Search

Background: Self-management education is a fundamental aspect in the health care of people with diabetes to develop the necessary skills for the improvement of health outcomes. Patients are required to have the competencies to manage electronic information resources-that is, an appropriate level of digital health literacy. The European project IC-Health aimed to improve digital health literacy among people with diabetes through the cocreation of massive open online courses (MOOCs)., Objective: We report the preliminary results obtained in 3 participating countries in the IC-Health project (Italy, Spain, and Sweden) regarding (1) experience of the participants during the cocreation process of MOOCs, (2) perceived changes in their digital health literacy level after using MOOCs, and (3) a preliminary assessment of the acceptability of MOOCs., Methods: The cocreation of the MOOCs included focus groups with adults and adolescents with diabetes and the creation of independent communities of practice for type 1 diabetes and type 2 diabetes participants aimed to co-design the MOOCs. Quantitative measures of the acceptability of MOOCs, experience in the cocreation process, and increase in digital health literacy (dimensions of finding, understanding, and appraisal) were assessed., Results: A total of 28 participants with diabetes participated in focus groups. Adults and adolescents agreed that the internet is a secondary source of health-related information. A total of 149 participants comprised the diabetes communities of practice. A total of 9 MOOCs were developed. Acceptability of the MOOCs and the cocreation experience were positively valued. There was a significant improvement in digital health literacy in both adults and adolescents after using MOOCs (P<.001)., Conclusions: Although the results presented on self-perceived digital health literacy are preliminary and exploratory, this pilot study suggests that IC-Health MOOCs represent a promising tool for the medical care of diabetes, being able to help reduce the limitations associated with low digital health literacy and other communication barriers in the diabetes population., (©Yolanda Alvarez-Perez, Lilisbeth Perestelo-Perez, Amado Rivero-Santana, Ana M Wagner, Alezandra Torres-Castaño, Ana Toledo-Chávarri, Andrea Duarte-Díaz, Dácil Alvarado-Martel, Barbara Piccini, Stephan Van den Broucke, Jessica Vandenbosch, Carina González-González, Michelle Perello, Pedro Serrano-Aguilar, IC-Health Project Consortium. Originally published in JMIR Diabetes (https://diabetes.jmir.org), 13.12.2021.)

Background: Most of the existing studies demonstrating the relationships between health literacy and health service use have been conducted outside Europe and cannot be generalised to European healthcare systems. Moreover, the majority of studies measure healthcare use via self-reports. This study investigated whether health literacy is related to the use of health services measured objectively via patient records in a European country., Methods: 9617 members of a Belgian health insurance fund (59% females, ages 18-88 years, mean age 55.8 years) completed an online questionnaire including the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q) and agreed to have their responses linked to the insurance fund's health service use records. A two-part model approach was used to assess the association between health literacy and the use of healthcare services and the costs related, adjusting for personal and behavioural characteristics., Results: Low health literacy is associated with more admissions to 1-day clinics, general practitioner (GP) home consultations, psychiatrist consultations and ambulance transports, and with longer stays in general hospitals. Associations with psychiatric hospitalisations and specialist consultations are also found but are not significant when correction for multiple comparisons is applied. In contrast, health literacy is not significantly related to the number of GP consultations, admissions to 1-day surgical clinics or emergency consultations. The relationship between health literacy and medication use is inconsistent., Conclusion: The results partly confirm that low health literacy is associated with greater use of healthcare services, and especially of more specialised services. Improving the health literacy of the population can be an effective strategy to promote a more (cost)-effective use of the healthcare services and thus contribute to population health., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Increased sensitivity to killing by human serum complement occurs in Salmonella typhimurium strains in which the 95-kilobase virulence plasmid is integrated into the chromosome. This phenotypic change appears to be due to alterations in plasmid gene expression and is reversed by the presence of an autonomous plasmid bearing a cloned region of the virulence plasmid. Accordingly, this region has been termed rsk for reduced serum killing. Sequence analysis of the region reveals that rsk is composed of a series of direct 10-base-pair (bp) repeats with a 21-nucleotide periodicity. Two adjacent repeats are identical, but increasing loss of conservation is apparent with increased distance both 5' and 3' of these highly conserved 10-mers. The smallest isolated sequence which restores the serum-resistant phenotype is only 66 bp long and contains the two identical 10-mers and one degenerate 10-mer (8 of 10 bp conserved) 3' of these. The minimal rsk region of 66 bp does not appear to contain a coding sequence, or a promoter, for a structural gene. It is proposed that the minimal rsk is an isolated regulatory site involved in the regulation of the serum resistance of S. typhimurium. Integration of the 95-kilobase plasmid disrupts the normal regulation of virulence plasmid genes, resulting in an increase in the killing of the bacteria by complement activated by the classical pathway. The introduction of the minimal rsk on a multiple-copy plasmid restores resistance to serum killing, possibly through the titration of a trans-acting regulatory factor.

The association of the virulence plasmid of Salmonella typhimurium with resistance to the bactericidal activity of human serum was studied in chromosomally isogenic pairs of strains differing in their virulence plasmid status. The presence of the plasmid correlated in three pairs of strains with resistance to serum. The absence of the plasmid correlated with increased sensitivity to serum, whereas the reintroduction of the plasmid to the cell resulted in the restoration of resistance to serum. Complement was activated by the classical and alternative pathways equally well by both strains of a pair, but the differential bactericidal action of serum was apparent only after the activation of complement by the classical pathway. No differences in the chemical compositions or in the molecular weight ranges of the lipopolysaccharides were apparent between paired strains. This work confirms the presence of a virulence plasmid-associated mechanism of resistance to serum and distinguishes it from lipopolysaccharide-mediated resistance.

Integration of the Salmonella typhimurium virulence plasmid into the chromosome reduces mouse virulence, serum resistance, and HeLa cell adhesion-invasion while prolonging lag time in minimal medium. The proposed virulence plasmid regulatory element, rsk, partially restores virulence and fully restores the other three phenotypes to wild-type levels. Plasmid curing reduces virulence without affecting the other phenotypes. rsk has no apparent effect on the cured strain.

Functionally hepatectomized rabbits showed convulsions and coma within 2 hours after the intravenous injection of fat emulsion and heparin. Intravenous injection of the detergent triton prevented this syndrome, if given before the fat emulsion and heparin, and reversed it if given subsequently. Extremely high plasma non-esterified fatty acid levels were noted in rabbits showing the convulsive syndrome, but not in animals that received the detergent. The mechanism of the convulsions probably includes the toxicity of high amounts of non-esterified fatty acids.