Background. In Chile and Latin America, cervical cancer disproportionately affects women of low socioeconomic status. Mobile technology (mHealth) may be able to address this disparity by targeting women in underserved populations. However, there is a lack of information regarding barriers to the implementation of mHealth interventions in underserved populations.Methods. We conducted nine focus groups among women 25-64 years of age to better understand the implementation barriers and perceptions of a text message-based intervention designed to improve cervical cancer screening rates. We used the PRECEDE PROCEED model to categorize identified themes using template analysis.Results. Focus group results indicated that older women use mobile phones to receive calls from family and friends but seldom send text messages. They also prefer personal contact with their health care providers regarding Pap testing. Younger women, on the other hand, find text messaging easy to use, and frequently send texts to family and friends. Importantly, women of all ages mentioned they would like to receive text messages about Pap tests.Factors that facilitate uptake of the intervention include ease of access to Pap testing, inclusion of family members, and reminder messaging. Potential barriers include cost and the impersonal nature of messaging. Health team members support an mHealth intervention even though they acknowledge the potential barriers to this strategy.These results overall support the implementation of an mHealth intervention to increase cervical cancer screening rates.Conclusion: Our study describes the opinions of women non-adherent to Pap testing on the potential use of mobile technologies for cervical cancer screening. Although overall acceptance was positive, older women prefer personal contact and phone calls over text messaging. Information surrounding these preferences will aid in the implementation of effective strategies to improve cancer screening in underserved populations.

Introducción: El diagnóstico prenatal de anomalías congénitas tiene como objetivo ofrecer consejería apropiada, identificar aquellas patologías que se benefician de terapia fetal y coordinar la derivación de estas pacientes a centros terciarios para un óptimo manejo perinatal. Para el diagnóstico y manejo de las anomalías congénitas en el Hospital Dr. Sótero Del Río contamos con un equipo multidisciplinario. El objetivo de este estudio es describir nuestra experiencia como centro de referencia en Santiago de Chile en relación al diagnostico prenatal de malformaciones congénitas, estudio genético prenatal y resultados perinatales. Métodos: Estudio retrospectivo y descriptivo. Se incluyó a las pacientes registradas en las bases de datos ecográficas entre 2010 y 2019 del Hospital Dr. Sotero del Rio. Se revisaron fichas clínicas para evaluación y seguimiento postnatal. Resultados: Se evaluaron 404 pacientes con sospecha de malformaciones congénitas o marcadores de aneuploidías. La edad gestacional media de la evaluación fue 29 semanas (14-38 semanas). La mediana de la edad gestacional al parto fue 37.6 semanas (20-41 semanas). Se obtuvo un 78% de recién nacidos vivos, 12% óbitos fetales y 10% mortineonatos. Las malformaciones más frecuentes fueron cardiovasculares, sistema nervioso central, hidrops, extremidades, abdomen y genitourinario. Se realizo el estudio genético en 232 pacientes; 61% resultado normal, 12.5% trisomía 21, 8% trisomía 18, 4% trisomía 13, 4% XO, 4% otras. Se analizaron las pacientes que se acogieron a la ley de interrupción voluntaria del embarazo. Conclusión: Destacamos la importancia de derivación a centros de referencia de pacientes con sospecha de malformaciones congénitas para un adecuado diagnostico prenatal, ofrecer un manejo con equipo multidisciplinario y así mejorar los resultados neonatales. Palabras claves: malformaciones congénitas, diagnostico prenatal, equipo multidisciplinario.

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Introduction: Cervical cancer is a serious public health problem. An estimated 270,000 women die every year from cervical cancer and more than 85% of these deaths take place in developing countries. Chile´s national cervical cancer program was created in 1987. Since then, and with the systematic implementation of cervical cancer screening through Papanicolau (Pap) smears, cervical cancer mortality rates have dropped significantly. Cancer screening rates, however, have stabilized in the last 10 years at approximately 59%. Additionally, most late-stage cervical cancers are diagnosed in low-socioeconomic-status (SES) Latinas. Mobile technologies may have use in improving health disparities due to their widespread availability. In Chile, more than 80% of low-SES people own a cell phone. Nevertheless, developing an effective mHealth intervention may require tailoring and adjusting of available technology in developing countries. The aim of this study was to describe key aspects of an mHealth intervention to be used in Latinas from an underserved area of Santiago, Chile. Methods: We held 9 focus groups at three health care centers with Latinas between 25-64 years old and midwives. Focus groups were recorded, and transcribed verbatim. We analyzed and coded the data grouping findings into relevant themes. With these findings, we developed a customized mHealth intervention that is now being tested using a randomized controlled trial (RCT) in a vulnerable area of Santiago, Chile. Results: Development: The results of our study revealed key aspects to consider for the final intervention: We asked about mode of delivery, content, frequency, and duration of the ideal intervention. Mode of delivery: Although younger women preferred texting and other “indirect” modes of communication, older women were not as savvy with reading texts--their preferred method of contact was a phone call. Content: Women agreed that messages needed to be clear and written in simple language. They would like the messages to have information about cervical cancer, as well as Pap smear availability at their health care centers. Frequency and duration of the intervention: Women mentioned the messages should be sent every week and no more than two times a week. They would like the messages to alternate being sent during weekends and weekday evenings to allow for sufficient time to read them. Previous studies had shown that a duration of 6 months would be effective to promote change in screening behavior. The final intervention was designed with the following characteristics: 1. Four months of text messages and two months of automated phone calls; 2. Twice a week on Wednesday and Sunday evenings; 3. Two types of messages: Information about cervical cancer and clinic hours, scheduling procedures, etc. Implementation: We planned to deliver the text and phone messages using a custom web platform connected to a generic SMS gateway provider. Lack of close relations between two such providers and Chilean mobile carriers generated profound disruptions in the reliability with which messages were sent during testing. After an iterative trial-and-error we settled for our current provider, which is delivering messages for our clinical trial without major issues. Conclusions: Developing and implementing an effective mHealth intervention requires tailoring according to cultural, socioeconomic, and educational characteristics of the population as well as knowledge of the technology available in every country. Transferring technologies proven easy to implement in developed countries is not as straightforward as it may seem. Our intervention is currently being tested through a RCT in a vulnerable population of Santiago, Chile. We hope to learn more about the implementation of such technologies in vulnerable populations, thus improving cancer screening rates across the country. Citation Format: Javiera Martinez Gutierrez, Daniel Capurro, Francis Ciampi, Mauricio Soto, Mackenzie C. Momany, Emilia Cea, Tania Mergudich, Klaus Puschel. Developing and implementing an mHealth intervention for cervical cancer prevention in Santiago, Chile [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C74.

Study question Is it effective to request a second consecutive semen sample in patients with less than 1 million TPMSC in a first semen sample for IUI? Summary answer In men with TPMSC under one million, the issuing of a second consecutive sample reached pregnancy rates similar to those published for IUI. What is known already IUI offers a comparable cumulative live birth rate in 3-4 cycles compared to IVF and can be preferred as a cost-effective first-line treatment in mild male factor or unexplained infertility. The quality of the processed semen sample is an important factor for the IUI success. The WHO recommends an abstinence period to ensure best quality of semen samples. However, it has been observed that when men with moderate male factor who are unable to meet the minimum requirements for IUI are asked to produce a second sample better counts are obtained; questioning the time correlation between abstinence and semen quality. Study design, size, duration This was a retrospective study conducted in the reproductive medicine unit of a private hospital in Chile between July 2015 and March 2021. All patients who underwent IUI in the study period that had an TPMSC less than 1 million in the eyaculate and to whom a second consecutive sample was requested were included. Participants/materials, setting, methods 118 patients who underwent 140 IUI cycles were included in the study. All the patients with an PMSC under 1 million at the time of the IUI were requested a second consecutive semen sample within an hour or two from the previous eyaculate. The second samples were processed and used for insemination. The primary outcome was pregnancy rate. The secondary outcomes were semen quality (TPMSC of first and second semen samples). Main results and the role of chance Between 2015 and 2021 there were 140 IUI cycles in which a second consecutive semen sample was requested, including 118 patients. Overall 17 pregnancies were achieved. The pregnancy rate per cycle was 12,14% and the pregnancy rate per patient was 14,4%. The live birth rate per patient was 10,2%. Regarding the sperm sample analysis, the median TPMSC of the first semen sample was 261.437. The median PMSC of the second consecutive sample was 7.315.000. 126 patients had an TPMSC of 0 in the first semen sample while only 9 patients had an IMSC of 0 in the second sample. In five cases a third consecutive sample was requested of which 4 patients had their cycles canceled because they did not meet the target PMSC. One patient had an TPMSC of 1.687.000 in the third sample. Finally, of the 118 patients who did not meet the requirements for IUI with the first sample, only 19 cycles were canceled. Limitations, reasons for caution The study has the limitation of being a retrospective and descriptive study with no contol group. Also the group is heterogeneous because it includes patients with different female factors for infertility. Wider implications of the findings In developing countries and low-income settings the IUI remains a more accessible alternative in patients with infertility. Routinely recollecting a second semen sample in men with TPMSC <1 million would reduce cycle cancellation rates due to not achieving an optimal TPMSC, reaching pregnancy rates similar to those published for IUI. Trial registration number Not applicable