Cultural adaptation of two school-based smoking prevention programs in Bogotá, Colombia.

Smoking prevention among adolescents is a public health challenge that is even more significant in low- and middle-income countries where local evidence is limited and smoking rates remain high. Evidence-based interventions could be transferred to low- and middle-income country settings but only after appropriate cultural adaptation. This paper aims to describe the process of the cultural adaptation of two school-based smoking prevention interventions, A Stop Smoking in Schools Trial and Dead Cool, to be implemented in Bogotá, Colombia. A recognized heuristic framework guided the cultural adaptation through five stages. We conducted a concurrent nested mixed-methods study consisting of a qualitative descriptive case study and a quantitative pre- and post quasi-experiment without a control. Contextual, content, training, and implementation modifications were made to the programs to address cultural factors, to maintain the fidelity of implementation, and to increase the pupils' engagement with the programs. Modifications incorporated the suggestions of stakeholders, the original developers, and local community members, whilst considering the feasibility of delivering the programs. Involving stakeholders, original program developers, and community members in the cultural adaptation of evidence-based interventions is essential to properly adapt them to the local context, and to maintain the fidelity of program implementation.

Peer teacher training (PTT) in action.

BACKGROUND: The benefits of peer teaching for tutors, students and institutions are well documented. Skills in peer teaching, assessment and feedback are cited as important graduate attributes by international medical councils; however, the literature on preparation for this role, specifically peer teacher training (PTT), is sparse. This study evaluated the implementation of a PTT programme adopted from the Medical School at the University of Sydney in 2016. The programme was adopted to support the development of skills in UK medical undergraduates. The training was accessed by students studying at the University of Leicester in 2017 and 2018. METHODS: The course was evaluated using mixed methods. Students completed pre- and post-course self-rated questionnaires. Semi-structured focus groups were conducted after each course to investigate students' perceptions. RESULTS: Twenty fourth-year medical students attended the PTT. Students reported improvements in their understanding of educational principles, confidence in teaching and feedback skills, and an increased likelihood of volunteering to teach. Focus groups revealed potential benefits for future patient interaction and preparation for educator roles. DISCUSSION: The PTT provided an effective approach for medical students to gain perceived competence and confidence in teaching and giving feedback. Students reported an increased propensity for teaching when qualified. Students with lower self-reported teaching ability reported greater improvements following the course. Students reported unanticipated perceived benefits for improving patient education and obtaining teaching accreditation for their portfolio and future clinical roles. They perceived potential value if the training were to be made interprofessional on future courses. Furthermore, this study demonstrates the transferability of the PTT programme across university settings.

Association of the progesterone receptor gene with breast cancer risk: a single-nucleotide polymorphism tagging approach.

Association studies on susceptibility to breast cancer using single nucleotide polymorphisms (SNP) in the progesterone receptor (PGR) gene have been previously published, but the results have been inconclusive. We used a comprehensive SNP-tagging approach to search for low-penetrance susceptibility alleles in a study of up to 4,647 cases and 4,564 controls, in a two-stage study design. We identified seven tagging SNPs using genotype data from the National Institute of Environmental Health Sciences (NIEHS) Environmental Genome Project and typed these, and an additional three SNPs, in 2,345 breast cancer cases and 2,284 controls (set 1). Three SNPs showed no evidence for association and were not studied further, whereas seven SNPs (rs11571171, rs7116336, rs660149, rs10895068, rs500760, rs566351, and rs1042838) exhibited significant associations at P < 0.1 using either a heterogeneity or trend test and progressed to be genotyped in set 2. After both stages, only one SNP was significantly associated with an increased risk of breast cancer - the PGR-12 (rs1042638) V660L valine to leucine polymorphism [VL heterozygotes (odds ratio, 1.13; 95% confidence interval, 1.03-1.24) and the LL homozygotes (odds ratio, 1.30; 95% confidence interval, 0.98-1.73), P(het) = 0.008, P(trend) = 0.002]. Similar estimates were obtained in a combined analysis of our data with those from three other published studies. We conclude that the 660L allele may be associated with a moderately increased risk of breast cancer, but that other common SNPs in the PGR gene are unlikely to be associated with a substantial risk of breast cancer.