Case-Based Specialty Training for Medical Students to Elicit Social Determinants of Health.

Introduction: Without explicit education and training on how social determinants of health (SDoH) impact patient care and health outcomes, medical schools are failing to effectively equip future physicians to serve their patients. We created this workshop on health equity with a focus on SDoH to help students more effectively communicate with diverse populations. Methods: Third-year medical students and faculty were provided with class guides, learning objectives, role-play vignettes containing clerkship-specific history and physical exams, schedules, and discussion questions during a 2-hour session centered on SDoH. The workshop's impact was measured through mixed-methods analysis of surveys. Results: Based on pre- and postsurvey results from 87 participants, medical students strongly agreed that (1) SDoH factor more into a patient's health outcomes than the clinical encounter (pre: 67%, post: 87%), (2) it is their duty to gather information about SDoH (pre: 86%, post: 97%), (3) neighborhood safety is one of the key SDoH (pre: 88%, post: 97%), (4) they understood the impact of upstream interventions (pre: 35%, post: 93%), (5) they could efficiently screen all patients for SDoH at every medical encounter (pre: 27%, post: 86%), and (6) they could find preliminary resources to quickly assist patients in need of help regarding particular SDoH (pre: 26%, post: 85%). Discussion: This was the first iteration of this workshop; challenges involved piloting the content, time restraints, and organizational structure of the workshop design. Future directions include making SDoH curricula an integral part of undergraduate medical education and diverse clinical environments.

La pandemia COVID-19 y la administración de la salud: el caso de la región Puno / The COVID-19 pandemic and health administration: the case of the Puno Regione / A pandemia de COVID-19 e a administração da saúde: o caso da região de Puno

El objetivo de la investigación fue analizar el impacto de la pandemia del COVID-19 en la administración de los servicios de salud y en la atención al paciente, caso de la región Puno, reflejados en los indicadores del sistema de gestión de calidad en cuanto al manejo de recursos desde los distintos puntos o pilares elementales dentro de la administración de salud. Materiales y métodos. se amparó bajo una investigación documental observacional con diseño de análisis descriptivo. La muestra proviene de un análisis que se llevó a cabo en 31 indicadores de actividad (IA) pertenecientes a 7 áreas del Servicio. En su mayoría, estos indicadores experimentaron un aumento tanto en marzo (20%) como en abril (25%). Conclusiones: indican que se observó un incremento en los ensayos clínicos relacionados con el tratamiento del SAR-Cov-2, los cuales abarcaron las unidades de cuidados intensivos (UCI) y las salas de urgencias (SU). Esto incluyó la dispensación de dosis individuales y el inicio y preparación de las salas de urgencias.

The objective of the research was to analyze the impact of the COVID-19 pandemic on the administration of health services and patient care, in the case of the Puno region, as reflected in the indicators of the quality management system in terms of resource management from the different points or elemental pillars within the health administration. Materials and methods. was based on an observational documentary research with a descriptive analysis design. The sample comes from an analysis carried out on 31 activity indicators (AI) belonging to 7 areas of the Service. Most of these indicators experienced an increase in both March (20%) and April (25%). Conclusions indicate that an increase was observed in clinical trials related to SAR-Cov-2 treatment, which spanned intensive care units (ICU) and emergency rooms (ED). This included single-dose dispensing and ED initiation and preparation.

O objetivo da investigação foi analisar o impacto da pandemia da COVID-19 na administração dos serviços de saúde e na assistência aos doentes na região de Puno, tal como se reflecte nos indicadores do sistema de gestão da qualidade em termos de gestão de recursos a partir dos diferentes pontos ou pilares básicos da administração da saúde. Materiais e métodos. baseou-se numa investigação documental observacional com um desenho de análise descritiva. A amostra provém de uma análise efectuada sobre 31 indicadores de atividade (IA) pertencentes a 7 áreas do Serviço. A maioria destes indicadores registou um aumento tanto em março (20%) como em abril (25%). Conclusões. indicam que houve um aumento dos ensaios clínicos relacionados com o tratamento do SAR-Cov-2, que abrangeu as unidades de cuidados intensivos (UCI) e os serviços de urgência (SU). Isto incluiu a distribuição de doses únicas e a iniciação e preparação de EDs.

Melanoma: Does It Present Differently in Darker Skin Tones?

Introduction: There are vast differences in clinical presentations of melanoma across skin tones. Individuals with darker skin tones tend to have a higher prevalence of advanced-stage melanoma, which correlates with increased mortality. We designed this interactive workshop to increase nursing and medical trainees' awareness of the epidemiology, prevention, and treatment of melanoma in individuals of darker skin tones. Methods: The Kern model was used in the design, implementation, and evaluation of the workshop. The 75-minute workshop consisted of a PowerPoint presentation, video-based reflection activities, and case studies. Evaluation consisted of pre- and postworkshop questionnaires. The workshop was implemented two times among 63 nursing students, 11 medical students/residents, and six medical faculty. Results: Seventy-one participants completed the pre- and postworkshop evaluations. A comparison of pre- and postworkshop responses utilizing the Wilcoxon matched-pair signed rank test showed a statistically significant increase in learners' confidence to address each learning objective. Discussion: Through this interactive educational presentation, medical and nursing trainees can gain heightened awareness of melanoma across various skin tones, especially unique presentations in darker skin tones.

Targeting PELP1 oncogenic signaling in TNBC with the small molecule inhibitor SMIP34.

PURPOSE: Triple-negative breast cancer (TNBC) is the most aggressive subtype of breast cancer. Oncogenic PELP1 is frequently overexpressed in TNBC, and it has been demonstrated that PELP1 signaling is essential for TNBC progression. The therapeutic utility of targeting PELP1 in TNBC, however, remains unknown. In this study, we investigated the effectiveness of SMIP34, a recently developed PELP1 inhibitor for the treatment of TNBC. METHODS: To ascertain the impact of SMIP34 treatment, we used seven different TNBC models for testing cell viability, colony formation, invasion, apoptosis, and cell cycle analysis. Western blotting and RT-qPCR were used to determine the mechanistic insights of SMIP34 action. Using xenograft and PDX tumors, the ability of SMIP34 in suppressing proliferation was examined both ex vivo and in vivo. RESULTS: TNBC cells' viability, colony formation, and invasiveness were all decreased by SMIP34 in in vitro cell-based assays, while apoptosis was increased. SMIP34 treatment promoted the degradation of PELP1 through the proteasome pathway. RT-qPCR analyses confirmed that SMIP34 treatment downregulated PELP1 target genes. Further, SMIP34 treatment substantially downregulated PELP1 mediated extranuclear signaling including ERK, mTOR, S6 and 4EBP1. Mechanistic studies confirmed downregulation of PELP1 mediated ribosomal biogenesis functions including downregulation of cMyc and Rix complex proteins LAS1L, TEX-10, and SENP3. The proliferation of TNBC tumor tissues was decreased in explant experiments by SMIP34. Additionally, SMIP34 treatment markedly decreased tumor progression in both TNBC xenograft and PDX models. CONCLUSIONS: Together, these findings from in vitro, ex vivo, and in vivo models show that SMIP34 may be a useful therapeutic agent for inhibiting PELP1 signaling in TNBC.

Primary adrenal insufficiency masking as an adrenal B-cell lymphoma.

We report here a woman in her 70s presenting with adrenal insufficiency secondary to a primary adrenal lymphoma. The patient had a previous history of aphthous ulcers on dexamethasone and was referred to endocrinology with symptoms of fatigue and orthostasis. Subsequent Cosyntropin stimulation showed primary adrenal insufficiency and adrenal CT demonstrated large infiltrative masses. Adrenal biopsy confirmed the diagnosis of primary adrenal lymphoma of the B-cell type. This case demonstrates the importance of including lymphoma in the differential diagnosis of adrenal insufficiency, particularly in the elderly population and in the setting of negative 21-hydroxlyase antibody results.

A First-in-Class Inhibitor of ER Coregulator PELP1 Targets ER+ Breast Cancer.

Most patients with estrogen receptor alpha-positive (ER+) breast cancers initially respond to treatment but eventually develop therapy resistance with disease progression. Overexpression of oncogenic ER coregulators, including proline, glutamic acid, and leucine-rich protein 1 (PELP1), are implicated in breast cancer progression. The lack of small molecules that inhibits PELP1 represents a major knowledge gap. Here, using a yeast-two-hybrid screen, we identified novel peptide inhibitors of PELP1 (PIP). Biochemical assays demonstrated that one of these peptides, PIP1, directly interacted with PELP1 to block PELP1 oncogenic functions. Computational modeling of PIP1 revealed key residues contributing to its activity and facilitated the development of a small-molecule inhibitor of PELP1, SMIP34, and further analyses confirmed that SMIP34 directly bound to PELP1. In breast cancer cells, SMIP34 reduced cell growth in a dose-dependent manner. SMIP34 inhibited proliferation of not only wild-type (WT) but also mutant (MT) ER+ and therapy-resistant breast cancer cells, in part by inducing PELP1 degradation via the proteasome pathway. RNA sequencing analyses showed that SMIP34 treatment altered the expression of genes associated with estrogen response, cell cycle, and apoptosis pathways. In cell line-derived and patient-derived xenografts of both WT and MT ER+ breast cancer models, SMIP34 reduced proliferation and significantly suppressed tumor progression. Collectively, these results demonstrate SMIP34 as a first-in-class inhibitor of oncogenic PELP1 signaling in advanced breast cancer. SIGNIFICANCE: Development of a novel inhibitor of oncogenic PELP1 provides potential therapeutic avenues for treating therapy-resistant, advanced ER+ breast cancer.

Perfil microbiologico y de resistencia antimicrobiana en infecciones adquiridas en la comunidad. Hospital Universitario San José de Popayán / Microbiological profile and resistance spectrum of the community acquired bacterial infection of the San Jose Universitary Hospital in Popayan

Resumen Objetivo. Describir el perfil microbiológico y de resistencia bacteriana de los aislamientos en adultos con infecciones adquiridas en comunidad en el Hospital Universitario San José de junio 2016 a diciembre 2019. Metodología. Se realizó un estudio descriptivo de corte transversal, análisis retrospectivo de los aislamientos microbiológicos en adultos desde junio 2016 a diciembre 2019, basado en la data institucional. Se analizó la información con STATA15,0. Se obtuvo la aprobación del comité de ética del hospital. Resultados. Se incluyeron 5121 aislamientos microbiológicos, el 61% en el servicio de urgencias. El urocultivo fue la muestra más frecuente. Escherichia coli fue el germen más común tanto a nivel general como en urocultivos, hemocultivos y cultivos de líquido peritoneal. La resistencia a ampicilina y amp/sul fue elevada, hasta del 68% para E. coli. El 20% de los Staphylococcus aureus fueron resistentes a meticilina. Se observó una resistencia inusual a carbapenémicos por parte de Pseudomonas aeruginosa. Discusión. El perfil microbiológico concuerda con la literatura mundial y nacional, sin embargo, el HUSJ tiene un comportamiento microbiológico que debe ser estudiado a profundidad. Conclusión. Los porcentajes de resistencia a antibióticos de uso frecuente son elevados. Se requiere ajustes de las guías de manejo institucionales y nacionales.

Abstract Objetive. To describe the microbiological profile and resistance spectrum of the community acquired bacterial infection of the San Jose university hospital from june 2016 to december 2019 Methodology. A retrospective transverse descriptive study of microbial organisms found in adults in the institution from June 2016 to December 2019, the study is based in the hospital data. The analysis of the information was made with SATA 15.0. Results. 5121 samples were included, 61% from the emergency department. Urine culture was the most frequent sample taken. Escherichia coli was the most frequent isolated bacterial, in all samples, urine culture, blood culture, and peritoneal culture. Ampiciline r and ampiciline/sulbactam was high up to 68% of the E. Coli cultures. 20% of Staphylococcus aureus were methicillin resistant. Unusual carbapenemic resistance was found in the Pseudomona aeruginosa isolates.. Discussion. The data of the bacterial resistance spectrum Concord which was is found in the general medical literature, nevertheless the HUSJ, has a microbial behaviour that must be studied thoroughly. Conclusion. The antibiotic bacterial resistance to common used antibiotics is high. Adjustments are required in the instucional and national management guidelines

Chloroquine Sensitizes GNAQ/11-mutated Melanoma to MEK1/2 Inhibition.

PURPOSE: Mutational activation of GNAQ or GNA11 (GNAQ/11), detected in >90% of uveal melanomas, leads to constitutive activation of oncogenic pathways, including MAPK and YAP. To date, chemo- or pathway-targeted therapies, either alone or in combination, have proven ineffective in the treatment of patients with metastatic uveal melanoma. EXPERIMENTAL DESIGN: We tested the efficacy of chloroquine or hydroxychloroquine, in combination with MAPK pathway inhibition in GNAQ/11-mutated cells in vitro and in vivo and identified mechanisms of MEK1/2 inhibitor plus chloroquine-induced cytotoxicity. RESULTS: Inhibition of GNAQ/11-mediated activation of MAPK signaling resulted in the induction of autophagy. Combined inhibition of Gα and autophagy or lysosome function resulted in enhanced cell death. Moreover, the combination of MEK1/2 inhibition, using trametinib, with the lysosome inhibitor, chloroquine, also increased cytotoxicity. Treatment of mice bearing GNAQ/11-driven melanomas with trametinib plus hydroxychloroquine resulted in inhibition of tumor growth and significantly prolonged survival. Interestingly, lysosomal- and autophagy-specific inhibition with bafilomycin A1 was not sufficient to promote cytotoxicity in combination with trametinib. However, the addition of YAP inhibition with trametinib plus bafilomycin A1 resulted in cell death at comparable levels to trametinib plus chloroquine (T/CQ) treatment. Furthermore, T/CQ-treated cells displayed decreased YAP nuclear localization and decreased YAP transcriptional activity. Expression of a constitutively active YAP5SA mutant conferred resistance to T/CQ-induced cell death. CONCLUSIONS: These results suggest that YAP, MEK1/2, and lysosome function are necessary and critical targets for the therapy of GNAQ/11-driven melanoma, and identify trametinib plus hydroxychloroquine as a potential treatment strategy for metastatic uveal melanoma.

Association between high blood pressure and fitness and fatness in adolescents / Presión arterial alta asociada con condición física y adiposidad en adolescentes

Abstract Introduction: Excess adiposity is considered the most important risk factor for high blood pressure (HBP) in children and adolescents. Objectives: To explore the association between HBP and overweight (OW) and abdominal obesity (AO), mediated by cardiorespiratory fitness (CRF). To analyze the combined effect of excess adiposity and CRF on HBP among a sample of school-aged children from Montería, Colombia. Materials and methods: Cross-sectional study conducted in a sample of 546 adolescents aged between 11 and 18 years from 14 randomly selected schools in Montería. Blood pressure, anthropometric, and fitness measures were evaluated by trained personnel using standardized protocols and instrumentation. The association of HBP with fitness and fatness was analyzed using logistic regression models. Results: HBP was associated with OW, AO and low CRF. The inclusion of CRF in this model did not attenuate the association between HBP and OW and between HPB and AO. Adolescents with higher adiposity and low CRF were more likely to have HBP compared with those with lower adiposity and high CRF. Moreover, it was found that excess adiposity and low CRF had an additive effect on the risk for HBP among the sample. Conclusion: HBP is a prevalent condition in children and adolescents from Montería, Colombia. HBP is significantly associated with OW, AO, and low CRF; therefore, it is necessary to implement initiatives to promote healthy habits aimed at this population in order to reduce the incidence rate of HBP in Colombian adolescents.

Resumen Introducción. El exceso de adiposidad es considerado como el factor de riesgo más importante para la presión arterial alta (PAA) en niños y adolescentes. Objetivos. Explorar la asociación entre PAA y sobrepeso (SP) y obesidad abdominal (OA), mediada por condición física cardiorrespiratoria (CFC), y analizar el efecto combinado de la adiposidad excesiva y la CFC en la PAA en una muestra de escolares de Montería, Colombia. Materiales y métodos. Estudio transversal realizado en 546 adolescentes con edades entre 11 y 18 años de 14 escuelas seleccionadas aleatoriamente en Montería. Se evaluó la presión arterial, los indicadores antropométricos y la condición física; las mediciones fueron realizadas por personal capacitado mediante el uso de protocolos e instrumentos estandarizados. La asociación de PAA con condición física y adiposidad fue analizada a través de modelos de regresión logística. Resultados. Se encontró una asociación entre PAA y SP, OA y baja CFC. La inclusion de la CFC en el modelo no atenuó la asociación entre PAA y SP y entre PAA y OA. Los adolescentes con mayor adiposidad y baja CFC fueron más propensos a presentar PAA que aquellos con menor adiposidad y alta CFC. Además, se observó que la presencia de adiposidad excesiva y baja CFC aumenta el riesgo de desarrollar PAA. Conclusión. La PAA es una condición prevalente en niños y adolescentes de Montería, además se encontró una asociación estádisticamente significativa entre PAA y SP, OA, y baja CFC, por lo que es necesario que en el país se implementen estrategias que promuevan hábitos saludables en escolares y permitan reducir la tasa de incidencia de PAA en esta población.

Differential transcriptional profiles identify microglial- and macrophage-specific gene markers expressed during virus-induced neuroinflammation.

BACKGROUND: In the healthy central nervous system (CNS), microglia are found in a homeostatic state and peripheral macrophages are absent from the brain. Microglia play key roles in maintaining CNS homeostasis and acting as first responders to infection and inflammation, and peripheral macrophages infiltrate the CNS during neuroinflammation. Due to their distinct origins and functions, discrimination between these cell populations is essential to the comprehension of neuroinflammatory disorders. Studies comparing the gene profiles of microglia and peripheral macrophages, or macrophages in vitro-derived from bone marrow, under non-infectious conditions of the CNS, have revealed valuable microglial-specific genes. However, studies comparing gene profiles between CNS-infiltrating macrophages and microglia, when both are isolated from the CNS during viral-induced neuroinflammation, are lacking. METHODS: We isolated, via flow cytometry, microglia and infiltrating macrophages from the brains of Theiler's murine encephalomyelitis virus-infected C57BL/6 J mice and used RNA-Seq, followed by validation with qPCR, to examine the differential transcriptional profiles of these cells. We utilized primary literature defining subcellular localization to determine whether or not particular proteins extracted from the transcriptional profiles were expressed at the cell surface. The surface expression and cellular specificity of triggering receptor expressed on myeloid cells 1 (TREM-1) protein were examined via flow cytometry. We also examined the immune response gene profile within the transcriptional profiles of these isolated microglia and infiltrating macrophages. RESULTS: We have identified and validated new microglial- and macrophage-specific genes, encoding cell surface proteins, expressed at the peak of neuroinflammation. TREM-1 protein was confirmed to be expressed by infiltrating macrophages, not microglia, at the peak of neuroinflammation. We also identified both unique and redundant immune functions, through examination of the immune response gene profiles, of microglia and infiltrating macrophages during neurotropic viral infection. CONCLUSIONS: The differential expression of cell surface-specific genes during neuroinflammation can potentially be used to discriminate between microglia and macrophages as well as provide a resource that can be further utilized to target and manipulate specific cell responses during neuroinflammation.

Indicación de cssárea en el instituto materno ifantil (imi) bogotá - Colombia.. serie de casos / Indication of caesarea in the Instituto Materno Infantil (IMI) Colombia - Bogotá. Case series

Antecedentes. La cesárea es una intervención quirúrgica que tiene sus indicaciones y que como cualquier otra cirugía tiene riesgos, máxime cuando están involucrados la madre y su fruto. Esta serie de casos describe las principales indicaciones de cesárea en el Instituto Materno Infantil de Bogotá durante los meses de enero a abril de 2011; hasta el momento no se habían documentado estas indicaciones en este centro hospitalario obstétrico y perinatal. Se realiza una revisión de la literatura con el fin de comparar estos datos. Objetivo. Describir los diagnósticos asociados a la cesárea en el Instituto Materno Infantil de Bogotá Colombia. Materiales y métodos. Diseño del estudio, serie de casos. Población: pacientes sometidas a cesárea durante los meses de enero a abril de 2011, pertenecientes al régimen subsidiado de atención en salud, atendidas en un centro de referencia distrital de tercer nivel materno y perinatal. Se revisaron la base de datos Embase y las librerías electrónicas PubMed y Medline con las palabras clave cesarean delivery, cesarean section, idioma inglés, limitada a los últimos 12 años. Muestreo secuencial consecutivo del libro de registros de procedimientos quirúrgicos del Instituto Materno Infantil de Bogotá. Se tomaron como variables a medir los diagnósticos asociados a las cesáreas, no hubo criterios de exclusión. Análisis estadístico descriptivo. Resultados. El diagnóstico de cesárea anterior correspondió al 26,4% de las cesáreas realizadas en el IMI; siguieron en orden de frecuencia: estado fetal insatisfactorio 15,5%, trastornos hipertensivos del embarazo 15,5%, detención secundaria de la dilatación y el descenso 5,5%, ruptura prematura de membranas 4,7%. Conclusión. La cesárea anterior constituyó la indicación de cesárea más frecuente en esta institución. Los trastornos hipertensivos del embarazo y la ruptura prematura de membranas se encontraron dentro de los diagnósticos más frecuentes que llevaron a la cesárea en el IMI, diagnósticos que no se reportan en los registros internacionales.

Background. Caesarean section is a surgical procedure that has its indications and any other surgery is not without risk, especially when involving the mother and its fruit. This case series describes the main indications for cesarean section in the Instituto Materno Infantil in Bogotá during the months of January to April of 2011, so far no such indications were documented in this hospital obstetric and perinatal. A review of the literature in order to compare these data. Objective. To describe the diagnosis associated with cesarean section in the Instituto Materno Infantil (IMI) in Bogotá Colombia. Materials and methods. Study design, case series. Population, patients undergoing cesarean section during the months of January to April of 2011, belonging to the subsidized health care and who atended a district referral center tertiary maternal and perinatal. We reviewed the database Enbase and PubMed and Medline electronic libraries with keywords cesarean delivery, cesarean section, in English, limited to the last 12 years. Sequential sampling logbook consecutive of surgical procedures of the Instituto Materno Infantil in Bogotá. Were taken as variables to measure the diagnoses associated with Csections, there were no exclusion criteria. Descriptive statistics analysis. Results. The diagnosis of previous cesarean corresponded to 26,4% of cesareans in IMI, followed in order of frequency: 15,5% unsatisfactory fetal status, hypertensive disorders of pregnancy 15,5%, secondary detention of dilatation and decline 5,5%, premature rupture of membranes 4,7%. Conclusion. Previous caesarean section was the most frequent indication for cesarean section in this institution. Hypertensive disorders of pregnancy and premature rupture of membranes were found within the most common diagnoses leading to caesarean section in IMI, diagnoses leading to caesarean section in IMI, diagnoses that are not reported in the international registers.

All-cause 1-, 5-, and 10-year mortality in elderly people according to activities of daily living stage.

OBJECTIVES: To examine the independent association between five stages of activities of daily living (ADLs) and mortality after accounting for known diagnostic and sociodemographic risk factors. DESIGN: For five stages of ADLs (0 to IV), determined according to the severity and pattern of ADL limitations, unadjusted life expectancies and adjusted associations with mortality were estimated using a Cox proportional hazards regression model. SETTING: Community. PARTICIPANTS: Nine thousand four hundred forty-seven participants aged 70 and older from the second Longitudinal Study of Aging. MEASUREMENTS: One-, 5-, and 10-year survival and time to death. RESULTS: Median life expectancy was 10.6 years for participants with no ADL limitations and 6.5, 5.1, 3.8, and 1.6 years for those at ADL stages I, II, III, and IV, respectively. The sociodemographic- and diagnostic-adjusted hazard of death at 1 year was five times as great at stage IV as at stage 0 (hazard ratio = 5.6, 95% confidence interval = 3.8-8.3). The associations between ADL stage and mortality declined over time but remained statistically significant at 5 and 10 years. CONCLUSION: ADL stage continued to explain mortality risk after adjusting for known risk factors including advanced age, stroke, and cancer. ADL stages might aid clinical care planning and policy as a powerful prognostic indicator particularly of short-term mortality, improving on current ADL measures by profiling activity limitations of relevance to determining community support needs.

Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City.

OBJECTIVES: We investigated health care utilization, barriers to care, and hormone use among male-to-female transgender persons residing in New York City to determine whether current care is in accord with the World Professional Association for Transgender Health and the goals of Healthy People 2010. METHODS: We conducted interviews with 101 male-to-female transgender persons from 3 community health centers in 2007. RESULTS: Most participants reported having health insurance (77%; n = 78) and seeing a general practitioner in the past year (81%; n = 82). Over 25% of participants perceived the cost of medical care, access to specialists, and a paucity of transgender-friendly and transgender-knowledgeable providers as barriers to care. Being under a physician's care was associated with high-risk behavior reduction, including smoking cessation (P = .004) and obtaining needles from a licensed physician (P = .002). Male-to-female transgender persons under a physician's care were more likely to obtain hormone therapies from a licensed physician (P < .001). CONCLUSIONS: Utilization of health care providers by male-to-female transgender persons is associated with their reduction of some high-risk behaviors, but it does not result in adherence to standard of care recommendations for transgender individuals.

Factors associated with emergency department utilization by urban lesbian, gay, and bisexual individuals.

There are no published studies to date on emergency department (ED) utilization by the lesbian, gay, and bisexual (LGB) community despite documented lack of access to health care for this community. This study explored the frequency of ED visits and sociodemographic and health-related factors associated with ED utilization among a convenience sample of LGB individuals. A sample of 360 LGB individuals was interviewed to assess socio-demographics, sexual practices, mental health, drug use, chronic disease history, and frequency of emergency department use. Emergency department utilization was categorized as 0, 1, or > or =2 visits. Bivariate statistics were applied to assess the association of various factors with emergency department utilization. Patient characteristics were as follows: age, 29.0; male, 53.1 percent; Hispanic, 57.8 percent; Black, 37.2 percent; and reported less than a college degree, 79.4 percent. Most (77.7 percent) had a primary care doctor and (86.3 percent) were comfortable discussing LGB-related health issues with their provider. Over 12 months, 25.3 percent had 1 ED visit and 16.4 percent had > or =2 ED visits. One or more emergency department visits was significantly associated with lower age, lower education, lower income, recent psychological distress, recent mental health counseling or medications, desired mental health treatment, abuse by partner, cigarette use, marijuana use, and asthma (p < 0.05). Despite reported access to primary care, our LGB sample exhibited a higher proportion of single and > or =2 ED visits than comparable populations. Mental health and cigarette use were associated with emergency department utilization and deserve further exploration for reducing emergency department visitation by and improving emergency department care for LGB individuals.

Cigarette smoking and lesbian and bisexual women in the Bronx.

This study investigated the prevalence of cigarette smoking, smoking patterns, and smoking cessation efforts of Black and Hispanic lesbian and bisexual women from a poor, urban community. One-on-one interviews were conducted with a convenience sample of 130 self-identified Black and Hispanic lesbian and bisexual women from the Bronx, NY. Bivariate statistics were used to determine differences between Black and Hispanic respondents in smoking prevalence, frequency, desire to quit, and impact on family unit. Fifty-five percent of Black respondents and sixty-two percent of Hispanic respondents were current smokers. Hispanics were more likely than Blacks to have a partner (p < 0.04), 2 or more children (p < 0.05), and an asthmatic in their household (p < 0.02). Hispanics were less likely than Blacks to have ever attempted to quit (p < 0.04) and to have made a serious attempt to quit in the past year (p < 0.02). Culturally sensitive interventions are needed to help Hispanic lesbian and bisexual women move from the pre-contemplative to action stage of quitting. The large proportion of current smokers requires greater access to effective smoking cessation tools.

Cloning and characterization of hCTF18, hCTF8, and hDCC1. Human homologs of a Saccharomyces cerevisiae complex involved in sister chromatid cohesion establishment.

A growing body of evidence suggests that establishment of sister chromatid cohesion is dependent on replication fork passage over a precohesion area. In Saccharomyces cerevisiae, this process involves an alternative replication factor C (RFC) complex that contains the four small RFC subunits as well as CTF18, CTF8, and DCC1. Here, we show that an evolutionarily conserved homologous complex exists in the nucleus of human cells. We demonstrate that hCTF18, hCTF8, and hDCC1 interact with each other as well as with the p38 subunit of RFC. This alternative RFC-containing complex interacts with proliferating cell nuclear antigen but not with the Rad9/Rad1/Hus1 complex, a proliferating cell nuclear antigen-like clamp involved in the DNA damage response. hCTF18 preferentially binds chromatin during S phase, suggesting a role during replication. Our data provide evidence for the existence of an alternative RFC complex with a probable role in mammalian sister chromatid cohesion establishment.

Estudio de la transición aerobico-anaerobica a 2600M de altura, mediante la determinación del "OBLA", en fútbolistas colombianos de diferentes categorías y su correlación con variables fisiológicas y antropométricas / Aerobic capacity in soccer players

El fútbol es uno de los deportes más populares en latinoamérica. Muchos estudios se han ocupado de evaluar la importancia de la capacidad aeróbica en este deporte escencialmente táctico y técnico, que se desarrolla en condiciones intermitentes que hacen difícil su valoración. Se estudiaron 21 jugadores juveniles y 8 jugadores de élite en Colombia, en una primera fase, para evaluar la transición aeróbica anaeróbica por medio de la determinación del lactato plasmático (OBLA) y su correlación con las características antropométricas. Se encontró una diferencia de talla y peso entre las categorías (p=0.01, p=0.003 respectivamente). La media para el OBLA a 4mM.L -1 en los juveniles fue 168.7 +_ 14.4 ppm y de 161.3 +_ para los profesionals (p=0.05) , que corresponde a una velocidad de 3.3 +_ 0.5 m.s -1 y 3.7 +_ 0.3 m.s -12 respectivamente. Tanto los juveniles como los profesionales mostraron más de un 90 por ciento de la FC máxima en la transición aeróbica (OBLA). El comportamiento de la FC con el incremento de la carga mostró una diferencia significativa entre las categorías en todos los estadíos del protocolo de Kindermann (p<0.02). No hubo correlación entre la FC en umbral y la intensidad de 70 y 80 por ciento por el método de Astrand para control del entrenamiento (r=0.32). Este estudio preliminar presenta los primeros datos de las características fisiológicas de los futbolistas Colombianos y demuestra una ligera inferioridad morfo-funcional en relación con los estandares internacionales