A Permutation Entropy analysis to determine significant daily intervals to improve risk stratification tasks from COVID patients.

SARS-CoV-2 infection has a wide range of clinical manifestations making its diagnosis difficult, which is an important problem to solve. We evaluated heart rate data extracted from the Stanford University database. The data set considers heart rate and step records of 118 patients, where 90 correspond to healthy individuals and 28 patients with COVID. Each daily record was divided into 5-minute segments, providing 288 data per patient. The date of symptom onset was considered as a reference point to extract subsets of data whose variability was considerable, such as 30 days before the date and 30 days after it. Each of the 60 segments of 288 data per patient was treated using Permutation Entropy, Approximate Entropy, Spectral Entropy and Singular Value Decomposition Entropy. The average of the data from each group was used to construct the circadian profiles which were analyzed using the Mann-Whitney-Wilcoxon test, determining the most relevant 5-minute segments, whose p-value was less than 0.05. In this way, the Spectral Entropy was discarded as it did not show any significantly different segment. The efficiency of the method was reflected in the performance of a logistic model for binary classification proposed in this work, which reflected an accuracy of 94.12% in the PE case, 88% in the ApEn case and 94% in the SVDE case. The proposed analysis turns out to be highly efficient when detecting significant segments that allow improving the classification tasks carried out by Machine Learning models, which provides a basis for the study of statistics such as entropy to delimit databases and improve the performance of classifier models.

Análisis prospectivo y líneas estratégicas de acción para la producción agraria colombiana en un entorno pos-COVID-19 / Prospective analysis and strategic lines of action for colombian agricultural production in a pos-COVID-19 environment

El artículo desarrolla un análisis prospectivo exploratorio, orientado a la identificación de elementos de análisis, escenarios y líneas de acción estratégicas sobre la producción agraria colombiana en un entorno pos COVID-19. El método empleado desarrolló revisión de literatura, análisis estructural para la identificación de escenarios y la enunciación de líneas de acción. Los hallazgos sugieren que la crisis de demanda es el elemento más influyente, y que posibles transformaciones del sector tendrían que pasar por cambios en el uso de los territorios agrarios, en la subordinación institucional y en una novedosa perspectiva de seguridad alimentaria.

The purpose of the article was to develop a prospective exploratory analysis, oriented to the identification of elements of analysis, scenarios and strategic lines of action, on Colombian agricultural production in a post Covid-19 environment. The method used developed a literature review, structural analysis for the identification of scenarios and the enunciation of strategic lines. The findings suggest that the demand crisis is the most influential element, and that transformations in the sector would have to go through changes in the use of agrarian territories, in institutional subordination and in a novel perspective of food security.

Adolescer Saudável: screening and follow-up of risk at school.

OBJECTIVE: To characterize adolescents referred to medical consultation based on the screening tool "Perfil de Saúde do Utente Adolescente", and to compare to information gathered from a questionnaire and data assessed during the visit. METHODS: A retrospective and descriptive study, with analysis of the questionnaires filled out by adolescents and their respective medical records, in the period from January 2013 to June 2016. RESULTS: A total of 54 adolescents were seen, 57% male and mean age of 12±1.7 years. In the questionnaire, 37% stated that they had some kind of health problem; 35% would like to change the relationship with their parents; 18% had some concern about safety at school; and 39% made dietary mistakes. Approximately 31% had consumed alcohol, 13% had tried smoking, and 4% had used other drugs. At the first medical appointment, 38% stated they had chronic disease, 11% reported poor family environment, 39% had school problems and 39% made dietary mistakes. About 13% had tried smoking, 24% had tried to consume alcohol, and 2% had tried other drugs. Thirty seven percent of adolescents were referred to adolescent medicine consultation, and 39% to another hospital consultation. CONCLUSION: Many of the biopsychosocial risk items identified through the questionnaire were confirmed during consultation, indicating that it could be a useful screening method for problems linked to the adolescence period.

Does excessive use of smartphones and apps make us more impulsive? An approach from behavioural economics.

PURPOSE: Problematic smartphone use has been associated with negative effects in work and school environments. This study proposes the application of a behavioural economics perspective to establish whether heavy smartphone users show a tendency to devalue the consequences of their behaviour in the long term. To address this proposition, the study sought to establish how an objective measurement of usage time of smartphones and apps might help to predict, firstly, participants' choice behaviour and, secondly, their perceived dependence levels. DESIGN/METHODOLOGY/APPROACH: An objective measurement of the usage time of smartphones and apps was conducted over four weeks (N = 560 data points), and a computer-based intertemporal choice task and the Spanish version of the Smartphone Addiction Inventory (SPAI) were applied. The participants were twenty undergraduate college students. FINDINGS: Although the usage time of devices and apps failed to predict the choice behaviour, a correlation was found between the total usage time of smartphones and WhatsApp and Facebook apps and users' dependence level. On the other hand, dependence had a positive effect on the average selection of the impulsive choice. ORIGINALITY/VALUE: This paper proposes the application of a behavioural economics perspective to explore the relationship between objectively measured usage time of smartphone and apps, choice behaviours in an intertemporal task and users' perceived dependence levels. This allows us to consider an alternative to the traditional psychiatric approach in an environment of increasing access to and use of mobile digital platforms.

Adolescent students attitudes towards sexuality: the construction and validation of a scale / Atitudes dos alunos adolescentes sobre a sexualidade: construção e validação de uma escala

ABSTRACT Objective: To construct a scale of adolescents' attitudes towards sexuality and to determine their psychometric characteristics. Methods: Methodological study conducted with 394 students from the 8th to 12th grades of a school in central Portugal. They answered a questionnaire consisting of the Adolescent Students' Attitude Scale for Sexuality (E3AS) and socio-demographic and academic data. The project received a favorable opinion from the National Data Protection Commission (authorization No. 10421/2017). Construct validity analysis was performed through exploratory factor analysis and internal consistency was performed through Cronbach's alpha. A maximum error probability of 5% was considered. Results: The mean age of the sample was 14.9±1.4 years, with 53.3% being female. The instrument consisted of 34 items distributed into five factors: F1. Family planning and sex education (α=0.826); F2. First sexual relationship (α=0.819); F3. Violation of sexual rights and who to turn to in the event of unplanned pregnancies (α=0.695); F4. Gender expression and identity (α=0.542), and F5. Unplanned pregnancy and parenting (α= 0.761), with a total alpha value of 0.766, accounting for 45.3% of total variance. Conclusions: The psychometric adequacy of the E3AS for the Portuguese population allows us to affirm that it is a valid and reliable instrument that can be used in future studies to assess the attitudes of adolescent students towards sexuality.

RESUMO Objetivo: Construir uma escala de atitudes dos adolescentes em face da sexualidade e determinar as suas caraterísticas psicométricas. Métodos: Estudo metodológico realizado com 394 alunos do 8º ao 12º ano de escolaridade de uma escola da região Centro de Portugal que responderam a um questionário constituído da Escala de Atitudes dos Alunos Adolescentes em face da Sexualidade e de dados sociodemográficos e acadêmicos. O projeto recebeu parecer favorável da Comissão Nacional de Proteção de Dados (autorização nº 10421/2017). Realizou-se a análise de validade do constructo, por análise fatorial exploratória, e de consistência interna, por alfa de Cronbach. Foi considerada probabilidade de erro máximo de 5%. Resultados: A média de idades da amostra foi de 14,9±1,4 anos, e 53,3% dos participantes eram do sexo feminino. O instrumento foi constituído de 34 itens distribuídos por cinco fatores: Fator 1. Planejamento familiar e educação sexual (α=0,826); Fator 2. Primeira relação sexual (α=0,819); Fator 3. Violação dos direitos sexuais e a quem recorrer na gravidez não planejada (α=0,695); Fator 4. Expressão e identidade de gênero (α=0,542); Fator 5. Gravidez não planejada e parentalidade (α=0,761). O valor do alfa total da escala foi 0,766, o que explica 45,3% da variância total. Conclusões: A adequação psicométrica da escala para a população portuguesa permite afirmar que se trata de um instrumento válido e confiável, que poderá ser utilizado em estudos futuros com o intuito de avaliar as atitudes dos alunos adolescentes em face da sexualidade.

Adolescer Saudável: screening and follow-up of risk at school / Adolescer Saudável: rastreio e seguimento do risco na escola

ABSTRACT Objective To characterize adolescents referred to medical consultation based on the screening tool "Perfil de Saúde do Utente Adolescente", and to compare to information gathered from a questionnaire and data assessed during the visit. Methods A retrospective and descriptive study, with analysis of the questionnaires filled out by adolescents and their respective medical records, in the period from January 2013 to June 2016. Results A total of 54 adolescents were seen, 57% male and mean age of 12±1.7 years. In the questionnaire, 37% stated that they had some kind of health problem; 35% would like to change the relationship with their parents; 18% had some concern about safety at school; and 39% made dietary mistakes. Approximately 31% had consumed alcohol, 13% had tried smoking, and 4% had used other drugs. At the first medical appointment, 38% stated they had chronic disease, 11% reported poor family environment, 39% had school problems and 39% made dietary mistakes. About 13% had tried smoking, 24% had tried to consume alcohol, and 2% had tried other drugs. Thirty seven percent of adolescents were referred to adolescent medicine consultation, and 39% to another hospital consultation. Conclusion Many of the biopsychosocial risk items identified through the questionnaire were confirmed during consultation, indicating that it could be a useful screening method for problems linked to the adolescence period.

RESUMO Objetivo Caracterizar adolescentes referenciados à consulta médica a partir do instrumento de triagem Perfil de Saúde do Utente Adolescente e comparar as informações obtidas do questionário e os dados avaliados na consulta. Métodos Estudo retrospectivo e descritivo, com análise dos questionários preenchidos por adolescentes e respectivos processos clínicos da consulta realizada no período de janeiro de 2013 a junho de 2016. Resultados Foram consultados 54 adolescentes, 57% do sexo masculino, com média de idade 12±1,7 anos. No questionário, 37% responderam ter algum problema de saúde; 35% gostariam de mudar a relação com os pais; 18% tinham algum tipo de preocupação com a segurança na escola; e 39% cometiam erros alimentares. Aproximadamente 31% já tinham consumido álcool, 13% já tinham experimentado fumar, e 4% tinham experimentado outras drogas. Na primeira consulta, 38% dos respondentes responderam ter doença crônica, 11% referiram mau ambiente familiar, 39% apresentaram problemas escolares e 39% revelaram erros alimentares. Cerca de 13% experimentaram fumar, 24% consumiram álcool, e 2% experimentaram outras drogas. Foram referenciados à consulta de medicina do adolescente 37% dos adolescentes, e 39% foram direcionados a outra consulta hospitalar. Conclusão Em consulta, confirmaram-se muitos dos itens de risco biopsicossocial identificados por meio do questionário aplicado, o que pode indicar que este é um método útil no rastreio de problemática ligada à adolescência.

ADOLESCENT STUDENTS' ATTITUDES TOWARDS SEXUALITY: THE CONSTRUCTION AND VALIDATION OF A SCALE.

OBJECTIVE: To construct a scale of adolescents' attitudes towards sexuality and to determine their psychometric characteristics. METHODS: Methodological study conducted with 394 students from the 8th to 12th grades of a school in central Portugal. They answered a questionnaire consisting of the Adolescent Students' Attitude Scale for Sexuality (E3AS) and socio-demographic and academic data. The project received a favorable opinion from the National Data Protection Commission (authorization No. 10421/2017). Construct validity analysis was performed through exploratory factor analysis and internal consistency was performed through Cronbach's alpha. A maximum error probability of 5% was considered. RESULTS: The mean age of the sample was 14.9±1.4 years, with 53.3% being female. The instrument consisted of 34 items distributed into five factors: F1. Family planning and sex education (α=0.826); F2. First sexual relationship (α=0.819); F3. Violation of sexual rights and who to turn to in the event of unplanned pregnancies (α=0.695); F4. Gender expression and identity (α=0.542), and F5. Unplanned pregnancy and parenting (α= 0.761), with a total alpha value of 0.766, accounting for 45.3% of total variance. CONCLUSIONS: The psychometric adequacy of the E3AS for the Portuguese population allows us to affirm that it is a valid and reliable instrument that can be used in future studies to assess the attitudes of adolescent students towards sexuality.

OUTPATIENT ANALYTIC ASSESSMENT OF ANOREXIA NERVOSA - THE IMPORTANCE OF VENOUS BLOOD GASES.

OBJECTIVE: To evaluate serum biochemical parameters' evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. METHODS: Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. RESULTS: A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). CONCLUSIONS: Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.

Outpatient analytic assessment of anorexia nervosa — the importance of venous blood gases / Avaliação laboratorial em ambulatório na anorexia nervosa: a importância da gasometria venosa

ABSTRACT Objective: To evaluate serum biochemical parameters' evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. Methods: Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. Results: A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). Conclusions: Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.

RESUMO Objetivo: Avaliar a evolução laboratorial, particularmente da gasometria venosa, na anorexia nervosa (AN), correlacionando os achados com parâmetros clínicos. Métodos: Estudo retrospetivo com adolescentes com AN seguidos em ambulatório, entre janeiro de 2014 e maio de 2017. Foram comparadas três avaliações: (t1) primeira consulta; (t2) consulta com escore Z de índice de massa corpórea (IMC) mais baixo; e (t3) consulta com escore Z de IMC mais elevado. Resultados: Incluídos 24 adolescentes, 87,5% do sexo feminino, idade média de apresentação de 14,9±1,7 anos, início dos sintomas 6,4±3,2 meses antes da primeira consulta. Em t1, escore Z de IMC de -1,91±1,11 kg/m2 e % de peso ideal de 84,3±9,2. Tinham amenorreia 88%. Em t2 as alterações laboratoriais encontradas foram: gasometria venosa alterada em 100%, ferritina alterada (72% elevada), função tiroideia alterada (53% com diminuição da tiroxina), dislipidemia (31% com elevação de lipoproteína de alta densidade, 25% com hipercolesterolemia), elevação da ureia (25%), elevação da alanina aminotransferase (14%), hipoglicemia (14%) e anemia (9%). A acidose respiratória esteve presente em 91% em t1, 100% em t2 e 94% em t3. Verificou-se diminuição significativa entre t2 e t3 da pressão parcial de CO2 (pCO2) média (57,2 versus 53,6 mmHg; p=0,009) e HCO3 médio (30,0 versus 28,8 mEq/L; p=0,023). Conclusões: A acidose respiratória e o aumento da ferritina foram comuns nesse grupo. Acidose respiratória foi a alteração mais frequente, com variação significativa de pCO2 e HCO3 na fase de recuperação. A gasometria venosa deve ser considerada na avaliação laboratorial na AN, pois parece ser importante na avaliação da gravidade e monitorização da doença.

[Contraception for Adolescents: Knowledge and Practices in Portugal]. / Contraceção em Adolescentes: Conhecimentos e Práticas em Portugal.

INTRODUCTION: Adolescents are a target group for reproductive health intervention. Family physicians, gynecologists and pediatricians are the main providers of contraceptive counseling. MATERIAL AND METHODS: Correlational, cross-sectional study, approved by the ethics committee of Leiria Hospital, Portugal. Data was collected through a validated online questionnaire (Cronbach's alpha and Exploratory Factorial Analysis) using a semantic differential scale (1 - Totally Agree; 5 - Totally Disagree). Higher scores were indicative of greater knowledge or suitability concerning the matter in question. Results were compared by gender, specialty, years of career and rank: consultant or resident. RESULTS: We received 338 responses (51% family physicians, 29% pediatricians, 20% gynecologists), 66% were specialists, 36% had been working for less than 5 years and 17% for more than 20 years. Awareness of national recommendations was higher in gynecologists [4.38 (1.09)] and in the female gender [3.65 (1.41)] with statistically significant differences. Gynecologists had more recent training [3.79 (1.42)] and considered themselves to be up-to-date [4.41 (0.70)], p < 0.001. DISCUSSION: The questionnaire showed reliability and validity. Gynecologists were more familiarized with adolescent contraception; pediatricians and young clinicians highlighted the need for an update on this matter. Gynecologists had more training and considered themselves up-to-date, so training in this area seems to have a positive impact. CONCLUSION: Knowledge about contraceptive counseling is not yet sufficient, so it is very important to invest in the continuous medical education of clinicians.

Introdução: Os adolescentes são um grupo de intervenção prioritária em saúde reprodutiva. Os médicos de medicina geral e familiar, ginecologistas e pediatras são os principais responsáveis pelo aconselhamento contracetivo. Material e Métodos: Estudo transversal, correlacional, de natureza quantitativa, aprovado pela comissão de ética do Centro Hospitalar de Leiria. Dados colhidos em questionário online validado (alfa de Cronbach e Análise Fatorial Exploratória), constituído por itens de tipo diferencial semântico, com cinco pontos ("Discordo totalmente ­ 1" e "Concordo totalmente ­ 5"). Pontuações mais elevadas conotam-se com maior conhecimento ou adequabilidade na questão. Análise por género, especialidade, anos de carreira e grau de formação: especialista, interno de formação específica. Resultados: Obtiveram-se 338 respostas (51% médicos de medicina geral e familiar, 29% pediatras, 20% ginecologistas). Do total, 66% eram especialistas, 36% tinham menos de cinco anos de carreira e 17% tinham mais de 20 anos de carreira. O conhecimento das recomendações foi superior entre os ginecologistas [4,38 (1,09); p < 0,001] e no género feminino [3,65 (1,41); p = 0,039] com diferença estatisticamente significativa. Os ginecologistas receberam mais formação recentemente [3,79 (1,42)] e consideram estar atualizados [4,41 (0,70), p < 0,001]. Discussão: O questionário revelou validade e fiabilidade. Os ginecologistas estão mais familiarizados com a contraceção na adolescência, enquanto pediatras e clínicos mais novos referem maior necessidade de atualização. Os ginecologistas receberam formação recentemente e consideram estar atualizados, pelo que a formação na área parece ter impacto positivo. Conclusão: O conhecimento acerca do aconselhamento contracetivo ainda não é ótimo, pelo que é fundamental investir na formação dos profissionais de saúde.

Sexual behaviors: study in the youth.

OBJECTIVE: To characterize sexual behaviors in a sample of adolescents and youth. METHODS: An analytical descriptive study using a questionnaire about sexual behaviors, adapted from the World Health Organization. It was distributed to students from a Portuguese city aged 14-24 years, during two months. Two age groups were defined: G1 - students aged 14-19 years; G2 - aged 20-24 years. RESULTS: The sample included 2,369 students, 61% females and 70% in G1. The mean age of first sexual intercourse was 16.4±1.8 years; 93% used some contraceptive method in the first sexual intercourse. Out of those who did not use contraception in the first sexual intercourse, 83% were in G1 (p<0.001). Emergency contraception was used at least once by 54% (63% in G2, p<0.001). Among those who had unprotected sexual intercourses, 9% were under the influence of alcohol, 53.6% were female and 53.4% were in G2 (p<0.001). Homosexual contacts occurred in 21% of cases; in that, 62% in G1 and 84% among females (p<0.001). CONCLUSION: The use of contraceptionin the first sexual intercourse was common in our sample. However, the number of adolescents not using any contraceptive method in subsequent sexual intercourses, and the high percentage of them who consider it unnecessary, are a concern. Unprotected sexual intercourses, as well as unplanned intercourses and under influence of alcohol or drugs, especially in the youngest, urge the need for intervention regarding sexual education.

What are the most frequent diagnoses in adolescence? The reality of an Adolescent Medicine Clinic.

OBJECTIVE: To characterize the care flow and the primary diagnoses of an Adolescent Medicine Clinic. METHODS: A retrospective descriptive study, with analysis of clinical processes of adolescents (10-18 years) seen at the Adolescent Medicine Clinic, from January 2006 to December 2013. The following variables were analyzed: sex, age, number of visits, referring service and primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. As to the variable age, the adolescents were divided into two groups: Group I comprised those aged 10-14 years, and Group II, 15-18 years. RESULTS: A total of 7,692 visits were carried out, in that, 1,659 first visits (22%), with an annual growth rate of 6%. The mean age was 14.2 years, and 55% of patients were female. The group of endocrine, nutritional and metabolic diseases was the most representative in our sample (34%), with obesity being the most frequent diagnosis in both sexes and age groups (23%), with a higher prevalence in males (13% male versus 10% female, p<0.001) and younger adolescents (18% in Group I versus 5% in Group II p<0.001). The group of mental and behavioral disorders was the second most prevalent (32%), affecting mainly females (39% female versus 22% male, p<0.001) and the older age group (39% Group II versus 27% Group I, p<0.001). Social problems were the primary diagnosis in 8% of visits. CONCLUSION: Most diseases diagnosed have a strong behavioral and social component, particularly mental disorders and obesity. This specific type of diagnoses reinforces the need for a global approach for adolescents and specialized adolescent medicine units/clinics.

What are the most frequent diagnoses in adolescence? The reality of an Adolescent Medicine Clinic / Quais os diagnósticos mais frequentes na adolescência? A realidade de uma consulta de Medicina do Adolescente

ABSTRACT Objective To characterize the care flow and the primary diagnoses of an Adolescent Medicine Clinic. Methods A retrospective descriptive study, with analysis of clinical processes of adolescents (10-18 years) seen at the Adolescent Medicine Clinic, from January 2006 to December 2013. The following variables were analyzed: sex, age, number of visits, referring service and primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. As to the variable age, the adolescents were divided into two groups: Group I comprised those aged 10-14 years, and Group II, 15-18 years. Results A total of 7,692 visits were carried out, in that, 1,659 first visits (22%), with an annual growth rate of 6%. The mean age was 14.2 years, and 55% of patients were female. The group of endocrine, nutritional and metabolic diseases was the most representative in our sample (34%), with obesity being the most frequent diagnosis in both sexes and age groups (23%), with a higher prevalence in males (13% male versus 10% female, p<0.001) and younger adolescents (18% in Group I versus 5% in Group II p<0.001). The group of mental and behavioral disorders was the second most prevalent (32%), affecting mainly females (39% female versus 22% male, p<0.001) and the older age group (39% Group II versus 27% Group I, p<0.001). Social problems were the primary diagnosis in 8% of visits. Conclusion Most diseases diagnosed have a strong behavioral and social component, particularly mental disorders and obesity. This specific type of diagnoses reinforces the need for a global approach for adolescents and specialized adolescent medicine units/clinics.

RESUMO Objetivo Caracterizar o movimento assistencial e conhecer os diagnósticos principais de uma consulta de Medicina do Adolescente. Métodos Estudo descritivo retrospectivo, com análise dos processos clínicos dos adolescentes (10 a 18 anos) seguidos na consulta de Medicina do Adolescente, de janeiro de 2006 a dezembro de 2013. Foram analisadas as variáveis: sexo, idade, número de consultas, entidade que referenciou e diagnósticos principais, de acordo com a Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde. Com relação à variável idade, os adolescentes foram divididos em dois grupos: Grupo I, que incluiu adolescentes de 10 a 14 anos, e Grupo II, que incluiu aqueles com 15 aos 18 anos. Resultados Realizaram-se 7.692 consultas, sendo 1.659 (22%) primeiras consultas, com taxa de crescimento anual de 6%. A média de idade foi de 14,2 anos, com 55% do sexo feminino. O grupo das doenças endócrinas, nutricionais e metabólicas foi o mais representativo da amostra (34%), sendo a obesidade o diagnóstico mais frequente em ambos os sexos e grupos etários (23%), com maior prevalência nos rapazes (13% homens versus 10% mulheres; p<0,001) e nos adolescentes mais jovens (18% do Grupo I versus 5% do Grupo II; p<0,001). O grupo dos transtornos mentais e do comportamento foi o segundo mais prevalente (32%), afetando principalmente as adolescentes (39% mulheres versus 22% homens; p<0,001) e o grupo etário mais velho (39% do Grupo II versus 27% do Grupo I; p<0,001). Problemas sociais constituíram o principal diagnóstico em 8% das consultas. Conclusão A maioria das patologias diagnosticadas tem forte componente comportamental e social, com destaque para as doenças mentais e a obesidade. Esta tipologia específica de diagnósticos evidencia a necessidade de uma abordagem global do adolescente e de unidades/consultas especializadas nesta faixa etária.

Sexual behaviors: study in the youth / Comportamentos sexuais: estudo em jovens

ABSTRACT Objective: To characterize sexual behaviors in a sample of adolescents and youth. Methods: An analytical descriptive study using a questionnaire about sexual behaviors, adapted from the World Health Organization. It was distributed to students from a Portuguese city aged 14-24 years, during two months. Two age groups were defined: G1 - students aged 14-19 years; G2 - aged 20-24 years. Results: The sample included 2,369 students, 61% females and 70% in G1. The mean age of first sexual intercourse was 16.4±1.8 years; 93% used some contraceptive method in the first sexual intercourse. Out of those who did not use contraception in the first sexual intercourse, 83% were in G1 (p<0.001). Emergency contraception was used at least once by 54% (63% in G2, p<0.001). Among those who had unprotected sexual intercourses, 9% were under the influence of alcohol, 53.6% were female and 53.4% were in G2 (p<0.001). Homosexual contacts occurred in 21% of cases; in that, 62% in G1 and 84% among females (p<0.001). Conclusion: The use of contraceptionin the first sexual intercourse was common in our sample. However, the number of adolescents not using any contraceptive method in subsequent sexual intercourses, and the high percentage of them who consider it unnecessary, are a concern. Unprotected sexual intercourses, as well as unplanned intercourses and under influence of alcohol or drugs, especially in the youngest, urge the need for intervention regarding sexual education.

RESUMO Objetivo: Caracterizar os comportamentos sexuais em uma amostra de adolescentes e jovens. Métodos: Estudo descritivo analítico, utilizando um questionário sobre comportamentos sexuais adaptado da Organização Mundial da Saúde. O questionário foi distribuído a estudantes entre os 14 e os 24 anos de uma cidade portuguesa, em período de 2 meses. Definiram-se dois grupos etários: G1, para estudantes de 14 a 19 anos; e G2, de 20 a 24 anos. Resultados: Da amostra, constaram 2.369 estudantes, sendo 61% do sexo feminino e 70% do G1. A média de idade da primeira relação sexual foi de 16,4± 1,8 anos. Foi utilizado método contraceptivo na primeira relação sexual em 93%. Dos que não utilizaram, 83% pertenciam ao G1 (p<0,001). Entre os estudantes, 54% recorreram pelo menos uma vez à contracepção de emergência (63% do G2; p<0,001). Dos que tiveram relações sexuais desprotegidas, 9% estavam sob influência do álcool. Destes últimos, 53,6% eram do sexo feminino e 53,4% pertenciam ao G2 (p<0,001). Os contatos homossexuais ocorreram em 21% dos casos, dos quais 62% eram do G1 e 84% do sexo feminino (p<0,001). Conclusão: O recurso à contracepção na primeira relação sexual foi uma prática comum na nossa amostra. No entanto, o número de adolescentes que não utiliza método contraceptivo nas relações subsequentes e a elevada percentagem que o considera desnecessária são preocupantes. Para além das relações sexuais desprotegidas, as relações não planejadas e sob o efeito de álcool ou drogas, sobretudo entre os mais novos, reforçam a necessidade de intervenção no âmbito da educação sexual.

Diseño y validación de la encuesta "costo financiero del cuidado de la enfermedad crónica" / Design and validation of the financial cost of the chronic illness care survey

Resumen Objetivo: Diseñar y validar la encuesta "Costo financiero del cuidado de la Enfermedad crónica" para medir el consumo real efectivo (CRE) e impacto familiar de cuidar a una persona con enfermedad crónica (EC) en Colombia. Metodología: Estudio descriptivo de tipo metodológico realizado entre 2012 y 2013 en cuatro fases: 1) Revisión bibliográfica para seleccionar los referentes y construir la propuesta preliminar de la Encuesta. 2) Validación inicial realizada con familiares de personas con EC; 3) Validación con expertos y 4) Afinamiento de la versión definitiva de la Encuesta mediante su aplicación. Resultados: La encuesta "Costo financiero del cuidado de la EC" está compuesta de cuatro dimensiones que incluyen: Los datos de identificación; el CRE atribuible al cuidado de las personas con EC; la percepción de carga asociada con el costo financiero y, por último, las observaciones relacionadas con el costo del cuidado. Conclusiones: Se diseñó y validó la encuesta "Costo financiero del cuidado de la EC", la cual es un aporte original que permite medir el consumo real efectivo e impacto familiar de cuidar a una persona con enfermedad crónica (EC) en Colombia.

Abstract Objective: Design and validate the survey "Financial Cost of Chronic Ilness Care" to measure the actual money consumption and the family impact of caring for a person with chronic illness in Colombia. Methodology: This is a descriptive methodological study that was conducted in 2012 -2013 including four phases: 1) The literature review in order to select the references and build the preliminary proposal of the Survey. 2) Initial validation on the families of people with Chronic illness; 3) Validation with experts and 4) Implementation of a pilot survey. Results: The "Financial Cost of Chronic Illness Care" survey is composed of four dimensions including: Identification data; The actual money consumption attributable to the care of people with chronic illness; The perception of the financial burden associated with cost, and finally, observations related to the cost of care. Conclusions: The Financial Cost of Chronic Illness Care Survey was designed and validated as an original contribution for measuring actual money consumption as well as the family impact of caring for a person with chronic disease in Colombia.

Sistemas de información: definiciones, usos y limitantes al caso de la producción ovina colombiana / Information systems: definitions, applications and limiting of the colombian sheep production / Sistemas de informação: definições, usos e limitações para o caso da produção colombiana de ovelhas

Resumen El acceso rápido y eficiente a una información confiable y precisa permite adoptar una posición adecuada a la hora de tomar una decisión para solucionar un problema con un menor costo; la información es por lo tanto una sustancia figurativa, y se pueden nombrar ciertas posturas sobre ella: la posesión, la acumulación, exceso ("sobrecarga"), la desigualdad distributiva ("los que tienen y los que no"), la medición, la "comoditización", y así sucesivamente, antes de entender per se el uso de los sistemas de información. Es incuestionable el hecho de que mucha gente está derivando grandes ventajas de estas nuevas fuentes de conocimiento prestadas por redes y sistemas de información, en el marco de lo que ahora se convenciona llamar el sector cuaternario de la economía. Los datos, información y el conocimiento son eslabones de una cadena cíclica en la que el último eslabón realimenta la cadena, a la vez que el valor del recurso y la aportación e implicación humana son cada vez mayores. El objeto de la presente revisión es aportar al entendimiento de los sistemas de información y su orientación actual como herramienta para la mejora de la competitividad del sector ovino nacional.

Abstract The fast and efficient access to reliable and accurate information allows adopting a suitable position when making a decision to troubleshoot a lower cost; information is thus a figurative substance, and can appoint certain positions on it: possession, accumulation, excess ("overload"), distributive inequality ("the haves and have-nots"), measurement, the "commoditization", and so on, before understanding per se the use of information systems. It is unquestionable that many people are deriving great advantages of these new sources of knowledge borrowed from networks and information systems, as part of what is now called the "quaternary sector of the economy". The data, information and knowledge are links in a cyclic chain where the last link in the chain fed, while the resource value and contribution and human involvement are increasing. The purpose of this review is to provide an understanding of information systems and the current focus as a tool for improving the competitiveness of the Colombian domestic sheep industry.

Resumo O acesso rápido e eficiente às informações confiáveis e precisas permitem adoptar uma posição adequada ao tomar uma decisão para solucionar um custo menor; informação é, portanto, uma substância figurativa, e pode designar certas posições sobre ele: a posse, a acumulação, o excesso ("sobrecarga"), a desigualdade distributiva ("os que têm e os que não têm"), medição, o "commoditization", e assim por diante, antes de compreender per se a utilização de sistemas de informação. É inquestionável que muitas pessoas estão a retirar grandes vantagens destas novas fontes de conhecimento emprestado de redes e sistemas de informação, como parte do que hoje é chamado de conven setor quaternário da economia. Os dados, informação e conhecimento são elos de uma cadeia cíclica, onde o último elo da cadeia alimentados, enquanto o valor de recursos e contribuição e envolvimento humano estão aumentando. O objetivo desta revisão é fornecer uma compreensão de sistemas de informação e o foco atual como uma ferramenta para melhorar a competitividade da indústria ovina doméstica.

Carga financiera del cuidado familiar del enfermo crónico en la Región Andina de Colombia / The Financial Burden of Family Care of the Chronically Ill in the Colombian Andean Region / Carga financeira do cuidado familiar do doente crónico na região andina da Colômbia

Introducción Describir y analizar la carga financiera del cuidado familiar del enfermo crónico en la Región Andina de Colombia. Materiales y métodos: Estudio que hace parte del 'Programa para la disminución de la carga de la enfermedad crónica en Colombia'. Su muestra la constituyeron 92 familias que residen en la región Andina de Colombia. Se emplearon los instrumentos "GCPC-UN- D", para caracterizar a los sujetos y la Encuesta "Costo financiero del cuidado de la Enfermedad crónica", para conocer el consumo real efectivo familiar. La Carga financiera atribuible al cuidado familiar se determinó bajo la metodología Caracol. Resultados: Los costos que más agobian a las familias de la Región Andina colombiana son, en su orden, los de salud, transporte, vivienda, alimentación y comunicaciones. El consumo real efectivo familiar se modifica al cuidar a una persona con enfermedad crónica. Discusión: Las familias colombianas que residen en la región Andina del país tienen una elevada carga financiera atribuible al cuidado de una persona con enfermedad crónica.

Objective: To describe and analyze the financial burden of family care of the chronically ill in the Colombian Andean region. Materials and methods: This study is part of the Program for the Reduction of the burden of chronic disease in Colombia. The sample included 92 families residing in the Colombian Andean region. The Instruments "GCPC-UN- D" were used to characterize the subjects and the Survey Financial cost of chronic disease care of Montoya et al, to identify the real effective household consumption. The financial burden attributable to family care was determined under the Caracol methodology. Results: Costs that most afflict families of the Colombian Andean Region are in their order health, transportation, housing, food and communications. Family caring for a person with chronic illness affects its effective household consumption. Discussion: Colombian families residing in the Andean region of the country have a high financial burden attributable to caring for a person with chronic disease.

Introdução: Descrever e analisar a carga financeira do cuidado familiar do doente crónico na Região Andina da Colômbia. Materiais e métodos: Estudo que faz parte do Programa para a diminuição da carga da doença crónica na Colômbia. A sua amostra a constituíram 92 famílias que residem na região Andina da Colômbia. Se empregaram os instrumentos "GCPC-UN- D" para caracterizar aos sujeitos e o Questionário "Custo financeiro do cuidado da Doença crónica" para conhecer o consumo real efetivo familiar. A carga financeira atribuível ao cuidado familiar se determinou sob a metodologia caracol. Resultados: os custos que mais afligem às famílias da Região Andina colombiana são em sua ordem, os de saúde, transporte, vivenda, alimentação e comunicações. O consumo real efetivo familiar se modifica ao cuidar a uma pessoa com doença crónica. Discussão: as famílias colombianas que residem na região Andina do País têm uma elevada carga financeira atribuível ao cuidado de uma pessoa com doença crónica na Colômbia.