Patient perspectives on routinely being asked about their race and ethnicity: Qualitative study in primary care.

OBJECTIVE: To understand patients' perspectives on responding to a question about their race and ethnicity in a primary care setting. DESIGN: Qualitative study using semistructured individual interviews conducted between May and July 2016. SETTING: An academic family health team in Toronto, Ont, where collection of sociodemographic data has been routine since 2013. PARTICIPANTS: Twenty-seven patients from 5 of the 6 clinic sites of the family health team, ranging in age, sex, educational background, and immigration status. METHODS: Semistructured interviews were conducted with patients who completed a sociodemographic questionnaire after registration for their medical appointment. Patients were asked whether responding to the question was difficult or uncomfortable, how they interpreted the term race and ethnicity, and what response options they considered. Interviews were audiorecorded, transcribed, and coded iteratively. MAIN FINDINGS: Patients did not report discomfort with responding to a question about race and ethnicity in their family doctor's office. Although many patients considered the question straightforward, some patients reported different interpretations of the question. For example, some thought the question about race and ethnicity related to parental origin or ancestry, whereas others considered the question to be about personal place of birth or upbringing. Many patients appreciated being able to select from a variety of specific response options, but this also posed a difficulty for patients who could not easily find an option that reflected their identity. Patients with mixed heritage experienced the most challenges selecting a response. CONCLUSION: Patients attending a primary care clinic were not uncomfortable responding to a question about race and ethnicity. However, patients had different interpretations of what was being asked. Future research should explore perspectives of patients in other primary care settings and test different methods for collecting data about their race and ethnicity.

Ser422 phosphorylation blocks human Tau cleavage by caspase-3: Biochemical implications to Alzheimer's Disease.

Proteolytic truncation of microtubule associated human (h) Tau protein by caspase-3 at the carboxy (C) terminus has been linked to the pathogenesis of Alzheimer's Disease (AD). This cleavage likely occurs between Asp421↓Ser422 leading to the formation of 421-mer truncated Tau protein which has been found to be present as aggregate in high level after phosphorylation in mortal AD brain tissue compared to normal. At least 50 phosphorylation sites involving Ser, Thr and Tyr residues have been identified or proposed in hTau and a selected number of them have been implicated in hTau aggregation following latter's proteolytic truncation. Interestingly, it is further noted that Ser422 residue present in the P1' position of hTau caspase-3 cleavage region is a potential phosphorylation site. So we became interested to examine in vitro the effect of phospho-Ser422 residue on hTau cleavage by caspase-3 which is a crucial upstream event associated with hTau self-assembly leading to AD pathogenesis. The goal of this project is to study in vitro the caspase-3 cleavage site of hTau protein and to examine the kinetics of this cleavage following Ser422 phosphorylation and treatment with caspase-3 inhibitors. This is achieved by designing peptides from the sequence of hTau protein containing the proposed caspase-3 cleavage region. Peptides were designed from 441-mer major human Tau protein sequence that encompasses the proposed caspase-3 cleavage site [Asp421↓Ser422]. Corresponding phospho-, dextro-Ser422 and dextro-Asp421 analogs were also designed. Peptides were synthesized by solid phase chemistry, purified and fully characterized by mass spectrometry. These were then incubated with recombinant caspase-3 enzyme under identical condition for digestion and analyzed for cleavage by mass spectrometry and RP-HPLC chromatograms. Our results indicated that while the control peptide is efficiently cleaved by caspase-3 at Asp421↓Ser422 site producing the expected N- and C-terminal fragment peptides, the corresponding phospho-Ser422 peptide remained completely resistant to the cleavage. Substitution of Asp421 by its dextro isoform also blocks peptide cleavage by caspase-3. However substitution of Ser422 by its dextro isoform in the peptide did not affect the cleavage significantly. The above results were further confirmed by caspase-3 digestion experiment in the presence of varying amounts of caspase-3 inhibitor (Ac-DQVD-aldehyde) which was found to block this cleavage in a highly effective manner. Our results highlighted the crucial significance of Ser422 phosphorylation and suggest that the kinase associated with this Ser-phosphorylation may protect Tau from aggregation. Thus specific promoters/activators of this kinase may find useful therapeutic benefits in arresting Tau truncation by caspase-3 and the progression of AD. In addition our data demonstrated that Tau-peptides where Ser422 or Asp421 are substituted by their respective dextro isomers, exhibit different cleavage kinetics by caspase-3 and this may have important implications in therapeutic intervention of Tau aggregation and associated AD.

Advocacy in community-based service learning: perspectives of community partner organizations.

Background: Health advocacy is a core competency for physicians, which can be developed through community-based service-learning (CBSL). This exploratory study investigated the experiences of community partner organizations (CPOs) participating in CBSL in the context of health advocacy. Methods: A qualitative study was conducted. Nine CPOs at a medical school participated in interviews on topics pertaining to CBSL and health advocacy. Interviews were recorded, transcribed, and coded. Major themes were identified. Results: CPOs perceived a positive impact from CBSL through student activities and connecting with the medical community. There was no unifying definition of health advocacy. Advocacy activities varied depending on the individual's role (i.e., CPO, physician, and student), which encompassed providing patient care or services, raising awareness of healthcare issues, and influencing policy changes. CPOs had different perceptions of their role in CBSL from facilitating service-learning opportunities to teaching students in CBSL, while a few desired to be involved in curriculum development. Conclusion: This study provides further insight into health advocacy from the lens of CPOs, which may inform changes to health advocacy training and the CanMEDS Health Advocate Role to better align with the values of community organizations. Engaging CPOs in the broader medical education system may improve health advocacy training and ensure a positive bidirectional impact.

Contexte: La promotion de la santé est une compétence fondamentale pour les médecins, qui peux être développée dans le cadre de l'apprentissage par le service communautaire (ASC). Cette étude exploratoire examine les expériences des organismes communautaires partenaires (OCP) participant à l'ASC en ce qui concerne le volet promotion de la santé. Méthodes: Dans le cadre d'une étude qualitative, neuf OCP d'une faculté de médecine ont participé à des entretiens sur des sujets liés à l'ASC et à la promotion de la santé. Les entretiens ont été enregistrés, transcrits et codés, et les thèmes principaux en ont été extraits. Résultats: Les OCP ont perçu un effet positif de l'ASC, notamment par le biais des activités étudiantes et des liens établis avec la communauté médicale. Nous n'avons pas relevé de définition commune de la promotion de la santé. Les activités s'y rapportant varient selon le rôle de la personne (OCP, médecin ou étudiant) et comprennent la prestation de soins ou de services aux patients, la sensibilisation aux enjeux de santé et la promotion de changements d'orientations politiques. Les divers OCP avaient des perceptions différentes de leur rôle dans l'ASC, allant d'offrir des activités d'apprentissages aux étudiants en ASC, au désir de participer à l'élaboration des programmes d'études. Conclusion: Cette étude permet de mieux saisir le point de vue des OCP sur la promotion de la santé. Elle peut ainsi éclairer les révisions du rôle CanMEDS de promoteur de la santé et de la formation en la matière de façon à les aligner davantage sur les valeurs des organismes communautaires. L'intégration des OCP à la formation médicale au sens large pourrait contribuer à améliorer le volet promotion de la santé de cette dernière et profiter aux partenaires de part et d'autre.

Scaling of Early Social Cognitive Skills in Typically Developing Infants and Children with Autism Spectrum Disorder.

We delineate the sequence that typically developing infants pass tasks that assess different early social cognitive skills considered precursors to theory-of-mind abilities. We compared this normative sequence to performance on these tasks in a group of autistic (AUT) children. 86 infants were administered seven tasks assessing intention reading and shared intentionality (Study 1). Infants responses followed a consistent developmental sequence, forming a four-stage scale. These tasks were administered to 21 AUT children (Study 2), who passed tasks in the same sequence. However, performance on tasks that required following others' eye gaze and cooperating with others was delayed. Findings indicate that earlier-developing skills provide a foundation for later-developing skills, and difficulties in acquiring some early social cognitive skills in AUT children.