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Barriga F, Wietstruck A, Schulze-Schiappacasse C, Catalán P, Sotomayor C, Zúñiga P, Aguirre N, Vizcaya C, Le Corre N, Villarroel L. Individualized dose of anti-thymocyte globulin based on weight and pre-transplantation lymphocyte counts in pediatric patients: a single center experience. Bone Marrow Transplant 2024; 59:473-478. [PMID: 38253868 DOI: 10.1038/s41409-024-02206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
Anti-thymocyte globulin (ATG) has become a standard in preventing GVHD in related and unrelated donor transplantation, but there is no consensus on the best administration schedule. The PARACHUTE trial reported excellent CD4 immune reconstitution (CD4 IR) using a dosing schedule based on the patient's weight and pre-conditioning absolute lymphocyte count (ALC). In 2015 we introduced the PARACHUTE dosing schedule for pediatric patients at our center. One hundred one patients were transplanted for malignant and non-malignant diseases. In this non-concurrent cohort CD4 IR+, defined by a single CD4 count >50/µL on day 90, was seen in 81% of patients. The incidence of grade II-IV and III to IV aGvHD was 26.6% and 15.3% and 5% for cGvHD with no severe cases. We found no difference in aGvHD between donor type and stem cell sources. Five-year EFS and OS were 77.5% and 83.5%. Grade III-IV GFRS was 75.2%. CD4 IR+ patients had better EFS (93.1% vs. 77.7%, p = 0.04) and lower non-relapse mortality (2.7% vs. 22.2%, p = 0.002). The PARACHUTE ATG dosing schedule individualized by weight and ALC results in good early immune reconstitution, low incidence of cGvHD, and favorable survival for patients with different disease groups, donor types, and stem cell sources.
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Affiliation(s)
- Francisco Barriga
- Section of Hematology, Oncology and Stem Cell Transplantation. Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Angelica Wietstruck
- Section of Hematology, Oncology and Stem Cell Transplantation. Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Clara Schulze-Schiappacasse
- Department of Pediatric Infectious Diseases, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Catalán
- Section of Hematology, Oncology and Stem Cell Transplantation. Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Sotomayor
- Section of Hematology, Oncology and Stem Cell Transplantation. Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pamela Zúñiga
- Section of Hematology, Oncology and Stem Cell Transplantation. Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Noemi Aguirre
- Section of Hematology, Oncology and Stem Cell Transplantation. Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Vizcaya
- Department of Pediatric Infectious Diseases, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicole Le Corre
- Department of Pediatric Infectious Diseases, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Department of Public Health, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Bravo P, Dois A, Villarroel L, González-Agüero M, Fernández-González L, Sánchez C, Martinez A, Turén V, Quezada C, Guasalaga ME, Härter M. Factors influencing the implementation of shared decision-making in breast cancer care: protocol for a mixed-methods study. BMJ Open 2023; 13:e074111. [PMID: 37474182 PMCID: PMC10360429 DOI: 10.1136/bmjopen-2023-074111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Chile is committed to actively involving patients in their healthcare. However, little is known about how this is translated into clinical encounters. Breast cancer (BC) is the first cause of cancer-related death in Chilean women. National policy guarantees standard care, and treatment decisions should be made along this process that can have long-term consequences for women. So, BC is a particularly well-suited case study to understand the complexity of patient participation in decision-making. OBJECTIVE To identify the factors that affect the active involvement of patients in the BC treatment decision-making process, considering the perspectives and practices of health professionals and women facing the disease. METHOD AND ANALYSIS We will conduct a mixed-method study through a convergent parallel design in three stages: (1) A qualitative study: non-participant observation of the tumour board (TB) meetings; semi-structured interviews with key informants from TBs; documentary analyses; semi-structured interviews with women facing BC; and non-participant observations of clinical encounters; (2) a cross-sectional study with 445 women facing BC stages I-III from three hospitals in Santiago, Chile. We will measure the level of expected participation, experienced participation, decisional conflict, quality of life (QoL) and satisfaction with healthcare. Descriptive analysis will be performed, and multivariable binary logistic regression models will be adjusted to identify factors associated with high levels of QoL or satisfaction; (3) an integration study will bring together the data through a joint display technique. ETHICS AND DISSEMINATION The study has been conceived and will be conducted according to international and local agreements for ethical research. Ethical approval has been granted by two Ethics Committees in Chile.The results will be disseminated to scientific and lay audiences (publications in scientific journals and conferences, seminars and a website for plain language dissemination).
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Affiliation(s)
- Paulina Bravo
- School of Nursing, Pontifical Catholic University of Chile, Santiago, Chile
- Instituto Oncologico Fundacion Arturo Lopez Perez, Providencia, Santiago, Chile
| | - Angelina Dois
- School of Nursing, Pontifical Catholic University of Chile, Santiago, Chile
| | - Luis Villarroel
- Department of Public Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - César Sánchez
- Department of Hematology and Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Martinez
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, New Hempshire, USA
| | - Valentina Turén
- School of Nursing, Pontifical Catholic University of Chile, Santiago, Chile
| | - Constanza Quezada
- School of Nursing, Pontifical Catholic University of Chile, Santiago, Chile
| | | | - Martin Härter
- Universitats Klinikum Hamburg-Eppendorf, Hamburg, Germany
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Aranda E, Iha S, Solari S, Rodríguez D, Romero V, Villarroel L, Pereira J, Panes O, Mezzano D. Serotonin secretion by blood platelets: accuracy of high-performance liquid chromatography-electrochemical technique compared with the isotopic test and use in a clinical laboratory. Res Pract Thromb Haemost 2023; 7:102156. [PMID: 37601022 PMCID: PMC10439442 DOI: 10.1016/j.rpth.2023.102156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/07/2023] [Accepted: 07/06/2023] [Indexed: 08/22/2023] Open
Abstract
Background Mild secretion defects are the most frequent and challenging blood platelet disorders to diagnose. Most δ-granule secretion tests lack validation, are not quantitative, or have unreliable response to weak platelet agonists. Objectives To compare platelet serotonin secretion by HPLC-electrochemical detection technique (HPLC-ECD) with the reference isotopic test (3H-5-HT), evaluating its performance in clinical laboratories. Methods The assay validation followed STARD-2015 recommendations. HPLC-ECD measured the nonsecreted serotonin remaining in platelet pellets after aggregation, comparing it with the reference 3H-5-HT assay. We studied subjects with inherited and aspirin-induced blood platelet disorders and assessed the HPLC-ECD operation for routine clinical diagnosis. Results Calibration curves were linear (R2 = 0.997), with SD for residuals of 3.91% and analytical sensitivity of 5ng/mL. Intra- and interassay imprecision bias ranged between -8.5% and 2.1% and -9% and 3.1%, respectively. Serotonin recovery and stability were >95%, and the variability range of measurements was -5.5% to 4.6%. Statistical differences detected between tests were biologically irrelevant, with bias of 1.48% (SD, 8.43) and CI agreement of -18% to 15%. Both assays distinctly detected platelet secretion induced by 10 μM epinephrine and 4 μmM adenosine diphosphate. However, HPLC-ECD is quantitative and more sensitive to low serotonin content in blood platelets. Reference cutoffs for each agonist were determined in 87 subjects. Initially, the HPLC-ECD requires relatively expensive equipment and trained operators but has remarkably cheap running costs and a turn-around time of 24-36 hours. We have used this diagnostic tool routinely for >8 years. Conclusion HPLC-ECD assay for platelet serotonin secretion is highly accurate, has advantages over the reference 3H-5-HT test, and is suitable as a clinical laboratory technique.
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Affiliation(s)
- Eduardo Aranda
- Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Seiki Iha
- Department of Clinical Laboratory, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sandra Solari
- Department of Clinical Laboratory, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David Rodríguez
- Department of Clinical Laboratory, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Viviana Romero
- Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile
| | - Jaime Pereira
- Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Olga Panes
- Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diego Mezzano
- Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Castillo-Valenzuela O, Duarte L, Arredondo M, Iñiguez G, Villarroel L, Pérez-Bravo F. Childhood Obesity and Plasma Micronutrient Deficit of Chilean Children between 4 and 14 Years Old. Nutrients 2023; 15:nu15071707. [PMID: 37049547 PMCID: PMC10096594 DOI: 10.3390/nu15071707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: To analyze the nutritional status and plasma levels of vitamins and minerals in a cohort of Chilean children between 4 and 14 years old from three cities in Chile (Santiago, Antofagasta, and Concepcion). Design: This is a descriptive analysis of micronutrient levels in Chilean children as it relates to obesity and food consumption. Setting: This study included 1235 children from schools in Santiago (central area), Antofagasta (northern area), and Concepcion (southern area) in Chile. Results: Plasma levels of micronutrients revealed deficiencies in children from all these cities. Copper (26.4%) and calcium (33.0%) deficiencies were found in the children from Antofagasta, whereas iron (26.7%) and zinc (20.8%) deficiencies were found in the children from Concepcion and Santiago, respectively. The percentage of children with vitamin D deficiencies was exceptionally high in all cities (over 78%). The analysis of micronutrients and nutritional status revealed that vitamin D deficiencies were significantly higher (p = 0.02) in overweight children, particularly in Antofagasta. In the analysis of the nutritional status of children and their food consumption habits, the proportion of overweight and obesity was significantly higher (p = 0.001) in children that skipped breakfast compared to children that did not. Finally, children from low socioeconomic levels were significantly more overweight and obese compared to children from high socioeconomic levels (p < 0.05). Conclusions: this is the first study to describe plasma levels of micronutrients in Chilean children and adolescents. High percentages of obesity, overweight, and vitamin D deficiency were detected in children. These results are of significant relevance to future public health policies in Chile.
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Perehudoff K, 't Hoen E, Mara K, Balasubramaniam T, Abbott F, Baker B, Boulet P, Kamal-Yanni M, Martin M, Munoz Tellez V, Natsis Y, Ortún-Rubio V, Rathod S, Torrent M, Vawda Y, Villarroel L, Love J. A pandemic treaty for equitable global access to medical countermeasures: seven recommendations for sharing intellectual property, know-how and technology. BMJ Glob Health 2022; 7:bmjgh-2022-009709. [PMID: 35840169 PMCID: PMC9295647 DOI: 10.1136/bmjgh-2022-009709] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/04/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Katrina Perehudoff
- Law Centre for Health and Life, University of Amsterdam, Amsterdam, The Netherlands .,Medicines Law & Policy, Amsterdam, The Netherlands
| | - Ellen 't Hoen
- Medicines Law & Policy, Amsterdam, The Netherlands.,Global Health, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kaitlin Mara
- Medicines Law & Policy, Amsterdam, The Netherlands
| | | | - Frederick Abbott
- College of Law, Florida State University, Tallahassee, Florida, USA
| | - Brook Baker
- School of Law, Northeastern University, Boston, Massachusetts, USA
| | | | | | - Manuel Martin
- Access Campaign, Medecins Sans Frontieres, Geneva, Switzerland
| | - Viviana Munoz Tellez
- Intellectual Property and Biodiversity Programme, South Centre, Geneve, Switzerland
| | - Yannis Natsis
- European Social Insurance Platform, Brussels, Belgium
| | - Vicente Ortún-Rubio
- Department of Economics and Business, Pompeu Fabra University, Barcelona, Spain
| | | | - Maties Torrent
- Menorca School of Public Health, Institut Menorquí d'Estudis, Menorca, Spain
| | - Yousuf Vawda
- School of Law, University of KwaZulu-Natal, Durban, South Africa
| | | | - James Love
- Knowledge Ecology International, Washington, DC, USA
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6
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Pardo R, Vilca M, Villarroel L, Davalji T, Obrycki JF, Mazumdar M, Avila C, Mellado C. Neural tube defect prevalence does not increase after modification of the folic acid fortification program in Chile. Birth Defects Res 2022; 114:259-266. [PMID: 35218603 DOI: 10.1002/bdr2.1994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND In 2000, Chile's Ministry of Health mandated fortification of wheat flour with folic acid at a concentration of 2.2 mg/kg to prevent neural tube defects (NTDs), resulting in a 50% reduction in NTD prevalence. Concerns about possible collateral effects of high folic acid intake led, in 2009, to decrease the folic acid fortification to 1.8 mg/kg of flour. Our study evaluated the impact of this modification on the prevalence of NTDs in Santiago. METHODS This study measured the prevalence of NTDs in live births and stillbirths born in Santiago. We calculated prevalence ratios (PR) and 95% confidence intervals (CI) between pre-folic acid fortification (1999-2000), post-folic acid fortification (2001-2009), and post-modified folic acid fortification (2010-2015) periods for all NTDs and their specific types. We used chi-square tests to analyze proportions, and a Joinpoint regression to visualize prevalence time trends. RESULTS The NTD prevalence for the period 2001-2015 was 8.9 per 10,000 births, which represents a 48% reduction (PR = 0.52; 95% CI = 0.45-0.61; p < .001) from the pre-folic acid fortification period. During 2010-2015, the NTD prevalence was 9.5/10,000 births, which was higher, but not statistically significantly different from 2001 to 2009 prevalence of 8.6/10,000 (PR = 1.11; 95% CI = 0.96-1.30, p = .17). CONCLUSIONS Decreasing the concentration of folic acid fortification was not associated with a statistically significant change in the prevalence of NTDs. Mandatory folic acid fortification continues to be a safe and highly effective policy to prevent NTDs. Future studies should evaluate the prevalence of NTDs across Chile and adherence to folic acid fortification mandates.
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Affiliation(s)
- Rosa Pardo
- Genetics Unit, Pediatrics Service, Complejo Asistencial Dr. Sótero del Río, Puente Alto, Chile.,Genetics Section, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile.,Neonatology Unit, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Marcela Vilca
- Neonatology Unit, Department of Obstetrics and Gynecology, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tahera Davalji
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - John F Obrycki
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maitreyi Mazumdar
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Claudia Avila
- Neonatology Unit, Complejo Hospitalario San José, Santiago, Chile
| | - Cecilia Mellado
- Genetics Unit, Pediatrics Service, Complejo Asistencial Dr. Sótero del Río, Puente Alto, Chile.,Genetics Unit, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Sapag JC, Traub C, Velasco PR, Arratia T, Alvarado R, Aracena M, Poblete FC, Villarroel L, Bravo P, Álvarez-Huenchulaf C, Jofré Escalona A, Vargas-Malebrán N, Bobbili S, Bustamante I, Khenti A, Corrigan PW. Reducing stigma toward mental illness and substance use issues in primary health care in Chile: Protocol of a cluster controlled trial study. Front Psychiatry 2022; 13:1083042. [PMID: 36606131 PMCID: PMC9808783 DOI: 10.3389/fpsyt.2022.1083042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chile is implementing a Community Mental Health Model with a strong role of primary health care (PHC). PHC has great potential to early detection and provision of accessible and coordinated services to people who present mental illness and/or substance use issues (MISUI). However, stigma toward people with MISUI among PHC professionals is a significant barrier to accessing good quality of care. A wealth of literature supports the importance of reducing stigma for this population. The main goal of this research project is to determine the effectiveness of a comprehensive anti-stigma intervention in reducing stigmatizing attitudes and behaviors among PHC providers toward individuals with MISUI in the Chilean context, using Centros de Salud Familiar (CESFAMs) as the point of intervention. METHODS The intervention is based on an initiative that was previously developed in Canada and then also pilot-tested in Lima, Peru, with the Center for Addiction and Mental Health (Ontario, Canada). The model will be culturally adapted with CESFAM PHC provider and user inputs to be relevant and valid to Chile. The 18-month intervention includes five (5) components that are simultaneously implemented in CESFAMs: (1) Develop a Team of Local Champions in each intervention CESFAM, comprising PHC providers and users; (2) Analysis of Internal CESFAM Policies, Procedures, and Protocols to determine areas of improvement in service delivery for individuals with MISUI; (3) Raising Awareness of stigma toward MISUI using various forms of media within the CESFAM; (4) Innovative Contact-Based Education workshops on anti-stigma and recovery principles, co-lead by academic/clinical trainers and a person with lived experience of MISUI; and (5) Recovery-Based Arts, a multi-week arts workshop for PHC providers and users to produce artwork related to MISUI and recovery, culminating in an exhibition to showcase artwork for the CESFAM providers, users, and community. The expected intervention outcomes are the following: Participation in the experimental group will result in a significant decrease in stigmatizing attitudes among PHC providers toward individuals with MISUI compared with the control group as measured by the Chilean version of the Opening Minds Scale for Health Care Providers Scale (OMS-HC); Participation in the experimental group will result in a significant decrease of PHC users experiences of stigma conveyed by PHC providers compared with the control group as measured by the Internalized Stigma of Mental Illness (ISMI) scale, validated for the Chilean population. The changes in attitudes and behaviors within the experimental group will be sustained over time as measured at 6 months-follow-up. To evaluate the effectiveness of this 18-month intervention, a 4-year, two-arm, cluster-randomized controlled trial is proposed, with CESFAMs being the unit of randomization (or "cluster"). Implementation Science approach will be taken to measure relevant implementation outcomes for each component of the intervention, and through qualitative data collection with CESFAM providers and authorities. Data analysis will be carried out using SAS 9.4 (specifically, using POC MIXED and PROC GENMOD) and R 3.5. Mixed-effect modeling will used for both PHC provider and user data, which will include individuals and CESFAMs as random effects and group (intervention/control) as fixed effects. DISCUSSION This study represents a new stage of relevant and innovative research in mental health and stigma in Chile that will contribute to improving access and quality of care for people with MISUI. Evaluating the impact of the intervention model and its implementation will provide the necessary tools to scale the intervention up to other CESFAMs across Chile. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT05578066].
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Affiliation(s)
- Jaime C Sapag
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Medicina Familiar, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Carolina Traub
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paola R Velasco
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tamara Arratia
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rubén Alvarado
- Departamento de Salud Pública, Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso, Chile.,Programa de Salud Mental, Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Marcela Aracena
- Escuela de Psicología, Facultad de Ciencias Sociales, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando C Poblete
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Bravo
- Escuela de Enfermería, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cinthia Álvarez-Huenchulaf
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana Jofré Escalona
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nelson Vargas-Malebrán
- Departamento de Salud Pública, División de Salud Pública y Medicina Familiar, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sireesha Bobbili
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Inés Bustamante
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Akwatu Khenti
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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Bay C, Henriquez R, Villarroel L, Gana JC. Effect of music on pediatric endoscopic examinations: a randomized controlled trial. Endosc Int Open 2021; 9:E599-E605. [PMID: 33869733 PMCID: PMC8043808 DOI: 10.1055/a-1352-3244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background and study aims The primary objective was to measure the effect of music as an adjunct to sedation in patient anxiety levels during pediatric endoscopic examinations. Patients and methods We performed a single-blind randomized controlled trial comparing music with no music in children aged 2 to 18 years. Anxiety was measured using the Modified Yale Preoperative Anxiety Scale (m-YPAS) and the Visual Analog Anxiety Scale (VAS-anxiety). Patient perception of pain was evaluated with the Wong-Baker Faces Pain Rating Scale (WBFPRS). Patient experience, family satisfaction, and endoscopist perception of difficulty were evaluated. Sedative doses were recorded. Results A total of 51 children were randomized to the experimental group and 49 children to the control group. The mean ages were 10.5 years and 12.3 years, respectively. There were 63 % female subjects with no differences between groups. Overall, there were 85 upper endoscopies and 15 colonoscopies. In the recovery unit, the experimental group had lower average m-YPAS scores (mean score 27.7 vs 34.7; P < 0.001), a higher proportion of them had low m-YPAS scores (80 % vs 49 % P < 0.001), had lower VAS-anxiety scores [mean score 0.55 vs 1.57 ( P = 0.003)], and had lower WBFPRS scores [mean score 2.7 vs 1.3 ( P = 0.001)]. There were no statistically significant differences found in the amount of standard sedation given to the groups, nor in additional sedation administered. In the experimental group, the patient-reported experience was significantly better. Conclusions The study results show that music reduces anxiety and pain associated with endoscopic procedures in children. It also facilitates these procedures and improves patient satisfaction.
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Affiliation(s)
- Constanza Bay
- Department of Pediatrics, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Romina Henriquez
- Endoscopy Unit, Center of Medical Specialties, Red de Salud UC Christus, Chile
| | - Luis Villarroel
- Department of Public Health, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Juan Cristóbal Gana
- Department of Gastroenterology and Nutrition, Division of Pediatrics, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
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Troncoso J, Morales-Meyer T, Villarroel L, Turrillas P, Rodríguez-Nuñez A. [Adaptation and validation in Chile of the patient identification instrument needing palliative care: NECPAL-CCOMS-ICO 3.1©]. Aten Primaria 2021; 53:101994. [PMID: 33740612 PMCID: PMC7985705 DOI: 10.1016/j.aprim.2021.101994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/29/2020] [Accepted: 11/18/2020] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Adapt and validate the NECPAL instrument in Chile. DESIGN Prospective, longitudinal, analytical study for validation of the instrument in 5 stages: cultural adaptation, content validation, pilot test, application, and statistical analysis. PLACE Four primary care centers of the South East Metropolitan Health Service, in Santiago, Chile. PARTICIPANTS Primary health care physicians and nurses for cultural adaptation and application, and palliative care experts for content validation. MAIN MEASUREMENTS Cultural adaptation was carried out through cognitive interviews. Content validity was measured using Delphi method and the Lawshe content validity ratio (CVR) was obtained. In the pilot test, we measured stability (test-retest), inter judge harmony and application time in 14 chronic advanced patients (CAP). The test was applied to this same group, calculating the sample according to Nunally's recommendation. RESULTS A sample of 118 CAP was obtained. The CVR was 0.75 and the average testing time was 6.7 min (SD = 4.01). The test-retest obtained a Kappa test concordance index between 0.632 and 1.0; and the interjudge harmony agreement between 0.192 and 0.692. The surprise question (PS) was positive in 20.3% of the sample. The main conditions associated with the disease-specific severity item, were fragility (23.7%), chronic heart disease (21.2%) and chronic lung disease (12.7%). The demand group and specific severity indicators obtained a greater predictive capacity of PS+, with an area under the curve of 0.808 (95% CI: 0.697-0.918). CONCLUSIONS NECPAL is feasible to be used in Chile, has adequate psychometric properties and will allow early detection of patients in need of palliative care.
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Affiliation(s)
- Jonathan Troncoso
- Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Región Metropolitana, Chile
| | - Tina Morales-Meyer
- Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Región Metropolitana, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Región Metropolitana, Chile
| | - Pamela Turrillas
- Cátedra de Cuidados Paliativos, Universidad de Vic y Central de Catalunya, Barcelona, Barcelona, España
| | - Alfredo Rodríguez-Nuñez
- Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile, Región Metropolitana, Chile.
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Balcells ME, Rojas L, Le Corre N, Martínez-Valdebenito C, Ceballos ME, Ferrés M, Chang M, Vizcaya C, Mondaca S, Huete Á, Castro R, Sarmiento M, Villarroel L, Pizarro A, Ross P, Santander J, Lara B, Ferrada M, Vargas-Salas S, Beltrán-Pavez C, Soto-Rifo R, Valiente-Echeverría F, Caglevic C, Mahave M, Selman C, Gazitúa R, Briones JL, Villarroel-Espindola F, Balmaceda C, Espinoza MA, Pereira J, Nervi B. Early versus deferred anti-SARS-CoV-2 convalescent plasma in patients admitted for COVID-19: A randomized phase II clinical trial. PLoS Med 2021; 18:e1003415. [PMID: 33657114 PMCID: PMC7929568 DOI: 10.1371/journal.pmed.1003415] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Convalescent plasma (CP), despite limited evidence on its efficacy, is being widely used as a compassionate therapy for hospitalized patients with COVID-19. We aimed to evaluate the efficacy and safety of early CP therapy in COVID-19 progression. METHODS AND FINDINGS The study was an open-label, single-center randomized clinical trial performed in an academic medical center in Santiago, Chile, from May 10, 2020, to July 18, 2020, with final follow-up until August 17, 2020. The trial included patients hospitalized within the first 7 days of COVID-19 symptom onset, presenting risk factors for illness progression and not on mechanical ventilation. The intervention consisted of immediate CP (early plasma group) versus no CP unless developing prespecified criteria of deterioration (deferred plasma group). Additional standard treatment was allowed in both arms. The primary outcome was a composite of mechanical ventilation, hospitalization for >14 days, or death. The key secondary outcomes included time to respiratory failure, days of mechanical ventilation, hospital length of stay, mortality at 30 days, and SARS-CoV-2 real-time PCR clearance rate. Of 58 randomized patients (mean age, 65.8 years; 50% male), 57 (98.3%) completed the trial. A total of 13 (43.3%) participants from the deferred group received plasma based on clinical aggravation. We failed to find benefit in the primary outcome (32.1% versus 33.3%, odds ratio [OR] 0.95, 95% CI 0.32-2.84, p > 0.999) in the early versus deferred CP group. The in-hospital mortality rate was 17.9% versus 6.7% (OR 3.04, 95% CI 0.54-17.17 p = 0.246), mechanical ventilation 17.9% versus 6.7% (OR 3.04, 95% CI 0.54-17.17, p = 0.246), and prolonged hospitalization 21.4% versus 30.0% (OR 0.64, 95% CI, 0.19-2.10, p = 0.554) in the early versus deferred CP group, respectively. The viral clearance rate on day 3 (26% versus 8%, p = 0.204) and day 7 (38% versus 19%, p = 0.374) did not differ between groups. Two patients experienced serious adverse events within 6 hours after plasma transfusion. The main limitation of this study is the lack of statistical power to detect a smaller but clinically relevant therapeutic effect of CP, as well as not having confirmed neutralizing antibodies in donor before plasma infusion. CONCLUSIONS In the present study, we failed to find evidence of benefit in mortality, length of hospitalization, or mechanical ventilation requirement by immediate addition of CP therapy in the early stages of COVID-19 compared to its use only in case of patient deterioration. TRIAL REGISTRATION NCT04375098.
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Affiliation(s)
- María Elvira Balcells
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Rojas
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Program of Pharmacology and Toxicology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicole Le Corre
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Diagnostic Virology Laboratory, Red de Salud UC CHRISTUS, Santiago, Chile
| | - Constanza Martínez-Valdebenito
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Diagnostic Virology Laboratory, Red de Salud UC CHRISTUS, Santiago, Chile
| | - María Elena Ceballos
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcela Ferrés
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Diagnostic Virology Laboratory, Red de Salud UC CHRISTUS, Santiago, Chile
| | - Mayling Chang
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Vizcaya
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Mondaca
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Álvaro Huete
- Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Castro
- Department of Intensive Care Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Sarmiento
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Pizarro
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricio Ross
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime Santander
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bárbara Lara
- Emergency Medicine Section, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcela Ferrada
- Clinical Research Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Vargas-Salas
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Beltrán-Pavez
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- HIV/AIDS Work Group, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Ricardo Soto-Rifo
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- HIV/AIDS Work Group, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Fernando Valiente-Echeverría
- Laboratory of Molecular and Cellular Virology, Virology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- HIV/AIDS Work Group, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Mauricio Mahave
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Carolina Selman
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Raimundo Gazitúa
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | | | - Franz Villarroel-Espindola
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
- Translational Medicine Research Laboratory, Fundación Arturo López Pérez, Santiago, Chile
| | - Carlos Balmaceda
- Health Technology Assessment Unit, Clinical Research Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel A. Espinoza
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime Pereira
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bruno Nervi
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Bravo P, Dois A, Fernández-González L, Hernández-Leal MJ, Villarroel L. [Validation of the Informed Choice instrument for Chilean women facing a mammography decision in primary care]. Aten Primaria 2021; 53:101943. [PMID: 33592532 PMCID: PMC7893429 DOI: 10.1016/j.aprim.2020.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022] Open
Abstract
Objetivo Adaptar y validar el instrumento Informed Choice (IC) para la decisión de mamografía al contexto chileno. Diseño Estudio transversal, analítico, de adaptación y validación psicométrica. Emplazamiento Centro de atención primaria del sector sur oriente de Santiago de Chile. Métodos 1) traducir y contra-traducir IC; 2) realizar un grupo focal para la relevancia cultural/lingüística; 3) examinar la validez del contenido; 4) pilotar el instrumento; 5) aplicar para validación. Para la consistencia interna se usó el alfa de Cronbach, prueba de esfericidad de Bartlett y la medida de Kaiser-Meyer-Olkin para determinar correlaciones entre las variables y análisis factorial. Resultados Se construyeron 3 versiones del IC, modificándose según la opinión de usuarios y expertos. La validación se llevó a cabo en una muestra de 70 mujeres. La edad media fue de 54,4 años, el 47,1% de educación secundaria completa y el 92,9% al menos se había realizado alguna vez una mamografía. Se realizó análisis factorial del IC y se eliminó uno de sus ítems. El alfa de Cronbach final fue 0,79. Conclusión El uso de instrumentos de medición requiere de su validación previa ya que la versión original puede variar de acuerdo al contexto cultural donde será aplicado y las necesidades locales particulares. El proceso de validación del IC permite contar con un instrumento confiable para medir la decisión de las mujeres que deben realizarse la mamografía en la dimensión conocimiento, actitud e intención hacia el examen.
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Affiliation(s)
- Paulina Bravo
- Departamento de Salud de la Mujer, Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile; School of Social Sciences, Cardiff University, Cardiff. Reino Unido
| | - Angelina Dois
- Departamento de Salud de Adulto y Senescente, Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - María José Hernández-Leal
- Facultat d'Economia i Empresa, Universitat Rovira i Virgili, Campus Bellissens, Reus, España; Research Centre on Industrial and Public Economic (CREIP) Reus, España
| | - Luis Villarroel
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Ríos JC, Villarroel L, Torres M, Astaburuaga JP, Leiva C, Cook P, Medel P, Cortés S. [Urinary heavy metals and blood lead levels among residents of Antofagasta, Chile]. Rev Med Chil 2021; 148:746-754. [PMID: 33480372 DOI: 10.4067/s0034-98872020000600746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 05/28/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The presence of toxic metals in human populations is strongly associated with chronic diseases. AIM To determine levels of lead, chromium, cadmium, mercury and inorganic arsenic (AsIn) in the general population aged over 5 years in Antofagasta, Chile. MATERIAL AND METHODS People living in Urban Antofagasta for at least five years were considered eligible. Biological samples were obtained to measure heavy metals. RESULTS One thousand two hundred three participants with a median age of 43 years (656 women) were studied. Their mean time of residence in the city was 30 years, and 52% smoked. Eight percent of the adult population and 12% of children had AsIn values above 35 µg/L, while 75% of the population had levels below 21.9 µg/L. The other metals were below the risk levels defined by the health authority (10 µg/L for chromium, 10 µg/L for mercury, 2 µg/L for cadmium, 5 and 10 μg/dL for blood lead for children and adults, respectively). The factors associated with high levels of AsIn in adults were male sex, living more than 200 meters from monitoring points, and low schooling. In children, the associated variables were high intake of seafood products and having a caregiver with less than 8 years of schooling. Contrary to expectations, the greatest risk of presenting altered levels of the metals occurred in the population living more than 500 meters from the identified risk sources (90% of the population). CONCLUSIONS The findings of this study suggest that all potential sources of exposure to AsIn should be evaluated, and surveillance actions should be established to reduce involuntary exposure to this metalloid.
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Affiliation(s)
- Juan Carlos Ríos
- Centro de Información Toxicológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marisa Torres
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Cinthya Leiva
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paz Cook
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricio Medel
- Centro de Información Toxicológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sandra Cortés
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Munoz-Osores E, Maldonado-Campos I, Olivares-Labbe MT, Villarroel L, Gana JC. Corticosteroids for Eosinophilic Esophagitis in Children: A Meta-analysis. Pediatrics 2020; 146:peds.2020-0874. [PMID: 33115796 DOI: 10.1542/peds.2020-0874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 12/11/2022] Open
Abstract
CONTEXT Treatment of eosinophilic esophagitis (EoE) is focused on dietary, pharmacologic, and endoscopic therapy options. Within the pharmacologic alternatives, topical corticosteroids are the most used, and a large number of studies evaluating their effectiveness have been published, requiring a new summary of evidence. OBJECTIVE To evaluate the histologic and clinical effectiveness of the use of corticosteroids in pediatric patients with a diagnosis of EoE. DATA SOURCES Cochrane Central Register of Controlled Trials, Medline, Embase, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, Latin American and Caribbean Health Sciences Literature, and ClinicalTrials.gov (June 2019). STUDY SELECTION We selected randomized controlled trials assessing corticosteroids versus a placebo or dietary treatment of EoE in children. DATA EXTRACTION Methodologic quality of evidence was evaluated by using the Cochrane Collaboration's risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system. The primary outcomes were clinical and histologic improvement. RESULTS A total of 1655 studies were identified. Five studies were included (206 patients). Histologic response was 49.25% in the corticosteroids group and 4.16% in the placebo group (risk ratio 11.05 [confidence interval 3.8-32.15]; P < .0001). Symptomatic response was 33.6% in the corticosteroids group and 21.8% in the control group (risk ratio 1.62 [confidence interval 0.94-2.79]; P = .08). There were no major adverse effects. LIMITATIONS Heterogeneity of the diagnosis of EoE. CONCLUSIONS Our review revealed favorable results of corticosteroids versus placebo, mainly in histologic response. More studies are needed, by using validated clinical scores, to obtain more reliable results.
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Affiliation(s)
| | | | | | | | - J C Gana
- Division of Pediatrics, .,Department of Gastroenterology and Nutrition, Escuela de Medicina, and
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Abarca K, Rey-Jurado E, Muñoz-Durango N, Vázquez Y, Soto JA, Gálvez NM, Valdés-Ferrada J, Iturriaga C, Urzúa M, Borzutzky A, Cerda J, Villarroel L, Madrid V, González PA, González-Aramundiz JV, Bueno SM, Kalergis AM. Safety and immunogenicity evaluation of recombinant BCG vaccine against respiratory syncytial virus in a randomized, double-blind, placebo-controlled phase I clinical trial. EClinicalMedicine 2020; 27:100517. [PMID: 33073219 PMCID: PMC7548429 DOI: 10.1016/j.eclinm.2020.100517] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/23/2020] [Accepted: 08/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is responsible for most respiratory tract infections and hospitalizations in infants and represents a significant economic burden for public health. The development of a safe, effective, and affordable vaccine is a priority for the WHO. METHODS We conducted a double-blinded, escalating-dose phase 1 clinical trial in healthy males aged 18-50 years to evaluate safety, tolerability, and immunogenicity of a recombinant Mycobacterium bovis BCG vaccine expressing the nucleoprotein of RSV (rBCG-N-hRSV). Once inclusion criteria were met, volunteers were enrolled in three cohorts in an open and successive design. Each cohort included six volunteers vaccinated with 5 × 103, 5 × 104, or 1 × 105 CFU, as well as two volunteers vaccinated with the full dose of the standard BCG vaccine. This clinical trial (clinicaltrials.gov NCT03213405) was conducted in Santiago, Chile. FINDINGS The rBCG-N-RSV vaccine was safe, well-tolerated, and no serious adverse events related to the vaccine were recorded. Serum IgG-antibodies directed against Mycobacterium and the N-protein of RSV increased after vaccination, which were capable of neutralizing RSV in vitro. Additionally, all volunteers displayed increased cellular response consisting of IFN-γ and IL-2 production against PPD and the N-protein, starting at day 14 and 30 post-vaccination respectively. INTERPRETATION The rBCG-N-hRSV vaccine had a good safety profile and induced specific cellular and humoral responses. FUNDING This work was supported by Millennium Institute on Immunology and Immunotherapy from Chile (P09/016), FONDECYT 1190830, and FONDEF D11E1098.
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Affiliation(s)
- Katia Abarca
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Enfermedades Infecciosas e Inmunología Pediátricas, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Corresponding authors at: Millennium Institute on Immunology and Immunotherapy. Pontificia Universidad Católica de Chile. Av. Libertador Bernardo O'Higgins No. 340, Santiago 8331010, Santiago, Chile.
| | - Emma Rey-Jurado
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Natalia Muñoz-Durango
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Endocrinología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yaneisi Vázquez
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge A. Soto
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás M.S. Gálvez
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Valdés-Ferrada
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Iturriaga
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Enfermedades Infecciosas e Inmunología Pediátricas, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcela Urzúa
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
| | - Arturo Borzutzky
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Enfermedades Infecciosas e Inmunología Pediátricas, División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime Cerda
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victoria Madrid
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo A. González
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José V. González-Aramundiz
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Farmacia, Facultad de Química y de Farmacia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susan M. Bueno
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Corresponding authors at: Millennium Institute on Immunology and Immunotherapy. Pontificia Universidad Católica de Chile. Av. Libertador Bernardo O'Higgins No. 340, Santiago 8331010, Santiago, Chile.
| | - Alexis M. Kalergis
- Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O'Higgins No. 340, Santiago, Chile
- Departamento de Endocrinología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
- Corresponding authors at: Millennium Institute on Immunology and Immunotherapy. Pontificia Universidad Católica de Chile. Av. Libertador Bernardo O'Higgins No. 340, Santiago 8331010, Santiago, Chile.
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D'Apremont I, Marshall G, Musalem C, Mariani G, Musante G, Bancalari A, Fabres J, Mena P, Zegarra J, Tavosnanska J, Lacarrubba J, Solana C, Vaz Ferreira C, Herrera T, Villarroel L, Tapia JL. Trends in Perinatal Practices and Neonatal Outcomes of Very Low Birth Weight Infants during a 16-year Period at NEOCOSUR Centers. J Pediatr 2020; 225:44-50.e1. [PMID: 32454113 DOI: 10.1016/j.jpeds.2020.05.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe trends in mortality, major morbidity, and perinatal care practices of very low birth weight infants born at NEOCOSUR Neonatal Network centers from January 1, 2001, through December 31, 2016. STUDY DESIGN A retrospective analysis of prospectively collected data from all inborn infants with a birthweight of 500-1500 g and 23-35 weeks of gestation. RESULTS We examined data for 13 987 very low birth weight infants with a mean birth weight of 1081 ± 281 g and a gestational age of 28.8 ± 2.9 weeks. Overall mortality was 26.8% without significant changes throughout the study period. Decreases in early onset sepsis from 6.3% to 2.8% (P <.001), late onset sepsis from 21.1% to 19.5% (P = .002), retinopathy of prematurity from 21.3% to 13.8% (P <.001), and hydrocephalus from 3.8% to 2.4% (P <.001), were observed. The incidence for bronchopulmonary dysplasia decreased from 17.3% to 16% (P = .043), incidence of severe intraventricular hemorrhage was 10.4%, necrotizing enterocolitis 11.1%, and periventricular leukomalacia 3.8%, and did not change over the study period. Administration of antenatal corticosteroids increased from 70.2% to 82.3% and cesarean delivery from 65.9% to 75.4% (P <.001). The use of conventional mechanical ventilation decreased from 67.7% to 63.9% (P <.001) and continuous positive airway pressure use increased from 41.3% to 64.3% (P <.001). Survival without major morbidity increased from 37.4% to 44.5% over the study period (P <.001). CONCLUSIONS Progress in perinatal and neonatal care at network centers was associated with an improvement in survival without major morbidity of very low birth weight infants during a 16-year period. However, overall mortality remained unchanged.
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Affiliation(s)
- Ivonne D'Apremont
- Department of Neonatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de, Chile; Neonatal Unit, Hospital Dr. Sotero del Río, Santiago, Chile
| | - Guillermo Marshall
- Departament of Public Health, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Claudia Musalem
- Department of Neonatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de, Chile
| | - Gonzalo Mariani
- Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Musante
- Maternal and Infant Department, Hospital Universitario Austral, Pilar, Argentina
| | - Aldo Bancalari
- Hospital Guillermo Grant, Concepción, Faculty of Medicine, Universidad de Concepción, Chile
| | - Jorge Fabres
- Department of Neonatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de, Chile
| | - Patricia Mena
- Department of Neonatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de, Chile; Neonatal Unit, Hospital Dr. Sotero del Río, Santiago, Chile
| | - Jaime Zegarra
- Department of Pediatrics, Universidad Cayetano Heredia, Lima, Perú
| | - Jorge Tavosnanska
- Hospital Juan Fernández and Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Claudio Solana
- Division of Neonatology, Hospital RamSardá, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Catalina Vaz Ferreira
- Department of Neonatology, Centro Hospitalario Pereira Rossell, Universidad de la República, Montevideo, Uruguay
| | - Tamara Herrera
- Department of Neonatology, Centro Hospitalario Pereira Rossell, Universidad de la República, Montevideo, Uruguay
| | - Luis Villarroel
- Departament of Public Health, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - José L Tapia
- Department of Neonatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago de, Chile.
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Aguayo GA, Schritz A, Ruiz-Castell M, Villarroel L, Valdivia G, Fagherazzi G, Witte DR, Lawson A. Identifying hotspots of cardiometabolic outcomes based on a Bayesian approach: The example of Chile. PLoS One 2020; 15:e0235009. [PMID: 32569307 PMCID: PMC7307745 DOI: 10.1371/journal.pone.0235009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is a need to identify priority zones for cardiometabolic prevention. Disease mapping in countries with high heterogeneity in the geographic distribution of the population is challenging. Our goal was to map the cardiometabolic health and identify hotspots of disease using data from a national health survey. METHODS Using Chile as a case study, we applied a Bayesian hierarchical modelling. We performed a cross-sectional analysis of the 2009-2010 Chilean Health Survey. Outcomes were diabetes (all types), obesity, hypertension, and high LDL cholesterol. To estimate prevalence, we used individual and aggregated data by province. We identified hotspots defined as prevalence in provinces significantly greater than the national prevalence. Models were adjusted for age, sex, their interaction, and sampling weight. We imputed missing data. We applied a joint outcome modelling approach to capture the association between the four outcomes. RESULTS We analysed data from 4,780 participants (mean age (SD) 46 (19) years; 60% women). The national prevalence (percentage (95% credible intervals) for diabetes, obesity, hypertension and high LDL cholesterol were 10.9 (4.5, 19.2), 30.0 (17.7, 45.3), 36.4 (16.4, 57.6), and 13.7 (3.4, 32.2) respectively. Prevalence of diabetes was lower in the far south. Prevalence of obesity and hypertension increased from north to far south. Prevalence of high LDL cholesterol was higher in the north and south. A hotspot for diabetes was located in the centre. Hotspots for obesity were mainly situated in the south and far south, for hypertension in the centre, south and far south and for high LDL cholesterol in the far south. CONCLUSIONS The distribution of cardiometabolic risk factors in Chile has a characteristic pattern with a general trend to a north-south gradient. Our approach is reproducible and demonstrates that the Bayesian approach enables the accurate identification of hotspots and mapping of disease, allowing the identification of areas for cardiometabolic prevention.
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Affiliation(s)
- Gloria A. Aguayo
- Population Health Department, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Anna Schritz
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Maria Ruiz-Castell
- Population Health Department, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gonzalo Valdivia
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Guy Fagherazzi
- Population Health Department, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Daniel R. Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Andrew Lawson
- Department of Public Health Sciences, Medical University of South Carolina, South Carolina, Charleston, United States of America
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Martínez X, Zapata Y, Pinto V, Cornejo C, Elbers M, van der Graaf M, Villarroel L, Hodgson MI, Rigotti A, Echeverría G. Intake of Non-Nutritive Sweeteners in Chilean Children after Enforcement of a New Food Labeling Law that Regulates Added Sugar Content in Processed Foods. Nutrients 2020; 12:nu12061594. [PMID: 32485840 PMCID: PMC7352803 DOI: 10.3390/nu12061594] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 12/16/2022] Open
Abstract
After enforcement of a new food labeling law in 2016, Chile exhibits a greater offer to reduced sugar products with addition of non-nutritive sweeteners (NNS). Many of these products are consumed by children, who are at greater risk of reaching the acceptable daily intake (ADI) of these food additives. The objective of this study was to evaluate the intake levels of NNS in Chilean schoolchildren after the enactment of the aforementioned law. A total of 250 Chilean children 6-12 years old were surveyed. NNS intake was assessed through a food frequency questionnaire. All children evaluated consumed at least one NNS during the previous month. Sucralose had the highest consumption frequency reaching 99.2%, followed by acesulfame-K (92.8%), stevia (86.0%), and aspartame (85.2%). Aspartame showed the highest median intake, which came mainly from beverages (96%). No children exceeded the ADI of any NNS. Smaller children exhibited a higher body weight-adjusted intake of sucralose, acesulfame-K, stevia, and aspartame (p < 0.05). In Chile, a wide range of processed foods with NNSs is available and all schoolchildren evaluated consumed at least one product containing NNS. However, this consumption does not exceed defined ADIs for any of the six sweeteners authorized for food use in Chile.
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Affiliation(s)
- Ximena Martínez
- Center for Molecular Nutrition and Chronic Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins, Región Metropolitana, 340 Santiago, Chile; (X.M.); (Y.Z.); (V.P.); (C.C.); (M.E.); (M.v.d.G.); (A.R.)
| | - Yazmín Zapata
- Center for Molecular Nutrition and Chronic Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins, Región Metropolitana, 340 Santiago, Chile; (X.M.); (Y.Z.); (V.P.); (C.C.); (M.E.); (M.v.d.G.); (A.R.)
| | - Victoria Pinto
- Center for Molecular Nutrition and Chronic Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins, Región Metropolitana, 340 Santiago, Chile; (X.M.); (Y.Z.); (V.P.); (C.C.); (M.E.); (M.v.d.G.); (A.R.)
| | - Camila Cornejo
- Center for Molecular Nutrition and Chronic Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins, Región Metropolitana, 340 Santiago, Chile; (X.M.); (Y.Z.); (V.P.); (C.C.); (M.E.); (M.v.d.G.); (A.R.)
| | - Martje Elbers
- Center for Molecular Nutrition and Chronic Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins, Región Metropolitana, 340 Santiago, Chile; (X.M.); (Y.Z.); (V.P.); (C.C.); (M.E.); (M.v.d.G.); (A.R.)
- Hanzehogeschool Groningen, University of Applied Sciences, 9747 AS Groningen, The Netherlands
| | - Maaike van der Graaf
- Center for Molecular Nutrition and Chronic Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins, Región Metropolitana, 340 Santiago, Chile; (X.M.); (Y.Z.); (V.P.); (C.C.); (M.E.); (M.v.d.G.); (A.R.)
- Hanzehogeschool Groningen, University of Applied Sciences, 9747 AS Groningen, The Netherlands
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins 340, Santiago, Región Metropolitana, Chile;
| | - María Isabel Hodgson
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins 340, Santiago, Región Metropolitana, Chile;
| | - Attilio Rigotti
- Center for Molecular Nutrition and Chronic Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins, Región Metropolitana, 340 Santiago, Chile; (X.M.); (Y.Z.); (V.P.); (C.C.); (M.E.); (M.v.d.G.); (A.R.)
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins 340, Santiago, Región Metropolitana, Chile;
| | - Guadalupe Echeverría
- Center for Molecular Nutrition and Chronic Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins, Región Metropolitana, 340 Santiago, Chile; (X.M.); (Y.Z.); (V.P.); (C.C.); (M.E.); (M.v.d.G.); (A.R.)
- Department of Nutrition, Diabetes and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile, Av. Libertador Bernardo O’Higgins 340, Santiago, Región Metropolitana, Chile;
- Correspondence: ; Tel.: +56-2-2354-2837
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18
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Alé MC, Echeverría G, Jugo A, Villarroel L, Maiz A, Rigotti A. [Non-HDL cholesterol levels in Chilean population and their association with diabetes mellitus and cardiovascular disease]. Rev Med Chil 2020; 147:1365-1373. [PMID: 32186596 DOI: 10.4067/s0034-98872019001101365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022]
Abstract
Background Despite aggressive treatment aimed at lowering LDL cholesterol (LDL-C) levels with statins, there is a high residual prevalence of cardiovascular diseases, which may depend on plasma cholesterol transported in other atherogenic lipoproteins. Aims To describe non-HDL cholesterol (non-HDL-C) levels in the Chilean population and their association with diabetes mellitus and cardiovascular disease. To evaluate compliance with non-HDL-C therapeutic goals -according to individual cardiovascular risk- at different levels of triglycerides, in comparison with LDL-C goal achievement. Material and Methods: We analyzed data from 2,792 Chilean subjects aged ≥ 15 years who were included in the 2009-2010 National Health Survey and had valid data for blood lipids, diabetes, and cardiovascular disease. Results Forty five percent of subjects had high non-HDL-C levels. The proportion of diabetic and non-diabetic subjects with high non-HDL-C levels was 81 and 42%, respectively (p < 0.01). A significant discordance was observed in the achievement of therapeutic objectives when LDL-C or non-HDL-C levels were considered, particularly in presence of triglycerides ≥ 150 mg/dl. Namely, 8% of the population showed elevated levels of high non-HDL-C despite adequate LDL-C levels. Conclusions Evaluation and management of elevated non-HDL-C in patients with adequate levels of LDL-C seems worthwhile considering the discordance observed between these blood cholesterol fractions. This strategy may be effective to reduce the residual cardiovascular risk in the Chilean population.
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Affiliation(s)
- María Consuelo Alé
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Guadalupe Echeverría
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Aranzazu Jugo
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alberto Maiz
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Attilio Rigotti
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Sapag JC, Klabunde R, Villarroel L, Velasco PR, Álvarez C, Parra C, Bobbili SJ, Mascayano F, Bustamante I, Alvarado R, Corrigan P. Validation of the Opening Minds Scale and patterns of stigma in Chilean primary health care. PLoS One 2019; 14:e0221825. [PMID: 31487333 PMCID: PMC6728029 DOI: 10.1371/journal.pone.0221825] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/15/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Stigma toward people with mental health problems (MHP) in primary health care (PHC) settings is an important public health challenge. Research on stigma toward MHP is relatively scarce in Chile and Latin America, as are instruments to measure stigma that are validated for use there. The present study aims to validate the Opening Minds Scale for Health Care Professionals (OMS-HC) among staff and providers in public Chilean PHC clinics, and examine differences in stigma by sociodemographic characteristics. METHODS 803 participants from 34 PHC clinics answered a self-administered questionnaire. Confirmatory factor analysis was completed. Average 15-item OMS-HC scores were calculated, and means were compared via t-test or ANOVA to identify group differences. Correlations of OMS-HC scores with other commonly used stigma scores were calculated to evaluate construct validity. RESULTS The 3-factor OMS-HC structure was confirmed in this population. The average OMS-HC (α = 0.69) score was 34.55 (theoretical range 15-75). Significantly lower (less stigmatizing) mean OMS-HC scores were found in those with additional training and/or personal experience with MHP. CONCLUSION The validated, Spanish version of OMS-HC can be of use to further research stigma toward MHP in Chile and Latin America, advancing awareness and inspiring interventions to reduce stigma in the future.
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Affiliation(s)
- Jaime C. Sapag
- Department of Public Health, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- WHO/PAHO Collaborating Centre, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Ontario, Canada
| | - Rachel Klabunde
- Department of Public Health, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paola R. Velasco
- Department of Public Health, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cinthia Álvarez
- Department of Public Health, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Parra
- Department of Public Health, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sireesha J. Bobbili
- WHO/PAHO Collaborating Centre, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Ontario, Canada
| | - Franco Mascayano
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York City, New York, United States of America
| | - Inés Bustamante
- Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rubén Alvarado
- Mental Health Program, School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Institute of Health Sciences, Universidad O’Higgins, Rancagua, Chile
| | - Patrick Corrigan
- Department of Psychology, Lewis College of Human Sciences, Illinois Institute of Technology, Chicago, Illinois, United States of America
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20
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Serrano CA, Ling SC, Verdaguer S, León M, Jarufe N, Guerra JF, Pattillo JC, Benítez C, Villagrán A, Torres J, Concha M, Villarroel L, Dellepiane P, Domínguez P, Martínez J, Gana JC. Portal Angiogenesis in Chronic Liver Disease Patients Correlates with Portal Pressure and Collateral Formation. Dig Dis 2019; 37:498-508. [PMID: 31067534 DOI: 10.1159/000500115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/03/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND/AIMS One hallmark of chronic liver disease in patients with portal hypertension is the formation of portal-systemic collaterals in which angiogenesis has a fundamental role. We studied patients with chronic liver disease undergoing liver transplantation to correlate levels of circulating angiogenic factors in portal and peripheral circulation with portal pressure and portal-systemic collaterals. METHODS Sixteen patients who underwent liver transplantation were enrolled. During transplant surgery, we determined portal venous pressure and portal-systemic collateral formation. We determined angiogenics mediator levels in systemic and portal plasma. Peripheral plasma from healthy donors was measured as controls. RESULTS Vascular endothelial growth factor (VEGF)-R1 and 2, Ang-1 and 2, Tie2, FGF- 1 and 2, CD163, PDGFR-β, PDGFsRα, PDGF-AB and BB, CD163, TGF-β VASH-1 levels were significantly different in the controls in comparison to cases. Significantly decreased portal venous levels of Ang-1, FGF-1, PDGF-AB/BB, and CC were observed in patients with higher portal pressure. Peripheral VEGF, Ang-1, pPDGF-AB, BB, and CC were significantly decreased in patients with more severe collateral formation. While peripheral VEGF-R1 was higher in patients with severe collateral formation. For portal circulation, VEGF, Ang-1, -pPDGF-AB, BB, and CC were significantly decreased in patients with more severe collateral formation Conclusions: Angiogenesis factors correlated with portal pressure and collateral formation and different patterns of circulating angiogenesis mediators were found in peripheral and portal blood of patients with chronic liver disease. These results support the importance of angiogenic pathways in cirrhosis and portal hypertension and highlight areas for further study to identify clinically useful noninvasive markers of portal pressure and collateral formation.
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Affiliation(s)
- Carolina A Serrano
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Simon C Ling
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sofia Verdaguer
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Miguel León
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Jarufe
- Digestive Surgery Department, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Francisco Guerra
- Digestive Surgery Department, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Carlos Pattillo
- Pediatric Surgery Section, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Benítez
- Department of Gastroenterology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrea Villagrán
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Torres
- Pathology Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mario Concha
- Anesthesiology Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Dellepiane
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pilar Domínguez
- Digestive Surgery Department, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Martínez
- Digestive Surgery Department, Surgery Division, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Cristóbal Gana
- Department of Pediatric Gastroenterology and Nutrition, Division of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile,
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Bustamante-Ara N, Villarroel L, Paredes F, Huidobro A, Ferreccio C. Frailty and health risks in an agricultural population, Chile 2014–2017. Arch Gerontol Geriatr 2019; 82:114-119. [DOI: 10.1016/j.archger.2019.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 01/20/2023]
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Pinto V, Landaeta-Díaz L, Castillo O, Villarroel L, Rigotti A, Echeverría G, Study Group E. Assessment of Diet Quality in Chilean Urban Population through the Alternate Healthy Eating Index 2010: A Cross-Sectional Study. Nutrients 2019; 11:nu11040891. [PMID: 31010023 PMCID: PMC6521181 DOI: 10.3390/nu11040891] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 01/10/2023] Open
Abstract
Most worldwide causes of disease and death are strongly associated with dietary factors and the application of eating indexes has proved to be a useful tool to determine diet quality in populations. The aim of this study was to evaluate the diet quality in Chile through the application of the Alternate Healthy Eating Index 2010 (AHEI-2010). A representative sample (n = 879) of Chilean urban population aged 15–65 years old from the Latin American Study of Nutrition and Health (Estudio Latinoamericano de Nutrición y Salud; ELANS) was used. Dietary intake data were obtained through two 24-hour food recalls and one beverage frequency questionnaire, which were used to calculate AHEI-2010 and its association with sociodemographic and anthropometric variables. In this Chilean sample, the AHEI-2010 score was 43.7 ± 7.8 points (mean ± SD). Trans fats and sodium intake were the highest scoring AHEI-2010 components whereas sugar-sweetened beverages and whole grains had the lowest score. Women, older subjects, and individuals in medium-high socioeconomic levels had significantly higher mean AHEI-2010 scores. No association was found between AHEI-2010 and body mass index (BMI), or nutritional status. Conclusions: Diet quality in the Chilean urban population aged 15–65 years old is far from optimal. Thus, there is room for significant improvement of diet quality in Chile through design and implementation of public health policies, particularly in high-risk groups for chronic diseases.
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Affiliation(s)
- Victoria Pinto
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330033, Chile.
| | | | - Oscar Castillo
- Escuela de Nutrición, Universidad Finis Terrae, Santiago 7501015, Chile.
| | - Luis Villarroel
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile.
| | - Attilio Rigotti
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330033, Chile.
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile.
| | - Guadalupe Echeverría
- Centro de Nutrición Molecular y Enfermedades Crónicas, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330033, Chile.
- Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile.
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Herrera TI, Vaz Ferreira MC, Toso A, Villarroel L, Silvera F, Ceriani-Cernadas JM, Tapia JL. Neonatal outcomes of antenatal corticosteroids in preterm multiple pregnancies compared to singletons. Early Hum Dev 2019; 130:44-50. [PMID: 30665038 DOI: 10.1016/j.earlhumdev.2019.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Antenatal corticosteroids (ACS) during preterm labour reduce neonatal mortality and morbidity. Evidence on preterm multiple pregnancies is limited and contradictory. OBJECTIVE Compare the effect of ACS on very low birth weight infant's (VLBW) mortality and morbidity among singleton and multiple pregnancies. STUDY DESIGN Retrospective cohort study, employing prospectively collected data, of infants 23 to 34 weeks' gestation and 500 to 1500 g born at the Neocosur Neonatal Network centers during 2007-2016. Neonatal outcomes were compared among singleton and multiple pregnancies exposed to at least one dose of ACS to those not exposed using logistic regression analyses controlled for birthweight, gestational age, sex, small for gestational age (SGA) and mode of delivery. RESULTS A total of 13,864 infants were studied; 2948 multiple (21.3%) and 10,904 singleton pregnancies (78.7%). Overall, 11,218 (81.4%) received at least one dose of ACS with a significant reduction in the risk of death, RDS and grade III or IV IVH compared to those not exposed. Both singleton and multiple pregnancies exposed to ACS showed similar reduced risk of death (aRR 0.41 [95% CI, 0.36-0.47] vs. aRR 0.46 [95% CI, 0.34-0.64]). However, ACS were not associated with reduced odds of RDS (aRR 0.89 [95% CI, 0.66-1.23]) or grade III or IV IVH (aRR 0.99 [95% CI, 0.67-1.48]) in multiple pregnancies. CONCLUSION The benefit of administration of at least one dose of ACS in VLBW multiple and singleton pregnancies is comparable in terms of death. However, ACS showed no relevant impact in short-term morbidity in multiple pregnancies.
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Affiliation(s)
- Tamara I Herrera
- Departamento de Neonatología, Centro Hospitalario Pereira Rossell, Universidad de la República, Montevideo, Uruguay.
| | - María C Vaz Ferreira
- Departamento de Neonatología, Centro Hospitalario Pereira Rossell, Universidad de la República, Montevideo, Uruguay
| | - Alberto Toso
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Fernando Silvera
- Departamento de Neonatología, Centro Hospitalario Pereira Rossell, Universidad de la República, Montevideo, Uruguay
| | | | - José L Tapia
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
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24
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Karzulovic L, García P, Wozniak A, Villarroel L, Hirsch T, Concha I, Catalán S, Cifuentes L. [Does a clinical prediction rule anticipate the diagnosis for streptococcal pharyngitis in children aged 2 to 15?]. Rev Chilena Infectol 2019; 35:476-482. [PMID: 30724993 DOI: 10.4067/s0716-10182018000500476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 07/27/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The etiology of a streptococcal pharyngitis must be documented by laboratory techniques to avoid unnecessary antimicrobial treatment, but this strategy increases cost for the patient. Available scores applied in children or adults are imperfect. AIM To develop a clinical prediction rule to aid the diagnostic process of streptococcal pharyngitis (SP) in children in a low-resource setting. METHODS Three hundred and eighteen patients aged 2 to 15 years who were evaluated for suspected SP at the Pediatric Emergency Department and the Pediatric Ambulatory Unit of Red Salud UC-Christus entered the study. A throat culture and a rapid antigen detection test for Streptococcus pyogenes were obtained from each patient. Data were analyzed for possible clinical predictors of SP with univariate and multiple regression analyses. RESULTS Seventy-three cases of SP were diagnosed (23.9%). In the univariate analysis, fever was inversely associated with SP (p = 0.002). Odynophagia, palatal petechiae, and season of the year (autumn and winter) were positively associated with SP (p = 0.007, p < 0.001 and p = 0.03 respectively). In multiple regression analysis the models did not have sufficient power to predict streptococcal etiology. CONCLUSION Clinical predictors, even those systematically included in clinical prediction rules, did not show sufficient predictive power to safely include or exclude SP in this setting, and thus, it is necessary to improve access to confirmatory tests.
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Affiliation(s)
- Lorena Karzulovic
- Departamento de Pediatría, Escuela de Medicina, Universidad Católica de Chile, Santiago, Chile
| | - Patricia García
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Aniela Wozniak
- Departamento de Laboratorios Clínicos, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tamara Hirsch
- Departamento de Pediatría, Escuela de Medicina, Universidad Católica de Chile, Santiago, Chile
| | - Ida Concha
- Departamento de Pediatría, Escuela de Medicina, Universidad Católica de Chile, Santiago, Chile
| | - Silvia Catalán
- Departamento de Pediatría, Escuela de Medicina, Universidad Católica de Chile, Santiago, Chile
| | - Lorena Cifuentes
- Departamento de Pediatría, Escuela de Medicina, Universidad Católica de Chile, Santiago, Chile
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Bravo P, Dois A, Hernández MJ, Villarroel L. Conflicto decisional en personas con diabetes mellitus e hipertensión arterial usuarias del nivel primario de atención de salud de Chile. Rev Med Chil 2018; 146:1286-1293. [DOI: 10.4067/s0034-98872018001101286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022]
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26
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Alé MC, Echeverría G, Jugo A, Villarroel L, Maiz A, Rigotti A. Levels of Non-high Density Lipoprotein Cholesterol and Association with Diabetes Mellitus and Cardiovascular Disease in the Chilean Population. ATHEROSCLEROSIS SUPP 2018. [DOI: 10.1016/j.atherosclerosissup.2018.04.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Oyarzún MF, Barja S, Domínguez MA, Villarroel L, Arnaiz P, Mardones F. [Breastfeeding, obesity and metabolic syndrome at school age]. ACTA ACUST UNITED AC 2018; 89:173-181. [PMID: 29799883 DOI: 10.4067/s0370-41062018000200173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/04/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Breastfeeding (BF) can be a protective factor against obesity and its associated metabolic complications. OBJECTIVE To determine the association between breastfeeding history and present obesity, metabolic syndrome (MS) and insulin resistance (IR). PATIENTS AND METHODS Cross-sectio nal study in 20 public schools in Santiago, Chile. Anthropometry and blood pressure were assessed. Blood lipids, glucose, insulin and HOMA index were measured in a fast blood sample. Parents answe red a survey on BF. MS was defined according to Cook's criteria and IR as HOMA > 90th percentile. Parents answered a survey about the antecedent of breastfeeding. Chi2 and Fischer tests were used (SSPS). RESULTS 3,278 surveys were valid. Average age: 11.4 ± 1 years, 52.3% were female. Most of them (98.2%) were breasted, with a 15.9% prevalence of obesity versus 18.6% in the group that was not breastfed (p = 0.039). There was a non-significant trend of higher prevalence in MS and its components (except IR) in the non-breastfed group. The group breastfed from three to six months had a lower prevalence of obesity and MS components than the 0 to 3 months group ; the effect was the opposite when BF lsted longer than nine months. CONCLUSIONS The prevalence of obesity was higher in children that did not received breastfeeding. A longer breastfeeding time during the first semester of life was associated with lower prevalence of obesity and metabolic complications.
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Affiliation(s)
| | - Salesa Barja
- Departamento de Gastroenterología y Nutrición Pediátrica, División de Pediatría. Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | | | - Luis Villarroel
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pilar Arnaiz
- División de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Francisco Mardones
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
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Reyes MM, de Lima L, Taboada P, Villarroel L, Vial JDD, Blanco O, González R, Parra I, Toledo G, Bonati P, Nervi F. [A scale to assess spiritual symptoms in palliative care]. Rev Med Chil 2017; 145:747-754. [PMID: 29171623 DOI: 10.4067/s0034-98872017000600747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/03/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Liliana de Lima
- Association for Hospice and Palliative Care, Houston, Texas, USA
| | - Paulina Taboada
- Centro de Bioética, Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Rina González
- Departamento Salud del Niño y Adolescente, Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Pilar Bonati
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Flavio Nervi
- Departamento Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
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29
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Bravo P, Contreras A, Dois A, Villarroel L. [Adapting and validating the generic instrument CollaboRATE™ to measure women's participation in health related decision-making during the reproductive process]. Aten Primaria 2017; 50:274-281. [PMID: 28760344 PMCID: PMC6836994 DOI: 10.1016/j.aprim.2017.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 03/05/2017] [Accepted: 04/10/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION There is a worldwide interest in involving patients in health related decisions, so patients can actively search for therapeutic options and choose course of action that allows them to have better quality of life and wellbeing. The majority of the instruments available to capture the degree of participation in medical decision-making are in English and have been developed in high income countries. OBJECTIVE To adapt and validate for the Chilean context the instrument CollaboRATE™, to measure women's participation in medical decisions during the reproductive process. DESIGN Cross-sectional study to adapt and validate the instrument CollaboRATE™. LOCATION Maternity units in Santiago, Chile. PARTICIPANTS Puerperal women in maternity units of three public hospitals. METHOD Translation and back-translation, cultural and linguistic relevance with service users and final revision by experts. Study for validation with 90 puerperal women. RESULTS The Chilean version of CollaboRATE™ demonstrated to be a reliable instrument to capture the degree of patients' participation in medical decision-making. Cronbach alpha was above 0.89. CONCLUSIONS This study provides the first instrument to capture the prevalence of SDM in a Latin American country. This instrument will be critical in future research efforts that seek to explore to what extent people are being involved in the decisions related to their healthcare.
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Affiliation(s)
- Paulina Bravo
- Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile; School of Social Sciences, Cardiff University, Cardiff, Reino Unido.
| | - Aixa Contreras
- Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Angelina Dois
- Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Poblete F, Barticevic NA, Zuzulich MS, Portilla R, Castillo-Carniglia A, Sapag JC, Villarroel L, Sena BF, Galarce M. A randomized controlled trial of a brief intervention for alcohol and drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in primary health care in Chile. Addiction 2017; 112:1462-1469. [PMID: 28239995 DOI: 10.1111/add.13808] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/11/2016] [Accepted: 02/20/2017] [Indexed: 11/28/2022]
Abstract
AIM To study the effectiveness of a brief intervention (BI) associated with the ASSIST (Alcohol Smoking and Substance Involvement Screening Test) for alcohol and illicit drug use as part of a systematic screening program implemented in primary care. DESIGN A multi-center randomized open-label trial stratified using the ASSIST-specific substance involvement score (for alcohol, scores ranged from 11 to 15 and 16 to 20; and for the other substances from 4 to 12 and 13 to 20). SETTING A total of 19 primary care centers (n = 520), eight emergency rooms (n = 195) and five police stations (n = 91) were evaluated. PARTICIPANTS A total of 12 217 people aged between 19 and 55 years were screened for moderate alcohol and drug use risk as defined by the ASSIST Chilean version. A total of 806 non-treatment-seekers were randomized. INTERVENTION AND COMPARISON ASSIST-linked BI (n = 400) compared with an informational pamphlet on risk associated with substance use (n = 406). MEASUREMENTS Total ASSIST alcohol and illicit involvement score (ASSIST-AI), and ASSIST-specific score for alcohol, cannabis and cocaine at baseline and at 3-month follow-up. FINDINGS Sixty-two per cent of participants completed follow-up. An intention-to-treat analysis showed no difference between the two groups for the ASSIST-AI score [mean difference (MD) = - 0.17, confidence interval (CI) = -1.87, 2.20], either for specific scores alcohol (MD = 0.18, CI = -1.45, 1.10), cannabis (MD = -0.62, CI = -0.89, 2.14) or cocaine (MD = -0.79, CI = -2.89, 4.47). CONCLUSION It is not clear whether a brief intervention associated with the Alcohol Smoking and Substance Involvement Screening Test is more effective than an informational pamphlet in reducing alcohol and illicit substance consumption in non-treatment-seeking, primary care users with moderate risk.
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Affiliation(s)
- Fernando Poblete
- School of Medicine, Department of Public Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolas A Barticevic
- School of Medicine, Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria Soledad Zuzulich
- School of Medicine, Nursing School, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Portilla
- Research Department, National Service for Prevention and Rehabilitation of Drug and Alcohol Consumption, Santiago, Chile
| | - Alvaro Castillo-Carniglia
- Department of Emergency Medicine, UC Davis School of Medicine, Violence Prevention Research Program, Sacramento, CA, USA
| | - Jaime C Sapag
- School of Medicine, Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- School of Medicine, Department of Public Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Brena F Sena
- Columbia University School of Public Health, New York, NY, USA
| | - Magdalena Galarce
- School of Medicine, Center for Study of Addiction, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Arellano G, Acuña E, Reyes LI, Ottum PA, De Sarno P, Villarroel L, Ciampi E, Uribe-San Martín R, Cárcamo C, Naves R. Th1 and Th17 Cells and Associated Cytokines Discriminate among Clinically Isolated Syndrome and Multiple Sclerosis Phenotypes. Front Immunol 2017; 8:753. [PMID: 28713377 PMCID: PMC5491887 DOI: 10.3389/fimmu.2017.00753] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 06/13/2017] [Indexed: 12/02/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic, inflammatory, and demyelinating disease of the central nervous system. It is a heterogeneous pathology that can follow different clinical courses, and the mechanisms that underlie the progression of the immune response across MS subtypes remain incompletely understood. Here, we aimed to determine differences in the immunological status among different MS clinical subtypes. Blood samples from untreated patients diagnosed with clinically isolated syndrome (CIS) (n = 21), different clinical forms of MS (n = 62) [relapsing–remitting (RRMS), secondary progressive, and primary progressive], and healthy controls (HCs) (n = 17) were tested for plasma levels of interferon (IFN)-γ, IL-10, TGF-β, IL-17A, and IL-17F by immunoanalysis. Th1 and Th17 lymphocyte frequencies were determined by flow cytometry. Our results showed that IFN-γ levels and the IFN-γ/IL-10 ratio were higher in CIS patients than in RRMS patients and HC. Th1 cell frequencies were higher in CIS and RRMS than in progressive MS, and RRMS had a higher Th17 frequency than CIS. The Th1/Th17 cell ratio was skewed toward Th1 in CIS compared to MS phenotypes and HC. Receiver operating characteristic statistical analysis determined that IFN-γ, the IFN-γ/IL-10 ratio, Th1 cell frequency, and the Th1/Th17 cell ratio discriminated among CIS and MS subtypes. A subanalysis among patients expressing high IL-17F levels showed that IL-17F and the IFN-γ/IL-17F ratio discriminated between disease subtypes. Overall, our data showed that CIS and MS phenotypes displayed distinct Th1- and Th17-related cytokines and cell profiles and that these immune parameters discriminated between clinical forms. Upon validation, these parameters might be useful as biomarkers to predict disease progression.
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Affiliation(s)
- Gabriel Arellano
- School of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
| | - Eric Acuña
- School of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
| | - Lilian I Reyes
- Faculty of Science, Universidad San Sebastián, Santiago, Chile
| | - Payton A Ottum
- School of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
| | - Patrizia De Sarno
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Luis Villarroel
- Department of Public Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ethel Ciampi
- Department of Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Neurology Service, Hospital Sotero del Río, Santiago, Chile
| | - Reinaldo Uribe-San Martín
- Department of Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile.,Neurology Service, Hospital Sotero del Río, Santiago, Chile
| | - Claudia Cárcamo
- Department of Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Naves
- School of Medicine, Institute of Biomedical Sciences (ICBM), Universidad de Chile, Santiago, Chile
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Brockmann PE, Gozal D, Villarroel L, Damiani F, Nuñez F, Cajochen C. Geographic latitude and sleep duration: A population-based survey from the Tropic of Capricorn to the Antarctic Circle. Chronobiol Int 2017; 34:373-381. [DOI: 10.1080/07420528.2016.1277735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Pablo E. Brockmann
- Department of Pediatric Cardiology and Pulmonology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Sleep Medicine Center, Department of Neurology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - David Gozal
- Sections of Pediatric Sleep Medicine and Pulmonology, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - Luis Villarroel
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Damiani
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Nuñez
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
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Ruiz-Vásquez L, Olmeda AS, Zúñiga G, Villarroel L, Echeverri LF, González-Coloma A, Reina M. Insect Antifeedant and Ixodicidal Compounds from Senecio adenotrichius. Chem Biodivers 2016; 14. [DOI: 10.1002/cbdv.201600155] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/19/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Liliana Ruiz-Vásquez
- Instituto de Productos Naturales y Agrobiología (IPNA) (CSIC); ES-38206 La Laguna, Tenerife Spain
| | | | - Gustavo Zúñiga
- Facultad de Química y Biología; Universidad de Santiago de Chile (USACH); Santiago Chile
| | - Luis Villarroel
- Facultad de Química y Biología; Universidad de Santiago de Chile (USACH); Santiago Chile
| | - Luis Fernando Echeverri
- Facultad de Ciencias Exactas y Naturales; Instituto de Química; Universidad de Antioquia; Medellín Colombia
| | | | - Matías Reina
- Instituto de Productos Naturales y Agrobiología (IPNA) (CSIC); ES-38206 La Laguna, Tenerife Spain
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Echeverría G, Urquiaga I, Concha MJ, Dussaillant C, Villarroel L, Velasco N, Leighton F, Rigotti A. Validación de cuestionario autoaplicable para un índice de alimentación mediterránea en Chile. Rev Med Chil 2016; 144:1531-1543. [DOI: 10.4067/s0034-98872016001200004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/14/2016] [Indexed: 11/17/2022]
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Balcells ME, García P, Tiznado C, Villarroel L, Scioscia N, Carvajal C, Zegna-Ratá F, Peña C, Naves R. Vitamin D Deficiency and Latent Tuberculosis Infection Risk Among Tuberculosis Household Contacts. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- María Elvira Balcells
- Infectious Diseases Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricia García
- Clinical Laboratory Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Tiznado
- Clinical Laboratory Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Villarroel
- Public Health Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Natalia Scioscia
- Clinical Laboratory Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camila Carvajal
- Infectious Diseases Department/Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francesca Zegna-Ratá
- Infectious Diseases Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Peña
- Respiratory Department, Hospital San Borja Arriarán, Santiago, Chile
| | - Rodrigo Naves
- Instituto De Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
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Neira V, Corbalán R, Pereira J, Panes O, Garayar B, Aizman A, Llevaneras S, Villarroel L. Evaluación de la anticoagulación con rivaroxaban, en pacientes con fibrilación auricular no valvular de reciente diagnóstico. Rev Med Chil 2016; 144:1103-1111. [DOI: 10.4067/s0034-98872016000900002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/12/2016] [Indexed: 11/17/2022]
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Barrera F, Azócar L, Molina H, Schalper KA, Ocares M, Liberona J, Villarroel L, Pimentel F, Pérez-Ayuso RM, Nervi F, Groen AK, Miquel JF. Effect of cholecystectomy on bile acid synthesis and circulating levels of fibroblast growth factor 19. Ann Hepatol 2016; 14:710-21. [PMID: 26256900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED Background and rationale for the study. FGF19/15 is a gut-derived hormone presumably governing bile acid (BA) synthesis and gallbladder (GB) refilling. FGF19 mRNA is present in human GB cholangiocytes (hGBECs); however, the physiological significance of GB-derived FGF19 remains unknown. We investigated whether hGBECs secrete FGF19 and the effects of cholecystectomy on serum FGF19 ([FGF19]s) and BA synthesis. MATERIAL AND METHODS FGF19 expression was assessed by qRT-PCRs and immunostaining in hGBECs and terminal ileum, and quantified in bile and serum by ELISA. Basal and BA (chenodexycholic acid, CDCA) induced FGF19 expression and secretion was analyzed in primary cultured hGBECs and GB-d1 cell line. Pre and postprandial serum changes in [FGF19]s, 7α-hydroxy-4-cholestene-3-one (C4, a marker of BA synthesis) and BA were evaluated in plasma of gallstone disease patients at baseline and after cholecystectomy. RESULTS FGF19 mRNA levels were ~250-fold higher in hGBECs compared to distal ileum. GB bile contained ~23-fold higher FGF19 levels compared to serum (p < 0.0001). CDCA induced dose-dependent expression and secretion of FGF19 in hGBECs and GB-d1 cells. Cholecystectomy increased plasma BA synthesis ≥ 2-fold (p < 0.0001), and altered the diurnal rhythm and significantly reduced [FGF19]s noon peak. BA serum levels, serum cholesterol and triglyceride content remained unchanged. CONCLUSIONS In conclusion human GB cholangiocytes constitutively express and secrete high levels of FGF19 in a process regulated by BA. Resection of this organ doubles BA synthesis concomitantly with changes in [FGF19]s. These findings suggest a potential connection between GB cholangiocytes-derived FGF19 and BA metabolism that could lead to metabolic dysregulation following cholecystectomy.
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Affiliation(s)
- Francisco Barrera
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Lorena Azócar
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Héctor Molina
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Kurt A Schalper
- Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Marcia Ocares
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Jessica Liberona
- Nutrición y Diabetes, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Luis Villarroel
- Salud Pública y Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Fernando Pimentel
- Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Rosa M Pérez-Ayuso
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Flavio Nervi
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Albert K Groen
- Department of Pediatrics and Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Juan F Miquel
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
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Brockmann PE, Diaz B, Damiani F, Villarroel L, Núñez F, Bruni O. Impact of television on the quality of sleep in preschool children. Sleep Med 2016; 20:140-4. [DOI: 10.1016/j.sleep.2015.06.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
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Caussade S, Contreras I, Villarroel L, Fierro L, Sánchez I, Bertrand P, Holmgren NL. [Spirometric values in healthy Chilean children and adolescents]. Rev Med Chil 2016; 143:1386-94. [PMID: 26757862 DOI: 10.4067/s0034-98872015001100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/13/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Spirometric flow and volume measurement are essential to evaluate patients with pulmonary disease. In Chile, several reference equations are used. AIM To measure flow and expiratory volumes in healthy children and adolescents and compare their results with theoretical values according to Knudson, Quanjer, Gutierrez and NANHES III. SUBJECTS AND METHODS Spirometries were performed according to international standards in 1589 healthy children and adolescents aged 6 to 18 years (861 females) who lived in Santiago, Chile. RESULTS The obtained values for forced vital capacity, expiratory volume in one second, peak expiratory flow, were significantly higher than those calculated according to the above mentioned standards (p < 0.0001) with differences up to 18.7%. We constructed reference formulas for ages ranging from 6 to 18 years, separated by gender, using age, weight and height as independent variables. The latter had the greater influence on formula construction. CONCLUSIONS The use of these new local formulas with allow the correct interpretation of spirometric results obtained in Chilean children and adolescents.
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Henríquez-Henríquez M, Villarroel L, Henríquez H, Zamorano F, Rothhammer F, Aboitiz F. Intratask Variability As a Correlate for DRD4 and SLC6A3 Variants: A Pilot Study in ADHD. J Atten Disord 2015; 19:987-96. [PMID: 22930791 DOI: 10.1177/1087054712455844] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED Behavioral variability may be an ADHD key feature. Currently used ex-Gaussian/Fast Fourier Transform analyses characterize general distribution and oscillatory/rhythmic components of performance but are unable to demonstrate slow cumulative changes over entire tasks. OBJECTIVE To explore how performance of ADHD children and unaffected sibs gradually evolves in relation to genetic variants linked to ADHD. METHOD A total of 40 kids (20 ADHD-discordant sib pairs) between 8 and 13 years resolved a visual Go/NoGo with 10% NoGo probability. Variable number tandem repeats (VNTRs) at DRD4 and SLC6A3 were identified following standard protocols. Performance changes were assessed by linear/logistic mixed-effect models. RESULTS Models exploring SLC6A3 effects demonstrated less accentuated increments of response time (RT) (p = .046) and cumulative increments in the correct responses to "NoGo" (p = .00027) in 10R/10R participants. Models for DRD4 showed faster decline of correct responses to "Go" (p = .0078) in 2R/7R carriers. CONCLUSION Dynamical analysis of attention/inhibition measures may unravel new correlates to DRD4 and SLC6A3 variants.
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Dussaillant C, Echeverría G, Villarroel L, Marin PP, Rigotti A. [UNHEALTHY FOOD INTAKE IS LINKED TO HIGHER PREVALENCE OF METABOLIC SYNDROME IN CHILEAN ADULT POPULATION: CROSS SECTIONAL STUDY IN 2009-2010 NATIONAL HEALTH SURVEY]. NUTR HOSP 2015; 32:2098-104. [PMID: 26545665 DOI: 10.3305/nh.2015.32.5.9657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION metabolic syndrome (MS) is a clustering of risk factors known to promote cardiovascular disease and diabetes. Environmental factors, such as unhealthy diet, play a major role in the development of this condition. In this study, we evaluated the prevalence of MS and its association with food intake quality among Chilean adults. METHODS we analyzed data of 2 561 adults (≥ 18 years-old) included in the last National Health Survey (NHS 2009-2010) who had appropriate information to diagnose MS based on ATP III-NCEP guidelines. Consumption frequency of fish, whole grains, dairy, fruits and vegetables was also analyzed and associated with MS prevalence. Using a healthy diet score (HDS), we described the overall diet quality and further correlated it with MS prevalence. RESULTS we found that lower whole grain intake was associated with greater MS prevalence (OR = 1.78; 95% CI: 1.088-2.919; p = 0.022). HDS showed better diet quality among women and in subjects with increasing age and higher educational level. A HDS < 3 points was associated with an increased risk of MS (OR HDS < 3 / HDS ≥ 3 = 3.69; 95% CI 1.884-7.225, p < 0.001). CONCLUSION Chilean adult population exhibits a high prevalence of MS linked to a poor diet quality.
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Affiliation(s)
- Catalina Dussaillant
- Centro de Nutrición Molecular y Enfermedades Crónicas. Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile..
| | | | | | - Pedro Paulo Marin
- Programa de Geriatría y Gerontología. Departamento de Medicina Interna..
| | - Attilio Rigotti
- Centro de Nutrición Molecular y Enfermedades Crónicas. Departamento de Nutrición, Diabetes y Metabolismo, Escuela de Medicina, Pontificia Universidad Católica, Santiago, Chile..
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Barrera F, Azócar L, Molina H, Schalper KA, Ocares M, Liberona J, Villarroel L, Pimentel F, Pérez-Ayuso RM, Nervi F, Groen AK, Miquel JF. Effect of cholecystectomy on bile acid synthesis and circulating levels of fibroblast growth factor 19. Ann Hepatol 2015. [PMID: 26256900 DOI: 10.1016/s1665-2681(19)30766-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
UNLABELLED Background and rationale for the study. FGF19/15 is a gut-derived hormone presumably governing bile acid (BA) synthesis and gallbladder (GB) refilling. FGF19 mRNA is present in human GB cholangiocytes (hGBECs); however, the physiological significance of GB-derived FGF19 remains unknown. We investigated whether hGBECs secrete FGF19 and the effects of cholecystectomy on serum FGF19 ([FGF19]s) and BA synthesis. MATERIAL AND METHODS FGF19 expression was assessed by qRT-PCRs and immunostaining in hGBECs and terminal ileum, and quantified in bile and serum by ELISA. Basal and BA (chenodexycholic acid, CDCA) induced FGF19 expression and secretion was analyzed in primary cultured hGBECs and GB-d1 cell line. Pre and postprandial serum changes in [FGF19]s, 7α-hydroxy-4-cholestene-3-one (C4, a marker of BA synthesis) and BA were evaluated in plasma of gallstone disease patients at baseline and after cholecystectomy. RESULTS FGF19 mRNA levels were ~250-fold higher in hGBECs compared to distal ileum. GB bile contained ~23-fold higher FGF19 levels compared to serum (p < 0.0001). CDCA induced dose-dependent expression and secretion of FGF19 in hGBECs and GB-d1 cells. Cholecystectomy increased plasma BA synthesis ≥ 2-fold (p < 0.0001), and altered the diurnal rhythm and significantly reduced [FGF19]s noon peak. BA serum levels, serum cholesterol and triglyceride content remained unchanged. CONCLUSIONS In conclusion human GB cholangiocytes constitutively express and secrete high levels of FGF19 in a process regulated by BA. Resection of this organ doubles BA synthesis concomitantly with changes in [FGF19]s. These findings suggest a potential connection between GB cholangiocytes-derived FGF19 and BA metabolism that could lead to metabolic dysregulation following cholecystectomy.
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Affiliation(s)
- Francisco Barrera
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Lorena Azócar
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Héctor Molina
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Kurt A Schalper
- Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Marcia Ocares
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Jessica Liberona
- Nutrición y Diabetes, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Luis Villarroel
- Salud Pública y Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Fernando Pimentel
- Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Rosa M Pérez-Ayuso
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Flavio Nervi
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Albert K Groen
- Department of Pediatrics and Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Juan F Miquel
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago, Chile
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Latorre G, Besa P, Parodi CG, Ferrer V, Azocar L, Quirola M, Villarroel L, Miquel JF, Agosin E, Chianale J. Prevalence of lactose intolerance in Chile: a double-blind placebo study. Digestion 2015; 90:18-26. [PMID: 25096822 DOI: 10.1159/000363229] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/28/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND STUDY AIMS Lactase non-persistence (LNP), or primary hypolactasia, is a genetic condition that mediates lactose malabsorption and can cause lactose intolerance. Here we report the prevalence of lactose intolerance in a double-blind placebo study. METHODS The LCT C>T-13910 variant was genotyped by RT-PCR in 121 volunteers and lactose malabsorption was assessed using the hydrogen breath test (HBT) after consuming 25 g of lactose. Lactose intolerance was assessed by scoring symptoms (SS) using a standardized questionnaire following challenge with a lactose solution or saccharose placebo. RESULTS The LNP genotype was observed in 57% of the volunteers, among whom 87% were HBT⁺. In the HBT⁺ group the median SS was 9 and in the HBT⁻ group the median SS was 3 (p < 0.001). No difference was observed in the SS when both groups were challenged with the placebo. The most common symptoms included audible bowel sounds, abdominal pain and meteorism. In the ROC curve analysis, an SS ≥ 6 demonstrated 72% sensitivity and 81% specificity for predicting a positive HBT. To estimate prevalence, lactose intolerance was defined as the presence of an SS ≥ 6 points after subtracting the placebo effect and 34% of the study population met this definition. CONCLUSIONS The LNP genotype was present in more than half of subjects evaluated and the observed prevalence of lactose intolerance was 34%.
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Affiliation(s)
- Gonzalo Latorre
- Medical Student, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
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Méndez L, Lagoa M, Quiroga T, Margozzini P, Azócar L, Molina HR, Vera A, Villarroel L, Arrese M, Hampe J, Buch S, Miquel JF. [Prevalence of Gilbert syndrome and its genetic determinants in Chile]. Rev Med Chil 2015; 141:1266-74. [PMID: 24522354 DOI: 10.4067/s0034-98872013001000005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 07/26/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND In Europeans the TATA box TA7 repeat promoter variant in the UGT1A1 gene (UGT1A1*28) is the major determinant of bilirubin levels. AIM To study the prevalence of Gilbert Syndrome (GS) and its genetic determinants in Chile. MATERIAL AND METHODS Three different studies were conducted. The prevalence of GS in Chile was assessed in 991 subjects with normal liver tests (ALT and GGT) from the 2nd National Health Survey. We defined GS as a total bilirubin (TB) between 1.4-5mg/dL. The second study assessed the genotype prevalence of SNP rs6742078 (in LD with UGT1A1*28) and rs4149056 in 500 DNA samples of non-related Hispanics. Finally, a case-control study was designed to assess the phenotype-genotype correlation. UGT1A1*28 and rs4149056 variants were determined by direct sequencing and allelic discrimination assays (TaqMan), respectively. RESULTS Prevalence of GS in the general Chilean population was 2.6% (4.5% in males and 0.5% in female). No correlation with age, educational level or home location was found. Genotypes for UGT1A1*28 (TA6/6 50.5%, TA6/7 37.8%, TA7/7 11.7%) and rs4149056 (TT 74.1%, CT 22.8%, and CC 3.1%) variants were similar to Europeans. In the case-control study, most patients with GS were homozygotes for UGT1A1*28 (TA7/7, 74%). Of note, 44% of patients with intermediate TB levels were also TA7/7, compared to 7% in normal subjects. SLCO1B1 genotype was not correlated with TB levels. CONCLUSIONS While the prevalence of GS was lower in Chile compared to Europeans (~5%), the prevalence of UGT1A1*28 homozygotes was similar (~12%). In Chilean Hispanics, the UGT1A1*28 variant explain 75% of GS phenotype.
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Arnaiz P, Barja S, Villarroel L, Domínguez A, Godoy I, Castillo O, Farías M, Mardones F. [Subclinical atheroesclerosis and metabolic syndrome in children]. NUTR HOSP 2014; 28:1587-93. [PMID: 24160220 DOI: 10.3305/nh.2013.28.5.6767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Metabolic syndrome (MS) in children has been associated to subclinical atherosclerosis as estimated by carotid intima-media thickness (CIMT). OBJECTIVES We aim to ascertain the influence of MS, insulin resistance (IR) and nutritional status on CIMT. Percentiles with an increased risk of CIMT were also explored. METHODS A cross-sectional study of 447 children attending public schools in Santiago, Chile, was performed during years 2009-2011. This sample was selected considering the presence of one or more MS component and IR. Anthropometry and BP were assessed. A blood sample for determination of glycemia, insulinemia and lipids was taken. CIMT was assessed using high resolution ultrasonography with automated software. Pearson correlation, Student's t-test, Chisquared test, and stepwise logistic regression were computed. RESULTS Mean age was 11.5 ± 1.0 years old (range 10- 14); 59% girls; 93% pubertal; 72% excess weight; 24% MS; and 15% IR. Mean values of MS components in children with CIMT ≥ percentile 75 versus < percentile 75 had differences for systolic BP or diastolic BP ≥ percentile 90 (BP ≥ percentile 90) and high density lipoproteins cholesterol ≤ 40 mg/dL (CHDL ≤ 40 mg/dL). The logistic regression for CIMT ≥ percentile 75 only selected BP ≥ percentile 90 and CHDL ≤ 40 mg/dL. The logistic regression for CIMT ≥ percentile 90 did not select independent variables. CONCLUSIONS In this group of children BP ≥ percentile 90 and CHDL ≤ 40 mg/dL values were associated to CIMT ≥ percentile 75. Influences of IR and nutritional status on CIMT were not found.
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Affiliation(s)
- Pilar Arnaiz
- División de Pediatría.Facultad de Medicina. Pontificia Universidad Católica de Chile. Santiago. Chile
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46
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Barja S, Barrios X, Arnaiz P, Domínguez A, Villarroel L, Castillo O, Farías M, Ferreccio C, Mardones F. [Blood lipids in Chilean children 10-14 years of age]. NUTR HOSP 2014; 28:719-25. [PMID: 23848095 DOI: 10.3305/nh.2013.28.3.6359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Plasma lipid levels in children and adolescents are evaluated with international references. The objective was to describe them in Chilean students, to compare them with the most used reference (Lipids Research Clinics Program) and the cut-off points recommended in 2011. METHODS Cross-sectional study in 3325 children, 10 to 14 years of age. Anthropometry and auto-report of pubertal development were performed. A 12 hours fast blood sample was taken to measure total (TC), highdensity lipoprotein cholesterol (HDLC) and triglycerides (TG). Low-density lipoprotein cholesterol (LDLC) was calculated with Friedewald formula. Variables were described, Hochberg test for multiple comparisons and stepwise lineal regression were applied. The degree of agreement between local percentiles and the two international references was studied. RESULTS We studied 3,063 children, 11.4 ± 0.9 years old, 53% girls, 20.9% pre-pubertal, 22.6% had overweight, and 15.8% obesity. Averages: TC: 159.2 ± 28.3, HDLC: 51.9 ± 12.1, LDLC: 89.0 ± 31.5 and TG: 93.2 ± 60 mg/dL. Boys had higher HDLC: 53.3 ± 12.2 vs. 50.6 ± 11.8 mg/dL and lower TG: 86.2 ± 58.2 vs. 99.5 ± 61.7 mg/dL than girls (p < 0,001). Influences of nutritional status, sex and age were significant. We founded high agreement with the reference for TC and LDLC, but HDLC levels were lower and TG were higher, for their cut-off points: percentiles 10th and 95th, respectively. CONCLUSIONS Blood lipids were influenced by nutritional status, sex and age. Percentile values were comparable to the international reference except for HDLC and TG, showing a more atherogenic pattern.
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Affiliation(s)
- Salesa Barja
- Departamento de Pediatría, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
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Domínguez DM, Reina M, Villarroel L, Fajardo V, González-Coloma A. Bioactive Furanoeremophilanes from Senecio otites Kunze ex DC. ACTA ACUST UNITED AC 2014; 63:837-42. [DOI: 10.1515/znc-2008-11-1209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The furanoeremophilanes 6β-angeloyloxy-1, 10-dehydrofuranoeremophilan-9-one (1), 6β- hydroxy-1, 10-dehydrofuranoeremophilan-9-one (2) and 6β-propionyloxy-1, 10-dehydrofuranoeremophilan- 9-one (3) were isolated from Senecio otites, their structures elucidated by spectral analyses, and their insecticidal and phytotoxic properties evaluated. Compounds 1-3 proved to be effective aphid antifeedants against Myzus persicae and Rhopalosiphum padi and had postingestive negative effects on Spodoptera littoralis larvae. These compounds did not have any phytotoxic effects on Lactuca sativa.
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Affiliation(s)
- Dulce M. Domínguez
- Instituto de Productos Naturales y Agrobiología CSIC, La Laguna, Tenerife, España
| | - Matías Reina
- Instituto de Productos Naturales y Agrobiología CSIC, La Laguna, Tenerife, España
| | - Luis Villarroel
- Facultad de Química y Biología, Universidad de Santiago de Chile (USACH), Santiago, Chile. Fax: 56-2-6 8121 08
| | - Victor Fajardo
- Facultad de Ciencias, Universidad de Magallanes, Punta Arenas, Chile
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Valdivieso S, Sirhan M, Aguirre C, Ivelic JA, Aillach E, Villarroel L. Attitudes of medical students toward psychiatry in a Chilean medical school. Acad Psychiatry 2014; 38:309-11. [PMID: 24668370 DOI: 10.1007/s40596-014-0089-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 09/13/2013] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The authors assess the attitudes of seventh-year medical students with regard to psychiatry and patients with psychiatric illness during the psychiatry clerkship. METHODS A 32-item questionnaire regarding attitudes toward psychiatry and patients with psychiatric illness was administered at the beginning of the psychiatry clerkship. RESULTS One hundred and ten seventh-year students participated in the study, providing responses anonymously. Average negative attitude item score was 2.45 ± 0.3 (range 1.7-3.3). Eighty-three students (75 %) responded to all the questions with an average negative attitude item score of 2.43 ± 0.3 (range 1.7-3.3) and a total negative attitude item score of 77.9 ± 10.3 (range 55-104). CONCLUSIONS Undergraduate students of a Chilean medical school showed fairly positive attitudes toward psychiatry and toward patients with psychiatric illness.
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Affiliation(s)
- Sergio Valdivieso
- Pontificia Universidad Católica de Chile School of Medicine, Santiago, Región Metropolitana, Chile,
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Abstract
BACKGROUND delirium is frequently under diagnosed in older hospitalised patients. Predictive models have not been widely incorporated in clinical practice. OBJECTIVE to develop and validate a predictive score for incident delirium. DESIGN AND SETTING two consecutive observational prospective cohorts (development and validation) in a university affiliated hospital. SUBJECTS inpatients 65 years and older. METHODS in the development cohort patients were assessed within the first 48 h of admission, and every 48 h thereafter, using the confusion assessment method to diagnose delirium and data were collected on comorbidity, illness severity, functional status and laboratory. Delirium predictive score (DPS) was constructed in the development cohort using variables associated with incident delirium in the multivariate analysis (P < 0.05), and then tested in a validation cohort of comparable patients, admitted without delirium. Receiver operating characteristic (ROC) analysis and likelihood ratio (LR) were calculated. RESULTS the development cohort included 374 patients, incident delirium occurred in 25. After multivariate analysis incident delirium was independently associated with lower functional status (Barthel Index) and a proxy for dehydration (elevated urea to creatinine ratio). Using these variables, DPS was constructed with a performance in the ROC curve area of 0.86 (95% CI: 0.82-0.91) and (-) LR = 0.16 and (+) LR = 3.4. The validation cohort included 104 patients and the performance of the score was ROC 0.78 (95% CI: 0.66-0.90). CONCLUSIONS This simple predictive model highlights functional status and a proxy for dehydration as a useful tool for identifying older patients that may benefit from close monitoring and preventive care for early diagnosis of delirium.
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Affiliation(s)
- Marcela P Carrasco
- Internal Medicine, Geriatric Unit, Medical Faculty, Pontificia Universidad Católica de Chile, Santiago de Chile, RM, Chile
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Luque MJ, Tapia JL, Villarroel L, Marshall G, Musante G, Carlo W, Kattan J. A risk prediction model for severe intraventricular hemorrhage in very low birth weight infants and the effect of prophylactic indomethacin. J Perinatol 2014; 34:43-8. [PMID: 24113396 DOI: 10.1038/jp.2013.127] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 08/22/2013] [Accepted: 08/27/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Develop a risk prediction model for severe intraventricular hemorrhage (IVH) in very low birth weight infants (VLBWI). STUDY DESIGN Prospectively collected data of infants with birth weight 500 to 1249 g born between 2001 and 2010 in centers from the Neocosur Network were used. Forward stepwise logistic regression model was employed. The model was tested in the 2011 cohort and then applied to the population of VLBWI that received prophylactic indomethacin to analyze its effect in the risk of severe IVH. RESULT Data from 6538 VLBWI were analyzed. The area under ROC curve for the model was 0.79 and 0.76 when tested in the 2011 cohort. The prophylactic indomethacin group had lower incidence of severe IVH, especially in the highest-risk groups. CONCLUSION A model for early severe IVH prediction was developed and tested in our population. Prophylactic indomethacin was associated with a lower risk-adjusted incidence of severe IVH.
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Affiliation(s)
- M J Luque
- Division de Pediatria, Hospital Clinico Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - J L Tapia
- Seccion de Neonatologia, Hospital Clinico Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - L Villarroel
- Departamento Salud Publica, Pontificia Universidad Catolica, Santiago, Chile
| | - G Marshall
- Facultad de Matematicas, Pontificia Universidad Catolica, Santiago, Chile
| | - G Musante
- Servicio de Neonatologia, Hospital Universitario Austral, Pilar, Argentina
| | - W Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Kattan
- Seccion de Neonatologia, Hospital Clinico Pontificia Universidad Catolica de Chile, Santiago, Chile
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