Changes in Cancer Screening Knowledge Among a Prospective Cohort of Spanish-Speaking Hispanic Community Outreach Event Participants in Florida and Puerto Rico.

The current study examined cancer prevention and early detection awareness (pre-workshop) and changes in knowledge (from pre- to post-workshop) among Hispanic/Latino (H/L) community members who participated in Spanish-language educational outreach events in Puerto Rico (PR) and Florida (FL). Spanish-language educational outreach events were comprised of an educational session lasting approximately 45-60 min and were delivered to groups in rural and urban community settings by a single trained community health educator (CHE). The research team assessed sociodemographic characteristics, personal and familial cancer health history, as well as awareness and knowledge (pre-test) of a range of cancer prevention and screening topics. Following the presentation, participants completed a post-test knowledge survey which also measured likelihood of engaging in cancer screening, cancer preventive behaviors, and cancer research as a result of information presented during the session. Change in the average knowledge score was evaluated using a paired samples t-test. Post-session likelihood of completing cancer screening and preventive behaviors and engaging in cancer research were examined using descriptive statistics and group/site comparisons. The percentage reporting awareness of screening procedures ranged from 33% (PSA test) to 79% (mammogram). H/L in PR reported higher percentage of stool blood test awareness when compared to H/L in FL (χ2(1)= 19.20, p<.001). The average knowledge score increased from 5.97 at pre-test to 7.09 at post-test (Cohen's d=0.69). The increase was significant across all participants (t(315)= 12.4, p<.001), as well as within the FL site (t(124)= 6.66, p<.001, d=0.59) and the PR site (t(190)=10.66, p<.001, d=0.77). Results from this study suggest that educational outreach events delivered to H/L community members by a CHE are valuable strategies to address challenges regarding cancer screening knowledge and engagement in multiple behaviors.

Performance of standardised colposcopy to detect cervical precancer and cancer for triage of women testing positive for human papillomavirus: results from the ESTAMPA multicentric screening study.

BACKGROUND: Colposcopy, currently included in WHO recommendations as an option to triage human papillomavirus (HPV)-positive women, remains as the reference standard to guide both biopsy for confirmation of cervical precancer and cancer and treatment approaches. We aim to evaluate the performance of colposcopy to detect cervical precancer and cancer for triage in HPV-positive women. METHODS: This cross-sectional, multicentric screening study was conducted at 12 centres (including primary and secondary care centres, hospitals, laboratories, and universities) in Latin America (Argentina, Bolivia, Colombia, Costa Rica, Honduras, Mexico, Paraguay, Peru, and Uruguay). Eligible women were aged 30-64 years, sexually active, did not have a history of cervical cancer or treatment for cervical precancer or a hysterectomy, and were not planning to move outside of the study area. Women were screened with HPV DNA testing and cytology. HPV-positive women were referred to colposcopy using a standardised protocol, including biopsy collection of observed lesions, endocervical sampling for transformation zone (TZ) type 3, and treatment as needed. Women with initial normal colposcopy or no high-grade cervical lesions on histology (less than cervical intraepithelial neoplasia [CIN] grade 2) were recalled after 18 months for another HPV test to complete disease ascertainment; HPV-positive women were referred for a second colposcopy with biopsy and treatment as needed. Diagnostic accuracy of colposcopy was assessed by considering a positive test result when the colposcopic impression at the initial colposcopy was positive minor, positive major, or suspected cancer, and was considered negative otherwise. The main study outcome was histologically confirmed CIN3+ (defined as grade 3 or worse) detected at the initial visit or 18-month visit. FINDINGS: Between Dec 12, 2012, and Dec 3, 2021, 42 502 women were recruited, and 5985 (14·1%) tested positive for HPV. 4499 participants with complete disease ascertainment and follow-up were included in the analysis, with a median age of 40·6 years (IQR 34·7-49·9). CIN3+ was detected in 669 (14·9%) of 4499 women at the initial visit or 18-month visit (3530 [78·5%] negative or CIN1, 300 [6·7%] CIN2, 616 [13·7%] CIN3, and 53 [1·2%] cancers). Sensitivity was 91·2% (95% CI 88·9-93·2) for CIN3+, whereas specificity was 50·1% (48·5-51·8) for less than CIN2 and 47·1% (45·5-48·7) for less than CIN3. Sensitivity for CIN3+ significantly decreased in older women (93·5% [95% CI 91·3-95·3] in those aged 30-49 years vs 77·6% [68·6-85·0] in those aged 50-65 years; p<0·0001), whereas specificity for less than CIN2 significantly increased (45·7% [43·8-47·6] vs 61·8% [58·7-64·8]; p<0·0001). Sensitivity for CIN3+ was also significantly lower in women with negative cytology than in those with abnormal cytology (p<0·0001). INTERPRETATION: Colposcopy is accurate for CIN3+ detection in HPV-positive women. These results reflect ESTAMPA efforts in an 18-month follow-up strategy to maximise disease detection with an internationally validated clinical management protocol and regular training, including quality improvement practices. We showed that colposcopy can be optimised with proper standardisation to be used as triage in HPV-positive women. FUNDING: WHO; Pan American Health Organization; Union for International Cancer Control; National Cancer Institute (NCI); NCI Center for Global Health; National Agency for the Promotion of Research, Technological Development, and Innovation; NCI of Argentina and Colombia; Caja Costarricense de Seguro Social; National Council for Science and Technology of Paraguay; International Agency for Research on Cancer; and all local collaborative institutions.

Ten Steps to Conduct a Systematic Review.

This article introduces a concise 10-step guide tailored for researchers engaged in systematic reviews within the field of medicine and health, aligning with the imperative for evidence-based healthcare. The guide underscores the importance of integrating research evidence, clinical proficiency, and patient preferences. It emphasizes the need for precision in formulating research questions, utilizing tools such as PICO(S)(Population Intervention Comparator Outcome), PEO (Population Exposure Outcome), SPICE (setting, perspective, intervention/exposure/interest, comparison, and evaluation), and SPIDER (expectation, client group, location, impact, professionals, service and evaluation), and advocates for the validation of research ideas through preliminary investigations. The guide prioritizes transparency by recommending the documentation and registration of protocols on various platforms. It highlights the significance of a well-organized literature search, encouraging the involvement of experts to ensure a high-quality search strategy. The critical stages of screening titles and abstracts are navigated using different tools, each characterized by its specific advantages. This diverse approach aims to enhance the effectiveness of the systematic review process. In conclusion, this 10-step guide provides a practical framework for the rigorous conduct of systematic reviews in the domain of medicine and health. It addresses the unique challenges inherent in this field, emphasizing the values of transparency, precision, and ongoing efforts to improve primary research practices. The guide aims to contribute to the establishment of a robust evidence base, facilitating informed decision-making in healthcare.

Robotic Magnetic Surgery: Results From the First Prospective Clinical Trial.

To evaluate a novel Magnetic Robotic Platform during reduced-port laparoscopic surgery in a prospective, multicenter clinical trial. Background: Magnetic surgery has been developed to increase the benefits of minimally invasive surgery, with prior studies demonstrating its clinical benefits. Robotic-assisted surgery increases the surgeon's control over the instruments, offering less dependency on an assistant. The synergism of both techniques may escalate these individual benefits. Methods: A prospective, multicenter, single-arm, open-label study was performed to assess the safety and performance of a robotic magnetic surgical system (Levita Robotic Platform). The investigational device was used during reduced-port laparoscopic cholecystectomy and laparoscopic bariatric surgery. The primary endpoints evaluated were safety and feasibility. Patients were followed for 30 days post-procedure. Results: Between May 2021 and December 2021, 30 patients undergoing laparoscopic surgery were recruited. There were 22 females and 8 males with a mean age of 39 years (22-69 years) and median body mass index of 33 kg/m2 (21.6-50.4 kg/m2). Procedures included 15 gastric sleeves, 14 cholecystectomies, and 1 Roux en-Y gastric bypass. The procedures were successfully performed by utilizing the robotic magnetic surgical system and a reduced-port technique in all 30 patients. No device-related serious adverse events were reported. The device provided adequate visualization and retraction in all cases. Conclusions: This clinical trial shows for the first time that this novel Magnetic Robotic Platform is safe and feasible in reduced-port laparoscopic cholecystectomy and laparoscopic bariatric surgery. This robotic platform brings the benefits of magnetic surgery in terms of reduction of incisions plus increasing the control for the surgeon.

Complementary Effect of Maternal Sildenafil and Fetal Tracheal Occlusion Improves Lung Development in the Rabbit Model of Congenital Diaphragmatic Hernia.

OBJECTIVE: To evaluate the effect of combining antenatal sildenafil with fetal tracheal occlusion (TO) in fetal rabbits with surgically induced congenital diaphragmatic hernia (CDH). BACKGROUND: Although antenatal sildenafil administration rescues vascular abnormalities in lungs of fetal rabbits with CDH, it only partially improves airway morphometry. We hypothesized that we could additionally stimulate lung growth by combining this medical treatment with fetal TO. METHODS: CDH was created on gestational day (GD)23 (n=54). Does were randomized to receive either sildenafil 10 mg/kg/d or placebo by subcutaneous injection from GD24 to GD30. On GD28, fetuses were randomly assigned to TO or sham neck dissection. At term (GD30) fetuses were delivered, ventilated, and finally harvested for histological and molecular analyses. Unoperated littermates served as controls. RESULTS: The lung-to-body-weight ratio was significantly reduced in sham-CDH fetuses either (1.2 ±â€Š0.3% vs 2.3 ±â€Š0.3% in controls, P=0.0003). Sildenafil had no effect on this parameter, while CDH fetuses undergoing TO had a lung-to-body-weight ratio comparable to that of controls (2.5 ±â€Š0.8%, P<0.0001). Sildenafil alone induced an improvement in the mean terminal bronchiolar density (2.5 ±â€Š0.8 br/mm2 vs 3.5 ±â€Š0.9 br/mm2, P=0.043) and lung mechanics (static elastance 61 ±â€Š36 cmH2O /mL vs 113 ±â€Š40 cmH2O/mL, P=0.008), but both effects were more pronounced in fetuses undergoing additional TO (2.1 ±â€Š0.8 br/mm2, P=0.001 and 31 ±â€Š9 cmH2O/mL, P<0.0001 respectively). Both CDH-sham and CDH-TO fetuses treated with placebo had an increased medial wall thickness of peripheral pulmonary vessels (41.9 ±â€Š2.9% and 41.8 ±â€Š3.2%, vs 24.0 ±â€Š2.9% in controls, P<0.0001). CDH fetuses treated with sildenafil, either with or without TO, had a medial thickness in the normal range (29.4% ±â€Š2.6%). Finally, TO reduced gene expression of vascular endothelial growth factor and surfactant protein A and B, but this effect was counteracted by sildenafil. CONCLUSION: In the rabbit model for CDH, the combination of maternal sildenafil and TO has a complementary effect on vascular and parenchymal lung development.

Brief Report: Hispanic Patients' Trajectory of Cancer Symptom Burden, Depression, Anxiety, and Quality of Life.

Background: Anxiety and depression symptoms are known to increase cancer symptom burden, yet little is known about the longitudinal integrations of these among Hispanic/Latinx patients. The goal of this study was to explore the trajectory and longitudinal interactions among anxiety and depression, cancer symptom burden, and health-related quality of life in Hispanic/Latinx cancer patients undergoing chemotherapy. METHODS: Baseline behavioral assessments were performed before starting chemotherapy. Follow-up behavioral assessments were performed at 3, 6, and 9 months after starting chemotherapy. Descriptive statistics, chi-square tests, Fisher's exact tests, and Mann-Whitney tests explored associations among outcome variables. Adjusted multilevel mixed-effects linear regression models were also used to evaluate the association between HADS scores, follow-up visits, FACT-G scale, MDASI scale, and sociodemographic variables. RESULTS: Increased cancer symptom burden was significantly related to changes in anxiety symptoms' scores (adjusted ß^ = 0.11 [95% CI: 0.02, 0.19]. Increased quality of life was significantly associated with decreased depression and anxiety symptoms (adjusted ß^ = -0.33; 95% CI: -0.47, -0.18, and 0.38 adjusted ß^= -0.38; 95% CI: -0.55, -0.20, respectively). CONCLUSIONS: Findings highlight the need to conduct periodic mental health screenings among cancer patients initiating cancer treatment.

Variable mesh optimization applied to fringe pattern demodulation using a Bézier surface.

We present a parametric method to carry out a demodulation process in complex fringe pattern images with either open or closed fringes; this method is based on the parallel demodulation algorithm and introduces a novel way, to the best of our knowledge, to approximate the phase map using the Bezier surface control points. For this study, a recently developed population meta-heuristic called Variable Mesh Optimization is introduced to implement the optimization process. The results of the proposed method improve the phase error and the run time scores in comparison with other global optimization algorithms, which address this type of problem.

Alimentación, comportamiento de oviposición, ciclo de vida y enemigos naturales de Hamadryas feronia (Nymphalidae) en la Amazonía del Perú / Feeding, oviposition behavior, life cycle, and natural enemies of Hamadryas Feronia (Nymphalidae) in the Peruvian Amazon

Resumen Introducción: Hamadryas feronia feronia, se mimetiza sobre las cortezas de los árboles y suele emitir sonidos al volar que llaman la atención; posee un buen potencial para los bionegocios (exportación, elaboración de artesanías y centros turísticos de crianza). Sin embargo, aún se desconocen sus aspectos biológicos que obstaculizan su crianza en cautiverio. Objetivos: Determinar los aspectos biológicos de alimentación, comportamiento de oviposición, ciclo de vida y los enemigos naturales de Hamadryas feronia feronia L. en San Rafael-Indiana, Loreto, Perú. Métodos: Los muestreos fueron realizados desde enero 2018 a diciembre 2019 en la comunidad de San Rafael, río Amazonas. Los adultos fueron observados durante el día, se registraron sus plantas alimenticias, su comportamiento de oviposición, su ciclo biológico y sus enemigos naturales. El ciclo de vida fue evaluado en el laboratorio, utilizando 20 huevos recientemente depositados en las hojas de su planta hospedera. Resultados: Las larvas de H. feronia feronia se alimentan de las hojas de Dalechampia juruana y los adultos se alimentan de la savia de la corteza de los árboles de Cedrela odorata, Spondias mombin, Uncaria guianensis y de los frutos fermentados de Syzygium malaccense y Pouteria caimito. Los adultos vuelan en días soleados, los machos emiten un fuerte sonido al volar. Las hembras previo a la oviposición revolotean de forma irregular alrededor de su planta hospedera entre las 8.00 y las 14.00 h y depositan sus huevos en el haz y envés de las hojas de forma aislada con mayor frecuencia en el envés (N= 85). La duración del ciclo, desde huevo hasta adulto fue de 28.24 días. El periodo promedio del huevo fue 3.75 ± 0.40 días. La larva pasa por cinco estadíos larvales: el primero duró 3.21 ± 1.03 días, el segundo 2.78 ± 0.73 días, el tercero 2.67 ± 0.77 días, el cuarto 3.22 ± 0.81 días, y el quinto 4.61 ± 0.70 días. El periodo de la prepupa duró 1.33 ± 0.49 días y el de pupa 6.67 ± 0.80 días; los adultos nacieron entre las 10:00 y 11:00 h. Los machos adultos viven en promedio 31.80 ± 3.29 días, la hembra 42.00 ± 2.14 días y sus huevos son parasitados por un microhimenóptero (Scelionidae). Conclusiones: Este estudio permitió conocer los aspectos biológicos de H. feronia feronia identificando sus plantas alimenticias tanto de las larvas como de los adultos, su comportamiento de oviposición, así mismo se ha determinado que tiene un ciclo biológico relativamente corto con un periodo menor de un mes y sus huevos son consumidos por un pequeño Himenóptero que puede obstaculizar su producción. Este trabajo brinda información necesaria para desarrollar la crianza de H. feronia feronia, orientado a su conservación, la educación ambiental y los bionegocios (turismo y artesanía) en la Amazonia peruana.

Abstract Introduction: Hamadryas feronia feronia, which mimics the bark of trees and often makes attention-grabbing sounds when flying, has good potential for bio-business (export, handicrafts and tourist breeding centers). However, its biological aspects are still unknown, which hinder its captive breeding. Objectives: To determine the biological aspects of feeding, oviposition behavior, life cycle and natural enemies of Hamadryas feronia feronia L. in San Rafael-Indiana, Loreto, Peru. Methods: Sampling was conducted from January 2018 to December 2019 in the community of San Rafael, Amazon River. Adults were observed during the day, their food plants, oviposition behavior, biological cycle and natural enemies were recorded. The life cycle was evaluated in the laboratory, using 20 eggs recently deposited on the leaves of their host plant. Results: The larvae of H. feronia feronia feed on the leaves of Dalechampia juruana and the adults feed on the bark sap of Cedrela odorata, Spondias mombin, Uncaria guianensis and the fermented fruits of Syzygium malaccense and Pouteria caimito. Adults fly on sunny days, males emit a loud sound when flying. Females prior to oviposition flit irregularly around their host plant between 8.00 and 14.00 h and deposit their eggs on the upper and underside of leaves in isolation, most frequently on the underside. The duration of the cycle from egg to adult was 28.24 days. The average egg period was 3.75 ± 0.40 days. The larvae passed through five larval instars: the first instar 3.21 ± 1.03 days, the second 2.78 ± 0.73 days, the third 2.67 ± 0.77 days, the fourth 3.22 ± 0.81 days, and the fifth 4.61 ± 0.70 days. The prepupal period lasted 1.33 ± 0.49 days and the pupal period 6.67 ± 0.80 days; the adults hatched between 10:00 to 11:00 h. Adult males lived on average 31.80 ± 3.29 days, the female 42.00 ± 2.14 days and their eggs were parasitized by a microhymenopteran (Scelionidae). Conclusions: This study allowed to know the biological aspects of H. feronia feronia identifying its food plants of both larvae and adults, its oviposition behavior, as well as it has been determined that it has a relatively short biological cycle with a period of less than one month and its eggs are consumed by a small Hymenoptera that can hinder its production. This work provides necessary information to develop the breeding of H. feronia feronia, oriented to its conservation, environmental education and biotrade (tourism and handicrafts) in the Peruvian Amazon.

Dysfunctional Eating Behaviors and Dietary Intake in Puerto Rico.

Dysfunctional eating behaviors (DEB: emotional eating (EE), uncontrolled eating (UE) and cognitive restraint (CR)) are prevalent in U.S. Latinos and may influence diet. However, this has not been studied in Puerto Rico (PR). This study documents DEB in PR, and explores associations with diet. Cross-sectional study of adults (n = 92) in Ponce, PR. DEB were measured with the TFEQ-R18-V2. The Block Fat and Fruits and Vegetables Screener measured dietary intake. Analysis included adjusted proportions, means and linear regressions. 76%, 88%, and 87% of participants experienced EE, UE and CR, respectively. EE was associated with calories from fats (ß = 1.95, 95% CI 0.40, 3.51) and saturated fats (ß = 3.26, 95% CI 0.67, 5.85), and CR with fruits and vegetables (ß = 0.69, 95% CI 0.20, 1.19). A large percentage of the sample experienced DEB. EE and CR were associated with dietary intake. Studies are needed to understand associations between DEB, diet and health in PR.

Decídetexto: Feasibility and Acceptability of a Mobile Smoking Cessation Intervention in Puerto Rico.

The purpose of this pilot study was to assess the feasibility and acceptability of a mobile smoking cessation intervention in Puerto Rico. This was a single-arm pilot study with 26 smokers in Puerto Rico who were enrolled in Decídetexto, a mobile smoking cessation intervention. Decídetexto incorporates three integrated components: (1) a tablet-based software that collects smoking-related information to develop an individualized quit plan, (2) a 24-week text messaging counseling program with interactive capabilities, and (3) pharmacotherapy support. Outcome measures included self-reported 7-day point prevalence abstinence at Months 3 and 6, pharmacotherapy adherence, satisfaction with the intervention, and changes in self-efficacy. The average age of the participants was 46.8 years (SD 12.7), half of them (53.8%) were female. Most participants (92.3%) smoked daily and half of them (53.8%) used menthol cigarettes. All participants requested nicotine patches at baseline. However, only 13.0% of participants used the patch >75% of days. At Month 3, 10 participants (38.4%) self-reported 7-day point prevalence abstinence (88.5% follow-up rate). At Month 6, 16 participants (61.5%) self-reported 7-day point prevalence abstinence (76.9% follow-up rate). Most participants (90%, 18/20) reported being satisfied/extremely satisfied with the intervention at Month 6. Self-efficacy mean scores significantly increased from 40.4 (SD 12.1) at baseline to 57.9 (SD 11.3) at Month 3 (p < 0.01). The study suggests that Decídetexto holds promise for further testing among Puerto Rican smokers.

A semi-automated method for unbiased alveolar morphometry: Validation in a bronchopulmonary dysplasia model.

Reproducible and unbiased methods to quantify alveolar structure are important for research on many lung diseases. However, manually estimating alveolar structure through stereology is time consuming and inter-observer variability is high. The objective of this work was to develop and validate a fast, reproducible and accurate (semi-)automatic alternative. A FIJI-macro was designed that automatically segments lung images to binary masks, and counts the number of test points falling on tissue and the number of intersections of the air-tissue interface with a set of test lines. Manual selection remains necessary for the recognition of non-parenchymal tissue and alveolar exudates. Volume density of alveolar septa ([Formula: see text]) and mean linear intercept of the airspaces (Lm) as measured by the macro were compared to theoretical values for 11 artificial test images and to manually counted values for 17 lungs slides using linear regression and Bland-Altman plots. Inter-observer agreement between 3 observers, measuring 8 lungs both manually and automatically, was assessed using intraclass correlation coefficients (ICC). [Formula: see text] and Lm measured by the macro closely approached theoretical values for artificial test images (R2 of 0.9750 and 0.9573 and bias of 0.34% and 8.7%). The macro data in lungs were slightly higher for [Formula: see text] and slightly lower for Lm in comparison to manually counted values (R2 of 0.8262 and 0.8288 and bias of -6.0% and 12.1%). Visually, semi-automatic segmentation was accurate. Most importantly, manually counted [Formula: see text] and Lm had only moderate to good inter-observer agreement (ICC 0.859 and 0.643), but agreements were excellent for semi-automatically counted values (ICC 0.956 and 0.900). This semi-automatic method provides accurate and highly reproducible alveolar morphometry results. Future efforts should focus on refining methods for automatic detection of non-parenchymal tissue or exudates, and for assessment of lung structure on 3D reconstructions of lungs scanned with microCT.

Experiencia clínica del uso de la ficha SIP/CLAP en mujeres con aborto espontáneo resuelto por vía quirúrgica / Clinical experience of the use of the SIP/CLAP form use in women with spontaneous abortion treated by surgical means

INTRODUCCIÓN Y OBJETIVOS: En Chile, existen datos parcializados en cuanto a la prevalencia de aborto. La población migrante ha generado un cambio en las características de las pacientes en situación de aborto. El objetivo es describir las características demográficas y clínicas de las mujeres con aborto de manejo quirúrgico con y sin complicaciones. MÉTODOS: Estudio Descriptivo Transversal. Se incluyeron mujeres atendidas por aborto, sometidas a método de evacuación y que estuvieran ingresadas al sistema SIP/CLAP. Se compararon mujeres con o sin complicaciones con respecto a diferentes características demográficas y clínicas. Se calculó Odd Ratio para algunas variables de interés. RESULTADOS: Se incluyeron 554 mujeres, un 13% (N= 73) tuvo complicación al ingreso, principalmente hemorrágica (40%). Las características demográficas fueron similares en ambos grupos. Hubo mayor riesgo de complicación en mujeres con abortos previos (OR: 2,4 (IC 1,3-4,5), p =0.00), cuando el diagnóstico de ingreso fue aborto incompleto (OR: 85,3 (IC 25,2-288), p=0,00) y cuando se realizó legrado (OR: 4 (IC 2,5-6,5) p=0,00). La mayoría de las pacientes con complicaciones no planeó el embarazo (OR: 11 (IC 3,4-37,7), p=0,00) y no usó método anticonceptivo en esta gestación. El 70% recibió método anticonceptivo al egreso. CONCLUSIONES: Existen características clínicas asociadas a complicación en mujeres con aborto de manejo quirúrgico en nuestro centro, como diagnóstico de ingreso, embarazo no planificado, aborto previo y tipo de evacuación. Existen limitaciones en cuanto a la cantidad y calidad de información, sin embargo, nuestros resultados permiten conocer el perfil de pacientes atendidas por aborto en nuestro centro.

INTRODUCTION AND OBJECTIVES: In Chile, there are partial data regarding the prevalence of abortion. The migrant population has generated a change in the characteristics of patients in an abortion situation. The objective is to describe the demographic and clinical characteristics of women with surgical abortion with and without complications. METHODS: Transversal Descriptive Study. Women treated for abortion, undergoing evacuation method and who were admitted to the SIP / CLAP system were included. Women with or without complications were compared with respect to different demographic and clinical characteristics. Odd Ratio was calculated for some variables of interest. RESULTS: 554 women were included, 13% (N = 73) had complication at admission, mainly hemorrhagic (40%). Demographic characteristics were similar in both groups. There was an increased risk of complication in women with previous abortions (OR: 2.4 (IC 1.3-4.5), p = 0.00), when the diagnosis of admission was incomplete abortion (OR: 85.3 (IC 25.2- 288), p = 0.00) and when curettage was performed (OR: 4 (IC 2.5-6.5) p = 0.00). The majority of patients with complications did not plan pregnancy (OR: 11 (IC 3.4-37.7), p = 0.00) and did not use a contraceptive method in this pregnancy. 70% received contraceptive method upon discharge. CONCLUSIONS: There are clinical characteristics associated with complications in women with surgical management abortion in our center, such as admission diagnosis, unplanned pregnancy, previous abortion and type of evacuation. There are limitations regarding the quantity and quality of information, however, our results allow us to know the profile of patients treated for abortion in our center.

Using species distribution models to locate the potential cradles of the allopolyploid Gypsophila bermejoi G. López (Caryophyllaceae).

Polyploidy has been an influential force in plant evolution, playing a crucial role in diversification. Differences in polyploid and diploid distributions have been long noted, with polyploid taxa especially abundant in harsh environments. These plants have higher photosynthetic rates and/or higher tolerance to water deficits. Moreover, there is data pointing to an increase in the rate of unreduced gamete formation by plants under conditions of stress. Accordingly, a higher frequency of polyploid individuals would be expected in populations living under extreme environments, a phenomenon that may be relevant when considering the origin of allopolyploid species. Hybridization between distinct autopolyploids is known to produce allopolyploids and hence, a high frequency of compatible autopolyploids in an area could enhance the formation of stable populations of the corresponding allopolyploid hybrid. Here we consider the allopolyploid species Gypsophila bermejoi G. López and its parental taxa G. struthium L. subsp. struthium and G. tomentosa L. We have used Species Distribution Models to locate areas with low bioclimatic suitability for both parental taxa during the Last Glacial Maximum (LGM), hypothesizing that the rate of tetraploid hybrid formation would be higher than expected where low suitability areas of both parental species overlap. We selected those areas taking into account the strict gypsophyllic nature of these taxa. There is data pointing to a post-glacial origin of the current G. bermejoi populations and according to our hypothesis, such locations could be centers for hybrid tetraploid formation or potential cradles of this species. Indeed, potential Mid-Holocene cradles were also identified in this manner. The evolution of bioclimatic suitability in both LGM and Mid-Holocene cradles was studied to assess the possible survival of the hybrids, and the current distribution of G. bermejoi proved to be consistent with our hypothesis.

Preterm birth impairs postnatal lung development in the neonatal rabbit model.

BACKGROUND: Bronchopulmonary dysplasia continues to cause important respiratory morbidity throughout life, and new therapies are needed. The common denominator of all BPD cases is preterm birth, however most preclinical research in this area focusses on the effect of hyperoxia or mechanical ventilation. In this study we investigated if and how prematurity affects lung structure and function in neonatal rabbits. METHODS: Pups were delivered on either day 28 or day 31. For each gestational age a group of pups was harvested immediately after birth for lung morphometry and surfactant protein B and C quantification. All other pups were hand raised and harvested on day 4 for the term pups and day 7 for the preterm pups (same corrected age) for lung morphometry, lung function testing and qPCR. A subset of pups underwent microCT and dark field imaging on day 0, 2 and 4 for terms and on day 0, 3, 5 and 7 for preterms. RESULTS: Preterm pups assessed at birth depicted a more rudimentary lung structure (larger alveoli and thicker septations) and a lower expression of surfactant proteins in comparison to term pups. MicroCT and dark field imaging revealed delayed lung aeration in preterm pups, in comparison to term pups. Preterm birth led to smaller pups, with smaller lungs with a lower alveolar surface area on day 7/day 4. Furthermore, preterm birth affected lung function with increased tissue damping, tissue elastance and resistance and decreased dynamic compliance. Expression of vascular endothelial growth factor (VEGFA) was significantly decreased in preterm pups, however in the absence of structural vascular differences. CONCLUSIONS: Preterm birth affects lung structure and function at birth, but also has persistent effects on the developing lung. This supports the use of a preterm animal model, such as the preterm rabbit, for preclinical research on BPD. Future research that focuses on the identification of pathways that are involved in in-utero lung development and disrupted by pre-term birth, could lead to novel therapeutic strategies for BPD.

Simvastatin attenuates lung functional and vascular effects of hyperoxia in preterm rabbits.

BACKGROUND: Bronchopulmonary dysplasia (BPD) remains a frequent complication following preterm birth, affecting respiratory health throughout life. Transcriptome analysis in a preterm rabbit model for BPD revealed dysregulation of key genes for inflammation, vascular growth and lung development in animals exposed to hyperoxia, which could be prevented by simvastatin. METHODS: Preterm rabbits were randomized to either normoxia (21% O2) or hyperoxia (95% O2) and within each condition to treatment with 5 mg/kg simvastatin daily or control. Lung function, structure and mRNA-expression was assessed on day 7. RESULTS: Simvastatin partially prevented the effect of hyperoxia on lung function, without altering alveolar structure or inflammation. A trend towards a less fibrotic phenotype was noted in simvastatin-treated pups, and airways were less muscularized. Most importantly, simvastatin completely prevented hyperoxia-induced arterial remodeling, in association with partial restoration of VEGFA and VEGF receptor 2 (VEGFR2) expression. Simvastatin however decreased survival in pups exposed to normoxia, but not to hyperoxia. CONCLUSION: Repurposing of simvastatin could be an advantageous therapeutic strategy for bronchopulmonary dysplasia and other developmental lung diseases with pulmonary vascular disease. The increased mortality in the treated normoxia group however limits the translational value at this dose and administration route.

Correction: The proportion of alveolar type 1 cells decreases in murine hypoplastic congenital diaphragmatic hernia lungs.

[This corrects the article DOI: 10.1371/journal.pone.0214793.].

Health Innovation Laboratories: towards strong Primary Health Care (PHC)in the Federal District of Brasilia. / Laboratórios de inovação em saúde: por uma Atenção Primária à Saúde forte no Distrito Federal, Brasil.

This article emphasizes PHC as a fundamental strategy for the sustainability of the SUS, based on its impact on health indicators. The attributes and requirements for Robust PHC are based on statements from researchers, policy makers and institutions, including the PAHO/WHO Representation in Brazil. The model proposed is the result of discussions with workers, researchers and health managers in Brazil, endorsing the commitments outlined in the Alma Ata Declaration. The article details the methodology of Health Innovation Laboratories used by PAHO/WHO in Brazil to systematize knowledge generated by innovative health experiences, including the Healthy Brasilia Project, an ongoing activity run by the Health Department of the Federal District (DF) of Brasilia, which has made important changes in the healthcare model, with emphasis on the expansion of Family Health Strategy coverage. This article analyzes the results of the Innovation Laboratories in Robust PHC in the FD that will be consolidated in a Case Study. The initiative aims to raise awareness amongst managers and health workers about innovation in health processes and policies that are essential for the sustainability of theSUS, focusing on the exchange of knowledge between peers about relevant initiatives in PHCin Brazil.

O artigo defende a APS como estratégia fundamental para a sustentabilidade do SUS, subsidiado em resultados sobre o impacto da APS nos indicadores de saúde e outras áreas. São apresentados os atributos e requisitos para uma APS Forte, defendidos por pesquisadores, formuladores de políticas e instituições, entre elas a Representação da OPAS/OMS no Brasil. O formato advogado é fruto de discussão realizada com trabalhadores, pesquisadores e gestores de saúde do país, reafirmando os compromissos da Declaração de Alma Ata. O artigo detalha a metodologia de Laboratórios de Inovação em Saúde, utilizada pela OPAS/OMS no Brasil para identificar e sistematizar experiências inovadoras em saúde, incluindo o acompanhamento do Projeto Brasília Saudável, da Secretaria de Saúde do DF, que vem apresentando importantes transformações no modelo de atenção à saúde, com ênfase na ampliação da cobertura da Estratégia Saúde da Família. O artigo resgata e analisa os trabalhos desenvolvidos pelo Laboratório de Inovação em APS Forte no DF até o momento e que serão sistematizados em Estudo de Caso. A iniciativa visa sensibilizar gestores e trabalhadores em saúde para a inovação em processos e políticas de saúde, sendo essencial para a sustentabilidade do SUS, privilegiando troca de conhecimentos entre pares sobre iniciativas adotadas na APS do Brasil.

Preferences, use of and satisfaction with mental health services among a sample of Puerto Rican cancer patients.

OBJECTIVE: The purpose of this study was to describe the preferences, the use, satisfaction of mental health services (MHS) among a sample of Puerto Rican patients with cancer undergoing oncology treatment. METHODS: A convenience sample of 120 patients diagnosed with cancer was recruited. Self-report questionnaires assessed socio-demographic and background questions, and the Mental Health Service Preference, Utilization and Satisfaction Questionnaire (MHSPUS). The Socio-demographic and Background Questionnaire inquired about participants' demographic and socioeconomic characteristics, and included questions such as history of psychiatric diagnosis and spiritual practices. Univariate and Chi square analyses were used for descriptive purposes. Logistic regressions were used to explore associations between sociodemographic factors and MHS preferences and use. RESULTS: The majority of the sample were females (53.8%), 61 and older (53.8%), and married or living with partner (57.1%), and reported an income equal to or less than $12,000 per year (44.4%), which places them under the US federal poverty line. Most of the participants (66.7%) reported being receptive to seeking services. Findings showed a significant association between living situation and past (p < .05) and lifetime use (p < .05) of MHS and past use of MHS. Participants living alone were more like to have used MHS in the past and during their lifetime. Adjusted logistic regression analyses revealed that living with someone was a protective factor for not using MHS in their lifetime (OR = 0.28; C1 = 0.08-0.95). Participants preferred to receive MHS at the oncology clinic, preferably on the date of their oncology appointments and during morning hours. CONCLUSION: Findings support the integration of mental health services within the oncology practice setting.

Four climate change scenarios for Gypsophila bermejoi G. López (Caryophyllaceae) to address whether bioclimatic and soil suitability will overlap in the future.

Climate change has altered the global distribution of many species. Accordingly, we have assessed here the potential shift in the distribution of Gypsophila bermejoi G. López under distinct scenarios of future climate change, this being a species endemic to the Iberian Peninsula. For strict gypsophiles, climatic changes affecting their potential area of distribution could be critical if the new range is not overlapped with suitable soils. Thus, the narrow bioclimatic niche and the endemic nature of this plant could make this species particularly vulnerable to climate change. We used the Maximum Entropy (MaxEnt) method to study the potential distribution of this taxon under four different scenarios of climate change, pin-pointing relevant changes in the potential distribution of this plant and enabling possible future areas of refuge to be assessed. Such scenarios are defined according to four Representative Concentration Pathways (RCPs) [, which represent different trends in the concentration of atmospheric carbon dioxide. As a result, we predict notable changes in the potential distribution of G. bermejoi, and the overlap between soil and bioclimatic suitability would be affected. We also used a Principal Component Analysis (PCA) to model the bioclimatic niche of this species, comparing it with that of its parental taxa. The evolution of bioclimatic suitability was assessed at the current locations of G. bermejoi and as this plant is a strict gypsophile, we generated suitability maps for sites with gypsum soils. Ultimately, this study identifies relevant changes in the potential distribution of G. bermejoi under specific climatic scenarios, observing remarkable differences in the outcomes of the different climate change scenarios. Interestingly, in some scenarios the bioclimatic suitability of G. bermejoi will be enhanced at many locations and even in the worst scenario some possible refuge areas were identified. G. bermejoi behaves more like a hardy survivor than as early victim.

Laboratórios de inovação em saúde: por uma Atenção Primária à Saúde forte no Distrito Federal, Brasil / Health Innovation Laboratories: towards strong Primary Health Care (PHC)in the Federal District of Brasilia

Resumo O artigo defende a APS como estratégia fundamental para a sustentabilidade do SUS, subsidiado em resultados sobre o impacto da APS nos indicadores de saúde e outras áreas. São apresentados os atributos e requisitos para uma APS Forte, defendidos por pesquisadores, formuladores de políticas e instituições, entre elas a Representação da OPAS/OMS no Brasil. O formato advogado é fruto de discussão realizada com trabalhadores, pesquisadores e gestores de saúde do país, reafirmando os compromissos da Declaração de Alma Ata. O artigo detalha a metodologia de Laboratórios de Inovação em Saúde, utilizada pela OPAS/OMS no Brasil para identificar e sistematizar experiências inovadoras em saúde, incluindo o acompanhamento do Projeto Brasília Saudável, da Secretaria de Saúde do DF, que vem apresentando importantes transformações no modelo de atenção à saúde, com ênfase na ampliação da cobertura da Estratégia Saúde da Família. O artigo resgata e analisa os trabalhos desenvolvidos pelo Laboratório de Inovação em APS Forte no DF até o momento e que serão sistematizados em Estudo de Caso. A iniciativa visa sensibilizar gestores e trabalhadores em saúde para a inovação em processos e políticas de saúde, sendo essencial para a sustentabilidade do SUS, privilegiando troca de conhecimentos entre pares sobre iniciativas adotadas na APS do Brasil.

Abstract This article emphasizes PHC as a fundamental strategy for the sustainability of the SUS, based on its impact on health indicators. The attributes and requirements for Robust PHC are based on statements from researchers, policy makers and institutions, including the PAHO/WHO Representation in Brazil. The model proposed is the result of discussions with workers, researchers and health managers in Brazil, endorsing the commitments outlined in the Alma Ata Declaration. The article details the methodology of Health Innovation Laboratories used by PAHO/WHO in Brazil to systematize knowledge generated by innovative health experiences, including the Healthy Brasilia Project, an ongoing activity run by the Health Department of the Federal District (DF) of Brasilia, which has made important changes in the healthcare model, with emphasis on the expansion of Family Health Strategy coverage. This article analyzes the results of the Innovation Laboratories in Robust PHC in the FD that will be consolidated in a Case Study. The initiative aims to raise awareness amongst managers and health workers about innovation in health processes and policies that are essential for the sustainability of theSUS, focusing on the exchange of knowledge between peers about relevant initiatives in PHCin Brazil.