Patient perspectives on a proposed pharmacy-based colorectal cancer screening program.

Colorectal cancer (CRC) is a common and preventable cancer. CRC screening is underutilized, particularly within medically underserved communities. Most interventions aimed at increasing CRC screening are delivered through primary care clinics. Pharmacies are more accessible than traditional primary care settings and may be ideally suited for delivering CRC screening and increasing access. Fecal immunochemical test is an at-home, stool-based CRC screening test that could be distributed through pharmacies. The purpose of our study was to assess patient perspectives on receiving fecal immunochemical test-based CRC screening through pharmacies. We conducted semi-structured interviews with participants residing in North Carolina and Washington. Interviews explored acceptability and intervention design preferences for a pharmacy-based CRC screening program. The interview guide was informed by Andersen's Healthcare Utilization Model and the Theoretical Domains Framework. Interviews were conducted at the University of North Carolina at Chapel Hill and Fred Hutchinson Cancer Research Center, audio-recorded, and transcribed. Patients perceived a pharmacy-based CRC screening program to be highly acceptable, citing factors such as ease of pharmacy access and avoiding co-pays for an office visit. Some concerns about privacy and coordination with patients' primary care provider tempered acceptability. Trust and positive relationships with providers and pharmacists as well as seamless care across the CRC screening continuum also were viewed as important. Patients viewed pharmacy-based CRC screening as an acceptable option for CRC screening. To improve programmatic success, it will be important to ensure privacy, determine how communication between the pharmacy and the patient's provider will take place, and establish closed-loop care, particularly for patients with abnormal results.

Colon cancer is a common and preventable cancer in the USA and testing for colon cancer can be done at home with a simple test. Yet, many people remain unscreened. This is particularly true for people who may not have ready access to health care, such as those who have limited incomes or resources or who live in rural areas. Most people live close to a pharmacy and visit a pharmacy more frequently than a primary care office. Pharmacies commonly offer services beyond medication dispensing (e.g. flu shot, diabetes management), making them a potential avenue for increasing colon cancer screening. This study aimed to learn what patients think about receiving colon cancer screening through pharmacies. We interviewed 32 people who fit the age-range recommended for colon cancer screening. They were open to, even embracing of, getting screened for colon cancer through a pharmacy, primarily because of its convenience, accessibility, and because it would not require a co-pay. At the same time, they emphasized the need for privacy and coordination with their primary care provider. We concluded that colon cancer screening in pharmacies is potentially a good option for people, provided they have privacy and that their primary care providers are informed.

Implementation strategies in the Exploration and Preparation phases of a colorectal cancer screening intervention in community health centers.

BACKGROUND: Adoption of colorectal cancer (CRC) screening has lagged in community health center (CHC) populations in the USA. To address this implementation gap, we developed a multilevel intervention to improve screening in CHCs in our region. We used the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide this effort. Here, we describe the use of implementation strategies outlined in the Expert Recommendations for Implementing Change (ERIC) compilation in both the Exploration and Preparation phases of this project. During these two EPIS phases, we aimed to answer three primary questions: (1) What factors in the inner and outer contexts may support or hinder colorectal cancer screening in North Carolina CHCs?; (2) What evidence-based practices (EBPs) best fit the needs of North Carolina CHCs?; and (3) How can we best integrate the selected EBPs into North Carolina CHC systems? METHODS: During the Exploration phase, we conducted local needs assessments, built a coalition, and conducted local consensus discussions. In the Preparation phase, we formed workgroups corresponding to the intervention's core functional components. Workgroups used cyclical small tests of change and process mapping to identify implementation barriers and facilitators and to adapt intervention components to fit inner and outer contexts. RESULTS: Exploration activities yielded a coalition of stakeholders, including two rural CHCs, who identified barriers and facilitators and reached consensus on two EBPs: mailed FIT and navigation to colonoscopy. Stakeholders further agreed that the delivery of those two EBPs should be centralized to an outreach center. During Preparation, workgroups developed and refined protocols for the following centrally-delivered intervention components: a registry to identify and track eligible patients, a centralized system for mailing at-home stool tests, and a process to navigate patients to colonoscopy after an abnormal stool test. CONCLUSIONS: This description may be useful both to implementation scientists, who can draw lessons from applied implementation studies such as this to refine their implementation strategy typologies and frameworks, as well as to implementation practitioners seeking exemplars for operationalizing strategies in early phases of implementation in healthcare.

Primary care provider perspectives on the role of community pharmacy in colorectal cancer screening: a qualitative study.

BACKGROUND: The United States Preventive Services Task Force (USPSTF) lists 32 grade A or B recommended preventive services for non-pregnant United States (US) adults, including colorectal cancer screening (CRC). Little guidance is given on how to implement these services with consistency and fidelity in primary care. Given limited patient visit time and competing demands, primary care providers (PCPs) tend to prioritize a small subset of these recommendations. Completion rates of some of these services, including CRC screening, are suboptimal. Expanding delivery of preventive services to other healthcare providers, where possible, can improve access and uptake, particularly in medically underserved areas or populations. Fecal immunochemical testing (FIT) (at-home, stool-based testing) for CRC screening can be distributed and resulted without PCP involvement. Pharmacists have long delivered preventive services (e.g., influenza vaccination) and may be a good option for expanding CRC screening delivery using FIT, but it is not clear how PCPs would perceive this expansion. METHODS: We used semi-structured interviews with PCPs in North Carolina and Washington state to assess perceptions and recommendations for a potential pharmacy-based FIT distribution program (PharmFIT™). Transcripts were coded and analyzed using a hybrid inductive-deductive content analysis guided by the Consolidated Framework for Implementation Research (CFIR) to elucidate potential multi-level facilitators of and barriers to implementation of PharmFIT™. RESULTS: We completed 30 interviews with PCPs in North Carolina (N = 12) and Washington state (N = 18). PCPs in both states were largely accepting of PharmFIT™, with several important considerations. First, PCPs felt that pharmacists should receive appropriate training for identifying patients eligible and due for FIT screening. Second, a clear understanding of responsibility for tracking tests, communication, and, particularly, follow-up of positive test results should be established and followed. Finally, clear electronic workflows should be established for relay of test result information between the pharmacy and the primary care clinic. CONCLUSION: If the conditions are met regarding pharmacist training, follow-up for positive FITs, and transfer of documentation, PCPs are likely to support PharmFIT™ as a way for their patients to obtain and complete CRC screening using FIT.

Uptake of colorectal cancer screening after mailed fecal immunochemical test (FIT) outreach in a newly eligible 45-49-year-old community health center population.

PURPOSE: We assessed fecal immunochemical test (FIT) uptake following a mailed FIT intervention among 45-49-year-olds newly eligible for colorectal cancer (CRC) screening based on 2021 United States Preventive Services Task Force screening recommendations. We also tested the effect of an enhanced versus plain mailing envelope on FIT uptake. METHODS: In February 2022 we mailed FITs to eligible 45-49-year-olds at one Federally Qualified Health Center (FQHC) clinic. We determined the proportion who completed FITs within 60 days. We also conducted a nested randomized trial comparing uptake using an enhanced envelope (padded with tracking label and colored messaging sticker) versus plain envelope. Finally, we determined the change in CRC screening by any modality (e.g., FIT, colonoscopy) among all clinic patients in this age group (i.e., clinic-level screening) between baseline and 6 months post-intervention. RESULTS: We mailed FITs to 316 patients. Sample characteristics: 57% female, 58% non-Hispanic Black, and 50% commercially insured. Overall, 54/316 (17.1%) returned a FIT within 60 days, including 34/158 (21.5%) patients in the enhanced envelope arm versus 20/158 (12.7%) in the plain envelope arm (difference 8.9 percentage points, 95% CI: 0.6-17.2). Clinic-level screening among all 45-49-year-olds increased 16.6 percentage points (95% CI: 10.9-22.3), from 26.7% at baseline to 43.3% at 6 months. CONCLUSION: CRC screening appeared to increase following a mailed FIT intervention among diverse FQHC patients aged 45-49. Larger studies are needed to assess acceptability and completion of CRC screening in this younger population. Visually appealing mailers may improve uptake when implementing mailed interventions. Trial registration The trial was registered on May 28, 2020 at ClinicalTrials.gov (identifier NCT04406714).

Caracterización clínica y etiológica de una muestra de niños y adultos con disfagia atendida en dos centros asistenciales en Medellín (Colombia). Estudio retrospectivo

Introducción: la disfagia es un trastorno frecuente a lo largo del ciclo vital, que posee diferentes etiologías en relación con su tipo clínico en orofaríngea o esofágica. Objetivo: caracterización clínica y etiológica de una muestra con disfagia atendida en dos centros asistenciales de salud en la ciudad de Medellín (Colombia), mostrando la etiología y el tipo clínico de disfagia según los grupos de edad. Métodos: estudio observacional, descriptivo y retrospectivo, mediante la revisión y análisis de historias y registros clínicos de pacientes con diagnóstico de disfagia, atendidos entre el 2012 al 2018 en un hospital universitario y un centro de fonoaudiología en deglución. Resultados: muestra de 527 pacientes. Distribuidos en menores de 18 años 45,4 % (239/527); 18 a 59: 20,1 % (106/527) y mayores de 60: 34,5 % (182/527). Tipo clínico, etiología y condición de salud más frecuente en toda la muestra: disfagia orofaríngea, etiología funcional y enfermedades neurológicas. Enfermedades más frecuentes causantes de la disfagia en menores de 18 años fueron los trastornos del desarrollo infantil; grupo 18 a 59 años, los tumores/cáncer y en mayores de 60 años, los procesos neurodegenerativos. Conclusión: la disfagia orofaríngea por etiología funcional es frecuente en todo el ciclo vital y, al parecer, las enfermedades neurológicas explican en gran parte su fisiopatología. En adultos mayores se asocia con trastornos neurodegenerativos y en menores de 60 años (incluyendo los niños) la etiología es diversa. Sus causas y características clínicas deben ser tenidas en cuenta para procesos de promoción, diagnóstico, tratamiento y rehabilitación.

Summary Introduction: Dysphagia is a frequent disorder throughout the life cycle, which has different etiologies in relation to its clinical type in oropharyngeal or esophageal. Objective: Clinical and etiological characterization of a sample with dysphagia attended in two health care centers in the city of Medellín (Colombia), showing the etiology and clinical type of dysphagia according to age groups. Methods: Observational, descriptive, and retrospective study, through the review and analysis of and clinical records of patients with a diagnosis of dysphagia, treated between 2012 and 2018 in a university hospital and a speech therapy center in swallowing. Results: Sample of 527 patients. Distributed in those under 18 years 45.4% (239/527); 18 to 59: 20.1% (106/527) and over 60: 34.5% (182/527). Clinical type, etiology, and most frequent health condition in the entire sample: oropharyngeal dysphagia, functional etiology, and neurological diseases. The most frequent conditions causing dysphagia in children under 18 years of age were childhood development disorders; group 18 to 59 years, cancer and, in those over 60 years of age, neurodegenerative processes. Conclusion: Oropharyngeal dysphagia due to functional etiology is common throughout the life cycle, and neurological diseases seem to largely explain its pathophysiology. In older adults it is associated with neurodegenerative disorders, and in those under 60 years of age (including children) the etiology is diverse. Its causes and clinical characteristics must be considered for promotion, diagnosis, treatment, and rehabilitation processes.

Centralized colorectal cancer screening outreach and patient navigation for vulnerable populations in North Carolina: study protocol for the SCORE randomized controlled trial.

BACKGROUND: Although colorectal cancer (CRC) screening is effective in reducing CRC mortality, screening rates in vulnerable populations served by community health centers (CHCs) remain below national targets. CHCs in North Carolina are challenged to reach CRC screening targets as they tend to be under-resourced, have limited capacity to implement and sustain population health interventions, and typically operate independently from one another and from regional colonoscopy providers. The Scaling Colorectal Cancer Screening Through Outreach, Referral, and Engagement (SCORE) project is designed to address barriers to CRC screening in partnership with CHCs by implementing a multilevel intervention that includes centralized support infrastructure for mailed fecal immunochemical test (FIT) outreach and patient navigation to follow-up colonoscopy. This paper describes protocols for the SCORE implementation trial. METHODS: We will conduct a type 2 hybrid effectiveness-implementation trial that will assess effectiveness at increasing CRC screening and follow-up rates while also assessing implementation outcomes. The planned trial sample will include 4000 CHC patients who are at average CRC risk and due for screening. Participants will be randomized 1:1 to receive either usual care or a multilevel intervention that includes mailed FIT outreach and patient navigation support to follow-up colonoscopy for those with abnormal FIT. The primary effectiveness outcome is completion of any CRC screening test at six months after randomization. We will also conduct a multilevel assessment of implementation outcomes and determinants. DISCUSSION: This hybrid effectiveness-implementation trial will evaluate the effectiveness and implementation of an intervention that provides centralized infrastructure for mailed FIT screening and patient navigation for CHCs that operate independently of other healthcare facilities. Findings from this research will enhance understanding of the effectiveness of a centralized approach and factors that determine successful implementation in vulnerable patient populations. TRIAL REGISTRATION: The trial was registered on May 28, 2020, at ClinicalTrials.gov (identifier NCT04406714).

Modified Natural Dolomite and Its Influence on the Production of Glycerol Carbonate: Effects of Structural and Basicity Properties.

A systematic study over different treatment conditions, including hydrothermal and acid-thermal, was successfully carried out to determine the most suitable conditions to enhance the textural properties and surface chemical composition of natural dolomite. The reconstruction of dolomite after various treatments enhanced the surface area by 4-5 times and diminished the pore diameter between 70% and 81% compared to the untreated parent dolomite. The Rietveld analysis of the X-ray diffraction (XRD) patterns revealed changes in the crystalline compositions after each treatment. When the treated dolomite was used as a catalyst to produce glycerol carbonate via a transesterification reaction of glycerol and dimethyl carbonate, the crystalline Ca(OH)2 concentration of the modified dolomite and the apparent glycerol carbonate formation rate (rgc) are well-correlated. The results suggest that an increase of the crystalline Ca(OH)2 concentration could be related with surface basicity at the weak and moderate strength sites that may lead to an increase in catalytic activity. The hydrothermal treated dolomite showed a selectivity of glycerol carbonate greater than 99% and rgc value 3.42 mmol/min·gcat, which was higher than that achieved on other samples. This study could aid to the proper selection of dolomite treatment for the desired crystalline composition, depending on the applications of this highly available mineral.

Chilean Medical and Midwifery Faculty's Views on Conscientious Objection for Abortion Services.

CONTEXT: In 2017, Chile reformed its abortion law to allow the procedure under limited circumstances. Exploring the views of Chilean medical and midwifery faculty regarding abortion and the use of conscientious objection (CO) at the time of reform can inform how these topics are being taught to the country's future health care providers. METHODS: Between March and September 2017, 30 medical and midwifery school faculty from universities in Santiago, Chile were interviewed; 20 of the faculty taught at secular universities and 10 taught at religiously affiliated universities. Faculty perspectives on CO and abortion, the scope of CO, and teaching about CO and abortion were analyzed using a grounded theory approach. RESULTS: Most faculty at secular and religiously affiliated universities supported the rights of clinicians to refuse to provide abortion care. Secular-university faculty generally thought that CO should be limited to specific providers and rejected the idea of institutional CO, whereas religious-university faculty strongly supported the use of CO by a broad range of providers and at the institutional level. Only secular-university faculty endorsed the idea that CO should be regulated so that it does not hinder access to abortion care. CONCLUSIONS: The broader support for CO in abortion among religious-university faculty raises concerns about whether students are being taught their ethical responsibility to put the needs of their patients above their own. Future research should monitor whether Chile's CO regulations and practices are guaranteeing people's access to abortion care.

RESUMEN Contexto: En 2017, Chile reformó su ley de aborto para permitir el procedimiento bajo circunstancias limitadas. Explorar las opiniones del personal académico de medicina y partería en relación con el aborto y el uso de la objeción de conciencia (OC) en el momento de la reforma, puede informar sobre los temas que están siendo enseñados a los futuros prestadores de servicios de salud del país. Métodos: Entre marzo y septiembre de 2017, fueron entrevistados 30 miembros del personal académico de las facultades de medicina y partería de universidades en Santiago, Chile. Veinte de ellos enseñaban en universidades laicas y diez en universidades con afiliación religiosa. Se analizaron las perspectivas del personal académico sobre la OC y el aborto, el alcance de la OC, y la enseñanza sobre OC y aborto, mediante el uso de un enfoque de teoría fundamentada. Resultados: La mayoría del personal académico de las universidades laicas y de las de afiliación religiosa apoyó el derecho del personal clínico a rehusarse a proveer servicios de aborto. En general, el personal académico de las universidades laicas pensó que la OC debería limitarse a proveedores de servicios específicos y rechazó la idea de una OC institucional, mientras que el personal académico de las universidades con afiliación religiosa apoyó decididamente el uso de la OC por un amplio conjunto de proveedores y a nivel institucional. Solamente el personal académico de las universidades laicas avaló la idea de que la OC debería ser regulada de tal forma que no obstaculizara el acceso a los servicios de aborto. Conclusions: El amplio apoyo a la OC en relación con el aborto en el personal académico de las universidades con afiliación religiosa genera preocupaciones sobre si se está enseñando a los estudiantes sobre su responsabilidad ética de poner las necesidades de sus pacientes por encima de las propias. Futuras investigaciones deben monitorear si las reglamentaciones y prácticas en materia de OC en Chile están garantizando el acceso de las personas a los servicios de aborto.

RÉSUMÉ Contexte: En 2017, le Chili a réformé sa législation de l'avortement, autorisant l'intervention dans des circonstances limitées. Létude de l'opinion du corps professoral des facultés de médecine et des écoles de sages-femmes concernant l'avortement et le recours à l'objection de conscience (OC) au moment de la réforme peut éclairer la manière dont ces sujets sont enseignés aux futurs prestataires de soins de santé du pays. Méthodes: Entre mars et septembre 2017, 30 professeurs et enseignants de facultés et écoles de médecine et de sages-femmes à Santiago (Chili) ont été interviewés; 20 enseignaient dans des universités laïques et 10, dans des universités de confession religieuse. Leurs points de vue sur l'OC et l'avortement, la portée de l'OC et l'enseignement relatif à l'OC et à l'avortement ont été analysés selon l'approche de la théorie ancrée. Résultats: Pour la plupart, le corps professoral des universités laïques et de confession religieuse reconnaissait le droit des cliniciens à refuser la prestation de soins d'avortement. Les professeurs d'universités laïques estimaient généralement que l'OC devrait être limitée à certains prestataires spécifiques et rejetaient la notion de l'OC institutionnelle, alors que ceux des facultés et écoles de confession religieuse soutenaient fermement le recours à l'OC par un large éventail de prestataires et au niveau institutionnel. Seul le corps professoral laïc souscrivait à l'idée que l'OC doit être réglementée de manière à ne pas entraver l'accès aux soins d'avortement. Conclusions: Le soutien plus large de l'OC à l'avortement parmi le corps professoral d'universités de confession religieuse soulève des questions quant à savoir si les étudiants sont sensibilisés à leur responsabilité éthique de faire passer les besoins de leurs patientes avant les leurs. La recherche future devra surveiller si la réglementation et la pratique de l'OC au Chili garantissent l'accès aux soins d'avortement.

Chemosensory Basis of Feeding Behavior in Pacific White Shrimp, Litopenaeus vannamei.

AbstractThe Pacific white shrimp, Litopenaeus vannamei, is important as the principal species in the worldwide aquaculture of shrimp. It has also become a model in the study of crustacean biology, especially because it is one of the first decapod crustaceans to have its genome sequenced. This study examined an aspect of the sensory biology of this shrimp that is important in its aquaculture, by describing its peripheral chemical sensors and how they are used in acquiring and consuming food pellets. We used scanning electron microscopy to describe the diversity of sensilla on the shrimp's major chemosensory organs: antennules, antennae, mouthparts, and legs. Using behavioral studies on animals with selective sensory ablations, we then explored the roles that these chemosensory organs play in the shrimp's search for, and acquisition and ingestion of, food pellets. We found that the antennules mediate odor-activated searching for pellets, with both the lateral and medial antennular flagella contributing to this behavior and thus demonstrating that both aesthetasc (olfactory) and distributed chemosensors on the antennules can mediate this behavior. Once the shrimp finds and grasps the food pellet, the antennular chemoreceptors no longer play a role, and then the chemoreceptors on the mouthparts and legs control ingestion of the pellets. This sequence of chemosensory control of feeding in L. vannamei, a dendrobranchiate crustacean with small antennules and an ability to live and feed in both benthic and pelagic environments, is generally similar to that of the better-studied, large-antennuled, benthic reptantian crustaceans, including spiny lobsters (Achelata), clawed lobsters and crayfish (Astacidea), and crabs (Meirua).

"Obviously there is a conflict between confidentiality and what you are required to do by law": Chilean university faculty and student perspectives on reporting unlawful abortions.

BACKGROUND AND OBJECTIVES: While Chile recently decriminalized abortion in cases of rape, lethal fetal anomaly, and to save a woman's life, most abortions are still criminalized. We assessed medical and midwifery school faculty and students' views on punishing and reporting people involved in unlawful abortion, and their understanding of their obligation to protect patient confidentiality and to report unlawful abortions. METHODS: We interviewed 30 medical and midwifery school clinician faculty from seven public, private, secular and Catholic-affiliated universities, all located in the metropolitan region of Santiago, Chile. Medical (n = 239) and midwifery (n = 79) students at these same seven universities completed an online survey. We coded faculty interview transcripts, and analyzed codes related to maintaining patient confidentiality and reporting unlawful abortion. We summarized student views related to reporting and imprisoning people involved in unlawful abortion, and used general estimating equation (GEE) models to identify the factors associated with support for criminalization. RESULTS: Faculty and students generally did not support reporting or imprisoning anyone involved in an unlawful abortion and believed that protecting patient information takes precedence over reporting. Yet, faculty described pressures to report in the public sector and several cases where they or their colleagues were involved in reports. Most students somewhat/strongly agreed (78%) that patient information concerning an unlawful abortion should be kept confidential; 35% strongly/somewhat agreed that a clinician involved in an unlawful surgical abortion should be imprisoned, and 18% agreed that the woman involved should be imprisoned, with students from secular universities being significantly less likely to support reporting and punishing people involved in unlawful abortion, than students from Catholic universities. DISCUSSION: There is a need to clarify clinicians' ethical obligations in abortion care, in particular in Catholic universities, so that they can ensure that their patients have access to high quality confidential health care services.

Medical and midwifery students' views on the use of conscientious objection in abortion care, following legal reform in Chile: a cross-sectional study.

BACKGROUND: In August 2017, Chile lifted its complete ban on abortion by permitting abortion in three limited circumstances: 1) to save a woman's life, 2) lethal fetal anomaly, and 3) rape. The new law allows regulated use of conscientious objection (CO) in abortion care, including allowing institutions to register as objectors. This study assesses medical and midwifery students' support for CO, following legal reform. METHODS: From October 2017 to May 2018, we surveyed medical and midwifery students from seven universities located in Santiago, Chile. Universities included 4 secular (2 public and 2 private) and 3 private religiously-affiliated universities; all offering medical degrees with a specialization in obstetrics and gynecology (ob-gyn) and five offering midwifery degrees. We used generalized estimating equations (GEE) to identify characteristics associated with student support for CO, intentions to use CO to refuse to care for someone seeking abortion, and support for CO at the institutional level. RESULTS: 333 of the 413 eligible students who opened the survey, completed the questions on conscientious objection; 26% were seeking medical degrees with an ob-gyn specialty, 25% were seeking midwifery degrees, and 49% were seeking medical degrees and had not yet decided their specialty. While nearly all endorse requirements for conscientious objecting clinicians to inform (92%) and refer (91%) abortion-seeking patients, a minority (18%) would personally use conscientious objection to avoid caring for a patient seeking abortion (12% secular and 39% religious university students). About half of religious-university students (52%) and one-fifth of secular-university (20%) students support objections at the institutional level. CONCLUSIONS: Most students support the regulated use of CO which preserves patients' access to abortion care. Religious-university student views on the use of conscientious objection in abortion care are discordant with those of their institutions which currently support institutional-level objections.

Medical and midwifery student attitudes toward moral acceptability and legality of abortion, following decriminalization of abortion in Chile.

OBJECTIVE: Soon after Chile decriminalized abortion under three limited circumstances in 2017, we assessed medical and midwifery students' attitudes about abortion morality and legality when compared to national opinions. STUDY DESIGN: We administered an anonymous, online survey to medical and midwifery students from seven secular and religiously-affiliated universities in Santiago, Chile. We compared student responses to a nationally representative public opinion survey. MAIN OUTCOME MEASURES: We examined three main outcomes related to abortion attitudes: (1) moral acceptability of abortion and legal support for abortion in (2) one or (3) all listed circumstances. We used general estimating equations to examine whether university type, field of study, and other student characteristics are associated with each outcome and compared student views toward abortion legality with those of the general public. RESULTS: Among the 369 student respondents, most agreed that abortion can be a good thing for some women in some situations (82%). When compared to the general public, a larger proportion of students supported decriminalizing abortion in at least one (83% and 97%, respectively) or all (17% and 51%, respectively) seven listed circumstances. While secular university students held significantly more favorable views about abortion morality and legality than students from religiously-affiliated universities, the majority of students from both university types supported abortion in the three cases in which it was recently decriminalized. CONCLUSIONS: Medical and midwifery students from not only secular but also religiously-affiliated universities are very supportive of the recent decriminalization of abortion, which presents training opportunities for both types of universities.

Efectos de las lesiones del sistema nervioso sobre la fisiología de la micción / Effects of nervous system injuries on the physiology of urination

Resumen La disfunción neurogénica del tracto urinario inferior abarca una amplia variedad de trastornos que se caracterizan por una disfunción de la fisio logía de la micción. Muchas veces su diagnóstico no suele ser fácil y suele primero diagnosticarse la disfunción del tracto urinario y posteriormente encontrar el diagnóstico del trastorno neurológico que lo ocasiona. Todos estos trastornos terminan afectando gravemente la calidad de vida de las pacientes, por sus complicaciones propias y las derivadas de la condición. Algunas de estas complicaciones son infecciones urinarias recurrentes, incontinencia urinaria, disfunción del vaciamiento vesical, estenosis uretral y enfermedad renal progresiva con daño irreversible. Los objetivos de esta revisión son exponer las diferentes alteraciones neurológicas según la cla sificación SALE y describir cómo afectan la fisiología de la micción.

Abstract Neurogenic dysfunction of the lower urinary tract encompasses a wide variety of disorders, which are characterized by a dysfunction of the urination physiology. In many times the diagnosis of this type of pathologies is usually not so easy, and the urinary tract dysfunc tion can be diagnosed first and secondarily find the diagnosis of the neurological disorder that causes it. All these disorders end up se riously affecting the quality of life of these patients, due to their own complications and the complications derived from the condition. Some of the associated complications are recurrent urinary tract infections, urinary incontinence and bladder emptying dysfunction, urethral stricture and progressive kidney disease with irreversible damage. The location of the neurological lesion does not always de termine the type of inferior urinary dysfunction. The objective of this review is to expose the different neurological alterations according to the SALE classification and describe how they affect the physiol ogy of urination.

Future health providers' willingness to provide abortion services following decriminalisation of abortion in Chile: a cross-sectional survey.

OBJECTIVE: To assess Chilean medical and midwifery students' attitudes and willingness to become trained to provide abortion care, shortly after abortion was decriminalised in 2017. DESIGN: We fielded a cross-sectional, web-based survey of medical and midwifery students. We used generalised estimating equations to assess differences by type of university and degree sought. SETTING: We recruited students from a combination of seven secular, religiously-affiliated, public and private universities that offer midwifery or medical degrees with a specialisation in obstetrics and gynaecology, located in Santiago, Chile. PARTICIPANTS: Students seeking medical or midwifery degrees at one of seven universities were eligible to participate. We distributed the survey link to medical and midwifery students at these seven universities; 459 eligible students opened the survey link and 377 students completed the survey. PRIMARY AND SECONDARY OUTCOMES: Intentions to become trained to provide abortion services was our primary outcome of interest. Secondary outcomes included moral views and concerns about abortion provision. RESULTS: Most students intend to become trained to provide abortion services (69%), 20% reported that they will not provide an abortion under any circumstance, half (50%) had one or more concern about abortion provision and 16% agreed/strongly agreed that providing abortions is morally wrong. Most believed that their university should train medical and midwifery students to provide abortion services (70%-79%). Secular university students reported higher intentions to provide abortion services (beta 0.47, 95% CI: 0.31 to 0.63), more favourable views (beta 0.52, CI: 0.32 to 0.72) and were less likley to report concerns about abortion provision (adjusted OR 0.47, CI: 0.23 to 0.95) than students from religious universities. CONCLUSION: Medical and midwifery students are interested in becoming trained to provide abortion services and believe their university should provide this training. Integrating high-quality training in abortion care into medical and midwifery programmes will be critical to ensuring that women receive timely, non-judgemental and quality abortion care.

Rfx6 promotes the differentiation of peptide-secreting enteroendocrine cells while repressing genetic programs controlling serotonin production.

OBJECTIVE: Enteroendocrine cells (EECs) of the gastro-intestinal tract sense gut luminal factors and release peptide hormones or serotonin (5-HT) to coordinate energy uptake and storage. Our goal is to decipher the gene regulatory networks controlling EECs specification from enteroendocrine progenitors. In this context, we studied the role of the transcription factor Rfx6 which had been identified as the cause of Mitchell-Riley syndrome, characterized by neonatal diabetes and congenital malabsorptive diarrhea. We previously reported that Rfx6 was essential for pancreatic beta cell development and function; however, the role of Rfx6 in EECs differentiation remained to be elucidated. METHODS: We examined the molecular, cellular, and metabolic consequences of constitutive and conditional deletion of Rfx6 in the embryonic and adult mouse intestine. We performed single cell and bulk RNA-Seq to characterize EECs diversity and identify Rfx6-regulated genes. RESULTS: Rfx6 is expressed in the gut endoderm; later, it is turned on in, and restricted to, enteroendocrine progenitors and persists in hormone-positive EECs. In the embryonic intestine, the constitutive lack of Rfx6 leads to gastric heterotopia, suggesting a role in the maintenance of intestinal identity. In the absence of intestinal Rfx6, EECs differentiation is severely impaired both in the embryo and adult. However, the number of serotonin-producing enterochromaffin cells and mucosal 5-HT content are increased. Concomitantly, Neurog3-positive enteroendocrine progenitors accumulate. Combined analysis of single-cell and bulk RNA-Seq data revealed that enteroendocrine progenitors differentiate in two main cell trajectories, the enterochromaffin (EC) cells and the Peptidergic Enteroendocrine (PE) cells, the differentiation programs of which are differentially regulated by Rfx6. Rfx6 operates upstream of Arx, Pax6 and Isl1 to trigger the differentiation of peptidergic EECs such as GIP-, GLP-1-, or CCK-secreting cells. On the contrary, Rfx6 represses Lmx1a and Tph1, two genes essential for serotonin biosynthesis. Finally, we identified transcriptional changes uncovering adaptive responses to the prolonged lack of enteroendocrine hormones and leading to malabsorption and lower food efficiency ratio in Rfx6-deficient mouse intestine. CONCLUSION: These studies identify Rfx6 as an essential transcriptional regulator of EECs specification and shed light on the molecular mechanisms of intestinal failures in human RFX6-deficiencies such as Mitchell-Riley syndrome.

Queratosis seborreica en el fondo de saco de Douglas: reporte de un caso / Seborrheic keratoses in the recto-uterine pouch: Case report

Resumen ANTECEDENTES: Existen pocos reportes de neoplasias epiteliales con apariencia escamosa originadas en el cuello uterino o la vagina. Estas lesiones se clasifican, por su similitud morfológica, en lesiones similares a queratosis seborreica. Cuando ésta aparece en la mucosa de la vulva o vagina debe establecerse la diferenciación con lesiones intraepiteliales escamosas de bajo y alto grado. OBJETIVO: Describir un caso de queratosis seborreica en el saco de Douglas. CASO CLÍNICO: Paciente de 70 años, con pérdida involuntaria de orina con los esfuerzos; se le colocó una cinta suburetral para resolver este problema. Durante el procedimiento se detectó una lesión en la mucosa vaginal, a las seis del reloj, en el fondo del saco de Douglas, de 1.2 x 1 cm, color pardo y consistencia blanda. Durante el procedimiento se tomó una muestra para estudio histopatológico que se reportó como: epidermis con marcada hiperqueratosis, acantosis regular, ensanchamiento y anastomosis de las crestas con formación de perlas córneas, dermis con infiltrado inflamatorio crónico perivascular, negativo para malignidad. Se estableció el diagnóstico de queratosis seborreica hipertrófica, positiva para tinción de P16 que orientó a infección de virus del papiloma. El tratamiento fue: escisión con evolución satisfactoria y seguimiento. CONCLUSIONES: La queratosis seborreica en el fondo de saco de Douglas se reporta de manera excepcional, su comportamiento es benigno y casi siempre se asocia con tipos de virus del papiloma humano de bajo riesgo.

Abstract BACKGROUND: Thera are few repots of intraepithelial neoplasms with origins in the cervix or vagina with squamous appearance. This kind of lesions have been classified because of their morphologic similarities, in the category of "seborrheic keratoses like". When seborrheic keratoses appears in the vaginal or vulvar mucosa, it has to be differentiated from low and high grade intraepithelial squamous lesions. OBJECTIVE: To describe a case of seborrheic keratoses in the recto-uterine pouch. CLINICAL CASE: 70 years old patient, who underwent surgery for stress urinary incontinence with a sub-urethral sling. During the procedure, a lesion in the vaginal mucosa was detected, specifically in the recto-uterine pouch, of 1.2 x 1 cm length, with a light brown color and soft consistency. A specimen was taken from the lesion during the procedure for histopathological study, which reported: hyperkeratosis in the epidermis, regular acanthosis, thickening and anastomosis of the crests with formation of corneal pearls, dermis with inflammatory, chronic, perivascular infiltration, with no signs of malignancy. The diagnosis was hypertrophic seborrheic keratoses, positive for P16 stain which orients to HPV infection. The lesion was removed and the patient continued follow up with her primary care provider. CONCLUSIONS: Seborrheic keratoses in this location is uncommon, with few reports in literature. These lesions are usually benign and are associated to HPV of low risk.

[Chronic recurrent multifocal osteomyelitis in a pediatric patient, a case report]. / Osteomielitis crónica multifocal recurrente en paciente pediátrico, reporte de caso.

INTRODUCTION: Chronic recurrent multifocal osteomyelitis (CRMO) is a very rare disease, of unknown origin that affects primarily the metaphysis of long bones. It is characterized by an insidious onset of symptoms and multiple remissions. The chronicity of symptoms, the diagnostic imaging and the lack of response to first line antibiotic treatment, should be helpful for diagnostic. OBJECTIVE: Present a clinical case, based on clinical, laboratory, radiologic imaging and histopathological results, that ultimately led to the diagnostic of CRMO. CASE REPORT: 9 year old, female patient, with one month of bilateral knee and left ankle arthralgia. Bone Gammagraphy and full body MRI, showed multifocal bone inflammation. These findings led to a biopsy, that turned negative for malignancy and infection. Given all the information available from the laboratory test results, radiologic imaging and histopathological findings, CRMO diagnosis was made. NSAID treatment was order, with good results. CONCLUSIONS: CRMO is a rare disease that even to date and with cutting edge technology, still represents a diagnostic challenge that primarily relies on a high level of suspicion, for a timely and correct treatment.

[Vertical transmission of chikungunya virus infection. Case Report]. / Reporte de caso de transmisión vertical de la infección por virus chikungunya.

Chikungunya virus infection is a disease transmitted by vectors, in which vertical transmission was described in years 2005-2006. An infection rate up to 49% in neonates born from mothers with active viremia during labor has been observed. Perinatal infection could results in serious complications and potential cognitive impairment. OBJECTIVE: To describe a newborn with Chikungunya virus infection secundary to vertical transmission. Clínical case: A female newborn is analyzed. She presented with fever and exanthema during her first week of life, elevation of transaminases and thrombocytopenia. Her mother had had symptoms compatible with chikungunya virus infection on the day of the delivery. Specific IgM antibodies against chikungunya were documented and the diagnosis was confirmed. CONCLUSION: Given the high perinatal transmissibility rate of chikungunya virus, this diagnosis should be considered in every newborn child of a mother with suggestive symptoms of chikungunya in the days surrounding delivery.

Reporte de caso de transmisión vertical de la infección por virus chikungunya / Vertical transmission of chikungunya virus infection: case report

La infección por virus chikungunya es una enfermedad transmitida por vectores, que en los años 2005-2006 se describió la transmisión vertical, con una tasa de infección en el recién nacido hasta del 49% en madres con presencia de viremia durante el parto. Puede presentar manifestaciones clínicas graves en los neonatos y potenciales secuelas en el neurodesarrollo. OBJETIVO: Presentar un caso de infección por virus chikungunya vertical y revisión de la literatura disponible. CASO CLÍNICO: Recién nacido de sexo femenino que inició con fiebre y exantema durante la primera semana de vida, posteriormente con elevación de transaminasas y trombocitopenia, con el antecedente de un cuadro clínico en la madre de síntomas compatibles con infección por chikungunya el día del parto. Se documentaron anticuerpos tipo IgM específicos para chikungunya que establecieron el diagnóstico. CONCLUSIONES: Dada la alta tasa de transmisibilidad perinatal de la infección por virus chikungunya, este diagnóstico debe considerarse en todo recién nacido hijo de madre con síntomas sugestivos de la infección en el período cercano al parto.

Chikungunya virus infection is a disease transmitted by vectors, in which vertical transmission was described in years 2005-2006. An infection rate up to 49% in neonates born from mothers with active viremia during labor has been observed. Perinatal infection could results in serious complications and potential cognitive impairment. OBJECTIVE: To describe a newborn with Chikungunya virus infection secundary to vertical transmission. CLINICAL CASE: A female newborn is analyzed. She presented with fever and exanthema during her first week of life, elevation of transaminases and thrombocytopenia. Her mother had had symptoms compatible with chikungunya virus infection on the day of the delivery. Specific IgM antibodies against chikungunya were documented and the diagnosis was confirmed. CONCLUSION: Given the high perinatal transmissibility rate of chikungunya virus, this diagnosis should be considered in every newborn child of a mother with suggestive symptoms of chikungunya in the days surrounding delivery.

Osteomielitis crónica multifocal recurrente en paciente pediátrico, reporte de caso / Chronic recurrent multifocal osteomyelitis in a pediatric patient, a case report

Introducción: La osteomielitis crónica multifocal recurrente (OCMR) es una enfermedad rara de causa desconocida, que afecta principalmente la metáfisis de los huesos largos; se caracteriza por un cuadro clínico insidioso de exacerbaciones y remisiones; la cronicidad de los síntomas, los hallazgos imagenológicos y la falta de respuesta al manejo con antibióticos, orientan al diagnóstico. Objetivo: Presentar los datos clínicos, resultados de laboratorio, imagenológicos y estudios histo- patológicos que permiten realizar el diagnóstico de OCMR. Caso clínico: Paciente de sexo femenino de 9 años, con artralgias en ambas rodillas y tobillo izquierdo de 1 mes de duración. Los estudios de gammagrafía ósea y resonancia corporal total evidenciaron compromiso óseo multifocal; con estos hallazgos, se realizó biopsia que fue negativa para infección y malignidad. Por la evolución, estudios de laboratorio, radiológicos e histo-patológicos se diagnosticó OCMR. Se inició tratamiento con anti-inflamatorios no esteroides con adecuada respuesta. Conclusiones: La OCMR es una patología poco frecuente de difícil diagnóstico, por lo que se requiere de una alta sospecha clínica para realizar un adecuado enfoque y tratamiento oportuno.

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a very rare disease, of unknown origin that affects primarily the metaphysis of long bones. It is characterized by an insidious onset of symptoms and multiple remissions. The chronicity of symptoms, the diagnostic imaging and the lack of response to first line antibiotic treatment, should be helpful for diagnostic. Objective: Present a clinical case, based on clinical, laboratory, radiologic imaging and histopathological results, that ultimately led to the diagnostic of CRMO. Case report: 9 year old, female patient, with one month of bilateral knee and left ankle arthralgia. Bone Gammagraphy and full body MRI, showed multifocal bone inflammation. These findings led to a biopsy, that turned negative for malignancy and infection. Given all the information available from the laboratory test results, radiologic imaging and histopathological findings, CRMO diagnosis was made. NSAID treatment was order, with good results. Conclusions: CRMO is a rare disease that even to date and with cutting edge technology, still represents a diagnostic challenge that primarily relies on a high level of suspicion, for a timely and correct treatment.