Climate-related experiences and harms in the wake of the COVID-19 pandemic: results from a survey of 152,088 Mexican youth.

The dual crises of COVID-19 and climate change are impacting the lives of adolescents and young people as they transition to adulthood in an uncertain world, yet they are often excluded from research and political discourse. We surveyed young people about their needs and experiences, critical to engaging them and designing effective programs and policies to address these intersecting harms. The 2022 round of a national online survey through the Violence Outcomes in COVID-19 Epoch (VoCes) Study surveyed 152,088 Mexican youth (15-24 years). Logistic regressions were implemented to identify characteristics associated with four climate responses (economic, work-related, receiving government support, or social network support). Overall, 8.1% of participants experienced a recent climate hazard, with major impacts including housing damage from floods, and crop/livestock losses from drought. Participants who experienced a climate hazard were more likely to have experienced a pandemic-related harm, suggesting a dual impact. Poor youth were more likely to report economic losses from both the pandemic and a climate event but least likely to receive government support. Economic effects from the pandemic are exacerbating climate-related harms, unequally threatening the poorest youth. Engaging young people in decision-making and supporting the most vulnerable youth is critical for the next generation to thrive.

The Multidimensional, Intersecting Impacts of COVID-19 on Young People's Lives: Evidence From Cross-Sectional Surveys in Mexico, India, and Kenya.

PURPOSE: Studies have documented diverse adverse effects of the COVID-19 pandemic on young people's lives-for instance on mental health, education/employment prospects, and intrafamily violence. We sought to generate much-needed evidence regarding whether, and which, young people are experiencing multiple intersecting effects. METHODS: Data come from cross-sectional surveys with young people ages 15-25 years in Mexico (nationwide, n = 55,692), Kenya (four counties, n = 2,750), and India (two states, n = 3,537), collected from late 2020 to early 2022. We used latent class analysis to identify subgroups based on multiple adverse effects, then examined associations between these subgroups and COVID-19 infections/family deaths, and sociodemographic characteristics. RESULTS: We found prevalent adverse impacts overall and two distinct subgroups in each country-one experiencing higher levels of all impacts, such as on mental health (44%-78% across countries), education/employment (22%-84%), intrafamily violence (22%-49%), and friendships (66%-86%). This subgroup comprised 40% of the sample in Mexico, 25% in Kenya, and 35% in India. In multivariate analyses, this group consistently had greater odds of experiencing COVID-19-related infections and deaths of loved ones. They were more likely socioeconomically disadvantaged, older, urban residents. Associations with other characteristics were country-specific. DISCUSSION: This study provides novel cross-country evidence that a subgroup of young people has experienced intersecting adverse impacts of COVID-19 on their lives. Findings also confirm prior evidence of multiple elevated vulnerabilities in general. Expanded provision of multiple layers of support is required, particularly for the most vulnerable subgroup, as are multi-sectoral policies and interventions to prevent intersectional effects in future times of crisis.

Interventions to Improve the Reproductive Health of Undocumented Female Migrants and Refugees in Protracted Situations: A Systematic Review.

OBJECTIVE: Limited evidence exists on interventions aimed at enabling reproductive health (RH) services access for undocumented female migrants and refugee women. We aimed to identify intervention characteristics and impacts on RH outcomes among migrants and refugee women in protracted situations. METHODS: We conducted a systematic literature review of RH intervention studies that reported on migrants and refugee women in protracted situations. We applied 2 search strategies across 6 databases to identify peer-reviewed articles in English, Spanish, and Portuguese. Eligible studies were assessed for content and quality. RESULTS: Of the 21,453 screened studies, we included 10 (all observational) for final data extraction. Interventions implemented among migrant and refugee women included financial support (n=2), health service delivery structure strengthening (n=4), and educational interventions (n=4). Financial support intervention studies showed that enabling women to obtain RH services for free or at a low cost promoted utilization (e.g., increased use of contraception). Interventions that established or strengthened health service delivery structures and linkage demonstrated increased prenatal visits, decreased maternal mortality, and facilitated access to safe abortion through referral services or access to medical abortion. Educational interventions indicated positive effects on RH knowledge and the importance of involving peers and meeting the unique needs of a mobile population. All intervention studies emphasized the need to accommodate migrant security concerns and cultural and linguistic needs. CONCLUSION: Interventions in protracted situations reported positive outcomes when they were migrant or refugee-centered and complementary, culturally acceptable, geographically proximate, and cost-sensitive, as well as recognized the concerns around legality and involved opportunities for peer learning. Free or low-cost RH services and greater availability of basic and emergency maternal and neonatal care showed the most promise but required further community outreach, education, and stronger referral mechanisms. We recommend further participatory implementation research linked to policy and programming.

Quality of care in abortion in the era of technological and medical advancements and self-care.

BACKGROUND: Discussions around quality of abortion care have been focused mainly on service-delivery aspects inside healthcare facilities. More recently, with availability of medical abortion (MA), increase in its self-use, and emergence of other delivery platforms such as telemedicine, the responsibility of quality care has broadened to actors outside of facilities. BODY OF TEXT: This commentary discusses the meaning of quality of abortion care with the paradigm shift brought by medical and technological advancement in abortions, and raises questions on the role of the state in ensuring quality in abortion management-especially in settings where abortion is decriminalized, but also in countries where abortion is permitted under certain circumstances. It consolidates the experience gained thus far in the provision of safe abortion services and also serves as a forward-thinking tool to keep pace with the uptake of newer health technologies (e.g., availability of medical abortion drugs), service delivery platforms (e.g., telemedicine, online pharmacies), and abortion care providers (e.g., community based pharmacists). CONCLUSIONS: This commentary provides context and rationale, and identifies areas for action that different stakeholders, including health advocates, policymakers, program managers, and women themselves, can adopt to fit into an alternative regime of abortion care.

Abortion Self-Care: A Forward-Looking Solution To Inequitable Access.

Following the World Health Organization's (WHO) definition of self-care, abortion self-care is the ability of pregnant individuals to manage their unwanted pregnancies with or without the support of health care providers-particularly, in the early weeks of pregnancy (up to 12 weeks' gestation). The advent of medication abortion (MA) has made this possible, as early self-managed MA at home is a safe, acceptable and cost-effective method of pregnancy termination. The drugs currently available for MA are mifepristone and misoprostol, as well as the two packaged together (also known as the combipack), which is more efficacious than misoprostol alone in evacuating the uterus and is considered the first-line medication for MA. Regardless of the legality of abortion where they live, women worldwide are using these medications to self-manage pregnancy termination inside or outside clinical settings-in conjunction with telemedicine services, peer-led support groups, hotlines and online information sources-which has contributed significantly to reducing maternal mortality and morbidity from unsafe procedures.

Stature is inversely associated with self-reported diabetes in middle-aged Mexican women / La estatura tiene una relación inversa con la diabetes autonotificada en las mujeres mexicanas de mediana edad

Objective. To investigate whether stature is associated with two highly prevalent cardiometabolic disorders—diabetes mellitus (DM) and high blood pressure (HBP) —in middle-aged Mexican women. Methods. We conducted a cross-sectional analysis of a sample of 93 481 middle-aged Mexican female teachers, all participating in the Mexican Teachers Cohort (MTC, or ESMaestras) study. We used a multivariable regression model to investigate the association of stature quintiles with the self-reported outcomes of DM and HBP. Results. After adjusting for birth cohort, ethnicity, family history, birthweight, occupation of household’s head during participant’s childhood, menopausal status, and geographical region of birthplace, stature was inversely associated with DM, with the odds for DM being 9% higher in the lowest stature quintile when compared to the highest stature quintile. Stratification for location of residence resulted in confirmation of the above-mentioned findings only in participants living in urban environments. Conclusions. We found an inverse association of stature with DM but not with HBP. Our data suggest that urban setting might be an important effect modifier of this association, which merits further investigation since it might provide valuable insights into the epidemiological transition occurring in developing countries.

Objetivo. Investigar si la estatura está asociada a dos trastornos cardiometabólicos — diabetes sacarina e hipertensión arterial— muy prevalentes en las mujeres mexicanas de mediana edad. Métodos. Realizamos un análisis transversal de una muestra de 93 481 maestras mexicanas de mediana edad que participaban en el Estudio de la Salud de las Maestras (ESMaestras). Utilizamos un modelo de regresión multivariante para investigar la relación entre los quintiles de estatura y los resultados autonotificados de diabetes sacarina e hipertensión arterial. Resultados. Después de ajustar los datos en función de la cohorte de nacimiento, la etnicidad, los antecedentes familiares, el peso al nacer, la ocupación del jefe del hogar durante la niñez de la participante, el estado menopáusico y la zona geográfica del lugar de nacimiento, se observó una relación inversa entre la estatura y la diabetes sacarina, dado que las probabilidades de aparición de esta última fue un 9 % mayor en el quintil más bajo de estatura que en el quintil más alto. La estratificación en función de la residencia permitió confirmar los resultados mencionados solo respecto de aquellas participantes que vivían en entornos urbanos. Conclusiones. Encontramos una relación inversa entre la estatura y la diabetes sacarina, pero no entre la estatura y la hipertensión arterial. Nuestros datos indican que el entorno urbano podría modificar considerablemente el efecto de esta relación, lo que amerita continuar con las investigaciones dado que podrían arrojar una luz valiosa sobre la transición epidemiológica en los países en desarrollo.

Stature is inversely associated with self-reported diabetes in middle-aged Mexican women.

OBJECTIVE: To investigate whether stature is associated with two highly prevalent cardiom- etabolic disorders-diabetes mellitus (DM) and high blood pressure (HBP) -in middle-aged Mexican women. METHODS: We conducted a cross-sectional analysis of a sample of 93 481 middle-aged Mexican female teachers, all participating in the Mexican Teachers Cohort (MTC, or ESMaestras) study. We used a multivariable regression model to investigate the association of stature quintiles with the self-reported outcomes of DM and HBP. RESULTS: After adjusting for birth cohort, ethnicity, family history, birthweight, occupation of household's head during participant's childhood, menopausal status, and geographical region of birthplace, stature was inversely associated with DM, with the odds for DM being 9% higher in the lowest stature quintile when compared to the highest stature quintile. Stratification for location of residence resulted in confirmation of the above-mentioned findings only in partici- pants living in urban environments. CONCLUSIONS: We found an inverse association of stature with DM but not with HBP. Our data suggest that urban setting might be an important effect modifier of this association, which merits further investigation since it might provide valuable insights into the epidemiological transition occurring in developing countries.

OBJETIVO: Investigar si la estatura está asociada a dos trastornos cardiometabólicos ­ diabetes sacarina e hipertensión arterial­ muy prevalentes en las mujeres mexicanas de mediana edad. MÉTODOS: Realizamos un análisis transversal de una muestra de 93 481 maestras mexicanas de mediana edad que participaban en el Estudio de la Salud de las Maestras (ESMaestras). Utilizamos un modelo de regresión multivariante para investigar la relación entre los quintiles de estatura y los resultados autonotificados de diabetes sacarina e hipertensión arterial. RESULTADOS: Después de ajustar los datos en función de la cohorte de nacimiento, la etnicidad, los antecedentes familiares, el peso al nacer, la ocupación del jefe del hogar durante la niñez de la participante, el estado menopáusico y la zona geográfica del lugar de nacimiento, se observó una relación inversa entre la estatura y la diabetes sacarina, dado que las probabilidades de aparición de esta última fue un 9 % mayor en el quintil más bajo de estatura que en el quintil más alto. La estratificación en función de la residencia permitió confirmar los resultados mencionados solo respecto de aque- llas participantes que vivían en entornos urbanos. CONCLUSIONES: Encontramos una relación inversa entre la estatura y la diabetes saca- rina, pero no entre la estatura y la hipertensión arterial. Nuestros datos indican que el entorno urbano podría modificar considerablemente el efecto de esta relación, lo que amerita continuar con las investigaciones dado que podrían arrojar una luz valiosa sobre la transición epidemiológica en los países en desarrollo.

Stature is inversely associated with self-reported diabetes in middle-aged Mexican women / La estatura tiene una relación inversa con la diabetes autonotificada en las mujeres mexicanas de mediana edad

ABSTRACT Objective To investigate whether stature is associated with two highly prevalent cardiometabolic disorders—diabetes mellitus (DM) and high blood pressure (HBP) —in middle-aged Mexican women. Methods We conducted a cross-sectional analysis of a sample of 93 481 middle-aged Mexican female teachers, all participating in the Mexican Teachers Cohort (MTC, or ESMaestras) study. We used a multivariable regression model to investigate the association of stature quintiles with the self-reported outcomes of DM and HBP. Results After adjusting for birth cohort, ethnicity, family history, birthweight, occupation of household's head during participant's childhood, menopausal status, and geographical region of birthplace, stature was inversely associated with DM, with the odds for DM being 9% higher in the lowest stature quintile when compared to the highest stature quintile. Stratification for location of residence resulted in confirmation of the above-mentioned findings only in participants living in urban environments. Conclusions We found an inverse association of stature with DM but not with HBP. Our data suggest that urban setting might be an important effect modifier of this association, which merits further investigation since it might provide valuable insights into the epidemiological transition occurring in developing countries.

RESUMEN Objetivo Investigar si la estatura está asociada a dos trastornos cardiometabólicos —diabetes sacarina e hipertensión arterial— muy prevalentes en las mujeres mexicanas de mediana edad. Métodos Realizamos un análisis transversal de una muestra de 93 481 maestras mexicanas de mediana edad que participaban en el Estudio de la Salud de las Maestras (ESMaestras). Utilizamos un modelo de regresión multivariante para investigar la relación entre los quintiles de estatura y los resultados autonotificados de diabetes sacarina e hipertensión arterial. Resultados Después de ajustar los datos en función de la cohorte de nacimiento, la etnicidad, los antecedentes familiares, el peso al nacer, la ocupación del jefe del hogar durante la niñez de la participante, el estado menopáusico y la zona geográfica del lugar de nacimiento, se observó una relación inversa entre la estatura y la diabetes sacarina, dado que las probabilidades de aparición de esta última fue un 9 % mayor en el quintil más bajo de estatura que en el quintil más alto. La estratificación en función de la residencia permitió confirmar los resultados mencionados solo respecto de aquellas participantes que vivían en entornos urbanos. Conclusiones Encontramos una relación inversa entre la estatura y la diabetes sacarina, pero no entre la estatura y la hipertensión arterial. Nuestros datos indican que el entorno urbano podría modificar considerablemente el efecto de esta relación, lo que amerita continuar con las investigaciones dado que podrían arrojar una luz valiosa sobre la transición epidemiológica en los países en desarrollo.

Factor structure of the Spanish version of the Patient Health Questionnaire-9 in Mexican women.

Structure of the Spanish version of the nine-item Patient Health Questionnaire (PHQ-9) has been inconclusive. We report the factor structure of the PHQ-9 in 55,555 women from the Mexican Teachers' Cohort (MTC). Factor structure of the PHQ-9 was assessed by exploratory and confirmatory factor analyses in two sub-samples (n = 27,778 and 27,777 respectively). A one-factor model of the PHQ-9 was the solution with the best fit to the data, exhibiting strong factor loadings (0.71 to 0.90) and high internal consistency (Cronbach's alpha = 0.89). A prevalence rate of moderate to high severity of depressive symptoms of 12.6% was identified. Results suggest that a global score is an appropriate measure of depressive symptoms and commend the use of the Spanish PHQ-9 as a measure of depression for research and clinical purposes.

Variables significativas para explicar el consumo de cocaína a los dos años de demanda de tratamiento / Relevant characteristics of cocaine consumption two years after starting treatment

El objetivo del presente estudio es analizar cuáles son las variables significativas para explicar la presencia de consumos de cocaína después de dos años de la demanda de tratamiento. La muestra está formada por 38 personas con dependencia de la cocaína que demandaron tratamiento en Centros de Drogodependencias de Galicia. En el momento de la evaluación inicial se analizaron una serie de variables y se administraron diversos cuestionarios pretratamiento (p. ej., AUDIT, BDI, STAI, MCMI-II, entrevista clínica del SCID, escala de deseo compulsivo de consumir cocaína [craving], etc.). Dos años después de dicha evaluación inicial se analiza la presencia de consumos de cocaína durante el mes previo. Las variables que han resultado significativas en relación a la presencia de dichos consumos son: el haber consumido heroína alguna vez en la vida, una puntuación alta en la escala de craving y un patrón de personalidad antisocial. Por lo tanto, es muy importante realizar una evaluación previa de la historia de consumo y los patrones de personalidad (AU)

The objective of the present study is to analyze which variables can explain the presence of cocaine consumption two years after demanding treatment. The sample is 38 cocaine dependent persons that demanded treatment in Centers of Drug Abuse in Galicia (N.W. Spain). For an initial assessment, several variables were considered and questionnaires administered related with the abstinence/relapse (i.e., AUDIT, BDI, STAI, MCMI-II, clinical interview of SCID, craving scale, etc.). Two-years later, we analyzed the presence of cocaine consumption (previous month). The significant variables to explain the presence of this consumption are: heroine consumption in lifetime, a high level in craving scale and antisocial personality patterns. In conclusion, a previous assessment of consumption history and personality patterns proves relevant for treatment programs

[What happens in a cocaine-dependent sample after 24 months of treatment?]. / ¿Que ocurre a los 24 meses del inicio del tratamiento en una muestra de personas con dependencia de la cocaina?

The evolution of people in treatment for cocaine dependence at public Drug Abuse Centers is a relevant topic in view of the notable increase in demand for such treatment in recent years. The aim of the present study was to analyze the evolution of people with cocaine dependence receiving treatment at public Drug Abuse Centers in Galicia (NW Spain), two years after the initial assessment for inclusion on the treatment program. The sample for the present study was 38 participants who formed part of a larger initial sample (N = 115). The variables analyzed were: substance use, social adjustment on the O.T.I. scale, problems with the legal system and perceived psychological distress as assessed with the scales and indices of the SCL-90 R. The results indicate that, after two years of treatment, 78.9% of those in the sample located (26% of the initial sample) had not consumed cocaine in the month prior to assessment, and that there was a reduction in psychological distress. These results indicate a positive evolution after two years of the sample of people in treatment for cocaine dependence assessed in this study.

¿Qué ocurre a los 24 meses del inicio del tratamiento en una muestra de personas con dependencia de la cocaína? / No disponible

La evolución de las personas que están en tratamiento por consumo de cocaína en Centros de Drogodependencias públicos, es un tema relevante debido al notable incremento de la demanda de estos tratamientos en los últimos años. El objetivo del presente estudio es analizar la evolución de personas con dependencia de la cocaína que han recibido tratamiento en Centros públicos de Drogodependencias de Galicia, tras dos años de haberse realizado una evaluación inicial. La muestra el presente estudio es de 38 sujetos que formaban parte de una muestra inicial más amplia (N =115), y las variables que se analizan son: el consumo de sustancias, el ajuste social con la escala del O.T.I., problemas con la justicia y el malestar psicológico percibido por el sujeto evaluado con las subescalas e índices del SCL-90 R. Los resultados obtenidos son:a los dos años, el 78.9% de la muestra localizada no ha consumido cocaína en el mes previo a la evaluación, lo cual representa un 26% de la muestra inicial, y una disminución del malestar percibido por el sujeto. Estos resultados indican una evolución positiva de la muestra de personas en tratamiento por dependencia de la cocaína a los dos años que ha sido analizada en el presente estudio

The evolution of people in treatment for cocaine dependence at public Drug Abuse Centers is a relevant topic in view of the notable increase in demand for such treatment in recent years.The aim of the present study was to analyze the evolution of people with cocaine dependence receiving treatment at public Drug Abuse Centers in Galicia (NW Spain), two years after the initial assessment for inclusion on the treatment program. The sample for the present study was 38 participants who formed part of a larger initial sample (N = 115). The variables analyzed were: substance use, social adjustment on the O.T.I. scale, problems with the legal system and perceived psychological distress as assessed with the scales and indices of the SCL-90 R. The results indicate that, after two years of treatment, 78.9% of those in the sample located (26% of the initial sample) had not consumed cocaine in the month prior to assessment, and that there was a reduction in psychological distress. These results indicate a positive evolution after two years of the sample of people in treatment for cocaine dependence assessed in this study