A comparative analysis of regional infection risk due to wastewater recontamination in the Mezquital Valley, Mexico

Urban wastewater reuse for agriculture provides reliable nutrient-rich water, reduces water stress, and strengthens food systems. However, wastewater reuse also presents health risks and characterizing the spatial dynamics of wastewater can help optimize risk mitigation. We conducted comparative risk analysis of exposure to wastewater in irrigation canals, where we compared those exposed to a) treated vs. untreated wastewater, and b) wastewater upstream vs. downstream from communities in the Mezquital Valley. The canal system with treated wastewater was sampled prior to being treated, directly after treatment, as well as before and after it flowed through a community. Along the canal system that carried untreated wastewater, we sampled before and after a community. We quantified the concentrations of bacterial, protozoal, and viral pathogens in the wastewater. Pathogen concentration data were used to calculate measures of relative risk between sampling points. Wastewater treatment reduced predicted bacterial pathogen infection risk in post-treatment locations (RR = 0.73, 95 % CI 0.61, 0.87), with no evidence of similar reductions in Giardia or viral pathogens (RR = 1.02, 95 % CI 0.56, 1.86 and RR = 1.18, 95 % CI 0.70, 2.02 respectively). Although infection risk decreased further down the canals, infection risk increased for bacterial pathogens after our sentinel community (RR = 1.94, 95 % 1.34, 2.86). For Giardia and viral pathogens infection risk was elevated but not significantly. We found similar evidence for increases in risk when comparing the treated section of the canal system with a canal section whose wastewater was not treated, i.e., the risk benefits of wastewater treatment were lost after our sentinel community for bacteria (RR = 5.27 vs. 2.08 for sampling points before and after our sentinel community respectively) and for Giardia (RR = 6.98 vs. 3.35 respectively). The increase in risk after transit through communities could have resulted from local community recontamination of the treated wastewater stream.

Short-term exposure to PM2.5 and 1.5 million deaths: a time-stratified case-crossover analysis in the Mexico City Metropolitan Area

BACKGROUND

Satellite-based PM2.5 predictions are being used to advance exposure science and air-pollution epidemiology in developed countries; including emerging evidence about the impacts of PM2.5 on acute health outcomes beyond the cardiovascular and respiratory systems, and the potential modifying effects from individual-level factors in these associations. Research on these topics is lacking in low and middle income countries. We aimed to explore the association between short-term exposure to PM2.5 with broad-category and cause-specific mortality outcomes in the Mexico City Metropolitan Area (MCMA), and potential effect modification by age, sex, and SES characteristics in such associations.

METHODS

We used a time-stratified case-crossover study design with 1,479,950 non-accidental deaths from the MCMA for the period of 2004-2019. Daily 1 × 1 km PM2.5 (median = 23.4 μg/m3; IQR = 13.6 μg/m3) estimates from our satellite-based regional model were employed for exposure assessment at the sub-municipality level. Associations between PM2.5 with broad-category (organ-system) and cause-specific mortality outcomes were estimated with distributed lag conditional logistic models. We also fit models stratifying by potential individual-level effect modifiers including; age, sex, and individual SES-related characteristics namely: education, health insurance coverage, and job categories. Odds ratios were converted into percent increase for ease of interpretation.

RESULTS

PM2.5 exposure was associated with broad-category mortality outcomes, including all non-accidental, cardiovascular, cerebrovascular, respiratory, and digestive mortality. A 10-μg/m3 PM2.5 higher cumulative exposure over one week (lag06) was associated with higher cause-specific mortality outcomes including hypertensive disease [2.28% (95%CI: 0.26%-4.33%)], acute ischemic heart disease [1.61% (95%CI: 0.59%-2.64%)], other forms of heart disease [2.39% (95%CI: -0.35%-5.20%)], hemorrhagic stroke [3.63% (95%CI: 0.79%-6.55%)], influenza and pneumonia [4.91% (95%CI: 2.84%-7.02%)], chronic respiratory disease [2.49% (95%CI: 0.71%-4.31%)], diseases of the liver [1.85% (95%CI: 0.31%-3.41%)], and renal failure [3.48% (95%CI: 0.79%-6.24%)]. No differences in effect size of associations were observed between age, sex and SES strata.

CONCLUSIONS

Exposure to PM2.5 was associated with non-accidental, broad-category and cause-specific mortality outcomes beyond the cardiovascular and respiratory systems, including specific death-causes from the digestive and genitourinary systems, with no indication of effect modification by individual-level characteristics.

Lead Exposure Can Affect Early Childhood Development and Could Be Aggravated by Stunted Growth: Perspectives from Mexico

BACKGROUND

Lead can affect early childhood development (ECD) differentially due to nutritional deficiencies that lead to stunted growth, defined as being at least two standard deviations below the average height-for-age. These deficiencies are more frequent among children living in rural locations or with lower socioeconomic status (SES); however, studies at a population level are scarce worldwide. Early childhood development plays a crucial role in influencing a child's health and wellbeing throughout life. Therefore, the aim of this study was to analyze how stunted growth can modify the association between lead exposure and ECD in children from disadvantaged communities.

METHODS

Data were analyzed from the 2018 National Health and Nutrition Survey in localities with fewer than 100,000 inhabitants in Mexico (ENSANUT-100K). Capillary blood lead (BPb) levels were measured using a LeadCare II device and dichotomized as detectable (cutoff point ≥ 3.3 µg/dL) and non-detectable. As a measure of ECD, language development was assessed in n = 1394 children, representing 2,415,000 children aged 12-59 months. To assess the association between lead exposure and language z-scores, a linear model was generated adjusted by age, sex, stunted growth, maternal education, socioeconomic status, area, region (north, center, south), and family care characteristics; afterwards, the model was stratified by stunted growth.

RESULTS

Fifty percent of children had detectable BPb and 15.3% had stunted growth. BPb showed a marginal inverse association with language z-scores (β: -0.08, 95% CI: -0.53, 0.36). Children with detectable BPb and stunted growth had significantly lower language z-scores (β: -0.40, 95% CI: -0.71, -0.10) than those without stunted growth (β: -0.15, 95% CI: -0.36, 0.06).

CONCLUSIONS

Children with stunted growth are more vulnerable to the adverse effects of lead exposure. These results add to previous research calling for action to reduce lead exposure, particularly in children with chronic undernutrition.

Daily exposure to PM2.5 and 1.5 million deaths: A time-stratified case-crossover analysis in the Mexico City Metropolitan Area

Background

Satellite-based PM2.5 predictions are being used to advance exposure science and air-pollution epidemiology in developed countries; including emerging evidence about the impacts of PM2.5 on acute health outcomes beyond the cardiovascular and respiratory systems, and the potential modifying effects from individual-level factors in these associations. Research on these topics is lacking in Latin America.

Methods

We used a time-stratified case-crossover study design with 1,479,950 non-accidental deaths from Mexico City Metropolitan Area for the period of 2004-2019. Daily 1×1 km PM2.5 (median=23.4 μg/m3; IQR=13.6 μg/m3) estimates from our satellite-based regional model were employed for exposure assessment at the sub-municipality level. Associations between PM2.5 with broad-category (organ-system) and cause-specific mortality outcomes were estimated with distributed lag conditional logistic models. We also fit models stratifying by potential individual-level effect modifiers including; age, sex, and individual SES-related characteristics namely: education, health insurance coverage, and job categories.

Results

PM2.5 exposure was associated with higher total non-accidental, cardiovascular, cerebrovascular, respiratory, and digestive mortality. A 10-μg/m3 PM2.5 higher cumulative exposure over one week (lag06) was associated with higher cause-specific mortality outcomes including hypertensive disease [2.28% (95%CI: 0.26%-4.33%)], acute ischemic heart disease [1.61% (95%CI: 0.59%-2.64%)], other forms of heart disease [2.39% (95%CI: -0.35%-5.20%)], hemorrhagic stroke [3.63% (95%CI: 0.79%-6.55%)], influenza and pneumonia [4.91% (95%CI: 2.84%-7.02%)], chronic respiratory disease [2.49% (95%CI: 0.71%-4.31%)], diseases of the liver [1.85% (95%CI: 0.31%-3.41%)], and renal failure [3.48% (95%CI: 0.79%-6.24%)]. No differences in effect size of associations were observed between SES strata.

Conclusions

Exposure to PM2.5 was associated with mortality outcomes beyond the cardiovascular and respiratory systems, including specific death-causes from the digestive and genitourinary systems, with no indications of effect modification by individual SES-related characteristics.

Neurocognitive function in adult residents of a mining district in Mexico after reducing manganese exposure: Follow-up after 11 years

BACKGROUND

Little is known about the neurotoxic effects of chronic exposure to airborne Mn once exposure has been reduced. The environmentally exposed and the reference adult populations evaluated in 2002 were followed, after an environmental management program (EMP) was implemented to reduce the exposure in a mining district in Mexico.

OBJECTIVE

The aim of this study was to compare the association between exposure to Mn and neurocognitive performance in environmentally exposed and reference groups of adults before and after EMP implementation.

METHODS

In 2013, the same battery of neurocognitive tests used in the initial study (2002) was applied to 58 adults exposed to airborne Mn and 30 adults from the reference community. A cumulative exposure index (CEI) was estimated for the study population before and after the EMP. Categorical outcomes were analyzed using logistic regression, and the resulting ORs were compared between studies. Continuous outcomes were analyzed using linear regression. All models were adjusted for age, years of education, socioeconomic status and blood lead levels.

RESULTS

Exposed adults from the post-EMP study showed an improvement in fine motor and verbal regulation of motor skills (OR < 1) compared to the exposed adults from the pre-EMP study (OR > 1). In both pre- and post-studies, the exposed adults showed a deterioration in their dynamic organization of motor activity compared to the reference group (p < 0.05); however, they showed no significant change in attention and working-memory performance.

DISCUSSION

After four years of a significant reduction in airborne Mn levels resulting from EMP implementation, chronically exposed adults showed an improvement in fine motor and verbal regulation of motor skills; however, the remaining areas of their motor and cognitive functions remained impaired.

Prediction of daily mean and one-hour maximum PM2.5 concentrations and applications in Central Mexico using satellite-based machine-learning models

BACKGROUND

Machine-learning algorithms are becoming popular techniques to predict ambient air PM_2.5 concentrations at high spatial resolutions (1 × 1 km) using satellite-based aerosol optical depth (AOD). Most machine-learning models have aimed to predict 24 h-averaged PM_2.5 concentrations (mean PM_2.5) in high-income regions. Over Mexico, none have been developed to predict subdaily peak levels, such as the maximum daily 1-h concentration (max PM_2.5).

OBJECTIVE

Our goal was to develop a machine-learning model to predict mean PM_2.5 and max PM_2.5 concentrations in the Mexico City Metropolitan Area from 2004 through 2019.

METHODS

We present a new modeling approach based on extreme gradient boosting (XGBoost) and inverse-distance weighting that uses AOD, meteorology, and land-use variables. We also investigated applications of our mean PM_2.5 predictions that can aid local authorities in air-quality management and public-health surveillance, such as the co-occurrence of high PM_2.5 and heat, compliance with local air-quality standards, and the relationship of PM_2.5 exposure with social marginalization.

RESULTS

Our models for mean and max PM_2.5 exhibited good performance, with overall cross-validated mean absolute errors (MAE) of 3.68 and 9.20 μg/m³, respectively, compared to mean absolute deviations from the median (MAD) of 8.55 and 15.64 μg/m³. In 2010, everybody in the study region was exposed to unhealthy levels of PM_2.5. Hotter days had greater PM_2.5 concentrations. Finally, we found similar exposure to PM_2.5 across levels of social marginalization.

SIGNIFICANCE

Machine learning algorithms can be used to predict highly spatiotemporally resolved PM_2.5 concentrations even in regions with sparse monitoring.

IMPACT

Our PM_2.5 predictions can aid local authorities in air-quality management and public-health surveillance, and they can advance epidemiological research in Central Mexico with state-of-the-art exposure assessment methods.

Prenatal Co-Exposure to Manganese, Mercury, and Lead, and Neurodevelopment in Children during the First Year of Life

Lead (Pb), mercury (Hg), and manganese (Mn) are neurotoxic, but little is known about the neurodevelopmental effects associated with simultaneous prenatal exposure to these metals. We aimed to study the associations of Pb, Hg, and Mn prenatal levels (jointly and separately) with neurodevelopment in the first year of life. Methods: Pb, Hg, and Mn blood lead levels were measured in 253 pregnant women. Their offspring's neurodevelopment was assessed through the Bayley Scale of Infant Development III^® at one, three, six, and twelve months. The metals' mean blood levels (µg/L) were Pb = 11.2, Hg = 2.1, and Mn = 10.2. Mean language, cognitive, and motor development scores of the infants at each age were between low-average and average. Multilevel models' results showed that language development coefficients of the offspring decreased by 1.5 points per 1 µg/dL increase in maternal blood lead levels (p = 0.002); the magnitude of the aforementioned association increased in children with maternal blood Mn < 9.6 µg/L (ß = -1.9, p = 0.003) or Hg > 1.9 µg/L (ß = -1.6, p = 0.013). Cognitive and motor development had negative associations with maternal blood Pb levels; the latter was statistically significant when the interaction term between Pb, Mn, and Hg was included (ß = -0.037, p = 0.03). Prenatal exposure to low Pb levels may impair infants' neurodevelopment in the first year of life, even more so if they are exposed to Hg or deficient in Mn.

Short term exposure to ambient air pollutants and cardiovascular emergency department visits in Mexico city

Available data on the acute cardiovascular effect of ambient air pollution (AAP) in Latin America is limited considering that over 80% of its 1 billion inhabitants live in urban settlements with poor air quality. The study aim was to evaluate the association between Cardiovascular Emergency Department Visits (CEDVs) and AAP in Mexico City from 2016 to 2019 using generalized additive models with distributed lags to examine the percentage change of CEDVs and a backward approach of time-series model to calculate attributable fractions. A total of 48,891 CEDVs were recorded in a period of 1019 days. We estimated a significant percentage increase for each 10 μg/m³ of PM₁₀ at Lag0-5 (2.8%, 95%CI 0.6-5.0), PM_2.5 at Lag0-6 (3.7%, 95%CI 0.1-7.6), O₃ at Lag0-5 (1.1%, 95%CI 0.2-2.0), NO₂ at Lag0-4 (2.5%, 95%CI 0.3-4.7) and for each 1 mg/m³ of CO at Lag0 (6.6%, 95%CI 0.3-13.2). Overall, 10.3% of CEDVs in Mexico City may be related to PM¹⁰ exposure, 9.5% to PM_2.5, 10.3% to O₃, 11% to NO₂ and 5.7% to CO. AAP significantly increase cardiovascular morbidity impacting on emergency medical services.

Air pollution exposure and incidence of type 2 diabetes in women: A prospective analysis from the Mexican Teachers' Cohort

BACKGROUND

Air pollution is a risk factor for type 2 diabetes (T2D). However, scarse longitudinal studies have evaluated this association in low- and middle-income countries, where 80% of the worldwide cases of T2D occur.

OBJECTIVE

Our aim was to estimate the association between PM_2.5 and NO₂ exposure and incident T2D, in the Mexican Teachers' Cohort (MTC).

METHODS

We selected a subsample of female teachers from the MTC from Mexico City metropolitan area (MCMA), recruited in 2008 and with active follow-up every three years. We assigned the monthly time-weighted exposures (PM_2.5 and NO₂) using home and work addresses, until failure, censoring or death. We developed two high resolution (1 × 1-km) spatiotemporal predictive generalized additive models of PM_2.5 and NO₂. Incident diabetes was identified through self-report and two administrative databases of registered diabetes patients. We fitted time-varying Cox models to estimate hazard ratios of the relation between PM_2.5 and NO₂ and incident T2D, adjusting for confounding variables that were identified using a causal model.

RESULTS

A total of 13,669 teachers were followed-up for a maximum of 11.5 years, over which 996 incident T2D cases (88 cases per 100,000 person-months) occurred. Incident T2D increased by 72% (HR = 1.72 [1.47-2.01]) for each 10 μg/m³ increase of PM_2.5, and 52% for each 10 ppb of NO₂ (HR = 1.52 [1.37-1.68]).

DISCUSSION

Mid-term exposure to PM_2.5 and NO₂ was associated with a higher risk of T2D after adjusting for indoor wood smoke, socioeconomic status, and physical activity. These associations were attenuated in two-pollutant models but remained positive when evaluated long-term exposure. This is the first prospective study to evaluate T2D risk by exposure to both pollutants, PM_2.5 and NO₂ in a population from an upper middle-income country in the Americas.

Climate Trends and Consumption of Foods and Beverages by Processing Level in Mexican Cities

Background: Little is known about the potential impact of climate change on food systems and diet. We aimed to estimate the association of changes in rainfall and temperatures with consumption of unprocessed and processed foods among residents of Mexican cities by climate region.

Methods: We analyzed 3,312 participants of the 2012 Mexican National Health and Nutrition Survey with dietary intake and sociodemographic information linked to historical rainfall and temperature data collected by the Mexican National Weather Service. We classified foods as unprocessed, processed, or ultra-processed. We performed multilevel linear regression to estimate the association of annual change in rainfalls (for each 0.5 mm decrease) and temperatures (for each 0.1°C increase) at municipality level over the past 5 years with consumption of processed and unprocessed foods measured as the contribution to total energy intake. We investigated whether associations differed by climate region (tropical, temperate, and arid).

Results: Each 0.5 mm annual decrease in precipitation was associated with lower consumption of unprocessed foods and higher consumption of ultra-processed foods [mean differences in percent contribution to total energy intake −0.009% (95% CI: −0.019, < −0.001) and 0.011% (95% CI: 0.001, 0.021), respectively]. Each 0.1 degree Celsius annual increase in temperature was also associated with lower consumption of unprocessed and higher consumption of ultra-processed foods [mean differences in percent contribution to total energy intake was −0.03 (95% CI: −0.05, −0.01) and 0.03% (95% CI: <0.01, 0.05)]. When stratified by climate region these associations were only observed in tropical regions.

Conclusions: Decreases in rainfalls and increases in temperature were associated with lower consumption of unprocessed foods but higher consumption of ultra-processed foods, especially in tropical regions. Previous studies have established how food production affects the climate, our study suggests that climate change could, in turn, reinforce modern food production, closing a vicious circle with clear negative implications for planetary health.

Asociación entre mortalidad por Covid-19 y contaminación atmosférica en ciudades mexicanas

Objetivo. Analizar la asociación entre la exposición crónica a contaminantes atmosféricos y la tasa de mortalidad por Covid-19 en ciudades mexicanas. Material y métodos. Estudio ecológico en 25 ciudades mexicanas utilizando el reporte de casos diarios de muertes por Covid-19 (febrero a junio 2020) y datos validados de contaminantes atmosféricos, considerando concentraciones promedio en cada ciudad en el último año. Se utilizaron modelos de regresión Poisson, con modelos aditivos generalizados y variables de ajuste. Resultados. Se encontró un incremento significativo de 3.5% (IC95% 2.3-4.7) en la tasa de mortalidad por Covid-19 por incremento de 1μg/m3 de NO2. La asociación con PM2.5 fue no significativa, con un incremento de 1.8% por cada μg/ m3. Conclusiones. Los resultados sugieren una asociación entre la mortalidad por Covid-19 y la exposición a NO2. Esta primera aproximación del riesgo asociado con la contami-nación del aire requiere de análisis más precisos, pero es consistente con estudios de otras regiones.

Prenatal PM2.5 exposure and neurodevelopment at 2 years of age in a birth cohort from Mexico city

BACKGROUND

Recent studies have reported that air pollution exposure may have neurotoxic properties.

OBJECTIVE

To examine longitudinal associations between prenatal particles less than 2.5 μm in diameter (PM_2.5) exposure and neurodevelopment during the first two years of children's life.

METHODS

Analysis was conducted in PROGRESS, a longitudinal birth cohort between 2007 and 2013 in Mexico City. We used satellite data to predict daily PM_2.5 concentrations at high spatial resolution. Multivariate mixed-effect regression models were adjusted to examine cognitive, language and motor scores in children up to 24 months of age (n = 740) and each trimester-specific and whole pregnancy exposure to PM_2.5.

RESULTS

Models adjusted by child sex, gestational age, birth weight, smoking and mother's IQ, showed that each increase of 1 μg/m³ of PM_2.5 was associated with a decreased language function of -0.38 points (95% CI: -0.77, -0.01). PM_2.5 exposure at third trimester of pregnancy contributed most to the observed association.

CONCLUSION

Our findings suggest that language development up to 24 months of age may be particularly sensitive to PM_2.5 exposure during pregnancy.

Revisión rápida de los efectos de la variación de la temperatura y la humedad en la morbilidad y mortalidad por Covid-19

Objetivo. Resumir y analizar la evidencia de la asociación entre Covid-19 y factores climáticos. Material y métodos. Se utilizó la metodología de revisiones rápidas de Cochrane. Se buscaron artículos publicados del 1 de enero al 27 de abril de 2020 en una base de datos académica y preprints. Los títulos y resúmenes fueron revisados por dos investigadores y los textos completos por cinco investigadores. Resultados. De 354 artículos identificados, 26 cumplieron los criterios de elegibilidad establecidos. De éstos, 20 observaron una asociación inversa. Al evaluar su calidad, nueve calificaron con validez moderada, porque si bien ajustaron por covariables en el análisis, son estudios ecológicos. Conclusiones. A pesar de la homogeneidad de resultados, los factores climáticos explican un porcentaje pequeño de la variación de Covid-19. Son necesarios estudios con periodo de análisis más largo que capten tendencia y estacionalidad e incluyan factores de riesgo individuales.

Household water quality in areas irrigated with wastewater in the Mezquital Valley, Mexico

Wastewater for irrigation in low- and middle-income countries can recharge aquifers and potentially contaminate supply sources. The infiltration rate has increased 13-fold in Mexico's Mezquital Valley, the largest agricultural area wastewater-irrigated worldwide, thus we assume that wastewater had contaminated supply sources. Fecal indicator bacteria (FIB) counts were enumerated in household water of two wastewater-irrigated areas, Tula and Tlahuelilpan, and a groundwater irrigated area, Tecozautla. During 2016-2017, household water, wastewater, and groundwater were sampled, analyzing fecal coliforms, fecal enterococci, and Escherichia coli, following membrane filtration procedures, and confirming the presence of E. coli by polymerase chain reaction. Nearly 50% of household water contained fecal contamination of up to 4.62 × 10⁴ CFU/100 mL. Significant differences between FIB counts in household water from Tula and Tecozautla were observed by Kruskal-Wallis and Dunnett tests. Household water samples from Tula contained highest FIB counts. Wastewater from Tula and Tlahuelilpan contained counts of six orders-of-magnitude of FIB. Counts were high when residual chlorine was <0.2 mg L^-1 and underwater storage. This research serves as a baseline to observe improvement with a newly installed wastewater treatment plant. Safe irrigation wastewater reuse should be performed under strict surveillance, considering human safety a priority.

Impact of an intervention for reducing waste through educational strategy: A Mexican case study, what works, and why?

Generation and inadequate management of solid waste constitute a global challenge. Projections for 2050 portend an annual increase of 3.40 billion tons of waste. This study assessed the impact of an environmental education intervention (EEI) aimed at reducing waste generation and fomenting pro-environmental behaviors in an academic public-health institution in Mexico. The EEI was implemented over 20 months using a model of behavior change. Using a mixed-method design (QUAN + qual), baseline and follow-up measurements were performed through electronic questionnaires (n = 754), focus groups (n = 20), and waste quantification. A double-difference model was performed to measure pro-environmental behaviors impact: overall and by sex, age, educational level and function within the institution. Waste quantification was performed using a quartering method and weekly monitoring. The qualitative data were studied through thematic analysis. As a result of the EEI, women reduced their use of multilayer packaging (-15.6 pp, p < 0.05) and frequent use of non-ecological materials (-17.6 pp, p < 0.05). Graduate-level participants reduced their regular and frequent use of these materials (-33.3 pp, p < 0.05, 27.6 pp, p < 0.01), while those with lower educational levels increased their ecological behavior at home (12.1 pp, p < 0.05). Waste generation dropped by 60.1% vis-a-vis the baseline measurement. Our qualitative findings showed a relationship between holding a position of power in the institution and recycling. They also revealed that available infrastructure for separating waste contributed substantially to the observed impact. With actions centered on physical structure, community practice and institutional policy components, the EEI improved the pro-environmental behaviors and perceptions of participants.

[Mortality associated with fine and coarse suspended particles, in inhabitants of Monterrey Metropolitan Area]

OBJECTIVE

To estimate the mortality risk of fine (PM2.5) and coarse (PM2.5-10) particles in the Metropolitan Area of Mon-terrey (MAM).

MATERIALS AND METHODS

A retrospective ecological time-series analysis (2000-2014) was conducted using total and specific causes of mortality, and daily mean PM2.5 and PM2.5-10. Generalized additive distributed lag models controlling for trend, seasonality, day of the week, meteoro-logical conditions and gaseous pollutants.

RESULTS

Mean (SD) PM2.5 and PM2.5-10 concentrations were 26.59 μg/m3(11.06 μg/m3) and 48.83 μg/m3 (21.15 μg/m3). An increase of 10 μg/m3 of PM2.5 (lag 0) was associated with 11.16% (95%CI:1.03-21.39) increased risk of respiratory mortality in children <=5 years old and 6.6% (95%CI 3.31-9.37) increased risk of pneumonia-influenza in adults >=65 years old. The risk of mortality associated with the concentration of coarse particles was lower.

CONCLUSIONS

Positive and significant associations were observed between exposure to particulate matter and daily mortality in the MAM ́s population.

Modeling Spatial Risk of Diarrheal Disease Associated with Household Proximity to Untreated Wastewater Used for Irrigation in the Mezquital Valley, Mexico

BACKGROUND

Reusing wastewater for irrigation is a longstanding practice that enhances crop yields and improves climate resilience. Without treatment, however, wastewater contains harmful pathogens and chemicals. Reuse of untreated wastewater has been shown to be harmful to the health of nearby communities, but the routes of exposure are unknown and do not appear to be occupational. Some routes occur throughout entire communities, such as food contamination. Other routes may be spatially dependent, such as spread by domestic animals or through aerosolization.

OBJECTIVES

To examine whether those wastewater exposure routes with a spatial dependency affect health, we estimated the risks of diarrheal disease in children under age 5 associated with living near wastewater canals, while adjusting for potential individual- and household-level confounders.

METHODS

We conducted three surveys over 1 y in the Mezquital Valley, Mexico, to measure diarrhea in children. The distance between each participating household and a wastewater canal was measured using GPS coordinates. The association between proximity and diarrhea was estimated with a multilevel logistic regression model accounting for spatial autocorrelation.

RESULTS

A total of 564 households completed one to three surveys, resulting in 1,856 survey observations of 646 children. Children living 100m from a canal had 45% lower odds of diarrhea than those living within 10m of a canal, and children living 1000m away had 70% lower odds of diarrhea [100m vs. 10m adjusted odds ratio (OR)=0.55, 95% credible interval (CI): 0.33, 0.91; 1000m vs. 10m adjusted OR=0.30, 95% CI: 0.11, 0.82].

DISCUSSION

The estimated decline in diarrheal prevalence with household distance from a canal persisted after controlling for occupational exposure. Identifying the specific routes of exposure that drive this relationship will help identify which interventions, such as upstream treatment, can reduce health risks for entire communities where wastewater exposure occurs. https://doi.org/10.1289/EHP6443.

[Quick review: air pollution and morbi-mortalityby Covid-19.]

OBJECTIVE

To analyze the evidence on the relationship between air pollution and an increased risk of morbidity and mortality from Covid-19.

MATERIALS AND METHODS

An adaptation of the Cochrane rapid review methodology was used. The search was performed in PubMed and MedRxiv and was limited until April 28 and 26, respectively. The titles and abstracts were reviewed by five researchers who, in turn, reviewed the full texts of the final selection.

RESULTS

450 manuscripts were found, 15 met the inclusion criteria. The evidence reports that the incidence and risk of morbidity and mortality from Covid-19 increase with chronic and acute exposure to air pollution, particularly to particulate matter (PM2.5, P M10) and nitrogen dioxide.

CONCLUSIONS

More studies are required especially in Latin American cities. It is necessary to strengthen the recommendations in cities with higher levels of pollutants and to reduce their emissions.

Women exposure to household air pollution after an improved cookstove program in rural San Luis Potosi, Mexico

The state government of San Luis Potosí (SLP), Mexico implemented an improved cookstove (ICS) program in rural areas. As part of the comprehensive program evaluation, we compared fine particulate material (PM_2.5) concentrations in kitchens and patios in treated (TH), and non-treated households (NTH), and analyzed pollutant levels according to patterns of fuels and devices use reported by the women. A panel study was conducted in 728 households (357 TH and 371 NTH) in three regions of SLP including two sampling rounds in 2015-16. Data on exposure determinants, ICS conditions and cooking practices were collected. Daily PM_2.5 in kitchen and patio was measured in a subsample. The average treatment effect was estimated using the double difference method. We constructed a mixed linear model to estimate PM_2.5 levels for the entire study sample and obtained personal exposure according to time-activity logs. NTH had lower socioeconomic status compared to TH. The average daily PM_2.5 concentrations in NTH compared to TH were 155.2 and 92.6 μg/m³ for kitchen and 35.4 and 39.8 μg/m³ for patio, respectively. PM_2.5 levels showed significant regional differences but no significant treatment effect. In many cases, the ICS was added to previous open fire and LPG use (stacking). The household size, kitchen ventilation, relative humidity, temperature and the ratio of indoor/outdoor PM_2.5 concentration were significant predictors of kitchen PM_2.5 levels. The daily PM_2.5 personal exposure was significantly reduced using ICS in good conditions or LPG (57 μg/m³) compared to the traditional open fire (86 μg/m³). This study strengthens the evidence on the potential daily PM_2.5 exposure reduction for women using an ICS in good conditions or LPG, displacing the polluting open fire. Comprehensive strategies tailored to the sociocultural context of the communities are needed to implement clean energy programs that achieve adoption and sustained use of ICS or LPG.

Children's acute respiratory symptoms associated with PM2.5 estimates in two sequential representative surveys from the Mexico City Metropolitan Area

BACKGROUND

Respiratory diseases are a major component of morbidity in children and their symptoms may be spatially and temporally exacerbated by exposure gradients of fine particulate matter (PM_2.5) in large polluted urban areas, like the Mexico City Metropolitan Area (MCMA).

OBJECTIVES

To analyze the association between satellite-derived and interpolated PM_2.5 estimates with children's (≤9 years old) acute respiratory symptoms (ARS) in two probabilistic samples representing the MCMA.

METHODS

We obtained ARS data from the 2006 and 2012 National Surveys for Health and Nutrition (ENSaNut). Two week average exposure to PM_2.5 was assessed for each household with spatial estimates from a hybrid model with satellite measurements of aerosol optical depth (AOD-PM_2.5) and also with interpolated PM_2.5 measurements from ground stations, from the Mexico City monitoring network (MNW-PM_2.5). We used survey-adjusted logistic regressions to analyze the association between PM_2.5 estimates and ARS reported on children.

RESULTS

A total of 1,005 and 1,233 children were surveyed in 2006 and 2012 representing 3.1 and 3.5 million children, respectively. For the same years and over the periods of study, the estimated prevalence of ARS decreased from 49.4% (95% CI: 44.9,53.9%) to 37.8% (95% CI: 34,41.7%). AOD-PM_2.5 and MNW-PM_2.5 estimates were associated with significantly higher reports of ARS in children 0-4 years old [OR₂₀₀₆ = 1.29 (95% (CI): 0.99,1.68) and OR₂₀₀₆ = 1.24 (95% CI: 1.08,1.42), respectively]. We observed positive non-significant associations in 2012 in both age groups and in 2006 for children 5-9 years old. No statistically significant differences in health effect estimates of PM_2.5 were found comparing AOD-PM_2.5 or MNW-PM_2.5 for exposure assessment.

CONCLUSIONS

Our findings suggest that PM_2.5 is a risk factor for the prevalence of ARS in children and expand the growing evidence of the utility of new satellite AOD-based methods for estimating health effects from acute exposure to PM_2.5.

Short-term effects of ambient temperature on non-external and cardiovascular mortality among older adults of metropolitan areas of Mexico

Multi-city studies assessing the association between acute exposure to temperature and mortality in Latin American are limited. To analyze the short-term effect of changes in temperature (increase and decrease) on daily non-external and cardiovascular mortality from 1998 to 2014, in people 65 years old and over living in 10 metropolitan areas of Mexico. Analyses were performed through Poisson regression models with distributed lag non-linear models. Statistical comparison of minimum mortality temperature (MMT) and city-specific cutoffs of 24-h temperature mean values (5th/95th and 1st/99th percentiles) were used to obtain the mortality relative Risk (RR) for cold/hot and extreme cold/extreme hot, respectively, for the same day and lags of 0-3, 0-7, and 0-21 days. A meta-analysis was conducted to synthesize the estimates (RR_pooled). Significant non-linear associations of temperature-mortality relation were found in U or inverted J shape. The best predictors of mortality associations with cold and heat were daily temperatures at lag 0-7 and lag 0-3, respectively. RR_pooled of non-external causes was 6.3% (95%CI 2.7, 10.0) for cold and 10.2% (95%CI 4.4, 16.2) for hot temperatures. The RR_pooled for cardiovascular mortality was 7.1% (95%CI 0.01, 14.7) for cold and 7.1% (95%CI 0.6, 14.0) for hot temperatures. Results suggest that, starting from the MMT, the changes in temperature are associated with an increased risk of non-external and specific causes of mortality in elderly people. Generally, heat effects on non-external and specific causes of mortality occur immediately, while cold effects occur within a few days and last longer.

A follow-up study after an improved cookstove intervention in rural Mexico: Estimation of household energy use and chronic PM2.5 exposure

The benefits of improved biomass cookstoves (ICS) depends on their adoption and sustained use. Few studies have documented if and how they are used more than five years after being introduced. We conducted a 9-year prospective cohort study among young rural women in the highlands of Michoacan, Mexico. Participants had received a Patsari ICS during a community trial either in 2005 or 2006. With retrospective information collected in 2012-13, we studied the households' energy use, ICS survival, and cooking practices during the follow-up period. Using an exposure model constructed with personal PM_2.5 measurements in a subsample of homes at the time of the initial trial in 2005, we estimated the exposure associated with different energy use patterns during the follow-up period. The ICS had a mean lifespan of 4 years, after which more than half of the stoves were not in use; therefore, the use of open fire increased, particularly among the indigenous communities. ICS use peak was achieved two years after the initial trial, either exclusively or combined with open fire. Yearly household energy use and other variables were used to estimate chronic air pollution exposure. Mean PM_2.5 exposure during the follow-up period ranged from 51 to 319 μg/m³; the median was 102 and 146 μg/m³ for mainly ICS and mainly open fire use, respectively. The ICS has a useful period after which it needs maintenance, repair, or replacement. Unfortunately, many programs have not afforded a follow-up component. Exposure to biomass smoke air pollutants can be reduced by using an ICS instead of the traditional open fire. Household energy strategies should ensure equitable access to clean energy options adapted to local needs and preferences with culturally appropriate technology implemented on a sustainable perspective.

Environmental Health Promotion of a Contaminated Site in Mexico

Entangled in complex ecological, sociocultural, and economic systems, current environmental health problems require integrated participatory approaches. Alpuyeca, a semi-urban, highly marginalized community in South-Central Mexico burdened by lead and polychlorinated biphenyl (PCB) contamination, dengue fever, and intestinal diseases, illustrates this. Its residents are distinctive, however, for their concerted actions in the face of environmental problems and the presence of defenders of a prehispanic worldview based on the protection of nature. This article addresses the health impacts of an integrated environmental health promotion strategy implemented through a participatory action research intervention based on qualitative and quantitative methods. Different actors, sectors, dimensions, and knowledge types were harmonized in a collaborative space created specifically for our interdisciplinary research team, community residents and local authorities. Reflections, plans and actions were developed collectively in this space with the view of finding solutions anchored in the local culture. Results included sharp reductions in blood-lead concentrations among children, in entomological indices, and in PCB contamination, as well as capacity strengthening. Medium-level community participation was achieved. This work contributes evidence that participatory environmental health research can be effective in analyzing and reducing problems in communities with multiple environmental health concerns. It complements ecohealth and environmental health literacy approaches.

Socio-environmental assessment of a landfill using a mixed study design: A case study from México

Municipal solid waste management is a challenge for local authorities since mismanagement leads to environmental damage and social discontent. The objective of this study was to assess in an integrated manner the socio-environmental situation of a municipal landfill from México, using a design of mixed methods, which considered a quantitative evaluation of physicochemical and microbiological variables measured in leachates, surface and groundwater samples, soil and air, and a qualitative evaluation by in-depth interviews with the near-by inhabitants about their perception of the impacts of the landfill. The results show that leachates polluted the soil and surface water in a radius of up to 500 m from the landfill, but did not reach the groundwater, while the mean concentrations of PM₁₀, Mn, and Ni measured in air samples at the landfill of 146 µg m^-3, 0.12 µg m^-3, 0.10 µg m^-3, respectively, in the dry season and of Mn and Ni of 0.13 µg m^-3 and 0.11 µg m^-3, respectively, in the rainy season, surpassed permissible limits. From the residents perspective the landfill pollutes soil, water and air and it contributes to vehicle traffic and noise, promotes harmful fauna and disturbs the esthetic view. Air measurements coincide with social perception and in general, the applied mixed study design helped to assess in an integrated manner the socio-environmental concerns and to give advice to improve the current management of the landfill.

Design and efficacy of an Ecohealth competency-based course on the prevention and control of vector diseases in Latin America

OBJECTIVE

To design and analyze the efficacy of an Ecohealth competency-based course on the prevention and control of vector-borne-diseases for specific stakeholders.

MATERIALS AND METHODS

Multiple stakeholders and sectors of the region were consulted to identify Ecohealth group-specific competencies using an adjusted analysis matrix. Eight courses based on the competencies were implemented to train EA tutors. The effectiveness of the course was evaluated through the use of paired- t-tests by intervention group.

RESULTS

Strategic, tactical, academia and community stakeholder groups and their competencies were identified. An overall gain of 43 percentage points (p<0.001) was observed in terms of competencies score in trained tutors, which further trained 1 033 people.

CONCLUSIONS

The identification of the stakeholders and their competencies proved to be useful to guide training courses to significantly improve the initial competencies and create a critical mass to further advance the EA in the region.

Prenatal exposure to persistent organic compounds and their association with anogenital distance in infants

RESEARCH QUESTION

What is the association between prenatal exposure to persistent organic pollutants, separately and combined, and anogenital distance (in-utero endocrine disruption marker).

DESIGN

A cohort study conducted in Sonora, Mexico. Blood concentrations of polychlorobiphenyls (PCB) 28, 74, 118, 138/158, 153, 170, 180 and the isomers of dichlorodiphenyltrichloroethane (DDT) and its metabolites were determined in women in the third trimester of pregnancy; three variants of anogenital distance were measured on five occasions during the first year of life of their infants: 82 girls (402 observations) and 74 boys (356 observations).

RESULTS

Boys had negative and significant associations between anogenital distance/height and the concentrations of PCB 28 (beta = - 0.005;P = 0.006), PCB 74 (beta = - 0.003;P = 0.013), and PCB 170 (beta = - 0.005;P = 0.001) when analysed individually. Negative and significant associations were also found using statistical models applied to mixtures of compounds. The latter associations were sometimes larger in magnitude and significance, suggesting a possible potentiation of the compounds. No associations were observed between anogenital distance and DDT in either sex or with PCB in girls.

CONCLUSIONS

The decreased anogenital distance associated with prenatal exposure to the persistent organic pollutants, observed consistently in different analyses, suggests an under-masculinizing effect of these environmental pollutants in boys.

[Oxidative stress, lung function and exposure to air pollutants in Mexican schoolchildren with and without asthma]

OBJECTIVE.

To assess the association between the air pollutants exposure on markers of oxidative stress and lung function in schoolchildren with and without asthma from Salamanca and Leon Guanajuato, Mexico.

MATERIALS AND METHODS

We realized determinations of oxidative stress biomarkers and lung function tests in 314 schoolchildren. Information of air pollutants (O3, SO2, CO, PM2.5 and PM10) were obtained from monitoring stations and multiple linear regression models were run to assess the association.

RESULTS

An increase of 0.09 pmol in conjugated dienes was observed by exposure to PM10 lag 1 in asthmatics from Salamanca (p<0.05). The exposure to O3 during the same day increased the concentration of Lipohydroperoxides in 4.38 nmol in asthmatics of Salamanca, as well as in 2.31 nmol by exposure to PM10 lag 2 (p<0.05). The forced vital capacity decreased by 138 and 203 ml in children without asthma, respectively, due to exposure to carbon monoxide (p<0.05).

CONCLUSIONS

Exposure to air pollutants increase oxidative stress and decreased lung function in schoolchildren, with and without asthma.

Climate Change and Potential Health Effects in Mexican Children

Climate change (CC) is the most important challenge of our time, a long-term global problem and one of the most serious global threats to human health in the future. CC is the expression of changes in temperature and water cycle, floods and drought events, extreme heat waves and sea level rise. Children are particularly vulnerable because they are highly sensitive to climate changes. The main environmental hazards affecting children's health are poor household drinking water quality and availability, lack access to adequate sanitary facilities, poor hygiene practices, outdoor and indoor air pollution, vector-borne diseases, chemical hazards, and unintentional injuries. Except for some unintentional injuries, these environmental hazards are associated to CC.

Cardiovascular and Cerebrovascular Mortality Associated With Acute Exposure to PM2.5 in Mexico City

BACKGROUND AND PURPOSE

Acute exposure to particulate matter with aerodynamic diameter <2.5 μm (PM_2.5) is associated with acute cardiovascular and cerebrovascular mortality. The aim of this study was to evaluate these associations with specific causes of cardiovascular and cerebrovascular mortality in Mexico City.

METHODS

We obtained daily mortality records for Mexico City from 2004 to 2013 for cardiovascular and cerebrovascular causes in people ≥25 and ≥65 years old. Exposure to PM_2.5 was assessed with daily estimates from a new hybrid spatiotemporal model using satellite measurements of aerosol optical depth PM_2.5 and compared to ground level PM_2.5 measurements with missing data estimated with generalized additive models PM_2.5. We fitted Poisson regression models with distributed lags for all mortality outcomes.

RESULTS

An increase of 10 µg/m³ in aerosol optical depth PM_2.5 was associated with increased cardiovascular (1.22%; 95% confidence interval, 0.17-2.28) and cerebrovascular mortality (3.43%; 95% confidence interval, 0.10-6.28) for lag days 0 to 1 (lag 0-1). Stronger effects were identified for hemorrhagic stroke and people ≥65 years. Associations were slightly smaller using generalized additive models PM_2.5.

CONCLUSIONS

These results support the evidence that acute exposure to PM_2.5 is associated with increased risk of specific cardiovascular and cerebrovascular mortality causes.

Effects of climatic and social factors on dengue incidence in Mexican municipalities in the state of Veracruz

Objective:

To assess links between the social variables and longer-term El Niño-Southern Oscillation (ENSO) related weather conditions as they relate to the week-to-week changes in dengue incidence at a regional level.

Materials and methods:

We collected data from 10 municipalities of the Olmeca region in México, over a 10 year period (January 1995 to December 2005). Negative binomial models with distributed lags were adjusted to look for associations between changes in the weekly incidence rate of dengue fever and climate variability.

Results:

Our results show that it takes approximately six weeks for sea surface temperatures (SST -34) to affect dengue incidence adjusted by weather and social variables.

Conclusion:

Such models could be used as early as two months in advance to provide information to decision makers about potential epidemics. Elucidating the effect of climatic variability and social variables, could assist in the development of accurate early warning systems for epidemics like dengue, Chikungunya and Zika.

Factors that enable or limit the sustained use of improved firewood cookstoves: Qualitative findings eight years after an intervention in rural Mexico

Objective

The aim of this study was to analyze the factors enabling/limiting the use of improved cookstoves among rural fuel wood users from one mestizo and two indigenous communities eight years after an intervention in the state of Michoacan, in Mexico.

Methods

A qualitative study with an ethnographic perspective was conducted in 2013/2014 based on 62 interviews with women who had participated in an improved firewood cookstove program in 2005. Thematic qualitative content analysis was performed.

Results

Very few women from the indigenous communities were using the improved cookstove at the time of the study; the majority had dismantled or had ceased using it; whereas most of those from the mestizo community were using it for all of their cooking activities. In the indigenous communities, characterized by extended families, uptake of new technology was limited by traditional routine practices, rearrangement of rooms in the house, attachment to the traditional stove, a low- or non-risk perception of woodsmoke; gender relations, insufficient training, non-compliance with program recommendations and design-related aspects. Conversely, in the mestizo community, the uptake of the improved cookstove was favored by routine cooking practices in a nuclear family, a previous use of a raised cookstove and social representations on the health-disease-death effects of woodsmoke vs. the health benefits of cooking with improved stoves. The sociocultural dimension of communities and the cookstove design are aspects that either favor or limit the use of improved cookstoves in indigenous and mestizo populations.

Conclusions

Effective cookstove programs must take these elements into account from their early planning stages, and blend them into implementation and follow-up. Project communication, training and differentiated follow-up activities ensuring the operation and maintenance of the cookstove, should be designed according to the specific needs and traditions of each community; they should be based on the preferences and needs of the users.

Health risks from exposure to untreated wastewater used for irrigation in the Mezquital Valley, Mexico: A 25-year update

Wastewater reuse for agriculture is common worldwide; wastewater treatment, however, is rare in many countries, leading to high potential for exposure to harmful pathogens. Mexico City, one of the largest producers of untreated wastewater for agricultural use worldwide, was the site of key epidemiologic studies conducted in the 1990s. We both reviewed the literature on and conducted a cross-sectional study of diarrheal risk and wastewater contamination to provide an updated assessment of health risks and to inform an upcoming update of the 2006 WHO guidelines on wastewater reuse. We surveyed communities in the Mezquital Valley that use wastewater for irrigation and communities that use well water to compare the prevalence of self-reported diarrheal disease in children under five years old. Wastewater, well water, household environmental samples, and stool samples were collected and analyzed. Communities exposed to wastewater had a higher one-week prevalence of diarrhea (10%) compared to unexposed communities (5%). This association remained in an adjusted modified Poisson regression model (PR = 2.31, 95% CI 1.00, 5.31), but not when limited to households engaged in agriculture. Water quality indicators document differences between irrigation water from the two community groups. These results are in agreement with 25 population studies identified by our review that were conducted since or not included in the 2006 WHO guidelines and show consistent negative impacts of wastewater exposure on health. While overall diarrheal prevalence has declined when compared to studies conducted over 25 years ago in the same region, the association of diarrheal disease and wastewater exposure has remained and possibly increased. With rising urbanization worldwide, attention to these risks and wastewater treatment is becoming increasingly important.

Health impact assessment of decreases in PM10 and ozone concentrations in the Mexico City Metropolitan Area: a basis for a new air quality management program

OBJECTIVE

To conduct a health impact assessment (HIA) to quantify health benefits for several PM and O3 air pollution reduction scenarios in the Mexico City Metropolitan Area (MCMA). Results from this HIA will contribute to the scientific support of the MCMA air quality management plan (PROAIRE) for the period 2011-2020.

MATERIALS AND METHODS

The HIA methodology consisted of four steps: 1) selection of the air pollution reduction scenarios, 2) identification of the at-risk population and health outcomes for the 2005 baseline scenario, 3) selection of concentration-response functions and 4) estimation of health impacts.

RESULTS

Reductions of PM10 levels to 20 μg/m³ and O3 levels to 0.050ppm (98 µg/m³) would prevent 2300 and 400 annual deaths respectively. The greatest health impact was seen in the over-65 age group and in mortality due to cardiopulmonary and cardiovascular disease.

CONCLUSION

Improved air quality in the MCMA could provide significant health benefits through focusing interventions by exposure zones.

Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND

Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time.

METHODS

We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors.

FINDINGS

From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013.

INTERPRETATION

Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state.

FUNDING

Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.

Air pollution management and control in Latin America and the Caribbean: implications for climate change

OBJECTIVE

To assess the status of the legal framework for air quality control in all countries of Latin America and Caribbean (LAC); to determine the current distribution of air monitoring stations and mean levels of air pollutants in all capital and large cities (more than 100 000 inhabitants); and to discuss the implications for climate change and public policymaking.

METHODS

From January 2015-February 2016, searches were conducted of online databases for legislation, regulations, policies, and air pollution programs, as well as for the distribution of monitoring stations and the mean annual levels of air pollution in all LAC countries.

RESULTS

Only 117 cities distributed among 17 of 33 LAC countries had official information on ground level air pollutants, covering approximately 146 million inhabitants. The annual mean of inhalable particles concentration in most of the cities were over the World Health Organization Air Quality Guidelines; notably, only Bolivia, Peru, and Guatemala have actually adopted the guidelines. Most of the cities did not have information on particulate matter of 2.5 microns or less, and only a few measured black carbon.

CONCLUSIONS

The air quality regulatory framework should be updated to reflect current knowledge on health effects. Monitoring and control of ground level pollutants should be extended and strengthened to increase awareness and protect public health. Using the co-benefits of air pollution control for health and climate as a framework for policy and decision-making in LAC is recommended.

Modeling and estimating manganese concentrations in rural households in the mining district of Molango, Mexico

Airborne manganese (Mn) is considered the most hazardous route of exposure since Mn particles can enter into the body through the lung and may access the brain directly through olfactory uptake, thereby bypassing homeostatic excretory mechanisms. Environmental indoor and outdoor manganese concentrations in PM2.5 were monitored in ten rural households from two communities of Hidalgo, Mexico, from 2006 to 2007. Indoor and outdoor air samples of PM2.5 were collected using MiniVol samplers, and Mn concentrations in the filters were measured using proton-induced X-ray emission (PIXE). An adjusted generalized linear mixed model was applied and then used for estimating indoor concentrations in non-monitored households. Our monitoring results showed a higher daily average concentration of indoor PM2.5 vs. outdoor PM2.5 (46.4 vs. 36.2 μg/m(3), respectively); however, manganese concentration in PM2.5 indoor and outdoor was 0.09 μg/m(3) in both sceneries. Predictor variables of indoor Mn concentration were outdoor Mn concentration (64.5% increase per 0.1 μg/m(3) change in Mn) and keeping the windows open (4.2% increase). Using these predictors, the average estimated indoor Mn concentration in PM2.5 was 0.07 μg/m(3) (SD = 0.05). Our results confirm the direct effect of outdoor Mn levels, opening house windows, and the distance to the mining chimney in indoor Mn levels in houses.

Lead in school children from Morelos, Mexico: levels, sources and feasible interventions

Background: Lead is a pervasive pollutant, associated at low levels to many adverse health effects. Objective: To investigate lead levels, exposure pathways and intervention possibilities in school children from Alpuyeca, in Morelos, Mexico. Methods: Blood lead concentrations (BPb) were measured in 226 children in 2011. Exposure pathways were assessed through a questionnaire, lead measurements in different environmental matrices and spatial aggregation analysis of lead concentrations. Results: BPb ranged from 1.5 to 36.5 µg/dL, with a mean (SD) of 7.23 (4.9) µg/dL. Sixty-four and 18% of the children had BPb > 5 µg/dL and > 10 µg/dL, respectively. The use of lead glazed ceramics was reported in almost half of the households; it was the main BPb determinant and it was associated with an increased risk of having BPb > 5 g/dL by 2.7 times (p = 0.001). Environmental samples were within US EPA’s lead recommended limits, and blood lead levels were randomly distributed in the community. Conclusions: Lead remains a public health problem in Alpuyeca, Mexico. Unlike other local pollutants, lead exposure prevention can be achieved inexpensively and in a short term. Interventions should make mothers aware of lead’s health effects and empower them to safeguard their children’s health by avoiding the culturally ingrained use of lead glazed pottery.

[Gender inequity in health in contexts of environmental risk from mining and industrial activity in Mexico]

OBJECTIVE

Analyze how gender inequity manifests in contexts of poverty in different environmental risk scenarios in Mexico.

METHODS

Qualitative design based on six discussion groups and 54 in-depth interviews with women from six exposed communities: two to environmental manganese in a mining district, two in an industrial corridor, and two bordering a sanitary landfill. A document review of environmental and health studies in each area was done to relate them to the women's perspective on the problem.

RESULTS

In the three case studies, by gender roles, women stay at home and do housework and, therefore, are subject to intense environmental exposure when carrying out their daily tasks, such as house cleaning. Interview and discussion group results were found to be related to epidemiological study results. In the case of the mining district, women's perceptions are consistent with study comments on adverse cognitive effects of manganese exposure. In all three cases, there are serious limitations on women's political participation in environmental risk management.

CONCLUSIONS

Due to conditions of inequity, women are highly exposed to environmental health risks and their social participation in solving environmental problems is quite limited. These results have social and environmental policy implications in the areas studied, especially with regard to risk assessment, management, and communication.

Children's Respiratory Health After an Efficient Biomass Stove (Patsari) Intervention

Household use of fuelwood represents a socio-ecological condition with important health effects mainly in rural areas from developing countries. One approach to tackle this problem has been the introduction of efficient wood-burning chimney stoves. The aim of this study was to assess the impact of the introduction of Patsari stoves on the respiratory health of young children in highlands Michoacán, Mexico. A total of 668 households in six rural communities in a fuelwood using region were selected and randomized to receive an improved stove (Patsari) or rely entirely on the traditional wood fire until the end of the follow-up including 10 monthly visits. Adherence to the intervention was variable over the follow-up time. The actual use of the Patsari stove as reported by the mother showed a protective effect mainly on the upper and lower respiratory infection duration (IRR URI 0.79, 95% CI 0.70-0.89, and LRI 0.41, 95% CI 0.21-0.80) compared to households that used only an open fire. Fewer days of child's ill health represents saved time for the woman and avoided disease treatment costs for the family, as well as a decrease in public health costs due to a reduction in the frequency of patient visits.

Persistent organic pollutants (POPs) and metals in primiparous women: a comparison from Canada and Mexico

Under the North American Commission for Environmental Cooperation (CEC) and its Sound Management of Chemicals (SMOC) program, a tri-national human contaminant monitoring initiative was completed to provide baseline exposure information for several environmental contaminants in Canada, Mexico and the United States (U.S). Blood samples were collected from primiparous women in Canada and Mexico, and were analysed for a suite of environmental contaminants including polychlorinated biphenyls (PCBs), dichlorodiphenyldichloroethylene(p,p'-DDE),beta-hexachlorocyclohexane (β-HCH), mercury and lead. A multiple stepwise linear regression analysis was conducted using data from Canadian and Mexican primiparous mothers, adjusting for ethnicity group, age, pre-pregnancy BMI, years at current city and ever-smoking status. Concentrations of p,p'-DDE, β-HCH, and lead were found to be higher among Mexican participants; however, concentrations of most PCBs among Mexican participants were similar to Canadian primiparous women after adjusting for covariates. Concentrations of total mercury were generally higher among Mexican primiparous women although this difference was smaller as age increased. This initial dataset can be used to determine priorities for future activities and to track progress in the management of the selected chemicals, both domestically and on a broader cooperative basis within North America.

[Promotion of environmental health: close up of two fields. The case of Mexico]

En México, al igual que en otras regiones del mundo, se presentan desafíos complejos en salud ambiental que requieren de nuevos enfoques integradores, participativos e interdisciplinarios. El propósito de este artículo es mostrar las ventajas que puede aportar el campo de la promoción de la salud al de la salud ambiental para afrontar estos desafíos. Se abordan de manera general y particularmente para el caso de México las principales características de los dos campos. Además se discuten algunas de las diferencias epistemológicas y metodológicas que dificultan el acercamiento de las dos áreas y la utilidad de un concepto o campo de promoción de la salud ambiental. Finalmente se propone un modelo conceptual que permite visualizar los principales elementos a tomar en cuenta para investigaciones o intervenciones en promoción de la salud ambiental. Y se dan ejemplos de acciones en promoción de la salud ambiental en México, usando el modelo planteado.

[Local conditions of vulnerability associated with dengue in two communities of Morelos]

OBJECTIVE

To evaluate the vulnerability associated with the occurrence of dengue in two villages of Morelos, Mexico from 2006 to 2009. MATERIALS AND METHODS. A survey on knowledge, risk perception, prevention practices and water use was applied in two villages of Morelos. Using a principal component analysis, an index of local vulnerability to dengue (IVL) was constructed. The association of IVL with the disease at home was assessed using a Chi-square test.

RESULTS

The IVL included five components explaining 63% of the variance and was classified in three categories: low, medium and high. There was a significant association between increased vulnerability and prevalence of reported cases of dengue in Temixco and Tlaquiltenango.

CONCLUSION

The study of vulnerability to dengue allows us to identify local needs in the field of health promotion.

Risk: For Whom? Representations of Mining Activity by Different Social Actors in the Molango Manganese District of Hidalgo, Mexico

Previous studies have shown high levels of manganese exposure and neurocognitive damage in the population living in the mining zone in Molango, Mexico. One of the objectives of the Intersectoral Group on Environmental Management for the mining district has been to provide public participation in the risk management plan. To achieve this, it is important to know how the different social actors represent the mining activity. The objectives of this study were to characterize the social representations of the mining activity by different social actors. A qualitative design was used based on in-depth interviews of residents, public officials, and a mining company representative. The analysis was conducted according to themes for each group of actors. Essentially, distinct social representations of the different mining activities were identified. Residents viewed mining activities as synonymous with contamination and, therefore, as having affected all areas of their environment, health, and daily life. These activities were seen as a collective risk. The public officials and the mining company held that there was no evidence of harm and saw mining activities as a generator of regional development. Harm to health and the environment were seen as a stance taken by the communities in order to obtain economic benefits from the company. These images of the "other" are shaped by social, political, and cultural factors. They make it difficult for the actors to reach cooperative agreements and thereby affect progress on the risk management plan. Decisionmakers need to take these differences into account when promoting social participation.

[Environmental health in Mexico: current situation and future prospects]

Environmental health has been established in Mexico as a discipline since the early nineties resuming the sanitarian tradition developed over the past century and incorporating new knowledge generated by environmental toxicology and epidemiology. During the last decade there has been some progress in reviewing and updating the regulations, designing programs and policies to reduce exposure to pollutants and consolidating research groups and teaching in the area. However, the most prevalent problems previously diagnosed still remain and new risks have emerged due to environmental degradation (air pollution, toxics exposure and climate change among others) have been incorporated. If this trend persists, the environmental risks will continue to increase and multiply. The environmental health governance in Mexico has to be redesigned involving a transectoral approach. Future proposals might include: establishment of a National Environmental Health Program, update the situational diagnosis at national and regional level, strengthening teaching and graduate programs in environmental health as well as increase support for research in the area and development of an integrated environmental health surveillance system.

La salud ambiental en México: situación actual y perspectivas futuras

La salud ambiental se establece en México como disciplina a principios de los noventa retomando la tradición sanitarista del siglo pasado e incorporando nuevo conocimiento generado por la epidemiología y la toxicología ambiental. Durante la última década se han presentado avances en la revisión y actualización de la normatividad, se han diseñado programas y políticas para reducir la exposición a contaminantes y se han consolidado grupos de investigación y docencia en el área. Sin embargo, la mayoría de los problemas previamente diagnosticados prevalecen y se han incorporados nuevos riesgos a la salud producto del deterioro ambiental (contaminación atmosférica, exposición a tóxicos, cambio climático). Resulta necesario replantear el modelo de gobernanza en salud  ambiental en México desde una perspectiva transectorial. Se propone crear un Programa Nacional de Salud Ambiental, actualizar el diagnóstico en el  ámbito nacional y regional, fortalecer la enseñanza e investigación así como desarrollar un sistema integrado de vigilancia en salud ambiental.

Effect of environmental manganese exposure on verbal learning and memory in Mexican children

Manganese (Mn) is an essential metal, but in excess it becomes neurotoxic. Children's developing nervous system may be especially vulnerable to the neurotoxic effects of overexposure to this metal. The aim of this study was to assess the effect of Mn exposure on verbal memory and learning in 7- to 11-year-old children. We tested 79 children living in the Molango Mn-mining district and 95 children from a non-exposed community in the same State of Mexico. The Children's Auditory Verbal Learning Test (CAVLT) was administered. Blood and hair samples were obtained to determine Mn concentrations using atomic absorption spectrophotometry. CAVLT performance was compared between the two groups and multilevel regression models were constructed to estimate the association between biomarkers of Mn exposure and the CAVLT scores. The exposed group presented higher hair and blood Mn (p<0.001) than the non-exposed group (median 12.6 vs. 0.6μg/g, 9.5vs. 8.0μg/L respectively), as well as lower scores (p<0.001) for all the CAVLT subscales. Hair Mn was inversely associated with most CAVLT subscales, mainly those evaluating long-term memory and learning (β=-0.47, 95% CI -0.84, -0.09). Blood Mn levels showed a negative but non-significant association with the CAVLT scores. These results suggest that Mn exposure has a negative effect on children's memory and learning abilities.