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In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC, have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.

Vitamin D deficiency (VDD) and polymorphisms in the group-specific component (GC) gene are known to be associated in different populations. However, the effects of such genetic variants may vary across different populations. Thus, the objective of this study was to estimate the association between Vitamin D-Binding Protein (VDBP) haplotypes and VDD in mestizo postmenopausal women and Mexican Amerindian ethnic groups. This was a cross-sectional study of 726 postmenopausal Mexican women from the Health Workers Cohort Study (HWCS) and 166 postmenopausal women from the Metabolic Analysis in an Indigenous Sample (MAIS) cohort in Mexico. GC polymorphisms (rs7045 and rs4588) were analyzed by TaqMan probes. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured by Chemiluminescent Microparticle Immuno Assay. The prevalence of VDD serum 25(OH)D

Background Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease and cirrhosis. NAFLD is mediated by changes in lipid metabolism and known risk factors include obesity, metabolic syndrome, and diabetes. The aim of this study was to better understand differences in the lipid composition of individuals with NAFLD compared to controls, by performing direct infusion lipidomics on serum biospecimens from a cohort study of adults in Mexico. Methods A nested case-control study was conducted with a sample of 98 NAFLD cases and 100 healthy controls who are participating in an on-going, longitudinal study in Mexico. NAFLD cases were clinically confirmed using elevated liver enzyme tests and liver ultrasound or liver ultrasound elastography, after excluding alcohol abuse, and 100 controls were identified as having at least two consecutive normal alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ( Results NAFLD cases had differences in total amounts of serum cholesterol esters, lysophosphatidylcholines, sphingomyelins, and triacylglycerols (TAGs), however, other lipid subclasses were similar to controls. Analysis of individual TAG species revealed increased incorporation of saturated fatty acyl tails in serum of NAFLD cases. After adjusting for age, sex, body mass index, and PNPLA3 genotype, a combined panel of ten lipids predicted case or control status better than an area under the ROC curve of 0.83. Conclusions These preliminary results indicate that the serum lipidome differs in patients with NAFLD, compared to healthy controls, and suggest that assessing the desaturation state of TAGs or a specific lipid panel may be useful clinical tools for the diagnosis of NAFLD.

Background: Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains unknown. Methods: We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n=168,287) and non-fatal (13 cohorts, n=27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor. Results: Our RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 100,000 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana. Interpretation: RRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those estimated from cohorts in high-income countries. Funding: Wellcome Trust (214185/Z/18/Z)

We evaluated the association between leisure-time physical activity (LTPA), bone mineral content (BMC), and lean mass (LM) in whole body (wb) and limbs of the Mexican adult population. Our results demonstrate that some types of LTPA with relatively high/medium impact on bones such as football, basketball, tennis, and weightlifting improve BMC and LM. To evaluate the effect of different kinds of leisure-time physical activity (LTPA) on bone mass values and its association with lean mass (LM) in the whole body (wb) and limbs of a large sample of Mexican men and premenopausal (pre-MP) women. We conducted a cross-sectional analysis of data from the Health Workers Cohort Study. Bone mineral content (BMC, kg), bone area (cm2), and LM (kg) were measured with DXA. The LTPA level and the “sedentary” condition were determined using a validated questionnaire adapted for the Mexican population. One-way ANOVA tests evaluated the differences in weight, height, body mass index, and wb, lower limb (ll) and upper limb (ul) BMC and LM between the active (those who engaged in LTPA) and sedentary group. Relationships between BMC and LM values were analyzed. Slopes of the curves and Z scores of LTPA groups with respect to the sedentary group were compared. In men, both wb-BMC and ll-BMC were significantly higher in the groups performing basketball, football, tennis, weightlifting, and running, and all wb-LM, ll-LM, and ul-LM were higher in running, weightlifting, football, and basketball groups with respect to the sedentary group. Both the Z scores and the slopes of BMC-vs-LM relationships were higher than the controls, but only in the ll of male basketball and football players. Our findings demonstrate that some types of LTPA with relatively high/medium impact on bones, such as football, basketball, tennis, and weightlifting, improve both BMC and LM compared to sedentary individuals. Finally, this relationship is stronger for the bones found in the legs and it seems that women are less sensitive to this effect, possibly due to hormonal, dietary, and pharmacological reasons.

Ageism can be seen as systematic stereotypes, prejudice, and discrimination of people because of their age. For a long time, society has accepted negative stereotypes as a norm. When referring to older adults, the United Nations Global Report on Ageism warns about a severe impact. The Intergenerational Study for a Healthy Aging, a questionnaire about believes, stereotypes, and knowledge about older people and grandparents, was administered to 326 Spanish biology and medical students. Here we report the results of stereotype analysis through adjective qualification of the youth and older people performed before the survey. Content analysis of two open questions about metacognition at the end of the survey is also presented. The results show that: (1) The questionnaire promoted metacognition, (2) Positive metacognition toward grandparents was higher than for the general old population, (3) Most participants were not conscious about ageism, (4) Gender was a key factor—male students were more ageist than females, (5) The feeling of guilt was higher in the questionnaire about older people, (6) The metacognition exercise elicited thoughts and, in few cases, the need to take action to tackle ageism. In conclusion, both activities promoted active thoughts about older people vs. grandparents and helped participants realize unconscious ageism—specifically toward the older population—serving as an awareness activity that may help tackle ageism.

Background Although high consumption of soft drinks has been associated with excess of type 2 diabetes risk, the strength of this association in the Mexican population, where a type 2 diabetes genetic susceptibility has been well established, has been scarcely studied. This study aimed to estimate the risk of type 2 diabetes due to soft drinks consumption in a cohort of Mexicans. Methods We used data on 1445 participants from the Health Workers Cohort Study, a prospective cohort conducted in Cuernavaca, Mexico. Soft drinks consumption was assessed with a semi-quantitative 116-item food frequency questionnaire. Incident type 2 diabetes was defined as self-report of physician-diagnosed type 2 diabetes, fasting glucose > 126 mg/dl, or hypoglycemic medication at any examination. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models. Results With a total of 9526.2 person-years of follow-up, 109 incident cases of type 2 diabetes were observed. Type 2 diabetes incidence rate was 7.6, 11.0, and 17.1 per 1000 person-years across levels of soft drinks consumption of p Conclusions The consumption of soft drinks was associated with a higher risk of type 2 diabetes in a cohort of Mexican adults. Our results further support recommendations to limit soft drinks intake to address the growing diabetes epidemic in Mexico.

On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.

Background Leukemia is the most common cancer in childhood. The estimated incidence rate of childhood leukemia in Colombia is one of the highest in America and little is known about its spatial distribution. Purpose To explore the presence of space-time clustering of childhood leukemia in Colombia. Methods We included children less than 15 years of age with confirmed diagnosis of acute leukemia reported to the national surveillance system for cancer between 2009 and 2017. Kulldorff’s spatio-temporal scan statistics were used with municipality and year of diagnosis as units for spatial and temporal analysis. Results There were 3846 cases of childhood leukemia between 2009 and 2017 with a specific mean incidence rate of 33 cases per million person-years in children aged 0–14 years. We identified five spatial clusters of childhood leukemia in different regions of the country and specific time clustering during the study period. Conclusion Childhood leukemia seems to cluster in space and time in some regions of Colombia suggesting a common etiologic factor or conditions to be studied.

AimTo determine the association between known risk factors (e.g., obesity, metabolic syndrome and its components) and the development of pre-diabetes or diabetes over time in a cohort of Mexican health workers.MethodsParticipants in the Mexican Health Worker Cohort Study with complete information at two waves of data collection, 2004-2006 (W1) and 2011-2013 (W2), were included in the analysis (n = 1,174). Multivariable binary and multinomial logistic regression were used to examine the cross-sectional associations between specific risk factors and diabetes status (diabetes, pre-diabetes, or neither) at W1 and the longitudinal associations between changes in risk factors and progression of diabetes status from W1 to W2, respectively.ResultsMean time between waves was 7.0 years (SD 1.1). Prevalence of pre-diabetes and diabetes was 16% and 10% at W1 and increased to 30% and 16% at W2, respectively. The cross-sectional prevalence of pre-diabetes and diabetes was significantly higher among men, participants over the age of 45 years, and individuals who were overweight or obese or had metabolic syndrome (MS), three or more components of the MS, elevated alanine aminotransferase (ALT) levels, or elevated uric acid. In longitudinal analyses, remaining obese or gaining weight between waves was associated with an increased risk of developing pre-diabetes. A greater risk of developing pre-diabetes or diabetes was also observed among individuals who either maintained or acquired MS, elevated ALT, or elevated uric acid (only for diabetes) from W1 to W2.ConclusionsWeight gain and acquiring or maintaining MS, elevated ALT levels, or elevated uric acid were associated with a significant risk of developing pre-diabetes or diabetes. Our findings, especially in the context of the obesity epidemic in Mexico, point towards an urgent need for initiatives to help reduce excess weight in order to avert future cases of pre-diabetes and diabetes.

To estimate the burden of genital warts (GW)in Mexico.We estimated the annual incidence of GW based on data reported by specialist physicians. We also assessed GW treatment practices, the average cost of treatment, and the psychosocial burden of GW among patients.The annual incidence of GW in Mexico was estimated to be 547 200 cases. Treatment procedures vary by specialist and patient gender. The estimated annual cost was $195 million USD. The psychosocial impact of GW was slightly greater in males than females.This is the first evaluation of the burden of GW in Mexico. Our data suggest that GW are common, with significant health-related costs and psychosocial impact.Estimar la carga por verrugas genitales (VG) en México.Estimamos la incidencia anual de VG, con base en información proporcionada por médicos especialistas y el manejo de las VG, así como el costo promedio del tratamiento y la carga psicosocial de las VG.La incidencia anual de VG en México fue de 547 200 casos. Los tratamientos variaron según la especialidad y el sexo del paciente. El costo anual por VG fue de $195 millones de dólares estadounidenses. El impacto psicosocial de las VG es ligeramente mayor en hombres que en mujeres.Esta es la primera evaluación de la carga de VG en México. Los datos sugieren que las VG son frecuentes, tienen costos relacionados con salud e impactos psicosociales significativos.

CHD is becoming an increasing priority worldwide, as it is one of the main causes of death in low- and middle-income countries lately. This study aims to evaluate the association between beverage consumption patterns and the risk of CHD among Mexican adult population. We performed a cross-sectional analysis using data from 6640 adults participating in the Health Workers’ Cohort Study. Factor analysis was performed to identify beverage patterns using sex-specific Framingham prediction algorithms to estimate CHD risk. The prevalence of moderate to high CHD risk was 17·8 %. We identified four major beverage consumption patterns, which were categorised as alcohol, coffee/tea, soft drinks and low-fat milk. We observed a lower risk of CHD (OR=0·61; 95 % CI 0·46, 0·80; and OR=0·58; 95 % CI 0·43, 0·79, respectively) among participants in the upper quintile of alcohol or low-fat milk consumption compared with those in the bottom quintile. In contrast, a higher consumption of soft drinks was positively associated with CHD risk (OR=1·64; 95 % CI 1·21, 2·20) when compared with other extreme quintiles. Finally, coffee/tea consumption was not significantly associated with CHD risk. Our findings suggest that a beverage pattern characterised by a higher intake of sugar-sweetened beverages may be associated with an increased risk of CHD among the Mexican adult population, whereas patterns of moderate alcohol intake and low-fat milk may be associated with a reduced risk.

To describe the outcomes of risk management indicators for five types of cancer in population that is affiliated to the General System of Social Security in Health, in six cities of Colombia.Based on the data from the administrative cancer registry for the period 2016, the High Cost Disease Fund (CAC in Spanish) as a technical organization of the Colombian health system, processed and analyzed the data for the calculation of risk management indicators established in consensus based on the evidence found in six cities.There is a diversity in the indicators results found among the different cities, evidencing strengths and weaknesses in each of them for the different types of cancer. From the set of indicators, those with the best results presented are related to the greater detection of cancer in early stages or in situ, as well as a decrease in mortality, especially in colorectal and in gastric cancer. Most indicators in gastric cancer showed optimal results. Important measurements such as the opportunity for diagnosis and treatment are below the proposed standard for most types in all the six cities.The descriptive analysis of cancer risk management indicators shows certain weaknesses in the quality and timeliness of the care of cancer patients, the standards agreed upon in the consensus with the different actors of the system are not being reached, situation which may be due to a reality of problems of the Colombian health system, as well as deficiencies in the quality of the report to the CAC.Describir los resultados de los indicadores de gestión del riesgo para cinco cánceres en la población afiliada al Sistema General de Seguridad Social en Salud en Colombia en ciudades que tienen registros de cáncer.La Cuenta de Alto Costo (CAC) procesó y analizó la información del registro administrativo nacional de cáncer del periodo 2016 en Cali, Pasto, Bucaramanga, Manizales, Barranquilla y Medellín; para calcular los indicadores de gestión del riesgo establecidos en el consenso basado en la evidencia para la atención en cáncer.Existe diversidad en los resultados de los indicadores entre las diferentes ciudades, evidenciando fortalezas y debilidades en cada una de ellas y para los diferentes tipos de cáncer. Los indicadores que mejores resultados presentaron se relacionan con la mayor detección del cáncer en estadios tempranos, así como disminución de la mortalidad, especialmente en cáncer de colorrectal y en cáncer gástrico. El cáncer gástrico fue aquel que mayor cantidad de indicadores obtuvieron resultados óptimos. Mediciones importantes como la oportunidad de diagnóstico y de tratamiento se encuentran por debajo del estándar propuesto para la mayoría de los tipos de cáncer y de las ciudades.Se evidencia ciertas debilidades en la calidad y la oportunidad de la atención oncológica, no se están cumpliendo los estándares acordados en los consensos con los diferentes actores del sistema: puede deberse a una realidad de problemas del sistema de salud colombiano, así como a la necesidad de fortalecer la calidad del reporte por parte de las entidades a la CAC.

Non-alcoholic fatty liver disease (NAFLD) is the accumulation of extra fat in liver cells not caused by alcohol. Elevated transaminase levels are common indicators of liver disease, including NAFLD. Previously, we demonstrated that PNPLA3 (rs738409), LYPLAL1 (rs12137855), PPP1R3B (rs4240624), and GCKR (rs780094) are associated with elevated transaminase levels in overweight/obese Mexican adults. We investigated the association between 288 SNPs identified in genome-wide association studies and risk of elevated transaminase levels in an admixed Mexican-Mestizo sample of 178 cases of NAFLD and 454 healthy controls. The rs2896019, rs12483959, and rs3810622 SNPs in PNPLA3 and rs1227756 in COL13A1 were associated with elevated alanine aminotransferase (ALT, ≥40 IU/L). A polygenic risk score (PRS) based on six SNPs in the ADIPOQ, COL13A1, PNPLA3, and SAMM50 genes was also associated with elevated ALT. Individuals carrying 9–12 risk alleles had 65.8% and 48.5% higher ALT and aspartate aminotransferase (AST) levels, respectively, than those with 1–4 risk alleles. The PRS showed the greatest risk of elevated ALT levels, with a higher level of significance than the individual variants. Our findings suggest a significant association between variants in COL13A1, ADIPOQ, SAMM50, and PNPLA3, and risk of NAFLD/elevated transaminase levels in Mexican adults with an admixed ancestry. This is the first study to examine high-density single nucleotide screening for genetic variations in a Mexican-Mestizo population. The extent of the effect of these variations on the development and progression of NAFLD in Latino populations requires further analysis.

Background While soft drink intake is positively associated with weight gain, no previous study has investigated whether leisure-time physical activity modifies this association. We estimated the association between soft drink intake and body weight, and explored if this association differed by levels of leisure-time physical activity. Methods We used data from the health workers cohort study, a prospective study of Mexican adults (20 to 85y old), including 1268 health workers and their families, who were assessed at baseline (2004–2006) and follow-up (2010–2012). We assessed soft drink intake (cola and flavored soda) using a validated food frequency questionnaire. We measured leisure-time physical activity using a self-report questionnaire, and categorized according to the 2010 World Health Organization (WHO) recommendations. Body weight was measured by trained personnel. The association between changes in soft drink intake and weight change, and if such association varied by levels of physical activity was estimated through fixed-effect models. Results An increase in one serving per day of soft drink was associated with 0.10 kg (95% CI 0.00, 0.19) increase in weight per year. This association was not modified by leisure-time physical activity, as demonstrated by the magnitude of the coefficient of the interaction between soft drink, leisure-time physical activity, and time (− 0.03 kg, 95% CI − 0.27 to 0.21); people who complied with the WHO physical activity recommendations gained 0.36 kg/year per serving of soft drink, compared to 0.48 kg/year for people without sufficient physical activity. Conclusions Soft drink intake was associated with weight gain. Leisure-time physical activity did not modify the association between soft drink intake and weight gain. This finding challenges the idea that leisure-time physical activity is sufficient to counterbalance weight gain associated to soft drink intake.

Osteoporosis is a skeletal disease mainly affecting women over 50 years old and it represents a serious public health problem because of the high socioeconomic burden. This disease is characterized by deterioration of bone microarchitecture, low bone mineral density (BMD), and increased risk of fragility fractures. This study aimed to identify serum useful proteins as biomarkers for the diagnosis and/or prognosis of osteoporosis and fracture risk. We collected 446 serum samples from postmenopausal women aged &ge, 45 years old. Based on the BMD measurement, we classified the participants into three groups: osteoporotic, osteopenic, and normal. In an initial discovery stage, we conducted a proteomic approach using two-dimensional differential gel electrophoresis (2D-DIGE). The peptides into the spots of interest were identified through matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF/TOF). Enzyme-linked immunosorbent assay (ELISA) was performed to validate the proteins of interest. We identified 27 spots of interest when comparing low BMD versus normal BMD postmenopausal women. Based on their relevance in bone metabolism, we analyzed three proteins: ceruloplasmin (CP), gelsolin (GSN), and vitamin D-binding protein (VDBP). Our results demonstrated that low serum VDBP levels correlate with low BMD (osteopenic and osteoporotic). Therefore, VDBP could be considered as a novel, potential, and non-invasive biomarker for the early detection of osteoporosis.

Background The goal of this study was to determine whether the detection of histologically confirmed cases of cervical high-grade squamous intraepithelial lesions or worse (HSIL+) can be increased by having each liquid-based cytology (LBC) slide read by 2 cytotechnologists as part of routine screening. Methods Over 36,212 women aged 30 to 64 years participated in the Forwarding Research for Improved Detection and Access for Cervical Cancer Screening and Triage (FRIDA) Study in Mexico between 2013 and 2016. For each participant, 2 cervical samples were collected at the same clinic visit, one to test for high-risk human papillomavirus (hrHPV) and the other for LBC, which was used to triage those with a hrHPV positive result. LBC slides were evaluated by 7 cytotechnologists, with each slide read independently by 2 blinded cytotechnologists. All women with atypical cells of undetermined significance or a worse result were referred to colposcopy for further evaluation and diagnosis. Three pathologists evaluated the biopsy specimens to confirm the final HSIL+ diagnosis. The HSIL+ detection rates for the single versus double reading were estimated and compared. Results A total of 3,914 women with a positive hrHPV result were triaged with LBC. The first and second cytology readings resulted in 43 HSIL+ cases detected; the double-reading strategy detected 9 additional HSIL+ cases, resulting in a total of 52 HSIL+ cases. The HSIL+ detection rate increased from 10.99/1000 with a single reading to 13.29/1000 with the double-reading strategy (P = .004). Conclusion A 20.9% increase in HSIL+ cases detected was achieved with a double reading of the LBC slides in this sample of hrHPV-positive women.

Background Vigilant management of women with high-risk human papillomavirus (hrHPV) is necessary in cancer screening programs. To this end, we evaluated the performance of S5 (targeting DNA methylation in HPV16, HPV18, HPV31, HPV33, and human gene EPB41L3) to predict cervical intraepithelial neoplasia grade 2 or higher (CIN2+) in a sample of hrHPV-infected women referred to colposcopy in the FRIDA Study, a large screening trial in Mexico. A nested case-control sample with women referred to colposcopy either by atypical squamous cells of undetermined significance or higher (ASCUS+) in cytology and/or positive for HPV types 16 or 18 was tested by S5. Seventy-nine cases of CIN2+ were age-matched to 237 controls without a diagnosis of CIN2+ ( Results The S5 classifier separated women with CIN2+ from Conclusions S5 testing on hrHPV-positive women significantly increased diagnostic information compared to triage by HPV16/18 plus cytology and appears to have clinical utility as an additional test to substantially lessen burdens on colposcopy. Trial registration The FRIDA Study is registered in ClinicalTrials.gov, number NCT02510027.

Risk of hyperuricemia is modified by genetic and environmental factors. Our aim was to identify factors associated with serum uric acid levels and hyperuricemia in Mexicans. A pilot Genome-wide association study GWAS was performed in a subgroup of participants (n = 411) from the Health Workers Cohort Study (HWCS). Single nucleotide polymorphisms (SNPs) associated with serum uric acid levels were validated in all the HWCS participants (n = 1939) and replicated in independent children (n = 1080) and adult (n = 1073) case-control studies. The meta-analysis of the whole HWCS and replication samples identified three SLC2A9 SNPs: rs1014290 (p = 2.3 &times, 10&minus, 64), rs3775948 (p = 8.2 &times, 64) and rs11722228 (p = 1.1 &times, 17), and an ABCG2 missense SNP, rs2231142 (p = 1.0 &times, 18). Among the non-genetic factors identified, the visceral adiposity index, smoking, the metabolic syndrome and its components (waist circumference, blood pressure, glucose and hyperlipidemia) were associated with increased serum uric acid levels and hyperuricemia (p &lt, 0.05). Among the female HWCS participants, the odds ratio for hyperuricemia was 1.24 (95% CI, 1.01&ndash, 1.53) per unit increase in soft drink consumption. As reported in other studies, our findings indicate that diet, adiposity and genetic variation contribute to the elevated prevalence of hyperuricemia in Mexico.

The increase of prevalence of mental health problems in the elderly due to the aging of the population becomes an outstanding issue since in most individuals it happens in an already complex multimorbid scenario that may include frailty and age-related medical conditions. Depression, soon the major cause of global disease burden, can be found as an age-related comorbidity and frailty, or as part of neurodegenerative diseases and where females are more vulnerable to it. Thought the multifactorial aetiology and heterogeneous nature of depression render it difficult to be modelled in animals, active behaviours elicited in the Forced Swimming Test (FST) are used to screen antidepressant treatments. However, interpretation of immobility remains controversial. The present work addressed this issue in very-old (21 months) female C57bl/6 × 129 mice, also with the concern that a ‘6 minutes × 2 days’ protocol can result demanding for a very-old animal and confounding factors may also arise. Animals were behaviourally assessed for sensorimotor functions, emotionality and anxiety-like behaviours, novelty seeking, and immobility in a 2-days FST. The predictive value of the first day evidenced that one single assay as sufficient for the assessment of immobility, and that the repeated test did not increase the immobility response. Moreover, sensorimotor tasks, neophobia in the corner test and emotional behaviour in the dark-light box correlated with FST immobility, contributing to the response. The results support the concern of geroscience on the relevance of using aged animals but also aware about taking into account the complexity of their comorbid scenario.

Objective To examine changes in categories of soft drink consumption in a cohort of Mexican adults, three years after the implementation of the sugar sweetened beverage tax. Design Open cohort longitudinal analysis. Setting Three waves of the Health Workers Cohort Study, Mexico, spanning 2004 to 2018. Participants 1770 people aged 19 years or older with information on drinks consumption available in at least one of the three cohort waves. Main outcome measure Change in probability of belonging to one of four categories of soft drinks consumption (non, low, medium, high) after the tax was implemented. Heterogeneity of associations by income and education was also assessed. Results Before the implementation of the tax, more than 50% of the participants were medium and high consumers of soft drinks and less than 10% were in the non-consumer category. After the tax was implemented, 43% of the population was categorised as medium or high consumers and the prevalence of non-consumers increased to 14%. Three years after implementation of the tax on 1 January 2014, the probability of being a non-consumer of soft drinks increased by 4.7 (95% confidence interval 0.3 to 9.1) percentage points and that of being a low consumer increased by 8.3 (0.6 to 16.0) percentage points compared with the pre-tax period. Conversely, the probability of being in the medium and high levels of soft drinks consumption decreased by 6.8 (0.5 to 13.2) percentage points and 6.1 (0.4 to 11.9) percentage points, respectively. No significant heterogeneity of the tax across income levels was observed, but stronger effects of the tax were seen in participants with secondary school education or higher, compared with those with elementary school or less. Conclusions The Mexican sugar sweetened beverage tax was associated with a reduction in the probability of consuming soft drinks in this cohort of employees from a healthcare provider. The results cannot be extrapolated to the Mexican population, but they suggest that three years after implementation, the tax had helped to increase the proportion of people who do not consume soft drinks while decreasing the proportion of high and medium consumers.

ObjectiveTo prospectively examine the extent to which mealtime habits influences the risk of weight gain and obesity in Mexican adults.DesignWe performed a prospective cohort study. The Mealtime Habits Quality (MHQ) scale was used for assessing participants’ MHQ; the outcomes of interest were gain ≥5 % of body weight, developing overweight/obesity and abdominal obesity, after 7 years of follow-up. In order to estimate the independent effect of MHQ on anthropometric indicators, generalized linear models were computed to obtain adjusted relative risks (95 % CI).SettingThe state of Morelos, Mexico.SubjectsMexican adults (n 837) aged 18–70 years participating in a cohort study.ResultsCompared with participants classified in the higher MHQ category, individuals in the middle and lower MHQ groups had a 4·1 (2·5, 6·7) and 6·2 (3·9, 9·7) fold greater risk of gain ≥5 % of body weight, respectively; 6·6 (2·8, 15·5) and 8·6 (3·7, 19·8) fold greater risk of becoming overweight/obese, respectively; and 3·8 (2·0, 7·3) and 5·3 (2·8, 9·8) fold greater risk of developing abdominal obesity, respectively.ConclusionsThis study provides evidence about the influence of a set of mealtime habits on obesity indicators, showing that greater adherence to unadvisable mealtime habits increases the risk of developing unhealthy anthropometric indicators. Since the meal is one of the most important sources of food intake, and consequently weight status, the MHQ scale can be a useful population tool to predict weight gain and obesity.

Individual differences in premorbid behaviors and in those exhibited in the course of an infection disease may be useful to explain the individual susceptibility to infections, the underlying neuroimmunological mechanisms and be helpful to design patient oriented treatments with better prediction of pharmacological reactivity/outcome. Age (old) and gender (male) are also considered vulnerability factors. In the present study, the motor, emotional, anxious-like and social phenotypes of adult (6-month-old) and old (18-month-old) male C57BL/6 × 129Sv mice were determined using both a transversal and longitudinal designs prior to the analysis of LPS (150 mg/kg, i.p.)-induced sickness behavior and mortality. The results show: i) Individual premorbid behavioral phenotype had short- and long-term predictive value of hours of survival; ii) Persistence of behavioral traits from adulthood to old age and predictive value on hours of survival; iii) First signs of sickness behavior were also predicting mortality, mostly in old animals; iv) LPS-sickness behavior was the same at both ages but adult animals were able to show attempts of motor recovery; v) The mortality rate over 96 h was 100% in both ages, but old animals showed shorter survival times. In summary, these results confirm the relevance of age/aging but also individual behavioral differences in the premorbid phenotype and the morbidity response to the LPS-induced-sepsis that correlate with the individual's mortality. Thus, this work supports the translational scenarios to study personalized evaluation of risks factors and psycho-neuro-immunological mechanisms relevant for better interventions and prognosis in the critically ill young but specially aged patient population.

Health-care associated infections (HCAI) are a major threat on patient safety. According to the National and State Healthcare-Associated Infections Progress Report (1), in USA about 1 in 31 hospital patients has at least one HCAI. In 2015, 3% of hospitalized patients had one or more HCAI, and there were an estimated 687,000 HCAIs, with about 72,000 deaths due to HCAIs during their hospitalizations.

The aim of this study was to examine various psychosocial, behavioral, and socio-environmental factors in a multiethnic sample of healthy-weight, overweight, and obese youths in the United States (US) and Mexico and determine differences by sex. We conducted a cross-sectional analysis of 633 youths aged 11&ndash, 18 years who completed a self-reported questionnaire. Height and weight were measured to determine body mass index (BMI). Overweight and obese youth in both countries were significantly more likely to report a higher body image dissatisfaction (Odds Ratio (OR) = 1.67 and OR= 2.95, respectively), depressive symptoms (OR = 1.08 and OR = 1.12, respectively), perceive themselves as overweight (OR = 2.57) or obese (OR = 5.30), and a lower weight-specific quality of life (OR = 0.97 and OR = 0.95, respectively) than healthy-weight youth. Obese youth have lower healthy lifestyle priorities (OR = 0.75) and are less likely to be physically active (OR = 0.79) and eat breakfast (OR = 0.47) than healthy-weight youth. Additionally, overweight and obese youth are more likely to engage in weight control behaviors (OR = 5.19 and OR = 8.88, respectively) and restrained eating than healthy-weight youth. All the aforementioned results had a p-value of &lt, 0.05, which was considered statistically significant. The association between these factors and overweight or obesity remained significant after controlling for age, sex, race/ethnicity, and country. In conclusion, obesity was associated with a range of psychosocial, behavioral, and socio-environmental risk factors in both countries. Our findings support the need for multifactorial approaches when developing interventions to address the growing problem of obesity among youth in the US and Mexico.

Objective. To examine different health outcomes that are associated with specific lifestyle and genetic factors. Materials and methods. From March 2004 to April 2006, a sample of employees from three different health and academic institutions, as well as their family members, were enrolled in the study after providing informed consent. At baseline and follow-up (2010-2013), participants completed a self-administered questionnaire, a physical examination, and provided blood samples. Results. A total of 10 729 participants aged 6 to 94 years were recruited at baseline. Of these, 70% were females, and 50% were from the Mexican Social Security Institute. Nearly 42% of the adults in the sample were overweight, while 20% were obese. Conclusion. Our study can offer new insights into disease mechanisms and prevention through the analysis of risk factor information in a large sample of Mexicans.

There is scarce information about the link between specific single-nucleotide polymorphisms (SNPs) and risk of liver disease among Latinos, despite the disproportionate burden of disease among this population. Our aim was to investigate nine SNPs in or near the following genes: PNPLA3, LYPLAL1, PPP1R3B, GCKR, NCAN, IRS1, PPARG, and ADIPOR2 and examine their association with persistently elevated alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels in Mexican adults. Data and samples were collected from 741 participants in the Mexican Health Worker Cohort Study, in Cuernavaca, Mexico. We identified 207 cases who had persistently elevated levels of ALT or AST (≥40 U/L) and 534 controls with at least two consecutive normal ALT or AST results in a 6 month period, during 2004-2006 and 2011-2013. TaqMan assays were used to genotype the SNPs. The risk allele of PNPLA3 rs738409 was found to be associated with persistently elevated levels of ALT or AST, adjusting for age, sex, BMI, type 2 diabetes, and ancestry: (OR 2.28, 95% CI 1.13, 4.58). A significant association was found between the LYPLAL1, PPP1R3B, and GCKR risk alleles and elevated ALT or AST levels among overweight/obese adults. These results suggest that among Mexicans, the PNPLA3 (rs738409), LYPLAL1 (rs12137855), PPP1R3B (rs4240624), and GCKR (rs780094) polymorphisms may be associated with a greater risk of chronic liver disease among overweight adults. This study is the first to examine these nine SNPs in a sample of adults in Mexico.

Background: Latinos in the United States (US) have disproportionately higher rates of chronic liver disease (CLD). Since 2002, CLD has consistently been the sixth leading cause of overall mortality for Latinos, and the third cause of death among Latino males, ages 55-64. Latino men and women are twice as likely to have CLD and are 1.7 and 1.8 times more likely to die from liver cancer, respectively, than non-Hispanic whites (whites). The frequency of earlier stage liver disease, such as steatohepatitis, is also higher among Latinos (45%), than among whites (33%) or Blacks (24%). In Mexico, cirrhosis and other forms of CLD were the fifth leading cause of general mortality in 2015, and the third among males between the ages of 45 and 65 years. By 2050, an estimated 90% of cases of CLD in Mexico will be attributable to obesity and excessive alcohol consumption, as compared to other populations that have high rates of CLD due to infection with hepatitis B (HBV) or hepatitis C (HCV). Although infection with HBV or HCV and heavy alcohol use are well-known risk factors for CLD and liver cancer, up to 50% of cases do not present these risk factors. Other risk factors for CLD include obesity and diabetes, and the proposed mechanism is through the development of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). NAFLD is found in 80-90% of obese adults, 30-50% of diabetics, and 90% of patients with hyperlipidemia. In the U.S., the prevalence of NAFLD and NASH is highest among Latinos, followed by whites and Blacks. Rates of obesity are also higher among Latinos (42.5%) than whites (34.5%) in the US. In 2012, approximately 69% of men and 73% of women in Mexico were overweight or obese, and these numbers are predicted to rise to 88% and 91%, respectively, by 2050. The objective of this study was to compare the prevalence of risk factors for liver disease/cancer in a representative sample of Mexican-Americans who were born in the U.S. or Mexico, to a sample of adults who reside in Mexico. We hypothesized that Mexican-Americans in the U.S. would be at greater risk for CLD than their counterparts in Mexico. This hypothesis is based on studies suggesting that immigrant Mexican-Americans have better health outcomes than more acculturated, U.S.-born Mexican-Americans. Methods: Data for Mexican-Americans in the U.S. were obtained from the 1999-2014 National Health and Nutrition Examination Survey (NHANES), a cross-sectional, representative, examination survey of the total civilian noninstitutionalized population. The NHANES sample was restricted to Mexican-American participants who were 20 years and older, born in the U.S. or Mexico, not pregnant or breastfeeding, with medical insurance. The final NHANES sample consisted of 2,097 males and 2,177 females with complete questionnaire and laboratory data. The data in Mexico came from the Heath Worker Cohort Study (HWCS), a longitudinal study of workers and their immediate family members from two large health care institutions in Cuernavaca, Mexico: the Mexican Institute of Social Security (IMSS) and the National Institute of Public Health (INSP). Briefly, the HWCS collects information using physical examinations, self-reported questionnaires, and laboratory tests, which are comparable to those used for the NHANES surveys. From 2004 to 2006 (Wave 1), approximately 9,000 health workers enrolled in the HWCS. During 2011 to 2013 (Wave 2), a total of 1,855 participants were followed up. The final HWCS sample consisted of 3,010 men and 6,475 women 20 years and older who reside and were born in Mexico, with complete questionnaire and laboratory data. The total study sample of 13,798 individuals consisted of 9,485 Mexican subjects who currently reside in Mexico, 2,324 U.S.-born Mexican-Americans who live in the U.S., and 1,989 Mexican-Americans who were born in Mexico and now live in the U.S. The following known risk factors for liver disease/cancer were evaluated: elevated aminotransferase levels (elevated ALT was defined as >40 IU/L for men and women; elevated AST was defined as >40 IU/L for men and women), infection with HBV or HCV, metabolic syndrome, high total cholesterol, diabetes, obesity, abdominal obesity, and heavy alcohol use. The main independent variables for this study classified individuals by country of residence (i.e., Mexico versus the U.S.) and place of birth (i.e., U.S.-born versus Mexico- born). The HWCS participants represent Mexicans who were born and currently live in Mexico. Individuals from the NHANES sample were further classified by birthplace (U.S.-born versus Mexico-born). The following three groups were compared: (1) HWCS (Mexico resident, Mexico-born), (2) NHANES (U.S. resident, Mexico-born), and (3) NHANES (U.S. resident, U.S.-born). Other independent variables included age, sex, marital status, and education level. Regression analyses were used to investigate liver disease/cancer risk factors. Results: After controlling for age, marital status, and education level, the logistic regression results indicate that Mexico-born Mexican-American males were less likely to have HBV or HCV (OR 0.2, 95% CI 0.1-0.6) but were more likely to have high cholesterol (OR 1.4, 95% CI 1.1-1.8) than their counterparts in Mexico. U.S.-born Mexican-American males were more likely to have metabolic syndrome (OR 1.4, 95% CI 1.1-1.9) and diabetes (OR 3.0, 95% CI 1.9-4.8) than males in Mexico. Mexican-American males were much more likely to be obese, diabetic, have abdominal obesity, or be heavy/binge drinkers than Mexican males. The prevalence ratios and prevalence differences confirm the multivariate analyses findings and may provide more precise estimates of the increased risk of diabetes, obesity, abdominal obesity, and heavy/binge drinking observed among Mexico- and U.S.-born Mexican-American males, as compared to males in Mexico. The probability of having any of the aforementioned risk factors is greater among U.S.-born Mexican-Americans than among their Mexico-born counterparts. The adjusted multivariate results for females also indicate that Mexican-American females were significantly more likely to be obese, diabetic, have abdominal obesity, or be heavy/binge drinkers than Mexican males. The prevalence ratios and prevalence differences mirror the multivariate analyses findings for the aforementioned risk factors, showing a greater risk among U.S.-born as compared to Mexico-born Mexican-Americans. However, the prevalence ratio results indicate that Mexico- and U.S.-born Mexican-American females are significantly less likely to be infected with HBV or HCV than females in Mexico. Conclusions: The results of this binational analysis indicate that Mexican-Americans in the U.S. have more risk factors for liver disease/cancer than their counterparts in Mexico. These results can be used to design and implement more effective health-promotion programs to address the specific factors that put Mexicans at higher risk of developing liver disease/cancer in both countries. This study adds to the relatively scarce literature on binational research, and provides preliminary data for future studies of migrant health in the U.S. and Mexico. Other binational primary data collection projects with representative samples and comparable demographic, socioeconomic, and health status measures are needed to further investigate the growing problem of liver disease/cancer among Mexicans in both countries. Citation Format: Yvonne N. Flores, Zuo-Feng Zhang, Roshan Bastani, Mei Leng, Catherine M. Crespi, Paula Ramirez, Heather A. Stevens, Jorge Salmerón. Risk factors for liver disease/cancer among adults of Mexican descent in the United States and Mexico [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A34.

Cervical cancer remains an important cause of cancer mortality for Mexican women. HPV 16/18 typing may help to improve cervical cancer screening. Here we present the prevalence of high-risk human papillomavirus (hrHPV) including HPV16 and HPV18 from the FRIDA (Forwarding Research for Improved Detection and Access) population. Beginning in 2013, we recruited 30,829 women aged 30–64 in Tlaxcala, Mexico. Cervical samples were collected and tested for 14 hrHPV genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68). We used logistic regression to estimate odds ratios with 95 % confidence intervals for hrHPV infections according to putative risk factors. Prevalence of infection with any of the 14 hrHPV types was 11.0 %. The age-specific prevalence of all hrHPV formed a U-shaped curve with a higher prevalence for women aged 30–39 and 50–64 than women aged 40–49. Across all age groups, 2.0 % of women were positive for HPV16 and/or HPV18 (HPV16/18), respectively. HPV16/18 prevalence also showed a U-shaped curve with increased prevalence estimates for women aged both 30–39 and 60–64. Both prevalence curves had a significant quadratic age coefficient. Infections with hrHPV were positively associated with an increased number of lifetime sexual partners, a history of sexually transmitted disease, being unmarried, use of hormonal contraception, having a history of smoking and reported condom use in the multivariate model. The FRIDA population has a bimodal distribution of both hrHPV and HPV16/18 positivity with higher prevalences at ages 30–39 and 60–64. These findings will help to evaluate triage algorithms based on HPV genotyping. The trial is registered with ClinicalTrials.gov, number NCT02510027 .