The effect of educational intervention on the disease knowledge of diabetes mellitus patients

The prevention of diabetes and its complications is a challenge for the healthcare team. The aim of this study was to evaluate the effect of educational action on the disease knowledge of patients with type 2 diabetes. A randomized clinical trial was conducted with 62 patients registered in a service of reference in the treatment of hypertension in 2010. Data were collected through a questionnaire applied to the Intervention (IG) and Control (CG) groups at the beginning and at the end of the study. The IG participated in group educational activities, using problematization methodology. The results showed a significant increase in knowledge about diabetes in the patients of the IG, in all the topics (pLa prevención de diabetes y sus complicaciones es un desafío para el equipo de salud. El objetivo de esta investigación fue evaluar el efecto de acción educativa sobre el conocimiento de la enfermedad en pacientes portadores de diabetes tipo 2. Fue realizado ensayo clínico aleatorizado con 62 pacientes registrados en servicio de referencia en tratamiento de la hipertensión arterial en 2010. Los datos fueron obtenidos a través de un cuestionario aplicado a los grupos Intervención (GI) y Control (GC), al inicio y al final del estudio. El GI participó de actividades educativas grupales, utilizando la metodología problematizadora. Los resultados muestran un aumento significativo del conocimiento sobre la diabetes en pacientes del GI, en todas las cuestiones (pA prevenção do diabetes e suas complicações é um desafio para a equipe de saúde. O objetivo desta pesquisa foi avaliar o efeito de ação educativa sobre o conhecimento da doença em pacientes portadores de diabetes tipo 2. Foi realizado ensaio clínico randomizado com 62 pacientes cadastrados em serviço de referência para tratamento da hipertensão arterial, no ano 2010. Os dados foram obtidos através de questionário aplicado aos grupos intervenção (GI) e controle (GC), no momento inicial e no final do estudo. O GI participou de atividades educativas em grupo, utilizando a metodologia problematizadora. Os resultados mostraram aumento significativo do conhecimento sobre diabetes nos pacientes do GI, em todas as questões (p<0,05). No GC, algumas alterações observadas no conhecimento foram bem menores quando comparadas ao GI. Conclui-se que foi possível elevar os conhecimentos sobre a doença por meio da realização de atividades educativas. O registro clínico obteve identificador primário: RBR-58n26

JPN Guidelines for the management of acute pancreatitis: severity assessment of acute pancreatitis

This article addresses the criteria for severity assessment and the severity scoring system of the Ministry of Health and Welfare of Japan; now the Japanese Ministry of Health, Labour, and Welfare (the JPN score). It also presents data comparing the JPN score with the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Ranson score, which are the major measuring scales used in the United States and Europe. The goal of investigating these scoring systems is the achievement of earlier diagnosis and more appropriate and successful treatment of severe or moderate acute pancreatitis, which has a high mortality rate. This article makes the following recommendations in terms of assessing the severity of acute pancreatitis

Uncovering Enhancer Functions Using the α-Globin Locus

Over the last three decades, studies of the α- and β-globin genes clusters have led to elucidation of the general principles of mammalian gene regulation, such as RNA stability, termination of transcription, and, more importantly, the identification of remote regulatory elements. More recently, detailed studies of α-globin regulation, using both mouse and human loci, allowed the dissection of the sequential order in which transcription factors are recruited to the locus during lineage specification. These studies demonstrated the importance of the remote regulatory elements in the recruitment of RNA polymerase II (PolII) together with their role in the generation of intrachromosomal loops within the locus and the removal of polycomb complexes during differentiation. The multiple roles attributed to remote regulatory elements that have emerged from these studies will be discussed

Holding tight: cell junctions and cancer spread

Cell junctions are sites of intercellular adhesion that maintain the integrity of epithelial tissue and regulate signalling between cells. These adhesive junctions are comprised of protein complexes that serve to establish an intercellular cytoskeletal network for anchoring cells, in addition to regulating cell polarity, molecular transport and communication. The expression of cell adhesion molecules is tightly controlled and their downregulation is essential for epithelial-mesenchymal transition (EMT), a process that facilitates the generation of morphologically and functionally diverse cell types during embryogenesis. The characteristics of EMT are a loss of cell adhesion and increased cellular mobility. Hence, in addition to its normal role in development, dysregulated EMT has been linked to cancer progression and metastasis, the process whereby primary tumors migrate to invasive secondary sites in the body. This paper will review the current understanding of cell junctions and their role in cancer, with reference to the abnormal regulation of junction protein genes. The potential use of cell junction molecules as diagnostic and prognostic markers will also be discussed, as well as possible therapies for adhesive dysregulation

Demyelination in mild cognitive impairment suggests progression path to Alzheimer's disease.

The preclinical Alzheimer's disease (AD) - amnestic mild cognitive impairment (MCI) - is manifested by phenotypes classified into exclusively memory (single-domain) MCI (sMCI) and multiple-domain MCI (mMCI). We suggest that typical MCI-to-AD progression occurs through the sMCI-to-mMCI sequence as a result of the extension of initial pathological processes. To support this hypothesis, we assess myelin content with a Magnetization Transfer Ratio (MTR) in 21 sMCI and 21 mMCI patients and in 42 age-, sex-, and education-matched controls. A conjunction analysis revealed MTR reduction shared by sMCI and mMCI groups in the medial temporal lobe and posterior structures including white matter (WM: splenium, posterior corona radiata) and gray matter (GM: hippocampus; parahippocampal and lingual gyri). A disjunction analysis showed the spread of demyelination to prefrontal WM and insula GM in executive mMCI. Our findings suggest that demyelination starts in the structures affected by neurofibrillary pathology; its presence correlates with the clinical picture and indicates the method of MCI-to-AD progression. In vivo staging of preclinical AD can be developed in terms of WM/GM demyelination

Capacitação de profissionais da atenção primária à saúde para educação em Diabetes Mellitus Capacitación, de profesionales que actúan en la atención primaria a la salud, en educación en Diabetes Mellitus Training of professionals, acting in primary health care, in Diabetes Mellitus education

OBJETIVO: Apresentar o delineamento das oficinas educativas em Diabetes Mellitus e uma estratégia avaliativa voltada à atualização dos profissionais de saúde da atenção primária. MÉTODOS: As oficinas foram implementadas, utilizando metodologia participativa, técnicas lúdicas, vivências e dinâmicas de grupo, envolvendo a participação de 85 profissionais de saúde das Unidades Básicas de Saúde de Belo Horizonte/MG. Os conhecimentos sobre a doença e as competências requeridas para o autocuidado foram aferidos mediante a aplicação de instrumento especifico. As oficinas foram avaliadas com base em instrumento próprio. RESULTADOS: Foram observadas limitações no conhecimento dos profissionais centrados na fisiopatologia e nos exames complementares da doença. As oficinas contribuíram para o despertar do potencial reflexivo, crítico e criativo dos profissionais para a mudança no processo educativo. Foi considerada uma estratégia pedagógica, de fácil compreensão, interativa e lúdica. CONCLUSÕES: As oficinas contribuíram para o planejamento do processo educativo e a estruturação de um modelo de avaliação das práticas de promoção, da saúde e educação em Diabetes.<br>OBJETIVO: Presentar el proyecto de talleres educativos sobre diabetes y una estrategia de evaluación dirigida a la actualización de los profesionales de la salud en la atención primaria. MÉTODOS: Los talleres se llevaron a cabo utilizando la metodología participativa, las técnicas de juego, las experiencias y dinámicas de grupo, con la participación de 85 profesionales de la salud de las Unidades Básicas de Salud de Belo Horizonte, MG. El conocimiento sobre la enfermedad y las habilidades necesarias para el autocuidado fueron evaluados mediante la aplicación de instrumentos específicos. Los talleres fueron evaluados con base en instrumento propio. RESULTADOS: Se encontraron limitaciones en el conocimiento de los profesionales centrados en la fisiopatología y en las pruebas complementarias de la enfermedad. Los talleres ayudaron a despertar el potencial de reflexión, de crítica y de creatividad de los profesionales, que se necesita para cambiar el proceso educativo. Fue considerada una estrategia pedagógica, fácil de entender, interactiva y lúdica. CONCLUSIONES: Los talleres contribuyeron para la planificación del proceso educativo y la estructuración de un modelo de evaluación de las prácticas de promoción de la salud y de la educación en diabetes.<br>OBJECTIVE: To present the proposal of educational workshops on diabetes and a strategy of evaluation aimed at upgrading the professionals' performance in primary care. METHODS: The workshops were implemented using participatory methodology, play techniques, experiences, and group dynamics, involving the participation of 85 health professionals from Units of Primary Care, in the city of Belo Horizonte, MG. The knowledge about the disease and the skills required for self-care were measured by applying specific instruments. The workshops were evaluated based on the instrument developed for that purpose. RESULTS: There were limitations in the knowledge of professionals about pathophysiology and the disease's complementary tests. The workshops helped to awaken the potential of professionals (reflection, criticism and creativity) necessary to change the educational process. It was considered a pedagogical strategy, easy to understand, interactive and playful. CONCLUSIONS: The workshops contributed to the planning of the educational process and the structuring of an evaluation model of practices of health and education promotion in diabetes

Differential regulation of the α-globin locus by Krüppel-like factor 3 in erythroid and non-erythroid cells

Background: Krüppel-like Factor 3 (KLF3) is a broadly expressed zinc-finger transcriptional repressor with diverse biological roles. During erythropoiesis, KLF3 acts as a feedback repressor of a set of genes that are activated by Krüppel-like Factor 1 (KLF1). Noting that KLF1 binds α-globin gene regulatory sequences during erythroid maturation, we sought to determine whether KLF3 also interacts with the α-globin locus to regulate transcription. Results: We found that expression of a human transgenic α-globin reporter gene is markedly up-regulated in fetal and adult erythroid cells of Klf3−/− mice. Inspection of the mouse and human α-globin promoters revealed a number of canonical KLF-binding sites, and indeed, KLF3 was shown to bind to these regions both in vitro and in vivo. Despite these observations, we did not detect an increase in endogenous murine α-globin expression in Klf3−/− erythroid tissue. However, examination of murine embryonic fibroblasts lacking KLF3 revealed significant de-repression of α-globin gene expression. This suggests that KLF3 may contribute to the silencing of the α-globin locus in non-erythroid tissue. Moreover, ChIP-Seq analysis of murine fibroblasts demonstrated that across the locus, KLF3 does not occupy the promoter regions of the α-globin genes in these cells, but rather, binds to upstream, DNase hypersensitive regulatory regions. Conclusions: These findings reveal that the occupancy profile of KLF3 at the α-globin locus differs in erythroid and non-erythroid cells. In erythroid cells, KLF3 primarily binds to the promoters of the adult α-globin genes, but appears dispensable for normal transcriptional regulation. In non-erythroid cells, KLF3 distinctly binds to the HS-12 and HS-26 elements and plays a non-redundant, albeit modest, role in the silencing of α-globin expression. </p

The CACCC-binding protein KLF3/BKLF represses a subset of KLF1/EKLF target genes and is required for proper erythroid maturation in vivo

The CACCC-box binding protein erythroid Krüppel-like factor (EKLF/KLF1) is a master regulator that directs the expression of many important erythroid genes. We have previously shown that EKLF drives transcription of the gene for a second KLF, basic Krüppel-like factor, or KLF3. We have now tested the in vivo role of KLF3 in erythroid cells by examining Klf3 knockout mice. KLF3-deficient adults exhibit a mild compensated anemia, including enlarged spleens, increased red pulp, and a higher percentage of erythroid progenitors, together with elevated reticulocytes and abnormal erythrocytes in the peripheral blood. Impaired erythroid maturation is also observed in the fetal liver. We have found that KLF3 levels rise as erythroid cells mature to become TER119+. Consistent with this, microarray analysis of both TER119&#8722; and TER119+ erythroid populations revealed that KLF3 is most critical at the later stages of erythroid maturation and is indeed primarily a transcriptional repressor. Notably, many of the genes repressed by KLF3 are also known to be activated by EKLF. However, the majority of these are not currently recognized as erythroid-cell-specific genes. These results reveal the molecular and physiological function of KLF3, defining it as a feedback repressor that counters the activity of EKLF at selected target genes to achieve norma