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1.
Am J Dermatopathol ; 2019 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-31809272

RESUMEN

INTRODUCTION: Connexins (Cxs) are channel proteins that allow direct connection among cells and between cells and the extracellular space. There is very little information in the literature on the expression of Cxs by Merkel cell carcinoma (MCC). MATERIALS AND METHODS: Thirty-two cases of MCC were recovered from our archives and studied immunohistochemically for Cx43. RESULTS: All our cases expressed several neuroendocrine markers. Most cases showed nonimmunohistochemically perceptible staining for Cx43. There was no difference between Merkel cell polyomavirus (MCPyV)-positive and MCPyV-negative cases. One case could not be evaluated. Only 2 cases showed a focal (10% of the tumor) membranous staining of Cx43. One of these cases was MCPyV-negative and, in the other, CM2B4 could not be evaluated. CM2B4 was positive in 18 cases and negative in 13 cases, and it could not be evaluated in 1 case. CONCLUSIONS: MCC shows a low Cx43 level, with no differences between MCPyV-positive and MCPyV-negative cases. Therefore, this opens the door for Cx43 targeting in therapeutic approaches to MCC.

3.
Health Soc Care Community ; 27(6): 1363-1374, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31441179

RESUMEN

Today, 8.5% of the world's population is 65 and over, and this statistic will reach 17% by 2050 (He et al., U.S. Census Bureau, international population reports, P95/16-1, An ageing world: 2015, U.S., 2016). They are the people who, with increasing age, will find themselves more closely interfacing with the national health system, which in many countries shows strong imbalances between rural and urban areas. In this context, a fundamental role is played by the relatives who find themselves becoming informal caregivers to compensate for lack of services. To date, however, little has been done to help these people. In this article, we want to identify the nature and extent of research evidence that had its objective to help informal caregivers in rural, hard to reach areas (Grant & Booth, Health Information & Libraries Journal, 2009, 26, 91). Following the approach set out by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19), we conducted a scoping review in May 2018 and closed the review with an update in September 2018. We identified 14 studies published from 2012, the European Year of Active Ageing, promoted by the European Commission, which had three domains of implementation: emotional support to decrease the emotional burden of caregivers, educational support to increase their skills, and organisational support to improve the mobility of caregivers and carereceivers. Although informal caregivers play a fundamental role in many countries, the studies that have been involved in alleviating their caring burden are few; nevertheless, they provide interesting indications. This lack of attention confirms how this portion of the population is still neglected by scientific research and risks having unequal access to health and social care. Future research is needed, not only to create and improve services to caregivers in rural, hard to reach areas, but also to evaluate and focus on the participation and the engagement of caregivers in the co-design of these services.

4.
Explore (NY) ; 15(6): 415-418, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31377302

RESUMEN

BACKGROUND: Pediatric integrative medicine (PIM) refers to the combination of treatments from conventional medicine and complementary therapies for which there is evidence of safety and effectiveness. As pediatric use of complementary therapies increases, it is important to determine parental views on the use of these therapies by their children. OBJECTIVE: To describe parental experiences with a PIM service for management of pain, nausea/vomiting and anxiety in the context of an inpatient pediatric cardiology unit. DESIGN: Telephone interviews were carried out with the parents of pediatric cardiology inpatients. The interviews focused on their and their child's experiences with the PIM service while in the hospital. Interviews were transcribed, and analyzed using qualitative content analysis. RESULTS: Data saturation was reached after nine interviews conducted during the period between June 2015 and January 2016. Parents self-reported that the PIM service was particularly helpful at alleviating symptoms of anxiety in their children. Moreover, because their children were more at ease, parents also felt less anxiety. CONCLUSION: Pediatric integrative medicine as an adjunct to conventional care is seen as beneficial by parents of children admitted to a pediatric cardiology unit.

5.
Explore (NY) ; 15(4): 273-282, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30902568

RESUMEN

BACKGROUND: Literature suggests interprofessional education (IPE) and education about complementary therapies for health sciences students may be effectively combined. METHODS: A novel 30-hour, 10-week course for interprofessional undergraduate health sciences students combining IPE and complementary therapies learning objectives was developed and offered in 2012 (N = 71), 2013 (N = 120) and 2014 (N = 140). Pre-post mixed methods measurement occurred in three groups: one taking combined IPE-complementary therapies curriculum, and two control groups (one following non-specialized IPE curriculum, and one following combined IPE-continuing care curriculum). The students' attitudinal changes towards IPE and complementary therapies, and their comfort collaborating with students in other health sciences programs were measured using scales. Qualitative evaluation was conducted via content analysis of team-based reflective essays of their opinions towards what they learned about IPE and complementary therapies, and how it changed during the course. RESULTS: Quantitative results exhibited ceiling effects, revealing little change or difference between groups on all measures, with the exception of the Health Professional Collaborative Competency Perception Scale which indicated the students taking the IPE-complementary therapies course reported increased comfort collaborating in comparison with control groups. Qualitative results indicated students: increased their awareness and knowledge about complementary therapies, and were inspired to learn more, appreciated the need for collaboration and communication, desired to be more patient-centered, and wove concepts related to IPE and complementary therapies together. CONCLUSION: Combining IPE initiatives and basic complementary therapies education can save curricular time, and develop healthcare professionals who appear to be more ready to provide team-based, patient-centered care.

6.
Oncogene ; 38(23): 4429-4451, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30814684

RESUMEN

Gap junctions comprise arrays of intercellular channels formed by connexin proteins and provide for the direct communication between adjacent cells. This type of intercellular communication permits the coordination of cellular activities and plays key roles in the control of cell growth and differentiation and in the maintenance of tissue homoeostasis. After more than 50 years, deciphering the links among connexins, gap junctions and cancer, researchers are now beginning to translate this knowledge to the clinic. The emergence of new strategies for connexin targeting, combined with an improved understanding of the molecular bases underlying the dysregulation of connexins during cancer development, offers novel opportunities for clinical applications. However, different connexin isoforms have diverse channel-dependent and -independent functions that are tissue and stage specific. This can elicit both pro- and anti-tumorigenic effects that engender significant challenges in the path towards personalised medicine. Here, we review the current understanding of the role of connexins and gap junctions in cancer, with particular focus on the recent progress made in determining their prognostic and therapeutic potential.


Asunto(s)
Conexinas/metabolismo , Uniones Comunicantes/metabolismo , Neoplasias/metabolismo , Animales , Carcinogénesis , Comunicación Celular , Diferenciación Celular , Membrana Celular/metabolismo , Proliferación Celular , Citosol/metabolismo , Regulación de la Expresión Génica , Homeostasis , Humanos , Invasividad Neoplásica , Metástasis de la Neoplasia , Células Madre Neoplásicas/citología , Pronóstico , Dominios Proteicos , Isoformas de Proteínas , Investigación en Medicina Traslacional , Resultado del Tratamiento , Microambiente Tumoral
7.
Am J Dermatopathol ; 41(11): 810-818, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30839347

RESUMEN

INTRODUCTION: Benign cutaneous tumors with follicular differentiation are alleged to differentiate toward parts of the hair follicle. Connexin 43 (Cx43) is a gap junction protein, the tumoral role of which has been investigated in several types of tumors. OBJECTIVE: To study the pattern of expression of Cx43 in benign cutaneous tumors with follicular differentiation and to compare it with that shown by their alleged anatomical counterparts of the hair follicle. MATERIALS AND METHODS: Five cases each of trichofolliculoma, trichilemmoma, fibrofolliculoma/trichodiscoma, trichoblastoma, trichoepithelioma, pilomatrixoma, and proliferating trichilemmal tumor, 3 cases of pilar sheath acanthoma, and 1 case of tumor of the follicular infundibulum were examined. Anti-Cx43 antibody was used. RESULTS: Cx43 was expressed by all follicular tumors studied. Comparisons between trichoblastoma and trichoepithelioma and their respective normal counterparts could not be made. In 3 tumors (trichofolliculoma, pilomatrixoma, and the spectrum fibrofolliculoma/trichodiscoma), there was a parallelism between their Cx43 expression pattern and that of their alleged anatomical counterparts. In pilar sheath acanthoma, trichilemmoma, and the tumor of the follicular infundibulum, we only found partial similarities in Cx43 expression. Only the proliferating trichilemmal tumor showed a discordant pattern of expression. CONCLUSIONS: Cx43 expression is preserved in benign cutaneous tumors with follicular differentiation and the patterns of Cx43 expression in benign cutaneous tumors with follicular differentiation parallel those of their alleged anatomical counterparts in 5 types (either totally or partially). This preservation might be related to the good behavior of the entities studied.

8.
Physiother Theory Pract ; 35(1): 40-56, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29432058

RESUMEN

The therapeutic relationship between practitioner and patient is embedded in the clinical interaction. Research using self-report tools has illustrated that positively evaluated therapeutic relationships can have favorable impacts on patient satisfaction with services and clinical outcomes. However, little is known about how physiotherapists develop the connections, or positive attachments, that help establish the therapeutic relationship. This study aimed to identify the various ways that physiotherapists establish meaningful connections with their patients. Interpretive description, a qualitative methodology, was used to structure the inductive and iterative design. Eleven physiotherapists and 7 patients from private practice clinics participated in semi-structured interviews to describe their experiences of the therapeutic relationship. Textual data were analyzed using qualitative content analysis and constant comparison. The iterative data generation and analysis process resulted in a framework composed of three "ways" (i.e. categories) of establishing connections: (1) acknowledging the individual, (2) giving-of-self, and (3) using the body as a pivot point. Findings were supported by various rigor strategies including peer debrief and external audit. This framework demonstrates that establishing connections is a multi-faceted endeavor with personal and professional characteristics. The findings provide practical knowledge that can be used to guide clinicians, educators, and researchers in addressing the therapeutic relationship.


Asunto(s)
Fisioterapeutas/psicología , Relaciones Profesional-Paciente , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modalidades de Fisioterapia , Adulto Joven
9.
Cell Death Dis ; 9(12): 1166, 2018 12 05.
Artículo en Inglés | MEDLINE | ID: mdl-30518918

RESUMEN

Osteoarthritis (OA), a chronic disease characterized by articular cartilage degeneration, is a leading cause of disability and pain worldwide. In OA, chondrocytes in cartilage undergo phenotypic changes and senescence, restricting cartilage regeneration and favouring disease progression. Similar to other wound-healing disorders, chondrocytes from OA patients show a chronic increase in the gap junction channel protein connexin43 (Cx43), which regulates signal transduction through the exchange of elements or recruitment/release of signalling factors. Although immature or stem-like cells are present in cartilage from OA patients, their origin and role in disease progression are unknown. In this study, we found that Cx43 acts as a positive regulator of chondrocyte-mesenchymal transition. Overactive Cx43 largely maintains the immature phenotype by increasing nuclear translocation of Twist-1 and tissue remodelling and proinflammatory agents, such as MMPs and IL-1ß, which in turn cause cellular senescence through upregulation of p53, p16INK4a and NF-κB, contributing to the senescence-associated secretory phenotype (SASP). Downregulation of either Cx43 by CRISPR/Cas9 or Cx43-mediated gap junctional intercellular communication (GJIC) by carbenoxolone treatment triggered rediferentiation of osteoarthritic chondrocytes into a more differentiated state, associated with decreased synthesis of MMPs and proinflammatory factors, and reduced senescence. We have identified causal Cx43-sensitive circuit in chondrocytes that regulates dedifferentiation, redifferentiation and senescence. We propose that chondrocytes undergo chondrocyte-mesenchymal transition where increased Cx43-mediated GJIC during OA facilitates Twist-1 nuclear translocation as a novel mechanism involved in OA progression. These findings support the use of Cx43 as an appropriate therapeutic target to halt OA progression and to promote cartilage regeneration.


Asunto(s)
Cartílago Articular/inmunología , Comunicación Celular/genética , Senescencia Celular/genética , Condrocitos/inmunología , Conexina 43/genética , Osteoartritis/genética , Adipocitos/efectos de los fármacos , Adipocitos/inmunología , Adipocitos/patología , Antígenos CD/genética , Antígenos CD/inmunología , Carbenoxolona/farmacología , Cartílago Articular/patología , Estudios de Casos y Controles , Comunicación Celular/inmunología , Diferenciación Celular , Senescencia Celular/inmunología , Condrocitos/efectos de los fármacos , Condrocitos/patología , Conexina 43/inmunología , Inhibidor p16 de la Quinasa Dependiente de Ciclina/genética , Inhibidor p16 de la Quinasa Dependiente de Ciclina/inmunología , Regulación de la Expresión Génica , Humanos , Interleucina-1beta/genética , Interleucina-1beta/inmunología , Metaloproteinasas de la Matriz/genética , Metaloproteinasas de la Matriz/inmunología , Células Madre Mesenquimatosas/efectos de los fármacos , Células Madre Mesenquimatosas/inmunología , Células Madre Mesenquimatosas/patología , FN-kappa B/genética , FN-kappa B/inmunología , Proteínas Nucleares/genética , Proteínas Nucleares/inmunología , Osteoartritis/inmunología , Osteoartritis/patología , Cultivo Primario de Células , Índice de Severidad de la Enfermedad , Transducción de Señal , Proteína p53 Supresora de Tumor/genética , Proteína p53 Supresora de Tumor/inmunología , Proteína 1 Relacionada con Twist/genética , Proteína 1 Relacionada con Twist/inmunología
10.
Biochim Biophys Acta Biomembr ; 1860(12): 2499-2505, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30279151

RESUMEN

Cell-to-cell communication between bone, cartilage and the synovial membrane is not fully understood and it is only attributed to the diffusion of substances through the extracellular space or synovial fluid. In this study, we found for the first time that primary bone cells (BCs) including osteocytes, synovial cells (SCs) and chondrocytes (CHs) are able to establish cellular contacts and to couple through gap junction (GJ) channels with connexin43 (Cx43) being dominant. Transwell co-culture and identification by mass spectrometry revealed the exchange of essential amino acids, peptides and proteins including calnexin, calreticulin or CD44 antigen between contacting SCs, BCs and CHs. These results reveal that CHs, SCs and BCs are able to establish intercellular connections and to communicate through GJ channels, which provide a selective signalling route by the direct exchange of potent signalling molecules and metabolites.


Asunto(s)
Comunicación Celular , Condrocitos/metabolismo , Uniones Comunicantes/metabolismo , Osteocitos/metabolismo , Aminoácidos Esenciales/metabolismo , Calnexina/metabolismo , Calreticulina/metabolismo , Células Cultivadas , Técnicas de Cocultivo , Conexina 43/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Péptidos/metabolismo , Transducción de Señal , Membrana Sinovial/citología , Membrana Sinovial/metabolismo
11.
BMC Pregnancy Childbirth ; 18(1): 314, 2018 Aug 03.
Artículo en Inglés | MEDLINE | ID: mdl-30075762

RESUMEN

BACKGROUND: Many socioecological and structural factors affect women's diets, physical activity, and her access and receptivity to perinatal care. We sought to explore women's and providers' perceptions and experiences of health in the pre- and post-natal period while facing difficult life circumstances, and accessing a community-based program partially funded by Canada Prenatal Nutrition Program (CPNP) in Alberta, Canada. METHODS: Following the principles of community-based participatory research, we conducted a focused ethnography that involved five focus groups with women (28 in total), eight one-on-one interviews with program providers, and observations of program activities. Data were analyzed through qualitative content analysis to inductively derive codes and categories. RESULTS: Women perceived eating healthy foods, taking prenatal vitamins, and being physically active as key health behaviours during pregnancy and postpartum. However, they were commonly coping with many difficult life circumstances, and faced health barriers for themselves and their babies. These barriers included pregnancy or birth complications, family and spousal issues, financial difficulties, and living rurally. On the other hand, women and providers identified many aspects of the community-based program that addressed the burden of adversities as enablers to better health during pregnancy and postpartum. CONCLUSION: Community-based programs have an important role in alleviating some of the burden of coping with difficult life circumstances for women. With such potential, community-based programs need to be well supported through policies. Policies supporting these programs, and ensuring adequate funding, can enable more equitable services to rural women and truly promote maternal health during pregnancy and postpartum.


Asunto(s)
Fenómenos Fisiologicos de la Nutrición Prenatal/etnología , Condiciones Sociales , Adulto , Antropología Cultural , Canadá/epidemiología , Barreras de Comunicación , Investigación Participativa Basada en la Comunidad , /psicología , Conducta Alimentaria , Femenino , Humanos , Salud Materna/etnología , Fenómenos Fisiologicos Nutricionales Maternos/etnología , Evaluación de Necesidades , Embarazo , Salud Rural
12.
Qual Health Res ; 28(14): 2208-2219, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30160198

RESUMEN

We sought to understand the needs of involved Nehiyaw (Cree) fathers who supported their partners during pregnancy. We used qualitative description and a community-based participatory research approach. We carried out in-depth semi-structured interviews with six Nehiyaw fathers. Four also participated in photovoice and follow-up interviews. All data were content analyzed qualitatively. Fathers felt they had to support their partners and overcome challenges resulting from intergenerational colonial impacts (residential schools particularly) by reclaiming their roles and acknowledging the pregnancy as a positive change. Providing support was possible through their own strong support system stemming from family, faith, culture, and a stable upbringing with positive male role models and intact Nehiyaw kinships. Perinatal programming did little to include fathers. Attempts to improve perinatal care and outcomes should allow more inclusion of and support for Indigenous fathers through genuinely incorporating into care traditional culture and Elders, families, flexibility, cultural understanding, and reconciliation.


Asunto(s)
Características Culturales , Padre/psicología , Identidad de Género , Indios Norteamericanos/psicología , Mujeres Embarazadas/etnología , Adulto , Canadá , Investigación Participativa Basada en la Comunidad , Femenino , Humanos , Entrevistas como Asunto , Masculino , Atención Perinatal , Fotograbar , Embarazo , Investigación Cualitativa
13.
PLoS One ; 13(3): e0193571, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29513719

RESUMEN

INTRODUCTION: In response to revisions in global and national policy in 2011, six-month isoniazid preventive therapy (IPT) became freely available as a preventive measure for people living with HIV in the uMgungundlovu District of KwaZulu-Natal province, South Africa. Given a difference in uptake and completion by sex, we sought to explore the reasons why Zulu women were more likely to accept and complete IPT compared to men in an effort to inform future implementation. METHODS: Utilising a community-based participatory research approach and ethnographic methods, we undertook 17 individual and group interviews, and met regularly with grassroots community advisory teams in three Zulu communities located in uMgungundlovu District between March 2012-December 2016. FINDINGS & DISCUSSION: Three categories described women's willingness to initiate IPT: women are caregivers, women are obedient, and appearance is important. The findings suggest that the success of IPT implementation amongst clinic-utilising women of uMgungundlovu is related to the cultural gender norms of uMakoti, isiZulu for "the bride" or "the wife." We invoke the cultural concept of inhlonipho, meaning "to show respect," to discuss how the cultural values of uMakoti may conflict with biomedical expectations of adherence. Such conflict can result in misinterpretations by healthcare providers or patients, and lead some patients to fear the repercussions of asking questions or contemplating discontinuation with the provider, preferring instead to appear obedient. We propose a shift in emphasis from adherence-focussed strategies, characteristic of the current biomedical approach, to practices that promote patient agency in an effort to offer IPT more appropriately. IMPLICATIONS: Building on existing tools, namely the harm reduction model and the use of mini-ethnography, we provide guidance on how to support women to participate as agents in the decision to initiate or continue IPT, decisions which may also impact the health and choices of the family.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Antituberculosos/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud/etnología , Isoniazida/uso terapéutico , Aceptación de la Atención de Salud/etnología , Tuberculosis/prevención & control , Infecciones Oportunistas Relacionadas con el SIDA/etnología , Infecciones Oportunistas Relacionadas con el SIDA/psicología , Cultura , Femenino , Identidad de Género , Humanos , Entrevistas como Asunto , Masculino , Aceptación de la Atención de Salud/psicología , Factores Sexuales , Sudáfrica , Tuberculosis/etnología , Tuberculosis/psicología
14.
Arch Physiother ; 8: 3, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29468089

RESUMEN

Background: The therapeutic relationship between patient and physiotherapist is a central component of patient-centred care and has been positively associated with better physiotherapy clinical outcomes. Despite its influence, we do not know what conditions enable a physiotherapist and patient to establish and maintain a therapeutic relationship. This knowledge has implications for how clinicians approach their interactions with patients and for the development of an assessment tool that accurately reflects the nature of the therapeutic relationship. Therefore, this study's aim was to identify and provide in-depth descriptions of the necessary conditions of engagement of the therapeutic relationship between physiotherapists and patients. Methods: Interpretive description was the qualitative methodological orientation used to identify and describe the conditions that reflect and are practically relevant to clinical practice. Eleven physiotherapists with a minimum 5 years of clinical experience and seven adult patients with musculoskeletal disorders were purposively sampled from private practice clinics in Edmonton, Canada. The in-person, semi-structured interviews were completed in a location of the participant's choice and were audio recorded and transcribed. Qualitative content analysis was used to analyze the textual data and constant comparison techniques were integrated to refine the categories and sub-categories. Rigour strategies used throughout the study were peer debrief, interview notes, reflexive journaling, memoing, member reflections, audit trail, and external audit. Results: Four conditions were identified as necessary for establishing a therapeutic relationship: present, receptive, genuine, and committed. These conditions represent the intentions and attitudes of physiotherapists and patients engaging in the clinical interaction. Although distinct, the conditions appear related as being present and receptive create a foundation for being genuine and committed. Conclusions: These conditions of engagement are needed for physiotherapist and patient to "be" in a therapeutic relationship. Although communication skills are important for advancing therapists' relational abilities, awareness and integration of intentions and attitudes are essential for shaping behaviors that develop the therapeutic relationship. These findings also suggest there are characteristics of the therapeutic relationship specific to physiotherapy. Therefore, theories from other contexts (e.g., psychotherapy) should be used judiciously to guide physiotherapy practice and research.

15.
Ageing Res Rev ; 42: 56-71, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29258883

RESUMEN

Ageing processes play a major contributing role for the development of Osteoarthritis (OA). This prototypic degenerative condition of ageing is the most common form of arthritis and is accompanied by a general decline, chronic pain and mobility deficits. The disease is primarily characterized by articular cartilage degradation, followed by subchondral bone thickening, osteophyte formation, synovial inflammation and joint degeneration. In the early stages, osteoarthritic chondrocytes undergo phenotypic changes that increase cell proliferation and cluster formation and enhance the production of matrix-remodelling enzymes. In fact, chondrocytes exhibit differentiation plasticity and undergo phenotypic changes during the healing process. Current studies are focusing on unravelling whether OA is a consequence of an abnormal wound healing response. Recent investigations suggest that alterations in different proteins, such as TGF-ß/BMPs, NF-Kß, Wnt, and Cx43, or SASP factors involved in signalling pathways in wound healing response, could be directly implicated in the initiation of OA. Several findings suggest that osteoarthritic chondrocytes remain in an immature state expressing stemness-associated cell surface markers. In fact, the efficacy of new disease-modifying OA drugs that promote chondrogenic differentiation in animal models indicates that this may be a drug-sensible state. In this review, we highlight the current knowledge regarding cellular plasticity in chondrocytes and OA. A better comprehension of the mechanisms involved in these processes may enable us to understand the molecular pathways that promote abnormal repair and cartilage degradation in OA. This understanding would be advantageous in identifying novel targets and designing therapies to promote effective cartilage repair and successful joint ageing by preventing functional limitations and disability.


Asunto(s)
Envejecimiento/metabolismo , Cartílago Articular/fisiología , Diferenciación Celular/fisiología , Plasticidad de la Célula/fisiología , Osteoartritis/metabolismo , Regeneración/fisiología , Envejecimiento/patología , Animales , Cartílago Articular/patología , Proliferación Celular/fisiología , Condrocitos/metabolismo , Condrocitos/patología , Humanos , Osteoartritis/patología , Transducción de Señal/fisiología
16.
Scand J Caring Sci ; 32(2): 672-680, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28851066

RESUMEN

RATIONALE AND AIMS: Meaning is an integral aspect of life that drives behaviours, actions and emotions. Perception of pain is believed to be affected by the meaning of pain. Our primary aim was to investigate and discuss the determinants of meaning in acute pain following a traumatic injury. METHODOLOGICAL DESIGN: Using the Interpretive Description approach, a method of qualitative inquiry, 13 adults hospitalised due to their accidental injuries were recruited. Semi-structured interviews that were digitally recorded were used to collect the data. Ethical approval was received by our local Health Research Ethics Board, and all relevant ethical standards were followed as outlined in the approved ethics proposal. FINDINGS: The three primary determinants of meaning during an acute pain event, or the experience of acute pain include permanence of injuries, incongruence of care quality, and personal responses to the injury and care received. Although the permanence of an injury is lasting, we did not find any emotional response to this fact while the participants were hospitalised. The emotion characterising the personal response to the perceived poor quality of hospital care received was anxiety. CONCLUSION: Both the technical and personal components of healthcare quality have the potential to increase the perception of pain. Meanings in an acute pain event are primarily related to the determinants of incongruent care and the personal response to that determinant: anxiety.


Asunto(s)
Accidentes/psicología , Dolor Agudo/psicología , Calidad de Vida/psicología , Heridas y Traumatismos/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa
17.
J Cutan Pathol ; 45(1): 8-15, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28960405

RESUMEN

BACKGROUND: Gap junctions form communication compartments between cells. These channels assemble from connexin subunits. OBJECTIVE: To investigate the immunoexpression of connexin 43 (Cx43) in adult human hair follicles. METHODS: Cases were retrospectively obtained from our archives. RESULTS: We identified immunoexpression of Cx43 in the matrix, the papilla, the outer root sheath, the bulge, the medulla, the cortex, the shaft and the secretory part of the sebaceous gland. There was very low expression (VLE) of Cx43 in the perifollicular sheath, the mantle and the arrector pili muscle. The internal root sheath showed high-density expression in the bulb. Such expression abruptly decreased at different points in each of its layers at the point of keratinization. The isthmus showed Cx43-positive staining in the middle layers and all along, whereas there was VLE in the two outermost layers. The infundibulum showed expression all along the middle layers, whereas it showed VLE in the 2 outermost layers and in the 2 or 3 innermost layers. CONCLUSIONS: The bulge contains Cx43. Our results suggest that keratinization in the hair follicle is closely related to the decrease in Cx43 expression.


Asunto(s)
Conexina 43/metabolismo , Folículo Piloso/metabolismo , Humanos , Estudios Retrospectivos
18.
Pediatr Hematol Oncol ; 35(7-8): 373-384, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30785354

RESUMEN

INTRODUCTION: Sickle cell disease (SCD) is an inherited, multi-system, chronic disease with the highest prevalence affecting people of Sub-Saharan African descent. While major advances in SCD care have occurred over the last few decades in many African countries these advances are not readily available. Prior literature from Ghana and Kenya describe stigma, despair, and economic burden as well as hope when a child has SCD. When people migrate to North America with a child with SCD it is unknown whether their perception of the disease changes. We asked, "How do immigrant parents of children with SCD from Sub-Saharan Africa perceive, and manage the disease in the context of western medical care?" METHODS: The research question was explored with qualitative methodology, specifically focused ethnography. Semi-structured interviews were conducted with parent(s). The interviews were audio recorded, transcribed, and open coded. Rigor was determined through methodological coherence, appropriate and sufficient sampling, and iterative data collection and analysis. RESULTS: Twelve interviews were conducted. Identified themes are as follows: memories of SCD in Africa, the emotional journey towards acceptance, and parental approach to care for their child. CONCLUSIONS: Healthcare providers should be responsive to an immigrant families' needs and not expect linear progression of emotional acceptance to the diagnosis. Healthcare providers patience with the process helps establish trust, works to facilitate and encourage hope and acknowledges the strength of the families, and their dedication to their family member. Healthcare providers should acknowledge parents' sources of support (religion/family) and ensure parents are aware of medical advances.


Asunto(s)
Anemia de Células Falciformes/etnología , Anemia de Células Falciformes/genética , Emigración e Inmigración , África del Sur del Sahara/etnología , Canadá/etnología , Femenino , Humanos , Masculino
19.
Nutr Clin Pract ; 32(5): 664-674, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28841392

RESUMEN

BACKGROUND: Patients with head/neck or esophageal (HNE) cancer are likely to develop malnutrition throughout the course of their disease and its treatment. Although nutrition care is considered a cornerstone of disease management, clinical practices to treat malnutrition vary. The objective of this qualitative study is to understand the patients' experiences with nutrition care in the context of their treatment and recovery. METHODS: A descriptive qualitative study design was used to explore patients' experiences. Ten patients with head and neck (HN) cancer and 10 patients with esophageal cancer were interviewed near the completion of their cancer treatment using a semistructured interview guide. The data sets were analyzed separately using qualitative content analysis. The preliminary findings from each data set were compared and contrasted; 3 themes that crossed both data sets were identified. RESULTS: Three themes were identified: (1) coping with physical and psychosocial aspects of illness and nutrition; (2) understanding the nature of the illness, treatment, and nutrition pathway; and (3) being supported during the trajectory of care. The major differences between HN and esophageal groups were identified in the context of understanding and being supported: the lack of coordination throughout the trajectory of care and conflicting messages from healthcare providers were a source of uncertainty, confusion, and isolation in the HN group. The need for timely and ongoing patient-focused nutrition care, with formal and informal support, was identified in both groups. CONCLUSION: Models for nutrition care should support provision of consistent information across health professionals and throughout the treatment trajectory.


Asunto(s)
Neoplasias Esofágicas/terapia , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Neoplasias de Cabeza y Cuello/terapia , Conocimientos, Actitudes y Práctica en Salud , Desnutrición/prevención & control , Apoyo Nutricional , Atención Dirigida al Paciente , Adaptación Psicológica , Anciano , Alberta , Terapia Combinada/efectos adversos , Costo de Enfermedad , Neoplasias Esofágicas/fisiopatología , Medicina Basada en la Evidencia , Trastornos de Alimentación y de la Ingestión de Alimentos/etiología , Trastornos de Alimentación y de la Ingestión de Alimentos/fisiopatología , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Femenino , Neoplasias de Cabeza y Cuello/fisiopatología , Humanos , Masculino , Desnutrición/etiología , Desnutrición/terapia , Persona de Mediana Edad , Evaluación de Necesidades , Guías de Práctica Clínica como Asunto , Sistemas de Apoyo Psicosocial , Investigación Cualitativa , Estrés Psicológico/etiología , Estrés Psicológico/prevención & control , Estrés Psicológico/psicología
20.
Can J Diet Pract Res ; 78(4): 182-186, 2017 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-28537130

RESUMEN

Printed educational materials are a common source of health information, although their effectiveness in improving women's knowledge or self-care in pregnancy has been questioned. This study describes the information in printed educational materials that address healthy eating during pregnancy and gestational weight gain (GWG) that are currently used in Alberta, Canada. Content of 6 resources was analyzed using a constant comparison qualitative approach. Resources emphasized healthy eating, prenatal supplements, folate supplementation, and healthy weight gain. More resources discussed the importance of "eating enough" than provided guidance on avoiding excessive GWG. Themes identified were: "everything is important" meaning that all healthy behaviours are important, making prioritization difficult; "more is more" emphasized eating more over moderation; "everyone is individual" suggests women seek individualized care through the care provider; and "contradictions" describes differences in content and recommendations within and between resources. New or revised versions of resources should provide congruent information with up-to-date recommendations that are easily prioritized. Care providers should be aware of contradictory information or information that does not align with current recommendations within printed educational materials and be ready to help women address the areas important for her personal behaviour change.


Asunto(s)
Educación en Salud , Conocimientos, Actitudes y Práctica en Salud , Educación del Paciente como Asunto , Aumento de Peso , Alberta , Índice de Masa Corporal , Ingestión de Alimentos , Femenino , Conductas Relacionadas con la Salud , Humanos , Fenómenos Fisiologicos Nutricionales Maternos , Estado Nutricional , Embarazo , Investigación Cualitativa
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