Provider and Caregiver Perspectives on Telehealth Assessments for Autism Spectrum Disorder in Young Children: A Multimethod DBPNet Study Exploring Equity.

BACKGROUND: Telehealth uptake increased dramatically during the COVID-19 pandemic, including for autism spectrum disorder (ASD) assessment by developmental-behavioral pediatric (DBP) clinicians. However, little is known about the acceptability of telehealth or its impact on equity in DBP care. OBJECTIVE: Engage providers and caregivers to glean their perspectives on the use of telehealth for ASD assessment in young children, exploring acceptability, benefits, concerns, and its potential role in ameliorating or exacerbating disparities in access to and quality of DBP care. METHODS: This multimethod study used surveys and semistructured interviews to describe provider and family perspectives around the use of telehealth in DBP evaluation of children younger than 5 years with possible ASD between 3/2020 and 12/2021. Surveys were completed by 13 DBP clinicians and 22 caregivers. Semistructured interviews with 12 DBP clinicians and 14 caregivers were conducted, transcribed, coded, and analyzed thematically. RESULTS: Acceptance of and satisfaction with telehealth for ASD assessments in DBP were high for clinicians and most caregivers. Pros and cons concerning assessment quality and access to care were noted. Providers raised concerns about equity of telehealth access, particularly for families with a preferred language other than English. CONCLUSION: This study's results can inform the adoption of telehealth in DBP in an equitable manner beyond the pandemic. DBP providers and families desire the ability to choose telehealth care for different assessment components. Unique factors related to performing observational assessments of young children with developmental and behavioral concerns make telehealth particularly well-suited for DBP care.

Resident Communication With Patients and Families Preferring Languages Other Than English.

OBJECTIVES: Patients and families preferring languages other than English (LOE) often experience inequitable communication with their health care providers, including the underutilization of professional interpretation. This study had 2 aims: to characterize resident-perceived communication with families preferring LOE and to evaluate the impact of language preference on frequency of resident interactions with hospitalized patients and families. METHODS: This was a cross-sectional study at a quaternary care children's hospital. We developed a questionnaire for residents regarding their interactions with patients preferring LOE. We concurrently developed a communication tracking tool to measure the frequency of resident communication events with hospitalized patients. Data were analyzed with logistic and Poisson regression models. RESULTS: Questionnaire results demonstrated a high level of resident comfort with interpretation, though more than 30% of residents reported "sometimes" or "usually" communicating with families preferring LOE without appropriate interpretation (response rate, 47%). The communication tracking tool was completed by 36 unique residents regarding 151 patients, with a 95% completion rate. Results demonstrated that patients and families preferring LOE were less likely to be present on rounds compared with their counterparts preferring English (adjusted odds ratio, 0.17; 95% confidence interval [CI], 0.07-0.39). Similarly, patients and families preferring LOE were less likely to receive a resident update after rounds (adjusted odds ratio, 0.29; 95% CI, 0.13-0.62) and received fewer resident updates overall (incidence rate ratio, 0.45; 95% CI, 0.30-0.69). CONCLUSIONS: Hospitalized patients and families preferring LOE experience significant communication-related inequities. Ongoing efforts are needed to promote equitable communication with this population and should consider the unique role of residents.

Communication Experiences of Caregivers Using a Language Other Than English on Inpatient Services.

OBJECTIVES: Individuals who prefer to communicate about health care in a language other than English (LOE) experience poorer quality medical care and challenges when communicating with health care providers. The objective of this study was to elucidate how caregivers who prefer an LOE perceive communication with their physicians on an inpatient general pediatrics service. METHODS: Caregivers of patients admitted to the general pediatrics service at our urban freestanding children's hospital whose preferred language for medical care was Spanish, Arabic, Brazilian Portuguese, or Mandarin were eligible for this qualitative study. Semistructured interviews using video interpreter services were conducted to explore the participants' experiences communicating with their physicians. Interview transcripts were analyzed using conventional content analysis. RESULTS: We interviewed 15 participants representing 7 countries of origin and 4 non-English languages: Spanish, Arabic, Brazilian Portuguese, and Mandarin. Three main domains emerged, including: (1) use of interpreter services, (2) overall communication experience with physician providers, and (3) suggestions for improvement in physician communication. Salient themes included early identification of the need for an interpreter is essential and physicians' use of body language in combination with an interpreter enhances successful communication. CONCLUSIONS: This project fills a gap in existing literature by describing the perspectives of caregivers who prefer an LOE, including those speaking languages other than Spanish, as they communicate with inpatient pediatricians. In addition to ensuring appropriate use of interpreter services, physicians can focus on using plain language and gestures during encounters, helping to facilitate communication and provide culturally competent care for this population.

Improving Identification of Interpreter Need in the Pediatric Emergency Department.

OBJECTIVE: Patients with limited English proficiency (LEP) benefit from the appropriate use of medical interpreters. A multidisciplinary quality improvement team sought to improve communication with patients with LEP within a pediatric emergency department (ED). Specifically, the team aimed to improve the early identification of patients and caregivers with LEP, the utilization of interpreter services for those identified, and documentation of interpreter use in the patient chart. METHODS: Using clinical observations and data review, the project team identified key processes for improvement in the ED workflow and introduced interventions to increase identification of language needs and offer interpreter services. These include a new triage screening question, an icon on the ED track board that communicates language needs to staff, an electronic health record (EHR) alert with information on how to obtain interpreter services, and a new template to prompt correct documentation in the ED provider's note. Outcomes were tracked using statistical process control charts. RESULTS: All study measures met special cause for improvement during the 6-month study period and have been sustained during surveillance data collection. Identification rates for patients with LEP during triage increased from 60% to 77%. Interpreter utilization increased from 77% to 86%. The documentation of interpreter use increased from 38% to 73%. CONCLUSION: Using improvement methods, a multidisciplinary team increased the identification of patients and caregivers with LEP in an ED. Integration of this information into the EHR allowed for the targeted prompting of providers to use interpreter services and to correctly document their use.

Viability, yield and expansion capability of feline MSCs obtained from subcutaneous and reproductive organ adipose depots.

BACKGROUND: The source of multipotent stromal cells (MSC) can have a significant influence on the health and expansion capacity of the cells. As the applications for allogeneic MSCs in the treatment of feline diseases increase, the location of the initial donor tissue must be analyzed. To date, comparisons have only been made between feline MSCs collected from bone marrow or abdominal fat. This is the first report to compare cells obtained from different adipose depots in the cat with a focus on clinically relevant donor tissues. The tissue was collected from 34 healthy cats undergoing spaying (fat around the ovaries and uterine horn) or subcutaneous fat collected during surgical procedures. RESULTS: The amount of starting material is essential to isolate sufficient MSCs. The total tissue yield from the subcutaneous fat was significantly greater than could be obtained from around the reproductive organs, leading to 3 times more MSCs per donor. However, the concentration of MSCs obtained from reproductive fat was higher than from subcutaneous fat. In addition, the viability of the MSCs from the reproductive fat was significantly higher than the subcutaneous fat. Since most spaying occurs in young cats (under 18 months) reproductive fat was collected from adult cats during spaying, illustrating that age did not alter the yield or viability of the MSCs. When sufficient tissue was collected, it was digested either mechanically or enzymatically. Mechanical digestion further decreased the viability and yield of MSCs from subcutaneous fat compared to enzymatic digestion. Biomarkers of stem cell characterization, expansion capacity and function were detected using qPCR. CD70, CD90 and CD105 were all expressed in high levels in the 3 groups. However, the reproductive fat had higher levels of CD73 with the mechanically digested subcutaneous fat having the least. Gata6 was detected in all samples while Sox2 and Sox17 were also detected with higher quantities found in the enzymatically digested subcutaneous fat. Negative control genes of Gata4 and Pdx1 showed no detection prior to 50 cycles. During the first three passages, age of the donor, location of the donor tissue, or digestion protocol had no effect on cell culture doubling times or cell viability. CONCLUSIONS: While MSCs from reproductive fat had superior cells/tissue weight and initial viability, there were still dramatically fewer cells obtained compared to subcutaneous fat due to the limited amount of tissue surrounding the reproductive organs. Further, in P1-P3 cultures there were no differences noted in doubling time or cell viability between tissue obtained from reproductive or subcutaneous fat depots.

Caracterización del Comportamiento Sexual y Reproductivo y Acceso A los Servicios de Salud, de los Estudiantes de la Facultad de Ciencias Médicas de la Universidad de Cuenca / Characterization of Sexual and Reproductive Behavior and Access to Health Services, of the Students of the Faculty of Medical Sciences of the University of Cuenca

ANTECEDENTES: La población universitaria es principal-mente joven y por lo tanto expuesta a factores que puede generar efectos adversos en salud sexual y re-productiva, que conllevan a un bajo rendimiento académico e inclusive a la deserción estudiantil. OBJETIVO: Caracterizar el comportamiento sexual y re-productivo y las necesidades en salud de los en estudiantes de la Facultad de Ciencias Médicas de la Universidad de Cuenca. METODOLOGÍA: Tipo de estudio descriptivo. Universo: 3 265 estudiantes de la Facultad de Ciencias Médicas de la Universidad de Cuenca, en el período lectivo septiembre 2014- Febrero 2015. Muestra: fue aleatorizada por conglomerados (carrera y cursos) en las tres escue-las de la facultad de Ciencias Médicas. RESULTADOS: De los estudiantes encuestados, el 44.7% fueron de la escuela de medicina de 27.7% de enfermería, 27.7% tecnología médica; 68.6% mujeres y 31.4% varones, con una edad media de 21 años para ambos grupos; la mayoría son solteros 87.7%, mestizos 94.1% y heterosexuales 97.2%, que residen en zona urbana 81.5%. El 45.7% de las mujeres y el 70.1% de los varones son sexualmente activos, 15% son padres de familia, el 81,6% ha usado un método anticonceptivo MAC, sin embargo el uso consistente es de 55.1%. 66.2% de los encuestados ha acudido a un médico el último año; el 77.3% maneja suficiente información para la prevención de un embarazo y el 79.7% para la prevención de ITS. CONCLUSIONES: Pese a que los estudiantes tienen in-formación en sexualidad y acceden a los servicios de salud, los efectos adversos en salud sexual y reproduc-tiva son identificados como un problema que conlleva a deserción estudiantil y bajo rendimiento académico. Las principales soluciones para combatir los efectos adversos, incluyen: mejorar la calidad de información, fortalecer el acceso a servicios integrales de salud, generar espacios saludables.

OBJECTIVE: To characterize sexual and reproductive be-havior and health needs of students in the Faculty of Medical Sciences of the University of Cuenca. METHOD: descriptive study type. Universe: 3265 students of the Faculty of Medical Sciences of the University of Cuenca, in the academic year in September 2014 in February 2015. Sample: was randomized by cluster (ca-reer and courses) in the three schools of the Faculty of Medical Sciences. RESULTS: Of all the surveyed students, 44.7% were from medical school, nursing 27.7%, 27.7% medical technology; 68.6% female and 31.4% male, with a mean age of 21 years; most are unmarried 87.7%, 94.1% are heterosexual, mestizos 97.2% residing in urban areas 81.5%. 45.7% of the women and 70.1% of males are sexually active, 15% are parents, 81.6% have used a contraceptive, however the consistent use of contra-ceptives is 55.1%. 66.2% of respondents have visited a doctor last year; 77.3% handle sufficient information for the prevention of pregnancy and 79.7% for STD prevention. CONCLUSIONS: Although students have information on sexuality and access to health services, adverse effects on sexual and reproductive health are identified as a problem that leads to student dropout and low aca-demic performance. The main solutions to combat the adverse effects include: improving the quality of infor-mation, enhance access to comprehensive health ser-vices, generating healthy spaces.

Nuclear BAG6-UBL4A-GET4 complex mediates DNA damage signaling and cell death.

BCL2-associated athanogene 6 (BAG6) is a member of the BAG protein family, which is implicated in diverse cellular processes including apoptosis, co-chaperone, and DNA damage response (DDR). Recently, it has been shown that BAG6 forms a stable complex with UBL4A and GET4 and functions in membrane protein targeting and protein quality control. The BAG6 sequence contains a canonical nuclear localization signal and is localized predominantly in the nucleus. However, GET4 and UBL4A are found mainly in cytoplasm. Whether GET4 and UBL4A are also involved in DDR in the context of the BAG6 complex remains unknown. Here, we provide evidence that nuclear BAG6-UBL4A-GET4 complex mediates DDR signaling and damage-induced cell death. BAG6 appears to be the central component for the process, as depletion of BAG6 leads to the loss of both UBL4A and GET4 proteins and resistance to cell killing by DNA-damaging agents. In addition, nuclear localization of BAG6 and phosphorylation of BAG6 by ATM/ATR are also required for cell killing. UBL4A and GET4 translocate to the nucleus upon DNA damage and appear to play redundant roles in cell killing, as depletion of either one has no effect but co-depletion leads to resistance. All three components of the BAG6 complex are required for optimal DDR signaling, as BAG6, and to a lesser extent, GET4 and UBL4A, regulate the recruitment of BRCA1 to sites of DNA damage. Together our results suggest that the nuclear BAG6 complex is an effector in DNA damage response pathway and its phosphorylation and nuclear localization are important determinants for its function.

Avaliação da promoção do aleitamento materno em Hospitais Amigos da Criança / Evaluation of breastfeeding promotion in Baby-Friendly Hospitals

OBJETIVO:Avaliar o cumprimento dos Passos 4 a 10 dentre os Dez Passos para o Sucesso do Aleitamento Materno, preconizados pela Iniciativa Hospital Amigo da Criança (IHAC), criada pela Organização Mundial da Saúde (OMS). MÉTODOS: Estudo descritivo de corte transversal. Foram realizadas entrevistas com 100 puérperas nos dois hospitais credenciados pela IHAC em Salvador. Não foram incluídas mães ou recém-nascidos que não poderiam oferecer ou receber aleitamento materno exclusivo, respectivamente.Questionou-se sobre história obstétrica, aleitamento materno anterior, atendimento pré-natal e aspectos relacionados aos Passos Para o Sucesso do Aleitamento Materno. As questões foram elaboradas de acordo com os Critérios Globais para a IHAC. No mínimo 80 por cento das mães deveriam responder de forma satisfatória às perguntas correspondentes a cada passo para que ele fosse considerado como cumprido. Foi feita descrição de frequências para avaliar as respostas. RESULTADOS: O cumprimento foi insatisfatório para o Passo 4 (suporte ao aleitamento materno após o parto - 58 por cento), Passo 5 (aleitamento exclusivo durante a internação - 77 por cento) e Passo 10 (encaminhamento para grupo de suporte ao aleitamento materno - 5 por cento). Outros passos demonstraram bons resultados: Passo 6 (oferta de substitutos do leite materno - 19 por cento), Passo 7 (prática do alojamento conjunto - 91 por cento) e Passo 9 (não uso de chupetas e mamadeiras - 100 por cento). CONCLUSÕES: Houve boa aderência a alguns aspectos dos Critérios Globais da IHAC. Evidencia-se, no entanto, a necessidade de se ampliarem as discussões sobre os critérios para manter o título de "Hospital Amigo da Criança", uma vez que os resultados foram insatisfatórios em relação aos Passos 4, 5 e 10.

OBJECTIVE:To evaluate the compliance to steps 4 to 10 of the Ten Steps Program to Successful Breastfeeding recommended by the Baby-Friendly Hospital Initiative (BFHI), created by World Health Organization (WHO). METHODS: Cross-sectional descriptive study of 100 mothers in the immediate post-partum period admitted to both BFHI accredited hospitals in Salvador (Northeast Brazil). Newborns that could not be exclusively breastfed were not included. The mothers were questioned about obstetric history, previous breastfeeding, prenatal care, and aspects related to The Ten Steps to Successful Breastfeeding. Interviewers used a questionnaire based on the BFHI Global Criteria. At least 80 percent of the mothers had to satisfactorily answer the questions related to each step in order to consider them complied. Descriptive statistics was used to evaluate the answers. RESULTS: The compliance was unsatisfactory for Step 4 (support to breastfeeding initiation immediately after birth - 58 percent), Step 5 (exclusive breastfeeding during hospitalization - 77 percent), and Step 10 (referral of mothers to a breastfeeding support group following discharge from hospital - 5 percent). Other steps showed a satisfactory result: Step 6 (offer of formula - 19 percent), Step 7 (practice of rooming-in - 91 percent) and Step 9 (no pacifiers and bottles use - 100 percent). CONCLUSIONS: A satisfactory compliance with some aspects of the BFHI Global Criteria was noted, but more discussions about strategies to keep the title of "Baby Friendly Hospital" are needed, since the compliance was poor regarding Steps 4, 5 and 10.

Comparing breast feeding practices in baby friendly and non-accredited hospitals in Salvador, Bahia / Comparação das práticas de amamentação em hospitais IHAC e não credenciados em Salvador, Bahia

OBJECTIVES: to compare compliance with Steps 4 to 10 of The Steps to Successful Breastfeeding in two hospitals accredited by the Baby-Friendly Hospital Initiative (BFHI group) with two not yet accredited hospitals in Salvador. METHODS: a cross-sectional study was conducted with 100 women in BFHI-accredited hospitals and 103 women in non-BFHI-accredited hospitals by collecting data on their obstetric history, any breast feeding counseling received during antenatal care, and data on delivery and hospitalization. Data were obtained by applying questionnaires and reviewing patients' medical charts. The chi-square test was used for bivariate variables and Student's t test for continuous variables. RESULTS: statistically significant differences (p<0.05) were found between the BFHI-accredited group and the non-BFHI group with respect to steps 5 (77 percent vs 35.9 percent), 6 (81 percent vs 31 percent), 8 (77 percent vs 52.4 percent), and 9 (100 percent vs 94.2 percent). No differences were found between the two groups with respect to steps 4, 7 or 10. Satisfactory compliance with the requirements of the Baby-Friendly Hospital Initiative in BFHIaccredited hospitals was found only with respect to steps 6, 7 and 9. CONCLUSIONS: these results highlight the benefits of BFHI accreditation but emphasize the need for continuous and systematic evaluation in order to promote breastfeeding and provide support in BFHIaccredited maternity hospitals.

OBJETIVOS: comparar o cumprimento dos Passos de 4 a 10 dos Dez Passos para o Sucesso do Aleitamento Materno nos hospitais credenciados pela Iniciativa Hospital Amigo da Criança (grupo IHAC) em relação a hospitais não credenciados em Salvador. MÉTODOS: um estudo de corte transversal foi conduzido com 100 mulheres no grupo IHAC e 103 mulheres no grupo não-IHAC através de entrevista abordando história obstétrica, orientações sobre aleitamento materno durante o pré-natal, informações sobre o parto e internamento. A coleta de dados foi realizada através da aplicação de questionários e pesquisa de prontuários. O teste do quiquadrado foi realizado para variáveis dicotômicas e o t de Student para variáveis contínuas. RESULTADOS: diferença estatisticamente significante (p<0,05) foi encontrada entre os grupos IHAC e não-IHAC na avaliação dos passos 5 (77 por cento vs 35,9 por cento), 6 (81 por cento vs 31 por cento), 8 (77 por cento vs 52,4 por cento), e 9 (100 por cento vs 94,2 por cento). Não houve diferença entre os dois grupos na avaliação dos passos 4, 7 ou 10. O cumprimento satisfatório nos hospitais do grupo IHAC foi encontrado na avaliação dos Passos 6, 7 e 9. CONCLUSÕES: os resultados evidenciam os benefícios do credenciamento na IHAC, mas enfatiza a necessidade de avaliação contínua e sistemática da promoção e suporte ao aleitamento materno nos hospitais credenciados pela IHAC.