New insights into the pathogenesis of SARS-CoV-2 during and after the COVID-19 pandemic.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the respiratory distress condition known as COVID-19. This disease broadly affects several physiological systems, including the gastrointestinal, renal, and central nervous (CNS) systems, significantly influencing the patient's overall quality of life. Additionally, numerous risk factors have been suggested, including gender, body weight, age, metabolic status, renal health, preexisting cardiomyopathies, and inflammatory conditions. Despite advances in understanding the genome and pathophysiological ramifications of COVID-19, its precise origins remain elusive. SARS-CoV-2 interacts with a receptor-binding domain within angiotensin-converting enzyme 2 (ACE2). This receptor is expressed in various organs of different species, including humans, with different abundance. Although COVID-19 has multiorgan manifestations, the main pathologies occur in the lung, including pulmonary fibrosis, respiratory failure, pulmonary embolism, and secondary bacterial pneumonia. In the post-COVID-19 period, different sequelae may occur, which may have various causes, including the direct action of the virus, alteration of the immune response, and metabolic alterations during infection, among others. Recognizing the serious adverse health effects associated with COVID-19, it becomes imperative to comprehensively elucidate and discuss the existing evidence surrounding this viral infection, including those related to the pathophysiological effects of the disease and the subsequent consequences. This review aims to contribute to a comprehensive understanding of the impact of COVID-19 and its long-term effects on human health.

In experts' words: Translating theory to practice for teaching self-regulated learning.

INTRODUCTION: Health professions education (HPE) should help students to competently self-regulate their learning, preparing them for future challenges. This study explored the perspectives of expert self-regulated learning (SRL) researchers and practitioners on the practical integration of SRL theories into teaching. METHODS: An exploratory qualitative research study was conducted involving semi-structured interviews with acknowledged research leaders in the field of SRL and/or experienced professionals dedicated to teaching SRL strategies for complex skills in different disciplines. The data were analyzed using an iterative thematic approach guided by a six-step framework. RESULTS: Fifteen interviews were conducted with experts from six countries representing diverse contexts, cultures, and disciplines. We identified five themes related to translating theory to practice for teaching SRL in HPE: theoretical issues, cultural aspects, stakeholders' participation, teaching complexity, assessment, and feedback. CONCLUSIONS: This study presents a useful starting point for teaching SRL. The experts suggest a supportive learning environment with the guidance of competent teachers by using general and task-specific teaching and learning strategies, as well as sufficient sources and cycles of feedback, all tailored to the culture and context. These findings call for a shift in faculty development programs to foster teachers to support second-order scaffolding in HPE.

Identificación de contenidos de pertinencia intercultural para la atención de salud para el plan de estudios de odontología

Introducción: La diversidad cultural en Chile y las inequidades en el acceso y calidad de la atención requiere del desarrollo de competencias culturales en los profesionales de la salud debido a las inequidades en el acceso y calidad de la atención. A nivel internacional, se ha integrado la competencia cultural en los planes de estudio de las carreras de salud, pero en Chile está en sus etapas iniciales. Métodos: Se utilizó una metodología mixta que incluyó: revisión documental (búsquedas y análisis en bases de datos y documentos oficiales), entrevistas a informantes clave y consenso de expertos. Las entrevistas se transcribieron textuales y se realizó un análisis temático utilizando el software ATLAS.ti. Resultados: La revisión documental identificó dominios, objetivos e instrumentos utilizados para medir la competencia cultural en odontología. Las entrevistas revelaron cuatro categorías principales: concepciones de salud, facilitadores y barreras, y características de los profesionales de la salud. Se elaboró un listado de contenidos y resultados de aprendizaje, evaluados y consensuados por expertos. Conclusiones: La inclusión de la competencia cultural en los planes de estudio de odontología es esencial para una atención de salud más inclusiva y culturalmente segura. Se recomienda su integración longitudinal en diversos cursos, empleando metodologías efectivas de enseñanza y evaluación. Los resultados de este estudio ofrecen una guía para identificar los conocimientos, habilidades y actitudes necesarios para formar a los profesionales de salud que finalmente deben entregar una apropiada atención de salud con pertinencia intercultural.

Introduction: Cultural diversity in Chile and inequities in access and quality of care require the development of cultural competencies in health professionals. Internationally, cultural competence has been integrated into the curricula of health professional programs; however, in Chile it is still in its early stages. Methods: A mixed methodology included documentary review (searches and analysis in databases and official documents), key informant interviews and expert consensus. The interviews were transcribed verbatim, and thematic analysis was carried out using ATLAS.ti software. Results: The documentary review identified domains, objectives and instruments used to measure cultural competence in dentistry. The interviews revealed four main categories: conceptions of health, facilitators and barriers, and characteristics of health professionals. Experts developed, evaluated and agreed upon content and learning outcomes. Conclusion: Including cultural competence in dental curricula is essential for more inclusive and culturally safe health care. Its longitudinal integration into various courses, employing effective teaching and assessment methodologies, is recommended. The results of this study provide a guide to identifying the knowledge, skills, and attitudes needed to train health professionals who ultimately deliver appropriate health care with cultural pertinence.

[Intercultural Competences in Chilean Dental Education for Inclusive Healthcare]. / Identificación de contenidos de pertinencia intercultural para la atención de salud para el plan de estudios de odontología.

INTRODUCTION: Cultural diversity in Chile and inequities in access and quality of care require the development of cultural competencies in health professionals. Internationally, cultural competence has been integrated into the curricula of health professional programs; however, in Chile it is still in its early stages. METHODS: A mixed methodology included documentary review (searches and analysis in databases and official documents), key informant interviews and expert consensus. The interviews were transcribed verbatim, and thematic analysis was carried out using ATLAS.ti software. RESULTS: The documentary review identified domains, objectives and instruments used to measure cultural competence in dentistry. The interviews revealed four main categories: conceptions of health, facilitators and barriers, and characteristics of health professionals. Experts developed, evaluated and agreed upon content and learning outcomes. CONCLUSION: Including cultural competence in dental curricula is essential for more inclusive and culturally safe health care. Its longitudinal integration into various courses, employing effective teaching and assessment methodologies, is recommended. The results of this study provide a guide to identifying the knowledge, skills, and attitudes needed to train health professionals who ultimately deliver appropriate health care with cultural pertinence.

Transición entre Cursos Preclínicos y Clínicos de Odon tología: Análisis de las Dificultades y Recomendaciones

RESUMEN: La formación de cirujano dentista requiere de la integración de conocimientos y habilidades. Tradicionalmente el plan de estudio de la carrera se divide en un ciclo de ciencias básicas, un ciclo preclínico y un ciclo clínico. Se ha reportado que los alumnos de odontología presentan dificultad al iniciar el ciclo clínico, observándose altos niveles de ansiedad y depresión. El objetivo de esta investigación es recopilar información sobre las dificultades que presentan los alumnos de odontología UC en la transición de los cursos preclínicos a los cursos clínicos para identificar mejoras tendientes a facilitarla. Investigación cualitativa, en la que se realizaron 4 focus gropus a alumnos entre tercero y sexto año de la carrera de odontología UC. Los focus group fueron audio grabados y se realizó un análisis de contenido de sus transcripciones, utilizado el software Atlas Ti. Luego del análisis de contenido de las transcripciones de los focus groups se identificaro n tres unidades temáticas: características de la carrea, desafíos de la actividad clínica y mecanismos de afrontamiento. Los resultados de esta investigación sugieren que existen dificultades para la transición de los cursos preclínicos a los cursos clínicos, las que se relacionan con características propias de la carrera (exigente, con alta dedicación de tiempo y que requiere de capacidad de organización) y de la actividad clínica (presión por cumplir los requisitos clínicos y la importancia del desarrollo de habilidades no técnicas). Los estudiantes relataron diferentes mecanismos de afrontamiento para estas dificultades (ayuda psicológica, la medicación, la reducción de carga académica y el costear los tratamientos de los pacientes).

ABSTRACT: Education for dentists requires the integration of knowledge and skills. Traditionally, the dental curriculum is divided into a basic science cycle, a preclinical cycle and a clinical cycle. It has been reported that dental students have difficulty starting the clinical cycle, with high levels of anxiety and depression. The aim of this study is to gather information on the difficulties that dental students have in the transition from preclinical to clinical courses in order to identify improvements to facilitate it. Qualitative research, in which 4 focus groups were carried out with students between the third and sixth year of the dental school. The focus groups were audio recorded and a content analysis of their transcriptions was carried out using Atlas Ti software. After the content analysis of the transcripts of the focus groups, three thematic units were identified: characteristics of the program, challenges of clinical activity and coping mechanisms. The results of this research suggest that there are difficulties in the transition from preclinical to clinical courses, which are related to the characteristics of the program (highly demanding, with high time dedication and requiring organizational skills) and clinical activity (pressure to meet clinical requirements and the importance of developing non-technical skills). The students reported different coping mechanisms for these difficulties (psychological help, medication, reduction of academic load and paying for patients' treatments).

The best mirror of the students' longitudinal performance: Portfolio or structured oral exam assessment at clerkship?

OBJECTIVE: This study aimed to compare the strength of association (i.e., explained variability) of the cumulative grade point average (GPA) with the grades obtained in the clerkship portfolio and the final structured oral exam by dental students. METHODS: A prospective longitudinal study was designed to analyze quantitative data from three cohorts of dental school students. Univariate and multivariate linear regression models were built to evaluate the association between the students' cumulative GPA with the grades obtained in their clerkship portfolio and the final structured oral exam. RESULTS: In total, 171 students in the last year of the undergraduate program were considered (76% women, age average 24.8 ± 1.6 years). The dental students' grades of both portfolio and structured oral exam were significantly associated with the GPA score but with different strengths of association. The clerkship portfolio was more strongly associated with cumulative GPA than the structured oral exam (R2  = 19.6% versus R2  = 7.6%). On the opposite, the association between the structured oral exam and GPA can be interpreted as a lower precision in its practical significance and thus reflecting different concurrent validity. CONCLUSIONS: Considering the results of this study, it could probably incline the balance toward the portfolio because it may be closer to a programmatic assessment model, with timely feedback, development of metacognition, and the achievement of formative process measurement rather than evidence of a single instance of examination.

Análisis descriptivo del concurso de ingreso al ciclo de destinación y formación de cirujanos dentistas entre los años 2009 y 2018 / Descriptive analysis of the admission process to the destination and training cycle of dental surgeons between 2009 and 2018

RESUMEN: Introducción. Desde 1955 existe en Chile una estrategia de recursos humanos destinada a llevar profesionales de la salud a zonas rurales o de difícil acceso, denominada ciclo de destinación y formación (ex generales de zona). Existe poca información sobre las características de los postulantes a él. Esta investigación tiene como objetivo describir las postulaciones para el ingreso al ciclo entre los años 2009 al 2018. Metodología: Se obtuvieron los datos del ciclo desde la web del Ministerio de Salud, los que fueron completados con datos de la Superintendencia de Salud y web del Ministerio de Educación. Los datos se analizaron utilizando el software SPSS. Resultados: Se analizaron 10 concursos de ingreso al ciclo con un total de 1.689 postulantes, que representan 13,8% de cirujanos dentistas recién titulados entre años 2009-2018. El 60% de los postulantes son mujeres, pero las postulaciones de hombres son más efectivas (p=0,038). 5 universidades concentran 63% de las postulaciones y el 86% de las plazas (p<0,001). El offset se ha mantenido constante. Discusión: Existe poca investigación del tema y resulta de interés analizar las diferencias entre la efectividad de las postulaciones según sexo y universidad de origen, así como las motivaciones para postular.

ABSTRACT: Introduction. Since 1955, a human resources strategy has existed in Chile aiming to insert health professionals into rural or difficult-to-reach areas, called the EDF destination and training cycle (formerly, zone generals). There is little information regarding recent graduates entering this cycle and the factors conditioning their application. Therefore, this study aims to describe the cohorts that entered the EDF cycle between 2009 and 2018. Methodology: Data from the EDF application processes were obtained from the website of the Ministry of Health and completed with the records from the Superintendence of Health. Information on the total number of graduates from each Chilean university was obtained from the Ministry of Education website. The data were analyzed using the SPSS IBM Statistic v24 software. Results: Ten application processes for entering the EDF cycle were analyzed, encompassing a total of 1,689 applicants, representing 13.8% of the newly registered dental surgeons between 2009-2018. Even though 60% of the applicants are female, the applications from men are more effective (p=0,038). Five universities concentrate 63% of the applications and 86% of the places (p <0.001). The offset has remained constant. Discussion: There is little research on this subject and it would be interesting to analyze the reasons behind the differences between the effectiveness of the applications according to sex and university of origin, as well as the motivations of the applicants to apply.

Adaptation, psychometric properties, and implementation of the Mini-CEX in dental clerkship.

BACKGROUND: Workplace-based assessment is a key component of dental-student clerkships, allowing students to demonstrate clinical proficiency. PURPOSE: This study adapts the Mini-Clinical Evaluation Exercise (Mini-CEX) to a dentistry-program clerkship, analyzing the results and examining the psychometric properties of Mini-CEX. METHODS: First, Delphi panel methodology was used to ensure content validity. Mini-CEX was then piloted in the dental-clerkship program, with each student assessed by at least 2 supervisors and a peer student. Subsequently, psychometric properties, acceptability, and observation time were analyzed. RESULTS: The study was conducted between July and November 2019. Overall, 140 Mini-CEX evaluation exercises were carried out on 30 students by 84 supervisors and 56 peers. The adapted instrument was found to be unidimensional, obtaining an acceptable internal consistency (α = 0.74). As the assessor type changed, there were differences in observation time; the medians (Q1-Q3) were 10 minutes (5-15) for supervisors and 30 minutes (20-45) for peer students (P < 0.001). This difference was also observed in assessor perceptions (P < 0.001), with supervisors scoring a median of 6 (6-6.75) and peer students scoring a median of 7 (6-7). No differences were found between supervisor and peer scores. CONCLUSION: The adapted version of Mini-CEX can objectively assess the clinical performance of dental students, achieving validity and reliability values similar to those obtained in the original instrument.

Autoinstrucción para la búsqueda eficiente de información para alumnos de pregrado de odontología en una universidad chilena / Self-instruction for the efficient search of information for undergraduate students of Dentistry at a Chilean university

INTRODUCCIÓN: Para realizar una práctica clínica basada en la evidencia es fundamental que los profesionales de la salud sepan reconocer sus brechas de conocimiento y posean las herramientas necesarias para realizar búsquedas de información. Con el objetivo de mejorar la metodología de enseñanza-aprendizaje para la búsqueda eficiente, se diseñaron tres cápsulas de autoaprendizaje. SUJETOS Y MÉTODOS: Las cápsulas se aplicaron en cursos del primer, quinto y octavo semestre de la carrera de odontología y se analizaron sus resultados en los niveles 1 y 2 del modelo de evaluación de programas Kirkpatrick. Cada cápsula se evaluó en modalidad online mediante una tarea de aplicación y un cuestionario de cumplimiento de objetivos. RESULTADOS: Las cápsulas se aplicaron el primer y segundo semestre de 2018 a un total de 218 alumnos. Tanto alumnos como profesores se manifestaron satisfechos con la metodología y los contenidos, destacando la modalidad b-learning y la calidad del material instruccional. El 100% de los alumnos aprobó la evaluación asociada a cada cápsula. El promedio de percepción de alcance de objetivos fue del 72% para la cápsula 1, 80% para la cápsula 2 y 84% para la cápsula 3, con una mayor proporción de diferencias positivas (p = 0,00). CONCLUSIÓN: Las cápsulas de autoinstrucción para la enseñanza de búsqueda de evidencia son una metodología efectiva, en términos de reacción y aprendizaje

INTRODUCTION: To carry out an evidence-based clinical practice, health professionals must know how to recognize their knowledge gaps and have the necessary tools to search for information in order to improve their teaching methodology. Three self-learning capsules were designed to search efficiently for information. SUBJECTS AND METHODS: The capsules were applied in courses of the 1st, 5th and 8th semesters of the dentistry degree. The results were analyzed at levels 1 and 2 of the Kirkpatrick program evaluation model. Each capsule was evaluated in online mode through an application task and a and a fulfilling objectives questionnaire. RESULTS: The self-instruction capsules were applied to a total of 218 students. The satisfaction survey showed high values for students and teachers considering the methodology and content, highlighting the b-learning modality and the quality of the instructional material. All of the students approved the evaluation associated with each capsule. The average perception of goal achievement was 72% for capsule 1, 80% for capsule 2 and 84% for capsule 3, with a higher proportion of positive differences (p = 0.00). CONCLUSION: In terms of reaction and learning, it is an effective methodology to use self-instruction capsules for teaching evidence seeking

Number of Remaining Teeth and Its Association with Educational Level in Chilean Adults: Data from the National Health Survey 2016-2017.

INTRODUCTION: Several population studies have addressed oral health inequalities. Edentulism, functional dentition, and number of remaining teeth have been associated with different socioeconomic level measurements. The aim of this study was to evaluate the association between educational level and tooth loss in the Chilean population aged 15 years and above, based on the 2016-2017 National Health Survey (ENS 2016-2017). Material and Methods. The sample for this cross-sectional study comprised 5473 subjects. The main independent variable was educational level (LEL: low, MEL: medium, and HEL: high). To measure tooth loss, we considered the variables number of remaining teeth, edentulism, and functional dentition. We used logistic regressions to assess the condition of dentition according to the subject's EL. As to the number of teeth variable, linear regressions were conducted. The analyses were carried out considering the complex sampling design in SPSS 24.0. RESULTS: When comparing LEL subjects with HEL subjects, the adjusted difference in number of remaining teeth was 3.11 for the maxilla and 1.72 for the mandible. An individual with LEL had a 7.51 [3.50-16.10] and 6.06 [2.68-13.68] times higher risk of upper edentulism and lower edentulism than a HEL individual, respectively. Regarding functional dentition, the adjusted OR in HEL subjects was 13.33 [8.02-22.15] and in MEL subjects was 2.81 [2.03-3.87], compared to LEL results. CONCLUSIONS: LEL was associated with a significant tooth loss in the Chilean population. Subjects with LEL obtained a lower mean of number of remaining teeth and higher prevalence of edentulism and nonfunctional dentition.

Human Norovirus Proteins: Implications in the Replicative Cycle, Pathogenesis, and the Host Immune Response.

Human noroviruses (HuNoVs) are the cause of more than 95% of epidemic non-bacterial gastroenteritis worldwide, with some lethal cases. These viral agents affect people of all ages. However, young children and older adults are the highest-risk groups, being affected with the greatest rate of hospitalizations and morbidity cases. HuNoV structural proteins, especially VP1, have been studied extensively. In contrast, the functions of the non-structural proteins of the virus have been undescribed in depth. Studies on HuNoV non-structural proteins have mostly been made by expressing them individually in in vitro cultures, providing insights of their functions and the role that they play in HuNoV replication and pathogenesis. This review examines exhaustively the functions of both HuNoV structural and non-structural proteins and their possible role within the viral replicative cycle and the pathogenesis of the virus. It also highlights recent findings regarding the host's innate and adaptive immune responses against HuNoV, which are of great relevance for diagnostics and vaccine development so as to prevent infections caused by these fastidious viruses.

Validity of the self-reported number of teeth in Chilean adults.

BACKGROUND: Clinical dental evaluations are considered complex and costly measurements that epidemiological surveillance studies of multiple simultaneous chronic diseases currently require, for example National Health Surveys (ENS). Accordingly, simpler and more affordable methods need to be validated. The aim of this study was to assess the validity of the self-report on the total number of teeth in the general Chilean adult population. METHODS: A substudy was conducted on ENS 2016-2017 participants. A stratified random sample of 101 of them was subjected to a telephone questionnaire. This information was then compared with the results obtained from the oral examination performed by a trained nurse during a home visit. Spearman correlations, intraclass correlation coefficients and the Bland-Altman method were used to analyse the data. RESULTS: In men, the average number of teeth recorded during the oral examination coincided with the number of teeth in the self-report (22 teeth). In women, the total teeth average was 18 and 19 teeth according to the examination and self-report, respectively. For the total number of participants, a strong and significant Spearman correlation was obtained (ρ = 0.93); in men and women, the Spearman correlation observed was also strong and significant (ρ = 0.90 and ρ = 0.96 respectively). The value of the intraclass correlation coefficient indicated a significant concordance (CCI = 0.96) in both men and women (CCI = 0.93 and 0.98 respectively). A tendency to greater correlation was observed as the number of teeth decreased. CONCLUSIONS: The number of teeth self-reported by the subjects in this study correlated with the number of teeth recorded in the clinical examination. Self-report is a valid method to determine the number of teeth in national health surveys.