Browsing by Author "Vergara, Rodrigo"
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Item Cancer History Is Associated with Slower Speed of Cognitive Decline in Patients with Amnestic Cognitive Impairment(2022) Castillo, Rolando; Vergara, Rodrigo; Rogers, Nicole; Ponce, Daniela; Bennett, Magdalena; Behrens, MaríaBackground: Several epidemiological studies report a negative association between Cancer and Alzheimer's disease (AD). Objective: To characterize the trajectories of memory loss in individuals with early amnestic cognitive impairment with and without history of previous cancer. Methods: Cognitive deterioration was assessed using the Montreal Cognitive Assessment (MoCA) or MoCA-Memory Index Score (MoCA-MIS) biannually in subjects with early amnestic cognitive impairment followed-up retrospectively from 2007 to 2021. History of Cancer was obtained from clinical records. Simple linear regressions of MoCA-MIS scores were calculated for each subject and analyzed with K-means cluster analysis to identify subgroups with different cognitive decline trajectories. χ2 and t tests were used for descriptive categorical and continuous variables and mixed multiple linear regressions to determine cognitive decline covariates. Results: Analysis of the trajectory of cognitive decline in 141 subjects with early amnestic cognitive impairment identified two subgroups: Fast (n = 60) and Slow (n = 81) progressors. At baseline Fast progressors had better MoCA-MIS (p < 0.001) and functionality (CDR p = 0.02, AD8 p = 0.05), took less anti-dementia medications (p = 0.005), and had higher depression rates (p = 0.02). Interestingly, Fast progressors slowed their speed of memory decline (from 1.6 to 1.1 MoCA-MIS points/year) and global cognitive decline (from 2.0 to 1.4 total MoCA points/year) when Cancer history was present. Conclusion: Two trajectories of amnestic cognitive decline were identified, possibly derived from different neurophysiopathologies or clinical stages. This study suggests that a history of previous Cancer slows down amnestic cognitive decline, specifically in a subgroup of subjects with depression at baseline and accelerated deterioration at follow-up.Item Development and Validation of the Social Thermoregulation and Risk Avoidance Questionnaire (STRAQ-1)(2019) Vergara, Rodrigo; Hernández, Cristobal; Jaume, Francisco; Lindenberg, Siegwart; Klein, Richard; IJzerman, HansAttachment theory was built around the idea that infants rely on others to survive, and it is often forgotten that survival hinged on coping with environmental demands. Adult attachment reports have instead been organized around people’s subjective experience of safety and security in relationships. To resolve the gap between infant’s physical needs and adult attachment experiences, we made a first step by developing the Social Thermoregulation and Risk Avoidance Questionnaire (STRAQ-1) in 12 countries (N = 1510), providing a complementary measure to identify biological drives formative to attachment. We conjectured that co-regulatory patterns of temperature and stress are foundational to attachmentstyles and on this basis used a naïve bootstrapping method to find a robust solution, conducting seven exploratory factor analyses in an exploratory-confirmatory fashion. We identified 23 (out of 57) items in 4 subscales: Social Thermoregulation (Total Omega = .83), High Temperature Sensitivity (.83), Solitary Thermoregulation (.77), and Risk Avoidance (.57). In terms of external validity, we also found that the STRAQ-1 relates to emotion regulation strategies broadly and, importantly, relates to individual differences in attachment specifically, which in turn mediates the relationship with stress and health (making the scale face valid). Our approach provides a robust first effort in identifying biological mechanisms underlying attachment formation.Publication Performance of pre-transplant criteria in prediction of hepatocellular carcinoma progression and waitlist dropout(2022) Piñero, Federico; Thompson, Marcos; Boin, Ilka; Chagas, Aline; Quiñonez, Emilio; Bermúdez, Carla; Vilatobá, Mario; Santos, Luisa; Anders, Margarita; Hoyos , Sergio; Soares, Agnaldo; Menendez, Josemaría; Padilla, Martín; Poniachik, Jaime; Zapata, Rodrigo; Maraschio, Martín; Chong, Ricardo; Muñoz, Linda; Arufe, Diego; Figueroa, Rodrigo; Perales, Simone; Maccali, Claudia; Vergara, Rodrigo; McCormack, Lucas; Varón, Adriana; Marciano, Sebastián; Mattera, Juan; Carrilho, Flair; Silva, MarceloBackground & aim: Liver transplantation (LT) selection models for hepatocellular carcinoma (HCC) have not been proposed to predict waitlist dropout because of tumour progression. The aim of this study was to compare the alpha-foetoprotein (AFP) model and other pre-LT models in their prediction of HCC dropout. Methods: A multicentre cohort study was conducted in 20 Latin American transplant centres, including 994 listed patients for LT with HCC from 2012 to 2018. Longitudinal tumour characteristics, and patterns of progression were recorded at time of listing, after treatments and at last follow-up over the waitlist period. Competing risk regression models were performed, and model's discrimination was compared estimating Harrell's adapted c-statistics. Results: HCC dropout rate was significantly higher in patients beyond (24% [95% CI 16-28]) compared to those within Milan criteria (8% [95% IC 5%-12%]; p < .0001), with a SHR of 3.01 [95% CI 2.03-4.47]), adjusted for waiting list time and bridging therapies (c-index 0.63 [95% CI 0.57; 0.69). HCC dropout rates were higher in patients with AFP scores >2 (adjusted SHR of 3.17 [CI 2.13-4.71]), c-index of 0.71 (95% CI 0.65-0.77; p = .09 vs Milan). Similar discrimination power for HCC dropout was observed between the AFP score and the Metroticket 2.0 model. In patients within Milan, an AFP score >2 points discriminated two populations with a higher risk of HCC dropout (SHR 1.68 [95% CI 1.08-2.61]). Conclusions: Pre-transplant selection models similarly predicted HCC dropout. However, the AFP model can discriminate a higher risk of dropout among patients within Milan criteria.Publication Population attributable fraction of modifiable risk factors for dementia in Chile(2022) Vergara, Rodrigo; Zitko, Pedro; Slachevsky, Andrea; San Martin, Consuelo; Delgado, CarolinaIntroduction: Projected dementia incidence in Latin America and the Caribbean for the next decades is overwhelming. Access to local data, stratified by sex, is imperative for planning precise dementia-prevention strategies. Methods: We analyzed the individual and overall weighted population attributable fraction (PAF) of nine modifiable risk factors for dementia, in dementia-free subjects ≥45-years-old, using the 2016-2017 Chilean National Health Survey. Results: The overall weighted PAF for modifiable risk factors was 45.8% (42.2% to 49.3%). Variables with the highest PAF were lower education, high blood pressure, hearing loss, and obesity. Women showed a greater overall weighted PAF: 50.7% (45.3% to -56.1%), compared to men: 40.2% (35.4% to 45.0%), driven by a higher PAF for physical inactivity and depression in women. Discussion: The PAF for modifiable risk factors for dementia in Chile is higher than in previous world reports, due to a greater prevalence of cardiovascular risk factors. Women have a higher potential for dementia prevention. Highlights: The proportion of dementia associated to modifiable risk factors in Chile is 45.8%.The main modifiable risk factors are high blood pressure, obesity, and hearing loss.Women had a greater prevalence of physical inactivity and depression than men.Chile had a greater prevalence of metabolic risk factors than other world regions.Publication Sofrimento moral em residentes de medicina de universidades chilenas(2025) Jofré, Pamela; Vergara, Rodrigo; Suau , Thelma; Bastidas, Jaime; De la Barra, Diego; Salas Ibarra, Sofía PatriciaResumo O sofrimento moral, definido como o sofrimento que uma pessoa experimenta quando é obrigada a executar ações ou omissões que contradizem seus valores, tem sido descrito em todas as profissões da área da saúde e na formação delas, associando-se a consequências como despersonalização nos cuidados, baixa motivação no trabalho, questionamento vocacional e vínculo com o burnout. No Chile, tem sido pouco estudado e menos ainda em estudantes de medicina. Foi realizado um estudo observacional, descritivo e misto com internos de medicina de quatro universidades chilenas, por meio de um questionário distribuído eletronicamente, para conhecer sua frequência e principais fatores desencadeantes. Participaram 56 estudantes. Os resultados expressam a presença transversal de sofrimento moral nos estudantes das universidades exploradas. Destaca-se como principal fonte a dificuldade em obter o consentimento informado dos pacientes. Os resultados fornecem conhecimento útil para projetar programas educativos que abordem o sofrimento moral e suas principais fontes associadas. Abstract Moral distress, defined as the suffering a person experiences when forced to actions or omissions that contradict their values, has been described in all medical professions and related training, associated with consequences such as depersonalization in care, low motivation at work, vocational questioning, and in connection with burnout. In Chile, moral distress has been scarcely researched, and even less in medical students. This is an observational, descriptive and mixed research with medical residents from four universities in Chile using an electronically distributed questionnaire to study its frequency and main triggering factors. Participants included 56 students. The results show transversal occurrence of moral distress in students from the researched universities. The difficulty in obtaining informed consent from patients is noted as the main moral distress source. The results provide useful knowledge for designing educational programs that address moral distress and its main associated sources. Resumen La angustia moral, definida como el sufrimiento que experimenta una persona cuando se ve obligada a ejecutar acciones u omisiones que contradicen sus valores, ha sido descrita en todas las profesiones sanitarias y también en la formación de ellas, asociándose a consecuencias como despersonalización en los cuidados, baja motivación laboral, cuestionamiento vocacional y vinculación al burnout. En Chile, ha sido poco estudiada y menos aún en estudiantes de medicina. Se realizó un estudio observacional, descriptivo y mixto en internos de medicina de 4 universidades chilenas, mediante un cuestionario distribuido electrónicamente, para conocer su frecuencia y principales factores desencadenantes. Participaron 56 estudiantes. Los resultados expresan la presencia transversal de angustia moral en los estudiantes de las universidades exploradas. Destaca como fuente principal la dificultad en obtener el consentimiento informado de los pacientes. Los resultados aportan conocimiento útil para diseñar programas educativos que aborden la angustia moral y sus principales fuentes asociadas.