Segmented intravaginal ring for the combination delivery of hydroxychloroquine and anti-CCR5 siRNA nanoparticles as a potential strategy for preventing HIV infection.

Vaginal drug delivery has been shown to be a promising strategy for the prevention of sexually transmitted infections. Therapy delivered at the site of infection has many advantages including improved therapeutic efficacy, reduction in systemic toxicity, and reduced potential for development of drug resistance. We developed a "smart" combination intravaginal ring (IVR) that will (1) provide continuous release of hydroxychloroquine (HCQ) to induce T cell immune quiescence as the first-line of defense and (2) release nanoparticles containing anti-CCR5 siRNA only during sexual intercourse when triggered by the presence of seminal fluid as the second-line of defense. The IVR was capable of releasing HCQ over 25 days with a mean daily release of 31.17 ± 3.06 µg/mL. In the presence of vaginal fluid simulant plus seminal fluid simulant, over 12 × more nanoparticles (5.12 ± 0.9 mg) were released over a 4-h period in comparison to IVR segments that were incubated in the presence of vaginal fluid simulant alone (0.42 ± 0.19 mg). Anti-CCR5 siRNA nanoparticles were able to knockdown 83 ± 5.1% of CCR5 gene expression in vitro in the CD4+ T cell line Sup-T1. The IVR system also demonstrated to be non-cytotoxic to VK2/E6E7 vaginal epithelial cells.

The unintended effects of the COVID-19 pandemic and stay-at-home orders on abortions.

We study the effect of the COVID-19 pandemic and of government mandated mitigation policies on the number of abortions performed by Mexico City's public abortion program. We find that the COVID-19 pandemic and stay-at-home orders (SAHO) implemented in Mexico led to unintended consequences for women's sexual and reproductive health. Using difference-in-differences and event study analyses, we show that SAHO and the pandemic led to a fall in abortions of around 25% and find no evidence that unsafe abortions increased. We find a decrease in the share of single and teenage women getting abortions, arguably due to fewer unwanted pregnancies from decreased sexual activity, and estimate that at most 9.8% of the total fall in abortions can be attributed to this. We complement our analysis using call data from a government helpline and show that the SAHO time period led to fewer abortion- and contraception-related calls but to an increase in pregnancy-related calls.

Changes in Weight-Related Outcomes Among Adolescents Following Consumer Price Increases of Taxed Sugar-Sweetened Beverages.

Importance: Following the implementation of a tax on sugar-sweetened beverages (SSBs) in Mexico in 2014, SSB prices increased by about 10% on average, but differently across cities. It remains unclear how observed SSB price changes are associated with adolescent weight-related outcomes. Objective: To compare weight-related outcomes among adolescents living in cities with differential SSB price changes before and after the SSB tax was implemented in Mexico. Design, Setting, and Participants: Associations between differential SSB price changes and changes in weight-related outcomes were examined overall and by sex among 12 654 adolescents aged 10 to 18 years born between 1999 and 2002 living in 39 cities in Mexico. Multivariate regressions with individual fixed effects were applied on longitudinal individual-level yearly clinical data (height and weight) from 2012 to 2017 collected by the Instituto Mexicano del Seguro Social (IMSS) and merged with city-level SSB price data from 2011 to 2016 collected by the National Institute of Statistics and Geography (INEGI). Data were analyzed from July 2018 to July 2021. Exposures: Yearly city-level changes in SSB prices between 2011 and 2016. Main Outcomes and Measures: Age- and sex-specific body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) percentile and indicator for overweight or obesity if BMI was at or above the 85th percentile. Results: Before 2014, 46% of 12 654 adolescents (6850 girls and 5804 boys) included in this study had obesity or overweight. The mean (SD) age was 11.38 (1.08) years. Among girls, a 10% SSB price increase was associated with a 1.3 percentage point absolute decrease (95% CI, -2.19 to -0.36; P = .008) or a 3% relative decrease in overweight or obesity prevalence within 2 years of a price change. For girls with BMI at or above the 75th percentile pretax, this price increase was associated with a 0.59 lower BMI percentile (95% CI, -1.08 to -0.10; P = .02) or a 0.67% relative decrease. Improved outcomes for girls were observed in cities where price increases were greater than 10% after the tax. No such associations were observed for boys. Conclusions and Relevance: In this study, increased SSB prices were associated with decreased overweight or obesity prevalence among girls but not among boys. Improvements in outcomes were small, and mostly observed for girls with heavier weight and in cities where price increases after the tax were greater than 10%.

When less is more: Can reduced health monitoring improve medication adherence?

As the prevalence of chronic diseases rises, improving self-management has become an important determinant of the productivity of healthcare delivery. Recently, Mexico's largest healthcare provider began issuing automatic-refill prescriptions to stable hypertensive patients, thus reducing the frequency of health monitoring from 30- to 90-day intervals. Exploiting this change, I find that less monitoring implies no drawbacks in health outcomes and actually improves self-management of disease by increasing medication adherence when baseline monitoring is relatively frequent. The number of days when patients are out of medication between fillings falls by 2.2 days-an improvement in adherence of 6.4%. Furthermore, patients appear to value being on a low-frequency regime as they improve adherence in order to remain on it, suggesting that lower monitoring could be used as a "reward" to promote medication adherence or, potentially, other health behaviors. Finally, I find evidence of positive spillovers on adherence, as clinic congestion falls.

Air pollution exposure and COVID-19: A look at mortality in Mexico City using individual-level data.

We use individual-level data to estimate the effects of long- and short-term exposure to air pollution (PM2.5) on the probability of dying from COVID-19. To the best of our knowledge, our study is the first to look at this relationship using individual-level data. We find that for Mexico City there is evidence of a positive relationship between pollution and mortality that significantly grows with age and that appears to be mostly driven by long- rather than short-term exposure. By using a rich set of individual- and municipal-level covariates we are able to isolate the effect of exposure to pollution from other crucial factors, thus alleviating endogeneity concerns related to selection. Our results provide yet another reason for the need to implement environmental strategies that will reduce the exposure to air pollution: it is a key element to improve the general population's health. In addition, and considering that at this moment we do not know when the pandemic will stop or if SARS-CoV-2 will become a recurrent threat, the relationship that we uncovered suggests that financial resources should be allocated to improve medical services in those areas where PM2.5 concentrations tend to be high.

Caracterización de la conducta adaptativa en escolares con y sin discapacidad intelectual de la región de la Araucanía / Characterization of adaptive behavior in students with and without intellectual disabilities in the araucanía region

Esta investigación se enfoca en la caracterización de la conducta adaptativa en escolares con y sin discapacidad intelectual de la Región de La Araucanía, Chile. Se utilizó el Inventario para la Planificación de Servicios y Programación Individual (ICAP), aplicado a padres y/o tutores legales de 22 niños con discapacidad intelectual y 33 niños sin discapacidad. Las edades fluctuaron entre los 6 y 12 años, con un diseño no probabilístico en conglomerados. El método utilizado es descriptivo-comparativo. Los resultados señalan que existen diferencias de las conductas adaptativas, donde los escolares sin discapacidad presentan un mayor nivel de desarrollo, además ambos grupos poseen un perfil heterogéneo en las destrezas que componen el funcionamiento adaptativo, donde las destrezas motoras son las más altas, mientras que las destrezas de la vida en comunidad son las más bajas. Se concluye que las diferencias encontradas se ven afectadas por la presencia de discapacidad intelectual y por el contexto educativo. Esta investigación se enmarca en el proyecto de investigación DI12-0077 denominado Propiedades psicométricas de la versión española del Inventario para la planificación de servicios y la programación individual (ICAP), en escolares de la ciudad de Temuco.

This investigation focused on the characterization of adaptive behavior in students with or without intellectual disabilities in the Araucanía Region in Chile. The Inventory for Service Planning and Individual Programming (ICAP) was used with a sample of parents or legal tutors of 22 children with intellectual disabilities and 33 children without disabilities. The ages of the students ranged between 6 and 12 years, with a non-probabilistic cluster sampling design, with descriptive-comparative methods for analysis. Results show differences in adaptive behavior between the assessed groups, where students without disabilities show a higher level of development. Also both groups exhibit heterogeneous skill profiles, with motor skills being the most developed, and life skills in community being the least developed. These differences might have been affected by the presence of intellectual disabilities and by the educational contexts. This study is associated to the DI120077 research project entitled "Psychometric Properties of the Spanish version of the inventory for service planning and individual programming (ICAP), in students of the city of Temuco".