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Introduction: Breast cancer is the most common malignancy in the Americas, and the second leading cause of cancer death. Disparities in the time to treatment can significantly impact patient outcomes and typically affect lower socioeconomic individuals and/or ethnic minorities. Our study sought to evaluate disparities in time to treatment at three health institutions in Chile according to their type of health insurance (public or private).

Methods: Our study analyzed a database of breast cancer patients diagnosed between 2017 and 2018. Analyses included descriptive statistics and a linear regression model that incorporated clinical and demographic variables. Additionally, using a proportional risks model, we analyzed the association between clinical variables and mortality.

Results: Public health insurance (National Health Fund, FONASA) was associated with longer time-to-treatment and extended treatment times versus private health insurance (Social Security Institutions, ISAPRE; p < 0.0001). As expected, a more advanced stage at diagnosis was associated with lower survival. Our proportional risks model found that age was a predictor of breast cancer mortality in stage II patients. Also, total treatment time significantly increased the risk of breast cancer mortality in stage I patients. Conversely, total treatment time did not affect mortality on stages II or III.

Conclusions: We found significant disparities in the time to treatment of Chilean breast cancer patients using FONASA versus private ISAPRE. FONASA patients experience delays in the initiation of treatment and longer total treatment times compared to their private insurance counterparts. Finally, longer time-to-treatment was associated with more advanced stages and increased mortality.

The study aimed to assess the quality and applicability of current maternal-fetal health clinical practice guidelines that countries can adopt or adapt. A systematic search was conducted in the International Database of GRADE Guidelines (BIGG) for practice guidelines developed with the GRADE system (Grades of Recommendation, Assessment, Development, and Evaluation) and related to maternal-fetal care. The selected guidelines were evaluated with the AGREE-REX (Appraisal of Guidelines REsearch and Evaluation-Recommendations Excellence) tool to assess clinical applicability (domain-1), values and preferences (domain-2) and applicability (domain-3). The variables were presented descriptively, and a statistical analysis was performed on the domains according to institution and country of origin. Of 1,212 clinical practice guidelines, 72 met the inclusion criteria. According to the type of collaborating organization, the World Health Organization predominated with 58.3%, versus specialized medical societies. Domain 1, "Clinical applicability," was the best rated by the reviewers (68.5%) compared to domain 2, "Values and preferences" (60%). According to the type of institution that developed the clinical practice guideline, a significant difference was demonstrated in domains 1 (p= 0.000), 2 (p= 0.006) and 3 (p= 0.000). Only domains 1 (p= 0.000) and 3 (p= 0.018) were statistically significant based on country of origin. This study emphasizes the importance of improving the quality of maternal-fetal clinical practice guidelines developed by organizations and governmental institutions and the need to strengthen the institutionalization of the use of evidence to develop, adapt and implement practice guidelines in countries such as the United Kingdom, Canada, Spain, Colombia, the United States, among others.

The family encompasses a large group of Gram-negative bacteria of the order Enterobacterales, which are habitual residents of the intestinal and urinary tracts, behaving only as allochthons in the oral cavity. There is no consensus regarding the prevalence, determinants and consequences of high aero-digestive colonization by this family of bacteria. In light of this, a narrative review was conducted on the epidemiology and clinical impact of oral and oropharyngeal colonization by , differentiating by age groups. A bibliographic search was conducted in four digital databases: PubMed/MEDLINE, Scielo, Google Scholar and Cochrane library of clinical and preclinical studies published in the last twenty years (2003 to 2023), on asymptomatic colonization of in the upper aero-digestive tract, its determinants and clinical impact. Oral and oropharyngeal colonization by was 38.24 and 39% on average, respectively. The genera spp. (68.75%), spp. (68.75%), spp. (43.75%), spp. (25%), and spp. (25%) were the most prevalent taxonomic groups in the oral cavity, especially in children and adolescents, while spp. (22.5%), spp. (15.5%) and spp. (8%) were the most prevalent in the oropharyngeal area of senile subjects. This colonization is shown to be associated with an increased risk of infectious and inflammatory episodes such as pneumonia, inflammatory bowel disease, periodontal disease, and progression of renal failure; with determinants that differ depending on age, with periodontal disease being a shared risk factor for senile and non-senile groups. The presence of enterobacteria in the upper aerodigestive tract is significant, predominating in children and adolescents, promoted by various factors that differ according to age and with systemic consequences of an infectious or inflammatory nature in certain types of hosts. Its role in the pathogenesis of oral diseases such as periodontitis is still not possible to specify.

Introduction: Arboviruses such as dengue, Zika and chikungunya represent a threat to public health in several South American countries, including Ecuador. Accurate identification of local risk areas and detection of critical transmission points are crucial for the effective planning of vector control programs, particularly in the management of the effectively planning vector control programs, particularly in managing mosquito. This study aimed to characterize the variables of receptivity and vulnerability to arboviral transmission at the cantonal level, and to identify hotspots in Ecuador between 2015 and 2019.

Methods: Environmental and sociodemographic data at the cantonal level were used to perform a spatial analysis, which included a spatial autocorrelation analysis to identify transmission hotspots at the parish level. GeoDa software was used to detect these hotspots.

Results: The provinces of Ecuador with the highest levels of receptivity and vulnerability were Manabí, Guayas, El Oro and Esmeraldas. These levels were mainly related to temperature, altitude, and limited access to clean water services. Fifty-six cantons were identified as high transmission areas. Nine parishes were classified as transmission hotspots for five consecutive years.

Conclusions: The spatial analysis allowed for precisely identifying the more susceptible and vulnerable areas for arbovirus transmission in Ecuador. The persistence of transmission hotspots in certain municipalities was evidenced, influenced by environmental and sociodemographic factors. This evidence is key to adapt and improve vector surveillance and control strategies in the most affected regions.

Introduction: Malignant neoplasms of the oral cavity represent a public health problem worldwide with an increasing incidence, especially in young populations. In Ecuador, the epidemiology of these conditions has been little studied, limiting timely diagnosis and management. The study aims to identify the distribution of hospitalizations and deaths from oral cavity malignant neoplasms in Ecuador during the pre-pandemic years, from 2015 to 2019, describing spatiotemporal patterns by province, gender, and age.

Methods: An observational and descriptive study was conducted using the database of hospitalizations and deaths of the National Institute of Statistics and Census of Ecuador. Variables such as age, gender, province, and location of the neoplasms were analyzed, and frequencies, proportions, and crude rates were calculated.

Results: Between 2015 and 2019, 4444 hospitalizations and 726 deaths were reported, with a notable increase in 2019. Males predominated in all the studied years. Malignant neoplasms of unspecified sites and other sites of the tongue had the highest frequency of cases and deaths. Geographically, the provinces of Loja, El Oro, Cañar, Carchi, and Bolivar had the highest rates.

Conclusions: The study shows an increase in hospitalizations and deaths due to malignant neoplasms of the oral cavity between 2015 and 2019, highlighting the urgency of implementing public health strategies aimed at prevention, early detection, and timely treatment of this disease.

Introduction: Due to the increase and feminization of migration in Chile, and the resulting boost in the demand for sexual and reproductive health consultations, there is a need for analizaing migrants' access to health services from the health agents' perspective.

Objective: To characterize migrants' access to sexual and reproductive healthcare from the health agents' perspective.

Methods: Exploratory-descriptive qualitative study with a phenomenological approach. Theoretical sampling included midwives from primary health care (n=4) and staff from NGOs working with migrants (n=7). Data was collected through semi-structured interviews and a focus group, and then analyzed with ATLAS.ti.

Results: Through healthcare agents, we found that there are gaps in the migrants' access to sexual and reproductive healthcare, which are associated to a lack of information on the Chilean health system, the distance between their living places and the health centers, and health not being migrants' priority, plus other gaps affecting the LGBTQIA+ community. The agents also give suggestions on how to mitigate these gaps, such as increasing information strategies and facilitating cross-sector collaboration. There are positive elements as well, such as the primary healthcare teams' knowledge of health profiles per nationality, ability to fit their speech, and willingness to adapt healthcare to the different cultural practices.

Conclusión: There are gaps in the access of health care and use of sexual and reproductive health services by migrants, which are mainly associated to the lack of information on their rights in Chile and ignorance of sexual and reproductive health services. Information strategies should be expanded towards migrants.

Introduction: Health-related quality of life in patients undergoing chronic hemodialysis has become a fundamental criterion for evaluating the effectiveness of treatments, promoting the overall well-being of this population. The study aims to identify the factors associated with health-related quality of life in patients with chronic kidney disease undergoing hemodialysis in Huancayo, Peru, from September to November 2022.

Methods: Observational, descriptive, single-center, cross-sectional study in which sociodemographic data associated with health-related quality of life in hemodialysis patients were identified using the SF-36 instrument.

Results: The SF-36 questionnaire on health-related quality of life (HRQoL) was administered to 88 hemodialysis patients, of whom 68.2% were men, and 87.5% were undergoing outpatient dialysis. The main cause of chronic kidney disease was hypertension, affecting 46.6% of participants. Additionally, 80.7% had been on hemodialysis treatment for less than five years. In the bivariate analysis, significant differences were observed in the vitality dimension concerning educational level (p = 0.011) and sex (p = 0.049). Likewise, there was a significant difference between the average values of the emotional role dimension (p = 0.038) of the SF-36 in the nutritional status levels and a significant difference between the average total scores of the SF-36 in the salary levels (p = 0.048). The multivariate analysis identified correlations between nutritional status and pain; educational level and vitality; nutritional status and physical role; economic income; educational level and social function; and nutritional status and emotional role.

Conclusions: Patients on hemodialysis have a total health-related quality of life score ranging from low to moderate (90.8%). The factors associated with a lower quality of life are being male, poor nutrition, low educational level, and a poor emotional state. Early identification of these factors will allow the development of interventions to improve these patients' quality of life. It is crucial to design interventions focused on improving nutrition and preventing mental health disorders, paying special attention to men with low educational levels.

Introduction: Sexually transmitted infections (STIs) are a leading cause of premature mortality, with unsafe sex as a predominant risk factor. Changing risky sexual behaviors and adopting healthy habits is key to preventing STIs, including HIV, essential for public health. Technological advances in digital interventions have revealed significant opportunities, and systematic reviews have evaluated their effectiveness. These digital interventions, using technologies such as mobile phones, apps, and wearable devices, have shown great potential to reduce STIs, particularly among young people, who are a key population for their implementation.

Objective: This protocol aims to describe in advance a systematic review intended to gather, evaluate, and synthesize the available evidence on digital behavior change interventions for STI prevention. In particular, it seeks to identify the most effective behavior change techniques to guide the design of evidence-based interventions that contribute to reducing STIs.

Methods: This protocol outlines a review of systematic reviews. The methodological quality of the included reviews will be assessed using the AMSTAR-2 tool, following the PRISMA-P guidelines. Comprehensive searches will be conducted in Cochrane, PubMed, Epistemonikos, and PsycINFO. The inclusion criteria will focus on systematic reviews evaluating the effect of digital behavior change interventions for STI prevention, covering technologies such as mobile phones, apps, and websites. Data extraction will identify key components using the Behavior Change Techniques Taxonomy version 1 (BCTTv1). The protocol is registered in PROSPERO (CRD42023485887).

Expected results: This review is expected to provide theoretical insights into behavior change in STI prevention through digital interventions, identifying the most effective techniques. These findings will help design scalable, evidence-based interventions, aimed especially at youth, and guide policymakers in implementing more effective strategies to reduce STI transmission around the world.

Introduction: Studies on psychological violence in health care facilities have focused on the analysis of incidences in specific contexts. Nevertheless, consensus studies on the psychosocial factors of interprofessional violence related to interpersonal conflict and motivational demands are scarce. The aim of this study is to determine by Delphi consensus the psychosocial pattern of interprofessional violence in healthcare work for Peru and its geographical regions.

Methods: A mixed Delphi consensus method was applied, bringing together professionals with experience and knowledge of psychological violence. The study was conducted in three stages and three rounds of Delphi consultation between May 2023 and June 2024. The integration of consensus at regional and national levels was carried out through Graph Network Analysis.

Results: Up to the third stage of the study, 444 experts in 32 focus groups from 81 health care institutions participated. 70.5% of the participants were women and 27.6% worked in nursing and emergency departments. After the Delphi consensus analysis, we obtained a ranked list of six psychosocial factors of interprofessional violence for Peru and nine for the regions.

Conclusions: According to the consensus, two of the main psychosocial factors of interprofessional violence in health establishments in the Costa and Forest regions are the devaluation of work and harassment by superiors towards subordinates that induce them to change jobs or resign. Excessive control by colleagues was the first hierarchy for the Sierra region. The differences between geographical regions in Peru and between studies in other countries reflect that the phenomenon of interprofessional violence is very specific and contextual; in the case of Peru the differences between regions may be due to health care facilities with different characteristics (e.g., rural vs. urban facilities).