Abstract One of the most demanded services nowadays is the public transportation, and it is known that it is the second most fearful place for the user after an ATM on the street. Therefore, in this study, possible variables are determined in relation to the user's perception of the efficiency of the operation of a government concessioned public transportation system that vary the number of trips in a south of Mexico City’s corridor. Multiple linear regression models were used, and it was found that some days of the week are highly significant, that the demand is inelastic to the price of the service, that the variation of the demand is quantified according to the day of the week and how it is affected by insecurity and accidents issues.

Resumen Uno de los servicios más requeridos en la actualidad es el transporte público y se sabe que es el segundo sitio que más miedo produce al usuario después de un cajero automático en la vía pública. Es por ello, que en este estudio se determinan las posibles variables relacionadas con la percepción del usuario en cuanto a la eficiencia en la operación de un sistema de transporte público concesionado que hacen variar el número de viajes en un corredor al sur de la Ciudad de México. Se utilizaron modelos de regresión lineal múltiple y se encontró que algunos días de la semana son altamente significativos, que la demanda es inelástica al precio del servicio, se cuantifica la variación de esta según el día de la semana y cómo es afectada por los temas de inseguridad y accidentes.

ABSTRACT Introduction: Children cardiovascular diseases constitute a heterogeneous group of congenital and acquired conditions that represent an important cause of pediatric morbidity and mortality. Objective: Describe clinically and epidemiologically pediatric patients who died of cardiovascular diseases between 2005 and 2017. Methods: A retrospective cross-sectional descriptive study was conducted in the 117 pediatric patients who died with a diagnosis of cardiovascular diseases in the Villa Clara province, between 2005 and 2017, with a predominance of documentary analysis as a research method. Results: A mortality rate of 1.6 per 1000 live births was obtained, with a tendency to decrease over time, with a predominance of those who died with white skin (70.09%), and without differences in sex. Congenital heart disease (75.21%) was more frequent, such as aortic coarctation and transposition of large vessels. Among the acquired heart diseases, myocarditis was the most frequent (79.30%). 48.70% of patients were diagnosed in the first week of life and 63.25% of patients received medical treatment. The most frequent causes of death were congenital heart disease itself and multi-organ dysfunction due to sepsis in the congenital group and in those acquired cardiogenic shock. Conclusions: Congenital heart disease predominated, mainly aortic coarctation. Most patients received only medical treatment and the main direct causes of death were congenital heart disease itself and multi-organ dysfunction.

RESUMEN Introducción: Las enfermedades cardiovasculares de la infancia constituyen un grupo heterogéneo de afecciones congénitas y adquiridas que representan una causa importante de morbilidad y mortalidad pediátricas. Objetivo: Describir clínica y epidemiológicamente a los pacientes pediátricos fallecidos por enfermedades cardiovasculares entre los años 2005 y 2017. Métodos: Estudio descriptivo transversal retrospectivo en los 117 pacientes pediátricos fallecidos con diagnóstico de enfermedades cardiovasculares en la provincia de Villa Clara, entre los años 2005 y 2017, con predominio del análisis documental como método de investigación. Resultados: Se obtuvo una tasa de mortalidad de 1,6 por cada 1000 nacidos vivos con tendencia a disminuir en el tiempo, con predominio de los fallecidos con piel blanca (70,09 %), y sin diferencias en cuanto al sexo. Fueron más frecuentes las cardiopatías congénitas (75,21 %) como coartación aórtica y transposición de grandes vasos. Entre las cardiopatías adquiridas fue la miocarditis la más frecuente (79,30 %). Se diagnosticaron en la primera semana de vida 48,70 % de los pacientes y recibieron tratamiento médico 63,25 % de los pacientes. Las causas de muerte más frecuentes fueron la propia cardiopatía congénita de base y la disfunción multiorgánica por sepsis en el grupo de las congénitas y en las adquiridas el shock cardiogénico. Conclusiones: Predominaron las cardiopatías congénitas fundamentalmente la coartación aórtica. La mayoría de los pacientes recibieron solo tratamiento médico y las principales causas directas de muerte fueron la propia cardiopatía congénita y la disfunción multiorgánica.

Background: The presence of a chronic total occlusion (CTO) in a non-infarct-related artery in patients with acute myocardial infarction (AMI), may be a sign of bad prognosis. Aim: To estimate the long-term survival of patients with AMI who were studied with coronarography during 2013-2014 who had one or more CTO in a non-infarct-related artery. Material and Methods: Review of coronary angiograms performed between 2013 and 2014 to patients with an AMI. Patients were grouped as having or not a CTO in a non-infarct-related artery. Their medical records were reviewed, and mortality was determined requesting their death certificates. Results: Of 993 patients with AMI under-going coronarography, 233 (23.5%) had at least one CTO. Patients with CTO were older (66 and 62 years respectively). They also had a higher prevalence of hypertension, diabetes mellitus (DM), kidney failure and moderate to severe systolic ventricular dysfunction. The independent predictors of mortality were CTO, age, DM and kidney failure. Survival at an average follow-up period of 57 months was significantly higher in patients without CTO (89.5 and 80.3% respectively, p < 0.01). Conclusions: The presence of CTO in patients with acute myocardial infarction is associated with a higher frequency of cardiovascular risk factors and lower long-term survival.

ABSTRACT Background: during the COVID-19 pandemic, there was difficulty in accessing dermatology consultations, making it impossible to prioritize skin cancer cases. A teledermatology system was designed and implemented, through mobile telephony, for the study of patients with this pathology. Objective: to evaluate the impact of the teledermatology system for the study of skin cancer in patients treated at the Guillermo Fernández Hernández-Baquero Dermatological Hospital during the COVID-19 pandemic. Methods: a descriptive study was carried out to evaluate the impact of teledermatology in 88 patients with lesions suspected of skin cancers, referred from Primary Care and treated at the Guillermo Fernández Hernández-Baquero Dermatological Hospital in the period since April 1 2020 until April 1, 2021. A teledermatology system was designed, of the teleconsultation type with the possibility of remote diagnosis, based on the exchange of images and texts, on an Android mobile device. The descriptive statistical method was used. The results were expressed in tables for better understanding. Results: basal cell carcinoma predominated in 63.6 %. The clinic pathological correlation for basal cell carcinoma was 96.4 %, by teledermatology and by face-to-face consultation, respectively. Simple agreement was 93.2 %. Disagreements were slight for 6.8 %. The level of satisfaction was 95.5 %, very satisfied with the applied teledermatology system. Conclusions: the teledermatology system has technical feasibility, is efficient, useful, with diagnostic accuracy, reliability and reproducibility, being effective in the diagnosis of skin cancer, in unfavorable epidemiological conditions such as the COVID-19 pandemic.

RESUMEN Fundamento: durante la pandemia de la COVID-19 hubo dificultad para acceder a las interconsultas de dermatología por lo que se imposibilitaba priorizar los casos de cáncer de piel. Se diseñó e implementó un sistema de teledermatología, a través de la telefonía móvil, para el estudio de pacientes con esta patología. Objetivo: evaluar el impacto del sistema de teledermatología para el estudio del cáncer de piel, en pacientes atendidos en Hospital Dermatológico Guillermo Fernández Hernández-Baquero durante la pandemia de la COVID-19. Métodos: se realizó un estudio descriptivo para evaluar el impacto de la teledermatología en 88 pacientes con lesiones sospechosas de cánceres de piel, remitidos, de la Atención Primaria y atendidos en el Hospital Dermatológico Guillermo Fernández Hernández-Baquero en el período desde el primero de abril de 2020 hasta el primero de abril de 2021. Se diseñó un sistema de teledermatología, de tipo teleconsulta con la posibilidad de telediagnóstico, basado en el intercambio de imágenes y textos, en un dispositivo móvil Android. Se utilizó el método estadístico descriptivo. Los resultados se expresaron en tablas para su mayor comprensión. Resultados: el carcinoma basocelular predominó en el 63,6 %. La correlación clínico-patológica para el carcinoma basocelular fue de 96,4 %, por teledermatología y por consulta presencial, respectivamente. La concordancia simple fue de 93,2 %. Las discordancias fueron leves para un 6,8 %. El nivel de satisfacción fue de 95,5 %, muy satisfechos con el sistema de teledermatología aplicado. Conclusiones: el sistema de teledermatología tiene viabilidad técnica, es eficiente, útil, con exactitud diagnóstica, fiabilidad y reproductibilidad, siendo efectivo en el diagnóstico del cáncer de piel, en condiciones epidemiológicas desfavorables como la pandemia de la COVID-19.

ABSTRACT Vesicular lithiasis in childhood and adolescence has had a marked increase in recent years. In European countries such as England, cholecystectomies have tripled since 1997 and in 2012 at the Children's Hospital in Santiago de Cuba accounted for 96.4% of all major elective operations. At the IV National Symposium on Pediatric Surgery (Varadero, Matanzas, July 1-3, 2019) this " Clinical Practice Guidelines of Vesicular Lithiasis in Children and Adolescents" was presented, discussed and approved, and it was recommended, at the conclusion of that event, to share this guidelines through its publication, for pediatric surgery services to use it as a reference and to be applied in the institutions of the Cuban health system which are responsible for the health care of children and adolescents.

RESUMEN La litiasis vesicular en la infancia y adolescencia ha acusado un notable incremento en los últimos años. En países europeos, como Inglaterra, las colecistectomías se han triplicado desde 1997 y en el 2012 en el Hospital Infantil de Santiago de Cuba representó el 96,4 % de todas las operaciones mayores electivas. En el IV Simposio Nacional de Cirugía Pediátrica (Varadero, Matanzas, 1- 3 de julio de 2019) fue presentada, discutida y aprobada esta “Guía de Práctica Clínica de litiasis vesicular en niños y adolescentes” y se recomendó, al concluir dicho evento, compartir dicha guía a través de su publicación, para que los servicios de cirugía pediátrica la empleen como referencia y la apliquen en las instituciones del sistema cubano de salud encargadas de la atención sanitaria de niños y adolescentes.

Resumo Objetivo Definir a eficácia da biópsia vertebral percutânea guiada por fluoroscopia. Métodos Este é um estudo prospectivo de pacientes com síndrome de destruição vertebral em uma instituição. Os pacientes foram submetidos a biópsias vertebrais transpediculares percutâneas guiadas por fluoroscopia, com obtenção de tecido ósseo e tecido do disco intervertebral, para estudo histopatológico e microbiológico. Idade, sexo, segmento vertebral, estado neurológico, e resultados de biópsia e de cultura foram analisados. Resultados A idade média dos pacientes foi de 53,8 anos (gama: 2 a 83 anos), e o principal local acometido da coluna foi a segmento lombar, em 62% dos casos. Segundo a escala de disfunção da American Spinal Injury Association (ASIA), no pré-operatório, 49% dos pacientes foram classificados como ASIA E, e 100% apresentavam dor. A etiologia definitiva foi identificada em 83% dos pacientes. A etiologia foi agrupada em três categorias: infecciosa, neoplásica, e degenerativa (osteoporótica). O grupo infeccioso era composto por 36% dos pacientes da amostra, e Staphylococcus aureus foi o agente mais comumente identificado; em 34,9% dos casos, a etiologia era neoplásica, principalmente mieloma múltiplo e doença metastática por câncer de próstata; 21,7% dos pacientes apresentavam osteoporose. O tempo cirúrgico médio foi de 47,5 minutos, e a perda média de sangue foi de 10 mL. Nenhuma complicação foi relatada. Conclusão Nesta série, a biópsia percutânea transpedicular guiada por fluoroscopia teve 83% de eficácia no diagnóstico etiológico da síndrome de destruição vertebral. Este procedimento minimamente invasivo deve ser considerado bom, fácil, barato e reprodutível, com baixo risco de complicações em curto e longo prazos.

Abstract Objective To define the effectiveness of fluoroscopy-guided percutaneous vertebral biopsy. Methods Prospective study of patients with vertebral destruction syndrome at one institution. Percutaneous transpedicular vertebral biopsies guided by fluoroscopy were performed, and bony tissue and intervertebral disc tissue were extracted; histopathology and microbiology studies were also performed. Age, sex, vertebral segment, neurologic status, and biopsy and culture results were analyzed. Results The average age of the patients was 53.8 years (range: 2 to 83 years), and the main spine segment was the lumbar segment in 62% of the cases. According to the impairment scale of the American Spinal Injury Association (ASIA), preoperatively, 49% of the patients were classified as Asia E, and 100% had pain. Definitive etiology was identified in 83% of the sample. The etiology was grouped into three categories: infectious, neoplasia, and degenerative (osteoporotic). The infectious group was composed of 36% of the patients, in whom Staphylococcus aureus was the most common agent identified; in 34.9% the sample, the etiology was neoplastic, most commonly multiple myeloma and metastatic disease due to prostate cancer; 21.7% of the patients had osteoporosis. The average surgical time was of 47.5 minutes, the average blood loss was of 10 mL. No complications were reported. Conclusion Transpedicular percutaneous biopsy guided by fluoroscopy had an effectiveness of 83% for the etiological diagnosis of vertebral destruction syndrome in the present series. It should be considered a useful minimally-invasive procedure, which is easy, economical, and reproducible, with low risk of short- and long-term complications.

Background: Transcatheter aortic valve implantation (TAVI) is an effective and safe option for low, medium and high-risk patients with severe aortic stenosis (SAS). Aim: To analyze the clinical results and long-term survival of TAVI in our center. Material and Methods: Prospective analysis of 53 patients aged 73 ± 10 years with a Society of Thoracic Surgeons (STS) score of 7.3 ± 3.9%. Results: In 96% a transfemoral access was used and, in most patients, ProGlides™ as vascular closure device was used. General anesthesia and conscious sedation were used in 79 and 21% of cases, respectively. Fifty-three valves were implanted, 42 self-expandable (SEV) and 11 balloon-expandable (Edwards Sapiens). The implant was successful in 49 patients (92,4%). The transaortic gradient after TAVI was almost zero mmHg in all patients and one had a severe aortic regurgitation. Permanent pacemakers were needed in 17% of patients. Two patients had a pericardial effusion, and one had a major vascular complication. No strokes were recorded, and 30-day mortality was 3.7%. At long-term follow up (23.4 ± 21.6 months) the global survival was 85% and the rate of cardiovascular mortality was 5.9%. Conclusions: In this series of intermediate to high-risk patients, TAVI was associated with an excellent early and long-term survival.

Resumen: Introducción: En un contexto generalizado de violencias contra las mujeres, desde hace 15 años se ha mantenido una tendencia exponencial de homicidios en dicho sector poblacional en México. Metodología: Este estudio se llevó a cabo para identificar la magnitud y características de mujeres víctimas de homicidio, agente causal, día, hora y lugar donde ocurrió la agresión, no la muerte; así como comparar, por vecindario y municipio, la distribución espacial de 141 homicidios en el Área Metropolitana de Guadalajara (AMG) durante los años 2013 y 2018. Resultados: Con base en estos años, se identificó que la tasa de mortalidad aumentó de 2.29 (2013) a 3.48 (2018) homicidios por 100 mil mujeres en el AMG; este fue mayor en los municipios Tlajomulco de Zúñiga (2013) y San Pedro Tlaquepaque (2018). Para ambos años se identificaron dos vecindarios, localizados al sur del AMG, donde ocurrieron, en promedio, más víctimas de homicidio, principalmente en fin de semana, entre las 16 y 02 horas, y con armas de fuego. Además, la vivienda representó el lugar donde se cometió la mayoría de las agresiones fatales contra mujeres, cuya edad osciló entre 30 y 44 años (35.2 % en 2013 y 43.1 % en 2018). Conclusiones: Más allá del aumento de la magnitud de homicidios de mujeres, las estrategias para erradicar violencias, que generalmente anteceden la agresión, continúan sin funcionar adecuadamente; ni si quiera para evitar que las víctimas sean asesinadas en el lugar que históricamente ha sido el de mayor riesgo, es decir, la vivienda.

Abstract Introduction: In a general context of violence against women, an exponential trend in homicides in this population sector in Mexico has been maintained for 15 years. Methods: This study was carried out to identify the magnitude and characteristics of female homicide victims, causal agent, day, time and place where the aggression occurred, not death; as well as compare, by neighborhood and municipality, the spatial distribution of 141 homicides in the Metropolitan Area of Guadalajara (MAG) during 2013 and 2018. Results: Based on these years, it was identified that the mortality rate increased from 2.29 (2013) to 3.48 (2018) homicides per 100 thousand women in the MAG; this was higher in Tlajomulco de Zúñiga (2013) and San Pedro Tlaquepaque (2018) municipalities. For both analyzed years, two neighborhoods were identified, located south of the MAG, where,on average, more homicide victims occurred, mainly on weekends, between 4 pm and 2 pm, and with firearms. In addition, the house represented the place where most of the fatal aggressions against women were committed, whose age ranged from 30 to 44 years (35.2 % in 2013 and 43.1 % in 2018). Conclusion: Beyond the increase in the magnitude of female homicide victims, the strategies to eradicate violence, which generally precede the aggression, continue to not function properly; not even to prevent victims from being killed in the place that historically has been the most at risk, that is, living place.

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Abstract Introduction: Acute kidney injury is a frequent complication in patients with COVID-19 and its occurrence is a potential indicator of multi-organ dysfunction and disease severity. Objective: Develop, through an expert consensus, evidence-based recommendations for the prevention, diagnosis, and management of acute kidney injury in patients with SARS CoV2 / COVID-19 infection. Materials and methods: Based on a rapid systematic review in Embase and Pubmed databases and documents from scientific societies, we made preliminary recommendations and consulted with an expert group through an online tool. Then we defined agreement after at least 70 % consensus approval. Quality evidence was evaluated according to the type of document included. The strength of the recommendations was graded as strong or weak. Results: Fifty clinical experts declared their conflict of interest; the consultation took place between May 2 and 29, 2020. The range of agreement ranged from 75.5 % to 100 %. Recommendations for prevention, diagnosis and management of acute kidney injury in patients with SARS CoV2 infection are presented. Conclusions: Although the good quality information available regarding acute kidney injury in patients with COVID-19 is scarce, the recommendations of clinical experts will guide clinical decision-making and strategies around patients with this complication, guaranteeing care focused on the people, with high quality standards, and the generation of safety, health and wellness policies for multidisciplinary care teams.

ABSTRACT The evaluation of the quality of the air urges in the current moments with the purpose of preserving the health of the humans, this case makes reference to the emissions of the dioxide of sulfur (SO2) for the 64 fixed sources of the municipality of Caibarién, county of Villa Clara and its influence in the city, in the year 2018. The general objective was to evaluate the quality of the air for SO2 starting from the emissions to the atmosphere taken place by these sources. The calculation method was used based on the emission factor to determine the rate of the pollutants of both sources and the moderation of the dispersion of the pollutant to evaluate the quality of the air. The main results were, 69% of the fixed sources is well located and they emitted 1% of the total, 26% is partially well located and they expelled 96% and 5% they are not well located and they emitted 3%. The areas with deterioration of the quality of the air in the city of Caibarién are located to leeward of the not well located fixed sources, mainly the tanneries, with category of ¨Bad¨ and ¨Faulty¨ in 24 hours. They intend actions that contribute to reduce the consumption of fuel, to elevate the energy efficiency, to minimize the emissions and to favor the transport and dispersion of the pollutant, influencing positively in the elevation of the quality of the air in the areas affects.

RESUMEN La evaluación de la calidad del aire urge en los momentos actuales con el propósito de preservar la salud de los humanos, este caso hace referencia a las emisiones del dióxido de azufre (SO2) por las 64 fuentes fijas del municipio de Caibarién, provincia de Villa Clara y su influencia en la ciudad, en el año 2018. El objetivo general fue evaluar la calidad del aire para SO2 a partir de las emisiones a la atmósfera producidas por estas fuentes. Se utilizó el método de cálculo basado en el factor de emisión para determinar la tasa de los contaminantes de ambas fuentes y la modelación de la dispersión del contaminante para evaluar la calidad del aire. Los principales resultados fueron, el 69% de las fuentes fijas están bien ubicadas y emitieron el 1% del total, el 26% están parcialmente bien ubicadas y expulsaron el 96% y el 5% están mal ubicadas y emitieron el 3%. Las áreas con deterioro de la calidad del aire en la ciudad de Caibarién se ubican a sotavento de las fuentes fijas mal ubicadas, principalmente las tenerías, con categoría de ¨Mala¨ y ¨Deficiente¨ en 24 horas. Se proponen acciones que contribuyen a reducir el consumo de combustible, elevar la eficiencia energética, minimizar las emisiones y favorecer el transporte y dispersión del contaminante, influyendo positivamente en la elevación de la calidad del aire en las zonas afectas.

ABSTRACT In this work the inventory of atmospheric emissions of the 306 fixed sources is shown distributed in the seven coastal municipalities of the county of Villa Clara in the year 2018. The general objective was to quantify the emissions from the PM10 to the atmosphere taken place by these fixed sources. The calculation method was used based on the emission factor to determine the rate of the pollutant for sources. The main results were, to modernize the inventory of emissions of the fixed sources in this area of the provincial territory, removed by municipalities, Oaces and according to the classification of these sources keeping in mind the impact about the quality of the air. It was possible to determine that 80% of the fixed sources is well located and they emit 2% of the total of this pollutant, 17% is partially well located and they emit 96% and lastly 3% is not well located and they emit 2% of the load. The total emission of the PM10 was of 2 191,5 t/year, representing 75% of the provincial total, of it the well located fixed sources emitted 42,7 t/year, those partially well located 2 105,8 t/year and the not well located 43 t/year. These results provide the necessary and indispensable information for the proposals of actions that they contribute to reduce emissions, to minimize critical episodes of atmospheric contamination and to carry out the modelation of the dispersion of the pollutant and its evaluation.

RESUMEN En este trabajo se muestra el inventario de emisiones atmosféricas de las 306 fuentes fijas distribuidas en los sietes municipios costeros de la provincia de Villa Clara en el año 2018. El objetivo general fue cuantificar las emisiones del PM10 a la atmósfera producidas por estas fuentes fijas. Se utilizó el método de cálculo basado en el factor de emisión para determinar la tasa del contaminante por fuentes. Los principales resultados fueron, actualizar el inventario de emisiones de las fuentes fijas en esta zona del territorio provincial, desglosado por municipios, Oaces y de acuerdo a la clasificación de estas fuentes teniendo en cuenta el impacto sobre la calidad del aire. Se logró determinar que el 80% de las fuentes fijas están bien ubicadas y emiten el 2% del total de este contaminante, el 17% están parcialmente bien ubicadas y emiten el 96% y por último el 3% están mal ubicadas y emiten el 2% de la carga. La emisión total del PM10 fue de 2 191,5 t/año, representando el 75% del total provincial, de ello las fuentes fijas bien ubicadas emitieron 42,7 t/año, las parcialmente bien ubicadas 2 105,8 t/año y las mal ubicadas 43 t/año. Estos resultados proporcionan la información necesaria e imprescindible para las propuestas de acciones que contribuyan a reducir emisiones, minimizar episodios críticos de contaminación atmosférica y realizar la modelación de la dispersión del contaminante y su evaluación.

Abstract. Homicide mortality in Mexico is still a priority public-health issue. In 2012, it was one of the most frequent causes of death in men aged 15-44 years. Some Mexican States, including the State of Jalisco, show homicide mortality rates significantly higher than others; 48% of the homicides recorded in the country during the period 1990-2017 were committed in Jalisco. Important local-level differences have also been documented within the State; up to 50% of the homicides reported by official sources are usually perpetrated in the Guadalajara Metropolitan Zone (AMG, for its acronym in Spanish). The importance of gathering evidence based on spatially referenced data to address this issue is being increasingly recognized, not only to evaluate homicide mortality, but also to identify population groups at risk and high-priority areas, examine epidemiological behavior, and identifying spatial or temporal trends. Public health and healthcare geography provide various analytical tools that can be useful for supporting decision-making to better focus interventions aimed at reducing and preventing homicide mortality. The objectives of this study were to estimate the magnitude and identify the spatial distribution and trends of homicides perpetrated in the years 2013 and 2018 in the AMG, comparing the results at municipal and neighborhood levels. There are two official sources of homicide statistics in Mexico: the Instituto Nacional de Estadística y Geografía (National Institute of Statistics and Geography; INEGI, for its acronym in Spanish), and the Secretariado Ejecutivo del Sistema Nacional de Seguridad Pública (Executive Secretariat of the National Public Security System; SESNSP). However, both provide data aggregated at State or municipal levels only. To overcome this limitation, INEGI statistics were supplemented with local newspaper reports to derive the following information for homicides in the AMG in 2013 (n = 465) and 2018 (n = 988): date, address, neighborhood, and municipality where each homicide was perpetrated. These data allowed examining the geographic distribution of homicides across the 1,710 neighborhoods in the six AMG municipalities (Guadalajara, Zapopan, San Pedro Tlaquepaque, Tonalá, El Salto, and Tlajomulco de Zúñiga). Geostatistical techniques were used to analyze the distribution and spatial trend of homicide incidence from the point location data. The frequency of homicides by neighborhood and municipality were also calculated to estimate and map homicide rates (number per 100,000 inhabitants) for comparison vs. the aggregated data reported by INEGI for the two years studied. According to the two official data sources, homicide mortality increased from 2013 to 2018 in most of the AMG, except for the municipality of Zapopan; the increase was particularly high in the municipalities of Tlajomulco de Zúñiga and San Pedro Tlaquepaque, where the homicide rate increased from 20.3 to 50.7 and 4.6 to 18.8 homicides per 100,000 inhabitants, respectively. The geographic analysis of point-location data showed a high concentration of homicides in low-, medium-, and high-marginalization areas of the north and southwest parts of the municipality of Zapopan (29.2% of the homicides reported in 2013), as well as in the center and northeast parts of Guadalajara (14%). By contrast, the zones with high concentration of homicides in 2018 (25.4%) shifted towards the low-marginalization neighborhoods located on the northeast, central, and south parts of Guadalajara, in the limits between the municipalities of Tonalá and San Pedro Tlaquepaque. The homicides perpetrated in 2013 were distributed in 16.8% of the neighborhoods that make up the AMG, whereas those perpetrated in 2018 took place in 24.4% of the neighborhoods. Mortality rates in 2013 ranged from 4 (at the low-marginalization Miramar neighborhood, Zapopan) to 223.3 (at the low-marginalization Revolucionaria neighborhood, Guadalajara) homicides per 100,000 inhabitants; and from 3.8 (in the very high-marginalization Santa Cruz de Las Flores neighborhood, Tlajomulco de Zúñiga) to 2,006 (in the very high-marginalization Toluquilla neighborhood, San Pedro Tlaquepaque) homicides per 100,000 inhabitants in 2018. Despite of having used different sources and territorial scales for the geographic analysis, we were able to identify consistent patterns in the increase in homicide mortality from 2013 to 2018 in the AMG. These results provide valuable information for guiding strategies and available resources to target priority areas where the magnitude, distribution, and spatial trends observed at neighborhood and municipality levels indicate a high incidence of homicides and, thus, reduce the risks facing the population (54%) in the AMG neighborhoods recording high homicide rates.

Resumen. Los homicidios son un problema prioritario de seguridad pública en México dada la magnitud e impacto que los caracteriza; sin embargo, rara vez se estudian las causa de muerte y los hechos violentos desde una perspectiva geográfica y de salud pública. A partir de fuentes secundarias se llevó a cabo un análisis comparativo de homicidios ocurridos en 2013 y 2018 por colonias y municipios del Área Metropolitana de Guadalajara (AMG), Jalisco. Los homicidios fueron georreferenciados considerando el lugar donde ocurrió la agresión y analizados mediante medidas de tendencia central y dispersión con el objetivo de determinar la magnitud, distribución y tendencia espacial. Como resultado, la cantidad de homicidios ocurridos en el AMG aumentó de 2013 (n= 465) a 2018 (n= 988), salvo en el municipio de Zapopan. En 2018 la tasa de homicidios osciló entre 6.2 (Tonalá) y 50.7 por cada 100 mil habitantes (Tlajomulco de Zúñiga), un incremento hasta 4 veces mayor respecto al 2013. Además, el total de homicidios se concentró en el 16% (2013) y 24% (2018) de las colonias que integran el AMG, caracterizadas por ser en su mayoría de baja y muy baja marginación, lo que implicó un desplazamiento del noroeste-sureste hacia el norte-sur, respectivamente. Los resultados contribuyeron a identificar la magnitud y tendencia espacial de los homicidios asociadas a colonias de mayor riesgo, por lo que se trata de zonas donde se requiere redirigir y mejorar las políticas públicas para modificar los factores de riesgo, las actividades o comportamientos ilícitos que, generalmente, preceden a la ocurrencia de los homicidios.