The quest for universal health coverage: achieving social protection for all in Mexico

Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Flares in IIMs and the timeline following COVID-19 vaccination: a combined analysis of the COVAD-1 and -2 surveys

Objectives: Disease flares in the post-coronavirus disease 2019 (COVID-19) vaccination period represent a prominent concern, though risk factors are poorly understood. We studied these flares among patients with idiopathic inflammatory myopathies (IIMs) and other autoimmune rheumatic diseases (AIRDs). Methods: The COVAD-1 and -2 global surveys were circulated in early 2021 and 2022, respectively, and we captured demographics, comorbidities, AIRDs details, COVID-19 infection history and vaccination details. Flares of IIMs were defined as (a) patient self-reported, (b) immunosuppression (IS) denoted, (c) clinical sign directed and (d) with >7.9-point minimal clinically significant improvement difference worsening of Patient-Reported Outcomes Measurement Information System (PROMIS) PROMISPF10a score. Risk factors of flares were analysed using regression models. Results: Of 15 165 total respondents, 1278 IIMs (age 63 years, 70.3% female, 80.8% Caucasians) and 3453 AIRDs were included. Flares of IIM were seen in 9.6%, 12.7%, 8.7% and 19.6% patients by definitions (a) to (d), respectively, with a median time to flare of 71.5 (10.7-235) days, similar to AIRDs. Patients with active IIMs pre-vaccination (OR 1.2; 95% CI 1.03, 1.6, P = 0.025) were prone to flares, while those receiving rituximab (OR 0.3; 95% CI 0.1, 0.7, P = 0.010) and AZA (OR 0.3, 95% CI 0.1, 0.8, P = 0.016) were at lower risk. Female gender and comorbidities predisposed to flares requiring changes in IS. Asthma (OR 1.62; 95% CI 1.05, 2.50, P = 0.028) and higher pain visual analogue score (OR 1.19; 95% CI 1.11, 1.27, P < 0.001) were associated with disparity between self-reported and IS-denoted flares. Conclusion: A diagnosis of IIMs confers an equal risk of flares in the post-COVID-19 vaccination period to AIRDs, with active disease, female gender and comorbidities conferring a higher risk. Disparity between patient- and physician-reported outcomes represents a future avenue for exploration

Protons Spectrum from MAGIC Telescopes data

Imaging Atmospheric Cherenkov telescopes (IACTs) are designed to detect cosmic gamma rays. As a by-product, IACTs detect Cherenkov flashes generated by millions of hadronic air showers every night. We present the proton energy spectrum from several hundred GeV to several hundred TeV, retrieved from the hadron induced showers detected by the MAGIC telescopes. The protons are discriminated from He and other heavy nuclei by means of using machine learning classification. The energy estimation is based on a specially developed deep neural network regressor. In the last decade, Deep Learning methods gained much interest in the scientific community for their ability to extract complex relations in data and process large datasets in a short time. The proton energy spectrum obtained in this work is compared to the spectra obtained by dedicated cosmic ray experiments

Recent MAGIC results on Galactic binaries

X-ray and gamma-ray binaries are systems consisting of a compact object and normally a non-degenerate companion star. Most of these sources have been shown to emit radiation in a broad frequency range, from radio up to X-rays and sometimes gamma rays. We report on recent results in very high-energy gamma rays above 100 GeV obtained by the MAGIC Collaboration for the Galactic X-ray binaries MAXI J1820+070 and 1A 0535+262, and the gamma-ray binary HESS J0632+057. Multiwavelength data at lower energies are also provided for a better contextualisation of the sources

Very-high-energy gamma-ray emission from GRB 201216C detected by MAGIC

Gamma-ray bursts (GRBs) are the most energetic phenomena in the Universe. Many aspects of GRB physics are still under debate, such as the origin of their gamma-ray emission above the GeV energy range. In 2019, MAGIC detected TeV gamma rays from the long GRB 190114C, whose emission can be well explained by synchrotron-self Compton emission by relativistic electrons. However, it is still unclear whether such a process is common in GRBs, given the reduced number of GRBs detected until now at the very high energies (VHE). GRB 201216C is a long GRB and is the second one detected by MAGIC in this energy range. After receiving the alert provided by Swift-BAT, MAGIC automatically slewed to the GRB position, starting observations 56 seconds after the GRB onset. In the offline analyses of the collected data, we confirmed the detection of gamma-ray emission with a significance above 5 sigma. Following measurements from optical facilities, the redshift of this GRB was estimated to be z = 1.1. This makes GRB 201216C the most distant object ever detected by ground-based gamma-ray telescopes. In this contribution we will show the analysis results of the MAGIC data, also in comparison with past detected GRBs in the same energy range. Finally, accounting for available multi-wavelength observations, we will comment on the possible origin of the VHE emission detected by MAGIC

Extreme blazars under the eyes of MAGIC

Extreme high-frequency-peaked BL Lac objects (EHBLs) are the most energetic persistent sources in the universe. This contribution reports on long-term observing campaigns of tens of EHBLs that have been organized by the MAGIC collaboration to enlarge their population at VHE and understand the origin of their extreme properties. EHBLs are characterized by a spectral energy distribution (SED) featuring a synchrotron peak energy above 1 keV. Several EHBLs display a hard spectral index at very high energies (VHE; E &gt; 100 GeV), suggesting a gamma-ray SED component peaking significantly above 1 TeV. Such extreme properties are challenging current standard emission and acceleration mechanisms. Recent studies have also unveiled intriguing disparities in the temporal characteristics of EHBLs. Some sources seem to display a persistent EHBL behaviour, while others belong to the EHBL family only temporarily. Here, we present recent results of the first hard-TeV EHBL catalog. The MAGIC observations are accompanied by an extensive multiwavelength coverage to obtain an optimal determination of the SED. This allow us to investigate leptonic and hadronic scenarios for the emission. We also present the recent detection of the EHBL RX J0812.0+0237 in the VHE band by MAGIC. Finally, we discuss a broad multiwavelength campaign on the BL Lac type object 1ES 2344+514, which showed intermittent EHBL characteristics in August 2016

COVID-19 vaccine safety during pregnancy and breastfeeding in women with autoimmune diseases: results from the COVAD study

Objectives: We investigated COVID-19 vaccine safety in pregnant and breastfeeding women with autoimmune diseases (AID) in the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. Methods: Delayed-onset (>7 days) vaccine-related adverse events (AE), disease flares (DF), and AID-related treatment modifications were analyzed upon diagnosis of AID versus healthy controls (HC) and the pregnancy/breastfeeding status at the time of at least one dose of vaccine. Results: Among the 9201 participants to the self-administered online survey, 6787 (73.8%) were women. Forty pregnant and 52 breastfeeding patients with AID were identified, of whom the majority had received at least one dose of COVID-19 vaccine (100% and 96.2%, respectively). AE were reported significantly more frequently in pregnant than in non-pregnant patients (overall AE 45% vs 26%, p= 0.01; minor AE 40% vs 25.9%, p= 0.03; major AE 17.5% vs 4.6%, p< 0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC with respect to AE. Post-vaccination DF were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18.3% of age- and disease-matched non-pregnant and non-breastfeeding patients (n = 262). All pregnant/breastfeeding patients who experienced a DF were managed with glucocorticoids; 28.6% and 20% of them required initiation or change in immunosuppressants, respectively. Conclusion: This study provides reassuring insights into the safety of COVID-19 vaccines administered to women with AID during the gestational and post-partum periods, helping overcome hesitant attitudes, as the benefits for the mother and the fetus by passive immunization appear to outweigh potential risks

Follow-up observations of GW170817 with the MAGIC telescopes

The discovery of the electromagnetic counterpart AT2017gfo and the GRB 170817A, associated to the binary neutron star merger GW170817, was one of the major advances in the study of gamma- ray bursts (GRBs) and the hallmark of the multi-messenger astronomy with gravitational waves. Another breakthrough in GRB physics is represented by the discovery of the highly energetic, teraelectronvolt (TeV) component in the GRB 190114C, possibly an universal component in all GRBs. This conclusion is also suggested by the hint of TeV emission in the short GRB 160821B and a few more events reported in the literature. The missing observational piece is the joint detection of TeV emission and gravitational waves from a short GRB and its progenitor. MAGIC observed the counterpart AT2017gfo as soon as the visibility conditions allowed it, namely from January to June 2018. These observations correspond to the maximum flux level observed in the radio and X-ray bands. The upper limits derived from TeV observations are compared with the modelling of the late non-thermal emission using the multi-frequency SED