Abstract Background: The COVID-19 pandemic that emerged in Wuhan, China at the end of 2019, spread rapidly around the world with almost 600 million cases and 6.3 million deaths today. The most affected were health workers with at least three times the risk of contracting the disease than the general community. Most studies on seroprevalence in health workers focus on hospital care establishments and what happens in Primary Health Care (PHC) has not been investigated with the same intensity. Aim: To determine the prevalence of SARS-CoV-2 using IgG antibodies in primary health care personnel in La Pintana commune, risk factors and clinical characteristics, prior to vaccination in Chile. Methods: A cross-sectional design carried out in November 2020. Sociodemographic and clinical data were collected through face-to-face interviews, after providing informed consent. Specific IgG was determined by ELISA using N and S proteins. The differences between positive and negative subjects were studied using bivariate analysis and multivariate models, controlling for potential confounding variables. The study was approved by the Universidad del Desarrollo Scientific Ethics Committee. Results: 463 employees (51.4%) participated, finding a prevalence of 21.8%. The risk factors found were younger age, being a physician and having been in close contact with a case. 22% were asymptomatic. Among those with anosmia/ageusia, the probability of IgG+ was greater than 70%. Antibody titers increase with severity. Conclusions: Prevalence found in primary health care personnel is consistent with previous evidence. Younger age and medical profession are associated with a higher risk of illness.

Resumen Introducción: La pandemia de COVID-19 surgida en China a fines de 2019, se extendió rápidamente por el mundo, con casi 600 millones de casos y 6,3 millones de fallecidos en la actualidad. Los más afectados fueron los trabajadores de la salud con al menos tres veces más riesgo que la comunidad general de contraer la enfermedad. La mayoría de los estudios sobre seroprevalencia en trabajadores de la salud, se enfocan en establecimientos de atención hospitalaria y no se ha indagado con igual intensidad sobre lo que ocurre en la Atención Primaria de Salud (APS). Objetivos: Determinar prevalencia de SARS-CoV-2 mediante anticuerpos IgG en personal de atención primaria de comuna de La Pintana y explorar sus características clínicas y factores de riesgo, previo a la vacunación en Chile. Metodología: Diseño transversal realizado en noviembre 2020. Se recogieron datos sociodemográficos y clínicos mediante entrevista cara a cara, previa firma de consentimiento. Se determinó IgG específica mediante ELISA que utiliza proteína N y S. Las diferencias entre sujetos positivos y negativos se estudiaron mediante análisis bivariado y para asociaciones encontradas, se desarrollaron modelos multivariados controlando potenciales variables de confusión. El estudio contó con la aprobación del Comité Ético Científico de la Universidad del Desarrollo. Resultados: Participaron 463 funcionarios (51,4%) encontrando prevalencia de 21,8%. Los factores de riesgo fueron edad menor, ser médico y haber sido contacto estrecho de un caso. El 22% fue asintomático. Entre quienes presentan anosmia o ageusia, la probabilidad de IgG+ fue superior a 70%. Los títulos de anticuerpos aumentan significativamente con la gravedad. Conclusiones: La prevalencia en personal de atención primaria encontrada es concordante con la evidencia previa en trabajadores de salud. La menor edad y la profesión de médico se asocian a un mayor riesgo de enfermar.

RESUMEN La Diabetes mellitus constituye uno de los problemas de salud más importantes en el mundo por la alta carga de enfermedad en términos de discapacidad y mortalidad prematura que ocasiona, debido a su alta prevalencia e incidencia a nivel mundial se configura como una epidemia. Objetivo . Determinar el riesgo para desarrollar diabetes mellitus tipo II en las personas de la Cuidad de Cuenca. Materiales y métodos . Se realizó un estudio, descriptivo, correlacional, prospectivo, cuantitativo y de corte transversal, mediante la aplicación del test de FINDRISC, La muestra estuvo compuesta por 379 personas no diabéticas con edades comprendidas entre 18 y 65 años de edad. Resultados . Se determinó que las variables sexo, edad, el peso, la talla, el perímetro de cintura, el tiempo diario de actividad física y antecedentes familiares de DM1- 2 presentan una correlación significativa en el nivel 0,01 (bilateral) con el riesgo de desarrollar DM2 según la puntuación del test de FINDRISC. Conclusión . Los datos obtenidos sugieren la necesidad de programas de intervención multidisciplinar en las unidades de salud asociados a programas educativos, ingesta dietética adecuada y actividad física regular.

RESUMO A diabetes mellitus é um dos problemas de saúde mais importantes do mundo devido ao elevado peso da doença em termos de incapacidade e mortalidade prematura que provoca, devido à sua elevada prevalência e incidência a nível mundial é configurada como uma epidemia. Objectivo . Determinar o risco de desenvolvimento da diabetes mellitus tipo II nas pessoas da cidade de Cuenca. Materiais e métodos . Foi realizado um estudo descritivo, correlativo, prospectivo, quantitativo e transversal utilizando o teste FINDRISC. A amostra consistiu em 379 pessoas não diabéticas entre os 18 e os 65 anos de idade. Resultados . Foi determinado que as variáveis sexo, idade, peso, altura, circunferência da cintura, tempo de atividade física diária e história familiar de DM1- 2 apresentaram uma correlação significativa ao nível 0,01 (bilateral) com o risco de desenvolvimento de DM2 de acordo com a pontuação do teste FINDRISC. Conclusão . Os dados obtidos sugerem a necessidade de programas de intervenção multidisciplinar em unidades de saúde associados a programas educativos, ingestão alimentar adequada e actividade física regular.

ABSTRACT Diabetes mellitus is one of the most important health problems in the world due to the high burden of disease in terms of disability and premature mortality it causes, due to its high prevalence and incidence worldwide is configured as an epidemic. Objective . To determine the risk of developing type II diabetes mellitus in people from the city of Cuenca. Materials and methods . Descriptive, correlational, prospective, quantitative and cross-sectional study was carried out through the application of the FINDRISC test. The sample was composed of 379 non-diabetic persons between 18 and 65 years of age. Results. It was determined that the variables sex, age, weight, height, waist circumference, daily physical activity time and family history of DM1- 2 presented a significant correlation at the 0.01 level (bilateral) with the risk of developing DM2 according to the FINDRISC test score. Conclusion . The data obtained suggest the need for multidisciplinary intervention programs in health units associated with educational programs, adequate dietary intake and regular physical activity.

Resumo Este artigo apresenta a sistematização das percepções dos estudantes do curso de Planejamento Econômico e Social vinculados ao projeto de Extensão “Gestão Comunitária para o fortalecimento produtivo das Áreas Marítimas de Pesca Responsável”. Procura-se conhecer a forma em que a curricularização da extensão universitária oferece contribuições na transformação dos processos de ensino e aprendizagem a partir da reconstrução crítica das experiências do corpo estudantil. Metodologicamente, o trabalho é baseado na descoberta e interpretação subjetiva/ intersubjetiva da realidade, o que implica uma abordagem dialético-materialista. Foram utilizadas como instrumentos entrevistas de conversação e oficinas participativas. A partir da aplicação dos instrumentos, foram construídas quatro categorias analíticas, que permitiu demonstrar que os estudantes, através do acompanhamento social participativo de grupos locais, têm desconstruções de aprendizagem tradicional e que, a partir de sua experiência, constroem novas formas, estabelecendo espaços de diálogo e relações horizontais com as pessoas das comunidades, fortalecendo sua formação profissional.

Resumen Este artículo expone la sistematización de las percepciones de los estudiantes de la carrera de Planificación Económica y Social vinculados al proyecto de extensión “Gestión comunitaria para el fortalecimiento productivo de las Áreas Marinas de Pesca Responsable del Golfo de Nicoya” de la Universidad Nacional de Costa Rica. Su objetivo fue conocer la forma en la cual la curricularización de la extensión universitaria brinda aportes en la transformación de los procesos de enseñanza y aprendizaje desde la reconstrucción crítica de las experiencias del estudiantado. Metodológicamente, se trabajó a partir del descubrimiento y la interpretación subjetiva/intersubjetiva de la realidad, lo que conllevó un abordaje dialéctico–materialista. Se utilizaron como instrumentos la entrevista conversacional y talleres participativos. A partir de la aplicación de los instrumentos se construyeron cuatro categorías analíticas, las cuales permitieron demostrar que los y las estudiantes, por medio del acompañamiento social participativo a grupos locales, tienen deconstrucciones sobre aprendizajes tradicionales y que desde su experiencia construyen nuevas formas al establecer espacios de diálogo y relaciones horizontales con las personas de las comunidades, fortaleciendo su formación profesional.

Abstract This article exposes the systematization of the perceptions of the students of the Economic and Social Planning career linked to the project of Extension “Community Management for the productive strengthening of the Marine Areas of Responsible Fishing of Golfo de Nicoya”, it is tried to know the form in which the curricularization of the university extension offers contributions in the transformation of the processes of teaching and learning from the critical reconstruction of the experiences of the student body. Methodologically, the work is based on the discovery and subjective/ intersubjective interpretation of reality, which implies a dialectical–materialistic approach. We used as instruments the conversational interview and the realization of participative workshops. From the application of the instruments, four analytical categories were constructed, which allowed demonstrating that the students, by means of the social participative accompaniment to local groups, have deconstructions on traditional learning and that from their experience they construct new forms when establishing spaces of dialogue and horizontal relations with the people of the communities, strengthening their professional training.

ABSTRACT INTRODUCTION Population aging is a worldwide phenomenon. It is estimated that by 2050, one of five persons will be aged ≥60 years. In Chile, 15.8% of the population is now aged ≥60 years, and this figure will reach 30.7% by 2050. In 2006, a national program was implemented to provide assistive devices to older adults aged ≥65 years with limited mobility or difficulty performing activities of daily living. To date, there have been no assessments of the program’s effectiveness. OBJECTIVE Assess the effectiveness of an assistive devices policy in Chile on improving functional capacity of older adults aged ≥65 years, and beneficiaries’ perceptions of the services received, including changes in their quality of life. METHODS This was a before–after longitudinal study. A cohort of 309 persons was recruited, consisting of patients who received care at a public hospital in Santiago, Chile during 2014–2015. They were assessed before delivery of assistive devices, then followed for seven months, with repeated evaluations made in their homes. The following indicators were measured: functional capacity (Tinetti scale and Barthel Index); changes in perceived quality of life related to use of assistive devices; and other sociodemographic, clinical and protocol-compliance variables. A longitudinal analysis of before–after progress was carried out, as well as a description of service delivery and medical followup. RESULTS Sixty-eight percent of those surveyed were women; median age was 74 years, average schooling was 6 years, and 93% had low income (monthly income <US$398). Assistive devices increased independence in activities of daily living, improved mobility and perceived quality of life, and decreased fall risk and pain. One hundred percent felt satisfied with the service received, 91% were trained in use of the device, and delivery deadlines were met in 83% of cases, but only 2% were followed up. One negative aspect is that the program covers only 25% of estimated need. CONCLUSIONS This assistive device program helps improve functional capacity and perceived quality of life in vulnerable patients who are able to access it. It addresses a real need and is highly valued by patients. Although delivery schedules were fulfilled, followup care schedules were not.

Resumen El objetivo de este estudio fue establecer las relaciones entre habilidades de lenguaje expresivo y receptivo y habilidades prelectoras en niños en edad preescolar. Usando un diseño metodológico empírico observacional de corte transversal se evaluaron las habilidades de lenguaje oral y habilidades fonológicas a un total de 106 preescolares. Los modelos de regresión multivariante señalan que las habilidades expresivas explican una mayor varianza de habilidades fonológicas implicadas en la detección de rimas y sonidos iniciales de las palabras, precursores importantes para el aprendizaje posterior de la lectoescritura.

Abstract The objective of this study was to establish the relationship of receptive and expressive language abilities with pre-reading skills in preschoolers. An observational and cross-sectional study was carried out by evaluating oral language abilities and phonological skills in a total sample of 106 children. Multivariate regression models pointed out that expressive abilities significantly explain the variance of the phonological skills implied in the detection of rhymes and initial phonemes, which are important precursors for the subsequent literacy learning.

ABSTRACT INTRODUCTION Changes in the conceptualization of health and illness have led to development of theory and methods to study health-related quality of life. One instrument used frequently to measure this concept is the SF-12 survey, included in the Second National Health Survey carried out in Chile between 2009 and 2010. OBJECTIVE Estimate the association between socioeconomic status stratifiers and health-related quality of life in the adult population residing in Chile. METHODS We conducted a cross-sectional study of a subsample of the National Health Survey, in the population aged ≥25 years. Health-related quality of life was operationalized from two SF-12 composite scales: physical health-related quality of life and mental health-related quality of life. Both were categorized as good or poor relative to their median scores. Socioeconomic status stratifiers were education, employment status and monthly per capita household income. Multiple logistic regression models were generated for physical health-related quality of life and mental health-related quality of life, according to socioeconomic status stratifiers adjusted for several covariates. RESULTS The sample comprised 4473 respondents, 51.6% women, median age 47.8 years. The probability of poor quality of life was higher in persons with only primary school education, those not in the workforce and those whose monthly income was below 100,815 Chilean pesos (US$140); the effect was stronger for physical health-related quality of life (OR 2.8, 95% CI 1.8–4.2; OR 1.7, 95% CI 1.2–2.3 and OR 2.2, 95% CI 1.3–3.8, respectively) than for mental health-related quality of life (OR 1.4, 95% CI 1.1–1.8; OR 1.6, 95% CI 1.2–2.2 and OR 1.9, 95% CI 1.1—3.0, respectively). CONCLUSIONS The probability of poor health-related quality of life is higher in the worst socioeconomic status strata, and the effect is most pronounced in the most vulnerable groups. The direct effect of social stratifiers on living conditions and access to services—both strong influences on subjective health—would explain this finding and highlight the need to adopt equity-oriented strategies aimed at addressing the impact of socioeconomic status on health-related quality of life.

ABSTRACT INTRODUCTION Health systems are one determinant of health; their role is to facilitate timely and equitable access to quality services. The way in which a health system is organized can profoundly affect achievement of its objectives. The main feature of the Chilean health system is the coexistence of a public health insurance program (based on a social insurance model) with several market-based private health insurance companies. This hybrid structure provides an interesting framework for analyzing and evaluating the system’s effects on health inequalities. OBJECTIVE Assess Chilean public and private health insurance schemes’ performance and its effects on health inequalities. METHODS Public health insurance was compared with private insurance using indicators from 2013 (or the closest year) in the following domains: inputs, outputs (provider visits, discharges), outcomes (coverage) and impact (on health, quality of life, finances and patient satisfaction) as well as demographic and social determinant indicators. A conceptual framework for measuring health system performance was used. Data were obtained from administrative records and population-based surveys. RESULTS The publicly insured population had greater health care needs, was older (aging index 83.4 vs. 36.5) and poorer (17.2% vs. 1.5% below the poverty line) than the population covered by private insurers. The public insurer received average monthly funding of US$50.94 per beneficiary and spent US$51.43, while private insurers on average collected US$94.79 monthly per beneficiary, and spent US$69.63 on health services (excluding medical leave benefits). Private health insurance beneficiaries were more likely than their publicly insured counterparts to access specialized medical services (18.3% vs. 9.3%) and dentists (11.2% vs. 5.9%), have laboratory tests (18.1% vs. 4.8%), and undergo surgery (7.8% vs. 5.9%). Risk factor and disease prevalence was lower among private insurance beneficiaries for 16 of 18 tracer conditions, although age-adjusted differences were not significant. Finally, incidence of catastrophic spending was slightly lower among private insurance beneficiaries (3.7% vs. 4.2%), and a greater proportion of them were satisfied or very satisfied with the health system (37% vs. 17%). CONCLUSIONS The relative youth and better financial status of beneficiaries of private insurers is compatible with selection for lower risk. While private plans offer greater financial protection and receive higher user satisfaction ratings than the public plan, differences in financing between the two types of insurance affect availability and utilization of services. This constitutes a structural problem for the Chilean health system. There is an urgent need to move toward an integrated health system, in which incentives are aligned with social insurance objectives.

Introduction: Meningococcal disease (MD) is a major global problem because of its case fatality rate and sequels. Since 2012 cases of serogroup W have increased in Chile, with nonspecific clinical presentation, high case fatality rate and serious consequences. Objective: To characterize the evolution and outcome of MD cases between January 2012 and March 2013 in Chile. Material and Methods: Case series considering149 MD cases of 7 regions. A questionnaire was applied and clinical records were reviewed, including individual, agent, clinical course and healthcare process variables. The analysis allowed to obtain estimates of the OR as likelihoodof dying. Results: 51.5% was meningococcemia, the case fatality rate reached 27%, prevailing serogroup W (46.6%). Factors that increased the probability of dying: > age, belonging to indigenous people, having lived a stressful event, having diarrhea, impaired consciousness, cardiovascular symptoms, low oxygen saturation and low Glasgow coma scale score. Discussion: The case fatality rate exceeded normal levels and was higher in serogroup W. Increasing in this serogroup, associated to the increased presence of nonspecific symptoms or rapid progression to septicemia, hit a health system accustomed to more classic meningococcal disease presentation, which could partly explain the observed increased fatality rate.

Introducción: La enfermedad meningocóccica (EM) es un importante problema mundial por su letalidad y secuelas. Desde 2012 aumentaron en Chile los casos por serogrupo W, con presentación clínica inespecífica, elevada letalidad y secuelas graves. Objetivo: Caracterizar la evolución y desenlace de EM en casos desde enero de 2012 a marzo de 2013 en Chile. Material y Método: Serie de 149 casos de EM de siete regiones. Se aplicó un cuestionario y se revisaron registros clínicos, incluyendo variables del individuo, agente, curso clínico y proceso de atención. Los análisis permitieron obtener OR como estimadores de la probabilidad de fallecer. Resultados: El 51,5% se presentó como meningococcemia, la letalidad alcanzó a 27%, predominando el serogrupo W (46,6%). Aumentaron la probabilidad de fallecer: una mayor edad, pertenencia a pueblos originarios, haber vivido evento estresante, presentar diarrea, compromiso de conciencia, síntomas cardiovasculares, baja saturación de oxígeno y bajo puntaje de Glasgow. Discusión: La letalidad superó las frecuencias habituales y fue mayor en el serogrupo W. El aumento de este serogrupo, asociado a la mayor presencia de síntomas inespecíficos o a la rápida progresión a septicemia, impactó en un sistema de salud habituado a cuadros más clásicos de EM, lo que podría explicar en parte, la mayor letalidad observada.

The enzymatic additives obtained in fermentation processes are commonly incorporated in the diet of monogastric animals to improve feed conversion. The purpose of this study was to obtain two enzymatic additives for animal feed by solid state fermentation (SSF) and submerged fermentation (SF) by Aspergillus niger ANM-1 in a culture medium based on wheat bran. It was evaluated the effect of medium supplementation with various carbon sources on cellulase or endo b-1, 4-glucanases (EC 3.2.1.4) activity induction. It was noted that both types of cultivation procedures increased enzymatic activity (30.05 IU/mL (SS) and 20.85 IU/mL (SSF)) in the mediums without supplementation (P<0.05). There were no statistically significant differences in the effect of level of supplementation on the processes studied. The type of fermentation used was the most influential factor. The solid state process favored enzymatic activity of A. niger ANM-1 (P <0.01). Two multi-enzymatic additives were obtained through scaling of the fermenting processes. The additive obtained by SSF presented the highest enzymatic activities, larger content of proteins (37.49%) and lower requirements in electric power.

El absceso hepático piógeno en el período neonatal es una entidad poco habitual y con desenlace fatal en la mayoría de los casos. Se presenta la evolución clínica, radiológica, ecosonográfica y tomográfica de un recién nacido portador de un absceso hepático, el primero diagnosticado en la Maternidad "Concepción Palacios", localizado en lóbulo derecho, único secundario a cateterismo venoso. Se describe el manejo con antibióticoterapia de amplio espectro, sin necesidad de hepatocentesis (drenaje percutáneo), ni abordaje quirúrgico. Con evolución clínica satisfactoria.

Hepatic pyogen abscess in the neonatal period is very rare and in most cases fatal. We hereby present the clinical, radiological, ultrasound and tomographical studies of the first case diagnosed in the "Conception Palacios" Maternity. A newborn with hepatic abscess, localized in the right lobe, unique, as a consequence of venous catheterism. We describe management with wide spectrum antibiotic therapy, without surgical treatment. Clinical evolution was satisfactory.

When it is necessary to determine the susceptibility of Neisseria meningitidis (Nm) strains to antimicrobial drugs, it is important to consider that it should be analyzed in a double context. One of them related to the use of drugs in a specific medical treatment; and the other; to chemoprophylatic drugs, both with the same purpose: the accurate selection of the “in vivo” antimicrobial agent. This requires the study of the sensitivity and resistance of strains isolated in both carriers and patients. With the aim of further studying the behavior of the strains that currently circulate in Cuba, an antimicrobial drug susceptibility study was conducted in 90 strains isolated from carriers during the first half of 1998. The agar dilution method was used to determine the minimum inhibitory concentrations (MICs) to: penicillin, ampicillin, rifampin, sulfadiazine, chloramphenicol, ciprofloxacin, ceftriaxone, cefotaxime. The study of the three latter drugs was done for the first time in our country. The search for β- lactamase-producer strains was also performed. There was a predominance of penicillin sensitive strains (82,2%) with an intermediate sensitivity to ampicillin (57,8%), while 70% of the strains were sensitive to sulfadiazine. Regarding the rest of the antimicrobial drugs, 100% of the strains were sensitive. The paper shows the MICs for each drug as well as the phenotypic characteristics of the strains with the penicillin and sulfadiazine sensitivity and resistance patterns. No β-lactamase-producer strains were found.

Cuando se necesita conocer la susceptibilidad de Neisseria meningitidis (Nm) a las drogas antimicrobianas, se debe tener en cuenta que ésta se sitúa en un doble contexto: el relacionado con las drogas utilizadas en el tratamiento médico específico y el quimioprofiláctico, ambos con un mismo objetivo, la selección correcta del antimicrobiano in vivo. Esto obliga a estudiar de forma sistemática, la sensibilidad y resistencia de cepas aisladas en enfermos y portadores. Con el propósito de profundizar en el comportamiento de las cepas que circulan en Cuba actualmente, se realizó un estudio de susceptibilidad antimicrobiana a 90 cepas aisladas en portadores durante el primer semestre de 1998. Se utilizó el método de dilución en agar, determinando las concentraciones mínimas inhibitorias (CMIs) a: penicilina, ampicilina, rifampicina, sulfadiacina sódica, cloranfenicol, ciprofloxacina, ceftriaxona y cefotaxima. Los resultados de Nm in vitro a estas tres últimas drogas se conocen por primera vez en nuestro país. Se realizó también la búsqueda de cepas productoras de β-lactamasa. Predominaron las cepas sensibles a penicilina (82,2%) y con susceptibilidad intermedia a ampicilina (57,8%), mientras que, a sulfadiacina sódica el 70% de las cepas resultaron resistentes. El 100% de las cepas fueron sensibles al resto de los antimicrobianos.Se presentan las CMIs para cada droga y se relacionan las características fenotípicas de las cepas con los patrones de sensibilidad y resistencia a penicilina y sulfadiacina sódica. No se detectaron cepas productoras de β-lactamasa.