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Objective: The goal of this study was to investigate the association between neighborhood socioeconomic status (NSES) and BMI and to what extent this association is moderated by availability of fast-food (FF) outlets and pay-for-use physical activity (PA) facilities., Methods: Baseline data of adults in Lifelines (N = 146,629) were linked to Statistics Netherlands and a register using geocoding to compute, respectively, NSES (i.e., low, middle, high) and the number of FF outlets and PA facilities within 1 km of the residential address. Multivariable multilevel linear regression analyses were performed to examine the association between NSES and BMI. Two-way and three-way interaction terms were tested to examine moderation by FF outlets and PA facilities., Results: Participants living in low NSES areas had a higher BMI than participants living in high (B [95% CI]: 0.76 [0.65 to 0.87]) or middle NSES areas (B [95% CI]: 0.40 [0.28 to 0.51]), independent of individual socioeconomic status. Although two- and three-way interactions between NSES, FF outlets, and PA facilities were significant, stratified analyses did not show consistent moderation patterns., Conclusions: People living in lower NSES areas had a higher BMI, independent of their individual socioeconomic status. The study found no clear moderation of FF outlets and PA facilities. Environmental factors that may mitigate NSES differences in BMI should be the subject of future research., (© 2022 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)

This study dealt with the use of quinoa flour (QF) or teff flour (TF) as partial beef fat replacers in the formulation of emulsion-type sausages. A control (C) group was manufactured with 20% beef fat, while the other three groups were formulated with 10% beef fat plus 5% QF (Q), 5% TF (T), and 2.5% QF+2.5% TF (QT). Water-holding capacity of the emulsions was higher in Q (81.81%), T (82.20%), and QT (84.10%) samples than in C (64.83%) samples. Total expressible fluid and expressible fat were the lowest in Q and T samples, indicating the highest emulsion stability of those groups. Incorporation of QF and TF into formulations increased moisture and carbohydrate contents while decreased fat and energy values. Besides, the use of QF was effective to increase protein and dietary fiber contents. T sausages had lower luminosity (L*) and higher yellowness (b*) than C sausages, whilst Q sausages did not result in significant color changes. Higher cook yield values were recorded in Q (97.96%), T (98.21%), and QT (98.15%) samples compared with C (96.44%) samples. Inclusion of QF and TF to formulation led to lower hardness and gumminess, while utilization of TF was also effective to decrease chewiness. Consequently, healthier emulsified sausages were obtained by the inclusion of QF or TF that could decrease the fat content more than 50% without sacrificing overall quality, bringing advantages by quinoa over teff for increasing nutritional value and leading minimal modifications on color and texture., Competing Interests: The authors declare no potential conflicts of interest., (© Korean Society for Food Science of Animal Resources.)

Background and Objective: Given the increasing discussions of the impact of genetic medicine within family medicine, it is important to determine the most effective way of teaching this material to family medicine residents (FMRs). The objective of this study was to evaluate and compare the impact of three methods of delivering primary care genetic content to FMRs., Methods: Curriculum materials and assessment tools were created to teach and evaluate knowledge, skills, and attitudes around four core competencies in primary care genetics, with a focus on hereditary colorectal cancer (CRC). Participants were randomly allocated to four learning conditions: (1) no intervention (control), (2) web-based module outlining genetic concepts applied to CRC, (3) live presentation of the web-based material, (4) live presentation and subsequent standardized patient (SP) encounter. Three months later, all participants completed a written knowledge test, attitude survey, and a standardized patient-based performance assessment., Results: Sixty FMRs completed the study. All three educational interventions resulted in significantly improved outcome measures in knowledge and skills but not attitudes, compared to control. There was no significant difference in outcomes between intervention groups., Conclusion: FMRs acquired knowledge and improved skills in genetic medicine with three educational methods. Resources such as faculty expertise in genetic medicine and cost should guide decisions on curricular development for this rapidly expanding field. This may be especially relevant for programs with distributed teaching sites.

Context and Objectives: Chronic myeloid leukemia (CML) requires strict daily compliance with oral medication and regular blood and bone marrow control tests. The objective was to evaluate CML patients' perceptions about the disease, their access to information regarding the diagnosis, monitoring and treatment, adverse effects and associations of these variables with patients' demographics, region and healthcare access., Design and Setting: Prospective cross-sectional study among CML patients registered with the Brazilian Lymphoma and Leukemia Association (ABRALE)., Methods: CML patients receiving treatment through the public healthcare system were interviewed by telephone., Results: Among 1,102 patients interviewed, the symptoms most frequently leading them to seek medical care were weakness or fatigue. One third were diagnosed by means of routine tests. The time that elapsed between first symptoms and seeking medical care was 42.28 ± 154.21 days. Most patients had been tested at least once for Philadelphia chromosome, but 43.2% did not know the results. 64.8% had had polymerase chain reaction testing for the BCR/ABL gene every three months. 47% believed that CML could be controlled, but 33.1% believed that there was no treatment. About 24% reported occasionally stopping their medication. Imatinib was associated with nausea, cramps and muscle pain. Self-reported treatment adherence was significantly associated with normalized blood count, and positively associated with imatinib., Conclusions: There is a lack of information or understanding about disease monitoring tools among Brazilian CML patients; they are diagnosed quickly and have good access to treatment. Correct comprehension of CML control tools is impaired in Brazilian patients.

Background: The literature on simulated or standardized patient (SP) methodology is expanding. However, at the level of the program, there are several gaps in the literature. We seek to fill this gap through documenting experiences from four programs in Australia, Canada, Switzerland and the United Kingdom. We focused on challenges in SP methodology, faculty, organisational structure and quality assurance., Methods: We used a multiple case study method with cross-case synthesis. Over eighteen months during a series of informal and formal interactions (focused meetings and conference presentations) we documented key characteristics of programs and drew on secondary document sources., Results: Although programs shared challenges in SP methodology they also experienced differences. Key challenges common to programs included systematic quality assurance and the opportunity for research. There were differences in the terminology used to describe SPs, in their recruitment and training. Other differences reflected local conditions and demands in organisational structure, funding relationships with the host institution and national trends, especially in assessments., Conclusion: This international case study reveals similarities and differences in SP methodology. Programs were highly contextualised and have emerged in response to local, institutional, profession/discipline and national conditions. Broader trends in healthcare education have also influenced development. Each of the programs experienced challenges in the same themes but the nature of the challenges often varied widely.

In the study, a series of twelve ring-substituted 4-hydroxy-1H-quinolin-2-one derivatives were prepared. The procedures for synthesis of the compounds are presented. The compounds were analyzed using RP-HPLC to determine lipophilicity and tested for their photosynthesis-inhibiting activity using spinach (Spinacia oleracea L.) chloroplasts. All the synthesized compounds were also evaluated for antifungal activity using in vitro screening with eight fungal strains. For all the compounds, the relationships between the lipophilicity and the chemical structure of the studied compounds are discussed, as well as their structure-activity relationships (SAR).

Allogeneic stem cell transplantation has been increasingly performed for a variety of hematologic diseases. Clinically significant acute graft-versus-host disease (GVHD) occurs in 9 to 50% of patients who receive allogeneic grafts, resulting in high morbidity and mortality. There is no standard therapy for patients with acute GVHD who do not respond to steroids. Studies have shown a possible benefit of anti-TNF-a (infliximab)for the treatment of acute GVHD. We report here on the outcomes of 10 recipients of related or unrelated stem cell transplants who received 10 mg/kg infliximab, iv, once weekly for a median of 3.5 doses (range: 1-6) for the treatment of severe acute GVHD and who were not responsive to standard therapy. All patients had acute GVHD grades II to IV (II = 2, III = 3, IV = 5). Overall, 9 patients responded and 1 patient had progressive disease. Among the responders, 3 had complete responses and 6 partial responses. All patients with cutaneous or gastrointestinal involvement responded, while only 2 of 6 patients with liver disease showed any response. None of the 10 patients had any kind of immediate toxicity. Four patients died, all of them with sepsis. Six patients are still alive after a median follow-up time of 544 days (92-600) after transplantation. Considering the severity of the cases and the bad prognosis associated with advanced acute GVHD, we find our results encouraging. Anti-TNF-a seems to be a useful agent for the treatment of acute GVHD.

Objectives: To describe the use of patient-actors as educators in a senior-level pharmacy practice course, and to contrast the value and application of "standardized patient" and "simulated patient" educational methodologies., Design: The objective structured clinical examination (OSCE) of the licensing examination were utilized during and at the end of the course along with external assessment to determine the impact of this educational methodology. Interviews with a randomly selected cohort of 14 students were undertaken 3 years after graduation and licensure to evaluate long-term impact of this course., Assessment: Overall, students responded positively to the shift from "standardized" patients to "simulated" patients, recognizing their value in teaching clinical and pharmaceutical care skills. Concerns were expressed regarding objectivity in assessment and individual grading. Over 98% of students successfully passed the OSCE component of the licensing examination. Long-term follow-up suggests students valued this approach to education and that it provided them with a foundation for better understanding of the psychosocial needs of patients in practice., Conclusions: Simulated-patient educators can play an important role in the pharmacy curriculum, and can complement practitioner-educators in providing students with a real-world context for understanding complex patient care needs.

Objective: To develop a Professional Skills Enhancement Workshop (PSEW) to assist practitioners who require skills training to maintain competency and meet new standards of practice. Participants for this workshop were identified as those pharmacists who completed the peer review assessment process and who did not meet standards of practice expectations., Design: The full-day workshop consists of a half-day introduction to use of clinical drug information resources and approaches to addressing practice-based questions. The second part of the workshop introduces participants to the use of structured patient-interviewing techniques to elicit information using standardized patients. Participants in the workshop completed self-assessments as well as course evaluations. Subsequent to completion of the course, participants rechallenged the peer review assessment process, a test of their clinical skills consisting of a written test of clinical knowledge and an objective structured clinical examination (OSCE), to provide objective evidence of skills acquisition., Assessment: Over 90% of participants "agreed" or "strongly agreed" that the PSEW was helpful in reacquainting them with current standards of professional practice. Sixty-nine percent of participants who completed the peer review assessment rechallenge process following completion of the course were able to meet standards of practice expectations., Conclusions: In developing continuous professional development programs, first identifying the needs of all practitioners is essential. The PSEW provides one model for skills training for practitioners who, for a variety of reasons, may not have maintained the expected level of competency.

Background and Objectives: The management of chronic myeloid leukemia (CML) has changed radically since the introduction of imatinib therapy. The decision of whether to offer a patient a hematopoietic stem cell transplant (HSCT) must be based on the probability of success of the procedure. The aim of this retrospective analysis of 1,084 CML patients who received an allogeneic HSCT in 10 Brazilian Centers between February 1983 and March 2003 was to validate the EBMT risk score., Design and Methods: The study population comprised 647 (60%) males and 437 (40%) females, with a median age of 32 years old (range 1 - 59); 898 (83%) were in chronic phase, 146 (13%) were in accelerated phase and 40 (4%) were in blast crisis; 151 (14%) were younger than 20 years old, 620 (57%) were between 20 and 40 and 313 (29%) were older than 40; 1,025 (94%) received an HLA fully matched sibling transplant and only 59 (6%) received an unrelated transplant. In 283 cases (26%) a male recipient received a graft from a female donor. The interval from diagnosis to transplantation was less than 12 months in 223 (21%) cases and greater in 861 (79%). The overall survival, disease-free survival, transplant-related mortality and relapse incidence were 49%, 50%, 45% and 25%, respectively., Results: Of the 1084 patients, 179 (17%) had a risk score of 0 or 1, 397 (37%) had a score of 2, 345 (32%) had a score of 3, 135 (12%) had a score of 4 and 28 (2%) a score of 5 or 6. The overall survival (OS) rate in patients with risk scores 0-1 and 2 was similar (58% and 55%, respectively) but significantly better than that in patients with scores 3 or more (score 3 - 44%, 4 - 36 % and 5-6 - 27%, respectively) pp<0.001). Disease-free survival (DFS) and transplant related mortality (TRM) in a patients with a score of 3 or more were 46% and 49%, respectively and the relapse rate beyond score 5-6 was 77%. Disease status had a negative impact on all outcomes (OS, DFS, TRM, and relapse). The OS rate for male recipients of a graft from a female donor was 40% compared to 52% among the other donor-recipient pairs (p=0.004). DFS and TRM were significant for disease phase and female donor-male recipient (p<0.001 and p<0.003, respectively). In our experience, age and interval between diagnosis and transplant did influence OS, DFS, TRM, and relapse rate., Interpretation and Conclusions: Our results validate the EBMT risk score in the context of a developing country and confirm its usefulness for making point decisions in the imatinib era.

In our work, leading to new styrylquinoline and styrylquinazoline inhibitors of HIV integrase, we analyzed virtual combinatorial library that includes these compounds. Using this method we were able to find interesting synthetic targets. We optimized synthetic procedure yielding such compounds and obtained a couple of new analogues. Their activity will be evaluated in the near future.

Background: PBSC transplant provides 10 times more T cells than BMT However, the incidence and severity of acute GvHD is similar among recipients of both types of transplants. Studies in mouse models suggest that the similar clinical outcome in BMT and PBSCT is due to differences in the lymphokine profiles., Methods: PBMC, PBMC from G-CSF mobilized donors (G-PBMC)and BM mononuclear cells (BM-MC) were analyzed by flow cytometry and ELISA to detect gamma-IFN and IL-4 production. Hematoxylin and eosin staining was used to identify morphology and annexin/propidium-iodide was used for apoptosis assays., Results: We show decreased production of gamma-interferon (85%) and IL-4 (60%) in G-PBMC when compared with either PBMC or BM-MCT cells on ex vivo assays. Surprisingly, 85% of fresh G-PBMC is composed of low-density granulocytes (LDG), which undergo apoptosis after 48 h in culture. At this same time, gamma-IFN production from G-PBMC T cell was reverted. In vitro, G-CSF converts granulocytes into LDGs, able to inhibit T-cell function by H2O2 production, and not through immune-deviation towards a Th2-type phenotype., Discussion: We show that the estimated numbers of Th1 and Th2 cells infused in BMT and PBSCT do not differ significantly. These findings are discussed with reference to the relatively low incidence of acute GvHD in PBSCT shown in the literature. We suggest that these results might depend on the high number of granulocytes and progenitors infused. The potential use of granulocytes as immunosupressive short-term therapy is now being investigated by our group using a mouse experimental model.