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Lee D, Chen W, Kaku HN, Zhuo X, Chao ES, Soriano A, Kuncheria A, Flores S, Kim JH, Rivera A, Rigo F, Jafar-Nejad P, Beaudet AL, Caudill MS, Xue M. Antisense oligonucleotide therapy rescues disturbed brain rhythms and sleep in juvenile and adult mouse models of Angelman syndrome. eLife 2023; 12:e81892. [PMID: 36594817 PMCID: PMC9904759 DOI: 10.7554/elife.81892] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
UBE3A encodes ubiquitin protein ligase E3A, and in neurons its expression from the paternal allele is repressed by the UBE3A antisense transcript (UBE3A-ATS). This leaves neurons susceptible to loss-of-function of maternal UBE3A. Indeed, Angelman syndrome, a severe neurodevelopmental disorder, is caused by maternal UBE3A deficiency. A promising therapeutic approach to treating Angelman syndrome is to reactivate the intact paternal UBE3A by suppressing UBE3A-ATS. Prior studies show that many neurological phenotypes of maternal Ube3a knockout mice can only be rescued by reinstating Ube3a expression in early development, indicating a restricted therapeutic window for Angelman syndrome. Here, we report that reducing Ube3a-ATS by antisense oligonucleotides in juvenile or adult maternal Ube3a knockout mice rescues the abnormal electroencephalogram (EEG) rhythms and sleep disturbance, two prominent clinical features of Angelman syndrome. Importantly, the degree of phenotypic improvement correlates with the increase of Ube3a protein levels. These results indicate that the therapeutic window of genetic therapies for Angelman syndrome is broader than previously thought, and EEG power spectrum and sleep architecture should be used to evaluate the clinical efficacy of therapies.
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Affiliation(s)
- Dongwon Lee
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
- The Cain Foundation Laboratories, Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, United States
| | - Wu Chen
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
- The Cain Foundation Laboratories, Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, United States
| | - Heet Naresh Kaku
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
- The Cain Foundation Laboratories, Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, United States
| | - Xinming Zhuo
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, United States
| | - Eugene S Chao
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
- The Cain Foundation Laboratories, Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, United States
| | | | - Allen Kuncheria
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
| | - Stephanie Flores
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
| | - Joo Hyun Kim
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
- The Cain Foundation Laboratories, Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, United States
| | - Armando Rivera
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
- The Cain Foundation Laboratories, Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, United States
| | - Frank Rigo
- Ionis Pharmaceuticals, Carlsbad, United States
| | | | - Arthur L Beaudet
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, United States
| | - Matthew S Caudill
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
- Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, United States
| | - Mingshan Xue
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
- The Cain Foundation Laboratories, Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, United States
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, United States
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Flores S, San Sebastian M, De Alva P. Measuring the performance of health systems in Latin America. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Efficiency has been identified as a key intermediate policy objective for Universal Health Coverage. Despite that, it was estimated that 20 to 40% of health sector resource utilization is wasteful globally. An efficient use of existing resources in healthcare is critical and a priority policy in sustaining positive health outcomes for the population. This study aimed to perform a longitudinal efficiency analysis was found concerning health systems specific to all the Latin America region over the last 13 years.
Methods
Health Adjusted Life Expectancy (HALE), Diphtheria Pertussis Tetanus (DPT)Immunization and Survivability Rate of under-5 were chosen as outputs, while Pooled Health Expenditure, Gross Domestic Product (GDP) per Capita and Population over 65 were selected as inputs. Cross sectional Data Envelopment Analysis using five-year averages and a longitudinal Data Envelopment Analysis (DEA) were performed creating several model iterations with our selected indicators. All the models had an output orientation, adjusted for variable returns to scale and incorporating a five-year time lag between inputs and outputs.
Results
Our cross-sectional DEA Analysis found that the best performing country ended up being Nicaragua, followed by Cuba, Honduras, Costa Rica and Chile, while the countries performing the worst were Suriname, Venezuela and Guatemala. When observing efficiency scores behaviors longitudinally, all our model iterations result in the region decreasing efficiency in their health systems by 2.5% to 6.9% from 2000 to 2013, depending on the model chosen.
Conclusions
The study reveals that all countries in Latin American can improve their health systems efficiency performance to different extents. Latin America reduced total health system productivity between 2000 and 2013. Further studies are required to uncover the extent and causes of this regression. A similar analysis in Europe may be warranted and could aid policy making.
Key messages
• Overall efficiency in Latin American health systems has decreased by 3% to 7% over the last thirteen years.
• Nicaragua, Cuba, Honduras and Costa Rica seem to have the most efficient health systems in the region, whereas Venezuela and Guatemala are the least efficient.
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Affiliation(s)
- S Flores
- Institute for Public Health and Caring Science, Uppsala University , Uppsala, Sweden
| | - M San Sebastian
- Department of Epidemiology and Global Health, Umeå University , Umeå, Sweden
| | - P De Alva
- Institute for Public Health and Caring Science, Uppsala University , Uppsala, Sweden
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3
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Flores S, Feldman I, Sampaio F. Cost-effectiveness of two psychological treatments for the reduction of alcohol consumption. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Up to 7% of the Swedish population meets criteria for harmful use or alcohol dependency but only 10-20% seek treatment. One of the most recommended psychological treatments for controlled drinking is Motivational Enhancement Therapy (MET). Behavioural Self-Control Training (BSCT) is another treatment that is unique in that it is based on the psychology of learning and specifically focused on skills training. To our knowledge, no previous studies exist that evaluated the cost-effectiveness of BSCT for alcohol use disorders (AUD). The aim of this study is to assess the cost-effectiveness of BSCT compared to MET for patients with AUD aiming for controlled drinking over the longer-term from a societal perspective.
Methods
We modelled a cohort of patients with AUD who aim for controlled drinking, over a 10 year time horizon, and estimated the expected costs and outcomes of BSCT and MET. The model reflects the epidemiological transitions between drinking states, which reflect different levels of daily alcohol intake. Each drinking state is connected to temporary or long-term complications attributable to alcohol consumption, different costs and utilities. The data was sourced from a randomized trial evaluating the effectiveness of MET vs BSCT. Risks for complications and associated costs, utilities and mortality were sourced from the literature.
Results
Compared to MET, BSCT resulted in less total QALYs gained (4,7 vs 6,6 QALYs per patient). MET remains a cost effective treatment compared to BSCT [incremental cost-effectiveness ratio (ICER) = SEK 8497,79 per gained QALY] and a No Intervention scenario BSCT [incremental cost-effectiveness ratio (ICER) = SEK 16321,07 per gained QALY] at a threshold of 500.000 SEK per QALY.
Conclusions
This study suggests that MET should remain the recommended treatment for AUD patients with a goal of controlled drinking in favor of BSCT.
Key messages
• Motivational Enhancement Therapy should remain the recommended treatment for AUD patients with controlled drinking as their goal.
• A future study comparing Motivational Enhancemente Therapy to Behaivoral Self Control Training as recommended treatment in patients wanting to achieve abstinenece is suggested.
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Affiliation(s)
- S Flores
- Institute for Public Health and Caring Sciences, Uppsala University , Uppsala, Sweden
| | - I Feldman
- Institute for Public Health and Caring Sciences, Uppsala University , Uppsala, Sweden
| | - F Sampaio
- Institute for Public Health and Caring Sciences, Uppsala University , Uppsala, Sweden
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Hintermeier M, Gottlieb N, Oppenberg J, Mohsenpour A, Flores S, Rohleder S, Pernitez-Agan S, Lopez J, Wickramage K, Bozorgmehr K. COVID-19 among migrants, refugees, and IDPs: a synthesis of the global empirical literature. Eur J Public Health 2022. [PMCID: PMC9620535 DOI: 10.1093/eurpub/ckac131.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The COVID-19 syndemic reveals social and health inequalities, putting marginalized groups such as migrants at greater risk. Yet health systems fail to routinely monitor the health of migrants, refugees, and internally displaced persons. Our systematic review provides an up-to-date synthesis of the empirical evidence on COVID-19 infection risk, transmission, outcome of disease and risk of severe course of disease among migrant populations. It further aims to compile extant evidence on COVID-19 vaccination coverage among these groups, and on the effects of pandemic control measures on their health. Methods Following PRISMA guidelines, we registered a review protocol, searched 14 scientific databases and 4 pre-print servers using the WHO database of global literature on COVID-19, and hand-searched relevant websites for grey literature. The search period covers the time from 12/2019 to 11/30/2021. Articles in English, German and Spanish and all study designs were included. Results A total of 6966 references were identified for title and abstract screening. 518 records were screened in full-text, out of which 204 articles were included so far (conflict solving at full-text stage and data extraction are ongoing). Our review presents a broad landscape of different study designs, migrant populations and COVID-19 outcomes. Based on previous work, we expect to find a higher risk of infection in migrants and their disproportionate share among COVID-19 cases, and consolidate the (mental) health impacts of pandemic control measures. Our preliminary findings indicate a vast knowledge gap on vaccination coverage among migrant groups. Conclusions Two years into the syndemic, this review summarizes the global empirical evidence on the impact of the COVID-19 syndemic on migrant populations. With health systems often lacking related data, the review provides an important evidence base for the consideration of migrants in future pandemic preparedness policies. Key messages • The systematic review provides an up-to-date synthesis of the empirical evidence on COVID-19 among diverse migrant populations globally. • Knowledge on vaccination coverage in migrants remains patchy.
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Affiliation(s)
- M Hintermeier
- Department of General Practice and HSR, University Hospital Heidelberg , Heidelberg, Germany
- Departmentof Population Medicine and Health Research, Bielefeld University , Bielefeld, Germany
| | - N Gottlieb
- Departmentof Population Medicine and Health Research, Bielefeld University , Bielefeld, Germany
| | - J Oppenberg
- Departmentof Population Medicine and Health Research, Bielefeld University , Bielefeld, Germany
| | - A Mohsenpour
- Departmentof Population Medicine and Health Research, Bielefeld University , Bielefeld, Germany
| | - S Flores
- Department of Public Health and Caring Sciences, Uppsala University , Uppsala, Sweden
| | - S Rohleder
- Department of General Practice and HSR, University Hospital Heidelberg , Heidelberg, Germany
- Departmentof Population Medicine and Health Research, Bielefeld University , Bielefeld, Germany
| | - S Pernitez-Agan
- UN Migration Agency, International Organization for Migration , Manila, Philippines
| | - J Lopez
- UN Migration Agency, International Organization for Migration , Manila, Philippines
| | - K Wickramage
- UN Migration Agency, International Organization for Migration , Manila, Philippines
| | - K Bozorgmehr
- Department of General Practice and HSR, University Hospital Heidelberg , Heidelberg, Germany
- Departmentof Population Medicine and Health Research, Bielefeld University , Bielefeld, Germany
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Lewis T, Flores S, Sabacan L, Choy P, Thannickal H, Shieh Y, Tice J, Ziv E, Madlensky L, Eklund M, Yau C, Blanco A, Tong B, Goodman D, Anderson N, Harvey H, Fors S, Park HL, Raouf S, Stewart S, Wernisch J, Koenig B, Kaplan C, Hiatt R, Wenger N, Lee V, Heditsian D, Brain S, Moorehead D, Parker BA, Borowsky A, Anton-Culver H, Naeim A, Kaster A, van ‘t Veer L, LaCroix AZ, Olopade OI, Sheth D, Garcia A, Lancaster R, Plaza M, Fiscalini AS, Esserman L. Abstract P5-19-04: The WISDOM study: Reducing sequential steps and implementing parallel workflows in pragmatic trials. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-19-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:The WISDOM Study is a preference-tolerant pragmatic study, comparing annual mammograms to a risk-based screening. Eligibility includes women ages 40-74 years with no history of breast cancer or DCIS. Participants are enrolled to one study arm: annual screening or risk-based screening (includes genetic testing). Pragmatic trials often involve gathering real-time data over multiple time points. Collecting real-time data sequentially can limit enrollment, delay study assignments, and reduce participant engagement. The WISDOM Study has identified such bottlenecks and has implemented parallel workflows, reducing the overall wait time for participants to complete required study steps. These data highlight how moving participants through the study more efficiently can improve enrollment and retention and inform other pragmatic trials. Methods: WISDOM participants have the option to either choose their study arm or be randomized into one as part of the preference tolerant randomized trial design. Participants then complete breast health questionnaires and genetic testing (if in the risk-based arm). This information is analyzed by the WISDOM breast cancer risk assessment algorithm, the result of which is then communicated to the participant through a screening assignment letter (SAL). Specific data elements, such as breast density found participants’ mammogram reports and genetic testing results are required for study randomization process and risk assessment calculations, respectively. The WISDOM randomization algorithm is stratified by several factors, including breast cancer risk estimated using the Breast Cancer Surveillance Consortium (BCSC) model, which uses mammographic density as a key input variable. The study team changed the workflow to allow participants to proceed to randomization without specific information by imputing both density and risk. Additionally, a parallel workflow improvement process was implemented to obtain mammogram reports while genetic testing was being completed. Results: Before the weighted BCSC and imputed density algorithms were introduced, it took an average of 47 days to randomize participants after completion of the baseline enrollment questionnaires. Now, participants are randomized immediately which has reduced delays by 100%. Prior to implementing the parallel workflow for genetic testing and mammogram ascertainment, genetic testing kits were sent only after mammogram reports were collected and validated. The expected turnaround time for genetic testing results was 30-60 days and on average, results were returned to participants in 42 days. Streamlining the study design to obtain mammogram reports while participants complete their genetic testing has shortened the time for participants to receive their screening assignment letters (SALs) from an average of 160 days to 78 days, a reduction by 49%. In comparison, participants in the annual arm of the study who do not complete genetic testing, receive their SALs after an average of 38 days from enrollment. This is due to long wait times to obtain mammographic densities from outside medical facilities. Conclusions: Creating parallel data ascertainment workflows and reducing sequential steps in the study process has increased completion of individual enrollment activities. Participants now are randomized immediately upon joining the study and have access to their SALs and genetic results more rapidly. This approach eliminated randomization wait times and improved efficiency of the early in the enrollment process. We are evaluating the impact on participant retention going forward. Workflow efficiency is critical to improve the patient experience, and our learnings can inform future trial design, particularly for studies requiring data from outside sources.
Citation Format: Tomiyuri Lewis, Stephanie Flores, Leah Sabacan, Patricia Choy, Halle Thannickal, Yiwey Shieh, Jeffrey Tice, Elad Ziv, Lisa Madlensky, Martin Eklund, Christina Yau, Amie Blanco, Barry Tong, Deborah Goodman, Nancy Anderson, Heather Harvey, Steele Fors, Hannah L Park, Samrrah Raouf, Skye Stewart, Janet Wernisch, Barbara Koenig, Celia Kaplan, Robert Hiatt, Neil Wenger, Vivian Lee, Diane Heditsian, Susie Brain, Dolores Moorehead, Barbara A Parker, Alexander Borowsky, Hoda Anton-Culver, Arash Naeim, Andrea Kaster, Laura van ‘t Veer, Andrea Z LaCroix, Olufunmilayo I Olopade, Deepa Sheth, Agustin Garcia, Rachel Lancaster, Michael Plaza, Wisdom Study, Athena Breast Health Network Investigators, Advocate Partners, Allison S Fiscalini, Laura Esserman. The WISDOM study: Reducing sequential steps and implementing parallel workflows in pragmatic trials [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-19-04.
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Affiliation(s)
- Tomiyuri Lewis
- University of California, San Francisco, San Francisco, CA
| | | | - Leah Sabacan
- University of California, San Francisco, San Francisco, CA
| | - Patricia Choy
- University of California, San Francisco, San Francisco, CA
| | | | - Yiwey Shieh
- University of California, San Francisco, San Francisco, CA
| | - Jeffrey Tice
- University of California, San Francisco, San Francisco, CA
| | - Elad Ziv
- University of California, San Francisco, San Francisco, CA
| | | | | | - Christina Yau
- University of California, San Francisco, San Francisco, CA
| | - Amie Blanco
- University of California, San Francisco, San Francisco, CA
| | - Barry Tong
- University of California, San Francisco, San Francisco, CA
| | | | | | | | - Steele Fors
- University of California, San Diego, San Diego, CA
| | | | | | | | | | - Barbara Koenig
- University of California, San Francisco, San Francisco, CA
| | - Celia Kaplan
- University of California, San Francisco, San Francisco, CA
| | - Robert Hiatt
- University of California, San Francisco, San Francisco, CA
| | - Neil Wenger
- University of California, Los Angeles, Los Angeles, CA
| | - Vivian Lee
- University of California, San Francisco, San Francisco, CA
| | | | - Susie Brain
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | - Arash Naeim
- University of California, Los Angeles, Los Angeles, CA
| | | | | | | | | | | | | | | | | | | | - Laura Esserman
- University of California, San Francisco, San Francisco, CA
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6
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Choy P, Lewis T, Flores S, Sabacan L, Thannickal H, Goodman S, Shieh Y, Madlensky L, Tice JA, Ziv E, Eklund M, Blanco A, Tong B, Goodman D, Anderson N, Harvey H, Fors S, Park HL, Petruse A, Stewart S, Raouf S, Wernisch J, Koenig B, Kaplan C, Hiatt R, Wenger N, Lee V, Heditsian D, Brain S, Moorehead D, Parker BA, Borowsky A, Anton-Culver H, Naeim A, Kaster A, van 't Veer L, LaCroix AZ, Olopade OI, Sheth D, Garcia A, Lancaster R, James J, Joseph G, Study W, Fiscallini AS, Esserman L. Abstract P5-19-01: The impact of streamlined processes and patient-directed messaging to improve enrollment in a remote, pragmatic clinical trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-19-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Recent advances in technology have made it possible to conduct remote clinical trials that allow individuals to participate from home with comfort, privacy, and ease. Despite these advances, challenges persist in running remote trials, such as survey question redundancies, lack of patient-initiated data-sharing tools, and unclear patient communication around critical enrollment steps. The Women Informed to Screen Depending on Measures of risk (WISDOM) Study is a pragmatic, preference-tolerant randomized control breast cancer screening trial comparing personalized risk-based screening to traditional, annual screening. The study population includes women ages 40-74 without a history of breast cancer or DCIS. Since 2016, study enrollment has been available to all women in the U.S. who meet study eligibility criteria. Since October 2020, WISDOM has implemented multiple strategies to improve participant experience: participant-initiated data-sharing tools and clear participant messaging. This abstract presents the efficacy of these interventions as they relate to increasing patient enrollment in remote, pragmatic clinical trials. Methods The WISDOM Study online enrollment process includes registration, participant study arm selection or randomization, online consent, and enrollment (submission of multiple study surveys over a secure, online platform). Barriers to online enrollment were uncovered through an internally-conducted needs assessment of participants who enrolled between 2019-2020, and participant feedback obtained through phone interviews conducted by WISDOM’s embedded ethics study. Improvements to our online enrollment procedures were executed in October 2020 and included: improving the clarity of study arm selection options, streamlining data collection surveys, and enacting a secure, patient-initiated online data-sharing tool and an online portal feature with auto-launch of critical information. Study metrics were obtained through Google Analytics and Salesforce. Results Prior to the end of 2020, only 62% of the 30,046 participants who registered for the WISDOM Study completed study enrollment. After improving the enrollment process, of the 5,334 participants registered for the study between Jan-June 2021, 69% completed the enrollment process finishing both the online consent and survey forms. Conversion from consent to enrollment went from 78% in January 2020 to 93% in June 2021. Currently, 56% participants complete enrollment in one day. Streamlining online patient questionnaires led to an increase in completion rates, with 75% of participants completing their yearly surveys, compared to 59% prior to April 2021. A secure patient upload feature for data sharing led to 1,054 participants successfully sharing their mammogram reports with WISDOM between March - June 2021. Previously, mammogram reports were missing for 20% of enrolled participants. This feature has enabled WISDOM to process 300 additional mammogram reports per month. Integration of an auto-launch feature in the participant’s portal in Feb 2021 has led to a 17% increase in participants viewing their screening recommendations in Yr 1. Prior to auto-launch, only 59% (n=6328) of Yr 1 screening recommendations and 61% (n=3681) of genetic testing reports were viewed by participants. Since implementation, the numbers increased to 78% (n=8406) and 85% (n=5160), respectively. Conclusions. Streamlining data to the most essential elements, and minimizing the steps required to share clinical documents, complete questionnaires and open key study notification is essential to improving enrollment rates in virtual, pragmatic trials. Patient-initiated data-sharing tools such as the ability for participants to share documents through secure, online portals is one example of success.
Citation Format: Patricia Choy, Tomiyuri Lewis, Stephanie Flores, Leah Sabacan, Halle Thannickal, Steffanie Goodman, Yiwey Shieh, Lisa Madlensky, Jeffrey A. Tice, Elad Ziv, Martin Eklund, Amie Blanco, Barry Tong, Deborah Goodman, Nancy Anderson, Heather Harvey, Steele Fors, Hannah Lui Park, Antonia Petruse, Skye Stewart, Samrrah Raouf, Janet Wernisch, Barbara Koenig, Celia Kaplan, Robert Hiatt, Neil Wenger, Vivian Lee, Diane Heditsian, Susie Brain, Dolores Moorehead, Barbara A Parker, Alexander Borowsky, Hoda Anton-Culver, Arash Naeim, Andrea Kaster, Laura van 't Veer, Andrea Z LaCroix, Olufunmilayo I. Olopade, Deepa Sheth, Agustin Garcia, Rachel Lancaster, Jennifer James, Galen Joseph, Wisdom Study, Athena Breast Health Network Investigators and Advocates, Allison Stover Fiscallini, Laura Esserman. The impact of streamlined processes and patient-directed messaging to improve enrollment in a remote, pragmatic clinical trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-19-01.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Elad Ziv
- UC San Francisco, San Francisco, CA
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Bailey NJ, Rockett TBO, Flores S, Reyes DF, David JPR, Richards RD. Effect of MBE growth conditions on GaAsBi photoluminescence lineshape and localised state filling. Sci Rep 2022; 12:797. [PMID: 35039503 PMCID: PMC8763887 DOI: 10.1038/s41598-021-04477-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/17/2021] [Indexed: 11/09/2022] Open
Abstract
A series of gallium arsenide bismide device layers covering a range of growth conditions are thoroughly probed by low-temperature, power-dependent photoluminescence measurements. The photoluminescence data is modelled using a localised state profile consisting of two Gaussians. Good agreement with the raw data is achieved for all layers whilst fixing the standard deviation values of the two Gaussians and constraining the band gap using X-ray diffraction data. The effects of growth temperature and bismuth beam equivalent pressure on the localised state distributions, and other model variables, are both shown to be linked to emission linewidth and device properties. It is concluded that bismuth rich surface conditions are preferable during growth in order to produce the narrowest emission linewidths with this material. These results also show how the growth mode of a gallium arsenide bismide layer can be inferred ex-situ from low-temperature photoluminescence measurements.
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Affiliation(s)
- N J Bailey
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
| | - T B O Rockett
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
| | - S Flores
- University Research Institute on Electron Microscopy & Materials, (IMEYMAT), Universidad de Cádiz, Puerto Real, 11510, Cádiz, Spain
| | - D F Reyes
- University Research Institute on Electron Microscopy & Materials, (IMEYMAT), Universidad de Cádiz, Puerto Real, 11510, Cádiz, Spain
| | - J P R David
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK
| | - R D Richards
- Department of Electronic and Electrical Engineering, University of Sheffield, Sheffield, UK.
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Lima-Oliveira G, Brennan-Bourdon LM, Varela B, Arredondo ME, Aranda E, Flores S, Ochoa P. Clot activators and anticoagulant additives for blood collection. A critical review on behalf of COLABIOCLI WG-PRE-LATAM. Crit Rev Clin Lab Sci 2020; 58:207-224. [PMID: 33929278 DOI: 10.1080/10408363.2020.1849008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In the clinical laboratory, knowledge of and the correct use of clot activators and anticoagulant additives are critical to preserve and maintain samples in optimal conditions prior to analysis. In 2017, the Latin America Confederation of Clinical Biochemistry (COLABIOCLI) commissioned the Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) to study preanalytical variability and establish guidelines for preanalytical procedures to be applied by clinical laboratories and health care professionals. The aim of this critical review, on behalf of COLABIOCLI WG-PRE-LATAM, is to provide information to understand the mechanisms of the interactions and reactions that occur between blood and clot activators and anticoagulant additives inside evacuated tubes used for laboratory testing. Clot activators - glass, silica, kaolin, bentonite, and diatomaceous earth - work by surface dependent mechanism whereas extrinsic biomolecules - thrombin, snake venoms, ellagic acid, and thromboplastin - start in vitro coagulation when added to blood. Few manufacturers of evacuated tubes state the type and concentration of clot activators used in their products. With respect to anticoagulant additives, sodium citrate and oxalate complex free calcium and ethylenediaminetetraacetic acid chelates calcium. Heparin potentiates antithrombin and hirudin binds to active thrombin, inactivating the thrombin irreversibly. Blood collection tubes have improved continually over the years, from the glass tubes containing clot activators or anticoagulant additives that were prepared by laboratory personnel to the current standardized evacuated systems that permit more precise blood/additive ratios. Each clot activator and anticoagulant additive demonstrates specific functionality, and both manufacturers of tubes and laboratory professional strive to provide suitable interference-free sample matrices for laboratory testing. Both manufacturers of in vitro diagnostic devices and laboratory professionals need to understand all aspects of venous blood sampling so that they do not underestimate the impact of tube additives on laboratory testing.
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Affiliation(s)
- G Lima-Oliveira
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - L M Brennan-Bourdon
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Comisión Para la Protección Contra Riesgos Sanitarios del Estado de Jalisco (COPRISJAL), Secretaria de Salud, Guadalajara, México
| | - B Varela
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Quality Assurance, LAC, Montevideo, Uruguay
| | - M E Arredondo
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Management Area, Clinical Laboratory, BIONET S.A, Santiago, Chile
| | - E Aranda
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Laboratory of Thrombosis and Hemostasis, Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S Flores
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Clinical Laboratory, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - P Ochoa
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Facultad de Medicina, Universidad Católica de Cuenca, Cuenca, Ecuador
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Burke LS, Kalyanaraman K, Flores S, Khong T, Selover D, Rusch-Salazar L. Influenza A Virus Escape Mutations and their Effects on Binding Affinity. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.06914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Lamattina D, Venzal JM, Costa SA, Arrabal JP, Flores S, Berrozpe PE, González-Acuña D, Guglielmone AA, Nava S. Ecological characterization of a tick community across a landscape gradient exhibiting differential anthropogenic disturbance in the Atlantic Forest ecoregion in Argentina. Med Vet Entomol 2018; 32:271-281. [PMID: 29368343 DOI: 10.1111/mve.12295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/10/2017] [Accepted: 12/03/2017] [Indexed: 06/07/2023]
Abstract
An ecological analysis of a tick (Ixodida: Ixodidae) community across a landscape gradient presenting differential anthropogenic disturbance in the Atlantic Forest ecoregion in Argentina was performed. Ticks were collected from vegetation and hosts between September 2014 and August 2016. A total of 12 697 free-living ticks and 3347 specimens from hosts were collected, including 317 ticks infesting humans. The values obtained show considerable species diversity in the forest environment accompanied by low equitability. The similarity index derived from a comparison of forest and agricultural environments was higher than that calculated by comparing forest and urban environments. The data suggest that although a cycle of one generation per year is apparent in some species, more than one cohort may co-exist within the populations of some of these species. Well-marked patterns of the seasonal distribution of free-living tick species emerged in environments with no anthropic modification. The results indicate that forest environments are more suitable habitats than agricultural and urban environments for many species of native tick, but are unsuitable for exotic species that have successfully established in environments that have been modified by man.
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Affiliation(s)
- D Lamattina
- Instituto Nacional de Medicina Tropical (INMeT), Ministerio de Salud de la Nación, Puerto Iguazú, Argentina
| | - J M Venzal
- Laboratorio de Vectores y Enfermedades Transmitidas, Facultad de Veterinaria, CENUR Litoral Norte-Salto, Universidad de la República, Salto, Uruguay
| | - S A Costa
- Instituto Nacional de Medicina Tropical (INMeT), Ministerio de Salud de la Nación, Puerto Iguazú, Argentina
| | - J P Arrabal
- Instituto Nacional de Medicina Tropical (INMeT), Ministerio de Salud de la Nación, Puerto Iguazú, Argentina
| | - S Flores
- Instituto Nacional de Medicina Tropical (INMeT), Ministerio de Salud de la Nación, Puerto Iguazú, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - P E Berrozpe
- Instituto Nacional de Medicina Tropical (INMeT), Ministerio de Salud de la Nación, Puerto Iguazú, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - D González-Acuña
- Departamento de Ciencia Animal, Facultad de Ciencias Veterinarias, Universidad de Concepción, Chillán, Chile
| | - A A Guglielmone
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Instituto Nacional de Tecnología Agropecuaria, Estación Experimental Agropecuaria Rafaela, Rafaela, Argentina
| | - S Nava
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- Instituto Nacional de Tecnología Agropecuaria, Estación Experimental Agropecuaria Rafaela, Rafaela, Argentina
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11
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Clague DeHart J, Rosen C, Wong L, Moore S, Flores S, Salehian B, Mortimer J. Abstract P2-13-06: Pancreatic nutrition program (PNP): A novel weight reduction program for breast cancer survivors. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-13-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Breast cancer survivors have a high prevalence of metabolic dysfunction—characterized by high glucose and weight gain. Regardless of menopausal status, overweight and obese women are at increased risk for developing breast cancer and those who are diagnosed with breast cancer experience adverse cancer-related outcomes. The underlying principle of the Pancreatic Nutrition Program (PNP) is that bio-individualized healthy food choices—eating the correct foods and food combinations for an individual's body—can minimize fluctuations in insulin by keeping blood glucose regulated (70-100 mg/dL) and this will promote sustained weight loss, improved health, and quality of life. METHODS: The primary endpoint was change in body weight at 24 weeks post-PNP. The study was powered to detect a 10% loss of weight from baseline. Secondary endpoints included change in: glucose levels, insulin resistance, body composition, body chemistry, physical fitness, biological markers, quality of life, and compliance. Postmenopausal, non-diabetic breast cancer survivors (stages I-III) within 5 years of completion of treatment who had a body mass index of 25-33 kg/m2 were recruited. For the first 12 weeks, patients wore a glucometer (Abbott), which recorded glucose every 15 minutes continuously, and kept a food journal. During weekly meetings, glucometer data was reviewed with journal entries to identify food choices and combinations that would kept the subject's glucose levels between 70-100 mg/dL. At the end of the 12-weeks, the weekly meetings and glucometer were discontinued and patients were expected to maintain the PNP for an additional 12 weeks. Study endpoints were measured at baseline, 12-week and 24-week visits. RESULTS: Of the 21 patients enrolled in the study, 12 were non-Hispanic Caucasian, 5 were Hispanic, 2 were African-American, and 2 were Asian. The median age was 56 years (43-76 years). Twenty were estrogen-receptor positive, 18 progesterone-receptor positive, and 8 were HER2/neu positive. The mean body weight at baseline was 170.9 lbs (±20.4 lbs). Two patients dropped out prior to 12-weeks and 1 developed recurrent disease. Among the 18 eligible women who completed the first 12 weeks, the median weight loss at 12-weeks was 10.1 lbs (1.5-19.6 lbs). The median waist circumference lost was 2.5 inches (gain of 0.4 inches-loss of 5.5 inches). Among the women whose total cholesterol was above 200 mg/dL, 71% reduced their cholesterol below 200 mg/dL by 12-weeks. All women who had triglyceride levels above 150 mg/dL reduced their levels below 150 mg/dL by 12-weeks. Likewise, among women who were identified as being pre-diabetic based on fasting glucose or hemoglobin A1c levels, all were within normal range at 12-weeks. 6-month testing will be completed in August. Among the 15 women eligible for 6-month testing, 8 (53%) completed the testing. Of those, 7 (88%) maintained their positive results. CONCLUSIONS: Bio-individualized food choices based on glucose response combined with culturally-sensitive nutrition counseling may provide a feasible mechanism for sustainable weight loss in a population at high-risk of metabolic dysfunction. However, to increase adherence, a tapering strategy should be developed after the first 12-weeks of health counseling.
Citation Format: Clague DeHart J, Rosen C, Wong L, Moore S, Flores S, Salehian B, Mortimer J. Pancreatic nutrition program (PNP): A novel weight reduction program for breast cancer survivors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-13-06.
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Affiliation(s)
- J Clague DeHart
- Beckman Research Institute of the City of Hope, Duarte, CA; City of Hope National Medical Center, Duarte, CA
| | - C Rosen
- Beckman Research Institute of the City of Hope, Duarte, CA; City of Hope National Medical Center, Duarte, CA
| | - L Wong
- Beckman Research Institute of the City of Hope, Duarte, CA; City of Hope National Medical Center, Duarte, CA
| | - S Moore
- Beckman Research Institute of the City of Hope, Duarte, CA; City of Hope National Medical Center, Duarte, CA
| | - S Flores
- Beckman Research Institute of the City of Hope, Duarte, CA; City of Hope National Medical Center, Duarte, CA
| | - B Salehian
- Beckman Research Institute of the City of Hope, Duarte, CA; City of Hope National Medical Center, Duarte, CA
| | - J Mortimer
- Beckman Research Institute of the City of Hope, Duarte, CA; City of Hope National Medical Center, Duarte, CA
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Genevois C, de Escalada Pla M, Flores S. Novel strategies for fortifying vegetable matrices with iron and Lactobacillus casei simultaneously. Lebensm Wiss Technol 2017. [DOI: 10.1016/j.lwt.2017.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Flores S, Montoya P, Ruiz-Montoya L, Villaseñor A, Valle A, Enkerlin W, Liedo P. Population Fluctuation of Ceratitis capitata (Diptera: Tephritidae) as a Function of Altitude in Eastern Guatemala. Environ Entomol 2016; 45:802-811. [PMID: 27247307 DOI: 10.1093/ee/nvw051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/08/2016] [Indexed: 06/05/2023]
Abstract
Population fluctuations of Ceratitis capitata (Wiedemann) were evaluated over a period of 12 mo in four altitudinal strata (400-750, 750-1,100, 1,100-1,450, and 1,450-1,800 meters above sea level, masl) in Eastern Guatemala. Within each altitudinal range, sampling plots were established in coffee plantations and adjacent areas, in which Jackson traps were set and baited with Trimedlure. Coffee berries and other host fruits were collected. Population density was lowest at the 400-750 masl stratum and highest at 1,450-1,800 masl. At every altitudinal range, the fluctuations of the pest were associated mainly with the availability of ripe coffee berries as a primary host. From 750-1,450 masl, the pest was also associated with the availability of sweet orange and mandarins in commercial and backyard orchards. The highest densities of the pest were recorded in the dry season. Citrus were the main alternate host where ripe coffee berries were not available. This knowledge on population dynamics of C. capitata will contribute to develop more effective area-wide pest management strategies including the use of sterile insects, natural enemies, and bait sprays.
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Affiliation(s)
- S Flores
- El Colegio de la Frontera Sur, Tapachula, Chiapas, Mexico (; ), Moscafrut Program SAGARPA-IICA Metapa de Domínguez, Chiapas, Mexico ,
| | - P Montoya
- Moscafrut Program SAGARPA-IICA Metapa de Domínguez, Chiapas, Mexico
| | - L Ruiz-Montoya
- El Colegio de la Frontera Sur, San Cristóbal de las Casas, Chiapas, Mexico
| | - A Villaseñor
- Co-direction of Regional Medfly Program Mexico - Guatemala - USA (; ; ), and
| | - A Valle
- Co-direction of Regional Medfly Program Mexico - Guatemala - USA (; ; ), and
| | - W Enkerlin
- Co-direction of Regional Medfly Program Mexico - Guatemala - USA (; ; ), and Insect Pest Control Section, Joint FAO/IAEA Division, Vienna, Austria
| | - P Liedo
- El Colegio de la Frontera Sur, Tapachula, Chiapas, Mexico (; )
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Ciancio G, Tryphonopoulos P, Gaynor J, Guerra G, Sageshima J, Roth D, Chen L, Kupin W, Mattiazzi A, Tueros L, Flores S, Hanson L, Powell R, Ruiz P, Vianna R, Burke G. Pilot Randomized Trial of Tacrolimus/Everolimus vs Tacrolimus/Enteric-Coated Mycophenolate Sodium in Adult, Primary Kidney Transplant Recipients at a Single Center. Transplant Proc 2016; 48:2006-10. [DOI: 10.1016/j.transproceed.2016.03.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/19/2016] [Accepted: 03/01/2016] [Indexed: 10/21/2022]
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15
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Clague DeHart J, Cheung-Wong L, Smith R, Flores S, Mortimer J. Abstract P4-10-10: The City of Hope breast cancer survivorship study: A longitudinal look at symptoms. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-10-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Breast cancer survivors report many symptoms post treatment. However, longitudinal data, including pre-treatment measures, are scarce making it difficult to accurately attribute symptoms, as patients experience many changes; hormonal fluctuation, chemotherapy, additive endocrine therapy. Therefore, we undertook this longitudinal study to distinguish the impact of these different treatments along the survivorship time course, starting with time at diagnosis.
METHODS: Female, breast cancer survivors completed symptom questionnaires (Qx) pre-treatment (pre-tx), at 6-months follow-up (during-tx) and 12-months (post-tx) follow-up. Women rated symptoms in the past week as not at all, a little bit, somewhat, quite a bit, and very much. Symptoms included, hot flashes, vaginal discharge, vaginal itching, vaginal dryness, pain during intercourse, loss of interest in intercourse, weight gain, dizziness, vomiting diarrhea, headaches, abdominal bloating, breast sensitivity, mood swings, irritability, and joint pain. Additional measures included view of overall health, overall pain in the past month, and average fatigue in the past week. Chi-square tests were conducted across time points and stratified by menopausal status and type of treatment. Symptom changes from baseline, clustered by subject, were entered into a generalized estimating equation (GEE) models.
RESULTS: Of the 237 breast cancer survivors (median pre-tx age: 53 years, range: 24-70), who completed the pre-tx Qx, 112 completed the 6-month Qx and 95 completed the 12-month Qx. Women reported an increase in hot flashes from pre-tx to 6-months (p<0.001) and pre-tx to 12-months (p=0.04), with a slight decrease from 6 to 12 months (p=0.19). An increase in vomiting was observed from pre-tx to 6-months (p=0.04). Women reported an increase in vaginal discharge from pre-tx to 12-months (p=0.04), and a decrease in average fatigue in the past week from pre-tx to 12-months (p=0.04). Both overall pain in the past month and joint pain in the past week increased from pre-tx to 6-months and then decreased below pre-tx levels at 12-months (p=0.03 and p=0.12, respectively). Changes in hot flashes, vaginal dryness, pain during intercourse and weight gain were only observed among premenopausal women, while changes in vaginal discharge were only observed among postmenopausal women. GEE modeling showed associations between the use of endocrine therapy and increased hot flashes (Odds Ratio [OR]: 2.60, 95% Confidence Interval [CI]: 1.97-3.42), vaginal discharge (1.38; 1.15-1.66), pain during intercourse (1.34; 1.05-1.72), weight gain (1.61; 1.22-2.12) and joint pain (1.90; 1.48-2.45). By 12-months, severity of all symptoms decreased, except for vaginal discharge. Associations were observed between the use of chemotherapy and decreased weight gain (OR: 0.66, 95% CI: 0.48-0.91) and decreased breast sensitivity (0.67; 0.49-0.93).
CONCLUSIONS: Several symptoms thought to be related to treatment may actually be present at time of diagnosis and many treatment-related symptoms appear to decrease by 12-months. Severity appears to be modified by menopausal status and type of treatment. Our results give crucial insight for the development of effective symptom-based management and intervention along the treatment time course.
Citation Format: Clague DeHart J, Cheung-Wong L, Smith R, Flores S, Mortimer J. The City of Hope breast cancer survivorship study: A longitudinal look at symptoms. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-10-10.
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Wong L, Chung C, Flores S, Mortimer J. Abstract P1-10-23: Bladder symptoms in women with newly diagnosed breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-10-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Changes in bladder function are recognized effects of aging and menopause but have not generally been reported in women treated for breast cancer. We initiated a prospective trial to assess the impact of (neo) adjuvant therapy on women with early stage breast cancer.
Methods: Women with newly diagnosed invasive breast cancer who were to initiate (neo) adjuvant chemotherapy or endocrine therapy were approached for study participation. At baseline a urinalysis, urine culture, and self assessment quality of life questionnaires were completed. The Urogenital Distress Inventory (UDI-6) assesses bladder symptoms and the Incontinence Impact Questionnaire (IIQ-7) assesses the impact of bladder symptoms on quality of life. Three months after initiation of (neo)adjuvant therapy, the quality of life questionnaires were repeated. We report the results of the pretreatment questionnaires.
Results: Between February and June, 2015, forty-nine women with newly diagnosed breast cancer were enrolled on study. The median age was 54 (Range 25-78); 21 were premenopausal and 28 postmenopausal. Twenty nine (59%) were treated in the adjuvant setting; 12 with chemotherapy and 17 with endocrine therapy. Twenty patients, (41%) were treated in the neoadjuvant setting with chemotherapy. Prior to initiation of therapy, " Frequent urination" was reported in 38 (65%), " Leakage related to urgency" in 5 ( 10%), " Leakage with physical activity" in 32 (55%) and "Small amounts of leakage" in 32 (55%). Bladder symptoms impacted the ability to perform household chores in 8 (16%), Physical recreation in 10 (20%), social activities in 9 (18%), and Emotional health in 5 (10%).
Conclusions: Symptoms of bladder dysfunction are common in women with newly diagnosed breast cancer even before therapy is initiated.
Citation Format: Wong L, Chung C, Flores S, Mortimer J. Bladder symptoms in women with newly diagnosed breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-23.
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Affiliation(s)
- L Wong
- City of Hope National Medical Center, Duarte, CA; The Angeles Clinic, Los Angeles, CA
| | - C Chung
- City of Hope National Medical Center, Duarte, CA; The Angeles Clinic, Los Angeles, CA
| | - S Flores
- City of Hope National Medical Center, Duarte, CA; The Angeles Clinic, Los Angeles, CA
| | - J Mortimer
- City of Hope National Medical Center, Duarte, CA; The Angeles Clinic, Los Angeles, CA
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Boatright D, Simon J, Jarou Z, Tunson J, Flores S, Woods C, Heron S, Gisondi M, Druck J. 167 Factors Important to Underrepresented Minority Applicants When Selecting an Emergency Medicine Program. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Valdés J, Flores S, Fuentes E, Osorio-Fuentealba C, Jaimovich E, Molina A. IGF-1 Induces IP3-dependent Calcium Signal Involved in the Regulation of Myostatin Gene Expression Mediated by NFAT During Myoblast Differentiation. J Cell Physiol 2015. [DOI: 10.1002/jcp.24846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Flores S, Davis M, Pittelkow M, Sandroni P, Weaver A, Fealey R. Abnormal sweating patterns associated with itching, burning and tingling of the skin indicate possible underlying small-fibre neuropathy. Br J Dermatol 2015; 172:412-8. [DOI: 10.1111/bjd.13576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 01/29/2023]
Affiliation(s)
- S. Flores
- Department of Dermatology; Mayo Clinic; 200 First St SW Rochester MN 55905 U.S.A
| | - M.D.P. Davis
- Department of Dermatology; Mayo Clinic; 200 First St SW Rochester MN 55905 U.S.A
| | - M.R. Pittelkow
- Department of Dermatology; Mayo Clinic; 200 First St SW Rochester MN 55905 U.S.A
- Department of Biochemistry and Molecular Biology; Mayo Clinic; 200 First St SW Rochester MN 55905 U.S.A
| | - P. Sandroni
- Department of Neurology; Mayo Clinic; 200 First St SW Rochester MN 55905 U.S.A
| | - A.L. Weaver
- Division of Biomedical Statistics and Informatics; Mayo Clinic; 200 First St SW Rochester MN 55905 U.S.A
| | - R.D. Fealey
- Department of Neurology; Mayo Clinic; 200 First St SW Rochester MN 55905 U.S.A
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Genevois C, Flores S, de Escalada Pla M. Effect of iron and ascorbic acid addition on dry infusion process and final color of pumpkin tissue. Lebensm Wiss Technol 2014. [DOI: 10.1016/j.lwt.2014.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Parikh MP, Krishnan S, Ganipisetti VM, Flores S. Classic image: peripheral blood smear in a case of Plasmodium falciparum cerebral malaria. Case Reports 2014; 2014:bcr-2014-205820. [DOI: 10.1136/bcr-2014-205820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Flores S, Zuloaga R, Retamales A, Andrade C, Pino K, Molina A, Valdes J. P5.78 IGF-1 induces myostatin expression through differential activation of the signaling pathways PI3K/Akt, Calcineurin/NFAT, ERK/CREB, CamK-MEF, Smad2/3 during myoblast proliferation and differentiation. Neuromuscul Disord 2011. [DOI: 10.1016/j.nmd.2011.06.1106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cicalini S, Almodovar S, Grilli E, Flores S. Pulmonary hypertension and human immunodeficiency virus infection: epidemiology, pathogenesis, and clinical approach. Clin Microbiol Infect 2011; 17:25-33. [DOI: 10.1111/j.1469-0691.2010.03286.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Valencia P, Flores S, Wilson L, Illanes A. Batch reactor performance for enzymatic synthesis of cephalexin: influence of catalyst enzyme loading and particle size. J Biotechnol 2010. [DOI: 10.1016/j.jbiotec.2010.08.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mansergh G, Flores S, Koblin B, Hudson S, McKirnan D, Colfax GN. Alcohol and drug use in the context of anal sex and other factors associated with sexually transmitted infections: results from a multi-city study of high-risk men who have sex with men in the USA. Sex Transm Infect 2009; 84:509-11. [PMID: 19028957 DOI: 10.1136/sti.2008.031807] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Men who have sex with men (MSM) who use alcohol and drugs are at especially high risk for sexually transmitted infections (STIs); more information is needed about associated factors to improve risk reduction. We assessed reported STIs and demographic and event-level alcohol and drug use characteristics associated with STIs in a diverse, multi-city study in the USA of MSM who use substances. Improved risk reduction efforts are needed for this group as well as some initiatives tailored to men who are HIV positive, younger and use drugs (not alcohol) in the context of anal sex.
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Affiliation(s)
- G Mansergh
- CDC Divison of HIV/AIDS Prevention, 1600 Clifton Rd, Mailstop E37, Atlanta 30333, USA.
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Zimmerman M, Flores S. 210. Autoimmune-Mediated Vascular Injury in the Setting of Type I Diabetes. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chillo S, Flores S, Mastromatteo M, Conte A, Gerschenson L, Del Nobile M. Influence of glycerol and chitosan on tapioca starch-based edible film properties. J FOOD ENG 2008. [DOI: 10.1016/j.jfoodeng.2008.02.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Petrache I, Diab K, Knox KS, Twigg HL, Stephens RS, Flores S, Tuder RM. HIV associated pulmonary emphysema: a review of the literature and inquiry into its mechanism. Thorax 2008; 63:463-9. [PMID: 18443163 DOI: 10.1136/thx.2007.079111] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Chronic lung diseases are increasingly recognised complications of the human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). Of these, pulmonary emphysema, characterised by permanent destruction of the lung parenchyma distal to the terminal bronchioles accompanied by various degrees of inflammation, is emerging as a distinct source of morbidity for patients infected with HIV. Similarly, HIV is now frequently cited as a susceptibility factor for the development of emphysema, independent of cigarette smoking status. The presence of common coexistent confounding factors that may predispose patients to chronic lung injury such as drugs, opportunistic infections and malnutrition, limits the scope of studies of direct mechanisms involved in HIV associated emphysematous lung disease. We review the clinical studies supporting a direct association between HIV infection and emphysema. Recent developments in the basic understanding of HIV infection and emphysema are also reviewed, since they may aid in understanding the pathobiology of HIV associated emphysema. The authors emphasise how HIV infection may affect cytotoxic lymphocyte activation, lung capillary endothelial cell injury and apoptosis, sphingolipid imbalance and oxidative stress in the lung. A better understanding of the pathogenesis of HIV associated pulmonary emphysema may provide clues and therapeutic targets that have broader application in this disease, including cigarette smoke induced emphysema.
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Affiliation(s)
- I Petrache
- Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Indiana University, Van Nuys Medical Science Building, 635 Barnhill Drive, MS224, Indianapolis, IN 46202-5120, USA.
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Ruiz-Aragón J, García-Agudo L, Flores S, Rodríguez MJ, Marín P, García-Martos P. [Susceptibility to antimicrobial agents of rapidly growing mycobacteria]. Rev Esp Quimioter 2007; 20:429-432. [PMID: 18563216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Rapidly growing mycobacteria are often associated with human diseases. We investigated the in vitro susceptibilities of 40 isolates to six antimicrobial agents: 17 Mycobacterium fortuitum, 11 M. chelonae and 12 M. abscessus isolated from several human sources: 29 respiratory secretions, 5 cutaneous abscesses, 4 corneal ulcers and 2 urine samples of patients treated at "Hospital Puerta del Mar" (Cádiz). Susceptibility studies were determined by the broth microdilution method for amikacin, clarithromycin, ciprofloxacin, levofloxacin, imipenem and cefoxitin. Results suggest that amikacin is the most effective antimicrobial agent for treating infections due to rapidly growing mycobacteria. Clarithromycin and imipenem show good activity against M. fortuitum and M. abscessus, but not against M. chelonae. Quinolones are only effective against M. fortuitum. It's important to identify, in rapidly growing mycobacteria infections, the etiologic agent to determine correct treatment.
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Affiliation(s)
- J Ruiz-Aragón
- Servicio de Microbiología, Hospital Universitario Puerta del Mar, Cádiz, Spain.
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Ortega J, Flores S, Roqueta J, Pujol M, Cañadas S, Domínguez P, Balcells J. O.83. ¿Es útil el BIS en el manejo de la sedación del paciente crítico pediátrico? An Pediatr (Barc) 2007. [DOI: 10.1016/s1695-4033(07)70559-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Quintero J, Ortega J, Bueno J, Flores S, Roqueta J. Predictive value of indocyanine green clearance in acute liver failure in children: comparison with King's College and Clichy scores. Crit Care 2007. [PMCID: PMC4095451 DOI: 10.1186/cc5558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Crudeli G, Pochon D, Olazarri M, Monzón N, Chaparro L, Flores S, Patiño E, Cedrés J. Morphometric evaluation of male Mediterranean buffaloes in Northern Corrientes, Argentina. Italian Journal of Animal Science 2007. [DOI: 10.4081/ijas.2007.s2.1281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ramirez-Cacho WA, Flores S, Schrader RM, McKay J, Rayburn WF. Effect of chronic maternal methadone therapy on intrapartum fetal heart rate patterns. ACTA ACUST UNITED AC 2006; 13:108-11. [PMID: 16443503 DOI: 10.1016/j.jsgi.2005.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Treatment of maternal opioid dependence with methadone is associated with a delay in fetal heart rate (FHR) accelerations in nonstress tests. The objective of this investigation was to determine the effect of methadone maintenance therapy on intrapartum FHR patterns. METHODS This retrospective cohort study compared intrapartum FHR tracings from 56 methadone-treated patients > or =36 weeks gestation with a control group of nonsubstance using patients matched for maternal age, parity, gestational age, and ethnicity. Blinded FHR interpretation included the recording of baseline, variability, accelerations, and late or severe variable decelerations. The 8-point FHR scoring system was based on the National Institute of Child Health and Human Development Research Planning Workshop guidelines. We considered a 25% reduction in the score during the latent phase to be significant. RESULTS The median maintenance dose of methadone was 70 mg daily, with a range between 20 mg and 130 mg. Each patient tested negative for other substances on urine screening before admission. The significantly lower FHR score in the methadone group (mean difference, 1.4; 95% confidence interval, 1.1 to 1.7) was attributed to a lower baseline (P <.05), less moderate or marked variability (P <.01), and a lower proportion of accelerations during the first stage of labor (P <.01). A higher proportion of methadone-exposed fetuses had late or severe variable decelerations in the second stage (44.2% vs 22.9%; P <.03). Analgesic needs, operative vaginal or cesarean delivery rates, and Apgar scores less than 7 at 1 and 5 minutes were not significantly different between the two groups. CONCLUSIONS Chronic maternal methadone treatment affects intrapartum FHR patterns by reducing the variability, baseline, and proportion of accelerations during the first stage. These subtle drug-induced effects do not compromise intrapartum decision-making or immediate newborn adjustments.
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Affiliation(s)
- William Andres Ramirez-Cacho
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, University of New Mexico, Albuquerque, New Mexico 87111, USA.
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Rugo H, Dickler, Traina Y, Scott J, Moore D, Brogi E, Bruckner J, Flores S, Hudis C, Park J. A phase II trial of letrozole in combination with bevacizumab in patients with hormone receptor-positive metastatic breast cancer: Correlation of response with circulating endothelial (CEC) and epithelial cells (CTC). EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)80415-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Grauch J, Flores S. 151 IMMUNOGLOBULIN G FRACTION OF SERUM FROM PREDIABETIC PATIENTS INCREASES REDUCED NICOTINAMIDE-ADENINE-DINUCLEOTIDE PHOSPHATE OXIDASE-MEDIATED OXIDATIVE STRESS ON HUMAN ENDOTHELIAL CELLS IN VITRO. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Grauch J, Flores S. Immunoglobulin G Fraction of Serum from Prediabetic Patients Increases Reduced Nicotinamide-Adenine-Dinucleotide Phosphate Oxidase–Mediated Oxidative Stress on Human Endothelial Cells in Vitro. J Investig Med 2006. [DOI: 10.1177/108155890605401s35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Dickler M, Rugo H, Caravelli J, Brogi E, Sachs D, Panageas K, Flores S, Moasser M, Norton L, Hudis C. Phase II trial of erlotinib (OSI-774), an epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor, and bevacizumab, a recombinant humanized monoclonal antibody to vascular endothelial growth factor (VEGF), in patients (pts) with metastatic breast cancer (MBC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.2001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Dickler
- Memorial Sloan-Kettering Cancer Cancer, New York, NY; University of California, San Francisco, CA
| | - H. Rugo
- Memorial Sloan-Kettering Cancer Cancer, New York, NY; University of California, San Francisco, CA
| | - J. Caravelli
- Memorial Sloan-Kettering Cancer Cancer, New York, NY; University of California, San Francisco, CA
| | - E. Brogi
- Memorial Sloan-Kettering Cancer Cancer, New York, NY; University of California, San Francisco, CA
| | - D. Sachs
- Memorial Sloan-Kettering Cancer Cancer, New York, NY; University of California, San Francisco, CA
| | - K. Panageas
- Memorial Sloan-Kettering Cancer Cancer, New York, NY; University of California, San Francisco, CA
| | - S. Flores
- Memorial Sloan-Kettering Cancer Cancer, New York, NY; University of California, San Francisco, CA
| | - M. Moasser
- Memorial Sloan-Kettering Cancer Cancer, New York, NY; University of California, San Francisco, CA
| | - L. Norton
- Memorial Sloan-Kettering Cancer Cancer, New York, NY; University of California, San Francisco, CA
| | - C. Hudis
- Memorial Sloan-Kettering Cancer Cancer, New York, NY; University of California, San Francisco, CA
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Flores S, Gosset G, Flores N, de Graaf AA, Bolívar F. Analysis of carbon metabolism in Escherichia coli strains with an inactive phosphotransferase system by (13)C labeling and NMR spectroscopy. Metab Eng 2002; 4:124-37. [PMID: 12009792 DOI: 10.1006/mben.2001.0209] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We have developed Escherichia coli strains that internalize glucose utilizing the GalP permease instead of the phosphoenolpyruvate:carbohydrate phosphotransferase system. It has been demonstrated that a strain with these modifications (PTS(-)Glc(+)) can direct more carbon flux into the aromatic pathway than the wild-type parental strain (N. Flores et al., 1996, Nat. Biotechnol. 14, 620-623; G. Gosset et al., 1996, J. Ind. Microbiol. 17, 47-52; J. L. Baéz et al., 2001, Biotechnol. Bioeng. 73, 530-535). In this study, we have determined and compared the carbon fluxes of a wild-type strain (JM101), a PTS(-)Glc(-) strain, and two isogenic PTS(-)Glc(+) derivatives named PB12 and PB13 by combining genetic, biochemical, and NMR approaches. It was determined that in these strains a functional glk gene in the chromosome is required for rapid glucose consumption; furthermore, glucokinase-specific activities were higher than in the wild-type strain. (13)C labeling and NMR analysis allowed the determination of differences in vivo which include higher glycolytic fluxes of 93.1 and 89.2% compared with the 76.6% obtained for the wild-type E. coli. In PB12 and PB13 we found a flux through the malic enzymes of 4 and 10%, respectively, compared to zero in the wild-type strain. While flux through the Pck enzyme was absent in PB12 and PB13, in the wild type it was 7.7%. Finally, it was found that in the JM101 and PB12 strains both the oxidative and the nonoxidative branches of the pentose phosphate pathway contributed to ribose 5-phosphate synthesis, whereas in PB13 this pentose was synthesized almost exclusively through the oxidative branch. The determined carbon fluxes correlate with biochemical and genetic characterizations.
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Affiliation(s)
- S Flores
- Departamento de Microbiología Molecular, Instituto de Biotecnología, Universidad Nacional Autónoma de México, 62250 Cuernavaca, México
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Faggioni R, Cattley RC, Guo J, Flores S, Brown H, Qi M, Yin S, Hill D, Scully S, Chen C, Brankow D, Lewis J, Baikalov C, Yamane H, Meng T, Martin F, Hu S, Boone T, Senaldi G. IL-18-binding protein protects against lipopolysaccharide- induced lethality and prevents the development of Fas/Fas ligand-mediated models of liver disease in mice. J Immunol 2001; 167:5913-20. [PMID: 11698468 DOI: 10.4049/jimmunol.167.10.5913] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IL-18-binding protein (IL-18BP) is a natural IL-18 inhibitor. Human IL-18BP isoform a was produced as fusion construct with human IgG1 Fc and assessed for binding and neutralizing IL-18. IL-18BP-Fc binds human, mouse, and rat IL-18 with high affinity (K(D) 0.3-5 nM) in a BIAcore-based assay. In vitro, IL-18BP-Fc blocks IL-18 (100 ng/ml)-induced IFN-gamma production by KG1 cells (EC(50) = 0.3 microg/ml). In mice challenged with an LD(90) of LPS (15 mg/kg), IL-18BP-Fc (5 mg/kg) administered 10 min before LPS blocks IFN-gamma production and protects against lethality. IL-18BP-Fc administered 10 min before LPS blocks IFN-gamma production induced by LPS (5 mg/kg) with ED(50) of 0.005 mg/kg. Furthermore, IL-18BP-Fc (5 mg/kg) abrogates LPS (5 mg/kg)-induced IFN-gamma production even when administered 6 days before LPS but shows no effect when administered 9 or 12 days before LPS. Given 10 min before LPS challenge to mice primed 12 days in advance with heat-killed Propionibacterium acnes, IL-18BP-Fc prevents LPS-induced liver damage and IFN-gamma and Fas ligand expression. Given at the moment of priming with P. acnes, IL-18BP-Fc decreases P. acnes-induced granuloma formation, macrophage-inflammatory protein-1alpha and macrophage-inflammatory protein-2 production and prevents sensitization to LPS. IL-18BP-Fc also prevents Con A-induced liver damage and IFN-gamma and Fas ligand expression as well as liver damage induced by Pseudomonas aeruginosa exotoxin A or by anti-Fas agonistic Ab. In conclusion, IL-18BP can be engineered and produced in recombinant form to generate an IL-18 inhibitor, IL-18BP-Fc, endowed with remarkable in vitro and in vivo properties of binding and neutralizing IL-18.
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Affiliation(s)
- R Faggioni
- Amgen, Inc., Thousand Oaks, CA 91320, USA.
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de la Torre S, Gilson GJ, Flores S, Curet LB, Qualls CE, Rayburn WF. Is high-dose misoprostol able to lower the incidence of cesarean section? A randomized controlled trial. J Matern Fetal Med 2001; 10:85-90. [PMID: 11392598 DOI: 10.1080/714052723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether high-dose (100 microg) misoprostol was able to increase the rate of successful labor induction and lower the incidence of Cesarean section without adverse fetal effects. METHODS A total of 360 women were randomized to receive either oxytocin (n = 192) by intravenous infusion, or misoprostol (n = 168) 100 microg intravaginally every 4 h. The Cesarean section rate was the primary end-point. Incidences of uterine and fetal heart rate abnormalities during labor and adverse neonatal outcomes were assessed as secondary end-points. RESULTS Compared with those women receiving oxytocin, patients given misoprostol had a significantly shortened labor (10.7+/-6.0 vs. 15.4+/-10.4 h, p < 0.001). The Cesarean section rate did not differ between patients receiving misoprostol or oxytocin (36 (21.4%) vs. 38 (19.8%), p = 0.79) despite a sample size adequate to detect a 13 percentage point difference in this outcome. Patients receiving misoprostol had a higher incidence of the hyperstimulation syndrome (27 (16.1%) vs. 9 (4.7%), p < 0.001), and of fetal intolerance of labor as an indication for Cesarean delivery (23 (63.9%) vs. 15 (39.5%), p = 0.06), and had a greater number of umbilical artery cord blood pH findings of< 7.20 (20 (43.5%) vs. 6 (17.1%), p = 0.02). These worrisome trends on interim analysis resulted in our prematurely terminating the study. CONCLUSION High-dose intravaginal misoprostol did not reduce the Cesarean section rate and was associated with a greater hazard of fetal intolerance of labor.
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Affiliation(s)
- S de la Torre
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque 87131, USA
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Torre SDL, Gilson GJ, Flores S, Curet LB, Qualls CE, Rayburn WF. Is high-dose misoprostol able to lower the incidence of Cesarean section? A randomized controlled trial. J Matern Fetal Neonatal Med 2001. [DOI: 10.1080/jmf.10.2.85.90] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pérez-Cuevas R, Reyes H, Guiscafré H, Juárez-Díaz N, Oviedo M, Flores S, Muñoz O. The primary care clinic as a setting for continuing medical education: program description. CMAJ 2000; 163:1295-9. [PMID: 11107467 PMCID: PMC80340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
The Mexican Institute of Social Security (IMSS) is Mexico's Largest state-financed health care system, providing care to 50 million people. This system comprises 1450 family medicine clinics staffed by 14,000 family physicians, as well as 240 secondary care hospitals and 10 tertiary care medical centres. We developed a program of continuing medical education (CME) for IMSS family physicians. The program had 4 stages, which were completed over a 7-month period: development of clinical guidelines, training of clinical instructors, an educational intervention (consisting of interactive workshops, individual tutorials and peer group sessions), and evaluation of both physicians' performance and patients' health status. The pilot study was conducted in an IMSS family medicine clinic providing care to 45,000 people; 20 family physicians and 4 clinical instructors participated. The 2 main reasons for visits to IMSS family medicine clinics are acute respiratory infections and type 2 diabetes mellitus. Therefore, patients being treated at the clinic for either of these illnesses were included in the study. The sources of data were interviews with physicians and patients, clinical records and written prescriptions. A 1-group pretest-posttest design was used to compare physicians' performance in treating the 2 illnesses of interest. We found that the daily activities of the clinic could be reorganized to accommodate the CME program and that usual provision of health care services was maintained. Physicians accepted and participated actively in the program, and their performance improved over the course of the study. We conclude that this CME strategy is feasible, is acceptable to family physicians and may improve the quality of health care provided at IMSS primary care facilities. The effectiveness and sustainability of the strategy should be measured through an evaluative study.
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Affiliation(s)
- R Pérez-Cuevas
- Epidemiological Investigation and Health Services Research Unit, Mexican Institute of Social Security, Mexico City, Mexico.
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Abstract
In response to abscisic acid (ABA), the duckweed Spirodela polyrrhiza (L.) activates a developmental pathway that culminates in the formation of dormant structures known as turions. Levels of the mRNA encoding D-myo-inositol-3-phosphate synthase (EC.5.5.1.4) which converts glucose-6-phosphate to inositol-3-phosphate, increase early in response to ABA. In order to understand the role of this enzyme in turion formation, we have investigated changes in inositol metabolism in ABA-treated plants. Here, we show that ABA-treatment leads to a 3-fold increase in free inositol, which peaks 2 d after treatment. This increase is followed by sequential increases in inositol phosphates and in accumulation of inositol hexakis-phosphate (InsP6), in particular. In addition, we observed an early increase in a novel inositol bisphosphate which is not directly on the pathway to InsP6. In control plants, we observed synthesis and turnover of both inositol pentakisphosphate and InsP6. Two compounds more polar than InsP6 (diphosphoinositol polyphosphates) were present in both ABA-treated and control plants. Together, this suggests that the role of InsP6 in plants may be more complex than simply that of a storage compound during dormancy.
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Affiliation(s)
- S Flores
- Institute of Plant Sciences, Plant Biochemistry and Physiology, ETH Zürich, Switzerland
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Flores S, Opazo H, Valderrama D, Aguilera R, Marchese A, Valderrama S. [Triple therapy of short-term with azithromycin, amoxycillin and omeprazole for the eradication of Helicobacter pylori]. Rev Med Chil 2000. [PMID: 11008354 DOI: 10.4067/s0034-98872000000500008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The high cost and complexity of therapeutic schemes for the eradication of Helicobacter pylori has stimulated the search of simpler and cheaper treatment options. AIM To evaluate the efficacy of 3 days of azithromycin 500 mg od, 7 days of amoxycillin 750 mg tid and omeprazole, 20 (Group A) or 40 mg (Group B) on randomization, as a treatment for Helicobacter pylori infection in patients with endoscopically diagnosed peptic ulcer. METHODS H. pylori status of peptic ulcer patients was pathologically confirmed by the examination of five gastric biopsies using the Giemsa stain and by rapid urease testing in two gastric biopsies. H. pylori status was reassessed not less than 28 days after completing treatment. Adverse events and compliance were evaluated. RESULTS Fifty four patients (29 men, 25 women, mean age 48 years) were enrolled, 28 in Group A and 27 in Group B. Per protocol the infection was cured in 58.8% of patients (30/51; 95% CI: 45-73%). On an intention to treat basis, H pylori infection was cured in 55%. Minor side effects including diarrhea and nausea were reported by 32% of patients. Ninety-five per cent of patients consumed more than 95% of prescribed medications. H. pylori was successfully eradicated in 61% of group A and 57% of group B patients (p = NS). CONCLUSION Short term therapy with azithromycin was poorly effective in curing H. pylori infection. The compliance was excellent. Increasing Omeprazole from 20 to 40 mg/day did not improve treatment effectiveness.
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Affiliation(s)
- S Flores
- Departmento de Gastroenterologia, Hospital Valparaíso, Universidad de Valparaíso.
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Abstract
In order to investigate the genomic compatibility between allopatric rodent species, Phyllotis darwini and Phyllotis magister, we have studied several cytogenetic and reproductive features of their laboratory hybrids. Of thirty-one pairings between species, only five were successful, producing eleven newborns. Like parents, hybrids had 38 metacentric chromosomes, except for the subtelocentric Y chromosome inherited from P. magister. There was almost total C and G band correspondence between homeologous autosomes. However, parental sex chromosomes had different morphology, C and G bands. Ag-NOR bands appeared as small telomeric Ag+ regions, distributed in four chromosomal pairs of darwini, three of magister and four homeologous chromosomes of the hybrids. The three forms had similar indexes of NOR activity per cell, in spite of the variability in NOR expression which was always detected. Usually, only one member of parental homologous chromosomes showed AgNOR+; nevertheless, both homeologous chromosomes were active in many hybrid cells. The frequencies of cells that expressed their ribosomal genes in the two homologous or homeologous NOR chromosomes were similar in parental and hybrid cells. These results strongly suggest that ribosomal genes of both parental genomes would function codominantly in the hybrids. The gonad histological and morphometric analyses showed that hybrids conformed to Haldane's rule, since females were fertile and males were infertile. Our results indicate that P. darwini and P. magister genomes can function in relative harmony and compatibility when they are placed together in their laboratory generated hybrids, suggesting that these species have few genetic differences, probably because they have recently diverged.
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Affiliation(s)
- L I Walker
- Laboratorio de Citogenética Evolutiva de Mamíferos, Facultad de Medicina, Universidad de Chile.
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Crespo-Hernández CE, Flores S, Torres C, Negrón-Encarnación I, Arce R. Photochemical and photophysical studies of guanine derivatives: intermediates contributing to its photodestruction mechanism in aqueous solution and the participation of the electron adduct. Photochem Photobiol 2000; 71:534-43. [PMID: 10818783 DOI: 10.1562/0031-8655(2000)071<0534:pipaps>2.0.co;2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The low-intensity steady-state (254 nm), microsecond flash and nanosecond (266 nm) laser photolysis of some guanine (Gua) derivatives in aqueous solution were studied. A photodestruction yield between 10(-3) and 10(-2) at a base concentration of 75 microM was determined for 254 nm irradiation at room temperature using high-performance liquid chromatography. This yield decreases with increasing purine concentration. For a similar concentration of the purine bases (2 +/- 1) x 10(-5) M, the yield increases as follows: Gua approximately 9-ethylguanine < deoxyguanosine approximately guanosine (Guo) < guanosine 5'-monophosphate. At concentrations higher than 2 x 10(-4) M the Gua derivatives' photodestruction yield seems to converge to a limiting value of the order of 10(-4). This behavior is explained in terms of self-quenching and aggregation effects which deactivate the excited states of the bases. The yields of electron photoejection have been determined in the nanosecond laser photolysis (0.083) and in the low-intensity steady-state (5.8 x 10(-3)) for Guo. Competition experiments using electron scavengers suggest that the electron adducts of the bases are one of the principal species participating in the photodestruction mechanism of these monomeric Gua. Close to 75% of the total destruction yield has contributions from initial reactions of the photojected electron at neutral pH. The quantum yield of photodestruction of Guo increases when the pH is increased as follows: 4.7 x 10(-3) (pH 1.1), 6.5 x 10(-3) (pH 2.9), 7.7 x 10(-3) (pH 7.5) and 8.1 x 10(-3) (pH 11.9). This dependence on pH and the electron scavenger experiments provide further evidence for the radical anion or its protonated form as one of the principal species involved in the photodestruction of the bases at the different pH. Under oxygen saturated conditions a 22% increase in the destruction yield is observed for Guo. However, for the dinucleotides adenylyl (3'-->5')-guanosine and thymidylyl (3'-->5')2'-deoxyguanosine, the participation of the electron is 41 and 36%, respectively, suggesting that going into a more DNA or RNA-like structure, the participation of the electron adducts species in the photodamage of DNA and RNA decreases. A mechanism of photodestruction for the Gua derivatives is proposed which takes into account these findings.
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Flores S, García-Lorda P, Munné C, Salas-Salvadó J. [Training in dietetics and nutrition from the point of view of the primary care physician]. NUTR HOSP 2000; 15:45-50. [PMID: 10846893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND AND GOALS Professionals in primary health care have to face a large number of patients with pathologies arising out of nutritional and dietary disorders as well as cope with society's growing interest in such issues. For this reason, we have attempted to assess the extent of the knowledge in questions of nutrition and dietetics that primary health care doctors feel they have received in comparison with what they might have considered necessary, as well as assess the capacity that these doctors feel they have to cope with clinical situations requiring a knowledge of nutrition. SCOPE AND SUBJECTS: 250 doctors working in Primary Health Care and belonging to the Tarragona Province Medical Association. ACTION Participants received a self-administered questionnaire in which they had to: a) answer closed questions on their sense of clinical ability to handle dietary and nutritional problems; b) give a score for the importance that 62 previously-defined subjects should have in their general medical training; and c) give a score for the attention paid to these topics during their undergraduate training. RESULTS 36 doctors (age: 38.6 +/- 10 years) with an average accumulated experience in medicine of 12.5 +/- 9.2 years replied to the survey. Respondents reported that 42.5 +/- 25% of their patients required nutritional or dietary action and only 28 +/- 24% receive the same. As for their undergraduate training in nutrition, 19.4% of them considered it to be non-existent and 58.4% described it as insufficient. Respondents reported little ability to handle different clinical situations, particularly involving the identification of patients requiring secondary vitamin therapy or nutritional support and the prescription of low lactose diets. Except for the area of biochemistry and nutritional physiology, respondents reported a great discrepancy between the attention that should have been given during their undergraduate years to the subjects proposed and the training they really received, particularly in questions of clinical dietetics, diet and the prevention of disease as well as nutritional support in disease. CONCLUSIONS The undergraduate training in questions of dietetics and nutrition is clearly seen to be scant according to primary health care physicians. This might explain in part the insufficient clinical capacity that these professionals feel they have in such matters and the high percentage of patients who do not receive the nutritional and dietary attention these doctors feel is necessary.
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Affiliation(s)
- S Flores
- Unitat de Nutrició Humana, Facultat de Medicina i Ciènces de la Salut de Reus, Universitat Rovira i Virgili, España
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Affiliation(s)
- D Saxena
- Department of Biology, New York University, New York 10003, USA
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Pérez-Cuevas R, Reyes H, Pego U, Tomé P, Ceja K, Flores S, Gutiérrez G. Immunization promotion activities: are they effective in encouraging mothers to immunize their children? Soc Sci Med 1999; 49:921-32. [PMID: 10468396 DOI: 10.1016/s0277-9536(99)00178-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Mass media communication is an important strategy for increasing parental uptake and to promote community participation when large-scale immunization activities are carried out. In Mexico, the National Vaccination Council (CONAVA) launches three immunization campaigns every year accompanied by three vaccination promotion campaigns. This study was conducted to assess whether communication activities to promote CONAVA's Second National Health Week (SNHW) were effective in providing information to mothers about the importance of immunizing their children under five years of age and in prompting them to seek immunization services. A probability sample of mothers living in the metropolitan area of Mexico City and having at least one child under five years old was selected for the study. Four outcome variables were defined as measuring the impact of the campaign: (1) mothers' knowledge about the SNHW; (2) mothers' comprehension indicating how well they understood the campaign messages (aware, partly aware and unaware); (3) mothers' motivation, i.e. whether or not they sought out immunizations for their children under the age of five and (4) mothers' opinion of how well they liked the messages. A total of 935 mothers were interviewed; 88.2% knew about the SNHW, 64.3% were aware that the campaign aimed to provide immunizations, and most held a favorable opinion about the messages. Among aware mothers, 87.5% of their children received immunizations. In this group 72.1% were prompted by the information in the campaign to seek immunizations for their children while 27.9% had to be personally invited to participate in the campaign. The latter occurred either when health workers or volunteers visited mothers in their homes or by soliciting mothers' participation as they visited or passed by immunization health posts. In the unaware mothers group, 72.7% of their children received immunizations; 62.5% of the mothers took their children because of information they received through the campaign while 37.5% had to be personally invited to immunize their children. Mothers with better socioeconomic status were more aware of the campaign, but a high percentage of them did not seek immunizations, while mothers with middle and lower socioeconomic status were motivated to immunize their children through the campaign. Promotion activities and messages communicated through the mass media were appropriate to inform and motivate mothers to seek immunization services for their children.
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Affiliation(s)
- R Pérez-Cuevas
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Doctores Mexico DF, Mexico.
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Pérez-Cuevas R, Guiscafré H, Reyes H, Juárez N, Espinosa F, Flores S, Oviedo M. Evaluation of an educational intervention directed at family physicians using a clinical-teaching center strategy. J Clin Epidemiol 1999. [DOI: 10.1016/s0895-4356(99)80122-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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