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Byline: Atefeh. Ahmadi, Aazam. Heidarzadeh, Mahlagha. Dehghan, Mohammah. Safarizadeh, Mansooreh. Forouzi Introduction: Spirituality is considered an important source against chronic diseases and can promote self-esteem, mental comfort, and hope in [...]

Problem The coronavirus disease 2019 (COVID-19) pandemic has disrupted health systems worldwide and threatened the supply of essential medicines. Especially affected are vulnerable patients in low- and middle-income countries who can only afford access to public health systems. Approach Soon after physical distancing and curfew orders began on 15 March 2020 in Kenya, we rapidly implemented three supply-chain strategies to ensure a continuous supply of essential medicines while minimizing patients' COVID-19 exposure risks. We redistributed central stocks of medicines to peripheral health facilities to ensure local availability for several months. We equipped smaller, remote health facilities with medicine tackle boxes. We also made deliveries of medicines to patients with difficulty reaching facilities. Local setting To implement these strategies we leveraged our 30-year partnership with local health authorities in rural western Kenya and the existing revolving fund pharmacy scheme serving 85 peripheral health centres. Relevant changes In April 2020, stocks of essential chronic and non-chronic disease medicines redistributed to peripheral health facilities increased to 835 140 units, as compared with 316 330 units in April 2019. We provided medicine tackle boxes to an additional 46 health facilities. Our team successfully delivered medications to 264 out of 311 patients (84.9%) with noncommunicable diseases whom we were able to reach. Lessons learnt Our revolving fund pharmacy model has ensured that patients' access to essential medicines has not been interrupted during the pandemic. Success was built on a community approach to extend pharmaceutical services, adapting our current supply-chain infrastructure and working quickly in partnership with local health authorities. Probleme La pandemie de maladie a Coronavirus 2019 (COVID-19) a bouleverse les systemes de sante du monde entier et menace l'approvisionnement en medicaments essentiels. Dans les pays a faible et moyen revenu, les patients vulnerables ayant uniquement acces aux soins de sante publics ont ete particulierement affectes. Approche Peu apres l'instauration de la distanciation physique et du couvre-feu le 15 mars 2020 au Kenya, nous avons rapidement mis en oeuvre trois strategies visant a assurer un approvisionnement continu en medicaments essentiels, tout en limitant les risques d'exposition des patients au coronavirus. Nous avons redistribue les principaux stocks de medicaments aux etablissements sanitaires peripheriques afin de garantir leur disponibilite pendant plusieurs mois. Nous avons fourni des boites de materiel medical aux petits centres de soins implantes dans des regions reculees. Nous avons egalement livre des medicaments aux patients incapables de se rendre dans un etablissement. Environnement local Pour deployer ces strategies, nous avons profite de nos trente annees de partenariat avec les autorites sanitaires locales dans les regions rurales du Kenya occidental et compte sur le modele existant de financement pharmaceutique renouvelable, qui dessert 85 centres de soins peripheriques. Changements significatifs Les stocks de medicaments essentiels servant au traitement de maladies chroniques et non chroniques redistribues aux centres de soins peripheriques sont passes de 316 330 unites en avril 2019 a 835 140 unites en avril 2020. Nous avons procure des boites de materiel medical a 46 centres de soins supplementaires. Notre equipe a reussi a livrer des medicaments a 264 des 311 patients (84,9%) souffrant de maladies non transmissibles que nous sommes parvenus a contacter. Lecons tirees Grace a notre modele de financement pharmaceutique renouvelable, les patients ont pu acceder aux medicaments essentiels sans interruption durant la pandemie. Ce succes repose sur une approche communautaire destinee a etendre les services pharmaceutiques en adaptant l'infrastructure de notre chaine d'approvisionnement actuelle, et en avancant rapidement par le biais de partenariats avec les autorites sanitaires locales. Situacion La pandemia de la enfermedad por Coronavirus 2019 (COVID-19)ha perturbado los sistemas sanitarios de todo el mundo y ha amenazado el suministro de medicamentos esenciales. Se ven especialmente afectados los pacientes vulnerables de los paises de ingresos bajos y medios que solo pueden acceder a los sistemas sanitarios publicos. Enfoque Poco despues de que comenzaran el distanciamiento fisico y las ordenes de toque de queda el 15 de marzo de 2020 en Kenia, pusimos en marcha rapidamente tres estrategias para garantizar un suministro continuo de medicamentos esenciales y minimizar al mismo tiempo los riesgos de exposicion de los pacientes al COVID-19. Redistribuimos las existencias centrales de medicamentos a los centros de salud perifericos para garantizar la disponibilidad local durante varios meses. Equipamos a los centros de salud mas pequenos y remotos con cajas de botiquin. Tambien hicimos entregas de medicamentos a pacientes con dificultades para llegar a los centros. Marco regional Para poner en practica estas estrategias, hemos aprovechado nuestra asociacion de 30 anos con las autoridades sanitarias locales de las zonas rurales del oeste de Kenia y nos hemos apoyado en el modelo existente de financiacion farmaceutica rotatoria, que atiende a 85 centros de salud perifericos. Cambios importantes Las existencias de medicamentos esenciales para el tratamiento de enfermedades cronicas y no cronicas redistribuidas a los centros de atencion periferica pasaron de 316.330 unidades en abril de 2019 a 835.140 unidades en abril de 2020. Hemos adquirido cajas de material medico para otros 46 centros de salud. Nuestro equipo pudo entregar medicamentos a 264 de los 311 pacientes (84,9%) con enfermedades no transmisibles con los que logramos contactar. Lecciones aprendidas Gracias a nuestro modelo de financiacion farmaceutica rotatoria, los pacientes pudieron acceder a los medicamentos esenciales sin interrupcion durante la pandemia. Este exito se basa en un enfoque comunitario para ampliar los servicios farmaceuticos adaptando nuestra infraestructura de cadena de suministro existente y avanzando rapidamente mediante asociaciones con las autoridades sanitarias locales., Introduction The Coronavirus disease 2019 (COVID-19) pandemic has challenged health systems worldwide as they cope with the demands of infection control and management of the disease while maintaining the delivery [...]

The tight junction protein claudin-2 is upregulated in disease. Although many studies have linked intestinal barrier loss to local and systemic disease, these have relied on macromolecular probes. In vitro analyses show, however, that these probes cannot be accommodated by size- and charge-selective claudin-2 channels. We sought to define the impact of claudin-2 channels on disease. Transgenic claudin-2 overexpression or IL-13-induced claudin-2 upregulation increased intestinal small cation permeability in vivo. IL-13 did not, however, affect permeability in claudin-2-knockout mice. Claudin-2 is therefore necessary and sufficient to effect size- and charge-selective permeability increases in vivo. In chronic disease, T cell transfer colitis severity was augmented or diminished in claudin-2-transgenic or -knockout mice, respectively. We translated the in vitro observation that casein kinase-2 (CK2) inhibition blocks claudin-2 channel function to prevent acute, IL-13-induced, claudin-2-mediated permeability increases in vivo. In chronic immune-mediated colitis, CK2 inhibition attenuated progression in claudin-2-sufficient, but not claudin-2-knockout, mice, i.e., the effect was claudin-2 dependent. Paracellular flux mediated by claudin-2 channels can therefore promote immune-mediated colitis progression. Although the mechanisms by which claudin-2 channels intensify disease remain to be defined, these data suggest that claudin-2 may be an accessible target in immune-mediated disorders, including inflammatory bowel disease., Introduction Barriers that define distinct tissue compartments and separate self from non-self are necessary for survival of multicellular organisms. In some organs, for example the integument and bladder, the barrier [...]

Introduction: Chronic conditions, particularly diabetes, and related health conditions continue to be a major concern in the United States, especially in Hispanic populations. This study evaluated the effect of an integrated behavioral health care model, including promotoras(es), on a primarily Hispanic population living with diabetes. Method: Seven hundred fifty-six participants were enrolled in an intervention (n = 329) or comparison group (n = 427) and followed up for 12 months. We used a quasiexperimental design to compare participants who received coordinated integrated behavioral health care with those who received usual care from a federally qualified health center. The outcomes were HbA1c, blood pressure, body mass index, depressive symptoms (Patient Health Questionnaire-9), and quality of life (QoL). These outcomes were analyzed as continuous variables using linear regression with backward model selection. Longitudinal analyses were conducted using a likelihood-based approach to general linear mixed models. Results: A total 563 intervention (n = 239) and comparison (n = 324) participants completed an end point assessment. After adjusting for important covariates. the intervention had a QoL score 5.36 points higher than the comparison participants on average after 12 months. The trajectories of QoL and Patient Health Questionnaire-9 scores differed over time, with intervention participants experiencing greater improvements. There were no statistically significant differences detected for other outcomes. Discussion: Enabling access to services and providers to enhance participants' ability to manage their chronic disease led to positive impacts on mental health. The connection between QoL and diabetes has been of great interest to researchers, including the effects of relationships with promotoras(es). The impact of integrating care on QoL in this vulnerable population is discussed. Keywords: community health workers/promotoras(es), diabetes, Hispanic population, integrated behavioral health, quality of life, Hispanics are the largest minority group in the United States, constituting 16.7% of the nation (U.S. Census Bureau, 2012). Hidalgo County, in the Rio Grande Valley border region of Texas, [...]