Hector Lamadrid-Figueroa

Instituto Nacional de Salud Pública | INSP · Department of Perinatal Health

Background Quality of obstetric care may not be constant within clinics and hospitals. Night shifts and weekends experience understaffing and other organizational hurdles in comparison with the weekday morning shifts, and this may influence the risk of maternal deaths. Objective To analyze the hourly variation of maternal mortality within Mexican...

The 'Seguro Médico Siglo XXI' (SMSXXI), a universal coverage medical insurance programme for children under 5 years of age, started in 2006 to help avoid catastrophic health expenditures in poor families without social security in Mexico. The study used information from the National Health Information System for the 2006-14 period. An ecological ap...

Objective Hispanic populations typically show a high prevalence of dyslipidemias, especially of low high‐density lipoproteins (HDLs) or HDL cholesterol. Highly admixed populations are ideal groups to clarify the role of genetic ancestry on HDL concentrations, isolating it from that of other factors. The objective of this study was to estimate the a...

Background. Estimates of the sub-national distribution of maternal disorders in Mexico beyond Maternal Mortality Ratios are scarce. Characterizing the sub-national variation of maternal disorders may make it possible to focus more on interventions and thereby reduce their occurrence in a more meaningful and sustained manner. Aim. To analyze and de...

Numerous studies have established associations between single nucleotide polymorphisms (SNPs) and various behavioral and neurodevelopmental conditions. This study explores the links between SNPs in candidate genes involved in central nervous system (CNS) physiology and their implications for the behavioral and emotional aspects in children and teen...

Introduction: Frequent consumption of ultra-processed foods (UPFs) during pregnancy is linked to excess intake of added sugar, fat, and sodium and inadequacy of several micronutrients. Diet quality during pregnancy should be maximized as inadequate levels of key nutrients and excessive intake of energy and added sugar might influence mother-child h...

Early life phthalates exposure has been associated with adverse respiratory outcomes. However, evidence linking prenatal phthalates exposure and childhood lung function has been inconclusive. Additionally, few studies have examined phthalates exposure as a mixture and explored sexually dimorphic associations. We aimed to investigate sex-specific as...

Background The COVID-19 pandemic has not only caused tremendous loss of life and health but has also greatly disrupted the world economy. The impact of this disruption has been especially harsh in urban settings of developing countries. We estimated the impact of the pandemic on the occurrence of food insecurity in a cohort of women living in Mexic...

Background Maternal mortality is a critical indicator of healthcare quality, and in Mexico, this has become increasingly concerning due to the stagnation in its decline, alongside a concurrent increase in cesarean section (C-section) rates. This study characterizes maternal deaths in Mexico, focusing on estimating the association between obstetric...

Background Metal(oid)s have been cross-sectionally associated with lung function outcomes in childhood but there is limited data on their combined effects starting in utero. Child sex may further modify these effects. Objective Examine associations between in utero and early life exposure to metals assessed via novel dentine biomarkers and childho...

Globally, there is growing concern over the presence of lead (Pb) in foods because it is a heavy metal with several toxic effects on human health. However, monitoring studies have not been conducted in Mexico. In this study, we estimated the concentrations of Pb in the most consumed foods and identified those that exceeded the maximum limits (MLs)...

Background Non-communicable diseases (NCDs) are the leading causes of mortality in Mexico. Factors contributing to NCDs-related deaths may vary across small geographic areas such as municipalities. We aimed to predict municipal-level factors associated with NCD mortality in Mexican adults from 2005 to 2021 using the small-area analysis (SSA) approa...

Objective: To estimate the impact of maize consumption on aflatoxin B1 [AFB1] levels, a potent carcinogen, in Mexican adults living in south and eastern Mexico. Methods: Study participants were women and men ≥40 years of age living in five high hepatocellular carcinoma burden states who participated in Mexico’s 2018 National Health and Nutrition Su...

Objective. To present the development of a training model called AMBAR (Atención a la mujer embarazada y al recién nacido [Care for pregnant women and newborns]), which was designed to improve the quality of attention of health personnel responsible for obstetric care. Materials and methods. AMBAR was designed based on the results of a qualitative...

From 2005 to 2019, the Mexican government financed cervical cancer treatment for individuals without social security insurance through Seguro Popular’s Fund for Protection against Catastrophic Health Expenses. To better understand the impact of this program on access to treatment, we estimated the cervical cancer treatment gap (the proportion of pa...

Introduction: During adolescence, dairy product intake has shown conflicting associations with Metabolic Syndrome (MetS) components, which are risk factors for cardiovascular disease. Objective: This study aims to investigate the association between plasma fatty acids (FAs) C15:0, C17:0 and t-C16:1n-7, as biomarkers of dairy intake, with MetS an...

Purpose: Women in low-and-middle income countries face persistent barriers to cervical cancer treatment. To reduce financial barriers to cervical cancer treatment, in 2005 Mexico implemented public financing for treatment for women with Seguro Popular, a government insurance program for individuals without social security. Methods: We estimated the...

Citation: Schilmann, A.; Sánchez-Pájaro, A.; Ovilla-Muñoz, M.T.; Téllez-Sosa, J.; Bravo-Romero, S.; Bahena-Reyes, S.Y.; Lobato, M.; Martínez-Barnetche, J.; Alpuche-Aranda, C.M.; Lamadrid-Figueroa, H.; et al. SARS-CoV-2 Wastewater Surveillance in Ten Cities from Mexico. Water 2023, 15, 799. https://doi. Abstract: We aimed to estimate the lead time a...

Background Birth care in Mexican health institutions is highly medicalized and of poor quality because of the prevalence of outdated and dangerous practices. AMBAR—a training program for health care providers on the use of evidence‐based midwifery practices—was implemented during 2016–2018 and evaluated to assess the impact of training on key pract...

Unlabelled: Data integration of epidemiologic studies across different geographic regions can provide enhanced exposure contrast and statistical power to examine adverse respiratory effects of early-life exposure to particulate matter <2.5 microns in diameter (PM2.5). Methodological tools improve our ability to combine data while more fully accoun...

Self-help groups (SHGs) for people living with HIV (PLHIV) are organizations created by the community to provide individuals with security, affection, improved self-esteem, and a sense of belonging. However, SHGs have also been used by the government to help implement HIV control policies. This study aimed to identify the characteristics associated...

Background and aim: An association between lead (Pb) exposure and antisocial behaviors has been documented, but findings have been inconclusive. We aimed to estimate the association between prenatal, early childhood, and preadolescent/adolescent (periadolescent) Pb exposure and aggression and conduct problems in periadolescent residents of Mexico...

Heavy metals (HMs) can be accumulated along the food chain; their presence in food is a global concern for human health because some of them are toxic even at low concentrations. Unprocessed or minimally processed foods are good sources of different nutrients, so their safety and quality composition should be guaranteed in the most natural form tha...

Introduction: there is scarce evidence of the effects of obesity and gestational weight- gain (GWG) on hemoglobin (Hb) levels in pregnancy. Little is known about the implications in offspring when pregnant mothers present with both at delivery. Aim: to identify if pre-pregnancy body mass index (BMI) and GWG are associated with Hb levels at pregn...

Introduction: Heavy metals such as Lead (Pb) and Mercury (Hg) can affect adipose tissue mass and function. Considering the high prevalence of exposure to heavy metals and obesity in Mexico, we aim to examine if exposure to Pb and Hg in adolescence can modify how fat is accumulated in early adulthood. Methods: This study included 100 participants...

Objective: To determine the magnitude of mortality due to acute lymphoblastic leukemia (ALL) nationally and by age group, sex, state of residence and insurance status, as well as to evaluate time trends during the period 1998-2018 Materials and methods. We obtained ALL mortality data and estimated age-standardized national, state-level and health...

La práctica de la cesárea ha crecido considerablemente a pesar de los riesgos en la salud de la madre y de la persona recién nacida.

Objective: To examine overall, sex, and state-specific liver cancer mortality trends in Mexico. Materials and meth-ods. Joinpoint regression was used to examine the trends in age-standardized mortality rates of liver cancer between 1998-2018. Estimated annual percent change with 95% confi-dence intervals (95%CI) were computed. Age-period-cohort mo...

As Mexico’s government restructures the health system, a comprehensive assessment of Seguro Popular’s Fund for Protection against Catastrophic Expenses (FPGC) can help inform decision makers to improve breast cancer outcomes and health system performance. This study aimed to estimate the treatment gap for breast cancer patients treated under FPGC a...

Abstract Background Lead (Pb) exposure is a global health hazard causing a wide range of adverse health outcomes. Yet, the mechanisms of Pb toxicology remain incompletely understood, especially during pregnancy. To uncover biological pathways impacted by Pb exposure, this study investigated serum metabolomic profiles during the third trimester of p...

Background Lead is a ubiquitous pollutant with deleterious effects on human health and remains a major current public health concern in developing countries. This heavy metal may interfere with nucleic acids via oxidative stress or epigenetic changes that affect biological markers of aging, e.g., telomere length and DNA methylation (DNAm). Telomere...

Objective: To analyze the clinical records of patients with gastric adenocarcinoma, treated at two different public health institutions in Mexico to determine survival rates. Methods: Cox proportional-hazards model was fitted to identify the factors involved in survival of patients. Result: The results show that subjects aged 41 to 50 years of age...

Objective: To analyze the clinical records of patients with gastric adenocarcinoma, treated at two different public health institutions in Mexico to determine survival rates. Methods: Cox proportional-hazards model was fitted to identify the factors involved in survival of patients. Result: The results show that subjects aged 41 to 50 years of age...

In the last decade, Venezuela suffers a humanitarian crisis, leading to massive emigration. One of the most vulnerable migrants´ groups is pregnant women. We analyzed the perinatal outcomes of Venezuelan migrants in Colombia and identified if migration was associated with perinatal outcomes. Birth data were obtained from the 2017 Colombian national...

Abstract BACKGROUND AND AIM: Lead is a ubiquitous pollutant with deleterious effects on human health and remains as a major current public health concern in countries in development. Telomere length shortening has been related with aging in newborns. DNA methylation levels with specific CpG sites could be used as "epigenetic clocks" to predict bio...

Prenatal lead exposure, telomere length in cord blood and DNA methylation age in the PROGRESS cohort Jose Francisco Herrera Moreno, Haotian Wu, Tessa R. Bloomquist, Maria José Rosa, Allan C. Just, Hector Lamadrid Figueroa, Guadalupe Estrada Gutierrez, Martha M. Téllez Rojo, Robert O. Wright, and Andrea A. Baccarelli. Environmental Health Perspect...

Exposure to metals including lead (Pb), cadmium (Cd), and arsenic (As), may impair kidney function as individual toxicants or in mixtures. However, no single medium is ideal to study multiple metals simultaneously. We hypothesized that multi-media biomarkers (MMBs), integrated indices combining information across biomarkers, are informative of adve...

Background: Lead (Pb) exposure is a global health hazard causing a wide range of adverse health outcomes. Yet, the mechanisms of Pb toxicology remain incompletely understood, especially during pregnancy. To uncover biological pathways impacted by Pb exposure, this study investigated serum metabolomic profiles during the third trimester of pregnancy...

We aimed to estimate vaccination coverage and factors associated in completing schemes in children under 5 years old between 2000 and 2018. A secondary analysis was carried out on five national health surveys between 2000 and 2018 in Mexico. The sample was 53,898 children under 5 years old, where 30% of missing vaccination information was imputed u...

Objectives: To describe the prevalence and correlates of depressive symptoms, generalized anxiety disorder (GAD), and perceived negative mental health impact during the SARS-Cov-2 pandemic in Mexico City and evaluate their association with adherence to stay-at-home directives. Methods: Baseline data from a cohort study of 2,016 Mexico City governme...

Resumen La aleatorización mendeliana es un método epidemiológico propuesto para controlar las asociaciones espurias en los estudios observacionales. Estas asociaciones suelen estar causadas por la confusión derivada de factores sociales, ambientales y de comportamiento, que pueden ser difíciles de medir. La aleatorización mendeliana se basa en la s...

Objective Local characteristics of populations have been associated with COVID-19 outcomes. We analyze the Municipality-level factors associated with a high COVID-19 mortality rate of in Mexico. Methods We retrieved information from cumulative confirmed symptomatic cases and deaths of COVID-19 as of June 20 th , 2020 and data from most recent cens...

Objective. To investigate the magnitude and distribution of the main causes of death, disability, and risk factors in Haiti. Methods. We conducted an ecological analysis, using data estimated from the Global Burden of Disease Study 2017 for the period 1990-2017, to present life expectancy (LE), healthy life expectancy (HALE) at under 1-year-old, ca...

Background: Cadmium is a ubiquitous, toxic heavy metal associated with several adverse health outcomes, including high blood pressure, in adults. The impact of maternal cadmium burden on offspring birth weight and have not been thoroughly explored. We investigated associations of prenatal cadmium burden with birth weight and offspring blood pressur...

Introduction In the last decade, Venezuela suffers a humanitarian crisis, leading to massive emigration to border countries, including Colombia. One of the most vulnerable migrant groups is pregnant women. They face social and economic challenges, in addition to the barriers to access public health care services. These circumstances might increase...

Low-grade inflammation is a suggested mechanism in the development of Metabolic Syndrome (MetS), and diet could act as a regulator. Therefore, we hypothesized that the cumulative DII exposure from diet during infancy through adulthood would be positively associated with the MetS and its components in young Mexican adults. 100 participants from the...

Background. Inequalities and burden of comorbidities of the Coronavirus disease 2019 (COVID-19) vary importantly inside the countries. We aimed to analyze the Municipality-level factors associated with a high COVID-19 mortality rate of in Mexico. Methods. We retrieved information from 142,643 cumulative confirmed symptomatic cases and 18,886 deaths...

Actualización de la curva epidémica de acuerdo a un modelo Gompertz de 3 parámetros. De acuerdo al comportamiento de la epidemia en México en las últimas semanas el pico se alcanzó el pasado viernes 10 de Julio. La r2 del modelo es 99.97%.

Problem and background: During the past two decades, Mexico has launched innovative maternal health initiatives to improve maternal and neonatal outcomes, placing emphasis on the incorporation of professional midwifery practices into the healthcare system. This study explored the perceptions of healthcare providers and women using public birth car...

Dado el comportamiento de la epidemia en México en las últimas semanas, las proyecciones de casos nuevos de COVID-19, muestra ahora un máximo de casos nuevos de aproximadamente 4,700 casos nuevos diarios el 9 y 10 de Julio, y un máximo de muertes de alrededor de 450 el 23-25 de Junio. La caída de la epidemia, si se sigue la trayectoria actual, serí...

Objectives In the context of the introduction of the SSB tax in Mexico in 2014, we aimed to estimate national trends in the consumption of sweetened, unsweetened and alcoholic beverages in Mexican adults: 2006–2016. Methods We analyzed data from the FFQ-questionnaire of the National Surveys of Nutrition and Health 2006, 2012 and 2016. Beverages we...

Background: According to UNAIDS, the HIV epidemic has stabilized. This as a result of increased condom use and greater access to coverage for antiretroviral therapy (ART). In Central America, civil society organizations work with self-help groups (SHGs) organized in conjunction with public health services to implement interventions seeking to incr...

Modelo de regresión No-Lineal (con función Gompertz) de los casos confirmados acumulados hasta el 20 de Abril. A partir del 21 de Abril se proyecta hacia el futuro con bandas de confianza de 95%. Los números de casos nuevos se han comportado erráticamente en los últimos días, lo que ha incrementado la incertidumbre de las predicciones. Aclaro que...

Modelo de regresión No-Lineal (con función Gompertz) de los casos confirmados acumulados hasta el 18 de Abril. A partir del 19 de Abril se proyecta hacia el futuro con bandas de confianza de 95%. El modelo predice que el pico de la epidemia en el país será el 13 de mayo. Los casos confirmados totales se acercarían a 60000. Aclaro que esto es un mod...

Modelo de regresión No-Lineal (con función Logística) de los casos confirmados acumulados hasta el 17 de Abril. A partir del 18 de Abril se proyecta hacia el futuro con bandas de confianza de 95%. El modelo predice que estamos en (o próximos a) el pico de la epidemia en el país y pronto empezaría la disminución de casos. Aclaro que esto es un model...

Abstract Background Continuing education is essential for healthcare workers. Education interventions can help to maintain and improve competency and confidence in the technical skills necessary to address adverse events. However, characteristics of the health provider such as age (related to more critical and reflexive attitude); sex (relationship...

Background: Lead is a neurotoxic metal potentially affecting the developing brain. Children are particularly susceptible since they can absorb between 50% and 100% of ingested lead. There is no safe level for lead, therefore preventing exposure is crucial. We previously reported a positive association between lead concentrations found in candy and...

Problem In Mexico, women are often disrespected and abused during birth, evidence-based practices are seldom used, while outdated and dangerous procedures linger. Background Disrespectful and abusive practices in Mexico have been reported but are not necessarily well-documented; none of the reports so far have relied on direct observation of birth...

Objective: To study the double burden of overweight and anemia in Mexican women during pregnancy and if pre-pregnancy body mass index (BMI) and weight gain are associated with the development of anemia. Methods: In a sample of 98 pregnant women from an ongoing birth cohort, weight and hemoglobin at different gestational weeks, as well as pre-pregna...

Purpose The Early Life Exposure in Mexico to ENvironmental Toxicants (ELEMENT) Project is a mother–child pregnancy and birth cohort originally initiated in the mid-1990s to explore: (1) whether enhanced mobilisation of lead from maternal bone stores during pregnancy poses a risk to fetal and subsequent offspring neurodevelopment; and (2) whether ma...

Background. According to the last Global Burden of Disease Study (GBD 2017), liver cirrhosis was the 4th leading cause of death in Mexico, positioning this country 30th globally in terms of liver cirrhosis mortality. Objective. The primary objective is to provide a systematic overview of liver cirrhosis mortality for the 32 states of Mexico by age...

Context Early life cortisol plays an important role in bone, muscle and fat mobilization processes, which could influence body composition, affecting anthropometric indicators like weight and height. Objective To explore the association between diurnal cortisol levels and growth indexes in children from 12 to 48 months of age. Design This study i...

Background: A significant proportion of newborn and maternal deaths can be prevented through simple and cost-effective strategies. The main aim of this study was to evaluate the impact of the PRONTO obstetric-emergency management training for improving evidence-based birth attendance practices among providers attending the training at 12 hospitals...

Negative binomial regression model results. (DOCX)

Appendix. Complete maternal death classification; hourly c-section percentages; complete lag analysis results. (DOCX)

Percentage of missing values imputed in the births and deaths datasets. (DOCX)

Si bien la mortalidad materna en México ha disminuido notablemente, se debe seguir trabajando para cumplir con los Objetivos de Desarrollo Sostenible, en particular con los objetivos 3 y 5, considerando las condiciones locales de los servicios de salud en el marco de los determinantes sociales (oms, 2009). Una de las estrategias aprobadas mundialme...

Background: Cardiovascular disease in women often develops without conventional risk factors. Prenatal loss is a common pregnancy outcome that may result in physiological changes can increase the potential future risk of cardiovascular disease. Insufficient information exists regarding the impact of pregnancy loss on early markers of cardiovascula...

Table S1. Adjusted Odds Ratios for Subclinical Carotid Atherosclerosis (95% Confidence Intervals) According to History of Pregnancy Loss and Excluding Women With History of Autoimmune Disorders (Rheumatoid Arthritis and Lupus, n=75) Table S2. Adjusted Percentage Differences (95% Confidence Intervals) in Mean Intima–Media Thickness Comparing Women...

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 co...

Somos el tercer país que menos gasta en salud entre todos los países de la OCDE en términos de porcentaje del PIB. Sin embargo si lo vemos en términos de gasto per cápita somos el último lugar. Si nos limitamos al gasto gubernamental, esto equivale a 558 dólares por mexicano al año, lo cual es 40% menor que el país que nos precede (Letonia); menos...

Si bien durante los últimos años México ha sido escenario de diversos esfuerzos por identificar prioridades de investigación en temas de salud específicos, desde hace más de dos décadas no se había hecho ningún intento por identificar prioridades para la salud en general; es decir, dirigidas a atender el conjunto de problemas de salud que generan m...

Background In Mexico, although the majority of births are attended in hospitals, reports have emerged of obstetric violence, use of unsafe practices, and failure to employ evidence-based practices (EBP). Recent attention has refocused global efforts towards provision of quality care that is both patient-centered and evidence-based. Scaling up of lo...

Study protocol in English. (PDF)

Delivery level dataset. (XLSX)

CONSORT checklist. (PDF)

Study protocol in Spanish. (PDF)

Hospital level dataset. (XLSX)

Objetivo: Estimar la cobertura efectiva (CE) del tratamiento de hipertensión arterial (HTA) en adultos mexicanos en 2012 y compararla con lo reportado en 2006. Material y métodos: Se analizó la Encuesta Nacional de Salud y Nutrición 2012. Se estimó la población que necesita recibir atención, la población que utiliza los servicios dado que los nece...

Introduction: Coronary heart disease (CHD) is the leading cause of death worldwide. CHD mortality rates have decreased in most high-income countries, but increased in some Latin-American countries. CHD mortality rates have plateaued among young adults (<55 years) in the US, UK and Australia, but trends in Latin-America are largely unknown. Few stud...

Objetivo: Se realizó un diagnóstico situacional de la cirrosis hepática en México a nivel estatal a partir del análisis del Estudio de la Carga de la Enfermedad 2013 (GBD 2013). Metodología:El presente consistió en un estudio ecológico con sentido exploratorio. Se buscaron patrones que sugirieran etiologías sociodemográficas específicas para México...

Background Indoor residual spraying (IRS) is known to reduce malaria transmission. In northern Uganda, a high endemic area, IRS has been implemented since 2006. Limited data however, exists on the effect of IRS on the malaria burden. This study sought to assess the effect of IRS on malaria morbidity in the high intensity area of northern Uganda. Re...

Introducción La productividad del INSP en términos de artículos científicos es constantemente analizada y presentada en diversos foros como evidencia del progreso institucional. Es indudable que la producción de artículos ha mostrado un crecimiento constante desde la creación del Instituto. Sin embargo, las estadísticas presentadas se limitan a aná...

Environmental factors have been associated with specific physical activity domains, including leisure-time and transport physical activity, in some high income countries. Few studies have examined the environmental correlates for domain-specific physical activity in low-and middle-income countries, and results are inconsistent. We aimed to estimate...

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....