To assess, from a systems perspective, how climate vulnerability and socio-economic and political differences at the municipal and state levels explain food insecurity in Mexico.

Using a cross-sectional design with official secondary data, we estimated three-level multinomial hierarchical linear models.

The study setting is Mexico’s states and municipalities in 2014.

Heads of households in a representative sample of the general population.

At the municipal level, vulnerability to climate disasters and a poverty index were significant predictors of food insecurity after adjusting for household-level variables. At the state level, gross domestic product and the number of nutrition programmes helped explain different levels of food insecurity but change in political party did not. Predictors varied in strength and significance according to the level of food insecurity.

Findings evidence that, beyond food assistance programmes and household characteristics, multiple variables operating at different levels – like climate vulnerability and poverty – contribute to explain the degree of food insecurity. Food security governance is a well-suited multisectoral approach to address the complex challenge of hunger and access to a nutritious diet.

To describe the results of an intervention program to reduce the rate of surgical site infection (SSI) in the breast tumor department of a referral teaching hospital for patients with cancer.

Preventive measures introduced in the Breast Tumor Department of the study hospital included the following: starting in July 2000, use of sterile technique for wound care; starting in 2001, use of closed antireflux silicone evacuation systems, use of perioperative antimicrobial prophylaxis, provision of feedback to surgeons, and remodeling of the ambulatory wound care clinic. We conducted surveillance of all patients who underwent mastectomy between February 1 and December 31, 2001, and the SSI rate was calculated. A case-control analysis was performed for risk factors known to be associated with SSI. Results were compared with the data from 2000.

The study included data on 385 surgeries. SSIs were registered in 52 (13.7%) of these 385, which was a rate 58.6% less than the 2000 infection rate (33.1%). Risk factors associated with SSI included concomitant chemotherapy and radiation therapy (OR, 3.6 [95% confidence interval {CI}, 1.9-7.1]), surgery performed during an evening shift (OR, 1.9 [95% CI, 1.1-3.6]), and insertion of a second drainage tube during the late postoperative period (OR, 2.8 [95% CI, 1.4-5.7]). The mean number (± SD) of postoperative visits to the outpatient wound care clinic was reduced from 11.6 ± 7.1 in 2000 to 9.2 ± 4.4 in 2001 (P< .001, Student's t test). The mean number of days that the evacuation systems were used was reduced from 19.0 to 16.0 days (P =.001, Student's t test).

Continuous wound surveillance, along with feedback to surgeons, use of closed antireflux evacuation systems, and standardized practices in wound and drainage-tube care, decreased by 58.6% the rate of SSI in a breast surgical department with high rates of infection.