Local Health Service Response to COVID-19 in Mexico: Notes From an Exploratory Qualitative Study.

BACKGROUND: The main goal of a health system is to maintain or improve people's health. The COVID-19 pandemic showed the fragility of health systems worldwide. In Mexico, the pandemic affected the performance of the health system, along with the presence of contextual conditions such as its segmentation and high prevalence of chronic diseases. AIMS: To analyze from an approach to the functions of the health system, the service delivery, human resources, financing, and stewardship/governance in the local health services of five states of Mexico, from the perspective of the staff working in health centers. METHODS: This is an exploratory qualitative study conducted from November 2020 to August 2021, involving 124 health professionals from 39 health facilities (18 rural and 21 urban). The technique used was the semi-structured interview. Interview guides were developed according to core topics. Subsequently, the thematic analysis method was used. RESULTS: The lack of financial resources delayed prevention efforts and made it difficult for health centers to adapt to the crisis. Inequity was found in the distributive efficiency of staff between rural and urban areas and levels of care. In addition, there was evidence of capacity for coordination, capacity sharing, and joint participation between health institutions, civil authorities, and the population to face the emergency. CONCLUSIONS: We identified relevant public health actions that showed the capacity of local health services to organize a response to the pandemic at the level of the actors responsible for these services.

The Role of Cytokinins during the Development of Strawberry Flowers and Receptacles.

Cytokinins play a relevant role in flower and fruit development and plant yield. Strawberry fruits have a high commercial value, although what is known as the "fruit" is not a "true" botanical fruit because it develops from a non-reproductive organ (receptacle) on which the true botanical fruits (achenes) are found. Given cytokinins' roles in botanical fruits, it is important to understand their participation in the development of a non-botanical or accessory "fruit". Therefore, in this work, the role of cytokinin in strawberry flowers and fruits was investigated by identifying and exploring the expression of homologous genes for different families that participate in the pathway, through publicly available genomic and expression data analyses. Next, trans-zeatin content in developing flowers and receptacles was determined. A high concentration was observed in flower buds and at anthesis and decreased as the fruit approached maturity. Moreover, the spatio-temporal expression pattern of selected CKX genes was evaluated and detected in receptacles at pre-anthesis stages. The results point to an important role and effect of cytokinins in flower and receptacle development, which is valuable both from a biological point of view and to improve yield and the quality of this fruit.

Prevalence of Latent Tuberculosis Infection (LTBI) in Mexican Patients With Rheumatoid Arthritis (RA).

INTRODUCTION: Patients with rheumatoid arthritis (RA) are at increased risk of developing tuberculosis, and even more so if they receive biological agents. In Mexico, the prevalence of latent tuberculosis infection (LTBI) in RA diagnosed by interferon-gamma release assay (IGRA) is largely unknown. The objective was to determine LTBI prevalence and the associated risk factors in rheumatoid arthritis patients. METHODS: A cross-sectional study was performed comprising 82 patients with RA who attended the rheumatology service at a second-level hospital. Demographic characteristics, comorbidity, Bacillus Calmette-Guerin (BCG) vaccination and smoking history, type of treatment, disease activity and functional capacity were investigated. The Disease Activity Score 28 and the Health Assessment Questionnaire-Disability Index were applied for the estimate of RA activity and functional capacity. Further information was compiled from the electronic medical records and personal interviews. LTBI was determined by QuantiFERON TB Gold Plus (QIAGEN, Germantown, USA). RESULTS: Prevalence of LTBI was 14% (95% confidence interval (CI): 8.6% to 23.9%). Factors associated with LTBI were history of smoking (odds ratio (OR) = 6.63 95% CI 1.01 to 43.3) and disability score (OR = 7.19 95%CI 1.41 to 36.6). CONCLUSIONS: The prevalence of LTBI in Mexican patients with RA was 14%. Our results suggest prevention of smoking and functional incapacity could reduce the risk of LTBI. Further research could endorse our results.

Local health systems resilience in managing the COVID-19 pandemic: lessons from Mexico.

The concept of resilience was applied to the public health field to investigate the way health systems are impacted by health crises, what conditions allow them to mitigate the blow and how they reorganize once the crisis is over. In 2020, the COVID-19 pandemic caused by the SARS-CoV-2 virus represented a global challenge demanding immediate response to an unprecedented health crisis. Various voices drew attention to the intensity of the crisis in countries with greater inequalities, where the pandemic converged with other social emergencies. We documented the experiences of health personnel who faced the pandemic at the primary care level while simultaneously maintaining the functioning of other areas of medical care. Our results derived from a qualitative study comprising 103 participants from five states of Mexico. We aimed to show through inferential analysis their perspective on what we call 'the resilience of local health systems'. We observed three stages of experience during the crisis: (a) Preparation (official guidelines received to organize care, training and planning of epidemiological surveillance); (b) Adaptation (performance of community-based prevention activities, infrastructure modifications, telehealth); and (c) Learning (participatory governance with city councils, business sector and organized population). The study suggests that the local health systems analysed benefited from the initiatives of health personnel that in some cases positively exceeded their duties. In terms of the resilience analysis, they were able to handle the impact of the crisis and cope with it. Their transformative capacity came from the strategies implemented to adapt health services by managing institutional resources. Their experience represents a lesson on the strengthening of the essential functions of health systems and shows a way to address successfully the increasingly complex health challenges of the present and future times.

[Comparison of a community-based nutritional intervention and a conventional nutritional intervention in Mayan communities in Mexico]. / Comparación de una intervención nutricional basada en la comunidad y una intervención nutricional convencional en localidades mayas de México.

Poor nutritional conditions persist in many Mayan communities in Yucatán, Mexico, even though various programs have been implemented. The study aimed to compare the effects of a community-based nutritional intervention with an intercultural focus versus a conventional nutritional intervention on body mass index (BMI) and diet in women in Mayan communities in Yucatán. The sample included adult women with BMI ≥ 25kg/m2 from neighboring rural Mayan villages. Both interventions lasted three months with 11 sessions and followed the prevailing guidelines. The community-based intervention used an intercultural tool called Good Mayan Food [Plato del Bien Comer Maya], besides strategies designed according to information obtained from a prior qualitative study phase using interviews. The group that received the community-based intervention (n = 7), compared to the conventional intervention group (n = 9), showed larger decreases in BMI (-0.58 ± 0.70 kg/m2 and +0.27 ± 0.64kg/m2; p = 0.042), waist circumference (-2.15 ± 2.60 cm and -0.50 ± 0.75 cm; p = 0.042), and consumption of fats (-53.23 ± 21.92 grams and -7.34 ± 25.77 grams; p = 0.004), as well as higher increases in weekly consumption of some local foods such as nance fruit (p = 0.012), tamarind (p = 0.001), and chili peppers (p = 0.004). The community-based intervention was the only one to show a significant decrease in daily calorie intake (baseline: 2,067 ± 91 kcal/day, at three months: 1,474 ± 31 kcal/day; p = 0.018), and both groups showed decreases in the consumption of ultra-processed foods, but without significant differences between the two groups. The community-based intervention group showed better results than the conventional intervention group.

Las malas condiciones nutricionales en muchas localidades mayas de Yucatán, México, persisten, a pesar de que se han implementado diversos programas. El objetivo fue comparar los efectos de una intervención nutricional basada en la comunidad con enfoque intercultural (INBC) y una intervención nutricional convencional (INC), sobre el índice de masa corporal (IMC) y la dieta en mujeres de localidades mayas de Yucatán. Fueron incluidas mujeres adultas con IMC ≥ 25kg/m2 de dos pequeñas localidades rurales mayas vecinas. Ambas intervenciones fueron de tres meses y con 11 sesiones, siguiendo la normatividad vigente; en la INBC fue utilizada la herramienta intercultural, denominada Plato del Bien Comer Maya, además se incluyeron en la INBC estrategias diseñadas con base en información obtenida en una fase previa de estudio cualitativo con entrevistas. El grupo con la INBC (n = 7), en comparación con el grupo con la INC (n = 9), tuvo una mayor disminución de IMC (-0,58 ± 0,70 kg/m2 y +0,27 ± 0,64 kg/m2; p = 0,042), de la circunferencia de cintura (-2,15 ± 2,60 cm y -0,50 ± 0,75 cm; p = 0,042) y del consumo de grasas (-53,23 ± 21,92 gramos y -7,34 ± 25,77 gramos; p = 0,004), así como mayor incremento en las frecuencias semanales de consumo de algunos alimentos locales como nance (p = 0,012), tamarindo (p = 0,001) y chile (p = 0,004), la INBC fue la única que presentó una disminución significativa en el consumo diario de calorías (basal: 2.067 ± 91 kcal/día, a los tres meses: 1.474 ± 31 kcal/día; p = 0,018), hubo en ambos grupos disminuciones en el consumo de alimentos ultraprocesados, pero sin diferencias comparando los grupos; el grupo con la INBC obtuvo mejores resultados que el grupo con la INC.

As más condições nutricionais em muitas localidades maias de Yucatán (México) persistem apesar da implementação de diversos programas. O objetivo era comparar os impactos de uma intervenção nutricional baseada na comunidade com enfoque intercultural (INBC) e uma intervenção nutricional convencional (INC), sobre o índice de massa corporal (IMC) e a dieta de mulheres de localidades maias de Yucatán. Foram incluídas mulheres adultas com IMC ≥ 25kg/m2 de duas pequenas localidades rurais maias vizinhas. Ambas as intervenções duraram três meses e contaram com 11 sessões, conforme as normas vigentes; na INBC, foi utilizada a ferramenta intercultural denominada Prato de Comer Bem Maia [Plato del Bien Comer Maya], além de estratégias adicionais idealizadas com base em dados obtidos em uma fase prévia de estudo qualitativo com entrevistas. Em comparação com o grupo com a INC (n = 9), o grupo com a INBC (n = 7) teve maior diminuição de IMC (-0,58 ± 0,70 kg/m2 e +0,27 ± 0,64 kg/m2; p = 0,042), da circunferência abdominal (-2,15 ± 2,60 cm y -0,50 ± 0,75 cm; p = 0,042) e do consumo de gorduras (-53,23 ± 21,92 gramas y -7,34 ± 25,77 gramas; p = 0,004), bem como um aumento maior das frequências semanais de consumo de alguns alimentos locais como o murici (p = 0,012), o tamarindo (p = 0,001) e pimenta (p = 0,004). A INBC foi a única a apresentar uma diminuição significativa do consumo diário de calorias (inicial: 2.067 ± 91 kcal/dia, após três meses: 1.474 ± 31 kcal/dia; p = 0.018). Houve em ambos os grupos redução equivalente do consumo de alimentos ultraprocessados; o grupo com a INBC obteve melhores resultados que o grupo com a INC.

Vulnerability as a palimpsest: Practices and public policy in a Mexican hospital setting.

Vulnerability is a concept associated with the effects of social inequities to access health care services. On a hospital level, vulnerable populations must be identified and favored over others. The aims of this study were the analysis of the conceptions and practices of social workers regarding vulnerable patients, and the identification of theoretical elements of vulnerability given by academics. Hospital ethnography and a focus group were implemented. Social workers related vulnerability to the social needs of each patient; however, they state that they have dilemmas to identify a person in a vulnerable condition; these dilemmas are related to social differences and deservingness. Academics indicated that the vulnerability should refer to the lack of access to health services offered by the institution. Academics agree with social workers regarding the importance of considering the overlapped social and individual circumstances in each patient to recognize their vulnerable condition, regardless of belonging to any of the pre-established vulnerable groups. Finally, taking into account the way of conceptualizing vulnerability and how public policy on the identification of vulnerable patients in the hospital has been implemented, these two elements are explained using the palimpsest model, which is a figure of thought that can be applied to analyze the sociocultural significance of this complex issue, as well as other social dynamics.

Comparación de una intervención nutricional basada en la comunidad y una intervención nutricional convencional en localidades mayas de México / Comparison of a community-based nutritional intervention and a conventional nutritional intervention in Mayan communities in Mexico / Comparação entre uma intervenção nutricional baseada na comunidade e uma intervenção nutricional convencional em localidades maias de México

Las malas condiciones nutricionales en muchas localidades mayas de Yucatán, México, persisten, a pesar de que se han implementado diversos programas. El objetivo fue comparar los efectos de una intervención nutricional basada en la comunidad con enfoque intercultural (INBC) y una intervención nutricional convencional (INC), sobre el índice de masa corporal (IMC) y la dieta en mujeres de localidades mayas de Yucatán. Fueron incluidas mujeres adultas con IMC ≥ 25kg/m2 de dos pequeñas localidades rurales mayas vecinas. Ambas intervenciones fueron de tres meses y con 11 sesiones, siguiendo la normatividad vigente; en la INBC fue utilizada la herramienta intercultural, denominada Plato del Bien Comer Maya, además se incluyeron en la INBC estrategias diseñadas con base en información obtenida en una fase previa de estudio cualitativo con entrevistas. El grupo con la INBC (n = 7), en comparación con el grupo con la INC (n = 9), tuvo una mayor disminución de IMC (-0,58 ± 0,70 kg/m2 y +0,27 ± 0,64 kg/m2; p = 0,042), de la circunferencia de cintura (-2,15 ± 2,60 cm y -0,50 ± 0,75 cm; p = 0,042) y del consumo de grasas (-53,23 ± 21,92 gramos y -7,34 ± 25,77 gramos; p = 0,004), así como mayor incremento en las frecuencias semanales de consumo de algunos alimentos locales como nance (p = 0,012), tamarindo (p = 0,001) y chile (p = 0,004), la INBC fue la única que presentó una disminución significativa en el consumo diario de calorías (basal: 2.067 ± 91 kcal/día, a los tres meses: 1.474 ± 31 kcal/día; p = 0,018), hubo en ambos grupos disminuciones en el consumo de alimentos ultraprocesados, pero sin diferencias comparando los grupos; el grupo con la INBC obtuvo mejores resultados que el grupo con la INC.

Poor nutritional conditions persist in many Mayan communities in Yucatán, Mexico, even though various programs have been implemented. The study aimed to compare the effects of a community-based nutritional intervention with an intercultural focus versus a conventional nutritional intervention on body mass index (BMI) and diet in women in Mayan communities in Yucatán. The sample included adult women with BMI ≥ 25kg/m2 from neighboring rural Mayan villages. Both interventions lasted three months with 11 sessions and followed the prevailing guidelines. The community-based intervention used an intercultural tool called Good Mayan Food [Plato del Bien Comer Maya], besides strategies designed according to information obtained from a prior qualitative study phase using interviews. The group that received the community-based intervention (n = 7), compared to the conventional intervention group (n = 9), showed larger decreases in BMI (-0.58 ± 0.70 kg/m2 and +0.27 ± 0.64kg/m2; p = 0.042), waist circumference (-2.15 ± 2.60 cm and -0.50 ± 0.75 cm; p = 0.042), and consumption of fats (-53.23 ± 21.92 grams and -7.34 ± 25.77 grams; p = 0.004), as well as higher increases in weekly consumption of some local foods such as nance fruit (p = 0.012), tamarind (p = 0.001), and chili peppers (p = 0.004). The community-based intervention was the only one to show a significant decrease in daily calorie intake (baseline: 2,067 ± 91 kcal/day, at three months: 1,474 ± 31 kcal/day; p = 0.018), and both groups showed decreases in the consumption of ultra-processed foods, but without significant differences between the two groups. The community-based intervention group showed better results than the conventional intervention group.

As más condições nutricionais em muitas localidades maias de Yucatán (México) persistem apesar da implementação de diversos programas. O objetivo era comparar os impactos de uma intervenção nutricional baseada na comunidade com enfoque intercultural (INBC) e uma intervenção nutricional convencional (INC), sobre o índice de massa corporal (IMC) e a dieta de mulheres de localidades maias de Yucatán. Foram incluídas mulheres adultas com IMC ≥ 25kg/m2 de duas pequenas localidades rurais maias vizinhas. Ambas as intervenções duraram três meses e contaram com 11 sessões, conforme as normas vigentes; na INBC, foi utilizada a ferramenta intercultural denominada Prato de Comer Bem Maia [Plato del Bien Comer Maya], além de estratégias adicionais idealizadas com base em dados obtidos em uma fase prévia de estudo qualitativo com entrevistas. Em comparação com o grupo com a INC (n = 9), o grupo com a INBC (n = 7) teve maior diminuição de IMC (-0,58 ± 0,70 kg/m2 e +0,27 ± 0,64 kg/m2; p = 0,042), da circunferência abdominal (-2,15 ± 2,60 cm y -0,50 ± 0,75 cm; p = 0,042) e do consumo de gorduras (-53,23 ± 21,92 gramas y -7,34 ± 25,77 gramas; p = 0,004), bem como um aumento maior das frequências semanais de consumo de alguns alimentos locais como o murici (p = 0,012), o tamarindo (p = 0,001) e pimenta (p = 0,004). A INBC foi a única a apresentar uma diminuição significativa do consumo diário de calorias (inicial: 2.067 ± 91 kcal/dia, após três meses: 1.474 ± 31 kcal/dia; p = 0.018). Houve em ambos os grupos redução equivalente do consumo de alimentos ultraprocessados; o grupo com a INBC obteve melhores resultados que o grupo com a INC.

Vulnerability and risk: reflections on the COVID-19 pandemic. / La vulnerabilidad y el riesgo: reflexiones a propósito de la pandemia del covid-19.

At the end of December 2019, SARS-COV-2 virus was identified as responsible for the COVID-19 pandemic. The rapid spread of transmission exposed structural failures of modern societies and of the health systems in preventing and containing a health threat. Scientific discussion has focused on the search for a vaccine, but less on understanding the social response to the current global threat and fear of outbreaks. In this essay, we reflect, based on the social sciences, on the importance of linking three concepts: vulnerability-perception-risk. This is necessary to develop preventive strategies appropriate to population circumstances, especially with the most vulnerable population, in favor of health equity.

A finales de diciembre 2019 se identificó el virus SARS-COV-2 como responsable de la pandemia de Covid-19. La rápida expansión de la transmisión puso al descubierto fallas estructurales de las sociedades modernas y de los sistemas de salud para prevenir y contener una amenaza sanitaria. La discusión científica se ha concentrado en la búsqueda de una vacuna, pero menos en comprender la respuesta social ante la amenaza globalizada actual y el temor a los rebrotes. En este ensayo reflexionamos, desde las ciencias sociales, sobre la importancia de vincular tres conceptos: vulnerabilidad-percepción-riesgo. Esto es necesario para desarrollar estrategias preventivas adecuadas a las circunstancias poblacionales, especialmente con la población más vulnerable, a favor de la equidad en salud.

No final de dezembro de 2019, o vírus SARS-COV-2 foi identificado como responsável pela pandemia de Covid-19. A rápida propagação da transmissão expôs falhas estruturais das sociedades modernas e dos sistemas de saúde na prevenção e contenção de uma ameaça sanitária. A discussão científica tem se concentrado na busca por uma vacina, mas menos na compreensão da resposta social à atual ameaça global e ao medo de novos surtos. Neste ensaio refletimos, a partir das ciências sociais, sobre a importância de associar três conceitos: vulnerabilidade-percepção-risco. Isso é necessário para desenvolver estratégias preventivas adequadas às circunstâncias da população, principalmente junto à população mais vulnerável, em prol da equidade na saúde.

Los Grupos de Ayuda Mutua como posible estrategia de apoyo emocional para personas indígenas que padecen diabetes / Mutual Aid Groups as a possible emotional support strategy for indigenous people with diabetes

Resumen: Objetivo: Reflexionar sobre el apoyo emocional que los Grupos de Ayuda Mutua (GAM) dan a personas indígenas con diabetes y su importancia en el apego al tratamiento. Material y métodos: Estudio cualitativo: 25 entrevistas semiestructuradas; tres grupos focales (17 participantes); y observación no participante. Se realizó análisis de contenido con el apoyo del programa Atlas-ti. Resultados: Se identificaron expresiones emocionales relacionadas con el padecimiento. La opinión sobre el trabajo grupal fue positiva. El GAM es un espacio de catarsis, pero no funciona como soporte para enfrentar las restricciones del tratamiento y el impacto emocional en caso de complicaciones mayores. Conclusiones: Con la debida capacitación del personal de salud a cargo de los grupos, los GAM pueden llegar a ser espacios de soporte emocional para las personas indígenas y contribuir a su bienestar.

Abstract: Objective: To think about the emotional support that Mutual Aid Groups (MAG) offer up to indigenous people with diabetes and their importance in adherence to treatment. Materials and methods: Qualitative study: 25 semi-structured interviews; 3 focus groups (17 participants); and non-participant observation. Content analysis was carried out with the support of the Atlas-ti program. Results: We identified emotional expressions related to the disease. The opinion about MAGs and group work was positive. The MAG is a catharsis space, but it does not work as a support to face the restrictions of the treatment and the emotional impact in case of major complications. Conclusions: With proper training of the health personnel in charge of the groups, MAGs can become emotional support spaces for indigenous people and contribute to their well-being.

La vulnerabilidad y el riesgo: reflexiones a propósito de la pandemia del covid-19 / Vulnerabilidade e risco: reflexões sobre a pandemia de Covid-19 / Vulnerability and risk: reflections on the COVID-19 pandemic

RESUMEN A finales de diciembre 2019 se identificó el virus SARS-COV-2 como responsable de la pandemia de Covid-19. La rápida expansión de la transmisión puso al descubierto fallas estructurales de las sociedades modernas y de los sistemas de salud para prevenir y contener una amenaza sanitaria. La discusión científica se ha concentrado en la búsqueda de una vacuna, pero menos en comprender la respuesta social ante la amenaza globalizada actual y el temor a los rebrotes. En este ensayo reflexionamos, desde las ciencias sociales, sobre la importancia de vincular tres conceptos: vulnerabilidad-percepción-riesgo. Esto es necesario para desarrollar estrategias preventivas adecuadas a las circunstancias poblacionales, especialmente con la población más vulnerable, a favor de la equidad en salud.

RESUMO No final de dezembro de 2019, o vírus SARS-COV-2 foi identificado como responsável pela pandemia de Covid-19. A rápida propagação da transmissão expôs falhas estruturais das sociedades modernas e dos sistemas de saúde na prevenção e contenção de uma ameaça sanitária. A discussão científica tem se concentrado na busca por uma vacina, mas menos na compreensão da resposta social à atual ameaça global e ao medo de novos surtos. Neste ensaio refletimos, a partir das ciências sociais, sobre a importância de associar três conceitos: vulnerabilidade-percepção-risco. Isso é necessário para desenvolver estratégias preventivas adequadas às circunstâncias da população, principalmente junto à população mais vulnerável, em prol da equidade na saúde.

ABSTRACT At the end of December 2019, SARS-COV-2 virus was identified as responsible for the COVID-19 pandemic. The rapid spread of transmission exposed structural failures of modern societies and of the health systems in preventing and containing a health threat. Scientific discussion has focused on the search for a vaccine, but less on understanding the social response to the current global threat and fear of outbreaks. In this essay, we reflect, based on the social sciences, on the importance of linking three concepts: vulnerability-perception-risk. This is necessary to develop preventive strategies appropriate to population circumstances, especially with the most vulnerable population, in favor of health equity.

Place of residence and social marginalization as prognostic factors for prostate cancer survival in Veracruz, Mexico. / Lugar de residencia y grado de marginación como factores pronóstico de supervivencia al cáncer de próstata en Veracruz, México.

OBJECTIVES: To determine if the place of residence and the level of social marginalization are associated with prostate cancer survival. MATERIALS AND METHODS: All patients diagnosed with prostate cancer (PC) in the period from 2013 to 2017 in a tertiary healthcare hospital in Veracruz, Mexico were included. Patients resided in rural and urban areas. Variables were collected according to clinical-epidemiological and histopathological characteristics. The Kaplan Meier method and the Log Rank test were used to measure survival. Prognostic factors were determined by calculating the adjusted hazard ratio (HRa) in a multivariate analysis using the Cox proportional risk method. RESULTS: A total of 186 PC cases were analyzed. Overall, after 5 years, 48.3% of the patients survived. Men living in urban areas had a higher probability of survival than those living in rural areas (HRa 1.67, 95% CI 1.16-2.41). Similarly, people living in areas classified as low- marginalization zones had a higher probability of survival than those living in areas with a high level of social marginalization (HRa 2.32, 95% CI 1.47-3.66). CONCLUSIONS: To reside in a rural place was identified as a negative prognostic factor for the survival of patients with PC regardless of other sociodemographic and clinical variables; patients living in high-marginalization places had an unfavorable survival prognosis.

OBJETIVOS: Determinar si el lugar de residencia y el grado de marginación se encuentran asociados a la supervivencia al cáncer de próstata. MATERIALES Y MÉTODOS: Se incluyeron a todos los pacientes diagnosticados con cáncer de próstata (CP) en el periodo 2013-2017 en un hospital de tercer nivel de atención de Veracruz, México. Los casos expuestos fueron los pacientes que habitualmente residían en zonas rurales, los no expuestos fueron los de zonas urbanas. Se recolectaron variables según características clínico epidemiológicas e histopatológicas. Para medir la supervivencia se utilizó el método de Kaplan Meier y la prueba de Log Rank. Los factores pronósticos fueron determinados calculando hazard ratio ajustado (HRa) en un análisis multivariado mediante el método de riesgos proporcionales de Cox. RESULTADOS: Se analizaron 186 casos de CP. La supervivencia global a 5 años fue de 48,3%. Los hombres que residían en zonas urbanas tuvieron una probabilidad de supervivencia mayor que quienes residían en zonas rurales (HRa 1,67; IC 95%: 1,16-2,41). Asimismo, las personas que vivían en lugares catalogados como zonas de baja marginación tuvieron una mayor probabilidad de supervivencia que quienes vivían en zonas de alta marginación (HRa 2,32; IC 95%: 1,47-3,66). CONCLUSIONES: El lugar de residencia rural se identificó como un factor de mal pronóstico para la supervivencia de pacientes con CP independientemente de otras variables sociodemográficas y clínicas; los pacientes que vivían en lugares con grados de marginación más elevados tuvieron un pronóstico desfavorable de supervivencia.

Lags in the provision of obstetric services to indigenous women and their implications for universal access to health care in Mexico.

Through quantitative and qualitative methods, in this article the authors describe the perspectives of indigenous women who received antenatal and childbirth medical care within a care model that incorporates a non-governmental organisation (NGO), Partners in Health. They discuss whether the NGO model better resolves the care-seeking process, including access to health care, compared with a standard model of care in government-subsidised health care units (setting of health services networks). Universal health coverage advocates access for the most disadvantaged and vulnerable populations as a priority. However, the issue of access includes problems related to the effect of certain structural social determinants that limit different aspects of the obstetric care process. The findings of this study show the need to modify the structure of organisational values in order to place users at the centre of medical care and ensure respect for their rights. The participation of agents outside the public system, such as NGOs, can be of great value for moving in this direction. Women's participation is also necessary for learning how they are being cared for and the extent to which they are satisfied with obstetric services. This research experience can be used for other countries with similar conditions.

Lugar de residencia y grado de marginación como factores pronóstico de supervivencia al cáncer de próstata en Veracruz, México / Place of residence and social marginalization as prognostic factors for prostate cancer survival in Veracruz, Mexico

Resumen Objetivos: Determinar si el lugar de residencia y el grado de marginación se encuentran asociados a la supervivencia al cáncer de próstata. Materiales y métodos: Se incluyeron a todos los pacientes diagnosticados con cáncer de próstata (CP) en el periodo 2013-2017 en un hospital de tercer nivel de atención de Veracruz, México. Los casos expuestos fueron los pacientes que habitualmente residían en zonas rurales, los no expuestos fueron los de zonas urbanas. Se recolectaron variables según características clínico epidemiológicas e histopatológicas. Para medir la supervivencia se utilizó el método de Kaplan Meier y la prueba de Log Rank. Los factores pronósticos fueron determinados calculando hazard ratio ajustado (HRa) en un análisis multivariado mediante el método de riesgos proporcionales de Cox. Resultados: Se analizaron 186 casos de CP. La supervivencia global a 5 años fue de 48,3%. Los hombres que residían en zonas urbanas tuvieron una probabilidad de supervivencia mayor que quienes residían en zonas rurales (HRa 1,67; IC 95%: 1,16-2,41). Asimismo, las personas que vivían en lugares catalogados como zonas de baja marginación tuvieron una mayor probabilidad de supervivencia que quienes vivían en zonas de alta marginación (HRa 2,32; IC 95%: 1,47-3,66). Conclusiones: El lugar de residencia rural se identificó como un factor de mal pronóstico para la supervivencia de pacientes con CP independientemente de otras variables sociodemográficas y clínicas; los pacientes que vivían en lugares con grados de marginación más elevados tuvieron un pronóstico desfavorable de supervivencia.

ABSTRACT Objectives: To determine if the place of residence and the level of social marginalization are associated with prostate cancer survival. Materials and methods: All patients diagnosed with prostate cancer (PC) in the period from 2013 to 2017 in a tertiary healthcare hospital in Veracruz, Mexico were included. Patients resided in rural and urban areas. Variables were collected according to clinical-epidemiological and histopathological characteristics. The Kaplan Meier method and the Log Rank test were used to measure survival. Prognostic factors were determined by calculating the adjusted hazard ratio (HRa) in a multivariate analysis using the Cox proportional risk method. Results: A total of 186 PC cases were analyzed. Overall, after 5 years, 48.3% of the patients survived. Men living in urban areas had a higher probability of survival than those living in rural areas (HRa 1.67, 95% CI 1.16-2.41). Similarly, people living in areas classified as low- marginalization zones had a higher probability of survival than those living in areas with a high level of social marginalization (HRa 2.32, 95% CI 1.47-3.66). Conclusions: To reside in a rural place was identified as a negative prognostic factor for the survival of patients with PC regardless of other sociodemographic and clinical variables; patients living in high-marginalization places had an unfavorable survival prognosis.

Expression of gynoecium patterning transcription factors in Aristolochia fimbriata (Aristolochiaceae) and their contribution to gynostemium development.

BACKGROUND: In Aristolochia (Aristolochiaceae) flowers, the congenital fusion of the anthers and the commissural, stigmatic lobes forms a gynostemium. Although the molecular bases associated to the apical-basal gynoecium patterning have been described in eudicots, comparative expression studies of the style and stigma regulatory genes have never been performed in early divergent angiosperms possessing a gynostemium. RESULTS: In this study, we assess the expression of five genes typically involved in gynoecium development in Aristolochia fimbriata. We found that all five genes (AfimCRC, AfimSPT, AfimNGA, AfimHEC1 and AfimHEC3) are expressed in the ovary, the placenta, the ovules and the transmitting tract. In addition, only AfimHEC3, AfimNGA and AfimSPT are temporarily expressed during the initiation of the stigma, while none of the genes studied is maintained during the elaboration of the stigmatic surfaces in the gynostemium. CONCLUSIONS: Expression patterns suggest that CRC, HEC, NGA and SPT homologs establish ovary and style identity in Aristolochia fimbriata. Only NGA,HEC3 and SPT genes may play a role in the early differentiation of the stigmatic lobes, but none of the genes studied seems to control late stigma differentiation in the gynostemium. The data gathered so far raises the possibility that such transient expression early on provides sufficient signal for late stigma differentiation or that unidentified late identity genes are controlling stigma development in the gynostemium. Our data does not rule out the possibility that stigmas could correspond to staminal filaments with convergent pollen-receptive surfaces.

Los Grupos de Ayuda Mutua como posible estrategia de apoyo emocional para personas indígenas que padecen diabetes.

Objetivo. Reflexionar sobre el apoyo emocional que los Grupos de Ayuda Mutua (GAM) dan a personas indígenas con diabetes y su importancia en el apego al tratamiento. Material y métodos. Estudio cualitativo: 25 entrevistas semiestructuradas; tres grupos focales (17 participantes); y observación no participante. Se realizó análisis de contenido con el apoyo del programa Atlas-ti. Resultados. Se identificaron expresiones emocionales relacionadas con el padecimiento. La opinión sobre el trabajo grupal fue positiva. El GAM es un espacio de catarsis, pero no funciona como soporte para enfrentar las restricciones del tratamiento y el impacto emocional en caso de complicaciones mayores. Conclusiones. Con la debida capacitación del personal de salud a cargo de los grupos, los GAM pueden llegar a ser espacios de soporte emocional para las personas indígenas y contribuir a su bienestar.

The importance of the cultural dimension of food in understanding the lack of adherence to diet regimens among Mayan people with diabetes.

OBJECTIVE: To understand non-adherence to medically recommended diets among Mayans with diabetes. DESIGN: Using partially sequential mixed methods, questionnaires, semi-structured brief and in-depth interviews were applied. Questionnaire data were analysed with Pearson's χ2 and Student's t tests and qualitative interviews with grounded theory microanalysis. SETTING: Rural, predominantly Mayan communities in Chiapas, Quintana Roo and Yucatan, Mexico, 2008-2012. PARTICIPANTS: Purposive sample of Mayans with type 2 diabetes; using public health care; 168 women and twenty-seven men; age 21-50+ years. RESULTS: Participants understood diabetes as caused by negative emotions, divine punishment, revenge via spells, chemicals in food and high sugar/fat consumption. Eliminating corn, pork, sugary beverages and inexpensive industrialized foods was perceived as difficult or impossible. More Mayans reporting not understanding physician instructions (30 v. 18 %) reported difficulty reducing red meat consumption (P = 0·051). Non-adherence was influenced by lack of patient-provider shared knowledge and medical recommendations misaligned with local culture. Men whose wives prepared their meals, women who liked vegetables and young adults whose mothers prepared their meals reported greater adherence to dietary recommendations. Partial adherents said it made life tolerable and those making no physician-recommended dietary changes considered them too restrictive (they meant 'starving to death'). Over half (57 %) of participants reported non-adherence; the two principal reasons were dislike of recommended foods (52·5 %) and high cost (26·2 %). CONCLUSIONS: Adherence to dietary regimens in diabetes treatment is largely related to social and cultural issues. Taking cultural diversity, food preferences, local food availability and poverty into consideration is essential when developing health-promotion activities related to diabetes.

Whole genomic sequencing as a tool for diagnosis of drug and multidrug-resistance tuberculosis in an endemic region in Mexico.

BACKGROUND: Whole genome sequencing (WGS) has been proposed as a tool for diagnosing drug resistance in tuberculosis. However, reports of its effectiveness in endemic countries with important numbers of drug resistance are scarce. The goal of this study was to evaluate the effectiveness of this procedure in isolates from a tuberculosis endemic region in Mexico. METHODS: WGS analysis was performed in 81 tuberculosis positive clinical isolates with a known phenotypic profile of resistance against first-line drugs (isoniazid, rifampin, ethambutol, pyrazinamide and streptomycin). Mutations related to drug resistance were identified for each isolate; drug resistant genotypes were predicted and compared with the phenotypic profile. Genotypes and transmission clusters based on genetic distances were also characterized. FINDINGS: Prediction by WGS analysis of resistance against isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin showed sensitivity values of 84%, 96%, 71%, 75% and 29%, while specificity values were 100%, 94%, 90%, 90% and 98%, respectively. Prediction of multidrug resistance showed a sensitivity of 89% and specificity of 97%. Moreover, WGS analysis revealed polymorphisms related to second-line drug resistance, enabling classification of eight and two clinical isolates as pre- and extreme drug-resistant cases, respectively. Lastly, four lineages were identified in the population (L1, L2, L3 and L4). The most frequent of these was L4, which included 90% (77) of the isolates. Six transmission clusters were identified; the most frequent was TC6, which included 13 isolates with a L4.1.1 and a predominantly multidrug-resistant condition. CONCLUSIONS: The results illustrate the utility of WGS for establishing the potential for prediction of resistance against first and second line drugs in isolates of tuberculosis from the region. They also demonstrate the feasibility of this procedure for use as a tool to support the epidemiological surveillance of drug- and multidrug-resistant tuberculosis.

Expression and function of the bHLH genes ALCATRAZ and SPATULA in selected Solanaceae species.

The genetic mechanisms underlying fruit development have been identified in Arabidopsis and have been comparatively studied in tomato as a representative of fleshy fruits. However, comparative expression and functional analyses on the bHLH genes downstream the genetic network, ALCATRAZ (ALC) and SPATULA (SPT), which are involved in the formation of the dehiscence zone in Arabidopsis, have not been functionally studied in the Solanaceae. Here, we perform detailed expression and functional studies of ALC/SPT homologs in Nicotiana obtusifolia with capsules, and in Capsicum annuum and Solanum lycopersicum with berries. In Solanaceae, ALC and SPT genes are expressed in leaves, and all floral organs, especially in petal margins, stamens and carpels; however, their expression changes during fruit maturation according to the fruit type. Functional analyses show that downregulation of ALC/SPT genes does not have an effect on gynoecium patterning; however, they have acquired opposite roles in petal expansion and have been co-opted in leaf pigmentation in Solanaceae. In addition, ALC/SPT genes repress lignification in time and space during fruit development in Solanaceae. Altogether, some roles of ALC and SPT genes are different between Brassicaceae and Solanaceae; while the paralogs have undergone some subfunctionalization in the former they are mostly redundant in the latter.

[Adolescents opinions regarding Plato del Bien Comer Maya as nutrition health promotion tool.] / Opiniones de adolescentes sobre el Plato del Bien Comer Maya como herramienta de promoción de la salud.

OBJECTIVE: To know opinions of adolescents from Cholul, Yucatán, about Plato del Bien Comer Maya in order to improve it as health promotion tool. MATERIALS AND METHODS: Qualitative study, formative research. Three focus groups were carried out, participating 28 adolescents: 12-16 years old. Criteria of inclusion: studying middle school; to have native family from the town. Analysis of the data made manually. RESULTS: Comparatively with the national Plato del Bien Comer, the Plato Maya was better identified because have local food products easier to obtain and cheaper. The principal finding was to understand Fruto is a linguistic variation word which represents in Maya context both fruits and vegetables. This might be an important key to improve health promotion activities with that population. CONCLUSIONS: In order to have better results in nutritional interventions, it is necessary to design educational-communicative strategies in accordance with the local culture.

OBJETIVO: Conocer opiniones sobre el Plato del Bien Comer Maya de adolescentes de Cholul, Yucatán, para mejorar la herramienta comunicativa y utilizarla en actividades depromoción de la salud. MATERIAL Y MÉTODOS: Estudio cualitativo, de investigación formativa. Se realizaron tres grupos focales, participaron 28 adolescentes de secundaria: 12-16 años. Criterios de inclusión: pertenecer a alguno de los tres grados de la escuela y tener familias originarias del poblado. El análisis de los datos se realizó manualmente. RESULTADOS: En comparación con el Plato del Bien Comer nacional, el Plato Maya fue mejor identificado por tener elementos locales a los que pueden acceder fácilmente y con costos menores. Se identificó la palabra fruto como una variación lingüística que representa en ese contexto tanto a las frutas como a las verduras. CONCLUSIONES: Para tener mejores resultados en intervenciones nutricionales es necesario diseñar estrategias educativo-comunicativas acordes con la cultura local.

Opiniones de adolescentes sobre el Plato del Bien Comer Maya como herramienta de promoción de la salud / Adolescents opinions regarding Plato del Bien Comer Maya as nutrition health promotion tool

Resumen: Objetivo: Conocer opiniones sobre el Plato del Bien Comer Maya de adolescentes de Cholul, Yucatán, para mejorar la herramienta comunicativa y utilizarla en actividades de promoción de la salud. Material y métodos: Estudio cualitativo, de investigación formativa. Se realizaron tres grupos focales, participaron 28 adolescentes de secundaria: 12-16 años. Criterios de inclusión: pertenecer a alguno de los tres grados de la escuela y tener familias originarias del poblado. El análisis de los datos se realizó manualmente. Resultados: En comparación con el Plato del Bien Comer nacional, el Plato Maya fue mejor identificado por tener elementos locales a los que pueden acceder fácilmente y con costos menores. Se identificó la palabra fruto como una variación lingüística que representa en ese contexto tanto a las frutas como a las verduras. Conclusiones: Para tener mejores resultados en intervenciones nutricionales es necesario diseñar estrategias educativo-comunicativas acordes con la cultura local.

Abstract : Objective: To know opinions of adolescents from Cholul, Yucatán, about Plato del Bien Comer Maya in order to improve it as health promotion tool. Materials and methods: Qualitative study, formative research. Three focus groups were carried out, participating 28 adolescents: 12-16 years old. Criteria of inclusion: studying middle school; to have native family from the town. Analysis of the data made manually. Results: Comparatively with the national Plato del Bien Comer, the Plato Maya was better identified because have local food products easier to obtain and cheaper. The principal finding was to understand Fruto is a linguistic variation word which represents in Maya context both fruits and vegetables. This might be an important key to improve health promotion activities with that population. Conclusions: In order to have better results in nutritional interventions, it is necessary to design educational-communicative strategies in accordance with the local culture.