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Background: The presence of toxic metals in human populations is strongly associated with chronic diseases. Aim: To determine levels of lead, chromium, cadmium, mercury and inorganic arsenic (AsIn) in the general population aged over 5 years in Antofagasta, Chile. Material and Methods: People living in Urban Antofagasta for at least five years were considered eligible. Biological samples were obtained to measure heavy metals. Results: One thousand two hundred three participants with a median age of 43 years (656 women) were studied. Their mean time of residence in the city was 30 years, and 52% smoked. Eight percent of the adult population and 12% of children had AsIn values above 35 µg/L, while 75% of the population had levels below 21.9 µg/L. The other metals were below the risk levels defined by the health authority (10 µg/L for chromium, 10 µg/L for mercury, 2 µg/L for cadmium, 5 and 10 μg/dL for blood lead for children and adults, respectively). The factors associated with high levels of AsIn in adults were male sex, living more than 200 meters from monitoring points, and low schooling. In children, the associated variables were high intake of seafood products and having a caregiver with less than 8 years of schooling. Contrary to expectations, the greatest risk of presenting altered levels of the metals occurred in the population living more than 500 meters from the identified risk sources (90% of the population). Conclusions: The findings of this study suggest that all potential sources of exposure to AsIn should be evaluated, and surveillance actions should be established to reduce involuntary exposure to this metalloid.

Purpose: Cancer is the leading cause of death in the Hispanic/Latino population (referred to as “Latinx” henceforth) - the largest and fastest growing racial ethnic minority group in the U. S. A. Compared to non-Latinx Whites, Latinx individuals and their family caregivers experience a greater cancer burden which are disproportionally affected by social determinants of health. Although research suggests that family-based psychosocial interventions can benefit both patients and caregivers in psychological functioning, marital functioning, and quality of life, insufficient attention has been given to the psychosocial needs of Latinx patients with cancer and caregivers. This review systematically examined the characteristics and outcomes of family-based psychosocial interventions offered to adult Latinx patients with cancer and their caregivers. Methods: We searched six databases from their dates of inception through August 19, 2021. Studies eligible for inclusion are as follows: (1) targeted adult Latinx patients diagnosed with cancer and their adult caregivers (≥ 18 years of age); or targeted participants with multiple ethnic groups but reported Latinx sub-group analysis; (2) included family-based psychosocial interventions; (3) used randomized controlled trial (RCT)or quasi-experimental designs; and (4) were published in English, Spanish or Portuguese. Members of our multidisciplinary team assessed the risk of bias of the reviewed studies using the Cochrane Collaboration’s Risk of Bias Tool. We summarized the narratives and themes of each study and its results. Results: Our database searches yielded six studies (four published in English; one in Spanish; one in both English and Spanish). The interventions were conducted in U.S. and Brazil. Four studies were RCTs, and two studies used a quasi-experimental design. The sample size ranged from 18 patient-caregiver dyads to 230 dyads. Cultural sensitivity was considered in the intervention design and implementation, such as a diverse range of family members (e.g. spouses/partner, children, parents, siblings) included as caregivers; cultural adaptations of intervention contents (e.g., with respect to the importance of familism) and methods (e.g., most delivered by telephone); and bilingual interventionists. The interventions showed beneficial effects on multiple aspects of psychosocial outcomes for both patients and caregivers, including quality of life, social support, cancer knowledge and efficacy, as well as health behavior. We also identified methodological limitations in the reviewed studies. Discussion: Finding from this systematic review contribute to a deeper understanding of family-based psychosocial interventions among Latino cancer population. The small number of psychosocial interventions focused on adult Latinx patients with cancer and their caregivers is concerning considering Latinx populations are disproportionally burdened by cancer. Future research needs to design and evaluate culturally appropriate interventions to support Latinx patients and families who cope with cancer. Citation Format: Ting Guan, Lisa Hart Ranzinger, Abdulrahman Abdulmuslih S. Alfahad, Yu Ping, Shenmeng Xu, Karl Shieh, Jamie Conklin, Paz Cook, Susana Barroso, Natalia Villegas, Lixin Song. Psychosocial interventions for adult Latinx patients with cancer and their caregivers in family-based studies: A systematic review [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A046.

Chile has high incidence rates of gallbladder cancer globally, particularly among Amerindian women, who also have a high prevalence of gallstones. We examined differences in inflammatory biomarkers between Mapuche and non-Mapuche women from the Chile Biliary Longitudinal Study, a cohort of women with ultrasound-detected gallstones. We randomly selected 200 Mapuche women frequency matched to non-Mapuche women on age and statin use Inflammatory biomarkers were analyzed using a multiplex assay and linear regression to assess associations of a priori markers (CCL20, CXCL10, IL-6, and IL-8) with ethnicity. Novel biomarkers were analyzed using exploratory factor analysis (EFA) and sufficient dimension reduction (SDR) to identify correlated marker groups, followed by linear regression to examine their association with ethnicity. The mean values of IL-8 were higher in Mapuche than non-Mapuche women (P = 0.04), while CCL20, CXCL10, and IL-6 did not differ significantly by ethnicity. EFA revealed two marker groups associated with ethnicity (P = 0.03 and P

Gallbladder cancer (GBC) is a highly fatal cancer that can be cured through cholecystectomy if identified early. The presence of gallstones is the primary risk factor for GBC, but few people with gallstones develop GBC. A key question is what drives the development of GBC among persons with gallstones. We initiated the Chile Biliary Longitudinal Study (Chile BiLS) to address this question. From 2016 to 2019, Chile BiLS enrolled 4,726 women aged 50–74 years with ultrasound-detected gallstones from southern-central Chile, accounting for an estimated 36% of eligible women with gallstones in the study area. The median age was 59 years; 25% of the women were Amerindian (Mapuche), 60% were obese, 25% had diabetes, and 6% had cardiovascular disease. Participants will be followed for gallbladder dysplasia or cancer for 6 years. As of April 30, 2020, over 91% of those eligible completed the year 2 follow-up visit. Data being collected include epidemiologic and sociodemographic information, anthropometric measurements, blood pressure, and tooth counts. Biosamples being taken include baseline plasma, buffy coat, red blood cells, serum, blood clot from serum, and PAXgene whole blood (PreAnalytiX GmbH, Hombrechtikon, Switzerland). Complete gallbladder sampling is conducted for most participants undergoing cholecystectomy. The Chile BiLS cohort study will increase our understanding of GBC etiology and could identify potential risk stratification and early detection strategies in high-risk areas.

Gallbladder dysplasia can progress to cancer and may be associated with increased cancer risk at other biliary tract sites. Thus, its accurate identification is relevant both for etiologic understanding and for clinical purposes. Data on the frequency and distribution of gallbladder dysplasia are lacking due to limited gallbladder sampling and inability to visualize dysplasia grossly. An expert pathology group used consensus criteria to review 140 totally sampled consecutive cholecystectomy specimens from Chilean women. Three cases (2%) revealed incidental invasive carcinoma, all T2, along with high-grade dysplasia (HGD). The surface area covered by dysplasia or cancer in these cases was 9%, 37%, and 87%. Although the first longitudinal (“diagnostic”) section of the whole gallbladder captured HGD or cancer in all three cases, the deepest focus of invasive carcinoma was not present in this section. Fourteen additional cases (10%) had low-grade dysplasia (LGD), which was typically very focal (covering

The presence of toxic metals in human populations is strongly associated with chronic diseases.To determine levels of lead, chromium, cadmium, mercury and inorganic arsenic (AsIn) in the general population aged over 5 years in Antofagasta, Chile.People living in Urban Antofagasta for at least five years were considered eligible. Biological samples were obtained to measure heavy metals.One thousand two hundred three participants with a median age of 43 years (656 women) were studied. Their mean time of residence in the city was 30 years, and 52% smoked. Eight percent of the adult population and 12% of children had AsIn values above 35 µg/L, while 75% of the population had levels below 21.9 µg/L. The other metals were below the risk levels defined by the health authority (10 µg/L for chromium, 10 µg/L for mercury, 2 µg/L for cadmium, 5 and 10 μg/dL for blood lead for children and adults, respectively). The factors associated with high levels of AsIn in adults were male sex, living more than 200 meters from monitoring points, and low schooling. In children, the associated variables were high intake of seafood products and having a caregiver with less than 8 years of schooling. Contrary to expectations, the greatest risk of presenting altered levels of the metals occurred in the population living more than 500 meters from the identified risk sources (90% of the population).The findings of this study suggest that all potential sources of exposure to AsIn should be evaluated, and surveillance actions should be established to reduce involuntary exposure to this metalloid.

Comision Nacional de Investigacion Cientifica y Tecnologica (CONICYT), a Chilean governmental scientific research commission: Fondo de Financiamiento de Centros de Investigacion en A reas Prioritarias (FONDAP) 15130011 Comision Nacional de Investigacion Cientifica y Tecnologica (CONICYT) CONICYT FONDECYT 1170395 Faculty of Medicine of Universidad Catolica del Maule University School of Medicine of the Pontificia Universidad Catolica de Chile University Ilustre Municipalidad de Molina (Molina's municipality) Molina hospital United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Cancer Institute (NCI) NIH National Cancer Institute- Division of Cancer Epidemiology & Genetics Office of Research on Women's Health of the United States National Institutes of Health Pontificia Universidad Catolica de Chile University CONICYT Program for Academic Insertion (PAI) 77170040 Curico hospital

Background: Molecular techniques for human papillomavirus (HPV) detection have a good performance as screening tests and could be included in cervical cancer early detection programs. We conducted a population-based trial comparing HPV detection and Papanicolaou as primary screening tests, in a public health service in Santiago, Chile. Aim: To describe the experience of implementing this new molecular test and present the main results of the study. Material and Methods: Women aged 25 to 64 enrolled in three public health centers were invited to participate. In all women, samples were collected for Papanicolaou and HPV DNA testing, and naked-eye visual inspection of the cervix with acetic acid was performed. Women with any positive screening test were referred to the local area hospital for diagnostic confirmation with colposcopy and biopsy of suspicious lesions. Results: Screening results were obtained for 8265 women, of whom 931 (11.3%) were positive to any test. The prevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was 1.1%; nine women had invasive cervical cancer. Sensitivities for the detection of CIN2+ were 22.1% (95% confidence interval (CI) 16.4-29.2) for Papanicolaou and 92.7% (95% CI 84.4-96.8) for HPV testing; specificities were 98.9% (95% CI 98.7-99.0) and 92.0% (95% CI 91.4-92.6) respectively. Conclusion: This experience showed that the implementation of a molecular test for cervical cancer screening is not a major challenge in Chile: it was well accepted by both the health team and the participants, and it may improve the effectiveness of the screening program.

La educación en salud es un proceso complejo que requiere de la incorporación de conocimientos, habilidades, actitudes y valores necesarios para formar profesionales en el área, además de estrategias que permitan una evaluación integral de las competencias adquiridas. El objetivo de este trabajo es determinar el estado del arte existente acerca del uso de metodologías innovadoras en aprendizaje y evaluación para el desarrollo de habilidades clínicas en el área de la salud. La literatura revisada destaca metodologías tales como Examen Clínico Objetivo Estructurado, Instrucción y aprendizaje con ayuda computacional, Programas de aprendizaje basados en Internet, Programas basados en computación Multimedia, y Simulación de realidad virtual, cuyo enfoque educativo permite a los estudiantes de enfermería aplicar e integrar los conocimientos recién adquiridos con la experiencia clínica, de manera de generar mayor seguridad y confianza previo a la llegada al paciente verdadero. Estos métodos favorecen la autoconfianza en los estudiantes al ser tecnologías que propician el aprendizaje en un entorno seguro, provocando altos niveles de rendimiento clínico, académico y en la satisfacción con el curso. Además, estas tecnologías permiten el desarrollo de estrategias cognoscitivas superiores, más que la adquisición de solo conocimiento, lo que a la larga fomenta el logro de competencias. La implementación de tecnologías de este tipo requiere del fortalecimiento de los equipos de trabajo para la planificación e implementación de cambios. Sin embargo, las experiencias de simulación en un laboratorio nunca reemplazarán las experiencias clínicas con pacientes verdaderos.

Background We previously conducted a population-based screening trial of high-risk human papillomavirus (hrHPV) testing and conventional cytology, demonstrating higher sensitivity (92.7 % vs 22.1 % for CIN2+) but lower positive predictive value (10.5 % vs 23.9 %) of hrHPV testing. Here we report the performance of HPV16/18 genotyping to triage the hrHPV positive participants. Methods Women aged 25 years and older received hrHPV (Hybrid Capture 2) and Papanicolaou testing; positives by either test underwent colposcopy and directed biopsy, as did a sample of double-negatives. hrHPV positive women were reflex-tested with HPV16/18 genotyping (Digene HPV Genotyping PS Test). Results Among the 8,265 participants, 10.7 % were hrHPV positive, 1.7 % had ASCUS+ cytology, 1.2 % had CIN2+; 776 (88 %) hrHPV positive women had complete results, of whom 38.8 % were positive for HPV16 (24.0 %), HPV18 (9.7 %) or both (5.1 %). CIN2+ prevalence in HPV16/18 positive women (16.3 %, 95 % CI 12.3-20.9) was twice that of HPV16/18 negative women (8.0 %, 95 % CI 5.7-10.8). HPV16/18 genotyping identified 40.5 % of CIN2, 66.7 % of CIN3 and 75.0 % of cancers. Compared to hrHPV screening alone, HPV16/18 triage significantly reduced the referral rate (10.7 % vs 3.7 %) and the number of colposcopies required to detect one CIN2+ (9 vs 6). When HPV16/18 negative women with baseline ASCUS+ cytology were also colposcopied, an additional 14 % of CIN2+ was identified; referral increased slightly to 4.2 %. Conclusions HPV16/18 triage effectively stratified hrHPV positive women by their risk of high-grade lesions. HPV16/18 positive women must be referred immediately; referral could be deferred in HPV16/18 negative women given the slower progression of non-HPV16/18 lesions, however, they will require active follow-up.

Molecular techniques for human papillomavirus (HPV) detection have a good performance as screening tests and could be included in cervical cancer early detection programs. We conducted a population-based trial comparing HPV detection and Papanicolaou as primary screening tests, in a public health service in Santiago, Chile.To describe the experience of implementing this new molecular test and present the main results of the study.Women aged 25 to 64 enrolled in three public health centers were invited to participate. In all women, samples were collected for Papanicolaou and HPV DNA testing, and naked-eye visual inspection of the cervix with acetic acid was performed. Women with any positive screening test were referred to the local area hospital for diagnostic confirmation with colposcopy and biopsy of suspicious lesions.Screening results were obtained for 8265 women, of whom 931 (11.3%) were positive to any test. The prevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was 1.1%; nine women had invasive cervical cancer. Sensitivities for the detection of CIN2+ were 22.1% (95% confidence interval (CI) 16.4-29.2) for Papanicolaou and 92.7% (95% CI 84.4-96.8) for HPV testing; specificities were 98.9% (95% CI 98.7-99.0) and 92.0% (95% CI 91.4-92.6) respectively.This experience showed that the implementation of a molecular test for cervical cancer screening is not a major challenge in Chile: it was well accepted by both the health team and the participants, and it may improve the effectiveness of the screening program.

To investigate the potential determinants of Helicobacter pylori infection between adults 21-65 years old.Data are from the initial screening visit of a randomized clinical trial of three antibiotic regimens to eradicate H. pylori, conducted in seven sites (Santiago-Chile, Túquerres-Colombia, Guanacaste-Costa Rica, Copán-Honduras, Obregón and Tapachula-México, León-Nicaragua). Thousand eight hundred and fifty-nine adults from the general population were screened for H. pylori infection using an urea breath test (UBT) and were interviewed to assess socioeconomic-, demographic-, and symptom-related characteristics. Logistic regression was used to assess the relationship between these characteristics and H. pylori positivity at enrollment.Among the 1,852 eligible participants for whom a conclusive UBT result was obtained, H. pylori prevalence was 79.4 %, ranging from 70.1 to 84.7 % among the seven centers. Prevalence did not differ by sex (female: 78.4, male: 80.9; p = 0.20) or age (p = 0.08). H. pylori positivity increased with increasing number of siblings (p trend0.0001). Participants with education beyond 12 years were less likely to be UBT-positive (OR 0.4: 0.3-0.6, compared to participants with 0-6 years of schooling) as were those employed outside the home (OR 0.7: 0.6-1.0). Odds of H. pylori infection increased with the presence of certain living conditions during childhood including having lived in a household with an earth floor (OR 1.8: 1.4-2.4), lack of indoor plumbing (OR 1.3: 1.0-1.8) and crowding (OR 1.4: 1.0-1.8, for having more than two persons per bedroom). Regarding current household conditions, living with more than 3 children in the household (OR 1.7: 1.2-2.5) and crowding (OR 1.8: 1.3-2.3) were associated with H. pylori infection.The prevalence of H. pylori in adults was high and differed significantly among the six Latin American countries studied (p0.001). Our findings confirm the strong link between poor socioeconomic conditions and H. pylori infection.

Introduction Gastric cancer (GC) is the second leading cause of cancer-related deaths worldwide. Previously, we identified a potential biomarker for non-invasive detection of GC, the DNA methylation of the promoter region of Reprimo, a p53-dependent G2 arrest mediator candidate. Here we developed a quantitative assay (MethyLight) for a mass screening of GC and we reported the preliminary findings of our ongoing prospective trial STEAD-GC (Screening and Triage test for Early Detection of Gastric Cancer) which is being conducted in Chile, a country with a high mortality rate for GC. Methods Twenty GC cases (tumor, non-tumor tissues and plasma samples) and 41 symptomatic chronic gastritis cases (29 tissues and 12 pairs of tissue and plasma samples) were evaluated for Reprimo levels by MethyLight after DNA extraction and bisulfite conversion. Results Clinical characteristics were similar in both groups. Age average for GC were 61 y.o with 2:1 male/female ratio. For symptomatic chronic gastritis cases age average was 55 y.o and 1:1 male/female ratio. In tissues and plasma, DNA concentrations were similar in both groups (Avg 32.2 ng/ml [range: 8.9-70.8 ng/ml]). The average DNA levels of Reprimo were higher in GC [964,215 copies/ml, 539,593 copies/ml and 80,113 copies/ml in tumor, non-tumor and plasma, respectively] but lower in symptomatic chronic gastritis [137,721 copies/ml and 8,387 copies/ml, tissue and plasma, respectively]. By a ROC curve we calculated a cut-off of 15,125 copies/ml (specificity 92.9% & sensibility 91.3%). With this cut-off our method correctly identified 10 out of 12 gastritis cases and 16 out of 20 GC cases (p value Conclusion We have developed a MethyLight assay for a noninvasive high-throughput screening of GC. Although we have tested our assay in a small group of samples, results presented here suggest that our STEAD-GC trial may be suitable for a mass screening of GC.