IntroductionIndigenous women in Mexico represent a vulnerable population in which three kinds of discrimination converge (ethnicity, gender and class), having direct repercussions on health status. The discrimination and inequity in health care settings brought this population to the fore as a priority group for institutional action. The objective of this study was to evaluate the processes and performance of the “Casa de la Mujer Indígena”, a community based project for culturally and linguistically appropriate service delivery for indigenous women. The evaluation summarizes perspectives from diverse stakeholders involved in the implementation of the model, including users, local authorities, and institutional representatives.MethodsThe study covered five Casas implementation sites located in four Mexican states. A qualitative process evaluation focused on systematically analyzing the Casas project processes and performance was conducted using archival information and semi-structured interviews. Sixty-two interviews were conducted, and grounded theory approach was applied for data analysis.ResultsFew similarities were observed between the proposed model of service delivery and its implementation in diverse locations, signaling discordant operating processes. Evidence gathered from Casas personnel highlighted their ability to detect obstetric emergencies and domestic violence cases, as well as contribute to the empowerment of women in the indigenous communities served by the project. These themes directly translated to increases in the reporting of abuse and referrals for obstetric emergencies.ConclusionsThe model’s cultural and linguistic competency, and contributions to increased referrals for obstetric emergencies and abuse are notable successes. The flexibility and community-based nature of the model has allowed it to be adapted to the particularities of diverse indigenous contexts. Local, culturally appropriate implementation has been facilitated by the fact that the Casas have been implemented with local leadership and local women have taken ownership. Users express overall satisfaction with service delivery, while providing constructive feedback for the improvement of existing Casas, as well as more cost-effective implementation of the model in new sites. Integration of user’s input obtained from this process evaluation into future planning will undoubtedly increase buy-in. The Casas model is pertinent and viable to other contexts where indigenous women experience disparities in care.
Voltage-gated Ca 2؉ channels in arterial myocytes can mediate Ca 2؉ release from the sarcoplasmic reticulum and, thus, induce contraction without the need of extracellular Ca 2؉ influx. This metabotropic action of Ca 2؉ channels (denoted as calcium-channelinduced calcium release or CCICR) involves activation of G proteins and the phospholipase C-inositol 1,4,5-trisphosphate pathway. Here, we show a form of vascular tone regulation by extracellular ATP that depends on the modulation of CCICR. In isolated arterial myocytes, ATP produced facilitation of Ca 2؉ -channel activation and, subsequently, a strong potentiation of CCICR. The facilitation of L-type channel still occurred after full blockade of purinergic receptors and inhibition of G proteins with GDPS, thus suggesting that ATP directly interacts with Ca 2؉ channels. The effects of ATP appear to be highly selective, because they were not mimicked by other nucleotides (ADP or UTP) or vasoactive agents, such as norepinephrine, acetylcholine, or endothelin-1. We have also shown that CCICR can trigger arterial cerebral vasoconstriction in the absence of extracellular calcium and that this phenomenon is greatly facilitated by extracellular ATP. Although, at low concentrations, ATP does not induce arterial contraction per se, this agent markedly potentiates contractility of partially depolarized or primed arteries. Hence, the metabotropic action of L-type Ca 2؉ channels could have a high impact on vascular pathophysiology, because, even in the absence of Ca 2؉ channel opening, it might mediate elevations of cytosolic Ca 2؉ and contraction in partially depolarized vascular smooth muscle cells exposed to small concentrations of agonists.L-type Ca 2ϩ channel ͉ vascular contractility ͉ excitation-contraction coupling C ontraction of vascular smooth muscle cells (VSMCs) determines vessel diameter and, thus, regulates blood flow and pressure. VSMC contraction is triggered by a rise of cytosolic calcium ion concentration ([Ca 2ϩ ]) due to either transmembrane Ca 2ϩ influx or Ca 2ϩ release from the sarcoplasmic reticulum (SR). Extracellular Ca 2ϩ entry normally occurs through L-type voltagedependent Ca 2ϩ channels, although there are numerous ligandgated membrane channels that are also Ca 2ϩ permeable (1). Ca 2ϩ release from the SR is mediated by inositol trisphosphate (InsP 3 ) and ryanodine receptors. Vasoactive agents acting on the different vascular territories induce VSMC contraction by binding to membrane receptors and the subsequent activation of one or more of the Ca 2ϩ -entry and͞or Ca 2ϩ -release channels (2-5).We have described a previously unnoticed metabotropic effect of vascular L-type Ca 2ϩ channels, denoted as calcium-channelinduced Ca 2ϩ release (CCICR), which requires Ca 2ϩ channel activation but is independent of extracellular Ca 2ϩ influx (6). This new Ca 2ϩ -release mechanism depends on the conformational change of L-type Ca 2ϩ channels and the downstream activation of the G protein͞phospholipase C (PLC) cascade, leading to synthesis of InsP 3 and C...
The purpose of this study was to determine which strategy of embryo transfer has a better trade-off in live birth delivery rate versus multiple pregnancy considering patient acceptance: elective single embryo transfer (eSET) or elective double embryo transfer (eDET). In all, 199 women <38 years of age undergoing their first IVF treatment in a private centre were included in a prospective open-label randomised controlled trial. Patients were randomised into four groups: (1) eSET on Day 3; (2) eSET on Day 5; (3) eDET on Day 3; and (4) eDET on Day 5. Per patient, main analysis included acceptance of assigned group, as well as multiple and live birth delivery rates of the fresh cycle. Secondary analysis included the rates of subsequent cryotransfers and the theoretical cumulative success rate. Of 98 patients selected for eSET, 40% refused and preferred eDET. The live birth delivery rate after eDET was significantly higher after eDET versus eSET (65% vs 42%, respectively; odds ratio=1.6, 95% confidence interval 1.1-2.1). No multiple births were observed after eSET, compared with 35% after eDET. Although live birth delivery is higher with eDET, the increased risk of multiple births is avoided with eSET. Nearly half the patients refused eSET even after having been well informed about its benefits.
Several reports in the literature suggest delayed implantation of in vitro-fertilized human embryos compared to in vivo-fertilized eggs. The use of high-frequency transvaginal transducers for early detection of pregnancy has allowed the identification of the gestational sac with very low serum human chorionic gonadotropin (beta-hCG) levels. Thus, the present study evaluated whether retarded implantation can be identified using this novel technology. We studied 13 single pregnancies after in vitro fertilization (IVF) and 14 pregnancies after artificial insemination either by husband (n = 6) or donor (n = 8). In the IVF patients, oocytes were retrieved 35 hours after hCG administration. Embryo transfer occurred approximately 48 hours after retrieval. Artificial insemination was performed 24 and 48 hours after hCG administration. Transvaginal ultrasound scans and serum beta-hCG levels were evaluated every 3 days starting day 12 post-hCG administration. Serum beta-hCG levels rose in parallel when in vitro- and in vivo-fertilized embryos were compared. Similarly, there was no difference between groups in the mean time needed to detect early embryonic structures, such as the embryonic sac, yolk sac, and heartbeats, or the growth rate of the gestational sac. In conclusion, there was no difference in detecting implantation and early embryonic development of human embryos fertilized in vivo versus in vitro as ascertained by ultrasound scans and serum beta-hCG levels. An embryonic sac is detected 23-24 days after hCG administration in pregnancies achieved by assisted reproductive techniques.
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