BackgroundFinancial toxicity (FT) reflects multi-dimensional personal economic hardships borne by cancer patients. It is unknown whether measures of FT—to date derived largely from English-speakers—adequately capture economic experiences and financial hardships of medically underserved low English proficiency US Hispanic cancer patients. We piloted a Spanish language FT instrument in this population.MethodsWe piloted a Spanish version of the Economic Strain and Resilience in Cancer (ENRICh) FT measure using qualitative cognitive interviews and surveys in un-/under-insured or medically underserved, low English proficiency, Spanish-speaking Hispanics (UN-Spanish, n = 23) receiving ambulatory oncology care at a public healthcare safety net hospital in the Houston metropolitan area. Exploratory analyses compared ENRICh FT scores amongst the UN-Spanish group to: (1) un-/under-insured English-speaking Hispanics (UN-English, n = 23) from the same public facility and (2) insured English-speaking Hispanics (INS-English, n = 31) from an academic comprehensive cancer center. Multivariable logistic models compared the outcome of severe FT (score > 6).ResultsUN-Spanish Hispanic participants reported high acceptability of the instrument (only 0% responded that the instrument was “very difficult to answer” and 4% that it was “very difficult to understand the questions”; 8% responded that it was “very difficult to remember resources used” and 8% that it was “very difficult to remember the burdens experienced”; and 4% responded that it was “very uncomfortable to respond”). Internal consistency of the FT measure was high (Cronbach’s α = 0.906). In qualitative responses, UN-Spanish Hispanics frequently identified a total lack of credit, savings, or income and food insecurity as aspects contributing to FT. UN-Spanish and UN-English Hispanic patients were younger, had lower education and income, resided in socioeconomically deprived neighborhoods and had more advanced cancer vs. INS-English Hispanics. There was a higher likelihood of severe FT in UN-Spanish (OR = 2.73, 95% CI 0.77–9.70; p = 0.12) and UN-English (OR = 4.13, 95% CI 1.13–15.12; p = 0.03) vs. INS-English Hispanics. A higher likelihood of severely depleted FT coping resources occurred in UN-Spanish (OR = 4.00, 95% CI 1.07–14.92; p = 0.04) and UN-English (OR = 5.73, 95% CI 1.49–22.1; p = 0.01) vs. INS-English. The likelihood of FT did not differ between UN-Spanish and UN-English in both models (p = 0.59 and p = 0.62 respectively).ConclusionIn medically underserved, uninsured Hispanic patients with cancer, comprehensive Spanish-language FT assessment in low English proficiency participants was feasible, acceptable, and internally consistent. Future studies employing tailored FT assessment and intervention should encompass the key privations and hardships in this population.
Introduction: Social isolation (SI) after stroke is associated with increased ischemic injury and significantly delayed recovery due to exacerbation of microglial activation and immune mediated pro-inflammatory mechanisms. Studies have identified miRNAs that modulate and regulate this inflammatory transition through inflammasome NLRP3 activation. However, studies examining miRNA-based microglial activation in SI within the neuro-immune landscape are limited. We investigated miRNA profiles in aged mice to provide biomarkers and to identify underlying mechanisms related to microglial activation within the cerebral environment to mitigate this pathological microglial phenotype. Methods: Aged C57BL/6 male mice (18-20 months) were subjected to a 60-minute middle cerebral artery occlusion (MCAO) followed by reperfusion and were assigned to either (SI) or continued pair-housing (PH) immediately after stroke. On day 15, mice were sacrificed, and plasma samples were subjected to microRNAome (miRNAome) analysis. Top miRNAs were identified using bioinformatics frameworks and pathway analysis was performed using KEGG platform. Flow Cytometry (FACS) was performed on brain tissue and blood to determine if stroke or SI leads to changes in microglial and systemic myeloid activation. Results: The whole miRNAome panel analysis revealed 12 differentially expressed miRNAs (FC of 3 or higher) within the plasma following volcano plot and unsupervised hierarchical clustering analysis confirmed by qPCR validation (P< 0.05). Network analysis revealed miR-495-3p as a pivotal node that targeted the largest subset of immune specific genes (P< 0.05); most notable for the inflammasome NLRP3, a regulator of microglial activation. Significant microglial activation was seen in post-stroke SI mice compared to pair-housed cohorts, identified through MHC-II presentation and the intracellular release of pro-inflammatory cytokines. Conclusion: This study provides an overview of the miRNA changes induced by post-stroke isolation. Additionally, these results suggest that there is potential to use plasma-based miRNAs as a source of novel biomarkers. Further, microglial inflammasome specific pathways appear to be involved in post-stroke social isolation.
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