Bottom-up innovative responses to COVID-19 in Latin America and the Caribbean: addressing deprioritized populations / Respuestas innovadoras a la COVID-19 generadas desde la base en América Latina y el Caribe: abordaje de grupos poblacionales desatendidos / Respostas inovadoras de baixo para cima à COVID-19 na América Latina e no Caribe com foco em populações não priorizadas

ABSTRACT Objective. To identify and describe innovative initiatives implemented as a response to the interruption of health services during the COVID-19 pandemic in Latin America and the Caribbean (LAC). Methods. This was a descriptive study that reviewed 34 initiatives implemented during the COVID-19 pandemic in LAC to address health services needs among deprioritized groups. The review of initiatives included four phases: a call for submissions of innovative initiatives from LAC countries; a selection of initiatives that had the ability to address health services gaps and that were innovative and effective; systematization and cataloging of the selected initiatives; and a content analysis of the information collected. Data were analyzed from September to October 2021. Results. The 34 initiatives show important variations regarding the target populations, the stakeholders involved, level of implementation, strategies, scope, and relevance of the innovative initiative. There was also evidence of the emergence of a bottom-up set of actions in the absence of top-down actions. Conclusion. The findings of this descriptive review of 34 initiatives implemented during the COVID-19 pandemic in LAC suggest that systematizing the strategies and lessons learned has the potential to expand learning for re-establishing and improving post-pandemic health services.

RESUMEN Objetivo. Detectar y describir iniciativas innovadoras instrumentadas como respuesta a la interrupción de los servicios de salud durante la pandemia de COVID-19 en América Latina y el Caribe (ALC). Métodos. Se trata de un estudio descriptivo en el que se examinaron 34 iniciativas instrumentadas durante la pandemia de COVID-19 en ALC para hacer frente a las necesidades de servicios de salud en grupos poblacionales desatendidos. La revisión constó de cuatro fases: convocatoria para la presentación de iniciativas innovadoras por parte de los países de la Región; selección de iniciativas capaces de abordar las deficiencias en los servicios de salud y que fueran innovadoras y eficaces; sistematización y clasificación de las iniciativas seleccionadas; y análisis del contenido de la información recopilada. Los datos se analizaron entre septiembre y octubre del 2021. Resultados. Las 34 iniciativas presentan importantes diferencias en cuanto a los grupos poblacionales destinatarios, las partes interesadas implicadas, el grado de aplicación, las estrategias, el alcance y la pertinencia de la iniciativa innovadora. También se constató el surgimiento de un conjunto de acciones generadas desde la base como respuesta a la ausencia de medidas aplicadas de forma descendente. Conclusión. Los resultados de esta revisión descriptiva de 34 iniciativas aplicadas en ALC durante la pandemia de COVID-19 sugieren que la sistematización de las estrategias y las enseñanzas extraídas podría ser útil para ampliar el aprendizaje con vistas al restablecimiento y la mejora de los servicios de salud pospandémicos.

RESUMO Objetivo. Identificar e descrever iniciativas inovadoras implementadas em resposta à interrupção dos serviços de saúde durante a pandemia de COVID-19 na América Latina e no Caribe (ALC). Métodos. Este estudo descritivo analisou 34 iniciativas implementadas durante a pandemia de COVID-19 na ALC para atender às necessidades de serviços de saúde entre grupos que haviam perdido prioridade. A análise das iniciativas incluiu quatro fases: chamada pública para a apresentação de iniciativas inovadoras de países da ALC; seleção de iniciativas inovadoras e efetivas capazes de abordar lacunas nos serviços de saúde; sistematização e catalogação das iniciativas selecionadas; e análise de conteúdo das informações coletadas. Os dados foram analisados de setembro a outubro de 2021. Resultados. As 34 iniciativas apresentam variações importantes com relação às populações-alvo, partes interessadas envolvidas, nível de implementação, estratégias, escopo e relevância da iniciativa inovadora. Também houve evidências do surgimento de um conjunto de ações de baixo para cima (bottom-up) na ausência de ações de cima para baixo (top-down). Conclusão. Os resultados desta análise descritiva de 34 iniciativas implementadas durante a pandemia de COVID-19 nos países da ALC sugerem que a sistematização das estratégias e das lições aprendidas tem o potencial de ampliar as oportunidades de aprendizado para reestabelecer e aprimorar os serviços de saúde pós-pandemia.

Análisis del ambiente educacional en escuela de odontología chilena / Assessment of the educational environment in a Chilean dental school

Objetivo Evaluar la precepción del ambiente educativo por parte de los estudiantes de odontología en 2 períodos críticos de su formación: preclínico y clínico, transición desde la sala de clase a ambientes clínicos y comienzo de la atención de pacientes. Método Doscientos setenta y cinco estudiantes de odontología de la Universidad San Sebastián fueron sometidos al cuestionario DREEM en su versión en español el año 2012, en 3.er, 4.° y 5.° año (117 estudiantes en preclínico y 158 en clínica). Se calcularon los resultados individuales y los promedios globales e individuales de cada dominio. El test de Chi cuadrado fue realizado para analizar las diferencias entre los datos nominales. El coeficiente alfa de Cronbach fue utilizado para evaluar la consistencia interna de las subescalas del cuestionario. Valores de p menores a 0,05 fueron considerados significativos. Resultados La puntuación media fue de 120,42 en el área preclínica y de 121,83 a 110,38 en el área clínica. Con respecto al proceso de enseñanza aprendizaje, los estudiantes tienen una buena percepción del ambiente. Los dominios de percepción de los profesores y autopercepción social obtuvieron los puntajes más bajos. Discusión La percepción de los estudiantes de preclínico es diferente a los del área clínica. Estos últimos sienten que la participación en el aula disminuye, lo que puede deberse al mayor número de horas clínicas versus horas teóricas. La identificación de áreas positivas y negativas permite orientar acciones para mejorar el ambiente educativo para los estudiantes de la facultad.

Objective To evaluate the educational environment in dental school perceived by students at two critical transitional periods in their education: Preclinical and clinical (transition from the classroom to clinical environments and commencement of patient care) Method A total of 275 dental students (third, fourth and fifth year) of the San Sebastian University Dental School were asked to complete the Spanish adaptation of the DREEM Questionnaire in 2012 in (117 were preclinical and 158 were clinical students). The individual results were calculated, as well as both the overall and individual domain scores. The chi-squared test was used to analyse differences in nominal data. Cronbach's alpha was employed to assess the internal consistency of the subscales of the instrument. A P<.05 was considered statistically significant. Results The mean score was 120.42 in the preclinical area, and 121.83 to 110.38 in the clinical area. As regards the learning and teaching process, students have a good perception of the environment. The domains of perception of Teachers and Social Self-Perception obtain the lowest scores. Discussion The perceptions of the students in the preclinical area differ from those of the clinical area, with the latter feeling that participation in the classroom decreases. This may be due to the fact that the number of practice hours are much greater than theory hours, leading to a considerable reduction in the amount of classroom time at the expense of an increase in clinical hours. The identified positive and negative areas will help to focus actions to improve the educational environment for dentistry students.

T-kininogen inhibits kinin-mediated activation of ERK in endothelial cells

Serum levels of T-kininogen increase dramatically as rats approach the end of their lifespan. Stable expression of the protein in Balb/c 3T3 fibroblasts leads to a dramatic inhibition of cell proliferation, as well as inhibition of the ERK signaling pathway. T-kininogen is a potent inhibitor of cysteine proteinases, and we have described that the inhibition of ERK activity occurs, at least in part, via stabilization of the MAP kinase phosphatase, MKP-1. Since fibroblasts are not a physiological target of T-kininogen, we have now purified the protein from rat serum, and used it to assess the effect of T-kininogen on endothelial cells. Adding purified T-kininogen to EAhy 926 hybridoma cells resulted in inhibition of basal ERK activity levels, as estimated using appropriate anti-phospho ERK antibodies. Furthermore, exogenously added T-kininogen inhibited the activation of the ERK pathway induced by either bradykinin or T-kinin. We conclude that the age-related increase in hepatic T-kininogen gene expression and serum levels of the protein could have dramatic consequences on endothelial cell physiology, both under steady state conditions, and after activation by cell-specific stimuli. Our results are consistent with T-kininogen being an important modulator of the senescent phenotype in vivo