Quasi-experimental evaluation of a nationwide diabetes prevention programme.

Diabetes is a leading cause of morbidity, mortality and cost of illness1,2. Health behaviours, particularly those related to nutrition and physical activity, play a key role in the development of type 2 diabetes mellitus3. Whereas behaviour change programmes (also known as lifestyle interventions or similar) have been found efficacious in controlled clinical trials4,5, there remains controversy about whether targeting health behaviours at the individual level is an effective preventive strategy for type 2 diabetes mellitus6 and doubt among clinicians that lifestyle advice and counselling provided in the routine health system can achieve improvements in health7-9. Here we show that being referred to the largest behaviour change programme for prediabetes globally (the English Diabetes Prevention Programme) is effective in improving key cardiovascular risk factors, including glycated haemoglobin (HbA1c), excess body weight and serum lipid levels. We do so by using a regression discontinuity design10, which uses the eligibility threshold in HbA1c for referral to the behaviour change programme, in electronic health data from about one-fifth of all primary care practices in England. We confirm our main finding, the improvement of HbA1c, using two other quasi-experimental approaches: difference-in-differences analysis exploiting the phased roll-out of the programme and instrumental variable estimation exploiting regional variation in programme coverage. This analysis provides causal, rather than associational, evidence that lifestyle advice and counselling implemented at scale in a national health system can achieve important health improvements.

[Appropriate range of body mass index and body weight management guidelines for Chinese oldest old (T/CNSS 021-2023)].

Body mass index (BMI) is widely recognized as an important indicator of physical health. However, the current BMI standard and guidelines primarily focus on children and general adults, neglecting the specific needs of the oldest old aged 80 years or older. To address this gap, this guideline aims to provide recommendations on the appropriate range of BMI and weight management for the oldest old in China, including age calculation, defining the appropriate BMI range, BMI measurement indicators, and weight management strategies. It is intended to be utilized by medical and health organizations at all levels, as well as medical and nursing service institutions, to evaluate the BMI and manage the weight of the oldest old population.

Estrategia y plan de acción sobre la promoción de la salud en el contexto de los Objetivos de Desarrollo Sostenible 2019-2030 / Strategy and Plan of Action on Health Promotion within the Context of the Sustainable Development Goals 2019-2030 / Stratégie et plan d'action sur la promotion de la santé dans le contexte des objectifs de développement durable 2019-2030

El objetivo de esta Estrategia y plan de acción sobre la promoción de la salud en el contexto de los Objetivos de Desarrollo Sostenible 2019-2030 es renovar la promoción de la salud por medio de acciones sociales, políticas y técnicas que aborden los determinantes sociales de la salud, con el fin de mejorar la salud y reducir las inequidades en el contexto de la Agenda 2030. Este documento está vinculado a la Estrategia para el acceso universal a la salud y la cobertura universal de salud de la OPS y se centra en el trabajo con todos los niveles de gobierno, en particular el nivel local, para empoderar a las personas y comunidades en sus entornos y territorios. Dada su importancia, la intersectorialidad y la participación social se consideran como dos ejes transversales en todo el plan de acción y deberían reflejarse en las actividades para alcanzar cada línea estratégica (véase el anexo A). El compromiso con los principios del respeto de los derechos humanos, la equidad y la inclusión, teniendo en cuenta específicamente las cuestiones de género, la etnicidad, la interculturalidad y las discapacidades entre otros aspectos, es la base de todas las líneas estratégicas de acción. Cada país deberá adaptar la respuesta nacional, subnacional y local a su propia situación, contexto y prioridades. El presente plan de acción se basa en cuatro líneas estratégicas de acción que se refuerzan mutuamente, a saber, fortalecer los entornos saludables clave; facilitar la participación y el empoderamiento de la comunidad, y el compromiso de la sociedad civil; fortalecer la gobernanza y el trabajo intersectorial para mejorar la salud y el bienestar, y abordar los determinantes sociales de la salud, y fortalecer los sistemas y servicios de salud incorporando un enfoque de promoción de la salud.

The goal of this Strategy and Plan of Action on Health Promotion within the Context of the Sustainable Development Goals 2019-2030 is to renew health promotion through social, political, and technical actions, and addressing the sustainable development goals in order to improve health and reduce health inequities within the context of the 2030 Agenda. This document is linked to PAHO's Strategy for Universal Access to Health and Universal Health Coverage and focuses on work with all levels of government, but particularly the local level, to empower people and communities in their settings and territories. Given the importance of intersectoral action and social participation, these are considered as two cross-cutting axes throughout the Plan of Action and should be reflected in actions to achieve each strategic line. Commitment to the principles of respect for human rights, equity, and inclusivity, with specific consideration of gender, ethnicity, interculturality and disabilities, among others, underpins all the strategic lines of action. Each country will need to tailor its national, subnational, and local responses to its own situation, context and priorities. This Plan of Action is based on four mutually reinforcing strategic lines of action: strengthening key healthy settings; enabling community participation and empowerment and civil society engagement; enhancing governance and intersectoral work to improve health and well-being and address the social determinants of health; and strengthening health systems and services by incorporating a health promotion approach. The Strategy and Plan of Action on Health Promotion are aligned with the Universal Access to Health and Health Coverage 2014, the Astana Declaration 2018 and the Sustainable Development Goals.

Le but de la Stratégie et plan d'action sur la promotion de la santé dans le contexte des objectifs de développement durable 2019-2030 est de renouveler la promotion de la santé grâce à des mesures de nature sociale, politique et technique qui agissent sur les déterminants sociaux de la santé, afin d'améliorer la santé et de réduire les iniquités en santé dans le contexte du Programme à l'horizon 2030. Le présent document est lié à la Stratégie pour l'accès universel à la santé et la couverture sanitaire universelle de l'OPS et est axé sur la collaboration avec tous les niveaux de gouvernement, mais en particulier le niveau local, visant à accroître l'autonomie des personnes et des communautés dans leurs milieux et leurs territoires. Étant donné l'importance de l'action intersectorielle et de la participation sociale, ces deux aspects sont considérés comme représentant deux axes transversaux dans l'ensemble du plan d'action et devront se traduire par des mesures destinées à réaliser chaque axe stratégique (voir l'annexe A). L'adhésion aux principes de respect des droits de l'homme, de l'équité et de l'inclusivité, en tenant compte plus particulièrement du sexe, de l'appartenance ethnique, de l'interculturalité et des handicaps, entre autres facteurs, sous-tend tous les axes stratégiques d'intervention. Chaque pays devra adapter les réponses qu'il met en œuvre aux niveaux national, infranational et local à sa propre situation, à son propre contexte et à ses propres priorités. Ce plan d'action se fonde sur quatre axes stratégiques d'intervention qui se confortent mutuellement : renforcer des milieux sains névralgiques ; permettre la participation et l'autonomisation des communautés et la mobilisation de la société civile ; consolider la gouvernance et l'action intersectorielle en vue d'améliorer la santé et le bien-être et d'agir sur les déterminants sociaux de la santé, et renforcer les systèmes et les services sanitaires par l'intégration d'une approche de promotion de la santé.

Blog: ACT Promoção da Saúde: Dia Mundial do Câncer 2022

O Dia Mundial do Câncer é uma data celebrada anualmente em 4 de fevereiro. Em 2022, o Dia Mundial estará focado na conscientização sobre as desigualdades enfrentadas pelos pacientes na busca por tratamento. Segundo o site oficial, “embora estejamos vivendo em uma época de avanços surpreendentes na prevenção, no diagnóstico e no tratamento do câncer, muitas pessoas encontram dificuldades pelo caminho. Renda, nível educacional, localização geográfica e discriminação por raça, gênero, orientação sexual, idade, capacitismo e estilo de vida são alguns dos fatores que podem influenciar negativamente a busca por cuidados.” Em apoio ao Dia Mundial, a ACT fará um relançamento da nota técnica reformulada “Câncer: é possível prevenir fatores de risco”, publicada originalmente em novembro, com várias postagens nas mídias sociais e produção de vídeos falando sobre os principais fatores de risco modificáveis da doença. Também somos apoiadores da campanha Vá de Lenço, organizada anualmente pela Abrale para a data.

Mississippi CHAMPS: Decreasing Racial Inequities in Breastfeeding.

Mississippi CHAMPS addressed racial inequities in breastfeeding by implementing community and hospital-based practice changes in accordance with the BFHI and by parallel community work.

Estrategia Nacional de Salud para los objetivos sanitarios al 2030 / National Health Strategy for health objectives by 2030

La Reforma de Salud del año 2004 (Ley de Autoridad Sanitaria Nº19.937), establece como parte de la función rectora del Ministerio de Salud (MINSAL), la definición de objetivos sanitarios y en torno a ellos, el desarrollo de procesos de planificación sanitaria que han considerado una década para su logro. Los objetivos sanitarios se sitúan en una posición estratégica para el sector, enmarcando su desarrollo a través del Plan Nacional de Salud, instrumento que figura como su carta de navegación y que expone los principales desafíos sanitarios, estableciendo acciones y abordajes para enfrentarlos. Estos expresan la misión que la política pública se propone alcanzar en el mediano y largo plazo, específicamente en lo que respecta a mejorar la salud de la población, haciendo los esfuerzos para prolongar la vida y los años de vida libres de enfermedad y, simultáneamente, actuar sobre la reducción de las desigualdades en salud, mejorando la salud de los grupos más desfavorecidos de la sociedad(1). Cada ciclo de formulación de objetivos guarda coherencia con el periodo que lo antecede, dado que, los resultados alcanzados o no alcanzados modulan y determinan las prioridades y metas que el sector se propondrá para el nuevo decenio. En Chile, la formulación de OS fue impulsada por la ministra de Salud Michelle Bachelet el año 2000 en el marco del proceso de Reforma que empezaba a tomar forma en el sector. La experiencia de países como Estados Unidos, el Reino Unido y Canadá que habían realizado procesos similares, sirvió de referencia para el primer ejercicio de formulación que se realizó en Chile. La evaluación de ese periodo concluyó que más del 50% de las metas propuestas habían sido logradas. No obstante, había muchos aspectos que mejorar como la alineación sectorial con los OS y los instrumentos de gestión, la incorporación de mecanismos de monitoreo, la disponibilidad de instrumentos estandarizados y el fortalecimiento del Plan Nacional de Salud en el sector y el intersector. El decenio 2011 a 2020, convocó al sector salud en torno a la formulación de nuevos OS, así se definieron: Mejorar la salud de la población; Disminuir las inequidades; Aumentar la satisfacción de la población y Asegurar la calidad de las prestaciones de salud. Al finalizar esta década, el balance deja resultados disímiles entre las diferentes temáticas, sin embargo, la experiencia planteó aprendizajes relevantes para la formulación de los nuevos OS tanto en materia de salud poblacional como de gestión institucional, no sólo para el sector sino tambien para el intersector. En contexto del inicio de una nueva década, el Departamento de Estrategia Nacional de Salud (DENS) de la División de Planificación Sanitaria (DIPLAS) desarrolló el proceso de formulación de los Objetivos Sanitarios de la Década 2021-2030 y la construcción de un nuevo Plan Nacional de Salud, abarcando la implementación de cinco etapas sucesivas y considerando el desarrollo de una dimensión estratégica, una operativa y una participativa, a fin de crear una red de intervenciones coordinadas, coherentes y sólidas. Para ello, a lo largo de dicho proceso, se promovió el involucramiento de los distintos actores de la organización y la instalación de diversos escenarios para el desarrollo de una planificación sanitaria integrativa y multinivel, basada en el trabajo intra-intersectorial

Prevention of Pediatric Overweight and Obesity: Position of the Academy of Nutrition and Dietetics Based on an Umbrella Review of Systematic Reviews.

This Academy of Nutrition and Dietetics Position Paper reports current evidence on pediatric overweight and obesity prevention interventions and discusses implications for registered dietitian nutritionists (RDNs). An overview of current systematic reviews provided evidence-based results from a range of nutrition interventions according to developmental age group (ages 2 to 5, 6 to 12, and 13 to 17 years). Twenty-one current systematic reviews of nutrition interventions demonstrated a beneficial effect of nutrition and physical activity interventions on body mass index measures and no adverse events were identified. RDNs impart nutrition expertise in a wide range of settings to provide comprehensive care for children and adolescents as their nutrition and developmental needs change over time. This Position Paper outlines the current roles of, and proposed directions for, RDNs engaged in pediatric overweight and obesity prevention. Prevention of pediatric overweight and obesity requires comprehensive strategies ranging from policy-level to individual-level interventions in settings that will have the most beneficial impact for children according to their developmental stage. This Position Paper advocates for increased availability of nutrition and food access programs and interventions to reduce risk of pediatric obesity and associated adverse health outcomes both now and for future generations.

What is the effectiveness of community-based health promotion campaigns on chlamydia screening uptake in young people and what barriers and facilitators have been identified? A mixed-methods systematic review.

BACKGROUND: The UK National Chlamydia Screening Programme uses an opportunistic approach. Many programmes use campaigns to raise awareness of chlamydia screening in young people. This review aimed to assess the effectiveness of campaigns on uptake of chlamydia screening in young people. METHODS: We conducted a mixed-methods systematic review of articles assessing the outcomes of community-based health-promotion campaigns to increase chlamydia screening in young people, their experiences of the campaigns and other facilitators and barriers to the conduct of the campaigns. We searched four databases for quantitative and qualitative studies with no language restrictions. MAIN RESULTS: From 10 329 records identified, 19 studies (20 articles) were included in the review: 14 quantitative, 2 qualitative and 3 mixed methods. All studies with quantitative outcomes were before-after study designs or interrupted time series. The prediction interval for relative change (RC) in test counts ranged from 0.95 to 1.56, with a summary pooled estimate of RC 1.22 (95% CI 1.14 to 1.30, 13 studies, I2=97%). For test positivity rate, 95% prediction interval was 0.59 to 1.48, with a summary pooled estimate of RC 0.93 (95% CI 0.81 to 1.07, 8 studies, I2=91.8%). Large variation in characteristics between studies precluded exploring outcomes by type of campaign components. Seven major qualitative themes to improve screening were identified: targeting of campaigns; quality of materials and message; language; anonymity; use of technology; relevance; and variety of testing options. CONCLUSIONS: Health promotion campaigns aiming to increase chlamydia testing in those aged 15-24 years may show some effectiveness in increasing overall numbers of tests, however numbers of positive tests do not follow the same trend. Qualitative findings indicate that campaigns require clear, relevant messaging that displays the full range of testing options and assures anonymity in order to be effective.

Recomendações para operacionalização da política nacional de promoção da saúde na atenção primária à saúde / Recommendations for the Operationalization of the National Health Promotion Policy in Primary Health Care

A promoção da saúde consiste em um conjunto de estratégias focadas na melhoria da qualidade de vida dos indivíduos e coletividades. As ações de promoção da saúde são potencializadas por meio de ações coordenadas entre governo, setor saúde e outros setores sociais e econômicos para estabelecer estratégias que devem dialogar com as necessidades locais e as diferenças socioeconômicas e culturais em prol da construção de políticas públicas que promovam ambientes e territórios saudáveis, reforcem a ação comunitária na direção dos assuntos de saúde, desenvolvam habilidades pessoais de cuidado por meio da divulgação de informação e da educação para a saúde e reorientem os serviços de promoção da saúde, com a participação da comunidade e de outros setores (1). O desenvolvimento de ações para a promoção da saúde no âmbito da Atenção Primária à Saúde (APS) desponta como importante resposta à reestruturação do modelo de atenção à saúde e à operacionalização de ações que priorizam uma abordagem fundamentada nos determinantes sociais da saúde. Nessa perspectiva, a promoção da saúde seria a estratégia preferencial para viabilizar a articulação de conhecimentos interdisciplinares no cuidado individual e coletivo, bem como a APS seria o lócus privilegiado para mobilização comunitária, capaz de propiciar mudanças de cultura organizacional, ampliação do escopo de ações e reorganização dos sistemas locais de saúde (1,2). O presente documento tem como objetivo definir recomendações, no sentido de orientar a operacionalização da Política Nacional de Promoção da Saúde (PNPS) na APS, obtidas por meio de consenso de especialistas vinculados à temática de promoção da saúde, seguida de consulta pública, e direcionadas a colocar em prática os princípios e as proposições derivadas da PNPS, nas diversas conjunturas e nos diferentes contextos em que venham a ser implementadas (3)

Estrategia y plan de acción sobre la promoción de la salud en el contexto de los objetivos de desarrollo sostenible: 2019-2030

En la Estrategia y plan de acción sobre la promoción de la salud en el contexto de los Objetivos de Desarrollo Sostenible 2019-2030 se busca renovar la promoción de la salud por medio de acciones sociales, políticas y técnicas que aborden los determinantes sociales de la salud, las condiciones en las cuales las personas nacen, crecen, viven, trabajan y envejecen (1), con el fin de mejorar la salud y reducir las inequidades en la salud en el marco de la Agenda 2030 para el Desarrollo Sostenible.

Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review.

Importance: With the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking. Objectives: To perform a systematic review of clinical practice guidelines for falls prevention and management for adults 60 years or older in all settings (eg, community, acute care, and nursing homes), evaluate agreement in recommendations, and identify potential gaps. Evidence Review: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses statement methods for clinical practice guidelines on fall prevention and management for older adults was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, PEDro, and Epistemonikos databases. Medical Subject Headings search terms were related to falls, clinical practice guidelines, management and prevention, and older adults, with no restrictions on date, language, or setting for inclusion. Three independent reviewers selected records for full-text examination if they followed evidence- and consensus-based processes and assessed the quality of the guidelines using Appraisal of Guidelines for Research & Evaluation II (AGREE-II) criteria. The strength of the recommendations was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation scores, and agreement across topic areas was assessed using the Fleiss κ statistic. Findings: Of 11 414 records identified, 159 were fully reviewed and assessed for eligibility, and 15 were included. All 15 selected guidelines had high-quality AGREE-II total scores (mean [SD], 80.1% [5.6%]), although individual quality domain scores for clinical applicability (mean [SD], 63.4% [11.4%]) and stakeholder (clinicians, patients, or caregivers) involvement (mean [SD], 76.3% [9.0%]) were lower. A total of 198 recommendations covering 16 topic areas in 15 guidelines were identified after screening 4767 abstracts that proceeded to 159 full texts. Most (≥11) guidelines strongly recommended performing risk stratification, assessment tests for gait and balance, fracture and osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions. The strengths of the recommendations were inconsistent for vitamin D supplementation, addressing cognitive factors, and falls prevention education. Recommendations on use of hip protectors and digital technology or wearables were often missing. None of the examined guidelines included a patient or caregiver panel in their deliberations. Conclusions and Relevance: This systematic review found that current clinical practice guidelines on fall prevention and management for older adults showed a high degree of agreement in several areas in which strong recommendations were made, whereas other topic areas did not achieve this level of consensus or coverage. Future guidelines should address clinical applicability of their recommendations and include perspectives of patients and other stakeholders.

Development and Validation of a Lifestyle Behavior Tool in Overweight and Obese Women through Qualitative and Quantitative Approaches.

There is a paucity of effective intervention tools for overweight/obese women to assess, guide and monitor their eating behavior. This study aimed to develop a lifestyle intervention tool, assess its acceptability and usefulness, and verify its construct validity in overweight/obese women. The 6P tool (Portion, Proportion, Pleasure, Phase, Physicality, Psychology) was developed and 15 women with a body mass index (BMI) ≥ 25 kg/m2 were interviewed to assess its perceived acceptability and usefulness. Subsequently, the revised 6P tool was tested in 46 women with a BMI ≥ 25 kg/m2. The Three-Factor Eating Questionnaire (TFEQ), International Physical Activity Questionnaire-Short (IPAQ), and weight were measured at baseline and one-month. Most participants were satisfied with the presentation of the 6P tool (86.8%), and agreed it was useful in guiding healthy eating (81.6%) and raising awareness of eating behavior (97.4%). There were significant improvements in cognitive restraint (p = 0.010) and disinhibition (p = 0.030) (TFEQ), portion size (P1), pleasure behaviors (P3), and total composite 6P score (p < 0.001). However, there was no significant reduction in weight or increase in physical activity. The 6P tool is acceptable and presents with good validity for assessing lifestyle behaviors.

Composición nutricional y declaraciones nutricionales del plátano de Canarias / Nutritional composition and nutritional claims of Canary Islands banana

Objetivos: el plátano de Canarias es el único fruto del género Musa que se produce en territorio español. Desde el año 2013 se cataloga como un alimento con Indicación Geográfica Protegida (IGP). El plátano de Canarias presenta características propias a nivel organoléptico que lo diferencian de otros frutos de consumo del mismo género como la banana. Sin embargo, hasta la fecha no se habían realizado estudios detallados sobre su composición nutricional y las posibles declaraciones nutricionales derivadas de su composición. Métodos: en el presente trabajo se muestran los resultados del análisis bromatológico del plátano de Canarias, realizado a través de distintas técnicas (cromatografía liquida, espectroscopia, espectrofotometría y polarimetría) en un estado óptimo de maduración del fruto (estadio 6). Adicionalmente, se hizo uso de la legislación vigente concerniente a las declaraciones de la composición nutricional de alimentos (Reglamento N.º 1169/2011) para esclarecer aquellas atribuibles al plátano. Resultados: el plátano de Canarias es un alimento con alto contenido por porción comestible en vitamina B6 (0,52 g/100 g) y fuente de potasio (419,9 mg/100 g), fibra dietética total (2,22 g/100 g) y vitamina C (12,35 mg/100 g) de manera natural, de acuerdo con la legislación vigente en materia de etiquetado alimentario. Conclusiones: la ingesta diaria de un plátano de Canarias contribuye a alcanzar el consumo recomendado de tres piezas de fruta al día, aportando unos valores de referencia de nutrientes (VRN) óptimos de vitaminas (B6, C), minerales (potasio) y fibra dietética, con el consiguiente valor añadido a nivel nutricional que pone de manifiesto su importancia como alimento de producción local y su incorporación como tal en el contexto de una dieta saludable. (AU)

Objectives: Canary Islands bananas represent the only native cultivar of Musa spp. present in Spanish territory. Since 2013, it has the Protected Geographical Indication label, which confers an additional value to this fruit. Bananas from the Canary Islands have certain organoleptic properties that make them stand out from among other commonly consumed Musa spp. However, to date, no studies have been reported including an extended nutritional composition of this product. Methods: the present work shows the main nutritional components of bananas from the Canary Islands as determined by different analytical techniques (mainly liquid chromatography, spectroscopy, spectrophotometry, and polarimetry) when at their best in terms of ripeness (grade 6). Moreover, potential nutrition claims relating to their composition were proposed using the current legislation. Results: the fruit's remarkable content, edible portion, in vitamin B6 (0.52 g/100 g), dietary fiber (2.22 g/100 g), potassium (419.9 mg/100 g), and vitamin C (12.35 mg/100 g) should be highlighted. Additionally, these components could appear on nutritional labeling as claims, according to current European regulations. Conclusions: a daily consumption of one Canary Islands banana contributes to the recommended dietary intake of vitamin B6, vitamin C, potassium, and dietary fiber. The high nutritional value of this fruit enhances its presence in the Mediterranean eating pattern, being remarkable as a local product with excellent nutritional properties. (AU)

Plan de Acciones Integrales de Salud (PAIS) / Comprehensive Action Plan of Health (PAIS)

A partir del enfoque de la salud presentado en el informe "A New Perspective on the Health of Canadians" de 1974 escrito por Marc Lalonde, entonces ministro de salud y bienestar de Canadá, se desarrolló el concepto de "determinantes sociales de la salud" (DSS). La Organización Mundial de la Salud (OMS) los define como "Las circunstancias en que las personas nacen, crecen, traba- jan, viven y envejecen, incluido el conjunto más amplio de fuerzas y sistemas que influyen sobre las condiciones de la vida cotidiana". Numerosos programas y políticas nacionales e internacio- nales los han utilizado como marco de referencia. Entre esos programas está la estrategia de Municipios Saludables que se implementó durante los años 2001-2019. Si bien hay un consenso muy amplio en torno a esta perspectiva en el campo de la salud, no hay una clara definición de estrategias de abordaje concretas para las problemáticas de salud relacionadas a los determi- nantes sociales. El desafío que implica definir estas estrategias aumenta mientras más distancia se toma de los temas y perspectivas usualmente utilizadas en el campo de la salud. En este sen- tido, se diseñó el Plan de Acciones Integrales de Salud (PAIS) como herramienta para lograr abordajes operativos de los determinantes de la salud, de objetivar este desafío en los distintos contextos sociosanitarios de la Argentina. El PAIS se compone de siete líneas de promoción de la salud municipal con temáticas generales: 1) Ciudad Amigable para Personas Mayores, cuyas sublíneas abordan: la accesibilidad del entor- no físico, la integración social y las Residencias para Personas Mayores; 2) Gestión de Servicios de Salud sólo estará disponible en las provincias que tienen municipios con efectores de salud propios y se divide en las siguientes sublíneas: Salud Mental, Géneros y Diversidad y Enfermeda- des Crónicas no Transmisibles; 3) Salud Ambiental, posee también una sublínea: Gestión de Resi- duos Sólidos Urbanos; 4) Seguridad Vial; 5) Seguridad Alimentaria; 6) Entornos Saludables y 7) Fortalecimiento Institucional que se divide en las sublíneas: Fortalecimiento Institucional, Parti- cipación Comunitaria y Equidad. Cada línea de promoción de la salud está compuesta de acciones, con sus respectivos indicadores de avance y medios de verificación. Las acciones están secuenciadas en cinco etapas, siendo la primera de una duración de dos meses mientras que las siguientes de cuatro meses, cuyo cum- plimiento determina las transferencias: firma del convenio, diagnóstico, dos de implementación y por último una de evaluación y resultados finales. De esta forma, el PNCMyCS logra establecer una estrategia financiera de apoyo por objetivos alcanzados entre los municipios y las provin- cias.

Impact of interprofessional service-learning on the effectiveness of knowledge transfer of antimicrobial resistance to Hong Kong elders: a quasi-experiment.

BACKGROUND: Community perception on antimicrobials plays a role in driving the development of antimicrobial resistance (AMR). The aim of the study was to evaluate the impact of interprofessional service-learning on the effectiveness of AMR knowledge transfer in Hong Kong elders aged 65 or above and students from university and secondary schools. METHODS: A quasi-experimental pretest-posttest controlled study was carried out from July 2018 to March 2019 for elderly subjects and a pre- and post-test were conducted in students from May to August 2018. Elderly subjects were recruited from the university-based community outreach program. The community outreach team consisted of both university and secondary school students. Students were provided with training of geriatric care and AMR before they reached out to the community. The one-to-one intervention with the aid of video and verbal explanation to educate the elderly about the definition, causes, and consequences of AMR, and preventive measures against AMR was provided. Questionnaires on knowledge of antibiotics and AMR were used as tools to reflect on the effectiveness for both students and elderly subjects. The questionnaire was completed twice, before and 1 week after the intervention. Chi-square test, t tests and regression analysis were used to analyze the data. RESULTS: A total of 93 Chinese elders, 61 of them in the intervention group and 32 in the control group participated in the study. The score obtained by the intervention group increased from 40.1 to 83.3% (p < 0.001) following intervention, while that of control group increased from 33.0 to 44.0% (p < 0.001). The increase attained in the intervention group was significantly greater than that of the control group (p < 0.001). A total of 95 secondary students and 88 university students have completed the pre-post questionnaires with 42.21% and 13% increment in AMR knowledge after the training (p < 0.001). CONCLUSION: The significant change in knowledge level showed effective AMR knowledge transfer to both elders and students. The study could be used as a reference when allocating resources to implement effective interprofessional service-learning for better community health education in elderly populations. TRIAL REGISTRATION: This study was approved by the Chinese University of Hong Kong Survey and Behavioural Research Ethics Committee in December 2018 (Ref no. SBRE-18-214).

[Nutritional composition and nutritional claims of Canary Islands banana]. / Composición nutricional y declaraciones nutricionales del plátano de Canarias.

INTRODUCTION: Objectives: Canary Islands bananas represent the only native cultivar of Musa spp. present in Spanish territory. Since 2013, it has the Protected Geographical Indication label, which confers an additional value to this fruit. Bananas from the Canary Islands have certain organoleptic properties that make them stand out from among other commonly consumed Musa spp. However, to date, no studies have been reported including an extended nutritional composition of this product. Methods: the present work shows the main nutritional components of bananas from the Canary Islands as determined by different analytical techniques (mainly liquid chromatography, spectroscopy, spectrophotometry, and polarimetry) when at their best in terms of ripeness (grade 6). Moreover, potential nutrition claims relating to their composition were proposed using the current legislation. Results: the fruit's remarkable content, edible portion, in vitamin B6 (0.52 g/100 g), dietary fiber (2.22 g/100 g), potassium (419.9 mg/100 g), and vitamin C (12.35 mg/100 g) should be highlighted. Additionally, these components could appear on nutritional labeling as claims, according to current European regulations. Conclusions: a daily consumption of one Canary Islands banana contributes to the recommended dietary intake of vitamin B6, vitamin C, potassium, and dietary fiber. The high nutritional value of this fruit enhances its presence in the Mediterranean eating pattern, being remarkable as a local product with excellent nutritional properties.

INTRODUCCIÓN: Objetivos: el plátano de Canarias es el único fruto del género Musa que se produce en territorio español. Desde el año 2013 se cataloga como un alimento con Indicación Geográfica Protegida (IGP). El plátano de Canarias presenta características propias a nivel organoléptico que lo diferencian de otros frutos de consumo del mismo género como la banana. Sin embargo, hasta la fecha no se habían realizado estudios detallados sobre su composición nutricional y las posibles declaraciones nutricionales derivadas de su composición. Métodos: en el presente trabajo se muestran los resultados del análisis bromatológico del plátano de Canarias, realizado a través de distintas técnicas (cromatografía liquida, espectroscopia, espectrofotometría y polarimetría) en un estado óptimo de maduración del fruto (estadio 6). Adicionalmente, se hizo uso de la legislación vigente concerniente a las declaraciones de la composición nutricional de alimentos (Reglamento N.º 1169/2011) para esclarecer aquellas atribuibles al plátano. Resultados: el plátano de Canarias es un alimento con alto contenido por porción comestible en vitamina B6 (0,52 g/100 g) y fuente de potasio (419,9 mg/100 g), fibra dietética total (2,22 g/100 g) y vitamina C (12,35 mg/100 g) de manera natural, de acuerdo con la legislación vigente en materia de etiquetado alimentario. Conclusiones: la ingesta diaria de un plátano de Canarias contribuye a alcanzar el consumo recomendado de tres piezas de fruta al día, aportando unos valores de referencia de nutrientes (VRN) óptimos de vitaminas (B6, C), minerales (potasio) y fibra dietética, con el consiguiente valor añadido a nivel nutricional que pone de manifiesto su importancia como alimento de producción local y su incorporación como tal en el contexto de una dieta saludable.

Pharmacological treatment of a depressive episode and recurrent depressive disorder - guidelines of the Polish Psychiatric Association and the National Consultant for Adult Psychiatry. / Leczenie farmakologiczne epizodu depresji i zaburzen depresyjnych nawracajacych ­ wytyczne Polskiego Towarzystwa Psychiatrycznego i Konsultanta Krajowego ds. Psychiatrii Doroslych.

Under the auspices of the Polish Psychiatric Association and the National Consultant in Psychiatry, on the basis of analysis of international guidelines, the expert group consisting of psychiatrists and an epidemiologist compiled recommendations for the treatment of adepressive episode and recurrent depressive disorder. The recommendations take into account the information that the patient should receive before starting the treatment, the selection criteria for the treatment method and the choice of the antidepressant, the method of assessing the efficacy of treatment, treatment monitoring, and the duration of treatment. Formulating the recommendations, the experts analyzed the source data for their applicability in Poland. The current recommendations of scientific societies and an analysis of the literature on the treatment of depressive episodes and recurrent depressive disorder broken down by the treatment of acute episodes and maintenance treatment, as well as the recommendations on the method of creating guidelines have been taken into account. Furthermore, the guidelines developed in collaboration with the Supreme Medical Council and the Polish Psychiatric Association, entitled: "Diagnostic work-up and treatment of depression in adults - guidelines for family physicians", and recommendations of theNationalConsultantin Adult Psychiatry have been taken into account. The recommendations were discussed among the experts and accepted by the General Board of the Polish Psychiatric Association. Subsequently, the recommendations were modified in line with the Board's commentsand endorsed by the Association for use in the management of patients with depression in Poland.