Barriers to Pediatric Sickle Cell Disease Guideline Recommendations.

National guidelines recommend that providers counsel all patients with sickle cell anemia about hydroxyurea (HU) therapy and screen children with sickle cell anemia annually for the risk of stroke with transcranial Doppler (TCD). We surveyed a national convenience sample of sickle cell disease clinicians to assess factors associated with low adherence. Adherence was 46% for TCD screening. Low adherence was associated with a lack of outcome expectancy (eg, a belief that there would be poor patient follow-up to TCD testing; P < .05). Adherence was 72% for HU counseling. Practice barriers (eg, lack of support staff or time) and a lack of agreement with HU recommendations were associated with low adherence (P < .05). This study demonstrates that different types of strategies are needed to improve TCD screening (to address follow-up and access to testing) versus HU counseling (to address physician agreement and practice barriers)

Intracellular trafficking and cellular uptake mechanism of PHBV nanoparticles for targeted delivery in epithelial cell lines

Indexación: Web of Science; Scopus; Scielo.Background: Nanotechnology is a science that involves imaging, measurement, modeling and a manipulation of matter at the nanometric scale. One application of this technology is drug delivery systems based on nanoparticles obtained from natural or synthetic sources. An example of these systems is synthetized from poly(3-hydroxybutyrate-co-3-hydroxyvalerate), which is a biodegradable, biocompatible and a low production cost polymer. The aim of this work was to investigate the uptake mechanism of PHBV nanoparticles in two different epithelial cell lines (HeLa and SKOV-3). Results: As a first step, we characterized size, shape and surface charge of nanoparticles using dynamic light scattering and transmission electron microscopy. Intracellular incorporation was evaluated through flow cytometry and fluorescence microscopy using intracellular markers. We concluded that cellular uptake mechanism is carried out in a time, concentration and energy dependent way. Our results showed that nanoparticle uptake displays a cell-specific pattern, since we have observed different colocalization in two different cell lines. In HeLa (Cervical cancer cells) this process may occur via classical endocytosis pathway and some internalization via caveolin-dependent was also observed, whereas in SKOV-3 (Ovarian cancer cells) these patterns were not observed. Rearrangement of actin filaments showed differential nanoparticle internalization patterns for HeLa and SKOV-3. Additionally, final fate of nanoparticles was also determined, showing that in both cell lines, nanoparticles ended up in lysosomes but at different times, where they are finally degraded, thereby releasing their contents. Conclusions: Our results, provide novel insight about PHBV nanoparticles internalization suggesting that for develop a proper drug delivery system is critical understand the uptake mechanism.https://jnanobiotechnology.biomedcentral.com/articles/10.1186/s12951-016-0241-

Safety of probiotics and synbiotics in children under 18 years of age

This study aimed to systematically evaluate safety of probiotics and synbiotics in children ageing 0-18 years. This study is the third and final part in a safety trilogy and an update is provided using the most recent available clinical data (2008-2013) by means of the Common Terminology Clinical Adverse Events (CTCAE version 4.0) classification. Safety aspects are represented and related to number of participants per probiotic strain/culture, study duration, dosage, clinical condition and selected afflictions. Analysis of 74 clinical studies indicated that probiotic and/or synbiotic administration in children is safe with regard to the specific evaluated strains, dosages and duration. The population of children include healthy, immune compromised and obese subjects, as well as subjects with intestinal disorders, infections and inflammatory disorders. This study revealed no major safety concerns, as the adverse events (AEs) were unrelated, or not suspected to be related, to the probiotic or synbiotic product. In general the study products were well tolerated. Overall, AEs occurred more frequent in the control arm compared to children receiving probiotics and/or synbiotics. Furthermore, the results indicate inadequate reporting and classification of AEs in the majority of the studies. In addition, generalizability of conclusions are greatly limited by the inconsistent, imprecise and potentially incomplete reporting as well as the variation in probiotic strains, dosages, administration regimes, study populations and reported outcomes

Exposure to Tobacco Smoke and Chronic Asthma Symptoms

The objective was to determine if tobacco exposure is associated with year-round asthma symptoms. We analyzed baseline data from a multistate survey of 896 pediatric patients with asthma participating in a randomized controlled trial. Daytime symptoms, nocturnal symptoms, and limitations in activity because of asthma tend to increase during the winter season (p < 0.05 for all comparisons, except spring to winter daytime symptoms). One hundred forty of 896 (16%) children had year-round symptoms (i.e., active asthma symptoms during every season). Using separate multivariate analyses, we found that having a parent who smokes (odds ratio [OR]: 2.22; 95% confidence interval [CI]: 1.35, 3.64) or a member of the household who smokes (OR: 1.94; 95% CI: 1.29, 2.93) was associated with a higher likelihood of year-round symptoms, controlling for region of residence, insurance status, and use of a daily controller medication. Asthma symptoms are more likely to increase in the winter season. In anticipation of these patterns, clinicians should consider initiating controller medication therapy or reinforcing asthma education prior to these time periods for those patients at risk for seasonal exacerbations. Exposure to tobacco smoke is associated with year-round asthma symptoms, highlighting the importance of health care providers identifying and counseling about smoking cessation, especially for children with year-round asthma symptoms. (Pediatr Asthma Immunol 2005; 18[4]:180–188.)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63404/1/pai.2005.18.180.pd

Gender and rural history: A roundtable

The aim of this debate article is to promote a discussion of a historiographical nature (not ideological, not political) about the meaning, place and role of gender in both the rural past and the rural historiography. The discussion revolves around a variety of questions, ranging from the relevance, the opportunity and the very history of the use of gender category in rural history, to the analysis of gender (im)balances in the community of historians working in this broadly defined field of studies, not to mention the very definition of what is meant by gender. These and other related topics, for which there are no single or definitive answers, are debated here in a roundtable format.info:eu-repo/semantics/publishedVersio

Parent Perception of Their Child’s Asthma Control and Concurrent Complementary and Alternative Medicine Use

We conducted a cross-sectional survey of 1322 parents of children with asthma to measure the prevalence and factors associated with complementary and alternative medicine (CAM) use for pediatric asthma. Multivariate regression techniques were used to determine factors associated with CAM use. Eleven percent (141/1322) of children were given CAM. Parents of children on daily medications who were perceived to have poor asthma control were almost three times more likely to use CAM than parents of children on no daily medications who were perceived to have high asthma control (risk ratio: = 2.81; confidence interval: 1.72, 4.60); age, gender, race, income, and education level were not significant independent predictors. Parent perception of asthma control is significantly associated with CAM use. It is important for providers to elicit information regarding CAM use in the clinic, as this may imply that the asthma symptoms may not be well controlled.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63130/1/pai.2008.0503.pd