HEARTS in the Americas is the largest-scale implementation of the WHO's global initiative, with 33 countries participating, 28 having adopted standardized clinical pathways, and about 10 000 primary healthcare facilities engaged. Despite progress, fragmented care, limited availability of validated blood pressure devices, restricted access to essential medicines, and weak quality assurance systems continue to hinder hypertension control and cardiovascular risk management. In response, PAHO and participating countries co-developed the HEARTS Quality Framework. Grounded in regional implementation, this model synthesizes global evidence and lessons from Latin America and the Caribbean. Co-designed by Ministries of Health, care providers, and international experts, it translates HEARTS strategies into actionable system-level objectives. Clearly defined outcome indicators and implementation targets promote institutionalization, quality improvement, and primary healthcare strengthening- supporting HEARTS scale-up and equitable outcomes. With appropriate contextualization, the HEARTS Quality Framework provides a practical roadmap for countries beyond the Region to advance primary healthcare-based chronic disease care. HEARTS en las Américas constituye la implementación a mayor escala de la iniciativa mundial HEARTS de la Organización Mundial de la Salud (OMS), con la participación de 33 países, 28 de los cuales han adoptado vías clínicas estandarizadas, y cerca de 10 000 centros de atención primaria implicados. A pesar de los avances, algunos factores como la atención fragmentada, la escasa disponibilidad de dispositivos validados para medir la presión arterial, el acceso restringido a medicamentos esenciales y la debilidad de los sistemas de garantía de la calidad continúan obstaculizando el control de la hipertensión y la gestión del riesgo cardiovascular. En respuesta, la Organización Panamericana de la Salud (OPS) y los países participantes elaboraron conjuntamente el marco de calidad de HEARTS. Partiendo de las experiencias regionales de implementación, este modelo sintetiza la evidencia mundial y las enseñanzas de América Latina y el Caribe. Diseñado conjuntamente por ministerios de salud, prestadores de servicios y expertos internacionales, este marco de calidad traduce las estrategias de HEARTS en objetivos operativos ejecutables a nivel del sistema de salud. Los indicadores de resultados y las metas de implementación, claramente definidos, fomentan la institucionalización, la mejora continua de la calidad y el fortalecimiento de la atención primaria de salud, apoyando la expansión de HEARTS y la obtención de resultados equitativos. Con la contextualización adecuada, el marco de calidad de HEARTS ofrece una hoja de ruta práctica para que otros países fuera de la Región de las Américas avancen hacia una atención de las enfermedades crónicas basada en la atención primaria de salud. A iniciativa HEARTS nas Américas é a implementação em maior escala da iniciativa mundial HEARTS da Organização Mundial da Saúde (OMS), com a participação de 33 países – 28 dos quais adotaram itinerários clínicos padronizados – e de cerca de 10 000 centros de atenção primária. Apesar dos avanços, alguns fatores, como a atenção fragmentada, a disponibilidade limitada de aparelhos validados para medir a pressão arterial, o acesso restrito a medicamentos essenciais e a fragilidade dos sistemas de garantia da qualidade, continuam dificultando o controle da hipertensão arterial e o manejo do risco cardiovascular. Em resposta, a Organização Pan-Americana da Saúde (OPAS) e os países participantes elaboraram conjuntamente o marco de qualidade da iniciativa HEARTS. Com base nas experiências regionais de implementação, esse modelo sintetiza as evidências mundiais e as lições aprendidas na América Latina e no Caribe. Elaborado em conjunto por ministérios da Saúde, prestadores de serviços e especialistas internacionais, o marco de qualidade traduz as estratégias da iniciativa HEARTS em objetivos operacionais executáveis no âmbito do sistema de saúde. Os indicadores de resultados e as metas de implementação, claramente definidos, fomentam a institucionalização, a melhoria contínua da qualidade e o fortalecimento da atenção primária à saúde, apoiando a expansão da iniciativa HEARTS e a obtenção de resultados equitativos. Com a devida contextualização, o marco de qualidade da iniciativa HEARTS oferece um roteiro prático para que outros países fora da Região das Américas promovam a atenção às doenças crônicas no âmbito da atenção primária à saúde.
To present the background, results, contributions, challenges, future prospects of the Regional Network of Focal Points for Prevention, Detection, and Response to Substandard and Falsified Medical Products (SF Network) in the Americas during the two decades of its existence. A documentary review was conducted to identify the background, results, and future prospects of the SF Network. The time horizon considered was 1999 -2025. The data are presented in narrative form. At present, 28 countries in the Region of the Americas have active participation in the initiative. This has made it possible to: exchange information on nearly 650 incidents over the past 10 years; publish 12 technical documents on this subject; and convene 14 national meetings and workshops in the Region. The three key achievements of the initiative are collaborative work, the strengthening of market surveillance and control capacities among members, and the sustainability strategy. The achievements, experiences, and actions of the SF Network represent a success story that demonstrates the value and necessity of using models that facilitate exchange and collaboration between countries. The future of the SF Network should focus on new forms of member participation that strengthen the development of solutions and strategies, in relation to both known issues and emerging regional and global challenges. Presentar los antecedentes, los resultados alcanzados, las contribuciones, así como los desafíos y las perspectivas futuras de la Red regional de puntos focales para la prevención, la detección y la respuesta a productos médicos subestándares y falsificados en las Américas (Red SF) durante sus dos décadas de existencia. Se realizó una revisión documental con el fin de identificar los antecedentes, los resultados y la perspectiva futura de la Red SF. Se contemplaron como horizonte temporal los años 1999 y 2025. Los datos se presentan de forma narrativa. En la actualidad, 28 países de la Región de las Américas participan activamente en la iniciativa. Esto ha permitido intercambiar información sobre cerca de 650 incidentes en los últimos diez años, publicar 12 documentos técnicos sobre esta temática y desarrollar 14 jornadas y talleres nacionales en la Región. El trabajo colaborativo, el fortalecimiento de las capacidades de vigilancia y control del mercado de los miembros; y su estrategia de sostenibilidad son los tres logros clave de la iniciativa. Los logros, las experiencias y las acciones de la Red SF constituyen un caso de éxito que demuestra el valor y la necesidad de utilizar modelos que favorezcan el intercambio y colaboración entre los países. El futuro de la Red SF debería enfocarse en nuevas formas de participación de sus miembros que fortalezcan el desarrollo de soluciones y estrategias, tanto en lo relativo a las problemáticas conocidas como a los desafíos emergentes regionales y globales. Apresentar os antecedentes, os resultados alcançados e as contribuições, bem como os desafios e as perspectivas futuras da Rede regional de pontos focais de prevenção, detecção e resposta no âmbito de produtos médicos de qualidade inferior e falsificados na Região das Américas (Rede SF) ao longo de duas décadas de existência. Foi realizada uma análise documental para identificar os antecedentes, os resultados alcançados e as perspectivas futuras da Rede SF. Considerou-se o período entre 1999 e 2025. As informações obtidas são apresentadas em formato narrativo. Atualmente, 28 países da Região das Américas participam ativamente da iniciativa. O trabalho da rede possibilitou o intercâmbio de informações sobre cerca de 650 incidentes nos últimos 10 anos, a publicação de 12 relatórios técnicos sobre o tema e a organização de 14 seminários e workshops nacionais na Região. O trabalho colaborativo entre os países, o fortalecimento das capacidades de vigilância e controle pós-comercialização e a estratégia de sustentabilidade destacam-se como as três principais conquistas da iniciativa. As conquistas, experiências e ações da Rede SF evidenciam uma trajetória de sucesso e demonstram a importância e a necessidade de utilizar modelos que promovam o intercâmbio de informações e a colaboração entre países. O trabalho futuro da rede deverá se concentrar em novas formas de participação dos membros com o objetivo de fortalecer o desenvolvimento de soluções e estratégias, tanto em relação a problemas conhecidos quanto a desafios emergentes em âmbito regional e global.
The irregular migration of unaccompanied girls, boys, and adolescents from Central America, Mexico, and the United States has increased over the past decade. These individuals face a continuum of violence at the origin, path, and destination of their trajectories that affects their mental health and well-being. This study investigates the violence suffered by these unaccompanied girls, boys, and adolescents in their communities of origin, migratory journey, and final destination, exploring the associated mental health problems and implemented coping strategies. This binational qualitative study was carried out (June 2022-June 2023) with semi-structured interviews with 20 unaccompanied girls, boys, and adolescents from Central America and 14 key informants in Mexico and the United States of America. Unaccompanied girls, boys, and adolescents described multiple forms of violence in their place of origin, during the path, and final destination. These experiences generated emotional, cognitive, and behavioral consequences consistent with migratory stress, including anxiety, depressive symptoms, suicidal ideation, and difficulties in adapting. However, adolescents used coping strategies such as migrating to escape violence, denouncing perpetrators, consolidating support networks with peers and civil society organizations, continuing their studies, and starting family life again at their destination. The findings show the exposure of unaccompanied girls, boys, and adolescents to a continuum of structural and daily violence that affects their mental health and challenges government support. However, they also show their capacity for resilience and action. A comprehensive public policy approach is needed that acknowledges these experiences, guarantees mental health care, and ensures the best interest of these young migrants. La migración irregular de niñas, niños y adolescentes no acompañados de Centroamérica hacia México y Estados Unidos ha aumentado en la última década. Estos adolescentes enfrentan un continuum de violencia en el origen, tránsito y destino, que impacta su salud mental y bienestar. Este estudio analiza las violencias experimentadas por niñas, niños y adolescentes no acompañados en sus comunidades de origen, durante el tránsito migratorio y en el destino, explorando los problemas de salud mental asociados y las estrategias de afrontamiento implementadas. Se realizó un estudio cualitativo binacional (junio 2022-junio 2023) con entrevistas semiestructuradas a 20 niñas, niños y adolescentes no acompañados de origen centroamericano y 14 informantes clave en México y Estados Unidos. Niñas, niños y adolescentes no acompañados reportaron múltiples violencias en el origen, durante el tránsito y en el destino. Estas experiencias generaron consecuencias emocionales, cognitivas y conductuales consistentes con estrés migratorio, incluyendo ansiedad, síntomas depresivos, ideación suicida y dificultades de adaptación. A pesar de ello, los adolescentes desplegaron estrategias de afrontamiento como migrar para escapar de la violencia, denunciar a perpetradores, conformar redes de apoyo con pares y organizaciones de la sociedad civil, continuar estudios y reiniciar la vida familiar en destino. Los hallazgos evidencian la exposición de niñas, niños y adolescentes no acompañados a un continuum de violencias estructurales y cotidianas que afectan su salud mental y desafían la protección estatal. Sin embargo, también muestran su capacidad de resiliencia y agencia. Se requiere un abordaje integral en políticas públicas que reconozca estas experiencias, garantice atención en salud mental y asegure el interés superior de la niñez migrante. A migração irregular de garotas, garotos e adolescentes desacompanhados da América Central, México e Estados Unidos tem aumentado na última década. Estes indivíduos enfrentam um continuum de violência na origem, caminho e destino de suas trajetórias, afetando a saúde mental e bem-estar. Este estudo investiga a violência sofrida por estes garotos, garotas e adolescentes desacompanhados em suas comunidades de origem, durante o percurso migratório e o destino final, explorando os problemas de saúde mental associados e as estratégias de enfrentamento implementadas. Foi realizado um estudo qualitativo binacional (junho de 2022-junho de 2023) com entrevistas semiestruturadas com 20 garotas, garotos e adolescentes desacompanhados oriundos da América Central e 14 informantes-chave no México e Estados Unidos. Garotas, garotos e adolescentes desacompanhados descreveram múltiplas formas de violência no seu local de origem, durante o caminho e no destino final. Estas vivencias geraram consequências emocionais, cognitivas e comportamentais consistentes com estresse migratório, incluindo ansiedade, sintomas depressivos, ideação suicida e dificuldades em se adaptar. Contudo, os adolescentes utilizaram estratégias de enfrentamento como migração para escapar da violência, denuncia de perpetradores, consolidar redes de apoio com pares e organizações da sociedade civil, continuar os estudos e recomeçar a vida em família no destino. Os achados evidenciam a exposição dos garotas, garotos e adolescentes desacompanhados a um continuum de violências estruturais e cotidianas que afetam sua saúde mental e desafiam o suporte governamental. Contudo, também mostram sua capacidade de resiliência e ação. É necessário uma abordagem integral de políticas públicas que reconheça estas vivências, garanta atenção em saúde mental e assegure o interesse destes jovens migrantes.
Cardiovascular diseases remain the leading cause of premature morbidity and mortality globally, with hypertension as their main modifiable risk factor. In Latin America and the Caribbean, hypertension affects more than 30% of adults, yet control rates remain alarmingly low. The HEARTS in the Americas Initiative, led by the Pan American Health Organization, promotes a model of team-based care to enhance risk management for hypertension and cardiovascular diseases within primary health care. Team-based care leverages the skills of diverse health professionals, including nurses, pharmacists and community health workers, to optimize resource allocation, task-sharing and care delivery. Evidence underscores the effectiveness of team-based care in improving blood pressure control, reducing hospitalizations and enhancing quality of life through strategies such as periodic follow up and medication titration. Despite its benefits, implementing team-based care faces cultural and systemic barriers. This special report outlines a policy framework to scale team-based care across the Region of the Americas, ensuring equitable access to high-quality, cost-effective prevention and care for cardiovascular diseases. Las enfermedades cardiovasculares siguen siendo la principal causa de morbilidad y mortalidad prematuras en todo el mundo, y la hipertensión es su principal factor de riesgo modificable. En América Latina y el Caribe, aunque la hipertensión afecta a más del 30% de las personas adultas, las tasas de control siguen siendo alarmantemente bajas. La iniciativa HEARTS en las Américas, liderada por la Organización Panamericana de la Salud, promueve un modelo de atención basada en el trabajo en equipo para mejorar el manejo del riesgo de hipertensión y enfermedades cardiovasculares en la atención primaria de salud. En la atención basada en el trabajo en equipo se aprovechan las competencias de diversos profesionales de la salud —por ejemplo, profesionales de la enfermería, personal farmacéutico y agentes comunitarios de salud— para optimizar la asignación de recursos, la división de tareas y la prestación de cuidados. La evidencia subraya la eficacia de la atención basada en el trabajo en equipo para mejorar el control de la presión arterial, reducir el número de hospitalizaciones y mejorar la calidad de vida mediante estrategias como el seguimiento periódico y el ajuste de la medicación. A pesar de sus ventajas, la implantación de la atención basada en el trabajo en equipo enfrenta obstáculos culturales y sistémicos. En este informe especial se presenta un marco de política para ampliar la atención basada en el trabajo en equipo en toda la Región de las Américas, garantizando un acceso equitativo a una prevención y atención de buena calidad y costo-efectiva de las enfermedades cardiovasculares. As doenças cardiovasculares continuam sendo a principal causa de morbimortalidade prematura no mundo, e a hipertensão arterial é o principal fator de risco modificável. Na América Latina e no Caribe, a hipertensão arterial afeta mais de 30% dos adultos, mas as taxas de controle permanecem assustadoramente baixas. A iniciativa HEARTS nas Américas, liderada pela Organização Pan-Americana da Saúde, promove um modelo de atenção baseada em equipe para aprimorar a gestão do risco de hipertensão arterial e doenças cardiovasculares na atenção primária à saúde. A atenção baseada em equipe procura aproveitar as habilidades de diversos profissionais da saúde, como profissionais de enfermagem e farmácia e agentes comunitários de saúde, para otimizar a alocação de recursos, o compartilhamento de tarefas e a prestação de cuidados. As evidências destacam a efetividade da atenção baseada em equipe para melhorar o controle da pressão arterial, reduzir as internações hospitalares e melhorar a qualidade de vida, por meio de estratégias como o acompanhamento periódico e o ajuste da dose dos medicamentos. Apesar de seus benefícios, a implementação da atenção baseada em equipe enfrenta barreiras culturais e sistêmicas. Este relatório especial descreve uma estrutura de política para ampliar a atenção baseada em equipe em toda a Região das Américas, garantindo acesso equitativo a serviços custo-efetivos de alta qualidade para prevenção e cuidado de doenças cardiovasculares.
How treatment shapes survival after breast-cancer recurrence in Latin America remains poorly described. We extended follow-up of the Latin American Cancer Research Network cohort to quantify post-recurrence overall survival, describe systemic-therapy pathways, and assess the robustness of survival estimates to incomplete follow-up. We conducted a cohort study of women enrolled with stage I-III breast cancer at 31 centres in Argentina, Brazil, Chile, Mexico, and Uruguay between 2011 and 2014. Vital status and systemic treatments were updated from medical records to July 1, 2025. The main outcome was overall survival after recurrence, defined from first recurrence to death from any cause or censoring. Kaplan-Meier curves and log-rank tests compared survival by immunohistochemistry-defined subtype. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated with a Firth-penalised Cox model. Sensitivity analyses included best-case and worst-case censoring, inverse-probability-of-censoring weighting, and Fine-Grey competing-risk regression. Systemic-therapy sequences were reconstructed for up to six lines. Vital status was updated for 970 of 1191 women (81.4%), and 162 had a documented first recurrence. Median overall survival after recurrence was 24.0 months (IQR 9.6-45.6). Compared with triple-negative breast cancer, adjusted HRs were 0.64 (95% CI 0.20-1.77) for hormone receptor-negative/HER2-positive disease, 0.54 (0.26-1.14) for hormone receptor-positive/HER2-negative disease, and 0.93 (0.39-2.20) for hormone receptor-positive/HER2-positive disease. Chemotherapy was the first-line regimen in 83 of 162 patients (51%), endocrine monotherapy in 55 of 162 (34%), and trastuzumab-pertuzumab-taxane or cyclin-dependent kinase 4 and 6 inhibitor-based regimens in eight of 162 (5%). Overall, 87 of 162 patients (54%) initiated second-line therapy. Adjusted subtype HRs were imprecise and should be interpreted cautiously. Steep treatment-line attrition, limited uptake of contemporary targeted therapies, and incomplete follow-up in some health-system settings indicate modifiable regional gaps in metastatic breast-cancer care. ASCO Conquer Cancer & Pfizer Competitive Grant for Quality Improvement (contract award No. 87534309); Center for Global Health at the United States-National Cancer Institute at the National Institutes of Health (contract award No. HHSN2612010000871/NO2-PC-2010-00087); Fogarty International Center, NIH, HHS; and Susan G. Komen for the Cure; in Argentina, Instituto Nacional del Cáncer (Ministry of Health), Fundación Argentina de Nanotecnología, Agencia Nacional de Promoción Científica y Tecnológica, CONICET (Ministry of Science, Technology, and Productive Innovation); Brazil, Ministério da Saúde (Ministry of Health); Chile, Instituto de Salud Pública (Public Health Institute) and Ministerio de Salud (Ministry of Health); and Mexico, Consejo Estatal de Ciencia y Tecnología de Jalisco (COECYTJAL) and Universidad de Sonora (University of Sonora). La forma en que el tratamiento condiciona supervivencia tras recurrencia del cáncer de mama en América Latina sigue estando escasamente descrita. Extendimos el seguimiento de la cohorte de la Latin American Cancer Research Network para cuantificar la supervivencia global después de recurrencia, describir trayectorias de tratamiento sistémico y evaluar solidez de las estimaciones frente al seguimiento incompleto. Realizamos un estudio de cohorte de mujeres con cáncer de mama estadio I-III en 31 centros de Argentina, Brasil, Chile, México y Uruguay entre 2011 y 2014. Estado vital y tratamientos sistémicos se actualizaron hasta Julio 1, 2025. El desenlace principal fue supervivencia global después de recurrencia. Se comparó supervivencia según subtipo por inmunohistoquímica mediante curvas de Kaplan–Meier y pruebas de log-rank. Los cocientes de riesgos ajustados (HR) con intervalos de confianza (IC) del 95% se estimaron con un modelo de Cox penalizado de Firth. También se realizaron análisis de sensibilidad y se reconstruyeron secuencias de tratamiento sistémico hasta seis líneas. Se actualizó estado vital de 970/1191 mujeres (81.4%), y 162 tuvieron una primera recurrencia documentada. Supervivencia global después de recurrencia fue 24.0 meses (RIC 9.6–45.6). En comparación con cáncer de mama triple-negativo, HR ajustados fueron 0.64 (IC 95% 0.20–1.77) para receptores hormonales negativos y HER2-positivo, 0.54 (0.26–1.14) para receptores hormonales positivos y HER2-negativo, y 0.93 (0.39–2.20) para receptores hormonales positivos y HER2-positivo. Quimioterapia fue tratamiento de primera línea en 83/162 pacientes (51%), monoterapia endocrina en 55/162 (34%), y esquemas con trastuzumab-pertuzumab-taxano o inhibidores CDK4/6 en 8/162 (5%). 87/162 pacientes (54%) iniciaron segunda línea. HR ajustados fueron imprecisos y deben interpretarse con cautela. La marcada pérdida de pacientes entre líneas, limitada incorporación de terapias dirigidas contemporáneas y el seguimiento incompleto en algunos entornos del sistema de salud señalan brechas regionales modificables en atención de cáncer de mama metastásico. ASCO Conquer Cancer & Pfizer Competitive Grant for Quality Improvement (contrato No. 87534309); Center for Global Health del United States National Cancer Institute en los National Institutes of Health (contrato No. HHSN2612010000871/NO2-PC-2010-00087); Fogarty International Center, NIH, HHS; y Susan G. Komen for the Cure; en Argentina, Instituto Nacional del Cáncer, Fundación Argentina de Nanotecnología, Agencia Nacional de Promoción Científica y Tecnológica y CONICET; en Brasil, Ministério da Saúde; en Chile, Instituto de Salud Pública y Ministerio de Salud; y en México, Consejo Estatal de Ciencia y Tecnología de Jalisco (COECYTJAL) y Universidad de Sonora.
Analyze spatiotemporal trends in mental disorder diagnoses in Mexico between 2019 and 2023. An ecological study was conducted based on records of mental disorder diagnoses in the population aged ≥21 years with social security coverage. SITE: Mexico, based on data from the National Open Data Platform on primary care units of the Mexican Social Security Institute (IMSS). A total of 12,561,531 records obtained from diagnoses of mental disorders in the population aged ≥21 years with social security coverage during the period 2019-2023. Rates were estimated, adjusted for sex and age. Spatio-temporal trends were evaluated using Moran's I index. Classification of mental disorder, sex, age, entity, year. At the national level, the mental disorder rate rose from 2419 per 100,000 population in 2019 to 7192 in 2023. Anxiety and obsessive-compulsive disorders, substance use disorders, and depressive episodes were the main diagnosis in both sexes. The data show a growing trend in mental disorders of various etiologies, in addition to depression and anxiety, which are treated by healthcare services. These disorders exhibited regional and gender-based variations during the study period. It is recommended to expand health service coverage to strengthen the detection and diagnosis of mental disorder, reinforce primary care in regions at greatest risk, and incorporate prevention strategies for disorders that may increase in magnitude (dementias, Alzheimer's disease, schizophrenia, and delusional disorders). Analizar las tendencias espaciotemporales de los diagnósticos de trastornos mentales en México durante el período 2019-2023. Se realizó un estudio ecológico basado en los registros de diagnósticos de trastornos mentales en la población con seguro social de ≥21 años. Mexico, a partir de datos de la Plataforma Nacional de Datos Abiertos sobre unidades médicas de primer nivel del Instituto Mexicano del Seguro Social (IMSS). Un total de 12,561,531 registros obtenidos de los diagnósticos de trastornos mentales en la población ≥21 años con seguridad social durante el período 2019-2023. Se estimaron las tasas, ajustadas por sexo y edad. Las tendencias espaciotemporales se evaluaron utilizando Moran I. Clasificación del desorden mental, sexo, edad, entidad, año. A nivel nacional, la tasa de trastornos mentales aumentó de 2419 por cada 100 000 habitantes en 2019 a 7192 en 2023. Los trastornos de ansiedad y obsesivo-compulsivos; abuso de sustancias y episodios depresivos fueron los principales diagnósticos en ambos sexos. Los datos muestran una tendencia al alza en los trastornos mentales de diversas etiologías, además de la depresión y la ansiedad, que son tratados por los servicios sanitarios. Estos trastornos mostraron variaciones regionales y de género durante el periodo de estudio. Se recomienda ampliar la cobertura de servicios de salud para fortalecer la detección y diagnóstico de trastornos mentales, reforzar la atención primaria en las regiones de mayor riesgo, además de incorporar estrategias de prevención para trastornos que podrían incrementar su magnitud (dementias; Alzheimer's disease; schizophrenia and delusional disorders).
The population of migrant, refuge, and asylum-seeking children and adolescents across the globe has increased in recent decades. These minors often undergo adverse experiences that negatively impact their mental health and psychosocial well-being (MHPWB). In light of the transient nature and multiple stressors inherent in the transit stage, this scoping review was conducted to characterize the evidence on interventions aimed at promoting the MHPWB of minors during their migration journey. Following the PRISMA-ScR guidelines, we systematically searched the MEDLINE, Embase, Global Health, APA PsycInfo, and Web of Science databases, as well as the Google Scholar search engine, for studies published between January 2010 and September 2025 that included the evaluation of some aspect of interventions aimed at promoting MHPWB in minors during transit, regardless of the language and location where the study was conducted. Systematic reviews of the literature were excluded. The data most relevant to answering the research questions were presented in tables and accompanied by a narrative synthesis. Of the 1,835 unique documents identified, 28 met the inclusion criteria. Most of the interventions had been implemented in refugee camps and were aimed at school-age children and adolescents who had been forcibly displaced, mainly from the Middle East. Most of the interventions combined different approaches, such as psychoeducation and cognitive-behavioral therapy, and had a family or group approach. All interventions reported some degree of positive change on children's MHPWB. However, few studies considered at-risk subgroups, and no interventions targeted two of the main forcibly displaced populations at the time of the study, Venezuelans and South Sudanese. Our study effectively describes existing interventions aimed at promoting MHPWB for minors in transit and their effectiveness and/or implementation process, as well as identifies gaps in the current evidence and lessons learned that can help improve future interventions. INTRODUCCIóN: La población de niños y adolescentes migrantes, refugiados y solicitantes de asilo ha aumentado en las últimas décadas a nivel global. A menudo, estos menores experimentan experiencias adversas que impactan negativamente sobre su salud mental y bienestar psicosocial (SMBP). Considerando la naturaleza transitoria y los múltiples estresores inherentes a la etapa de tránsito, se realizó la presente revisión de alcance para caracterizar la evidencia sobre las intervenciones orientadas a promover la SMBP de menores durante el viaje migratorio. MéTODOS: Siguiendo las guías de PRISMA-ScR, buscamos de forma sistemática en las bases de datos MEDLINE, Embase, Global Health, APA PsycInfo y Web of Science, así como en el motor de búsqueda Google Scholar, estudios publicados entre enero de 2010 y septiembre de 2025 que incluyeran la evaluación de algún aspecto de las intervenciones destinadas a promover la SMBP de los menores durante el tránsito, independientemente del idioma y lugar donde se hubiera realizado el estudio. Se excluyeron revisiones sistemáticas de la literatura. Los datos más relevantes para responder a las preguntas de investigación fueron presentados en tablas y se acompañaron de una síntesis narrativa. RESULTADOS: De los 1835 documentos únicos identificados, 28 cumplieron con los requisitos de inclusión. La mayoría de las intervenciones habían sido implementadas en campos de refugiados y estaban dirigidas a menores en edad escolar y adolescentes desplazados forzados, principalmente originarios de Oriente Medio. La mayoría de las intervenciones combinaban diferentes abordajes, como la psicoeducación y la terapia cognitive-conductual, y tenían un abordaje familiar o grupal. Todas las intervenciones reportaron algún nivel de cambio positivo sobre la SMBP de los menores. Sin embargo, fueron pocos los estudios que consideraran a subgrupos en riesgo, así como no se identificaron intervenciones orientadas a dos de las principales poblaciones desplazadas forzosas en el período de estudio, la venezolana y sudsudanesa. CONCLUSIONES: Nuestro estudio logra de forma efectiva describir las intervenciones existentes destinadas a promover la SMBP de menores en tránsito y su efectividad y/o proceso de implementación, así como identificar brechas en la evidencia actual y aprendizajes que pueden ayudar a mejorar futuras intervenciones.
To analyze sociodemographic determinants associated with medical care before death from heart failure (HF) in Mexico, comparing 2019 and 2023. A retrospective cross-sectional analytical study was conducted using national mortality records from the General Directorate of Epidemiology (DGE). HF deaths (ICD-10: I50.0-I50.9) from 2019 and 2023 were selected, representing pre- and post-pandemic (COVID-19) contexts. The variables included gender, age, education, marital status, health insurance coverage, area of residence, region, place of death, and year of occurrence. Multiple logistic regression was applied to estimate odds ratios (OR) with 95% confidence intervals (95% CI). In the 2019-2023 period, 13,510 HF deaths were recorded (6,077 in 2019 and 7,433 in 2023). The probability of receiving medical care before death was 22% higher in 2023 compared to 2019 (OR 1.22; 95%CI 1.10-1.36). Medical care was more likely among individuals aged ≥80 years old, with higher educational levels, living in urban areas, and with health insurance coverage. Being male, lacking health coverage, and dying at home were associated with a lower probability of receiving medical care. The interaction between health insurance coverage and place of death revealed reduced access to medical care among individuals without social security who died at home. Substantial gaps in access to medical care persist, associated with structural and social inequalities. The post-pandemic recovery of coverage indicates a partial strengthening of the health system. Strengthening primary health care, expanding effective universal coverage, and developing strategies targeting vulnerable groups are recommended. Analizar los determinantes sociodemográficos asociados con la asistencia médica antes del fallecimiento por ICa en México, comparando 2019 y 2023. Estudio transversal retrospectivo, con enfoque analítico, basado en registros nacionales de mortalidad de la Dirección General de Epidemiología (DGE). Se seleccionaron defunciones por ICa (CIE-10: I50.0-I50.9) correspondientes a 2019 y 2023, periodos representativos del contexto pre y pospandemia (COVID-19). Las variables incluidas fueron sexo, edad, escolaridad, estado civil, derechohabiencia, área de residencia, región, sitio de defunción y año de ocurrencia. Se aplicó regresión logística múltiple para estimar odds ratio (OR) con intervalos de confianza al 95% (IC95%). En el periodo 2019-2023 se registraron 13.510 defunciones por ICa (6.077 en 2019 y 7.433 en 2023). La probabilidad de recibir asistencia médica antes del fallecimiento fue 22% mayor en 2023 en comparación con 2019 (OR 1,22; IC95% 1,10-1,36). La asistencia fue más probable en personas de 80 años o más, con mayor escolaridad, residencia urbana y derechohabiencia. Ser Hombre, no contar con cobertura médica y fallecer en el hogar se asociaron con una menor probabilidad de recibir atención. La interacción entre derechohabiencia y sitio de defunción reveló una reducción de la atención médica en quienes no contaban con seguridad social y fallecieron en el hogar. Persisten brechas sustanciales en el acceso a la atención médica asociadas con desigualdades estructurales y sociales. La recuperación de la cobertura posterior a la pandemia evidencia un fortalecimiento parcial del sistema de salud. Se recomienda fortalecer la atención primaria, ampliar la cobertura universal efectiva y desarrollar estrategias dirigidas a grupos vulnerables.
This article critically examines commensurability in public health - that is, the possibility of comparing phenomena according to a common standard, using indicators - as well as the scope and limits of such comparability when it is mistaken for complete understanding. It proposes a brief audit framework for constructing and interpreting indicators when commensurability is partial, using the maternal mortality ratio (MMR) as an example. With reference to the MMR, the article shows how definitions, time windows, and the quality of data recording affect comparability across contexts, and how performance pressure may induce reactive administrative or behavioral shifts, which must be empirically assessed. This paper does not argue against measurement or quantitative accountability; rather, it seeks to strengthen them through transparency of assumptions, reporting on quality and uncertainty, and the use of triangulation and auditing when incentives are high. It thus avoids both technocratic drift and the relativism that dismisses measurement on the grounds that it is constructed. It concludes by proposing that dimensions not captured by the indicator - lived experience, dignity, and trajectories of access and care - be granted specific status and formally integrated into the interpretation, through layering of evidence and case reviews. Este artículo examina de manera crítica la conmensurabilidad en salud pública, es decir, la posibilidad de comparar fenómenos bajo un patrón común mediante indicadores, así como los alcances y límites de esta comparabilidad cuando se confunde con la comprensión. Propone un marco breve de auditoría para construir e interpretar indicadores cuando la conmensurabilidad es parcial y utiliza la razón de mortalidad materna (RMM) como ejemplo. Aplicado a la RMM, el artículo muestra cómo las definiciones, las ventanas temporales y la calidad del registro afectan la comparabilidad entre contextos, y cómo la presión por desempeño puede inducir reactividad en forma de desplazamientos administrativos o conductuales, cuya presencia debe evaluarse empíricamente. El texto no argumenta contra la medición ni contra la rendición de cuentas cuantitativa, sino que busca fortalecerlas mediante la transparencia de los supuestos, el informe de calidad e incertidumbre, y la triangulación y la auditoría cuando hay incentivos altos. De esta forma, evita la deriva tecnocrática y el relativismo que desestima la medición por ser construida. Por último, propone otorgar estatus explícito a dimensiones no capturadas por el indicador —experiencia vivida, dignidad y trayectorias de acceso y cuidado—, y las incorpora formalmente en la interpretación mediante capas de evidencia y revisiones de caso. Este artigo examina de maneira crítica a comensurabilidade na saúde pública, ou seja, a possibilidade de comparar fenômenos sob uma base comum por meio de indicadores, bem como o alcance e os limites de tal comparabilidade quando esta se confunde com a compreensão. Propõe-se um breve quadro de auditoria para construir e interpretar indicadores quando a comensurabilidade for apenas parcial, utilizando a razão de mortalidade materna (RMM) como exemplo. Aplicado à RMM, o artigo mostra como as definições, os recortes temporais e a qualidade dos registros afetam a comparabilidade entre contextos, e como a pressão por desempenho pode induzir à reatividade na forma de mudanças administrativas ou comportamentais, o que requer uma avaliação empírica. O texto não argumenta contra a medição ou a prestação de contas quantitativa, pelo contrário, busca fortalecê-las por meio da transparência sobre os pressupostos, da apresentação de dados sobre a qualidade e a incerteza e do uso de triangulação e auditoria quando os incentivos sejam altos. Dessa forma, evita-se o desvio tecnocrático e o relativismo que desvaloriza a medição por ser um construto. Por fim, propõe-se explicitar as dimensões não capturadas pelos indicadores — experiência vivida, dignidade e trajetórias de acesso e atenção — e incorporá-las formalmente à interpretação por meio de camadas de evidência e análises de casos.
Keeping an adequate glycemic control is a major global challenge. Approximately 42% of individuals achieve the recommended HbA1c targets. To compare glycemic control in 2 independent cohorts of patients with type 2 diabetes mellitus treated before and during the COVID-19 pandemic in primary care in Mexico City. Analytical observational study; records of 3598 patients with 2 HbA1c determinations (2562 pre-pandemic and 1036 pandemic) from 213 health units were analyzed. Means, proportions, and t and chi-squared tests were calculated; metabolic control was defined as HbA1c ≤ 8%. Mean HbA1c was 9.1% in both groups in the first measurement; at the last measurement, it was lower in the pre-pandemic group (8.0% vs. 8.3%; p < 0.001). The percentage of controlled patients increased from 38.5% to 58.5% pre-pandemic and from 37.8% to 54.2% during the pandemic (p = 0.017). Dual oral therapy achieved the greatest increase in control (22.5% pre-pandemic, 28.3% pandemic); isolated insulin therapy and absence of pharmacological treatment were less effective under pandemic conditions. The pandemic was associated with lower glycemic control; however, regimens with 1 or 2 oral antidiabetic agents retained their effectiveness. Ensuring continuity of care, drug supply, and support for lifestyle measures will be crucial in future crises. mantener el control glucémico adecuado es un gran reto a nivel mundial. Alrededor del 42% de las personas alcanzan los objetivos de HbA1c recomendados. comparar el control glucémico en 2 grupos independientes de pacientes con diabetes mellitus tipo 2 atendidos antes y durante la pandemia de COVID-19 en el primer nivel de atención de la Ciudad de México. estudio observacional analítico; se analizaron los registros de 3598 pacientes con 2 determinaciones de HbA1c (2562 prepandemia y 1036 pandemia) de 213 unidades de salud. Se calcularon medias, proporciones y pruebas t y chi cuadrada; el control metabólico se definió como HbA1c ≤ 8%. en promedio la HbA1c en la primera medición fue 9.1% en ambos grupos; en la última medición fue menor en el grupo prepandemia (8.0% frente a 8.3%; p < 0.001). El porcentaje de pacientes controlados pasó de 38.5% a 58.5% prepandemia y de 37.8% a 54.2% en pandemia (p = 0.017). La terapia dual oral logró el mayor incremento de control (22.5% en prepandemia, 28.3% en pandemia); la insulinoterapia aislada y la ausencia de fármacos fueron menos eficaces bajo condiciones pandémicas. la pandemia se asoció con menor control glucémico; sin embargo, esquemas con 1 o 2 antidiabéticos orales conservaron efectividad. Asegurar continuidad asistencial, abasto de medicamentos y apoyo en medidas de estilo de vida será crucial en futuras crisis.
To analyze the regulatory frameworks on assisted fertilization in continental Latin America by comparing key aspects related to access, coverage, and beneficiaries. An exploratory descriptive study was carried out based on a review of laws, decrees, resolutions, and directives in force in 17 Spanish-speaking Latin American countries. The information was obtained from official sources in the areas of health, justice, and human rights, complemented by reports from international organizations. Regulations of assisted fertilization, egg cryopreservation, and surrogacy were analyzed; access, coverage, and beneficiary populations were considered. Nine of the countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Nicaragua, Panama, Peru, and Uruguay) have some form of specific regulation, while the others (Bolivia [Plurinational State of], Ecuador, El Salvador, Guatemala, Honduras, Mexico, Paraguay, and Venezuela [Bolivarian Republic of]) have legal vacuums, indirect regulations, or a lack of formal norms. Argentina and Uruguay offer the most comprehensive models, with universal public coverage. In Brazil and Chile, free access is restricted to the public system, while in other countries treatment is concentrated in the private sector. Cryopreservation is permitted in most countries that have regulations, with variations in duration and funding. Surrogacy is regulated only in Brazil and Uruguay, and partially in Colombia, while other countries prohibit it or have no regulations. The regulation of assisted fertilization in continental Latin America is heterogeneous and reflects structural inequities in access to reproductive services. Analizar los marcos regulatorios sobre fertilización asistida en América Latina continental mediante la comparación de aspectos clave relacionados con el acceso, la cobertura y los beneficiarios. Se realizó un estudio exploratorio descriptivo con base en la revisión de leyes, decretos, resoluciones y circulares vigentes en 17 países latinoamericanos hispanohablantes. La información se obtuvo de fuentes oficiales de los ámbitos de la salud, la justicia y los derechos humanos, complementada con informes de organismos internacionales. Se analizaron las normativas relativas a la fertilización asistida, la crioconservación de óvulos y la gestación subrogada; se consideraron el acceso, la cobertura y la población beneficiaria. Nueve de los países (Argentina, Brasil, Chile, Colombia, Costa Rica, Nicaragua, Panamá, Perú y Uruguay) cuentan con alguna forma de regulación específica, mientras que los restantes (Bolivia [Estado Plurinacional de], Ecuador, El Salvador, Guatemala, Honduras, México Paraguay y Venezuela [República Bolivariana de]) presentan vacíos legales, regulaciones indirectas o ausencia de normativas formales. Argentina y Uruguay ofrecen los modelos más integrales, con cobertura pública universal. En Brasil y Chile, el acceso gratuito se restringe al sistema público, mientras que en otros países los tratamientos se concentran en el ámbito privado. La crioconservación está permitida en la mayoría de los países que cuentan con regulaciones, aunque varía en cuanto a la duración y el financiamiento. La gestación subrogada solo cuenta con regulación en Brasil y Uruguay, y parcialmente en Colombia, mientras que otros países la prohíben o carecen de normativa. La regulación de la fertilización asistida en América Latina continental es heterogénea y refleja inequidades estructurales en el acceso a los servicios reproductivos Analisar os marcos regulatórios sobre fertilização assistida na América Latina continental mediante a comparação de aspectos essenciais relacionados a acesso, cobertura e beneficiários. Foi realizado um estudo exploratório descritivo com base na revisão de leis, decretos, resoluções e portarias vigentes em 17 países latino-americanos de língua espanhola. As informações foram obtidas de fontes oficiais nas áreas de saúde, justiça e direitos humanos, complementadas por relatórios de organismos internacionais. Foram analisadas as normas relativas à fertilização assistida, criopreservação de óvulos e gestação de substituição, considerando o acesso, a cobertura e a população beneficiária. Nove países (Argentina, Brasil, Chile, Colômbia, Costa Rica, Nicarágua, Panamá, Peru e Uruguai) dispõem de alguma forma de regulação específica, enquanto os demais (Bolívia [Estado Plurinacional da], El Salvador, Equador, Guatemala, Honduras, México, Paraguai e Venezuela [República Bolivariana da]) têm lacunas legislativas e regulações indiretas ou não contam com normas formais. A Argentina e o Uruguai oferecem os modelos mais abrangentes, com cobertura pública universal. No Brasil e no Chile, o acesso gratuito é restrito ao sistema público, enquanto em outros países o tratamento concentra-se na esfera privada. A criopreservação é permitida na maioria dos países que dispõem de regulação, embora haja variações em termos de duração e financiamento. A gestação de substituição só é regulada no Brasil e no Uruguai, e parcialmente na Colômbia, enquanto outros países a proíbem ou não dispõem de normas. A regulação da fertilização assistida na América Latina continental é heterogênea e reflete iniquidades estruturais no acesso aos serviços reprodutivos.
Dengue is a globally significant arboviral disease in tropical regions such as southeastern Mexico. The "Healthy Environments and Communities" (E&CS) program, led by the Health Secretariat, promotes community practices to eliminate Aedes aegypti breeding sites. However, factors influencing its implementation and fidelity remain unclear. To determine the factors affecting fidelity in implementing the E&CS program targeting breeding site elimination in Río Florido, Tapachula. An observational mixed-methods study was conducted. The quantitative component evaluated fidelity among health personnel using a CFIF-based instrument, measuring Content Details, Frequency, Duration, and Coverage. Independent-samples t-tests compared mean fidelity scores between subgroups (DSVII and CSLL). The qualitative component included semi-structured interviews with health personnel and community members, coded using a priori CFIR categories and emergent themes to identify barriers and facilitators. Frequencies of barriers and facilitators among health personnel subgroups were compared using Fisher's exact test, and chi-square tests assessed differences in distribution. Overall mean fidelity was 91.2% (95% CI: 88.5-93.4%). By construct, Content Details reached 92.4%, Frequency 89.8%, Duration 90.5%, and Coverage 91.3%. Among health personnel (n = 23; 142 responses), Fisher's exact test showed no significant differences (p > 0.05). After combining responses, the distribution did not differ from chance (χ² = 9.73, df = 6, p = 0.136). In the Río Florido community, significant differences were observed (χ² = 83.16, df = 11, p < 0.001). Main barriers included "insufficient attention from the health center" and perceiving the Health Secretariat as responsible for dengue. Key facilitators were recognition of E&CS, respectful relationships with health personnel, and belief in program success. High fidelity of the E&CS program (>90%) in Río Florido was accompanied by a differentiated pattern of barriers and facilitators, balanced among health personnel but uneven in the community. Addressing these factors through an implementation research (IR) approach could strengthen the sustainability and effectiveness of dengue control strategies.
The Atoyac river basin is one of the most polluted watershed basins in Mexico. Recent studies have reported the presence of organochlorine pesticides (OCPs) in this highly urbanized region through environmental monitoring, raising concerns about potential health risks, particularly for children and adolescents. We still lack information about its human exposure through biological samples that represent a more realistic measure of OCPs body burden. To evaluate, we compared the serum concentrations of OCPs in children and adolescents living within and outside the Atoyac watershed basin. We included 428 individuals under 20 years old who participated as controls in a population-based study conducted in three central-southern Mexican states (2021-2024). We collected sociodemographic characteristics through face-to-face interviews and obtained serum samples in which we quantified 24 OCPs by gas chromatography. To georeference, we classified the participants as living within or outside the Atoyac basin and compared their respective serum concentrations for those OCPs detected over 10% of samples. We found two heterogeneous spatial distribution patterns of OCPs serum concentrations. HCB, dieldrin, oxychlordane, and endosulfan sulfate were higher in the Atoyac basin, with the two formers being statistically significant. In contrast, p,p'-DDE was significantly higher outside the Atoyac basin. The two patterns of exposure between the two regions emphasized one pattern driven by industry and agriculture, and the second driven by vector-borne disease control. It reinforces the need for regulation and increased monitoring in the Atoyac river basin to provide information about adverse health effects in children and adolescents. The Atoyac River basin is one of the most polluted areas in Mexico. Organochlorine pesticides (OCPs) are harmful chemicals used in the environment, which may pose health risks‐especially to the youth. However, there is little knowledge about how these chemicals are actually getting into people's bodies. Researchers tested blood samples from 428 children under the age of 20. These participants lived either inside or outside the Atoyac basin and were part of a larger study in three states in central‐southern Mexico between 2021 and 2024. The researchers also gathered information about the participants' backgrounds through interviews. We tested the blood for 24 different OCPs and compared the levels between those living in and outside the Atoyac basin. We found that some pesticides‐like HCB and dieldrin‐were higher in those living in the Atoyac basin. Others, like p,p′‐DDE, were higher in people living outside the basin. These results suggest there are different sources of pesticide exposure: in the Atoyac basin, pollution likely comes from industry and farming, while in other areas, it may come from efforts to control disease‐carrying insects. The study highlights the need for stronger pollution controls and monitoring in the Atoyac River basin to protect children's health.
ObjectiveTo evaluate national and regional trends in age-standardized mortality rates (ASMRs) from childhood-onset systemic lupus erythematosus (cSLE) in Mexico between 2000 and 2023, stratified by sex and region.MethodsThis cross-sectional, retrospective study used the INEGI national death registry via the Public Health Intelligence Unit (UISP-INSP). Deaths in children aged 1-14 years attributed to cSLE were identified using ICD-10 codes M32.1, M32.8, and M32.9, excluding M32.0. ASMRs per 100,000 population were calculated using the 2010 Mexican census as a reference. Trends by year, sex, and region were analyzed using Poisson regression models with log link and population offset. Incidence rate ratios (IRRs) with 95% confidence intervals were estimated.ResultsFrom 2000 to 2023, 637 cSLE deaths were recorded among 280,334 child deaths. Females accounted for 80.4% (ASMR 0.13; 95% CI 0.12-0.15), nearly fourfold higher than males (0.03; 95% CI 0.03-0.04). Although the Central and Midwest regions concentrated over 60% of total deaths, ASMRs were similar across regions (range 0.08-0.09 per 100,000). No consistent temporal trend in mortality was observed. Poisson regression confirmed significantly lower mortality in boys compared to girls (IRR 0.24; 95% CI 0.19-0.29; p < 0.001) with no statistically significant regional differences.ConclusionscSLE mortality in Mexico has remained stable over time, with a marked female predominance. The regional distribution of deaths likely reflects population density rather than major differences in mortality risk. Strengthening early diagnosis, paediatric rheumatology care networks, and national surveillance systems is essential to reduce disease burden.
The Santo Domingo Declaration highlights the challenges and opportunities to improve education, regulations, public policies, and access to peritoneal dialysis (PD) in Latin America. It emphasizes the need to address structural inequalities in training and care, establishing minimum competency standards and strengthening health infrastructure. Inspired by initiatives such as the Standardised Outcomes in Nephrology-Peritoneal Dialysis (SONG-PD) and the European Specialty Examination in Nephrology (ESENeph), the declaration underlines the importance of harmonizing nephrologist training to promote standardised and internationally aligned competencies. Additionally, it outlines strategies to prioritize patients' quality of life, ensure accessibility and economic sustainability, and foster the implementation of satellite units and innovative technologies. Finally, it calls for intersectoral collaboration to ensure inclusive and equitable healthcare in the region. A Declaração de Santo Domingo destaca os desafios e as oportunidades para aprimorar a educação, as regulamentações, as políticas públicas e o acesso à diálise peritoneal (DP) na América Latina. Enfatiza a necessidade de enfrentar desigualdades estruturais na formação e na assistência, estabelecendo padrões mínimos de competências e fortalecendo a infraestrutura de saúde. Inspirada em iniciativas como o Standardized Outcomes in Nephrology–Peritoneal Dialysis (SONG-PD) e o European Specialty Examination in Nephrology (ESENeph), a declaração ressalta a importância da harmonização na formação dos nefrologistas, promovendo uma capacitação uniforme e alinhada aos padrões internacionais. Além disso, aborda estratégias para priorizar a qualidade de vida dos pacientes, garantir acessibilidade e sustentabilidade econômica, e incentivar a implementação de unidades satélites e tecnologias inovadoras. Por fim, faz um chamado à colaboração intersetorial para assegurar um cuidado inclusivo e equitativo na região.
ObjectivesGiven steady increases in age-standardized colorectal cancer incidence, health authorities in Mexico could consider implementing a colorectal cancer screening program. To inform program design, we evaluated the cost-effectiveness of fecal immunochemical testing (FIT) among a hypothetical cohort of 45-year-old residents of Mexico City. We adapted a validated US microsimulation model of colorectal cancer to reflect epidemiological outcomes in Mexico City.MethodsUsing the adapted model, we estimated the lifetime health outcomes and costs associated with no screening and with FIT strategies that varied by the start age, end age, screening interval, and hemoglobin threshold for colonoscopy referral. We obtained costs from published reports and formularies. We calculated incremental cost-effectiveness ratios and identified the cost-effective FIT strategy as the strategy with the highest ratio below the willingness-to-pay threshold of 381,000 MXN per quality-adjusted life-year (QALY) gained (i.e., three times Mexico's per-capita Gross Domestic Product).ResultsCompared with no screening, the effectiveness of FIT screening ranged from 23 to 49 QALYs gained per 1000 45-year-olds. Biennial FIT from age 50 to 70 with the most lenient threshold for colonoscopy referral (10 μg of hemoglobin/g of feces) was the cost-effective strategy. The starting age of screening was sensitive to assumptions about the cost of unreturned test kits, outreach costs, and colorectal cancer risk.ConclusionsScreening for colorectal cancer with FIT may be cost-effective in Mexico City. Additional studies are needed to assess whether the colonoscopy capacity is sufficient to support a lenient referral threshold.
Background: The Perri Auditory Verbal Learning Test (Perri-AVLT) is a cognitive tool designed to assess verbal learning and memory. Currently, demographically adjusted norms for the Perri-AVLT are not available for elderly Mexican adults. Objective: This study aimed to develop regression-based norms from elderly Mexican adults to enable demographic adjustments for clinical interpretation. Methods: The sample included 294 elderly Mexican adults aged 60-89 (224 cognitively normal individuals, and 70 clinical cases) from Mexico (Jalisco, Guanajuato, and Mexico City). Participants were administered the Perri-AVLT. A multivariate regression-based norming approach was used to evaluate the effects of age, sex, and years of education on test performance. Results: The multivariate regression model showed that years of education were a significant predictor of cognitive performance across all Perri-AVLT trials. The Pearson correlation for all Perri-AVLT trials was high. Conclusion: This study provides regression-based normative data for the Perri-AVLT adjusted for sociodemographic factors. These norms can be used to evaluate verbal learning and memory in elderly Mexican adults. This information can support a neuropsychologist in cognitive assessment, rehabilitation, and research.
In 2020-2021, both Mexico and the United States implemented similar, newly formatted nutrition facts labels (NFLs). Mexico simultaneously implemented front-of-package warning labels (FoPWLs), which emphasize high amounts of less healthy nutrients described in NFLs (e.g., calories, sugar, salt, trans fat, and saturated fat) to enhance consumer understanding of nutrition information. To evaluate these policies by comparing pre- and postpolicy trends in self-reported responses to NFLs. Annual surveys from the adult International Food Policy Study (2018-2023) were analyzed for Mexico (n = 24,832) and the United States (n = 25,464). Outcomes included reported ease of finding nutrition information in grocery stores and awareness, use, and understanding of NFLs (all measured on 1-5 Likert scales). A difference-in-differences method using adjusted and weighted linear regression models compared cross-country differences in trends for these outcomes over the transition (2019-2020), early (2019-2021), mid (2019-2022), and late (2019-2023) postimplementation periods relative to prepolicy trends (2018-2019). Trends over the transition period (compared with prepolicy) were stable within and across countries. For all outcomes, trends up to the early implementation period (compared with prepolicy) were more positive in Mexico than in the United States (i.e., ease of finding nutrition information B = 0.195, P = 0.003; awareness B = 0.220, P < 0.001; understanding B = 0.332, P < 0.001; and use B = 0.211, P = 0.006), driven by both increases in Mexico (i.e., ease of finding B = 0.126, P = 0.008; awareness B = 0.132, P = 0.001; understanding B = 0.198, P < 0.001; and use B = 0.087, P = not significant [ns]) and decreases in the United States (i.e., ease of finding information B = ns; awareness B = -0.088, P = -0.049; understanding B = -0.134, P = 0.002; and use B = -0.124, P = 0.025). When evaluating mid and late postimplementation periods, contrasts favored Mexico over the United States for all outcomes, except NFL use, which did not differ within or across countries. Newly formatted NFLs in the United States did not increase awareness, understanding, or use of NFLs, particularly when compared with Mexico's new NFLs that were accompanied by FoPWLs. Further research should determine the labeling effects on eating behaviors.
To psychometrically validate the Spanish version of the Paykel Suicidal Behavior Scale in the Mexican adolescent population, and to establish an optimal cut-off point to identify risk of suicidal behavior in school contexts. A cross-sectional study was conducted in 2022 with a non-probabilistic sample of 1,407 students from eight public high schools in the state of Morelos, Mexico. The mean age was 17 years, 58.7% were female and 41.3% were male. The students completed an online questionnaire that included the Paykel Suicidal Behavior Scale, the Center for Epidemiological Studies Depression Scale, and the Depression Anxiety and Stress Scale. A confirmatory factor analysis, item response theory, factorial invariance analysis (by sex, gender identity, and school grade), divergent validity analysis, and ROC curves were applied in this study. The confirmatory factor analysis was found to be acceptable. The factor loadings ranged from 0.799 to 0.938. Item discrimination parameters were elevated (2.33 to 6.63), with difficulties ranging from 0.17 to 1.11. Factor invariance was confirmed in all subgroups. The divergent validity of the Paykel Suicidal Behavior Scale was satisfactory, as evidenced by its moderate correlations with the Epidemiological Studies Depression Scale (r = 0.507), depression (r = 0.644), anxiety (r = 0.570), and stress (r = 0.541). ROC analysis identified an optimal cutoff point of ≥ 1.0, with sensitivity of 75.93% and specificity of 76.54%. The Mexican version of the Paykel Suicidal Behavior Scale demonstrates robust psychometric properties, including validity, reliability, and factorial invariance in the adolescent school population. The scale's brevity, clarity, and ease of application make it an effective tool for school screening, allowing for timely detection and referral to mental health services. Its use is recommended in adolescent suicide prevention programs in educational contexts in Mexico.
Dementia is increasing rapidly in Latin America and the Caribbean (LAC), but research output remains limited. Tracking publication trends, themes, and collaborations is key to guiding regional research and policy. Bibliometric analysis was conducted on dementia-related publications from 21 LAC countries (1990 to 2024) using Scopus. Thirteen keywords identified relevant articles, classified into themes through artificial intelligence (AI)-assisted and manual review. Bibliometrix and VOSviewer assessed publication trends, country and institutional output, and collaboration networks. Of 201,939 worldwide publications, 6003 (3%) included at least one LAC-affiliated author. Brazil produced 49.9% of all dementia publications, followed by Argentina and Mexico. Clinical scenarios (15%) and basic science (14%) dominated thematic output. Mexico, Argentina, and Chile led regional collaboration efforts. Despite growth, dementia research in LAC remains concentrated in a few countries, with major thematic gaps and uneven collaboration. Strengthening cross-country partnerships, broadening research themes, and increasing investment in applied and policy-focused studies are essential.