Past trends and future projections of palliative care needs in Chile: analysis of routinely available death registry and population data.

BACKGROUND: The number of people with palliative care needs is projected to increase globally. Chile has recently introduced legislation for universal access to palliative care services for patients with severe and terminal illnesses, including non-cancer conditions. We aimed to estimate the number of people affected by serious health-related suffering and need for palliative care in Chile to 2050. METHODS: We used data on all deaths registered in Chile between 1997-2019 and population estimates for 1997-2050. We used Poisson regression to model past trends in causes of death adjusted by age, sex and population estimates, to project the number of deaths for each cause from 2021 to 2050. We applied the Lancet Commission on Palliative Care and Pain Relief weights to these projections to identify decedents and non-decedents with palliative care needs. RESULTS: Population palliative care needs in Chile are projected to increase from 117 (95% CI 114 to 120) thousand people in 2021 to 209 (95% CI 198 to 223) thousand people in 2050, a 79% increase (IRR 1.79; 95% CI 1.78-1.80). This increase will be driven by non-cancer conditions, particularly dementia (IRR 2.9, 95% CI 2.85-2.95) and cardiovascular conditions (IRR 1.86, 95% CI 1.83-1.89). By 2050, 50% of those estimated to need palliative care will be non-decedents (not expected to die within a year). CONCLUSIONS: Chile will experience a large increase in palliative care needs, particularly for people with dementia and other non-cancer conditions. Improved availability of high-quality services, expanded clinician training and new sustainable models of care are urgently required to ensure universal access to palliative care.

[Rehospitalization of preterm infants below 32 weeks of gestational age in the first 2 years post discharge]. / Rehospitalización en prematuros menores de 32 semanas o menores de 1.500 g en los primeros 2 años posteriores al alta.

Preterm infants, especially those of lower gestational age (GA), are at high risk of hospital readmission in the early years. OBJECTIVE: To describe the frequency and characteristics of readmissions in preterm infants younger than 32 weeks of GA or weighing less than 1500 g (< 32w/< 1500 g) at 2 years post-discharge from neonatology. PATIENTS AND METHOD: Retrospective observational study of a cohort of newborns < 32w/< 1500 g discharged from a public health care center (2009-2017). The frequency, time of occurrence, risk factors, causes, and severity of hospital readmissions were analyzed. The respective perinatal characteristics and subsequent readmissions were described. The Ethics Committee approved the data collection protocol. RESULTS: 989 newborns < 32w/< 1500 g were included; 410 (41.5%) were readmitted at least once before the age of 2 years, equivalent to 686 episodes (1.7/child); 129 children (31.4%) were admitted to the Pediatric Intensive Care Unit (PICU), with a mean length of stay of 7.7 days. The greatest risk for hospital readmission was during the first 6 months post-discharge. The main cause was respiratory (70%) and respiratory syncytial virus was the most frequent germ. The risk factors associated with readmission due to respiratory causes were bronchopulmonary dysplasia (BPD) (OR: 1.73; 95%CI: 1.26-2.37) and number of siblings (OR: 1.18; 95%CI: 1.04-1.33). CONCLUSIONS: Newborns < 32s/< 1500 g are at high risk of hospital readmission due to respiratory causes and PICU admission in the first months post-discharge; BPD and number of siblings were the main risk factors.

Asymptomatic herpes simplex virus brain infection elicits cellular senescence phenotypes in the central nervous system of mice suffering multiple sclerosis-like disease.

Experimental autoimmune encephalomyelitis (EAE) is a demyelinating disease affecting the central nervous system (CNS) in animals that parallels several clinical and molecular traits of multiple sclerosis in humans. Herpes simplex virus type 1 (HSV-1) infection mainly causes cold sores and eye diseases, yet eventually, it can also reach the CNS, leading to acute encephalitis. Notably, a significant proportion of healthy individuals are likely to have asymptomatic HSV-1 brain infection with chronic brain inflammation due to persistent latent infection in neurons. Because cellular senescence is suggested as a potential factor contributing to the development of various neurodegenerative disorders, including multiple sclerosis, and viral infections may induce a premature senescence state in the CNS, potentially increasing susceptibility to such disorders, here we examine the presence of senescence-related markers in the brains and spinal cords of mice with asymptomatic HSV-1 brain infection, EAE, and both conditions. Across all scenarios, we find a significant increases of senescence biomarkers in the CNS with some differences depending on the analyzed group. Notably, some senescence biomarkers are exclusively observed in mice with the combined conditions. These results indicate that asymptomatic HSV-1 brain infection and EAE associate with a significant expression of senescence biomarkers in the CNS.

Growth patterns in infants born to women with pregestational overweight/obesity supplemented with docosahexaenoic acid during pregnancy.

BACKGROUND: Previous studies of maternal docosahexaenoic acid (DHA) supplementation during pregnancy have controversial and contrasting results on the short and long-term effects on early child growth. The impact of this nutritional intervention on the postnatal growth patterns in the offspring of women with pregestational overweight/obesity (PGO) also remains controversial. OBJECTIVE: To analyze the postnatal growth patterns during the first 4 months of life in the offspring of women with PGO randomly supplemented with 800 mg/day (PGO-800) compared with normative doses of 200 mg/day (PGO-200) of DHA during pregnancy (<15 weeks of gestation until delivery). METHODS: This study evaluated the growth patterns during the first 4 months of life of 169 infants of the women that participated in the MIGHT study (NCT02574767). We included the infants of women from the PGO-200 (n = 81) and PGO-800 group (n = 88). The growth patterns (weight, length, and head circumference) and change in z-score (World health Organization charts) were evaluated. RESULTS: Throughout the first 4 months of life, the infants of the PGO-800 group had lower weight-for-length z-score (coef. -0.65, 95% confidence interval [CI] -1.07, -0.22, p = 0.003) and lower body mass index-for-age z-score (coef. -0.56, 95% CI -0.99, -0.12, p = 0.012) compared with the PGO-200 group adjusted by maternal body mass index, gestational weight gain, gestational age, insulin in cord blood and infant feeding (exclusive breastfed, not breastfed, and partially breastfed). CONCLUSIONS: Maternal supplementation with DHA during pregnancy could beneficially limit the offspring's postnatal weight gain during the first 4 months of life.

Spatio-temporal distribution of hospitalizations for chronic Chagas disease and risk factors associated with in-hospital mortality and surgical intervention in Chile.

Chagas disease (CD) is a neglected parasitic zoonotic disease that affects over 6 million people worldwide. We conducted a retrospective study to analyze the spatiotemporal trends and risk factors for hospitalization rates of CD with cardiac and digestive diagnoses in Chile. We used the Mann-Kendall analysis for temporal trends, Global Moran's Index, and Local Indicators of Spatial Association to identify spatial autocorrelation, and regression models to determine the risk factors associated with in-hospital mortality and surgical intervention. Between 2010 and 2020, a total of 654 hospitalizations were reported, corresponding to 527 individuals. The hospitalization rate steadily decreased over the years (t = -0.636; p = 0.009). The Global Moran's I for the study period showed a positive spatial autocorrelation for hospitalization municipality and for residence municipality of CD patients (I = 0.25, p<0.001 and I = 0.45, p<0.001 respectively), indicating a clustering of hospitalizations in northern municipalities. The most frequent diagnosis was a chronic CD with digestive system involvement (55.8%) followed by a chronic CD with heart involvement (44.2%). The highest percentage of hospital discharges was observed among males (56.9%) and in the 60-79 age group (52.7%). In-hospital mortality risk was higher with increasing age (OR = 1.04), and in patients with cardiac involvement (OR = 2.3), whereas factors associated with the risk of undergoing a surgical intervention were sex (OR = 1.6) and diagnosis of CD with digestive involvement (OR = 4.4). The findings of this study indicate that CD is still a significant public health burden in Chile. Efforts should focus on improving access to timely diagnoses and treatment, reducing disease progression and hospitalization burden, and supporting clinicians in preventing complications and deaths.

"Appagalo" a Customized Mobile Health Intervention (mHealth) for Smoking Cessation in Women: A Randomized Controlled Trial.

BACKGROUND: Almost 30% of Chilean women report cigarette smoking with important repercussions on their health. OBJECTIVE: Design and test a mobile phone intervention for smoking cessation in young women. STUDY DESIGN: A mobile application (app) was created using the best available evidence and consumer input. Its effectiveness was assessed through a randomized clinical trial. STUDY PARTICIPANTS: Women 18 to 44 years old from middle-class neighborhoods in Santiago, Chile. Inclusion criteria were intention to quit cigarette smoking in the following month and having a smartphone cell phone. Women with positive screening for risky alcohol consumption were excluded. INTERVENTION: App with content to support cigarette smoking cessation over 6 months. The control arm included an app that delivered general messages to promote permanence in the study. Telephone follow-up was performed at 6 weeks, and at 3 and 6 months after randomization. MAIN OUTCOME MEASURE: No smoking in the past 7 days at 6 weeks from enrolment. Intention-to-treat analysis was carried out using SPSS 17.0 with a significance level set at .05. RESULTS: 309 women entered the study. Mean number of cigarettes smoked in a day was 8.8. 58.6% of the participants (n = 181) completed the follow-up for the primary outcome. With intention-to-treat analysis, 9.7% of participants in the intervention group reported not having smoked any cigarettes in the last 7 days vs 3.2% in the control group (RR 2.98 CI 95% 1.11-8.0, P = .022). Additionally, 12.3% vs 1.9% of the participants in the intervention group and control group reported continuous abstinence at 6 weeks, respectively (RR 6.29 95% CI 1.9-20.8, P < .001). Continuous abstinence was also significant at 6 months (P-value of .036). CONCLUSIONS: The "Appagalo" app is an effective tool to support smoking cessation in young women. It is a simple mHealth alternative for smoking cessation that can contribute to improving women's health in the Americas and worldwide.

Secondary respiratory early and late infections in mechanically ventilated patients with COVID-19.

BACKGROUND: Patients with COVID-19 receiving mechanical ventilation may become aggravated with a secondary respiratory infection. The aim of this study was to describe secondary respiratory infections, their predictive factors, and outcomes in patients with COVID-19 requiring mechanical ventilation. METHODS: A cohort study was carried out in a single tertiary hospital in Santiago, Chile, from 1st June to 31st July 2020. All patients with COVID-19 admitted to the intensive care unit that required mechanical ventilation were included. RESULTS: A total of 175 patients were enrolled, of which 71 (40.6%) developed at least one secondary respiratory infection during follow-up. Early and late secondary infections were diagnosed in 1.7% and 31.4% respectively. Within late secondary infections, 88% were bacterial, 10% were fungal, and 2% were of viral origin. One-third of isolated bacteria were multidrug-resistant. Bivariate analysis showed that the history of corticosteroids used before admission and the use of dexamethasone during hospitalization were associated with a higher risk of secondary infections (p = 0.041 and p = 0.019 respectively). Multivariate analysis showed that for each additional day of mechanical ventilation, the risk of secondary infection increases 1.1 times (adOR = 1.07; 95% CI 1.02-1.13, p = 0.008) CONCLUSIONS: Patients with COVID-19 admitted to the intensive care unit and requiring mechanical ventilation had a high rate of secondary infections during their hospital stay. The number of days on MV was a risk factor for acquiring secondary respiratory infections.

Safety and Non-Inferiority Evaluation of Two Immunization Schedules with an Inactivated SARS-CoV-2 Vaccine in Adults: A Randomized Clinical Trial.

Several vaccines have been developed to control the COVID-19 pandemic. CoronaVac®, an inactivated SARS-CoV-2 vaccine, has demonstrated safety and immunogenicity, preventing severe COVID-19 cases. We investigate the safety and non-inferiority of two immunization schedules of CoronaVac® in a non-inferiority trial in healthy adults. A total of 2302 healthy adults were enrolled at 8 centers in Chile and randomly assigned to two vaccination schedules, receiving two doses with either 14 or 28 days between each. The primary safety and efficacy endpoints were solicited adverse events (AEs) within 7 days of each dose, and comparing the number of cases of SARS-CoV-2 infection 14 days after the second dose between the schedules, respectively. The most frequent local AE was pain at the injection site, which was less frequent in participants aged ≥60 years. Other local AEs were reported in less than 5% of participants. The most frequent systemic AEs were headache, fatigue, and myalgia. Most AEs were mild and transient. There were no significant differences for local and systemic AEs between schedules. A total of 58 COVID-19 cases were confirmed, and all but 2 of them were mild. No differences were observed in the proportion of COVID-19 cases between schedules. CoronaVac® is safe, especially in ≥60-year-old participants. Both schedules protected against COVID-19 hospitalization.

Safety and Immunogenicity of an Inactivated Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine in a Subgroup of Healthy Adults in Chile.

BACKGROUND: The development of effective vaccines against coronavirus disease 2019 is a global priority. CoronaVac is an inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine with promising safety and immunogenicity profiles. This article reports safety and immunogenicity results obtained for healthy Chilean adults aged ≥18 years in a phase 3 clinical trial. METHODS: Volunteers randomly received 2 doses of CoronaVac or placebo, separated by 2 weeks. A total of 434 volunteers were enrolled, 397 aged 18-59 years and 37 aged ≥60 years. Solicited and unsolicited adverse reactions were registered from all volunteers. Blood samples were obtained from a subset of volunteers and analyzed for humoral and cellular measures of immunogenicity. RESULTS: The primary adverse reaction in the 434 volunteers was pain at the injection site, with a higher incidence in the vaccine than in the placebo arm. Adverse reactions observed were mostly mild and local. No severe adverse events were reported. The humoral evaluation was performed on 81 volunteers. Seroconversion rates for specific anti-S1-receptor binding domain (RBD) immunoglobulin G (IgG) were 82.22% and 84.44% in the 18-59 year age group and 62.69% and 70.37% in the ≥60 year age group, 2 and 4 weeks after the second dose, respectively. A significant increase in circulating neutralizing antibodies was detected 2 and 4 weeks after the second dose. The cellular evaluation was performed on 47 volunteers. We detected a significant induction of T-cell responses characterized by the secretion of interferon-γ (IFN-γ) upon stimulation with Mega Pools of peptides from SARS-CoV-2. CONCLUSIONS: Immunization with CoronaVac in a 0-14 schedule in Chilean adults aged ≥18 years is safe, induces anti-S1-RBD IgG with neutralizing capacity, activates T cells, and promotes the secretion of IFN-γ upon stimulation with SARS-CoV-2 antigens.

Producción de leche materna y estado emocional en madres de recién nacidos de muy bajo peso / Breast milk production and emotional state in mothers of very low birth weight infants

Introducción. Existe poca evidencia de la influencia de variables emocionales en la lactancia de madres de recién nacidos de muy bajo peso al nacer (RNMBPN). El objetivo de este estudio fue medir la producción de leche materna (PLM) en dos momentos de la internación neonatal y su asociación con los niveles de ansiedad, depresión y autoeficacia en lactancia en madres de RNMBPN.Población y métodos. Estudio prospectivo, observacional, multicéntrico en madres de RNMBPN (500-1500 g), en 9 centros de la Red NEOCOSUR. La PLM se obtuvo midiendo lo extraído por cada madre. Se utilizaron las escalas STAI para ansiedad, BDI para depresión, y, la escala piloto ALMA para autoeficacia. Estas fueron aplicadas a los 14 días de vida y a las 36 semanas posmenstruales. Se registraron, además, las características biosociales de madres y neonatos. Resultados. Participaron 118 madres. La PLM media a los 14 días fue de 169 ml (desvío estándar ­DE­ ± 132,4) y de 285 ml (DE ± 266,9) a las 36 semanas, y se asoció significativamente con percepción de autoeficacia en lactancia (p < 0,001), que se mantuvo durante la hospitalización. Existió una tendencia a menor producción en madres con mayores índices de depresión a los 14 días de vida de su hijo, pero no a las 36 semanas. No se encontró asociación entre PLM y ansiedad. No se encontraron asociaciones consistentemente significativas con variables biosociales. Conclusión. La PLM se asoció positivamente con autoeficacia en lactancia; no se encontró asociación con ansiedad y depresión en madres de RNMBPN

Introduction. There is little evidence regarding the influence of emotional variables on breastfeeding among mothers of very low birth weight infants (VLBWIs). The objective of this study was to measure breast milk production (BMP) at two points in time during neonatal hospitalization and its association with anxiety, depression, and breastfeeding self-efficacy levels among mothers of VLBWIs.Population and methods. Prospective, observational, and multicenter study in mothers of VLBWIs (500-1500 g) from 9 NEOCOSUR Network centers. BMP was obtained by measuring the amount extracted by each mother. The STAI scale was used for anxiety, the BDI scale for depression, and the ALMA pilot scale for self-efficacy. They were administered at 14 days of life and at 36 weeks of postmenstrual age. The biosocial characteristics of mothers and neonates were also recorded.Results. A total of 118 mothers participated. Mean BMP was 169 mL (standard deviation [SD]: ± 132.4) at 14 days and 285 mL (SD: ± 266.9) at 36 weeks, and it was significantly associated with the perception of breastfeeding self-efficacy (p < 0.001), which was maintained during hospitalization. There was a lower production trend among mothers with higher depression indices at 14 days of life, but not at 36 weeks. No association was observed between BMP and anxiety. No consistently significant associations were observed with biosocial variables.Conclusion. BMP was positively associated with breastfeeding self-efficacy; no association was observed with anxiety and depression among mothers of VLBWIs

Breast milk production and emotional state in mothers of very low birth weight infants. / Producción de leche materna y estado emocional en madres de recién nacidos de muy bajo peso.

INTRODUCTION: There is little evidence regarding the influence of emotional variables on breastfeeding among mothers of very low birth weight infants (VLBWIs). The objective of this study was to measure breast milk production (BMP) at two points in time during neonatal hospitalization and its association with anxiety, depression, and breastfeeding self-efficacy levels among mothers of VLBWIs. POPULATION AND METHOS: Prospective, observational, and multicenter study in mothers of VLBWIs (500-1500 g) from 9 NEOCOSUR Network centers. BMP was obtained by measuring the amount extracted by each mother. The STAI scale was used for anxiety, the BDI scale for depression, and the ALMA pilot scale for selfefficacy. They were administered at 14 days of life and at 36 weeks of postmenstrual age. The biosocial characteristics of mothers and neonates were also recorded. RESULTS: A total of 118 mothers participated. Mean BMP was 169 mL (standard deviation [SD]: ± 132.4) at 14 days and 285 mL (SD: ± 266.9) at 36 weeks, and it was significantly associated with the perception of breastfeeding self-efficacy (p < 0.001), which was maintained during hospitalization. There was a lower production trend among mothers with higher depression indices at 14 days of life, but not at 36 weeks. No association was observed between BMP and anxiety. No consistently significant associations were observed with biosocial variables. CONCLUSION: BMP was positively associated with breastfeeding self-efficacy; no association was observed with anxiety and depression among mothers of VLBWIs.

Introducción. Existe poca evidencia de la influencia de variables emocionales en la lactancia de madres de recién nacidos de muy bajo peso al nacer (RNMBPN). El objetivo de este estudio fue medir la producción de leche materna (PLM) en dos momentos de la internación neonatal y su asociación con los niveles de ansiedad, depresión y autoeficacia en lactancia en madres de RNMBPN. Población y métodos. Estudio prospectivo, observacional, multicéntrico en madres de RNMBPN (500-1500 g), en 9 centros de la Red NEOCOSUR. La PLM se obtuvo midiendo lo extraído por cada madre. Se utilizaron las escalas STAI para ansiedad, BDI para depresión, y, la escala piloto ALMA para autoeficacia. Estas fueron aplicadas a los 14 días de vida y a las 36 semanas posmenstruales. Se registraron, además, las características biosociales de madres y neonatos. Resultados. Participaron 118 madres. La PLM media a los 14 días fue de 169 ml (desvío estándar ­DE­ ± 132,4) y de 285 ml (DE ± 266,9) a las 36 semanas, y se asoció significativamente con percepción de autoeficacia en lactancia (p < 0,001), que se mantuvo durante la hospitalización. Existió una tendencia a menor producción en madres con mayores índices de depresión a los 14 días de vida de su hijo, pero no a las 36 semanas. No se encontró asociación entre PLM y ansiedad. No se encontraron asociaciones consistentemente significativas con variables biosociales. Conclusión. La PLM se asoció positivamente con autoeficacia en lactancia; no se encontró asociación con ansiedad y depresión en madres de RNMBPN.

Clinical characteristics and outcomes of people living with HIV hospitalized with COVID-19: a nationwide experience.

In this prospective, multicentric, observational study, we describe the clinical characteristics and outcomes of people living with HIV (PLHIV) requiring hospitalization due to COVID-19 in Chile and compare them with Chilean general population admitted with SARS-CoV-2. Consecutive PLHIV admitted with COVID-19 in 23 hospitals, between 16 April and 23 June 2020, were included. Data of a temporally matched-hospitalized general population were used to compare demography, comorbidities, COVID-19 symptoms, and major outcomes. In total, 36 PLHIV subjects were enrolled; 92% were male and mean age was 44 years. Most patients (83%) were on antiretroviral therapy; mean CD4 count was 557 cells/mm3. Suppressed HIV viremia was found in 68% and 56% had, at least, one comorbidity. Severe COVID-19 occurred in 44.4%, intensive care was required in 22.2%, and five patients died (13.9%). No differences were seen between recovered and deceased patients in CD4 count, HIV viral load, or time since HIV diagnosis. Hypertension and cardiovascular disease were associated with a higher risk of death (p = 0.02 and 0.006, respectively). Compared with general population, the HIV cohort had significantly more men (OR 0.15; IC 95% 0.07-0.31) and younger age (OR 8.68; IC 95% 2.66-28.31). In PLHIV, we found more intensive care unit admission (OR 2.31; IC 95% 1.05-5.07) but no differences in the need for mechanical ventilation or death. In this cohort of PLHIV hospitalized with COVID-19, hypertension and cardiovascular comorbidities, but not current HIV viro-immunologic status, were the most important risk factors for mortality. No differences were found between PLHIV and general population in the need for mechanical ventilation and death.

Interim report: Safety and immunogenicity of an inactivated vaccine against SARS-CoV-2 in healthy chilean adults in a phase 3 clinical trial.

Background: The ongoing COVID-19 pandemic has had a significant impact worldwide, with an incommensurable social and economic burden. The rapid development of safe and protective vaccines against this disease is a global priority. CoronaVac is a vaccine prototype based on inactivated SARS-CoV-2, which has shown promising safety and immunogenicity profiles in pre-clinical studies and phase 1/2 trials in China. To this day, four phase 3 clinical trials are ongoing with CoronaVac in Brazil, Indonesia, Turkey, and Chile. This article reports the safety and immunogenicity results obtained in a subgroup of participants aged 18 years and older enrolled in the phase 3 Clinical Trial held in Chile. Methods: This is a multicenter phase 3 clinical trial. Healthcare workers aged 18 years and older were randomly assigned to receive two doses of CoronaVac or placebo separated by two weeks (0-14). We report preliminary safety results obtained for a subset of 434 participants, and antibody and cell-mediated immunity results obtained in a subset of participants assigned to the immunogenicity arm. The primary and secondary aims of the study include the evaluation of safety parameters and immunogenicity against SARS-CoV-2 after immunization, respectively. This trial is registered at clinicaltrials.gov ( NCT04651790 ). Findings: The recruitment of participants occurred between November 27 th , 2020, until January 9 th , 2021. 434 participants were enrolled, 397 were 18-59 years old, and 37 were ≥60 years old. Of these, 270 were immunized with CoronaVac, and the remaining 164 participants were inoculated with the corresponding placebo. The primary adverse reaction was pain at the injection site, with a higher incidence in the vaccine arm (55.6%) than in the placebo arm (40.0%). Moreover, the incidence of pain at the injection site in the 18-59 years old group was 58.4% as compared to 32.0% in the ≥60 years old group. The seroconversion rate for specific anti-S1-RBD IgG was 47.8% for the 18-59 years old group 14 days post immunization (p.i.) and 95.6% 28 and 42 days p.i. For the ≥60 years old group, the seroconversion rate was 18.1%, 100%, and 87.5% at 14, 28, and 42 days p.i., respectively. Importantly, we observed a 95.7% seroconversion rate in neutralizing antibodies for the 18-59 years old group 28 and 42 days p.i. The ≥60 years old group exhibited seroconversion rates of 90.0% and 100% at 28 and 42 days p.i. Interestingly, we did not observe a significant seroconversion rate of anti-N-SARS-CoV-2 IgG for the 18-59 years old group. For the participants ≥60 years old, a modest rate of seroconversion at 42 days p.i. was observed (37.5%). We observed a significant induction of a T cell response characterized by the secretion of IFN-γ upon stimulation with Mega Pools of peptides derived from SARS-CoV-2 proteins. No significant differences between the two age groups were observed for cell-mediated immunity. Interpretation: Immunization with CoronaVac in a 0-14 schedule in adults of 18 years and older in the Chilean population is safe and induces specific IgG production against the S1-RBD with neutralizing capacity, as well as the activation of T cells secreting IFN-γ, upon recognition of SARS-CoV-2 antigens. Funding: Ministry of Health of the Chilean Government; Confederation of Production and Commerce, Chile; Consortium of Universities for Vaccines and Therapies against COVID-19, Chile; Millennium Institute on Immunology and Immunotherapy.

Evaluation of the Health Assessment Questionnaire Disability Index in Chilean patients with rheumatoid arthritis.

BACKGROUND: The Health Assessment Questionnaire Disability Index (HAQDI) is one of the main instruments used to evaluate functional status in rheumatoid arthritis (RA). AIM: To assess the reliability and validity of the Spanish version of HAQDI in Chilean RA population. MATERIALS AND METHODS: The questionnaire was applied to 98 patients with RA aged 44 ± 12 years (90% women). Reliability was assessed using Cronbach's alpha statistic for internal consistency. Construct validity was assessed by comparing total HAQDI value and eight HAQDI domains with multiple parameters of disease activity. Discriminant validity was evaluated by classifying disease activity in low, medium or high and evaluating HAQDI value in each category. Floor and ceiling effects were evaluated. To assess construct validity, principal components analysis was performed using varimax rotation. RESULTS: There were no issues in the comprehensibility of the questionnaire. Mean HAQDI score was 1.57 ± 0.66. Standardized Cronbach's Alpha was 0.883. Correlations between Chilean HAQ domains had a p value less than 0.001, and values ranged from 0.317 to 0.597. Activity parameters, DAS 28 and CDAI were significantly correlated with HAQDI domains. Mean HAQDI values were 0.98 ± 0.59,1.45 ± 0.57, and 1.90 ± 0.56 for mild, moderate and severe disease activity. A principal components analysis identified two factors that accounted for 70.0% of total variability. CONCLUSIONS: This study shows that the Spanish version of HAQDI is reliable and valid and can be used in Chilean patients with RA.

Growth restriction increases the risk of bronchopulmonary dysplasia, death, and sepsis in twins of 30 weeks or less of gestation. / Restricción de crecimiento aumenta el riesgo de displasia broncopulmonar, muerte y sepsis en gemelos de 30 o menos semanas de gestación.

INTRODUCTION: Multiple factors influence the risk of morbidity and mortality of premature infants with intrauterine growth restriction (IUGR). The comparison of twins with different intrauterine growth allows evaluating the effect of the restriction, excluding maternal factors and prenatal mana gement. Our objective was to assess the effect of IUGR on acute and chronic morbidity, and mortality of extreme preterm twins. PATIENTS AND METHOD: Twins weighing less than 1500 grams and gesta tion equal to or less than 30 weeks, of the Neocosur Network. Separate analyses were performed on concordant twin pairs, and on mild and severe discordant twins, evaluating the effect of IUGR on morbidity and mortality. A multivariate analysis was performed in order to establish the impact of this effect. RESULTS: 459 twin pairs, 227 concordant twins, 110 of mild discordance, and 122 of severe discordance. Among the concordant ones, there was only a difference in oxygen uptake at 36 weeks. In those of mild discordance, the smaller twin presented a lower frequency of hyaline membrane disease and required fewer doses of surfactant, but had a higher risk of bronchopulmonary dysplasia (BPD) or death. In severe discordant twins, the smaller one presented higher mortality, sepsis, use and permanence in mechanical ventilation, despite the lower frequency of hyaline membrane disease. In multiple regression analysis, the combined risk of BPD or death was higher in the smaller twin and of severe discordance. CONCLUSION: In discordant twins, the acute respiratory pathology was more frequent in the larger one, although the risk of BPD or death was higher in the one with IUGR.

Evaluation of the Health Assessment Questionnaire Disability Index in Chilean patients with rheumatoid arthritis / Evaluación del Health Asessment Questionnaire Disability Index (HAQDI) en pacientes chilenos con artritis reumatoide

ABSTRACT Background: The Health Assessment Questionnaire Disability Index (HAQDI) is one of the main instruments used to evaluate functional status in rheumatoid arthritis (RA). Aim: To assess the reliability and validity of the Spanish version of HAQDI in Chilean RA population. Materials and Methods: The questionnaire was applied to 98 patients with RA aged 44 ± 12 years (90% women). Reliability was assessed using Cronbach's alpha statistic for internal consistency. Construct validity was assessed by comparing total HAQDI value and eight HAQDI domains with multiple parameters of disease activity. Discriminant validity was evaluated by classifying disease activity in low, medium or high and evaluating HAQDI value in each category. Floor and ceiling effects were evaluated. To assess construct validity, principal components analysis was performed using varimax rotation. Results: There were no issues in the comprehensibility of the questionnaire. Mean HAQDI score was 1.57 ± 0.66. Standardized Cronbach's Alpha was 0.883. Correlations between Chilean HAQ domains had a p value less than 0.001, and values ranged from 0.317 to 0.597. Activity parameters, DAS 28 and CDAI were significantly correlated with HAQDI domains. Mean HAQDI values were 0.98 ± 0.59,1.45 ± 0.57, and 1.90 ± 0.56 for mild, moderate and severe disease activity. A principal components analysis identified two factors that accounted for 70.0% of total variability. Conclusions: This study shows that the Spanish version of HAQDI is reliable and valid and can be used in Chilean patients with RA.

Antecedentes: El Health Assessment Questionnaire Disability Index es uno de los principales instrumentos utilizados para evaluar incapacidad funcional en la artritis reumatoide (AR). Objetivo: Evaluar la fiabilidad y validez del HAQDI en la población chilena con AR. Material y Método: El cuestionario fue respondido por 98 pacientes con AR de 44 ± 12 años de edad (90% mujeres). La confiabilidad se evaluó usando la estadística alfa de Cronbach. La validez de constructo se evaluó comparando el valor total de HAQDI y de cada uno de sus dominios con múltiples parámetros de actividad de la enfermedad. La validez discriminante se evaluó clasificando la actividad de la enfermedad en bajo, medio o alto y evaluando el valor de HAQDI en cada categoría. Se determinaron efectos de piso y techo. Se realizó un análisis factorial utilizando rotación de varimax. Resultados: El valor promedio del HAQDI fue de 1,57 ± 0.66. El alfa estandarizado de Cronbach fue 0,883. Las correlaciones entre dominios de HAQDI tuvieron un valor p < 0,001 con valores entre 0,317 y 0,597. Los parámetros de actividad se correlacionaron significativamente con los dominios HAQDI. Se encontraron diferencias significativas entre el puntaje de HAQDI en relación con los grados de actividad de la enfermedad. Los valores medios de HAQDI fueron 0,98 ± 0,59, 1,45 ± 0,57 y 1,90 ± 0,56 para actividad leve, moderada y severa, respectivamente. El análisis de componentes principales identificó dos factores que representaron el 70.0% de la variabilidad total. Conclusiones: La versión española de HAQDI es confiable y válida en pacientes chilenos con AR.

Vitamin D and Bone Mineral Density in HIV Newly Diagnosed Therapy-Naive Patients Without Any Secondary Causes of Osteoporosis.

Bone loss and vitamin D deficiency are common in HIV patients. However, bone health status in newly diagnosed HIV patients has not been thoroughly described. Our aim was to assess the bone mineral density (BMD), bone resorption and vitamin D status in newly diagnosed HIV patients. A prospective observational study in HIV newly diagnosed therapy-naive persons. Patients with secondary causes of osteoporosis were excluded. Bone densitometry (DXA), a bone resorption marker (CTx), 25-hydroxyvitamin D (25OHD), CD4 count and HIV viral load (VL) were done in 70 patients. Vitamin D results were compared with a group of healthy volunteers. All patients were men, mean age 31 years (19-50). Low BMD (Z score ≤ 2.0) was found in 13%, all of them in lumbar spine, and in only one patient also in femoral neck. Bone resorption was high in 16%. One out of four participants had low BMD or high bone resorption. Vitamin D deficiency (25OHD < 20 ng/mL) was found in 66%. Mean 25OHD in patients was significantly lower than in healthy volunteers (p = 0.04). No associations were found between BMD, CTx, 25OHD and VL or CD4 count. We hypothesize that HIV infection negatively affects bone health based on the results we found among newly diagnosed, therapy-naive, HIV-infected patients, without any known secondary causes of osteoporosis. Low BMD or high bone resorption, are significantly prevalent in these patients. HIV-infected patients had a higher prevalence of vitamin D deficiency than controls, which was not correlated with CD4 count or VL.

Restricción de crecimiento aumenta el riesgo de displasia broncopulmonar, muerte y sepsis en gemelos de 30 o menos semanas de gestación / Growth restriction increases the risk of bronchopulmonary dysplasia, death, and sepsis in twins of 30 weeks or less of gestation

INTRODUCCIÓN: Múltiples factores influyen en el riesgo de morbimortalidad del prematuro con restricción del crecimiento intrauterino (RCIU). La comparación de gemelos con crecimiento intrauterino discordante permite evaluar su efecto, excluyendo factores maternos y manejo prenatal. Nuestro objetivo fue evaluar el efecto de la RCIU sobre la morbilidad aguda, crónica y mortalidad, en parejas de recién nacidos gemelares prematuros extremos. PACIENTES Y MÉTODO: Gemelos menores de 1500 g y 30 semanas de gestación, de la Red Neocosur. Se realizaron análisis separados de pares de gemelos concordantes, discordantes leves y severos, evaluando el efecto de la RCIU sobre morbi-mortalidad. Se realizó análisis multivariado para establecer magnitud del efecto. RESULTADOS: 459 pares de gemelos, 227 concordantes, 110 discordantes leves y 122 severos. Entre los concordantes solo hubo diferencia en uso de oxígeno a las 36 semanas. En discordantes leves, el menor tuvo menos enfermedad de membrana hialina y requirió menos dosis de surfactante, pero tuvo un mayor riesgo de Displasia broncopulmonar (DBP) o muerte. En discordantes severos, el menor presentó mayor mortalidad, sepsis, utilización y permanencia en ventilación mecánica, pese a menor frecuencia de enfermedad de membrana hialina. En regresión múltiple, el riesgo combinado de DBP o muerte fue mayor en gemelo menor y discordante severo. CONCLUSIÓN: En gemelos discordantes, la patología respiratoria aguda fue más frecuente en el gemelo mayor, aunque el riesgo de DBP o muerte fue mayor en el gemelo con RCIU.

INTRODUCTION: Multiple factors influence the risk of morbidity and mortality of premature infants with intrauterine growth restriction (IUGR). The comparison of twins with different intrauterine growth allows evaluating the effect of the restriction, excluding maternal factors and prenatal mana gement. Our objective was to assess the effect of IUGR on acute and chronic morbidity, and mortality of extreme preterm twins. PATIENTS AND METHOD: Twins weighing less than 1500 grams and gesta tion equal to or less than 30 weeks, of the Neocosur Network. Separate analyses were performed on concordant twin pairs, and on mild and severe discordant twins, evaluating the effect of IUGR on morbidity and mortality. A multivariate analysis was performed in order to establish the impact of this effect. RESULTS: 459 twin pairs, 227 concordant twins, 110 of mild discordance, and 122 of severe discordance. Among the concordant ones, there was only a difference in oxygen uptake at 36 weeks. In those of mild discordance, the smaller twin presented a lower frequency of hyaline membrane disease and required fewer doses of surfactant, but had a higher risk of bronchopulmonary dysplasia (BPD) or death. In severe discordant twins, the smaller one presented higher mortality, sepsis, use and permanence in mechanical ventilation, despite the lower frequency of hyaline membrane disease. In multiple regression analysis, the combined risk of BPD or death was higher in the smaller twin and of severe discordance. CONCLUSION: In discordant twins, the acute respiratory pathology was more frequent in the larger one, although the risk of BPD or death was higher in the one with IUGR.

Physical activity in the classroom to prevent childhood obesity: a pilot study in Santiago, Chile.

This paper describes a 4-month pilot study that tested the suitability of a physical activity intervention for first graders (children aged 6 and 7 years) in a public school in Santiago, Chile. Teachers were trained to deliver the programme in the classroom during the school day. Teachers were surveyed to determine if this intervention fit within their curriculum and classroom routines and they reported in a focus group that it was suitable for them. All children actively participated in the programme and positive changes in their attitudes towards physical activity were observed by their teachers. Anthropometrics, blood pressure and hand grip strength were measured in the students. A significant reduction was observed in children with high waist circumference ≥ 90th percentile, and in mean systolic blood pressure. However, statistical power values for those comparisons were rather low. Anthropometry and hand grip strength were not modified. The latter calculations and the lack of a control group are showing the weaknesses of this pilot study and that further research with a larger sample size and an experimental design is strongly needed.

Maximal isometric muscle strength values obtained By hand-held dynamometry in children between 6 and 15 years of age.

INTRODUCTION: In this study we aimed to determine the maximal isometric muscle strength of a healthy, normal-weight, pediatric population between 6 and 15 years of age using hand-held dynamometry to establish strength reference values. The secondary objective was determining the relationship between strength and anthropometric parameters. METHODS: Four hundred normal-weight Chilean children, split into 10 age groups, separated by 1-year intervals, were evaluated. Each age group included between 35 and 55 children. RESULTS: The strength values increased with increasing age and weight, with a correlation of 0.83 for age and 0.82 for weight. The results were similar to those reported in previous studies regarding the relationships among strength, age, and anthropometric parameters, but the reported strength differed. CONCLUSIONS: These results provide normal strength parameters for healthy and normal-weight Chilean children between 6 and 15 years of age and highlight the relevance of ethnicity in defining reference values for muscle strength in a pediatric population. Muscle Nerve 55: 16-22, 2017.