Telomere Length as a New Risk Marker of Early-Onset Colorectal Cancer.

Early-onset colorectal cancer (EOCRC; age younger than 50 years) incidence has been steadily increasing in recent decades worldwide. The need for new biomarkers for EOCRC prevention strategies is undeniable. In this study, we aimed to explore whether an aging factor, such as telomere length (TL), could be a useful tool in EOCRC screening. The absolute leukocyte TL from 87 microsatellite stable EOCRC patients and 109 healthy controls (HC) with the same range of age, was quantified by Real Time Quantitative PCR (RT-qPCR). Then, leukocyte whole-exome sequencing (WES) was performed to study the status of the genes involved in TL maintenance (hTERT, TERC, DKC1, TERF1, TERF2, TERF2IP, TINF2, ACD, and POT1) in 70 sporadic EOCRC cases from the original cohort. We observed that TL was significantly shorter in EOCRC patients than in healthy individuals (EOCRC mean: 122 kb vs. HC mean: 296 kb; p < 0.001), suggesting that telomeric shortening could be associated with EOCRC susceptibility. In addition, we found a significant association between several SNPs of hTERT (rs79662648), POT1 (rs76436625, rs10263573, rs3815221, rs7794637, rs7784168, rs4383910, and rs7782354), TERF2 (rs251796 and rs344152214), and TERF2IP (rs7205764) genes and the risk of developing EOCRC. We consider that the measurement of germline TL and the status analysis of telomere maintenance related genes polymorphisms at early ages could be non-invasive methods that could facilitate the early identification of individuals at risk of developing EOCRC.

Familial component of early-onset colorectal cancer: opportunity for prevention.

BACKGROUND: Individuals with a non-syndromic family history of colorectal cancer are known to have an increased risk. There is an opportunity to prevent early-onset colorectal cancer (age less than 50 years) (EOCRC) in this population. The aim was to explore the proportion of EOCRC that is preventable due to family history of colorectal cancer. METHODS: This was a retrospective multicentre European study of patients with non-hereditary EOCRC. The impact of the European Society of Gastrointestinal Endoscopy (ESGE), U.S. Multi-Society Task Force (USMSTF), and National Comprehensive Cancer Network (NCCN) guidelines on prevention and early diagnosis was compared. Colorectal cancer was defined as potentially preventable if surveillance colonoscopy would have been performed at least 5 years before the age of diagnosis of colorectal cancer, and diagnosed early if colonoscopy was undertaken between 1 and 4 years before the diagnosis. RESULTS: Some 903 patients with EOCRC were included. Criteria for familial colorectal cancer risk in ESGE, USMSTF, and NCCN guidelines were met in 6.3, 9.4, and 30.4 per cent of patients respectively. Based on ESGE, USMSTF, and NCCN guidelines, colorectal cancer could potentially have been prevented in 41, 55, and 30.3 per cent of patients, and diagnosed earlier in 11, 14, and 21.1 per cent respectively. In ESGE guidelines, if surveillance had started 10 years before the youngest relative, there would be a significant increase in prevention (41 versus 55 per cent; P = 0.010). CONCLUSION: ESGE, USMSTF, and NCCN criteria for familial colorectal cancer were met in 6.3, 9.4, and 30.4 per cent of patients with EOCRC respectively. In these patients, early detection and/or prevention could be achieved in 52, 70, and 51.4 per cent respectively. Early and accurate identification of familial colorectal cancer risk and increase in the uptake of early colonoscopy are key to decreasing familial EOCRC.

Trump's electoral speeches and his appeal to the American white working class.

This paper contributes to the study of social change by considering boundary work as a dimension of cultural change. Drawing on the computer-assisted qualitative analysis of 73 formal speeches made by Donald Trump during the 2016 electoral campaign, we argue that his political rhetoric, which led to his presidential victory, addressed the white working class's concern with their declining position in the national pecking order. He addressed this group's concern by raising their moral status, that is, by (1) emphatically describing them as hard-working Americans who are victims of globalization; (2) voicing their concerns about 'people above' (professionals, the rich, and politicians); (3) drawing strong moral boundaries toward undocumented immigrants, refugees, and Muslims; (4) presenting African Americans and (legal) Hispanic Americans as workers who also deserve jobs; (5) stressing the role of working-class men as protectors of women and LGBTQ people. This particular case study of the role of boundary work in political rhetoric provides a novel, distinctively sociological approach for capturing dynamics of social change.

Women's perceptions of iron deficiency and anemia prevention and control in eight developing countries.

The World Health Organization estimates that 58% of pregnant women in developing countries are anemic. In spite of the fact that most ministries of health in developing countries have policies to provide pregnant women with iron in a supplement form, maternal anemia prevalence has not declined significantly where large-scale programs have been evaluated. During the period 1991-98, the MotherCare Project and its partners conducted qualitative research to determine the major barriers and facilitators of iron supplementation programs for pregnant women in eight developing countries. Research results were used to develop pilot program strategies and interventions to reduce maternal anemia. Across-region results were examined and some differences were found but the similarity in the way women view anemia and react to taking iron tablets was more striking than differences encountered by region, country or ethnic group. While women frequently recognize symptoms of anemia, they do not know the clinical term for anemia. Half of women in all countries consider these symptoms to be a priority health concern that requires action and half do not. Those women who visit prenatal health services are often familiar with iron supplements, but commonly do not know why they are prescribed. Contrary to the belief that women stop taking iron tablets mainly due to negative side effects, only about one-third of women reported that they experienced negative side effects in these studies. During iron supplementation trials in five of the countries, only about one-tenth of the women stopped taking the tablets due to side effects. The major barrier to effective supplementation programs is inadequate supply. Additional barriers include inadequate counseling and distribution of iron tablets, difficult access and poor utilization of prenatal health care services, beliefs against consuming medications during pregnancy, and in most countries, fears that taking too much iron may cause too much blood or a big baby, making delivery more difficult. Facilitators include women's recognition of improved physical well being with the alleviation of symptoms of anemia, particularly fatigue, a better appetite, increased appreciation of benefits for the fetus, and subsequent increased demand for prevention and treatment of iron deficiency and anemia.

Prueba molecular genotype MTBDRplus, una alternativa para la detección rápida de tuberculosis multidrogorresistente / Molecular test genotype MTBDRplus, an alternative to rapid detection of multidrug resistance tuberculosis

La prueba molecular Genotype MTBDRplus, es un método que permite identificar las mutaciones más frecuentes asociadas con la resistencia a las drogas antituberculosas de primera línea: isoniacida (INH) y rifampicina (RIF). El objetivo de este estudio fue evaluar el desempeño de la prueba molecular con cultivos y muestras de esputo con baciloscopía positiva. Se evaluó 95 cultivos y 100 esputos con perfiles de resistencia previamente determinados por el método de referencia “proporciones agar en placa” (APP). La prueba molecular a partir de cultivos mostró una sensibilidad de 100 por ciento;97,5 por ciento y 96,9 por ciento para RIF, INH y multidrogorresistente (MDR) respectivamente; mientras que para esputo la sensibilidadfue de 95,7 por ciento; 96,8 por ciento y 95,2 por ciento para RIF, INH y MDR respectivamente. Se concluye que Genotype MTBDRplus es una herramienta muy útil para la detección rápida de la resistencia a INH y RIF simultáneamente (MDR) en un máximo de72 h a partir de esputo o de cultivo

Increasing awareness of danger signs in pregnancy through community- and clinic-based education in Guatemala.

OBJECTIVE: This study evaluates the effectiveness of a set of information, education, and communication (IEC) strategies designed to increase the awareness of danger signs in pregnancy, delivery, or the postpartum period among pregnant or recently pregnant women. METHODS: Three IEC programs were implemented in 4 regions of southwestern Guatemala between April 1997 and May 1998: (1) a clinic-based program involving the training of health providers in prenatal counseling and the provision of educational media to clients; (2) a community-based strategy consisting of radio messages regarding obstetric complications; and (3) educational sessions conducted through women's groups. Three surveys were conducted. In 1997, 637 pregnant women were interviewed at clinics where the interventions had been implemented. In 1998, 163 pregnant women using a subset of the same health clinics were interviewed. In 1999, a population-based survey of 638 pregnant and postpartum women was conducted. Using logistic regression, we model awareness of danger signs as a function of sociodemographic characteristics, prenatal care utilization, and IEC interventions. RESULTS: Among women using health clinics, the likelihood of having heard of danger signs nearly tripled between 1997 and 1998, when the clinic interventions were fully implemented. In 1999, those who had heard radio messages or participated in women's groups were, respectively, 3 times and 5 times more likely to have heard of danger signs in pregnancy. CONCLUSIONS: Safe motherhood programs can effectively increase knowledge of danger signs through clinic- and community-based educational strategies.

Tres proyectos simplificados de atencion primaria de salud y su efecto sobre la nutricion y la salud infantiles / Three simplified primary health care projects and their effects on child nutrition and health

This article considers the effects on child nutrition and health achieved by three simplified primary health care projects developed by the Institute of Nutrition of Central America and Panama in rural areas of Guatemala from 1969 to 1981. The first of this projects encompassed four non-indian communities of El Progreso department and the other two, several Indian communities in the departments of Solola and Suchitepequez. In all of them, curative and preventive services were provided by primary health care workers supervised by a physician that made periodic visits to the community health care centers. These workers included nursing and perinatal auxiliaries, health promoters, and traditional birth attendants trained in the examination, diagnosis and treatment of patients. In addition, a program was carried out for the vaccination of expectant mothers with tetanus toxoid. A substantial reduction of infant mortality was observed in the course of the three projects. The reduction was most pronounced in El Progreso, where children and expectant mothers received food supplements. There was also a marked improvement in the nutritional status and growth of the children. In view of the current worsening of the economic problems of the Latin American countries and the impracticability of allocating more funds to health care, the authors suggest extending health services by means of simplified primary

Infecciones respiratorias agudas en ninos menores de dos anos de la zona rural de Guatemala / Acute respiratory infections in children under two years old in rural areas of Guatemala

An epidemiologic study was carried out from October 1977 to September 1978 on children under two years of age living on several coffee plantations in southern Guatemala who presented various clinical manifestations of acute respiratory infection. The purpose of the sutdy was to examine the relationship between the illness and the socioeconomic characteristics and nutritional status of the same population. At the same time, an evaluation was made of the degree to which the health posts located on the plantations were used in providing care for the infections. On the basis of the consultations done at these posts and from bi-weekly home visits by a team of trained health promoters, information was collected during each quarter on the frequency and duration of nasal secretion, cough, stertor, as well as on the children's physical growth and their socioeconomic characteristics. The clinical manifestations were correlated with several risk factors reflecting certain socioeconomic characteristics, such as the availability of drinking water in the home, the degree of literacy of the head of family, and type of housing. There were notable negative values in the z score for all anthropometric indicators, signifying retarded physical growth in the children studied. This retardation was greater in those who had one or more episodes of clinically acute respiratory infection than those who did not have any

La lactancia materna en la etiología de la diarrea / Breast feeding in the etiology of diarrhea

La información proveniente de distintos estudios antropológicos llevados a cabo en Guatemala dentro de un proyecto del INCAP en apoyo de los programas y actividades de salud y nutrición maternoinfantil, revela que, de acuerdo a la perspectiva popular, la leche materna juega un papel definido en la etiología de las enfermedades diarreicas, en el niño lactante. Este artículo presenta información acerca de las clasificaciones populares de las enfermedades diarreicas que difieren de las definiciones biomédicas de las mismas. Se detallan los distintos tipos de factores que pueden alterar la calidad de la leche materna que, a su vez, puede producir enfermedades gastrointestinales en el niño lactante. Se señalan, asimismo, las posibilidades y limitaciones del marco conceptual popular "caliente-rfrio" tan común en los sistemas de creencias médicas populares de América Latina, como modelo explicativo. Finalmente, se sugieren implicaciones de los hallazgos de estos estudios para los programas de salud pública, especialmente en el área de comunicación y educación en lactancia materna y en la aplicación del enfoque de alto riesgo

Crecimiento físico y menarquia en adolescentes de Guatemala / Physical growth and menarche in Guatemalan adolescents

Se efectuó un estudio sobre medidas antropométricas y la edad de menarquia en un grupo de adolescentes de las áreas urbana y rural de Guatemala. Los resultados indican que la edad de menarquia es mayor en las adolescentes indígenas residentes en el medio rural, que en las no indígenas, siendo más baja en las adolescentes urbanas. La edad de menarquia está directamente asociada a medidas de crecimiento físico (peso, perímetro dl brazo y talla) y de composición corporal (índice de masa corporal). Esto sugiere que ambos, crecimiento físico y maduración sexual, son procesos interrelacionados en un mismo fenómeno conocido como la edad de desarrollo

Tres proyectos simplificados de atención primaria de salud y su efecto sobre la nutrición y la salud infantiles / Three simplified primary health care projects and their effects on child nutrition and health

Se analizan los efectos que tuvieron sobre la salud y la nutrición infantiles tres proyectos simplificcados de atención primaria de salud desarrollados por el Instituto de Nutricción de Centro América y Panamá en zonas rurales de Guatemala entre 1969 y 1981. El primero se efectuó en cuatro comunidades no indígenas del departamento de El Progreso, y los otros dos en diversas comunidades indígenas de los departamentos de Sololá y Suchitepéquez. En todos ellos prestaron servicios de atención curativa y preventiva trabajadores primarios de salud bajo la supervisión de un médico que visitaba periódicamente los puestos de salud de cada comunidad. Estos trabajadores, que fueron auxiliares de enfermería, promotores de salud, comadronas empíricas y auxiliares perinatólogas, se adiestraron para el examen, diagnóstico y tratamiento de los pacientes. Asimismo, se llevó a cabo un programa de vacunación de embarazadas con roxoide tetánico. Se observó una importante reducción de la tasa de mortalidad infantil durante el desarrollo de los tres proyectos. Esta reduccicón fue más marcada en El Progreso, donde los niños y las gestantes recibieron alimentación complementaria. También se apreció un notable mejoramiento del estado nutricional y el crecimiento infantiles. Dada la agudización actual de los problemas económicos de los países de América Latina, y la impracticabilidad de asignar más recursos a la atención de la salud, los autores sugieren extender los servicios de salud a través de proyectos simplificados de atención primaria. Estos proyectos deben utilizar los recursos humanos locales y la tecnología apropiada con el mayor provecho posible, así como promover la participación de la comunidad

Infecciones respiratorias agudas en ninos menores de dos anos de la zona rural de Guatemala / Acute respiratory infections in children under two years old in rural áreas of Guatemala

An epidemiologic study was carried out from October 1977 to September 1978 on children under two years of age living on several coffee plantations in southern Guatemala who presented various clinical manifestations of acute respiratory infection. The purpose of the study was to examine the relationship between the illness and the socioeconomic characteristics and nutritional status of the same population. At the same time, an evaluation was made of the degree to which the health posts located on the plantations were used in providing care for the infections. On the basis of the consultations done at these posts and from bi-weekly home visits by a team of trained health promoters, information was collected during each quarter on the frequency and duration of nasal secretion, cough, stertor, as well as on the children's physical growth and their socioeconomic characteristics. The clinical manifestations were correlated with several risk factors reflecting certain socioeconomic characteristics, such as the availability of drinking water in the home, the degree of literacy of the head of family, and type of housing. There were notable negative values in the z score for all anthropometric indicators, signifying retarded physical growth in the children studied. This retardation was greater in those who had one or more episodes of clinically acute respiratory infection than those who did not have anym

Informe final del estudio del caso del centro de salud de la Colonia Primero de Julio / Colonia Health Center Case Study Final Report First of July

Como parte de la colaboración del Instituto de Nutrición de Centro América y Panama (INCAP) al Programa de Coordinación Interinstitucional y Extensión de Cobertura en el Area Guatemala-Sur del Hospital Roosevelt se realizó el presente estudio de caso del Centro de Salud de la Colonia Primero de Julio. El principal objetivo del estudio fue el de presentar una visión de conjunto de este servicio de salud, especialmente de las actitudes y actividades del personal que labora en el mismo y de su interación con los usuarios. La metodología de Investigación consistió en una combinación de las técnicas características del trabajo de campo antropólogico o método etnográfico. Entre los hallazgos se identificaron algunas dificultades en el funcionamiento del Centro relacionados con el horario del mismo y de algunos miembros del personal, con el área de información, la pre-consulta, la consulta y la referencia de pacientes al Hospital Roosevelt. El personal de enfermería identificó como principal problema en su trabajo la consulta por demanda, el comportamiento descortés de los pacientes que acuden al Centro, la falta de materiales y medicamentos, la referencia de pacientes al Hospital Roosevelt y hacer lo que no les gusta. Sin embargo, las actitudes de la mayoría del personal hacia su trabajo son positivas. Se detectó un problema de relaciones entre el personal que se encuentra dividido casí por mitad en dos grupos. Este problema afecta el buen funcionamiento del Centro y es causa de mucha tensión y fricciones entre el personal. El trato del personal hacia los usuarios del Centro no es malo, pero generalmente es indiferente. Por su parte usuarios, sí bien se quejan de la tardanza en ser atendidos, consideran que la atención que recibien en el Centro es buena...