Respuesta inmunitaria al SARS-CoV-2 y factores asociados previo a la vacunación, en personal de salud de atención primaria en una comuna de Santiago, Chile

Resumen Introducción: La pandemia de COVID-19 surgida en China a fines de 2019, se extendió rápidamente por el mundo, con casi 600 millones de casos y 6,3 millones de fallecidos en la actualidad. Los más afectados fueron los trabajadores de la salud con al menos tres veces más riesgo que la comunidad general de contraer la enfermedad. La mayoría de los estudios sobre seroprevalencia en trabajadores de la salud, se enfocan en establecimientos de atención hospitalaria y no se ha indagado con igual intensidad sobre lo que ocurre en la Atención Primaria de Salud (APS). Objetivos: Determinar prevalencia de SARS-CoV-2 mediante anticuerpos IgG en personal de atención primaria de comuna de La Pintana y explorar sus características clínicas y factores de riesgo, previo a la vacunación en Chile. Metodología: Diseño transversal realizado en noviembre 2020. Se recogieron datos sociodemográficos y clínicos mediante entrevista cara a cara, previa firma de consentimiento. Se determinó IgG específica mediante ELISA que utiliza proteína N y S. Las diferencias entre sujetos positivos y negativos se estudiaron mediante análisis bivariado y para asociaciones encontradas, se desarrollaron modelos multivariados controlando potenciales variables de confusión. El estudio contó con la aprobación del Comité Ético Científico de la Universidad del Desarrollo. Resultados: Participaron 463 funcionarios (51,4%) encontrando prevalencia de 21,8%. Los factores de riesgo fueron edad menor, ser médico y haber sido contacto estrecho de un caso. El 22% fue asintomático. Entre quienes presentan anosmia o ageusia, la probabilidad de IgG+ fue superior a 70%. Los títulos de anticuerpos aumentan significativamente con la gravedad. Conclusiones: La prevalencia en personal de atención primaria encontrada es concordante con la evidencia previa en trabajadores de salud. La menor edad y la profesión de médico se asocian a un mayor riesgo de enfermar.

Abstract Background: The COVID-19 pandemic that emerged in Wuhan, China at the end of 2019, spread rapidly around the world with almost 600 million cases and 6.3 million deaths today. The most affected were health workers with at least three times the risk of contracting the disease than the general community. Most studies on seroprevalence in health workers focus on hospital care establishments and what happens in Primary Health Care (PHC) has not been investigated with the same intensity. Aim: To determine the prevalence of SARS-CoV-2 using IgG antibodies in primary health care personnel in La Pintana commune, risk factors and clinical characteristics, prior to vaccination in Chile. Methods: A cross-sectional design carried out in November 2020. Sociodemographic and clinical data were collected through face-to-face interviews, after providing informed consent. Specific IgG was determined by ELISA using N and S proteins. The differences between positive and negative subjects were studied using bivariate analysis and multivariate models, controlling for potential confounding variables. The study was approved by the Universidad del Desarrollo Scientific Ethics Committee. Results: 463 employees (51.4%) participated, finding a prevalence of 21.8%. The risk factors found were younger age, being a physician and having been in close contact with a case. 22% were asymptomatic. Among those with anosmia/ageusia, the probability of IgG+ was greater than 70%. Antibody titers increase with severity. Conclusions: Prevalence found in primary health care personnel is consistent with previous evidence. Younger age and medical profession are associated with a higher risk of illness.

Perspectiva ética de la priorización de vacunación contra el COVID-19 en Chile

The SARS-CoV-2 pandemic has generated an important health and economic impact on the world. Vaccines emerge as an intervention that can contribute to the control of the pandemic. Vaccines were approved for emergency use in the United States, Europe, as well as in Chile, however, they will not be immediately available, creating the need to prioritize vaccine distribution. The World Health Organization (WHO) and other international agencies established ethical frameworks to guide the distribution of the COVID-19 vaccine globally. In Chile, the Advisory Council on Vaccines and Immunizations (CAVEI) and the COVID-19 Advisory Council of the Ministry of Health (MINSAL) recommended the groups to prioritize vaccination, based on the available evidence stating that this information could change over time. In this article, we propose a reference framework of ethical principles and values to support the decision-making of prioritization and distribution of vaccines in Chile. We propose three timeless values: maximizing benefits, prioritizing the most vulnerable, reciprocity, and two transversal bioethics principles: justice and transparency. This reference framework contributes to the vaccination plan communication, the decision-making by the authorities and supports the prioritization strategy's valúes framework. With an explicit values framework we can expect better communication or priorities, a greater acceptance of SARS-CoV-2 vaccination plan by the community and an increased vaccination coverage to protect the population.

Effect of the biological functionalization of nanoparticles on magnetic CLEA preparation.

Lipase immobilization using adsorption on magnetic nanoparticles, cross-linked enzyme aggregates (CLEA), and a combination of both techniques was investigated. Experimental designs were used for the optimization of the immobilization observing that the pH and ionic strength play a principal role during the lipase immobilization and its activity. For adsorption on magnetic nanoparticles and CLEA synthesis the optimal condition was pH and 100 mM. Besides, during the CLEA synthesis, glutaraldehyde concentration showed to be a significant effect on the enzyme activity. A comparison between a magnetic CLEA prepared with (Lip@mCLEA) and without (mCLEA) biological functionalized magnetic nanoparticles was made observing that the use of functionalized support showed the best performance activity. All biocatalytic systems developed gives to the enzyme thermal stability between 45 and 70 °C, being Lip@mCLEA the more stable biocatalyst. Similar behavior was observed at different pH, where both Lip@mCLEA and mCLEA showed stability at a range of pH 5 to 8. The immobilized biocatalysts showed the same affinity of the subtract that the free enzyme suggested that the enzyme structure not modified the active site. The combination of both types of immobilization show evidenced the importance of the biological functionalization of the support when magnetic CLEA is produced.

Techno-functional properties of HoPS from lactic acid bacteria of different origins as potential food additives.

Homopolysaccharides (HoPS) produced by lactic acid bacteria (LAB) are highly versatile, biocompatible and safe compounds. In this work, six HoPS from different species of Weisella and Leuconostoc were identified as thermally stable dextrans, with endothermic crystalline deformations between 214 and 239 °C. These dextrans proved to have greater solubility and capacities to retain water and oil than similar polymers in other reports. Furthermore, a surface morphology study presented cubic grumps, stratify mesh with irregular grumps, and highly compact filaments. Assays in vitro revealed moderate antioxidant, browning and foaming activities as well as technological properties, such as anti-syneresis, emulsifying and flocculating activities, even at low concentrations. Taking into account bipolymers' microstructure, functionalities and performance in both, aqueous and hydrophobic matrixes, plus their capacity to maintain themselves at elevated temperatures, we consider these HoPS beneficial and natural food additives.

[Ethical perspective for the COVID-19 vaccine prioritization in Chile]. / Perspectiva ética de la priorización de vacunación contra el COVID-19 en Chile.

The SARS-CoV-2 pandemic has generated an important health and economic impact on the world. Vaccines emerge as an intervention that can contribute to the control of the pandemic. Vaccines were approved for emergency use in the United States, Europe, as well as in Chile, however, they will not be immediately available, creating the need to prioritize vaccine distribution. The World Health Organization (WHO) and other international agencies established ethical frameworks to guide the distribution of the COVID-19 vaccine globally. In Chile, the Advisory Council on Vaccines and Immunizations (CAVEI) and the COVID-19 Advisory Council of the Ministry of Health (MINSAL) recommended the groups to prioritize vaccination, based on the available evidence stating that this information could change over time. In this article, we propose a reference framework of ethical principles and values to support the decision-making of prioritization and distribution of vaccines in Chile. We propose three timeless values: maximizing benefits, prioritizing the most vulnerable, reciprocity, and two transversal bioethics principles: justice and transparency. This reference framework contributes to the vaccination plan communication, the decision-making by the authorities and supports the prioritization strategy's valúes framework. With an explicit values framework we can expect better communication or priorities, a greater acceptance of SARS-CoV-2 vaccination plan by the community and an increased vaccination coverage to protect the population.

Consenso de expertos en la asistencia multidisciplinaria y el abordaje integral de la insuficiencia cardiaca. Desde el alta hospitalaria hasta la continuidad asistencial con primaria / Expert consensus on multidisciplinary management and integrated approaches in heart failure. Continuity of care from hospital discharge to primary care

La insuficiencia cardiaca es una enfermedad que precisa un tratamiento multidisciplinario, dadas la diversidad de causas y entornos clínicos implicados que las tratan y las diferentes estrategias terapéuticas que precisan la participación indispensable de diversas disciplinas. La presencia en los servicios de cardiología de unidades de insuficiencia cardiaca centradas en el tratamiento de los pacientes con esta afección y unidades de rehabilitación cardiaca que, entre sus indicaciones para la reducción de la morbimortalidad, también están implicadas en la atención de esos mismos pacientes puede causar dificultades de coordinación y pérdida de una atención integral centrada en el paciente. Por estos motivos, en el presente documento se plantea una estrategia de coordinación entre las diferentes unidades implicadas en el tratamiento de los pacientes dentro de los servicios de cardiología y la continuidad asistencial con atención primaria, tanto tras haber conseguido la estabilidad como la interrelación para una coordinación posterior más efectiva

Heart failure is a condition that requires a multidisciplinary approach to treatment because of the wide range of causes and clinical contexts that may be involved and because the diverse treatment strategies used necessitate the participation of multiple disciplines. In cardiology departments, the presence of both heart failure units that focus on the treatment of affected patients and cardiac rehabilitation units that, as well as targeting reductions in morbidity and mortality, are also involved in caring for the same patients can create difficulties for coordination and can result in the loss of comprehensive patient-centered care. For these reasons, this paper presents a strategy for coordinating the different units involved in patient management in cardiology departments and for ensuring continuity of care in primary care, both immediately after achieving stabilization and subsequently, when these interactions are important for effective coordination

Assistive Devices for Older Adults: A Longitudinal Study of Policy Effectiveness, Santiago, Chile, 2014-2016.

INTRODUCTION Population aging is a worldwide phenomenon. It is estimated that by 2050, one of five persons will be aged ≥60 years. In Chile, 15.8% of the population is now aged ≥60 years, and this figure will reach 30.7% by 2050. In 2006, a national program was implemented to provide assistive devices to older adults aged ≥65 years with limited mobility or difficulty performing activities of daily living. To date, there have been no assessments of the program's effectiveness. OBJECTIVE Assess the effectiveness of an assistive devices policy in Chile on improving functional capacity of older adults aged ≥65 years, and beneficiaries' perceptions of the services received, including changes in their quality of life. METHODS This was a before-after longitudinal study. A cohort of 309 persons was recruited, consisting of patients who received care at a public hospital in Santiago, Chile during 2014-2015. They were assessed before delivery of assistive devices, then followed for seven months, with repeated evaluations made in their homes. The following indicators were measured: functional capacity (Tinetti scale and Barthel Index); changes in perceived quality of life related to use of assistive devices; and other sociodemographic, clinical and protocol-compliance variables. A longitudinal analysis of before-after progress was carried out, as well as a description of service delivery and medical followup. RESULTS Sixty-eight percent of those surveyed were women; median age was 74 years, average schooling was 6 years, and 93% had low income (monthly income

¿Sirven las ayudas técnicas a las personas mayores? Percepción desde la Atención Primaria sobre esta Garantía Explícita en Salud, Santiago, Chile / Are technical aids useful for elderly people? The perception of primary health care-based informants about this Explicit Health Guarantee in Santiago, Chile

OBJETIVO: Conocer la percepción de informantes clave pertenecientes a la red de Atención Primaria de Salud en Chile, respecto al proceso de gestión asistencial y el impacto del programa nacional de Garantías Explícitas en Salud (GES) sobre la entrega de ayudas técnicas a personas mayores. MATERIALES Y MÉTODOS: Un estudio cualitativo basado en análisis de casos múltiples, en el cual se realizó entrevistas semi-estructuradas a 8 informantes clave de la red asistencial, fue desarrollado en 2015 en tres comunas de Santiago, Chile. El análisis de la información recogida se realizó mediante análisis de contenido, y se finalizó el muestreo de máxima variación al saturar la información. Se resguardaron los criterios de rigor científico y el protocolo fue aprobado por un Comité de Ética. RESULTADOS: Hay una percepción de cobertura y detección de necesidad como adecuada en pacientes bajo control, aunque desde la perspectiva de los informantes, hay desconocimiento de esta garantía en la población. La necesidad es detectada por cualquier profesional de salud, pero la indicación es exclusivamente médica, lo que genera barreras de acceso. Hay una entrega oportuna; sin embargo, no se realiza seguimiento ni se aprecia como parte de una atención integral. Se percibe que la ayuda técnica es de calidad y la articulación de la red es adecuada, aunque no hay retroalimentación a Atención Primaria de Salud. El impacto lo consideran positivo en pacientes y familiares: mejora la ejecución de actividades diarias y genera mayor autonomía y capacidad de desplazamiento. CONCLUSIONES: Existe una percepción positiva de este programa GES y su impacto en la mejoría en la calidad de vida de vida de los pacientes. Pero, la entrega de ayudas técnicas se encuentra desvinculada de una atención integral, por ende, este programa prioriza sólo la garantía de oportunidad.

OBJECTIVE: To assess the perception of key informants working in Primary Health Care in Chile, regarding the administration and impact of the national Explicit Health Guarantees (GES) program which provides technical aids to vulnerable elderly adults. MATERIAL AND METHODS: A qualitative study, based on multiple case analysis of semi--structured interviews with 8 key informants of the healthcare network, was conducted in 2015 in three municipalities of Santiago, Chile. The collected information was analyzed by means of content analysis, and máximum variation sampling was carried out until the data saturation point was reached. Rigorous scientific criteria were safeguarded, and the study protocol was approved by an Ethics Committee. RESULTS: Patients deemed the program's coverage and detection of needs to be adequate, although informants conveyed that the general population is largely unaware of the program. While any health professional can detect a patient's need for technical aids, only physicians can prescribe the devices, which generates access barriers. Technical aid delivery is timely; however, it is not monitored or considered to form part of a comprehensive care system. Assistive devices are perceived to be high quality, and the delivery network coordination is seen as adequate, although there is no feedback to Primary Health Care. The program's impact is considered positive among patients and family members, as it improves the performance of daily activities and generates greater autonomy and mobility. CONCLUSIONS: This GES program is positively perceived and viewed to improve patients' quality of life. However, the delivery of technical aids is disconnected from an integral care approach, and thus the program only prioritizes the guarantee of opportunity.

Controlled degradability of PCL-ZnO nanofibrous scaffolds for bone tissue engineering and their antibacterial activity.

Up to date, tissue regeneration of large bone defects is a clinical challenge under exhaustive study. Nowadays, the most common clinical solutions concerning bone regeneration involve systems based on human or bovine tissues, which suffer from drawbacks like antigenicity, complex processing, low osteoinductivity, rapid resorption and minimal acceleration of tissue regeneration. This work thus addresses the development of nanofibrous synthetic scaffolds of polycaprolactone (PCL) - a long-term degradation polyester - compounded with hydroxyapatite (HA) and variable concentrations of ZnO as alternative solutions for accelerated bone tissue regeneration in applications requiring mid- and long-term resorption. In vitro cell response of human fetal osteoblasts as well as antibacterial activity against Staphylococcus aureus of PCL:HA:ZnO and PCL:ZnO scaffolds were here evaluated. Furthermore, the effect of ZnO nanostructures at different concentrations on in vitro degradation of PCL electrospun scaffolds was analyzed. The results proved that higher concentrations ZnO may induce early mineralization, as indicated by high alkaline phosphatase activity levels, cell proliferation assays and positive Alizarin-Red-S-stained calcium deposits. Moreover, all PCL:ZnO scaffolds particularly showed antibacterial activity against S. aureus which may be attributed to release of Zn2+ ions. Additionally, results here obtained showed a variable PCL degradation rate as a function of ZnO concentration. Therefore, this work suggests that our PCL:ZnO scaffolds may be promising and competitive short-, mid- and long-term resorption systems against current clinical solutions for bone tissue regeneration.

Synthesis, DFT calculations of structure, vibrational and thermal decomposition studies of the metal complex Pb[Mn(C3H2O4)2(H2O)2].

The metallo-organic complex Pb[Mn(C3H2O4)2(H2O)2] was synthesized and characterized by IR and Raman spectroscopy and powder X-ray diffraction methods. The cell parameters for the complex were determined from powder X-ray diffraction using the autoindexing program TREOR, and refined by the Le Bail method with the Fullprof program. A hexagonal unit cell was determined with a=b=13.8366(7)Å, c=9.1454(1)Å, γ=120°. The DFT calculated geometry of the complex anion [Mn(C3H2O4)2(H2O)2](2-) is very close to the experimental data reported for similar systems. The IR and Raman spectra and the thermal analysis of the complex indicate that only one type of water molecules is present in the structure. The thermal decomposition of Pb[Mn(C3H2O4)2(H2O)2] at 700 °C in air produces PbO and Pb2MnO4 as final products. The crystal structure of the mixed oxide is very similar to that reported for Pb3O4.