Artículos Medicina y Ciencias de la Salud

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Competencias digitales en la formación de profesionales de enfermería: reflexiones sobre modelos teóricos, integración y desafíos
(2025) Contreras, Jorge; Pérez, Claudia
INTRODUCCIÓN. En los últimos años, la educación superior ha atravesado un proceso de transformación acelerado por la integración de competencias digitales, fundamentales en la formación docente. Estas competencias resultan clave tanto para la enseñanza general como para la preparación efectiva de los futuros profesionales de enfermería para desempeñarse en entornos clínicos cada vez más digitalizados. Este artículo presenta un ensayo teórico reflexivo, basado en una revisión conceptual de marcos teóricos. OBJETIVO. analizar las competencias digitales en el ámbito universitario, identificar los modelos que las sustentan y discutir su aplicación en contextos educativos actuales. MÉTODO. Se exploran modelos teóricos, como Krumsvik, Pozos, TPACK y DigCompEdu, que ofrecen perspectivas sobre cómo las competencias digitales pueden integrarse eficazmente en la educación superior. Se discuten las fortalezas y limitaciones de estos modelos. Finalmente, se propone un esquema teórico basado en tres bucles dinámicos: didáctico, curricular y metodológico, para facilitar la integración efectiva de las competencias digitales en la enseñanza. CONCLUSIÓN: En el ámbito de la enfermería, estas competencias son clave para preparar a los futuros profesionales para un entorno clínico altamente tecnificado, mejorando tanto la calidad de la enseñanza como el cuidado de los pacientes. INTRODUCTION. In recent years, higher education has undergone a rapid transformation driven by the integration of digital competencies, which are essential in teacher training. These skills are key not only for general teaching but also for the effective preparation of future nursing professionals to work in increasingly digitalized clinical environments. This article presents a reflective theoretical essay based on a conceptual review of theoretical frameworks. OBJECTIVE. To analyze digital competencies in the university context, identify the models that support them, and discuss their application in current educational settings. METHOD. Theoretical models such as Krumsvik, Pozos, TPACK, and DigCompEdu are explored, offering insights into how digital competencies can be effectively integrated into higher education. The strengths and limitations of these models are discussed. Finally, a theoretical framework is proposed based on three dynamic loops—didactic, curricular, and methodological—to facilitate the effective integration of digital competencies into teaching. CONCLUSION. In the field of nursing, these competencies are essential for preparing future professionals for highly technological clinical environments, thereby enhancing both the quality of teaching and patient care.
Unmet supportive care needs of young women with breast cancer in Chile during follow-up stage after treatment: A qualitative study
(2025) Vezzani, Francisca; Cabieses, Báltica; Obach, Alexandra; Torrealba, Sonia; Carvajal, Iderta
Background: Breast cancer is a significant public health issue, with a rising incidence in young women who have more aggressive tumors and a poorer prognosis. In 2022, breast cancer accounted for 20.8% of all cancers in women in Chile, highlighting the urgent need for targeted research and support for young survivors. This study aims to explore the unmet supportive care needs of these young women during their follow-up period post-treatment, addressing gaps in existing literature and healthcare responses. Methods: Qualitative case study using semi-structured online interviews with 20 women who had a cancer diagnosis under 45 years of age. A thematic content analysis was conducted. Study approved by the Scientific Ethics Committee of the Universidad del Desarrollo, Chile. Results: Three primary areas of concern and unmet supportive care needs were identified during follow-up period: access to information, rehabilitation and integration, and mental health. These areas are deeply interconnected, and the absence of validation of these young women's needs leads to a lack of adequate and comprehensive support from health professionals, deepening women's sense of abandonment by the health system. Discussion and conclusion: The findings align with international literature, revealing that young women face unique challenges related to their life course. The lack of adequate support from healthcare professionals highlights the need for a multidisciplinary, person- and family-centred approach to care. It should address interlinked needs and advocate the involvement of patient organisations. This would enhance support and education regarding the needs of young women and their overall well-being during recovery process.
Global health education programs: Are we embedding contemporary global health needs into the curriculum of master's programs?
(2026) Singh, Samraj; Roberts, Antonia; Cabieses, Báltica; Mezones, Edward; Al-Kassab, Ali; Espinoza, Manuel
Introduction: Global health education (GHE) is expected to prepare professionals to address complex, interlinked global challenges. However, current GHE structures often reflect persistent power asymmetries between the Global North and South, limiting the development of a truly global and equitable health workforce. This review examines how global health master's programs are distributed geographically and to what extent their thematic focus and core curricular content reflect current global health priorities, particularly those related to equity and social justice. Methods: A mapping review of 86 graduate-level GHE programs worldwide was conducted to examine their geographic distribution, thematic focus, and curricular content. Programs were categorized by region and analyzed for thematic emphasis and pedagogical approaches, based on publicly available information on modules and learning activities. Results: The review found that 84% of GHE programs are offered by institutions in the Global North. Programs in the Global South are fewer but tend to emphasize environmental health, governance, and community engagement, often incorporating experiential learning. Across all regions, key topics such as health systems, global health challenges, sustainability, law, ethics, and human rights are unevenly integrated. This variability risks producing graduates with inconsistent competencies to address global health priorities. The dominance of Global North institutions in GHE reflects broader structural inequities in global health. While emerging North-South and South-South collaborations and field-based learning suggest a shift toward more reciprocal models, many programs lack clearly defined aims and accountability frameworks. Discussion: To advance GHE, curricula must embed equity, interdisciplinarity, and regional relevance. Explicit learning outcomes should include power analysis and partnership-building, co-designed and co-delivered with institutions and communities from both the Global North and South. Such reforms are essential to cultivate a workforce capable of addressing global health challenges with contextual sensitivity and systemic insight.
"Le quita el pecho a su hijo y se va a trabajar”: estereotipos de indianidad y violencias históricas en la percepción de equipos de salud sobre la maternidad de migrantes bolivianas en Chile
(2026) Carreño Calderón, Alejandra; Murray, Marjorie
Background: The presence of adolescents in migration flows through Latin America and Caribbean (LAC) has increased in recent years. Adolescents are usually considered healthy due to their low mortality rates compared to the general population. However, existing research shows that adolescence is a phase of life in which mental health, sexual and reproductive health and other needs may increase. Migration, as a social determinant of health, can lead to experiencing compounded vulnerabilities among adolescent migrants, especially those already living in disadvantaged conditions. Objective: aims to estimate and compare social inequalities in health faced by adolescent migrants from LAC living in Chile versus locals, as well as to unveil perceptions and experiences related to additional barriers to accessing to healthcare in the country. Method: A mixed methods study was designed to socially and epidemiologically characterise the adolescent migrant population in Chile. First, two population-based surveys (CENSO 2017; CASEN 2022; REM 2021 and EH 2021) and national epidemiological records were analysed. Second, perceptions and experiences of accessing primary healthcare services were explored through 42 in-depth interviews with healthcare teams (n = 18) and parents of adolescent migrants (n = 24). Quantitative and qualitative data were analysed separately and then integrated to identify the main findings. The study was approved by the Ethics Committee of the Universidad del Desarrollo. Results: The study identified social inequalities negatively affecting adolescent migrant compared with their Chilean peers, including lower access to education, housing and higher chances of having to work. Regarding health, sexual and reproductive needs and experiences are identified, including adolescent pregnancy. Barriers to access to primary healthcare programmes dedicated to adolescent health, which are little known and underused by the migrant population, were also identified. Conclusions: Adolescent migrants in Chile face important social inequalities in health compared to locals and additional barriers to exercise their right to health, putting their current and future health at risk. Priority actions are needed for this specific group, and must focus on increasing the acceptability and coverage of preventive care, as well as strengthening their participation in the social and health decisions affecting them.
Addressing health inequalities and barriers to access among adolescent migrants in Chile: a mixed methods study
(2025) Carreño Calderón, Alejandra; Obach, Alexandra; Cabieses, Báltica; Oyarte, Marcela; Arias, Alicia
Background: The presence of adolescents in migration flows through Latin America and Caribbean (LAC) has increased in recent years. Adolescents are usually considered healthy due to their low mortality rates compared to the general population. However, existing research shows that adolescence is a phase of life in which mental health, sexual and reproductive health and other needs may increase. Migration, as a social determinant of health, can lead to experiencing compounded vulnerabilities among adolescent migrants, especially those already living in disadvantaged conditions. Objective: aims to estimate and compare social inequalities in health faced by adolescent migrants from LAC living in Chile versus locals, as well as to unveil perceptions and experiences related to additional barriers to accessing to healthcare in the country. Method: A mixed methods study was designed to socially and epidemiologically characterise the adolescent migrant population in Chile. First, two population-based surveys (CENSO 2017; CASEN 2022; REM 2021 and EH 2021) and national epidemiological records were analysed. Second, perceptions and experiences of accessing primary healthcare services were explored through 42 in-depth interviews with healthcare teams (n = 18) and parents of adolescent migrants (n = 24). Quantitative and qualitative data were analysed separately and then integrated to identify the main findings. The study was approved by the Ethics Committee of the Universidad del Desarrollo. Results: The study identified social inequalities negatively affecting adolescent migrant compared with their Chilean peers, including lower access to education, housing and higher chances of having to work. Regarding health, sexual and reproductive needs and experiences are identified, including adolescent pregnancy. Barriers to access to primary healthcare programmes dedicated to adolescent health, which are little known and underused by the migrant population, were also identified. Conclusions: Adolescent migrants in Chile face important social inequalities in health compared to locals and additional barriers to exercise their right to health, putting their current and future health at risk. Priority actions are needed for this specific group, and must focus on increasing the acceptability and coverage of preventive care, as well as strengthening their participation in the social and health decisions affecting them.
Mental health and the healthy immigrant effect in Chile: a comparative cross-sectional study with international migrants and locals
(2025) Blukacz, Alice; Oyarte, Marcela; Cabieses, Báltica; Madrid, Paula; Obach, Alexandra
Introduction: The question of whether international migrants appear to be in better health than the locals, and whether this "healthy immigrant effect" declines over time is a highly relevant one, especially with regards to mental health. Based on a community-based survey conducted in Santiago, Chile, this study compares the mental health outcomes of international migrants versus local populations and examines differences within the international migrant group of respondents. Methods: Observational cross-sectional study. Data was collected with international migrants and Chilean participants in 2021-2022 through a structured questionnaire. The study examined self-reported stress and mood disorders in relation to demographic, socioeconomic, health, and migration-related factors. Descriptive analyses were conducted for all variables overall and stratified by perceived stress, mood disorders, and migration status. Associations were assessed using Chi-square or Fisher's exact tests, with Cramer's V used to evaluate effect size. Multiple imputation (m = 5) addressed missing data using the mice package in R, followed by generalised logistic regression models fitted across imputed datasets and combined using Rubin's rules; stepwise selection based on AIC was used for variable reduction, and models were run for the full sample and separately for the migrant population. Results: The sample included 1,656 international migrants and 1,664 locals. Being a migrant was negatively associated with reporting stress and mood disorders in all analyses. Among migrants, the main risk factors for stress were perceiving a high number of migrants in the neighbourhood and having experienced abuse as a migrant and for mood disorders the main risk factor was reporting having experienced abuse as a migrant as well as a longer stay in Chile. Discussion: We found a healthy immigrant effect for mental health among international migrants in Chile, which declined over time in the case of mood disorders. Chilean participants reported very high levels of mental health issues, consistent with existing studies. However, results for international migrants highlight both risk and protective factors linked to migration processes, which are unique to them, warranting a specific approach to their mental health needs.
Desigualdades en salud en Chile post COVID-19: adscripción y acceso efectivo según sexo y condición migrante
(2025) Nuñez, Marilaura; Delgado, Iris; Matute, María Isabel; Cabieses, Báltica; Munoz Venturelli, Paula
Introducción: En 2022, tras la pandemia de COVID-19, aproximadamente el 93% de los países de la Región de las Américas continuaron reportando interrupciones en los servicios esenciales de salud, con peores resultados en los grupos sociales vulnerables. El presente estudio busca describir las barreras de acceso a la atención médica en Chile, desagregadas por sexo y condición de migrante internacional. Métodos: Estudio transversal que analizó los resultados de la encuesta CASEN 2022 a personas ≥18 años. Se calculó la adscripción, el acceso efectivo y las barreras de salud según la condición de migrante internacional y el sexo. Se realizaron modelos de regresión logística múltiple ajustando por edad, ruralidad, nivel educativo, ocupación y quintil de ingresos. El modelo se expresó como Odds Ratio ajustado (ORadj) con un intervalo de confianza del 95% en STATA v.18.5. Resultados: En Chile, en el año 2022, un total de 14.767.688 personas participaron en este estudio, con una edad media de 45,4 años (DE: 17,8), de las cuales el 51,2% eran mujeres y el 9,27% migrantes. En cuanto al seguro de salud, el 3,11% de la población no estaba afiliada al sistema de salud, siendo los hombres (ORadj: 0,6; IC 95%: 0,54-0,68) y los inmigrantes (ORadj: 10,3; 8,78-12,15) los grupos más afectados. En cuanto al acceso efectivo, el 17,4% tenía necesidades de salud, con predominio del sexo femenino (ORadj: 1,3; IC 95%: 1,21-1,32). Sin embargo, de quienes tenían necesidades y las expresaron, el 39,2% expresó necesidades no satisfechas, con mayor probabilidad de mostrarlo en mujeres (ORadj: 1,2; IC 95%: 1,10-1,27). Conclusiones: En Chile, la cobertura del sistema de salud sigue siendo un desafío para los hombres y la población migrante. Observamos con preocupación los altos porcentajes de necesidades de salud insatisfechas, especialmente entre las mujeres. La intersección del sexo y la migración internacional revela una doble vulnerabilidad en el acceso a la atención médica que justifica un estudio más profundo.
Exploring the characteristics of cancer-centred civil society organisations in Chile: A qualitative study
(2025) Roberts, Antonia; Vezzani, Francisca; Cabieses, Báltica; Obach, Alexandra; Campaña, Carla; Espinoza, Manuel
Background: In Chile, civil society organisations in health have been historically active in population health and specifically in cancer; they have had an important role in addressing patients' and families' necessities. Although they occupy a central role, there is no clarity about who they are, how they are organised, the goals that guide their performance and how they materialize social participation in health. Based on that, this study aimed to explore the characteristics of civil society organisations that work in cancer in Chile and to identify the networks they build with other actors to achieve their goals. Materials and methods: Qualitative case study using semi-structured online interviews with organisation representatives, politicians, decision-makers and academics related to cancer in Chile. Content analysis was performed, admitting emerging categories from the participants' narratives. Results: Three main profiles of organisations were identified: (i) Long-established organisations focused on influencing public policy and decision-making in cancer, (ii) Growing organisations focused on informing and supporting families and patients, (iii) Newly established organisations focused on patient well-being, such as sports activities. Relationships between groups and other actors involve perceived benefits like the growth of the organisations and funding for activities. However, perceived barriers and inequities are also identified, mainly lack of financial resources, competition between organisations and insufficient information. Discussion: The objectives of civil society organisations in cancer are diverse and reflect multiple ways of practising social participation in health. Tensions generate unequal participation and missed opportunities to promote public health in cancer in Chile. The study highlights the importance of recognising cancer social organisations as essential actors in public health. It is crucial to involve them in formulating and implementing comprehensive responses to maximise the opportunities for progress in this field.
Barriers to accessing formal cancer care from the perspective of informal caregivers: a qualitative study
(2025) Campaña, Carla; Cabieses, Báltica; Obach, Alexandra; Vezzani, Francisca; Estay, Angela; Carrillo, Diego
Background: Cancer is a significant public health concern in Chile, with breast and lung cancers being among the most common and deadly types. Informal caregivers provide essential healthcare procedures and physical, emotional, and financial support to cancer patients, taking on significant responsibilities they must balance with their lives. Many of these responsibilities are directly related to healthcare and patient care processes, so the healthcare system is critical to the caregiver's experience. This study aims to identify health system barriers in the healthcare of lung and breast cancer patients through the voice of informal caregivers in Chile. Methods: An exploratory qualitative case study design was used, following the COREQ criteria. Twenty informal caregivers of adult breast and lung cancer patients were recruited from different regions of Chile through snowball sampling and online outreach. Semi-structured interviews were conducted between March and June 2023. Data were analyzed using deductive thematic analysis guided by Tanahashi's effective coverage framework, which focuses on four dimensions of healthcare access: availability, accessibility, acceptability, and contact. Atlas.ti software was used for coding and thematic organization. Results: Caregivers reported significant barriers across the four dimensions: (i) availability, lack of medical equipment and home care resources, especially in public hospitals; (ii) accessibility, long wait times, fragmented care across institutions, and high out-of-pocket costs, particularly for those outside the public health insurance (FONASA) coverage; (iii) acceptability, inadequate communication from healthcare providers, with limited information on diagnosis and prognosis; (iv) contact, poor continuity of care, with a lack of coordination between healthcare providers, leading to feelings of isolation and frustration among caregivers. Conclusions: The study reveals critical gaps in Chile's healthcare system. Caregivers play an essential role in patient care but receive insufficient support from the healthcare system. Addressing the identified barriers, including improving communication, coordination, and support for caregivers, is crucial for achieving better healthcare outcomes and reducing disparities in cancer care. These findings have significant implications for policymakers, highlighting the need for reforms to support caregivers and enhance the cancer care continuum in Chile.
Unmet needs and new challenges in young women's sexual and reproductive health and rights: a qualitative study in Chile's Metropolitan Region
(2025) Obach, Alexandra; Sadler, Michelle; Robledo, Consuelo; Wright, Ciara; Cabieses, Báltica
In Chile, despite important advances in access to contraception and a steady reduction in unplanned pregnancy, longstanding barriers for young people to access sexual and reproductive health (SRH) and rights - rooted in a conservative and religious background - have been highlighted by recent socio-political movements, including the feminist student wave of 2018 and the social uprising of 2019. The COVID-19 pandemic further strained access, leading to the suspension of many in-person services. In this context, we conducted a qualitative study between 2020 and 2023 to explore young women's perceptions of sexuality and SRH, their interactions with the formal healthcare system, and the diverse resources they engage with to access support and care. 23 in-depth interviews were carried out with heterosexual and non-heterosexual women aged 18-25 in Chile's Metropolitan Region. The findings reveal a mismatch between young women's holistic understanding of sexuality - which includes emotional, biological, and political dimensions - and the healthcare system's reductionist, heteronormative, and risk-based approach, which became more visible after these societal upheavals. As a result, young women may use biomedical SRH services strategically for prescriptions and testing, while seeking more comprehensive support outside the formal system through virtual platforms, health professionals giving online support, and civil society organisations. The study concludes that systemic changes in the health system are needed to bridge these divides and uphold the sexual and reproductive rights of young women in Chile, especially those who identify as non-heterosexual.
Ethnic disparities in the association between maternal socioeconomic status and childhood anemia in Peru: a nationwide multiyear cross-sectional study
(2025) Al-kassab-Córdova, Ali; Intimayta, Claudio; Robles, Pamela; Urrunaga, Diego; Cabieses, Báltica
Background: Maternal socioeconomic status (SES) is closely linked to children's health outcomes. However, the marginalization-related diminished returns theory suggests that increases in SES yield smaller health gains for marginalized populations-such as Afro-Peruvian and Indigenous groups-compared to majority groups like Mestizos, largely due to systemic barriers and social disadvantage. Therefore, the current study aimed to explore ethnic disparities in the association between maternal SES on childhood anemia in Peru. Methods: Using data from the 2017 to 2023 Peruvian Demographic and Health Survey, we conducted a cross-sectional study including children aged 6-59 months with their respective mothers. Ethnicity was grouped into Mestizo, Afro-Peruvian, and Indigenous (Quechua, Aimara, and native of the Amazon). Three proxies of SES were used: wealth index, level of education, and years of education. After stratifying by ethnicity, we estimated prevalence ratios (PR) with their respective 95% confidence intervals (95% CI) using generalized linear models with Poisson family. Interaction was assessed on multiplicative and additive scales. Findings: Among 234,364 Peruvian mothers, 45.7% (n = 107,118) identified as Mestizo, 12.6% (n = 29,557) as Afro-Peruvian, and 41.7% (n = 97,689) as Indigenous. The overall prevalence of anemia in children was 32.2%. The association between a very rich wealth index and lower prevalence of anemia was weaker among Indigenous (PR = 0.63, 95% CI: 0.56-0.72) compared to Mestizo individuals (PR = 0.46, 95% CI: 0.42-0.50). Similarly, the association between higher maternal education and lower anemia prevalence was less pronounced for Afro-Peruvian (PR = 0.70, 95% CI: 0.62-0.79) and Indigenous groups (PR = 0.81, 95% CI: 0.77-0.86) than for Mestizos (PR = 0.63, 95%CI: 0.59-0.67). A similar pattern was noted with maternal years of education (Mestizos [PR = 0.95, 95% CI: 0.94-0.96], Afro-Peruvian [PR = 0.97, 95% CI: 0.96-0.98], and Indigenous [PR = 0.98, 95% CI: 0.98-0.99]). Interaction analysis confirmed significantly weaker associations for Afro-Peruvian and Indigenous individuals compared to Mestizos. Interpretation: Maternal SES is associated with lower prevalence of childhood anemia, with stronger associations observed among Mestizo populations compared to Afro-Peruvian and Indigenous groups. This pattern aligns with the marginalization-related diminished returns theory. Maximizing SES alone does not preclude ethnic disparities but rather, may even widen them, highlighting the need for equity-focused interventions that address underlying structural and systemic barriers. Funding: Self-funded.
Multimorbidity profile among cancer-related hospitalization events in younger and older patients: a large-scale nationwide cross-sectional study
(2025) Bernal, Yanara; Campaña, Carla; Sanhueza, Cristobal; Apablaza, Mauricio; Armisen, Ricardo; Delgado, Iris
Background Multimorbidity, the coexistence of two or more chronic diseases, among cancer patients offers critical insights into shared risk factors, while posing increasing challenges for healthcare systems due to the complexity of care required. Despite its relevance, research in multimorbidity across different age groups is limited in middle income countries. Methods We analyzed cancer-related hospitalizations between 2019 and 2023, using a nationwide Diagnosis-Related Groups database covering 68 Chilean health institutions. We examined the distribution of 40 chronic conditions, multimorbidity prevalence, comorbidity profile, and their distribution across age group, sex, and cancer diagnosis. Findings We identified 4,722,723 hospitalization events, including 149,270 unique adult patients hospitalized with cancer (mean of 63 ± 15.17 years old). Multimorbidity was present in 47.9% of all cancer-related hospitalizations, increasing steeply with age: 14% in patients aged 18–35, 24.9% in those 36–50, and 55.5% in patients >50 years. Obesity and diabetes were among the most common comorbid conditions across age groups, with significant variations by sex. Notably, obesity was more prevalent in younger patients, particularly those aged 18–35, whereas hypertension showed an inverse profile, increasing markedly with age. Interpretation Multimorbidity profile reflect both the clinical complexity of cancer care and potential shared biological and environmental pathways in carcinogenesis. These findings highlight the need to transition from diseasecentered to person-centered care models. In Chile, understanding multimorbidity in younger and middle-aged adults may inform precision prevention, integrated service delivery, and equitable planning for both oncologic and non-oncologic care. Funding This study was conducted without external funding.
The mutational landscape and actionable targets of gallbladder cancer: an ancestry-informed and comparative analysis of a Chilean population
(2025) Erices, José; González, Evelin; Salgado, Marcela; Barahona, Carol; Freire, Matías; Sepúlveda, Gonzalo; Ampuero, Diego; Blanco, Alejandro; Gárate, Valentina; Báez, Pablo; Tapia, Camilo; Toro, Jessica; Gallegos, Iván; Barajas, Olga; Ahumada, Mónica; Sanhueza, Verónica; Spencer, Loreto; De Toro, Gonzalo; Morales, Erik; Gutiérrez, Lorena; Morales, Fernanda; Marin, Arnaldo; Varela, Nelson; Bermejo, Justo; Armisen, Ricardo; Marcelain, Katherine
Introduction: Gallbladder cancer (GBC) is a highly aggressive malignancy with one of the highest incidence rates reported in Chile. Despite its clinical impact, molecular characterization of GBC in Latin American populations remains limited, and the absence of effective targeted therapies underscores the urgent need for new therapeutic strategies. Methods: We collected 118 tumor samples, of which 56 passed sequencing quality control using the Oncomine™ Comprehensive Assay v1. Somatic variants were identified with ANNOVAR and Cancer Genome Interpreter, and ancestry was inferred using ADMIXTURE and PCA with ancestry-informative markers. Comparative analyses were performed with Japanese, Singaporean, and U.S. cohorts. Results: A total of 535 somatic mutations were detected in 43 genes, with TP53 (30%), TSC2 (29%), and NOTCH1 (27%) being the most frequently mutated. We identified 121 clinically actionable variants in ATM, BRCA1/2, EGFR, ERBB2, and other genes. Exploratory analysis suggested an association between higher Mapuche ancestry and TP53 mutations. Comparative analyses revealed distinct mutational patterns in the Chilean cohort relative to Asian and U.S. datasets. Conclusion: This ancestry-informed genomic analysis provides the first comprehensive landscape of Chilean GBC, identifying actionable alterations with potential therapeutic relevance and supporting the development of population-specific precision oncology strategies.
Avibactam–Cyclodextrin Inclusion Complexes: Computational and Thermodynamic Insights for Drug Delivery, Detection, and Environmental Scavenging
(2025) Alcázar, Jackson; Campodónico, Paola; López, René
The escalating crisis of multidrug resistance, together with the persistence of antibiotic residues in clinical and environmental matrices, demands integrated strategies that couple sensitive detection, efficient decontamination, and controlled delivery. However, current techniques for quantifying avibactam (AVI)—a broad-spectrum β-lactamase inhibitor— such as HPLC-UV lack the sensitivity and specificity required for both therapeutic drug monitoring and environmental surveillance. Encapsulation of AVI within cyclodextrins (CDs) may simultaneously enhance its stability, bioavailability, and detectability, while the high binding affinities of CDs position them as molecular traps capable of scavenging residual AVI. In this study, the inclusion complexation of AVI with various CDs was examined through molecular dynamics (MD) simulations, experimental isothermal titration calorimetry (ITC), and non-covalent interaction (NCI) analysis. Stable 1:1 inclusion complexes were observed between AVI and β-cyclodextrin (β-CD), 2,6-dimethyl-β-cyclodextrin (DM-βCD), and 2-hydroxypropyl-β-cyclodextrin (HP-β-CD), with standard Gibbs free energies of binding (∆G◦) of –3.64, –3.24, and –3.11 kcal/mol, respectively. In contrast, γ-cyclodextrin (γ-CD) exhibited significantly weaker binding (∆G◦ = –2.25 kcal/mol). DFT-based NCI analysis revealed that cooperative interaction topology and cavity complementarity, rather than the sheer number of localized contacts, govern complex stability. Combined computational and experimental data establish β-CD derivatives as effective supramolecular hosts for AVI, despite an entropic penalty in the DM-β-CD/AVI complex. These CD–AVI affinities support the development of improved analytical methodologies and pharmaceutical formulations, and they also open avenues for decontamination strategies based on molecular trapping of AVI.
Comparando la percepción de ambientes alimentarios entre barrios de distinto nivel socioeconómico en Santiago, Chile: un estudio transversal
(2024) Egaña, Daniel; Gálvez, Patricia; Rodríguez, Lorena; Villegas, Rodrigo; Castillo, Bárbara; Molina, Paulina
En las últimas décadas, se ha relevado la importancia de actuar en factores contextuales de la obesidad, entre ellos, los ambientes alimentarios. Recientemente, en Chile se validó la Encuesta de Medida del Entorno Nutricional Percibido, NEMS-P-Ch. Sin embargo, no existen investigaciones que hayan evaluado la percepción del grado de obesogenicidad/saludable de estos ambientes y se desconoce si difieren entre hogares de distinto nivel socioeconómico (NSE). El objetivo de este estudio es comparar la percepción sobre los ambientes alimentarios entre hogares de barrios de alto y bajo NSE de Santiago, Chile. Estudio transversal, mediante muestreo aleatorio sistemático de hogares. Se aplicó NEMS-P-Ch a 256 hogares (128 de cada comuna). Su aplicación entrega un puntaje global y puntajes asociados a la percepción de cada ambiente. Personas de la comuna de alto NSE presentan mayor ingreso familiar mensual, mayor proporción de personas con educación superior completa y menor número de habitantes en el hogar, respecto a la comuna de bajo NSE. Al comparar el puntaje global, participantes de la comuna de NSE alto perciben el entorno alimentario más salu dable que habitantes de menor NSE y hay diferencias significativas en tres de cuatro ambientes evaluados (doméstico, abastecimiento y vía pública). Mientras la mayoría de los ambientes se perciben como pantanos alimentarios, el ambiente doméstico se percibe más saludable en ambas comunas, asimilable a la idea de oasis alimentario. Estos resultados deberían movilizar acciones nacionales y locales para mejorar la disponibilidad y acceso a alimentos saludables, especialmente en barrios de menor NSE, que perciben sus ambientes alimentarios más obesogénicos.
Torsión lingular espontánea como causa rara de dolor torácico de manejo quirúrgico: Reporte de un caso
(2024) Berrios C., Nicolás; Ortega S., José; Paz A., Sebastián
Objetivo: Describir un caso extremadamente raro de torsión pulmonar espontánea en una paciente sin antecedentes de trauma o cirugía torácica, y discutir su importancia clínica. Materiales y Métodos: Se analizó el caso de una paciente femenina de 56 años que presentó dolor torácico súbito. Para el diagnós tico, se emplearon métodos como el examen físico, la tomografía computarizada y la videotoracoscopia (VTC). Resultados: La VTC reveló un infarto del segmento lingular inferior por torsión pulmonar, llevan do a la realización de una resección segmentaria de la língula sin complicaciones. Discusión: La torsión pulmonar espontánea es rara y generalmente se asocia con condiciones subyacentes como neumotórax, atelectasias, infecciones, derrame pleural, defectos congénitos o tumores. Este caso es inusual al carecer de dichos antecedentes, aunque se detectó una infección viral concomitante. Dada la gravedad de las po tenciales complicaciones mortales, resulta crucial un diagnóstico y tratamiento oportunos. Conclusión: Se presenta un caso inusual de torsión pulmonar espontánea. A pesar de su rareza, es vital considerarlo en el diagnóstico diferencial de dolor torácico agudo.
Factors associated with loneliness in Latin-American family care partners during the COVID-19 pandemic
(2024) Leon, Tomas; Tapia-Munoz, Thamara; Slachevsky Chonchol, Andrea; Costa Beber, Bárbara; Aguzzoli, Fernando; Nubia, Carla; Vilar-Compte, Mireya; Gaitan-Rossi, Pablo; Olavarria, Loreto; Castro, Loreto; Pinto, Alejandra; Guajardo, Tania; Grycuk, Emilia; Chen, Yaohua; Iracema Leroi, Iracema; Lawlor, Brian; Duran-Aniotz, Claudia; O’ Sullivan, Roger; Miranda-Castillo, Claudia; International Working Group
Background: COVID-19-related restrictions led to an increase in overall loneliness and social isolation. Before the pandemic, care partners reported higher levels of loneliness and higher loneliness prevalence compared to non-care partners. Because of the spread and severity of the infections, and the access to support spread, we expect a different impact of the COVID-19 pandemic on LATAM care partners. Objectives: To describe the loneliness levels of LATAM caregivers and to identify socioeconomic and health factors associated. Design: An international online cross-sectional survey for care partners, embedded within the ‘Coping with Loneliness and Isolation during COVID-19’ (CLIC) Study conducted between June 2020– and November 2020. Setting: We analysed data from 246 family care partners living in Latin American countries (46% Mexico, 26% Chile,18% Brazil, and 10% from Argentina, Peru, Venezuela, Panama, Guatemala y Costa Rica). Measurements: We assessed loneliness using the 6-items of De Jong Gierveld loneliness Scale. We described the levels of overall, emotional, and social loneliness pre and during Covid, and reported the distribution of care partners who improved, worsened or maintained their levels of loneliness. Moreover, we used longitudinal multiple linear regression models with bootstraps errors of 1,000 iterations to identify factors associated with the levels of overall, emotional, and social loneliness during the pandemic. Results: Participants were mostly women, 50 years and older, in a partnership, highly educated and with finances meeting their needs, with good to excellent physical and mental health. Among the total of care partners, 55% perceived higher overall loneliness, 56% higher emotional loneliness, and 21% higher social loneliness during the pandemic in comparison with pre-COVID-19 levels. Perceived mental health was associated with the overall, emotional, and social loneliness. Conclusions: Regardless of their living and health situation, during the pandemic, loneliness increased in all groups of care partners. These should be taken in consideration when planning public health approaches for crises such as pandemics or other large-scale disruptive events.
Histiocitosis de Erdheim Chester como desafío diagnóstico ante un cuadro sistémico: reporte de un caso
(2024) García, Dominga; Flores, Yorman; Vergara, Maximiliano; Labarca, Cristian
Las histiocitosis están dadas por células mieloides patogénicas y pueden clasificarse en Langerhans (LCH) y no LCH. En este último grupo se encuentra la enfermedad de Erdheim-Chester (ECD) que se caracteriza por el compromiso multiorgánico, hallazgos imagenológicos frecuentes y estudio histológico confirmatorio. Se presenta un caso con compromiso multiorgánico y confirmación histológica. Caso Clínico: Hombre, 50 años, con cuadro de 18 meses de debilidad muscular proximal simétrica asociada a parámetros inflamatorios elevados, y 6 meses de molestias visuales y exoftalmos. Por imágenes se objetivan masa retro-orbitaria inespecífica y masa fibrótica retroperitoneal con infiltración perivascular, miocárdico, perirrenal y suprarrenal e hipermetabolismo óseo. Se inicia manejo con corticoides sistémicos y se solicita estudio con biopsia de masa retroperitoneal con histiocitos espumosos, positivos para CD68, negativos para CD1a y con estudio positivo para mutación BRAFV600. Se inicia manejo con Vemurafenib con respuesta favorable. Discusión: Existen menos de 500 casos de ECD reportados en la literatura. Su patogenia aún no está clara, pero se han descrito cohortes que evidencian su compromiso multiorgánico, incluyendo compromiso óseo, neurológico, orbitario, retroperitoneal, renal, pulmonar, endocrinológico y cutáneo, entre otros. Existen alteraciones imagenológicas e histológicas típicas que conforman sus criterios diagnósticos, concordantes con los descritos en este paciente. El tratamiento de primera línea es con IFN-alfa que ha demostrado mejorar sobrevida, pero asociado a efectos adversos Como segunda línea se ha propuesto Vemurafenib en casos con mutación BRAFV600 positiva, corticoides, entre otros inmunosupresores, pero se requieren más estudios.
Morphine self-administration is inhibited by the antioxidant N‐acetylcysteine and the anti-inflammatory ibudilast; an effect enhanced by their co-administration
(2024) Quintanilla, María Elena; Morales, Paola; Santapau, Daniela; Gallardo, Javiera; Rebolledo, Rocío; Riveras, Gabriel; Acuña, Tirso; Herrera-Marschitz, Mario; Israel, Yedy; Ezquer, Fernando
Background The treatment of opioid addiction mainly involves the medical administration of methadone or other opioids, aimed at gradually reducing dependence and, consequently, the need for illicit opioid procurement. Thus, initiating opioid maintenance therapy with a lower level of dependence would be advantageous. There is compelling evidence indicating that opioids induce brain oxidative stress and associated glial activation, resulting in the dysregulation of glutamatergic homeostasis, which perpetuates drug intake. The present study aimed to determine whether inhibiting oxidative stress and/or neuroinflammation reduces morphine self-administration in an animal model of opioid dependence. Methods Morphine dependence, assessed as voluntary morphine self-administration, was evaluated in Wistar-derived UChB rats. Following an extended period of morphine self-administration, animals were administered either the antioxidant N-acetylcysteine (NAC; 40 mg/kg/day), the anti-inflammatory ibudilast (7.5 mg/kg/day) or the combination of both agents. Oxidative stress and neuroinflammation were evaluated in the hippocampus, a region involved in drug recall that feeds into the nucleus accumbens, where the levels of the glutamate transporters GLT-1 and xCT were further assessed. Results Daily administration of either NAC or ibudilast led to a mild reduction in voluntary morphine intake, while the co-administration of both therapeutic agents resulted in a marked inhibition (-57%) of morphine self-administration. The administration of NAC or ibudilast markedly reduced both the oxidative stress induced by chronic morphine intake and the activation of microglia and astrocytes in the hippocampus. However, only the combined administration of NAC + ibudilast was able to restore the normal levels of the glutamate transporter GLT-1 in the nucleus accumbens. Conclusion Separate or joint administration of an antioxidant and anti-inflammatory agent reduced voluntary opioid intake, which could have translational value for the treatment of opioid use disorders, particularly in settings where the continued maintenance of oral opioids is a therapeutic option.
Biobanks and data interoperability in Latin America: engendering high-quality evidence for the global research ecosystem
(2024) Valdés Meza, Erick; Lecaros Urzúa, Juan Alberto
Currently, each biobank in Latin America operates with its own set of standards for database creation and management, resulting in a lack of regional and international interoperability. Furthermore, regulations concerning data protection, curation, and the transfer of biological samples and associated data vary significantly from country to country, by complicating efforts to create a unified data-sharing platform. To address these challenges, Latin America should promote the development of an integrated regional network of biobanks to generate high-quality evidence within the global research ecosystem. This initiative will combine regulatory science—focused on interoperability standards across semantic, technical, legal, and organizational dimensions—and meta-science, which assesses the quality of scientific practice. Evidence indicates that harmonized standards in biobanks lead to higher-quality, more reliable data, thereby facilitating the reproducibility of scientific studies. This paper aims to identify and address existing regulatory, policy, and infrastructure gaps in Latin America to establish harmonized interoperability criteria essential for reproducing biomedical studies. Additionally, it seeks to propose minimum standards for regulating biobank networks, which will promote the development of medical products on a global scale, thereby engendering high quality evidence for the global research ecosystem and enhancing Latin America’s integration into it.

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