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Speed limits are an evidence-based intervention to prevent traffic collisions and deaths, yet their impact on air pollution in cities is understudied. The objective of this study was to investigate the association between lower speed limits and air pollution. We leverage the introduction of a new road safety policy in Mexico City in December 2015 which lowered speed limits, increased fines, and installed speed radars to enforce compliance. We tested whether the policy had an impact on particulate matter (PM2.5) and nitrogen dioxide (NO2) at the city level, and whether air-quality monitoring stations' proximity to speed radars moderated this effect due to more acceleration and deceleration around radars. NO2 and PM2.5 concentrations from January 2014 to December 2018 were obtained from the National System of Air Quality Information. Air-quality monitoring stations were classified as in close-proximity or far-from-speed radars. Interrupted time series analyses were conducted for each outcome separately, using linear mixed models and adjusting for seasonality and time-varying confounders: registered vehicles, temperature, wind-speed and relative humidity. The results suggest improvement in both contaminants after the speed limits policy. For NO2, the pre-policy trend was flat, while the post-policy trend showed a decline in concentrations of 0.04 ppb/week. For PM2.5, concentrations were increasing pre-policy by 0.08 µg/m3 per week, then this trend flattened in the post-policy period to a weekly, non-significant, increase of 0.03 µg/m3 (p = 0.08). Air-quality monitors' proximity to speed radars did not moderate the effect of the policy on either of the pollutants. In conclusion, the speed limits policy implemented in Mexico City in 2015 was associated with improvements in air pollution.

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BACKGROUND: Non-medical use of psychoactive medication is a public health problem. Studies in other contexts indicate that individual sociodemographic characteristics are associated with non-medical use, but these associations have not been assessed in the Mexican context. OBJECTIVES: To estimate the prevalence non-medical and medical use of psychoactive medication among Mexican adolescents and adults' medication users and to estimate the associations between sociodemographic characteristics and non-medical use of psychoactive medication, using data from a nationally representative sample. METHODS: Secondary analysis of data collected from the National Survey of Drug, Alcohol, and Tobacco Consumption (ENCODAT) 2016 to 2017. The analytical sample included people aged 12 to 65 years. The sample was stratified into two age categories: adolescents (12-17 years) and adults (18-65 years). Sub-analyses were performed to describe prevalence of use and non-medical use of psychoactive medication at the state-level. Descriptive statistics and multinomial logistic regression models were used to estimate associations between sociodemographic characteristics and medical, non-medical, and non-use of psychoactive medication in adolescents and adults. RESULTS: Among Mexican medication users in 2016, the national prevalence of non-medical use of psychoactive drugs was 19.6%; 22.2% among adolescents and 19.4% among adults. States adjacent to the US-Mexico border reported the highest levels of non-medical use of psychoactive medication. Illicit drug consumption was associated with non-medical use. Sociodemographic characteristics associated with non-medical use varied between adolescents and adults. CONCLUSIONS: There is a high proportion of non-medical use of psychoactive drugs among Mexican medication users, especially among young people. Understanding factors associated with the misuse of psychoactive medications in Mexico can inform policy for prevention and treatment.

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One of the most critical time periods in childhood is from birth to five years of age. Children exposed to alcohol and/or tobacco via family members and neighborhood are at risk for childhood developmental delays. This study evaluated the association of early childhood development with the prevalence of alcohol consumption and tobacco use in Mexican municipalities. This is a cross-sectional study. Early childhood development information from 2,345 children aged from 36 to 59 months was obtained from the 2015 Mexican National Survey of Boys, Girls, and Women (ENIM). Data on alcohol consumption and tobacco use come from the 2016 Mexican National Survey on Drugs, Alcohol, and Tobacco Consumption (ENCODAT). Multilevel logistic models were fitted to evaluate the association of the prevalence of alcohol consumption and tobacco use with the inadequacy of early childhood development. Children living in municipalities with high prevalence of alcohol consumption (OR = 13.410; 95%CI: 2.986; 60.240) and tobacco use (OR = 15.080; 95%CI: 2.040; 111.400) were less likely to be developmentally on track regarding early childhood development after adjustment for individual variables related to the child's development and other environmental variables at municipal level. Childhood exposure to alcohol and tobacco in the neighborhood may directly contribute to inadequate early childhood development. These findings suggest that there is an urgent need to develop effective interventions aimed at reducing alcohol consumption and tobacco use in municipalities to ensure adequate early childhood development.

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Dysbiosis plays an important role in the development of bacterial infections in the gastric mucosa, particularly Helicobacter pylori. The international guidelines for the treatment of H. pylori infections suggest standard triple therapy (STT). Nevertheless, because of the increasing resistance rates to clarithromycin, metronidazole has been widely considered in several countries. Unfortunately, the non-justified administration of antibiotics induces dysbiosis in the target organ. We characterized the gastric microbiota of patients diagnosed with follicular gastropathy and pangastropathy attributed to H. pylori infection, before and after the administration of STT with metronidazole. Dominant relative abundances of Cutibacterium were observed in pre-treatment patients, whereas H. pylori was observed at <11%, suggesting the multifactor property of the disease. The correlation of Cutibacterium acnes and H. pylori with gastric infectious diseases was also evaluated using quantitative real-time polymerase chain reaction. The dominance of C. acnes over H. pylori was observed in gastritis, gastropathies, and non-significant histological alterations. None of the microorganisms were detected in the intestinal metaplasia. Post-treatment alterations revealed an increase in the relative abundances of Staphylococcus, Pseudomonas, and Klebsiella. Non-H. pylori gastrointestinal bacteria can be associated with the initiation and development of gastric diseases, such as pathobiont C. acnes.

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BACKGROUND: Aging and multimorbidity (MM) are not enough to explain patient heterogeneity and outcomes. The objective of this study was to estimate the effect of multimorbidity patterns and indicators of socioeconomic, behavioral, and functional dimensions on the risk of death in a cohort of people ≥50 years old. METHODS: We analyzed a cohort of 7,342 persons ≥50 years old from the Mexican Health and Aging Study (MHAS), stratified by age groups (50-64, 65-84, ≥85 years old). MM was defined as the co-occurrence of two or more chronic diseases (CDs), and additional analysis included functional, socioeconomic, and behavioral indicators. Prevalence was estimated using descriptive analysis. Latent class analysis (LCA) was used to identify MM patterns, and logistic regression models were performed to estimate the risk of death at two and 18 years of follow-up. RESULTS: The most prevalent conditions were chronic pain, depression, and hypertension, with 60% of the subjects exhibiting MM at the initial evaluation. In all three age groups, indicators of the functional dimension were identified as risk factors for death. Economic precariousness was an additional risk factor in the 65-84 age group while living without a partner was an added risk factor in the ≥85 age group. For the 50-64 age group, "poor" self-perception of health and lack of physical exercise were identified as long-term risk factors for death. CONCLUSION: MM is a complex phenomenon that requires the implementation of age-specific care models. Health, socioeconomic and behavioral conditions should be considered to mitigate the risk of premature death.

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Anti-inflammatory and analgesic medications (AAMs) are widely used in Mexico and the rest of the world. Their excessive acquisition can lead to waste, representing an unnecessary expense for families and the public health system. The aim of this study was to estimate the economic cost of the waste of unused AAMs collected by the National System for the Collection of Residues of Containers and Medications (SINGREM, the acronym in Spanish) in Mexico City during 2019. Data from SINGREM on discarded AAMs in Mexico City were classified by the type and quantity of drug, pharmaceutical dosage form, origin, dose, and the complete or incomplete condition of the package. The unitary cost for each medication was based on public tenders of the Mexican Social Security Institute (IMSS) for the public sector and the prices in large drug store franchises for the private sector. A decision-making model was constructed to appraise the total cost of discarded AAMs. The economic cost of the 48924 units of discarded AAMs in SINGREM containers in Mexico City during 2019 was approx. USD$143500, of which over USD$127000 corresponded to the private health sector. The current findings evidence an enormous accumulation of unneeded or expired AAMs in Mexico City. According to the present data, the cost of such waste is substantial. The estimated cost was 8-fold higher for discarded medications originating from the private versus the public healthcare sector. It is important to implement measures to prevent this waste and increase awareness of the consequences of inadequate drug disposal.

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Background: Latin America and the Caribbean (LAC) is one of the most urbanized and violent regions worldwide. Homicides in youth (15-24 years old, yo) and young adults (25-39yo) are an especially pressing public health problem. Yet there is little research on how city characteristics relate to homicide rates in youth and young adults. We aimed to describe homicide rates among youth and young adults, as well as their association with socioeconomic and built environment factors across 315 cities in eight LAC countries. Methods: This is an ecological study. We estimated homicide rates in youth and young adults for the period 2010-2016. We investigated associations of homicide rates with sub-city education and GDP, Gini, density, landscape isolation, population and population growth using sex-stratified negative binomial models with city and sub-city level random intercepts, and country-level fixed effects. Findings: The mean sub-city homicide rate per 100,000 in persons aged 15-24 was 76.9 (SD = 95.9) in male and 6.7 (SD = 8.5) in female, and in persons aged 25-39 was 69.4 (SD = 68.9) in male and 6.0 (SD = 6.7) in female. Rates were higher in Brazil, Colombia, Mexico and El Salvador than in Argentina, Chile, Panama and Peru. There was significant variation in rates across cities and sub-cities, even after accounting for the country. In fully adjusted models, higher sub-city education scores and higher city GDP were associated with a lower homicide rate among male and female (rate ratios (RR) per SD higher value in male and female, respectively, 0.87 (CI 0.84-0.90) and 0.90 (CI 0.86-0.93) for education and 0.87 (CI 0.81-0.92) and 0.92 (CI 0.87-0.97) for GDP). A higher city Gini index was associated with higher homicide rates (RR 1.28 (CI 1.10-1.48) and 1.21 (CI 1.07-1.36) in male and female, respectively). Greater isolation da was also associated with higher homicide rates (RR 1.13 (CI 1.07-1.21) and 1.07 (CI 1.02-1.12) in male and female, respectively). Interpretation: City and sub-city factors are associated with homicide rates. Improvements to education, social conditions and inequality and physical integration of cities may contribute to the reduction of homicides in the region. Funding: The Wellcome Trust [205177/Z/16/Z].

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Abstract: One of the most critical time periods in childhood is from birth to five years of age. Children exposed to alcohol and/or tobacco via family members and neighborhood are at risk for childhood developmental delays. This study evaluated the association of early childhood development with the prevalence of alcohol consumption and tobacco use in Mexican municipalities. This is a cross-sectional study. Early childhood development information from 2,345 children aged from 36 to 59 months was obtained from the 2015 Mexican National Survey of Boys, Girls, and Women (ENIM). Data on alcohol consumption and tobacco use come from the 2016 Mexican National Survey on Drugs, Alcohol, and Tobacco Consumption (ENCODAT). Multilevel logistic models were fitted to evaluate the association of the prevalence of alcohol consumption and tobacco use with the inadequacy of early childhood development. Children living in municipalities with high prevalence of alcohol consumption (OR = 13.410; 95%CI: 2.986; 60.240) and tobacco use (OR = 15.080; 95%CI: 2.040; 111.400) were less likely to be developmentally on track regarding early childhood development after adjustment for individual variables related to the child's development and other environmental variables at municipal level. Childhood exposure to alcohol and tobacco in the neighborhood may directly contribute to inadequate early childhood development. These findings suggest that there is an urgent need to develop effective interventions aimed at reducing alcohol consumption and tobacco use in municipalities to ensure adequate early childhood development.

Resumen: El grupo de edad que se extiende desde el nacimiento hasta los 5 años es uno de los periodos más críticos en la infancia. Niños expuestos al alcohol y/o al tabaco a través de la familia y vecinos corren el riesgo de sufrir un retraso en el desarrollo infantil. Este estudio evaluó la asociación del desarrollo durante la primera infancia con la prevalencia del consumo de alcohol y tabaco en municipios mexicanos. Se trata de un estudio transversal. Las informaciones sobre el desarrollo durante la primera infancia de 2.345 niños de 36 a 59 meses se obtuvieron a través de la Encuesta Nacional de los Niños, Niñas y Mujeres en México (ENIM) de 2015. Los datos sobre el consumo de alcohol y tabaco son de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco en México (ENCODAT) de 2016. Se ajustaron los modelos logísticos multiniveles para evaluar la asociación de la prevalencia de consumo de alcohol y tabaquismo con desarrollo durante la primera infancia inadecuado. Los niños que viven en municipios que tienen una alta prevalencia de consumo de alcohol (OR = 13,410; IC95%: 2,986; 60,240) y tabaquismo (OR = 15,080; IC95%: 2,040; 111,400) se asociaron con la probabilidad más alta de tener un desarrollo durante la primera infancia inadecuado tras el ajuste de las variables individuales relacionadas al desarrollo del niño y a otras variables ambientales en nivel municipal. La exposición infantil al alcohol y al tabaco en la vecindad puede contribuir directamente a un desarrollo durante la primera infancia inadecuado. Estos hallazgos indican una necesidad urgente de desarrollar intervenciones eficaces destinadas a reducir el consumo de alcohol y tabaquismo en los municipios para asegurar un desarrollo durante la primera infancia adecuado.

Resumo: A faixa etária que se estende do nascimento aos 5 anos de idade é um dos períodos mais críticos na infância. Crianças expostas ao álcool e/ou tabaco por meio de familiares e vizinhos estão em risco de atraso no desenvolvimento infantil. Este estudo avaliou a associação do desenvolvimento durante a primeira infância com a prevalência do consumo de álcool e tabaco em municípios mexicanos. Trata-se de um estudo transversal. As informações sobre o desenvolvimento durante a primeira infância de 2.345 crianças de 36 a 59 meses foram obtidas pela Pesquisa Nacional Sobre Crianças e Mulheres no México (ENIM) de 2015. Os dados sobre consumo de álcool e tabaco são da Pesquisa Nacional sobre Consumo de Drogas, Álcool e Tabaco no México (ENCODAT) de 2016. Modelos logísticos multiníveis foram ajustados para avaliar a associação da prevalência de consumo de álcool e tabagismo com desenvolvimento durante a primeira infância inadequado. Crianças que vivem em municípios com alta prevalência de consumo de álcool (OR = 13,410; IC95%: 2,986; 60,240) e tabagismo (OR = 15,080; IC95%: 2,040; 111,400) foram associadas à maior probabilidade de ter um desenvolvimento durante a primeira infância inadequado após ajuste às variáveis individuais relacionadas ao desenvolvimento da criança e a outras variáveis ambientais em nível municipal. A exposição infantil ao álcool e tabaco na vizinhança pode contribuir diretamente para o desenvolvimento durante a primeira infância inadequado. Estas descobertas demonstram uma necessidade urgente de desenvolver intervenções eficazes destinadas a reduzir o consumo de álcool e tabagismo nos municípios para garantir um desenvolvimento durante a primeira infância adequado.

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BACKGROUND: During the Covid-19 pandemic, children and adolescents faced poverty, potentially dying from preventable causes, or missing out essential vaccines. The aim of this study was to assess potential environmental and individual factors associated to COVID-19 mortality in children and adolescents in Mexico. METHODS: This cross-sectional study analysed the official data of 131,001 children under 10 years of age and adolescents between 10 and 19 years of age with COVID-19 disease, in Mexico. Participants were diagnosticated between March 2020 and June 13, 2021. The environmental variables such as malnutrition, vaccination coverage and social lag index were evaluated at the state level. Multilevel models were fitted to evaluate the association between environmental and individual factors and COVID-19 mortality. FINDINGS: A total of 773 (0.6%) children and adolescents died due to COVID-19. Younger age (OR = 0.878, 95%CI: 0.869-0.888), diabetes (OR = 3.898, 95%CI: 2.596-5.851), immunosuppression (OR = 5.410, 95%CI: 4.088-7.158), obesity (OR = 1.876, 95%CI: 1.397-2.521), hypertension (OR = 1.906, 95%CI: 1.239-2.932), cardiovascular disease (OR = 2.288, 95%CI: 1.482-3.531), and chronic kidney disease (OR = 13.250, 95%CI: 9.066-19.350) were associated with mortality. COVID-19 mortality was directly associated with social lag index and malnutrition (ORvery high = 2.939, 95%CI: 1.111-7.775, and OR = 1.390, 95%CI: 1.073-1.802, respectively), and inversely associated with population density (OR = 0.374, 95%CI: 0.204-0.688). Finally, children and adolescents living in areas with a higher percentage of people with incomplete education (OR = 1.045, 95%CI: 1.011-1.081), of children of school age of 6-14 years who do not attend school (OR = 1.266, 95%CI: 1.032-1.554), and of illiterate population aged 15 and over (OR = 1.086, 95%CI: 0.999-1.179) were associated with a higher risk of COVID-19 mortality. INTERPRETATION: Malnutrition, social lag index and population density are key factors to understand COVID-19 mortality in children and adolescents. Also, age and pre-existing comorbidities were also associated with worse COVID-19 prognosis. FUNDING: No funding was secured for this study.

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BACKGROUND: Childhood is considered the most important phase of human development; within it the period from birth to 5 years of age is particularly critical, given the speed at which changes occur. The context where children live can influence early childhood developmnent (ECD) by providing or limiting opportunities to learn, play and establish social interactions. This study explored the associations between characteristics of the urban environment and ECD in 2,194 children aged 36 to 59 months living in urban municipalities in Mexico. METHODS: We obtained ECD information from the 2015 Survey of Boys, Girls, and Women (ENIM, for its Spanish acronym), measured with the Early Childhood Development Index. The urban environment was evaluated at the municipal level, considering variables from five environment domains: physical, social, service, socioeconomic, and governance. Multilevel logistic models were fitted to assess the association between urban environment characteristics and the inadequacy of ECD in general and by specific development domains: learning, socio-emotional, physical, and alpha-numeric. RESULTS: Inadequate ECD was inversely associated with the availability of libraries (OR = 0.55, 95% CI: 0.43, 0.72), and positively associated with population density (OR = 1.01, 95% CI: 1.01-1.02). For the specific ECD domains, inadequate socio-emotional development was inversely associated with the availability of libraries (OR = 0.66, 95% CI: 0.51, 0.85). Inadequate literacy-numeracy knowledge was associated inversely with the availability of daycare centers (OR = 0.56, 95% CI: 0.32, 0.97), and directly associated with the number of hospitals and clinics (OR = 1.87, 95% CI: 1.29, 2.72). Finally, the marginalization index was positively associated with inadequacy in the learning domain (OR = 1.80, 95% CI: 1.06, 3.03). CONCLUSIONS: Some aspects of the urban environment associated with ECD, suggest that intervening in the urban context could improve overall child development. Investment in resources oriented to improve socio-emotional development and literacy (such as libraries and daycare), could foster ECD in Mexico.

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Children's early development is influenced by characteristics of the child, family, and environment, including exposure to substance abuse. The aim was to examine the association of early childhood development (ECD) with the prevalence of psychoactive substance use in Mexican municipalities. We obtained ECD data from the 2015 Survey of Boys, Girls, and Women (ENIM, for its Spanish acronym), measured with the ECD Index. The prevalence of psychoactive substance use was estimated at the municipal level, using the 2016 National Survey of Drug, Alcohol, and Tobacco Use (ENCODAT, for its Spanish acronym). Multilevel logistic models were fitted to evaluate the association between drug use and inadequacies in ECD overall and in four specific ECD domains: socio-emotional, literacy-numeric, learning, and physical. Inadequate ECD was directly associated with illegal drug use (OR = 1.10; 95% CI: 1.03, 1.17). For the specific ECD domains, inadequate socio-emotional development was directly associated with illegal drug use (OR = 1.08; 95% CI: 1.01, 1.15). These findings suggest that exposure to illegal drug use may influence ECD, and especially can lead to socio-emotional problems, although this cannot be considered the unanimous determinant of the problems presented. The implementation of evidence-based interventions to prevent drug abuse is necessary.

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Background: Little is known about the potential impact of climate change on food systems and diet. We aimed to estimate the association of changes in rainfall and temperatures with consumption of unprocessed and processed foods among residents of Mexican cities by climate region. Methods: We analyzed 3,312 participants of the 2012 Mexican National Health and Nutrition Survey with dietary intake and sociodemographic information linked to historical rainfall and temperature data collected by the Mexican National Weather Service. We classified foods as unprocessed, processed, or ultra-processed. We performed multilevel linear regression to estimate the association of annual change in rainfalls (for each 0.5 mm decrease) and temperatures (for each 0.1°C increase) at municipality level over the past 5 years with consumption of processed and unprocessed foods measured as the contribution to total energy intake. We investigated whether associations differed by climate region (tropical, temperate, and arid). Results: Each 0.5 mm annual decrease in precipitation was associated with lower consumption of unprocessed foods and higher consumption of ultra-processed foods [mean differences in percent contribution to total energy intake -0.009% (95% CI: -0.019, < -0.001) and 0.011% (95% CI: 0.001, 0.021), respectively]. Each 0.1 degree Celsius annual increase in temperature was also associated with lower consumption of unprocessed and higher consumption of ultra-processed foods [mean differences in percent contribution to total energy intake was -0.03 (95% CI: -0.05, -0.01) and 0.03% (95% CI: <0.01, 0.05)]. When stratified by climate region these associations were only observed in tropical regions. Conclusions: Decreases in rainfalls and increases in temperature were associated with lower consumption of unprocessed foods but higher consumption of ultra-processed foods, especially in tropical regions. Previous studies have established how food production affects the climate, our study suggests that climate change could, in turn, reinforce modern food production, closing a vicious circle with clear negative implications for planetary health.

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Our objective was to describe the prevalence and changes in tobacco use and tobacco control policies in Latin American countries and cities before and after ratification of the 2003 Framework Convention on Tobacco Control (FCTC). Country-level tobacco policy data came from reports on the global tobacco epidemic (World Health Organization, 2007-2014). Global Youth Tobacco Survey data, 2000-2011, came from six countries (Argentina, Brazil, Chile, Colombia, Mexico, Peru), 31 cities and 132,065 students. Pre- and post-FCTC prevalence and relative changes were estimated. All countries showed improvements in tobacco control policies but Mexico and Peru showed the smallest improvements. In general, adolescents reduced their tobacco use, reported less exposure to smoking at home, more tobacco education, and more retailer refusals to sell them cigarettes. Adolescents reported smaller reductions in secondhand smoke exposure outside the home and no change in exposure to tobacco media/promotions. Pre-FCTC prevalence and relative changes during the post-FCTC period were more heterogeneous across cities than across countries. Despite overall improvements in tobacco policies and the decline in exposure to tobacco, policies related to media/promotions and secondhand smoke need strengthening. There was wide variation in adolescent exposure to tobacco between cities (within countries), which suggested major heterogeneity of policy implementation at the local level.

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OBJECTIVES: To examine the factors associated with satisfaction with healthcare services provided to patients with diabetes, hypertension, and/or dyslipidemia in the Mexican population. METHODS: In a cross-sectional, retrospective study, we used data from the 2016 Half-Way National Health and Nutrition Survey in Mexico (ENSANUT MC 2016). This contained self-reported information about patient satisfaction and use of healthcare services by 2529 adults. An ordinal regression model was performed to identify predictors of overall patient satisfaction. RESULTS: Good or very good satisfaction was reported by 85.2% of the respondents. Patient satisfaction was positively associated with the quality of medical care (very good, odds ratio [OR] = 29.71, 95% confidence interval [CI] 9.04-97.62; good, OR = 13.24, 95% CI 5.07-34.57; and regular, OR = 6.56, 95% CI 2.49-17.30) and having been attended by a medical specialist (OR = 2.42, 95% CI 1.01-5.83). Patient satisfaction was negatively associated with a worse perception of health status (OR = 0.07, 95% CI 0.02-0.25), no change in health status (OR = 0.377, 95% CI 0.15-0.98), time in the waiting room (OR = 0.99, 95% CI 0.99-1.01), and poor conditions of the health center (OR = 0.09, 95% CI 0.04-0.18). CONCLUSION: There are several elements of organization, structure, and delivery of healthcare that are associated with patient satisfaction, although our findings need to be confirmed using longitudinal designs. Governments could use these findings to strengthen actions for improving patient satisfaction.

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RESUMEN Objetivos. Estimar la satisfacción con la atención en salud recibida en los establecimientos del Ministerio de Salud (MINSA) en el Perú y determinar sus factores asociados en adultos peruanos. Materiales y métodos. Estudio analítico de corte transversal empleando datos de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza (ENAHO) 2018. La satisfacción con la atención en salud recibida fue calificada como: muy mala, mala, buena, y muy buena. Se describieron las características de la población en estudio mediante frecuencias y proporciones ponderadas. Para determinar los factores asociados a la satisfacción con la atención recibida, se estimó un modelo logístico ordinal generalizado. Resultados. Se incluyó un total de 14 206 adultos (población expandida: 7 684 602) que reportaron haber sido atendidos en algún establecimiento de salud del MINSA. A nivel nacional, el 74,3% de usuarios reportó una satisfacción con el servicio recibido como «bueno o muy bueno¼. Padecer una enfermedad crónica, tener una lengua materna nativa o vivir en aglomeraciones poblacionales mayores a 2000 personas se asoció con una menor satisfacción con la atención recibida. Vivir en la selva se asoció con un reporte de mayor satisfacción con la atención. Conclusiones. Tres de cada cuatro usuarios externos califican como buena o muy buena la atención recibida en establecimientos del MINSA. Existen subgrupos poblacionales con una menor satisfacción de la atención recibida. Incidir en la mejora de la satisfacción de estos usuarios mejoraría la calidad de la atención en el MINSA, el mayor prestador en salud en Perú.

ABSTRACT Objectives. To estimate satisfaction with the healthcare received at facilities of the Ministry of Health (MINSA) of Peru and determine its associated factors in Peruvian adults. Materials and Methods. Analytical cross-sectional study using data from the National Household Survey on Living Conditions and Poverty (ENAHO) 2018. Satisfaction with healthcare received was rated as very bad, bad, good, and very good. The characteristics of the study population were described using weighted frequencies and proportions. To determine the factors associated with satisfaction with the care received, a generalized ordinal logistic model was estimated. Results. The study included a total of 14,206 adults (expanded population: 7,684,602) who reported having been treated at a MINSA healthcare facility. At the national level, 74.3% of users reported satisfaction with the service received as "good or very good". Having a chronic illness, having a native mother tongue, or living in a population with agglomerations of more than 2000 people were associated with lower satisfaction with the care received. Living in the jungle area was associated with a report of greater satisfaction with the care. Conclusions. Three out of four external users rate the care received at MINSA facilities as good or very good. There are population subgroups with less satisfaction with the care received. Improving the satisfaction of these users would improve the quality of care at the facilities of MINSA, the largest health provider in Peru.

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OBJECTIVES.: To estimate satisfaction with the healthcare received at facilities of the Ministry of Health (MINSA) of Peru and determine its associated factors in Peruvian adults. MATERIALS AND METHODS.: Analytical cross-sectional study using data from the National Household Survey on Living Conditions and Poverty (ENAHO) 2018. Satisfaction with healthcare received was rated as very bad, bad, good, and very good. The characteristics of the study population were described using weighted frequencies and proportions. To determine the factors associated with satisfaction with the care received, a generalized ordinal logistic model was estimated. RESULTS.: The study included a total of 14,206 adults (expanded population: 7,684,602) who reported having been treated at a MINSA healthcare facility. At the national level, 74.3% of users reported satisfaction with the service received as "good or very good". Having a chronic illness, having a native mother tongue, or living in a population with agglomerations of more than 2000 people were associated with lower satisfaction with the care received. Living in the jungle area was associated with a report of greater satisfaction with the care. CONCLUSIONS.: Three out of four external users rate the care received at MINSA facilities as good or very good. There are population subgroups with less satisfaction with the care received. Improving the satisfaction of these users would improve the quality of care at the facilities of MINSA, the largest health provider in Peru.

OBJETIVOS.: Estimar la satisfacción con la atención en salud recibida en los establecimientos del Ministerio de Salud (MINSA) en el Perú y determinar sus factores asociados en adultos peruanos. MATERIALES Y MÉTODOS.: Estudio analítico de corte transversal empleando datos de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza (ENAHO) 2018. La satisfacción con la atención en salud recibida fue calificada como: muy mala, mala, buena, y muy buena. Se describieron las características de la población en estudio mediante frecuencias y proporciones ponderadas. Para determinar los factores asociados a la satisfacción con la atención recibida, se estimó un modelo logístico ordinal generalizado. RESULTADOS.: Se incluyó un total de 14 206 adultos (población expandida: 7 684 602) que reportaron haber sido atendidos en algún establecimiento de salud del MINSA. A nivel nacional, el 74,3% de usuarios reportó una satisfacción con el servicio recibido como «bueno o muy bueno¼. Padecer una enfermedad crónica, tener una lengua materna nativa o vivir en aglomeraciones poblacionales mayores a 2000 personas se asoció con una menor satisfacción con la atención recibida. Vivir en la selva se asoció con un reporte de mayor satisfacción con la atención. CONCLUSIONES.: Tres de cada cuatro usuarios externos califican como buena o muy buena la atención recibida en establecimientos del MINSA. Existen subgrupos poblacionales con una menor satisfacción de la atención recibida. Incidir en la mejora de la satisfacción de estos usuarios mejoraría la calidad de la atención en el MINSA, el mayor prestador en salud en Perú.

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OBJECTIVES: . To estimate out-of-pocket spending on health (GBS) and identify its associated factors in Peruvian older adults. MATERIALS AND METHODS.: Analytical cross-sectional study of the National Household Survey on Living Conditions and Poverty (ENAHO) 2017. Older adults were considered to be all individuals aged 60 and over and the GBS was considered the main study variable. Prevalence ratios (PR) and adjusted prevalence ratios (PRa) were estimated for each of the factors associated with GBS. GBS means were estimated using a generalized linear model with gamma distribution and log binding function. All confidence intervals (95%) of the estimators were calculated by bootstrapping with the normal-based method. RESULTS: . Eighteen 386 older adults were included, of which 56.5% reported GBS. The mean and median GBS is S/. 140.8 (USD 43.2) and S/. 34.5 (USD 10.6), respectively. Factors such as urban origin, a higher level of education, chronic diseases and higher per capita expenses increase the probability of GBS by up to 1.6 times. In those affiliated to the Integral Health Insurance (SIS), the GBS is reduced by 63.0 soles (USD 19.3) compared to those without any health insurance. CONCLUSIONS: . Six out of ten older Peruvian adults reported GBS to attend to their health needs. This generates an access inequity in terms of health services, mainly for socially-vulnerable groups. We suggest researching into the economic impact of health insurance and the preventive-promotional approach to chronic diseases, in order to reduce GBS and improve the efficiency of the Peruvian health system.

OBJETIVOS.: Estimar el gasto de bolsillo en salud (GBS) e identificar sus factores asociados en adultos mayores peruanos. MATERIALES Y MÉTODOS.: Estudio transversal analítico de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza (ENAHO) 2017. Se consideró como adulto mayor a todo individuo de 60 y más años y el GBS como variable principal de estudio. Se estimaron razones de prevalencia (RP) y razones de prevalencia ajustada (RPa) para cada uno de los factores asociados a GBS. Las medias del GBS fueron estimadas mediante un modelo lineal generalizado con distribución gamma y función de enlace log. Todos los intervalos de confianza (95 %) de los estimadores fueron calculados mediante bootstrapping con el método basado en la normal. RESULTADOS.: Se incluyeron 18 386 adultos mayores, de los cuales en el 56,5 % se reportó GBS. La media y mediana del GBS es de 140,8 (USD 43,2) y 34,5 (USD 10,6) soles, respectivamente. Factores como procedencia urbana, mayor nivel de educación, padecer enfermedades crónicas y mayores gastos per cápita aumentan hasta 1,6 veces la probabilidad de GBS. En los afiliados al Seguro Integral de Salud (SIS) se reduce el GBS en 63,0 soles (USD 19,3) comparado con aquellos sin ningún seguro de salud. CONCLUSIONES.: Seis de cada diez adultos mayores peruanos reportó GBS para atender su salud. Esto genera inequidad en el acceso a los servicios de salud, principalmente para los grupos socialmente vulnerables. Se sugiere investigar el impacto económico de los seguros sanitarios y el abordaje preventivo-promocional de las enfermedades crónicas, en aras de reducir el GBS y mejorar la eficiencia del sistema de salud peruano.

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BACKGROUND: Mexico approved mandatory nutrient-based standards for foods sold in schools in 2011. The aim of this study was to analyse the association between compliance with nutrition standards for foods sold in schools and children's school snacks. METHODS: Data came from three surveys representative of Mexican elementary schools in 13 states and their students (2012, 2013 and 2015); n = 645 children from N = 99 different schools. Information on foods sold in schools and snacks consumed by children was collected through direct observation. Compliance with the standards was defined as the proportion of foods sold in school which met nutrition criteria established by the standards. Snacks were classified as healthy if they contained at least one fruit or vegetable and had no sugar-sweetened beverages. Robust logistic regression models for cross-sectional and repeated surveys aggregated at the school-level were fitted to quantify the association between school compliance with standards and healthy snacks. RESULTS: On average across waves 27% of foods sold complied with nutrition standards; 18% of children consumed a healthy snack. For snacks purchased in school, a 10% increase in school compliance with the standards was associated with a 32% increase in the odds of a healthy snack (OR = 1.32; 95%CI 1.09,1.61); no association was observed for snacks brought from home. The odds of a healthy snack increased over time in schools where compliance with the standards improved (OR = 3.89; 95%CI 1.47,10.31) but not in those where compliance remained constant or decreased. CONCLUSIONS: Only a small proportion of children are eating healthy snacks in school. School compliance with standards increases the likelihood of a healthy snack if it is bought at school. Our findings support better implementation of the standards and additional strategies to enhance the policy to achieve its aim of reducing childhood obesity.

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RESUMEN Objetivos. Estimar el gasto de bolsillo en salud (GBS) e identificar sus factores asociados en adultos mayores peruanos. Materiales y métodos. Estudio transversal analítico de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza (ENAHO) 2017. Se consideró como adulto mayor a todo individuo de 60 y más años y el GBS como variable principal de estudio. Se estimaron razones de prevalencia (RP) y razones de prevalencia ajustada (RPa) para cada uno de los factores asociados a GBS. Las medias del GBS fueron estimadas mediante un modelo lineal generalizado con distribución gamma y función de enlace log. Todos los intervalos de confianza (95 %) de los estimadores fueron calculados mediante bootstrapping con el método basado en la normal. Resultados. Se incluyeron 18 386 adultos mayores, de los cuales en el 56,5 % se reportó GBS. La media y mediana del GBS es de 140,8 (USD 43,2) y 34,5 (USD 10,6) soles, respectivamente. Factores como procedencia urbana, mayor nivel de educación, padecer enfermedades crónicas y mayores gastos per cápita aumentan hasta 1,6 veces la probabilidad de GBS. En los afiliados al Seguro Integral de Salud (SIS) se reduce el GBS en 63,0 soles (USD 19,3) comparado con aquellos sin ningún seguro de salud. Conclusiones. Seis de cada diez adultos mayores peruanos reportó GBS para atender su salud. Esto genera inequidad en el acceso a los servicios de salud, principalmente para los grupos socialmente vulnerables. Se sugiere investigar el impacto económico de los seguros sanitarios y el abordaje preventivo-promocional de las enfermedades crónicas, en aras de reducir el GBS y mejorar la eficiencia del sistema de salud peruano.

ABSTRACT Objectives . To estimate out-of-pocket spending on health (GBS) and identify its associated factors in Peruvian older adults. Materials and Methods. Analytical cross-sectional study of the National Household Survey on Living Conditions and Poverty (ENAHO) 2017. Older adults were considered to be all individuals aged 60 and over and the GBS was considered the main study variable. Prevalence ratios (PR) and adjusted prevalence ratios (PRa) were estimated for each of the factors associated with GBS. GBS means were estimated using a generalized linear model with gamma distribution and log binding function. All confidence intervals (95%) of the estimators were calculated by bootstrapping with the normal-based method. Results . Eighteen 386 older adults were included, of which 56.5% reported GBS. The mean and median GBS is S/. 140.8 (USD 43.2) and S/. 34.5 (USD 10.6), respectively. Factors such as urban origin, a higher level of education, chronic diseases and higher per capita expenses increase the probability of GBS by up to 1.6 times. In those affiliated to the Integral Health Insurance (SIS), the GBS is reduced by 63.0 soles (USD 19.3) compared to those without any health insurance. Conclusions . Six out of ten older Peruvian adults reported GBS to attend to their health needs. This generates an access inequity in terms of health services, mainly for socially-vulnerable groups. We suggest researching into the economic impact of health insurance and the preventive-promotional approach to chronic diseases, in order to reduce GBS and improve the efficiency of the Peruvian health system.

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Abstract Objective: To evaluate the efficacy of natriuretic peptide (NP)-guided therapy compared to clinically-guided therapy in reducing mortality and hospital admissions in chronic heart failure (HF) patients. Methods: Randomised clinical trials (RCT) were selected through a systematic review. Four meta-analyses were conducted for the outcomes of overall mortality, HF-related mortality, overall hospital admissions, and HF-related hospital admissions. Heterogeneity between studies and publication bias were also assessed. Results: Nine RCTs were found with a total of 1914 patients. NP-guided therapy significantly reduced overall mortality and HF-related hospital admissions. No significant results were found for HF-related mortality and overall hospital admissions. Some clinical heterogeneity regarding interventions performed was found between studies. Publication bias was found for HF-related and overall hospital admissions. Conclusions: NP-guided therapy seems to improve outcomes compared to clinically-guided therapy. However, heterogeneity found between interventions might reduce the generalisation of these results. Specific interventions of the clinical trials should be examined when making recommendations regarding NP-guided therapy. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/).

Resumen Objetivo: Evaluar la eficacia de la terapia guiada por el péptido natriurético (PN) en comparación con la terapia guiada clínicamente para reducir la mortalidad y la hospitalización de la insuficiencia cardiaca (IC) crónica. Métodos: Los ensayos clínicos aleatorizados fueron seleccionados a través de una revisión sistemática. Cuatro metaanálisis se realizaron para los resultados de mortalidad general, mortalidad por IC, hospitalización general y la hospitalización por IC. Se evaluó la heterogeneidad entre los estudios y el sesgo de publicación. Resultados: Nueve ensayos clínicos aleatorizados se encontraron con un total de 1,914 pacientes. La terapia guiada con el PN reduce significativamente la mortalidad general y la hospitalización por IC. No se encontraron resultados significativos para la mortalidad por IC y la hospitalización general. El sesgo de publicación se encontró para las hospitalizaciones por IC y globales. Conclusiones: La terapia guiada por PN parece mejorar los resultados en comparación con la terapia guiada clínicamente. Sin embargo, la heterogeneidad encontrada entre las intervenciones podría reducir la generalización de estos resultados. Las intervenciones específicas de los ensayos clínicos deben ser analizadas al hacer recomendaciones con respecto a la terapia de guiada por PN. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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