Health In Mexico Research Articles

How does urbanization affect perceptions and traditional knowledge of medicinal plants?

BackgroundThe use and knowledge of medicinal plants play an essential role in community health in rural Mexico. Medicinal plants are part of the local heritage and provide a source of economic income. Nevertheless, knowledge of their use has declined due to factors like accelerated urbanization. Some authors have proposed that by reducing natural spaces, urbanization generates changes that impact the recognition, use, and management of natural resources. Here, we evaluate how urbanization affects the knowledge, use, and perception of medicinal plants in a Biosphere Reserve in Mexico.MethodsUsing a mixed methodology including quantitative and qualitative analyses, we generated a list of medicinal plants, methods of preparation, prevalence of illness, and use in two communities with different degrees of urbanization.ResultsA total of 217 medicinal plants were identified. The more urbanized community had greater knowledge of, and used, a larger number of introduced plant species, while the less urbanized community used and had more knowledge about wild plants. One of the factors explaining these differences was occupation, with people who work outdoors showing greater knowledge of wild plants.ConclusionsUrbanization can lead to a loss of knowledge of the use and management of local wild species, with implications for the conservation of biocultural heritage. Substitution of native medicinal plants by introduced species shows disinterest and disuse in the local medicinal flora, which could be reflected in their ecosystems.

Universities and programs promoting health in Mexico

Introduction: Universities are the ideal place to promote health because it offers facilities to provide comprehensive care as marked by the World Health Organization (1986) in the Ottawa Charter for health promotion. This is how this work seeks to describe the health promotion programs of universities in Mexico to generate relevant information on this particular topic. Objective: To describe the health promotion programs of higher education institutions in Mexico. Methodology: The review was carried out in PUBMED, CROSSREF, LILACS, SCIELO and government institutions indexing sources. For the selection of articles, it was considered to analyze government pages such as RMUPS and public and private universities due to lack of information. The review criteria that were taken into account were the objective, areas of attention, type of user, level of prevention and finally operation of the health promotion programs of the universities. Results: Of the programs of institutions of higher education reviewed it was found that they have similarities regarding their objectives where the majority promote the adoption of healthy lifestyles, in addition to the fact that a wide group of services such as medical care, nutritional care, and psychological care as the main, the operation of the program is diverse and 100% manage a level of primary prevention. Conclusions: There is a clear and direct interests by the authorities of the different universities in Mexico, there are currently 43 institutions that make up the RMUPS.

Abstract 47: Survival of Breast Cancer in Women Treated Under Mexico's Seguro Popular

Abstract Purpose: To determine 5-year survival for breast cancer among uninsured women treated under Mexico's Seguro Popular landmark health reform according to clinical stage and identify factors associated to survival. Methods: We conducted a retrospective cohort study with data obtained from national reimbursement claims of patients treated under Seguro Popular from January 2007 to December 2016. Reimbursement data was cross-linked with a national mortality registry. We used the Kaplan-Meier method to estimate overall survival according to different variables and stratified them by clinical stage as early (I-IIA), locally advanced (IIB-IIIC), and metastatic (IV). We explored the relation between age, hospital patient volume, hospital infrastructure, and mortality. Hazard ratios and 95% confidence intervals (95%CI) were estimated, using the Cox proportional hazards model to adjust for clinical stage. Results: A total of 57,175 patients with breast cancer were analyzed. The mean age was 43.4 (SD 12.4). Most patients had locally advanced disease at diagnosis (55.1%, n=31,559) and 9.5% (n=5,435) had metastatic disease. The distribution of clinical stage did not appear to change over time (11% in 2007 vs. 13% in 2015 for metastatic disease). Five-year survival was 88.9% (CI95% 88.3-89.5) for early-stage disease, 69.6% (CI95% 69-70.2) for locally advanced cancer, and 36.9% (CI95% 35.4-38.5) for metastatic disease. These survival estimates did not change over time. After adjustment for clinical stage, age <40 years old (HR 1.17 [CI95% 1.12-1.23]), low hospital patient volume (≤248 patients/year, HR 1.21 [CI95% 1.17-1.25]), and treatment at a locally funded hospital (HR 1.15 [CI95% 1.11-1.2]) were associated with higher mortality. Conclusions: While Seguro Popular provided access to treatment for breast cancer, a high proportion of women were treated at advanced stages and clinical stage at diagnosis and survival did not appear to change over a decade. Future programs should prioritize early detection and strengthen quality of care. Citation Format: Antonio Bandala-Jacques, Rodrigo Huerta-Gutierrez, Salvador Zamora-Muñoz, Paula Cabrera, Alejandro Mohar, Martin Lajous. Survival of Breast Cancer in Women Treated Under Mexico's Seguro Popular [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 47.

Abstract LB081: Systemic inflammation is associated with increased risk of mortality after invasive breast cancer among Hispanic women from New Mexico

Abstract Introduction: Soluble tumor necrosis factor receptor-II (sTNF-R2), a circulating pro-inflammatory biomarker, has been found to associated with obesity and increased risk of breast cancer. No studies to date have examined the association between sTNF-R2 and risk of mortality among Hispanic breast cancer survivors, an at-risk population due to their high prevalence of obesity and poor prognosis. The current study examined the long-term effects of sTNF-R2 on risk of mortality among Hispanic and non-Hispanic white (NHW) breast cancer survivors from the New Mexico Health Eating Activity and Lifestyle Study. Methods: A total of 397 invasive breast cancer survivors (96 Hispanic, 301 NHW) contributed data for the present study. Women with breast cancer diagnosed between July 1996 and March 1999 were ascertained through the National Cancer Institute's Surveillance Epidemiology and End Results registry in New Mexico. Baseline demographic characteristics, anthropometric measures, and blood samples were collected approximately 5 months post diagnosis by trained interviewers. Plasma levels of sTNF-R2 were assayed and measures were log-transformed to conform to normality. The main predictor of low (referent) vs high sTNF-R2 levels was based on the median value. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the associations between sTNF-R2 and all-cause mortality were calculated using Cox proportional hazards regression models overall and by ethnicity. Models were adjusted for age at diagnosis, education, breast cancer stage, treatment, and body mass index (BMI). Results: A total of 133 deaths (53 breast cancer-specific deaths) were observed after a median follow-up time of 13 years. While Hispanic women had higher baseline BMI (mean= 27.21, standard deviation (SD)= 5.83) compared to NHW women (mean= 25.68, SD= 5.36) (p< 0.001), significant differences by ethnicity for sTNF-R2 levels were not observed. In models adjusted for ethnicity and other covariates, the association between high vs low levels of plasma sTNF-R2 and risk of mortality was not statistically significant among all women (HR, 1.36; 95% CI 0.90-2.03). However, in models stratified by ethnicity, Hispanic women had increased risk of mortality of almost 3-fold (HR, 2.83; 95% CI 1.21-6.63), while the association among NHW women was attenuated and was not statistically significant (HR, 0.99; 95% CI 0.61-1.61). The statistical interaction between sTNF-R2 and ethnicity with risk of mortality was not statistically significant (p= 0.10). Conclusion: Our study results suggest Hispanic breast cancer survivors with high levels of systemic inflammation measured by sTNF-R2 are at increased risk of mortality. These results could inform targeted intervention studies to decrease inflammation and reduce risk of mortality among this at-risk population. Citation Format: Avonne E. Connor, Stephanie D. Boone, Kathy B. Baumgartner, Richard N. Baumgartner. Systemic inflammation is associated with increased risk of mortality after invasive breast cancer among Hispanic women from New Mexico [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB081.

Comparative analysis of the legal framework on mental health and suicide in Mexico

Analyze the legislative and normative framework on mental health and suicide in Mexico. A secondary analysis of the main legal systems on mental health and suicide, in force until September 2020, of the 32 entities in Mexico and at the federal level was carried out. 51 documents were analyzed. Only 14 states have a mental health law and two states have a law on suicide. At the federal level, the guidelines for the care of suicidal behavior are defined in the technical standards issued by the Health Ministry. However, in both state and national health laws, there have been omissions in this regard. Prevention is not defined in depth in most of the documents analyzed. It is a priority to promote comprehensive laws on mental health and suicidal behavior harmonized at the national level.

Micronutrient Status and Child Growth in Mexico: Results From the 2018 National Health and Nutrition Survey (ENSANUT)

ObjectivesTo examine the associations between micronutrient status and child growth, as part of the National Health and Nutrition Survey in Mexico. MethodsData from the National Health and Nutrition Survey (ENSANUT 2018) were analyzed to examine the association between micronutrient status and child growth in 1,656 children 36 to 59 months of age. Micronutrient biomarkers (serum ferritin (SF), vitamin B12, vitamin D, serum zinc) were measured in venous blood samples via immunoassays. Child weight and height were measured using standardized procedures, and indicators weight-for-age (WAZ), height-for-age (HAZ), weight-for-height (WHZ), and body mass index (BMI) Z-scores were calculated using the WHO Anthro V3.1 and categorized as per WHO Child Growth Standards. Micronutrient biomarkers were natural logarithmically transformed prior to analyses. Iron deficiency was defined as SF < 12.0 μg/L and iron insufficiency was defined as SF < 20.0 μg/L. Vitamin B12 deficiency and insufficiency were defined as < 148 and < 221 pmol/L, respectively. Vitamin D deficiency was defined as < 50 nmol/L, and zinc deficiency was defined as < 65μg/dL. Survey linear regression models were used to examine associations of micronutrient status with WHO Z-scores. ResultsSerum ferritin concentrations (β [SE]: 0.096 [0.001], p < 0.0001) and vitamin B12 (0.092 [0.003], p < 0.0001) concentrations were associated with higher WHZ. Vitamin B12 (0.171 [0.004], p < 0.0001), vitamin D (0.358 [0.007], p < 0.0001), and zinc (0.122 [0.006], p < 0.0001) concentrations were associated with higher HAZ. Iron deficiency (β [SE]: -0.469 [0.004], p < 0.0001) and zinc deficiency (-0.203 [0.01], p < 0.0001) were associated with lower WHZ, and vitamin B12 (-0.449 [0.002], p < 0.0001), vitamin D (-0.215 [0.001], p < 0.0001) and zinc (-0.216 [0.01], p < 0.0001) deficiencies were associated with lower HAZ. ConclusionsMicronutrient deficiencies of vitamin B12, vitamin D, and zinc were associated with lower linear growth in young children in Mexico. Funding SourcesENSANUT was funded by The Ministry of Health of Mexico.

Financialization of the pharmaceutical industry and its impact on urban peripheries in the Metropolitan area of the Valley of Mexico

The process of financialization is present in the health sector, particularly in the case of large pharmaceutical companies. In the case of Mexico, there has been an expansion of pharmacies with medical offices as a result of capital flows, but also due to the absence of a quality public health system. This paper analyzes how the contemporary processes of pharmaceutical company financialization have allowed the expansion of the medical office-based pharmacy scheme and, to a certain extent, the “substitution” of health services managed by public authorities in the urban peripheries of the Metropolitan Zone of the Valley of Mexico. Based on information from Farmacias Benavides and Farmacias Guadalajara, issued by the Mexican Stock Exchange, on several indicators on health and pharmacies in Mexico, as well as semi-structured interviews with residents of the metropolitan periphery, it is argued that the exponential growth of pharmacies in the last two decades is linked to the policy of expansion and construction of social housing. These housing projects, largely due to weak regulatory controls, do not develop an adequate health infrastructure both in qualitative and quantitative terms, thus favoring the opening of financial instruments that have allowed large pharmaceutical companies to expand in recent decades.

Visualizing complex healthcare disparities: proof of concept for representing a cyclical continuum of care model for a retrospective cohort of patients with musculoskeletal infections

BackgroundCare continuum models (also known as care cascade models) are used by researchers and health system planners to identify potential gaps or disparities in healthcare, but these models have limited applications to complex or chronic clinical conditions. Cyclical continuum models that integrate more complex clinical information and that are displayed using circular data visualization tools may help to overcome these limitations. We performed proof-of-concept cyclical continuum modeling for one such group of conditions—musculoskeletal infections—and assessed for racial and ethnic disparities across the complex care process related to these infections.MethodsCyclical continuum modeling was performed in a diverse, retrospective cohort of 1648 patients with musculoskeletal infections, including osteomyelitis, septic arthritis, and/or infectious myositis, in the University of New Mexico Health System. Logistic regression was used to estimate the relative odds of each element or outcome of care in the continuum. Results were visualized using circularized, map-like images depicting the continuum of care.ResultsRacial and ethnic disparities differed at various phases in the care process. Hispanic/Latinx patients had evidence of healthcare disparities across the continuum, including diabetes mellitus [odds ratio (OR) 2.04, 95% confidence interval (CI): 1.61, 2.60 compared to a white non-Hispanic reference category]; osteomyelitis (OR 1.28, 95% CI: 1.01, 1.63); and amputation (OR 1.48; 95% CI: 1.10, 2.00). Native American patients had evidence of disparities early in the continuum (diabetes mellitus OR 3.59, 95% CI: 2.63, 4.89; peripheral vascular disease OR 2.50; 95% CI: 1.45, 4.30; osteomyelitis OR 1.43; 95% CI: 1.05, 1.95) yet lower odds of later-stage complications (amputation OR 1.02; 95% CI: 0.69, 1.52). African American/Black non-Hispanic patients had higher odds of primary risk factors (diabetes mellitus OR 2.70; 95% CI: 1.41, 5.19; peripheral vascular disease OR 4.96; 95% CI: 2.06, 11.94) and later-stage outcomes (amputation OR 2.74; 95% CI: 1.38, 5.45) but not intervening, secondary risk factors (osteomyelitis OR 0.79; 95% CI: 0.42, 1.48).ConclusionsBy identifying different structural and clinical barriers to care that may be experienced by groups of patients interacting with the healthcare system, cyclical continuum modeling may be useful for the study of healthcare disparities.

Multidimensional analysis of health in Mexico: implementation of fuzzy sets

BackgroundThe national health and nutrition survey allows to know the state of health of the Mexican population, it provides data for the analysis of different factors and / or indicators of health, diseases and nutritional conditions, such as chronic degenerative diseases and depressive symptoms, which, in turn, if both occur simultaneously, they will have a negative impact on health. This article studies the four factors involved in the overall health of the population in Mexico: excess weight, diabetes, high blood pressure, and depressive symptoms, which are used to conduct a multidimensional characterization and analysis.MethodsTwo methodological resources are applied, a descriptive statistical characterization and the construction of a multidimensional health index with the use of fuzzy sets, through the National Health and Nutrition Survey (ENSANUT 2018–19 - for its acronym in Spanish) in Mexico.ResultsThe results reveal a growing percentage of individuals who experience detriments to their health, that is, the factors being studied have had a negative impact and tend to follow international projections. The construction of a multidimensional index enables the interaction between the factors being studied, thus allowing for an adequate modeling for the identification of health in Mexico.ConclusionThis study aims to elucidate the current state of health throughout the population in Mexico by using the most current data provided by the autonomous public body of statistics and geography to build a multidimensional panorama using four elementary public health indicators (diabetes, obesity, high blood pressure, and depressive symptoms).

Prevención de CLABSI por el uso de tapón desinfectante 3M Curos®: metanálisis y evaluación económica

Background. Healthcare-associated infections are a relevant health-public issue because of their economic and social impact; thus, they represent a challenge for the health institutions and the personnel in charge of fighting the infections. Particularly, central venous catheter-associated infections require a long-period administration of antibiotics, which increases the catheter blockade. That may derive in replacing the catheter, more extended hospital stays, and a higher sepsis risk. Objective. To analyze the efficacy of the disinfectant cap (3M Curos®), compared to the traditional disinfection method of the needle-free connectors, catheters or disinfectant ports. Material and Methods. A systematic review, meta-analysis, and cost-effectiveness study were performed to determine the effectiveness of the disinfectant cap in order to define the efficiency compared to the traditional disinfection method. Univariate, multivariate, and probabilistic sensitivity analyses were performed to reduce uncertainty. Results. The disinfectant cap had an infection ratio of 1.54 infections per 1,000 catheters / day vs. traditional desinfection methods, which had a ratio of 4.84 infections per 1,000 catheters / day. Those results led to find a cost difference of $21,819.39 USD for 3M Curos® and $67,165.26 USD for traditional methods. Conclusions. The disinfectant cap proves to be a more efficient alternative for pediatric health in Mexico.

Taxes to Unhealthy Food and Beverages and Oral Health in Mexico: An Observational Study

In January 2014, taxes on sugar-sweetened beverages and nonessential energy-dense food were implemented in Mexico to discourage the consumption of these products. Published evaluations have shown reductions in purchases of taxed food and beverages associated with the implementation of this fiscal policy. Although there are some studies on the impact on health based on simulation studies, no evaluations with empirical data on changes in oral health have been published. We used administrative records and data from an epidemiological surveillance system to estimate changes in (1) outpatient visits related to dental caries; (2) having experienced dental caries: Decayed, Missing and Filled Teeth (DMFT) >0 for permanent dentition or dmft >0 for primary dentition (dmft); (3) number of teeth with caries experience (DMFT and dmft), (4) cases with DMFT >0 or dmft >0, and (5) the series of mean DMFT or dmft, associated with the taxes. We estimated probit and negative binomial models for outcomes at individual level, and interrupted time series analysis for population-level outcomes. The implementation of the taxes was associated with negative changes in the trends of outpatient visits, as well as for cases with DMFT >0, dmft >0 and mean DMFT. Taxes were also associated with a lower probability of having experienced dental caries and with a lower number of teeth with caries experience in the samples studied. Our results suggest positive impacts of the implementation of taxes on unhealthy food and beverages in the oral health of Mexicans, which are the first health benefits observed, and add to the health benefits predicted by modeling studies.

Older adults at risk of Covid-19 and their socioeconomic ans family vulnerabilities: an analysis with MHAS

The objective of this manuscript is to analyze the socioeconomic and family characteristics of 50 years and older population who are at high risk of testing positive for Covid-19, being hospitalized or intubated in Mexico. We used two sources of information, the database of the Ministry of Health on Covid-19 and the Mexican Health and Aging Study in Mexico, in the first, regression models are estimated to calculate the risk and they are applied in the second to analyze socioeconomic and family vulnerabilities. Results show that gender and age are strong predictors of high risk. Those with less schooling, those who work without having a place, those who perceive their economic situation as fair or bad, as well as those who live in single-person households, receive financial and non-financial help from their children are presented as a highly vulnerable group to Covid-19 and its repercussions. It is necessary to develop strategies and support aimed to minimize the impacts of events such as the pandemic, ensure access to quality and timely health services, an economic income in accordance with the needs, and maintaining the standards of well-being of older adults.

The Permeating Effects of Violence on Health Services and Health in Mexico.

Mexico's violence related to organized crime activity has grown to epidemic levels in the last 12 years. We interviewed 22 Mexican health care providers from five states to examine how violence impacts health care services and health. We transcribed and analyzed semi-structured interviews using framework analysis. Our findings describe the ways in which community violence in Mexico permeates health care services, impacting health care providers, and the health of patients. We developed a model to reflect our main themes that illustrate how violence permeates health care services over geographic space and time. We identified three thematic categories: (a) the impact of violence on health care facilities and service provision, (b) the impact of violence on providers, and (c) the impact of violence on the health of the community. Our model articulates a dynamic process of the spread and permeation of violence. Prior literature focuses on the impact of violence as an occupational hazard and the effect of war or civil conflict on health care services. We extend this literature by documenting the impacts of widespread violence on Mexican health care services and providers. We discuss how violence impacts services, providers, and health in a country that is not officially at war. We compare our findings to previous literature on occupational violence in health professions and the impacts on health services in official war zones. Finally, we highlight the implications for health care practice and policy. We suggest that violence should be considered throughout the care continuum in Mexico and make the case for violence as a structural contributor to health and health disparities in Mexico. We suggest additional research on this under-investigated topic.

Offspring Educational Attainment and Older Parents' Cognition in Mexico.

Population-level disparities in later-life cognitive health point to the importance of family resources. Although the bulk of prior work establishes the directional flow of resources from parents to offspring, the "linked lives" perspective raises the question of how offspring resources could affect parental health as well. This paper examines whether adult children's education influences older parents' (aged 50+) cognitive health in Mexico, where schooling reforms have contributed to significant gains in the educational achievements of recent birth cohorts. Harnessing a change in compulsory school laws and applying an instrumental variables approach, we found that each year of offspring schooling was associated with higher overall cognition among parents, but was less predictive across different cognitive functioning domains. More offspring schooling improved parents' cognitive abilities in verbal learning, verbal fluency, and orientation, but not in visual scanning, visuo-spatial ability, or visual memory. The beneficial effects of offspring schooling on those cognitive domains are more salient for mothers compared to fathers, suggesting potential gendered effects in the influence of offspring schooling. The results remained robust to controls for parent-child contact and geographic proximity, suggesting other avenues through which offspring education could affect parental health and a pathway for future research. Our findings contribute to growing research which stresses the causal influence of familial educational attainment on population health.

Seroprevalencia de Mycobacterium avium subespecie paratuberculosis en bovinos sospechosos sacrificados en rastro de Sonora, México

Paratuberculosis is an infectious-contagious disease caused by the bacterium Mycobacterium avium subspecie paratuberculosis (MAP), which affects the digestive tract of ruminants. MAP is distributed worldwide; however, there are no publications on the seroprevalence of this disease in cattle in the state of Sonora. Therefore, the objective of this study was to detect MAP seropositivity in cattle in Sonora, as well as to know its apparent prevalence in a population of adult cattle with emaciation and cachexia. Three hundred and eighty-five serum samples were analyzed from 370 female and 15 male cattle, older than 3 years, born in the state with signs of emaciation and cachexia. Data were collected on age, breed, zootechnical purpose and municipality of origin. The zootechnical purpose of the animals was mostly dual purpose cattle with 84.93% (370/385). The samples were processed using the commercial ELISA test. The results show an apparent seroprevalence of 2.08% (8/385) and the municipalities that presented seropositive animals were Hermosillo with 3 samples, as well as Guaymas, Huachinera, Ures, Villa Pesqueira and Fronteras, with one sample each. The present study demonstrates for the first time seropositivity to Mycobacterium avium subspecies paratuberculosis in cattle in Sonora. In addition to a low apparent seroprevalence in the cattle population sampled. The presence of MAP in Sonora, which could be considered a neglected disease, highlights the need to know its possible role in public health in Mexico.

North-South Displacement Effects of Environmental Regulation: The Case of Battery Recycling

This study examines the effect of a tightening of the U.S. air-quality standard for lead in 2009 on the relocation of battery recycling to Mexico and on infant health in Mexico. In the U.S., airborne lead dropped sharply near affected plants, most of which were battery-recycling plants. Exports of used batteries to Mexico rose markedly. In Mexico, production increased at battery-recycling plants, relative to comparable industries, and birth outcomes deteriorated within two miles of those plants, relative to areas slightly farther away. The case provides a salient example of a pollution-haven effect between a developed and a developing country.

Lifetime poly-victimization and psychopathological symptoms in Mexican adolescents

BackgroundThere is a lack of research on the impact of poly-victimization on mental health in Mexico. ObjectiveThe purpose of this study was to analyze the relationship between poly-victimization and both internalizing and externalizing symptoms, in a community sample of Mexican adolescents. The starting hypothesis of this study was that poly-victimization would be a better predictor of internalizing and externalizing symptoms than individual categories of victimization (conventional crimes, caregiver victimization, peer and sibling victimization, sexual victimization, witnessing victimization, and electronic victimization). Participants and settingsThe sample comprised 1068 adolescents from public schools in Morelia city (Western Mexico). Adolescents completed the Mexican version of the Juvenile Victimization Questionnaire and the Latin version of the Youth Self Report. MethodsHierarchical regression analyses were conducted to determine the contributions of victimization and poly-victimization in predicting internalizing and externalizing symptomatology. ResultsPoly-victimization accounted for more variability in scores of externalizing and internalizing symptoms than a single type of victimization. Even when poly-victimization was considered, conventional crimes contributed to predicting both internalizing and externalizing symptoms, caregiver victimization was a predictor of internalizing symptoms and witnessing victimization was a protective factor for internalizing symptoms and total problems. ConclusionsThis is the first study in Mexico analyzing the psychological impact of poly-victimization. Our results should be taken into consideration by clinicians and those who design public policies. Conventional crimes need to be specifically addressed when assessing Mexican adolescents.

Abortion laws and women’s health

We examine the impact of progressive and regressive abortion legislation on women's health in Mexico. Following a 2007 reform in the Federal District of Mexico which decriminalised and subsidised early-term elective abortion, multiple other Mexican states increased sanctions on illegal abortion. We observe that the original legalisation resulted in a sharp decline in maternal morbidity, particularly morbidity due to haemorrhage early in pregnancy. We observe small or null impacts on women's health from increasing sanctions on illegal abortion. These results quantify the considerable improvements in non-mortal health outcomes flowing from legal access to abortion.

Impact Evaluation of VKN-NIMHANS-ECHO Model of Capacity Building for Mental Health and Addiction: Methodology of Two Randomized Controlled Trials.

Background:Bridging the alarming treatment gap for mental disorders in India requires a monumental effort from all stakeholders. Harnessing digital technology is one of the potential ways to leapfrog many known barriers for capacity building.Aim and Context:The ongoing Virtual Knowledge Network (VKN)–National Institute of Mental Health and Neurosciences (NIMHANS)–Extension of Community Health Outcomes (ECHO) (VKN–NIMHANS–ECHO: hub and spokes model) model for skilled capacity building is a collaborative effort between NIMHANS and the University of New Mexico Health Sciences Centre, USA. This article aims to summarize the methodology of two randomized controlled trials funded by the Indian Council of Medical Research (ICMR) designed to evaluate the effectiveness of the VKN–NIMHANS–ECHO model of training as compared to training as usual (TAU).Methods:Both RCTs were conducted in Karnataka, a southern Indian state in which the DMHP operates in all districts. We compared the impact of the following two models of capacity building for the DMHP workforce (a) the VKN–NIMHANS–ECHO model and (b) the traditional method. We use the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement to describe the methods of these two trials.Trial 1 is to evaluate the “Effectiveness of addition of Virtual-NIMHANS–ECHO tele-mentoring model for skilled capacity building in providing quality care in alcohol use disorders by the existing staff of DMHP districts of Karnataka.” Hub for trial 1 was set up at NIMHANS and the spokes were psychiatrists and other mental health professionals headquartered in the district level office. Trial 2 assesses the implementation and evaluation of the NIMHANS–ECHO blended training program for the DMHP workforce in a rural south-Indian district of Karnataka state. The hub for trial 2 was set up in the district headquarter of Ramanagaram. Hub specialists are DMHP psychiatrists, whereas spokes are the non-doctor workforce (including auxiliary nurse midwives [ANMs] and accredited social health activists [ASHA] workers) medical officers of primary health centers. The location of the HubHub differs in these two studies. Both trials are funded by the ICMR, Government of IndiaDiscussion:Both these trials, though conceptually similar, have some operational differences which have been highlighted. If demonstrated to be effective, this model of telementoring can be generalized and widely merged into the Indian health care system, thus aiding in reducing the treatment gap for patients unable to access care.

Assessing the continuum of care for maternal health in Mexico, 1994-2018.

ObjectiveTo describe the temporal and geographical patterns of the continuum of maternal health care in Mexico, as well as the sociodemographic characteristics that affect the likelihood of receiving this care.MethodsWe conducted a pooled cross-sectional analysis using the 1997, 2009, 2014 and 2018 waves of the National Survey of Demographic Dynamics, collating sociodemographic and obstetric characteristics of 93 745 women aged 12–54 years at last delivery. We defined eight variables along the antenatal–postnatal continuum, both independently and conditionally. We used a pooled fixed-effects multivariable logistic model to determine the likelihood of receiving the continuum of care for various properties. We also mapped the quintiles of adjusted state-level absolute change in continuum of care coverage during 1994–2018.FindingsWe observed large absolute increases in the proportion of women receiving timely antenatal and postnatal care (from 48.9% to 88.2% and from 39.1% to 68.7%, respectively). In our conditional analysis, we found that the proportion of women receiving adequate antenatal care doubled over this period. We showed that having social security and a higher level of education is positively associated with receiving the continuum of care. We observed the largest relative increases in continuum of care coverage in Chiapas (181.5%) and Durango (160.6%), assigned human development index categories of low and medium, respectively.ConclusionDespite significant progress in coverage of the continuum of maternal health care, disparities remain. While ensuring progress towards achievement of the health-related sustainable development goal, government intervention must also target underserved populations.