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Darney B.G.,Instituto Nacional Of Salud Publica
Obstetrics and Gynecology | Year: 2017

Women in areas of the Americas with endemic Aedes mosquito populations are at risk for exposure to Zika virus, which can cause fetal brain abnormalities and associated congenital microcephaly. Individual health care providers may encounter health system barriers to providing evidence-based care. We focus on Mexico and the state of Texas to highlight the role of health system factors in contraceptive access in the context of Zika and highlight efforts in Puerto Rico as an example of initiatives to improve access to contraception. In Mexico, states with the highest unmet need for contraception are low-lying coastal states. The government recently announced an investment to combat Zika but made no mention of family planning initiatives to assist women in preventing pregnancy. In Texas, the Department of State Health Services has issued recommendations to help women and men avoid mosquito bites; the issue of whether women should plan or avoid pregnancy is not addressed. Puerto Rico has the largest number of confirmed cases of Zika virus in the U.S. states and territories. Recently, the Centers for Disease Control and Prevention Foundation launched the Zika Contraception Access Network, which provides contraceptives at no cost to participating clinics in Puerto Rico. The Zika virus highlights weaknesses in health systems that make it difficult for women to use contraception if they want to delay births. Women across the globe, with or without Zika virus, need access to contraception to prevent unintended pregnancy, and health care providers require functioning health systems that offer support to ensure access is a reality. © 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.


Grant
Agency: European Commission | Branch: H2020 | Program: RIA | Phase: SC1-PM-22-2016 | Award Amount: 15.59M | Year: 2016

ZIKAlliance is a multidisciplinary project with a global One Health approach, built: on a multi-centric network of clinical cohorts in the Caribbean, Central & South America; research sites in countries where the virus has been or is currently circulating (Africa, Asia, Polynesia) or at risk for emergence (Reunion Island); a strong network of European and Brazilian clinical & basic research institutions; and multiple interfaces with other scientific and public health programmes. ZIKAlliance will addrees three key objectives relating to (i) impact of Zika virus (ZIKV) infection during pregnancy and short & medium term effects on newborns, (ii) associated natural history of ZIKV infection in humans and their environment in the context of other circulating arboviruses and (iii) building the overall capacity for preparedness research for future epidemic threats in Latin America & the Caribbean. The project will take advantage of large standardised clinical cohorts of pregnant women and febrile patients in regions of Latin America and the Caribbean were the virus is circulating, expanding a preexisting network established by the IDAMS EU project. I will also benefit of a very strong expertise in basic and environmental sciences, with access to both field work and sophisticated technological infrastructures to characterise virus replication and physiopathology mechanisms. To meet its 3 key objectives, the scientific project has been organised in 9 work packages, with WP2/3 dedicated to clinical research (cohorts, clinical biology, epidemiology & modeling), WP3/4 to basic research (virology & antivirals, pathophysiology & animal models), WP5/6 to environmental research (animal reservoirs, vectors & vector control) , WP7/8 to social sciences & communication, and WP9 to management. The broad consortium set-up allow gathering the necessary expertise for an actual interdisciplinary approach, and operating in a range of countries with contrasting ZIKV epidemiological status.


Dantes H.G.,Instituto Nacional Of Salud Publica | Farfan-Ale J.A.,Noguchi Institute | Sarti E.,Sanofi S.A.
PLoS Neglected Tropical Diseases | Year: 2014

This systematic literature review describes the epidemiology of dengue disease in Mexico (2000–2011). The annual number of uncomplicated dengue cases reported increased from 1,714 in 2000 to 15,424 in 2011 (incidence rates of 1.72 and 14.12 per 100,000 population, respectively). Peaks were observed in 2002, 2007, and 2009. Coastal states were most affected by dengue disease. The age distribution pattern showed an increasing number of cases during childhood, a peak at 10–20 years, and a gradual decline during adulthood. All four dengue virus serotypes were detected. Although national surveillance is in place, there are knowledge gaps relating to asymptomatic cases, primary/secondary infections, and seroprevalence rates of infection in all age strata. Under-reporting of the clinical spectrum of the disease is also problematic. Dengue disease remains a serious public health problem in Mexico. © 2014 Dantés et al.


Grant
Agency: European Commission | Branch: FP7 | Program: CSA-CA | Phase: HEALTH.2011.3.4-3 | Award Amount: 2.29M | Year: 2011

Inequalities and vulnerable groups health, as well as the slow advances to achieve the health- related Millennium Development Goals, are concerns that need to be addressed, notably for low and middle-income countries. While some countries have made advances, these remain unknown to other ones which could still benefit from their experience. Higher collaboration could help but is quite difficult to achieve. The MASCOT project gathers therefore 11 partners from 3 geographical areas (Europe, Latin America & Africa), an advisory board and additional relevant experts to answer this problematic. The work is specifically designed to achieve defined objectives: - to create links between North-South and South-South efforts in addressing maternal and child health and health inequalities (MCH&I) in developing countries - to provide evidence on best practice and policy advice for the development of future public health and health systems interventions. Following a first step of standardisation and quality control procedures, the project will implement mapping activities in individual countries of the 3 regions of interest in order to assess the current situation of MCH inequalities, to identify institutions and research teams performing research in this area, to detect promising projects and research results as well as strategies, programs and policies implemented to tackle MCH inequalities. This will result in recommendations of best practices and policy advice to countries willing to implement actions to improve MCH&I. An important part of the work will also stimulate multi-lateral collaboration and knowledge transfer as a key activity of MASCOT. All along the project, different tools such as meetings, workshops, partnering event, website, and brochures will be used to communicate and promote the exchange between health stakeholders and policy-makers. Ultimately MASCOT should thus allow reducing gaps in health inequalities between and within different regions of the world.


Grant
Agency: European Commission | Branch: FP7 | Program: CSA-CA | Phase: HEALTH.2011.3.4-2 | Award Amount: 2.35M | Year: 2011

SDH-Nets aim is to build, strengthen and link research capacities for health and its social determinants (SDH) in African and Latin American low- and middle income countries (LMIC) in close collaboration with European partners. The focus on SDH will allow for an in-depth and broad capacity-building approach, including managerial and technical excellence, ethical issues, and research strategies. Lessons learnt will be checked against best practices and success factors in other Latin American, African and global settings, leading to lessons learnt on how to build SDH-related research capacity with strong relevance to the respective context. A sound mapping exercise of (i) social determinants of health (SDH) and research activity in the field; (ii) national and global stakeholders in the research environment, and (iii) existing research capacities in the participating countries will be carried out building the basis for developing and piloting innovative research capacity building tools with a particular focus on research management, ethics and methodology relevant to comprehensively address social determinants of health. Finally, links between research and policy will be forged and lessons will be drawn to support the development of sustainable and attractive research structures and expertise. SDH-Net will be carried out by a strong consortium, based on clusters of existing networks of best in its kind public health institutions from Mexico, Colombia, Brazil and South Africa, Tanzania, and Kenya. The team is complemented by three distinguished European institutions: London School of Hygiene and Tropical Medicine; COHRED, and University of Geneva. SDH-Net is coordinated by GIZ with long term experience in health research and capacity building in LMIC, and IESE Business School, excellent in management capacity building. SDH-Net will have an important impact by developing a concept for research capacity building on individual, institutional and system level, contributing to research system strengthening and to the creation of research landscapes that enable and stimulate locally relevant, interdisciplinary research. It will lead to enhanced capacities for conducting and managing research on SDH and links between research, policy and practice will be forged by developing tools and mechanisms facilitating sustained collaboration. Furthermore, SDH-Net will lay foundations and provide tools for further research capacity building and research system strengthening in the future.


Romieu I.,Instituto Nacional Of Salud Publica
Research report (Health Effects Institute) | Year: 2012

The ESCALA* project (Estudio de Salud y Contaminación del Aire en Latinoamérica) is an HEI-funded study that aims to examine the association between exposure to outdoor air pollution and mortality in nine Latin American cities, using a common analytic framework to obtain comparable and updated information on the effects of air pollution on several causes of death in different age groups. This report summarizes the work conducted between 2006 and 2009, describes the methodologic issues addressed during project development, and presents city-specific results of meta-analyses and meta-regression analyses. The ESCALA project involved three teams of investigators responsible for collection and analysis of city-specific air pollution and mortality data from three different countries. The teams designed five different protocols to standardize the methods of data collection and analysis that would be used to evaluate the effects of air pollution on mortality (see Appendices B-F). By following the same protocols, the investigators could directly compare the results among cities. The analysis was conducted in two stages. The first stage included analyses of all-natural-cause and cause-specific mortality related to particulate matter < or = 10 pm in aerodynamic diameter (PM10) and to ozone (O3) in cities of Brazil, Chile, and México. Analyses for PM10 and O3 were also stratified by age group and O3 analyses were stratified by season. Generalized linear models (GLM) in Poisson regression were used to fit the time-series data. Time trends and seasonality were modeled using natural splines with 3, 6, 9, or 12 degrees of freedom (df) per year. Temperature and humidity were also modeled using natural splines, initially with 3 or 6 df, and then with degrees of freedom chosen on the basis of residual diagnostics (i.e., partial autocorrelation function [PACF], periodograms, and a Q-Q plot) (Appendix H, available on the HEI Web site). Indicator variables for day-of-week and holidays were used to account for short-term cyclic fluctuations. To assess the association between exposure to air pollution and risk of death, the PM10 and O3 data were fit using distributed lag models (DLMs). These models are based on findings indicating that the health effects associated with air pollutant concentrations on a given day may accumulate over several subsequent days. Each DLM measured the cumulative effect of a pollutant concentration on a given day (day 0) and that day's contribution to the effect of that pollutant on multiple subsequent (lagged) days. For this study, exposure lags of up to 3, 5, and 10 days were explored. However, only the results of the DLMs using a 3-day lag (DLM 0-3) are presented in this report because we found a decreasing association with mortality in various age-cause groups for increasing lag effects from 3 to 5 days for both PM10 and O3. The potential modifying effect of socioeconomic status (SES) on the association of PM10 or O3 concentration and mortality was also explored in four cities: Mexico City, Rio de Janeiro, São Paulo, and Santiago. The methodology for developing a common SES index is presented in the report. The second stage included meta-analyses and metaregression. During this stage, the associations between mortality and air pollution were compared among cities to evaluate the presence of heterogeneity and to explore city-level variables that might explain this heterogeneity. Meta-analyses were conducted to combine mortality effect estimates across cities and to evaluate the presence of heterogeneity among city results, whereas meta-regression models were used to explore variables that might explain the heterogeneity among cities in mortality risks associated with exposures to PM10 (but not to O3). The results of the mortality analyses are presented as risk percent changes (RPC) with a 95% confidence interval (CI). RPC is the increase in mortality risk associated with an increase of 10 microg/m3 in the 24-hour average concentration of PM10 or in the daily maximum 8-hour moving average concentration of O3. Most of the results for PM10 were positive and statistically significant, showing an increased risk of mortality with increased ambient concentrations. Results for O3 also showed a statistically significant increase in mortality in the cities with available data. With the distributed lag model, DLM 0-3, PM10 ambient concentrations were associated with an increased risk of mortality in all cities except Concepci6n and Temuco. In Mexico City and Santiago the RPC and 95% CIs were 1.02% (0.87 to 1.17) and 0.48% (0.35 to 0.61), respectively. PM10 was also significantly associated with increased mortality from cardiopulmonary, respiratory, cardiovascular, cerebrovascular-stroke, and chronic obstructive lung diseases (COPD) in most cities. The few nonsignificant effects generally were observed in the smallest cities (Concepción, Temuco, and Toluca). The percentage increases in mortality associated with ambient O3 concentrations were smaller than for those associated with PM10. All-natural-cause mortality was significantly related to O3 in Mexico City, Monterrey, São Paulo and Rio de Janeiro. Increased mortality risks for some specific causes were also observed in these cities and in Santiago. In the analyses stratified by season, different patterns in mortality and O3 were observed for cold and warm seasons. Risk estimates for the warm season were larger and significant for several causes of death in São Paulo and Rio de Janeiro. Risk estimates for the cold season were larger and significant for some causes of death in Mexico City, Monterrey, and Toluca.(ABSTRACT TRUNCATED).


Lagunas-Martinez A.,Instituto Nacional Of Salud Publica | Madrid-Marina V.,Instituto Nacional Of Salud Publica | Gariglio P.,CINVESTAV
Biochimica et Biophysica Acta - Reviews on Cancer | Year: 2010

Cervical cancer (CC) constitutes a major women health problem. Clinical, molecular, and epidemiological investigations have identified persistent infection with high risk human papillomavirus (HR-HPV) as the major cause of CC. HR-HPVs lead to development of cervical carcinoma, predominantly through the action of E5, E6 and E7 viral oncoproteins. After HR-HPV infection, viral proteins employ strategies to modulate apoptosis. The E2 viral protein induces apoptosis in both normal and HPV-transformed cells through activation of caspase-8. The E5 protein can impair CD95L- and TRAIL-mediated apoptosis, which suggests that it may prevent apoptosis at early stages of viral infection. E6 inhibits apoptosis through the proteolytic inactivation of pro-apoptotic proteins such as p53, FADD, or procaspase-8, employing the ubiquitin proteasome pathway, or through interactions with proteins that form the death-inducing signaling complex (DISC) such as TNF-R1. On the other hand, E7 oncoprotein expressing cells are usually predisposed to undergo apoptosis. Useful targets for therapeutic strategies would interfere with expression or function of HR-HPV proteins to eliminate cells that express viral oncoproteins. In this review, we summarize the available data on the interaction of early HPV proteins with cellular factors that promote cell death, and the functional consequences of these interactions on apoptosis. © 2009 Elsevier B.V. All rights reserved.


Barquera S.,Instituto Nacional Of Salud Publica | Campos I.,Instituto Nacional Of Salud Publica | Rivera J.A.,Instituto Nacional Of Salud Publica
Obesity Reviews | Year: 2013

Summary: Mexico's obesity prevalence is one of the world's highest. In 2006, academics, and federal and state government agencies initiated efforts to design a national policy for obesity prevention. The Ministry of Health (MOH) established an expert panel to develop recommendations on beverage intake for a healthy life in 2008. Subsequently, the MOH, with support from academia, initiated the development of the National Agreement for Healthy Nutrition (ANSA). ANSA was signed by all relevant sectoral actors in 2010 and led to initiatives banning sodas and regulating unhealthy food in schools and the design of other yet to be implemented initiatives, such as a front-of-package labeling system. A main challenge of the ANSA has been the lack of harmonization between industry interests and public health objectives and effective accountability and monitoring mechanisms to assess implementation across government sectors. Bold strategies currently under consideration include taxation of sugar-sweetened beverages, improvement of norms for healthy food in schools, regulation of food and beverage marketing to children and implementation of a national front-of-pack labeling system. Strong civil society organizations have embraced the prevention of obesity as their goal and have used evidence from academia to position obesity prevention in the public debate and in the government agenda. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.


Nigenda G.,Instituto Nacional Of Salud Publica
Salud Publica de Mexico | Year: 2013

One third of the primary care units in the public system keeps being covered exclusively by interns. It is shown that with the resources available in the System for Social Protection in Health it is possible to hire graduate health personnel for all Ministry of Health rural units. It is necessary to modify the current legislation to impede an intern to be located in units without supervision of a graduate doctor. There is an urgent need for a reform of social service in medicine that responds both to the institutional modernization and to the increased capacity of the newly insured to demand high-quality services.


Objective. To describe the socioeconomic (SE) indicator developed for the analysis of the National Health and Nutrition Survey 2012 (NHNS 2012) and its validation. Materials and methods. The SE indicator was generated imputing deciles of income level to the households on the NHNS 2012, using demographic and socioeconomic characteristics, and based on the National Income and Expenditure Survey 2010. As a validation, distribution of different household characteristics related to SE status was described by predicted decile. Results. The resulting SE indicator adequately describes heterogeneity on standard socioeconomic variables, as schooling years of the head of household, income, access to services, and household assets. Conclusion. The socioeconomic heterogeneity captured by the proposed SE indicator allows identifying variability and gaps on health outcomes and programs coverage related to socioeconomic level.

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