The Health Equity Network of the Americas: inclusion, commitment, and action / La Red de las Américas para la Equidad en Salud: inclusión, compromiso y acción

ABSTRACT The Health Equity Network of the Americas (HENA) is a multidisciplinary network that promotes knowledge sharing and intersectoral action for equity in health and human rights in the Americas. The objectives of HENA are: 1) to share successful experiences in the development of interventions, considering the social determinants and determination of health, to achieve participatory and community-based health responses; 2) to analyze the health, social, political, environmental and economic impacts of the COVID-19 pandemic; 3) to identify the effects of pandemic care on populations most at risk because of their age and pre-existing health conditions; 4) examine the situation at borders and population movements in the spread of the pandemic and its effects on migrant populations; 5) propose strategies to ensure access to comprehensive care for pregnant women in order to reduce maternal and neonatal suffering, morbidity, and mortality; and 6) analyze violations of human rights and the right to health of historically marginalized populations, including street dwellers and other communities that depend on public spaces and the street for survival. The analytical and intervention models for health equity at HENA are based on various approaches, including social medicine, social epidemiology, medical anthropology, human ecology, and One Health.

RESUMEN La Red de las Américas para la Equidad en Salud (RAES) es una red multidisciplinaria que promueve el intercambio de conocimientos y la acción intersectorial para la equidad en salud y los derechos humanos en las Américas. Los objetivos de la RAES consisten en: 1) compartir experiencias exitosas en el desarrollo de intervenciones, considerando la determinación y los determinantes sociales, para lograr respuestas participativas y comunitarias en salud; 2) analizar los impactos sanitarios, sociales, políticos, ambientales y económicos de la pandemia de COVID-19; 3) identificar los efectos de la atención de la pandemia en las poblaciones de mayor riesgo por su edad y las condiciones de salud preexistentes; 4) examinar la situación de las fronteras y de los movimientos de población en la propagación de la pandemia y de sus efectos en las poblaciones migrantes; 5) proponer estrategias para asegurar el acceso a la atención integral de las mujeres gestantes, con el fin de reducir el sufrimiento, la morbilidad y la mortalidad materna y neonatal; y 6) analizar vulneraciones de derechos humanos y del derecho a la salud de poblaciones históricamente marginalizadas, incluyendo habitantes en situación de calle y otras comunidades que dependen de los espacios públicos y de la calle para sobrevivir. Los modelos analíticos y de intervención para la equidad en salud de la RAES se desarrollan desde varios enfoques, como la medicina social, la epidemiologia social, la antropología médica, la ecología humana y el de Una sola salud.

Prevalence and Severity of Fecal Incontinence in Veterans

BACKGROUND/AIMS: Fecal incontinence (FI) is a common complaint that increases in prevalence with age. Our aim was to determine the prevalence of FI and assess its severity by self-report in a male-predominant Veteran outpatient clinic setting. METHODS: An anonymous 28 item questionnaire was administered to a convenience sample of veterans awaiting appointments. FI was defined as a loss of liquid or solid stool at least monthly. Multivariable logistic and linear models were used to identify predictors of FI prevalence and severity. RESULTS: One hundred thirty-three gastroenterology (GI) participants and 126 primary care (PC) participants completed the survey. Ninety-four of 259 participants (36.3%, 95% confidence interval [CI]: 30.4–42.5) reported an episode of FI (41.4% GI participants vs 31.0% PC participants; P = 0.078) with 33.6% having FI within the last 30 days (36.8% GI participants vs 30.2% PC participants; P = 0.122). Participants with more bowel movements per week (P = 0.005) and per day (P < 0.001) and with a higher Bristol Stool Scale form (P = 0.010) were more likely to have FI. Of participants with FI, mean Fecal Incontinence Severity Index score was 23.0 ± 9.5 with a significantly higher symptom score in GI participants compared to PC participants (25.2 ± 10.0 vs 20.1 ± 8.2; P = 0.011). Few participants had ever been asked by (35.0%) or evaluated by (18.0%) a doctor for FI symptoms. CONCLUSIONS: FI is a common complaint and under-recognized problem in the male-dominant Veteran population. Despite its prevalence, relatively few participants were asked about FI, with even less being treated. Due to the possible effects and implications on quality of life, more should be done to recognize this condition and arrange treatment.

Gene Expression Profiling and Assessment of Vitamin D and Serotonin Pathway Variations in Patients With Irritable Bowel Syndrome

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a multifaceted disorder that afflicts millions of individuals worldwide. IBS is currently diagnosed based on the presence/duration of symptoms and systematic exclusion of other conditions. A more direct manner to identify IBS is needed to reduce healthcare costs and the time required for accurate diagnosis. The overarching objective of this work is to identify gene expression-based biological signatures and biomarkers of IBS. METHODS: Gene transcripts from 24 tissue biopsy samples were hybridized to microarrays for gene expression profiling. A combination of multiple statistical analyses was utilized to narrow the raw microarray data to the top 200 differentially expressed genes between IBS versus control subjects. In addition, quantitative polymerase chain reaction was employed for validation of the DNA microarray data. Gene ontology/pathway enrichment analysis was performed to investigate gene expression patterns in biochemical pathways. Finally, since vitamin D has been shown to modulate serotonin production in some models, the relationship between serum vitamin D and IBS was investigated via 25-hydroxyvitamin D (25[OH]D) chemiluminescence immunoassay. RESULTS: A total of 858 genetic features were identified with differential expression levels between IBS and asymptomatic populations. Gene ontology enrichment analysis revealed the serotonergic pathway as most prevalent among the differentially expressed genes. Further analysis via real-time polymerase chain reaction suggested that IBS patient-derived RNA exhibited lower levels of tryptophan hydroxylase-1 expression, the enzyme that catalyzes the rate-limiting step in serotonin biosynthesis. Finally, mean values for 25(OH)D were lower in IBS patients relative to non-IBS controls. CONCLUSIONS: Values for serum 25(OH)D concentrations exhibited a trend towards lower vitamin D levels within the IBS cohort. In addition, the expression of select IBS genetic biomarkers, including tryptophan hydroxylase 1, was modulated by vitamin D. Strikingly, the direction of gene regulation elicited by vitamin D in colonic cells is “opposite” to the gene expression profile observed in IBS patients, suggesting that vitamin D may help “reverse” the pathological direction of biomarker gene expression in IBS. Thus, our results intimate that IBS pathogenesis and pathophysiology may involve dysregulated serotonin production and/or vitamin D insufficiency.

A sting in the tail: The N-terminal domain of the androgen receptor as a drug target / 亚洲男科学杂志(英文版)

The role of androgen receptor (AR) in the initiation and progression of prostate cancer (PCA) is well established. Competitive inhibition of the AR ligand-binding domain (LBD) has been the staple of antiandrogen therapies employed to combat the disease in recent years. However, their efficacy has often been limited by the emergence of resistance, mediated through point mutations, and receptor truncations. As a result, the prognosis for patients with malignant castrate resistant disease remains poor. The amino-terminal domain (NTD) of the AR has been shown to be critical for AR function. Its modular activation function (AF-1) is important for both gene regulation and participation in protein-protein interactions. However, due to the intrinsically disordered structure of the domain, its potential as a candidate for therapeutic intervention has been dismissed in the past. The recent emergence of the small molecule EPI-001 has provided evidence that AR-NTD can be targeted therapeutically, independent of the LBD. Targeting of AR-NTD has the potential to disrupt multiple intermolecular interactions between AR and its coregulatory binding partners, in addition to intramolecular cross-talk between the domains of the AR. Therapeutics targeting these protein-protein interactions or NTD directly should also have efficacy against emerging AR splice variants which may play a role in PCA progression. This review will discuss the role of intrinsic disorder in AR function and illustrate how emerging therapies might target NTD in PCA.

Potential Role of Estrogen Metabolite 2-Methoxyestradiol in Health and Disease.

2-Methoxyestradiol (2-ME2) is an endogenous metabolite of 17β-estradiol (E2) that was originally thought to be an inert end product of estrogen metabolism. However, studies con ducted over the past two decades have shown 2-ME2 to be a promising anticancer agent. Reports suggest that 2-ME2 directly infuences tumor growth through mechanisms which reduce cell proliferation or induce apoptosis as well as through the inhibition of angiogenesis. Incidentally, 2-ME2 as an anticancer agent has poor bioavailability, and this has led to the development of several analogs and derivatives, which currently have had limited success. Thus, it is imperative that we re-evaluate our understanding of 2-ME2-mediated effects in order to innovatively derive, or generate, more effcacious cancer treatment options. In this review, the roles of 2-ME2 in cancer as well as the highly variable mechanisms of action reported for this metabolite are discussed.

Effects of Nitrogen Availability on the Fate of Litter-Carbon and Soil Organic Matter Decomposition.

Aims: To determine whether addition of inorganic nitrogen (N) directly to maize litter (stalk and leaf) with differing tissue quality impacts litter and soil organic matter (SOM) decomposition. We tested whether N addition leads to 1) faster litter decomposition, 2) less SOM-C decomposition and 3) increased incorporation of organic-C into soil-C fractions thereby increasing C sequestration potential in maize-based systems. Methodology: We investigated decomposition of two types of maize litter (stalk and leaf) with differing tissue quality both in the field and in a laboratory incubation experiment. In the field, litter was placed on the soil surface and at 10 cm soil depth to investigate the effect of litter burial and N addition on litter decomposition. Litter was harvested at six and twelve month intervals. In the incubation experiment, maize and stalk litter was ground and incorporated into the soil and incubated at 25ºC for 120 days. We measured CO2-C evolved and employed δ13C natural abundance differences between litter-C and SOM-C to measure both litter-C and SOM-C decomposition. At the end of the experiment, we examined soil-C storage via soil physical fractionation. Results: Exogenous N addition to litter had little effect both litter and SOM decomposition in the field and the laboratory except for in the stalk litter treatment where there was an 8% decrease in litter-C loss and a 5% increase in SOM-C loss in the laboratory incubation experiment. N addition to litter increased decomposition of litter in the first 20 days of litter decomposition in the laboratory incubation experiment, but reduced litter decomposition rates after day 20. N addition to litter had very little effect on C storage in soil aggregates. In the field, litter placement, and physical litter structure influenced decomposition much more than N inputs. Thus, adding N to litter is not an effective strategy to sequester C in maize-based systems.

A ten-year assessment of anabolic steroid misuse among competitive athletes in Puerto Rico / Valoración por diez años del abuso de esteroides anabólicos entre los atletas de competencia de Puerto Rico

OBJECTIVE: Little is known about anabolic androgenic steroids (AAS) misuse in the Caribbean region in spite of increased popularity among athletes and adolescents. The present study examines the usage of AAS among competitive athletes in Puerto Rico. METHODS: Doping test results of competitive athletes obtained by random sampling out of competition during the 2000-2009 period were analysed. Doping tests were executed by the Centre for Sports, Health and Exercise Sciences (Albergue Olímpico, Salinas, Puerto Rico). A total of 550 athletes were monitored during 2000-2009. Information was collected with regard to competitive sport, gender and AAS compounds whenever a positive test result was encountered. RESULTS: From the total sample of monitored cases during the past decade, 5.4% showed adverse analytical findings. Anabolic androgenic steroids misuse was detected among male (62%) and female (38%) athletes. Weightlifting showed the greatest percentage of positive AAS doping test results (70% of total cases) and stanozolol was the most commonly misused exogenous androgen (60% of abused AAS whether alone or as part of a cocktail). Testosterone was the most common endogenous misused steroid (10% of misused compounds). CONCLUSION: In Puerto Rico, AAS misuse was detected across competitive sports for both genders. Although AAS misuse among Puerto Rican athletes shares some features that are consistent with the international sports community, it is imperative to address AAS misuse in the Caribbean region.

OBJETIVO: Poco se sabe acerca del abuso de los esteroides anabólicos androgénicos (EAA) en la región del Caribe, a pesar de su creciente popularidad entre atletas y adolescentes. El estudio presente examina el uso de EAA entre los atletas de competencia en Puerto Rico. MÉTODOS: Se analizaron los resultados de la prueba de dopaje practicada a atletas de competencia mediante un muestreo aleatorio realizado a partir de competencias celebradas durante el 2000-2009. Las pruebas de dopaje fueron realizadas por el Centro de Deportes, Salud y Ciencias del Ejercicio (Albergue Olímpico, Salinas, Puerto Rico). Se monitorearon un total de 550 atletas durante 2000-2009. Se recogió información en relación con los deportes de competencia, género, y compuestos de EAA, siempre que la prueba arrojara resultados positivos. RESULTADOS: De la muestra total de casos supervisados durante la década pasada, 5.4% mostraron resultados analíticos adversos. Se detectó un uso inapropiado de esteroides anabólicos androgénicos entre los atletas varones (62%) y hembras (38%). El levantamiento de pesas mostró el porcentaje más alto de resultados de dopaje positivos a EAA (70% del total de casos) y el estanozolol fue el andrógeno exógeno más comúnmente mal empleado (60% de los EAA usados inapropiadamente, bien solos o como parte de un cóctel). La testosterona fue el esteroide endógeno más comúnmente abusado (10% de los compuestos mal empleados). CONCLUSIÓN: En Puerto Rico, se detectó uso inapropiado de EAA en los deportes de competencia de ambos géneros. Aunque el abuso de EAA entre los atletas portorriqueños comparte algunas de las características correspondientes a la comunidad internacional de deportes, es absolutamente necesario profundizar en el problema del abuso de los EAA en el área del Caribe.

Operational issues and trends associated with the pilot introduction of zinc for childhood diarrhoea in Bougouni district, Mali.

Zinc for the treatment of childhood diarrhoea was introduced in a pilot area in southern Mali to prepare for a cluster-randomized effectiveness study and to inform policies on how to best introduce and promote zinc at the community level. Dispersible zinc tablets in 14-tablet blister packs were provided through community health centres and drug kits managed by community health workers (CHWs) in two health zones in Bougouni district, Mali. Village meetings and individual counselling provided by CHWs and head nurses at health centres were the principal channels of communication. A combination of methods were employed to (a) detect problems in communication about the benefits of zinc and its mode of administration; (b) identify and resolve obstacles to implementation of zinc through existing health services; and (c) describe household-level constraints to the adoption of appropriate home-management practices for diarrhoea, including administration of both zinc and oral rehydration solution (ORS). Population-based household surveys with caretakers of children sick in the previous two weeks were carried out before and four months after the introduction of zinc supplementation. Household follow-up visits with children receiving zinc from the health centres and CHWs were conducted on day 3 and 14 after treatment for a subsample of children. A qualitative process evaluation also was conducted to investigate operational issues. Preliminary evidence from this study suggests that the introduction of zinc does not reduce the use of ORS and may reduce inappropriate antibiotic use for childhood diarrhoea. Financial access to treatments, management of concurrent diarrhoea and fever, and high use of unauthorized drug vendors were identified as factors affecting the effectiveness of the intervention in this setting. The introduction of zinc, if not appropriately integrated with other disease-control strategies, has the potential to decrease the appropriate presumptive treatment of childhood malaria in children with diarrhoea and fever in malaria-endemic areas.