Latino Health Access: Comparative Effectiveness of a Community-Initiated Promotor/a-Led Diabetes Self-management Education Program.

Community-initiated health interventions fill important gaps in access to health services. This study examines the effectiveness of a community-initiated health intervention to improve diabetes management in an underserved community of color using a retrospective observational study, comparing a study intervention, the Latino Health Access Diabetes Self-Management Program (LHA-DSMP), with usual care. The LHA-DSMP is a 12-session community health worker (promotor/a) intervention developed and implemented by a community-based organization in a medically underserved area. Usual care was delivered at a federally qualified health center in the same geographic area. Participants were 688 predominantly Spanish-speaking Latinx adults with type 2 diabetes. The main outcome was change in glycemic control (glycosylated hemoglobin [HbA1c]) from baseline to follow-up. At 14-week follow-up, mean (95% CI) HbA1c decrease was -1.1 (-1.3 to -0.9; P < .001) in the LHA-DSMP cohort compared with -0.3 (-0.4 to -0.2; P < .001) in the comparison cohort. Controlling for baseline differences between cohorts, the adjusted difference-in-differences value in HbA1c was -0.6 (-0.8 to -0.3; P < .001) favoring the LHA-DSMP. A community-initiated promotor/a-led educational program for diabetes self-management is associated with clinically significant improvement in blood sugar control, superior to what was observed with usual medical care.

Overall user satisfaction with family planning services and associated quality care factors: a cross-sectional analysis.

BACKGROUND: Studies of user satisfaction with family planning services (FPSs) have been conducted in different countries, and have been employed to identify ways of improving health, reducing costs and implementing reforms. The present work is the first-ever study undertaken in Mexico on the subject. Our objective was to identify how overall user satisfaction with FPSs in Mexico was related to: healthcare logistics, the functional value of services and the quality of interpersonal relations. METHODS: Users of 18 public clinics were surveyed in 2015. Data collected referred to their past and present use of FPSs, as well as to their perceptions of the services provided. We built a logistic regression model with potentially influential variables in order to assess their association with overall satisfaction. RESULTS: According to the self-reports of the 722 users interviewed, the following factors were decisive in their overall satisfaction with services: receiving sufficient information during visits (OR = 3.38; 95% CI:1.88-6.06), feeling that their opinions were taken into consideration by clinic staff (OR = 2.58; 95% CI:1.14-5.85), feeling that the motives for their visits were addressed (OR = 2.71; 95% CI:1.29-5.71), being assigned enough time for consultation (OR = 2.35; 95% CI:1.26-4.37), having the opportunity to ask questions and clarify doubts (OR = 2.31; 95% CI:1.21-4.43), experiencing no or few interruptions during their medical consultations (OR = 1.97;95% CI:1.10-3.51), and feeling satisfied with the contraceptive method provided (OR = 1.79; 95% CI:1.03-3.11). CONCLUSIONS: Service providers must be kept well informed on the perspective of users concerning user expectations. Taking into account the cultural context and perceived needs of users while providing service would improve the quality of care and, hence, the overall satisfaction of users.

Mitogen-activated protein kinase ERK1/2 regulates the class II transactivator.

The expression of major histocompatibility class II genes is necessary for proper antigen presentation and induction of an immune response. This expression is initiated by the class II transactivator, CIITA. The establishment of the active form of CIITA is controlled by a series of post-translational events, including GTP binding, ubiquitination, and dimerization. However, the role of phosphorylation is less clearly defined as are the consequences of phosphorylation on CIITA activity and the identity of the kinases involved. In this study we show that the extracellular signal-regulated kinases 1 and 2 (ERK1/2) interact directly with CIITA, targeting serine residues in the amino terminus of the protein, including serine 288. Inhibition of this phosphorylation by dominant-negative forms of ERK or by treatment of cells with the ERK inhibitor PD98059 resulted in the increase in CIITA-mediated gene expression from a class II promoter, enhanced the nuclear concentration of CIITA, and impaired its ability to bind to the nuclear export factor, CRM1. In contrast, inhibition of ERK1/2 activity had little effect on serine-to-alanine mutant forms of CIITA. These data suggest a model whereby ERK1/2-mediated phosphorylation of CIITA down-regulates CIITA activity by priming it for nuclear export, thus providing a means for cells to tightly regulate the extent of antigen presentation.