A microbiota gastrointestinal humana normal é um ecossistema complexo constituído por microrganismos anaeróbios que desempenham papel fundamental na manutenção da saúde e de funções fisiológicas do hospedeiro. O presente estudo objetivou caracterizar a microbiota intestinal de pacientes portadores de constipação funcional e de pacientes com espinha bífida e intestino neurogênico e compará-las com pacientes saudáveis. Estudo transversal inclui 25 crianças com constipação funcional, 25 pacientes saudáveis e 14 pacientes com intestino neurogênico e espinha bífida. A metodologia molecular foi utilizada para determinação do perfil da microbiota intestinal. O DNA total das amostras de fezes foi extraído com o kit QIAamp DNA Stool®-QIAGEN e realizado sequenciamento do gene 16S rRNA (MiSeq (Illumina). As sequências obtidas foram processados no QUIIME. A análise dos dados obtidos foi realizada por meio de estatística descritiva. A diversidade e riqueza da microbiota intestinal foi avaliada pelos índices Shannon, Simpson e Chao e a contribuição de outras variáveis (sexo, tempo de amamentação exclusiva, uso de medicação nos pacientes constipados, tipo de parto e presença de sintomas no momento da coleta da amostra de fezes) foi obtida por análises multivariada. Firmicutes foi o filo mais predominante seguido do filo Bacteroidetes nos três grupos de estudo. Bifidobacterium foi mais abundante nos constipados funcionais do que nos saudáveis. O filo Tenericutes foi mais abundante em pacientes que nasceram por parto cesárea se comparados com parto vaginal independente do grupo de estudo. Participantes sintomáticos no momento da coleta, apresentaram maior abundância do gênero Ruminoclostridium em relação aos indivíduos assintomático, independente do grupo de estudo. No grupo dos pacientes saudáveis, os participantes sintomáticos no momento da coleta possuíam nível maior do gênero Phascolarctobacterium. Quanto ao sexo, tempo de amamentação exclusiva e medicações utilizadas para tratamento da doença, não foram encontradas nenhuma diferença na microbiota entre os grupos. Concluímos, portanto, que pacientes com constipação intestinal funcional apresentaram maior abundância de Bifidobacterium, em relação ao grupo controle, tal achado não foi observado no grupo de intestino neurogênico / The human gastrointestinal microbiota is a complex ecosystem consisting of anaerobic microorganisms that play a key role in maintaining the health and physiological functions of the host. The present study aimed to characterize the intestinal microbiota of patients with functional constipation and patients with spina bifida and neurogenic gut and to compare them with healthy patients. A cross-sectional study included 25 children with functional constipation, 25 healthy patients and 14 patients with neurogenic gut and spina bifida. The molecular methodology was used to determine the profile of the intestinal microbiota. Total DNA from the faeces samples was extracted with the QIAamp DNA Stool®-QIAGEN kit and sequenced the 16S rRNA gene (MiSeq (Illumina)). The sequences obtained were processed in QUIIME. Data analysis was performed using descriptive statistics. The diversity and richness of the intestinal microbiota was evaluated by the Shannon, Simpson and Chao indices and the contribution of other variables (sex, exclusive breastfeeding time, use of medication to treat constipation, type of delivery and presence of symptoms in the sampling time) was obtained by multivariate analysis. Firmicutes was the most predominant phylum followed by the phylum Bacteroidetes in the three study groups. Bifidobacterium was more abundant in patients with functional constipation than in healthy ones. The phylum Tenericutes was more abundant in patients who were born by cesarean section compared to vaginal delivery independent of the study group. Symptomatic participants at the time of collection had greater abundance of the genus Ruminoclostridium in relation to the asymptomatic individuals, independent of the study group. In the group of healthy patients, the symptomatic participants at the time of collection had a higher level of the genus Phascolarctobacterium. Regarding sex, exclusive breastfeeding time and medications used to treat the disease, no difference was found in the microbiota between the groups. We conclude, therefore, that patients with functional intestinal constipation had a greater abundance of Bifidobacterium, in relation to the control group, such finding was not observed in the group of neurogenic intestine.

Background: Measuring the acquisition of self-management skills are part of evidence based health care transition practice. Youth with Spina Bifida have significant demands for self-management and high self-care burden. We developed an 11 item Spina-Bifida -TRAQ to assess self-management skills specific for Spina Bifida including urine, stool continence management, and skin and shunt maintenance. A detailed description of the SB-TRAQ, its reliability and criterion validity are presented elsewhere. Objective: To examine the predictive validity of the Spina Bifida-TRAQ among youth with Spina Bifida. Design/Methods: Participants include 90 youth with Spina Bifida who attend a clinic participating in the National Spina Bifida Patient Registry (NSBPR) (see Table1 for demographics). Youth completed the newly developed 11-item SB-TRAQ. De-identified NSBPR data from the electronic medical record (EMR) was linked with participants’ responses from the SBTRAQ. Two separate regressions were conducted using: age, sex, race, ethnicity, insurance, lesion level, lifetime # of shunt revisions, and SB-TRAQ to predict urinary incontinence (UI) episodes/month, and stool incontinence (SI) episodes/month. Results: Two separate multiple linear regressions were calculated to predict frequency (times per month) of UI and SI based on age, sex, race, ethnicity, insurance, having an IEP, spinal cord lesion level, lifetime number of shunt revisions, and SB-TRAQ. For UI, a significant regression equation was found (F(9,77) = 2.44, p<.001), with an R2 of .22. SB-TRAQ and IEP were significant predictors of UI; youths’ UI decreased 1.15 days/month for each point increase in SB-TRAQ; youth with an IEP had .83 more episodes of UI/month than did youth without an IEP. The model for SI had a significant regression equation (F(9,75) = 3.18, p<.001), with an R2 of .28. SB-TRAQ and lesion level were significant predictors of SI; youths SI decreased .58 days for each point increase in SB-TRAQ; each lower lesion levels (.13/level) had fewer SI episodes/month than did those with higher lesion levels. Conclusion(s):

OBJECTIVE The transition of the young adult with spina bifida (YASB) from pediatric to adult health care is considered a priority by organized pediatrics. There is a paucity of transition programs and related studies. Jacksonville Health and Transition Services (JaxHATS) is one such transition program in Jacksonville, Florida. This study’s purpose was to evaluate the health care access, utilization, and quality of life (QOL) of a group of YASBs who have transitioned from pediatric care. METHODS A survey tool addressing access to health care and quality of health and life was developed based on an established survey. Records of the Spinal Defects Clinic held at Wolfson Children’s Hospital and JaxHATS Clinic were reviewed and YASBs (> 18 and < 30 years old) were identified. RESULTS Ten of the 12 invited YASBs in the Jacksonville area completed the surveys. The mean age of respondents was 25.1 years. All reported regular medical home visits, 8 with JaxHATS and 2 with other family care groups. All reported easy access to medical care and routine visits to spina bifida (SB) specialists; none reported difficulty or delays in obtaining health care. Only 2 patients required emergent care in the last year for an SB-related medical problem. Seven respondents reported very good to excellent QOL. Family, lifestyle, and environmental factors were also examined. CONCLUSIONS In this small group of YASBs with a medical home, easy access to care for medical conditions was the norm, with few individuals having recent emergency visits and almost all reporting at least a good overall QOL. Larger studies of YASBs are needed to evaluate the positive effects of medical homes on health and QOL in this population.

Background: Measuring the acquisition of self-management and health care utilization skills are part of evidence based health care transition practice. Youth with Spina Bifida (SB) have significant demands for self-management and high self-care burden. To complement HCT skills assessed in the TRAQ, we developed an 11 item SB-TRAQ to assess self-management skills specific to Spina Bifida. Similar to the TRAQ, the SB-TRAQ uses a 5-point Likert responses using Stages of Change. Objective: To develop and assess the reliability and validity of a questionnaire to measure independence and skill acquisition for youth with SB. Design/Methods: Working with a multidisciplinary team of experts in the care of youth with SB we developed a twelve item questionnaire specific to the main facets of SB self-care and -management including urine and stool continence, prevention of skin breakdown and awareness of signs of shunt malfunction. The items were reviewed and revised through several iterations by healthcare providers and patients. The SB-TRAQ was fielded in an SB Specialty Clinic participating in the National Spina Bifida Patient Registry (NSBPR). Ninety youth with SB completed the 20-item TRAQ and the 12-item SB-TRAQ. Item response means, and distributions were assessed. A principal component analysis (PCA) was conducted with oblique rotation (promax). We also assessed criterion validity by examining the correlation of the SB-TRAQ supplement with the TRAQ and age. Results: Sample characteristics and scale information for the TRAQ and SB-TRAQ supplements are displayed in Table 1, including a Cronbach alpha of 0.9 for the SB-TRAQ. The item characteristics are provided in Table 2. Results of the factor analysis show eleven items loaded onto one factor, with almost all items loadings > 0.7 . One item did not load, resulting in an 11 item solution. The primary factor explained 62% of the variance. Intraclass correlations of the SB-TRAQ supplement with the TRAQ overall scale and subscales demonstrated good criterion validity (TRAQ overall ICC = .74; ICCs varied among the subscales and the SB-TRAQ). Additionally, the SB-TRAQ, as hypothesized, was significantly and positively correlated with age (Pearson correlation .29, p<.01). Conclusion(s): Results of our analyses demonstrate that the SB-TRAQ had good internal reliability and excellent criterion validity as demonstrated by strong correlation with age and the validated TRAQ. The SB-TRAQ can be a useful tool to help youth with SB achieve independence and self-management.

Young women with mobility limiting disorders face many challenges as they move through adolescence into young adulthood. In addition to the challenges of this developmental period, they must consider their disability as they manage their lives. Competent decision making is a foundational skill for self-management and for transition in adulthood. It is also a protective factor for resilience.There is little research on decision making in adolescents with disabilities. Therefore, the purpose of this qualitative study was to explore the decision making experiences of female adolescents and young women with mobility limiting disorders. Theoretical underpinnings for the study included Resilience Theory and Phenomenology. Phenomenological methodology guided data collection and analysis. Study participants included six young women between the ages of 16 and 25 who met established inclusion criteria. Participants were interviewed using an interview schedule. Transcripts of the audiotaped interviews were analyzed for themes. An individual profile of decision making in self-management for each participant was developed from analysis of interviews. A composite depiction of the phenomenon of decision making in self-management was developed from analysis of the participant profiles. The following conclusions were drawn from the composite depiction. Decision making in self-management is a dynamic, developmental process that encompasses choices across many dimensions of life activities. Parents' attitudes and expectations can have significant influence on the development of decision making in young women with mobility limiting disorders. Having or taking the opportunity to make decisions may contribute to the development of decisional competence and independence. Barriers, such as social stereotypes and lack of community resources, influence decision making. The ability of the study participants to "see past the disability" creates a broader vision of opportunities for decision making to achieve their goals.The results of this research should be useful to nurses and other health professionals as they collaborate with adolescents with disabilities and their families in fostering and supporting competent decision making in self-management. Future research is recommended on decision making in specific dimensions of self-management such as socialization and, using quantitative and qualitative methods to compare this phenomenon in adolescents with and without disabilities and between genders.

No description available.

Les transitions de cadhérines sont souvent impliquées dans des phénomènes de ségrégation cellulaire mettant en jeu un phénomène de Transition Epithélium-Mésenchyme (TEM). Cependant, lors de la formation du système nerveux central, la transition E-/N-cadhérine n'entraîne pas de TEM et, contrairement au modèle en vigueur, nos résultats montrent que celle-ci n'est absolument pas un prérequis nécessaire aux mouvements morphogénétiques de la neurulation. Le point important lors de la formation du système nerveux central semble surtout être le contrôle de la cinétique de cette transition E-/N-Cadhérine. Le système nerveux central d'oiseau se forme au cours du développement selon des modes bien distincts : dans la région antérieure de l'embryon, la neurulation primaire ; dans la région postérieure, la neurulation dite secondaire conduit à un tube nerveux généré par accrétion cellulaire dont la lumière centrale est créée par cavitation. Dans la région thoracique, le tube neural se forme selon un mode totalement original ayant certaines caractéristiques des deux modes classiques, c'est la neurulation intermédiaire. Les précurseurs neuraux du tube neural intermédiaire et secondaire effectuent une TEM puis migrent postérieurement de manière coordonnée et dirigée grâce au dépôt polarisé de fibronectine induit par la protéine de la polarité planaire, Prickle, puis se ré-épithélialisent. Les Cellules de la Crête Neurale (CCN) constituent un tissu à part du tube neural. Nous montrons que ces cellules se distinguent du reste du neuroépithélium par un répertoire d'expression de cadhérines spécifiques

Thesis (Ph. D.)--Carleton University, 1991. / Also available in electronic format on the Internet.

Thesis--University of Oklahoma. / Bibliography: leaves 57-60.

Thesis (M.S.)--University of Wisconsin-Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 63-67).