Metodología de la Encuesta Nacional de Salud y Nutrición 2022 y Planeación y diseño de la Ensanut Continua 2020-2024.

OBJETIVO: Presentar el diseño de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2022 y cuantificar el avance de la Ensanut Continua 2020-2024. Material y métodos. La Ensanut 2022 es la tercera encuesta de la serie de en-cuestas denominada Ensanut Continua 2020-2024. En este documento se describe el alcance de la Ensanut 2022 y sus procedimientos de muestreo, medición y organización logís-tica. Además, se presenta el avance esperado de la Ensanut Continua 2020-2024 al concluir la Ensanut 2022. Resulta-dos. La Ensanut 2022 obtendrá, a nivel nacional, al menos 10 160 entrevistas completas de hogar y 9 441 resultados de seropositividad a SARS-CoV-2. CONCLUSIONES: La Ensanut 2022 estimará la prevalencia de seropositividad a SARS-CoV-2 a nivel nacional y regional y avanzará en la acumulación de información para alcanzar los objetivos de la Ensanut Con-tinua 2020-2024.

Centennial of the School of Public Health of Mexico. Leadership, tradition and competitive advantage.

Not available.

National Institute of Public Health/School of Public Health of Mexico: contributions to social equity and knowledge-based public policies.

The School of Public Health of Mexico (ESPM, in Spanish), was founded on March 23, 1922, several years after the creation of the first schools of public health in the United States of America (USA), such as Johns Hopkins in 1916 and those of Harvard, Yale, and Columbia, among others. The Escuela de Salubridad, as the ESPM was initially called, was the first of its kind in Latin America and the fifth in the world; thus, it was responsible for providing the first public health degrees in Mexico to medical health officers and other higher education diplomas in the fields of hygiene and public health. Several years after its own founding, in 1987, the ESPM co-founded the National Institute of Public Health (INSP, in Spanish) which to date continues to be the organization in which the ESPM is housed. Since the ESPM merged with the INSP, research and human resources training have been considered necessary processes for initiating and strengthening structural change in the field of health at the national and regional levels. As part of its centennial, the ESPM is committed to the continued expansion of its future perspective through the restructuring of its academic programs; this is a process in which the instilling of values, a unified curriculum based on public health, a flexible educational model and social commitment are fundamental. Key words: Public Health, Public Health School of Mexico, social equity and education.

Towards a unified curriculum system based on a public health holistic approach. Renovation of the academic programs at the School of Public Health of Mexico.

Public health training cannot be practiced in isolation, but rather within the framework of substantive conceptual visions, the organizational structure and teaching culture in a broad sense. The School of Public Health of Mexico (ESPM), in the mist of its 100th anniversary, is implementing an educational restructure with the guidance of conceptual and ethical principles. The restructure of the academic pro-grams will follow a constructivist pedagogical model, based on renewed institutional practices that integrates research, teaching and community outreach, making for truly transfor-mative learning. The new design of the whole structure of its academic programs has the objetive of making them flexible, less technical-based but more practical, and a within an uni-fied curricular system that articulates and allows continuity between master's degrees and doctorates programs. In the new structure, the curriculum will have a common core for all the academic programs, emerging from the study of the essential bases of public health, human rights, including gender and social perspectives, principles of global health, ethics of public health practice, environmental and animal health inferences and community outreach in the form of social retribution. The Institute's research groups will be the functional units for investigation and teaching, thus students will be integrated into these at an early stage, under the guidance of a tutor. In this context, the requirements for a comprehensive, unifying and at the same time flexible cur-riculum will support training of Public Health with a holistic approach. The current programs were analyzed including the review of their courses, regarding the pertinence of their contents and proposed competencies. We present herein a description of these observations, and propose a new com-mon core (conceptual-operative) with compulsory courses as the base for all programs. The participation of all academic bodies in reviewing the proposed new common core, as well as the syllabus and courses, identified those that are essential in each program's study concentration area, is indicated.

Efficacy, immunogenicity, and safety of a quadrivalent HPV vaccine in men: results of an open-label, long-term extension of a randomised, placebo-controlled, phase 3 trial.

BACKGROUND: The quadrivalent human papillomavirus (HPV) vaccine was shown to prevent infections and lesions related to HPV6, 11, 16, and 18 in a randomised, placebo-controlled study in men aged 16-26 years. We assessed the incidences of external genital warts related to HPV6 or 11, and external genital lesions and anal dysplasia related to HPV6, 11, 16, or 18, over 10 years of follow-up. METHODS: The 3-year base study was an international, multicentre, double-blind, randomised, placebo-controlled trial done at 71 sites in 18 countries. Eligible participants were heterosexual men (aged 16-23 years) or men who have sex with men (MSM; aged 16-26 years). Men who had clinically detectable anogenital warts or genital lesions at screening that were suggestive of infection with non-HPV sexually transmitted diseases, or who had a history of such findings, were excluded. Eligible participants were randomly assigned (1:1) to receive three doses of either quadrivalent HPV vaccine or placebo on day 1, month 2, and month 6, administered as a 0·5-mL injection into the deltoid muscle. The 7-year, open-label, long-term follow-up extension study was done at 46 centres in 16 countries. Participants who received one or more doses of the quadrivalent HPV vaccine in the base study were eligible for enrolment into the long-term follow-up study (early vaccination group). Placebo recipients were offered the three-dose quadrivalent HPV vaccine at the end of the base study; those who received one or more quadrivalent HPV vaccine doses were eligible for enrolment into the long-term follow-up study (catch-up vaccination group). The primary efficacy endpoints were the incidence of external genital warts related to HPV6 or 11 and the incidence of external genital lesions related to HPV6, 11, 16, or 18 in all participants and the incidence of anal intraepithelial neoplasia (including anal warts and flat lesions) or anal cancer related to HPV6, 11, 16, or 18 in MSM only. The primary efficacy analysis was done in the per-protocol population for the early vaccination group, which included participants who received all three vaccine doses, were seronegative at day 1 and PCR-negative from day 1 through month 7 of the base study for the HPV type being analysed, had no protocol violations that could affect evaluation of vaccine efficacy, and had attended at least one visit during the long-term follow-up study. For the catch-up vaccination group, efficacy was assessed in the modified intention-to-treat population, which included participants who had received at least one vaccine dose, were seronegative and PCR-negative for HPV types analysed from day 1 of the base study to the final follow-up visit before receiving the quadrivalent HPV vaccine, and had at least one long-term follow-up visit. Safety was assessed in all randomised participants who received at least one vaccine dose. This study is registered with ClinicalTrials.gov, NCT00090285. FINDINGS: Between Aug 10, 2010, and April 3, 2017, 1803 participants were enrolled in the long-term follow-up study, of whom 936 (827 heterosexual men and 109 MSM) were included in the early vaccination group and 867 (739 heterosexual men and 128 MSM) were included in the catch-up vaccination group. Participants in the early vaccination group were followed up for a median of 9·5 years (range 0·1-11·5) after receiving the third dose of the quadrivalent HPV vaccine, and participants in the catch-up vaccination group were followed up for a median of 4·7 years (0·0-6·6) after receiving the third dose. In early vaccine group participants during long-term follow-up compared with the placebo group in the base study, the incidence per 10 000 person-years of external genital warts related to HPV6 or 11 was 0·0 (95% CI 0·0-8·7) versus 137·3 (83·9-212·1), of external genital lesions related to HPV6, 11, 16, or 18 was 0·0 (0·0-7·7) versus 140·4 (89·0-210·7), and of anal intraepithelial neoplasia or anal cancer related to HPV6, 11, 16, or 18 in MSM only was 20·5 (0·5-114·4) versus 906·2 (553·5-1399·5). Compared with during the base study (ie, before quadrivalent HPV vaccine administration), during the long-term follow-up period, participants in the catch-up vaccination group had no new reported cases of external genital warts related to HPV6 or 11 (149·6 cases per 10 000 person-years [95% CI 101·6-212·3] vs 0 cases per 10 000 person-years [0·0-13·5]) or external genital lesions related to HPV6, 11, 16, or 18 (155·1 cases per 10 000 person-years [108·0-215·7] vs 0 cases per 10 000 person-years [0·0-10·2]), and a lower incidence of anal intraepithelial neoplasia or anal cancer related to HPV6, 11, 16, or 18 (886·0 cases per 10 000 person-years [583·9-1289·1] vs 101·3 cases per 10 000 person-years [32·9-236·3]). No vaccine-related serious adverse events were reported. INTERPRETATION: The quadrivalent HPV vaccine provides durable protection against anogenital disease related to HPV6, 11, 16, and 18. The results support quadrivalent HPV vaccination in men, including catch-up vaccination. FUNDING: Merck Sharp & Dohme.

Metodología de la Encuesta Nacional de Salud y Nutrición 2021.

Objetivo. Describir el diseño de la Encuesta Nacional de Salud y Nutrición 2021 (Ensanut 2021). Material y métodos. La Ensanut 2021 es una encuesta probabilística de hogares que forma parte de la serie de Ensanut Continua 2020-2024. En esta ocasión se describen el alcance, el muestreo, la medición y la organización logística. Resultados. Se planea obtener al menos 12 060 entrevistas de hogar completas a nivel nacional y 9 837 muestras para determinar seropositividad a SARS-CoV-2 a nivel nacional. Conclusiones. La Ensanut 2021 permitirá realizar inferencias regionales sobre la prevalencia de seropositividad a SARS-CoV-2 y también acumular información para realizar inferencias estatales en el año 2024.

Metodología de la Encuesta Nacional de Salud y Nutrición 2020 sobre Covid-19.

Objetivo. Describir el diseño y los resultados de campo de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2020 so-bre Covid-19. Material y métodos. La Ensanut Covid-19 es una encuesta probabilística de hogares. En este artículo se describen los siguientes elementos del diseño: alcance, muestreo, medición, inferencia y logística. Resultados. Se obtuvieron 10 216 entrevistas de hogar completas y 9 464 resultados sobre seropositividad a SARS-CoV-2. La tasa de respuesta de hogar fue 80% y la de prueba de seropositividad de 44%. Conclusiones. El diseño probabilístico de la Ensa-nut Covid-19 permite hacer inferencias estadísticas válidas sobre parámetros de interés para la salud pública a nivel nacional y regional; en particular, permitirá hacer inferencias de utilidad práctica sobre la prevalencia de seropositividad a SARS-CoV-2 en México. Además, la Ensanut Covid-19 podrá ser comparada con Ensanut previas para identificar potenciales cambios en los estados de salud y nutrición de la población mexicana.

[Public health in the first wave: a research agendafor cooperation under Covid-19]. / La salud pública en la primera ola: una agenda para la cooperación ante Covid-19.

Covid-19 represents one of the largest challenges in the recent history of public health. It is fundamental that we strengthen scientific cooperation under a common goal: to protect the health of the population. In this article, we present ideas that need urgent and collaborative efforts. We discuss the estimation of the magnitude of the epidemic through a nationwide seroprevalence panel, as well as new strategies to monitor the epidemic in real time. We also analyze the negative externalities associated to the pandemic. Finally, we present a general framework to develop ideas to come out of the lockdown, highlighting the importance of implementing sustainable and equitable structural interventions. We call for solidarity and cooperation, focusing our efforts and creativity in the resolution of the problems that currently affect Mexico and the world.

El Covid-19 representa uno de los retos más grandes en la historia reciente de la salud pública. Es fundamental que se fortalezcan los lazos de cooperación científica bajo un obje-tivo común: proteger la salud de la población. En este artículo se presentan ideas que necesitan un desarrollo urgente y colaborativo. Se discute la estimación de la magnitud de la epidemia mediante un panel nacional de seroprevalencia y nuevas estrategias para mejorar el monitoreo en tiempo real de la epidemia. También se analizan las externalidades nega-tivas asociadas con la respuesta a la pandemia. Finalmente, se presenta un marco general para el desarrollo de ideas para salir del confinamiento, resaltando la importancia de implementar acciones estructurales, sostenibles y equitativas. Se hace un llamado a la solidaridad y la cooperación, donde nuestros esfuerzos y creatividad se dediquen a la resolución de los problemas que enfrentan México y el mundo.

[Public health literacy in the face of the Covid-19 pandemic emergency]. / Alfabetización en salud pública ante la emergencia de la pandemia por Covid-19.

Health literacy is the process of obtaining knowledge, motivation and individual competencies to understand and access information, express opinions and make decisions with respect to health promotion and maintenance. This applies in different contexts, environments, and throughout life. This conceptual perspective is very necessary in the face of the SARS-CoV-2 virus emergency. This virus produces the Covid-19 disease, which has become a pandemic of devastating effects not only healthwise, but also, importantly, from an economic, political and social point of view. This essay seeks to establish the scientific evidence-based elements that guide public policies for prevention and control. Some of these elements are: a) epidemiologic intelligence. This includes not only the strategy of public surveillance, but also sentinel and event-based surveillance, as it is impossible to actually identify all positive cases; b) Mitigating measures against the spread of the epidemic, such as social distancing and hygiene, washing hands, quarantine, restricting movement and using masks, among others; c) Measures to suppress transmission when the number of cases is very high, such as strict measures to stay at home; d) strengthening health services 'capacity for medical attention and improving health services' ability to prevent transmission, including the use of diagnostic tests; e) the development of prophylactic vaccines against Covid-19, as well as the development of therapeutic agents. All of these actions must be rapidly implemented, from a multidisciplinary and multisectorial public health perspective, and they absolutely must also be taken with the community's participation as shared responsibility. Therefore, public health literacy is needed.

La alfabetización en salud es el proceso centrado en la obtención del conocimiento, la motivación y las competencias individuales para entender y acceder a información, expresar opiniones y tomar decisiones relacionadas con la promoción y el mantenimiento de la salud, lo que es aplicable en diferentes contextos, entornos y a lo largo de toda la vida. Esta perspectiva conceptual es muy necesaria ante la emergencia del virus SARS-CoV-2 que produce la enfermedad Covid-19, la cual ha producido una pandemia con efectos devastadores, no sólo desde el punto de vista de la salud, sino también, de manera muy importante, desde el económico, político y social. En este ensayo se tratan de establecer los elementos basados en la evidencia científica que orientan las políticas públicas de prevención y control, entre los que destacan: a) la inteligencia epidemiológica, la cual incluye no sólo la estrategia de vigilancia poblacional sino, ante la imposibilidad real de identificación de todos los casos positivos, la puesta en práctica de estrategias de vigilancia centinela y la vigilancia basada en eventos; b) las medidas de mitigación de la propagación de la epidemia, tales como distanciamiento social e higiene, lavado de manos, cuarentena, restricción de movimiento y utilización de cubrebocas, entre otras; c) medidas de supresión de la transmisión cuando el número de casos es muy elevado, como el endurecimiento de medidas drásticas de encierro en casa; d) fortalecimiento de la capacidad de atención médica en los sistemas de salud e incremento de la capacidad de prevención de la transmisión en los servicios de salud, incluyendo la utilidad de las pruebas diagnósticas; y e) el desarrollo de vacunas profilácticas contra Covid-19, así como la generación de agentes terapéuticos. Todas estas acciones no sólo deben implementarse rápidamente desde la perspectiva multidisciplinaria y multisectorial de la salud pública para contener, prevenir y controlar la epidemia, sino que necesitan obligatoriamente del concurso de la comunidad como responsabilidad compartida. Debido a todo esto, es necesaria la alfabetización en salud pública.