A Geospatial Model to Identify Areas Associated with Late- Stage Breast Cancer: A Spatial Epidemiology Approach.

OBJECTIVE: The aim of this study was to show how a geospatial model can be used to identify areas with a higher probability for late-stage breast cancer (BC) diagnoses. METHODS: Our study considered an ecological design. Clinical records at a tertiary care hospital were reviewed in order to obtain the place of residence and stage of the disease, which was classified as early (0-IIA) and late (IIB-IV) and whose diagnoses were made during the 2013-2017 period. Then, they were geolocated to identify the distribution and spatial trend. Subsequently, the pattern of location, i.e. scattered, random and concentrated, was statistically assessed and a geospatial model was elaborated to determine the probability of late diagnoses in the state of Jalisco, Mexico. RESULT: There were 1 954 (N) geolocated BC diagnoses: 58.3% were late. During the five-year period, a southwest-northeast trend was identified, nearly 9.5% of the surface of Jalisco, where 6 out of 10 (n= 751) late- stage diagnoses were concentrated. A concentrated and statistically significant pattern was identified in the southern, central and northern Pacific area of Jalisco, where the geospatial model delimited the places with the highest probability of late clinical stages (p <0.05). CONCLUSION: The geographical differences associated with the late diagnoses of BC suggest it is necessary to adapt and focus the strategies for early detection as an alternative to create a major impact on the population. Reproducible analysis tools were used in other contexts where geolocation data are available to complement public policies and strategies aimed to control BC.

Public Policies and Programs for the Prevention and Control of Breast Cancer in Latin American Women: Scoping Review.

BACKGROUND: Breast cancer has positioned itself worldwide as one of the main public health problems, especially in Latin America. In some countries, several programs for the prevention and control of breast cancer in women have been developed and implemented on a permanent basis, but there are no public reports on the policies that originated such programs. OBJECTIVE: A scoping review of scientific publications that identify the type, extent, and scope of policies and programs for the prevention and control of breast cancer in Latin American women was performed, and the main results were presented in this paper. METHODS: This scoping review was carried out according to the method by Arksey and O'Malley based on 3 fundamental questions about breast cancer prevention and control policies in Latin America: their type, extent and scope, and reference framework. The search period was from 2000 to 2019, and the search was carried out in the following databases: MEDLINE (PubMed), MEDLINE (EbscoHost), CINAHL (EbscoHost), Academic Search Complete (EbscoHost), ISI Web of Science (Science Citation Index), and Scopus in English, Spanish, and Portuguese, and Scielo, Cochrane, and MEDES-MEDicina in Spanish and Portuguese. Of the 743 studies found, 20 (2.7%) were selected, which were analyzed using descriptive statistics and qualitative content analysis. RESULTS: The selected studies identified several Latin American countries that have generated policies and programs to prevent and control breast cancer in women, focusing mainly on risk communication, prevention and timely detection, effective access to health services, improvement of the screening process, and evaluation of screening programs. Evaluation criteria and greater participation of civil society in policy design and program execution are still lacking. This could undoubtedly help eliminate existing barriers to effective action. CONCLUSIONS: Although several Latin American countries have generated public policies and action programs for the prevention and control of breast cancer, a pending issue is the evaluation of the results to analyze the effectiveness and impact of their implementation given the magnitude of the public health problem it represents and because women and civil society play an important role in its prevention and control. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/12624.

[Spatio-temporal trend in detections of diabetes mellitus and systematic arterial hypertension in IMSS users, 2004-2019]. / Tendencia espacio-temporal de detecciones de diabetes mellitus e hipertensión arterial sistémica en usuarios del IMSS, 2004-2019.

Background: Diabetes Mellitus (DM) and heart diseases, which include Systemic Arterial Hypertension (SAH), have been positioned as the two main causes of mortality in Mexico, which represents important challenges for the different health institutions. Objective: To analyze the spatio-temporal trend of DM and SAH based on the detections made in first and and second level units of the Instituto Mexicano del Seguro Social, during the period 2004-2019. Material and methods: Ecological study in which detection rates of both diseases were calculated per 1,000 persons according to year, triennium and representation. The spatiotemporal trend was analyzed by spatial statistics using Geographic Information Systems. Results: During 2004-2019 therere were 9 399 889 and 11 862 069 detections on average of DM and SAH, respectively. Regarding DM, the detection rate ranged from 203.4 (2004) to 384.4 (2019) per 1000 persons, this trend increased in Tamaulipas. While SAH decreased from 1140.2 (2004) to 352 (2019) per 1000 persons in Veracruz Sur and Tamaulipas, respectively. Conclusions: The observed spatio-temporal trend can contribute to organizing and guiding, according to representation and level of care, institutional programs, integrated care protocols, clinical practice guidelines and other public policy instruments available at the Instituto Mexicano del Seguro Social to improve early detection, care, control and access to medications for DM and SAH.

Introducción: la diabetes mellitus (DM) y las enfermedades del corazón, entre las que se incluye la hipertensión arterial sistémica (HTA), se han posicionado entre las primeras causas de mortalidad en México, lo que plantea retos importantes para las diferentes instituciones de salud. Objetivo: analizar la tendencia espacio-temporal de DM e HTA con base en las detecciones realizadas en unidades de primero y segundo nivel del Instituto Mexicano del Seguro Social (IMSS), durante el periodo 2004-2019. Materiales y métodos: estudio ecológico en el que se calcularon las tasas de detección de ambos padecimientos por mil derechohabientes según año, trienio y representación. La tendencia espacio-temporal se analizó mediante estadística espacial utilizando Sistemas de Información Geográfica. Resultados: de 2004 a 2019 hubo 9 399 889 y 11 862 069 detecciones en promedio de DM e HTA, respectivamente. Referente al primer padecimiento, la tasa de deteccion osciló de 203.4 (2004) a 384.4 (2019) por mil derechohabientes, cuya tendencia aumentó en Tamaulipas. Mientras que la HTA disminuyó de 1140.2 (2004) a 352 (2019) detecciones por mil derechohabientes en Veracruz Sur y Tamaulipas, respectivamente. Conclusiones: la tendencia espacio-temporal observada puede contribuir a organizar y orientar, según su representación y nivel de atención, los programas institucionales, protocolos de atención, guías de práctica clínica y demás instrumentos de políticia pública disponibles en el IMSS para mejorar la detección oportuna, atención, control y acceso a medicamentos para DM e HTA.

Tendencia espacio-temporal de detecciones de diabetes mellitus e hipertensión arterial sistémica en usuarios del IMSS, 2004-2019 / Spatio-temporal trend in detections of diabetes mellitus and systematic arterial hypertension in IMSS users, 2004-2019

Introducción: la diabetes mellitus (DM) y las enfermedades del corazón, entre las que se incluye la hipertensión arterial sistémica (HTA), se han posicionado entre las primeras causas de mortalidad en México, lo que plantea retos importantes para las diferentes instituciones de salud. Objetivo: analizar la tendencia espacio-temporal de DM e HTA con base en las detecciones realizadas en unidades de primero y segundo nivel del Instituto Mexicano del Seguro Social (IMSS), durante el periodo 2004-2019. Material y métodos: estudio ecológico en el que se calcularon las tasas de detección de ambos padecimientos por mil derechohabientes según año, trienio y representación. La tendencia espacio-temporal se analizó mediante estadística espacial utilizando Sistemas de Información Geográfica. Resultados: de 2004 a 2019 hubo 9 399 889 y 11 862 069 detecciones en promedio de DM e HTA, respectivamente. Referente al primer padecimiento, la tasa de deteccion osciló de 203.4 (2004) a 384.4 (2019) por mil derechohabientes, cuya tendencia aumentó en Tamaulipas. Mientras que la HTA disminuyó de 1140.2 (2004) a 352 (2019) detecciones por mil derechohabientes en Veracruz Sur y Tamaulipas, respectivamente. Conclusiones: la tendencia espacio-temporal observada puede contribuir a organizar y orientar, según su representación y nivel de atención, los programas institucionales, protocolos de atención, guías de práctica clínica y demás instrumentos de políticia pública disponibles en el IMSS para mejorar la detección oportuna, atención, control y acceso a medicamentos para DM e HTA.

Background: Diabetes Mellitus (DM) and heart diseases, which include Systemic Arterial Hypertension (SAH), have been positioned as the two main causes of mortality in Mexico, which represents important challenges for the different health institutions. Objective: To analyze the spatio-temporal trend of DM and SAH based on the detections made in first and and second level units of the Instituto Mexicano del Seguro Social, during the period 2004-2019. Material and methods: Ecological study in which detection rates of both diseases were calculated per 1,000 persons according to year, triennium and representation. The spatio-temporal trend was analyzed by spatial statistics using Geographic Information Systems. Results: During 2004-2019 therere were 9 399 889 and 11 862 069 detections on average of DM and SAH, respectively. Regarding DM, the detection rate ranged from 203.4 (2004) to 384.4 (2019) per 1000 persons, this trend increased in Tamaulipas. While SAH decreased from 1140.2 (2004) to 352 (2019) per 1000 persons in Veracruz Sur and Tamaulipas, respectively. Conclusions: The observed spatio-temporal trend can contribute to organizing and guiding, according to representation and level of care, institutional programs, integrated care protocols, clinical practice guidelines and other public policy instruments available at the Instituto Mexicano del Seguro Social to improve early detection, care, control and access to medications for DM and SAH.

A Local Health Situation Room for COVID-19: Recommendations for Decision-Making From a Higher Education Institution in Mexico.

Introduction: The Situation Room is a physical or virtual space where experts systematically analyze information to characterize a health situation, especially during emergencies. Decision-making processes are made toward solving health needs and promoting collaboration among institutions and social sectors. This paper presents the context and circumstances that led the University of Guadalajara (UdeG) to install a local health situation room (HSR) to address the COVID-19 pandemic at this institution based in the state of Jalisco, Mexico, a narrative is also made of its working processes and some of its results. Methods: The design of this situation room for COVID-19 was based on the methodology established by the Pan American Health Organization (PAHO)/WHO. This local-type situation room was installed on February 12, 2020. The health problem was characterized, and strategic lines, objectives, and goals were established; the first analysis was derived from an action plan deployed at the UdeG. The strategic lines were situational diagnosis, preventive actions, and containment strategies. Results: The situation room influenced the activities of the UdeG before the epidemic cases started in the state. One of the actions with the greatest impact was developing a mathematical model for predicting COVID-19 cases. Subsequently, new models have been developed according to the epidemiological evolution of the disease, helping manage the epidemic in the state. Another important result was the early closing of face-to-face university activities, reducing contagion risks and the mobility of more than 310,000 students, faculty, and administrative personnel throughout Jalisco. Conclusions: A consequence of the closure was that the confinement generated by the pandemic was the change to virtual meetings from April 2020 to date; but at the same time, this working format was a strength, since it influenced the decision of the university board to change all the academic activities to virtual format before other educational, economic, and social activities in the state did. By April 2020, the situation room transcended its institutional boundaries and was invited to participate at the Jalisco State's Health Committee. Its recommendations have helped to maintain the state with one of Mexico's lowest COVID-19 incidence and mortality rates.

[Using geo-intelligence to estimate risk of introduction of influenza type A in MexicoCenário de risco de introdução do vírus da influenza A no México estimado com o uso de inteligência geográfica]. / Escenario de riesgo de introducción de la influenza tipo A en México estimado mediante geointeligencia.

OBJECTIVE: Estimate the probabilistic potential of introduction of the causative agent of influenza type A in Mexico, using geo-intelligence applied to health. METHODS: Ecological study of 1,973 influenza outbreaks with a high degree of pathogenicity, worldwide during the period 2014-2016. Geospatial modeling was developed with geo-intelligence tools such as spatial representation, a relational model, spatial characterization of the inoculum source with the maximum entropy model and the receiver operating characteristic (ROC) curve, using multicriteria spatial analysis. This was validated with the Moran index and geographically weighted regression. RESULTS: Isochrones (at an initial distance of 548 km) were estimated for health risks and their exponential growth; at the fourth isochrone, the east and west coasts of the United States of America and a part of Central America were identified as possible areas that favor the introduction of the pathogen. Also, a COR curve = 0.923 was obtained; two risk periods for introduction were identified (September-March and April-August, with north-south and south-north trajectories, respectively) with high positive autocorrelation for geospatial modeling; and in one scenario, more than half of Mexico was found to be at high risk of introduction, with an estimated 78 million people exposed. A positive association was identified between significant risk areas (p < 0.001). CONCLUSION: More than 50% of Mexican territory was found to be at risk of introduction of the causative agent of influenza type A, with approximately 70% of the population exposed.

OBJETIVO: Estimar o cenário probabilístico em potencial de introdução do vírus da influenza A no México com o uso de inteligência geográfica em saúde. MÉTODOS: Estudo ecológico de 1.973 surtos mundiais de influenza de alta patogenicidade ocorridos no período 2014­2016. Foi desenvolvido um modelo geoespacial com ferramentas de inteligência geográfica, como representação espacial, modelo de conexidade, caracterização espacial da fonte de inóculo com o modelo de máxima entropia e curva ROC (receiver operating characteristic) com avaliação espacial por múltiplos critérios e validação com o índice de Moran e regressão geograficamente ponderada. RESULTADOS: Foram estimadas isócronas do risco de saúde com uma distância de 548 km e o crescimento exponencial destes linhas; até a quarta isócrona, foram identificadas as costas leste e oeste dos Estados Unidos (EUA) e parte da América Central como possível superfície que favorece a introdução do vírus. Foi também estimada uma curva ROC de 0,923, sendo identificados dois períodos de risco de introdução do vírus (setembro­março e abril­agosto) com trajetórias de norte-sul e sul-norte, respectivamente, com elevada autocorrelação positiva para o modelo geoespacial. Foi estimado um cenário em que mais da metade do México apresenta alto risco de introdução do vírus da influenza, com 78 milhões de pessoas expostas. E foi observada uma associação positiva entre as áreas de risco significativo (P < 0,001). CONCLUSÃO: Observa-se que mais de 50% do território mexicano está sob risco de introdução do vírus da influenza A, com cerca de 70% da população exposta.

Escenario de riesgo de introducción de la influenza tipo A en México estimado mediante geointeligencia

[RESUMEN]. Objetivo. Estimar el escenario potencial probabilístico de introducción del agente causal de la influenza tipo A en México mediante geointeligencia sanitaria. Métodos. Estudio ecológico en el que consideran 1 973 brotes de influenza con alto grado de patogenicidad en el mundo durante el período 2014-2016. Se desarrolló un modelado geoespacial con herramientas de la geointeligencia, como la representación espacial, modelo de conexidad, caracterización espacial de la fuente de inoculo con el modelo de máxima entropía y la curva característica de operación receptora (COR) mediante la evaluación espacial multicriterio y se validó con el índice de Moran y la regresión geográficamente ponderada. Resultados. Se estimaron las isocronas de riesgo sanitario con una distancia de 548 km y su crecimiento exponencial; hasta la cuarta isócrona se identificaron las costas este y oeste de Estados Unidos de América (EEUU) y una porción de América Central como posible superficie que favorece la introducción del patógeno. Se obtuvo, también, una curva COR = 0,923, se identificaron dos períodos de riesgo de introducción (setiembre-marzo) y (abril-agosto) con trayectorias de norte-sur y sur-norte respectivamente, con alta autocorrelación positiva para el modelado geoespacial, y se estimó un escenario donde más de la mitad de México se encuentra en un riesgo alto de introducción, con 78 millones de personas expuestas. Se identificó una asociación positiva entre las áreas de riesgo significativo (P < 0,001). Conclusión. Se evidencia que más de 50% del territorio mexicano se encuentra en riesgo de introducción del agente causal de la influenza tipo A, con aproximadamente 70% de la población expuesta.

[ABSTRACT]. Objective. Estimate the probabilistic potential of introduction of the causative agent of influenza type A in Mexico, using geo-intelligence applied to health. Methods. Ecological study of 1,973 influenza outbreaks with a high degree of pathogenicity, worldwide during the period 2014-2016. Geospatial modeling was developed with geo-intelligence tools such as spatial representation, a relational model, spatial characterization of the inoculum source with the maximum entropy model and the receiver operating characteristic (ROC) curve, using multicriteria spatial analysis. This was validated with the Moran index and geographically weighted regression. Results. Isochrones (at an initial distance of 548 km) were estimated for health risks and their exponential growth; at the fourth isochrone, the east and west coasts of the United States of America and a part of Central America were identified as possible areas that favor the introduction of the pathogen. Also, a COR curve = 0.923 was obtained; two risk periods for introduction were identified (September-March and April-August, with north-south and south-north trajectories, respectively) with high positive autocorrelation for geospatial modeling; and in one scenario, more than half of Mexico was found to be at high risk of introduction, with an estimated 78 million people exposed. A positive association was identified between significant risk areas (p < 0.001). Conclusion. More than 50% of Mexican territory was found to be at risk of introduction of the causative agent of influenza type A, with approximately 70% of the population exposed.

[RESUMO]. Objetivo. Estimar o cenário probabilístico em potencial de introdução do vírus da influenza A no México com o uso de inteligência geográfica em saúde. Métodos. Estudo ecológico de 1.973 surtos mundiais de influenza de alta patogenicidade ocorridos no período 2014–2016. Foi desenvolvido um modelo geoespacial com ferramentas de inteligência geográfica, como representação espacial, modelo de conexidade, caracterização espacial da fonte de inóculo com o modelo de máxima entropia e curva ROC (receiver operating characteristic) com avaliação espacial por múltiplos critérios e validação com o índice de Moran e regressão geograficamente ponderada. Resultados. Foram estimadas isócronas do risco de saúde com uma distância de 548 km e o crescimento exponencial destes linhas; até a quarta isócrona, foram identificadas as costas leste e oeste dos Estados Unidos (EUA) e parte da América Central como possível superfície que favorece a introdução do vírus. Foi também estimada uma curva ROC de 0,923, sendo identificados dois períodos de risco de introdução do vírus (setembro–março e abril–agosto) com trajetórias de norte-sul e sul-norte, respectivamente, com elevada autocorrelação positiva para o modelo geoespacial. Foi estimado um cenário em que mais da metade do México apresenta alto risco de introdução do vírus da influenza, com 78 milhões de pessoas expostas. E foi observada uma associação positiva entre as áreas de risco significativo (P < 0,001). Conclusão. Observa-se que mais de 50% do território mexicano está sob risco de introdução do vírus da influenza A, com cerca de 70% da população exposta.

[Air pollutants and their correlation with medical visits for acute respiratory infections in children less than five years of age in urban Guadalajara, Mexico]. / Contaminantes atmosféricos y su correlación con infecciones agudas de las vías respiratorias en niños de Guadalajara, Jalisco.

OBJECTIVE: To describe the correlation between the concentration levels of atmospheric air pollutants and the number of medical visits to IMSS, ISSSTE and of SSJ healthcare facilities of the Urban Area of Guadalajara between 2000-2002 by children under five years suffering from acute respiratory infections. MATERIAL AND METHODS: An ecological study was performed to describe the correlation between the interpolated monthly average modes, monthly mobile average of air pollutants: carbon monoxide, nitrogen dioxide, ozone, and particles with an aerodynamic diameter of less than 10 microns (PM10) and sulfur dioxide,and the number of medical visits per month due to acute respiratory infections in children under five years. RESULTS: The air pollutants: carbon monoxide and nitrogen dioxide show a significant correlation with the incidence of acute respiratory infections in children less than five years of age in the Urban Area of Guadalajara. The correlation coefficients were: CO (r= 0.05) and NO2 (r= 0.09). CONCLUSIONS: Although the concentrations of air pollutants stay below the official limit, carbon monoxide and nitrogen dioxide affect the health of the child population of the Urban Area of Guadalajara. Although the monthly average mode and monthly mobile average does not exceed the established legislation,the registered maximums do exceed it; this indicates that although throughout most of the day there is no latent risk of population exposure to the air pollutants, during some hours of certain days there is a risk for the population of breathing air contaminated with concentrations higher than the limit, which can cause the development of acute respiratory infections.

Contaminantes atmosféricos y su correlación con infecciones agudas de las vías respiratorias en niños de Guadalajara, Jalisco / Air pollutants and their correlation with medical visits for acute respiratory infections in children less than five years of age in urban Guadalajara, Mexico

OBJETIVO: Describir la relación entre los niveles de concentración de los contaminantes atmosféricos y el número de consultas por infecciones agudas de las vías respiratorias en niños menores de cinco años del IMSS, ISSSTE y SSJ del área urbana de Guadalajara, en el lapso de 2000 a 2002. MATERIAL Y MÉTODOS: Se realizó un estudio ecológico transversal para describir la correlación entre las modas promedio mensuales, medias móviles mensuales interpoladas de los contaminantes (monóxido de carbono, dióxido de nitrógeno, ozono, partículas menores de 10 micras y dióxido de azufre) y las consultas mensuales registradas por infecciones agudas de las vías respiratorias en niños menores de cinco años. RESULTADOS: Los contaminantes atmosféricos monóxido de carbono y dióxido de nitrógeno muestran correlación significativa con las infecciones agudas de las vías respiratorias en niños menores de cinco años del área urbana de Guadalajara. Las correlaciones presentadas fueron: CO (r= 0.05) y NO2 (r= 0.09). CONCLUSIONES: Pese a que las concentraciones de contaminantes se mantienen por debajo de la norma oficial, los contaminantes monóxido de carbono y dióxido de nitrógeno inciden en la salud de la población infantil del área urbana de Guadalajara. Aunque las modas mensuales y medias móviles mensuales no rebasan la normatividad establecida, sí lo hacen los máximos registrados; esto permite indicar que si bien en la mayor parte del día no hay una exposición potencial de riesgo para la población a los contaminantes, sí existe exposición potencial de riesgo para la población al aire contaminado con concentraciones fuera de la norma durante algunas horas de ciertos días, lo cual puede influir de manera significativa en el incremento de infecciones agudas de las vías respiratorias superiores.

OBJECTIVE: To describe the correlation between the concentration levels of atmospheric air pollutants and the number of medical visits to IMSS, ISSSTE and of SSJ healthcare facilities of the Urban Area of Guadalajara between 2000-2002 by children under five years suffering from acute respiratory infections. MATERIAL AND METHODS: An ecological study was performed to describe the correlation between the interpolated monthly average modes, monthly mobile average of air pollutants: carbon monoxide, nitrogen dioxide, ozone, and particles with an aerodynamic diameter of less than 10 microns (PM10) and sulfur dioxide, and the number of medical visits per month due to acute respiratory infections in children under five years. RESULTS: The air pollutants: carbon monoxide and nitrogen dioxide show a significant correlation with the incidence of acute respiratory infections in children less than five years of age in the Urban Area of Guadalajara. The correlation coefficients were: CO (r= 0.05) and NO2 (r= 0.09). CONCLUSIONS: Although the concentrations of air pollutants stay below the official limit, carbon monoxide and nitrogen dioxide affect the health of the child population of the Urban Area of Guadalajara. Although the monthly average mode and monthly mobile average does not exceed the established legislation, the registered maximums do exceed it; this indicates that although throughout most of the day there is no latent risk of population exposure to the air pollutants, during some hours of certain days there is a risk for the population of breathing air contaminated with concentrations higher than the limit, which can cause the development of acute respiratory infections.

Factores geográficos en la epidemiología de la intoxicación por Karwinskia (tullidora) en México / Geographical factors in the epidemiology of intoxication by Karwinskia (tullidora) in Mexico

Las Parálisis Flácidas causadas por el consumo de los frutos de las plantas del género Karwinskia (tullidora) han emergido como un problema de salud pública en ciertas regiones de México. Investiga los factores geográficos asociados a esta patología, en 72 casos reportados en México de 1990 a 1994. La distribución geográfica de casos coincide con las 11 especies reportadas de Karwinskia en México. La mayoría se relacionaron con la K. humboldtiana y, en menor medida, con K. mollis, K. parvifolia, K. johnstonil y K. rzedowskii. La presencia de casos es mayor en regiones con climas secos (79,2 por cento), vegetación de Matorrales Aridos (41,7 por cento) y altitudes menores de mil metros (54,1 por cento). Se determinaron tres diferentes zonas de riesgo: la zona del río Balsas, la región norte del país, así como las zonas áridas y secas centrales de los estados de Puebla, Hidalgo, San Luis Potosí y Querétaro. Las comunidades menores de 2.500 habitantes y con niveles de bienestar y de educación bajos son las más afectadas.