Search

Abstract Background Ashbya gossypii is a filamentous fungus widely utilized for industrial riboflavin production and has a great potential as a microbial chassis for synthesizing other valuable metabolites such as folates, biolipids, and limonene. Engineered strains of A. gossypii can effectively use various waste streams, including xylose-rich feedstocks. Notably, A. gossypii has been identified as a proficient biocatalyst for producing limonene from xylose-rich sources. This study aims to investigate the capability of engineered A. gossypii strains to produce various plant monoterpenes using agro-industrial waste as carbon sources. Results We overexpressed heterologous terpene synthases to produce acyclic, monocyclic, and bicyclic monoterpenes in two genetic backgrounds of A. gossypii. These backgrounds included an NPP synthase orthogonal pathway and a mutant erg20 F95W allele with reduced FPP synthase activity. Our findings demonstrate that A. gossypii can synthesize linalool, limonene, pinene, and sabinene, with terpene synthases showing differential substrate selectivity for NPP or GPP precursors. Additionally, co-overexpression of endogenous HMG1 and ERG12 with heterologous NPP synthase and terpene synthases significantly increased sabinene yields from xylose-containing media. Using mixed formulations of corn-cob lignocellulosic hydrolysates and either sugarcane or beet molasses, we achieved limonene and sabinene productions of 383 mg/L and 684.5 mg/L, respectively, the latter representing a significant improvement compared to other organisms in flask culture mode. Conclusions Engineered A. gossypii strains serve as a suitable platform for assessing plant terpene synthase functionality and substrate selectivity in vivo, which are crucial to understand monoterpene bioproduction. The NPP synthase pathway markedly enhances limonene and sabinene production in A. gossypii, achieving levels comparable to those of other industrial microbial producers. Furthermore, these engineered strains offer a novel approach for producing monoterpenes through the valorization of agro-industrial wastes.

The pathogenesis of frontal fibrosing alopecia has been linked to specific genetic variants. CYP1B1 codes for a component of the cytochrome p450 machinery that is involved in the metabolism of xenobiotic oestrogens. The study of the prevalence of polymorphisms in this gene may help to understand their role in the development of frontal fibrosing alopecia. The aim of this study is to describe the frequency of genetic variations in the alleles HLA-B*07:02 and CYP1B1 in patients with frontal fibrosing alopecia. A cross-sectional study was designed to evaluate blood samples from patients with frontal fibrosing alopecia who attended the Dermatology Department at University Hospital Ramón y Cajal (Madrid, Spain), in search of the polymorphisms rs9258883 and rs1800440 in the alleles HLA-B*07:02 and CYP1B1, respectively. A total of 223 patients were included in the study. Among the 83.8% of patients who carried the rs9258883 polymorphism in HLA-B*07:02, 58.7% were heterozygous for this variant and it was not present in 14.8% of the cases. The majority of patients with frontal fibrosing alopecia lacked the protective rs1800440 polymorphism in CYP1B1 (75.2%). This suggests a relevant role of this variant in development of frontal fibrosing alopecia. The genetic approach to this condition might influence patient prognosis and therapy options.

Abstract Background Limonene is a cyclic monoterpene that has applications in the food, cosmetic, and pharmaceutical industries. The industrial production of limonene and its derivatives through plant extraction presents important drawbacks such as seasonal and climate issues, feedstock limitations, low efficiency and environmental concerns. Consequently, the implementation of efficient and eco-friendly bioprocesses for the production of limonene and other terpenes constitutes an attractive goal for microbial biotechnology. In this context, novel biocatalysts with the ability to produce limonene from alternative carbon sources will help to meet the industrial demands of limonene. Results Engineered strains of the industrial fungus Ashbya gossypii have been developed to produce limonene from xylose. The limonene synthase (LS) from Citrus limon was initially overexpressed together with the native HMG1 gene (coding for HMG-CoA reductase) to establish a limonene-producing platform from a xylose-utilizing A. gossypii strain. In addition, several strategies were designed to increase the production of limonene. Hence, the effect of mutant alleles of ERG20 (erg20 F95W and erg20 F126W ) were evaluated together with a synthetic orthogonal pathway using a heterologous neryl diphosphate synthase. The lethality of the A. gossypii double mutant erg20 F95W−F126W highlights the indispensability of farnesyl diphosphate for the synthesis of essential sterols. In addition, the utilization of the orthogonal pathway, bypassing the Erg20 activity through neryl diphosphate, triggered a substantial increase in limonene titer (33.6 mg/L), without critically altering the fitness of the engineered strain. Finally, the overexpression of the native ERG12 gene further enhanced limonene production, which reached 336.4 mg/L after 96 h in flask cultures using xylose as the carbon source. Conclusions The microbial production of limonene can be carried out using engineered strains of A. gossypii from xylose-based carbon sources. The utilization of a synthetic orthogonal pathway together with the overexpression of ERG12 is a highly beneficial strategy for the production of limonene in A. gossypii. The strains presented in this work constitute a proof of principle for the production of limonene and other terpenes from agro-industrial wastes such as xylose-rich hydrolysates in A. gossypii.

Abstract In 2016, the WHO included haemoglobin values within normal ranges as a diagnostic criterion for Polycythaemia Vera (PV). Since then, concerns have arisen that a large number of patients are undergoing unnecessary screening for PV. To address this issue, we estimated the prevalence of JAK2 p.V617F in individuals with elevated haemoglobin or haematocrit and developed and validated a screening algorithm for PV. A total of 15,366 blood counts performed in seven non-consecutive days were reviewed, of which 1001 were selected for subsequent JAK2 p.V617F mutation screening. Eight (0.8%) new JAK2 p.V617F-mutated cases were detected. From ROC curves, a two-step algorithm was developed based on the optimal cut-off for the detection of the JAK2 p.V617F mutation. The algorithm was prospectively validated in an independent cohort of 15,298 blood counts. A total of 1595 (10.4%) cases met the criterion for haemoglobin or haematocrit, of whom 581 passed to step 2 (3.8% of the total). The JAK2 p.V617F mutation was detected in 7 of the 501 patients tested, which accounts for 0.04% of the total cohort and 0.4% of patients with erythrocytosis. In conclusion, this data show that our two-step algorithm improves the selection of candidates for JAK2 p.V617F testing.

Abstract Background Inflammatory pseudotumour has been used to describe an inflammatory or fibrosing tumoral process of an undetermined cause that may involve a variety of organ systems, including the lungs, spleen, liver, lymph nodes, pancreas and extrahepatic bile duct with potential for recurrence and persistent local growth. In this article, we report a patient with a big mass of uncertain nature and behavior. Case presentation A 60-year-old woman presented with a 1-week history of abdominal pain, fever and jaundice. Six months before she had had right upper quadrant pain that was interpreted as biliary colic. A contrast-enhanced CT scan showed a big mass of soft tissue with diffuse infiltration of the gallbladder, displacement of the transverse colon, hepatic flexure and duodenum. For diagnostic distinction between a chronic inflammatory disease or a neoplasm, exploratory laparotomy was required. Intraoperative exploration disclosed a big mass of hard texture involving the gallbladder, with multiple concrements, hepatoduodenal ligament, right and transverse mesocolon, stomach and duodenum. Cholecystectomy was performed, preserving adjacent organs with macroscopic desmoplastic reaction. Histopathologic examination of the gallbladder showed a spindle cell proliferation with diffuse chronic inflammatory infiltrate of lymphocytes, plasma cells and hyalinized fibrous stroma. No vascular invasion or cellular atypia were evident. Conclusion Inflammatory pseudotumour is a rare condition and diagnostic distinction from a chronic inflammatory disease or other neoplasm is only possible by histopathologic examination. There is a limited number of case reports in the literature indicating tumor location in the gallbladder.

Gangliosides are glycolipids occurring in higher animals, with a sphingoid core in the form of ceramide, bound to a glycan moiety including several units of sialic acid. Gangliosides are involved in important (patho)-physiological processes as components of cell membranes in humans, which has led to intensive study and interest in production strategies. Their structural variability depends on the combination of a sphingoid base, a fatty acyl chain, and an attached oligosaccharide. The combinatorial diversity differs and grows exponentially in synthetic biology approaches, e.g., use of microbial cell factories. A specific analytical platform accounting for this complexity is not available to date. However, quantification of the intermediates of the whole biosynthetic route is needed to boost projects on biotechnological ganglioside production. In this study, a fast high-throughput quantitative LC-MS/MS methodology was developed to cover analysis of gangliosides, with a wider structural perspective adapted to fungal organisms. This work was achieved using metabolically engineered strains that further allowed to test detection in biological complex matrixes. Ganglioside backbones—hitherto uncharacterized—with the five most common fungal sphingoid bases and both simple and hydroxylated fatty acids were subjected to characterization. The addition of glycans to the polar head was also successfully monitored with up to 4 units—corresponding to GD3 which bears two sialic acid units and furthermore represents the common precursor for the whole ganglio-series. This platform represents an improved methodology to study the biochemical diversity associated to gangliosides for natural and metabolically engineered biosynthetic pathways.

Abstract Lysosomal diseases (LD) are a group of about 70 rare hereditary disorders (combined incidence 1:5000) in which diverse lysosomal functions are impaired, impacting multiple organs and systems. The first clinical signs and symptoms are usually unspecific and shared by hundreds of other disorders. Diagnosis of LD traditionally relies on performing specific enzymatic assays, if available, upon clinical suspicion of the disorder. However, the combination of the insidious onset of LD and the lack of awareness on these rare diseases among medical personnel results in undesirable diagnostic delays, with unchecked disease progression, appearance of complications and a worsened prognosis. We tested the usefulness of a next‐generation sequencing‐based gene panel for quick, early detection of LD among cases of idiopathic splenomegaly and/or thrombocytopenia, two of the earliest clinical signs observed in most LD. Our 73‐gene panel interrogated 28 genes for LD, 1 biomarker and 44 genes underlying non‐LD differential diagnoses. Among 38 unrelated patients, we elucidated eight cases (21%), five with LD (GM1 gangliosidosis, Sanfilippo disease A and B, Niemann‐Pick disease B, Gaucher disease) and three with non‐LD conditions. Interestingly, we identified three LD patients harboring pathogenic mutations in two LD genes each, which may result in unusual disease presentations and impact treatment. Turnaround time for panel screening and genetic validation was 1 month. Our results underline the usefulness of resequencing gene panels for quick and cost‐effective screening of LDs and disorders sharing with them early clinical signs.

Summary The filamentous fungus Ashbya gossypii is currently used for the industrial production of vitamin B2. Furthermore, the ability of A. gossypii to grow using low‐cost substrates together with the inexpensive downstream processing makes this fungus an attractive biotechnological chassis. Indeed, the production in A. gossypii of other high‐added value compounds such as folic acid, nucleosides and biolipids has been described. Hence, the development of new methods to expand the molecular toolkit for A. gossypii genomic manipulation constitutes an important issue for the biotechnology of this fungus. In this work, we present a one‐vector CRISPR/Cas9 system for genomic engineering of A. gossypii. We demonstrate the efficiency of the system as a marker‐less approach for nucleotide deletions and substitutions both with visible and invisible phenotypes. Particularly, the system has been validated for three types of genomic editions: gene inactivation, the genomic erasure of loxP scars and the introduction of point mutations. We anticipate that the use of the CRISPR/Cas9 system for A. gossypii will largely contribute to facilitate the genomic manipulations of this industrial fungus in a marker‐less manner.

The CRISPR/Cas9 system is a novel genetic tool which allows the precise manipulation of virtually any genomic sequence. In this protocol, we use a specific CRISPR/Cas9 system for the manipulation of Ashbya gossypii. The filamentous fungus A. gossypii is currently used for the industrial production of riboflavin (vitamina B2). In addition, A. gossypii produces other high-value compounds such as folic acid, nucleosides and biolipids. A large molecular toolbox is available for the genomic manipulation of this fungus including gene targeting methods, rapid assembly of heterologous expression modules and, recently, a one-vector CRISPR/Cas9 editing system adapted for A. gossypii that allows marker-free engineering strategies to be implemented. The CRISPR/Cas9 system comprises an RNA guided DNA endonuclease (Cas9) and a guide RNA (gRNA), which is complementary to the genomic target region. The Cas9 nuclease requires a 5′-NGG-3′ trinucleotide, called protospacer adjacent motif (PAM), to generate a double-strand break (DSB) in the genomic target, which can be repaired with a synthetic mutagenic donor DNA (dDNA) by homologous recombination (HR), thus introducing a specific designed mutation. The CRISPR/Cas9 system adapted for A. gossypii largely facilitates the genomic edition of this industrial fungus.

Background: The 5-year survival rate of patients with pancreatic ductal adenocarcinoma (PDAC) is around 5% due to the fact that the majority of patients present with advanced disease that is treatment resistant. Familial pancreatic cancer (FPC) is a rare disorder that is defined as a family with at least two affected first degree relatives, with an estimated incidence of 4%–10%. The genetic basis is unknown in the majority of families although around 10%–13% of families carry germline mutations in known genes associated with hereditary cancer and pancreatitis syndromes. Methods: Panel sequencing was performed of 35 genes associated with hereditary cancer in 43 PDAC cases from families with an apparent hereditary pancreatic cancer syndrome. Findings: Pathogenic variants were identified in 19% (5/26) of PDAC cases from pure FPC families in the genes MLH1, CDKN2A, POLQ and FANCM. Low frequency potentially pathogenic VUS were also identified in 35% (9/26) of PDAC cases from FPC families in the genes FANCC, MLH1, PMS2, CFTR, APC and MUTYH. Furthermore, an important proportion of PDAC cases harboured more than one pathogenic, likely pathogenic or potentially pathogenic VUS, highlighting the multigene phenotype of FPC. Interpretation: The genetic basis of familial or hereditary pancreatic cancer can be explained in 21% of families by previously described hereditary cancer genes. Low frequency variants in other DNA repair genes are also present in 35% of families which may contribute to the risk of pancreatic cancer development. Funding: This study was funded by the Instituto de Salud Carlos III (Plan Estatal de I + D + i 2013–2016): ISCIII (PI09/02221, PI12/01635, PI15/02101 and PI18/1034) and co-financed by the European Development Regional Fund ‘‘A way to achieve Europe’’ (ERDF), the Biomedical Research Network in Cancer: CIBERONC (CB16/12/00446), Red Temática de investigación cooperativa en cáncer: RTICC (RD12/0036/0073) and La Asociación Española contra el Cáncer: AECC (Grupos Coordinados Estables 2016). Keywords: Familial pancreatic cancer, Panel sequencing, DNA repair and hereditary cancer genes, Pathogenic variants

Objetivo: Conocer el significado que otorga el usuario mapuche, adscrito al Programa Salud Cardiovascular 2016, Consultorio Makewe, Temuco, Chile, a la hipertensión arterial. Metdología: Investigación bajo el paradigma cualitativo, con base en la teoría fundamentada. La muestra fue conformada por veintidós usuarios, no probabilística, intencionada de casos por criterios y conveniencia, de acuerdo con criterios de inclusión. La recolección de información se hizo mediante dos grupos focales y ocho entrevistas en profundidad, hasta llegar al punto de saturación, previa firma de consentimiento informado. El análisis se caracterizó por ser dinámico y creativo, basado en la estrategia de método comparativo constante, realizando codificación y análisis simultáneo. La validez se comprobó con criterios de rigor y fue triangulada por investigadores. La investigación fue autorizada por el Comité Ético Científico de la Universidad de La Frontera. Resultados: Para hipertensión arterial emergieron cuatro categorías: “Significado” (definición del concepto), “Causa” (percepción), “Convivir” (cambios) y “Tratamiento” (farmacológico, herbolaria, machi —curandera o consejera—). Conclusiones: Sin haber definido la patología, los mapuches la asocian a signos, síntomas y causas; confían en tratamientos otorgados por un equipo de salud, pero no en las/los machis, reconociendo algunas de ellas como buenas, las que por alta demanda y costo son inaccesibles. En general, se ha descuidado la Ley Indígena 19253 de 1993, que da lugar a la institucionalización del Programa de Salud con Población Mapuche (promap), dependiente del Servicio de Salud Araucanía.

Ashbya gossypii is a filamentous fungus that is currently exploited for the industrial production of riboflavin. In addition, metabolically engineered strains of A. gossypii have also been described as valuable biocatalysts for the production of different metabolites such as folic acid, nucleosides, and biolipids. Hence, bioproduction in A. gossypii relies on the availability of well-performing gene expression systems both for endogenous and heterologous genes. In this regard, the identification of novel promoters, which are critical elements for gene expression, decisively helps to expand the A. gossypii molecular toolbox. In this work, we present an adaptation of the Dual Luciferase Reporter (DLR) Assay for promoter analysis in A. gossypii using integrative cassettes. We demonstrate the efficiency of the analysis through the identification of 10 new promoters with different features, including carbon source-regulatable abilities, that will highly improve the gene expression platforms used in A. gossypii. Three novel strong promoters (PCCW12, PSED1, and PTSA1) and seven medium/weak promoters (PHSP26, PAGL366C, PTMA10, PCWP1, PAFR038W, PPFS1, and PCDA2) are presented. The functionality of the promoters was further evaluated both for the overexpression and for the underexpression of the A. gossypii MSN2 gene, which induced significant changes in the sporulation ability of the mutant strains.

Background: Amongst others, cocaine consumption has a detrimental effect in the vascular supply to the mesenteric area causing abdominal ischemic changes. Early recognition of these changes and adequate treatment are essential to avoid serious complications and possible death of the patient from sepsis. Case report: In this case study, the subject is a 40-years-old gentleman presenting with acute abdominal pain due to multiple ischemic changes in both small bowel and sigmoid loops. The patient required emergency surgical intervention consisting of bowel resection and anastomosis. The pathologic analysis of the segment showed transmural necrosis and necrotizing phlebitis caused by the ingestion of drugs or toxic agents. The patient later confirmed the habitual consumption of cocaine. Discussion: The increase in cocaine consumption and other recreational toxins substructed from erythroyilon coca alcaloids amongst young people have generated a large number of admissions to Hospital Accident and Emergency Departments with patients complaining of acute abdominal pain. In many of these cases, surgical intervention is required and in some cases patients will sadly die without a proper diagnosis. Some of the most common effects of cocaine and its compounds includes; hollow viscus perforation, gastro-intestinal bleed, and other vascular problems such as enteritis and ischemic colitis. It appears clear that there is a great need for an advance history taking of these patients and their habit to cocaine and other drugs together with a urine test for drug screening. These together with a suspicion of a non- occlusive ischemic bowel caused by the effects of cocaine in young adults with no cardiac risk factors will guide clinicians and establish, and plan the correct treatment for these categories of patients.

Se presenta una metodología aplicada al análisis técnico y fundamental del mercado bursátil, como herramienta facilitadora (aunque no omnipotente), para reducir la incertidumbre sobre el efecto del riesgo (sistemático y no sistemático) en el proceso de toma de decisiones sobre inversiones

BACKGROUND: To investigate the effects of a caffeine-containing energy drink on soccer performance during a simulated game. A second purpose was to assess the post-exercise urine caffeine concentration derived from the energy drink intake. METHODOLOGY/PRINCIPAL FINDINGS: Nineteen semiprofessional soccer players ingested 630 ± 52 mL of a commercially available energy drink (sugar-free Red Bull®) to provide 3 mg of caffeine per kg of body mass, or a decaffeinated control drink (0 mg/kg). After sixty minutes they performed a 15-s maximal jump test, a repeated sprint test (7 × 30 m; 30 s of active recovery) and played a simulated soccer game. Individual running distance and speed during the game were measured using global positioning satellite (GPS) devices. In comparison to the control drink, the ingestion of the energy drink increased mean jump height in the jump test (34.7 ± 4.7 v 35.8 ± 5.5 cm; P

Con el fin de evaluar el efecto de la complementación con heno-melaza-urea sobre la ganancia de peso, duración de lactancia y producción láctea en 31 cabras criollas, se realizó un ensayo en San José de los Ranchos, municipio Torres del estado Lara, Venezuela. Las cabras, con un peso vivo promedio de 28,87 Ó 2 Kg., fueron sometidas a través de un diseño completamente aleatorizado a los siguientes tratamientos, To: Testigo (pastoreo y ramoneo de especies nativas exclusivamente); T1: To + heno (55,55%)-melaza (44,45%) y T2: To + heno (53,19%)-melaza (42,55%)-urea (4,26%), siendo complementados ambos grupos cuando los animales eran encorralados durante la noche. Se obtuvieron diferencias significativas (P0,05), con medias de 16,30; 17,51 y 18,70 Kg./ semana y 9,00; 8,43 y 9,00 semanas para To, T1 y T2, respectivamente. Se puede concluir que la complementación con heno-melaza-urea constituye una fuente nutricional potencial para recuperar la condición corporal de cabras criollas lactantes, manejadas en condiciones extensivas similares a las descritas en este ensayo

Se presenta una metodología aplicada al análisis técnico y fundamental del mercado bursátil, como herramienta facilitadora (aunque no omnipotente), para reducir la incertidumbre sobre el efecto del riesgo (sistemático y no sistemático) en el proceso de toma de decisiones sobre inversiones.

BackgroundOutdoor secondhand smoke (SHS) concentrations are usually lower than indoor concentrations, yet some studies have shown that outdoor SHS levels could be comparable to indoor levels under specific conditions. The main objectives of this study were to assess levels of SHS exposure in terraces and other outdoor areas of hospitality venues and to evaluate their potential displacement to adjacent indoor areas.MethodsNicotine and respirable particles (PM2.5) were measured in outdoor and indoor areas of hospitality venues of 8 European countries. Hospitality venues of the study included night bars, restaurants and bars. The fieldwork was carried out between March 2009 and March 2011.ResultsWe gathered 170 nicotine and 142 PM2.5 measurements during the study. The median indoor SHS concentration was significantly higher in venues where smoking was allowed (nicotine 3.69 µg/m3, PM2.5: 120.51 µg/m3) than in those where smoking was banned (nicotine: 0.48 µg/m3, PM2.5: 36.90 µg/m3). The median outdoor nicotine concentration was higher in places where indoor smoking was banned (1.56 µg/m3) than in venues where smoking was allowed (0.31 µg/m3). Among the different types of outdoor areas, the highest median outdoor SHS levels (nicotine: 4.23 µg/m3, PM2.5: 43.64 µg/m3) were found in the semi-closed outdoor areas of venues where indoor smoking was banned.ConclusionsBanning indoor smoking seems to displace SHS exposure to adjacent outdoor areas. Furthermore, indoor settings where smoking is banned but which have a semi-closed outdoor area have higher levels of SHS than those with open outdoor areas, possibly indicating that SHS also drifts from outdoors to indoors. Current legislation restricting indoor SHS levels seems to be insufficient to protect hospitality workers--and patrons--from SHS exposure. Tobacco-free legislation should take these results into account and consider restrictions in the terraces of some hospitality venues to ensure effective protection.

El artículo aborda el trabajo remunerado en la vejez como fenómeno complejo, para enriquecer la discusión de la Terapia Ocupacional y los estudios sobre la ocupación acerca del tema. Se detiene en la relevancia del trabajo como ocupación y reflexiona sobre las desigualdades que se construyen en torno al trabajo de las personas mayores. Al proponer un diálogo interdisciplinario con la perspectiva del curso de la vida, destaca la relación entre las trayectorias laborales y los contextos históricos en los que estas se insertan. El texto resalta la importancia del tema para la Terapia Ocupacional, la necesidad de comprender el trabajo en la vejez y de cuestionar la mirada individualizadora que tienden a usar los estudios disciplinares sobre el asunto. Esto implica dinamizar las teorías clásicas de la Terapia Ocupacional, de manera que trasciendan los enfoques clínicos centrados en la prevención y el tratamiento de las enfermedades de las personas mayores, y se interroguen por los sistemas políticos, económicos y sociales en los que se enmarca el trabajo de esta población.

La investigación es una experiencia de innovación docente a través de una estrategia de simulación, juego de roles, poco usada en la docencia universitaria. El propósito fue verificar si el juego de roles con grabación de video es una estrategia efectiva para la adquisición de la competencia de entrevistar y explorar si este favorece el desarrollo de aprendizaje significativo en el estudiantado. El método consideró una investigación de tipo mixta y un diseño pre-experimental de una sola medición al final. La intervención pedagógica fue realizada en una asignatura de Psicología Laboral durante un periodo de 4 meses. El juego de roles fue la estrategia protagonista. Participaron 13 estudiantes que conformaban el curso. Posterior a la intervención, se realizó una evaluación para estimar el impacto de la experiencia a través de tres instrumentos: Escala de aprendizaje significativo, de Guirao-Goris et al. (2007); Cuestionario de Innovación didáctica, de Bartlett y Morrow (2001), y una Rúbrica para evaluar el logro la competencia. Se analizaron descriptivamente los datos. Los resultados evidencian, en el estudiantado, una valoración favorable de la estrategia usada para lograr aprendizajes efectivos y una percepción de logro de aprendizaje significativo y, en el docente, una evaluación que avala el logro del aprendizaje de la competencia de entrevista.

This article provides a critical review of the understanding of health promotion strategies, as suggested by the World Health Organization for the elderly. It shows different approaches aimed at deconstructing such concept and suggests a counter-hegemonic way of understanding it, based on subjectivity, historicity, territoriality, decision-making capacity and social engagement in health-sickness-care of the elderly processes. From a theoretical standpoint, some considerations are suggested to view health promotion as a scientific generation field which can impact policy implementation and health training of occupational therapists, thereby developing effective tools for the care and wellbeing of the elderly, instead of just a replication of health care practices

Los cambios asociados al envejecimiento y las posibilidades de satisfacción de las necesidades que de ello se derivan, hacen que en Chile los espacios comunitarios de atención y nuevas estrategias de intervención se transformen en una posibilidad para la mantención y la recuperación de la salud de las personas mayores. El objetivo fue identificar el valor terapéutico del “juego” en personas mayores, como un aporte con fines terapéuticos, especialmente en contextos de intervención en comunidad con esta población. El presente artículo muestra los resultados de una investigación-acción-participativa con 12 personas mayores de 60 años, en siete sesiones, durante el año 2013 en la comuna de Valdivia, Región de Los Ríos (Chile). Se realizó un taller experiencial abierto, grupo de discusión y aplicación del test de Jugueteo. Se muestra el efecto de la vinculación comunitaria para la construcción de un significado positivo de la actividad lúdica. Se describen conductas de las personas mayores sobre la base de indicadores que evidencian el impacto en el desempeño de actividades terapéuticas. La sistematización de la investigación-acción-participativa muestra el significado atribuido a la actividad lúdica, por sobre la atribución a la recreación, la resignificación de espacios lúdicos dentro de lo cotidiano y comunitario, que permite pensarlo como estrategia terapéutica innovadora.

Las desigualdades en salud constituyen una prioridad creciente, en la medida que éstas se han hecho más evidentes y las estrategias implementadas, han fracasado. El resultado de la Comisión de Determinantes Sociales de la Salud impulsada por la OMS, estimuló la reflexión y entregó un avance en la interpretación conceptual; no obstante, este no es más que la ratificación institucional del tema, que en América Latina lleva décadas presente, con la explicación desde la medicina social y la salud colectiva. Críticas a las sugerencias hechas por la Comisión, giran sobre la falta de una aproximación concreta y territorial a las políticas sociales. Así, el objetivo del artículo es pasar revista al documento de la OMS sobre Determinantes sociales de la salud, analizar las políticas sociales de Chile, para finalmente, someter a cuestión el rol de la Terapia ocupacional, que como disciplina del área de la salud, ha de contribuir en el desarrollo de estrategias que cumplan con lo esgrimido por el organismo internacional. El propósito es tensionar la reflexión sobre un eje insoslayable para el cumplimiento de lo planteado por la Comisión: la formación de una masa crítica sobre la cuestión social y política de los agentes de salud.