From Simulation to Reality: Predicting Torque with Fatigue Onset via Transfer Learning.

Muscle fatigue impacts upper extremity function but is often overlooked in biomechanical models. The present work leveraged a transfer learning approach to improve torque predictions during fatiguing upper extremity movements. We developed two artificial neural networks to model sustained elbow flexion: one trained solely on recorded data (i.e., direct learning) and one pre-trained on simulated data and fine-tuned on recorded data (i.e., transfer learning). We simulated muscle activations and joint torques using a musculoskeletal model and a muscle fatigue model (n = 1,701 simulations). We also recorded static subject-specific features (e.g., anthropometric measurements) and dynamic muscle activations and torques during sustained elbow flexion in healthy young adults (n = 25 subjects). Using the simulated dataset, we pre-trained a long short-term memory neural network (LSTM) to regress fatiguing elbow flexion torque from muscle activations. We concatenated this pre-trained LSTM with a feedforward architecture, and fine-tuned the model on recorded muscle activations and static features to predict elbow flexion torques. We trained a similar architecture solely on the recorded data and compared each neural network's predictions on 5 leave-out subjects' data. The transfer learning model outperformed the direct learning model, as indicated by a decrease of 24.9% in their root-mean-square-errors (6.22 Nm and 8.28 Nm, respectively). The transfer learning model and direct learning model outperformed analogous musculoskeletal simulations, which consistently underpredicted elbow flexion torque. Our results suggest that transfer learning from simulated to recorded datasets can decrease reliance on assumptions inherent to biomechanical models and yield predictions robust to real-world conditions.

A multi-modal evaluation of experimental pain and psychological function in women with carpometacarpal osteoarthritis.

Objective: Thumb carpometacarpal osteoarthritis (CMC1 OA) is a prevalent and debilitating condition that lacks effective treatments. Understanding the multidimensional pain experience across CMC1 OA disease stages is crucial to improving treatment outcomes. This study examined how radiographic CMC1 OA severity is associated with physical, psychological, and somatosensory function. Method: Thirty-one women with early-stage (Eaton-Littler 1-2) or end-stage (Eaton-Littler 3-4) radiographic CMC1 OA completed validated questionnaires to assess pain, disability, and psychological function. Additionally, experimental pain was measured in each participant using quantitative sensory testing (QST) (mechanical, pressure, vibratory, thermal) at seven body sites (thenar, hypothenar, brachioradialis bi-laterally; quadriceps on affected side). Cohort differences (early-vs. end-stage) across all variables were analyzed using a multivariable modeling approach that included fixed effects and interactions; notably, age was controlled as a confounder. Results: End-stage CMC1 OA participants had higher scores in the pain (p â€‹= â€‹0.01) and function (p â€‹= â€‹0.02) portions of the AUSCAN assessment, self-reported disability of the DASH questionnaire (p â€‹= â€‹0.04), and painDETECT scores (p â€‹= â€‹0.03), indicating greater pain and disability compared to early-stage participants. Additionally, end-stage CMC1 OA participants demonstrated reduced vibratory detection and heat pain thresholds at multiple body sites (p's â€‹< â€‹0.05), with significant interactions observed across the mechanical and cold stimuli. Conclusion: Findings revealed women with end-stage CMC1 OA exhibited increased neuropathic pain characteristics and somatosensory loss compared to those with early-stage CMC1 OA. These results underscore the importance of addressing both peripheral and centralized pain mechanisms and the need for multimodal approaches in the treatment of CMC1 OA.

Disease severity versus pain severity: Range of motion differences during single- and multiplanar tasks in women with carpometacarpal osteoarthritis.

In carpometacarpal osteoarthritis (CMC OA) of the thumb, to what extent treatments should be directed by radiographic disease severity versus pain-based indicators remains an open question. To address this gap, this study investigated the relative impact of disease severity and pain severity on the range of motion in participants with CMC OA. We hypothesized larger differences would exist between extremes in the pain severity cohort than the disease severity cohort, suggesting pain modulates movement to a greater extent than joint degradation. Thirty-one female participants (64.6 ± 10.9 years) were grouped as symptomatic or asymptomatic (pain severity cohort) and early stage OA or end-stage OA (disease severity cohort) using radiographs and questionnaires. Kinematics were measured during single-planar and multiplanar range of motion tasks. Joint angle differences between groups were statistically compared. Differences in self-reported pain, function, and disability were evident in both participant cohorts. Notably, substantial distinctions emerged exclusively during multiplanar tasks, with a greater prevalence in the disease severity cohort compared to the pain severity cohort. Participants with end-stage OA also exhibited similar overall area covered during circumduction in comparison to those with early-stage OA, despite having a decreased range of motion at the CMC joint. The study underscores the importance of assessing multiplanar tasks, potentially leading to earlier identification of CMC OA. While movement compensations such as employing the distal thumb joints over the CMC joint were observed, delving deeper into the interplay between pain and movement could yield greater insight into the underlying factors steering these compensatory mechanisms.

A Secondary Analysis: Comparison of Experimental Pain and Psychological Impact in Individuals with Carpometacarpal and Knee Osteoarthritis.

Purpose: Evaluate sensory and psychological differences in individuals with thumb carpometacarpal (CMC) and/or knee osteoarthritis (OA) pain. This secondary analysis focuses on comparing the effects of OA at large and small joints in community-dwelling adults. Patients and Methods: A total of 434 individuals were recruited from communities in Gainesville, FL and Birmingham, AL. Each participant completed health and clinical history questionnaires, quantitative sensory testing, and physical functional tests. Participants were divided into four groups based on their pain ("CMC pain" (n = 33), "knee pain" (n = 71), "CMC + knee pain" (n = 81), and "pain-free" controls (n = 60)). ANCOVAs were performed to identify significant differences in experimental pain and psychological variables across groups. Results: The "CMC + knee pain" group had lower pressure pain thresholds (lateral knee site, p < 0.01) and higher temporal summation of mechanical pain (knee, p < 0.01) when compared to "CMC pain" and "pain-free" groups. The "knee pain" group had lower heat pain tolerance at the forearm site (p = 0.02) and higher mechanical pain (p < 0.01) at both tested sites in comparison to the "CMC pain" group. Lastly, the "CMC + knee pain" group had the highest self-reported pain (p < 0.01) and disability (p < 0.01) compared to all other groups. Conclusion: Results suggest knee OA compounded with CMC OA increases disease impact and decreases emotional health compared to OA at either the CMC or knee joint alone. Results also support a relationship between the number of painful joints and enhanced widespread pain sensitivity. Measuring pain at sites other than the primary OA location is important and could contribute to more holistic treatment and prevention of OA progression.

Measuring fascicle lengths of extrinsic and intrinsic thumb muscles using extended field-of-view ultrasound.

Complex motion of the human thumb is enabled by the balanced architectural design of the extrinsic and intrinsic thumb muscles. Given that recent imaging advances have not yet been applied to enhance our understanding of the in vivo properties of thumb muscles, the objective of this study was to test the reliability and validity of measuring thumb muscle fascicle lengths using extended field of view ultrasound (EFOV-US). Three muscles (FPL: flexor pollicis longus, APB: abductor pollicis brevis, and ECU: extensor carpi ulnaris) were imaged in eight healthy adults (4 female; age, 21.6 ± 1.3 years; height, 175.9 ± 8.3 cm)[mean ± SD]. Measured fascicle lengths were compared to cadaveric data (all muscles) and ultrasound data (ECU only). Additionally, to evaluate how fascicle lengths scale with anthropometric measurements, height, forearm length, hand length, and hand width were recorded. The EFOV-US method obtained precise fascicle length measurements [mean ± SD] for the FPL (6.2 ± 0.5 cm), APB (5.1 ± 0.3 cm), and ECU (4.0 ± 0.4 cm). However, our EFOV-US measurements were consistently different (p < 0.05) than prior cadaveric data, highlighting the need to better understand differences between in vivo and ex vivo fascicle length measurements. Fascicle length was significantly related to only hand length (r2 = 0.56, p = 0.03) for APB, highlighting that anthropometric scaling may not accurately estimate thumb muscle length. As the first study to apply EFOV-US to measure thumb muscle fascicle lengths, this study expands the utility of this imaging technology within the upper limb.

Etapa pos-COVID-19 para el sector de la salud: acciones inmediatas, mediatas y de largo alcance / Post- COVID-19 stage for the health sector: immediate, mediate, and long-range actions

Durante la pandemia por COVID-19, más de 559 millones de personas enfermaron y más de 6,3 millones fallecieron. Todos los continentes sufrieron sus efectos devastadores. Al cierre de la primera quincena de julio de 2022, aun cuando las cifras mostraban tendencia al descenso en comparación con los dos años precedentes, no se podía decir que la pandemia había finalizado. Se había reportado hasta ese entonces a nivel mundial más de un millón doscientos mil casos nuevos y la presencia de variantes del virus al acecho.1,2 En la actualidad, las autoridades en todos los sectores de la sociedad se preocupan y ocupan por las acciones para enfrentar las nefastas consecuencias derivadas de este azote que ha marcado las primeras décadas del siglo xxi. El sector salud, en particular Cuba, enfrenta un escenario diferente desde muy diversos ángulos. No hay una rama de su quehacer que no deba replantearse los enfoques y las acciones inmediatas, mediatas y de largo alcance. Muchas pueden ser las interrogantes. Sin pretender ser exhaustivos, algunas...(AU)

Ciencia, formación profesional y desarrollo socioeconómico: temas para un debate / Science, professional education and socioeconomic development: topics for a debate

La conocida revista The Lancet1 publicó recientemente un estudio multinacional y multifactorial sobre la preparación para enfrentar la pandemia COVID-19 en 177 países, en el periodo del 1 de enero de 2020 al 30 de septiembre de 2021. El artículo enfatiza sobre la asociación de las tasas de infección y de letalidad a un grupo de factores contextuales. Dicho estudio sugiere que factores como la cohesión social y la confianza en las autoridades sanitarias tienen un mayor efecto que los recursos económicos y propios del sistema de salud de los países. Las estadísticas desfavorables de países como Estados Unidos de América o Reino Unido confirman que no es suficiente contar con estos recursos. En estos países los esfuerzos del personal sanitario y los recursos a su disposición no fueron suficiente para mitigar los efectos negativos provocados por el no cumplimiento de las medidas higiénico-sanitarias orientadas globalmente. Las de mayor incidencia fueron no usar las mascarillas, no mantener el distanciamiento social y la no aceptación de las vacunas. Paradójicamente, países con menos recursos obtuvieron mejores resultados al contar con los factores de cohesión y...(AU)

Linear relationship between electromyography and shear wave elastography measurements persists in deep muscles of the upper extremity.

Recent works have demonstrated a linear relationship between muscle activation and shear modulus in various superficial muscles. As such, it may be possible to overcome limitations of traditional electromyography (EMG) methods by assessing activation using shear wave elastography. However, the relationship has not been wholly validated in deep muscles. This study measured the association between squared shear wave velocity, which is related to shear modulus, and activation within superficial and deep muscles. This relationship was also compared between surface and intramuscular EMG electrodes. We simultaneously recorded EMG and shear wave velocity in one deep (brachialis) and one superficial (brachioradialis) muscle in ten healthy individuals during isometric elbow flexion across a wide range of contraction intensities. Muscle activation and squared shear wave velocity demonstrated good reliability (ICC > 0.75) and showed a linear relationship (P < 0.05) for all muscle/EMG electrode type combinations (study conditions) after down-sampling. Study condition was not a significant within-subject factor to the slope or intercept of the relationship (P > 0.05). This work demonstrates that activation of both superficial and deep muscles can be assessed noninvasively using ultrasound shear wave elastography and is a critical step toward demonstrating elastography's utility as an alternative to EMG.

Anthropometric scaling of musculoskeletal models of the hand captures age-dependent differences in lateral pinch force.

Musculoskeletal models and computer simulations enable non-invasive study of muscle function and contact forces. Hand models are useful for understanding the complexities of hand strength, precision movement, and the dexterity required during daily activities. Yet, generic models fail to accurately represent the entire scope of the population, while subject-specific models are labor-intensive to create. The objective of this study was to assess the efficacy of scaled generic models to represent the broad spectrum of strength profiles across the lifespan. We examined one hundred lateral pinch simulations using a generic model of the wrist and thumb anthropometrically scaled to represent the full range of heights reported for four ages across childhood, puberty, older adolescence, and adulthood. We evaluated maximum lateral pinch force produced, muscle control strategies, and the effect of linearly scaling the maximum isometric force. Our simulations demonstrated three main concepts. First, anthropometric scaling could capture age-dependent differences in pinch strength. Second, a generic muscle control strategy is not representative of all populations. Lastly, simulations do not employ optimal fiber length to complete a lateral pinch task. These results demonstrate the potential of anthropometrically-scaled models to study hand strength across the lifespan, while also highlighting that muscle control strategies may adapt as we age. The results also provide insight to the force-length relationship of thumb muscles during lateral pinch. We conclude that anthropometric scaling can accurately represent age characteristics of the population, but subject-specific models are still necessary to represent individuals.

Tratamiento efectivo de la toxina botulínica tipo A en el espasmo hemifacial, Guantánamo 2018-2019 / Botulinum toxin type A efficient treatment in patients with hemifacial spasm, Guantanamo 2018-2019

RESUMEN Introducción: No se encuentran antecedentes de investigaciones que aborden resultados de la aplicación de toxina botulínica tipo A en pacientes con espasmo hemifacial en la provincia Guantánamo. Objetivo: Evaluar los resultados terapéuticos de la aplicación de toxina botulínica tipo A en pacientes con espasmo hemifacial atendidos en consulta de Neurología. Método: Se realizó un estudio descriptivo longitudinal de 21 pacientes atendidos en servicio de Neurología con espasmo hemifacial y tratamiento con toxina botulínica tipo A, desde enero 2018 hasta enero 2019. Las variables estudiadas fueron: edad, sexo, hemicara afectada, periodo de latencia, duración, desaparición del efecto clínico de toxina botulínica tipo A, y porciento de incapacidad funcional en pacientes al aplicar la escala de discapacidad antes y después de la aplicación del tratamiento. Resultados: Predominó el sexo femenino con 57,1%, edad mayor de 55 años con 57,14 %, lado afectado predominante el izquierdo con 57,14 %, el periodo de latencia de la toxina botulínica tipo A fue entre el tercer y décimo día con 14 pacientes para un 66,67 %, el tiempo máximo de duración del tratamiento fue de uno a dos meses con un 57,14 %, y la desaparición del efecto terapéutico de la toxina fue entre el tercer y cuarto mes con un 52,38%. Luego de la aplicación de la escala de evaluación clínica del espasmo hemifacial se evidenció disminución del porcentaje de pacientes con incapacidad funcional. Conclusiones: La toxina botulínica tipo A es efectiva en el tratamiento del espasmo hemifacial.

ABSTRACT Introduction: No research records were founded dressing the results of the application of botulinum toxin type A in patients with hemifacial spasm in Guantanamo province. Objective: to evaluate the therapeutic results of the application of botulinum toxin type A in patients with hemifacial spasm treated in a Neurology consultation. Method: a descriptive and longitudinal study was carried out in 21 patients attended in Neurology service with hemifacial spasm and botulinum toxin type A treatment, fromJanuary 2018 to January 2019. The variables studied were: age, gender, hemiface affected, latency period, duration, disappearance of the clinical effects of botulinum toxin type A, and percentage of functional disability in patients when applying the disability scale before and after the treatment. Results: Female cases predominated (57.1%), agesover 55 years (57.14 %), the most common affected side of the face was the left, with 57.14 %, the latency period of botulinum toxin type A was between the third to the tenth day in 14 of the patients (66.67 %), the maximum time of duration of treatment ranged from one to two months (57.14 %), and the disappearance of the therapeutic effect of the toxin in the patients was between the third to the fourth month (52.38%). After the application of the clinical assessment scale of hemifacial spasm, a decrease in the percentage of patients with functional disability was evidenced. Conclusions: Botulinum toxin type A is effective in the treatment of hemifacial spasm.

La pesquisa activa. Primer eslabón del enfrentamiento a la COVID-19 en el Policlínico Docente "Antonio Maceo" / Active research. First link in the confrontation with the COVID-19 in Antonio Maceo Teaching Polyclinic

Introducción: Las circunstancias que envuelven la aparición y desarrollo de la COVID-19, requirió se pusiera en marcha un programa de pesquisaje activo en todo el país, apoyados en las experiencias de campañas anteriores ante enfermedades transmisibles, adoptándose nuevas estrategias ajustadas a las actuales circunstancias. Objetivo: Describir los resultados de la pesquisa activa como estrategia de enfrentamiento a la COVID-19 en el Policlínico Docente Antonio Maceo. Material y Métodos: Se realizó un estudio cuantitativo, descriptivo, con carácter retrospectivo de los resultados de la pesquisa activa realizada por estudiantes y profesores, para identificar personas con sintomatología respiratoria de la COVID- 19, del 1 al 30 de abril. Se utilizó el cálculo de promedio y porcentaje como métodos descriptivos. Resultados: En 90,3 por ciento de las viviendas visitadas por día se alcanzó pesquisar 85 por ciento de estas, por Consultorio Médico de la Familia y 63,5 por ciento de los habitantes. Se identificaron personas con sintomatología respiratoria en 96,6 por ciento de los consultorios. Conclusiones: El trabajo realizado a través de la pesquisa activa, permitió identificar casos con síntomas respiratorios relacionados con la COVID-19. Se logró pesquisar diariamente de manera efectiva un alto porciento de viviendas y adultos mayores. Las acciones de promoción de salud realizadas por estudiantes y profesores con la oportuna vigilancia por el Médico y Enfermera de la Familia fueron elementos fundamentales que contribuyeron a detener el avance de la enfermedad(AU)

Introduction: The circumstances that involve the emergence and development of COVID-19, required the implementation of an active research program throughout the country supported by the experiences from previous campaigns against communicable diseases, adopting new strategies adapted to the current circumstances. Objective: To describe the results of the active research as a strategy to confront the COVID-19 in the Antonio Maceo Teaching Polyclinic. Material and Methods: A quantitative, descriptive, retrospective study of the results of the active research made by students and teachers to identify people with respiratory symptoms of COVID-19 was conducted from April 1srt to April 30th. The calculation of average and percentage was used as descriptive methods. Results: Of the 90.3 percent of the homes visited daily, 85 percent of them and 63.5 percent of the inhabitants were investigated by the Family Doctor´s Offices. Persons with respiratory symptoms were identified in 96.6 percent of the doctor´s offices. Conclusions: The work carried out through the active research allowed to identify cases with respiratory symptoms related to COVID-19. A high percentage of houses and elderly people were effectively investigated daily. The health promotion actions carried out by students and teachers with the timely surveillance by the Family Doctor and Family Nurse were fundamental elements that contributed to stop the advance of the disease(AU)

Apuntes para el estudio de la internacionalización de los servicios profesionales de Salud en Cuba / Notes for the study of the internationalization of the professional services of health in Cuba

Se realiza una revisión bibliográfica de las tendencias de estudios en el campo de la internacionalización de los servicios profesionales en el mundo contemporáneo con el objetivo de explorar la visibilidad de la experiencia cubana en la literatura científica en este campo y proponer líneas de desarrollo de futuras investigaciones en sus diferentes aristas. Se analiza su pertinencia a la luz de las características de nuestro país, avalado por su exitoso aporte práctico en las últimas seis décadas a más de un centenar de países, así como su reciente incorporación a nuevas modalidades en pleno desarrollo a nivel mundial. Se esbozan propuestas de temas de investigación que contribuyan a mejorar la calidad y eficiencia de estos servicios en todos sus ámbitos de expresión(AU)

A literature review is carried out of the trends of studies in the field of internationalization of professional services in the contemporary world. Its relevance is analyzed considering the characteristics of our country, supported by its successful practical contribution in the last six decades to more than a hundred countries, as well as its recent incorporation into new modalities in full development worldwide. Proposals are outlined for research topics that contribute to improving the quality and efficiency of these services in all areas of expression(AU)

Compliance with management guidelines in patients with suspected dengue.

Dengue is an endemic disease in Puerto Rico, with three to nine thousand suspected dengue cases reported yearly. In PR, physicians are required to maintain medical education courses about dengue in order to recertify their medical licenses. The purpose of this study was to describe characteristics of patients admitted to Bella Vista Hospital with suspected dengue and estimate the compliance with guidelines established by the CDC documented in medical records. A total of 197 medical records of patients admitted with diagnosis of suspected dengue during January 1, 2013 through December 31, 2013 were reviewed. The annual distribution of admitted cases showed a higher incidence during the months of June through September, with August having the higher incidence of all. Combined aches and pains were most commonly reported at admission with a prevalence of 82%. In general there was a low prevalence of severe disease as per definition at presentation (DM, clinical fluid accumulation, hepatomegaly, pregnancy and/or renal insufficiency). Overall, compliance with CDC established guidelines were only partially followed. The guideline that was followed more frequently was a daily CBC, with 95% of patients having this as part of their management. Prevalence of administration of isotonic intravenous fluids was 63%, monitoring of vital signs was 48%), and administration of bolus of intravenous fluid was11%. No fatalities were reported during the period.

La formación de recursos humanos en salud necesarios para el mundo y los paradigmas vigentes / Formation of the human resources in health required worldwide and the present paradigms

Se reflexiona sobre los paradigmas vigentes para la formación de recursos humanos en salud necesarios para el mundo, tomando en consideración algunos de sus determinantes como: voluntad política, recursos financieros y flujo migratorio. Se ponen de manifiesto las causas e implicaciones, en última instancia, sociales, de la utilización del modelo flexneriano para la formación de estos recursos. Se analizan además los diferentes retos que enfrenta hoy a nivel mundial la educación de pregrado y posgrado en Ciencias de la Salud

Some reflections were made on the present paradigms of the formation of human resources in health worldwide, taking several determinants into consideration such as political willingness, financial resources and migration flows. The causes and implications, ultimately of social origin, of the use of the Flexner´s model for the formation of these resources were explained. Additionally, the different challenges that the undergraduate and the graduate education in health sciences are facing at present worldwide were analyzedAU)

Bacillus cereus y su implicación en la inocuidad de los alimentos: parte II / Bacillus cereus and its involvement in food safety: part II

Bacillus cereus da lugar a un síndrome diarreico y a uno emético, similares a los producidos por otros microbios transmitidos por alimentos. Se evalua la presencia de B cereus en alimentos asociados a brotes de origen alimentario y se precisa su implicación como agente causal. Se estudiaron 108 muestras relacionadas con 57 brotes producidos en Ciudad de La Habana desde el 2004 al 2007. La enumeración de B cereus se realizó según la ISO 7932:2004 y la NC 38-02-12:1988. Ademàs se investigó: Staphylococcus coagulasa positiva (NC ISO 6888-1:2003), Clostridium perfringens (NC 38-02-11:1988 e ISO 7937:2004) y Salmonella (ISO 6579:2002); así como, coliformes totales (NC ISO 4832:2002), coliformes fecales y Escherichia coli (NC 38-02-14:1989)...

Bacillus cereus causes diarrheal and emetic syndromes similar to those provoked by other foodborne pathogens. Objetives: To evaluate the presence of B cereus in foodstuffs associated to outbreaks and to find out if it is the causative agent. One hundred eight suspected food samples associated to 57 outbreaks were analyzed using ISO 7932:2004 and Cuban standard no. 38-02-12:1988. Also other microorganisms such as positive Staphylococci coagulase(Cuban standard ISO 6888-1:2003), Clostridium perfringens (Cuban standard 38-02-11:1988 and ISO 7937:2004) and Salmonella (ISO 6579:2002) as well as total coliforms (ISO 4832:2002), fecal coliforms and Escherichia coli (Cuban standard 38-02-14:1989)...

HLA class I polymorphism in the Cuban population.

The extreme polymorphism found at some of the human leukocyte antigen (HLA) system loci makes it an invaluable tool for population genetic analyses. In the present study the genetic polymorphism of the Cuban population was estimated at HLA-A, -B, and -Cw loci by DNA typing. HLA class I allele and haplotype diversity were determined in 390 unrelated Cuban individuals (188 whites and 202 mulattos) from all over the country. In whites 19, 27, and 14 allele families for the HLA-A, -B, and -Cw loci, respectively, were identified. In mulattos, for the same loci, 20, 18, and 14 allele families were identified. Allele and haplotypes frequencies, comparisons with other worldwide populations based on genetic distances, neighbor-joining dendrograms, and correspondence analyses were estimated. Most of the identified allele groups and haplotypes are also common to sub-Saharan African and Europeans populations. However, Amerindian and Asian alleles were also detected at lower frequencies. The results clearly reveal the high diversity and interethnic admixture of the studied population. Our results provide useful information for the further studies of the Cuban population evolution and disease association in terms of HLA class I genes.

Guía práctica para el manejo alimentario nutricional de grupos vulnerables en situaciones de emergencias / Toolkit for nutritional food handling vulnerable groups in emergencies

El objetivo del presente material es suministrar algunos alimentos que se debeb llevar a cabo para garantizar el adecuado funcionamiento de los servicios de alimentación, tanto a nivel familiar como colectivo, para preservar el estado nutricional y la salud de la población afectada por estos fenómenos.