Effect of educational intervention for compliance of school adolescents with the human papillomavirus vaccine

ABSTRACT Objective: to assess the effects of “Piss off, HPV!”, an educational intervention to increase adolescents’ knowledge, attitude and compliance with human papillomavirus vaccination. Method: a randomized clinical trial by cluster, carried out in six schools in two municipalities in Ceará, with 238 girls. The control group (n = 120) received routine instructions, and the intervention group (n = 118), printed message cards about the quadrivalent HPV vaccine. A pre- and post-intervention knowledge, attitude and practice survey was applied to both groups. The McNemar test, to analyze knowledge, attitude and pre- and post-intervention practice, the chi-square test, to compare compliance in relation to knowledge and attitude, and a logistic regression model, to assess vaccine compliance, were carried out. A significance level of 5% was adopted. Results: pre-intervention, knowledge was inadequate and attitude was adequate in both groups. Post-intervention, adequate knowledge and practices became greater in the intervention group. Adequate post-intervention knowledge and attitude, in addition to being 12 years of age or older, increase the chance for vaccination, explaining 70% of the practice. Conclusion: the educational intervention was effective for adolescents’ knowledge and compliance with the quadrivalent HPV vaccine. UTN: U1111-1254-5546; ReBEC: RBR-107hzdqt.

Efeito de intervenção educativa para adesão de adolescentes escolares à vacina contra o papilomavírus humano

RESUMO Objetivo: avaliar os efeitos da intervenção educativa “Sai fora, HPV!” para aumento do conhecimento, atitude e adesão de adolescentes à vacinação contra o papilomavírus humano. Método: ensaio clínico randomizado por conglomerado, realizado em seis escolas de dois municípios cearenses, com 238 meninas. O grupo controle (n = 120) recebeu orientações rotineiras, e o grupo intervenção (n = 118), cartões-mensagem impressos sobre a vacina HPV quadrivalente. Aplicou-se inquérito conhecimento, atitude e prática pré- e pós-intervenção em ambos os grupos. Realizaram-se Testes de McNemar, para analisar conhecimento, atitude e prática pré- e pós-intervenção, do Qui-Quadrado, para comparar adesão em relação ao conhecimento e atitude, e modelo de regressão logística, para avaliação da adesão à vacina. Adotou-se nível de significância 5%. Resultados: pré-intervenção, conhecimento era inadequado e atitude adequada em ambos os grupos. Pós-intervenção, conhecimento e práticas adequados se tornaram maior no grupo intervenção. Conhecimento e atitude adequados pós-intervenção, além da idade maior ou igual a 12, aumentam a chance para vacinação, explicando 70% da prática. Conclusão a intervenção educativa foi efetiva para conhecimento e adesão da vacina HPV quadrivalente pelas adolescentes. UTN: U1111-1254-5546; ReBEC: RBR-107hzdqt.

Telephone interventions in adherence to receiving the Pap test report: a randomized clinical trial

Objective:

to test the efficacy of the behavioral and educational interventions undertaken by telephone, for women’s attendance at the consultation to receive the Pap test report.

Method:

a randomized clinical trial, with a sample randomized in three groups: telephone call - educational (n=171), telephone call - reminder (n=171) and comparison (n=169). The inclusion criteria were to be of legal age, to have become sexually active, to undertake the preventive examination during the study and to have a mobile or fixed telephone. The educational group received a telephone call involving a script based in the motivational interview and in the Brazilian guidelines. The behavioral group received a telephone call involving a reminder about the consultation. The comparison group received a card with details of when to return for a consultation regarding the results.

Results:

the women who received one of the interventions had a non-return rate of 7.3% and an increase of 39% (RR CI95%: 1.24-1.55) in the protection against this outcome. In the individual analysis of the interventions, it was evidenced that both are efficacious, as the telephone call - reminder reduces the woman’s failure to return to the service by 40% (RR CI95%: 1.25-1.57), while the telephone call - educational does so by 37% (RR CI95%: 1.22-1.54). The rates of non-return were of 6.5% and 8.2%, respectively, as against 33.1% in the comparison group.

Conclusion:

the interventions tested showed greater efficacy in the educational and behavioral contexts, in relation to the normal attendance, as they motivated the women to return to the service to receive the Pap test report. Clinical trial register: RBR-w3vnc.

Comparison among the efficacy of interventions for the return rate to receive the pap test report: randomized controlled clinical trial

Objective:

to test the effects of a behavioral, an educative and a comparative intervention on women's adherence to the return appointment to receive the pap test report.

Methods:

randomized controlled clinical trial at a Primary Health Care Service, involving three groups: EG (educative session and test demonstration), BG (recall ribbon) and standard intervention (card containing the return appointment - graphical reminder), called comparative group here (CG). To select the sample, the following was established: having started sexual activity and undergoing the pap smear during the study, resulting in 775 women.

Results:

among the 775 women, 585 (75.5%) returned to receive the test result within 65 days. The educative group presented the highest return rate (EG=82%/CG=77%/BG=66%), statistically significant only when compared to the behavioral group (p=0.000). The educative group obtained the smallest interval (p<0.05) concerning the mean number of days of return to receive the test result (EG:M=43days/BG:M=47.5days/CG:M=44.8 days).

Conclusion:

the educative group reached higher return rates and the women returned earlier, but the behavioral intervention showed to be the least effective. Brazilian Clinical Trial Register: RBR-93ykhs.

PGC-1β regulates HER2-overexpressing breast cancer cells proliferation by metabolic and redox pathways

Breast cancer is a prevalent neoplastic disease among women worldwide which treatments still present several side effects and resistance. Considering that cancer cells present derangements in their energetic homeostasis, and that peroxisome proliferator-activated receptor- gamma coactivator 1 (PGC-1) is crucial for cellular metabolism and redox signaling, the main objective of this study was to investigate whether there is a relationship between PGC-1 expression, the proliferation of breast cancer cells and the mechanisms involved. We initially assessed PGC-1β expression in complementary DNA (cDNA) from breast tumor of patients bearing luminal A, luminal B, and HER2-overexpressed and triple negative tumors. Our data showed that PGC-1β expression is increased in patients bearing HER2-overexpressing tumors as compared to others subtypes. Using quantitative PCR and immunoblotting, we showed that breast cancer cells with HER2-amplification (SKBR-3) have greater expression of PGC-1β as compared to a non-tumorous breast cell (MCF-10A) and higher proliferation rate. PGC-1β expression was knocked down with short interfering RNA in HER2-overexpressing cells, and cells decreased proliferation. In these PGC-1β-inhibited cells, we found increased citrate synthase activity and no marked changes in mitochondrial respiration. Glycolytic pathway was decreased, characterized by lower intracellular lactate levels. In addition, after PGC-1β knockdown, SKBR-3 cells showed increased reactive oxygen species production, no changes in antioxidant activity, and decreased expression of ERRα, a modulator of metabolism. In conclusion, we show an association of HER2-overexpression and PGC-1β. PGC-1β knockdown impairs HER2-overexpressing cells proliferation acting on ERRα signaling, metabolism, and redox balance.

Development and validating an educational booklet for childbirth companions

Objective The article describes the steps in producing and validating an educational booklet for childbirth companions. Method Methodological study conducted in 2011 consisting of the following steps: situational assessment; establishing brochure content; content selection and referencing; drafting the text; design of illustrations; layout; consultation of specialists; consultation of target audience; amendments; proofreading; evaluation using the Flesch Reading Ease Formula. The topics portrayed the sequence of events involving support from gestation to the postpartum period. Results The concordance rate among companions was greater than or equal to 81.8% for the topics organisation, writing style, presentation and motives. The overall Content Validity Index of the booklet was 0.94. The booklet was classified as easy reading or very easy reading according to the results of the Flesch Reading Ease Formula. Conclusion The presentation and content of the manual were validated for use with the target audience by the specialists and representatives of the target audience.

[Pregnancy in adolescence description and analysis of care provided]

This work is aimed at describing and analyzing prenatal care to teenage women through the Brazilian Prenatal and Birth Humanization Program (BPBHP). It's a descriptive quantitative study conducted between March and July 2009 based on a form and interview with 200 teenage women during the postpartum period in a maternity ward of Sistema Unico de Satúde (Brazilian Unified Health System), which is considered a reference in obstetric care. The young women received prenatal care through the public service (96.4%) which began during the first trimester (47.4%), they didn't have the minimum medical appointments required (52.6%), took iron supplements (96.9%), received tetanus immunization (80.5%) and didn't have enough orientation (46.0%). The laboratory tests were performed during their first medical appointment (80.0%), but only a third were repeated in the third trimester. Therefore, the BPBHP doesn't meet all the standards set by the Ministéio da Saúde (Ministry of Health), and there are improvements to be made in the early service phase, ongoing care, demand for second exam samples and availability of orientation.

Exame físico no pré-natal: construção e validação de hipermídia educativa para a Enfermagem

OBJETIVO: Descrever o processo de desenvolvimento e validação de uma hipermídia educacional para graduandos e profissionais de enfermagem a respeito da técnica de realização do exame físico no pré-natal. MÉTODOS: Estudo de desenvolvimento, realizado entre junho e outubro de 2010, seguindo as etapas: levantamento do conteúdo, produção das mídias, organização do espaço aluno-tutor, elaboração, disponibilização e validação da hipermídia. RESULTADOS: Foram desenvolvidos hipertextos, hiperlinks, recursos audiovisuais, espaços de comunicação, avaliações e material de apoio. Os sete especialistas em enfermagem consideraram totalmente adequada a coerência da hipermídia para a prática de enfermagem e para a facilitação do processo ensino-aprendizagem. Dos três especialistas em Informática, dois consideraram totalmente adequada a funcionalidade da hipermídia. CONCLUSÃO: Construiu-se construiu uma hipermídia, utilizando diversos recursos midiáticos que a tornam apta a otimizar o processo ensino e aprendizagem e que foi validada por especialistas.

Análise da capacidade diagnóstica dos exames preventivos do câncer de colo uterino

OBJETIVO: Avaliar a capacidade diagnóstica dos exames citológicos, colposcópico e histológico na detecção de lesões pré-malignas. MÉTODOS: Estudo documental, retrospectivo, com abordagem quantitativa, realizado no Instituto de Prevenção do Câncer (IPC), em Fortaleza-CE. A população foi composta por prontuários de 112 mulheres que possuíam o resultado dos três exames. Adotou-se o teste de qui-quadrado e considerou-se estatisticamente significativo quando p < 0,05. Foram aplicados a sensibilidade e especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) para a citologia e colposcopia. RESULTADOS: A partir da comparação entre os exames diagnósticos observou-se que a citologia obteve uma sensibilidade de 89,8%, uma especificidade de 35,7%, um VPP de 90,7% e um VPN de 33,3%. A colposcopia alcançou uma sensibilidade de 84,7%, uma especificidade de 50%, um VPP de 92,2% e um VPN de 31,8%. CONCLUSÃO: Observou-se que esses exames apresentaram valores de sensibilidade e especificidade que podem alternar-se, indicando-se a associação de ambos para melhorar a acurácia do diagnóstico das lesões pré-malignas.

Análise da influência do acondicionamento diferenciado de lâminas para colpocitologia no resultado laboratorial

Objetivou-se verificar a influência das formas de acondicionamento de lâminas de colpocitologia nos resultados dos laudos laboratoriais concernentes a Epitélios Representativos da Amostra, Alterações Celulares Benignas e atipias celulares. Estudo descritivo, quantitativo, realizado entre abril e junho de 2008. Participaram 72 mulheres que realizaram exame preventivo do câncer de colo uterino, em um Centro de Parto Natural de Fortaleza-CE. De cada participante foram coletados dois esfregaços de espécime cérvico-vaginal: um foi acondicionado junto ao de outras usuárias (caso), e outro isoladamente (controle), atendendo aos padrões técnicos. Seguiu-se o critério de "cegagem" da leitura das lâminas. Os resultados das duas lâminas foram comparados verificando discordâncias nos diferentes armazenamentos. Houve discordância de 58,3% em relação aos Epitélios Representativos da Amostra e 48,2% com relação às Alterações Celulares Benignas. Os resultados sugerem novos estudos sobre formas de acondicionamento, controle da intrasubjetividade do técnico responsável pela leitura e ordem de coleta das lâminas caso e controle.

Ranking the toxicity of fatty acids on Jurkat and Raji cells by flow cytometric analysis

The fatty acids have an important role in the control of leukocyte metabolism and function. Higher concentrations of certain fatty acids, particularly polyunsaturated fatty acids (PUFAs) and volatile fatty acids, can cause cell death via apoptosis or, when concentrations are greater, necrosis. In this study, we determined the highest concentrations of various fatty acids that are non-toxic to two human leukemic cell lines, Jurkat (T-lymphocyte) and Raji (B-lymphocyte). Toxicity was evaluated by either loss of membrane integrity and/or DNA fragmentation using flow cytometric analysis. There were no remarkable differences for the toxicity of the fatty acids between B and T cell lines. The cytotoxicity of the fatty acids was related to the carbon chain length and number of double bonds: docosahexaenoic acid=eicosapentaenoic acid=arachidonic acid=gamma-linolenic acid=stearic acid=palmitic acid > linoleic acid=palmitoleic acid > vacenic acid=lauric acid > oleic acid > elaidic acid > capric acid > butyric acid > caprylic acid=caproic acid=propionic acid. The proportion of cells undergoing apoptosis or necrosis, induced by the fatty acids tested, remains to be investigated.

[Thyroid carcinoma in children and adolescents - review of six cases]

OBJECTIVE: Childhood thyroid carcinoma is a rare entity whose management is controversial. The objective of the present study was to evaluate the characteristics of these patients in terms of diagnosis and evolution. PATIENT AND METHODS: The evolution of six patients with thyroid cancer, followed at a Pediatric Endocrinology Unit during the past 17 years, was retrospectively reviewed. RESULTS: Six female patients with age ranging from 4.5 to 12 years were studied. In all 6 cases, thyroid nodules were present on the initial evaluation. Ultrasonography and 131I scintigraphy showed solid and cold nodules in four patients. Histologic findings indicated four papillary and two follicular carcinomas. All patients were submitted to total thyroidectomy; four were subsequently submitted to radiodine therapy due to the presence metastases and/or residual thyroid tissue. CONCLUSION: Our findings support the notion that children and adolescents with thyroid carcinoma have a positive prognosis; no cases of death occurred after 17 years of follow-up. Our data are in agreement with the literature, which describes low mortality rates for these cases.

Seven DNA polymorphisms at the candidate genes of atherosclerosis in Brazilian women with angiographically documented coronary artery disease

The possible association of genetic markers at the apolipoprotein E (HhaI polymorphism), apolipoprotein B (XbaI, EcoRI and Ins/Del polymorphisms), and low-density lipoprotein receptor (LDLR) (AvaII, HincII and PvuII polymorphisms) with coronary artery disease (CAD) was evaluated in 50 Brazilian women with CAD diagnosed by angiography and in 100 healthy women (controls). The frequency of E3/E4 genotype for HhaI polymorphism at the Apo E gene was significantly higher in CAD patients than in controls (40% vs. 14%, respectively, P<0.001). Similarly, the X-X- genotype for XbaI polymorphism was more frequent in CAD individuals than controls (42% vs. 12%, P<0.0001). The A+A+ and P1P1 genotypes for AvaII and PvuII polymorphisms at the LDLR locus were also higher in CAD subjects than controls (44% vs. 16%, P<0.001 and 64% vs. 39%, P<0.05, respectively). The estimated relative risks for CAD in women carrying the E3/E4, X-X-, A+A+ and P1P1 genotypes were 4.1 [95% confidence interval (CI), 3.0-5.6], 5.3 (95% CI, 3.8-7.5), 4.1 (95% CI, 3.0-5.5), and 2.8 (95% CI, 2.2-3.6), respectively. This study demonstrates that Apo E, Apo B and LDLR gene polymorphisms are associated with CAD in Brazilian Caucasian women.

A novel retron that produces RNA-less msDNA in Escherichia coli using reverse transcriptase

Bacterial retroelements, or retrons, use reverse transcriptase (RT) to produce a multicopy single-stranded DNA (msDNA) molecule that is covalently linked to RNA. In these studies we show that a retron from Escherichia coli 110, a clinical isolate, produces a novel RNA-less msDNA with a 5' phosphate residue. The msDNA is a 74-nucleotide single-stranded DNA molecule with a stable stem-loop structure without a mismatched base pair. Only the genes encoding msDNA (msd), msdRNA (msr), and RT (ret) are required to produce the msDNA molecule. The organization of these genes on the retron was similar to that of other elements producing branched msDNA-RNA. The conserved guanine, which is the branched residue in msDNA-RNA complexes and is essential for branch formation, is also present. Site-directed mutagenesis showed that this guanine is essential for the production of RNA-less msDNA. We postulate that the RNA-less msDNA in strain 110 is produced by nucleolytic cleavage of the branched msDNA-RNA compound.

Isolation and characterization of host mutants defective in msDNA synthesis: role of ribonuclease H in msDNA synthesis

In some Escherichia coli strains, a single-stranded DNA (msDNA) covalently linked to RNA is produced by a reverse transcriptase (RT) encoded by a genetic element called a retron. We have looked for host genes involved in msDNA synthesis. From screening of 10,000 mutants generated by Tn5 insertions, we obtained 3 chromosomal mutants defective msDNA synthesis. Analysis showed that all 3 mutants were affected in the gene for ribonuclease H (rnh). In rnh mutants, the reverse transcription products were heterogeneous with several sizes, smaller and bigger than the wild-type msDNA, showing that the reverse transcription is inhibited by the lack of RNase H activity. It also suggests that the RT recognizes the structure of msDNA for the termination of reverse transcription.

Virulence factors and biochemical characteristics of serotypes of Escherichia coli serogroup O29

Escherichia coli strains belonging to serogroup O29 were studied. Invasiveness was the most common virulence factor described in this serogroup, but a few papers also reported production of heat-stable (ST) enterotoxin. In the present study invasive ability was found in O29:H- strains, whereas production of ST-I enterotoxin was observed only in serotype O29:H21 strains, showing that virulence was a characteristic of specific serotypes or bioserotypes within the O29 serogroup. Different serotypes were found among strains that were neither invasive nor toxigenic. Invasive strains were biochemically less active than the toxigenic ones and presented the invasiveness plasmid (pINV) of about 120 to 140 megadaltons, whereas hybridization tests showed that ST-I production was related to a plasmid of about 90 megadaltons. A diffuse adherence pattern to HeLa cells was observed in all ST-I isolates, but the role of this adherence in the pathogenicity of these strains was not determined. Thus, a unique biochemical pattern and plasmid profile may be useful characteristics to distinguish between pathogenic (toxigenic or invasive) and nonpathogenic O29 strains.