The challenge of sustainability: Long-term results from the Fifty-Fifty peer group-based intervention in cardiovascular risk factors.

BACKGROUND: The Fifty-Fifty trial demonstrated that a peer-group-based intervention was able to improve healthy behaviors in individuals with cardiovascular (CV) risk factors immediately post-intervention. OBJECTIVES: To determine the long-term sustainability of a one-year peer-group-based intervention focused on CV health and behavior. METHODS: A total of 543 adults aged 25 to 50 years with at least 1 CV risk factor were screened and recruited, received initial training through workshops, and were then randomized 1:1 to a peer-group-based intervention group (IG) or a self-management control group (CG) for 12 months. At a median of 52 months from baseline, 321 participants were re-assessed (~60% retention). The primary outcome was the mean change in a composite health score related to blood pressure, exercise, weight, alimentation, and tobacco use (Fuster-BEWAT score [FBS], range 0-15). Intervention effects were assessed using linear-mixed effects models. RESULTS: The mean age of retained participants was 48.0 years (SD: 5.4), and 73% were female. Consistent with previous results, the change of overall FBS was significantly greater in the IG than in the CG at 12-month follow-up (between-group difference, 0.60 points; 95% CI, 0.08-1.12; P = .025). Assessment of long-term sustainability (52-month follow-up) showed that there were no between-group differences in the mean overall FBS (IG mean score, 8.52; 95% CI, 7.97-9.07 vs CG mean score, 8.51; 95% CI, 7.93-9.10; P = .972) or in the change of overall FBS from screening (IG mean change, 0.64; 95% CI, 0.00-1.28; CG mean change, 0.46; 95% CI, -0.20-1.12; P = .497). CONCLUSIONS: A one-year peer-group-based intervention showed favorable results at immediate post-intervention but did not demonstrate significant differences between the IG and CG at 52 months. Combination of an initial training period (workshops) with the maintenance of peer-support groups or other re-intervention strategies may be required to achieve sustained effects on healthy behaviors. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02367963. Registered (https://clinicaltrials.gov/show/NCT02367963).

Adequacy of usual macronutrient intake and macronutrient distribution in children and adolescents in Spain: A National Dietary Survey on the Child and Adolescent Population, ENALIA 2013-2014.

OBJECTIVES: To describe the nutritional profile and assess the National Dietary Survey on the Child and Adolescent Population project in Spain (ENALIA) regarding usual total energy and macronutrient intake. METHODS: A cross-sectional nationally representative sample of 1862 children and adolescents (age 6 months to 17) was surveyed between 2013 and 2014 following European methodology recommendations. Dietary information was collected using two methods, dietary records (for children from age 6 months to 9 years) and 24-h dietary recall (participants age 10 and older). Usual intake was estimated by correcting for within-person intake variance using the Iowa State University (ISU) method. A probability analysis was used to assess compliance with dietary reference intakes in the target population. RESULTS: Protein consumption in the age 1-3 group as a percentage of total energy exceeded the upper limit of the Acceptable Macronutrient Distribution Range (AMDR) by 4.7% for boys and 12.1% for girls. 42.9% of girls age 4-8 were under the lower limit of the AMDR for carbohydrates. 43.4% of boys and 46.9% of girls between 4 and 17 exceeded the AMDR in total fat intake, saturated fatty acids (SFAs) accounting for 12.3% of total energy. CONCLUSIONS: The results suggest that Spanish children and adolescents could improve macronutrient distribution by reducing fat and increasing carbohydrate intake across all age groups, and decreasing protein intake, especially in young children.

Salt content in bread in Spain, 2014.

INTRODUCTION: excess salt intake is associated to the risk of cardiovascular diseases. Bread is one of the foods that contributes the most salt to the diet in Spain. It is important to monitor the salt content of bread. OBJECTIVE: to quantify the amount of salt in bread in Spain in 2014, and to compare it to the amount of salt in 2008. METHODS: this cross-sectional study was conducted in Spain in 2014, and 1,137 loaves of bread (three types: barra, a Spanish style, similar in shape to a baguette; baguettes and wholemeal) were purchased at bakeries with and without on-site workrooms and at supermarkets in all of Spain's autonomous communities. Salt content (g/100 g bread) was estimated by determining total sodium. In one subsample, mean salt content was estimated by determining chlorides; it was compared to previous data of 2008 salt content (chloride determination). RESULTS: the mean salt content was 2.08 g/100 g (SD: 0.32) with a minimum value of 0.30 and a maximum of 3.33. The mean salt content was similar in barraand baguette-type breads (2.09 g/100 g) and somewhat lower in wholemeal. The mean salt was 2.07 g/100 g in breads made with fresh dough and 2.12 g/100 g in breads made with frozen dough. The mean salt content (chlorides) was 1.64 g/100 g (SD: 0.42) in 2014 and 1.63 g/100 g (SD: 0.37) in 2008. This was not a significant difference (p = 0.428). CONCLUSIONS: the amount of salt in common bread in Spain remains stable from 2008.

Adequacy of Usual Vitamin and Mineral Intake in Spanish Children and Adolescents: ENALIA Study.

Background: The National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA) provides data to assess the usual micronutrient intake among Spanish infants, children, and adolescents. Methods: Cross-sectional survey (November 2012-July 2014) of a representative sample of Spanish children and adolescents (six months-17 years) (n = 1862). Dietary information was collected using two non-consecutive one-day food diaries (six months-10 years old) or two 24 h dietary recalls (11 years and older) separated by at least 14 days. Estimates were calculated using the Iowa State University method and PC-SIDE software (version 1.0, department of statistics, center for agricultural and rural development, Ames, IA, USA) to account for within- and between-person variation. Results: Usual intake of vitamin D was insufficient in practically all individuals. Vitamin E, folate, and calcium were insufficient, especially from nine years of age, and magnesium and iodine from 14 years of age. The percentage of subjects with insufficient intakes was higher among females. Sodium intake was excessive in a considerable percentage of the population, especially in males, and it increased with age. Finally, over half of children under four years of age had zinc usual intakes that exceeded the Tolerable Upper Level. Conclusion: Vitamin and mineral intake in Spain should be improved, especially in late childhood and adolescence. Nutritional intervention and educational strategies are needed to promote healthy eating habits and correct micronutrient inadequacies in Spanish children and adolescents.

A Comprehensive Lifestyle Peer Group-Based Intervention on Cardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program.

BACKGROUND: Cardiovascular diseases stem from modifiable risk factors. Peer support is a proven strategy for many chronic illnesses. Randomized trials assessing the efficacy of this strategy for global cardiovascular risk factor modification are lacking. OBJECTIVES: This study assessed the hypothesis that a peer group strategy would help improve healthy behaviors in individuals with cardiovascular risk factors. METHODS: A total of 543 adults 25 to 50 years of age with at least 1 risk factor were recruited; risk factors included hypertension (20%), overweight (82%), smoking (31%), and physical inactivity (81%). Subjects were randomized 1:1 to a peer group-based intervention group (IG) or a self-management control group (CG) for 12 months. Peer-elected leaders moderated monthly meetings involving role-play, brainstorming, and activities to address emotions, diet, and exercise. The primary outcome was mean change in a composite score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT score, 0 to 15). Multilevel models with municipality as a cluster variable were applied to assess differences between groups. RESULTS: Participants' mean age was 42 ± 6 years, 71% were female, and they had a mean baseline Fuster-BEWAT score of 8.42 ± 2.35. After 1 year, the mean scores were significantly higher in the IG (n = 277) than in the CG (n = 266) (IG mean score: 8.84; 95% confidence interval (CI): 8.37 to 9.32; CG mean score: 8.17; 95% CI: 7.55 to 8.79; p = 0.02). The increase in the overall score was significantly larger in the IG compared with the CG (difference: 0.75; 95% CI: 0.32 to 1.18; p = 0.02). The mean improvement in the individual components was uniformly greater in the IG, with a significant difference for the tobacco component. CONCLUSIONS: The peer group intervention had beneficial effects on cardiovascular risk factors, with significant improvements in the overall score and specifically on tobacco cessation. A follow-up assessment will be performed 1 year after the final assessment reported here to determine long-term sustainability of the improvements associated with peer group intervention. (Peer-Group-Based Intervention Program [Fifty-Fifty]; NCT02367963).

The ALADINO study: a national study of prevalence of overweight and obesity in Spanish children in 2011.

The aim of the study was to determine the prevalence of overweight and obesity in children in Spain using different sets of cut-off criteria, through a community-based cross-sectional study. The study was conducted in a representative sample of Spanish children between 6 and 9 years, recruited in Spanish schools, between October 2010 and May 2011. 7,569 boys and girls were selected. All were weighed and measured, and their parents were asked about their socioeconomic background, food habits and physical activity. The BMI of each was calculated, and the prevalence of overweight and obesity was determined by age and sex using Spanish reference tables (SPART), IOTF reference values, and WHO growth standards. The prevalence of overweight in boys ranged from 14.1% to 26.7%, and in girls from 13.8% to 25.7%, depending on the cut-off criteria. The prevalence of obesity in boys ranged from 11.0% to 20.9%, and in girls from 11.2% to 15.5%. The prevalence of obesity was the highest among those same children when using the SPART or WHO criteria. Overweight and obesity remain widespreading among Spanish children; a consensus on the definition of overweight and obesity cut-off criteria is necessary.

Epidermal growth factor promotes epidermal growth factor receptor nuclear accumulation by a pathway dependent on cytoskeleton integrity in human breast cancer cells.

BACKGROUND AND AIMS: The epidermal growth factor receptor (EGFR) is activated by extracellular ligands of the epidermal growth factor (EGF) family, resulting in a cascade of cytoplasmic signaling events. Emerging evidence indicates a mode of EGF signaling in which growth factor signals are transmitted via EGFR nuclear transport. The aim of this study was to determine whether EGF promotes EGFR nuclear accumulation and the role of clathrin-coated pits, EGFR kinase activity, caveolae microdomains and cytoskeleton integrity in breast cancer cells. METHODS: MCF-7 cells were treated without or with 100 ng/ml EGF for various times and nuclear extracts were obtained. Nuclear accumulation of EGFR was analyzed by SDS-PAGE followed by Western blotting of nuclear extracts using an anti-EGFR Ab or with a phosphospecific Ab against the Tyr-1068 of EGFR and with anti-Rb Ab as the loading control. DNA binding activity of EGFR was analyzed by EMSA using nuclear extracts and a radiolabeled oligonucleotide probe representing the AT-rich minimal sequence (ATRS). RESULTS: EGF induces the nuclear accumulation of EGFR, an increase in EGFR phosphorylation at Tyr-1068 and the formation of the complex EGFR-DNA in MCF-7 and MDA-MB-231 breast cancer cells. In addition, EGFR nuclear accumulation is dependent of clathrin-coated pits, EGFR kinase activity, caveolae microdomains and cytoskeleton integrity. CONCLUSIONS: This study demonstrates that in breast cancer cells EGF promotes nuclear accumulation of EGFR and is dependent on clathrin-coated pits, EGFR kinase activity, caveolae microdomains and cytoskeleton integrity.

Oleic acid induces ERK1/2 activation and AP-1 DNA binding activity through a mechanism involving Src kinase and EGFR transactivation in breast cancer cells.

GPR40 and GPR120 are G-protein-coupled receptors that can be activated by medium- and long-chain fatty acids. GPR40 is expressed in several breast cancer cell lines and its stimulation with oleic acid (OA) induces cell proliferation. However, the signal transduction pathways activated by OA have not been studied in detail. Our results demonstrate that both GPR40 and GPR120 are expressed in MCF-7 cells. Stimulation of MCF-7 and MDA-MB-231 cells with OA promoted the phosphorylation of ERK1/2 at Thr-202 and Tyr-204 and the formation of AP-1-DNA complex in a fashion dependent of Src kinase activity and EGFR transactivation. Furthermore, proliferation induced by OA is restricted to breast cancer cells in a fashion dependent of ERK1/2 activation and matrix metalloproteinases. In summary, our data indicate that proliferation induced by OA is restricted to breast cancer cells, and that ERK1/2 activation and AP-1-DNA complex formation are mediated by Src family kinases and transactivation of EGFR.

Arachidonic acid promotes FAK activation and migration in MDA-MB-231 breast cancer cells.

Arachidonic acid (AA) is a common dietary n-6 polyunsaturated fatty acid that is present in an esterified form in cell membrane phospholipids, and it might be present in the extracellular microenvironment. In particular, AA promotes MAPK activation and mediates the adhesion of MDA-MB-435 breast cancer cells to type IV collagen. However, the signal transduction pathways mediated by AA have not been studied in detail. Our results demonstrate that stimulation of MDA-MB-231 breast cancer cells with AA promotes an increase in the phoshorylation of Src and FAK, as revealed by site-specific antibodies that recognized the phosphorylation state of Src at Tyr-418, and of FAK at tyrosine-397 and in vitro kinase assays. In addition, AA also induces an increase in the migration of MDA-MB-231 cells. In contrast, AA does not induce phosphorylation of FAK and an increase in cell migration of non-tumorigenic epithelial cells MCF10A. Inhibition of Gi/Go proteins, LOX and Src activity prevent FAK activation and cell migration. In conclusion, our results demonstrate, for the first time, that Gi/Go proteins, LOX and Src play an important role in FAK activation and cell migration induced by AA in MDA-MB-231 breast cancer cells.

Src kinase regulates metalloproteinase-9 secretion induced by type IV collagen in MCF-7 human breast cancer cells.

Matrix metalloproteinases (MMPs) are a family of endopeptidases that collectively are capable to degrading all components of the extracellular matrix (ECM) and they have been implicated in several aspects of tumor progression, such as invasion through basement membrane (BM) and insterstitial matrices, angiogenesis and tumor cell growth. In particular, MMP-2 and MMP-9 have been associated with the ability of tumor cells to metastasize due to their capacity to degrade type IV collagen (Col-IV), the main component of BM, and to their elevated expression in malignant tumors. However, nothing is known about the regulation of MMP-9 secretion and expression in breast cancer cells stimulated with Col-IV. Our results demonstrate that stimulation of MCF-7 cells with Col-IV promoted the secretion of MMP-9, as revealed by gelatin zymography and Western blotting using specific antibodies that recognized MMP-9. In addition, inhibition of Src and FAK kinase activity prevented MMP-9 secretion. In contrast, MMP-9 expression was not up-regulated by treatment with Col-IV. These results demonstrate that Col-IV regulates the secretion of MMP-9 via a Src and FAK dependent pathway in MCF-7 cells.

[Priorities in health promotion according to primary care health professionals: a Delphi study]. / Prioridades en promoción de la salud según los profesionales de atención primaria: un estudio Delphi.

OBJECTIVES: To find out the opinions of primary care professionals on prevention activities in clinical practice, as well as the perceived obstacles to carrying them out and ways of overcoming them. PARTICIPANTS: A total of 129 professionals participated, including primary care doctors, nurses, technicians, primary care service managers, and public health professionals. DESIGN: Delphi questionnaire sent by e-mail. SETTING: Primary care in Catalonia, Spain. MAIN MEASUREMENTS AND RESULTS: Two rounds were made with response rates of 48.9% and 67.4%, respectively. Convergence of over 40% was obtained in all the questions after the second round. The main problems for prevention in clinical practice were lack of time, lack of training and the attitudes of the professionals themselves towards prevention. To improve implementing prevention in the practice, the professionals pointed out, training in communication skills, advice methodology and the use of clinical practice guidelines. CONCLUSIONS: Health professionals pointed out some specific needs in training which could help to improve the inclusion of prevention activities. On the other hand, it was noted that the attitudes of the professionals themselves towards prevention need to be improved.

Type IV collagen induces STAT5 activation in MCF7 human breast cancer cells.

A rapid increase in the tyrosine phosphorylation of signal transducer and activators of transcription (STAT) proteins has been extensively documented in cells stimulated with cytokines and growth factors, but virtually nothing is known about the regulation of STAT5 activation in breast cancer cells stimulated with basement membrane (BM) components. Stimulation of MCF7 cells with type IV collagen (Col-IV) promoted a striking increase in the phosphorylation of STAT5 at Tyr-694, as revealed by site-specific antibodies that recognized the phosphorylated state of this residue. In addition, Col-IV also stimulated STAT5 nuclear translocation and an increased in STAT5 DNA binding activity. Treatment with the selective Src family inhibitor pyrazolopyrimidine PP-2 prevented STAT5 phosphorylation at Tyr-694, nuclear translocation of STAT5 and the STAT5-DNA complex formation. Our results demonstrate, for the first time, that stimulation with Col-IV induces STAT5 phosphorylation of endogenous STAT5 at Tyr-694, nuclear translocation of STAT5 and increases in STAT5 DNA binding activity via a Src-dependent pathway in MCF7 cells.

Entamoeba histolytica: focal adhesion kinase and Erk phosphorylation are altered in the cytoskeleton mutant BG-3.

The Entamoeba histolytica mutant BG-3 has several altered cytoskeletal properties, including the distribution of actin and certain surface characteristics such as osmolarity and electrophoretic mobility. By Western blot analysis and assays for cell adhesion to collagen, we demonstrate that mutant BG-3 shows an increase in the phosphorylation levels of protein kinases that participate in proliferation, adhesion and migration, such as focal adhesion kinase and MAP kinase (Erk2), and that it has also altered its capacity of binding to collagen type I. These results indicate that E. histolytica cytoskeleton integrity plays an important role in adhesion and thus invasion of the host.

Memoria e historia / Memory and hiitory / Memory and history / Memoria e hiitoria

O conteúdo deste artigo resume a exposição da autora do I Colóquio Latino-Americano de História da Enfermagem, realizado no Rio de Janeiro, em agosto de 2000 e a convite da Escola de Enfemagem Anna Nery. Nele se resumem os conceitos de História e Memória e se faz uma reflexão sobre o que, na sua opinião, ocorre na Espanha, em relação à História da profissão da área de Enfemagem.