Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial.

BACKGROUND: Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates remain below 20% in the country. METHODS: We conducted an 18-month, two-arm, pragmatic cluster-randomised controlled trial evaluating the effect of a quality improvement intervention, based on the Plan-Do-Study-Act cycles, considering barriers and catalysts to articulate theory and practice, to increase CRC screening rates using FITs at primary care level. The study involved ten public primary health centres in Mendoza province, Argentina. The primary outcome measure was the rate of effective CRC screening. Secondary outcomes were the rate of participants with a positive FIT, tests with invalid results and the rate of participants referred for colonoscopy. RESULTS: Screening was effective in 75% of the participants in the intervention arm vs 54.2% in the control arm, OR 2.5 (95% CI 1.4 to 4.4, p=0.001). These results remained unchanged after adjusting for individual demographic and socioeconomic characteristics. Regarding secondary outcomes, the overall prevalence of positive tests was 17.7% (21.1% in the control arm and 14.7% in the intervention arm, p=0.3648). The overall proportion of participants with inadequate test results was 5.2% (4.9% in the control arm vs 5.5% in the intervention arm, p=0.8516). All the participants with positive tests were referred for colonoscopy in both groups. CONCLUSIONS: An intervention based on quality improvement strategies proved to be highly successful in increasing effective CRC screening in Argentina's primary care setting within the public healthcare system. TRIAL REGISTRATION NUMBER: NCT04293315.

COVID-19: Solidarity initiatives for food security in the Mayan indigenous region of south-southeast Mexico.

The food sector was seriously affected by COVID-19 in southern-southeast Mexico, a Mayan region with high levels of poverty, malnutrition, and extreme weather events. The present study aimed to identify, from the dimensions of food security, citizen-led initiatives that emerged as strategies to guarantee food access in five states in the south-southeast of Mexico. A total of 7446 news articles were collected from five online newspapers and 53 food initiatives were identified. The six dimensions of food security analysis were used as a guide for our critical review of gathered media reports. The access dimension of food security was the most addressed using collection drives and food delivery to vulnerable populations. Review results underscore the critical role of community strengthening to increase and sustain food resilience.

Regeneration Defects in Yap and Taz Mutant Mouse Livers Are Caused by Bile Duct Disruption and Cholestasis.

BACKGROUND AND AIMS: The Hippo pathway and its downstream effectors YAP and TAZ (YAP/TAZ) are heralded as important regulators of organ growth and regeneration. However, different studies provided contradictory conclusions about their role during regeneration of different organs, ranging from promoting proliferation to inhibiting it. Here we resolve the function of YAP/TAZ during regeneration of the liver, where Hippo's role in growth control has been studied most intensely. METHODS: We evaluated liver regeneration after carbon tetrachloride toxic liver injury in mice with conditional deletion of Yap/Taz in hepatocytes and/or biliary epithelial cells, and measured the behavior of different cell types during regeneration by histology, RNA sequencing, and flow cytometry. RESULTS: We found that YAP/TAZ were activated in hepatocytes in response to carbon tetrachloride toxic injury. However, their targeted deletion in adult hepatocytes did not noticeably impair liver regeneration. In contrast, Yap/Taz deletion in adult bile ducts caused severe defects and delay in liver regeneration. Mechanistically, we showed that Yap/Taz mutant bile ducts degenerated, causing cholestasis, which stalled the recruitment of phagocytic macrophages and the removal of cellular corpses from injury sites. Elevated bile acids activated pregnane X receptor, which was sufficient to recapitulate the phenotype observed in mutant mice. CONCLUSIONS: Our data show that YAP/TAZ are practically dispensable in hepatocytes for liver development and regeneration. Rather, YAP/TAZ play an indirect role in liver regeneration by preserving bile duct integrity and securing immune cell recruitment and function.

Peritumoral activation of the Hippo pathway effectors YAP and TAZ suppresses liver cancer in mice.

The Hippo signaling pathway and its two downstream effectors, the YAP and TAZ transcriptional coactivators, are drivers of tumor growth in experimental models. Studying mouse models, we show that YAP and TAZ can also exert a tumor-suppressive function. We found that normal hepatocytes surrounding liver tumors displayed activation of YAP and TAZ and that deletion of Yap and Taz in these peritumoral hepatocytes accelerated tumor growth. Conversely, experimental hyperactivation of YAP in peritumoral hepatocytes triggered regression of primary liver tumors and melanoma-derived liver metastases. Furthermore, whereas tumor cells growing in wild-type livers required YAP and TAZ for their survival, those surrounded by Yap- and Taz-deficient hepatocytes were not dependent on YAP and TAZ. Tumor cell survival thus depends on the relative activity of YAP and TAZ in tumor cells and their surrounding tissue, suggesting that YAP and TAZ act through a mechanism of cell competition to eliminate tumor cells.

Towards Productive Cities: Environmental Assessment of the Food-Energy-Water Nexus of the Urban Roof Mosaic.

Cities are rapidly growing and need to look for ways to optimize resource consumption. Metropolises are especially vulnerable in three main systems, often referred to as the FEW (i.e., food, energy, and water) nexus. In this context, urban rooftops are underutilized areas that might be used for the production of these resources. We developed the Roof Mosaic approach, which combines life cycle assessment with two rooftop guidelines, to analyze the technical feasibility and environmental implications of producing food and energy, and harvesting rainwater on rooftops through different combinations at different scales. To illustrate, we apply the Roof Mosaic approach to a densely populated neighborhood in a Mediterranean city. The building-scale results show that integrating rainwater harvesting and food production would avoid relatively insignificant emissions (13.9-18.6 kg CO2 eq/inhabitant/year) in the use stage, but their construction would have low environmental impacts. In contrast, the application of energy systems (photovoltaic or solar thermal systems) combined with rainwater harvesting could potentially avoid higher CO2 eq emissions (177-196 kg CO2 eq/inhabitant/year) but generate higher environmental burdens in the construction phase. When applied at the neighborhood scale, the approach can be optimized to meet between 7% and 50% of FEW demands and avoid up to 157 tons CO2 eq/year. This approach is a useful guide to optimize the FEW nexus providing a range of options for the exploitation of rooftops at the local scale, which can aid cities in becoming self-sufficient, optimizing resources, and reducing CO2 eq emissions.

Rooftop greenhouses in educational centers: A sustainability assessment of urban agriculture in compact cities.

Today, urban agriculture is one of the most widely used sustainability strategies to improve the metabolism of a city. Schools can play an important role in the implementation of sustainability master plans, due their socio-educational activities and their cohesive links with families; all key elements in the development of urban agriculture. Thus, the main objective of this research is to develop a procedure, in compact cities, to assess the potential installation of rooftop greenhouses (RTGs) in schools. The generation of a dynamic assessment tool capable of identifying and prioritizing schools with a high potential for RTGs and their eventual implementation would also represent a significant factor in the environmental, social, and nutritional education of younger generations. The methodology has four-stages (Pre-selection criteria; Selection of necessities; Sustainability analysis; and Sensitivity analysis and selection of the best alternative) in which economic, environmental, social and governance aspects all are considered. It makes use of Multi-Attribute Utility Theory and Multi-Criteria Decision Making, through the Integrated Value Model for Sustainability Assessments and the participation of two panels of multidisciplinary specialists, for the preparation of a unified sustainability index that guarantees the objectivity of the selection process. This methodology has been applied and validated in a case study of 11 schools in Barcelona (Spain). The social perspective of the proposed methodology favored the school in the case-study with the most staff and the largest parent-teacher association (social and governance indicators) that obtained the highest sustainability index (S11); at a considerable distance (45%) from the worst case (S3) with fewer school staff and parental support. Finally, objective decisions may be taken with the assistance of this appropriate, adaptable, and reliable Multi-Criteria Decision-Making tool on the vertical integration and implementation of urban agriculture in schools, in support of the goals of sustainable development and the circular economy.

Urban planning and agriculture. Methodology for assessing rooftop greenhouse potential of non-residential areas using airborne sensors.

The integration of rooftop greenhouses (RTGs) in urban buildings is a practice that is becoming increasingly important in the world for their contribution to food security and sustainable development. However, the supply of tools and procedures to facilitate their implementation at the city scale is limited and laborious. This work aims to develop a specific and automated methodology for identifying the feasibility of implementation of rooftop greenhouses in non-residential urban areas, using airborne sensors. The use of Light Detection and Ranging (LIDAR) and Long Wave Infrared (LWIR) data and the Leica ALS50-II and TASI-600 sensors allow for the identification of some building roof parameters (area, slope, materials, and solar radiation) to determine the potential for constructing a RTG. This development represents an improvement in time and accuracy with respect to previous methodology, where all the relevant information must be acquired manually. The methodology has been applied and validated in a case study corresponding to a non-residential urban area in the industrial municipality of Rubí, Barcelona (Spain). Based on this practical application, an area of 36,312m2 out of a total area of 1,243,540m2 of roofs with ideal characteristics for the construction of RTGs was identified. This area can produce approximately 600tons of tomatoes per year, which represents the average yearly consumption for about 50% of Rubí total population. The use of this methodology also facilitates the decision making process in urban agriculture, allowing a quick identification of optimal surfaces for the future implementation of urban agriculture in housing. It also opens new avenues for the use of airborne technology in environmental topics in cities.

Violência obstétrica no Brasil: uma revisão narrativa / Violencia obstétrica en Brasil: una revisión narrativa / Obstetrical violence in Brazil: a narrative review

Resumo Este artigo teve como objetivo realizar uma revisão narrativa de estudos sobre violência obstétrica. Para isso, abordou-se o histórico do parto e suas intervenções, o conceito de violência obstétrica, os marcos legais e o panorama brasileiro da assistência ao parto. Após a revisão das pesquisas realizadas sobre o assunto, constatou-se que não há um consenso em relação ao conceito de violência obstétrica no Brasil, embora as evidências indiquem que essa prática ocorra. Os dados apontam para a necessidade de uma conceituação de violência obstétrica, preferencialmente em documentos legais que a definam e criminalizem. Tal conceituação auxiliará na identificação e enfrentamento dessas situações. Consideram-se necessárias mudanças nas práticas assistenciais vigentes, visando a reduzir as intervenções desnecessárias e as violações aos direitos das mulheres.

Resumen Este artículo tuvo como objetivo realizar una revisión narrativa de los estudios sobre la violencia obstétrica. Para esto, se abordó la historia del parto y sus intervenciones, el concepto de violencia obstétrica, los marcos legales del parto y el panorama brasilero de la asistencia al parto. Después de la revisión de las investigaciones realizadas sobre el asunto, se verificó que no hay un consenso en relación al concepto de violencia obstétrica en Brasil, así las evidencias indiquen que esa práctica ocurre. Los datos apuntan a la necesidad de una conceptualización de la violencia obstétrica, preferiblemente en documentos legales que la definan y la criminalicen. Tal conceptualización ayudará en la identificación y enfrentamiento de esas situaciones. Se consideran necesarios cambios en las prácticas asistenciales vigentes, apuntando a reducir las intervenciones desnecesarias y las violaciones a los derechos de las mujeres.

Abstract This paper aims to fulfill a narrative review of researches on obstetric violence. Therefore, to approach the topic, we used concepts such as child-birth history, as well as its interventions, obstetric violence theories, legal marks, and the Brazilian panorama on delivery care. After reviewing published researches on the subject, we noted that there is no consensus about what obstetric violence is in Brazil, although evidences point that it happens. Data point to the need of defining obstetric violence, especially in legal documents which define it and criminalize it. Such concept will help to identify and to face these situations. We consider the changes in the current care practices compulsory, aiming to reduce unnecessary interventions and violations of women's rights.

Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study.

BACKGROUND: Obesity has become a global public health problem, which also affects children. It has been proposed that the educational interventions during childhood could be a key strategy in the prevention of obesity. OBJECTIVE: To evaluate the efficacy of an intervention on food habits and physical activity in school children. METHODS: A 2-year cluster-randomised prospective study with two parallel arms was used to evaluate an intervention programme in children in their first year of primary schooling (5-6 years of age) in schools in the city of Granollers. The intervention consisted of the promotion of healthy eating habits and physical activity by means of the educational methodology Investigation, Vision, Action and Change (IVAC). At the beginning and at the end of the study (2006 and 2008) the weight and height of each child was measured in situ, while the families were given a self-report physical activity questionnaire and the Krece Plus quick test. RESULTS: Two years after the beginning of the study, the body mass index of the children in the control group was 0.8 kg/m(2) higher than that of the intervention schools. The intervention reduced by 62% the prevalence of overweight children. Similarly, the proportion of children that ate a second piece of fruit and took part in an after-school physical activity increased in the intervention group. In the control group, the weekly consumption of fish was reduced. CONCLUSIONS: The educational intervention in healthy eating habits and physical activity in the school could contribute to lessen the current increase in child obesity.

Detection of secondary mumps vaccine failure by means of avidity testing for specific immunoglobulin G.

The aim of this study was to discriminate between primary and secondary vaccine failure in children with mumps using IgG avidity testing. Thirty-nine serum samples from children with mumps, confirmed by specific IgM, were studied. The patients were grouped according to their immunization status. The secondary immune response was defined by IgG with an avidity index >32%. A secondary response in infected children previously immunized was considered as a secondary vaccine failure. Vaccinated children presented higher IgG titers and IgG avidity than unvaccinated children. The proportion of secondary immune responses in unvaccinated patients was lower than that obtained in previously vaccinated infected patients. Avidity testing can be a useful tool to detect secondary vaccine failure in mumps.