Mapping potentially avoidable premature mortality in Mexico: subnational, sex, and age group trends.

This study aimed to analyze the trends and disparities in preventable or treatable mortality rates among different age groups, sexes, and states in Mexico from 2000 to 2019. Using national data from 2000 to 2019, we examined potentially avoidable premature mortality (PAPM) rates, disaggregated into preventable and treatable deaths. Trends over time were visualized using the average annual percent change (AAPC) derived from joinpoint analysis. Subnational analysis was conducted to identify state-specific trends for each sex and age group. The national PAPM rate decreased from 297 deaths per 100,000 in 2000 to 281 per 100,000 in 2019. Potentially preventable premature mortality (PPPM) rates were more pronounced than potentially treatable premature mortality (PTPM) rates, with 170 deaths per 100,000 and 111 per 100,000, respectively. Sex-based disparities were observed particularly in the working-age population. Our analysis at the state level revealed significant differences in trends, as certain regions experienced reductions while others rises. These disparities became more evident when examining the different aspects of PAPM, especially in terms of PTPM. Our study highlights the differences in PAPM rates across age groups, sexes, and states in Mexico. Despite a general downward trend, upward trends were observed in the male working-age group. There was also wide variation among states, highlighting the need to use PAPM in conjunction with other health metrics for a holistic health analysis.

Hospital accreditation in Mexico fails to improve the quality of healthcare: lessons from an impact evaluation.

Healthcare quality in low- and middle-income countries poses a significant challenge, contributing to heightened mortality rates from treatable conditions. The accreditation of health facilities was part of the former health reform in Mexico, proposed as a mechanism to enhance healthcare quality. This study assesses the performance of hospital accreditation in Mexico, utilizing indicators of effectiveness, efficiency, and safety. Employing a longitudinal approach with controlled interrupted time series analysis (C-ITSA) and fixed effects panel analysis, administrative data from general hospitals in Mexico is scrutinized. Results reveal that hospital accreditation in Mexico fails to enhance healthcare quality and, disconcertingly, indicates deteriorating performance associated with increased hospital mortality. Amidst underfunded health services, the implemented accreditation model proves inadequately designed to uplift care quality. A fundamental redesign of the public hospital accreditation model is imperative, emphasizing incentives for structural enhancement and standardized processes. Addressing the critical challenge of improving care quality is urgent for Mexico's healthcare system, necessitating swift action to achieve effective access as a benchmark for universal healthcare coverage.

Height & income: Labor returns of health in Mexico from 2000 to 2018.

Investment in health has been proposed as a mechanism to promote upward social mobility. Previous analyses have reported inconsistent estimates of the returns to investment in health in Mexico based on different models for different years. We aim to estimate returns for Mexico using data from four time points Adult height and labor income are drawn from the periodical national health and nutrition surveys-a group of relatively standardized surveys-that are representative of individuals living in the country in 2000, 2006, 2012 & 2018. These surveys collect anthropometric measurements and information on individuals' labor income. We estimated Mincerian models separately for men and women using OLS, Heckman, instrumental variables, and Heckman with instrumental variables models. Our results indicate significant and positive returns to health for the four surveys, similar in magnitude across years for women and with variations for men. By 2018, returns to health were about 7.4% per additional centimeter in height for females and 9.3% for males. Investments in health and nutrition during childhood and adolescence that increase health capital-measured as adult height-may promote social mobility in Mexico and similar countries to the extent that these investments differentially increase health capital among the poor.

Navigating HER2-Low Testing in Invasive Breast Cancer: Update Recommendations for Pathologists.

The article discusses the importance of accurately distinguishing HER2-low from HER2-negative breast cancer, as novel ADCs have demonstrated activity in a large population of patients with HER2-low-expressing BC. While current guidelines recommend a dichotomous classification of HER2 as either positive or negative, the emergence of the HER2-low concept calls for standardization of HER2 testing in breast cancer, using currently available assays to better discriminate HER2 levels. This review covers the evolution and latest updates of the ASCO/CAP guidelines relevant to this important biomarker in breast cancer, including still-evolving concepts such as HER2 low, HER2 heterogeneity, and HER2 evolution. Our group presents the latest Mexican recommendations for HER2 status evaluation in breast cancer, considering the ASCO/CAP guidelines and introducing the HER2-low concept. In the era of personalized medicine, accurate HER2 status assessment remains one of the most important biomarkers in breast cancer, and the commitment of Mexican pathologists to theragnostic biomarker quality is crucial for providing the most efficient care in oncology.

SARS-CoV-2 infection by trimester of pregnancy and adverse perinatal outcomes: a Mexican retrospective cohort study.

OBJECTIVE: Conflicting evidence for the association between COVID-19 and adverse perinatal outcomes exists. This study examined the associations between maternal COVID-19 during pregnancy and adverse perinatal outcomes including preterm birth (PTB), low birth weight (LBW), small-for-gestational age (SGA), large-for-gestational age (LGA) and fetal death; as well as whether the associations differ by trimester of infection. DESIGN AND SETTING: The study used a retrospective Mexican birth cohort from the Instituto Mexicano del Seguro Social (IMSS), Mexico, between January 2020 and November 2021. PARTICIPANTS: We used the social security administrative dataset from IMSS that had COVID-19 information and linked it with the IMSS routine hospitalisation dataset, to identify deliveries in the study period with a test for SARS-CoV-2 during pregnancy. OUTCOME MEASURES: PTB, LBW, SGA, LGA and fetal death. We used targeted maximum likelihood estimators, to quantify associations (risk ratio, RR) and CIs. We fit models for the overall COVID-19 sample, and separately for those with mild or severe disease, and by trimester of infection. Additionally, we investigated potential bias induced by missing non-tested pregnancies. RESULTS: The overall sample comprised 17 340 singleton pregnancies, of which 30% tested positive. We found that those with mild COVID-19 had an RR of 0.89 (95% CI 0.80 to 0.99) for PTB and those with severe COVID-19 had an RR of 1.53 (95% CI 1.07 to 2.19) for LGA. COVID-19 in the first trimester was associated with fetal death, RR=2.36 (95% CI 1.04, 5.36). Results also demonstrate that missing non-tested pregnancies might induce bias in the associations. CONCLUSIONS: In the overall sample, there was no evidence of an association between COVID-19 and adverse perinatal outcomes. However, the findings suggest that severe COVID-19 may increase the risk of some perinatal outcomes, with the first trimester potentially being a high-risk period.

Anaplastic large cell lymphoma with ALK::ATIC fusion mimicking a histiocytic sarcoma debuting as an anterior thoracic soft tissue tumor with exceptional clinicopathological, morphological and molecular features.

A 56-year-old woman debuted with a palpable painless mass in the anterior thorax wall at the level of the second and third right parasternal intercostal space, which progressively increased in size over 5 months accompanied by localized skin rash, mild dyspnea and chest pain when changing position. Imaging studies showed a soft tissue mass measuring 75 × 62 mm and a density of 34 Hounsfield Units that had caused the lysis of the costal arches and grew expansively towards the anterior mediastinum, without identifying mediastinal adenopathies only by this imaging method. Core biopsy was performed, which was initially diagnosed as histiocytic sarcoma (HS); however, when the diagnostic panel was expanded to include molecular and NGS studies, the final diagnosis was anaplastic large cell lymphoma with ALK::ATIC fusion. Here, we report a very rare neoplasm with unusual clinical presentation, histopathology and molecular features.

Genetic parameters for different types of medullated fibre in Alpacas.

The quality of alpaca textile fibre has great potential, especially if objectionable fibres (coarse and medullated fibres) that cause itching are reduced, considering that objectionable fibres can be identified by diameter and medullation types. The objective of this study was to estimate genetic parameters for medullar types and their respective diameters to evaluate the possibility of incorporating them as selection criteria in alpaca breeding programmes. The research used 3149 alpaca fibre samples collected from 2020 to 2022, from a population of 1626 Huacaya type alpacas. The heritability and correlations of the percentages of non-medullated (NM), fragmented medulle (FM), uncontinuous medullated (UM), continuous medullated (CM), and strongly medullated (SM) fibres were analysed, also the fibre diameter (FD) for each of the medullation types. The heritability estimated for medullation types were 0.25 ± 0.01, 0.18 ± 0.01, 0.10 ± 0.01, 0.20 ± 0.01 and 0.11 ± 0.01 for NM, FM, UM, CM and SM, respectively. The genetic correlations for medullation categories ranged from 0.15 ± 0.03 to 0.66 ± 0.02 (in absolute values). The heritabilility estimated for fibre diameter (FD) of each of the medullation types were 0.29 ± 0.03, 0.27 ± 0.02, 0.35 ± 0.02, 0.30 ± 0.02, 0.25 ± 0.02 and 0.10 ± 0.02 for FD, FD_NM, FD_FM, FD_UM, FD_CM and FD_SM, respectively. The genetic correlations for fibre diameter of the medullation types ranged from 0.04 ± 0.04 to 0.97 ± 0.01. FD, NM and FM are the main traits to be used as selection criteria under a genetic index, since they would reduce fibre diameter, and also increase NM and FM, and, in addition reducing indirectly CM, SM, and SM_FD. Therefore, the quality of alpaca fibre could be improved.

Mapping potentially avoidable premature mortality in Mexico: subnational, sex, and age group trends / Identificación de la mortalidad prematura potencialmente evitable en México: tendencias subnacionales, por sexo y grupo de edad / Mapeamento da mortalidade prematura potencialmente evitável no México: tendências subnacionais, por sexo e faixa etária

Abstract: This study aimed to analyze the trends and disparities in preventable or treatable mortality rates among different age groups, sexes, and states in Mexico from 2000 to 2019. Using national data from 2000 to 2019, we examined potentially avoidable premature mortality (PAPM) rates, disaggregated into preventable and treatable deaths. Trends over time were visualized using the average annual percent change (AAPC) derived from joinpoint analysis. Subnational analysis was conducted to identify state-specific trends for each sex and age group. The national PAPM rate decreased from 297 deaths per 100,000 in 2000 to 281 per 100,000 in 2019. Potentially preventable premature mortality (PPPM) rates were more pronounced than potentially treatable premature mortality (PTPM) rates, with 170 deaths per 100,000 and 111 per 100,000, respectively. Sex-based disparities were observed particularly in the working-age population. Our analysis at the state level revealed significant differences in trends, as certain regions experienced reductions while others rises. These disparities became more evident when examining the different aspects of PAPM, especially in terms of PTPM. Our study highlights the differences in PAPM rates across age groups, sexes, and states in Mexico. Despite a general downward trend, upward trends were observed in the male working-age group. There was also wide variation among states, highlighting the need to use PAPM in conjunction with other health metrics for a holistic health analysis.

Resumen: Este estudio tuvo como objetivo analizar las tendencias y disparidades en las tasas de mortalidad evitable o tratable en diferentes grupos de edad, sexo y estados de México en el período de 2000 a 2019. Con base en datos nacionales de 2000 a 2019, se analizaron las tasas de mortalidad prematura potencialmente evitable (MPPE), dividiéndolas en muertes evitables y tratables. Las tendencias a largo plazo se observaron mediante el cambio porcentual promedio anual (CPPA) obtenido del análisis de regresión joinpoint. Se realizó un análisis subnacional para identificar las tendencias específicas de cada estado por sexo y grupo de edad. La tasa nacional de MPPE disminuyó de 297 muertes por cada 100.000 en el año 2000 a 281 por cada 100.000 en el 2019. Las tasas de mortalidad prematura potencialmente prevenible (MPPP) fueron mayores que las de mortalidad prematura potencialmente tratable (MPPT), con 170 muertes por cada 100.000 y 111 por cada 100.000, respectivamente. Este análisis reveló variaciones sustanciales en las tendencias por estado, ya que algunas regiones tuvieron disminución mientras que otras un aumento. Estas disparidades se hicieron más evidentes cuando los aspectos de la MPPE se analizaron con más detalle, especialmente en términos de MPPT. Este estudio destaca las variaciones en las tasas de la MPPE entre grupo de edad, sexo y estados en México. A pesar de una tendencia general hacia el declive, se observaron tendencias al alza en la población masculina en edad de trabajar. Además, se observaron considerables variaciones entre estados, lo que muestra la necesidad de aplicar la MPPE en conjunto con otros indicadores de salud para realizar un análisis holístico de salud.

Resumo: Este estudo teve como objetivo analisar as tendências e disparidades nas taxas de mortalidade evitável ou tratável em diferentes faixas etárias, sexos e estados do México de 2000 a 2019. Usando dados nacionais de 2000 a 2019, examinamos as taxas de mortalidade prematura potencialmente evitável (MPPE), dividindo-as entre mortes evitáveis e tratáveis. As tendências ao longo do tempo foram visualizadas usando a variação percentual média anual (VPMA) obtida a partir da análise de regressão joinpoint. Foi efectuada uma análise subnacional para identificar as tendências específicas de cada estado para cada sexo e faixa etária. A taxa nacional de MPPE diminuiu de 297 mortes a cada 100 mil em 2000 para 281 a cada 100 mil em 2019. As taxas de mortalidade prematura potencialmente prevenível (MPPP) foram mais acentuadas do que as mortalidade prematura potencialmente tratável (MPPT), com 170 mortes a cada 100 mil e 111 a cada 100 mil, respetivamente. A nossa análise a nível estatal revelou variações substanciais nas tendências, uma vez que certas regiões registaram reduções enquanto outras apresentaram aumentos. Essas disparidades tornaram-se mais evidentes quando os aspectos da MPPE foram analisados mais detalhadamente, especialmente em termos de MPPT. Nosso estudo destaca as variações nas taxas de MPPE entre faixas etárias, sexos e estados no México. Apesar de uma tendência geral para o declínio, foram observadas tendências de aumento na população masculina em idade ativa. Além disso, foram observadas variações consideráveis entre os estados, o que reforça a necessidade de aplicar a MPPE em conjunto com outros indicadores de saúde para efetuar uma análise holística da saúde.

How predictive of SARS-CoV-2 infection are clinical characteristics at presentation among individuals with COVID-like symptoms treated at the Mexican Institute of Social Security.

BACKGROUND: The COVID-19 pandemic has progressed rapidly, with the emergence of new virus variants that pose challenges in treating infected individuals. In Mexico, four epidemic waves have been recorded with varying disease severity. To understand the heterogeneity in clinical presentation over time and the sensitivity and specificity of signs and symptoms in identifying COVID-19 cases, an analysis of the changes in the clinical presentation of the disease was conducted. AIM: To analyze the changes in the clinical presentation of COVID-19 among 3.38 million individuals tested for SARS-CoV-2 at the Mexican Social Security Institute (IMSS) from March 2020 to October 2021 and evaluate the predictivity of signs and symptoms in identifying COVID-19 cases. METHODS: A retrospective analysis of clinical presentation patterns of COVID-19 among individuals treated at IMSS was performed, contrasting the signs and symptoms among SARS-CoV-2-positive individuals with those who tested negative for the virus but had respiratory infection symptoms. The sensitivity and specificity of each sign and symptom in identifying SARS-CoV-2 infection were estimated. RESULTS: The set of signs and symptoms reported for COVID-19-suspected patients treated at IMSS were not highly specific for SARS-CoV-2 positivity. The signs and symptoms exhibited variability based on age and epidemic wave. The area under the receiver operating characteristic (ROC) curve was 0.62 when grouping the five main symptoms (headache, dyspnea, fever, arthralgia, and cough). Most of the individual symptoms had ROC values close to 0.5 (16 out of 22 between 0.48 and 0.52), indicating non-specificity. CONCLUSIONS: The results highlight the difficulty in making a clinical diagnosis of COVID-19 due to the lack of specificity of signs and symptoms. The variability of clinical presentation over time and among age groups highlights the need for further research to differentiate whether the changes are due to changes in the virus, who is becoming infected, or the population, particularly with respect to prior infection and vaccination status.

Genome-Wide Association Study of Fiber Diameter in Alpacas.

The aim of this study was the identification of candidate genomic regions associated with fiber diameter in alpacas. DNA samples were collected from 1011 female Huacaya alpacas from two geographical Andean regions in Peru (Pasco and Puno), and three alpaca farms within each region. The samples were genotyped using an Affymetrix Custom Alpaca genotyping array containing 76,508 SNPs. After the quality controls, 960 samples and 51,742 SNPs were retained. Three association study methodologies were performed. The GWAS based on a linear model allowed us to identify 11 and 35 SNPs (-log10(p-values) > 4) using information on all alpacas and alpacas with extreme values of fiber diameter, respectively. The haplotype and marker analysis method allowed us to identify nine haplotypes with standardized haplotype heritability higher than six standard deviations. The selection signatures based on cross-population extended haplotype homozygosity (XP-EHH) allowed us to identify 180 SNPs with XP-EHH values greater than |3|. Four candidate regions with adjacent SNPs identified via two association methods of analysis are located on VPA6, VPA9, VPA29 and one chromosomally unassigned scaffold. This study represents the first analysis of alpaca whole genome association with fiber diameter, using a recently assembled alpaca SNP microarray.

Who is most at risk of dying if infected with SARS-CoV-2? A mortality risk factor analysis using machine learning of patients with COVID-19 over time: a large population-based cohort study in Mexico.

OBJECTIVE: COVID-19 would kill fewer people if health programmes can predict who is at higher risk of mortality because resources can be targeted to protect those people from infection. We predict mortality in a very large population in Mexico with machine learning using demographic variables and pre-existing conditions. DESIGN: Cohort study. SETTING: March 2020 to November 2021 in Mexico, nationally represented. PARTICIPANTS: 1.4 million laboratory-confirmed patients with COVID-19 in Mexico at or over 20 years of age. PRIMARY AND SECONDARY OUTCOME MEASURES: Analysis is performed on data from March 2020 to November 2021 and over three phases: (1) from March to October in 2020, (2) from November 2020 to March 2021 and (3) from April to November 2021. We predict mortality using an ensemble machine learning method, super learner, and independently estimate the adjusted mortality relative risk of each pre-existing condition using targeted maximum likelihood estimation. RESULTS: Super learner fit has a high predictive performance (C-statistic: 0.907), where age is the most predictive factor for mortality. After adjusting for demographic factors, renal disease, hypertension, diabetes and obesity are the most impactful pre-existing conditions. Phase analysis shows that the adjusted mortality risk decreased over time while relative risk increased for each pre-existing condition. CONCLUSIONS: While age is the most important predictor of mortality, younger individuals with hypertension, diabetes and obesity are at comparable mortality risk as individuals who are 20 years older without any of the three conditions. Our model can be continuously updated to identify individuals who should most be protected against infection as the pandemic evolves.

[Trend in inequities in homicides in Mexico, 2000-2021: longitudinal ecological studyDesigualdades nas taxas de homicídios do México no período de 2000 a 2021: estudo ecológico longitudinal]. / Tendencia de las inequidades en homicidios en México para el periodo de 2000 a 2021: análisis ecológico longitudinal.

Objective: To document trends in inequity in homicide rates in Mexico for the period 2000-2021, at the state and national levels. Methods: An observational, longitudinal ecological study was conducted in which standardized homicide mortality rates were estimated, by municipality and sex. Municipalities were classified in five groups, according to the Social Lag Index. The absolute inequality gap was obtained, as well as differences between groups with very high and very low social lag, for each year of the study period. Results: In the 32 states, an increase was observed in the rate of death by homicide, with higher rates among men but a greater relative increase among women (+127.86% vs. +110.03%). The absolute gap between municipalities with very high and very low social lag narrowed in the period, due to higher homicide rates in municipalities with low social lag and a modest reduction in municipalities with very high social lag. Conclusions: In Mexico, between 2000 and 2021, the absolute gap in deaths by homicide between municipalities with very high and very low social lag declined due to higher homicide rates in municipalities with lower social lag. It is necessary to strengthen policies and actions aimed at addressing the social determinants of interpersonal violence.

Objetivo: Documentar as tendências de desigualdade nas taxas de homicídio do México no período de 2000 a 2021 em nível estadual e nacional. Métodos: Foi realizado um estudo ecológico observacional e longitudinal no qual se estimaram taxas padronizadas de mortalidade por homicídio por município e sexo. Os municípios foram classificados em cinco grupos conforme o índice de defasagem social. Calculou-se a diferença absoluta de desigualdade como a diferença entre os grupos com defasagem social muito alta e muito baixa, para cada ano do período estudado. Resultados: Em todos os 32 municípios, observou-se aumento na taxa de mortalidade por homicídio; as taxas foram mais altas entre homens, embora o aumento relativo tenha sido maior entre as mulheres (variação percentual: 127,86% comparado a 110,03%). A diferença absoluta entre municípios com defasagem social muito alta e muito baixa diminuiu no período estudado devido ao aumento na taxa de mortalidade por homicídio nos municípios com defasagem social baixa e uma certa redução nos que tinham defasagem social muito alta. Conclusões: No México, entre 2000 e 2021, a diferença absoluta nas mortes por homicídio entre municípios com defasagem social muito alta e muito baixa diminuiu devido ao aumento na taxa de homicídios nos municípios com uma menor defasagem social. É necessário reforçar políticas e iniciativas que abordam os determinantes sociais da violência interpessoal.

Tendencia de las inequidades en homicidios en México para el periodo de 2000 a 2021: análisis ecológico longitudinal

[RESUMEN]. Objetivo. Documentar las tendencias de la inequidad en las tasas de homicidio en México para el periodo 2000-2021, a nivel estatal y nacional. Métodos. Se realizó un estudio ecológico observacional y longitudinal en el cual se estimaron las tasas estandarizadas de mortalidad de homicidios por municipio y sexo. Clasificando a los municipios de acuerdo con el Índice de Rezago Social en cinco grupos. Se obtuvo la brecha absoluta de desigualdad, así como la diferencia entre los grupos de muy alto y muy bajo rezago social para cada año del periodo estudiado. Resultados. En las 32 entidades se observa un incremento en la tasa de mortalidad por homicidios, con tasas mayores entre hombres, pero un incremento relativo mayor entre mujeres (porcentaje de cambio: 127,86 vs 110,03). La brecha absoluta entre municipios de muy alto y muy bajo rezago social se ha cerrado en el periodo por el incremento en la tasa de mortalidad por homicidios en los municipios de bajo rezago social y por una cierta reducción en los de muy alto rezago social. Conclusiones. En México, entre 2000 y 2021 se redujo la brecha absoluta en las defunciones por homicidios entre municipios de muy alto y muy bajo rezago social debido al incremento en la tasa de homicidios en los municipios de menor rezago social. Es necesario reforzar políticas y acciones encaminadas a atender los determinantes sociales de la violencia interpersonal.

[ABSTRACT]. Objective. To document trends in inequity in homicide rates in Mexico for the period 2000–2021, at the state and national levels. Methods. An observational, longitudinal ecological study was conducted in which standardized homicide mortality rates were estimated, by municipality and sex. Municipalities were classified in five groups, accor- ding to the Social Lag Index. The absolute inequality gap was obtained, as well as differences between groups with very high and very low social lag, for each year of the study period. Results. In the 32 states, an increase was observed in the rate of death by homicide, with higher rates among men but a greater relative increase among women (+127.86% vs. +110.03%). The absolute gap between municipalities with very high and very low social lag narrowed in the period, due to higher homicide rates in municipalities with low social lag and a modest reduction in municipalities with very high social lag. Conclusions. In Mexico, between 2000 and 2021, the absolute gap in deaths by homicide between municipa- lities with very high and very low social lag declined due to higher homicide rates in municipalities with lower social lag. It is necessary to strengthen policies and actions aimed at addressing the social determinants of interpersonal violence.

[RESUMO]. Objetivo. Documentar as tendências de desigualdade nas taxas de homicídio do México no período de 2000 a 2021 em nível estadual e nacional. Métodos. Foi realizado um estudo ecológico observacional e longitudinal no qual se estimaram taxas padroni- zadas de mortalidade por homicídio por município e sexo. Os municípios foram classificados em cinco grupos conforme o índice de defasagem social. Calculou-se a diferença absoluta de desigualdade como a diferença entre os grupos com defasagem social muito alta e muito baixa, para cada ano do período estudado. Resultados. Em todos os 32 municípios, observou-se aumento na taxa de mortalidade por homicídio; as taxas foram mais altas entre homens, embora o aumento relativo tenha sido maior entre as mulheres (variação per- centual: 127,86% comparado a 110,03%). A diferença absoluta entre municípios com defasagem social muito alta e muito baixa diminuiu no período estudado devido ao aumento na taxa de mortalidade por homicídio nos municípios com defasagem social baixa e uma certa redução nos que tinham defasagem social muito alta. Conclusões. No México, entre 2000 e 2021, a diferença absoluta nas mortes por homicídio entre municí- pios com defasagem social muito alta e muito baixa diminuiu devido ao aumento na taxa de homicídios nos municípios com uma menor defasagem social. É necessário reforçar políticas e iniciativas que abordam os determinantes sociais da violência interpessoal.

Evaluating the design of the Integrated Care for Older People: a theory of change approach.

Introduction: Given the progressive aging of the population, there is an urgent need at the health system level to implement effective models to care for older people (OP). Healthy aging is imperative to reach the Sustainable Development Goals. The World Health Organization (WHO) developed the Integrated Care for Older People (ICOPE) strategy to address this challenge. Implementing ICOPE requires its adaption to a specific context. We propose a pathway for such adaptation through an evaluation of the design of ICOPE; thus, we aim to describe the Theory of Change (ToC) of ICOPE and evaluate it for its implementation in Mexico City. Methods: Based on the WHO and published literature documentation, we drafted an initial ToC for ICOPE. Then, we validated the ToC with experts in ICOPE, after which we evaluated and refined it by discussing the causal pathway, intervention required to activate it, rationale, and assumptions in consecutive workshops with 91 stakeholders and healthcare workers, using the nominal group technique to reach a consensus. Results: The resulting ToC has the potential to contribute to healthy aging by three expected impacts: (1) prevention, reversal, or delaying of the decline of intrinsic capacity (IC) in OP; (2) improvement of the quality of life of OP; and (3) increase of disability-free life expectancy. The ICOPE causal pathway had ten preconditions, including the availability of resources, identifying at-risk individuals, available treatments, and evaluating results. Discussion: We adapted ICOPE to a specific implementation context by evaluating its ToC in a participatory process that allows us to identify challenges and address them, at least in terms of the guidelines to operate the strategy. As ICOPE is an approach for a primary healthcare system, its adoption in a community healthcare program is promising and feasible. Evaluation as a tool could contribute to the design of effective interventions. The evaluation of the design of ICOPE for its implementation contributes to the strength of its potential to improve care for OP. This design for implementing ICOPE has the potential to be applied to similar contexts, for example, in other lower-middle-income countries.

Changes in the epidemiological profile of SARS-CoV-2-positive individuals in Mexico across pandemic waves as an explanation of fatality reduction: a retrospective observational study.

OBJECTIVES: We aim to quantify shifts in hospitalisation and mortality and how those were related to the first three phases of the epidemic and individuals' demographics and health profile among those with a positive test for SARS-CoV-2 treated at the Mexican Social Security Institute's facilities from March 2020 to October 2021. DESIGN: Retrospective observational study using interrupted time series analysis to identify changes in hospitalisation rate and case fatality rate (CFR) by epidemic wave. SETTING: Data from the Mexican Institute of Social Security's (IMSS) Online Influenza Epidemiological Surveillance System (SINOLAVE) that include all individuals that sought care at IMSS facilities all over Mexico. PARTICIPANTS: All individuals included in the SINOLAVE with a positive PCR or rapid test for SARS-CoV-2. PRIMARY AND SECONDARY OUTCOME MEASURES: Monthly test positivity rates, hospitalisation rates, CFRs and prevalence of relevant comorbidities by age group. RESULTS: From March 2020 to October 2021, the CFR declined between 1% and 3.5%; the declines were significant for those 0-9, 20-29, 30-39, 40-49 and 70 and older. The decline was steep during the first wave and was less steep or was temporarily reversed at the beginning of the second and third waves (changes in the trend of about 0.3% and 3.8%, and between 0.7% and 3.8%, respectively, for some age groups), but then continued to the end of the analytical period. Prevalence of diabetes, hypertension and obesity among patients testing positive also declined-two for most age groups (reductions of up to 10 percentage points for diabetes, 12 percentage points for hypertension and 19 percentage points for obesity). CONCLUSION: Data suggest that the decrease in COVID-19 fatality rate is at least partially explained by a change in the profile of those contracting the disease, that is, a falling proportion of individuals with comorbidities across all age groups.

Evolution of differences in clinical presentation across epidemic waves among patients with COVID-like-symptoms who received care at the Mexican Social Security Institute.

Background: Timely monitoring of SARS-CoV-2 variants is crucial to effectively managing both prevention and treatment efforts. In this paper, we aim to describe demographic and clinical patterns of individuals with COVID-19-like symptoms during the first three epidemic waves in Mexico to identify changes in those patterns that may reflect differences determined by virus variants. Methods: We conducted a descriptive analysis of a large database containing records for all individuals who sought care at the Mexican Social Security Institute (IMSS) due to COVID-19-like symptoms from March 2020 to October 2021 (4.48 million records). We described the clinical and demographic profile of individuals tested (3.38 million, 32% with PCR and 68% with rapid test) by test result (positives and negatives) and untested, and among those tested, and the changes in those profiles across the first three epidemic waves. Results: Individuals with COVID-19-like symptoms were older in the first wave and younger in the third one (the mean age for those positive was 46.6 in the first wave and 36.1 in the third wave; for negatives and not-tested, the mean age was 41 and 38.5 in the first wave and 34.3 and 33.5 in the third wave). As the pandemic progressed, an increasing number of individuals sought care for suspected COVID-19. The positivity rate decreased over time but remained well over the recommended 5%. The pattern of presenting symptoms changed over time, with some of those symptoms decreasing over time (dyspnea 40.6 to 14.0%, cough 80.4 to 76.2%, fever 77.5 to 65.2%, headache 80.3 to 78.5%), and some increasing (odynophagia 48.7 to 58.5%, rhinorrhea 28.6 to 47.5%, anosmia 11.8 to 23.2%, dysgeusia 11.2 to 23.2%). Conclusion: During epidemic surges, the general consensus was that any individual presenting with respiratory symptoms was a suspected COVID-19 case. However, symptoms and signs are dynamic, with clinical patterns changing not only with the evolution of the virus but also with demographic changes in the affected population. A better understanding of these changing patterns is needed to improve preparedness for future surges and pandemics.

Socioeconomic and geographic inequities in vaccination among children 12 to 59 months in Mexico, 2012 to 2021.

Objective: To document the evolution of socioeconomic and geographical inequalities in childhood vaccination in Mexico from 2012 to 2021. Methods: Repeated cross-sectional analysis using three rounds of National Health and Nutrition Surveys (2012, 2018, and 2021). Dichotomous variables were created to identify the proportion of children who received no dose of each vaccine included in the national immunization schedule (BCG; diphtheria, pertussis, and tetanus-containing; rotavirus; pneumococcal conjugate; and measles, mumps, and rubella [MMR]), and the proportion completely unvaccinated. The distribution of unvaccinated children was analyzed by state, and by socioeconomic status using the concentration index. Results: The prevalence of completely unvaccinated children in Mexico was low, with 0.3% children in 2012 and 0.8% children in 2021 receiving no vaccines (p = 0.070). Notwithstanding, for each vaccine, an important proportion of children missed receiving any dose. Notably, the prevalence of MMR unvaccinated children was 10.2% (95% CI 9.2-11.1) in 2012, 22.3% (95% CI 20.9-23.8) in 2018, and 29.1% (95% CI 26.3-31.8) in 2021 (p < 0.001 for the difference between 2012 and 2021). The concentration index indicated pro-rich inequalities in non-vaccination for 2 of 5 vaccines in 2012, 3 of 5 vaccines in 2018, and 4 of 5 vaccines in 2021. There were marked subnational variations. The percentage of MMR unvaccinated children ranged from 3.3% to 17.9% in 2012, 5.5% to 36.5% in 2018, and 13.1% to 72.5% in 2021 across the 32 states of Mexico. Conclusions: Equitable access to basic childhood vaccines in Mexico has deteriorated over the past decade. Vigilant equity monitoring coupled with tailored strategies to reach those left out is urgently required.

Intestinal-type adenocarcinoma arising from a villous adenoma in the renal pelvis in the context of a kidney abscess: Case report.

Villous adenoma is a benign neoplasm with an exceptional presentation in the renal pelvis, hence very few cases have been reported. Herein we present the case of a patient who presented with left flank pain clinically suggestive of complicated pyelonephritis, culminating in simple nephrectomy with a villous adenoma in the renal pelvis as histopathological finding associated to the presence of a microscopic focus of intestinal-type adenocarcinoma.

Socioeconomic and geographic inequities in vaccination among children 12 to 59 months in Mexico, 2012 to 2021

[ABSTRACT]. Objective. To document the evolution of socioeconomic and geographical inequalities in childhood vaccina- tion in Mexico from 2012 to 2021. Methods. Repeated cross-sectional analysis using three rounds of National Health and Nutrition Surveys (2012, 2018, and 2021). Dichotomous variables were created to identify the proportion of children who received no dose of each vaccine included in the national immunization schedule (BCG; diphtheria, pertussis, and tetanus-containing; rotavirus; pneumococcal conjugate; and measles, mumps, and rubella [MMR]), and the proportion completely unvaccinated. The distribution of unvaccinated children was analyzed by state, and by socioeconomic status using the concentration index. Results. The prevalence of completely unvaccinated children in Mexico was low, with 0.3% children in 2012 and 0.8% children in 2021 receiving no vaccines (p = 0.070). Notwithstanding, for each vaccine, an important proportion of children missed receiving any dose. Notably, the prevalence of MMR unvaccinated children was 10.2% (95% CI 9.2–11.1) in 2012, 22.3% (95% CI 20.9–23.8) in 2018, and 29.1% (95% CI 26.3–31.8) in 2021 (p < 0.001 for the difference between 2012 and 2021). The concentration index indicated pro-rich inequalities in non-vaccination for 2 of 5 vaccines in 2012, 3 of 5 vaccines in 2018, and 4 of 5 vaccines in 2021. There were marked subnational variations. The percentage of MMR unvaccinated children ranged from 3.3% to 17.9% in 2012, 5.5% to 36.5% in 2018, and 13.1% to 72.5% in 2021 across the 32 states of Mexico. Conclusions. Equitable access to basic childhood vaccines in Mexico has deteriorated over the past decade. Vigilant equity monitoring coupled with tailored strategies to reach those left out is urgently required.

[RESUMEN]. Objetivo. Documentar la evolución de las inequidades socioeconómicas y geográficas en la vacunación infantil en México del 2012 al 2021. Métodos. Se llevó a cabo un análisis transversal repetido con tres rondas (2012, 2018 y 2021) de la Encuesta Nacional de Salud y Nutrición (ENSANUT). Se crearon variables dicotómicas para determinar la proporción de la población infantil que no había recibido cada una de las vacunas incluidas en el calendario nacional de vacunación (BCG; difteria, tos ferina y tétanos; rotavirus; conjugado neumocócico; y sarampión, parotiditis y rubéola [triple viral]) y la proporción de la población infantil completamente sin vacunar. La distribución de la población infantil sin vacunar se analizó por estado y nivel socioeconómico mediante el índice de concentración. Resultados. La prevalencia de la población infantil completamente sin vacunar en México fue baja, con 0,3% en el 2012 y 0,8% en el 2021 de la población infantil que no recibió ninguna vacuna (p = 0,070). No obstante, en relación con cada vacuna, una gran proporción de población infantil no recibió ninguna dosis. En particu- lar, la prevalencia de la población infantil sin vacunarse con la triple viral fue de 10,2% (IC del 95% 9,2–11,1) en el 2012, 22,3% (IC del 95% 20,9–23,8) en el 2018 y 29,1% (IC del 95 % 26,3–31,8) en el 2021 (p < 0,001 para la diferencia entre el 2012 y el 2021). El índice de concentración reveló desigualdades que favorecen a los estratos más ricos en la probabilidad de no estar vacunado para 2 de las 5 vacunas en 2012, en 3 de las 5 vacunas en 2018, y en 4 de las 5 vacunas en el 2021. Asimismo, hubo marcadas variaciones subnacionales: el porcentaje de la población infantil que no recibió la vacuna triple viral osciló entre 3,3% y 17,9% en el 2012, entre 5,5% y 36,5% en el 2018 y entre 13,1% y 72,5% en el 2021 en los 32 estados de México. Conclusiones. El acceso equitativo a las vacunas infantiles básicas en México se ha deteriorado en el último decenio. Es urgentemente necesario un monitoreo vigilante de la equidad, así como estrategias adaptadas, para poder vacunar a la población al margen.

[RESUMO]. Objetivo. Documentar a evolução das desigualdades socioeconômicas e geográficas na vacinação infantil no México, no período entre 2012 e 2021. Métodos. Foi realizada a análise repetida de dados transversais obtidos em três ciclos da Pesquisa Nacional de Saúde e Nutrição do México (2012, 2018 e 2021). Variáveis dicotômicas foram elaboradas para estimar o percentual de crianças que não receberam nenhuma dose de cada uma das vacinas do calendário nacio- nal de vacinação (a saber: vacina BCG, vacina contra difteria, coqueluche e tétano, vacina contra rotavírus, vacina pneumocócica conjugada e vacina contra sarampo, caxumba e rubéola [SCR]) e a proporção de crianças totalmente não vacinadas. O índice de concentração foi usado para analisar a distribuição das cri- anças não vacinadas por estado e condição socioeconômica. Resultados. A prevalência de crianças totalmente não vacinadas foi baixa no país (0,3% em 2012 e 0,8% em 2021, p = 0,070). Porém, um percentual significativo deixou de receber alguma dose de vacina. A prevalência de crianças não vacinadas com a vacina SCR foi 10,2% (IC 95% 9,2-11,1) em 2012, 22,3% (IC 95% 20,9-23,8) em 2018 e 29,1% (IC 95% 26,3-31,8) em 2021 (p < 0,001 para a diferença entre 2012 e 2021). O índice de concentração indicou desigualdade de renda entre vacinados e não vacinados com relação a 2 das 5 vacinas em 2012, 3 das 5 vacinas em 2018 e 4 das 5 vacinas em 2021. Houve uma grande variação geográfica na vacinação infantil. Em particular, o percentual de não vacinados com a vacina SCR nos 32 estados do país variou de 3,3% a 17,9% em 2012, 5,5% a 36,5% em 2018 e 13,1% a 72,5% em 2021. Conclusões. Ocorreu uma piora no acesso equitativo à vacinação básica infantil na última década no Méx- ico. É imprescindível monitorar atentamente a equidade e implementar estratégias específicas para garantir a cobertura vacinal de todos.

Readiness for Integrated Care of Older People: A Cross-Sectional Study in Mexico.

AIM: To evaluate the readiness of the Mexican healthcare system to implement the integrated care for older people (ICOPE) approach into an existing healthcare model. METHODS: We conducted a cross-sectional study with data from 2473 healthcare workers analyzed using the model for understanding success in quality (MUSIQ) framework to gather data from healthcare professionals. Their perceptions regarding the readiness for ICOPE were assessed across five dimensions: team, microsystem, infrastructure, organization, and external environment. RESULTS: Only 717 (29%) of the participants believed ICOPE could be successfully implemented in Mexico without any modifications. A total of 1261 (51%) participants rated the readiness of ICOPE with some barriers. The main barriers were reallocating resources and the external environment. OBSERVATION: Mexico's healthcare system faces barriers to innovation that could hinder the successful integration of the ICOPE approach. A systematic identification of these barriers provides an opportunity to suggest adaptations and refinements to increase the probability of success. Using the contextual factors identified as facilitators and the proposal of interventions such as the ICOPE app could improve the chances of success. CONCLUSION: The participants of this study evaluated ICOPE as ready to implement, with some contextual barriers. The readiness evaluation supports the stakeholders' and policymakers' decisions in implementing and monitoring the program in a natural setting. Evaluating the readiness of the intervention increases the possibility of aligning the innovation with contextual factors, increasing the chances of its successful adoption and implementation.