Biaryls as potent, tunable dual neurokinin 1 receptor antagonists and serotonin transporter inhibitors.

Depression is a serious illness that affects millions of patients. Current treatments are associated with a number of undesirable side effects. Neurokinin 1 receptor (NK1R) antagonists have recently been shown to potentiate the antidepressant effects of serotonin-selective reuptake inhibitors (SSRIs) in a number of animal models. Herein we describe the optimization of a biaryl chemotype to provide a series of potent dual NK1R antagonists/serotonin transporter (SERT) inhibitors. Through the choice of appropriate substituents, the SERT/NK1R ratio could be tuned to afford a range of target selectivity profiles. This effort culminated in the identification of an analog that demonstrated oral bioavailability, favorable brain uptake, and efficacy in the gerbil foot tap model. Ex vivo occupancy studies with compound 58 demonstrated the ability to maintain NK1 receptor saturation (>88% occupancy) while titrating the desired level of SERT occupancy (11-84%) via dose selection.

A framework for visual communication at Nature.

The scientific journal Nature, published weekly since 1869, serves as an excellent case study in visual communication. While journals are becoming increasingly specialist, Nature remains firmly multidisciplinary; and unlike many scientific journals, it contains original journalism, opinion pieces, and expert analysis in addition to peer-reviewed research papers. This variety of content types-covering an extensive range of scientific disciplines-translates into a wide and varied audience, and the need to employ an equally wide variety of communication styles. For example, a research paper may employ technical language to communicate to a highly specialized audience in that field, whereas a news story on the same subject will explain the science to an educated lay audience, often adding a wider context and stripping out acronyms. Each type of piece will use a communication approach tailored for its intended audience. This is true for visual content as well: the intended audience of a scientific figure, illustration or data visualization will determine the design approach to that visual. At Nature, given the high volume of content plus high quality standards, this process is applied in a fairly systematic way, using a framework to guide creative decision-making. That framework is described here, along with a discussion of best practices for the design of research figures and graphics by context.

Percepção das gestantes sobre o pré-natal em um centro de atendimento do interior do sul do Brasil / Pregnant women perceptions about prenatal care in a health care center in the interior of the south of Brazil

O objetivo deste estudo descritivo e qualitativo foi conhecer a percepção das gestantes sobre a importância do pré-natal e sobre o papel da equipe de saúde durante o pré-natal e sua relação com a gestante. Para tanto, realizou-se entrevista com 14 gestantes com idade entre 18 e 38 anos, em Unidade de Referência à Saúde da Mulher, em município do interior do estado do Rio Grande do Sul. Os dados foram analisados a partir da técnica de análise numa perspectiva dialética, sendo analisadas as relações contidas nos discursos, tanto da perspectiva individual quanto coletiva. Para elas, o pré-natal é um momento importante para se conhecer como está a saúde do bebê e a sua. Neste sentido, o papel da equipe de saúde é fundamental. No entanto, relataram dificuldades quanto à oportunidade de conversarem com os médicos sobre isso, pois eles têm pouco tempo e disponibilidade para orientações. Salientaram que enfermeiras e nutricionistas são mais acessíveis e oferecem informações importantes sobre este momento. Os resultados deste estudo mostram a necessidade de mais espaços de escuta das gestantes, de suas necessidades e inseguranças, pois isto poderá impactar positivamente na saúde da gestante e do recém-nascido.(AU)

The aim of this descriptive and qualitative research was to know pregnant women´s perceptions about the importance of prenatal care and about their relation with the health care team. The survey´s profile is qualitative and it researched a group of 14 pregnant women with ages between 18 and 38, in the Woman´s Health Reference Unit of Cruz Alta, RS. Data were collected through individual interviews with open questions and dealt with by a dialectical content analysis method. The relations found in discourse were analyzed both individually and collectively. Women said that prenatal care is important for them to know about theirs and the baby´s health conditions. They also argued that the health team may facilitate or make it difficult for them to get the necessary information. Lack of opportunity to talk to doctors about fears and anxieties about pregnancy and especially about delivery is something that makes the communication difficult. On the other hand, the team composed by nurses and nutritionists is usually very attentive and the orientations they give are highly important for pregnancy and childbirth.(AU)

A physician self-assessment tool for quality improvement.

A physician self-assessment (PSA) tool was evaluated as an alternative to full chart reviews to assess guideline adherence. PSAs, consisting of brief self-report questionnaires, were developed for asthma management and mammography screening and were mailed to participating physicians in a partially capitated Medicaid managed care insurance program. A random chart audit was conducted at each practice site, and results were compared to the PSA responses. An 85% concordance was found between the asthma PSA and chart data, and an 88% concordance was found between the mammography PSA and chart data. These findings suggest that the PSA, combined with random chart audits, can be a viable alternative to full chart reviews.

Identifying barriers and facilitating factors to improve screening mammography rates in women diagnosed with mental illness and substance use disorders.

Little is known about screening mammography rates among women diagnosed with mental illness-even though some studies have suggested that this population might be particularly vulnerable to breast cancer. The purpose of this pilot study was to identify facilitators and barriers to mammography among women diagnosed with mental illness and/or substance use disorders. Four focus groups were conducted, with a total of 26 women, ages 40-65 years, with mental illness and/ or substance use disorders. Analysis was performed using the grounded-theory editing approach. Several major themes emerged from the transcripts: (1) motivators for obtaining mammograms, (2) fears and concerns, (3) shame and embarrassment, (4) the clinical environment, (5) provider-patient communication, and (6) the need for increased patient education. A family history of breast cancer and/or cancer was the most powerful motivator among focus group participants for obtaining a mammogram. Doctor recommendations and referrals were also identified as key facilitating factors. The overall knowledge of mammography and breast cancer among these women suggested educational deficiencies-despite extensive breast cancer screening and awareness campaigns. The findings highlight the importance of patient education as well as the positive effects of physician recommendations to encourage patients to receive breast cancer screening.