[«Missing time¼: Experiences of demand management doctors in Chilean primary health care]. / «Falta tiempo¼: experiencias de médicos gestores de la demanda en la atención primaria de salud chilena.

OBJECTIVE: Characterize the current situation of the demand manager physician (DMP) in primary health care (PHC), from the perceptions of those who fulfill this role, their medical peers and the directors of the family health centers (CESFAMs). DESIGN: Qualitative cross-sectional study with a grounded theory approach. SITE: Four CESFAMs from the South East Metropolitan Health Service in Santiago, Chile. PARTICIPANTS: Demand manager physician, general practitioners and directors of CESFAM. METHOD: A semi-structured interview and discussion group were used as data collection technique. Open, axial, and selective coding was carried out with the support of the NVivo12 software. RESULTS: In practice, DMP performs more functions than those defined for the position by the Ministry of Health, generating the feeling of lack of time to carry out their work, what represents their main barrier at work and reflects the absence of institutional support they receive from their employees. Among these invisible functions are: providing feedback to the medical team, leading clinical meetings, and generating reference protocols. For the good performance of the DMP it is necessary to have technical skills and be recognized by their peers. It was estimated that the family doctor is the most suitable professional for the position. The work of the DMP is limited by institutional factors such as waiting lists, lack of specialists, and poor coordination between levels of care. CONCLUSIONS: Standardizing the functions of the DMP is a necessary element for its consolidation and achieving the objectives of maintaining continuity of care in the population.

Age-related effects on the neural processing of semantic complexity in a continuous narrative: Modulation by gestures already present in young to middle-aged adults.

The processing of semantically complex speech is a demanding task which can be facilitated by speech-associated arm and hand gestures. However, the role of age concerning the perception of semantic complexity and the influence of gestures in this context remains unclear. The goal of this study was to investigate if age-related differences are already present in early adulthood during the processing of semantic complexity and gestures. To this end, we analyzed fMRI images of a sample of 38 young and middle-aged participants (age-range: 19-55). They had the task to listen and to watch a narrative. The narrative contained segments varying in the degree of semantic complexity, and they were spontaneously accompanied by gestures. The semantic complexity of the story was measured by the idea density. Consistent with previous findings in young adults, we observed increased activation for passages with lower compared to higher complexity in bilateral temporal areas and the precuneus. BOLD signal in the left frontal and left parietal regions correlated during the perception of complex passages with increasing age. This correlation was reduced for passages presented with gestures. Median-split based post-hoc comparisons confirmed that group differences between younger (19-23 years) and older adults within the early adult lifespan (24-55 years) were significantly reduced in passages with gestures. Our results suggest that older adults within early adulthood adapt to the requirements of highly complex passages activating additional regions when no gesture information is available. Gestures might play a facilitative role with increasing age, especially when speech is complex.

The facilitative effect of gestures on the neural processing of semantic complexity in a continuous narrative.

Gestures are elemental components of social communication and aid comprehension of verbal messages; however, little is known about the potential role of gestures in facilitating processing of semantic complexity in an ecologically valid setting. The goal of this study was to investigate whether cognitive load, as indexed by semantic complexity, is modulated by the presentation of gestures accompanying speech. Twenty healthy participants watched 16 video clips of a short narrative while instructed to carefully listen to and watch the narrator while functional magnetic resonance imaging (fMRI) data were acquired. The videos contained passages with and without various co-speech gestures, as well as passages where the semantic complexity was either low or high, as measured by the metric of idea density. Increasing semantic complexity led to reduced activation within the default mode network (DMN); whereas, presents of gestures decreased activation in language-related regions (left middle temporal gyrus and left inferior frontal gyrus) and increased activation in high-level visual and multimodal regions of occipitotemporal cortex. Most interestingly, an interaction between semantic complexity and gestures was observed in a language-related area in left anterior temporal cortex; specifically, increasing gestures led to a greater drop in activation with high vs. Low semantic complexity. These results provide evidence that the facilitation of gestures on semantic processing, particularly for complex narratives, is reflected in the neural substrates of language processing.

Prevalencia de síndrome metabólico en pacientes psoriáticos chilenos / Prevalence of metabolic syndrome in Chilean patients with psoriasis

Introducción: Existe poca información de la asociación entre Psoriasis y síndrome metabólico (SM) en Chile. Objetivos: Determinar la prevalencia de SM en psoriáticos chilenos. Material y métodos: Se realizó un estudio caso-control, con 487 pacientes (238 psoriáticos y 239 controles). En ambos grupos se analizó la prevalencia de SM además del exceso de peso, hipertensión arterial, diabetes mellitus 2, hipertrigliceridemia y niveles de HDL bajo. Resultados: Los psoriáticos presentaron mayor probabilidad de padecer SM versus los controles (35,29% vs 23,29%) OR 1,8 (1,20-2,66) p<0,05. Se asoció también con circunferencia abdominal aumentada (57,14% vs 36,94) OR 2,6 (1,79 - 3,78), exceso de peso (85,99% vs 63,45%) OR 2,46 (1,62 ­ 3,73) p<0,05 y diabetes mellitus 2 (13,45% vs 4,42%) OR 3,85 (1,79 - 8,26) p<0,05. Conclusiones: Se encontró una mayor prevalencia de SM, exceso de peso, circunferencia abdominal aumentada y diabetes mellitus 2 en el grupo psoriático en comparación al grupo control.

Background: There is a paucity of information about Psoriasis and metabolic syndrome (MS) association in Chile. Aim: To determine the MS prevalence in Chilean psoriatic patients. Material and Methods: A case-control study was conducted which included 487 patients (238 psoriatic patients and 239 controls). In both groups, MS prevalence, overweight, hypertension, diabetes mellitus type 2, hypertriglyceridemia and low HDL were analyzed. Results: Psoriatic patients were more likely to present MS than controls (35.29% vs 23.29%) OR 1.8 (1.20 to 2.66) p <0.05. In addition, it was associated with increased abdominal circumference (57.14% vs 36.94) OR 2.6 (1.79 to 3.78), overweight (85.99% vs 63.45%) OR 2.46 (1.62 to 3.73) p <0.05 and diabetes mellitus type 2 (13.45% vs. 4.42%) OR 3.85 (1.79 to 8.26) p <0.05. Conclusions: There is a higher prevalence of MS, overweight, increased abdominal circumference and type 2 diabetes mellitus in the psoriatic group compared with the control group.