Diferentes caminos para formarse y certificar como Especialista en Cirugía Plástica, Estética y Reparadora / Different paths to train and certify as a Specialist in Plastic, Aesthetic and Reconstructive Surgery

La presente publicación responde a la necesidad de encuadrar la situación actual de los profesionales de Cirugía Plástica, Estética y Reparadora. Encuadre que se presentará a partir de las diferentes instituciones y actores intervinientes y de los marcos normativos que, en la actualidad, subyacen al reconocimiento de la especialidad y de los profesionales que la ejercen.

This publication responds to the need to frame the current situation of Plastic, Aesthetic and Reconstructive Surgery professionals. This frame that will be presented from the different institutions and actors involved and the regulatory frameworks that, currently, underlie the recognition of the specialty and the professionals who practice it.

E-cigarette Tobacco Retail Licensing Laws: Variance Across US States as of January 1, 2020.

Objectives. To describe how US states and the District of Columbia regulate e-cigarette sales by examining e-cigarette-specific tobacco retail licensing (TRL) laws.Methods. We coded 25 state-level e-cigarette TRL laws (effective as of January 1, 2020) for provisions we labeled as either "core" (e.g., presence of license terms, fees, and penalties) or "descriptive" (e.g., license fee amount and term length).Results. Overall, 23 laws clearly defined a license term, 23 laws required a license fee, and 19 laws identified penalties for violations that included both license suspension and revocation. Fees widely ranged ($5-$1000 annually), and 8 laws did not explicitly direct fees toward TRL administration or enforcement. No law required that retailers comply with all local, state, and federal tobacco or e-cigarette laws.Conclusions. Most laws contained core TRL provisions. Several laws, however, had minimal license fees and did not direct fees toward administration or enforcement. As youth e-cigarette use increases, more states should consider establishing e-cigarette TRL laws or incorporating provisions into existing TRL laws.

Levels of support for the licensing of tobacco retailers in Australia: findings from the National Drug Strategy Household Survey 2004-2016.

BACKGROUND: Assessing public opinion towards tobacco policies is important, particularly when determining the possible direction of future public health policies. The aim of this study was to describe the implementation of tobacco retailer licensing systems by state and territory governments in Australia, and to use the National Drug Strategy Household Survey (NDSHS) to assess levels of public support for a retailer licensing system in each jurisdiction over time and by a range of socio-demographic and behavioural attributes. METHODS: National and state/territory estimates of public support for a tobacco retailer licensing system were derived as proportions using NDSHS data from 2004 to 2016. The effect of one's jurisdiction of residence on the likelihood of supporting such an initiative in 2016 was assessed using logistic regression while controlling for various socio-demographic and behavioural characteristics. RESULTS: Public support for a tobacco retailer licensing system ranged from a high of 67.2% (95% CI 66.5-67.9%) nationally in 2007 and declined to 59.5% (95% CI 58.9-60.2%) in 2016. In 2016, support was greatest amongst those from Tasmania, those aged 50 years and older, females, those from the least disadvantaged areas, those living in major cities, never-smokers and never-drinkers. After adjusting for the socio-demographic and behavioural attributes of respondents, those from Queensland were significantly less likely to support a licensing system (adjusted OR = 0.85, 95% CI 0.77-0.94) compared to those from other jurisdictions, while those from Tasmania were significantly more likely to support a licensing system compared to those from other jurisdictions (adjusted OR = 1.29, 95% CI 1.09-1.52). CONCLUSIONS: A clear majority of the public support a tobacco retailer licensing system, regardless of whether or not such a system is already in place in their jurisdiction of residence. Tobacco control initiatives other than a retailer licensing system may explain some of the residual variations in support observed between jurisdictions.

Tobacco Retail Licensing and Density 3 Years After License Regulations in Philadelphia, Pennsylvania (2012-2019).

Objectives. To evaluate changes in licensed tobacco retailers and retailer density 5 years before and 3 years after novel tobacco retailer licensing regulations were implemented in a large, urban area.Methods. We used administrative tobacco license data (n = 23 806 licenses, 2012-2019) to calculate (1) annual retailer density by district (n = 18), (2) density by district and school income status, and (3) retailers within 500 feet of schools (n = 673) before and after regulations.Results. Observed tobacco retailer density declined by 20.3% (from 1.97 to 1.57 per 1000 daytime residents) 3 years after regulation implementation. Regression results showed a decline in the trend of retailers per 1000 daytime population (b = -0.19; 95% confidence interval[CI] = -0.23, -0.14) that was modestly but significantly greater in low-income districts (interaction b = -0.18; 95% CI = -0.25, -0.11) and a 12% decline in the rates of retailers near schools (rate ratio = 0.88; 95% CI = 0.85, 0.92) following implementation of the regulations. We did not observe similar density changes in comparable cities.Conclusions. Tobacco retailer licensing strategies can be an effective policy approach to reduce the availability of tobacco and tobacco marketing, lessen socioeconomic disparities in tobacco retailer density, and decrease the number of tobacco outlets near schools.

Producción científica y licenciamiento de escuelas de medicina en el Perú / Scientific production and licensing of medical schools in Peru

La nueva ley universitaria 30220 del 2014 creó la obligatoriedad del licenciamiento institucional de todas las universidades peruanas a cargo de la Superintendencia Nacional de Educación Superior Universitaria - SUNEDU, el primer programa de pregrado en pasar por el mismo proceso será medicina. El licenciamiento de programas de medicina es necesario para garantizar que las condiciones en que se imparte la carrera en el Perú son las adecuadas, con la alta posibilidad de cierre de algunas escuelas de medicina. Una vez que una escuela de medicina haya demostrado que cumple con las condiciones básicas de calidad, se realiza una evaluación cualitativa y una cuantitativa que incluye tres criterios: producción científica en Web of Science, impacto medido a través del índice H, y resultados del examen nacional de medicina, para determinar los años de licenciamiento. Este artículo realiza una evaluación de los indicadores cuantitativos vinculados a investigación usando Web of Science y Scopus, además de hacer revisiones técnicas y metodológicas de los mismos; así como sugerencias para los otros indicadores.

The new university law 30220 of 2014 introduced the mandatory institutional licensing of all Peruvian universities by the National Superintendence of Higher University Education (SUNEDU, in Spanish). The first undergraduate program to go through this process will be medicine. The licensing of medical programs is necessary to ensure that the conditions in which the program is taught in Peru are adequate, with a high probability of closing some medical schools. Once a medical school has demonstrated that it meets the basic conditions of quality, a qualitative and quantitative evaluation is carried out that includes three criteria: scientific production in the Web of Science, impact measured through the H index, and results of the national medical exam, to determine the years of licensing. This article evaluates the quantitative indicators linked to research using Web of Science and Scopus, in addition to making technical and methodological revisions of them. Suggestions for the other indicators are also covered by this article.

Tobacco Retail Licensing and Youth Product Use.

BACKGROUND: Restricting youth access to tobacco is a central feature of US tobacco regulatory policy, but impact of local tobacco retail licensing (TRL) regulation on cigarette smoking rates remains uncertain. Effects of TRL on other tobacco product use and use as adolescents reach the age to legally purchase tobacco products has not been investigated. METHODS: Prevalences of ever and past 30-day cigarette, electronic cigarette (e-cigarette), cigar, and hookah use were assessed in a survey of a cohort of 1553 11th- and 12th-grade adolescents (mean age: 17.3 years); rates of initiation were evaluated 1.5 years later. An American Lung Association (2014) youth access grade was assigned to each of 14 political jurisdictions in which participants lived on the basis of the strength of the local TRL ordinance. RESULTS: At baseline, participants living in 4 jurisdictions with "A" grades (ie, with most restrictive ordinances) had lower odds of ever cigarette use (odds ratio [OR] 0.61; 95% confidence interval [CI] 0.41-0.90) and of past 30-day use (OR 0.51; 95% CI 0.29-0.89) than participants in 10 D- to F-grade jurisdictions. At follow-up at legal age of purchase, lower odds of cigarette use initiation (OR 0.67; 95% CI 0.45-0.99) occurred in jurisdictions with stronger TRL policy. Lower odds of e-cigarette initiation at follow-up (OR 0.74; 95% CI 0.55-0.99) and of initiation with past 30-day use (OR 0.45; 95% CI 0.23-0.90) were also associated with better regulation. CONCLUSIONS: Strong local TRL ordinance may lower rates of cigarette and e-cigarette use among youth and young adults.

Lineamientos para emisión de certificados de habilitación de establecimientos de atención para la salud, públicos y privados: unidad técnica normativa 2019 / Guidelines for the issuance of certificates of authorization of health care establishments, public and private: normative technical unit 2019

El objetivo del documento es la normalización de los criterios mínimos que deben cumplir los establecimientos de salud para su funcionamiento. Además, es un modelo básico para ser certificado, previo a solicitar la licencia sanitaria. Contiene unos fundamentos legales, así como las definiciones de rigor en torno al tema central. Incluye las indicaciones a seguir, para la solicitud de inspección, previo a la certificación. Incluye el anexo: "Guía de inspección de condiciones de habilitación de establecimientos de atención para la salud" (anexo A). También, "Modelo de certificación de habilitación" (anexo B). "Categorías de establecimientos regulados por DRACES" (anexo C). El anexo D y último, contiene todo el fundamento legal que deben conocer quienes soliciten ser habilitados.

Radiation safety analysis for the A-BNCT facility in Korea.

A Proton Accelerator based Boron Neutron Capture Therapy (A-BNCT) facility is under development in Korea. Neutron beams for treatment are produced from a beryllium (Be) target and an 8 mA, 10 MeV proton beam. The purpose of the research is a radiation shielding analysis and an activation analysis for the facility design satisfying the radiation safety requirements as well as obtaining an operating license for the radiation facility according to a domestic nuclear commissioning procedure. The radiation shielding analysis was performed using the MCNPX computational particle transport code. The radiation source terms in the facility were evaluated and utilized in the shielding calculations. The minimum concrete thickness satisfying the designated dose rate of 5 µSv/h for the worker's area and 0.25 µSv/h for the public area were estimated and applied to the design. For an assessment of the radiation safety inside the facility, the dose rates were evaluated at several positions, such as behind the shielding door, around the primary barriers near the radiation sources, and in the penetrations of the ducts. The dose rate distribution was mapped for verification of the radiation safety for the entire facility. An activation analysis was carried out for the concrete walls, air, target assembly, beryllium target, and cooling water using FISPACT-2010 code. Concentrations of the activation products and dose rate induced by the radionuclides after shutdown were evaluated for the purpose of safe operation of the facility. The results were reviewed with the radiation safety regulations in Korea. As a result, it was proved that the final facility design satisfies the safety requirements.

Implementation is not enough: Graduated drivers licensing benefits from a comprehensive enforcement, education, and awareness campaigns.

BACKGROUND: Graduated drivers license (GDLs) are required in most states. Graduated drivers licenses are intermediate licenses requiring a supervisory period prior to full licensure. Surveys suggests poor acceptance of GDL restrictions high variability in GDL compliance. New Jersey initiated GDLs in 2002 and introduced a comprehensive public health campaign in 2010. This study analyzed the effect of GDL and the campaign on teen driver-related fatalities and hypothesized that implementation alone was insufficient to decrease deaths. METHODS: Data were analyzed from 1998 to 2016 from New Jersey's Fatal Accident Investigation Unit. In 2005, collaboration with state police added total crash fatalities and teen passenger deaths to the data set. Patterns in data before and after GDL implementation in 2002 and a comprehensive campaign in 2010 were evaluated to determine effects in New Jersey. Paired t tests, analysis of variance, and regression analyses were performed, with p value less than 0.05 considered significant. RESULTS: Little effect was seen after initiation of GDL, with no change in number of dead teen drivers (44 vs. 49, p > 0.05) or fatal accidents (117 vs.115, p > 0.05) in the 4 years before and after implementation. However, after the comprehensive campaign, decreases are seen in dead teenaged drivers (42 vs. 22, p < 0.005) and total fatal accidents involving teens (107 vs. 61, p < 0.005). Comparing 4 years before and 6 years after the campaign demonstrates decreases in total crash fatalities involving teen drivers (112 vs. 66, p < 0.05) and in the number of dead teenaged passengers in a vehicle operated by another teen (19 vs. 11 p < 0.05). CONCLUSIONS: Implementation of GDLs alone may not be an effective strategy in decreasing the number of teen fatalities. A multipronged approach combining comprehensive, public-health based campaign with targeted enforcement is necessary to decrease the number of teen driver-related deaths. Additional studies are needed to assess the relationship between decreased death and compliance with GDLs. LEVEL OF EVIDENCE: Retrospective comparative study, level III.

The effect of verified pediatric trauma centers, state laws, and crash characteristics on time trends in adolescent motor vehicle fatalities, 1999-2015.

BACKGROUND: Motor vehicle crashes are a leading cause of adolescent death from trauma. A recent study found American College of Surgeons-verified pediatric trauma centers (vPTC) were inversely correlated with pediatric mortality, but the analysis was limited to a single year. This study assesses the contribution of vPTCs, crash characteristics, and state driver laws on 15- to 17-year-old motor vehicle crash mortality for all 50 states from 1999 to 2015. METHODS: Prospective data on motor vehicle fatalities, crash characteristics, state driving laws, and American College of Surgeons-verified trauma centers were collected from publicly available sources for 50 US states from 1999 to 2015. A mixed fixed/random effects multivariate regression model was fitted to assess the relative contribution of crash characteristics, state laws, and vPTCs while controlling for state variation and time trends. RESULTS: The final regression model included driver and crash characteristics, verified trauma centers, and state laws. Camera laws ([B = -0.57 [p < 0.001]) were associated with a 57% decrease in the rate of change in adolescent crude fatalities. The lagged Level 1 vPTC crude rate (B = -0.12 [p < .001]) was protective and contributed independently to a 12% decline in the rate of change in teen fatalities over the time period. Seat belt laws (B = -0.15 [p < 0.001]), graduated driver's license passenger restrictions (B = -0.07[p < 0.001]), graduated driver's license learner permit period (B = -0.04 [p < 0.002]), nondeployed airbag (B = -0.003 [p < 0.001]), and Hispanic heritage (B = -0.003 [p < 0.05]) were protective. Increased risk of fatality was associated with minivan (B = 0.01 [p < 0.001]), speed > 90 mph (B = 0.004 [p < 0.001]), rural roads (B = 0.002 [p < 0.002], unknown seat belt compliance (B = 0.004 [p < 0.001]), and dry road surface (B = 0.005 [p < 0.001]). CONCLUSIONS: State camera laws during the study time frame are associated with a 57% decrease in the rate of change in adolescent crude fatalities; vPTCs during the study time period reduced overall rate of change in the crude fatality rate by 12%. State laws, restrictions on teenage passengers and longer learner's permit periods, and seat belt laws are associated with significant decreases in the crude teen mortality rate. LEVEL OF EVIDENCE: Prospective study and prevention, level III.

State Firearm Laws and Interstate Transfer of Guns in the USA, 2006-2016.

In a cross-sectional, panel study, we examined the relationship between state firearm laws and the extent of interstate transfer of guns, as measured by the percentage of crime guns recovered in a state and traced to an in-state source (as opposed to guns recovered in a state and traced to an out-of-state source). We used 2006-2016 data on state firearm laws obtained from a search of selected state statutes and 2006-2016 crime gun trace data from the Bureau of Alcohol, Tobacco, Firearms, and Explosives. We examined the relationship between state firearm laws and interstate transfer of guns using annual data from all 50 states during the period 2006-2016 and employing a two-way fixed effects model. The primary outcome variable was the percentage of crime guns recovered in a state that could be traced to an original point of purchase within that state as opposed to another state. The main exposure variables were eight specific state firearm laws pertaining to dealer licensing, sales restrictions, background checks, registration, prohibitors for firearm purchase, and straw purchase of guns. Four laws were independently associated with a significantly lower percentage of in-state guns: a waiting period for handgun purchase, permits required for firearm purchase, prohibition of firearm possession by people convicted of a violent misdemeanor, and a requirement for relinquishment of firearms when a person becomes disqualified from owning them. States with a higher number of gun laws had a lower percentage of traced guns to in-state dealers, with each increase of one in the total number of laws associated with a decrease of 1.6 percentage points in the proportion of recovered guns that were traced to an in-state as opposed to an out-of-state source. Based on an examination of the movement patterns of guns across states, the overall observed pattern of gun flow was out of states with weak gun laws and into states with strong gun laws. These findings indicate that certain state firearm laws are associated with a lower percentage of recovered crime guns being traced to an in-state source, suggesting reduced access to guns in states with those laws.

U.S. cannabis legalization and use of vaping and edible products among youth.

BACKGROUND: Alternative methods for consuming cannabis (e.g., vaping and edibles) have become more popular in the wake of U.S. cannabis legalization. Specific provisions of legal cannabis laws (LCL) (e.g., dispensary regulations) may impact the likelihood that youth will use alternative methods and the age at which they first try the method - potentially magnifying or mitigating the developmental harms of cannabis use. METHODS: This study examined associations between LCL provisions and how youth consume cannabis. An online cannabis use survey was distributed using Facebook advertising, and data were collected from 2630 cannabis-using youth (ages 14-18). U.S. states were coded for LCL status and various LCL provisions. Regression analyses tested associations among lifetime use and age of onset of cannabis vaping and edibles and LCL provisions. RESULTS: Longer LCL duration (ORvaping: 2.82, 95% CI: 2.24, 3.55; ORedibles: 3.82, 95% CI: 2.96, 4.94), and higher dispensary density (ORvaping: 2.68, 95% CI: 2.12, 3.38; ORedibles: 3.31, 95% CI: 2.56, 4.26), were related to higher likelihood of trying vaping and edibles. Permitting home cultivation was related to higher likelihood (OR: 1.93, 95% CI: 1.50, 2.48) and younger age of onset (ß: -0.30, 95% CI: -0.45, -0.15) of edibles. CONCLUSION: Specific provisions of LCL appear to impact the likelihood, and age at which, youth use alternative methods to consume cannabis. These methods may carry differential risks for initiation and escalation of cannabis use. Understanding associations between LCL provisions and methods of administration can inform the design of effective cannabis regulatory strategies.

[Radiation protection in medical research : Licensing requirement for the use of radiation and advice for the application procedure]. / Strahlenschutz in der medizinischen Forschung : Genehmigungsbedürftigkeit von Strahlenanwendungen und Hinweise zum Antragsverfahren.

BACKGROUND: In Germany, persons who are to be exposed to radiation for medical research purposes are protected by a licensing requirement. However, there are considerable uncertainties on the part of the applicants as to whether licensing by the competent Federal Office for Radiation Protection is necessary, and regarding the choice of application procedure. AIM: The article provides explanatory notes and practical assistance for applicants and an outlook on the forthcoming new regulations concerning the law on radiation protection of persons in the field of medical research. MATERIALS AND METHODS: Questions and typical mistakes in the application process were identified and evaluated. RESULTS AND DISCUSSION: The qualified physicians involved in a study are responsible for deciding whether a license is required for the intended application of radiation. The decision can be guided by answering the key question whether the study participants would undergo the same exposures regarding type and extent if they had not taken part in the study. When physicians are still unsure about their decision, they can seek the advisory service provided by the professional medical societies. Certain groups of people are particularly protected through the prohibition or restriction of radiation exposure. A simplified licensing procedure is used for a proportion of diagnostic procedures involving radiation when all related requirements are met; otherwise, the regular licensing procedure should be used. The new radiation protection law, which will enter into force on the 31st of december 2018, provides a notification procedure in addition to deadlines for both the notification and the licensing procedures. In the article, the authors consider how eligible studies involving applications of radiation that are legally not admissible at present may be feasible in the future, while still ensuring a high protection level for study participants.

New Zealand tobacco control experts' views towards policies to reduce tobacco availability.

AIM: Higher tobacco retailer density promotes smoking by making cigarettes more accessible and available, and by increasing environmental cues to smoke. We aimed to examine tobacco control experts' views on policies that could reduce tobacco retail availability. METHODS: Telephone interviews with 25 individuals drawn from academia, non-governmental organisations, Maori and Pacific health, smoking cessation services, district health boards and other public health-related organisations. We used a semi-structured interview guide to explore the perceived importance of reducing tobacco retail supply, views on different policy options and barriers to policy adoption. Qualitative content analysis was conducted using transcripts as the data source. RESULTS: Participants believed tobacco retailer licensing was an important short-term step towards the 2025 goal. In the long-term, participants envisaged tobacco only being available at a small number of specialised outlets, either pharmacies or adult-only stores. To achieve that long-term scenario, participants suggested a sinking-lid policy on licences or a zoning approach could be adopted to gradually reduce outlet density. Policies banning sales at certain types of outlet were not considered feasible. CONCLUSIONS: There is tension between the tobacco retail reduction policies seen as more likely to be politically acceptable, and the need to make substantial changes to the tobacco retail environment by 2025. Future research could investigate possible legal mechanisms for requiring existing tobacco retailers to transition out of selling tobacco.

Caracterización del examen estatal teórico ordinario de Licenciatura en Enfermería / Characterization of the ordinary theoretical state exam of Licentiate in Infirmary

Introducción: el examen estatal teórico constituye el último ejercicio evaluativo en la formación del estudiante de la carrera de Licenciatura en Enfermería, en el mismo ha de mostrar el dominio de la base científico técnica de su actuación profesional. Objetivos: caracterizar el examen estatal teórico ordinario de la carrera de Llicenciatura en Enfermería en el curso 2014-2015, con el propósito de identificar las principales dificultades de este y realizar sugerencias para incrementar su calidad. Métodos: se utilizó la revisión documental y la consulta a especialistas. La muestra estuvo conformada por los 33 exámenes estatales realizados por estudiantes del año terminal de la carrera en la Facultad "General Calixto García" en dicho curso. Resultados: la totalidad de las preguntas estuvieron bien conformadas, la frecuencia de errores estuvo relacionada con el dominio del contenido por los estudiantes, no así con los tipos de preguntas y su elaboración, la incidencia de mayores dificultades fueron las preguntas de tipo Selección Múltiple, Complemento Simple y Agrupado. No hubo preguntas con enfoque de promoción, y las de prevención, representadas en porcientos, no acordes con la importancia que ello reviste por constituir este un importante principio del Sistema de Salud Cubano. Predominaron los resultados desfavorables en temáticas relacionadas con la Enfermería Clínico Quirúrgica y Enfermería Ginecobstétrica. La asignación del número de preguntas, según tipo de estas por especialidad, se realizó equitativamente. Conclusiones: a través de la caracterización del examen, se logró identificar dificultades y realizar sugerencias para el mejoramiento de la calidad del mismo en futuras ediciones(AU)

Introduction: The theoretical state exam constitutes the last exercise evaluative in the formation of the student of the career of Licentiate in Iinfirmary; in the same one it must show the domain of the base scientist technique of its professional performance. Objectives: To characterize the ordinary theoretical state exam of the career of Licentiate in Infirmary in the course 2014-2015, with the purpose of identifying the main difficulties of this, and to carry out suggestions to increase their quality. Methods: It was used the documental revision and the consultation to specialists. The sample was conformed by the 33 state exams carried out by the students of the terminal year of the career in the General Faculty Calixto García in this course. Results: The entirety of the questions was well conformed, the frequency of errors was related with the domain of the content for the students, I didn't seize with the types of questions and its elaboration, the incidence of more difficulties was the questions of type Selection Multiple Simple and Contained Complement. There were not questions with promotion focus, and those of prevention represented by percents non chords with the importance that you had it to constitute this an important principle of the Cuban System of Health. The unfavorable results prevailed in thematic related with the Surgical Clinical Infirmary and Infirmary Ginecobstétrica. The assignment of the number of questions, according to type of these for specialty, was carried out equally. Conclusions: It was achieved through the characterization of the exam, to identify difficulties and to carry out suggestions for the improvement of the quality of the same one in their future editions(AU)