Synthesis of PEGylated amphiphilic block copolymers with pendant linoleic moieties by combining ring-opening polymerization and click chemistry.

This study focused on synthesizing and characterizing PEGylated amphiphilic block copolymers with pendant linoleic acid (Lin) moieties as an alternative to enhance their potential in drug delivery applications. The synthesis involved a two-step process, starting with ring-opening polymerization of ε-caprolactone (CL) and propargylated cyclic carbonate (MCP) to obtain PEG-b-P(CL-co-MCP) copolymers, which were subsequently modified via click chemistry. Various reaction conditions were explored to improve the yield and efficiency of the click chemistry step. The use of anisole as a solvent, N-(3-azidopropyl)linoleamide as a substrate, and a reaction temperature of 60°C proved to be highly efficient, achieving nearly 100% conversion at a low catalyst concentration. The resulting copolymers exhibited controlled molecular weights and low polydispersity, confirming the successful synthesis. Furthermore, click chemistry allows for the attachment of Lin moieties to the copolymer, enhancing its hydrophobic character, as deduced from their significantly lower critical micelle concentration than that of traditional PEG-b-PCL systems, which is indicative of enhanced stability against dilution. The modified copolymers exhibited improved thermal stability, making them suitable for applications that require high processing temperatures. Dynamic light scattering and transmission electron microscopy confirmed the formation of micellar structures with sizes below 100 nm and minimal aggregate formation. Additionally, 1H NMR spectroscopy in deuterated water revealed the presence of core-shell micelles, which provided higher kinetic stability against dilution.

ncRNAs Orchestrate Chemosensitivity Induction by Neddylation Blockades.

We performed an integrative transcriptomic in silico analysis using lung adenocarcinoma A549 cells treated with the neddylation inhibitor MLN4924 and the gefitinib-resistant PC9 cell line (PC9GR). We focused on the transcriptional effects of the top differentially expressed ncRNA biotypes and their correlating stemness factors. Interestingly, MLN4924-treated cells showed a significant upregulation of mRNAs involved in carcinogenesis, cell attachment, and differentiation pathways, as well as a parallel downregulation of stemness maintenance and survival signaling pathways, an effect that was inversely observed in PC9GR cells. Moreover, we found that stemness factor expression could be contrasted by selected up-regulated ncRNAs upon MLN4924 treatment in a dose and time-independent manner. Furthermore, upregulated miRNAs and lncRNA-targeted mRNAs showed an evident enrichment of proliferation, differentiation, and apoptosis pathways, while downregulated ncRNA-targeted mRNAs were implicated in stem cell maintenance. Finally, our results proved that stemness (KLF4 and FGFR2) and epithelial-mesenchymal transition (ZEB2, TWIST2, SNAI2, CDH2, and VIM) factors, which are highly expressed in PC9GR cells compared to gefitinib-sensitive PC9 cells, could be abrogated with the neddylation inhibitor MLN4924 mainly through activation of epithelial differentiation pathways, thus exerting a protective role in lung cancer cells and chemosensitivity against lung tumorigenic transformation.

FIGO statement: Fertility preservation.

Fertility preservation is a growing field in reproductive medicine that may raise ethical questions. Preservation of fertility must be discussed with the patient if gonadotoxic treatment is required, whether in the case of benign or malignant pathology, or in the management of transgender identity. As a result, surgery or chemotherapy that has fewer adverse impacts on fertility should be proposed if this does not alter the prognosis of the disease. If the risk of infertility persists, then fertility cryopreservation should be proposed for children and adults of reproductive age. Sperm, oocytes, and gonadal tissue can be cryopreserved for many years. FIGO wishes to emphasize the importance of fertility preservation in the medical and surgical management of patients, and the importance of a specialized, multidisciplinary approach.

Percepción familiar de la vigilancia del desarrollo psicomotor en niños menores de un año / Family Perception about Surveillance of Psychomotor Development in Infants Aged less than one Year

Introducción: El desarrollo psicomotor es un proceso gradual y continuo; las familias cubanas necesitan herramientas que les permitan vigilarlo. Objetivo: Describir las percepciones que poseen las familias de la vigilancia del desarrollo psicomotor de sus hijos menores de un año. Métodos: Se realizó una investigación cualitativa, de tipo fenomenológica, en el Consultorio del Médico y la Enfermera de la Familia No. 9 del Policlínico Universitario Héroes del Moncada, La Habana, de noviembre 2019 a febrero 2022. El referente teórico fue el Modelo de Traducción del Conocimiento. Las unidades de análisis fueron ocho familias que tenían un niño menor de un año, a las que se aplicó el Método Creativo Sensible, mediante la dinámica de arte del Árbol del conocimiento. Se grabaron las sesiones, y las narrativas fueron transcritas en un cuerpo textual a las que se les realizó análisis de contenido. Resultados: Las familias expresaron que la llegada del niño significó alegría y unión familiar; así como la necesidad de contar con diferentes materiales que ayudaran para la vigilancia del desarrollo psicomotor. De las 33 pautas analizadas fue necesario traducir tres al lenguaje familiar. Conclusiones: El nacimiento de un hijo tuvo un efecto favorable. La dinámica empleada fue efectiva para el propósito de la descripción de las pautas del desarrollo psicomotor para niños cubanos por las familias estudiadas. Se evidenció la necesidad de algún tipo de herramienta para la vigilancia del desarrollo psicomotor(AU)

Introduction: Psychomotor development is a gradual and continuous process; Cuban families need tools that allow them to monitor it. Objective: To describe the families' perceptions with respect to monitoring the psychomotor development of their infants aged less than one year. Methods: A qualitative research, of phenomenological type, was carried out in the family doctor and nurse's office 9, belonging to Policlínico Universitario Heroes del Moncada, of Havana, from November 2019 to February 2022. The theoretical reference was the knowledge translation model. The units of analysis were 8 families with an infant aged less than one year and applied the creative sensitive method, using the art dynamics of the tree of knowledge. The sessions were recorded, and the narratives were transcribed into a textual body later subjected to content analysis. Results: The families expressed that the arrival of the child meant joy and family unity, as well as the need to have different materials that help monitor the child's psychomotor development. Of the 33 guidelines analyzed, it was necessary to translate three into a family language. Conclusions: The birth of a child had a favorable effect. The used dynamics was effective for the purpose that the studied families describe psychomotor development guidelines for their Cuban children. The need for some kind of tool for monitoring of psychomotor development was evidenced(AU)

Factores de riesgo en la edad reproductiva / Risk Factors in the Reproductive Age

Por medio de la presente y motivados por la lectura y análisis del artículo Características clínicas y microbiológicas de la infección de vías urinarias bajas en población ambulatoria,1 quisiéramos llamar la atención sobre un tema que últimamente tiene poca visibilidad en las publicaciones. Se trata de los factores de riesgo presentes en la edad reproductiva y que inciden negativamente en futuros embarazos, lo que se conoce como factores de riesgo preconcepcional. Al revisar lo publicado en los últimos cinco años apenas se aborda directamente el tema, que por demás mantiene vigencia capital cuando de salud materno infantil se trata. En el trabajo que motiva el análisis, se expresa la frecuencia de aparición de las infecciones urinarias bajas en ambos sexos, más frecuentes en mujeres...(AU)

Epigenetic mechanisms of particulate matter exposure: air pollution and hazards on human health.

Environmental pollution nowadays has not only a direct correlation with human health changes but a direct social impact. Epidemiological studies have evidenced the increased damage to human health on a daily basis because of damage to the ecological niche. Rapid urban growth and industrialized societies importantly compromise air quality, which can be assessed by a notable accumulation of air pollutants in both the gas and the particle phases. Of them, particulate matter (PM) represents a highly complex mixture of organic and inorganic compounds of the most variable size, composition, and origin. PM being one of the most complex environmental pollutants, its accumulation also varies in a temporal and spatial manner, which challenges current analytical techniques used to investigate PM interactions. Nevertheless, the characterization of the chemical composition of PM is a reliable indicator of the composition of the atmosphere, the quality of breathed air in urbanized societies, industrial zones and consequently gives support for pertinent measures to avoid serious health damage. Epigenomic damage is one of the most promising biological mechanisms of air pollution-derived carcinogenesis. Therefore, this review aims to highlight the implication of PM exposure in diverse molecular mechanisms driving human diseases by altered epigenetic regulation. The presented findings in the context of pan-organic cancer, fibrosis, neurodegeneration and metabolic diseases may provide valuable insights into the toxicity effects of PM components at the epigenomic level and may serve as biomarkers of early detection for novel targeted therapies.

Outcomes for critical illness in children with cancer: Analysis of risk factors for adverse outcome and resource utilization from a specialized center in Mexico.

Introduction: Children with cancer have a higher risk of adverse outcomes during critical illness than general pediatric populations. In Low- and middle-income countries, lack of resources can further negatively impact outcomes in critically ill children with cancer. Methods: In this study, we describe the outcomes of a large cohort of children with cancer including mortality and resource utilization. We performed a retrospective review of all patients admitted to our PICU between December 12th, 2013 and December 31st, 2019. Outcomes were defined as recovery or death and resource utilization was described via use of critical care interventions, Length of stay as well as PICU- and Mechanical Ventilation- free days. Results: Overall mortality was 6.9% while mortality in the unplanned admissions was 9.1%. This remained lower than expected mortality based on PIM2 scoring. Type of PICU admission, Neurological Deterioration as a cause of PICU admission, and PIM2 were significant as risk factors in univariate analysis, but only PIM2 remained significant in the multivariate analysis. Discussion: Our Study shows that high survival rates are achievable for children with cancer with critical illness in resource-limited settings with provision of high-quality critical care. Organizational and clinical practice facilitating quality improvement and early identification and management of critical illness may attenuate the impact of known risk factors for mortality in this population.

Serum Levels of Galectin-9 are Increased in Cervical Cancer Patients and are Higher in Advanced Clinical Stages.

Purpose: Cervical cancer (CC) is the second most frequent cancer in undeveloped countries. Serum biomarkers could be useful for evaluation of the treatment response and as a complementary means to improve diagnosis. The expression of galectin-9 is altered in cancer tissue, and higher concentrations are found in the serum of cancer patients. The objectives of this study were (a) to determine the serum galectin-9 concentration in patients with intraepithelial lesions and CC, (b) to determine if the concentration was related to the clinicopathological characteristics and (c) to determine if the galectin-9 concentration was related to its expression level in tumour tissue. Patients and Methods: In all, 222 serum samples from women with different diagnoses, including premalignant lesions and CC, as well as samples from women with normal cytology were included in the study. The serum galectin-9 concentration was determined by ELISA. To evaluate the expression level of galectin-9 in CC tissue, immunohistochemistry was performed in 34 CC biopsy specimens. Results: The galectin-9 concentration in the serum of CC patients (8.171 ng/mL) was increased compared with serum from women with normal epithelia (4.654 ng/mL) and those with low-grade (4.806 ng/mL) and high-grade (5.354 ng/mL) intraepithelial lesions (p value < 0.0001). The area under the ROC curve considering the CC group and the control group was 0.882. The optimal cut-off value was ≥6.88 ng/mL, the specificity obtained was 100%, and the sensitivity was 68.2%. In the CC group, the analysis of the clinical stage showed an increase of galectin-9 in the advanced stage IV group. Serum galectin-9 was not related to the level of galectin-9 expression in tissue, which suggests that galectin-9 is not secreted by tumour cells. Conclusion: The serum galectin-9 concentration is related to cancer progression, as the level of this protein is higher in patients with advanced-stage disease.

Advances of Epigenetic Biomarkers and Epigenome Editing for Early Diagnosis in Breast Cancer.

Epigenetic modifications are known to regulate cell phenotype during cancer progression, including breast cancer. Unlike genetic alterations, changes in the epigenome are reversible, thus potentially reversed by epi-drugs. Breast cancer, the most common cause of cancer death worldwide in women, encompasses multiple histopathological and molecular subtypes. Several lines of evidence demonstrated distortion of the epigenetic landscape in breast cancer. Interestingly, mammary cells isolated from breast cancer patients and cultured ex vivo maintained the tumorigenic phenotype and exhibited aberrant epigenetic modifications. Recent studies indicated that the therapeutic efficiency for breast cancer regimens has increased over time, resulting in reduced mortality. Future medical treatment for breast cancer patients, however, will likely depend upon a better understanding of epigenetic modifications. The present review aims to outline different epigenetic mechanisms including DNA methylation, histone modifications, and ncRNAs with their impact on breast cancer, as well as to discuss studies highlighting the central role of epigenetic mechanisms in breast cancer pathogenesis. We propose new research areas that may facilitate locus-specific epigenome editing as breast cancer therapeutics.

The FIGO ovulatory disorders classification system.

Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding, and infertility, and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical, and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical, and procedural interventions. Collaborative research, effective education, and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to WHO, was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This manuscript describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians, and trainees using the "GAIN-FIT-PIE" mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and Vascular; Physiological, Idiopathic, Endocrine). The tertiary level allows for specific diagnostic entities. It is anticipated that, if widely adopted, this system will facilitate education, clinical care, and the design and interpretation of research in a fashion that better informs progress in this field. Integral to the deployment of this system is a periodic process of reevaluation and appropriate revision, reflecting an improved understanding of this collection of disorders.

The FIGO Ovulatory Disorders Classification System†.

Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding and infertility and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical and procedural interventions. Collaborative research, effective education and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to the World Health Organization (WHO), was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This article describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians and trainees using the 'GAIN-FIT-PIE' mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and Vascular; Physiological, Idiopathic, Endocrine). The tertiary level allows for specific diagnostic entities. It is anticipated that, if widely adopted, this system will facilitate education, clinical care and the design and interpretation of research in a fashion that better informs progress in this field. Integral to the deployment of this system is a periodic process of reevaluation and appropriate revision, reflecting an improved understanding of this collection of disorders.

The FIGO Ovulatory Disorders Classification System.

Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding, and infertility, and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical, and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical, and procedural interventions. Collaborative research, effective education, and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to WHO, was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This manuscript describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians, and trainees using the "GAIN-FIT-PIE" mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and vascular; Physiological, Idiopathic, Endocrine). The tertiary level allows for specific diagnostic entities. It is anticipated that, if widely adopted, this system will facilitate education, clinical care, and the design and interpretation of research in a fashion that better informs progress in this field. Integral to the deployment of this system is a periodic process of reevaluation and appropriate revision, reflecting an improved understanding of this collection of disorders.

Epigenetic Regulation in Exposome-Induced Tumorigenesis: Emerging Roles of ncRNAs.

Environmental factors, including pollutants and lifestyle, constitute a significant role in severe, chronic pathologies with an essential societal, economic burden. The measurement of all environmental exposures and assessing their correlation with effects on individual health is defined as the exposome, which interacts with our unique characteristics such as genetics, physiology, and epigenetics. Epigenetics investigates modifications in the expression of genes that do not depend on the underlying DNA sequence. Some studies have confirmed that environmental factors may promote disease in individuals or subsequent progeny through epigenetic alterations. Variations in the epigenetic machinery cause a spectrum of different disorders since these mechanisms are more sensitive to the environment than the genome, due to the inherent reversible nature of the epigenetic landscape. Several epigenetic mechanisms, including modifications in DNA (e.g., methylation), histones, and noncoding RNAs can change genome expression under the exogenous influence. Notably, the role of long noncoding RNAs in epigenetic processes has not been well explored in the context of exposome-induced tumorigenesis. In the present review, our scope is to provide relevant evidence indicating that epigenetic alterations mediate those detrimental effects caused by exposure to environmental toxicants, focusing mainly on a multi-step regulation by diverse noncoding RNAs subtypes.

Drospirenone: a Latin American perspective for oestrogen-free oral contraception.

AIM: Combined hormonal contraceptives, despite their high efficacy, are associated with an increased relative risk of cardiovascular events. The contraceptive mechanism of action of combined pills depends fundamentally on their progestin component. METHODS: A narrative review was performed. RESULTS: The drospirenone-only pill, including this synthetic progestogen with antimineralocorticoid and antiandrogenic activity, has high contraceptive efficacy that has been demonstrated with a 24-day schedule of 4-day administration of hormone-free pills. Due to its safety profile, the drospirenone-only pill is suitable even in high-risk populations, such as women with high blood pressure, thromboembolism, smoking or dyslipidemia. CONCLUSION: Considering the increasing prevalence of these comorbidities in Latin America, the 4 mg drospirenone-only pill is suggested as one of the strategies of choice in the region for those women who choose oral contraceptives.

Medicina Tradicional y Complementaria en el contexto colombiano: una breve mirada / Traditional and Complementary Medicine in the Colombian context: a brief look

Este capítulo presenta un breve contexto de la Medicina Complementaria (MTAC ­ Medicina y Terapias Alternativas y Complementarias como actualmente se denomina en Colombia), y la Medicina Tradicional- Ancestral (MT-A) de los grupos étnicos que habitan en el país (pueblos indígenas, pueblo ROM gitano, comunidades afrocolombianas, raizales y palenquera). El contexto incluye información referente a los antecedentes históricos, la normativa, la situación actual, y menciona elementos del marco académico e investigativo de la MT-A y la MTAC. Aunque en el Sistema General de Seguridad Social en Salud (SGSSS) colombiano prima el enfoque convencional de atención en salud (medicina alopática, facultativa u occidental), los saberes en salud propios de grupos étnicos, así como las Medicinas Complementarias, y Alternativas también se contemplan como parte del sistema. La Ley 1438 de 2011, en su capítulo III "Para la implementación de la Atención Primaria en Salud (APS) en el marco del Sistema General de Seguridad Social en Salud", menciona dentro de sus elementos la "Interculturalidad, que incluye entre otros, los elementos de prácticas tradicionales, alternativas y complementarias para la atención en salud". Sin embargo, se hace una distinción y legislación diferencial entre ellas. Mientras que, la Medicina Tradicional o Ancestral, MT-A, hace referencia a la medicina de los grupos étnicos de Colombia (Rom Gitanos, Pueblos Indígenas y comunidades Negras, Afrocolombianas, Raizales y Palenqueras), las Medicinas y Terapias Alternativas y Complementarias- MTAC son definidas como "aquellas técnicas, prácticas, procedimientos, enfoques o conocimientos que utilizan la estimulación del funcionamiento de las leyes naturales para la autorregulación del ser humano con el objeto de promover, prevenir, tratar y rehabilitar la salud de la población desde un pensamiento holístico". Cabe aclarar que las medicinas tradicionales de otros países, como la MT China y la MT Ayurveda, se incluyen dentro de las MTAC y no como MT-A, puesto que no son propias de los grupos étnicos del país. Dados estos planteamientos, en este capítulo se presentarán algunos aspectos históricos y legislativos, así como el contexto actual de manera separada para las MTAC, y para las MT-A.

Histone H3K9 and H3K14 acetylation at the promoter of the LGALS9 gene is associated with mRNA levels in cervical cancer cells.

Galectin-9 levels have been reported to be altered in several cancer types, but the mechanism that regulates the expression of Galectin-9 has not been clarified. Galectin-9 is encoded by the LGALS9 gene, which gives rise to eight mRNA variants. The aims of this study were: (a) to identify the mRNA variants of LGALS9, (b) to characterize CpG methylation and H3K9 and H3K14 histone acetylation at the promoter of the LGALS9 gene, and (c) to characterize the relationship between these modifications and LGALS9 expression level in cervical cancer cells. All mRNA variants were detected in HaCaT (nontumoural keratinocytes) and SiHa cells, and seven were observed in HeLa cells. The promoter region of LGALS9 contains eight CpG dinucleotides. No hypermethylation pattern related to low LGALS9 expression was identified in tumour cells. Chromatin immunoprecipitation analysis demonstrated higher acetylation of H3K9ac and H3K14ac in HaCaT cells, which was related to higher mRNA levels. The presence of the mRNA variants suggests that alternative splicing may regulate the expression of galectin-9 isoforms. The results of this study suggest that histone acetylation, but not promoter CpG methylation, may be involved in the transcriptional regulation of the LGALS9 gene.

Educación del diabético en el contexto de la medicina familiar en Cuba / Education of the Diabetic Patient and Family Medicine in Cuba

Introducción: La educación de una persona diabética constituye un aspecto esencial para el manejo y control de la enfermedad. La educación para la salud desarrolla procesos de aprendizaje participativos para la construcción de la salud y el mejoramiento de la calidad de vida. Objetivo: Identificar los principales enfoques de las investigaciones relacionadas con la educación para la salud de las personas diabéticas en el contexto de la medicina familiar en Cuba. Métodos: Se realizó un trabajo de revisión bibliográfica. Se utilizó la biblioteca virtual de salud que se encuentra en el sitio web http://www.Infomed.sld.cu y los descriptores: diabetes mellitus, educación para la salud, atención primaria de salud, promoción de salud en Cuba. Las principales fuentes de información fueron revistas, libros de autores cubanos, anuario estadístico de salud de Cuba, repositorios de tesis doctorales y maestría, boletines y comunicaciones en APS, además se revisaron las bases de datos: ciencias de la salud general, PubMed /Medline y documentos de organismos internacionales. También se realizó una búsqueda en Internet, en Google académico, con las mismas palabras claves. Conclusiones: La mayoría de las investigaciones para la educación de las personas diabéticas se centran en el desarrollo de programas educativos que muestran efectividad para incrementar conocimientos y modificar prácticas de salud, están enfocadas en las áreas de actitudes personales, ambientes favorables y educación terapéutica. La medicina familiar juega un papel rector en las acciones desarrolladas para la educación del diabético(AU)

Introduction: The education of a diabetic person is an essential aspect for the management and control of the disease. Health education develops participatory learning processes for the construction of health and the improvement of the quality of life. Objective: To identify the main research approaches related to education for the health of diabetics in the context of family medicine in Cuba. Methods: A review of the literature was carried out during 5 weeks, from June 19 to July 21, 2017. The virtual health library was used. Conclusions: Most of the research for the education of diabetic people focuses on the development of educational programs that show effectiveness to increase knowledge and modify health practices, and they are focused on the areas of personal attitudes, favorable environments and therapeutic education. Family medicine plays a leading role in the actions developed for the education of the diabetic patient(AU)

El Programa del médico y enfermera de la familia: desarrollo del modelo de atención médica en Cuba

[RESUMEN]. El modelo de medicina familiar cubano se desarrolla, desde hace más de tres décadas, como el tercer modelo de atención médica del período revolucionario en Cuba. Es la expresión más acabada de la aplicación de la estrategia de atención primaria de salud. Aún muestra potencial para la mejora en la organización, la calidad y la eficiencia de los servicios de salud en el primer nivel de atención de salud. El objetivo esencial de este trabajo es describir el modelo, sus singularidades, sus elementos distintivos, y sus principales logros, retos y desafíos. Se realizó una revisión documental en artículos de revistas, libros y documentos oficiales del Ministerio de Salud Pública de Cuba sobre la creación y desarrollo del modelo, seleccionados y analizados por expertos para la elaboración del presente informe. Se presentan elementos conceptuales del modelo, así como indicadores que sustentan la información. En este trabajo se identificaron las principales características de la medicina familiar en Cuba, sus logros fundamentales, retos y desafíos. Con base en sus resultados, se concluye que el modelo de medicina familiar de Cuba es un referente para la Región de las Américas. Es aún un modelo en desarrollo, perfectible y susceptible de transformaciones para enfrentar nuevos retos, el mayor de los cuales será renovar el modelo manteniendo y fortaleciendo las ideas fundacionales del programa.

[ABSTRACT]. The Cuban family medicine model has been developed, for more than three decades, as the third model of medical care of the revolutionary period in Cuba. It is the complete expression of the application of the primary health care strategy. However, it is still possible to improve the organization, quality and efficiency of health services in the first level of health care. The objective of this article is to describe the model, its singularities, distinctive elements, main achievements, and challenges. A documentary review was made from journal articles, books and official documents of the Ministry of Public Health of Cuba on the creation and development of the model; documents were selected and analyzed by experts for the preparation of this report. Conceptual elements of the model are presented, as well as indicators supporting the information. The main characteristics of family medicine in Cuba, its fundamental achievements, and challenges are presented. Based on its results, Cuba’s family medicine model is a reference for the Region of the Americas. It is still a model in development, however, perfectible and susceptible to transformations to face new challenges, more importantly to renew the model keeping and strengthening the foundational ideas of the program.

[RESUMO]. O modelo cubano de medicina familiar foi desenvolvido, há mais de três décadas, como o terceiro modelo de assistência médica do período revolucionário em Cuba. É a expressão mais completa da aplicação da estratégia de atenção primária à saúde. Ainda mostra potencial de melhoria na organização, qualidade e eficiência dos serviços de saúde no primeiro nível de cuidados de saúde. O objetivo essencial deste trabalho é descrever o modelo, suas singularidades, elementos distintivos, principais conquistas, e desafios. Para isso, foi feita uma revisão documental em artigos de revistas, livros e documentos oficiais do Ministério da Saúde Pública de Cuba sobre a criação e desenvolvimento do modelo, selecionados e analisados por especialistas para a elaboração deste relatório. Os elementos conceituais do modelo são apresentados, bem como indicadores que suportam a informação. Identificamos as principais características da medicina familiar em Cuba, suas conquistas fundamentais, e desafios. Com base em seus resultados, conclui-se que o modelo de medicina familiar de Cuba é uma referência para a Região das Américas. Ainda é um modelo em desenvolvimento, perfeitável e susceptível a transformações para enfrentar novos desafios, o maior dos quais será renovar o modelo com a manutenção e fortalecimento das idéias fundamentais do programa.