An Iterative Process for Training Design and Implementation Increased Health Workers' Knowledge for Taking Nutrition Behavior Change to Scale.

BACKGROUND: The shortage of skilled, motivated, and well-supported health workers is a major barrier to scaling up nutrition interventions and services. OBJECTIVE: The objective of this study is to describe the process for developing and implementing a training of health personnel for the delivery of the Integrated Strategy for Attention to Nutrition (EsIAN), an evidence-based strategy for promoting infant and young child feeding through primary health care in Mexico. The specific objective is to provide a case study and highlight challenges, as well as elements to successfully mitigate these, and discuss potential applications of findings beyond the Mexican context. METHODS: The design and implementation of training followed a 5-phase process: situation analysis, formative research, large-scale feasibility study, redesign and scale up, and evaluation. We conducted document reviews, surveys, and focus groups during the first phases to inform and refine the training, as well as a pre- and posttraining telephone survey to evaluate change in knowledge. RESULTS: The initial phases of the design provided a clear understanding of the opportunities and challenges for promoting infant and young child feeding, as well as health workers' routines and practices, which informed training design. The feasibility study allowed tailoring and refinement of training. The vertical coherence and coordination between the federal and state levels during redesign and scale up facilitated compliance with training timeline and process. Evaluation results showed significant improvement in knowledge posttraining of up to 19 percentage points. CONCLUSIONS: The EsIAN training component for health providers was developed using a systematic approach to consolidate and generate relevant evidence, following an iterative process to test, learn, and improve both design and implementation. This process allowed for flexibility to take advantage of new opportunities and respond to findings from iterations. Garnering and ensuring political support allowed for continuity and sustainability of actions.

Exercise regulates lipid droplet dynamics in normal and fatty liver.

Lipids droplets (LD) are dynamics organelles that accumulate neutral lipids during nutrient surplus. LD alternates between periods of growth and consumption through regulated processes including as de novo lipogenesis, lipolysis and lipophagy. The liver is a central tissue in the regulation of lipid metabolism. Non-Alcoholic Fatty Liver Diseases (NAFLD) is result of the accumulation of LD in liver. Several works have been demonstrated a positive effect of exercise on reduction of liver fat. However, the study of the exercise on liver LD dynamics is far from being understood. Here we investigated the effect of chronic exercise in the regulation of LD dynamics using a mouse model of high fat diet-induced NAFLD. Mice were fed with a high-fat diet or control diet for 12 weeks; then groups were divided into chronic exercise or sedentary for additional 8 weeks. Our results showed that exercise reduced fasting glycaemia, insulin and triacylglycerides, also liver damage. However, exercise did not affect the intrahepatic triacylglycerides levels and the number of LD but reduced their size. In addition, exercise decreased the SREBP-1c levels, without changes in lipolysis, mitochondrial proteins or autophagy/lipophagy markers. Unexpectedly in the control mice, exercise increased the number of LD, also PLIN2, SREBP-1c, FAS, ATGL, HSL and MTTP levels. Our findings show that exercise rescues the liver damage in a model of NAFLD reducing the size of LD and normalizing protein markers of de novo lipogenesis and lipolysis. Moreover, exercise increases proteins associated to LD dynamics in the control mice.

Riñón poliquístico infantil / Infantile polycystic kidney

Se presentan 8 casos de Riñón Poliquístico Infantil y se expone la nueva teoría que lo liga a la fibrosis hepática congénita, situando ambas entidades como dos elementos de un mismo cuadro clínico. Los casos presentados reúnen todas las características clínicas y de laboratorio requeridas para el diagnóstico recomendándose la ecografía renal para efectuarlo. Se destaca la magnitud de la hipertensión arterial, de muy difícil manejo, hecho también consignado en la literatura