Search

OBJECTIVE: We sought to investigate whether prenatal vitamin C and E supplementation reduces the incidence of gestational hypertension (GH) and its adverse conditions among high- and low-risk women. STUDY DESIGN: In a multicenter randomized controlled trial, women were stratified by the risk status and assigned to daily treatment (1 g vitamin C and 400 IU vitamin E) or placebo. The primary outcome was GH and its adverse conditions. RESULTS: Of the 2647 women randomized, 2363 were included in the analysis. There was no difference in the risk of GH and its adverse conditions between groups (relative risk, 0.99; 95% confidence interval, 0.78-1.26). However, vitamins C and E increased the risk of fetal loss or perinatal death (nonprespecified) as well as preterm prelabor rupture of membranes. CONCLUSION: Vitamin C and E supplementation did not reduce the rate of preeclampsia or GH, but increased the risk of fetal loss or perinatal death and preterm prelabor rupture of membranes. [ABSTRACT FROM AUTHOR]

Objectives: 1) To design and validate indicators to measure the quality of the process of care that climacteric stage women receive in family medicine clinics (FMC). 2) To assess the quality of care that climacteric stage women receive in FMC. 3) To determine the association between quality of care and health-related quality of life (HR-QoL) among climacteric stage women.Methods: The study had two phases: I. Design and validation of indicators to measure the quality of care process by using the RAND/UCLA Appropriateness Method. II. Evaluation of the quality of care and its association with HR-QoL through a cross-sectional study conducted in two FMC located in Mexico City that included 410 climacteric stage women. The quality of care was measured by estimating the percentage of recommended care received (PRCR) by climacteric stage women in three process components: health promotion, screening, and treatment. The HR-QoL was measured using the Cervantes scale (0-155). The association between quality of care and HR-QoL was estimated through multiple linear regression analysis.Results: The lowest mean of PRCR was for the health promotion component (24.1%) and the highest for the treatment component (86.6%). The mean of HR-QoL was 50.1 points. The regression analysis showed that in the treatment component, for every 10 additional points of the PRCR, the global HR-QoL improved 2.8 points on the Cervantes scale (coefficient -0.28, P < 0.0001).Conclusion: The indicators to measure quality of care for climacteric stage women are applicable and feasible in family medicine settings. There is a positive association between the quality of the treatment component and HR-QoL; this would encourage interventions to improve quality of care for climacteric stage women. [ABSTRACT FROM AUTHOR]

Alumina-lantana (2.5, 5, 7.5 and 10 wt% La) mixed oxides of suitable texture to be applied as supports of catalysts for hydrodesulfurization of FCC naphtha-range oil-derived distillates were prepared by rare-earth pore-filling impregnation through corresponding nitrate. Co, Mo and P were deposited on binary carriers by one-pot simultaneous impregnation method used during commercial hydrotreating catalysts preparation. Materials were characterized by N2 physisorption, XRD, SEM–EDS, adsorbed CO2 FTIR (basicity measurements), Raman and UV–vis spectroscopies. Sulfided catalysts were studied by chemical composition (EDAX) and HR-TEM. In general, amount and strength of surface basic sites increased with rare-earth content in binary carriers at 5 wt% and higher. Deposited molybdates dispersion augmented with lanthanum content in carriers. However, progressively increasing rare-earth loading on supports was detrimental on gas-phase thiophene HDS (523–563 K, steady-state fixed-bed plug-flow reactor operating at atmospheric pressure). Hardly sulfidable tetrahedral Mo species could be originated by decomposition of heteropolymolybdates originally present in one-pot acidic (pH ~ 1.9) Co–Mo–P solutions by impregnating at basic conditions in pores of La-modified carriers. At isoconversion (~ 10%) rare-earth containing sulfided CoMo catalysts had decreased yield to fully saturated n-butane as to the material supported on pristine alumina.Alumina-lantana (2.5, 5, 7.5 and 10 wt% La) mixed oxides of suitable texture to be applied as supports of catalysts for hydrodesulfurization of FCC naphtha-range oil-derived distillates were prepared by rare-earth pore-filling impregnation through corresponding nitrate. Co, Mo and P were deposited on binary carriers by one-pot simultaneous impregnation method used during commercial hydrotreating catalysts preparation. Materials were characterized by N2 physisorption, XRD, SEM–EDS, adsorbed CO2 FTIR (basicity measurements), Raman and UV–vis spectroscopies. Sulfided catalysts were studied by chemical composition (EDAX) and HR-TEM. In general, amount and strength of surface basic sites increased with rare-earth content in binary carriers at 5 wt% and higher. Deposited molybdates dispersion augmented with lanthanum content in carriers. However, progressively increasing rare-earth loading on supports was detrimental on gas-phase thiophene HDS (523–563 K, steady-state fixed-bed plug-flow reactor operating at atmospheric pressure). Hardly sulfidable tetrahedral Mo species could be originated by decomposition of heteropolymolybdates originally present in one-pot acidic (pH ~ 1.9) Co–Mo–P solutions by impregnating at basic conditions in pores of La-modified carriers. At isoconversion (~ 10%) rare-earth containing sulfided CoMo catalysts had decreased yield to fully saturated n-butane as to the material supported on pristine alumina.Alumina-lantana (2.5, 5, 7.5 and 10 wt% La) mixed oxides of suitable texture to be applied as supports of catalysts for hydrodesulfurization of FCC naphtha-range oil-derived distillates were prepared by rare-earth pore-filling impregnation through corresponding nitrate. Co, Mo and P were deposited on binary carriers by one-pot simultaneous impregnation method used during commercial hydrotreating catalysts preparation. Materials were characterized by N2 physisorption, XRD, SEM–EDS, adsorbed CO2 FTIR (basicity measurements), Raman and UV–vis spectroscopies. Sulfided catalysts were studied by chemical composition (EDAX) and HR-TEM. In general, amount and strength of surface basic sites increased with rare-earth content in binary carriers at 5 wt% and higher. Deposited molybdates dispersion augmented with lanthanum content in carriers. However, progressively increasing rare-earth loading on supports was detrimental on gas-phase thiophene HDS (523–563 K, steady-state fixed-bed plug-flow reactor operating at atmospheric pressure). Hardly sulfidable tetrahedral Mo species could be originated by decomposition of heteropolymolybdates originally present in one-pot acidic (pH ~ 1.9) Co–Mo–P solutions by impregnating at basic conditions in pores of La-modified carriers. At isoconversion (~ 10%) rare-earth containing sulfided CoMo catalysts had decreased yield to fully saturated n-butane as to the material supported on pristine alumina.Alumina-lantana (2.5, 5, 7.5 and 10 wt% La) mixed oxides of suitable texture to be applied as supports of catalysts for hydrodesulfurization of FCC naphtha-range oil-derived distillates were prepared by rare-earth pore-filling impregnation through corresponding nitrate. Co, Mo and P were deposited on binary carriers by one-pot simultaneous impregnation method used during commercial hydrotreating catalysts preparation. Materials were characterized by N2 physisorption, XRD, SEM–EDS, adsorbed CO2 FTIR (basicity measurements), Raman and UV–vis spectroscopies. Sulfided catalysts were studied by chemical composition (EDAX) and HR-TEM. In general, amount and strength of surface basic sites increased with rare-earth content in binary carriers at 5 wt% and higher. Deposited molybdates dispersion augmented with lanthanum content in carriers. However, progressively increasing rare-earth loading on supports was detrimental on gas-phase thiophene HDS (523–563 K, steady-state fixed-bed plug-flow reactor operating at atmospheric pressure). Hardly sulfidable tetrahedral Mo species could be originated by decomposition of heteropolymolybdates originally present in one-pot acidic (pH ~ 1.9) Co–Mo–P solutions by impregnating at basic conditions in pores of La-modified carriers. At isoconversion (~ 10%) rare-earth containing sulfided CoMo catalysts had decreased yield to fully saturated n-butane as to the material supported on pristine alumina.Alumina-lantana (2.5, 5, 7.5 and 10 wt% La) mixed oxides of suitable texture to be applied as supports of catalysts for hydrodesulfurization of FCC naphtha-range oil-derived distillates were prepared by rare-earth pore-filling impregnation through corresponding nitrate. Co, Mo and P were deposited on binary carriers by one-pot simultaneous impregnation method used during commercial hydrotreating catalysts preparation. Materials were characterized by N2 physisorption, XRD, SEM–EDS, adsorbed CO2 FTIR (basicity measurements), Raman and UV–vis spectroscopies. Sulfided catalysts were studied by chemical composition (EDAX) and HR-TEM. In general, amount and strength of surface basic sites increased with rare-earth content in binary carriers at 5 wt% and higher. Deposited molybdates dispersion augmented with lanthanum content in carriers. However, progressively increasing rare-earth loading on supports was detrimental on gas-phase thiophene HDS (523–563 K, steady-state fixed-bed plug-flow reactor operating at atmospheric pressure). Hardly sulfidable tetrahedral Mo species could be originated by decomposition of heteropolymolybdates originally present in one-pot acidic (pH ~ 1.9) Co–Mo–P solutions by impregnating at basic conditions in pores of La-modified carriers. At isoconversion (~ 10%) rare-earth containing sulfided CoMo catalysts had decreased yield to fully saturated n-butane as to the material supported on pristine alumina.Alumina-lantana (2.5, 5, 7.5 and 10 wt% La) mixed oxides of suitable texture to be applied as supports of catalysts for hydrodesulfurization of FCC naphtha-range oil-derived distillates were prepared by rare-earth pore-filling impregnation through corresponding nitrate. Co, Mo and P were deposited on binary carriers by one-pot simultaneous impregnation method used during commercial hydrotreating catalysts preparation. Materials were characterized by N2 physisorption, XRD, SEM–EDS, adsorbed CO2 FTIR (basicity measurements), Raman and UV–vis spectroscopies. Sulfided catalysts were studied by chemical composition (EDAX) and HR-TEM. In general, amount and strength of surface basic sites increased with rare-earth content in binary carriers at 5 wt% and higher. Deposited molybdates dispersion augmented with lanthanum content in carriers. However, progressively increasing rare-earth loading on supports was detrimental on gas-phase thiophene HDS (523–563 K, steady-state fixed-bed plug-flow reactor operating at atmospheric pressure). Hardly sulfidable tetrahedral Mo species could be originated by decomposition of heteropolymolybdates originally present in one-pot acidic (pH ~ 1.9) Co–Mo–P solutions by impregnating at basic conditions in pores of La-modified carriers. At isoconversion (~ 10%) rare-earth containing sulfided CoMo catalysts had decreased yield to fully saturated n-butane as to the material supported on pristine alumina.Alumina-lantana (2.5, 5, 7.5 and 10 wt% La) mixed oxides of suitable texture to be applied as supports of catalysts for hydrodesulfurization of FCC naphtha-range oil-derived distillates were prepared by rare-earth pore-filling impregnation through corresponding nitrate. Co, Mo and P were deposited on binary carriers by one-pot simultaneous impregnation method used during commercial hydrotreating catalysts preparation. Materials were characterized by N2 physisorption, XRD, SEM–EDS, adsorbed CO2 FTIR (basicity measurements), Raman and UV–vis spectroscopies. Sulfided catalysts were studied by chemical composition (EDAX) and HR-TEM. In general, amount and strength of surface basic sites increased with rare-earth content in binary carriers at 5 wt% and higher. Deposited molybdates dispersion augmented with lanthanum content in carriers. However, progressively increasing rare-earth loading on supports was detrimental on gas-phase thiophene HDS (523–563 K, steady-state fixed-bed plug-flow reactor operating at atmospheric pressure). Hardly sulfidable tetrahedral Mo species could be originated by decomposition of heteropolymolybdates originally present in one-pot acidic (pH ~ 1.9) Co–Mo–P solutions by impregnating at basic conditions in pores of La-modified carriers. At isoconversion (~ 10%) rare-earth containing sulfided CoMo catalysts had decreased yield to fully saturated n-butane as to the material supported on pristine alumina. [ABSTRACT FROM AUTHOR]

Purpose. To provide a novel and personalized method ( FLIP, FLow and Irradiation Personalized) using patient-specific circulating blood flows and individualized time-dependent irradiation distributions, to quantify the dose delivered to blood in large vessels during proton or photon external beam radiotherapy. Methods. Patient-specific data were obtained from ten cancer patients undergoing radiotherapy, including the blood velocity field in large vessels and the temporal irradiation scheme using photons or protons. The large vessels and the corresponding blood flow velocities are obtained from phase-contrast MRI sequences. The blood dose is obtained discretizing the fluid into individual blood particles (BPs). A Lagrangian approach was applied to simulate the BPs trajectories along the vascular velocity field flowlines. Beam delivery dynamics was obtained from beam delivery machine measurements. The whole IS is split into a sequence of successive IEs, each one with its constant dose rate, as well as its corresponding initial and final time. Calculating the dose rate and knowing the spatiotemporal distribution of BPs, the dose is computed by accumulating the energy received by each BP as the time-dependent irradiation beams take place during the treatment. Results. Blood dose volume histograms from proton therapy and photon radiotherapy patients were assessed. The irradiation times distribution is obtained for BPs in both modalities. Two dosimetric parameters are presented: (i) D 3% , representing the minimum dose received by the 3% of BPs receiving the highest doses, and (ii) V 0.5 Gy , denoting the blood volume percentage that has received at least 0.5 Gy. Conclusion. A novel methodology is proposed for quantifying the circulating blood dose along large vessels. This methodology involves the use of patient-specific vasculature, blood flow velocity field, and dose delivery dynamics recovered from the irradiation machine. Relevant parameters that affect the dose received, as the distance between large vessels and CTV, are identified., (© 2024 Institute of Physics and Engineering in Medicine. All rights, including for text and data mining, AI training, and similar technologies, are reserved.)

Background: Comprehensive antenatal care (ANC) must prioritize competent, evidence-based medical attention to ensure a positive experience and value for its users. Unfortunately, there is scarce evidence of implementing this holistic approach to ANC in low- and middle-income countries, leading to gaps in quality and accountability. This study assessed care competence, women's experiences during the first ANC visit, and the factors associated with these care attributes., Methods and Findings: The study analyzed cross-sectional baseline data from the maternal eCohort study conducted in Mexico from August to December 2023. The study adapted the Quality Evidence for Health System Transformation (QuEST) network questionnaires to the Mexican context and validated them through expert group and cognitive interviews with women. Pregnant women aged 18 to 49 who had their first ANC visit with a family physician were enrolled in 48 primary clinics of the Instituto Mexicano del Seguro Social across 8 states. Care competence and women's experiences with care were the primary outcomes. The statistical analysis comprised descriptive statistics, multivariable linear and Poisson regressions. A total of 1,390 pregnant women were included in the study. During their first ANC visit, women received only 67.7% of necessary clinical actions on average, and 52% rated their ANC experience as fair or poor. Women with previous pregnancies (adjusted regression coefficient [aCoef.] -3.55; (95% confidence intervals [95% CIs]): -4.88, -2.22, p < 0.001), at risk of depression (aCoef. -3.02; 95% CIs: -5.61, -0.43, p = 0.023), those with warning signs (aCoef. -2.84; 95% CIs: -4.65, -1.03, p = 0.003), common pregnancy discomforts (aCoef. -1.91; 95% CIs: -3.81, -0.02, p = 0.048), or those who had a visit duration of less than 20 minutes (<15 minutes: aCoef. -7.58; 95% CIs: -10.21, -4.95, p < 0.001 and 15 to 19 minutes: aCoef. -2.73; 95% CIs: -4.79, -0.67, p = 0.010) and received ANC in the West and Southeast regions (aCoef. -5.15; 95% CIs: -7.64, -2.66, p < 0.001 and aCoef. -5.33; 95% CIs: -7.85, -2.82, p < 0.001, respectively) had a higher probability of experiencing poorer care competence. Higher care competence (adjusted prevalence ratio [aPR] 1.004; 95% CIs:1.002, 1.005, p < 0.001) and receiving care in a small clinic (aPR 1.19; 95% CIs: 1.06, 1.34, p = 0.003) compared to a medium-sized clinic were associated with a better first ANC visit experience, while common pregnancy discomforts (aPR 0.94; 95% CIs: 0.89, 0.98, p = 0.005) and shorter visit length (aPR 0.94; 95% CIs: 0.88, 0.99, p = 0.039) were associated with lower women's experience. The primary limitation of the study is that participants' responses may be influenced by social desirability bias, leading them to provide socially acceptable responses., Conclusions: We found important gaps in adherence to ANC standards and that care competence during the first ANC visit is an important predictor of positive user experience. To inform quality improvement efforts, IMSS should institutionalize the routine monitoring of ANC competencies and ANC user experience. This will help identify poorly performing facilities and providers and address gaps in the provision of evidence-based and women-centered care., Competing Interests: MEK is a member of the Editorial Board of PLOS Medicine. SVD, CQF, MPC, DPM, VMG, LRGC, MCCM, VMG, MARG, GEA, CEPR, CAPA, and ASD are employed by the IMSS, yet IMSS played no role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript. RPC and CA have declared that no competing interests exist., (Copyright: © 2024 Doubova et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Mobile health (mHealth) interventions may be an efficacious strategy for promoting health behaviors among pediatric populations, but their success at the implementation stage has proven challenging. The purpose of this article is to provide a blueprint for using human-centered design (HCD) methods to maximize the potential for implementation, by sharing the example of a youth-, family-, and clinician-engaged process of creating an mHealth intervention aimed at promoting healthcare transition readiness., Method: Following HCD methods in partnership with three advisory councils, we conducted semistructured interviews with 13- to 15-year-old patients and their caregivers in two phases. In Phase 1, participants described challenges during the transition journey, and generated ideas regarding the format, content, and other qualities of the mHealth tool. For Phase 2, early adolescents and caregivers provided iterative feedback on two sequential intervention prototypes. Data were analyzed using thematic analysis in Phase 1 and the rapid assessment process for Phase 2., Results: We interviewed 11 youth and 8 caregivers. The sample included adolescents with a range of chronic health conditions. In Phase 1, participants supported the idea of developing an autonomy-building tool, delivering transition readiness education via social media style videos. In Phase 2, participants responded positively to the successive prototypes and provided suggestions to make information accessible, relatable, and engaging., Conclusions: The procedures shared in this article could inform other researchers' plans to apply HCD in collaboration with implementation partners to develop mHealth interventions. Our future directions include iteratively developing more videos to promote transition readiness and implementing the intervention in clinical care., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Perturbations in complex media, due to their own dynamical evolution or to external effects, are often seen as detrimental. Therefore, a common strategy, especially for telecommunication and imaging applications, is to limit the sensitivity to those perturbations in order to avoid them. Here, instead, we consider enhancing the interaction between light and perturbations to produce the largest change in the output intensity distribution. Our work hinges on the use of tensor-based techniques, presently at the forefront of machine learning explorations, to study intensity-based measurements where its quadratic relationship to the field prevents the use of standard matrix methods. With this tensor-based framework, we can identify the maximum-information intensity channel which maximizes the change in its output intensity distribution and the Fisher information encoded in it about a given perturbation. We further demonstrate experimentally its superiority for robust and precise sensing applications. Additionally, we derive the appropriate strategy to reach the precision limit for intensity-based measurements, leading to an increase in Fisher information by more than four orders of magnitude compared to the mean for random wavefronts when measured with the pixels of a camera., (© 2024. The Author(s).)

Introduction: Liquefied petroleum gas (LPG) is a clean cooking fuel that emits less household air pollution (HAP) than polluting cooking fuels (e.g. charcoal, wood). While switching from polluting fuels to LPG can reduce HAP and improve health, the impact of 'stacking' (concurrent use of polluting fuels and LPG) on adverse health symptoms (e.g. headaches, eye irritation, cough) among female cooks is uncertain., Methods: Survey data from the CLEAN-Air(Africa) study was collected on cooking patterns and health symptoms over the last 12 months (cough, wheezing, chest tightness, shortness of breath, eye irritation, headaches) from approximately 400 female primary cooks in each of three peri‑urban communities in sub-Saharan Africa: Mbalmayo, Cameroon; Obuasi, Ghana; and Eldoret, Kenya. Random effects Poisson regression, adjusted for socioeconomic and health-related covariates, assessed the relationship between primary and secondary cooking fuel type and self-reported health symptoms., Results: Among 1,147 participants, 10 % ( n = 118) exclusively cooked with LPG, 45 % ( n = 509) stacked LPG and polluting fuels and 45 % ( n = 520) exclusively cooked with polluting fuels. Female cooks stacking LPG and polluting fuels had significantly higher odds of shortness of breath (OR 2.16, 95 %CI:1.04-4.48) compared with those exclusively using LPG. In two communities, headache prevalence was 30 % higher among women stacking LPG with polluting fuels (Mbalmayo:82 %; Eldoret:65 %) compared with those exclusively using LPG (Mbalmayo:53 %; Eldoret:33 %). Women stacking LPG and polluting fuels (OR 2.45, 95 %CI:1.29-4.67) had significantly higher odds of eye irritation than women cooking exclusively with LPG. Second-hand smoke exposure was significantly associated with higher odds of chest tightness (OR 1.92, 95 % CI:1.19-3.11), wheezing (OR 1.76, 95 % CI:1.06-2.91) and cough (OR 1.78, 95 %CI:1.13-2.80)., Conclusions: In peri‑urban sub-Saharan Africa, women exclusively cooking with LPG had lower odds of several health symptoms than those stacking LPG and polluting fuels. Promoting a complete transition to LPG in these communities may likely generate short-term health benefits for primary cooks., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 The Author(s).)

The presence of SNPs in genes related to DNA damage repair in M. tuberculosis can trigger hypermutagenic phenotypes with a higher probability of generating drug resistance. The aim of this research was to compare the presence of SNPs in genes related to DNA damage repair between sensitive and DR isolates, as well as to describe the dynamics in the presence of SNPs in M. tuberculosis isolated from recently diagnosed TB patients of the state of Veracruz, Mexico. The presence of SNPs in the coding regions of 65 genes related to DNA damage repair was analyzed. Eighty-six isolates from 67 patients from central Veracruz state, Mexico, were sequenced. The results showed several SNPs in 14 genes that were only present in drug-resistant genomes. In addition, by following of 15 patients, it was possible to describe three different dynamics of appearance and evolution of non-synonymous SNPs in genes related to DNA damage repair: 1) constant fixed SNPs, 2) population substitution, and 3) gain of fixed SNPs. Further research is required to discern the biological significance of each of these pathways and their utility as markers of DR or for treatment prognosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Pérez-Martínez, Zenteno-Cuevas. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: The Mexican government has pursued multiple initiatives to improve healthcare coverage and financial protection. Yet, out-of-pocket health spending and use of private sector providers in Mexico remains high. In this paper, we sought to describe the characteristics of public and private healthcare users, describe recent visit quality across provider types, and to assess whether perceiving the public healthcare sector as poor quality is associated with private health sector use., Methods and Findings: We analyzed the cross-sectional People's Voice Survey conducted from December 2022 to January 2023. We used Chi-square tests to compare contextual, individual, and need-for-care factors and ratings of most recent visits between users of public (social security and other public providers) and private sector providers (stand-alone private providers and providers adjacent to pharmacies). We used a multivariable Poisson regression model to assess associations between low ratings of public healthcare sources and the use of private care. Among the 811 respondents with a healthcare visit in the past year, 31.2% used private sources. Private healthcare users were more educated and had higher incomes than public healthcare users. Quality of most recent visit was rated more highly in private providers (70.2% rating the visit as excellent or very good for stand-alone private providers and 54.3% for pharmacy-adjacent doctors) compared to social security (41.6%) and other public providers (46.6%). Those who perceived public health institutions as low quality had a higher probability of seeking private healthcare., Conclusion: Users rated public care visits poorly relative to private care; at the population level, perceptions of poor quality care may drive private care use and hence out-of-pocket costs. Improving public healthcare quality is necessary to ensure universal health coverage., Competing Interests: HHL is an academic Editor for PLOS Global Public Health. Other authors have declared no competing interests., (Copyright: © 2024 Doubova et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Type 2 diabetes (DM2) is an increasingly prevalent disease that challenges tuberculosis (TB) control strategies worldwide. It is significant that DM2 patients with poor glycemic control (PDM2) are prone to developing tuberculosis. Furthermore, elucidating the molecular mechanisms that govern this susceptibility is imperative to address this problem. Therefore, a pilot transcriptomic study was performed. Human blood samples from healthy controls (CTRL, HbA1c < 6.5%), tuberculosis (TB), comorbidity TB-DM2, DM2 (HbA1c 6.5-8.9%), and PDM2 (HbA1c > 10%) groups (n = 4 each) were analyzed by differential expression using microarrays. We use a network strategy to identify potential molecular patterns linking the differentially expressed genes (DEGs) specific for TB-DM2 and PDM2 (p-value < 0.05, fold change > 2). We define OSM, PRKCD, and SOCS3 as key regulatory genes (KRGs) that modulate the immune system and related pathways. RT-qPCR assays confirmed upregulation of OSM, PRKCD, and SOCS3 genes (p < 0.05) in TB-DM2 patients (n = 18) compared to CTRL, DM2, PDM2, or TB groups (n = 17, 19, 15, and 9, respectively). Furthermore, OSM, PRKCD, and SOCS3 were associated with PDM2 susceptibility pathways toward TB-DM2 and formed a putative protein-protein interaction confirmed in STRING. Our results reveal potential molecular patterns where OSM, PRKCD, and SOCS3 are KRGs underlying the compromised immune response and susceptibility of patients with PDM2 to develop tuberculosis. Therefore, this work paved the way for fundamental research of new molecular targets in TB-DM2. Addressing their cellular implications, and the impact on the diagnosis, treatment, and clinical management of TB-DM2 could help improve the strategy to end tuberculosis for this vulnerable population., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Mycolicibacterium fortuitum , a fast-growing nontuberculous mycobacterium, is a significant pathogen in healthcare-associated infections, encompassing skin, soft tissue, and pulmonary diseases. In this study, we present draft genome sequences from 12 M . fortuitum strains isolated from sputum samples from patients diagnosed with pulmonary infections in Mexico., Competing Interests: The authors declare no conflict of interest.

Objective: To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications., Methods: A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022., Results: Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I., Conclusion: SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it., Competing Interests: Conflicts to interest: none to declare, (© 2024. Federação Brasileira de Ginecologia e Obstetrícia. All rights reserved.)

Genetic variation in tuberculosis is influenced by the host environment, patients with comorbidity, and tuberculosis-type 2 diabetes mellitus (TB-T2DM) and implies a higher risk of treatment failure and development of drug resistance. Considering the above, this study aimed to evaluate the influence of T2DM on the dynamic of polymorphisms related to antibiotic resistance in TB. Fifty individuals with TB-T2DM and TB were initially characterized, and serial isolates of 29 of these individuals were recovered on day 0 (diagnosis), 30, and 60. Genomes were sequenced, variants related to phylogeny and drug resistance analyzed, and mutation rates calculated and compared between groups. Lineage X was predominant. At day 0 (collection), almost all isolates from the TB group were sensitive, apart from four isolates from the TB-T2DM group showing the mutation katG S315T, from which one isolate had the mutations rpoB S450L, gyrA A90G, and gyrA D94G. This pattern was observed in a second isolate at day 30. The results provide a first overview of the dynamics of mutations in resistance genes from individuals with TB-T2DM, describing an early development of resistance to isoniazid and a rapid evolution of resistance to other drugs. Although preliminary, these results help to explain the increased risk of drug resistance in individuals with TB and T2DM.

Background: Relatively clean cooking fuels such as liquefied petroleum gas (LPG) emit less fine particulate matter (PM 2·5 ) and carbon monoxide (CO) than polluting fuels (eg, wood, charcoal). Yet, some clean cooking interventions have not achieved substantial exposure reductions. This study evaluates determinants of between-community variability in exposures to household air pollution (HAP) across sub-Saharan Africa., Methods: In this measurement study, we recruited households cooking primarily with LPG or exclusively with wood or charcoal in peri-urban Cameroon, Ghana, and Kenya from previously surveyed households. In 2019-20, we conducted monitoring of 24 h PM 2·5 and CO kitchen concentrations (n=256) and female cook (n=248) and child (n=124) exposures. PM 2·5 measurements used gravimetric and light scattering methods. Stove use monitoring and surveys on cooking characteristics and ambient air pollution exposure (eg, walking time to main road) were also administered., Findings: The mean PM 2·5 kitchen concentration was five times higher among households cooking with charcoal than those using LPG in the Kenyan community (297 μg/m 3 , 95% CI 216-406, vs 61 μg/m 3 , 49-76), but only 4 μg/m 3 higher in the Ghanaian community (56 μg/m 3 , 45-70, vs 52 μg/m 3 , 40-68). The mean CO kitchen concentration in charcoal-using households was double the WHO guideline (6·11 parts per million [ppm]) in the Kenyan community (15·81 ppm, 95% CI 8·71-28·72), but below the guideline in the Ghanaian setting (1·77 ppm, 1·04-2·99). In all communities, mean PM 2·5 cook exposures only met the WHO interim-1 target (35 μg/m 3 ) among LPG users staying indoors and living more than 10 min walk from a road., Interpretation: Community-level variation in the relative difference in HAP exposures between LPG and polluting cooking fuel users in peri-urban sub-Saharan Africa might be attributed to differences in ambient air pollution levels. Thus, mitigation of indoor and outdoor PM 2·5 sources will probably be critical for obtaining significant exposure reductions in rapidly urbanising settings of sub-Saharan Africa., Funding: UK National Institute for Health and Care Research., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

COVID-19 had severe direct and indirect effects on health and well-being in Latin America. To understand the extent to which disruptions among non-COVID-19-related health services affected population health, we used administrative data from the period 2015-21 to examine public hospital discharges and mortality for conditions amenable to health care in four Latin American countries: Brazil, Ecuador, Mexico, and Peru. Between March 2020 and December 2021, hospitalization rates for these conditions declined by 28 percent and mortality rates increased by 15 percent relative to prepandemic years. Noncommunicable diseases accounted for 89 percent of this rise in mortality. The poorest states in each country experienced relatively larger increases in mortality. Our results, which focus on the health effects of service disruption, suggest that maintaining health care services in this region during the pandemic could have avoided at least 96,000 deaths. Policies should focus on maintaining essential health care services during emergencies, particularly for patients with noncommunicable diseases, and on minimizing negative consequences by ensuring coordinated and continuous care; leveraging alternative modalities of care, such as telemedicine; broadening the role of nonphysician health care workers; and expanding options for medication delivery.

Genomics has significantly revolutionized pathogen surveillance, particularly in epidemiological studies, the detection of drug-resistant strains, and disease control. Despite its potential, the representation of Latin American countries in the genomic catalogues of Mycobacterium tuberculosis (Mtb), the bacteria responsible for Tuberculosis (TB), remains limited. In this study, we present a whole genome sequencing (WGS)-based analysis of 85 Mtb clinical strains from 17 Mexican states, providing insights into local adaptations and drug resistance signatures in the region. Our results reveal that the Euro-American lineage (L4) accounts for 94% of our dataset, showing 4.1.2.1 (Haarlem, n = 32), and 4.1.1.3 (X-type, n = 34) sublineages as the most prevalent. We report the presence of the 4.1.1.3 sublineage, which is endemic to Mexico, in six additional locations beyond previous reports. Phenotypic drug resistance tests showed that 34 out of 85 Mtb samples were resistant, exhibiting a variety of resistance profiles to the first-line antibiotics tested. We observed high levels of discrepancy between phenotype and genotype associated with drug resistance in our dataset, including pyrazinamide-monoresistant Mtb strains lacking canonical variants of drug resistance. Expanding the Latin American Mtb genome databases will enhance our understanding of TB epidemiology and potentially provide new avenues for controlling the disease in the region., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Mejía-Ponce et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Most research on community empowerment provides evidence on engaging communities for health promotion purposes rather than attempts to create empowering conditions. This study addresses this gap., Intervention: Big Local started in 2010 with £271M from the National Lottery. Ending in 2026, it gives 150 relatively disadvantaged communities in England control over £1M to improve their neighbourhoods., Objective: To investigate health and social outcomes, at the population level and among engaged residents, of the community engagement approach adopted in a place-based empowerment initiative., Study Design, Data Sources and Outcome Variables: This study reports on the third wave of a longitudinal mixed-methods evaluation. Work package 1 used a difference-in-differences design to investigate the impact of Big Local on population outcomes in all 150 Big Local areas compared to matched comparator areas using secondary data. The primary outcome was anxiety; secondary outcomes included a population mental health measure and crime in the neighbourhood. Work package 2 assessed active engagement in Big Local using cross-sectional data and nested cohort data from a biannual survey of Big Local partnership members. The primary outcome was mental well-being and the secondary outcome was self-rated health. Work package 3 conducted qualitative research in 14 Big Local neighbourhoods and nationally to understand pathways to impact. Work package 4 undertook a cost-benefit analysis using the life satisfaction approach to value the benefits of Big Local, which used the work package 1 estimate of Big Local impact on life satisfaction., Results: At a population level, the impacts on 'reporting high anxiety' (-0.8 percentage points, 95% confidence interval -2.4 to 0.7) and secondary outcomes were not statistically significant, except burglary (-0.054 change in z -score, 95% confidence interval -0.100 to -0.009). There was some effect on reduced anxiety after 2017. Areas progressing fastest had a statistically significant reduction in population mental health measure (-0.053 change in z -score, 95% confidence interval -0.103 to -0.002). Mixed results were found among engaged residents, including a significant increase in mental well-being in Big Local residents in the nested cohort in 2018, but not by 2020; this is likely to be COVID-19. More highly educated residents, and males, were more likely to report a significant improvement in mental well-being. Qualitative accounts of positive impacts on mental well-being are often related to improved social connectivity and physical/material environments. Qualitative data revealed increasing capabilities for residents' collective control. Some negative impacts were reported, with local factors sometimes undermining residents' ability to exercise collective control. Finally, on the most conservative estimate, the cost-benefit calculations generate a net benefit estimate of £64M., Main Limitations: COVID-19 impacted fieldwork and interpretation of survey data. There was a short 4-year follow-up (2016/20), no comparators in work package 2 and a lack of power to look at variations across areas., Conclusions: Our findings suggest the need for investment to support community organisations to emerge from and work with communities. Residents should lead the prioritisation of issues and design of solutions but not necessarily lead action; rather, agencies should work as equal partners with communities to deliver change., Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research Programme (16/09/13) and will be published in full in Public Health Research ; Vol. 11, No. 9. See the NIHR Journals Library website for further project information.

Introduction: Patients with rheumatoid arthritis (RA) are at increased risk of developing tuberculosis, and even more so if they receive biological agents. In Mexico, the prevalence of latent tuberculosis infection (LTBI) in RA diagnosed by interferon-gamma release assay (IGRA) is largely unknown. The objective was to determine LTBI prevalence and the associated risk factors in rheumatoid arthritis patients., Methods: A cross-sectional study was performed comprising 82 patients with RA who attended the rheumatology service at a second-level hospital. Demographic characteristics, comorbidity, Bacillus Calmette-Guerin (BCG) vaccination and smoking history, type of treatment, disease activity and functional capacity were investigated. The Disease Activity Score 28 and the Health Assessment Questionnaire-Disability Index were applied for the estimate of RA activity and functional capacity. Further information was compiled from the electronic medical records and personal interviews. LTBI was determined by QuantiFERON TB Gold Plus (QIAGEN, Germantown, USA)., Results: Prevalence of LTBI was 14% (95% confidence interval (CI): 8.6% to 23.9%). Factors associated with LTBI were history of smoking (odds ratio (OR) = 6.63 95% CI 1.01 to 43.3) and disability score (OR = 7.19 95%CI 1.41 to 36.6)., Conclusions: The prevalence of LTBI in Mexican patients with RA was 14%. Our results suggest prevention of smoking and functional incapacity could reduce the risk of LTBI. Further research could endorse our results., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Zavala del Ángel et al.)

Although beta-amyloid (Aβ) and phosphorylated tau remain the preferred targets for disease-modifying treatments (DMT) against Alzheimer's disease (AD), part of the pathophysiological mechanisms of cognitive impairment are related to neuroinflammation and oxidative stress. In mild cognitive impairment (MCI), a prodromal stage of AD and other neurodegenerative conditions, the joint appearance of inflammation, oxidative stress, and metabolic alterations are the common pathways of neurotoxicity and neurodegeneration. The standardized extract of Ginkgo biloba EGb 761 interferes with the pathogenic mechanisms involved in both the development of cognitive impairment due to AD and that of vascular origin. The primary objective of this study is to compare changes in the levels of blood markers of inflammation and oxidative stress after treatment with EGb 761 in a cohort of 100 patients with MCI. In addition, we aim to assess changes in these blood markers during an additional 12-month extension phase in which patients in the control group will also receive EGb 761 and patients in the active group will extend their treatment duration. Secondary objectives include comparing changes in neuropsychiatric and cognitive test scores between the baseline (v0) and 12-month visits (v2). This study is a Phase IV, single-center, randomized, open-label, parallel-group clinical trial consisting of the 12-month follow-up of a cohort of participants with MCI [Global Deterioration Scale (GDS) = 3] and an extension with an additional 12-month follow-up. During the first 12 months, participants will be randomized into two arms: in one arm, patients will receive 1 daily tablet of EGb 761 240 mg orally (study group, n = 50), while in the other arm, patients will not receive EGb 761 and will undergo the same assessments as the treated group (control group, n = 50). After the first 12 months of the study, patients in the EGb 761-treated group will continue treatment, and patients in the control group will be offered one EGb 761 240 mg tablet per day orally. All participants will be monitored for an additional 12 months. A battery of blood markers of inflammation and oxidative stress will be quantified at v0, v1, v2, v3, and v4. The Olink Proteomics panel of inflammation markers ( https://www.olink.com/products/inflammation/ ) will be used to evaluate 92 proteins associated with inflammatory diseases and related biological processes. The second panel measures 92 proteins involved in neurological processes. At v0, v2, and v4, neuropsychological and neurological evaluations will be conducted in addition to vital signs and anthropometric studies using a body composition monitor with bioimpedance technology (Tanita). Sixty percent of the 100 MCI patients recruited were women. The mean age was 73.1 years, and the mean time between symptom onset and MCI diagnosis was 2.9 years. The mean Mini-Mental State Examination (MMSE) score was 26.7. Depressive and anxiety disorders, as well as vascular risk factors, were the most frequent comorbidities among the cohort. The study is still ongoing, and results for the first year of treatment (v0, v1, v2) are expected by 2023. Individuals with MCI have an elevated risk of developing dementia. EGb 761 is used worldwide for the symptomatic treatment of cognitive disorders due to its neuroprotective effects. In experimental models and clinical observational studies, EGb 761 has shown strong antioxidant and anti-inflammatory activity. As a result, this study has been proposed to evaluate the antioxidant and anti-inflammatory effects on plasma markers and their potential clinical correlation with the progression of cognitive decline in patients with MCI.Trial registration: Registro Español de estudios clínicos (REec) number 2020-003776-41, ClinicalTrials.gov Identifier: NCT05594355., (© 2023. The Author(s).)

The aim of this study was to analyze the efficiency of a system of treatment of organic swine waste as a management tool in the transformation of organic waste into products of value in the swine industry. The residues from the pig farm and the products obtained (compost, biol and biogas) were quantified and characterized, as were the energy used within the process and the distribution of the products. The negative impacts on the soil and adjacent river, as well as the efficiency of the compost as fertilizers and biol in grass and corn crops, were evaluated. The subsystems were: S1-slurry separation, S2-anaerobic digestion, S3-composting solid fraction of slurry, and S4-composting of dead tissues. S2 was not efficient in obtaining biol, with COD and TSS required. The process requires 31.1 kW/d of electrical energy and 3.22 L/d of diesel. The biogas (35,486.0 m 3 /d) is used for cooking food and heating houses, whilst the compost (82 kg/d) and biol (7.72 m 3 /d) replace inorganic fertilizers in crops. The system was adequate for the transformation of 38,109.0 kg/d of waste into valuable products. The biol needs further treatment time or to couple biodigesters-another treatment. The pig farm can be considered eco-efficient., Competing Interests: Conflict of interestThe authors have no conflicts of interest to declare that are relevant to the content of this article., (© Springer Nature Japan KK, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Rhabdoid tumors are malignant neoplasms of low prevalence, aggressive behavior, and high mortality. They were initially described as renal tumors, although tumors with the same histopathological and immunohistochemical characteristics have been discovered in other locations, mainly in the central nervous system. Few cases of mediastinal location have been reported internationally. This work aimed to describe the case of a mediastinal rhabdoid tumor., Case Report: We describe the case of an 8-month-old male patient admitted to the pediatric department with dysphonia and laryngeal stridor progressing to severe respiratory distress. Contrast-enhanced computed tomography of the thorax showed a large mass with homogeneous soft tissue density, and smooth and well-defined borders, with suspicion of malignant neoplasm. Due to the oncological emergency compressing the airway, empirical chemotherapy was initiated. Subsequently, the patient underwent incomplete tumor resection due to its invasive nature. The pathology report showed morphology compatible with a rhabdoid tumor, which immunohistochemical and genetic studies corroborated. Chemotherapy and radiotherapy to the mediastinum were administered. However, the patient died three months after the initial treatment due to the aggressive behavior of the tumor., Conclusions: Rhabdoid tumors are aggressive and malignant entities difficult to control and have poor survival. Early diagnosis and aggressive treatment are required, although the 5-year survival does not exceed 40%. It is necessary to analyze and report more similar cases to establish specific treatment guidelines., (Copyright: © 2023 Permanyer.)

Background: Bovine pericardium (BP) is a scaffold widely used in soft tissues regeneration; however, its calcification in contact with glutaraldehyde, represent an opportunity for its application in hard tissues, such as bone in the oral cavity., Objective: To develop and to characterize decellularized and glutaraldehyde-crosslinked bovine pericardium (GC-BP) as a potential scaffold for guided bone regeneration GBR., Methods: BP samples from healthy animals of the bovine zebu breed were decellularized and crosslinked by digestion with detergents and glutaraldehyde respectively. The resulting cell-free scaffold was physical, chemical, mechanical, and biologically characterized thought hematoxylin and eosin staining, DNA quantification, scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), uniaxial tensile test, cell viability and live and dead assay in cultures of dental pulp stem cells (DPSCs)., Results: The decellularization and crosslinking of BP appeared to induce conformational changes of the CLG molecules, which led to lower mechanical properties at the GC-BP scaffold, at the same time that promoted cell adhesion and viability of DPSCs., Conclusion: This study suggests that the decellularized and GC-BP is a scaffold with the potential to be used promoting DPSCs recruitment, which has a great impact on the dental area.

Objectives: To compare sociodemographic and clinical characteristics among obese and non-obese women in Mexico and analyze the association between obesity and pregnancy complications., Methods: We conducted a secondary data analysis of the 2018-2019 Mexican National Survey of Health and Nutrition. We included women aged 20-49 years who had at least one live birth in the five years preceding the survey (n = 1573). We performed a double-weighted (by IP-weights and survey-weights) multilevel multiple logistic regression analysis., Results: Obesity was prevalent in 32% of pregnant women. Obese and non-obese women received similar antenatal care. 42.6% of obese women, compared to 33.6% of non-obese had one or more pregnancy or labor complications. Compared with non-obese women, obese women were older and had more chronic diseases. Obesity was associated with a 48% increase in the probability of complications., Conclusion: Due to the high prevalence of obesity among Mexican women of reproductive age and given the independent association between obesity and complications during pregnancy and labor, the development and implementation of specific clinical guidelines on weight management before conception, during pregnancy, and post-partum for women who are obese is an unmet need in Mexico., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

We study the conditions under which fluorescent beads can be used to emulate single fluorescent molecules in the calibration of optical microscopes. Although beads are widely used due to their brightness and easy manipulation, there can be notable differences between the point spread functions (PSFs) they produce and those for single-molecule fluorophores, caused by their different emission patterns and sizes. We study theoretically these differences for various scenarios, e.g., with or without polarization channel splitting, to determine the conditions under which the use of beads as a model for single molecules is valid. We also propose methods to model the blurring due to the size difference and compensate for it to produce PSFs that are more similar to those for single molecules.

Objective: Over 900 million people in sub-Saharan Africa (SSA) live in energy poverty, relying on cooking polluting fuels (e.g. wood, charcoal). The association between energy poverty and mental/physical health-related quality of life (HRQoL) among women in SSA, who are primarily tasked with cooking, is unknown., Methods: Females (n ​= ​1,150) from peri-urban Cameroon, Kenya and Ghana were surveyed on their household energy use and mental/physical health status using the standardized Short-Form 36 (SF-36) questionnaire. Random effects linear regression linked household energy factors to SF-36 mental (MCS) and physical component summary (PCS) scores. A binary outcome of 'likely depression' was derived based on participants' MCS score. Random effects Poisson regression with robust error variance assessed the relationship between household energy factors and odds of likely depression., Results: The prevalence of likely depression varied by a factor of four among communities (36%-Mbalmayo, Cameroon; 20%-Eldoret, Kenya; 9%-Obuasi, Ghana). In the Poisson model (coefficient of determination (R 2 ) ​= ​0.28), females sustaining 2 or more cooking-related burns during the previous year had 2.7 (95%CI:[1.8,4.1]) times the odds of likely depression as those not burned. Females cooking primarily with charcoal and wood had 1.6 times (95%CI:[0.9,2.7]) and 1.5 times (95%CI:[0.8,3.0]) the odds of likely depression, respectively, as those primarily using liquefied petroleum gas. Women without electricity access had 1.4 (95%CI:[1.1,1.9]) times the odds of likely depression as those with access. In the MCS model (R 2  ​= ​0.23), longer time spent cooking was associated with a lower average MCS score in a monotonically increasing manner. In the PCS model (R 2  ​= ​0.32), women injured during cooking fuel collection had significantly lower (-4.8 95%CI:[-8.1,-1.4]) PCS scores., Conclusion: The burden of energy poverty in peri-urban communities in SSA extends beyond physical conditions. Experiencing cooking-related burns, using polluting fuels for cooking or lighting and spending more time cooking are potential risk factors for lower mental HRQoL among women., Competing Interests: The authors have no competing interest to declare., (© 2022 The Authors.)

Access to clean energy for cooking is central to achieving Sustainable Development Goal 7. Latest predictions suggest that this goal will not be met by 2030, with further setbacks due to the COVID-19 pandemic. We investigated the impacts of COVID-19 restrictions on household cooking fuel, practices and dietary behaviours in a peri-urban community in Central Cameroon. Using surveys (n = 333) and qualitative semi-structured interviews (n = 12), we found negative financial impacts and high levels of food insecurity, with 83 % and 56 % of households reporting reduced income and insufficient food, respectively. Households reduced food intake and cooking frequency and relied more heavily on local sources (e.g., farmland) to feed their families. Changes in primary cooking fuel were less pronounced and fuel choice was inherently linked to cooking behaviours, with some households utilising LPG more often for simple tasks, such as reheating food. Local systems were key in sustaining food and fuel access and households demonstrated resilience by employing numerous mechanisms to overcome challenges. Our findings underline the vulnerability of households in maintaining sufficient food intake and sustaining clean cooking, highlighting how policy needs to take a nuanced approach considering food-energy dynamics and strengthening local systems to ensure access to clean energy is resistant to system shocks., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

The adult population in Chile has a high prevalence of dental caries and non-functional dentition. Fifteen years after the Health Reform, aimed to reduce health inequalities, it is necessary to analyse changes in social inequalities in oral health in Chilean adults., Methods: A secondary analysis of data from 2003 and 2016-2017 National Health Surveys (NHS) in Chile was performed on seven oral health outcomes in adults: prevalence of untreated caries, prevalence of severe untreated caries, number of teeth with untreated caries, prevalence of functional dentition, prevalence of edentulism, number of remaining natural teeth and utilization of dental services. Inequalities were measured with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) by education level., Results: A decrease of caries inequalities measured with SII was observed from 2003 to 2016-17 NHS but an increase of remaining teeth inequalities was measured. The SII of the remaining teeth increased from 6.6 [95% CI = 5.0, 8.2] in 2003 to 8.8 [95% CI = 7.3, 10.3] in 2016-17. The SII of functional dentition by education increased from 29.0 [95% CI = 22.0, 36.0] in 2003 to 38.8 [95% CI = 32.6, 45.0]) in 2016-17. The utilization of dental services ≤1 year was the only outcome that showed a decrease in absolute and relative inequality, the SII was 33.9 [95% CI = 23.3, 45.6] in 2003 and 26.2 [95% CI = 16.6, 35.8] in 2016-17 and the RII decreased from 2.5 [95% CI = 1.7, 3.3] in 2003 to RII = 1.8 [95% CI = 1.4, 2.3] in 2016-17., Conclusion: The increase of tooth loss inequalities in contrast to the decrease of inequalities in dental services utilization show the need to re-evaluate the current dental programmes for adults in Chile. This may include establishing a stronger oral health promotion strategy and greater dental treatment coverage focusing on avoiding tooth extractions in vulnerable social groups., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Patients with depression and mild cognitive impairment (MCI) are at greater risk of developing dementia. Depression involves a higher risk of suicidal ideation (SI) and suicide attempts (SA). Biomarkers of Alzheimer's Disease (AD) could help to clarify the role of depression and SI in AD., Method: Fifty-nine participants aged > 50 with criteria of MCI positive (MCI-AD) (n=22) and negative (MCI-Non AD) (n=24) AD and healthy controls (HC) (n=13) were evaluated. We used the Geriatric Depression Scale (GDS-30) and the GDS-SI factor to measure depression and indirect risk for suicide, respectively. Additionally, AD biomarkers such as amyloid-ß (Aß), hyperphosphorilated tau (P-tau), and total tau (T-tau) in cerebrospinal fluid (CSF) were analyzed., Results: No significant differences between the groups were found in depression. However, in the MCI-AD group, lower P-tau and T-tau levels were related to higher GDS-SI scores, suggesting that MCI-AD patients with lower AD pathology are at a higher risk of suicide., Conclusions: The result highlights the importance of considering SI in the initial phases of AD, and the potential role of AD biomarkers in early detection of symptoms.

Objective: Adapt and validate EMPODERA-TB in order to measure empowerment of patients with pulmonary tuberculosis (TB)., Methods: An instrument initially designed to measure empowerment of patients with chronic diseases was adapted and validated to measure empowerment of patients with tuberculosis. The items applicable to patients with tuberculosis were selected and adapted. Validation was performed using exploratory and confirmatory factor analysis, and internal consistency was determined using Cronbach's alpha coefficient, based on data from a sample of 49 patients of Mexican origin diagnosed with pulmonary tuberculosis., Results: The instrument comprised 19 items grouped into three dimensions: knowledge acquisition, information-sharing skills, and decision-making skills. Acceptable goodness-of-fit was observed (SRMR: 0.124; CD: 0.999); internal consistency for the three dimensions was 0.878, 0.879, and 0.808, respectively, and for the instrument overall it was 0.885., Conclusions: The instrument showed acceptable goodness-of-fit and adequate internal consistency, making it possible to measure empowerment of patients with pulmonary tuberculosis. This instrument will be useful in TB clinical practice and epidemiology in Spanish-speaking Latin American countries. It will allow implementation of strategies that improve knowledge and adherence to treatment, interactions with patients or individuals at risk of infection, and development of prevention strategies.

Objective: Adolescents and young adults (AYA) living with chronic illness are as sexually active and interested in having children as healthy peers. Few studies have examined the intersection of managing chronic illness and concerns about realizing reproductive goals, including fertility, pregnancy, childbirth, and parenting. Even less is understood regarding how these concerns might be associated with psychological distress. This study examines associations between the reproductive health concerns (RHC) and health-related stress of AYA patients living with chronic conditions including rheumatologic, cardiac, pulmonology, gastrointestinal disorders, and solid organ transplant., Methods: A total of 140 patients aged 15 to 20 years (68% female; 81% Hispanic/Latinx) recruited from a transition program located at a safety-net pediatric institution completed surveys examining multiple dimensions of RHC and health-related quality of life (life satisfaction, illness burden, and illness-related anxiety) and condition-related stress. Exploratory factor analyses of RHC variables yielded 3 factors used in regression analyses to identify convergent validity of RHC factors with health-related mental health measures., Results: Three RHC factor loadings emerged: concern about availability to raise children (timing/future), impact of condition/medication on fertility and childbearing (pregnancy/fertility), and impact of condition on motivation to have children (motivation/decision-making). Positive associations were found between all RHC factors and illness-related anxiety; condition-related stress was associated with motivation/decision-making., Conclusion: RHC, health-related anxiety, and stress can impede healthy sexual and reproductive health and development of AYA living with chronic conditions. Providers' proactive exploration of patients' concerns about their reproductive future can offer critical support as they navigate the unique existential challenges of early adulthood., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Rifampicin is one of the most important drugs for the treatment of tuberculosis (TB). Polymorphisms in SLCO1B1 and SLC10A1 genes are associated with impaired transporter function of drug compounds such as rifampicin. The relationship between genetic variation, clinical comorbidities, and rifampicin exposures in TB patients has not been completely elucidated. The aim of this study was to investigate the prevalence of SLCO1A1 and SLCO1B1 polymorphisms in TB and TB-DM patients and to determine their relationship with rifampicin pharmacokinetics on patients from México. Blood samples were collected in two hospitals in Baja California, Mexico from February through December 2017. Sampling included 19 patients with TB, 11 with T2DM and 17 healthy individuals. Polymorphisms genotype rs2306283, rs11045818, rs11045819, rs4149056, rs4149057, rs72559746,rs2291075 and rs4603354 of SLCO1B1 and rs4646285 and rs138880008 of SLC10A1 were analyzed by Sanger's sequencing. None of the SLCO1B1 and SLC10A1 variants were significantly associated with rifampicin C max . TB and T2DM patients with suboptimal C max rifampicin levels showed wild alleles in rs11045819 and rs2291075 in SLCO1B1 SLC10A1 and SLC10A1. This is the first study to analyze SLC10A1 and SLCO1B1 polymorphisms in TB and TB-T2DM patients and healthy individuals in Mexico. Further research to confirm and extend these findings is necessary., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Zika virus (ZIKV) infection in pregnancy is associated with birth and developmental alterations in infants. In this study, clinical records of 47 infants whose mothers had Zika during pregnancy or clinical manifestations compatible with Zika were reviewed. A description of the infants' anomalies was established, and a neurodevelopmental assessment was performed on 18 infants, using the Evaluation of Infant Development (EDI for its initialism in Spanish) and DDST-II (Denver Developmental Screening Test II) tests. From his sample, 74.5% of the infants evaluated had major anomalies and 51.9% had minor anomalies. The incidence of major anomalies, related to trimester of pregnancy, was 84.2% for the first trimester, 77.8% for the second trimester, and 37.5% in the third trimester. A similar trend was observed in the frequency of infants without anomalies and was less evident in the incidence of minor anomalies ( p = 0.016). Through neurodevelopmental assessments, EDI identified 27.8% of infants as having normal development, while 55.5% of affected infants had developmental delay, and 16.7% were at risk for developmental delay. The DDSST-II showed that 77.7% infants had delay in the gross motor and language area, 88.8% in the fine-adaptative motor area, and 72.2% in the personal-social area. In this work, children of mothers with ZIKV infection during pregnancy may have major or minor anomalies regardless of the trimester of pregnancy in which the infection occurred. The neurodevelopmental assessment shows that ZIKV can cause a developmental delay in infants with the fine-adaptative motor area being the most affected.

Introduction: COVID-19 has tested the resilience of health systems globally and exposed existing strengths and weaknesses. We sought to understand health systems COVID-19 adaptations and decision making in Liberia and Merseyside, UK., Methods: We used a people-centred approach to carry out qualitative interviews with 24 health decision-makers at national and county level in Liberia and 42 actors at county and hospital level in the UK (Merseyside). We explored health systems' decision-making processes and capacity to adapt and continue essential service delivery in response to COVID-19 in both contexts., Results: Study respondents in Liberia and Merseyside had similar experiences in responding to COVID-19, despite significant differences in health systems context, and there is an opportunity for multidirectional learning between the global south and north. The need for early preparedness; strong community engagement; clear communication within the health system and health service delivery adaptations for essential health services emerged strongly in both settings. We found the Foreign, Commonwealth and Development Office (FCDO) principles to have value as a framework for reviewing health systems changes, across settings, in response to a shock such as a pandemic. In addition to the eight original principles, we expanded to include two additional principles: (1) the need for functional structures and mechanisms for preparation and (2) adaptable governance and leadership structures to facilitate timely decision making and response coordination. We find the use of a people-centred approach also has value to prompt policy-makers to consider the acceptance of service adaptations by patients and health workers, and to continue the provision of 'routine services' for individuals during health systems shocks., Conclusion: Our study highlights the importance of a people-centred approach, placing the person at the centre of the health system, and value in applying and adapting the FCDO principles across diverse settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Alzheimer's disease has a long asymptomatic phase that offers a substantial time window for intervention. Using this window of opportunity will require early diagnostic and prognostic biomarkers to detect Alzheimer's disease pathology at predementia stages, thus allowing identification of patients who will most probably progress to dementia of the Alzheimer's type and benefit from specific disease-modifying therapies. Consequently, we searched for CSF proteins associated with disease progression along with the clinical disease staging. We measured the levels of 184 proteins in CSF samples from 556 subjective cognitive decline and mild cognitive impairment patients from three independent memory clinic longitudinal studies (Spanish ACE, n = 410; German DCN, n = 93; German Mannheim, n = 53). We evaluated the association between protein levels and clinical stage, and the effect of protein levels on the progression from mild cognitive impairment to dementia of the Alzheimer's type. Mild cognitive impairment subjects with increased CSF level of matrix metalloproteinase 10 (MMP-10) showed a higher probability of progressing to dementia of the Alzheimer's type and a faster cognitive decline. CSF MMP-10 increased the prediction accuracy of CSF amyloid-β 42 (Aβ42), phospho-tau 181 (P-tau181) and total tau (T-tau) for conversion to dementia of the Alzheimer's type. Including MMP-10 to the [A/T/(N)] scheme improved considerably the prognostic value in mild cognitive impairment patients with abnormal Aβ42, but normal P-tau181 and T-tau, and in mild cognitive impairment patients with abnormal Aβ42, P-tau181 and T-tau. MMP-10 was correlated with age in subjects with normal Aβ42, P-tau181 and T-tau levels. Our findings support the use of CSF MMP-10 as a prognostic marker for dementia of the Alzheimer's type and its inclusion in the [A/T/(N)] scheme to incorporate pathologic aspects beyond amyloid and tau. CSF level of MMP-10 may reflect ageing and neuroinflammation., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)