Telemonitoring with TECCU of active Inflammatory Bowel Disease is Not Inferior to Standard Care: Short-term Results of a Multicentre Randomized Controlled Trial of GETECCU.

BACKGROUND: Telemonitoring is not consistently superior to standard care for inflammatory bowel disease (IBD), yet non-inferiority may be an acceptable outcome if remote care is more efficient. OBJECTIVE: To compare the remission time and quality of life of patients with an active IBD controlled by standard care or through the TECCU App (Telemonitoring of Crohn´s Disease and Ulcerative Colitis). METHODS: A 2-arm, randomized, multicentre trial with a non-inferiority design was performed at 24 Spanish hospitals on adult patients with IBD who initiated immunosuppressant or biological therapy. Patients were randomized into telemonitoring (G_TECCU) or standard care groups (G_Control). The follow-up schedule was based on telemonitoring contacts through the TECCU App in G_TECCU, and on in-person visits and telephone calls in G_Control, as in clinical practice. In both groups, treatment was adjusted according to the evolution of disease activity and medication adherence, which were measured through specific indices and biological markers at each check-up. The primary outcome was time in remission after 12-weeks, with quality of life, medication adherence, adverse events and patient satisfaction as secondary outcomes. RESULTS: Of 169 patients enrolled, 158 were randomized, and 150 were analyzed per protocol: telemonitoring (n=71); control (n=79). After 12-week, the time in clinical remission was not inferior after telemonitoring (4.20 ±3.73 weeks) to that in the controls (4.32 ±3.28 weeks), with a mean difference between arms of -0.12 weeks (95% CI -1.25-,1.01), non-inferiority p=0.017). The mean reduction of CRP values was -15.40 mg/L (SD=90.15, P =0.195) in G_TECCU and -13.16 mg/L (SD=54.61, P =0.053) in G_control, without significant differences between the two arms (P=.726). Similarly, the mean improvement of FC levels was 832.3 mg/L (SD=1825.0, P=.003) in G_TECCU and 1073.5 mg/L in G_Control (SD=3105.7, P=.03), but differences were not significant (P=.965). Quality of life improved in both groups, with a mean rise in the IBDQ-9 score of 13.44 points in G_TECCU (SD=19.1; P<.001) and 18.23 points [SD=22.9]; P=.001) in G_Control. Moreover, the proportion of patients who adhered to their medication rose significantly from 35.2% (25/71) to 67.6% (48/71) in G_TECCU (P=.001) and from 45.6% (36/79) to 73.4% (58/79) in G_Control (P=.001). Satisfaction remained stable around 90%, although non-inferiority was not demonstrated for secondary outcomes. CONCLUSIONS: Telemonitoring patients with active IBD is not inferior to standard care to achieve and maintain short-term remission. TECCU may be an alternative follow-up tool if the improved health outcomes and costs are confirmed in the long-term. CLINICALTRIAL: The trial is registered at ClinicalTrials.gov with the identifier NCT06031038; https://classic.clinicaltrials.gov/ct2/show/NCT06031038. INTERNATIONAL REGISTERED REPORT: RR2-10.2196/resprot.9639.

Impact of Clostridioides difficile infection in patients admitted with ulcerative colitis.

BACKGROUND: Patients with ulcerative colitis (UC) are at increased risk of Clostridioides difficile infection (CDI), which is the principal causative agent of nosocomial diarrhoea in western countries. This has been related to complications such as need of colectomy and mortality among these patients. The aim of this study was to assess the incidence and impact of CDI in patients hospitalised with UC. METHODS: Case-control retrospective study including patients admitted due to a UC flare from January 2000 to September 2018. Porpensity score matching (PSM) was performed to minimise selection bias taking into account the small number of cases compared to controls. RESULTS: 339 patients were included; CDI in 35 (10.3%) patients. After PSM, 35 (33.33%) cases and 70 (66.67%) controls were analysed. Patients with CDI presented higher rates of readmission (52.9% vs. 21.4%, p = .001), increased mortality within the first 3 months post-discharge (5.9% vs. 0%, p = .042) and increased need of therapy intensification in the first year after admission (20.7% vs. 12.5%, p = .001). No risk factors for CDI were identified. Multivariable cox regression showed that treatment with 5-aminosalycilates at baseline (HR 0.42, 95% CI 0.18-0.92) and albumin <3.5 g/dL (HR 3.11, 95% CI 1.21-8.03) were associated with worse outcomes. CONCLUSIONS: CDI is a prevalent situation in hospitalised UC patients related to higher mortality within the first 3 months after the infection, need for therapy intensification within the first year and readmission. Our results underline the importance of CDI detection in patients with a flare of UC.

First report of foliar nematode (Aphelenchoides pseudobesseyi) on soybean in Colombia.

Soybean (Glycine max L.) is produced in over 70,000 ha in the Altillanura Region, eastern Colombia (Agronet 2023). From 2018 to 2020, foliar symptoms like green stem and foliar retention of soybean, which in Brazil can cause up to 100% soybean yield losses (Meyer et al. 2017), were observed in soybean fields in Colombia. During 2020, samples from symptomatic plants in reproductive stages (R1-R8) were collected from different commercial soybean fields in the Altillanura Region. Over 200 samples were processed, using an incubation method described in Coyne et al. (2014). Nematodes were recovered from photosynthetic leaf tissues and enlarged nodes/buds with population densities ranging from 13 to 132 and 36 to 936 nematodes/10g, respectively. Adult females were morphologically and molecularly characterized as Aphelenchoides pseudobesseyi (Oliveira et al. 2019; Subbotin et al. 2020). Female body length (n = 20) ranged from 653.3 to 806.3 µm (mean = 723 µm ± 52.7), stylet length from 11.0 to 12.3 µm (11.8 µm ± 0.3), body diameter from 14.8 to 17.9 µm (16.3 µm ± 1.1), post-uterine sac length from 38.7 to 51.9 µm (44.6 µm ± 5.1), vulva to anus from 145.5 to 223.2 µm (172.2 µm ± 22.4), and 26% of the vulva-anus distance. Genomic DNA was extracted (QIAGEN DNeasy® Blood & Tissue kit) from a pool of nematodes. The D2A/D3B (Tenente et al. 2004) primers were used to amplify and sequence the D2/D3 expansion region of the 28S rRNA gene. PCR product (~759 bp) was purified, sequenced, deposited in GenBank (OQ930285), and compared to previously deposited sequences (e.g., KX356756, KY510840, KY510839, KY510841, KT692694, KY510842, MH187565) by means of the BLAST algorithm. Similarly, 988F and 18SR-Burs (De Jesus et al. 2016) primers were used to amplify and sequence the near full-length 18S RNA gene (SSU). PCR product was purified, sequenced, deposited in GenBank (OQ954344), and compared to previously deposited sequences (e.g., KT454962, KT943534, KT943535, KY510835, KY510836, KY510837, KY510838, MH187565). Phylogenetic Bayesian analysis (Ronquist et al. 2012) of the of the D2/D3 and 18S regions placed this nematode from Colombia in the A. pseudobesseyi clade (PP = 100). To fulfill a modified Koch's postulates, the A. pseudobesseyi population described above was used in a greenhouse assay. In total, 120 soybean plants (cv. Flor Blanca) were infected with 200 A. pseudobesseyi (females + males)/plant. Briefly, at cotyledon stage (VC), 50 µl aliquot containing 50 A. pseudobesseyi was delivered onto each cotyledon and unifoliolate leaves (200 nematodes/plant). Sterile water was delivered to 80 plants which served as control. Plants were kept in the greenhouse at approximately 25°C and covered with clear plastic bag for 72 h to maintain over 90% relative humidity. After 15, 30, 45, and 60 days, soybean plants (n = 20) were processed, A. pseudobesseyi quantified, and the average reproduction factor (final population/initial population) was 0.1, 2.9, 14.0, and 1.8, respectively. Infected plants showed symptoms of blistering leaves with malformation (midrib vein twist), and A. pseudobesseyi was not observed in control plants. To our knowledge, this is the first report of A. pseudobesseyi parasitizing soybean buds and leaves in Colombia. Soybean is an important commodity for the Altillanura Region, and it is important to monitor the risk posed by this nematode. Furthermore, a better understanding of the nematode-host interaction and epidemiology in Colombia soybean producing regions is needed.

Lower methane emissions were associated with higher abundance of ruminal Prevotella in a cohort of Colombian buffalos.

BACKGROUND: Ruminants burp massive amounts of methane into the atmosphere and significantly contribute to the deposition of greenhouse gases and the consequent global warming. It is therefore urgent to devise strategies to mitigate ruminant's methane emissions to alleviate climate change. Ruminal methanogenesis is accomplished by a series of methanogen archaea in the phylum Euryarchaeota, which piggyback into carbohydrate fermentation by utilizing residual hydrogen to produce methane. Abundance of methanogens, therefore, is expected to affect methane production. Furthermore, availability of hydrogen produced by cellulolytic bacteria acting upstream of methanogens is a rate-limiting factor for methane production. The aim of our study was to identify microbes associated with the production of methane which would constitute the basis for the design of mitigation strategies. RESULTS: Moderate differences in the abundance of methanogens were observed between groups. In addition, we present three lines of evidence suggesting an apparent higher abundance of a consortium of Prevotella species in animals with lower methane emissions. First, taxonomic classification revealed increased abundance of at least 29 species of Prevotella. Second, metagenome assembly identified increased abundance of Prevotella ruminicola and another species of Prevotella. Third, metabolic profiling of predicted proteins uncovered 25 enzymes with homology to Prevotella proteins more abundant in the low methane emissions group. CONCLUSIONS: We propose that higher abundance of ruminal Prevotella increases the production of propionic acid and, in doing so, reduces the amount of hydrogen available for methanogenesis. However, further experimentation is required to ascertain the role of Prevotella on methane production and its potential to act as a methane production mitigator.

Development and Psychometric Testing of a Tool Measuring Nurses' Competence for Disaster Response.

INTRODUCTION: There is a growing awareness among governments, communities, and health care agencies of the need to evaluate roles and competencies in disaster nursing. A validated instrument was developed to evaluate nurses' competencies for disaster response. METHODS: A psychometric evaluation study was developed in 2 stages: 1) content and face validity, and 2) verification of feasibility and reliability with test-retest. Competencies were extracted from the Framework of Disaster Nursing Competencies published by the International Council of Nurses. The participants included 8 experts in emergencies and disasters who were nurses with a PhD and had more than 2 years of experience with education or clinical practice in emergencies or disasters, and 326 nurses from a mobile emergency care service in southern Brazil. The data analysis used a content validity index and intraclass correlation coefficients. The psychometric properties of the instrument included reliability assessed with Cronbach alpha, feasibility and test-retest reliability assessed with t tests and intraclass correlation coefficients, and factor analysis. RESULTS: The overall evaluation of the instrument yielded an intraclass correlation coefficient of 0.92 (SD = 0.04), and the mean content validity index was acceptable at 0.88 (SD = 0.12). Out of 51 items, 41 were validated and organized in 3 domains according to factor analysis: 1) care of the community; 2) care of the individual and family; and 3) psychological support and care of vulnerable populations. The instrument demonstrated good internal consistency (Cronbach α = 0.96) and adequate test-retest reliability (intraclass correlation coefficient >0.7). DISCUSSION: The Nurses' Disaster Response Competencies Assessment Questionnaire showed good internal consistency, adequate reproducibility, and appropriate feasibility for use to evaluate nurses' competencies for disaster response.

Fatal necrotic tracheitis by Aviadenovirus in captive Alagoas curassows (Pauxi mitu) extinct from the wild.

Extinct from nature, captive young Alagoas curassows (Pauxi mitu) were found agonizing or dead with respiratory disease. Intranuclear inclusion bodies were found in the epithelia of the trachea, associated with marked necrotic tracheitis. An Aviadenovirus was isolated in chicken eggs and characterized genetically with 99% identity to the fowl Aviadenovirus A, as based on the hexon protein gene. This is the first report of respiratory disease caused by Aviadenovirus in any cracid species in Brazil, recommending for stricter biosecurity in the conservation premises. RESEARCH HIGHLIGHTS Fatal tracheitis in curassows extinct from nature was associated with Aviadenovirus A. Seven-month-old Alagoas curassows (Aves: Cracidae) died with haemorrhagic tracheitis. Aviadenovirus A with 99% identity to fowl adenovirus 1 was detected in dead curassows. Fatal tracheitis by Aviadenovirus was described in Pauxi mitu (Aves: Cracidae).

Dynamics of Caligus rogercresseyi (Boxshall & Bravo, 2000) in farmed Atlantic salmon (Salmo salar) in southern Chile: Are we controlling sea lice?

Caligus rogercresseyi generates the greatest losses in the salmon industry in Chile. The relationship between salmon farming and sea lice is made up of various components: the parasite, host, environment and farming practices, which make it difficult to identify patterns in parasite population dynamics to define prevention and control strategies. The objectives of this study were to analyse and compare the effect of farming, sanitary practices and environmental variables on the abundance of gravid females (GF) and juveniles (JUV) of C. rogercresseyi on Salmo salar in three Salmon Neighborhood Areas (SNAs) in Region 10, south of Chile. Linear mixed-effects models of the negative binomial distribution were used to evaluate the effect of the different explanatory variables on GF and JUV. Productive variables were the key drivers explaining the abundance of GF and JUV. Results suggest that C. rogercresseyi is not controlled and JUV are persistent in the three SNAs, and sanitary practices do not control the dissemination of the parasite among sites. Environmental variables had a low impact on sea lice abundance. There is a need to perform analysis for modelling of parasite population dynamics to improve Integrated Pest Management, including changes in the governance to achieve an effective prevention and control.

Avian Pox in Native Captive Psittacines, Brazil, 2015.

To investigate an outbreak of avian pox in psittacines in a conservation facility, we examined 94 birds of 10 psittacine species, including sick and healthy birds. We found psittacine pox virus in 23 of 27 sick birds and 4 of 67 healthy birds. Further characterization is needed for these isolates.

An objective definition for clinical suspicion of T-cell-mediated rejection after liver transplantation.

A uniform definition of clinical suspicion of T-cell-mediated rejection (TCMR) in liver transplantation (LT) is needed to homogenize clinical decisions, especially within randomized trials. This multicenter study included a total of 470 primary LT recipients. The derivation cohort consisted of 142 patients who had clinically driven liver biopsies at any time after LT. The external validation cohort included 328 patients who underwent protocol biopsies at day 7-10 after LT. The rates of moderate-severe histological TCMR were 33.8% in the derivation cohort and 43.6% in the validation cohort. Independent predictors (ie, risk factors) of moderate-severe TCMR in the derivation cohort were as follows: serum bilirubin >4 mg/dL (OR=5.83; P<.001), rising bilirubin within the 4 days prior to liver biopsy (OR=4.57; P=.003), and blood eosinophils count >0.1×109 /L (OR=3.81; P=.004). In the validation cohort, the number of risk factors was an independent predictor of moderate-severe TCMR (OR=1.74; P=.001), after controlling for hepatitis C status. The number of risk factors paralleled the rates of moderate-severe TCMR in the derivation and validation cohorts (P<.001 in both comparisons). In conclusion, increased serum bilirubin, rising bilirubin and eosinophilia are validated risk factors for moderate-severe histological TCMR and could be used as objective criteria to select candidates for liver biopsy.

Stress response of Salmo salar (Linnaeus 1758) when heavily infested by Caligus rogercresseyi (Boxshall & Bravo 2000) copepodids.

The year-round presence of ovigerous females of the parasite Caligus rogercresseyi in the fish farms of southern Chile results in a continuous source of the copepodid (infestive) stage of this louse. The short generation time in spring-summer could lead to high abundances of this copepodid, potentially leading to high infestation levels for fish. Knowing how heavy lice infestations affect Salmo salar can help determine how to time antiparasitic treatments so as to both minimize the treatment impact and reduce lice infestation levels for fish. This study aimed to describe the effects of high infestations of the copepodid stage of C. rogercresseyi on the physiology of S. salar. Two groups of S. salar were used: an infested group (75 copepodids per fish) and a control group (not infested). Sixty-five days after the first infestation, the infested fish group was re-infested at an infestation pressure of 200 copepodids per fish. Sampling was done prior to and following the second infestation, at 56 and 67 days (the latter 2 days following the second infestation). Several physiological variables were measured: cortisol (primary stress response) and glucose, proteins, amino acids, triglycerides, lactate, osmolality levels, and number and diameter of skin mucous cells (secondary stress responses). The plasma cortisol, glucose, and triglyceride levels were altered in the heavily infested fish, as was the diameter of skin mucous cells. These results suggest that heavy infestations of C. rogercresseyi lead to an acute stress response, metabolic reorganization, and increased mucus production in S. salar under heavy infestation conditions.

Need for therapeutic escalation in patients with refractory ulcerative proctitis: Results from the PROCU study of the ENEIDA registry.

BACKGROUND: Ulcerative proctitis (UP) can have a milder, less aggressive course than left-sided colitis or extensive colitis. Therefore, immunosuppressants tend to be used less in patients with this condition. Evidence, however, is scarce because these patients are excluded from randomised controlled clinical trials. Our aim was to describe the characteristics of patients with refractory UP and their disease-related complications, and to identify the need for immunosuppressive therapies. METHODS: We identified patients with UP from the prospective ENEIDA registry sponsored by the GETECCU. We evaluated socio-demographic data and complications associated with immunosuppression. We defined immunosuppression as the use of immunomodulators, biologics and/or small molecules. We used logistic regression to identify factors associated with immunosuppressive therapy. RESULTS: From a total of 34,716 patients with ulcerative colitis, we identified 6281 (18.1%) with UP; mean ± SD age 53 ± 15 years, average disease duration of 12 ± 9 years. Immunosuppression was prescribed in 11% of patients, 4.2% needed one biologic agent and 1% needed two; 2% of patients required hospitalisation, and 0.5% underwent panproctocolectomy or subtotal colectomy. We identified 0.2% colorectal tumours and 5% extracolonic tumours. Patients with polyarthritis (OR 3.56, 95% CI 1.86-6.69; p < 0.001) required immunosuppressants. CONCLUSIONS: Among patients with refractory UP, 11% required immunosuppressant therapy, and 4.2% required at least one biologic agent.

Interactions of Plasmodium juxtanucleare and chicken anaemia virus: establishing a model.

The pathogens Plasmodium juxtanucleare and chicken anaemia virus (CAV) are easily transmitted and potentially harmful to chickens. In this study, we established an experimental model to investigate the effects of avian malaria caused by P. juxtanucleare in white leghorn specific-pathogen-free (SPF) chicks previously immunosuppressed with CAV. Parasitaemia, haematological variables and clinical and pathological parameters were determined in four different experimental groups: chicks coinfected by CAV and P. juxtanucleare strain (Coinfected group), chicks exclusively infected by CAV (CAV group) or P. juxtanucleare (Malaria group) and uninfected chicks (Control group). Our data demonstrated that P. juxtanucleare parasitaemia was significantly higher in the Coinfected group. Furthermore, haematological parameters, including the RBC, haematocrit and haemoglobin concentration were significantly reduced in coinfected chicks. In agreement with the changes observed in haematological features, the mortality among coinfected chicks was higher compared with animals with single infections. Clinical analysis indicated moderate changes related to different organs size (bursa of Fabricius, heart and liver) in coinfected birds. The experimental coinfection of SPF chickens with P. juxtanucleare and CAV may represent a research tool for the study of avian malaria after CAV immunosuppression, enabling measurement of the impacts caused by different pathogens during malarial infection.

IImpact of the COVID-19 pandemic on the nursing students education in a public university in Colombia.

OBJECTIVES: To explore the impacts of the COVID-19 pandemic on nursing student education in one public university in Medellin, Colombia. METHODS: This descriptive qualitative study used content analysis to address the following questions: (1) How has the COVID-19 pandemic impacted nursing education at the University of Antioquia? (2) What were the most important challenges experienced by nursing students? (3) What was most supportive for the students during the pandemic? and (4) What were the potential opportunities and lessons learned related to nursing education? Data were collected virtually through individual online interviews with 14 undergraduate nursing students and analysed using qualitative content analysis with constant comparisons. RESULTS: Four main categories of findings related to the experience of undergraduate nursing students during the COVID-19 pandemic were identified: (1) transitioning to online learning, (2) managing the digital world, (3) impacts on clinical training, and (4) work-related stressors. Key challenges included home environments that were not conducive to learning, reduced social interactions with peers and faculty, accessing technology required for online education and insufficient preparation for clinical practice. Family members and university-provided resources were important sources of student support. Whereas the pandemic limited opportunities for hands-on clinical training, the shift to online learning allowed for the development of skills related to informational technologies and telehealth. CONCLUSIONS: Undergraduate students at the University of Antioquia identified significant barriers to learning during the COVID-19 pandemic restrictions and transition to online learning, as well as new opportunities for the development of digital skills among both students and faculty.

Education for Sustainable Development: Challenges for Postgraduate Programmes.

As the world faces progressive and interconnected global crises and conflicts, the educational expectations set out in the 2030 Agenda for Sustainable Development are in jeopardy. With the COVID-19 pandemic in its third year, the war in Ukraine has exacerbated the food, energy, humanitarian, and refugee crises, all against the backdrop of an unfolding climate emergency. The aim of this research is to analyse the challenges faced by postgraduate programmes in training human talent for sustainable development on the basis of Grounded Theory. To do so, we have used a dialogical intervention through the complementary experiences of authorities of higher-education institutions that live day by day for a fair, quality, and sustainable education. With a naturalistic qualitative method, where the hermeneutic analysis procedure is structured in five phases, and with data from key informants from 9 countries, 20 interviews are obtained with key informants in Latin American and Spanish universities during 2021, according to inclusion criteria such as: belonging to a higher-education institution, with a doctorate degree, with more than 10 years of experience in management, and training in postgraduate programmes. The data are processed through ATLAS.ti9, which allows for the analysis of the key informants' discourses. The findings show that the university institutions that currently offer postgraduate programmes are considering improving the quality of education; the first challenge is to redesign the curricula according to the demands of the current and future world, incorporating technological resources and knowledge of the environment; inter- and transdisciplinary curricula that form enterprising postgraduates with a solid ethical life project; critical, complex, and systemic thinking.

Initial management of intraabdominal abscesses and preventive strategies for abscess recurrence in penetrating Crohn's disease: a national multicenter study based on ENEIDA registry.

INTRODUCTION: Intra-abdominal abscesses complicating Crohn's disease (CD) are a challenging situation. Their management, during the hospitalization and after resolution, is still unclear. METHODS: Adult patients with CD complicated with intraabdominal abscess who required hospitalization were included from the prospectively maintained ENEIDA registry from GETECCU. Initial strategy effectiveness and safety to resolve abscess was assessed. Survival analysis was performed to evaluate recurrence risk. Predictive factors associated with resolution were evaluated by multivariate regression and predictive factors associated with recurrence were assessed by Cox regression. RESULTS: 520 patients from 37 Spanish hospitals were included; 322 (63%) were initially treated with antibiotics alone, 128 (26%) with percutaneous drainage, and 54 (17%) with surgical drainage. The size of the abscess was critical to the effectiveness of each treatment. In abscesses < 30mm, the antibiotic was as effective as percutaneous or surgical drainage. However, in larger abscesses, percutaneous or surgical drainage was superior. In abscesses > 50mm, surgery was superior to percutaneous drainage, although it was associated with a higher complication rate. After abscess resolution, luminal resection was associated with a lower 1-year abscess recurrence risk (HR 0.43, 95% CI 0.24-0.76). However, those patients who initiated anti-TNF therapy had a similar recurrence risk whether luminal resection had been performed. CONCLUSIONS: Small abscesses (<30mm) can be managed with antibiotics alone, while larger ones require drainage. Percutaneous drainage will be effective and safer than surgery in many cases. After discharge, anti-TNF therapy reduces abscess recurrence risk in a similar way to bowel resection.

Social Participation in Health: A Community-Based Participatory Research Approach to Capacity Building in Two Colombian Communities.

BACKGROUND: In Latin America, community participation in health issues is subject to corrupt and self-serving interest. Research recommends strengthening communities' abilities to develop actions that involve them in the coproduction of their health. OBJECTIVES: This study aims (1) to understand social participation in health based on the discourse of community leaders and institutional representatives and (2) to design and implement an educational strategy for capacity building within two communities in Colombia. METHODS: The study used a community-based participatory research partnership between researchers, community leaders, and institutional representatives. To understand social participation in health, 17 interviews were conducted with leaders and institutional representatives. Based on this assessment, an educational strategy was designed and implemented with residents of two communities, which resulted in 28 people taking part in 14 pedagogical workshops. The strategy was evaluated through focus groups and the results of the project were validated by all the interested parties. RESULTS: Interviewees' perception of participation is reduced to access to health care services. They identified that the agencies and institutions promote participation only to comply with the law. The communities stated that they had few tools to resolve situations that violate their right to health. Therefore, leaders and researchers developed an educational strategy custom tailored, so the community could acquire the capacities to confront injustices and bureaucracy in the health system and public services. CONCLUSIONS: This participatory research empowered communities to defend their right to health. The findings are a reference for social participation in health initiatives in similar contexts.

Prevotella: A Key Player in Ruminal Metabolism.

Ruminants are foregut fermenters that have the remarkable ability of converting plant polymers that are indigestible to humans into assimilable comestibles like meat and milk, which are cornerstones of human nutrition. Ruminants establish a symbiotic relationship with their microbiome, and the latter is the workhorse of carbohydrate fermentation. On the other hand, during carbohydrate fermentation, synthesis of propionate sequesters H, thus reducing its availability for the ultimate production of methane (CH4) by methanogenic archaea. Biochemically, methane is the simplest alkane and represents a downturn in energetic efficiency in ruminants; environmentally, it constitutes a potent greenhouse gas that negatively affects climate change. Prevotella is a very versatile microbe capable of processing a wide range of proteins and polysaccharides, and one of its fermentation products is propionate, a trait that appears conspicuous in P. ruminicola strain 23. Since propionate, but not acetate or butyrate, constitutes an H sink, propionate-producing microbes have the potential to reduce methane production. Accordingly, numerous studies suggest that members of the genus Prevotella have the ability to divert the hydrogen flow in glycolysis away from methanogenesis and in favor of propionic acid production. Intended for a broad audience in microbiology, our review summarizes the biochemistry of carbohydrate fermentation and subsequently discusses the evidence supporting the essential role of Prevotella in lignocellulose processing and its association with reduced methane emissions. We hope this article will serve as an introduction to novice Prevotella researchers and as an update to others more conversant with the topic.

The role of physico-chemical interactions in the seasonality of toxic dinoflagellate cyst assemblages: The case of the NW Patagonian fjords system.

Harmful algal blooms (HABs) are recurrent in the NW Patagonia fjords system and their frequency has increased over the last few decades. Outbreaks of HAB species such as Alexandrium catenella, a causal agent of paralytic shellfish poisoning, and Protoceratium reticulatum, a yessotoxins producer, have raised considerable concern due to their adverse socioeconomic consequences. Monitoring programs have mainly focused on their planktonic stages, but since these species produce benthic resting cysts, the factors influencing cyst distributions are increasingly gaining recognition as potentially important to HAB recurrence in some regions. Still, a holistic understanding of the physico-chemical conditions influencing cyst distribution in this region is lacking, especially as it relates to seasonal changes in drivers of cyst distributions, as the characteristics that favor cyst preservation in the sediment may change through the seasons. In this study, we analyzed the physico-chemical properties of the sediment (temperature, pH, redox potential) and measured the bottom dissolved oxygen levels in a "hotspot" area of southern Chile, sampling during the spring and summer as well as the fall and winter, to determine the role these factors may play as modulators of dinoflagellate cyst distribution, and specifically for the cysts of A. catenella and P. reticulatum. A permutational analysis of variance (PERMANOVA) showed the significant effect of sediment redox conditions in explaining the differences in the cyst assemblages between spring-summer and fall-winter periods (seasonality). In a generalized linear model (GLM), sediment redox potential and pH were associated with the highest abundances of A. catenella resting cysts in the spring-summer, however it was sediment temperature that most explained the distribution of A. catenella in the fall-winter. For P. reticulatum, only spring-summer sediment redox potential and temperature explained the variation in cyst abundances. The implications of environmental (physico-chemical) seasonality for the resting cysts dynamics of both species are discussed.

Factors Associated with Postpartum Sexual Dysfunction in Spanish Women: A Cross-Sectional Study.

(1) Background: Female sexual dysfunction (FSD) has a high prevalence globally, and perinatal factors favor FSD, especially in the postpartum period. The aim was to determine the prevalence and factors influencing FSD in the postpartum period; (2) Methods: An observational study carried out in three primary care centers in southern Spain, with women in the postpartum period who had a single low-risk birth. One hundred and seventeen women answered the Female Sexual Function questionnaire during the 4th month postpartum, between January 2020 and December 2021. Sociodemographic, obstetric, neonatal variables and level of self-esteem were analyzed. A multiple logistic regression model was carried out; (3) Results: 78.4% had high level of self-esteem. FSD prevalence was 89.7%. Factors related to FSD were having an instrumental vaginal delivery, women with university studies, and prenatal preparation. Maternal age ≥ 35, multiparity, pathological processes in the child, a medium-low level of self-esteem and newborn weight were associated with disorders in some of domains of sexual function; (4) Conclusions: FSD is highly prevalent in the postpartum period and is associated with preventable factors. A preventive approach by health professionals to these factors is essential. Health services should implement postpartum follow-up programs, which may coincide in time and place with newborn follow-up programs.

Barriers and facilitators to breastfeeding support practices in a neonatal intensive care unit in Colombia.

OBJECTIVES: To assess breastfeeding support practices and related barriers and facilitators in a large Intensive Care Unit, Neonatal (NICU) in Medellín, Colombia, as part of a broader quality improvement initiative to enhance breastfeeding support. METHODS: A mixed-methods descriptive design was used to collect data on care practices and outcomes related to NICU breastfeeding support. Data sources included the Neo-BFHI's self-assessment questionnaire of breastfeeding policies and practices, clinical observations, and a retrospective review of 51 patient charts. RESULTS: Of the 51 charts reviewed, 98% of the infants received breastmilk during their hospitalization but the majority (84%) also received formula and only 8% of infants were exclusively breastfed at the time of NICU discharge. All NICU staff received education on mother and baby-friendly care, and the unit complied with the International Code of Marketing of Breast-milk substitutes. However, resources to support lactation (e.g., access to breastfeeding specialists, breast pumps, written teaching materials for parents) were limited, and infants were only allowed to consume milk expressed within the hospital. Mother-infant separation, as well as staff beliefs and care routines, also limited important breastfeeding support practices such as skin-to-skin care and early initiation of direct breastfeeding. CONCLUSIONS: The self-assessment questionnaire and observations revealed a high value for breastfeeding and a family-centered approach to care in the NICU. Key challenges to sustaining breastfeeding in the NICU included a lack of facilities for supporting parental presence, barriers to expression and provision of mother's milk, and a high rate of bottle-feeding with formula.