This study aimed to assess HPV16 variant period prevalence and sequential acquisition at genital and anal sites in men from the USA and Latin America, using data from the HPV Infection in Men (HIM) Study cohort. Among 635 men with genital and 115 with anal HPV16, 53 men tested positive for any HPV16 variant at both sites, and HPV16 A1 was most prevalent at both sites, more so at the anal canal. Sequential acquisition of HPV16 A1 occurred in 30.4% (genital to anal) and 29.4% (anal to genital). These findings offer insight into HPV16 variant distribution across anatomic sites in men.

OBJETIVO:Analizar los resultados del programa de detección oportuna de cáncer de mama mediante tamizaje de la Secretaría de Salud en México (2017) a partir de seis indicadores de proceso comparados con la medición de 2011, así como con estándares de la Organización Mundial de la Salud. Material y métodos. Se midieron seis indicadores de proceso del programa: 1) población blanco a tamizar mediante mastografía; 2) proyección de infraestructura disponible para tamizaje; 3) cobertura de mastografía; 4) porcentaje de casos con evaluación especializada; 5) porcentaje de casos con malignidad lo suficientemente alta para realizar biopsia y confirmar diagnóstico; y 6) porcentaje de casos que inician tratamiento. Se compararon los indicadores con los de 2011 y con estándares internacionales. Se graficaron los indicadores del programa a nivel nacional y por grado de marginación. RESULTADOS:Las coberturas de los últimos cinco indicadores fueron 38.1, 19.1, 13.3, 5.3 y 38.3%, respectivamente. En comparación con los últimos cinco indicadores de 2011, en los de 2017 se observó un incremento de 1.1, 4.1, 9.0, 3.2 y 37.1%, respectivamente. CONCLUSIONES:Los resultados mostraron un bajo desempeño del programa de prevención y control del cáncer de mama. Se encontró una capacidad insuficiente para poder tamizar al total de la población de mujeres de 40 a 69 años usuarias de la Secretaría de Salud.

Oral human papillomavirus (HPV) is associated with oropharyngeal cancer (OPC). Although OPC incidence is increasing globally, knowledge of oral HPV infection rates is limited. Here we carried out an observational epidemiological analysis of oral HPV incidence in 3,137 men enrolled from the United States, Mexico and Brazil between 2005 and 2009. Individuals were followed for new HPV infection for a median of 57 months. Cumulative incidence and factors associated with acquisition were also assessed. The incidence rate of oral oncogenic HPV was 2.4 per 1,000 person-months, did not vary with age and was constant throughout the study period. Risk of oral HPV acquisition was significantly associated with alcohol consumption, having male sexual partners, more lifetime female sexual partners, more oral sex given and higher educational attainment. These data indicate that men are at risk of acquiring oral HPV throughout their lifetime, suggesting that catch-up vaccination may reduce new infection incidence. Multinational analysis of oral human papillomavirus infection incidence and associated factors in 3,137 men reveals infection risk is maintained throughout lifetime, with implications for vaccination strategies.

he objective of this paper is to identify the main challengesand opportunities for the training of public health professionalsto strengthen the public health system and implement a new health care model in Mexico. This article describes how the reform of the public health system in Mexico poses challengesand opportunities for the training of health professionals. The use of new approaches in public health education is discussed,using as an example the implementation of a competency-based constructivist approach at the School of Public Health of Mexico/National Institute of Public Health (ESPM/INSP, in Spanish). The implementation of a new public health system in Mexico requires essential and specific competencies among the health professionals. The development of innovative models in education will allow progress in the training of public health professionals. To obtain the necessary skills for the implemen-tation of this new model, it will be necessary to increase the relationship between research and teaching, use trans and multidisciplinary approaches, seeking a greater emphasis on practice and a reduction in schooling in educational programs.It will also be important to consider the development of cross-sectional competencies, ethical and gender aspects and an evaluation of these new educational models to strengthenfuture activities

El Instituto Nacional de Salud Pública (INSP) se encuentra, desde el año 2022, en un proceso denominado “Renovación institucional para el fortalecimiento del Sistema Nacional de Salud y el bienestar social”. Esta propuesta de transformación institucional interna fue desarrollada con base en un análisis crítico previo del desempeño en investigación, docencia, vinculación y procesos administrativos del INSP. Los resultados del análisis revelaron que la necesidad de una renovación estructural era factible y deseable.

El 21 de julio de 2023, en un seminario interno de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, se presentaron los resultados de la Encuesta Nacional de Salud y Nutrición Continua 2022 (Ensanut Continua 2022). Junto con expertos del más alto nivel, se plantearon recomendaciones con el fin de apoyar la salud de la población mexicana. Dichas recomendaciones giran en torno a las temáticas incluidas en la Ensanut Continua 2022, como vacunación, salud de niños y adolescentes, salud mental y dificultades de funcionamiento y estado de nutrición y enfermedades crónicas en adultos, entre otras. Los logros de este esfuerzo realizado para obtener información de manera continua son cruciales para saber cómo hacer frente a los factores que afectan a nuestra salud y poder tomar mejores decisiones de política pública en esta materia, bajo la premisa de que los problemas públicos requieren ser medidos y monitoreados permanentemente.

Las encuestas poblacionales de salud proporcionan información valiosa para orientar las políticas públicas e identificar la eficiencia de los procesos de atención y de los perfiles epidemiológicos de diversas exposiciones y entidades mórbidas. El uso adecuado de datos demográficos de alta calidad, representativos y oportunos, puede ayudar indirectamente a los ciudadanos a vivir vidas más sanas y más largas. Por esta razón, los datos de las encuestas nacionales de salud, al contar con estándares de elevada calidad, son muy útiles para la formulación de políticas de salud, la utilización de indicadores para realizar investigación operativa y para la monitorización de la calidad de los procesos de atención. Consecuentemente, hacer alusión a la Encuesta Nacional de Salud y Nutrición (Ensanut) que implementa el Instituto Nacional de Salud Pública (INSP) es asociarla con un proyecto emblemático de la Secretaría de Salud de México.

Abstract High-risk human papillomavirus (hrHPV) testing is now the most recommended primary method for cervical cancer screening worldwide. Clinician-collected cervical sampling continues to be the main sampling method, but hrHPV vaginal self-sampling is an appealing alternative because of its greater acceptability and potentially higher cost-effectiveness. This study aimed to determine whether hrHPV vaginal self-sampling is comparable with clinician-collected cervical sampling for detecting histologically confirmed high-grade cervical intraepithelial neoplasia (CIN2/3) as part of a cervical cancer screening program in Mexico. We analyzed data from 5,856 women screened during a hrHPV-based screening study. Clinical performance and diagnostic efficiency metrics were estimated for the two sampling methods for the CIN3 and CIN2+ endpoints, using three triage strategies: HPV16/18 genotyping, HPV16/18/33/58 extended genotyping, and HPV16/18/31/33/58 extended genotyping. hrHPV-positivity was found in 801 (13.7%) cervical and 897 (15.3%) vaginal samples. All women with hrHPV-positive samples were referred to colposcopy, which detected 17 total CIN3 cases before considering retrospective triage strategies. Using the HPV16/18/31/33/58 extended genotyping strategy, 245 women had hrHPV-positive cervical samples and 269 had hrHPV-positive vaginal samples. Ten CIN3 cases were detected each among women with hrHPV-positive cervical samples and among those with hrHPV-positive vaginal samples when using this strategy, with no significant differences in sensitivity and specificity observed. We observe that self- and clinician-collected sampling methods are comparable for detecting CIN3 and CIN2+ regardless of the triage strategy used. These findings can help public health officials to develop more cost-effective cervical cancer screening programs that maximize participation. Prevention Relevance: We found that hrHPV vaginal self-sampling is comparable with hrHPV clinician cervical sampling when using any triage strategy to refer women to colposcopy, so self-sampling is a viable cervical screening method. Therefore, policymakers should consider incorporating self-sampling into cervical screening programs to increase screening coverage and reduce cervical cancer burden. See related Spotlight, p. 649

La muerte súbita cardiaca es un problema de salud pública a nivel mundial. Aunque su incidencia no es conocida, se estima que causa hasta 50% de la mortalidad de origen cardíaco y hasta 20% de la mortalidad total en los adultos. En México, estimaciones previas sugieren que causa en promedio 33 000 muertes al año; sin embargo, los datos no son precisos. La mitad de los eventos por muerte súbita cardiaca se deben a un paro cardiaco súbito extrahospitalario que, de no ser atendido oportunamente, deriva en una muerte súbita cardiaca. Por tanto, la capacidad de responder pronta y adecuadamente a estos eventos con las maniobras y equipos necesarios mejora la sobrevida de las víctimas. Para atender este problema, en algunos estados del país se han creado espacios cardioprotegidos que permiten realizar maniobras de reanimación cardiopulmonar y desfibrilación cardiaca de acceso público oportunamente. Como objetivo, los profesionales de la salud establecen la importancia de implementar espacios cardioprotegidos y crear políticas públicas al respecto en todo el país.

Sudden cardiac death is a worldwide public health problem. Although its incidence is not known, it is estimated to cause up to 50% of cardiac-related mortality and up to 20% of total mortality in adults. In Mexico, previous estimates suggest that it causes an average of 33 000 deaths per year; however, the data are not precise. Half of all sudden cardiac death events are due to out-of-hospital sudden cardiac arrest which, if not treated promptly, leads to sudden cardiac death. Therefore, the ability to respond promptly and adequately to these events with the necessary maneuvers and equipment improves the survival of the victims.To address this problem, in some states of the country, cardioprotected spaces have been created to allow timely cardiopulmonary resuscitation and cardiac defibrillation maneuvers to be performed in public access. As an objective, health professionals establish the importance of implementing cardioprotected spaces and creating public policies in this regard throughout the country.

On July 21, 2023, in an internal seminar of the Mexican National Health Institutes and High Specialty Hospitals, the results of the National Health and Nutrition Continuous Survey 2022 (Ensanut Continua 2022) were presented. Experts at the highest level made recommendations in order to support the health of the Mexican population. Those recommendations revolve around the topics included in Ensanut Continua 2022, such as vaccination, children and adolescent's health, mental health and functioning difficulties, nutritional status and chronic diseases in adults, among others. The achievements of this effort to obtain information on an ongoing basis are crucial to knowing how to cope with the factors that have an impact on our health and be able to make better public policy decisions in this matter, under the premise that public problems need to be permanently measured and monitored.

Los Institutos Nacionales de Salud (INS) miembros de la Red Regional Latinoamericana de la Asociación Internacional de Institutos Nacionales de Salud Pública, reunidos en forma presencial en la sede del Instituto Nacional de Salud Pública de México, en la Ciudad de Cuernavaca, los días 5 al 7 de octubre de 2022, contando con la participación de los directores o representantes de los INS de (...)

Prevalence of cervical high-risk human papillomavirus (hrHPV) infection varies greatly. Data on distribution of hrHPV infection constitute important evidence for decision-making when implementing HPV testing into cervical cancer screening programs. We estimate the prevalence of cervical hrHPV infection in a large sample of women in a middle-income country and explore variation by age, community marginalization and region in women using public cervical cancer screening services. Records covering 2010–2017 from a registry of hrHPV test results (Hybrid Capture 2 and polymerase chain reaction) in 2,737,022 women 35–64 years were analyzed. In this observational study, 32 states were categorized into five geographical regions and classified by degree of marginalization. We stratified by test type and estimated crude and adjusted prevalence and rate ratios and used Poisson models and joinpoint regression analysis. Prevalence was higher in women 35–39 years, at 10.4

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Rates of oropharyngeal cancer (OPC) associated with human papillomavirus (HPV) infection are increasing in men. The obligate precursor to OPC is a persistent infection with an oncogenic HPV type that is unable to be cleared via natural immunity alone. However, the factors that influence HPV persistence at the oral cavity are unknown. It is plausible that long-term infection with other pathogens at the same anatomic site indicates an overall inability to clear an oral infection. Epstein-Barr virus (EBV) is a saliva-transmitted gamma herpesvirus that infects 90% of the population by adulthood and replicates in the epithelial cells of the oropharynx. This study aimed to investigate whether oral EBV shedding, a marker of active viral replication, could serve as a biomarker for persistent, oncogenic oral HPV infection in men. Men with an HPV16 or 18 oral infection present at the baseline visit of the HPV Infection in Men (HIM) Study were included (n=63). Briefly, men from Tampa, FL, U.S.; Cuernavaca, Mexico; and Sao Paolo, Brazil were followed every 6 months for a median of 4.1 years. Men completed a risk factor questionnaire and provided an oral gargle sample at each visit. For this study, the baseline, 6-month, and 12-month oral specimens were HPV genotyped using the SPF10 PCR-DEIA-LiPA25 system. Presence of EBV was evaluated in the baseline specimen using PCR to amplify and quantify the EBV DNA on the Rotor-Gene Q MDx instrument. Men with the same oral HPV type present at the 6-month and 12-month visit were categorized as 6-month and 12-month oral HPV persistent, respectively. The association between EBV and persistent HPV infection was investigated using a logistic regression model adjusted for age, country, and smoking. Among 63 men with oral HPV 16/18 infection at baseline, 44 HPV infections did not persist, 19 persisted to at least 6-months and 11 persisted to at least 12 months. Among the total sample, 32 also had EBV detected in the oral gargle at baseline. Among men who did not have a persistent HPV infection, 21 (47.7%) had EBV detected at baseline while 11 (57.9%) men with an HPV infection that persisted at least 6 months had detectable EBV at baseline; and 9 (81.8%) of the men who persisted to 12 months had EBV detected. Mean EBV viral load was highest among men who persisted to at least 12 months (5.0 log copies/ml) and was significantly higher than men who did not persist (2.5 log copies/ml; p=0.047). Detection of oral EBV at baseline was significantly associated with elevated risk of ≥12-month oral HPV 16/18 persistence (aOR: 9.90; 95% CI: 1.38-70.96), but not ≥6-month HPV 16/18 persistence (aOR: 1.62; 95% CI: 0.52-5.06).These data support the hypothesis that EBV reactivation may be a biomarker of poor immune control leading to increased risk of oral HPV persistence. The use of a biomarker that identifies men whose HPV infection may persist would be a useful tool to allow for screening and early detection of OPC. Citation Format: Brittney L. Dickey, Anna R. Giuliano, Bradley Sirak, Martha Abrahamsen, Eduardo Lazcano-Ponce, Luisa L. Villa, Anna E. Coghill. Co-infection with Epstein-Barr virus impacts oral HPV persistence [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2264.

Objetivo. Explorar las experiencias y percepciones de la calidad de vida (CV) en cuidadores familiares (CF) de personas con discapacidad intelectual (PDI) en Morelos y Sinaloa, México. Material y métodos. Estudio cualitativo. Se realizaron 18 entrevistas semiestructuradas a CF de PDI que asistían a escuelas básicas públicas en Huitzilac, Morelos y Culiacán, Sinaloa, México. Se realizó análisis de contenido con apoyo del programa ATLAS.ti.8.0. Resultados. Los CF experimentaron un deterioro en distintas dimensiones: bienestar emocional, físico y material, desarrollo personal, autodeterminación y relaciones interpersonales, deterioro que afecta negativamente su CV. Los lazos de empatía, acompañamiento y motivación con otros CF son beneficiosos y los libera de actividades por lapsos breves, disminuyendo así la carga del cuidado de una PDI. Conclusiones. Cuidar a una PDI puede afectar negativamente la CV de las y los CF. Se sugiere el desarrollo de intervenciones para atención, apoyo y orientación integral; asimismo, crear y fortalecer grupos de ayuda mutua con otros cuidadores.