High fat diet- induced obesity decreases ErbB receptors expression in liver and adipose tissue in C57BL/6 mice

Neuregulins (NRGs) are a family of signaling proteins that bind to receptor tyrosine kinases of the ErbB family (ErbB2 to ErbB4), which can homo- or heterodimerize depending on their structural features and cell type. Many studies have proposed that decreased NRG levels are a common characteristic of obesity. In liver and adipose tissue, the increase in NRG expression has protective effects against obesity. However, it is still unknown whether ErbBs expression is altered in this pathology. We hypothesized that high fat diet-induced obesity downregulates ErbB receptors expression in obese mice compared to normal weight mice. Males C57BL/6 mice (n=6-7 for each group) were fed for 12 weeks and divided into: (i) control diet (CD; 10%-kcal fat, 20%-kcal protein, 70%-kcal carbohydrates), and (ii) high fat diet (HFD; 60%-kcal fat, 20%-kcal protein, 20%-kcal carbohydrates). General parameters and ErbBs expression (qPCR, immunohistochemistry and Western blot) were evaluated. We observed a significant increase in final body weight (47%), adipose tissue to body weight ratio (244%) and HOMA-IR (69%), among other parameters, in obese mice. In HFD group significantly decreased ErbB2 (48%) and ErbB3 (66%) mRNA levels in liver (no change in ErbB4), and ErbB2 (43%), ErbB3 (76%) and ErbB4 (35%) in adipose tissue, compared to CD. Furthermore, ErbB2 and ErbB3 protein levels decreased significantly in HFD group compared to the CD in liver. Therefore, our results suggest that HFD-induced obesity significantly decreases ErbBs expression in liver and adipose tissue in this murine model, that may be associated with alterations in the NRG pathway in obese mice.

Las neuregulinas (NRGs) son una familia de proteínas de señalización que se unen a receptores tirosina quinasas de la familia ErbB (ErbB2 a ErbB4), que pueden homo- o heterodimerizar dependiendo de sus características estructurales y del tipo celular. Estudios han propuesto que la disminución de los niveles de NRG es una característica común de la obesidad. En el hígado y el tejido adiposo (TA), el aumento de la expresión de NRG tiene efectos protectores contra la obesidad. Sin embargo, aún se desconoce si la expresión de ErbBs está alterada en esta patología. Nuestra hipótesis es que la obesidad inducida por una dieta alta en grasas (DAG) disminuye la expresión de los ErbB en ratones obesos. Ratones machos C57BL/6 (n=6-7 para c/grupo) fueron alimentados durante 12 semanas y divididos en: (i) dieta control (DC; 10%-kcal grasa, 20%-kcal proteína, 70%-kcal carbohidratos), y (ii) DAG (60%-kcal grasa, 20%-kcal proteína, 20%-kcal carbohidratos). Se evaluaron los parámetros generales y la expresión de ErbBs (qPCR, inmunohistoquímica y Western blot). Observamos un aumento significativo del peso corporal final (47%), de la relación tejido adiposo/peso corporal (244%) y del HOMA-IR (69%), entre otros parámetros, en ratones obesos. En este grupo disminuyó significativamente los niveles de ARNm de ErbB2 (48%) y ErbB3 (66%) en el hígado (sin cambios en ErbB4), y de ErbB2 (43%), ErbB3 (76%) y ErbB4 (35%) en el TA. Además, los niveles de proteína ErbB2 y ErbB3 disminuyeron significativamente, en comparación con el grupo DC en el hígado. Nuestros resultados sugieren que la obesidad inducida por DAG disminuye significativamente la expresión de ErbBs en el hígado y el TA, que puede estar asociado con alteraciones en la vía NRG en ratones obesos.

Students' perception of instructors and burnout levels in chilean dental students

The educational environment affects dental students' well-being and academic achievement, with unclear impact from clinical instructors on burnout levels. This study is aimed to determine the impact of students' perception about their clinical instructors in its burnout levels in a sample of Chilean dental students. Methods: A cross-sectional study was conducted among fourth and fifth-year dental students at the University of Concepción (Chile), collecting data on various variables including demographics, effective teaching hours, instructor treatment, knowledge delivery, student appreciation, and burnout assessed using Maslach's Burnout Inventory (MBI). Data were gathered through a self-administered survey and analyzed using STATA 10/SE software (p<0.05). Results: One-hundred and seventy students participated, high levels of emotional exhaustion (51.76%), depersonalization (56.47%), and personal accomplishment (60.59%) were found. Female students (p=0.0008), those who perceive inadequate treatment from instructors towards patients (p=0.0496), and those who rate the instructor as obstructionist (p=0.0208) reported higher levels of emotional exhaustion. 5th year students (p=0.0142), students who perceive indifferent treatment from instructors towards students (p=0.0002), and those who rate the instructor as obstructionist (p=0.0026) exhibited higher levels of depersonalization. 4th year students (p=0.0475) and those who perceive indifferent treatment from instructors towards students (p=0.0221) showed lower levels of personal accomplishment. There was a correlation between depersonalization and effective teaching hours (rho=-0.2166, p=0.0046). Conclusion: Students' perception about their clinical instructors as indifferent towards the students, obstructionist in the teaching process, with inadequate treatment towards the patients, and less effective teaching hours is associated with higher students' burnout levels.

Adecuaciones para la atención de personas con discapacidad sensorial en los CESFAM del Servicio de Salud Concepción / Adjustments for the care of people with sensory disabilities in primary health centers

BACKGROUND: People with Sensory Disabilities (PcDS) face barriers for equal access to health care. Thus, health centers require adjustments to comply with equal access that allows an universal coverage of care. AIM: To characterize the adjustments for the care of PcDS in primary health centers in Concepción, Chile. Material and Methods: Cross-sectional study using data obtained through a questionnaire to key informants or via Transparency Law, and direct observation. The variables were subdivided into four categories, namely infrastructure, communication, skills, and environment. RESULTS: The analyzed health centers have a high proportion of general adjustments of their physical settings. However, there is a lack of specific adjustments for deaf and blind people, especially communicational ones. Conclusions: There is a paucity of adjustments for the health care of PcDS in the analyzed health centers. This deficiency underscores the barriers faced by PcDS for receiving care in the Chilean public health system.

Clean beauty: artigo de revisão sobre a nova tendência em cosméticos / Clean beauty - literature review of new trends in cosmetics

Nos últimos anos, cresce a tendência pela busca de cosméticos "amigos da natureza", sem ingredientes químicos ou sintéticos, impulsionando as vendas de produtos pertencentes a este nicho de mercado. Atualmente, o termo clean beauty refere-se a produtos que não contenham ingredientes sobre os quais não se conheça o impacto que terão em nosso organismo ou seu potencial dano ambiental. Entretanto, a definição do que é um cosmético verde, bem como vegano, natural e orgânico, não é regulamentada pela Agência Nacional de Vigilância Sanitária (Anvisa), sendo o objetivo deste artigo fazer uma revisão das definições para facilitar o entendimento médico sobre o tema.

In recent years, there has been an increasing trend toward the search for nature-friendly cosmetics without chemical or synthetic ingredients, thus boosting sales of products within this market niche. Currently, the term clean beauty refers to products that do not contain ingredients with unknown impacts on our bodies or that are potentially harmful to the environment. However, the definition of green beauty products, as well as vegan, natural, or organic products, is not regulated by ANVISA. Therefore, this study aimed to review these definitions to facilitate the medical understanding of the subject

Factors Associated with Oral Health-Related Quality of Life in Preschoolers of Concepción, Chile: A Cross-Sectional Study

Abstract Objective: To identify the factors associated with Oral Health-Related Quality of Life (OHRQoL) in preschool children of Concepción, Chile. Material and Methods: A cross-sectional study was conducted in a sample of enrolled preschoolers who attend public schools in Concepción, Chile. To measure OHRQoL, the chilean version of the Early Childhood Oral Health Impact Scale (ECOHIS) was used; sociodemographic variables of the children and their parents were also recorded, as well as variables regarding the last visit to the dentist. To determine differences in the ECOHIS score for categorical variables, ANOVA and t-test were used, while Pearson's r was used to correlate ECOHIS with quantitative variables (p<0.05). Results: A total of 175 children were surveyed, with a distribution of 89 boys and 86 girls aged 56-to-79 months. The total score of the ECOHIS had a mean of 4.48 ±5.96, with a score between 0-38. Statistically significant associations were with parent's educational attainment (r=−0.159), dmft (r=0.380), OHI-S debris (r=0.174) and reason for the last visit to the dentist, the highest average in the ECOHIS scores was registered in the urgency reason. Conclusion: Oral health status, dental service utilization and educational level are associated with the OHRQoL of preschoolers of Concepción (AU).

Association of social factors and health conditions with capacity and performance

ABSTRACT OBJECTIVE Determine and measure the association of social factors and health conditions with worse capacity and performance levels. METHODS Dependent variables consisted of performance and capacity; independent variables comprised age, gender, level of education, personal income, and health conditions. Means (95%CI) of performance and capacity were presented according to the independent variables. Generalized linear models, using a mutual adjustment for all variables considered statistically significant (p < 0.05), measured the associations between each exposure and outcomes. Study population included 12,265 individuals. RESULTS Older women with lower education and income levels and with some health condition showed the worst performance and capacity. CONCLUSION Results showed that the capacity and performance levels of the Chilean population changed according to social demographic characteristics and health conditions.

Factor analysis of the cross-cultural adaptation of the multidimensional attitudes scale towards deaf persons in Chilean dental students

There are various instruments to measure attitudes toward persons with disabilities (PwD). The Multidimensional Attitudes Scale (MAS) toward PwD is a three-dimension scale with good psychometric properties; the Spanish version has been validated with a four-factor structure. Aim: To examine the factor structure of a cross-cultural adapted version of the Spanish MAS towards deaf persons in a sample of Chilean dental students. Methods: This cross-sectional study involved five Chilean public health experts that reviewed the scale for obtaining a preliminary version of a 30-item modified MAS towards deaf persons; a pilot with 15 dental students was performed, and a final sample composed of 311 students was included. For the exploratory factor analysis (EFA), maximum likelihood estimation (ML) for determining the number of factors and parallel analysis (PA) was used, with Oblimin for the rotation method. Cronbach's alpha was used to assess reliability. The root mean square error of approximation (RMSEA), comparative fit index (CFI), incremental fit index (IFI), goodness of fit index (GFI), Tucker-Lewis fit index (TLI-NNF) and root mean square of residuals (RMSR) were used to assess model fit. Results: All items had a normal distribution with the exception of items 7 and 10. The four-factor structure without item 10 in this EFA presented an adequate Cronbach's alpha (>0.83), suggesting acceptable reliability. RMSEA, TLI-NNFI, RMSR, GFI and CFI indices suggested a good fit of the model and were consistent with the literature. Conclusion: The Spanish modified version of the MAS towards deaf persons has a four-factor structure, which in consistent with a previous version of the MAS

Chilean Health Professionals Attitudes Towards Deafness: A Cross-Sectional Study

Abstract Objective: To assess the attitudes of health professionals towards Deafness and its association with sociodemographic and Deaf contact experience. Material and Methods: A cross-sectional study was carried out in Concepcion, Chile. The sample size was estimated in 171 health professionals. The following variables were considered: sociodemographics, Deaf contact experience, and attitudes to deafness scale (ADS scale). To evaluate the association between the variables, t-test and Spearman correlation test were used (p<0.05). Results: People who had taken a LSCh course had significant more positive attitudes towards item 1 "Deaf people should learn to lipread", with a 2 points difference and in persons who do not know a Deaf person, with 1-point difference. Also, persons who have received some kind of formation in Deafness have a better attitude in item 3 "I would like to have more Deaf friends" with 1-point difference. An inverse correlation was observed within age (rho = -0.237; p=0.0014), years of academic service (rho = -0.323; p<0.0001) or PHC service (rho = -0.1085; p=0,364). Conclusion: The attitude of health professionals towards Deafness was neutral. This attitude is not modulated by sex, type of profession, type of relationship with Deaf people, type of training in hearing disability, Chilean Sign Language Courses or degree of frequency of healthcare delivery to Deaf patients. However, it is modulated by age and years of service.

Improving Dental Service Utilization Rate Using a Proactive Telephone-Based Scheduling Strategy in Primary Healthcare

Abstract Objective: To determine the effect of a proactive telephone-based scheduling strategy to improve dental service utilization rate in primary healthcare. Material and Methods: A retrospective study was carried out based on the dental appointments' records of a primary healthcare center before-strategy and after-strategy periods. The variables studied for both periods were the number of dental appointments requested, dental appointments undergone, no-shows, and available quotas. Data collection was performed by two researchers between May and June 2018. Descriptive statistics were used to calculate the absolute and relative frequencies. Results: A total of 10,193 records of dental appointments were registered within the two periods. After-strategy period, dental appointments undergone increased by 16,7%, no-shows decreased by 3%, and available quotas decreased by 21.3%. Conclusion: A proactive telephone-based scheduling strategy increased the dental service utilization rate in primary healthcare.

Estado actual de la atención sanitaria de personas con discapacidad auditiva y visual: una revisión breve / Health care of people with visual or hearing disabilities

Visual or hearing disabilities account for 20% of people reporting some sort of disability. We performed a literature review about the interaction that people with visual or hearing disabilities have with the health care system. We found that these people report a lower quality of life and have a higher frequency of physical and psychological ailments. They also have difficulties to obtain an adequate health care and report a paucity of trained professionals to take care of them.

Avaliação histológica da redução do conteúdo melânico cutâneo após realização de microagulhamento na região anterior do colo / Histologic evaluation of the reduction of cutaneous melanin content after microneedling on the chest

Introdução: A região anterior do tórax constitui área fotoexposta que apresenta efeitos do fotodano. O microagulhamento é opção segura para rejuvenescimento dessa área, promovendo também a melhora de discromias. Objetivo: Avaliar a resposta histológica cutânea após três sessões mensais de microagulhamento para tratamento de discromias da região anterior do tórax. Métodos: Foram realizadas, três sessões mensais de microagulhamento com agulhas de 1,5mm de comprimento, e também biópsias cutâneas antes e 90 dias após o início do estudo. As amostras histológicas foram avaliadas com as colorações de HE e Fontana-Masson. O conteúdo de melanina foi mensurado com base em clusters dérmicos. Resultados: Seis pacientes com idades entre 38 e 67 anos, fototipos II-III, escala Glogau II-IV foram incluídos. Uma correlação positiva foi observada entre o tempo e o conteúdo dérmico de melanina (p= 0,029): três sessões de microagulhamento reduziram esse conteúdo no D90 em comparação com o tempo inicial (6.4 ± 1.7 MC em D0 versus 3.1 ± 0.4 em D90, p = 0.05). Três pacientes relataram melhora global da pele no D90. Conclusões: O mecanismo proposto do microagulhamento para promover clareamento inclui proliferação de fibroblastos e neocolagênese na derme superior. Esse é o primeiro estudo a avaliar histologicamente os achados associados ao clareamento da região do tórax decorrente do microagulhamento.

Introduction: The chest is a photoexposed area that shows effects of photodamage. Microneedling is a safe option for the rejuvenation of this area, also leading to improvement in dyschromias. Objective: To evaluate histologic cutaneous response after three monthly sessions of microneedling for the treatment of dyschromias on the chest. Methods: Three monthly sessions of microneedling, with 1.5mm length needles were performed, as well as skin biopsies before and 90 days after commencement of the study. Histologic samples were evaluated with H&E and Fontana-Masson stains. Melanin content was measured based on dermal clusters. Results: Six patients between 38 and 67 years of age, phototypes II-III, Glogau scale II-IV were included. A positive correlation was observed between the time and dermal content of melanin (p= 0.029): three sessions of microneedling reduced this content on D90 compared to the beginning (6.4 ± 1.7 MC on D0 versus 3.1 ± 0.4 on D90, p = 0.05). Three patients reported global skin improvement on D90. Conclusions: The proposed mechanism of microneedling to promote lightening includes fibroblast proliferation and neocollagenesis in the upper dermis. This is the first study to evaluate the histology of the findings associated to lightening of the chest due to microneedling.

Caries prevalence in teenagers from the Integral Dental Attention Program for fourth-year secondary school students of the Trehuaco and Lota communes, 2018

Introduction: Caries and periodontal diseases are the most common infectious diseases that affect the human being. Currently in Chile, caries has a high prevalence and constitutes an important public health issue. Therefore, in 2015 the Integral Dental Attention Program was introduced for fourth-year secondary school students. Objective: to determine the prevalence of caries in the Trehuaco and Lota communes in fourth-year secondary school students. Materials and methods: the selected population consisted of teenagers from the Integral Dental Attention Program for fourth-year secondary school students at public and semi-private schools, with a total universe of 114 teenagers, 70 of which belong to the Lota commune. Clinical records were analyzed to obtain the variables, which were DMFT index, FONASA (public health insurance) coverage level, medical records and sex. Results: DMFT value was 6.2 for teenagers from Trehuaco and 5.41 for teenagers from Lota; 4.9 for men and 6.7 for women; 5 for the D coverage level of FONASA and over 6.86 for the other levels. Conclusion: Caries prevalence was higher in teenagers from the Trehuaco commune. Regarding sex, female teenagers were more affected. Likewise, regarding FONASA coverage level, the more affected were those from the A, B and C levels.

Dental examiners consistency in applying different oral health indices in permanent dentition for a population-based study

Different indices to identify dental diseases have been developed. For population-based studies, it is imperative to use simple and reliable indices, but most importantly, clinical examiners should reach an agreement, in order to increase inter-observer reliability and obtain reliable data. The objective of this study was to describe the calibration process of the Dental Aesthetic Index, Community Periodontal Index, Simplified Oral Hygiene Index and International Caries Detection and Assessment System ICDAS II by two academics from the Public Health Department of Dentistry. All calibrations started with the individual reading of the official documents of each index and, when possible, were followed by a lecture, in-vitro or ex-vivo training and concluded with an in-vivo training. A high inter-observer reliability was obtained between the two academics in all indices.

Exploratory factor analysis of the chilean deafness attitude scale

Negative attitudes mean a barrier for People with Disability (PwD), but attitudes towards Deaf people are structurally different from the rest of the PwD. The aim of this study is to evaluate the factorial structure and internal reliability of the Attitudes towards Deafness Scale (ADS) applied in health professionals from Concepcion, Chile. The ADS was translated to Spanish and back-translated to English, then reviewed by public health experts, and a pilot application was carried out to 15 health professional to make final modifications. The Chilean ADS version was applied to 182 health professional from primary care centers and academics working in health schools. Reliability analysis with estimation of the Cronbach's alpha coefficient, and exploratory factor analysis were made. The data presented adequate values to perform exploratory factor analysis (KMO=0.73; Bartlett's sphericity test p <0.00001). A maximum likelihood extraction method and a Quartimax rotation method with Kaiser standardization were used for a four-factor model, in which 11 items presented loads of less than 0.5, so the final model was left with 11 items. A Cronbach's alpha coefficient of 0.70 was determined in the final model, with an alpha of 0.77 for the first factor, 0.55 for the second, 0.77 for the third, and 0.61 for the fourth. The exploratory factor analysis suggested a four-dimensional structure for ADS Chilean version. The four subscales and the scale in general presented an adequate Cronbach's alpha, suggesting acceptable internal consistency

Laser versus microagulhamento para tratamento de cicatriz facial - Relato de caso / Laser versus microneedling for the treatment of facial scar ­ Case report

Tanto o microagulhamento quanto o laser fracionado ablativo podem ser utilizados para o tratamento de cicatrizes. Neste artigo relata-se o caso de paciente do sexo feminino foi tratada em metade de cicatriz perioral com laser fracionado ablativo de CO2 e na outra metade da cicatriz com microagulhamento utilizando roller 2mm. Os resultados obtidos foram superiores na metade submetida ao procedimento com laser.

Both microneedling and ablative fractional laser can be used for the treatment of scars. The present article reports the case of a female patient who had the first half of a perioral scar treated with ablative fractional CO2 laser, and the second half treated with microneedling, using a 2mm roller. Outcomes were superior in the half treated with laser.

The Current Status of Dental Education and the Dental Profession in Chile

Objective: To describe the current situation of the dental profession in Chile, including training and workforce issues. Material and Methods: Data were collected from different national institutions, which included information regarding number of current registered dentists, university of graduation, geographical distribution, professional position, additional specialty certifications obtained, the number and characteristics of dental surgeons who work in the public and private sectors, the traditional character of the university, the accreditation status of the undergraduate dental programs and the general population number. Results: Currently there are 32 schools of Dentistry in Chile, of which 21 have their quality certified. There are 19,100 Chilean dentists and 1,727 foreign dentists registered. The number of graduates from private universities has increased significantly. Currently, 2,164 dentists work for MINSAL. Less than a third hold a specialty certification. Forty-five percent of the dental specialists obtained their certification from universities. The current professional ratio is 104 dentists per 100,000 habitants. Conclusion: The number of dentists in Chile has increased progressively during the last years, mainly associated with the opening of new dental schools. Only 28% of the Chilean dental schools have certified their quality for the total duration of the undergraduate program. Regarding the workforce, there is a public/private and geographical inequities in dentists' distribution.