The effect of a single session of psychological first aid in the emergency department on PTSD and depressive symptoms three months post-intervention: results of a randomised controlled trial.

Background: Despite its popularity, evidence of the effectiveness of Psychological First Aid (PFA) is scarce.Objective: To assess whether PFA, compared to psychoeducation (PsyEd), an attention placebo control, reduces PTSD and depressive symptoms three months post-intervention.Methods: In two emergency departments, 166 recent-trauma adult survivors were randomised to a single session of PFA (n = 78) (active listening, breathing retraining, categorisation of needs, assisted referral to social networks, and PsyEd) or stand-alone PsyEd (n = 88). PTSD and depressive symptoms were assessed at baseline (T0), one (T1), and three months post-intervention (T2) with the PTSD Checklist (PCL-C at T0 and PCL-S at T1/T2) and the Beck Depression Inventory-II (BDI-II). Self-reported side effects, post-trauma increased alcohol/substance consumption and interpersonal conflicts, and use of psychotropics, psychotherapy, sick leave, and complementary/alternative medicine were also explored.Results: 86 participants (51.81% of those randomised) dropped out at T2. A significant proportion of participants in the PsyEd group also received PFA components (i.e. contamination). From T0 to T2, we did not find a significant advantage of PFA in reducing PTSD (p = .148) or depressive symptoms (p = .201). However, we found a significant dose-response effect between the number of delivered components, session duration, and PTSD symptom reduction. No significant difference in self-reported adverse effects was found. At T2, a smaller proportion of participants assigned to PFA reported increased consumption of alcohol/substances (OR = 0.09, p = .003), interpersonal conflicts (OR = 0.27, p = .014), and having used psychotropics (OR = 0.23, p = .013) or sick leave (OR = 0.11, p = .047).Conclusions: Three months post-intervention, we did not find evidence that PFA outperforms PsyEd in reducing PTSD or depressive symptoms. Contamination may have affected our results. PFA, nonetheless, appears to be promising in modifying some post-trauma behaviours. Further research is needed.

Psychological First Aid (PFA) is widely recommended early after trauma.We assessed PFA's effectiveness for decreasing PTSD symptoms and other problems 3 months post-trauma.We didn't find definitive evidence of PFA's effectiveness. Still, it seems to be a safe intervention.

A fragment based competitive 19F LB-NMR platform for hotspot directed ligand profiling.

Ligand binding hotspots are regions of protein surfaces that form particularly favourable interactions with small molecule pharmacophores. Targeting interactions with these hotspots maximises the efficiency of ligand binding. Existing methods are capable of identifying hotspots but often lack assays to quantify ligand binding and direct elaboration at these sites. Herein, we describe a fragment-based competitive 19F Ligand Based-NMR (LB-NMR) screening platform that enables routine, quantitative ligand profiling focused at ligand-binding hotspots. As a proof of concept, the method was applied to 4'-phosphopantetheine adenylyltransferase (PPAT) from Mycobacterium abscessus (Mabs). X-ray crystallographic characterisation of the hits from a 960-member fragment screen identified three ligand-binding hotspots across the PPAT active site. From the fragment hits a collection of 19F reporter candidates were designed and synthesised. By rigorous prioritisation and use of optimisation workflows, a single 19F reporter molecule was generated for each hotspot. Profiling the binding of a set of structurally characterised ligands by competitive 19F LB-NMR with this suite of 19F reporters recapitulated the binding affinity and site ID assignments made by ITC and X-ray crystallography. This quantitative mapping of ligand binding events at hotspot level resolution establishes the utility of the fragment-based competitive 19F LB-NMR screening platform for hotspot-directed ligand profiling.

Adherencia al automonitoreo en diabetes tipo 2: plataforma "ClouDi" vs. Educación presencial. / Adherence to self-monitoring in type 2 diabetes: "ClouDi" platform vs. Face-to-face follow-up / Adesão à automonitorização na diabetes tipo 2: plataforma "ClouDi" vs. acompanha-mento presencial

Introducción: El uso de mHealth puede mejorar la adherencia a el automonitoreo con glucometría capilar (GC) en la transición del ámbito hospitalario al ambulatorio. Objetivo: evaluar la adherencia al automonitoreo con GC de los pacientes con Diabetes Tipo 2 (DM2) vinculados a un programa de educación usuarios de mHealth (ClouDi) comparado con el programa de educación y seguimiento presencial usual. Materiales y métodos: Estudio longitudinal prospectivo. Se analizaron pacientes con DM2 valorados por consulta de educación de diabetes con indicación de tratamiento con insulina al egreso hospitalario. Se analizaron dos grupos: uno con seguimiento presencial y otro vinculado a un programa educativo y uso de ClouDi. Resultados: De los 86 pacientes (44% de sexo femenino, 41 usuarios ClouDi, edad promedio 58.8 ± 11.2 años, con una media de duración de la diabetes de 7.8 ± 7.4 años), 53.6% se encontraban en estrato 2, el 92.9% pertenecían al régimen contributivo, el 42.9% con educación básica primaria y 51.2% empleados. Fue considerada la adherencia a la GC al realizar y registrar 3 o más mediciones por día en los pacientes de ClouDi fue mayor comparado con los pacientes en cuidado usual (64.4% vs 28.2%, p <0.001), independiente de las variables sociodemográficas. Conclusión: El uso de ClouDi se asoció a mayor adherencia a automonitoreo con GC comparado con seguimiento presencial independiente de variables sociodemográficas. El uso de esta tecnología podría ser útil en el seguimiento de pacientes usuarios de insulina al egreso hospitalario

Introduction: The use of mHealth can improve adherence to self-monitoring blood Glucose (SMBG) in the transition from hospital to outpatient setting. Objective: To evaluate adherence to self-monitoring with GC in patients with type 2 diabetes (T2DM) linked to an mHealth user education program (ClouDi) compared with the usual face-to-face education and follow-up program. Materials and Methods: Prospective longitudinal study. Patients with T2D assessed by diabetes education counseling with an indication for insulin treatment at hospital discharge were analyzed. Two groups were analyzed: one with face-to-face follow-up and another linked to an educational program and use of ClouDi. Results: Of the 86 patients (44% female, 41 ClouDi users, mean age 58.8 ± 11.2 years, with a mean duration of diabetes of 7.8 ± 7.4 years), 53.6% were in stratum 2, 92.9% belonged to the contributory system, 42.9% with basic pri-mary education and 51.2% were employed. Compliance with the SMBG was considered if 3 or more measurements per day were taken and recorded, was higher in ClouDi patients com-pared to usual care patients (64.4% vs. 28.2%, p <0.001), independent of sociodemographic variables.Conclusions: The use of ClouDi was associated with greater adherence to SMBG compared to in-person follow-up, independent of sociodemographic variables. The use of this technology may be useful in monitoring insulin-using patients after hospital discharge

Introdução: A utilização do mHealth pode melhorar a adesão à automonitorização com glico-metria capilar (GC) na transição do hospital para o ambulatório. Objetivo: avaliar a adesão ao automonitoramento com GC de pacientes com Diabetes Tipo 2 (DM2) vinculados a um progra-ma de educação de usuários de mHealth (ClouDi) em comparação com o programa habitual de educação e acompanhamento presencial. Materiais e métodos: Estudo prospectivo longitudi-nal. Foram analisados pacientes com DM2 avaliados por consulta de educação em diabetes com indicação de tratamento insulínico na alta hospitalar. Foram analisados dois grupos: um com acompanhamento presencial e outro vinculado a um programa educativo e uso do ClouDi. Re-sultados: Dos 86 doentes (44% do sexo feminino, 41 utilizadores do ClouDi, idade média 58,8 ± 11,2 anos, com duração média da diabetes de 7,8 ± 7,4 anos), 53,6% encontravam-se no estra-to 2, 92,9% pertenciam ao regime contributivo, 42,9% com ensino fundamental básico e 51,2% empregados. A adesão ao GC foi considerada quando realizada e registrada 3 ou mais medidas por dia em pacientes ClouDi foi maior em comparação aos pacientes em cuidados habituais (64,4% vs 28,2%, p <0,001), independente das variáveis sociodemográficas. Conclusão: O uso do ClouDi esteve associado à maior adesão ao automonitoramento com GC em comparação ao acompanhamento presencial independente das variáveis sociodemográficas. O uso dessa tecnologia pode ser útil no monitoramento de pacientes usuários de insulina na alta hospitalar

Situational diagnosis of policies in Latin American and Caribbean countries for the use of fluoride and reduction of sugar consumption.

Policy evaluation and guidance on fluoride use and sugar consumption in Latin American and Caribbean countries (LACC) may provide a scientific evidence basis for policymakers, dental professionals, civil society organizations and individuals committed to improving public oral health. A cross-sectional study was conducted to evaluate the extent of implementation of policies/guidelines on fluoride use, and sugar consumption in LACC. The study had two stages. First a questionnaire covering four major areas was developed: fluoridation of public water supplies; salt fluoridation; fluoride dentifrices, and sugar consumption. Then, the questionnaire was applied to collect data among representative participants in public oral health from LACC. Ninety-six participants from 18 LACC answered the questionnaire. One-hundred seventy documents were attached, and 285 links of websites were provided by the respondents. Implementation of policies and guidelines on water and table salt fluoridation and processed and ultra-processed food consumption were found in most countries, with some issues in the consensus and coverage. Thus, differences were identified in the extent of implementation of public oral health strategies on sugar consumption and fluoridation among the countries. There is no consensus on the policies in LACC to reduce sugar consumption and for the use of fluoride. A few policies and guidelines were applied in isolated countries, with a variety of strategies and standards. For future actions, it will be important to encourage the development of strategies and public policies within countries, and to evaluate the effectiveness of existing policies in reducing dental caries and in improving oral health in LACC.

Prácticas y creencias con el uso de plantas medicinales en lactantes de San Andrés Isla

Introducción: El uso de plantas medicinales es parte de la cultura tradicional de muchas poblaciones alrededor del mundo, se utilizan para prevenir enfermedades y preservar la salud de los individuos, siendo un conocimiento que conservan las madres y abuelas para el cuidado de la primera infancia. Sin embargo, existen muchos vacíos en la investigación con respecto al uso y propiedades de plantas medicinales en lactantes y población general. Objetivo: Analizar y describir las prácticas y creencias con el uso ancestral de plantas medicinales en lactantes de la comunidad raizal en San Andrés Isla. Materiales y métodos: Estudio cualitativo descriptivo etnográfico aplicado a una muestra por conveniencia de ocho abuelas de la comunidad Raizal de San Andrés Isla. Se realizó la descripción y el análisis de las ideas, prácticas sociales, comportamientos, creencias, significados y conocimientos en torno al uso de plantas medicinales en lactantes. Resultados: Aún se conservan los conocimientos ancestrales con el uso de plantas medicinales liderado por las abuelas. El uso de plantas medicinales en lactantes se rige únicamente por la necesidad de manejo de situaciones de salud. En esta investigación se encontraron 23 ejemplares de plantas medicinales de uso en lactantes, de estas son pocas las que se encuentran registradas en el vademécum colombiano de plantas medicinales. Discusión: Los hallazgos concuerdan con los resultados de otros estudios que evidencian la importancia de la tradición cultural en el cuidado de los lactantes, el protagonismo de la experiencia acumulada de las abuelas en estos saberes y prácticas; además de corroborar que el uso de plantas medicinales en lactantes se rige únicamente por la necesidad de cuidado ante situaciones de salud que lo ameritan. Solo dos ejemplares de las plantas medicinales clasificadas por las mujeres raizales de este estudio se encuentran referenciadas en el vademécum colombiano de plantas medicinales. Conclusiones: Las plantas medicinales abordan un amplio espectro de usos y propiedades que necesitan un extenso estudio para su registro y divulgación.

Introduction: The use of medicinal plants is part of the traditional culture of many populations around the world. Used to prevent diseases and preserve the health of individuals, it is a knowledge that mothers and grandmothers keep for early childhood care. However, there are many gaps in research regarding the use and properties of medicinal plants in infants and the general population. Objective: Analyze and describe the practices and beliefs with the ancestral use of medicinal plants in infants by the Raizal community in San Andrés Island. Materials and methods: It's a qualitative study with a descriptive ethnographic design applied to a convenience sample of 8 grandmothers from the Raizal community of San Andrés Island. We made out a description and analysis of the ideas, social practices, behaviors, beliefs, meanings, and knowledge about the uses of medicinal plants on infants. Results: The ancestral knowledge of medicinal plants use led by the grandmothers still persevered. The use of medicinal plants on infants administers only to the need of health situations. The investigation found 23 specimens of medicinal plants used in infant breastmilk, just a few plants found in this study are registered in the Colombian Vademecum of medicinal plants. Discussion: The findings agree with the results of other studies that show the importance of cultural traditions in the care of infants, the role of the accumulated experience of grandmothers in this knowledge and practices. In addition to corroborating that the use of medicinal plants in infants is governed solely by the need for care in health situations that warrant it. Only two specimens of the medicinal plants classified by the Raizal women in this study are referenced in the Colombian Vademecum of medicinal plants. Conclusion: Medicinal plants address a wide spectrum of uses and properties that need extensive study for their registration and dissemination.

Electrochemical conversion of CO2 using metal-organic framework catalysts.

Metal-organic frameworks (MOFs) have been an excellent platform for carbon dioxide reduction reactions (CO2RR). In this work, the feasibility of electrochemical reduction of CO2 to obtain C2-deep value-added products was investigated by the preparation of Mg-containing MOF-74 samples combined with transition metal cations (Ni2+, Co2+ and Zn2+). The prepared MOFs were used as electrocatalysts in CO2RR. Chronoamperometric analysis coupled to ATR-FTIR spectroscopy was employed to characterize the CO2 reduction products and subsequently via 1H NMR. Although an isostructural crystalline structure was observed in all synthesized MOFs, the pore diameter distribution was significantly affected due to the Mg coordination along with each transition metal nuclei with the organic ligand to form the MOF-74. Our results showed that Mg-containing MOF-74 electrocatalysts combined with Ni, Co and Zn ions successfully reduced CO2 to C2-deep products, while the monometallic Mg-MOF-74 showed only CO2 mineralization. An ester acetate, isopropyl alcohol, and formic acid were produced by Mg/Ni-MOF-74; isopropyl alcohol was provided by Mg/Co-MOF-74, and ethanol was generated by Mg/Zn-MOF-74. We observed that the change of the transition cation was a key factor in the selectivity of the obtained products, while the degree of Mg ions effectively incorporated into the MOF structure tuned the porosity and the electrocatalytic activity. Among them, Mg/Zn-MFOF-74 showed the highest Mg content loaded after synthesis and thus the most favorable electrocatalytic behavior towards CO2 reduction.

Situational diagnosis of policies in Latin American and Caribbean countries for the use of fluoride and reduction of sugar consumption

Abstract Policy evaluation and guidance on fluoride use and sugar consumption in Latin American and Caribbean countries (LACC) may provide a scientific evidence basis for policymakers, dental professionals, civil society organizations and individuals committed to improving public oral health. A cross-sectional study was conducted to evaluate the extent of implementation of policies/guidelines on fluoride use, and sugar consumption in LACC. The study had two stages. First a questionnaire covering four major areas was developed: fluoridation of public water supplies; salt fluoridation; fluoride dentifrices, and sugar consumption. Then, the questionnaire was applied to collect data among representative participants in public oral health from LACC. Ninety-six participants from 18 LACC answered the questionnaire. One-hundred seventy documents were attached, and 285 links of websites were provided by the respondents. Implementation of policies and guidelines on water and table salt fluoridation and processed and ultra-processed food consumption were found in most countries, with some issues in the consensus and coverage. Thus, differences were identified in the extent of implementation of public oral health strategies on sugar consumption and fluoridation among the countries. There is no consensus on the policies in LACC to reduce sugar consumption and for the use of fluoride. A few policies and guidelines were applied in isolated countries, with a variety of strategies and standards. For future actions, it will be important to encourage the development of strategies and public policies within countries, and to evaluate the effectiveness of existing policies in reducing dental caries and in improving oral health in LACC.

Prácticas y saberes de excombatientes de las FARC-EP sobre el tratamiento de la leishmaniasis cutánea / Practices and knowledge of ex-combatents of the FARC-EP on the treatment of cutaneous leishmaniasis

RESUMEN Introducción: La Leishmaniasis es una enfermedad infecciosa parasitaria zoonótica que afecta la piel, las mucosas y las vísceras. Es endémica en 98 países y hay más de 350 millones de personas en riesgo de transmisión. En Colombia, los campamentos de las antiguas Fuerzas Armadas Revolucionarias de Colombia, se ubicaban en zonas selváticas donde la enfermedad está presente. El objetivo del presente trabajo está dirigido a describir las prácticas y saberes de los excombatientes de las FARC-EP sobre la Leishmaniasis cutánea y su manejo en escenarios de combate al convivir con esta enfermedad. Métodos: El estudio es cualitativo/exploratorio, donde se abordaron los conocimientos sobre la enfermedad y su forma de transmisión, como también aquellas prácticas relacionadas con el uso de medicamentos para su tratamiento. Resultados: En el análisis de las entrevistas se encontró que los excombatientes conocen el ciclo de la enfermedad desde sus vivencias y por transmisión oral, como también de prácticas curativas propias adaptadas al contexto del conflicto armado, esta experiencia los llevó a desarrollar estrategias de gestión del conocimiento basado en la evidencia. Discusión: Las entrevistas dan cuenta del conocimiento empírico y clínico de los excombatientes sobre el ciclo de la enfermedad; no existe un registro documental, ni manuales de procedimientos realizados en la selva por las FARC-EP sobre tratamiento de enfermedades; los miembros de las FARC-EP a desarrollar estrategias de gestión del conocimiento basados en la evidencia; el contexto de conflicto afectó de manera importante el tiempo y los recursos técnicos para manejar la Leishmaniasis, esto posibilitó las respuestas alternativas a la enfermedad documentadas en este trabajo.

ABSTRACT Introduction: Leishmaniasis is a zoonotic parasitic infectious disease that affects the skin, mucous membranes and viscera. It is endemic in 98 countries and there are more than 350 million people at risk of transmission. In Colombia, the camps of the former Revolutionary Armed Forces of Colombia were located in jungle areas where the disease is present. The objective of this work is aimed at describing the practices and knowledge of ex-combatants of the FARC-EP about cutaneous Leishmaniasis and its management in combat scenarios when living with this disease. Methods: The study is qualitative/exploratory, where knowledge about the disease and its form of transmission were addressed, as well as those practices related to the use of medications for its treatment. Results: In the analysis of the interviews it was found that the ex-combatants know the cycle of the disease from their experiences and by oral transmission, as well as their own healing practices adapted to the context of the armed conflict, this experience led them to develop knowledge management strategies based on the evidence. Discussion: The interviews give an account of the empirical and clinical knowledge of the ex-combatants about the cycle of the disease; There is no documentary record, nor manuals of procedures carried out in the jungle by the FARC-EP on the treatment of diseases; the members of the FARC-EP to develop evidence-based knowledge management strategies; the context of conflict significantly affected the time and technical resources to manage Leishmaniasis, this made possible the alternative responses to the disease documented in this work.

Mutational spectra distinguish SARS-CoV-2 replication niches

Exposure to different mutagens leaves distinct mutational patterns that can allow prediction of pathogen replication niches (Ruis 2022). We therefore hypothesised that analysis of SARS-CoV-2 mutational spectra might show lineage-specific differences, dependant on the dominant site(s) of replication and onwards transmission, and could therefore rapidly infer virulence of emergent variants of concern (VOC; Konings 2021). Through mutational spectrum analysis, we found a significant reduction in G>T mutations in Omicron, which replicates in the upper respiratory tract (URT), compared to other lineages, which replicate in both upper and lower respiratory tracts (LRT). Mutational analysis of other viruses and bacteria indicates a robust, generalisable association of high G>T mutations with replication within the LRT. Monitoring G>T mutation rates over time, we found early separation of Omicron from Beta, Gamma and Delta, while the mutational burden in Alpha varied consistent with changes in transmission source as social restrictions were lifted. This supports the use of mutational spectra to infer niches of established and emergent pathogens.

Extended biofilm formation time by Streptococcus sanguinis modifies its non-cariogenic behavior, in vitro.

Although the commensal Streptococcus sanguinis [ S. sanguinis] is isolated from caries-free people, it can ferment carbohydrates producing acids. We aimed to characterize S. sanguinis cariogenic potential as a function of different enamel biofilm formation periods, in vitro. Saliva-coated enamel slabs were inoculated with S. sanguinis to form initial biofilms for 8, 12 or 16 h in presence of sucrose and followed by a period in medium with glucose for 16, 12 or 8 h, respectively, until completion of 24 h. To simulate cariogenic challenges, S. sanguinis biofilms were exposed to 10% sucrose for 5 minutes, 3x/day for 5 days. Biofilm biomass, viable cells, total proteins, intracellular and extracellular polysaccharides production, acidogenicity and enamel demineralization were determined. Biofilms of Streptococcus mutans [ S. mutans ] served as caries-positive control. Biofilms of S. sanguinis forming on enamel for 12 and 16 h showed higher demineralization than those formed during 8 h, but lower than S. mutans biofilms, regardless of the initial biofilm formation time. No differences were detected in the biofilm properties among the different biofilm formation times tested for S. sanguinis . Increased enamel initial biofilm formation time by S. sanguinis appears to induce a cariogenic potential, but lower than S. mutans .

Seminarios autogestionados de psiquiatría como modelo de participación estudiantil activa en pregrado. Experiencia 2014-2021 en la Pontificia Universidad Católica de Chile / Self-managed psychiatry seminars as a model of active student participation in undergraduate education

In the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.

The ABCDE psychological first aid intervention decreases early PTSD symptoms but does not prevent it: results of a randomized-controlled trial.

BACKGROUND: Early Psychological First Aid (PFA) has been widely recommended for preventing posttraumatic stress disorder (PTSD). However, its lack of empirical evidence of safety and effectiveness has been criticized. OBJECTIVES: To assess the effectiveness of PFA-ABCDE, an original PFA protocol, for preventing PTSD one month after the intervention and decreasing PTSD symptoms at one and six months of follow up. METHODS: We assessed the eligibility of 1,140 adult survivors of recent trauma (≤ 72 hours) consulting five emergency departments in Chile. Two hundred twenty-one were randomized to receive either PFA-ABCDE (active listening, breathing retraining, categorization of needs, referral to ancillary services, and psychoeducation) or only psychoeducation. We used the Composite International Diagnostic Interview (CIDI) to assess PTSD diagnosis. The Posttraumatic Checklist (PCL), the Beck Depression Inventory-II (BDI-II), and a 0-10 points analogue visual scale were used to assess PTSD symptoms, depressive symptoms, and immediate distress relief after the intervention. RESULTS: We found no difference between the experimental and control groups in the frequency of PTSD one month after the intervention (PFA-ABCDE = 23/76 [30.3%], psychoeducation = 18/75 [24.0%], adjusted odds ratio = 1.39, 95% confidence interval = 0.63-3.07, p = .408). Immediately after the intervention, participants who received PFA-ABCDE reported greater distress relief (PFA-ABCDE mean = 9.06, psychoeducation mean = 8.55, Cohen's d = 0.30, p = .038). Fewer PTSD symptoms were reported by those who received PFA-ABCDE one month after the intervention (PFA-ABCDE mean = 36.26, psychoeducation mean = 43.62, Cohen's d = 0.42, p = .033). We found no difference in depressive symptoms at one-month follow up (p = .713) nor in PTSD symptoms six months after the intervention (p = .986). CONCLUSIONS: PFA-ABCDE does not prevent PTSD diagnosis, but it provides immediate distress relief and decreases PTSD symptoms in the short term.

Antecedentes: Los Primeros Auxilios Psicológicos (PAP) han sido recomendados para prevenir el Trastorno de Estrés Postraumático (TEPT) en supervivientes de trauma. A pesar de su popularidad, la escasez de evidencia empírica sobre su seguridad y efectividad ha sido criticada.Objetivos: Evaluar la efectividad de los PAP-ABCDE, un protocolo original de PAP, para prevenir el TEPT al mes de seguimiento y disminuir los síntomas de TEPT luego de uno y seis meses de seguimiento.Métodos: Evaluamos elegibilidad de 1.140 adultos supervivientes de trauma reciente (≤ 72 horas) que consultaron cinco servicios de urgencia en Chile. Doscientos veintiún fueron aleatorizados a recibir PAP-ABCDE (escucha activa, reentrenamiento de la respiración, categorización de necesidades, derivación a redes de apoyo, y psicoeducación) o sólo psicoeducación. Utilizamos la Composite International Diagnostic Interview (CIDI) para evaluar el diagnóstico de TEPT. La Posttraumatic Checklist (PCL), la Beck Depression Inventory-II (BDI-II), y una escala visual análoga de 0-10 puntos fueron utilizadas para evaluar síntomas de TEPT, síntomas depresivos, y alivio inmediato de distrés luego de la intervención.Resultados: No encontramos diferencia entre el grupo experimental y el grupo control en la frecuencia de TEPT un mes después de la intervención (PAP-ABCDE = 23/76 [30,3%], psicoeducación = 18/75 [24,0%], odds ratio ajustado = 1,39, intervalo de confianza 95% = 0,63-3,07, p = ,408). Inmediatamente después de la intervención los participantes que recibieron PAP-ABCDE reportaron un mayor alivio de distrés (media en PAP = 9,06, media en psicoeducación = 8,55, d de Cohen = 0,30, p = ,038). Menos síntomas de TEPT fueron reportados un mes después de la intervención por aquellos que recibieron PAP-ABCDE (media de PAP-ABCDE = 36,26, media de psicoeducación = 43,62, d de Cohen = 0,42, p = ,033). No encontramos diferencias en síntomas depresivos al mes de seguimiento (p = ,713) ni en síntomas de TEPT seis meses después de la intervención (p = ,986).Conclusiones: Los PAP-ABCDE no previenen el diagnóstico de TEPT, pero brindan alivio inmediato del distrés y disminuyen la severidad de los síntomas del TEPT en el corto plazo.

Developing a protocol for a preventive oral health exam for elderly people (EDePAM) using E-Delphi methodology.

The aim of this study was to develop a Preventive Oral Health Exam for Elderly People (EDePAM), using the e-Delphi technique, to diagnose oral health problems in people 65 or older. The e-Delphi technique was used with experts in multiple stages, and in a final workshop, where an agreement on an examination protocol was reached for diagnosing dental caries, oral mucosa lesions, periodontal diseases, and masticatory function disorders. Quantitative analyses of all the rounds of the e-Delphi method were conducted. It was agreed that the International Caries Detection and Assessment System (ICDAS) should be used together with a modified version of the Nyvad criteria to detect and assess caries lesions. It was also agreed that an assessment was needed of the different factors involved in determining caries risk, namely socioeconomic level, access to fluoride, level of dependence/functionality, salivary flow, history of head and neck cancer treatment, use of medications that decrease salivary flow, diet, use of removable dental prostheses, exposure of root surfaces, and caries history. Furthermore, patients would be required to undergo an examination of the oral mucosa, where any existing lesion should be described in terms of its clinical appearance, location, and risk potential. It was also agreed that an assessment of masticatory function should be performed using the Leake index, together with chewing-gum combined with a color scale to categorize masticatory performance. The number of pairs of occluding antagonist teeth was considered as the best predictor of masticatory function. The 2018 classification by the American Academy of Periodontology (AAP) / European Federation of Periodontology (EFP) was accepted as the standard to assess periodontal status, and it was agreed that this assessment should include an evaluation of clinical attachment loss and bleeding on probing. The novel EDePAM was considered as appropriate for conducting a functional assessment of oral health by providing a comprehensive diagnosis of oral diseases.

[Self-managed psychiatry seminars as a model of active student participation in undergraduate education]. / Seminarios autogestionados de psiquiatría como modelo de participación estudiantil activa en pregrado. Experiencia 2014-2021 en la Pontificia Universidad Católica de Chile.

In the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.

Obstáculos para ser deportista de alto rendimiento en Chile / Obstáculos para ser esportista de alto rendimento no Chile / Obstacles to be a high-performance athlete in Chile

La masificación de los deportes ha hecho visible la interacción de varias dimensiones del rendimiento que favorecen o dificultan el desarrollo de un deportista de alto rendimiento. Algunas de estas dimensiones son el contexto social/cultural en el que viven los deportistas, la influencia de las políticas públicas en el desarrollo a largo plazo de las carreras deportivas, el entorno familiar, de amigos y entrenadores, así como también aspectos nutricionales y psicológicos. Este estudio de tipo cualitativo busca comprender desde la voz de los y las deportistas cuáles son los aspectos considerados como obstaculizadores para el alto rendimiento en Chile. Los resultados demuestran que son obstaculizadores la falta de apoyo, la carrera dual, implementación para entrenar y discriminación de género. Se concluye proponiendo nuevos horizontes para las políticas públicas en el marco del apoyo a deportistas que se hagan cargo de resolver estos obstaculizadores. (AU)

A massificação do esporte tornou visível a interação de várias dimensões do desempenho que favorecem ou dificultam o desenvolvimento de um atleta de alto rendimento. Algumas delas são o contexto sociocultural em que os atletas vivem, a influência das políticas públicas no desenvolvimento a longo prazo da carreira esportiva, o ambiente familiar, amigos, treinadores, além de aspectos nutricionais e psicológicos. Este estudo qualitativo busca compreender a partir da voz dos atletas quais são os aspectos considerados como obstáculos ao alto rendimento no Chile. Os resultados mostram que os obstáculos são a falta de apoio, dupla carreira, implementação de formação e discriminação de gênero. Conclui propondo novos horizontes para as políticas públicas no âmbito do apoio aos atletas que se encarregam de resolver esses obstáculos. (AU)

The massification of sports has made visible the interaction of various dimensions of performance that favor or hinder the development of high-performance athletes. Some of these are the social and cultural context in which athletes live, the influence of public policies on the long-term development of sports careers, the family environment, friends, coaches, as well as nutritional and psychological aspects. This qualitative study seeks to understand from the voice of athletes what are the aspects considered as obstacles to high performance in Chile. The results show that the obstacles are the lack of support, dual career, implementation to train and gender discrimination. It concludes by proposing new horizons for public policies in the framework of supporting athletes who take charge of solving these obstacles. (AU)

Developing a protocol for a preventive oral health exam for elderly people (EDePAM) using E-Delphi methodology

Abstract The aim of this study was to develop a Preventive Oral Health Exam for Elderly People (EDePAM), using the e-Delphi technique, to diagnose oral health problems in people 65 or older. The e-Delphi technique was used with experts in multiple stages, and in a final workshop, where an agreement on an examination protocol was reached for diagnosing dental caries, oral mucosa lesions, periodontal diseases, and masticatory function disorders. Quantitative analyses of all the rounds of the e-Delphi method were conducted. It was agreed that the International Caries Detection and Assessment System (ICDAS) should be used together with a modified version of the Nyvad criteria to detect and assess caries lesions. It was also agreed that an assessment was needed of the different factors involved in determining caries risk, namely socioeconomic level, access to fluoride, level of dependence/functionality, salivary flow, history of head and neck cancer treatment, use of medications that decrease salivary flow, diet, use of removable dental prostheses, exposure of root surfaces, and caries history. Furthermore, patients would be required to undergo an examination of the oral mucosa, where any existing lesion should be described in terms of its clinical appearance, location, and risk potential. It was also agreed that an assessment of masticatory function should be performed using the Leake index, together with chewing-gum combined with a color scale to categorize masticatory performance. The number of pairs of occluding antagonist teeth was considered as the best predictor of masticatory function. The 2018 classification by the American Academy of Periodontology (AAP) / European Federation of Periodontology (EFP) was accepted as the standard to assess periodontal status, and it was agreed that this assessment should include an evaluation of clinical attachment loss and bleeding on probing. The novel EDePAM was considered as appropriate for conducting a functional assessment of oral health by providing a comprehensive diagnosis of oral diseases.

Extended biofilm formation time by Streptococcus sanguinis modifies its non-cariogenic behavior, in vitro

Abstract Although the commensal Streptococcus sanguinis [ S. sanguinis] is isolated from caries-free people, it can ferment carbohydrates producing acids. We aimed to characterize S. sanguinis cariogenic potential as a function of different enamel biofilm formation periods, in vitro. Saliva-coated enamel slabs were inoculated with S. sanguinis to form initial biofilms for 8, 12 or 16 h in presence of sucrose and followed by a period in medium with glucose for 16, 12 or 8 h, respectively, until completion of 24 h. To simulate cariogenic challenges, S. sanguinis biofilms were exposed to 10% sucrose for 5 minutes, 3x/day for 5 days. Biofilm biomass, viable cells, total proteins, intracellular and extracellular polysaccharides production, acidogenicity and enamel demineralization were determined. Biofilms of Streptococcus mutans [ S. mutans ] served as caries-positive control. Biofilms of S. sanguinis forming on enamel for 12 and 16 h showed higher demineralization than those formed during 8 h, but lower than S. mutans biofilms, regardless of the initial biofilm formation time. No differences were detected in the biofilm properties among the different biofilm formation times tested for S. sanguinis . Increased enamel initial biofilm formation time by S. sanguinis appears to induce a cariogenic potential, but lower than S. mutans .

Fluoride bioavailability on demineralized enamel by commercial mouth rinses.

The ability of mouth rinses, available in the international market, to form reaction products on demineralized enamel (bioavailability test) was evaluated in vitro. Nine mouth rinses purchased in Chile were evaluated; eight formulated with NaF (one containing 100 µg F/mL and seven containing 226) and one with Na2FPO3 (226 µg F/mL as ion F). Demineralized enamel slabs (n=15 per mouth rinse) were sectioned; one half was subjected to the assigned mouth rinse treatment for 10 min and the other half was used to obtain baseline data. Loosely bound and firmly bound fluoride formed on enamel were determined with an ion-specific electrode and the values were expressed in µg F/cm2. The concentration of fluoride and the pH of the mouth rinses were previously determined. Concentrations of loosely bound and firmly bound fluoride formed on enamel were independently analyzed by ANOVA and Tukey's test (α=5%). The loosely bound and firmly bound fluoride concentrations (µg F/cm2) formed ranged from 3.2 to 36.2 and 0.4 to 1.7, respectively. Loosely bound fluoride formed on enamel was significantly more effective in discriminating the effect of different commercial mouth rinses than firmly bound fluoride. Mouth rinses with 226 ppm F as NaF and low pH presented significantly greater bioavailability of fluoride on enamel than those with higher pH or lower NaF concentration. The mouth rinse with Na2FPO3 showed low reactivity. Although further studies are necessary, the findings showed that commercial fluoride-containing mouth rinses have important variations in enamel fluoride bioavailability, which may result in differences on anticaries efficacy.

Fluoride bioavailability on demineralized enamel by commercial mouthrinses.

The ability of mouthrinses, available in the international market, to form reaction products on demineralized enamel (bioavailability test) was evaluated in vitro. Nine mouthrinses purchased in Chile were evaluated; eight formulated with NaF (one containing 100 µg F/mL and seven containing 226) and one with Na2FPO3 (226 µg F/mL as ion FPO3 ). Demineralized enamel slabs (n=15 per mouthrinse) were sectioned; one half was subjected to the assigned mouthrinse treatment for 10 min and the other half was used to obtain baseline data. Loosely bound and firmly bound fluoride formed on enamel were determined with an ion-specific electrode and the values were expressed in µg F/cm2. The concentration of fluoride and the pH of the mouthrinses were previously determined. Concentrations of loosely bound and firmly bound fluoride formed on enamel were independently analyzed by ANOVA and Tukey's test (α=5%). The loosely bound and firmly bound fluoride concentrations formed ranged from 3.2 to 36.2 and 0.4 to 1.7, respectively. Loosely bound fluoride formed on enamel was significantly more effective in discriminating the effect of different commercial mouthrinses than firmly bound fluoride. Mouthrinses with 226 ppm F as NaF and low pH presented significantly greater bioavailability of fluoride on enamel than those with higher pH or lower NaF concentration. The mouthrinse with Na2FPO3 showed low reactivity. Although further studies are necessary, the findings showed that commercial fluoride-containing mouthrinses have important variations in enamel fluoride bioavailability, which may result in differences on anticaries efficacy.

[Comparison of different methods to estimate glomerular filtration rate in older adults]. / ¿Son equivalentes los diferentes métodos para estimar la función renal en los adultos mayores?

BACKGROUND: Glomerular filtration rate (GFR) estimation in older adults using a creatinine clearance/24-hour (CrCl) or an equation based on serum creatinine, are often considered equivalent by clinicians. AIM: To compare GFR estimated (eGFR) with the available equations and measured CrCl in patients ≥ 70 years. A secondary aim was to know the differences in chronic kidney disease (CKD) classification, when using the different eGFR formulas. PATIENTS AND METHODS: In 144 patients aged 77 ± 5 years (58% men), CrCl was measured and GFR was estimated using MDRD, CKD-EPI, BIS-1 and FAS formulas. The eGFR and the stage of CKD were compared according to the different equations used. RESULTS: GFR estimated by MDRD and CKD-EPI equations was 7.8 and 8.4 mL/min/1.73 m2 lower than 24-hour ClCr, respectively. This difference was even greater using the BIS-1 and FAS equations. Twenty-four-hour CrCl classified 47.2% of the patients in a category of renal function > 60 mL/min/1.73 m2, while MDRD and CKD-EPI equations classified just over a third, and BIS-1 and FAS formulas around 20% of the patients. CONCLUSIONS: The practice of considering equivalent the GFR estimation using the creatinine-based equations with measured creatinine clearance in older adults should be reconsidered, because their results differ markedly.