What quantifies good primary care in the United States? A review of algorithms and metrics using real-world data.

Primary care physicians (PCPs) play an indispensable role in providing comprehensive care and referring patients for specialty care and other medical services. As the COVID-19 outbreak disrupts patient access to care, understanding the quality of primary care is critical at this unprecedented moment to support patients with complex medical needs in the primary care setting and inform policymakers to redesign our primary care system. The traditional way of collecting information from patient surveys is time-consuming and costly, and novel data collection and analysis methods are needed. In this review paper, we describe the existing algorithms and metrics that use the real-world data to qualify and quantify primary care, including the identification of an individual's likely PCP (identification of plurality provider and major provider), assessment of process quality (for example, appropriate-care-model composite measures), and continuity and regularity of care index (including the interval index, variance index and relative variance index), and highlight the strength and limitation of real world data from electronic health records (EHRs) and claims data in determining the quality of PCP care. The EHR audits facilitate assessing the quality of the workflow process and clinical appropriateness of primary care practices. With extensive and diverse records, administrative claims data can provide reliable information as it assesses primary care quality through coded information from different providers or networks. The use of EHRs and administrative claims data may be a cost-effective analytic strategy for evaluating the quality of primary care.

Electroencephalographic signatures of dogs with presumptive diagnosis of canine cognitive dysfunction.

Canine cognitive dysfunction (CCD) is a highly prevalent neurodegenerative disease considered the canine analog of early Alzheimer's disease (AD). Unfortunately, CCD cannot be cured. However, early therapeutic interventions can slow the progression of cognitive decline and improve quality of life of the patients; therefore, early diagnosis is ideal. In humans, electroencephalogram (EEG) findings specific to AD have been described, and some of them have successfully detect early stages of the disease. In this study we characterized the EEG correlates of CCD, and we compared them with the EEGs of healthy aging dogs and dogs at risk of developing CCD. EEG recordings were performed in 25 senior dogs during wakefulness. Dogs were categorized in normal, at risk of CCD or with CCD according to their score in the Rofina questionnaire. We demonstrated that, quantitative EEG can detect differences between normal dogs and dogs with CCD. Dogs with CCD experience a reduction in beta and gamma interhemispheric coherence, and higher Joint Lempel Ziv complexity. Dogs at risk of developing CCD, had higher alpha power and interhemispheric coherence, making these features potential markers of early stages of the disease. These results demonstrate that quantitative EEG analysis could aid the diagnosis of CCD, and reinforce the CCD as a translational model of early AD.

Sensitivity, specificity, and cut-off points in the Brief Questionnaire for Measuring Disordered Eating Behaviors in Mexican Women.

BACKGROUND: Evidence suggests that disordered eating behaviors can result in eating disorders, which is already a reality for the Mexican population, representing an increasingly complex public health problem. Early detection is therefore essential. AIM OF THE STUDY: To obtain the sensitivity, specificity, and cut-off points of the Brief Questionnaire for Measuring Disordered Eating Behaviors to identify eating disorders in Mexican women. METHODS: The Eating Disorders Examination-Questionnaire and the Brief Questionnaire for Disordered Eating Behaviors were applied to patients diagnosed with eating disorders at two public health institutions and university students. ROC analysis was performed to determine sensitivity, specificity, predictive values, and cut-off points. RESULTS: Three cut-off points were obtained: first: eight points (Sensitivity = 60.7%, Specificity = 92.2%), showing low risk; second: 11 points (sensitivity = 24.1%; specificity = 98.9%), detecting moderate risk; and, finally, 15 points and over (sensitivity = 4.46%; specificity = 100%), indicating high risk. CONCLUSIONS: The instrument adequately identifies those individuals who are not at risk for eating disorders, making it possible to channel prevention efforts towards those who do have DEB, thus optimizing resources. LEVEL OF EVIDENCE: Level III: case-control analytic study.

When clean eating isn't as faultless: the dangerous obsession with healthy eating and the relationship between Orthorexia nervosa and eating disorders in Mexican University students.

BACKGROUND: Orthorexia Nervosa is an eating disorder that has been scarcely studied in characteristics, causes and symptoms, as well as in consequences and the relationship with other eating disorders. The present study had as its main objective the analysis of said relationship and inquisition of the possibility of predicting the development of an eating disorder from the presence of orthorexia nervosa. Also, it analyzed the differences by sex in Mexican university students. METHODS: The sample consisted of 911 university students (65.4% women and 34.6% men), between an age range of 18 to 28 years old (M = 21 and SD = 1.9). Two questionnaires were responded: the ORTO14MX, a version of the ORTO-15 instrument previously validated in Mexican students, and the EDE-Q in its short version. Besides, sociodemographic data of interest was obtained and used for this study. RESULTS: The Pearson's correlation analysis demonstrated statistically significant relations, from mild to moderate, between the factors that make up both scales, while the linear regression analysis demonstrated that 40% of the variance is explained with the factors from the ORTO-14MX scale in the overall sample for the study. Additionally, statistically significant differences were found between men and women regarding all the subscales conforming the instruments that measured orthorexia and eating disorders. CONCLUSION: These results show a moderate predictive degree, that as promising as it is, isn't conclusive. Likewise, it was confirmed that women are still more vulnerable to develop orthorexia or another eating disorder. It can be concluded that there's a vast necessity for more studies measuring the relationship between orthorexia nervosa and eating disorders, in Latinamerican samples with diverse characteristics in sociocultural backgrounds, and clinical samples.

INTRODUCCIÓN: La ortorexia nervosa es un trastorno de la conducta alimentaria que ha sido poco estudiado, tanto en sus características, causas y síntomas, como en sus consecuencias y en la relación con otros trastornos de la conducta alimentaria. El presente estudio tuvo como objetivo analizar dicha relación e indagar si es posible predecir la aparición de un trastorno de la conducta alimentaria a partir de la presencia de ortorexia nervosa, además de analizar diferencias por sexo en estudiantes universitarios mexicanos. MÉTODO: Participaron en el estudio 911 estudiantes universitarios (65.4% fueron mujeres y el 34.6% hombres), en un rango de edades entre 18 y 28 años (M = 21 y DE = 1.9) que respondieron dos cuestionarios que son: ORTO-14MX, una versión del instrumento ORTO-15 previamente validada en estudiantes mexicanos y el EDE-Q en su versión corta, además de proporcionar algunos datos sociodemográficos de interés para este estudio. RESULTADOS: El análisis de correlación de Pearson reveló relaciones estadísticas significativas de leves a moderadas entre los factores que componen ambas escalas, mientras que el análisis de regresión lineal mostró un que un 40% de la varianza es explicada a partir de los factores que componen la escala ORTO-14MX en la muestra de estudio. Adicionalmente se encontraron diferencias estadísticamente significativas entre hombres y mujeres con respecto a todas las subescalas de los instrumentos que midieron ortorexia y trastornos de la conducta alimentaria. CONCLUSIONES: Estos resultados mostraron un grado de predicción moderada que sí bien es prometedora, no resulta totalmente concluyente. Asimismo, se confirmó que las mujeres siguen siendo más vulnerables a padecer ortorexia o un TCA. Se concluye la necesidad de continuar estudiando la relación entre la ortorexia y los TCAs, en muestras latinoamericanas con otras características socio demográficas y en población clínica.

The management of diabetes in everyday life study: Design and methods for a pragmatic randomized controlled trial comparing the effectiveness of text messaging versus health coaching.

Background African American patients with uncontrolled diabetes living in medically underserved areas need effective clinic-based interventions to improve self-care behaviors. Text messaging (TM) and health coaching (HC) are among the most promising low-cost population-based approaches, but little is known about their comparative effectiveness in real-world clinical settings. Objective Use a pragmatic randomized controlled trial design to determine the comparative effectiveness of TM and HC with enhanced usual care (EC) in African American adults with uncontrolled diabetes and multiple chronic health conditions. Methods/design The Management of Diabetes in Everyday Life (MODEL) study is randomizing 646 patients (n = 581with anticipated 90% retention) to 3 intervention arms: TM, HC, and EC. Participants are African American adults living in medically underserved areas of the Mid-South, age ≥ 18, with uncontrolled diabetes (A1c ≥ 8), one or more additional chronic conditions, and who have a phone with texting and voicemail capability. Primary outcome measures: the general diet, exercise, and medication adherence subscales of the revised Summary of Diabetes Self-Care Activities questionnaire assessed at one year. Secondary outcomes: diabetes-specific quality of life, primary care engagement, and average blood sugar (A1c). The study will also assess heterogeneity of treatment effects by six key baseline participant characteristics. Conclusions We describe the design and methods of the MODEL study along with design revisions required during implementation in a pragmatic setting. This trial, upon its conclusion, will allow us to compare the effectiveness of two promising low-cost primary care-based strategies for supporting self-care behaviors among African Americans individuals with uncontrolled diabetes. ClinicalTrials.gov registration number: NCT02957513.

Resilience of aquatic systems: Review and management implications.

Our understanding of how ecosystems function has changed from an equilibria-based view to one that recognizes the dynamic, fluctuating, nonlinear nature of aquatic systems. This current understanding requires that we manage systems for resilience. In this review, we examine how resilience has been defined, measured and applied in aquatic systems, and more broadly, in the socioecological systems in which they are embedded. Our review reveals the importance of managing stressors adversely impacting aquatic system resilience, as well as understanding the environmental and climatic cycles and changes impacting aquatic resources. Aquatic resilience may be enhanced by maintaining and enhancing habitat connectivity as well as functional redundancy and physical and biological diversity. Resilience in aquatic socioecological system may be enhanced by understanding and fostering linkages between the social and ecological subsystems, promoting equity among stakeholders, and understanding how the system is impacted by factors within and outside the area of immediate interest. Management for resilience requires implementation of adaptive and preferably collaborative management. Implementation of adaptive management for resilience will require an effective monitoring framework to detect key changes in the coupled socioecological system. Research is needed to (1) develop sensitive indicators and monitoring designs, (2) disentangle complex multi-scalar interactions and feedbacks, and (3) generalize lessons learned across aquatic ecosystems and apply them in new contexts.

Influencia de las actividades del día y la semana en los niveles de actividad física de los escolares: estudio de corte transversal / Influence of daily and weekly activities in the physical activity levels of school children: a cross-sectional study

Introducción: las diversas actividades relacionadas con un estilo activo que los escolares realizan durante el día y la semana interactúan para influir en el nivel total de actividad física de los niños. Objetivo: identificar la influencia que tienen las actividades ejecutadas por los escolares durante los diferentes momentos del día y la semana sobre los niveles de actividad física. Métodos: estudio de corte transversal analítico sobre 3598 estudiantes de escuelas públicas de entre 10 y 14 años de edad. Se aplicó una encuesta que midió las características sociodemográficas. Mediante el Cuestionario de Actividad Física para Escolares (PAQ-C) se evaluaron los niveles de actividad física. Se realizó una regresión logística multivariante como análisis estadístico a través del programa SPSS v.24. Resultados: el 64,3 % de los estudiantes no cumplen con las recomendaciones de actividad física. Son más inactivos los escolares que no realizan suficiente actividad física (AF) durante el fin de semana [OR: 3,7 (IC 95 %: 2,9-4,5)], los que no son activos físicamente después de la escuela [OR: 3,1 (IC 95 %: 2,3-4,2], los que no practican actividades como saltar en su tiempo libre [OR: 3,2 (IC 95 %: 1,9-5,2] y los que no usan la bicicleta [OR: 3,7 (IC 95 %: 2,7-5,1]. Conclusiones: los niveles de AF de los escolares dependen de la integración de diferentes contextos y periodos del día y la semana. La influencia de las actividades durante el fin de semana y la educación física muestra la función que tienen la familia y la escuela sobre la adquisición y práctica de estilos de vida activos

Introduction: the distinct activities related to an active lifestyle that schoolchildren perform during the day and week interact to influence the children's total level of physical activity. Objective: to identify the influence that the activities developed by school children during the different times of the day and the week have on the levels of physical activity. Method: a cross-sectional study conducted in 3,598 public school students aged between 10 and 14 years. The demographic characteristics were evaluated, as well as the levels of physical activity through the Physical Activity Questionnaire for Schoolchildren (PAQ-C). A multivariate logistic regression analysis was performed as statistical analysis using the SPSS v.24 software program. The raw odds ratio (OR) was estimated. Results: in all, 64.3 % of the students failed to comply with physical activity recommendations. Students who are more inactive include those who do not perform enough physical activity during the weekend [OR: 3.7 (95 % CI: 2.9-4.5)], those who are not physically active after school [OR: 3.1 (95 % CI: 2.3-4.2)], those who do not practice activities such as jumping in their free time [OR: 3.2 (95 % CI: 1.9-5.2)], and those who do not ride a bicycle [OR: 3.7 (95 % CI: 2.7-5.1)]. Conclusions: the levels of physical activity in students depend on the integration of different contexts and periods during the day and the week. The influence of weekend activities and physical education shows the role that the family and school play in the acquisition and practice of an active lifestyle

The Management of Diabetes in Everyday Life (MODEL) program: development of a tailored text message intervention to improve diabetes self-care activities among underserved African-American adults.

Tailoring health-related materials is an effective mechanism to encourage behavior change; however, little research has described processes and critical characteristics for effective tailoring in underserved populations. The purpose of this study is to describe a process using input from content experts and lay patient advisors to tailor text messages focused on improving self-care behaviors of African-American adults with diabetes and identify characteristics of messages perceived to be most effective. An initial library of tailorable messages was created using theory-based approaches, expert opinion, and publicly available materials. A study-specific advisory council representing the program's intended population provided sequential individual and focus group review of a sample of draft messages focused on medication use, healthy eating, and physical activity. Messages were reviewed for content, tone, and applicability to African-American adults with diabetes from underserved communities. Based on this feedback, messages were revised and a final library of tailorable messages was constructed for use in a text messaging intervention. The initial library had over 5,000 tailorable messages. Participants preferred messages that included: (1) encouraging statements without condescension; (2) short sentences in lay language; (3) specific, actionable instructions; and (4) content relatable to daily activities of living. When possible, messages with similar themes should be repeated over short periods of time to improve the odds of material being absorbed and action being taken. Input from patient participants and advisors is essential for designing deeply tailored messages that honor the preferences, values, and norms of the population under study and promote health behavior change. TRIAL REGISTRATION: NCT02957513.

[Influence of daily and weekly activities in the physical activity levels of school children: a cross-sectional study]. / Influencia de las actividades del día y la semana en los niveles de actividad física de los escolares: estudio de corte transversal.

INTRODUCTION: Introduction: the distinct activities related to an active lifestyle that schoolchildren perform during the day and week interact to influence the children's total level of physical activity. Objective: to identify the influence that the activities developed by school children during the different times of the day and the week have on the levels of physical activity. Method: a cross-sectional study conducted in 3,598 public school students aged between 10 and 14 years. The demographic characteristics were evaluated, as well as the levels of physical activity through the Physical Activity Questionnaire for Schoolchildren (PAQ-C). A multivariate logistic regression analysis was performed as statistical analysis using the SPSS v.24 software program. The raw odds ratio (OR) was estimated. Results: in all, 64.3% of the students failed to comply with physical activity recommendations. Students who are more inactive include those who do not perform enough physical activity during the weekend [OR: 3.7 (95% CI: 2.9-4.5)], those who are not physically active after school [OR: 3.1 (95% CI: 2.3-4.2)], those who do not practice activities such as jumping in their free time [OR: 3.2 (95% CI: 1.9-5.2)], and those who do not ride a bicycle [OR: 3.7 (95% CI: 2.7-5.1)]. Conclusions: the levels of physical activity in students depend on the integration of different contexts and periods during the day and the week. The influence of weekend activities and physical education shows the role that the family and school play in the acquisition and practice of an active lifestyle.

INTRODUCCIÓN: Introducción: las diversas actividades relacionadas con un estilo activo que los escolares realizan durante el día y la semana interactúan para influir en el nivel total de actividad física de los niños. Objetivo: identificar la influencia que tienen las actividades ejecutadas por los escolares durante los diferentes momentos del día y la semana sobre los niveles de actividad física. Métodos: estudio de corte transversal analítico sobre 3598 estudiantes de escuelas públicas de entre 10 y 14 años de edad. Se aplicó una encuesta que midió las características sociodemográficas. Mediante el Cuestionario de Actividad Física para Escolares (PAQ-C) se evaluaron los niveles de actividad física. Se realizó una regresión logística multivariante como análisis estadístico a través del programa SPSS v.24. Resultados: el 64,3% de los estudiantes no cumplen con las recomendaciones de actividad física. Son más inactivos los escolares que no realizan suficiente actividad física (AF) durante el fin de semana [OR: 3,7 (IC 95%: 2,9-4,5)], los que no son activos físicamente después de la escuela [OR: 3,1 (IC 95%: 2,3-4,2], los que no practican actividades como saltar en su tiempo libre [OR: 3,2 (IC 95%: 1,9-5,2] y los que no usan la bicicleta [OR: 3,7 (IC 95%: 2,7-5,1]. Conclusiones: los niveles de AF de los escolares dependen de la integración de diferentes contextos y periodos del día y la semana. La influencia de las actividades durante el fin de semana y la educación física muestra la función que tienen la familia y la escuela sobre la adquisición y práctica de estilos de vida activos.

Production of a Dibrominated Aromatic Secondary Metabolite by a Planctomycete Implies Complex Interaction with a Macroalgal Host.

The roles of the majority of bacterial secondary metabolites, especially those from uncommon sources, are still elusive even though many of these compounds show striking biological activities. To further investigate the secondary metabolite repertoire of underexploited bacterial families, we chose to analyze a novel representative of the yet untapped bacterial phylum Planctomycetes for the production of secondary metabolites under laboratory culture conditions. Development of a planctomycetal high density cultivation technique in combination with high resolution mass spectrometric analysis revealed Planctomycetales strain 10988 to produce the plant toxin 3,5-dibromo-p-anisic acid. This molecule represents the first secondary metabolite reported from any planctomycete. Genome mining revealed the biosynthetic origin of this doubly brominated secondary metabolite, and a biosynthesis model for the compound was devised. Comparison of the biosynthetic route to biosynthetic gene clusters responsible for formation of polybrominated small aromatic compounds reveals evidence of an evolutionary link, while the compound's herbicidal activity points toward a complex interaction of planctomycetes with their macroalgal host.

Relación entre estatus nutricional, insatisfacción corporal y conductas alimentarias de riesgo en estudiantes de nutrición / Relationship between nutritional status, body dissatisfaction and risky eating behaviors in Nutrition students

Resumen La presión sociocultural sobre los estudiantes universitarios, y en particular los que estudian nutrición, influye de manera negativa en su imagen corporal (IC), lo que favorece la adopción de conductas alimentarias de riesgo (CAR), independientemente de su estatus nutricional (ETN). El propósito del presente trabajo fue analizar la relación entre insatisfacción corporal (INC), ETN y CAR en estudiantes de nutrición. Participaron 370 estudiantes de una universidad privada (93.5% mujeres), con edad promedio de 19.5 años (DE = 2.5). Aunque 81% de los estudiantes era normopeso, 72.3% presentaron INC. Los participantes con obesidad, sobrepeso o normopeso presentaron riesgo moderado de presentar CAR (p < .05), pero no aquellos que estaban satisfechos con su IC (p < .05). Específicamente, los estudiantes que desearon tener una silueta más delgada mostraron mayor riesgo de presentar CAR (OR = 2.97, p < .05) vs. quienes deseaban tener una más robusta (p = .76). Además, a mayor índice de masa corporal, mayor práctica de ejercicio para bajar de peso, dietas restrictivas, atracones y pérdida de control al comer (p < .05). Es necesario desarrollar intervenciones orientadas a mejorar la satisfacción corporal para prevenir CAR entre estudiantes universitarios, y con mayor énfasis en aquellos que optan por cursar la carrera de nutrición.

Abstract The sociocultural pressure on university students, and particularly those studying Nutrition, negatively influences their body image (BI), which favors the adoption of risky eating behaviors (REB), regardless of their nutritional status (NS). The purpose of this study was to describe the relationship between body dissatisfaction (BD), NS and REB in Nutrition students. A total of 370 students from a private university participated (93.5% women), with a mean age of 19.5 years (SD = 2.5). Although 81% of the students were normal weight, 72.3% had BD. Participants with obesity, overweight or normal weight had moderate risk of REB (p < .05), but not those who were satisfied with their BI (p < .05). Specifically, students who wished to have a thinner silhouette showed greater risk of REB (OR = 2.97, p < .05) vs. those who wished to have a robust silhouette (p = . 76). In addition, the higher body mass index, the more exercise to lose weight, restrictive diets, binge eating and loss of control when eating (p < .05). It is necessary to develop interventions aimed at improving body satisfaction to prevent REB among university students, with greater emphasis on those who choose Nutrition as a professional career.

Use of virtual games for interactive learning in a pharmacy curriculum.

BACKGROUND AND PURPOSE: To evaluate student pharmacists' attitudes and satisfaction toward playing educational virtual games in the classroom. EDUCATIONAL ACTIVITY AND SETTING: Virtual games were played in the classroom setting. First year student pharmacists participated in two Mimycx quests in the Healthcare Communication and the Psychiatry/Neurology courses. Students were randomly assigned into teams and worked together to complete the assigned quest games. Completion of the pre- and post-quest questionnaires via Qualtrics was voluntary. FINDINGS: A total of 79 student pharmacists played the Mimycx quests. Only 66 students completed both pre- and post-quest questionnaires. Students indicated their familiarity with game concepts related to the virtual environment and avatars used in the study. The change in their attitudes and satisfaction about the Mimycx virtual learning experience was significant between the two learning time points. SUMMARY: The use of virtual gaming technology could enhance student pharmacists' learning and engagement in the classroom. Students benefitted from increased familiarity with virtual, educational gaming concepts in their experiences with Mimycx, although no statistically significant differences were found regarding their attitudes toward communication and teamwork.

The impact of work-related stress on medication errors in Eastern Region Saudi Arabia.

OBJECTIVE: To examine the relationship between overall level and source-specific work-related stressors on medication errors rate. DESIGN: A cross-sectional study examined the relationship between overall levels of stress, 25 source-specific work-related stressors and medication error rate based on documented incident reports in Saudi Arabia (SA) hospital, using secondary databases. SETTING: King Abdulaziz Hospital in Al-Ahsa, Eastern Region, SA. PARTICIPANTS: Two hundred and sixty-nine healthcare professionals (HCPs). MAIN OUTCOME MEASURES: The odds ratio (OR) and corresponding 95% confidence interval (CI) for HCPs documented incident report medication errors and self-reported sources of Job Stress Survey. RESULTS: Multiple logistic regression analysis identified source-specific work-related stress as significantly associated with HCPs who made at least one medication error per month (P < 0.05), including disruption to home life, pressure to meet deadlines, difficulties with colleagues, excessive workload, income over 10 000 riyals and compulsory night/weekend call duties either some or all of the time. Although not statistically significant, HCPs who reported overall stress were two times more likely to make at least one medication error per month than non-stressed HCPs (OR: 1.95, P = 0.081). CONCLUSION: This is the first study to use documented incident reports for medication errors rather than self-report to evaluate the level of stress-related medication errors in SA HCPs. Job demands, such as social stressors (home life disruption, difficulties with colleagues), time pressures, structural determinants (compulsory night/weekend call duties) and higher income, were significantly associated with medication errors whereas overall stress revealed a 2-fold higher trend.

RiceAtlas, a spatial database of global rice calendars and production.

Knowing where, when, and how much rice is planted and harvested is crucial information for understanding the effects of policy, trade, and global and technological change on food security. We developed RiceAtlas, a spatial database on the seasonal distribution of the world's rice production. It consists of data on rice planting and harvesting dates by growing season and estimates of monthly production for all rice-producing countries. Sources used for planting and harvesting dates include global and regional databases, national publications, online reports, and expert knowledge. Monthly production data were estimated based on annual or seasonal production statistics, and planting and harvesting dates. RiceAtlas has 2,725 spatial units. Compared with available global crop calendars, RiceAtlas is nearly ten times more spatially detailed and has nearly seven times more spatial units, with at least two seasons of calendar data, making RiceAtlas the most comprehensive and detailed spatial database on rice calendar and production.

Unmet Primary Care Needs in Diabetic Patients with Multimorbidity in a Medically Underserved Area.

BACKGROUND: Diabetic patients with multimorbidity in medically underserved minority communities are less engaged in primary care and experience high emergency department (ED) utilization. This study assesses unmet primary care needs among diabetic patients in a medically underserved area (MUA). COMMUNITY CONTEXT: A suburb of Memphis-Whitehaven, Tennessee (Shelby County, ZIP codes 38109 and 38116)-majority African American (96.6%) with 30.5% below the poverty level. METHODS: Community case study using multiple data sources including diabetes registry, individual interviews, focus groups, and a survey of 30 ED patients with diabetes and multimorbidity. RESULTS: Diabetes registry data indicated that 95.5% of 5723 diabetic patients had multimorbidity. Over 91.5% were uncontrolled at some point in 2014 to 2015. Only 83% of patients with diabetes and multimorbidity reported having a primary care provider (PCP) and those without a PCP were more likely to report delays in needed care. Patients expressed strong interest in health coaching (88%) and receiving text messages from the doctor's office (73%). Individual patient interviews (n = 9) and focus groups (n = 11) revealed common primary care and self-care experiences and needs including diabetes education, improved patient-provider communication, health-care access and coverage, and strengthened primary care and community. CONCLUSION: This study demonstrates that almost 1 in 5 ED complex diabetic patients in an MUA do not have a PCP, and that difficulty accessing primary care often results in patients forgoing needed care. Qualitative findings support these conclusions. These results suggest that primary care capacity and infrastructure to support diabetes self-care need strengthening in MUAs.

Detecting and Managing Adverse Effects of Antipsychotic Medications: Current State of Play.

Antipsychotics are some of the most frequently prescribed medications not only for psychotic disorders and symptoms but also for a wide range of on-label and off-label indications. Because second-generation antipsychotics have largely replaced first-generation antipsychotics as first-line options due to their substantially decreased risk of extrapyramidal side effects, attention has shifted to other clinically concerning adverse events associated with antipsychotic therapy. The focus of this article is to update the nonextrapyramidal side effects associated with second-generation antipsychotics. Issues surrounding diagnosis and monitoring as well as clinical management are addressed.

Prevalence of metilentetrahidrofolate reductase C677T polymorphism,consumption of vitamins B6, B9, B12 and determination of lipidichydroperoxides in obese and normal weight Mexican population / Prevalencia del polimorfismo C677T de la metilentetrahidrofolato reductasa, consumo de las vitaminas B6, B9, B12 y determinación de hidroperóxidos lipídicos en población mexicana obesa y con peso normal

Introduction: Oxidative stress is a key factor in the development of the principal comorbidities of obesity. Methylenetetrahydrofolate reductase enzyme (MTHFR) participates in the metabolism of folate with the action of vitamins B6 and B12. The gene of MTHFR may present a single nucleotide polymorphism (SNP) at position 677 (C677T), which can promote homocysteinemia associated to the production of free radicals. Objective: To determine the frequency of SNP C677T of the MTHFR, evaluate the consumption of vitamins B6, B9, B12 and determine the concentration of plasma lipid hydroperoxides (LOOH) in obese and control groups. Methods: 128 Mexican mestizo according to their body mass index were classified as normal weight (Nw; n = 75) and obesity (ObeI-III; n = 53). Identification of SNP C677T of MTHFR was performed by PCR-RFLP technic. The consumption of vitamins B6, B9 and B12 was assessed by a validate survey. LOOH was determined as an indicator of peripheral oxidative stress. Results: There was no statistical difference in the frequency of the C677T polymorphism between the TT homozygous genotype in Nw (0.19) and ObeI-III (0.25). The frequency of T allele in Nw was 0.45 and 0.51 in ObI-III group. There were no statistical differences in the consumption of vitamins B6, B9 and B12 between Nw and ObI-III groups. The LOOH showed statistical difference (p < 0.05) between Nw and ObI-III group. Discussion: Oxidative stress is present in all grades of obesity although there were no differences in the vitamin consumption and the SNP C677T between Nw and ObeI-III groups (AU)

Introducción: El estrés oxidativo es un factor clave en el inicio y el desarrollo de las comorbilidades de la obesidad. La enzima metiltetrahidrofolato reductasa (MTHFR) participa en el metabolismo del folato con la acción de las vitaminas B9 y B12. El gen MTHFR puede presentar un polimorfismo de un solo nucleótido (SNP) en la posición 677 (C677T), que puede promover homocisteinemia asociada a la producción de radicales libres. Objetivo: Determinar la frecuencia del SNP C677T de la MTHFR, evaluar el consumo de vitaminas B6, B9, B12 y determinar la concentración de hidroperóxidos lipídicos (LOOH) en plasma en un grupo de obesos y testigo. Métodos: Se clasificaron 128 mexicanos mestizos de acuerdo a su índice de masa corporal en normopeso (Nw; n = 75) y obesidad (ObeI-III; n = 53). Se identificó el SNP C677T de la MTHFR mediante la técnica de PCR-RFLP. El consumo de vitaminas B6, B9 y B12 se evaluó mediante una encuesta validada. Se determinaron LOOH como un indicador de estrés oxidativo periférico. Resultados: No hubo diferencia estadística significativa en la frecuencia del polimorfismo C677T entre homocigotos TT en Nw (0,19) y ObeI-III (0,25). La frecuencia del alelo T en Nw fue de 0,45, y 0,51 en el grupo ObeI-III. Los LOOH mostraron diferencia estadística significativa (p < 0,05) entre Nw y ObI-III. Discusión: El estrés oxidativo está presente en todos los grados de obesidad aunque no hubo diferencia entre el consumo de vitaminas y el SNP C677T entre los grupos de Nw y ObeI-III (AU)

[Comparison of resting energy expenditure determined by indirect calorimetry and estimated by predictive formulas in women with obesity degrees I to III]. / Comparación del gasto energético en reposo determinado mediante calorimetría indirecta y estimado mediante fórmulas predictivas en mujeres con grados de obesidad I a III.

INTRODUCTION: The determination of resting energy expenditure (REE) is calculated in clinical practices by predictive formulas; however the result varies among the population due to several factors. OBJECTIVE: To compare the REE determination by indirect calorimetry and by Harris-Benedict (HB), Mifflin (MF), World Health Organization (WHO), Institute of Medicine (IOM), "Formula Rápida" (FR) and Valencia (VA) formulas, in women with obesity grades I to III. METHODS: Mexican mestizo adult women were included in the study and stratified in three groups according to their body mass index (BMI). Grade I obesity (BMI 30.0-34.9, n = 42), grade II (BMI 35.0-39.9, n = 38) and grade III (BMI > 40, n = 41). REE was determined by indirect calorimetry and by the aforementioned equations. Kruskal-Wallis ANOVA and Dunn test were used for statistical comparison and p < 0.05 was accepted as a statistical difference. RESULTS: There were no statistical difference between the REE values estimated by formulas HB, WHO and VA regarding the CI. The accuracy obtained from these formulas was 63%, 67% and 64%, respectively, when data were analyzed in a single group. The IOM, ER and MF formulas showed statistically significant difference versus the CI and their accuracy were 58%, 53%, and 54%, respectively. In grade III obesity VA (78%) and FR (71%) accuracy were the highest obtained. DISCUSSION: HB, WHO and VA formulas were the best to estimate REE in Mexican women with BMI > 30. In obesity grade III FR and VA formulas showed the best performance.

Introducción: La determinación del gasto energético en reposo (GER) se calcula cotidianamente a partir de fórmulas predictivas aunque el resultado varía dependiendo de la población. Objetivo: Comparar la determinación del GER mediante calorimetría indirecta y mediante las ecuaciones Harris-Benedict (HB), Mifflin (MF), Organización Mundial de la Salud (OMS), «Institute of Medicine¼ (IOM), Fórmula Rápida (FR) y Valencia (VA) en mujeres con grados de obesidad I a III. Métodos: Mujeres adultas mestizas mexicanas se incluyeron en el estudio y formaron 3 grupos a partir del índice de masa corporal (IMC). Obesidad grado I (IMC 30,0-34,9; n = 42), grado II (IMC 35,0-39,9; n = 38) y grado III (IMC > 40; n = 41). Se determinó el GER mediante calorimetría indirecta y mediante las ecuaciones antes señaladas. ANOVA de Kruskal-Wallis y la prueba de Dunn se emplearon para el análisis estadístico (p < 0,05 se aceptó como diferencia). Resultados: No se observó diferencia estadística entre los valores de las fórmulas HB, OMS y VA respecto a la CI. La concordancia obtenida de dichas fórmulas fue 63%, 67% y 64%, respectivamente, al analizar los datos en un solo grupo de obesidad. Asimismo, las fórmulas IOM, ER y MF mostraron diferencia estadística significativa versus la CI, siendo la concordancia 58%, 53% y 54%, respectivamente. En el grado III de obesidad la concordancia de VA (78%) y FR (71%) fue la mayor obtenida. Discusión: Las fórmulas HB, OMS y VA fueron las mejores para estimar el GER en mujeres mexicanas con IMC>30. En el grado III VA y FR muestran el mejor desempeño.

Comparación del gasto energético en reposo determinado mediante calorimetría indirecta y estimado mediante fórmulas predictivas en mujeres con grados de obesidad I a III / Comparison of resting energy expenditure determined by indirect calorimetry and estimated by predictive formulas in women with obesity degrees I to III

Introducción: La determinación del gasto energético en reposo (GER) se calcula cotidianamente a partir de fórmulas predictivas aunque el resultado varía dependiendo de la población. Objetivo: Comparar la determinación del GER mediante calorimetría indirecta y mediante las ecuaciones Harris-Benedict (HB), Mifflin (MF), Organización Mundial de la Salud (OMS), "Institute of Medicine" (IOM), Fórmula Rápida (FR) y Valencia (VA) en mujeres con grados de obesidad I a III. Métodos: Mujeres adultas mestizas mexicanas se incluyeron en el estudio y formaron 3 grupos a partir del índice de masa corporal (IMC). Obesidad grado I (IMC 30,034,9; n = 42), grado II (IMC 35,0-39,9; n = 38) y grado III (IMC > 40; n = 41). Se determinó el GER mediante calorimetría indirecta y mediante las ecuaciones antes señaladas. ANOVA de Kruskal-Wallis y la prueba de Dunn's se emplearon para el análisis estadístico (p < 0,05 se aceptó como diferencia). Resultados: No se observó diferencia estadística entre los valores de las fórmulas HB, OMS y VA respecto a la CI. La concordancia obtenida de dichas fórmulas fue 63%, 67% y 64%, respectivamente, al analizar los datos en un solo grupo de obesidad. Asimismo, las fórmulas IOM, ER y MF mostraron diferencia estadística significativa versus la CI, siendo la concordancia 58%, 53% y 54%, respectivamente. En el grado III de obesidad la concordancia de VA (78%) y FR (71%) fue la mayor obtenida. Discusión: Las fórmulas HB, OMS y VA fueron las mejores para estimar el GER en mujeres mexicanas con IMC > 30. En el grado III VA y FR muestran el mejor desempeño (AU)

Introduction: The determination of resting energy expenditure (REE) is calculated in clinical practices by predictive formulas; however the result varies among the population due to several factors. Objective: To compare the REE determination by indirect calorimetry and by Harris-Benedict (HB), Mifflin (MF), World Health Organization (WHO), Institute of Medicine (IOM), "Formula Rápida" (FR) and Valencia (VA) formulas, in women with obesity grades I to III. Methods: Mexican mestizo adult women were included in the study and stratified in three groups according to their body mass index (BMI). Grade I obesity (BMI 30.034.9, n = 42), grade II (BMI 35.0-39.9, n = 38) and grade III (BMI > 40, n = 41). REE was determined by indirect calorimetry and by the aforementioned equations. Kruskal-Wallis ANOVA and Dunn's test were used for statistical comparison and p < 0.05 was accepted as a statistical difference. Results: There were no statistical difference between the REE values estimated by formulas HB, WHO and VA regarding the CI. The accuracy obtained from these formulas was 63%, 67% and 64%, respectively, when data were analyzed in a single group. The IOM, ER and MF formulas showed statistically significant difference versus the CI and their accuracy were 58%, 53%, and 54%, respectively. In grade III obesity VA (78%) and FR (71%) accuracy were the highest obtained. Discussion: HB, WHO and VA formulas were the best to estimate REE in Mexican women with BMI > 30. In obesity grade III FR and VA formulas showed the best performance (AU)

Prevalence of metilentetrahidrofolate reductase C677T polymorphism, consumption of vitamins B6, B9, B12 and determination of lipidic hydroperoxides in obese and normal weight Mexican population.

INTRODUCTION: Oxidative stress is a key factor in the development of the principal comorbidities of obesity. Methylenetetrahydrofolate reductase enzyme (MTHFR) participates in the metabolism of folate with the action of vitamins B6 and B12. The gene of MTHFR may present a single nucleotide polymorphism (SNP) at position 677 (C677T), which can promote homocysteinemia associated to the production of free radicals. OBJECTIVE: To determine the frequency of SNP C677T of the MTHFR, evaluate the consumption of vitamins B6, B9, B12 and determine the concentration of plasma lipid hydroperoxides (LOOH) in obese and control groups. METHODS: 128 Mexican mestizo according to their body mass index were classified as normal weight (Nw; n=75) and obesity (ObeI-III; n=53). Identification of SNP C677T of MTHFR was performed by PCR-RFLP technic. The consumption of vitamins B6, B9 and B12 was assessed by a validate survey. LOOH was determined as an indicator of peripheral oxidative stress. RESULTS: There was no statistical difference in the frequency of the C677T polymorphism between the TT homozygous genotype in Nw (0.19) and ObeI-III (0.25). The frequency of T allele in Nw was 0.45 and 0.51 in ObI-III group. There were no statistical differences in the consumption of vitamins B6, B9 and B12 between Nw and ObI-III groups. The LOOH showed statistical difference (p < 0.05) between Nw and ObI­III group. DISCUSSION: Oxidative stress is present in all grades of obesity although there were no differences in the vitamin consumption and the SNP C677T between Nw and ObeI­III groups.

Introducción. El estrés oxidativo es un factor clave en el inicio y el desarrollo de las comorbilidades de la obesidad. La enzima metiltetrahidrofolato reductasa (MTHFR) participa en el metabolismo del folato con la acción de las vitaminas B9 y B12. El gen MTHFR puede presentar un polimorfismo de un solo nucleótido (SNP) en la posición 677 (C677T), que puede promover homocisteinemia asociada a la producción de radicales libres. Objetivo. Determinar la frecuencia del SNP C677T de la MTHFR, evaluar el consumo de vitaminas B6, B9, B12 y determinar la concentración de hidroperóxidos lipídicos (LOOH) en plasma en un grupo de obesos y testigo. Métodos. Se clasificaron 128 mexicanos mestizos de acuerdo a su índice de masa corporal en normopeso (Nw; n=75) y obesidad (ObeI-III; n=53). Se identificó el SNP C677T de la MTHFR mediante la técnica de PCR-RFLP. El consumo de vitaminas B6, B9 y B12 se evaluó mediante una encuesta validada. Se determinaron LOOH como un indicador de estrés oxidativo periférico. Resultados. No hubo diferencia estadística significativa en la frecuencia del polimorfismo C677T entre homocigotos TT en Nw (0.19) y ObeI-III (0.25). La frecuencia del alelo T en Nw fue de 0.45, y 0.51 en el grupo ObeI-III. Los LOOH mostraron diferencia estadística significativa (p.