Presymptomatic Testing for Huntington's Disease in Mexico: 28 Years of Experience.

INTRODUCTION: Huntington's disease (HD) is a genetic neurodegenerative disorder with dominant inheritance. Our center in Mexico City has offered presymptomatic testing (PT) since 1995. OBJECTIVE: To describe the main clinical and demographic characteristics of at-risk HD individuals who applied to the PT program, the reasons for seeking it, and the molecular results. METHODS: A cross-sectional study was conducted with sociodemographic and clinical data of all PT applicants from 1995-2023. Reasons for seeking PT were assessed using a modified questionnaire. In addition, anxiety, and depressive symptoms before and after PT were evaluated with Beck's instruments; cognitive impairment (CI) was assessed with the Mini-Mental State Examination (MMSE) and molecular results. RESULTS: 214 people applied for PT (2.1% of the at-risk population identified in our center); 63% were women (mean age of 37.11 years). 204 (95.3%) were accepted and 190 received results. 70% indicated that the main reason for applying for PT was to inform their offspring about the risk of inheriting HD. Significant differences were observed in the reasons for seeking PT by age group. Although some subjects received treatment, Beck's instrument scores did not indicate special attention or pharmacological treatment. The MMSE showed probable CI in 20 subjects. Of those who received results, 37% were carriers of a full penetrance allele. CONCLUSION: Our center has the only formal PT program for HD in Mexico. The reasons for seeking PT are varied and age-related. Although PT is offered to all subjects at risk for HD, uptake remains low.

Prevalence of different variations of non-consented care during the childbirth process in Mexico by geographical regions: comparing ENDIREH survey data from 2016 to 2021.

INTRODUCTION: Non-consented care, a form of obstetric violence involving the lack of informed consent for procedures, is a common but little-understood phenomenon in the global public health arena. The aim of this secondary analysis was to measure the prevalence and assess change over time of non-consented care during childbirth in Mexico in 2016 and 2021, as well as to examine the association of sociodemographic, pregnancy-, and childbirth-factors with this type of violence. METHODS: We measured the prevalence of non-consented care and three of its variations, forced sterilization or contraception, forced cesarean section, and forced consent on paperwork, during childbirth in Mexico for 2016 (N = 24,036) and 2021 (N = 19,322) using data from Mexico's cross-sectional National Survey on the Dynamics of Household Relationships (ENDIREH). Weighted data were stratified by geographical regions. We performed adjusted logistic regression analyses to explore associations. RESULTS: The national prevalence of non-consented care and one of its variations, pressure to get a contraceptive method, increased from 2016 to 2021. A decrease in the prevalence was observed for forced contraception or sterilization without knowledge, forcing women to sign paperwork, and non-consented cesarean sections nationally and in most regions. Women between the ages of 26 and 35 years, married, cohabiting with partner, living in urban settings, who do not identify as Indigenous, and who received prenatal services or gave birth at the Mexican Institute of Social Security (IMSS) facilities experienced a higher prevalence of non-consented care. Being 26 years of age and older, living in a rural setting, experiencing stillbirths in the last five years, having a vaginal delivery, receiving prenatal services at IMSS, or delivering at a private facility were significantly associated with higher odds of reporting non-consented care. CONCLUSION: While a decrease in most of the variations of non-consented care was found, the overall prevalence of non-consented care and, in one of its variations, pressure to get contraceptives, increased at a national and regional level. Our findings suggest the need to enforce current laws and strengthen health systems, paying special attention to the geographical regions and populations that have experienced higher reported cases of this structural problem.

Plasmodium vivax Infections among Immigrants from China Traveling to the United States.

Beginning in 2023, we observed increased Plasmodium vivax malaria cases at an institution in Los Angeles, California, USA. Most cases were among migrants from China who traveled to the United States through South and Central America. US clinicians should be aware of possible P. vivax malaria among immigrants from China.

Integrating socioeconomic and ecological data into restoration practice.

Driven by the United Nations Decade on Restoration and international funding initiatives, such as the Mangrove Breakthrough, investment in mangrove restoration is expected to increase. Yet, mangrove restoration efforts frequently fail, usually because of ad hoc site-selection processes that do not consider mangrove ecology and the socioeconomic context. Using decision analysis, we developed an approach that accounts for socioeconomic and ecological data to identify sites with the highest likelihood of mangrove restoration success. We applied our approach in the Biosphere Reserve Marismas Nacionales Nayarit, Mexico, an area that recently received funding for implementing mangrove restoration actions. We identified 468 potential restoration sites, assessed their restorability potential based on socioeconomic and ecological metrics, and ranked sites for implementation with spatial optimization. The metrics we used included favorable conditions for propagules to establish and survive under sea-level rise, provision of ecosystem services, and community dynamics. Sites that were selected based on socioeconomic or ecological metrics alone had lower likelihood of mangrove restoration success than sites that were selected based on integrated socioeconomic and ecological metrics. For example, selecting sites based on only socioeconomic metrics captured 16% of the maximum attainable value of functioning mangroves able to provide propagules to potential restoration sites, whereas selecting sites based on ecological and socioeconomic metrics captured 46% of functioning mangroves. Our approach was developed as part of a collaboration between nongovernmental organizations, local government, and academics under rapid delivery time lines given preexisting mangrove restoration implementation commitments. The systematic decision process we used integrated socioeconomic and ecological considerations even under short delivery deadlines, and our approach can be adapted to help mangrove restoration site-selection decisions elsewhere.

Integración de datos socioeconómicos y ecológicos en las prácticas de restauración Resumen Se espera que la inversión en la restauración de los manglares incremente debido a la Década de Restauración de las Naciones Unidad y las iniciativas internacionales de financiamiento, como The Mangrove Breakthrough. Sin embargo, los esfuerzos de restauración de manglares fallan con frecuencia, generalmente por los procesos de selección de sitios ad­hoc que no consideran la ecología del manglar y el contexto socioeconómico. Usamos el análisis de decisiones para desarrollar una estrategia que considera los datos socioeconómicos y ecológicos para identificar los sitios con mayor probabilidad de éxito de restauración. Aplicamos nuestra estrategia en la Reserva de la Biósfera Marismas Nacionales Nayarit, México, un área que recibió financiamiento reciente para la restauración del manglar. Identificamos 468 sitios potencialmente restaurables, evaluamos su potencial de restauración con base en medidas ecológicas y socioeconómicas y clasificamos los sitios para la implementación con la optimización espacial. Las medidas que usamos incluían las condiciones favorables para que los propágulos se establezcan y sobrevivan con el incremento en el nivel del mar, el suministro de servicios ambientales y las dinámicas de la comunidad. Los sitios seleccionados sólo con base en las medidas ecológicas o socioeconómicas tuvieron una menor probabilidad de éxito de restauración que los sitios que se seleccionaron con base en medidas socioeconómicas y ecológicas integradas. Por ejemplo, la selección de sitios con base sólo en las medidas socioeconómicas capturó el 16% del máximo valor alcanzable de manglares funcionales capaces de proporcionar propágulos a los sitios potenciales de restauración, mientras que la selección basada en medidas ecológicas y socioeconómicas capturó el 46% de los manglares funcionales. Desarrollamos nuestra estrategia como parte de una colaboración entre organizaciones no gubernamentales, el gobierno local y académicos sujetos a una fecha pronta de entrega debido a los compromisos preexistentes para la restauración de manglares. El proceso de decisión sistemática que usamos integró las consideraciones ecológicas y socioeconómicas incluso con plazos cortos de entrega. Nuestra estrategia puede adaptarse para apoyar en la selección de sitios de restauración de manglares en otros sitios.

Pediatric tuberculosis in Mexico: A retrospective analysis of 100 patients.

Background: Analyzing the epidemiology and clinical manifestations of pediatric tuberculosis in endemic regions is crucial to meet the goal of ending tuberculosis. The objective was to assess the various clinical scenarios of tuberculosis in a large pediatric cohort in Mexico. Methods: This retrospective study from a pediatric referral center in Mexico included patients diagnosed with tuberculosis from 2012 to 2021. We analyzed clinical data and diagnostic study results, including demographic characteristics, underlying medical conditions, BCG vaccination, clinical presentation, imaging findings, microbiologic data, treatment, and clinical outcomes. Basic descriptive statistics and Chi-squared analysis were performed to summarize the metadata of pediatric patients with different clinical presentations of tuberculosis and evaluate their association with mortality, respectively. Results: A total of 100 patients were included with a mean age of 7.76 years ± 1.49 years. The most prevalent clinical presentation was pulmonary tuberculosis (n = 51). Only 51 patients were immunized with Bacillus Calmette-Guérin vaccine. The most commons symptoms were fever, cough and weight loss. Among patients with meningeal tuberculosis (n = 14), the most common clinical signs were seizures, fever, and vomiting. Cure was achieved in 52 patients, 12 patients died, and 36 continue in treatment. Clinical presentation of tuberculosis (p-value = 0.009) and immunodeficiency (p-value = 0.015) were significantly associated with mortality. Conclusions: Increasing the visibility of tuberculosis is imperative to end this disease. We report relevant clinical data of a large pediatric tuberculosis cohort, stratified by the different forms of disease. A high index of suspicion of tuberculosis is required for a timely diagnosis and treatment initiation, particularly among immunocompromised individuals, in whom mortality is higher.

"That is when I understood everything": Ideological trajectories of pro-choice female doctors in Mexico.

OBJECTIVES: There is little evidence about how physicians become abortion clinicians or advocates. We describe the ideological trajectories of pro-choice female Mexican doctors and the factors that made them pro-choice. STUDY DESIGN: In this qualitative study, we conducted semistructured interviews with members of the Mexican Network of Female Pro-choice Physicians. Participants came from eight diverse states. We used a feminist epistemology approach and analyzed data using inductive coding as well as a priori categories (becoming pro-choice, trajectories, and training). RESULTS: We included 24 female pro-choice physicians. We identified five intersecting factors that influenced becoming pro-choice: feminism, personal experiences, confrontation with the inequalities and violence that women experience, role models, and routine exposure to abortion care. Participants described three ideological trajectories: being pro-choice before studying medicine, not having a specific opinion, and changing from "pro-life" to "pro-choice." Participants described the absence of abortion training in medical schools, stigmatizing training, and the use of alternative training sources. CONCLUSIONS: In the absence of training on abortion during medical education, a combination of intersecting personal as well as work-related experience may turn doctors into pro-choice abortion clinicians and/or advocates. The findings of this study may be used to develop comprehensive medical curricula as well as strategies directed at doctors who have never received training on abortion care, such as promoting interactions with nonmedical abortion providers, education on inequalities and violence against women, moving beyond public health to a human rights and gender perspective, and exposure to routine safe abortion care. IMPLICATIONS: Mexican female doctors become pro-choice clinicians who provide abortion care and/or advocates in spite of their medical education.

Diabetes subgroups and sociodemographic inequalities in Mexico: a cross-sectional analysis of nationally representative surveys from 2016 to 2022.

Background: Differences in the prevalence of four diabetes subgroups have been reported in Mexico compared to other populations, but factors that may contribute to these differences are poorly understood. Here, we estimate the prevalence of diabetes subgroups in Mexico and evaluate their correlates with indicators of social disadvantage using data from national representative surveys. Methods: We analyzed serial, cross-sectional Mexican National Health and Nutrition Surveys spanning 2016, 2018, 2020, 2021, and 2022, including 23,354 adults (>20 years). Diabetes subgroups (obesity-related [MOD], severe insulin-deficient [SIDD], severe insulin-resistant [SIRD], and age-related [MARD]) were classified using self-normalizing neural networks based on a previously validated algorithm. We used the density-independent social lag index (DISLI) as a proxy of state-level social disadvantage. Findings: We identified 4204 adults (median age: 57, IQR: 47-66, women: 64%) living with diabetes, yielding a pooled prevalence of 16.04% [95% CI: 14.92-17.17]. When stratified by diabetes subgroup, prevalence was 6.62% (5.69-7.55) for SIDD, 5.25% (4.52-5.97) for MOD, 2.39% (1.95-2.83) for MARD, and 1.27% (1.00-1.54) for SIRD. SIDD and MOD clustered in Southern Mexico, whereas MARD and SIRD clustered in Northern Mexico and Mexico City. Each standard deviation increase in DISLI was associated with higher odds of SIDD (OR: 1.12, 95% CI: 1.06-1.12) and lower odds of MOD (OR: 0.93, 0.88-0.99). Speaking an indigenous language was associated with higher odds of SIDD (OR: 1.35, 1.16-1.57) and lower odds of MARD (OR 0.58, 0.45-0.74). Interpretation: Diabetes prevalence in Mexico is rising in the context of regional and sociodemographic inequalities across distinct diabetes subgroups. SIDD is a subgroup of concern that may be associated with inadequate diabetes management, mainly in marginalized states. Funding: This research was supported by Instituto Nacional de Geriatría in Mexico.

Leaf functional traits and ecological niche of Fagus grandifolia and Oreomunnea mexicana in natural forests and plantings as a proxy of climate change.

PREMISE: Functional traits reflect species' responses to environmental variation and the breadth of their ecological niches. Fagus grandifolia and Oreomunnea mexicana have restricted distribution in upper montane cloud forests (1700-2000 m a.s.l.) in Mexico. These species were introduced into plantings at lower elevations (1200-1600 m a.s.l.) that have climates predicted for montane forests in 2050 and 2070. The aim was to relate morphological leaf traits to the ecological niche structure of each species. METHODS: Leaf functional traits (leaf area, specific leaf area [SLA], thickness, and toughness) were analyzed in forests and plantings. Atmospheric circulation models and representative concentration pathways (RCPs: 2.6, 4.5, 8.5) were used to assess future climate conditions. Trait-niche relationships were analyzed by measuring the Mahalanobis distance (MD) from the forests and the plantings to the ecological niche centroid (ENC). RESULTS: For both species, leaf area and SLA were higher and toughness lower in plantings at lower elevation relative to those in higher-elevation forests, and thickness was similar. Leaf traits varied with distance from sites to the ENC. Forests and plantings have different environmental locations regarding the ENC, but forests are closer (MD 0.34-0.58) than plantings (MD 0.50-0.70) for both species. CONCLUSIONS: Elevation as a proxy for expected future climate conditions influenced the functional traits of both species, and trait patterns related to the structure of their ecological niches were consistent. The use of distances to the ENC is a promising approach to explore variability in species' functional traits and phenotypic responses in optimal versus marginal environmental conditions.

Comparison of Four Predictive Scores for Cardiovascular Risk in Mexican People with HIV.

Persons with HIV (PWH) face an increased risk of cardiovascular events due to immune activation, comorbidities, and certain antiretrovirals (ARVs). However, the current cardiovascular risk (CVR) scores are not specifically directed toward PWH. This study aimed to assess the agreement between different predictive CVR scores and explore their relationship with clinical and demographic data in Mexican PWH. A descriptive cross-sectional analysis was conducted in 200 PWH with a mean age of 42 years who were treated at a Mexican urban center from 2017 to 2018. The majority (83%) was on ARV treatment and 79.5% had undetectable viral loads (VLs). Moderate- to high-risk scores were infrequent, with Framingham Risk Score for Hard Coronary Heart Disease scores showing higher values, with very low concordance among all scores. Logistic regression analysis revealed significant associations between the CVR scores and the initial recorded VL, CD4 cell count, and elevated triglyceride levels. However, no associations were found with measures such as body mass index or abdominal circumference. Treatment with integrase strand transfer inhibitors (INSTIs), particularly first-generation inhibitors, showed strong associations with all predictive scores, notably ASCVD (odds ratio = 7.03, 95% confidence interval 1.67-29.64). The poor concordance among the CVR scores in PWH highlights the need for a specific score that considers comorbidities and ARV drugs. Despite the relatively young age of the participants, significant correlations were observed between INSTI use, initial VL, CD4 cell count, and triglyceride levels, which are factors not considered in the existing risk scores. Regardless of the actual value of the scores, screening for CVR in PWH is recommended.

Impacto de la pandemia de COVID-19 en las tendencias de mortalidad por enfermedades cardiovasculares en México, 2000-2022 / Impact of the COVID-19 pandemic on cardiovascular disease mortality trends in Mexico, 2000–2022

Objetivo: Estimar el impacto de la pandemia de COVID-19 en tendencia de la mortalidad por enfermedad cardiovascular (ECV) en México. Métodos: Se realizó un estudio ecológico donde se analizaron las defunciones por ECV reportadas en México bajo la clasificación CIE-10 con los códigos I10 al I99 para el periodo 2000 al 2022. Se calcularon las tasas de mortalidad estandarizadas por edad a nivel nacional y estatal, y posteriormente se estimó la variación porcentual anual mediante el análisis de joinpoint para conocer los cambios en la tendencia de la mortalidad en el periodo estudiado. Resultados: Se presentó un incremento de 27,96 muertes por cada 100.000 habitantes del 2000 al 2022 en México. El análisis joinpoint muestra en el periodo 2019 a 2021 un cambio porcentual anual a nivel nacional de 17.398, y posteriormente se presenta una tendencia negativa entre los años 2021-2022. Los estados como Guanajuato, Tlaxcala y Querétaro mostraron los mayores incrementos en las tendencias de la mortalidad por ECV durante la pandemia por COVID-19. Conclusiones: La tendencia de la mortalidad por ECV en México se incrementó de manera importante durante la pandemia por COVID-19.(AU)

Objective: To estimate the impact of the COVID-19 pandemic on cardiovascular disease (CVD) mortality trends in Mexico. Methods: An ecological study was conducted where deaths from CVD reported in Mexico under the ICD-10 classification with codes I10 to I99 for the period 2000–2022 were analyzed. Age-standardized mortality rates were calculated at the national and state levels, then the annual percentage variation was estimated using joinpoint analysis to know the changes in the mortality trend in the period studied. Results: There was an increase of 27.96 deaths per 100,000 inhabitants from 2000 to 2022 in Mexico. The joinpoint analysis shows in the period 2019–2021 an annual percentage change at the national level of 17,398 and subsequently a negative trend is presented between the years 2021–2022. The states of Guanajuato, Tlaxcala and Querétaro showed the largest increases in CVD mortality trends during the COVID-19 pandemic. Conclusions: The trend in CVD mortality in Mexico increased significantly during the COVID-19 pandemic.(AU)

Pérdida significativa como factor del alcoholismo / Perda significativa como fator de alcoolism / Significant loss as a factor in alcoholism

La relación de la pérdida significativa de un ser queridoy el alcoholismo ha minimizado las implicaciones sobremecanismos de afrontamientos para generar conductassaludables. Este artículo se basa en entrevistas semiestructuradasa profundidad en hombres de entre 30 y 70 años, conmás de 10 años en Alcohólicos Anónimos del Estado deTamaulipas, México. El objetivo fue reflexionar sobre lossignificados de la pérdida significativa de un ser querido yel alcoholismo. En la búsqueda del significado, se explicaque un factor que lleva al alcoholismo no es una sola pérdidasignificativa de personas queridas, sino un cúmulo tambiende pérdidas materiales y no materiales, se reflejaron recursoslimitados para afrontar las pérdidas, la relación entre lapérdida significativa con el alcoholismo fue mediado pordos principales aspectos, las creencias sobre los efectos queproduce el consumo de alcohol como formas de escapar de larealidad y las influencia de la familia al inicio del consumode alcohol. Por otra parte, la presencia de lo espiritual, laconciencia y las emociones que experimentan durante suproceso de duelo y alcoholismo, los llevó a identificar elproblema de la adicción, que permitió influir en el procesode rehabilitación.(AU)

A relação entre a perda significativa de um ente querido e oalcoolismo tem minimizado as implicações nos mecanismosde enfrentamento para gerar comportamentos saudáveis.Este artigo é baseado em entrevistas semiestruturadas emprofundidade com homens entre 30 e 70 anos, com mais de10 anos em Alcoólicos Anônimos no Estado de Tamaulipas,México. O objetivo foi refletir sobre os significados da perdasignificativa de um ente querido e do alcoolismo. Na buscade sentido, explica-se que um fator que leva ao alcoolismonão é uma única perda significativa de entes queridos, mastambém um acúmulo de perdas materiais e imateriais,recursos limitados foram refletidos para enfrentar as perdas,a relação entre a perda significativa com o alcoolismo foimediada por dois aspectos principais, as crenças sobre osefeitos que o consumo de álcool produz como formas defuga da realidade e a influência da família no início doconsumo de álcool. Por outro lado, a presença do espiritual,da consciência e das emoções que vivenciam durante oprocesso de luto e alcoolismo, levaram-nos a identificar oproblema da dependência, o que lhes permitiu influenciaro processo de reabilitação.(AU)

The relationship between the significant loss of a lovedone and alcoholism has minimized the implications oncoping mechanisms to generate healthy behaviors. Thisarticle is based on in-depth semi-structured interviews withmen between the ages of 30 and 70, with more than 10years in Alcoholics Anonymous in the State of Tamaulipas,Mexico. The objective was to reflect on the meanings of the significant loss of a loved one and alcoholism. In thesearch for meaning, it is explained that a factor that leadsto alcoholism is not a single significant loss of loved ones,but also an accumulation of material and non-materiallosses, limited resources were reflected to face the losses,the relationship between the loss significant with alcoholismwas mediated by two main aspects, beliefs about the effectsthat alcohol consumption produces as ways of escapingfrom reality and the influence of the family at the beginningof alcohol consumption. On the other hand, the presenceof the spiritual, the conscience and the emotions that theyexperience during their mourning process and alcoholism,led them to identify the problem of addiction, which allowedthem to influence the rehabilitation process.(AU)

Current status and challenges in timely detection of cervical cancer in Mexico: expert consensus.

Cervical cancer is a significant public health problem in low- and middle-income countries, accounting for 85% of new cases worldwide. Due to poorly organized screening programs, cervical cancer is more likely to develop in vulnerable groups who do not initiate or rarely undergo screening. Cervical cytology and detecting high-risk human papillomavirus types are the recommended screening tools. Further, these strategies allow for accurately identifying women at a higher risk of cervical cancer and establishing screening times. New detection tools, such as novel biomarkers or automatic HPV detection in the vagina or urine, can improve screening coverage. This review aims to identify the challenges faced by detection programs and screening tools in Mexico to provide evidence-based recommendations to improve early detection programs for cervical cancer.

Larvae trypanorhynch (Cestoda) infecting the dusky flounder, Syacium papillosum (Paralichthyidae: Pleuronectiformes) in the continental shelf of the Yucatan Peninsula, Mexico.

Trypanorhynch cestode larvae were found parasitizing specimens of dusky flounder Syacium papillosum (Linnaeus, 1758) in the Southeastern Gulf of Mexico (s-GoM). Plerocercoids were recovered from a total of 194 flatfish, embedded in the intestine and stomach wall. Trypanorhynch were identified using morphology and a molecular phylogeny using newly sequenced partial 28S (region D1-D3) ribosomal DNA in combination with data derived from other species of trypanorhynchs available from GenBank. Larvae representing three genera of trypanorhynch cestodes, Nybelinia Poche, 1926; Kotorella Euzet & Radujkovic, 1989 and Oncomegas Dollfus, 1929 were found in dusky flounder specimens in the s-GoM. These plerocercoids represent six species: Nybelinia sp. 1, Nybelinia sp. 2, Nybelinia sp. 3, Nybelinia sp. 4, Kotorella pronosoma (Stossich, 1901) and Oncomegas wageneri (Linton, 1890) Dollfus, 1929. All cestode specimens in this study represent new locality records for their respective species.

Implementation of a roadmap for the comprehensive diagnosis, follow-up, and research of childhood leukemias in vulnerable regions of Mexico: results from the PRONAII Strategy.

The main objective of the National Project for Research and Incidence of Childhood Leukemias is to reduce early mortality rates for these neoplasms in the vulnerable regions of Mexico. This project was conducted in the states of Oaxaca, Puebla, and Tlaxcala. A key strategy of the project is the implementation of an effective roadmap to ensure that leukemia patients are the target of maximum benefit of interdisciplinary collaboration between researchers, clinicians, surveyors, and laboratories. This strategy guarantees the comprehensive management of diagnosis and follow-up samples of pediatric patients with leukemia, centralizing, managing, and analyzing the information collected. Additionally, it allows for a precise diagnosis and monitoring of the disease through immunophenotype and measurable residual disease (MRD) studies, enhancing research and supporting informed clinical decisions for the first time in these regions through a population-based study. This initiative has significantly improved the diagnostic capacity of leukemia in girls, boys, and adolescents in the regions of Oaxaca, Puebla, and Tlaxcala, providing comprehensive, high-quality care with full coverage in the region. Likewise, it has strengthened collaboration between health institutions, researchers, and professionals in the sector, which contributes to reducing the impact of the disease on the community.

Association between maternal cardiometabolic markers and fetal growth in non-complicated pregnancies: a secondary analysis of the PRINCESA cohort.

The objective of this study was to evaluate the association of maternal cardiometabolic markers trajectories (glucose, triglycerides (TG), total cholesterol, systolic blood pressure (SBP) and diastolic blood pressure (DBP)) with estimated fetal weight trajectories and birth weight in Mexican pregnant women without medical complications. Cardiometabolic marker trajectories were characterized using group-based trajectory models. Mixed-effect and linear regression models were estimated to assess the association of maternal trajectories with estimated fetal weight and birth weight. The final sample comprised 606 mother-child dyads. Two trajectory groups of maternal cardiometabolic risk indicators during pregnancy were identified (high and low). Fetuses from women with higher values of TG had higher weight gain during pregnancy ( ß ^ = 24.00 g; 95%CI: 12.9, 35.3), were heavier at the sixth month ( ß ^ =48.24 g; 95%CI: 7.2, 89.7) and had higher birth weight ( ß ^ = 89.08 g; 95%CI: 20.8, 157.4) than fetuses in the low values trajectory. Fetuses from mothers with high SBP and DBP had less weight in the sixth month of pregnancy ( ß ^ = - 42.4 g; 95%CI: - 82.7, - 2.1 and ß ^ = - 50.35 g; 95%CI: - 94.2, - 6.4), and a higher DBP trajectory was associated with lower birth weight ( ß ^ = - 101.48 g; 95%CI: - 176.5, - 26.4). In conclusion, a longitudinal exposition to high values of TG and BP was associated with potentially adverse effects on fetal growth. These findings support the potential modulation of children's phenotype by maternal cardiometabolic conditions in pregnancies without medical complications.

Water, sanitation, and hygiene access among people who inject drugs in Tijuana and San Diego in 2020-2021: a cross-sectional study.

BACKGROUND: Water, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area. METHODS: In this cross-sectional binational study, we interviewed PWID (age 18+) in 2020-2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates. RESULTS: Of 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02-2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28-1.64), and bathing (aRR: 1.21, 95%CI: 1.06-1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07-3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52-2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55-6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36-4.89) than participants living in permanent housing. CONCLUSION: WASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID-especially those who are unsheltered.

Influence of biomass burning on ozone levels in the Megalopolis of Central Mexico during the COVID-19 lockdown.

The massive reductions in anthropogenic emissions resulting from the COVID-19 lockdown provided a unique opportunity to evaluate the effect of mitigation measures aiming to abate air pollution. In Mexico, the total lockdown period took place during the dry-hot season when biomass burning activity is enhanced. Here, we investigate the role of biomass burning emissions on regional ozone levels in the Megalopolis of Central Mexico. The studied period covers the lockdown phases 2 and 3, and the first month of the New Normal. We applied a factor separation technique and process analysis to estimate the pure and synergistic contributions of emission reductions under lockdown and that from biomass burning to daily ozone maximum concentrations in 7 metropolitan areas of different states in the Megalopolis. The results revealed that biomass burning plumes likely masked the effect of massive reductions from mobile emissions, impacted the PBL development during phase 3 and favored transition and mixed NOx-limited and VOC-limited regional regimes. This contributed to increased ozone production in the middle to lower PBL by changing the regional background levels which potentially could bias high ozone production efficiency estimations. Given the Megalopolis contribution to economic and societal development at national scale, our study suggests that ozone mitigation measures during the dry-hot season targeting mainly mobile emissions will likely be offset by biomass burning plumes. A regional and synergic policy aiming to control biomass burning would help to reduce the occurrence of high ozone levels in Central Mexico with the co-benefit of tackling short-lived climate pollutants.

The Legacy of President Lázaro Cárdenas for Health Care Reform in Today's Mexico.

Mexican President Andrés Manuel López Obrador's historic election victory in 2018 marked a sharp break from past decades of neoliberal socioeconomic policies. López Obrador campaigned on the promise of deep reform, with health care high on his agenda. The public health care sector had been decimated by decades of budget cuts, eroding workers' morale and patients' confidence, and crippling all aspects of the system. This article looks back to the creation of the nation's public health care system in the early twentieth century during the administration of President Lázaro Cárdenas (1934-1940). This "universal" system was designed to implement a central social justice goal of the Mexican Revolution of health care for all. The program rested on two pillars: providing care to the nation's vast, impoverished rural population and actively engaging communities in their own health care. Our objective is to critically assess the two presidents' health care initiatives within the distinct historical contexts of their administrations.

Exploring local perceptions and drivers of engagement in biodiversity monitoring among participants in payments for ecosystem services schemes in southeastern Mexico.

Payments for ecosystem services (PES) are widely applied incentive-based instruments with diverse objectives that increasingly include biodiversity conservation. Yet, there is a gap in understanding of how to best assess and monitor programs' biodiversity outcomes. We examined perceptions and drivers of engagement related to biodiversity monitoring through surveys among current PES participants in 7 communities in Mexico's Selva Lacandona. We conducted workshops among survey participants that included training and field deployment of tools used to monitor biodiversity and land cover, including visual transects, camera traps, acoustic recorders, and forest cover satellite images. We conducted pre- and postworkshop surveys in each community to evaluate changes in respondents' perceptions following exposure to biodiversity monitoring training and related field activities. We also reviewed existing research on participatory environmental management and monitoring approaches. One quarter of current PES participants in the study area participated in our surveys and workshops. The majority stated interest in engaging in diverse activities related to the procedural aspects of biodiversity monitoring (e.g., planning, field data collection, results dissemination) and acknowledged multiple benefits of introducing biodiversity monitoring into PES (e.g., knowledge and capacity building, improved natural resource management, and greater support for conservation). Household economic reliance on PES was positively associated with willingness to engage in monitoring. Technical expertise, time, and monetary constraints were deterrents. Respondents were most interested in monitoring mammals, birds, and plants and using visual transects, camera traps, and forest cover satellite images. Exposure to monitoring enhanced subsequent interest in monitoring by providing respondents with new insights from their communities related to deforestation and species' abundance and diversity. Respondents identified key strengths and weaknesses of applying different monitoring tools, which suggests that deploying multiple tools simultaneously can increase local engagement and produce complementary findings and data. Overall, our findings support the relevance and usefulness of incorporating participatory biodiversity monitoring into PES.

Explorando las percepciones locales y los impulsores de la participación en el monitoreo de la biodiversidad entre participantes de esquemas de pagos por servicios ambientales en el sureste de México Resumen Los pagos por servicios ambientales (PSA) son instrumentos basados en incentivos ampliamente aplicados cuyos diversos objetivos incluyen cada vez más la conservación de la biodiversidad. Sin embargo, existe una brecha en la comprensión de cómo evaluar y monitorear los resultados de los programas en materia de biodiversidad. Examinamos las percepciones y los impulsores de la participación relacionados al monitoreo de la biodiversidad a través de encuestas entre participantes actuales de PSA en siete comunidades de la Selva Lacandona de México. Realizamos talleres entre los participantes de las encuestas que incluyeron capacitación y despliegue en campo de herramientas utilizadas para monitorear la biodiversidad y la cobertura del suelo, incluidos transectos visuales, cámaras trampa, grabadores acústicos e imágenes satelitales de la cobertura forestal. Realizamos encuestas antes y después del taller en cada comunidad para evaluar los cambios en las percepciones de los participantes tras su involucramiento en la capacitación de monitoreo de biodiversidad y las actividades de campo relacionadas. También revisamos la investigación existente sobre enfoques de monitoreo y gestión ambiental participativa. Una cuarta parte de los participantes actuales de PES en el área de estudio participaron en nuestras encuestas y talleres. La mayoría declaró interés en participar en diversas actividades relacionadas con los aspectos procesales del monitoreo de la biodiversidad (por ejemplo, planificación, recopilación de datos de campo, difusión de resultados) y reconoció múltiples beneficios de introducir el monitoreo de la biodiversidad en los PSA (por ejemplo, creación de conocimientos y capacidades, mejora de la gestión de los recursos naturales, y mayor apoyo a la conservación). La dependencia económica de los hogares de los PSA se asoció positivamente con la voluntad de participar en el monitoreo. Los factores inhibidores fueron la experiencia técnica, el tiempo y las limitaciones monetarias. Los encuestados estaban más interesados en monitorear mamíferos, aves y plantas y en utilizar transectos visuales, cámaras trampa e imágenes satelitales de la cubierta forestal. La exposición al monitoreo aumentó el interés posterior en el monitoreo al brindar a los encuestados nuevos conocimientos de sus comunidades relacionados con la deforestación y la abundancia y diversidad de especies. Los encuestados identificaron fortalezas y debilidades clave al aplicar diferentes herramientas de monitoreo, lo que sugiere que implementar múltiples herramientas simultáneamente puede aumentar la participación local y producir hallazgos y datos complementarios. En general, nuestros hallazgos respaldan la relevancia y utilidad de incorporar el monitoreo participativo de la biodiversidad en los PSA.

Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study.

BACKGROUND: Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. OBJECTIVE: This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. METHODS: NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children's age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants' experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. RESULTS: Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was "good," "useful," and "helpful" for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. CONCLUSIONS: While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. TRIAL REGISTRATION: ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896.