The Physical Activity Promotion Environment In Mexican Health Care Settings

Purpose: The health care environment is recognized as a promising setting in which to promote physical activity (PA). Nearly 40% of Mexican adults are inactive and whether Mexican health care environments are promoting PA is unknown. The purpose of this study was to describe and compare the PA promotion environment in Guadalajara, Mexico. Methods: Forty primary care clinics and hospitals from the three health care systems in Guadalajara were sampled: 15 from the Secretary of Health, 14 from the Social Security Institutes and 11 from the private sector. A tool for measuring the PA environment of health care settings, including the availability of written PA materials, was developed. Face validity and inter-rater reliability of the tool were established (kappa=.75). Level of care (primary, secondary, and tertiary), number of floors and type of health care system of each clinic and hospital were also recorded. The tool was then used to assess the availability, accessibility, visibility, signage, cleanliness, and safety of all stairs, elevators, and green spaces at each health care setting and to record the presence of written PA materials including posters, brochures, leaflets, flyers, articles, and ‘cartels’ (hand-made posters) in the foyer and one waiting room of each clinic and hospital. Results: Thirty (75%) clinics and hospitals had stairs, 17 (42%) had elevators, 22 (55%) had green spaces and 11 (28%) had promotional PA materials (only posters or cartels). The availability of PA posters/cartels was significantly associated with health care system type (X2(2)=8.11, p\u3c.05) and with level of care (X2(2)=6.68, p\u3c.05), where primary care clinics from the Secretary of Health had significantly more PA promotional materials than clinics and hospitals from the other two systems. The health care PA environment score reflected by the stair, elevator, and green space indicators was not significantly different between the three Mexican health care systems (p\u3e.05); the score was low across the three systems (Mean=3.7, SD=2.7, Range=-2-10). Conclusions: Mexican health care settings are not PA friendly. Interventions to enhance the PA promotion environment in the three Mexican health care systems are needed to reach inactive patients

Evaluación de la actividad tripanosomicida de 4 extractos metanólicos de plantas con uso medicinal

La enfermedad de Chagas es potencialmente mortal, se estima que en el mundo hay entre 6 - 7 millones de personas infectadas; actualmente, existen dos medicamentos para tratar la enfermedad, benznidazol y nifurtimox; ambos son eficaces si se administran en la etapa aguda, pero su eficacia disminuye después del inicio de la infección, además presentan efectos secundarios serios. En el siguiente estudio se evaluó la actividad anti-Trypanosoma de extractos metanólicos de plantas con uso medicinal. Se evaluaron cuatro extractos, siendo Haematoxylum brasiletto el extracto con la mejor actividad, presentó una DL50 de 543 μl/mL. Ninguno de los extractos presentó una citotoxicidad elevada. Por lo que H. brasilleto, es una opción para buscar tratamientos alternativos contra la enfermedad de Chagas.Chagas disease is a life threatening problem, an estimated between 6 - 7 million of people are infected worldwide; currently, there are only two drugs to treat the disease, benznidazole and nifurtimox; however both them are effective only on the acute phase, and its effectiveness decreases after the onset of infection and also shows serious side effects. In this study the anti-Trypanosoma activity of methanolic plant extracts were evaluated. Extracts of Haematoxylum brasiletto showed the best activity with a LD50 of 543 μl/mL. None of the extracts showed high cytotoxicity. H. brasilleto is an option as an alternative treatments for Chagas disease

Actividad contra Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) de extractos metanólicos de plantas de uso medicinal en México

Abstract: Activity against Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) of methanolic extracts of medicinal use plants in Mexico. American trypanosomiasis is a potentially lethal disease caused by the hemoflagellate protozoan Trypanosoma cruzi. This neglected disease affects from 6 to 7 million people worldwide. Currently there are only two medicines to treat this disease: beznidazol and nifurtimox, both effective if they are administrated in the acute phase of infection, although their effectiveness fades away in the chronic phase; it also induces significant side effects. The aim of this study is to screen the trypanocidal activity of methanolic extracts from Hematoxilum brasiletto, Marrubium vulgare, Schinus molle, and Cympongon citratus, against T. cruzi epimastigotes, followed by the chromatographic separation, and identification of active compounds of the best candidate by colored chemical reactions; furthermore, it was also determined their cytotoxic effect in human lymphocytes and the brine shrimp Artemia salina. The extract of H. brasiletto showed the highest anti-T. cruzi activity with a inhibitory concentration (IC50) of 543 µg/mL; in descending order, it was followed by M. vulgare (IC50 = 647 µg/mL), S. molle (IC = 827 µg/mL) and finally, C. citratus (IC = 1 210 µg/mL). The chromatographic fraction Fr22 from H. brasiletto showed the best anti-T. cruzi effectivity (IC50 = 0.238 mg/mL), when compared to the other fraction or the whole extract, with no cytotoxic effect against human lymphocytes or A. salina. The active compounds were identified as tannins, quinones, flavonoids and sesquiterpenlactones. In conclusion, active compounds against T. cruzi were identified for the first time in H. brasiletto, with non-cytotoxic effects. The H. brasiletto extract, according to our results, could be used as an alternative treatment for the Chagas disease; however, additional studies will be necessary to test their activity and doses in a murine model, with the complete identification of the active compounds, on which we are investigating. Rev. Biol. Trop. 65 (4): 1459-1469. Epub 2017 December 01. Key words: Trypanosoma cruzi, Haematoxylum brasiletto, medicinal plants, methanolic extracts

Physical Activity Interventions Among Hispanics: A RE-AIM Review

Purpose: To determine the degree to which physical activity interventions for Hispanic populations reported on both internal and external validity factors using the RE-AIM framework (reach & representativeness, effectiveness, adoption, implementation, maintenance). Methods: We systematically identified English (PubMed; EbscoHost) and Spanish (SCIELO; Biblioteca Virtual en Salud) language studies published between 2001 and 2012 that tested physical activity, exercise, or fitness promotion interventions in Hispanic populations. We reviewed 142 abstracts and identified 40 studies that met the eligibility criteria (27 in English and 13 in Spanish). A validated 21-item RE-AIM abstraction tool was used to determine the quality of reporting across studies (0-7=low, 8-14=moderate, and 15-21=high). Additional items were included to provide more detail about the methods used across the RE-AIM dimensions (n=29 items). Results: The number of indicators reported ranged from 4-14 with the majority of studies falling in the moderate quality-reporting category. English and Spanish language articles did not differ on the number of indictors reported (8.1 vs 7.9), but Spanish articles were superior in reporting reach (59% vs 43% of indicators) while English articles were superior in reporting effectiveness (69% vs 56%). Representativeness of participants and settings was rarely reported regardless of publication language with no studies reporting on characteristic differences between settings that participated and those that did not. Only 14% of the studies reported on participant representativeness. Further, only 11% of studies reported on cost of implementation, none reported on costs associated with start-up or maintenance of the intervention, and no study conducted a cost effectiveness analysis. Conclusions: Regardless of language of publication, physical activity intervention research for Hispanics should increase the attention to, and measurement of, external validity and cost factors that are critical in the decision making process in practice settings and can increase the likelihood of translation into community or clinical practice

The Public Health Leadership and Implementation Academy for Noncommunicable Diseases.

PURPOSE AND OBJECTIVES: Low- and middle-income countries (LMICs) have a large burden of noncommunicable diseases and confront leadership capacity challenges and gaps in implementation of proven interventions. To address these issues, we designed the Public Health Leadership and Implementation Academy (PH-LEADER) for noncommunicable diseases. The objective of this program evaluation was to assess the quality and effectiveness of PH-LEADER. INTERVENTION APPROACH: PH-LEADER was directed at midcareer public health professionals, researchers, and government public health workers from LMICs who were involved in prevention and control of noncommunicable diseases. The 1-year program focused on building implementation research and leadership capacity to address noncommunicable diseases and included 3 complementary components: a 2-month online preparation period, a 2-week summer course in the United States, and a 9-month, in-country, mentored project. EVALUATION METHODS: Four trainee groups participated from 2013 through 2016. We collected demographic information on all trainees and monitored project and program outputs. Among the 2015 and 2016 trainees, we assessed program satisfaction and pre-post program changes in leadership practices and the perceived competence of trainees for performing implementation research. RESULTS: Ninety professionals (mean age 38.8 years; 57% male) from 12 countries were trained over 4 years. Of these trainees, 50% were from India and 29% from Mexico. Trainees developed 53 projects and 9 publications. Among 2015 and 2016 trainees who completed evaluation surveys (n = 46 of 55), we saw pre-post training improvements in the frequency with which they acted as role models (Cohen's d = 0.62, P <.001), inspired a shared vision (d = 0.43, P =.005), challenged current processes (d = 0.60, P <.001), enabled others to act (d = 0.51, P =.001), and encouraged others by recognizing or celebrating their contributions and accomplishments (d = 0.49, P =.002). Through short on-site evaluation forms (scale of 1-10), trainees rated summer course sessions as useful (mean, 7.5; SD = 0.2), with very good content (mean, 8.5; SD = 0.6) and delivered by very good professors (mean, 8.6; SD = 0.6), though they highlighted areas for improvement. IMPLICATIONS FOR PUBLIC HEALTH: The PH-LEADER program is a promising strategy to build implementation research and leadership capacity to address noncommunicable diseases in LMICs

Global Matrix 3.0 Physical Activity Report Card Grades for Children and Youth: Results and Analysis From 49 Countries

Background: Accumulating sufficient moderate to vigorous physical activity is recognized as a key determinant of physical, physiological, developmental, mental, cognitive, and social health among children and youth (aged 5–17 y). The Global Matrix 3.0 of Report Card grades on physical activity was developed to achieve a better understanding of the global variation in child and youth physical activity and associated supports. Methods: Work groups from 49 countries followed harmonized procedures to develop their Report Cards by grading 10 common indicators using the best available data. The participating countries were divided into 3 categories using the United Nations’ human development index (HDI) classification (low or medium, high, and very high HDI). Results: A total of 490 grades, including 369 letter grades and 121 incomplete grades, were assigned by the 49 work groups. Overall, an average grade of “C-,” “D+,” and “C-” was obtained for the low and medium HDI countries, high HDI countries, and very high HDI countries, respectively. Conclusions: The present study provides rich new evidence showing that the situation regarding the physical activity of children and youth is a concern worldwide. Strategic public investments to implement effective interventions to increase physical activity opportunities are needed

Global matrix 4.0 physical activity report card grades for children and adolescents : results and analyses from 57 countries

Background: The Global Matrix 4.0 on physical activity (PA) for children and adolescents was developed to achieve a comprehensive understanding of the global variation in children’s and adolescents’ (5–17 y) PA, related measures, and key sources of influence. The objectives of this article were (1) to summarize the findings from the Global Matrix 4.0 Report Cards, (2) to compare indicators across countries, and (3) to explore trends related to the Human Development Index and geo-cultural regions. Methods: A total of 57 Report Card teams followed a harmonized process to grade the 10 common PA indicators. An online survey was conducted to collect Report Card Leaders’ top 3 priorities for each PA indicator and their opinions on how the COVID-19 pandemic impacted child and adolescent PA indicators in their country. Results: Overall Physical Activity was the indicator with the lowest global average grade (D), while School and Community and Environment were the indicators with the highest global average grade (C+). An overview of the global situation in terms of surveillance and prevalence is provided for all 10 common PA indicators, followed by priorities and examples to support the development of strategies and policies internationally. Conclusions: The Global Matrix 4.0 represents the largest compilation of children’s and adolescents’ PA indicators to date. While variation in data sources informing the grades across countries was observed, this initiative highlighted low PA levels in children and adolescents globally. Measures to contain the COVID-19 pandemic, local/international conflicts, climate change, and economic change threaten to worsen this situation

Assessing the physical activity environment in Mexican healthcare settings

Objective. To assess the informational, educational and instrumental environments among Mexican healthcare settings for their potential to promote physical activity (PA).Materials and methods. The Environmental Physical Activity Assessment Tool for Healthcare Settings (EPATHS) was developed to assess the PA environments of 40 clinics/hospitals representing the three Mexican healthcare systems in Guadalajara. The EPATHS assessed the presence and quality of PA enhancing features in the informational (e.g. signage),educational (e.g. pamphlets), and instrumental (e.g. stairs)environments of included clinics/hospitals. Results. 28 (70%) clinics/hospitals had more than one floor with stairs; 60% of these had elevators. Nearly 90% of stairs were visible, accessible and clean compared to fewer than 30% of elevators. Outdoor spaces were observed in just over half (55%) of clinics/hospitals, and most (70%) were of good quality. Only 25% clinics/hospitals had educational PA materials. Conclusions.The PA instrumental environment of Mexican healthcare settings is encouraging. The informational and educational environments could improve