[Health-related quality of life in Chileans from vulnerable communes]. / Calidad de vida relacionada con la salud en chilenos de comunas vulnerables.

OBJECTIVE: The COVID-19 pandemic and the resulting social and health crisis impacted the well-being of the population. Health-related quality of life (HRQoL) could be affected, mainly in conditions of social vulnerability. The objective was to analyze the HRQoL and the psychometric properties of the EQ-5D instrument in adult Chilean population from vulnerable communes of the Metropolitan Region. METHOD: Cross-sectional study carried out during quarantine period April to June 2021. Five hundred adults residing in Chilean communes were selected and completed a structured questionnaire by video-call, including the EQ-5D instrument. Descriptive analyzes and confirmatory factor analyzes of the traditional reflective model were performed. RESULTS: The age of the sample was 36.36±12.41 years, the majority reported having a secondary education level and being employed. Regarding the EQ-5D instrument, the most affected dimensions were pain/discomfort and anxiety/depression. The global health status was 73.0±19.71 points. The model showed an adequate fit: χ2=6.992, p=0.221, CFI=0.996, TLI=0.993, RMSEA=0.028 (90% CI: 0.000-0.073) and SRMR=0.067. In addition, the items of the scale were good indicators of the construct of interest. CONCLUSIONS: In a pandemic context, the population was mostly affected by pain/discomfort and anxiety/depression. The EQ-5D instrument is a useful tool to estimate CRSV in the Chilean population in the context of pandemic. In addition, the psychometric evidence supports the dimensionality of the construct and the potential utility of decomposing its analysis.

Genetics of spontaneous cervical and coronary artery dissections.

Objectives: Spontaneous cervical artery dissections (SCeAD) and coronary artery dissections (SCoAD) are major causes of neurovascular and cardiovascular morbidity in young adults. Although multiple aspects of their etiology are still unknown, most consensuses are focused on the presence of constitutional genetic aspects and environmental triggers. Since recent evidence of genetic contribution points to a possible overlap between these conditions, we aimed to describe current information on SCeAD and SCoAD genetics and their potential shared pathological aspects. Materials and methods: A narrative review is presented. Publications in English and Spanish were queried using database search. The articles were evaluated by one team member in terms of inclusion criteria. After collecting, the articles were categorized based on scientific content. Results: Given that patients with SCeAD and SCoAD rarely present connective tissue disorders, other genetic loci are probably responsible for the increased susceptibility in some individuals. The common variant rs9349379 at PHACTR1 gene is associated with predisposition to pathologies of the arterial wall, likely mediated by variations in Endothelin-1 (ET-1) levels. The risk of arterial dissection may be increased for those who carry the rs9349379(A) allele, associated with lower expression levels of ET-1; however, the local effect of this vasomotor imbalance remains unclear. Sex differences seen in SCeAD and SCoAD support a role for sex hormones that could modulate risk, tilting the delicate balance and forcing vasodilator actions to prevail over vasoconstriction due to a reduction in ET-1 expression. Conclusions: New evidence points to a common gene variation that could explain dissection in both the cervical and coronary vasculatures. To further confirm the risk conferred by the rs9349379 variant, genome wide association studies are warranted, hopefully in larger and ethnically diverse populations.

Promoting the Participation of "Hard-to-Reach" Migrant Populations in Qualitative Public Health Research during the COVID-19 Pandemic in Chile.

The COVID-19 pandemic has further deepened socioeconomic and health inequities worldwide, especially among populations experiencing social vulnerability, such as international migrants. Sustained lockdowns and social distancing have raised challenges to conducting public health research with hard-to-reach populations. This study aims at exploring strategies to recruit "hard-to-reach" international migrants for qualitative public health research during the pandemic in Chile, based on the authors' experience. A retrospective qualitative evaluation process was carried out on the recruitment processes of three qualitative research projects focused on international migrants in Chile. All projects were implemented during the COVID-19 pandemic, demanding complementary and flexible strategies: (i) social media; (ii) snowball sampling; (iii) referrals from social workers and pro-migrant and migrant-led organizations; (iv) vaccination centers and healthcare centers; and (v) community-based recruitment. The strategies are qualitatively evaluated around seven emerging qualitative categories: (i) feasibility during lockdown periods; (ii) speed of recruitment; (iii) geographical coverage; (iv) sample diversity; (v) proportion of successful interviews; (vi) ethical considerations; and (vii) cost. Engaging hard-to-reach international migrants in public health research during the pandemic required constantly adapting recruitment strategies. Furthermore, relying on strategies that were not only Internet-based promoted the participation of populations with limited access to the Internet and low-digital literacy.

Challenges for the prevention of hypertension among international migrants in Latin America: prioritizing the health of migrants in healthcare systems.

Among the health priorities of international migrants, non-communicable diseases such as hypertension are of major interest due to their increasing prevalence, mainly in low- and middle-income countries. Previous evidence has reported a significant risk of hypertension in international migrants derived from multiple exposures during the migration process and at the destination, such as living conditions, health literacy and access to preventive services. Also, poorer disease control has been found compared to the local population. Considering existing deficiencies in access and use of healthcare services related to hypertension prevention and continuity of care of migrants globally, we aimed to offer a Latin American perspective of the challenges faced by international migrants residing in Latin America in accessing hypertension preventive care from a human rights, equity, and universal primary healthcare approaches. From a health systems perspective, we conducted a scoping review of scientific literature on hypertension prevention and control among international migrants in Latin America and the Caribbean. Based on the findings, we discuss the potential influence of migration and health policies on healthcare systems and individual and structural barriers to healthcare access, including lack of insurance, linguistic barriers, limited intercultural competence, and geographical and financial barriers. From existing evidence related to hypertension, we highlight the particular healthcare needs of migrants and their implications for regional public health goals. This aligns with promoting culturally tailored interventions considering the migration process, lifestyle patterns, structural vulnerabilities, and gender particularities in hypertension prevention, diagnosis, and treatment. We advocate for developing universal, voluntary, and systemic regional screening and disease control initiatives in Latin America for hypertension and other chronic conditions.

Calidad de vida relacionada con la salud en chilenos de comunas vulnerables / Health-related quality of life in Chileans from vulnerable communes

Objetivo: La pandemia de COVID-19 y la crisis sociosanitaria resultante tuvieron impacto sobre el bienestar de la población. La calidad de vida relacionada con la salud (CVRS) podría verse afectada, principalmente en condición de vulnerabilidad social. El objetivo fue analizar la CVRS y las propiedades psicométricas del instrumento EQ-5D en población chilena adulta de comunas vulnerables de la Región Metropolitana. Método: Estudio transversal realizado durante la cuarentena de abril-junio de 2021. Se seleccionaron 500adultos residentes en comunas de Chile que completaron por videollamada un cuestionario estructurado incluyendo el instrumento EQ-5D. Se realizaron análisis descriptivos y factoriales confirmatorios del modelo reflectivo tradicional. Resultados: La edad promedio fue de 36,36 ± 12,41 años, la mayoría reportaron un nivel educativo secundario y estar empleado. Con respecto al instrumento EQ-5D, se encontró mayor afectación en la dimensión dolor/malestar y ansiedad/depresión. El estado de salud global evaluado con la escala visual análoga fue de 73,0 ± 19,71 puntos. El modelo evaluado presentó un ajuste adecuado: 2 = 6.992, p = 0.221, CFI = 0.996,TLI = 0.993, RMSEA = 0.028 (IC90%: 0.000-0.073) y SRMR = 0.067. Además, los ítems de la escala resultaron buenos indicadores del constructo de interés. Conclusiones: En contexto de pandemia, la población estudiada presentó mayor afectación en las dimensiones dolor/molestia y ansiedad/depresión. El instrumento EQ-5D es una herramienta útil para estimarla CVRS en población chilena en contexto de pandemia. Además, la evidencia psicométrica respalda la unidimensionalidad del constructo y la potencial utilidad de descomponer su análisis.(AU)

Objective: The COVID-19 pandemic and the resulting social and health crisis impacted the well-being ofthe population. Health-related quality of life (HRQoL) could be affected, mainly in conditions of socialvulnerability. The objective was to analyze the HRQoL and the psychometric properties of the EQ-5Dinstrument in adult Chilean population from vulnerable communes of the Metropolitan Region. Method: Cross-sectional study carried out during quarantine period April to June 2021. Five hundredadults residing in Chilean communes were selected and completed a structured questionnaire by video-call, including the EQ-5D instrument. Descriptive analyzes and confirmatory factor analyzes of thetraditional reflective model were performed. Results: The age of the sample was 36.36 ± 12.41 years, the majority reported having a secondary edu-cation level and being employed. Regarding the EQ-5D instrument, the most affected dimensions werepain/discomfort and anxiety/depression. The global health status was 73.0 ± 19.71 points. The model sho-wed an adequate fit: 2 = 6.992, p = 0.221, CFI = 0.996, TLI = 0.993, RMSEA = 0.028 (90% CI: 0.000–0.073)and SRMR = 0.067. In addition, the items of the scale were good indicators of the construct of interest. Conclusions: In a pandemic context, the population was mostly affected by pain/discomfort andanxiety/depression. The EQ-5D instrument is a useful tool to estimate CRSV in the Chilean populationin the context of pandemic. In addition, the psychometric evidence supports the dimensionality of theconstruct and the potential utility of decomposing its analysis.(AU)

A comparative analysis of health status of international migrants and local population in Chile: a population-based, cross-sectional analysis from a social determinants of health perspective.

BACKGROUND: During recent decades intraregional migration has increased in Latin America. Chile became one of the main receiving countries and hosted diverse international migrant groups. Evidence have suggested a healthy migrant effect (HME) on health status, but it remains scarce, controversial and needs to be updated. This study performed a comprehensive analysis verifying the existence of HME and its association with social determinants of health (SDH). METHODS: We analyzed data from the Chilean National Socioeconomic Characterization Survey (CASEN, version 2017). Unadjusted prevalence of health status indicators such as negative self-perceived health, chronic morbidity, disability, and activity limitations were described in both international migrants and local population. Adjusted associations between these outcomes and sets of demographics, socioeconomic, access to healthcare, psychosocial and migration-related SDH were tested using multivariate logistic regression in each population. The HME for each health outcome was also tested using multivariate logistic regression and sequentially adjusting for each set of SDH (ref = Chilean). RESULTS: International migrants had lower unadjusted prevalence of all health indicators compared to Chileans. That is, unadjusted analysis revealed an apparent HME in all health outcomes. Age, unemployment, and health care system affiliation were associated with health outcomes in both populations. Psychosocial determinants were both risk and protective for the analysed health outcomes. After adjustment for each set of SDH, the immigrant health advantage was only significant for chronic morbidity. Being migrant was associated with 39% lower odds of having chronic diseases compared to locals (OR: 0.61; 95% CI: 0.44-0.84; P = 0.0003). For all other outcomes, HME disappeared after adjusting by SDH, particularly unemployment, type of health system and psychosocial factors. CONCLUSIONS: Testing the HME in Chile revealed an advantage for chronic morbidities that remained significant after adjustment for SDH. This analysis shed light on health disparities between international migrants and local population in the Latin American region, with special relevance of unemployment, type of health system and psychosocial SDH. It also informed about differential exposures faced during migration process that could dissolve the HME over time. Evidence from this analytical approach is useful for informing health planning and intersectoral solutions from a SDH perspective.

Unequal Access and Use of Health Care Services among Settled Immigrants, Recent Immigrants, and Locals: A Comparative Analysis of a Nationally Representative Survey in Chile.

Globally, and particularly in the Latin American region, international migration continues to grow. Access and use of health care services by migrants vary according to their country of origin and residence time. We aimed to compare the access and use of health care services between international migrants (including settled migrants from Peru, Argentina, Bolivia, Ecuador; Emerging migrants from Venezuela, Dominican Republic, Colombia, Haiti; and migrants from other countries) and the Chilean population. After performing a secondary data analysis of population-based nationally representative surveys (CASEN 2011-2017), access and use patterns (insurance, complementary insurance, non-consultation, and non-treatment coverage) were described and compared among settled immigrants, recent emerging immigrants, others, and locals. Immigrants had a significantly higher uninsured population compared to locals. Specifically, in CASEN 2017, 19.27% of emerging (95% CI: 15.3-24.1%), 11.79% of settled (95% CI: 10.1-13.7%), and 2.25% of locals (95% CI: 2.1-2.4%) were uninsured. After 2013, settled and recent emerging migrants showed higher percentages of non-consultation. Collaborative and interculturally relevant strategies from human rights and equity perspectives are needed. Initiatives with a particular focus on recent immigrants can contribute to reducing the existing disparities in health care access and use with locals due to lack of insurance and treatment coverage.

Effects of A High Intensity Interval Session on Mucosal Immune Function and Salivary Hormones in Male and Female Endurance Athletes.

Although the effects of high intensity interval training (HIIT) on health and sports performance are well documented, the effects of this training type on mucosal immune function remain unclear. The aim of this study was to assess the impact of an acute HIIT session on salivary immune and endocrine marker levels (immunoglobulin A (sIgA), alpha amylase (sAA), cortisol (C), and testosterone (T)) in male and female endurance athletes. Twenty subjects (ten males and ten females) underwent ten bouts of treadmill running using a 4 min:2 min work:rest ratio at ~90% of peak oxygen uptake (VO2peak). Saliva samples were collected 5 min before and 20 min post-exercise. During work intervals, female participants had a higher HR than male participants (+4.0 ± 5%; p = 0.008). Rating of perceived exertion (RPE) increased throughout the duration of the HIIT session in both males and females (main time effect: p < 0.001), but was higher in males than females (+17 ± 4%; time x gender main effect: p < 0.001). Lactate concentrations were similar in both males and females. Exercise increased the concentration of salivary IgA (males: +24 ± 6%, p = 0.004; females: +27 ± 3%, p = 0.03), salivary alpha-amylase (males: +44 ± 22%, p = 0.036; females: +71 ± 26%, p = 0.026) and salivary cortisol (males: +41 ± 24%, p = 0.015; females: +55 ± 24%, p = 0.005). Testosterone levels and the Testosterone/Cortisol ratio remained stable in both males and females. These findings suggest that the physiological stress produced by a HIIT session does not affect immune function and does not disturb the anabolic/catabolic balance.

Anti-Inflammatory Effect of Exercise Mediated by Toll-Like Receptor Regulation in Innate Immune Cells - A Review.

Over the last three decades, the combination of a sedentary lifestyle and excessive food intake has led to a significant increase in the prevalence of obesity. The latter favors a chronic low-grade inflammatory state and an over-activation of the innate immune system, which contribute to insulin resistance and type 2 diabetes. Physical exercise is a powerful preventive tool and treatment for several diseases as it induces metabolic and immune effects that provide health benefits. Exercise is known to reduce inflammation; however, the underlying mechanisms responsible are not fully elucidated. One proposed mechanism is a reduced expression and/or activation of pro-inflammatory toll-like receptors (TLRs) on innate immune cells after exercise, which could contribute to the protective effect of exercise against insulin resistance and the prevention of the development of metabolic diseases. The aim of the present study is therefore to review the current evidence about the anti-inflammatory effects of exercise and toll-like receptors regulation on immune cells in humans.Key PointsObesity leads to a low-grade chronic inflammatory state and an over-activation of the innate immune system that is directly involved in the develop metabolic syndrome.The anti-inflammatory effect of exercise has been previously suggested through the reduction of the expression and/or activation of pro-inflammatory toll-like receptors (TLRs) in innate immune cells, which represent one of the main inflammatory responses triggered by obesityThe underlying mechanisms in which toll-like receptors expression modulate the reduction of chronic inflammation are not fully elucidated.

Toll like receptor expression induced by exercise in obesity and metabolic syndrome: A systematic review.

BACKGROUND: Obesity and metabolic syndrome are disorders that correlate with the activation of pro-inflammatory pathways and cytokine production, to which Toll like receptors (TLR) contribute. Exercise may act as an anti-inflammatory modulator, but there is no consensus about the role of the TLR in this tuning. The present styudy aims to systematically review the current evidence on exercise-induced TLR regulation in animals and humans suffering from obesity and metabolic syndrome. METHODS: Pubmed and Scopus databases were searched for publications from 1990 to September 2015. Search terms included: "Toll like Receptor", "TLR", "exercise", "obesity", "diabetes", and "metabolic syndrome". Elegibility criteria comprised: randomized control trials, cross-sectional and cohort studies; human or animal models with metabolic syndrome; any type of exercise; TLR expression measurement in any tissue by a clearly reported technique. The quality of selected studies was assessed using a modified version of the Downs and Black Quality Assessment Checklist. Data of study design; population; exercise type, timing and training elements; measurement technique, tissue analyzed and main outcome were extracted and categorized to facilitate data synthesis. RESULTS: 17 studies were included, of which 11 publications obtained a high, 5 a moderate and 1 a low score for quality assessment. A total of 8 human studies were analyzed: 6 studies used endurance continuous or interval training protocols, 1 study resistance training and the remaining study was performed following a marathon race. Blood cells were analyzed in seven studies, of which four studies sampled peripheral blood mononuclear cells (PBMC), three analyzed whole blood and one study sampled skeletal muscle. Nine animal studies were included: 8 used endurance training and 1 acute aerobic exercise. A variety of tissues samples were explored such as PBMC, skeletal muscle, adipose, vascular and nervous tissue. Globally, the animal studies showed a marked tendency towards a down-regulation of TLR2 and 4 expression accompagnied with, a reduced activation of nuclear factorkappaB (NF-κB) signaling and cytokine production, and an improvement in insulin sensitivity and body composition. CONCLUSION: While animal studies showed a marked tendency towards TLR2 and 4 down-regulation after chronic endurance exercise, the current evidence in human is not sufficiently robust to conclude any role of TLR in the anti-inflammatory properties of exercise.

Effects of Caffeine on Countermovement-Jump Performance Variables in Elite Male Volleyball Players.

PURPOSE: To examine the effects of a moderate dose of caffeine in elite male volleyball players on countermovement-jump (CMJ) performance, as well as temporal concentric- and eccentric-phase effects. METHODS: Ten elite male volleyball players took part in 2 experimental days via a randomized crossover trial 1 wk apart in which they ingested either 5 mg/kg of caffeine or a placebo in double-blind fashion. Heart rate and blood pressure were measured at rest and 60 min postingestion. Afterward, subjects also performed 3 CMJ trials 60 min postingestion, of which the average was used for further analysis. They filled out a questionnaire on possible side effects 24 h posttrial. RESULTS: Caffeine intake, compared with placebo, increased CMJ peak concentric force (6.5% ± 6.4%; P = .01), peak power (16.2% ± 8.3%; P < .01), flight time (5.3% ± 3.4%; P < .01), velocity at peak power (10.6% ± 8.0%; P < .01), peak displacement (10.8% ± 6.5%; P < .01), peak velocity (12.6% ± 7.4%; P < .01), peak acceleration (13.5% ± 8.5%; P < .01), and the force developed at peak power (6.0% ± 4.0%; P < .01) and reduced the time between peak power and peak force (16.7% ± 21.6%, P = .04). Caffeine increased diastolic blood pressure by 13.0% ± 8.9% (P < .05), whereas no adverse side effects were found. CONCLUSIONS: The ingestion of 5 mg/kg of anhydrous caffeine improves overall CMJ performance without inducing side effects.

Muscle Activity Onset Prior to Landing in Patients after Anterior Cruciate Ligament Injury: A Systematic Review and Meta-Analysis.

Muscle activation during landing is paramount to stabilise lower limb joints and avoid abnormal movement patterns. Delayed muscle activity onset measured by electromyography (EMG) has been suggested to be associated with anterior cruciate ligament (ACL) injury. Therefore, the aim of this systematic review and meta-analysis was to test the hypothesis if ACL-injured patients display different results for muscle onset timing during standard deceleration tasks compared to healthy control participants. PubMed, Embase, Scopus and ScienceDirect databases were systematically searched over the period from January 1980 to February 2015, yielding a total of 1461 citations. Six studies meeting inclusion criteria underwent quality assessment, data extraction and re-computing procedures for the meta-analysis. The quality was rated "moderate" for 2 studies and "poor" for 4. Patients included and procedures used were highly heterogeneous. The tasks investigated were single leg hopping, decelerating from running or walking, tested on a total of 102 ACL-injured participants and 86 controls. EMG analyses of the muscles vastus lateralis, vastus medialis, lateral and medial hamstrings revealed trivial and non-significant standardised mean differences (SMD<0.20; p>0.05) between patients and control participants. Furthermore, no differences were found between the contralateral leg of patients and controls for muscle activity onset of the medial and lateral gastrocnemius (SMD<0.20; p>0.05). Based on 3 studies, the involved legs of ACL-injured patients showed overall earlier muscle activity onset compared to control participants for the medial gastrocnemius (SMD = 0.5; p = 0.05). Similar results were found for the lateral gastrocnemius (SMD = 2.1; p<0.001), with a greater effect size but based only on a single study. We conclude that there are no differences between leg muscles of ACL-injured patients and healthy controls regarding the muscle activity onset during landing. However, current evidence is scarce and weak, which highlights the need for further research in this area.