Repositorio Institucional
Nuestra plataforma Reúne, conserva y difunde la producción intelectual en formato digital de estudiantes, académicos e investigadores de la Universidad del Desarrollo. Es una plataforma web colaborativa diseñada y administrada por el Sistema de Bibliotecas, en el que participan las unidades académicas como proveedoras de contenido, ejerciendo el rol de editor en su respectiva “comunidad” Leer Más...
¿Qué estás buscando?
Recent Submissions
Early high‑sensitivity troponin elevation and short‑term mortality in sepsis: a systematic review with meta‑analysis
(2025) Gajardo, Abraham I. J.; Ferrière‑Steinert, Santiago; Valenzuela Jiménez, Joaquín; Heskia Araya, Sebastián; Kouyoumdjian Carvajal, Thomas; Ramos‑Rojas, José; Medel, Juan Nicolás
Background Serum cardiac troponin (cTn) elevation is a well-established phenomenon in sepsis. However, the clinical significance of this phenomenon with high-sensitivity (hs) assays and the current sepsis definition needs to be settled.
Research Question What is the association between early serum cTn levels measured by hs-assays and the risk of short-term mortality in septic patients?
Study Design and Methods We conducted a systematic review using a comprehensive PubMed, Scopus, and Embase search. Studies were eligible if they reported association data on early hs-cTn and mortality in an adult sample with sepsis that met the Sepsis-3 definition. For the synthesis of the effect of hs-cTn on mortality, we applied random effect models on the pooled unadjusted and adjusted odds ratio (OR and aOR, respectively) of elevated vs. normal hs-cTn serum values, and on the crude standardized mean difference (SMD) of hs-cTn between survivors and non-survivors.
Results In total, 6242 patients from 17 studies were included, with short-term mortality rates ranging from 16.9% to 53.8%. Using a crude analysis, non-survivor patients showed higher hs-cTn than survivors (SMD of 0.87, 95%CI: 0.41–1.33). Elevated hs-cTn was associated with increased mortality (OR = 1.78, 95% CI: 1.41–2.25). However, this prognostic effect was absent in studies that adjusted for different confounders (aOR = 1.06, 95% CI: 0.99–1.14).
Discussion and Conclusions Non-survivors of sepsis exhibited significantly elevated hs-cTn levels. While elevated hs-cTn levels are associated with an increased risk of mortality, they are not independently associated with this outcome in sepsis.
Using the OSCE to assess medical students’ communication and clinical reasoning during five years of restricted clinical practice
(2025) Armijo-Rivera, Soledad; Zamorano Saavedra, Catalina; Vicencio-Clarke, Scarlett; Behrens Pérez, Claudia; Pérez-Villalobos, Cristhian
Background Objective and Structured Clinical Examination (OSCE) is a widely used evaluation method for health profession students. In Chile, physicians OSCEs have incorporated clinical reasoning and patient-centered communication assessment since 2015. The overall impact of the COVID-19 pandemic on undergraduate medical clinical practice remains unknown, in particular whether this context disproportionately affected lower-income
regions, as was the case analysed in this study.
Aim This research compares the OSCE patient-centered communication and clinical reasoning results among five cohorts of intermediate-level medical students with restricted clinical practice in Chile.
Methods We designed an observational study analyzing five cohorts of fourth-year medical students with different clinical practice opportunities, with 3rd to 4th-year progression analysis in two cohorts. Adaptations to compensate lack of clinical practice hours include high-fidelity simulation and theoretical discussion of clinical cases, as well as formative OSCE at third-year level in two cohorts. Communication in OSCE was assessed using the Communication
Assessment Tool (CAT) and Clinical Reasoning (CR) with a register form (that includes a global score, History Taking, Differential Diagnosis, and Therapeutic Plan subscores). Descriptive statistics and central tendency measurements were applied to analyze CAT and CR scores, along with Kruskal-Wallis tests and Wilcoxon’s test for paired sample analysis.
Findings The 2018 cohort shows the lowest results in both variables although it was the cohort with more clinical practice opportunities. The higher CAT result was in the 2021 cohort, while the 2022 cohort exhibited a significantly higher CR score (p < 0.05). There is a linear tendency to grow over the years for both measures. The 2023 cohort shows significant improvement between third-year and fourth-year OSCEs in all items of CAT and a detriment in CR, while
the 2022 cohort shows a significant increment in CR and four items of CAT (p < 0.05).
Conclusion The students with fewer hours of clinical practice showed similar CR and communication results to the prepandemic group, probably because of the adaptations implemented. Simulation was an effective alternative.
Advancing the assessment of clinical competence in Latin America: a scoping review of OSCE implementation and challenges in resource-limited settings
(2025) Armijo-Rivera, Soledad; Fuenzalida-Muñoz, Brenda; Bozzo-Navarrete, Sergio; Kunakov, Natasha; Sanhueza, Jacqueline; Cornejo, Carla; Vicencio-Clarke, Scarlett; Miranda-Hurtado, Cesar; Elbers-Arce, Alexandra; Shibao-Miyasato, Hector; Soublette, Alix; Sandoval, Ana María; Cicibel Casas-Bueno, Fresia; Delgado, Ximena
Background Objective Structured Clinical Examination (OSCE) is important to assess clinical competencies in health professions. However, in Latin America, a region with limited resources, the implementation and quality of OSCEs remain underexplored despite their increasing use. This study analyses how the OSCE has been applied and how its quality has evolved in Latin America.
Methods A scoping review methodology was used, including a search across PubMed, Scopus, WOS, LILACS and Scielo, including studies on the implementation of OSCE in Latin America, written in English, French, Portuguese, or Spanish. Their quality was assessed using the AMEE guidelines 81 and 49 criteria and MMERSQI. Data were extracted regarding OSCE structure, evaluator training, validity, reliability, and the use of simulated patients.
Results 365 articles were obtained, of which 69 met the inclusion criteria. The first report on OSCE implementation in the region dates back to 2000. Three countries accounted for 84.06% of the reports (Chile, Mexico, Brazil). 68.12% was applied in undergraduate programs. In this group, the implementation was mainly in Medicine (69.57%), with lesser use in physiotherapy (7.95%) and nursing (2.9%). The number of stations and duration of each varied, with 18-station
circuits being the most common. Evidence of validity and reliability of the OSCE was reported in 26.09%, feedback to students in 33,33%, and simulated patient training in 37.68% of the reports. A notable trend in the quinquennial analysis is the increased use of high-fidelity simulations and the shift towards remote OSCEs during the pandemic.
The inclusion of inactive stations, inadequate training for simulated patients, and the absence of evidence supporting instrument validation are recurrently reported challenges in OSCE studies. The overall methodological quality has improved, as evidenced by OSCE Committee and Blueprint in nearly 50% of the studies and rising MMERSQI scores, especially in recent years.
Ancient genomes reveal a deep history of Treponema pallidum in the Americas
(2025) Barquera, Rodrigo; Sitter, T. Lesley; Kirkpatrick, Casey L.; Ramirez, Darío A.; Kocher, Arthur; Spyrou, Maria A.; Couoh, Lourdes R.; Talavera-González, Jorge A.; Castro, Mario; Hunnius, Tanya von; Guevara, Evelyn K.; Hamilton, W. Derek; Roberts, Patrick; Scott, Erin; Fabra, Mariana; Da Peña, Gabriela V.; Pacheco, Aryel; Rodriguez, Mónica; Aspillaga, Eugenio; Tiliakou, Anthi; Nelson, Elizabeth A.; Giffin, Karen L.,; Bianco, Raffaela A.; Rohrlach, Adam B.; García Martínez, María de los Angeles; Ballesteros Solís, Fabiola A.; Sajantila, Antti; Saunders, Shelley R.; Nores, Rodrigo; Herbig, Alexander; Krause, Johannes; Bos, Kirsten I.
Human treponemal infections are caused by a family of closely related Treponema pallidum that give rise to the diseases yaws, bejel, pinta and, most notably, syphilis1. Debates on a common origin for these pathogens and the history of syphilis itself have weighed evidence for the ‘Columbian hypothesis’2, which argues for an American origin, against that for the ‘pre-Columbian hypothesis’3, which argues for the presence of the disease in Eurasia in the Medieval period and possibly earlier. Although molecular data has provided a genetic basis for distinction of the typed subspecies4, deep evolution of the complex has remained unresolved owing to limitations in the conclusions that can be drawn from the sparse palaeogenomic data that are currently available. Here we explore this evolutionary history through analyses of five pre- and peri-contact ancient treponemal genomes from the Americas that represent ancient relatives of the T. pallidum subsp. pallidum (syphilis), T. pallidum subsp. pertenue (yaws) and T. pallidum subsp. endemicum (bejel) lineages. Our data indicate unexplored diversity and an emergence of T. pallidum that post-dates human occupation in the Americas. Together, these results support an American origin for all T. pallidum characterized at the genomic level, both modern and ancient.
Experiencias reportadas por adolescentes durante el covid-19 y su impacto en el bienestar subjetivo
(2024) Benavente Delgado, Mariavictoria; Alfaro Inzunza, Jaime
Introducción: las experiencias asociadas con el covid-19 y sus efectos continúan siendo temas de interés, ya que no solo se estiman consecuencias en la salud y los hábitos de vida, sino en el bienestar de quienes experimentaron distintos grados de estrés social, emocional o económico en ese periodo. El bienestar subjetivo, y particularmente la satisfacción con la vida, se ha vinculado con resultados positivos para el desarrollo en la adolescencia, así como bajos índices de satisfacción con la vida se han relacionado con desajustes sociales y emocionales. El objetivo del artículo es mostrar cuál fue el efecto que experiencias asociadas con el covid-19 tuvieron sobre la satisfacción con la vida de un grupo de adolescentes chilenos. Materiales y métodos: participaron 1459 estudiantes de secundaria de tres regiones de Chile. Los datos se recolectaron de manera remota entre abril y julio de 2021 mediante cuestionarios de autorreporte. Resultados: los estudiantes que vivieron experiencias negativas durante la pandemia, como problemas familiares o poco respaldo escolar, tuvieron menores puntuaciones en satisfacción con la vida. El apoyo percibido de la escuela y la familia son variables relevantes en la comprensión de la satisfacción con la vida en contextos estresantes. Conclusiones: la pandemia afectó a la muestra estudiada. Se discute acerca de la importancia de identificar estresores y protectores de los grados de satisfacción con la vida en la adolescencia.
Reinforced falsetto to increase the glottic closure in patients diagnosed with unilateral vocal fold paralysis: A preliminary study
(2025) Orellana Marambio, Patricio; Rosales, Felipe Gonzalo; Monichi, Giovanna
There is favourable evidence in speech therapy for the rehabilitation of vocal fold paralysis.
Nonetheless, contemporaneous studies that apply reinforced falsetto were not found. The aim of this study is to determine the results of speech therapy using reinforced falsetto for complete glottic closure in patients diagnosed with unilateral vocal fold paralysis, who were treated at the Laboratory of Voice at the
‘Universidad del Desarrollo’ in Chile between 2015 and 2023. A descriptive, observational and retrospective study was performed on 10 adult participants. Before therapy, grade of dysphonia was severe in 90% of the participants, whilst moderate in the remaining 10%. Incomplete glottic closure was observed in 100% of the
participants. After the therapy, grade of dysphonia was diagnosed as being mild in 60% of the cases, and normal in the remaining 40% of participants. All the participants recovered their glottic closure. Significant differences were observed pre-intervention and post-intervention in: fundamental frequency; sound intensity;
harmonics; maximum phonation time; glottic closure; and dysphonia severity. In conclusion, the reinforced falsetto technique was favourable for the glottic closure in the sample of participants studied. Further, there was clinical improvement in all the analysed acoustic and laryngoscopic variables. Speech therapy using reinforced falsetto could therefore be useful for the rehabilitation of unilateral vocal fold paralysis. It is suggested that extra research is performed, including a representative sample, in order to generalise the results and make them applicable to the general population.
The electroencephalography protocol for the Accelerating Medicines Partnership® Schizophrenia Program: Reliability and stability of measures
(2025) Mathalon, Daniel H.; Nicholas, Spero; Roach, Brian J.; Billah, Tashrif; Lavoie, Suzie; Whitford, Thomas; Hamilton, Holly K.; Addamo, Lauren; Anohkin, Andrey; Bekinschtein, Tristan; Belger, Aysenil; Buccilli, Kate; Cahill, John; Carrión, Ricardo E.; Damiani, Stefano; Dzafic, Ilvana; Ebdrup, Bjørn H.; Izyurov, Igor; Jarcho, Johanna; Jenni, Raoul; Jo, Anna; Kerins, Sarah; Lee, Clarice; Martin, Elizabeth A.; Mayol-Troncoso, Rocio; Niznikiewicz, Margaret A.; Parvaz, Muhammad; Pogarell, Oliver; Prieto-Montalvo, Julio; Rabin, Rachel; Roalf, David R.; Rogers, Jack; Salisbury, Dean F.; Shaik, Riaz; Shankman, Stewart; Stevens, Michael C.; Suen, Yi Nam; Swann, Nicole C.; Tang, Xiaochen; Castillo-Passi, Rolando I.
Individuals at clinical high risk for psychosis (CHR) have variable clinical outcomes and low conversion rates, limiting development of novel and personalized treatments. Moreover, given risks of antipsychotic drugs, safer effective medications for CHR individuals are needed. The Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ) Program was launched to address this need. Based on past CHR and schizophrenia studies, AMP SCZ assessed electroencephalography (EEG)-based event-related potential (ERP), eventrelated oscillation (ERO), and resting EEG power spectral density (PSD) measures, including mismatch negativity (MMN), auditory and visual P300 to target (P3b) and novel (P3a) stimuli, 40-Hz auditory steady state response, and resting EEG PSD for traditional frequency bands (eyes open/closed). Here, in an interim analysis of AMP SCZ EEG measures, we assess test-retest reliability and stability over sessions (baseline, month-2 follow-up) in CHR (n=654) and community control (CON; n=87) participants. Reliability was calculated as Generalizability (G)-coefficients, and changes over session were assessed with paired t-tests. G-coefficients were generally good to excellent in both groups (CHR: mean =0.72, range=0.49–0.85; CON: mean=0.71, range=0.44–0.89). Measure magnitudes significantly (p < 0.001) decreased over session (MMN, auditory and visual target P3b, visual novel P3a, 40-Hz ASSR) and/or over runs within sessions (MMN, auditory/visual novel P3a and target P3b), consistent with habituation effects. Despite these small systematic habituation effects, test-retest reliabilities of the AMP SCZ EEG-based measures are sufficiently strong to support their use in CHR studies as potential predictors of clinical outcomes, markers of illness progression, and/or target engagement or secondary outcome measures in controlled clinical trials. Watch Dr Daniel H. Mathalon discuss their work and this article: https://vimeo.com/1066564687.
Women report worse metrics of positive body image and fat talk: Findings of an exploratory study in a Chilean sample
(2025) Calisto, Javiera; Salazar, Catalina; Seco, Macarena; Vergara-Barra, Pablo; Leonario-Rodriguez, Marcell
This study aimed to investigate the correlation between a positive body image and fat talk, along with the influencing factors shaping their relationship within a cohort of Chilean participants. A cross-sectional exploratory study was undertaken, with variables drawn from the Body Appreciation Scale (BAS) and the Fat Talk Questionnaire (FTQ). Body image distortion was gauged through anthropometric measurements juxtaposed with Standard Figural Stimuli (SFS). women exhibited lower levels of body image positivity in comparison to men (p = 0,049), coupled with a statistically significant elevation in exposure to fat-phobic discussions (p = 0,005). Remarkably, these two variables were associated irrespective of gender, age, nutritional status, or socioeconomic status within the evaluated population.
Representaciones sociales sobre el suicidio en la adolescencia: Un estudio cualitativo con madres y padres de adolescentes de la comuna de Concepción
(2025) González-Montenegro, Pablo; Díaz-Olguín, Rodrigo; Sánchez-Oñate, Alejandro Antonio; Colarte-Peña, Isidora; Vergara-Barra, Pablo
El suicidio en la adolescencia cuenta con abundantes estudios, pero persisten lagunas en la investigación cualitativa focalizada en las representaciones sociales y la perspectiva de los padres. Este trabajo caracterizó dichas representaciones en padres y madres de adolescentes chilenos, empleando un diseño al estilo de una teoría fundamentada. Se incluyeron 12 participantes de la comuna de Concepción, seleccionados mediante muestreo teórico, sin experiencias cercanas con el suicidio. La codificación abierta identificó 27 categorías que describen sus creencias y actitudes. Con base en estas categorías, se desarrolló un modelo comprensivo que coincide parcialmente con diversos enfoques teóricos y revela mitos persistentes alrededor de este fenómeno. Estos hallazgos evidencian la necesidad de reforzar la intervención en centros de salud y establecimientos educativos, a fin de apoyar a las familias en la identificación temprana de señales y la prevención del suicidio adolescente.
Biofunctional Polyvinyl Alcohol/Xanthan Gum/Gelatin Hydrogel Dressings Loaded with Curcumin: Antibacterial Properties and Cell Viability
(2025) Rivera, María; Cament, Alejandro; Ahumada, Manuel; Corrales, Teresa; García, Verónica; Pablos, Jesús; Osorio, Javiera; Ramos, Giselle; Vargas, Leslie; Marcelo Ezquer; Ezquer, Marcelo; Ortiz, J. Andrés
This study explores the development of biocompatible hydrogel dressings incorporating curcumin as an alternative antibacterial agent. In this context, hydrogels were prepared using polyvinyl alcohol, xanthan gum, gelatin, and curcumin as a therapeutic component. FTIR spectroscopy confirmed the successful incorporation of curcumin into the hydrogel matrix, while release profiles demonstrated sustained release. Mechanical testing indicated that xanthan gum reduced elongation and strength in hydrogels, while the combination of xanthan gum and gelatin increased stiffness without loss of elasticity. Curcumin had no major effect on the tensile and rheological properties, preserving the structural integrity of the hydrogels. The hydrogels demonstrated antibacterial activity against Pseudomonas aeruginosa and Staphylococcus aureus ATCC strains, as well as multidrug methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates. Biocompatibility was confirmed through viability assays with immortalized human keratinocytes (HaCaT) and adult human dermal fibroblasts (HDFa), showing no acute cytotoxic effects after 48 h of exposure. Their effective action against clinically relevant bacteria and high cytocompatibility position these hydrogels as promising candidates for infection management and antibiotic resistance mitigation in wound care applications.
Persistence and recurrence after removal of idiopathic epiretinal membrane
(2025) Reichel, Felix F.; Labbe, Eduardo; Gelisken, Faik; Seitz, Immanuel P.; Hagazy, Sherif; Dimopoulos, Spyridon
OBJECTIVES: To analyse the incidence of persistence and recurrence after the peeling of idiopathic epiretinal membrane (ERM) and to describe its clinical features.
METHODS: This retrospective study included 666 eyes (645 patients) that underwent macular surgery for ERM removal. Optical coherence tomographic (OCT) images taken within three months after surgery and at the following visits, clinical parameters and surgery related factors were analysed to investigate the incidence and associated factors of ERM persistence and recurrence.
Postoperative ERM types were categorised depending on the size ( < 100 μm, ≥100 μm) and the location (foveal, parafoveal, outside the parafovea)
RESULTS: The mean follow-up time was 29.4 months. ERM persistence (examination within 3 months) was found in 29.6% of all eyes. Only 1.9% of the eyes presented foveal ERM persistence. Foveal recurrence, defined as reappearance or growth of persistent ERM covering the fovea, was found in 8.2%. In 84.4% of eyes with foveal ERM recurrence, postoperative persistence of ERM of varying severity were identified. None of the pre-operative or surgery related factors were found significantly associated with ERM recurrence. Persistent ERM within the parafovea was the most significant risk factor for foveal ERM recurrence.
CONCLUSION: Recurrence of ERM is generally preceded by the persistence of ERM fragments found in the early postoperative period. Growth of ERM persistence from the parafoveal region was often the origin of foveal ERM recurrence. Insufficient peeling seems to be the most significant predisposing factor for foveal ERM recurrence.
Post-COVID-19 symptoms in a community sample: Exploratory study in two Chilean cities, 2023–2024
(2025) Molina, Xaviera; Awad, Camila; Ramírez-Santana, Muriel; Rubilar, Paola; pablaza, Mauricio; Nunez-Franz, Loreto
Background: SARS-CoV-2 infection affects health, well-being, and the economy, especially considering the persistence of symptoms following an acute episode. This study aims to (1) estimate the frequency of symptoms following SARS-CoV-2 infections, (2) characterize symptoms compatible with post-COVID-19 conditions, and (3) explore risk factors for persistent symptoms among individuals from two Chilean cities diagnosed with COVID-19 at least once.
Methods: This cross-sectional exploratory study involved a convenience sample of individuals who participated in a prior seroprevalence study in Chile. Participants were recruited by phone between November 2023 and January 2024, and self-reported persistent COVID-19 symptoms using the modified Yorkshire Rehabilitation Scale, which assessed symptom severity and functional disability across three dimensions.
Bivariate analysis explores the association between sociodemographic and health variables and reported symptoms using the Mann-Whitney-Wilcoxon and Kruskal-Wallis tests. Two Negative binomial models (Model 1: clinical factors and Model 2: clinical plus sociodemographic factors) evaluated factors associated with the severity of post-COVID-19 symptoms.
Results: Of the 144 participants successfully contacted, 83 met the inclusion criteria. A total of 80.7 % reported symptoms consistent with post-COVID-19. The most frequently reported symptoms were sleep disturbances (59.7 %), anxiety (59.7 %), and memory problems (58.2 %). Only three participants had received a formal post-COVID diagnosis, and none were receiving care through Chile’s universal post-COVID program. Symptom severity was significantly higher in women (p = 0.04), individuals with two or more COVID-19 episodes (p = 0.04), and those with comorbidities (p = 0.02). Negative binomial regression analysis indicated that multiple COVID-19 episodes were associated with greater symptom severity.
Conclusions: A high percentage of participants experienced post-COVID-19 symptoms. Despite the high symptom burden, access to formal diagnosis and care was minimal, highlighting the need to strengthen diagnostic and management protocols within the Chilean healthcare system.
Arsenic Exposure During Pregnancy and Childhood: Factors Explaining Changes over a Decade
(2025) Rubilar, Paola; Hirmas, Macarena; Apablaza, Mauricio; Awad, Camila; Molina, Xaviera; Muñoz, María Pía; Delgado, Iris; Zanetta-Colombo, Nicolás C.; Castillo-Laborde, Carla; Matute, María Isabel; Retamal, Mauricio; Olea, Andrea; Pino, Paulina; González, Claudia; Carvajal, Cristóbal; Iglesias, Verónica
Arsenic chronic exposure, particularly in its inorganic form, represents a significant public health concern. This study was conducted in Arica, the northernmost city in the country, whose inhabitants have been exposed to inorganic arsenic both naturally through drinking water and anthropogenically due to a toxic waste disposal site. We explored changes in inorganic arsenic levels in a cohort of pregnant women and their children over a decade, identifying exposure trends and their determinants. We used data on arsenic exposure through maternal urine samples during pregnancy, collected by the Health Authority between 2013 and 2016 (measurement 1), and followed up with assessments of their children in 2023 (measurement 2). Temporal changes in inorganic arsenic concentration were analyzed using the Wilcoxon Signed-Rank test, and a mixed linear regression model was employed to determine which factors contributed to urinary inorganic arsenic levels.
We did not observe significant differences in mean arsenic concentrations between the two-time points (p = 0.4026). The mixed linear regression model revealed that children consuming bottled water had 8.3% lower urinary inorganic arsenic concentrations than those drinking tap water (95% CI: −15.36 to −0.54%). Additionally, children from ethnic groups had 8.64% higher inorganic arsenic concentrations (95% CI: 0.49 to 17.5%), while those with caregivers with higher education showed a 13.67% reduction (95% CI: −25.06 to −0.56%). Despite mitigation efforts, these findings underscore the ongoing risk of inorganic arsenic exposure among vulnerable populations. They further emphasize the importance of addressing natural arsenic contamination in water and implementing targeted interventions to reduce disparities associated with socioeconomic and demographic factors.
Clustering of Oral Health‐Related Behaviors and TheirAssociation With Sociodemographic Factors inAdolescents Living in England, Wales, and NorthernIreland
(2025) Ávila, Camila; Venturelli, Renato; Ladevig, Dominga; Georgios, Tsakos; Richard, Watt
Objectives
This study investigated the clustering patterns of oral health-related behaviors and their relationship with sociodemographic factors in a national sample of 12- and 15-year-olds from England, Wales, and Northern Ireland.
Material and Methods
Data from the Child Dental Health Survey (CDHS) 2013 were analyzed. Five individual behaviors were considered: smoking, alcohol use, tooth brushing frequency, sugar intake, and dental attendance. Explanatory variables included sex, age, and eligibility for free school meal (FSM) (as a marker of socioeconomic deprivation). Clustering patterns were assessed using counted clusters, pairwise correlation, and observed/expected ratio analysis. Logistic regression models were performed to assess the associations between behavioral clusters and sociodemographic factors.
Results
The study included 4932 young people, with 51.5% aged 15 years, 50.6% male, and 17.4% eligible for FSM. Statistical differences were found in individual behaviors: Males were more likely to report lower tooth brushing frequency (28.1% vs. 13.6% for females), while 15-year-olds were more likely to engage in smoking (28.0% vs. 6.0%) and alcohol consumption (73.5% vs. 29.2%) compared to 12-year-olds. FSM-eligible adolescents were more likely to engage in all risk behaviors, except for alcohol consumption. Seven significant behavioral clusters were identified through O/E analysis, each involving combinations of two or three risk behaviors. In the regression analysis, age was strongly associated with these clusters. For example, 15-year-olds had significantly higher odds (OR: 7.04; 95% CI: 4.85–10.22) of exhibiting the cluster involving smoking and alcohol use compared to 12-year-olds. Sex and FSM eligibility also showed significant, though weaker, associations with five of the identified behavioral patterns.
Conclusions
Detrimental oral health behavioral clusters were more commonly observed among males, 15-year-olds, and adolescents from less advantaged backgrounds.
Resilience as empathy predictor in nursing students
(2025) Díaz-Narváez, Víctor P.; Madero Zambrano, Kendy; Fortich-Mesa, Natalia; Hoyos Hoyos, Vivi; Vilca Quiro, Lindsey W.; Reyes-Reyes, Alejandro; Reyes Reyes, Fernando Teddy; Gamarra-Moncayo, José
Objective. To determine if resilience can predict empathy. Specifically, explain what would be the effect of the resilience dimensions on the dimensions of empathy in the nursing students examined in this study. Methods. Cross-sectional study with the participation of 340 nursing students from a private university in Colombia. Jefferson’s Empathy Scale (student version) and the Resilience-Trait Scale were used. The complete psychometry of the Empathy and Resilience scales was carried out, followed by the application of Structural Equations. Results. Ecological Resilience predicts negatively the dimensions of “Compassionate Care” (ß = -0.11) and “Walking in the patient’s shoes” (ß = -0.19); the Engineering Resilience predicts positively the dimension “Walking in the patient’s shoes” (ß = 0.08). Conclusion. Overall, resilience predicts empathy, thereby, introducing empathetic training of nursing students in the population studied must also include training in resilience.
Visual attention during non-immersive virtual reality balance training in older adults with mild to moderate cognitive impairment: an eye-tracking study
(2025) Maldonado, Marcos; Jara, Gonzalo; González Seguel, Felipe
Background: Older adults with cognitive impairment often present with balance deficits, reduced walking speed, and attentional difficulties-particularly in executive function. These challenges increase fall risk and complicate traditional rehabilitation approaches. Eye-tracking technology offers an objective way to evaluate attention by analyzing oculomotor behavior during tasks, but its use in clinical rehabilitation contexts is still limited.
Objective: The aim of this study is to investigate visual attention using eye-tracking metrics during a non-immersive virtual reality-based balance training program in older adults with mild to moderate cognitive impairment.
Methods: This was an exploratory pilot study with a prospective, descriptive cohort, based on a non-controlled, quasi-experimental design of seven older adults with mild to moderate cognitive impairment. Each patient underwent VR-based balance training using RehametricsⓇ software, while their attention was assessed via eye-tracking (Tobii Pro Glasses 2 Refurbished Wireless). Clinical assessments included the Mini-BESTest, Functional Gait Assessment, 6-Minute Walk Test, 4-Meter Walk Test, and Montreal Cognitive Assessment (MoCA). Eye-tracking data focused on fixation patterns, microsaccades, and pupil diameter as indicators of attentional processing.
Results: Patients showed a small numerical increase, without reaching statistical significance in task difficulty progression (p = 0.016), lower limb endurance (p = 0.016), and single-leg support time (p = 0.031). Clinical tests revealed a slight increase, though results were not statistically significant in balance and walking speed (p = 0.063). Eye-tracking data indicated increased fixation stability and decreased pupil diameter, suggesting more efficient attention allocation during motor tasks.
Conclusions: Eye-tracking provided valuable metrics into attentional behavior during balance training in older adults with cognitive impairment. Its integration into non-immersive virtual reality rehabilitation may help better understand and address cognitive-motor interactions. Further studies with larger samples are needed to confirm these preliminary findings.
Population-based seroprevalence survey: post-pandemic COVID-19 vaccination, related factors, and geographic distribution of vaccine acceptability in Chile
(2025) Nuñez-Franz, Loreto; Rubilar, Paola; Apablaza, Mauricio; Canales, Luis; Cortés, Lina J.; Molina, Xaviera; Said, Macarena; Olivares, Kathya; Correa, Juan; Ramírez-Santana, Muriel
Background Prevention of infectious diseases is based on host protection, especially using vaccines. Several factors have been linked to the acceptance of vaccines in the population. Chile achieved high COVID-19 vaccination coverage early in the pandemic. The study aimed to determine the prevalence of antigens and antibodies,
vaccination status, geographical distribution, and factors related to vaccine acceptability.
Methods In two Chilean cities, the fourth round of a population-based seroprevalence cross-sectional survey was conducted in May 2024. 654 participants aged seven or older were recruited. After signing consent, participants were interviewed, blood samples were taken to identify antibodies against SARS-CoV-2 using ELISA, and antigens were assessed through a nasal swab rapid test. Territorial analysis of the vaccine dose distribution was carried out.
Results All participants tested negative for antigens and positive for antibodies against SARS-CoV-2, with an overall vaccination uptake rate of 98,5%. However, their vaccination status was heterogeneous. Territorial distribution showed a slight geographical clustering of vaccine doses in both cities. 52.7% had the basic scheme and/or boosters, 32.1% had the bivalent vaccine, and 13.7% had anti-Omicron. Self-report identification with a risk group was not associated with vaccine adherence. City, age, education, and comorbidities were associated with perceived and actual risk discrepancies.
Conclusions Overall, vaccine acceptance is high. However, the acceptance of the last two doses was below expectations and showed heterogeneous geographical distribution. Adulthood is the most important predictor of vaccine uptake. Participants underestimated their level of risk. Risk communication must be improved, especially for risk groups, to help them perceive themselves as beneficiaries of vaccination. Efforts should be made to disseminate information on vaccine safety and counter misinformation to increase knowledge about vaccines.
Exploring axial muscle performance with the supine bridging activity across critical illness recovery: A prospective observational study
(2025) Lee, Juan; Muñoz, Felipe; Hermosilla, Cristofer; Peña, Nicole; Castillo, Felipe; Ugarte, Sebastián; Castro, Ana; González, Felipe
Introduction: Limb and respiratory muscle weakness acquired in the intensive care unit (ICU) are commonly associated with long-term functional impairments. However, the extent to which axial muscles might be affected remains poorly understood. Therefore, this study aims to explore the association between axial muscle performance assessed through a supine bridging activity and physical function across critical illness recovery. Secondarily, we investigated the predictability of the supine bridging activity with the walking ability.
Methods: Prospective observational study of patients who walked independently before admission and were mechanically ventilated for ≥48 hours in a Chilean medical ICU. The assessment session, conducted on awakening, ICU discharge, and high-dependency unit (HDU) discharge, included the supine bridging activity (performance scored from 0 to 5, with higher scores representing better performance, and lifting duration in seconds) and walking ability. Performance over-time was compared by Friedman’s test for multiple comparisons (Bonferroni corrections). Logistic regressions were used to explore the association of supine bridging activity with in-hospital walking ability. We also produced a Receiver Operating Characteristic curve for the predictability of walking ability.
Results: We enrolled 33 adults, completing 86 supine bridging activity assessments across time points. Supine bridging activity performance improved significantly over time, with a median (P25 to P75) of 2 (1 to 4) on awakening, 3 (1 to 5) at ICU discharge, and 5 (2 to 5) at HDU discharge (p<0.001). Higher supine bridging activity scores on awakening were associated with a significantly higher likelihood of walking at HDU discharge (odds ratio: 12.17; 95% CI: 1.36 to 108.68; p=0.025). Lifting >14.5 seconds during the supine bridging activity at awakening predicted walking ability at HDU discharge (area under the curve=0.77).
Conclusions: Supine bridging activity performance on awakening was associated with walking ability post ICU discharge, with potential implications on rehabilitation interventions aimed at improving axial muscle strength from early stages of critical illness.
Latin American association for the study of the liver (ALEH) guidance on preoperative care in liver transplantation: referral criteria, patient assessment, and waiting list management
(2025) Mainardi, Victoria; Pages, Josefina; Menendez, Josemaría; Zapata, Rodrigo; Díaz, Luis; Marciano, Sebastian; Cairo, Fernando; Padilla, Martin; Tenorioz, Laura; Urzua, Alvaro; Navarro, Lucia; Dominguez, Nicolas; Coste, Pablo; Mendizabal, Manuel; Martinez, Jorge; Lopez, Sergio; Varon, Adriana; De Medeiros, Alfeu; Abad, Jhon; Restrepo, Juan; Codes, Liana; Lisboa, Paulo; Pérez, Norma; Castro, Graciela; Terrabuio, Débora; Mário, Pessoa; Girala, Marcos; Lucca Schiavon, Leonardo; Aguileraz, Edgard; Valenzuela, Kenia; Samada, Marcia; Gerona, Solange; Villamil, Alejandra
Liver transplantation (LT) is the standard of care therapy for patients with decompensated cirrhosis, early-stage hepatocellular carcinoma, acute liver failure, and other expanding indications. Latin America is a highly heterogeneous region characterized by an uneven distribution of socio-economic conditions and irregular access to health resources, and consequently LT activity varies across the region. This current guidance on preoperative care in LT represents a collaborative effort to assess and standardize preoperative evaluation of liver transplant candidates in Latin America. It is the first position paper of the special interest group on LT of the Latin American Association for the Study of the Liver (ALEH), which provides evidence-based comprehensive recommendations regarding whom to refer, how to assess LT candidates and how to manage patients on the waiting list, taking into consideration their applicability in Latin America.
Multimodal neuroimaging of fatigability development
(2025) Bedard, Patrick; Knutson, Kristine; McGurrin, Patrick; Vial Undurraga, Felipe; Popa, Traian; Horovitz, Silvina; Hallett, Mark; Nath, Avindra; Walitt, Brian
Fatigability refers to the inability of the neuromuscular system to generate enough force to produce movements to meet task challenges. Fatigability has a central and a peripheral component linked via the neuromuscular system, but how these two components interact as fatigue develops lacks a complete understanding. The effects of fatigability are experienced in healthy humans but also accompany various disorders, often exacerbating their symptoms. We studied how fatigability develops in the neuromuscular system using multimodal neuroimaging. We recruited healthy participants to perform a fatiguing grip force task, while recording force, electromyography of forearm muscles (EMG), electroencephalography (EEG), and functional magnetic resonance imaging (fMRI) in 30-second blocks of grip task alternating with 30 seconds of rest. The task entailed maintaining 50% of the maximum force. We combined EMG and EEG to compute corticomuscular coherence and combined EEG and fMRI to compute EEG-informed fMRI. We selected eight task blocks specific to each participant to represent how the neuromuscular system adapted from pre-fatigability to actual fatigability. Those included five blocks for pre-fatigability in which participants could generate enough force to match the required 50% of maximum force and three blocks when the force fell below that limit. Across blocks of the grip force task, we observed changes in the neuromuscular system that preceded grip force changes. We found that electromyography of arm muscles shifted from high to low frequency, EEG in the channel covering the contralateral sensorimotor area increased steadily up to the fifth block and then plateaued, and fMRI signal also increased in the cerebellum. Corticomuscular coherence increased within each of the 30-second blocks of the grip task. EEG-informed fMRI revealed areas of the brain that the traditional regression did not, including the bilateral sensorimotor cortex, temporal-parietal junction, and supplementary motor area. Thus, as fatigability developed, the neuromuscular system experienced changes earlier than the actual behavior. While we found evidence for fatigability of central and peripheral origins, peripheral fatigue seems to occur first.