Barriers to diverse clinical trial participation in Duchenne muscular dystrophy: Engaging Hispanic/Latina caregivers and health professionals.

BACKGROUND: Despite the increasing availability of clinical trials in Duchenne muscular dystrophy, racial/ethnic minorities and other populations facing health disparities remain underrepresented in clinical trials evaluating products for Duchenne. We sought to understand the barriers faced by Hispanic/Latino families specifically and underrepresented groups more generally to clinical trial participation in Duchenne. METHODS: We engaged two participant groups: Hispanic/Latino caregivers of children with Duchenne in the US, including Puerto Rico, and health professionals within the broader US Duchenne community. Caregiver interviews explored attitudes towards and experiences with clinical trials, while professional interviews explored barriers to clinical trial participation among socio-demographically underrepresented families (e.g., low income, rural, racial/ethnic minority, etc.). Interviews were analyzed aggregately and using a thematic analysis approach. An advisory group was engaged throughout the course of the study to inform design, conduct, and interpretation of findings generated from interviews. RESULTS: Thirty interviews were conducted, including with 12 Hispanic/Latina caregivers and 18 professionals. We identified barriers to clinical trial participation at various stages of the enrollment process. In the initial identification of patients, barriers included lack of awareness about trials and clinical trial locations at clinics that were less likely to serve diverse patients. In the prescreening process, barriers included ineligibility, anticipated non-compliance in clinical trial protocols, and language discrimination. In screening, barriers included concerns about characteristics of the trial, as well as mistrust/lack of trust. In consent and recruitment, barriers included lack of timely decision support, logistical factors (distance, time, money), and lack of translated study materials. CONCLUSIONS: Numerous barriers hinder participation in Duchenne clinical trials for Hispanic/Latino families and other populations experiencing health disparities. Addressing these barriers necessitates interventions across multiple stages of the clinical trial enrollment process. Recommendations to enhance participation opportunities include developing clinical trial decision support tools, translating prominent clinical trials educational resources such as ClinicalTrials.gov, fostering trusting family-provider relationships, engaging families in clinical trial design, and establishing ethical guidelines for pre-screening potentially non-compliant patients.

Thermal comfort conditions at microclimate scale and surface urban heat island in a tropical city: A study on João Pessoa city, Brazil.

Surface urban heat islands (SUHIs) are one of the most studied phenomena in urban climates because they generate problems for the well-being of the urban population. This study analyzed the thermal comfort conditions at microclimate scale and SUHI for João Pessoa city, Brazil. Micrometeorological data (temperature and air humidity data) collected at 10 stations in 2011 and 2018 were used to calculate Thom's discomfort index (TDI) for João Pessoa city. Satellite images from Landsat 5/TM for 1991, 2006, and 2010 and Landsat 8/OLI for 2018 were used for land use and land cover classification and to identify SUHI. The obtained results highlighted that the SUHI area in João Pessoa city was 26 km2 and that almost half of the heat island area was concentrated in the Geisel, Aeroclube, Valentina, Distrito Industrial, Cristo Redentor, and Mangabeira neighborhoods. Regarding the micrometeorological data, higher values were obtained for 2018 in the dry periods (summer) and during the day. Based on the results, a considerable increase in discomfort during the daytime was observed in urbanized areas of the city from 2010 - 2018 due to the increase in the average temperature in João Pessoa between 1991 and 2018.

Two Piwis with Ago-like functions silence somatic genes at the chromatin level.

Most sRNA biogenesis mechanisms involve either RNAse III cleavage or ping-pong amplification by different Piwi proteins harbouring slicer activity. Here, we follow the question why the mechanism of transgene-induced silencing in the ciliate Paramecium needs both Dicer activity and two Ptiwi proteins. This pathway involves primary siRNAs produced from non-translatable transgenes and secondary siRNAs from targeted endogenous loci. Our data does not indicate any signatures from ping-pong amplification but Dicer cleavage of long dsRNA. Ptiwi13 and 14 prefer different sub-cellular localizations and different preferences for primary and secondary siRNAs but do not load them mutually exclusive. Both Piwis enrich for antisense RNAs and show a general preference for uridine-rich sRNAs along the entire sRNA length. In addition, Ptiwi14-loaded siRNAs show a 5´-U signature. Our data indicates both Ptiwis and 2´-O-methylation contributing to strand selection of Dicer cleaved siRNAs. This unexpected function of the two distinct vegetative Piwis extends the increasing knowledge of the diversity of Piwi functions in diverse silencing pathways. We describe an unusual mode of action of Piwi proteins extending not only the great variety of Piwi-associated RNAi pathways but moreover raising the question whether this could have been the primordial one.

Analysis of 3' End Modifications in microRNAs by High-Throughput Sequencing.

MicroRNAs are ~22 nt small, non-coding RNAs that direct posttranscriptional silencing of gene expression to regulate animal development, physiology, and disease. An emerging mechanism that controls the biogenesis of microRNAs is the addition of non-templated nucleotides, predominantly uridine, to the 3' end of precursor-microRNAs, in a process that is commonly referred to as tailing. Here, we describe methods that enable the systematic characterization of tailing events in mature microRNAs and their precursors. We report protocols for untargeted and targeted cDNA library preparation procedures, as exemplified in the context of the model organism Drosophila melanogaster and focusing on precursor-microRNAs. We also refer to a dedicated computational framework for the subsequent analysis of untemplated nucleotide additions in cDNA libraries. The described methods for the systematic characterization of posttranscriptional modifications in gene regulatory small RNAs and their precursors will be instrumental in clarifying regulatory concepts that control posttranscriptional gene silencing.

SAÚDE MENTAL MATERNA: RASTREANDO OS RISCOS CAUSADORES DA DEPRESSÃO PÓS-PARTO / MATERNAL MENTAL HEALTH: TRACKING DOWN THE RISKS FOR POSTPARTUM DEPRESSION / SALUD MENTAL DE LA MADRE: RASTREANDO LOS RIESGOS DE LA DEPRESIÓN POSPARTO

Objetivo: identificar os fatores de riscos que contribuem para DPP em mulheres assistidas em maternidade do interior do Maranhão. Método: abordagem quantitativa de caráter descritivo e exploratório. Realizou-se a coleta de dados em uma maternidade no interior do Maranhão, com uma amostra de 280 puérperas em atendimento na maternidade. O instrumento utilizado para coleta dos dados foi a Escala de Depressão Pós-parto de Edimburgo (EPDS), os dados foram tratados e analisados conforme o estatística descritiva. Resultados: detectou-se que 80 (28,6%) delas apresentavam risco para DPP. A baixa escolaridade, a baixa renda e o desemprego são os três principais fatores encontrados entres as mães com riscos para DPP, com índice acima de 50%. Conclusão: esta pesquisa possibilitou a caracterização de um perfil de vulnerabilidade para DPP de uma região importante do estado. A abordagem desta temática mostra que ainda existe um longo caminho a ser percorrido para a melhoria e agilidade dos serviços de saúde no rastreamento, prevenção e tratamento da depressão puerperal.

Objective: to identify the risk factors that contribute to PPD in women assisted at a maternity hospital in the countryside of the Maranhão state. Method: a descriptive and exploratory study with a quantitative approach. The data collection was carried out in a maternity hospital in the state of Maranhão, with a sample of 280 mothers in maternity care. The instrument used for data collection was the Edinburgh Postnatal Depression Scale (EPDS), the data were processed and analyzed according to the statistical. Results: it was found that 80 (28,6%) of them were at risk for PPD. Low education, low income and unemployment are the three main factors found among mothers with risk for PPD, with index above of 50%. Conclusion: this study allowed the characterization of a vulnerability profile for PPD in an important region of the state. The approach of this issue shows that there is still a long way to go to improve and speed of health services to screening, prevention and treatment of postpartum depression.

Objetivo: Identificar los factores de riesgo que contribuyen a la PPD en mujeres atendidas en un hospital de maternidad en el estado de Maranhão. Método: estudio descriptivo y exploratorio con enfoque cuantitativo. La recolección de datos fue en una maternidad en el estado de Maranhão, con una muestra de 280 madres hospitalizadas en la maternidad. El instrumento utilizado para la recolección de datos fue la escala de depresión posparto de Edimburgo (EPDS), los datos fueron procesados y analizados de acuerdo con el método estadístico. Resultados: se encontró que 80 (28,6%) de ellos eran en riesgo de PPD. El bajo nivel de educación, los bajos ingresos económicos y el desempleo son los tres factores principales encontrados entres las madres con riesgo de PPD, con índice superior a 50%. Conclusión: este estudio permitió la caracterización de un perfil de vulnerabilidad para la DPP en una región importante del estado. El enfoque de esta cuestión pone de manifiesto que todavía queda un largo camino por recorrer para mejorar y agilizar los servicios de salud para la detección, prevención y tratamiento de la depresión posparto.

Differential Contribution of Acute and Chronic Inflammation to the Development of Murine Mammary 4T1 Tumors.

Based on the notion that inflammation favors tumorigenesis, our experiments comparatively assessed the influence of acute and chronic inflammation on the development of a murine mammary tumor (4T1). In addition, we characterized angiogenic and inflammatory markers in the tumor tissue and systemically. Subcutaneous implantation of polyether-polyurethane sponge discs in Balb/c mice was used to host 4T1 tumor cells (1x10(6)), which were inoculated intraimplant 24 h or 10 days post implantation. Flow cytometric analysis of enzyme-digested implants revealed that, after 24 hours, the population of leukocytes was primarily characterized by neutrophils (42.53% +/- 8.45) and monocytes (37.53% +/- 7.48), with some lymphocytes (16.27% +/- 4.0) and a few dendritic cells (1.82% +/- 0.36). At 10 days, macrophages were predominant (37.10% +/- 4.54), followed by lymphocytes (28.1% +/- 4.77), and monocytes (22.33% +/- 3.05), with some dendritic cells (13.60% +/- 0.55) and neutrophils (11.07% +/- 2.27). A mammary tumor grown in a chronic inflammatory environment was 2-fold when compared with one grown in acute inflammation and 5-fold when compared with tumor alone. The levels of pro-angiogenic cytokine (VEGF-Vascular Endothelial Growth Factor) were higher in implant-bearing tumor when 4T1 cells were grown in 10-day old implants as compared to the VEGF levels of the two other groups. Overall, the levels of the inflammatory markers evaluated (NAG -N-acetylglucosaminidase, TNF-α-Tumor Necrosis Factor-α) were higher in both groups of implant-bearing tumors and in serum from those animals when compared with the tumor alone levels. This inflammation-related difference in tumor growth may provide new insights into the contribution of different inflammatory cell populations to cancer progression.

Spatial distribution of tuberculosis and relationship with living conditions in an urban area of Campina Grande--2004 to 2007.

This research aimed to study the spatial distribution of tuberculosis and its relationship with living conditions in the urban area of the city of Campina Grande in the period from 2004 until 2007. It is an ecologic study which used the city's neighborhood distribution; demographic, social and economic data from year 2000 census; and the new cases of tuberculosis reported to the Disease and Reporting Information System. Georeferencing was done for the cases of tuberculosis, and disease incidence was calculated by neighborhood. Rates were softened and the Global Moran Index was calculated. Social-economic data were grouped in quartiles according to the Life Condition Index, calculating the incidence of TB in each stratum of living conditions. The results showed that the spatial distribution of tuberculosis in the city is not uniform. Grouping neighborhoods according to the Life Conditions Index revealed social differences that can justify the occurrence of higher incidence rates in the most socially and economically vulnerable regions. The best living condition stratum presented a high incidence possibly due to the underreporting of the cases of tuberculosis caused mainly by the centralization of disease control services. We hope that this study may help outline control strategies for the city of Campina Grande, from the perspective of health promotion, for a disease so socially determined, as is the case of TB.

Distribuição espacial da tuberculose e a relação com condições de vida na área urbana do município de Campina Grande - 2004 a 2007 / Spatial distribution of tuberculosis and relationship with living conditions in an urban area of Campina Grande - 2004 to 2007

A pesquisa objetivou estudar a distribuição espacial da tuberculose e a sua relação com condições de vida na área urbana do município de Campina Grande no período de 2004 a 2007. Trata-se de um estudo ecológico que utilizou a malha dos bairros do município; dados demográficos, sociais e econômicos do censo 2000; e os casos novos de tuberculose notificados no Sistema de Informação de Agravos e Notificação. Realizou-se o georeferenciamento dos casos de tuberculose e calculou-se a taxa de incidência da doença por bairro. Foi feita suavização das taxas e calculado o Índice de Moran Global. Os dados socioeconômicos foram agrupados em quartis segundo o Índice de Condições de Vida e calculou-se a incidência da tuberculose em cada estrato de condições de vida. Os resultados mostram que a distribuição espacial da tuberculose na cidade não é uniforme. O agrupamento dos bairros de acordo com o Índice de Condições de Vida revelou diferenças sociais que podem justificar a ocorrência das maiores taxas de incidência nas regiões social e economicamente mais vulneráveis. O estrato de melhor condição de vida apresentou elevada incidência, possivelmente devido à subnotificação dos casos de tuberculose causada principalmente pela centralização do serviço de controle da doença. Espera-se que este estudo possa subsidiar o delineamento das estratégias de controle no município de Campina Grande, na perspectiva da promoção da saúde, de uma doença tão caracteristicamente de determinação social como a TB.

This research aimed to study the spatial distribution of tuberculosis and its relationship with living conditions in the urban area of the city of Campina Grande in the period from 2004 until 2007. It is an ecologic study which used the city's neighborhood distribution; demographic, social and economic data from year 2000 census; and the new cases of tuberculosis reported to the Disease and Reporting Information System. Georeferencing was done for the cases of tuberculosis, and disease incidence was calculated by neighborhood. Rates were softened and the Global Moran Index was calculated. Social-economic data were grouped in quartiles according to the Life Condition Index, calculating the incidence of TB in each stratum of living conditions. The results showed that the spatial distribution of tuberculosis in the city is not uniform. Grouping neighborhoods according to the Life Conditions Index revealed social differences that can justify the occurrence of higher incidence rates in the most socially and economically vulnerable regions. The best living condition stratum presented a high incidence possibly due to the underreporting of the cases of tuberculosis caused mainly by the centralization of disease control services. We hope that this study may help outline control strategies for the city of Campina Grande, from the perspective of health promotion, for a disease so socially determined, as is the case of TB.

Segurança do paciente na administração de medicamentos: relato de experiência / Patient safety in medication administration: experience report

Este trabalho tem como objetivo relatar a experiência da revisão do processo e administração de medicamentos, a partir da construção de fluxogramas e recomendações que minimizem os erros ao entorno da administração. Trata-se de um relato de experiência realizado em um hospital escola do interior do Estado de São Paulo. Conclui-se que existe a necessidade do envolvimento administrativo na alteração de rotinas e normas que envolvam equipes multiprofissionais. A ação conjunta entre educação continuada e o serviço de enfermagem favorece um trabalho reflexivo, promovendo uma enfermagem voltada para atender os interesses dos pacientes.

Caracterização do serviço de enfermagem em uma unidade leito dia em aids / The characterization a day AIDS unit

Este estudo teve como objetivo caracterizar a unidade leito-dia em AIDS no que se refere ao fluxo de pacientes e cuidadores atendidos na unidade, bem como a frequência e o tempo dispendido para a realização dos procedimentos...