Multimorbidity and 11-year mortality in adults: a prospective analysis using the Chilean National Health Survey.

Research on morbidity and mortality often emphasizes individual diseases over the cumulative effects of multimorbidity, especially in low- and middle-income countries. This study aimed to analyze the association between multimorbidity and all-cause mortality in a representative sample of the Chilean population. This longitudinal study used data from 3701 subjects aged ≥15 years who participated in the Chilean National Health Survey conducted between 2009 and 2010. We included 16 self-reported highly prevalent morbidities. All-cause mortality data from an 11-year follow-up were collected from the Chilean Civil Registry. The Cox proportional hazard model, adjusted for confounders, determined the association between multimorbidity categories and all-cause mortality. Of the total sample, 24.3% reported no morbidity, while 50.4% two or more. After adjustment, participants with four or more morbidities had a 1.66 times higher mortality risk [95% confidence interval (CI): 1.03-2.67] than those without morbidities. The mortality risk increased by 10% for each additional morbidity [HR: 1.09 (CI: 1.04-1.16)]. Multimorbidity was common in the Chilean population and increased the mortality risk, which greatly challenges the health system to provide an integral and coordinated approach to healthcare.

[Transitional care for people with chronic health conditions]. / Cuidado de transición: calidad y seguridad de la atención en personas con condiciones crónicas de salud.

People with chronic conditions and elderly frequently use different levels of health care. If those are not coordinated, patients are exposed to complications and adverse effects. To avoid this, the implementation of transitional care (TC) is proposed, which includes the coordination and follow-up of users through the different care settings. We aimed to analyze the concept of transitional care, its characteristics and impact on people with chronic conditions. A search of articles published between 2012 and 2019 in Google Scholar, MEDLINE, CINAHL and Cochrane Library databases was conducted looking for articles related to the concept of transitional care, characteristics, and impact on people with chronic conditions. Several models of TC have been formulated and the literature identifies common interventions, namely telephone follow-up, outpatient clinics and home visits for self-management support. Reports show that TC reduces re-hospitalizations, care costs, increases quality of life and user satisfaction with the health system.

Antarctic Rahnella inusitata: A Producer of Cold-Stable ß-Galactosidase Enzymes.

There has been a recent increase in the exploration of cold-active ß-galactosidases, as it offers new alternatives for the dairy industry, mainly in response to the current needs of lactose-intolerant consumers. Since extremophilic microbial compounds might have unique physical and chemical properties, this research aimed to study the capacity of Antarctic bacterial strains to produce cold-active ß-galactosidases. A screening revealed 81 out of 304 strains with ß-galactosidase activity. The strain Se8.10.12 showed the highest enzymatic activity. Morphological, biochemical, and molecular characterization based on whole-genome sequencing confirmed it as the first Rahnella inusitata isolate from the Antarctic, which retained 41-62% of its ß-galactosidase activity in the cold (4 °C-15 °C). Three ß-galactosidases genes were found in the R. inusitata genome, which belong to the glycoside hydrolase families GH2 (LacZ and EbgA) and GH42 (BglY). Based on molecular docking, some of these enzymes exhibited higher lactose predicted affinity than the commercial control enzyme from Aspergillus oryzae. Hence, this work reports a new Rahnella inusitata strain from the Antarctic continent as a prominent cold-active ß-galactosidase producer.

[Advanced practice nursing as a proposal to improve access and coverage in oncology for Latin America]. / Una propuesta para mejorar el acceso y cobertura en oncología para Latinoamérica: enfermería de práctica avanzada.

PAHO/WHO proposes to implement the role of Advanced Practice Nurse (APN) in Latin America, to reduce gaps in coverage and access to health care. For this purpose, it is necessary to train nursing professionals with an expanded role, which allows them to collaborate in the diagnosis, treatment, and monitoring of people with specific diseases, under established protocols and clinical guidelines and within consolidated interdisciplinary health teams in a cost-effective way. One of the areas with the greatest coverage deficit in Latin America is adult oncology, with inequality in care opportunities for these patients. Part of the premature deaths attributable to this disease are due to the lack of access to timely diagnosis and treatment. As a contribution to the reduction of this gap, a training program of Advanced Nursing Practice was developed, addressing the most urgent needs in the field of oncology. The necessary competencies were defined to develop a professional-level master's degree program, considering prevention, early detection, diagnosis, treatment, and monitoring of people with oncological diseases at different levels of care. A program of this kind is an opportunity to reduce the access gap and coverage of health care for people with cancer, improving their quality of life and their survival.

[Physical activity and sedentary behaviors among people with cancer]. / Nivel de actividad física y sedentarismo en personas con diagnóstico de cáncer en Chile.

BACKGROUND: One of the side effects of cancer treatment is a low level of physical activity (PA) due to fatigue and pain. AIM: To quantify PA levels in Chilean people with cancer. MATERIAL AND METHODS: Analysis of the National Health Survey 2016-2017 including 6,233 participants, comparing those with and without a self-report of cancer was conducted. Levels of PA and sitting time were assessed using the Global Physical Activity Questionnaire. RESULTS: 3% of participants [confidence intervals (CI): 2.6; 3.9] reported having cancer and 34% [95% CI: 22.7; 46.7] of these reported being physically inactive, compared to 25% [95% CI: 22.5; 27,3] of those without cancer. Participants with cancer performed 56 and 77 minutes/day lower vigorous and total PA than participants without cancer. No differences between groups were observed for commuting PA, moderate PA and sedentary time. Lower level of PA was independent of the years elapsed since the diagnosis of cancer. CONCLUSIONS: People with cancer are less physically active than their counterparts without the disease.

[Association between cognitive impairment and depression in Chilean older adults]. / Diagnóstico médico de depresión se asocia a sospecha de deterioro cognitivo en adultos mayores.

BACKGROUND: Depression has been previously associated with cognitive impairment in high income country populations. However, its association in the Chilean population has not been investigated. AIM: To investigate the association between depression and cognitive impairment. MATERIAL AND METHODS: Data from 1384 Chilean adults aged > 60 years, participating in the National Health Survey 2009-2010 was analyzed. Cognitive impairment was assessed using the Mini Mental Examination score. The medical diagnosis of depression was self-reported. The association between depression and cognitive impairment was assessed using a logistic regression. RESULTS: Depression was positively associated with cognitive impairment. However, the magnitude of the association was higher in men (Odds ratio (OR) = 4.02 [95% confidence intervals (CI): 1.44; 6.61], p < 0.01]) than in women (OR = 2.23 [95%CI: 1.03; 3.43], p = 0.04). Older adults who were diagnosed for the first time with depression after 65 years of age, showed a stronger association with cognitive impairment (OR = 6.65 [95% CI: 2.39; 10.9], p < 0.01) than those diagnosed before 55 years. CONCLUSIONS: Our study confirms the association between depression and cognitive impairment. Further research is needed to elucidate the nature and potential mechanisms that link depression with cognitive impairment.

[Effect of a multidimensional intervention for prevention of falls in the eldery]. / Efecto de una intervención multidimensional en personas mayores autovalentes para el manejo del riesgo de caídas.

OBJECTIVE: To evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community. DESIGN: Randomised clinical trial. SETTING: Family health centre, primary care. PARTICIPANTS: Independent elderly people living in the community. INTERVENTION: For intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n=77), and those assigned to the control group (CG, n=77) received usual care in the family health centre. MAIN MEASUREMENTS: Perception of risk of falls, number of risk factors and number of falls in the study period. RESULTS: In both groups there were increases in the perception of risk factors for falling associated with walking (IG: P<.001 and CG: P<.001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r=0.25) and shoes (r=0.24), as well as an increase in the perception of risk of falls associated with walking (r=0.21) and the presence of objects or furniture (r=0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P=.004). CONCLUSIONS: The multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.

Sociodemographic patterns of urine sodium excretion and its association with hypertension in Chile: a cross-sectional analysis.

OBJECTIVE: The aim of the study was to determine the main factors (sociodemographic, anthropometric, lifestyle and health status) associated with high Na excretion in a representative population of Chile. DESIGN: Na excretion (g/d), a valid marker of Na intake, was determined by urine analysis and Tanaka's formulas. Blood pressure was measured by trained staff and derived from the mean of three readings recorded after 15 min rest. The associations of Na excretion with blood pressure and the primary correlates of high Na excretion were determined using logistic regression. SETTING: Chileans aged ≥15 years.ParticipantsParticipants (n 2913) from the Chilean National Health Survey 2009-2010. RESULTS: Individuals aged 25 years or over, those who were obese and those who had hypertension, diabetes or metabolic syndrome were more likely to have higher Na excretion. The odds for hypertension increased by 10·2 % per 0·4 g/d increment in Na excretion (OR=1·10; 95 % CI 1·06, 1·14; P < 0·0001). These findings were independent of major confounding factors. CONCLUSIONS: Age, sex, adiposity, sitting behaviours and existing co-morbidities such as diabetes were associated with higher Na excretion levels in the Chilean population. These findings could help policy makers to implement public health strategies tailored towards individuals who are more likely to consume high levels of dietary salt.

[Association between sleep duration and cognitive impairment in older people]. / ¿Cuál es la asociación entre el tiempo destinado a dormir y el desarrollo de deterioro cognitivo en adultos mayores chilenos?

Background Sleep duration may be a risk factor for cognitive impairment. Aim To investigate the association between sleep duration and cognitive function in Chilean older adults. Material and Methods We analyzed information from 1,384 participants aged > 60 years participating in the National Health Survey 2009-2010 who were assessed with the Mini Mental State Examination (MMSE) and self-reported their average daily sleep hours. Logistic regression analysis was performed to investigate the association between MMSE and sleep duration. Results Compared to those participants who reported sleeping 7 hours per day, those that reported sleeping < 5 hours had a higher odd for cognitive impairment (Odds ratio (OR): 3.66 [95% confidence intervals (CI: 1.69; 7.95], p < 0.01). Similarly, those who reported sleeping > 8 hours per day also showed a higher odd for cognitive impairment (OR: 2.56 [95% CI: 1.32; 4.95], p < 0.01). This association was even stronger for people who reported more than 10 hours of sleep per day (OR: 4.46 [95% CI: 1.32; 4.95], p < 0.01). Conclusions Long and short sleep duration is associated with cognitive impairment in older adults in Chile independent of major confounding factors.

[Physical activity and sedentary behaviours are associated with cognitive impairment in Chilean older adults]. / Actividad física y tiempo sedente se asocian a sospecha de deterioro cognitivo en población adulta mayor chilena.

BACKGROUND: Lifestyle factors could promote healthy ageing. AIM: To investigate the association between physical activity (PA), sedentary behavior and cognitive impairment in Chilean older adults. MATERIAL AND METHODS: We included 1,390 participants from the National Health Survey (2009-2010). The Mini-Mental State Examination was used to diagnose cognitive impairment. Physical activity and sedentary behavior were assessed with the Global Physical Activity Questionnaire (GPAQ). Logistic regression was performed to investigate the associations. RESULTS: Compared with older adults with lower levels of PA (< 48 min/day), those with middle (48-248 min/day) and higher (>248 min/day) levels of PA had lower odds for cognitive impairment (Odds ratio (OR): 0.57 [95% confidence intervals (CI): 0.33; 0.82], p < 0.01 and 0.58 [95% CI: 0.32; 0.83], p < 0.01, respectively). Participants who reported spending more than 8 hours/day sitting had a high odds for cognitive impairment compared to those who spent < 4 hours/day (OR: 3.70 [95% CI: 1.37; 6.03], p = 0.01). CONCLUSIONS: Both PA and sedentary behavior were independently associated with cognitive decline independent of major confounding factors in Chilean older adults.

[Association between FTO (ns9939609) genotype and adiposity markers in Chilean adults]. / Asociación entre el polimorfismo rs9939609 del gen FTO y marcadores de adiposidad en población adulta chilena.

BACKGROUND: Numerous studies have identified the role of Fat-mass-associated-gene (FTO) in the development of obesity. AIM: To investigate the association of FTO gene with adiposity markers in Chilean adults. MATERIAL AND METHODS: 409 participants were included in this cross-sectional study. The association between FTO (rs9939609) genotype and adiposity markers was determined using linear regression analyses. Adiposity markers included were: body weight, body mass index, fat mass, waist circumference, hip circumference and waist/hip ratio. RESULTS: A fully adjusted model showed a significant association between FTO genotype and body weight (2.16 kg per each extra copy of the risk allele [95% confidence intervals (CI): 0.45 to 3.87], p = 0.014), body mass index (0.61 kg.m-2 [95% CI: 0.12 to 1.20], p = 0.050) and fat mass (1.14% [95% CI: 0.39 to 1.89], p = 0.010). The greater magnitude of association was found between the FTO gene and fat mass when the outcomes were standardized to z-score. CONCLUSIONS: This study confirms an association between the FTO gene and adiposity markers in Chilean adults, which is independent of major confounding factors.

Frailty Index as a Predictor of Mortality in Middle-Aged and Older People: A Prospective Analysis of Chilean Adults.

We aimed to investigate the association between frailty status and all-cause mortality in middle-aged and older people. We included 2661 individuals aged ≥ 35 from the Chilean National Health Survey 2009−2010. Mortality was determined through linkage with the Chilean Civil Registry and Identification. A 36-item frailty index (FI) was used to assess the frailty status. Associations between frailty status and all-cause mortality were assessed using Kaplan−Meier and Cox proportional hazard models adjusted for sociodemographic and lifestyle factors. A non-linear association was investigated using penalized cubic splines fitted in the Cox models. During an 8.9 median follow-up (interquartile range of 8.6−9.0), 308 individuals died (11.5%). Lower survival rates were observed in frail individuals compared to pre-frail and robust people (log-rank < 0.001). Compared with robust individuals, frail people had a higher mortality risk (HR: 2.35 [95% CI: 1.57 to 3.51]). Frail middle-aged individuals had a higher risk of dying independently of major risk factors.

Association of Progranulin Gene Expression from Dyspeptic Patients with Virulent Helicobacter pylori Strains; In Vivo Model.

(1) Background: Gastric cancer, the fourth most common cause of death from tumors in the world, is closely associated with Helicobacter pylori. Timely diagnosis, therefore, is essential to achieve a higher survival rate. In Chile, deaths from gastric cancer are high, mainly due to late diagnosis. Progranulin has reflected the evolution of some cancers, but has been poorly studied in gastric lesions. Aiming to understand the role of progranulin in H. pylori infection and its evolution in development of gastric lesions, we evaluated the genic expression of progranulin in gastric tissue from infected and non-infected patients, comparing it according to the epithelial status and virulence of H. pylori strains. (2) Methods: The genic expression of progranulin by q-PCR was quantified in gastric biopsies from Chilean dyspeptic patients (n = 75) and individuals who were uninfected (n = 75) by H. pylori, after receiving prior informed consent. Bacteria were grown on a medium Columbia agar with equine-blood 7%, antibiotics (Dent 2%, OxoidTM), in a microaerophilic environment, and genetically characterized for the ureC, vacA, cagA, and iceA genes by PCR. The status of the tissue was determined by endoscopic observation. (3) Results: Minor progranulin expression was detected in atrophic tissue, with a sharp drop in the tissue colonized by H. pylori that carried greater virulence, VacAs1m1+CagA+IceA1+. (4) Conclusions: Progranulin shows a differential behavior according to the lesions and virulence of H. pylori, affecting the response of progranulin against gastric inflammation.

Predictors of the Level of Physical Activity in Physically Active Older People.

There has not been much study of risk profiles in older people according to different levels of practice in physical activity. For this reason, the aim of this research was to evaluate whether the elements that influence the quality of life and factors such as gender and education can predict the level of physical activity in the physically active elderly population. The Fernández−Ballesteros quality of life questionnaire and the WHO International Physical Activity Questionnaire were applied to a sample of 397 people with a mean age of 69.65 years (SD = 4.71). The results revealed the following predictive factors of practicing a low level of physical activity (p < 0.05): being a woman; having a low educational level; and low scores in activity and leisure and in functional skills. In conclusion, gender, education, functional skills, activity and leisure, and health are elements of quality of life that predict the level of physical activity performed by the elderly, where it is necessary to use leisure activities (visiting friends, playing games, running errands) as an indirect way to increase participation in physical activity.

MALDI-TOF MS and 16S RNA Identification of Culturable Gastric Microbiota: Variability Associated with the Presence of Helicobacter pylori.

Helicobacter pylori is the main bacteria associated with gastroduodenal diseases. Recent studies have reported that gastric microbiota might be modified by the H. pylori colonization, favoring gastric lesions' development. In Chile, the region of La Araucanía concentrates a high risk of gastric cancer associated with Helicobacter pylori colonization, rurality, poverty, and Mapuche ethnicity. Hence, we aimed to identify the culturable gastric microbiota and characterize its variability at different stages of epithelial injury, based on its H. pylori colonization in dyspeptic patients from this Chilean region. Microaerophilic bacteria strains were isolated from antrum biopsies of 155 dyspeptic patients' biopsies and identified using MALDI-TOF MS or 16sRNA gene sequencing for non-pylori species identification, and UreC gene amplification for H. pylori confirmation. We found 48 species from 18 families, mainly belonging to Neisseriaceae (21.3%), Streptococcaceae (20.0%), Actynomicetaceae (9.0%), Enterobacteriaceae, and Lactobacillaceae (4.5%); however, Streptococcaceae and Actinomycetaceae families showed a significant reduction in samples infected with H. pylori, along with a considerably lower diversity of species. Our results revealed a microbiota modification due to H. pylori colonization associated with the gastric epithelial state, suggesting a potential microbiota role for developing and progressing gastric diseases.

Prevalence of Infection and Antibiotic Susceptibility of Helicobacter pylori: An Evaluation in Public and Private Health Systems of Southern Chile.

Helicobacter pylori colonizes half of the human population. Age, ethnicity, and socioeconomic status are factors that influence the prevalence of the infection. This is important in southern Chile, one of the most unequal regions in the world, where a significant difference in the health access of the population occurs due to the existence of two competing health systems. Moreover, in the last few years, current protocols of H. pylori eradication have shown high rates of resistance with reduced therapeutic efficacy. This study reported the epidemiology of infection and attempted to identify divergent points among the population beneficiaries of the two health care schemes in southern Chile. Biopsies from public (n = 143) and private (n = 86) health systems were studied. At the same time, clinical and sociodemographic factors were evaluated. H. pylori strains were obtained from gastric biopsies for culture and molecular testing. Antibiotic susceptibility was determined by the agar dilution method. Differences about ethnicity, rural residence, and education (p ≤ 0.05) were observed between beneficiaries of the two health systems. The prevalence of H. pylori was 45%, with no significant differences regardless of the socioeconomic conditions. The only identified risk factor associated with H. pylori infection was Mapuche ethnicity (OR (odds ratio) = 2.30). H. pylori showed high resistance rates, particularly against clarithromycin (40%), levofloxacin (43.1%), and metronidazole (81.8%). This study highlighted the importance of Mapuche ancestry as a risk factor in southern Chile and emphasized the need to search for new eradication strategies as well as further studies evaluating therapeutic efficacy.

High prevalence of CTX-M-1 group in ESBL-producing enterobacteriaceae infection in intensive care units in southern Chile.

Enterobacteria-producing extended-spectrum ß-lactamases (ESBL) play an important role in healthcare infections, increasing hospitalization time, morbidity and mortality rates. Among several ESBLs that emerge from these pathogens, CTX-M-type enzymes had the most successful global spread in different epidemiological settings. Latin America presents high prevalence of CTX-M-2 in ESBL-producing enterobacterial infections with local emergence of the CTX-M-1 group. However, this high prevalence of the CTX-M-1 group has not yet been reported in Chile. The aim of this study was to identify ESBLs among enterobacteria isolated from clinical samples of critically ill patients from southern Chile. One-hundred thirty seven ESBL-producing bacteria were isolated from outpatients from all critical patient units from Hernán Henríquez Aravena Hospital. Phenotype characterization was performed by antibiogram, screening of ESBL, and determination of minimum inhibitory concentration (MIC). PCR was used for genetic confirmation of resistance. Molecular typing was performed by ERIC-PCR. ESBL-producing isolates were identified as Klebsiella pneumoniae (n=115), Escherichia coli (n=18), Proteus mirabilis (n=3), and Enterobacter cloacae (n=1), presenting multidrug resistance profiles. PCR amplification showed that the strains were positive for blaSHV (n=111/81%), blaCTX-M-1 (n=116/84.7%), blaTEM (n=100/73%), blaCTX-M-2 (n=28/20.4%), blaCTX-M-9 (0.7%), blaPER-1 (0.7%), and blaGES-10 (0.7%). The multiple production of ESBL was observed in 93% of isolates, suggesting high genetic mobility independent of the clonal relationship. The high frequency of the CTX-M-1 group and a high rate of ESBL co-production are changing the epidemiology of the ESBL profile in Chilean intensive care units. This epidemiology is a constant and increasing challenge, not only in Chile, but worldwide.