Association of Maternal age 35 years and over and prenatal care utilization, preterm birth, and low birth weight, Mexico 2008–2019

Objective: We compared prenatal care utilization, preterm birth, and low birth weight neonates among women 35 years and older compared to women 20-34 years old in Mexico, 2008-2019. Methods: We used birth certificate data and conducted a historical cohort study of all singleton live births in Mexico from 2008-2019. Study outcomes were inadequate prenatal care (timing of initiation of care and number of visits), preterm birth, and low birth weight. We compared outcomes among women 35-39, 40-44, and 45-49 with births to women 20-34. We used logistic regression to account for individual and contextual confounders. Results: We included a total of N=19,526,922 births; 11.9% (n=2,325,725) were to women 35 and older. Compared to women aged 20 to 34, the oldest (45-49 years old) were more likely to reside in poorer communities, have less education, and be uninsured. The odds of inadequate prenatal care (aOR 1.12 95% CI 1.09-1.15 p Conclusion: Women who deliver at 35 years old and over are a heterogeneous group in Mexico. Being 35 years old and older is associated with increases in preterm birth and low birth weight neonates. Women who give birth between 45-49 may be especially vulnerable

Con la ley y sin la ley/ With and without the law: Utilization of abortion services and case fatality in Mexico, 2000–2016

El objetivo del presente estudio fue describir la utilización de los servicios de salud y los casos fatales producto de los eventos abortivos a través del sistema de salud mexicano. El acceso al aborto inducido sigue siendo altamente restringido en México. En la Ciudad de México, se despenalizó el aborto inducido en el primer trimestre en 2007, y los servicios estuvieron disponibles de inmediato tanto en el sector público bajo el programa Interrupción Legal de Embarazo (ILE) como en el sector privado. La ley de aborto inducido se determina en el nivel estatal en México. La ley del aborto fuera de la ciudad de México (31 estados), la ley del aborto varía. El acceso al aborto inducido bajo la excepción de violación ha sido legal en todo el país desde 2016. Sin embargo, en las instalaciones de salud de todo Méxicos, se realiza abortos cuando están los casos están contemplados en la Clasificación Internacional de Enfermedades 10 revisión (CIE-10) código O00-O08(embarazo ectópico y molar, espontáneo, aborto incompleto e inducido. La letalidad debida a eventos abortivos representa un subconjunto de muertes por causas obstétricas directas totales. Se anticipa que la letalidad aumentará a medida que aumente las situaciones donde los eventos abortivos son muy inseguros, los pacientes están muy enfermos y / o la atención médica es de deficiente calidad. Por el contrario, se esperaría una disminución de la mortalidad en caso de utilización aumenta en situaciones donde los abortos son "menos inseguros", la salud sea menos complicada, el acceso a los servicios mejore y / o exista atención de mejor calidad. Es importante documentar tanto la utilización como los resultados de la gama de servicios de aborto que se brindan en todo el público con la finalidad de proporcionar evidencia para guiar la prestación de servicios y la formulación de políticas.wileyonlinelibrary.com/journal/ijg

Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007–2015

Describe las tendencias temporales y geográficas en la utilización de servicios de aborto en el segundo trimestre dentro de las instalaciones en todo México. Utiliza datos del 2007-2015 del Sistema Automatizado de alta hospitalaria de México (SAEH) para identificar eventos abortivos en el segundo trimestre (ICD O02-O08) en hospitales públicos en los 32 estados de México. Describe la utilización, calcula las tasas utilizando datos de población y utilizamos la regresión logística para identificar los factores a nivel estatal y de la mujer (marginación a nivel municipal, ley de aborto a nivel estatal) asociados con la utilización de los servicios del segundo trimestre versus los del primer trimestre. Identifica 145 956 abortos en el segundo trimestre, o el 13.4% del total de hospitalizaciones documentadas por aborto entre 2007 y 2015. La tasa de utilización anual del aborto en el segundo trimestre se mantuvo constante, entre 0.5 y 0.6 por 1000 mujeres de 15 a 44 años. Las mujeres que viven en municipios altamente marginados tenían 1.43 probabilidades más altas de utilizar servicios de aborto en su segundo trimestre que en el primer trimestre, en comparación con las mujeres en municipios con baja marginación (IC del 95%: 1.18 a 1.73). Vivir en un estado con una excepción de salud o anomalía fetal a las restricciones de aborto no se asoció con una mayor utilización de los servicios de aborto en el segundo trimestre. Los resultados sugieren que existe la necesidad de todos los tipos de servicios de aborto en el segundo trimestre en México. Para mejorar los resultados de salud para las mujeres mexicanas, especialmente las más vulnerables, se debe garantizar el acceso a servicios de aborto seguro en el segundo trimestre mediante la implementación de las excepciones legales actuales y una atención renovada a la capacitación de los proveedores de atención médica

Atención prenatal en grupo: efectividad y retos de su implementación

Group prenatal care is an alternative model of care during pregnancy, replacing standard individual prenatal care. The model has shown maternal benefits and has been implemented in different contexts. We conducted a narrative review of the literature in relation to its effectiveness, using databases such as PubMed, EBSCO, Science Direct, Wiley Online and Springer for the period 2002 to 2018. In addition, we discussed the challenges and solutions of its implementation based on our experience in Mexico. Group prenatal care may improve prenatal knowledge and use of family planning services in the postpartum period. The model has been implemented in more than 22 countries and there are challenges to its implementation related to both supply and demand. Supply-side challenges include staff, material resources and organizational issues; demand-side challenges include recruitment and retention of participants, adaptation of material, and perceived privacy. We highlight specific solutions that can be applied in diverse health systems.La atención prenatal en grupo es un modelo alternativo de atención durante el embarazo, que sustituye la atención prenatal individual estándar. El modelo ha mostrado beneficios maternos y se ha implementado en diferentes contextos. Llevamos a cabo una revisión narrativa de la literatura en relación a su efectividad, utilizando bases de datos como PubMed, EBSCO, Science Direct, Wiley Online y la editorial Springer, para el periodo 2002 a 2018. Adicionalmente, discutimos los retos y soluciones de su implementación desde nuestra experiencia en México. La atención prenatal en grupo puede mejorar el conocimiento prenatal y el uso de servicios de planificación familiar en el postparto. El modelo se ha implementado en más de 22 países y existen retos de su implementación desde la oferta y la demanda. Los retos desde la oferta incluyen al personal, recursos materiales y cuestiones organizacionales; desde la demanda, el reclutamiento y retención de participantes, adaptación del material y privacidad percibida. Resaltamos soluciones concretas que pueden aplicar a diversos sistemas de salud

Group Prenatal Care in Mexico: perspectives and experiences of health personnel

OBJETIVO: Identificar barreras y facilitadores de la implementación del modelo de Atención Prenatal en Grupo en México (APG), desde la perspectiva del personal de salud. MÉTODOS: Estudio cualitativo descriptivo en cuatro clínicas de la Secretaría de Salud en dos estados de México (Morelos e Hidalgo) de junio de 2016 a agosto de 2018. Se realizaron 11 entrevistas semi-estructuradas a prestadores de servicios de salud. Se exploraron sus percepciones y experiencias durante la implementación del modelo de APG. Se identificaron barreras y facilitadores para su adopción en dos dimensiones: a) estructurales (espacio, recursos, personal de salud, volumen de pacientes, comunidad) y b) actitudinales (motivación, liderazgo, aceptabilidad, abordaje de problemas, clima y comunicación). RESULTADOS: Las barreras más relevantes reportadas en el nivel estructural fueron la disponibilidad de espacio físico en las unidades y la sobrecarga de trabajo del personal de salud. Se identificó la dificultad para adoptar una relación menos jerárquica durante la atención a las gestantes en el nivel actitudinal. El principal facilitador a nivel actitudinal fue la aceptabilidad que los prestadores tienen del modelo. Un hallazgo específico para el contexto de la implementación en México fue la resistencia al cambio en la relación médico-paciente; resulta difícil abandonar el modelo jerárquico prevaleciente y cambiar a una relación más horizontal con las gestantes. CONCLUSIONES: El análisis de la implementación del modelo de APG en México, desde la perspectiva del personal de salud, ha evidenciado barreras y facilitadores similares a las experiencias en otros contextos. Esfuerzos futuros para la adopción del modelo deberán enfocarse en la atención oportuna de las barreras identificadas, sobre todo aquellas señaladas en la dimensión actitudinal que pueden ser modificadas a través de capacitaciones continuas al personal de salud.OBJECTIVE: Identify barriers and facilitators to implementing the Group Prenatal Care model in Mexico (GPC) from the health care personnel’s perspective. METHODS: We carried out a qualitative descriptive study in four clinics of the Ministry of Health in two states of Mexico (Morelos and Hidalgo) from June 2016 to August 2018. We conducted 11 semi-structured interviews with health care service providers, and we examined their perceptions and experiences during the implementation of the GPC model. We identified the barriers and facilitators for its adoption in two dimensions: a) structural (space, resources, health personnel, patient volume, community) and b) attitudinal (motivation, leadership, acceptability, address problems, work atmosphere and communication). RESULTS: The most relevant barriers reported at the structural level were the availability of physical space in health units and the work overload of health personnel. We identified the difficulty in adopting a less hierarchical relationship during the pregnant women’s care at the attitudinal level. The main facilitator at the attitudinal level was the acceptability that providers had of the model. One specific finding for Mexico’s implementation context was the resistance to change the doctor-patient relationship; it is difficult to abandon the prevailing hierarchical model and change to a more horizontal relationship with pregnant women. CONCLUSION: Analyzing the GPC model’s implementation in Mexico, from the health care personnel’s perspective, has revealed barriers and facilitators similar to the experiences in other contexts. Future efforts to adopt the model should focus on timely attention to identified barriers, especially those identified in the attitudinal dimension that can be modified by regular health care personnel training

Identification of Plant Extracts that Inhibit the Formation of Diabetes-Linked IAPP Amyloid

The extracts of 27 vegetables, spices and herbs were screened for their functional ability to inhibit the aggregation of islet amyloid polypeptide (IAPP, amylin) into toxic amyloid aggregates. The aggregation of IAPP has been directly linked to the death of pancreatic β-islet cells in type 2 diabetes. Inhibiting the aggregation of IAPP is believed to have the potential to slow, if not prevent entirely, the progression of this disease. As vegetables, spices and herbs are known to possess many different positive health effects, the extracts of 27 plants (abundant within the United States and spanning several plant families) were screened for their ability to inhibit the formation of toxic IAPP aggregates. Their anti-amyloid activities were assessed through (1) thioflavin T binding assays, (2) visualization of amyloid fibers using atomic force microscopy and (3) cell rescue studies. From this research, mint, peppermint, red bell pepper and thyme emerged as possessing the greatest anti-amyloid activity

Integrated Carbon Budget Models for the Everglades Terrestrial-Coastal-Oceanic Gradient: Current Status and Needs for Inter-Site Comparisons

Recent studies suggest that coastal ecosystems can bury significantly more C than tropical forests, indicating that continued coastal development and exposure to sea level rise and storms will have global biogeochemical consequences. The Florida Coastal Everglades Long Term Ecological Research (FCE LTER) site provides an excellent subtropical system for examining carbon (C) balance because of its exposure to historical changes in freshwater distribution and sea level rise and its history of significant long-term carbon-cycling studies. FCE LTER scientists used net ecosystem C balance and net ecosystem exchange data to estimate C budgets for riverine mangrove, freshwater marsh, and seagrass meadows, providing insights into the magnitude of C accumulation and lateral aquatic C transport. Rates of net C production in the riverine mangrove forest exceeded those reported for many tropical systems, including terrestrial forests, but there are considerable uncertainties around those estimates due to the high potential for gain and loss of C through aquatic fluxes. C production was approximately balanced between gain and loss in Everglades marshes; however, the contribution of periphyton increases uncertainty in these estimates. Moreover, while the approaches used for these initial estimates were informative, a resolved approach for addressing areas of uncertainty is critically needed for coastal wetland ecosystems. Once resolved, these C balance estimates, in conjunction with an understanding of drivers and key ecosystem feedbacks, can inform cross-system studies of ecosystem response to long-term changes in climate, hydrologic management, and other land use along coastlines

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Travelling for Abortion Services in Mexico 2016–2019: Community-Level Contexts of Mexico City Public Abortion Clients

Objective: To describe the community context of women who travel to access Mexico City’s public sector abortion programme and identify factors associated with travelling from highly marginalised settings. Methods: We used data from the Interrupción Legal de Embarazo (ILE) programme (2016–2019) and identified all abortion clients who travelled from outside Mexico City. We merged in contextual information at the municipality level and used descriptive statistics to describe ILE clients’ individual characteristics and municipalities on several measures of vulnerability. We also compared municipalities that ILE clients travelled from with those where no one travelled from. We used logistic regression to identify factors associated with travelling to access ILE services from highly marginalised versus less marginalised municipalities. Results: Our sample included 21 629 ILE clients who travelled to Mexico City from 491 municipalities within all 31 states outside Mexico City. The majority of clients travelled from the least marginalised (81.9%) and most populated (over 100 000 inhabitants; 91.3%) municipalities. Most (91.2%) ILE clients came from municipalities with adolescent fertility rates in the bottom three quintiles. Clients with a primary or secondary education (vs high school or more) and those from a municipality with a high adolescent fertility rate (top two quintiles) had higher odds of travelling from a highly marginalised (vs less) municipality (adjusted odds ratio (aOR) 1.46, 95% CI 1.35 to 1.58 and aOR 1.89, 95% CI 1.68 to 2.12, respectively). Conclusion: ILE clients travel from geographically and socioeconomically diverse communities. There is an unmet need for legal abortion across Mexico

Trends in Subdermal Contraceptive Implant Use in Mexico 2009-2018: A Population-Based Study.

Objective The purpose of this study is to describe subdermal implant use in Mexico over time, by state, and by age. Methods We conducted a repeated cross-sectional study using the 2009, 2014, and 2018 waves of the National Survey of Demographic Dynamics (ENADID). Our outcome was current use of contraception, by type, with a focus on the implant. We used visualizations, descriptive and bivariate statistics, and multinomial models to assess change over time, geographic patterns, method mix, and factors associated with implant use (vs. IUD or other hormonal methods). Results Implant use is increasing over time in Mexico, from 1.1% of women who have ever used a method in 2009 to 4.5% in 2018 (p Conclusion Use of subdermal implants is increasing over time in Mexico and is concentrated among adolescents. Implants have the potential to expand access to highly effective contraception in Mexico