The RhoJ-BAD signaling network: An Achilles' heel for BRAF mutant melanomas.

Genes and pathways that allow cells to cope with oncogene-induced stress represent selective cancer therapeutic targets that remain largely undiscovered. In this study, we identify a RhoJ signaling pathway that is a selective therapeutic target for BRAF mutant cells. RhoJ deletion in BRAF mutant melanocytes modulates the expression of the pro-apoptotic protein BAD as well as genes involved in cellular metabolism, impairing nevus formation, cellular transformation, and metastasis. Short-term treatment of nascent melanoma tumors with PAK inhibitors that block RhoJ signaling halts the growth of BRAF mutant melanoma tumors in vivo and induces apoptosis in melanoma cells in vitro via a BAD-dependent mechanism. As up to 50% of BRAF mutant human melanomas express high levels of RhoJ, these studies nominate the RhoJ-BAD signaling network as a therapeutic vulnerability for fledgling BRAF mutant human tumors.

Brain and muscle Arnt-like protein-1 (BMAL1) controls circadian cell proliferation and susceptibility to UVB-induced DNA damage in the epidermis.

The role of the circadian clock in skin and the identity of genes participating in its chronobiology remain largely unknown, leading us to define the circadian transcriptome of mouse skin at two different stages of the hair cycle, telogen and anagen. The circadian transcriptomes of telogen and anagen skin are largely distinct, with the former dominated by genes involved in cell proliferation and metabolism. The expression of many metabolic genes is antiphasic to cell cycle-related genes, the former peaking during the day and the latter at night. Consistently, accumulation of reactive oxygen species, a byproduct of oxidative phosphorylation, and S-phase are antiphasic to each other in telogen skin. Furthermore, the circadian variation in S-phase is controlled by BMAL1 intrinsic to keratinocytes, because keratinocyte-specific deletion of Bmal1 obliterates time-of-day-dependent synchronicity of cell division in the epidermis leading to a constitutively elevated cell proliferation. In agreement with higher cellular susceptibility to UV-induced DNA damage during S-phase, we found that mice are most sensitive to UVB-induced DNA damage in the epidermis at night. Because in the human epidermis maximum numbers of keratinocytes go through S-phase in the late afternoon, we speculate that in humans the circadian clock imposes regulation of epidermal cell proliferation so that skin is at a particularly vulnerable stage during times of maximum UV exposure, thus contributing to the high incidence of human skin cancers.

Six country vignettes: Strengthening radiotherapy and theranostics.

BACKGROUND: For cancer patient populations worldwide, the synchronous scale-up of diagnostics and treatments yields meaningful gains in survival and quality of life. Among advanced cancer therapies, radiotherapy (RT) and theranostics are key to achieving practical, high-quality, and personalized precision medicine - targeting disease manifestations of individual patients and broad populations, alike. Aiming to learn from one another across different world regions, the six country vignettes presented here depict both challenges and victories in de novo establishment or improvement of RT and theranostics infrastructure. METHODS: The International Atomic Energy Agency (IAEA) convened global RT and theranostics experts from diverse world regions and contexts to identify relevant challenges and report progress in their own six countries: Belgium, Brazil, Costa Rica, Jordan, Mongolia, and South Africa. These accounts are collated, compared, and contrasted herein. RESULTS: Common challenges persist which could be more strategically assessed and addressed. A quantifiable discrepancy entails personnel. The estimated radiation oncologists (ROs), nuclear medicine physicians (NMPs), and medical physicists (MPs for RT and nuclear medicine) per million inhabitants in the six collective countries respectively range between 2.69-38.00 ROs, 1.00-26.00 NMPs, and 0.30-3.45 MPs (Table 1), reflecting country-to-country inequities which largely match World Bank country-income stratifications. CONCLUSION: Established goals for RT and nuclear medicine advancement worldwide have proven elusive. The pace of progress could be hastened by enhanced approaches such as more sustainably phased implementation; better multinational networking to share lessons learned; routine quality and safety audits; as well as capacity building employing innovative, resource-sparing, cutting-edge technologic approaches. Bodies such as ministries of health, professional societies, and the IAEA shall serve critical roles in convening and coordinating more innovative RT and theranostics translational research, including expanding nuanced global database metrics to inform, reach, and potentiate milestones most meaningfully. POLICY SUMMARY: Aligned with WHO 25×25 NCDs target; WHA70.12 and WHA76.5 resolutions.

Factores de riesgos de mortalidad por enfermedades cardiovasculares en adultos mayores / Mortality Risk Factors from Cardiovascular Diseases in Older Adults

Introducción: Las enfermedades cardiovasculares ateroescleróticas están en el nivel máximo de las enfermedades que afectan tanto a mujeres como a hombres adultos mayores en todo el mundo. Objetivo: Evaluar las posibles diferencias de sexo y tipo de enfermedad aterosclerótica, en pacientes mayores de 60 años, fallecidos por enfermedad cardiovascular. Métodos: Se realizó un estudio descriptivo de corte transversal en 237 adultos mayores, fallecidos por enfermedad cardiovascular, perteneciente a tres áreas de salud del municipio Santiago de Cuba, en el período de enero a diciembre de 2021 Se analizaron variables socio-demográficas y clínicas. La información fue procesada y analizada mediante estadística descriptiva. Se sistematizó la información con el paquete estadístico versión 22 y Excel. Resultados: Existieron diferencias significativas en los factores de riesgos de tabaquismo y alcoholismo con una mayor frecuencia en la población masculina, la obesidad, el sedentarismo y la diabetes mellitus fue más relevante en las mujeres, con similar comportamiento en el infarto agudo de miocardio y la enfermedad cerebrovascular. Conclusiones: La mortalidad generada por las enfermedades cardiovasculares, en la población de adultos mayores, es similar para ambos sexos la presencia de factores de riesgo evidenciaron la misma frecuencia para la mortalidad por enfermedad del corazón y cerebrovascular(AU)

Introduction: Atherosclerotic cardiovascular diseases are at the highest level of diseases that affect both older women and men worldwide. Objective: To evaluate the possible differences of sex and type of atherosclerotic disease in patients over 60 years of age who died of cardiovascular disease. Methods: A descriptive cross-sectional study was carried out in 237 older adults who died from cardiovascular disease, belonging to three health areas of Santiago de Cuba municipality, from January to December 2021. Sociodemographic and clinical variables were analyzed. The information was processed and analyzed using descriptive statistics. The information was systematized with the statistical package version 22 and Excel. Results: There were significant differences in the risk factors of smoking and alcoholism with a higher frequency in the male population, obesity, sedentary lifestyle. Diabetes mellitus was more relevant in females, with similar behavior for acute myocardial infarction and cerebrovascular disease. Conclusions: The mortality generated by cardiovascular diseases, in the population of older adults, is similar in both sexes. The presence of risk factors showed the same frequency for mortality from heart disease and cerebrovascular disease(AU)

Nuevos factores de riesgo cardiovascular en el adulto mayor

Introducción: Se han explorado los posibles predictores no tradicionales de enfermedades cardiovasculares en personas mayores. Objetivo: Identificar los factores de riesgo no tradicionales de mortalidad por enfermedades cardiovasculares en adultos mayores. Métodos: Se realizó un estudio analítico de tipo casos y controles en pacientes adultos mayores pertenecientes a 3 áreas de salud del municipio Santiago de Cuba, durante el año 2021. Los casos fueron pacientes fallecidos por enfermedad cardiovascular de tipo ateroesclerótica y los controles, pacientes adultos mayores vivos, sin la enfermedad. Se determinó la razón de productos cruzados (OR), el intervalo de confianza (IC) y la prueba ji cuadrado para identificar los factores de riesgo que se asociaron a la mortalidad. Resultados: La fragilidad (OR= 3,380; IC: 2,476-4,615; p= 0,000) y el deterioro cognitivo (OR= 2,731; IC: 2,006-3,717; p= 0,000] mostraron asociación estadística muy significativa con la mortalidad; los pacientes con 3 o más factores de riesgo presentaron un mayor riesgo de mortalidad (OR= 4,683). Conclusiones: La fragilidad y la multimorbilidad son nuevos predictores de mortalidad por enfermedades cardiovasculares en adultos mayores, que cuando se asocian, implican mayor riesgo.

Introduction: Possible non-traditional predictors of cardiovascular diseases in older people have been explored. Objective: Identify non-traditional risk factors predictive of mortality from cardiovascular diseases in older adults. Method: An analytical case-control study was carried out on older adult patients belonging to 3 health areas of the Santiago de Cuba municipality, during the year 2021. Cases: patients who died due to atherosclerotic cardiovascular disease, and controls, older adult patients alive, without the disease. The cross-product ratio (OR), the confidence interval (CI) and the chi-square test were determined to identify the factors that were associated with the onset of the disease. Results: Frailty (OR= 3.380; CI: 2.476-4.615; p= 0.000) and cognitive impairment (OR= 2.731; CI: 2.006-3.717; p= 0.000) showed a very significant statistical association with mortality; patients with 3 or more risk factors presented a higher risk of mortality (OR= 4.683). Conclusions: Frailty and multimorbidity are new predictors of mortality from cardiovascular diseases in older adults, which when associated imply greater risk.

Factores predictivos de mortalidad por cardiopatía ateroesclerótica en ancianos / Predictive factors of mortality due to atherosclerotic heart disease in elderly: en

Introducción: Las enfermedades cardiovasculares constituyen la primera causa de muerte en Cuba y el mundo. Objetivo: Identificar los factores predictivos de defunciones por enfermedad cardiovascular aterosclerótica en personas de edad avanzada. Métodos: Se realizó un estudio analítico, de tipo caso-control, que incluyó a 237 pacientes fallecidos a causa de cardiopatía ateroesclerótica (casos) y 711 ancianos vivos (controles), pertenecientes a 3 áreas de salud del municipio de Santiago de Cuba, desde enero hasta diciembre de 2021. Resultados: Los factores predictivos que formaron parte del modelo fueron el tabaquismo, la dieta poco saludable, el sedentarismo, la diabetes mellitus, la enfermedad renal crónica, la fragilidad, el deterioro cognitivo y la multimorbilidad. Conclusiones: Los factores de riesgo tradicionales seleccionados en este estudio, combinados con otras condiciones potenciales, mejoraron la predicción de la mortalidad por cardiopatías en ancianos y facilitaron la orientación de las intervenciones preventivas en este grupo poblacional.

Introduction: Cardiovascular diseases constitute the first death cause in Cuba and the world. Objective: To identify the predictive factors of deaths due to atherosclerotic cardiovascular disease in elderly people. Methods: An analytic case-control type study was carried out that included 237 dead patients due to atherosclerotic heart disease (cases) and 711 living elderly (control), belonging to 3 health areas of Santiago de Cuba municipality, from January to December, 2021. Results: The predictive factors that were part of the model were nicotine addiction, not very healthy diet, physical inactivity, diabetes mellitus, chronic renal disease, fragility, cognitive deterioration and multimorbidity. Conclusions: The traditional risk factors selected in this study, combined with other potential conditions, improved the prediction of mortality due to heart disease in elderly and facilitated the orientation of preventive interventions in this population group.

Escala predictiva de mortalidad por afección cardiovascular en adultos mayores del municipio de Santiago de Cuba / Predictive scale of mortality due to cardiovascular affection in elderly from Santiago de Cuba municipality i: en

Introducción: En el contexto del envejecimiento saludable, la prevención de las enfermedades cardiovasculares es un desafío. Objetivo: Diseñar una escala, basada en factores de riesgo identificados, para la predicción de la mortalidad por afección cardiovascular en ancianos. Métodos: Se realizó un estudio analítico, observacional y retrospectivo, de tipo caso-control, que incluyó a 536 ancianos mayores de 60 años de edad pertenecientes a 3 áreas de salud (policlínicos Ramón López Peña, Municipal y 28 de Septiembre) del municipio de Santiago de Cuba, durante el 2021. La escala se derivó del análisis de regresión logística binaria de los factores de riesgo cardiovascular identificados. Resultados: En la medida que aumentó el puntaje de la escala, se incrementó el porcentaje de pacientes fallecidos. El área bajo la curva fue de 0,836 (p= 0,000) y en la prueba de bondad de ajuste de Hosmer-Lemeshow se obtuvo p= 1,000. Conclusiones: La escala propuesta permitió predecir la mortalidad por afección cardiovascular en adultos mayores, con muy buena capacidad de discriminación y calibración.

Introduction: In the context of healthy aging, the prevention of cardiovascular diseases is a challenge. Objective: To design a scale, based on identified risk factors, for predicting mortality due to cardiovascular affection in elderly. Methods: An analytic, observational and retrospective case-control study was carried out that included 536 elderly over 60 years, belonging to 3 health areas (Ramón López Peña, Municipal and 28 de Septiembre polyclinics) from Santiago de Cuba municipality, during 2021. The scale was derived from the analysis of binary logistical regression of the identified cardiovascular risk factors. Results: As the score of the scale increased, the percentage of dead patients increased. The area under the curve was of 0.836 (p = 0.000) and in the Hosmer-Lemeshow test was obtained p = 1.000. Conclusions: The proposed scale allowed predicting mortality due to cardiovascular affection in elderly, with very good discrimination capacity and calibration.

De la formación basada en competencias a las actividades profesionales encomendables / From competency-based training to entrustable professional activities

Introducción: En los últimos años, la formación por competencias transita hacia las actividades profesionales encomendables, enfoque que facilita su operativización y evaluación. Objetivo: Actualizar los conceptos y metodologías del enfoque de actividades profesionales encomendables. Material y Métodos: Se realizó una revisión de alcance en la que se consultaron las bases de datos: SciELO, LILACS y PubMed. Se usó el término de búsqueda: "entrustable profesional activities", tanto en español, como en inglés, desde el año 2005 al 2021. Se encontraron 1 011 artículos en total, se revisaron 290, de los cuales se seleccionaron finalmente 43, todos relacionados con aspectos conceptuales y metodológicos de las actividades profesionales encomendables. Desarrollo: Se explica el concepto de actividades profesionales encomendables, sus características, usos, descripción y diferencias con el término "competencia". Se mencionan los pasos para desarrollarlas según Taylor, y se mencionan algunos desafíos de su aplicación. Conclusiones: Las actividades profesionales encomendables constituyen un novedoso enfoque en la educación médica contemporánea, que no siempre es bien comprendido. Aplicable no solo a pregrado, sino también a posgrado, especialidades médicas-quirúrgicas, tecnologías de la salud, enfermería y otras. Se ofrece información actualizada sobre su descripción y se reflexiona sobre su aplicación e implementación en el contexto nacional y regional(AU)

ABSTRACT Introduction: In recent years, competency training has moved towards training with entrustable professional activities, an approach that facilitates its operationalization and evaluation. Objective: To update the conceptual and methodological aspects of the entrustable professional activities approach. Material and Methods: Databases such as Scielo, LILACS and PubMed were used to collect information. The search term: "entrustable professional activities" was used in both Spanish and English. The review was undertaken during the period from 2005 to 2021. A total of 1 011 articles were found; 290 were read, and 37 were selected. All selected articles were related to conceptual and methodological aspects of entrustable professional activities. Development: The concept of entrustable professional activities is defined, as well as its characteristics, uses, and differences with the term "competence". The steps to develop entrustable professional activities according to Taylor are mentioned. Some challenges for its application in the national context are also mentioned. Conclusions: The entrustable professional activities constitute a novel approach to contemporary medical education, which is not always well understood. The e ntrustable professional activities are applicable not only to undergraduate but also to postgraduate education, medical-surgical specialties, health technologies, nursing, and others. Updated information on entrustable professional activities, their description, and reflections on their application and implementation in national and regional contexts are provided(AU)

Hyperglycemia among persons with hepatitis C: not the classical diabetic phenotype.

Using data from the Third National Health and Nutrition Examination Survey (United States, 1988-1994), we compared clinical phenotypes of hepatitis C virus (HCV)-seropositive and seronegative adults aged 20-89 years with hyperglycemia (impaired fasting glucose (IFG) or type 2 diabetes, n=3566 including 86 with HCV). Seroprevalence was higher among younger persons (3.4% for ages 20-59 versus 0.9% for ages 60-89, p=0.002), while traditional correlates of diabetes (hypertension, coronary heart disease) were more prevalent among older persons (both comparisons, p<0.0001). To prevent confounding by age, younger and older persons were analyzed separately. In both age groups, HCV was associated with signs of hepatic impairment and B-cell clonal expansion (higher alanine aminotransferase (ALT) and serum globulin, lower total cholesterol and platelet count). Only among younger persons, however, was HCV also associated with a marker for advanced hepatic fibrosis (elevated serum ferritin) and absence of the classical diabetic phenotype (overweight, coronary heart disease). In addition, among younger persons, HCV was currently associated with family history of diabetes, positively in persons with diabetes and inversely in those with IFG, suggesting that family history of diabetes may serve as a cofactor for progression from HCV-associated IFG to diabetes.

Pigment Production Analysis in Human Melanoma Cells.

The human epidermal melanocyte is a highly specialized pigmented cell that serves to protect the epidermis from ultraviolet (UV) damage through the production of melanin, or melanogenesis. Misregulation in melanogenesis leading to either hyper- or hypo-pigmentation is found in human diseases such as malasma and vitiligo. Current therapies for these diseases are largely unsuccessful and the need for new therapies is necessary. In order to identify genes and or compounds that can alter melanogenesis, methods are required that can detect changes in pigment production as well as expression of key melanogenesis transcription factors and enzymes. Here we describe methods to detect changes in melanogenesis in a human melanoma cell line, MNT-1, by (1) analyzing pigment production by measuring the absorbance of melanin present by spectrophotometry, (2) analyzing transcript expression of potent regulators of melanogenesis by qunatitative reverse-transcription (RT)PCR and (3) analyzing protein expression of potent regulators of melanogenesis by Western blot (WB).

Alfabetización en salud y estrategias de cambio conductual para el enfrentamiento a la COVID -19 / Health literacy and strategies of behavioral change for the COVID - 19 confrontation

Para reducir la transmisión del coronavirus, no bastan solo las intervenciones ambientales, sociales y sistémicas, sino es importante actuar sobre el comportamiento de los individuos, factor que favorece la transmisión. Resulta necesario el empleo de mecanismos efectivos de información, educación y comunicación, basados en la alfabetización en salud de forma crítica y con principios básicos de cambios de conducta. Estos enfoques, no aplicados usualmente, van más allá de la simple información y educación sanitarias, pues deben ser llevados a cabo no solo por profesionales de la salud sino por todas las personas influyentes en la población. Se explica el funcionamiento de los principios del cambio de comportamiento, su aplicación en la etapa de enfrentamiento a la COVID - 19 y se muestran algunos enlaces digitales sobre cómo hacer en la alfabetización en salud.

The environmental, social and systemic interventions are not enough to reduce the transmission of coronavirus, but it is important to act on the individuals behavior, a factor that favors the transmission. The use of effective mechanisms of information, education and communication is necessary, based on health literacy in a critical way and with basic principles of behavior changes. These approaches, not usually implemented, go beyond the simple information and health education, because they should be carried out not only by health professionals but also by all the influential people in the population. The functioning of the behavior change principles and their implementation in the COVID - 19 confrontation stage are explained and some digital links on how to proceed in health literacy are shown.

De la educación médica continua al desarrollo profesional continuo basado en competencias / From continuous medical education to competence-based continuous professional development

Introducción: En la última década ha existido una evolución conceptual y documental que abarca desde la educación médica continua, el desarrollo profesional continuo hasta el desarrollo profesional basado en competencias. Objetivo: Revisar el estado actual de la educación médica continua en el mundo, su evolución y las posibilidades de su perfeccionamiento en Cuba. Métodos: Se realizó una revisión bibliográfica en las bases de datos MedLine, PubMed, SciELO, LILACS mediante los descriptores: "educación médica continua" y "desarrollo profesional continuo". Se priorizaron las revistas internacionales de educación médica y los artículos de los últimos 5 años. Asimismo, se revisó el sitio web de la federación mundial de educación médica. Resultados: La educación médica continua y permanente constituye un principio de la educación médica. Esta transita desde la educación médica continua hasta el desarrollo profesional continuo, y luego al desarrollo profesional continuo basado en competencias y a la educación continua interprofesional. Se muestra la evolución conceptual, y se relaciona la educación médica basada en competencias con el desarrollo profesional continuo. Se mencionan las características de una efectiva educación médica continua y un desarrollo profesional continuo, que pudieran ser aplicables a nuestro contexto. Conclusiones: La necesidad de perfeccionar y mejorar el nuevo modelo económico y social del país ha requerido nuevas resoluciones ministeriales y estatales acerca del desarrollo profesional continuo de los trabajadores y profesionales del país, incluidos los del sector de la salud. Se requiere actualizar los conceptos y las prácticas en este orden para estar a tono con las tendencias internacionales(AU)

Introduction: In the last decade, there has been a conceptual and documental evolution that ranges from continuous medical education and continuous professional development to competence-based professional development. Objective: To review the updated theory about continuous medical education worldwide, its evolution and the possibilities for its improvement in Cuba. Methods: A bibliographic review was carried out in the databases MedLine, PubMed, SciELO, and LILACS, using the descriptors educación médica continua [continuous medical education] and desarrollo profesional continuo [continuous professional development]. We prioritized international medical education journals and articles within the last five years. We also reviewed the website of the World Federation for Medical Education. Results: Continuous and permanent medical education is a principle of medical education. It evolves from continuous medical education to continuous professional development, and then to continuous competence-based professional development and continuous interprofessional education. The conceptual evolution in this area is shown, and competence-based medical education is presented with a focus on its relation with continuous professional development. The characteristics are mentioned corresponding to effective continuous medical education and continuous professional development, which could be applied in our setting. Conclusions: The need to perfect and improve the new economic and social model of the country has required new ministerial and state resolutions concerning continuous professional development of the country's workers and professionals, including those in the health sector. Updating concepts and practices in this respect is required in order to be in tune with international trends(AU)

Venous thromboembolism among patients with advanced lung cancer randomized to prinomastat or placebo, plus chemotherapy.

Two clinical trials have suggested that the combination of vascular endothelial growth factor inhibitor with chemotherapy is associated with venous thromboembolism (VTE). This retrospective cohort study investigates whether a similar association exists when matrix metalloproteinase inhibitor (prinomastat) is combined with chemotherapy. Patients (n=1,023) with stage IIIB, IV, or recurrent non-small cell lung cancer (NSCLC) were followed during 2 randomized, double-blind trials of prinomastat versus placebo orally bid, plus gemcitabine/cisplatin (GC) or paclitaxel/carboplatin (PC). VTE included deep venous thrombosis (DVT) or pulmonary embolism (PE) confirmed by imaging or autopsy. Risks identified in univariate analysis (incidence densities compared by t test) were confirmed in multivariate analysis (proportional hazards model). During 7,500.3 patient-months, 58 VTE (31 PE, 27 isolated DVT) were confirmed in 54 patients. On univariate analysis, VTE was associated with central venous catheter placed within 3 months, 15 mg prinomastat plus GC, and to a lesser extent, 15 mg prinomastat plus PC, baseline performance status, and histologic type. VTE incidence was not increased by 15 mg prinomastat alone (post-discontinuation of chemotherapy), by chemotherapy plus placebo, or by 5 or 10 mg prinomastat plus chemotherapy. On multivariate analysis,VTE hazards (95% confidence interval) were 5.69 (2.61, 12.40) with recently placed central catheter, 2.78 (1.42, 5.43) with 15 mg prinomastat plus GC, and 2.06 (0.98, 4.31) with 15 mg prinomastat plus PC; performance status and histology were nonsignificant. We can conclude that combined treatment with 15 mg prinomastat plus chemotherapy approximately doubles the hazard of VTE among patients with advanced NSCLC.

Abogacía de salud, la partaqe olvidada de la promoción de salud en medicina familiar / Health Advocacy, the forgotten part of health promotion in family medicine

Introducción: La abogacía de salud es una estrategia de la promoción de salud y un componente esencial y fundamental de ella, mas no siempre se ve así, a veces se confunde o se intercambia con la promoción de salud misma. Objetivo: Realizar una revisión bibliográfica sobre el término abogacía de salud y su relación con la promoción de salud y la medicina familiar. Métodos: Análisis documental de la literatura encontrada en bases de datos y análisis y síntesis de estos documentos desde un enfoque socio-histórico y lógico. Conclusiones: A pesar de que es un tema sugerido para su inclusión en los programas de formación de medicina familiar según los estándares globales de la Organización Mundial de Médicos de Familia y Generales (2013), existen muy escasas referencias en la literatura hispana y latinoamericana de medicina familiar. La abogacía de salud es habitualmente subestimada y obviada como parte de la promoción de salud en medicina familiar, es una actitud, una competencia y una responsabilidad social del médico en general(AU)

Introduction: Health advocacy is a health promotion strategy and an essential and fundamental component of it, but it does not always looks like this, sometimes it is confused or exchanged with the promotion of health itself. Objective: To carry out a bibliographical review on the term health advocacy and its relationship with the promotion of health and family medicine. Methods: Documentary analysis of the literature found in data and analysis bases, and summary of these documents from a socio-historical and logical approach. Conclusions: Although it is a suggested topic for inclusion in family medicine training programs according to global standards of the World Organization of Family and General Physicians (2013), there are very few references in the Hispanic and Latin American literature on Family Medicine. Health advocacy is usually underestimated and ignored as part of health promotion in family medicine, it is an attitude, a competence and a social responsibility of the general practitioners(AU)

Modelos sobre promoción de salud en medicina familiar internacional e implicaciones en medicina general integral / Models on health promotion in international family medicine and implications in comprehensive general medicine

RESUMEN Introducción: los conceptos de salud y promoción de salud han evolucionado en los últimos años, oscilan desde una concepción médica hasta una más general lo cual ha conllevado a nuevas redefiniciones. Objetivo: identificar los diferentes modelos/enfoques en promoción de salud en la medicina familiar contemporánea internacional para proponer un modelo integrador sobre la base de lo mejor de cada modelo identificado. Método: se realizó una revisión bibliográfica de enero a marzo del 2019 en las bases de datos: MEDLINE y SciELO, usando palabras claves como: health promotion, y family medicine, family physician, general practice, general practitioner; se consultaron libros de texto de Medicina Familiar y Comunitaria de países como Estados Unidos, Canadá, España, Brasil, Argentina, y capítulos de libros y bibliografía básica sobre promoción de salud de reconocidos autores, utilizando como criterio de inclusión la práctica y enseñanza de la promoción de salud en la medicina familiar. Resultados: se exponen los diferentes modelos de la promoción de salud en la medicina familiar internacional: biomédico, educativo, de comportamientos/estilos de vida, de empoderamiento, de etapas de vida, socioambiental, de desigualdades sociales en salud, ecológico y salutogénico, los que fueron analizados a partir de diferentes puntos de vista de varios autores. Conclusiones: luego de un proceso de inducción, deducción, de análisis y síntesis, se propone un modelo integrador que recoge lo mejor de los modelos identificados y que pudiera aplicarse a la medicina general integral cubana.

ABSTRACT Background: the concepts of health and health promotion have evolved in recent years, ranging from a medical concept to a more general one, which has led to new redefinitions. Objective: to identify the different models / approaches in health promotion in international contemporary family medicine to propose an integrating model based on the best of each identified model. Method: a literature review was carried out from January to March 2019 in the databases: MEDLINE and SciELO, using keywords such as: health promotion, and family medicine, family physician, general practice, general practitioner; We consulted textbooks of Family and Community Medicine from countries such as the United States, Canada, Spain, Brazil, Argentina, and book chapters and basic bibliography on health promotion of recognized authors, using as an inclusion criterion the practice and teaching of health promotion in family medicine. Results: the different models of health promotion in international family medicine are presented: biomedical, educational, behavioral / lifestyles, empowerment, stages of life, socio-environmental, social inequalities in health, ecological and salutogenic, which were analyzed from different points of view of several authors. Conclusions: after a process of induction, deduction, analysis and synthesis, an integrating model is proposed that gathers the best of the identified models which could be applied to the Cuban comprehensive general medicine.

Prescripción social, una dimensión de la promoción de salud en la medicina general integral / Social Prescription, a Dimension of Health Promotion in Family Medicine

La prescripción social permite al médico de familia orientar, indicar, prescribir al paciente servicios y ayudas no médicas disponibles en la comunidad, que podrían proporcionarles bienestar y remediar problemas que tradicionalmente se van de la típica solución ofrecida por el profesional de la atención primaria. La prescripción social está relacionada con la prescripción de activos de salud, estilos de vida, intersectorialidad y determinantes sociales de la salud en la localidad que trabaja el médico de familia, y puede ser un componente de un nuevo modelo de salud en la atención primaria. En este trabajo se ofrecen ejemplos de servicios de prescripción social y se sugiere ampliar la lista con facilitadores/pacientes/usuarios en la comunidad(AU)

Social prescription allows the family physician to guide, indicate, prescribe the patient services and non-medical aids available in the community, which could provide welfare and solve problems that traditionally go away from the typical solution offered by the primary care professional. Social prescription is related to the prescription of health assets, lifestyles, intersectoriality and social determinants of health in the community where the family physicians works and can be a component of a new health model in primary care. This paper offers examples of social prescription services, while it is suggested to expand the list with facilitators, patients and users in the community(AU)

La Promoción de Salud en varios escenarios de actuación / Health Promotion in several actions' scenarios

Leímos con gran satisfacción el artículo Seis décadas de avances y retos para la promoción de la salud en Cuba, publicado en su revista por un colectivo de autoras muy reconocidas por su labor profesional. En este trabajo, como dice su título, se abordan los avances y retos de la promoción de salud (PdS) en nuestro país en las últimas décadas.1 Parte de su valor es la multisectorialidad de sus autoras, lo que permite conocer el trabajo que se realiza en el ámbito de la PdS en escenarios como: salud pública, educación superior, ciencias pedagógicas, cultura física y deporte. Su contenido se distingue por el debate objetivo, poco complaciente, que reconoce algunas de las dificultades que tiene el país para lograr la plena promoción de la salud, según lo establecido por los prerrequisitos descritos en la carta de Ottawa.2 Entre los temas debatidos está la situación de la vivienda y la crisis económica durante la década del 90, por la desaparición del socialismo en países de Europa Oriental.1 Uno de los postulados de la declaración de Curitiba es: la práctica de la promoción de la salud está influenciada directa e indirectamente por la política y por las ideologías.3) Lo que queda implícito en el texto del artículo, que plantea que la promoción de salud es el reflejo del sistema social político y económico. En Cuba se privilegian las conquistas sociales de nuestro sistema (paz, equidad, educación, salud gratuita y accesible para todos, electricidad universal, ecosistema estable, justicia social); predomina el bienestar social, reflejo de una voluntad política que garantiza la igualdad y la satisfacción de las necesidades básicas, en la manera de lo posible. No obstante, no ha sido posible alcanzar la prosperidad total y óptima como consecuencia de amenazas externas como el bloqueo económico norteamericano y algunas debilidades internas como la toma de...(AU)

Modelo integrador para la formación en promoción de salud de especialistas en Medicina General Integral / Integrating model for training in health promotion for specialists in Comprehensive General Medicine

RESUMEN Fundamento: concurren diferentes enfoques y modelos para abordar la enseñanza y práctica de la promoción de salud en la medicina familiar a nivel internacional; sin embargo, en Cuba no existía un modelo integrador para su implementación en este ámbito. Objetivo: diseñar un modelo integrador para la formación en promoción de salud de residentes y especialistas de Medicina General Integral. Métodos: se realizó una investigación de desarrollo en el Policlínico Universitario "Ramón López Peña" en el curso académico 2018-2019; se usaron métodos teóricos: histórico-lógico, analítico-sintético, inductivo-deductivo y la modelación, y de nivel empírico: la revisión documental, y para la valoración del producto la reunión de consenso. Resultados: se presentó una definición del modelo integrador realizado sobre la base de un proceso de abstracción, inducción y deducción de modelos internacionales; se describió su marco epistemológico, el contexto social en que se inserta, la representación gráfica, la explicación de cada dimensión, sus criterios de uso, las formas de instrumentación y evaluación. Conclusiones: el modelo propuesto resultó adecuado según el criterio de los especialistas consultados, quienes lo consideraron pertinente, efectivo, viable, relevante y factible de ser aplicado en el contexto para el cual se diseñó.

ABSTRACT Background: There are different approaches and models to address the teaching and practice of health promotion in family medicine at international level; however, in Cuba there was not any integrating model for its implementation in this area. Objective: to design an integrating model for training in health promotion for residents and specialists in Comprehensive General Medicine. Methods: a development research was carried out at "Ramón López Peña" University Polyclinic in the 2018-2019 academic year; Theoretical methods were used: historical-logical, analytical-synthetic, inductive-deductive and modeling, and empirical level ones: the documentary review, and the consensus meeting for the valuation of the product. Results: a definition of the integrating model was carried out based on a process of abstraction, induction and deduction of international models; its epistemological framework was described, the social context in which it is inserted, the graphic representation, the explanation of each dimension, its criteria of use, and the forms of instrumentation and evaluation. Conclusions: the proposed model was adequate according to the criteria of the specialists consulted, who considered it relevant, effective, viable, relevant and feasible to be applied in the context it was designed for.

II Encuentro de Alcaldes y Alcaldesas de Municipios y Comunidades Saludables en la Región de las Américas / II Meeting of Mayors and Mayoresses from Municipalities and Healthy Communities in the America Region

En noviembre del pasado año 2018 se efectuó en la ciudad de Santiago de Cuba el II Encuentro de Alcaldes y Alcaldesas de Municipios y Comunidades Saludables en la Región de las Américas. En este artículo se exponen los acuerdos tomados en este evento en cuanto a la Estrategia Regional de Promoción de Salud por parte de los diferentes países participantes y, además, se dan a conocer algunas de las acciones ejecutadas al respecto y otras en proyección en la provincia de Santiago de Cuba.

On November of last year 2018, it was hold in Santiago de Cuba city the II Meeting of Mayors and Mayoresses from Municipalities and Healthy Communities in the America Region. In this work, the agreements taken in this event as for the Regional Strategy of Health Promotion on the part of the different participant countries are exposed and, also, some of the tasks implemented on this respect and others in projection in Santiago de Cuba province.