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This paper analyses the role of metropolises that occupy a secondary place in urban systems and distinguishes between the intermediation and other strategic roles that they can play. As an empirical approximation to secondary cities, the paper operationalises mid-sized cities according to population size and evaluates the economic performance of metropolitan areas within Mexico’s urban system. Drawing on the theories of borrowed size and agglomeration shadows, the paper discusses whether mid-sized metropolitan areas in Mexico have evolved into intermediate urban centres that can drive development and growth. Additionally, the study identifies the economic performance factors across the group of mid-sized metropolises. Different economic performance indicators are calculated and an econometric model is estimated for the period 2008–2018. We find that, with a few exceptions, mid-sized metropolitan areas in Mexico have not evolved into intermediate metropolises and face challenges that limit their strategic role in their respective urban system. This analysis contributes to the literature on secondary cities by studying and providing empirical insights into the functioning and evolution of urban systems that have traditionally been centralised around a single megacity, such as Mexico City.

Abstract Background Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021. Methods We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective. Results Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women. Conclusions These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations.

Sponges represent one of the groups with the greatest abundance and diversity among invertebrates. They tolerate a wide range of environmental factors allowing them to surpass the survival of other organisms. Punta Amapala is located between the eastern coastal plain and the Gulf of Fonseca, El Salvador, characterized by the presence of rocky reefs surrounded by sand. Sponge richness, frequency and distribution of rocky reefs at Punta Amapala was recorded following the transect and quadrat methodology. The study resulted in the recording of ten taxa: Aplysina gerardogreeni, Haliclona spp., Axinella nayaritensis, Endectyon (Endectyon) hyle, Mycale (Carmia) cecilia, M. (Zygomycale) ramulosa, Tedania (Tedania) tropicalis, Cliona californiana, C. euryphylle and a sponge of the subclass Calcinea (Calcarea). It is necessary to increase the studies directed to this group in order to know with greater accuracy their richness in the reefs of El Salvador and thus to understand the ecological role they play in ecosystem.

IntroductionClinical practice guidelines (CPGs) contain recommendations for specific clinical circumstances, including maternal malnutrition. This study aimed to identify the CPGs that provide recommendations for preventing, diagnosing, and treating women’s malnutrition. Additionally, we sought to assess the methodological quality using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.MethodsAn online search for CPGs was performed, looking for those that contained lifestyle and nutritional recommendations to prevent, diagnose and treat malnutrition in women during the preconception period using PubMed and different websites. The reviewers utilized the AGREE II instrument to appraise the quality of the CPGs. We defined high-quality guidelines with a final score of > 70%.ResultsThe titles and abstracts from 30 guidelines were screened for inclusion, of which 20 guidelines were fully reviewed for quality assessment. The overall quality assessment of CPGs was 73%, and only 55% reached a high-quality classification. The domains in the guidelines classified as high-quality had the highest scores in “Scope and Purpose” and “Clarity of Presentation” with a median of 98.5 and 93%, respectively.DiscussionFurther assessment is needed to improve the quality of the guidelines, which is an opportunity to strengthen them, especially in the domains with the lowest scores.

IntroductionMaternal and child malnutrition is a worldwide public health problem with short, medium, and long-term adverse consequences for both mother and child. In Mexico, maternal and child malnutrition represents a serious public health problem that must be urgently addressed. In this context, Primary Health Care (PHC) plays an important role in the prevention, detection, monitoring, and treatment of the different forms of maternal and child malnutrition. Assessing the quality of nutritional care offered at this level of care is necessary in order to improve it; however, there are no indicators for the evaluation of this quality. Therefore, this study aimed at developing a set of indicators to assess the quality of maternal and child nutritional care at PHC.MethodsWe developed indicators for different stages of life: preconception, pregnancy, infancy, and preschool age. A systematic review of the literature on clinical guidelines for the prevention, diagnosis, and treatment of the different forms of malnutrition was carried out; the recommendations of the guidelines evaluated with good quality were extracted.ResultsBased on these recommendations, 22 indicators were constructed. A pilot study was carried out to validate the indicators and 16 indicators were selected to assess the maternal and child nutritional care at PHC.

En el contexto de la globalización se ha preponderado la competitividad para promover el desarrollo regional o local; aquí se evalúa el desarrollo municipal, y su relación con la competitividad en el marco de la profundización de la apertura e integración económicas. Se analiza el estado de Tamaulipas, México, por su posición relativa en la economía y geografía nacionales, que le permite participar activamente en los procesos de vinculación con el exterior. La investigación comprende a sus 43 municipios, para los cuales se estiman los niveles de competitividad y desarrollo de 1990 a 2010. Se emplea el análisis de regresión con datos de panel, para evaluar el vínculo entre estas dos variables. Las estimaciones revelan las disparidades espaciales persistentes, y sugieren que una mayor competitividad deriva en más desarrollo. La evidencia también indica la repercusión diferenciada que han tenido otras variables.

Esta pesquisa teve como objetivos identificar os grupos de usuários segundo o grau de satisfação com a atenção recebida nos Módulos Gerontológicos e determinar os principais fatores associados. Trata-se de estudo transversal realizado com 181 usuários nos 36 módulos do Seguro Social dos Trabalhadores Públicos, no México. O nível de satisfação foi avaliado segundo três aspectos: características gerais da atenção recebida, amabilidade no trato e infraestrutura. Foi realizada uma análise de conglomerados para identificar grupos de usuários segundo o grau de satisfação e um modelo de regressão logística ordinal para identificar os fatores associados. Estiveram satisfeitos com o serviço 53% dos usuários; medianamente satisfeitos, 34,3%; e insatisfeitos, 12,7%. Os principais fatores associados com maior grau de satisfação foram: ser mulher, maior idade e ser chefe/a de família. O sistema de saúde deve dirigir sua atenção para esse grupo populacional que é crescente e incentivar o desenvolvimento de uma atenção de qualidade que contemple as suas necessidades.Se objetivó identificar grupos de usuarios según grado de satisfacción con la atención recibida en Módulos Gerontológicos, y determinar los principales factores asociados. Estudio transversal, muestra de 181 pacientes de los 36 módulos del Seguro Social de Trabajadores Estatales, en México. El nivel de satisfacción fue evaluado bajo tres aspectos: características generales de la atención recibida; amabilidad en el trato e infraestructura. Se realizó análisis de conglomerados para identificar grupos de pacientes según grado de satisfacción y un modelo de regresión logística ordinal para identificar factores asociados. Resultaron satisfechos con el servicio 53% de los pacientes; medianamente satisfechos 34,3% e insatisfechos 12,7%. Los principales factores asociados a mayor grado de satisfacción fueron: ser mujer, mayor edad, ser jefe/a de familia. El sistema de salud debe dirigir su atención a este grupo poblacional creciente, e incentivar el desarrollo de una atención calificada que contemple sus necesidades.The aim of this study was to identify groups of users according to their degree of satisfaction with geriatric care services and determine the primary factors associated with satisfaction. This was a cross-sectional study of 181 people enrolled in 36 modules pertaining to the State Workers Social Security Institute (ISSSTE) in Mexico. Degree of satisfaction was measured according to the following three areas: general characteristics of services offered, friendliness of staff and infrastructure. A cluster analysis was performed to identify groups of users according to their level of satisfaction, and an ordinal logistic regression model was used to determine the associated factors. Fifty-three percent were satisfied with the services, 34.3% were fairly satisfied and 12.7% were dissatisfied. The main characteristics associated with a greater degree of satisfaction were being female, older and the head of household. The health system must address this growing population and ensure the development of quality care to meet their needs.

En este texto se revisa la evolución reciente de las zonas metropolitanas en México. Se presentan elementos de discusión teórica y conceptual acerca de la visión económica del fenómeno metropolitano y se describe la conformación y estructuración del sistema metropolitano en México. A partir de datos de los censos económicos (1998, 2003 y 2008) y de los censos de población y vivienda (1990, 2000 y 2010) se examina una serie de indicadores que dan cuenta de distintas dimensiones de las economías metropolitanas, de su población, así como del sistema metropolitano en su conjunto. Por un lado se encuentra un declive en varios aspectos del sistema de metrópolis; por otro, un reacomodo progresivo en el interior del sistema, donde la heterogeneidad urbana persiste. Los resultados, sin embargo, dependen de cada una de las variables consideradas.

Background: The presence of fetal fibronectin in vaginal secretions has been regarded as a predictor of labor in pregnant term and preterm. Objective: For this reason the purpose of this study was to evaluate the predictive validity of fibronectin in pregnant women who attended the General Hospital SSH Pachuca, Hidalgo, Mexico. Methodology: We included pregnant patients admitted to hospital for pregnancy control. Fetal fibronectin was determined in all participants and then followed until the onset of labor. Results: A total of 148 patients participated. One group with 53 patients less than 37 weeks gestation, and another group of 95 patients with 37 or more weeks gestation. In general, the test showed an average sensitivity of 72.5% and specificity 82.9% average for both groups. Conclusion: Based on these results, we recommend using fibronectin test in pregnant women after 32 weeks of gestation, both in emergency departments and outpatient clinics.

Esta pesquisa teve como objetivos identificar os grupos de usuários segundo o grau de satisfação com a atenção recebida nos Módulos Gerontológicos e determinar os principais fatores associados. Trata-se de estudo transversal realizado com 181 usuários nos 36 módulos do Seguro Social dos Trabalhadores Públicos, no México. O nível de satisfação foi avaliado segundo três aspectos: características gerais da atenção recebida, amabilidade no trato e infraestrutura. Foi realizada uma análise de conglomerados para identificar grupos de usuários segundo o grau de satisfação e um modelo de regressão logística ordinal para identificar os fatores associados. Estiveram satisfeitos com o serviço 53% dos usuários; medianamente satisfeitos, 34,3%; e insatisfeitos, 12,7%. Os principais fatores associados com maior grau de satisfação foram: ser mulher, maior idade e ser chefe/a de família. O sistema de saúde deve dirigir sua atenção para esse grupo populacional que é crescente e incentivar o desenvolvimento de uma atenção de qualidade que contemple as suas necessidades.