Factores de riesgo para complicaciones graves de COVID-19, comparando tres olas epidemiológicas. Un enfoque desde la atención primaria en México / Risk factors for COVID-19 severe complications comparing three major epidemiological waves: An approach from primary health care in Mexico

Objetivos: Describir la asociación entre las enfermedades crónicas no transmisibles y la edad, con la hospitalización, desenlaces clínicos graves y las defunciones por COVID-19 en los casos confirmados en población mexicana, comparando las tres primeras olas epidemiológicas de la pandemia en México. Diseño: Se realizó un análisis transversal utilizando el Sistema de Vigilancia Epidemiológica de Enfermedad Respiratoria Viral para COVID-19. Emplazamiento: Sistema de Vigilancia Epidemiológica de Enfermedad Respiratoria Viral en México (SISVER). Participantes: Población mexicana confirmada para SARS-CoV-2 registrada en el SISVER. Mediciones principales: Los desenlaces graves analizados fueron hospitalización, neumonía, necesidad de ventilación mecánica, ingreso a la UCI y defunción. Se evaluó la asociación (odds ratio [OR]) entre los desenlaces y las variables clínicas, comparando las tres olas epidemiológicas en México. Resultados: Una edad mayor de 65 años se asocia a un mayor porcentaje de hospitalización, neumonía, y notablemente, con el total de defunciones, independientemente del efecto de las comorbilidades crónicas. Existe interacción entre la edad en conjunto con la obesidad, la cual se asocia con la hospitalización y neumonía. Estos hallazgos fueron consistentes a lo largo de las tres olas epidemiológicas.Conclusión: La obesidad, EPOC y la diabetes en interacción con la edad se asocian con peores desenlaces clínicos, primordialmente con defunciones en los pacientes con COVID-19.(AU)

Objectives: To describe the association between chronic noncommunicable diseases and age with hospitalization, death and severe clinical outcomes for COVID-19 in confirmed cases within the mexican population, comparing the first three epidemiological waves of the pandemic in Mexico. Design: We performed an analysis using Mexico's Government Epidemiological Surveillance System database for COVID-19. Emplacement: Mexico's Epidemiological Surveillance System for Respiratory Diseases. Participants: Mexican population confirmed with SARS-CoV-2 registered on Mexico's Epidemiological Surveillance System for Respiratory Diseases. Primary measurements: The analysed severe outcomes were hospitalization, pneumonia, use of mechanical ventilation, intensive care unit admission and death. The association (odds ratio) between the outcomes and clinical variables was evaluated, comparing the three epidemiological waves in Mexico. Results: Age over 65 is associated with a higher ratio of hospitalization and pneumonia, independent of the effect of chronic comorbidities. There is an interaction between age and obesity, which is associated with hospitalization, pneumonia and highly associated with death. These findings were consistent throughout the three epidemiological waves. Conclusion: Obesity, COPD and diabetes in interaction with age, are associated with worse clinical outcomes and, more importantly, death in patients with COVID-19.(AU)

[Risk factors for COVID-19 severe complications comparing three major epidemiological waves: An approach from primary health care in Mexico]. / Factores de riesgo para complicaciones graves de COVID-19, comparando tres olas epidemiológicas. Un enfoque desde la atención primaria en México.

OBJECTIVES: To describe the association between chronic noncommunicable diseases and age with hospitalization, death and severe clinical outcomes for COVID-19 in confirmed cases within the mexican population, comparing the first three epidemiological waves of the pandemic in Mexico. DESIGN: We performed an analysis using Mexico's Government Epidemiological Surveillance System database for COVID-19. EMPLACEMENT: Mexico's Epidemiological Surveillance System for Respiratory Diseases. PARTICIPANTS: Mexican population confirmed with SARS-CoV-2 registered on Mexico's Epidemiological Surveillance System for Respiratory Diseases. PRIMARY MEASUREMENTS: The analysed severe outcomes were hospitalization, pneumonia, use of mechanical ventilation, intensive care unit admission and death. The association (odds ratio) between the outcomes and clinical variables was evaluated, comparing the three epidemiological waves in Mexico. RESULTS: Age over 65 is associated with a higher ratio of hospitalization and pneumonia, independent of the effect of chronic comorbidities. There is an interaction between age and obesity, which is associated with hospitalization, pneumonia and highly associated with death. These findings were consistent throughout the three epidemiological waves. CONCLUSION: Obesity, COPD and diabetes in interaction with age, are associated with worse clinical outcomes and, more importantly, death in patients with COVID-19.

Asociación de la exposición a contaminantes atmosféricos con indicadores epidemiológicos de morbilidad y mortalidad por Covid-19 en el Valle de México.

OBJETIVO: Analizar la asociación de la concentración de con-taminantes atmosféricos y los indicadores epidemiológicos de Covid-19 en la Zona Metropolitana del Valle de México (ZMVM). Material y métodos. Se diseñó un estudio epidemiológico ecológico. Se utilizaron modelos lineales tipo Poisson para variables de conteo y modelos lineales de efectos aleatorios en variables continuas para cuantificar la asociación entre los contaminantes atmosféricos y los indicadores de Covid-19. Los datos obtenidos fueron del 28 de febrero de 2020 al 30 de junio de 2021. La exposición a contaminantes se estratificó por estaciones climáticas. RESULTADOS: Los contaminantes que tuvieron asociación significativa con indicadores de morbilidad y mortalidad fueron CO, NOX, O3 y PM10. En la estación seca fría el CO y el NOX tuvieron efecto sobre los casos diarios confirmados y las defunciones diarias. Las PM10 se asociaron con efecto en los indicadores de casos diarios confirmados, incidencia diaria, porcentaje de hospitalizados y la tasa de letalidad. CONCLUSIONES: Los resultados sugieren una asociación entre el comportamiento epidemiológico de Covid-19 y la exposición a CO, NOX, O3 y PM10, en la que se encontró un mayor efecto en la estación seca-fría en la ZMVM.

Genomic sovereignty or the enemy within / Soberanía genómica o el enemigo interior / Soberania genômica ou o inimigo interior

Genomic sovereignty is a concept that has become very popular among developing countries such as India, China, South Africa and Mexico. This concept is a response to developed countries that have taken advantage of those countries and researchers who don't have the means for protecting their own biogenetic resources. In this article we argue that genomic sovereignty is not about the “others” extracting and exploiting local “human genetic resources”, but developing and implementing the ethical, legal and administrative tools, based on transparency, openness and equal access to biological material, in order to build up a robust research networks. Being biological samples a scarce and valuable good, we conclude that controlling the access to this resource by means of the law, without a well implemented biobanking system and a clear scientific policy may lead to a situation where asymmetric relations are generated among research groups of the very same developing country. We would advice to those countries pretending to protect their biological samples and data from the outside, before developing laws against possible “intrusions”, they need to design strategies to promote equal and fair access to both resources paramount to biomedical research.

“Soberanía genómica” es un concepto que se ha hecho muy popular entre los países en desarrollo, como India, China, Sudáfrica y México. Este concepto es una respuesta a los países desarrollados que han tomado ventaja, aprovechándose de aquellos países y de los investigadores que no tienen los medios para proteger sus propios recursos biogenéticos. En este artículo argumentamos que la soberanía genética no se trata de impedir que “otros” extraigan y exploten “los recursos genéticos humanos” locales, sino del desarrollo y de la aplicación de las herramientas éticas, jurídicas y administrativas basadas en la transparencia, la apertura e igualdad en el acceso al material biológico, con el fin de construir redes de investigación sólidas. Al ser las muestras biológicas un bien escaso y valioso, concluimos que el control del acceso a este recurso, por medio de la ley, sin un sistema de biobancos bien implementado y sin una política científica clara, puede llevar a una relación asimétrica entre los grupos de investigación del mismo país en desarrollo. Nos gustaría advertir a los países que pretenden proteger sus muestras biológicas y datos asociados que, antes que elaborar leyes contra posibles intrusiones, es necesario diseñar estrategias para promover el acceso justo y equitativo a los recursos primordiales para la investigación biomédica.

“Soberania genômica” é um conceito que se fez muito popular entre os países em desenvolvimento, como Índia, China, África do Sul e México. Este conceito é uma resposta aos países desenvolvidos que obtiveram vantagem, aproveitando-se daqueles países e dos investigadores que não têm meios para proteger os seus próprios recursos biogenéticos. Neste artigo argumentamos que a soberania genética não trata de impedir que “outros” extraiam e explorem “os recursos genéticos humanos” locais, senão do desenvolvimento e da aplicação das ferramentas éticas, jurídicas e administrativas baseadas na transparência, abertura e igualdade no acesso ao material biológico, com a finalidade de construir redes de investigação sólidas. Por serem as amostras biológicas um bem escasso e valioso, concluimos que o controle do acesso a este recurso, por meio da lei, sem um sistema de biobancos bem implementado e sem uma política científica clara, pode levar a uma relação assimétrica entre os grupos de investigação de um mesmo país em desenvolvimento. Gostaríamos advertir aos países que pretendem proteger suas amostras biológicas e dados associados que, antes de elaborar leis contra possíveis intromissões, é necessário projetar estratégias para promover o acesso justo e equitativo aos recursos primordiais para a investigação biomédica.

[Equity, public health and genomics: the legal, social and biotechnology challenge in México]. / Equidad, salud pública y genómica: el reto jurídico, social y biotecnológico en México.

Mexico has entered an era where health research is enriched by the study of genetic variants that determinate how the different human populations are differentially susceptible to diseases. The objective is to design new strategies in health care and services based on medical genomics. However, to ensure universal access to these products, we should rethink the legal aspects that facilitate the design of health policies, based on the principle of equity. Intrinsic factors of the Mexican health system as inequity, poverty and low investment in health research, are challenges that add to the development of appropriate distribution strategies for the use of new genomic products for health. This article discusses these challenges and establish the basis to design policies and appropriate use of these new genomic-based health care services.

La medicina genómica en las políticas de salud pública: una perspectiva de investigadores mexicanos del área biomédica

Objetivo. Explorar las perspectivas de los investigadores en medicina genómica y cómo incide esta última en las políticas de salud en México. Material y métodos. Se realizó una investigación cualitativa a partir de entrevistas semiestructuradas,durante el II Congreso Nacional de de Medicina Genómica celebrado en México del 25 al 27 de octubre de 2006. Resultados. Se identificaron cuatro categorías con respecto a la aplicabilidad de la medicina genómica y la viabilidad política de la investigación genómica. Algunos investigadores consideran que las tres “P” de la medicina genómica, predictiva, personalizada y preventiva, generaron “expectativas exageradas” sobre su impacto real en salud pública. Las opiniones se dividieron entre aquéllos que consideran la medicina genómica como el nuevo “paradigma” de salud pública y quienen piensan que se trata más bien de una herramienta de la salud pública.

[HumGen in Spanish: a comparative description of human genetics regulatory framework in Latin America]. / HumGen en Español: descripción comparativa del marco normativo de genética humana en América Latina.

OBJECTIVE: To provide a research database of normative documents in Spanish related to human genetics (HG). METHODS: This is a researchable database, where normative texts are related to HG. The ELSI issues are compiled, combining documents with national, regional, and international influence. The selection of these laws is done through a process of rigorous qualitative research. The portal is aimed at the general public, but with an emphasis on decision makers who possess the capacity to formulate policies on matters related to HG. Several normative documents, issued by international and regional organizations, are included, as well as documents of local government agencies of different countries. RESULTS: From the laws and policies available in the database, 39% are decrees of international organizations, 12% are regional normative texts, and 49% are national laws and policies. From all the national legal texts, 48% are laws or policies that belong to Spain. CONCLUSIONS: Latin American countries are not adopting a futuristic perspective because they do not regulate or legislate the technology resulting from research in HG. The HumGen Portal is a tool that will help the development of regulatory frameworks in Spanish-speaking countries, which will be suitable to current scientific progress.

[Genomic medicine in public health policies: a perspective of Mexican biomedical researchers]. / La medicina genómica en las políticas de salud pública: una perspectiva de investigadores mexicanos del área biomédica.

OBJECTIVE: The purpose of this study was to explore the researcher's perspectives on genomic medicine (GM) and its consequences in the decision-making process regarding the health policy in Mexico. MATERIALS AND METHODS: An exploratory qualitative research was conducted (semi-structured questionnaire). The study was conducted during the II National Congress of GM (25 - 27th October 2006). RESULTS: We identified four categories amongst the researcher's perspectives regarding the applicability of GM and the political feasibility of the genomics research. Some researchers believe that the 3P's of GM (Predictive, Personalized, Preventive) have generated "inflated expectations" on the real impact on public health (PH). Opinions were divided among those who believed that GM is the new 'paradigm' of PH and those who thought that GM is part of a set of tools for PH. CONCLUSION: To improve the health conditions of the Mexican population, GM must be part in the solution of the PH problems, but we need a realistic view.

La medicina genómica en las políticas de salud pública: una perspectiva de investigadores mexicanos del área biomédica / Genomic medicine in public health policies: a perspective of Mexican biomedical researchers

OBJETIVO: Explorar las perspectivas de los investigadores en medicina genómica y cómo incide esta última en las políticas de salud en México. MATERIAL Y MÉTODOS: Se realizó una investigación cualitativa a partir de entrevistas semiestructuradas, durante el II Congreso Nacional de de Medicina Genómica celebrado en México del 25 al 27 de octubre de 2006. RESULTADOS: Se identificaron cuatro categorías con respecto a la aplicabilidad de la medicina genómica y la viabilidad política de la investigación genómica. Algunos investigadores consideran que las tres "P" de la medicina genómica, predictiva, personalizada y preventiva, generaron "expectativas exageradas" sobre su impacto real en salud pública. Las opiniones se dividieron entre aquéllos que consideran la medicina genómica como el nuevo "paradigma" de salud pública y quienen piensan que se trata más bien de una herramienta de la salud pública. CONCLUSIÓN: Si bien no cabe duda que la medicina genómica constituye uno de los campos de la salud pública orientados a mejorar las condiones de salud de los mexicanos, no deben perderse de vista sus alcances reales.

OBJECTIVE: The purpose of this study was to explore the researcher's perspectives on genomic medicine (GM) and its consequences in the decision-making process regarding the health policy in Mexico. MATERIALS AND METHODS: An exploratory qualitative research was conducted (semi-structured questionnaire). The study was conducted during the II National Congress of GM (25 - 27th October 2006). RESULTS: We identified four categories amongst the researcher's perspectives regarding the applicability of GM and the political feasibility of the genomics research. Some researchers believe that the 3P's of GM (Predictive, Personalized, Preventive) have generated "inflated expectations" on the real impact on public health (PH). Opinions were divided among those who believed that GM is the new 'paradigm' of PH and those who thought that GM is part of a set of tools for PH. CONCLUSION: To improve the health conditions of the Mexican population, GM must be part in the solution of the PH problems, but we need a realistic view.

Individualidad genética y la Declaración Universal sobre el Genoma Humano y los Derechos Humanos / No disponible

El artículo explora la relación epistémica y ontológica entre Ciencia y Derecho a partir del concepto de individuo en la Declaración Universal sobre el Genoma Humano y los Derechos Humanos. Se argumenta en favor de una mejor comprensión de dicha relación para prever posibles consecuencias éticas y sociales de la Ley derivadas de conceptos con un fuerte significado científico (AU)

In this article we explore the epistemic and ontological relationship between Science and Law through the concept of individual in the Universal Declaration of the Human Genome and Human Rights. We argue for a better understanding of this relationship in order to foresee ethical and social consequences derived from Law adopting concepts with a strong scientific meaning (AU)

[Genetic individuality and the universal declaration on the human genome and human rights]. / Individualidad genética y la declara- ción universal sobre el genoma hu- mano y los derechos humanos.

In this article we explore the epistemic and ontological relationship between science and law through the concept of individual in the Universal Declaration of the Human Genome and Human Rights. We argue for a better understanding of this relationship in order to foresee ethical and social consequences derived from Law adopting concepts with a strong scientific meaning.