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Objectives: To determine the level of dental health care coverage in people aged >/=18 years across the country, and to identify the factors associated with coverage. Material and methods: Using the instruments and sampling strategies developed by the World Health Organization for the World Health Survey, a cross-sectional national survey was carried out at the household and individual (adult) levels. Dental data were collected in 20 of Mexico's 32 states. The relationship between coverage and environmental and individual characteristics was examined through logistic regression models. Results: Only 6098 of 24 159 individual respondents reported having oral problems during the preceding 12 months (accounting for 14 284 621 inhabitants of the country if weighted). Only 48% of respondents reporting problems were covered, although details of the appropriateness, timeliness and effectiveness of the intervention(s) were not assessed. The multivariate regression model showed that higher level of education, better socioeconomic status, having at least one chronic disease and having medical insurance were positively associated with better dental care coverage. Age and sex were also associated. Conclusions: Overall dental health care coverage could be improved, assuming that ideal coverage is 100%. Some equality of access issues are apparent because there are differences in coverage across populations in terms of wealth and social status. Identifying the factors associated with sparse coverage is a step in the right direction allowing policymakers to establish strategies aimed at increasing this coverage, focusing on more vulnerable groups and on individuals in greater need of preventive and rehabilitative interventions. [ABSTRACT FROM AUTHOR]

Astrocytes are the most abundant type of glial cell in the central nervous system. Upon injury and inflammation, astrocytes become reactive and undergo morphological and functional changes. Depending on their phenotypic classification as A1 or A2, reactive astrocytes contribute to both neurotoxic and neuroprotective responses, respectively. However, this binary classification does not fully capture the diversity of astrocyte responses observed across different diseases and injuries. Transcriptomic analysis has revealed that reactive astrocytes have a complex landscape of gene expression profiles, which emphasizes the heterogeneous nature of their reactivity. Astrocytes actively participate in regulating central nervous system inflammation by interacting with microglia and other cell types, releasing cytokines, and influencing the immune response. The phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway is a central player in astrocyte reactivity and impacts various aspects of astrocyte behavior, as evidenced by in silico , in vitro , and in vivo results. In astrocytes, inflammatory cues trigger a cascade of molecular events, where nuclear factor-κB serves as a central mediator of the pro-inflammatory responses. Here, we review the heterogeneity of reactive astrocytes and the molecular mechanisms underlying their activation. We highlight the involvement of various signaling pathways that regulate astrocyte reactivity, including the PI3K/AKT/mammalian target of rapamycin (mTOR), α v β 3 integrin/PI3K/AKT/connexin 43, and Notch/PI3K/AKT pathways. While targeting the inactivation of the PI3K/AKT cellular signaling pathway to control reactive astrocytes and prevent central nervous system damage, evidence suggests that activating this pathway could also yield beneficial outcomes. This dual function of the PI3K/AKT pathway underscores its complexity in astrocyte reactivity and brain function modulation. The review emphasizes the importance of employing astrocyte-exclusive models to understand their functions accurately and these models are essential for clarifying astrocyte behavior. The findings should then be validated using in vivo models to ensure real-life relevance. The review also highlights the significance of PI3K/AKT pathway modulation in preventing central nervous system damage, although further studies are required to fully comprehend its role due to varying factors such as different cell types, astrocyte responses to inflammation, and disease contexts. Specific strategies are clearly necessary to address these variables effectively., (Copyright © 2025 Copyright: © 2025 Neural Regeneration Research.)

Astrogliosis is a process by which astrocytes, when exposed to inflammation, exhibit hypertrophy, motility, and elevated expression of reactivity markers such as Glial Fibrillar Acidic Protein, Vimentin, and Connexin43. Since 1999, our laboratory in Chile has been studying molecular signaling pathways associated with "gliosis" and has reported that reactive astrocytes upregulate Syndecan 4 and α V β 3 Integrin, which are receptors for the neuronal glycoprotein Thy-1. Thy-1 engagement stimulates adhesion and migration of reactive astrocytes and induces neurons to retract neurites, thus hindering neuronal network repair. Reportedly, we have used DITNC1 astrocytes and neuron-like CAD cells to study signaling mechanisms activated by the Syndecan 4-α V β 3 Integrin/Thy-1 interaction. Importantly, the sole overexpression of β 3 Integrin in non-reactive astrocytes turns them into reactive cells. In vitro, extensive passaging is a simile for "aging", and aged fibroblasts have shown β 3 Integrin upregulation. However, it is not known if astrocytes upregulate β 3 Integrin after successive cell passages. Here, we hypothesized that astrocytes undergoing long-term passaging increase β 3 Integrin expression levels and behave as reactive astrocytes without needing pro-inflammatory stimuli. We used DITNC1 cells with different passage numbers to study reactivity markers using immunoblots, immunofluorescence, and astrocyte adhesion/migration assays. We also evaluated β 3 Integrin levels by immunoblot and flow cytometry, as well as the neurotoxic effects of reactive astrocytes. Serial cell passaging mimicked the effects of inflammatory stimuli, inducing astrocyte reactivity. Indeed, in response to Thy-1, β 3 Integrin levels, as well as cell adhesion and migration, gradually increased with multiple passages. Importantly, these long-lived astrocytes expressed and secreted factors that inhibited neurite outgrowth and caused neuronal death, just like reactive astrocytes in culture. Therefore, we describe two DITNC1 cell types: a non-reactive type that can be activated with Tumor Necrosis Factor (TNF) and another one that exhibits reactive astrocyte features even in the absence of TNF treatment. Our results emphasize the importance of passage numbers in cell behavior. Likewise, we compare the pro-inflammatory stimulus versus long-term in-plate passaging of cell cultures and introduce them as astrocyte models to study the reactivity process.

Limited data are available in Mexico on the prevalence of alcohol and drug use and the possible differences in their effects on types of road traffic injury (RTI), such as those involving pedestrians, drivers or passengers of motorcycles or other motor vehicles, and the association between substance use and driving behaviors, for preventive purposes. The sample comprised 433 adult RTI patients, admitted to the emergency department (ED) of a public hospital in Mexico City (January to April 2022). Breath Alcohol Concentration (BAC) was measured using a breath tester, and six types of drugs (amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, and methamphetamine) were assessed using a saliva screen test. RTI patients also self-reported their alcohol and drug use in the six hours prior to the accident. Approximately 62% of respondents had been involved in a motorcycle crash. One in three patients self-reported or had traces of a substance in their saliva or breath. The most common substance was alcohol (23.6%), followed by cannabis and stimulants (10.9%). One in five patients reported having used a cell phone ten minutes before the injury. One in three had not been using any safety device, the only behavior exacerbated by substance use. We found a high prevalence of substance use in the sample of RTI patients admitted to the ED, regardless of the type of the RTI, together with high cell phone rates. Motorcycle passengers under the influence were particularly likely not to have been wearing a helmet., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The objective of this paper was to identify the main indicators used to measure the performance in emergency trauma care. A literature review was carried out in the electronic databases: PubMEd, LILACS and Epistemónikos, including publications between January 2011 and December 31, 2021, in Spanish, English and Portuguese. A total of 962 publications were identified. When reviewing the full text, 48 articles were included. The indicators were classified in the dimensions of process and results. 100 different indicators were identified to analyze the performance of emergency trauma care. 71% were process indicators, including service time and triage. In the results dimension 29 indicators were identified; mortality was the indicator most analyzed as well as length of stay. Six indicators on the disability of injured people and 14 indicators related to satisfaction were identified, the most frequent being complaints. Various indicators have been used to assess the performance of emergency trauma care. In the results dimension, the indicators related to satisfaction and disability after injuries have been little explored. Decision-makers and those responsible for emergency care must promote performance evaluation exercises to learn about their current situation using appropriate and sensitive indicators with the available data., (Licencia CC 4.0 (BY-NC-ND) © 2023 Revista Médica del Instituto Mexicano del Seguro Social.)

Competing Interests: The authors declare no conflicts of interest.

Down syndrome (DS) is characterized by the trisomy of chromosome 21 and by cognitive deficits that have been related to neuronal morphological alterations in humans, as well as in animal models. The gene encoding for amyloid precursor protein (APP) is present in autosome 21, and its overexpression in DS has been linked to neuronal dysfunction, cognitive deficit, and Alzheimer's disease-like dementia. In particular, the neuronal ability to extend processes and branching is affected. Current evidence suggests that APP could also regulate neurite growth through its role in the actin cytoskeleton, in part by influencing p21-activated kinase (PAK) activity. The latter effect is carried out by an increased abundance of the caspase cleavage-released carboxy-terminal C31 fragment. In this work, using a neuronal cell line named CTb, which derived from the cerebral cortex of a trisomy 16 mouse, an animal model of human DS, we observed an overexpression of APP, elevated caspase activity, augmented cleavage of the C-terminal fragment of APP, and increased PAK1 phosphorylation. Morphometric analyses showed that inhibition of PAK1 activity with FRAX486 increased the average length of the neurites, the number of crossings per Sholl ring, the formation of new processes, and stimulated the loss of processes. Considering our results, we propose that PAK hyperphosphorylation impairs neurite outgrowth and remodeling in the cellular model of DS, and therefore we suggest that PAK1 may be a potential pharmacological target., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: In response to brain injury or inflammation, astrocytes undergo hypertrophy, proliferate, and migrate to the damaged zone. These changes, collectively known as "astrogliosis", initially protect the brain; however, astrogliosis can also cause neuronal dysfunction. Additionally, these astrocytes undergo intracellular changes involving alterations in the expression and localization of many proteins, including α v β 3 integrin. Our previous reports indicate that Thy-1, a neuronal glycoprotein, binds to this integrin inducing Connexin43 (Cx43) hemichannel (HC) opening, ATP release, and astrocyte migration. Despite such insight, important links and molecular events leading to astrogliosis remain to be defined., Methods: Using bioinformatics approaches, we analyzed different Gene Expression Omnibus datasets to identify changes occurring in reactive astrocytes as compared to astrocytes from the normal mouse brain. In silico analysis was validated by both qRT-PCR and immunoblotting using reactive astrocyte cultures from the normal rat brain treated with TNF and from the brain of a hSOD1 G93A transgenic mouse model. We evaluated the phosphorylation of Cx43 serine residue 373 (S373) by AKT and ATP release as a functional assay for HC opening. In vivo experiments were also performed with an AKT inhibitor (AKTi)., Results: The bioinformatics analysis revealed that genes of the PI3K/AKT signaling pathway were among the most significantly altered in reactive astrocytes. mRNA and protein levels of PI3K, AKT, as well as Cx43, were elevated in reactive astrocytes from normal rats and from hSOD1 G93A transgenic mice, as compared to controls. In vitro, reactive astrocytes stimulated with Thy-1 responded by activating AKT, which phosphorylated S373Cx43. Increased pS373Cx43 augmented the release of ATP to the extracellular medium and AKTi inhibited these Thy-1-induced responses. Furthermore, in an in vivo model of inflammation (brain damage), AKTi decreased the levels of astrocyte reactivity markers and S373Cx43 phosphorylation., Conclusions: Here, we identify changes in the PI3K/AKT molecular signaling network and show how they participate in astrogliosis by regulating the HC protein Cx43. Moreover, because HC opening and ATP release are important in astrocyte reactivity, the phosphorylation of Cx43 by AKT and the associated increase in ATP release identify a potential therapeutic window of opportunity to limit the adverse effects of astrogliosis., (© 2023. The Author(s).)

Objetivo: Estimar el nivel de exposición a riesgos de ac-cidentes en hogares vulnerables, identificando sus factores asociados y analizar su relación con la ocurrencia de acciden-tes en México. Material y métodos. Estudio transversal que analiza una submuestra de información del Secretariado Técnico del Consejo Nacional para la Prevención de Acci-dentes, recolectada durante 2016-2019. Se utilizó regresión Poisson para estimar factores asociados con el número de riesgos presentes en hogares donde residía población infantil (<5) y adulta mayor (75+) y regresión logística para analizar la ocurrencia de accidentes., Resultados: En hogares con <5 hubo en promedio seis riesgos; 2.9 donde residían 75+. La prevalencia de lesiones accidentales el año previo fue 3.1% (IC95%=2.0,4.6) en <1 año, 7.6% (IC95%=6.9,8.4) en 1-4 años y 17.1% (IC95%=15.6,18.7) en 75+. Las caídas fueron la principal causa., Conclusiones: Existe un elevado número de riesgos en hogares con población vulnerable; es necesario fortalecer las estrategias de prevención, educación y promoción de la salud.

Background: Limited data from low- and middle-income countries (LMICs) on the severity of road traffic injuries (RTIs) and their relation to different variables of interest are routinely obtained. Knowledge on this subject relies on evidence from high-income countries, which might not be the same as in LMICs. This information is greatly needed to advance and inform local and regional efforts towards the United Nations' Decade of Action and the Sustainable Development Goals., Methods: From May 2012 to November 2014, a RTI surveillance system was implemented in two referral hospitals in two Mexican cities, León and Guadalajara, with the objective of exploring the relationship between Injury Severity Score (ISS) and different sociodemographic characteristics of the injured as well as different variables related to the event and the environment. All individuals suffering RTIs who visited the Emergency Rooms (ER) were included after granting informed consent. A Zero-Truncated Negative Binomial Model was employed to explore the statistical association between ISS and variables of interest., Results: 3024 individuals participated in the study: 2185 (72.3%) patients from León and 839 patients (27.7%) from Guadalajara. Being male, in the 20-59 age-group, having less schooling, events occurring in Guadalajara, on Sundays, at night, and arriving at ER via public/private ambulance were all associated with an increased log count of ISS. Found a significant interaction effect (p-value< 0.05) between type of road user and alcohol intake six hours before the accident on severity of the injury (ISS). The use of illicit drugs, cellphones and safety devices during the event showed no association to ISS., Conclusions: Our study contributes to the statistical analysis of ISS obtained through RTI hospital surveillance systems. Findings might facilitate the development and evaluation of focused interventions to reduce RTIs in vulnerable users, to enhance ER services and prehospital care, and to reduce drink driving., (© 2022. The Author(s).)

Objective: To evaluate advancements in the prevention of road traffic injuries (RTI) in Mexico in the context of the United Nation's Decade of Action for Road Safety., Methods: An analysis of the trend and age-period-cohort effects of RTI mortality from 1999 to 2018 was conducted. Mortality figures were age-standardized using the direct method and population estimates of 2018 as the standard. To evaluate whether advancements might be attributed to higher levels of death misclassification, we conducted sensitive analysis using multiple imputation to redistributed deaths allocated to non-specific ICD-10 codes. Non-fatal RTI from four nationally representative health surveys (2000, 2006, 2012 and 2018) were analyzed., Findings: Implementation of Mexico's National Road Safety Strategy 2011-2020 was associated with an average annual percentage change reduction in the age-standardized RTI mortality rate of 1.3% (95%-CI: -1.8,-0.9). Reductions are more evident in pedestrians and four + wheelers (-6.7% and -5.3%, respectively, from 2011 to 2018); mortality trend in motorcyclists increased from 1999 to 2018 an average of 12.8% annually (95%-CI: 9.9, 15.9). Potential underestimation of mortality due to death misclassification decreased from 22.7% in 1999 to 16.4% in 2018; sensitive analysis showed that reductions might not be attributed to death misclassification. Non-fatal injuries decreased in four + wheelers but increased in motorcyclists. The number of individuals suffering permanent consequences from RTI increased., Conclusions: Results showed some potential gains of Mexico's road safety strategies: RTI in four + wheelers decreased. Efforts should be put in place urgently to prevent the growing number of RTI in motorcyclists., (Copyright © 2021. Published by Elsevier Ltd.)

Various families of ion channels have been characterized in mesenchymal stem cells (MSCs), including some members of transient receptor potential (TRP) channels family. TRP channels are involved in critical cellular processes as differentiation and cell proliferation. Here, we analyzed the expression of TRPM8 channel in human bone marrow MSCs (hBM-MSCs), and its relation with osteogenic differentiation. Patch-clamp recordings showed that hBM-MSCs expressed outwardly rectifying currents which were increased by exposure to 500 μM menthol and were partially inhibited by 10 μM of BCTC, a TRPM8 channels antagonist. Additionally, we have found the expression of TRPM8 by RT-PCR and western blot. We also explored the TRPM8 localization in hBM-MSCs by immunofluorescence using confocal microscopy. Remarkably, hBM-MSCs treatment with 100 μM of menthol or 10 μM of icilin, TRPM8 agonists, increases osteogenic differentiation. Conversely, 20 μM of BCTC, induced a decrease of osteogenic differentiation. These results suggest that TRPM8 channels are functionally active in hBM-MSCs and have a role in cell differentiation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Henao, Grismaldo, Barreto, Rodríguez-Pardo, Mejía-Cruz, Leal-Garcia, Pérez-Núñez, Rojas, Latorre, Carvacho and Torres.)

Objective: To estimate the prevalence of speeding in the city of Xalapa, Veracruz, in Mexico and to identify factors potentially associated to this risk behavior., Methods: A cross-sectional study was conducted on December 2019 in Xalapa, Veracruz. Speed measurement was conducted in a random sample of 10% of all the main roads in the urban area ( n  = 12). Observations were conducted over the course of one week at different times spending no more than 1.5 h in each site at a time. All vehicles circulating in each observation site during the data collection were included in the sample. Characteristics of drivers, vehicles and the environment were also collected and analyzed, using logistic regression analysis and a multiple ordinal regression model to identify factors associated to speeding and more serious violations of speed limits., Results: Average speed of the 3,390 vehicles observed was 50.97 km/h. Prevalence of speeding was 65.66% (95%-CI: 64.04-67.26%); 26.96% (95%-CI: 25.47-28.49) exceeded the speed limit by 50%. Speeding and more serious violations of speed limits were more frequent in light vehicles, residential zones and during weekends. More serious violations of speed limits were also more frequent on smaller roads, where speed limit were lower and during morning hours., Conclusions: The great majority of vehicles transgress speed limits in Xalapa, Veracruz. Our results support the urgent need to implement speed control measures in the city. Changes in road infrastructure design, as well as promoting a comprehensive speeding legislation (with adequate speed limits and correctly enforced) aimed at reducing exposure to this key risk factor are recommended. As evaluation of road safety interventions is key, our data could be used as a baseline to evaluate the effects and impact of future interventions implemented in this Mexican city.

Objective: To characterize the epidemiology of unintentional asphyxias in Mexico from 1999 to 2017., Method: Secondary analysis of vital registries, three national health surveys and information from the safety inspection program of the Ministry of Health in Mexico were used to characterize fatal and non-fatal drownings (ICD-10: W65-W74) and other asphyxias including suffocation, chocking and strangulation (ICD-10: W75-W84), and to estimate the level of exposure to different risk factors within households and daycares., Results: 100,834 deaths were registered, 44.66% were drowning and 77.17% male. Drownings mainly affect children and adolescents, occur in April, July and August, on Sundays, during the afternoon. Other asphyxias affect children and the elderly more frequently, occur mainly from December to February, on Sundays and from 4 to 6h. According to ENSANut-2012, 53,065 individuals experience a non-fatal asphyxia per year, 26.21% of them with permanent consequences in their health and wellbeing. Important risks of unintentional asphyxias are present in 38% of daycares and 80% of households analyzed., Conclusions: Unintentional asphyxias are a major public health problem that needs to be urgently attended to achieve the Sustainable Development Goals, in particular the 3.2. Evidence presented in this work constitutes an input to inform and orient efforts directed to tackle this problem., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To estimate the prevalence of non-fatal uninten-tional injuries in Mexican population and to analyze individual, environmental and household factors associated with its occurrence., Materials and Methods: A cross-sectional study, analyzed the prevalence of unintentional injuries from Encuesta Nacional de Salud y Nutrición (Ensanut 2018-19), which is a nationally representative health survey designed with a probability, stratified and cluster sampling, in three stages. Association with variables of interest was explored using logistic regression analysis., Results: Prevalence of non-fatal unintentional injuries was 4.5% (IC95%: 4.2-4.7), equivalent to 5.6 million people per year. Of them, 22.3% or 1.2 million suffered permanent consequences. Probability of having unintentional injuries was higher in the North and Center regions, as in Mexico City-State of Mexico; in males from 0 to 59 and females of 60 or more years of age, in people living with disabilities and those who self-reported depres-sion symptoms., Conclusions: Strengthening unintentional injury prevention is necessary and urgent, especially within vulnerable groups of population., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Background: To date, the burden of injury in Mexico has not been comprehensively assessed using recent advances in population health research, including those in the Global Burden of Disease Study 2017 (GBD 2017)., Methods: We used GBD 2017 for burden of unintentional injury estimates, including transport injuries, for Mexico and each state in Mexico from 1990 to 2017. We examined subnational variation, age patterns, sex differences and time trends for all injury burden metrics., Results: Unintentional injury deaths in Mexico decreased from 45 363 deaths (44 662 to 46 038) in 1990 to 42 702 (41 439 to 43 745) in 2017, while age-standardised mortality rates decreased from 65.2 (64.4 to 66.1) in 1990 to 35.1 (34.1 to 36.0) per 100 000 in 2017. In terms of non-fatal outcomes, there were 3 120 211 (2 879 993 to 3 377 945) new injury cases in 1990, which increased to 5 234 214 (4 812 615 to 5 701 669) new cases of injury in 2017. We estimated 2 761 957 (2 676 267 to 2 859 777) disability-adjusted life years (DALYs) due to injuries in Mexico in 1990 compared with 2 376 952 (2 224 588 to 2 551 004) DALYs in 2017. We found subnational variation in health loss across Mexico's states, including concentrated burden in Tabasco, Chihuahua and Zacatecas., Conclusions: In Mexico, from 1990 to 2017, mortality due to unintentional injuries has decreased, while non-fatal incident cases have increased. However, unintentional injuries continue to cause considerable mortality and morbidity, with patterns that vary by state, age, sex and year. Future research should focus on targeted interventions to decrease injury burden in high-risk populations., Competing Interests: Competing interests: SLJ works in an influenza/RSV grant that is funded by Sanofi Pasteur., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: Speeding is responsible for countless traffic collisions and road traffic injuries (RTIs) around the world. It threatens the lives of passengers in motor vehicles as well as the safety of other individuals sharing the public roads. Little evidence has been provided by low- and middle-income countries on speed transgression patterns., Objective: To document the prevalence of speeding in motor vehicles with four or more wheels and to analyse the associated factors in four Mexican cities., Methods: We conducted a cross-sectional study in the cities of Guadalajara-Zapopan, León, Cuernavaca and Villahermosa. Data on speed, drivers, vehicles, road infrastructure and the environment were collected from a randomly selected sample of urban road segments. We identified the factors associated with speeding through a logistic multiple regression model., Results: With an overall prevalence of 47% (95% CI 45.83 to 48.18), speeding occurred most frequently in Villahermosa (61.07%, 95% CI 59.10 to 63.01) as compared to León (51%, 95% CI 48.07 to 53.92), Cuernavaca (47.6%, 95% CI 45.35 to 49.85) and Guadalajara-Zapopan (20.76%, 95% CI 18.75 to 22.88). Speeding increased in the afternoons, on roads with numerous lanes, on Thursdays and Sundays and in foggy weather, but decreased in cities with speed control strategies and on roads with low visibility. No differences were observed between sexes or among age groups., Conclusions: Evidence from our study highlights the urgent need to implement speed control measures such as changes in road infrastructure and design, and to promote comprehensive speeding legislation aimed at reducing exposure to this important risk factor., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To estimate the prevalence of pickup trucks transporting people in the cargo area and to identify factors associated to this behavior in three Mexican cities. Methods: Eight rounds of roadside observations of randomly selected pickup trucks were conducted from August 2012 to November 2014 in three Mexican cities: Guadalajara-Zapopan, León and Cuernavaca. Results: Overall, 4.03% of the 4,611 pickup trucks observed were transporting people in the cargo area (95% CI: 3.48 - 4.64%). This implies that a total of 427 passengers were traveling unsafely in the cargo area of pickup trucks; of all them 22.01% were children and 82.20% were male. Prevalence of exposure to this risky behavior was higher in León (5.77%, 95% CI: 4.73 - 6.97%) than in Cuernavaca (3.73%, 95% CI: 2.49 - 5.35%) and Guadalajara-Zapopan (2.70%, 95% CI: 2.05 - 3.48%). According to this data, exposure to this risk factor has decreased in time. Male drivers, not using seatbelt correctly carried passengers in the cargo area more frequently. Conclusions: Results support the importance of improving and enforcing current legislation and evaluating strategies directed to prevent exposure to this risky behavior with the potential of contributing to lowering the high burden that road traffic injuries imposed in Mexican public health.

Objective: To estimate the prevalence of unintentional injuries (UI) in people residing in localities with <100 000 inhabitants and to analyze its association with different environmental, household and individual characteristics., Materials and Methods: Cross-sectional design that analyses the UI component of Ensanut 100k, which is a probabilistic national survey that focused on households beneficiaries of the program Prospera and those with fewer economic capabilities. Prevalence of UI was estimated considering the complex design of the survey. Association with variables of interest was explored using logistic regression analysis., Results: Prevalence of UI was 5.15% (CI95%: 1.43-6.16); probability was higher in male, those living in the region CDMX-EdoMex, and those with hearing and motor disability., Conclusions: Policies directed to prevent UI need to be strengthened to promote health and quality of life amongst individuals, par- ticularly those with social and economic vulnerability, and to reduce the burden that these conditions impose to public health in Mexico., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Background and Objective: The characteristics of human hematopoietic stem cells are conditioned by the microenvironment of the bone marrow, where they interact with other cell populations, such as mesenchymal stem cells and endothelial cells; however, the study of this microenvironment is complex. The objective of this work was to develop a 3D culture system by magnetic levitation that imitates the microenvironment of human HSC., Methods and Results: Human bone marrow-mesenchymal stem cells, umbilical cord blood-hematopoietic stem cells and a non-tumoral endothelial cell line (CC2811, Lonza Ⓡ ) were used to develop organotypic multicellular spheres by the magnetic levitation method. We obtained viable structures with an average sphericity index greater than 0.6, an average volume of 0.5 mm 3 and a percentage of aggregation greater than 70%. Histological studies of the organotypic multicellular spheres used hematoxylin and eosin stains, and an evaluation of vimentin expression by means of immunohistochemistry demonstrated an organized internal structure without picnotic cells and a high expression of vimentin. The functional capacity of human hematopoietic stem cells after organotypic multicellular spheres culture was evaluated by multipotency tests, and it was demonstrated that 3D structures without exogenous Flt3L are autonomous in the maintenance of multipotency of human hematopoietic stem cells., Conclusions: We developed organotypic multicellular spheres from normal human cells that mimic the microenvironment of the human hematopoietic stem cells. These structures are the prototype for the development of complex organoids that allow the further study of the biology of normal human stem cells and their potential in regenerative medicine.

In recent years, the therapeutic use of mesenchymal stromal cells (MSC) has generated a valuable number of scientific studies that delve into their biological characteristics and their potential in regenerative medicine; however, the impact of the clinical characteristics of tissue donors, from which these cells are isolated, on their potential in applied clinical research is not yet clear. The objective of this study was to evaluate the impact of the clinical characteristics of bone marrow donors on the quality of this tissue as a source of MSC for therapeutic use. Human MSC were isolated, characterized and cultured (according to ISCT criteria) from bone marrow samples from volunteer donors (n = 70) attending the Department of Orthopedics and Traumatology of the Hospital Universitario San Ignacio (Bogota, Colombia) for surgery of prosthetic hip replacement that agreed to participate voluntarily in the study. Donor data such as age, gender, weight, smoker and type of anesthesia used during the surgical procedure were recorded, and the impact of these characteristics on the volume of tissue collection, mononuclear cell count and confluence time of cells with fibroblastoid morphology was evaluated. Correlation coefficients between quantitative variables were calculated with Spearman's correlation test, and the association between qualitative and quantitative variables was evaluated with biserial correlation coefficient. A significant correlation was observed between the age of the donors and the time necessary to obtain confluent cells in vitro (r = 0.2489, P = 0.0377); similarly, the correlation between the volume of bone marrow collected and the number of mononuclear cells obtained was significant (r = 0.7101, P = 0.0001). Although a negative correlation tendency was observed between the mononuclear cell count and the confluence time, this was not significant (r = -0.2041, P = 0.0950). No significant associations were observed between gender, smoking status or type of anesthesia and the expansion characteristics of human mesenchymal stromal cells. Bone marrow donor age and the tissue collection volume impact the time of obtaining MSC in vitro and the mononuclear cell count with which the culture starts. These conditions must be considered when the bone marrow is selected as the tissue for obtaining MSC., Competing Interests: None.

The aim of this article was to analyze the timeliness of emergency medical care (time transpired between the injury and the first contact with the Emergency Medical System) and its assocation with different negative health outcome in traffic accident victims treated at two Mexican hospitals, one in Guadalajara, Jalisco, and the other in León, Guanajuato, based on data from the Motor Vehicle Accident Epidemiological Surveillance System of the Bloomberg Philanthropies' Global Road Safety Program. Information was obtained on all patients treated for motor vehicle injuries in referral hospitals from May 2012 to November 2014. Multinomial logistic regression was used to model the health outcomes, categorized as short stay, prolonged hospitalization, disability, and death, compared to timeliness of care, adjusted by different target variables. A total of 2,575 patients were analyzed. Time from injury to care was 103.74 minutes (± 231.36) in León and 75.37 minutes (± 156.87) in Guadalajara; it was 38.02 and 36.23 minutes, respectively, in patients that received prehospital medical care. Timely care was associated with less prolonged hospital stay, but not with lower incidence of disability or death. Receiving prehospital medical care was associated statistically with negative health consequences. Timely care was associated with lower probability of prolonged hospitalization. Strategies are needed to evaluate and in turn improve the technical quality of prehospital medical care, including timeliness of care and adequate regulation.

Objective: To analyze the progress towards the accomplishment of the expected goal in the middle of the Decade of Action for Road Safety 2011-2020 in Mexico and its states., Methods: This is a secondary analysis of road traffic deaths in Mexico between 1999 and 2015. We projected the trend for the period 2011-2020 using a time series analysis (autoregressive integrated moving average models). We used the value of the Aikaike Information Criterion to determine the best model for the national level and its 32 states., Results: Mexico is progressing, approaching the proposed goal, which translates into 10,856 potentially prevented deaths in the five-year period from 2011 to 2015. This was due to a decrease in the number of deaths of motor vehicle occupants, as the deaths of pedestrians and motorcyclists were higher than expected. At least one third of the states had values below their goal; although the mortality rate remains unacceptably high in five of them. We identified four states with more deaths than those originally projected and other states with an increasing trend; thus, both cases need to strengthen their prevention actions., Conclusions: The analysis can allow us to see the progress of the country in the middle of the Decade of Action, as well as identify the challenges in the prevention of traffic injuries in vulnerable users. It contributes with elements that provide a basis for a need to rethink both the national goal and the goal of the different states.

Aim: To estimate the Drink Driving Attributable Fraction (DDAF) of road traffic injury mortality in car occupants in Mexico during 2010-13., Design: A case-control study was conducted to examine the presence of alcohol in analysed body fluids of car occupants killed in fatal crashes (cases) compared with car drivers tested in alcohol-testing checkpoints who were not involved in a fatal collision (controls). Two data sets were used for the period 2010-13: the forensic module of the Epidemiological Surveillance System on Addictions that included car occupants killed in a collision (cases) and a data set from alcohol-testing at police checkpoints available for matching municipalities (controls)., Setting: Mexico., Participants: The analysed study sample included 1718 car occupants killed in a traffic collision and 80 656 drivers tested at alcohol police checkpoints, all from 10 municipalities., Measurements: Unadjusted and adjusted odds ratios (OR) of presence of alcohol in body fluids were obtained stratified by sex and age groups and the interaction with these two variables were assessed. The ORs were used to calculate the DDAF., Findings: It was estimated that 19.5% of car occupants' deaths due to road traffic injuries were attributable to alcohol consumption [95% confidence interval (CI) = 19.1-19.9]. The adjusted OR of presence of alcohol was 6.84 (95% CI = 6.06-7.71) overall. For males it was 7.21 (95% CI = 6.35-8.18) and for females it was 4.45 (95% CI = 3.01-6.60). The ORs were similar across younger age bands (10-19 years: 9.61, 95% CI = 6.72-13.73; 20-29 years: 7.70, 95% CI = 6.28-9.4; and 30-49 years: 7.21, 95% CI = 5.98-8.70); and lower but still elevated among older people (50+ years: 3.19, 95% CI = 2.19-4.65)., Conclusions: An estimated 19.5% of car occupant deaths in Mexico may have been caused by alcohol in 2010-13., (© 2017 Society for the Study of Addiction.)

With the objective of analyzing fatal and non-fatal road traffic injuries in cyclists and to document helmet use in this road user to inform sustainable mobility policies, a descriptive analysis of four secondary official information sources was conducted at the national level: mortality, Ministry of Health's hospital discharges, Unintentional and Violence Registry System (SIS-SS-17-P) and the 2012 National Health and Nutrition Survey (ENSANUT). Only SIS-SS-17-P and ENSANUT document helmet use. Except for ENSANUT information analyzed is of 2014.A total of 190 cyclists died in Mexico during 2014 and 392 were hospitalized; head was the anatomical region most frequently affected (63% and 32%, respectively). Only 0.75% of the 667 cases registered in SIS-17 reported helmet use and 24% suffered head injuries. Of the 165,348 non-fatally injured cyclists from ENSANUT <10% used helmet, 24% had head injuries and more than 16,000 suffered permanent injuries. Whereas cyclist-friendly infrastructure is an effective intervention to prevent injuries in the long term, helmet use could potentially reduce the frequency and severity of head injuries in the short run while bicycle use widespread as a means of transportation providing "safety in numbers".

Objective: Study federal and state regulations to determine to what extent road safety recommendations are followed with regard to different risk factors and protective factors., Methods: A descriptive analysis was made of the legal frameworks for road safety at the federal level and in the 32 Mexican states, identifying those that had regulations respecting the main risk factors (speeding, drinking and driving, and cellphone use while driving) and the main protective factors against road injuries (helmet use, seat belt use, and use of child restraint systems). The adequacy of these regulations was analyzed on the basis of Pan American Health Organization/World Health Organization (PAHO/WHO) recommendations. The types of sanctions prescribed in these regulations are also described., Results: Slightly less than 10% of the entities studied had specific regulations respecting the six protective and risk factors considered. It was noted that "drinking and driving" and "helmet use" are, respectively, the risk factor and protective factor most commonly included in state laws. Adequate regulations were found in only two states: Zacatecas (regarding speeding) and Jalisco (seat belts, child restraint systems, and helmet use). Monetary fines are the most frequently applied sanction., Conclusions: It is a key priority to promote comprehensive laws with provisions that adequately address technical and scientific criteria for protection and prevention, as well as appropriate mechanisms for monitoring, regulation, and sanctions., Competing Interests: Conflictos de interés. Ninguno declarado por los autores.

Objective: To estimate the potential underestimation of mortality from traffic injuries at the subnational level in Mexico for a period of 15 years and to identify social and economic variables at the state level that could potentially be associated with the quality of statistical classification of deaths., Materials and Methods: Secondary analysis of validated mortality databases for the period 1999-2013 was conducted. Using multiple imputation models, registries that could potentially be attributed to road traffic deaths were estimated and the potential underestimation of mortality due to this external cause was quantified. A simple correlation analysis was carried out., Results: The potential underestimation of deaths from traffic injuries during the period was 18.85% at the national level, with significant variations by state. From the data analyzed, there was no statistical evidence of any association of the percentage of road traffic deaths underestimation with the variables analyzed., Conclusions: Performance in terms of mortality classification is different at the state level in Mexico. This information is useful for targeting interventions to improve the recording of deaths in the country.

In humans, Down syndrome (DS) is caused by the presence of an extra copy of autosome 21. The most striking finding in DS patients is intellectual disability and the onset of Alzheimer's disease (AD)-like neuropathology in adulthood. Gene overdose is most likely to underlie both developmental impairments, as well as altered neuronal function in DS. Lately, the disruption of cellular signaling and regulatory pathways has been implicated in DS pathophysiology, and many of such pathways may represent common targets for diverse DS-related genes, which could in turn represent attractive therapeutical targets. In this regard, one DS-related gene Down Syndrome Cell Adhesion Molecule (DSCAM), has important functions in neuronal proliferation, maturation, and synaptogenesis. p21-associated kinases (PAKs) appear as a most interesting possibility for study, as DSCAM is known to regulate the PAKs pathway. Hence, in DS, overexpressed DSCAM could deregulate PAKs activity and affect signaling pathways that regulate synaptic plasticity such as dendritic spine dynamics and axon guidance and growth. In the present work, we used an immortalized cell line derived from the cerebral cortex of an animal model of DS such as the trisomy 16 (Ts16) fetal mouse (named CTb), and a similar cell line established from a normal littermate (named CNh), to study the effect of DSCAM in the PAKs pathway. The present study shows that DSCAM is overexpressed in CTb cells by approximately twofold, compared to CNh cells. Congruently, PAK1, as well as its downstream effectors LIMK and cofilin, stay phosphorylated for longer periods after DSCAM activation in the CTb cells, leading to an altered actin dynamics, expressed as an increased basal F/G ratio and reduced neurite growth, in the trisomic condition. The present work presents the correlation between DSCAM gene overexpression and a dysregulation of the PAK pathway, resulting in altered morphological parameters of neuronal plasticity in the trisomic cell line, namely decreased number and length of processes.

Road traffic crashes have been an increasing threat to the wellbeing of road users worldwide; an unacceptably high number of people die or become disabled from them. While high-income countries have successfully implemented effective interventions to help reduce the burden of road traffic injuries (RTIs) in their countries, low- and middle-income countries (LMICs) have not yet achieved similar results. Both scientific research and capacity development have proven to be useful for preventing RTIs in high-income countries. In 1999, a group of leading researchers from different countries decided to join efforts to help promote research on RTIs and develop the capacity of professionals from LMICs. This translated into the creation of the Road Traffic Injuries Research Network (RTIRN) - a partnership of over 1,100 road safety professionals from 114 countries collaborating to facilitate reductions in the burden of RTIs in LMICs by identifying and promoting effective, evidenced-based interventions and supporting research capacity building in road safety research in LMICs. This article presents the work that RTIRN has done over more than a decade, including production of a dozen scientific papers, support of nearly 100 researchers, training of nearly 1,000 people and 35 scholarships granted to researchers from LMICs to attend world conferences, as well as lessons learnt and future challenges to maximize its work.

This study estimated the economic costs of permanent disability caused by road traffic injuries in Mexico during 2012. From the health system's perspective, a bottom-up approach was used to calculate direct medical costs (hospitalization, outpatient care, rehabilitation, and prostheses). From society's perspective, using a human capital approach, indirect costs were associated with loss of productivity for the victims and their caregivers. Permanent disability due to road traffic injuries takes a high toll on the health system and Mexican society. From the health system perspective, the cost was US$269,529,480.72, or US$1,496.33 per victim. The estimated average cost to society was US$3,445.45 during the first year. The total average cost per victim was US$4,941.77, resulting in a total economic cost of US$1,119,761,632.53 during 2012. The study's findings highlight the need to design and implement more rigorous and efficient public policies to control and prevent road traffic injuries in Mexico.

Background: Acute poisoning is one of the most common reasons for emergency department visits around the world. In Pakistan, the epidemiological data on poisoning is limited due to an under developed poison information surveillance system. We aim to describe the characteristics associated with intentional and unintentional poisoning in Pakistan presenting to emergency departments., Methods: The data was extracted from the Pakistan National Emergency Department Surveillance (Pak-NEDS) which was an active surveillance conducted between November 2010 and March 2011. All patients, regardless of age, who presented with poisoning to any of Pakistan's seven major tertiary care centers' emergency departments, were included. Information about patient demographics, type of poisoning agent, reason for poisoning and outcomes were collected using a standard questionnaire., Results: Acute poisoning contributed to 1.2% (n = 233) of patients with intentional and unintentional injuries presenting to EDs of participating centers. Of these, 68% were male, 54% were aged 19 to 44 and 19% were children and adolescents (<18 years). Types of poisoning included chemical/gas (43.8%), drug/medicine (27%), alcohol (16.7%) and food/plant (6%). In half of all patients the poisoning was intentional. A total of 11.6% of the patients were admitted and 6.6% died., Conclusion: Poisoning causes more morbidity and mortality in young adults in Pakistan compared to other age groups, half of which is intentional. Improving mental health, regulatory control for hazardous chemicals and better access to care through poison information centers and emergency departments will potentially help control the problem.

Motorcycle use as a functional and recreational means of transportation is increasing in Mexico; the associated mortality rate has also increased. Appropriate helmet use can reduce a motorcyclist's risk of death or serious injury. This study quantified the prevalence of motorcycle helmet use in three Mexican cities (Cuernavaca, Guadalajara-Zapopan, and León) within the context of several ongoing road safety initiatives. Four rounds of roadside observations were conducted between November 2010 and April 2012. The overall prevalence of helmet use was 73.8% among all users; helmet use was much lower among females (55.3%). Drivers tended to use helmets more frequently than passengers (76.3% vs. 51.6%). The prevalence was higher in León (85.9%, 95% CI = 84.8-87.0) than Cuernavaca (71.5%, 95% CI = 69.3-73.6) and Guadalajara-Zapopan (62.7%, 95% CI = 61.1-64.2). Helmet use decreased in León (p = 0.003) but increased in Guadalajara-Zapopan (p = 0.000) during this period. Motorcycle helmet use could be improved in all three cities. Since motorcycle use is increasing, interventions targeting motorcycle users and greater enforcement of helmet use are necessary to reduce crashes and non-fatal and fatal injuries.

The municipalities of Guadalajara and Zapopan, Jalisco State, Mexico, have participated in efforts to reduce road traffic injuries. They have participated actively in the Mexican Road Safety Initiative since 2008. As a result, in September 2010 they passed laws to reduce the legal alcohol levels for driving motor vehicles. To assess the short-term impact of these measures on rates and severity of alcohol-related collisions and injuries, we conducted a secondary analysis of official databases on mortality, morbidity, and collisions. We performed a time-series analysis to assess the trend. Significant changes were observed in the monthly proportion of alcohol-related deaths and collision rates following these interventions. The article concludes with recommendations to improve the reform's enforcement and results.

Based on a review of secondary data and the scientific literature and an analysis of the ENSANut-2012 database, the current study provides a comprehensive overview of the current burden of road traffic injuries (RTI) in Mexico and analyzes the country's social response to RTI. The high collision, injury, mortality, and disability rates associated with this public health problem represent a high cost for Mexican society, especially for families. The paper argues that the Mexican response has focused on vehicle occupants while overlooking vulnerable road users and has prioritized strategies with limited effectiveness. Although the country's existing legislation addresses the main risk factors, enforcement has been limited. Finally, the paper makes some recommendations for strengthening the Mexican strategy to prevent RTI, such as safe, equitable, healthy, and sustainable mobility for all types of road users. Despite some strides in RTI prevention, there are still challenges and opportunities to be addressed in the future.

Background: In January 2008, a national multifaceted road safety intervention program (IMESEVI) funded by the Bloomberg Philanthropies was launched in Mexico. Two years later in 2010, IMESEVI was refocused as part of a 10-country international consortium demonstration project (IMESEVI/RS10). We evaluate the initial effects of each phase of the road safety intervention project on numbers of RT crashes, injuries and deaths in Mexico and in the two main target cities of Guadalajara-Zapopan and León., Methods: An interrupted time series analysis using autoregressive integrated moving average (ARIMA) modeling was performed using monthly data of rates of RT crashes and injuries (police data), as well as deaths (mortality system data) from 1999-2011 with dummy variables representing each intervention phase., Results: In the period following the first intervention phase at the country level and in the city of León, the rate of RT crashes decreased significantly (p<0.05). Notably, following the second intervention phase although there was no reduction at the country level, there has been a decrease in the RT crash rate in both Guadalajara-Zapopan (p = 0.029) and in León (p = 0.029). There were no significant differences in the RT injury or death rates following either intervention phase in either city., Conclusion: These initial results suggest that a multi-faceted road safety intervention program appears to be effective in reducing road crashes in a middle-income country setting. Further analysis is needed to differentiate the effects of various interventions, and to determine what other economic and political factors might have affected this change.