RESEARCH ARTICLE

The transformation of medical research in Mexico:
A structural analysis of thematic domains,
institutional affiliations, authors’ cohorts,
and possible correlations

Keine offenen Zugänge

Tagebuch

Matías Federico Milia1

, Claudia Gonzalez Brambila1

,

Ángel Lee2

, and José Ignacio Ponce1

1Departamento Académico de Administración, Instituto Tecnológico Autónomo de México, Ciudad de México, Mexiko
2Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Ciudad de México, Mexiko

Schlüsselwörter: authorship, historical analysis, medicine, Mexiko, R&D capabilities, thematic domains

ABSTRAKT

Global research on medical and health-related issues has experienced a profound
reconfiguration over the last 30 Jahre. The rise of new areas of inquiry has transformed the
medical research landscape as staff with medical training gradually relinquished their
prominence and specialists from other disciplines raised their profile within research teams.
Given this, research priorities seem to be shifting increasingly towards laboratory-based and
innovation-oriented research lines. The unfolding of these shifts in nonhegemonic countries
such as Mexico is still to be understood. This paper surveys structural changes in Mexican
medical research from 1993 Zu 2021 by observing temporal aggregation of authorships,
emerging thematic features, and institutional affiliation patterns. It also explores correlations
between these findings and their possible explanations. The results allow us to empirically
describe significant changes in medical research done in Mexico. We detected periods of
stability in authorship allowing us to describe stages in the accumulation of research and
Entwicklung (R&D) capabilities. The identified semantic patterns allowed us to characterize
this transformation, observing subsequent stages of an accumulation and specialization
process that began in the mid-1990s. Darüber hinaus, we found divergent thematic and institutional
patterns that point towards a growing gap between research conducted in health institutions
and scientific ones.

1.

EINFÜHRUNG

Medical research is a multifaceted scientific field involved in a rapid transformation mani-
fested in the specialization and differentiation of its various branches. Historically, medicine
has stood out among academic science for being tightly connected to both industry and the
Zustand (Edgerton, 2008, P. 198). Over recent decades, scientific publications have become
increasingly oriented toward medical applications (Wong, 2019). These changes can be
understood from at least two different perspectives. Einerseits, new discoveries and
findings allow increasing transformations based on developments that carry scientific and
technological relevance. These advances have implied changes in the profiles and back-
ground of researchers (Keating & Cambrosio, 2003). How new discoveries and developments
are received and further developed becomes a crucial issue in understanding the different

Zitat: Milia, M. F., Brambila, C. G.,
Lee, Á., & Ponce, J. ICH. (2023). Der
transformation of medical research
in Mexico: A structural analysis of
thematic domains, institutional
affiliations, authors’ cohorts, Und
possible correlations. Quantitative
Science Studies, 4(1), 262–282.
https://doi.org/10.1162/qss_a_00239

DOI:
https://doi.org/10.1162/qss_a_00239

Peer Review:
https://www.webofscience.com/api
/gateway/wos/peer-review/10.1162
/qss_a_00239

Erhalten: 10 Februar 2022
Akzeptiert: 28 September 2022

Korrespondierender Autor:
Matías Federico Milia
matias.milia@itam.mx

Handling-Editor:
Gabriel Velez Cuartas

Urheberrechte ©: © 2023 Matías Federico
Milia, Claudia Gonzalez Brambila,
Ángel Lee, and José Ignacio Ponce.
Veröffentlicht unter Creative Commons
Namensnennung 4.0 International (CC BY 4.0)
Lizenz.

Die MIT-Presse

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The transformation of medical research in Mexico

ways in which knowledge is created. Science does not happen in closed and isolated spaces;
andererseits, it is a form of communication between people (Secord, 2004). The circulation
of knowledge is perhaps a crucial feature of modern science, as it remains a collective effort
that requires the participation of multiple parties, even if they take very different roles (Kreimer,
2006). Trotzdem, distinctive research profiles emerge in specific circumstances, with foci of interest,
institutional structures, and scientific cohorts that emerge tied to geographical and temporal
coordinates.

Andererseits, countries of the Global South, even though standing in a disadvantaged
position in the international division of scientific labor, still have margins for influencing
the production of knowledge (Losego & Arvanitis, 2008). National policy then becomes a pri-
vileged tool to address these challenges. In Mexico, the low participation of the private sector
in research financing has made government sources responsible for almost 77% of the allo-
cated funds, one of the highest in Latin America (RICYT, 2022). Trotzdem, resources dedicated to
R&D are only 0.31% of the gross domestic product (BIP) (Quiroga-Garza, Garza-Cisneros
et al., 2022).

In nonhegemonic countries, such as Mexico, this becomes particularly relevant due not
only to the importance that public policy has had in the attempts to direct and promote
research addressing the so-called National Problems (Dutrénit, Santiago-Rodríguez, &
Vera-Cruz, 2006) but also to the limitations of public funding to address them (Natera,
Rojas-Rajs et al., 2019A). In den vergangenen Jahren, in Mexico and many Latin American countries,
the development of research capabilities has been at the core of science policy efforts.
Perhaps the more notable ones in Mexico are the development and training of new
researchers and the increase in scientific production (CONACYT, 2002, 2008, 2014,
2018). Medical research stands out as one of the most relevant areas for these efforts
(González-Brambila & Veloso, 2007; Lancho-Barrantes & Cantú-Ortiz, 2019), while closely
related to a complex and compartmentalized health system (Frenk, González-Pier et al., 2006;
Gómez-Dantés, Sesma et al., 2011) marked by inequality, high administrative costs and a
structural financial imbalance among its users (OECD, 2016). This makes medical research
stand out as a relevant object of inquiry as is a place where different professional profiles
(d.h., physicians and professional researchers) converge in research activities. Given this
scenario, publications by active Mexican researchers become a key element in characterizing
and depicting the broad scope of actual transformations in the national research landscape
related to the matter.

Medical research in Mexico lies entangled between transformations of global reach and
a set of policy efforts on a national scale rolled out in a complex scenario with research
communities of different backgrounds. As these changes slowly aggregate through time,
they cannot be grasped without considering a significant time period. Mexico having
devoted its policy efforts in the last decades to training new scientists and growing its pub-
lication output, while prioritizing health-related research, it remains relevant to understand
how this endeavor has unfolded. daher, this paper aims to answer the following ques-
tionen: how did the production of medical knowledge evolve in Mexico from 1993 Zu 2021?
What are the key cohorts of authors supporting these transformations? And how does this
relate to the thematic domains and institutional collaboration structures that support this
evolution?

To do so, we study the publication patterns and underlying structures of the production of
knowledge of Mexican researchers in medicine. Somit, this paper concentrates on a histori-
cal analysis of Mexican authorships and publications. To understand the evolution in the

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The transformation of medical research in Mexico

accumulation processes of research capabilities, we observe a set of top authors and their
temporal distribution. After doing so, we detect periods of authorship stability. We continue to
identify main research interests by observing specific semantic features in the published
documents. We looks for relevant semantic and institutional patterns that help to portray this
transformation. Dann, we focus on establishing relations between the structural features detected
while discussing the implications of these findings. Endlich, by contrasting the results, we reflect
on the method used and the critical transformations in the structural features in Mexico’s
medical research.

2. LITERATURE REVIEW

Medical research has steadily increased its relevance and its size in recent decades (Wong,
2019). Changes such as sedentary lifestyles, stress, the rise of diets with an increased intake of
fats and sugars, the rise of new pathogens, or the general aging of the populations are
examples of the social transformations that have raised the importance of knowledge on med-
ical issues. Such transitions have transformed the prevalence of some pathologies and marked
the emergence of others. Even if the importance of academic science conducted in connec-
tion to medicine has been there since at least the 19th century, these social transformations
seem to be putting health-related research on the rise. In medicine, a close relation between
professional practice and academic science has made it stand out, establishing tight connec-
tions to industry and the state (Edgerton, 2008, P. 186). Although knowledge construction
implies an interactive process between diverse parties (Secord, 2004), it entails different roles
and positions with cognitive implications resulting from subordinate relations (Kreimer,
2006). Medical knowledge circulates marked by this close relation between practice and
Forschung. Dann, it becomes a privileged space to map scientific transformation in specific
coordinates.

In the case of Mexico, the health sector stands out as an important area for scientific capac-
ity building (Torres, Jasso, & Martínez, 2014). Gleichzeitig, the impact of specific
disorders—such as diabetes mellitus—has proven to have significant economic impacts
(Barraza-Lloréns, Guajardo-Barrón et al., 2015). Diabetes and related metabolic diseases rep-
resent about 20% of the preventable deaths in Mexico (Quiroga-Garza et al., 2022), Werden
a national priority from 2000 onwards (Dutrénit, Natera et al., 2021, S. 3–18). Likewise,
unforeseen health emergencies, such as that linked to the COVID-19 pandemic, have shown
the importance of scientific capabilities to address emerging health and social challenges
(Diéguez-Campa, Pérez-Neri et al., 2021; Raut, Sah et al., 2021). Health research in Mexico
appears both as an increasingly relevant field of study and one that inserts itself into the local
scenario with specific threads.

In this North American country, medical research appears tightly connected to structural
features of the Mexican health system, a system marked by the lack of integration between
its different branches (Gómez-Dantés et al., 2011). In Mexico, not only are public and private
health providers highly decoupled, but the public health services are financed, managed, Und
carried out by different institutions. Daher, patients with health insurance receive attention from
diverse public providers according to the nature of their employer; ISSSTE provides care for
public servants and IMSS for the remaining insurees. Patients without any insurance are treated
mainly by the Secretariat of Health (SSA) and its hospital network.

On top of this, the most important Mexican higher education institutions (HEIs) do not rely,
as in other countries, on academic medical centers or university hospitals to conduct medical

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The transformation of medical research in Mexico

research and training. The training of physicians in different specialties is accomplished
mainly in national specialty institutes, relatively autonomous but under the coordination of
the Secretariat of Health. Daher, the institutional complexity of health services in Mexico
affects research activities, as access to critical resources remains scattered across different
institutions.

Knowledge produced under these conditions remains a relevant object of study, as it helps
when grasping scientific change and describing features of its changes in noncentral locations.
Scientific change has been understood as a differentiation process that results from the disag-
gregation of research objects deriving from simultaneous processes of change and stability
(Abbott, 2001, S. 3–33). This distinction and branching process comes with the increasing
size of a community of inquiry, something tightly intertwined with the disaggregation of the
objects of knowledge. In each generation, specificity increases as each lineage splits into sub-
ordinate parts. This paper aims to chart the development and evolution of such a research
landscape as a way of empirically addressing and discussing the process of scientific change
in Mexican medical research.

As stated, medical research entails the complexity of a close connection between research
and practice, while remaining a relevant arena for its industrial and political ramifications.
Trotzdem, an ongoing differentiation process has been reported by members of this community
der Praxis: medical doctors. Internal observations that physicians have made on the changes
in their profession and the relation with knowledge production activities offer a glimpse of
the ongoing generational changes in this research landscape. Zum Beispiel, in den Vereinigten
Zustände, a significant decrease has been reported in the proportion of physician-researchers
who apply for research funding (Nathan, 1998) and those who receive it (Martin, Lindquist,
& Kotchen, 2008). When documenting this shift, claims highlight the critical role that
research-focused physicians play in applying new medical knowledge (DeMaria, 2003;
Wyngaarden, 1979).

In recent decades the medical research ecosystem seems to have increased its complexity
and undergone various changes that pushed forward the disciplinary distinction. High costs,
deferred results, more competitive funding, new regulations, and lack of trained research
personnel, unter anderen, have been some of the challenges for clinical research (Sung,
2003). Training physicians to conduct research activities has been proposed to respond to
the increase in investigations conducted by researchers not trained in medical schools
(Goldhamer, Cohen et al., 2009). Trotzdem, changes in medical research structure seem
to be structural and long-lasting. Scientific staff specialization and professionalization appear
to be entangled with the rising complexity and diminishing participation of physicians in
medical research.

The decrease in the importance of medical staff in research can be thought of as an evo-
lution of the order of things established in the early postwar period (Rigal, 2008; Valier &
Timmermann, 2008). Dort, standardized experimental medicine started playing a critical role
in mobilizing statistics and quantitative tools to evaluate medical care, assess the success of
the therapeutic intervention, and orient the planning of health services and laboratory
Forschung.

Keating and Cambrosio (2003, P. 43) described an analogous process, one that reshaped
the content of medical sciences as the rise of new entities, both existing as biological entities
and pathological signs. In this new emergent model, a new “relation between biology and the
clinic” is at the center. This is a shift that allowed medical biologists to increase their interven-
tion in “the clinical realm and reshape the organization and content of medicine.” In research,

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The transformation of medical research in Mexico

this translates into a new set of skills and interactions that support the development of new
research agendas.

In this transforming research landscape, one defined by rising standardization, new scien-
tific platforms, and specific kinds of collaborations attached to it, the importance of publishing
authors remains crucial. In a national context, where the training of new scientists remains a
priority, changes in publishing authors offer a way of assessing the rhythm of these shifts. Indi-
viduals’ experience over time constitutes a salient social force because it connects the past
with the present and the future (Abbott, 2016, S. 3-15). Somit, the historical recurrence
of authorship can be considered a key indicator to assess the evolution of the different stages
of a national research landscape. Darüber hinaus, in biomedical sciences, authorship results from
coproduction between junior and senior researchers (Biagioli & Galison, 2003, S. 309–311).
Somit, cohorts of authors offer a good data source to map the transformation of a specific
intermediate social group—medical researchers—and it is to be expected that the repetition
or nonrepetition of prominent authors will allow us to capture the changes in the historical
structure of prominent roles in laboratories and research teams over the years. Darüber hinaus, Dort
is a trend towards cooperative scientific research due to the rapid diffusion of research outputs,
stimulated through the Internet, and the complexity of interdisciplinary research topics (Er &
Zhou, 2022).

It becomes relevant to take a look at the overall research landscape of medicine in Mexico,
as research in health sciences has grown the most, zwischen 1980 Und 2001, compared to
other areas of knowledge (Gonzalez-Brambila & Veloso, 2007, P. 1041). Auch, zwischen
2007 Und 2016, medicine stood out as one of the most productive disciplines in Mexico
(Lancho-Barrantes & Cantú-Ortiz, 2019, P. 506). Even though the number of publications
has increased constantly, von dem 22 research areas analyzed in which the Essential Science
Indicators (ESI) scientific publications are classified, Clinical Medicine had one of the lowest
participations, around 0.5% (Toche, 2019).

Regarding Mexico, it is essential to keep in mind that the training of new researchers and
the increase in scientific productivity have been central points of Mexican STI policy during
the last decades (CONACYT, 2002, 2008, 2014, 2018)—a policy sustained on the expectation
that the resulting outcomes would greatly contribute to solving the so-called National Prob-
lems (Dutrénit et al., 2006). Trotzdem, research studying diabetes-related projects with
public funding in Mexico from 2002 Zu 2014 found them not to have a significant “consider-
ation of knowledge use.” (Natera et al., 2019A). Mexican STI policies seem to place incentives
that are overly oriented towards basic research, barely promoting the actual use of the new
scientific knowledge. This appears as a repeated threat for developing countries, as a general
mismatch between the research agendas and the needs of health systems has been reported
(Natera, Tomassini, & Vera-Cruz, 2019B).

Like other developing countries, Mexico can be thought of as a nonhegemonic country,
which cannot fix new research agendas but still steers its way in the international scientific
landscape through STI policy and by choosing specific topics and partners (Losego &
Arvanitis, 2008). This means that a national research landscape emerges from a blend
between policy and the agency of its members. As medicine lies among the most relevant
areas of research, in terms of policy and productivity, the question of the evolution of this
research domain connects not only to policy-induced transformations but also to the specific
shape it takes in terms of the groups of active researchers, the topics on which they publish,
and the collaboration structures that support it. Shedding light on the structural features of
these transformations becomes a key element in grasping the shaping trends of this research

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The transformation of medical research in Mexico

Raum, and while at it, providing empirical material to describe the reach of specific forces in
this transformation.

3. MATERIALS AND METHODS

We retrieved the information from the Web of Science ( WoS) database. The reasons behind
using WoS over other databases are that The focal points of PubMed are life sciences and
biomedical disciplines whereas Scopus and WoS cover all scientific areas, including multidis-
ciplinary fields (AlRyalat, Malkawi, & Momani, 2019); it has been shown that in WoS the dis-
tribution of non-English documents is more homogeneous, with the widest representation of
life sciences and medicine (Pranckutė, 2021; Vera-Baceta, Thelwall, & Kousha, 2019); Und
other studies related to the Mexican system have been carried out using WoS (González-
Brambila et al., 2013; González-Brambila & Veloso, 2007).

We wrote a targeted query to capture publications related to medical specialties and sub-
specialties. To establish the areas to focus on, we resorted to a simplified categorization based
on the Association of American Colleges standards (St. George’s University, 2021). We did so
because it represented most of the medical fields that serve each of the realms of care.
Although we assume that these specialties localize in the Mexican case as part of negotiations
and pre-existing institutional, infrastructural, and material relations, we also take them as a
valid criterion that mirrors the standardization processes that support the universal character
of medical procedures (Timmermans & Berg, 1997). Based on a comprehensive analysis of
these specialties, and after multiple iterations, data retrieval was pursued using a query line
that focused on areas of interest to the practice of medicine:

CU=Mexico AND (SU=ANATOMY OR SU=MEDICAL ETHICS OR SU=BIOLOGY OR
SU=GENETICS OR SU=MICROBIOLOGY OR SU=BIOPHYSICS OR SU=NEUROLOGY
OR SU=DENTISTRY OR SU=ONCOLOGY OR SU=DERMATOVENEROLOGY OR
SU=OPHTHALMOLOGY OR SU=EPIDEMIOLOGY OR SU=OTOLARYNGOLOGY
OR SU=FORENSIC MEDICINE OR SU=PATHOLOGY OR SU=GYNECOLOGY OR
SU=OBSTETRICS OR SU=PEDIATRICS OR SU=HISTOLOGY OR SU=EMBRYOLOGY
O R S U = P H A R M A C O L O G Y O R S U = H Y G I E N E O R S U= P H Y S I O LO G Y O R
SU=PATOPHYSIOLOGY OR SU=BIOCHEMISTRY OR SU=PSYCHOLOGY OR
SU=PSYCHIATRICS OR SU=IMMUNOLOGY OR SU=RADIOLOGY OR SU=
INFECTIOUS DISEASES OR SU=SOCIAL MEDICINE OR SU=TELEMEDICINE OR SU=
SPORTS MEDICINE OR SU=INTERNAL MEDICINE OR SU=SURGERY)

The resultant registers were cleaned to ensure the quality of the data. The database was
retrieved with coverage up to June 2021, produzieren 55,783 records (Milia, González-
Brambila, & Ponce Sánchez, 2022). The results were processed using the CorText platform
(Breucker, Cointet et al., 2016). Based on the authorship equivalences, we computed the
optimal division in temporal periods using the statistical criterion of Tibshirani, Walther, Und
Hastie (2001). This process detects frequency distributions to produce a matrix based on the
cosine distances between the distributions of authors for each pair of years. This represents the
distance between the composition of a data set in 2 different years, and is then able to detect
emergent periods of time based on the most productive researchers.

The analysis included authors based on a minimum publication threshold to capture the
most relevant researchers. Dann, it considered only those with at least 35 articles published
zwischen 1993 Und 2021, insgesamt 871 researchers. These authors were cosigners in 34,349

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The transformation of medical research in Mexico

documents—62% of the studied registers. For the analysis, authors were not distinguished by
nationality to represent the population effectively active during the years studied.

To assess the landscape of medical research in Mexico, we resorted to semiautomated
textual analysis, a technique used to identify thematic domains in scientific publications
(Barbier, Bompart et al., 2012). Using the CorText platform, we detected the 250 most repre-
sentative terms, resorting to natural language processing techniques for the semantic analysis.
Multiterms were detected with a maximal length of three words. The detection process
focused on extracting noun phrases from the fields: titles (TI), abstracts (AB), author keywords
(DE), and keywords calculated by the WoS (ID) Algorithmus.

We processed our corpus in a two-tier approach: first using classical linguistic processes to
define a set of candidate noun phrases; und zweitens, establishing the most relevant multiterms
and selecting them. To define a list of candidate terms, textual fields were processed using
part-of-speech tagging, chunking, and normalizing techniques. Later, the resulting multiterms
were gathered into stemmed classes.

To select the resulting multiterm groups, relevant terms were processed to discard those
with no special meaning, selecting them by high unithood (Frantzi, Ananiadou, & Mima,
2000). Dann, terms with high termhood (Kageura & Umino, 1996) were chosen. This was to
avoid including descriptors that, although they may be very frequent in the corpus, are not
useful in characterizing the content of the documents. Multiterms with low termhood were
identified using a similar approach to van Eck and Waltman’s (2011) and selected using a
second-order analysis as described by Bernard, Andrei et al. (2015, P. 57). Infolge, nur
the most specific multiterms were kept. Endlich, the resulting terms were manually curated,
eliminating empty and redundant descriptors and harmonizing synonyms. We performed a
co-occurrence analysis on the resulting terms.

Using a hierarchical community identification algorithm, namely the Louvain algorithm
(Blondel, Guillaume et al., 2008), clusters of terms were detected. Modularity, a parameter that
measures the density of connections in a community (Lambiotte, Delvenne, & Barahona,
2014), was set to 1.5 to detect groupings with a greater number of nodes given the level of
detail (250 Bedingungen) gebraucht. For this optimization, we used an algorithm to define a parameter
resolution value (Aynaud, 2020). Given the nondeterministic nature of this process, slight var-
iations can happen in different computations. Trotzdem, given the size of the calculated
Netzwerke, additional runs were computed and still reported a community structure consistent
with those included here. Each cluster was interpreted and contrasted with the analytical cat-
egories presented using distant reading techniques to situate relevant terms in context. Some of
the emerging labels were manually curated to better express their analytical relevance. Diese
criteria were incorporated into the interpretation of the results.

Signatures in medicine for Mexico are a problem due to the great variety and the lack of
standardization in international databases. As we have stated in this research, this is a space
in which at least two types of professionals converge. Einerseits, there are personnel
with medical training and employed in the different health institutions; andererseits,
there is a variety of scientists not trained in medicine but whose research is relevant to med-
ical discussions. Although the standardization of signatures on scientific articles has advanced
significantly, it has done so, über alles, in institutions that are an active part of the scientific
System. Im Gegensatz, the institutional affiliations of health professionals are characterized by
being highly variable, unsystematic and, in manchen Fällen, even chaotic. The designations
include multiple institutional names, different ways of simplifying the names, and even
typing errors.

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As the methodology of this research requires information on the participation in research
activity of the institutions of the Mexican health system, we have proceeded to enrich our
database with institutional information. For this purpose, we have constructed a dictionary1
including descriptors for the main institutions of the Mexican scientific-technological system
and the Mexican health system. These descriptors allow us to identify the institutions within
the addresses (C1) reported by the authors.

This has left us with 2,367 variations to describe a total of 454 institutions, both Mexican
and foreign. From this dictionary, we have generated a new variable (AD_1) detecting the
mentions of these institutions as descriptors of the articles in the database. This method has
allowed us to solve our database’s structural problem and provide more precise information to
answer our research question. Of the total number of documents (55,783) that make up the
analyzed sample, the signatures of only 5.3% (2,960 documents) could not be normalized
with this technique, extracting at least one institution from the signature.

We used community-detection algorithms to find relationships between institutions with at
least 45 documents (301) published in the studied period. This threshold allowed us to drop
institutions with very few documents, allowing us to build a better-structured and more stable
collaboration map. Following this, institutional collaboration patterns were detected. Based on
diese Ergebnisse, we looked for relationships between the detected thematic domains and the
emergent groups in institutional collaborations by plotting a nonhomogeneous network. Dann,
the evolution of semantic and institutional mappings was traced to understand the composi-
tion of these fields and its relationships over time.

4. ERGEBNISSE

4.1. Temporal Authorship Structure

To better understand how the cohorts of researchers were active in medical research in Mexico
zwischen 1993 Und 2021, we have resorted to detecting periods of stability in the authorships
of the papers included in our database. As Figure 1 zeigt an, these authorships split into five
different periods with distinctive degrees of internal coherence.

Figur 1 shows a color scale representing the degree of similarity between the authorships
registered in the studied years. The scale goes from the most similar (0, Grün) to the most
dissimilar (1, Weiß). Different shades of blue represent the points in between. Detected
periods appear on the upper right side. The same color criteria allow one to portray the
periods’ inner coherence in terms of authorship and compare them to the other resulting

1 To do so, we have extracted a list of the main institutional ascriptions from the complete addresses (C1)
available in our database. Dort, we limited our analysis to the first 15,000 most recurrent addresses. Wir
then sorted them alphabetically and proceeded with the semiautomatic construction of a dictionary of
equivalences. After detecting semantic regularities in the addresses we used a manual validation process.
In this process, we have identified and standardized the names of the main institutions—scientific and,
über alles, of the Mexican health system—detected in our database. Likewise, the dictionary has been
cleaned to reduce the possibility of duplication in the detections and to avoid false positives in the detection
of these institutions. In cases of relevant organizations of the Mexican health system, we have proceeded to
an expansion of terms detecting recurrent variations that were not part of the first list. For the institutions of
the scientific system, priority has been given to the highest level of institutional aggregation; in the case of
medical institutions, priority has been given to institutes and specialty hospitals as the unit of analysis. Im
case of national public health organizations (IMMS, ISSSTE, SSA, usw.) the different clinics and establish-
ments have been grouped under a single category.

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Figur 1. Period detection based on authorships recurrence between 1993 Und 2021.

periods. An additional color code has been included for each of them to identify detected
periods more easily.

Our analysis has allowed us to access the internal correspondence of authorships within
each period and compare the periods between them. Somit, Erste, we can assess how recurrent
authorships are inside each detected period; und zweitens, we can know how much each
detected period resembles the others. The resemblance in the yearly authorship structure is
valuable information for understanding how cohorts of researchers evolve. The activity of
authors with more than 35 documents published between 1993 Und 2021 can be divided into
five different periods. Between 1993 Und 1995 (0.98; indicated by red), authorships show a
brief and loosely connected first period. Authors active during these years tend to lessen their
participation over time.

A second one goes from 1996 Zu 1999 and shows a firm and robust structure (0.39; Gelb).
Authors active in these years, especially in 1998 Und 1999, continue to publish in the third
Zeitraum (2000–2006; 0.34; Weiß)—nevertheless, researchers active between 1996 Und 2006
notoriously lose prominence after 2007.

The fourth period (2007–2015; 0.3; Grün) has the strongest resemblance of authorships. Es
is also the longest of the detected periods, with a total length of 8 Jahre. The last one (2016–
2021; 0.4; purple) has a complex structure. Erste, many of the researchers active in past years
will not register papers in 2017 Und 2018. Zweite, it shows the emergence of a new cohort of
authorships from 2016 onward.

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Figur 1 has allowed us to map three critical breaks in the authorship structure and, somit,
in the cohorts of professionals active in Mexican medical research. In 1996, a new generation
of scientists became involved in the field. Those researchers started to leave and lessen their
participation in 2007, where authors already active in former years welcomed newcomers to
the field. Endlich, aus 2016 und weiter, a new group of scientists rapidly arose as critical players
in medical research in Mexico.

4.2. Overall Thematic Features

A semantic description of the leading research topics developed by Mexican medical
researchers between 1993 Und 2021 is available in Figure 22. The overall structural organiza-
tion of the terms co-occurrence network can be analyzed by stressing four different areas of the
resulting map. The first one, consisting of [C1] Und [C2], shows strong connections between
these two clusters. [C1] Bacillus subtilis & Escherichia coli (11,876 documents, 21%), Berichte
on research about specific pathogens (Candida albicans, Staphylococcus aureus, Escherichia
coli, usw.) and antibacterial activity. The other, [C2] cancer cells & cell proliferation (7,641 doc-
uments, 14%), deals with genetic research related to cancer investigation. It mostly provides
evidence on the biological basis that allowed the identification of cancer cells in different
expressions.

On the upper side of the network, we find [C3] male Wistar rats & Gehirnregionen (8,308
documents, 15%). This cluster grasps a research line oriented to the experimental investiga-
tions done using laboratory rats ( Wistar rats) to study the brain and neurodegenerative
diseases.

Opposed to [C1] Und [C2] es ist [C4] Mexican Patients & risk factors (19,492 documents,
35%). Hier, we find mostly clinical, epidemiological research and statistical analysis that
allows us to understand the characteristic of the Mexican population and the distribution of
specific pathologies (diabetes mellitus, lung cancer, mental disorders, tract infections, gastric
cancer, usw.). Reports on clinical trials and case-control studies are normally used to compare
drugs, medical procedures, devices, and other treatments. This cluster shows connections to
two other clusters: [C5] HPV infection & human papillomavirus (932 documents, 2%), a cluster
that mostly grasps research on cervical and prostate cancers and their causes; Und [C8] breast
cancer & breast cancer patients (735 documents, 1%). [C8] shows the relevance of breast
cancer research and its uniqueness, which stands apart from other research interests. Never-
theless, its strong relation to [C4] shows that the research is mostly patient-based and
epidemiological.

At the lower corner of our graph, there is [C7] T lymphocytes & dendritic cells (3,017 doc-
uments, 5%). This cluster allows for identifying research on cellular characterization concern-
ing the immune response and the immune system reaction to antigens and microorganisms. Es
is related mostly to cancer research. Endlich, a poorly connected cluster, [C6] DNA repair &
DNA damage (204 documents, 0.4%), points to the study of DNA repair pathways. The overall
structure of the network shows very differentiated research areas that seem loosely connected,
indicating an essential specialization of Medical research in Mexico. Surprisingly, none of the
main diseases reported in ENASEM in 2012 Und 2018 appear as the main areas of research in
Mexiko (INEGI, 2018).

2 An interactive version of this map is available here: https://documents.cortext.net/lib/mapexplorer/explorerjs
.html?file=https://assets.cortext.net/docs/ bdf3eeec1206b569a31f173258493397#. Cluster labels have been
curated and may differ in the interactive version of this mapping.

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Figur 2. Terms co-occurrence network describing semantic features of medical research conducted in Mexico from 1993 Zu 2021.

4.3.

Institutional Network of Authorships

Detected patterns of institutional collaboration are plotted in Figure 33. Dort, we have found
four different communities that detect how different research facilities, from Mexico and the
rest of the world, collaborate in knowledge production activities. At first look, our mapping
shows two macrogroups of institutions. The first one and most prominent in terms of docu-
ments is [AD4] IPN & UNAM (44,271 documents). This cluster is composed mainly of
Mexican HEI. The three most notable are the National Autonomous University of Mexico
(UNAM), the National Polytechnic Institute (IPN), and the Center for Advanced Research
(CINVESTAV), all federal institutions.

Most of the public universities from other States of the Republic are grouped in this cluster,
such as the National Autonomous University of Nuevo Leon (UANL), the University of
Guadalajara (UDG), and the Autonomous University of San Luis Potosí (UASLP). Private insti-
tutions are also relevant to this group, such as the Technological Institute of Monterrey (ITESM)
and the Anahuac University. Most of the National Health Institutes are part of this cluster, solch
as the National Institute of Pediatrics (ICH. N. de Pediatría), of Neurology (ICH. N. Neurología y
Neurocirugía), and of Cancer Research (ICH. N. Cancerología). National Health Institutes serve
as specialized health institutions that belong to a network of highly specialized hospitals that
provide third-level medical care in specific medical specialties. These institutions are also
devoted to scientific research and training new specialists.

3 An interactive version of this map is available here: https://documents.cortext.net/lib/mapexplorer/explorerjs
.html?file=https://assets.cortext.net/docs/a5d69ac27748b6cb27c247c4bfa7ef00. Cluster labels have been
curated and may differ in the interactive version of this mapping.

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Figur 3.

Institutional collaborations in medical research in Mexico from 1992 Zu 2021.

Other important health institutions, such as the Centro Médico Siglo XXI (part of IMSS) oder
Hospital 20 de Noviembre (part of ISSSTE) are also part of this cluster. The cluster [AD4] can
be interpreted as highly oriented towards scientific research in connection to the Mexican
scientific institutions.

Three other clusters, [AD1] Sec. Salud (Mx) & U. Oxford (Vereinigtes Königreich) (2,684 documents, 5%),
[AD2] U. Michigan (USA) & U. Maryland (USA) (3,013 documents, 5%), Und [AD3] INSP
(Mx) & H. Gral. CDMX (2,108 documents, 5%) form another macrogroup that stresses collab-
oration with international research facilities. Dort, [AD1] stands out for collaboration with
prestigious universities such as Oxford (Großbritannien), Harvard (Vereinigte Staaten), or King’s
College (Großbritannien). The most relevant Mexican institution is the Secretariat of Health
(SSA), followed by the Northwestern Center for Biological Research (CIBNOR).

In der Zwischenzeit, [AD3] shows the strong collaboration of many European universities with
researchers from the National Public Health Institute (INSP), an institute mostly related to pub-
lic health from an epidemiological perspective. The Children’s Hospital of Boston (Vereinigt
Zustände) is also a relevant institution but is mostly connected to the General Hospital of Mexico
(Hospital General de México) and other foreign institutions. The General Hospital of Mexico
falls under the administration of the Secretariat of Health and employs a wide range of spe-
cialists. The same situation can be observed in [AD2], where universities from the United
Zustände (UCSF, University of Texas, Universität von Michigan), European national research insti-
tutions (CNRS, from France; CSIC, from Spain) are strongly related, mostly among each other.

Allgemein, these three clusters—AD1, AD2, and AD3—show how strongly connected
international institutions are to each other. It seems to be the case here that these clusters show
a number of very internationalized research efforts. Many different parties take part in interna-
tional collaboration networks, where papers gain a lot of different signatures of participant

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researchers. Dort, Mexican collaboration competes with the active participation of interna-
tional researchers. The presence of clusters with such substantial participation is not an indi-
cation that no Mexican institution is participating in research efforts with these foreign research
Zentren; it is signaling that their participation is not relevant enough to be worth mapping.

4.4. Thematic and Institutional Co-Occurrences

We have established different thematic orientations within Mexican medical research and
found the most relevant collaborations between institutions. In Abbildung 4, we have put these
findings in relation to each other. By bringing these two sets of entities together, it is now pos-
sible to see two nonhomogeneous communities. The first one relates public Higher Education
Institutions in [AD4] to topical groups in [C1], [C2], [C3], [C7], Und [C6], all clusters relatively
connected that can be spotted on the right-hand side in Figure 2. These clusters, which deal
with topics related to genetics, microbiology, and experimental procedures, point towards a
set of specific infrastructure such as laboratories, Ausrüstung, and support from research staff.

Andererseits, another community is detected between the institutions from [AD2],
[AD3], Und [AD1] and the thematic clusters [C4], [C5], Und [C8] which lie on the left-hand
side of Figure 2. These clusters are mostly related to epidemiological research. From this, es ist
possible to say that research done by Mexican researchers who are not connected to HEIs
tends to lean towards these kinds of subjects.

4.5. Evolution Over Time

So far, we have shared some structural features concerning authorships, on an individual and
institutional level, and the thematic features of Mexican medical research. Results have shown
that a particular group of institutions has pushed forward specific agendas. What is still missing

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Figur 4. Network of co-occurrence of institutional and thematic clusters.

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is to understand if these thematic and thematic-institutional structures have a steady or
dynamic behavior during our studied period.

In Abbildung 5, we present the evolution of the proportional distribution of each of the thematic
clusters through the detected period based on authorships’ evolution. This analysis demon-
strates two things. Erste, it shows whether a cluster has varied in size against the other clusters
detected in our corpus. Zweite, and connected to the first, it allows us to evaluate the evolu-
tion of the relevance (volume-wise) of each of the thematic areas that describe medical
research in Mexico. The results are consistent with the structural analysis resulting from
Figur 1. The first change in the authorship structure, detected from 1996 An, relates to the
beginning of an increased relevance for [C4], related to the description of the orientation of
Mexican population towards specific diseases.

We also spotted a cohort of authors reducing their participation in research from 2007
onwards, also detecting the second wave of newcomers. This shift also has implications
regarding the thematic structure of the scientific papers and the knowledge they produce.
We not only observe a second increase of [C4]’s importance, but the cluster related to neu-
rological experimentation with laboratory rats, [C3], starts to lose relevance slightly. Das
trend is confirmed as this cluster loses more volume and finally concedes its third place in
relevance to [C2]. Dann, it seems safe to assume that a significant proportion of the authors
that have lessened their research activity during this last period relate to [C1] Und [C3], beide
topics that were more relevant at the beginning of the examination period. Auch, the group of
newcomers detected from 2016 on appears to be related to cellular [C1] and epidemiological
Forschung [C4].

Endlich, Figur 6 is a good complement of the former analysis as it allows one to understand
how institutional and thematic clusters have developed over time. Results show the growing
importance of Mexican medical research of health institutions and epidemiological research.
This points towards an acceleration in the transformations in the orientation of research done
in Mexico on medical-related issues. Given the structure of this transformation, it is safe to
assume that many of the late newcomers—from 2016 on—relate to these health institutions

Figur 5. Evolution of the proportional weight of documents corresponding to each of the thematic clusters in the detected time periods.

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Figur 6. Evolution of the proportional weight of the co-occurrences of institutional and thematic
clusters in each of the detected time periods.

and their international partners. This points to an acceleration in the transformations in the
orientation of research done in Mexico on medical-related issues.

5. DISKUSSION

This paper has shown features of medical research published between 1993 Und 2021 In
Mexiko, a nonhegemonic country in the world scientific arena. We have taken a particular
interest in authorships. They offer a way of understanding the accumulation rhythms in
research capabilities, a salient trait in science policy implemented in the country during the
last 30 Jahre. We have been able to map significant breaks in the authorship structure. Three of
them arise as critical movements, starting in 1996, 2007, Und, finally, In 2016. They all point
towards meaningful changes in who is conducting and publishing research, but they unfold in
different ways.

Following Biagioli and Galison (2003), we have interpreted these authorships as a result
of a coproduction between junior and senior researchers. In 1996, a new generation rose
suddenly, but it was not long before they started languishing. They seem to be trailblazers
of medical research in their institutions. This new generation of researchers could be stimu-
lated from the Programa de Apoyo a la Ciencia en Mexico (PACIME), the first World Bank loan
dedicated to strengthening S&T in Mexico (González-Brambila & Veloso, 2007), angesichts
that training of researchers takes around 5 Jahre. This decline draws an interesting contrast.
What we have identified as the second grand wave of newcomers erupts swiftly from 2007 An,
with many of them active and publishing before that date.

The data from authors who consolidated their relevance from 2007 on is consistent with the
profile of junior researchers advancing their careers. This coincides with the drop in federal
science and technology expenditure as a percentage of GDP, which gradually descends from
0.42 In 2000 Zu 0.32 In 2007 (CONACYT, 2010). Darüber hinaus, as this analysis has shown, Die
consolidation of this cohort goes along with a shift in the thematic profile of published
research as shown in Figure 5.

Im Gegensatz, aus 2016 und weiter, a new cohort of medical researchers rapidly gained numbers
and importance in publications with Mexican signatures. Because few authorships of these

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new researchers show activity in the early years of the studied periods, we can assume that this
is a new group of newcomers. In 2016, the number of people classified as part of the stock of
human resources in S&T increased 20.3%, in comparison to the previous year (CONACYT &
SIICYT, 2016). Darüber hinaus, the number of researchers accepted in the SNI in health sciences
erhöht 13% aus 2015 Zu 2016, Und 12.3% aus 2016 Zu 2017 (CONACYT & SIICYT,
2018A).

Interesting findings arise as we look at these changes through the lenses of the thematic and
institutional structure of Mexican medical research. Gesamt, the eight topical domains from
the studied documents—Figure 2—can be organized into two clear macrogroups, as the cor-
respondence between thematic and institutional clusters has shown in Figure 3. One group
appears strongly connected to data gathered during everyday work with patients, so we have
chosen to call it patient based. Notoriously, these sets of concerns appear firmly linked with
public institutions such as the General Hospital of Mexico and the Mexican Secretariat of
Health (SSA). Both institutions are devoted to nonspecialized health services and conducting
primarily clinical and epidemiological research in strong collaboration with a large group of
international institutions.

Research produced using more sophisticated techniques—as in genetics, microbiology,
immunology, or neurodegenerative diseases—appears strongly connected to a vast array of
HEIs and specialty hospitals. This sort of experimental research arises in strong connection
with a kind of research that we have called laboratory based. Hier, the availability of infra-
Struktur, resources, and previous experience is a crucial element. In contrast to other detected
dynamics involving international collaborations, we have found that HEIs based in Mexico
City, such as UNAM, IPN, or CINVESTAV, provide leadership to institutions in other states
of the Republic. The role of these organizations in setting and consolidating a medical
research agenda is noteworthy. These findings4, when contrasted with claims made about
the subordinated integration (Kreimer, 2006) help differentiate ways of integrating into the
international arena within the Mexican medical landscape. Because national HEIs and spe-
cialty hospitals lie at the center of their collaboration clusters, laboratory-based research
appears with a higher negotiation margin when building their research agendas than patient-
based research lines.

We have noted a growing gap between research conducted in health institutions and
scientific ones, pointing towards a historical pattern of specialization in medical research in
Mexiko. Over the years, patient-based research has steadily increased its proportional volume
compared with other research lines. As the distance between both detected branches of
research seems to be widening, it seems hard to validate the existing assumption in the inter-
national community of physicians that a greater number of research-focused doctors will help
translate research into practice (DeMaria, 2003; Wyngaarden, 1979). Darüber hinaus, this research
has stronger collaboration ties with institutions from the Global North than with Mexican ones.
Somit, these changes signal a specific profile in the rising participation of Mexican
researchers in transnational research efforts, one that leans primarily on patient information.

The diminishing importance of laboratory-based research lessens the significance of insti-
tutions that train new physicians and active members of the Mexican scientific system (d.h.,

4 Our methodological approach has prioritized a national scale. This means that larger patterns of the inter-
national collaboration structures cannot be captured. Somit, as our database is not built around a specific
drug, pathogen, or disease (Levin, Kreimer, & Jensen, 2021), we are only able to compare the importance of
international collaboration between the different detected topics.

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HEIs and specialty hospitals). Along with this change, the ability to define and deploy research
agendas on a national level by big Mexican HEIs such as UNAM and IPN seems challenged.
This rising specialization pattern comes as a critical finding to inform the management of STI
efforts, especially if those are set to tackle issues of national relevance.

6. CONCLUSIONS
This article’s main objective has been to describe and understand the structural features of
scientific communities producing knowledge in medicine and health sciences in Mexico by
looking at emergent traits of its scientific production. This paper has shed light on the relations
between publishing authors, semantic clusters, and collaboration structures. It has shown, Zu
some extent, crucial and emergent structural features that mediate knowledge production in
an increasingly relevant area as medicine in a nonhegemonic country such as Mexico.

We have detected different styles in collaboration structures. Styles that correlate to the his-
torical structure drawn by trained and active researchers and the overall thematic orientation
of research. A laboratory-based kind of research arises, performed by scientists working at HEIs
and specialty hospitals. Our data demonstrate that these scientists have longer careers and
seem to be losing prominence in medical research in Mexico. Trotzdem, they appear to have a
higher negotiation margin in their research agendas when compared to the other detected
Stil, which we have called patient-based research.

Patient-based medical science shows a contrasting portrait. Strong links with international
scientific consortia point to a limited possibility of directing research. These Mexican medical
researchers appear in our analysis as a recent and fast-growing cohort, strongly connected to
health system institutions. Dort, official strategies were put in place by the national adminis-
tration and promoted from 2013 on the development of bioethics commissions, on both
national and state levels (SSN, 2013, P. 64). They also endorsed the creation of bioethical
committees in public hospitals, establishing the necessary conditions for Mexican researchers
in health institutions to partake in global biomedicine and biomedical research efforts.

The unbalanced nature of the collaboration networks casts a shadow over the opportunities
that these research-focused specialists have for doing translational research. The influence of
institutions not primarily devoted to scientific and educational matters on a national research
landscape is an important takeaway of these results. In future research, more of this can be
learned by analyzing the diversity of collaboration and relating it to impact, using citations
as a measure of impact.

In our findings, specific international collaborations arise as a crucial dimension for understand-
ing the evolution of medical research in Mexico. Trotzdem, this seems to remain a lightly
addressed matter in national planning (SSN, 2013, 2020). Our paper brings forward important
evidence to discuss the limits that science policy and priority setting can have in a national
scenario. These results highlight the selective influence that certain international linkages can have
in national scenarios, limiting the reach of national policy to define either research topics or
Partner. This research provides evidence that can be of use to inform future policy efforts on
the subject.

In Mexico, even though researchers in medicine and health sciences have taken different
Positionen, most of them work for academic institutions (CONACYT & SIICYT, 2018B). Es ist
important to note that academic institutions do not have hospitals or provide healthcare ser-
vices, and thus there is a division between those who mainly do research and those who focus
mainly on healthcare services. Bedauerlicherweise, there is no relevant information regarding

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federal expenditure dedicated to research in medicine and health sciences. It would be of
interest to have an estimate of the average cost of each published paper over time and in each
of the detected clusters of knowledge. Auch, it would be desirable to deeply analyze the most
prevalent issues in each thematic cluster.

It remains relevant to know if other areas with an important state-led service infrastructure,
such as agriculture or energy research, have similar publication patterns for the Mexican case.
An outline and comparison of these structural features in different areas of research would
have meaningful implications for science policy and institutional research strategies.

Auch, future research can profit significantly from data triangulation with institutional data
sources, such as the one from SNI, which would help to better understand the role that
incentives for research productivity have had in steering the trends found here.

This study has focused on a set of the most relevant authors to explore the temporal struc-
ture research capabilities. These researchers, as stated above, are signers or cosigners of 62%
of the analyzed documents. Trotzdem, this approach has a couple of limitations. Erste, Die
informed lack of normalization in signatures especially affects some groups among the studied
authors. As explained, the lack of normalization seems to be more common in health institu-
tions and in Mexican organizations. Somit, this bias toward normalized authors’ names could
mean that some groups are overrepresented in our study of authorship cohorts.

Auch, as it stresses a bias towards the most productive authors, this work somehow down-
sizes the relevance of less productive authors and diminishes their role in sustaining the
scientific effort described here. Dann, a more detailed characterization of the documents
published by these less-productive authors would be extremely helpful in ascertaining their
role in the historical pattern of specialization detected here. Where is the work? What do they
Forschung? With whom do they publish? Future research can be devised to specifically address
this topic.

Our findings report these transformations mostly in a descriptive manner. Somit, there is
much to gain in future qualitative research informed by these findings. A round of interviews
with members of the identified communities can be of great help in validating and expanding
the findings on the structural evolution of medical research in Mexico.

Research of this type generates information that could be useful for policymakers to iden-
tify key elements for the design of institutional and government strategies for improving the
health of the ecosystem in Mexico. Daher, this paper contributes with key insights and
Methoden, and provides tools for informing the evolution and transformation of medical
research in Mexico.

ACKNOWLEDGMENTS

We thank Daniel Rubí and Yamil Sanchez for data collection.

BEITRÄGE DES AUTORS

Matías Federico Milia: Konzeptualisierung, Datenkuration, Formal Analysis. Untersuchung,
Methodik, Software, Visualisierung, Writing—original draft, Writing—review & Bearbeitung.
Claudia Gonzalez Brambila: Konzeptualisierung, Akquise von Fördermitteln, Methodik, Project
administration, Ressourcen, Aufsicht, Writing—review & Bearbeitung. Ángel Lee: Aufsicht,
Validierung, Writing—review & Bearbeitung, José Ignacio Ponce: Datenkuration, Untersuchung,
Ressourcen, Validierung, Writing—review & Bearbeitung.

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COMPETING INTERESTS

The authors have no competing interests.

FUNDING INFORMATION

We gratefully acknowledge the financial support of the Consejo Nacional de Ciencia y
Tecnología (A1S9013). Claudia González Brambila also acknowledges the financial support
of the Asociación Mexicana de Cultura, A.C.

DATA AVAILABILITY

Data are publicly accessible on the Open ICPSR repository (Milia et al., 2022).

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