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Background: Reducing maternal mortality ratio (MMR) remains a paramount goal for low- and middle-income countries (LMICs), especially after COVID-19's devastating impact on maternal health indicators. We describe our experience implementing the Hospital Padrino Strategy (HPS), a collaborative model between a high-complexity hospital (Fundación Valle del Lili) and 43 medium- and low-complexity hospitals in one Colombian department (an administrative and territorial division) from 2021 to 2022, to sustain the trend towards reducing MMR. The study aimed to assess the effects of implementing HPS on both hospital performance and maternal health indicators in Valle del Cauca department (VCD). Methods: A mixed-methods study was conducted, comprising two phases. In the first phase, we investigated a cohort of hospitals through prospective follow-up to assess the outcomes of HPS implementation on hospital performance and maternal health indicators in VCD. In the second phase, qualitative data were collected through focus groups with 131 health workers from 33 hospitals to explore the implications of the HPS implementation on healthcare personnel. All data were obtained from records within the HPS implementation and from the Health Secretary of VCD. Findings: Evidence shows that in the context of HPS, 51 workshops involved 980 healthcare workers, covering the entire territory. Substantial improvements were observed in hospital conditions and healthcare personnel's technical competencies when providing obstetric care. Seven hundred eighty-five pregnant women with obstetric or perinatal emergencies received care through telehealth systems, with a progressive increase in technology adoption. Nine percent required Intensive Care Unit (ICU) admission, and none died. The MMR decreased from 78.8 in 2021 to 12.0 cases per 100,000 live births by 2022. Improvements in indicators and conducted training sessions instilled confidence and empowerment among the healthcare teams in the sponsored hospitals, as evidenced in focus groups derived from a sample of 131 healthcare workers from 33 hospitals. Interpretation: Implementing the Hospital Padrino Strategy led to a significant MMR reduction, and consolidated a model of social healthcare innovation replicable in LMICs. Funding: The Hospital Padrino Strategy was funded by the Fundación Valle del Lili and the Health Secretary of Valle del Cauca. Furthermore, this study received funding from a general grant for research from Tecnoquimicas S.A.

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BACKGROUND: Improved access to health care and quality of services require integrated efforts and innovations, including community empowerment and participation in transformation processes. Chagas disease is a neglected tropical disease that is generally controlled by insecticide spraying. To achieve community empowerment in a health program, actions for social innovations may include: community-based research, interdisciplinary and intersectoral participation, community perception of direct benefits and participation in health or environmental improvements. The aim of this study was to describe and analyze the processes by which an interdisciplinary team, in collaboration with communities of Comapa, Guatemala, developed an effective solution to address the risk for Chagas disease. METHODS: A qualitative study involving interviews semi-structured and direct observation was conducted using a case study approach to describe and understand the community-based research and intervention process developed by researchers from the Laboratory of Applied Entomology and Parasitology of the Universidad de San Carlos of Guatemala (Laboratorio de Entomologia y Parasitologia Aplicada). Nine interviews were conducted with the investigators, innovators, members of the community in which the intervention had been implemented. NVivo software (version 12) was used for the emergent coding and analysis of the interviews. RESULTS: Processes of social transformation were evident within households, and the communities that transcended the mere improvement of walls and floors. New social dynamics that favored the household economy and conditions of hygiene and home care that positively impacted the health of the community. We describe how the integration of criteria of social innovation into a home improvement strategy for Chagas disease control, can generate processes of transformation in health by considering sociocultural conditions, encouraging dialogue between public health approaches and traditional practices. We identify and discuss processes for Social Innovations in Health and identify their potential in improving community health in Latin America. CONCLUSIONS: When social innovation criteria are included in a health control initiative, the community-based research and the interdisciplinary and intersectoral participation facilitate the implementation of the control strategy, the perceived benefits by the community and its empowerment to sustain and share the strategy. The case study provided understanding of the intersectoral and interdisciplinary dynamics in particular contexts, and documented the relevance of innovation criteria in health processes.

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Introducción. La presentación prematura de la enfermedad coronaria es relativamente frecuente, pero sus factores predictores todavía no se conocen bien. Método. Analizamos los factores de riesgo en varones canarios: 515 pacientes menores de 51 años, con enfermedad coronaria documentada, y 436 controles mayores de 56 años, sin enfermedad. Resultados. La serie presenta una elevada prevalencia de factores de riesgo; el 98% de los pacientes y el 93% de los controles tenían al menos un factor de riesgo cardiovascular (p < 0,001). Encontramos diferencias significativas (p < 0,001) en la frecuencia de antecedente familiar de enfermedad prematura (35% pacientes y 15% controles), tabaquismo (85% pacientes y 76% controles) y dislipemia (78% pacientes y 53% controles) superior en pacientes. La hipertensión arterial resultó el factor más prevalente en controles (51% pacientes y 66% controles; p < 0,001). Pese al tratamiento con estatinas, los pacientes presentaban índices aterogénicos (triglicéridos/colesterol unido a lipoproteínas de alta densidad [cHDL]) más elevados que los controles (promedio 5,39 pacientes y 4,10 controles; p < 0,001). La enfermedad coronaria se adelantaba 2 años en pacientes con índices aterogénicos superiores a 5,5 (48,2 años con índice bajo y 46,6 años con índice aterogénico alto; p < 0,013). El análisis multivariante de pacientes normotensos seleccionó índice aterogénico superior a 4 (p < 0,004; odds ratio (OR) = 1,263-3,617), antecedentes familiares de enfermedad coronaria prematura (p < 0,013; OR = 1,154-3,980) y dislipemia (p < 0,001; OR = 1,936-5,346), como principales predictores de enfermedad coronaria prematura. Conclusiones. A pesar de su juventud, la prevalencia de factores de riesgo en pacientes canarios masculinos es muy elevada. El índice aterogénico resulta una herramienta muy útil y relativamente independiente de las estatinas, para detectar los sujetos con riesgo de presentar enfermedad coronaria prematura (AU)

Introduction. Although premature coronary heart disease (CHD) is relatively frequent, the factors predicting its development are still poorly defined. Method. We analyzed risk factors and lipid profiles in a series of men from the Canary Islands (Spain): 515 patients aged less than 51 years with documented CHD and 436 elderly controls aged more than 56 years without CHD. Results. Most patients and controls had at least one major risk factor (98% of patients and 93% of controls; P<.001). We found significant differences (P<.001) in the prevalence of a family history of premature CHD (35% of patients and 15% of controls), smoking (85% of patients and 76% of controls), and dyslipidemia (78% of patients and 53% of controls). Only hypertension was more common among controls (51% of patients and 66% of controls; P<.001). Despite statin therapy, patients showed a higher atherogenic index (triglycerides/high density lipoprotein HDL-cholesterol [HDL-c] ratio) than controls, the mean index being 5.39 in patients and 4.10 in controls (P<.001). In normotensive patients the multivariate analysis shows as the major predictors of premature coronary disease: atherogenic index higher than 4 (P<.004, OR = 1.154-3.980), and dislypidemia (P<.001, OR = 1.936-5.346). Conclusion. Despite their youth, male patients with CHD in the Canary Islands have a very high prevalence of risk factors. The atherogenic index is a highly useful tool and is relatively independent of the effects of statin therapy in detecting individuals at risk for premature CDH (AU)

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BACKGROUND: We were interested in identifying possible nutritional reasons for growth faltering among breastfed infants in the rural farming community of San Mateo, Capulhuac, Mexico (2800 m above sea level). OBJECTIVE: We examined the prevalence of inadequate iron and folate status among lactating Otomi women and determined to what extent their iron and folate nutriture influenced the milk concentrations of these nutrients. DESIGN: Lactating women (n = 71) provided blood and milk samples and dietary information at a mean (+/- SD) of 22 +/- 13 d postpartum. Blood indexes included hemoglobin, hematocrit, serum iron, total-iron-binding capacity, ferritin, transferrin receptor, mean cell volume, plasma folate, and erythrocyte folate. RESULTS: Approximately 62% and 58% of the women had nutritional anemia defined as a hemoglobin concentration

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Se presenta el caso de una mujer de 20 años con lesiones granulomatosas periorbitarias, asintomáticas de diez años de evolución. La histología mostró un infiltrado granulomatoso con intensa eosinofilia. La paciente respondió excelentemente a la diamino difenil sulfona. Se comenta la rareza de esta entidad, la inusual morfología de las lesiones y la notable respuesta a la DDS

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