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Social determinants of health and disparities in cancer care for patients with metastatic breast cancer in Mexico.
(American Society of Clinical Oncology (ASCO), 2025)
Chavarri Guerra, Yanin
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Verduzco-Aguirre, Haydee Cristina
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Esparza-Orozco, Maria Fernanda
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Ramos Lopez, Wendy Alicia
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Alvarado, Montserrath
Background: Patients diagnosed with metastatic breast cancer (MBC) in low- and middle-income countries (LMICs) face poorer outcomes than their counterparts in high-income countries. Social determinants of health (SDH)—including housing, food security, employment, and education—have been increasingly recognized as critical non-medical factors influencing access to care and cancer-related outcomes. We aimed to describe SDH among Mexican patients with MBC and examine their association with treatment adherence, receipt of standard therapy, and survival. Methods: This was a prospective multicenter cohort study including patients from three public cancer centers in Mexico City. Eligible participants were adults with MBC receiving first- or second-line systemic therapy. A trained patient navigator conducted structured interviews at baseline and every three months over one year using validated questionnaires (SDH needs, SEAMS, FACT-G, and BPI). Treatments were categorized as standard or non-standard based on NCCN guidelines. Associations between SDH and clinical outcomes were explored using chi-square tests. Linear mixed models were used to assess longitudinal changes in health-related quality of life. Survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Results: A total of 324 patients were included (mean age 58.1 years; 99.7% female). At baseline, 92% reported at least one SDH-related need, most commonly employment (77.5%), housing (55.2%), and food (45.7%). The mean number of SDH needs at baseline was 3.1±1.8, remaining consistent across timepoints. Receipt of standard treatment was lower among those with needs in utilities (47.6% vs. 69.1%, p= 0.001) and education (58.0% vs. 69.0%, p= 0.046). Median SEAMS scores improved slightly over time (35 to 37). Median follow-up was 12.1 months (95% CI, 12.05-12.15). One-year overall survival was 85.0% (95% CI, 81.0–89.0), with no differences based on presence (p = 0.61) or number of SDH needs (p = 0.51) at baseline. The presence of any SDH need was significantly associated with FACT-G scores (p = 0.002) throughout the follow-up period. FACT-G scores were consistently lower in patients with any SDH need, and no significant interaction was observed between time and presence of any SDH need (p = 0.481). Conclusions: SDH needs were highly prevalent and persistent among patients with MBC in Mexico and were associated with lower likelihood of receiving guideline-concordant care and lower quality of life. Addressing these social barriers through targeted interventions may be critical to improving treatment equity and clinical outcomes in LMIC settings. ©The authors ©American Society of Clinical Oncology.
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Impact of a bioethics and humanities program on the educational training of nephrology residents
(Oxford University Press (OUP), 2025-09-24)
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Gómez Guerrero, Irma
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Garcia-Villalobos, Gloria
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Martin Alemañy, Geovana
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Aguiñaga-Chiñas, Nuria
Background: Modern medical training must integrate not only clinical skills but also ethical and humanistic competencies. In 2013, a structured program in bioethics and humanism was implemented as part of a nephrology residency curriculum. The objective of this study was to evaluate the impact of a 3-year humanism and bioethics program for nephrology residents that focused on improving clinical communication, reducing complaint and lawsuit numbers, increasing patient satisfaction, and supporting decision-making centered on quality of life. Methods: A longitudinal, ambispective cohort (2010–19), our 3-year curriculum delivered weekly 1-h sessions for 6 months/year to 45 residents and was facilitated by three faculty instructors across six core themes. To relate outcomes to the intervention, analyses were anchored to the 2013 launch and compared pre-program (2010–13) versus post-program (2014–19) rates of formal complaints, legal claims, patient satisfaction and maximum benefit discharges. Results: Formal complaints decreased from 47.8 to 26.0 per year [incidence rate ratio (IRR) 0.54, 95% confidence interval (CI) 0.44–0.67; P < .001; Holm <0.001]. Legal claims were reduced from 4.25 to 0.17 per year (IRR 0.039, 95% CI 0.005–0.295; P = .0016; Holm = 0.0016). Maximum benefit discharges increased from 4.25 to 76.5 per year (IRR 18.0, 95% CI 11.09–29.21; P < .001; Holm <0.001). For satisfaction, the ordinal logistic model showed an odds ratio (OR) of 3.53 (95% CI 1.96–6.38; P < .001; Holm = 0.0001), consistent with the dichotomous sensitivity analysis (≥4 vs ≤3) (OR 4.08, 95% CI 2.16–7.71; P < .000). Conclusions: The humanism and bioethics program was proven to be an effective and transformative educational tool that promoted ethical, empathetic and patient-centered nephrology practices. The positive impact of this program was evident in both clinical indicators and strengthened medical professionalism. ©The authors ©Oxford University Press (OUP) © Clinical Kidney Journal.
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Who Holds the Reins of Power in Chaos? Military Involvement and the Emergence of a De Facto State of Exception in Mexico
(Universidad Panamericana, 2025-03-04)
Torres-Checa, Daniel E.
Mexico’s public security has been progressively moving towards militarization for at least eighteen years. The army’s participation, previously reserved for war and exceptional junctures, has normalized. This article critically reviews the military’s role in Mexico’s bloodshed and human rights crisis during the 2006-2024 period. I argue that the ongoing phenomenon has perpetuated the cycle of violence, threatened democratic standards, and severely impacted human rights. In this framework, I question whether the policy of militarization can be placed in the context of a de facto state of exception. My aim, in short, is to assess the ways in which militarization reinforces exceptionality and how they both signal a counter-phenomena to human rights.
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Psychosocial Characteristics of Mexican Girls and Female Adolescents at Risk of Homelessness
(Emerald Publishing Limited, 2025)
Castaños-Cervantes, Susana
Women at risk of homelessness present psychosocial deficits at a higher degree than the rest of the general population. Such features diminish their psychological functioning, well-being, and health-related quality of life. Still, few studies worldwide have addressed their psychological traits. This study examined some psychosocial characteristics (e.g. anxiety, depression, assertiveness, and emotion regulation) present in a group of Mexican females at risk of homelessness. The main findings revealed that functional emotion regulation strategies and anxiety explained 31% and 58.5% of the variance for assertiveness and depression, respectively. Results in this study support assertive behaviours and emotion regulation strategies as protective factors and serve as evidence for a risk and resilience framework. Clinical implications are that effective treatments should focus on these traits from a multicultural approach to address the psychological needs of this vulnerable group efficiently. ©The authors ©Emerald.
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Prevention and treatment of neonatal hypothermia through an implementation science study in Jaltenango Chiapas, Mexico
(International Society of Global Health, 2025)
Frade Garcia, Alejandro
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Servitje Azcarraga, Lucila
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Espinosa Olivas, María Azucena
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García Ulloa, Laila Zulema
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Garcia-Santisteban, Rodrigo
Background Neonatal hypothermia is preventable but common, contributing to neonatal morbidity and mortality especially in low resource settings. Kangaroo Mother Care (KMC) is the preferred method to prevent hypothermia, but relying on it as a continuous heat source is challenging. This study introduced a novel Infant Warmer to complement KMC in a low resource community hospital through an implementation science approach. Methods We conducted a prospective, interventional cohort study in Jaltenango Chiapas, Mexico from January 2022 to November 2022. Our intervention was 1) an educational programme about the importance of euthermia and optimal thermoregulatory practices including KMC, and 2) provision of an Infant Warmer designed for low-resource settings with training of health care providers. Our hypothesis was that neonatal hypothermia rates would decrease after our intervention. Our aims were to reduce rates of hypothermia and increase knowledge and confidence regarding neonatal thermoregulation. The study had three phases: Pre-Intervention (January to May), Intervention, and Warmer Use (June to November). We collected clinical data during the Pre-Intervention and Warmer Use Phases, including temperature on admission and six hours later called ‘Follow-Up’. At three-time points we conducted surveys of health care providers regarding their knowledge of hypothermia, confidence in keeping babies warm, and attitudes regarding the Warmer. We also conducted a parent survey. Results We studied 372 newborns. Comparing Pre-Intervention to Warmer Use Phases, rates of hypothermia decreased from 62 to 27% on admission and 59 to 11% on Follow-Up. The mean admission and Follow-Up temperatures increased by 0.06°C (C) and 0.23°C (P=0.003) respectively. Healthcare providers’ knowledge of hypothermia and confidence in keeping newborns warm also improved throughout the study. Conclusions: We found high baseline rates of neonatal hypothermia in this low resourced hospital. We successfully lowered hypothermia rates by providing appropriate equipment to complement KMC and improved knowledge of hypothermia through education interventions. © The authors © International Society of Global Health.
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Management of scientific and ancestral knowledge: a decision-making model in mezcal industry in Mexico
(Frontiers Media SA, 2025)
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Leyva-Hernández, Sandra Nelly
Introduction: Knowledge management is essential to ensure the sustainability of rural communities and small producers since it generates value for innovation, productivity, and competitiveness. The aim of this study is to identify relevant factors for adequate decision-making in managing knowledge in the Mexican mezcal industry and its impact on developing rural communities and small producers - mezcaleros. For this purpose, a decision-making model for managing scientific and ancestral knowledge is created to support links with universities, research centers, and rural communities to accelerate innovation and competitiveness in this sector. Methods: The analysis methods were carried out through decision-making, machine-learning techniques, and fuzzy logic. Results: The Bayesian Network model suggests that the preceding variables to optimize the Mezcaleros Knowledge Management are the Mezcaleros Indigenous community, the Denomination of Origin, Scientific and Ancestral Knowledge, Waste Management and Use, and Jima. Discussion: This knowledge management model aims to guide small producers to be more productive and competitive through the support of a facilitator. ©The authors ©Frontiers in Artificial Intelligence ©Frontiers Media SA.
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Knowledge and innovation management model in the mezcal industry in Mexico
(Elsevier, 2025)
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Leyva-Hernández, Sandra Nelly
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This research aims to study and analyze knowledge management in the mezcal sector in Mexico and its impact on the development of rural communities through Bayesian-networks with machine learning techniques. A model is made in which the critical factors that impact is identified and quantified to optimally manage the knowledge that generates value and translates into innovation and competitive advantages. The results show that the most relevant factors to adequate knowledge and innovation management are commercialization and marketing capacity, value system model, ancient knowledge, strategic business model, process management, competencies, Business structure model, Facilitators governments, universities, mezcaleros, and indigenous communities. ©The authors ©Elsevier Ltd.
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Sustainability and Quality of Life in Marginalized Areas: An Impact Evaluation of a Community Center in Santa Fe, Mexico
(MDPI, 2024)
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The aim of this paper is to present the results of an impact evaluation of a community center in health, capacity building, and digital access, which form an approximation of quality of life, in the population of Santa Fe town in Mexico City, from 2022 to 2024. The methodology is quantitative, using an impact index and the differences in differences (DD) technique. The data were obtained from primary sources with surveys undertaken via questionnaires. The center is operated by a private university and funded by private firms. The results show a positive impact of 0.287127 out of 1 on the weighted impact index, which allows us to consider this program successful in improving the quality of life of the target population. Through impact evaluation, the effectiveness of interventions and opportunities for improvement are identified, fostering collaboration among local actors, including community members, state-run public programs, and community centers. This collaborative effort improves the quality of life, creating a sustainable community wherein each actor addresses specific needs. Impact evaluation plays a crucial role in measuring sustainability because it is a continuous improvement process that, when combined with other actions, enhances the community’s overall well-being. ©2024 MDPI, The authors.
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Optimization of public resources through an ensemble-learning model to measure quality perception in the social protection system in health of Mexico
(Springer, 2018)
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Rivera-Peña, Gustavo
In order to optimize the use of public resources, a model of ensemble learning was proposed to measure the perception of quality in the medical care granted to the people affiliated to the social protection in health system of Mexico. Which allows a more efficient allocation of resources based on the main areas of opportunity identified in the measurement of service quality. Identify the effect of the main factors that are directly related to the satisfaction level and perception of quality of health services. A satisfaction index was built using an ensemble model using principal component analysis, logistic model and bagging meta-estimator, to identify the effect of a group of factors in the perception of quality of health services and monitor the perceived quality of users in real time. The survey data collected for the “Social Protection System in Health-SPSS 2014” was used, considering a sample of 28,290 users. The proposed index shows, in general, the positive perception of quality of health services, the national average index was of 0.0756, 95% CI [− 9.714 to 2.027]. There are factors statistically significant (P < 0.05) that influence these results, among the most important that can be highlighted is the good perception of infrastructure OR 2.12; CI [95% 1.9–2.36]; the gratuity of the service provided OR 1.98; CI [95% 1.42–2.76]; and full medicines supply OR 1.81; CI [95% 1.91–2.36]. The key factors identified that determine the perception of quality allow to define focused strategies and lines of action to improve service quality as well as better allocation of resources. ©Springer, The Authors.
Scopus© Citations 1 21
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Benefit-Cost Analysis of Nonprofit Cataract Surgery Services: A Social Return on Investment Approach at the Mexican Institute of Ophthalmology
(International Society for Third-Sector Research, 2024)
Aleman-Castilla, Benjamin
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Ochoa-Ramírez, Paola
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López-Star, Ellery
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Dahik Loor, Ana Cristina
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Espinosa-Vega, Daniela
Cataract is the primary cause of treatable blindness in low- and middle-income countries. Due to limited resources, the public sector often fails to provide adequate services, resulting in long waiting times, low quality or significant quantity gaps. Nonprofits are crucial in providing supplementary or complementary funding and resources for affordable eye care and other public goods and services. This study evaluates costs and benefits of cataract surgery at the nonprofit Mexican Institute of Ophthalmology (IMO) using data from interviews conducted in 2022 to estimate its social return. For every peso invested, the average stakeholder receives a 12:1 return in improved autonomy, self-confidence, and reduced stress levels. Sensitivity analysis suggests a SROI ratio of at least 2:1 in the most restrictive scenario, increasing to 33:1 under more lenient assumptions. Measuring and communicating the social value of nonprofit activities is critical for optimizing resource allocation, enhancing accountability, and generating valuable insights into their effectiveness. © International Society for Third-Sector Research
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