Artículos Medicina y Ciencias de la Salud

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Therapeutic trajectories of families with rare diseases in Chile from the perspectives of patients, carers, and healthcare workers: a qualitative study
(2025) Cabieses, Báltica; Obach, Alexandra; Roberts, Antonia; Repetto, Gabriela
Background Rare diseases are conditions that have a low prevalence in the population and a high disease burden and are often chronic and progressive. International evidence concerning the experience of people and families living with rare diseases is scarce, leading to late and erroneous diagnoses, as well as non-specific treatments. This study explored the therapeutic trajectories of people and families living with rare diseases within Chile’s public and private healthcare systems from the perspective of patients, caregivers, and medical teams, including the initial symptoms, first consultation, testing, diagnosis, treatment, and follow-up. Methods A qualitative exploratory study was conducted through multiple case studies. Sixty participants were interviewed in person and/or virtually: patients (n = 16), caregivers (n = 22), healthcare workers (n = 20), and two patient organisation leaders. The material was analysed using thematic analysis. The project was approved by the Scientific Ethics Committee of Facultad de Medicina Clínica Alemana, Universidad del Desarrollo. Results After similar initial symptoms and first consultation, three main types of trajectories were identified: (i) the path taken by those who reach a diagnosis for a disease that has specific treatment available; (ii) the journey of those who reach a diagnosis for their health condition, but their disease does not have a specific treatment available; and (iii) the trajectory of those who have not reached a diagnosis and receive symptomatic treatments for symptoms. Conclusions The therapeutic trajectories of patients with rare symptoms are similar in terms of initial symptoms and first consultation. However, their paths diverge at the diagnostic stage, with diverse experiences related to these journeys, largely based on having a diagnosis and whether there is a specific treatment. Rare conditions in Chile requires further attention and urgent action that considers those who live with them and their families.
Infectious diseases prevention and vaccination in migrants in Latin America: The challenges of transit through the treacherous Darien gap, Panama
(2025) Rodriguez-Morales, Alfonso J.; Puerta-Arias, María Camila; Husni, Rola; Montenegro-Idrogo, Juan J.; Escalera-Antezana, Juan Pablo; Alvarado-Arnez, Lucia E.; Bonilla-Aldana, D. Katterine; Camacho-Moreno, German; Mendoza, Henry; Rodriguez-Sabogal, Ivan Arturo; Millán-Oñate, Jose; Lopardo, Gustavo; Arce, Octavio A.; Cimerman, Sergio; Socorro Souza Chaves, Tânia do; Orduna, Tomas; Lloveras, Susana; Cabrera, Maritza; Thormann, Monica; Özsürekçi, Yasemin; Pérez-Sánchez, Clevy; Sandoval, Nancy; Lysien Zambrano, Lysien; Alvarez-Moreno, Carlos A.; Chacon-Cruz, Enrique; Villamil-Gomez, Wilmer E.; Arteaga-Livias, Kovy; Savio-Larriera, Eduardo; Cardona-Ospina, Jaime A.; Risquez, Alejandro; Forero-Peña, David A.; Contreras, Krisell; Sah, Ranjit; León-Figueroa, Darwin A.; Acosta-España, Jaime David; Sierra, Leandro; López-Delgado, Darío Sebastián; Solarte-Portilla, Marco A.; Escobedo, Angel A.; Haque, Shafiul; Amer, Fatma A.; Leblebicioglu, Hakan; Ulloa-Gutierrez, Rolando; Galan-Rodas, Eden; Matsee, Wasin; Fernandez, Marisa Liliana; Echazarreta, Sofia; Cabieses, Báltica
Human migration is a dynamic, multifaceted and complex phenomenon shaped by economic, political, social, climatic and environmental factors [1–4]. Migration refers to the relocation of individuals from their habitual residence to a new location, while travel involves journeying between destinations for various purposes [5]. In recent years, migration trends have been shaped by globalisation, technological advancements, climate change, armed conflicts, social and economic disparities and political and religious persecution. Migration poses challenges for individual nations and represents a crucial humanitarian and global health issue requiring coordinated international efforts and long-term planning [6–8].
Intersectionality, racism, and mental health of migrants arriving at borders in Latin America: a qualitative study based on in-depth interviews with key informants of the cases of Ecuador and Chile
(2025) Rocha-Jiménez, Teresita; Torres, Irene; Cabieses, Báltica; López-Cevallos, Daniel F.; Mercado-Órdenes, Mercedes
Background Migration is a social determinant of health, as human mobility is associated with the health outcomes of those who move. Social sciences research on migration and health needs to transition from an individual approach to models that reveal how place, processes of racialization, and structural elements impact immigrant health. We aim to describe, from the key informant's perspective in depth, the case of intersectionality, racism, and gender and related perceived effects on Venezuelan migrants' mental health at two relevant Latin American borders. Methods The present study is a multisite observational cross-sectional qualitative project on two selected borders, the northern borders of Chile (Antofagasta, Iquique, Arica) and Ecuador (Tulcán, Nueva Loja). In-depth semi-structured interviews with key informants were collected in (n = 30) Chile from May to December 2022 and in Ecuador (n = 30) from October to December 2022. 22 participants were men, and 38 were women, and in-depth interviews were analysed using an inductive thematic approach. Findings We found structural axes (i.e., socioeconomic, migration status, gender) of power that intersect in migrants' and refugees’ conditions and experiences in their access to health and mental health care. Interpretation We proposed the notions of intersectionality and racism to deliberately connect complex and dynamic concepts relevant to migrant and refugee health research, such as the racism faced by historically racialized populations based on their phenotypes, social class, and/or nationality and socioeconomic and gender inequalities.
Barriers to access to insulin pumps in Chile: A qualitative study of a high-cost technology
(2025) Cabieses, Báltica; Obach, Alexandra; Madrid, Paula; Paredes, Daniela
Objective: To investigate the barriers to accessing advanced insulin delivery system from the experiences of patients with type 1 diabetes (T1DM), family members, and treatment teams. Methods: A qualitative study, taking a comprehensive approach, investigated a person’s experience with T1DM and receiving insulin pump treatment, emphasizing the barriers to accessing it. A case study was conducted, considering a diverse range of individuals, including young patients, adult patients, family members or care givers, and health professionals. Twenty-nine semi-structured individual interviews provided a rich and varied perspective on the issue. Results: According to study participants, the main barriers to access to insulin pump treatment for T1DM patients in Chile were the following: (i) Geographic barriers, (ii) Socioeconomic barriers, (iii) Administrative barriers, and (iv) Barriers from health teams. Participants also identified emerging barriers related to the insulin pump’s adaptation process. Conclusions: Despite the barriers and bottlenecks identified, an effort to fill short gaps in access to insulin pump treatment by the Chilean health system is recognized. To keep improving in equitative access to high-cost treatments in T1DM and other chronic conditions, it is imperative to consider the active and meaningful participation of patients and their families in health decision-making. This can lead to more patient-centric and effective healthcare policies and practices.
Perceived barriers to reaching equity in effective access to diagnosis and treatment for women with breast cancer in Chile
(2025) Campaña, Carla; Cabieses, Báltica; Obach, Alexandra; Vezzani, Francisca
Globally, it has been reported inequities in breast cancer effective access to health care. The objective of this study was to explore perceived inequities in access to effective diagnosis and treatment in women with breast cancer according to Tanahashi model and social determinants of health model. An exploratory case study, under a qualitative paradigm, was conducted. Theoretical sampling guided the selection of diverse participant profiles, comprising breast cancer patients, healthcare professionals and a civil society leader. The strategies for the recruitment process included social networks, civil society organizations, health professionals, and the snowball technique. Online semi-structured interviews were conducted. Interviews were transcribed, anonymized, and coded using ATLAS.Ti for deductive thematic analysis. Barriers to effective healthcare access were identified in all components of Tanahashi model. Accessibility and acceptability were the components with most perceived barriers. From the determinants of health model, a woman from the public health system, with low income, under 30 or over 40, and residing in a different region from the metropolitan region faces more barriers to access to an effective healthcare. The main barriers were for the high centralisation of healthcare in Chile, not integrated health system network, misinformation to the patient, and non-humanized healthcare. The results of this study offer a comprehensive exploration of perceived barriers to effective breast cancer diagnosis and treatment in Chile, using a qualitative approach incorporating diverse perspectives. Findings underscore significant systemic challenges across Tanahashi’s model components, impacting the overall care experience. The study reveals structural inequities hindering healthcare access, reflecting global patterns in fragmented health systems.
Education as a social determinant of the health of international migrants and locals in Chile between 2013 and 2022
(2025) Blukacz, Alice; Oyarte, Marcela; Cabieses, Báltica; Díaz, Janepsy
Background: Education is a recognised social determinant of health and interacts with other determinants including employment and income. International migration may disrupt these interactions. Education in Chile reflects wider socioeconomic inequalities and in the last decade, it has welcomed an increasing number of migrants. Objective: To analyse education as a social determinant of health among international migrants and locals between 2013 and 2022. Methods: Observational cross-sectional study based on five versions of the CASEN survey. Education, employment, and income were analysed in relation to healthcare needs for both populations and logistic regression models were estimated for each year. For 2022, the interactions between education and employment were explored in relation to healthcare needs. Results: International migrants showed a higher education level and employment rate than Chileans, and a smaller proportion reported healthcare needs. After adjusting for demographic and socioeconomic factors, locals aged 19–25 and 26–59 were more likely to report healthcare needs compared to international migrants across multiple years. The effects of education, employment, and income on healthcare needs among locals and international migrants showed fluctuating ORs without marked trends. In 2022, significant differences in healthcare needs were observed among migrants and locals based on interactions between education and employment, with non-overlapping confidence intervals particularly among unemployed, less-educated youth, middle-aged migrants with incomplete basic education, and older individuals. Conclusions: This study provides an overview of education as a social determinant of health among international migrants and locals for the last decade and call for targeted in-depth analyses on the topic.
Socioeconomic and spatial distribution of depressive symptoms and access to treatment in Peru: A repeated nationwide cross-sectional study from 2014 to 2021
(2025) Villarreal-Zegarra, David; Al-kassab-Córdova, Ali; Otazú-Alfaro, Sharlyn; Cabieses, Báltica
Background: Globally, evidence indicates that poverty and geographical setting influence the prevalence of depressive symptoms and access to treatment. Therefore, this study aimed to evaluate the socioeconomic and spatial distribution of depressive symptoms and treatment in Peru. Methods: We conducted an observational study based on the analysis of secondary data derived from the Peruvian Demographic and Health Surveys for 2014–2021. Using the Patient Health Questionnaire-9 on depressive symptoms, we estimated the Erreygers concentration index (ECI) to identify socioeconomic inequality in depressive symptoms and access to treatment. Spatial analyses were conducted using Global Moran’s I, Kriging interpolation, hotspot analysis (Getis-Ord-Gi*), and the Bernoulli-based Kulldorff spatial analysis. Results: The surveys included a total of 113,392 participants. Depressive symptoms exhibited only negative ECI values throughout the 2014–2021 period (pro-poor distribution), whereas access to treatment only displayed positive ECI values (pro-rich distribution). We identified two and four significant clusters in the southeastern areas of Peru in 2014 and 2021, respectively. Conclusions: Depressive symptoms were concentrated among the poorest, whereas access to treatment was remarkably concentrated among the wealthiest groups. A clustered spatial pattern was observed, and similar high-risk areas were identified. Social policies that address unequal socioeconomic and spatial distribution in depressive symptoms and treatment are required.
La construcción de “vulnerabilidad” y “agencia” en niñas y adolescentes no acompañadas: percepción de las y los actores intervinientes en Chile
(2024) Ortiz-López, Juan Eduardo; Poblete-Godoy, Daniela; Acuña Ramirez, Valeria; Dufraix Tapia, Iciar; Salinas Pérez, Sius-Geng; Pavez-Soto, Iskra; Alfaro Contreras, Carmen
El artículo examina las percepciones de autoridades, profesionales y activistas sobre las expe-riencias de niñas y adolescentes no acompañadas en Chile, enfocándose en cómo adultos in-tervinientes construyen los conceptos de vulnerabilidad y agencia. A través de una metodolo-gía cualitativa que utiliza las entrevistas semiestructuradas, el estudio evidencia que las niñas yadolescentes enfrentan una extrema vulnerabilidad en situaciones como la gestación, la explo-tación sexual y otras formas de agresión. A pesar de estas dificultades, también se identificanestrategias de agencia durante su trayecto, donde a menudo viajan acompañadas por adultosen relaciones de poder desiguales. Las entrevistas subrayan la urgencia de priorizar la atencióna adolescentes gestantes en las fronteras, mejorar la coordinación intersectorial para ofrecer unapoyo integral y replantear las políticas públicas y programas desde una perspectiva de género.
Diagnóstico y etapificación de cáncer de mama en Chile: estudio por encuesta no probabilística de III a IV frecuencia y tiempos
(2024) Campaña, Carla; Oyarte, Marcela; Cabieses, Báltica; Obach, Alexandra
INTRODUCCIÓN La progresión del cáncer de mama involucra mecanismos fisiológicos como metástasis. Los retrasos en diagnóstico y tratamiento aumentan el riesgo de mortalidad y se asocian a barreras de acceso a la salud. En Chile, el cáncer de mama es altamente prevalente y su diagnóstico temprano ha mejorado, aunque persisten disparidades en el proceso de enfermedad. Este estudio caracterizó exámenes de diagnóstico y etapificación, tiempos de espera y perfiles sociodemográficos para identificar demoras e inequidades en la atención. MÉTODOS Estudio de encuesta. Utilizando una muestra no probabilística, se aplicó un cuestionario en plataforma encriptada previo consentimiento informado. En el instrumento se recogieron datos de exámenes solicitados, tiempos asociados, etapificación y características sociodemográficas. Estas variables fueron analizadas utilizando estadística descriptiva, test de asociación, intervalos de confianza y test de comparación utilizando bootstrapping. RESULTADOS Se logró una muestra de 263 personas. Los exámenes más solicitados fueron biopsia (99,62%) y exámenes de sangre (80,23%). La mediana de exámenes solicitados fue de 6 (Q1:4, Q3:8), con media 5,87 (desviación estándar: 2,24). No se observaron diferencias significativas en el porcentaje de personas a quienes se solicitó la totalidad de exámenes según variables estudiadas. Los intervalos día-hora-resultado oscilaron entre 1 y 365 días. La mediana día-hora-resultado de la biopsia fue de 15 días (Q1:10, Q3:30). Las personas entre 40 y 49 años, no residentes de la capital, pertenecientes al quintil I de ingreso, con educación media, del sistema público de salud, con diagnóstico en etapa tardía presentaron mayores medianas de día-hora-resultado en biopsia. No hubo diferencia significativa en la cantidad de exámenes solicitados según etapificación (I a II y III a IV). CONCLUSIONES La biopsia en Chile es el examen de elección para la confirmación diagnóstica en cáncer de mama. Otros exámenes son solicitados independientemente de la etapa del diagnóstico, existiendo una discordancia con las recomendaciones de la guía clínica. El pronóstico del cáncer es crucial, especialmente en países con mayores inequidades.
Determinants of COVID-19 and non-COVID-19 vaccine confidence in low- and middle-income countries: A systematic review of qualitative evidence and thematic synthesis
(2025) Blukacz, Alice; Obach, Alexandra; Vásquez, Paola; Campaña, Carla; Huerta, Catalina; Bernal, Yanara; Cabieses, Báltica
Background: The COVID-19 pandemic has shown the immediate risk for global and public health posed by vaccination inequities worldwide. The regions most affected are low- and middle-income countries (LMICs). In addition to systemic challenges, vaccine hesitancy driven by low vaccine confidence has been identified as a threat to vaccine uptake. The aim of this systematic review of qualitative literature is to explore the determinants of COVID-19 and non-COVID-19 vaccine confidence in LMICs. Methods: A systematic review was conducted following the PRISMA and ENTREQ guidelines. The electronic databases Cinahl, Embase, Pubmed, Scopus and Web of Science were searched for qualitative studies focusing on the topic of interest in LMICs published between 2013 and 2023. The quality of the studies was assessed using the Joanna Briggs Institute’s Checklist for Qualitative Research. A thematic synthesis was conducted. The study was registered on the Open Science Framework platform. Findings: 66 studies were included in the review. Three main determinants of vaccine confidence were identified: (1) General perceptions of the safety and efficacy of vaccines; (2) Information and experience; (3) Trust in healthcare providers, institutions, and systems. General perceptions of vaccine safety and efficacy were similar between COVID-19 and non-COVID-19 vaccines, and doubts regarding vaccine safety were neither new nor exclusive to the COVID-19 vaccine, indicating a persisting challenge. Furthermore, low vaccine confidence was partly determined by broader dynamics of mistrust towards Western countries and institutions, which was reflected for both vaccine groups. While conspiracy theories have been persisting determinants of low confidence, low COVID-19 vaccine confidence was partly determined by what was perceived as a lack of specific information. Conclusion: Persistent challenges to vaccine confidence were identified, rooted in colonial legacies and global health inequities, as well as limited intercultural approaches to building trust with regards to vaccines.
Unravelling the potential relationship between the climate crisis and the health of migrant children in LAC: perceptions from migrant parents and healthcare professionals in Chile
(2024) CARREÑO CALDERON, ALEJANDRA; Blukacz, Alice; Cabieses, Báltica
Introduction Latin America and the Caribbean (LAC) is one of the regions most affected by the climate crisis, which is connected to international migration through a complex nexus. During the last years, migratory flows on the continent have increasingly included children and adolescents who are migrating through non-authorised crossing points. The existing literature shows how inequities negatively affect migrant children and the role that healthcare systems can play to mitigate them. Objective Based on a qualitative study, the paper aims to analyse the role of the climate crisis on the healthcare needs of migrant children from LAC who are currently living in Chile, from the point of view of parents from five main countries of immigration in Chile and healthcare professionals. Method An exploratory study was conducted in Arica, Antofagasta and Santiago. In-depth interviews with 20 migrant parents and 20 healthcare professionals were carried out. The interviews were transcribed verbatim and a thematic analysis was performed. Results Three findings emerged from this study: (1) food insecurity affects LAC migrant children in their country of origin and during their migratory trajectories to Chile, (2) natural disasters and environmental degradation in the countries of origin are not the only drivers of migration for LAC families but also prevent returns, even when they remain undocumented and (3) LAC migrant children are exposed to urban pollution and contaminants in informal settlements due to difficulties in accessing formal housing, among others. Conclusions The climate crisis must be integrated into the study of migrant health in LAC, considering the current context of multiple political, health and economic crises in the region. Healthcare professionals and communities play a central role in creating interventions to build sustainable and resilient universal healthcare systems.
Nutrición, niñez y migración: Desafío para su abordaje desde un enfoque de interculturalidad en salud
(2024) CARREÑO CALDERON, ALEJANDRA; Cabieses, Báltica; Blukacz, Alice
Introducción La presencia de niños y niñas migrantes en Chile ha crecido numéricamente, especialmente de aquellos provenientes de América Latina y el Caribe. Hoy se calcula que en Chile un 10,4% de los niños entre 0-14 años son migrantes (CASEN 2020). Desde la determinación social de la salud, la bibliografía indica que la presencia de niñez migrante implica diversos desafíos en temas como inequidades en la afiliación a servicios, el acceso a programas de prevención y promoción de salud, así como mayor exposición a pobreza multidimensional y condiciones de vida desfavorables para su bienestar integral. Sin embargo, una de las dimensiones menos exploradas de estas inequidades se refiere a los temas nutricionales que a nivel internacional han sido identificados como prioritarios tanto por los efectos que la transición alimentaria tiene sobre los niños migrantes, como el registro de desnutrición en niños provenientes de países a alto riesgo de inseguridad alimentaria. Objetivos La propuesta pretende indagar en las percepciones de padres, madres y tutores migrantes así como de personal de atención primaria, sobre las necesidades nutricionales que enfrentan los niños durante su trayectoria migratoria (en país de origen, tránsito y destino) y los desafíos que enfrenta el sistema de salud para abordar las temáticas nutricionales desde un enfoque de interculturalidad Método Enmarcado en un proyecto cualitativo-etnográfico mayor se desarrollaron 10 entrevistas en profundidad a padres, madres y tutores de niños, niñas y adolescentes que pasaron por paso no habilitado en Chile entre los años 2019-2023, a 10 miembros de equipos de atención primaria encargados de atención directa a población migrantes, a 5 informantes clave, encargados de programas sociales y de salud dedicados a infancia y adolescencia y a 5 miembros de ONG’s dedicados al abordaje de temas migratorios, logrando un N=30. Las entrevistas fueron transcritas y se realizó análisis temático a través de la codificación de las mismas. Resultados principales Si bien en Chile existen desde hace años esfuerzos importantes para el abordaje de la desnutrición por exceso durante la infancia y adolescencia, los hallazgos demuestran: 1) el resurgimiento de temas de desnutrición por déficit, especialmente en niños que se encuentran en situación migratoria irregular y en madres migrantes que viven gestaciones en condiciones de vulnerabilidad social; 2) las dificultades que encuentran los equipos de salud para abordar temáticas nutricionales desde un enfoque de interculturalidad, especialmente en temas como la introducción de alimentación sólida en lactantes y la adecuación de recomendaciones alimentarias y 3) la necesidad de profundizar sobre los efectos de la transición alimentaria en niños, niñas y adolescentes migrantes considerando el mayor acceso en Chile a alimentación ultraprocesada, el mayor consumo de carbohidratos como el pan y la adecuación de las dietas a ritmos laborales que reducen los tiempos para el acceso y preparación de alimentos considerados saludables. Conclusiones Se presentan resultados sobre la situación nutricional de niños, niñas y adolescentes migrantes en Chile. Se destaca el resurgimiento de la desnutrición por déficit como problemática que afecta a población infanto-juvenil, las posibles consecuencias de la transición alimentaria debido al mayor acceso a alimentos ultraprocesados y la necesidad de incorporar el enfoque intercultural en los programas de atención dedicados a la nutrición de niños y niñas.
“Hasta que me embaracé no conocí matrona”: salud sexual y reproductiva de jóvenes mujeres mapuche, Chile
(2024) CARREÑO CALDERON, ALEJANDRA; Obach, Alexandra; Correa Matus, M. Eliana
Este estudio pretende explorar la prevención y promoción de salud sexual y reproductiva en jóvenes mapuche de entre 18 y 24 años, indagando en las relaciones que establecen con el sistema de salud biomédico y en los desafíos para la inclusión de la interculturalidad en las prestaciones dirigidas a esta población. Se trata de una investigación cualitativa de estudio de caso. Se aplicaron 32 entrevistas en profundidad a jóvenes mapuche de sectores rurales y urbanos de la región de la Araucanía, Chile. Se identifica la persistencia un abordaje sanitario que carece de herramientas interculturales y de enfoque de derechos sexuales y reproductivos. Las jóvenes reportan falta de acceso a educación sexual tanto por la distancia que establecen con los servicios biomédicos de atención primaria como por las dificultades de hablar de sexualidad con los adultos de sus comunidades. Se concluye que persisten inequidades en el derecho a la salud sexual y reproductiva de jóvenes indígenas, especialmente en mujeres. Es necesario incorporar el enfoque intercultural y de derechos en la formulación de políticas públicas para esta población. Tales intervenciones requieren ser diseñadas e implementadas involucrando tanto a a población joven como a los agentes de salud de sus comunidades de origen.
Methylated Reprimo Cell-Free DNA as a Non-Invasive Biomarker for Gastric Cancer
(2025) Maturana, María; Padilla, Oslando; Santoro, Pablo; Alarcón, Maria; Olivares, Wilda; Blanco, Alejandro; Armisen, Ricardo; Garrido, Marcelo; Aravena, Edmundo; Barrientos, Carlos; Calvo, Alfonso; Corvalán, Alejandro
Restrictions resulting from the COVID-19 pandemic abruptly reversed the slow decline of the diagnosis and mortality rates of gastric cancer (GC). This scenario highlights the importance of developing cost-effective methods for mass screening and evaluation of treatment response. In this study, we evaluated a non-invasive method based on the circulating methylated cell-free DNA (cfDNA) of Reprimo (RPRM), a tumor suppressor gene associated with the development of GC. Methylated RPRM cfDNA was analyzed in three de-identified cohorts: Cohort 1 comprised 81 participants with GC and 137 healthy donors (HDs); Cohort 2 comprised 27 participants with GC undergoing gastrectomy and/or chemotherapy analyzed at the beginning and after three months of treatment; and Cohort 3 comprised 1105 population-based participants in a secondary prevention program who underwent esophagogastroduodenal (EGD) endoscopy. This cohort includes 180 normal participants, 845 participants with premalignant conditions (692 with chronic atrophic gastritis [AG] and 153 with gastric intestinal metaplasia/low-grade dysplasia [GIM/LGD]), 21 with high-grade dysplasia/early GC [HGD/eGC], and 59 with advanced GC [aGC]). A nested case-control substudy was performed using a combination of methylated RPRM cfDNA and pepsinogens (PG)-I/II ratio. The dense CpG island of the promoter region of the RPRM gene was bisulfite sequenced and analyzed to develop a fluorescence-based real-time PCR assay (MethyLight). This assay allows the determination of the absolute number of copies of methylated RPRM cfDNA. A targeted sequence of PCR amplicon products confirmed the gastric origin of the plasma-isolated samples. In Cohort 1, the mean value of GCs (32,240.00 copies/mL) was higher than that of the HD controls (139.00 copies/mL) (p < 0.0001). After dividing this cohort into training–validation subcohorts, we identified an area under the curve of 0.764 (95% confidence interval (CI) = 0.683–0.845) in the training group. This resulted in a cut-off value of 87.37 copies/mL (sensitivity 70.0% and specificity 80.2%). The validation subcohort predicted sensitivity of 66.67% and a specificity of 83.33%. In Cohort 2 (monitoring treatment response), RPRM levels significantly decreased in responders (p = 0.0042) compared to non-responders. In Cohort 3 (population-based participants), 18.9% %, 24.1%, 30.7%, 47.0%, and 71.2% of normal, AG, GIM/LGD, HGD/eGC, and aGC participants tested positive for methylated RPRM cfDNA, respectively. Overall sensitivity and specificity in distinguishing normal/premalignant conditions vs. GC were 65.0% (95% CI 53.52% to 75.33%) and 75.9% (95% CI 73.16% to 78.49%), respectively, with an accuracy of 75.11% (95% CI 72.45% to 77.64%). Logistic regression analyses revealed an OR of 1.85 (95% CI 1.11–3.07, p = 0.02) and an odds ratio (OR) of 3.9 (95% CI 1.53–9.93, p = 0.004) for the risk of developing GIM/LGD and HGD/eGC, respectively. The combined methylated RPRM cfDNA and PG-I/II ratio reached a sensitivity of 78.9% (95% CI 54.43% to 93.95%) and specificity of 63.04% (95% CI 52.34% to 72.88%) for detecting HGD/eGC vs. three to six age- and sex-matched participants with premalignant conditions. Our results demonstrate that methylated RPRM cfDNA should be considered a direct biomarker for the non-invasive detection of GC and a predictive biomarker for treatment response.
Uso de rúbricas para la evaluación de textos académicos: un desafío en la enseñanza de enfermería
(2023) Riquelme, Giselle; Pérez, Claudia; Aedo, Vivian
Introducción: Tanto la enseñanza de la escritura como la forma en que se evalúa constituyen un desafío importante en educación superior. La utilización de estrategias evaluativas permite remediar las carencias en habilidades de escritura, al ser no solo un recurso de evaluación exhaustivo y didáctico, sino que también, una guía para el desarrollo del texto en sí mismo. Objetivo: Desarrollar metodologías evaluativas para mejorar los aspectos de forma y contenido en la escritura de textos académicos en Enfermería. Metodología: el proyecto contó de tres fases que contemplaron la construcción de dos instrumentos (fase 1), su aplicación en un texto académico y respectivos ajustes (fase 2), y la evaluación de dicha aplicación (fase 3). Resultados: se obtuvieron dos rúbricas de tipo analíticas conformadas por los ítems de FORMA (aspectos de escritura) y CONTENIDO (aspectos de investigación), las que fueron aplicadas tres veces al texto para evaluar su progreso, observándose mejoras en la calificación global, en coherencia y cohesión en FORMA, y marco teórico, resultados y metodología, en CONTENIDO. Discusión: el uso de rúbricas analíticas son una herramienta muy útil a la hora de evaluar textos académicos. Son instrumentos sumamente completos pues miran el proceso como un todo, actuando no solo como una instancia evaluativa, sino que también formadora para el estudiantado, a la vez que se configuran como una guía para el desarrollo de la escritura. Introduction: Both the teaching of writing and the way it is evaluated constitute major challenges in higher education. The use of evaluative strategies can help remediate deficiencies in writing skills by being not only an exhaustive and didactic evaluation resource, but also a guide for the development of the text itself. OBJECTIVE: Develop evaluative methodologies to improve aspects of form and content in the writing of academic texts in Nursing. METHODOLOGY: The project had three phases that considered the construction of two instruments (phase 1), their application in an academic text (thesis report) and respective adjustments (phase 2), and, finally, the evaluation of said application. RESULTS: Two analytical headings were obtained (quantitative methodology and qualitative methodology), consisting of the items of FORM (writing aspects) and CONTENT (research aspects), respectively, which were applied three times to the text to evaluate its progress. Improvements were observed in the overall rating, in the areas of coherence and cohesion in FORM, and in the theoretical framework, results, and methodology in CONTENT. DISCUSSION: Analytical rubrics are a very useful tool when evaluating academic texts. They are extremely comprehensive instruments because they look at the process as a whole, serving not only as an evaluative tool, but also as a training opportunity for students, providing a guide for the development of academic writing skills.
Virtual reality: acquisition of skills in physical examination of nursing students
(2024) Contreras, Jorge; Pérez, Claudia; Aedo, Vivian; Leyton, Katherine
The Nursing Process (NP) is a fundamental tool for providing quality patient care. It has 5 stages, the first being the assessment, which is considered the most relevant since it supports the NP in the information obtained. In this stage, inspection, palpation, percussion, and auscultation techniques are used in the physical examination as tools in the assessment process. Virtual reality could be a beneficial intervention to train nursing students in acquiring their inspection and auscultation skills in the cardiac, respiratory, and digestive systems. The objective of this study was to evaluate the didactic strategy with the use of virtual reality in the acquisition of physical examination skills in the cardiac, respiratory, and digestive systems in nursing students. Methodology: a quantitative study of the quasi-experimental design of one group with pre and post-intervention evaluation was carried out. Results: the results in the pre-test related to the median was 5.5, varying positively with an increase in the post-test to 6.3, obtaining that the application of a didactic strategy with virtual reality significantly improves/enhances the processes of acquisition of physical exploration skills in nursing students. Discussion: the results obtained in our research demonstrate that the use of a realistic and low-cost simulator for cardiac, respiratory, and digestive exploration improves the acquisition of skills and stimulates learning in the student, in addition to facilitating the deliberate practice of the procedure before performing it on a real patient. The incorporation of virtual reality in the acquisition of physical examination skills in the cardiac, respiratory, and digestive systems is an instrument that can be added to the nursing curriculum as a new didactic strategy.
¿Cambió la pandemia la imagen de las enfermeras españolas? Identidad enfermera y voz como fuentes informativas
(2024) González, Hildegart; Gómez, Beatriz; Errasti, Begoña; Choperena, Ana; Díaz, Isabel; Alfaro, Amaranta; Pérez, Claudia
Introducción: Los medios de comunicación son claves en la configuración de la imagen social de las enfermeras. La difusión de una imagen de enfermería incoherente con su identidad profesional tiene consecuencias adversas para las enfermeras, para el conjunto del sistema sanitario y para la sociedad. Objetivo: Comparar la imagen de las enfermeras y su papel como fuentes informativas en 2019-2020 tomando como marco para el análisis la identidad profesional consensuada por ISPIN. Estudiar si durante pandemia por COVID-19 la imagen de las enfermeras en los medios fue más completa y si se les dio un mayor protagonismo como fuentes informativas. Material y Método: Análisis cuantitativo mediante instrumento que evalúa la coherencia entre la imagen publicada y la identidad profesional enfermera definida por ISPIN en las 468 noticias publicadas en El País y El Mundo en 2019-2020, que incluían la palabra enfermera/s, enfermeros/s o enfermería. Resultados: La presencia mediática de las enfermeras aumentó en 2020. Las temáticas principales en las que se las mencionó durante los dos años estuvieron relacionadas con cuestiones problemáticas del ejercicio de la profesión. El número de informaciones publicadas en las que se describe su trabajo diario aumentó en 2020. El rol más difundido fue el asistencial, pero la visibilidad de su función como gestoras creció durante la pandemia. Los estereotipos para representarlas se redujeron y la presencia de hombres enfermeros fue mayor. Conclusión: Aunque se incrementó la presencia de las enfermeras y de sus asociaciones como fuentes informativas, no fueron fuentes principales en la mayoría de las noticias. Introduction: The media plays a crucial role in shaping nurses' social image. Disseminating a nursing image inconsistent with their professional identity has adverse consequences for nurses, the healthcare system, and society. Objective: To compare nurses' image and role as information sources in 2019 and 2020, the professional identity framework agreed upon by ISPIN will be used for analysis. To study whether the image of nurses in the media during the COVID-19 pandemic was more comprehensive and whether they were given a more significant role as information sources. Material and Method: Quantitative analysis using an instrument that evaluates the coherence between the published image and the professional nurse identity defined by ISPIN in 468 news articles published in El País and El Mundo in 2019 and 2020, which included the words nurse(s) or nursing. Results: The media presence of nurses increased in 2020. The main topics in which they were mentioned during the two years were related to problematic issues within the profession. The number of reports describing their daily work increased in 2020. The most widely publicized role remained caregiving, but their visibility as managers grew during the pandemic. Stereotypes used to represent them decreased, and the presence of male nurses was more significant. Conclusion: Although the presence of nurses and their associations as information sources increased, they were not the primary sources in most of the news articles.
Analizar los rasgos definitorios de un currículo de formación de profesionales de la salud basados en interculturalidad de una facultad de medicina: analizado desde la fenomenografía
(2025) Pérez, Claudia; Medina, José
Introducción la integración de la competencia intercultural en el currículo de profesionales de la salud es un elemento crucial para abordar las diversas necesidades de atención en salud de sociedades cada vez más multiculturales. El manuscrito analiza los rasgos definitorios de un currículo de formación de profesionales de la salud basados en la interculturalidad, destacando la necesidad de integrar la perspectiva intercultural en el currículo de educación para las carreras de la salud. Método estudio cualitativo con enfoque fenomenográfico. Se realizaron 27 entrevistas a estudiantes, docentes y autoridades de una facultad de medicina, elegidas por muestreo opinático. El análisis de los datos se realizó a partir de los 7 pasos para el análisis fenomenográfico descrito por Dahlgren y Fallsberg. Resultados el análisis permitió distinguir que los rasgos definitorios están conformados por 3 categorías: a) Competencia intercultural en el currículo, b) Metodologías de enseñanza-aprendizaje para la competencia intercultural y c) Desafíos para la implementación de la competencia intercultural. Conclusión la importancia de integrar la competencia intercultural en la formación de profesionales de la salud, a través de módulos específicos, enfoques transversales, interdisciplinarias y competencias genéricas es fundamental. La implementación de metodologías de enseñanza experienciales y prácticas, así como la adaptación de las estructuras institucionales, son esenciales para superar los desafíos que presenta la enseñanza de esta. Al adoptar una visión integral y proactiva en la formación de los estudiantes, las instituciones pueden ayudar a preparar a los futuros profesionales de la salud para un mundo cada vez más diverso, promoviendo una atención más inclusiva y culturalmente competente. Introduction The integration of intercultural competence into the curriculum of health professionals is a crucial element in addressing the diverse health care needs of increasingly multicultural societies. The manuscript analyzes the defining features of a training curriculum for health professionals based on interculturality, highlighting the need for intercultural integration in the education curriculum for health careers. Method Qualitative study with a phenomenographic approach. Twenty-seven interviews were carried out with students, teachers and authorities of a medical school, chosen by opinion sampling. Data analysis was carried out using the 7 steps for phenomenographic analysis described by Dahlgren and Fallsberg. Results The analysis allowed us to distinguish that the defining traits are made up of 3 categories: a) Intercultural competence in the curriculum, b)Teaching-learning methodologies for intercultural competence and c) Challenges for the implementation of intercultural competence. Conclusion The importance of integrating intercultural competence in the training of health professionals, through specific modules, transversal, interdisciplinary approaches and generic competences is fundamental. The implementation of experiential and practical teaching methodologies, as well as the adaptation of institutional structures, are essential to overcome the challenges presented by teaching of this. By taking a comprehensive and proactive view in training students, institutions can help prepare future health professionals for an increasingly diverse world, promoting more inclusive and culturally competent care.
Diet quality of Chilean schoolchildren: How is it linked to adherence to dietary guidelines?
(2025) Pinheiro Fernandes, Anna Christina; Araneda, Jacqueline; Quintiliano Scarpelli Dourado, Daiana; Pizarro, Tito; Marques, Maria
Introduction: In Chile, the prevalence of overweight among schoolchildren over the age of 5 is approximately 50%, one of the highest in the Americas region. This is largely influenced by the presence of inadequate food environments, characterized by limited access to healthy foods and a high availability of highly processed foods (HPF). This study analyzes food consumption in Chilean schoolchildren and the association of this with the Chilean Dietary Guidelines Based on Foods (DGBF) and the HPF consumption. Material and methods: The sample (1,094 schoolchildren) was obtained from the baseline of the FONDEF IT18I0016 project, in Santiago-Chile. Anthropometry and socioeconomic data were measured. Dietary intake was assessed using a validated semi-quantitative frequency survey featuring images of food groups aligned with DGBF, as well as HPF. All data were collected by trained professional nutritionists. Associations between dependent and independent variables, and potential confounding factors were calculated using logistic regression models with stepwise backward/forward. A p < 0.05 was accepted as significant, using Stata 16.0. Results: Most of the students (54.1%) were with malnutrition by excess and 20.0% exhibited abdominal obesity. Twenty percent of the students met the recommended intake for DGBF (fruits, vegetables, fish, milk and dairy products, legumes, water) and less than 5% did not consume any HPF. Consuming some sub-groups of HPF in moderate quantities (either no consumption or occasional consumption) increases the likelihood of meeting DGBF: candies and sweets (OR: 0.72; p = 0.04), pies with or without filling (OR: 0.63; p = 0.01), and salted snacks (OR: 0.67; p = 0.02). Conclusion: Our results contribute to reaffirm the need to enhance healthy food consumption among schoolchildren and to discourage the intake of HPF, particularly focusing on specific sub-groups of HPF that may increase the risk of displacing the consumption of food groups recommended by the DGBF.
Ambiente alimentario alrededor de establecimientos educacionales municipalizados de la ciudad de Chillán
(2024) Araneda, Jacqueline; Toledo, Álvaro; Inzunza, Constanza; Córdova, Carolina; Pinheiro Fernandes, Anna Christina
Introducción: Los ambientes alimentarios externos a los establecimientos educacionales influyen en la alimentación y el estado nutricional de los niños. Objetivo: Determinar el tipo del ambiente alimentario que rodea establecimientos educacionales municipalizados de la ciudad de Chillán. Materiales y método: Se realizó un estudio descriptivo de corte transversal con una muestra de cuatro establecimientos educacionales municipali-zados y 139 puntos de venta de alimentos. Se utilizaron pautas de observación para medir ambientes alimentarios a 400 metros a partir del punto central de cada escuela. Las pautas evaluaron los puntos de venta de alimentos, según disponibilidad, variedad y publicidad de alimentos. Resultados:El 50% de los puntos de venta de alimentos que rodean a los establecimientos educacionales son categorizados como no saludables. Solo un 9% es considerado un punto de venta saludable. Conclusiones: Se observó una alta densidad de puntos de venta de alimentos no saludables alrededor de las escuelas estudiadas, propiciando un ambiente obesogénico. Es imperativo establecer políticas públicas para mejorar el ambiente alimentario escolar. Food environments outside educational establishments influence children’s diet and nutritional status. Objective: To determine the type of food environment that surrounds the municipal educational establishments of the city of Chillán. Material and method: A cross-sectional descriptive study was conducted involving a sample of four municipal educational establishments and 139 food establishments. Observation guidelines were used to measure food environments 400 meters from the center point of each school, evaluating food outlets based on food avai-lability, variety, and advertising. Results: 50% of food outlets surrounding educational establishments were categorized as unhealthy. Only 9% were considered a healthy selling point. Conclusions: A high density of unhealthy food outlets was observed around the schools studied, fostering an obesogenic environment. It is imperative to establish public policies to improve the school food environment.

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