Cultural competence in a primary healthcare center in Santiago de Chile: a mixed methods design.

BACKGROUND: The immigrant population in Chile is growing significantly, challenging the health care system's capacity to provide sensitive and effective care. AIM: To assess the cultural competence of Chilean primary health workers. MATERIAL AND METHODS: This mixed-methods study used a quantitative scale and semi-structured interviews to examine the cultural competence of a Chilean primary health care team in their care for the international migrant population. The study pointed to specific variables that were associated with increased cultural competence, including age, intercultural life experiences, and having received relevant training. RESULTS: The two approaches produced largely convergent results. The dimensions of cultural competence with the highest scores on the quantitative scale were also the theoretical dimensions with the greatest discursive density in the qualitative analysis. CONCLUSIONS: The analysis provides a starting point for policies aimed at the development of cultural competence in the national scenario, suggesting a general direction to foster transcultural competence in health, such as formal training and the promotion of informal spaces ofsensibilization.

A plant volatile alters the perception of sex pheromone blend ratios in a moth.

Mate finding in most moths is based on male perception of a female-emitted pheromone whose species specificity resides in component chemistry and proportions. Components are individually detected by specialized olfactory receptor neurons (ORNs) projecting into the macroglomerular complex (MGC) of the male brain. We asked how robust ratio recognition is when challenged by a plant volatile background. To test this, we investigated the perception of the pheromone blend in Agrotis ipsilon, a moth species whose females produce a blend of Z7-dodecenyl acetate (Z7-12:Ac), Z9-tetradecenyl acetate (Z9-14:Ac), and Z11-hexadecenyl acetate in a 4:1:4 ratio optimally attractive for males. First, we recorded the responses of specialist ORNs for Z7 and Z9 and showed that heptanal, a flower volatile, activated Z7 but not Z9 neurons. Then, we recorded intracellularly the responses of MGC neurons to various ratios and showed that heptanal altered ratio responses of pheromone-sensitive neurons. Finally, we analyzed the behavior of males in a wind tunnel and showed that their innate preference for the 4:1:4 blend was shifted in the presence of heptanal. Pheromone ratio recognition may thus be altered by background odorants. Therefore, the olfactory environment might be a selective force for the evolution of pheromone communication systems.

Clinical study of Maggot therapy for Fournier's gangrene.

Fournier's Gangrene is a fulminating necrotizing fasciitis of the perineum and genitalia. Standard treatment involves immediate excision of all necrotic tissue, aggressive antibiotic coverage, and supportive medical care. Still, the infection is commonly fatal or disfiguring. Wound treatment with disinfected blowfly larvae (maggot debridement therapy or MDT) has been shown to be highly effective, with multiple studies demonstrating effective debridement, disinfection, and promotion of granulation tissue. MDT also has been associated with preservation of viable tissue and minimised blood loss. This report describes a prospective clinical study of MDT for Fournier's gangrene aimed to test the hypothesis that early use of maggots could decrease the number of surgical treatments required to treat Fournier's gangrene. Subjects were provided with one initial surgical excision, followed by debridement using only medical grade Lucilia sericata larvae. Only two subjects were enrolled, both diabetic men. Intensive care and culture-directed antimicrobial coverage were administered as usual. Maggot debridement was associated with the disappearance of necrotic tissue, control of infection and granulation tissue growth. In both subjects, wounds healed without requiring further surgical resection or anatomical reconstruction. Maggot therapy decreased the number of surgical procedures that otherwise would have been necessary, and led to favourable outcomes.

Rapid cultivar identification of barley seeds through disjoint principal component modeling.

Classification of barley varieties is a crucial part of the control and assessment of barley seeds especially for the malting and brewing industry. The correct classification of barley is essential in that a majority of decisions made regarding process specifications, economic considerations, and the type of product produced with the cereal are made based on the barley variety itself. This fact combined with the need to promptly assess the cereal as it is delivered to a malt house or production facility creates the need for a technique to quickly identify a barley variety based on a sample. This work explores the feasibility of differentiating between barley varieties based on the protein spectrum of barley seeds. In order to produce a rapid analysis of the protein composition of the barley seeds, lab-on-a-chip micro fluid technology is used to analyze the protein composition. Classification of the barley variety is then made using disjoint principle component models. This work included 19 different barley varieties. The varieties consisted of both winter and summer barley types. In this work, it is demonstrated that this system can identify the most likely barley variety with an accuracy of 95.9% based on cross validation and can screen summer barley with an accuracy of 95.2% and a false positive rate of 0.0% based on cross validation. This demonstrates the feasibility of the method to provide a rapid and relatively inexpensive method to verify the heritage of barley seeds.

Patient safety first... a California partnership for health.

BACKGROUND: In California in 2009, Anthem Blue Cross joined forces with three regional hospital associations (RHAs) and an independent evaluator in an initial three-year, $6-million effort to address patient safety. METHODS: During Phase 1 of the Patient Safety First... a California Partnership for Health program (2010-2012), more than 180 of the 395 hospitals represented by the RHAs shared and implementated best practices in learning collaboratives. The three initial areas of focus were (1) health care-associated infections-ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI); (2) sepsis mortality; and (3) perinatal care-reduction of elective deliveries prior to 39 weeks of gestation. To measure progress, the difference in the average rates from 2009 (baseline) to 2012 was calculated using data from hospitals that reported for every quarter from 2009 through 2012. RESULTS: The rate decreases-57% for VAP cases per 1,000 ventilator-days, 43% for CLABSI cases per 1,000 central line-days, 24% reduction for CAUTI cases per 1,000 patient-days, 26% reduction for sepsis deaths per 100 sepsis cases, and 74% for elective deliveries < 39 gestational weeks-were statistically significant at the .05 level, except for CAUTI. A cost-avoidance analysis showed that these reductions were associated with a saving of 3,576 lives and an avoidance of $63.8 million in costs statewide (not limited to Anthem Blue Cross members). CONCLUSION: The Patient Safety First program provides a long-term opportunity for collaboration among different health care sectors to share best practices to improve health care for Californians. Phase 2 will continue to addresssepsis and elective deliveries and add other initiatives.

Developmental differences in spatially distinct populations of the forensically relevant blow fly Lucilia sericata - About the comparability of developmental studies (and case work application).

The cosmopolitan blow fly Lucilia sericata is often used in forensic case work for estimating the minimum postmortem interval (PMImin). For this, the age of immature specimens developing on the dead body is calculated by measuring the time taken to reach the sampled developmental stage at a given temperature. To test whether regional developmental data of L. sericata is valid on a global scale, the time taken to reach different developmental stages was compared between a population from Mexico and one from Germany at two different constant temperatures. The German population of L. sericata was collected in Frankfurt/Main, while the Mexican population originated near Oaxaca de Juarez and was transported to Germany in the larval stage. Only the F1 generation was used to avoid adaption of the Mexican flies. Eggs were immediately placed at 20 °C and 30 °C. Five times 30 freshly eclosed larvae per replicate (n = 5) were then transferred to a cup of minced meat in separate containers. The larvae were checked every 8 h for migration, pupariation or emergence of adult flies. The time at which the first individual and 50 % of the specimens per container entered each of these stages, was recorded. Significant differences in the time of development between the two populations were observed at both temperatures. At 20 °C, the first specimens of the Mexican population reached all developmental stages a little (< 1 day to < 2 days) earlier than the German L. sericata. At 30 °C, the Mexican flies also reached the post-feeding stage slightly earlier (0.2 days). However, at 30 °C, the German flies started pupariation significantly earlier (after 5 days) than the Mexican flies (6.9 days) and the adults from Germany also emerged earlier (10.5 days compared to 13.1 days). The same pattern was observed when looking at 50 % of the total number of specimens per container. A comparison with previously published developmental studies was difficult as the experimental design varied widely between studies. However, the results were within the range of most studies. Our study has shown that age estimation can vary widely depending on the population on which the reference data used for the calculations are based. This highlights the importance of using local and population-specific developmental data for estimating the age of blow flies in case work.

Navigating Dravet syndrome in Spain: A cross-sectional study of diagnosis, management, and care coordination.

OBJECTIVES: Dravet syndrome (DS) is a rare form of refractory epilepsy that begins in the first year of life. Approximately 85% of patients have a mutation in the SCN1A gene, which encodes a voltage-gated sodium channel. The main objective of the present work was to assess the degree of knowledge of DS among Spanish primary care (PC) professionals, the communication flow between them and the pediatric neurologists (PNs), and the services available and resources offered to patients in Spain when searching for a diagnosis and adequate treatment. METHODS: Two anonymized online surveys on DS diagnosis and patient management in PC were conducted with Spanish PC pediatricians (PCPs) and caregivers of DS patients in Spain. RESULTS: Most PCPs are aware of genetic epilepsy but lack full knowledge of DS and patient advocacy groups (PAGs). Access to epilepsy treatments varies among regions, with many referrals to hospitals and pediatric neurologists. Diagnosis is often delayed, with misdiagnoses and frequent emergency room (ER) visits. Treatment involves multiple drugs, and sodium channel blockers are used, which are contraindicated in DS treatment. Improved training, resources, and communication are needed for early diagnosis. SIGNIFICANCE: To improve the care and treatment of DS patients in Spain, early diagnosis is required and, possibly, specific efforts aimed at identifying patients in adulthood, generating socio-sanitary structures that integrate social and health services to provide comprehensive care, taking into account the different features and comorbidities of the disease. PLAIN LANGUAGE SUMMARY: Dravet syndrome (DS) is a form of genetic epilepsy that starts within the first year of life. We present a study showing that, while family doctors are aware of genetic epilepsies, many don't have a complete understanding of DS. Unfortunately, getting the right diagnosis can take a long time, leading to unnecessary visits to the emergency room. Patients often need several medications, and sometimes they're given drugs that aren't recommended for DS. The takeaway is that training for doctors, more resources, and improved communication could help creating better healthcare systems and therefore give easier access to the right therapies.

Not all maggots are created equal; not all maggots are therapeutic.

Maggots in a wound ("myiasis") cannot be considered maggot therapy (therapeutic myiasis) unless, at a minimum, the species is known to be safe and effective, and the maggots have been properly disinfected. Documenting treatment details is critical and allows us to determine the cause of problems, if they arise.

Montreal Cognitive Assessment (MoCA) as a screening tool for cognitive impairment in early stages of psychosis.

Background: Cognitive alterations have been reported in early stages of psychosis including people with First Episode Psychosis (FEP), Clinical High-Risk Mental State (CHR), and Psychotic-Like Experience (PLE). This study aimed to compare the cognitive function in early stages of psychosis using the Montreal Cognitive Assessment (MoCA), a low-cost and brief assessment tool of cognitive functions. Methods: A total of 154 individuals, including 35 with FEP, 38 CHR, 44 PLE, and 37 healthy controls (HC), were evaluated with the MoCA in Santiago, Chile. We calculated the mean total score of the MoCA and the standard deviation of the mean. Groups were assessed for a trend to lower scores in a pre-determined sequence (HC > PLE > CHR > FEP) using the Jonckheere-Terpstra test (TJT). Results: The mean total MoCA scores were 24.8 ± 3.3 in FEP, 26.4 ± 2.4 in CHR, 26.4 ± 2.3 in PLE, and 27.2 ± 1.8 in HC. The analyses revealed a significant trend (p < 0.05) toward lower MoCA individual domain scores and MoCA total scores in the following order: HC > PLE > CHR > FEP. The mean total scores of all groups were above the cut-off for cognitive impairment (22 points). Conclusions: The MoCA describes lower scores in cognition across early stages of psychosis and may be a useful low-cost assessment instrument in early intervention centers of poorly resourced settings.

Behavioral report of Chrysomya rufifacies in response to substrate infestation by Lucilia sericata and Lucilia cuprina using a tetrahedron olfactometer device.

Calliphoridae are widespread globally and can inhabit a variety of habitats. In this brief report, we assessed the appeal of Chrysomya rufifacies to resources that were previously inhabited by Lucilia sericata and L. cuprina, both common carrion colonizers. Two hundred adult male and female (1:1) C. rufifacies were released under controlled conditions into clear plastic cages (45 x 45 x 45 cm) with four types of substrates: beef-liver; liver with 100 third-instar larvae of L. cuprina; (III) liver containing 100 third-instar larvae of L. sericata; and liver containing 100 third-instar larvae of C. rufifacies. Each substrate was left in place for 24 hours at the end of a tube connected to the cage, where sticky traps were positioned to capture flies that might have been attracted to a specific substrate. The results indicate variations in the attraction of flies to different types of livers colonized by larvae of various species. It is suggested that flies may have specific preferences depending on the species of larvae present in the substrate. The liver without larvae was the preferred choice, while beef liver with C. rufifacies larvae was the least attractive. Results of statistical tests indicated that there is independence between attractiveness preference and the presence of C. rufifacies flies. Although there is a trend among certain levels of the variables in the correspondence analysis, these relationships are not statistically significant. However, they indicate specific patterns of association between different groups of flies and species of larvae. This study demonstrated that C. rufifacies does not show reduced attraction to any of the resources. A tetrahedron olfactometer device has been used for the first time in a behavioral study of C. rufifacies flies. This may enable future studies to enhance the understanding of fly behavior.

Preliminary Bioactivity Assessment of Myrothecium Species (Stachybotryaceae) Crude Extracts against Aedes aegypti (Diptera: Culicidae): A First Approach from This Phytopathogenic Fungi.

Mosquitoes, as insect vectors, play a crucial role in transmitting viruses and parasites, leading to millions of human deaths in tropical and subtropical regions worldwide. This study aimed to evaluate the effects of ethanolic extracts of three species within the genus Myrothecium (M. roridum, M. dimerum, and M. nivale) on Aedes aegypti mosquito larvae to assess the inhibitory effect on growth and development, as well as to determine mortality. We quantify the average lethal concentrations and provide a qualitative characterization of the chemical groups responsible for their potential. Phytochemical screening revealed the presence of alkaloids, flavonoids, and terpenoids in the ethanolic extracts of the three fungal species. Tannins were found only in the extracts of M. dimerum and M. roridum. We observed a clear dependence of the effects of the crude extracts on mosquito larvae on the concentrations used and the duration of exposure. The toxic effect was observed after 48 h at a concentration of 800 ppm for both M. dimerum and M. nivale, while M. roridum showed effectiveness after 72 h. All three species within the genus Myrothecium exhibited 100% biological activity after 72 h of exposure at 600 ppm. At lower concentrations, there was moderate growth and development inhibitory activity in the insect life cycle. The study highlights the effectiveness of crude Myrothecium extracts in combating mosquito larvae, with effects becoming apparent between 48 and 72 h of exposure. This initial approach underscores the potential of the fungus's secondary metabolites for further in-depth analysis of their individual effects or synergies between them.

Morphometric and microstructural characteristics of hippocampal subfields in mesial temporal lobe epilepsy and their correlates with mnemonic discrimination.

Introduction: Pattern separation (PS) is a fundamental aspect of memory creation that defines the ability to transform similar memory representations into distinct ones, so they do not overlap when storing and retrieving them. Experimental evidence in animal models and the study of other human pathologies have demonstrated the role of the hippocampus in PS, in particular of the dentate gyrus (DG) and CA3. Patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HE) commonly report mnemonic deficits that have been associated with failures in PS. However, the link between these impairments and the integrity of the hippocampal subfields in these patients has not yet been determined. The aim of this work is to explore the association between the ability to perform mnemonic functions and the integrity of hippocampal CA1, CA3, and DG in patients with unilateral MTLE-HE. Method: To reach this goal we evaluated the memory of patients with an improved object mnemonic similarity test. We then analyzed the hippocampal complex structural and microstructural integrity using diffusion weighted imaging. Results: Our results indicate that patients with unilateral MTLE-HE present alterations in both volume and microstructural properties at the level of the hippocampal subfields DG, CA1, CA3, and the subiculum, that sometimes depend on the lateralization of their epileptic focus. However, none of the specific changes was found to be directly related to the performance of the patients in a pattern separation task, which might indicate a contribution of various alterations to the mnemonic deficits or the key contribution of other structures to the function. Discussion: we established for the first time the alterations in both the volume and the microstructure at the level of the hippocampal subfields in a group of unilateral MTLE patients. We observed that these changes are greater in the DG and CA1 at the macrostructural level, and in CA3 and CA1 in the microstructural level. None of these changes had a direct relation to the performance of the patients in a pattern separation task, which suggests a contribution of various alterations to the loss of function.

Application of pharmacovigilance tools in a case of subacute anterior angle narrowing while under furosemide exposure.

Sulfonamides have been related to drug-induced acute angle closure of the eye, but scarce reports exist concerning furosemide. We describe the second case of acute chamber narrowing (ACN) during furosemide exposure. A 65-year-old man with a renal transplant presented with ACN, after 3 months of furosemide intake. Finally, the patient required a bilateral iridotomy and right lens replacement. ACN has been associated with drugs containing sulfonamide derivatives, but an evaluation with pharmacovigilance scales for adverse drug reaction (ADR)-standardised causality assessment has not been provided. We use this case to illustrate how medicines and an ADR should be evaluated and reported. The spreading of pharmacovigilance information on what should be a rare and unexpected condition related to a drug could mean that other reports emerge about ADR with this drug and regulatory agencies perform consequently, as happened with topiramate.

SuPepMem: A database of innate immune system peptides and their cell membrane interactions.

Host defense peptides (HDPs) are short cationic peptides that play a key role in the innate immune response of all living organisms. Their action mechanism does not depend on the presence of protein receptors, but on their ability to target and disrupt the membranes of a wide range of pathogenic and pathologic cells which are recognized by their specific compositions, typically with a relatively high concentration of anionic lipids. Lipid profile singularities have been found in cancer, inflammation, bacteria, viral infections, and even in senescent cells, enabling the possibility to use them as therapeutic targets and/or diagnostic biomarkers. Molecular dynamics (MD) simulations are extraordinarily well suited to explore how HDPs interact with membrane models, providing a large amount of qualitative and quantitative information that, nowadays, cannot be assessed by wet-lab methods at the same level of temporal and spatial resolution. Here, we present SuPepMem, an open-access repository containing MD simulations of different natural and artificial peptides with potential membrane lysis activity, interacting with membrane models of healthy mammal, bacteria, viruses, cancer or senescent cells. In addition to a description of the HDPs and the target systems, SuPepMem provides both the input files necessary to run the simulations and also the results of some selected analyses, including structural and MD-based quantitative descriptors. These descriptors are expected to be useful to train machine learning algorithms that could contribute to design new therapeutic peptides. Tools for comparative analysis between different HDPs and model membranes, as well as to restrict the queries to structural and time-averaged properties are also available. SuPepMem is a living project, that will continuously grow with more simulations including peptides of different sequences, MD simulations with different number of peptide units, more membrane models and also several resolution levels. The database is open to MD simulations from other users (after quality check by the SuPepMem team). SuPepMem is freely available under https://supepmem.com/.

Growth of the Black Soldier Fly Hermetia illucens (Diptera: Stratiomyidae) on Organic-Waste Residues and Its Application as Supplementary Diet for Nile Tilapia Oreochromis niloticus (Perciformes: Cichlidae).

The black soldier fly, Hermetia illucens (BSF, Diptera: Stratiomyidae) is an insect with high protein value and a potential feed agent for animals aimed for human consumption. The growth parameters of BSF larvae reared on four substrates-restaurant-waste, fruit-waste, fish-waste, and commercial tilapia food-for 41 days before processing for inclusion into Oreochromis niloticus (Perciformes: Cichlidae, Nile tilapia) commercial fry diets at 30% (70:30) were determined. On fly larvae, the food substrate based on restaurant waste yielded the greatest larval weight and length. BSF larvae fed a fish-waste diet showed the shortest developmental time. The fruit-waste diet induced the lowest weight and length in the fly larvae/pre-pupae (immature stage). The pre-pupal protein values were similar to commercial food. On fry-fish, the diets with pre-pupae grown on fish waste showed the greatest yields regarding weight (biomass), length, and nutritional content. These results suggest the BSF has the potential to be used in fish feed and provides an alternative for commercial cultivation.

The Impact of Frailty Screening on Radiation Treatment Modification.

BACKGROUND: Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs) in oncology settings. We analyzed if screening tools modified radiotherapy in oncogeriatric patients. METHODS: Patients ≥ 65 years, irradiated between December 2020 and March 2021 at the Hospital Provincial de Castellón, completed the frailty G8 and estimated survival Charlson questionnaires. The cohort was stratified between G8 score ≤ 14 (fragile) or >14 (robust); the cutoff point for the Charlson index was established at five. RESULTS: Of 161 patients; 69.4% were male, the median age was 75 years (range 65-91), and the prevailing performance status (PS) was 0-1 (83.1%). Overall, 28.7% of the cohort were frail based on G8 scores, while the estimated survival at 10 years was 2.25% based on the Charlson test. The treatment administered changed up to 21% after frailty analysis. The therapies prescribed were 5.8 times more likely to be modified in frail patients based on the G8 test. In addition, patients ≥ 85 years (p = 0.01), a PS ≥ 2 (p = 0.008), and limited mobility (p = 0.024) were also associated with a potential change. CONCLUSIONS: CGAs remain the optimal assessment tool in oncogeriatry. However, we found that the G8 fragility screening test, which is easier to integrate into patient consultations, is a reliable and efficient aid to rapid decision making.

Bactericidal Activity of Chrysomya rufifacies and Cochliomyia macellaria (Diptera: Calliphoridae) Larval Excretions-Secretions Against Staphylococcus aureus (Bacillales: Staphylococcaceae).

The inhibitory effect of Chrysomya rufifacies (Macquart) and Cochliomyia macellaria (Fabricius) larval excretions-secretions (ES) on Staphylococcus aureus was determined using a portable colorimetric method without the need for any dedicated spectral instrument. Polystyrene 96 well microplates were used and 100 µl of the bacterial inoculum (5 × 105 CFU/ml) plus 100 µl of the dipteran exosecretions at different concentrations were added to each well. Subsequently, 50 µl of a 1% solution of the triphenyl tetrazolium chloride stain was added to each well to determine the bacterial viability. The color development in each well was measured with the ImageJ software S. aureus was exposed to different concentrations of the ES of both species individually. At a concentration of 800 ppm ES of C. rufifacies or Co. macellaria, bacterial growth was inhibited 97.45 ± 1.70% and 82.21 ± 1.88%, respectively. As expected, exposure to a lower concentration (i.e., 50 ppm) was less inhibitory (C. rufifacies ES, 77.65 ± 4.25% and Co. macellaria ES, 43.54 ± 4.63%). This study demonstrates for the first time the bactericidal activity of C. rufifacies and Co. macellaria ES against S. aureus. This finding is promising as it could result in the identification and synthesis of proteins capable of suppressing pathogen development in wounds. Additionally, the proposed method can simplify the use of expensive laboratory instruments for antimicrobial activity determination.

Cultural competence in a primary healthcare center in Santiago de Chile: a mixed methods design / Competencia cultural en un centro de atención primaria en Santiago de Chile: un diseño de métodos mixtos

BACKGROUND: The immigrant population in Chile is growing significantly, challenging the health care system's capacity to provide sensitive and effective care. AIM: To assess the cultural competence of Chilean primary health workers. MATERIAL AND METHODS: This mixed-methods study used a quantitative scale and semi-structured interviews to examine the cultural competence of a Chilean primary health care team in their care for the international migrant population. The study pointed to specific variables that were associated with increased cultural competence, including age, intercultural life experiences, and having received relevant training. RESULTS: The two approaches produced largely convergent results. The dimensions of cultural competence with the highest scores on the quantitative scale were also the theoretical dimensions with the greatest discursive density in the qualitative analysis. CONCLUSIONS: The analysis provides a starting point for policies aimed at the development of cultural competence in the national scenario, suggesting a general direction to foster transcultural competence in health, such as formal training and the promotion of informal spaces ofsensibilization.

ANTECEDENTES: La población migrante en Chile ha crecido significativamente, desafiando la capacidad del sistema de salud de proporcionar atenciones sensibles y eficaces. OBJETIVO: Examinar la competencia cultural de un equipo de atención primaria de salud. MATERIAL Y MÉTODOS: Este estudio de métodos mixtos utilizó una escala cuantitativa y entrevistas semiestructuradas, para examinar la competencia cultural de un equipo de atención primaria de salud en su atención a la población migrante internacional. Se evaluaron variables específicas que se asociaron con una mayor competencia cultural, entre ellas la edad, las experiencias vividas de interculturalidad y el haber recibido capacitación. RESULTADOS: Los dos enfoques produjeron resultados ampliamente convergentes. Las dimensiones de la competencia cultural con las puntuaciones más altas en la escala cuantitativa, fueron también las dimensiones teóricas con mayor densidad discursiva en el análisis cualitativo, lo que ayuda a dilucidar la evolución de este fenómeno en Chile. CONCLUSIONES: El análisis proporciona un punto de partida para las políticas dirigidas al desarrollo de la competencia cultural en el escenario nacional, sugiriendo una dirección general para fomentar la competencia transcultural en salud, como la capacitación formal y la promoción de espacios informales de sensibilización.

Parental stress and children adjustment in kinship foster families.

This work focuses on a multidimensional exploration of the stress experienced by kinship foster carers. This study is the first one conducted on Spanish sample, with 116 kinship foster families and foster children, between the ages of 4 and 11 years. In general, data indicate that the carer's parental stress scores are within the normative range. The existing heterogeneity among these families is also reported, highlighting a carers group with high stress levels. Parental stress correlated with children variables (initial adversity index, adaptation, evolution and behavioral adjustment); caregiver and family variables (main carer's health, no correlation was found with social support network or with economic needs) and child-carer relationship variables (acceptance-rejection, relationship with the main caregiver and with other family members). Finally, the predictive model performed shows that the more behavioral and emotional problems foster children exhibit, the more stress the carers experience. This is also true the worse the relationships with other relatives are and the poorer the health of the main carer is.

Evaluación de la eficacia de un programa no farmacológico de reducción de peso basado en educación nutricional y fomento de la actividad física en el lugar de trabajo / Evaluation of the effectiveness of a non-pharmacologic intervention based on worksite nutrition and physical activity for controlling employee overweight and obesity

Objetivo: evaluar la eficacia de una intervención basada en educación nutricional y fomento de la actividad física en la reducción de peso de los empleados en su lugar de trabajo. Material y Métodos: 558 empleados realizaron la evaluación inicial recogiéndose datos antropométricos y analíticos. Con un equipo multidisciplinar (nutricionista, entrenador personal, médico y enfermero/a) se planificaron dieta y plan de ejercicios individualizados que se ajustaron en cada visita de seguimiento durante 6 meses. Resultados: 209 empleados finalizaron el ensayo consiguiéndose un porcentaje de pérdida de peso de 9,94 ± 4,67 %(IC 95% 9,22-10,55) y disminución de índice de masa corporal de 3,2 puntos (IC 95% 3,01-3,44) con una p<0.001. Un 85,65% de participantes logró una pérdida de peso ≥ 5%. Conclusión: la intervención fue eficaz reduciendo peso e índice de masa corporal del empleado cuando este se implicó en todo el proceso. Sería deseable aumentar la motivación del participante

Aim: to evaluate the effectiveness of an intervention based on worksite nutrition and physical activity for controlling employee overweight and obesity. Material and Methods: 558 employees completed the initial evaluation, collecting anthropometric and analytical data. A multidisciplinary team (nutritionist, personal trainer, doctor and nurse) planned a diet and individualized exercise plan that were re-evaluated at each follow-up visit for 6 months. Results: 209 employees completed the trial. A weight loss rate of 9.94 ± 4.67% (95% CI 9.22-10.55) and a decrease in body mass index of 3.2 points (95% CI 3.01-3 , 44) with p <0.001. 85.65% of participants achieved a weight loss ≥ 5%. Conclusion: the intervention was effective in reducing employee weight and body mass index when he/she was committed. It would be desirable to increase motivation of the participant to achieve the goal