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Mass violence events, especially in healthcare settings, have devastating consequences and long-lasting effects on the victims and the community. The rate of violent events in Mexico, especially in hospital settings, has increased since 2006, but has become more evident in 2018. Guanajuato State, located in central Mexico, is among the states most affected by the wave of violence, especially active shooter events. The year 2019 had the highest number of incidents. Therefore, the Silver Code and the components of Safe Hospitals, in accordance with the Hartford consensus and PAHO guidelines, were implemented in the hospitals of the Institute of Public Health of the State of Guanajuato, with a focus on the actions of healthcare personnel to prevent collateral damage. Although subsequently there were still fatalities and injuries in the events involving active shooters in the hospitals, there were no casualties among healthcare personnel, according to data from the Institute of Public Health, Guanajuato State. This paper presents information from the data from General Directorate of Epidemiology to describe the hospital mass violence situation in the State of Guanajuato, Mexico and recounts the step taken to effectively manage and prevent these situations moving forward. Specific recommendations based on international consensus and our experience provided include increasing the level of security checks for people entering the hospital premises, training healthcare personnel on violence-related preparedness and improving management of active shooter events consistent with published evidence, to reduce the possibility of casualties., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

During the COVID-19 pandemic, Latin American and Caribbean countries implemented stringent public health and social measures that disrupted economic and social activities. This study used an integrated model to evaluate the epidemiological, economic, and social trade-offs in Argentina, Brazil, Jamaica, and Mexico throughout 2021. Argentina and Mexico displayed a higher gross domestic product (GDP) loss and lower deaths per million compared with Brazil. The magnitude of the trade-offs differed across countries. Reducing GDP loss at the margin by 1 percent would have increased daily deaths by 0.5 per million in Argentina but only 0.3 per million in Brazil. We observed an increase in poverty rates related to the stringency of public health and social measures but no significant income-loss differences by sex. Our results indicate that the economic impact of COVID-19 was uneven across countries as a result of different pandemic trajectories, public health and social measures, and vaccination uptake, as well as socioeconomic differences and fiscal responses. Policy makers need to be informed about the trade-offs to make strategic decisions to save lives and livelihoods.

Background: Phthalate exposure has been associated with increased childhood behavioral problems. Existing studies failed to include phthalate replacements and did not account for high correlations among phthalates. Phthalates' exposure is higher in Mexico than in U.S. locations, making it an ideal target population for this study., Aim: To examine associations between 15 maternal prenatal phthalate metabolite concentrations and children's behavioral problems., Methods: We quantified phthalate metabolites in maternal urine samples from maternal-child dyads (n = 514) enrolled in the Programming Research in Obesity, Growth Environment and Social Stress (PROGRESS) birth cohort in Mexico City. We performed least absolute shrinkage and selection operator (LASSO) regressions to identify associations between specific-gravity adjusted log 2 -transformed phthalate metabolites and parent-reported 4-6 year old behavior on the Behavior Assessment System for Children (BASC-2), accounting for metabolite correlations. We adjusted for socio-demographic and birth-related factors, and examined associations stratified by sex., Results: Higher prenatal mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) urinary concentrations were associated with increased hyperactivity scores in the overall sample (β = 0.57, 95% CI = 0.17, 1.13) and in girls (β = 0.54, 95% CI = 0.16, 1.08), overall behavioral problems in boys (β = 0.58, 95% CI = 0.20, 1.15), and depression scores in boys (β = 0.44, 95% CI = 0.06, 0.88). Higher prenatal monobenzyl phthalate (MBzP) concentrations were associated with reduced hyperactivity scores in girls (ß = -0.54, 95% CI = -1.08, -0.21)., Discussion: Our findings suggested that prenatal concentrations of phthalates and their replacements altered child neurodevelopment and those associations may be influenced sex., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Impact Statement: We are submitting data regarding the prevalence and type distribution of the HPV infection and the risk factors associated with it, which may provide a valuable reference to reinforce screening strategies, and to maintain HPV genotype surveillance in Mexico. We discuss the overall prevalence of HPV infection as detected in normal cytological samples stratified by age, different types of infection, and oncogenic capacity. One of the most important findings was that common HPV genotypes detected in healthy women were the genotype numbers: 6, 31, 16, and 56, likewise, smoking and having a history of more than three sexual partners over their lifetime, represented the main risk factors in this study. Furthermore, we found a low frequency of cytological abnormalities and CIN 1-3 in women with HR-HPV.

Background: Dyslipidaemias result from the interaction between genetic and environmental factors, including diet disequilibrium and physical inactivity. Among the genetic factors associated with serum lipids, the Taq1B CETP polymorphism has been investigated. The B1 allele has been considered as a risk factor for dyslipidaemia because of its association with greater CETP levels and higher serum triglycerides. The present study aimed to determine the role of the Taq1B polymorphism with lipid and anthropometric variables and its interaction with diet and physical activity., Methods: In total, 215 subjects were enrolled in this cross-sectional study. Diet intake was evaluated using a 3-day food consumption record and physical activity was determined in accordance with World Health Organization recommendations. The Taq1B CETP polymorphism was determined by allelic discrimination., Results: Subjects with the B1B2/B2B2 genotype, who had a sucrose consumption ≥5% of the total kcal day -1 , had higher levels of total cholesterol (TC) [165.55 (142.21-188.89) mg dL -1 versus 200.19 (184.79-215.60) mg dL -1 ; P for interaction = 0.034] and low-density lipoprotein [99.29 (75.52-123.05) mg dL -1 versus 128.64 (113.59-143.69) mg dL -1 ; P for interaction = 0.037] than subjects with the B1B1 genotype. Subjects who did not perform physical activity and had the B1B2/B2B2 genotype showed significantly higher levels of TC [177.48 (161.36-193.60) mg dL -1 versus 194.49 (185.43-203.56) mg mL -1 ; P for interaction = 0.033] than subjects with the B1B1 genotype., Conclusions: We provide evidence that subjects with inadequate environmental factors carriers of the polymorphic genotype had higher serum lipid levels than subjects with the B1B1 genotype., (© 2020 The British Dietetic Association Ltd.)

Background: In women of reproductive age, pregestational overweight and/or obesity could result in negative outcomes for both, mother and child., Objective: To investigate the association between pregestational body mass index (PBMI) and maternal adverse outcomes (MAO) during childbirth, in women assisted during 2014, in a public hospital in Mérida, Yucatán, Mexico., Material and Methods: 427 pregnant women assisted during childbirth were consecutively included, identifying among them those who did not have any MAO (n = 137), whose demographic and clinical data, including PBMI, were compared with those who did have at least one MAO (n = 290). Odds ratios (OR) and 95% confidence intervals (95% CI) were obtained using a binary logistic regression model (LRM)., Results: 33% had normal PBMI, and 37% had obesity. Urgent cesarean section was the most frequent MAO (58.8%). According to the LRM, schooling (secondary school level, OR: 0.56; 95% CI: 0.34-0.94), primigravidae ( OR: 6.88; 95% CI: 3.37-12.58), and secondigravidae women (OR: 5.57; 95% CI: 3.04-10.24), the number of prenatal visits (≥ 5, OR: 3.49; 95% CI: 1.54-7.91), and PBMI (overweight, OR: 0.41: 95% CI: 0.23-0.72) were identified as clinically and statistically significant., Conclusions: Women with overweight were at low risk for MAO, while schooling (secondary school level) reduced risk by 44%, being a primigravidae or a secondigravidae increased risk more than 6 and 5 times, respectively. Paradoxically, prenatal visits (≥ 5 medical visits) increased risk more than 3 times., (Copyright: © 2020 Revista Medica del Instituto Mexicano del Seguro Social.)

Background: Late adolescents with asthma are rarely studied, since generally they are not included in children or adult groups; in addition, studies assessing asthma trends are scarce in Mexico, and their results might differ from findings in developed countries., Objective: To determine the trends in asthma prevalence and its symptoms in late adolescents over a period of 7 years., Methods: The prevalence of asthma and its symptoms were compared in two cross-sectional population-based cohorts, one from 2009 and the other from 2016., Results: The presence of wheezing sometime in life and during the previous year was significantly increased between 2009 and 2016 (12.8 % versus 20.1 % and 7.3 % versus 10.3 %, p < 0.001 and 0.002, respectively). The prevalence of asthma went from 7.8 % in 2009 to 12.7 % in 2016 (p < 0.0001). In addition, the prevalence of allergic rhinitis (4.5 % versus 9.0 %) and atopic dermatitis (3.8 % versus 5.2 %) also showed marked increases (p < 0.0001 and 0.051, respectively)., Conclusions: The prevalence of asthma and some of its symptoms in late adolescents substantially increased in a 7-year period.

Background: Human papillomavirus (HPV) subtypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68 have been implicated in the development of cervical cancer (CC). These 13 high risk HPV types have been shown to be present in up to 99.7% of CC samples. In Mexico, this cancer is the leading cause of death from malignancy among women. The aim of this study was to determine the prevalence of different HPV genotypes and investigate epidemiological aspects associated with HPV infection in women from Cozumel. Material and methods: We performed an epidemiological, prospective and cross sectional study with 1,187 who accepted participation in a campaign of screening for CC, during the period 2014 to 2015. Data on epidemiological and socio-economic variables were obtained. Cervical cells were collected for detection of HPV DNA and typing of HPV-positive samples by Multiplex PCR, using a commercial kit for 16 viral genotypes. Results: The overall prevalence of HPV in women from Cozumel was 15.8 % (188/1,187), either single (13.6%) or multiple (2.19 %). The most common HPV types , in descending order of frequency, were 58 (24.5 %), 59 (13.3 %), 39 (12.2 %) and 66 (9.6 %). The most frequent high risk types were HPV-58 and -59 and of low risk HPV types the most common was HPV-6. Number of sexual partners (OR=4.78; 95% CI= 2.73-8.37; P=<0.0001) and age of first coitus (OR=0.51; 95% CI=0.32-0.81; P=<0.0011) were significantly associated with HPV infection. Conclusions: Our data indicate that the overall incidence of high risk HPV infection in Cozumel is low as compared to other studies worldwide, with a different profile of subtypes. However, as expected, risky sexual behavior was found associated with positive cases of HPV. These results highlight the need for establish strategies to prevent HPV acquisition and evaluate the impact of a vaccine application in the Cozumel population., (Creative Commons Attribution License)

Objective: To investigate the validity and internal consistency of the Mexican version of the CBCL/1.5 -5 that assesses the most common psychopathology in pre-school children in clinical and epidemiological settings., Patients and Method: A total of 438 parents from two groups, clinical-psychiatric (N= 62) and community (N= 376) completed the CBCL/1.5-5/Mexican version., Results: The internal consistency was high for total problems α=0.95, and internalized α=0.89 and externalized α=0.91 subscales. The test re-test (one week) using the intraclass correlation coefficient (ICC) was ≥ 0.95 for the internalized, externalized, and total problems subscales. The ROC curve for the criterion status of clinically-referred vs. non-referred using the total problems scale ≥ 24 resulted in an AUC (area under curve) of 0.77, a specificity 0.73, and a sensitivity of 0.70., Conclusions: The CBCL/1.5 -5/Mexican version is a reliable and valid tool., (Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Ballast water is a significant vector of microbial dissemination; however, biofouling on commercial vessel hulls has been poorly studied with regard to pathogenic bacteria transport. Biofouling on three commercial vessels and seven port structures in Ensenada, Baja California, Mexico, was examined by qPCR to identify and quantify Vibrio parahaemolyticus, a worldwide recognized food-borne human pathogen. Pathogenic variants (trh+, tdh+) of V. parahaemolyticus were detected in biofouling homogenates samples from several docks in Ensenada and on the hulls of ships with Japanese and South Korean homeports, but not in reference sampling stations. A total of 26 tdh+ V. parahaemolyticus colonies and 1 ORF8+/O3:K6 strain were also isolated from enriched biofouling homogenate samples confirming the qPCR analysis. Our results suggest that biofouling is an important reservoir of pathogenic vibrios. Thus, ship biofouling might be an overlooked vector with regard to the dissemination of pathogens, primarily pathogenic V. parahaemolyticus.

Asthma is a complex disease for which genetic predisposition has been widely documented. Considerable evidence supports the hypothesis that polymorphisms in the muscarinic-cholinergic (CHRM) genes could be involved in asthma pathogenesis, bronchial hyperresponsiveness, and mucus secretion. To determine whether single nucleotide polymorphisms (SNPs) or haplotypes in CHRM1, CHRM2, or CHRM3 are associated with asthma in Mexican pediatric population. We performed a case-control study including 398 pediatric cases with asthma and 450 healthy controls. We analyzed 19 SNPs distributed among these three genes. Two of the seven SNPs located in CHRM2, the 3' untranslated region rs8191992 and rs6962027, differed significantly in allele frequencies between patients with asthma and healthy controls [odds ratio (OR) 1.42, 95 % confidence interval (95 % CI) 1.14-1.77, P = 0.001, and OR 1.50, 95 % CI 1.21-1.87, P = 0.0002, respectively]. Statistical significance remained after multiple comparison corrections (P = 0.003 and P = 0.005, respectively). The haplotypes AA and TT, containing both major and minor alleles from rs8191992 and rs6962027, also differed between cases and controls. The haplotype AA occurred at a lower frequency in cases (OR 0.67, 95 % CI 0.53-0.85, P = 0.001) whereas the haplotype TT was overrepresented in cases compared to controls (28 vs 21 %, respectively; OR 1.46, 95 % CI 1.15-1.85, P = 0.002). No association was observed between CHRM1 or CHRM3 SNPs or haplotypes and asthma. CHRM2 polymorphisms are implicated in the genetic etiology of asthma.

Objective: Apply a mathematical model to estimate the epidemic patterns of influenza A (H1N1) in Mexico during the stages of application and suspension of measures to mitigate the epidemic., Methods: The effective reproductive number (R) for each state of Mexico during and after the application of social distancing measures was estimated by the SIR model (susceptible, infected, and recovered individuals) based on data published by the Ministry of Health of Mexico., Results: From the beginning of the outbreak until suspension of school activities (28 April-13 May 2009), the national median of R was 1.13. In the following period (14 May-17 July 2009) the national median of R decreased to 1.01., Conclusions: It was demonstrated that several epidemic scenarios occurred at the national level. It is suggested that heterogeneous patterns at the state level be taken into account in decision-making on the adoption of measures to mitigate influenza epidemics.

Objective: Back pain (BP) is frequent in the community; its prevalence in México is 6%. Our objective was to determine the prevalence of BP in Mexican communities and determine its most important characteristics., Methods: A cross-sectional study of individuals aged > 18 years was conducted in Mexico City and in urban communities in the state of Nuevo León. Sampling in Mexico City was based on community census and in Nuevo León, on stratified, balanced, and random sampling. Procedures included a door-to-door survey, using the Community Oriented Program for the Control of Rheumatic Diseases, to identify individuals with BP > 1 on a visual analog scale in the last 7 days. General practitioners/rheumatology fellows confirmed and characterized BP symptoms., Results: In all, 8159 individuals (mean age 43.7 yrs, two-thirds female) were surveyed and 1219 had BP. The prevalence of nontraumatic BP in the last 7 days was 8.0% (95% CI 7.5-8.7). The mean age of these individuals was 42.7 years, and 61.9% were female. Thirty-seven percent had inflammatory BP [prevalence of 3.0% (95% CI 2.7-3.4)]. Compared with the state of Nuevo Léon, the characteristics and consequences of BP in Mexico City were more severe. In logistic regression analysis, living in Mexico City, having a paid job, any kind of musculoskeletal pain, high pain intensity, and obesity among other variables were associated with BP., Conclusion: The prevalence of nontraumatic BP in the last 7 days in urban communities in México is 8.0%. However, clinical features and consequences differed among the communities studied, suggesting a role for local factors in BP.

We carried out surveys realized field work from March to September 2000 to get the current distribution of Cebids in the state of Campeche, Mexico. Based on interviews and direct observations. We defined the distribution of Ateles geoffroyi yucatanensis and Alouatta pigra and we documented the first time localities where Allouata palliata is found in the state. We made distributional maps of each species using vegetation overlays from Inventario Nacional Forestal (Inv For) and each point documented during fieldwork. We presented the distribution of species according to confiability of the verified or expected data. Using the attributes table of Inv For, we calculated the areas of distribution which were 22,735 km2 for Alouatta sp. and 18,501 km2 for A. g. yucatanensis. We also presented the area occupied by each species according to vegetation types and the relative proportion of these vegetation types in the state. We confirmed the ability of Alouatta sp. to survive in disturbed environments produced by habitat fragmentation, and the affinity of A. g. yucatanesis to well preserved habitats.

The group selected for this evaluation consisted of 109 normal people with an average age of 25, coming from two different sociocultural levels (high and low) of Mexico City. All were completely evaluated by Luria's battery for neuropsychological assessment, adapted by Ardila, Ostrosky, and Canseco, 1981. This group of tests measures nine different areas: Motor Functions, Somatosensory Knowledge, Auditory Knowledge, Visuospatial Knowledge, Cognitive Processes, Language, Reading, Writing and Basic Calculations. For all of these, the higher performance standards were achieved by the subjects from the high sociocultural level. A significant interaction between sociocultural level and sex was observed. The differences between sexes appear only in subjects from the low sociocultural level. Factor analysis of the battery revealed that the most sensitive items to sociocultural level were those related on one hand, to the handling of complex structural and conceptual aspects of language and on the other hand, to the organization of motor sequences and in general motor programming. Research related to the differences found is reviewed and implications for clinical assessment are discussed.