Integration of Total Worker Health® Training for Occupational Health and Safety Professionals with Efforts to Promote Worker Health, Safety, and Well-Being in Mexico.

OBJECTIVE: We sought to test whether a two-week Total Worker Health (TWH) training mapped to TWH education competencies could be administered to a Mexican audience of occupational safety and health professionals and could lead to positive changes to knowledge and behaviors. METHODS: This study employed robust program evaluation methods collected before and after each of the nine training days and at the end of the course. RESULTS: Overall course quality received a mean score of 4.6 (SD = 0.6) and 98.8% of participants agreed that their TWH knowledge increased. All participants intended to make at least one change to their professional practice, most frequently helping companies assess their organizational culture to support health, safety, and well-being. CONCLUSIONS: This TWH training was well-received and led to positive self-reported increase in knowledge and abilities to influence workers' health, safety, and wellbeing.

SARS-CoV-2 seroprevalence and respiratory disease disability claims in Mexico City Metropolitan Area.

OBJECTIVE: To characterize the impact of SARS-CoV-2 infection in workers from an essential large-scale company in the Greater Mexico City Metropolitan Area using point prevalence of acute infection, point prevalence of past infection through serum antibodies and respiratory disease short-term disability claims (RD-STDC). MATERIALS AND METHODS: Four randomized surveys, three during 2020 before and one after (December 2021) vaccines' availability. OUTCOMES: point prevalence of acute infection through saliva PCR (polymerase chain reaction) testing, point prevalence of past infection through serum antibodies against Covid-19, RD-STDC and prevalence of symptoms during the previous six months. RESULTS: Prevalence of SARS-CoV-2 cases was 1.29-4.88%, on average, a quarter of participants pre-vaccination were seropositive; over half of participants with a RD-STDC had antibodies. The odds of having antibodies were 6-7 times more among workers with an RD-STDC. CONCLUSIONS: High antibody levels against Covid-19 in this study population reflects that coverage is high among workers in this industry. STDCs are a useful tool to track workplace epidemics.

The Omicron wave in Mexico: vaccine protection against progression to severe Covid-19 in SARS-CoV-2-infected workers.

OBJECTIVE: To assess the effectiveness of seven Covid-19 vaccines in preventing disease progression (DP) using data from national private sector workers during the Omicron wave in Mexico from January 2 to March 5, 2022. MATERIALS AND METHODS: This study employed an administrative retrospective cohort design, analyzing DP (hospitalization or death due to respiratory disease) among workers who filed a respiratory short-term disability claim and tested positive for SARS-CoV-2. Risk ratios (RRadj) were estimated using Poisson regression models adjusted for various factors. RESULTS: Vaccinated individuals had a lower risk of hospitalization and death compared with unvaccinated individuals. The overall RRadj for hospitalization and death were 0.36 (95%CI 0.32, 0.41) and 0.24 (0.17, 0.33), respectively. When evaluating vaccines individually, the RRadj for hospitalization were as follows Pfizer BioNTech 0.27 (95%CI 0.22, 0.33), Moderna 0.29 (95%CI 0.15, 0.57), Sinovac 0.32 (95%CI 0.25, 0.41), AstraZeneca 0.39 (95%CI 0.34, 0.46), Sputnik 0.39 (95%CI 0.28, 0.53), CanSino 0.41 (95%CI 0.24, 0.7), and Janssen 0.53 (95%CI 0.39, 0.72). The RRadj for death were as follows: Pfizer BioNTech 0.12 (95%CI 0.07, 0.19), Sputnik 0.15 (95%CI 0.06, 0.38), Sinovac 0.29 (95%CI 0.16, 0.53), AstraZeneca 0.30 (95%CI 0.20, 0.44), CanSino 0.38 (95%CI 0.1, 1.4), and Janssen 0.50 (95%CI 0.26, 0.97). CONCLUSION: Covid-19 vaccines significantly reduced the risk of severe disease during the Omicron wave in Mexico.

Assessing the real-world effectiveness of five SARS-CoV-2 vaccines in a cohort of Mexican pensioners: a nationwide nested test-negative design study.

Background: Despite the extensive distribution of COVID-19 vaccines across Latin America, research on their real-world performance remains limited. We aimed to evaluate the effectiveness of five vaccines (BNT162b2, AZD1222, CoronaVac, Gam-COVID-Vac, and Ad5-nCoV) in a cohort of 2,559,792 pensioners covered by the Mexican Institute of Social Security. Methods: We conducted a nested test-negative design study on 28,271 individuals tested for SARS-CoV-2 infection between April and November 2021, accounting for 29,226 separate episodes. We used mixed-effects logistic regression models to estimate the vaccine effectiveness (VE) in fully vaccinated individuals for symptomatic infection, hospitalization, severe disease, and death. Findings: The median age of the study population was 70 years (interquartile range 65-76) and 76.4% (21,598/28,271) were male. VE rates were 56.3%, 75.3%, 79.7%, and 79.8% against symptomatic infection (95% confidence interval [CI]: 53.5-59.0), hospitalization (95% CI: 73.4-77.0), severe disease (95% CI: 78.0-81.3), and death (95% CI: 78.1-81.4), respectively. When evaluating vaccines individually, all showed moderate to high VE, with the best being BNT162b2 (symptomatic infection, 69.8%, 95% CI: 67.3-72.0; hospitalization, 84.1%, 95% CI: 82.5-85.6; severe disease, 88.2%, 95% CI: 86.7-89.5; and death, 88.3%, 95% CI: 86.9-89.6) and Gam-COVID-Vac (symptomatic infection, 70.0%, 95% CI: 64.8-74.4; hospitalization, 86.8%, 95% CI: 83.7-89.3; severe disease, 91.9%, 95% CI: 89.4-93.9; and death, 92.0%, 95% CI: 89.5-93.9). Interpretation: All five SARS-CoV-2 vaccines available for this population showed moderate to high levels of protection against COVID-19 and its progression to severe outcomes. Funding: Fundación IMSS, México.

Hacia el diseño de Vida Saludable, un nuevo programa de estudios para la educación básica en México.

OBJETIVO: Describir el proceso de diseño de Vida Saludable, un nuevo programa de estudios para la educación básica en México. Material y métodos. Se conformó un equipo de trabajo entre especialistas en salud y la Secretaría de Educación Pública. Se establecieron las bases científicas de Vida Saludable, se seleccionaron y evaluaron materiales para Vida Saludable, y se revisaron contenidos vigentes de salud incluidos en otras asignaturas. RESULTADOS: Alimentación, actividad física e higiene y limpieza fueron definidos como los tres ejes temáticos para Vida Saludable. Se aprobaron 3 de 228 insumos para usarse en Vida Saludable y 71.7% de los con-tenidos vigentes en educación básica sobre salud requieren ediciones. CONCLUSIONES: Vida Saludable es un parteaguas hacia la alfabetización en materia de salud en educación básica en México, que se alinea con la agenda global para preservar la salud humana y planetaria.

Longevity and Neutralizing Capacity of IgG Antibodies against SARS-CoV-2 Generated by the Application of BNT162b2, AZD1222, Convidecia, Sputnik V, and CoronaVac Vaccines: a Cohort Study in the Mexican Population.

The WHO has approved the use of several vaccines during the COVID-19 pandemic; experience over the last 2 years has indicated that dose demand can only be covered using more than one design. Therefore, having scientific evidence of the performance of the different vaccines applied in a country is highly relevant. In Mexico, 5 vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were used, allowing a cohort study to analyze the generation of anti-S1/S2 IgG antibodies and anti-RBD antibodies with neutralizing activity at 0, 21, 90, and 180 days after vaccination. Five groups of participants were formed on the basis of the type of vaccine received and were divided on the basis of whether they previously had or did not have COVID-19. After completing the vaccination schedule, the seroprevalence was 95.5, 97.5, 81.0, 95.2, and 90.0% (BNT162b2, AZD1222, Convidecia, Sputnik V, and CoronaVac, respectively). Among the participants without COVID-19 prior to vaccination, the largest amount of antibodies in the 90-day period was observed in the BNT162b2 group, and the amount of antibodies in the Sputnik V group decreased the least over time. Even though the percentages of seroconversion obtained in this study were lower than those currently reported in other parts of the world, the tested vaccines are able, in most cases, to induce a good production of IgG antibodies anti-S1/S2 and neutralizing capacity. The fact that there are people who have not produced antibodies during the study leaves open some questions that must be investigated to avoid the appearance of serious cases of COVID-19. IMPORTANCE Since the start of the vaccination programs against COVID-19 in 2020, it was evident that due to global shortages, the demand for the dose required in Mexico could only be covered by acquiring different vaccines. Therefore, determining the effectiveness of these and the longevity of acquired immunity is extremely important in a scenario where SARS-CoV-2 circulation becomes endemic and booster doses are required periodically. Our data reveal significant differences both in the generation of antibodies as well as in their longevity for the vaccines applied in the country but suggest that, in general, the Mexican population can reach a high capacity to neutralize the virus, therefore, regarding less the variant for which they were designed.

Examining Geographical Differences in the HIV Care Continuum Among Men Who Have Sex with Men in Mexico.

We analyzed data collected by the Encuesta de Sexo Entre Hombres study from 15,233 Mexican men who have sex with men (MSM) between May-July 2017 to examine differences in the HIV care continuum. Data were stratified into 6 geographical regions. Prevalence ratios assessed associations between region and care outcomes. Among participants never testing HIV positive (n = 13,583), 66.1% had ever been tested and 43.0% in the past year. Among HIV-positive persons (n = 1,650), 83.9% reported counseling post-diagnosis, 61.9% timely linkage to care, 42.4% timely CD4/viral load results, 38.2% timely access to antiretroviral therapy (ART), and 87.7% were currently on ART. The Ciudad de México /Estado de México region had significantly superior care continuum outcomes in ever and recent HIV testing, linkage to care, CD4/viral load results, and current ART use. Understanding geographical variations in HIV care for MSM in Mexico is one important step to inform efforts for ending HIV/AIDS by 2030 in Latin America.

RESUMEN: Analizamos los datos de 15,233 hombres mexicanos que tienen sexo con hombres (HSH) recopilados entre mayo y julio de 2017 por el estudio Encuesta de Sexo Entre Hombres para examinar las diferencias en el continuo de la atención del VIH. Los datos se estratificaron en seis regiones geográficas. Se utilizaron razones de prevalencia para evaluar las asociaciones entre la región y los resultados de la atención. Entre los participantes sin prueba de VIH positiva (n = 13 583), el 66.1% se había hecho la prueba alguna vez en su vida y el 43.0% en el último año. Entre las personas que refirieron pruebas de VIH positivas (n = 1 650), el 83.9% informó asesoramiento post-diagnóstico, el 61.9% vinculación oportuna a la atención, el 42.4% resultados oportunos de CD4/carga viral, el 38.2% acceso oportuno a la terapia antirretroviral (TAR) y el 87.7% continuaba en TAR. La región de la Ciudad de México/Estado de México tuvo resultados del continuo de la atención significativamente superiores en pruebas de VIH pasadas y recientes, vinculación con la atención, resultados de carga viral/CD4 y uso actual de TAR. Comprender las variaciones geográficas de la atención del VIH en HSH en México es un paso importante para informar los esfuerzos para poner fin a la epidemia de HIV/Sida para 2030 en Latinoamérica.

Three years of COVID-19 in children that attend the Mexican Social Security Institute's 1,350 child day-care centers, 2020-2023.

Background: Studies have suggested that children are less likely than adults to develop COVID-19; however, with the emergence of SARS-CoV-2 variants, hospitalization and death due to this cause have increased among the youngest ones. Methods: Retrospective, descriptive analytical study of the COVID-19 cases, hospitalizations and deaths occurred in children under five years who attended in Child Day-Care Centers (Centros de Atención Infantil-CAIs) of the Mexican Social Security Institute (IMSS) from 20th July 2020 to 31st March 2023. Results were compared with Mexico's and the US's national-level data. Incidence, attack (children and workers) and mortality rates were estimated. The risks of getting sick, being hospitalized and dying due to COVID-19 were calculated by year. Results: There were 4,369 COVID-19 cases among children from IMSS CAIs; 67 (1.5%) required hospitalization and only two deaths were reported (0.04%). Both at IMSS CAIs and at a national level in Mexico and the US, the highest incidences of COVID-19 among children under five years occurred during Omicron prevalence. The attack rate among workers (32.93%) was higher than children (4.99%). Hospitalization and mortality rates in the US decreased since the anti-COVID 19 vaccine was introduced in children older than six months, unlike the rates in Mexico, where the vaccine for this age group was not available. By the year 2020, the children that attended the IMSS CAIs were 77.3% less likely to be hospitalized; 80.9% in 2021, 93.2% in 2022, and 77.7% by March 2023, compared to same age children in Mexico. In 2021, the children that attended IMSS CAIs were 90.6% less likely to die due to COVID-19, and by March 2023, this likelihood was 34.3% lower than the rest of children in this age group in Mexico. Conclusions: Children that attended IMSS CAIs had a smaller risk of hospitalization and death due to COVID-19. However, the high rates of hospitalization and death due to SARS-CoV-2 in children under five years in our country point to the need and urgency of vaccination against this virus in this age group, as well as of the adherence to strict detection and medical referral protocols.

Epidemiology of sudden infant death syndrome in Mexico, 2005-2020.

Background: Sudden Infant Death Syndrome (SIDS) constitutes one of the main causes of mortality in children under one year of age in developed countries; it's frequency to varies geographically. In Mexico the real incidence of SIDS is not known. Methods: National databases of deaths in children under one year of age, from 2005 to 2020, were analyzed, due to Sudden Unexpected Infant Death (SUID) [SIDS (R95), accidental suffocation in a sleeping environment (W75), and other ill-defined and unspecified causes of mortality (R99), according to the International Classification of Diseases, tenth revision (ICD 10)]. Mortality rates per year of occurrence due to SUID and their subcategories were calculated. Simple frequencies of SIDS were obtained per year and month of occurrence, state of residence, age, place of death, and access to social security services. Results: In the study period 473,545 infant deaths occurred; 7,714 (1.62%) deaths were due to SUID; of these, 6,489 (84%) were due to SIDS, which is among the 10 leading causes of infant death in Mexico. The average mortality rate for SUID was 22.4/100,000 live births, for SIDS was 18.8/100,000 live births. Mortality rates within the states were variable, ranging from 2.4/100,000 to 105.1/100,000 live births. In 81% of SIDS records there was no autopsy; 38% of deaths due to SIDS occurred in infants under one month of age, up to 87% of deaths occurred in families without social security services or it was unknown, and 76.2% of deaths occurred at home. Deaths were more frequent during the last months of autumn and during winter. Conclusion: In Mexico there is an underregistry of SIDS as cause of death, along with other SUID categories. Health workers need to be trained to improve diagnosis and data registration, including the practice of autopsies; additionally, it is necessary to implement a public health campaign.

Metodología de una encuesta por internet para hombres que tienen sexo con hombres en México.

OBJETIVO: Describir el diseño, implementación y el perfil de los participantes de la Encuesta de Sexo Entre Hombres (ES Entre Hombres). Material y métodos. ES Entre Hombres es una encuesta en línea no probabilística aplicada a nivel nacional a hombres de 18 años o más, que tienen sexo con hombres (HSH) y que usan internet. La población de estudio se reclutó a través de publicidad en diversos sitios de encuentro en línea y los cuestionarios se autoaplicaron con SurveyGizmo. RESULTADOS: Durante 11 semanas se registró un total de 15 875 autoaplicaciones elegibles y completas de las 32 entidades del país. La mayoría de los participantes fueron jóvenes (<29 años; 65.7%) y personas que acceden a internet diariamente (94.3%). Conclusión. Las encuestas realizadas por internet para poblaciones como los HSH representan un método costoefectivo de estudio poblacional, ya que tienen el potencial de ahorrar recursos y alcanzar muestras grandes, lo que a la vez facilita la cobertura geográfica a un bajo costo.

Plataforma CLIMSS como herramienta de alfabetización en salud durante la crisis sanitaria de Covid-19.

OBJETIVO: Describir a la plataforma Cursos en Línea Masivos del IMSS (CLIMSS) como herramienta de alfabetización en salud, a través de la evaluación de la eficiencia terminal, la ganancia de competencias y satisfacción de los usuarios de cursos en línea masivos en el tema de Covid-19. Material y métodos. Se analizaron datos de 20 cursos ofertados entre marzo y octubre de 2020. Se evaluaron las calificaciones pre y pos, el número total de registros, el total de cursos terminados y la satisfacción del usuario. RESULTADOS: Se registraron un total de 4.9 millones de usuarios y 10 millo-nes de inscripciones, en todos los estados de la República mexicana, con una eficiencia terminal de 85%, una ganancia de competencias de 30% y una satisfacción de 9.34 (10). CONCLUSIONES: La plataforma CLIMSS ha mostrado ser una herramienta para la alfabetización en salud con un alcance de millones de mexicanos en temas relacionados con la crisis sanitaria Covid-19.

Patient sexuality disclosure experience and associations with clinical sexual health outcomes among HIV-negative men who have sex with men in Mexico.

Many men who have sex with men (MSM) do not disclose their sexuality to their healthcare provider, despite potential health benefits. Data from the 2017 Encuesta de Sexo Entre Hombres online survey of 13,277 HIV-negative or unknown status MSM in Mexico were used to explore MSM patients' sexuality disclosure experience on sexual health outcomes using multivariable Poisson models with robust variance estimation to estimate adjusted prevalence ratios (aPR). Sexual health outcomes included Hepatitis B (HepB) and human papillomavirus (HPV) vaccination, and lifetime and past year HIV testing. Overall, 53.9% (n/N) disclosed their sexuality to their healthcare provider, and of those 6.4%, 62.9%, and 30.7% reported a negative, neutral, or positive disclosure experience, respectively. In comparison to no disclosure, neutral and positive disclosure experiences were associated with HepB vaccination (aPR[95% Confidence Interval (95% CI)] = 1.17[1.09, 1.25], p < 0.001; aPR[95% CI] = 1.35[1.25, 1.46], p < 0.001, respectively) and positive disclosure experiences were associated with HPV vaccination (aPR[95% CI] = 1.46[1.24, 1.71], p < 0.001). Those who disclosed their sexual behavior were more likely than those who did not disclose their sexual behavior to have received an HIV test in their lifetime (negative: aPR[95% CI] = 1.51[1.43, 1.60], p < 0.001; neutral: aPR[95% CI] = 1.61[1.56, 1.66], p < 0.001; positive: aPR[95% CI] = 1.64[1.58, 1.69], p < 0.001) and an HIV test in the past year (negative: aPR[95% CI] = 1.89[1.70, 2.10], p < 0.001; neutral: aPR[95% CI] = 2.09[1.98, 2.20], p < 0.001; positive: aPR[95% CI] = 2.24[2.12, 2.37], p < 0.001). There is a need to implement trainings for healthcare providers that focus on sexual health risk assessments and creating a space that encourages MSM patients and healthcare providers to discuss sexual health.

Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020-2021: A death certificates study in a middle-income country.

Background: The death toll after SARS-CoV-2 emergence includes deaths directly or indirectly associated with COVID-19. Mexico reported 325,415 excess deaths, 34.4% of them not directly related to COVID-19 in 2020. In this work, we aimed to analyse temporal changes in the distribution of the leading causes of mortality produced by COVID-19 pandemic in Mexico to understand excess mortality not directly related to the virus infection. Methods: We did a longitudinal retrospective study of the leading causes of mortality and their variation with respect to cause-specific expected deaths in Mexico from January 2020 through December 2021 using death certificate information. We fitted a Poisson regression model to predict cause-specific mortality during the pandemic period, based on the 2015-2019 registered mortality. We estimated excess deaths as a weekly difference between expected and observed deaths and added up for the entire period. We expressed all-cause and cause-specific excess mortality as a percentage change with respect to predicted deaths by our model. Findings: COVID-19 was the leading cause of death in 2020-2021 (439,582 deaths). All-cause total excess mortality was 600,590 deaths (38⋅2% [95% CI: 36·0 to 40·4] over expected). The largest increases in cause-specific mortality, occurred in diabetes (36·8% over expected), respiratory infections (33·3%), ischaemic heart diseases (32·5%) and hypertensive diseases (25·0%). The cause-groups that experienced significant decreases with respect to the expected pre-pandemic mortality were infectious and parasitic diseases (-20·8%), skin diseases (-17·5%), non-traffic related accidents (-16·7%) and malignant neoplasm (-5·3%). Interpretation: Mortality from COVID-19 became the first cause of death in 2020-2021, the increase in other causes of death may be explained by changes in the health service utilization patterns caused by hospital conversion or fear of the population using them. Cause-misclassification cannot be ruled out. Funding: This study was funded by Conacyt.

Vaccine Effectiveness of CanSino (Adv5-nCoV) Coronavirus Disease 2019 (COVID-19) Vaccine Among Childcare Workers-Mexico, March-December 2021.

BACKGROUND: Beginning in March 2021, Mexico vaccinated childcare workers with a single-dose CanSino Biologics (Adv5-nCoV) coronavirus disease 2019 (COVID-19) vaccine. Although CanSino is currently approved for use in 10 Latin American, Asian, and European countries, little information is available about its vaccine effectiveness (VE). METHODS: We evaluated CanSino VE within a childcare worker cohort that included 1408 childcare facilities. Participants were followed during March-December 2021 and tested through severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction or rapid antigen test if they developed any symptom compatible with COVID-19. Vaccination status was obtained through worker registries. VE was calculated as 100% × (1 - hazard ratio for SARS-CoV-2 infection in fully vaccinated vs unvaccinated participants), using an Andersen-Gill model adjusted for age, sex, state, and local viral circulation. RESULTS: The cohort included 43 925 persons who were mostly (96%) female with a median age of 32 years; 37 646 (86%) were vaccinated with CanSino. During March-December 2021, 2250 (5%) participants had laboratory-confirmed COVID-19, of whom 25 were hospitalized and 6 died. Adjusted VE was 20% (95% confidence interval [CI], 10%-29%) against illness, 76% (95% CI, 42%-90%) against hospitalization, and 94% (95% CI, 66%-99%) against death. VE against illness declined from 48% (95% CI, 33%-61%) after 14-60 days following full vaccination to 20% (95% CI, 9%-31%) after 61-120 days. CONCLUSIONS: CanSino vaccine was effective at preventing COVID-19 illness and highly effective at preventing hospitalization and death. It will be useful to further evaluate duration of protection and assess the value of booster doses to prevent COVID-19 and severe outcomes.

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

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

Metodología de una encuesta por internet para hombres que tienen sexo con hombres en México / Methodology of an internet survey for men who have sex with men in Mexico

Resumen: Objetivo: Describir el diseño, implementación y el perfil de los participantes de la Encuesta de Sexo Entre Hombres (ES Entre Hombres). Material y métodos: ES Entre Hombres es una encuesta en línea no probabilística aplicada a nivel nacional a hombres de 18 años o más, que tienen sexo con hombres (HSH) y que usan internet. La población de estudio se reclutó a través de publicidad en diversos sitios de encuentro en línea y los cuestionarios se autoaplicaron con SurveyGizmo. Resultados: Durante 11 semanas se registró un total de 15 875 autoaplicaciones elegibles y completas de las 32 entidades del país. La mayoría de los participantes fueron jóvenes (<29 años; 65.7%) y personas que acceden a internet diariamente (94.3%). Conclusión: Las encuestas realizadas por internet para poblaciones como los HSH representan un método costoefectivo de estudio poblacional, ya que tienen el potencial de ahorrar recursos y alcanzar muestras grandes, lo que a la vez facilita la cobertura geográfica a un bajo costo.

Abstract: Objective: To describe the design, implementation and profile of participants in the Sex Between Men Survey (ES entre Hombres). Materials and methods: ES entre Hombres is an online non-probabilistic survey applied at a national level to men 18 years of age or older, who have sex with men (MSM) and who use the internet. The target population was recruited through advertising on various online meeting sites and the questionnaires were self-administered using SurveyGizmo. Results: During 11 weeks a total of 15 875 eligible participants completed a self-applied questionnaire in 32 Mexican states. Most of the participants were young people (<29 years old; 65.7%) and people who access the internet daily (94.3%). Conclusion: Internet surveys for populations such as MSM represent a cost-effective method for population-based studies, since they have the potential to save resources and reach large samples sizes, providing geographic coverage at a low cost.

Plataforma CLIMSS como herramienta de alfabetización en salud durante la crisis sanitaria de Covid-19 / CLIMSS online platform as a health literacy tool during the health crisis of Covid-19

Resumen: Objetivo: Describir a la plataforma Cursos en Línea Masivos del IMSS (CLIMSS) como herramienta de alfabetización en salud, a través de la evaluación de la eficiencia terminal, la ganancia de competencias y satisfacción de los usuarios de cursos en línea masivos en el tema de Covid-19. Material y métodos: Se analizaron datos de 20 cursos ofertados entre marzo y octubre de 2020. Se evaluaron las calificaciones pre y pos, el número total de registros, el total de cursos terminados y la satisfacción del usuario. Resultados: Se registraron un total de 4.9 millones de usuarios y 10 millones de inscripciones, en todos los estados de la República mexicana, con una eficiencia terminal de 85%, una ganancia de competencias de 30% y una satisfacción de 9.34 (10). Conclusiones: La plataforma CLIMSS ha mostrado ser una herramienta para la alfabetización en salud con un alcance de millones de mexicanos en temas relacionados con la crisis sanitaria Covid-19.

Abstract: Objective: To describe the Massive Online Open Courses (MOOC) or Cursos en Línea Masivos del IMSS (CLIMSS) platform as a health literacy tool by evaluating the terminal efficiency, the competence gains, and the users' satisfaction of the massive online courses offered by the Mexican Institute of Social Security, on Covid- 19. Materials and methods: Data from 20 courses offered between March and October 2020 were analyzed. We evaluated scores from the pre and post-tests, the total number of registries, total courses completed, and users' satisfaction. Results: We registered a total of 4.9 million users and 10 million registrations, in all Mexican states, with a terminal efficiency of 85%, a competence gain of 30%, and a users' satisfaction of 9.34 (10). Conclusions: The CLIMSS platform has proven to be a tool for health literacy reaching millions of Mexicans on Covid-19 related topics.

Domain-specific effects of prenatal fluoride exposure on child IQ at 4, 5, and 6-12 years in the ELEMENT cohort.

OBJECTIVE: Prenatal exposure to fluoride has been associated with adverse neurodevelopmental outcomes. However, the neuropsychological profile of fluoride's developmental neurotoxicity at low levels and the stability of this relationship across childhood has not been characterized. We investigated the longitudinal and domain specific effect of prenatal fluoride exposure on IQ among children ages 4, 5, and 6-12 years in the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) cohort. METHODS: We measured the average of maternal urinary fluoride at each trimester of pregnancy adjusted for creatinine (MUFCRE). Children were administered the McCarthy Scales of Children's Abilities at ages 4 (N = 386) and 5 (N = 308), and the Wechsler Abbreviated Scale of Intelligence at age 6-12 (N = 278). We used generalized estimating equation (GEE) models to estimate the population averaged effect of MUFCRE concentration on longitudinal General Cognitive Index (GCI)/Full-Scale IQ (FSIQ), Verbal IQ (VIQ), and Performance IQ (PIQ) scores (N = 348). We tested for possible interactions between MUFCRE and child sex as well as for MUFCRE and time point on children's IQ. All models controlled for relevant available covariates. RESULTS: The mean/median MUFCRE concentration was 0.90/0.83 mg/L (SD = 0.39; IQR, 0.64-1.11 mg/L). A 0.5 mg/L increase in MUFCRE predicted an average 2.12-point decrease in GCI/FSIQ (95% CI: -3.49, -0.75) and 2.63-point decrease in PIQ (95% CI: -3.87, -1.40). MUFCRE was marginally associated with VIQ across time (B = -1.29, 95% CI: -2.60, 0.01). No interactions between MUFCRE and child sex or MUFCRE and time were observed. CONCLUSION: The negative association between prenatal fluoride exposure and longitudinal IQ was driven by decrements in non-verbal intelligence (i.e. PIQ), suggesting that visual-spatial and perceptual reasoning abilities may be more impacted by prenatal fluoride exposure as compared to verbal abilities.

[The estimated economic impact of cardiovascular and diabetes mellitus complications 2019-2028]. / Estimación del impacto económico por complicaciones cardiovasculares y de diabetes mellitus 2019-2028.

Background: In Mexico, diabetes mellitus (DM) and diseases cardiovascular, register an upward trend. Objective: To estimate the number of complications due to cardiovascular events (CVD) and complications derived from DM (CDM) accumulated in beneficiaries of the Mexican Institute of Social Security (IMSS) from 2019 to 2028, as well as the expense for medical and economic benefits in a scenario baseline and one of change in metabolic profile due to lack of medical follow-up during the COVID-19 pandemic. Material and methods: The number of CVD and CDM was estimated from 2019, with a 10-year risk projection using the ESC CVD Risk Calculator and United Kingdom Prospective Diabetes Study, considering risk factors registered in the institutional databases. Results: From 2019 to 2028, cumulative CVD cases were estimated at 2 million and those of CDM in 960 thousand, with an impact on medical spending of 439,523 million pesos and on the economic benefits of 174,085 millions. When considering the COVID-19 pandemic, CVD events and CDM increased by 589 thousand, with an increase in spending of 93,787 million pesos for medical care and 41,159 million for economic benefits. Conclusions: Without a comprehensive intervention in the management of CVD and CDM, the cost by both diseases will continue to increase, with financial pressures getting older.

Introducción: en México la diabetes mellitus (DM) y las enfermedades cardiovasculares, registran una tendencia ascendente. Objetivo: estimar el número de complicaciones por eventos cardiovasculares (ECV) y complicaciones derivadas de la DM (CDM) acumuladas en derechohabientes del Instituto Mexicano del Seguro Social (IMSS) de 2019 a 2028, así como el gasto por prestaciones médicas y económicas en un escenario de referencia y uno de cambio en el perfil metabólico debido a la falta de seguimiento médico durante la pandemia por COVID-19. Material y métodos: se estimó el número de ECV y CDM a partir de 2019, con una proyección de riesgo a 10 años con los modelos ESC CVD Risk Calculator y United Kingdom Prospective Diabetes Study, considerando los factores de riesgo registrados en las bases de datos institucionales. Resultados: de 2019 a 2028, los casos acumulados de ECV se estimaron en 2 millones y los de CDM en 960 mil, con un impacto sobre el gasto médico de 439,523 millones de pesos y sobre las prestaciones económicas de 174,085 millones. Al considerar la pandemia por COVID-19, los eventos de ECV y de las CDM aumentaron en 589 mil, con un incremento del gasto en 93,787 millones de pesos por atención médica y en 41,159 millones por prestaciones económicas. Conclusiones: sin una intervención integral al manejo de ECV y de CDM, el gasto por ambas enfermedades seguirá incrementándose, con presiones financieras cada vez mayores.