Staff and participant perceptions of optimal recruitment and retention strategies for biomedical cohort studies in the Caribbean.

PURPOSE: To identify staff and participants perspectives of best practices that facilitate achieving enrollment and retention targets in biomedical cohort studies in Caribbean populations. METHODS: Eight focus group discussions (FGDs) were held with research stakeholders including research (i) nurses/study supervisors, (ii) field staff/data collectors, and (iii) rural and urban participants of the Third Jamaica Health and Lifestyle Survey (a national NCD risk factor survey with biospecimen collection) to capture qualitative data on experiences with recruitment, training, retention challenges and potential solutions or strategies for strengthening future efforts. RESULTS: Our findings indicate that trained, experienced study staff with good interpersonal communication skills enhanced the proficiency of field operations and attracted study participants. Targeted community and stakeholder engagement alongside strong support from the coordinating center increased the reach and efficiency of the data collectors. Timely participant feedback, gender-appropriate approaches, and socioeconomic balance enhanced equitable enrollment and retention of participants of cohort studies particularly the hard to reach groups. CONCLUSION: Well-functioning research teams using traditional and social media promotion, applying gender-appropriate and personalized approaches together with strategies for reaching the less accessible socioeconomic groups, are effective for recruiting and retaining members of a Caribbean cohort. These strategies may also enhance the recruitment of other Black populations in the Diaspora including the US and Caribbean into biomedical studies including cancer research.

Burden of caregivers of adult patients with schizophrenia attending public health clinics in Jamaica

OBJECTIVE: To determine the extent and socio-demographic determinants of burden of care of caregivers of adult schizophrenic patients. DESIGN AND METHODS: Cross-sectional study of 115 dyads of schizophrenic patients-caregivers attending public mental health clinics, March 24 – April 4, 2014 were consecutively recruited. Burden of care was evaluated using the 22-item Zarit Burden Scale (maximum score, 88). Multiple linear regression model explored factors associated with caregiver burden. RESULTS. Caregivers were predominantly females (75.7%) and were on average 50.8 ñ 15.0 years. Most schizophrenic patients were males (65.2%) and were on average 43.6 ñ 17.2 years old. Caregivers showed on average, mild to moderate burden (score, 30.0 ñ 14.7; median, 28.0). There was a tendency for caregivers of patients who were parents or spouses to have higher levels of burden. In multivariable analyses, higher burden of caregiving was associated with inability to perform self-care, closer kinship and higher numbers of psychotic episodes in the previous year. CONCLUSIONS: Functional and social factors were important determinants of caregiver burden. Further investigations are needed which consider factors such as health status and health expenditures as predictor variables of caregiver burden.

El paradigma stop signal como medida de inhibición conductual / The Stop Signal Paradigm: a measure of behavioral inhibition

El Paradigma de la Señal de Parar, Stop Signal en inglés, es uno de los procedimientos más utilizados para medir el control inhibitorio. Su amplia difusión se explica por dos motivos: su extensa aplicación en el ámbito de la neuropsicología clínica y, porque aporta un índice -el tiempo de frenado- que no se obtiene con otros paradigmas o procedimientos. Esta medida, refiere al tiempo que necesita el individuo para inhibir una respuesta preponderante. El cálculo del índice deriva de un modelo clásico de inhibición, el "Modelo de Carrera de Caballos". Sin embargo, el modelo no ha sido suficientemente difundido en nuestro medio, debido a la complejidad de los análisis matemáticos de base y a que la bibliografía disponible en español en este tema es casi inexistente. Por ello, el objetivo de este trabajo es efectuar una revisión sobre este método y presentar algunas de sus aplicaciones en la neuropsicología clínica y de la psicopatología, tales como para el trabajo con pacientes con trastorno bsesivo compulsivo, adicciones, y trastorno de atención, entre otros. MÉD.UIS. 2014;27(3):89-98.

The Stop Signal Paradigm is one of the most used procedures for measuring the inhibitory control. Their widespread diffusion is due to two reasons: its extensive application in the field of clinical neuropsychology and because it provides an index-braking time-that is not accessible with other paradigms or procedures. This index is defined as the time required for inhibiting a dominant response. The method used to calculate this measure is based on a classical model of inhibition: the "Horse Race Model". However, their diffusion is limited in our environment because the available literature in Spanish is poor due to the complexity of mathematical analysis involved. Therefore, the aim of this work is to carry out a review of this method and present some of its applications in the field of clinical neuropsychology and psychopathology, such as working with patients with obsessive compulsive disorder, addictions, and attention disorder, among others. MÉD.UIS. 2014;27(3):89-98.

Función ejecutiva y uso de estrategias semánticas en niños / Executive function and use of semantic strategies in children

El objetivo de este trabajo es analizar el uso de estrategias semánticas en población infantil y el efecto del funcionamiento ejecutivo sobre la frecuencia de uso de estas estrategias. Se trabajó con una muestra de 185 niños escolarizados de escuelas de gestión privada divididos en 4 grupos en función del curso. Los niños realizaron 4 ensayos de aprendizaje analizándose la cantidad de estrategias utilizadas a lo largo de los ensayos así como las diferencias de ensayo a ensayo. Además, se utilizaron diferentes tareas e índices de evaluación de la función ejecutiva. En primer lugar, los resultados muestran que, en la medida que se incrementa el nivel de escolaridad, los niños tienden a implementar un número mayor de estrategias semánticas en tareas de aprendizaje y recuerdo. En segundo lugar, se realizó un análisis discriminado por curso de las curvas de aprendizaje de las estrategias semánticas. Se encontró que, cuando se controlan las variables de funcionamiento ejecutivo, sólo se obtiene un efecto significativo para el factor ensayos, y desaparece la significación estadística tanto en la adquisición y uso de estrategias entre los ensayos en los distintos cursos, como en las diferencias en el total de estrategias empleadas entre los cursos. De este modo, los resultados indican que el funcionamiento ejecutivo puede jugar un rol de importancia en el uso de estrategias de codificación de información en niños.

The aim of this study is to analyze the use of semantic strategies on child population as well as the effect of executive function on frequency use of these strategies. A sample of 185 schooled children in private schools divided in 4 groups according to the level participated in this study. Children performed 4 learning attempts, so the quantity of used strategies along assays as well as differences from assay to assay were analyzed. Moreover, different tasks and assessment indexes about executive function were used. First, results showed that as the school level increases children tend to apply a major number of semantic strategies in learning and memory tasks. Secondly, a discriminate analysis by course of the learning curves of semantic strategies was carried out. It was possible to find that when the executive function' variable is controlled, what is obtained is a significant effect for the assay factor, and the statistic significance disappears on both acquisition and used of strategies between assays in different courses, and on differences in all the strategies used between courses. As a matter of fact, results indicate that executive function can play a roll of importance in use of strategies of coding information in children.

Disponibilidad de recursos materiales en el hogar y adquisición de habilidades pre-lectoras / Availability of resources and the acquisiton of pre-reading skills in the family context / Disponibilidade de recursos materiais e aquisição de habilidades pré-leitoras em contexto familiar

El aprendizaje de la lectura implica un conjunto de factores que hacen posible su adquisición. Entre estos, se destacan el contexto alfabetizador familiar, entendido como el conjunto de los recursos del hogar que abarcan experiencias en las cuales el niño se encuentra en contacto con eventos que involucran la lectoescritura y la disponibilidad de materiales impresos; además de las habilidades y conocimientos prelectores definidos como precursores de la lectura formal, que tienen sus orígenes en las experiencias tempranas de la vida de un niño. El objetivo de este trabajo es explorar y describir las relaciones entre el contexto alfabetizador familiar y el rendimiento en habilidades prelectoras. Para ello se seleccionó una muestra de 88 niños de 5 años de edad, de ambos sexos, y a los cuidadores de los mismos niños a quienes se les administró una entrevista semiestructurada y precodificada denominada Evaluación del Contexto Alfabetizador y la versión en español del Get Ready to Read! Screening Tool de Whitehurst & Lonigan. Los resultados permitieron establecer una asociación estadísticamente significativa entre los índices disponibilidad de recursos materiales vinculados a la lectura en el hogar -especialmente el acceso a medios tecnológicos- y el rendimiento en habilidades prelectoras, demostrando la importancia que tienen para la alfabetización las características del medio ambiente en el que se desenvuelve el niño.(AU)

Learning to read involves a number of factors. Among these, we focus on the family context related to literacy. We understand this context as a set of resources, including experiences in which the child is in contact with the events surrounding the literacy and the availability of printed materials, as well as skills and knowledge of pre- reading, identified as precursors of formal reading. In this study we aim to explore and describe the relationships between family background and performance in pre-reading skills. We take, as sample, 88 children 5 years old, both sexes, and their parents. We interviewed the family to evaluate the family context and used the the Spanish version of “Get Ready to Read! Screening Tool” by Whitehurst & Lonigan. The results indicate a statistically significant association between rates of resource availability of reading materials at home - particularly access to technological means - and performance in pre-reading skills. This reveals the importance of the characteristics of environment in which the child grows to the development of literacy.(AU)

Aprender a ler envolve um conjunto de fatores. Entre estes, destaca-se a leiturabilidade no contexto da família, entendida como um conjunto de recursos domésticos que incluem experiências em que a criança está em contato com os acontecimentos envolvendo a alfabetização e disponibilidade de materiais; habilidades de pré-leitura e habilidades identificadas como precursoras da leitura formal. O objetivo deste trabalho foi explorar as relações entre os antecedentes familiares e o desempenho de alfabetização em habilidades pré-leitura. Participaram 88 crianças de 5 anos de idade e os seus cuidadores. A eles foram administradas uma entrevista de avaliação de contexto da família e a versão espanhola de Get Ready to Read! Screening Tool. Os resultados indicam uma associação com significância estatística entre as taxas de disponibilidade de recursos materiais de leitura em casa e realização de habilidades pré-leitoras, sugerindo a importância das características do lar para alfabetização.(AU)

Análisis de procesos de codificación y recuperación en pacientes conesclerosis múltiple (EM) / Analysis of codification and recovery processes in patients with Multiple Sclerosis (MS)

El objetivo principal de este trabajo fue el estudio exhaustivo de los procesos mnésicos en un grupo de pacientes con diagnóstico de esclerosis múltiple (EM). La teoría clásica sobre el tema considera que en esta patología se producen defectos en los procesos de recuperación de la memoria episódica. Estudios recientes aportan evidencia a favor de una hipótesis alternativa que atribuye el origen del trastorno mnésico a una alteración en los procesos de codificación y organización de la información. El tema es aún hoy objeto de discusión y debate. Por eso en este trabajo se estudió el funcionamiento de estos procesos de codificación y recuperación, para ello se utilizó un conjunto de diversos índices incluidos en el Test de Aprendizaje Verbal España Complutense (TAVEC). Se trabajó con un grupo de 36 pacientes con diagnóstico de EM y un grupo control de población normativa (n=36) emparejados por edad y nivel educacional. Los resultados obtenidos sugieren la existencia de alteraciones en los procesos de codificación y de recuperación mnésicos. Esto nos permite interpretar los defectos en los procesos de recuperación como una disfunción secundaria de la alteración en la codificación y organización de la información.

The primary target of this work was the exhaustive study of memory processes in a group of patients with diagnosis of Multiple Sclerosis (MS). The classic theory considers that in this pathology defects in the processes of recovery of the episodic memory take place. Recent studies contribute evidence in favor of an alternative hypothesis that it attributes the origin of the memory disorder to an alteration in the codification processes and organization of the information. The subject is still today in discussion. For that reason in this work we studied the operation of codification and recovery processes, for it was used the Test of Verbal Learning Spanish Complutense (TAVEC). One worked with a group of 36 patients with I diagnose of command post and a group control of healthy subjects matched up by age and educational level. The obtained results suggest the existence of alterations in the memory processes of codification and recovery. This allows us to interpret the defects in the processes of recovery like a secondary impairment of the alteration in the codification and organization of the information.

Clinical-neurologic, cytogenetic and molecular aspects of the Prader-Willi and Angelman syndromes.

The Prader-Willi syndrome (PWS) and the Angelman syndrome (AS) are human neurogenetic disorders involving the imprinting mechanism, at the 15q11-13 chromosome region. The predominant genetic defects in PW are 15q11-13 deletions of paternal origin and maternal chromosome 15 uniparental disomy. In contrast, maternal deletions and paternal chromosome 15 uniparental disomy are associated with a different neurogenetic disorder, the AS. In both disorders, these mutations are associated with parent-of-origin specific methylation at several 15q11-13 loci. We studied 5 patients suspect of PWS and 4 patients suspect of AS who were referred to the Medical Genetics Unit at the University Hospital of Medical School from Ribeirão Preto. Our objective was to establish the correct clinical and etiological diagnosis in these cases. We used conventional cytogenetics, methylation analysis with the probe KB17 (CpG island of the SNRPN gene) by Southern blotting after digestion with the Xba I and Not I restriction enzymes. We studied in patients and their parents the segregation of the (CA)*** repeats polymorphisms by PCR, using the primers 196 and IR4-3R. All the patients had normal conventional cytogenetical analysis. We confirmed 3 cases of PWS: one by de novo deletion, one by maternal chromosome 15 uniparental disomy and one case with no defined cause determined by the used primers. We confirmed 2 cases of AS, caused by de novo deletion at the 15q11-13 region, and one case with normal molecular analysis but with strong clinical characteristics.

Variability of anticardiolipin antibody isotype distribution in 3 geographic populations of patients with systemic lupus erythematosus.

OBJECTIVE: To investigate the prevalence of anticardiolipin antibodies (aCL) and isotype distribution and their clinical associations with the features of the antiphospholipid syndrome (APS) in 3 different ethnic groups of patients with systemic lupus erythematosus (SLE). METHODS: The study population consisted of 152 African-American, 136 Afro-Caribbean (Jamaican), and 163 Hispanic (Colombian) unselected patients with SLE. Serum samples were studied for the prevalence of aCL and isotype distribution. All aCL measurements were performed in the same laboratory by ELISA. RESULTS: Positive results for 1 of the 3 aCL isotypes were found in 42 African-Americans (28%), 28 Afro-Caribbeans (21%), and 43 Hispanics (26%). IgG aCL was the dominant isotype in Hispanic and African-American patients, while IgA was the dominant isotype in Afro-Caribbeans. Of note, IgA aCL was found in all Afro-Caribbean patients who were aCL positive, while only 3 patients in this group had IgG aCL and 2 had IgM aCL. Clinical features of the APS were found to correlate better in Hispanics than in African-Americans and Afro-Caribbean patients with aCL isotypes. CONCLUSION: Our data suggest the existence of ethnic differences in the prevalence and isotype distribution of aCL as well as in their clinical relevance in patients with SLE. Further studies of the role of genetic and/or environmental factors in the observed differences are required.

Urbanization, roads, and rural population change in the Ecuadorian Andes.

"Like many developing countries Ecuador has experienced extensive ubanization in the past twenty-five years as well as a shift in the pattern of rural population change between the 1960s and 1970s. Rural places with difficult access to cities (without roads and located far from cities) gained population during the 1960s but lost population during the 1970s. Rural places with easy access to cities (i.e., located near cities or on all-weather roads) continued to gain population during the 1970s. The explanation for the differential ability of rural places to retain their population during the 1970s focuses on increases in labor circulation by peasants and growth in the numbers of small, urban-oriented manufacturing and agricultural enterprises in accessible rural areas. The article concludes with a discussion on the implications of these findings for policies to reduce rates of rural-urban migration."