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BackgroundCOVID-19 health emergency caused an increase in the demand for hospitalization and high costs for the health system.ObjectiveTo estimate COVID-19 care direct costs from the perspective of the healthcare provider in a secondary care hospital that underwent conversion during the first year of health emergency.Material and methodsRetrospective, observational study. Information on quantities of goods and services was obtained from the SINOLAVE and CVOED platforms and from hospital administrative sources. Four cost groups were defined and estimated with 2021 unit prices in US dollars.ResultsMean hospital length of stay (n = 3,241 patients) was 10.8 ± 8.2 days. Average cost of care per patient was USD 6,557 ± 4,997. Respiratory therapy with assisted mechanical ventilation was used by 13% of patients.ConclusionsThe costs of COVID-19 medical care represent a large amount of resources. Most part of the costs (95%) were derived from hospital stay, respiratory therapy without assisted mechanical ventilation and costs related to personal protective equipment, hygiene, infrastructure adaptation and payments to medical personnel.

Background: COVID-19 health emergency caused an increase in the demand for hospitalization and high costs for the health system. Objective: To estimate COVID-19 care direct costs from the perspective of the healthcare provider in a secondary care hospital that underwent conversion during the first year of health emergency. Material and methods: Retrospective, observational study. Information on quantities of goods and services was obtained from the SINOLAVE and CVOED platforms and from hospital administrative sources. Four cost groups were defined and estimated with 2021 unit prices in US dollars. Results: Mean hospital length of stay (n = 3,241 patients) was 10.8 ± 8.2 days. Average cost of care per patient was USD 6,557 ± 4,997. Respiratory therapy with assisted mechanical ventilation was used by 13% of patients. Conclusions: The costs of COVID-19 medical care represent a large amount of resources. Most part of the costs (95%) were derived from hospital stay, respiratory therapy without assisted mechanical ventilation and costs related to personal protective equipment, hygiene, infrastructure adaptation and payments to medical personnel.

BackgroundNonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease and cirrhosis. NAFLD is mediated by changes in lipid metabolism and known risk factors include obesity, metabolic syndrome, and diabetes. The aim of this study was to better understand differences in the lipid composition of individuals with NAFLD compared to controls, by performing direct infusion lipidomics on serum biospecimens from a cohort study of adults in Mexico.MethodsA nested case-control study was conducted with a sample of 98 NAFLD cases and 100 healthy controls who are participating in an on-going, longitudinal study in Mexico. NAFLD cases were clinically confirmed using elevated liver enzyme tests and liver ultrasound or liver ultrasound elastography, after excluding alcohol abuse, and 100 controls were identified as having at least two consecutive normal alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (

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

The aim of this study was to examine various psychosocial, behavioral, and socio-environmental factors in a multiethnic sample of healthy-weight, overweight, and obese youths in the United States (US) and Mexico and determine differences by sex. We conducted a cross-sectional analysis of 633 youths aged 11-18 years who completed a self-reported questionnaire. Height and weight were measured to determine body mass index (BMI). Overweight and obese youth in both countries were significantly more likely to report a higher body image dissatisfaction (Odds Ratio (OR) = 1.67 and OR= 2.95, respectively), depressive symptoms (OR = 1.08 and OR = 1.12, respectively), perceive themselves as overweight (OR = 2.57) or obese (OR = 5.30), and a lower weight-specific quality of life (OR = 0.97 and OR = 0.95, respectively) than healthy-weight youth. Obese youth have lower healthy lifestyle priorities (OR = 0.75) and are less likely to be physically active (OR = 0.79) and eat breakfast (OR = 0.47) than healthy-weight youth. Additionally, overweight and obese youth are more likely to engage in weight control behaviors (OR = 5.19 and OR = 8.88, respectively) and restrained eating than healthy-weight youth. All the aforementioned results had a p-value of

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

OBJECTIVE:To estimate the burden of genital warts (GW)in Mexico. MATERIALS AND METHODS:We estimated the annual incidence of GW based on data reported by specialist physicians. We also assessed GW treatment practices, the average cost of treatment, and the psychosocial burden of GW among patients. RESULTS:The annual incidence of GW in Mexico was estimated to be 547 200 cases. Treatment procedures vary by specialist and patient gender. The estimated annual cost was $195 million USD. The psychosocial impact of GW was slightly greater in males than females. CONCLUSIONS:This is the first evaluation of the burden of GW in Mexico. Our data suggest that GW are common, with significant health-related costs and psychosocial impact.

AimTo compare the prevalence of chronic liver disease (CLD) risk factors in a representative sample of Mexican-Americans born in the United States (US) or Mexico, to a sample of adults in Mexico.MethodsData for Mexican-Americans in the US were obtained from the 1999-2014 National Health and Nutrition Examination Survey (NHANES), which includes persons of Mexican origin living in the US (n = 4274). The NHANES sample was restricted to Mexican-American participants who were 20 years and older, born in the US or Mexico, not pregnant or breastfeeding, and with medical insurance. The data in Mexico were obtained from the 2004-2013 Health Worker Cohort Study in Cuernavaca, Mexico (n = 9485). The following known risk factors for liver disease/cancer were evaluated: elevated aminotransferase levels (elevated alanine aminotransferase was defined as > 40 IU/L for males and females; elevated aspartate aminotransferase was defined as > 40 IU/L for males and females), infection with hepatitis B or hepatitis C, metabolic syndrome, high total cholesterol, diabetes, obesity, abdominal obesity, and heavy alcohol use. The main independent variables for this study classified individuals by country of residence (i.e., Mexico vs the US) and place of birth (i.e., US-born vs Mexico-born). Regression analyses were used to investigate CLD risk factors.ResultsAfter adjusting for socio-demographic characteristics, Mexican-American males were more likely to be obese, diabetic, heavy/binge drinkers or have abdominal obesity than males in Mexico. The adjusted multivariate results for females also indicate that Mexican-American females were significantly more likely to be obese, diabetic, be heavy/binge drinkers or have abdominal obesity than Mexican females. The prevalence ratios and prevalence differences mirror the multivariate analysis findings for the aforementioned risk factors, showing a greater risk among US-born as compared to Mexico-born Mexican-Americans.ConclusionIn this study, Mexican-Americans in the US had more risk factors for CLD than their counterparts in Mexico. These findings can be used to design and implement more effective health promotion policies and programs to address the specific factors that put Mexicans at higher risk of developing CLD in both countries.

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

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

Background: Hypertension and type 2 diabetes (T2D) are the most prevalent noncommunicable diseases in Mexico and worldwide. According to international practice management guidelines, the principal chronic management therapy is daily oral medication., Aim: We aim to describe the trends of antihypertensive, antidiabetic, and nonsteroidal anti-inflammatory (NSAID) drugs use among the Mexican adult population from 2004-2018., Methods: We analyzed data from the Health Workers Cohort Study (HWCS) for males and females aged >18 years. We calculated the prevalence of chronic diseases and utilization for every kind of antihypertensive, antidiabetic, and NSAIDs (measured by self-reported utilization) at baseline and two follow-ups (2004, 2010, and 2017). Trends were analyzed using Fisher's exact test., Results: Hypertension prevalence increased from 19.8 to 30.3%, higher than T2D prevalence from 7.0 to 12.8% through fourteen years of follow-up. Like the self-reported dual therapy, the proportion of patients using beta-blockers and angiotensin II receptor blockers increased. Regarding T2D, the prevalence of metformin utilization increased to 83.9%. The utilization of common NSAIDs, mainly for muscular pain, remained around 13 to 16%., Conclusions: Our findings showed a changing prevalence of drug utilization for hypertension and T2D between 2004 and 2018 and consistent use of NSAIDs in the adult Mexican population., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Janinne Ortega-Montiel et al.)

Objective: This study aimed to explore whether African American/Black and Hispanic/Latino adolescents are being asked about electronic cigarette (e-cigarette) use (vaping) and advised not to use them., Methods: In 2021, adolescents ( N = 362) with no vaping history, self-identified as African American/Black and/or Hispanic/Latino, and able to read and speak English and/or Spanish were recruited through partner schools and community-based organizations. Participants completed a survey reporting sociodemographic characteristics (e.g., race/ethnicity, gender, and language of preference) and they were asked about e-cigarette use and/or were advised not to use them by a health professional., Results: In total, 12% of African American/Black and 5% of Hispanic/Latino participants reported not seeing a health professional in the year prior to enrollment. Of the participants who reported visiting a health professional, 50.8% reported being asked and advised about vaping. Over one-quarter (28.4%) of participants were neither asked nor advised regarding vaping. Compared to English-speaking participants, Spanish-speaking participants were significantly less likely to be asked about e-cigarette use (45.2 vs. 63.9%, p = 0.009) and advised not to use them (40.3 vs. 66.9%, p < 0.001). Moreover, compared to African American/Black participants, Hispanic/Latino participants were significantly less likely to be advised not to use e-cigarettes (52.9 vs. 68.6%, p = 0.018). Furthermore, compared to male participants, female participants were significantly less likely to be advised not to use e-cigarettes (51.3 vs. 68.2%, p = 0.003)., Conclusion: Compared to English-speaking participants, Spanish-speaking participants were significantly less likely to self-report being asked about e-cigarette use and advised not to use them. Moreover, Hispanic/Latino and female adolescents were significantly less likely to self-report being advised not to use e-cigarettes compared to their Black/African American and male counterparts. Future research is needed to improve health professional attention toward asking about and advising against vaping among adolescents., 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 © 2023 Connolly, Croft, Ramírez-Palacios, Cai, Hill, Orfin, Rivera, Wilson, Li, McIntosh, Ossip, Cupertino and Cartujano-Barrera.)

We developed a Sustainable Dietary Score (SDS) based on the EAT-Lancet commission's recommendations and evaluated its adherence in a sample of Mexican adults. We used data on 1908 men and women aged 19 to 59 participating in the Health Workers Cohort Study in 2004. Fourteen of the healthy reference diet components were used to develop the SDS. We computed an individual SDS for each food component with scales from 0 (non-adherence) to 10 (perfect adherence), as well as a total SDS including all components, ranging from 0 to 140, based on a food frequency questionnaire. Our score incorporates characteristics of the context in which the score is applied, such as the high consumption of tortillas and eggs, and cut-off points that consider the nutrient deficiencies that prevail in the Mexican population. We propose a practical methodology to estimate a SDS incorporating a gradual score for a better distinction between the degrees of adherence to the reference diet proposed by the EAT-Lancet Commission.

The objective of this study was to evaluate the effectiveness of digital and traditional methods and strategies in the recruitment of Mexican individuals who smoke into a cessation study. Recruitment method refers in general to either digital or traditional recruitment. Recruitment strategies refer to the particular recruitment type utilized within each recruitment method. Traditional recruitment strategies included radio interviews, word of mouth, newspaper advertisement, posters/banners placed in primary healthcare clinics, and medical referrals. Digital recruitment strategies involved emails and study advertisements through social media (i.e., Facebook, Instagram and Twitter) and website. In a 4-month period, 100 Mexican individuals who smoke were successfully enrolled into a smoking cessation study. The majority of participants were enrolled via traditional recruitment strategies (86%) compared to the digital recruitment strategies (14%). Individuals screened in the digital method were more likely to be eligible to participate in the study, compared to the traditional method. Similarly, in comparison to the traditional method, individuals in the digital method were more likely to enroll in the study. However, these differences were not statistically significant. Both traditional and digital strategies made important contributions to the overall recruitment effort., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: The goal of this study was to determine whether the detection of histologically confirmed cases of cervical high-grade squamous intraepithelial lesions or worse (HSIL+) can be increased by having each liquid-based cytology (LBC) slide read by 2 cytotechnologists as part of routine screening., Methods: Over 36,212 women aged 30 to 64 years participated in the Forwarding Research for Improved Detection and Access for Cervical Cancer Screening and Triage (FRIDA) Study in Mexico between 2013 and 2016. For each participant, 2 cervical samples were collected at the same clinic visit, one to test for high-risk human papillomavirus (hrHPV) and the other for LBC, which was used to triage those with a hrHPV positive result. LBC slides were evaluated by 7 cytotechnologists, with each slide read independently by 2 blinded cytotechnologists. All women with atypical cells of undetermined significance or a worse result were referred to colposcopy for further evaluation and diagnosis. Three pathologists evaluated the biopsy specimens to confirm the final HSIL+ diagnosis. The HSIL+ detection rates for the single versus double reading were estimated and compared., Results: A total of 3,914 women with a positive hrHPV result were triaged with LBC. The first and second cytology readings resulted in 43 HSIL+ cases detected; the double-reading strategy detected 9 additional HSIL+ cases, resulting in a total of 52 HSIL+ cases. The HSIL+ detection rate increased from 10.99/1000 with a single reading to 13.29/1000 with the double-reading strategy (P = .004)., Conclusion: A 20.9% increase in HSIL+ cases detected was achieved with a double reading of the LBC slides in this sample of hrHPV-positive women., (© 2020 American Cancer Society.)

Objective: Our aim was to examine prospectively predictors of subclinical renal alterations among adults without chronic kidney disease., Materials and Methods: We analyzed data from a cohort of Mexican adults (n=757). Kidney function (2010) was assessed with the estimated glomerular filtration rate (eGFR-Cr), serum creatinine and uric acid. Predictors of each kidney function marker (2004) were identified with linear and logistic regression models., Results: 33% had an eGFR-Cr 40 years old and users of antihypertensive medication; and higher among those with a high protein intake. Serum creatinine predictors were similar to those observed for eGFR-Cr. Uric acid decreased in men, among those with obesity, hypertension and high cholesterol., Conclusions: Conventional kidney function biomarkers are useful to identify subclinical alterations. Some predictors of kidney function are potentially modifiable, therefore susceptible for intervention among high-risk groups., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

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

Osteoporosis is a metabolic bone disorder characterized by low bone mineral density and decreased bone strength, leading to an increased risk of fractures with a consequent increase in morbidity and mortality. The current methods to estimate the fracture risk are very limited. microRNAs (miRNAs) have been considered as good biomarkers for many pathological processes, including osteoporosis. Some circulating miRNAs are associated with regulation of bone formation and differentiation of bone cells. The aim of this study, was to analyze the expression of miRNAs in serum of patients with osteoporosis (n = 20) and healthy controls (n = 20). Expression of 754 miRNAs was analyzed through quantitative real time RT-PCR arrays. Seven miRNAs showed significant differences between groups. The microRNAs miR-23b-3p, miR-140-3p and miR-885-5p were selected based on fold change and p-values (40.5, p = 0.038, 20.7, p = 0.045, and 2.2, p = 0.002; respectively) for validation in independent serum samples from patients with osteopenia (n = 28), osteoporosis (n = 26) and osteoporotic hip fracture (n = 21). After validation, we confirm differences across the groups for miR-23b-3p and miR-140-3p. Our data pointed miR-140-3p and miR-23b-3p as potential biomarkers candidates for osteoporosis in postmenopausal women., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: In Mexico, 40% of hypertensive patients see their blood pressure under control. The evidence to keep hypertension (HT) under control is scarce, particularly in older adults who have the highest prevalence and require more health services. The objective was to determine the impact of a double intervention to increase the percentage of hypertensive patients with blood pressure levels under control and estimate differences among adults and older adults., Methods: Quasi-experimental design including reorganization and training to physicians using clinical guidelines in four primary healthcare units at the Instituto Mexicano del Seguro Social (IMSS). We included adults who participated whether in the intervention group (IG) or in the control group without equivalence (CGNE). We used regression models for longitudinal data for systolic pressure (SP) and diastolic pressure (DP) variables and proportion of patients with hypertension under control., Results: 530 participants, 272 in the IG; 57.5% were ≥ 60 years. In the IG decreased the SP, β= −5.93 (95%CI −9.59, −2.28) and increased the proportion with blood pressure under control in young adults (OR 1.48, 95%CI 1.02, 2.14). In the elderly the intervention decreased the DP among those with HT and other comorbidities, β= −3.57(95%CI −6.72, −0.41), p < 0.05., Conclusion: The interventions reduced SP among adults and DP among older adults with hypertension and other comorbidities. Actions of secondary prevention addressed to each group of age are needed to achieve the control of hypertension at IMSS.