Potent Induction of Envelope-Specific Antibody Responses by Virus-Like Particle Immunogens Based on HIV-1 Envelopes from Patients with Early Broadly Neutralizing Responses.

Longitudinal studies in HIV-1-infected individuals have indicated that 2 to 3 years of infection are required to develop broadly neutralizing antibodies. However, we have previously identified individuals with broadly neutralizing activity (bNA) in early HIV-1 infection, indicating that a vaccine may be capable of bNA induction after short periods of antigen exposure. Here, we describe 5 HIV-1 envelope sequences from individuals who have developed bNA within the first 100 days of infection (early neutralizers) and selected two of them to design immunogens based on HIV-1-Gag virus-like particles (VLPs). These VLPs were homogeneous and incorporated the corresponding envelopes (7 to 9 µg of gp120 in 1010 VLPs). Both envelopes (Envs) bound to well-characterized broadly neutralizing antibodies (bNAbs), including trimer-specific antibodies (PGT145, VRC01, and 35022). For immunogenicity testing, we immunized rabbits with the Env-VLPs or with the corresponding stabilized soluble envelope trimers. A short immunization protocol (105 days) was used to recapitulate the early nAb induction observed after HIV-1 infection in these two individuals. All VLP and trimeric envelope immunogens induced a comparably strong anti-gp120 response despite having immunized rabbits with 30 times less gp120 in the case of the Env-VLPs. In addition, animals immunized with VLP-formulated Envs induced antibodies that cross-recognized the corresponding soluble stabilized trimer and vice versa, even though no neutralizing activity was observed. Nevertheless, our data may provide a new platform of immunogens, based on HIV-1 envelopes from patients with early broadly neutralizing responses, with the potential to generate protective immune responses using vaccination protocols similar to those used in classical preventive vaccines. IMPORTANCE It is generally accepted that an effective HIV-1 vaccine should be able to induce broad-spectrum neutralizing antibodies. Since most of these antibodies require long periods of somatic maturation in vivo, several groups are developing immunogens, based on the HIV envelope protein, that require complex and lengthy immunization protocols that would be difficult to implement in the general population. Here, we show that rabbits immunized with new envelopes (VLP formulated) from two individuals who demonstrated broadly neutralizing activity very early after infection induced specific HIV-1 antibodies after a short immunization protocol. This evidence provides the basis for generating protective immune responses with classic vaccination protocols with vaccine prototypes based on HIV envelope sequences from individuals who have developed early broadly neutralizing responses.

Wine astringency: more than just tannin-protein interactions.

Red wines are characterized by their astringency, a very important sensory attribute that affects the perceived quality of wines. Three mechanisms have been proposed to explain astringency, and two theories describe how these mechanisms work in an integrated manner to produce tactile sensations such as drying, roughening, shrinking and puckering. The factors involved include not only tannins and salivary proteins, but also anthocyanins, grape polysaccharides and mannoproteins, as well as other wine matrix components that modulate their interactions. These multifactorial interactions could be responsible for different sensory responses and therefore need to be further studied. This review presents the latest advances in astringency perception and its possible origins, with special attention on the interactions of components, their impact on oral perception and the development of astringency sub-qualities. Future research efforts should concentrate on understanding the mechanisms involved as well as on the limiting factors related to the conformation and stability of the tannin-salivary protein complexes. © 2021 Society of Chemical Industry.

High prevalence of SARS-CoV-2 detection and prolonged viral shedding in stools: A systematic review and cohort study.

OBJECTIVES: To: 1. Describe the frequency of viral RNA detection in stools in a cohort of patients infected with SARS-CoV-2, and 2. Perform a systematic review to assess the clearance time in stools of SARS-CoV-2. METHODS: We conducted a prospective cohort study in two centers between March and May 2020. We included SARS-CoV-2 infected patients of any age and severity. We collected seriated nasopharyngeal swabs and stool samples to detect SARS-CoV-2. After, we performed a systematic review of the prevalence and clearance of SARS-CoV-2 in stools (PROSPERO-ID: CRD42020192490). We estimated prevalence using a random-effects model. We assessed clearance time by using Kaplan-Meier curves. RESULTS: We included 32 patients; mean age was 43.7±17.7 years, 43.8% were female, and 40.6% reported gastrointestinal symptoms. Twenty-five percent (8/32) of patients had detectable viral RNA in stools. The median clearance time in stools of the cohort was 11[10-15] days. Systematic review included 30 studies (1392 patients) with stool samples. Six studies were performed in children and 55% were male. The pooled prevalence of viral detection in stools was 34.6% (twenty-four studies, 1393 patients; 95%CI:25.4-45.1); heterogeneity was high (I2:91.2%, Q:208.6; p≤0.001). A meta-regression demonstrates an association between female-gender and lower presence in stools (p=0.004). The median clearance time in stools was 22 days (nineteen studies, 140 patients; 95%CI:19-25). After 34 days, 19.9% (95%CI:11.3-29.7) of patients have a persistent detection in stools. CONCLUSIONS: Detection of SARS-CoV-2 in stools is a frequent finding. The clearance of SARS-CoV-2 in stools is prolonged and it takes longer than nasopharyngeal secretions.

Early versus deferred anti-SARS-CoV-2 convalescent plasma in patients admitted for COVID-19: A randomized phase II clinical trial.

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.

Prevalence of M184V and K65R in proviral DNA from PBMCs in HIV-infected youths with lamivudine/emtricitabine exposure.

OBJECTIVES: We analysed the prevalence of M184V/I and/or K65R/E/N mutations archived in proviral DNA (pDNA) in youths with perinatal HIV, virological control and who previously carried these resistance mutations in historic plasma samples. METHODS: We included vertically HIV-infected youths/young adults aged ≥10 years in the Madrid Cohort of HIV-1 Infected Children and Adolescents, exposed to lamivudine and/or emtricitabine, with M184V/I and/or K65R/E/N in historic plasma samples, on antiretroviral therapy (ART), virologically suppressed (HIV-1 RNA <50 copies/mL), and with available PBMCs in the Spanish HIV BioBank. Genomic DNA was extracted from PBMCs and HIV-1 RT gene was amplified and sequenced for resistance testing by Stanford HIV Resistance tool. RESULTS: Among the 225 patients under follow-up in the study cohort, 13 (5.8%) met selection criteria, and RT sequences were recovered in 12 (92.3%) of them. All but one were Spaniards, carrying subtype B, with a median age at PBMCs sampling of 21.3 years (IQR: 15.6-23.1) with 4 years (IQR 2.1-6.5) of suppressed viral load (VL). Nine (75%) youths did not present M184V/I in pDNA after at least 1 year of viral suppression. In December 2019, the remaining three subjects carrying M184V/I in pDNA maintained suppressed viraemia, and two still used emtricitabine in ART. CONCLUSIONS: The prevalence of resistance mutations to lamivudine and emtricitabine in pDNA in a cohort of youths perinatally infected with HIV who remain with undetectable VL, previously lamivudine and/or emtricitabine experienced, was infrequent. Our results indicate that ART including lamivudine or emtricitabine may also be safe and successful in youths with perinatal HIV with previous experience of and resistances to these drugs detected in plasma.

Development of an Isavirus minigenome system to study the function of the pocket RNA-binding domain of the viral nucleoprotein (NP) in salmon cells.

The Isavirus is an orthomyxovirus with a genome composed of eight segments of negative single-strand RNA (-ssRNA). It has been proposed that the eight genomic segments of the Isavirus are organized as a ribonucleoprotein (RNP) complex called a minigenome, which contains all the viral RNA segments, a viral heterotrimeric polymerase and multiple copies of the viral nucleoprotein (NP). Here, we develop an Isavirus minigenome system and show the importance of the formation of active RNPs and the role of viral NP R189, R194, R302 and K325 residues in the NP RNA-binding domain in the context of RNPs. The results indicate it is possible to generate a minigenome in salmon cells, a composite ISAV RNPs with EGFP-based chimeric vRNA with heterotrimeric polymerase (PB1, PB2, PA) and NP protein using CMV-based auxiliary plasmids. It was also shown that NP R189, R194, R302 and K325 residues are important to generate viral mRNA from the constituted RNPs and a detectable reporter protein. This work is the first salmon cell-based minigenome assay for the Isavirus, which was evaluated by a bioinformatic and functional study of the NP protein in viral RNPs, which showed that correct NP-vRNA interaction is key to the functioning of RNPs.

[Balanced scorecard in health]. / Cuadro de mando en salud.

OBJECTIVE: To evaluate the installation of strategies in the higher complexity hospitals (HMC, in Spanish) of public health in Chile starting from the results of the Balanced Scorecard (BSC), during the years 2011-2012. MATERIALS AND METHODS: The implementation of the BSC is described, the strategies and indicators identified, and the results of the 57 HMC compared and analyzed. RESULTS: Starting from the comparison of the results it is discovered that the BSC allows to evaluate the installation of the strategies. CONCLUSION: Differences are identified in the installation of the strategies by geographical area, with North presenting a higher score (20.21), followed by Center (10.41) and South (19.50), which can be explained by the size and complexity of this establishments, variables that should be incorporated in the evaluation of the results of the BSC.

Transmitted Drug Resistance and HIV Diversity Among Adolescents Newly Diagnosed With HIV in Spain.

BACKGROUND: Virologic characterization of newly HIV-diagnosed adolescents could help to improve their specific needs. The objective was to describe the transmitted drug resistance mutations (TDR) and its transmission by clusters in this population in Spain. METHODS: TDR to retrotranscriptase and protease inhibitors included in the WHO TDR list 2009 implemented in the Calibrated Population Resistance tool v8.0 (Stanford) were studied in HIV pol sequences from all HIV-diagnosed adolescents (12-19-year-old) enrolled during 2004-2019 period in the Spanish pediatric and adult (CoRISpe-CoRIS) cohorts. The found TDR were compared with the provided by the Stanford algorithm v9.0 2021. HIV-1 variants and transmission clusters were also studied. RESULTS: Among 410 HIV-1 adolescents diagnosed, 141 (34.4%) had available ART-naive sequences. They were mostly male (81.6%), Spanish (55.3%) and with behavioral risk (92.2%), mainly male-to-male sexual contact (63.1%). TDR prevalence was significantly higher by Stanford versus WHO list (18.4% vs. 7.1%; P = 0.004). The most prevalent TDR by the WHO list was K103N (3.6%) and by Stanford E138A (6.6%), both at retrotranscriptase. E138A, related to rilpivirine/etravirine resistance, was absent in the WHO list. One in 4 adolescents carried HIV-1 non-B variants. We described 5 transmission clusters, and 2 carried TDR mutations. CONCLUSIONS: Our data suggest a high TDR prevalence in adolescents with a new HIV diagnosis in Spain, similar to adults, 2 active TDR transmission clusters, and the need for the WHO TDR list update. These findings could have implications for the options of the recently available rilpivirine-related long-acting treatment and in first-line regimen election.

Evaluation of zeolite, nanomagnetite, and nanomagnetite-zeolite composite materials as arsenic (V) adsorbents in hydroponic tomato cultures.

There is a growing interest in the use of adsorbent nanoparticles to mitigate the toxic effects of pollutants in natural matrices. However, due to their small size, nanoparticles have the potential to transport and disseminate contaminants adsorbed on their surfaces into environmental compartments with greater risk to human, animal, or plant health. This potential consequence of nanoparticle application remains largely unstudied. Here, we studied the application of three adsorbents, including zeolite (Z, micrometric size), nanomagnetite (Mt), and a nanomagnetite-zeolite composite (MtZ) intended to mediate arsenic toxicity in hydroponic tomato cultures. Adsorption studies showed an arsenate adsorption sequence of MtZ (6.2 mg g-1) ≥ Mt (4.7 mg g-1) â‰« Z (0.3 mg g-1). Tomatoes grown under the Mt condition demonstrated the lowest growth rate (4.2 cm), corresponding to a 45% decrease compared to the control (7.6 cm), as well as the highest oxidative stress level (0.024 µmol g-1) as indicated by malondialdehyde (MDA) concentration, almost twice the control (0.014 µg g-1). Tomatoes grown under MtZ conditions showed a 22% decreased growth (5.9 cm) but MDA levels (0.012 µmol g-1) were comparable to the control. Together, these results suggest that Mt at the nanometric size could obstruct channels in the plant and prevent absorption of water and nutrients. Anchoring nanomaterials in larger composites of micrometer size presents a promising alternative that would retain their super-adsorbent properties while avoiding toxicity due to nanometric size.

Accuracy of a RT-qPCR SARS-CoV-2 detection assay without prior RNA extraction.

The current COVID-19 pandemic constitutes a threat to the population worldwide with over 21 million infected people. There is an urgent need for the development of rapid and massive detection tools as well as the identification and isolation of infected individuals. we sought to evaluate different RT-qPCR kits and protocols to evaluate the best approach to be used omitting an RNA extraction step. We have investigated the sensitivity and performance of different commercially available RT-qPCR kits in detecting SARS-CoV-2 using 80 extracted RNA and NSS from COVID-19 diagnosed patients. We evaluated the ability of each kit to detect viral RNA from both kit-extracted or directly from a pre-boiled NSS observing that direct RNA detection is possible when Ct values are lower than 30 with the three kits tested. Since SARS-CoV-2 testing in most locations occurs once COVID-19 symptoms are evident and, therefore, viral loads are expected to be high, our protocol will be useful in supporting SARS-CoV-2 diagnosis, especially in America where COVID-19 cases have exploded in the recent weeks as well as in low- and middle-income countries, which would not have massive access to kit-based diagnosis. The information provided in this work paves the way for the development of more efficient SARS-CoV-2 detection approaches avoiding an RNA extraction step.

Insights into neutralizing antibody responses in individuals exposed to SARS-CoV-2 in Chile.

Chile has one of the worst numbers worldwide in terms of SARS-CoV-2 positive cases and COVID-19-related deaths per million inhabitants; thus, characterization of neutralizing antibody (NAb) responses in the general population is critical to understanding of immunity at the local level. Given our inability to perform massive classical neutralization assays due to the scarce availability of BSL-3 facilities in the country, we developed and fully characterized an HIV-based SARS-CoV-2 pseudotype, which was used in a 96-well plate format to investigate NAb responses in samples from individuals exposed to SARS-CoV-2 or treated with convalescent plasma. We also identified samples with decreased or enhanced neutralization activity against the D614G spike variant compared with the wild type, indicating the relevance of this variant in host immunity. The data presented here represent the first insights into NAb responses in individuals from Chile, serving as a guide for future studies in the country.

Virological outcome among HIV infected patients transferred from pediatric care to adult units in Madrid, Spain (1997-2017).

The aim of this transversal study was to describe the virological and immunological features of HIV-infected youths transferred from pediatric to adult care units since 1997 vs. the non-transferred patients from the Madrid Cohort of HIV-infected children and adolescents in Spain. We included 106 non-transferred and 184 transferred patients under clinical follow-up in 17 public hospitals in Madrid by the end of December 2017. Virological and immunological outcomes were compared in transferred vs. non-transferred patients. ART drug resistance mutations and HIV-variants were analyzed in all subjects with available resistance pol genotypes and/or genotypic resistance profiles. Among the study cohort, 133 (72.3%) of 184 transferred and 75 (70.7%) of 106 non-transferred patients had available resistance genotypes. Most (88.9%) of transferred had ART experience at sampling. A third (33.3%) had had a triple-class experience. Acquired drug resistance (ADR) prevalence was significantly higher in pretreated transferred than non-transferred patients (71.8% vs. 44%; p = 0.0009), mainly to NRTI (72.8% vs. 31.1%; p < 0.0001) and PI (29.1% vs. 12%; p = 0.0262). HIV-1 non-B variants were less frequent in transferred vs. non-transferred (6.9% vs. 32%; p < 0.0001). In conclusion, the frequent resistant genotypes found in transferred youths justifies the reinforcement of HIV resistance monitoring after the transition to avoid future therapeutic failures.

Análisis bibliométrico de la literatura científica del control de la gestión de redes sanitarias / Bibliometric analysis of the scientific literature on health network management control

La información es el elemento básico de toda investigación científica, la cual requiere encontrar datos y tratarlos con la finalidad de obtener información agregada. Además, es necesario conocer el punto de vista de diversos autores que ya han abordado el tema de investigación. Por ello, los análisis bibliométricos han adquirido gran importancia en el ámbito científico. El presente trabajo tuvo como objetivo revisar en profundidad la literatura científica relacionada con el control de la gestión de las redes sanitarias, para identificar las publicaciones más relevantes, los autores más influyentes y las diferentes tendencias. Se trabajó con la base de datos Web of Science (WoS) para analizar 476 artículos, atendiendo a una serie de indicadores bibliométricos en un período de 51 años. Este estudio indica que la literatura científica de las redes sanitarias es un área de conocimiento en plena vigencia y actualidad, orientado principalmente al estudio teórico del análisis de redes; prevalece la metodología cuantitativa, mediante fuentes de información primaria; el idioma predominante es el inglés y solo se presentan recientes hallazgos relacionados con el estudio descriptivo del control de las redes sanitarias(AU)

Information is the basic element of all scientific research, which requires finding data and processing them in order to obtain aggregate information. In addition, it is necessary to know the point of view of various authors who have already addressed the research topic. Therefore, bibliometric analyses have acquired great importance in the scientific field. The present work aimed at reviewing in depth the scientific literature related to health network management control, in order to identify the most relevant publications, the most influential authors and the different trends. The Web of Science (WoS) database was used to analyze 476 articles, based on a series of bibliometric indicators over a period of 51 years. This study indicates that the scientific literature on health networks is an area of knowledge in full force and topicality, mainly oriented to the theoretical study of network analysis; the quantitative methodology prevails, through primary information sources; the predominant language is English and only recent findings related to the descriptive study of the control of health networks are presented(AU)

¿Ha disminuido la colectomía por crisis de colitis ulcerosa?

Background: Treatment for moderate-severe active ulcerative colitis (UC) includes steroids, biologic therapy and total colectomy. Aim: To describe the features of patients with moderate to severe active UC, their hospital evolution and need for colectomy. Material and Methods: Non-concurrent cohort study of all patients admitted to our institution with a diagnosis of moderate or severe UC crisis between January 2008 and May 2019. Truelove Witts (TW) criteria were used to categorize disease severity. Twelve-month colectomy-free survival was estimated with Kaplan-Meier survival analysis. Results: One hundred-twenty patients aged 16 to 89 (median 35) years had 160 admissions for acute moderate to severe UC. Median admission per patient was 1 (1-3), and median hospital stay was six days (1-49). Cytomegalovirus and Clostridioides difficile were found in 17.5 and 14.2% of crises, respectively. Corticosteroids were used in all crises and biologic therapy in 6.9% of them. Emergency or elective colectomies were performed in 18.3 and 6.7% of patients, respectively. The need for emergency total colectomy decreased from 24.6 to 7.8% (Risk ratio 3.16, p < 0.01) between de first and second half of the study period. Kaplan-Meier analysis for long term colectomy-free survival in both periods confirmed this decrease (p < 0.01). Conclusions: Medical treatment for moderate to severe UC crises had a 86.3% success and a small percentage required emergency total colectomy. Emergency surgery decreased in the last decade.

Guiding the humoral response against HIV-1 toward a MPER adjacent region by immunization with a VLP-formulated antibody-selected envelope variant.

Preventive HIV-1 vaccine strategies rely on the elicitation of broadly neutralizing antibody (bNAb) responses, but their induction in vivo by vaccination remains challenging. Considering that the ability of an epitope to elicit effective humoral immunity depends on its exposure on the virion, we have used a reverse genetics approach to select variants from an HIV-1 AC10_29 randomly mutated envelope library that showed increased affinity for a selected bNAb (4E10 bNAb targeting the HIV-1 MPER region). Isolated envelope sequences were analyzed by deep-sequencing showing a small number of dominant changes, including the loss of four potential N-linked glycosylation sites and disruption of the V1/V2 loop. Accordingly, the dominant variant (LR1-C1), showed not only increased affinity for MPER bNAbs 4E10 and 2F5, but also higher affinity for an additional antibody targeting the V3 loop (447-52D) that could be a consequence of an open conformation tier 1-like Env. Furthermore, the amino acids specific for the selected variant are associated with an increased sensitivity for 4E10 and 2F5 antibodies. In vivo studies showed that sera from mice immunized with LR1-C1 viruses possessed an improved neutralizing activity compared to the wild-type AC10_29 env. While Virus Like Particles (VLPs) carrying this envelope were unable to induce detectable neutralizing activity in immunized rabbits, one animal showed antibody response to the 4E10-proximal region. Our data establish a novel approach that has the potential to yield HIV envelope immunogen sequences that direct antibody responses to specific envelope regions.

Factores que impactan en la calidad de vida y su incidencia en las directrices sanitarias / Factors that impact quality of life and their impact on health guidelines / Fatores que impactam na qualidade de vida e sua incidência nas diretrizes sanitárias

Resumen Objetivo: identificar los factores que impactan en la calidad de vida de las personas y su incidencia en las directrices sanitarias, a partir del área de dirección estratégica. Metodología: investigación cuantitativa, en la cual se utilizó la Encuesta Nacional de Calidad de Vida 2015-2016 e información de los servicios de salud de Chile al año 2019, se determinó una muestra de 6.818 personas sobre la cual se aplicó un modelo de ecuaciones estructurales. Resultados: se obtiene un valor del índice global de ajuste GoF de 0.5131, considerado un buen ajuste del modelo, y la calidad de vida fue explicada en un 48,2 % por los factores internos y externos considerados. Además, las directrices estratégicas sanitarias fueron explicadas en un 32,1 % por la calidad de vida, comprobando que incide en las directrices de salud del país. Conclusiones: la calidad de vida posee un carácter multidimensional que se puede visualizar a través de un modelo que reúne los factores internos y externos y, debido a que la calidad de vida es fundamental para mejorar el bienestar de la población, está presente en las directrices sanitarias de los servicios de salud de Chile.

Abstract Objective: to identify the factors that impact on the quality of life of people and their impact on health guidelines based on the area of strategic management. Methodology: quantitative research, in which the National Quality of Life Survey 2015-2016 and information from the Chilean health services to the year 2019 were used. A sample of 6.818 people was determined on which a model of structural equations was applied. Results: a global goodness of fit index, GoF of 0.5131 was obtained, considered a good fit of the model, and 48.2% of quality of life was explained by the internal and external factors considered. In addition, the strategic health guidelines were explained in 32.1% by the quality of life, verifying that it affects the health guidelines of the country. Conclusions: quality of life has a multidimensional character that can be visualized through a model that brings together internal and external factors and, because quality of life is essential to improve the well-being of the population, it is present in health guidelines of the Chilean health services.

Resumo Objetivo: identificar os fatores que impactam na qualidade de vida das pessoas e sua incidência nas diretrizes sanitárias, a partir da área de direção estratégica. Metodologia: pesquisa quantitativa, na qual se utilizou a Enquete Nacional de Qualidade de Vida 2015-2016 e informação dos serviços de saúde do Chile ao ano 2019, se determinou uma amostra de 6.818 pessoas sobre a qual se aplicou um modelo de equações estruturais. Resultados: obtémse um valor do índice global de ajuste GoF de 0.5131, considerado um bom ajuste do modelo, e a qualidade de vida foi explicada em um 48,2 % pelos fatores internos e externos considerados. Além, as diretrizes estratégicas sanitárias foram explicadas em um 32,1 % pela qualidade de vida, comprovando que incide nas diretrizes de saúde do país. Conclusões: a qualidade de vida possui um caráter multidimensional que se pode visualizar a través de um modelo que reúne os fatores internos e externos e, devido a que a qualidade de vida é fundamental para melhorar o bem-estar da população, está presente nas diretrizes sanitárias dos serviços de saúde do Chile.

[Methodology for the prevention and intervention of psychosocial risks at work in the public health sector]. / Metodología para la prevención e intervención de riesgos psicosociales en el trabajo del sector público de salud.

OBJECTIVE: To create a methodology for the prevention and intervention of psychosocial risks at workplaces related to public health. METHODOLOGY: First, an assessment tool called SUSESO-ISTAS 21 was applied, and the results were analyzed considering the three levels of care of the health care network of a Chilean public health service. Then, strategies and actions were designed and validated (along with the technical teams and managers of the workplaces under study), which helped developing a methodology for the prevention and intervention of psychosocial risks. This was a quantitative cross-sectional study. For the determination of the sample, a sampling by clusters was performed, obtaining 141 questionnaires applied to the workers of the institutions under study. RESULTS: A high complexity hospital showed 90 % of the 20 sub-dimensions assessed, which is a risk higher than the one established for the Chilean population; for primary care, the result was of 85 %, and for medium complexity hospital 70 %. DISCUSSION: Psychological requirements is the psychosocial dimension that poses the biggest threat, and psychological demands, the emotional sub-dimension with the highest proportion, which represents a high exposure for the Chilean working population. CONCLUSION: Based on the application of the questionnaire, it is concluded that the workplaces under study are at a high psychosocial risk, that is, they present high stress and risk for the health of the working population.

OBJETIVO: Elaborar una metodología de prevención e intervención de riesgos psicosociales presentes en el trabajo en establecimiento de salud pública. MÉTODO: Primera parte: aplicación del instrumento de evaluación denominado SUSESO-ISTAS 21 y análisis de resultados en los tres niveles de atención de la red asistencial de un servicio de salud pública chileno. Segunda parte: se diseña y valida (con equipos técnicos y directivos de los establecimientos en estudio), las estrategias y acciones, desarrollándose una metodología para la prevención e intervención de riesgos psicosociales. Tipo estudio: cuantitativo de corte transversal. Para la determinación de la muestra se realizó un muestreo por conglomerados, obteniéndose 141 cuestionarios aplicados a funcionarios/as de los establecimientos en estudio. RESULTADOS: El hospital de alta complejidad presenta el 90 % de las 20 subdimensiones evaluadas un riesgo alto mayor al establecido para la población chilena, para la atención primaria el resultado fue de un 85 %, y para el hospital de mediana complejidad un 70 %. DISCUSIÓN: La dimensión con mayor riesgo psicosocial corresponde a la dimensión exigencias psicológicas, siendo la subdimensión exigencias psicológicas emocionales la que presenta la mayor proporción, lo que representa una situación de exposición alta según lo establecido para la población trabajadora chilena. CONCLUSIÓN: De la aplicación del cuestionario, se concluye que los establecimientos en estudio se encuentran en una situación de riesgo psicosocial alto, es decir, presentan alta tensión y alto riesgo para la salud de las personas en el trabajo.

Análisis de la miel de abeja en Chile: un estudio de caso en el sector apícola / Honey bee analysis in Chile: a case study in the beekeeping sector / Análise das abelhas no Chile: estudo de caso no setor da apicultura

RESUMEN La finalidad de este estudio consiste en analizar la miel de abeja en Chile para proponer lineamientos estratégicos que permitan contribuir a la gestión del sector apícola chileno. Para ello, la metodología utilizada es un estudio de caso, para lo cual se aplica en el año 2021 una encuesta a 84 consumidores y a 40 apicultores de la Región del Biobío en Chile. Los resultados del estudio permiten apreciar que el 38% de los apicultores se dedica hace más de 10 años a la producción de miel y el 50% senala que aprendió solo del rubro, siendo las principales dificultades enfrentadas la organización y el tiempo, la sanidad y nutrición. Además, el 42% de los apicultores plantean que el cambio climático, las plagas y sequías afectaron la producción de la miel entre un 0 y 20%. Mientras que el 30% de los consumidores encuestados considera como prioridad el prestigio o reputación del producto. Se concluye la relevancia de los lineamientos estratégicos para guiar el desarrollo de la cadena de la miel en Chile y se recomienda su implementación para el fortalecimiento del sector apícola a nivel nacional e internacional. СLASIFICACIÓN JEL: 170, 013

ABSTRACT The purpose of this study is to analyze bee honey in Chile to propose strategic guidelines that allow contributing to the management of the Chilean beekeeping sector For this, the methodology used is a case study for which a survey of 84 consumers and 40 beekeepers of the Biobío Region in Chile is applied in 2021. The results of the study allow us to appreciate that 38% of beekeepers have been dedicated to honey production for more than 10 years and 50% indicate that they only learned about the field, the main difficulties faced being organization and time, health and nutrition. In addition, 42% of beekeepers indicate that climate change, plagues and droughts affected honey production between 0 and 20%. While 30% of consumers surveyed consider the prestige or reputation of the product as a priority. The relevance of the strategic guidelines to guide the development of the honey chain in Chile is concluded and its implementation is recommended for the strengthening of the beekeeping sector at a national and international level. JEL CLASSIFICATION: 170, 013

RESUMO O objetivo deste estudo é analisar a análise das abelhas no Chile a fim de propor diretrizes estratégicas que contribuam para a gestão do setor apícola chileno. Para este fim, a metodologia utilizada é um estudo de caso, para o qual foi realizada uma pesquisa com 84 consumidores e 40 apicultores na Região de Biobío, no Chile, em 2021. Os resultados do estudo mostram que 38% dos apicultores estão envolvidos na produção de mel há mais de 10 anos e 50% dizem que só aprenderam sobre o negócio, sendo as principais dificuldades a organização e o tempo, a saúde e a nutrição. Além disso, 42% dos apicultores dizem que a mudança climática, as pragas e as secas afetaram a produção de mel em 0-20%. Enquanto 30% dos consumidores pesquisados consideram o prestígio ou a reputação do produto como prioridade. A relevância das diretrizes estratégicas para orientar o desenvolvimento da cadeia do mel no Chile está concluída e sua implementação é recomendada para o fortalecimento do setor apícola a nível nacional e internacional. CLASSIFICAÇÃO JEL: 170, 013