Syndemics of Severity and Frequency of Elder Abuse: A Cross-Sectional Study in Mexican Older Females

Background: Elder abuse is a common phenomenon with important effects on the health and well-being of older adults. There are important gaps in elder abuse measurement, as it is usually reported as the absence or presence of elder abuse, disregarding its severity and frequency. Objectives: Identify different ways of measuring severity and frequency of elder abuse and assess whether different experiences of severity and frequency suggest syndemic relationships. Methods: Through a sample of 534 non-institutionalized Mexican older women, we assessed how severity (i.e., number of abusive experiences and number of types of abuses) and frequency (i.e., if abusive experiences had happened few or many times) correlate among them. For each of these measures we estimated a multinomial model to examine associations with social support, functional impairments, socioeconomic status, food insecurity, depression, and comorbidities, while controlling for key socio-demographic variables. Results: 30.5% of the older women reported psychological abuse, 8.2% financial exploitation, 5.1% caregiver neglect, 3.5% physical abuse, and 1.2% sexual abuse. In terms of frequency, 77.8% of the women self-reported having never been abused or only once in the last 12 months, whereas 13.1% reported abusive experiences repeating few times, and 9.9% repeating many times. In terms of severity, 66.7% of the older women had not been abused, 22.3% had suffered one type of abuse, and 11.1% two or more. Similarly, 15.0% reported one abusive experience, 8.1% two, and 10.3% three or more abusive events during the last 12 months. Severity measures showed similar associations: social support and high socioeconomic level as protective factors among those with less severe abuse, whereas increased depression, food insecurity and functional impairments were associated with more severe experiences of elder abuse. Frequency followed a different pattern, depressive symptoms were significantly associated with those with few experiences (compared to those with none or once), while functional impairments were associated with many experiences of elder abuse. Conclusions: It is relevant to assess elder abuse through its severity and frequency as inter-individual variability and the complexity of the experience shows different determinants suggesting a syndemic approach. This has important clinical and policy implications

Association between breastfeeding and child stunting in Mexico

Background: Globally, the prevalence of child stunting has been decreasing over the past decades. How-ever, in low-and middle-income countries such as Mexico, stunting is still the most prevalent form of undernutrition affecting a large number of children in the most vulnerable conditions. Breastfeeding has been identified as one of the key affordable and modifiable maternal health behaviors protecting against child stunting. Objective: To examine the association between breastfeeding (defined as never breastfed, any breast-feeding for \u3c6 months, and any breastfeeding for ≥6 months) and other individual-, household-, and area-level factors with child stunting (defined as length/height-for-age-z-score for sex under –2 standard deviations of the World Health Organization child growth standards’ median) in Mexico. Methods: Secondary data analysis using the 2012 Mexican Health and Nutrition Survey, which allowed representativeness of rural and urban areas at national level and among 4 regions in Mexico. Our subset included data on 2,089 singleton Mexican children aged 6–35 months with information on previously identified risk and protective factors for stunting. We conducted fixed-and mixed-effects logistic regression models sequentially controlling for each level of factors. Findings: Overall, 12.3% of children were stunted and 71.1% were breastfed for ≥6 months. Any breast-feeding and being female were consistent protective factors against child stunting across all models. In contrast, child low birthweight, maternal short stature, higher number of children aged \u3c5 years per household, and moderate to severe food insecurity were consistent risk factors for child stunting across all models. Conclusions: According to our findings, efforts to reduce child stunting in Mexico should include prenatal strategies aiming to prevent low birthweight offspring particularly among short-stature women, moderate to severe food insecure households, families with a higher number of children aged \u3c5 years, and indigenous communities. Postnatal components should include multilevel strategies to support breastfeeding

How much can Mexican healthcare providers learn about breastfeeding through a semi-virtual training? A propensity score matching analysis

Background: Mexico has shown a worrisome decrease in breastfeeding indicators, especially in the lowest socioeconomic level. Improving breastfeeding protection, promotion, and support services through workforce development is a key area of intervention. The objective of this study is to assess the influence on breastfeeding knowledge and abilities of a semi-virtual training for primary healthcare providers assisting beneficiaries of PROSPERA in Mexico, which is one of the largest conditional cash-transfer programs in the world. Methods: Two independent cross-sectional samples of healthcare providers were drawn at baseline and post-intervention in three states of Mexico. Baseline data were collected among primary physicians, registered nurses and nurse technicians (i.e. unit of analysis) on July 2016 (n = 529) and post-training between March and April 2017 (n = 211). A 19-item telephone questionnaire assessed providers\u27 general knowledge about breastfeeding, breastfeeding benefits and clinical aspects of breastfeeding, clinical ability to solve problems and abilities to overcome breastfeeding challenges. The effects of the training were assessed through a propensity score matching (PSM) stratified by types of providers (i.e. physicians, registered nurses, nurse technicians). Results: The PSM analysis showed significant improvements among all providers in the general knowledge about breastfeeding (around 20 percentage points [pp]) and knowledge about breastfeeding benefits (approximately 50 pp). In addition, physicians improved their knowledge about clinical aspects of breastfeeding (7 pp), while registered nurses improved in their ability to solve breastfeeding problems (14 pp) and in helping mothers overcome breastfeeding challenges (12 pp). Conclusions: Promoting a breastfeeding enabling environment in Mexico to improve breastfeeding rates will require improving the knowledge and skills of healthcare providers. While a semi-virtual training showed large improvements in knowledge, developing skills among providers may require a more intensive approach

Syndemics of Severity and Frequency of Elder Abuse: A Cross-Sectional Study in Mexican Older Females

Background: Elder abuse is a common phenomenon with important effects on the health and well-being of older adults. There are important gaps in elder abuse measurement, as it is usually reported as the absence or presence of elder abuse, disregarding its severity and frequency.Objectives: Identify different ways of measuring severity and frequency of elder abuse and assess whether different experiences of severity and frequency suggest syndemic relationships.Methods: Through a sample of 534 non-institutionalized Mexican older women, we assessed how severity (i.e., number of abusive experiences and number of types of abuses) and frequency (i.e., if abusive experiences had happened few or many times) correlate among them. For each of these measures we estimated a multinomial model to examine associations with social support, functional impairments, socioeconomic status, food insecurity, depression, and comorbidities, while controlling for key socio-demographic variables.Results: 30.5% of the older women reported psychological abuse, 8.2% financial exploitation, 5.1% caregiver neglect, 3.5% physical abuse, and 1.2% sexual abuse. In terms of frequency, 77.8% of the women self-reported having never been abused or only once in the last 12 months, whereas 13.1% reported abusive experiences repeating few times, and 9.9% repeating many times. In terms of severity, 66.7% of the older women had not been abused, 22.3% had suffered one type of abuse, and 11.1% two or more. Similarly, 15.0% reported one abusive experience, 8.1% two, and 10.3% three or more abusive events during the last 12 months. Severity measures showed similar associations: social support and high socioeconomic level as protective factors among those with less severe abuse, whereas increased depression, food insecurity and functional impairments were associated with more severe experiences of elder abuse. Frequency followed a different pattern, depressive symptoms were significantly associated with those with few experiences (compared to those with none or once), while functional impairments were associated with many experiences of elder abuse.Conclusions: It is relevant to assess elder abuse through its severity and frequency as inter-individual variability and the complexity of the experience shows different determinants suggesting a syndemic approach. This has important clinical and policy implications

Food insecurity measurement and prevalence estimates during the COVID-19 pandemic in a repeated cross-sectional survey in Mexico

Objective: To validate the telephone modality of the Latin American and Caribbean Food Security Scale (ELCSA) included in three waves of a phone survey to estimate the monthly household food insecurity prevalence during the COVID-19 pandemic in Mexico. Design: We examined the reliability and internal validity of the ELCSA scale in three repeated waves of cross-sectional surveys with Rasch models. We estimated the monthly prevalence of food insecurity in the general population and in households with and without children and compared them with a national 2018 survey. We tested concurrent validity by testing associations of food insecurity with socio-economic status and anxiety. Setting: ENCOVID-19 is a monthly telephone cross-sectional survey collecting information on the well-being of Mexican households during the pandemic lockdown. Surveys used probabilistic samples, and we used data from April (n 833), May (n 850) and June 2020 (n 1674). Participants: Mexicans 18 years or older who had a mobile telephone. Results: ELCSA had an adequate model fit and food insecurity was associated, within each wave, with more poverty and anxiety. The COVID-19 lockdown was associated with an important reduction in food security, decreasing stepwise from 38·9 % in 2018 to 24·9 % in June 2020 in households with children. Conclusions: Telephone surveys were a feasible strategy to monitor reductions in food security during the COVID-19 lockdown

Design, synthesis and evaluation of a tripodal receptor for phosphatidylinositol phosphates

Phosphatidylinositol phosphates (PIPs) are membrane phospholipids that play crucial roles in a wide range of cellular processes. Their function is dictated by the number and positions of the phosphate groups in the inositol ring (with seven different PIPs being active in the cell). Therefore, there is significant interest in developing small-molecule receptors that can bind selectively to these species and in doing so affect their cellular function or be the basis for molecular probes. However, to date there are very few examples of such molecular receptors. Towards this aim, herein we report a novel tripodal molecule that acts as receptor for mono- and bis-phosphorylated PIPs in a cell free environment. To assess their affinity to PIPs we have developed a new cell free assay based on the ability of the receptor to prevent alkaline phosphatase from hydrolysing these substrates. The new receptor displays selectivity towards two out of the seven PIPs, namely PI(3)P and PI(3,4)P2. To rationalise these results, a DFT computational study was performed which corroborated the experimental results and provided insight into the host–guest binding mode

Costing of actions to safeguard vulnerable Mexican households with young children from the consequences of COVID-19 social distancing measures

COVID-19 has imposed unprecedented challenges to society. As the pandemic evolves, the social distancing measures that have been globally enforced, while essential, are having undesirable socioeconomic side effects particularly among vulnerable populations. In Mexico, families who depend upon informal employment face increased threats to their wellbeing, and households who in addition have young children may face long-term consequences. The Mexican government has not yet taken actions, but a coalition of non-governmental organizations is advocating in partnership with academic institutions for social protection actions such as a cash transfer and basic services subsidies for families with young children, subsisting from the informal sector economy. To facilitate governmental action, we estimated the costs for implementation of these recommendations. The methodology used could be replicated in other countries facing similar challenges