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IMPORTANCE: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterized by progressive degeneration of upper and lower motor neurons at the spinal or bulbar level. OBJECTIVE: We aim to describe the most frequent otolaryngology (ORL) complaints and voice disturbances in patients with bulbar onset ALS. DESIGN: Retrospective cohort study. SETTING: Single-center study with combined ORL and ALS clinic evaluation. PARTICIPANTS: Patients with a confirmed diagnosis of ALS following an ORL visit and who underwent comprehensive voice assessments between January 2021 and January 2023. EXPOSURE: Objective voice assessments. MAIN OUTCOMES AND MEASURES: Glottal functional index (GFI), voice handicap index (VHI), reflux system index (RSI), and voice quality characteristics such as shimmer, jitter, maximum phonation time (MPT), and other essential parameters were assessed. RESULTS: One hundred and thirty-three patients (age 62.17 ± 10.79, 54.48% female) were included. Three patients were referred from the ORL department to the ALS clinic. The most frequent symptoms were; dysphagia, dysarthria, facial weakness, pseudobulbar affect, and sialorrhea. The mean of forced vital capacity was 59.85%, EAT-10 15.91 ± 11.66, RSI 25.84 ± 9.03, GFI 14.12 ± 5.58, VHI-10 42.81 ± 34.94, MPT 15.22 s ± 8.06. Many patients reported voice impairments mainly related to spastic dysarthria and the combination of lower and upper motor neuron dysarthria, hypernasality, reduced verbal expression, and articulatory accuracy. Shimmer was increased to 8.46% ± 7.20, and jitter to 2.26% ± 1.39. CONCLUSIONS AND RELEVANCE: Based on our cohort, this population with bulbar onset ALS has a higher frequency of voice disturbance characterized by hypernasality, spastic dysarthria, and reduced verbal expression. LEVEL OF EVIDENCE: Level 3.

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Objetivos: Validar transculturalmente para contexto chileno, cuestionario en inglés que evalúa competencias comunicacionales empleadas por el odontólogo con sus pacientes. Métodos: Se realizaron seis etapas: traducción, panel de expertos, entrevistas cognitivas, adaptación en línea, método test y re-test, evaluando la consistencia interna y estabilidad, y retrotraducción al inglés. Se realizó un análisis descriptivo de las variables sociodemográficas y un análisis descriptivo de los ítems del cuestionario considerando la media de las puntuaciones, desviación estándar y proporción de respuestas positivas, neutras y negativas. Resultados: 70 participantes contestaron el cuestionario (42 mujeres y 28 hombres, edad promedio 38 años). Las entrevistas cognitivas y comité de expertos permitieron hacer adaptaciones a la cultura chilena. Con respecto a la consistencia interna y estabilidad del cuestionario, el valor obtenido para α-Cronbach fue mayor a 72% y λ-Guttman mayor a 81%. Para la estabilidad del cuestionario el coeficiente de correlación Spearman fue de 72% y los coeficientes de concordancia fueron mayores a 76% (valor-p<0,05). Conclusiones: El cuestionario sobre la literacidad de salud oral en el contexto chileno es válido desde la perspectiva de la adaptación transcultural y confiable desde la perspectiva de la consistencia interna y estabilidad.

Objectives: Transcultural validation of a survey in the Chilean context that assesses communication skills of dentists with patients, from English to Spanish. Methods: The process considered six stages: translation, a panel of experts, cognitive interviews, online adaptation, test and re-test practice to assess internal consistency and stability, and finally, back-translation into English. The method included the analysis of the sociodemographic variables and a descriptive analysis of the questionnaire items, considering the mean of the scores, standard deviation, and proportion of positive, neutral, and negative responses. Results: 70 participants answered the questionnaire (42 women and 28 men, average age 38 years). The cognitive interviews and the suggestions of the panel of experts allowed for some changes to better adapt to the Chilean culture. Regarding the internal consistency and stability of the questionnaire, the value obtained for α-Cronbach was greater than 72% and for λ-Guttman greater than 81%. Furthermore, the Spearman correlation coefficient was 72%, and the concordance coefficients were higher than 76% (p-value <0.05). Conclusions: The questionnaire on health literacy in the Chilean context is valid from the perspective of cross-cultural adaptation and reliable from the internal consistency and stability standpoint.

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Phosphorus (as phosphate, Pi) and iron (Fe) are critical nutrients in plants that are often poorly available in the soil and can be microbially affected. This work aimed to evaluate how plant-rhizobacteria interaction changes due to different Pi or Fe nutritional scenarios and to study the underlying molecular mechanisms of the microbial modulation of these nutrients in plants. Thus, three proteobacteria (Paraburkholderia phytofirmans PsJN, Azospirillum brasilense Sp7, and Pseudomonas putida KT2440) were used to inoculate Arabidopsis seeds. Additionally, the seeds were exposed to a nutritional factor with the following levels for each nutrient: sufficient (control) or low concentrations of a highly soluble source or sufficient concentrations of a low solubility source. Then, the effects of the combinatorial factors were assessed in plant growth, nutrition, and genetic regulation. Interestingly, some bacterial effects in plants depended on the nutrient source (e.g., increased aerial zones induced by the strains), and others (e.g., decreased primary roots induced by Sp7 or KT2440) occurred regardless of the nutritional treatment. In the short-term, PsJN had detrimental effects on plant growth in the presence of the low-solubility Fe compound, but this was not observed in later stages of plant development. A thorough regulation of the phosphorus content was detected in plants independent of the nutritional treatment. Nevertheless, inoculation with KT2440 increased P content by 29% Pi-deficiency exposed plants. Conversely, the inoculation tended to decrease the Fe content in plants, suggesting a competition for this nutrient in the rhizosphere. The P-source also affected the effects of the PsJN strain in a double mutant of the phosphate starvation response (PSR). Furthermore, depending on the nutrient source, PsJN and Sp7 strains differentially regulated PSR and IAA- associated genes, indicating a role of these pathways in the observed differential phenotypical responses. In the case of iron, PsJN and SP7 regulated iron uptake-related genes regardless of the iron source, which may explain the lower Fe content in inoculated plants. Overall, the plant responses to these proteobacteria were not only influenced by the nutrient concentrations but also by their availabilities, the elapsed time of the interaction, and the specific identities of the beneficial bacteria. Graphical AbstractThe effects of the different nutritional and inoculation treatments are indicated for plant growth parameters (A), gene regulation (B) and phosphorus and iron content (C). Figures created with BioRender.com with an academic license.

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Coastal zones are complex systems where sustainability needs local participative governance, whose absence may result in conflicts between social actors. In its absence, the first step should be a diagnosis of the current situation based on integrative conceptual frameworks such as the DPSIR. However, in conflicting situations, the generated model needs validation from social actors. Chiloé Island is a critical Chilean coastal fishery and aquaculture area, coexisting with subsistence and cultural uses of marine resources. This article analyzes the current ecological state of the Chiloé coastal zone and its main social-ecological impact using a DPSIR model. We validated its results through a household survey and interviews with local experts and social actors. Results show that increased coastal fisheries and aquaculture generate a critical decrease of coastal species, eutrophication, and pollution that, along with harmful algal blooms, generate conflicts. Social validation showed that experts and local social actors have different perceptions of conflicting parties and conflict solutions. Following a post-normal approach, we propose three ideas to start social-ecological governance of Chiloé coastal marine ecosystems.

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RESUMEN: Los determinantes sociales de salud impactan significativamente en la salud oral. El rol de las madres es relevante en la salud de sus hijos. Objetivo: Conocer prácticas en salud oral de madres e hijos de 2 a 5 años en sus hogares, sus experiencias, logros y dificultades. Diseño: Estudio cualitativo con análisis de entrevistas en profundidad a 20 cuidadoras que asisten a Centros de Salud Familiar de la Región Metropolitana de Santiago. Resultados: Las cuidadoras se sienten responsables por la salud oral en sus hijos; padre y niño parecieran asumir roles más pasivos. Valoran la atención odontológica en el CESFAM pero les preocupa qué pasará a largo plazo. La salud oral se relaciona con estética y mejores oportunidades laborales. Valoran los dientes primarios, pero aún más los definitivos, aunque sin creer que estos permanezcan en boca toda la vida. Las cuidadoras manejan correcta información sobre cómo cuidar la salud oral. Esperan evitar experiencias negativas odontológicas en sus hijos. Conclusión: Las estrategias clínicas y educativas odontológicas, debieran considerar los contextos sociales de los niños, trabajando colaborativamente junto a sus madres. Es relevante avanzar en cómo los determinantes sociales afectan la salud oral.

ABSTRACT: Social determinants have a fundamental impact on oral health, which includes oral health care habits. Caregivers can be a key factor to develop them in their children. Objective: Understand the oral health care practices of caregivers and children aged 2 to 5 years in their homes, recognizing their experiences, achievements, and difficulties. Design: Qualitative study obtained in in-depth interviews with 20 caregivers, attending family health centers in the Santiago Metropolitan Region. Results: Caregivers feel responsible for their children's oral health care, while fathers and children seem to have a more passive role than the mother. They value dental care at CESFAM, but they are worried about their future long-term care. Oral health is related to aesthetics and better job opportunities. The primary teeth are essential, but permanents are more relevant; however, they do not believe that they remain in mouth for life. Caregivers handle correct information about oral health care. They hope that their children will not live negative dental experiences. Conclusion: The clinical and educational dentistry strategies should consider the children's social environment, and working as a teamwork with caregivers. It is relevant to conduct further studies on how social determinants affect oral health.

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