ABSTRACT
BACKGROUND: Community health workers (CHWs) have been placed in many rural areas in India to increase villagers' connections to basic preventive health care. In this study, we describe how pregnant women and mothers of young children react when CHWs inform them that they, or their child, are at high risk of pregnancy-related complications or early childhood developmental delays, and further screening and health care from a physician is recommended. METHODS: In this longitudinal study in rural villages in West Bengal, India, pregnant mothers, as well as mothers of children aged 12-24 months, were screened for high risk complications. They were re-contacted and asked questions regarding how and to what extent did visits by the CHWs improve their household's overall health behavior, along with details about what additional care, if any, they sought. These responses are presented by different demographic and medical characteristics. RESULTS: Of the 231 pregnant women, all said they had sought additional care in response to the CHW visit, and all stated that feedback from the CHW resulted in improvement to their health behaviors. Most (90%) pregnant women gave birth at an institution. Among the 213 mothers of young children who were followed up, all sought additional care in response to the CHW's visit. Most (67%) mentioned that they had a significant improvement in their health behaviors following feedback from the CHW, and the rest stated that they had some improvement. CONCLUSIONS: With the proper training, CHWs can be partners in health care to improve the health of vulnerable populations, not only in rural areas of India, but also in other developing countries. CHWs can promote positive health outcomes in their villages of residence.
Subject(s)
Community Health Workers , Developmental Disabilities/therapy , Patient Acceptance of Health Care , Pregnancy Complications/therapy , Referral and Consultation , Adolescent , Adult , Child, Preschool , Developing Countries , Developmental Disabilities/epidemiology , Developmental Disabilities/psychology , Feasibility Studies , Female , Follow-Up Studies , Humans , India , Infant , Longitudinal Studies , Male , Mothers/psychology , Patient Acceptance of Health Care/psychology , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/psychology , Prospective Studies , Risk Factors , Rural Population , Vulnerable Populations/psychology , Young AdultABSTRACT
Dengue viral infections are endemic or epidemic in virtually all tropical countries. Among individuals infected with the dengue virus, severe dengue syndromes (i.e., dengue haemorrhagic fever and dengue shock syndromes) tend to affect only some and this may be due to a combination of host genetic susceptibility and viral factors. In this review article we analyse and discuss the present knowledge of non-human leucocyte antigen host genetic susceptibility to severe dengue syndromes. The relevance of genetic polymorphisms in the pathways of antigen recognition, uptake, processing and presentation, activation of interferon α responses, mast cell and complement activation and T cell activation and dengue disease severity has been reviewed and analysed.
Subject(s)
Antigens/genetics , Genetic Predisposition to Disease , Immunity/genetics , Severe Dengue , Humans , Polymorphism, Genetic , Severe Dengue/genetics , Severe Dengue/immunology , T-Lymphocytes/immunologyABSTRACT
Approximately 50% of prostate cancers are associated with gene fusions of the androgen-regulated gene TMPRSS2 to the oncogenic erythroblast transformation-specific (ETS) transcription factor ERG. The three-dimensional proximity of TMPRSS2 and ERG genes, in combination with DNA breaks, facilitates the formation of TMPRSS2-ERG gene fusions. However, the origins of DNA breaks that underlie gene fusion formation in prostate cancers are far from clear. We demonstrate a role for inflammation-induced oxidative stress in the formation of DNA breaks leading to recurrent TMPRSS2-ERG gene fusions. The transcriptional status and epigenetic features of the target genes influence this effect. Importantly, inflammation-induced de novo genomic rearrangements are blocked by homologous recombination (HR) and promoted by non-homologous end-joining (NHEJ) pathways. In conjunction with the association of proliferative inflammatory atrophy (PIA) with human prostate cancer, our results support a working model in which recurrent genomic rearrangements induced by inflammatory stimuli lead to the development of prostate cancer.
Subject(s)
Inflammation/genetics , Oncogene Proteins, Fusion/genetics , Prostatic Neoplasms/genetics , Serine Endopeptidases/genetics , Androgens/genetics , Cell Line, Tumor , DNA Breaks , DNA End-Joining Repair/genetics , DNA-Binding Proteins/genetics , Humans , Inflammation/complications , Inflammation/pathology , Male , Oxidative Stress/genetics , Prostatic Neoplasms/complications , Prostatic Neoplasms/pathology , Transcriptional Regulator ERG/geneticsABSTRACT
Recurrent gene fusions involving ETS family genes are a distinguishing feature of human prostate cancers, with TMPRSS2-ERG fusions representing the most common subtype. The TMPRSS2-ERG fusion transcript and its splice variants are well characterized in prostate cancers; however, not much is known about the levels and regulation of wild-type ERG. By employing an integrative approach, we show that the TMPRSS2-ERG gene fusion product binds to the ERG locus and drives the overexpression of wild-type ERG in prostate cancers. Knockdown of TMPRSS2-ERG in VCaP cells resulted in the downregulation of wild-type ERG transcription, whereas stable overexpression of TMPRSS2-ERG in the gene fusion-negative PC3 cells was associated with the upregulation of wild-type ERG transcript. Further, androgen signaling-mediated upregulation of TMPRSS2-ERG resulted in the concomitant upregulation of wild-type ERG transcription in VCaP cells. The loss of wild-type ERG expression was associated with a decrease in the invasive potential of VCaP cells. Importantly, 38% of clinically localized prostate cancers and 27% of metastatic prostate cancers harboring the TMPRSS2-ERG gene fusions exhibited overexpression of wild-type ERG. Taken together, these results provide novel insights into the regulation of ERG in human prostate cancers.
Subject(s)
Prostatic Neoplasms/genetics , Serine Endopeptidases/genetics , Trans-Activators/genetics , Base Sequence , Cell Line, Tumor , Chromatin Immunoprecipitation , DNA Primers , Gene Knockdown Techniques , Humans , Male , Promoter Regions, Genetic , Prostatic Neoplasms/pathology , RNA, Messenger/genetics , Transcriptional Regulator ERGABSTRACT
Gene fusions play a critical role in cancer progression. The mechanisms underlying their genesis and cell type specificity are not well understood. About 50% of human prostate cancers display a gene fusion involving the 5' untranslated region of TMPRSS2, an androgen-regulated gene, and the protein-coding sequences of ERG, which encodes an erythroblast transformation-specific (ETS) transcription factor. By studying human prostate cancer cells with fluorescence in situ hybridization, we show that androgen signaling induces proximity of the TMPRSS2 and ERG genomic loci, both located on chromosome 21q22.2. Subsequent exposure of the cells to gamma irradiation, which causes DNA double-strand breaks, facilitates the formation of the TMPRSS2-ERG gene fusion. These results may help explain why TMPRSS2-ERG fusions are restricted to the prostate, which is dependent on androgen signaling.
