportada en otros sitios del mundo.

Introduction. The autopsy has been recognized as a useful tool for medical education and for quality improvement, evaluating therapeutic and diagnostic measures. In the last 50 years, the autopsy rates have constantly declined. Interestingly, between 1972 and 2002, the discrepancies between clinical diagnoses and autopsy findings haven't diminished, even with all the technological improvements now available. This research enables us to determine the discrepancy rate between our clinical diagnosis and autopsy results, as well as the main diseases that need diagnostic or therapeutic improvements in our hospital. Our objectives were: 1. To obtain the discrepancy rate between clinical diagnoses and autopsy findings. 2. To determine the most frequent type of discrepancy, according with the Goldman criteria, modified by Battle, and 3. To evaluate the possible association of these discrepancies with the number of admissions, length of stay, patient's age and physician's age. Material and methods. A retrospective, observational, comparative and transversal study. Sample: all cases that had an autopsy between January 1st and December 31th 2004. Cases with an incomplete record were excluded. The main variables analyzed were: age, gender, number of admissions and their length of stay, main clinical service, type of autopsy, main clinical and autopsy diagnoses and probable cause of death. Results. In the year 2004 there were 209 deaths registered with 62 autopsies (29.7% rate). We found a discrepancy in the main clinical diagnosis in 15 cases (24.6%); and, according with the Goldman criteria, modified by Battle, we found a class I discrepancy in 5 cases (8.2%) and a class II discrepancy in 4 cases (6.6%). We didn't find significant statistical differences in patients older than a year compared with patients less than 1 year old. There were no significant differences regarding the number of admissions and their length of stay, or variations the artendiag with the attending physician's age. Conclusions. Our main discrepancies were in infectious diseases, similar to other studies. Our discrepancy numbers are similar to others reported in the world. It is important to analyze these cases with the physicians involved, and together learn from our mistakes, working to improve diagnostic and therapeutic measures, and overall, quality of care.