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

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

Integrating Comprehensive Rehabilitation Care to Multimorbidity Approach: A Challenge for the Chilean Public Health System.

The multimorbidity approach involves promotional and preventive strategies. The demand for rehabilitation services has grown exponentially in recent years, leading to the urgency of rethinking care delivery. In Chile, there are laws, programs, and guidelines that, from their theoretical basis, include a person-centered care focus. But in real practice, multiple barriers trigger important fragmentation of care. In response, a new strategy has been proposed to answer whether comprehensive rehabilitation care based on multimorbidity positively impacts the health system performance, people's functionality, and quality of life, which will be implemented as a pilot study with a national scale-up focus.

El enfoque de multimorbilidad implica estrategias promocionales y preventivas. La demanda de servicios de rehabilitación ha crecido exponencialmente en los últimos años, lo que ha llevado a la urgencia de repensar la organización y entrega de prestaciones. En Chile existen leyes, programas y lineamientos que, desde su base teórica, incluyen un enfoque de atención centrado en la persona. Pero en la práctica real, múltiples barreras generan una importante fragmentación de la atención. En respuesta, se ha propuesto una nueva estrategia para responder si una rehabilitación integral basada en el enfoque de la multimorbilidad impacta positivamente en el desempeño del sistema de salud, la funcionalidad de las personas y la calidad de vida, que se implementará como un estudio piloto con un enfoque de escalamiento nacional.

Effect of backbone flexibility on charge transfer rates in peptide nucleic acid duplexes.

Charge transfer (CT) properties are compared between peptide nucleic acid structures with an aminoethylglycine backbone (aeg-PNA) and those with a γ-methylated backbone (γ-PNA). The common aeg-PNA is an achiral molecule with a flexible structure, whereas γ-PNA is a chiral molecule with a significantly more rigid structure than aeg-PNA. Electrochemical measurements show that the CT rate constant through an aeg-PNA bridging unit is twice the CT rate constant through a γ-PNA bridging unit. Theoretical calculations of PNA electronic properties, which are based on a molecular dynamics structural ensemble, reveal that the difference in the CT rate constant results from the difference in the extent of backbone fluctuations of aeg- and γ-PNA. In particular, fluctuations of the backbone affect the local electric field that broadens the energy levels of the PNA nucleobases. The greater flexibility of the aeg-PNA gives rise to more broadening, and a more frequent appearance of high-CT rate conformations than in γ-PNA.

Rational approaches for the design of effective human immunodeficiency virus type 1 nonnucleoside reverse transcriptase inhibitors.

The binding of several classes of nonnucleoside reverse transcriptase inhibitors (NNRTIs) to wild-type (wtRT) and K103N mutant (mRT) human immunodeficiency virus type 1 (HIV-1) reverse transcriptase is studied by molecular dynamics and energy decomposition techniques. The imidoylthiourea (ITU), diaryltriazine (DATA), and diarylpyrimidine (DAPY) NNRTIs studied maintain the hydrogen bond with Lys101 during the 3 ns molecular dynamics trajectories. When bound to mRT, all the DAPYs studied establish hydrogen bonds with Glu138; among these, those of the potent inhibitors TMC120 and TMC125 are water-mediated. The molecular interactions of the NNRTIs in the binding pocket are correlated to the drugs' potency. Quantitative free energy analyses show a linear relationship between the van der Waals energetic component and the potency against wtRT. The molecular basis of the interaction between NNRTIs and RT presented here provide quantitative approaches for the design of novel effective anti-HIV drugs.

Crystal structure of chiral gammaPNA with complementary DNA strand: insights into the stability and specificity of recognition and conformational preorganization.

We have determined the structure of a PNA-DNA duplex to 1.7 A resolution by multiple-wavelength anomalous diffraction phasing method on a zinc derivative. This structure represents the first high-resolution 3D view of a hybrid duplex containing a contiguous chiral PNA strand with complete gamma-backbone modification ("gammaPNA"). Unlike the achiral counterpart, which adopts a random-fold, this particular gammaPNA is already preorganized into a right-handed helix as a single strand. The new structure illustrates the unique characteristics of this modified PNA, possessing conformational flexibility while maintaining sufficient structural integrity to ultimately adopt the preferred P-helical conformation upon hybridization with DNA. The unusual structural adaptability found in the gammaPNA strand is crucial for enabling the accommodation of backbone modifications while constraining conformational states. In conjunction with NMR analysis characterizing the structures and substructures of the individual building blocks, these results provide unprecedented insights into how this new class of chiral gammaPNA is preorganized and stabilized, before and after hybridization with a cDNA strand. Such knowledge is crucial for the future design and development of PNA for applications in biology, biotechnology, and medicine.

Solution structure of a peptide nucleic acid duplex from NMR data: features and limitations.

This paper describes the results of a 1D and 2D NMR spectroscopy study of a palindromic 8-base pair PNA duplex GGCATGCC in H2O and H2O-D2O solutions. The (1)H NMR peaks have been assigned for most of the protons of the six central base pairs, as well as for several amide protons of the backbone. The resulting 36 interbase and base-backbone distance restraints were used together with Watson-Crick restraints to generate the PNA duplex structure in the course of 10 independent simulated annealing runs followed by restrained molecular dynamics (MD) simulations in explicit water. The resulting PNA structures correspond to a P-type helix with helical parameters close to those observed in the crystal structures of PNA. Based on the current limited number of restraints obtained from NMR spectra, alternative structures obtained by MD from starting PNA models based on DNA cannot be ruled out and are also discussed.

Educación en enfermería y cuidado de personas con condiciones crónicas: avances y desafíos / Nursing education and care for people with chronic conditions: advances and challenges

INTRODUCCIÓN: El escenario mundial actual de las enfermedades crónicas (EC) es preocupante. Representan el grueso de la carga de enfermedad, en una población envejecida y con alta prevalencia de factores de riesgo. Para mejorar los resultados de las personas con EC, una de las líneas de trabajo prioritarias es la incorporación del apoyo al automanejo, como parte del rol profesional de profesionales de la salud. La principal debilidad percibida hoy es la falta de formación teórico-práctica desde la formación de pregrado. OBJETIVO: evaluar la enseñanza acerca del cuidado en condiciones crónicas de salud, en la formación de pregrado de la Escuela de Enfermería. METODOLOGÍA: Estudio mixto que incluyó a) Análisis del plan de estudios de pregrado vigente 2) Exploración de la experiencia previa de la unidad en investigación y educación continua en cuidados crónicos; consulta con expertos, incluyendo miembros clínicos de equipos de salud que participan en la atención a crónicos. 3) Revisión de la literatura de modelos teóricos para los cuidados crónicos 4) Explorar, a través de las percepciones de los profesores, el grado de implementación de los cuidados de enfermería para las EC. RESULTADOS: Se detectó un bajo nivel de incorporación de la educación para el cuidado crónico en el currículum y ausencia de uso de conceptos claves relacionados con esto. Esto debe hacerse a lo largo de un proceso educativo que progresivamente aumenta el nivel de complejidad en la aplicación de los cuidados a las personas con EC y que se encuentra en implementación en un nuevo plan de estudio en ejecución desde el año 2022.

INTRODUCTION: The global current scenario in non-communicable diseases (NCD) is worrisome. In Chile these conditions represent the bulk of the disease burden, in an ageing population with a high prevalence of risk factors for NCDs. Thus, the training of health professionals in this field is paramount. PURPOSE: to share our experience at the school of nursing (SON) in designing and integrating chronic care and self-management support for people with chronic conditions in the undergraduate program. METHODOLOGY: a) Revision of the undergraduate curriculum 2) Exploring SON previous experience in research and continuing education in chronic care; consultation with experts including clinical members of health teams that participate in delivering chronic care. 3) Review of the literature to find theoretical models for chronic care 4) explore, through the lecturers' perceptions, the degree of implementation of nursing care for NCDs in clinical practice. RESULTS AND CONCLUSIONS: We found that there was a lack of incorporation of subjects and contents on chronic care in the curriculum and in clinical settings. It is important to incorporate chronic care and self-management support in nursing education at the theoretical and the clinical level. This should be done throughout an education process that increases progressively the level of complexity in the application of caring for people with NCDs. The SON will implement this approach in the new curricula starting on 2022.

Adaptación cultural y análisis psicométrico de una escala de comportamientos de autocuidado en personas con insuficiencia cardíaca / Cultural adaptation and psychometric analysis of a scale of self-care behaviors in persons with heart failure

INTRODUCCIÓN: La Insuficiencia Cardiaca se ha descrito como un síndrome de proporciones epidémicas, con una prevalencia de un 1-3% de la población adulta mundial menor de 60 años. Las conductas de autocuidado constituyen una estrategia clave en la elaboración de intervenciones exitosas que disminuyan la re-hospitalización, mortalidad y mejoren la calidad de vida. OBJETIVO: Adaptar y validar la Escala Revisada de Comportamientos de Autocuidado en Falla Cardiaca (Revised Heart Failure Self Care Behavior Scale) en personas con insuficiencia cardíaca, que se encuentran en seguimiento ambulatorio, en dos Hospitales Públicos chilenos. METODOLOGÍA: Estudio transversal de adaptación y análisis psicométrico del instrumento de medición Escala de Valoración de Comportamientos de Autocuidado en personas con Insuficiencia Cardíaca diseñada por Nancy Artinian. Emplazamiento: Unidades ambulatorias de seguimiento en Hospitales Públicos chilenos. Participantes: Usuarios con Insuficiencia Cardíaca que asistieron a dos Policlínicos de seguimiento de Insuficiencia Cardiaca de dos Centros de Salud de nivel secundario de dos comunas de Santiago en Chile. Método: Se realizó juicio de expertos para la adaptación cultural del instrumento, se aplicó el análisis factorial exploratorio con rotación oblicua. RESULTADOS: Escala Chilena de Valoración Comportamientos de Automanejo en Insuficiencia Cardiaca presentó una adecuada adaptación cultural, pruebas sicométricas que garantizan su validez de constructo y fiabilidad adecuada, con Alfa de Cronbach del Instrumento de 0,84 IC [0,80-0,88]. CONCLUSIONES: Se proporciona un instrumento que permite conocer conductas de autocuidado de los pacientes con IC, esto le permite ser utilizado por los profesionales que atienden a personas que padecen de IC en Chile.

INTRODUCTION: Heart failure (HF) has been described as a syndrome of epidemic proportions, with a prevalence of 1-3% amongst the global adult population under 60 years of age. Self-care behaviors are a key strategy in the development of successful interventions that reduce re-hospitalization, mortality and improve quality of life. OBJECTIVE: To adapt and validate the Revised Heart Failure Self-Care Behavior Scale in people with heart failure, who are in outpatient follow-up, in two Chilean public hospitals. DESIGN: Cross-sectional study of adaptation and psychometric analysis of the measuring instrument Scale of Assessment of Self-Care Behavior in Persons with Heart Failure, designed by Nancy Artinian. Location: Outpatient follow-up units in Chilean public hospitals. Participants: Patients with Heart Failure who attended two heart failure outpatient follow-up clinics within two secondary healthcare centers located in two districts of Santiago, Chile. Method: Expert judgments were made for the cultural adaptation of the instrument, followed by exploratory factor analysis with oblique rotation. RESULTS: The Chilean Scale of Assessment of Self-Management Behaviors in Heart Failure presented adequate cultural adaptation, psychometric tests that guarantee its validity in terms of its construction and adequate reliability. Cronbach's Alpha of the Instrument was 0,84 IC [0,80-0,88] CONCLUSIONS: The study provides a tool that allows us to ascertain the self-care behaviors of patients with HF, allowing it to be used by professionals who care for people with HF in Chile.

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

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

Docking of non-nucleoside inhibitors: neotripterifordin and its derivatives to HIV-1 reverse transcriptase.

The docking of small molecules to proteins has played an important role in the understanding of drug/receptor interactions. An important drug/receptor interaction is between non-nucleoside inhibitors of HIV-1 RT and the non-nucleoside binding pocket. We report the results of docking calculations in which we have docked known and proposed non-nucleoside reverse transcriptase inhibitors to the type 1 virus. The proposed NNRTIs dock in a similar position and orientation as known inhibitors. In addition, we observe a linear correlation between the calculated interaction energy and EC50 for the inhibitors, suggesting that the docked structure orientation and the interaction energies are reasonable. Two hydrogen bonds between nevirapine and RT (3HVT and 1VRT) are observed and are reproduced across different docking schemes. Since we used two different HIV-1 RT crystal structures (3HVT and 1VRT), which are at different levels of resolution (2.9 and 2.2 A, respectively), we propose that structures with resolutions better than 3 A can be used to produce reasonable docking results.

Synthesis, biological evaluation and molecular modeling of 4,6-diarylpyrimidines and diarylbenzenes as novel non-nucleosides HIV-1 reverse transcriptase inhibitors.

A series of novel 4,6-diarylpyrimidines (4,6-DAPY) and diarylbenzenes (DABE) compounds were synthesized and evaluated as inhibitors of human immunodeficiency virus type-1 (HIV-1). Among them, the most potent HIV-1 inhibitors were 8b, 8d, 14b and 18 (EC(50) = 0.049, 0.381, 0.599 and 0.398 µM, respectively), with HIV-1 inhibitory activity improved or similar to nevirapine (NVP, EC(50) = 0.097 µM) and delavirdine (DEV, EC(50) = 0.55 µM). The other compounds displayed moderate activity (8c, EC(50) = 5.25 µM) or were inactive (8a and 14a) against HIV-1 replication. Molecular modeling studies were performed with the synthesized compounds in complex with the wild-type reverse transcriptase (RT). A correlation was found between the anti-HIV activity and the electrostatic energy of interaction with Lys101 residue. These findings enrich the SAR of these Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) families.

The structure of a gamma-modified peptide nucleic acid duplex.

This paper presents the results of an NMR spectroscopy and distance-restrained molecular dynamics (MD) study of a gamma-methylated, palindromic, 8-base pair peptide nucleic acid (gamma-PNA) duplex. The goal of this study was to examine the impact of the gamma-backbone modification on the structure of the PNA duplex. The 2D NMR information involving the backbone methyl group, especially the NOEs between the methyl protons and those of the amide and methylene groups of the backbone, led to distance restraints useful in the elucidation of the structure of the backbone of gamma-PNA. Integration of the NOE peaks resulted in 138 inter-proton distance restraints, which were used in ten independent simulated annealing followed by 2 ns restrained MD runs. These simulations led to the conclusion that the gamma-PNA duplex adopts a general P-form helical structure similar to that observed for non-modified PNA but with a smaller base pair rise, which is an A-like helical feature, and a slight helical bending towards the major groove (PDB ID ). These properties of the gamma-PNA duplex may be induced by the gamma-methyl group. A similar effect of the methyl group was revealed by a previous NMR study of single stranded gamma-PNA [A. Dragulescu-Andrasi, S. Rapireddy, B. M. Frezza, C. Gayathri, R. R. Gil and D. H. Ly, J. Am. Chem. Soc., 2006, 128, 10258-10267]. It appears that the steric constraint exerted by the gamma-methyl on the backbone orientation is relatively independent of the base pairing and stacking and thus is likely to manifest when other substituents are introduced at the gamma-position of the PNA.

Effect of a bound non-nucleoside RT inhibitor on the dynamics of wild-type and mutant HIV-1 reverse transcriptase.

HIV-1 reverse transcriptase (RT) is an important target for drugs used in the treatment of AIDS. Drugs known as non-nucleoside RT inhibitors (NNRTI) appear to alter the structural and dynamical properties of RT which in turn inhibit RT's ability to transcribe. Molecular dynamics (MD), principal component analysis (PCA), and binding free energy simulations are employed to explore the dynamics of RT and its interaction with the bound NNRTI nevirapine, for both wild-type and mutant (V106A, Y181C, Y188C) RT. These three mutations commonly arise in the presence of nevirapine and result in resistance to the drug. We show that a bound NNRTI hinders the motion of almost all RT amino acids. The mutations, located in the non-nucleoside RT inhibitor binding pocket, partially restore RT flexibility. The binding affinities calculated by molecular mechanics/Poisson-Boltzmann surface accessibility (MM-PBSA) show that nevirapine interacts stronger with wild-type RT than with mutant RT. The mutations cause a loss of van der Waals interactions between the drug and the binding pocket. The results from this study suggest that a good inhibitor should efficiently enter and maximally occupy the binding pocket, thereby interacting effectively with the amino acids around the binding pocket.

Effect of PNA backbone modifications on cyanine dye binding to PNA-DNA duplexes investigated by optical spectroscopy and molecular dynamics simulations.

Optical spectroscopy and molecular dynamics simulations have been used to study the interaction between a cationic cyanine dye and peptide nucleic acid (PNA)-DNA duplexes. This recognition event is important because it leads to a visible color change, signaling successful hybridization of PNA with a complementary DNA strand. We previously proposed that the dye recognized the minor groove of the duplex, using it as a template for the assembly of a helical aggregate. Consistent with this, we now report that addition of isobutyl groups to the PNA backbone hinders aggregation of the dye when the substituents project into the minor groove but have a weaker effect if directed out of the groove. UV-Visible and circular dichroic spectroscopy were used to compare aggregation on the different PNA-DNA duplexes, while molecular dynamics simulations were used to confirm that the substituents block the minor groove to varying degrees, depending on the configuration of the starting amino acid. In addition to a simple steric blockage effect of the substituent, the simulations suggest that directing the isobutyl group into the minor groove causes the groove to narrow and the duplex to become more rigid, structural perturbations that are relevant to the growing interest in backbone-modified PNA for applications in the biological and materials sciences.

Relación entre malnutrición por exceso e hipercolesterolemia en escolares de primer año de enseñanza básica de colegios pertenencientes al sector de los Quillayes, comuna de La Florida / Relation between malnutrition for excess and hypercholesterolemia of 1st grade students belonging to schools at Los Quillayes, La Florida, Santiago

Estudio de tipo transversal, con el objetivo de determinar la relación entre malnutrición por exceso (sobrepeso y obesidad) e hipercolesterolemia en escolares de primero de enseñanza básica, pertenecientes a colegios municipalizados del sector de Los Quillayes de la comuna de La Florida, Santiago de Chile, durante el período diciembre 2001 y enero 2002. La muestra estuvo constituida por 232 niños de primero básico de cuatro colegios del sector de Los Quillayes, seleccionadps aleatoriamente por conglomerado en una etapa. Las principales caracterísiticas de la población fueron las siguientes, 51.3 porciento era de sexo femenino, y el resto de sexo masculino, el rango de edad al que pertenecían oscilaba entre los 6 a 10.8 años. Como resultados se obtuvo que la mayoría de la muestra presentó un estado nutricional normal (59.6 porciento), el 20.6 porciento se encontraba obeso y el 17.5 porciento con sobrepeso. En relación a niveles sanguíneos de colesteroltoral, el 84 por ciento dela población presentó valores adecuados, el 15.1 porciento niveles de riesgo o intermedio, y sólo un 0.9 porciento (2 casos) niveles altos, mayores o iguales a 200mg/dl. Al analizar la relación entre malnutrición por exceso e hipercolesterolemia, se observó que no existe relación entre ambas variables, ya que niveles de colesterol alterados se presentaban casi en igual proporción entre los manutridos por exceso y los con estado nutricional normal (16.09 porciento y 15.6 porciento respectivamente)