Validation of the health literacy scale in patients with hypertension in Mexico.

INTRODUCTION: Health literacy integrates skills around health care. The measurement of health literacy is relevant for proposing improvement interventions. The European HLS-EU-Q16 scale allows to comprehensively evaluate health literacy, but its psychometric properties have not been assessed in Mexico. OBJECTIVE: To validate the HLS-EU-Q16 scale in patients with hypertension in Mexico. METHODS: A validation study of a measuring instrument was carried out. The construct was evaluated by means of factor analysis; internal consistency, using Cronbach's alpha; and test-retest reliability, using intraclass correlation coefficient (ICC). The information was collected by interviewing 349 patients with hypertension in a family medicine unit of the Mexican Institute of Social Security, from April to June 2022. RESULTS: In 23.8% of the patients, health literacy was inadequate; in 44.4%, problematic; and in 31.8%, sufficient. The scale was found to retain 12 items and two factors (HLS-EU-Q12M). Cronbach's alpha was 0.83, and ICC was 0.94. CONCLUSION: The HLS-EU-Q12M scale in Mexican Spanish is a valid instrument for assessing health literacy in adults with hypertension.

ANTECEDENTES: La alfabetización en salud integra las habilidades en torno al cuidado de la salud. La medición de la alfabetización en salud es relevante para proponer intervenciones de mejora. La escala europea HLS-EU-Q16 permite evaluar la alfabetización en salud de forma integral, pero sus propiedades psicométricas no se han evaluado en México. OBJETIVO: Validar la escala HLS-EU-Q16 en pacientes con hipertensión en México. MATERIAL Y MÉTODOS: Se realizó estudio de validación de un instrumento de medición. El constructo se evaluó mediante análisis factorial, la consistencia interna mediante alfa de Cronbach y la confiabilidad prueba-reprueba mediante coeficiente de correlación intraclase (CCI). La información fue recolectada mediante entrevistas a 349 pacientes con hipertensión en una unidad de medicina familiar del Instituto Mexicano del Seguro Social, de abril a junio de 2022. RESULTADOS: El 23.8 % de los pacientes tuvo una alfabetización en salud inadecuada; 44.4 %, problemática; y 31.8 %, suficiente. Se encontró que la escala está conformada por 12 reactivos y dos factores (HLS-EU-Q12M). El alfa de Cronbach fue de 0.83 y el CCI, de 0.94. CONCLUSIÓN: La escala HLS-EU-Q12M es un instrumento válido en español de México para evaluar la alfabetización en salud en adultos con hipertensión arterial.

Randomized evaluation of decision support interventions for atrial fibrillation: Rationale and design of the RED-AF study.

BACKGROUND: Shared decision making (SDM) improves the likelihood that patients will receive care in a manner consistent with their priorities. To facilitate SDM, decision aids (DA) are commonly used, both to prepare a patient before their clinician visit, as well as to facilitate discussion during the visit. However, the relative efficacy of patient-focused or encounter-based DAs on SDM and patient outcomes remains largely unknown. We aim to directly estimate the comparative effectiveness of two DA's on SDM observed in encounters to discuss stroke prevention strategies in patients with atrial fibrillation (AF). METHODS: The study aims to recruit 1200 adult patients with non-valvular AF who qualify for anticoagulation therapy, and their clinicians who manage stroke prevention strategies, in a 2x2 cluster randomized multi-center trial at six sites. Two DA's were developed as interactive, online, non-linear tools: a patient decision aid (PDA) to be used by patients before the encounter, and an encounter decision aid (EDA) to be used by clinicians with their patients during the encounter. Patients will be randomized to PDA or usual care; clinicians will be randomized to EDA or usual care. RESULTS: Primary outcomes are quality of SDM, patient decision making, and patient knowledge. Secondary outcomes include anticoagulation choice, adherence, and clinical events. CONCLUSION: This trial is the first randomized, head-to-head comparison of the effects of an EDA versus a PDA on SDM. Our results will help to inform future SDM interventions to improve patients' AF outcomes and experiences with stroke prevention strategies.

Development of a Smartphone App for Regional Care Coordination Among High-Risk, Low-Income Patients.

Background: Despite widespread adoption of health information technology, U.S. providers face persistent barriers to coordination of care. We sought to develop and implement a patient-centered smartphone app that facilitates care coordination when patients receive care at any hospital in a region. Materials and Methods: Partnering with patients and primary care teams at a federally qualified health center (FQHC), we developed an app that (1) used real-time location data to identify encounters at 41 regional hospitals; (2) sent notifications to users' phones, asking them to confirm hospital arrival/discharge, and; (3) sent automated messages to primary care teams about confirmed hospital encounters. App design included multiple, successive rounds of active patient participation. In a small beta test of the initial version of the app, high-risk, low-income FQHC patients ran the app on their phone for 3 months. A formative mixed methods evaluation examined the app's technical performance and user experience. Results: Twelve patients enrolled in the beta test and provided follow-up data; 11 (92%) were racial/ethnic minorities. Participants obtained emergency or inpatient care at four regional hospitals. The app had 75% sensitivity to detect events when notifications should have fired, and 90% positive predictive value (PPV) of events when notifications fired. Barriers to implementation related to the app's user interface and the performance of its location tracking algorithm. Conclusions: We partnered with patients from a traditionally underserved population to develop a new smartphone-based approach to regional care coordination. The app had moderate sensitivity and high PPV for identifying regional hospital visits.

Monocyte (THP-1) Response to Silver Nanoparticles Synthesized with Rumex hymenosepalus Root Extract.

The study, synthesis, and application of nanomaterials in medicine have grown exponentially in recent years. An example of this is the understanding of how nanomaterials activate or regulate the immune system, particularly macrophages. In this work, nanoparticles were synthesized using Rumex hymenosepalus as a reducing agent (AgRhNPs). According to thermogravimetric analysis, the metal content of nanoparticles is 55.5% by weight. The size of the particles ranges from 5-26 nm, with an average of 11 nm, and they possess an fcc crystalline structure. The presence of extract molecules on the nanomaterial was confirmed by UV-Vis and FTIR. It was found by UPLC-qTOF that the most abundant compounds in Rh extract are flavonols, flavones, isoflavones, chalcones, and anthocyanidins. The viability and apoptosis of the THP-1 cell line were evaluated for AgRhNPs, commercial nanoparticles (AgCNPs), and Rh extract. The results indicate a minimal cytotoxic and apoptotic effect at a concentration of 12.5 µg/mL for both nanoparticles and 25 µg/mL for Rh extract. The interaction of the THP-1 cell line and treatments was used to evaluate the polarization of monocyte subsets in conjunction with an evaluation of CCR2, Tie-2, and Arg-1 expression. The AgRhNPs nanoparticles and Rh extract neither exhibited cytotoxicity in the THP-1 monocyte cell line. Additionally, the treatments mentioned above exhibited anti-inflammatory effects by maintaining the classical monocyte phenotype CD14++CD16, reducing pro-inflammatory interleukin IL-6 production, and increasing IL-4 production.

Prevalence and appropriateness of in-person versus not-in-person ambulatory antibiotic prescribing in an integrated academic health system: A cohort study.

OBJECTIVES: Ambulatory antibiotic stewardship generally aims to address the appropriateness of antibiotics prescribed at in-person visits. The prevalence and appropriateness of antibiotics prescribed outside of in-person visits is poorly studied. DESIGN AND SETTING: Retrospective cohort study of all ambulatory antibiotic prescribing in an integrated health delivery system in the United States. PARTICIPANTS: Antibiotic prescribers and patients receiving oral antibiotic prescriptions between January 2016 and December 2019. MAIN OUTCOME MEASURES: Proportion of antibiotics prescribed with in-person visits or not-in-person encounters (e.g., telephone, refills). Proportion of prescriptions in in 5 mutually exclusive appropriateness groups: 1) chronic antibiotic use; 2) antibiotic-appropriate; 3) potentially antibiotic-appropriate; 4) non-antibiotic-appropriate; and 5) not associated with a diagnosis. RESULTS: Over the 4-year study period, there were 714,057 antibiotic prescriptions ordered for 348,739 unique patients by 2,391 clinicians in 467 clinics. Patients had a mean age of 41 years old, were 61% female, and 78% White. Clinicians were 58% women; 78% physicians; and were 42% primary care, 39% medical specialists, and 12% surgical specialists. Overall, 81% of antibiotics were prescribed with in-person visits and 19% without in-person visits. The most common not-in-person encounter types were telephone (10%), orders only (5%), and refill encounters (3%). Of all antibiotic prescriptions, 16% were for chronic use, 15% were antibiotic-appropriate, 39% were potentially antibiotic-appropriate, 22% were non-antibiotic-appropriate, and 8% were not associated with a diagnosis. Antibiotics prescribed in not-in-person encounters were more likely to be chronic (20% versus 15%); less likely to be associated with appropriate or potentially appropriate diagnoses (30% versus 59%) or non-antibiotic-appropriate diagnoses (8% versus 25%); and more likely to be associated with no diagnosis (42% versus <1%). CONCLUSIONS: Ambulatory stewardship interventions that focus only on in-person visits may miss a large proportion of antibiotic prescribing, inappropriate prescribing, and antibiotics prescribed in the absence of any diagnosis.

Development of Complementary Encounter and Patient Decision Aids for Shared Decision Making about Stroke Prevention in Atrial Fibrillation.

Introduction: Decision aids (DAs) are helpful instruments used to support shared decision making (SDM). Patients with atrial fibrillation (AF) face complex decisions regarding stroke prevention strategies. While a few DAs have been made for AF stroke prevention, an encounter DA (EDA) and patient DA (PDA) have not been created to be used in conjunction with each other before. Design: Using iterative user-centered design, we developed 2 DAs for anticoagulation choice and stroke prevention in AF. Prototypes were created, and we elicited feedback from patients and experts via observations of encounters, usability testing, and semistructured interviews. Results: User testing was done with 33 experts (in AF and SDM) and 51 patients from 6 institutions. The EDA and PDA underwent 1 and 4 major iterations, respectively. Major differences between the DAs included AF pathophysiology and a preparation to meet with the clinician in the PDA as well as different language throughout. Content areas included personalized stroke risk, differences between anticoagulants, and risks of bleeding. Based on user feedback, developers 1) addressed feelings of isolation with AF, 2) improved navigation options, 3) modified content and flow for users new to AF and those experienced with AF, 4) updated stroke risk pictographs, and 5) added structure to the preparation for decision making in the PDA. Limitations: These DAs focus only on anticoagulation for stroke prevention and are online, which may limit participation for those less comfortable with technology. Conclusions: Designing complementary DAs for use in tandem or separately is a new method to support SDM between patients and clinicians. Extensive user testing is essential to creating high-quality tools that best meet the needs of those using them. Highlights: First-time complementary encounter and patient decision aids have been designed to work together or separately.User feedback led to greater structure and different experiences for patients naïve or experienced with anticoagulants in patient decision aids.Online tools allow for easier dissemination, use in telehealth visits, and updating as new evidence comes out.

Zingiber officinale-Derived Extracellular Vesicles Attenuate Bleomycin-Induced Pulmonary Fibrosis Trough Antioxidant, Anti-Inflammatory and Protease Activity in a Mouse Model.

Idiopathic pulmonary fibrosis (IPF) is the most frequent and severe idiopathic interstitial pneumonia. It is a chronic and progressive disease with a poor prognosis and is a major cause of morbidity and mortality. This disease has no cure; therefore, there is a clinical need to search for alternative treatments with greater efficacy. In this study, we aimed to evaluate the effect of extracellular vesicles (EVs) from Zingiber officinale (EVZO) in a murine model of bleomycin (BLM)-induced IPF administered through an osmotic minipump. EVZO had an average size of 373 nm and a spherical morphology, as identified by scanning electron microscopy. Label-free proteomic analysis of EVZOs was performed by liquid chromatography coupled to mass spectrometry, and 20 proteins were identified. In addition, we demonstrated the protease activity of EVZO by gelatin-degrading zymography assay and the superoxide dismutase (SOD) activity of EVZO by an enzymatic assay. In the BLM-induced IPF mouse model, nasal administration of 50 µg of EVZO induced recovery of alveolar space size and decreased cellular infiltrate, collagen deposition, and expression of α-SMA-positive cells. Additionally, EVZO inhibited inflammatory markers such as iNOS and COX-2, lipid peroxidation, and apoptotic cells. These results show that EVZO may represent a novel natural delivery mechanism to treat IPF.

Evolution and some functions of the NprR-NprRB quorum-sensing system in the Bacillus cereus group.

Quorum-sensing (QS) is a bacterial mechanism for regulation of gene expression in response to cell density. In Gram-positive bacteria, oligopeptides are the signaling molecules to elicit QS. The RNPP protein family (Rap, NprR, PlcR, and PrgX) are intracellular QS receptors that bind directly to their specific signaling peptide for regulating the transcription of several genes. NprR is the activator of a neutral protease in Bacillus subtilis, and it has been recently related to sporulation, cry genes transcription and extracellular protease activity in strains from the B. cereus group. In the B. thuringiensis genome, downstream nprR, a gene encoding a putative QS signaling propeptide (nprRB) was found. We hypothesized that the nprR and nprRB co-evolved because of their coordinated function in the B. cereus group. A phylogenetic tree of nucleotide sequences of nprR revealed six pherotypes, each corresponding to one putative mature NprRB sequence. The nprR tree does not match the current taxonomic grouping of the B. cereus group or the phylogenetic arrangement obtained when using MLST markers from the same strains. SKPDI and other synthetic peptides encoded in the nprRB gene from B. thuringiensis serovar thuringiensis strain 8741 had effect on temporal regulation of sporulation and expression of a cry1Aa'Z transcriptional fusion, but those peptides that stimulated earlier detection of spores decreased cry1Aa expression suggesting that NprR may either activate or repress the transcription of different genes.

Schoolchildren's tooth brushing characteristics and oral hygiene habits assessed with video-recorded sessions at school and a questionnaire.

Tooth brushing habits become established during the first years of childhood and last throughout lifetime. To assess tooth-brushing characteristics, the procedure was videotaped at school and a questionnaire on oral hygiene knowledge, attitudes and practices was completed. A total 146 5- to 8-year-old low-SES schoolchildren from Bogotá participated. The median total tooth brushing time was 115 sec (75% Q3-178 sec; 25% Q1-83 sec). The median time the toothbrush was in the child's mouth was 89 sec (75% Q3-145 sec; 25% Q1-65 sec). Most children brushed their maxillary (97%), mandibular (95%), anterior (96%) and posterior (81%) teeth. The surfaces most often brushed were the buccal-anterior-maxillary (96%) and mandibular (94%) surfaces. The amount of toothpaste dispensed was 2/3 of toothbrush head in 51% of children. Most children spat (93%), used the mirror (78%), and rinsed their mouth (72%). The majority (97%) was confident that the toothbrushing session was effective. The questionnaire revealed the following: none of the children brush their teeth at school; only 34% is supervised by an adult during the tooth brushing procedure, and only 30% brush twice a day. The study shows overall positive findings of tooth brushing while being observed, in terms of time and use of toothpaste. These results, together with the poor oral-health status and toothbrushing habits reported at home, highly recommend incorporating daily-supervised school-based tooth brushing sessions with fluoride toothpaste.

"It closes the gap when the ball is dropped": patient perspectives of a novel smartphone app for regional care coordination after hospital encounters.

Background: Despite the broad adoption of electronic health records (EHRs) for inpatient and outpatient care, and wide availability of EHR-linked portals, these tools are not always effective in informing primary care teams about patients' emergency department (ED) visits or inpatient admissions, leading to persistent gaps in care coordination. The objective of this study was to understand how patients with limited patient portal use in a safety net setting engaged with a smartphone app that used location tracking to detect and notify care teams about patients' hospital use in order to stimulate care coordination and follow-up care. Methods: We recruited English- and Spanish-speaking adults at high risk of hospital use from a Federally Qualified Health Center (FQHC). The app detected when patients visited the hospital and asked them to confirm a hospital visit. When confirmed, the app notified the primary care team about the visit, and the care team followed up with patients according to the FQHC protocols for care coordination. We collected qualitative data on app experience from participants who used the app for four months and used a general inductive approach to identify recurring themes. Results: Participants generally reported a positive app experience, as it helped solve the problem of poor follow-up care. "I liked the goal of the app…Ultimate goal of it was comforting", recounted one participant when describing her app experience. Participants thought the app push notifications could be refined and the app itself could be modernized. Participants also suggested improvements to the push notifications they received from the app and the visit information they entered into the app for care teams to receive. Some participants also suggested improvements to the FQHC's care coordination workflows facilitated by the app, like an immediate connection to the patient's primary care team. Conclusions: The app was well received by low-income patients at high risk of ED/inpatient visits. Future research is needed to determine feasibility of implementation in other settings.

Addressing Medical and Social Needs to Reduce Unnecessary Health Care Utilization and Costs: A Qualitative Study.

This study explored the goals, and care delivery approaches, of 14 interventions to address patients' medical and social needs. In qualitative interviews with clinicians and researchers, several themes emerged. Participants frequently described their overall goal as meeting patients' diverse needs to prevent avoidable acute care utilization. Medical needs were addressed by ensuring patients received primary care and actively coordinating care across clinical settings. Participants perceived social needs as tightly linked with medical needs, as well as a need for interpersonal skills among intervention staff. Descriptions of overall approaches to meeting patients' needs frequently aligned with principles of trauma-informed care and patient-centered care.

Look-Back and Look-Forward Durations and the Apparent Appropriateness of Ambulatory Antibiotic Prescribing.

Ambulatory antibiotic stewards, researchers, and performance measurement programs choose different durations to associate diagnoses with antibiotic prescriptions. We assessed how the apparent appropriateness of antibiotic prescribing changes when using different look-back and look-forward periods. Examining durations of 0 days (same-day), -3 days, -7 days, -30 days, ±3 days, ±7 days, and ±30 days, we classified all ambulatory antibiotic prescriptions in the electronic health record of an integrated health care system from 2016 to 2019 (714,057 prescriptions to 348,739 patients by 2391 clinicians) as chronic, appropriate, potentially appropriate, inappropriate, or not associated with any diagnosis. Overall, 16% percent of all prescriptions were classified as chronic infection related. Using only same-day diagnoses, appropriate, potentially appropriate, inappropriate, and not-associated antibiotics, accounted for 14%, 36%, 22%, and 11% of prescriptions, respectively. As the duration of association increased, the proportion of appropriate antibiotics stayed the same (range, 14% to 18%), potentially appropriate antibiotics increased (e.g., 43% for -30 days), inappropriate stayed the same (range, 22% to 24%), and not-associated antibiotics decreased (e.g., 2% for -30 days). Using the longest look-back-and-forward duration (±30 days), appropriate, potentially appropriate, inappropriate, and not-associated antibiotics, accounted for 18%, 44%, 20%, and 2% of prescriptions, respectively. Ambulatory programs and studies focused on appropriate or inappropriate antibiotic prescribing can reasonably use a short duration of association between an antibiotic prescription and diagnosis codes. Programs and studies focused on potentially appropriate antibiotic prescribing might consider examining longer durations.

A new hypothesis for the importance of seed dispersal in time.

Most studies on seed dispersal in time have focused on seed dormancy and the physiological triggers for germination. However, seed dispersed by animals with low metabolic and moving rates, and long gut-passage times such as terrestrial turtles, could be considered another type of dispersal in time. This study tests the hypothesis that seeds dispersed in time may lower predation rates. We predicted that seeds deposited below parent trees after fruiting fall has finished is advantageous to minimize seed predators and should show higher survival rates. Four Amazonian plant species, Dicranostyles ampla, Oenocarpus bataua, Guatteria atabapensis and Ocotea floribunda, were tested for seed survival probabilities in two periods: during fruiting and 10-21 days after fruiting. Experiments were carried out in two biological stations located in the Colombian Amazon (Caparú and Zafire Biological Stations). Seed predation was high and mainly caused by non-vertebrates. Out of the four plant species tested, only Guatteria atabapensis supported the time escape hypothesis. For this species, seed predation by vertebrates after the fruiting period increased (from 4.1% to 9.2%) while seed predation by non-vertebrates decreased (from 54.0% to 40.2%). In contrast, seed predation by vertebrates and by non-vertebrates after the fruiting period in D. ampla increased (from 7.9% to 22.8% and from 40.4% to 50.6%, respectively), suggesting predator satiation. Results suggest that for some species dispersal in time could be advantageous to avoid some type of seed predators. Escape in time could be an additional dimension in which seeds may reach adequate sites for recruitment. Thus, future studies should be address to better understand the survival advantages given by an endozoochory time-dispersal process.

Analysis of the experience of the geriatric fracture program in two institutions in Colombia: a reproducible model?

Background: hip fracture is the major cause of morbidity and mortality. Geriatric fracture programs promise to improve the quality of care, health outcomes and reduce costs. Objective: To describe the results related to the Geriatric fracture programs implementation in two Colombian institutions to assess reproducibility. Methods: We performed A retrospective descriptive study of the patients treated under the Geriatric fracture programs in two institutions in Colombia. The information was collected from the initial year of implementation until 2018. Demographic characteristics, length of stay, hospitalization complications, readmissions and mortality were described. Consumption of healthcare resources was defined using base cases determined with local experts and costs were estimated using standard methods. Results: 475 patients were included in the Geriatric fracture programs. We observed an increase in the number of patients. The length of stay decreased between 8.5% and 26.1% as did the proportion of total complications, with delirium having the greatest reduction. A similar situation was seen for first year mortality (from 10.9% to 4.7%), in-hospital deaths and readmissions. Estimates of costs of stay and complications showed reductions in all scenarios, varying between 22% and 68.3%. Conclusions: The present study presents the experience of two institutions that implemented the Geriatric fracture programs with increase in the number of patients treated and reductions in the time of hospital stay, the proportion of complications, readmissions, mortality and estimated costs. These are similar between both institutions and with other published implementations. This could hint that geriatric fracture program may be implemented with reproducible results.

Antecedentes: las fracturas de cadera son una causa importante de morbilidad y mortalidad. Los programas de fracturas geriátricas prometen mejorar la calidad de la atención, los desenlaces clínicos y reducir costos. Objetivos: Describir los resultados relacionados con la implementación de un programa de fracturas geriátricas en dos instituciones en Colombia para evaluar la reproducibilidad. Métodos: Realizamos un estudio retrospectivo descriptivo de los pacientes atendidos en el programa de fracturas geriátricas en dos instituciones en Colombia. Se obtuvo información desde el año de implementación hasta 2018. Se describió información demográfica, de estancia hospitalaria, de complicaciones, de rehospitalizaciones y de mortalidad. Se determinó un caso base de consumo de recursos con expertos y se costeó usando métodos estandarizados. Resultados: Se incluyeron 475 pacientes. Se observó un aumento en la cantidad de pacientes. La duración de estancia disminuyó entre 8.5% y 26.1%, así como la frecuencia de complicaciones. Se encontraron reducciones en mortalidad en el primer año (entre 10.9% y 4.7%), muertes hospitalarias y rehospitalizaciones. Los costos estimados mostraron reducciones entre 22% y 68.3%. Conclusiones: El presente estudio muestra la experiencia de implementación de programa de fracturas geriátricas en dos instituciones en Colombia, mostrando aumento en cantidades de pacientes y reducciones en estancia hospitalaria, frecuencia de complicaciones, rehospitalizaciones, mortalidad y costos estimados. Los resultados fueron similares en las dos instituciones y comparables con otros descritos en literatura. Esto sugiero que los programas de fracturas geriátricas se pueden implementar con resultados reproducibles.

Effectiveness of interventions for the reversal of a metabolic syndrome diagnosis: An update of a meta-analysis of mixed treatment comparison studies / Efectividad de las intervenciones para revertir el diagnóstico del síndrome metabólico: actualización de un metaanálisis de comparación mixta de tratamientos

Introduction: Identifying the most effective interventions to reverse the metabolic syndrome can be key in the design of clinical strategies to prevent progression to type 2 diabetes mellitus and cardiovascular disease. Objective: To estimate the effect size of the interventions used for the reversal of metabolic syndrome. Materials and methods: We searched in Embase and Medline databases for randomized clinical trials with an outcome defined as the reversal of the metabolic syndrome diagnosis. We classified the interventions in four dimensions: 1) lifestyle (diet and exercise); 2) pharmaceuticals; 3) a combination of both, and 4) control groups, and we conducted a mixed treatment comparison analysis. Results: Additional to the previous meta-analysis published by Dunkley, et al. in 2012, we dentified two other studies. Lifestyle interventions had 2.61 more chances to achieve the reversal of the metabolic syndrome than the control group, with a credible interval between 1.00 and 5.47. Pharmaceutical treatments showed a 3.39 higher chance of reversing the syndrome compared with the control group, but the credible interval was estimated from 0.81 to 9.99. Lifestyle interventions had 1.59 more chance of reversal than the pharmaceutical treatments. Conclusion: Diet and physical activity-based interventions had a higher probability of effectiveness to reverse a metabolic syndrome diagnosis.

Introducción. El conocer las intervenciones más efectivas para revertir el síndrome metabólico es clave para el diseño de estrategias clínicas de prevención de enfermedades como la diabetes mellitus de tipo 2 y la enfermedad cardiovascular. Objetivo. Sintetizar el tamaño del efecto de las intervenciones disponibles para revertir un diagnóstico de síndrome metabólico. Materiales y métodos. Se hizo la búsqueda en Embase y Medline, incluyendo los ensayos clínicos en los que la variable "respuesta" se definía como la reversión del diagnóstico del síndrome metabólico. Se categorizaron las intervenciones en cuatro dimensiones: 1) estilo de vida (dieta y ejercicio); 2) farmacia; 3) combinación de estilo de vida y farmacia, y 4) grupos de control; finalmente, se hizo una comparación mixta de tratamientos. Resultados. Se detectaron dos estudios adicionales a los incluidos en el metaanálisis publicado por Dunkley, et al., en el 2012. Se estimó que las intervenciones relacionadas con el estilo de vida tuvieron 2,61 veces (intervalo de credibilidad entre 1,00 y 5,47) más probabilidades de revertir el síndrome metabólico que las de los grupos de control y las relacionadas con los tratamientos farmacéuticos, una probabilidad de 3,39 veces más que las del grupo de control, pero con un intervalo de credibilidad entre 0,81 y 9,99. Las intervenciones sobre el estilo de vida tuvieron 1,59 veces más probabilidades de revertir el síndrome metabólico que las del tratamiento farmacéutico. Conclusión. Las estrategias basadas en la dieta y la actividad física de las personas, tuvieron una mayor probabilidad de ser más efectivas para revertir el diagnóstico de síndrome metabólico.

A theoretical and experimental approach to evaluate zein-calcium interaction in nixtamalization process.

The possible interactions between α-zein and Ca2+ in nixtamalization process were analyzed from a multidisciplinary approach, considering the effect of these interactions on the thermal properties of the nixtamalized flour. SDS-PAGE under reducing and non-reducing conditions did not reveal differences between patterns of zeins from nixtamalized and control samples. However, analysis from affinity capillary electrophoresis indicated an increment in protein volume when calcium is added to zein extracted from nixtamalized flour. In addition, the binding constant for the zein-calcium interaction was calculated indicating a higher affinity for calcium by zein from nixtamalized samples. Molecular dynamics simulations indicated that the interaction α-zein-Ca2+ through C-ter was more favorable than Glu48. However, in excess of Ca2+ ions, each site could bind one calcium atom at the same time, confirming that aggregation of α-zein through calcium bridges is possible, expanding the technological applications of this protein.

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.

Validación de la escala de alfabetización en salud en pacientes con hipertensión arterial en México / Validation of the health literacy scale in patients with hypertension in Mexico

Resumen Antecedentes: La alfabetización en salud integra las habilidades en torno al cuidado de salud. La medición de la alfabetización en salud es relevante para proponer intervenciones de mejora. La escala europea HLS-EU-Q16 permite evaluar la alfabetización en salud de forma integral, pero sus propiedades psicométricas no se han evaluado en México. Objetivo: Validar la escala HLS-EU-Q16 en pacientes con hipertensión en México. Material y métodos: Se realizó estudio de validación de un instrumento de medición. El constructo se evaluó mediante análisis factorial, la consistencia interna mediante alfa de Cronbach y la confiabilidad prueba-reprueba mediante coeficiente de correlación intraclase (CCI). La información fue recolectada mediante las entrevistas a 349 pacientes con hipertensión en una unidad de medicina familiar del Instituto Mexicano del Seguro Social, de abril a junio de 2022. Resultados: El 23.8 % de los pacientes tuvo una alfabetización en salud inadecuada; 44.4 %, problemática; y 31.8 %, suficiente. Se encontró que la escala está conformada por 12 reactivos y dos factores (HLS-EU-Q12M). El alfa de Cronbach fue de 0.83 y el CCI, de 0.94. Conclusión: La escala HLS-EU-Q12M es un instrumento válido en español de México para evaluar la alfabetización en salud en adultos con hipertensión arterial.

Abstract Background: Health literacy integrates skills around health care. The measurement of health literacy is relevant for proposing improvement interventions. The European HLS-EU-Q16 scale allows to comprehensively evaluate health literacy, but its psychometric properties have not been assessed in Mexico. Objective: To validate the HLS-EU-Q16 scale in patients with hypertension in Mexico. Material and methods: A validation study of a measuring instrument was carried out. The construct was evaluated by means of factor analysis; internal consistency, using Cronbach's alpha; and test-retest reliability, using intraclass correlation coefficient (ICC). The information was collected by interviewing 349 patients with hypertension in a family medicine unit of the Mexican Institute of Social Security, from April to June 2022. Results: In 23.8% of the patients, health literacy was inadequate; in 44.4%, problematic; and in 31.8%, sufficient. The scale was found to retain 12 items and two factors (HLS-EU-Q12M). Cronbach's alpha was 0.83, and ICC was 0.94. Conclusion: The HLS-EU-Q12M scale in Mexican Spanish is a valid instrument for assessing health literacy in adults with hypertension.

Analysis of the experience of the geriatric fracture program in two institutions in Colombia: a reproducible model? / Análisis de la experiencia del programa de fracturas geriátricas en dos instituciones en Colombia: ¿un modelo reproducible?

Abstract Background: hip fracture is the major cause of morbidity and mortality. Geriatric fracture programs promise to improve the quality of care, health outcomes and reduce costs. Objective: To describe the results related to the Geriatric fracture programs implementation in two Colombian institutions to assess reproducibility. Methods: We performed A retrospective descriptive study of the patients treated under the Geriatric fracture programs in two institutions in Colombia. The information was collected from the initial year of implementation until 2018. Demographic characteristics, length of stay, hospitalization complications, readmissions and mortality were described. Consumption of healthcare resources was defined using base cases determined with local experts and costs were estimated using standard methods. Results: 475 patients were included in the Geriatric fracture programs. We observed an increase in the number of patients. The length of stay decreased between 8.5% and 26.1% as did the proportion of total complications, with delirium having the greatest reduction. A similar situation was seen for first year mortality (from 10.9% to 4.7%), in-hospital deaths and readmissions. Estimates of costs of stay and complications showed reductions in all scenarios, varying between 22% and 68.3%. Conclusions: The present study presents the experience of two institutions that implemented the Geriatric fracture programs with increase in the number of patients treated and reductions in the time of hospital stay, the proportion of complications, readmissions, mortality and estimated costs. These are similar between both institutions and with other published implementations. This could hint that geriatric fracture program may be implemented with reproducible results.

Resumen Antecedentes: las fracturas de cadera son una causa importante de morbilidad y mortalidad. Los programas de fracturas geriátricas prometen mejorar la calidad de la atención, los desenlaces clínicos y reducir costos, Objetivos: Describir los resultados relacionados con la implementación de un programa de fracturas geriátricas en dos instituciones en Colombia para evaluar la reproducibilidad Métodos: Realizamos un estudio retrospectivo descriptivo de los pacientes atendidos en el programa de fracturas geriátricas en dos instituciones en Colombia. Se obtuvo información desde el año de implementación hasta 2018. Se describió información demográfica, de estancia hospitalaria, de complicaciones, de rehospitalizaciones y de mortalidad. Se determinó un caso base de consumo de recursos con expertos y se costeó usando métodos estandarizados. Resultados: Se incluyeron 475 pacientes. Se observó un aumento en la cantidad de pacientes. La duración de estancia disminuyó entre 8.5% y 26.1%, así como la frecuencia de complicaciones. Se encontraron reducciones en mortalidad en el primer año (entre 10.9% y 4.7%), muertes hospitalarias y rehospitalizaciones. Los costos estimados mostraron reducciones entre 22% y 68.3%. Conclusiones: El presente estudio muestra la experiencia de implementación de programa de fracturas geriátricas en dos instituciones en Colombia, mostrando aumento en cantidades de pacientes y reducciones en estancia hospitalaria, frecuencia de complicaciones, rehospitalizaciones, mortalidad y costos estimados. Los resultados fueron similares en las dos instituciones y comparables con otros descritos en literatura. Esto sugiero que los programas de fracturas geriátricas se pueden implementar con resultados reproducibles.

[Identifying different susceptibility loci associated with early onset diabetes and cardiovascular disease in Mexican families]. / Identificación de distintos loci de susceptibilidad relacionados al desarrollo de diabetes de inicio temprano y enfermedad cardiovascular en familias mexicanas.

Coronary artery disease and diabetes mellitus are among the primary mortality and morbidity causes in Mexico. Genetic factors play a fundamental role in the development of these entities. In the past few years due to the recognition and study of families with monogenic forms of diabetes and dislipidemias associated with development of atherosclerosis, several genes and loci have been associated with these conditions through genetic linkage studies. These studies have provided evidence of the genetic heterogeneity that exists and the type of genes involved in different ethnic groups. The study of Mexican families with early-onset diabetes and combined familial hyperlipidemia showed the participation of different genetic loci associated with these conditions in the Mexican population. These findings show the value of gene mapping strategies in the identification of the genetic component in these entities in our population.