Knowledge gaps and confidence in counseling about aneuploidy screening and testing: A survey of prenatal care clinicians.

OBJECTIVES: Comprehensive counseling on prenatal genetic screening and diagnostic testing is challenging for clinicians. We sought to identify baseline clinician knowledge of prenatal genetic screening and diagnostic testing and needs to promote counseling aligned with ACOG recommendations. METHODS: We performed an anonymous, cross-sectional survey of clinicians at two unaffiliated, tertiary academic institutions to assess the knowledge of, confidence in, and time spent counseling on prenatal genetic screening and diagnostic testing. Stata (Version 17, College Station, TX) was used to perform descriptive statistics. Deductive and inductive coding was used to analyze responses regarding ideal education resources. RESULTS: The survey response rate was 78% (100/129). Only 36% of respondents correctly answered knowledge questions about prenatal genetic screening and diagnostic testing. A majority, 59% (16/39), of those confident or extremely confident in counseling were unable to answer all questions accurately. Respondents reported a median of 5.6 min (95% CI 4.9-6.4 min) spent counseling. Thematic analysis of free responses revealed desire for visual tools that discuss financial costs and patient values. CONCLUSIONS: Surveyed clinicians demonstrated deficiencies in knowledge about prenatal genetic counseling. To provide better and more comprehensive care, we noted a desire for the development of formalized resources for clinician and patient education.

The Erice 58 Charter on 'The health of migrants. An equity challenge for the public health system'.

Abstract: The Erice 58 Charter titled "The Health of Migrants: a Challenge of Equity for the Public Health System", was unanimously approved at the conclusion of the 58th Residential Course of the School of Epidemiology and Preventive Medicine 'Giuseppe D'Alessandro' entitled "The Health of Migrants: a Challenge of Equity for the Public Health System. Epidemiological, clinical-relational, regulatory, organisational, training and public communication aspects at international, national and local level', which took place from 28 March to 2 April 2022 in Erice (Sicily, Italy), at the 'Ettore Majorana' Foundation and Centre for Scientific Culture. The Course was promoted by the Italian Society of Migration Medicine (S.I.M.M.) and the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI), with the collaboration and patronage of the Istituto Superiore di Sanità (ISS). 72 learners participated (mainly resident doctors in 'Hygiene and Preventive Medicine' but also other health service professionals), whose average age was 37 years; on the basis of territorial origin, 13 of the 20 Italian regions were represented. During the intense learning experience, which consisted of 18 frontal lessons (with 20 lecturers from the bio-medical, socio-anthropological and journalistic fields) and 7 working group sessions (supported by 4 classroom tutors in addition to the lecturers) in 'blended learning' mode, the various dimensions and critical issues related to the possibility of guaranteeing truly inclusive health policies for foreigners/migrants, throughout the country, were identified and discussed from an 'Health Equity' perspective. This enabled a small editorial group to draw up the basic document that, in the last session of the Course, was discussed and modified by all participants into the version of the 'Erice 58 Charter' presented here.

[Public health strategies in the prevention of induced abortion. An experience of interprofessional education based strategy]. / Strategie di Sanità pubblica nella Prevenzione delle IVG. Una esperienza basata sulla formazione interprofessionale.

In Italy recent statistics show a huge difference between abortion rate among Italian and migrant women: is it an inequity in health? The Italian Ministry of Health / Center for Disease Prevention and Control, which recognized this issue as a specific public health problem, has financed a national Project whose aim was the prevention of abortion among migrant women. The Project was characterized by a multitasking approach: 1) information and health education of migrant women and their communities; 2) education of health and social care professionals; 3) analysis and development of new proposals for the networks of services directed towards the improvement of woman's health. In this article the Authors describe the main characteristics of the realized intervention of inter-professional education. It began with a multidisciplinary process for the identification of educational needs which has allowed the identification of educational goals. A Training of Trainers event was then organized in order to involve and make the ten Italian Regions partners of the Project aware of their responsibilities. A DVD collecting all the material of the course and other useful resources was produced in order to support the educational process. At the moment it is not possible to evaluate the medium- and long-time results of the process (e.g. the efficacy of educational interventions or the health outcomes related to the reduction of abortion among migrant women). Nevertheless all the actors involved have made positive evaluations on the usefulness of the process.

Electroencephalogram of asymptomatic adult subjects.

OBJECTIVES: The objective of this study is to investigate the incidence of epileptiform activity, focal or generalized slowing, patterns of uncertain significance and the effects of hyperventilation, photic stimulation and sleep on the electroencephalogram of asymptomatic adult subjects. METHODS: The studied group consisted of 100 male subjects with a mean age of 34 years (range 18-45 years). Each subject was screened closely for personal or family history of seizures, HIV, head trauma and drug abuse. Half of the subjects had a magnetic resonance imaging scan (MRI). RESULTS: In no subject resting or activated EEG showed any epileptiform activity or excessive slowing (focal or generalized). One subject demonstrated an H-response, one disclosed an alpha asymmetry of more than 50% and one showed slow alpha variant. Fourteen and 6 positive burst (12%) and small sharp spikes (11%) were the two most common patterns of uncertain significance. CONCLUSION: In a carefully screened population of young and middle age adults, the incidence of epileptiform activity, photoparoxysmal response or excessive slowing is less than 1%.

Granzyme A activates an endoplasmic reticulum-associated caspase-independent nuclease to induce single-stranded DNA nicks.

The cytotoxic T lymphocyte protease granzyme A (GzmA) initiates a novel caspase-independent cell death pathway characterized by single-stranded DNA nicking. The previously identified GzmA substrate SET is in a multimeric 270-420-kDa endoplasmic reticulum-associated complex that also contains the tumor suppressor protein pp32. GzmA cleaved the nucleosome assembly protein SET after Lys(176) and disrupted its nucleosome assembly activity. The purified SET complex required only GzmA to reconstitute single-stranded DNA nicking in isolated nuclei. DNA nicking occurred independently of caspase activation. The SET complex contains a 25-kDa Mg(2+)-dependent nuclease that degrades calf thymus DNA and plasmid DNA. Thus, GzmA activates a DNase (GzmA-activated DNase) within the SET complex to produce a novel form of DNA damage during cytotoxic T lymphocyte-mediated death.