Hortensia Reyes-Morales

Introduction: Multimorbidity, which is defined as the presence of two or more simultaneous diseases, is a growing global health problem that is influenced by social conditions, the interaction and overlap of which have been rarely recognized. Thus, this study aimed to analyze the impact of relevant social inequalities on the risk of Multimorbidity in Mexican adults with an intersectional approach. Methods: The data of 4,806 people older than 20 years who participated in the National Health and Nutrition Survey (ENSANUT) 2023 were analyzed. Multimorbidity was defined as the self-reported presence of two or more chronic diseases. A multilevel analysis of individual heterogeneity and discriminatory precision was used to identify intersectional inequalities. Results: The combinations of social attributes made up 38 strata. Social attributes explained 24.62% of the individual variability with respect to having Multimorbidity with an acceptable capacity to discriminate between having Multimorbidity or not. Young men who had higher education, employment and no social security had a lower probability of Multimorbidity; older women who had less education and no employment but did have social security were at greater risk. The main effects explained the total variance between strata, and important differences persisted between social combinations. Conclusion: This intersectional work reveals various social identities that are grouped into strata and represent patterns of social disadvantage associated with Multimorbidity.

Objectives. To analyze the density and inequality of human resources in nutrition (HRN) in the Mexican public health system, as well as their evolution between 2019 and 2023. Materials and methods. An ecological study was conducted with secondary information sources for 2019 and 2023. The density of HRN per 100,000 inhabitants was estimated, based on the total population, and its distribution was analyzed according to social security institution, level of care, and federative entity. In addition, the density of HRN for adults with overweight or obesity (OoO) was estimated for 2023. To estimate the inequality in the state distribution of HRN, the concentration index (CI) was used, and the marginalization index as a stratifier. Results. In Mexico, the density of HRN increased from 5.9 in 2019 to 6.9 per 100,000 inhabitants in 2023; however, this increase was unequal among federative entities, institutions, and levels of care. In second and third-level care units, the density reached up to 22.41 HRN per 100,000 inhabitants, while in the first level it was 2.0. There is a higher concentration of HRN in entities with lower marginalization (CI=0.13 in 2019; CI=0.11 in 2023), units for the population with social security (CI=0.36 in 2019; CI=0.33 in 2023), and second and third levels (CI=0.20 in 2019; CI=0.18 in 2023). Conclusions. In Mexico, between 2019 and 2023, the density of HRN increased, but state- level and by level of care inequalities persist. Strengthening its planning and distribution, particularly at the first level of care, is essential to respond to the nutritional and epidemiological needs of the country.

Summary Background Frailty is a dynamic geriatric syndrome characterized by progressive deterioration related to age. Objective To describe the trajectories and estimate the transition probabilities between frailty phenotypes and identify clinical variables and drugs associated with the transition to more severe phenotypes over four years of follow-up in a cohort of elderly people living in the community. Study design Secondary analysis of data from the study “Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults”. The baseline sample included adults ≥ 60 years, with annual monitoring for four years. Main outcome measures Frailty phenotype, chronic diseases, multimorbidity, medications, polypharmacy, and sociodemographic variables. The trajectories were identified using the optimal alignment algorithm, and the longitudinal patterns of fragility were analyzed with hierarchical clustering techniques. The annual transition probabilities were estimated with a nested Markov model, and the factors associated with the transitions were identified using ordinal multilevel mixed-effects logistic regression models. Results The initial cohort included 973 patients. Four frailty trajectories were identified. The transitions between frailty phenotypes were asymmetric, and the lowest annual rate of occurrence was improvement. The effect of time (follow-up), each additional year of a person, being female, suffering from multimorbidity (MM) and receiving antihypertensive, psycholeptic and/or psychoanaleptic, antiparkinsonian, or antivertiginous drugs increased the probability of moving toward a more severe state of frailty; a higher level of education and having a partner conferred a protective effect. Conclusion Early identification of the prefrailty condition offers a window of opportunity to reverse it or prevent further deterioration.

Objetivo. Analizar la factibilidad política, legal, técnica y social de incluir a los consultorios adyacentes a farmacias (CAF) privadas como parte de la red de atención ambulatoria de los servicios de salud que atiende a personas sin seguridad social en un estado en México. Material y métodos. Se realizó un estudio de caso con metodología mixta secuencial, entre febrero y junio de 2023 que exploró la factibilidad política, legal, técnica y social de incluir los CAF. Para la dimensión política, se aplicaron entrevistas semiestructuradas y una matriz que valoró el posicionamiento, poder e interés de los actores clave. Para la dimensión legal se realizó un análisis documental del marco legal y normativo sobre prestación de servicios de salud; la dimensión técnica analizó la disponibilidad de consultorios y personal médico, y para la dimensión social se aplicó un cuestionario a usuarios de CAF. Resultados. En la dimensión política, los actores clave estuvieron medianamente a favor; en la dimensión legal los documentos no restringen la inclusión de los CAF a la red pública; en la dimensión técnica, la complementariedad de recursos humanos e infraestructura aumenta su disponibilidad para la atención ambulatoria; y en la dimensión social, los usuarios estuvieron de acuerdo con la inclusión de los CAF como parte de la red de atención pública para la atención de la población sin seguridad social. Conclusiones. La inclusión de los CAF es una alternativa al corto plazo para fortalecer la atención ambulatoria pública. El respaldo social y el marco legal, pese a los desafíos políticos, validan su potencial para ampliar el acceso a la atención de salud de la población sin seguridad social.

Objective: Analyze the frequency and distribution of COVID-19 diagnostic testing (RT-PCR and Ag-RDT) in Mexico during 2020-2022, and identify the sociodemographic and regional factors associated with their use. Methods: Ecological and cross-sectional study using secondary data from the National Epidemiological Surveillance System for Respiratory Diseases (SISVER). Approximately 15 million tests performed in public and private institutions between June 2020 and April 2022 were analyzed at individual and municipal levels to describe distribution by sex, age, social security coverage, and regional marginalization. Results: Ag-RDT was the most frequently used test nationwide, with testing concentrated in Mexico City and other economically developed regions, while marginalized and predominantly indigenous areas showed the lowest testing rates. Conclusion: Significant inequalities were found in access to COVID-19 testing in Mexico, highlighting the influence of socioeconomic and territorial disparities and the need for equity-oriented public health and nursing strategies.

The empowerment of persons facing chronic conditions in Mexico can support health care in the context of vertical and fragmented institutions. The American short form Patient Activation Measure (PAM) is a 13-item instrument designed to assess patient knowledge, skills and confidence for self-management. PAM-13 was translated into Mexican Spanish, its psychometric properties were established for both sick and healthy persons, and its external validity assessed against health service utilization. The translation was carried out according to WHO guidelines. The PAM 13-Mexico was applied in a nationally representative household survey to healthy persons and to persons living with diabetes and hypertension, equally divided within a sample of 2,400 persons. The instrument was also applied to an opportunistic sample of 136 women living with breast cancer in two large cities. Internal consistency and cross-validation against care variables were computed. Results were compared to similar data for other high and upper middle-income countries. The psychometric properties of the PAM 13-Mexico were generally good. The level of internal consistency is high (α = 0.88; McDonald’s omega coefficient = 0.88) and item-rest correlations are moderate to strong. The Mexican mean PAM score (77.1) is greater than the American (61.9) and the Danish (64.2). The association with health service utilization and quality was weak to strong. The PAM-13 Mexico is a reliable instrument to measure empowerment of persons to address chronic diseases. The validity of PAM-13 needs to be researched against a wider set of health care variables and with diverse populations.

Functional limitation represents a major health concern among older adults, with its incidence increased based on personal characteristics such as being a woman, having minor levels of education, and lower socioeconomic status, leading to health inequities. Addressing these inequities requires comprehensive frameworks like intersectionality to provide a broader perspective. This study analyzes health inequities in functional limitation among Mexican older adults using data from the 2021 round of the Mexican Health and Aging Study (MHAS) within an intersectional framework. The Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) technique, recognized as the gold standard in quantitative intersectionality research, was employed. Six variables were assessed: age, sex, education, social engagement, economic status, and access to health services. The results indicate that age, social engagement, and economic status were the main variables that explain functional limitation. Enhancing social engagement emerges as a practical short-term strategy to improve functionality and reduce inequities. Contrary to prior evidence, sex was not directly associated with functional limitation. Therefore, higher rates of functionality loss previously reported in the literature may not simply be linked to being a woman but rather to the societal implications of being a woman in contemporary contexts. Similarly, access to health services did not show a significant relationship with functional limitation despite the health system being a critical intermediate social determinant of health with the potential to address inequities. This research underscores the importance of intersectionality in understanding inequality, offering a nuanced perspective on overlapping systems of oppression and privilege to address disparities in Mexican older adults.