Health systems do not have the capacity to finance all services. The impact of choosing one option or another is important in order to prioritize health resources. Citizen participation can help to set priorities or to select the interventions that will receive public funding. We reviewed the literature searching for articles that reported mechanisms to gather information about citizens’ values or preferences about health system coverage. We identified 363 publications, 18 articles were analyzed in full, and 7 articles were included in the review. Three articles were European, two were from Australia and two from Latin America. The most commonly used mechanisms to gather information were interviews and surveys. We conclude that there is a limited number of articles with examples of tools to capture information about values and preferences in health decision processes. The main barrier observed was the lack of standardized processes to collect the values and preferences of the community.

Abstract: Vitamin D (VD) is essential for calcium and phosphorus metabolism. Its deficiency can cause rickets. In Chile, newborns receive 400UI/day supplementation from the first day of age until the first year. Objective: To describe the VD plasma levels in healthy infants who received supplementation and secondarily to correlate this with seasonality and nutritional status. Subjects and Method: Cross sectional study. Infants on exclusive or mixed breastfeeding, with monthly pediatric checkups recei ving 400 UI VD supplementation were evaluated, measuring VD plasma levels at 6 months of age, weight, and length, and their nutritional status was classified according to the WHO growth referen ces (weight/age and weight/length). The VD cut-off concentration values were ≤ 20 ng/ml, 21- 29 ng/ ml, and ≥ 30 ng/ml considered as deficiency, insufficiency, and sufficiency, respectively. Results: 40 infants were studied, 40% had insufficient levels and 40% presented deficiency. Season and nutritio nal status were variables significantly related to lower VD values (Winter-Spring p = 0.007; at risk of malnutrition p = 0.038). Conclusions: The population who received supplementation presented a high frequency of VD deficiency and insufficiency which increases during winter and spring and in subjects at risk of malnutrition.

Resumen: La vitamina D (VD) es indispensable para el metabolismo del calcio y fósforo, su deficiencia puede causar raquitismo. En Chile se suplementa con 400 UI /diarias desde el primer mes hasta el año de vida. Objetivo: Describir las concentraciones plasmáticas de VD en lactantes sanos suplementados y secundariamente, evaluar la asociación del estatus de VD con estacionalidad y estado nutricional. Sujetos y Método: Estudio de corte transversal. Se evaluó a lactantes con lactancia materna exclusiva o mixta que acudían a controles pediátricos mensuales y recibían suplementación de VD a dosis de 400 UI diarias. A los 6 meses de edad se midió la concentración plasmática de VD, el peso y la talla. Posteriormente se clasificó el estado nutricional (peso/edad y peso/talla) según los referentes de la OMS. De acuerdo a la concentración plasmática de VD, se definió como normal ≥ 30 ng/ml, insuficiencia si esta fue entre 20 y 29 ng/ml y deficiencia < 20 ng/ml. Resultados: Se estudiaron 40 lactantes, 40% tuvieron concentracio nes de VD insuficientes y 40% deficientes. En el modelo de regresión lineal múltiple, las variables que se asociaron, de modo significativo, con una menor concentración de VD fueron: el periodo del año invierno-primavera (p = 0,007) y el riesgo de desnutrición (p = 0,038). Conclusiones: La frecuencia de deficiencia e insuficiencia de VD es elevada en nuestra población suplementada, dicho déficit es mayor durante el invierno y la primavera y en sujetos con riesgo de desnutrición.

Background: Breast cancer (BC) has a high mortality rate in developing countries due to a scarcity of early detection. Risk communication is critical to support women who face the decision to undertake BC screening. Thus, they can balance their perceived and real risk, and make informed choices. Aim: To describe experts’ views on how the provision of information related to BC screening should be made. Material and Methods: A qualitative study with focus groups with national experts was conducted. Open coding was performed. Results: Four categories on the way information about BC screening should be provided emerged: to communicate about the need of the exam; the pros and cons of the test; fear as a barrier for understanding; and involving women in the decision-making process. Conclusions: These findings emphasize the need to include risk communication strategies in the patient-provider relationship and encourage and respect women's autonomy when facing the BC screening decision.

Background: The Family and Community Health Model (MAIS) establishes the continuity of care as an essential principle. The Family Study, as a clinical strategy, allows to have sufficient and timely information and knowledge about users of health care services, facilitates their accompaniment and is a source of information to improve the quality of care and the management of health centers. Aim: To develop a tool to conduct family studies, devised by experts in Primary Health Care. Material and Methods: Using a qualitative method, an electronic Delphi was conducted on 24 experts on primary health care. Afterwards, the content validation was carried out with the participation of judges. Results: The resulting tool considers two levels of family assessment. It allows to distinguish those families that would benefit from interventions of greater complexity than those derived from the usual care of health centers. Conclusions: The tool to perform family studies responds to the informational and continuity component of Continuity of Patient Care principle. It may be a proposal for the continuous improvement of Chilean primary care.

Abstract Rhodophiala pratensis is an endemic geophyte from Chile with great importance to the national market of cut flowers and potted and garden plants. However, many geophytes have conservation issues and are considered endangered species. Efficient and controlled propagation techniques have been useful for the commercial production of this species and for its conservation. A micropropagation protocol using seeds was developed to determine an optimum method to increase bulb production rates and plant production. The effect of sucrose levels in the medium on the growth of bulbs was tested in vitro (30, 60 and 90 g L-1). Then, the effects on shoot and bulb induction of the cytokinin BAP at concentrations of 1.0, 2.0 and 4.0 mg L-1 with the auxin NAA at concentrations of 0.1, 1.0 and 2.0 mg L-1 were analyzed. The germination rate after eight weeks increased to 86% with very low contamination (7%). Bulb growth increased when high levels of sucrose were added to the medium; the optimum sucrose concentration was 90 g L-1. Acclimatization was successful, with a plant survival rate of 63% and an average bulb growth of 0.5 cm. This is the first study to demonstrate the possibility of propagating R. pratensis seeds in vitro.

Resumen Rhodophiala pratensis es un planta geófita endémica de Chile con gran importancia para el mercado nacional de flores, macetas y plantas de jardín. Sin embargo, muchas de estas geófitas tienen problemas de conservación, siendo consideradas especies en peligro de extinción. Para la conservación y producción comercial de esta especie, las técnicas de propagación eficiente y controlada han sido muy útiles. Por esto, se desarrolló un protocolo de micropropagación utilizando semillas para determinar un método óptimo que permita aumentar las tasas de producción de bulbos y la producción de plantas. Se probó el efecto de distintas concentraciones de sacarosa en el medio de cultivo sobre el crecimiento in vitro de los bulbos (30, 60 y 90 g L-1). A continuación, se analizaron los efectos de la citoquinina BAP en concentraciones de 1.0, 2.0 y 4.0 mg L-1 con auxina NAA en concentraciones de 0.1, 1.0 y 2.0 mg L-1 en la inducción de brotes y bulbos. La tasa de germinación después de ocho semanas aumentó a 86% con una contaminación muy baja (7%). El crecimiento del bulbo aumentó cuando se añadieron altos niveles de sacarosa al medio, con una concentración óptima de 90 g L-1. La aclimatación tuvo éxito con una supervivencia de plantas del 63%, con un promedio de crecimiento de bulbo de 0.5 cm. Esta es la primera investigación que demuestra la posibilidad de propagar semillas de R. pratensis in vitro.

Background: Decisional conflict refers to the personal uncertainty about which course of action to take when the choice involves risk, regret, or challenge to personal life values. Aim: To determine the level of decisional conflict (DC) of people with Diabetes Mellitus (DM) or High Blood Pressure (HBP) attending primary care centers (PCC) in Chile. Patients and Methods: A Spanish version of the Decisional Conflict Scale (DCS) was applied to patients who were recruited if they had DM or HBP, were 18 years old or older, and had an appointment at the PCC the day of the recruitment. The scale was self-administered. Analysis of covariance (ANCOVA) was used to determine association between DC and other variables of interest while controlling confounding variables. Results: The scale was answered by 1075 participants from 24 PCC aged 62 ± 14 years (74% female). Average score for the DCS scale was 16.8 ± 12.9 of a maximum of 100 points indicating a higher DC. The sub-scale “information” had the highest score (19.9 ± 20.0). Low educational level and older age were significantly associated with higher DCS scores (p < 0.05). Having a bad health perception, deciding to initiate a medical treatment and being attended by a doctor were significantly associated with higher DC. These associations persisted when confounding variables such as sex, age and education were controlled. Conclusions: People with DM or HBP who have a poor health perception, who initiated their treatment and were attended by a doctor had higher levels of DC, independent of their age and educational level.

ABSTRACT Objective Describe users' experience with participation in clinical decision-making at Family Health Centers (CESFAM) in the Primary Health Care (PHC) system. Methods Qualitative descriptive study. Focus groups made up of CESFAM users were held in southeastern Santiago, Chile, and the information was thematically analyzed using Atlas.ti version 6® software. Results Five focus groups were held (n = 41). The main themes that emerged from the discussions were the passive role of users in decisions and delegated decision-making, based on their trust in the health professional. Users' passive role limits their opportunities for participation in clinical decision-making, ceding power to the health professional. However, establishing a therapeutic partnership allows users to feel that they are being treated as unique individuals whom the professional listens to and respects, ensuring that the decisions of the health team can be trusted, since they look out for the users' real interests. Conclusion Users' participation in clinical encounters is still limited in Chile. However, bolstering that participation is essential for increasing user satisfaction and promoting people-centered care.

RESUMEN Objetivo Describir la experiencia de participación en las decisiones clínicas desde la perspectiva de usuarios de Centros de Salud Familiar (CESFAM) de la Atención Primaria de Salud (APS). Métodos Estudio de diseño cualitativo descriptivo; se realizaron grupos focales con usuarios de CESFAM del área sudeste de Santiago, Chile, y análisis temático de la información utilizando el programa Atlas.ti versión 6®. Resultados Se realizaron cinco grupos focales (n = 41). Los principales temas emergentes fueron el rol pasivo de los usuarios en las decisiones y la toma de decisión delegada, basada en la confianza en el profesional. El rol pasivo de los usuarios limita las oportunidades de participación en las decisiones clínicas y mantiene el poder en los profesionales de la salud. A pesar de ello, el establecimiento de una alianza terapéutica les permita sentirse tratados como personas únicas, escuchados y respetados por los profesionales, lo que asegura que las decisiones tomadas por el equipo de salud son confiables, pues velan por sus reales intereses. Conclusión La participación de los usuarios en los encuentros clínicos es aún escasa en el país. Sin embargo, potenciar esta participación es esencial para aumentar la satisfacción usuaria y promover un cuidado centrado en la persona.

RESUMO Objetivo Descrever a experiência de participação nas decisões clínicas dos usuários dos Centros de Saúde Familiar (CESFAM) de atenção primária à saúde. Métodos Estudo qualitativo descritivo conduzido em grupos de discussão formados por usuários dos CESFAM da região sudeste da cidade de Santiago, no Chile. Foi realizada uma análise temática das informações com o uso do programa de software ATLAS.ti® versão 6. Resultados Foram formados cinco grupos de discussão (n = 41). Os principais tópicos abordados foram o papel passivo dos usuários nas decisões e a tomada de decisão delegada aos profissionais na base da confiança. O papel passivo restringe as oportunidades de participação dos usuários nas decisões clínicas e mantém o poder nas mãos dos profissionais da saúde. Apesar disso, ao ser criada uma aliança terapêutica, os usuários se sentem tratados como indivíduos únicos que são ouvidos e respeitados pelos profissionais, o que assegura que as decisões tomadas pela equipe de saúde sejam confiáveis porque protegem os reais interesses dos usuários. Conclusão Os usuários ainda têm pouca participação nas interações clínicas no Chile. Porém, é fundamental reforçar esta participação para melhorar a satisfação do usuário e promover uma atenção mais centrada na pessoa.

ABSTRACT Objective To describe the competencies for primary health care teams (PHC) in different topics related to the direct care of the user and the management of primary health centers, according to the perception of Chilean experts in PHC. Methods Mixed design studio. An electronic Delphi method was conducted with 29 national experts in APS. Results A matrix of specific competences related to direct work with families and to the management of the health center prioritized in three levels is proposed. Experts agreed that a critical mass of professionals with competencies in PHC is required. Conclusions The challenge of reorganizing health systems around a strong and quality PHC can only be achieved with the participation of professionals who understand and practice the attributes and fundamental principles of PHC. The results of this study show a competency profile for PHC professionals aligned with international recommendations achievable through continuous education strategies.

RESUMEN Objetivo Describir las competencias para equipos de atención primaria en salud (APS) en distintos tópicos vinculados a la atención directa del usuario y a la gestión de los centros de salud primarios, de acuerdo a la percepción de expertos chilenos en APS. Métodos Estudio de diseño mixto. Se realizó un Delphi electrónico con 29 expertos nacionales en APS. Resultados Se propone una matriz de competencias específicas vinculada al trabajo directo con familias y a la gestión del centro de salud priorizados en tres niveles. Los expertos concuerdan que se requiere una masa crítica de profesionales que cuenten con competencias que le conciernen a la APS. Conclusiones El reto de reorganizar los sistemas de salud en torno a una APS fuerte y de calidad solo puede lograrse con la participación de profesionales que comprendan y practiquen los atributos y principios fundamentales de la APS. Los resultados de este estudio dan cuenta de un perfil de competencias para profesionales de APS alineado con recomendaciones internacionales alcanzable a través de estrategias de educación continua.

RESUMO Objetivo Descrever as habilidades para equipes de atenção primária à saúde (APS) sobre vários tópicos vinculados com a atenção direta do usuário e gestão de centros de saúde, de acordo com a percepção de especialistas chilenos na APS. Métodos Estudo de desenho misto. Foi realizado um Delphi eletrônico com 29 especialistas nacionais em APS. Resultados É proposta uma matriz de competências específicas vinculada ao trabalho direto com famílias e à gestão do centro de saúde priorizados em três níveis. Os especialistas concordam que se requer uma massa crítica de profissionais que contem com competências em APS. Conclusões O desafio de reorganizar os sistemas de saúde em torno de uma APS forte e de qualidade só se pode conseguir com a participação de profissionais que entendem e pratiquem os atributos e os princípios fundamentais da APS. Os resultados deste estudo mostram um perfil de competências para profissionais de APS alinhados com recomendações internacionais que podem ser alcançadas através de estratégias de educação contínua.

Background: The Family and Community Health Model is based on three essential principles: user-centered care, comprehensive care and continuity of care. Aim: To describe the attributes and characteristics of the guiding principles of the Family and Community Health Model (FHM) from the perspective of primary care experts. Material and Methods: This was a qualitative study. An electronic Delphi was conducted with 29 national experts on primary care. Results: The experts agree that user centered care must be based on a psycho-social model integrating the multiple factors that influence health problems. It also must integrate patients’ individual features, family and environmental issues. The proposed actions promote shared decision making. To promote integral care, anticipatory guidelines should be expanded and health care of patients with chronic conditions should be improved. Continuity of care should be promoted increasing working hours of medical centers and easing access to integrated electronic medical records, thereby generating efficient links between the different care levels. Conclusions: The results of the study can guide the clinical and administrative management of health teams, allowing the strengthening of primary health care according to the local realities.

ABSTRACT Natural antioxidants may be used in order to increase storage stability of poultry meat. The aim of this study was to determine the storage stability of poultry meat from broilers fed with diets containing dry oregano at different doses 0, 1.25, 2.5, 3.75 and 5%. The following parameters were evaluated: peroxides index, total mesophilic aerobic count (RAM), color (CIELab), nutritional com position, sensory characteristics (color and aroma intensity) and consumer acceptance. The results showed that poultry meat from broilers fed with dry oregano exhibited a lower oxidation of lipids at the beginning of refrigerated storage. Regarding color, higher differences (AE > 5) were observed in the treatments with higher doses of oregano (2.5-5%) seven days after storage when compared with the control. No variation in TMA values were found between treatments. Lipid content was higher in the treatments with a higher amount of oregano added (3.75 and 5%), while consumer acceptance was also higher. It can be concluded that the storage stability of poultry meat from broilers fed with diets containing dry oregano increases at the beginning of the storage due to lower lipid oxidation.

RESUMEN Los antioxidantes naturales pueden ser usados para aumentar la estabilidad de la carne de pollo durante el almacenamiento. El objetivo de este estudio fue determinar la estabilidad durante el almacenamiento de carne de pollos alimentados con una dieta suplementada con orégano seco en dosis 0; 1,25; 2,5; 3,75 y 5% con respecto a la materia seca ofrecida. Los parámetros evaluados durante el almacenamiento de la carne fueron: índice de peróxidos, recuento de aerobios mesófilos (RAM), color (espacio CIELab), composición nutricional, características sensoriales (color, intensidad de aroma) y aceptación. Se encontró que la carne de pollos alimentados con dietas suplementadas con orégano seco presentó una menor oxidación de lípidos al inicio del almacenamiento en refrigeración, mayores diferencias de color (AE > 5) con respecto al control en los tratamientos con mayor inclusión de orégano (2,5-5%) a los siete días de almacenamiento, un RAM sin variación entre tratamientos, un mayor contenido de lípidos en tratamientos con mayor inclusión de orégano (3,75 y 5%), y una mayor aceptación por el consumidor. Se puede concluir que la estabilidad de la carne de pollos alimentados con orégano seco como ingrediente dietario aumenta al inicio del almacenamiento por la menor oxidación de lípidos.

Background: The integral Model of Family and Community Health care is based on three essential principles: patient centered care, comprehensive care and continuity of care. Aim: To know the perception of primary care clinic users about the elements that should be considered in a patient centered integrated health care. Material and Methods: Ten males and 31 females aged 18 to 78 years, users of two public family primary care centers participated in focus groups, which were recorded. A qualitative descriptive research design based on content analysis according to Krippendorf was done. Results: Seven issues emerged from the description of patients’ experiences: professional-patient relationship, fragmentation of care, continued care with the same professional, promotion and prevention, availability of services and patient records. Conclusions: There are difficulties to install an integral model of family and community health care. The concerns raised by participants should be considered in order to modify the design of these models.

Hyperphenylalaninaemias are defined by a blood phenylalanine over 2 mg/dl. The main cause is due to a mutation in the gene that codes the phenylalanine hydroxylase that catalyses the reaction that converts phenylalanine into tyrosine. The hyperphenylalaninaemias are classified into benign or mild hyperphenylalaninaemias, or mild, moderate or classic phenylketonurias. Due to its delayed detection outside the neonatal period it causes severe mental retardation. Its detection along with congenital hypothyroidism has been part of the National Neonatal Screening Program since 1992 in Chile. This article aims to answer the most common questions asked by the paediatrician when faced with a patient with hyperphenylalaninaemias.

Las hiperfenilalaninemias se definen por un nivel sanguíneo de fenilalanina sobre 2 mg/dl. La principal causa es una mutación en el gen que codifica la fenilalanina hidroxilasa que cataliza la reacción que transforma la fenilalanina en tirosina. Las hiperfenilalaninemias se clasifican en benignas o leves, y las fenilcetonurias en leves, moderadas y clásicas. Debido a que su detección más allá del periodo neonatal causa retardo mental severo, desde 1992 en Chile su detección, junto con la del hipotirodismo congénito, es parte del Programa Nacional de Pesquisa Neonatal. Este artículo pretende responder las preguntas más comunes que se puede hacer el pediatra cuando enfrenta a un paciente con hiperfenilalaninemias.

The healthcare model is shifting from a paternalistic towards a more inclusive and participative approach, such as shared decision making (SDM). SDM considers patients as autonomous and responsible agents. SDM is a therapeutic approach where healthcare providers and patients share the best evidence available to make a decision according to the values and preferences of the patient. Decision aids are tools that can facilitate this information exchange. These tools help patients to increase knowledge about options, reduce decisional conflict and improve satisfaction. Additionally, communication skills play a key role within the professional-patient relationship, as they facilitate sharing information and preferences in an effective and respectful manner. This therapeutic approach could support the reduction of health inequalities that affect Latin America, as it promotes an active and informed participation of patients in their healthcare process

El modelo de atención en salud paternalista está derivando hacia modelos más participativos, como lo es la toma de decisiones compartidas (TDC), en el que se considera al paciente como agente responsable y autónomo. La TDC representa un enfoque terapéutico en el que profesionales y pacientes comparten la mejor evidencia científica disponible para tomar una decisión, incorporando los valores y preferencias del paciente. Este intercambio de información puede facilitarse mediante el uso de herramientas de ayuda para la TDC, que han demostrado ser efectivas para mejorar el conocimiento, la satisfacción del paciente, y reducir el conflicto decisional. En este sentido, las habilidades comunicacionales ejercen un rol fundamental en el establecimiento de la relación profesional - paciente, facilitando el intercambio de información y preferencias de manera efectiva y respetuosa. Esta aproximación terapéutica podría apoyar la reducción de las disparidades en salud que prevalecen en Latinoamérica, al facilitar que las personas puedan participar informada y activamente en el cuidado de su salud.

Background: Late diagnosis of HIV is a problem of international and national relevance. Despite the availability of HIV testing in primary health care, it is often performed too late. Aim: To identify facilitators and barriers to early HIV testing in primary health care. Methods: Four databases of nursing, psychological, biomedical, and health related professions areas were examined with a review protocol. Results were grouped into two main subjects: facilitators and barriers occurring among the population, among health care workers, and within primary health care centers. Results: Perception of risk behaviors, self-care, social support, trust, confidentiality of the examination, the offer of the examination, and the knowledge of early treatment have been recognized as facilitators for taking the exam. The lack of information about the test and the disease are recognized as the main barrier to access the test. This information is a cornerstone to design and implement strategies to increase the number of people taking voluntarily HIV testing.

Introducción: El diagnóstico tardío de la infección por VIH es un problema universal. A pesar de la disponibilidad del test de ELISA para el diagnóstico de esta infección en la atención primaria de salud, las personas continúan tomándoselo tardíamente. Objetivo: Conocer los factores que facilitan o dificultan que las personas accedan oportunamente al examen en la atención primaria de salud. Métodos: Cuatro bases de datos del área de la enfermería, psicológica, salud biomédica y profesiones afines (años 2001-2012) fueron examinadas con un protocolo de revisión. Resultados: De 195 artículos detectados, 15 cumplieron con los criterios de inclusión y fueron agrupados en dos grandes temas: elementos facilitadores y elementos obstaculizadores de la persona, de los profesionales y de los centros de atención primaria de salud. Percepción de conductas de riesgo, autocuidado, apoyo social, la confianza, confidencialidad del examen, el ofrecimiento del examen y el conocimiento de un tratamiento oportuno han sido reconocidos como uno de los elementos facilitadores para la toma del examen. La falta de información sobre el test y la enfermedad son reconocidas como los principales obstaculizadores para acceder al test. Discusión: La información obtenida es un pilar fundamental para diseñar e implementar estrategias destinadas a aumentar el número de personas que solicitan voluntariamente al examen.