Resumen Introducción: México es un país con alta prevalencia de sobrepeso y obesidad. Sin embargo, los programas de alimentación social a menudo se enfocan solo en la desnutrición en grupos de población vulnerables. Objetivo: estimar la asociación del sobrepeso y la obesidad (SO) con la participación en un programa de transferencias monetarias condicionadas (TMC) y otros programas de sociales de alimentación en mujeres de 15 a 49 años de la población económicamente más vulnerable de México. Métodos: se analizaron datos antropométricos, así como información sobre participación en programas de alimentación social, inseguridad alimentaria en el hogar y variables sociodemográficas de mujeres de 15 a 49 años residentes en localidades de menos de 100.000 habitantes en México. Los datos se derivaron de la Encuesta Nacional de Salud y Nutrición de México 2018. Se aplicó un modelo de regresión logística múltiple para estimar la asociación entre SO y la participación en programas de alimentación social, así como otras covariables. Resultados: la prevalencia de SO en las mujeres que se beneficiaron de TMC fue del 62 %, mientras que para las mujeres que participaron de este y otros programas la prevalencia fue del 72,9 % (p = 0,04). Se observó una asociación protectora entre el programa CCT y SO (OR = 0,72, p = 0,04). Además, beneficiarse de los comedores comunitarios del DIF reveló una asociación de riesgo con SO (OR = 2,76, p = 0,03). Conclusiones: es fundamental que el diseño de políticas públicas y programas de alimentación social consideren la evidencia científica generada a través de diversas experiencias en México, como el programa de TMC Prospera. Esto permitirá a los tomadores de decisiones abordar los problemas epidemiológicos de salud y nutrición que afectan a la población mexicana en la actualidad.

Abstract Introduction: Mexico is a country with a high prevalence of overweight and obesity. However, social feeding programs often target only undernutrition in vulnerable population groups. Objective: to estimate the association of overweight and obesity (OW) with participation in a conditional cash transfers (CCT) program and other social feeding programs in women 15-49 years of age within the most economically vulnerable population in Mexico. Methods: anthropometric data, as well as information on participation in social feeding programs, household food insecurity and sociodemographic variables, were analyzed for women aged 15-49 living in localities of under 100,000 inhabitants in Mexico. Data was derived from the Mexican National Health and Nutrition Survey 2018. A multiple logistic regression model was applied to estimate the association between OW and participation in social feeding programs, as well as other covariables. Results: the prevalence of OW in women who benefited from CCT was 62 %, while for women who participated in this as well as other programs the prevalence was 72.9 % (p = 0.04). A protective association was observed between the CCT program and OW (OR = 0.72, p = 0.04). Additionally, benefitting from DIF Community Kitchens revealed a risk association with OW (OR = 2.76, p = 0.03). Conclusions: it is critical that the design of public policy and social feeding programs consider the scientific evidence generated through rich experiences in Mexico, such as the program of CCT Prospera. This will allow decision-makers to address the epidemiological health and nutrition problems impacting the Mexican population today.

ABSTRACT The Water Quality Indices (WQI) are tools that help to communicate the status of quality to a non-specialized audience, they are based on the existing regulations of the region. The objective of this project was to determine the WQI in five Participatory Observatories (PO) located in the north of Mexico, in addition to generating maps and charts that present information in a concrete and clear way on water quality and risk areas. Using data from the Comisión Nacional del Agua, the water quality was evaluated with the León and Canadian Council of Ministers of the Environment indices, as well as the microbiological quality based on fecal coliform reports. PO sites are classified, in terms of microbiological quality, from “excellent” to “heavily contaminated”. Under the permissible limits by the official Mexican standards for water for human consumption and agricultural irrigation, a relative scale was applied with a score of 0 to 100, for the indices determined in the POs. The results indicate, through the maps developed in the study, the presence of three microbiologically contaminated sites. Regarding the quality required for human consumption, the Canadian index classifies the quality of the water as “poor” in all the sites studied, while the León index classifies it on the scale of “contaminated” to “slightly contaminated”. Both indices indicate the imperative need for treatment before being used for human consumption.

RESUMEN Los índices de calidad del agua (ICA) son herramientas para comunicar la calidad del agua a una audiencia no especializada, basándose en los datos del monitoreo de los cuerpos de agua. El objetivo de este proyecto fue determinar el ICA en cinco observatorios participativos (OP) ubicados en el norte de México, además de generar mapas y cuadros que presenten la información de forma concreta y clara sobre la calidad del agua y zonas de riesgo. Utilizando los datos de la Comisión Nacional del Agua se determinó la calidad de agua con los índices de León y del Consejo Canadiense de Ministros de Medio Ambiente, así como la calidad microbiológica con base en los reportes de coliformes fecales. Se clasificaron los sitios de los OP, en cuanto a la calidad microbiológica, de “excelente” a “fuertemente contaminada”. De acuerdo con los límites permisibles por las normas oficiales mexicanas para agua de consumo humano y riego agrícola, se aplicó una escala relativa con un puntaje de 0 a 100, para los índices determinados en los OP. Los resultados indican a través de los mapas desarrollados en el estudio, la presencia de tres sitios fuertemente contaminados microbiológicamente. En lo referente a la calidad requerida para consumo humano, el índice canadiense califica la calidad del agua como “pobre” en todos los sitios estudiados, mientras que el índice de León la clasifica en la escala de “contaminada” a “levemente contaminada”. Ambos índices indican la necesidad imperiosa de un tratamiento antes de ser destinada al uso de consumo humano.

Resumen Con relación a 2022, los estudios sobre las condiciones ambientales al interior de las aulas se han incrementado debido a que se relacionan con el bienestar, el rendimiento y la productividad de los estudiantes en términos de concentración, atención y aprendizaje durante el horario escolar. Evaluar las condiciones del espacio educativo una vez habitado puede ser fundamental para identificar ajustes ambientales que puedan mejorar el rendimiento de los alumnos en los aprendizajes a través de estrategias de diseño en los equipamientos escolares de la localidad. Se presenta la evaluación de las condiciones térmicas y lumínicas de tres aulas diseñadas para funcionar con ventilación natural, en dos edificios de la Universidad Autónoma de Baja California, en Tijuana, México, durante el periodo de transición frio-cálido. Se realizaron mediciones físicas de los indicadores ambientales, incluyendo temperatura, humedad relativa y luz natural. Un total de 181 estudiantes completaron los cuestionarios de la encuesta sobre el ambiente interior. Este estudio tuvo como objetivo evaluar las condiciones ambientales del espacio y determinar la influencia en el confort de los ocupantes. Los resultados mostraron que más del 50% de los estudiantes se encontraban en una situación de incomodidad térmica cuando la temperatura estaba fuera del rango de 19.7°C -27.7°C, consistente con la aplicación de las Zonas de Confort Adaptativo de ASHRAE. Los valores de luz natural de las tres aulas estuvieron por debajo del mínimo requerido de 300 Lux para aulas educativas [1, 2]. Los edificios con orientaciones Oeste y Sur registraron valores de iluminancia que podrían producir deslumbramiento y aumentar el malestar térmico debido a la alta radiación solar. Los resultados confirmaron la estrecha relación entre las condiciones ambientales y el confort de los estudiantes en las aulas.

Abstract About 2022, studies on environmental conditions inside classrooms have increased because they are related to well-being, performance, and student productivity in terms of concentration, attention, and learning during school hours. Assessing the conditions of the educational space once inhabited can be fundamental to identifying environmental adjustments that could improve achievement in learning through design strategies in school facilities in the locality. The evaluation of the thermal and luminic conditions of three classrooms designed to function with natural ventilation, in two buildings of the Universidad Autónoma of Baja California, in Tijuana, Mexico, during the cold-warm transition period is presented. Physical measurements of environmental indicators were made, including temperature, relative humidity, and daylight. A total of 181 students completed the environmental survey questionaries. This study aimed to evaluate the interior environmental space conditions and determine the influence on occupants' comfort. Results showed that more than 50% of the students were in a thermal discomfort situation when the temperature was out of range of 19.7°C -27.7° C, consistent with the application of the ASHRAE Adaptative Comfort Zones. Daylight values were below the minimum required of 300 Lux for educational classrooms specificity in [1, 2] of the three classrooms. Building's orientations, West and South registered illuminance values that could produce glare and increase thermal discomfort due to high solar radiation. The results confirmed the close relationship between environmental conditions and students' comfort in classrooms.

Background: It is imperative to have effective programs to improve or maintain the health of aged people. Aim: To evaluate the effectiveness of an intervention based on a multidimensional program in Senior centers in Chile five months after its implementation, in the domains of physical and mental health, functionality and quality of life in aged people. Material and Methods: Sixty participants older than 60 years completed a multidimensional program for one month that included interventions of guided physical exercises, in addition to educational and social activities. They were evaluated at baseline and one and five months after the intervention. Results: After the first and fifth months, significant improvements were observed in the five times sit to stand test (5TSTS) and gait speed (WST), in addition, significant improvements were observed in literacy measured by the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA). At the fifth month, slight improvements were observed in the Yesavage and short Falls efficacy scales, Barthel index, Unipodal Station and EuroQol five-dimensional quality of life tests. Conclusions: A multidimensional program for aged people lasting one month, improved the physical health dimension and literacy by the fifth month of evaluation.

ABSTRACT OBJECTIVES Compare self-perceived discrimination between immigrants and locals in Chile and analyze the relationship between immigration and perceived discrimination and immigration, discrimination and health outcomes, adjusting for sociodemographic characteristics and social capital. METHODS Cross-sectional study, using population-based survey (CASEN2017). We selected 2,409 immigrants (representative of N = 291,270) and 67,857 locals (representative of N = 5,438,036) over 18 years of age surveyed. We estimated logistic regression models, considering the complex sample, with discrimination, self-rated health, medical treatment, healthcare system membership, complementary health insurance, medical consultation and problems when consulting as dependent variables, immigration and discrimination as main exposure variables, and social capital and sociodemographic variables as covariates of the models. RESULTS Immigrants were more likely to perceive discrimination in general compared to locals (OR = 2.31; 95%CI: 1.9-2.9). However, this does not occur for all specific reasons for discrimination; skin color and physical appearance were the most frequent causes of discrimination in immigrants. The interaction between immigration and discrimination was significantly related to worse self-rated health outcomes and treatment for pathologies, disfavoring discrimination against immigrants. In both locals and immigrants, discrimination was not associated with health care access outcomes, except for problems during consultation in locals (OR = 1.61; 95%CI 1.4-1.8). CONCLUSIONS In Chile, experiences of discrimination are intertwined with other forms of rejection and social exclusion, so it is urgent to raise awareness among the population to prevent these discriminatory practices, especially in health care and daily use places. It is essential to address discrimination in order to have an impact on intermediate variables and health outcomes. The extension of the results to the entire immigrant population could be very useful to deepen the problem and improve the estimates made.

RESUMEN OBJETIVOS Comparar la autopercepción de discriminación entre inmigrantes y locales en Chile y analizar la relación entre inmigración y discriminación percibida e inmigración, discriminación y resultados de salud, ajustando por características sociodemográficas y capital social. MÉTODOS Estudio transversal, utilizando encuesta poblacional (CASEN2017). Se seleccionaron 2.409 inmigrantes (representativos de N = 291.270) y 67.857 locales (representativos de N = 5.438.036) mayores de 18 años encuestados. Se estimaron modelos de regresión logística, considerando la muestra compleja, con discriminación, salud autoevaluada, tratamiento médico, pertenencia al sistema de salud, seguros complementarios de salud, consulta médica y problemas al consultar como variables dependientes, inmigración y discriminación como variables de exposición principal, y capital social y variables sociodemográficas como covariables de los modelos. RESULTADOS Inmigrantes tuvieron mayor posibilidad de percibir discriminación en general comparado con locales (OR = 2,31; IC95% 1,9–2,9). Sin embargo, esto no ocurre para todos los motivos específicos de discriminación; color de piel y apariencia física fueron las causas de discriminación más frecuentes en inmigrantes. La interacción entre inmigración y discriminación se relacionó significativamente con peores resultados de salud autoevaluada y tratamiento por patologías, en desfavor de los inmigrantes discriminados. Tanto en locales como en inmigrantes la discriminación no se asoció con resultados de acceso a atención en salud, excepto problemas durante la consulta en locales (OR = 1,61; IC95% 1,4–1,8). CONCLUSIONES En Chile, las experiencias de discriminación se entrelazan con otras formas de rechazo y exclusión social, por lo cual es urgente concientizar a la población para prevenir estas prácticas discriminatorias, sobre todo en la atención en salud y lugares de uso cotidiano. Abordar la discriminación es indispensable para lograr impactar en variables intermedias y resultados de salud. La extensión de los resultados a toda la población inmigrante podría ser de amplia utilidad para profundizar la problemática y mejorar las estimaciones realizadas.

ABSTRACT OBJECTIVES Compare self-perceived discrimination between immigrants and locals in Chile and analyze the relationship between immigration and perceived discrimination and immigration, discrimination and health outcomes, adjusting for sociodemographic characteristics and social capital. METHODS Cross-sectional study, using population-based survey (CASEN2017). We selected 2,409 immigrants (representative of N = 291,270) and 67,857 locals (representative of N = 5,438,036) over 18 years of age surveyed. We estimated logistic regression models, considering the complex sample, with discrimination, self-rated health, medical treatment, healthcare system membership, complementary health insurance, medical consultation and problems when consulting as dependent variables, immigration and discrimination as main exposure variables, and social capital and sociodemographic variables as covariates of the models. RESULTS Immigrants were more likely to perceive discrimination in general compared to locals (OR = 2.31; 95%CI: 1.9-2.9). However, this does not occur for all specific reasons for discrimination; skin color and physical appearance were the most frequent causes of discrimination in immigrants. The interaction between immigration and discrimination was significantly related to worse self-rated health outcomes and treatment for pathologies, disfavoring discrimination against immigrants. In both locals and immigrants, discrimination was not associated with health care access outcomes, except for problems during consultation in locals (OR = 1.61; 95%CI 1.4-1.8). CONCLUSIONS In Chile, experiences of discrimination are intertwined with other forms of rejection and social exclusion, so it is urgent to raise awareness among the population to prevent these discriminatory practices, especially in health care and daily use places. It is essential to address discrimination in order to have an impact on intermediate variables and health outcomes. The extension of the results to the entire immigrant population could be very useful to deepen the problem and improve the estimates made.

RESUMEN OBJETIVOS Comparar la autopercepción de discriminación entre inmigrantes y locales en Chile y analizar la relación entre inmigración y discriminación percibida e inmigración, discriminación y resultados de salud, ajustando por características sociodemográficas y capital social. MÉTODOS Estudio transversal, utilizando encuesta poblacional (CASEN2017). Se seleccionaron 2.409 inmigrantes (representativos de N = 291.270) y 67.857 locales (representativos de N = 5.438.036) mayores de 18 años encuestados. Se estimaron modelos de regresión logística, considerando la muestra compleja, con discriminación, salud autoevaluada, tratamiento médico, pertenencia al sistema de salud, seguros complementarios de salud, consulta médica y problemas al consultar como variables dependientes, inmigración y discriminación como variables de exposición principal, y capital social y variables sociodemográficas como covariables de los modelos. RESULTADOS Inmigrantes tuvieron mayor posibilidad de percibir discriminación en general comparado con locales (OR = 2,31; IC95% 1,9–2,9). Sin embargo, esto no ocurre para todos los motivos específicos de discriminación; color de piel y apariencia física fueron las causas de discriminación más frecuentes en inmigrantes. La interacción entre inmigración y discriminación se relacionó significativamente con peores resultados de salud autoevaluada y tratamiento por patologías, en desfavor de los inmigrantes discriminados. Tanto en locales como en inmigrantes la discriminación no se asoció con resultados de acceso a atención en salud, excepto problemas durante la consulta en locales (OR = 1,61; IC95% 1,4–1,8). CONCLUSIONES En Chile, las experiencias de discriminación se entrelazan con otras formas de rechazo y exclusión social, por lo cual es urgente concientizar a la población para prevenir estas prácticas discriminatorias, sobre todo en la atención en salud y lugares de uso cotidiano. Abordar la discriminación es indispensable para lograr impactar en variables intermedias y resultados de salud. La extensión de los resultados a toda la población inmigrante podría ser de amplia utilidad para profundizar la problemática y mejorar las estimaciones realizadas.

ABSTRACT: Almost ten years after the implementation of the successful public oral health promotion program for preschoolers in Chile, we present the previous study that collected the vision and meanings for parents about oral health issues of their preschool children in urban and rural Chile in seven different communities. The high prevalence of dental caries and their consequences throughout the lifetime in Chile has made health promotion a relevant strategy that allows facing the current health situation by implementing prevention-oriented programs focused on the pre-school level population, like the “Sembrando Sonrisas” program whose educational component focuses on parents and caregivers. In this line, it is worth mentioning the Health Beliefs Model (HBM), which acts as a predictor for the health practices that parents develop concerning their children, which can be activated and or modified by educational strategies or counseling provided by health professionals. This study seeks to explore, through qualitative methodology, the belief system around the oral health needs perceived by parents and caregivers of pre-school children who participated in the testing of the Preventive Oral Health Program in pre-school level population in 7 counties of the country during 2007. The results obtained showcase that parents and guardians assign oral health care to third parties (dentists, pre-school educators) while reporting a lack of understandable information so that they can replicate practices in their children. On the other hand, postponing the visit to the dentist is justified due to previous bad experiences and lack of access to dental care services. However, dental health is relevant from an aesthetic point of view and as an element to overcome social prejudice.

RESUMEN: A casi diez años de la implementación del exitoso programa público de promoción de la salud bucal para preescolares en Chile, se presenta el estudio previo que recogió la visión y significados para los padres acerca de temas de salud oral de sus hijos preescolares en un Chile urbano y rural de siete comunas distintas. Bien sabemos que la alta prevalenci a de la caries dental en Chile y sus consecuencias a lo largo del ciclo vital, ha relevado la Promoción de Salud como una estrategia necesaria para la situación sanitaria de hace una década y para la actual a través de la implementación de programas con enfoque preventivo, como lo es el programa Sembrando Sonrisas, cuyo componente educativo se centra en los/as cuidadores de preescolares. En esta línea, cabe destacar que el Modelo de Creencias en Salud (MCS) actúa como un predictor para las prácticas en salud que desarrollan los/as cuidadores respecto a sus hijos, las cuales pueden ser activadas y/o modificadas por estrategias educativas o consejería otorgada por profesionales de la salud. Este estudio buscó explorar, mediante metodología cualitativa, los sistemas de creencias en torno a las necesidades en salud oral percibidas por padres y cuidadores/as de niños/ as preescolares que participaron del pilotaje del Programa preventivo de salud bucal en población preescolar el año 2007. Los resultados obtenidos evidencian elementos que pudieron condicionar la conducta en torno a los cuidados de la salud oral de las/ os cuidadores hacia los preescolares. Entre los hallazgos, se encuentra que los padres y apoderados atribuían los cuidados en salud oral a terceras personas (odontólogos y educadoras de párvulos), al tiempo que relatan una falta de información en términos comprensibles para que ellos puedan replicar prácticas adecuadas en sus hijos. Por otro lado, la postergación de la visita al odontólogo se explica debido a malas experiencias previas y falta de acceso a servicios de atención odontológica. Sin embargo, la salud dental es relevada desde un punto de vista estético y como un elemento importante en la superación de estigmas sociales.

The COVID-19 pandemic had a significant impact on the management of chronic diseases such as cancer. Comprehensive care, from preventive strategies to palliative care for cancer patients, has been strongly affected by multiple factors associated with the pandemic. The hampering of early detection, timely diagnosis, as well as recommended treatment and follow-up are side effects of SARS-CoV-2 infection worldwide that will undoubtedly produce changes in the prognosis and survival of oncologic patients. Through this narrative review, we report global and local figures of these effects, as a first approach to tackle the challenge of updating cancer care.

Biological medications are effective for the treatment of cancer and inflammatory diseases. The aim of this review is to summarize the available evidence in systematic reviews or meta-analyses about the risk of infection in patients with cancer, arthritis, psoriasis and inflammatory bowel disease who use biological medications. We included systematic reviews or meta-analyses of controlled clinical trials and case/control studies that analyze infections during and after treatment with FDA-approved biological medications for the treatment of cancer, arthritis, inflammatory bowel disease and psoriasis, both in adults and children. The following databases were consulted: PubMed, Epistemonikos, Crochrane reviews, JIB, and Prospero. A quality guideline (AMSTAR) was applied to the selected studies. We included 26 studies. The risk of infections in patients with solid organ cancer is consistent in the literature. In psoriasis there is a risk of non-serious infections. In arthritis and other inflammatory diseases there is a risk of serious infections. In inflammatory bowel disease there is a risk for opportunistic infections. In conclusion, in patients with cancer and inflammatory diseases use biological medications entails a risk of infection. The evidence is different depending on the underlying disease of each patient.

ABSTRACT This study aimed to determine the apparent digestibility coefficients and digestible energy of dry velvet bean fodder (Mucuna pruriens). The indirect method was used, considering as a basal diet the concentrate used in the university guinea pig farm (Lima, Peru). The experiment had an adaptation phase (14 days) and a faecal collection phase (5 days). Ten adult male 3-month old guinea pigs randomly distributed in individual metabolic cages were used. Five animals were fed the basal diet and the other five with the experimental diet: 80% basal diet and 20% dry velvet bean fodder. The apparent digestibility coefficients obtained for the dry velvet bean were: 66.29% dry matter, 66.13% organic matter, 74.02% crude protein, 50.82% crude fibre, 60.18% ether extract, 78.22% nitrogen- free extract and 73.33% ash. The estimated digestible energy value was 2.61 kcal/g.

RESUMEN El estudio tuvo como objetivo determinar los coeficientes de digestibilidad y la energía digestible del forraje seco de mucuna (Mucuna pruriens). Se empleó el método indirecto, considerando como dieta basal el concentrado utilizado en la Granja de Cuyes de Cieneguilla (Lima, Perú). El experimento tuvo una fase de adaptación (14 días) y otra de colección de heces (5 días). Se utilizaron 10 cuyes machos adultos de tres meses de edad, distribuidos en forma aleatoria en jaulas metabólicas individuales. Cinco animales fueron alimentados con la dieta basal y los otros cinco con la dieta experimental: 80% dieta basal y 20% forraje seco de mucuna. Los coeficientes de digestibilidad aparente obtenidos para la mucuna fueron: 66.29% de materia seca, 66.13% de materia orgánica, 74.02% de proteína cruda, 50.82% de fibra cruda, 60.18% de extracto etéreo, 78.22% de extracto libre de nitrógeno y 73.33% de ceniza. El valor de energía digestible estimado fue de 2.61 kcal/g.

Invasive meningococcal disease is challenging for public health, mainly when it manifests with sudden changes in incidence, serogroups and hypervirulent clones that spread in the population, causing great alarm due to its sequelae and often fatal course, a situation that occurred in Chile, starting at week 26 of the year 2012. To face this scenario, an organization of multidisciplinary teams was required, called W-135 Action Plan in Chile, which included sanitary alerts, education, reinforcement of the epidemiological surveillance of suspicious cases, immediate diagnosis through state-of-the-art techniques, blocking of contacts, communication plans, and, from the 42nd week, ON the vaccination campaign was started for children aged from 9-months-old to less than 5 years of age. The vaccination strategy had a great impact on the decrease in incidence (1.3 to 0.1/100,000) and case fatality rate in the vaccinated population (23% to 0%), with a high safety profile, leading to its subsequent inclusion in the national immunization program. The ability to develop molecular, clinical and epidemiological studies allowed us to better understand the situation, supporting public health policy decisions for its control. The W-135 Action Plan implemented by the Ministry of Health in Chile, to manage the outbreak of meningococcal disease by Neisseria meningitidis serogroup W, demonstrated that the coordination of these efforts, through an organized Action Plan, allows the implementation of campaigns at the national level achieving high coverage of risk populations in short periods of time, generating a positive impact on the health of the population.

Abstract The plasmid-encoded toxin (Pet) is one of the most studied Enterobacteriaceae autotransporters produced by the enteroaggregative Escherichia coli (EAEC). It is responsible of morphological changes in enterocytes during EAEC infection. Recently, Pet was found in the genome of the Proteus mirabilis RTX339 strain [P. mirabilis (Pet+)]. P. mirabilis causes complicated urinary tract infections (UTI) in patients having urinary catheters and structural or functional abnormalities. In this study, an UTI was induced in BALB/c female mice with the P. mirabilis (Pet+) strain. Mice infected by P. mirabilis (Pet+) showed bacterial colonization in bladder and kidney, from the second up to the tenth day post-infection. Morphological changes were evidenced by histology. Multiple exfoliated rounded cells were observed in the bladder transitional epithelium, as well as, structural cell alterations in the kidney cortex. The presence of Pet into exfoliated and parenchymal cells was confirmed by confocal microscopy. Cytoskeleton alterations were observed in those sites where Pet was detected. Pet expressed by P. mirabilis (Pet+) strain, contributes to its pathogenicity, affecting urinary tissues during the course of the infection.

Resumen La toxina Pet (plasmid-encoded toxin) producida por Escherichia coli (EAEC) es uno de los autotransportadores más estudiados en la familia Enterobacteriaceae. Es responsable de cambios morfológicos en enterocitos durante la infección por EAEC. Recientemente, Pet fue encontrada en el genoma de una cepa de Proteus mirabilis RTX339 [P. mirabilis (Pet+)]. P. mirabilis causa infección en el tracto urinario (ITU) en pacientes que usan catéteres o que presentan anomalías estructurales o funcionales. En este estudio una ITU con P. mirabilis (Pet+) fue inducida en ratones hembras BALB/c. Los ratones infectados con P. mirabilis (Pet+) muestran una colonización bacteriana en vejiga y riñón desde el segundo hasta el día decimo de la infección. Los cambios morfológicos fueron evidenciados por histología. Se observaron múltiples células exfoliadas del epitelio de transición de la vejiga, así como alteraciones morfológicas en la corteza renal. Se confirmó la presencia de Pet en las células exfoliadas y en las del parénquima por microscopía confocal. Las alteraciones del citoesqueleto fueron observadas en los sitios donde se detectó Pet. La toxina Pet expresada por la cepa de P. mirabilis (Pet+) contribuye a la patogenicidad y afecta tejidos urinarios durante el curso de la infección.

Objective: to present the development of a toolkit for education quality improvement in universal health and primary health care, targeting schools of nursing and midwifery in Latin American and Caribbean countries. Methods: an expert work group conducted a systematic literature review, selected key content and completed toolkit drafting, using an iterative consensus approach. International partners reviewed the toolkit. Cognitive debriefing data were analyzed, revisions and new tools were integrated, and the final version was approved. Results: twenty-two articles were identified and mapped as resources. The Model for Improvement, a data-driven approach to performance analysis, was selected for its widespread use and simplicity in carrying out the following steps: 1) organize a team, 2) assess improvement need regarding universal health and primary health care education, 3) set an aim/goal and identify priorities using a matrix, 4) establish metrics, 5) identify change, 6) carry out a series of Plan-Do-Study-Act learning cycles, and 7) sustain change. Conclusions: the Education Quality Improvement Toolkit, developed through stakeholder consensus, provides a systematic, and potentially culturally adaptable approach to improve student, faculty, and program areas associated with universal health coverage and access.

Objetivo: presentar el desarrollo de un kit de herramientas para la mejora de la calidad de la educación en salud universal y atención primaria de salud, dirigido a las escuelas de enfermería y obstetricia en los países de América Latina y el Caribe. Métodos: un grupo de trabajo de expertos realizó una revisión sistemática de la literatura, seleccionó el contenido clave y redactó las herramientas, utilizando un consenso iterativo. Socios internacionales revisaron el kit de herramientas. Se analizaron los datos de la entrevista cognitiva, se integraron las revisiones y las nuevas herramientas, y se aprobó la versión final. Resultados: veintidós artículos fueron identificados y registrados como recursos. Se seleccionó el Modelo para Mejoramiento, un enfoque basado en datos para el análisis del desempeño, por su uso generalizado y sencillez para realizar los siguientes pasos: 1) organizar un equipo, 2) evaluar la necesidad de mejora con respecto a la educación universal en salud y atención primaria de salud, 3) establecer el objetivo e identificar las prioridades utilizando una matriz, 4) establecer métricas, 5) identificar el cambio, 6) llevar a cabo una serie de ciclos de aprendizaje Planear-Hacer-Estudiar-Actuar, y 7) mantener el cambio. Conclusiones: el Kit de Herramientas para la Mejora de la Calidad de la Educación, desarrollado mediante el consenso de las partes interesadas, proporciona un enfoque sistemático y culturalmente adaptable en potencia para mejorar las áreas de los estudiantes, profesores y programas que se encuentran asociados con el acceso y cobertura universal de salud.

Objetivo: apresentar o desenvolvimento de um kit de ferramentas para melhoria da qualidade da educação em saúde universal e na atenção primária à saúde em escolas de enfermagem e obstetrícia na América Latina e no Caribe. Métodos: um grupo de especialistas realizou uma revisão sistemática da literatura, selecionou conteúdos-chave e desenvolveu uma versão preliminar do kit, através de uma abordagem iterativa de consenso. Posteriormente, esta versão foi submetida a revisão por parceiros internacionais. Foram efetuadas análise dos dados obtidos em entrevista cognitiva, seguida da integração de revisões e de novas ferramentas até a se alcançar a aprovação da versão final. Resultados: vinte e dois estudos foram identificados e mapeados como recursos. O Modelo de Melhoria - uma abordagem baseada em dados para a análise de desempenho - foi selecionado devido a sua ampla difusão e simplicidade na execução das seguintes fases: 1) formação de uma equipe, 2) avaliação das melhorias necessárias na educação em saúde universal e atenção primária à saúde, 3) determinação de objetivos/metas e definição de prioridades com base numa matriz, 4) estabelecimento de métricas, 5) identificação de mudanças, 6) realização de uma série de ciclos de aprendizagem Planeje-Faça-Estude-Atue, e 7) manutenção das mudanças. Conclusões: o Kit de Ferramentas para Melhoria da Qualidade da Educação, desenvolvido a partir do consenso entre as partes envolvidas, representa uma abordagem sistemática, potencialmente adaptável às diversas culturas, para aprimorar aspectos do corpo discente, do corpo docente e de programas de educação relacionados com a cobertura e o acesso à saúde universal.

Objetivo: apresentar o desenvolvimento de um kit de ferramentas para melhoria da qualidade da educação em saúde universal e na atenção primária à saúde em escolas de enfermagem e obstetrícia na América Latina e no Caribe. Métodos: um grupo de especialistas realizou uma revisão sistemática da literatura, selecionou conteúdos-chave e desenvolveu uma versão preliminar do kit, através de uma abordagem iterativa de consenso. Posteriormente, esta versão foi submetida a revisão por parceiros internacionais. Foram efetuadas análise dos dados obtidos em entrevista cognitiva, seguida da integração de revisões e de novas ferramentas até a se alcançar a aprovação da versão final. Resultados: vinte e dois estudos foram identificados e mapeados como recursos. O Modelo de Melhoria - uma abordagem baseada em dados para a análise de desempenho - foi selecionado devido a sua ampla difusão e simplicidade na execução das seguintes fases: 1) formação de uma equipe, 2) avaliação das melhorias necessárias na educação em saúde universal e atenção primária à saúde, 3) determinação de objetivos/metas e definição de prioridades com base numa matriz, 4) estabelecimento de métricas, 5) identificação de mudanças, 6) realização de uma série de ciclos de aprendizagem Planeje-Faça-Estude-Atue, e 7) manutenção das mudanças. Conclusões: o Kit de Ferramentas para Melhoria da Qualidade da Educação, desenvolvido a partir do consenso entre as partes envolvidas, representa uma abordagem sistemática, potencialmente adaptável às diversas culturas, para aprimorar aspectos do corpo discente, do corpo docente e de programas de educação relacionados com a cobertura e o acesso à saúde universal.

Objective: to present the development of a toolkit for education quality improvement in universal health and primary health care, targeting schools of nursing and midwifery in Latin American and Caribbean countries. Methods: an expert work group conducted a systematic literature review, selected key content and completed toolkit drafting, using an iterative consensus approach. International partners reviewed the toolkit. Cognitive debriefing data were analyzed, revisions and new tools were integrated, and the final version was approved. Results: twenty-two articles were identified and mapped as resources. The Model for Improvement, a data-driven approach to performance analysis, was selected for its widespread use and simplicity in carrying out the following steps: 1) organize a team, 2) assess improvement need regarding universal health and primary health care education, 3) set an aim/goal and identify priorities using a matrix, 4) establish metrics, 5) identify change, 6) carry out a series of Plan-Do-Study-Act learning cycles, and 7) sustain change. Conclusions: the Education Quality Improvement Toolkit, developed through stakeholder consensus, provides a systematic, and potentially culturally adaptable approach to improve student, faculty, and program areas associated with universal health coverage and access.

Objetivo: presentar el desarrollo de un kit de herramientas para la mejora de la calidad de la educación en salud universal y atención primaria de salud, dirigido a las escuelas de enfermería y obstetricia en los países de América Latina y el Caribe. Métodos: un grupo de trabajo de expertos realizó una revisión sistemática de la literatura, seleccionó el contenido clave y redactó las herramientas, utilizando un consenso iterativo. Socios internacionales revisaron el kit de herramientas. Se analizaron los datos de la entrevista cognitiva, se integraron las revisiones y las nuevas herramientas, y se aprobó la versión final. Resultados: veintidós artículos fueron identificados y registrados como recursos. Se seleccionó el Modelo para Mejoramiento, un enfoque basado en datos para el análisis del desempeño, por su uso generalizado y sencillez para realizar los siguientes pasos: 1) organizar un equipo, 2) evaluar la necesidad de mejora con respecto a la educación universal en salud y atención primaria de salud, 3) establecer el objetivo e identificar las prioridades utilizando una matriz, 4) establecer métricas, 5) identificar el cambio, 6) llevar a cabo una serie de ciclos de aprendizaje Planear-Hacer-Estudiar-Actuar, y 7) mantener el cambio. Conclusiones: el Kit de Herramientas para la Mejora de la Calidad de la Educación, desarrollado mediante el consenso de las partes interesadas, proporciona un enfoque sistemático y culturalmente adaptable en potencia para mejorar las áreas de los estudiantes, profesores y programas que se encuentran asociados con el acceso y cobertura universal de salud.