Browsing by Author "Castro, Ana"
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Publication Cardiovascular risk factors and the allostatic interoceptive network in dementia(2025) Hazelton, Jessica; Migeot, Joaquín; Gonzalez, Raul; Altschuler, Florencia; Duran, Claudia; Wen, Olivia; Galván, Dante; Barttfeld, Pablo; Medel , Vicente; González, Cecilia; Castro, Ana; Hernández, Hernán; Gonzalez, Carolina; Castaner, Olga; Hu, Kun; Li, Peng; Maria Isabel Behrens; Behrens, Maria Isabel; Bruno, Martin; Cardona, Juan; Custodio, Nilton; Santamaria, Hernando; Garcia, Adolfo; Godoy, Maria; Avila, José; Maito, Marce; Matallana, Diana; Miller, Bruce; Lopera, Francisco; Okada , Maira; Pina, Stefanie; Possin, Katherine; France, Elisa de Paula; Reyes, Pablo; Slachevsky Chonchol, Andrea; Sosa, Ana; Takada, Leonel; Yokoyama, Jennifer; Ibanez, AgustinAims: Cardiovascular risk factors, such diabetes, hypertension, blood pressure, obesity, and smoking, are linked with allostatic-interoception-the continuous monitoring of internal bodily states in anticipation of environmental demands. These risk factors are associated with dementia risk. How these factors affect brain networks vulnerable to neurodegeneration and involved in allostatic-interoception, such as the Allostatic-Interoceptive Network (AIN), is unknown. We investigated the relationship between cardiovascular risk and AIN structure and function in frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD). Methods and results: We recruited 1501 participants (304 with FTLD, 512 with AD, and 685 healthy controls) from the Multi-Partner Consortium to Expand Dementia Research in Latin America (ReDLat). A cardiovascular risk score was calculated based on: age, sex, diabetes, hypertension, systolic blood pressure, body mass index, and smoking status. Cardiovascular risk was associated with grey matter integrity and functional connectivity in age- and sex-matched patient-control groups focusing on predefined regions of interest within the AIN. Higher cardiovascular risk was associated with reduced structural integrity and functional connectivity within the AIN in both FTLD and AD. FTLD patients showed more extensive structural and functional connectivity disruptions throughout the AIN. In AD patients, structural reductions in the AIN were prominent, with functional connectivity restricted to the hippocampus, parahippocampal gyrus, and orbitofrontal regions. Conclusion: Cardiovascular risk factors appear to adversely impact the AIN structure and function, with disease-specific patterns of vulnerability. Results underscore the importance of integrating cardiovascular health into models of neurodegenerative disease and managing cardiovascular health to support brain integrity in dementia.Item Characteristics of physiotherapy staffing levels and caseload: a cross-sectional survey of Chilean adult Intensive Care Units(2019) Aranis, Nadine; Molina, Jorge; Leppe, Jaime; Castro, Ana; Fu, Carolina; Merino, CatalinaIntroduction: The European Society of Intensive Care Medicine recommends the presence of a specialist physiotherapist, available every five beds, seven days a week in the high complexity Intensive Care Unit. However, in Chile the adherence of adult Intensive Care Units to this recommendation is unknown. Objective: To describe the organizational characteristics and the physiotherapist availability in adult Intensive Care Units in Chile, and according to the adherence to international recommendations, inform health decision-makers. Methods: Observational study based on a telephone survey. All adult Intensive Care Units institutions of high complexity, private hospitals and teaching health centers in Chile were eligible (n = 74). The primary outcome measures were the proportion of institutions with physiotherapist availability 24 hours a day and seven days a week (24/7 physiotherapist), a maximum caseload per physiotherapist of five patients and the presence of a specialist physiotherapist. Results: Response rate was 86.5%, with 59% of responding units being public and 83% offering level III care. 70% of the adult Intensive Care Units in Chile have 24/7 physiotherapist (87% of the public and 46% of the private sector). 41% of the centers had a maximum caseload per physiotherapist of five patients during the day on weekdays. This number decreased on weekends and during night shifts. 23% of the Intensive Care Units had a specialist physiotherapist, being more common in the private sector (31%). Conclusions: In Chilean adult ICU, 24/7 physiotherapist availability is high, the prevalence of physiotherapists with specialist training is low. Future efforts should focus on promoting the uptake of specialist training.Item Dramatic effects of control measures on deaths from yellow fever in Havana, Cuba, in the early 1900s(Sage Publications, 2017) Lechuga, Rita; Castro, Ana;Yellow fever, named as such due to the jaundice it may cause in an infected person, is a tropical, vector-borne disease, endemic in certain areas of Africa and the Americas (WHO 2014). Records suggest that yellow fever in the Americas occurred on the Yucatan peninsula as far back as 1648 (CDC 2010). During the early years of yellow fever epidemics in the Americas in the 18th and 19th centuries, European armies suffered greatly from outbreaks. For example, the British army lost 20,000 out of 27,000 men in Cartagena, Colombia in 1741, and the French army lost 8,000 men in Santo Domingo in 1803 (Brês 1986). One of the most significant epidemics occurred in Panama in the late 19th century, when yellow fever and malaria struck French workers constructing the Panama Canal. The project cost thousands of lives lost to yellow fever and malaria, and millions of dollars, contributing, with corruption and political scandal, to bankrupting the French company constructing the Canal (US Dept. of State No Date; Skinner 1988).Publication 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, FelipeIntroduction: 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.Item Impact on Mental, Physical and Cognitive functioning of a Critical care sTay during the COVID-19 pandemic (IMPACCT COVID-19): protocol for a prospective, multicentre, mixed-methods cohort study(2021) Castro, Ana; Merino, Catalina; González, Felipe; Camus, Agustín; Leppe, Jaime; IMPACCT COVID-19 study groupIntroduction The ongoing pandemic could affect the duration, variety and severity of the mental, physical, and cognitive impairments intensive care unit (ICU) survivors and their families frequently present. We aim to determine the impact of the COVID-19 pandemic on the mental, physical, and cognitive health of survivors, the experience of their families and their treating healthcare professionals.Item Lower limb injuries epidemiology and risk factors in army recruits from Chilean military academy: A prospective cohort study.(Elsevier, 2011) Leppe, Jaime; Utreras, Carolina; Nuñez, Daniela; Cerda, Enrique; Castro, AnaPurpose: To quantify injuries and to identify intrinsic risk factors for lower limb injury that could be modified or prevented through training. Relevance: Finding modifiable intrinsic factors that increase the risk is crucial, because it would allow to carry out a prevention program in the most vulnerable subjects or to add a new cutoff point for the admission physical tests. Participants: 193 subjects participated (mean 19y.o., SD: 1.2y.o.), 84.97% men, first year army recruits. Methods: Closed Prospective Cohort Study since February until November 2009. Subjects were assessed at the beginning of the period through Single leg triple hop test and Star Excursion Balance Test (SEBT). In order to classify the physical fitness we used the admission physical test, including time to run 3200 m, sit-ups and push-ups in 60 seconds and timed 1500 m swimming. Recruits were followed-up through passive surveillance. Academy's physician adjudicated injuries. Diagnosis and resting time was recorded on physical activity restriction certificate (PARC), which were checked fortnightly. Analysis: Data collected about PARC was analyzed by month and by trimester. The cumulative incidence was calculated. We compared injured and non-injured for the variables measured, (Wilcoxon and Kruskall–Wallis, respectively). Survival analysis using Cox's regression model was used for risk. Alfa 5%. Results: Injury cumulative incidence was 36.27%, 64.29% in February-April. 76% probability of injury in February-April. 59.42% of injuries were located in the functional unit knee-leg and 36.2% in ankle-foot. The most common diagnoses were: Sprains (24.28%), Tendinitis and Patellofemoral Pain Syndrome (18.57% each). The median of days lost due to injury was 10, range 3–22. In admission physical tests, injured subjects got worse scores in comparison to uninjured (statistically no significant, p > 0.05) In a multivariate model, none of the intrinsic factors studied increased the risk of injury. Conclusions: Our highest injury rate is concentrated in the first trimester, period characterized by high physical military training. Dynamic Balance and Physical fitness cannot explain injuries in our population. A highest cutoff point for admission is unreasonable. Exhausting and prolonged military training, differences between training regimens (e.g. strengthening and speed endurance training in military and sport training) and cumulative number of hours/week of physical activity (Military, sport and/or gym training) could better explain the high incidence of injury in this cohort than intrinsic factors. Neglecting to assess these factors prevents further conclusions; this along with lack of investigation of previous injury history were our weaknesses. Future research should focus in these topics. The prospective design is our greatest strength. Implications: Different training regimens should be synchronized in military and sport training; also PT should record hours/week of training to control possible overuse injuries.