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BackgroundSince its appearance, COVID-19 has immensely impacted our society. Public health measures, from the initial lockdowns to vaccination campaigns, have mitigated the crisis. However, SARS-CoV-2’s persistence and evolving variants continue to pose global threats, increasing the risk of reinfections. Despite vaccination progress, understanding reinfections remains crucial for informed public health responses.MethodsWe collected available data on clinical and genomic information for SARS-CoV-2 samples from patients treated in Mexico City from 2020 epidemiological week 10 to 2023 epidemiological week 06 encompassing the whole public health emergency’s period. To identify clinical data we utilized the SISVER (Respiratory Disease Epidemiological Surveillance System) database for SARS-CoV-2 patients who received medical attention in Mexico City. For genomic surveillance we analyzed genomic data previously uploaded to GISAID generated by Mexican institutions. We used these data sources to generate descriptors of case number, hospitalization, death and reinfection rates, and viral variant prevalence throughout the pandemic period.FindingsThe fraction of reinfected individuals in the COVID-19 infected population steadily increased as the pandemic progressed in Mexico City. Most reinfections occurred during the fifth wave (40%). This wave was characterized by the coexistence of multiple variants exceeding 80% prevalence; whereas all other waves showed a unique characteristic dominant variant (prevalence >95%). Shifts in symptom patient care type and severity were observed, 2.53% transitioned from hospitalized to ambulatory care type during reinfection and 0.597% showed the opposite behavior; also 7.23% showed a reduction in severity of symptoms and 6.05% displayed an increase in severity. Unvaccinated individuals accounted for the highest percentage of reinfections (41.6%), followed by vaccinated individuals (31.9%). Most reinfections occurred after the fourth wave, dominated by the Omicron variant; and after the vaccination campaign was already underway.InterpretationOur analysis suggests reduced infection severity in reinfections, evident through shifts in symptom severity and care patterns. Unvaccinated individuals accounted for most reinfections. While our study centers on Mexico City, its findings may hold implications for broader regions, contributing insights into reinfection dynamics.

The relationship between international trade and the gender gap is complex. On one hand, foreign insertion can generate economic opportunities for women in the export sector. On the other hand, it can also result in heightened competition and the relocation of jobs, especially in the context of global value chains (GVCs). The study on the gender gap through GVCs examines the mechanisms within production networks that contribute to enhance women's economic empowerment and gender equality. The paper analyzes the relationship between the gender gap, GVCs, technological intensity of exports, and female empowerment in the EU-27, investigating whether GVCs could reduce or worsen gender disparities. The aim of this paper is to expand the gender gap studies incorporating the effects of trade in value added in the European Union. The study used a panel of data from various sources, including Eurostat, Trade in Employment (TiM), and the World Bank. The results suggest that an increase in exports, regardless of the level of technological intensity, tends to exacerbate the gender gap in export sectors by increasing the proportion of male workers relative to female workers. However, a higher female participation rate in medium-low technology sectors could reduce the gender gap in export sectors. The study identified obstacles to female insertion in export markets, including the need to improve education and training for women in high-demand areas, promote STEM (science, technology, engineering and mathematics) education and labor participation for women. This paper makes significant contributions to the literature by incorporating global value GVCs and considering the European context. Additionally, it provides an in-depth analysis of socioeconomic factors that are crucial for designing policies aimed at addressing gender inequality.

Abstract End-point RT-PCR is a suitable alternative diagnostic technique since it is cheaper than RT-qPCR tests and can be implemented on a massive scale in low- and middle-income countries. In this work, a bioinformatic approach to guide the design of PCR primers was developed, and an alternative diagnostic test based on end-point PCR was designed. End-point PCR primers were designed through conservation analysis based on kmer frequency in SARS-CoV-2 and human respiratory pathogen genomes. Highly conserved regions were identified for primer design, and the resulting PCR primers were used to amplify 871 nasopharyngeal human samples with a previous RT-qPCR based SARS-CoV-2 diagnosis. The diagnostic test showed high accuracy in identifying SARS-CoV-2-positive samples including B.1.1.7, P.1, B.1.427/B.1.429 and B.1.617.2/ AY samples with a detection limit of 7.2 viral copies/µL. In addition, this test could discern SARS-CoV-2 infection from other viral infections with COVID-19-like symptomatology. The designed end-point PCR diagnostic test to detect SARS-CoV-2 is a suitable alternative to RT-qPCR. Since the proposed bioinformatic approach can be easily applied in thousands of viral genomes and over highly divergent strains, it can be used as a PCR design tool as new SARS-CoV-2 variants emerge. Therefore, this end-point PCR test could be employed in epidemiological surveillance to detect new SARS-CoV-2 variants as they emerge and propagate.

Abstract Serosurveillance helps establish reopening guidelines and determine the immunity levels in different populations to reach herd immunity. Then, there is an urgent need to estimate seroprevalence population wide. In Mexico, information about COVID-19 cases and related deaths is scarce. Also, there is no official serosurveillance, limiting our knowledge of the impact of the SARS-CoV-2 pandemic. Here, we report the prevalence of anti-SARS-CoV-2 antibodies in 522,690 unvaccinated people from July 5th to December 31st, 2020. The overall seroprevalence was 32.8% and highest in adults aged 30–39 years (38.5%) than people under 20 years (33.0%) or older (28.9%). Moreover, in a cohort of 1655 individuals confirmed COVID-19 by PCR, we found that symptomatic people (HR = 2.56) increased seroconversion than presymptomatic. Also, we identified that the most discriminative symptoms for COVID-19 that could predict seroconversion were anosmia and ageusia (HR = 1.70), fever, myalgia/arthralgia, and cough (HR = 1.75). Finally, we found that obese people had lower seroconversion (HR = 0.53) than healthy people, but the opposite happens in diabetic people (HR = 1.39). These findings reveal that around one-third of Mexican outpatients had anti-SARS-CoV-2 antibodies before vaccination. Also, some symptoms improve empirically COVID-19 diagnosis and seroconversion. This information could help fine-tune vaccination schemes and the reopening and back-to-work algorithms.

The Environmental Kuznets Curve (EKC) hypothesis has become an important topic in the literature on the effects of growth on the environment, albeit surrounded by some controversy and nuance. Although this hypothesis has been analyzed in the literature in multiple ways and using different variables, there is still a gap in the consideration of global value chains (GVCs), which delve into the international division of production. This is particularly important in the intermediate stages of production, as they include tasks with a greater environmental impact. This research aims to analyze the environmental effects of economic growth and foreign trade linked to GVCs in a sample of 12 countries of East and Southeast Asia, given their strong insertion in GVCs. Based on the EKC, variables such as GDP per capita, environmental impact, and renewable energy consumption are incorporated. As a novelty, the research also includes GVCs participation and position indexes, and different measures of CO2 emissions. Our results confirm the existence of a nonlinear relationship between economic activity and its environmental effects, although with important nuances depending on the mode of insertion of each country in GVCs. In this sense, although all the selected countries increased their total emissions, substantial disparities are observed depending on the perspective considered (producer, consumer, and exports). Ultimately, it is concluded that, for an effective reduction of the environmental impact in these countries, it is essential to design policy measures, targeting new technologies, consumption and production patterns, and attracting green foreign direct investment. [ABSTRACT FROM AUTHOR]

The construction industry is known for its high rate of accidents. Among the different possible causes of this situation, we could find lack of sleep and fatigue. Chronic sleep deprivation is a determining factor in the deterioration of vigilance and alert, and consequently a risk factor for occupational accidents. Fatigue is the answer of our organism to sustained physical and mental stress. Regretfully, those topics have been ovelooked in the construction industry. The objective of this study is to understand better these phenomena, such as sleep duration and fatigue, and whether they are interrelated, and to propose strategies to mitigate them and contribute to the reduction of accidents in construction projects. We worked with 154 male construction workers from one Chilean construction company. To assess sleep quality, we used the Pittsburgh Sleep Quality Index (PSQI). To evaluate fatigue, we used a personal computer version of the Psychomotor Vigilance Test (PC-PVT) that measures alertness and vigilance. This 5-minute test was performed on construction workers on-site in the morning. Those people who took part in the test were classified into various groups according to self-reported sleep hours, namely: 7–9 h (26%), 5–7 h (61.7%), and

Objectives: The COVID-19 diagnosis is difficult and ambiguous due to nonspecific symptoms. Further, data from Mexico arehospitable population-based without signs and symptoms information. Thus, this work aims to provide epidemiology information about the burden of COVID-19 in Mexican outpatients and to identify symptomatic COVID-19 profiles that could help in the early diagnosis of the disease. Methods: From June to September, epidemiological, clinical, and demographic data of 482,413 individuals diagnosed by RT-PCR test for SARS-CoV-2 in Salud Digna clinics were collected. Results: We observed a 41% incidence of SARS-CoV-2 infections with a mean age of 36 years and with young adults (20–40 years) being the most affected. Among occupations, delivery persons (OR 1.38) or informal traders (OR 1.33) had a higher risk of COVID-19. Moreover, 13% of SARS-CoV-2 infections were in presymptomatic patients. Finally, we identified three different symptomatic profiles (common, respiratory, and gastrointestinal) associated with COVID-19. Conclusion: The incidence of SARS-CoV-2 was high among outpatients with a significant proportion of presymptomatic carriers, and thus it is necessary to increase testing and continue SARS-CoV-2 surveillance with a better description of signs and symptoms; in this regard, we identified three symptomatic profiles that could help in the diagnosis of COVID-19.

El sector automotriz mexicano -integrado en la cadena de valor regional de América del Norte, liderada por los Estados Unidos- se caracteriza por desempeñar principalmente tareas de carácter manufacturero, lo que limita su aportación en términos de valor agregado. Sin embargo, ello no implica que el impacto medioambiental generado por dichas tareas sea proporcional al valor que aporta. El objetivo de este trabajo es analizar esta doble vertiente del sector automotriz mexicano, mediante la caracterización tanto de su estructura productiva como de su impacto medioambiental relativo a sus flujos comerciales exteriores. Los resultados revelan una participación desigual en la cadena regional de valor según las exportaciones de valor agregado mexicanas se consideren en términos monetarios o de emisiones, lo que manifiesta una mayor aportación en términos de emisiones que de valor en comparación con los Estados Unidos.

The aim of this paper is to analyze the participation in the global textile and apparel value chain with special attention, first, to the case of three dynamic and interrelated economies (Mexico, the United States, and China); and second, to a general approach to a larger sample of countries through the analysis of trade in value added. From the descriptive analysis, a high domestic share in each country’s exports is found. However, China is the leading exporter in the industry, accounting for around a third of the domestic value added in the global textile final demand. An econometric estimation has also been carried out to observe the effects of tariffs, FDI, and labor costs on the total and backward participation in the textile GVC. In this case, the sample has been extended to 39 developed and 22 developing countries. The results reveal tariff protection as a determinant of the degree of participation of the sector, especially when backward participation and developing economies are considered. However, FDI and labor costs only show the expected results in the case of developing countries. This may be due to the different tasks performed by developing economies (primarily manufacturing) versus developed economies (branding, design) within the sector’s value chain.

The first cases of unexplained pneumonia were reported in Wuhan, China, in December of 2019. Later, a novel coronavirus (SARS-CoV-2) was identified as the causal agent of pneumonia. This virus has since spread to more than 180 countries and has been declared a pandemic by the World Health Organization. Herein, we aimed to determine the epidemiological and clinical characteristics of symptomatic patients with coronavirus disease 2019 (COVID-19) and the relationship between the influenza vaccine with a lower risk of severe COVID-19 infection in the state of Sinaloa. We collected demographic and clinical data of 4,040 patients with acute respiratory infections across Sinaloa state hospitals from February 28 to May 15, 2020. The prevalence of COVID-19 among hospitalized patients with respiratory symptoms in Sinaloa showed 45.2% of men were more affected than women (p < 0.001), and people aged 40–49 years were the most affected. The main symptoms of COVID-19 infection were cough and fever (p < 0.001), while hypertension, obesity, and type 2 diabetes were the chronic diseases associated with COVID-19 than non-COVID-19 (p < 0.003). Healthcare workers were most likely to be infected compared to other occupations (p < 0.001). The general lethality rate was 14.1%, and males >62 years were the ones who had a higher lethality rate (p < 0.001); the aforementioned chronic diseases were related to higher lethality of COVID-19 (p < 0.001). Likewise, higher lethality was seen in housewives and patient retirees/pensioners compared with other occupations (p < 0.001). Finally, we found there was a relationship between influenza vaccination and a lower risk of severe COVID-19 infection and mortality (p < 0.001). These findings showed that healthcare workers, men >62 years with chronic diseases, and retired people were most affected. Furthermore, the influenza vaccine could decrease the severeness of COVID-19 cases.

The COVID-19 pandemic has brought economic activity to a standstill unprecedented in recent history. The aim of this paper is to analyse the potential economic and sectoral impact resulting from suspension of certain activities. The analysis of production linkages and the hypothetical extraction method constitute the methodology applied, taking as a reference trade relation of Spain with the EU, USA and China in 2015. The results obtained based on the four possible scenarios proposed show a decline in GDP due to the paralysis of a set of sectors, revealing the existence of strong production linkages through Global Value Chains.

Omicron is the most mutated SARS-CoV-2 variant—a factor that can affect transmissibility, disease severity, and immune evasiveness. Its genomic surveillance is important in cities with millions of inhabitants and an economic center, such as Mexico City. Results. From 16 November to 31 December 2021, we observed an increase of 88% in Omicron prevalence in Mexico City. We explored the R346K substitution, prevalent in 42% of Omicron variants, known to be associated with immune escape by monoclonal antibodies. In a phylogenetic analysis, we found several independent exchanges between Mexico and the world, and there was an event followed by local transmission that gave rise to most of the Omicron diversity in Mexico City. A haplotype analysis revealed that there was no association between haplotype and vaccination status. Among the 66% of patients who have been vaccinated, no reported comorbidities were associated with Omicron; the presence of odynophagia and the absence of dysgeusia were significant predictor symptoms for Omicron, and the RT-qPCR Ct values were lower for Omicron. Conclusions. Genomic surveillance is key to detecting the emergence and spread of SARS-CoV-2 variants in a timely manner, even weeks before the onset of an infection wave, and can inform public health decisions and detect the spread of any mutation that may affect therapeutic efficacy.

Introducción: Las terapias complementarias se han ido incorporando cada vez más en la atención de salud, especialmente en áreas como la oncología, cuidados paliativos, rehabilitación y obstetricia. En varios países, son los propios profesionales de la salud los que las han incorporado en forma integrada a su práctica clínica, llevándolos a cambiar el paradigma del sistema biomédico actual, permitiendo brindar un cuidado más integral y autónomo. Objetivo: Comprender la experiencia de los profesionales de salud de Chile al incorporar las terapias complementarias en su práctica clínica. Método: Estudio cualitativo fenomenológico. Se invitó a participar a profesionales de la salud, con certificación en una terapia no convencional, la cual integran a su práctica clínica. Tras la firma del consentimiento, se realizaron las entrevistas en profundidad hasta lograr la saturación de los datos. El proceso de investigación se realizó siguiendo las 10 etapas de Streubert. Resultados: Participaron 11 profesionales de salud, quienes desarrollan terapias como el reiki, terapia floral y acupuntura integrada a su práctica clínica. Se develó que la incorporación de Terapias Complementarias le dio mayor sentido a la propia labor como profesional de la salud, sin embargo, hubo facilitadores y obstaculizadores del proceso, lo cual les generó nuevos desafíos para la integración con la medicina alópata. Conclusión: La integración de las Terapias Complementarias ampliaron las herramientas terapéuticas, lo que generó en ellos mayor satisfacción profesional al brindar una atención más humana y centrada en la persona, reconociendo la necesidad de incorporar estos saberes en los currículos de las carreras de la salud.

RESUMEN Introducción: El envejecimiento poblacional aumenta el riesgo de tener dependencia y con ello demandar cuidados. Las familias son quienes principalmente cuidan a sus mayores, teniendo también que asumir responsabilidades laborales. El doble rol como trabajador y cuidador se convierte en un factor de riesgo para su propia salud. Objetivo: Generar conocimiento comprensivo acerca de la experiencia vivida de participar en un programa de apoyo al trabajador/cuidador familiar de un adulto mayor dependiente, ofrecido en el espacio laboral. Metodología: estudio cualitativo fenomenológico. Se realizaron 14 entrevistas semiestructuradas a personas que participaron en al menos un 70% de los talleres del “Programa de apoyo al trabajador/ cuidador familiar”, y que eran cuidadores primarios o secundarios de un adulto mayor dependiente. Se entrevistó hasta cumplir con el criterio de saturación de resultados. El análisis se realizó a través del método propuesto por Streubert y cols. Resultados: se develaron tres categorías comprensivas: apoyo institucional para el fortalecimiento del trabajador/ cuidador, necesidades de cuidado del cuidador y multiplicidad de roles. Conclusiones: Los participantes reconocen el programa de apoyo a cuidadores familiares como un gesto de preocupación, solidaridad y empatía a través del cual la institución demuestra el valor que tienen sus empleados y una forma de validarlos como seres humanos trascendentes y multidimensionales.

RESUMEN La enfermedad de Alzheimer (EA) es una de las demencias más comunes y afecta al 8% de la población mayor de 65 años y al 30% de la población mayor de 80 años en los países con una alta expectativa de vida. Esta enfermedad es devastadora tanto por el deterioro progresivo de la persona que la presenta como por el impacto que produce en la familia, en la que habitualmente la responsabilidad de ser el “cuidador principal” recae sobre uno de sus integrantes. Objetivo: conocer la experiencia de ser cuidador principal de un familiar con EA y sus necesidades de cuidado. Metodología: se utilizó un diseño cualitativo fenomenológico. Resultados: se entrevistaron 8 cuidadores familiares de personas con EA. La vivencia de los cuidadores se develó en seis categorías comprensivas interrelacionadas entre sí: Inicio de los síntomas y búsqueda de un diagnóstico; Impacto de la enfermedad; Adaptación; Perfil del cuidador; Necesidad de no perder la esencia de la persona y Devolviendo la esperanza. Conclusión: Las categorías comprensivas dan cuenta de un proceso que viven los cuidadores desde el inicio de los síntomas hasta la adopción de su rol como cuidador. Este conocimiento podría aportar información para generar programas de atención innovadores que permitan acompañar a los cuidadores y su familia en el proceso de cuidados que requieren las personas con EA, para de esa manera contribuir a mejorar su calidad de vida, la de su familia y la del familiar a su cuidado.

The SARS-CoV-2 pandemic is one of the most concerning health problems around the globe. We reported the emergence of SARS-CoV-2 variant B.1.1.519 in Mexico City. We reported the effective reproduction number (Rt) of B.1.1.519 and presented evidence of its geographical origin based on phylogenetic analysis. We also studied its evolution via haplotype analysis and identified the most recurrent haplotypes. Finally, we studied the clinical impact of B.1.1.519. The B.1.1.519 variant was predominant between November 2020 and May 2021, reaching 90% of all cases sequenced in February 2021. It is characterized by three amino acid changes in the spike protein: T478K, P681H, and T732A. Its Rt varies between 0.5 and 2.9. Its geographical origin remain to be investigated. Patients infected with variant B.1.1.519 showed a highly significant adjusted odds ratio (aOR) increase of 1.85 over non-B.1.1.519 patients for developing a severe/critical outcome (p = 0.000296, 1.33–2.6 95% CI) and a 2.35-fold increase for hospitalization (p = 0.005, 1.32–4.34 95% CI). The continuous monitoring of this and other variants will be required to control the ongoing pandemic as it evolves.

AIM: To assess the proportion of refractive errors in the Mexican population that visited primary care optometry clinics in fourteen states of Mexico. METHODS: Refractive data from 676 856 patients aged 6 to 90y were collected from optometry clinics in fourteen states of Mexico between 2014 and 2015. The refractive errors were classified by the spherical equivalent (SE), as follows: sphere+½ cylinder. Myopia (SE>-0.50 D), hyperopia (SE>+0.50 D), emmetropia (-0.50≤SE≤+0.50), and astigmatism alone (cylinder≥-0.25 D). A negative cylinder was selected as a notation. RESULTS: The proportion (95% confidence interval) among all of the subjects was hyperopia 21.0% (20.9-21.0), emmetropia 40.7% (40.5-40.8), myopia 24.8% (24.7-24.9) and astigmatism alone 13.5% (13.4-13.5). Myopia was the most common refractive error and frequency seemed to increase among the young population (10 to 29 years old), however, hyperopia increased among the aging population (40 to 79 years old), and astigmatism alone showed a decreasing trend with age (6 to 90y; from 19.7% to 10.8%). There was a relationship between age and all refractive errors (approximately 60%, aged 50 and older). The proportion of any clinically important refractive error was higher in males (61.2%) than in females (58.3%; P

Purpose. To know the perceptions of mothers and health professionals in relation to the care provided and received during breastfeeding at primary health care level. Methods. A qualitative exploratory study was conducted with breastfeeding mothers (10) and primary health care professionals (24). Data was gathered through indepth interviews and focus groups. Data analysis was performed through thematic content analysis. The rigor of the study was ensured by the Guba and Lincoln criteria for qualitative research. Ethical aspects were addressed through the informed consent process, confidentiality, and methodological rigor. Results. The experience of providing/receiving breastfeeding support was revealed as a dynamic, multidimensional care and support process, through three central themes: 1. Influence of previous care and support experiences during the breastfeeding process; 2. Importance of the context within which care is framed; and 3. Addressing emotions to establish trust between professionals and mothers. Conclusion. The study findings contribute to further understanding a complex phenomenon, such as breastfeeding support and care for mothers/families, from the experience of the actors involved, deepening the experiences of both in integrated manner. In addition, the relational, organizational, and contextual dimensions that influence support, and that should guide care, are also highlighted. How to cite this article: Lucchini-Raies C, Márquez-Doren F, Garay Unjidos N, Contreras J, Jara D, Calabacero C, et al., Care during Breastfeeding: Perceptions of Mothers and Health Professionals. Invest. Educ. Enferm. 2019; 37(2):e09.