Abstract Background HIV is treated as a chronic disease, but high lost-to-follow-up rates and poor adherence to medication result in higher mortality, morbidity, and viral mutation. Within 18 clinical sites in rural Zambézia Province, Mozambique, patient adherence to antiretroviral therapy has been sub-optimal. Methods To better understand barriers to adherence, we conducted 18 community and clinic focus groups in six rural districts. We interviewed 76 women and 88 men, of whom 124 were community participants (CP; 60 women, 64 men) and 40 were health care workers (HCW; 16 women, 24 men) who provide care for those living with HIV. Results While there was some consensus, both CP and HCW provided complementary insights. CP focus groups noted a lack of confidentiality and poor treatment by hospital staff (42% CP vs. 0% HCW), doubt as to the benefits of antiretroviral therapy (75% CP vs. 0% HCW), and sharing medications with family members (66% CP vs. 0%HCW). Men expressed a greater concern about poor treatment by HCW than women (83% men vs. 0% women). Health care workers blamed patient preference for traditional medicine (42% CP vs. 100% HCW) and the side effects of medication for poor adherence (8% CP vs. 83% CHW). Conclusions Perspectives of CP and HCW likely reflect differing sociocultural and educational backgrounds. Health care workers must understand community perspectives on causes of suboptimal adherence as a first step toward effective intervention.
The purpose of this study was to determine if early enteral nutrition improves outcome for trauma patients with an open abdomen (OA).Retrospective review was used to identify 78 patients who required an OA for >or=4 hospital days, survived, and had available nutrition data. Demographic data and nutrition data comprising enteral nutrition initiation day and daily % target goal were collected. Patients were divided into 2 groups: early enteral feeding (EEN), initiated 4 days). Outcomes included infectious complications, early closure of the abdominal cavity (<8 days from original celiotomy), and fistula formation.Fifty-three of 78 (68%) patients were men, with a mean age of 35 years; 74% had blunt trauma. Forty-three of 78 (55%) patients had EEN, whereas 35 of 78 (45%) had LEN. There was no difference with respect to demographics, injury severity, or infectious complication rates. Thirty-two of 43 (74%) patients with EEN had early closure of the abdominal cavity, whereas 17 of 35 (49%) patients with late feeding had early closure (p = .02). Four of 43 (9%) patients with EEN demonstrated fistula formation, whereas 9 of 35 (26%) patients with late feeding formed fistulae (p = .05). The EEN group had lower hospital charges (p = .04) by more than $50,000.EEN in the OA was associated with (1) earlier primary abdominal closure, (2) lower fistula rate, (3) lower hospital charges.
Mozambique has one of the world's highest burdens of HIV infection. Despite the increase in HIV-testing services throughout the country, the uptake has been low. To identify barriers to HIV testing we conducted a study in six rural districts in Zambézia Province. We recruited a total of 124 men and women from the community through purposeful sampling to participate in gender-specific focus group discussions about barriers to HIV testing. The participants noted three main barriers to HIV testing: 1) poor conduct by clinicians, including intentional disclosure of patients' HIV status to other community members; 2) unintentional disclosure of patients' HIV status through clinical practices; and, 3) a widespread fatalistic belief that HIV infection will result in death, particularly given poor access to adequate food. Improving quality and confidentiality within clinical service delivery, coupled with the introduction of food-supplement programmes should increase people's willingness to test and remain in care for HIV disease.
AACR Annual Meeting-- Apr 14-18, 2007; Los Angeles, CA
2833
Recent evidence has suggested a role for Akt/protein kinase B (PKB) in cellular motility and invasion. Previously, we have demonstrated a role for RhoC GTPase in conferring a highly motile and invasive phenotype to inflammatory breast cancer (IBC) cells. RhoC contains a putative Akt phosphorylation site at serine 71, similar to the other members of the Rho subfamily. Studies have suggested that Akt phosphorylation of RhoC prevents GTP binding and subsequent activation of RhoC, thus leading to cellular motility. In this present study we examined the role of Akt phosphorylation of RhoC in breast cancer cell invasion. The SUM 149 inflammatory breast cancer cell line overexpresses RhoC, lacks the PTEN gene, and consequently expresses a constitutively active Akt. Using this SUM 149 IBC cell line, we demonstrate that RhoC is a reputed substrate for Akt phosphorylation. We are able to decrease phospho-RhoC levels and inhibit SUM 149 cellular motility through inhibiting Akt activation with commercially available Akt inhibitors. We are also able to inhibit cellular motility by inhibiting the phosphoinositide-3 kinase pathway with LY294002 or decreasing total levels of Akt with siRNA. In contrast, the MDA435 breast cancer cell line expresses RhoC but has normal expression of PTEN and low active Akt levels. By introducing activated Akt into these MDA435 breast cancer cells, increased phospho-RhoC levels result, along with increased cell motility and invasion. These results suggest that Akt phosphorylation of RhoC in breast cancer cells is required for cellular migration and invasion.
