Adipose Tissue Dysfunction and Energy Balance Paradigms in People Living With HIV.

Over the past 4 decades, the clinical care of people living with HIV (PLWH) evolved from treatment of acute opportunistic infections to the management of chronic, noncommunicable comorbidities. Concurrently, our understanding of adipose tissue function matured to acknowledge its important endocrine contributions to energy balance. PLWH experience changes in the mass and composition of adipose tissue depots before and after initiating antiretroviral therapy, including regional loss (lipoatrophy), gain (lipohypertrophy), or mixed lipodystrophy. These conditions may coexist with generalized obesity in PLWH and reflect disturbances of energy balance regulation caused by HIV persistence and antiretroviral therapy drugs. Adipocyte hypertrophy characterizes visceral and subcutaneous adipose tissue depot expansion, as well as ectopic lipid deposition that occurs diffusely in the liver, skeletal muscle, and heart. PLWH with excess visceral adipose tissue exhibit adipokine dysregulation coupled with increased insulin resistance, heightening their risk for cardiovascular disease above that of the HIV-negative population. However, conventional therapies are ineffective for the management of cardiometabolic risk in this patient population. Although the knowledge of complex cardiometabolic comorbidities in PLWH continues to expand, significant knowledge gaps remain. Ongoing studies aimed at understanding interorgan communication and energy balance provide insights into metabolic observations in PLWH and reveal potential therapeutic targets. Our review focuses on current knowledge and recent advances in HIV-associated adipose tissue dysfunction, highlights emerging adipokine paradigms, and describes critical mechanistic and clinical insights.

Uso profiláctico de antimicrobianos fuera de la práctica quirúrgica y de procedimientos invasivos: bases conceptuales y operativas

El uso preventivo de antimicrobianos es de larga data y no se restringe a antibacterianos. Lo más consensuado y estructurado es la profilaxis antimicrobiana perioperatoria y ante procedimientos invasivos. Fuera de este contexto hay gran cantidad de situaciones, menos caracterizadas, con riesgo de infecciones en que se usan ampliamente, muchas veces con menor sistematización. Esta presentación presenta las bases conceptuales y operativas de este segundo tipo de profilaxis. Conceptualmente la profilaxis primaria pretende evitar la infección por agente único conocido o variados, por exposición ambiental o susceptibilidad específica de ese hospedero y es implementable antes o después de la exposición. Producida esta infección la meta de la profilaxis secundaria intenta evitar la enfermedad y puede tomar dos modalidades, en infecciones sin evidencias de enfermedad clínica o daños, la profilaxis corresponde a "tratamiento de infección latente" y, si aún en ausencia de manifestaciones clínicas, hay elementos de laboratorio precoces premonitorios de progresión, la profilaxis se denomina "tratamiento anticipatorio". Se presentan operacionalmente y resumidas las situaciones en contexto médico no invasivo con uso potencial preventivo de antimicrobianos en base a agentes posibles, situaciones ambientales de riesgo, vulnerabilidad del hospedero, medicamentos a usar, su duración y efectividad con enfoque mayoritario en medicina de adultos.

Antimicrobial use with preventive purpose probably began shortly after its therapeutic use, especially antibiotics. More consensus and sistematization exist with perioperative and invasive procedures prophylaxis. However, beyond that context, there is great number of non invasive medical situations with high risk of secondary infections either by acquisition of pathogens or activation of latent ones, in which antimicrobials are routinely used with preventive purpose, albeit with less sistematization and consensus. This presentation aims to lay down the conceptual and operational basis for antimicrobial prophylaxis in these settings, whose objective is preventing an infection (primary prophylaxis) by a known or a variety of pathogens, either by person to person transmission, enviromental exposure or particular susceptibility of the host, and can be implemented before or after exposure. If already infected, the antimicrobial prophylaxis goal is to avoid progression to disease (secondary prevention) and may take two conceptual approaches; first, without clinical disease but significant risk of progression, the modality can be called "treatment of latent infection". In the second, also clinically asymptomatic, but with premonitory laboratoy signs of impending progression present, early use of antimicrobial is called "preemptive treatment". This presentation will describe the most frequent medical situations where preventive use of antimicrobials is employed, together with the medications most consensually used, according to the host, the agent(s) and medical situation, with emphasis in adults.

Effects of gamma irradiation on the sensory and metabolic profiles of two peach cultivars.

BACKGROUND: The suitability of commercial peaches for minimal processing (MP) is limited, mainly due to shortened shelf-life. Gamma irradiation has emerged in MP fruits as a promising technology. This study aimed to investigate the effects of gamma irradiation on the sensory and metabolic profiles of MP peaches from two cultivars - 'Forastero' (FT) and 'Ruby Prince' (RP) - and evaluate the relationship between both profiles. MP peaches were packaged and divided into two groups: one without additional treatment (K) and the other subjected to gamma irradiation (1.0 kGy, I- irradiation treatment), making a total of four samples (FTK, FTI, RPK and RPI). The sensory profile was carried out by an assessor panel. Metabolite analysis was accomplished by gas chromatography-mass spectrometry. RESULTS: Irradiation significantly affected color, homogeneity, peach aroma, total flavor intensity, peach flavor, sweetness and juiciness in FT, increasing their intensities. In the RP cultivar, irradiation increased brightness, total aroma intensity, peach aroma, and flavor and texture descriptors. Regarding metabolites, only malic acid and sucrose increased their concentrations in the irradiated samples. Partial least squares showed that sucrose was mainly correlated with sweet, total aroma intensity and peach flavors, and linked with FTI sample. Bitter along with peach aroma and total intensity flavor were associated with RPI sample. CONCLUSION: The applied dose accelerated the ripening process of the peach. The study highlights the importance of complementing sensory analysis with metabolomics tools to optimize fruit quality in minimally processed peaches. © 2023 Society of Chemical Industry.

¿Participan los pacientes crónicos en su plan de tratamiento?: resultados de la encuesta nacional de salud, Chile, ENS 2016-2017 / Do chronic patients participate in decision-making about their treatment plans? Results of a national health survey, Chile, ENS 2016-2017

Introducción: el apoyo al automanejo, la participación y retroalimentación son centrales en la implementación de una atención centrada en el usuario en el marco del modelo de cuidados crónicos. Esto ha demostrado mejorar diversos resultados sanitarios. Objetivo: estimar el grado de participación de los pacientes hipertensos y diabéticos, en las decisiones sobre su plan de tratamiento en población adulta chilena. Métodos: análisis secundario de la Encuesta Nacional de Salud (ENS) 2016-2017, muestra aleatoria estratificada de hogares, multietápica por conglomerados, representativa de la población adulta chilena. Se incluyó población mayor de 15 años hipertensa o diabética bajo tratamiento. Se describen las prevalencias expandidas de la variable percepción de participación en la toma de decisio-nes sobre plan terapéutico en escala Likert de 5 niveles, según edad, sexo, zona urbana/rural y nivel educacional. Se utilizó regresión logística y OR ajustados. Resultados: el 72,3% de los diabéticos y el 71,9% de los hipertensos, refieren "nunca" haber sido consultados al preparar su plan de tratamiento. En la población hipertensa, existe una percepción de participación significativamente más baja en mujeres que en hombres (OR ajustado por edad = 0,5 (IC 95% de 0,3-0,8) no se observaron diferencias estadísticamente significativas según edad, ruralidad ni nivel educacional. Conclusiones: la población hipertensa y diabética percibe bajos niveles de participación en el diseño de su plan terapéutico y los resultados sugieren inequidad de género en hipertensos. Este estudio permitirá evaluar futuras políticas y modificaciones al modelo de cuidados crónicos en el sistema de salud chileno.

Introduction: Self-management support, activation, participation, and feedback are core elements in chronic care models. Patients' participation in decision-making has been shown to improve health outcomes. Objective: To estimate the degree of participation of hypertensive and diabetic patients in decisions about their treatment plan in the general Chilean adult population. Methods: Secon-dary analysis of the "Encuesta Nacional de Salud (National Health Survey) (ENS) 2016-2017" multistage random stratified sample of households representative of the Chilean adult population. Hypertensive or diabetic populations older than 15 years of age that were under treatment were included. The weighted prevalence of the variable "perception of participation in decision making about their treatment plan" was described on a Likert scale of 5 levels, according to age, sex, urban/rural area, and educational level. We used logistic regression and adjusted OR. Results 72.3.5% of diabetic and 71.9% of hypertensive patients say they have "never" been asked their opinion about their treatment plan. In the hypertensive population, women perceived less participation than men (OR adjust by age =0.5 [IC 95% de 0.3-0.8]), with no significant differences observed by age, rurality, or educational level. Conclusions: Hypertensive and diabetic populations perceive low levels of participation in the design of their therapeutic plan, results also suggest gender inequity. This study contributes essential insights for the reformulation of Chilean chronic care models and may stand as a baseline to evaluate the implementation of future health policy.

Brain structural parameters correlate with University Selection Test outcomes in Chilean high school graduates.

How well students learn and perform in academic contexts is a focus of interest for the students, their families, and the entire educational system. Although evidence has shown that several neurobiological factors are involved in scholastic achievement (SA), specific brain measures associated with academic outcomes and whether such associations are independent of other factors remain unclear. This study attempts to identify the relationship between brain structural parameters, and the Chilean national University Selection Test (PSU) results in high school graduates within a multidimensional approach that considers socio-economic, intellectual, nutritional, and demographic variables. To this end, the brain morphology of a sample of 102 students who took the PSU test was estimated using Magnetic Resonance Imaging. Anthropometric parameters, intellectual ability (IA), and socioeconomic status (SES) were also measured. The results revealed that, independently of sex, IA, gray matter volume, right inferior frontal gyrus thickness, and SES were significantly associated with SA. These findings highlight the role of nutrition, health, and socioeconomic variables in academic success.

Advancing towards the implementation of patient-centred care in Chile: An opportunity to effectively practice shared decision-making.

In Chile, local normative and guidelines place patient-centred care (PCC) as a desirable means and outcome for each level of health care. Thus, a definition of PCC is provided, and for the first time shared decision-making (SDM) is included as an intended practice. During the past five years the country has shown progress on the implementation of PCC. A large pilot study was conducted in one of the Metropolitan Health Services, and now the health authority is committed to escalate a PCC strategy nationwide. From the practice domain, most of the work is being placed on the training of health professionals. Patients' preparation for the clinical encounter is scarce, thereby limiting their potential to participate in their care. At the research domain, the country shows a strengthened agenda that has advanced from a diagnostic phase (including the exploration from social sciences) to a purposeful stage which involves the development of training programs, patient decision aids, international collaborations, and other PCC interventions. The country is now positioned to secure new initiatives to empower patients and allow them to take an active role, as a key component of PCC and SDM.

Heightened levels of plasma growth differentiation factor 15 in men living with HIV.

Plasma biomarkers that reflect energy balance disorders in people living with HIV (PLWH) remain limited. Growth differentiation factor 15 (GDF15) abundance in plasma of mice and humans induces negative energy balance but also becomes highly elevated in obesity and other metabolic diseases. We sought to compare plasma GDF15 levels in PLWH and HIV-negative persons and mouse models expressing the HIV accessory protein Vpr (that recapitulate HIV-associated metabolic disorders) and determine their relationship to metabolic parameters. We measured liver Gdf15 mRNA levels and plasma GDF15 levels in male Vpr mice and littermate controls. In parallel, we analyzed plasma GDF15 levels in 18 male PLWH on stable, long-term antiretroviral therapy and 13 HIV-negative men (6 healthy controls and 7 with metabolic syndrome). Plasma GDF15 levels were correlated with anthropometric and immune cell parameters in humans. Gene expression analysis of Vpr mouse liver demonstrated elevated Gdf15 mRNA. Plasma GDF15 levels were also higher in Vpr mouse models. Levels of plasma GDF15 in PLWH were greater than in both HIV-negative groups and correlated positively with the CD4/CD8 T cell ratio in PLWH. Plasma GDF15 levels correlated positively with age in the HIV-negative subjects but not in PLWH. Since GDF15 levels predict fatty liver disease and energy balance disorders, further studies are warranted to determine the effect of GDF15 in mediating the metabolic disturbances that occur in Vpr mice and PLWH.

DPP4 (Dipeptidyl Peptidase-4) Inhibition Increases Catecholamines Without Increasing Blood Pressure During Sustained ACE (Angiotensin-Converting Enzyme) Inhibitor Treatment.

BACKGROUND: DPP4 (dipeptidyl peptidase-4) inhibitors comprise a class of oral diabetes medication that have the potential for off-target cardiovascular effects. We previously showed that DPP4 inhibition attenuates the hypotensive effect of acute ACE (angiotensin-converting enzyme) inhibition and increases norepinephrine. Here, we investigated the effects of DPP4 during sustained ACE inhibition compared with during therapy with an ARB (angiotensin receptor blocker) or calcium channel blocker (neutral comparator) in a randomized, double-blinded crossover study. METHODS: We enrolled 106 adults with type 2 diabetes and hypertension and 100 received intervention. Subjects were randomized to one of 3 blood pressure arms: ramipril, valsartan, or amlodipine for a total of 15 weeks and received 3 one-week crossover therapies in random order: placebo + placebo, sitagliptin + placebo, and sitagliptin + aprepitant separated by 4-week washout. RESULTS: We found that DPP4 inhibition increased norepinephrine during ramipril but did not increase blood pressure. Aprepitant, a NK1 (substance P) receptor blocker, lowered standing heart rate during renin-angiotensin-aldosterone system blockade with ramipril or valsartan. CONCLUSIONS: Increased catecholamines during concurrent ACE and DPP4 inhibition may contribute to cardiovascular complications in patients predisposed to heart failure.

Generation of fruit postharvest gene datasets and a novel motif analysis tool for functional studies: uncovering links between peach fruit heat treatment and cold storage responses.

MAIN CONCLUSION: A survey of developed fruit gene-specific datasets and the implementation of a novel cis-element analysis tool indicate specific transcription factors as novel regulatory actors under HT response and CI protection. Heat treatment (HT) prior to cold storage (CS) has been successfully applied to ameliorate fruit chilling injury (CI) disorders. Molecular studies have identified several HT-driven benefits and putative CI-protective molecules and mechanisms. However, bioinformatic tools and analyses able to integrate fruit-specific information are necessary to begin functional studies and breeding projects. In this work, a HT-responsive gene dataset (HTds) and four fruit expression datasets (FEds), containing gene-specific information from several species and postharvest conditions, were developed and characterized. FEds provided information about HT-responsive genes, not only validating their sensitivity to HT in different systems but also revealing most of them as CS-responsive. A special focus was given to peach heat treatment-sensitive transcriptional regulation by the development of a novel Perl motif analysis software (cisAnalyzer) and a curated plant cis-elements dataset (PASPds). cisAnalyzer is able to assess sequence motifs presence, localization, enrichment and discovery on biological sequences. Its implementation for the enrichment analysis of PASPds motifs on the promoters of HTds genes rendered particular cis-elements that indicate certain transcription factor (TF) families as responsible of fruit HT-sensitive transcription regulation. Phylogenetic and postharvest expression data of these TFs showed a functional diversity of TF families, with members able to fulfil roles under HT, CS and/or both treatments. All integrated datasets and cisAnalyzer tool were deposited in FruitGeneDB (https://www.cefobi-conicet.gov.ar/FruitGeneDB/search1.php), a new available database with a great potential for fruit gene functional studies, including the markers of HT and CS responses whose study will contribute to unravel HT-driven CI-protection and select tolerant cultivars.

Peach Fruit Development: A Comparative Proteomic Study Between Endocarp and Mesocarp at Very Early Stages Underpins the Main Differential Biochemical Processes Between These Tissues.

Peach (Prunus persica) is an important economically temperate fruit. The development follows double sigmoid curve with four phases (S1-S4). We centered our work in the early development. In addition to S1, we studied the very early stage (E) characterized by the lag zone of the exponential growing phase S1, and the second stage (S2) when the pit starts hardening. "Dixiland" peach fruit were collected at 9 (E), 29 (S1), and 53 (S2) days after flowering (DAF) and endocarp and mesocarp were separated. There was a pronounced decrease in total protein content along development in both tissues. Quantitative proteomic allowed the identification of changes in protein profiles across development and revealed the main biochemical pathways sustaining tissue differentiation. Protein metabolism was the category most represented among differentially proteins in all tissues and stages. The decrease in protein synthesis machinery observed during development would be responsible of the protein fall, rather than a proteolytic process; and reduced protein synthesis during early development would reroute cell resources to lignin biosynthesis. These changes were accompanied by net decrease in total amino acids in E1-S1 and increase in S1-S2 transitions. Amino acid profiling, showed Asn parallels this trend. Concerted changes in Asn and in enzymes involved in its metabolism reveal that increased synthesis and decreased catabolism of Asn may conduct to an Asn increase during very early development and that the ß-Cyano-Alanine synthase/ß-Cyano-Alanine hydratase could be the pathway for Asn synthesis in "Dixiland" peach fruit. Additionally, photosynthetic machinery decays during early development in mesocarp and endocarp. Proteins related to photosynthesis are found to a higher extent in mesocarp than in endocarp. We conclude mesocarpic photosynthesis is possible to occur early on the development, first providing both carbon and reductive power and latter only reductive power. Together with proteomic, histological tests and anatomical analysis help to provide information about changes and differences in cells and cell-walls in both tissues. Collectively, this work represents the first approach in building protein databases during peach fruit development focusing on endocarp and mesocarp tissues and provides novel insights into the biology of peach fruit development preceding pit hardening.

AtCAF-1 mutants show different DNA damage responses after ultraviolet-B than those activated by other genotoxic agents in leaves.

Chromatin assembly factor-1 (CAF-1) is a histone H3/H4 chaperone that participates in DNA and chromatin interaction processes. In this manuscript, we show that organs from CAF-1 deficient plants respond differently to ultraviolet-B (UV-B) radiation than to other genotoxic stresses. For example, CAF-1 deficient leaves tolerate better UV-B radiation, showing lower cyclobutane pyrimidine dimer (CPD) accumulation, lower inhibition of cell proliferation, increased cell wall thickness, UV-B absorbing compounds, and ploidy levels, whereas previous data from different groups have shown that CAF-1 mutants show shortening of telomeres, loss of 45S rDNA, and increased homologous recombination, phenotypes associated to DNA breaks. Interestingly, CAF-1 deficient roots show increased inhibition of primary root elongation, with decreased meristem size due to a higher inhibition of cell proliferation after UV-B exposure. The decrease in root meristem size in CAF-1 mutants is a consequence of defects in programmed cell death after UV-B exposure. Together, we provide evidence demonstrating that root and shoot meristematic cells may have distinct protection mechanisms against CPD accumulation by UV-B, which may be linked with different functions of the CAF-1 complex in these different organs.

Being a first-time father. Their experiences and meanings: A Qualitative Systematic Review.

INTRODUCTION: Becoming a first-time father is an important change in the life of men and families. Studies on the subject show that these kinds of changes have the power to put life into perspective. Being an involved father has a deep meaning for the child and the family. OBJECTIVE: To explore the experience of becoming a first-time father during the child first year of the life. SUBJECTS AND METHODS: A qualitative systematic review was conducted in 2014 in three stages, based on the Joanna Briggs Institute Method for Qualitative Systematic Reviews (QSR). The stages used in this QSR were: establishing the question, determining the type of studies to be included, defining the evaluation criteria, and synthesizing the data. Papers that assessed clinical prognoses were considered such as first-time parenting experience and child care during the first year of life. Only primary qualitative studies including ethnography, phenomenology, narrative analysis, and action research were con sidered. RESULTS: Three meta-syntheses were obtained from the analysis: 1) fatherhood adjustment process, 2) paternal role development, and 3) being an active father. The path towards adoption and the fulfillment of the paternal role is mediated by different processes that are consolidated during the child first year of life. CONCLUSIONS: The results support the idea that fathers want to be active parti cipants in the care of their children, that public policies should consider both parents equal in terms of their parenting responsibilities, and that the protection of the family and the family environment is a priority as a health promotion intervention.

Being a first-time father: their experiences and meanings: a qualitative systematic review / Experiencias y significados de ser padre por primera vez: una revisión sistemática cualitativa

INTRODUCTION: Becoming a first-time father is an important change in the life of men and families. Studies on the subject show that these kinds of changes have the power to put life into perspective. Being an involved father has a deep meaning for the child and the family. OBJECTIVE: To explore the experience of becoming a first-time father during the child first year of the life. SUBJECTS AND METHODS: A qualitative systematic review was conducted in 2014 in three stages, based on the Joanna Briggs Institute Method for Qualitative Systematic Reviews (QSR). The stages used in this QSR were: establishing the question, determining the type of studies to be included, defining the evaluation criteria, and synthesizing the data. Papers that assessed clinical prognoses were considered such as first-time parenting experience and child care during the first year of life. Only primary qualitative studies including ethnography, phenomenology, narrative analysis, and action research were con sidered. RESULTS: Three meta-syntheses were obtained from the analysis: 1) fatherhood adjustment process, 2) paternal role development, and 3) being an active father. The path towards adoption and the fulfillment of the paternal role is mediated by different processes that are consolidated during the child first year of life. CONCLUSIONS: The results support the idea that fathers want to be active parti cipants in the care of their children, that public policies should consider both parents equal in terms of their parenting responsibilities, and that the protection of the family and the family environment is a priority as a health promotion intervention.

INTRODUCCIÓN: Ser padre por primera vez es un cambio importante en la vida del hombre y la familia. Los estudios en torno al tema demuestran que este tipo de cambios tienen la capacidad de poner la vida en perspectiva. Ser un padre participativo tiene un significado profundo para el niño/a y la familia. OBJETIVO: Explorar la experiencia de ser padre por primera vez durante el primer año de la vida del hijo/a. SUJETOS Y MÉTODO: Se realizó una revisión sistemática cualitativa en 2014 en 3 etapas, basado en el Joanna Briggs Institute Method para Revisiones Sistemáticas Cualitativas (QSR). Las etapas usadas en este QSR fueron: establecimiento de la pregunta, determinar el tipo de estudios a incluir, definir los criterios de evaluación, y realizar la síntesis de los datos. Se consideraron manuscritos que evaluaran los pronósticos clínicos: experiencia de ser padre por primera vez y cuidados del niños durante el primer año de vida. Solo estudios cualitativos primarios incluyendo estudios de etnografía, fenomenología, análisis de narrativa e investigación de acciones fueron considerados. RESULTADOS: Se obtuvieron tres meta-síntesis del análisis: 1) proceso de ajuste a la paternidad; 2) desarrollo del rol paterno y 3) ser un padre activo. El camino hacia la adopción y el cumplimiento del rol paterno está mediado por diversos procesos que durante el primer año de vida del niño/a se consolidan. CONCLUSIONES: Los resultados apoyan la propuesta de que los padres desean ser protagonistas del cuidado de sus hijos/as, que las políticas públicas deben considerar a ambos padres como iguales en términos de sus responsabilidades de crianza, y que la protección de la familia y el entorno familiar es una priori dad como intervención de promoción de salud.

Apoyo social percibido en pacientes con Hipertensión Arterial y Diabetes Mellitus tipo II en Atención Primaria y su relación con autopercepción de salud / Social support, self-rated health, treatment adherence and effectiveness in patients with type II diabetes and hypertension

Background: A high level of social support (SS) is associated with better health outcomes in many conditions, such as chronic diseases. Aim : To describe the level of SS in patients with Hypertension and type II Diabetes at Primary Health Care level in Chile and its association with self-rated health, adherence to treatment and better glycemic and blood pressure control. Material and Methods : SS was measured using a social support inventory previously validated in Chile. Self-Rated Health was assessed with a single non-comparative general question; adherence to medication was assessed using the four-item Morisky medication adherence scale. Blood glucose and blood pressure control were also assessed. A logistic regression was performed to estimate Prevalence Odds Ratio (POR) and Robust Poisson method to estimate the Prevalence Ratio (PR). Results : Eighty three percent of the 647 participants evaluated high for SS. There was a significant correlation between SS and Self-rated health (POR 2.32; 95% confidence intervals (CI) 1.19-11.23; PR 1.18; 95% CI 1.07-1.31). No statistically significant association was observed with medication adherence, glycemic or blood pressure control. Conclusions: High levels of SS were found. The association between self-rated health suggests that SS interventions targeting vulnerable subgroups would be worthwhile.

[Social support, self-rated health, treatment adherence and effectiveness in patients with type II diabetes and hypertension]. / Apoyo social percibido en pacientes con Hipertensión Arterial y Diabetes Mellitus tipo II en Atención Primaria y su relación con autopercepción de salud.

BACKGROUND: A high level of social support (SS) is associated with better health outcomes in many conditions, such as chronic diseases. AIM: To describe the level of SS in patients with Hypertension and type II Diabetes at Primary Health Care level in Chile and its association with self-rated health, adherence to treatment and better glycemic and blood pressure control. MATERIAL AND METHODS: SS was measured using a social support inventory previously validated in Chile. Self-Rated Health was assessed with a single non-comparative general question; adherence to medication was assessed using the four-item Morisky medication adherence scale. Blood glucose and blood pressure control were also assessed. A logistic regression was performed to estimate Prevalence Odds Ratio (POR) and Robust Poisson method to estimate the Prevalence Ratio (PR). RESULTS: Eighty three percent of the 647 participants evaluated high for SS. There was a significant correlation between SS and Self-rated health (POR 2.32; 95% confidence intervals (CI) 1.19-11.23; PR 1.18; 95% CI 1.07-1.31). No statistically significant association was observed with medication adherence, glycemic or blood pressure control. CONCLUSIONS: High levels of SS were found. The association between self-rated health suggests that SS interventions targeting vulnerable subgroups would be worthwhile.

Differential lipidome remodeling during postharvest of peach varieties with different susceptibility to chilling injury.

Peaches ripen and deteriorate rapidly at room temperature. Therefore, refrigeration is used to slow these processes and to extend fruit market life; however, many fruits develop chilling injury (CI) during storage at low temperature. Given that cell membranes are likely sites of the primary effects of chilling, the lipidome of six peach varieties with different susceptibility to CI was analyzed under different postharvest conditions. By using liquid chromatography coupled to mass spectrometry (LC-MS), 59 lipid species were detected, including diacyl- and triacylglycerides. The decreases in fruit firmness during postharvest ripening were accompanied by changes in the relative amount of several plastidic glycerolipid and triacylglyceride species, which may indicate their use as fuels prior to fruit senescence. In addition, levels of galactolipids were also modified in fruits stored at 0°C for short and long periods, reflecting the stabilization of plastidic membranes at low temperature. When comparing susceptible and resistant varieties, the relative abundance of certain species of the lipid classes phosphatidylethanolamine, phosphatidylcholine and digalactosyldiacylglycerol correlated with the tolerance to CI, reflecting the importance of the plasma membrane in the development of CI symptoms and allowing the identification of possible lipid markers for chilling resistance. Finally, transcriptional analysis of genes involved in galactolipid metabolism revealed candidate genes responsible for the observed changes after cold exposure. When taken together, our results highlight the importance of plastids in the postharvest physiology of fruits and provide evidence that lipid composition and metabolism have a profound influence on the cold response.

Comparative proteomic and metabolomic studies between Prunus persica genotypes resistant and susceptible to Taphrina deformans suggest a molecular basis of resistance.

The worldwide-distributed leaf peach curl disease is caused by the biotroph Taphrina deformans. To characterize the plant-fungus interaction, resistant and susceptible Prunus persica genotypes grown in the orchard were studied. Asymptomatic leaves were tested for fungal presence. In all resistant leaves analyzed the fungus was not detected. Conversely, leaves from the susceptible genotype were categorized according to the presence or absence of the pathogen. Comparative metabolomic analysis disclosed the metabolite composition associated with resistant and susceptible interactions, and of compounds involved in fungal growth inhibition such as chlorogenic acid, whose in vitro antifungal activity was verified in this work. Differential proteome studies revealed that chloroplasts are important site of plant defense responses against T. deformans. Members of the Bet-v1-like family protein differentially responded to the pathogen. Extracellular pathogenesis-related proteins, evaluated by qRT-PCR, and an enone oxidoreductase are constitutively present in leaves of resistant trees and could be related to fungal resistance. This study is a global view of the changes in the metabolome, proteome and transcripts related to plant defense in naturally infected leaves of susceptible plants during the asymptomatic stage. Additionally, it provides clues to the successful molecular mechanisms operating in resistant plants, which neither develop the disease nor harbor the pathogen.

Patient-centred care and shared decision making in Chile: Rising momentum for progress and implementation in clinical practice.

The Chilean legislation establishes that patients have rights and responsibilities in regards to their healthcare. This is an important statement as it declares that people must be informed and become actively involved in their care; meanwhile, the health system needs to coordinate the provision of personalised and effective services. Although patient-centred care (PCC) and shared decision making (SDM) are relatively new concepts in Chile, the country is experiencing an interesting political momentum to create more interventions to achieve PCC and SDM and explore clinical implementation. Currently, research efforts in Chile have focused on better understanding the state of the art related to both concepts and how new clinical approaches could help to operationalize them.

Unravelling early events in the Taphrina deformans-Prunus persica interaction: an insight into the differential responses in resistant and susceptible genotypes.

Leaf peach curl is a devastating disease affecting leaves, flowers and fruits, caused by the dimorphic fungus Taphrina deformans. To gain insight into the mechanisms of fungus pathogenesis and plant responses, leaves of a resistant and two susceptible Prunus persica genotypes were inoculated with blastospores (yeast), and the infection was monitored during 120 h post inoculation (h.p.i.). Fungal dimorphism to the filamentous form and induction of reactive oxygen species (ROS), callose synthesis, cell death and defence compound production were observed independently of the genotype. Fungal load significantly decreased after 120 h.p.i. in the resistant genotype, while the pathogen tended to grow in the susceptible genotypes. Metabolic profiling revealed a biphasic re-programming of plant tissue in susceptible genotypes, with an initial stage co-incident with the yeast form of the fungus and a second when the hypha is developed. Transcriptional analysis of PRs and plant hormone-related genes indicated that pathogenesis-related (PR) proteins are involved in P. persica defence responses against T. deformans and that salicylic acid is induced in the resistant genotype. Conducted experiments allowed the elucidation of common and differential responses in susceptible versus resistant genotypes and thus allow us to construct a picture of early events during T. deformans infection.