Determinantes de la inseguridad alimentaria y su asociación con prácticas de alimentación y lactancia materna en el primer año de vida

OBJETIVO

analizar los determinantes de la Inseguridad Alimentaria (IA) y su relación con las Prácticas de Alimentación (PA) y las Prácticas de Lactancia Materna (PLM) en el primer año de vida.

MÉTODOS

análisis de tipo cuantitativo sobre el binomio madre-hijo de una cohorte en México. Los datos de interés fueron el estado de seguridad alimentaria (SA), las PA y las PLM. Se desarrolló un modelo de regresión para evaluar determinantes asociados a la IA y un análisis de medias para determinar el impacto de la IA en las PA y las PLM.

RESULTADOS

el 54.1% de hogares presentó algún grado de IA. Las madres con pareja (OR = 0.25; p = 0.05) y con escolaridad superior (OR = 0.50; p = 0.04) tuvieron menor riesgo de padecer IA. En contraste, los hogares con mujeres mayores de 25 años estuvieron más expuestos a la IA (OR = 3.0; p = 0.00). Los hogares con IA introducen alimentos no recomendados como dulces, galletas o pastelitos (p = 0.00) y bebidas no lácteas azucaradas (p = 0.05) de forma prematura.Conclusiones:la IA requiere mayor atención por sus efectos en las PA y las PLM, las cuales son consideradas como factores asociados al desarrollo de mala nutrición.

Global health diplomacy in Mexico: insights from key actors in the field

BACKGROUND

Global health diplomacy (GHD) focuses on the actions taken by diverse stakeholders from different nations -governments, multilateral agents, and civil society- to phenomena that can affect population health and its determinants beyond national borders. Although the literature on conceptual advancements of GHD exists, empirical studies about how health becomes an issue of relevance for foreign policy are scarce. We present an analysis of the entry processes of health into the foreign policy and diplomatic domains in Mexico from the perspective of key informants of three different sectors.

METHODS

A purposive sample of high-rank representatives of three sectors involved in GHD was designed: Two from Health Sector (HS), four from Foreign Affairs Sector (FAS), and three from Non-governmental organizations (NGOs). Nine semi-structured interviews were conducted exploring the topics of: (1) Health concerns entering diplomatic and foreign policy; (2) Processes that allow actors to influence foreign policy and negotiation and; (3) Impact of multilateral negotiations on decision-making at the national level.

RESULTS

Our analysis suggests that GHD in Mexico is hierarchically driven by the FAS and health concerns only enter foreign policy when they are relevant to national priorities (such as trade or security). HS possesses a lesser degree of influence in GHD, serving as an instance of consultation for the FAS when deciding on health-related issues at global meetings (i.e., World Health Assembly). NGOs resort to lobbying, advocacy, networking, and coalition-working practices with other sectors (academy, think-tanks) to prevent harmful impacts on local health from multilateral decisions and as a mean to compensate its power asymmetry for influencing GHD processes in relation to the government.

CONCLUSIONS

GHD in Mexico occurs in a context of asymmetric power relationships where government actors have the strongest influence. However, NGOs' experience in raising awareness of health risks needs to be weighted by government decision-makers. This situation calls for capacity building on intersectoral communication and coordination to create formal mechanisms of GHD practices, including the professionalization and training on GHD among government agencies.

Breastfeeding and feeding practices in the first year of life and its association with overweight and obesity of children in Mexico

Abstract Objectives: to evaluate feeding practices in the first year of life and their association with the development of overweight and obesity in children in Mexico. Methods: the association between overweight and obesity with different feeding practices were evaluated. The data was processed using the statistical package Stata version 14 using logistic regression models. Results: 396 children were evaluated; the prevalence of overweight and obesity was 6% and 7.7% presented a possible risk of overweight. 6.9% had exclusive breastfeeding in the first 6 months of life and 71.7% were fed infant formula. The variables significantly associated with the development of overweight and obesity in the first year of life were the age of the child (p =0.043, RR=0.57), the introduction of fluids in the first three days of life (p=0.02, RR=2.90), consumption of foods with a high sugar content (p =0.01, RR=0.25), consumption of milk other than breast (p =0.02, RR3.25) and egg consumption (p =0.05; RR=0.28). Conclusions: our results show that it is essential to attend complementary feeding practices and reinforce exclusive breastfeeding in the first year of life, as measures to prevent overweight and obesity to improve health in childhood.

Global Health Diplomacy (GHD) and the integration of health into foreign policy: Towards a conceptual approach

Since the end of the Cold War, health has gone from a peripheral concern in foreign policy negotiations to a prominent place on the global political agenda. While the rise of health onto the foreign policy agenda is by now old news, the driving forces behind its expansion into new political spheres remain understudied and undertheorized. This article builds on empirical findings from a four-country study of the integration of health into foreign policy, and proposes a conceptual approach to GHD to improve understanding of the conditions under which health is successfully positioned on the foreign policy agenda. Our approach consists of three dimensions: features of institutions and the interest various actors represent in GHD; the ideational environment in which GHD operates; and issue characteristics of the specific health concern entering foreign policy. Within each dimension, we identify specific variables that, in combination, make up the explanatory power of the proposed approach. The proposed approach does not relate to, or build upon, a single social sciences, public health, or international relations (IR) theory, but can be seen as a heuristic device to identify dimensions and variables that may shape why certain health issues rise onto the foreign policy agenda.

Social determinants of overweight and obesity in the mother-child binomial: evidences from Mexico

Background

To analyze the influence of socioeconomic determinants on the development of overweight and obesity in the mother-child binomial.

Methods

This is a study based on a prospective cohort of the mother-child binomial. Using STATA software, the association between the mothers’ body mass index and the nutritional status of minors was analyzed using a logistic regression model with socioeconomic and demographic variables.

Results

The combined prevalence of overweight and obesity in cohort mothers was 53.2%. A statistically significant association was found between the overweight mothers and minors with possible risk of overweight (p 0.001) and with overweight (p 0.001). The logistic regression model was adjusted by age and marital status and linked maternal overweight and obesity with the following variables: severe food insecurity (RR 1.17, CI 0.04–0.31), having a health problem (RR 1.5, CI 0.86–2.05), income (RR 1.79, CI .49–1.30), smoking (RR 1.1, CI 0.80–1.37) and dietary pattern (RR 1.5, CI 0.38–0.87).

Conclusions

The study highlights the importance of paying attention to risk factors starting at the gestational stage, since at this time the mother’s nutritional status has an influence on the offspring’s growth and development. Evidences exist of an association between intergenerational transmission of obesity and socioeconomic aspects of the mother. These evidences must be considered in the revision and adjustments to health system interventions for the prevention of obesity in the mother-child binomial.

Barreras y facilitadores para una alimentación saludable y actividad física en mujeres embarazadas con sobrepeso y obesidad

Objetivo:

identificar barreras y facilitadores sobre dieta saludable y actividad física en mujeres embarazadas con sobrepeso y obesidad que viven en entornos de vulnerabilidad social y económica, destacando determinantes socioeconómicos y culturales.

Metodología:

estudio cualitativo longitudinal, donde las entrevistadas corresponden a mujeres embarazadas seleccionadas de una cohorte prospectiva en México. Se aplicó una guía semiestructurada de entrevista que exploró barreras y facilitadores para llevar una dieta saludable y poder realizar actividad física. Las entrevistas se transcribieron y codificaron en Atlas Ti, generando 23 códigos temáticos.

Resultados:

existen barreras y facilitadores contextuales y sociales que predisponen un mayor riesgo de padecer sobrepeso y obesidad durante el embarazo. Destacan conocimientos limitados sobre una dieta saludable, condiciones de vulnerabilidad social, así como un sentido de fragilidad en las mujeres que incrementa su sedentarismo.

Conclusiones:

en el diseño e implementación de intervenciones en promoción de la salud es fundamental considerar las barreras y facilitadores culturales y socioeconómicas sobre alimentación saludable y actividad física durante el embarazo, para desarrollar intervenciones de salud pública que favorezcan una mayor prevención de sobrepeso y obesidad en mujeres embarazadas.

[Socioeconomic determinants of maternal obesity in Mexico and France. Comparative analysis of two cohorts]

OBJECTIVE

To identify and analyze the socioeconomic indicators of maternal obesity in Mexico and France.

MATERIAL AND METHODS

Comparative study of two cohorts: EDEN (France) and NUTTSEA (Mexico). The study population consisted of women who requested prenatal consultation at week 24 of pregnancy. Data were collected using questionnaires and semi-structured interviews. The variables of interest were socioeconomic aspects, nutrition, anthropometry and food security. The quantitative analysis was performed using Stata and the qualitative analysis with Atlas-ti.

RESULTS

In the EDEN cohort, 68.6% were aged 25-34 years, 73% had paid employment and 53% completed high school. In addition, 6.6% reported having difficulty accessing food and the mean gestational BMI was 23.23 ± 4.6. In the NUTTSEA cohort, 55% were in the age range 18-24 years, 15% reported having paid employment, 42% had completed secondary education, 32.1% presented a degree of food insecurity, and the mean BMI was 27.8 ± 4.8.

CONCLUSIONS

The qualitative and quantitative results of both cohorts suggest that populations with greater socio-economic vulnerability are more prone to maternal obesity, which leads to determine guidelines on barriers and facilitators to strengthen programs to prevent it maternal obesity.

Trends and challenges in diabetes for middle-income countries: Evidence from Mexico

The epidemiological and economic burden of diabetes poses one of the main challenges for health systems worldwide. This is particularly relevant in middle-income countries because of the constant growing trends that have been observed in recent years. In order to identify trends and challenges on epidemiological and economic burden from diabetes in a middle-income country we developed a longitudinal analysis on costs and trends in the number of cases of diabetes in Mexico. The study population included total annual cases of diabetes at national level. Regarding the annual cumulative incidence for 2016 versus 2018, depending on the institution there is an increase of 9-13% (p < 0.001). Comparing the economic burden from incidence in 2016 versus 2018 (p < 0.05), there is a 26% increase. The total amount for diabetes in 2017 (US dollars) was $9,684,780,574. It includes $ 4,292,085,964 in direct costs and $ 5,392,694,610 in indirect costs. The total direct costs are: $ 510,986,406 for uninsured population; $ 1,416,132,058 for insured population; $ 2,235,969,330 for users' pockets. This is an example of what is happening in the management of diabetes care in middle-income countries and we suggest review and rethinking strategies of prevention, planning, organisation and resource allocation.

Challenges on the epidemiological and economic burden of diabetes and hypertension in Mexico

OBJECTIVE

To analyze the epidemiological and economic burden of the health services demand due to diabetes and hypertension in Mexico.

METHODS

Evaluation study based on a time series study that had as a universe of study the assured and uninsured population that demands health services from the three main institutions of the Health System in Mexico: The Health Department, the Mexican Institute of Social Security, and Institute of Services and Social Security for State Workers. The financing method was based on instrumentation and consensus techniques for medium case management. In order to estimate the epidemiological changes and financial requirements, a time series of observed cases for diabetes and hypertension 1994–2013 was integrated. Probabilistic models were developed based on the Box-Jenkins technique for the period of 2013–2018 with 95% confidence intervals and p < 0.05.

RESULTS

Comparing results from 2013 versus 2018, in the five regions, different incremental trends of 14%–17% in epidemiological changes and 58%-66% in the economic burden for both diseases were observed.

CONCLUSIONS

If the risk factors and the different models of care remained as they currently are in the three institutions analyzed, the financial consequences would be of greater impact for the Mexican Institute of Social Security, following in order of importance the Institute of Services and Social Security for State Workers and lastly the Health Department. The financial needs for both diseases will represent approximately 13%–15% of the total budget allocated to the uninsured population and 15%–17% for the population insured depending on the region.

Improving access to health care for undocumented immigrants in the United States

OBJECTIVE

To identify policies that increase access to health care for undocumented Mexican immigrants.

MATERIALS AND METHODS

Four focus groups (n=34 participants) were conducted with uninsured Mexican immigrants in Los Angeles, California. The feasibility and desirability of different policy proposals for increasing access were discussed by each group.

RESULTS

Respondents raised significant problems with policies including binational health insurance, expanded employer-provided health insurance, and telemedicine. The only solution with a consensus that the change would be feasible, result in improved access, and they had confidence in was expanded access to community health centers (CHC's).

CONCLUSIONS

Given the limited access to most specialists at CHC's and the continued barriers to hospital care for those without health insurance, the most effective way of improving the complete range of health services to undocumented immigrants is through immigration reform that will bring these workers under the other health care reform provisions.

Evidence on equity, governance and financing after health care reform in Mexico: lessons for Latin American countries

This article includes evidence on equity, governance and health financing outcomes of the Mexican health system. An evaluative research with a cross-sectional design was oriented towards the qualitative and quantitative analysis of financing, governance and equity indicators. Taking into account feasibility, as well as political and technical criteria, seven Mexican states were selected as study populations and an evaluative research was conducted during 2002-2010. The data collection techniques were based on in-depth interviews with key personnel (providers, users and community leaders), consensus technique and document analysis. The qualitative analysis was done with ATLAS TI and POLICY MAKER softwares. The Mexican health system reform has modified dependence at the central level; there is a new equity equation for resources allocation, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. Inequality on resources allocation in some regions and catastrophic expenditure for users is unequal in all states, producing more negative effects on states with high social marginalization. Special emphasis is placed on the analysis of the main strengths and weaknesses, as relevant evidences for other Latin American countries which are designing, implementing and evaluating reform strategies in order to achieve equity, good governance and a greater financial protection in health.

An explanatory analysis of economic and health inequality changes among Mexican indigenous people, 2000-2010

INTRODUCTION

Mexico faces important problems concerning income and health inequity. Mexico's national public agenda prioritizes remedying current inequities between its indigenous and non-indigenous population groups. This study explores the changes in social inequalities among Mexico's indigenous and non-indigenous populations for the time period 2000 to 2010 using routinely collected poverty, welfare and health indicator data.

METHODS

We described changes in socioeconomic indicators (housing condition), poverty (Foster-Greer-Thorbecke and Sen-Shorrocks-Sen indexes), health indicators (childhood stunting and infant mortality) using diverse sources of nationally representative data.

RESULTS

This analysis provides consistent evidence of disparities in the Mexican indigenous population regarding both basic and crucial developmental indicators. Although developmental indicators have improved among the indigenous population, when we compare indigenous and non-indigenous people, the gap in socio-economic and developmental indicators persists.

CONCLUSIONS

Despite a decade of efforts to promote public programs, poverty persists and is a particular burden for indigenous populations within Mexican society. In light of the results, it would be advisable to review public policy and to specifically target future policy to the needs of the indigenous population.

Capacidad del marco jurídico de las instituciones públicas de salud de México para apoyar la integración funcional

Objetivo. Evaluar la capacidad del marco legal federal para gobernar el financiamiento de las instituciones públicas de salud mediante esquemas innovadores que les permiten comprar y vender servicios de salud de y a otros proveedores públicos, como una estrategia para mejorar su desempeño. Material y métodos. Con base en indicadores de alineamiento normativo respecto de la integración funcional entre instituciones proveedoras públicas y de gobernanza, se analizó el contenido de los programas nacionales de salud y de leyes y lineamientos oficiales pertinentes para la coordinación financiera. Resultados. Se identificó un avance considerable en la implementación de convenios para la coordinación de las instituciones públicas. No obstante, el marco legal en apoyo al Sistema Nacional de Salud y al sector salud muestra deficiencias y contradicciones que limitan su alcance, mientras que el Padrón General de Salud carece del sustento legal necesario para convertirse en una herramienta de amplio beneficio para la integración. Si bien los convenios de intercambio de servicios están avanzando con base en tarifas y lineamientos compartidos, se carece de incentivos que promuevan su expansión. Conclusiones. Es recomendable actualizar el marco legal para la coordinación del Sistema Nacional de Salud, procurando un enfoque más armónico y general que impulse la integración funcional.

[Capacity of the legal framework of public health institutions in Mexico to support their functional integration]

OBJECTIVE

Evaluate the capacity of the federal legal framework to govern financing of health institutions in the public sector through innovative schemes--otherwise known as functional integration--, enabling them to purchase and sell health services to and from other public providers as a strategy to improve their performance.

MATERIALS AND METHODS

Based on indicators of normative alignment with respect to functional integration across public health provider and governance institutions, content analysis was undertaken of national health programs and relevant laws and guidelines for financial coordination.

RESULTS

Significant progress was identified in the implementation of agreements for the coordination of public institutions. While the legal framework provides for a National Health System and a health sector, gaps and contradictions limit their scope. The General Register of Health is also moving forward, yet it lacks the necessary legal foundation to become a comprehensive tool for integration. The medical service exchange agreements are also moving forward based on tariffs and shared guidelines. However, there is a lack of incentives to promote the expansion of these agreements.

CONCLUSIONS

It is recommended to update the legal framework for the coordination of the National Health System, ensuring a more harmonious and general focus to provide functional integration with the needed impulse.

Entamoeba histolytica: the over expression of a mutated EhRabB protein produces a decrease of in vitro and in vivo virulence

Vesicular trafficking, which is implicated in secretion of cytolytic molecules as well as in phagocytosis, plays an important role in the pathogenic mechanism of Entamoeba histolytica, the protozoan parasite causative of human amoebiasis. Thus, Rab GTPases, that are key regulators of vesicle trafficking, should be considered as molecules involved in the parasite virulence. EhRabB is a Rab protein located in cytoplasmic vesicles that are translocated to phagocytic mouths during ingestion of target cells, suggesting that this Rab protein is involved in phagocytosis. To prove this hypothesis, we over expressed the wild type EhrabB gene and a mutant gene encoding for a protein (RabBN118I) unable to bind guanine nucleotides and therefore constitutively inactive. The over expression of the mutated protein in E. histolytica trophozoites provoked a dominant negative effect, reflected in a significant decrease of both phagocytosis and cytopathic effect as well as in a failure to produce hepatic abscesses in hamsters. These results confirm that EhRabB is involved in phagocytosis and virulence of E. histolytica.

Health insurance for undocumented immigrants: opportunities and barriers on the Mexican side of the US border

OBJECTIVE

This article aims to identify opportunities, barriers and challenges in Mexico's policy networks for the development of healthcare programs for undocumented migrants in the USA and their families.

METHODS

We used policy analysis, in-depth interviews and a case study. Key stakeholders at the federal, state and municipal levels in one major migrant-sending state were interviewed. We also conducted an in-depth case study of one community to obtain the perceptions of local health workers, migrant families and local nongovernmental organizations.

RESULTS

Findings identified opportunities and barriers involving the stakeholders, institutions, social interactions and types of relationships necessary for further progress on binational policies. There was wide interest in creating binational health insurance with different degrees of potential involvement by political actors and variation in local actors' willingness to be covered by some type of health insurance scheme.

CONCLUSIONS

The use of the opportunities to overcome barriers depends on the identification of high, medium or low interaction among key stakeholders, integration of coalitions and negotiating skills of all stakeholders involved.

Thermal Properties of Mineralized and Non Mineralized Type I Collagen in Bone

The research about the structural stability of bone, as a composite material, compromises a complete understanding of the interaction between the mineral and organic phases. The thermal stability of human bone and type I collagen extracted from human bone by different methods was studied in order to understand the interactions between the mineral and organic phases when is affected by a degradation/combustion process. The experimental techniques employed were calorimetry and infrared spectroscopy (FTIR) techniques. The extracted type I collagens result to have a bigger thermal stability with a Tmax at 500 and 530 Celsius degrees compared with the collagen present in bone with Tmax at 350 Celsius degrees. The enthalpy value for the complete degradation/combustion process were similar for all the samples, being 8.4 +- 0.11 kJ/g for recent bones diminishing with the antiquity, while for extracted collagens were 8.9 +- 0.07 and 7.9 +-1.01 kJ/g. These findings demonstrate that the stability loss of type I collagen is due to its interactions with the mineral phase, namely carbonate hydroxyapatite. This cause a change in the molecular properties of the collagen during mineralization, specifically in its cross-links and other chemical interactions, which have a global effect over the fibers elasticity, but gaining tensile strength in bone as a whole tissue. We are applying this characterization to analyze the diagenetic process of bones with archaeological interest in order to identify how the environmental factors affect the molecular structure of type I collagen. In bone samples that proceed from an specific region with the same environmental conditions, the enthalpy value per unit mass was found to diminish exponentially with respect to the bone antiquity.

Microstructure and Thermal Expansion Properties of Ostrich Eggshell

Textures of calcite crystals from ostrich (Struthio camelus) eggshells were examined with X ray diffractometry (XRD), transmission and scanning electron microscopy (TEM, SEM), and the thermal stability by thermal expansion analysis (TEA). Results showed that textures vary through the thickness of the eggshell and that expansion properties and thermal behaviour are unusual. Crystals from ostrich eggshell are arranged in two main configurations or layers; the outer layer with the c-axis of crystals oriented perpendicular to the eggshell surface and the inner layer with the c-axes of the crystals arranged almost parallel to eggshell surface; thermal expansion analysis show high stability through a wide range of temperatures until a steep growth near 450-460°C. These results show that the manipulation of crystal texture and properties is under biological control and a better understanding of this biological phenomenon will provide more and better data for improving new synthetic composite materials.

The crystal structure of FeInGe2O7

A new iron indium germanate has been prepared as polycrystalline powder material which crystallizes in the monoclinic system (S.G. C2/m, No. 12). The structure was characterized by X-ray powder diffraction and Rietveld refinement of the resulting diffraction pattern. The cell parameters are a = 6.5124(4) Å, b = 8.5914(5) Å, c = 4.8936(3) Å, β = 102.683(2)°, V = 267.12(3) Å3 and Z = 2. The structure contains R+3 cations (R=Fe, In) almost equally distributed in distorted RO6 octahedral sites. These octahedra are joined by edge sharing forming a hexagonal arrangement on the ab planes. The RO6 octahedra layers are held together by sheets of isolated Ge2O7 diorthogroups constituted by a double tetrahedra sharing a common vertex. This compound has the thortveitite structure and keeps a strong relationship with the FeYGe2O7 germanate, which presents two R+3 sites with six-coordinated (R=Fe) and seven-coordinated (R=Y) oxygens, corresponding to the different symmetry given by the monoclinic space group P21/m (No. 11)

The crystal structure of InYGe2O7 germanate

A new indium yttrium germanate presenting the thortveitite structure with symmetry described by the space group C2/m (No. 12) has been prepared by high temperature solid state reaction as polycrystalline powder material. This crystallizes in the monoclinic system, with cell parameters a = 6.8286(1) Å, b = 8.8836(2) Å, c = 4.9045(1) Å, β= 101.8340(7)º, V = 291.195(9) Å3 and Z = 2. The structure was characterized by X-ray powder diffraction and Rietveld refinement of the diffraction pattern. The In3+ and Y+3 cations occupy the same octahedral site forming a hexagonal arrangement on the ab planes. In their turn, the hexagonal arrangements of InO6/YO6 octahedral layers are held together by sheets of isolated diorthogroups constituted by a double tetrahedra sharing a common vertex. In this compound, the Ge2O7 diorthogroup shows the C2h symmetry implying a Ge-O-Ge angle of 180º, being an important feature of the thortveitite structure, which has been controversial in some reported papers. A remarkable photo-luminescence effect (in comparison with glass) was observed when the sample was irradiated with α-particles beam during the RBS experiments employed to analyze the chemical stoichiometry.

Effects of health decentralization, financing and governance in Mexico

OBJECTIVE: To identify the effects of decentralization on health financing and governance policies in Mexico from the perspective of users and providers. METHODS: A cross-sectional study was carried out in four states that were selected according to geopolitical and administrative criteria. Four indicators were assessed: changes and effects on governance, financing sources and funds, the final destination of resources, and fund allocation mechanisms. Data collection was performed using in-depth interviews with health system key personnel and community leaders, consensus techniques and document analyses. The interviews were transcribed and analyzed by thematic segmentation. RESULTS: The results show different effectiveness levels for the four states regarding changes in financing policies and community participation. Effects on health financing after decentralization were identified in each state, including: greater participation of municipal and state governments in health expenditure, increased financial participation of households, greater community participation in low-income states, duality and confusion in the new mechanisms for coordination among the three government levels, absence of an accountability system, lack of human resources and technical skills to implement, monitor and evaluate changes in financing. CONCLUSIONS: In general, positive and negative effects of decentralization on health financing and governance were identified. The effects mentioned by health service providers and users were related to a diversification of financing sources, a greater margin for decisions around the use and final destination of financial resources and normative development for the use of resources. At the community level, direct financial contributions were mentioned, as well as in-kind contributions, particularly in the form of community work.

Functional characterization of EhADH112: an Entamoeba histolytica Bro1 domain-containing protein

EhADH112 is part of the EhCPADH complex, a protein involved in key events of the Entamoeba histolytica host invasion. EhADH112 participates in trophozoite adherence to target cells and in phagocytosis. We report here the finding of two EhADH112 homologues in the E. histolytica genome (EhADH112-like proteins). EhADH112 and its relatives have a Bro1 domain at their amino-terminus and a consensus context for phosphorylation by Src-tyrosine kinases, both involved in signal transduction processes in other organisms. Our findings associate EhADH112 to supplementary functions related to those reported for the Alix/AIP1 family. To elucidate the precise function of EhADH112, we studied the phenotypes displayed by trophozoites transfected with the Ehadh112 full gene. Transfected trophozoites overexpressed a 78 kDa protein, which was mainly targeted to the EhCPADH complex. Moreover, these trophozoites exhibited enhanced phagocytic rates, providing further evidence of EhADH112 contribution to adhesion and phagocytosis activities.

Entamoeba histolytica: structural and functional analysis of the Ehadh112 gene promoter

The Entamoeba histolytica Ehcp112 and Ehadh112 genes that encode the EhCPADH complex are separated by a non-coding 188pb region. Their proximity suggests a coordinated expression regulation for both genes. Here, we studied the structure and function of 996 bp (p996CAT) upstream the ATG start codon of the Ehadh112 gene. The p996CAT plasmid drove CAT transcription with a 78% of the activity showed by actin promoter. Deletion of 330 bp at the 5' end of p966CAT to produce the p776CAT plasmid, decreased activity to 40% in relation to actin promoter and to 50% of p996CAT, suggesting the presence of a silencer in this region. Interestingly, deletion of other 297 bp to the p776CAT to generate the p469CAT plasmid, augmented activity in 2.5-fold compared with p776CAT construction, showing the presence of a proximal enhancer promoter. Transcription initiation sites (-69 and -150 bp), TATA like box, GAAC, and Inr elements, as well as putative DNA binding motifs, were mapped in the -1 to -469 bp core promoter region.

The Entamoeba histolytica Ehcp112 gene has a distal and weak promoter

Ehcp112 encodes the Entamoeba histolytica EhCP112 cysteine protease that is part of the EhCPADH complex. By in silico analysis we identified putative transcription factor-binding sites along 837 bp upstream the Ehcp112 gene ATG codon. A TATA-like motif (TATATAAA) was located at -36 to -29 bp, a GAAC box (GAACC) was found at -10 to -14 bp and an Inr sequence (TTCAAC) at -8 to -2 bp. These tripartite promoter elements are in non-canonical positions, downstream the transcription initiation site (-280 bp). We cloned four Ehcp112 promoter fragments in pBSCAT-ACT plasmid to obtain pI (355 bp), pII (681 bp), pIII (833 bp), and pIV (554 bp) constructs. In transfected trophozoites, only pIII drove CAT activity with 44% efficiency in relation to actin promoter activity. Our results showed the presence of a distal and weak promoter in the Ehcp112 gene. The active DNA region is inside the open reading frame of the Ehrab B gene, suggesting that expression of both genes could be coordinately regulated.

Structural characterization of SmMn2GeO7 single microcrystals by electron microscopy

Single microcrystals of the new compound samarium dimanganese germanium oxide, SmMn2GeO7, were grown using the flux method in a double spherical mirror furnace (DSMF). The micrometric crystals were observed and chemically analysed with scanning electron microscopy (SEM) and X-ray energy dispersive spectroscopy (EDX). The structural characterization and chemical analysis of these crystals were also carried out using transmission electron microscopy (TEM) and high-resolution transmission electron microscopy (HRTEM), together with electron-energy-loss spectroscopy (EELS). We found that the new quaternary compound crystallizes in the orthorhombic system with the point group mmm (D2h), space group Immm (No. 71) and cell parameters a=8.30 (10), b=8.18 (10), c=8.22 (10) A and V=558.76 A3.

Evidences on weaknesses and strengths from health financing after decentralization: lessons from Latin American countries

OBJECTIVE

The main objective was to identify trends and evidence on health financing after health care decentralization.

STUDY DESIGN

Evaluative research with a before-after design integrating qualitative and quantitative analysis. Taking into account feasibility, political and technical criteria, three Latin American countries were selected as study populations: Mexico, Nicaragua and Peru.

DATA SOURCES

The methodology had two main phases. In the first phase, the study referred to secondary sources of data and documents to obtain information about the following variables: type of decentralization implemented, source of finance, funds of financing, providers, final use of resources and mechanisms for resource allocation. In the second phase, the study referred to primary data collected in a survey of key personnel from the health sectors of each country.

FINDINGS

The trends and evidence reported in all five financing indicators may identify major weaknesses and strengths in health financing.

CONCLUSIONS

Weaknesses: a lack of human resources trained in health economics who can implement changes, a lack of financial resource independence between the local and central levels, the negative behavior of the main macro-economic variables, and the difficulty in developing new financing alternatives. Strengths: the sharing between the central level and local levels of responsibility for financing health services, the implementation of new organizational structures for the follow-up of financial changes at the local level, the development and implementation of new financial allocation mechanisms taking as a basis the efficiency and equity principles, new technique of a per-capita adjustment factor corrected at the local health needs, and the increase of financing contributions from households and local levels of government.

Efectos de la descentralización en el financiamiento de la salud en México

OBJETIVO: Identificar las tendencias y los efectos de la descentralización en las políticas de financiamiento de la salud en México. MÉTODOS: La población de estudio incluyó cuatro estados seleccionados bajo criterios técnicos: diferente desarrollo socio-económico; implementación de la descentralización; base de datos sobre información económica; confiabilidad y validéz de las bases de datos; y apoyo de un equipo interdisciplinario de investigación. Las técnicas de recopilación de información se basaron en entrevistas a profundidad con personal clave y análisis de documentos y bases de datos sobre los presupuestos estatales en salud para el período 1990-2000. RESULTADOS: El modelo de análisis propuesto permitió identificar las tendencias y efectos de la descentralización sobre las principales fuentes de financiamiento en salud: Hogares, Gobiernos Federal, Estatal y Municipal. Hay evidencias de niveles de efectividad muy variada en cuanto a los cambios en las políticas de financiamiento, particularmente en lo que se refiere a las tendencias en los montos económicos por tipo de fuente de financiamiento. CONCLUSIONES: Hay estados donde los hogares, los municipios y el mismo gobierno estatal han hecho efectivo un incremento importante en el financiamiento de la salud, pero también hay Estados donde continúa la dependencia económica del nivel federal y donde Hogares, Municipios y Estados no están dispuestos ni capacitados para asumir responsabilidad económica en materia de salud.

Ehp53, an Entamoeba histolytica protein, ancestor of the mammalian tumour suppressor p53

This paper reports the identification of Ehp53, a p53-like Entamoeba histolytica protein, which binds to the human p53 DNA consensus sequence (oli-p53). Monoclonal antibodies against p53 (Ab-1 and Ab-2) recognized a single 53 kDa spot in two-dimensional gels and inhibited the formation of complexes produced by E. histolytica nuclear extracts and oli-p53. Additionally, E. histolytica gene promoter sequences with high homology to oli-p53 formed complexes with nuclear proteins that were abolished by oli-p53. Ehp53 protein levels increased in UV-irradiated trophozoites. This protein was also detected in Entamoeba moshkovskii and Entamoeba invadens. By confocal microscopy, Ehp53 was located in the nuclei, EhkO organelles and cytoplasm. The Ehp53-encoding gene was cloned and its predicted amino acid sequence showed 30-54 % and 50-57 % homology with important domains of the human and the Drosophila melanogaster p53 proteins, respectively. This homology included the tetramerization domain, the nuclear export signal and a nuclear localization signal. Ehp53 also contains seven of the eight DNA-binding residues and two of the four Zn(2+)-binding sites described for p53. A recombinant Ehp53 was recognized by Ab-2. Ehp53 is believed to be the first p53-like protein found in protozoa and may be the evolutionary ancestor of the mammalian p53.

Multidrug resistance in the protozoan parasite Entamoeba histolytica

In this review we discuss the mechanisms and molecules involved in the multidrug resistance (MDR) of the protozoan parasite Entamoeba histolytica. Drug resistant mutants exhibited the main characteristics presented by the MDR mammalian cells. They showed cross-resistance to several unrelated drugs that is reverted by calcium channel blockers. MDR phenotype in E. histolytica is regulated at a transcriptional level by the EhPgp1 gene, which is constitutively expressed and by the EhPgp5 gene, whose expression is induced in the presence of the drug. Transcription factors participate in the expression regulation of these genes. After over transcription, the EhPgp genes are amplified, cooperating to produce the MDR phenotype. Post-transcriptional mechanisms such as mRNA stability seem to be involved in this phenomenon. As for other mdr gene products, the EhPGP5 protein functions as a chloride current inductor or as a regulator of cellular regulatory volume decrease.

Entamoeba histolytica: DNA carrier vesicles in nuclei and kinetoplast-like organelles (EhkOs)

Entamoeba histolytica, the protozoan responsible for human amoebiasis, has a complex genome, whose linear chromosomes and DNA circles have so far eluded detailed analysis. We report the detection by transmission electron microscopy of nuclear vesicles (0.05-0.3 microm in diameter) carrying DNA in E. histolytica trophozoites. In late anaphase many of these nuclear vesicles were found to be organized in structures of approximately 2.5 x 1 microm, in association with chromosomes and microtubules. In glutaraldehyde-fixed and detergent-treated trophozoites, nuclear vesicles displayed a non-membranous envelope. Binding of phosphotungstate stain and recognition by serum from patients with systemic lupus erythematosus indicated that these vesicles contain DNA. Similar DNA carrier vesicles were found in the cytoplasm and in the E. histolytica kinetoplast-like organelle (EhkO). By Feulgen staining, we detected DNA carrier vesicles entering or leaving the nuclei, suggesting a structural relationship between the nuclear vesicles and the vesicles present in the EhkOs.

Specific detection of Entamoeba histolytica DNA by hemolysin gene targeted PCR

Diagnostic differentiation of pathogenic Entamoeba histolytica from non-pathogenic Entamoeba dispar is of great clinical importance. We have developed and evaluated a new polymerase chain reaction (PCR) assay (haemo-PCR) based on the novel E. histolytica hemolysin gene HLY6. The specificity of this assay was confirmed by analyzing different Entamoeba species, faeces samples, human and bacterial DNA, and digestion of amplification products with appropriate restriction enzymes. The sensitivity was confirmed by serial dilutions of E. histolytica HM-1:IMSS DNA in the excess of human DNA. Totally, 45 clinical samples were analyzed by the haemo-PCR assay including amoebic liver abscess (ALA) fluids from 23 patients suspected for amoebiasis, four faeces samples containing E. histolytica and E. dispar, and positive and negative controls. The results were compared with those obtained with PCRs for cystein-rich surface protein (P30) and small subunit ribosomal RNA (ssu rRNA) genes. The haemo-PCR gave a positive result in 18 (89%) ALA fluids compared with 14 (77%) and five (28%) by PCR for p30, and ssu rRNA, respectively. PCR products were obtained only from specimens containing E. histolytica DNA. The haemo-PCR assay was therefore found to be a valuable diagnostic tool for identification of E. histolytica infections both in faeces and ALA samples.

Circular and linear DNA molecules in the Entamoeba histolytica complex molecular karyotype

Entamoeba histolytica genome was analysed by pulsed field gel electrophoresis under conditions to separate linear chromosomes in the 170-1400 kb range. We identified linear DNA molecules of 227, 366, 631, 850, 1112 and 1361 kb (mean sizes obtained by three different methods) and we estimated their reorientation times and migration velocities at various experimental conditions. DNA shift mobility assays, using ethidium bromide, suggested that bands migrating at 227 and 631 kb contain linear and circular DNA, whereas a band at 436 kb has only circular DNA. We obtained a regression equation relating sizes of supercoiled DNA molecules with their migration velocities during a pulse at constant electric field and temperature. We also developed a computer program (EHPATTERNS) that predicts the migration per pulse and the resolution order of circular and linear E. histolytica DNA at different pulse times and constant driving and frictional forces. The simulation showed that linear DNA molecules frequently co-migrate with circular molecules, but circular molecules change when the pulse time varies. This molecular mixture generates broad bands and difficulties in the interpretation of the molecular karyotype of E. histolytica.