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Consumo de edulcorantes no calóricos en niños: un scoping review
Get PDFTesis presentada a la Facultad de Ciencias de la Salud de la Universidad del Desarrollo para optar al grado académico de Licenciado/a en Nutrición y Dietética.Introducción: La obesidad, considerada por la OMS como una enfermedad crónica, afecta a más de mil millones de personas en el mundo, posicionando a Chile entre los países con mayores tasas en América del Sur. Las causas son multifactoriales, destacando factores genéticos, malos hábitos alimentarios y un entorno sociocultural desfavorable. Por lo que, a nivel mundial hay una preocupación acerca del incremento de sobrepeso y obesidad en la población general, lo que llevó a la industria alimentaria a incorporar edulcorantes no calóricos (ENC) como alternativa más “saludable” como sustituto del azúcar. Sin embargo, su alto consumo, especialmente en niños, plantea riesgos metabólicos aún desconocidos. Ante esta problemática, se propone analizar el consumo de ENC en la población infantil y los posibles efectos en su salud
Productividad, bienestar y factores psicosociales, en los funcionarios de una institución de salud
Get PDFProyecto de grado presentado a la Facultad de Psicología de la Universidad del Desarrollo para optar al grado académico de Magíster en Desarrollo Organizacional y Dirección de personasEste proyecto de grado aborda los desafíos de productividad y bienestar, en una institución de salud pública de alta complejidad. Se centra en describir la desconexión entre la planificación estratégica y la implementación de políticas de bienestar.
El objetivo principal es desarrollar y proponer un programa de intervención basado en la evidencia, que mejore el bienestar y los factores psicosociales que afectan al personal. Los objetivos específicos incluyen:
Evaluar las condiciones actuales de productividad y bienestar del personal, analizar los resultados obtenidos para identificar principales áreas de mejora y diseñar, proponer estrategias de intervención.
El diagnóstico de la encuesta PROBIO, reveló aspectos en la distribución por género y edad, con una predominancia de mujeres (71%) sobre hombres (29%) en el personal. La mayoría del personal que respondió la encuesta, fueron profesionales que se encuentran en el rango de edad de 25 a 39 años (55%). En los resultados de la encuesta destacaron altos niveles de empoderamiento laboral (93% de los funcionarios) y significado del trabajo (83%), mientras que la escala seguridad psicológica, demuestra que un 57% de las personas, se encuentra en el límite del rango mínimo indicado. Estos resultados sugieren que mientras que hay áreas de fortaleza que pueden ser aprovechadas para impulsar mejoras, también existen desafíos significativos que requieren intervenciones específicas. La escala de bienestar laboral indica que un 67% de los funcionarios presentan una experiencia laboral satisfactoria, así como también se observa que un 60% de las personas, presenta la capacidad personal o colectiva de producir resultados en términos de una cierta cantidad y calidad de bienes o servicios y su relación con los recursos utilizados para producirlos.
Con respecto a la información recogida de forma cualitativa, se infiere que el bienestar del personal, se ve afectado por diferentes situaciones, jerarquía,
liderazgo, transparencia, plan estratégico y comunicación, que describen la rotación de personal, justicia organizacional, estrés laboral, alineación de los servicios y el compromiso de los funcionarios
Patterns of social interaction in the educational experience analized through a computational social sciences perspective
Get PDFTesis doctoral presentada a la Facultad de Gobierno de la Universidad del Desarrollo para optar al grado de Doctor en Ciencias de la Complejidad SocialThis research explores how social interactions in educational settings influence academic outcomes, cooperation, and group dynamics in primary school classrooms.
By applying methods from Computational Social Sciences and Complex Systems, this work integrates three key approaches: network science to measure social structure and student positioning, the collection of behavioral data through field experiments based on game theory applied in the classroom, and econometric analysis to approximate causal effects.
The first study examines how reciprocity in social relationships within the classroom enhances academic performance, showing that students who engage in reciprocal interactions achieve better results. The second study investigates how friendship modulates hierarchical relations in public schools, finding that cooperation dynamics among peers are strongly influenced by social status, but friendships can mitigate these hierarchies. The third study focuses on the social interactions of children with Autism Spectrum Disorder (ASD) within classrooms that incorporate both students with and without special educational needs, showing that these students tend to occupy peripheral positions in social networks and engage less frequently in reciprocal relationships.
The findings of this project provide a deeper understanding of social relationships in educational contexts, with significant implications for managing classroom dynamics and designing educational policies aimed at improving school coexistence and social inclusion
Jealousy as Predicted by Allocation and Reception of Resources in an Economic Game
Get PDFEvidence is abundant that evolution by selection has produced sex differences in the design of adaptations to solve the problems surrounding reproduction. A prime example is the design of human jealousy, which research suggests is triggered by distinct evoking acts that are specific challenges for women and men in their exclusive reproductive bond. It follows that jealousy would be directed toward driving away interlopers who could potentially threaten the bond with the romantic partner or increase mate retention efforts in response to sex-specific threats. To explore this possibility, we use as a methodological innovation an eco
nomic game for the evocation of jealousy. With a modified dictator game, we showed men and women in a committed relationship, conditions in which the partner or an intrasexual rival allocates money to (investing condition), or obtains money from (receiving condition), the partner or an opposite sex third party that they recently met. A sample of 56 heterosexual couples (n =112) participated in a laboratory setting. Our results show the different scenarios of this dictator game exerted the expected evocation of jealousy (controlling individual differences), with women being more jealous by the partner’s allocation of resources to a rival, and men reporting slightly more jealousy by their partner receiving money from a rival. We discuss the implications of this method to advance the comprehension of the adaptive function of sex differences in jealousy, the use of economic games, and possible modifications to improve the similarity of the game to a real assessment of actual male jealousyVersión publicad
Risk of death from COVID-19 compared to deaths from respiratory diseases, 2015-2019, Chile
Get PDFObjetivo: Determinar cuando el riesgo de muerte por COVID-19 durante el 2020-2023 difiere del riesgo de muerte por enfermedades respiratorias virales ocurridas durante 2015-2019.
Materiales y métodos: Estudio ecológico de series de tiempo. Las muertes por COVID-19 se obtuvieron del Ministerio de Salud y las muertes por enfermedades virales (códigos CIE-10 J09X, J100, J101, J108, J110, J111, J118, J120, J121, J122, J123, J128, J129 y J189) del Departamento de Estadísticas e Información de Salud. Para el análisis, se generó el período prepandémico (2015-2019) calculando la mediana de muertes y de habitantes por meses y año por enfermedades respiratorias virales. Luego se calculó la tasa de mortalidad general anual usando como numerador las muertes anuales y denominador la población del país al 30 de junio de cada año. Para la comparación del periodo prepandémico y pandémico según mes y año, se utilizó el modelo de regresión Poisson. Se reporta Incidence Rate Ratio (TIR) e Intervalos de confianza al 95%.
Resultados: Entre 2015-2019 se registraron 15081 defunciones por enfermedades respiratorias virales y desde marzo-2020 hasta agosto-2023 se registraron 53376 por COVID-19. La mayor mortalidad por COVID-19 fue el 2020, 2021 y 2022, TIR:5,57, 7,18 y 4,07 respectivamente. Desde el 2023 la mayor mortalidad es mayor por enfermedades respiratorias virales (TIR:0,93,IC95%:0,88-0,99).
Conclusión: El análisis de incidencias de mortalidad, puede ser un criterio útil para el manejo de epidemias, ya que es una manera de aproximarnos a inferir que la gravedad de la pandemia de COVID-19 podría estar concluyendo.
Objective: Determine when the risk of death from COVID-19 in 2020-2023 differs from the risk of death from viral respiratory illness in 2015-2019.
Materials and Methods: Ecological time series study. Deaths due to COVID-19 were obtained from the Ministry of Health and deaths due to viral diseases (ICD-10 code: J09X, J100, J101, J108, J110, J111, J118, J120, J121, J122, J123, J128, J129 and J189) from the "Departamento de Estadísticas e Información de Salud". For the analysis, the pre-pandemic period (2015-2019) was generated by calculating the median number of deaths and inhabitants per month and year due to viral respiratory diseases. Then, the annual overall mortality rate was calculated using as numerator the annual deaths and denominator the population of the country as of June 30 of each year. The Poisson regression model was used to compare the pre-pandemic and pandemic periods by month and year. Incidence Rate Ratio (IRR) and 95% confidence intervals are reported.
Results: Between 2015-2019 there were 15081 deaths due to viral respiratory diseases and from March-2020 to August-2023 there were 53376 deaths due to COVID-19. The highest mortality due to COVID-19 was in 2020, 2021 and 2022, IRR:5.57, 7.18 and 4.07 respectively. Since 2023, the highest mortality is due to viral respiratory diseases (IRR:0.93,95%CI:0.88-0.99).
Conclusion: The analysis of mortality incidences can be a useful criterion for the management of epidemics, since it is a way to approximate that the severity of the COVID-19 pandemic could be coming to an end.Versión Publicad
Doble problema: COVID-19 prolongado e incidencia de diabetes mellitus tipo 2 - una revisión sistemática
Get PDFObjective: This systematic review aims to clarify COVID-19’s impact on the onset of T2D in adults. Material and methods: Following PRISMA guideli-nes, this systematic review sourced data from multiple databases from 2019 to April 20th, 2023. Two reviewers handled screening, with a third-party resolving disagreement. The focus was on COVID-19 cases with post-infection T2D symptoms persisting for two or more months. Exclusions included those outside the 18-70 age range, prior T2D history, pregnancy, and animal studies. Rayyan software facilitated article screening, STATA 18 performed meta-analysis, and bias was assessed using JBI tools. The study is registered in PROSPERO (ID: CRD42023414096). Results: A total of 173 articles were retrieved, of which 23 (11.6%) remained for extraction. 13 cohort studies with 11.551.026 participants were included for the meta-analysis, which found that the COVID-19 population had 1.4 greater risk of being diagnosed with T2D in comparison with the population without COVID-19or with other respiratory diseases. The other study designs were narratively analyzed, describing similar results as the meta-analysis. Discussion: New onset T2D is a potential consequence of LC. While T2D increases COVID-19 complications, the relationship appears bidirectional. Given the novelty of the topic and potential newer studies, further reviews are needed to understand LC’s impact on chronic diseases like T2D globally. Further studies should be carried out on this specific topic that could raise the burden of T2D between all the other symptoms that may be caused by LC. In addition, it is necessary to adapt the interventions according to each country’s possibilities.
Objetivo: El objetivo de esta revisión es aclarar el impacto del COVID-19 en nuevos diagnósticos de DM2. Material y Métodos: Esta revisión se elaboró en base a las guías PRISMA. Dos revisores realizaron una búsqueda en bases de datos, incluyendo artículos desde el 2019 hasta el 20 de abril de 2023 en adultos, diagnosticados al menos una vez con COVID-19, sin diagnóstico previo de DM2. Excluyeron: embarazadas, niños y diabetes mellitus I. Esta revisión se registró en PROSPERO (ID: CRD42023414096) el 6 de abril de 2023. Resultados: Un total de 173 artículos se obtuvieron luego de la búsqueda, de los cuales 23 (11,6%) quedaron para extracción. 13 estudios de cohorte con 11.551.026 participantes se incluyeron en el metaanálisis, que encontraron que la población que tuvo COVID tiene un 1,4 veces más riesgo de ser diagnosticados con DM2 en comparación a quienes no tuvieron el diagnóstico o fueron diagnosticados con otra patología respiratoria. Los diseños de estudio se describieron narrativamente, describiendo resultados similares a los del metaanálisis. Discusión: El nuevo diagnóstico de DM2 es una potencial consecuencia de LC. Mientras aumenta la DM2, aumentan las complicaciones de COVID-19, la relación aparenta ser bidireccional. Ya que estos hallazgos son medianamente recientes, no existe mucha evi-dencia disponible al respecto, por lo tanto, se requiere un mayor número de estudios al respecto, además de la creación de nuevas políticas de salud pública ad hoc a las posibilidades de cada país.Publicad
Functional Capacity in Activities of Daily Living in the Alzheimer’s Disease Continuum
Get PDFBackground
The most common and prevalent dementia worldwide is Alzheimer’s disease (AD). AD is a continuum composed of Subjective Cognitive Impairment (SCD), Mild Cognitive Impairment (MCI), and Alzheimer’s Disease dementia (ADD) stage. One of the main clinical variables in patients with dementia is performance in functional capacity since its alterations are associated with poor prognosis and disease progression. Functional capacity is measured through activities of daily living (ADL), which are divided into three domains: i) Basic (BADL), ii) Instrumental (IADL), and iii) Advanced (AADL). The study aimed to characterize the performance of the different stages of the AD continuum in the ADL domains and their association with cognitive abilities.
Method
A cross-sectional study of subjects at different stages of the AD continuum was conducted: Healthy Controls (CTR) (n = 17), SCD (n = 77), MCI (n = 30), and ADD (n = 23), who were matched for age, sex, and education. ADLs were estimated using The Technology-Activities of Daily Living Questionnaire (T-ADLQ), which assesses the three domains and a total score. T-ADLQ performance was compared across groups and correlated with cognitive ability instruments (ACE-III and IFS).
Result
The results showed that patients with ADD performed worse on the BADL, IADL, and total ADLs compared to the other three groups. There were no significant differences between the CTR, SCD, and MCI on the BADL, IADL, and total ADLs. However, the AADL, in addition to differentiating the ADD patients from the other three groups, also showed differences between CTR and MCI subjects and between SCD and MCI subjects (Table 1 and Figure 1). The correlation study showed that AADL correlated significantly with global cognitive and executive function assessment (Figure 2).
Conclusion
AADL shows progressive functional impairment at different stages of the AD continuum, which is further associated with global cognitive and executive function performances. As one progresses to a more advanced stage of the disease continuum, the performance of ADLs, especially AADLs, worsens, which could indicate a marker of disease progression, allowing for better patient follow-up.Versión Aceptad
Improved heart failure due to reversible cause: reasons for not stopping therapy
Get PDFLa insuficiencia cardíaca (IC) con fracción de eyección mejorada (FEVIm) se refiere a un subgrupo de pacientes con IC con fracción de eyección reducida (FEVIr), que una vez implementado el tratamiento adecuado (bloqueo neurohumoral, dispositivos, retiro de noxa u otro según corresponda) pueden evolucionar con mejoría de la función ventricular. Las poblaciones estudiadas con FEVIm son heterogéneas, incluyendo una amplia gama tales como la miocardiopatía dilatada (MCD) idiopática, familiar, isquémica y un subgrupo de causas históricamente conocidas como “reversibles”, que clínicamente se cree que tienen mayor potencial de recuperación al retiro de la noxa y podrían tener una eventual suspensión de la terapia médica óptima (TMO). En esta revisión se destacarán varios aspectos que ayudan a comprender el porqué, incluso en estas causas reversibles, al constatar una FEVIm no debería suspenderse el TMO. Es difícil determinar si en realidad es seguro el retiro, ya que desconocemos precisamente qué impulsa la recuperación ventricular. Una recaída de la FEVI, no sólo podría demorar una segunda recuperación, sino que también afectaría sobrevida del paciente.
Heart failure (HF) with total or partial normalization of ejection fraction (LVEF) is a subgroup of patients with HF who, after implementing the appropriate treatment (neurohumoral block, devices, noxa withdrawal or others as appropriate) can evolve with improvement in LVEF. This group of patients, include a wide range of HF causes, including idiopathic, familial, and ischemic dilated cardiomyopathy (DCM). Also, included is a subgroup of causes which are clinically believed to have greater potential for recovery upon withdrawal of noxa and eventual consideration of discontinuation of optimal medical therapy may be considered. In this review, several aspects are highlighted that help to understand why even in these reversible causes, when HF of LVEF is confirmed, optimal medical treatment should be continued since it is quite difficult to predict whether withdrawal will be truly safe.Versión Aceptad
Hospital discharge rate for seizures in newborns in chile: an observational study between 2020-2023
Get PDFIntroducción: Las convulsiones neonatales son una emergencia médica, caracterizada por episodios de actividad eléctrica cerebral anormal en el recién nacido. Objetivo: Dada la antigüedad de los datos, se propone actualizar la tasa de egreso hospitalario por convulsiones neonatales en el periodo 2020-2023 en Chile. Metodología: Estudio observacional, descriptivo y transversal, sobre la tasa de egreso hospitalario por convulsiones neonatales en población menor de un año, en el periodo 2020-2023 en Chile, según las variables sexo y duración de estadía hospitalaria. Los datos se recolectaron desde el Departamento de Estadísticas e Información en Salud y el Instituto Nacional de Estadística de Chile. Resultado: Se estudiaron 519 casos, determinando una tasa de egreso hospitalario del periodo de 0,60 casos por cada 1000 habitantes, observándose las tasas más altas el año 2022. Destaca un predominio en sexo masculino. Se estableció el promedio de estadía hospitalaria en 14,25 días, siendo estas más prolongadas en el sexo masculino. Discusión: Se obtuvieron tasas de egreso hospitalario similares a las reportadas internacionalmente, y su dinámica podría asociarse a consecuencias post-COVID. El comportamiento del sexo masculino coincide con la literatura internacional, donde este se asociaría a una mayor inmadurez y vulnerabilidad al momento del nacimiento. El tiempo de estadía hospitalaria sería mayor a lo descrito en otros países, lo que podría explicarse por diferencias sustanciales en el sistema de salud. Conclusión: Se pone de manifiesto la influencia de factores epidemiológicos, clínicos y contextuales en las tendencias observadas, reforzando la necesidad de un enfoque diferenciado en el diagnóstico y manejo.
Introduction: Neonatal seizures are a medical emergency characterized by episodes of abnormal cerebral electrical activity in the newborn. Objective: Given the age of the data, this study aims to update the hospital discharge rate for neonatal seizures during the period 2020-2023 in Chile. Methodology: Observational, descriptive, and cross-sectional study on the hospital discharge rate due to neonatal seizures in the population under 1 year of age during the period 2020-2023 in Chile, according to the variables of sex and duration of hospital stay. Data were collected from the Department of Health Statistics and Information and the National Institute of Statistics of Chile. Result: A total of 519 cases were studied, determining a hospital discharge rate of 0,60 cases per 1000 inhabitants during this period of time, with the highest rates observed in 2022. A predominance in male sex was noted. The average hospital stay was established at 14,25 days, with longer stays observed in males. Discussion: The obtained hospital discharge rate are similar to those reported internationally, and their trend may be associated with post-COVID consequences. The male predominance aligns with international literature, where it ́s associated with greater immaturity and vulnerability at birth. The length of hospital stay appears to be longer than that reported in other countries, which may be explained by substantial differences in the healthcare system. Conclusion: The influence of epidemiological, clinical, and contextual factors on the observed trends is evident, reinforcing the need for a differentiated approach to diagnosis and management
Implementation of a goal-directed Care Bundle for intracerebral hemorrhage: Results of embedded process evaluation in the INTERACT3 trial
Get PDFThe third, stepped-wedge, cluster-randomized, Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT3), has shown that a goal-directed multi-faceted Care Bundle incorporating protocols for the management of physiological variables was safe and effective for improving functional recovery in a broad range of patients with acute intracerebral hemorrhage (ICH). The INTERACT3 Care Bundle included time- and target-based protocols for the management of early intensive lowering of systolic blood pressure (SBP, target <140mmHg), glucose control (target 6.1-7.8 mmol/L in those without diabetes and 7.8-10.0 mmol/L in those with diabetes), anti-pyrexia treatment (target body temperature ≤37.5°C), and the rapid reversal of warfarin-related anticoagulation (target international normalized ratio <1.5). An embedded process evaluation was conducted to allow a better understanding of how the Care Bundle was implemented in different countries to enhance the transferability of this evidence in the international context. This study used a mixed-methods approach involving interviews, focus group discussions, and surveys to evaluate the implementation outcomes included fidelity, dose, reach, acceptability, appropriateness, adoption, and sustainability. Interviews (n = 27), focus group discussions (n = 3), and quantitative surveys (n = 48) were conducted in 7 low- and middle-income countries (LMICs) and 1 high-income country during 2019-2022. The Care Bundle was generally delivered as planned and well accepted by stakeholders, although some difficulties were reported in reaching the SBP and glycemic targets. Contextual factors including staff shortage, limited availability of antihypertensive drugs, and delayed systems of care processes, were common barriers to implementing the Care Bundle. Facilitating factors included good communication and collaboration with staff in emergency departments, the development of pathways within available resources, and regular training and monitoring. Our process evaluation provides useful insights into the contextual barriers which need to be addressed for effective scale up of the Care Bundle implementation in a global context. Trial registration: INTERACT3 is registered at Clinicaltrials.gov (NCT03209258) and the Chinese Clinical Trial Registry (ChiCTR-IOC-17011787).Versión Publicad